OBSTETRICS
FOR NURSES
BY
CHARLES B. REED, M.D.,
Obstetrician to Wesley Memorial Hospital, Chicago.
_ONE HUNDRED THIRTY ILLUSTRATIONS_
ST. LOUIS
C. V. MOSBY COMPANY
1917
COPYRIGHT, 1917, BY C. V. MOSBY COMPANY
_Press of
C. V. Mosby Company
St. Louis_
TO HIS LOYAL FRIEND
EUGENE S. GILMORE
THIS BOOK IS AFFECTIONATELY DEDICATED BY THE AUTHOR
------------------------------------------------------------------------
PREFACE
It might seem that an apology was necessary for presenting a new
textbook on obstetrics for nurses when so many are to be had for the
asking. But when a teacher is rarely or never satisfied with his own
work it is too much to expect that he will ever fully endorse the
product of another. It may be therefore largely a personal matter that
none of the existent books seem to exhibit the fullness of information,
the conciseness of expression, and the emphasis due to certain subjects
that the present writer would hope to find.
The necessities apparently demand such an arrangement of our obstetrical
doctrine that the book may serve for class instruction and at the same
time be complete enough for post-graduate reference.
To secure this much discrimination is necessary. The confusion attendant
upon overabundance must be avoided as well as the discouragement that is
not infrequently produced by a large book or a periphrastic style.
Hitherto there has been a tendency to teach the nurse too little rather
than too much but conditions have changed. Vocational instruction is not
only more methodical and far reaching but it is developmental. The
present day nurse expects not merely to assist the physician and earn a
stipulated reward, but she is constantly alert to attain her own
maturity as a professional woman.
To be a capable and intelligent assistant it is not sufficient to have a
clear comprehension of her particular duties, but she must have a
defined and critical conception of what the doctor is aiming to
accomplish.
This is especially true in obstetrics where the nurse has the additional
responsibility of giving support and counsel to her patient in the
various emergencies that arise. Moreover, to attain her intellectual
maturity the nurse must strive unremittingly to understand the
complicated processes that take place under her observation.
She must cooperate with her doctor whose associate she is and secure the
confidence of her patient who relies upon her for guidance in the perils
she is facing. For childbirth is a peril. It is no longer the normal
process it once was. Civilization has changed the shape of the pelvic
bones, altered the muscles of parturition and weakened the nerve centers
that control the event.
The birth of a child is equal in severity and seriousness to many of the
major operations. It is not an affair to be entered upon lightly nor
managed without the utmost foresight and care.
The dangers that are recognized and prepared for in this book by what
may seem to some to be an extravagant technic, are very real dangers,
extremely subtle, and against them at times every precaution and every
defense proves unavailing.
Nevertheless, skill, thoughtfulness, and above all, cleanliness, will
avert the worst, as well as unhappily the most common of these
disasters. If our nurses could be convinced of this, the difficulties
and apprehensions of childbirth would be greatly diminished.
The nurse should see to it that her patient is surrounded by all the
precautions and safeguards against infection that she would demand for a
member of her own family. This means of course that her work will be far
more exacting and onerous but also it will save many nights of anxiety
and not infrequently a life.
This book represents the obstetric ideas and technic which the writer
has endeavored for years to impress upon his students and nurses with
such emendations and changes as experience and scientific progress have
suggested. It is a selective essence distilled from the recurrent
harvests that workers in this field have brought forth during centuries
of consecrated effort. To all these forerunners the writer acknowledges
a deep personal indebtedness.
In the preparation of the book thanks are due particularly to Charlotte
Gregory, Head Nurse of the Wesley Maternity, whose rare ability as
teacher, technician and executive and whose untiring vigilance has been
a leading factor in securing and maintaining the high state of
efficiency in this department. She has kindly contributed Chapters XXIII
and XXIV, together with valuable suggestions and criticisms in other
portions of the text.
The author also takes pleasure in acknowledging his obligations to
Florence Olmstead, Head Nurse of the Dispensary of the Northwestern
University Medical School, whose long experience in feeding babies gives
to her words an unquestioned authority. Chapter XXII is almost entirely
her work.
To the various publishers who have courteously allowed the reproduction
of valuable illustrations from the books of other writers thanks are
also extended, and to his own publishers especially for their cordial
and sympathetic cooperation the author wishes to express his warmest
gratitude.
C. B. R.
Chicago, 1917.
CONTENTS
CHAPTER I
PAGE
ANATOMY 17
CHAPTER II
PHYSIOLOGY 33
CHAPTER III
NORMAL PREGNANCY 51
CHAPTER IV
HYGIENE OF NORMAL PREGNANCY 66
CHAPTER V
ABNORMAL PREGNANCY 74
CHAPTER VI
ABNORMAL PREGNANCY (CONTINUED) 89
CHAPTER VII
PREPARATIONS FOR LABOR AND THE NORMAL COURSE OF LABOR 98
CHAPTER VIII
THE MECHANISM OF NORMAL LABOR 120
CHAPTER IX
THE CARE OF THE PATIENT DURING NORMAL LABOR 129
CHAPTER X
THE NORMAL PUERPERIUM 151
CHAPTER XI
UNUSUAL PRESENTATIONS AND POSITIONS 165
CHAPTER XII
OPERATIONS 179
CHAPTER XIII
MINOR OPERATIONS 200
CHAPTER XIV
COMPLICATIONS IN LABOR 214
CHAPTER XV
COMPLICATIONS IN LABOR (CONTINUED) 228
CHAPTER XVI
THE ABNORMAL PUERPERIUM 242
CHAPTER XVII
INFECTION 255
CHAPTER XVIII
THE CARE OF THE CHILD 265
CHAPTER XIX
THE CARE OF THE CHILD (CONTINUED) 278
CHAPTER XX
THE CARE OF THE CHILD (CONTINUED) 287
CHAPTER XXI
THE CARE OF THE CHILD (CONTINUED) 298
CHAPTER XXII
INFANT FEEDING 310
CHAPTER XXIII
CLEANLINESS AND STERILIZATION 323
CHAPTER XXIV
DIETS AND FORMULÆ 330
CHAPTER XXV
SOLUTIONS AND THERAPEUTIC INDEX 340
ILLUSTRATIONS
FIG. PAGE
1. The normal female pelvis 18
2. The planes of the brim, the cavity, and the outlet 19
3. Visceral relations 20
4. Uterus and appendages 22
5. Normal position of pelvic organs 24
6. The external genitals 25
7A. Varieties of hymen 27
7B. Varieties of hymen 28
8A. The excreting ducts of the mammary gland 29
8B. Lobules and duct of the mammary gland 29
9. Nipple, areola, and the glands of Montgomery 30
10. Supernumerary milk glands in the axillæ 31
11. The three ages of the breast 31
12. Development of the ovary 34
13. Graafian follicles 35
14. Human spermatozoa 36
15. The chorionic villi about the third week of pregnancy 38
16. Diagram illustrating relations of structures of the
human uterus at the end of the seventh week of
pregnancy 39
17. Maternal surface of the placenta and membranes 40
18. Fœtal surface of human placenta 41
19. The egg at term with uterus removed 42
20. Normal attitude of fœtus 43
21. Fœtal skulls showing sutures 44
22A. and B. Child’s head at term, showing diameters 45
23. The fœtal circulation 49
24. Gravid uterus at the end of the eighth week 52
25. Striæ gravidarum 54
26. Bimanual examination 60
27. Abdominal enlargement at different months of pregnancy 63
28. Height of the uterus at various months of pregnancy 64
29. Twins 83
30. Diagram representing the sites for the various forms
of tubal pregnancy 90
31. Abdominal binder with crosspiece to hold vulvar pads 100
32. T-binder, used in all cases after the fifth day post
partum 100
33. Breast binder 101
34. Baby’s dress with winged sleeves 102
35. The bag of waters begins to act on the cervix 111
36. The effect of the pains. The cervix before labor
begins 112
37. The effect of the pains. The cervix begins to be
“effaced” 112
38. The effect of the pains. The cervix is effaced, and
the dilatation of the os begins 113
39. The effect of the pains. The cervix is effaced and the
os continues to dilate 113
40. The cervix is effaced and the os dilated 115
41. Child in second stage of labor 116
42. The head passing over the perineum 117
43. Normal expulsion of the placenta according to Schultze 118
44. The child in left-occipito-anterior position 122
45. The child in right-occipito-anterior position 123
46. The descent of the head in right-occipito-anterior
position 124
47. Internal anterior rotation and extension of the head
in a left-occipito-anterior position 124
48. Extension 125
49. Extension completed. Expulsion 125
50. A cephalhæmatoma 127
51. Points of greatest intensity of fœtal heart tones 130
52. Handling forceps, kept sterile in a jar of alcohol 132
53. Palpation. What is in the pelvis? 134
54. Palpation. What is in the fundus? 135
55. Palpation. Where is the back? Where are the small
parts? 136
56. Patient draped for internal examination 137
57. Delivery in side position 141
58. Sheet twisted into a sling 147
59. Repair of perineum 148
60. The progress of involution 152
61. The breech. Left-sacro-anterior position 166
62. The breech. Left-sacro-posterior position 167
63. Extraction of the breech 170
64. Breech delivery. Extraction of the trunk 171
65. Breech delivery. Delivering the shoulder 172
66. The delivery of the after-coming head by the
Smellie-Veit maneuver 172
67. Shoulder presentation 173
68. Face presentation 175
69. Descent of the chin in face presentation 176
70. Delivery in face presentation 177
71. Exaggerated lithotomy position 181
72. Dorsal position when assistants are available 182
73. Instruments for artificial delivery of the head 183
74. Forceps operation. Introduction of the left blade 186
75. Forceps operation. The introduction of the right blade 187
76. Forceps operation. Locking the handles 187
77. Forceps operation. The way the blades should grasp the
fœtal head 188
78. Forceps operation. Traction on the handles 189
79. Forceps operation. The delivery of the head 189
80. Version. Seizing a foot 190
81. Version. The child rotates as pressure is made upon
the head and traction upon the foot 191
82. Version is complete when the knee appears at the vulva 192
83. The Walcher position 194
84. The Wiegand compression of the child’s head to force
it into the pelvis 195
85. The Naegele perforator 196
86. Apparatus for getting a sterile specimen of urine from
an infant 201
87. Tampon of the uterus 203
88. Tampon of vagina 204
89. Pean forceps 208
90. Hand bulb syringe; and Vorhees bags; bag rolled and
grasped by Pean forceps ready for introduction 209
91. Vorhees bag in place 210
92. Episiotomy 212
93. Various forms of pelvic deformity 215
94. The pelvimeter 216
95. The various diameters of the inlet 216
96. Measuring the distance between the anterior superior
spines of the pelvis 217
97. Measuring the external conjugate 218
98. Measuring the diagonal conjugate with the finger 219
99. Various forms of placenta prævia 229
100. The knee-elbow posture 236
101. The knee-chest posture 236
102. The exaggerated lithotomy position obtained with a
sheet sling 237
103. The improvised Trendelenburg position 237
104. The dorsal position with stirrups 238
105. Dorsal position across the bed 239
106. Flexed dorsal position with feet on the table 240
107. The Sims position 241
108. Examples of imperfect nipples 245
109. A standard nipple shield 246
110. A standard breast pump 251
111. Germs most frequently found in cases of puerperal
fever 256
112. Rubber bath tub 266
113. The Pettit cord clamp 268
114. Standard breast pump; Standard nursing bottle; the
breast tray; the Wansbrough lead nipple shield; the
Brophy nipple for harelip and cleft palate 271
115. Proper position of mother while nursing child 274
116. Proper method of taking rectal temperature 276
117. Method of passing the tracheal catheter 279
118. Byrd’s method of artificial respiration. Extension and
inspiration 280
119. Byrd’s method of artificial respiration. Beginning
flexion and expiration 280
120. Byrd’s method of artificial respiration. Flexion and
compression 281
121. Method of giving gavage 284
122. Apparatus for gavage or lavage 286
123. Cleft palate nipple 288
124. The device for feeding the child with cleft palate 288
125. Device for assisting the cleft palate child to nurse 289
126. Method of strapping an umbilical hernia 290
127. Proper position for introduction of a suppository 299
128. Hydrocephalus 307
129. Anencephalus 308
130. Elements of human milk 312
OBSTETRICS FOR NURSES
CHAPTER I
ANATOMY
The study of obstetrics is an investigation of the passage, the
passenger, and the driving powers of labor, as well as of the various
complications and anomalies that may attend the process of reproduction.
The passage is composed of a bony canal, called the pelvis, and the soft
tissues which line and almost close its outlet.
=The pelvis= is made up of four bones; the sacrum, the coccyx, and two
other large structures of irregular shape, called the hip, or innominate
bones. Joined by cartilage and held in place by ligaments, they form a
cavity or basin which, in the male is deep, narrow, small and
funnel-shaped, while in the female, slighter bones, expanded openings
and wider arches make a broad, shallow channel, through which the child
is born.
The bony pelvis is divided for description into two parts, the upper or
false pelvis, and the lower or true pelvis. The upper pelvis is formed
by the wings of the innominate bones and has but two functions of
importance to child-bearing. It acts as a guide to direct the child into
the true passage, and when measured by the pelvimeter, it gives
information as to the shape and size of the inlet to the true pelvis.
The true pelvis is of most concern to the obstetrician, because
anomalies in its size or shape may impede the progress of labor or
render it impossible. The pelvis is divided conveniently into three
parts: the brim, the outlet, and the cavity.
The _brim_, _inlet_, or _upper pelvic strait_, is the boundary line
between the false and true pelvis. It is traced from the upper border of
the symphysis along the iliopectineal line on both sides to the
promontory of the sacrum. The shape and size of this opening varies much
in different races and individuals, both normally and through disease;
and when pathologically altered, both shape and size may exercise a
marked influence on the course of labor. In American women, the outline
of the brim is roughly heart-shaped, like an ovoid with an indentation
where the promontory of the sacrum impinges upon the opening.
[Illustration: Fig. 1.—The normal female pelvis. (Eden.) The lines _ab_
and _cd_ divide the pelvis into the right and left anterior and the
right and left posterior quadrants. _ab_ indicates the anteroposterior
diameter of the brim, _cd_ shows the transverse diameter while _gh_ and
_ef_ represent, respectively, the right and left oblique diameters.]
The brim or inlet has four important diameters to be remembered;
important because the hard, round head of the child must pass through
them by accommodating its diameters as favorably as possible to those of
this opening. These diameters are named respectively the anteroposterior
or conjugate diameter, the transverse, and the right and left oblique
diameters. The two oblique diameters attain their greatest importance
when the pelvis is irregularly distorted, but the others are essential
in every case where labor impends. It is to secure an estimate of these
latter diameters that the bony prominences are measured. This upper
opening lies not horizontally, but in oblique relation to the body in
standing position, and the weight of the abdominal viscera rests largely
upon the bones and in consequence does not crowd into the inlet unless
forced in by corsets or faulty habits.
[Illustration: Fig. 2.—The planes of (_a_) the brim, (_b_) the cavity
and (_c_) the outlet. (Eden.)]
Passing through the brim, a cavity is found below it, midway between the
inlet and outlet, which is nearly round in shape. This is the
“excavation,” or the _true pelvis_. Then comes the _outlet_, bounded in
front by the pubic arch and soft parts, and behind by the coccyx pushed
back as far as it can go. It is ovoid in shape, but the long axis of
this ovoid lies at right angles with the axis of the ovoid inlet.
We find, therefore, a succession of three geometric figures or planes
through which the head must pass by means of a spiral motion called
rotation. These figures are inclined to one another so markedly in front
that a line drawn through the center of each will curve forward at both
ends, one end passing out near the umbilicus, the other through the
vulva. This is known as the axis of the pelvis or the curve of Carus.
[Illustration: Fig. 3.—Visceral relations. (Redrawn from Gray.)]
THE SOFT PARTS
Inside the pelvis are the organs of generation with their accessory
structures and supporting tissues.
Of first importance are the ovaries, tubes and uterus, together with the
vagina. These special structures are the true genital organs. They are
bounded in front by the bladder, behind by the rectum, above by the
abdominal viscera, and surrounded everywhere by muscular, mucous and
fatty tissues, which support them and aid their function.
=The Vagina.=—The vagina is a hollow organ, about four inches long,
attached to the cervix above and the vulva below. It is an elastic
sheath bounded in front by the bladder and behind by the rectum. Under
normal conditions, this tube easily admits one or two fingers, but
during labor it dilates enormously to allow the head to pass. The vagina
is lined with a thick mucous membrane, ridged and roughened by folds,
which are called rugæ. Thus a continuous channel connects the ovary with
the outside and through it pass, at appropriate times, the ovule, the
menstrual blood, the uterine secretions, the child, the placenta, and
the lochia.
=The Uterus.=—The uterus (womb) is a pear-shaped organ, flattened from
before backward, and composed of unstriped or involuntary muscle cells
and connective tissue. Normally the virgin uterus measures from two and
one-half to three inches in length, and weighs about two ounces. It is
suspended in the middle of the pelvis by strong ligaments, so that the
fundus inclines gently forward against the bladder. When the bladder
fills, the uterus is pushed backward. Most of the organ is internal, but
a small part of the lower pole is grasped by the vagina, in which the
lower end with its invaluable aperture, the os, dips and swings. The
part above the vagina is called the body or fundus, and is covered with
the serous membrane (peritoneum) that lines the abdominal cavity. Below
the fundus is the cervix or neck, which lies partly above and partly
within the vagina. The cavity of the uterus is usually closed by the
apposition of the walls. The inner surface is covered with a peculiar
kind of membrane called the endometrium, which is highly vascular. The
uterine cavity opens into the vagina through the os, which is small and
round in the nulliparous woman, and slit-shaped or gaping in the woman
who has borne a child.
[Illustration: Fig. 4.—Uterus and appendages. On either side of the
uterus will be seen the ovary, the fimbriated extremity of the tube, the
tube, and the round ligament. The vagina lies open below. (Lenoir and
Tarnier.)]
=Fallopian Tubes.=—On either side of the upper end of the uterus are the
orifices of the Fallopian tubes, through which the egg, escaping from
the ovary, finds access to the uterine cavity. These tubes extend
outward from the uterus about four inches, and terminate in a
bell-shaped opening with long, ragged fingers which hang loosely down
toward the ovary. The tubes are lined by epithelial cells having
hair-like projections, (ciliæ) which wave automatically toward the
uterus. Thus impelled by a gentle current, the egg moves definitely
along the tube toward the uterus and against this current the
spermatozoa force their way to meet and fertilize the egg.
=The Ovaries.=—On either side of the pelvis, close to the fringed end of
the Fallopian tube and attached to it, lies a small, hard, almond-shaped
organ, called the ovary. This is the intrinsic sexual gland of the
female. It contains the small cells which are to ripen and become eggs.
Each ovary is said to contain about thirty-six thousand eggs, or ovules.
=The Bladder.=—The bladder lies between the pubic bone and the uterus.
It is a reservoir for urine, filled by means of two little tubes called
ureters, that run down from the kidneys. It drains through the urethra
which opens just below the pubic bone in front of, and just above, the
vaginal opening. The bladder should be emptied frequently during labor.
=The Anus.=—The large bowel (colon) terminates in an opening near the
middle of the genital crease. This opening is called the anus. It is
closed by a contracting muscle, the sphincter, which acts like a
puckering string. Just inside of the opening is a group of large veins
which may become enlarged, inflamed, and bleed during pregnancy. They
are then called hæmorrhoids.
=The Rectum.=—Upward from the anus and to the left of the uterus extends
the rectum. This is the end of the intestinal canal and is supplied with
an abundance of nerves. When the head presses upon it, it gives the
sensation of a bowel movement, and warns the observer of the low
position of the head. The anus pouts as the head comes down and the
anterior walls become visible. In severe cases of labor, the sphincter
is sometimes torn. The bowels should be emptied by an enema as early as
possible in the first stage of labor.
=The Peritoneum.=—The peritoneum is a thin, glistening, serous membrane,
which lines the abdominal cavity and drops down from above over the
uprising tops of the bladder and uterus. Folding together at the sides
and extending to the walls of the pelvis, it encloses the tubes and
round ligaments in deep, flat masses, called the broad ligaments. This
is the structure that becomes so perilously inflamed (peritonitis) when
infected by germs that find entrance through the genital passage.
[Illustration: Fig. 5.—Normal position of pelvic organs, seen from above
and in front. They are enveloped in peritoneum. (Bougery and Jacob, in
American Text Book.)]
THE EXTERNAL GENITALS
The external genitals form the vulva. Under this name are included the
mons veneris, the labia majora, the labia minora, the clitoris, the
vestibule, the hymen and the glands of Bartholin.
The entire groove from the mons veneris to a point well up on the sacrum
forms a deep fold or crevice, which is known as the _genital crease_.
That part of the genital crease lying between the anus and vulva is
technically known as the _perineum_ (q.v.)
[Illustration: Fig. 6.—The external genitals. (Redrawn from Gray.)]
=The Mons Veneris.=—The mons veneris is a gently rounded pad of fat
lying just above the junction of the pubic bones (the symphysis). The
overlying integument is filled with sebaceous glands and covered with
hair at puberty.
=The Labia Majora.=—The labia majora are the large lips of the vulva.
They are loose, double folds of skin extending downward from the mons
veneris to the anterior boundary of the perineum and covered externally
with hair. Normally they lie in apposition and conceal the vaginal
opening. They correspond to the male scrotum.
=The Labia Minora.=—The labia minora, or nymphæ, are two small folds of
skin and mucous membrane, that extend from the clitoris obliquely
downward and outward for an inch and a half on each side of the entrance
to the vagina. On the upper side, where they meet and invest the
clitoris, the fold is called the prepuce, but on the under side they
constitute the frænum.
The labia minora are sometimes enormously enlarged in the black races
and are then called the Hottentot apron.
=The Clitoris.=—The clitoris is an erectile structure analogous to the
erectile tissue of the penis. The free extremity is a small, rounded,
extremely sensitive tubercle, called the glans of the clitoris. About
the clitoris there forms a whitish substance called smegma. This is a
good culture medium for germs and must be carefully sponged away when
the vulva is prepared for delivery.
=The Vestibule.=—The vestibule is bounded by the clitoris above, the
labia minora on the sides, and the vaginal orifice below. It contains
the opening of the urethra, which is called the meatus urinarius.
=The Hymen.=—The hymen is a thin fold of membrane which closes the
vaginal opening to a greater or lesser extent in virgins. It varies much
in shape and consistency. It is sometimes absent, or it may persist
after copulation, hence its presence or absence can not be considered a
test of virginity. When torn, the edges shrink up and form little
irregularities called carunculæ myrtiformes.
[Illustration: Fig. 7 _A_.—Varieties of hymen. (American Text Book.)]
=Bartholin Glands.=—Bartholin glands are located on each side of the
commencement of the vagina. Each gland discharges by a small duct just
external to the hymen. They are often the seat of a chronic gonorrhœal
inflammation and must be watched carefully, lest infection extend to the
mother after labor, or to the eyes of the child in passing.
[Illustration: Fig. 7 _B_.—Varieties of hymen. (American Text Book.)]
=The Perineum.=—The perineum is a body of muscle, fascia, connective
tissue, and skin, situated between the vagina and the rectum. The vagina
bends forward and the rectum backward, so a triangular area is left
between them which is filled by the perineal body. It is about two
inches long from before backward, and becomes progressively thinner the
deeper it extends.
[Illustration: Fig. 8 _A_.—The excreting ducts of the mammary gland.
(Lenoir and Tarnier.)]
[Illustration: Fig. 8 _B_.—Lobules and duct of the mammary gland.
(Lenoir and Tarnier.)]
The perineal body is flattened out and compressed by the passage of the
head and in many cases torn. (Thirty per cent of primiparas and ten to
fifteen per cent of multiparas.) It should be repaired immediately.
=The Mammary Glands.=—The mammary glands are secondary but highly
important parts of the genital system. They are formed by a dipping down
of skin glands and they perform the special function of secreting milk.
The breast is made up of fifteen or twenty lobes, each of which, like a
bunch of grapes, clusters about and discharges into a single tube which,
in turn, leads to the nipple. The area between the lobes is filled with
fat and connective tissue.
[Illustration: Fig. 9.—Nipple, areola, and the glands of Montgomery.
(Eden.)]
The _nipple_ is pink or darkly pigmented. It is composed of erectile
tissue and under stimulation, it rises from the surface of the gland so
that it is easily taken into the mouth.
[Illustration: Fig. 10.—Supernumerary milk glands in the axillæ. They
may be found also below the breasts. (Witkowski.)]
[Illustration: Fig. 11.—The three ages of the breast—virginity,
maturity, and senescence. (Witkowski.)]
Surrounding the nipple is a darkly pigmented area from one inch to four
inches in diameter that is called the _areola_. It contains hard,
shot-like nodules, the glands, or tubercles, of Montgomery. These often
secrete milk and sometimes become infected. It occasionally happens that
more than two breasts may be found on the human female, and not
infrequently pieces of mammary tissue may be discovered in the axilla or
on the chest or back.
The mammary gland is undeveloped at birth, but, nevertheless it may fill
with milk (witches’ milk). At puberty, after marriage, and during
pregnancy, the gland reaches maturity. It is only after delivery,
however, that the functional climax is attained.