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HEALTH NOTES 
 
 FOR 
 
 YOUNG WIVES 
 
 AIMEE RAYMOND SCHEOEDER, M.D. 
 
 J>/V0U 
 
 NEW YORK 
 WILLIAM WOOD & COMPANY 
 
 1895 
 
Copyright 1895 
 
 BY 
 
 WILLIAM WOOD & COMPANY • 
 
PREFACE. 
 
 There is no doubt that, even under the 
 most favorable conditions, the months of 
 pregnancy represent a time of physical 
 and mental trial to the young mother. Be 
 the anticipations of parenthood never so 
 joyful, the child never so ardently longed 
 for, the preparations for its advent made 
 with a tender pleasure hitherto unknown, 
 the mind filled with plans for its future 
 care and education, mingled in the more 
 serious -minded with feelings of almost 
 awful responsibility in the ushering into 
 life of a human soul, still there must of 
 necessity be often present the thought of 
 the coming ordeal, the time of danger and 
 of pain. Moreover, physical disturbances 
 of a more or less severe nature frequently 
 accompany or complicate the condition. 
 Some of these are in certain cases unavoid- 
 able; others could be avoided by a little 
 
11 PREFACE. 
 
 knowledge and care. A good physician 
 should be the chief source of information, 
 inasmuch as each case differs from an- 
 other in many particulars, according to 
 the peculiarities of the individual, so that 
 it is difficult to lay down general rules to 
 meet every emergency. Busy practition- 
 ers do not always remember to give in- 
 formation upon minor points, unless spe- 
 cially consulted upon them; the timidity 
 natural to most women, or a total igno- 
 rance of the body and its laws and needs, 
 causing them to accept all symptoms as a 
 matter of course, prevent their asking the 
 necessary questions, and thus oftentimes 
 they suffer quite needlessly from the lack 
 of a little simple instruction. Moreover, 
 not all women are so situated that they 
 can call upon their physician for help in 
 every dilemma. To these young wives in 
 especial it is hoped that the following 
 pages may be of use. 
 
 The author wishes to acknowledge her 
 indebtedness for valuable facts to the 
 works of Drs. Lusk, Parvin, Bulkley, 
 Shoemaker, Winckel, Munde, Lloyd, Gar- 
 
PREFACE. iii 
 
 rigues, Winckel, Penrose, Clara Shaw, 
 and George Allan, D.D.S. 
 
 The tables of infant feeding are quoted 
 from Dr. T. M. Rotch, and the dietary for 
 children after weaning from Dr. Samuel 
 Adams. 
 
contents. 
 
 CHAPTER I. 
 
 PAGE 
 
 Introductory Remarks — Structure of the Organs 
 of Generation — Development of the Child . . 1 
 
 CHAPTER II. 
 
 Symptoms of Pregnancy — Prenatal Influences — 
 Choice of Physician and Nurse 12 
 
 CHAPTER III. 
 
 Essentials of a Healthy Pregnancy — Hygiene of 
 the House — Occupations — Exercise — Diet 
 — Bathing — Sleep — Douches — Clothing — 
 Care of Breasts 24 
 
 CHAPTER IV. 
 
 Nausea and Vomiting — Constipation — Diarrhoea 
 —Excess of Saliva— Care of the Teeth 43 
 
 CHAPTER V. 
 
 Anaemia — Swelling of Lower Extremities — Vari- 
 cose Veins— Piles — Palpitation — Fainting — 
 ifficulty in Breathing 59 
 
VI CONTENTS. 
 
 CHAPTER VI. 
 
 PAGE 
 
 Disorders of the Bladder and Kidneys— Con- 
 vulsions— Itching of Vulva— Leucorrhoea— 
 Vegetations 70 
 
 CHAPTER VII. 
 
 Disorders of the Nervous System — Mental Atti- 
 tude of the Expectant Mother — Sleepless- 
 ness — Neuralgia 82 
 
 CHAPTER VIII. 
 
 Diseases of the Skin— Mask of Pregnancy — 
 Pruritus 93 
 
 CHAPTER IX. 
 
 Diseases which forbid Pregnancy — Effect of 
 Pregnancy upon certain Diseases 97 
 
 CHAPTER X. 
 Miscarriage 107 
 
 CHAPTER XI. 
 Preparations for Confinement 115 
 
 CHAPTER XII. 
 
 The Stages of Labor — Directions for the conduct 
 of Labor in Emergencies — After-care of 
 Mother 131 
 
CONTENTS. Vll 
 
 CHAPTER XIII. 
 
 PAGE 
 
 Care of the Infant after Birth — Bath — Dress- 
 ing the Cord — Examination of Child — 
 Attention to Bowels and Bladder — Sleep. . . 165 
 
 CHAPTER XIV. 
 
 Debility in the Newly-born — Apparent Asphyxi- 
 ation — Care of the Eyes , . . . . 173 
 
 CHAPTER XV. 
 
 Infant Feeding — Weaning— Diet after Weaning 
 —Bathing 184 
 
 Index 203 
 
OHAPTEE I 
 
 INTRODUCTORY REMARKS — STRUCTURE 
 
 OF THE ORGANS OF GENERATION — 
 
 DEVELOPMENT OF THE CHILD. 
 
 It may not be the manifest destiny of 
 every woman to become a wife and a 
 mother. It is, however, a possibility to 
 all. That being the case, it is a matter 
 to astound the thoughtful that so little 
 preparation for their probable experiences, 
 needs, and duties is deemed necessary. 
 Many readers will remember Mrs. Diaz's 
 story of the philosopher from a distant 
 planet who comes to this earth and whose 
 notice is attracted to the little children. 
 Upon inquiry he finds that they are the 
 future men and women of the country; 
 that dangers of all kinds surround them — 
 inherent evil tendencies may readily de- 
 velop into crimes threatening not only 
 their own but the country's welfare ; dif- 
 ferences of temperament call for the 
 
2 INTRODUCTORY. 
 
 utmost skill, discernment, wisdom, and 
 knowledge in their education, and it is 
 granted that no occupation can excel this 
 in its scope, power, and influence. Upon 
 further inquiry he finds that the "opera- 
 tors upon these delicate and complex pieces 
 of mental machinery " are the mothers, 
 and, with a delightful naivete, he takes it 
 for granted that such all-important per- 
 sonages in the nation as the mothers must 
 be the recipients of an education most 
 comprehensive and judicious, as well as 
 one especially directed to the vocation 
 which is conceded to be peculiarly theirs 
 — an education which will teach them to 
 understand the various temperaments of 
 their children and their needs, to direct 
 the culture of their intellectual and moral 
 nature, and to apply hygienic laws in 
 their physical training. When he dis- 
 covers that although the training of chil- 
 dren is universally held to be a woman's 
 chief business, yet the young women re- 
 ceive no special education fitting them 
 for it, that husbands rarely think of pro- 
 viding their wives with literature designed 
 
INTRODUCTORY. 3 
 
 to give them the necessary information, 
 the philosopher indulges in the following 
 soliloquy: " There seems to be blindness 
 and stupidity somewhere among these 
 people. From what they say of the diffi- 
 culty of bringing up their children, it 
 must take an archangel to do it rightly; 
 still they do not think a woman who is 
 married and settles down to family life 
 needs much education. Moreover, in edu- 
 cating young women, that which is uni- 
 versally acknowledged to be the chief 
 business of their lives receives not the 
 least attention " ! ! 
 
 Leaving aside ethical considerations, and 
 looking at the matter merely from the 
 point of view of physical self-preserva- 
 tion, is it not strange indeed that the body, 
 the one thing which is ever present with 
 us from birth until death, to which we 
 are chained in a life sentence, as it were, 
 and whose welfare concerns us more inti- 
 mately than any other thing in the world, 
 is precisely that which arouses the least 
 interest ? All the "ologies" seem to take 
 precedence over physiology; yet a study 
 
4 THE THORAX. 
 
 more fascinating in itself and more per- 
 sonally interesting could not easily be 
 imagined. However, it is not our place 
 to write a treatise on physiology. A few 
 words upon the structure of the organs 
 special to women may, however, be of use 
 to the wife and expectant mother, and are 
 necessary to the understanding of what 
 happens in pregnancy. 
 
 That portion of the body known as the 
 trunk is divided into two parts, the thorax, 
 or chest, and the abdomen. 
 
 The thorax reaches from the neck to 
 the lower extremity of the breast bone in 
 front, and to the last rib on each side. 
 It contains the lungs, heart, and great 
 blood vessels. The abdomen is divided 
 into the upper part, or abdomen proper, 
 and the lower, or pelvis. The former ex- 
 tends from the chest, from which it is 
 separated by a muscular partition called 
 the diaphragm, to a point a trifle below 
 the upper border of the hip bone. It con- 
 tains the stomach, the greater part of the 
 bowels or intestines, the liver, spleen, pan- 
 creas, and kidneys. Just below the abdo- 
 
ORGANS OF GENERATION. 
 
 mq^L proper, and artificially divided from 
 it to facilitate description, is the pelvis, or 
 pelvic cavity, which contains a small part 
 of the intestines, the bladder, and the or- 
 gans of generation. In the centre is the 
 
 Fig. 1. —Uterus and Appendages. 
 a, 6, c, uterus; d, neck of uterus; /, /, ligaments holding up 
 uterus; #, g, Fallopian tubes; h, fimbriated end of tube, 
 opened to show its form ; », z, ovaries ; k, vagina, opened to 
 show neck of uterus. 
 
 uterus, or womb, which is, in those who 
 have never borne children, a pear-shaped 
 body, about two and a half inches long, 
 
6 ORGANS OF GENERATION. 
 
 one and a half broad at the upper part, 
 half an inch in the lower, and is one inch 
 thick. It is composed of muscle, with 
 a lining of mucous membrane, and is 
 hollow. From each side of it projects a 
 tube from three to four inches long, its 
 cavity continuous with that of the uterus, 
 but only one-twenty-fifth of an inch in 
 diameter at the opening. The Fallopian 
 tube, as it is called, increases in size to- 
 ward the outer end, where it is large 
 enough to admit a goose quill. It does 
 not extend in a straight line, but curves 
 slightly upward and then downward ; its 
 ends are fringe-like in shape, and one of 
 these fringe-like points is attached to an 
 oval, solid mass, about an inch and a 
 half long, known as the ovary. This is 
 fastened, by means of a little cord or liga- 
 ment about an inch long, to the uterus. 
 These five bodies— uterus, tubes, and 
 ovaries — constitute the organs of genera- 
 tion. The lower part, or neck, of the ute- 
 rus projects into a canal from two and a 
 half to three inches long, called the va- 
 gina. Although a canal, its walls lie 
 
THE OVARIES. 7 
 
 close together. The external organs of 
 generation are called collectively the vulva. 
 
 The ovaries contain a large number of 
 tiny egg cells or follicles ; there are about 
 thirty-six thousand in each one. During 
 childhood they are not perfectly developed, 
 but at the age of puberty (which varies 
 from about the tenth year in hot countries, 
 such as India, to the eighteenth or twen- 
 tieth in cold countries, such as Norway, 
 and in our own country is at the thirteenth 
 or fourteenth year) these cells mature, and 
 about every fourth week one bursts open 
 upon the surface of the ovary, discharging 
 an ovum, or egg, which is about one- 
 one-hundred-and twentieth of an inch in 
 diameter. The ovum, in some way not 
 yet perfectly understood, is carried into 
 the Fallopian tube through the finger-like 
 ends, and travels by way of the tube into 
 the uterus, from which it is discharged 
 into the vagina. A flow of blood usually 
 accompanies its discharge, and is known 
 as menstruation, or monthly sickness. 
 
 The process described is that occurring 
 to the unfertilized ovum. When, how- 
 
8 THE PLACENTA. 
 
 ever, conception has taken place, a very- 
 different series of events occur. Instead 
 of being discharged through the vagina, 
 the ovum fastens itself to the uterine wall. 
 Both the ovum and the lining of the ute- 
 rus undergo great changes : membranes 
 are thrown around the little egg, until it 
 is enclosed in a small bag ; the child de- 
 velops within this pouch, which becomes 
 filled with fluid and is known as the " bag 
 of waters." Meanwhile, about the end of 
 the third month of pregnancy, the pla- 
 centa or after-birth is formed upon and 
 from the lining of the uterus. It is a soft 
 mass, consisting chiefly of blood vessels, 
 which are separated from the blood vessels 
 of the embryo, or foetus, or young child, 
 by only a thin membrane, through which a 
 constant interchange takes place of waste 
 matters from the blood of the child, and 
 nourishment from the blood of the mother. 
 The infant, or, more properly speaking, 
 the foetus, is connected with the placenta 
 by means of the umbilicus, umbilical cord, 
 or navel string. 
 
 As the child increases in size the uterus 
 
DEVELOPMENT OF THE CHILD. 9 
 
 also grows until it reaches to about an inch 
 below the lower end of the breast bone. 
 Of course it pushes upon the organs of 
 the abdomen, displacing them more or less, 
 so that it is not at all wonderful that many 
 uncomfortable sensations are produced 
 merely by the development of the child. 
 At the end of the months of pregnancy 
 "term" is reached, and "labor," which 
 means contraction of the muscular walls 
 of the uterus, expels the infant. The ute- 
 rus then begins to diminish in size, and in 
 a few weeks has returned almost to its 
 original dimension, which is, however, 
 never entirely regained. It may interest 
 the young mother to know the stage of de- 
 velopment of the child at different periods 
 in the pregnancy. 
 
 During the first month it has no defi- 
 nite form, and is about one-twelfth of an 
 inch in length. 
 
 At the commencement of the second 
 month it is about half an inch in length 
 and weighs about sixty grains. The head 
 may be just distinguished. Toward the 
 end of the second month the body is from 
 
10 DEVELOPMENT OF THE CHILD. 
 
 one to one and a half inches long. The 
 head and extremities are visible. 
 
 Third month.— The body grows to the 
 length of three, or even three and a half, 
 inches. Fingers and toes are formed. 
 The head is large compared with the body. 
 Nose, ears, anus (entrance to bowels), and 
 mouth are formed — the two last-named 
 being closed. Eyelids joined together ; a 
 membrane covers the pupils. 
 
 Fourth month.— Length of body, five 
 and a half to six inches. Weight, three 
 to six ounces. The sex is distinguishable. 
 The mouth and anus are open. The nails 
 begin to appear. 
 
 Fifth month. — Body grows from five 
 and a half to nine or ten inches by the 
 end of the month. Weight increases to 
 ten ounces. 'The head is one-third the 
 length of the whole foetus. Hair and nails 
 visible. Downy hair appears over the sur- 
 face of the whole body. 
 
 Sixth month. — Length, eleven to twelve 
 inches. Weight, one pound. Hair and 
 eyelashes distinct. The pupils are still 
 
DEVELOPMENT OF THE CHILD. 11 
 
 covered by the little membrane, and the 
 eyelids adhere together. 
 
 Seventh month, — Length, about four- 
 teen inches. Weight, three to four pounds. 
 The eyelids open, and the membrane over 
 the pupil begins to disappear. The nails are 
 formed, and an oily matter covers the skin. 
 
 Eighth month.— Length, about sixteen 
 inches. Weight, four or five pounds. The 
 membrane over the pupil disappears. The 
 nails reach to the ends of the fingers. 
 The downy hair begins to disappear from 
 the face. 
 
 Ninth month.— Length, eighteen to 
 twenty inches. The weight varies, the 
 average being about seven pounds. A 
 few cases are on record of children weigh- 
 ing fifteen and sixteen pounds, but they 
 were usually still-born. 
 
CHAPTER IT. 
 
 SYMPTOMS OF PREGNANCY — PRENATAL 
 
 INFLUENCES— CHOICE OF PHYSICIAN 
 
 AND NURSE. 
 
 The young wife is frequently at a loss to 
 determine whether she be really pregnant. 
 
 The symptoms of pregnancy are di- 
 vided into two classes: those in the first 
 can be decided upon by the mother herself; 
 those in the second, by the physician. Yet 
 it must be remembered that no one sign is 
 absolutely positive, and that a group of 
 such symptoms must be present before it 
 can be definitely announced that she is with 
 child. 
 
 Absence of the monthly sickness 
 is the first thing usually noticed, and under 
 ordinary conditions this is accepted as 
 proof, especially if it have been absent for 
 two successive periods. It must, however, 
 be borne in mind that a low physical con- 
 dition, poverty of the blood, cold, fatigue, 
 
SYMPTOMS OF PREGNANCY. 13 
 
 and even fright or excitement of any kind, 
 will, in some persons, cause a non-appear- 
 ance of menstruation. In a few cases, on 
 the other hand, the condition of pregnancy 
 has not been suspected because the month- 
 ly flow has continued to appear two or three 
 times, or even, though rarely, throughout 
 pregnancy. Frequently a white discharge 
 occurs at the usual time for the flow, or 
 even at other times; but it need cause no 
 alarm, as it is merely a result of the con- 
 gested state of the uterus. 
 
 Morning sickness is a second sign. 
 This is often entirely absent, and it may 
 be caused in the non-pregnant by dyspep- 
 sia; still, in connection with absence of the 
 monthly sickness, it is a valuable indica- 
 tion. It occurs after the first two or three 
 weeks, is most marked in the second month, 
 and usually ceases at the end of the third 
 month. 
 
 Changes in the breast constitute the 
 third sign. A slight feeling of fulness, a 
 little tingling sensation, or sensitiveness to 
 pressure, or pain, is sometimes experi- 
 enced. At any time from the end of the 
 
14 SYMPTOMS OF PREGNANCY. 
 
 first month to the end of the fourth cer- 
 tain changes in color occur: the skin of 
 the nipple, which becomes more promi- 
 nent, is darkened, and the pink ring 
 around it becomes brown in hue. Slight 
 grain-like elevations also appear on this 
 ring. These changes are not an invari- 
 able rule, and they are of value in deter- 
 mining a first pregnancy only, as the 
 coloration and granulation are usually 
 permanent. 
 
 An increase in the size of the abdo- 
 men is the fourth sign, but as it may come 
 from fat, from gas in the bowels, from 
 tumors, or even from hysteria, it is not 
 an absolute guide. During the first eight 
 weeks, indeed, the abdomen becomes flat- 
 ter, because the increased weight in the 
 uterus tends to drag it downward. As the 
 child develops, however, it rises higher and 
 higher. At the end of the twelfth week 
 it may be felt just above the bone in front, 
 known as the pubic bone; at the end of the 
 sixth month it is about on a level with the 
 navel; and at the end of the thirty-eighth 
 week it reaches to almost the end of the 
 
SYMPTOMS OF PREGNANCY. 15 
 
 breast bone, sinking a little during the two 
 weeks before labor. 
 
 Quickening, known as "feeling life/* 
 is the fifth sign, felt about the eighteenth 
 or twentieth week. This is due to the 
 movements of the child, and is at first a 
 slight, tremulous feeling rather than a defi- 
 nite motion, becoming more pronounced 
 as the child increases in size and strength. 
 The movements may be so few and so in- 
 considerable as scarcely to be felt through- 
 out pregnancy, or so active as to cause 
 considerable pain. In some cases they 
 suddenly cease altogether for weeks, or 
 even for the remainder of pregnancy, 
 causing the mother to fear that the child 
 has died. Death of the foetus sometimes 
 occurs, to be sure, but rarely, and mere 
 cessation of the movements need not cause 
 alarm. On the other hand, women of a 
 nervous temperament, and those very de- 
 sirous of having children, have sometimes 
 mistaken muscular movements for quick- 
 ening. As a rule, however, the symptom 
 is readily recognized. 
 
 By careful examination of the abdomen 
 
16 SYMPTOMS OF PREGNANCY. 
 
 in the early months, and of the uterus 
 through the vagina, the physician is able 
 to perceive certain signs more indicative 
 of pregnancy than are the sensations ex- 
 perienced by the mother. A purple tint- 
 ing of the parts, changes in the neck and 
 body of the uterus, perception of various 
 parts of the child's body, and, most impor- 
 tant of all, the sound of the child's heart, 
 are some of these signs. The latter is 
 heard by pressing the ear to the abdomen. 
 The foetal heart beats more rapidly than 
 that of the mother, and is an infallible 
 sign of pregnancy, but rarely perceptible 
 before the eighteenth week. Sometimes 
 two hearts are distinctly heard, and the 
 physician is able to detect the presence of 
 twins. 
 
 The young mother is always anxious to 
 know how to determine the exact date of 
 her confinement. This is a very nearly 
 impossible thing, as there exists a certain 
 amount of irregularity, varying with indi- 
 viduals, and as it is rarely possible to know 
 the exact date of conception. One au- 
 thority states that a child may be born 
 
SYMPTOMS OF PREGNANCY. 17 
 
 within two hundred and forty to three 
 hundred and twenty days of the last 
 menstrual period. The average duration 
 of pregnancy is two hundred and eighty 
 days — forty weeks, or ten lunar months — 
 and the usual method of calculation is to 
 count backward three months from the 
 date of the beginning of the last men- 
 struation, and then add seven days (in 
 leap years, after February, six days). No 
 physician should be blamed for refusing 
 to fix the exact date of confinement. 
 Neither should he be expected to foretell 
 the birth of twins, for this is oftentimes 
 absolutely impossible of prediction. Pa- 
 rents are usually anxious to know the 
 sex of the child before birth, and some 
 even hope to influence the production of 
 the desired sex. Even physicians have 
 attempted to solve the problem, books and 
 articles have been written upon the sub- 
 ject, various startling and original theo- 
 ries have been announced. It may be 
 definitely asserted, however, that as yet 
 science has thrown no light upon the sub- 
 ject, and parents must still be content to 
 
18 PRENATAL INFLUENCES. 
 
 wait until the birth of the child decides the 
 question. 
 
 Another and more important subject 
 often occupies the attention of the young 
 mother. Can she, of her own will, in- 
 fluence the health, character, tempera- 
 ment, mind, and appearance of the child 
 whom she is bearing ? Widely do the opin- 
 ions of physicians vary upon this point. 
 Some assert that certain sights, emotions, 
 thoughts, and desires have a pronounced 
 effect upon the unborn babe ; that de- 
 formities or objects which have made a 
 profound impression upon the mother are 
 reproduced upon the child ; that by per- 
 sistent gazing at pictures of beautiful 
 persons the child may be endowed with 
 similar beauty ; that scientific, literary, 
 artistic, musical, or kindred tastes may be 
 created by a firm determination on the 
 part of the mother that they shall exist ; 
 and, in fact, that within certain limits 
 almost any trend may be given to the 
 character of the offspring. Many are the 
 anecdotes related by women to illustrate 
 this point ; while they cannot all be re- 
 
PRENATAL INFLUENCES. 19 
 
 ceived without the proverbial grain of 
 salt, it will not do to dismiss them as 
 altogether unworthy of attention. A suffi- 
 ciently large number of well-authenticated 
 facts following presumed causes are al- 
 ways to be treated with respect, but one 
 must be sure that they are authenticated, 
 and that imagination, exaggeration, or 
 mere hearsay does not play too large a role. 
 Some men of science believe absolutely in 
 this prenatal influence ; others of equal 
 standing deny it altogether, and claim 
 that the majority of the accounts are un- 
 trustworthy, the remainder mere coinci- 
 dences, and that nothing as yet known of 
 physiological laws warrants the belief that 
 the mother can by any volition influence 
 the child, nor that any emotional impres- 
 sion can in any way alter its development. 
 If, however, it please the young mother to 
 believe that she can mould her child's 
 character in these months of waiting, 
 there can be not the slightest objection to 
 her so doing. Since there is a doubt upon 
 the subject, by all means let the child 
 have the benefit of the doubt. Let the 
 
20 CHOICE OF PHYSICIAN. 
 
 mother fill her mind with lofty, beauti- 
 ful, and pleasing thoughts, read the best 
 books, study masterpieces of art, listen to 
 the noblest music, associate chiefly with 
 those of her friends whose hearts and 
 minds are best and truest, think only lov- 
 ingly, hopefully, and with the highest 
 aspirations of and for the coming life for 
 whose being and well-being she is respon- 
 sible. By so doing her own nature will 
 be uplifted and her character strength- 
 ened, and she will be better fitted to in- 
 fluence and guide the child after birth — 
 and perhaps before. Her mind, more- 
 over, will be more diverted from her own 
 physical ailments, and, by the reaction of 
 mind upon matter, her body will be in a 
 better condition to bear the coming or- 
 deal. 
 
 The choice of a good physician should 
 be early made. Then the case should be 
 put in his hands, and, without displaying 
 undue fussiness, he should be consulted 
 about details. Prudery should not in- 
 terfere with a thorough examination, if it 
 is thought advisable. While in the ma- 
 
EXAMINATION OF URINE. 21 
 
 jority of cases the child is in the most 
 natural position for delivery, in others 
 there is what is called a malposition or 
 false presentation. If the physician know 
 of this in time, he can often by gentle 
 measures remedy the trouble and save 
 great pain and even danger. He should 
 also know the shape and size of the bony 
 parts which make up the pelvis, as such 
 knowledge will greatly influence the man- 
 agement of labor. 
 
 The existence of diseases which might 
 be transmitted to the child, or which might 
 in some way increase the difficulties of 
 labor, is sometimes unknown to the mother, 
 but may be discovered by the physician in 
 time to be checked. 
 
 The urine should be submitted for ex- 
 amination by the physician as often as 
 once a fortnight, beginning with the sixth 
 month of pregnancy. This is an absolute 
 necessity, as many cases of kidney disease 
 have resulted disastrously simply from 
 neglect of this precaution. Early recogni- 
 tion of albumin in the urine will warn the 
 physician to institute a course of treat- 
 
22 SELECTION OF NURSE. 
 
 ment which will greatly lessen the chances 
 of harm. 
 
 Unless the young mother have in view 
 some particular nurse whom she is anxious 
 to have with her during her confinement, 
 it is well to leave the choice to the physi- 
 cian. A graduate of one of the good train- 
 ing schools is to be preferred ; but, should 
 the price be too high for the purse of the 
 patient, an intelligent woman, who is will- 
 ing to follow the doctor's directions impli- 
 citly, and who is not so filled with a sense 
 of her own importance that she permits 
 herself to add variations of her own to the 
 treatment prescribed, may often be all that 
 is needed. Midwives are to be avoided. 
 In some countries they are by law obliged 
 to receive special training ; in this country 
 they are not. Many of them are able to 
 conduct normal cases with intelligence ; 
 very few know anything whatsoever about 
 even the simplest complications. 
 
 The pregnant woman seems to be re- 
 garded as legitimate prey for the outpour- 
 ing of advice, harrowing experiences, and 
 superstitions known as "granny tales, " 
 
SUPERSTITIONS. 23 
 
 Some of the latter are so absurd that one 
 wonders that any reasonable woman can 
 be made to believe them. Others have a 
 semblance of truth. 
 
 It is a time-honored belief that a 
 thwarted ' ' longing " upon the part of the 
 woman for any special article of food will 
 result in a birth-mark upon the child re- 
 sembling in shape the coveted article. 
 This idea is entirely without foundation, 
 but it is easy to see how a succession of 
 coincidences may have given rise to its 
 conception. But what shall be said of the 
 gravely uttered prediction that " the child 
 would be born without a hair on its head, 
 because the mother had never experienced 
 heartburn during pregnancy " ? Such a 
 remark seems almost too senseless to quote, 
 but it is a fair example of the many silly 
 tales which would be harmless were it not 
 for the fact that they disturb and worry 
 the pregnant woman at a time when her 
 mind should be peculiarly free from even 
 the slightest anxiety. 
 
CHAPTER III. 
 
 ESSENTIALS OF A HEALTHY PREGNANCY 
 —HYGIENE OF THE HOUSE— OCCUPA- 
 TIONS — EXERCISE — DIET— BATH- 
 ING— SLEEP — DOUCHES — 
 CLOTHING— CARE 
 OF BREASTS. 
 
 Pregnancy, or the condition of being 
 with child, is not, as many seem to regard 
 it, a diseased state of the system, some- 
 thing out of the ordinary, unnatural, ab- 
 normal. It is, on the contrary, a natu- 
 ral condition, for which Nature has made 
 every provision, and statistics go far to 
 prove that the health of women who have 
 borne children is, on the whole, better 
 than that of the sterile. The condition, 
 in other words, is physiological. Modern, 
 or, as we call it, civilized, life has done 
 much to complicate matters. The nearer 
 to Nature a people live the easier are preg- 
 nancy and labor. As we cannot, however, 
 
HEALTHY PREGNANCY. 25 
 
 and would not if we could, revert to the 
 condition of savages, our concern must 
 be to ascertain what, under existing cir- 
 cumstances, are the best means to secure 
 a comfortable pregnancy and natural de- 
 livery. 
 
 The first essential is good health on the 
 part of the mother, which includes her 
 perfect physical development, maturity, 
 and a sound condition of the uterine 
 organs. The pelvis should be of fair size, 
 the muscles of the body in good tone, 
 and the general health good. As regards 
 maturity, it may be asserted that in the 
 very young and late in life pregnancy is 
 not so well borne as between the ages of 
 twenty and thirty-five. This, of course, 
 does not mean that it is disastrous to have 
 them before or after that time, but simply 
 that the best conditions for both mother 
 and child are met with at a period when 
 the parent is fully developed physically 
 and mentally, and in the prime of her vigor. 
 There is a general impression that a first 
 labor occurring after thirty-five years is 
 apt to be fatal. This is erroneous: labor 
 
26 HEALTHY PREGNANCY. 
 
 is likely to be longer in a woman of ma- 
 ture years, because the body is usually 
 more firmly knit and less yielding, and 
 the dangers of prolonged labor, such as 
 exhaustion and a possible tendency to 
 haemorrhage, may be increased; otherwise 
 there is no more danger than in the case 
 of younger women. The very young and 
 the very mature are more apt to miscarry 
 than those in the prime of child-bearing 
 life. 
 
 The effect of pregnancy upon uterine 
 troubles will be touched upon in a later 
 chapter. Suffice it to say that it is a mis- 
 take to suppose that they are likely to be 
 cured by the condition. While a strong 
 constitution is the first requisite to a good 
 pregnancy, and while good health cannot 
 be created in a few months, but is rather 
 the outcome of inheritance or of judicious 
 care from infancy, much may be done to 
 strengthen the system and to overcome 
 actual ills. It is always essential to ob- 
 serve hygienic precautions or the laws of 
 health; it is imperative during pregnancy. 
 
 The VENTILATION, DRAINAGE, and 
 
HYGIENE OF THE HOUSE. 27 
 
 heating of the house should receive 
 careful attention. The air should be kept 
 fresh and pure, and should consequently 
 be changed very frequently; but rooms 
 must not be allowed to become so cold 
 that the patient feels chilly while sitting 
 in them. It is a mistake to suppose that 
 women living in the country necessarily 
 have more fresh air than those living in 
 crowded cities. They have, to be sure, 
 every chance of obtaining it, but how 
 many improve the opportunity ? In cold 
 weather how often are the windows of 
 the living room opened and the air per- 
 mitted to rush in ? Are they not kept 
 closed while the stove rages, and the dif- 
 ferent members of the family sit in the 
 room hour after hour, constantly adding 
 to the heaviness and impurity of the air ? 
 Every few hours the windows should be 
 opened for several minutes, and, as the in- 
 coming air is rich in oxygen, it will heat 
 more rapidly than foul air. At night the 
 window should be opened at least two 
 inches ; the smaller the room the more 
 necessary is this measure. Night air is 
 
28 HYGIENE OF THE HOUSE. 
 
 not always the noxious thing which many 
 people consider it; certainly not half so 
 harmful as the atmosphere of a room 
 which has been breathed over and over 
 again by the persons in it, coming out 
 each time from the lungs laden with 
 waste matters from the body. It is not a 
 pleasant thought that we are inhaling 
 particles of matter from the organism of 
 other people, yet we constantly and with 
 perfect equanimity do what we consider it 
 so unpleasant to think about ! 
 
 One cannot be too careful in regard to 
 drains, cesspools, and plumbing. No foul 
 gases should come near the pregnant wo- 
 man, whose system is doubly sensitive to 
 injurious influences. There should be no 
 doubt upon the subject : careful investi- 
 gation should be made and evils promptly 
 remedied. The room in which the patient 
 is to be confined should, if possible, be 
 chosen with especial reference to its health- 
 fulness and comfort. It should be sunny, 
 large, easily heated, easily ventilated, free 
 from many hangings and draperies, scru- 
 pulously clean, removed from the neigh- 
 
EXERCISE. 29 
 
 borhood of water closet or privy. Details 
 as to its preparation will be given later. 
 In summer, of course, a cool c and shaded 
 room will be chosen. 
 
 Exercise is of great importance to the 
 pregnant woman. This does not mean 
 that she is to rush restlessly about, unnec- 
 essarily fatiguing herself with extraordi- 
 nary exertions, but it does mean that she 
 should in pleasant weather keep in the 
 open air as much as possible, and walk 
 as much as she can without feeling 
 tired. Dancing, horseback riding, run- 
 ning, jumping, lifting heavy weights, lift- 
 ing the arms high, in fact all exercise of 
 a violent or jerking nature, is to be 
 avoided. Quiet, regular walks, drives in 
 an easy carriage, rides in the horse cars 
 (not the omnibus), may all be done with 
 benefit. Women who do their own house- 
 work, and who feel able to do it at this 
 time, can continue their usual habits in 
 that respect ; but it would be best for them 
 to hire some one to attend to the washing, 
 scrubbing, and heavy sweeping. True, 
 many strong women do all this work up to 
 
30 EXERCISE. 
 
 the last moment and seem none the werse 
 for it ; but the exceptionally strong cannot 
 be taken as a guide to the average Ameri- 
 can woman. Moreover, the after -history 
 of many of these same apparently ro- 
 bust women who take no precautions be- 
 fore labor, and who often leave their beds 
 within two or three days after confine- 
 ment, does not always bear out their boast 
 that it " hurt them not a particle." When, 
 a year or two later, they seek the dispen- 
 sary clinics for treatment of "womb 
 troubles," it seldom occurs to them that 
 there is any connection between their pre- 
 sent ills and previous imprudence. 
 
 No general rule can be given for exer- 
 cise. What will benefit one patient may 
 injure another ; but a little common sense 
 goes a great way, and the reasonable wo- 
 man will walk daily, if she can do so with- 
 out fatigue, in spite of friends who would 
 keep her stretched out upon her lounge in 
 a condition of semi-invalidism, and refuse 
 to walk when tired, notwithstanding accu- 
 sations of laziness. If everything is pro- 
 gressing in a natural manner, let her 
 
SELF-CONTROL. 31 
 
 pursue her usual every-day life, enjoy the 
 society of her friends, read, play, paint, 
 and do whatever gives her the most plea- 
 sure and keeps her in a cheerful frame 
 of mind, but avoiding ill-ventilated and 
 crowded halls and parlors. At the periods 
 of the month corresponding to menstrua- 
 tion it would be well for her to keep 
 somewhat quieter than usual, and should 
 there at such times be any pain she must 
 maintain a reclining posture. 
 
 If the pregnant woman is of an at all 
 excitable disposition, let her endeavor at 
 this time to exercise special self-control ; 
 for the nervous equilibrium is very easily 
 disturbed, and hysterical habits can readily 
 be formed which may persist and render 
 her life intolerable to herself and to her 
 friends. By hysterical is not meant 
 simply fits of laughing and crying, but 
 rather an excess of emotional feeling dis- 
 played in various ways, as extreme sen- 
 sitiveness, irritability, excitement, exalta- 
 tion alternating with despondency — in 
 fact, " emotional excitement out of pro- 
 portion to any given cause " ; a distur- 
 
32 DIET. 
 
 bance of the serenity which should char- 
 acterize a well-poised nature such as 
 should belong to one who is to be guide, 
 teacher, and example to a human being. 
 While all who surround a prospective 
 mother should endeavor to keep her in a 
 cheerful, happy, soothed, and calm condi- 
 tion, she herself should be doubly watch- 
 ful to see that this state of mind be depen- 
 dent upon inward force of character rather 
 than upon external surroundings. To 
 this end she should avoid the indulgence 
 and cultivation of nonsensical fads and 
 fancies, and rid herself of the idea that 
 because she is " in a family way " she may 
 and must do anything that comes into her 
 head to do, on the pretext that to be 
 thwarted in her wishes injures the child. 
 Neither must she go to the other extreme 
 and become so morbidly conscientious as 
 to consider that the reaction of physical 
 ailments upon the nervous system is an 
 evidence of depravity upon her part. In 
 fact, let her, as far as possible, deliberately 
 keep her mind away from herself. 
 As to the question of diet, if appetite 
 
DIET. 33 
 
 and digestion are good, let her eat as 
 heartily as she feels inclined of wholesome, 
 nutritious food, such as soup, meat, vege- 
 tables, bread, cereals, fruit, fish, oysters, etc. 
 It is not, however, at all necessary to eat 
 more than the usual amount of food, under 
 the supposition that she is " eating for 
 two." Highly spiced or rich dishes, fried 
 food, sweets, desserts, wines, are to be 
 taken in moderation, on account of the 
 predisposition to indigestion. Coffee and 
 tea should be sparingly indulged in ; a 
 fondness for milk is to be encouraged, for 
 a better diet does not exist. It would 
 even be desirable to try to cultivate a taste 
 for it, or to overcome a repugnance. Many 
 with whom it does not easily digest might 
 be able to take it skimmed, or with a tea- 
 spoonful of lime water to the glass, or 
 mixed with Vichy or Apollinaris, or con- 
 taining a pinch of salt. The addition of a 
 tablespoonf ul of Horlick's Malted Milk ren- 
 ders it palatable to some ; or of a beaten 
 yolk of egg, or a teaspoonful of sherry, 
 port, or Madeira. Should any particu- 
 lar article of diet be known to disagree, 
 
34 BATHING. 
 
 it must of course be avoided. The rule 
 is childishly simple, but daily broken by 
 thousands who are not children. Spe- 
 cial diet for those suffering from constipa- 
 tion will be considered later. 
 
 Certain writers have advocated the ex- 
 clusive use of fruit or of vegetables in 
 order to secure painless labor for the 
 mother. Even were the result insured by 
 such a course, which we have no warrant 
 for believing, no true-hearted woman 
 would wish to secure relief from pain at 
 the expense of her child's health. That 
 this would be the case is evident, since 
 the whole aim of the treatment is to lessen 
 the development of the infant and make its 
 bones soft and pliable — in other words, to 
 underfeed it and to give it a predisposi- 
 tion to rickets. 
 
 Bathing. — Women accustomed to a 
 daily sponge bath of cold water may con- 
 tinue its use, being careful, however, not 
 to become chilled. Warm baths once or 
 twice a week may be taken in addition ; 
 they should not be too hot, and should not 
 last longer than fifteen minutes. It is of 
 
BATHING. 35 
 
 extreme importance that the whole body be 
 frequently washed. If the pores of the 
 skin be clogged by dust or excretions, the 
 free action of the perspiration will be in- 
 terfered with, and, as water and other 
 substances representing waste material 
 from the system must be got rid of, 
 double work will be thrown upon the kid- 
 neys, which in pregnancy are easily over- 
 taxed and weakened, to their perhaps 
 lasting injury. 
 
 Russian and Turkish baths offer too 
 great contrasts of heat and cold, and too 
 violent passive exercise, to be safe during 
 pregnancy. Sea bathing is also too fa- 
 tiguing to be endured by any but the 
 exceptionally robust. 
 
 The external genital organs should be 
 washed at least twice a day with warm 
 water and soap, to which may be added a 
 little Cologne or toilet water if desired. 
 The advice may be considered superfluous 
 by many naturally -neat women, but it is 
 necessary in view of the widespread super- 
 stition which exists against the use of 
 water during pregnancy, and even during 
 
36 INTERNAL DOUCHES. 
 
 menstruation. Water does no harm ; on 
 the contrary, it prevents much annoying 
 irritation and is in every way of benefit. 
 Cold water may be used, but most people 
 prefer tepid or warm water. Should there 
 exist any irritation of the parts, clear 
 water, or water in which a little borax is 
 dissolved, should be used, or else, after 
 washing with soap, the parts should be 
 rinsed with clear water. 
 
 Internal douches of warm (not hot) 
 water may be taken with advantage, pro- 
 viding that certain precautions be ob- 
 served. Very hot water, or water pro- 
 jected in sudden shocks, or coming with 
 great force against the neck of the uterus, 
 would be liable to cause miscarriage ; 
 therefore the form of syringe worked by 
 squeezing a rubber bulb is to be avoided, 
 as it sends the water in jets. The fountain 
 syringe, either as a rubber bag or any re- 
 ceptacle connected by a long tube with the 
 nozzle, is the one to be preferred, as the 
 water flows continuously. It must not be 
 placed high above* the body, for the force 
 of the flow increases with the height; 
 
INTERNAL DOUCHES. 37 
 
 about three feet will be the suitable dis- 
 tance. The nozzle, or "tip," may be of 
 rubber or glass, but the holes in it must 
 be on the side£ and not at the end. The 
 douche is to be taken in a reclining posi- 
 tion, either on one of the douche pans 
 which can be bought at a good drug store 
 or instrument-maker's in the cities, or ly- 
 ing crosswise on the bed, the hips drawn 
 to the edge and the feet resting upon two 
 chairs. A rubber sheet or piece of oil- 
 cloth is placed beneath the body, and rests 
 in a receptacle upon the floor, in such a 
 way that the returning water is conducted 
 into it. By means of this position, and by 
 hanging the douche bag at a slight eleva- 
 tion only, the stream of water is gentle, 
 and the neck of the uterus and the vagina 
 are bathed in it rather than subjected to 
 any sudden shock. The douche may be 
 taken in a sitting posture, which is of 
 course a less complicated proceeding, but 
 the water returns so quickly that it is less 
 efficacious. However, it is much better 
 than no douche at all. A teaspoonful of 
 borax may be added to each quart of 
 
38 CLOTHING. 
 
 water (no douche should contain less than 
 two quarts), or a teaspoonful of the anti- 
 septic known as creolin. 
 
 The bowels must move freely every day. 
 More will be said upon the subject in the 
 next chapter. 
 
 Sleep is a necessity to the pregnant 
 woman. Her nights should be undis- 
 turbed, and frequent naps during the day 
 will calm her nerves and give her refresh- 
 ment. She should lie down often in the 
 daytime, closing her eyes and relaxing 
 her muscles, even if she cannot sleep. 
 
 The clothing, from the very early 
 months of pregnancy, should be thor- 
 oughly loose and comfortable. Some wo- 
 men refuse to give up their corsets ; in 
 such cases they should buy the lightest 
 corset possible, remove the steel, and let 
 out the laces until they feel no pressure 
 when breathing deeply. A far better plan 
 is to buy one of the many waists made on 
 purpose for pregnancy, and obtainable at 
 any corset shop, dry-goods shop, or reform- 
 underclothing establishment. The under- 
 clothing is to be fastened to it by buttons 
 
CLOTHING. 39 
 
 or tapes, so that their weight will be borne 
 by the shoulders rather than by the hips 
 and abdomen. It is not a good plan to 
 leave off the stays and fasten the under- 
 clothing as usual, without any substitute 
 in the way of a waist ; the bands and 
 strings cut into the flesh and create much 
 discomfort. The breasts, moreover, which 
 are increasing in size and weight, need 
 support. A tolerably comfortable waist 
 may be manufactured out of an old corset 
 by removing the steel, sewing on shoul- 
 der straps, and cutting off the corset all 
 around (or, if preferred, simply in the front) 
 just below the waist line, sewing buttons 
 or tapes near the edge to support the under- 
 clothing. The breasts are supported, the 
 lines are shapely and trim, yet there is no 
 pressure upon the abdomen. But the steel 
 must be removed. 
 
 Tight clothing interferes with the 
 circulation, with breathing, and with the 
 digestion, predisposing to faintness, dys- 
 pepsia, constipation, palpitation, and short- 
 ness of breath; moreover, the bowels are 
 crowded down upon the uterus, which is 
 
40 CARE OF THE BREASTS. 
 
 more than ordinarily liable to be pressed 
 out of place, with very serious results to 
 the patient. 
 
 Garters should not be worn. They in- 
 terfere with the circulation and predispose 
 to varicose veins. Stocking supporters that 
 fasten to the corset waist can be purchased 
 everywhere, or can be manufactured from 
 a piece of elastic ending in two pieces of 
 strong tape that contain buttonholes. Per- 
 sons living in the country can order them 
 by mail, as various kinds, all alike in gene- 
 ral principles, are largely advertised. 
 
 The body should be covered with flannel 
 or silk, which in winter must be thick and 
 warm, in the summer may be gauze-like 
 in quality. The main point is that every 
 part of the body should at all times be 
 thoroughly warm and comfortable. 
 
 The care of the breasts is of great 
 importance, since their neglect may lead 
 to intense suffering when the child begins 
 to nurse. Cracked nipples cause an agony 
 of pain, and sometimes lead to the forma- 
 tion of abscesses. 
 
 The breasts begin at a very early date in 
 
CARE OF THE BREASTS. 41 
 
 pregnancy to increase in size and to be- 
 come tender. All pressure must be re- 
 moved from them, and there must be ample 
 room for growth. Cotton wadding and 
 other heating materials must not be placed 
 over them. Breast-forms of crinoline 
 gauze, such as are sold in corset shops, 
 might be used to advantage to keep off the 
 pressure of the clothing without heating 
 the breasts. A secretion of a small amount 
 of milk is early formed, and is apt to ooze 
 and dry upon the nipples, forming crusts 
 underneath which the skin becomes very 
 tender. This should be gently washed off 
 every day with warm water and castile 
 soap, and rinsed with pure water. There 
 should be no rubbing, but gentle pressure 
 with a soft sponge or a bit of absorbent 
 cotton. After the washing a little cocoa 
 butter may be applied, or olive oil, almond 
 oil, or cocoanut oil if preferred. Some have 
 advised hardening the nipples with alco- 
 hol, brandy, benzoin, arnica, etc. ; but Na- 
 ture has placed many fat glands about the 
 nipple, indicating that it is to be kept soft 
 and pliable, and it would seem the most 
 
42 CARE OF THE BREASTS. 
 
 reasonable plan to assist Nature, not by 
 removing the oil, but by adding more. Oil 
 gently rubbed on the whole breast every 
 evening will do much to relieve the feeling 
 of tightness and discomfort which comes 
 from its swollen condition. 
 
 Should the nipples be on a level with the 
 skin or below it, they must be drawn out, 
 so that when the child attempts to nurse 
 it may be able to do so. Hard rubbing is 
 injurious. They may be drawn out two 
 or three times every day with the thumb 
 and forefinger; or the bowl of a clean clay 
 pipe may be placed over them, and suction 
 made through the stem by another person. 
 By means of a rubber tube fitted to the 
 stem, the patient herself could perform this 
 little manoeuvre, which should be kept up 
 for about five minutes at a time. Breast 
 pumps are sold for the purpose of develop- 
 ing the nipple, but create so much suction 
 that, unless used just in the right way, 
 they are apt to do harm. 
 
OHAPTEE IY. 
 
 NAUSEA AND VOMITING — CONSTIPATION— 
 DIARRHCEA — EXCESS OF SALIVA- 
 CARE OF THE TEETH. 
 
 Nausea and vomiting are apt to oc- 
 cur in pregnancy, and, when not excessive, 
 need cause no alarm. They are, however, 
 the source of so much discomfort and suf- 
 fering that all possible means should be 
 taken for their relief. " Morning sick- 
 ness " has been so named because it usu- 
 ally appears as soon as the patient raises 
 her head from the pillow; it may, how- 
 ever, come on at any time during the day. 
 Sometimes there is intense nausea and 
 very little vomiting ; in other cases there 
 is no nausea, but food will simply not re- 
 main in the stomach. These symptoms 
 appear in the first few weeks of preg- 
 nancy, and usually disappear within two 
 or three months, but they have been 
 known in rare cases to continue through- 
 
44 NAUSEA AND VOMITING. 
 
 out the whole period of pregnancy. In 
 any case it is better to consult the physi- 
 cian; but when the condition, in spite of 
 all efforts to overcome it, persists, and the 
 patient loses strength and grows daily 
 more feeble, a physician must be con- 
 sulted. 
 
 It would be beyond the province of 
 this book to prescribe for this condition 
 of "pernicious vomiting/' which, untreat- 
 ed, may become a most serious compli- 
 cation. For the relief of the more or- 
 dinary form of the trouble there are 
 several methods to be tried. In the first 
 place, let the patient be given a cup of 
 weak tea or of coffee, with or without a 
 dry biscuit or a piece of toast, the first 
 thing in the morning, before she has even 
 attempted to rise. Let her then lie down 
 for a quarter of an hour, a half-hour, or 
 an hour if necessary, rise slowly and 
 dress quietly, sitting down as much as 
 possible and avoiding all sudden move- 
 ments. If the breakfast is rejected, and 
 the patient has sufficient courage, let her 
 repeat it three or four times if necessary, 
 
NAUSEA AND VOMITING. 45 
 
 for sometimes by such persistence the 
 food is finally retained. 
 
 Vomiting occurring just before or just 
 after a meal can often be overcome by a 
 strict attention to diet, by refusing every- 
 thing which is difficult of digestion, and by 
 experimenting with a variety of food sub- 
 stances in order to determine what will be 
 tolerated by the stomach. Sometimes a 
 little cracked ice taken just before a meal 
 will relieve the trouble, or a mustard plas- 
 ter or hot-water bag or bottle applied to 
 the skin over the stomach may answer the 
 purpose. If regular meals are out of the 
 question, it is well to try the effect of giv- 
 ing a little food very often — about every 
 two hours. Soups, chicken broth, clam 
 juice, extract of beef in boiling water, to 
 which is added a little rice or vermicelli, 
 the white of an egg in ice-water or shaken 
 up in sherry, a cup of hot milk, equal 
 parts of milk and lime water, or milk and 
 Vichy or Apollinaris, or soda water, kou- 
 myss, dry champagne, toasted Boston 
 crackers, soda crackers, any dry biscuit 
 or cracker which is not sweet, are some of 
 
46 HEARTBURN — CONSTIPATION. 
 
 the articles of food which may be tried. 
 It is essential not to repeat the same thing 
 too often, otherwise disgust may be ex- 
 cited, and only a small amount should be 
 given at each time. Nibbling a dry bis- 
 cuit will often give comfort when nothing 
 else is retained by the stomach. Should 
 the patient express a decided wish for any 
 particular article of food, unless it is 
 known to be indigestible it would be 
 well to try it, not because thwarting the 
 " longing" would injure the child, but 
 because the capricious stomach of the 
 mother may be able to retain the coveted 
 article and give the condition of the diges- 
 tive organs a turn for the better. 
 
 It should be understood that in some 
 cases the nausea and vomiting absolutely 
 cannot be overcome, and the mother must 
 simply wait and bear it as patiently as she 
 can. 
 
 Heartburn often occasions much dis- 
 tress, but can rarely be entirely cured. A 
 half-teaspoonf ul of the aromatic spirits of 
 ammonia in water may give relief. 
 
 Constipation is one of the most fre- 
 
CONSTIPATION. 47 
 
 quent disorders of pregnancy, and, while 
 sometimes the result of a constipated 
 habit, often occurs in those who at other 
 times are perfectly regular. It is of the 
 utmost importance that it should be over- 
 come ; the waste material from the child 
 as well as from the mother has to be 
 thrown off during pregnancy ; moreover, 
 neglect in this particular leads to nausea 
 and vomiting, loss of appetite, headaches, 
 pains in the back and abdomen, and haem- 
 orrhoids or piles. In the last months of 
 pregnancy the presence of thick masses in 
 the intestines may assist in causing pre- 
 mature labor. Straining efforts are also 
 very harmful. 
 
 The patient should make an effort every 
 day at the same hour to obtain an evacua- 
 tion of the bowels. No matter whether it 
 is successful or unsuccessful, it should be 
 persisted in daily, and no attempt be made 
 at any other hour than the one chosen. A 
 habit may thus be established. Very little 
 seems to be known by the majority of 
 people about the laws governing the action 
 of the intestines. It is not a simple pro- 
 
48 CONSTIPATION. 
 
 cess, but one influenced by several agents. 
 The intestines are partially composed of 
 muscle, which, like all muscles, are con- 
 trolled by the action of the nerves. A 
 slow, continuous movement of these mus- 
 cles narrows the tube and pushes its con- 
 tents gradually onward through the twen- 
 ty-five feet of its length until it reaches 
 the rectum, whence it is expelled. This 
 motion, or peristalsis, as it is called, is in- 
 creased by some influences, diminished by 
 others. The presence of a fair-sized mass 
 of waste matter excites its activity, where- 
 fore it is easy to infer that a diet proper to 
 a regular action of the intestines must be 
 composed not only of nourishing food, but 
 of ^ood which contains considerable mate- 
 rial not needed in the system, which will 
 act mechanically upon the walls of the 
 bowels. The condition of the nervous 
 system is also important, a fact which few 
 people realize, and which may account for 
 some of the apparently miraculous cures of 
 constipation effected by methods of treat- 
 ment which, by placing the patient's mind 
 in a condition of passive acquiescence, 
 
CONSTIPATION. 49 
 
 faith, or enthusiasm, as the case may be, 
 bring the nerves into obedience to this 
 mental state, and often do good work in 
 relieving symptoms of diseases which are 
 directly under the control of the nervous 
 system. This influence is generally rec- 
 ognized in hysteria. But an ignorance 
 of physiology prevents a great number of 
 people from realizing that many forms of 
 constipation belong to the class of nervous 
 disorders. If they were not fonder of fol- 
 lowing vagaries than of listening to their 
 own physicians, they might give science 
 the credit for what they prefer to ascribe 
 to " science falsely so-called." A proof of 
 the action of the nerves upon the intes- 
 tinal tract is seen in the action of violent 
 emotions — grief, anxiet}^, suspense, worry 
 — in causing constipation or diarrhoea, an 
 experience common to every one. 
 
 Again, the flow of bile has a marked 
 effect upon peristalsis, and foods adapted 
 to stimulate its flow will sometimes have 
 to be taken. Glands in the small intestines 
 secrete fluid which aids in the healthy 
 action of the bowels. In diarrhoea these 
 
50 CONSTIPATION. 
 
 glands are so active that they afterward 
 are obliged to rest from their activity, 
 which accounts for the constipation that 
 usually follows looseness of the bowels. 
 Some medicines act directly upon these 
 glands and give watery stools, resulting 
 later in costiveness. 
 
 Exercise, by increasing the circulation 
 of the blood and by giving tone to the 
 muscles and also to the nerves, is a great 
 weapon in the warfare against this dis- 
 order. 
 
 It will be seen, by this very imperfect 
 outline of the forces controlling the ac- 
 tion of the bowels, that the remedies lie 
 close at hand. Diet is of the first impor- 
 tance, but here, as usual, individual pe- 
 culiarities come into play, and what will" 
 benefit one will not affect another. 
 
 Sweets, such as cakes, candies, and pies, 
 are constipating and should be avoided. 
 Meat and bread are very nutritious foods, 
 but do not contain enough waste material ; 
 to them should be added green vegetables, 
 oatmeal and other cereals, brown bread, 
 figs, stewed prunes, honey, and baked 
 
CONSTIPATION. 51 
 
 apples. Fruit acts like a charm upon 
 some, while in other cases it causes indi- 
 gestion with resulting constipation. An 
 apple, orange, or grape fruit before break- 
 fast has cured certain cases of costiveness. 
 Coffee and tea are as a rule constipating, 
 but some people depend upon their morn- 
 ing cup of cafe au-lait to bring about the 
 desired action of the bowels. Oftentimes 
 drinking a large amount of water at dif- 
 ferent times during the day will be of use ; 
 some people take a glass of cold or of hot 
 water upon arising, and another at night 
 just before retiring. Vichy or Apollinaris 
 may be preferred. Should diet prove of 
 no value in overcoming constipation, it is 
 very likely that the nervous system is at 
 fault. The directions given in a previous 
 chapter should be followed, and a quiet, 
 calm, healthy condition of the nerves cul- 
 tivated. The formation of the habit of 
 daily solicitation of the action of the 
 bowels, with concentration of the mind 
 upon the process, will probably act upon 
 the nervous system in time. Sometimes 
 the waste material daily accumulates in 
 
52 CONSTIPATION. 
 
 the rectum, but the patient has not ner- 
 vous force sufficient to expel it, or else the 
 mass of matter is so dry that it passes' 
 with difficulty. In these cases the inser- 
 tion in the rectum at night of a piece of 
 cocoa butter, as large as the first joint of 
 the little finger, will often be efficacious ; 
 or injections may have to be resorted to, 
 which may consist of two or three tea- 
 spoonfuls of olive oil in a little water, 
 of about a pint of hot water in which is 
 dissolved a teaspoonful of salt, or the 
 same amount of soap and water. These 
 dissolve the hardened masses. A small 
 amount of cold water acts upon the mus- 
 cles of the rectum, and is perhaps the best 
 form of injection to take, as it strength- 
 ens instead of enfeebling the parts. A 
 large amount of water should never be 
 used in an enema ; it distends the rectum 
 so enormously that the muscles are weak- 
 ened by the stretching and after a while 
 refuse to act. 
 
 Should the trouble lie further up in the 
 intestine and be unaffected by diet, exer- 
 cise, and injections, laxatives will have to 
 
DIARRHCEA. 53 
 
 be administered. Strong purgatives must 
 not be used in pregnancy, and very few 
 laxatives should be taken without consult- 
 ing the physician. Castor oil is too apt to 
 be followed by constipation to be useful; 
 Hunyadi water, magnesia, and seidlitz 
 powders are of benefit where the bowels 
 are to be cleared out with rapidity on some 
 one occasion; but they should not be de- 
 pended upon in habitual constipation, as 
 they act upon the glands that secrete fluid 
 and lead to their inactivity later. Licorice 
 powder is a good laxative. Rhubarb is 
 sometimes apt to cause griping. The pre- 
 parations of cascara sagrada are the best 
 to take, in spite of their unpleasant taste, 
 as they act by strengthening the muscles 
 of the intestines instead ' of weakening 
 them. A teaspoonful of the fluid extract 
 of cascara taken at night will usually be 
 sufficient to produce a natural movement; 
 more obstinate cases may take a second 
 teaspoonful in the morning. 
 
 Diarrhcea, the opposite condition, is 
 often a troublesome complication of preg- 
 nancy. It may be simply the result of 
 
54 SALIVA. 
 
 undigested food which is detained in the 
 bowels and causes irritation. The offending 
 matter should be removed by means of a 
 wineglassful of Hunyadi water, or a seid- 
 litz powder; should this not cause a cessa- 
 tion of the difficulty, the doctor must be 
 consulted. An injection of warm water 
 will often be of benefit, and in any case 
 will often relieve the burning sensation at 
 the lower part of the rectum caused by 
 acrid discharges. Only the simplest food 
 should be eaten, avoiding green vegetables, 
 fruit, and other opening articles of diet. 
 
 Saliva in increased amount is often 
 an annoying accompaniment of pregnancy. 
 It is not dangerous unless it become so 
 marked as to affect the appetite and diges- 
 tion, and so to weaken the system. It is 
 not possible to entirely cure this symptom, 
 but relief has sometimes been obtained by 
 chewing gum arabic, sugar candy, small 
 pieces of dried orange peel, holding pieces 
 of ice in the mouth, or rinsing the mouth 
 with a few drops of the tincture of myrrh 
 in a teaspoonful of water. Preparations 
 of iron taken as a tonic give some relief. 
 
INFLAMMATION OF THE GUMS. 55 
 
 Inflammation of the gums may oc- 
 cur. It is sometimes confined to slight 
 redness and swelling; in other cases the 
 trouble is far more serious, the gums bleed 
 profusely, are extremely tender, and shrink 
 away from the teeth, which become loose 
 in their sockets. A good dentist should 
 be at once consulted. One, well known 
 for his researches in the line of dental 
 medicine, says: "During pregnancy the 
 teeth should be well cared for, and on lines 
 abreast with the knowledge of the day as 
 to the causes of decay and loss of the teeth. 
 The old saying that ' each child costs a 
 tooth * has a grain of truth in it, but un- 
 fortunately the underlying facts in the 
 case are generally misapprehended. The 
 customary belief is that the substance of 
 the teeth of the expectant mother is ab- 
 sorbed, and in some mysterious manner 
 transposed to the organs of the developing 
 child; in other words, that the child's teeth 
 are nourished directly at the expense of the 
 mother's. This is all a mistake. There is 
 no such thing as a direct or indirect trans- 
 ference of substances from the teeth of 
 
56 CARE OF THE TEETH. 
 
 the mother to the child. The teeth of the 
 pregnant woman and the nursing mother 
 do suffer during these periods, but wholly 
 from other and more simple reasons. In 
 fact, the woman's condition is only to be 
 held accountable to the same extent as, 
 and no more than, any other invalid 
 state that would bring in its train bodily 
 weakness, mental and moral distress, ac- 
 companied by disturbed digestive func- 
 tions. Such a condition causes neglect of 
 the ordinary care and attention that the 
 teeth usually receive. Teeth once formed 
 and in their place become diseased and 
 troublesome from external influences only. 
 This fact should be constantly kept in 
 mind. The decay of the teeth always 
 starts on the outside, and is brought about 
 by the formation of an acid or acids from 
 the decomposition of particles of food in 
 the crevices of or between the teeth. The 
 direct agents at work are bacteria. It 
 may safely be stated as a rule that if the 
 mouth and teeth are kept clean and sweet, 
 the teeth will suffer no more at this period 
 than at any other in a woman's life." 
 
CARE OF THE TEETH. 57 
 
 Scarcely any one at the present day 
 needs to be told that bacteria are micro- 
 scopically small vegetable growths, of 
 many forms and diverse natures, some 
 harmless, others the cause of a variety of 
 diseases. They develop rapidly wherever 
 suitable ground is found, and this, for 
 some species, consists in dirt or decom- 
 posing animal or vegetable matter, accom- 
 panied by moisture and warmth. Un- 
 cleansed teeth most admirably fulfil these 
 conditions. It follows that cleanliness is 
 their foe. The teeth must be brushed 
 with a good tooth powder at least twice 
 a day, having a care to twist and turn 
 the brush in such a way that the bristles 
 will enter the spaces between the teeth. 
 An up-and-down motion is better than 
 a sideways movement, and the patient 
 need not be afraid of plying the brush 
 vigorously, even when the gums are ten- 
 der. At night the teeth should be scoured 
 with castile soap, or with the Melior tooth 
 soap sold for the purpose, in order to coun- 
 teract acid secretions from food. The 
 mouth should also be rinsed daily with an 
 
58 CARE OF THE TEETH. 
 
 antiseptic — a few drops of Listerine in a 
 spoonful of water, or the Dental Elixir of 
 Dr. Edward Kirk, which is a delightful 
 preparation. Salt and water is a good 
 substitute for those unable to afford the 
 luxury of the above-mentioned antiseptics. 
 If the patient is unable to attend to her 
 teeth, an attendant or nurse should do so. 
 Toothpicks and floss silk should be used to 
 dislodge particles of food, and about once 
 a week the tartar may be removed from 
 the teeth by taking a little stick of wood 
 (cedar if obtainable), thinned at the end, 
 and dipping it into a good tooth powder, 
 such as the Melior for instance, thoroughly 
 scraping the teeth outside, inside, and be- 
 tween, especially near the gums. 
 
 There is no need of offering up teeth 
 upon the altar of Maternity. 
 
CHAPTEK V. 
 
 ANEMIA — SWELLING OF LOWER EX- 
 TREMITIES—VARICOSE VEINS — PILES 
 — PALPITATION — FAINTING — DIF- 
 FICULTY IN BREATHING. 
 
 The circulation of the blood during 
 pregnancy is more active than at other 
 times, the pulse being increased in fre- 
 quency and in fulness. The amount of 
 water in the blood is increased, the red 
 blood globules decreased ; there is less al- 
 bumen and less iron than usual. This is 
 not a diseased condition, but if at all ex- 
 aggerated may easily become so, and even 
 when not exaggerated is apt to cause cer- 
 tain unpleasant symptoms, such as dizzi- 
 ness, ringing in the ears, dimness of sight, 
 flushing of the face, etc. 
 
 Anjemia, or poverty of the blood, shown 
 by pallor of the face, of the gums, and of 
 the mucous membrane under the eyelids, 
 causes general weakness, loss of appetite, 
 
60 SWELLING OF FEET AND LEGS. 
 
 pains of a neuralgic nature, dizziness, 
 fainting, disturbances of digestion. The 
 patient should be more than usually care- 
 ful to follow the laws of health ; to live in 
 the light and air and sunshine ; to walk 
 daily as far as her strength will permit; to 
 eat simple and nourishing food ; to keep 
 the bowels open, secure uninterrupted sleep 
 at night, and to rest frequently during the 
 day; to keep the mind as cheerful as possi- 
 ble by congenial society, harmless amuse- 
 ments, and the reading of entertaining 
 books. Should medicine be needed, and 
 the physician not obtainable, one of Blaud's 
 five-grain iron pills may be taken three 
 times a day after meals. 
 
 Swelling of the feet and legs, 
 and even of the vulva, often becomes 
 troublesome, especially toward the last 
 months of pregnancy. When this is not 
 due to a diseased state of the kidneys (a 
 fact which the physician ascertains by ex- 
 amination of the urine), this symptom need 
 not cause alarm unless the swelling be ex- 
 treme. The treatment for mild cases con- 
 sists in lying down or keeping the feet 
 
VARICOSE VEINS. 61 
 
 elevated as often as possible, and in apply- 
 ing hot wet cloths when the swollen part 
 becomes painful from distention. Reme- 
 dies to increase the flow of urine and thus 
 remove fluids from the body will be given, 
 if necessary, by the physician, and tonics 
 administered. 
 
 Varicose veins, or dilated veins, some- 
 times cause discomfort and pain, but are 
 less apt to occur in a first pregnancy than 
 when a mother has already borne several 
 children. Women who stand much upon 
 their feet are more subject to them than 
 others. In the legs they cause a feeling 
 of heaviness, fatigue in walking, and a 
 dull ache which disappears in the horizon- 
 tal position. When the trouble is seated 
 in the deep veins and severe in its nature, 
 the legs become feeble and trembling, al- 
 most unable to support the weight of the 
 body. Rupture of these large veins is 
 rare, and when it occurs is usually due to 
 a fall, a blow, or to scratching. Should 
 this accident occur, the leg must be ele- 
 vated and a finger pressed firmly upon 
 the bleeding point until medical aid can 
 
62 VARICOSE VEINS. 
 
 be summoned. This is very important ; 
 the loss of blood, if excessive, may cause 
 fainting, or even death. 
 
 For the relief of the discomfort caused 
 by varicose veins the patient should, as 
 
 Fig. 2. 
 
 in the case of swollen extremities, lie 
 down as much and as often as possible, or 
 keep the feet elevated. Although mode- 
 rate exercise is beneficial, let her avoid 
 long walks, standing, or fatiguing efforts. 
 
VARICOSE VEINS. 63 
 
 Garters greatly aggravate the trouble, as 
 do tight corsets and bands about the waist. 
 Abdominal belts, if well made and well 
 fitting, afford relief by removing pres- 
 sure on the veins. They may be obtained 
 of a reliable instrument-maker in any city. 
 
 Fig. 3. 
 
 Cloths wrung out in hot water, wrapped 
 about the leg and frequently renewed, 
 often give relief, and a properly applied 
 bandage is of the utmost benefit. A piece 
 of soft unbleached muslin is cut into strips 
 two and a half inches wide and sewed to- 
 gether at the ends. Beginning at the foot, 
 
64 VARICOSE VEINS. 
 
 several turns are made around it to give a 
 strong support ; then the bandage is wound 
 firmly around the ankle and up the leg, 
 letting each twist overlap the other about 
 an inch. When the calf is reached and 
 the bandage begins to bulge, it should be 
 reversed by sharply folding it over upon 
 itself, and then continued around as be- 
 fore. A little practice will soon make this 
 easy. If this description is not under- 
 stood, a stitch may be taken wherever the 
 bandage bulges, to make it lie smoothly. 
 It should be firm enough to give support, 
 but should not press uncomfortably at any 
 point nor give a general sensation of 
 tightness. It should be removed at night. 
 Some prefer a rubber bandage. Elastic 
 stockings of silk or thread can be ordered 
 at a reliable drug store or of instrument- 
 makers. It is always best to have them 
 made to order and fitted to the leg, but 
 they can, if necessary, be ordered through 
 the mail, carefully following directions for 
 measurement which are furnished upon 
 application. 
 Varicose veins of the genital region 
 
HEMORRHOIDS. 65 
 
 often cause intense itching, but must not 
 be scratched for fear of rupture. The 
 patient should lie down a great part of the 
 time, and, if there be a sensation of heavi- 
 ness and stretching of the skin, she can 
 apply a pad of cotton batting, wrapped in a 
 linen napkin which keeps it in place. Hot 
 wet cloths may be applied to give relief. 
 
 Hemorrhoids, or Piles, are really 
 varicose veins about the rectum, and may 
 be internal or external. They are often 
 caused by constipation, which allows of 
 an accumulation in the rectum of hard 
 matter which presses upon the blood ves- 
 sels, interferes with the circulation of the 
 blood, and consequently causes a dilata- 
 tion of the blood vessels. Straining at 
 stool further increases the pressure and 
 the difficulty. They may also be caused 
 by the pressure of the enlarged uterus 
 upon the blood vessels. Sometimes the 
 trouble is so slight as to cause very little 
 inconvenience, merely giving a sensation 
 of discomfort when sitting or standing, 
 and disappearing within a few days. In 
 other cases the pain is intense and the dis- 
 
66 HEMORRHOIDS. 
 
 comfort almost unbearable ; the patient 
 can neither sit, stand, nor walk without 
 pain ; the piles, if external, swell and be- 
 come tense and hard, tender and painful 
 to the touch ; if internal they may bleed 
 or swell, and protrude from the opening, 
 giving a sensation of weight impossible to 
 describe, and a constant desire to empty 
 the bowels. Hard matters passing these 
 tumors irritate and wound them, some- 
 times leaving a raw and ulcerated surface. 
 The pain at stool is agonizing, and a burn- 
 ing sensation often persists during a great 
 part of the day. 
 
 When the haemorrhoids are very severe 
 the physician must be consulted. 
 
 Constipation must be overcome, and 
 a free movement of the bowels obtained 
 every twenty-four hours. Powdered sul- 
 phur, compound licorice powder, mag- 
 nesia, a wineglassful of Hunyadi water, 
 will give soft stools. An injection of 
 warm water in which are a few teaspoon- 
 f uls of sweet oil may produce the neces- 
 sary action. The diet should be simple 
 and consist largely of green vegetables 
 
PALPITATION OF THE HEART. 67 
 
 and fruit. Alcohol is to be avoided, and 
 tea and coffee very sparingly taken. If 
 the piles protrude from the rectum they 
 must be pushed back in place, using a 
 small sponge or a soft rag wet with cold 
 water. 
 
 For relief of the pain, injections of a 
 small quantity of cold water (half a pint) 
 are sometimes of benefit. Small bits of 
 cocoa butter or lard introduced into the 
 rectum have a soothing effect upon inter- 
 nal piles. Hot wet cloths, upon which 
 has been sprinkled a little laudanum, may 
 be laid on the parts when the pain is ex- 
 treme, but frequent local baths of cold 
 water, and injections of cold water in suf- 
 ficiently small quantity to be retained, are 
 better as treatment of the condition. 
 
 Many women are troubled with palpi- 
 tation of the heart. This may be 
 due to anaemia, to nervousness, to indiges- 
 tion, or to pressure of the enlarged uterus 
 upon the blood vessels, interfering with 
 the circulation and thus with the action 
 of the heart. It may come on after eat- 
 ing, or at night, or be caused by violent 
 
68 FAINTING ATTACKS. 
 
 emotion. The best treatment is quiet, rest, 
 and strict attention to diet, which should 
 be nourishing and non-stimulating. If it 
 come on when the patient lies down, let 
 her be propped up with pillows and sleep 
 in that position. Ten drops of the spirits 
 of camphor or half a teaspoonful of the 
 compound tincture of lavender in a table- 
 spoonful of water sometimes calm the 
 nerves. Very severe and frequently re- 
 peated palpitations must be treated by the 
 doctor. 
 
 Fainting attacks sometimes occur 
 and need not occasion alarm. They may 
 follow a sudden change of position, be 
 caused by excitement or emotion, or come 
 on during a meal or while digestion is 
 going on. The loss of consciousness may 
 be complete or may be only partial. The 
 woman should be laid flat on the floor or 
 couch, without a pillow under her head, 
 her clothes loosened, and plenty of fresh 
 air should be admitted. Smelling salts 
 may be applied to the nose, ten drops of 
 the spirits of camphor in a tablespoonf ul of 
 water may be put in the mouth, or half a 
 
DIFFICULTY IN BREATHING. 69 
 
 teaspoonful of the aromatic spirits of am- 
 monia in the same amount of water. If 
 that do not restore her to consciousness 
 the hands and feet may be rubbed, and 
 mustard leaves applied to the soles of the 
 feet. A person subject to attacks of faint- 
 ness must avoid crowded assemblies or 
 overheated rooms, eat plentifully of sim- 
 ple, nourishing food, secure free move- 
 ments of the bowels every day, and live 
 in the fresh air as much as possible. 
 
 Difficulty in breathing is frequent- 
 ly experienced during the latter months of 
 pregnancy, and while it may be due to the 
 fact that the enlarged uterus presses the 
 other organs against the diaphragm, and 
 this upon the lungs, it is often purely a 
 nervous symptom, and is frequently ac- 
 companied by a nervous cough. Very 
 little can be done in the way of relief, 
 except to see that the clothing is loose 
 and to assume whatever bodily position 
 is found to give the most ease. 
 
OHAPTEE VI. 
 
 DISORDERS OF THE BLADDER AND KID- 
 NEYS — CONVULSIONS— ITCHING OF 
 VULVA — LEUCORRHCEA — 
 VEGETATIONS. 
 
 The bladder being situated directly in 
 front of the lower part of the uterus, it is 
 easy to understand that as the latter or- 
 gan enlarges it may by pressure cause a 
 variety of disturbances in the former. 
 There is often a desire to void the urine, 
 occurring so frequently as to be a source 
 of great annoyance to the patient. The 
 amount of urine is not increased, but the 
 pressure of the uterus upon the neck of 
 the bladder causes an irritation which is 
 manifested by straining movements that 
 occur as often as every hour and result in 
 the discharge of only a few drops of fluid. 
 At a later stage there may be incontinence 
 of urine — that is to say, an inability to 
 retain it — coughing, sneezing, laughing, 
 
DISORDERS OF THE BLADDER. 71 
 
 walking, or a sudden movement causing a 
 small amount to be quite involuntarily 
 expelled. These disorders are difficult to 
 cure ; often the only remedy is the birth 
 of the child, and that must be awaited 
 with what patience can be commanded. 
 Some relief may be obtained by lying 
 down with a pillow or two under the body 
 to lift the pelvis and thus relieve pressure. 
 The vulva must be washed frequently and 
 thoroughly with hot water, as the urine 
 has an irritating effect upon the skin, and 
 talc powder or a good toilet powder may 
 be dusted over the surface. 
 
 The opposite condition of difficulty in 
 passing water, amounting sometimes to 
 absolute retention of urine, may be 
 caused by direct pressure of the enlarged 
 uterus, may depend upon nervous influ- 
 ence, or may in the later months be due to 
 the position of the .child's head as it sinks 
 into the pelvis. It will not do to let this 
 condition remain without treatment. If 
 urine has not been passed for twelve hours, 
 active measures must be taken. The pa- 
 tient may try the effect of immersion in a 
 
72 DISORDERS OF THE KIDNEYS. 
 
 very hot full bath or in a sitz bath for ten 
 or fifteen minutes. Should this not suc- 
 ceed, the doctor or nurse must introduce 
 the catheter and relieve the bladder; this is 
 a very simple matter, giving no pain what 
 ever. Retention of urine, if neglected, 
 may lead to inflammation of the bladder, 
 to distention, and even to rupture. 
 
 Allusion has already been made to the 
 necessity for having the urine examined by 
 the physician. As early as the sixth month 
 specimens should be sent, in a perfectly 
 clean bottle, as often as once a fortnight ; 
 in the last two months it should be sent 
 every week. The importance of doing this 
 cannot be overrated. Before collecting 
 the urine the patient should take a vagi- 
 nal douche and wash the vulva, otherwise 
 discharges from the vagina are apt to 
 complicate the examination. 
 
 The kidneys are especially liable to be- 
 come diseased during pregnancy, and, if 
 the condition is recognized in time, much 
 may be done to improve it. Some of the 
 symptoms are : swelling of the ankles and 
 legs, hands and arms and face, with a puffy 
 
DISORDERS OF THE KIDNEYS. 73 
 
 look beneath the eyes and a dry skin; 
 headaches, dizziness, ringing in the ears, 
 dimness of sight, neuralgias, constipation 
 alternating with diarrhoea, nausea and 
 vomiting of an obstinate type. A patient 
 who has some of these symptoms should 
 not therefore jump to the conclusion that 
 her kidneys are diseased ; as we have seen, 
 swelling may come from a poor condition 
 of the blood or too little of it, and disturb 
 ances of the circulation, while disorders of 
 the digestive tract, pain, etc., may be due 
 to various causes. She should, however, 
 be put sufficiently upon her guard to take 
 proper precautions, and to consult her 
 physician, who will indicate a course of 
 treatment. She can co-operate with him 
 by, in the first place, avoiding any chilling 
 of the body. It is well known that the 
 kidneys and the skin, as well as the lungs 
 and bowels, do their part in ridding the 
 body of substances which it does not need. 
 The amount of what is called insensible 
 perspiration (that which passes off into the 
 air as vapor and is not condensed in drops 
 upon the surface of the body) is about two 
 
74 DISORDERS OF THE KIDNEYS. 
 
 pounds daily. Any one who has worn a 
 rubber cloak for several hours at a time 
 must often have had occasion to notice 
 this perspiration condensed upon its inner 
 surface because it cannot pass through it. 
 Now, in cold weather, and under the in- 
 fluence of sudden chilling of the body, the 
 blood vessels of the skin contract and less 
 moisture is given off, which naturally 
 throws more work upon the kidneys. 
 Congestion of the blood also occurs in 
 the internal organs under the influence of 
 cold, in which the kidneys share ; if they 
 are already weakened by disease it can 
 readily be understood that any extra effort 
 on their part will tend to further injure 
 them. The chief thing, then, is to keep 
 the skin in a healthy condition, in order 
 that it may do its own share, and even 
 a little more than its share, in ridding 
 the body of waste matters. Warm daily 
 baths, with vigorous rubbing of the skin as 
 soon as the patient leaves the bath ; mas- 
 sage to stimulate the circulation and by 
 that means increase the perspiration; exer- 
 cise for the same purpose; warm flannels 
 
DISORDERS OF THE KIDNEYS. 75 
 
 all over the body to keep it warm and by 
 their slightly irritating action to keep the 
 skin in good condition; daily friction of the 
 body with a brush or a coarse towel, are 
 some of the means to be employed. A 
 prolonged stay in hot water should not be 
 resorted to, unless the physician advises it. 
 Diet is of great importance in impending 
 disease of the kidneys. In severe cases 
 nothing but milk should be taken. If the 
 patient object to milk it can be rendered 
 more digestible by mixing it with Vichy. 
 Apollinaris, or a little lime water ; and 
 more palatable by heating, by the addition 
 of a tablespoonful of coffee or even a tea- 
 spoonful of rum, brandy, or whiskey. 
 Rinsing the mouth with Listerine and 
 water, peppermint water, or a few drops 
 of the tincture of myrrh in water, will do 
 much to relieve the unpleasant pasty feel- 
 ing which some persons experience after 
 drinking milk. Rennet pudding and other 
 predigested milks make an agreeable 
 change, as do matzoon and koumyss. 
 
 Alcohol, except in medicinal quantity, is 
 to be avoided in kidney disease, tea and 
 
76 DISORDERS OF THE KIDNEYS. 
 
 coffee sparingly used, sweets and pastries 
 to be entirely renounced, as little meat as 
 possible to be eaten, the main reliance 
 being placed upon milk and vegetables. 
 Vichy water, Granular Lithia, Buffalo 
 Lithia, Poland water, and seltzer may be 
 taken in large amounts. 
 
 Convulsions as a result of kidney dis- 
 ease are fortunately of rare occurrence ; 
 yet -it is desirable to know the symptoms 
 of their approach, since, if they are immi- 
 nent, medical aid should be at once sum- 
 moned. They are usually ushered in by 
 restlessness and uneasiness, headache, 
 dizziness, nausea and vomiting, flashes of 
 light before the eyes, seeing things double, 
 dimness or loss of sight, and twitchings of 
 the muscles, especially those of the face. 
 The twitchings increase in violence and 
 are united to convulsive movements of the 
 arms and lower extremities. 
 
 The patient should be laid upon a "bed 
 or lounge and her clothing loosened. An 
 abundance of fresh air should be admitted 
 to the room. Part of a folded towel, nap- 
 kin, or handkerchief placed between the 
 
ITCHING OF GENITALS. 77 
 
 teeth will prevent biting of the tongue. 
 The feet are to be kept warm, and no 
 stimulants are to be administered. 
 
 One of the most annoying of the minor 
 ills of pregnancy is itching of the geni- 
 tal kegion, which at times becomes abso- 
 lutely intolerable. It may be due to irritat- 
 ing urine, to a discharge from the vagina, 
 to eczema, or it may be of purely nervous 
 origin. Should simple measures fail to 
 relieve it, the patient should not hesitate 
 to have the parts examined, so that the 
 cause of the trouble may be ascertained 
 and treatment addressed to that cause. 
 
 The following are some of the methods 
 which may be employed to alleviate the 
 discomfort : washing the parts several 
 times a day in water as hot as can be 
 borne, carefully drying with a soft cloth; 
 sitting in lukewarm salt and water for a 
 few seconds ; placing upon the parts a 
 compress of linen or fine cotton soaked in 
 borax water, in lead water, or in oil of 
 sweet almonds, retained in position by a 
 napkin. One authority recommends wash- 
 ing the parts with warm water and drying 
 
78 ITCHING OF GENITALS. 
 
 them with linen, then saturating a small 
 sponge in a lotion composed of 
 
 Bichloride of mercury grains 31 
 
 Alcohol fluidrachms 3 
 
 Rose water fluidounces 1| 
 
 Distilled water fluidounces 15 
 
 and passing it rapidly over the itching- 
 surface, so as to thoroughly moisten it. 
 The first sensation is that of burning, but 
 this may be relieved by washing with cold 
 water, and subsequent applications become 
 less and less painful. The bottle contain- 
 ing the lotion should be marked: " Poison. 
 For external use only." 
 
 Another writer recommends the follow- 
 ing ointment: 
 
 Camphor drachm 1 
 
 Chloral hydrate drachm 1 
 
 Ointment of rose water. ounce 1 
 
 The two first-mentioned substances are to 
 be rubbed up together, and the ointment of 
 rose water added. 
 
 The following lotion applied three times 
 a day, after washing with water as hot as 
 can be borne, is highly recommended: 
 
ITCHING OF GENITALS. 79 
 
 Carbolic acid , drachm 1 
 
 Chloral hydrate grains 40 
 
 Spirits of camphor. drachms 2 
 
 Glycerin drachms 4 
 
 Water sufficient to make ounces 4 
 
 When eczema is the cause of the irrita- 
 tion, lead lotion (which can be obtained at 
 any druggist's) or the lead and opium wash 
 may be applied, the parts dried, and then 
 powdered lycopodium, talc powder, or any 
 good toilet powder dusted on the surface. 
 The rjarts should always be washed imme- 
 diately after passing urine, and must never 
 be scratched or irritated. Perfect clean- 
 liness, rest in the recumbent position, and 
 an unstimulating diet will often be suffi- 
 cient to relieve the distress. The avoid- 
 ance of coffee alone will sometimes cure 
 the trouble; tea and wine are to be es- 
 chewed; milk, cocoa, and the mineral 
 waters may be substituted. Soups and 
 broths, beef, mutton, poultry, vegetables, 
 bread and butter, eggs, oatmeal, hominy, 
 and other cereals, fruit in moderate amount, 
 may be taken ; but fried articles of food, 
 pork, ham, and bacon, veal, salt fish, pas- 
 
80 LEUCORRHOEA. 
 
 try, sweets, rich cake and puddings, must 
 be avoided. Fresh fish and shell fish cause 
 an irritating eruption in some cases; if 
 there be no idiosyncrasy of this kind they 
 may be eaten. 
 
 Leucorrhcea, a white or yellowish- 
 green discharge from the vagina, is not 
 infrequent in pregnancy. This alone is 
 often the cause of the burning and itching 
 just described. Vaginal douches may be 
 taken for its relief, bearing in mind the 
 precautions recommended in a previous 
 chapter. To each quart of water used 
 should be added a tablespoonful of pow- 
 dered borax, or a teaspoonful of powdered 
 alum, or one of zinc sulphate or of carbolic 
 acid. The douche should be taken morn- 
 ing and evening, and the vulva washed 
 several times during the day. 
 
 Small wart-like growths sometimes 
 appear at the entrance of the vagina, pink- 
 ish in hue, and accompanied by pain, itch- 
 ing, and a disagreeable odor. They need 
 not cause alarm, for they are not danger- 
 ous, but it will be very difficult to get rid 
 of them. They may be bathed two or 
 
WART-LIKE GROWTHS. 81 
 
 three times a day with tannic acid and 
 water, using enough of the tannin to make 
 a syrupy mixture, after which the parts 
 should be kept separated by means of ab- 
 sorbent cotton or pieces of linen. Should 
 these vegetations grow with great rapidity 
 and become very troublesome, a physician 
 must be consulted. 
 
OHAPTEB TIL 
 
 DISORDERS OF THE NERVOUS SYSTEM- 
 MENTAL ATTITUDE OF THE EXPECT- 
 ANT MOTHER— SLEEPLESSNESS- 
 NEURALGIA 
 
 To those who have studied the delicate 
 adjustment of the nervous system, and 
 who know how its thousands of tiny 
 branches extend to every portion of the 
 human frame and how intimately these 
 branches are connected with each other, 
 it is matter for small wonder that so great 
 a change as pregnancy should cause sym- 
 pathetic disturbances in remote parts of 
 the body, and even affect the mental at- 
 titude of the patient. As one writer well 
 expresses it : " Pregnancy tries the en- 
 durance and pose, as it were, of the mind 
 — its capacity to face privation, discom- 
 fort, danger, and, in the case of the 
 primiparous woman " (one who is bearing 
 her first child), "unknown and exag- 
 
 
DISORDERS OF THE NERVOUS SYSTEM. 83 
 
 gerated horrors. In no walk of life 
 where great cares of business or of state 
 have at least their compensation, in no 
 scene of action or danger where applause 
 and heroism have their stimulation and 
 reward, can there be found a more dismal 
 and alarming conflict than that which in 
 her imagination presents itself to the 
 youthful, delicate, and untried woman 
 when, alone and to a great extent un- 
 aided, she first faces the inevitable hour. 
 With the rumors and traditions which her 
 curiosity has gathered in since first she 
 learned the secret of generation, she en- 
 dures the anxious suspense of many 
 weary months of waiting, while during 
 this period she often suffers much phy- 
 sical discomfort and sometimes serious 
 nutritional change. That this should 
 affect her imagination, depress her spirits 
 to the verge of melancholy, and even 
 sometimes jeopardize her reason, will not 
 be wondered at, I think, by those who 
 engage extensively in obstetric practice." 
 Loving relatives and friends are often 
 grieved by the apparent change in the 
 
84- mother's mental attitude. 
 
 disposition of the young wife ; irritability, 
 morbid views of life, attacks of the 
 "blues," fretfulness, an unreasonable 
 state of mind, obstinacy, fads and fancies 
 .for eccentric and unusual habits and 
 ways and for strange articles of diet, ap- 
 pear in persons who have hitherto been of 
 a uniformly cheerful and evenly balanced 
 temperament. These symptoms need not 
 cause alarm ; without undue humoring, 
 they can be largely checked by gentleness 
 and patience, and they often disappear 
 during the course of pregnancy, and, at 
 latest, after the birth of the child. Let 
 the young mother herself, as we have al- 
 ready suggested, summon all her powers 
 of will and intelligence to combat these 
 tendencies to unnatural and unamiable 
 frames of mind, and she may in great 
 measure avert the danger of fixing upon 
 herself habits which may last a lifetime. 
 Let her cultivate hopefulness, remember- 
 ing that each one of the 1,400,000,000 
 inhabitants of the globe has been born 
 in the same way. Let her realize that 
 the marvellous advances of modern sci- 
 
mother's mental attitude. 85 
 
 ence have done wonders in lessening the 
 dangers of childbirth ; that the greater 
 knowledge of possible complications en- 
 ables the physician to remedy many causes 
 of danger in pregnancy or early in labor ; 
 that by careful examination of the urine 
 another class of dangers may be averted ; 
 that the skilled use of instruments not 
 only shortens difficult labors, but permits 
 of births which in the old days could not 
 have occurred at all, but would have re- 
 sulted in the death of child or mother, 
 or both ; that the introduction of chlo- 
 roform and ether has gone far to lessen 
 the pain of labor ; and that the use of 
 " antiseptics " has well-nigh abolished the 
 much- dreaded childbed fever. Let her 
 fix her mind upon the compensations, the 
 joys of maternity, her proud position as a 
 link in the chain of the past and the fu- 
 ture. If she have not very strong mater- 
 nal instincts, she need not be overmuch 
 troubled by their absence, since they will 
 usually be created by her child's need 
 for her care ; but let her foster them by 
 cultivating the acquaintance of sweet 
 
86 SLEEPLESSNESS. 
 
 and well-bred children, and by the reading 
 of well- chosen books bearing upon the 
 subject. 
 
 Let her prepare for motherhood as she 
 would for a degree in letters, arts, or sci- 
 ence, and she will find that her mental and 
 moral disturbances will be greatly benefited 
 thereby. 
 
 Certain nervous disorders of a physical 
 nature often cause great distress. We re- 
 fer to insomnia, and to neuralgia in its 
 various forms. 
 
 Sleeplessness may become very dis- 
 tressing toward the latter months of preg- 
 nancy, and should be combated, as the 
 pregnant woman requires more rather than 
 less sleep than other women, and should 
 endeavor to have surplus strength to meet 
 the demands of labor. Let her in the 
 early months form the habit of going to 
 bed at a regular and early hour; let her 
 avoid excitement of any kind in the eve- 
 ning, and endeavor to have the mind in as 
 tranquil a condition as possible upon retir- 
 ing. If she finds that eating a late dinner 
 interferes with her sleep, let her take a 
 
SLEEPLESSNESS. 87 
 
 light meal in the evening. Coffee, tea, 
 and wine are to be avoided. On the other 
 hand, it may be of use to take a glass of 
 hot milk, a bit of toast, a biscuit, or some 
 other easily digested article just before 
 going to bed. A warm bath in the evening 
 will frequentl} 7 " induce sleep. The room 
 should be well aired before she attempts 
 to sleep, and well ventilated during the 
 night; upon lying down the patient should 
 try to relax both mind and body. We are 
 aware that it is far easier to give this ad- 
 vice than to follow it; nevertheless some- 
 thing may be accomplished by persistent 
 effort in the line indicated. The French 
 are very fond of sipping sugared water in 
 which are a few drops of orange -flower 
 water, and claim that it conduces to sleep. 
 It is harmless. If the sleeplessness cannot 
 be overcome, the physician may be con- 
 sulted in reference to some quieting medi- 
 cine; but without professional advice the 
 patient should on no account resort to 
 drugs, no matter how highly recommended 
 by a friend nor howsoever lauded by ad- 
 vertisements. A dependence upon drugs 
 
88 TOOTHACHE. 
 
 may be thus initiated, and lead to the 
 formation of a habit which will wreck the 
 future well-being and happiness of the pa- 
 tient and all who care for her. It is im- 
 possible to be too emphatic upon this point. 
 Toothache, or dental neuralgia, often 
 occurs during the first half of pregnancy. 
 A dentist should be consulted to ascertain 
 whether the teeth are in sound condition; 
 if not, he will treat them appropriately. 
 It is extremely foolish to have a tooth 
 extracted simply because it aches; modern 
 dentistry endeavors to preserve the teeth, 
 even when they are diseased. If a dentist 
 is not easily accessible, and the pain be 
 known to be caused by a decayed tooth, 
 various means may be tried for its allevia- 
 tion. A hot- water bag may be pressed to 
 the cheek, or a bag of hot hops or hot salt; 
 a piece of cotton soaked in paregoric and 
 laid on the gum against the aching tooth, 
 or soaked in camphor and used the same 
 way (the camphor will probably blister 
 the gum, but, if the toothache be severe, 
 the patient will scarcely mind that) ; or a 
 bit of cotton soaked in the oil of cloves, 
 
NEURALGIA. 89 
 
 which may also be pushed gently into 
 any cavity which may exist in the tooth. 
 Sometimes relief is obtained by laying on 
 a bit of cotton soaked in ether, or by equal 
 parts of oil of cloves and chloroform used in 
 the same way, or chloroform in which ten 
 grains of alum (to the half- ounce of chlo- 
 roform) have been dissolved. It is also 
 claimed that cotton steeped in chloroform 
 and placed in the ear of the affected side 
 will often give relief when other remedies 
 have failed. 
 
 ^ Dry alcoholic ext. opium, 
 
 Camphor aa grains 7£ 
 
 Balsam Peru, 
 
 Mastic, grains 15 
 
 Chloroform aa drachms 2£ 
 
 introduced into the cavity is said to stop 
 the pain instantly. 
 
 The pain of neuralgia often closely 
 resembles that of toothache from a de- 
 cayed tooth, owing to the fact that the 
 nerves which go to the teeth are themselves 
 affected and that the pain is conveyed 
 along their course. It is not always pos- 
 sible to relieve the pain, which, however, 
 
90 NEURALGIA. 
 
 often disappears of itself. Good effects 
 are frequently observed from clearing out 
 the bowels by a dose of castor oil, cascara, 
 Hunyadr water, or some other laxative. 
 This may be followed by a tonic treat- 
 ment — cod-liver oil or Blaud's iron pills, 
 for example. Neuralgia of the teeth and 
 face is sometimes relieved by rubbing the 
 cheek or part affected with a mixture of 
 equal parts of camphor and chloral hy- 
 drate with double the amount of vaseline. 
 A menthol pencil rubbed gently over the 
 seat of pain has been known to help the 
 condition. Or the following liniment may 
 be used: 
 
 Tincture of aconite root drachms 2 
 
 Tincture of belladonna drachms 2 
 
 Chloroform drachms 4 
 
 Soap liniment ounce 1 
 
 The suffering woman should avoid 
 draughts and keep herself quite warm, 
 applying hot flannels, hops, or a hot- 
 water bag to the face, if relief be obtained 
 thereby. In the way of internal medica- 
 tion very little can be done, although some 
 patients have derived benefit from the use 
 
PAIN IN LOWER PART OF BACK. 91 
 
 of fifteen grains of the salicylate of soda 
 taken three times a day in water, after 
 meals. It is unfortunate that very few 
 remedies can be said to be efficacious, since 
 scarcely anything causes more suffering 
 to the patient than neuralgia. 
 
 Pains in the abdomen due to neural- 
 gia are frequently observed during the 
 later months of pregnancy. The treat- 
 ment is the same as for the facial neural- 
 gia. Very small blisters may be applied 
 over the most painful spots — as, for in- 
 stance, a piece of mustard leaf the size of 
 a silver quarter of a dollar. 
 
 Pain in the lower part of the back, 
 in the pelvis, and cramps in the thighs and 
 legs caused by pressure of the enlarged 
 uterus upon the nerves which supply the 
 lower extremities, often disturb the patient 
 during the later months. The cramps 
 come on at night as a usual thing, waking 
 the patient from sleep. Rapid friction 
 and deep kneading of the muscles of the 
 leg are the best remedies, or walking 
 briskly around the room, or quickly ex- 
 tending and then bending the leg several 
 
92 PAIN IN LOWER PART OF BACK 
 
 times in succession. For the relief of the 
 pelvic pains and those of the back there is 
 very little to be done; nevertheless it is 
 worth while to try the effect of a support- 
 ing bandage for the abdomen, especially 
 if the latter be very large and have a ten- 
 dency to become pendulous. The band- 
 age may be made of a piece of thick un- 
 bleached muslin, about a foot wide, shaped 
 to the abdomen in front and snugly laced 
 or pinned in the back. Or an abdominal 
 supporter can be purchased of the instru- 
 ment-maker. It is also of benefit to as- 
 sume for ten or fifteen minutes at a time, 
 night and morning, the knee-chest posi- 
 tion. The patient kneels on the bed and 
 rests her chest on a low pillow or on the 
 ?bed itself. This is efficacious by removing 
 pressure for the time being. 
 
OHAPTEE Till. 
 
 DISEASES OF THE SKIN — MASK OF 
 PREGNANCY— PRURITUS. 
 
 The skin is sometimes affected m vari- 
 ous ways under the influence of preg- 
 nancy, one of the most curious and annoy- 
 ing modifications being the appearance of 
 yellowish spots on the face, known as the 
 mask of pregnancy. That the light has 
 something to do with their causation is 
 shown by the fact that they never extend 
 beyond the roots of the hair, and that when 
 the hair is worn over the forehead the part 
 covered by it is free from the spots. They 
 do not itch, and they are not raised above 
 the surface of the skin. As they usually 
 disappear after confinement, it is not nec- 
 essary to treat them, the more especially as 
 treatment is, as a rule, absolutely unpro- 
 ductive of result. 
 
 On the other hand, some chronic cases 
 of skin disorders are completely cured or 
 
94: PRURITUS. 
 
 greatly modified by pregnancy and by lac- 
 tation. 
 
 Pruritus, or itching, of the whole 
 surface of the body is oftentimes a verita- 
 ble torment to the pregnant woman, in a 
 few rare cases even leading to miscarriage. 
 A strict diet should be observed, such as 
 was recommended in pruritus of the geni- 
 tal region; the bowels must be kept freely 
 open. Alkaline baths may be taken : five 
 ounces of the carbonate of potash, or six 
 ounces of borax or of cooking soda, or six 
 ounces of powdered alum to a bathtub full 
 of water, may be used. The woman may 
 remain immersed in it for a few minutes, 
 and after drying rub into the skin a lotion 
 composed of three or four tablespoonf uls 
 of the following prescription in a glass of 
 warm water: 
 
 Carbolic acid drachms 1 J 
 
 Glycerin ounce I 
 
 Water ounces 3 
 
 Essence of thyme in sufficient quantity to 
 
 impart an agreeable odor; this may be 
 
 omitted. 
 
 Cloths soaked in very hot water and 
 
PRURITUS. 95 
 
 applied to the body sometimes afford relief. 
 Menthol has been of use in some cases, in 
 the proportion of ten grains to the ounce 
 of vaseline or of sweet oil. A dusting 
 powder which will occasionally give com- 
 fort is composed of 
 
 Powdered camphor drachm 1 
 
 Bismuth subnitrate ounce 1 
 
 Starch ounce 1 
 
 Olive oil, cocoa butter, almond oil, or 
 cocoanut oil may be rubbed into the skin, 
 and bismuth or the a^bove-mentioned pow- 
 der dusted over the body after their use. 
 A good way to apply the powder is to put 
 it into a little bag of fine cheese cloth, or 
 several thicknesses of the coarser cheese 
 cloth, and with this bag gently beat the 
 surface of the body. An eminent physi- 
 cian recommends this ointment : 
 
 Naphthol grains 20 
 
 Extract of belladonna grains 30 
 
 Lard ounce 1 
 
 or a half -ounce each of borax and pow- 
 dered alum in a quart of hot water. The 
 patient must persist in trying the various 
 
96 PRURITUS. 
 
 remedies suggested, and not be too easily 
 discouraged; yet it might easily happen 
 that none of them would be efficacious. 
 If her medical attendant cannot help her 
 with internal remedies, then she must en- 
 dure as best she can and await the cure 
 effected by delivery. 
 
CHAPTER IX. 
 
 DISEASES WHICH FORBID PREGNANCY 
 
 — EFFECT OF PREGNANCY UPON 
 
 CERTAIN DISEASES. 
 
 The diseases which we have already 
 considered have been those which are 
 liable to occur during the course of preg- 
 nancy, some of them, indeed, caused by 
 the condition, and none of them apt to 
 lead to disastrous results unless specially 
 and very unusually severe in type. 
 
 As regards other diseases, not the usual 
 accompaniments of her condition, but to 
 which she may be exposed during the 
 months of expectancy, it is essential that 
 the pregnant woman should know her 
 liability to contract them, their influence 
 upon her and upon the child, and the in- 
 fluence of her condition upon the progress 
 of the disease. She should also know 
 what diseases should absolutely forbid her 
 
 7 
 
98 NERVOUS DISORDERS. 
 
 having children at all, although such 
 knowledge were best obtained before the 
 condition occurs than after. 
 
 There is a widespread notion that dis- 
 eases of the uterus are benefited by mar- 
 riage and pregnancy. This is far from 
 being the case. A healthy state of every 
 organ in the body constitutes the ideal 
 condition for the mother as regards her 
 own health and that of the child. It is 
 true that displacements are usually recti- 
 fied during the months of gestation, but 
 they often cause miscarriage or grave 
 complications during labor. Moreover, 
 with very few exceptions, the displace- 
 ment again occurs, and usually in ag- 
 gravated measure, after confinement. 
 
 Nervous disorders and hysteria are 
 popularly supposed to be cured by preg- 
 nancy, but this, again, is an error. A 
 cure has followed in some cases, due per- 
 haps as much to the substitution of an 
 absorbing interest for a morbidly self- 
 centred condition, and the arousing of the 
 higher and nobler faculties and emotions, 
 as to any physical influence. The usual 
 
CONSUMPTION — EPILEPSY — BRIGHT'S. 99 
 
 tendency would be toward the aggrava- 
 tion of such disorders. 
 
 The diseases which should absolutely 
 forbid pregnancy are consumption, in- 
 sanity, epilepsy, Bright's disease, cancer, 
 certain diseases of the uterus, and de- 
 formities of the pelvis. 
 
 Consumption, in spite of an old theory 
 that its course was delayed by the condi- 
 tion, is, on the contrary, usually hastened 
 in its progress. The child is, as a general 
 thing, sickly and scrofulous, or it may be 
 apparently healthy and develop consump- 
 tion later in life. 
 
 Insanity is very liable to be inherited. 
 It is itself sometimes, but not always, un- 
 favorably affected by pregnancy. 
 
 Epilepsy is so likely to be inherited 
 that it is recognized in law as cause for 
 divorce, if it can be proved that its exist- 
 ence in one- of the parties to a marriage 
 was unknown to the other before the cere- 
 mony. It is itself not much affected by 
 pregnancy. 
 
 Bright's disease is so disastrously 
 influenced by the condition that, when 
 
100 CANCER— HEART DISEASE. 
 
 marked, physicians usually consider them- 
 selves justified in bringing on a miscar- 
 riage, or, at least, a premature labor. It 
 is not, however, believed to be hereditary, 
 the risk being entirely to the mother. 
 
 Cancer of the uterus is hastened in 
 its development by pregnancy : the same 
 is the case with certain other tumors of 
 that organ, w r hich are so stimulated to a 
 rapid growth that they not only endanger 
 the life and health of the mother by their 
 development, but may prove an obstacle 
 to the birth of the child. 
 
 Marked deformities of the pelvis 
 may endanger the life of either mother or 
 child; lesser deformities may simply com- 
 plicate labor. It should be left to the 
 physician to decide which is the case. 
 
 Some forms of heart disease should 
 come under the head of diseases forbidding 
 the bearing of children, because they are 
 aggravated by the condition of pregnancy. 
 In any case they can only have a bad in- 
 fluence, since they weaken the circulation 
 at a time when the woman has need of all 
 her strength. 
 
ERUPTIVE FEVERS. 101 
 
 We have not placed anjemia on the 
 list, yet in its marked or pernicious form 
 it certainly belongs in the category. The 
 patient is already so enfeebled by the dis- 
 ease that the shock of labor might be fatal 
 in its result; the child, too, would inherit 
 a weak constitution, if, indeed, it survived. 
 
 The influence of the eruptive fevers 
 upon a pregnant woman is so serious that 
 every precaution should be taken to isolate 
 her from possible infection, the old idea 
 that she is not liable to " catch " infectious 
 diseases being quite erroneous. The ex- 
 pectant mother cannot be too careful not 
 to expose herself to the danger of conta- 
 gion, for her own sake as well as that of 
 the unborn child. This class of diseases 
 tends to produce miscarriage, to cause 
 haemorrhage, and to affect the foetus. 
 
 Small-pox epidemics usually give rise 
 to many miscarriages and premature la- 
 bors. Some authorities state that this 
 disease attacks women who are pregnant 
 more often than any other eruptive fever. 
 It is apt to cause miscarriage and severe 
 haemorrhages. The child is often born with 
 
102 SCARLET FEVER — MEASLES. 
 
 the eruption or the scars upon the body, or 
 the eruption may be developed eight or 
 ten days after birth. Any woman in a 
 family way, and exposed to small-pox, 
 should be vaccinated at once, even if she 
 have been vaccinated before. It is not, 
 however, likely that the child within the 
 uterus will be affected by this vaccination, 
 therefore it should be subjected to the 
 same treatment soon after birth. 
 
 Scarlatina, or scarlet fever as it 
 is commonly called, is apt to be more fatal 
 when it occurs just after confinement than 
 before. The disease occurs rarely in preg- 
 nancy, and is somewhat modified by the 
 condition. 
 
 Measles is a rare complication, but 
 when it occurs is serious from its tendency 
 to produce miscarriage and haemorrhage 
 and to predispose to pneumonia. The foe- 
 tus is apt to be infected, and may have 
 the disease before birth or directly after. 
 
 Erysipelas is a complication to be 
 dreaded after childbirth, but is not so 
 serious during pregnancy. 
 
 Of thenon eruptive fevers, typhoid and 
 
MALARIAL FEVER— RHEUMATISM. 103 
 
 typhus occur rarely, but, when they do, 
 are apt to produce miscarriage. 
 
 There is a prevalent idea that pregnancy 
 lessens the chances of incurring malarial 
 fever, and to a certain extent this ap- 
 pears to be true, although some authori- 
 ties think it is due to the fact that preg- 
 nant women are usually more carefully 
 guarded than at other times, and there- 
 fore less exposed to the malarial poison. 
 Nevertheless it does sometimes occur, 
 and while it is not increased in severity by 
 the condition, it is apt to react unfavor- 
 ably upon both mother and child. Mis- 
 carriage or premature labor may be caused. 
 The foetus is likely to be affected by the 
 disease, cases being on record where it was 
 seized by periodic convulsive movements 
 within the uterus. Sometimes it develops 
 the symptoms of malarial poisoning soon 
 after birth. Occurring in the mother just 
 after confinement, it predisposes to haemor- 
 rhages, and it has the effect of diminish- 
 ing the secretion of milk. 
 
 Rheumatism of the uterus may 
 occur in women who have a tendency to, 
 
104 PNEUMONIA. 
 
 or who have suffered from, general rheu- 
 matism, and is characterized by pain or by 
 a sensation of distress in the uterus with- 
 out apparent cause. The pain frequently 
 changes its place, going from one side of 
 the uterus to the other, increasing and 
 diminishing, sometimes causing a drag- 
 ging sensation and heaviness that extend 
 to the thighs, the external genital region, 
 and the lower part of the back. Pressure 
 increases the pain, as do active movements 
 or straining efforts. The pain may sud- 
 denly leave this region and appear in 
 some other part of the body. As rheuma- 
 tism seems to have a predilection for mus- 
 cles, and as the walls of the uterus are 
 composed of muscular tissue, it is nowise 
 remarkable that they should sometimes be 
 the seat of the affection. It is not a dan- 
 gerous complication, but it causes much 
 pain and may predispose to miscarriage. 
 It may seriously retard labor by increasing 
 the suffering and interfering with the 
 proper action of the abdominal muscles. 
 
 Pneumonia is a very serious complica- 
 tion of pregnancy. The blood is less rich 
 
SIMPLE JAUNDICE. 105 
 
 than at other times, and the heart less well 
 nourished ; consequently, when the lungs 
 become stopped up by such an inflamma- 
 tory process as pneumonia, the heart is not 
 equal to the task of increasing the force of 
 the circulation to make up the difference. 
 
 Simple jaundice may occur during 
 pregnancy and exercise no harmful effect. 
 It is liable, however, to turn into the in- 
 tense jaundice which is a symptom of a 
 serious liver complaint and which may 
 cause the death of the foetus. 
 
 Our object in enumerating the above list 
 of diseases has certainly not been to alarm 
 the pregnant woman or to increase her 
 nervousness in regard to her condition. It 
 has been with the view of impressing upon 
 her the importance of increased vigilance 
 to meet increased dangers ; the necessity 
 for a tenfold greater observance of all hy- 
 gienic precautions than at other times, 
 scrupulous cleanliness, a rigidly sensible 
 and nourishing diet, a sufficient amount of 
 exercise and ample supply of fresh air, and 
 avoidance of ail possibility of contagion. 
 Also, the desire has been to arouse her to 
 
106 NEED OF AN EXAMINATION. 
 
 the necessity of a thorough medical exami- 
 nation. Let her, so soon as she suspects 
 pregnancy, put herself under the care of 
 her physician and permit a thorough ex- 
 amination of her heart, lungs and liver, 
 and general condition. 
 
 If, during the course of her pregnancy, 
 any of the diseases mentioned above should 
 supervene, let her remember that we have 
 indicated possibilities only in the result, 
 and that to be warned of them in time to 
 seek appropriate treatment is usually to 
 avert the evil. 
 
CHAPTER X. 
 
 MISCARRIAGE. 
 
 When the foetus dies and is expelled be- 
 fore the end of the twenty-eighth week of 
 pregnancy, the process is called abor- 
 tion, or, in popular language, miscar- 
 riage; after the seventh month, when the 
 child has a chance of life after its expul- 
 sion, it is termed premature labor. 
 
 Labor at term is a natural or physiologi- 
 cal process Not so miscarriage, which is 
 unnatural and to be classed with diseases. 
 It is far more harmful in its effect upon 
 the system than childbirth, and the dan- 
 gers attending it are very great, particu- 
 larly the danger of an exhausting or fatal 
 haemorrhage. 
 
 If the majority of women understood 
 • this fact more clearly, it is possible that 
 they might be more cautious about en- 
 deavoring to avoid the trials of maternity 
 by destroying the foetus. Leaving aside 
 
108 MISCARRIAGE. 
 
 the moral question involved, and the fact 
 that the operation which they frequently, 
 in the calmest manner, demand of their 
 physician, is a State's prison offence, a con- 
 sideration for their own physical welfare 
 should restrain them from overturning the 
 laws of Nature. 
 
 The existence of certain conditions in 
 which childbirth would endanger the life 
 of the mother is considered by law to jus- 
 tify the induction of miscarriage or of 
 premature labor by the physician ; a de- 
 formed pelvis, or one too small to allow of 
 the passage of the child's head, Bright's 
 disease, and some other maladies belong 
 to the category. The doctor is obliged to 
 exercise the greatest judgment in deter- 
 mining what physical state calls for his 
 intervention, and what time is the best 
 suited to the purpose ; and when the opera- 
 tion is performed it is done with every 
 possible precaution to avoid the danger of 
 blood-poisoning and to control haemor- 
 rhage. The woman who endeavors to rid 
 herself of her unborn child knows nothing 
 of these precautions ; she swallows power- 
 
MISCARRIAGE. 109 
 
 ful drugs of whose action upon her system 
 she is completely ignorant, and subjects 
 herself to mechanical violence which is 
 in itself harmful and which may lead to 
 blood-poisoning and to many other evils. 
 Some, it is true, escape injury ; but how 
 many are rendered sufferers for years, 
 only the clinics and the practice of physi- 
 cians tell. This ignorance or carelessness 
 of results is so widespread in this country 
 that foreign scientists call the production 
 of abortion the " American sin/' for which 
 reason we have deemed allusion to it to be 
 in place. 
 
 Miscarriage, then, from a medical or 
 hygienic point of view, is a misfortune ; 
 an accident to be dreaded and, if possible, 
 avoided. The causes are various. Some 
 women seem to have a tendency to mis- 
 carry, apart from any known cause. One 
 authority claims that temperament has 
 a marked effect — for instance, plethoric 
 persons being predisposed to congestive 
 troubles and haemorrhage, lymphatic peo- 
 ple often being subject to a certain weak- 
 ness of the organs of generation, and those 
 
110 MISCARRIAGE. 
 
 of a nervous temperament being liable to 
 suffer contractions of the uterus from very 
 slight stimulus. 
 
 A markedly delicate constitution, by not 
 allowing sufficient nourishment to the 
 foetus, may cause its death and expulsion. 
 Obesity, poor food, prolonged inaction 
 predispose to the trouble. All the diseases 
 mentioned in the preceding chapter are 
 likely to cause either miscarriage or pre- 
 mature labor. Diseases of the uterus, 
 inflammation, tumors and displacements 
 (especially when the uterus is tipped and 
 curved backward) cause the accident. 
 Constipation, by occasioning violent strain- 
 ing efforts, and by the accumulation of 
 waste matter in the rectum causing a con- 
 gestion of blood in the pelvic organs, and 
 by direct pressure of distended intestines 
 upon the uterus, can readily produce the 
 condition, as may uncontrollable vomiting 
 and coughing. A tendency to miscarry is 
 sometimes more marked at the date corre- 
 sponding to the monthly period. Causes 
 from without are largely instrumental in 
 bringing on miscarriages, as, for instance, 
 
MISCARRIAGE. Ill 
 
 violent exertion, over-fatigue, falls, stum- 
 bling, blows on the abdomen, lifting heavy 
 weights, strong purgatives, tight clothes, 
 the prolonged use of the sewing machine, 
 violent mental emotions, shock, fright. 
 No general rule can be given, for women 
 differ widely in their tendency to mis- 
 carry, in some a very slight cause sufficing 
 to start the process, while others seem able 
 to bear almost any amount of fatigue and 
 exertion without ill effect. Prudence and 
 caution would better be observed, however, 
 even in the very robust. 
 
 Certain diseases of the foetus itself may 
 cause miscarriage. The earlier an abor- 
 tion occurs in pregnancy the less is it 
 fraught with danger. The symptoms are 
 usually pain and haemorrhage ; both in- 
 crease in severity with the advance of 
 gestation. Sometimes the miscarriage is 
 very sudden, but as a rule more or less 
 marked symptoms precede it. These are, 
 a feeling of lassitude, a sensation of weight 
 and fulness in the abdomen, chilliness, 
 a frequent desire to pass water, a white 
 discharge from the vagina followed by a 
 
112 MISCARRIAGE. 
 
 slight discharge of blood. Or there may 
 be decided pain in the back and in the 
 abdomen, the latter occurring at regular 
 intervals and increasing in severity. The 
 flow of blood becomes more profuse, and 
 the foetus is finally discharged. In some 
 cases the flow is suspended for days or. 
 even weeks, and then reappears with re- 
 newed intensity. The foetus may be dis- 
 charged in fragments, and some portions 
 remaining behind may decompose within 
 the uterus and cause blood-poisoning. If 
 left to themselves these portions may be 
 discharged in the course of time, but it is 
 imperative to summon a physician and 
 have them removed in order to avoid seri- 
 ous consequences. 
 
 In order to prevent miscarriage the 
 pregnant woman should be exceedingly 
 careful to avoid strains, jars, excessive 
 fatigue, violent excitement, etc., etc. If 
 she have a tendency to abortion she should 
 be particularly watchful at the time corre- 
 sponding to her menstrual epochs; anaemia 
 and all other existing diseases must be 
 appropriately treated, and malpositions of 
 
MISCARRIAGE. 113 
 
 the uterus corrected by the physician. 
 Marital intercourse must be forbidden. If 
 the symptoms of a miscarriage appear, 
 the patient must lie flat in bed and send 
 for the doctor. Everything that she 
 passes from the vagina must be saved and 
 shown to him. She must keep as quiet as 
 possible, both physically and mentally, but 
 she need not take the advice of those who 
 would surround her with hot-water bottles 
 or with ice bags. Heat increases the ten- 
 dency to flow, and ice is an extreme mea- 
 sure which is scarcely necessary. If no 
 doctor is obtainable, let her send to the 
 druggist's for the fluid extract of viburnum 
 prunifolium, and take a teaspoonf ul of it 
 every two hours, or take a quarter of a 
 grain of morphine if she can get it. She 
 must remain in bed three or four days 
 after the symptoms of the threatened abor- 
 tion subside. 
 
 If miscarriage occur she must remain 
 in bed ten days or a fortnight, bearing in 
 mind that the tendency to haemorrhage is 
 greater than after a natural labor. 
 
 Premature labor sometimes occurs from 
 
 8 
 
114 MISCARRIAGE. 
 
 the same reason that do abortions, and 
 sometimes physicians bring it on artifici- 
 ally in order to benefit the mother's health 
 or save the child's life. There is a preva- 
 lent notion among women that a seventh- 
 month child has a better chance of sur- 
 viving than an eighth-month child, which 
 is nonsense, the reverse being the case. 
 The nearer term a child is born the better 
 developed will it be and the greater will 
 be its chance for life and strength. The 
 treatment during and after premature 
 birth is the same as for labor and term. 
 
 A discharge of blood occurring at any 
 time during pregnancy, whether large or 
 small in amount, sudden or consisting of a 
 perpetual little dribbling, should put the 
 patient upon her guard and cause her to 
 send for medical advice, while she is care- 
 ful to lie down and to avoid all fatigue or 
 mental excitement. 
 
CHAPTER XL 
 
 PREPARATIONS FOR CONFINEMENT. 
 
 The preparations for confinement are 
 important and should be attended to early, 
 lest labor come suddenly and prevent. 
 
 The room chosen should, if possible, be 
 large, sunny (in winter) and well venti- 
 lated, and removed from the vicinity of the 
 water closet. If there is a stationary 
 wash basin it should be tightly covered 
 with a piece of wood ; and Piatt's chlorides 
 may be poured down the pipe so as to fill 
 the trap, that there may be as little danger 
 as possible of poisoning from sewer gas. 
 Everything in the room must be scrupu- 
 lously clean, and the fewer the hangings 
 the better. Let the furniture include bed, 
 chairs, bureau, and one or two tables which 
 are to be given up to the physician's use. 
 If they are of common wood, like kitchen 
 tables, it will be all the better; or they may 
 have clean towels spread over them, or oil- 
 
116 PREPARATIONS FOR CONFINEMENT. 
 
 cloth, or several thicknesses of clean paper, 
 in case of the overturn of medicines, etc. 
 A bureau, chest of drawers, or shelves of a 
 closet should be near at hand, containing 
 towels, sheets, napkins, and the baby's 
 clothes. 
 
 A single bed is more easily managed 
 than a double one; still the latter may, and 
 in this country will usually have to be 
 used. If preferred, a cot can be used for 
 the labor, and the patient be transferred to 
 the bed afterward ; this method has some 
 advantages, but it is not a necessity. 
 
 A hair mattress is decidedly the best ; 
 if it cannot be obtained, as sometimes is 
 the case in the country, one of excelsior, 
 corn husks, or straw may be used ; but a 
 feather bed is to be shunned, unless boards 
 are the alternative. As one writer says : 
 " It is a combination of every objectionable 
 quality. Its use is nearly equivalent to 
 putting the patient into an immense poul- 
 tice ; it is warm, soft, absorbent, and con- 
 sequently nearly always damp. Unless it 
 is stuffed unusually full the patient sinks 
 at once into a hole ; it is impossible to keep 
 
PREPARATIONS FOR CONFINEMENT. 117 
 
 it level, and if it once gets wet there is no 
 way of renovating it." 
 
 The bed is to be placed in such a way 
 that the physician may stand on the right 
 side of. it, so that when he faces the pa- 
 tient he can use his right hand. It should 
 be prepared for labor as follows : Next to 
 the mattress there should be a rubber 
 sheet, about a yard and a half square, ex- 
 tending downward from just above the 
 place where the patient's hips will lie, and 
 reaching over the edge of the bed. Over 
 this is placed a blanket, and then a *h*^ 
 
 Of COttorL, e*UK^ 6l x «^ U xx^j uo uouu ill 
 
 summer if preferred. This is the perma- 
 nent dressing of the bed, and should be 
 made secure by safety pins. Above it is 
 placed a second rubber sheet, blanket, and 
 cotton sheet. (The blanket may be omitted 
 in both dressings, but adds to the comfort 
 of the patient.) An old clean sheet, folded 
 several times, may be placed across the 
 bed, under the patient's hips, to receive 
 discharges, or a pad made of clean bran 
 or of prepared jute contained in a cheese- 
 cloth bag. The covering sheet and blan- 
 
118 PREPARATIONS FOR CONFINEMENT. 
 
 kets are next put on, and the bed is in 
 readiness. At the conclusion of labor, 
 after the mother is washed and cleansed, 
 the upper rubber sheet, with whatever lies 
 between it and the patient, is removed, and 
 a clean bed remains beneath. "When rub- 
 ber sheets cannot be obtained, oil-cloth, 
 such as is used for covering kitchen tables, 
 may be substituted ; it is inexpensive. 
 
 Whatever comes in contact with the 
 patient must be scrupulously clean. 
 This should be an axiom of labor. The 
 
 TneTc±b f or ** wil1 be S iven a little later - 
 i uxiiig ,»^^ „^ xl> ^ woman at the 
 
 time should consist of a flannel undervest 
 
 (thick in winter, gauze in summer), 
 
 night-gown, and stockings. In some h( 
 
 ,- w » ~-~n S o. iu oumB Hos- 
 pitals stockings extending half-way up 
 the thighs are made of canton flannel and 
 pulled on when the woman takes to the 
 bed. They are easily made, as they must 
 ht very loosely, they add much to the 
 comfort of a modest woman, and they 
 prevent chilling. A wrapper should be 
 worn over the night-gown while sitting or 
 walking about the room in the first stage 
 
PREPARATIONS FOR CONFINEMENT. 119 
 
 of labor. When the woman lies upon the 
 bed for the second stage, it and the vest 
 may be folded or rolled well above the 
 hips, that they may not be soiled ; if pre- 
 ferred, an old (but clean) sheet may be 
 several times doubled and fastened about 
 the waist, opening in front, replacing the 
 folded sheet or pad which was placed 
 upon the bed to receive discharges. There 
 should be a full supply of merino, flannel, 
 or silk vests, and of night-gowns, in order 
 that they may be changed every day, as 
 nothing adds more to her well-being and 
 comfort than clean clothes. Loose flannel 
 jackets with wide sleeves may be worn 
 over the night-gown in bed for warmth. 
 Two or three binder bandages, about half 
 a yard wide, and long enough to go once 
 and one-third around the body (about a 
 yard and six inches), should be provided. 
 They are best made of unbleached muslin 
 and pinned with ordinary or safety pins, 
 as will be described later. Clean clothes 
 for the mother should in winter be warmed 
 by the fire, stove, register, or in the sun. 
 There should be a liberal supply of linen 
 
120 PREPARATIONS FOR CONFINEMENT. 
 
 napkins, for after labor these need to be 
 constantly changed to keep the discharges 
 from decomposing. If the patient's re- 
 sources permit, let her by all means pro- 
 cure or make, instead of the napkins, 
 "antiseptic pads" (anti-septic means 
 " against poison 9 % 
 
 The disease known as puerperal fever or 
 childbed fever, and called by physicians 
 "septicaemia," used to be the scourge of 
 childbirth ; a committee of a Berlin society 
 appointed to investigate the subject re- 
 ported that from ten to fifteen per cent of 
 the deaths occurring among women during 
 the child-bearing period were due to puer- 
 peral fever, and that this disease destroyed 
 almost as many as small-pox or cholera. 
 As one authority said, "to be laid on the 
 bed of confinement was equal to being de- 
 livered to the hangman." Many were the 
 views held as to its cause ; in the last cen- 
 tury a physician advocated what scores of 
 non-scientific people believe to this day, 
 that some irregularity in the secretion of 
 milk was to blame. "Milk-leg," "milk 
 gone to the brain," "milk in the joints" 
 
PREPARATIONS FOR CONFINEMENT. 121 
 
 are expressions which testify to the belief 
 that the milk wandered about the body in 
 an aimless and erratic manner. In the 
 middle of this century it was discovered 
 that the disease was due to the entrance 
 of some poison into the body from the 
 outside, and that this poison could be 
 destroyed by disinfectants ; later the im- 
 mense strides taken in accurate scientific 
 knowledge proved beyond question that 
 puerperal fever was a form of blood-poi- 
 soning, caused by the entrance of a germ 
 or bacterium into the body through the 
 wounds made by labor. Methods of pre- 
 venting its entrance were next studied, 
 with the result that the death rate from 
 this cause has been reduced from fifteen to 
 less than one per cent. The first and most 
 important of these methods is absolute 
 cleanliness. Nothing favors the growth 
 of bacteria causing this or any other dis- 
 ease so much as dirt. Consequently the 
 freer the sick-room from lodging places for 
 dirt, such as old or upholstered furniture, 
 draperies, carpets, etc., the better the out- 
 look for the patient. Soiled napkins, 
 
122 PREPARATIONS FOR CONFINEMENT. 
 
 towels, or clothes, vessels containing dis- 
 charges or dirty water, are so many breed- 
 ing places for germs and should not be 
 allowed to stand in the room. Ventilation 
 should be thorough, that floating particles 
 of dust may be removed; while the woman 
 herself, every article which comes in con- 
 tact with her, and the clothes and hands 
 of every person who attends to her should 
 be scrupulously, absolutely clean. The 
 physician and the trained nurse will of 
 course be vigilant in this respect ; the hints 
 here given are for the benefit of those who 
 cannot see their doctor often, and whose 
 attendants are not skilled in the modern 
 nursing of midwifery cases. Cleanliness, 
 then, is the first requisite. 
 
 Antiseptic pads, to be worn over the 
 vulva after childbirth, are desirable. They 
 may be purchased in the cities at a good 
 pharmacy, in the shape of bichloride gauze, 
 borated gauze, or salicylated gauze, and 
 simply cut into the proper lengths and 
 made of the requisite thickness. They are 
 somewhat expensive, but by far the best 
 since they come already prepared. If, 
 
PREPARATIONS FOR CONFINEMENT. 123 
 
 however, they prove too expensive, very 
 good pads may be made at home of cheese 
 cloth folded many times until it is about 
 half an inch thick and of the width and 
 length of a napkin when ready for use. 
 A solution of bichloride of mercury is the 
 best antiseptic to use in the preparation of 
 these pads ; but as this substance is very 
 poisonous, and from its lack of color easily 
 mistaken for other liquids, it should be em- 
 ployed only under the physician's direc- 
 tion. Creolin, however, is an excellent 
 antiseptic, which, on account of its milky 
 color and its characteristic odor, cannot 
 be mistaken for anything else. Five tea- 
 spoonfuls of it added to a quart of water 
 will make a two-per-cent solution, which 
 can be used to wash the vulva as well as 
 to prepare the pads. These should be 
 wrung out in the creolin solution and 
 dried, after which they are ready for use. 
 They should be thrown away after using. 
 If preferred, napkins may be used by pre- 
 paring in the same way, or a pad may be 
 reinforced by a prepared napkin to secure a 
 thicker covering to the vulva. Absorbent 
 
124 PREPARATIONS FOR CONFINEMENT. 
 
 cotton may be used instead of, or in addi- 
 tion to, the cheese cloth. These dressings 
 are to be changed four or five times a day 
 during the first week after delivery. 
 
 Carbolic acid may be used, in the pro- 
 portion of two teaspoonfuls to the pint of 
 water, but its odor is so unpleasant that 
 the creolin will usually be preferred. 
 
 The list of articles to be provided 
 for the mother's use is as follows : 
 
 A new fountain syringe holding at least two 
 quarts of water. 
 
 A dozen sheets, absolutely clean. (Fewer will do, 
 but it is desirable to have as many.) 
 
 Towels in abundance for the use of doctor and 
 nurse. 
 
 Two rubber sheets or table oil -cloth, each one and 
 a half yards wide. 
 
 An oil-cloth or rubber mat to put by the side of 
 the bed. 
 
 Two blankets to use in making the bed as directed 
 above. 
 
 Some old cotton sheets. 
 
 Cheese cloth, freshly boiled, for wash cloths. 
 
 Cheese cloth and creolin solution for pads. 
 
 A bedpan. 
 
 Two or three binders of unbleached muslin. 
 
 A clean tin or papier mache basin which can be 
 
PREPARATIONS FOR CONFINEMENT. 125 
 
 slipped under the patient's vulva to receive the after- 
 birth, and which must be afterward thrown away. 
 
 Three clean hand basins of agate or earthen ware 
 for physician's and nurse's use. 
 
 A slop jar loith a cover. 
 
 Two new nail brushes. 
 
 Castile soap. 
 
 A flask of brandy. 
 
 For the baby there should be provided 
 the following articles : 
 
 A yard or two of strong linen bobbin or Chinese 
 silk to tie the cord. 
 
 A small old blanket or square of soft flannel in 
 which to envelop the child immediately after birth. 
 
 A bottle of sweet oil. 
 
 A pair of blunt scissors 
 
 A soft hair brush. 
 
 A powder box and puff, with talc powder or 
 starch or lycopodium powder. 
 
 Castile soap. 
 
 Some soft towels. 
 
 A soft sponge. 
 
 Baby's bath tub ana thermometer. 
 
 Pincushion with safety pins. 
 
 Some squares of clean, soft linen or muslin four 
 inches wide. 
 
 A flinnel shawl about a yard square. 
 
 Fine flannel bands. 
 
 The baby's clothes. 
 
126 PREPARATIONS FOR CONFINEMENT. 
 
 In regard to this last item, the chief 
 thing to be remembered is that the cloth- 
 ing should be warm and the articles as 
 few in number as practicable. There is 
 no sense in tormenting an infant by in- 
 tricacies of dress. Mothers pin a band 
 around the child's abdomen so tightly that 
 it can scarcely breathe ; put on diapers so 
 large and clumsy that the poor little legs 
 are pushed out of their natural position ; 
 put on one garment after another, re- 
 peatedly turning baby over on its back, 
 then on its front, pulling the arms up and 
 through tight sleeves, buttoning, pinning, 
 fastening the while, and then, with admi- 
 rable logic, wonder why the baby cries, 
 overfeed it to stop its wails, or give it 
 some remedy for stomach-ache ! ! 
 
 A soft flannel shirt, high-necked and 
 long-sleeved, and opening in front, should 
 go next to the body; then a band of flan- 
 nel not hemmed at the edges; next, a 
 diaper of linen a yard in length and half 
 a yard wide, which is to be folded twice; 
 then a flannel dress about twenty-five 
 inches long from neck to hem, also open- 
 
PREPARATIONS FOR CONFINEMENT. 127 
 
 ing in the front, and over this a muslin 
 slip. Woollen knitted socks, long in the 
 leg, finish this costume, which is the one 
 used in the Woman's Hospital of Philadel- 
 phia, and has much to recommend it, in 
 that it is sufficiently warm without being 
 heavy, has not a series of skirts upon 
 waistbands, which are really superfluous 
 and bulk} r , and by fastening in front is 
 simply adjusted and prevents the child 
 from lying on buttons, pins, or knots. If 
 desired the outer slip can be made to 
 fasten behind. 
 
 Some persons prefer to have a set of 
 garments made, each a little larger than 
 the other, and arranged together before- 
 hand, slipping them on at one time. 
 
 In preparing a baby's wardrobe the ex- 
 pectant mother can of course collect as 
 many dainty and beautiful little articles 
 as she may desire, and her friends usually 
 enjoy adding pretty specimens of their 
 handiwork to the collection. Where econ- 
 omy is needful it is well to know the abso- 
 lute necessaries. These are, three dozen 
 linen diapers, eight or ten soft flannel 
 
128 PREPARATIONS FOR CONFINEMENT. 
 
 night-gowns, eight or ten flannel day- 
 slips, eight or ten muslin slips, six flannel 
 shirts, six pairs of socks, three flannel 
 bands, a little flannel or knitted shawl, 
 and two or three flannel jackets. The 
 number of each article can be increased 
 as desired, and a warm hood, cloak, and 
 afghan added. 
 
 A little crib or bassinet should be pre- 
 pared, but not a rocking cradle. A large 
 clothes hamper makes a good bed, and 
 many a baby has slept comfortably in a 
 bureau drawer placed upon two chairs, 
 with a pillow for a mattress. 
 
 The French have a nice little contri- 
 vance, called a maillot, which might well 
 be imitated here. It consists of a thin 
 mattress covered by a slip. The slip has 
 wings which meet in front and are tied 
 together by tapes, enfolding baby, who 
 lies on its back on the little mattress. 
 Some have a footpiece, but this is too con- 
 fining. It is a comfortable little affair, 
 and the baby can be laid down for a 
 moment on table or lounge without danger 
 of rolling off. 
 
PREPARATIONS FOR CONFINEMENT. 129 
 
 To return to the preparations for labor. 
 
 There should be close at hand some 
 means of rapidly heating water. In the 
 city it is well to have a small gas stove in 
 a closet or adjacent room, with a kettle of 
 water upon it; in the country the stove in 
 the living room should have a brightly 
 burning fire, over which is a large boiler 
 full of water. Warm water will be needed 
 by physician and nurse for thorough 
 cleansing of their hands before, during, 
 and after labor; it will be needed to wash 
 the mother and to bathe the child; and 
 some very hot water might suddenly be 
 wanted by the doctor to check haemor- 
 rhage from the uterus. Ice should also 
 be obtainable. When the second stage of 
 labor (to be described in the next chapter) 
 is reached it is well to have the following 
 objects arranged upon a table for the doc- 
 tor's use: a basin *in which to wash his 
 hands, and a jug of warm water near it; 
 castile soap and a new nail brush; another 
 basin which he may use for bichloride of 
 mercury solution; a bottle of creolin, a 
 bottle of vinegar, scissors, and a pile of 
 
130 PREPARATIONS FOR CONFINEMENT. 
 
 clean towels. The hot water, as said be- 
 fore, should be near at hand, and ice ob- 
 tainable at a moment's notice. The recep- 
 tacle for the afterbirth should be within 
 reach. The bed, of course, will be pre- 
 pared and the bedpan close at hand. A 
 clean night-gown and undershirt will be 
 warming and ready for use if needed, as will 
 the antiseptic pads and napkins. Safety- 
 pins should be accessible. The receiving 
 blanket for the baby will also be warming; 
 the scissors and linen bobbin, with four or 
 five squares of clean linen, will be in the 
 nurse's apron pocket, or on the table with 
 the articles for the doctor. These careful 
 preparations save confusion, bustle, and 
 delay at the important moment. 
 
 Arrangements for the baby's bath and 
 toilet will be, if possible, in another'room. 
 Here will be bath tub, hot water, the toi- 
 let articles already described, soft towels, 
 squares of soft linen, the bottle of oil, the 
 baby's clothes, all near the fire, with a low 
 chair for the nurse or whoever washes the 
 infant. 
 
CHAPTER XII. 
 
 THE STAGES OF LABOR— DIRECTIONS FOR 
 THE CONDUCT OF LABOR IN EMER- 
 GENCIES — AFTER-CARE OF 
 MOTHER. 
 
 Labor is the act of delivery or birth. 
 Its approach is heralded about two weeks 
 previously by a slight decrease in the size 
 of the abdomen, caused by the i€ settling" 
 or descent of the child's head into the 
 pelvic cavity. Pressure being diminished 
 above, the patient is usually able to breathe 
 with more comfort, and disturbances of the 
 stomach and palpitation cf the heart are 
 lessened. Increased difficulty in walking 
 may, however, be experienced, swelling of 
 the lower limbs is apt to be increased, 
 there is a constant desire to pass water, 
 sometimes diarrhoea occurs, and any ten- 
 dency to piles is aggravated. A more or 
 less abundant discharge comes from the 
 vagina, which with the near approach of 
 
132 THE STAGES OF LABOR. 
 
 labor may become tinged with blood, and 
 is called the " show." Pains are very lia- 
 ble to occur a few days or even a fortnight 
 before labor, and the patient has many 
 false alarms. These pains are usually of 
 the nature of cramps in the abdomen; they 
 come on at regular intervals, and usually 
 during the early hours of the night. Real 
 labor pains, as a rule, start in the lower 
 part of the back and gradually extend 
 forward to the abdomen and downward to 
 the thighs. They occur at regular inter- 
 vals, which become less and less until only 
 a few minutes intervene. 
 
 Before describing the course of labor it 
 is well to recall to mind that the uterus is 
 a muscular bag which has grown and been 
 stretched until it is now large enough to 
 contain a child from six and a half to ten 
 or more pounds in weight, a "placenta" 
 or afterbirth, membranes, and an average 
 amount of from one to two pints of fluid. 
 The lower part of the uterus which ex- 
 tends into the vagina is small, and is 
 called the cervix or neck. The child usu- 
 ally lies with its head down and bent for- 
 
THE STAGES OP LABOR. 133 
 
 ward upon its chest, its back to the front 
 of the mother, its arms folded across the 
 breast, the knees bent upward toward the 
 middle of the body. A new-born infant 
 always shows a tendency to double up its 
 arms and legs from force of habit. 
 
 The navel string, or umbilical cord, which 
 contains a vein and two arteries, leads 
 from the child's navel to the afterbirth. 
 It is about twenty inches long and about 
 the thickness of the little finger. The arte- 
 ries and vein are protected by a covering 
 of gelatin and a membranous sheath. A 
 closed bag of membranes completely en- 
 closes the child and contains the fluid in 
 which the infant floats. 
 
 When " term " is reached the process of 
 labor begins. The muscles forming the 
 walls of the uterus begin to contract and 
 the child is pushed downward. The first 
 thing to be accomplished is the opening 
 out or " dilatation " of the cervix, which 
 must, from a small, spindle-shaped body, 
 become as wide as the vagina and lower 
 part of the uterus, in order that there may 
 be no obstacle to the child's exit. The 
 
134 THE STAGES OF LABOR. 
 
 child's head is ill-fitted by its size and 
 shape to perform this task, hence Nature 
 has provided a wedge in the " bag of 
 waters." Some of the fluid by gravitation 
 falls in front of or just below the infant's 
 head, and, enclosed in the membranes, is 
 with each contraction pushed further into 
 the cervix. This is not the only cause of 
 the opening out of the cervix, but it greatly 
 facilitates the process. When the dilata- 
 tion is so far advanced that the diameter 
 of the opening is about three and a half 
 inches, the membranes become so stretched 
 that further pressure breaks them and the 
 water is expelled. This is the ' * bursting 
 of the bag of waters." An amusing story 
 is told of a young medical student who, 
 being left in charge of a confinement case, 
 fled from the scene in alarm and despair 
 when the membranes ruptured, thinking 
 that the bladder had burst ! 
 
 If the membranes do not open directly 
 in the centre, but toward one side, the head 
 of the child when it pushes forward may 
 carry a bit of membrane upon it. This is 
 the lucky "caul" of which so much has 
 
THE STAGES OF LABOR. 135 
 
 been said by midwives, and which some 
 parents carefully preserve to insure the 
 child's good fortune ! When the cervix is 
 completely stretched, if the membranes do 
 not rupture of themselves the physician 
 usually breaks them so as to prevent de- 
 lay. It is by feeling the cervix and deter- 
 mining the amount of dilatation that the 
 doctor is able to decide how far labor has 
 progressed and whether there is any delay 
 in the natural process. The patient should 
 always be willing to submit to the exami- 
 nation which the conscientious physician 
 must make. Sometimes the bag of waters 
 breaks very early — long before the cervix 
 is opened out. This may somewhat delay 
 matters by causing a " dry labor." 
 
 The complete dilatation of the cervix 
 ends what is known as the first stage of 
 labor. This, in the case of women who 
 have never borne children before, usually 
 lasts about sixteen hours, and is by some 
 women considered the most trying period 
 of all. The pains are of a nagging, teas- 
 ing, or cutting and grinding character, 
 and seem to accomplish nothing, although 
 
136 THE STAGES OF LABOR. 
 
 they are in reality constantly dilating the 
 cervix. 
 
 A word as to the meaning of the term 
 " pain " as used in this connection. Many 
 a woman has voted her doctor unfeeling 
 because he asks if she has " good pains/' 
 and is satisfied when they are frequent 
 and hard. The fact is that by "pain" he 
 does not mean the actual suffering, but 
 the contractions of the uterus which are 
 advancing labor and shortening the period 
 of torment. " Pain " is the technical term 
 for this contraction ; as suffering accompa- 
 nies the muscular act, and as the patient 
 cannot know how the process is advanc- 
 ing, the only way that the physician can 
 estimate the progress made (with the ex- 
 ception of an examination) is to ascertain 
 the nature and frequency of the pains. 
 
 During this stage the woman should not 
 lie down, and as a rule she will not wish 
 to do so, but will prefer to sit, to stand, or 
 to walk about This position may favor 
 the descent of the head. The contractions 
 of the uterus are purely involuntary ; she 
 can do nothing to hasten them, and strain- 
 
THE STAGES OF LABOR. 13? 
 
 ing efforts are worse than useless, as they 
 only fatigue her and deprive her of the 
 strength which she may profitably use 
 during the next stage. She should try to 
 bear the pains as patiently as possible, al- 
 though this is of course difficult. The in- 
 tervals between them are a great relief : 
 the patient gains strength and courage 
 by their means and breathes more easily, 
 while the child is saved from the disastrous 
 effects of continuous pressure. 
 
 The physician during the first stage 
 usually makes an examination, decides 
 how far labor is advanced, and leaves the 
 patient, to return in a few hours. This 
 the suffering woman is apt to consider 
 cruel behavior — she is in pain, and thinks 
 that her doctor should be with her to help 
 her, to hasten matters, and to relieve her 
 sufferings. That, however, is not a wise 
 thing for him to do. There is absolutely 
 nothing to be done to ease her ; drugs 
 which lull pain would lessen the contrac- 
 tions of the uterus, delay labor, and pro- 
 tract her agony ; there is no way of hasten- 
 ing this stage. Moreover, the physician 
 
138 THE STAGES OF LABOR. 
 
 needs to save his physical and mental 
 strength for the hard work of the following 
 stages, which he will be quite "unfitted to 
 perform if he remain continuously in the 
 sick-room, listening to every groan and 
 complaint and obliged to refuse appeals 
 for help. The average physician is not 
 made of iron; his sympathies are quick, 
 but he is obliged to protect his own nerv- 
 ous system for the work required of him, 
 instead of spending it in words, and for 
 that very purpose he often assumes a quiet 
 manner which the patient misinterprets as 
 a lack of feeling. Let her wait, and she 
 will see his sympathy expressed by skilled 
 and arduous work. 
 
 The husband and friends of the woman 
 are the ones to help and comfort her at 
 this period of labor, but the sick-room must 
 not be crowded. Very few people like to 
 have spectators of their physical suffer- 
 ings, and the presence of her husband and 
 mother, or some other dear relative or 
 friend besides the nurse, will be all-suffi- 
 cient to make the patient feel that sympa- 
 thy is felt for her and that help is near at 
 
THE STAGES OF LABOR. 139 
 
 hand. Any friend who delights in pic- 
 turing possible sufferings and detailing 
 horrible cases of which she has heard, or 
 confinements which she has gone through 
 or seen, should, on some pretext or other, 
 be removed from the room. It is brutal 
 to give anything but encouragement to a 
 woman at such a time. Possibly the friend 
 intends to mitigate her sufferings by the 
 contrast of worse cases, but she forgets 
 that where results are still uncertain any 
 one with the least fragment of an imagina- 
 tion would naturally think, " Perhaps my 
 case will turn out to be similar in atro- 
 city ! " 
 
 If pressure with the hand upon the 
 lower part of the back seems to afford any 
 relief, let it be given by the husband or 
 some person with strong muscles. Those 
 who think that chloroform or ether could 
 be advantageously administered during 
 the first stage are grievously in error, as 
 they would undoubtedly prolong labor. 
 The woman's strength should be kept up 
 by food, if she will take it; by tea, coffee, 
 broth, beef tea, milk — but not by alcohol. 
 
140 THE STAGES OF LABOR. 
 
 Let her during this stage remove her 
 clothing and put on the vest, night-dress, 
 and stockings in which she is to be con- 
 fined, with a loose wrapper over all. She 
 should also have her bowels cleaned out 
 by an enema of warm soapy water. This 
 is of extreme importance, as otherwise the 
 pressure of the child's head on the rectum 
 may cause the evacuation of its contents 
 during the second stage of labor, which is 
 an unpleasant and unfortunate occurrence. 
 The bladder should likewise be emptied; 
 if twelve hours pass without the patient 
 passing urine, the doctor should be in- 
 formed, that he may use means for its re- 
 moval, as pressure on the neck of the blad- 
 der later by the child's head might prevent 
 its evacuation and cause serious injury. 
 
 With the complete dilatation of the 
 cervix begins the second stage, or stage of 
 expulsion. The pains increase in severity 
 and frequency, and the muscles of the ab- 
 domen now begin to assist. They con- 
 tract involuntarily, but the patient can 
 increase their contractions by voluntary 
 efforts, and should do so. She would bet- 
 
THE STAGES OF LABOR. 141 
 
 ter lie on the bed at this point, or, if she 
 prefer to sit, be near enough to the bed to 
 rapidly place herself upon it. If she wish 
 it, a sheet or strong piece of cotton may 
 be fastened to the foot of the bed, and she 
 may pull upon it with each pain, bracing 
 her feet against the footboard; but if the 
 pains are very strong she would better not 
 do this. She may lie upon her back or 
 side. The question of posture in labor is 
 an interesting one. In England it is usual 
 for women to lie upon the left side ; in this 
 country the back is usually preferred. 
 " The Hindus, as well as the inhabitants 
 of Madras and the East Coast, prefer the 
 standing position, supported by female 
 friends or the husband. This is likewise 
 the case with the negroes of the Philippine 
 Islands, with the women of Central Africa 
 and those of the Boers, as well as many 
 Indians. Formerly Frenchwomen were 
 delivered in this position, and more re- 
 cently the Slavs in Upper Silesia. The 
 women of Polynesia, the negresses of Aus- 
 tralia, and the Persians (kneeling upon 
 three stones) give birth in the squatting 
 
142 THE STAGES OF LABOR. 
 
 position ; while many Russians give birth 
 to the child while swinging and hanging 
 from a beam, and the Brazilians are even 
 tied to a tree. Others hang to a cord sus- 
 pended from the ceiling. Some English 
 and German women are supported by the 
 husband's arm. In Meeran the parturi- 
 ent woman is suspended by a large, strong 
 towel and allowed to swing about . The 
 Abyssinians, Georgians, Armenians, Per- 
 sians, Tartars, Mongols, Kamtschatkans, 
 Greeks, and Esthuanians all kneel. The 
 Australians, the South Indians and Mas- 
 sauanians are delivered seated on a block 
 of wood ; the negroes of old Calabar sit- 
 ting on a stone; while women in Japan, 
 China, Turkey, Greece, Egypt, and Mes- 
 sina prefer the chair. This chair is of 
 very ancient origin, and has been used 
 from the earliest Egyptian times up to the 
 present. In old Rome, Holland, Germany, 
 and among the Bedouins many preferred 
 sitting upon some one's lap. The Brazilian 
 Indians, the women of the Antilles, of the 
 Sandwich Islands, of Sumatra, Australia, 
 Japan, China, Paon, India, are delivered 
 
THE STAGES OF LABOR. 143 
 
 in the recumbent position, lying on the 
 side. The side posture is generally used 
 by the Siamese Indians and North Ameri- 
 cans. Finally, some Italian women raise 
 the body and bend backward so that head 
 and feet nearly meet." 
 
 The quotation has been introduced sim- 
 ply as being of some interest. In this coun- 
 try, as said before, the patient usually lies 
 on her back, unless the physician direct 
 otherwise. She can, of course, frequently 
 change her position, and will be likely to 
 do so from restlessness. As the child's 
 head pushes down, the bladder will be 
 pressed upon and the woman experience 
 a constant desire to pass water. Toward 
 the last let her restrain herself from get- 
 ting up to sit upon a vessel, lest the child 
 might suddenly be born in this situation. 
 
 With each pain the child's head advances 
 into the vagina; after the pain it retreats a 
 trifle, but advances further with the next 
 one. Finally the head emerges. At this 
 point, to the great distress of the patient, 
 the physician sometimes by pressure for- 
 cibly holds the head back, which seems 
 
144 THE STAGES OF LABOR. 
 
 to her needless and cruel. The reason 
 is this: That part of the body between the 
 vagina and the opening of the rectum is 
 called the perineum, and plays an im- 
 portant part, too complex to be here de- 
 scribed, in supporting the vaginal walls. 
 The advancing head bulges and thins 
 this perineum, and a sudden movement 
 readily tears it. The wound may be 
 slight, but in some cases it extends through 
 to the rectum, and the after-consequences 
 are injurious to health of the parts. 
 The tear must either be sewed up imme- 
 diately after labor or be rectified by an 
 operation later. Now, by holding back 
 . the oncoming head so that the perineum 
 may become gradually stretched, by pre- 
 venting it from rushing through during a 
 pain, and by gently helping it through in 
 the interval between two pains, the physi- 
 cian can very frequently prevent all tear- 
 ing, or at least limit it to a slight injury 
 necessitating a few stitches only. Tears 
 of the cervix are usually beyond control of 
 the physician, but by no means occur in 
 every case. 
 
THE STAGES OF LABOR. 145 
 
 After the child's head is born there is a 
 short pause, during which it turns so as to 
 describe a quarter of a circle, in order to 
 bring the shoulders in the best position for 
 expulsion. With another pain or two 
 these and the rest of the body follow, and 
 the mother experiences a sense of immense 
 relief. This ends the second stage, which, 
 in case of a first confinement, is usually 
 about two hours in duration. 
 
 A lull of from five to twenty minutes 
 now occurs, during which time the nurse 
 is usually busy in attending to the infant, 
 in the way to be described later. Then 
 with a few more pains the afterbirth is ex- 
 pelled and labor is at an end. 
 
 It sometimes happens that the physician 
 is unable to get to a case in time, and that 
 the nurse or some friend of the patient is 
 obliged to conduct labor. A nurse who 
 has graduated from a training school will 
 know how to proceed, but a few directions 
 to the inexperienced may not be out of 
 place. 
 
 She should, in the first place, remain 
 
 calm and clear-headed. Let her remem- 
 10 
 
146 THE STAGES OF LABOR. 
 
 ber that, after all, labor is a natural pro- 
 cess, and that complicated cases are the 
 exception, not the rule. During the first 
 stage there is little or nothing to be done. 
 During the second the attendant should 
 stand by the bedside, and, when the head 
 appears in sight at the opening of the 
 vulva, she should place her left hand upon 
 the perineum — the space between the va- 
 gina and rectum — and with the thumb and 
 forefinger of the right hand seize the 
 child's head and press firmly upon it dur- 
 ing a pain, relaxing the pressure, and 
 merely keeping her fingers in contact with 
 the head, between the pains. This should 
 be repeated several times, until finally the 
 head emerges. Now let her at once feel 
 with her hand around the child's neck, to 
 ascertain whether the navel cord is wound 
 around it. If so, she should gently and 
 slowly draw it down until there is a loop 
 long enough to pass over the child's head. 
 This will save the infant from strangula- 
 tion. If not long enough to slip over the 
 head, the cord will at least be loosened, 
 and will slip over the shoulders when they 
 
THE STAGES OF LABOR. 147 
 
 emerge. Let her wait quietly until the 
 child's body is expelled, and then, receiv- 
 ing it in her hands, lay it gently down be- 
 tween the mother's thighs in such a way 
 that the cord is not put upon the stretch, 
 and that the face is not lying in the dis- 
 charges which come from the vagina. 
 The mouth should at once be freed from 
 any mucus which may be clogging it. 
 
 Meanwhile another assistant should 
 place a hand upon the mother's abdomen, 
 upon the upper border of the uterus, which 
 can be distinctly felt. She should not 
 press in her fingers nor lay the hand flat, 
 but, slightly hollowing it, lay it on the 
 rounded border of the uterus and keep it 
 there until the binder is put on. 
 
 No harm will be done if the afterbirth 
 is delivered before the child is separated 
 from it, but the usual way is to wait a few 
 minutes until the pulsations in the cord 
 are slow and feeble, then to take a piece 
 of flat linen bobbin or of Chinese silk and 
 tie it tightly around the cord, about one 
 $,nd a half inches from the child's body. 
 An inch further away another ligature 
 
148 THE STAGES OF LABOR. 
 
 should be tied, and the cord cut between 
 the two with scissors. Any blood oozing 
 from the cord which is attached to the 
 child should be wiped off, and the cord 
 watched for a few moments to be sure 
 that the oozing has ceased. If it still 
 flow, another ligature should be tied more 
 tightly within the first one. The baby's 
 eyes should now be carefully wiped with 
 a clean, soft bit of linen, and washed with 
 a little borax water (a third of a teaspoon- 
 ful of borax to a glass of tepid water) ; 
 then baby may be rolled in the receiving 
 blanket, laid upon a lounge or bed on its 
 right side, and covered with a warm 
 shawl. Wherever placed, its presence 
 should in some way be indicated, so as to 
 prevent its being inadvertently sat upon, 
 as has been known to occur. Providing 
 that the child be kept warm (it having 
 just come from a temperature of nearly 
 100° to a comparatively cold outer world), 
 and that an occasional glance be given to 
 the navel cord to ascertain that there is no 
 bleeding, the infant may remain for sev- 
 eral hours uncared for, if there be not a 
 
THE STAGES OF LABOR. 149 
 
 sufficient number of persons to attend to 
 both mother and child. Nurses who have 
 not been trained in a regular school usu- 
 ally think that the child needs washing 
 the moment the cord is cut, and run off 
 with it to some obscure corner to scrub it, 
 leaving the mother in charge of the physi- 
 cian alone. The child is no more unclean 
 than it has been for months, and can well 
 wait until the toilet of the mother, who has 
 had long hours of pain and fatigue, has 
 been attended to. 
 
 The delivery of the afterbirth consti- 
 tutes the third stage of labor, and is the 
 time most fraught with danger to the pa- 
 tient on account of a possible haemorrhage. 
 The physician is very seldom detained so 
 long that he cannot arrive in time to attend 
 to the expression of the afterbirth, and it 
 should be left for him to do, the attendant 
 quietly waiting with one hand pressed 
 firmly upon the uterus through the walls 
 of the abdomen, unless it is known that 
 he cannot arrive within an hour, or unless 
 there be haemorrhage. In that case, after 
 waiting perhaps twenty minutes for the 
 
150 THE STAGES OF LABOR. 
 
 spontaneous expulsion of the placenta, the 
 hand upon the abdomen should be pressed 
 firmly downward with a squeezing motion. 
 The cord is not to be palled on any pre- 
 text whatsoever. The afterbirth will usu- 
 ally appear at the vulva, should be seized 
 and extracted by turning it round and 
 round upon itself, drawing it gradually 
 down and out. Together with the mem- 
 branes it should be kept for the physician's 
 inspection, in order that he may satisfy 
 himself that no portion has been left within 
 the uterus, after which it should be disposed 
 of by burning. The hand upon the abdo- 
 men must still remain there, and should 
 follow the uterus, which is now about as 
 large as a large orange, above the pubic 
 bones. If the uterus should relax and 
 become large again, the openings of the 
 blood vessels, which are closed by the con- 
 traction of the organ, will be in danger of 
 reopening and causing haemorrhage, hence 
 the necessity for firm pressure. The vulva, 
 thighs, and any soiled adjacent parts 
 should be carefully washed with a solu- 
 tion of creolin in water, soiled sheets and 
 
THE STAGES OF LABOR. 151 
 
 clothing removed, clean garments put on 
 if needed, and the antiseptic pad and the 
 binder adjusted. The latter, as said be- 
 fore, consists of a piece of unbleached mus- 
 lin a foot and a half wide, and long enough 
 to go around the abdomen once and over- 
 lap. The lower border should come down 
 well over the hips. Beginning above, it 
 should be firmly pinned, but not pulled so 
 tight as to be uncomfortable. Ordinary 
 pins possess an advantage in that they can 
 be placed very close together and secure 
 a better-fitting binder ; in the hands of an 
 inexperienced assistant the safety pins will 
 be better, placed about an inch apart. 
 When the front is fastened the binder may 
 be pinned or sewed at the sides to adjust 
 it to the figure. The pad and napkin may 
 be fastened to the lower part of the binder. 
 This bandage serves a useful purpose in 
 giving a sense of support and comfort to 
 the woman, and many believe that it assists 
 in preserving the figure. 
 
 When perfectly clean as to person and 
 clothes the mother should be left to rest. 
 A sense of complete exhaustion will usually 
 
152 THE STAGES OF LABOR. 
 
 prevent any desire for food, but if she 
 wish for a little milk, broth, or beef tea, 
 she may have it. 
 
 No one should now be allowed in the 
 room except the husband, physician, and 
 nurse, for it is desirable that absolute rest 
 of mind and body follow the exertion of 
 labor. Near relations or a very intimate 
 friend may, if the mother desire it> come 
 in for a moment, singly, after forty-eight 
 hours ; but if the slightest restlessness or 
 fatigue be noticed after these visits they 
 must be interdicted. It would be better 
 if no friends came for seven days, but it is 
 useless to expect such self-restraint, there- 
 fore we consider it the wiser plan to ad- 
 vise that at first they merely step in to 
 say a word of congratulation and affection, 
 and then immediately withdraw. No one 
 should come to the sick-room to hold a 
 conversation with the patient under a 
 week, if all is going well. To worry the 
 young mother with any remarks about her- 
 self or the child which are not optimistic, 
 to trouble her with any details of house- 
 keeping, or to acquaint her with unpleasant 
 
THE STAGES OF LABOR. 153 
 
 news is intolerable. She should be allowed 
 to sleep a great part of the time, and no 
 well-meaning friend should read to her or 
 talk continuously to her for a week at 
 least. 
 
 The air of the room must be kept fresh 
 at all times. By carefully covering the 
 patient the windows may be thrown wide 
 open three times a day for a few minutes, 
 even in winter ; in summer they will of 
 course be open, unless the noise from the 
 street be less endurable than the heat. 
 
 The patient must be kept clean. The 
 antiseptic pad is to be changed five or six 
 times a day, and the vulva washed with 
 the creolin solution. Vaginal injections 
 are not to be given unless the doctor 
 orders them. The whole body must be 
 sponged with warm water and soap (and 
 each part wiped immediately after wash- 
 ing) every two days, the face and hands 
 washed at least twice a day. All soiled 
 articles are to be removed at once from 
 the room. 
 
 The discharge from the vagina is called 
 the lochia, and for two or three daj's fol- 
 
154 DIET AFTER LABOR. 
 
 lowing labor consists of blood mixed with 
 mucus and shreds of membrane. It then 
 becomes yellow or pale green, finally thin- 
 ner and less abundant, and ends in two 
 or three weeks. Cleanliness will usually 
 prevent odor, but if, in spite of washing 
 with an antiseptic solution, there should 
 be a strong and fetid smell, the doctor 
 should be told of it at once. 
 
 The binder is to be changed every day, 
 and great care exercised to see that it lie 
 smooth, as creases irritate the patient's 
 skin. 
 
 During the first twenty-four hours 
 rather light food should be taken — broths, 
 gruels, beef tea, milk, cocoa, dropped 
 eggs, tea and toast. On the second day 
 chicken, beef, mutton, and other simple 
 articles of diet may be taken. The old 
 idea of starving a woman after labor was 
 absurd ; after such an exhausting experi- 
 ence she needs to be sustained and nour- 
 ished. Of course care must be exercised 
 in the choice of food, and nothing eaten 
 which is in itself indigestible or which is 
 known to disagree with the patient. 
 
BOWELS AND BLADDER. 155 
 
 The bowels are usually constipated for 
 a few days after labor, On the third day 
 ah enema of warm water, or soap and 
 water, or water and castor oil, may be 
 given, or two tablespoonfuls of glycerin 
 or a glycerin suppository may be inserted 
 into the rectum. If this is not sufficient 
 to produce a movement the physician will 
 prescribe a laxative. The bowels must be 
 opened daily thereafter. 
 
 The bladder should be emptied every 
 eight hours at least. A great many physi- 
 cians believe that it is positively beneficial 
 to the patient to sit up for the purpose 
 of passing urine ; it allows clots and dis- 
 charges to escape from the vagina, and it 
 often causes the urine to flow when it has 
 been found impossible to pass it in the 
 recumbent position. If difficulty is expe- 
 rienced in passing urine, hot wet cloths 
 may be laid on the abdomen just above 
 the pubic bone, or the patient allowed to 
 sit upon a vessel half -filled with steaming 
 hot water. 
 
 The care of the breasts and nipples 
 is of the utmost importance. Milk is not 
 
156 CARE OF BREASTS. 
 
 secreted until the third day, but Nature 
 has provided a secretion, called the colos- 
 trum, which acts as a laxative upon the 
 infant's bowels. After the mother has 
 rested about two hours after labor, the 
 child should be put to the breast. The 
 nipples must be washed with warm water, 
 and a little sugared water may be put on 
 them if the child shows any disinclination 
 to nurse. The mother should turn on her 
 side (the right side if the right breast is 
 given), and the child's head be supported 
 by her arm. The nipple drops toward the 
 infant's mouth, and is more easily taken 
 than in other positions. Not only is this 
 early suckling of advantage to the child, 
 but of the greatest benefit to the mother, 
 as, through influence of the connecting 
 nerves, it excites the uterus to contract and 
 thus assists in preventing haemorrhage. 
 
 The milk usually appears on the third 
 day, but may be delayed until the sixth, 
 and may also be attended by a slight rise 
 of temperature with a little restlessness. 
 If the breasts are so full of milk as to be 
 painful, they may be very gently rubbed 
 
BREAST BINDER. 
 
 157 
 
 with sweet oil in the direction of the 
 nipples, one hand holding up the breasts in 
 such a way as to make counter-pressure. 
 The patient in such a case should take 
 very little liquid food, and would better 
 take a laxative, such as Hunyadi water, or 
 seidlitz powders, or magnesia. A band- 
 age often gives relief, and may consist 
 
 r 
 
 KJ 
 
 3 Feet 
 Fig. 4. 
 
 of simply a support passed under the 
 breast and over the opposite shoulder, or 
 of strips of muslin wound around the 
 breast and opposite shoulder several 
 times, each successive layer slightly over- 
 lapping the one below. A bandage much 
 in use is made of a straight piece of 
 strong unbleached muslin a yard long and 
 
158 CRACKED NIPPLES. 
 
 half a yard in width, in which holes are 
 cut for the neck and the arms, as shown 
 in the accompanying figure, and is both 
 simple and efficacious. Part 1 meets part 
 2 and is fastened over the shoulder ; 3 
 and 4 meet in front and are fastened by 
 safety pins. 
 
 The nipple must always be kept per- 
 fectly clean, to which end it must be 
 washed, before and after each nursing, 
 with tepid water, or borax and water, and 
 dried with a clean, soft cloth. 
 
 Care of the breasts during pregnancy 
 will do much to prevent tender or cracked 
 nipples. When they exist, however, dur- 
 ing lactation, they require special care, for 
 the pain caused by them may become 
 agonizing. They may be treated by ap- 
 plying daily cocoa butter, cocoanut oil, or 
 olive oil; or a little of the compound tinc- 
 ture of benzoin may be brushed over them 
 with a camel's-hair brush; this will cover 
 the cracks with a little film, and at the 
 same time relieve the pain and hasten 
 a cure. Relief may also be obtained by 
 laying on cloths wrung out in a solution 
 
CRACKED NIPPLES. 159 
 
 made by adding a teaspoonf ul of lotion of 
 sugar of lead to a glass of water, or by 
 dusting on a little powdered gum arabic, 
 or oxide of zinc, or tannin, or by first cov- 
 ering the nipple with glycerin and then 
 dusting on the tannin. Should all this be 
 of no avail a nipple shield must be used 
 for a few days. It should fit closely; the 
 part nearest the breast should be of glass or 
 of metal, and the tip of rubber. It must 
 be removed after nursing, thoroughly 
 cleansed, and kept in cold water, while 
 the breast should be washed with tepid 
 water and some one of the substances 
 mentioned above applied to the nipple. 
 
 Intense pain is sometimes caused by the 
 child's biting the nipple. It is astonish- 
 ing what force the little creatures are able 
 to exert. The nipple shield is the only pro- 
 tection, and must be worn in such a case. 
 
 However great the pain caused by nurs- 
 ing with a fissured nipple, we would 
 strongly urge the mother to persist in the 
 attempt, and not to give it up unless every 
 means of relief proves to be a failure and 
 the agony too great for endurance. 
 
160 NURSING OF CHILD. 
 
 Few women realize that their refusal to 
 nurse is a veritable calamity to the child. 
 Infants fed at the breast are stronger, 
 healthier, and far more flourishing than 
 those brought up on the bottle, and resist 
 diseases much better. Some children do 
 fairly well upon artificial feeding, but 
 these are the exception, and are usually 
 very healthy and vigorous by nature. 
 Language is scarcely strong enough to 
 emphasize the fact that every mother who 
 can do so should nourish her own child 
 and permit nothing to interfere with this 
 paramount duty. Extreme delicacy, con- 
 sumption, epilepsy, or other grave disease 
 of course forbids her nursing; fevers, shock, 
 grief, all violent mental emotions, render 
 the milk unfit for the infant's use; Nature 
 sometimes fails to supply milk in the neces- 
 sary amount or of suitable quality; social 
 conditions sometimes oblige the mother to 
 work for the support of herself and child, 
 necessitating her absence from home — all 
 these cases and some others forbid her 
 nursing her own child. But the woman 
 who, to save herself trouble or to pre- 
 
ABSCESS OF BREAST. 161 
 
 serve her figure, deliberately allows the 
 supply of milk in her breast to dry, and 
 gives her child over to a wet-nurse or 
 brings it up on the bottle, is guilty of 
 criminal negligence of duty. Her punish- 
 ment will be sure to follow, either in the 
 delicacy of constitution of her child, in the 
 endless annoyances caused by the average 
 wet-nurse, or the troubles incident to bot- 
 tle-feeding, which are far greater than the 
 trouble of nursing. 
 
 Cracked nipples, if neglected, may 
 lead to the formation of abscess of the 
 breast. When, three or four weeks after 
 confinement, the breast becomes hard, hot 
 to the touch, swollen and painful, and the 
 patient has a chill and fever, the child 
 must be kept entirely away from the 
 breast, nursing upon the other side only, 
 and the physician be at once summoned. 
 Poultices must not be applied at this stage, 
 as they encourage the formation of pus. 
 The physician will endeavor to prevent 
 the formation of pus, but in some cases 
 this will be an impossibility. The only 
 
 resource then is to open the abscess, and 
 
 11 
 
162 DURATION OF LYING-IN. 
 
 the sooner this is done the better, for de- 
 lay means more pain, much more destruc- 
 tion of tissue, slower healing, and a far 
 worse scar than does a prompt incision. 
 The question, " How long shall the 
 
 PATIENT REMAIN IN BED ?" is a difficult 
 
 one to answer, inasmuch as different cases 
 require different treatment. Many a tene- 
 ment-house patient gets up and does her 
 housework within three or four days, and 
 considers her neighbor a lazy creature be- 
 cause she lies in bed a full week. She 
 may suffer no inconvenience, and she may 
 live to repent her temerity. In either case 
 her example is not to be followed by the 
 woman of average strength. Some pin 
 their faith upon a " nine-days " lying-in, 
 but this cannot be made into a rule. 
 
 The uterus is gradually returning to a 
 normal size, and on the ninth day it has 
 usually contracted sufficiently to be con- 
 tained within the pelvis ; still this is not 
 always the case, and it is far better to err 
 upon the safe side and remain in bed too 
 long rather than too short a time. No 
 doubt it is irksome to stay in one place 
 
EXAMINATION AFTER LABOR. 163 
 
 after the first exhaustion has passed away, 
 but it is also exceedingly irksome to have 
 to be treated for uterine disease in later 
 months. So long as the discharges are 
 tinged with blood the patient must remain 
 in bed. If they have ceased to be thus 
 tinged, if she feel fairly well, she may on 
 the eighth day sit up in bed for half an 
 hour ; the next day she may be transferred 
 to a lounge, and remain there for a few 
 hours lying down. This may be repeated 
 the following day, after which, if she have 
 not been fatigued by the experiment, and 
 if no flow of blood have followed it, she 
 may sit up in an easy chair for an hour, 
 and increase the period day by day, always 
 lying down again the moment that she feels 
 fatigued. She must not stand on her feet 
 nor walk about for more than a few 
 moments until the tenth to the fifteenth 
 day, nor go down-stairs in less than three 
 weeks, nor out of the house before the fourth 
 or sixth week, and then only in very plea- 
 sant weather. Two or three weeks after 
 labor the physician will probably desire 
 an opportunity of examining the young 
 
164 EXAMINATION AFTER LABOR. 
 
 mother, to ascertain whether there have 
 been any tear of the perineum or of the 
 neck of the womb. The first of these con- 
 ditions is usually repaired immediately 
 after confinement, but there are cases in 
 which it is not deemed advisable. The 
 second condition can be remedied with a 
 slight operation at an early date, but if 
 neglected may lead to inflammation and 
 ulceration, to pain and weakness, which 
 will reduce the patient to a state of semi- 
 invalidism, cripple her usefulness, deprive 
 her of many pleasures, and perhaps years 
 later necessitate a really serious operation. 
 Therefore permission for the examination 
 should be readily granted. 
 
 We have purposely avoided a descrip- 
 tion of abnormal labors, since they can- 
 not be conducted by nurse or friend. A 
 physician's presence is necessary in any 
 labor; but whereas directions can be given 
 for meeting the emergencies of natural 
 labor, the accidents due to malpositions of 
 the child and other grave disasters cannot 
 be described in a book of this nature, nor 
 can directions be given for their treatment. 
 
CHAPTER XIII. 
 
 CARE OF THE INFANT AFTER BIRTH — 
 BATH — DRESSING THE CORD — EXAMI- 
 NATION OF CHILD — ATTENTION TO 
 BOWELS AND BLADDER — 
 SLEEP. 
 
 The care of the child now demands our 
 attention. The tying and severing of the 
 cord, the washing of eyes and clearing of 
 the mouth, have already been mentioned. 
 The bath is next in order. Bathtub, 
 clothes, towels, etc., are prepared near the 
 fire, stove, or register. The nurse sits on 
 a low chair, and may have a flannel apron 
 or a piece of flannel or soft blanket on her 
 lap. The baby at birth is more or less 
 covered with a thick, greasy substance 
 (called the vernix caseosa), which serves 
 the double purpose of protecting it while 
 in the uterus and of assisting it to glide 
 through the maternal parts during labor. 
 This is not to be removed by soap and 
 
166 CARE OF THE INFANT AFTER BIRTH. 
 
 water, but must be dissolved by means of 
 sweet oil or lard. The baby's eyes and 
 face should first be washed with a soft, 
 clean cloth and dried ; then the oil is thor- 
 oughly rubbed on the head and neck, 
 which are then washed with the cloth and 
 water. The chest, back, abdomen, legs, 
 anus, and genital organs are treated in the 
 same way, with especial care to cleanse 
 between all folds of skin where the vernix 
 is thickest. The bathtub is filled with 
 water at 95° to 100°, and the baby im- 
 mersed in it, the nurse's left hand support- 
 ing the neck and head, and her right hand 
 rubbing the body. Soap is not necessary ; 
 the skin of a newly -born infant is so sen- 
 sitive that soap only irritates it When 
 discharges from the bowels occur the ad- 
 jacent parts may be washed with soap, 
 which may also be used upon the whole 
 body when the baby is a few days old. 
 Pure Castile soap only should be used. 
 Upon removing the infant from the water 
 it is at once rolled in a warm, soft towel 
 and rubbed quite dry. If this is thor- 
 oughly done no powder will be needed, 
 
DRESSING OF THE CORD. 167 
 
 except on the genital region ; talc, talcine, 
 powdered starch, or lycopodium are pre- 
 ferable to perfumed toilet powders, which 
 are apt to contain substances irritating to 
 the baby's delicate skin. The baby is not 
 put into a bathtub again until after the 
 stump of the cord has fallen off, but is 
 sponged daily. The genital region should 
 be washed with clear water every time 
 the diapers are changed (which must be 
 done as soon as they are wet or soiled), and 
 powder freely applied. Diapers should 
 never be used a second time without wash- 
 ing. By attention to these details the 
 baby is frequently saved from chafing 
 and irritation of the parts. 
 
 The DRESSING OF THE CORD is the U£Xt 
 
 process in the care of the child, and here 
 the simplest way is the best. It should be 
 carefully dried and dusted over with pow- 
 dered boracic acid. A piece of borated 
 absorbent cotton or soft old linen about 
 three inches square, with a hole in the 
 centre, is slipped over the stump, which is 
 turned upward toward the baby's face and 
 to the left side, and the lower portion of 
 
168 DRESSING OF THE CORD. 
 
 the cotton is turned upward, so that the 
 stump lies between two layers of absor- 
 bent cotton or of linen. A soft flannel 
 belly band is placed over all, and fastened 
 by means of double tapes which pass 
 around the child's body and are tied in 
 front. This bandage should be rather 
 loose than tight. The dressing is left on 
 until the cord comes away; when it falls, 
 on about the fifth day. a small raw surface 
 is left. It must be remembered that blood- 
 poisoning might occur through this little 
 wound, and it must be treated aseptically 
 — that is to say, a little boracic acid in 
 powder may be dusted over it until it 
 heals. After this the flannel belly band is 
 no longer needed. 
 
 The old method of greasing the cord 
 was harmful ; putting on charred rags was 
 in a measure useful, as charcoal is an an • 
 tiseptic ; but boracic acid is easily obtained 
 at the druggist's and is much better for 
 the purpose. When the cord falls off, if 
 there should be any bleeding from the na- 
 vel (the place of detachment) the doctor 
 must be summoned. If there is any delay 
 
EXAMINATION, 169 
 
 in his coming a little styptic cotton should 
 be procured at the druggist's and laid on 
 the bleeding surface. Over that a cent 
 wrapped in a bit of borated cotton should 
 be placed and bound down snugly with the 
 flannel band. This may save the child 
 from bleeding to death. 
 
 After the cord is dressed there should be 
 a careful examination of the child, to 
 ascertain whether it is perfectly f ormed, 
 whether there is an opening to the rectum, 
 etc. Inexperienced persons are sometimes 
 alarmed at the shape of the baby's head, 
 which immediately after birth is very long 
 and drawn out, sometimes with a puffy 
 tumor upon it. The bones of the skull are 
 not solidly united in an infant, as in an 
 adult, but connected by membranes, so 
 that as the head descends through the 
 bony pelvis and the vagina the bones can 
 slightly overlap and thus adapt themselves 
 to the size and shape of the canal through 
 which it travels. In consequence of this 
 " moulding" the head emerges peculiar in 
 shape, and it often requires two or three 
 weeks for it to become of a natural round- 
 
170 MECONIUM. 
 
 ness. There should be no pressure on the 
 head to " shape" it, which some nurses 
 delight to apply. The puffy tumor may be 
 found upon any part of the head, and is 
 usual in tedious labors. The explanation 
 of it is that at the spot where it is formed 
 there happens to be no pressure ; the other 
 portions of the head are pressed upon by 
 the maternal parts, consequently a swell- 
 ing results at this point. It is not beauti- 
 ful to look at, but it need cause no alarm, 
 as it soon disappears. 
 
 The examination of the child being com- 
 pleted, its flannel shirt, diapers, and other 
 clothes are put on, having a care to fasten 
 them with tapes or with shield pins. A 
 cap is not needed, as the circulation in 
 a child's brain is very active just after 
 birth. 
 
 A few hours after birth, as has been said 
 before, the infant is placed at the breast. 
 The colostrum (the substance first secreted 
 by the breast) causes a discharge from the 
 bowels of a dark substance called the 
 meconium. If this is delayed a day the 
 baby should have a pinch of brown sugar, 
 
SLEEP. 171 
 
 or a teaspoonf ul of sweet oil, whey, or oil 
 of sweet almonds. 
 
 If no urine is passed the first day a 
 teaspoonful of cold water may be given 
 or the child immersed in a warm bath. In 
 fact, the baby may have passed water in 
 its bath unobserved by the nurse, so that 
 no real cause for alarm exists. 
 
 After its first nursing the baby may be 
 put to sleep. It is not a good thing to 
 put it in the bed with the mother ; it is not 
 a healthy way for the infant to sleep, and 
 there is danger that the mother may over- 
 lay it. A small crib may be drawn up 
 near the bed, and if the baby from the first 
 is accustomed to sleep in it instead of 
 being rocked in a cradle or dandled in 
 arms, much future unreasonableness on 
 the part of the small sovereign will be 
 saved. Moreover, it has been well stated 
 that when the baby is in the mother's bed 
 its head is often covered with the bed- 
 clothes and it breathes impure air, and if 
 it is restless the mother is apt to put it to 
 the breast to quiet it. This is of all things 
 most foolish. A baby is as apt to cry 
 
172 SLEEP. 
 
 from an overloaded stomach as from an 
 empty one, and the effect of soothing it 
 with a little more milk is like that obtained 
 from eating a second dinner to stop dys- 
 pepsia caused by the first. Often the trou- 
 ble is thirst ; this is not quenched by milk, 
 which is a food and not a drink. A little 
 sweetened water will frequently cause a 
 cessation of the trouble. 
 
CHAPTER XIV. 
 
 DEBILITY IX THE NJEWLY-BORN — 
 
 APPARENT ASPHYXIATION — 
 
 CARE OF THE EYES. 
 
 The child is not always born in the 
 healthy, normal condition which was 
 taken for granted in the last chapter. 
 
 From various causes it may be dead 
 when delivered, and the utmost sym- 
 pathy must be felt with the poor mother 
 who has borne so much discomfort for so 
 long a period/ and such pain at the last, 
 only to be disappointed in her hopes and 
 plans. People are too apt to dismiss the 
 subject lightly from their minds, giving 
 little pity, because the child had not lived 
 long enough for its parents to become at- 
 tached to it, nor for its absence to create 
 any sense of loss. Unquestionably a child 
 endears itself daily, and its death at a later 
 period is harder to bear ; nevertheless the 
 mother usually feels a warm love for her 
 
174 DEBILITY IN THE NEWLY-BORN. 
 
 babe long before its birth, its untimely 
 death causes more sorrow than is under- 
 stood by her friends, and the effect upon 
 convalescence must often be marked. The 
 tenderest care and consideration should be 
 shown to her, and everything done to con- 
 sole and uplift her spirit, not underrating 
 what her loss has been to her, nor seeking 
 to persuade her that her child was too 
 young to have had any individuality and 
 that therefore its death is not to be 
 mourned. To a woman with delicately 
 organized nerves this thought would be 
 pain rather than comfort. Let her rather 
 be encouraged to think that her child ex- 
 isted for a while for a definite purpose — 
 perhaps that she might in its memory do 
 some good thing for some other child in 
 one of the thousand little ways that will 
 suggest itself to the kind heart and fertile 
 brain. Such a thought as this will do 
 much toward sustaining her, and toward 
 inducing her to co-operate heartily with 
 physicians, nurses, and friends in the 
 effort to regain health and strength. 
 
 The child may, when born, present signs 
 
DEBILITY IX THE NEWLY-BORN. 175 
 
 of extreme debility; it may be ema- 
 ciated, its skin pale or bluish in hue, its 
 breathing difficult, and its voice moaning 
 instead of lusty and vigorous. In a hos- 
 pital such cases (often those of prematurely 
 born infants) have frequently recovered 
 by being placed in a couveuse, or incu- 
 bator, a box so arranged that while there 
 shall be perfect circulation of air within 
 it, the child is kept in an atmosphere of 
 great heat. In the hospital in Paris where 
 this apparatus has been used for several 
 years the mortality of prematurely born 
 children has decreased from 66 to 36.6 per 
 cent. 
 
 Persons living at home cannot, as a rule, 
 have such an apparatus, nor do physicians 
 keep them on hand. The hint to be taken 
 from them, however, is to keep the child 
 as hot as possible — from 98° to 100°. The 
 room must be extremely warm, the infant 
 kept in cotton batting with warm flannel 
 wraps over it and hot-water bags and 
 bottles surrounding it. We are told of 
 infants who have been given up as dead, 
 and abandoned in despair and left lying 
 
176 DEBILITY IN THE NEWLY-BORN. 
 
 before a very hot fire; in a little while the 
 extreme heat was found to have resusci- 
 tated them, and they have lived and done 
 well. 
 
 Such feeble children should not be fa- 
 tigued by bathing or by much handling- 
 It is best to oil them, and then to wash 
 them, if possible, in water of about 110° in 
 temperature, or in whiskey, or whiskey 
 and water, at the same degree of heat. If 
 the debility is extreme, even this should 
 not be attempted; the child should simply 
 be wrapped in cotton batting and flannel. 
 It will probably be too feeble to nurse, in 
 which case some of the mother's milk can 
 be drawn into a warm glass or teaspoon 
 (by gently rubbing the breast toward the 
 nipple) and dropped from the finger into 
 its mouth. Or, as recommended by one 
 authority, a teaspoonful of brandy or 
 whiskey may be added to five teaspoonfuls 
 of hot water slightly sweetened, and of 
 this mixture the infant may be given a 
 teaspoonful or two every few minutes, if 
 absolutely necessary, or every quarter- 
 hour, half-hour, or hour. It is claimed 
 
APPARENT ASPHYXIATION. 17? 
 
 that the lives of several feeble children 
 have been saved by this method. 
 
 Occasionally infants are born apparent- 
 ly dead who by patient and intelligent 
 efforts can be revived. The first thing to 
 be done is to make sure that there is nothing 
 in the throat obstructing respiration. The 
 nurse's little finger, covered with a clean, 
 fine bit of linen or muslin, may be crooked 
 and introduced into the mouth, and quickly 
 swept around the throat, dislodging any 
 mucus there. If this should not be suffi- 
 cient to restore breathing, the treatment 
 will differ according to whether the infant 
 is in one of two conditions of asphyxia. 
 In the first the face is red, or bluish, or 
 mottled; the child lies motionless without 
 breathing, while the heart may beat feebly 
 or not at all; the eyeballs protrude and 
 are bloodshot. In this case one of the best 
 things to do is to untie the tape from the 
 navel cord and allow a teaspoonf ul or two 
 of blood to escape, then quickly and firmly 
 tie it again. Sometimes this alone is suffi- 
 cient to restore life. If not, plunge the baby 
 
 into a bathtub of water at about 110° — and 
 12 
 
178 APPARENT ASPHYXIATION. 
 
 always use a thermometer to regulate heat, 
 which must not be guessed at — keep it in 
 for a half-minute, raise it to the surface 
 of the water, and dash very cold water en 
 the face and chest. If the attendant pre- 
 fer not to bleed the child, and if she wish 
 to do something to restore it even before 
 the afterbirth has been delivered, the hot 
 bath can be drawn to the side of the bed 
 upon a chair and the baby immersed. It 
 would be better to cut the cord, letting a 
 little blood escape, tie it, and then practise 
 the immersion. The baby may be plunged 
 into hot and cold water several times alter- 
 nately, ending with the hot water and 
 immediately wrapping the child in flannels. 
 Sometimes the attendant, by dropping a 
 little brandy from a height upon the child's 
 breast, may cause breathing movements. 
 Another way is to hold the baby's nose 
 and, placing the mouth against its lips, 
 breathe into them, then release the nose 
 and remove the mouth so that the air can 
 come out again, which it will be aided in 
 doing by pressure upon the child's sides at 
 the same time. This may be repeated 
 
APPARENT ASPHYXIATION. 179 
 
 every five seconds. A case is on record 
 of a father who, in a hopeless fashion, 
 breathed into his baby's lungs in this man- 
 ner for an hour without any success, but 
 was finally rewarded by slight efforts at 
 breathing on the child's part, who presently 
 breathed naturally and lived to become a 
 strong, healthy man. 
 
 Another method, known as the Sylves- 
 ter method, is to lay the child on its back, 
 with a little pillow or rolled towel under 
 its head ; its arms are then slowly raised 
 above its head and held there for five sec- 
 onds, then pressed down firmly against 
 the sides of the chest. This can be re- 
 peated five or six times, after which the 
 baby should be put in hot water to pre- 
 vent chilling of the body. Then it may 
 be taken out and the Sylvester method 
 tried again. 
 
 If the child is born apparently dead, but 
 the skin, instead of being red and swollen, 
 is extremely pale, the bleeding must not 
 be practised. On the contrary, the infant 
 should not be separated from the after- 
 birth until the pulsations in the cord can 
 
180 INFLAMMATION OF THE EYES. 
 
 no longer be felt. While still attached to 
 the placenta it should be plunged into hot 
 water, and then cold or iced water may be 
 dashed upon the chest and face. If this 
 cause the child to breathe or gasp, a little 
 brandy or whiskey and water, in the pro 
 portions given above, can be administered. 
 If these means fail the cord should be cut 
 and tied, and one of the methods of arti- 
 ficial breathing tried, which must be pa- 
 tiently and systematically persevered in. 
 
 About three days after birth the nurse 
 or attendant should carefully watch the 
 baby's eyes for the first sign of inflam- 
 matory trouble. If a little, thick secretion 
 appears beneath the lids at the corners of 
 the eyes, it should be gently washed off 
 by a clean bit of fine linen, or, better yet, 
 a new camers-hair brush dipped in borax 
 and water (half a teaspoonf ul of powdered 
 borax to a tumbler of water), after which 
 a little sweet oil may be applied. Some- 
 times this will be sufficient to remedy the 
 trouble. When, however, the secretion 
 persists and becomes thick and creamy, 
 the lids being swollen and red, the most 
 
INFLAMMATION OF THE EYES. 181 
 
 active measures must be taken or the 
 baby may become blind. It has been 
 estimated that 71.99 per cent of all per- 
 sons who become blind during the first 
 year of life become so from this disease, 
 which is known as ophthalmia neona- 
 torum, or ophthalmia of the newly-born ; 
 and when one considers that the disease 
 can usually ba prevented by cleanliness 
 and care, pity for the sufferers is mingled 
 with indignation at the ignorance or care- 
 lessness which permits the calamity. 
 
 It will be remembered that the direction 
 was given to wipe the baby's eyes with a 
 clean rag and wash them with a solution 
 of borax in water as soon as it was born. 
 This was with the view of preventing the 
 disease of which we are now speaking, 
 for if the discharges from the mother get 
 into the baby's eyes they are, under some 
 conditions, capable of occasioning the 
 trouble. The danger is not over after 
 birth, however, for carelessness in the use 
 of towels or rags which have been used 
 about the mother and become stained with 
 the discharges has often been the cause of 
 
182 INFLAMMATION OF THE EYES. 
 
 infection. It must not be inferred that all 
 vaginal discharges have this power of in- 
 fection ; it is only when certain diseased 
 conditions exist that they possess it, but, 
 as it is not always possible to tell whether 
 these are present, the safest way is to fore- 
 stall possible evil by prudent care. There- 
 fore the most absolute cleanliness should 
 be the rule in everything that is used 
 about the infant. 
 
 If, however, the disease have already 
 attacked the eyes, unceasing vigilance 
 will be required to combat the foe. Night 
 and day the child will have to be cared 
 for by physician and nurse to save it 
 from blindness. The matter is too serious 
 for home treatment ; moreover, there are 
 certain delicate shades of difference in the 
 conditions impossible of explanation to 
 those inexperienced in diseases, and which 
 require modifications of treatment. If 
 only one eye is affected the other should 
 be protected by a bandage of bichloride 
 gauze, a little square of the gauze being 
 placed directly against the eyelid. The 
 disease is infectious, and the greatest care 
 
INFLAMMATION OF THE EYES. 183 
 
 should be exercised to prevent the dis- 
 charges from getting into the unaffected 
 eye or into the eyes of any of the atten- 
 dants. After washing and dressing the 
 child's eyes the nurse's hands should be 
 washed in an antiseptic solution made 
 with creolin (five teaspoonfuls to the 
 quart) or carbolic acid (two teaspoonfuls 
 to the pint), or, under the physician's 
 directions, of the bichloride of mercury. 
 
CHAPTEE XV. 
 
 INFANT FEEDING — WEANING — DIET 
 AFTER WEANING— BATHING. 
 
 The feeding of infants is a subject of 
 the utmost importance, and the one which 
 causes the most perplexity to the in- 
 experienced mother. We have already 
 emphasized the fact that she should nurse 
 her child herself, if she be in good health 
 and have an abundant secretion of milk. 
 Even if the amount be scanty it is better 
 for her to give the child what there is, and 
 supplement the diet with artificial food, 
 than to resign nursing it altogether. Hu- 
 man milk is the most perfect food for 
 infants; it is, moreover, completely free 
 from bacteria, and can therefore not be 
 the source of infection to the child, which . 
 unfortunately is not the case with cow's 
 milk. 
 
INFANT FEEDING. 185 
 
 Assuming that the mother nurses her 
 own child, the manner and time of feed- 
 ing are of importance. While at the 
 breast it should devote itself to eating and 
 not be allowed to doze and begin again. 
 The breasts should be used alternately, 
 one at each feeding, and after each meal 
 the child's mouth should be washed out 
 with a bit of linen dipped in tepid water. 
 Twenty minutes will usually suffice for 
 each meal. 
 
 We have already stated that the child 
 should be put to the breast as soon as 
 possible after labor. It can be put there 
 at intervals of two hours thereafter. 
 During the first few days it will lose 
 weight, because the fluid secreted then is 
 insufficiently nourishing; little else will be 
 needed, however, unless the baby is fret- 
 ful, in which case a teaspoonful of warm 
 milk and water may be occasionally ad- 
 ministered. 
 
 The following rules have been given for 
 § the feeding of infants, it being understood " 
 that the child is fed less frequently at 
 night than during the day: 
 
186 INFANT FEEDING. 
 
 1st week, every2hrs.; 1 feedings in 24 hrs 
 
 1st to 6th week, " 2J " 8 " " 
 
 6th to 12th " " 3 " 6 " 
 
 At 6 months, " 3 " 6 
 
 At 10 " " 3 " 5 
 
 If a child is nursed too often the water 
 in the mother's milk becomes lessened in 
 amount and the milk is too rich for the 
 infant's digestion; while if the intervals 
 between nursing are too long the milk be- 
 comes thin and watery and is not suffi- 
 ciently nourishing. 
 
 Of course no iron-bound law can be laid 
 down in regard to the intervals of feeding, 
 because constitutions differ and the qual- 
 ity of the milk also differs in different 
 women, but the foregoing are excellent 
 general rules for guidance. Sometimes 
 the baby does not nurse properly and so 
 does not secure all the food that it needs. 
 But it is safe to say, as we have already 
 said, that infants usually suffer from over- 
 feeding rather than underfeeding, and 
 that it is foolish to still every cry by put- 
 ting the child at once to the breast. 
 
 The nursing mother must strictly ob- 
 
INFANT FEEDING. 187 
 
 serve the laws of health if she wish her 
 child to thrive. She should lead a regu- 
 lar, quiet life, free from excitement, 
 should keep early hours, have plenty of 
 fresh air and exercise, and be especially 
 careful in her diet. The infant is exceed- 
 ingly sensitive to changes in the mother's 
 milk produced by indigestion, fasting, 
 fatigue, mental emotion, fits of passion, 
 bodily ailments, certain articles of food, 
 medicines, etc. The mother should eat 
 simple, nourishing food, avoiding spices 
 and condiments and anything known to 
 be indigestible. Coffee and tea may be 
 taken in moderation, but it is a mistake to 
 suppose that a large amount of beer will 
 increase the flow of milk. Milk itself is 
 the best food for that purpose and should 
 be taken regularly and in large amount. 
 Strong purgatives are to be avoided. 
 
 If the physician decide that in the in- 
 terest of the child the mother would better 
 not nurse it, the secretion of milk should 
 be stopped by means of compression 
 exerted by the bandage previously de- 
 scribed. Belladonna ointment should first 
 
188 WET-NURSE. 
 
 be rubbed over the whole breast, and 
 cotton batting distributed smoothly and 
 evenly around the breasts, filling up the 
 hollows, so that pressure may be equalized. 
 The bandage is now put on very tightly 
 and left on for from seven to nine days. 
 If pain is caused the pressure should 
 rather be increased than diminished. 
 
 The choice now must be made between 
 a wet-nurse and artificial feeding. Un- 
 der proper conditions the former is the bet- 
 ter, but the conditions are hard to fulfil. 
 People of moderate means can ill bear the 
 expense, for wet-nurses realize their value 
 and charge high for their services. Per- 
 sons of large as well as those of small 
 means find it hard to stand the exactions, 
 whims, and caprices of the average wet- 
 nurse, who can usually constitute herself 
 absolute monarch of the household by 
 threats of leaving. Moreover, a woman 
 excellently qualified to nourish the child 
 is not necessarily intelligent or properly 
 educated in regard to the care of it in 
 other particulars, and constant supervi- 
 sion is needed in order to insure that the 
 
ARTIFICIAL FOODS. 189 
 
 rules of health are observed. The physi- 
 cian should always be the one to choose a 
 wet-nurse; there are certain qualifications 
 necessary in the way of physical health 
 which he must ascertain, and certain in- 
 vestigations to be made as to the nurse's 
 habits, disposition, the age of her own 
 child, etc. , etc. 
 
 Of all artificial foods, cow's milk is, 
 on the whole, the best. It requires modi- 
 fication before feeding it to an infant, for 
 it is less sweet than human milk, is richer 
 in certain substances, has an acid instead 
 of an alkaline reaction, and forms thicker 
 and tougher curds in the stomach. The 
 greatest care must be exercised to secure 
 the best milk obtainable. It should be 
 fresh, of good quality, and be taken from 
 perfectly healthy cows. It used to be sup- 
 posed that the best results were obtained 
 by having the milk from one cow only, but 
 this the best authorities now consider to 
 be an error. Cow's milk is by no means 
 always the same in its composition, as it 
 depends largely upon the quality of the food 
 which the animal obtains, certain herbs 
 
190 ARTIFICIAL FOODS. 
 
 altering its taste and sometimes its consti- 
 tution. Moreover, during the different 
 periods in the milking the milk varies in 
 quality, and the child usually does not 
 receive a mixture of the whole, but only one 
 portion ; when, on the contrary, it nurses, 
 it as a rule exhausts the whole supply of 
 one breast and thus receives both the 
 richer and the poorer quality. If the 
 " one cow " upon whose milk the baby is 
 fed happens to be diseased there is no 
 escape for the infant, whereas when milk 
 is taken from several cows there will be a 
 less amount from any particular one, and 
 the chances of freedom from taint are 
 better. The milk now obtainable in cities 
 is usually excellent in quality ; we refer, 
 of course, to that sold by reputable dairies. 
 In small grocery stores in crowded dis- 
 tricts the milk is often allowed to stand 
 for hours in a large can, the cover of 
 which often remains off. As a conse- 
 quence the milk absorbs odors and im- 
 purities from the air, is unfit for the 
 stomach of the strongest adult, and a 
 hundredfold more unfit for the delicate 
 
ARTIFICIAL FOODS. 191 
 
 stomach of an infant. It is always best, 
 when possible, to procure the bottled milk. 
 Women in the country are apt to con- 
 gratulate themselves that the milk they 
 obtain is above all suspicion ; so it may be, 
 so it ought to be — so in numberless cases it 
 is not. Who cannot recall a milk room in 
 some farm house whose open window is 
 directly above an open wooden trough 
 through which flows the slop water from 
 the kitchen, or which is near enough to 
 a privy to receive and absorb foulness 
 sufficient to cause many an infantile indi- 
 gestion and diarrhoea ? To rid milk of all 
 forms of impurity and bacteria it is neces- 
 sary to boil, or rather to sterilize, it. Un- 
 fortunately this process is apt to render it 
 more difficult of digestion, and some in- 
 fants who do not thrive upon milk scien- 
 tifically prepared will have to imbibe it in 
 a raw state, but always modified by the 
 admixture of other ingredients, as will be 
 described below. The following direc- 
 tions have been given for preparing in- 
 fants' food. As soon as the milk and 
 cream come in the morning, mix as follows: 
 
192 ARTIFICIAL FOODS. 
 
 Cream ounces 1£ 
 
 Milk ounce 1 
 
 Water ounces 5 
 
 Milk sugar drachms 3| 
 
 (A measuring glass, with the drachms 
 and ounces plainly marked, may be ob- 
 tained at a druggist's. Otherwise the 
 measures may be thus estimated : 
 
 Cream 12 teaspoonfuls or 3 tablespoonfuls 
 
 Milk 8 " "2 
 
 Water 10 tablespoonfuls 
 
 Milk sugar.. . 3^ teaspoonfuls 
 
 but it is far better .to obtain an accurate 
 measuring glass.) This mixture is then 
 heated. A sterilizing apparatus may be 
 purchased by those who can afford it, and 
 one with a perforated cover should be 
 chosen If this cannot be obtained an 
 ordinary kitchen double steamer may be 
 used. A bottle containing the milk mix- 
 ture, which has been poured in through a 
 funnel and its neck plugged with cotton, 
 is placed in the upper portion, while the 
 lower is filled with water, and the whole 
 placed over a gas or alcohol flame or on 
 the stove. After the water begins to boil 
 
ARTIFICIAL FOODS. 103 
 
 the bottle should remain over it for 
 twenty minutes, then be removed and the 
 mixture allowed to partially cool, after 
 which half an ounce (four teaspoonfuls) 
 of lime water is added, the cotton re- 
 placed, and the bottle kept on ice. Lime 
 water may be bought at the druggist's, 
 but a simple way to prepare it is to pro- 
 cure a piece of lime about the size of an 
 English walnut, add two quarts of pure 
 water, and let it stand for twenty-four 
 hours. 
 
 The mixture in the bottle represents the 
 amount of food to be given during the 
 twenty- four hours, and the nursing bottle 
 should be filled from it. 
 
 Should this process of sterilization de- 
 mand more time than is at the mother's 
 command, let her simply boil the mixture 
 just before feeding. 
 
 The estimated cost of the food thus pre- 
 pared is twelve cents a day. The amount 
 of the mixture to be given at each feeding 
 depends upon the age of the infant. In a 
 table given by a reliable authority it is 
 estimated that in the first week one ounce 
 
 13 
 
194 FEEDING BOTTLES. 
 
 is taken at each feeding, with an ave- 
 rage amount of ten ounces in the twenty- 
 four hours. 
 
 One to six weeks, l£-2 oz.; 12-16 oz. in 24 hrs. 
 Six to twelve weeks, 3-4 " 18-24 " "24 " 
 Six months, 6 "36 " " 24 " 
 
 Ten " 8 " 40 " " 24 " 
 
 This is the estimated amount for breast 
 milk, but the rule holds good for this mix- 
 ture, which has been made as nearly as 
 possible to resemble human milk. 
 
 Feeding bottles for infants should be 
 used in preference to a spoon or a cup. A 
 bottle should be chosen which has a rub- 
 ber nipple fastened directly to the top and 
 not connected by a tube. It is almost im- 
 possible to keep the tube clean, and more- 
 over the temptation is great to leave it 
 near the child, who is allowed to suck 
 or not as he feels inclined, even after the 
 supply of milk is exhausted. This prac- 
 tice is extremely harmful. The bottle 
 should be held to the infant's mouth, and 
 suckled, as are the breasts, for fifteen or 
 twenty minutes, then be at once removed, 
 washed in boiling water, kept in water in 
 
PATENT FOODS. 195 
 
 which is borax or else boracic acid, two 
 teaspoonfuls to the pint. Just before fill- 
 ing for another feeding it should be rinsed 
 with boiling water. 
 
 Condensed milk is a favorite with 
 many persons, because it is cheap and 
 easily prepared. It is, however, scarcely 
 nourishing enough to be depended upon 
 for a steady diet, and although a child 
 brought up on condensed milk may grow 
 rapidly and be fat and apparently in good 
 condition, it will probably not be as hardy 
 and vigorous as desirable. However, if 
 the choice be between poor cow's milk and 
 condensed milk, preference should be 
 given to the latter. Frequently, also, in 
 travelling it may be used because of its 
 convenience. It should be diluted with 
 water in the proportion of one teaspoon- 
 ful of milk to one ounce (eight teaspoon- 
 fuls) of water, and if the child is over a 
 month old a teaspoonful of cream should 
 be added. 
 
 Patent foods are occasionally useful 
 as an addition to a milk diet, but they all 
 contain more or less starch, and as the in- 
 
196 WEANING. 
 
 fantfs digestive system is not fully able to 
 cope with starch until it is ten or twelve 
 months old, it can easily be seen that these 
 foods would better be avoided. Yet, as in 
 the case of condensed milk, some children 
 seem to flourish upon their use ; these are, 
 however, exceptional, and are probably of 
 hardy constitution to start with. Milk 
 can usually be depended upon for a per- 
 fect food until the child is weaned . 
 
 The weaning of the infant is the next 
 point to be considered, and for this again 
 no definite law can be laid down. Be- 
 tween the ninth and the fourteenth month 
 is the rule usually given, and a year is about 
 the average. A variety of causes may 
 necessitate weaning at an earlier date. 
 The mother's milk may become scanty or 
 of poor quality, as evidenced by deteriora- 
 tion of the child's health ; the mother may 
 also become ill and unable to nurse. The 
 appearance of menstruation is considered 
 by many persons to be the signal for wean- 
 ing ; and while it is true that this may be 
 required, it should not be hastily done. 
 The condition of both child and mother 
 
WEANING. 197 
 
 should be carefully watched, and if neither 
 seems to suffer, and the baby appears to 
 digest its food properly and to be well 
 nourished, the mother may continue to 
 nurse it. Sometimes the menses appear 
 once, and then disappear again for several 
 months ; it would be a pity to deprive the 
 infant of breast milk in such a case, where- 
 fore let nothing be done in haste. 
 
 Pregnancy, however, as a usual thing, 
 will necessitate weaning. Some women 
 nurse their children for two or two and 
 a half years, believing that they cannot 
 become pregnant during lactation. This, 
 however, is a great mistake, and often re- 
 sults in the suffering of three people — the 
 mother, who has to bear the strain and ex- 
 haustion of nursing one child and carrying 
 a second ; the first child, who is fed upon 
 milk deficient in quality ; and the second 
 child, who is carried by an exhausted 
 mother when it has every right to expect 
 an heritage of the utmost strength which 
 can be given to it, and intra-uterine nour- 
 ishment of the best quality. Weaning 
 should, if possible, be a gradual process. 
 
198 WEANING. 
 
 It should also not occur during teething 
 nor during very hot or very cold weather. 
 The eight incisor teeth usually appear at 
 the twelfth month, which may be taken 
 as an indication that the child is ready 
 for something stronger than milk, which 
 should, however, continue to be the chief 
 feature of its diet for many months to 
 come. At first a little bread and milk 
 may be given instead of one of the regular 
 breast nursings, or a little hominy, oat- 
 meal, or mush in milk. Veal, mutton, 
 and chicken broths may be added later, 
 and beef tea which should contain bread or 
 rice, because in itself it is not nourishing. 
 
 The following dietary has been given for 
 a baby which has been weaned after it 
 has the eight incisor teeth and before the 
 eight molars appear : 
 
 "First meal, 6 a.m.: A cup of milk 
 with cream biscuit, or a slice of buttered 
 bread. 
 
 "Second meal, 8 a.m.: Stale bread 
 broken and soaked in a tumblerful of rich 
 milk. 
 
 " Third meal, 13 m. : A slice of buttered 
 
WEANING. 199 
 
 bread with about half a pint of weak beef 
 tea or mutton or chicken broth. 
 
 "Fourth meal, 4 p.m. : A tumblerful of 
 milk with crackers or a slice of buttered 
 bread. 
 
 "Fifth meal, 8 p.m.: A tumblerful of 
 milk with bread or crackers." 
 
 The child should not be wakened from 
 sleep to be fed, and if it be hungry before 
 the accustomed time it should be given its 
 food. When the sixteen teeth have de- 
 veloped, the following is substituted : 
 
 "First meal, 6 a.m. : Bread or crackers 
 with half a pint of milk 
 
 "Second meal, 8 a.m.: A tablespoonful 
 of oatmeal, cracked wheat, or cornmeal 
 mush with milk and a couple of slices of 
 buttered bread. 
 
 " Third meal, 12 m. : Bread and butter, 
 milk, and a soft-boiled egg. 
 
 c< Fourth meal, -4 p.m.: A piece of rare 
 roast beef to suck, mashed boiled potatoes 
 moistened with dish gravy, bread and 
 milk, and a small portion of bread jelly or 
 farina. 
 
 "Fifth meal, 8 p.m.: Milk and bread 
 
200 baby's bath. 
 
 and crackers ; or give the fourth meal at 
 3 p.m. and the fifth at 6 p.m., so that the 
 child may be put to bed by 7 o'clock/' 
 
 An infant should not be taken in the 
 open air until the fourth or fifth week in 
 summer, and about the sixth or eighth 
 week in winter. It should be kept at 
 home on very windy or damp days, and 
 should always be sufficiently and warmly 
 clad. At home it is well to let it wear 
 short dresses, even in early infancy, in 
 order that it may have a chance to kick 
 its feet about and so develop the muscles 
 of the legs. Creeping is an excellent ex- 
 ercise, but the floor must be free from 
 draughts of cold air. 
 
 The baby's bath should be given daily 
 with the regularity of clockwork; nothing 
 so promotes the necessary activity of the 
 skin. The water should be warm in early 
 infancy, and as summer approaches it can 
 be gradually and almost imperceptibly 
 cooled, until finally a cold bath can be 
 taken and enjoyed. This cold bath will 
 do more to prevent the taking of colds than 
 
baby's bath. 201 
 
 almost any other measure that can be de- 
 vised, besides laying the foundation for a 
 habit conducive to health and vigor. If, 
 after a time, and in spite of rapid friction 
 of the skin with hands and towel after the 
 bath, it is seen that the child shivers, is 
 pale and blue about the lips instead of 
 being in a healthful glow, the cold bath 
 must be stopped and the body be sponged 
 with cold water, drying each portion be- 
 fore the next is washed. Should this not 
 have the desired effect, warm water will 
 have to be used. The brisk and thorough 
 drying is an important part of the bath — a 
 soft towel may first be used, and then the 
 hands ; if skilfully managed the child will 
 enjoy it, and even, when old enough, join 
 in it with his own hands, which will add to 
 the benefit to be derived by joining active 
 to passive exercise. 
 
 Some one once made the remark that 
 " many children were washed out of the 
 world," and the phrase caught the popular 
 fancy, especially of the indolent and not 
 over-neat, and has been the justification 
 of much neglect in this particular. The 
 
202 baby's bath. 
 
 daily bath is a necessity to perfect health ; 
 and even were it not, the marked difference 
 in attractiveness to sight and smell be- 
 tween children who are carefully treated 
 in this respect and those who are not, 
 would render it desirable. An unbathed 
 child has a peculiarly musty odor, percep- 
 tible to all who approach it, with the ex- 
 ception perhaps of those who are always 
 with it, whereas it is the privilege and 
 right of babyhood to be as fresh as a rose 
 and as sweet. "Bathe the baby every 
 day ! " exclaimed a father in one of the 
 New York tenements — " why! that would 
 kill it ! " And the same horrified parent 
 fed the child daily upon beer instead of 
 milk ! 
 
 The question of disease in infancy is 
 foreign to this work. The chief object has 
 been to prepare the young wife for the 
 occurrences and emergencies of pregnancy 
 and labor, and to give a few simple direc- 
 tions for the care of her child during the 
 early months of its life. 
 
INDEX. 
 
 Abdomen, 4 
 
 increase in size of, 14 
 Abscess of breast, 161 
 Afterbirth, delivery of, 149 
 Age of mother as affecting labor, 25 
 Albumin in urine, 21 
 Anaemia, 59 
 
 pernicious, and effect of pregnancy upon, 
 101 
 Antiseptic pads, 122 
 Articles to be provided for infant, 125 
 to be provided for mother, 124 
 to be provided for physician, 129 
 Asphyxiation, apparent, of infant 177 
 treatment of, 177 
 
 Sylvester's method in treatment of, 
 179 
 
 Bacteria, 57 
 
 Bag of waters, function of, 134 
 
 Bandage for breasts, 157 
 
 of leg for varicose veins, 62 
 Bath, baby's first, 165 
 
 baby's daily, 200 
 Bathing during pregnancy, 34 
 Bed for confinement, 116 
 
 feather, objections to, 116 
 
 preparation of, 116 
 
204 INDEX 
 
 Binder, 151 
 
 Bladder, care of, after labor, 155 
 
 disorders of, during pregnancy, 70 
 Blood, circulation of, during pregnancy, 59 
 Bowels, care of, after labor, 155 
 Breast, abscess of, 161 
 
 bandage for, 157 
 
 care of, duriHg pregnancy, 40 
 
 care of, after labor, 155 
 
 changes in, 13 
 
 placing of child to, 156 
 
 pump, 42 
 Breathing, difficulty in, 69 
 Bright 's disease, effect of, upon pregnancy, 99 
 
 Cancer of uterus, effect of pregnancy upon, 
 
 100 
 Care of infant, 1 65 
 
 of mother after labor, 150 
 Caul, 134 
 
 Childbirth dangers lessened, 85 
 Cleanliness, importance of, in preparations for labor, 
 118 
 after labor, 153 
 Clothing for infant, 126 
 
 of woman during labor, 118 
 of woman during pregnancy, 38 
 tight, 39 
 Constipation, 46 
 
 causes of, 48 
 remedies for, 50 
 Consumption, effect of pregnancy upon, 99 
 Convulsions from kidney disease, 76 
 Cord, bleeding of, 168 
 dressing of, 167 
 tying of, 147 
 Corsets, 38 
 Creolin as an antiseptic, 123 
 
INDEX. 205 
 
 Date of confinement, 16 
 
 Debility in newly-born infants, 175, 176 
 
 Development of fetus, 9 
 
 Diarrhoea, 53 
 
 Diet after labor, 1 54 
 
 during pregnancy, 32 
 
 fruit or vegetable, 34 
 
 for child after weaning, 198 
 Douches, internal, 36 
 Discharges, 80, 111, 114, 181, 153 
 Diseases, influence of, upon pregnancy, 97 
 which forbid pregnancy. 97. 99 
 Drainage of house, 27 
 Dry labor, 135 
 
 Epilepsy, liability to be inherited, 99 
 Erysipelas, effect upon pregnancy, 102 
 Examination of pregnant woman, 20 
 
 after labor, 163 
 Exercise, 29 
 Eyes, care of infant's, at birth, 148 
 
 inflammation of, in infants, 180 
 
 Fainting attacks, 68 
 Feeding of infant, 184 
 
 after weaning, 198 
 
 amount of food to be taken, 194 
 
 artificial foods, 189 
 
 bottles, 194 
 
 patent foods, 195 
 
 ^reparation of food, 191 
 Fevers, eruptive, influence of, upon pregnant wo- 
 man, 101 
 
 non-eruptive, 102 
 
 puerperal, 120 
 Friends, visits after confinement, 152 
 
206 INDEX. 
 
 Garters, 40 
 
 Gums, inflammation of, 55 
 
 Haemorrhoids, 65 
 
 Heartburn, 46 
 
 Heart disease, effect of pregnancy upon, 100 
 
 Heating of house, 27 
 
 Infant, apparent asphyxiation of, 177 
 
 bath, first, 105 
 
 bathing, 200 
 
 care of, at birth, 148 
 
 clothes of, 126 
 
 debility of newly-born, 173, 175 
 
 diet after weaning, 198 
 
 examination of, after birth, 169 
 
 inflammation of eyes of, 180 
 
 meconium, 170 
 
 open air, 200 
 
 sleep, 171 
 
 still-born, 173 
 
 urine, 171 
 
 weaning of, 196 
 Insanity effect of pregnancy upon, 99 
 Itching of body, 94 
 
 of genitals, 77 
 
 Jaundice during pregnancy, 105 
 
 Kidneys, disease of, 72 
 
 treatment of disease of, 75 
 
 Labor, conduct of first stage, 137 
 dry, 135 
 
 duration of first stage, 135 
 posture in, 141 
 
INDEX. 20? 
 
 Labor, premature, 107 
 
 preparations for, 115 
 
 process of, 133 
 
 second stage of, 140 
 
 stages of, 131 
 
 symptoms of approach of, 131 
 
 third stage of, 149 
 Laxatives, 53 
 Leucorrhcea, 80 
 " Life," or quickening, 15 
 Lochia, 153 
 Longings, 23 
 Lying-in, duration of, 162 
 
 Malarial fever during pregnancy, 103 
 
 Mark of pregnancy, 93 
 
 Measles, effect of, upon pregnancy, 102 
 
 Meconium, 170 
 
 Menses, absence of, 12 
 
 Midwives, 22 
 
 Milk, cow's, 189 
 
 one cow's. 189 
 
 method of stopping secretion of, 187 
 
 preparation of cow's, 192 
 
 secretion of, 187 
 
 sterilization of, 191 
 Miscarriage, 107 
 
 causes of, 109 
 dangers of, 108 
 prevention of, 112 
 Morning sickness, 13 
 
 Nausea and vomiting, 43 
 
 treatment of, 44 
 Nervous disorders, effect of pregnancy upon, 
 98 
 system, disorders of, 82 
 
208 INDEX. 
 
 Neuralgia, abdominal, 91 
 
 facial, 89 
 Nipples, cracked or tender, 158 
 Nipple shield, 159 
 Nurse, choice of, 22 
 
 wet-, 188 
 Nursing of child by mother, 160, 184 
 
 causes which prevent, 160 
 
 manner of, 185 
 
 rules for, 1 86 
 
 Ophthalmia neonatorum, 181 
 Ovaries, 7 
 
 Pain, abdominal, 91 
 in back, 91 
 in legs, 91 
 Pains, meaning of term during labor, 136 
 Palpitation of heart, 67 
 Pelvis, deformities of, 100 
 Period, monthly, absence of, 12 
 Peristalsis, 48 
 
 Perspiration, amount passed daily, 73 
 Piles, 65 
 
 Placenta or afterbirth, 8 
 Pneumonia during pregnancy, 104 
 Pregnancy, diseases forbidding, 97, 99 
 
 duration of, 17 
 
 essentials of health in, 24 
 
 symptoms of, 12 
 
 symptoms of, perceptible to physician, 
 16 
 Prenatal influences, 18 
 Preparations for confinement, 115 
 Pruritus, 94 
 Purgatives, 53 
 
INDEX. 209 
 
 Quickening, 15 
 
 Rheumatism of uterus, 103 
 
 Room, choice and preparation of, for confinement, 
 115 
 
 Saliva, increased amount, 54 
 Scarlet fever, effect of, upon pregnancy, 102 
 Self control, 31 
 Septicaemia, 120 
 
 Sex of child, determination of, 17 
 Skin, diseases of, 93 
 Sleep, 38 
 Sleeplessness. 86 
 
 Sm^l-pox, effect of, upon pregnancy, 101 
 Superstitions about pregnancy, 22 
 Swelling of feet and legs, 60 
 
 Sylvester's method in treatment of apparent as- 
 phyxiation of infant, 179 
 
 Teeth, care of, 55 
 Thorax, 4 
 Toothache, 88 
 
 Typhoid and typhus fevers during pregnancy, 
 103 
 
 Urine, albumin in, 21 
 
 baby's, delay in passing, 171 
 
 examination of , 21, 72 
 
 incontinence of, 70 
 
 retention of, 71 
 Uterus and appendage, 5 
 
 development of, during pregnancy, 132 
 
 Varicose veins, 61 
 
 veins of genital region, 64 
 14 
 
210 INDEX. 
 
 Ventilation of house, 26 
 Vomiting, 43 
 
 Wart-like growths, 80 
 Weaning of infant, 196 
 Wet-nurse, 188 
 Whites, see Leucorrhoea 
 

 
 
 
 
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