sheets for the bed of a parturient woman, but I will repeat that
old ones are to be preferred, and really new ones, that is, only
once washed, never used. New towels are of course objectionable,
as being too harsh. If the patient likes a rough towel, use a
regular bath towel, if you can get it. Be careful, never to let
loose and wet ends of the wash cloth drag along exposed parts of
the body. It is a good plan to sew your wash cloth into a bag, and
to slip your hand inside, and work with it put on like a mitten. A
rubber or fibre sponge is to be preferred. Keep one for the face,
neck, arms, and hands, and another for the feet and legs. The
vulva is bathed best by means of a fountain syringe used as an
irrigator, and a little sterilized gauze twisted around your
dressing forceps. The gauze can be changed as often as necessary,
and is much more satisfactory than anything else, especially if
there has been a laceration.
The square of rubber sheeting, single width, is most useful. For
the confinement the bed should be made by first spreading over the
mattress the wide rubber sheet, over this put an old blanket, then
the under sheet; upon the right side of the bed, where most likely
the woman will lie, place the square of rubber, over that the old
comfortable, four double, and hold all in place with a sheet
folded like a hospital "draw-sheet." This must be firmly tucked in
at the sides under the mattress. It will seldom be found necessary
to change the under sheet, if the bed is made this way, and the
rubber square is drawn carefully away, with the comfortable and
draw sheet, when it is time to make the patient clean and dry
after the birth. It is a good plan now to tear this square in two,
and keep one piece directly under the clean draw sheet for the
first few days. This saves much washing.
An old blanket and a small one will be found invaluable for all
sorts of things--for example, to spread over the shoulders and
chest when the bandage is being pinned; to warm and wrap up the
feet and legs, if they show any signs of being cold; to cover one
knee and part of the body when using the irrigator, which when
there has been _any_ laceration, is a delicate piece of
business, as every nurse knows. Always fold up this invaluable and
constant friend, and put it in some handy but inconspicuous place;
it _is_ a friend, and a good one; but it is not a beautiful
object to look upon, and others not knowing its virtues would
think you untidy if it was in a noticeable place. The fountain
syringe is absolutely indispensable; and, though it may seem
unnecessarily large, yet I think a four-quart bag better than any
of the smaller sizes. To be sure, you never might need four quarts
in the bag, but it is so much easier managed, so much less liable
to spill over, if you have a large bag and put it only half or
three-quarters full. Then, too, you get so much more force if you
have more water in the bag, you need not use it all. A Davidson
syringe is very nice for some things that a fountain syringe could
not be used for. Oil enemas, for instance, also nutritive enemas.
After an oil enema be sure to wash your syringe _thoroughly_
with a strong solution of washing soda or ammonia, else you will
find the rubber of the bulb and tubing becoming pasty, and your
syringe will be utterly spoiled. The paper basin is very light and
easily handled and much to be preferred to a large china affair,
which may easily slide from warm, wet, slippery hands.
I often wonder that the women of our day, who are so sensible in
many things, should have abandoned the fashion of short night
gowns, which our grandmothers always provided for themselves at
these times. I remember asking one lady, when talking over what
she would need for her first baby, and for herself, at the time of
its birth, if she had not something short and plain that she could
wear. She looked very thoughtful for a moment and then said that
she thought she did have _one_ night-dress that did not have
a ruffle or embroidery around the bottom. She could wear that. It
certainly is not from motives of economy that our wealthy patients
do not have these most sensible of garments. I think they know
nothing about them, and they should have their virtues explained
to them. A pocket could be added to this garment, I think, and it
would be a real comfort to a woman. I know it would be to a nurse,
who usually has to hunt up the ever missing pocket handkerchief a
dozen times a day. Men always have pockets in their night-shirts,
and they are not sick half as much as the women. I wonder why
women do not imitate this most sensible custom. If your patient
will not let you cut off any of her old night-dresses, you must
use the long ones, of course, and change them as often as
necessary.
Bandages should always be made of soft unbleached muslin; double
is best, though I have used them of the single fold, and hemmed,
but they are firmer if double. They should be wide enough to come
down to the great trochanters, and up to a place two inches above
the umbilicus; long enough to fit the woman before she became
pregnant. She has likely some measure, or could get it from her
dress-maker. Women vary so much, it is hard to give an exact
measure in inches, but you might begin with a bandage fifty inches
long, and if the ends are too long, cut them off, and turn in the
edges of the cloth and overhand it neatly.
Obstetrical binders, or bandages are now seldom put on a
parturient woman, but in case they are to be used, I give the best
kind I know of. They are sometimes made to order, but I never knew
one of these to fit, or wash well.
The method of their application is of course taught in the
schools. The nurse should always know from the doctor, or the
prospective patient, if binders are to be worn, and instructions
given as to how to make them. Four or six will be enough.
Two or three yards of soft, unbleached muslin for breast-bandages
should be provided in case they are needed. A six-tailed bandage
is, I think, the best for this purpose. Tear down the first two
"tails" to within three inches of the others, and these passing
over the shoulders, and fastening to others, which are adjusted
over the breasts, keep the whole bandage in place.
It is not necessary to speak of the napkins or pads; these are
universally used, and readily bought, sterilized, and ready for
use. All sterilization is so thoroughly taught in the schools, I
have taken proficiency in this particular for granted.
There should always be a disinfectant or antiseptic of some sort
on hand.
Carbolic I-30, Platt's chlorides, permanganate of potash, or
something that will answer the purpose; bichloride of mercury,
etc. You must find out from the physician which he prefers, and of
what strength.
I must not forget to say that when you go to see you prospective
patient, and she shows you the room she expects to occupy, it
would be well to cast your eyes about for some rug, that you can,
if necessary, turn wrong side out and spread at the side of the
bed. Some doctors are very neat about their work, but some are--
well, perhaps I better not say it; we must not criticise the
doctors.
But sometimes it is best to have protection for the floor, it
gives the nurse a comfortable feeling quite beyond description to
know, that, no matter what may happen, the carpet will not be
ruined.
XII
AS TO WASHING THE BABY
In the first place get together everything you will need for the
bath and subsequent dressing. Have the clothes all laid in order
over a chair-back before an open fireplace, or over a radiator, or
if no better expedient suggest itself, fill bottles with hot
water, or get a hot water bag and fill that, and lay it
_over_ the clothes arranged in the order you will need them,
beginning the pile with the dress and having the band the last.
Have _two_ large, soft towels and keep them warm. If possible,
have an apron made of rubber cloth to tie about your waist.
At your side, on the floor, have a small blanket ready to
lay over the rubber apron when needed. Put your baby basket where
you can reach it, be sure that it contains all the things you will
need--sponge, soap, powder, pins, vaseline, etc., and an extra
diaper or two. Now get the tub (tin) and pour in the water until
it is about four inches deep. Have the water no warmer than 100 degrees
F. Bath thermometers are made that are quite cheap, and a great
convenience; one should always be at hand, as no nurse should ever
trust her feelings as to whether the water is hot enough or not.
Always test any water to be used for the sick or the delicate with
a thermometer. Another point a nurse should be most careful about,
is to be careful that her hands are warm before she takes the
baby, as her cold hands on his warm flesh will surely make him
scream.
All being now ready, take the baby and sit down with him,
spreading the blanket over your knees as you do so, and having the
tub just in front of you on another chair. The sponge is best to
use for the washing, but a piece of old table damask is very good.
Wash the eyes very carefully first, then the face, and dry on the
towel. Now hold the baby's head over the tub and give that a good
washing with soap on your bare hand, and rinse it well with plenty
of water, always holding the left hand under the head and neck.
Bring him back on your lap and thoroughly dry his head, then wash
and dry the ears carefully.
When you get this far you may undress the baby completely, being
most careful yet not taking any unnecessary time. When he is quite
ready for the tub, grasp him firmly with the right hand, letting
the buttocks rest in the palm of the hand, the fingers being
outspread, and the thumb coming up almost to the pubic bone. With
the left hand hold the head and shoulders. Lower him _very_
gently into the water. Any sudden movement is most injurious, as a
baby must never cry when the band is off, if it can be avoided. He
will often put out both hands as if trying to catch hold of
something. If he seems frightened at the same time, and cries
violently, let the buttocks rest on the bottom of the tub, and
with the right hand hold both of his, and he will be comforted.
I think it well to wash the whole body with your bare hand, well
soaped. Be careful to wash under the arms, in the bend of the
elbows, the groins, and under the knees, rinse him with the wash
cloth or sponge, and now lay one warm towel on your lap, and take
up the baby just as you put him in, slowly, and without shock, and
lay him in the warm towel. Lay the second one over him, and draw
over all the blanket, wrapping him up warm and snug. Put your hand
inside the blanket and dry him. This can be easily and quickly
done without at all uncovering the child. Pass the hand with a
slight squeezing movement over each arm and leg, and over the
front of the body. When this is done, you must undo the blanket,
and take the upper towel and dry most carefully all the creases,
and powder everywhere, especially if he is very fat. Get down to
the very bottom of every crease, and be sure it is dry and
powdered. Lay over the navel a compress of absorbent cotton,
unless the child is over four weeks old, and over this the band,
which should be unhemmed, and wide enough to extend from the hip
to the armpit. Lay the palm of your right hand firmly over band
and pad and turn the child carefully, holding your right hand
still under him, and with the left, clear away all damp towels,
and then straighten out the band that is wrinkled under one side.
Keep your knees close together. Now take away the right hand, and
see that the baby's knees are on the right side of your knee, and
the elbows well over the other side of your lap. Now you have the
baby where he can kick, but he can't wriggle or spring off your
lap. See that the back is dry, rub it a little with your hand, and
powder. Look carefully in the deep dimple just at the coccyx and
see if it is clean. Now pin the band snugly, but not too tight.
Use the smallest safety pins, and never pin directly over the
spine. Sometimes the abdomen is very large and it will be
necessary to make two little tucks in the lower edge of the band
in front to make it fit snugly.
While the baby is still on his stomach, lay in place the diaper,
and next the shirt, which should be open in the front, and the
pinning blanket. Lay all of these just as they should be, as
regards the back, and turn him, being careful to hold all the
clothes in place. If he is liable to chafe, or the movements of
the bowels are in any way irritating, use vaseline about the
buttocks. Now put the arms in the shirt sleeves and tie or button
it up, and then pin the petticoat or pinning blanket. Lay an extra
diaper folded many times under him, and fold the pinning blanket
just in three, bring the hem up to the waist and pin in place.
The dress goes on feet first. Slip it on over the pinning blanket,
and pass the right hand up under the buttocks, and with the left,
pull the dress into place, put the little hands in the sleeves,
and get it perfectly straight and smooth over the chest. Now pass
the fore-finger of the left hand down inside of all the clothes,
beginning at the neck, until you find the band (the first
garment), take a small safety pin or any small ornamental pin, and
pin thoroughly through everything. This last pin I consider most
necessary, as it keeps the dress, shirt, band and all in place.
Turn the baby over once more and put a similar pin in the back of
the dress, being very careful to get at the band. While the baby
is in this position put the blanket he wears during the day over
him, and a final turn brings him around, and he is washed and
dressed all but his mouth, which must be carefully washed with
clean, warm water or borax and water. This should be also done
many times each day, if the mouth is sore, and always a sharp
watch kept for white patches on lips, cheeks and tongue. If the
baby has hair to brush, it is well to brush it. It makes him look
very cunning, but if he is tired or sleepy, do not trouble him.
This washing and dressing should not occupy more than twenty
minutes, I have done it in fifteen where the baby was very well
behaved.
Be sure that the room is warm and that the windows and doors are
kept closed. Do not allow admiring relatives to come and go,
opening and shutting the doors as they do so. If they want to see
the operation, let them come and stay. A baby should never be
bathed in a tub until the stump of the cord is off and the navel
well and strong. If there is any inclination to pouting of the
navel, wash the child on your lap and do not take off the band
until the rest of the baby is all washed, dried, and powdered.
Then take off band and compress, and put on fresh ones as quickly
as possible, turn the child and pin as before directed.
In taking the clothing off, it is not necessary to turn the child
at all, the band being the only thing pinned in the back.
N. B.--This method of bathing is for a normally healthy child,
from the time it is one week old, until it is six months or more.
Until the stump of the cord has sloughed off, a baby should never
be put into the tub. If after the stump has sloughed there seems
to be any protrusion, or indeed any ulcerated look about the
naval, it is best to bathe the child on your lap. In all such
cases undress the baby as previously directed, until you come to
the band (flannel belly band). Wash, rinse, wipe and powder him,
being careful to make every part absolutely clean and dry. If the
band is soiled or wrinkled, or out of shape in any way, remove it
and put on a fresh one--looking every day, after three days, to
see if the stump has come off--and if it is still adherent, being
most careful not to disturb it in any way. Apply the fresh band
immediately. Turn the baby on its stomach, and when the back is
exposed, wash and rub the back gently with your warm hand. If the
band does not need changing, unpin it, rub the back, pin it up
again, and proceed in dressing as before. When the cord is once
fairly off, and the navel smooth and clean, you can put the baby
into the tub, very gently, slowly, and cautiously, remembering
that a sudden movement on your part may, in fact, always will make
him scream, and screaming with no band or compress on is for a
baby a very frequent cause of umbilical hernia. If the cord is
small when the child is born, there will be less danger of hernia,
but if it be a large one, then beware! It will not always be your
fault if the baby's navel is not small and flat when you are
leaving your case, but you will always be blamed for it, if it is
not. Notice carefully every morning when you bathe the child if
there is any umbilical protrusion, and report it without delay to
your doctor, if there is any, no matter how slight. This is not,
however, the place to treat of umbilical hernia, and we will go on
with the washing, If the child's skin is very tender, chafing
easily, wash with castile soap suds, rinse and dry carefully,
after every time he urinates, as well as when you bathe him.
Powder with talcum powder. Sometimes no powder will do it any
good, then try vaseline. If that will not do, ask the doctor if
you can try oxide of zinc ointment. Ordinarily, extreme care in
washing, drying and powdering will be sufficient, but it must be
done every time the diaper is changed. In this, as in other
things, eternal vigilance is absolutely necessary.
When the baby is about two or three weeks old, it is a good plan
to put some alcohol into the water in which he is bathed--two or
three ounces to the amount of water used in bathing. Have a small
bowl of cooler water, 70 degrees to 80 degrees, for the face, and
after that is washed, add a tablespoonful of alcohol to that also,
for the head. It helps to toughen the skin, and prevents the baby
from taking cold so easily.
If the baby seems much frightened by being put into the tub,
spread a bath towel or small thin blanket over it and have someone
hold his hands, so that he will not clutch so wildly at
everything, then lower him into the water, towel and all, and he
will not notice it so much.
I know of no place where deftness of handling shows to such
advantage as with a baby. He knows well enough if he is handled
properly or not, and his fretful cry, or violent screams, will
tell you without delay if he is not comfortable.
Once more, let me impress upon the minds of all who read this, the
necessity of having everything used about the tub and subsequent
dressing, warm. Anything cold will make the little one scream, and
I think all nurses will agree with me, that there is no more
nervous work than washing and dressing a baby who is crying (and
once he begins, he is only too apt to keep it up during the entire
time). This is especially true if a weak, ignorant mother is made
nervous by the noise, or a doting grandmother hovers about, making
remarks about "new fashioned ways," and wondering why this child
should cry when his mother was always so good, as a baby, in her
bath.
Now, as to the time of washing a baby. The morning is
unquestionably the time, but if the baby be very young (less than
two weeks) and has been wakeful during the night, I would let him
have his nap, even if it did delay you and interfere with your
plan of work. If he sleeps he is comfortable, and, unless for some
more serious reason than the bath, he ought not to be disturbed.
This, for babies in private practice. Hospital babies cannot be so
tenderly cared for. When there are ten or eleven to be washed in
one morning, choose, of course, the ones that are awake, as far as
you can, but there will always be one or two sleepy, warm little
ones about whom you will have some twinges of conscience as you
begin to wash their faces, but the work presses so, it must be
done.
A baby should not be bathed just after nursing, or when he is
hungry. Yet, most little babies go to sleep at the breast, and
very often do not waken until they are once more ready for eating.
This seems like stating a difficult problem, and I know it is not
always easy to select just the proper time, but the best way, I
think, is this.
If the baby is nursing from the breast, tell the mother, after
this nursing you wish to wash the child, and not to let him go off
for sound sleep. She can prevent it, and keep him for the twenty
minutes or half an hour it is necessary to wait after his meal,
meantime you have time to get everything in readiness for the
bath. It is a great mistake to attempt to bathe a baby when he is
hungry. He will scream for his food from the beginning to the end
of the performance, hesitating occasionally when something warm
touches his mouth, and he eagerly seeks his meal, only to redouble
his cries when not satisfied. Nothing is so persevering in its
endeavors, as a hungry baby. Satisfy its appetite first and wait a
reasonable length of time, wash him deftly and quickly, and he
will be so sleepy by the time you are through, you can lay him in
his bed and he will be asleep in a moment, when you can pick up
all the soiled clothing and the general "mess" of the bathing
operation, and leave the room once more tidy.
And just here, let me say a little about the washing of the baby's
clothes. Of course the dresses or slips, skirts, and the diapers
go to the laundress. Begin every morning on an entirely new, that
is newly-washed, set of diapers. Gather up all that have been used
the past twenty-four hours and have them washed. Perhaps they may
not be ironed, but washed they should be, every twenty-four hours,
even if you have to do it yourself, and I do not think a nurse
should ever be called upon to do this. Still, I would rather do it
than use a diaper over and over again.
But it is of the little shirts I particularly wish to speak. I
think the nurse should wash these, also the socks when they need
it, and the knitted shawls most babies wear. It takes very little
time to do this, and if you know how, you will do it much better
than any laundress. The best way to wash these things is in cool
borax water, and if there is any one place the baby has vomited
on, put a little dry powdered borax on (the place being wet), and
rub it in. Then wash by plunging it in the water and squeezing it
out. Do this again and again until the garment is clean. Rinse in
clear cool water, and wring as dry as possible in a towel; then
pull in shape and lay it on a clean towel to dry. It is a good
plan to lay it on a folded towel over a half shut register and
place a single fold of towel over. It will dry very soon. If you
are washing a baby's knitted shawl, be very careful about the
wringing. Lay a large towel (bath towel is the best) out flat,
and, having squeezed the most of the water from the blanket, lay
it carefully on the towel and roll both together, and wring very
tightly. If this towel gets wet take a second. When you are
satisfied that it is as dry as you can make it, lay it out on a
folded sheet on the floor, in some room not much used, and pull
and arrange it into its original shape and size.
Anything made of Germantown wool stretches terribly, but you can
arrange it as it ought to be. It will look ruffly here and there
and ridgy all over, but when it is dry it will shrink down all
right. Only do not hang it up, and when it is dry you will be
surprised to find it looks as good as new. If you are ever
consulted beforehand as to what would be nice for the baby, use
all your eloquence against _any_ color being put into these
knitted shawls. Germantown wool is the best to use, and plain
knitting or brioche stitch is the best to wear and wash, and these
things must be washed with the most careful handling. On the
nicest baby they will become dirty, and the delicate blues and
pinks become the dismalest wrecks when washed. Therefore, tell
your patient not to put any color in these first plain little
comfortable shawls. They should be a yard long by about three-
quarters wide. Two or three will be all you will need, and do not
use any of the fancy blankets sent in by friends. Lay these all
away, with a sachet bag or two, in some convenient drawer, and
never take them out unless the baby is required to look very fine
for a brief display to some friend. These delicate, fancy trifles
when once wet through or vomited on are ruined, and it should be
your aim to leave everything as good as you found it when you go
from the house. There will be plenty of time after you have left,
for the fond mamma to spoil all the pretty things, and as she does
so she will appreciate more and more your care of them.
XIII
THE VALLEY OF THE SHADOW