Produced by Richard Tonsing, Cindy Horton and the Online
Distributed Proofreading Team at http://www.pgdp.net (This
file was produced from images generously made available
by The Internet Archive)
MOTHER, NURSE AND INFANT:
A MANUAL
ESPECIALLY ADAPTED FOR THE GUIDANCE OF MOTHERS AND MONTHLY NURSES,
COMPRISING FULL INSTRUCTION IN REGARD TO
Pregnancy, Preparation for Child-Birth,
AND
The Care of Mother and Child,
AND DESIGNED TO IMPART SO MUCH KNOWLEDGE OF ANATOMY, PHYSIOLOGY,
MIDWIFERY, AND THE PROPER USE OF MEDICINES AS WILL SERVE INTELLIGENTLY
TO DIRECT THE WIFE, MOTHER AND NURSE IN ALL EMERGENCIES.
BY S. P. SACKETT, M. D.
NEW YORK:
H. CAMPBELL CO., PUBLISHERS
140–142 NASSAU ST.
1889.
COPYRIGHTED, 1889,
—BY—
S. P. SACKETT.
_All rights reserved._
PRESS OF E. D. NORTON,
ITHACA, N. Y.
------------------------------------------------------------------------
PREFACE.
The object of the author in writing this volume is to offer to nurses,
and especially to those women who desire to make “monthly nursing” a
vocation, the instruction which they need for that purpose, sufficiently
illustrated and at a moderate price.
The book is written under a firm conviction in the mind of the author
that a work of this character is needed at the present time—a work that
combines some information to the monthly nurse in regard to her peculiar
duties with considerable instruction in midwifery. He has many times
heard inquiries made for a book of this kind and has not been able to
point to one of the character desired. He has learned during the
forty-five years that he has practiced medicine in a small city and its
vicinity, that mother and nurse are often combined in the same person.
The important duty of nursing the sick is so generally performed by
mothers, that they also, as a class, require some scientific knowledge
to be acquired by means of plain, practical instruction. And, in fact,
throughout our country, every mother is liable, in an emergency, to be
called upon to fill the office of an accoucheur.
For the professional nurse, such technical and accurate knowledge should
be considered indispensable. The training schools for nurses in some of
our largest cities are doing a noble work, and are elevating the
standard of requirements for those who seek this field of true womanly
labor. But comparatively few of the many thousands who follow this
vocation are able to attend such schools; yet they are willing and
desirous to learn. Women seem instinctively to desire such knowledge. A
proper effort to place within their reach the means of obtaining the
necessary technical knowledge for their work, and especially for the
work of the nurse who attends upon the mother in childbirth, will not,
the author trusts, be deemed presumptuous. There are many excellent
nurses, who have become so without the aid of training school or such a
book as this, but it is hoped that this volume may make the acquirement
of the necessary knowledge more easy and furnish ready information of
value to those nurses who are most thoroughly perfected in their work.
Physicians, they will find, stand ready to aid them. The attending
physician, as a rule, may be depended upon to give such help as may be
necessary to the understanding of the instructions here presented, and
through their cooperation the number of earnest students in this
department of womanly labor may be multiplied.
The author, during the preparation of it, consulted many writers upon
obstetrics, medicine and nursing; and it is only because it would not be
compatible with the size of this volume, that he has not made frequent
references to these excellent works. But all that he has written has
been founded on his own knowledge, experience, and observation, while it
coincides with the expressed opinions of others who may be considered
good authority. In only two or three things has the author ventured to
advance beyond others.
S. P. S.
ITHACA, March, 1889.
CONTENTS.
Introduction 9
PART I.
PREGNANCY AND CONFINEMENT.
CHAPTER I.
Conduct of the Mother before and after Marriage 13
CHAPTER II.
Conduct of the Mother during Pregnancy 18
CHAPTER III.
Diseases of Pregnancy 22
CHAPTER IV.
Instructions to a Woman during the last stages of Gestation 26
CHAPTER V.
Directions to the Monthly Nurse 33
CHAPTER VI.
Care of the Mother during Labor and Confinement 36
CHAPTER VII.
Directions to the Nurse during the month 43
PART II.
ANATOMY AND PHYSIOLOGY OF THE FEMALE ORGANS—FŒTAL DEVELOPMENT.
CHAPTER I.
Of the Pelvis 55
CHAPTER II.
Parts contained in the Pelvis 64
CHAPTER III.
Physiology of the Uterus and Ovaries 70
CHAPTER IV.
Displacements of the Uterus 76
CHAPTER V.
Mismenstruation 87
CHAPTER VI.
Generation 93
CHAPTER VII.
The Ovum and its development 98
CHAPTER VIII.
The Fœtus 103
PART III.
PREGNANCY AND PARTURITION.
CHAPTER I.
Diagnosis of Pregnancy 113
CHAPTER II.
Abortion 119
CHAPTER III.
Parturition 123
CHAPTER IV.
Mechanical Phenomena of Labor 132
CHAPTER V.
Diagnosis of Artificial Labor 138
PART IV.
SKILLED NURSING AND MIDWIFERY.
CHAPTER I.
Preliminary instruction to the Nurse Midwife 145
CHAPTER II.
The Natural Labor 149
CHAPTER III.
Convalescence 163
CHAPTER IV.
Care of Infants 170
CHAPTER V.
Cases of Difficult Labor 177
CHAPTER VI.
Concluding instructions in Midwifery 192
PART V.
ÆTIOLOGY—SYMPTOMOTOLOGY—MEDICATION—NURSING.
CHAPTER I.
Causes of Disease 196
CHAPTER II.
Symptoms of Disease 203
CHAPTER III.
Diagnosis of Diseases of Children 217
CHAPTER IV.
Treatment of Inflammation in its initial stages 223
CHAPTER V.
Various circumstances, Contagion, Death, &c. 237
CHAPTER VI.
Surgical Nursing 251
PART VI.
REMEDIES AND REGIMEN.
CHAPTER I.
Hints in regard to the treatment of Common Diseases 262
CHAPTER II.
Emergencies, Accidents, Sudden Sickness 279
CHAPTER III.
Slight Hurts and Ailments 295
CHAPTER IV.
Dietetics, Food for Children 307
CHAPTER V.
Prescribing and Prescriptions 327
CHAPTER VI.
Medical Formulary 333
Glossary 364
Index 379
INTRODUCTION.
From the nature of the subjects treated in this work, the information
given becomes of interest to every woman, and is not intended for the
nurse of lying-in women only. It is believed that many young women will
study it carefully, that they may be prepared for all the duties and
responsibilities of life; some, perhaps, that they may be fitted for a
vocation under certain contingencies. But many of the instructions are
addressed particularly to mothers, because they especially will be able
to make a practical application of the knowledge received. Hence
considerable matter is inserted which is designed to be used by mothers
in their daily life, and having only a slight bearing on monthly
nursing. Necessarily, as the two objects are combined to suit the wants
both of the mother and nurse, there is not as much order and system in
the topics presented as would otherwise be desirable. I seek only to
have my instructions in the form that will be most useful, and I believe
that if mothers at the present time are sufficiently taught there will
be no lack, a few years hence, of nurses who are fully competent to care
for the sick, under the direction of competent physician. Hence I
address myself, first,
TO THE MOTHER.
To those who are mothers, every part of this small book is especially
commended. Upon the knowledge and skill and right action of those who
have the care of children and of the household, it will depend that the
right thing shall be done in such emergencies as are liable to occur.
You must necessarily care for your children, both to guard them from
sickness and to relieve their ailments. You must know the symptoms, at
least, how to observe the symptoms of diseases; and you may be called
upon, in the absence of the physician, to act as midwife. Be especially
careful to learn the instructions in regard to emergencies, because upon
your knowledge and prompt action the lives of your dear ones may depend.
TO THE PROFESSIONAL NURSE.
This work is written for you, and to you is especially commended the
modicum of medical knowledge herein contained. It is better for you to
learn well what you read than it is to read very extensively. You will
find sufficient in this small volume to demand your time and study for
months, and even for years, in connection with your nursing. It is not
expected that you will learn all the formulæ and prescriptions given.
These are inserted partly that you may learn to read prescriptions in
the various forms in which they are written, and partly that you may
occasionally use one, after consulting with your physician. Sometimes
you may copy one of them accurately and use it at the drug store,
consulting only with the apothecary.
But it will be of importance to you to obtain as much medical knowledge
as is herein contained, though it is not designed to make you
physicians. Do not act the part of a doctor until you understand every
thing pertaining to Anatomy and Physiology, and the nature and
properties of every medicine employed in the cure of disease. Of all
sciences the medical should embrace the widest domain of knowledge,
because ignorance here is fatal. But ignorance and thoughtlessness, and
want of skill and adaptation, may be fatal in your particular province.
The physician will generally tell you that the recovery of his patient
depends as much upon faithfulness and skill and care on your part as
upon his own medicines. Seek always to aid him, never to supercede him.
If you learn midwifery, it should be with the design of co-operating
with the doctor, and assisting him. You should be so educated that the
physician will feel willing to leave a case of tedious labor in your
care, instead of waiting at the bedside of the patient one or two days,
and neglecting his other patients. Your educated service will be
appreciated at such times by the doctor, as well as by the patient and
her friends. You will do the duties of nursing well, and take upon
yourself that part of the practice of a physician which he does not
desire, and which you can do equally well. Your part will be an
important one, and second only to that of the physician.
I expect, as the result of the study of this book, not that you will
assume to be physicians to any greater extent than you otherwise would,
but that you will act wisely and intelligently instead of confusedly, or
blindly, in the emergencies in which you will be called upon to
act,—that you will be, not merely attendants at the bedside of the sick,
but, that best aid to the physician, the true nurse.
Do not claim to be doctor or midwife, or anything whatever that you are
not. If a smattering of knowledge causes any affectation, it will only
degrade you. Study physiology in the books commonly used; store your
minds with the facts and instructions in this book; obtain additional
knowledge in every way that is practicable. As you have opportunity,
make practical application of the knowledge received, and you will
commend yourself more and more to your sick or suffering friends.
PART I.
PREGNANCY AND CONFINEMENT.
CHAPTER I.
CONDUCT OF THE MOTHER BEFORE AND AFTER MARRIAGE.
The physical treatment of children should begin, as far as may be
practicable, with the earliest formation of the embryo. It will involve
the conduct of the female even before her marriage, as well as during
her pregnancy—the various contingencies which effect her in health as
well as in disease. Very much depends on her to insure for her child a
vigorous constitution, or to prevent a feeble frame in the child. She
should not _enter_ into the holy state of marriage with heedless haste;
if she does, she will discharge its duties with inexcusable neglect. To
constitute a mother, in the best sense of the term, requires a patient
endurance of fatigue, and anxious solicitude, which will sorely tax the
mother’s strength. I would, if possible, diminish the toil and danger of
childbirth, and relieve the fatigue and anxiety of nursing.
And let me, in one paragraph, give a hint to the husband: that the
responsibility and care of the children is too much laid on the mother;
she is overburdened. Let the father partake in the arduous and
responsible duty of their education. And let me hint, also, that the
health and strength of the child depends upon the father as well as the
mother.
MARRIAGE SHOULD NOT BE AT TOO EARLY A PERIOD OF LIFE.—I am not disposed
to discourage early marriage, but I am decidedly opposed to a premature
one. Marriage should not take place until the body is healthily and
completely developed; to bear offspring prematurely endangers not only
the mother’s health, but it materially influences the health and
well-being of the child.
We cannot fix rigorously the age at which the body becomes fully
expanded. I am inclined to say it is at 20 in the female, and at 24 in
the male; but original stamina, education, climate, mode of life, etc.,
have their influence, and may make an earlier or a later marriage
proper.
The evil consequences resulting from precocious unions in this country
are: diminished vigor and shortened life in the husband; faded beauty,
blasted health, and premature old age in the mother, and a diminutive
stature, debility of body and imbecility of mind, perhaps a strong
predisposition to consumption, rickets, scrofula, etc., in the children.
MARRIAGE SHOULD BE WHEN THE PARTIES ARE IN HEALTH.—I do not say that
every ailment should be a bar to marriage or child-bearing. It is
possible that prolapsis uteri may be benefited by a pregnancy and
parturition. But if a woman has prolapsis uteri, or other ailment, it is
a poor preparation for the burdens of gestation, and good health is an
important qualification for the responsibilities of married life. No
learning can be of more importance to a young lady than to know how to
preserve health, and how to restore it when lost, for we cannot
reasonably expect healthy children from unhealthy parents. There are
numerous other complaints besides scrofula and insanity, inherited by
children. If a wife is to be healthy and strong, she must use means;
health will not come by wishing for it merely, and whether pleasant at
first or not, habit will make early rising, temperate living, taking
exercise, thorough ablution of the whole body, etc., easy. That state of
vigorous health and strength which prepares a woman to bear strong and
vigorous children, is attained not by idleness and luxury, and neglect
of personal cleanliness, nor by tight lacing, the use of stimulants, nor
by irregular modes of sleeping, etc., but by rising early, and taking
early walks in the open air, and engaging in household labor, or other
exercise during the day, going to bed betimes, living on an abundance of
good, wholesome food, by daily ablutions, followed by rubbing the skin
thoroughly, and in general by observing the laws of health. If a woman
who has thus preserved her health, marry a man who has been equally
careful to observe the laws of continence and hygiene, she may hope to
be the mother of a healthy child, and a blessing to all.
THE CONSTITUTION OF BOTH THE MALE AND FEMALE should be good and strong.
It is not enough that the body be well developed, if there is at the
same time a very feeble constitution. Even if the children of such
parents seem to be hale looking and robust, they do not attain old
age—are very liable to die young. If there is only a predisposition to
disease, such as is often inherited, it may be very doubtful whether the
parties ought to marry. If there is only a disposition to habits of
intoxication or dissipation, or to gout, madness, scrofula, consumption,
etc., in the man, we may advise the woman not to unite herself to him,
for these diseases do not show themselves until called into action by
some exciting cause.
But we advise the woman, if there is any physical disability which
renders her ineligible to the married state, that she should not pass it
over lightly, or conceal it, and we would recommend to a woman who may
have deformed pelvis, that she abstain from marriage, as she “may
purchase the title of wife at too dear a price.”
TEMPERAMENT is a matter of less importance in choosing a husband. It is
said to be the case that in choosing a mate, a person inclines strongly
to one unlike themselves. If it be true that a person of a nervous
temperament has a preference for the sympathetic, the sanguine for the
bilious, etc., it is probably nature imparts the liking that the
offspring may combine the excellence of both, the defects of neither.
BLOOD RELATIONSHIP is not necessarily a bar to union. Cousins may marry
when the family has traits of mental and physical excellence as a means
of perpetuating them, but it is not best to develop, by repeated unions,
a lurking disposition to disease, which may exist in any family.
MORAL AND MENTAL CHARACTER is of the greatest importance. It is not true
that “the reformed rake makes the best husband.” If he is not the prey
of loathsome diseases, the results of a vicious life, his constitution
is probably impaired, so that he cannot be the father of good, strong
children. The only way that women can guard their own health, and
preserve from degeneracy their offspring, is by having husbands of a
different character from that of the debauched rake.
CONDUCT OF THE MOTHER AFTER MARRIAGE.
The mother is accountable for the health and intelligence of her first
child; she must be careful of her own health before marriage and at the
time of marriage, as well as for the succeeding time.
I will here state a few things which seem unimportant, and yet are of
some little consequence. I consider that the great object of conjugal
union is the transmission of life, and I cannot believe that anything is
unnecessary or unimportant that has a tendency towards the perfect
health or well-being of the child that is yet to be born.
DURING THE FIRST FEW MONTHS AFTER MARRIAGE the wife should seek to have
bodily quiet, and mental calmness and serenity. The custom of hurrying
the bride from place to place may properly be condemned. So we would
have her avoid going into a whirl of excitement and pleasure—into a
round of visiting and late hours—into close, heated rooms—into
fashionable amusements—rich living and a want of rest—sitting in
ill-ventilated apartments—quickly bolting unquiet meals—drinking wine,
beer, or brandy, or other alcoholic stimulants—late rising in the
morning—sleeping in close, badly-ventilated rooms—living in rooms that
are kept dark—tight lacing—wearing thin clothing—worrying, and indulging
in ill-temper.
She should avoid these at all times, but her future health and happiness
depend so much upon her prudence and care during the first year of
married life, that we may properly give these hints and cautions in
regard to this particular time.
CHAPTER II.
CONDUCT OF THE MOTHER DURING PREGNANCY.
There are no signs of a fruitful conjugation, which in all cases
indicate to the woman that she is pregnant. Some few seem to know the
exact time; in some instances there is faintness, or vertigo, that in
these particular cases impress the fact upon the mind of the woman. But
usually, within a month, the point is tolerably certain, she being
assured by such signs as will be here pointed out. It now becomes her
duty to be especially careful, not only for herself, but also for her
offspring. Abortions frequently occur, especially in the first and last
pregnancies, and in the first months of pregnancy, these should be
avoided if possible.
The train of evils which follow when the habit of abortion is
established, as well as the moral obligation she is under to preserve
the life committed to her, should make her willing to endure the few
privations and conformities which her situation imposes on her. She must
avoid undue exercise of the muscles, such as long walks, dancing in hot
weather, hastily running up stairs, lifting heavy weights; she must
avoid things that inordinately hurry the circulation, such as heated
rooms, stimulating liquors, etc.; she must not overload the stomach, or
eat late suppers; she must not take drastic purgatives; must not
constipate her bowels by taking laudanum, etc.; must not compress the
chest by tight lacing; must not use strong tea or narcotics; must not
lie long in warm feather beds, and must not engage in severe study,
night watching, etc.
The pregnant woman need not indulge in a wayward or voracious appetite,
and, although there is a tendency to fullness and fever, she need not
necessarily be bled.
The pregnant woman needs fully as much food as usual, but she must avoid
excess in eating and drinking. Ripe fruits, lamb, veal, fresh fish,
milk, coffee, and, in general, every thing which agrees with the stomach
may be eaten; the taste, as a rule, is a safe guide, and may be
reasonably indulged. After the sixth month, she may properly eat four or
five meals a day.
The best plan of treatment for one to adopt who has longings is not to
give way to them, unless the longings be of a harmless, simple nature.
The CLOTHING of the pregnant woman should be suited to the season; but
as the vicissitudes of the weather affect her more than they previously
did, she should be dressed rather warm. In general, she should wear
flannel drawers, especially during advanced pregnancy.
Many women have done themselves an injury by lacing tight to conceal
their pregnancy. The dress should be loose and comfortable, nowhere
pressing tightly or unequally.
Stays or corsets may be used, in a proper manner, during the first five
or six months; they should be moulded to the shape of the changing
figure, and must not depress the nipple or the enlarging breasts. The
garters ought to be worn slack; tight garters are very injurious, and if
the veins are enlarged or varicose, it will be necessary for her to wear
an elastic silk stocking.
_Moderate_ exercise in the open air is proper during the period of
pregnancy, and walking is a good kind of exercise; but very long walks,
and dancing, ought not to be indulged in. Riding in a wagon over rough
roads, and railway traveling, are objectionable.
BATHING should be practiced with great care. A warm bath is too
relaxing; a tepid bath once a week is beneficial. Sponging the body
every morning with lukewarm water may be practiced, and the skin should
be quickly dried with a coarse towel. The temperature of the water may
be reduced gradually until it is quite cold. A sitz bath may be used
every morning, although it is best to sit in it but a few seconds. If it
gives a slight shock, it will be immediately followed by an agreeable
glow. Put a little warm water with the cold at first.
Ventilation is of the utmost importance. During the day time, the
windows in every unoccupied room in the house ought to be thrown open.
Attention should be directed to keeping the atmosphere in the sitting
and sleeping rooms of the house fresh. Many poor people sleep in a very
small, close bedroom, and breathe an air that is really poisonous. The
lady should see also that the house is kept light, that the drains are
in good and perfect order; that the privies are frequently emptied of
their contents, and that the drinking water supply be not contaminated.
SLEEP, by its sedative influence, and by the calmness of all the
functions that attend it, has a favorable influence upon the disturbed
nervous system of the mother, and upon the growth of the fœtus. Her
bedroom ought to be large and airy, and she should not have curtains
closely drawn about her bed. The windows of the room should be opened
during the day; the bedclothes should be thrown back, and everything
ventilated; the bed must not be loaded with clothes, and the bedroom at
night should be dark, and as far as possible from noise. These things
will tend to secure sleep; but if the pregnant woman should still be
restless, and feeling oppressed and hot, she should perhaps admit more
air into the room. Let her also attend every day to her bowels, that
they be not allowed to become costive; perhaps eat cooling fruits, live
on an abstemious diet, and if there is a feeling of faintness when she
attempts to lie down, she should have a bed so arranged that her
shoulders and head are elevated.
The pregnant woman ought to retire early to rest, and I would advise her
to lie abed in the morning as long as she can sleep well. If she cannot
sleep well, let her get up in good time in the morning, take a bath, or
thorough ablution, a stroll in the garden, an early breakfast, and then
perhaps a short walk, while the air is cool and exhilarating. A nap of
an hour or two after that, upon a sofa or lounge, will prove very
refreshing.
A TRANQUIL MIND is of the greatest importance. Forebodings of a gloomy
nature should not be encouraged, as they often are, by relating dismal
stories, etc. Unnecessary fear upon the part of the mother may have a
bad effect upon the child, as may also the indulgence in unbridled
anger, or yielding to temper,—perhaps may cause convulsions or
hemorrhage, or even abortion. There is reason to believe that the
imagination of the mother has an influence on the beauty of the child;
and it is quite certain that cheerfulness and equanimity of mind
contributes to the future good health of the child, and may even affect
its disposition and mental traits.
CHAPTER III.
DISEASES OF PREGNANCY.
Pregnancy is not a disease. Many women enjoy better health during its
continuance than any other time, and in general the pregnant woman is
not quite as much exposed to contagious and other diseases. But there
are certain disorders incident to pregnancy, of which it is necessary to
speak.
MORNING SICKNESS, when it is only troublesome during the early part of
the day, is generally borne without much complaint, or much medical
care. Before taking any medicine for it, I advise that the lady try such
simple means as the following: Let her take a cup of coffee or milk, and
eat a few crackers or a biscuit, after washing her hands and face, and
before rising in the morning; then let her remain in bed for about
fifteen minutes, then dress quickly and take a short walk. If the
sickness continues, let her eat freely of pop corn, and she may eat of
this occasionally during the day, or whenever she is suffering from
sickness, and let her partake of other food also during the day.
Persistent sickness and vomiting indicates a disordered condition of the
digestive apparatus, and requires appropriate remedies. Use successively
the following: Formula 85, 104, 81, 107.
VOMITING is sometimes so persistent and severe that the stomach can
retain nothing, or but very little food. Of course, such cases demand
the aid of a physician, and his efforts to give relief may be effectual,
when the medicine here directed fails.
COSTIVENESS is another complaint to which pregnant women are liable.
This is hurtful in its consequences, being not uncommonly the cause of
fever, tenesmus, pain in the bowels, and abortion. Care must be taken to
obviate costiveness by the use of such food as will have a laxative
effect. The use of graham bread, oatmeal gruel, raisins, figs, grapes,
roasted apples, baked pears, brown bread, cracked wheat, stewed prunes,
and other varieties of farinaceous food and fruit, may obviate the
necessity of taking opening medicines (F. 108, or milk of magnesia.) An
enema is an excellent remedy, and every lady should have a good enema
apparatus, by which she can administer an injection to herself, and if
she suffer from constipation, she should take an enema twice or three
times a week, and the early morning is the best time. The clyster may be
warm water, or castile soap and water, of the temperature of new milk.
It may be well to give occasionally an aperient to insure a thorough
clearance of the whole bowels, and castor oil, salad oil, citrate of
magnesia, seidlitz powder, stewed rhubarb, or an electuary of figs may
be given. I sometimes direct that the woman should take every day a
small dose of oil, in a cup of water gruel or oatmeal gruel.
SEVERE PAIN in the bowels and rectum is sometimes caused by a column of
hard and indurated feces, which remain for a number of days in the
rectum and colon. Not only pain but inflammation, and other serious
ills, may result if such a condition is neglected. If taking injections
does not suffice to give relief, manual assistance is necessary. The
nurse should learn the art of removing them if necessary; she should use
a convenient instrument, carefully conducting it into the anus, or she
may thrust her finger into the vagina to break the hard mass, and assist
in its expulsion, then she should wash it out with repeated clysters.
FOR ABDOMINAL PAINS that are caused by its distention, and by the weight
of the enlarged uterus, the woman should wear a bandage, or an abdominal
supporter, adjusted to fit the abdomen, and made with proper straps and
buckles to accommodate the increasing size of the abdomen. To relieve
the pain, the abdominal walls may be rubbed with equal parts of sweet
oil and laudanum.
Troublesome HEMORRHOIDS may be caused by constipation, and also by the
congestion in the parts, and by the pressure made on the vessels of the
part by the enlarged uterus. It is proper sometimes to use emollient
fomentations and cataplasms. Relief may often be given by making firm
and gentle pressure between the finger and thumb of each distinct tumor,
till they are all compressed and returned within the anus.
In cases of BLEEDING PILES, blood comes away each time the patient has a
stool. The patient ought to be as quick as possible in relieving the
bowels, and should not at such times sit one moment longer than is
absolutely necessary. If the piles are inflamed and painful, foment them
three times a day, and for half an hour each time, with hot water
containing a little carbolic acid—a one per cent. solution. Apply it by
means of a sponge. Extract witch hazel may be used also, and relief may
often be obtained by sitting over the steam of hot water for fifteen or
twenty minutes. Simply put hot water in a close vessel, and sit over it.
Sometimes the woman cannot sit in an ordinary chair, and she should sit
either on an air cushion, or a water cushion half filled with water,
placed on the chair. (F. 107.)
DIARRHŒA is a less frequent attendant of pregnancy than constipation,
and the latter is sometimes the cause of the former; in such cases an
aperient is required. (F. 109.) Should the complaint remain after the
operation of the laxative, opiates are proper, mixed with some mild
astringent medicine, aromatics, antacids, etc. (F. 69, 74, 79, 80, 95.)
TENESMUS, and also diarrhœa, are common attendants on abortion, of which
they are, indeed, sometimes the cause. Ipecac in half grain doses, with
powdered opium, and given every six hours; or frequently repeated doses
of opium may be needed. (F. 91, 92.) A flannel bag filled with hot table
salt, and applied near the part affected, may give great relief to pain.
HEARTBURN is a common and often a distressing symptom of pregnancy. I
would prescribe in such cases an abstemious diet, pepsin, ingluvin, and
other medicine to help digestion; antacids and laxatives. (F. 71, 72,
74.) Calcined magnesia is good; prepared chalk is harmful.
It is not necessary for me to dwell upon the few ailments that
occasionally afflict pregnant women that I have not yet referred to,—a
few words must suffice. If a woman who is pregnant is apt to be FAINT,
or to FAINT AWAY, I advise that she be laid down—that she lie flat on
her back, with a pillow under her head—that tight articles of dress be
loosened—windows raised—water should be sprinkled on her face, a few
drops of aromatic ammonia may be administered, and perhaps smelling
salts or hartshorn held to the nose. If it is simply fainting, it is not
dangerous.
A nervous pregnant woman is sometimes subject to PALPITATION OF THE
HEART, especially when lying down. A small dose of aromatic ammonia will
generally give relief.
If CRAMPS of the legs or thighs are troublesome, take F. 92, and tie a
handkerchief around the limb, above the part affected, and let it remain
a few minutes, and use friction. If cramp attacks the bowels or back, a
hot bag of salt, or a stone bottle filled with hot water and wrapped in
flannel, may be pressed against the part, and something similar should
be placed to the sole of the feet.
If PRURITIS PUDENDI—irritation and itching of the external parts—are
troublesome, use F. 195, 217, 220, and take frequently a tepid salt and
water sitz bath, remaining but a short time in the bath. If the parts
are hot and inflamed, and covered with an eruption, use either of the
following lotions: F. 217, 195.
CHAPTER IV.
INSTRUCTIONS TO A WOMAN DURING THE LAST MONTH OF PREGNANCY.
1. DO NOT TAKE TOO MUCH EXERCISE.—You may get relief from some of your
ailments by lying down considerably during the day. If there is
leucorrhœa (whites), strangury (a frequent inclination to void the
urine), incontinence (an inability to hold the water), pain in the hips
with numbness of the inferior (lower) extremities—if the veins of the
leg become varicose—if there are anasarcous swellings of the inferior
extremities—if there is a pendulous belly, the woman ought not to so
exercise as to produce fatigue. She may get some relief by sitting or
reclining in the way that is most agreeable.
2. USE MEANS TO HARDEN THE NIPPLES.—Those women who have never had
children ought to observe, before labor, whether there is a depressed
condition of the nipples; whether they contract as the breasts increase
in size. If they do, the condition can be corrected by wearing nipple
shields on them. And to harden the nipples: For at least a month before
labor, two or three times a day, rub them between the thumb and finger,
and bathe them in tincture of myrrh or cologne water, in which a little
alum has been dissolved. This will render the skin less sensitive, and
avert the distress occasioned by the tenderness of the nipples. If there
is especial reason to apprehend excoriated nipples, as there is when
they are rough and nodulated like a strawberry or raspberry, make a
solution of sulphate of zinc, one grain to the ounce of rosewater, in a
wide-mouth bottle, and tilt the bottle upon the nipple, and allow it to
remain there for a few minutes, several times every day (F. 198, 217.)
It is necessary also to protect the part from the pressure of stays and
the friction of the flannel vest. The stays may be removed entirely, or
the nipple may be protected by laying a soft linen rag, wet with water
and cologne, around it so that the pressure will not be directly on the
nipple. If the breasts are swollen or painful, the soreness will subside
of itself before the commencement of labor. It may be well, however, to
foment them with flannel wrung out of hot water, and support them as in
a sling by a broad handkerchief, passing over the opposite shoulder.
3. PAY NO ATTENTION TO THE CHILLING AND “HORRIFYING TALES OF GOSSIPING
BELDAMES.”—A cheerful flow of spirits which arises from the hope of a
happy event, inspires a woman with activity and resolution, and is the
best preparation for the pains of labor. Do not give way to gloomy and
melancholy forebodings or indulge in idle reveries. Any person is your
enemy who would exaggerate to you the dangers of labor; and let me here
say to you, that if you read in this book of certain unfavorable
contingencies, do not let your mind dwell upon them; they occur very
rarely indeed, and I hope I have given such advice and instruction, and
that you have been so cautious and careful that your chance is unusually
favorable.
4. DO NOT EXPOSE YOURSELF AT THIS TIME TO WET AND COLD.—Do not go out in
bad weather, and do not go to theatres and other crowded places at all.
You are especially liable at this time to renal difficulties, and if you
take cold, it will cause congestion of the kidneys, and more or less
urinary difficulty. It is easier to prevent such complaints than to cure
them.
5. TAKE BUT LITTLE MEDICINE.—In general you may rest in the hope that
all your troubles will vanish after your confinement, and you can hardly
hope to cure them sooner. But keep your bowels loose. If you cannot have
daily passages by eating fruits, bread made from unbolted flour, or
other laxative diet, take saline waters, compound licorice powder, etc.,
(F. 108.) If your bowels are constipated at the time that labor
commences, take at that time an active cathartic (F. 109).
6. SEEK AND ENGAGE THE BEST POSSIBLE PHYSICIAN.—I do not know but the
educated monthly nurse of the future may be well qualified to do all
that is necessary in an ordinary natural parturition. But heretofore
very few nurses trained in this country are thus prepared; perhaps the
popular sentiment is against such an education. But you must always
select a physician that you can confide in and trust if an operation is
necessary, or there is unusual difficulty.
7. IT IS GENERALLY WELL TO HAVE YOUR PHYSICIAN SEE YOU A MONTH BEFORE
THE TIME THAT YOU EXPECT TO BE CONFINED.—Indeed, I would have you
consult with your physician during the whole period of your pregnancy.
You may get very full directions from this book, but still, where it is
practicable, I advise that you consult with some skilled medical friend,
who knows your idiosyncracies, and can suggest modifications of the
directions as your own case demands. Specimens of your water should be
analyzed each week during the last month, if there are any signs of
albuminaria, etc., (especially if the face and ankles are bloated.) If
there is inability to pass the water, it may be necessary to draw it
with a catheter.
8. SUBMIT YOURSELF ENTIRELY TO THE DIRECTION OF YOUR PHYSICIAN.—Do not
indulge in any opinion that may clash with his, even if that opinion is
founded upon what is here written; you cannot expect to know more than
he. It may be that he will wish to examine you by palpation, etc., to
know if the fœtus lies as it should do, as something may be done to
correct a malposition by external manipulation if the effort is made
early. No good physician will permit that your sensibilities should be
shocked by an unreasonable demand. If you have studied this book
diligently you will be prepared to converse intelligently with your
physician, and you will understand and appreciate any directions that he
may give. If you have taken any medicine prepared from formula herein
inserted, you know, and can inform him what the medicine is; this is
better than it would be if you had taken patent medicine, of the
ingredients of which you are ignorant. Consult with your physician in
regard to the choice of a nurse, as he will be likely to know those that
understand their business, and that are in the habit of following the
doctor’s directions, or he may know whether the one you selected is now
attending a woman that has contagious disease.
9. CHOOSE A GOOD NURSE.—You should have the best possible aid that the
nature of circumstances will permit. Do not get a fine lady nurse that
requires to be constantly waited on by a servant, and do not get a
croaker that discourses of the sad and dreadful cases that have occurred
in her experience. Do not get any one that is addicted to intemperance,
or a potterer that is devoid of method and efficiency; that does the
wrong thing in the wrong way, and that is always out of her proper
place. Get a nurse that will not dose and medicate either the mother or
child when they are under the care of a physician, or assume any duty or
responsibility that belongs to him; that admits that the doctor is the
one to give orders. Get one that never reveals the private concerns of
her former employers; one that is not a mischief-maker, causing
dissention and disagreement in the household. Do not get one that is
young, if she is giddy and thoughtless and inexperienced, nor one that
is old, if she is deaf and stupid. Get, preferably, a married woman or a
widow; one that has at some time had the care of infants; one that has a
pleasant countenance, and is naturally cheerful; one that has calmness
and self possession, and firmness, and at the same time is gentle, kind,
good-tempered and obliging; she should have a light step, a pleasant
voice, a cheering smile, a dextrous hand, a gentle touch, and be gifted
in cooking for the sick. By preference, engage a monthly nurse; she will
not be so likely to come to you from a case of scarlet fever or
erysipelas, or other contagious disease.
If you can find a nurse of the kind described above, and if she be
properly instructed and educated, she will be invaluable to you, and if
she devotes her talents and her best energies to you and your infant,
she should be liberally paid. But there are many such women all over the
country, or will be when we can induce them to qualify themselves by
study and special effort. But, as really good nurses are full of
engagements, it may be necessary for you to engage her in the early
months of your pregnancy; only stipulate in the start that you will be
obliged to dispense with her services, if it happens that immediately
preceding your confinement she had been attending a woman that had
puerperal fever.
I do not say that you should necessarily engage a nurse that is educated
as a midwife. But such a one is to be preferred even if you have a
physician, and then the latter need not be detained from his patients
for so long a period of time; and if the last stage of the labor is so
rapid that the child is born before the doctor arrives, there need be no
trepidation; she will know well what to do. Thousands are born in this
country without the slightest assistance from a doctor, he not being at
hand nor not being in time, and yet both the mother and babe do well
almost invariably. As a rule the nurse that has studied and learned the
most is the best prepared to discharge the duties resting upon her.
A NURSE MAY PROPERLY BE IN ATTENDANCE A WEEK OR MORE BEFORE THE
TERMINATION OF PREGNANCY, if circumstances permit or require it. If
present she will attend to the following things: Choose a good airy room
for the lying-in chamber—one that can be well ventilated, where the
temperature can be kept at from 60° to 65°; one that is removed as much
as possible from noise and disturbance, and where the patient need not
be exposed to draughts. Provide needed articles of clothing for mother
and child, and dressings for the bed; short gowns to wear over the
chemise or ordinary night gown; a proper bandage of heavy muslin, as
much as one and a quarter yards in length and fourteen inches in width.
I prefer to have it of several thicknesses, and if it is quite long so
that the ends meet to be folded it keeps in place better, and if it is
gored it should be in such a manner that it is narrower at the lower
edge than it is two inches above, so as to prevent it when adjusted from
sliding upwards; the child’s binder, preferably some woolen material
about five inches in width and fourteen inches in length; the child’s
shirt (woolen or cotton, not starched); both a long and a short
petticoat; a frock or slip; a shawl or flannel blanket; napkins and
muslin diapers; also pieces of old muslin to be used to absorb blood and
water. Provide also for dressing the bed, a piece of impervious oiled
cloth, oiled silk, or rubber cloth; old sheets and comfortables; a piece
of carpet; have in readiness a pair of shears or scissors, a small box
of prepared lard or vaseline or a flask of salad oil, a package of pins
one and a half inches in length, besides ordinary pins; tape, bobbin or
wrapping twine; fine toilet soap; fine sponge for washing the child;
soft linen or carbolated cotton for dressing the naval; a box of
unirritating powder; a pile of towels, and a little aromatic ammonia or
brandy to be used in an emergency. Let every thing be placed in such
order that either may be found without hurry or bustle at a moment’s
notice. Hot and cold water should always be in readiness.
CHAPTER V.
DIRECTIONS TO THE MONTHLY NURSE.
If you attend a woman to whom the physician has already been called, you
will thereafter be subject entirely to his orders. Whatever your opinion
is, notwithstanding you have this book or any good authority for your
opinion, if it seems to conflict with his directions, obey him; on him
rests the responsibility and he is presumed to know what is best. But it
is best that you should confide in each other—be on such relations that
you can communicate to him anything you have learned about the case; be
free to ask of him explicit directions and instructions. But your duties
may precede his as well as accompany them, and I wish now to give
special directions in regard to things that first demand your attention.
1. A nurse may properly provide a soft rubber catheter and also a
syringe; this should be constructed so that it acts as an enema
apparatus when one pipe is used, and as a vaginal syringe when the other
pipe is applied. The holes in this pipe should be made so that the fluid
injected is thrown backward.
It is important that this last direction be observed. I know of one
instance where the vaginal pipe of a Davidson syringe was used, yet the
fluid injected passed through the cavity of the uterus and through the
Fallopian tube and entered the cavity of the peritoneum, causing severe
pain and inflammation.
Besides the things already mentioned, I advise that there be furnished
for use if needed a small blanket to receive the baby, a little bath
tub, two chamber vessels, a bed pan, carbolic acid, fluid extract of
ergot, and chloroform.
2. Being employed as a monthly nurse, do not (except very rarely indeed
in an emergency) give any medicine at all or any stimulant that has not
been ordered by the attending physician. Many women do not consider that
labor is a natural process; it is painful indeed, and often lingering
and tedious, but will go to a safe termination ordinarily without
interference; any medicine given, unless very wisely administered, is
much more likely to do harm than good.
3. Be still and noiseless as possible in doing necessary duties when
your patient is trying to sleep, or when she is in special need of
sleep. Sleep may be of great importance to her, and it may be put to
flight by a little carelessness in renewing the fire, or in walking if
you wear heavy and creaking shoes. Nurses at these times should wear
slippers and not shoes.
4. If you attend the lady for a week or more before the doctor is
called, there may be different ailments which you ought to note, at
least enough to know their true significance. Perhaps she has false
pains, and suffers so much that she believes that labor has commenced.
You will decide partly from the character of the pains. False pains are
colicky, though they may shift occasionally from the bowels to the back
and loins and may extend to the hips and thighs. They come at irregular
intervals, are sometimes violent and sometimes feeble, and they are
particularly troublesome at night.
Spurious pains are often caused by disordered stomach and may be
somewhat relieved by attention to the diet and by mild aperients (F.
108, 109), or by applying a flannel bag of hot salt. If quite severe
send for the doctor; do not give stimulants.
5. You may benefit the patient at this particular time when labor is
approaching, perhaps without giving her medicine. Possibly she may feel
very well for a day or two, and you will need to direct her exercise so
that she does not do too much. You may keep from her unpleasant sights
and seeming dangers; keep her room from being overheated; see that she
does not have late suppers, too great a quantity of food, or anything
that will produce a costive state of the bowels. See that her clothing
is not too light, that she does not have strong tea or coffee, and that
she does not lie too much in the bed. Secure as much as possible
tranquility and equanimity, by guarding against gusts of passion, by
keeping from her tales of horror and disaster which have happened to the
pregnant, by teaching her that she has nothing to fear in regard to her
child from the simple fact that some longing has been ungratified or
that she was appalled at some frightful object, as such fears are seldom
if ever realized; relieve her if possible of gloomy forebodings by
informing her how rarely death happens after a well conducted labor.
6. If you give any medicine at this time give only that which is
unirritating and mild.
7. Notice all the indications of approaching labor, the sinking down of
the uterus in the pelvis, the contractions of the womb that come on
without pain, or with slight pain, the change in the mind and temper of
the lady, the augmented mucous secretion, &c.
8. Although there is usually a sensation of buoyancy and lightness
accompanying or preceding the setting in of labor, there may be on the
other hand a feeling of anxiety and depression of spirits. Be very
careful that you are not betrayed into any manifestations of impatience;
no words but those of gentleness and encouragement and hope should fall
upon her ear.
CHAPTER VI.
CARE OF THE MOTHER DURING LABOR AND CONFINEMENT.
TRUE LABOR PAINS are distinguished from the false by the fact that they
are felt considerably in the back, passing down to the thighs, and by
their coming on at regular intervals. At first they recur nearly every
two hours, and they steadily increase in number and frequency, and are
grinding in their character. There are other signs which denote the
actual commencement of labor; there is usually a frequent desire to
empty the bowels and bladder, perhaps shiverings or rigors unattended
with a sensation of cold, sometimes a severe rigor, and these signs are
preceded or accompanied or followed by a discharge of mucus and blood,
called the show.
It is well now to send for the medical man, though if he lives near by
it is only necessary to let him know that his services may shortly be
required. If the patient suffers from nausea, vomiting, or chills and
shiverings, let her know that they are only incidents of her labor and
not unfavorable. Do not let her increase the pains or attempt to
increase them in any way; it is much better that the labor should
progress in a natural manner, even if it is very slow.
THE PREPARATION OF THE BED for the occupancy of the mother is now to be
attended to. Cover the right side of the bed (as the patient will
probably lie on her left side) with a piece of water-proof cloth or oil
cloth; upon the top of this a sheet is to be placed and fastened with
safety pins. Over this permanent dressing (on the top of the bed sheet)
a neatly folded draw sheet is adjusted (and a second rubber and draw
sheet is desirable), which, after the labor, can be removed, leaving the
first clean and dry. This second draw sheet and rubber, and also a
folded comfortable can be placed a little nearer the foot of the bed
than the other, and after the lady’s confinement she can be drawn up on
the permanent dressing, and the temporary dressing can be easily
removed. The other bedclothes may be adjusted in the usual manner.
A piece of carpet can be thrown on the floor by the side of the bed, and
it is well to have a hassock to put between the patient’s feet and the
foot-board or bed-post.
TO DRESS FOR THE OCCASION, a folded sheet should be adjusted around the
waist (or, instead of this, or above this, a petticoat), to extend from
the waist to the feet. (These will be removed after the delivery.) Then
a chemise should be put on in the usual manner, and drawn up and folded
high under the arms. She should then have on a clean nightgown, and over
it a warm wrapper; this can easily be slipped off when she is about to
go to bed, and the night-dress, if it is a long one, can be folded up
under her arms, so that it will not be soiled.
The STAYS must not be worn, as that prevents the free action of the
muscles of the chest and abdomen. The patient, during the first stage of
labor, may walk about or sit down, and need not confine herself to the
bed. She may be allowed such food as she can eat, but should not be
urged to take food.
THE BEST BEVERAGE for her is either a cup of warm tea, or of gruel or
arrowroot. Cold water will not hurt her if she desires it. A patient
ought, during labor, frequently to pass water. Some women, from false
delicacy, do not attend to it, and suffer severely for it.
THE DOCTOR OUGHT TO HAVE SOME ROOM to retire to that the patient may be
left very much to herself, and that she may have opportunity whenever
she desires to of thoroughly emptying either the bladder or bowels. It
is better that not more than two women be present with her, and even one
of these can be dispensed with if necessary.
THE ROOM SHOULD BE KEPT QUIET.—Let the attendants be quiet and
self-possessed, and let there be no noise, or excitement, or whispering.
There may be ordinary cheerful conversation, but when the pains become
very frequent and severe, it is best that this should be hushed enough
to have the patient feel that the attendants are not neglectful of her,
or careless about her. Cheerful words spoken to the patient of the
blessed relief that will come after enduring so much pain will do good.
When the membranes are ruptured and the waters discharged, the doctor
should be called in immediately. When he is present you will be subject
entirely to his direction.
If the medical man cannot be present pretty soon, I advise any nurse who
has diligently studied this book to make a digital examination, and
ascertain if there is a head presentation; if there is, there need not
be any anxiety about getting a doctor.
If the child is born before the doctor has time to reach the house, let
the patient be made to understand that there is not the slightest
danger; and, for yourself, observe the following directions:
Ascertain if a coil of naval string be about the neck of the infant; if
there is, remove it immediately. See that it has room to breathe; that
there is not a membrane over its mouth, and that its face is not buried
in the clothes or the discharges. If the child cries, give a minute’s
attention to the mother, to see that she is in an easy position, and for
a few minutes make pressure with one hand over her abdomen. If the child
does not cry the moment it is born, give it a smart blow on the back,
sprinkle a little cold water upon it, and put your finger in its mouth
to remove any mucus that may interfere with respiration.
After the child cries, and when no pulsation can be felt in the cord,
tie and cut it. Tie with a strong and not too fine a string, about one
and a half inches from the child’s body, and cut so as to leave that
portion of the cord attached to the child’s body about two and a half
inches long. Cut far enough from the ligature so that it will not be
liable to slip off. The ligature should be drawn tight when applied, and
it ought to be examined afterwards to know that it does not continue to
bleed.
I shall here summarize, in a very brief way, what you are to do in the
absence of the doctor: After the child is breathing properly and the
cord is cut, the mother may receive your attention. If the placenta is
not expelled spontaneously, place one or both your hands over the
uterus, and by friction, squeezing and pressure there, you will probably
cause enough contraction of the womb to start the placenta from its
attachments. You may then make slight traction on the cord, pulling only
gently, and it will probably come down; as it emerges from the vagina
gently twist or turn over the afterbirth, and you will secure the
removal of the membranes.
The soiled articles are now to be removed, a binder applied, the patient
placed nicely in bed and kept quiet; no talking, no visiting, no
excitement allowed.
The baby may now be attended to—be washed and dressed. Have at hand a
bowl of warm water, a small quantity of lard or oil, soap, fine sponge,
and the articles of clothing, including a binder, and by preference a
piece of flannel for washing. It is well also to have a small tub large
enough to dip the child in. If the child is much covered with the
“vernix caseosa,” rub it over with some unctuous substance, and then
wipe it off with the flannel or some soft cloth, being careful at the
same time that nothing gets into the eyes of the child, and being
careful to remove all the cheesy matter from the angles of the joints,
and from behind the ears. Have the water for the bath warm, but not hot;
take hold of the feet of the child with your right hand and putting the
left under its back and shoulders, lower it into the water, supporting
its head by your arm. While supporting its head with your left hand,
wash it all over, using toilet soap and (if you have it) a fine, clean
sponge; then lift it out into a warm towel and dry it thoroughly. Dust
with fine starch powder, made of wheaten flour, under the arms and
between the legs, and dress the naval by using a soft piece of linen
dipped in vaseline and having a hole in the center. It is well to put
another piece of linen around the cord, which may then be turned upward
or to the left side, and the binder applied. Some prefer to put
absorbant cotton around the cord. The binder or belly-band should be
made of flannel, and should be cut bias. Care should be taken to apply
it tight enough not to slip, but too tight an application should be
particularly avoided. All the garments of the child should be made
subservient to comfort and not to show; should be warm and not too
small; should consist in part of flannel during cool weather. When
dressing the child put one garment inside the other, and put the whole
on over the feet. But few pins need to be used if the clothes be
properly arranged; three pins are sufficient for the binder. The washing
or dressing of the child should be done quickly; a little cold water
should be given it; it should be all the time in a warm room, and may be
laid where it is quite warm.
The mother may demand a little more attention before the child is
applied to the breast. A folded napkin should at first have been applied
to the vulva. Look to it and see if it is much soiled with blood. When
it is, apply a clean one, and observe particularly that one is placed so
that it is partly under her; observe if her bandage is well retained in
its place, and if it presses well on the lower portion of the bowels. If
the binder is kept well adjusted it does good; it is of no use if it is
allowed to slip up from its place. A towel folded and laid over the
lower portion of the bowels, under the bandage, is useful as a compress,
and helps to keep the binder in place.
Everything should be arranged so that the patient can have rest and
quietness; but before she goes to sleep put the child to the breast. If
the nipple is retracted, an ordinary tobacco pipe may be used to draw it
out so that the child can get hold of it. If the child draws on the
breast, the milk which it obtains will serve to physic it, and it should
be applied to the breast every four or five hours; nothing else need be
given it, except perhaps a little sugar and water.
If necessary to induce the child to take the breast, a little sweetened
water or sweetened milk may be applied to the nipple. While the child is
nursing the mother may lay upon her side, and receive the child upon the
arm of that side upon which she is lying. Perhaps, in order to draw out
the nipple so that the child can grasp it in its mouth, it may be
necessary to use some bottle with a flat, smooth mouth; fill the bottle
with hot water; after a minute, empty it and place the mouth of the
bottle immediately over the nipple; as the bottle cools there will be
sufficient suction to elevate the sunken nipple.
Soon after the termination of the labor the woman may partake of some
light food—tea and toast, panada, or anything of a light, unirritating
character. From the very first, under ordinary circumstances, the woman
may be permitted to change her position as she may desire, from side to
side, or to be propped up in bed. Before going to sleep she ought to
urinate—in a lying position, if so inclined, or she can be raised up and
supported in a sitting position for a few minutes, if she desires to be.
The patient must not be allowed to exert herself, or remain too long in
a sitting posture. But I have never known a woman to be harmed by being
raised up and sitting for a minute at this particular time.
Unless there is unusual suffering from afterpains or hemorrhage, or
something that requires the attention of the physician, the patient will
now be desiring and seeking sleep, and everything should be arranged for
this object.
CHAPTER VII.
DIRECTIONS TO THE NURSE DURING THE MONTH.
The nurse will receive from the medical man such directions as the
peculiarities of the case seem to demand, but I deem it proper here to
give some general instructions. First, in regard to
CARE OF THE MOTHER.
REST is essential to the mother during the month. She should remain in
bed nearly all the time for at least two weeks, and should not return to
her household duties under a month. Perfect tranquility is essential,
that the womb may resume its former size and situation, and that
inflammation, ulceration, prolonged debility, pain and excessive
discharges be avoided, and that a good form be preserved. As a means of
preventing a flabby, pendulous belly, she may also, when she does walk
around, wear a utero-abdominal supporter or a well-fitting bandage. If a
bandage is worn it should be made of strong linen, cut bias, setting
snugly to the form, but not exerting unpleasant pressure. Its breadth
should be from twelve to eighteen inches.
The diet of a nursing woman should be both light and nourishing. I would
suggest for the first day well-boiled gruel, bread and milk, panada,
tea, dry toast and butter, or bread and butter. For the second day, beef
tea may be added (F. 58), and she should be served with food four times;
the third day she may eat a little chicken or game, and mashed potatoes
or rice pudding, and on the fourth day she can partake once of mutton or
beef. Arrow root (F. 44), with these articles mentioned, may form part
of her diet thereafter, but she may partake of such articles of her
former diet as are wholesome and nourishing. The woman must not be
starved; she demands food that will allow her to recuperate her
strength. Give her as nutritious food as she has appetite for, and can
easily digest and assimilate. (F. 58.)
For a BEVERAGE give toast water, barley water, and milk with the chill
taken off and a little salt added, tea, cocoa, or chocolate made with
one-half milk, new milk and water, cacao and broma, made with a large
proportion of milk. Either of these may be freely used as a drink. I
have always allowed my patients to drink freely of water from the first,
and an occasional cup of coffee is not harmful. When the mother
experiences any inconvenience from any articles of diet or drink, she
should not hesitate to abandon them, for if they disagree with her they
will also disagree with the child. (F. 10, 16, 18, 19, 20, 23, 25, 28.)
The LOCHIAL DISCHARGE, which occurs directly after a lying-in, is at
first of a reddish color, and gradually changes to a brownish hue, and
afterwards to a greenish shade. It is necessary that there should be
some discharge to continue for a week, and it often continues for three
weeks more. In some cases it has a disagreeable odor.
ABLUTIONS and cleansings are very necessary at this time. The parts
should be carefully cleansed every day, and it is never amiss to use for
this purpose a weak solution of chlorinated soda, or carbolic acid, or
permangenate of potassa, etc., (F. 153.) They may be used quite weak at
first, and afterwards of greater strength, if they do not cause
smarting. Tar water is excellent for an injection. The woman should
daily assume a position that will facilitate the discharge of the
lochia; sometimes get on her knees, or she may occasionally lie on her
face and stomach. There should be no bandages applied so as to confine
the secretions. A soft sponge and warm water may be used for ablutions
at first, or the parts may be bathed with warm water and oat meal gruel;
after bathing they should be dried with warm, dry towels; they may then,
by means of a piece of linen rag, be anointed with salad oil or
vaseline, or other bland oil. Once or twice a day the vagina should be
syringed out with some injection. (F. 153, 155.)
TO WASH OR CLEANSE the patient so that the pores of the skin in every
part are free and unobstructed, a soft napkin wet with warm soap and
water, should be passed underneath the bedclothing, and she should be
rubbed all over without any exposure to a draught of air. In some way
she should take a sponge bath every day.
The CLOTHING which a patient will wear immediately after a labor has
been already, indicated. As some garments worn during labor are not
necessarily soiled, they may be worn until the third or fourth day, when
the dress should be changed. This may be done without tiring or exposing
the patient. Without raising her up you can pull the bedgown down from
over each arm, and after removing it from under the body, you can draw
down the chemise and remove it from below. You can place her arms in the
sleeves of the clean chemise, throw it over her head and pull it down;
and put on a clean bedgown in a similar manner, or both may be put on at
once.
The BED CLOTHING as well as the body linen should be changed frequently.
In changing the upper sheet it should be pulled off from below, and the
clean one can be carried down in its place without removing the other
bedclothes, by plaiting the lower half of it. To put on a clean
under-sheet, plait one side of it, and place that under the patient
while she lies on her side, then let her turn on her back or other side
onto it, and draw out the plaited part. Care of this kind is necessary
until she is able to sit. Have the sheets well aired, and have a proper
temperature in the room.
THE LYING-IN ROOM should always be kept well ventilated and rather cool;
it is injurious to the patient to have the room kept at a high
temperature. Perhaps the ventilation can be secured by having a little
fire in the room, and by occasionally leaving the door of the apartment
ajar, at the same time being careful to guard against draughts. But
visitors remaining in the room, or any additional number of persons,
serve to vitiate the air, as well as to prevent the necessary repose of
the patient. A sensation of chilliness may be felt by the woman after
delivery, and her feet may be cold; if they are, something warm should
be applied to them, and sufficient clothing should be on the bed; but
afterwards be careful not to overload her with clothes, as well as to
avoid having the room overheated.
TOO MUCH LIGHT in the room may be injurious to the eyes of the mother or
child, and it is often necessary to darken the room somewhat for a few
days.
The lying-in woman will usually be confined to her room for two weeks.
After the first fifteen days she may very properly remove to another
room adjoining, or near at hand, and during her absence her room and bed
may be ventilated by throwing the windows wide open and throwing the
bedclothes back. Ordinarily she may, at the end of three weeks, take her
meals with the family, but she ought still to lie down occasionally to
rest her back. At about this time she may take an airing in a carriage,
if the weather be fine.
All lying-in women ought not to be treated alike in regard to DIET, etc.
While a light, unstimulating diet is best at first in ordinary cases,
the weak and delicate require good, nourishing food from the
commencement, such as beef tea, chicken broth, mutton chops, eggs, etc.,
(F. 57, 58, 59.) Oatmeal gruel increases the secretion of milk, is
nourishing and easily digested, at the same time it is simple and bland,
and proper for those that are corpulent, or strong and robust, and the
same may be said of good cow’s milk. But, as the healthy mother
furnishes daily from a quart to a quart and a half, she needs some meat
to keep up her strength. Never give stimulants to increase the woman’s
strength, or to increase the quantity of milk.
In some cases, after a severe and lingering labor, there is RETENTION OF
URINE. If the bladder cannot otherwise be emptied, the catheter must be
used every six or eight hours.
The bowels are usually costive after a confinement, and I prefer to give
a dose of castor oil the third day. If this or some other aperient is
not given, enemas should be administered sufficient to cause
evacuations.
The care of the MOTHER’S BREASTS is important. Before the milk is
abundantly secreted, she should not be fretted by very frequent
ineffectual attempts at nursing, though it may be necessary to draw out
the nipple by means of a breast pump. The milk should be drawn out when
the breasts become full and distended, and they should not be allowed to
remain hard and sore. Apply fomentations; cabbage leaves, wilted in hot
vinegar and water, or warm solution of carbolic acid, one part to
eighty. If they continue to be swelled and painful use F. 221, 223. It
may be necessary to make gentle pressure upon them by means of strips of
adhesive plaster, or by a sort of jacket or bandage, that should be
prepared especially for the purpose. When the breasts are closely
bandaged they should be supported on each side by pads of cotton, so
that the pressure will be made equally upon them.
Delay in applying the child to the breasts is often a cause of swelled
breasts. After it has been fed for a few days it may refuse to nurse,
and if it does nurse the nipple may be quite tender. But, unless for
some cause the secretion is to be checked, the effort should be made
every two hours to induce the child to draw. You will be more successful
in these efforts if you can reduce the heat and swelling. Rub the
breasts every four hours with good, warm olive oil, vaseline, or
camphorated oil, and keep the excoriated nipple thickly coated with
sub-nitrate of bismuth.
The breast should be rubbed, and the child should be nursed regularly,
although I do not advise that the child or the mother should be roused
from their slumbers; it is better to delay for awhile the usual effort.
But, even at first, a child can be nursed with considerable regularity
every hour and a half during the day, and twice during the night; and it
should be applied alternately to either breast, even if it seems to
prefer one to the other.
It is often necessary to wash the breast and nipple with warm water, and
dry it with a soft napkin, before applying the babe.
During all the time that the mother nurses the child, the MIND OF THE
MOTHER exerts an influence on the latter through her milk. If the
mother’s mind is very much disturbed by any apprehensions, fears or
anxieties, these perturbations will not only be likely to check the flow
of milk, but will alter its quality, and perhaps render it hurtful and
dangerous to the infant. The nurse should guard the patient as much as
possible from anything causing nervous agitation, fretting, anger,
grief, fear, sudden terror, or great anxiety, as these are injurious to
the mother, and may be harmful and fatal to the child. Equanimity and
cheerfulness of mind on the part of the mother are important at any
period of her pregnancy or nursing. I will now give more particular
directions in regard to
THE CARE OF THE CHILD.
THE FOOD OF THE CHILD, if it is necessary to feed it at first, may be
one-third of new milk and two-thirds of warm water, slightly sweetened.
It is not necessary that it should be fed for at least eight hours after
birth, and at first the quantity fed it must be small. Except in rare
cases the milk furnished by the mother will come soon enough, and in
sufficient quantity to supply the wants of the child, and it is best for
both that the child should draw it when secreted. For the instruction of
the mother, as well as the nurse, I here quote a paragraph upon the
nourishment and feeding of the child, not only of the new-born, but also
of the subsequent months:
“No form of artificial nourishment can compare with that furnished
by the mother. Women should know and consider the probability of
disease and death occurring from any other mode, and the
difficulties and annoyances to be encountered in the use of
artificial food. As a further inducement to her to nurse her own
child, she should know that her offspring is sure to imbibe with its
milk, deep, earnest affection. The mother who can nurse her own
offspring should commence within eight hours after delivery, and in
the mean time no trash should be put in its mouth to still its
cries, or for any other reason; if it has not been surfeited, it
will be disposed to take the breast. It should be placed to the
breast before they are gorged with milk, for at that later time the
flow is less easy, the parts are more irritable, and the child
sucking with greater power, we are more likely to have, as the
result, irritated nipples. Nature prompts all animals to suck their
mother soon after they are born; we are less liable to have sore,
irritated, cracked nipples, and there is less liability to infantile
colics, etc., if we follow the guidance of nature and instinct.”
As soon as possible accustom the child to the habit of nursing every two
hours. If there is a proper interval between the times of nursing, the
child draws with more avidity, actually empties the breast, and obtains
that part that contains the most cream. Endeavor also to have the
intervals longer at night, so that, from 10 P. M. to 6 A. M., it nurses
but once or twice. Still, if it wakes every two or three hours, demands
its supply of nourishment, and you cannot otherwise quiet the child, you
must indulge it. Do not accustom the child to sleeping on the mother’s
breast. If it sleep in its own crib or bed, properly clothed and
protected, it is less liable to have its rest disturbed. Avoid the
custom of having a young child sleep with old and sickly persons, and
also of having them sleep in ill-ventilated rooms, and of covering the
child’s face as it sleeps. There is danger that a child may die from
want of pure fresh air, from having its face pressed tightly in the
embrace of the person with whom it sleeps, from the multiplicity of its
clothes, and from the mass of bedclothing used by the mother, as well as
from improper food. A child should never be covered to sweat by reason
of the warmth of its clothing, or of that of the apartment.
If the mother does not enjoy good health, it may be better for her not
to nurse the child at night, but to have it fed once or twice with a
little diluted cow’s milk at night, and to nurse it during the day.
The following have been named as CAUSES WHY THE MOTHER CANNOT PROPERLY
NURSE THE CHILD:
1. When she cannot have a sufficient quantity of milk.
2. When the supply falls off from some defect which is not remediable.
3. When there is a strong venereal or scrofulous taint in the
constitution.
4. When suckling produces an active or painful disease in the mother, as
colic, etc.
5. When the mother is subject to great nervous debility; possesses an
irascible temperament, and cannot avoid grief and sorrow; and also when
she is suffering from certain hereditary chronic diseases.
WHEN A MOTHER CANNOT SUCKLE HER CHILD, if circumstances will allow, a
healthy wet-nurse should be procured. Choose one that is of a healthy
family; ascertain that there are no eruptions on her skin, or if there
be other disease; if she have a plentiful breast of milk, and if it be
of a good quality; if she has good nipples, and if her child is born
near the time that the one was that she is to nurse. Do not get a nurse
that menstruates during suckling, nor one that has a child which is
unhealthy, or has a sore mouth or blotches upon the skin.
Very feeble new-born babes cannot take the breast sometimes. In such
cases cow’s milk, water and sugar (F. 1) may be given in small
quantities at a time, but frequently repeated. If it takes only a
teaspoonful at a time it should be repeated every half hour.
Many mothers are unable to obtain the services of a wet-nurse. The milk
of a cow is the best substitute, and when this is of ordinary richness,
it may be diluted with an equal quantity of water, or thin barley water.
The following are leading principles to guide in giving infant food:
1. Aliment should always be presented to the infant stomach in a fluid
form.
2. Bread and other farinaceous substances are generally indigestible in
the infant stomach, and may better be excluded from infant feeding.
3. Cow’s or goat’s milk, when pure and modified so as to resemble as
much as possible human milk, will generally be found sufficient without
any other help to nourish the new-born infant.
4. If cow’s milk is used at first, diluted with twice as much water and
slightly sweetened, the proportion of water must be gradually lessened,
until after six months the milk may be given undiluted.
5. When good milk from one cow cannot be obtained, and the child does
not thrive upon the milk used, condensed milk may properly be
substituted.
6. There are various forms of infant food referred to in F. 1, 2, 3, 4,
11, 28, 45, 49, and if one of these is tried and proves satisfactory, it
will not be advisable to try new kinds of infant food which are at the
present time offered for sale. Milk should be the basis of all infantile
food; neither starch, dextrine or glucose sufficiently nourishes without
it; but we may use one of these foods without milk for one or two days,
in unsettled state of the stomach, with good results. (F. 61.)
THOROUGHLY WASH THE BABE EVERY MORNING from head to foot, using a large
wash bowl or nursing basin, half filled with water. First wet the head,
then immediately put the body in the bath, and with a sponge or piece of
flannel, cleanse the whole body, particularly the armpits, groins, and
between the thighs. The skin, after being thus cleansed, must be quickly
and thoroughly dried with soft towels, and the parts liable to become
sore, powdered; then all parts of the body and limbs should be gently
rubbed. During all the time, when the child is but a few days old, it
should not be exposed at all to the cold. The water for its bath should
be slightly warmer than new milk, and the time occupied in the bathing
should be short. Each time, after a passage from the bowels, the parts
should be washed with warm water, and if there is any chafing the
calamine powder should be applied.
THE NAVAL STRING should receive the attention of the nurse; within an
hour of the time it is at first tied, she should examine the dressing to
see if there has been any bleeding. If it bleeds, and the doctor is not
at hand, retie with a stout cord, drawing it quite tight. Each morning,
when the child is bathed, lift up the naval string with the rag dressing
and insert a little nice fresh tallow under it. When it is loose remove
it, but use no means to cause the separation. The naval is sometimes a
little sore, but seldom needs any dressing more than simply vaseline or
tallow.
AT NIGHT a child should be entirely undressed, and its clothing replaced
by other garments, those that are loose, light, and sufficiently warm
for it while it is under the bedclothes. For a very young child the
proper night-dress is a loose slip; when older, a pair of drawers,
fitting up well around the neck and covering the body and limbs, is a
good article. The clothing worn during the day should not be worn at
night, and the clothing when soiled should be immediately changed.
Whenever the child seems disposed to sleep, this should be encouraged.
Never arouse a child suddenly from its sleep. Be careful that there is
no unnecessary noises to disturb its sleeping. Time the bathing and
dressing so that the little one may not be unnecessarily disturbed. But
never give soothing syrups, anodynes for infants, or other nostrums to
induce them to sleep. If the child is restless, endeavor to ascertain if
there is not some cause that can be removed, such as tight clothing,
etc.
PREMATURE INFANTS may, under favorable circumstances and assiduous care,
live and thrive. Immediately after birth the child should be placed in a
warm bath, and then wrapped in cotton. The baths should be warmer than
usual, and must be frequently repeated. Awaken the child every one or
two hours to feed it. Milk (woman’s milk is the best) must be given it
by a teaspoon. With a view to the better development of the lungs, it
may be excited to cry by a slight irritation. Do not bring such children
into the open air for several months after the birth, as their passages
are readily affected.
PART II.
ANATOMY AND PHYSIOLOGY OF THE FEMALE ORGANS AND FŒTAL DEVELOPMENT.
CHAPTER I.
OF THE PELVIS.
The formative organs of generation are situated within a large cavity,
called the cavity of the pelvis, the walls of which are composed of
bones and soft parts. This basin (in Latin, _pelvis_) is an irregular,
long cavity, situated at the base of the spinal column, and above the
inferior extremities. In the adult the bony pelvis may be divided into
four parts or bones, viz: the os sacrum, two ossa innominata, and the os
coccygis, but in early life they are more minutely divisible.
THE SACRUM.
The sacrum (Fig. 1) terminates the vertebral column, and is perhaps the
most important bone in the pelvis, obstetrically considered, as it
enters largely into the various deformities of the pelvis. In the adult
it is of a triangular shape, the base of the triangle being above and
inclining forwards, the apex below and somewhat backwards; its length is
from four to four and a half inches; its breadth about four inches, and
the greatest thickness, two and a half inches. The internal surface is
concave to the amount of half an inch, crossed by four transverse lines,
marking the former division by cartilage; here are four pair of holes,
through which pass numerous nervous filaments, which afterwards form
part of the great sciatic nerve.
[Illustration]
Fig. 1– A represents the internal or anterior surface of the sacrum.
B B represents the articular processes.
C C represents the anterior sacral foramen.
D represents the articulating surface.
It is placed at the posterior part of the pelvis, where it appears like
a wedge forced in between the ossa innominata, immediately below the
vertebral column and directly above the coccyx.
THE OSSA INNOMINATA.
The os innominata (nameless bone, Fig. 2) is of a very irregular figure,
and the pair occupy the lateral and anterior parts of the pelvis. The
external or femoral surface is turned backwards and downwards, as well
as outward; at its superior part, inferiorly it looks downwards. Towards
the front, the external face presents the cotyloid cavity, or the
acetabulum; a little more in advance and below is the subpubic or
obturator foramen, which is nearly closed by the obturator ligament.
[Illustration:
Fig. 2. Right os innominatum, external surface.
Fig. 2—Represents the external surface of the right os innominatum. A.
The external iliac fossa; B, crest of the ilium; C, anterior
superior spine of the ilium; D, anterior inferior spine of the
ilium; E, horizontal branch of the pubis; F, posterior superior
spine of the ilium; G, posterior inferior spine of the ilium; H,
acetabulum; I, ischium; K, obturator foramen. At birth the haunch
bone, or os innominata, is composed of three bones connected by
cartilage. Fig. 3.
]
The superior portion of the bone is characterized on its abdominal or
internal face by a large excavation called the internal iliac fossa
(Fig. 4.) This portion is terminated below by a large rounded and
concave line. The inferior (lower) portion presents behind a nearly
triangular plane surface; near the middle of this is the obturator
foramen, and in front is the internal face of the os pubis.
[Illustration:
Fig. 3. Left os innominatum, external surface, etc.
Fig. 3—Left os innominatum, partly ossified. The haunch bone as it
exists in the child. A, pubis; B, ilium; C, ischium.
]
[Illustration:
Fig. 4. Right os innominatum, internal surface.
Fig. 4—Right os innominatum, internal surface. A, internal iliac
fossa; B, anterior superior spinous process of the ilium; C, crest
of the ilium; D, posterior superior spinous process of the ilium; E,
posterior inferior spinous process of the ilium; F, articular
surface; G, spine of the ischium; H, tuberosity of the ischium; I,
obturator foramen; K, ischia pubic ramus; L, crest of the pubis; M,
the pectineal eminence.
]
THE OS COCCYGIS.
[Illustration:
Fig. 5.
The os coccygis.
]
The OS COCCYGIS (Fig. 5) is three or four little bones united together
on the median line of the body, and attached to the os sacrum. Each
little bone is tipped with cartilage, and they are so united as to be
movable. The entire bones form a pyramid, the apex of which is below.
The internal surface is smooth, like that of the sacrum, terminating the
plane of the sacrum and bounding it anteriorly.
[Illustration:
Fig. 6. Vertical section of the pelvis.
Fig. 6—Inlet, outlet, and axis of the pelvis. a, b, plan of
inlet—superior strait; c, d, plan of outlet, or inferior strait; e,
f, axis of cavity; g, the coccyx extended as it is in labor.
]
Of the JOINTS OF THE PELVIS it is only necessary here to say that there
is no motion in them to facilitate labor, except that the
sacro-coccygeal joint is of the kind called ginglymoid, admitting of
extensive motion, especially backward, so as to permit the enlargement
of the lower outlet an inch or more. (Fig. 6.)
OF THE PELVIS IN GENERAL.
We will now consider the pelvis collectively or as a whole; its relation
to the rest of the body; its magnitude, axis, etc. It is connected with
the trunk by the articulation of the sacrum with the last lumber
vertebra, effected in the same manner as the junction of the vertebra
with each other; with the lower extremities it is connected by means of
the hip joints. When the pelvis is _in situ_, the brim is neither
horizontal nor perpendicular. It represents a cone, slightly flattened
from before backwards, the base of which being above, while the apex is
directed downwards.
When the body is erect the upper part of the sacrum and the acetabula
are nearly on the same descending line, the point of the os coccygis
being a little above the arch of the pubis, and the sacro-vertebral
angle three inches and nine lines higher than the pubis. Were it not for
the obliquity owing to the upright position of the human female, the
womb would gravitate low in the pelvis, and produce most injurious
pressure on the contained viscera. The lower or true pelvis is the part
involved in parturition, and its size and shape demands our attention.
THE BRIM OF THE PELVIS.
This is defined by the LINEO ILIO PECTINEA, which marks the boundary of
the true and false pelvis, and this _superior strait_ is the entrance of
the lesser pelvis. Its form has been variously described as being oval,
heart-shaped, and triangular. If we call it “triangular with angles
rounded off,” the base of the triangle is behind and the apex in front.
It would be nearly oval were not the oval form broken by the promontory
of the sacrum. This brim is the first solid resistance the head of the
fœtus meets in its descent through the pelvis.
DIAMETER OF THE PELVIS.
Different estimates are made by different anatomists of the measurements
of the brim of the pelvis. The following is nearly the correct size of
the ordinary female pelvis:
[Illustration:
Fig. 7. The bony pelvis.
Fig. 7—The pelvis seen from above. a a, The antero-posterior or
sacro-pubic diameter; b b, the transverse diameter; c c, the two
oblique diameters.
]
The circumference varies from thirteen to fifteen inches; the
antero-posterior diameter, _i. e._, from the prominence of the sacrum to
the upper edge of the symphasis pubis, (Fig. 6), is about four and a
quarter inches; the transverse across the widest part of the brim, at
right angles to the antero-posterior, is five and a quarter inches, and
the oblique from the sacro-iliac synchondrosis of one side to the
opposite of the brim, just above the acetabulum, is five inches. (Fig.
7).
THE CAVITY OF THE PELVIS, of which the fixed boundaries are the sacrum
and the pubis, is of unequal depth. The height in front is one and a
half inches; upon the sides, three and three-quarter inches, and it is
four and a quarter inches if a straight line be drawn from the
sacro-vertebral angle to the point of the coccyx, five and a quarter
inches following the curve of the sacrum, and six inches if the coccyx
be extended. (Fig. 6).
The antero-posterior diameter of the outlet from the arch of the pubis
to the point of the coccyx is usually four and a quarter inches, but may
increase to five inches during labor by the retrocession of the coccyx
(Fig. 8); the transverse from one tuber ischii to another is four and a
quarter inches, and the oblique about four and three-quarter inches.
[Illustration:
Fig. 8—Position of the pelvis and the axis at the termination of
labor.
Fig. 8—a b, Total axis of the excavation; c, the axis of the superior
strait; d e, perineum as distended at the moment of the passage of
the head.
]
It is important to notice that the diameters are entirely changed
between the rim and the outlet, and that the change is effected
gradually. The axes of the inlet and outlet form an obtuse angle with
each other (this is illustrated in Figs. 6 and 8.) The three diameters
taken at the center of the pelvis are very nearly equal—about four and
three-quarter inches.
DIFFERENCES OF THE PELVES.
There is considerable difference between the male and female pelvis, in
shape and size. The pelvis in the male is smaller but deeper; the bones
are thicker and the brim is more circular, the depth of the symphasis
pubis is greater, the sacrum is more perpendicular, the arch of the
pubis is narrower, the tuber ischii are nearer each other, and the
coccyx less movable. In the female the iliac fossæ are larger, the
interval separating the angle of the pubis from the acetabulum is
greater, causing the prominence of the hips and wider separation of the
thighs, the superior straight is larger and more elliptical, the curve
of the sacrum deeper and more regular, the tuberosities of the ischii
are further apart, and the arch of the pubis broader. From the greater
width of the female pelvis, and from the upper end of the thigh bones
being farther apart than in the male, the thigh bones approach each
other in their descent, giving a peculiarity to the movements of the
female in walking.
The soft parts lining the pelvis and covering it externally modify the
diameters of the pelvis, but the effect of these additions in
diminishing the internal diameter is not very great. The diameter of the
cavity is lessened thereby from one-fourth to one-half an inch.
USES OF THE PELVIS.
One function of the pelvis is to inclose and protect the bladder, rectum
and seminal vesicles of the male, the uterus, Fallopian tubes and
ovaries, as well as the bladder and rectum in the female. During labor
it affords a passage for the child.
TERMINAL OUTLET OF THE PELVIC CANAL.
This is not at the coccyx, but rather at the anterior commissure of the
perineum. This is so greatly distended at the last moment of labor as to
much prolong the posterior wall of the pelvic excavation and the canal
to be traversed by the fœtus. (Fig. 8).
[Illustration:
Fig. 9—Section of sacrum and pubis.
Measuring superior strait.
]
[Illustration:
Fig. 10.
Measuring inferior strait.
]