Causes.—Abortion may be induced by many causes due to the mother, father, and child. Among maternal causes may be mentioned any serious disease, especially fevers, when accompanied by a rash on the skin, such as smallpox, measles, scarlet fever. It is hard for a pregnant woman to go through one of these diseases, without having an abortion. Syphilis, tuberculosis, malaria, organic heart and kidney disease, diabetes, anemia, and systemic poisoning also are causes; nervous disturbances as shock, fright, sorrow, convulsions, chorea; mechanical causes, violent exercise, lifting, blows, falls, coughing, vomiting; local causes, as wrong position of the womb, inflammation of the womb, etc.; all are causes.
Causes. Due to the Father. Paternal.—Syphilis, alcoholism, lead poisoning, excessive venery, extremes of youth or old age.
Foetal Causes.—Disease of the after-birth, other parts, of cord, death of the foetus, placenta pravia, and yet many women are subjected to falls, blows, etc., who carry their child to full term.
Symptoms.—These vary with the period of pregnancy where they occur. In the earlier months the symptoms are those of profuse menstruation, sometimes accompanied by more pain perhaps than usual. The ovum is then so small that it escapes notice. In the profuse flow there may be unaccustomed clots of blood; when this trouble occurs later in pregnancy there are two constant symptoms which, together with the history of the case, render the diagnosis easy. These prominent and constant symptoms are pain and bleeding. The symptoms may be preceded by a bearing down feeling in the lower abdomen, with backache, frequent calls to pass urine, and a discharge from the vagina, that is a mixture of mucus and water. After these symptoms last for a shorter or longer time, labor pains set in, the bleeding increases and the contents of the womb are discharged. The ovum may be expelled whole when it looks like a huge blood clot, or it may be expelled partly and the membranes left behind; or the embryo (child) alone, surrounded by the transparent membrane, escapes.
If the after-birth has formed it may be cast off entire or piecemeal. The embryo (child) alone may escape, the neck of the womb contracts and shuts; bleeding persists for an indefinite period, for weeks and weeks, until the health of the poor woman is seriously affected. Persistent bleeding of this kind is almost always due to the retention of portions of the after-birth or membranes, and should prove to the woman that there is a serious condition existing which should be speedily corrected. A physician should be called who should make a thorough examination; and if such a condition as above described is found, should free the womb from its retained products, which are not only sapping the woman's life, but also rendering the future health of the womb very uncertain.
Threatened Abortion.—If a bleeding takes place in the woman who is pregnant, abortion may be assumed to threaten; a careful examination will usually settle this matter.
Inevitable Abortion.—The abortion is probably inevitable if the bleeding becomes persistent and free, the cervix softens, the womb dilates and the labor pains set in. Still in spite of all these conditions, the bleeding and pain may cease, and the pregnancy go on to full term, The result of these cases, if carefully and properly treated, is favorable as far as the mother is concerned.
Treatment. Preventive. In women where repeated abortions have occurred, the cause should be diligently sought for. If syphilis exists the treatment should be begun at the beginning of pregnancy. But when no special cause can be found, and an irritable condition of the womb is suspected to be present, the patient must be kept quiet in bed, especially at the time when menstruation would normally occur. She should also be guarded against lifting, fright, worry, over-exertion; and medicines like bromide of potash, five to fifteen grains at a dose, given to quiet and allay the nervous irritability.
Treatment of Threatened Abortion.—The patient should go to bed, lie down and remain there, and if possible be not only quiet physically, but also quiet mentally. The main remedy is opium, and if necessary to obtain a quick action it can be given hypodermically in the form of morphine. Otherwise, laudanum may be given by the mouth, twenty drops, repeated cautiously, every three or four hours as required, or it can be given in thirty-drop doses combined with a couple of ounces of starch water by the rectum. Extract of opium in pill form, one grain three times a day by the month; or a suppository of opium, one grain, may be inserted into the rectum every four to six hours. After the bleeding and pain have ceased, the emergency is probably passed; but rest in bed and quiet should be the routine for one or more weeks, and the patient should always rest in bed at the usual time of the menstrual period, during the remainder of the pregnancy.
Treatment of the Inevitable Abortion.—If the cervix is hard and the canal is not dilated, especially if the bleeding is free, the vagina should be packed full at once, if possible, with iodoform gauze. Rolls five yards long and two inches wide can be bought perfectly adapted to this purpose. A speculum should be used (Sims' or Graves') and the gauze should first be packed tightly into corners (fornices) around the cervix, then over the cervix and well down to the outlet. This should be held in place by a proper (T) bandage. The gauze can be removed in from twelve to twenty-four hours, and the ovum will generally be found lying upon the upper part of the packing, or in the canal that is now dilated, from which it can easily be removed. Sometimes it is necessary to repack and allow it to remain for another twelve hours as the canal has not been sufficiently dilated by the first packing. This packing not only causes the canal to dilate but usually stops the bleeding. After the ovum has been expelled an antiseptic vaginal douche should be given twice a day for a week or longer.
If at the first examination the cervix is found softened and the mouth of the womb is open, but the womb has not yet expelled its contents, the sterile (clean) finger may be introduced into the womb and the ovum and membranes loosened and taken away, while this is being done counter pressure should be made over the abdomen. After the womb has been cleared of all its contents an antiseptic solution should be used, carefully, in the womb to wash it out, and this followed by washing out of the vagina. The after treatment is the same as that for labor at full term. The woman should remain in bed at least ten days.
Placenta Praevia.—The after-birth is placed in the lower part of the womb; (after-birth before the child). This is a dangerous condition and terrible bleeding may occur. It occurs about one time out of every one thousand. The main symptom is bleeding and this may occur at any period of pregnancy. It usually appears from the seventh to the ninth month. The outset is without any appreciable reason and without pain. The amount of blood lost at the first attack may be so slight as to escape notice or copious enough to endanger the life of the mother. This flow may occur at any time during these months, and it may be small or great. If during the course of pregnancy the bleeding occurs at intervals in the increasing amount, the greater will be the loss of blood during the labor.
Treatment.—There is little danger of dangerous bleeding before the seventh month, and a waiting treatment may be adopted, but the woman should be closely watched and told what the trouble is, so she will be willing to remain quiet. Rest in bed, the avoidance of all muscular exercise and quieting medicines may enable the mother to carry the child until it can live, when pregnancy must be quickly terminated. If the child is dead the womb must be emptied at once. After the seventh month an expectant treatment is no longer allowable, and authorities declare the pregnancy should be terminated without delay. The mother is in great danger from sudden free flow. This treatment must be given by an experienced hand and only a physician can do it. If the pregnancy is allowed to continue to full term the danger to the woman is very great, as the mortality runs from thirty to sixty-five per cent; but under modern treatment it has been brought down to five to ten per cent. The death rate of the child is between fifty and seventy-five per cent.
Labor.—Labor may be defined as the physiological termination of pregnancy whereby the mature foetus (child) and its appendages (after-birth, etc.), are separated from the maternal organism.
Premonitory Signs of Labor.—Premonitory signs of labor, usually observed from one to two weeks before the onset of the labor pains, is a sinking down of the womb in the abdomen, whereby some of the unpleasant features of pregnancy are relieved, and the so-called "lightening" takes place. The waist line becomes small, the breathing is easier and the general well-being of the woman is better, so that her friends are attracted by her feeling of relief. But as a result of the womb descent and the consequent pressure, irritation of the bladder and rectum may occur, and she may have frequent calls to empty these organs. The vagina secretes more actively, the veins enlarge, some dropsy may appear in the extremities, and the womb contractions of pregnancy, which have been painless, begin to cause more and more discomfort.
These false pains recur at regular intervals of hours or even days, and generally at night, last for a varying period and usually disappear in the morning. They often deceive the woman and lead her to the belief that the labor has already begun; but examination of the cervix will reveal that this is not so. It is well to bear in mind that the true labor pains usually begin in the back, extend down to the thighs and often around to the front and they recur at regular intervals, and with increasing intensity.
The beginning of labor is characterized by recurring pains at regular intervals and of increasing severity. There is also a discharge from the vagina of mucus, and this is sometimes tinged with blood, "the show." If an examination is now made, it will be found that the cervix (neck of the womb) is shortened, and that the mouth of the womb is beginning to dilate. At the beginning, the pains are usually in the back and spread to the abdomen and down the thighs; but they may be felt first in the abdomen. They return every half hour or twenty minutes, but as labor goes on the interval is shortened, so that toward the end of the second stage when the child is being born, they appear to be continuous, and the patient feels as if she is encircled by a belt of pain; however, with all this, she will bear the suffering easier and better for she knows that progress is being made, and that she will soon be over the pains and the child born. A pain rarely lasts more than one minute.
STAGES OF LABOR.—First stage extends from the beginning of labor until the mouth of the womb is dilated. Second stage, from the complete dilation until the complete birth of the child. Third stage, from the birth of the child until the expulsions of the after-birth—Placenta.
The First Stage.—The first stage varies greatly in different women. The average duration of this stage is from ten to fourteen hours in the woman with the first child, and six to eight hours in the woman who has borne children. During this stage the woman prefers to remain on her feet, sit, stand or walk about. The amount of pain experienced varies greatly, according to the temperament of the patient; in nervous women it may be excessive. The pains now have nothing of that bearing down character which they afterward acquire; they are described as "grinding," are usually felt in the front. The genitals become bathed with secretions, which are sometimes tinged with blood. This is an especially trying period to a young wife, for she cannot see that the pains are doing any good, only making her restless, tired and nervous. Little can be done by the physician in this stage except to encourage and explain what is really being accomplished by these seemingly futile pains and by tact and proper encouragement, a physician tides this stage over and gives great comfort to the needy patient. This stage ends with the opening and dilation of the mouth of the womb and the second or expulsive stage sets in, with pains altered in character.
Second Stage.—The pains now become more frequent and severe and last longer, and the patient now manifests a strong desire to expel the contents of the womb. The woman now feels better in bed and when the pains come she involuntarily bears down, with each contraction she sets her teeth, takes a deep breath, fixes the diaphragm, contracts the muscles of the abdomen and bears down hard if you allow her to do so. The knowledge that she is working to overcome an obstacle gives her some satisfaction and she feels that she is accomplishing something by the efforts she is making. The physician can aid greatly by suggesting to the patient how to use the pains and how much bearing down to do. He can tell her when not to bear down, and so save her strength for the next real pain when bearing down will do good. Although the pains are really harder in this stage, nervous women suffer no more, for their mind is now concentrated upon the work at hand. Sometimes at the beginning of this stage the patient feels chilly or has a severe chill; a hot drink and more covering counteract this. Another phenomena is the escape of the waters and a lull in the pains for a little time, when they come on more effectively than before as the womb contracts down upon the child and is not hindered by the "bag of water." The pains keep on at intervals until the child is born and the physician can now be of help by guiding, directing and assisting the birth of the head. This stage averages about two hours.
Third Stage.—The birth of the head is very soon followed by the shoulders and the rest of the body, and the woman is now at comparative rest. The cord is now tied and cut and the child laid away, if all right, in a warm place until it can be washed and dressed. Following the birth of the child there is a short resting period, the contractions of the womb cease and it becomes smaller through retraction. After a few minutes the pains begin again, the after-birth separates from its attachment in the womb, and together with the membranes is extruded into the vaginal canal and vulvar opening; whence it can be easily delivered by pressing upon the abdomen over the lump (womb) and by guiding the after-birth with the cord. This should be done slowly so that the membranes will all come away with the after-birth.
This should always be examined to be certain that everything has come away. A greater or less amount of clots of blood come with the after-birth. The contraction of the womb stops the bleeding, one hand should be kept on the abdomen over the womb, to see that it remains hard and retracted. The womb moves under the hand. If it softens, gentle rubbing should be kept up and the womb will soon remain contracted. This stage averages about fifteen minutes.
MANAGEMENT OF LABOR.—Preparation of the Bed.—The bed should be high, springs not soft, with a firm and smooth mattress. It should be placed so that both sides are accessible. The bed should be made up on the right side as a rule, as the woman usually lies on her left side when delivered. Place a rubber, or an oil cloth sheet, over the mattress, and over this an ordinary muslin sheet and secure this with safety pins to the corners of the mattress. This is the permanent bed; on top of this is the second rubber sheet and this is covered with another muslin sheet and both held by safety pins. This is the temporary bed. Plenty of hot and cold boiled water should also be at hand. Frequently only a temporary bed is made with rubber or oil cloth underneath, blanket and sheet above this. They should be fastened so that the movements of the woman will not disorder them. These can be removed after the confinement and new, clean warm clothes put in their place. The objection to this is the woman may be too tired to be moved, while, with the permanent and temporary bed arrangement she need not be moved at all, only lifted, while the temporary bed is being removed and she is then let down easily upon clean bedding.
Preparation of the Patient.—The patient, if she desires, can take a full bath. The bowels should be moved thoroughly with a soap and water injection so that the rectum will be fully emptied. This makes labor not only easier, but pleasanter, as no feces will be discharged during labor. The bladder should also be emptied. The external organs should be scrupulously cleansed and bathed with some antiseptic solution, like glycothymoline, listerine, borolyptol, etc. A fresh suit of underwear may then be put on and over this a loose wrapper.
Examination of the Patient.—The physician needs to satisfy himself as to the position of the child, etc. This can be done by an examination of the abdomen and also of the vagina. He must determine whether the child is alive, its position, the condition of the cervix and mouth of the womb. In making such examination a routine plan should be adopted. The coat must be removed, the shirt sleeves turned up and the hands and arms washed with soap and water. The abdomen should be thoroughly palpated (felt) and listened to with the ear or stethoscope to determine the character of the child's heart beat, whether it be very slow, one hundred and twenty or less, or a very rapid one, one hundred and fifty or more. It may indicate danger to the child and necessitate a hurried delivery. After these things have been done, the hands and arms must again be thoroughly washed and sterilized, the fingers anointed with carbolated vaselin and the examination of the vagina made.
This cleanliness is necessary, and if this plan were carried out by everyone connected with the patient during the whole confinement, there would be fewer cases of "child-bed" fever, with its resultant diseases. The patient should lie on her back with the knees drawn up. There is no need for any exposure now, for the covering can be held up by an attendant so that it will not touch the physician's hands. The soft parts are now separated by the fingers of one hand while the examining fingers are introduced into the vagina. These fingers should never touch any external part and especially the parts near the anus. If the cervix is found to be long and the canal still undilated, or only slightly so, and especially if it is the first child (primipara), the physician's presence is not needed and he may safely leave for an hour or two. But if the mouth (os) of the womb is dilated to the size of a silver dollar he should on no account leave the house.
Frequent examination of the vagina should not be made. In ordinary cases during the first stage, the woman should be up and encouraged to walk about the room, to sit or assume any comfortable position. During a pain she may stand beside the bed resting her hands upon something or kneel in front of the bed or chair. The standing position assists in the birth. The bladder should be emptied frequently, as a distended bladder retards labor and may even stop the womb contractions. The pains become more frequent and severe as the end of this stage approaches and each contraction is now accompanied by straining or a bearing down effort on the part of the woman, and as a rule the membranes rupture spontaneously about this time. An examination of the vagina should now be made with the woman in bed, and if the membranes have not broken and the womb is completely dilated as shown during the pain, they may be ruptured by pressing against them with a finger-nail during a pain. Sometimes we use every means to retain the membranes intact, but that is when protection for the child is needed for sometime longer. If the suffering is very severe, during this stage, fifteen grains of chloral hydrate, well diluted with water, may be given every fifteen or thirty minutes until sixty grains have been given. (This medicine should never be given to a person with heart trouble). I find one drop doses of the tincture of Gelsemium every fifteen to thirty minutes of benefit, especially if the womb does not dilate well, or the patient is very nervous. The patient may receive and can receive light nourishment during this stage.
Management of the Second Stage.—After the rupture of the membranes the labor proceeds faster and a termination may be expected within a reasonable time. There is a short lull in the pains, usually, after the waters have escaped and during this time the patient should remove her clothing and put on a night dress, and to prevent its being soiled roll it well up under the arms and retain it there. After labor it can be very easily pulled down and made comfortable for the patient. A folded, clean, sterile sheet is now placed about the body and extremities and held in place by a cord around the waist. The opening in the sheet should be in the right side, as this will allow the assistance being given as needed. The powerful force of the abdominal muscles is now brought into action; the force is best utilized with the woman lying on her back.
She should now be encouraged to bear down during the pains and she will be greatly assisted by pulling on a sheet or long towel tied to the foot of the bed, or by holding the hand of the nurse. A support for her feet frequently aids the woman. Pressing low on her back relieves her to some extent. In the intervals between the pains she should rest, do nothing, and be perfectly passive. It is now that an anesthetic may be used to relieve the suffering. She should not be put completely under its influence for that is not only unnecessary, but injurious. Chloroform when used should be given on a handkerchief opened and loosely held over the woman's face, and administered drop by drop on the handkerchief. The handkerchief should be placed over the face at the beginning of the pain and be taken away as soon as the pain is stopped. The woman inhales the chloroform during the pains and their sharpness is blunted. Given in that way it is not considered dangerous. It should only be pushed to unconsciousness during a forceps delivery, and even then it is not always necessary to render the woman unconscious. I have used the forceps without giving an anesthetic. They should be placed without causing any special pain, and assist in delivery without causing any more pain when the head is down low. Of course if the forceps must be used when the head is high up a greater amount of anesthetic is needed.
Dr. Manton, of Detroit, says:—"The dangers of anesthetics are the same when employed for obstetric purposes as in surgery, and then use should be governed by the same rules in each instance." As soon as the head begins to dilate the vulvar opening, the patient should be turned on her left side with her knees drawn up and her body lying diagonally across the bed, with the buttocks close to and parallel with the edge. This position allows the physician to give better assistance and is no harder for the patient.
The physician with his hands thoroughly sterilized and with a clean sterilized gown, seats himself on the edge of the bed and watches the progress of the labor, ready to assist the woman at any moment. And at this time he can do much by words of encouragement and proper directions to the laboring woman how to use her pains so as to get the most from them; and also by manipulation of the soft parts and the head. The head advances more and more with each succeeding pain, and the perineum is put on the stretch, each contraction is followed by a resting pause during which the head slips back a little and relieves the perineum. Tear of the perineum is liable to take place when the head is about to escape through the vulvar opening, especially if the contractions are strong, the woman bears down forcibly and the interval between the pains is short, so that the head is forced out before the parts have time to completely dilate and soften. Here is where the physician's work comes in, by holding the head back and fully flexed (bent), chin upon the breast, and keeping the back of the head (occiput) well up towards the bone in front (pubic arch) until thc perineum is completely dilated.
The effect of the pains can be lessened, if necessary, also, by telling the woman to open her mouth and not to bear down during the pain for a few times. In this way the perineum will dilate properly and be torn little, if at all, and perhaps much future trouble for the woman saved. I always tell my patient why I ask her to do certain things in labor and I have never found any woman who, when able, was not willing to do as I asked. A torn perineum is not desirable, because even when sewn up immediately after labor, it may not unite thoroughly, and thus cause displacements of the womb in the future. A little time and care at the time of labor will save the perineum and every woman is willing to do her share when the conditions are plainly explained to her. It takes only a few minutes longer, and only a few more pains to bear. When the head begins to stretch the opening, the left hand of the physician should be carried over the woman's abdomen and between the thighs, her right leg being supported by a pillow placed between her knees, and this left hand presses the back of the head (occiput) forward and against the "pubic arch." The right hand may also press the head upward by being placed against the posterior portion of the dilated perineum. The edge of the perineum should now be closely watched. A small towel wrung out of a bowl of hot water placed handy on a chair, should be held constantly against the perineum to hasten the softening and dilatation of these tissues. Plenty of hot water and small towels should be at hand. The head advances with each pain and again recedes until the parts are properly dilated, and the perineum slips backward over the child's face.
If torn, it should be sewed before the physician leaves, as it can be done easily and without pain to the mother. As the head of the child emerges, the anesthetic should be pushed, or the woman told to open her mouth and cry out. This lessens the pain and the child's head emerges slower, and the perineum is saved. The child's head should be received in the hand. After the head is born, there is a lull for a few moments. Then the shoulders rotate into the proper position and are easily born. There may then be a flow of watery fluid for a few seconds. Before this time the physician has examined to see whether the cord is around the child's neck, released it if it has been, and also cleaned out the child's mouth. The child usually cries a little about this time and it is soon seen whether it needs quick attention. The perineum should be guarded also while the shoulders are being born as it can be torn by them. The shoulders are generally born without any help. The child's head is held in the physician's hand. As soon as the body is born, the child should be laid upon the bed behind the mother's thighs, and the cord pulled down to prevent it pulling upon the after-birth. After the beating in the cord has ceased, generally from five to ten minutes have elapsed, the cord is then tied, tight enough so it will not bleed afterward, about one or one and one half inches (some say more) from the body and tied a second time an inch or so from the first ligature, and the cord cut between the two ligatures. Care should be taken so as not to cut a finger or toe of the baby. If the cord is very thick it is best to pinch it at the point of tying and the contents stripped away before the first ligature is applied. After the cord is cut it should be wiped off to determine that bleeding from the vessels has been permanently cut off, and if not it should be tied again. The child is now taken up by placing the back of its neck in the hollow between the thumb and forefinger, and the other hand over the backbone. It should then be placed in a warm receiving blanket, and put in a safe place.
Management of the Third Stage,—The contractions of the womb are renewed and with the second or third the after-birth may be expressed. The top (fundus) of the womb is grasped by the hand through the relaxed abdominal walls, and squeezed, and at the same time make a downward pressure. The after-birth is loosened from the womb and slides through the vagina and outlet, and it may be caught in a tray which has been placed between the patient's legs, or by the hand and given a few twists in order to roll the membranes together; while this is being done, gentle rubbing should be applied to the womb, when the membranes will slip out without tearing; no drawing on the cord should be done in delivering the after-birth.
From the time of the birth of the head to the delivery of the after-birth the womb must be controlled by the firm pressure of the hand on the abdomen. It is well for the nurse, when the after-birth is separating from the womb to follow the womb, throughout this whole stage, by keeping her hand upon it and if, while the physician is attending to the child, the womb softens and enlarges she should at once notify him. There may be bleeding within the womb. After the womb is empty, friction should be made over the womb whenever it softens at all in order to stimulate the womb to perfect contraction, and it should be kept up at intervals for one hour after the after-birth and membranes have been delivered.
The eyes should be washed soon and normal respiration established. If the child does not breathe well, cold water may be sprinkled in the face and chest and if this fails, immersions in hot water at 106 degrees F., and sprinkling with cold water must be resorted to. If necessary, artificial respiration must be given. Slap the child on the back and move the arms up and down by the side a few times, or breathing into the child's mouth.
Another method.—Face the child's back, put an index finger in each arm-pit and the thumbs over the shoulders, so that their ends over-lap the collar-bone and rest on the front of the chest, the rest of the fingers going obliquely over the back of the chest. The child is suspended perpendicularly between the operator's knees. Its whole weight now hangs on the first fingers in the arm-pit; by these means the ribs are lifted, the chest is expanded and inspiration is mechanically produced. The infant is now swung upward till the operative's hands are just above the horizontal line, when the motion is abruptly, but carefully, arrested. The momentum causes the lower limbs and pelvis of the infant to topple over toward the operator. The greater part of the weight now rests on the thumbs, which press on the front of the chest, while the abdominal organs press upon the diaphragm. By these two factors, the chest is compressed and we get expiration, mechanically. After five seconds the first position is resumed again, and the lungs expand and fill with air. This process may be repeated several times until the breathing seems to be going naturally, and with delicate infants it should be the last resort.
After the breathing has been established the child should be wrapped in a warm flannel with hot water bags or cans near it, and left until the mother has been cared for. Infants at birth are covered with a white greasy substance, vernix caseosa, or cheesy varnish; it is removed by applying olive oil, vaselin or fresh lard, and afterward rubbing the skin gently with a soft cloth. The eyes and mouth should be washed out with pure warm water—or a saturated solution of boric acid, used. Separate squares of soft linen being used for this purpose. If the baby is born too soon or is very small, weak and undeveloped, it should be given an oil bath, only, and then wrapped in cotton wool and kept at a temperature of not less than 80 degrees F., for ten days or two weeks.
To a fully developed child the first bath may be given at once. Have everything ready before beginning, a foot tub, warm soft towels, warm water, castile soap, olive oil or vaselin, small squares of muslin or linen, dusting powder, a dressing for the navel and clothing, the latter consisting of a diaper, a flannel band, a shirt, long woolen stockings, a loose long sleeved flannel petticoat and a simple soft white outside garment, the two last, long enough to more than cover the feet. The infant should be wrapped in flannel and only the part which is being bathed at the moment should be exposed. The eyes are first bathed separately and with different cloths, and afterward the face, no soap being used; the head is then washed with warm water; very little soap should be used with infants as it is more or less irritating, and it is likely to injure the fine texture of the skin. Next, one should carefully clean the parts behind the ears and the crevices of the neck, arm-pits and joints and those between the buttocks and the thighs, and it is well to notice if all the natural openings are perfect; finally the baby is put down into the tub of warm water at about 96 degrees F., and washed off, with the head and back firmly supported with the left arm and hand during the bath. The baby is lifted out in a minute of two, held face downward for a moment and rinsed off with clean warm water. It is then wrapped in a warm towel and flannel and dried by patting, not rubbing. It is best to do all this on a table, instead of on the lap, and it should be large enough to hold a bath tub, every thing necessary for the bath and a pillow upon which to place the baby. Everything then can be done without stooping and with greater comfort to the child. Powder should not be used except where there are signs of chafing, when stearate of zinc is the best to use.
The navel is then dressed. A hole is cut in the center of a square of sterilized lint or linen which is slipped over the cord and folded about it; the cord is then laid toward the left side, and over it is put a small sterilized cotton pad which is held in place by the flannel bandage and just tight enough to hold. The binder may be kept on by sewing it smoothly with half a dozen large stitches, thus doing away with any danger of being injured from the pins. A binder should only be tight enough to hold the dressing for the navel. After the cord drops off the looser knitted band should be used. The infant is not bathed in the tub again until after the cord has been dried up and ready to drop off, which usually occurs on the fifth or sixth day, although it may not drop off for nine days. The cord should not be redressed in the meantime. (See Baby Department for further directions).
The first duty of the physician, following the third stage of labor, is to see that the womb is well contracted and control of this organ should be continued for at least one hour after delivery. This generally prevents excessive loss of blood. If necessary to promote womb contraction one teaspoonful of ergot can be given. After the womb has been kept in a state of contraction, the room should be rid of all evidences of labor and the woman made comfortable. The buttocks and thighs which have been soiled during the labor should be bathed with warm water and soap and the external genitals sprayed with an antiseptic solution, then dried with sterile gauze or cotton, the dressing applied to the vulva and the temporary bed removed, her night dress pulled down and the patient thus lying in a clean, comfortable bedding. The woman may then have a cup of weak tea, hot milk or broth and be left to rest; but during the first sleep the womb should be carefully watched lest it relax and serious, if not fatal, bleeding occur. In a normal confinement the dressings need not be changed, as a rule, oftener than six times in twenty-four hours, for the first few days. As soon as convenient after the first toilet is finished the physician sterilizes his hands and with the patient on her left side introduces one finger into the rectum and the thumb into the vagina to discover the condition of the perineum. Washing out of the vagina is not necessary as a rule.
The binder is considered indispensable, and should be made of unbleached muslin and wide enough to extend from the pubic (bone) to the breast-bone, and long enough to go around the patient's body and slightly lap. The binder should be pinned or sewed tightest in the middle, but it should not be so tight as to press upon the womb and crowd it backward or to either side. It acts as a splint to the muscles and assists in resting them to their natural condition.
Rest.—Complete rest of the body and mind is essential to the well being of the lying-in woman. She is better off without any company, and should see no one except her family for the first week or two. Outside visitors should be prohibited. The lying-in room should be kept free from noise and confusion, and the patient should be protected from annoyances of every kind. She should remain lying on her back for a few days and immediately following delivery she should not have a pillow for her head. Sleep is very necessary and desirable, and mild medicines should be given to produce it, if necessary. It is best not to sit up in the bed until the womb shall have had time to become smaller, and has resumed its natural position behind the pubis. Among the upper classes, when it takes the womb longer to regain its normal size, three weeks is a good rule to go by before sitting up in the room, and she should remain in her room until the end of the fourth week. Among healthy women of the laboring class, whose muscular system has not been injured by "culture" and social excesses, the womb and appendages regain their normal proportions more rapidly; but even they should remain in bed two weeks.
AFTER-PAINS.—Women who have borne children frequently suffer from the after-pains, occurring at irregular intervals, for two or three days and they may give rise to much distress. A few drops of spirits of camphor on a lump of sugar will often give relief when they are not severe. Also a drop of tincture of blue cohosh taken every two or three hours is valuable.
THE BLADDER.—If the patient is not able to pass urine it should be drawn once in eight or twelve hours or oftener if required. A No.7 rubber catheter is best. After it has been used, it should be sterilized by boiling and then kept in a bichloride solution (1-2000). It should be washed off with boiled water again before being used to remove the bichloride solution and greased with sterile oil. The parts should be exposed to pass the catheter, the labia separated by the finger and thumb, and the opening of the urethra and surrounding parts bathed clean with an antiseptic solution; unless you are clean decomposing discharges from the vagina may be introduced into the bladder and a cystitis set up. The care of the bladder is very important. It is not so sensitive after the labor and the woman may have urine when she does not think so. Sometimes she passes a little after trying and then thinks there is no more in the bladder. Even the attendants are deceived sometimes. I once had a case where the mother was the nurse. At each visit I inquired as to the amount of urine passed. I was told each time it was sufficient. She suffered severely the second day in the evening. I went to see her and against the protests of the mother I used the catheter and took away an enormous quantity of urine. In such cases the bladder should be emptied slowly to save the woman from shock.
A physician cannot always depend upon the patient's knowledge of her condition even in such matters and sometimes even the nurse is at fault.
THE BOWELS.—There should be a movement of the bowels the second or third day, and a soap and water enema containing a small teaspoonful of spirits of turpentine and one-half ounce of glycerin, will usually be sufficient. Later cascara cordial, castor oil, etc., may be used. Should the breasts be much swollen and painful and fever arise, saline laxatives are needed for two or three days, such as citrate of magnesia, rochelle salts, hunyadi water or seidlitz powder may be given.
Care of the Breasts.—Careful attention should be given them from the first. The nipples should be bathed after labor, with an antiseptic lotion (bichloride, 1-2000), dried and then covered with castor oil, a small square of clean sterile gauze being laid over each to protect the clothing. Bathe the nipples before and after each nursing with a warm saturated solution of boric acid and dry them carefully. The breasts may be supported by a binder, made of a strip of muslin sufficiently wide to extend from above to well below the breasts. If they are heavy and sagging place a layer of cotton at the outer border of each breast and they should be raised toward the middle line, the binder being pinned only tight enough to hold without pressing upon them. The breasts should not be pressed upon by anything. Shoulder straps can be pinned or sewed on the binder if it has a tendency to slip down. Should the breasts be much swollen relief can be obtained by massage with warm olive oil and by the use of a breast pump. The tips of the fingers only should be used in giving massage and the stroke should be light, from the circumference to the center. Roughness and pressure must be avoided.
INFLAMMATION OF THE BREAST, Abscess; Broken Breast.—This usually results from germs. The breast inflames, the milk tubes are choked and distended, there may be fever. There is sometimes severe local pain, hard swelling and an abscess forms and if this breaks it is called broken breast.
Treatment, Preventive.—Support breast with a binder. The milk should not be allowed to accumulate and cake. The breasts and nipples should be kept clean and dry. Breast pump should be used if necessary to get out the surplus milk. If the lumps continue and are painful, put cold applications to the breast. Have child nurse at the other breast. If it continues and will suppurate, apply moist heat, such as fomentations or poultices, and then open thoroughly. Poke root makes a splendid poultice for caked breasts. I have great faith in it. At the same time I give of the tincture one drop doses every hour. It is a splendid remedy and the poultice and remedy frequently stop the trouble. Inflammation of the breasts sometimes occurs in babies, generally in the first weeks. The swelling can be reduced by mild rubbing with warm carbolized oil used every day. Do not rub hard enough to hurt the baby. After the rubbing, absorbent cotton with carbolized oil should be applied and cover all with a thick layer of cotton held on with adhesives. If the breasts form pus they must be opened.
MOTHERS' REMEDIES. 1. Sore Breasts, a Never-Failing Remedy for.—"Take a pint of raw linseed oil and four ounces tincture of camphor, mix and apply a cloth saturated in the liniment to the affected parts, taking care that the whole surface of the inflamed parts is covered with the liniment. When the breasts become swollen or painfully inflamed, apply the liniment often to prevent gathering." Even if they have gathered it is an excellent outward application. It allays pain, is extremely soothing and seldom fails to effect a cure.
2. Swollen Breasts, an Herb Treatment for.—"Chamomile flowers one ounce, marshmallow roots one ounce, bruise and boil in one quart of water down to a pint. Foment the breast with this liquor as hot as can be borne; and then place the flowers and roots in a cloth and apply as a poultice."
3. Sore Breasts, a Hot Poultice for.—"Apply hot pancakes made of sour milk, saleratus and wheat flour, large enough to cover affected parts. Keep them changed often enough, so they will not be cold. This is an excellent remedy to steam out the inflammation." This is an old tried remedy and one to be relied upon. The steaming relieves the swelling and inflammation and gives relief quickly.
4. Caked Breasts, Fresh Hops for.—"Fry one pint of fresh hops in a half cup of lard until the lard is a rich brown, then strain, set away to cool and use as a salve."
5. Sore Breasts, a Poultice of Peach Leaves for.—"Take enough peach tree leaves to mix well with meal and water to the consistency of a poultice." This poultice should be applied hot, but should only be used in cases where the breast has matter or pus in it.
MOTHERS' REMEDIES.—l. Sore Nipples, a Good Wash for.—"Brandy and water mixed together and put on the nipples will harden them but should be washed off before the child nurses. If they are cracked, apply glycerin with starch, or arnica ointment."
2. Sore Nipples, Good Family Ointment for.—"Four ounces of white wax, one ounce bayberry wax, three ounces of spermaceti, one pint olive oil. Mix briskly over a slow fire, taking care to stir it briskly until cool." This is an excellent ointment for mothers when troubled with sore nipples; it moistens the skin and forms a coating. It is good for dry, scurvy, chapped hands, blotches on the face and all sores which require a mild ointment, but should be assisted with internal remedies when the case requires it.
The Lochia.—By this term is meant the discharges from the womb and soft parts after labor. They are mixed with blood at first and contain dark clots, mucus, shreds of the after-birth and pieces of the membrane. They become paler in color from the end of the third to the sixth day. After this the color is yellow, greenish and contains pus and fatty cells, with a little blood. This discharge varies in different women. In those who menstruate freely and do not nurse they are usually copious; when decomposed, they smell badly and the odor is penetrating. The flow may cease entirely between the second and sixth week. It is increased by exertions at about the time the patient begins to move about.
Diet.—This should consist at first of liquid, unstimulating food, given in small quantities and frequently. If the baby does not nurse, the liquids should be restricted. Some women on the first day can take milk, milk toast, or if desired, dry or buttered toast with coffee, tea, weak cocoa, according to the patient's taste. Water may be given if desired. On the second and third days, simple soups or any of the following may be added to the dietary: Meat broths, beef tea, soft boiled or poached eggs, raw or stewed oysters (no vinegar or spices) and some simple dessert, such as boiled custard or junket. During the next few days, chicken (white meat), scraped beef or mutton in small quantities, baked potato, rice and cereals may be given and by the end of the week a gradual return to the ordinary diet may be made. Should there be any tendency to constipation, the bowels should be opened by a simple enema (as before stated) or glycerin enema, etc.; or by one or more doses, 2 drams, of the compound licorice powder repeated in three or four hours, if necessary; or a half ounce of castor oil, or a half glass of hunyadi water. Cooked fruits for the constipation may also be given.
Bleeding After Delivery, Post-Partum Hemorrhage.—Bleeding from the womb occurring six hours after delivery is called post partum and after that time, is known as puerperal child-birth bleeding or hemorrhage.
Causes.—A relaxed condition of the womb, the retention of clots or parts of the membranes, etc., in the womb, a full rectum or bladder, fibroid tumors, deep tears of the cervix.
Symptoms.—If the bleeding is profuse, the pulse is fast, the woman looks pale, anxious and feels cold, restless, gaping, usually it comes from a relaxed, softened and enlarged womb.
Treatment.—In severe forms no time must be lost in securing contraction of the womb and the method employed for expelling the after-birth should be employed to expel clots. Grasp the womb over the abdomen, employ firm but gentle kneading, pressing downward. The pillows should be removed, the foot of the bed elevated twelve to eighteen inches, a preparation of ergot given by the mouth or hypodermically in the thigh. If these measures fail the hand and arm should be sterilized and inserted in the womb, all clots, etc., removed and pressure made over the abdomen on the womb while the hand is still there. This pressure and presence of the hand close the bleeding vessels in the womb. The hand should remain, while the kneading goes on externally, on the womb.
This kneading should be kept up until the womb contracts. The hand can then be removed from the vagina, while gentle kneading is slowly kept up over the womb. The womb should be closely watched for hours after. Bleeding very seldom occurs again, but it might. If the bleeding is more of an oozing, an injection of very hot water, 120 degrees F., through a long douche nozzle, directly into the womb cavity may be given. This is very effective for any kind of bleeding. Lemon juice or boiled vinegar can be added to the injection. Everything used must be perfectly clean or child-bed fever may be caused by these measures. After the womb has thoroughly contracted, it is sometimes of benefit to place a rubber bag filled with cold water over the pubic bone to prevent subsequent relaxations of the womb. Weakness can be met by hypodermics of whisky or brandy and strychnine, one-thirtieth of grain, injected hypodermically to stimulate the heart.
Pulse and Temperature.—The temperature may rise one to one and one-half degrees without the case being abnormal. The pulse falls after labor, ranging between sixty and seventy. A rise of temperature, a rapid pulse, a flushed face, a chill, pain or tenderness of the abdomen, and abnormal increase or decrease of the discharge, bleeding, or offensive odor of the discharge should cause suspicion of child-bed (puerperal) fever. This is a grave condition and results from infection which has taken place during labor or afterward. The septic matter may be carried in on the fingers or instruments by the physician or attendants, etc. The most usual sources are unclean hands, instruments and clothing which come in contact with the woman's genitals. The attack is usually ushered in during the second to the fourth day by a chill, or chilly sensations, etc., rise of temperature, rapid pulse, accompanied by headache and a feeling of weariness. The discharge may be increased at first, but later diminished and may cease; or it may be abundant, frothy and of a very fetid odor. Secretion of milk may fail, the bowels are usually constipated, pain in the abdomen develops.
Treatment.—If the interior of the womb is smooth, a single antiseptic womb injection should be given; if it contains foreign material or is rough, it should be scraped and then a douche given. This must be done carefully and with absolute cleanness. Turpentine stupes should be placed hot on the abdomen for the pain, or where cold feels more grateful the ice bag or cloths wrung out of cold or ice water should be applied over the abdomen, and covered with several thicknesses of flannel and changed as soon as they become heated. Medicines to relieve the pain may be given. Hot and cold sponging may be given to reduce the temperature, a little alcohol can be added to the water or the cold or hot pack may be used.
Diet.—This should be nourishing and supporting, and at first, liquid and consist largely of milk; but concentrated broths, jellies, and liquid beef, peptonoids, are useful. Stimulants should be given in these septic conditions. From one to two ounces of whisky may be given every three to four hours in the form of milk punch and, if possible, as much red or port wine also. Women in this condition can stand this treatment. Salines (salts) should be given to keep open the bowels.
CONVULSIONS. (Eclampsia).—All forms of convulsions may occur during pregnancy. They may occur during pregnancy and during labor. These are usually the result of kidney trouble. The attacks occur most often during the last three months of pregnancy. Their frequency is one to three hundred to one to five hundred cases. It occurs oftener in the first pregnancy, three to one.
Treatment.—Inhalation of chloroform to control the convulsion. Morphine in one-half grain dose can be given if no chloroform is handy. Place the patient in a hot water or vapor bath, or wrap blankets wrung out of hot water around her, and pile the bedding on until a profuse sweat is started. The sweating aids in eliminating the poison. Change the hot wet blankets as often as necessary. If the convulsions do not cease the womb must be emptied of its contents. If the convulsions occur during labor they should be treated in the same manner. The mortality then is about seven per cent. Chloral hydrate in thirty to sixty grain doses in three ounces of water may be injected into the rectum if the other remedies fail.
MILK LEG.—This is due to infection. It usually arises from an extension of a blood clot (thrombosis) of the womb or pelvic veins, to the thigh (femoral) vein, resulting in a partial or complete obstruction of the vein. It may come in less frequent cases, from a lymphatic infection.
Symptoms.—They may develop at any time between the tenth and thirtieth days or even later. These are general feelings of weariness, stiffness and soreness of the leg, especially when it is moved. There may first be pain in the region of the groin; or pain from the ankle to the groin and followed by swelling. The skin of the leg becomes markedly swollen, white and shiny. Later there is pitting on pressure, but not at first, because the skin is extremely stretched. Fever may accompany the attack, but it will subside long before the swelling of the leg has disappeared.
The vein may be felt as a hard lash-like cord, a red line of inflammation marking its course along the inner and under side of the thigh. The disease may last weeks, depending upon the severity of the trouble. The affected leg is disabled for a number of months after recovery. Recovery takes place as a rule. Absorption of the clot takes place, or the vessel remains closed, and another (compensatory) circulation is established.
Treatment.—The patient should lie in bed with the leg elevated and swathed in flannel or cotton wet with some quieting lotion. The following is a good lotion:—
Compound Soap Liniment 6 ouncesLaudanum 1-1/2 ouncesTincture Aconite Root 1/2 ounceTincture Belladonna 1/2 ounce
Wet the flannel or cotton with this. After the acute symptoms have passed the following ointment may be put on the leg:—
Ichthyol 45 grainsIodide of Lead 45 grainsChloride of Ammonium 10 grainsAlboline 1 ounce
The parts should not be rubbed lest a clot be loosened and travel in the general circulation and thus endanger life.
Diet.—Should be supporting. Salts for the bowels.
Preparation, Outfit, Nursing, Formulas for Preparation of Milkfor Bottle-Fed Infants; Weaning, Teething, Diet ThroughChildhood, All the Baby Diseases, etc., from the Best MedicalAuthority, Infant Hospitals and Nurses.
How long does pregnancy usually last? Two hundred and eighty days.
How can the time be reckoned? Count back three months from the first day of the last menstruation and add seven days to the date thus obtained. To be more accurate, you should add only six days in the months of April and September, five days in December and January, and in February four days.
What time of pregnancy does the form begin to change? It changes a little the first two months. It is flatter and lower down. After the third month there is a progressive enlargement.
What is quickening, and when first felt? It is a motion, of the foetus (child) in the womb, imparted to the abdominal walls, and is felt from the sixteenth to the twentieth week. It has been said to have occurred earlier in some cases.
Can you foretell twin pregnancy? Not to a certainty.
Can a mother influence her child as to character and temperament before birth? Authorities differ very much upon this point. The child inherits the physical characteristics of its parents. The frame of the mother's mind, some think, can be given in some degree to her offspring.
Will nervousness be inherited by the child? Not invariably; if the mother is fretful, irritable, cross, repining, etc., her child may be puny, cross and irritable, etc.
Do you believe in influences transmitted before birth (parental influences?) All must admit that there is a great deal in heredity, and the characteristics of parents are shown in their children.
Can a mother mark her baby? This is another disputed question.
When should the family physician be informed of the woman's condition? The first month.
Why? So that the woman will know how to live properly, and also that he will be given the urine twice each month to examine. This is for her protection and is necessary, because anything that may be wrong with the kidneys can be corrected much easier, and diet, etc. can be arranged to prevent future trouble.
What kind of diet should a pregnant woman have? She should eat only healthy articles of food. Stimulating, highly seasoned, rich, greasy foods should be avoided. Constipation is frequently present and the diet must be chosen with reference to that also. She should not restrict herself to one line of diet unless it is necessary.
Should she take a daily bath, if so, what kind and when? Yes, if it does her good. The pores of the skin should be kept open so that the kidneys will have less work to do. Spray and baths should be taken cold or lukewarm. Hot baths or Turkish baths are to be avoided. The time should be at the woman's convenience. Morning is preferable, if she does not feel the need of sleep.
Should she take a daily nap and when? Yes, one or two hours in the forenoon, and also in the afternoon.
Should she take exercise? Yes, exercise is necessary. This promotes the proper circulation of the blood, favors rest and sleep, relieves the "blues," tones the whole system, gives her good wholesome air and makes everything look better. It should not be violent. Slow walking and riding in an easy carriage. She should not ride a horse, run, jump, dance, or do any jerky or violent exercise; no heavy lifting or reaching up.
What about clothing? The clothing should be perfectly loose and comfortable. Garters and corsets are injurious, especially when the pregnancy has reached four or five months. The weight of the clothing should be borne by the shoulders instead of the hips. Special waists can be made for pregnant women. There should be no pressure on any part, especially on the womb and breasts.
What is the meaning of the word enciente? The Roman women were accustomed to wear a tight girdle about their waists which was called a cincture. This they removed when they were pregnant. They were then said to be incincta, or unbound. The term enciente is derived from this, and is frequently used to indicate pregnancy.
What are the main symptoms of miscarriage? Pain and bleeding.
Does it usually come on suddenly? Not as a rule. There are premonitory symptoms such as bearing down feeling in the pelvis, backache, frequent desire to pass water, a discharge from the vagina, and sometimes a little bloody flow.
At what period is it most common? Between the ninth and sixteenth weeks when the after-birth is forming.
What are the causes of miscarriage? Diseases of the womb, disease in the father, constipation, falls, over-exertion, violent emotions, such as shock, fright, anger, blows on the abdomen, over-lifting, reaching up, sewing on machine.
What is the first thing to do? Lie down, rest and send for a doctor.
Is it ever possible to stop it? Yes, and often.
Do the breasts need any special care? The nipple, if much drawn in and small, should be "pulled out" once or twice daily. It will do to rub sweet oil on the breasts every evening in order to relieve the tightness and discomfort, especially after the pregnancy has advanced some months.
Are there any diseases to which a pregnant woman is more subject? None. The kidneys need more watching.
Can any dentistry be done during pregnancy? Not if it makes her very nervous; but toothache can cause more harm from a diseased tooth than if it were treated carefully.
Why do pregnant women suffer from "varicose" veins? The enlarged womb presses upon the veins and thus obstructs the return flow of the blood. It is not so common during the first pregnancy.
Can anything be done for this trouble? The woman should lie down a good part of the time if possible, and also wear a perfectly fitting elastic stocking. They can be had of any size and length. The limb should be measured for them.
Does oiling and massaging the body do good? Some women claim it does; it certainly puts the muscles in better condition and strengthens the muscles of the abdomen which have so much part in the labor.
What is the morning sickness and are all women subject to it? Nausea and vomiting without any cause. No; many escape it entirely.
At what period of pregnancy does it usually occur? During the early months it is more frequent and troublesome.
How long does it usually last? Usually three or four months, but it may last during the whole pregnancy.
What can be done for it? In some cases arranging the diet to prevent and cure constipation relieves it. For fuller treatment see this heading under Obstetrics.
Does it ever endanger life? Not often, but a physician should be called if it is bad.
Can any strict rules be laid down for this trouble? No, but the food should be as concentrated as possible; egg-nog, ice cream, a bit of rare steak, etc., raw oysters, gruels, meat broths, etc., if liquids are well borne. It is surprising how little will keep up some women during pregnancy.
When and how often should the urine be examined? From the beginning and twice each month, and every week after the fifth month.
When should the nurse be called? Long enough before the expected time to get everything ready.
What is lightening? It is caused by the womb sinking down lower in the pelvis the last month, and this lightens the pressure upon the diaphragm and lungs.
What are false pains? They occur during the last few weeks of pregnancy at irregular intervals and are usually in the abdomen.
What is the bag of waters? It is a sac containing the fluid in which the child floats while in the womb. The amount of fluid varies from a pint to a gallon or more. When it ruptures there is a sudden flow of liquid, more or less continuous flow. It may occur at the very beginning of labor and is one of the signs of labor.
What are the other signs of approaching labor? A profuse discharge of mucus from the vagina, and this may be tinged with blood. The "show" pains begin generally in the back and are quite regular, one every twenty minutes or half hour. (Dilatation of the womb).
How should the baby be first washed? See Obstetrics.
What clothing should be put on? See Obstetrics chapter.
Care of the eyes.—Wipe the eyelids with clean gauze and water. If there has been much discharge from the vagina during pregnancy, the child's eyes should be washed cleanly and also one or two drops of the one per cent solution of silver nitrate should be put into each eye as a preventive. (See Obstetrics).
How often should the baby's bowels move? Two or three times daily for the first week, and then once or twice a day.
What is the appearance of the stool? It is soft, yellow and smooth and should not contain any lumps.
How about the urine? It should pass from six to ten times a day, and it should be colorless.
What is the average weight of a healthy baby? Seven to seven and one-half pounds.
Does it lose any weight during the first week? Yes, generally a few ounces, then it begins to gain at the rate of four to six ounces each week.
Should the newly-born babe have its eyes exposed to the light? The eyes are very sensitive, and the sun or artificial light should not be allowed to shine on them. The first day the baby is deaf, but his hearing develops and becomes very acute so that he is very much disturbed by sudden, sharp noises.
What is the "soft" spot on a baby's head? This is called the "fontanelle." Do not touch this spot. This closes in time. At six months of age the fontanelle is somewhat larger than it was at birth because the brain expands faster than the boney matter deposited around the edges in the skull bones. After this another deposit of bone goes on more rapidly than the growth of the brain substance, and by sixteen or eighteen months the opening should be entirely closed.
When should the baby be given the second tub bath? Not until the cord has dropped off.
How and when should this be given? The room should be warm. The head and face should be washed first and dried; then the body soaped and the infant placed in the tub with its head and body well supported by the hands. The bath should be given quickly with no special rubbing, drying with a soft towel. (An hour after feeding).
What should be the temperature of the bath? One hundred degrees F. for the first few weeks, later ninety-eight F. After six months ninety-five F.; during the second year from eighty-five to ninety degrees F.
What should you use in giving the bath? Soft, clean sponges or smooth cloths. There should be separate pieces for each eye, for the head, face and buttocks.
What are the objections to sponges? They are very apt to become dirty and are hard to keep clean.
When should the daily bath be omitted? In the case of infants who are delicate and feeble, when the bath seems to harm them; in all forms of acute sickness, unless the bath is directed. In eczema and many other forms of skin diseases a great deal of harm is often done by soap and water or water baths.
How should a genuine bath be given? If possible the bath should be given in front of an open fire, in a room where the temperature is from seventy to seventy-two F. and the draughts kept off by a large screen. Have everything at hand with which to give the bath. A folding rubber bath-tub is the best, next a papier-mache one; or if tin must be used, put a piece of flannel in the tub to protect the baby from the tin. If necessary place the tub on a low table, place another low table to the right of the one on which the tub sets, and on this table should be the baby's basket containing a soft brush, different sizes of pins in a pin-cushion, several threaded needles, a thimble, squares of soft linen, absorbent cotton, wooden tooth-picks, a powder-box and puff, or a powder-shaker containing pure talcum powder, a box of bismuth subnitrate, one of cold cream, a tube of white vaselin, a dish containing castile, ivory, or pure French soap should be placed by the basket on the table; also a cup containing a saturated solution of boric acid; two cheese-cloth washcloths, a soft towel, a thermometer to test the water, several toothpicks on which a little absorbent cotton is twisted, and the rolled flannel band. Then a basin containing warm water, 98 to 100 degrees F., also one with cold water. The baby-clothes should be hung on a rack close at hand.
How to take care of a sore navel.—If it looks red or has a thin discharge coming from it, wash it carefully twice a day with saturated solution of boric acid; or if pus is there use a 1-5000 solution of bichloride of mercury. Use for a dusting powder one part of salicylic acid and nineteen parts of starch on it. It needs a physician's attention if it does not soon heal.
Do any physicians advocate a daily bath before the cord drops off? Yes; but not a full tub bath.
When does the cord drop off? In from five to ten days.
Does soap hurt a baby's skin? Some doctors claim it does.
Is it necessary to use a powder after the bath? No, if all moisture is removed, there is no need of powder. The skin can be kept cleaner and healthier without it.