,,mother1 ,,nurse ,,and ,,infant3 ,a ,,manual ,,especially ,,adapted ,,for ,,the ,,guidance ,,of ,,mothers ,,and ,,monthly ,,nurses1 ,,comprising ,,full ,,instruction ,,in ,,regard ,,to ,pregnancy1 ,preparation for ,child-,birth1 ,,and ,the ,care of ,mother and ,child1 ,,and ,,designed ,,to ,,impart ,,so ,,much ,,knowledge ,,of ,,anatomy1 ,,physiology1 ,,midwifery1 ,,and ,,the ,,proper ,,use ,,of ,,medicines ,,as ,,will ,,serve ,,intelligently ,,to ,,direct ,,the ,,wife1 ,,mother ,,and ,,nurse ,,in ,,all ,,emergencies4 ,,by ,s4 ,p4 ,,sackett1 ,m4 ,d4 ,,new ,,york3 ,h4 ,,campbell ,,co41 ,,publishers #adj-adb ,,nassau ,,st4 #ahhi4 ,,copyrighted1 #ahhi1 --,,by-- ,s4 ,p4 ,,sackett4 ,all rights reserved4 ,,press ,,of ,e4 ,d4 ,,norton1 ,,ithaca1 ,n4 ,y4 ---------------------------------------- -------------------------------- ,,preface4 ,the object of the author in writing this volume is to offer to nurses1 and especially to those women who desire to make 8monthly nursing0 a vocation1 the instruction which they need for that purpose1 sufficiently illustrated and at a moderate price4 ,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 midwifery4 ,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 desired4 ,he has learned during the forty-five years that he has practiced medicine in a small city and its vicinity1 that mother and nurse are often combined in the same person4 ,the important duty of nursing the sick is so generally performed by mothers1 that they also1 as a class1 require some scientific knowledge to be acquired by means of plain1 practical instruction4 ,and1 in fact1 throughout our country1 every mother is liable1 in an emergency1 to be called upon to fill the office of an accoucheur4 ,for the professional nurse1 such technical and accurate knowledge should be considered indispensable4 ,the training schools for nurses in some of our largest cities are doing a noble work1 and are elevating the standard of requirements for those who seek this field of true womanly labor4 ,but comparatively few of the many thousands who follow this vocation are able to attend such schools2 yet they are willing and desirous to learn4 ,women seem instinctively to desire such knowledge4 ,a proper effort to place within their reach the means of obtaining the necessary technical knowledge for their work1 and especially for the work of the nurse who attends upon the mother in childbirth1 will not1 the author trusts1 be deemed presumptuous4 ,there are many excellent nurses1 who have become so without the aid of training school or such a book as this1 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 work4 ,physicians1 they will find1 stand ready to aid them4 ,the attending physician1 as a rule1 may be depended upon to give such help as may be necessary to the understanding of the instructions here presented1 and through their cooperation the number of earnest students in this department of womanly labor may be multiplied4 ,the author1 during the preparation of it1 consulted many writers upon obstetrics1 medicine and nursing2 and it is only because it would not be compatible with the size of this volume1 that he has not made frequent references to these excellent works4 ,but all that he has written has been founded on his own knowledge1 experience1 and observation1 while it coincides with the expressed opinions of others who may be considered good authority4 ,in only two or three things has the author ventured to advance beyond others4 ,s4 ,p4 ,s4 ,,ithaca1 ,march1 #ahhi4 ,,contents4 ,introduction #i ,,part ,i4 ,,pregnancy ,,and ,,confinement4 ,,chapter ,i4 ,conduct of the ,mother before and after ,marriage #ac ,,chapter ,,ii4 ,conduct of the ,mother during ,pregnancy #ah ,,chapter ,,iii4 ,diseases of ,pregnancy #bb ,,chapter ,,iv4 ,instructions to a ,woman during the last stages of ,gestation #bf ,,chapter ,v4 ,directions to the ,monthly ,nurse #cc ,,chapter ,,vi4 ,care of the ,mother during ,labor and ,confinement #cf ,,chapter ,,vii4 ,directions to the ,nurse during the month #dc ,,part ,,ii4 ,,anatomy ,,and ,,physiology ,,of ,,the ,,female ,,organs--,f,,tal ,,development4 ,,chapter ,i4 ,of the ,pelvis #ee ,,chapter ,,ii4 ,parts contained in the ,pelvis #fd ,,chapter ,,iii4 ,physiology of the ,uterus and ,ovaries #gj ,,chapter ,,iv4 ,displacements of the ,uterus #gf ,,chapter ,v4 ,mismenstruation #hg ,,chapter ,,vi4 ,generation #ic ,,chapter ,,vii4 ,the ,ovum and its development #ih ,,chapter ,,viii4 ,the ,ftus #ajc ,,part ,,iii4 ,,pregnancy ,,and ,,parturition4 ,,chapter ,i4 ,diagnosis of ,pregnancy #aac ,,chapter ,,ii4 ,abortion #aai ,,chapter ,,iii4 ,parturition #abc ,,chapter ,,iv4 ,mechanical ,phenomena of ,labor #acb ,,chapter ,v4 ,diagnosis of ,artificial ,labor #ach ,,part ,,iv4 ,,skilled ,,nursing ,,and ,,midwifery4 ,,chapter ,i4 ,preliminary instruction to the ,nurse ,midwife #ade ,,chapter ,,ii4 ,the ,natural ,labor #adi ,,chapter ,,iii4 ,convalescence #afc ,,chapter ,,iv4 ,care of ,infants #agj ,,chapter ,v4 ,cases of ,difficult ,labor #agg ,,chapter ,,vi4 ,concluding instructions in ,midwifery #aib ,,part ,v4 ,,tiology--,,symptomotology--,,medicatio n--,,nursing4 ,,chapter ,i4 ,causes of ,disease #aif ,,chapter ,,ii4 ,symptoms of ,disease #bjc ,,chapter ,,iii4 ,diagnosis of ,diseases of ,children #bag ,,chapter ,,iv4 ,treatment of ,inflammation in its initial stages #bbc ,,chapter ,v4 ,various circumstances1 ,contagion1 ,death1 c4 #bcg ,,chapter ,,vi4 ,surgical ,nursing #bea ,,part ,,vi4 ,,remedies ,,and ,,regimen4 ,,chapter ,i4 ,hints in regard to the treatment of ,common ,diseases #bfb ,,chapter ,,ii4 ,emergencies1 ,accidents1 ,sudden ,sickness #bgi ,,chapter ,,iii4 ,slight ,hurts and ,ailments #bie ,,chapter ,,iv4 ,dietetics1 ,food for ,children #cjg ,,chapter ,v4 ,prescribing and ,prescriptions #cbg ,,chapter ,,vi4 ,medical ,formulary #ccc ,glossary #cfd ,index #cgi ,,introduction4 ,from the nature of the subjects treated in this work1 the information given becomes of interest to every woman1 and is not intended for the nurse of lying-in women only4 ,it is believed that many young women will study it carefully1 that they may be prepared for all the duties and responsibilities of life2 some1 perhaps1 that they may be fitted for a vocation under certain contingencies4 ,but many of the instructions are addressed particularly to mothers1 because they especially will be able to make a practical application of the knowledge received4 ,hence considerable matter is inserted which is designed to be used by mothers in their daily life1 and having only a slight bearing on monthly nursing4 ,necessarily1 as the two objects are combined to suit the wants both of the mother and nurse1 there is not as much order and system in the topics presented as would otherwise be desirable4 ,i seek only to have my instructions in the form that will be most useful1 and ,i believe that if mothers at the present time are sufficiently taught there will be no lack1 a few years hence1 of nurses who are fully competent to care for the sick1 under the direction of competent physician4 ,hence ,i address myself1 first1 ,,to ,,the ,,mother4 ,to those who are mothers1 every part of this small book is especially commended4 ,upon the knowledge and skill and right action of those who have the care of children and of the household1 it will depend that the right thing shall be done in such emergencies as are liable to occur4 ,you must necessarily care for your children1 both to guard them from sickness and to relieve their ailments4 ,you must know the symptoms1 at least1 how to observe the symptoms of diseases2 and you may be called upon1 in the absence of the physician1 to act as midwife4 ,be especially careful to learn the instructions in regard to emergencies1 because upon your knowledge and prompt action the lives of your dear ones may depend4 ,,to ,,the ,,professional ,,nurse4 ,this work is written for you1 and to you is especially commended the modicum of medical knowledge herein contained4 ,it is better for you to learn well what you read than it is to read very extensively4 ,you will find sufficient in this small volume to demand your time and study for months1 and even for years1 in connection with your nursing4 ,it is not expected that you will learn all the formul and prescriptions given4 ,these are inserted partly that you may learn to read prescriptions in the various forms in which they are written1 and partly that you may occasionally use one1 after consulting with your physician4 ,sometimes you may copy one of them accurately and use it at the drug store1 consulting only with the apothecary4 ,but it will be of importance to you to obtain as much medical knowledge as is herein contained1 though it is not designed to make you physicians4 ,do not act the part of a doctor until you understand every thing pertaining to ,anatomy and ,physiology1 and the nature and properties of every medicine employed in the cure of disease4 ,of all sciences the medical should embrace the widest domain of knowledge1 because ignorance here is fatal4 ,but ignorance and thoughtlessness1 and want of skill and adaptation1 may be fatal in your particular province4 ,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 medicines4 ,seek always to aid him1 never to supercede him4 ,if you learn midwifery1 it should be with the design of co-operating with the doctor1 and assisting him4 ,you should be so educated that the physician will feel willing to leave a case of tedious labor in your care1 instead of waiting at the bedside of the patient one or two days1 and neglecting his other patients4 ,your educated service will be appreciated at such times by the doctor1 as well as by the patient and her friends4 ,you will do the duties of nursing well1 and take upon yourself that part of the practice of a physician which he does not desire1 and which you can do equally well4 ,your part will be an important one1 and second only to that of the physician4 ,i expect1 as the result of the study of this book1 not that you will assume to be physicians to any greater extent than you otherwise would1 but that you will act wisely and intelligently instead of confusedly1 or blindly1 in the emergencies in which you will be called upon to act1--that you will be1 not merely attendants at the bedside of the sick1 but1 that best aid to the physician1 the true nurse4 ,do not claim to be doctor or midwife1 or anything whatever that you are not4 ,if a smattering of knowledge causes any affectation1 it will only degrade you4 ,study physiology in the books commonly used2 store your minds with the facts and instructions in this book2 obtain additional knowledge in every way that is practicable4 ,as you have opportunity1 make practical application of the knowledge received1 and you will commend yourself more and more to your sick or suffering friends4 ,,part ,i4 ,,pregnancy ,,and ,,confinement4 ,,chapter ,i4 ,,conduct ,,of ,,the ,,mother ,,before ,,and ,,after ,,marriage4 ,the physical treatment of children should begin1 as far as may be practicable1 with the earliest formation of the embryo4 ,it will involve the conduct of the female even before her marriage1 as well as during her pregnancy--the various contingencies which effect her in health as well as in disease4 ,very much depends on her to insure for her child a vigorous constitution1 or to prevent a feeble frame in the child4 ,she should not enter into the holy state of marriage with heedless haste2 if she does1 she will discharge its duties with inexcusable neglect4 ,to constitute a mother1 in the best sense of the term1 requires a patient endurance of fatigue1 and anxious solicitude1 which will sorely tax the mother's strength4 ,i would1 if possible1 diminish the toil and danger of childbirth1 and relieve the fatigue and anxiety of nursing4 ,and let me1 in one paragraph1 give a hint to the husband3 that the responsibility and care of the children is too much laid on the mother2 she is overburdened4 ,let the father partake in the arduous and responsible duty of their education4 ,and let me hint1 also1 that the health and strength of the child depends upon the father as well as the mother4 ,,marriage ,,should ,,not ,,be ,,at ,,too ,,early ,a ,,period ,,of ,,life4--,i am not disposed to discourage early marriage1 but ,i am decidedly opposed to a premature one4 ,marriage should not take place until the body is healthily and completely developed2 to bear offspring prematurely endangers not only the mother's health1 but it materially influences the health and well-being of the child4 ,we cannot fix rigorously the age at which the body becomes fully expanded4 ,i am inclined to say it is at #bj in the female1 and at #bd in the male2 but original stamina1 education1 climate1 mode of life1 etc41 have their influence1 and may make an earlier or a later marriage proper4 ,the evil consequences resulting from precocious unions in this country are3 diminished vigor and shortened life in the husband2 faded beauty1 blasted health1 and premature old age in the mother1 and a diminutive stature1 debility of body and imbecility of mind1 perhaps a strong predisposition to consumption1 rickets1 scrofula1 etc41 in the children4 ,,marriage ,,should ,,be ,,when ,,the ,,parties ,,are ,,in ,,health4--,i do not say that every ailment should be a bar to marriage or child-bearing4 ,it is possible that prolapsis uteri may be benefited by a pregnancy and parturition4 ,but if a woman has prolapsis uteri1 or other ailment1 it is a poor preparation for the burdens of gestation1 and good health is an important qualification for the responsibilities of married life4 ,no learning can be of more importance to a young lady than to know how to preserve health1 and how to restore it when lost1 for we cannot reasonably expect healthy children from unhealthy parents4 ,there are numerous other complaints besides scrofula and insanity1 inherited by children4 ,if a wife is to be healthy and strong1 she must use means2 health will not come by wishing for it merely1 and whether pleasant at first or not1 habit will make early rising1 temperate living1 taking exercise1 thorough ablution of the whole body1 etc41 easy4 ,that state of vigorous health and strength which prepares a woman to bear strong and vigorous children1 is attained not by idleness and luxury1 and neglect of personal cleanliness1 nor by tight lacing1 the use of stimulants1 nor by irregular modes of sleeping1 etc41 but by rising early1 and taking early walks in the open air1 and engaging in household labor1 or other exercise during the day1 going to bed betimes1 living on an abundance of good1 wholesome food1 by daily ablutions1 followed by rubbing the skin thoroughly1 and in general by observing the laws of health4 ,if a woman who has thus preserved her health1 marry a man who has been equally careful to observe the laws of continence and hygiene1 she may hope to be the mother of a healthy child1 and a blessing to all4 ,,the ,,constitution ,,of ,,both ,,the ,,male ,,and ,,female should be good and strong4 ,it is not enough that the body be well developed1 if there is at the same time a very feeble constitution4 ,even if the children of such parents seem to be hale looking and robust1 they do not attain old age--are very liable to die young4 ,if there is only a predisposition to disease1 such as is often inherited1 it may be very doubtful whether the parties ought to marry4 ,if there is only a disposition to habits of intoxication or dissipation1 or to gout1 madness1 scrofula1 consumption1 etc41 in the man1 we may advise the woman not to unite herself to him1 for these diseases do not show themselves until called into action by some exciting cause4 ,but we advise the woman1 if there is any physical disability which renders her ineligible to the married state1 that she should not pass it over lightly1 or conceal it1 and we would recommend to a woman who may have deformed pelvis1 that she abstain from marriage1 as she 8may purchase the title of wife at too dear a price40 ,,temperament is a matter of less importance in choosing a husband4 ,it is said to be the case that in choosing a mate1 a person inclines strongly to one unlike themselves4 ,if it be true that a person of a nervous temperament has a preference for the sympathetic1 the sanguine for the bilious1 etc41 it is probably nature imparts the liking that the offspring may combine the excellence of both1 the defects of neither4 ,,blood ,,relationship is not necessarily a bar to union4 ,cousins may marry when the family has traits of mental and physical excellence as a means of perpetuating them1 but it is not best to develop1 by repeated unions1 a lurking disposition to disease1 which may exist in any family4 ,,moral ,,and ,,mental ,,character is of the greatest importance4 ,it is not true that 8the reformed rake makes the best husband40 ,if he is not the prey of loathsome diseases1 the results of a vicious life1 his constitution is probably impaired1 so that he cannot be the father of good1 strong children4 ,the only way that women can guard their own health1 and preserve from degeneracy their offspring1 is by having husbands of a different character from that of the debauched rake4 ,,conduct ,,of ,,the ,,mother ,,after ,,marriage4 ,the mother is accountable for the health and intelligence of her first child2 she must be careful of her own health before marriage and at the time of marriage1 as well as for the succeeding time4 ,i will here state a few things which seem unimportant1 and yet are of some little consequence4 ,i consider that the great object of conjugal union is the transmission of life1 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 born4 ,,during ,,the ,,first ,,few ,,months ,,after ,,marriage the wife should seek to have bodily quiet1 and mental calmness and serenity4 ,the custom of hurrying the bride from place to place may properly be condemned4 ,so we would have her avoid going into a whirl of excitement and pleasure--into a round of visiting and late hours--into close1 heated rooms--into fashionable amusements--rich living and a want of rest--sitting in ill-ventilated apartments--quickly bolting unquiet meals--drinking wine1 beer1 or brandy1 or other alcoholic stimulants--late rising in the morning--sleeping in close1 badly-ventilated rooms--living in rooms that are kept dark--tight lacing--wearing thin clothing--worrying1 and indulging in ill-temper4 ,she should avoid these at all times1 but her future health and happiness depend so much upon her prudence and care during the first year of married life1 that we may properly give these hints and cautions in regard to this particular time4 ,,chapter ,,ii4 ,,conduct ,,of ,,the ,,mother ,,during ,,pregnancy4 ,there are no signs of a fruitful conjugation1 which in all cases indicate to the woman that she is pregnant4 ,some few seem to know the exact time2 in some instances there is faintness1 or vertigo1 that in these particular cases impress the fact upon the mind of the woman4 ,but usually1 within a month1 the point is tolerably certain1 she being assured by such signs as will be here pointed out4 ,it now becomes her duty to be especially careful1 not only for herself1 but also for her offspring4 ,abortions frequently occur1 especially in the first and last pregnancies1 and in the first months of pregnancy1 these should be avoided if possible4 ,the train of evils which follow when the habit of abortion is established1 as well as the moral obligation she is under to preserve the life committed to her1 should make her willing to endure the few privations and conformities which her situation imposes on her4 ,she must avoid undue exercise of the muscles1 such as long walks1 dancing in hot weather1 hastily running up stairs1 lifting heavy weights2 she must avoid things that inordinately hurry the circulation1 such as heated rooms1 stimulating liquors1 etc42 she must not overload the stomach1 or eat late suppers2 she must not take drastic purgatives2 must not constipate her bowels by taking laudanum1 etc42 must not compress the chest by tight lacing2 must not use strong tea or narcotics2 must not lie long in warm feather beds1 and must not engage in severe study1 night watching1 etc4 ,the pregnant woman need not indulge in a wayward or voracious appetite1 and1 although there is a tendency to fullness and fever1 she need not necessarily be bled4 ,the pregnant woman needs fully as much food as usual1 but she must avoid excess in eating and drinking4 ,ripe fruits1 lamb1 veal1 fresh fish1 milk1 coffee1 and1 in general1 every thing which agrees with the stomach may be eaten2 the taste1 as a rule1 is a safe guide1 and may be reasonably indulged4 ,after the sixth month1 she may properly eat four or five meals a day4 ,the best plan of treatment for one to adopt who has longings is not to give way to them1 unless the longings be of a harmless1 simple nature4 ,the ,,clothing of the pregnant woman should be suited to the season2 but as the vicissitudes of the weather affect her more than they previously did1 she should be dressed rather warm4 ,in general1 she should wear flannel drawers1 especially during advanced pregnancy4 ,many women have done themselves an injury by lacing tight to conceal their pregnancy4 ,the dress should be loose and comfortable1 nowhere pressing tightly or unequally4 ,stays or corsets may be used1 in a proper manner1 during the first five or six months2 they should be moulded to the shape of the changing figure1 and must not depress the nipple or the enlarging breasts4 ,the garters ought to be worn slack2 tight garters are very injurious1 and if the veins are enlarged or varicose1 it will be necessary for her to wear an elastic silk stocking4 ,moderate exercise in the open air is proper during the period of pregnancy1 and walking is a good kind of exercise2 but very long walks1 and dancing1 ought not to be indulged in4 ,riding in a wagon over rough roads1 and railway traveling1 are objectionable4 ,,bathing should be practiced with great care4 ,a warm bath is too relaxing2 a tepid bath once a week is beneficial4 ,sponging the body every morning with lukewarm water may be practiced1 and the skin should be quickly dried with a coarse towel4 ,the temperature of the water may be reduced gradually until it is quite cold4 ,a sitz bath may be used every morning1 although it is best to sit in it but a few seconds4 ,if it gives a slight shock1 it will be immediately followed by an agreeable glow4 ,put a little warm water with the cold at first4 ,ventilation is of the utmost importance4 ,during the day time1 the windows in every unoccupied room in the house ought to be thrown open4 ,attention should be directed to keeping the atmosphere in the sitting and sleeping rooms of the house fresh4 ,many poor people sleep in a very small1 close bedroom1 and breathe an air that is really poisonous4 ,the lady should see also that the house is kept light1 that the drains are in good and perfect order2 that the privies are frequently emptied of their contents1 and that the drinking water supply be not contaminated4 ,,sleep1 by its sedative influence1 and by the calmness of all the functions that attend it1 has a favorable influence upon the disturbed nervous system of the mother1 and upon the growth of the ftus4 ,her bedroom ought to be large and airy1 and she should not have curtains closely drawn about her bed4 ,the windows of the room should be opened during the day2 the bedclothes should be thrown back1 and everything ventilated2 the bed must not be loaded with clothes1 and the bedroom at night should be dark1 and as far as possible from noise4 ,these things will tend to secure sleep2 but if the pregnant woman should still be restless1 and feeling oppressed and hot1 she should perhaps admit more air into the room4 ,let her also attend every day to her bowels1 that they be not allowed to become costive2 perhaps eat cooling fruits1 live on an abstemious diet1 and if there is a feeling of faintness when she attempts to lie down1 she should have a bed so arranged that her shoulders and head are elevated4 ,the pregnant woman ought to retire early to rest1 and ,i would advise her to lie abed in the morning as long as she can sleep well4 ,if she cannot sleep well1 let her get up in good time in the morning1 take a bath1 or thorough ablution1 a stroll in the garden1 an early breakfast1 and then perhaps a short walk1 while the air is cool and exhilarating4 ,a nap of an hour or two after that1 upon a sofa or lounge1 will prove very refreshing4 ,a ,,tranquil ,,mind is of the greatest importance4 ,forebodings of a gloomy nature should not be encouraged1 as they often are1 by relating dismal stories1 etc4 ,unnecessary fear upon the part of the mother may have a bad effect upon the child1 as may also the indulgence in unbridled anger1 or yielding to temper1--perhaps may cause convulsions or hemorrhage1 or even abortion4 ,there is reason to believe that the imagination of the mother has an influence on the beauty of the child2 and it is quite certain that cheerfulness and equanimity of mind contributes to the future good health of the child1 and may even affect its disposition and mental traits4 ,,chapter ,,iii4 ,,diseases ,,of ,,pregnancy4 ,pregnancy is not a disease4 ,many women enjoy better health during its continuance than any other time1 and in general the pregnant woman is not quite as much exposed to contagious and other diseases4 ,but there are certain disorders incident to pregnancy1 of which it is necessary to speak4 ,,morning ,,sickness1 when it is only troublesome during the early part of the day1 is generally borne without much complaint1 or much medical care4 ,before taking any medicine for it1 ,i advise that the lady try such simple means as the following3 ,let her take a cup of coffee or milk1 and eat a few crackers or a biscuit1 after washing her hands and face1 and before rising in the morning2 then let her remain in bed for about fifteen minutes1 then dress quickly and take a short walk4 ,if the sickness continues1 let her eat freely of pop corn1 and she may eat of this occasionally during the day1 or whenever she is suffering from sickness1 and let her partake of other food also during the day4 ,persistent sickness and vomiting indicates a disordered condition of the digestive apparatus1 and requires appropriate remedies4 ,use successively the following3 ,formula #he1 #ajd1 #ha1 #ajg4 ,,vomiting is sometimes so persistent and severe that the stomach can retain nothing1 or but very little food4 ,of course1 such cases demand the aid of a physician1 and his efforts to give relief may be effectual1 when the medicine here directed fails4 ,,costiveness is another complaint to which pregnant women are liable4 ,this is hurtful in its consequences1 being not uncommonly the cause of fever1 tenesmus1 pain in the bowels1 and abortion4 ,care must be taken to obviate costiveness by the use of such food as will have a laxative effect4 ,the use of graham bread1 oatmeal gruel1 raisins1 figs1 grapes1 roasted apples1 baked pears1 brown bread1 cracked wheat1 stewed prunes1 and other varieties of farinaceous food and fruit1 may obviate the necessity of taking opening medicines 7,f4 #ajh1 or milk of magnesia47 ,an enema is an excellent remedy1 and every lady should have a good enema apparatus1 by which she can administer an injection to herself1 and if she suffer from constipation1 she should take an enema twice or three times a week1 and the early morning is the best time4 ,the clyster may be warm water1 or castile soap and water1 of the temperature of new milk4 ,it may be well to give occasionally an aperient to insure a thorough clearance of the whole bowels1 and castor oil1 salad oil1 citrate of magnesia1 seidlitz powder1 stewed rhubarb1 or an electuary of figs may be given4 ,i sometimes direct that the woman should take every day a small dose of oil1 in a cup of water gruel or oatmeal gruel4 ,,severe ,,pain in the bowels and rectum is sometimes caused by a column of hard and indurated feces1 which remain for a number of days in the rectum and colon4 ,not only pain but inflammation1 and other serious ills1 may result if such a condition is neglected4 ,if taking injections does not suffice to give relief1 manual assistance is necessary4 ,the nurse should learn the art of removing them if necessary2 she should use a convenient instrument1 carefully conducting it into the anus1 or she may thrust her finger into the vagina to break the hard mass1 and assist in its expulsion1 then she should wash it out with repeated clysters4 ,,for ,,abdominal ,,pains that are caused by its distention1 and by the weight of the enlarged uterus1 the woman should wear a bandage1 or an abdominal supporter1 adjusted to fit the abdomen1 and made with proper straps and buckles to accommodate the increasing size of the abdomen4 ,to relieve the pain1 the abdominal walls may be rubbed with equal parts of sweet oil and laudanum4 ,troublesome ,,hemorrhoids may be caused by constipation1 and also by the congestion in the parts1 and by the pressure made on the vessels of the part by the enlarged uterus4 ,it is proper sometimes to use emollient fomentations and cataplasms4 ,relief may often be given by making firm and gentle pressure between the finger and thumb of each distinct tumor1 till they are all compressed and returned within the anus4 ,in cases of ,,bleeding ,,piles1 blood comes away each time the patient has a stool4 ,the patient ought to be as quick as possible in relieving the bowels1 and should not at such times sit one moment longer than is absolutely necessary4 ,if the piles are inflamed and painful1 foment them three times a day1 and for half an hour each time1 with hot water containing a little carbolic acid--a one per cent4 solution4 ,apply it by means of a sponge4 ,extract witch hazel may be used also1 and relief may often be obtained by sitting over the steam of hot water for fifteen or twenty minutes4 ,simply put hot water in a close vessel1 and sit over it4 ,sometimes the woman cannot sit in an ordinary chair1 and she should sit either on an air cushion1 or a water cushion half filled with water1 placed on the chair4 7,f4 #ajg47 ,,diarrh,a is a less frequent attendant of pregnancy than constipation1 and the latter is sometimes the cause of the former2 in such cases an aperient is required4 7,f4 #aji47 ,should the complaint remain after the operation of the laxative1 opiates are proper1 mixed with some mild astringent medicine1 aromatics1 antacids1 etc4 7,f4 #fi1 #gd1 #gi1 #hj1 #ie47 ,,tenesmus1 and also diarrha1 are common attendants on abortion1 of which they are1 indeed1 sometimes the cause4 ,ipecac in half grain doses1 with powdered opium1 and given every six hours2 or frequently repeated doses of opium may be needed4 7,f4 #ia1 #ib47 ,a flannel bag filled with hot table salt1 and applied near the part affected1 may give great relief to pain4 ,,heartburn is a common and often a distressing symptom of pregnancy4 ,i would prescribe in such cases an abstemious diet1 pepsin1 ingluvin1 and other medicine to help digestion2 antacids and laxatives4 7,f4 #ga1 #gb1 #gd47 ,calcined magnesia is good2 prepared chalk is harmful4 ,it is not necessary for me to dwell upon the few ailments that occasionally afflict pregnant women that ,i have not yet referred to1--a few words must suffice4 ,if a woman who is pregnant is apt to be ,,faint1 or to ,,faint ,,away1 ,i advise that she be laid down--that she lie flat on her back1 with a pillow under her head--that tight articles of dress be loosened--windows raised--water should be sprinkled on her face1 a few drops of aromatic ammonia may be administered1 and perhaps smelling salts or hartshorn held to the nose4 ,if it is simply fainting1 it is not dangerous4 ,a nervous pregnant woman is sometimes subject to ,,palpitation ,,of ,,the ,,heart1 especially when lying down4 ,a small dose of aromatic ammonia will generally give relief4 ,if ,,cramps of the legs or thighs are troublesome1 take ,f4 #ib1 and tie a handkerchief around the limb1 above the part affected1 and let it remain a few minutes1 and use friction4 ,if cramp attacks the bowels or back1 a hot bag of salt1 or a stone bottle filled with hot water and wrapped in flannel1 may be pressed against the part1 and something similar should be placed to the sole of the feet4 ,if ,,pruritis ,,pudendi--irritation and itching of the external parts--are troublesome1 use ,f4 #aie1 #bag1 #bbj1 and take frequently a tepid salt and water sitz bath1 remaining but a short time in the bath4 ,if the parts are hot and inflamed1 and covered with an eruption1 use either of the following lotions3 ,f4 #bag1 #aie4 ,,chapter ,,iv4 ,,instructions ,,to ,a ,,woman ,,during ,,the ,,last ,,month ,,of ,,pregnancy4 #a4 ,,do ,,not ,,take ,,too ,,much ,,exercise4--,you may get relief from some of your ailments by lying down considerably during the day4 ,if there is leucorrha 7whites71 strangury 7a frequent inclination to void the urine71 incontinence 7an inability to hold the water71 pain in the hips with numbness of the inferior 7lower7 extremities--if the veins of the leg become varicose--if there are anasarcous swellings of the inferior extremities--if there is a pendulous belly1 the woman ought not to so exercise as to produce fatigue4 ,she may get some relief by sitting or reclining in the way that is most agreeable4 #b4 ,,use ,,means ,,to ,,harden ,,the ,,nipples4--,those women who have never had children ought to observe1 before labor1 whether there is a depressed condition of the nipples2 whether they contract as the breasts increase in size4 ,if they do1 the condition can be corrected by wearing nipple shields on them4 ,and to harden the nipples3 ,for at least a month before labor1 two or three times a day1 rub them between the thumb and finger1 and bathe them in tincture of myrrh or cologne water1 in which a little alum has been dissolved4 ,this will render the skin less sensitive1 and avert the distress occasioned by the tenderness of the nipples4 ,if there is especial reason to apprehend excoriated nipples1 as there is when they are rough and nodulated like a strawberry or raspberry1 make a solution of sulphate of zinc1 one grain to the ounce of rosewater1 in a wide-mouth bottle1 and tilt the bottle upon the nipple1 and allow it to remain there for a few minutes1 several times every day 7,f4 #aih1 #bag47 ,it is necessary also to protect the part from the pressure of stays and the friction of the flannel vest4 ,the stays may be removed entirely1 or the nipple may be protected by laying a soft linen rag1 wet with water and cologne1 around it so that the pressure will not be directly on the nipple4 ,if the breasts are swollen or painful1 the soreness will subside of itself before the commencement of labor4 ,it may be well1 however1 to foment them with flannel wrung out of hot water1 and support them as in a sling by a broad handkerchief1 passing over the opposite shoulder4 #c4 ,,pay ,,no ,,attention ,,to ,,the ,,chilling ,,and 8,,horrifying ,,tales ,,of ,,gossiping ,,beldames40--,a cheerful flow of spirits which arises from the hope of a happy event1 inspires a woman with activity and resolution1 and is the best preparation for the pains of labor4 ,do not give way to gloomy and melancholy forebodings or indulge in idle reveries4 ,any person is your enemy who would exaggerate to you the dangers of labor2 and let me here say to you1 that if you read in this book of certain unfavorable contingencies1 do not let your mind dwell upon them2 they occur very rarely indeed1 and ,i hope ,i have given such advice and instruction1 and that you have been so cautious and careful that your chance is unusually favorable4 #d4 ,,do ,,not ,,expose ,,yourself ,,at ,,this ,,time ,,to ,,wet ,,and ,,cold4--,do not go out in bad weather1 and do not go to theatres and other crowded places at all4 ,you are especially liable at this time to renal difficulties1 and if you take cold1 it will cause congestion of the kidneys1 and more or less urinary difficulty4 ,it is easier to prevent such complaints than to cure them4 #e4 ,,take ,,but ,,little ,,medicine4--,in general you may rest in the hope that all your troubles will vanish after your confinement1 and you can hardly hope to cure them sooner4 ,but keep your bowels loose4 ,if you cannot have daily passages by eating fruits1 bread made from unbolted flour1 or other laxative diet1 take saline waters1 compound licorice powder1 etc41 7,f4 #ajh47 ,if your bowels are constipated at the time that labor commences1 take at that time an active cathartic 7,f4 #aji74 #f4 ,,seek ,,and ,,engage ,,the ,,best ,,possible ,,physician4--,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 parturition4 ,but heretofore very few nurses trained in this country are thus prepared2 perhaps the popular sentiment is against such an education4 ,but you must always select a physician that you can confide in and trust if an operation is necessary1 or there is unusual difficulty4 #g4 ,,it ,,is ,,generally ,,well ,,to ,,have ,,your ,,physician ,,see ,,you ,a ,,month ,,before ,,the ,,time ,,that ,,you ,,expect ,,to ,,be ,,confined4--,indeed1 ,i would have you consult with your physician during the whole period of your pregnancy4 ,you may get very full directions from this book1 but still1 where it is practicable1 ,i advise that you consult with some skilled medical friend1 who knows your idiosyncracies1 and can suggest modifications of the directions as your own case demands4 ,specimens of your water should be analyzed each week during the last month1 if there are any signs of albuminaria1 etc41 7especially if the face and ankles are bloated47 ,if there is inability to pass the water1 it may be necessary to draw it with a catheter4 #h4 ,,submit ,,yourself ,,entirely ,,to ,,the ,,direction ,,of ,,your ,,physician4--,do not indulge in any opinion that may clash with his1 even if that opinion is founded upon what is here written2 you cannot expect to know more than he4 ,it may be that he will wish to examine you by palpation1 etc41 to know if the ftus lies as it should do1 as something may be done to correct a malposition by external manipulation if the effort is made early4 ,no good physician will permit that your sensibilities should be shocked by an unreasonable demand4 ,if you have studied this book diligently you will be prepared to converse intelligently with your physician1 and you will understand and appreciate any directions that he may give4 ,if you have taken any medicine prepared from formula herein inserted1 you know1 and can inform him what the medicine is2 this is better than it would be if you had taken patent medicine1 of the ingredients of which you are ignorant4 ,consult with your physician in regard to the choice of a nurse1 as he will be likely to know those that understand their business1 and that are in the habit of following the doctor's directions1 or he may know whether the one you selected is now attending a woman that has contagious disease4 #i4 ,,choose ,a ,,good ,,nurse4--,you should have the best possible aid that the nature of circumstances will permit4 ,do not get a fine lady nurse that requires to be constantly waited on by a servant1 and do not get a croaker that discourses of the sad and dreadful cases that have occurred in her experience4 ,do not get any one that is addicted to intemperance1 or a potterer that is devoid of method and efficiency2 that does the wrong thing in the wrong way1 and that is always out of her proper place4 ,get a nurse that will not dose and medicate either the mother or child when they are under the care of a physician1 or assume any duty or responsibility that belongs to him2 that admits that the doctor is the one to give orders4 ,get one that never reveals the private concerns of her former employers2 one that is not a mischief-maker1 causing dissention and disagreement in the household4 ,do not get one that is young1 if she is giddy and thoughtless and inexperienced1 nor one that is old1 if she is deaf and stupid4 ,get1 preferably1 a married woman or a widow2 one that has at some time had the care of infants2 one that has a pleasant countenance1 and is naturally cheerful2 one that has calmness and self possession1 and firmness1 and at the same time is gentle1 kind1 good-tempered and obliging2 she should have a light step1 a pleasant voice1 a cheering smile1 a dextrous hand1 a gentle touch1 and be gifted in cooking for the sick4 ,by preference1 engage a monthly nurse2 she will not be so likely to come to you from a case of scarlet fever or erysipelas1 or other contagious disease4 ,if you can find a nurse of the kind described above1 and if she be properly instructed and educated1 she will be invaluable to you1 and if she devotes her talents and her best energies to you and your infant1 she should be liberally paid4 ,but there are many such women all over the country1 or will be when we can induce them to qualify themselves by study and special effort4 ,but1 as really good nurses are full of engagements1 it may be necessary for you to engage her in the early months of your pregnancy2 only stipulate in the start that you will be obliged to dispense with her services1 if it happens that immediately preceding your confinement she had been attending a woman that had puerperal fever4 ,i do not say that you should necessarily engage a nurse that is educated as a midwife4 ,but such a one is to be preferred even if you have a physician1 and then the latter need not be detained from his patients for so long a period of time2 and if the last stage of the labor is so rapid that the child is born before the doctor arrives1 there need be no trepidation2 she will know well what to do4 ,thousands are born in this country without the slightest assistance from a doctor1 he not being at hand nor not being in time1 and yet both the mother and babe do well almost invariably4 ,as a rule the nurse that has studied and learned the most is the best prepared to discharge the duties resting upon her4 ,a ,,nurse ,,may ,,properly ,,be ,,in ,,attendance ,a ,,week ,,or ,,more ,,before ,,the ,,termination ,,of ,,pregnancy1 if circumstances permit or require it4 ,if present she will attend to the following things3 ,choose a good airy room for the lying-in chamber--one that can be well ventilated1 where the temperature can be kept at from #fj to #fe2 one that is removed as much as possible from noise and disturbance1 and where the patient need not be exposed to draughts4 ,provide needed articles of clothing for mother and child1 and dressings for the bed2 short gowns to wear over the chemise or ordinary night gown2 a proper bandage of heavy muslin1 as much as one and a quarter yards in length and fourteen inches in width4 ,i prefer to have it of several thicknesses1 and if it is quite long so that the ends meet to be folded it keeps in place better1 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 above1 so as to prevent it when adjusted from sliding upwards2 the child's binder1 preferably some woolen material about five inches in width and fourteen inches in length2 the child's shirt 7woolen or cotton1 not starched72 both a long and a short petticoat2 a frock or slip2 a shawl or flannel blanket2 napkins and muslin diapers2 also pieces of old muslin to be used to absorb blood and water4 ,provide also for dressing the bed1 a piece of impervious oiled cloth1 oiled silk1 or rubber cloth2 old sheets and comfortables2 a piece of carpet2 have in readiness a pair of shears or scissors1 a small box of prepared lard or vaseline or a flask of salad oil1 a package of pins one and a half inches in length1 besides ordinary pins2 tape1 bobbin or wrapping twine2 fine toilet soap2 fine sponge for washing the child2 soft linen or carbolated cotton for dressing the naval2 a box of unirritating powder2 a pile of towels1 and a little aromatic ammonia or brandy to be used in an emergency4 ,let every thing be placed in such order that either may be found without hurry or bustle at a moment's notice4 ,hot and cold water should always be in readiness4 ,,chapter ,v4 ,,directions ,,to ,,the ,,monthly ,,nurse4 ,if you attend a woman to whom the physician has already been called1 you will thereafter be subject entirely to his orders4 ,whatever your opinion is1 notwithstanding you have this book or any good authority for your opinion1 if it seems to conflict with his directions1 obey him2 on him rests the responsibility and he is presumed to know what is best4 ,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 case2 be free to ask of him explicit directions and instructions4 ,but your duties may precede his as well as accompany them1 and ,i wish now to give special directions in regard to things that first demand your attention4 #a4 ,a nurse may properly provide a soft rubber catheter and also a syringe2 this should be constructed so that it acts as an enema apparatus when one pipe is used1 and as a vaginal syringe when the other pipe is applied4 ,the holes in this pipe should be made so that the fluid injected is thrown backward4 ,it is important that this last direction be observed4 ,i know of one instance where the vaginal pipe of a ,davidson syringe was used1 yet the fluid injected passed through the cavity of the uterus and through the ,fallopian tube and entered the cavity of the peritoneum1 causing severe pain and inflammation4 ,besides the things already mentioned1 ,i advise that there be furnished for use if needed a small blanket to receive the baby1 a little bath tub1 two chamber vessels1 a bed pan1 carbolic acid1 fluid extract of ergot1 and chloroform4 #b4 ,being employed as a monthly nurse1 do not 7except very rarely indeed in an emergency7 give any medicine at all or any stimulant that has not been ordered by the attending physician4 ,many women do not consider that labor is a natural process2 it is painful indeed1 and often lingering and tedious1 but will go to a safe termination ordinarily without interference2 any medicine given1 unless very wisely administered1 is much more likely to do harm than good4 #c4 ,be still and noiseless as possible in doing necessary duties when your patient is trying to sleep1 or when she is in special need of sleep4 ,sleep may be of great importance to her1 and it may be put to flight by a little carelessness in renewing the fire1 or in walking if you wear heavy and creaking shoes4 ,nurses at these times should wear slippers and not shoes4 #d4 ,if you attend the lady for a week or more before the doctor is called1 there may be different ailments which you ought to note1 at least enough to know their true significance4 ,perhaps she has false pains1 and suffers so much that she believes that labor has commenced4 ,you will decide partly from the character of the pains4 ,false pains are colicky1 though they may shift occasionally from the bowels to the back and loins and may extend to the hips and thighs4 ,they come at irregular intervals1 are sometimes violent and sometimes feeble1 and they are particularly troublesome at night4 ,spurious pains are often caused by disordered stomach and may be somewhat relieved by attention to the diet and by mild aperients 7,f4 #ajh1 #aji71 or by applying a flannel bag of hot salt4 ,if quite severe send for the doctor2 do not give stimulants4 #e4 ,you may benefit the patient at this particular time when labor is approaching1 perhaps without giving her medicine4 ,possibly she may feel very well for a day or two1 and you will need to direct her exercise so that she does not do too much4 ,you may keep from her unpleasant sights and seeming dangers2 keep her room from being overheated2 see that she does not have late suppers1 too great a quantity of food1 or anything that will produce a costive state of the bowels4 ,see that her clothing is not too light1 that she does not have strong tea or coffee1 and that she does not lie too much in the bed4 ,secure as much as possible tranquility and equanimity1 by guarding against gusts of passion1 by keeping from her tales of horror and disaster which have happened to the pregnant1 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 object1 as such fears are seldom if ever realized2 relieve her if possible of gloomy forebodings by informing her how rarely death happens after a well conducted labor4 #f4 ,if you give any medicine at this time give only that which is unirritating and mild4 #g4 ,notice all the indications of approaching labor1 the sinking down of the uterus in the pelvis1 the contractions of the womb that come on without pain1 or with slight pain1 the change in the mind and temper of the lady1 the augmented mucous secretion1 c4 #h4 ,although there is usually a sensation of buoyancy and lightness accompanying or preceding the setting in of labor1 there may be on the other hand a feeling of anxiety and depression of spirits4 ,be very careful that you are not betrayed into any manifestations of impatience2 no words but those of gentleness and encouragement and hope should fall upon her ear4 ,,chapter ,,vi4 ,,care ,,of ,,the ,,mother ,,during ,,labor ,,and ,,confinement4 ,,true ,,labor ,,pains are distinguished from the false by the fact that they are felt considerably in the back1 passing down to the thighs1 and by their coming on at regular intervals4 ,at first they recur nearly every two hours1 and they steadily increase in number and frequency1 and are grinding in their character4 ,there are other signs which denote the actual commencement of labor2 there is usually a frequent desire to empty the bowels and bladder1 perhaps shiverings or rigors unattended with a sensation of cold1 sometimes a severe rigor1 and these signs are preceded or accompanied or followed by a discharge of mucus and blood1 called the show4 ,it is well now to send for the medical man1 though if he lives near by it is only necessary to let him know that his services may shortly be required4 ,if the patient suffers from nausea1 vomiting1 or chills and shiverings1 let her know that they are only incidents of her labor and not unfavorable4 ,do not let her increase the pains or attempt to increase them in any way2 it is much better that the labor should progress in a natural manner1 even if it is very slow4 ,,the ,,preparation ,,of ,,the ,,bed for the occupancy of the mother is now to be attended to4 ,cover the right side of the bed 7as the patient will probably lie on her left side7 with a piece of water-proof cloth or oil cloth2 upon the top of this a sheet is to be placed and fastened with safety pins4 ,over this permanent dressing 7on the top of the bed sheet7 a neatly folded draw sheet is adjusted 7and a second rubber and draw sheet is desirable71 which1 after the labor1 can be removed1 leaving the first clean and dry4 ,this second draw sheet and rubber1 and also a folded comfortable can be placed a little nearer the foot of the bed than the other1 and after the lady's confinement she can be drawn up on the permanent dressing1 and the temporary dressing can be easily removed4 ,the other bedclothes may be adjusted in the usual manner4 ,a piece of carpet can be thrown on the floor by the side of the bed1 and it is well to have a hassock to put between the patient's feet and the foot-board or bed-post4 ,,to ,,dress ,,for ,,the ,,occasion1 a folded sheet should be adjusted around the waist 7or1 instead of this1 or above this1 a petticoat71 to extend from the waist to the feet4 7,these will be removed after the delivery47 ,then a chemise should be put on in the usual manner1 and drawn up and folded high under the arms4 ,she should then have on a clean nightgown1 and over it a warm wrapper2 this can easily be slipped off when she is about to go to bed1 and the night-dress1 if it is a long one1 can be folded up under her arms1 so that it will not be soiled4 ,the ,,stays must not be worn1 as that prevents the free action of the muscles of the chest and abdomen4 ,the patient1 during the first stage of labor1 may walk about or sit down1 and need not confine herself to the bed4 ,she may be allowed such food as she can eat1 but should not be urged to take food4 ,,the ,,best ,,beverage for her is either a cup of warm tea1 or of gruel or arrowroot4 ,cold water will not hurt her if she desires it4 ,a patient ought1 during labor1 frequently to pass water4 ,some women1 from false delicacy1 do not attend to it1 and suffer severely for it4 ,,the ,,doctor ,,ought ,,to ,,have ,,some ,,room to retire to that the patient may be left very much to herself1 and that she may have opportunity whenever she desires to of thoroughly emptying either the bladder or bowels4 ,it is better that not more than two women be present with her1 and even one of these can be dispensed with if necessary4 ,,the ,,room ,,should ,,be ,,kept ,,quiet4--,let the attendants be quiet and self-possessed1 and let there be no noise1 or excitement1 or whispering4 ,there may be ordinary cheerful conversation1 but when the pains become very frequent and severe1 it is best that this should be hushed enough to have the patient feel that the attendants are not neglectful of her1 or careless about her4 ,cheerful words spoken to the patient of the blessed relief that will come after enduring so much pain will do good4 ,when the membranes are ruptured and the waters discharged1 the doctor should be called in immediately4 ,when he is present you will be subject entirely to his direction4 ,if the medical man cannot be present pretty soon1 ,i advise any nurse who has diligently studied this book to make a digital examination1 and ascertain if there is a head presentation2 if there is1 there need not be any anxiety about getting a doctor4 ,if the child is born before the doctor has time to reach the house1 let the patient be made to understand that there is not the slightest danger2 and1 for yourself1 observe the following directions3 ,ascertain if a coil of naval string be about the neck of the infant2 if there is1 remove it immediately4 ,see that it has room to breathe2 that there is not a membrane over its mouth1 and that its face is not buried in the clothes or the discharges4 ,if the child cries1 give a minute's attention to the mother1 to see that she is in an easy position1 and for a few minutes make pressure with one hand over her abdomen4 ,if the child does not cry the moment it is born1 give it a smart blow on the back1 sprinkle a little cold water upon it1 and put your finger in its mouth to remove any mucus that may interfere with respiration4 ,after the child cries1 and when no pulsation can be felt in the cord1 tie and cut it4 ,tie with a strong and not too fine a string1 about one and a half inches from the child's body1 and cut so as to leave that portion of the cord attached to the child's body about two and a half inches long4 ,cut far enough from the ligature so that it will not be liable to slip off4 ,the ligature should be drawn tight when applied1 and it ought to be examined afterwards to know that it does not continue to bleed4 ,i shall here summarize1 in a very brief way1 what you are to do in the absence of the doctor3 ,after the child is breathing properly and the cord is cut1 the mother may receive your attention4 ,if the placenta is not expelled spontaneously1 place one or both your hands over the uterus1 and by friction1 squeezing and pressure there1 you will probably cause enough contraction of the womb to start the placenta from its attachments4 ,you may then make slight traction on the cord1 pulling only gently1 and it will probably come down2 as it emerges from the vagina gently twist or turn over the afterbirth1 and you will secure the removal of the membranes4 ,the soiled articles are now to be removed1 a binder applied1 the patient placed nicely in bed and kept quiet2 no talking1 no visiting1 no excitement allowed4 ,the baby may now be attended to--be washed and dressed4 ,have at hand a bowl of warm water1 a small quantity of lard or oil1 soap1 fine sponge1 and the articles of clothing1 including a binder1 and by preference a piece of flannel for washing4 ,it is well also to have a small tub large enough to dip the child in4 ,if the child is much covered with the 8vernix caseosa10 rub it over with some unctuous substance1 and then wipe it off with the flannel or some soft cloth1 being careful at the same time that nothing gets into the eyes of the child1 and being careful to remove all the cheesy matter from the angles of the joints1 and from behind the ears4 ,have the water for the bath warm1 but not hot2 take hold of the feet of the child with your right hand and putting the left under its back and shoulders1 lower it into the water1 supporting its head by your arm4 ,while supporting its head with your left hand1 wash it all over1 using toilet soap and 7if you have it7 a fine1 clean sponge2 then lift it out into a warm towel and dry it thoroughly4 ,dust with fine starch powder1 made of wheaten flour1 under the arms and between the legs1 and dress the naval by using a soft piece of linen dipped in vaseline and having a hole in the center4 ,it is well to put another piece of linen around the cord1 which may then be turned upward or to the left side1 and the binder applied4 ,some prefer to put absorbant cotton around the cord4 ,the binder or belly-band should be made of flannel1 and should be cut bias4 ,care should be taken to apply it tight enough not to slip1 but too tight an application should be particularly avoided4 ,all the garments of the child should be made subservient to comfort and not to show2 should be warm and not too small2 should consist in part of flannel during cool weather4 ,when dressing the child put one garment inside the other1 and put the whole on over the feet4 ,but few pins need to be used if the clothes be properly arranged2 three pins are sufficient for the binder4 ,the washing or dressing of the child should be done quickly2 a little cold water should be given it2 it should be all the time in a warm room1 and may be laid where it is quite warm4 ,the mother may demand a little more attention before the child is applied to the breast4 ,a folded napkin should at first have been applied to the vulva4 ,look to it and see if it is much soiled with blood4 ,when it is1 apply a clean one1 and observe particularly that one is placed so that it is partly under her2 observe if her bandage is well retained in its place1 and if it presses well on the lower portion of the bowels4 ,if the binder is kept well adjusted it does good2 it is of no use if it is allowed to slip up from its place4 ,a towel folded and laid over the lower portion of the bowels1 under the bandage1 is useful as a compress1 and helps to keep the binder in place4 ,everything should be arranged so that the patient can have rest and quietness2 but before she goes to sleep put the child to the breast4 ,if the nipple is retracted1 an ordinary tobacco pipe may be used to draw it out so that the child can get hold of it4 ,if the child draws on the breast1 the milk which it obtains will serve to physic it1 and it should be applied to the breast every four or five hours2 nothing else need be given it1 except perhaps a little sugar and water4 ,if necessary to induce the child to take the breast1 a little sweetened water or sweetened milk may be applied to the nipple4 ,while the child is nursing the mother may lay upon her side1 and receive the child upon the arm of that side upon which she is lying4 ,perhaps1 in order to draw out the nipple so that the child can grasp it in its mouth1 it may be necessary to use some bottle with a flat1 smooth mouth2 fill the bottle with hot water2 after a minute1 empty it and place the mouth of the bottle immediately over the nipple2 as the bottle cools there will be sufficient suction to elevate the sunken nipple4 ,soon after the termination of the labor the woman may partake of some light food--tea and toast1 panada1 or anything of a light1 unirritating character4 ,from the very first1 under ordinary circumstances1 the woman may be permitted to change her position as she may desire1 from side to side1 or to be propped up in bed4 ,before going to sleep she ought to urinate--in a lying position1 if so inclined1 or she can be raised up and supported in a sitting position for a few minutes1 if she desires to be4 ,the patient must not be allowed to exert herself1 or remain too long in a sitting posture4 ,but ,i have never known a woman to be harmed by being raised up and sitting for a minute at this particular time4 ,unless there is unusual suffering from afterpains or hemorrhage1 or something that requires the attention of the physician1 the patient will now be desiring and seeking sleep1 and everything should be arranged for this object4 ,,chapter ,,vii4 ,,directions ,,to ,,the ,,nurse ,,during ,,the ,,month4 ,the nurse will receive from the medical man such directions as the peculiarities of the case seem to demand1 but ,i deem it proper here to give some general instructions4 ,first1 in regard to ,,care ,,of ,,the ,,mother4 ,,rest is essential to the mother during the month4 ,she should remain in bed nearly all the time for at least two weeks1 and should not return to her household duties under a month4 ,perfect tranquility is essential1 that the womb may resume its former size and situation1 and that inflammation1 ulceration1 prolonged debility1 pain and excessive discharges be avoided1 and that a good form be preserved4 ,as a means of preventing a flabby1 pendulous belly1 she may also1 when she does walk around1 wear a utero-abdominal supporter or a well-fitting bandage4 ,if a bandage is worn it should be made of strong linen1 cut bias1 setting snugly to the form1 but not exerting unpleasant pressure4 ,its breadth should be from twelve to eighteen inches4 ,the diet of a nursing woman should be both light and nourishing4 ,i would suggest for the first day well-boiled gruel1 bread and milk1 panada1 tea1 dry toast and butter1 or bread and butter4 ,for the second day1 beef tea may be added 7,f4 #eh71 and she should be served with food four times2 the third day she may eat a little chicken or game1 and mashed potatoes or rice pudding1 and on the fourth day she can partake once of mutton or beef4 ,arrow root 7,f4 #dd71 with these articles mentioned1 may form part of her diet thereafter1 but she may partake of such articles of her former diet as are wholesome and nourishing4 ,the woman must not be starved2 she demands food that will allow her to recuperate her strength4 ,give her as nutritious food as she has appetite for1 and can easily digest and assimilate4 7,f4 #eh47 ,for a ,,beverage give toast water1 barley water1 and milk with the chill taken off and a little salt added1 tea1 cocoa1 or chocolate made with one-half milk1 new milk and water1 cacao and broma1 made with a large proportion of milk4 ,either of these may be freely used as a drink4 ,i have always allowed my patients to drink freely of water from the first1 and an occasional cup of coffee is not harmful4 ,when the mother experiences any inconvenience from any articles of diet or drink1 she should not hesitate to abandon them1 for if they disagree with her they will also disagree with the child4 7,f4 #aj1 #af1 #ah1 #ai1 #bj1 #bc1 #be1 #bh47 ,the ,,lochial ,,discharge1 which occurs directly after a lying-in1 is at first of a reddish color1 and gradually changes to a brownish hue1 and afterwards to a greenish shade4 ,it is necessary that there should be some discharge to continue for a week1 and it often continues for three weeks more4 ,in some cases it has a disagreeable odor4 ,,ablutions and cleansings are very necessary at this time4 ,the parts should be carefully cleansed every day1 and it is never amiss to use for this purpose a weak solution of chlorinated soda1 or carbolic acid1 or permangenate of potassa1 etc41 7,f4 #aec47 ,they may be used quite weak at first1 and afterwards of greater strength1 if they do not cause smarting4 ,tar water is excellent for an injection4 ,the woman should daily assume a position that will facilitate the discharge of the lochia2 sometimes get on her knees1 or she may occasionally lie on her face and stomach4 ,there should be no bandages applied so as to confine the secretions4 ,a soft sponge and warm water may be used for ablutions at first1 or the parts may be bathed with warm water and oat meal gruel2 after bathing they should be dried with warm1 dry towels2 they may then1 by means of a piece of linen rag1 be anointed with salad oil or vaseline1 or other bland oil4 ,once or twice a day the vagina should be syringed out with some injection4 7,f4 #aec1 #aee47 ,,to ,,wash ,,or ,,cleanse the patient so that the pores of the skin in every part are free and unobstructed1 a soft napkin wet with warm soap and water1 should be passed underneath the bedclothing1 and she should be rubbed all over without any exposure to a draught of air4 ,in some way she should take a sponge bath every day4 ,the ,,clothing which a patient will wear immediately after a labor has been already1 indicated4 ,as some garments worn during labor are not necessarily soiled1 they may be worn until the third or fourth day1 when the dress should be changed4 ,this may be done without tiring or exposing the patient4 ,without raising her up you can pull the bedgown down from over each arm1 and after removing it from under the body1 you can draw down the chemise and remove it from below4 ,you can place her arms in the sleeves of the clean chemise1 throw it over her head and pull it down2 and put on a clean bedgown in a similar manner1 or both may be put on at once4 ,the ,,bed ,,clothing as well as the body linen should be changed frequently4 ,in changing the upper sheet it should be pulled off from below1 and the clean one can be carried down in its place without removing the other bedclothes1 by plaiting the lower half of it4 ,to put on a clean under-sheet1 plait one side of it1 and place that under the patient while she lies on her side1 then let her turn on her back or other side onto it1 and draw out the plaited part4 ,care of this kind is necessary until she is able to sit4 ,have the sheets well aired1 and have a proper temperature in the room4 ,,the ,,lying-,,in ,,room should always be kept well ventilated and rather cool2 it is injurious to the patient to have the room kept at a high temperature4 ,perhaps the ventilation can be secured by having a little fire in the room1 and by occasionally leaving the door of the apartment ajar1 at the same time being careful to guard against draughts4 ,but visitors remaining in the room1 or any additional number of persons1 serve to vitiate the air1 as well as to prevent the necessary repose of the patient4 ,a sensation of chilliness may be felt by the woman after delivery1 and her feet may be cold2 if they are1 something warm should be applied to them1 and sufficient clothing should be on the bed2 but afterwards be careful not to overload her with clothes1 as well as to avoid having the room overheated4 ,,too ,,much ,,light in the room may be injurious to the eyes of the mother or child1 and it is often necessary to darken the room somewhat for a few days4 ,the lying-in woman will usually be confined to her room for two weeks4 ,after the first fifteen days she may very properly remove to another room adjoining1 or near at hand1 and during her absence her room and bed may be ventilated by throwing the windows wide open and throwing the bedclothes back4 ,ordinarily she may1 at the end of three weeks1 take her meals with the family1 but she ought still to lie down occasionally to rest her back4 ,at about this time she may take an airing in a carriage1 if the weather be fine4 ,all lying-in women ought not to be treated alike in regard to ,,diet1 etc4 ,while a light1 unstimulating diet is best at first in ordinary cases1 the weak and delicate require good1 nourishing food from the commencement1 such as beef tea1 chicken broth1 mutton chops1 eggs1 etc41 7,f4 #eg1 #eh1 #ei47 ,oatmeal gruel increases the secretion of milk1 is nourishing and easily digested1 at the same time it is simple and bland1 and proper for those that are corpulent1 or strong and robust1 and the same may be said of good cow's milk4 ,but1 as the healthy mother furnishes daily from a quart to a quart and a half1 she needs some meat to keep up her strength4 ,never give stimulants to increase the woman's strength1 or to increase the quantity of milk4 ,in some cases1 after a severe and lingering labor1 there is ,,retention ,,of ,,urine4 ,if the bladder cannot otherwise be emptied1 the catheter must be used every six or eight hours4 ,the bowels are usually costive after a confinement1 and ,i prefer to give a dose of castor oil the third day4 ,if this or some other aperient is not given1 enemas should be administered sufficient to cause evacuations4 ,the care of the ,,mother',s ,,breasts is important4 ,before the milk is abundantly secreted1 she should not be fretted by very frequent ineffectual attempts at nursing1 though it may be necessary to draw out the nipple by means of a breast pump4 ,the milk should be drawn out when the breasts become full and distended1 and they should not be allowed to remain hard and sore4 ,apply fomentations2 cabbage leaves1 wilted in hot vinegar and water1 or warm solution of carbolic acid1 one part to eighty4 ,if they continue to be swelled and painful use ,f4 #bba1 #bbc4 ,it may be necessary to make gentle pressure upon them by means of strips of adhesive plaster1 or by a sort of jacket or bandage1 that should be prepared especially for the purpose4 ,when the breasts are closely bandaged they should be supported on each side by pads of cotton1 so that the pressure will be made equally upon them4 ,delay in applying the child to the breasts is often a cause of swelled breasts4 ,after it has been fed for a few days it may refuse to nurse1 and if it does nurse the nipple may be quite tender4 ,but1 unless for some cause the secretion is to be checked1 the effort should be made every two hours to induce the child to draw4 ,you will be more successful in these efforts if you can reduce the heat and swelling4 ,rub the breasts every four hours with good1 warm olive oil1 vaseline1 or camphorated oil1 and keep the excoriated nipple thickly coated with sub-nitrate of bismuth4 ,the breast should be rubbed1 and the child should be nursed regularly1 although ,i do not advise that the child or the mother should be roused from their slumbers2 it is better to delay for awhile the usual effort4 ,but1 even at first1 a child can be nursed with considerable regularity every hour and a half during the day1 and twice during the night2 and it should be applied alternately to either breast1 even if it seems to prefer one to the other4 ,it is often necessary to wash the breast and nipple with warm water1 and dry it with a soft napkin1 before applying the babe4 ,during all the time that the mother nurses the child1 the ,,mind ,,of ,,the ,,mother exerts an influence on the latter through her milk4 ,if the mother's mind is very much disturbed by any apprehensions1 fears or anxieties1 these perturbations will not only be likely to check the flow of milk1 but will alter its quality1 and perhaps render it hurtful and dangerous to the infant4 ,the nurse should guard the patient as much as possible from anything causing nervous agitation1 fretting1 anger1 grief1 fear1 sudden terror1 or great anxiety1 as these are injurious to the mother1 and may be harmful and fatal to the child4 ,equanimity and cheerfulness of mind on the part of the mother are important at any period of her pregnancy or nursing4 ,i will now give more particular directions in regard to ,,the ,,care ,,of ,,the ,,child4 ,,the ,,food ,,of ,,the ,,child1 if it is necessary to feed it at first1 may be one-third of new milk and two-thirds of warm water1 slightly sweetened4 ,it is not necessary that it should be fed for at least eight hours after birth1 and at first the quantity fed it must be small4 ,except in rare cases the milk furnished by the mother will come soon enough1 and in sufficient quantity to supply the wants of the child1 and it is best for both that the child should draw it when secreted4 ,for the instruction of the mother1 as well as the nurse1 ,i here quote a paragraph upon the nourishment and feeding of the child1 not only of the new-born1 but also of the subsequent months3 8,no form of artificial nourishment can compare with that furnished by the mother4 ,women should know and consider the probability of disease and death occurring from any other mode1 and the difficulties and annoyances to be encountered in the use of artificial food4 ,as a further inducement to her to nurse her own child1 she should know that her offspring is sure to imbibe with its milk1 deep1 earnest affection4 ,the mother who can nurse her own offspring should commence within eight hours after delivery1 and in the mean time no trash should be put in its mouth to still its cries1 or for any other reason2 if it has not been surfeited1 it will be disposed to take the breast4 ,it should be placed to the breast before they are gorged with milk1 for at that later time the flow is less easy1 the parts are more irritable1 and the child sucking with greater power1 we are more likely to have1 as the result1 irritated nipples4 ,nature prompts all animals to suck their mother soon after they are born2 we are less liable to have sore1 irritated1 cracked nipples1 and there is less liability to infantile colics1 etc41 if we follow the guidance of nature and instinct40 ,as soon as possible accustom the child to the habit of nursing every two hours4 ,if there is a proper interval between the times of nursing1 the child draws with more avidity1 actually empties the breast1 and obtains that part that contains the most cream4 ,endeavor also to have the intervals longer at night1 so that1 from #aj ,p4 ,m4 to #f ,a4 ,m41 it nurses but once or twice4 ,still1 if it wakes every two or three hours1 demands its supply of nourishment1 and you cannot otherwise quiet the child1 you must indulge it4 ,do not accustom the child to sleeping on the mother's breast4 ,if it sleep in its own crib or bed1 properly clothed and protected1 it is less liable to have its rest disturbed4 ,avoid the custom of having a young child sleep with old and sickly persons1 and also of having them sleep in ill-ventilated rooms1 and of covering the child's face as it sleeps4 ,there is danger that a child may die from want of pure fresh air1 from having its face pressed tightly in the embrace of the person with whom it sleeps1 from the multiplicity of its clothes1 and from the mass of bedclothing used by the mother1 as well as from improper food4 ,a child should never be covered to sweat by reason of the warmth of its clothing1 or of that of the apartment4 ,if the mother does not enjoy good health1 it may be better for her not to nurse the child at night1 but to have it fed once or twice with a little diluted cow's milk at night1 and to nurse it during the day4 ,the following have been named as ,,causes ,,why ,,the ,,mother ,,cannot ,,properly ,,nurse ,,the ,,child3 #a4 ,when she cannot have a sufficient quantity of milk4 #b4 ,when the supply falls off from some defect which is not remediable4 #c4 ,when there is a strong venereal or scrofulous taint in the constitution4 #d4 ,when suckling produces an active or painful disease in the mother1 as colic1 etc4 #e4 ,when the mother is subject to great nervous debility2 possesses an irascible temperament1 and cannot avoid grief and sorrow2 and also when she is suffering from certain hereditary chronic diseases4 ,,when ,a ,,mother ,,cannot ,,suckle ,,her ,,child1 if circumstances will allow1 a healthy wet-nurse should be procured4 ,choose one that is of a healthy family2 ascertain that there are no eruptions on her skin1 or if there be other disease2 if she have a plentiful breast of milk1 and if it be of a good quality2 if she has good nipples1 and if her child is born near the time that the one was that she is to nurse4 ,do not get a nurse that menstruates during suckling1 nor one that has a child which is unhealthy1 or has a sore mouth or blotches upon the skin4 ,very feeble new-born babes cannot take the breast sometimes4 ,in such cases cow's milk1 water and sugar 7,f4 #a7 may be given in small quantities at a time1 but frequently repeated4 ,if it takes only a teaspoonful at a time it should be repeated every half hour4 ,many mothers are unable to obtain the services of a wet-nurse4 ,the milk of a cow is the best substitute1 and when this is of ordinary richness1 it may be diluted with an equal quantity of water1 or thin barley water4 ,the following are leading principles to guide in giving infant food3 #a4 ,aliment should always be presented to the infant stomach in a fluid form4 #b4 ,bread and other farinaceous substances are generally indigestible in the infant stomach1 and may better be excluded from infant feeding4 #c4 ,cow's or goat's milk1 when pure and modified so as to resemble as much as possible human milk1 will generally be found sufficient without any other help to nourish the new-born infant4 #d4 ,if cow's milk is used at first1 diluted with twice as much water and slightly sweetened1 the proportion of water must be gradually lessened1 until after six months the milk may be given undiluted4 #e4 ,when good milk from one cow cannot be obtained1 and the child does not thrive upon the milk used1 condensed milk may properly be substituted4 #f4 ,there are various forms of infant food referred to in ,f4 #a1 #b1 #c1 #d1 #aa1 #bh1 #de1 #di1 and if one of these is tried and proves satisfactory1 it will not be advisable to try new kinds of infant food which are at the present time offered for sale4 ,milk should be the basis of all infantile food2 neither starch1 dextrine or glucose sufficiently nourishes without it2 but we may use one of these foods without milk for one or two days1 in unsettled state of the stomach1 with good results4 7,f4 #fa47 ,,thoroughly ,,wash ,,the ,,babe ,,every ,,morning from head to foot1 using a large wash bowl or nursing basin1 half filled with water4 ,first wet the head1 then immediately put the body in the bath1 and with a sponge or piece of flannel1 cleanse the whole body1 particularly the armpits1 groins1 and between the thighs4 ,the skin1 after being thus cleansed1 must be quickly and thoroughly dried with soft towels1 and the parts liable to become sore1 powdered2 then all parts of the body and limbs should be gently rubbed4 ,during all the time1 when the child is but a few days old1 it should not be exposed at all to the cold4 ,the water for its bath should be slightly warmer than new milk1 and the time occupied in the bathing should be short4 ,each time1 after a passage from the bowels1 the parts should be washed with warm water1 and if there is any chafing the calamine powder should be applied4 ,,the ,,naval ,,string should receive the attention of the nurse2 within an hour of the time it is at first tied1 she should examine the dressing to see if there has been any bleeding4 ,if it bleeds1 and the doctor is not at hand1 retie with a stout cord1 drawing it quite tight4 ,each morning1 when the child is bathed1 lift up the naval string with the rag dressing and insert a little nice fresh tallow under it4 ,when it is loose remove it1 but use no means to cause the separation4 ,the naval is sometimes a little sore1 but seldom needs any dressing more than simply vaseline or tallow4 ,,at ,,night a child should be entirely undressed1 and its clothing replaced by other garments1 those that are loose1 light1 and sufficiently warm for it while it is under the bedclothes4 ,for a very young child the proper night-dress is a loose slip2 when older1 a pair of drawers1 fitting up well around the neck and covering the body and limbs1 is a good article4 ,the clothing worn during the day should not be worn at night1 and the clothing when soiled should be immediately changed4 ,whenever the child seems disposed to sleep1 this should be encouraged4 ,never arouse a child suddenly from its sleep4 ,be careful that there is no unnecessary noises to disturb its sleeping4 ,time the bathing and dressing so that the little one may not be unnecessarily disturbed4 ,but never give soothing syrups1 anodynes for infants1 or other nostrums to induce them to sleep4 ,if the child is restless1 endeavor to ascertain if there is not some cause that can be removed1 such as tight clothing1 etc4 ,,premature ,,infants may1 under favorable circumstances and assiduous care1 live and thrive4 ,immediately after birth the child should be placed in a warm bath1 and then wrapped in cotton4 ,the baths should be warmer than usual1 and must be frequently repeated4 ,awaken the child every one or two hours to feed it4 ,milk 7woman's milk is the best7 must be given it by a teaspoon4 ,with a view to the better development of the lungs1 it may be excited to cry by a slight irritation4 ,do not bring such children into the open air for several months after the birth1 as their passages are readily affected4 ,,part ,,ii4 ,,anatomy ,,and ,,physiology ,,of ,,the ,,female ,,organs ,,and ,f,,tal ,,development4 ,,chapter ,i4 ,,of ,,the ,,pelvis4 ,the formative organs of generation are situated within a large cavity1 called the cavity of the pelvis1 the walls of which are composed of bones and soft parts4 ,this basin 7in ,latin1 pelvis7 is an irregular1 long cavity1 situated at the base of the spinal column1 and above the inferior extremities4 ,in the adult the bony pelvis may be divided into four parts or bones1 viz3 the os sacrum1 two ossa innominata1 and the os coccygis1 but in early life they are more minutely divisible4 ,,the ,,sacrum4 ,the sacrum 7,fig4 #a7 terminates the vertebral column1 and is perhaps the most important bone in the pelvis1 obstetrically considered1 as it enters largely into the various deformities of the pelvis4 ,in the adult it is of a triangular shape1 the base of the triangle being above and inclining forwards1 the apex below and somewhat backwards2 its length is from four to four and a half inches2 its breadth about four inches1 and the greatest thickness1 two and a half inches4 ,the internal surface is concave to the amount of half an inch1 crossed by four transverse lines1 marking the former division by cartilage2 here are four pair of holes1 through which pass numerous nervous filaments1 which afterwards form part of the great sciatic nerve4 ,illustration ,fig4 #a- ,a represents the internal or anterior surface of the sacrum4 ,b ,b represents the articular processes4 ,c ,c represents the anterior sacral foramen4 ,d represents the articulating surface4 ,it is placed at the posterior part of the pelvis1 where it appears like a wedge forced in between the ossa innominata1 immediately below the vertebral column and directly above the coccyx4 ,,the ,,ossa ,,innominata4 ,the os innominata 7nameless bone1 ,fig4 #b7 is of a very irregular figure1 and the pair occupy the lateral and anterior parts of the pelvis4 ,the external or femoral surface is turned backwards and downwards1 as well as outward2 at its superior part1 inferiorly it looks downwards4 ,towards the front1 the external face presents the cotyloid cavity1 or the acetabulum2 a little more in advance and below is the subpubic or obturator foramen1 which is nearly closed by the obturator ligament4 ,illustration3 ,fig4 #b4 ,right os innominatum1 external surface4 ,fig4 #b--,represents the external surface of the right os innominatum4 ,a4 ,the external iliac fossa2 ,b1 crest of the ilium2 ,c1 anterior superior spine of the ilium2 ,d1 anterior inferior spine of the ilium2 ,e1 horizontal branch of the pubis2 ,f1 posterior superior spine of the ilium2 ,g1 posterior inferior spine of the ilium2 ,h1 acetabulum2 ,i1 ischium2 ,k1 obturator foramen4 ,at birth the haunch bone1 or os innominata1 is composed of three bones connected by cartilage4 ,fig4 #c4 ,the superior portion of the bone is characterized on its abdominal or internal face by a large excavation called the internal iliac fossa 7,fig4 #d47 ,this portion is terminated below by a large rounded and concave line4 ,the inferior 7lower7 portion presents behind a nearly triangular plane surface2 near the middle of this is the obturator foramen1 and in front is the internal face of the os pubis4 ,illustration3 ,fig4 #c4 ,left os innominatum1 external surface1 etc4 ,fig4 #c--,left os innominatum1 partly ossified4 ,the haunch bone as it exists in the child4 ,a1 pubis2 ,b1 ilium2 ,c1 ischium4 ,illustration3 ,fig4 #d4 ,right os innominatum1 internal surface4 ,fig4 #d--,right os innominatum1 internal surface4 ,a1 internal iliac fossa2 ,b1 anterior superior spinous process of the ilium2 ,c1 crest of the ilium2 ,d1 posterior superior spinous process of the ilium2 ,e1 posterior inferior spinous process of the ilium2 ,f1 articular surface2 ,g1 spine of the ischium2 ,h1 tuberosity of the ischium2 ,i1 obturator foramen2 ,k1 ischia pubic ramus2 ,l1 crest of the pubis2 ,m1 the pectineal eminence4 ,,the ,,os ,,coccygis4 ,illustration3 ,fig4 #e4 ,the os coccygis4 ,the ,,os ,,coccygis 7,fig4 #e7 is three or four little bones united together on the median line of the body1 and attached to the os sacrum4 ,each little bone is tipped with cartilage1 and they are so united as to be movable4 ,the entire bones form a pyramid1 the apex of which is below4 ,the internal surface is smooth1 like that of the sacrum1 terminating the plane of the sacrum and bounding it anteriorly4 ,illustration3 ,fig4 #f4 ,vertical section of the pelvis4 ,fig4 #f--;,inlet1 outlet1 and axis of the pelvis4 a1 b1 plan of inlet--superior strait2 c1 d1 plan of outlet1 or inferior strait2 e1 f1 axis of cavity2 g1 the coccyx extended as it is in labor4 ,of the ,,joints ,,of ,,the ,,pelvis it is only necessary here to say that there is no motion in them to facilitate labor1 except that the sacro-coccygeal joint is of the kind called ginglymoid1 admitting of extensive motion1 especially backward1 so as to permit the enlargement of the lower outlet an inch or more4 7,fig4 #f47 ,,of ,,the ,,pelvis ,,in ,,general4 ,we will now consider the pelvis collectively or as a whole2 its relation to the rest of the body2 its magnitude1 axis1 etc4 ,it is connected with the trunk by the articulation of the sacrum with the last lumber vertebra1 effected in the same manner as the junction of the vertebra with each other2 with the lower extremities it is connected by means of the hip joints4 ,when the pelvis is in situ1 the brim is neither horizontal nor perpendicular4 ,it represents a cone1 slightly flattened from before backwards1 the base of which being above1 while the apex is directed downwards4 ,when the body is erect the upper part of the sacrum and the acetabula are nearly on the same descending line1 the point of the os coccygis being a little above the arch of the pubis1 and the sacro-vertebral angle three inches and nine lines higher than the pubis4 ,were it not for the obliquity owing to the upright position of the human female1 the womb would gravitate low in the pelvis1 and produce most injurious pressure on the contained viscera4 ,the lower or true pelvis is the part involved in parturition1 and its size and shape demands our attention4 ,,the ,,brim ,,of ,,the ,,pelvis4 ,this is defined by the ,,lineo ,,ilio ,,pectinea1 which marks the boundary of the true and false pelvis1 and this superior strait is the entrance of the lesser pelvis4 ,its form has been variously described as being oval1 heart-shaped1 and triangular4 ,if we call it 8triangular with angles rounded off10 the base of the triangle is behind and the apex in front4 ,it would be nearly oval were not the oval form broken by the promontory of the sacrum4 ,this brim is the first solid resistance the head of the ftus meets in its descent through the pelvis4 ,,diameter ,,of ,,the ,,pelvis4 ,different estimates are made by different anatomists of the measurements of the brim of the pelvis4 ,the following is nearly the correct size of the ordinary female pelvis3 ,illustration3 ,fig4 #g4 ,the bony pelvis4 ,fig4 #g--,the pelvis seen from above4 a a1 ,the antero-posterior or sacro-pubic diameter2 b b1 the transverse diameter2 c c1 the two oblique diameters4 ,the circumference varies from thirteen to fifteen inches2 the antero-posterior diameter1 i4 e41 from the prominence of the sacrum to the upper edge of the symphasis pubis1 7,fig4 #f71 is about four and a quarter inches2 the transverse across the widest part of the brim1 at right angles to the antero-posterior1 is five and a quarter inches1 and the oblique from the sacro-iliac synchondrosis of one side to the opposite of the brim1 just above the acetabulum1 is five inches4 7,fig4 #g74 ,,the ,,cavity ,,of ,,the ,,pelvis1 of which the fixed boundaries are the sacrum and the pubis1 is of unequal depth4 ,the height in front is one and a half inches2 upon the sides1 three and three-quarter inches1 and it is four and a quarter inches if a straight line be drawn from the sacro-vertebral angle to the point of the coccyx1 five and a quarter inches following the curve of the sacrum1 and six inches if the coccyx be extended4 7,fig4 #f74 ,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 inches1 but may increase to five inches during labor by the retrocession of the coccyx 7,fig4 #h72 the transverse from one tuber ischii to another is four and a quarter inches1 and the oblique about four and three-quarter inches4 ,illustration3 ,fig4 #h--,position of the pelvis and the axis at the termination of labor4 ,fig4 #h--;a b1 ,total axis of the excavation2 c1 the axis of the superior strait2 d e1 perineum as distended at the moment of the passage of the head4 ,it is important to notice that the diameters are entirely changed between the rim and the outlet1 and that the change is effected gradually4 ,the axes of the inlet and outlet form an obtuse angle with each other 7this is illustrated in ,figs4 #f and #h47 ,the three diameters taken at the center of the pelvis are very nearly equal--about four and three-quarter inches4 ,,differences ,,of ,,the ,,pelves4 ,there is considerable difference between the male and female pelvis1 in shape and size4 ,the pelvis in the male is smaller but deeper2 the bones are thicker and the brim is more circular1 the depth of the symphasis pubis is greater1 the sacrum is more perpendicular1 the arch of the pubis is narrower1 the tuber ischii are nearer each other1 and the coccyx less movable4 ,in the female the iliac foss are larger1 the interval separating the angle of the pubis from the acetabulum is greater1 causing the prominence of the hips and wider separation of the thighs1 the superior straight is larger and more elliptical1 the curve of the sacrum deeper and more regular1 the tuberosities of the ischii are further apart1 and the arch of the pubis broader4 ,from the greater width of the female pelvis1 and from the upper end of the thigh bones being farther apart than in the male1 the thigh bones approach each other in their descent1 giving a peculiarity to the movements of the female in walking4 ,the soft parts lining the pelvis and covering it externally modify the diameters of the pelvis1 but the effect of these additions in diminishing the internal diameter is not very great4 ,the diameter of the cavity is lessened thereby from one-fourth to one-half an inch4 ,,uses ,,of ,,the ,,pelvis4 ,one function of the pelvis is to inclose and protect the bladder1 rectum and seminal vesicles of the male1 the uterus1 ,fallopian tubes and ovaries1 as well as the bladder and rectum in the female4 ,during labor it affords a passage for the child4 ,,terminal ,,outlet ,,of ,,the ,,pelvic ,,canal4 ,this is not at the coccyx1 but rather at the anterior commissure of the perineum4 ,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 ftus4 7,fig4 #h74 ,illustration3 ,fig4 #i--,section of sacrum and pubis4 ,measuring superior strait4 ,illustration3 ,fig4 #aj4 ,measuring inferior strait4 ,,chapter ,,ii4 ,,parts ,,contained ,,in ,,the ,,pelvis4 ,the internal organs of generation are the vagina and uterus with its appendages2 but ,i will first describe the urethra and the perineum4 ,the ,,urethra is a membranous dilatable canal about an inch and a half in length1 and directed obliquely from before backwards1 and from below upwards1 running under and behind the symphasis pubis1 from which it is separated by loose celular tissue4 ,its inferior portion is intimately united to the vaginal walls4 ,its meatus1 the outlet for the urine1 is situated about an inch from the clitoris1 and immediately above the prominent enlargement of the anterior part of the vagina4 ,internally the urethra opens into the bladder4 ,its direction is subject to variation during pregnancy1 the bladder being carried upwards with the uterus1 the urethra curves under the pubic arch1 and then ascends perpendicularly4 ,the same change occurs when the uterus is enlarged from other causes4 ,in prolapse of the pelvic viscera the course is reversed4 ,the ,,perineum is the portion between the rectum and the vagina4 ,,the ,,uterus4 ,the uterus is the organ provided for the reception1 growth1 and ultimately for the expulsion of the ftus4 ,in the virgin normal state it is pear-shaped1 flattened from before backwards2 is situated in the cavity of the pelvis1 between the bladder and the rectum1 and projects into the upper end of the vagina below4 ,its upper end or base is directed upwards and forwards1 so that its axis corresponds very nearly with that of the superior strait1 and forms an angle with the vagina4 ,the uterus measures about three inches in length1 at its upper part two in breadth1 an inch in thickness1 and it weighs from one ounce to an ounce and a half4 ,the fundus is the upper broad extremity of the organ2 it is convex1 covered by peritoneum1 and placed in a line below the level of the brim of the pelvis4 ,the body gradually narrows from the fundus to the neck4 ,its anterior surface is flattened1 covered by peritoneum in the upper three-fourths of its extent1 and separated from the bladder by some convolutions of the small intestines2 the lower fourth is connected with the bladder4 ,its posterior surface is convex1 covered by peritoneum throughout1 and separated from the rectum by some convolutions of the intestines4 ,the lateral margins are concave1 and give attachment to the ,fallopian tubes above or superiorly1 and the round ligaments below2 and behind these1 and also below the ligament of the ovary4 ,the cervix is the lower and constricted portion of the uterus2 around its circumference is attached the upper end of the vagina1 and this extends upwards a greater distance behind than in front4 ,at the vaginal extremity of the uterus is a transverse aperture1 the ,,os ,,uteri1 bounded by two lips1 an anterior one which is thick1 and a posterior one1 narrow and long4 ,the os uteri1 or os tinc1 is generally about the size of a small goose-quill4 ,the canal of the cervix is from half to three-quarters of an inch long2 leading from the os uteri it first widens and then contracts again where it enters the body of the uterus4 ,the surface of the canal exhibits a variable number of follicles or vesicles called the glandula nabothi1 which secrete a thick mucus2 this blocks the canal after impregnation4 ,the cavity of the body and neck has a longitudinal extent of about two and a half inches2 in virgins it is much less4 7,fig4 #ab74 ,illustration3 ,fig4 #aa ,uterus1 bladder1 etc41 showing relative position4 ,fig4 #aa--,section of pelvis4 a1 section of pubis2 b1 bladder distended2 c1 the uterus in normal position2 e1 sacrum2 f1 urethra2 g1 vagina2 h1 hymen2 i1 the os uteri2 j1 meatus of urethra2 k1 vagina4 ,,structure ,,of ,,the ,,uterus4 ,the proper tissue of the womb is composed of fibres1 and is proved to be muscular4 ,in the unimpregnated state it is dense1 firm1 and of a grayish color4 ,the neck appears less firm than the body4 ,the internal or mucous membrane is thin1 smooth1 and closely adherent to the subjacent tissue4 ,it is a quarter of an inch thick at the middle of the body of the uterus2 in the neck it does not exceed one-twenty-fourth part of an inch in thickness4 ,it is continuous through the fimbriated extremity of the ,fallopian tubes with the peritoneum1 and through the os uteri with the mucous membrane of the vagina4 ,,the ,,fallopian ,,tubes4 ,the uterine or ,fallopian tubes are two canals1 about four inches long1 placed in the superior border of the broad ligaments of the uterus4 ,they extend for about three inches and a half1 when they expand and terminate with a fringed process called the fimbria1 which is applied to the ovary after impregnation4 ,the ,fallopian tubes serve the double purpose of a canal for transmitting the fecundating principle of the male and for carrying the germ furnished by the female to the uterus--in fact they are excretory ducts of the ovary4 ,injections into the uterus may pass into the peritoneal cavity1 through the ,fallopian tubes1 and cause peritonitis4 ,at each menstrual period an ovula passes along with the serum current in the ,fallopian tubes to the uterus4 ,,the ,,ovaries4 ,the ovaries in the female are said to be the analogues of the testicles in the male2 they both secrete a fluid that is essential to impregnation4 ,they are situated on either side of the uterus1 and are attached to either side of it by the posterior duplicature of the broad ligament called the ligament of the ovary4 7,fig4 #ab74 ,they are oval flattened bodies about an inch and a half long1 three-quarters of an inch wide at their greatest breadth1 and a quarter of a inch thick4 ,they are situated on the sides of the uterus in that portion of the broad ligament called the posterior wing1 just behind the ,fallopian tubes4 ,the ovary consists of a peculiar structure enclosed by two envelopes1 one of which is serous and the other fibrous4 ,within the fibrous coat is a special tissue called the stroma2 imbedded in this are numerous small round transparent vesicles in various stages of development1 varying in size from that of a millet seed to that of a hemp seed4 ,they are the ovisacs1 containing the ova1 and are called the ,graafian vesicles4 ,these have thin transparent walls and contain a clear fluid1 and within that the ovula4 ,fifteen or twenty may readily be distinguished in the adult female without the aid of magnifying glasses4 ,,the ,,vagina4 ,the vagina is a membranous canal1 extending from the vulva to the uterus obliquely through the pelvic cavity1 between the bladder and rectum1 having about the same direction as the axis of the pelvis4 ,it is described as being five or six inches in length and about two inches in diameter1 but it would be more correct to say that it is capable of being distended to these or greater dimensions1 for in its common state the os uteri is seldom found to be more than three inches from the external orifice1 and the vagina is contracted as well as shortened4 ,in great part the walls of the vagina are composed of spongy erectile tissue1 and their vascularity is a cause of considerable hemorrhage consequent on their rupture4 ,three layers combine to form the walls2 one external or cellulo-fibrous1 a middle or muscular one1 and the internal or mucous one4 ,the latter is of a pale red hue1 which becomes violet during menstruation and especially during pregnancy4 ,the mucous coat is disposed in the form of rug or folds anteriorly and posteriorly1 which are better developed in young virgins and aged females2 during advanced pregnancy1 and for a short time after delivery1 they are entirely effaced4 ,illustration3 ,fig4 #ab--,section of the ,uterus1 c4 ,fig4 #ab--,uterus1 ovaries and ,fallopian tubes4 ,section of the uterus1 etc4 a1 ,fundus of the uterus2 b1 cavity of the womb2 c1 cavity of the neck of the uterus2 d1 d1 the cavity of the ,fallopian tubes2 e1 fimbriated extremity2 f1 f1 the ovaries2 g1 the vagina2 h1 h1 the round ligaments2 i1 i1 the ligaments of the ovaries4 ,the upper part of the vagina is connected to the circumference of the os uteri but not in a straight line1 for the former stretches beyond the latter1 and being joined to the cervix1 its mucous membrane is reflected over the os uteri1 which by this mode of union is suspended with protuberant lips in the vagina1 and permitted to change its position in various ways and directions4 ,,the ,,external ,,organs4 ,the situation of the external organs of generation are indicated in the accompanying diagram 7,fig4 #aa47 ,it is not deemed necessary here to describe these1 but in regard to the hymen 7the membrane that in infancy nearly closes the orifice of the vagina71 we may remark that it is not a perfect test of virginity4 ,there are1 however1 examples recorded in works on midwifery where a slight surgical operation was necessary after marriage1 because this membrane was uncommonly strong4 ,,chapter ,,iii4 ,,physiology ,,of ,,the ,,uterus ,,and ,,ovaries4 ,menstruation is a periodical flow of blood having its source in the walls of the uterus4 ,but menstruation is excited by and dependent upon ovulation1 and the effective cooperation of both the uterus and ovaries is necessary to both menstruation and conception4 ,we shall consider these functions separately4 ,,menstruation4 ,in healthy women at the period of puberty1 a certain amount of sanguineous fluid is secreted by the lining membrane of the uterus1 and is excreted through the vagina every month2 this is termed the catamenia1 or menses1 and the function itself menstruation4 ,a female in whom the discharge recurs at the usual periods1 in the usual quantity1 and of the usual quality1 is said to be regular1 ,the occurrence of menstruation defines the period of puberty at which a girl becomes a woman capable of conception1 and its cessation terminates the prolific period of female life4 ,dr4 ,robinson1 of ,manchester1 ,england1 in a paper on the natural history of menstruation1 has stated the age at which it occurred in #dej cases4 ,according to his table1 #aj menstruated for the first time at #aa years of age1 #ai at #ab1 #ec at #ac1 #he at #ad1 #ig at #ae1 #gf at #af1 #eg at #ag1 #bf at #ah1 #bc at #ai1 and #d at #bj4 ,the time at which the first menstruation occurs varies exceedingly from the influence of climate1 habits of life and constitution4 ,there have been occasional instances of very precocious menstruation1 in which the first appearance of the discharge was attended with all the attributes of puberty4 ,i myself knew one case where a girl of nine years1 not only menstruated1 but presented the external signs of puberty1 such as prominent breasts1 wide pelvis1 rounded contour of body1 c4 ,the first appearance of the menses very rarely occurs without being preceded by premonitory symptoms4 ,there is usually a degree of languor and lassitude1 fatigue after exertion1 inequality of spirits1 dark shade under the eyes1 headache1 sometimes pain in the thyroid gland1 pain in the back1 a sensation of tension and swelling in the lower part of the abdomen1 and occasionally considerably fever4 ,not unfrequently strange nervous disturbances occur2 but all of these symptoms may pass off1 the first and second time1 without the appearance of the menses1 or with a white discharge only4 ,usually the phenomena may last from one to eight days1 then there is an abundant flow of mucus1 which after one or two days is mixed with blood1 and soon gives place to almost pure blood4 ,when this discharge takes place most of the unpleasant symptoms disappear1 and the female only complains of weakness and is somewhat pale4 ,the hemorrhage continues for several days1 then the amount of blood mingled with the vaginal mucosities diminishes1 soon there is mucus alone1 then the discharge ceases4 ,i should remark now that the propriety of applying the terms1 blood or hemorrhage1 to the menstrual secretion is properly questioned4 ,sometimes the first menstruation takes place without being preceded by any discomfort1 but pretty generally there is a change in the girl at the time1 both in her body and mind1 a change that fits her for the important duties that devolve upon her4 ,most young girls have a return of the discharge after a month1 the menses afterwards recurring regularly2 some do not become regular until after several months4 ,sometimes the function is imperfectly performed2 such cases are accompanied with considerable distress4 ,in some young girls the precursory symptoms of the first appearance of the menses may not be followed by a flow of blood1 and there is an apparent effort of nature recurring monthly for several months before the courses become established4 ,there are occasional examples of retarded menstruation4 ,i am acquainted with one woman who at the age of twenty-five years has not menstruated4 ,the absence of the menses does not render conception impossible1 in every case4 ,after the menses are established1 until the time of their cessation1 they generally return every month1 unless interrupted by pregnancy or nursing4 ,the average of the catamenial period is about twenty-eight days2 in a large number it is thirty days2 in some instances they recur every fifteen days4 ,the duration of the flow varies from one to eight days2 three or four days is the most usual duration4 ,the quantity of blood lost is variable2 from three to five ounces is said to be the average4 ,when the ovaries are congenitally absent1 or have been removed1 or have become disorganized1 menstruation is absent1 or ceases4 ,the cause of the menses is the successive evolution of the ,graafian vesicles2 but the regular process may go on in the ovary without the regular sanguineous discharge4 ,the menses continue in the majority of cases until about the age of #df years1 or perhaps in this country #dh years4 ,according to ,dr4 ,robertson1 of ,england1 the periods at which it closed in #gg individuals was1 in #a at the age of #ce years1 #d at #dj1 #a at #db1 #a at #dc1 #c at #dd1 #d at #de1 #c at #dg1 #aj at #dh1 #g at #di1 #bf at #ej1 #b at #ea1 #b at #eb1 #b at #ec1 #b at #ed1 #a at #eg1 #b at #fj1 and #a at #gj4 ,the average duration of the menstrual function is about #cj years4 ,the cessation of the ovarian function is generally announced several years in advance by irregularities of the menses4 ,besides the intermissions and irregularities1 there are other symptoms2 a general and indefinite feeling of uneasiness1 pelvic pains1 itching at the genital parts1 flashes of heat in the face1 alterations of chilliness and perspiration1 leucorrha1 etc4 ,these troubles are usually slight1 and disappear promptly4 ,the time of life has been called the ,,critical ,,period1 because there has been an opinion prevalent that peculiar dangers attend it4 ,however1 the mortality is not greater between the ages of #de and #ej years than at any other period of life4 ,yet it is true that in some instances diseases that had been latent previously1 declare themselves at this period4 ,,the ,,function ,,of ,,the ,,ovaries4 ,we will now consider the physiological action of the ovaries and its intimate connection with the action of the uterus in menstruation1 etc4 ,preceding the first menstruation an ovary is considerably enlarged1 becomes of a red color1 and its vascular apparatus is considerably congested2 the ,fallopian tube also becomes congested2 its fimbriated extremity is of a violet red color1 and has a velvety appearance4 ,the ,graafian vesicles increase in size2 fifteen or twenty of them1 more advanced than the others1 project from the surface of the ovary2 one of these grows so that after a few days it forms a tumor of the size of a cherry2 the walls of the vesicle1 being distended by an increased secretion of fluid1 becomes quite thin1 and at last are ruptured4 ,when the thinned walls give way1 the ovule is expelled1 with a part of the granular contents of the vesicle2 these are grasped by the fimbriated extremity of the ,fallopian tube which is prepared to receive it and convey it through its canal into the cavity of the uterus4 ,this evolution of an ovule excites numerous sympathies throughout the organism of the female1 and especially the generative organs4 ,the vascular apparatus of the womb becomes developed in an unusual manner2 a network of fine blood vessels surround the orifices of the numerous glandular tubes1 of which the membrane is almost entirely composed2 this gives a violet hue to the internal surface of the womb2 the utricular glands increase in size1 the muscular structure of the uterus acquires greater extension1 becomes redder and more spongy and supple1 the volume of the organ is increased1 the neck is tumefied and its orifice narrower1 the lips of the os tinc are warmer and their color deeper4 ,the vascular congestion which the uterus undergoes is accompanied with the exudation of sanguineous fluid1 which is at first but a few drops2 this communicates to the increased vaginal mucus a reddish hue4 ,after a day or two there is a bloody flow from the vascular network of the mucous membrane4 ,this flow1 which constitutes the menses1 is diminished after three or four days1 and the discharge again contains a large proportion of mucus and serum4 ,it is probable that the rupture of a ,graafian vesicle occurs during the last days of the flow1 ordinarily1 and it is also believed that venereal excitement is capable of exerting so much influence upon it that it may determine the rupture of an enlarged vesicle1 which1 without sexual intercourse1 would have remained whole several days longer4 ,after the discharge of the ovule consequent on the rupture of the ,graafian vesicle1 the walls of the vesicle contract on the matter that is effused within it1 and form a compact mass1 which after a time has an orange yellow color--this is called the corpus luteum4 ,ordinarily1 in the human female in the normal condition1 a new ,graafian vesicle increases in size every month1 becomes excessively developed1 and finally bursts and discharges its ovule1 to become1 through successive transformations1 the corpus luteum4 ,what is called the 8monthly sickness10 8monthlies10 8courses10 etc41 never occurs without having been preceded and accompanied by the development of a ,graafian vesicle4 ,,chapter ,,iv4 ,,of ,,displacements ,,of ,,the ,,uterus4 ,in order to compress as much as possible what ,i say upon these topics1 ,i shall consider here displacements of the uterus1 both of those which occur in the pregnant and non-pregnant women4 ,by the inflection of the peritoneum the uterus is permitted to expand freely during pregnancy1 and to rise without inconvenience into the cavity of the abdomen2 this it could not do if it was confined to its place by short ligaments1 or by adhesions4 ,but from the same cause1 women become liable to various diseases2 to the retroversion of the uterus1 and other displacements2 to dropsy of the peritoneum1 and to that species of hernia which is occasioned by the descent of the intestines between the vagina and rectum4 ,by ,,prolapsis is meant that condition in which the uterus falls below its natural level in the pelvic cavity4 ,,procidentia is a term used to signify the protrusion of the uterus beyond the vulva4 ,women are liable1 even when young1 to a falling of the womb1 but it occurs most commonly after the age of thirty-five1 in such as lead a laborious life4 ,amongst other causes may be enumerated violent bearing down efforts1 such as are made in straining to pass hardened feces1 or in urging an evacuation through a stricture in the rectum1 in coughing1 lifting heavy weights1 etc4 ,the immediate causes of the displacements are the pressure on the uterus by the viscera above it1 and a diminution in tone of the uterine supports4 ,displacements of the womb are more common among women who have hollow and capacious pelves2 in sufferers from dropsy1 and in delicate1 flabby subjects1 where the broad and round ligaments are affected and elongated4 ,there may be prolapsis during the early months of pregnancy1 and in cases where the pelvis is large and the ligaments are relaxed1 the womb may rest on the perineum2 or the neck1 and even the body may become visible externally2 but it subsequently rises out of the pelvic cavity1 assuming a normal position4 ,when a woman has prolapsis uteri she often complains of a sense of weight about the pelvis1 of dragging pains1 of a wearisome backache1 and of a leucorrhocal discharge4 ,menstruation is seldom interfered with1 and as the uterus goes back of itself1 or is easily pushed up when the patient is in bed1 conception may take place1 and the general health may not be directly affected4 ,in some few instances there is complete inability to pass water until the patient lies down and replaces the uterus with her finger2 in other cases micturition may be annoyingly frequent4 ,constipation is often complained of1 and1 if the woman be careless1 a large accumulation of feces may take place in the rectum4 ,by a vaginal examination the os uteri is found low down1 and if the cervix is of the natural length1 we know that it is prolapsis4 ,if a round tumor is seen projecting beyond the vulva1 and if at the lowest part of it there is what seems to be the mouth of the uterine cavity1 it may be advisable to introduce a sound or catheter1 to make sure that the opening is not a mere cleft in a uterine polypus4 7,of course1 you would not use a sound if you suspected pregnancy47 ,if there are ulcers1 cracks1 etc41 they may be detected1 the ulcers looking as if portions of the mucous lining had been punched out4 ,in pregnancy1 displacements may occur either slowly or suddenly1 though the woman may have had nothing of the kind previously1 or they may be the continuation of a previous prolapse4 ,the progressive development of the uterus generally removes the prolapsis about the fourth or fifth month1 but if the pelvis is very large1 it may possibly continue4 ,as in other cases of prolapsis1 the pregnant woman may suffer very much from it4 ,she may suffer from a feeling of weight at the anus2 painful tractions in the groins1 lumber regions and umbilicus2 a fetid discharge may come on2 there may be complete retention of urine1 very obstinate constipation1 etc42 and the pressure on the uterus may cause abortion4 ,for complete retention of the urine the catheter may be used1 or the womb may be pressed up by one or two fingers introduced into the vagina2 or the woman may be able to urinate if she lies down and elevates her hips considerably4 ,,the ,,operation ,,of ,,introducing ,,the ,,catheter may be performed by the educated nurse4 ,the patient being placed upon her back and the labia separated1 the point of the forefinger of the left hand should be placed just within the orifice of the vagina so as to press slightly the upper edge2 the catheter should then be passed along the inner surface of the finger until it is arrested by the anterior part of the vagina2 when there1 a very slight movement so as to elevate the point of the instrument a little1 enables the operator in the majority of cases to enter the catheter into the canal4 ,the operation is more difficult when the parts are swollen or distended1 as happens occasionally from disease1 during pregnancy or labor1 or after delivery4 ,if we cannot detect the orifice by the touch1 we may use a light1 and the patient may be placed on her side4 ,we may adopt another way to proceed4 ,the point of the forefinger finds the clitoris1 and passes from above downwards to the middle of the vestibule2 the first inequality met with is the orifice of the urethra1 into which the instrument can then be passed4 ,it will easily slide in if the instrument is not passed either to the right or the left of the median line4 ,when a woman who has previously suffered from prolapsis becomes pregnant1 it is sometimes necessary for her to keep the horizontal position during the first three or four months of pregnancy1 and after her confinement she should keep her bed a considerable time--perhaps for two months4 ,for the treatment of prolapsis in non-pregnant women1 the general principles are to be applied3 ,to afford artificial support to the superincumbent abdominal viscera2 give tone to the broad and round ligaments of the uterus1 to the vaginal walls and the perineum2 and to remove any complications that induce the falling1 such as uterine congestion1 hypertrophy1 cough1 constipation1 etc4 ,the uterus may usually be easily pushed back to its place when the patient is lying down1 or1 what is better1 her head much lower than her pelvis4 7,fig4 #ac74 ,the knee-chest position is the best one4 ,without going into the details of treatment in the use of bandages1 tents1 etc41 ,i may say that a nurse may1 in the absence of a physician1 use astringent vaginal injections1 astringent pessaries 7,f4 #aed1 #afc71 and cold soft water2 hip baths may also be used4 ,the nurse should know how to tamponade the vagina1 because1 when this is deemed advisable by the physician1 he desires that the process be repeated every day1 and in many instances it is not convenient or possible for him to make daily visits4 ,the vaginal tampon is used as a means of retaining the uterus in its normal position1 and also to hold medicinal agents applied to the cervix and vagina2 besides1 in some cases1 direct pressure on the pelvic vessels stimulates and thus benefits them when in a state of chronic1 passive dilatation1 or venous hyperemia4 ,tampons are also used in cases of hemorrhage from the uterus1 and as an absorbent of vaginal or uterine discharges1 and for various other purposes4 ,the nurse may receive instruction from the physician in each case in regard to the material1 etc41 to be used as tampon4 ,when it is desired to simply support the uterus in its place1 fine cotton batting may be used1 and this perhaps is1 in ordinary cases1 as good as any material4 ,but in some cases absorbent cotton1 oakum1 marine lint1 or wool may be preferred4 ,the size of the tampon will1 of course1 vary2 ordinarily one as large as a hen's egg may be introduced without difficulty2 sometimes one nearly as large as a goose egg may be necessary1 because a small one would not be retained4 ,cotton may be rolled tightly into the form of a cylinder1 or a small bag may be made of muslin or linen1 and cotton or other substance can be enclosed in this and applied4 ,the knee-pectoral position 7,fig4 #ac7 is the one in which a prolapsed uterus can best be replaced1 and the nurse can best tamponade the vagina while the patient is in that position4 ,the proper knee-pectoral or knee-chest position is shown in ,fig4 #ac4 ,the physician would1 with or without the aid of the nurse1 use a ,sims' speculum1 and first pack four small pledgets of cotton around the neck of the uterus4 ,one string can be tied in the kite-tail manner around each of these pledgets1 and there should be an end about ten inches long to be left out from the vagina1 so that the whole may be easily removed4 ,the nurse1 if alone1 however1 will usually press in but one tampon1 and she may do this while the patient is in the knee-chest position1 or1 what is nearly as well1 on her side or back1 having first1 by a digital examination1 ascertained that the uterus is in its proper position4 ,illustration3 ,fig4 #ac4 ,genu-pectoral position4 ,fig4 #ac--,knee-chest or genu-pectoral position4 a1 ,retroversion of the uterus4 b1 ,natural position of the uterus4 ,either the nurse or the patient herself may easily press a tampon into its proper position1 if she possesses an ordinary amount of boldness and dexterity4 ,she will find it more difficult to properly place it1 however1 if there is tannin or other astringent substance on the outside of it4 ,this has an astringent effect immediately when it comes in contact with the vagina1 and an unusual amount of vaseline is necessary to cover it4 ,if a solution of tannin1 alum1 acetate of lead1 sulphate of zinc1 or carbolic acid be used1 it is best to prepare several tampons at the same time2 soak all the tampons in the solution1 squeeze them out and dry them1 then when one is used put it inside a bag and apply it dry4 ,the patient herself1 if she is intelligent1 and is not too timid1 can introduce the tampon4 ,she should first smear its surface with vaseline1 lard1 or olive oil4 ,then lying on her back with thighs separated and flexed1 draw the labia apart with the fingers of one hand and steadily crowd the tampon into the vagina with the other1 always taking care to have a good1 strong cord1 one end attached to the tampon and the other hanging down to facilitate removal4 ,it is well also1 sometimes1 to place another pledget of cotton between the labia1 that can be removed when the woman urinates4 ,when all is well crowded into place1 the tampon should be retained by a broad ,t bandage1 covered by oiled silk when it rests against the vulva4 ,generally the whole should be removed within from eighteen to twenty-four hours1 and hot water or some cleansing injection used1 and the tampon be soon reapplied4 ,if opium or morphine is used with the tampon1 as it is sometimes when there is considerable pain1 first dip the cotton in glycerine1 and then sprinkle the narcotic on the outside4 ,if borax1 tannin1 alum1 acetate of lead1 sulphate of zinc1 chlorate of potash1 or carbolic acid is used1 ,i think it well to envelop the undissolved drug in cotton1 put it in the middle of the tampon1 and let it dissolve slowly in the vagina4 ,it is best when thus applied to let the whole suppository remain as much as forty-eight hours2 it should1 however1 be removed when it seems to cause smarting or excoriations4 ,the accompanying cut 7,fig4 #ac7 is inserted to show what is the knee-chest or genu-pectoral position1 as well as to exhibit the retroversion of the uterus4 ,note that in this position the hips are elevated1 and remember that it does not suffice to get on the hands and knees if the haunches are low down on the legs and ankles4 ,,retroflexion ,,and ,,antiflexion4 ,illustration3 ,fig4 #ad4 ,retroflexion of the uterus4 ,the condition known as retroflexion consists of a bending back of the uterus at a point where the neck joins the body1 so that the fundus is found between the cervix and rectum1 the os uteri being in the natural position4 ,in antiflexion we find the fundus pressing upon the bladder4 ,these displacements are rare in virgins4 ,the false membrane formed in peritonitis is now and then the cause of these deviations1 when there is superadded such causes as are mentioned for prolapsis4 ,the symptoms of ,,retroflexion are usually a dull1 weary and constant backache1 which is more marked about the sacral region1 pains that shoot down the thighs or the groins1 and a frequent desire to go to stool1 although nothing comes away4 ,the passage of a motion that is not at all constipated aggravates the pain and aching2 sexual intercourse is attended with suffering1 and is not followed by pregnancy2 and just before and after the monthly periods there is so much tenderness that sexual connection cannot be tolerated4 ,illustration3 ,fig4 #ae4 ,antiflexion of the uterus4 ,the catamenia come on with pain and difficulty1 but about the second day the flow of blood seems to give some relief4 ,the general health is bad1 there are frequent attacks of nausea1 the appetite is small1 the spirits are depressed1 and there are many what are called hysterical symptoms4 ,on examination the congested fundus may be found encroaching upon the rectum2 on touching this part the patient will exclaim that it is the seat of her sufferings1 and it is not uncommon to find tenderness of one or both ovaries4 ,not many of these symptoms are present in ,,antiflexion1 but this commonly produces great irritability of the bladder1 so that when the patient is in the erect position1 the desire to micturate is almost as great as in disease of the bladder4 ,illustration3 ,fig4 #af4 ,anteversion of the uterus4 ,the treatment includes replacing the uterus with the sound4 ,should there be adhesions1 however1 this might cause intolerable pain4 ,in such cases relief is given by the use of belladonna plasters and belladonna1 opium1 hyoscyamus1 or conium tampons4 ,one-half to one dram of the tincture of one of the narcotics may be added to the glycerine in which the tampon is soaked1 or the cervical end of the tampon may be dipped in the tincture4 ,suppositories and ointments may also be used4 7,f4 #afc1 #bad74 ,,retroversion ,,and ,,anteversion4 ,in ,,retroversion 7,fig4 #ac7 the fundus is turned toward the hollow of the sacrum1 while the os is drawn under the arch of the pubis4 ,,anteversion is characterized by the fundus being towards or against the bladder1 the os being directed to the cavity of the sacrum4 7,fig4 #af47 ,retroversion is liable to occur at the third month of pregnancy1 from the neglected distention of the bladder1 and from a morbid weight and enlargement1 though after the fourth month the uterus is too much enlarged to fall down in any way4 ,the chief symptoms are backache and bearing down pains4 ,it may happen that micturation will be impeded2 and if the bladder may be felt at the lower part of the abdomen1 or if the patient complain of a constant desire to pass water1 or especially if the urine should dribble away1 the catheter ought to be passed without loss of time1 and the bladder should be kept evacuated4 ,it may be necessary1 in order to restore the organ to its proper position1 to introduce the first and second fingers of one hand into the vagina1 and a finger of the other into the rectum4 ,,chapter ,v4 ,,mismenstruation4 ,,amenorrh,a4 ,the first variety of cases of amenorrha are those where no menstrual fluid has ever been secreted4 ,all girls1 as we have seen1 do not menstruate at fifteen years1 as all children do not cut their first teeth at seven months1 and in either case there may be no disease4 ,but when a female has reached adult life1 when her frame has assumed the character of womanhood1 when she is not chlorotic1 and when all her organs 7save the sexual7 perform their functions naturally1 then a cause of the absence of the flux should be looked for4 ,menstruation may be absent from congenital malformation4 ,the ovaries may be wanting1 or if present may be atrophied or diseased2 perhaps they present scarcely a trace of a ,graafian vesicle2 or these glands can exist and the uterus be absent or imperfect2 or there may not be found a trace of a vagina4 ,in the second variety of amenorrha there has been a secretion of the menses but no evacuation of them4 ,this may be because there is an occlusion of the vagina1 or the os uteri may be imperforate4 ,when the os is closed by a membrane1 the structure may be incised with the bistoury1 or perhaps be ruptured by the uterine sound4 ,the third variety is the most common form of amenorrha1 viz3 that in which the flux having been properly established and appearing regularly for a time1 has been prematurely arrested4 ,but it may be said of amenorrha in its various forms1 that it is not so much a disease as a symptom of disease2 a consequence of either individual organization1 disorder of the uterus or ovaries1 or of some other organ or organs sufficiently important to affect the constitution4 ,hence all the means that restore the system to health1 medicinal and hygienic1 may be recommended as tending to cure the complaint1 and hence we have to inquire whether there is serious disease in any of the organs when the question of pregnancy arises1 on account of the disappearance of the menses4 ,it is always necessary in treating amenorrha to consider the cause of it1 and we should know that it may come from torpitude of the secernent vessels of the uterus1 produced by anxiety of mind1 cold1 or suddenly suppressed perspiration2 falls1 especially when accompanied with terror2 or a general inertness and flaccidity of the system1 and more particularly of the ovaries4 7,f4 #agb1 #agc74 ,,dysmenorrh,a4 ,there are few women who pass through the whole period of sexual vigor without having more or less frequently to endure an attack of dysmenorrha4 ,some few females experience great pain with each flow1 from puberty to the change of life1 while in others pain is only an exceptional accompaniment4 ,with some women marriage effects a cure1 while in others it either aggravates or originates dysmenorrha4 ,three distinct varieties of dysmenorrha have to be considered3 the neuralgic1 the congestive1 and the mechanical4 ,the variety which is called ,,neuralgic ,,dysmenorrh,a is more frequent in unmarried females2 and if married1 in those that have not borne children2 and most frequently affects those of a nervous temperament1 and of a thin1 delicate habit4 ,the paroxysms present all the characteristics of neuralgia4 ,for a time before the catamenia appear there is a sense of general uneasiness1 a deep-seated feeling of cold and headache1 sometimes alternating with pain in the back and lower part of the abdomen1 perhaps extending down the thighs4 ,the flux comes on sometimes slowly and scantily1 or in some cases in slight gushes4 ,the discharge may be paler than natural1 and may be mixed with slight clots4 ,in some cases there is a membrane of plastic lymph discharged either in shreds1 or in the form of the uterine cavity that it has lined4 ,conception is rare under such circumstances4 ,though the disease seems to be of a simple neuralgic character1 it is supposed that there is a degree of inflammation of a peculiar kind in the mucous membrane where the plastic lymph is thrown off4 ,in regard to the duration of the period1 the constitutional injury sustained1 and as to the relief on the appearance of the menses1 the cases vary4 ,a peculiar irritability of the uterus is a common cause of this form of the disease1 but1 like amenorrha1 it may be caused by cold1 mental emotion1 or local injury from a fall4 ,in the treatment of this class of cases1 to reduce the pain1 opium1 conium1 hyoscyamus1 etc41 are given1 often combined with camphor4 7,f4 #afa1 #afc1 #aff1 #afg47 ,these should be given in the form of an enema1 or a suppository1 if the stomach is irritable4 7,f4 #afj47 ,the hot hip bath should be employed1 the patient remaining in it from thirty-five to forty minutes2 an ounce of carbonate of soda may be added to the water4 ,the good effects of the bath may be kept up by the use1 immediately afterwards1 of a pessary of oxide of zinc and belladonna4 7,f4 #afc47 ,it will be of benefit to take vaginal injections of tepid1 or warm1 or hot water on the approach of the menses1 and the patient should use a pediluvium1 or a hip bath1 for two or three nights in succession antecedent to the show of the menses4 ,during the interval every effort should be made to strengthen the patient1 and to diminish the irritability4 ,injections of tepid or cold water may be taken daily2 the diet should be nourishing1 and plenty of exercise in the open air should be taken by the patient4 ,some preparation of iron should be given1 and ,i have found ,f4 #agg particularly useful4 ,,congestive ,,dysmenorrh,a1 sometimes described as inflammatory dysmenorrha1 generally comes on at a later time of life than the neuralgic form4 ,it occurs in females of a full habit and of a sanguine temperament2 in the married as well as the unmarried1 and those that have not borne children4 ,restlessness and feverishness1 rigors1 flushing and headache generally precede the severer symptoms4 ,the sufferings commence1 or are generally aggravated four or five days before the period1 and it may continue for a week or more4 ,both before and after the catamenia appear1 there is great pain across the back1 aching of the limbs1 intolerance of light and sound1 weariness1 the face is flushed1 the skin hot1 the pulse full and bounding2 when the flow gets abundant the pain is mitigated1 though there are paroxysms of pain1 as small clots and shreds of membrane are thrown off from the uterine cavity4 ,under the influence of inflammation1 the epithelial coat of the uterine cavity and of the vagina is sometimes expelled4 ,in the interim between the periods the cervix uteri is congested and tender1 and pain will be excited by pressing the ovaries2 usually there is a tenacious leucorrhal discharge4 ,frequently the breasts swell and become tender as the period approaches4 ,in treating this form of dysmenorrha1 opiates must be used1 as in the former variety1 to afford some alleviation4 ,give also saline purgatives1 febrifuge medicines1 such as aconite1 veratrium1 and gelsemium2 also cooling drinks4 ,during the interval the patient should live plainly1 avoid stimulants1 and take moderate outdoor exercise4 ,the suppositories 7,f4 #afc7 may be used steadily4 ,if the disease be associated with a rheumatic diathesis1 the appropriate remedy for that should be used4 ,it is in such cases especially that chalybeate mineral water1 warm sea water1 baths1 colchicum1 iodide of potassium1 with friction and electricity applied directly to the hypogastric region1 succeed in restoring health4 7,f4 #ajc1 #afe74 ,,mechanical ,,dysmenorrh,a is that form in which there is some mechanical obstruction to the escape of the menstrual discharge4 ,the causes of the obstruction are various4 ,there may be either a stricture of the internal orifice of the uterus1 or a narrowing of the whole canal of the cervix1 or the external os uteri may be small and contracted1 or some tumor may interfere with the patency of the cervical canal1 and there may be retroflexion or antiflexion of the uterus4 ,in these cases there is more or less violent expulsive pain coming on in paroxysms1 and there is usually a scanty flow4 ,often the discharge escapes in gushes1 each gush being preceded by a bearing down effort1 and accompanied by an expulsive pain4 ,there are attacks of nausea1 restlessness and retching1 with flatulence2 there is always severe headache and congestion1 with tenderness of the ovaries2 and if there is endometritis1 there are some other inflammatory symptoms4 ,modern gynecology has various remedies for this class of cases1 of which it is not necessary to speak here4 ,,menorrhagia4 ,the term menorrhagia should be applied only to cases of menstrual flow1 although it is often employed to signify any considerable sanguineous discharge from the uterus1 other than normal monthly escape4 ,but ,i will say something here of cases where there is a more abundant or a more prolonged flow than is natural to the subject of it1 and of cases where there is a recurrence of the discharge at short intervals1 so as to seem almost continuous4 ,in that variety in which the discharge is normal in quality but the quantity is increased1 there is undue uterine congestion1 set up by constitutional causes1 or it is induced by slight disease of the uterus or ovaries4 ,when menorrhagia takes place in plethoric habits1 it is manifestly remedial1 and ought not to be restrained hastily4 ,we may endeavor to reduce the plethora1 and a cooling diet1 the recumbent position1 and saline cathartics may be enjoined4 7,f4 #fa74 ,if the flow continues five days or more1 and especially if depressing effects are manifested1 such as general weakness1 languor1 mental depression1 with pain in the head1 loins or back1 the patient is undoubtedly suffering from the loss of blood1 and it is best to restrain the flux by general and local means 7,f4 #agf47 ,at the time when the flow is profuse or long continued1 give strong cinnamon tea1 a teacupful at a time1 or teaspoonful doses of tincture cinnamon every hour4 ,astringent pessaries should sometimes be used4 ,formerly injections of cold water were given2 recently injections of hot water1 as hot as can be borne in the vagina1 are considered more effectual4 ,fluid extract of ergot1 in half-teaspoonful doses1 may be given every hour for two or three successive hours4 ,other remedies are elixir vitriol and turpentine1 opium and acetate of lead during the attack2 and counter irritation to the sacrum1 the douche to the loins1 sponging1 cold vaginal injections1 and the sitz bath during the interval4 7,f4 #age74 ,if astringent or cold injections are used1 the patient should lie upon her back in bed1 and the fluid should be thrown up gradually4 ,of course1 there are cases where only an experienced1 well-educated physician can do all that is required in removing the cause of the difficulty4 ,,chapter ,,vi4 ,,generation4 ,generation is effected in the human species through the medium of the two sexes2 to effect it there must be the actual contact of the male semen1 or its spermatozoa1 with a healthy ,graafian vesicle4 ,in ,,conception the ,,spermatic ,,fluid is furnished by the male4 ,when this is examined under the microscope it exhibits a great number of little bodies1 which are moving2 these are termed spermatic animalcules1 or spermatozoa4 ,these are met with in all animals capable of reproduction1 and they do not appear in the human species before puberty4 ,the ovule furnished by the female is existent in the ovary at the marriageable period4 ,fecundation takes place in the ovary2 probably1 sometimes1 also in the tube or uterus when the ovule is passing out after menstruation4 ,ordinarily the fluid ejaculated by the male must reach the uterus1 and in some way be conveyed to the ovaries through the ,fallopian tubes to produce fecundation4 ,it is believed that1 as the consequence of copulation1 the semen is thrown on the neck of the uterus2 that it is carried forward1 first1 by the movements proper to the uterus and tubes2 second1 by the movements proper to the spermatozoa till it reaches the ovum1 generally in the ovary2 that it enters the ovum1 and that then fecundation takes place4 ,upon being impregnated and the vesicle bursting1 the ovum is grasped by the free extremity of the ,fallopian tubes1 which is in contact with the ovary1 the ovum passes from the ovary to the canal1 is pressed onwards by the peristaltic motions of the tube through the duct1 and finally reaches the uterine cavity2 there it continues to grow during the ordinary term of gestation4 ,after two hundred and seventy days the ovule has developed into a child1 and is expelled through the natural parts of generation4 ,when gestation proceeds in this manner1 it is said to be normal1 or good1 or uterine2 sometimes 7though very seldom7 the ovule is arrested at some point in its passage1 and is developed outside of the womb2 this is termed an extra uterine pregnancy4 ,the time at which conception is most likely to occur is that immediately following the flow of the menses2 it may take place immediately before the flow1 and sexual intercourse may be fruitful even when it takes place in the middle of the interval between the sexual periods1 though the latter is unusual4 ,when conception takes place a few days or a few hours before the period1 it is not followed by the menstrual flow4 ,,utero-,,gestation4 ,at each menstrual period the bulk or size of the uterus is for the time increased1 and if conception takes place about that time1 the excitement maintains and soon increases the enlargement4 ,the mucous membrane becomes almost doubled in thickness1 and when the ovule arrives in the womb1 it finds it filled with the membrane1 the whole uterus is congested1 its vessels enlarge1 and are filled with blood1 many which were invisible before are now filled with red blood1 and the whole form an intricate network on the surface1 and in the substance of the organ2 the coats of the arteries increase in thickness2 the coats of veins are thinner1 and admit of still greater distention2 the nerves increase in size1 and may be seen accompanying the blood-vessels1 and there are changes not only in the volume1 but in the shape1 situation1 direction1 and relations of the uterus4 ,the organ increases slowly in size during the early4 months of pregnancy1 and more rapidly in the later4 ,the walls are distended1 however1 not mechanically from the development of the ovum1 but simultaneously with it1 and from a physiological cause2 in shape it becomes rounder1 and towards the end of pregnancy it has an ovoid form4 ,simultaneously there is an alteration in its position2 at first the neck subsides towards the floor of the pelvis2 the presence of the rectum may incline the fundus to the right and the neck to the left2 about the fourth month the uterus rises above the superior strait2 at four months the fundus uteri is two or three fingers in breadth above the pubis2 at five months it is within one finger's breadth of the umbilicus2 between the fifth and sixth month it passes the umbilicus2 at seven months it is three fingers' breadth above the naval2 at eight months it is four or five above1 but it does not rise higher during the last month4 ,while it is rising it follows the direction of the axis of the superior strait2 afterwards it inclines to the right oftener than to the left4 ,at term1 the superior part of the uterus is in contact with the abdominal walls usually1 but sometimes there may be some of the intestines interposed between them4 ,at full term the parietes of the womb are thicker than in the unimpregnated condition2 at the point corresponding to the insertion of the placenta1 thinner at the neck1 and otherwise it retains about its original thickness4 ,the uterus increases about forty times in weight during pregnancy2 at term it weighs about twenty-four ounces1 and its length is from twelve to fourteen inches1 its breadth from nine to ten1 and its depth1 antero-posteriorly1 eight to nine inches4 ,the os uteri1 after it is in the gravid state1 becomes somewhat swollen1 but soft and cushion-like4 ,this softening is at first superficial4 ,towards the end of the third month1 the lips of the os tinc are softened throughout their whole thickness1 and the softening increases from below upward4 ,the neck of the uterus seems somewhat elongated at the first1 but at the commencement of the sixth month the length of the cervix seems to diminish2 there is1 however1 no considerable shortening until the middle of the eighth month2 during the last fortnight of pregnancy it diminishes very rapidly1 and finally is totally effaced4 ,in primapara the os tinc is rounded at first1 and is not dilated4 ,in females that have had children the external orifice is widely open1 and the cavity in the neck is funnel-shaped1 continuing to increase until it reaches the internal orifice4 ,as gestation progresses the texture of the uterus changes4 ,the peritoneum spreads out in all directions without a decrease in thickness2 the mucous coat becomes apparent1 it grows redder and more vascular1 and its folds disappear2 the glands of the body of the womb grow longer2 the middle coat is enlarged by the increase in size of always existing muscular elements1 and the formation of new fibres and increased connective tissue4 ,there is1 towards the end of pregnancy1 an astonishing development of the vascular system2 the lymphatic vessels acquire considerable calibre1 and the nerves are developed in every way1 although the neurilemma is most affected4 ,the changes developed in the uterine mucous membrane are of especial interest4 ,its vascularity is greatly increased during menstruation1 the glands are enlarged1 the membrane thickened1 thrown into folds and becomes of a violet color2 this condition continuing until the ovule is discharged1 or until the last of the menstrual period4 ,the fecundation of the ovum will maintain and increase this vascular condition of the membrane4 ,its vessels are so enlarged as to cause small effusions beneath the epithelium1 which gives to the internal surface a spotted appearance2 after two or three weeks it is still more mottled1 more puffed up1 and furrowed with folds and wrinkles4 ,this membrane is the decidua1 which is afterwards expelled1 with other contents of the uterine cavity4 ,the ,,decidua ,,reflexa is a fold of the decidua in which the ftus is enveloped1 and both of these membranes1 which are at the last expelled with the ftus1 are developed from the uterine mucous membrane4 ,the uterine decidua1 after the second month1 grows thinner1 and its folds are gradually effaced2 after the fifth month it is only one twenty-fifth of an inch in thickness1 and it is still thinner at the termination of pregnancy4 ,at the fifth month it is separable from the uterus1 and the first trace of the new membrane which is to replace the decidua may be detected under it4 ,a partly uterine membrane may be thrown off when an abortion occurs1 during the early months of pregnancy4 ,,chapter ,,vii4 ,,the ,,ovum ,,and ,,its ,,development4 ,the ovum at maturity 7and not impregnated7 is described as being composed of the vitelline membrane1 which seems like albumen in appearance1 but is a thick1 transparent membrane1 without determinate texture2 second of the vitellus or yolk1 a granular liquid contained in the vitelline membrane1 composed of a coherent transparent viscid mass2 third of the germinal vesicle1 which is composed of a transparent colorless membrane1 enclosing a liquid also transparent2 and lastly1 of the germinal spot1 that is held in suspension in the liquid that the germinal vesicle contains4 ,the ovum passes slowly through the ,fallopian tubes1 and during the twelve days or more that it is passing to the uterus1 there is some development1 some increase in size1 and by the time it has reached the uterus it has become impossible to find in it either vesicle or germinal spot4 ,it is probable that in its passage it is nourished by the granulations which accompany it1 and by absorbing the liquid secreted by the oviduct4 ,as the impregnated ovum is developed1 the chorion1 the amnion and the embryo may be observed4 ,the chorion1 which corresponds to the membrane lining in the shell of an egg1 is found covering the ovum at the earliest period that it has been seen in the uterus4 ,it is smooth internally1 but externally it is covered with short round villi1 which at a later period remain only where the placenta is developed4 ,the chorion is enveloped in a great measure by the reflected decidua2 there is at the outset considerable space between the two1 mostly filled at first by the villi of the chorion1 though there may be between the two an effusion of blood2 these villi soon disappear1 and the membranes come in contact4 ,in that part of the chorion that is not covered by the decidua reflexa1 the villi are more and more developed1 and they contribute a most important part in the formation of the placenta4 ,at the same time that the placenta is formed1 the villi on the other portion of the chorion is obliterated1 so that the principal part of the chorion is a thin1 colorless1 transparent membrane1 united outwardly to the reflexed decidua by short1 delicate filaments1 and inwardly to the amnion by an albuminous layer called the tunica media4 ,there is also between the two membranes the vesicula alba4 ,this bears a perfect analogy to the yolk of an egg2 it is the vitellus surrounded by the blastoderm4 ,its use is to contain nutriment for the ftus before the development of the placenta4 ,the amnion is the most internal membrane of the ovum2 it is continuous with the margins of the ventral opening in the ftus1 and closely envelopes the embryo in the early period4 ,its internal surface exhales a liquid into its own internal cavity1 and in this the embryo swims freely4 ,as this membrane is more and more filled1 it presses back the exterior liquid and thereby condenses it until the amnion comes in contact with the chorion4 ,and since it adheres to the abdominal parietes of the ftus1 it furnishes as it extends a membranous sheath to the allantoid and umbilical vesicle1 and these vessels1 and all parts thus enclosed constitute the umbilical cord4 ,the placenta is an appendage of the chorion2 it is a soft1 spongy mass1 constituting the principal connection between the ovum and the uterus1 being destined to the hematosis and 7as we suppose7 to the nourishment of the ftus4 ,the placenta1 at the termination of utero gestation1 is a flattened body about an inch in thickness at the center2 its shape is circular or oval1 and it is from six to eight and one-half inches in diameter2 its internal surface is covered by the chorion and amnion1 and exhibits plainly the umbilical arteries and veins which converge to form the umbilical cord4 ,its ftal portion is formed by the hypertrophied villi of the chorion1 with which its circumference is continuous1 and its maternal portion is continuous with the decidua1 and is in fact a thickened part of that membrane4 ,as the villi of the chorion are developed on one part of its surface1 they ramify and form filaments that engraft themselves upon the uterine mucous membrane and adhere closely4 ,at the same time there is an inverse development of the uterine vessels1 which form vast numbers of loops that descend between the villi of the chorion1 and extend through to the ftal surface of the placenta4 ,an amorphous matter is soon thrown out which unites the two parts together4 ,the placenta is1 therefore1 composed of two parts1 distinct in their physiological action1 though they together present but one mass to our view4 ,one part is the ftal portion formed from the chorion2 the other is the maternal portion formed from the uterine mucous membrane1 of which it is a greatly thickened part4 ,after delivery the ftal placenta comes entirely away with the epithelial layer of the placental decidua1 and the placental distribution of the maternal vessels2 a portion of the maternal vessels remains attached to the uterus4 ,the placenta may be inserted upon any part of the uterine cavity1 although it is most usually near the fundus where the ovum must enter the womb4 ,if1 as is sometimes the case1 it is attached at the lower part1 over the orifice of the womb1 it causes unavoidable hemorrhage in the later months of pregnancy4 ,the umbilical cord1 funis1 or naval string1 is the connecting link between the child and mother4 ,it commences when the external lamina of the blastoderm with the alantois are so changed as to form a mere cord upon which the two umbilical arteries ramify1 and when all these have an enveloping sheath from the amnios4 ,it may be discerned in this state at the end of the first month2 at that time the ftal intestines may be seen to protrude beyond the umbilicus into the amnionic sheath1 but the cord is then cylindrical and very small4 ,there are progressive changes1 the cord becomes simplified1 the canal of the amnionic sheath is obliterated gradually at its extremity1 and as the effacement proceeds towards the umbilicus the intestine is pressed back so that no hernia remains4 ,there are two arteries in the cord2 these arise from the abdominal aorta in the ftus2 they go by a flexed and tortuous course to the placenta1 where they ramify and are distributed4 ,there is only one vein which returns the blood from the placenta2 there the radicles coalesce to form the branches2 these unite to form the umbilical vein4 ,this is not as flexuous as the arteries1 which1 being longer1 wind around the one venous trunk4 ,after the third month these may be plainly seen in the sheath imbedded in what has been called ,wharton's gellatine4 ,ordinarily the cord lies free and loose in the cavity of the amnion1 but occasionally owing to the movements of the child it may be coiled around the child's neck1 be tied in knots1 or it may escape below the head so as to prolapse during labor4 ,the length of the cord varies2 it is very rarely less than eight inches1 and it is sometimes six or eight feet long4 ,after the birth of the child1 the pulsation in the cord ceases within about fifteen minutes4 ,after the cord is cut that portion that is attached to the umbilicus dies and usually falls off about the fifth day4 ,the blood of the ftus is rated or undergoes a change in the placenta analagous to the change that our blood undergoes in the lungs4 ,,chapter ,,viii4 ,,the ,f,,tus4 ,the embryo first begins to be distinct about the third week2 is then about two lines long1 weighing one to two grains2 is surrounded by an amnion which lies loosely about it1 and obviously proceeds from the abdominal lamin2 it presents cerebral vesicles2 there is the appearance of an eye1 several arteries are seen though not distinctly formed2 the abdominal cavity is open for a considerable extent in front4 ,about the fifth week the embryo becomes more consistent2 the head is disproportionately large2 rudimentary eyes are indicated by two black spots2 the abdomen is nearly closed1 though at the umbilical aperture a loop of intestine escapes2 the abdominal members are present1 and the cord exists in a rudimentary condition2 the embryo is nearly two-thirds of an inch long and weighs about fifteen grains4 ,the successive changes in the development were1 #ast1 a germ membrane visible immediately after the bursting of the vesicle2 #b;d1 at some point an aggregation of granules forming the cumulus of the blastoderma2 #c;d1 the embryo developed lying at this point1 as it were upon the membranes1 which consist of three superimposed lamin or layers2 #dth1 on the serous layer arise the organs of animal life1 the brain and spinal marrow1 organs of sense1 skin1 muscles1 tendons1 ligaments1 cartilage1 and bone2 on the mucous the organs of vegetative life1 the intestinal canal1 lungs1 liver1 spleen1 pancreas and other glands4 ,the heart and vascular system arise from the vascular layer 7if this can be considered a separate one74 ,about the second week1 or perhaps the third1 there is a mass of globules loosely connected together forming the primitive streak of ,von ,baer1 and around this the area vasculosa is developed4 ,the globules of the primitive streak1 seem next to be developed into two lamin dorsales1 which is the axis of the future embryo1 and the origin of the spinal column4 ,that portion of the fluid that separates the chorda dorsalis from the lamina dorsalis is the future spinal cord1 and brain4 ,two other lamina--lamin ventrales of ,von ,baer--are in the mean time proceeding from the axis of the embryo1 one on each side2 they grow laterally and converge below the axis4 ,after the rudiments of organic life have been commenced in the central portion of the serous layer1 a fold of its peripheral portion arches over the dorsal surface of the embryo so as to represent a sac1 and is composed of two membranes2 the one next to the ftus is the amnion1 the other is gradually separated from the amnion and joins the serous lamina of the blastoderma2 this is the false amnion of ,pander4 ,the heart is formed at this early period1 and although there is no septum between the ventricles1 a vein may be seen entering into it1 and an artery passes out which divides into four branches to be distributed and ramified in different portions of the ftus4 ,the abdomen is yet an open cleft1 in which 7but projecting beyond it7 is the heart1 which is of very large dimensions2 behind the heart is the liver1 and under the liver the intestine which is attached by means of a distinct mesentery4 ,at this period 7three weeks7 the lungs are constituted of five or six lobules1 and two large glandular structures may also be discerned along the vertebral column1 which are called ,wolfian bodies2 these anticipate the function of the kidneys4 ,the alantois is seen arising from the lower part of the intestinal canal on a little vesicle and extending so as to encircle the embryo4 ,during the second month the extremities are growing1 and become more projecting2 the body is curved and the head bent downwards2 there are indications of the nostrils and a gaping oral aperture2 the forehead is more swelled because of the development of the hemispheres of the brain2 the spinal cord is cylindrical of nearly uniform thickness and terminating in a blunt extremity--posteriorly it is open2 the medulla oblongata makes a bend forwards at the top of the neck1 and then ascends perpendicularly into the capacious cranium4 ,the first centres of ossification appear about the seventh week on the clavicle and lower jaw4 ,at this time the kidneys and renal capsules begin to appear4 ,the only trace of muscular fibre is in the diaphragm4 ,the vertebral arches are not yet closed in1 and the ribs appear like little streaks2 the liver is very large and granular4 ,the stomach is assuming somewhat of its normal form2 the urinary bladder is enclosed1 but the anus is imperforate4 ,at this time the embryo is about an inch in length4 ,at two months the rudimentary organs of generation may be distinguished1 but their development does not clearly show the sex4 ,the embryo is from one and a half to two inches long and weighs near half an ounce1 the head forming two-thirds of the whole4 ,after this period the different parts are developed with tolerable rapidity4 ,at ten weeks the embryo is about two and a half inches in length4 ,at the end of the third month it is from five to six inches long and weighs from three to four ounces4 ,the thorax is closed at all points but is only slightly developed2 the cord contains no intestines1 and its spiral turns are evident2 the nails are beginning to appear2 the sex is distinct1 and the skin acquires some consistence4 ,at the fourth month the ftus is six to eight inches in length1 and weighs from seven to eight ounces4 ,a ftus born at this period might live for an hour or two4 ,at five months the length of the body1 including head and feet1 is from eight to ten inches1 and weighs from eight to eleven ounces2 at six months the weight is about one pound1 and the length is eleven to twelve and a half inches4 ,at seven months the ftus is from twelve and a half to fourteen inches long and weighs from three to five pounds4 ,the hands and feet1 including the nails1 are developed2 all its parts are tolerably firm1 and their respective dimensions better proportioned than formerly4 ,the scrotum usually contains one or both testicles1 they having descended through the inguinal ring1 from their original place near the vertebral column2 the eyelids are partly open2 the skin is very red and covered with down4 ,many children live and are reared that are born at seven months4 ,the length of a ftus born at term is eighteen or nineteen inches1 though the utmost limit is more than two feet4 ,the usual weight is from six to seven pounds2 children have been born1 however1 that were as much as eighteen pounds in weight4 ,i suspect that this will never occur unless the term has been extended beyond the usual period4 ,,at ,,term the ftus that is twenty inches long will generally measure ten and a half to eleven inches from the crown to the umbilicus4 ,the different parts are well developed and partly covered by a smegma called the vernix caseosa2 the head has attained the proper hardness1 and the scrotum usually contain the testicles4 ,in female children the nymph are generally covered entirely by the labia1 the breasts project1 and in both sexes contain frequently a milky fluid4 ,as soon as the child that has been carried the full time is born it usually cries1 opens its eyes1 and makes some struggling motions with its limbs2 it soon passes urine and feces1 and readily takes the breast4 ,with occasional exceptions the position of the child is unaltered from an early period of pregnancy to its termination1 whether the head be upwards or downwards4 ,the arms are generally folded over the chest1 the knees drawn up to the abdomen2 the back curved1 and the head bent upon the chest1 so as to occupy as little space as possible4 ,in ordinary cases the head is directed downwards1 and the face looks obliquely1 so that in the first and second position the back of the ftus is turned partly forwards1 and the belly in the third and fourth4 ,we are enabled in many cases to ascertain the position of the ftus in the uterus before labor has commenced1 by means of the stethescope1 by noting whether the pulsation is felt on one side or the other of the abdomen and observing whether it is heard clearly or not4 ,the longitudinal diameter of the head is from #d to #d inches1 the transverse from #c to #d1 the vertical #c to #c inches4 ,the transverse diameter of the shoulders and thorax is #d to #e2 the widest diameter of the hips #d to #e inches4 ,in general the measurements are a little less in the female than in the male4 ,the head of the ftus is large1 and as it is less compressible at term than other portions it merits a particular description2 we should be acquainted with all its characters1 that we may recognize them and thereby determine the position during labor4 ,the ftal head is ovoidal in form1 the large extremity being posterior4 ,several bones enter into the formation of the cranium2 they are1 #ast1 the frontal bone forming the forehead2 in the ftus even at term it is usually divided2 #b;d1 the two parietal bones1 one on each side of the head1 meeting on the median line at the top of the head2 they help to form the vault of the cranium2 #c;d1 the occipital bone1 forming the posterior and part of the base of the skull2 and #dth1 the temporal bones1 one on the right and one on the left side below the parietal1 completing the lateral portions of the cranium and contributing to form the base of it4 ,the cranial bones are not united to each other by sutures as they are in the adult1 but are separated1 the parietal bones especially1 by membranous intervals1 the intervals being larger in some children than in others4 ,these intervals1 or sutures and fontanelles1 must be carefully studied4 ,the sagittal suture is the antero-posterior one1 and extends from the root of the nose to the occipital bone4 ,it is formed in front by the interval that separates the frontal bone into two halves1 and superiorly by that between the two parietals4 ,there is a suture which crosses this1 called the transverse or coronal suture1 which is formed by the space existing between the frontal and parietal bones4 ,when the sagittal suture arrives at the superior angle of the occipital bone1 it seems to part and give rise to two oblique lateral sutures which are called lambdoidal2 these are formed by the posterior borders of the parietal bones and the superior one of the occipital4 ,just at the point where the coronal and the lambdoidal sutures join the sagittal one1 two membranous spaces1 larger than those just described1 are found2 these have received the name of fontanelles4 ,in cases of head presentation during labor1 one or the other of the fontanelles may be felt by the attending practitioner1 and this indicates to him the position of the head and the presentation4 ,the anterior fontanelle presents an extensive surface at the place where the transverse crosses the sagittal suture4 ,it is lozenge-shaped1 and is bounded by four bony angles4 ,the posterior fontanelle is formed by the union of the two lambdoidal sutures with the termination of the sagittal suture4 ,it is smaller than the anterior one1 and is of a triangular form4 ,it is bounded by the occipital bone and the angles of the parietal bones4 ,during labor the bones may overlap each other so that the sutures cannot be felt1 but the prominences of the bony margins will aid the diagnosis4 ,,the ,,physiology ,,of ,f,,tal ,,life4 ,the ovule1 after it arrives in the uterine cavity1 comes in contact at all points with the mucous membrane of the uterus4 ,its nutrition at first is organic by superficial imbibition2 afterwards1 probably the villi of the chorion imbibe the fluids there secreted1 and transmit them into the space between the chorion and the amnion1 thence it transcends through the walls of the amnion1 and a portion is conveyed into the ftus through the umbilical vesicle4 ,after the placenta is formed there may still be some absorption of some of the nutritive matters contained in the liquor amnii through the skin of the ftus1 but its growth is principally maintained by an assimilation of that which the radicles of the umbilical vessels take up in the placenta4 ,by means of the extensive contact existing between the vascular apparatus of the two placentas1 a transudation probably takes place of some part of the maternal blood1 which is absorbed and mingled with the ftal blood1 and furnishes some of the nutritive material4 ,when mingled with the ftal blood1 the nutritive elements supplied by the mother are devoted to the development of the organs4 ,it is supposed1 however1 that they undergo changes in the large liver of the ftus and in its intestines4 ,there is no true respiration in the uterine cavity1 but one function of the placenta is to renew the blood of the ftus from that of the mother1 in about the same way that the blood of fishes is rated by the water passing through the gills4 ,whether in the earlier months absorption is carried on by the surface alone1 or whether a portion of the liquor amnii finds its way to the stomach is difficult to decide1 but1 without doubt1 a certain amount of digestion is carried on4 ,the ,,circulation of the blood in the ftus cannot be understood without referring to certain anatomical peculiarities that do not exist in the adult4 ,these characteristics depend on the absence of respiration1 and disappear when it is established4 #ast4 ,the septum between the auricles of the heart is imperfect1 having in its center a valvular oval aperture called the foramen ovale4 #b;d4 ,the pulmonary artery1 soon after its origin1 gives off a branch1 the ductus arteriosis1 which enters the aorta just below the arch4 ,the pulmonary arteries are very small4 #c;d4 ,the umbilical artery in the ftus is a large vascular trunk1 which is nearly obliterated in after life4 ,the two umbilical arteries run forwards and inwards along the lateral and superior parts of the bladder1 then curve forwards to the abdominal wall1 along which they ascend to the umbilicus1 then pass along the cord to the placenta4 #dth4 ,the ftus further differs from the adult in having an umbilical vein1 which comes from the placental tissue1 traverses the length of the cord1 passes through the umbilical ring1 is mostly distributed to the liver1 but has a supplemental vein situated at the thick edge of the liver1 and leading to the vena cava ascendens1 called the ductus venosis4 ,the general effect of all these peculiarities is to render the heart virtually a single one2 to provide for the quiescent state of the lungs1 and to modify the distribution of fresh blood4 ,,the ,,course ,,of ,,the ,,blood ,,in ,,the ,f,,tus ,,is ,,as ,,follows3 ,the blood circulating in the umbilical vein is1 on entering the ftus1 a part of it discharged through the ductus venosis into the vena cava2 another part is distributed to the liver1 and is brought to the vena cava by the hepatic veins1 and then mingles also with that from the inferior extremities1 and then with that from the upper extremities as it passes into the right auricle4 ,a part of this is transmitted through the right ventricle1 and thence 7except a supply for the nourishment of the lungs7 through the ductus arteriosis into the descending aorta4 ,a second and larger part passes through the foramen ovale into the left auricle1 then into the left ventricle and arch of the aorta1 the branches of which supply the head and upper extremities4 ,the continued stream passes into the descending aorta1 mixing with that already described4 ,the whole now descends to the lower part of the aorta1 where a portion is sent to the inferior extremities1 but a larger part is drawn into the umbilical arteries1 and is carried by them into the placenta4 ,after birth remarkable changes take place4 ,something in the circumstances in which the child is placed stimulates respiration and crying1 by which means the lungs are inflated1 and space is afforded to the pulmonary circulation1 which supercedes the use of the foramen ovale and ductus arteriosis2 the blood from the lower extremities cannot pass through the umbilical arteries1 and does pass through the ascending cava into the right auricle and ventricle1 then into the lungs1 where it undergoes analagous changes to those effected in the placenta1 and is distributed to the body generally4 ,the ftal openings are generally obliterated in the course of a week1 though the foramen ovale1 or the ductus venosis1 may continue pervious for two or three weeks2 but soon the ductus venosis and the umbilical arteries are obliterated and the adult circulation established4 ,,part ,,iii4 ,,pregnancy ,,and ,,parturition4 ,,chapter ,i4 ,,diagnosis ,,of ,,pregnancy4 ,a few of the early signs of pregnancy are not made available to the physician ordinarily when his opinion is demanded4 ,a woman is naturally unwilling that her physician1 if he be a man1 should make even a digital examination1 and this makes it more necessary that the nurse should know all the rational signs4 ,one of these signs is the changed color of the mucous membrane of the vagina and labia4 ,this membrane is of a pale red color1 but it becomes of a violet hue during the time of menstruation1 and if a woman becomes pregnant1 the violet or deep red color becomes continuous4 ,there is also1 even in the commencement of pregnancy1 a peculiar odor to the secretion from the vagina and os uteri1 which has been compared to that of the vernix caseosa4 ,there is no sign of pregnancy by which we can always distinguish it in its early stages2 in some instances nearly all the rational signs are absent4 ,the general condition of a pregnant woman is changed in a greater or less degree1 but all are not changed alike4 ,generally she is plethoric1 the pulse is fuller and quicker2 the quantity of circulating fluid is augmented1 the quality altered by the increase of fibrine2 but these changes are not always obvious4 ,well marked sympathies are excited in various organs2 the nervous system may suffer especially2 the woman's temper and disposition may change2 she may become capricious1 may have likes and dislikes in eating1 especially if her digestion is weak2 there may be loss of appetite1 heartburn1 increased flow of saliva1 toothache1 excitability of mind1 sleepiness1 etc42 but even when many of these symptoms are present1 even when the liver and kidneys are affected1 so that the skin is sallow or discolored in patches1 and irritability of the bladder causes much pain and distress1 these various signs may only furnish a sum of probabilities amounting almost to certainty4 ,in some cases of pregnancy the skin1 instead of becoming sallow1 is more florid1 with occasional eruptions on the face4 ,some women become fat during pregnancy2 others lose flesh2 their faces1 in the early months1 are pinched and pointed1 and their features altered4 ,milk in the breasts1 especially in the first pregnancy1 is a sign which is said to be reliable2 but it is true of some women that1 during their period of menstruation1 their breasts enlarge2 there is a sensation of fullness1 with throbbing and tingling pain in them1 and that a milk fluid may be secreted2 the same symptoms that are present with others at the second month of pregnancy4 ,another change is a more marked sign in the breasts4 ,there is at first a soft and moist state of the skin1 and the little glandular follicles around the nipples are bedewed with a secretion4 ,this may often be seen at the second month1 and it may also be noticed that the veins of the breast look more blue1 and that the breasts themselves are firmer and more knotty to the touch4 ,there are1 however1 other signs which are more to be depended on than these that have been mentioned4 ,females cease to be regular during pregnancy4 ,a healthy married woman1 during the period of child-bearing1 bases her prediction upon this sign1 and is seldom disappointed4 ,but women are not all healthy2 disease and disorder of the womb1 or other organs of the body1 especially of the lungs1 may cause suppression of the catamenia2 and1 on the other hand1 the discharge may recur for several months after conception1 or even monthly during the period of utero gestation2 and1 in anomalous cases1 some young married women1 who had hitherto been quite regular1 ceased to menstruate for several months without any known cause4 ,morning sickness is one of the earliest signs of pregnancy1 as it often occurs within two weeks4 ,the nausea may be slight or it may be very distressing2 it may happen to be soon relieved1 but it usually continues for three or four months or longer4 ,it varies also as regards the time of day during which it continues to be bad2 but if it recurs at the regular time and in the regular manner1 it is of great value as an evidence of pregnancy1 when combined with other symptoms4 ,a dark brown areola around the nipple may usually be noticed at the end of the second month2 this is a distinguishing sign1 especially if it be a first pregnancy4 ,a month or two later1 the dark color is more obvious1 and it is darker in persons with dark hair1 etc4 ,it may be described as being a dark circle1 somewhat swollen1 or with a puffy turgescence1 both of the nipple and the surrounding disk2 the surface of the areola studded over and rendered unequal by the prominence of the glandular follicles1 the integument covering the part soft and moist2 sometimes small mottled patches1 of a whitish color1 scattered over the outer surface of the areola1 and for about an inch all around it4 ,these marks are quite plain at the fifth month1 and at six months a number of silvery streaks may be observed4 ,quickening is one of the most important signs of pregnancy1 and occurs about the fourth or fifth month2 not because the child is then first alive1 but because the womb then rises higher in the abdomen1 and because the child has reached a further state of development4 ,quickening is a proof that the woman is near half her time gone2 though it may happen that the sensation is observed as early as the third or fourth month1 instead of at four and a half months4 ,in some cases women do not know the time when they quicken1 as only a slight sensation is felt2 this some compare to the fluttering of a bird4 ,but a lady may at that time be faint1 or giddy1 or sick1 though there seemed to be nothing more than a mere pulsation4 ,subsequently1 however1 the movements become stronger and more frequent4 ,the motions of the child may be felt by a third person on placing the hand on the woman's abdomen1 especially if the person's hand be cold4 ,i have known one case in which1 by placing my hand on the woman's abdomen1 ,i caused motions which simulated active movements of the child1 although there was no ftus present4 ,,increased ,,size ,,and ,,hardness ,,of ,,the ,,abdomen is characteristic of pregnancy4 ,enlargement of the abdomen may be from flatulence1 but such enlargement is not persistent2 the belly is large one hour and small the next1 and on pressing the bowels firmly1 a rumbling of wind may be heard1 which perhaps may move about1 and on percussing 7tapping7 the part1 a hollow sound may be elicited1 as from a drum4 ,a large abdomen may be due to fat1 but there is a soft and doughy feeling that is characteristic of fat4 ,on the contrary1 in pregnancy1 hardness1 solidity and resistance to pressure characterize the gravid uterus1 and the enlargement is not only persistent1 but gradually increasing4 ,it is true that when a very fat woman is pregnant1 percussion or palpation of the abdomen may be fruitless1 and any certain diagnosis cannot be made1 but in most cases1 if we are careful to observe these conditions1 and also whether there is a distended bladder and rectum1 the diagnosis can be made after the fourth or fifth month4 ,to make an examination by percussion and palpation1 let the female lie down1 with the head raised and the thighs flexed on the abdomen2 then examine with both hands1 especially near the pubis4 ,pressure with the ends of all the fingers1 gradually moving them upward1 will enable us to detect the womb1 if it rise above the symphasis1 and also the size and height of the fundus4 ,ballottement1 or repercussion1 is used as a means of deciding upon the presence of a ftus2 a means that is most available about the fifth and sixth month4 ,the female examined should be in an upright position1 or if she be in bed1 her shoulders should be raised4 ,we are directed to introduce the forefinger into the vagina and touch the cervix uteri1 or1 rather1 in front of the neck upon the walls of the uterus2 then slightly jerking upward by slightly flexing the first joint of the finger2 observe if something recede from it and fall again in a moment4 ,the ballottement is said to be a sensation 8analagous to that produced by placing a ball of marble in a bladder full of water and then striking the bladder with the finger just under where the ball rests1 when the latter is thrown up and falls from its own weight upon the finger that displaced it40 ,when the vaginal touch is practiced1 while one finger remains in the vagina1 palpation of the uterus with the other hand may assist in the diagnosis by depressing the uterus1 or by holding it firmly in place4 ,then the jerk of the finger upon the head of the ftus causes it to float upwards a little in the liquor amnii and descend4 ,,auscultation is used to decide many cases of doubtful pregnancy4 ,the pulsations of the ftal heart are generally perceptible by the fifth month4 ,the examination may be made by applying the naked ear to the abdomen of the mother1 she being placed on her back in the bed with her head raised4 ,the ftal pulsations are frequent1 generally from #abj to #adj a minute4 ,the uterine souffle or bellows murmur may often be heard as early as the fourth month2 it is synchronous with the mother's pulse2 its seat is said to be the uterus1 and some believe that it indicates the position of the placenta4 ,this sound and the pulsation of the umbilical cord are not very important diagnostic signs1 and the same may be said of the presence of kiestiene in the urine1 which may1 however1 be detected as early as the third month4 ,some of the ailments that attend pregnancy ,i will now merely mention3 ,there may be irritability and a disposition to inflammation2 violent and obstinate vomiting2 indigestion and depraved appetite1 heartburn1 costiveness1 hemorrhoids1 liver spots or blotches1 especially about the face2 diarrha or dysentery2 strangury1 with a frequent inclination to void the urine2 leucorrha2 varicose veins in the legs1 thigh and abdomen2 inquietude1 and sleeplessness2 dropsy1 or an dematous condition of the lower extremities2 prurigo vulva2 either of these may be more or less troublesome1 but can hardly be regarded as diagnostic signs4 ,some remedies for these will be mentioned hereafter4 7,f4 #fi1 #gb1 #ge1 #ha1 #aca1 #agc1 #bjf1 #bbj74 ,the abdominal walls are often distended beyond what the woman is able to bear without inconvenience1 as the skin may become inflamed and crack4 ,it is much more common that the true skin beneath the epidermis cracks1 and1 although the outside is not altered1 there often remains upon the abdomen of women who have had children a number of small marks1 or little whitish streaks4 ,,chapter ,,ii4 ,,abortion4 ,if a premature expulsion of the ftus occur before the end of the seventh month1 it is called an abortion1 or miscarriage2 subsequent to this period1 premature labor4 ,the cause of abortion may be in the ovum or in the mother1 and it is more liable to occur at the beginning of each month corresponding to the menstrual period4 ,the maternal causes may arise from the condition of the mother or may be accidental2 may be anything that injuriously affects the mind or body4 ,debility of constitution1 consumption1 leucorrha1 uterine irritation1 febrile complaints1 and obstinate constipation may be causes1 but some women who are weak or sick retain the ovum with wonderful tenacity4 ,blows1 falls1 violent concussions1 excessive or sudden exertions1 straining1 severe coughing1 taking long walks1 riding on horseback1 or over rough roads in a carriage1 a long railway journey1 fright1 sudden shocks1 anger1 joy1 sorrow1 good or bad news suddenly told1 taking a wrong step in ascending or descending stairs1 lifting heavy weights1 violent drastic purgatives1 calomel1 dancing1 and tight lacing may excite the uterus to action and effect the expulsion of its contents4 ,it is an unfortunate thing for a woman if she miscarry with her first and second child1 for it often becomes a habit4 ,having once miscarried1 she is more likely to miscarry again1 and by repeated miscarriages her constitution is broken1 and the chances of her ever having a living child become very small4 ,a woman may experience some threatening or warning symptoms of miscarriage for one or two days before those of labor supervene4 ,there is usually a feeling of languor or weariness1 of lassitude and depression of spirits1 and a sense of uneasiness1 and then1 after these premonitory symptoms have lasted for some time1 there may be a discharge of mucus or blood from the vagina4 ,the show may increase to flooding1 and soon there may be pain1 at first slight and irregular1 afterwards of a grinding character1 and subsequently severe1 irregular1 and bearing down4 ,at this stage we may be quite certain that the pains will continue to recur until the ftus at least1 if not the afterbirth1 have passed into the vagina4 ,the progress in different cases is1 however1 quite dissimilar4 ,in the beginning of pregnancy the expulsion of the ovum might closely follow the accident that caused it4 ,for example1 a woman might slip in descending a staircase and fall violently on her seat1 causing immediate expulsion of the ovum1 with a large quantity of fluid blood4 ,there are some women who have acquired the habit of aborting1 and the ovum passes out of the womb with scarcely any pain1 little or no hemorrhage1 and the woman speedily recovers4 ,but it will very seldom happen1 after the first six weeks1 that there is not some interval between the accident and the consequent abortion1 and that there is not considerable and protracted pain4 ,if the cause of the abortion affects the mother instead of the ovum1 she generally experiences1 at the time of the accident1 a sharp pain about the loins or abdomen1 which may continue slightly for several days1 and then be renewed1 with violent uterine contractions1 and some serous and then bloody discharges from the vagina4 ,the progress of a miscarriage is not as regular as a labor at full term4 ,in many cases there are shiverings succeeded by fever for a day or more preceding the hemorrhage4 ,severe indisposition may continue for several days4 ,there may be not only considerable uterine pain1 but much pain in the bladder and loins2 a sense of sinking in the epigastrium1 of weight near the vulva and anus1 and an ineffectual desire to urinate4 ,such symptoms continue a longer or shorter time1 and then usually the ftus alone is expelled1 the placenta being retained4 ,the latter is generally detached after a time1 or it may 7if within the first three months7 be discharged and pass out in a dissolved condition1 with the lochia4 ,very alarming hemorrhage may precede and accompany abortion2 this makes the case one of danger at the time1 and may permanently affect the health of the woman afterwards4 ,the flooding may continue after the expulsion of the ovum2 but ,i have always found that in such cases there was a portion of the placenta that was detached1 and that might be removed1 though not perhaps without some difficulty4 ,a good physician should always be called in cases of continued flooding4 ,the patient ought always to preserve any and every substance discharged1 that it may be showed to the physician4 ,he should make a digital examination1 and he usually finds the os uteri to be partially dilated1 and a portion of the placenta hanging in the orifice4 ,it has always been my practice to see that all was removed before leaving my patient1 and ,i have known very dangerous hemorrhage to occur where this rule was not observed4 ,the placenta can generally be seized by two fingers and removed2 but if persevering efforts are necessary1 they should not be relinquished until the safety of the mother is assured1 which cannot be while the ovum1 or membranes1 or placenta remain in the uterus separated from their connections4 ,but it should always be considered especially important to ,,prevent ,,the ,,abortion4 ,if a woman is prone to miscarry1 she ought1 as soon as she is pregnant1 to lie down a great part of the day2 she must keep her mind calm and unruffled1 and must live on plain diet2 she should retire early to rest1 and she must have a separate sleeping apartment4 ,she should avoid taking active physic1 but keep her bowels open by diet or by the mildest aperients1 or1 possibly1 daily enemata4 ,gentle exercise may be taken1 alternated with frequent rest4 ,cold ablutions are proper every morning1 but the body should be rubbed afterwards with a coarse towel4 ,the most usual time for a woman to miscarry is from the eighth to the thirteenth week1 but if a woman have a particular time1 which to her is the usual period1 whenever that time approaches she should be unusually careful4 ,let her lie down more than she usually does2 let her avoid exciting amusements4 ,she might try to keep her bowels open by the external application of castor oil1 or by the mildest aperients1 or by hot water enemata4 ,if slight hemorrhage and trifling pains come on1 we should seek to arrest the abortion by giving perhaps grain doses of opium every four or five hours4 ,if the hemorrhage is severe1 a drachm dose of fluid extract of ergot may be given1 and a large draught of cinnamon tea2 perhaps a quarter of a grated nutmeg1 and1 in extreme cases1 a spoonful of brandy with it4 ,but let it be understood that in all such cases a physician should be called as soon as possible2 and while waiting for him the patient ought to lie on a hair mattress2 a vaginal injection of hot water may be given2 she should have but scant clothing upon the bed2 her room should be well ventilated1 and if she is faint from the loss of blood1 a little aromatic ammonia may be given4 ,,chapter ,,iii4 ,,parturition4 ,,false ,,pains occur most frequently in a first pregnancy1 but most pregnant women have occasional pains1 and these become more violent within three weeks of the full time4 ,they may be owing to a disordered stomach1 as well as to the action of the uterus2 but they usually come on at night1 and are liable to be mistaken for labor pains4 ,they are1 however1 unattended with show2 they often change from place to place1 perhaps going successively to the hips1 loins1 lower extremities and abdomen2 they come on at irregular intervals1 and are at one time violent1 at another feeble1 and they occasion no dilation of the os uteri2 but true pains come on with some regularity1 and usually increase in severity4 ,false pains are from various causes1 such as fatigue of any kind1 especially too long standing1 sudden and violent motions of the body1 costiveness or diarrha1 general feverishness1 agitation of the mind1 or a spasmodic action of the abdominal muscles4 ,it is necessary to adopt the means used for the relief of the pains to the apparent cause1 and generally to give an opiate proportioned to the degree of pain1 or to repeat in small quantities at proper intervals till the patient shall be composed4 ,,period ,,of ,,gestation4 ,the duration of pregnancy is not always absolutely a certain number of days4 ,the usual term is ten lunar months1 or nine calendar months and one week4 ,if we could have correct records of all cases we should probably find that half the cases of pregnancy terminated in labor in the fortieth week1 but that in a few instances the term was prolonged to the forty-fifth week and that in as many cases women were delivered of fully developed children as early as the thirty-seventh week4 ,a woman may make her count pretty correctly as follows3 ,she should first note the last day of her being unwell4 ,let forty weeks from that day be marked in an almanac1 and she may expect her labor to come on near that time4 ,it may happen that a woman who never has her menses while she is suckling1 may become pregnant and not have a date to count from2 but she ought in that case to reckon from the time that she quickens4 ,although quickening takes place at various periods1 she may then consider herself nearly half gone in her pregnancy1 and calculate that in four and a half months she will be delivered4 ,a woman may have a show for one or two monthly periods after her gestation commences1 but the discharge may be distinguished from the regular menstrual fluid by its being either small in quantity1 or by its clotting1 and generally by its lasting but a few hours4 ,the woman should reckon from the time when she had her last regular menstruation4 ,,parturition4 ,,natural ,,labor4 ,the uterine functions are characterized by periodicity4 ,if an abortion occurs that is not the result of an accident1 it is generally at what would have been1 but for conception1 a monthly period1 and even injuries are more likely to produce their bad effects at that particular time4 ,so the normal period for parturition corresponds to a menstrual period1 and generally labor may be looked for at about the tenth period after the last appearance of the catamenia4 ,we can hardly tell why it so uniformly happens at that particular time2 the process is analagous to the falling of ripe fruit--it drops because the fruit is fully matured4 ,it is not in accordance with the plan of this work to dwell at all upon any other than what is called natural labor1 but ,i shall include in this class all such as are terminated by the natural powers1 whether they be head1 face1 breach1 or foot presentations4 ,by ,,presentation1 ,i mean that part that presents itself at the brim of the pelvis1 so that the accoucheur's finger impinges upon it as the end is passed into the center of the os uteri4 ,the ,,diagnosis of the different presentations is made by the touch4 ,the head may be known by the hardness and roundness1 and more certainly by the fontanelles and sutures2 the breach by its general softness1 and by the tuberosity of the haunch bone2 by the cleft between the buttocks1 the scrotum or the vulva1 and the anus2 the knee by the hardness and roundness of the bone2 the foot by its form1 its being at right angles with the leg1 the nearly equal length of the toes1 the narrow heel1 etc42 and the face by the inequalities of the presenting part4 7,these inequalities cannot at first be felt2 upon touching it we first perhaps detect the brow1 then1 as labor progresses1 we may feel the nose1 mouth1 etc47 ,the head presents in about #ih cases out of #ajj4 ,,physiological ,,phenomena ,,of ,,labor4 ,according to the division made by standard authors on parturition1 its first stage extends from the beginning of labor to the complete dilatation of the os uteri2 the second terminates by the birth of the child1 and the third by the expulsion of the placenta4 ,during the last two or three weeks of the term1 the uterus sinks lower in the pelvis1 and seems to spread out laterally2 the lungs and stomach are not so much compressed1 and respiration and digestion1 if difficult1 become more easy1 and often the patient becomes more cheerful and active4 ,the precursory symptoms of labor vary in intensity in different women2 but it may be observed pretty generally that there is more activity and disposition to movement for one day preceding the real labor4 ,but during the last few days of the gestation there are contractions of the uterus1 which1 though short and distant1 and not attended with much pain1 are effective in dilating the cervix1 and preparing for the subsequent labors4 ,the subsidence of the lower end of the uterus into the pelvis1 however1 causes many unpleasant symptoms4 ,the pressure upon the bladder renders a frequent evacuation of its contents necessary2 there is often an ineffectual desire to urinate1 and sometimes strangury4 ,there is often a sense of weight about the anus1 an irritable state of the bowels1 occasional griping pains1 and a desire to go to stool when but little is passed1 and sometimes diarrha4 ,the dema and varices of the lower extremities augment1 the hemorrhoidal vessels swell up1 and the piles are larger4 ,these precursory symptoms are manifested more in primapara than in others4 ,to some1 walking becomes at this time impossible4 ,there are during the last month1 and especially toward the close of it1 painless uterine contractions2 there may be at first a sort of squeezing sensation with it4 ,but about twenty-four hours previous to the commencement of actual labor1 these contractions are accompanied with some pain and are periodical1 recurring perhaps every twenty or thirty minutes4 ,if an examination be made of the os tinc at the ,,commencement ,,of ,,labor it will be found that the rounded collar of the os is already effaced4 ,the pains then suddenly become acute1 and it can be observed that the uterus contracts if we notice its greater hardness and roundness during a pain4 ,the os uteri if somewhat dilated closes partially with each contracting1 and it can be observed that its margins are growing thinner though tense and resistant at the time of the pain4 ,the contractions distend the membranes2 these are first pressed on the neck1 then into it1 then as soon as the dilatation is sufficiently advanced engage in it in the form of the segment of a sphere1 whose dimensions progressively increase with the dilatations4 ,there is now and perhaps has been for several hours a glairy discharge from the vagina1 which becomes streaked with blood1 there are perhaps shiverings or rigors 7not accompanied with a cold skin71 the pains increase in force and frequency1 the pulse is hard1 full1 and rather frequent1 the countenance is flushed1 often there is vomiting1 and the patient is prone to despond and be discouraged4 ,she is less agitated after the pain subsides1 though it does not cease entirely4 ,during the interval the margins of the os again become supple1 the membrane that was tense while the pain lasted becomes flaccid1 and the child's head can be more plainly felt4 ,as the contractions are repeated the os uteri dilates more and more until it is completely opened and no part of its margin can be touched2 though very frequently from some obliquity of the uterus1 the margin on one side can be observed pushed down before the head of the child1 while that on the other side cannot be reached4 ,in ordinary cases the membranes are ruptured and the waters escape at the commencement of the second stage1 and the time occupied by the first stage is nearly three-fourths that for the whole labor4 ,but the duration of the stages as well as the time occupied by the parturition is exceedingly variable1 and the same may be said in regard to the duration and character of the pain4 ,we may observe here that pain is nearly inseparable from the contractions of the uterus1 so that in common language the two expressions are used indifferently2 but using the word in its ordinary sense the pain in the first stage of labor is different from that in the second4 ,what are called grinding pains characterize the first part of labor1 and although they differ in different individuals1 they are pretty generally so severe as to cause the patient to cry out4 ,as soon as the labor advances to the second stage there is a change in the character of the pains4 ,they are more frequent and longer and the intervals shorter2 but though the suffering may be greater the cry is more suppressed1 the bearing down is carried to a greater degree1 and each pain is succeeded by a calm more perfect than that in the first stage4 ,should the interval be rather long some patients get a little sleep between the pains1 but if there has not been a bursting of the waters previously there is generally now a pain sufficiently hard to break the membrane4 ,either in the first or last part1 or during the whole of the labor1 the woman says that the pain is in her back1 it being in the lumber and dorsal region2 the grinding pain she speaks of as being forward1 they seem however to go through from the umbilicus to the sacrum4 ,in cases where there is rigidity of the uterine orifice1 there is ,i believe pain especially in the back2 and when the os becomes fully dilated1 the pains are bearing down2 the patient at the accession of a pain holds her breath1 and seizing hold of something with her hands1 brings the muscles of the back and abdomen and extremities to aid the expulsive efforts of the uterus4 ,i do not doubt that this straining of the mother at this time is advantageous2 these efforts of the mother should not be encouraged1 however1 at the first part of the labor1 because then they do no good1 nor at the very last1 as combined efforts then may rupture the perineum4 ,as the head advances through the pelvic cavity the pressure upon the nerves which pass through it gives rise to cramps in the thighs and legs4 ,as the head passes into the vagina the walls become flabby and the canal seems to enlarge and elongate and to be prepared to yield to the pressure of the head4 ,if an internal examination be made the head will be perceived filling the cavity1 descending with each pain and receding at its conclusion--the advance ordinarily exceeding the recession1 though sometimes the gain is not perceptible4 ,when the head rests on the perineum1 that offers some resistance1 which seems to stimulate the uterus and abdominal muscles to greater efforts and more forcible contractions4 ,if it be a first labor there may be at this point a little delay in its progress4 ,but the ftal head being forced down by the rapidly recurring pains so presses against the floor of the pelvis that it yields and becomes bulging in front1 and distended1 though there still is recession as the pain intermits4 ,but adequate force is called into action2 each pain gains upon the advance made by its predecessor2 the vulva partially opens1 and at each pain they open more and more2 the resistance of the parts is finally overcome4 ,after the perineum has given the head its proper direction in its transit1 there usually comes a hard pain--forcing a loud cry from the woman--another pain succeeds immediately1 which expels the head altogether from the parts2 then after a short rest the uterine power is again exerted to expel the body of the child4 ,there may be an interval of a few minutes before the pains return with sufficient force to expel the shoulders1 but the child is in no particular danger2 it is best to wait awhile1 the nurse in the meantime making pressure with her hand over the uterus1 before any traction is made on the head or shoulders4 ,if the body is very large1 however1 it may be well soon to draw a little on the head or to reach with one finger into the axilla and to bring down the lower shoulders2 then the rest will be delivered without any difficulty4 ,the intense suffering of the mother is now exchanged for perfect joy or ease2 there is at once a transition from extreme misery to total freedom from pain1 though the labor is not yet completed4 ,ordinarily a few pains return before many minutes1 and complete the last stage of labor--the expulsion of the placenta4 ,sometimes the contractions that expel the child1 expel also the membranes and placenta2 but more generally they are only partially detached or they may be adherent and not easily removed4 ,after the birth of the child1 and the tying of the naval string1 it is proper to apply the hand upon the abdomen of the mother to ascertain whether there be another child1 and whether the uterus be contracting properly4 ,i advise that an effort should be made immediately to remove the afterbirth and secundines1 making firm pressure over the womb2 this will generally stimulate the uterus to make good contractions1 and may assist in pressing out the placenta4 ,i do not advise that a midwife should pull upon the cord1 but it is my practice to press the fingers of my right hand well into the vagina1 and as soon as possible grasp a little of the placenta2 my left hand at the same time pulling slightly on the cord1 and thus by combined effort removing the afterbirth pretty quickly4 ,i have never had much trouble about retained or adherent placenta in cases where ,i myself officiated in the delivery1 and ,i attribute my good fortune in this respect to the fact that ,i do not tie the placental portion of the cord1 preferring to let some blood discharge from the afterbirth1 thus diminishing its size1 and then if necessary ,i direct that considerable effort be made in the way of squeezing and pressure and friction over the uterus4 ,it is true that if nothing is done a pain will usually come on within twenty minutes that will expel the afterbirth very effectually including all the membranes1 and considerable clots of blood2 but ,i apprehend that in many cases during this delay there is an hour-glass contraction of the womb comes on1 which retains the placenta and prevents its proper separation4 ,but before attending to the placenta1 the necessary attention should be paid to the child4 ,a little cold water sprinkled on it will usually make the child cry1 if it does not breath immediately after it is born1 and this makes the change in it from uterine to breathing life4 ,the child may then be separated from the mother by cutting the cord4 ,after the removal of the child it is proper to endeavor to deliver the afterbirth1 though it may not be necessary at first to do anything more than to use friction over the uterus with moderate pressure1 which may be gradually increased4 ,,chapter ,,iv4 ,,mechanical ,,phenomena ,,of ,,labor4 ,the cavity of the uterus and that of the pelvis form a continuous ,,passage through which the child must be forced in its exit from the womb at birth4 ,the uterus possesses the character of muscularity and is the main agent in the expulsion of the child4 ,by its own muscular action the cavity of the uterus is diminished and pressure made on the ftus1 forcing it down towards the orifice1 distending the cervix1 and dilating the passage4 ,during the second stage of labor the power of the uterus is aided by the voluntary muscles of the abdomen and by the depression of the diaphragm4 ,the character of the passage will be brought to mind by recalling what was heretofore said of the diameter of the pelvis4 ,it will be remembered that the usual antero-posterior diameter of the brim does not exceed #d inches while the transverse is #e inches1 and that at the lower outlet the antero-posterior diameter is about #e inches and the transverse about #d inches4 ,the ,,first ,,obstacle which the child meets in its progress is the cervex uteri4 ,this being composed partly of muscular fibre which acts somewhat as a sphincter1 and partly of elastic celular tissue1 holds the sphincter in the tissue with a tenacity which is not easily overcome4 ,but repeated muscular contractions of the womb force down the bag of waters1 which forms a sort of wedge1 and this is forced down and into the os uteri1 compelling it to open4 ,there are also muscular fibres in the uterus which have a longitudinal as well as some that have a circular course1 and the action of the former tend after a time to retract the os1 over the ftal head4 ,the second obstacle is the bony brim of the pelvis into which the head of the ftus cannot pass until its long diameter is adapted to certain diameters of the pelvis4 ,the diameter of the bony pelvis is diminished over one-fourth of an inch by the soft parts upon it1 but the oblique diameter of the pelvis will admit the long diameter of the head of the child1 which does not often exceed #d inches4 ,the head usually presents in this way1 and passes in a somewhat spiral manner until it arrives at the outlet where the diameters are adjusted to each other4 ,the head is1 however1 too large to pass1 even in this way1 were it not that it admits of a degree of compression to facilitate the entrance and progress through2 this moulding is effected by the continued pains4 ,the head of the child which presents at the brim with the occiput towards the left acetabulum rotates during the passage1 so that the occiput at its exit is directly under the symphasis pubis2 the cause of the rotation is found in the form and direction of the passage and in the shape and size of the ftal head4 ,this presentation and position is the most common one1 though either of the following is liable to occur4 ,by naming the position we indicate just how a presenting part lies1 or is turned4 ,we adopt the following classification1 which accords with several good authors3 ,,presentations ,,and ,,positions4 ,,presentations4 ,,no4 ,,position4 ,,name ,,of ,,position4 ,a--,vertex or head #a ,occiput to left ,left occipito-iliac acetabulum4 anterior4 #b ,occiput to right ,right occipito-iliac acetabulum4 anterior4 #c ,occiput to ,symphasis ,occipito pubic4 pubis4 #d ,occiput to r4 ,r4 occipito-iliac sacro-iliac junc4 posterior4 #e ,occiput to l4 ,l4 occipito-iliac sacro-iliac junc4 posterior4 #f ,occiput to promon'y of ,occipito sacral4 sacrum ,b--,breach1 including #a ,sacrum to left ,left sacro-iliac inferior acetabulum4 anterior4 extremities4 #b ,sacrum to right ,right sacro-iliac acetabulum4 anterior4 #c ,sacrum to symphasis ,sacro pubic4 pubis4 #d ,sacrum to r4 ,left sacro-iliac sacro-iliac posterior4 junction4 #e ,sacrum to l4 ,right sacro-iliac sacro-iliac posterior4 junction4 #f ,sacrum to promont'y of ,sacro sacral4 sacrum4 ,c--,body1 including shoulders1 elbow and hand4 ,d--,face1 including six varieties4 ,the right occipito-iliac posterior 7,a #d7 position is not a very uncommon one1 but that variety which is described and named as the left occipito-iliac anterior 7,a #a71 in which the occiput is directed in front and to the left1 is most frequent4 ,these and other vertex presentations may be recognized even in the commencement of labor through the vaginal walls1 the head being known by its rounded spheroidal surface4 ,supposing that we have a case of the kind that is most common 7,a #a71 and that labor has begun1 we may introduce the finger through the os uteri and we encounter a rounded1 smooth and resistant surface1 which is the anterior part of the head1 and then by directing the finger upwards and backwards it will come in contact with the sagittal suture4 ,if the direction of the suture is oblique1 and if it runs from before backwards and from the left towards the right1 the position must be either the left anterior or the right posterior occipito-iliac one4 7,a #a or ,a #d74 ,to complete the diagnosis we follow with the finger the sagittal suture until it reaches the fontanelle1 and this determines the position4 ,if the posterior fontanelle is found to the left and in front1 and the anterior one is to the right and behind1 the position is ,a #a1 or the left antero-occipito-iliac one4 ,the back of the ftus is turned forwards and towards the left side1 while its face and anterior plane is turned backwards and towards the right1 and the occipito-frontal diameter of the child's head corresponds to the oblique diameter of the pelvic brim4 ,as the labor progresses and the head is forced down in the pelvis1 it is also more strongly flexed on the chest and the occiput is pressed down in the excavation4 ,with the occiput thus presenting1 it traverses all the space between the superior and inferior straits until it reaches the floor of the pelvis2 there it makes what is sometimes called the pivot turn--it executes a movement of rotation1 which carries the occiput behind the symphasis pubis and the forehead towards the hollow of the sacrum2 then the head being pressed forwards and stretching the perineum1 the forehead and face being disengaged from it1 emerge2 then after the perfect expulsion of the head it again rotates1 the occiput turns somewhat to the left thigh and the face towards the right thigh4 ,in the beginning of labor the shoulders are turned so as to correspond to the oblique diameter of the pelvic cavity1 but they pass through the pelvis in a transverse position4 ,after they reach the inferior strait1 the body rotates so that the right shoulder of the child turns towards the left side of the mother and the wide diameter of the shoulders is accommodated to the wide diameter of the strait1 and the rotation of the head1 which is free externally1 is secondary to the rotation of the shoulders4 ,in the ,,expulsion ,,of ,,the ,,body the right shoulder1 or subpubic one1 is the first one to appear in the vulvar fissure1 but the left or posterior one may be disengaged at the commissure of the perineum before the right one is delivered2 the remainder of the trunk is expelled very soon1 describing a prolonged spiral course in its passage4 ,a child originally in the ,,right ,,posterior-,,iliac position becomes converted towards the last of the labor into an occipito pubic or anterior one1 and the labor terminates as it does in ,a #a1 when the occiput was originally in front4 ,it is the left shoulder1 however1 which gets behind the arch of the pubis1 and the occiput is directed towards the right thigh after the head emerges4 ,in some instances1 though rarely1 the child originally in ,a #d position remains with the occiput behind to the termination of the labor4 ,in such cases the forehead comes under the pubis and remains there for a time1 while the occiput traverses the whole circle of the perineum2 then the whole head and face is immediately delivered4 ,it is not deemed necessary to describe here the mechanism of labor in the more unusual varieties which are so very numerous4 ,as regards ,,prognosis1 head presentations are the most favorable of all1 and those in which the occiput looks anteriorly in the beginning of labor are more favorable than those in which it is turned posteriorly4 ,in occipito-posterior positions the labor is more tedious than when the occiput is in front1 and the expulsion becomes particularly difficult when the head maintains its original position and does not rotate or take the pivot turn4 ,upon the ftal head after it is delivered there is almost always a protuberance to be found--a tumefaction1 more or less considerable upon some point of the vertex2 its greater size indicating a longer continuance of the labor1 and its seat indicating in what position the child was born4 ,this tumor is almost always located on one of the posterior superior angles of the parietal bones1 and shows that the occiput escaped under the pubic arch4 ,during the labor the whole head is strongly compressed except at one point on the vertex1 which therefore becomes the seat of a sero-sanguinolent infiltration4 ,this tumor disappears usually within forty-eight hours2 if it does not1 it may properly be punctured4 ,it may contain either serum1 or serum and blood1 or grumous blood4 ,,chapter ,v4 ,,diagnosis ,,of ,,artificial ,,labor4 ,when the expulsion of the ftus takes place from the efforts of nature alone1 the labor is called by some authors spontaneous or natural1 but when art is obliged to interfere it is called artificial4 ,it would be very useful to us if we could always decide in the commencement of labor whether the assistance of art would be required1 and ,i will group together in a few pages such instructions as ,i am able to give on this important subject4 ,the nurse or midwife will not very generally be able to decide any point by auscultation1 but she as well as the physician may judge from the appearance of the woman1 from her past history1 from palpation of the abdomen1 and from vaginal touch4 ,she should accustom herself to judging by all these means1 that she may be able to decide early whether the help of an accoucheur will be imperatively needed4 ,no one can decide certainly from simply seeing a patient in the beginning of labor1 whether her labor will be natural and spontaneous1 or artificial2 but ,i have many times when first looking at a lady1 if her complexion was fair1 and her form good1 but rather tall1 predicted that her accouchement would proceed regularly and favorably4 ,but in forming our opinion we need to know something of the previous health and present ailments of the patient1 and1 if a multipara1 the character of former labors4 ,if nausea and vomiting or any other ailment has reduced her strength so that she is exceedingly weak1 this may give rise to some reasonable apprehension2 but ,i have known a woman that could scarcely retain a morsel of food on her stomach for seven or eight months1 that had become very weak indeed and exceedingly emaciated1 who yet endured her labor well and soon recovered4 ,the general rule is1 that the more perfect the woman's health is1 the better she is fitted for child bearing1 but if her general health and strength is reduced below its proper standard by some previous or accompanying disease1 such for example as consumption1 she may endure the labor very well1 and succumb to the disease afterwards4 ,pregnant women are liable to be attacked with epidemic1 endemic1 and sporadic diseases4 ,eruptive fevers1 etc41 may attack parturient women1 and if they do1 the disease and labor in every case will have a reciprocal influence on each other--the disease will complicate the case4 ,influenza or intermittent fever may attack a woman at any period of gestation1 and there may be no serious results4 ,cholera1 small pox1 typhoid fever1 scarlet fever1 measles1 pneumonia1 and jaundice are liable to cause abortion1 and there is danger of fatal results1 or either of them would be a dangerous complication at the time of labor4 ,syphilis would be a cause of abortion or premature labor1 and any disease which allows the mother to carry the child the full term may reduce and weaken her4 ,glandular engorgements and scrofulous ulcers improve during gestation1 but if the woman is suffering from a fracture1 the bones will not unite very well4 ,tumors in the abdomen and pelvis may be an obstacle to delivery1 and ulcerations of the cervix may also be harmful and protract the labor1 as also may constipation1 dropsy1 and albuminuria4 ,the latter may not be detected without an analysis of the urine1 but dropsy will be obvious as soon as it exists4 ,the evidences of tumors and ulcerations are found by palpation and the touch--sometimes by the use of the speculum4 ,after learning the present appearance and the former history of the patient it may be necessary to examine further perhaps by palpation4 ,by ,,palpation we may sometimes 7but not always7 distinguish the head of the child1 and perhaps tell to which side its back is turned4 ,when making the examination let the patient lie on her back1 make gentle pressure when the pains are off and the abdomen is relaxed2 press the ends of your fingers above the body of the pubis2 by pressing downwards you may perhaps feel the head if it has descended into the pelvis4 ,you will need to press the abdomen carefully all over to ascertain if there are tumors1 and also to ascertain if the body or some other part presents at the cervix uteri4 ,if auscultation is used we may determine positively the position of the ftus by observing just where the sounds of the ftal heart may be most plainly heard4 ,the ,,vaginal ,,touch is the usual mode of determining whether there is an unfavorable presentation of the child1 as well as whether there is deformity of the pelvis1 tumors in the vagina1 ulcerations1 c4 ,when the head presents in the commencement of labor1 if the fundus of the uterus is not too much inclined forwards1 and there is no deformity of the pelvis1 the os may easily be reached1 and the hard round head of the child be felt without difficulty4 ,should a hard presenting part not be felt either through the dilated os or the walls of the uterus1 it may be because there is a breech or body presentation1 or there may be twins1 or there may be an unusual amount of water in the uterus1 or the child may have hydrocephalus--in either of these cases it might not be possible to decide immediately about the presentation and position4 ,,face ,,presentations cannot be detected very early in the labor4 ,before the membranes are ruptured the head is high and difficult of access4 ,when it is reached the forehead is first encountered1 afterwards we may feel the nose and mouth4 ,it is unfortunate for us that we cannot usually distinguish a face presentation in the early stage of labor4 ,it is not so important that we make an early diagnosis of presentation of the breech1 as there is no danger to the mother involved in the latter4 ,,presentation ,,of ,,the ,,body should always be detected early1 at least as soon as the membranes are ruptured4 ,the abdomen of the mother is much longer in the transverse diameter than is usual1 and the head of the child may sometimes be felt in the iliac fossa4 ,the form of the mother's abdomen is irregular as the ftus lies curved on itself4 ,when we are able to touch the ftus1 if the shoulder presents1 we first feel a small bony projection1 the acromion point of the shoulder2 then other points1 including the acute angle of the shoulder blade4 ,we should ascertain as soon as possible on which side the head lies1 and also the posterior plane of the child4 ,sometimes the hand comes down in the vagina or even appears at the vulva2 if it does we may know by that 7and by slipping the finger of our hand up into the axillary space7 just how the child lies4 ,if the back of the child's hand is turned towards the mother's right thigh the head is to the right1 and if to the left thigh1 to the left4 ,the little finger being towards the coccyx indicates that the child's back is towards the mother's loins1 and the same finger being towards the pubis is evidence that this is in front4 ,it is quite important that these points should be noted4 ,there are various causes of tedious1 difficult and obstructed labor1 and in each case we are obliged to depend principally upon the touch for diagnosis4 ,in some instances the difficulty will be obvious as soon as we attempt to make an examination4 ,a ,,narrow and ,,undilatable ,,vagina will be easily recognized1 but this will rarely be found a serious obstacle to the passage of the child2 as the labor proceeds the vagina seems naturally to dilate and to be more softened and relaxed4 ,cases have been reported where there was a scirrhus tumor or cancer connected with the neck of the uterus1 even during labor2 happily such cases are rare4 ,the scirrhus would be felt hard and unyielding4 ,a tumor of any kind connected with the os uteri1 the vagina or the rectum may obstruct the descent of the child's head more or less according to its size and mobility4 ,of course they can be detected4 ,a ,,vaginal ,,cystocele ought always to be rectified4 ,it sometimes happens that the bladder is caught by the head of the child in its descent into the cavity of the pelvis and pushed before it1 and it can be seen as a soft red tumor between the vulva4 ,the finger can be passed posterior to it1 but not anterior1 and the catheter cannot be passed in the usual direction4 ,a few cases are on record where a stone 7calculus7 in the bladder was pushed down before the ftal head4 ,a careful examination will show that the tumor is covered by the bladder2 its hardness will indicate its nature4 ,a ,,collection ,,of ,,hardened ,,feces ,,in ,,the ,,rectum is detected without difficulty4 ,it will be of an irregular form1 hard and inelastic4 ,,swelling ,,of ,,the ,,soft ,,parts may cause obstruction4 ,if the child's head is detained for a long time pressing upon the brim of the pelvis1 it may obstruct the circulation and diminish the capacity of the passage4 ,in such cases there is unusual heat and dryness in the parts4 ,when a nurse or midwife makes an examination by touching1 she needs to continue it through several pains1 and to repeat it again soon to know if there is any progress to the labor4 ,if the progress is very slow this may be from various causes1 some of which ,i will now simply name4 ,it may be because the uterus is very much distended1 and this renders the pains inefficient2 there may be partial and irregular contractions of the uterus1 weakness of constitution1 fever or local inflammation1 a want of irritability in the constitution1 a deformity of the pelvis and spine1 or doubts and fears on the part of the patient may diminish the action of the uterus4 ,the labor may be slow because it is the first one1 or because the membranes were ruptured too early1 or because the woman is advanced in years at the time of having her first confinement4 ,the uterus may be pitched over obliquely1 there may be extreme rigidity of the os uteri1 extreme rigidity of the soft parts of the mother1 a contracted or small pelvis1 the head of the child may be large and ossified so as to be unyielding4 ,one or both arms may come down by the side of the head of the child2 on the part of the mother there may be a distended bladder from inability to void the urine1 there may be cicatrices 7scars7 or adhesions of the vagina1 and in some cases it has happened that an enlarged ovary has dropped down into the pelvis1 or a portion of intestine containing scybala or hardened feces obstructs the passage1 or the os uteri is very minute1 or imperforate1 or totally absent4 ,some of these cases may demand the interference of art in the first stage of labor1 but delay at that time involves very little danger2 as a rule neither the mother nor child is in danger 7except when there is hemorrhage or convulsions7 on account of labor before the membranes are broken4 ,if the nurse can ascertain the cause of the delay and finds that time is what is especially needed1 she must exercise patience herself and encourage her patient to do so4 ,it is hardly possible to predict beforehand in what cases convulsions will occur1 but if there is much headache in the commencement of labor and if there has been considerable albumen in the urine of the patient1 we have especial reason to apprehend trouble of that kind4 ,the history of the case is important in forming an opinion as to whether there may be severe hemorrhage4 ,some women are naturally predisposed to flowing4 ,,part ,,iv4 ,,skilled ,,nursing ,,and ,,midwifery4 ,,chapter ,i4 ,,preliminary ,,instruction ,,to ,,the ,,nurse ,,midwife4 ,it is my design in giving the following instructions to prepare the student of this work to be a skilled or skillful nurse1 not to be simply a midwife2 to act in conjunction with1 not in opposition to1 physicians2 to conform to1 and not to violate laws which regulate the practice of medicine2 to officiate in cases of easy1 natural labor sometimes1 but never in cases requiring the use of instruments2 to be prepared to act in emergencies until the doctor can come and take the case2 not to treat the case when the services of a physician can be obtained and is desired or needed2 in short to act intelligently in all cases in which women now act perhaps blindly1 hurriedly and ignorantly4 ,the present state of feeling among our people1 and especially among the medical profession in this country1 would not sanction an effort to educate women solely as midwives4 ,but there is a general feeling or sentiment that every young lady ought to have that kind of education which may render her useful2 that she should be prepared in some way to minister to the desires1 wants and needs of her fellow creatures1 and that some part of that knowledge or skill should be of that kind which would be available if these persons were thrown on their own resources2 hence ,i would have some of you to be1 not only nurses of the sick1 but skilled nurses of lying-in women4 ,and should some young lady after studying this work1 decide to pursue the study of medicine thoroughly and become a physician1 the knowledge here obtained would be available4 ,,preliminary ,,instructions4 #a4 ,do not stop short of a thorough knowledge of this book1 every part of it4 #b4 ,endeavor here to get a knowledge of midwifery that will qualify you to attend ordinary cases of natural labor1 and enable you sometimes to give medicine when needed1 and when there are no physicians in attendance2 but understand that there are many times when the only proper thing for you to do is to send for a physician or experienced accoucheur4 #c4 ,do not hesitate to seek knowledge and experience and instruction from any source where you think that you can obtain it4 ,physicians will be willing to aid you1 and ,i think the time is coming when he will regard the educated nurse as his friend1 and not as his natural enemy4 #d4 ,i do not think it best that you should call yourself a midwife1 because if you do it will excite misapprehension and prejudice4 ,seek in every way to be skillful as a nurse1 and seek to have a corresponding reputation4 #e4 ,do not undervalue your position1 if you have the wisdom and courage and perseverance necessary to prepare you to minister to your sex in their time of greatest suffering and trial4 ,do not doubt that your mission is an honorable one4 ,and even if you do not minister very often to the sick in labor1 except as the right arm of the medical man1 you may help to raise the standard qualifications of the nurses of our land4 ,do not suppose that ,i am complaining harshly of our present supply of nurses4 ,women have shown a wonderful adaptability to the needs and exigencies of their suffering friends in nursing and caring for them4 ,and it is because they are so ready to receive instruction that ,i endeavor here to furnish good instruction for them4 #f4 ,do not suppose that your knowledge obtained by study is sufficient to enable you to act as midwife 7except in an emergency71 unless your studies are supplemented by observation1 as mother nurse1 c4 #g4 ,do not be unwilling to minister to women who are poor4 ,the young physician is willing to do something in this way to gain experience and for the sake of humanity1 and this will be your opportunity to gain experience without coming in competition with rivals4 #h4 ,the nurse as well as the medical man1 must study the phenomena of labor at the bedside of the patient4 ,no one can be qualified by mere reading for the duties of a midwife1 and no woman that is diligent and observing can attend a case of labor without some addition to her knowledge4 ,,instruction ,,to ,,the ,,nurse ,,midwife4 ,when ,i use the term nurse midwife ,i mean a nurse that has some knowledge of midwifery1 that can be called to attend to women near the time that she expects to be confined1 and that can remain in attendance for two weeks or more if it is desired or necessary4 ,sometimes a woman would1 if possible1 have a skilled nurse with her a week or more before confinement1 especially because she would thereby avoid sending for the physician unnecessarily1 and because she would be less likely to detain him for a long period of time4 ,if the nurse midwife understands her business she will in some cases do better for the woman than a physician in the commencement of labor4 ,for instance1 suppose that a doctor is called a distance of five miles and away from his home and his other patients1 and when he examines the case the pains seem to be of the character of false labor pains4 ,he knows that the real good of the patient might require that she should take an opiate1 but the doctor would be unwilling to give it lest it might protract a real labor1 and subject all parties to the inconveniences of a prolonged labor including unnecessary visits of the doctor4 ,the nurse who can remain with the patient1 if the labor should not be concluded in several days1 would be more likely to do just what the good of the woman requires4 ,and in such a case a skilled nurse would be peculiarly acceptable to a physician if he chanced to be called1 because he would be much more at liberty to leave his patient if it seemed necessary to do so4 ,when a nurse midwife is called to attend a case1 she should carry with her besides disinfectants1 a male catheter1 some laudanum or other opiate1 quinine1 and extract ergot1 in order to be prepared for emergencies4 ,ordinary cases may require no medicine1 but some cases do4 ,,chapter ,,ii4 ,,the ,,natural ,,labor4 ,a ,,natural ,,labor has been described as one 8in which the head presents1 and descends regularly into the pelvis2 where the progress is uncomplicated1 and concluded by the natural powers within twenty-four hours1 7each stage being of due proportion71 with safety to the mother and child1 and in which the placenta is expelled in due time40 ,a skillful1 careful examination in the commencement of labor will enable you perhaps to decide whether the labor will be natural or otherwise4 ,but it may be your duty first to know if your patient is in ordinary health1 or if she have any fever or organic disease1 and you should enquire about the bodily functions generally1 the condition of the pulse1 skin1 c4 ,before making a digital examination you should notice the character of the pains1 their frequency1 force and regularity1 the amount of voluntary effort1 the character of the outcry1 c4 ,from these enquiries you probably will be able to decide whether she is suffering from real labor1 or false pains4 ,she will1 however1 probably not object to a digital examination and your opinion will be founded principally upon that4 ,the modern practice is to wash the hands in antiseptic soap or some solution before making an examination4 ,we are directed by most writers to have the patient lie upon her left side near the edge of the bed when we examine her4 ,the fore finger of the right hand 7sometimes the left7 after being well oiled or soaped should be passed along the perineum into the vaginal orifice1 and is to be pressed upward and backward towards the promontory of the sacrum until the os uteri or the presenting part is found4 ,sometimes this is not reached without an effort4 ,when reached endeavor to find the ftal head or to determine what is the presenting part--feel sufficiently to distinguish the lips of the os uteri from the presenting portion of the ftus4 ,do not be hasty in making the examination2 wait till you examine sufficiently to know if the child is forced down2 observe both during the time of a pain and during an interval1 and observe if the pains dilate the os4 ,sometimes during a natural labor there may be a severe pain1 and when the pain is hardest1 the os contracts4 ,by waiting to take a number of pains you will learn if there is real progress4 ,when examining1 note the calibre1 heat and moisture of the vagina2 the general condition of the cervix2 the dilatability of the os uteri and the actual dilatation by the bag of waters or the ftal head during a pain4 ,if the head presents you can best learn the particular position when the pain is off2 and after the membranes are ruptured you can decide better than previously4 ,ordinarily the sagittal suture can be felt1 and perhaps both fontanelles1 but you must not be discouraged at all if you cannot determine the exact position4 ,doctors ordinarily do not deem it necessary4 ,if you can decide that it is a head presentation and that the woman is undoubtedly in labor1 you may probably decide that the labor will be natural1 and you may properly tell the friends so1 adding perhaps1 that it will depend upon the character of the ensuing pains whether the labor will be protracted or short4 ,various circumstances of which you are possibly not yet cognizant may make your case of labor a tedious or difficult one4 ,you have decided1 perhaps1 that there is no obstruction to the passage of the child1 no deformity of the pelvis1 scirrhus or other tumors in the vagina1 no cystocele1 no prolapsed ovary1 and that there is not a rigid perineum or imperforate vagina4 ,if there is1 you need to have a medical man present1 but should none be obtained you will need to repeat your examination from time to time4 ,observe if each pain presses down the bag of waters and dilates the mouth of the womb1 and if the soft parts are in a relaxed state1 and if there is a show4 ,even if the appearances are thus promising1 the labor may be slow and tedious from various causes4 #a4 ,possibly hardened feces maybe in the rectum2 if they are you may be assured of the fact when you make a digital examination1 as they seem like tumors posterior to the vagina4 ,the remedies are physic1 enemas1 rest--possibly opium4 #b4 ,inefficient pains may be due to a bladder distended with urine4 ,when this is suspected we should observe whether there is abdominal swelling 7not tympanitic7 low down2 pain on pressure which gives rise to a desire to urinate2 a constant desire to pass water though the patient has just performed the act1 or a dribbling of water from the parts4 ,if the bladder cannot otherwise be relieved a catheter should be used1 and as a precaution to avoid wetting the bedclothes it is well to have a catheter made long enough by affixing a piece of ,india rubber tubing to the end of it to reach a vessel at the side of the bed4 ,never use force in passing a catheter in4 ,it is very seldom that it is necessary to use it at all during labor4 #c4 ,if there is a hernial protrusion of the bowel1 or a calculus of the bladder falling down in the passage you will probably have a medical man to officiate4 ,but ,i may say that if there is need of your doing anything to replace them1 or if it is necessary to return a prolapsed bladder1 you can best do it when your patient is in the knee-chest position4 #d4 ,the lack of expulsive power is sometimes due to the want of sleep4 ,if the first stage1 that of dilatation1 is prolonged the subsequent uterine contractions seem to want efficiency4 ,in such cases if the patient can have a dose of opium or morphine administered to induce sleep it acts favorably4 ,where there is nervous excitement particularly1 the efficiency of the pains are increased if we give opium and first procure a period of rest4 #e4 ,the uterus may be greatly distended and its expulsory power thereby weakened4 ,in such cases there may be a suspension of the action of the uterus for several hours although the labor before that had made considerable progress4 ,if pains of labor are feeble or slow or suspended1 no harm can come to the mother or child 7in such cases7 except that the mother is compelled to bear them for a longer time4 ,the only remedy that ,i would suggest is that the distention be relieved by the rupture of the membranes and discharge of water4 ,if more efficient pains did not come on1 then ,i would give a dose of morphine1 which would either increase the pains1 or give a period of rest4 #f4 ,sometimes there are vehement and cramp-like pains in the abdomen producing no effect that is good and adequate1 caused by partial irregular or spasmodic contractions of the uterus--usually what are called hour-glass contractions4 ,if the bowels have been evacuated and there is no improvement1 ,i would give one-fourth grain of morphine which will enable the woman to go through her labor more easily1 and perhaps quite as quickly4 #g4 ,it is generally believed that a cord being very short and being around the neck of the child may protract a labor4 ,i do not deny that this may possibly occur1 and when the child's head is born1 and ,i find that there is a coil of the funis on its neck ,i loosen it4 #h4 ,weakness of the constitution when the general health of the woman is below the natural proper standard may be a cause why the uterine contractions are not severe4 ,but in such cases the parts are not rigid1 and nothing more than a dose of four or five grains of quinine is needed to make the pains effectual4 #i4 ,a want of irritability in the constitution frequently observed in fat and inactive women1 or in those who are exceedingly timid1 will sometimes be a cause of slow and lingering labor4 ,fear often lessens the energy of all the powers of the constitution1 and diminishes or wholly suppresses for a time the action of all the parts concerned in parturition4 ,attendants should endeavor to inspire such patients with activity and resolution1 and remove all fear from their minds4 ,these cases are not dangerous but ,i have often found it necessary in this kind of cases to apply forceps4 ,the skilled nurse might perhaps give eight or ten grains of quinine1 if no physician has charge of the case4 #aj4 ,every woman is expected to suffer greater pain and to have a more tedious labor with her first child1 and if a woman be advanced in age at the time of having her first child the difficulty attending her labor may be somewhat greater4 ,a longer time may be required for the completion of the labor than in ordinary cases1 but ,i do not advise giving any medicine unless it is perhaps a dose of quinine4 ,there may be a little more need of assistance by instruments1 c4 #aa4 ,an oblique position of the os uteri1 it being projected on one side or the other of the center of the superior strait1 or so far backwards that it cannot be felt for several hours after labor has begun1 is a cause of delay4 ,the presenting part may be found pressing against the walls of the pelvis at one point1 instead of keeping its course in the center of the pelvic cavity4 ,you should endeavor to place the patient so as to remedy this condition4 ,when the presenting part is found to one side1 it will be found that the fundus of the womb is lying to the opposite side2 this should be remedied by a proper support of the abdominal tumor or by holding it up by the hands4 ,for example1 if the os uteri be projected to the left side1 she ought to rest on the right side and have a pillow placed under her body2 some physicians would prefer that she lay on the left side1 but without the pillow under her4 #ab4 ,extreme rigidity of the os uteri is a cause of tedious and very painful labors4 ,it sometimes happens that the os is dilatable1 but the pains are not sufficiently expulsive4 ,perhaps at the same time the os is found far back towards the promontory of the sacrum1 and the head appears not to be driven directly into the os so as to aid in its dilatation1 but rather presses against the anterior wall of the cervix4 ,in such a case the end of the finger can be hooked into the anterior lip of the os uteri so as to aid in the dilatation1 and also to help correct the displacement of the os4 ,in other cases we may help dilate the os by a firm and gentle sweep of the finger around the advancing part of the child's head within the os4 ,but we cannot always do this1 because we may be afraid of rupturing the membranes prematurely4 ,if the membranes have been already ruptured1 we may act more boldly1 but we must never make any great efforts to dilate it artificially lest we excite inflammation4 ,in many cases it is best to give gr4 of morphine1 and inform the suffering woman that she cannot possibly get through her labor in a short time1 but if you can give her an hours' rest1 the os1 which is rigid1 will be more relaxed and pains more effectual4 #ac4 ,in first labors there is sometimes unusual rigidity of the soft parts1 which are external4 ,where the perineum is rigid it may require several hours continuance of the pains before it is sufficiently stretched to allow the head of the child to pass4 ,but the difficulty can hardly be relieved by our interposition4 ,we should generally wait the due time1 as we must also if the os coccygis is anchylosed with the sacrum4 #ad4 ,the head of the child may be comparatively large when the pelvis is of the ordinary form and size4 ,this may be a cause of delay though it may perhaps cause nothing more than prolonged1 tedious labor4 ,in such cases you have time to send for a doctor1 even if he lives at a distance4 ,after the woman has been a long time in labor he will think it best to apply the forceps4 ,you will be importuned in cases of slow and tedious labor to administer ergot1 but any one who knows the action of the drug would never give it in any of the following cases3 #a4 ,where the os is not well dilated4 #b4 ,when any mechanical obstacle exists to the passage of the child1 or when there is a tendency to convulsions1 and you should never give ergot except for hemorrhage2 and when you have much reason to fear it1 you may in such cases give one or two twenty drop doses of the fluid extract very near the termination of labor4 ,quinine may be given as an oxytocic with safety4 ,morphine is liable to render the pains weak for a time1 but it often increases their efficiency4 ,i will now enumerate your duties when you act as accoucheur4 #a4 ,ascertain if the lady is really in labor4 ,make a digital examination4 ,if the os is high up so as to be reached with difficulty1 slightly patulous and rigid1 and the pains are felt in front1 there is reason to believe that the labor has not yet commenced--that she only has false labor pains4 ,at this time attend to the bowels2 give perhaps paregoric or morphine to relieve her of what is to her useless and exhausting agony1 and enjoin rest4 ,you may at this time properly give her an enema containing of a grain of morphine or fifteen grains of chloral dissolved in gruel or starch or mucilage4 #b4 ,when you make an examination and find that the pains are efficient in producing a dilatation of the os uteri1 that the parts are soft and relaxed1 if there is a secretion called the show1 if there is a favorable presentation1 and the labor is making some progress1 the patient should be told of all that is favorable in the case4 #c4 ,be careful in making early examinations to1 first1 if possible1 reach the os with the finger4 ,when your finger presses against the cervix it will hurt her considerably more than it will when it presses against the presenting part of the child4 #b4 ,avoid rupturing the membranes4 #c4 ,notice if there is anything observable to hinder the progress of the labor4 #d4 ,note any progress of the labor4 #d4 ,if everything is favorable1 assure the patient of the fact2 if you have doubts and fears upon some point1 you need not express all your fear1 but do not delay to send for a physician4 #e4 ,you may in the early stage of labor1 permit the patient to move about as she wishes1 and she may rest on the sofa when tired4 ,she may have her usual diet1 but not any stimulants4 #f4 ,from time to time make an examination4 ,if the os is dilatable you need not fear that the membranes may then be ruptured4 ,learn as fully as possible the presentation and position1 and if you press your finger against the child's head you may thereby reinforce weak pains4 #g4 ,do not annoy the patient by pressing upon the back or anywhere during a pain if she requests you not to1 but when she does not object you can make such pressure as will reinforce the action of the abdominal muscles4 ,when she is lying on her back with her shoulders elevated so that she is in an almost vertical position1 you can stand beside her with your back towards her head1 and make the necessary palpation by pressing with your hands on her abdomen1 one of them on each side4 ,do this only when there is no tenderness1 when the os is dilated1 when there is a normal pelvic canal and a low position of the presenting part4 ,seek in thus pressing to move the uterus to the axis of the pelvic brim1 then with the palms of your hands to the sides or fundus of the uterus press gradually downward1 increasing the pressure for six or eight seconds1 and then gradually diminishing4 ,you may repeat this as often as she has a pain1 and with an increasing force1 and if the patient assents1 you may make such pressure unremitting4 #h4 ,when the os uteri is fully dilated or soft and dilatable1 the membranes may be broken by pressing with the end of your finger against it1 or if this does not suffice1 the finger nail previously nicked may open it4 #i4 ,when free hemorrhage occurs prior to delivery1 it may depend upon placenta previa2 that is1 upon the placenta being attached very near or over the mouth of the womb2 in such a case obtain a physician to take charge of the case if possible4 ,you may yourself give half a teaspoonful of extract of ergot in the emergency4 #aj4 ,during the progress of the labor you must always remember that the unassisted1 natural powers are in most instances fully sufficient to bring the labor to a safe termination1 and whatever you do should be of the kind that is not harmful4 ,the important thing for the attendants to possess is gentleness and patience1 and it is a good thing for the patient if she can be kept tranquil and cheerful4 #aa4 ,a little light food may be offered the patient at any time during labor4 #ab4 ,during the first stage of labor the patient must not strain or bear down to the pains1 but it is my practice when ,i examine my patient and find that the head has not yet entered the pelvis1 at the same time that the touch stimulates the uterus to contract1 ,i direct the patient to bear down during each pain4 ,after the head is fully engaged in the bones1 no stimulus to pain is needed2 however1 as the bearing down pains come on1 she should be advised to strain or press down4 #ac4 ,towards the last1 when she is in great pain1 if she be inclined to cry out1 let her do so2 never reprove her4 #ad4 ,i approve of giving chloroform in some cases1 but ,i do not advise the skilled nurse to give it except when a physician is present to direct its use4 #ae4 ,during the latter part of the labor the only assistance you can render the woman is to support the back1 and to give her something to pull upon if she is so inclined4 ,a sheet tied to the foot of the bed may be useful for this purpose4 ,at the very last1 bearing down efforts should be discouraged4 #af4 ,when the head is about to be expelled we always fear there may be slight or severe lacerations of the perineum4 ,do not in any way hasten the expulsion1 even if there should be a number of pains in which a part of the head presents externally during the pain1 and then recedes when the pain goes off4 ,i have not always been able to prevent laceration1 but the following directions are the best that ,i can give3 ,endeavor to have the patient extend her legs1 and do not have her knees drawn up close to the body at the last4 ,when the perineum is put on the stretch1 place the thumb and forefinger of the right hand on either side of the perineum1 and press so as to aid the stretching or distention4 ,when the perineum is distended and protruding you may cover the hand with a soft napkin and apply it across the perineum1 also by the sides of the vulva1 and make firm1 moderate pressure during the pain4 ,endeavor to have the pressure equable around the head of the child4 #ag4 ,when the head is expelled an attendant should make steady gentle pressure upon the uterus and follow it down1 keeping her hand firmly upon it for several minutes1 perhaps for half an hour1 or if you have given a little attention to the child1 you yourself may put your hand on the contracted uterus and firmly knead it for ten minutes4 #ah4 ,it is not necessary to extract the body immediately after the expulsion of the head4 ,it is better to wait three or four minutes for the return of a pain before making any traction4 #ai4 ,although a little traction can be made on the head1 it is a better way while an attendant presses on the uterus1 and while you hold on to the child's head with one hand1 insert a finger of the other hand into the axilla1 7under the child's arm7 and gently extract the body4 #bj4 ,the child may be born apparently asphyxiated--its face swollen--and of a dark livid color1 and at first make only feeble and gasping efforts at respiration2 if there is the least beating of the heart can be perceived1 there is fair hopes of its recovery4 ,the cord should at once be tied and the child removed from the mother4 ,if one or two slaps on its body does not make it cry1 try immediately artificial respiration by the ,sylvester method perhaps1 not omitting at first and afterwards to throw a little cold water on its body4 ,if these efforts fail ,i would try to induce respiration by placing my hand over its nostrils and blowing into its mouth1 and immediately afterwards compressing its lungs4 #ba4 ,as soon as the child cries1 as it most generally will as soon as it is born1 proceed to tie and separate the cord4 ,tie the cord tight1 so that it is thoroughly compressed and the vessels obliterated1 applying the ligature about one and a half inches from the child1 and then cut the cord one inch further from the child4 ,the child can be rolled in flannel and removed1 and you can attend to the mother and to the removal of the afterbirth4 #bb4 ,in only a very few cases ,i have had post partem hemorrhage or adherent placenta to trouble me1 and ,i commend to you the method that ,i have used for the removal of the placenta4 ,i do not tie the cord until circulation has ceased in it4 ,i then sever it1 and usually two or three ounces of blood may flow from it4 ,this ,i suffer to run into some vessel to avoid soiling the bed uselessly1 and then wind the cord around my right hand so that ,i can hold it4 ,if ,i cannot have an attendant to make proper pressure on the uterus1 ,i immediately endeavor to compress it as much as ,i possibly can with my left hand1 but ,i make very little traction on the cord4 ,i usually instruct some one else to make strong and firm pressure upon the uterus1 and ,i pass two fingers of one hand into the vagina1 and learn thereby when the placenta descends1 and if necessary assist in its removal4 ,although we should never hurry in removing the afterbirth1 ,i believe that it always is easily removed if we make the effort very soon after the child is born1 and if it is necessary for you to pass your hand into the uterus you can do so then better than at any other time4 ,judging from my own experience in cases of retained placenta1 if you pass your hand along the cord into the uterus1 you will find that an hour-glass contraction retains the afterbirth 7whether adherent or not7 in the fundus4 ,you will have to press your fingers through the constricted portion and grasp it1 and you can remove it steadily and slowly1 but not stopping to give it 8one or two turns in the vagina40 #bc4 ,,post ,,partem ,,hemorrhage is liable to occur2 when it does1 obtain a physician as soon as you can1 but some things must be done immediately4 #a4 ,some one must grasp and compress the womb continually4 #b4 ,remove the pillows and raise the foot of the bed so that the patient's body lies higher than her head4 #c4 ,if you have it1 give a small teaspoonful of extract of ergot1 or twenty drops spirits turpentine or 7,f4 #if47 #d4 ,examine to know if possible1 the source of the hemorrhage2 if it comes from the vagina or perineum where there is laceration1 it is not very dangerous4 ,inject hot water of the temperature of #aae into the uterus1 and apply a dry cotton cloth1 heated as hot as possible1 to the abdomen externally4 #e4 ,before using the injections remove all clots from the vagina4 #f4 ,quinine and stimulants may be exhibited if there is sinking1 and ice may be applied to the abdomen and to the internal surface of the uterus1 if the bleeding continues4 ,i will here direct another thing which is very effectual1 and which might be used at first in preference to anything else4 #g4 ,after removing the clots take a handkerchief or piece of muslin1 saturated with vinegar1 in your hand1 pass it entirely into the uterus1 and let it remain there #ae or #bj minutes1 and your hand also4 ,your hand will compress the open blood vessels1 and keep a clot in the mouth of them1 and the vinegar will act as the best astringent that can be used4 ,in one case of violent flooding ,i simply held my hand still in the uterus for five minutes1 and the flow ceased4 ,after the hemorrhage subsides you must be careful not to raise the patient's head above the level suddenly2 her life may be put in jeopardy by suddenly raising her so that she sits up4 ,,after ,,pains are very seldom severe in primapara cases1 and they are less likely to be severe if the proper manipulations have compelled the womb to close completely1 expelling all clots1 c4 ,but sometimes there is a peculiar irritability or neuralgic condition of the womb which gives rise to excruciating pains4 ,ordinarily you may use ,tully's powder4 7,f4 #abc1 #ic1 #ie1 #ajg47 ,,retention ,,of ,,urine in some cases necessitates repeated visits of the physician1 and he will appreciate a nurse who can introduce the catheter4 ,if the patient cannot at first void the urine1 perhaps the application of a hot wet sponge over the pubis may enable her to do so4 ,but it may be necessary to introduce a catheter two or three times a day until she regains her power over her bladder1 or until the swelling of the urethra subsides4 ,it is well for the nurse to know that owing to the distensible state of the abdominal parietes1 the patient will lay twelve or fourteen hours1 perhaps1 after the child is born1 without manifesting a desire to void the urine1 though her bladder may be very full1 and you should remind her of the necessity of passing the water1 lest it produce cystitis4 ,in some instances the urethra and neck of the bladder are extremely irritable1 causing strangury1 and there may be some difficulty in passing the catheter1 but the urine must be evacuated1 and afterwards it may be necessary to use ergot1 laxatives1 opiates and fomentations4 7,f4 #abe1 #abf1 #afb47 ,,chapter ,,iii4 ,,convalescence4 ,,variations ,,from ,,ordinary ,,convalescence will1 under ordinary circumstances1 receive necessary attention from the physician1 but the skilled nurse should know as much about them as possible1 and ,i here make a brief reference to some of them4 ,the ,,nervous ,,shock1 caused by the last pains of labor1 in some cases is very severe4 ,this is indicated not only by the exhaustion1 but by the countenance which is expressive of suffering1 anxiety and oppression4 ,the pulse may be very slow or unusually rapid1 the breathing may be panting4 ,opium is the best remedy1 and this may be given in small doses repeated1 or a teaspoonful of paragoric may be given1 also aromatic ammonia1 and #c or #d drops of spirits of camphor4 ,the ,,state ,,of ,,the ,,pulse after a natural labor soon comes down to near the ordinary standard2 if it remains above a hundred it is because there is some special cause4 ,it will be quick if there are very hard afterpains1 a tendency to flooding1 diarrha or disturbance of the stomach1 and it is quickened also when lactation commences4 ,the ,,lochial ,,discharge ordinarily continues about three weeks1 at first of pure blood mixed with coagula1 and if good uterine contraction has not been secured1 coagula may be expelled for several days after the delivery4 ,sometimes there is a ,,sudden ,,decrease ,,of ,,the ,,lochia1 perhaps on the fifth and sixth day1 and at the same time an increased bulk of the womb1 and increased frequency of the pulse4 ,apply hot fomentations to the abdomen1 and probably some clots will be expelled1 but at the same time give purgative enemata2 and if there is abdominal tenderness give an aromatic purgative and laudanum4 7,f4 #ajh1 #abb74 ,there are remarkable differences in the ,,quantity1 ,,quality ,,and ,,odor ,,of ,,the ,,lochia without any morbid affection of the uterus or vagina4 ,but when the lochia are acrid1 the vagina1 labia and external parts become excoriated1 and smarting or itching is caused4 ,try extreme cleanliness1 frequent bathing1 lead lotions1 black wash1 vaginal injections of warm water1 and ,f4 #aec1 #aed4 ,if the discharge ceases a few hours after birth1 or if it continues the usual time1 but in very small quantity1 or if it is prolonged beyond the usual period1 or if it is excessive at first1 and if at the same time all the other symptoms are favorable1 there is not occasion for much medicine1 though it may be necessary to give the patient a better diet1 possibly some tonics4 7,f4 #agd1 #age74 ,it sometimes occurs that the lochia is suddenly discharged in double quantity after the patient is permitted to sit up or walk about4 ,in such cases enjoin extra rest4 ,if the red discharge continues longer than usual1 or if it return after yellow or greenish discharges1 you should be on your guard against ,,hemorrhage4 ,enjoin rest in a horizontal position under light clothing4 ,occasionally the ,,lochia ,,have ,a ,,very ,,fetid ,,odor4 ,it is not very rare to observe a very disagreeable odor in the lochia without any bad results1 but this often indicates the retention and putrefaction of coagula or a small portion of the placenta or membranes4 ,syringe out the vagina freely night and morning with ,labaraques solution or some other antiseptic wash1 7,f4 #aec7 and once or twice a day with warm milk and water4 ,a weak solution of carbolic acid #a in #ej may be used1 and it may be proper to throw it into the uterus4 ,the ,,secretion ,,of ,,milk generally becomes established in about forty-eight hours1 and very often on the third day the breasts become turgid1 hot and painful4 ,there may1 or may not1 be some general disturbance1 fever1 chills1 c41 but if there is it will usually be relieved after the milk is drawn out4 ,it is customary on the morning of the third day to secure an action of the bowels1 and this generally allays the vascular action if it is excessive4 ,but very trivial causes may set up ,,inflammation ,,of ,,the ,,breast1 and this is always liable to end in suppuration1 which may be long continued and distressing4 ,the ,,mammary ,,inflammation may follow exposure to cold1 a blow or other injury on the breast1 some temporary engorgement of the lacteal tubes1 or sudden and depressing mental emotions1 and it often follows from fissures and erosions of the nipples4 ,to prevent the formation of an abscess1 endeavor to remove the engorgement of the lacteal ducts by gentle hand friction with oil or ,f4 #bji1 #bjb4 ,moderate the inflammation by giving five drops of the extract ,phytolacca decandra 7,poke root7 every two hours--give saline cathartics1 minute doses of aconite1 and perhaps a large dose of quinine4 ,keep the patient in bed and have the affected breast supported by a suspensory bandage4 ,apply hot fomentations containing a solution of carbolic acid1 or poultices containing it1 and the breasts may be smeared with belladonna extract rubbed down with glycerine2 or belladonna liniment or ointment may be applied 7,f4 #bja74 ,belladonna plasters or diachylon plasters may be useful4 ,give #ae grains bromide potassa4 ,,when ,,pus ,,has ,,formed notwithstanding efforts made to cure the inflammation1 as soon as it is near the surface so that it can be detected by the fluctuation1 the abscess should be opened4 ,during the last few years careful surgeons have been unwilling to make any incision or lance even an ordinary abscess without employing some antiseptic method1 such perhaps as the following3 ,the patient's skin where the incision is to be made1 is first to be washed in #a to #ajjj bichloride of mercury solution--hands and instruments employed in the work must touch nothing that is not sterilized2 hands must be washed in the same solution before operating--sponges that are used must be cleaned and stored in a #a to #bj carbolic acid solution1 and instruments must be soaked in the same for #ae minutes before being used1 and some apply a large wad of bichloride of cotton or gauze to catch the exuded pus4 ,the following is ,lister's antiseptic method which he first directed1 to prevent the introduction of air containing living germs3 8,a solution of one part of crystalized carbolic acid in four parts of boiled linseed oil having been prepared1 a piece of rag from four to six inches square is dipped into the oily mixture and laid upon the skin where the incision is to be made4 ,the lower edge of the rag being then raised a scalpel or bistoury dipped in the oil is plunged into the abscess and an opening about three-quarters of an inch in length is made1 and the instant the knife is withdrawn the rag is dropped upon the skin as an antiseptic curtain1 beneath which the pus flows out into a vessel placed to receive it1 and all the pus should be pressed out as near as may be4 ,for a dressing afterward ,playfair recommends the following3 ,about six teaspoonfuls of the above mentioned solution of carbolic acid in linseed oil is mixed up with common whiting to the consistence of firm paste2 this is spread upon a piece of tin foil about six inches square1 so as to form a layer about a quarter of an inch thick2 the tin-foil thus spread with putty is placed upon the skin1 so that the middle of it corresponds to the position of the incision1 the antiseptic rag used in making the incision being removed the instant before4 ,the tin-foil is then fixed securely by adhesive straps1 the lower edge being left free for the escape of the discharge into a folded towel placed over it1 and secured by a bandage4 ,the dressing is changed once in twenty-four hours1 as a general rule1 and must be methodically done4 ,a second similar piece of tin-foil having been spread with the putty1 a piece of rag is dipped in the oily solution and placed on the incision the moment the first tin is removed4 ,this prevents mischief during the cleaning of the skin with a dry cloth1 and pressing out the discharge from the cavity40 ,the same author directs methodical strapping of the breast with adhesive plaster1 in cases of long continued suppuration1 and he adds that 8much attention must be paid to general treatment1 and abundance of nourishing food1 appropriate stimulants and such medicine as iron and quinine will be indicated40 ,i give on the authority of another the following as good treatment for ,,sore ,,nipples3 8#a4 ,keep everything that will irritate1 whether clothing or medicine1 away from the nipple1 and have the excess of milk drawn from the breast in the easiest way possible4 #b4 ,keep the excoriated nipple thickly covered with sub-nitrate of bismuth4 #c4 ,when the nipples are cracked at the base keep the cracks filled with bismuth1 and put on a round piece of adhesive plaster starred in the centre1 and just large enough to slip over the nipple and extend around its base an inch or more every way4 ,when this is loosened it must be reapplied40 7,f4 #bca1 #bdc74 ,there are certain accidents of parturition so grave in their nature1 and attended by symptoms so alarming and urgent that no nurse would attempt to treat the patient except under the direction of a physician4 ,i only refer to them because it is believed that some of these serious cases might have been prevented by early proper action on the part of the midwife or other attendant4 ,,inversion ,,of ,,the ,,uterus sometimes occurs1 though but rarely4 ,if it is in the practice of a midwife1 and if she be at the time pulling on the cord1 that will be assigned as the cause of the accident4 ,inversion consists essentially in the enlarged and empty uterus being either partially or entirely turned inside out4 ,the immediate symptoms are those of shock or collapse--fainting1 small1 rapid and feeble pulse1 possibly convulsions1 or vomiting1 and a cold1 clammy skin4 ,the countenance becomes deadly pale1 the voice weak1 and other symptoms indicates sudden exhaustion or sinking4 ,in cases of partial inversion the symptoms are not so striking4 ,hemorrhage to a large amount1 frequently but not always occurs4 ,in more than half the cases no mechanical cause can be traced1 but as it is sometimes attributed to pulling on the cord1 to pressure with the hand on the fundus1 and also to the patient straining forcibly1 these combined causes should be avoided4 ,when the symptoms named are present1 you can give the patient some aromatic ammonia or other stimulant2 always obtain a physician as soon as possible4 ,,puerperal ,,mania is nearly always preceded by restlessness1 want of sleep1 and other premonitory symptoms4 ,when the mania first comes on there is usually causeless dislike to those around her1 and as the child may be the object of suspicion1 the nurse must be extremely careful that the patient does not have an opportunity to seriously injure it4 ,the course of treatment must be mainly directed to the maintenance of the strength of the patient1 and the two things most needful are a sufficient quantity of suitable food and sleep4 ,possibly your efforts in this direction before the disease is fully developed1 may ward off the disease4 ,,puerperal ,,septicemia was formerly called puerperal fever2 as its nature is now better understood than formerly1 we hope to do more than was formerly done to prevent it4 ,this fever is now very generally believed to be produced by the absorption of septic matter into the system1 through some tear or laceration in the generative tract such as exists after labor4 ,this septic matter may be from within the patient such as coagula1 or membrane1 or placenta partly decomposed2 or from without as might be on the hands of physician and nurse1 or in the air from cases of erysipelas1 c41 or in some way from puerperal patients4 ,the notion that puerperal fever and septicemia is produced by ,,bacteria has now become an established doctrine1 and has given rise to a rational treatment based thereon1 especially for their prevention4 ,as prophylactic means may be mentioned1 the use of a carbolic solution #a in #cj which the practitioner or nurse applies before touching any case1 the use of carbolized oil #a in #h for lubricating the fingers1 catheter1 forceps1 c42 syringing out the vagina with diluted ,condy's fluid1 rigid attention to cleanliness in napkins1 c4 ,the nurse should use antiseptics to only a very limited extent without the advice of a physician4 ,,chapter ,,iv4 ,,care ,,of ,,infant ,,children4 ,infants sometimes require treatment for ailments either slight or severe when the advice of a physician cannot be obtained4 ,the ,,naval is sometimes a little sore after the naval string comes away4 ,it may be dressed by putting a little simple cerate or vaseline or carbolized cosmoline on lint or a linen rag1 and applying it to the part affected every morning1 and a bread poultice every night until it is quite healed4 ,a ,,rupture ,,of ,,the ,,naval is sometimes caused by much crying1 and it may be occasioned by the nurse pulling on the cord to remove it before it will readily separate from the infant's body4 ,the best treatment is a piece of adhesive plaster as large as the top of a tumbler1 with a properly adjusted pad made of several folds of muslin fastened on the plaster1 which will keep the bowels from protruding4 ,the bandage or belly band can be put on over this4 ,if the infant have a ,,groin ,,rupture the only proper treatment is to keep on it day and night if it cry much1 a well fitting truss4 ,in applying the truss be careful to return the rupture thoroughly1 and endeavor to have it well adjusted or it will chafe and will not effectually cure4 ,if the child is ,,tongue ,,tied so that it cannot apply its tongue to the nipple to suck1 the frenum may be cut1 but it will not be necessary to make more than a small nick or a slight cut in it4 ,,milk ,,in ,,the ,,breasts ,,of ,,new ,,born ,,infants1 or a serous fluid resembling it1 is often found1 and sometimes there is considerable swelling both of the breasts of male and female children4 ,it is not the better way to apply plasters or to squeeze or press them1 but the milk may be drawn out by putting an open top thimble over the nipple and drawing on it4 ,,chafings may be caused by inattention to cleanliness4 ,fat babies are subject to them1 and when there is disorder of the bowels or kidneys they cannot at all times be prevented4 ,thoroughly sponge the parts with tepid rain water1 allowing the water from a well filled sponge to stream over them1 then carefully dry with a soft towel1 and perhaps dust over them sub-nitrate of bismuth4 7,f4 #bjb47 ,,diarrh,a and ,,dysentery and also ,,costiveness are among the ailments with which infants may be afflicted4 ,i wish to be particular in giving directions1 that these may generally be avoided1 but ,i must again repeat that the nurse should never be influenced by my advice to do any thing contrary to the directions of the attending physician4 ,to avoid the subsequent necessity of giving medicine you must be very careful in their administration at first4 ,it is indeed necessary that the meconium should be purged off at first1 but nature in general provides such physic as is required1 and if the child is applied to the mother's breast1 it obtains in the colostrum such medicine as it needs4 ,where the infant cannot obtain anything from the breast a gentle aperient may be given1 and ,i name the following as being suitable3 either molasses and water1 raw sugar1 a solution of manna in warm water1 a teaspoonful of sweet oil1 or of simple syrup of rhubarb1 or in more obstinate cases1 of castor oil1 or one-fourth teaspoonful compound licorice powder1 7,f4 #ajh47 but you must never give a drastic purgative1 and you must not repeat the aperient if the discharges become yellow and natural4 ,a young infant ought to have from three to six motions in the twenty-four hours1 the color ought to be of a bright yellow or orange1 and of the consistency of mustard as ordinarily prepared for the table1 and there ought not to be any lumps or curds in its motions4 ,a mother or nurse ought to be very observant of the state of the bladder and bowels--should inspect motions daily and see that they are not slimy1 or curdled1 or green4 ,if they are she should be very careful1 especially in regard to what the mother eats and drinks4 ,if the bowels are costive she must avoid the frequent repetition of opening medicine1 however gentle and well selected the aperients may be4 ,they interfere with digestion1 often irritate the bowels1 and render them more costive4 ,for the sake of the child as well as herself1 the mother may vary her diet considerably after the first week1 she may eat boiled and stewed1 broiled and roast meats1 mutton1 lamb1 and beef1 fish1 game1 and chickens1 potatoes1 turnips1 spinach1 celery1 peas1 beans1 figs1 bananas1 prunes1 baked apples1 c4 7,f4 #de to #fj47 ,the bowels of the child that nurses generally 7not always7 keep pace with those of the mother1 and she must endeavor both for her own sake and that of the child1 to keep her bowels loose by means of diet4 ,if necessary she must take physic4 7,f4 #ajg1 #ajh1 #aji47 ,if the constipated child nurses the mother and the mother constantly pays proper attention to her own health1 and especially to her diet1 the child will very seldom require physic4 ,indeed ,i would not give active physic when the child seemed well1 if it did not have a passage oftener than once a week4 ,if it has cow's milk or other food besides the mother's milk1 do not boil the milk and you can add to the cow's milk1 corn starch1 or the following3 ,make a thin mush by boiling a small quantity at a time of unbolted wheat flour in water and straining it through a sieve while hot4 ,the child may sometimes be fed with this alone1 a little sweetened4 ,molasses may be given freely1 or molasses and soda4 ,the child should be watched1 and if there is occasional costiveness1 and at the time any indisposition1 make a suppository of common soap about an inch in length and a quarter of an inch thick1 dip it in water and pass it into the rectum4 ,or give an injection of less than a gill of water with perhaps a teaspoonful of molasses and a pinch of salt4 ,but ,i would avoid the practice of giving an enema daily1 as tending to get up a bad habit in the system4 ,should the costiveness have provoked fever1 induced pain1 or excited convulsions1 active physic may be given1 either castor oil1 magnesia1 calomel1 or ,f4 #ajh4 ,but be sure that costiveness is not brought on by giving paregoric or other opiates1 and let a child drink freely of pure cold and fresh water4 ,the water may be boiled to destroy germs1 and then cooled in a refrigerator2 it should always be boiled before being used when there is an epidemic of bowel complaint prevailing4 ,in ,,dysentery there is a specific inflammation and ulceration of the mucous membrane of the colon1 especially of the lower part1 and of the rectum--there is generally some fever1 frequent and bloody stools1 tenesmus1 and griping pains4 ,sometimes it attacks an infant or a delicate child1 there being at first for several days diarrha1 the motions being slimy and frothy like frogspawn1 afterward entirely mucous and blood4 ,the child is dreadfully griped1 strains violently1 and screams1 and twists about every time it has a motion1 and there is vomiting and great prostration4 ,you should in treating the child at the breast still keep him to it1 and give it no other food4 ,if the mother's milk is not good1 procure if possible a healthy wet nurse4 ,if the child must be fed give it cow's milk from one healthy cow--fresh from the cow--small quantities at a time and frequently1 mixed with gum arabic water4 ,in the commencement a warm bath may be used1 or as a substitute you may wrap the child in a blanket that has been previously wrung out of hot water2 over this put a dry blanket and keep the child thus enveloped for twenty or thirty minutes4 ,formula #gd and #ii may be used1 but the dose for a young child must be small to accord with its age4 ,,cholera ,,infantum is more prevalent in the ,united ,states than in any other country4 ,the continued heat of summer is a predisposing cause1 and improprieties in diet and clothing1 worms1 premature weaning1 and teething are exciting causes4 ,you may treat this disease in the initial stage by giving ,f4 #hj1 and also for a child a year old1 injections of a gill of warm water in which a teaspoonful of common salt has been dissolved1 allowing the patient three or four times a draught of warm water1 as much as it desires to drink4 ,perhaps the drink will be immediately vomited1 but it will at least remove irritating matter from the stomach4 ,the injection1 too1 may operate immediately1 but it may bring with it a fecal or bilious discharge1 and if several times repeated1 its effects will be salutary4 ,a muslin cloth heated almost to scorching and applied once or twice dry to the neck1 may stop vomiting1 and draughts applied to the extremities may also be of much benefit4 ,after using injections of warm soft water1 anodyne injections may be given three or four times a day2 but cases of this kind are too serious for any nurse or mother to treat1 if the services of a physician can be obtained2 and ,i will only mention one or two things more4 ,when the extremities are cold put the child for a few minutes in a warm bath of mustard water1 and then employ friction to the skin4 ,i have found chicken tea made by boiling the chicken very soon after it is killed1 very useful in checking the vomiting and curing the child4 ,of course a physician will be obtained in these serious cases if possible4 ,,retention ,,of ,,urine in the newly born infant if slight is easily removed by giving two or three drops of spirits of nitre once an hour in a little sweetened water1 or if obstinate it may be aided by castor oil and the warm bath4 ,a little pumpkin seed or parsley root tea also succeeds remarkably well4 ,,apth is usually called the baby's sore mouth4 ,it generally begins on the inner part of the lower lip or corner of the mouth1 as a small white speck which resembles a coagulum of milk4 ,these aphthous white pustules soon appear over the inside of the cheeks and on the tongue and gums4 ,the eruption is very white and looks as if whey or curds were spread over the mouth1 which is hot and painful1 and the disease sometimes does1 and at other times does not cause fever4 ,i regard this complaint as being one of the germ diseases1 although the fact has not yet been demonstrated4 ,the children fed upon farinaceous food are most liable to this disease1 and during its continuance1 if the child is not at the breast it should be kept entirely to the milk of one cow4 ,medicine should be given with regard to the stomach and bowels4 ,if the passages from the bowels are green1 magnesia is a proper kind of physic1 and when there is diarrha use formula #hj1 #gg1 #ha4 ,,genuine ,,jaundice may attack a young child1 but this is to be distinguished from those cases where there is only a generally diffused ,,yellow ,,color ,,of ,,the ,,skin4 ,in the latter class of cases there are no symptoms indicating any serious disease2 the yellowness may continue for several days1 and this disappears without the aid of any medicine and without leaving any evil behind4 ,but in jaundice the whites of the eyes and the tears are tinged yellow1 and1 besides1 the feces are paler than they should be1 the urine is yellow1 and other serious symptoms are added4 ,if the bowels be costive1 or irritated to frequent efforts1 if the abdomen swells and becomes tense1 if the child is uneasy and inclined to vomit1 if it refuse the breast and frequently moans as if in pain1 if it emaciate rapidly1 jaundice in a bad form is present1 and there is probable disease of the liver4 ,call the doctor4 ,i need not continue my instructions any farther in regard to the diseases of infancy1 as you are expected to act as far as you can under the directions of a physician4 ,but ,i must again advise you as to how you are to treat your medical advisor4 ,give him your entire confidence4 ,be truthful and candid with him4 ,have no reservations2 give him a plain statement of the symptoms4 ,be prepared to state the exact time the child showed any illness4 ,tell him if the child had a chill2 if there be any eruption on the skin1 note the quantity and appearance of the urine1 the number1 color1 c41 of the stools--all the symptoms of the disease4 ,strictly obey the doctor's orders in diet1 in medicine1 in everything1 and never omit any of his suggestions4 ,if the case be severe1 never call a second physician without first consulting and advising with the one first chosen2 speak in the presence of children with respect and reverence of the doctor1 and endeavor to have them like him4 ,send for the doctor when practicable early in the morning1 as the daylight is most favorable for making the examination1 but if the illness come in the night do not delay on that account2 if you do not know what to do1 it is better that the doctor be called early than late4 ,,chapter ,v4 ,,cases ,,of ,,difficult ,,labor4 ,i wish to give you so much instruction in regard to cases of difficult labor that you may at least be prepared to decide in any case when the services of a physician is indispensably necessary1 to decide whether the parturition in a given case is a natural one that does not need any assistance1 or an unnatural one requiring the assistance of the art of midwifery1 scientific or manual1 for the relief of irregularities and difficulties4 ,in general ,i shall adopt ,churchill's divisions and definitions as ,i think they are very concise and correct4 ,,tedious ,,labor4 8,,definition4 ,the head of the child presents and the labor is terminated without manual or instrumental assistance1 but it is prolonged beyond twenty-four hours from causes which occasion delay in the first stage40 ,prolongation of labor is of comparatively small consequence when the membranes are still intact1 as they serve to protect the soft parts of the mother as well as the body of the child from injurious pressure1 but the mere lengthening of the labor may become a serious thing when the head has entered the pelvis1 when the uterus is strongly excited by reflex stimulation1 and when the maternal soft parts as well as the ftus and cord are exposed to severe pressure4 ,when we find no evil resulting from the delay we need not interfere1 but when we can remove the cause of it we are bound to do so4 ,in tedious labors the woman becomes fatigued1 the loss of sleep is much felt1 her spirits become depressed1 and the stomach is more or less disturbed1 but when the other bodily functions are performed regularly1 the skin is cool1 the pulse quiet1 the tongue clean and moist1 there is no headache1 and the pains recur tolerably regularly1 the condition of the patient is favorable1 though the pains are inefficient and vary in their duration and frequency4 ,there is usually loud outcry during the pain in the first stage of labor1 but there is often sufficient remission of the suffering for the woman to get some quiet sleep1 and generally there is progress to the labor4 ,,inefficient ,,action ,,of ,,the ,,uterus occurs most commonly in women confined for the first time1 and sometimes we can ascribe it to no cause but constitutional peculiarity1 or a deranged state of the digestive organs1 or mental depression2 in other cases it may be caused by irritation of the os and cervex uteri4 ,the skilled nurse may properly send for a medical man1 though he is not indispensably necessary in such cases4 ,the best thing which she can give in such cases is a quarter grain dose of morphine to suspend the pains and induce sleep1 or if this is not thought best it may be proper to give physic or stimulating enemata4 ,never give ergot to increase the pains1 but it may be proper to give several grains of quinine4 ,however1 giving medicine must be left as much as possible to the physician4 ,,excessive ,,amount ,,of ,,liquor ,,amnii with undue distention of the uterus in some cases renders the pains inefficient4 ,the unusually large size1 and the fluctuation of the abdominal tumor may be obvious1 but although an accoucheur might deem it advisable to evacuate the waters1 the skilled nurse who could not be certain that there was a favorable presentation1 should not do it4 ,she must exercise patience herself and encourage the patient to do so1 and time will probably do the work1 though it is better to commit the case to a doctor4 ,,an ,,undilatable ,,os ,,uteri1 which remains rigid although the pains are severe1 may sometimes be felt with its edges thin and stretched over the head1 and sometimes thick and tough4 ,in the majority of cases patience and time may overcome the obstacle1 but as it is best in some cases to give chloroform1 chloral1 c41 and in some instances to use local means to relax or dilate the os1 the physician should be sent for4 ,the nurse may properly give the patient a hip bath4 ,,premature ,,escape ,,of ,,the ,,liquor ,,amnii and ,,obliquity ,,of ,,the ,,uterus are both causes of tedious labor1 but not cause for apprehension or special interference4 ,i have already given some hints in regard to the treatment of the latter class of cases4 ,,the ,,posterior ,,lip ,,of ,,the ,,cervix ,,uteri ,,in ,,some ,,instances ,,is ,,retracted ,,while ,,the ,,anterior ,,is ,,drawn ,,tightly ,,over ,,the ,,crown ,,of ,,the ,,head4 ,in such cases it has been my practice to draw with my finger the anterior lip forward1 and during the time of the pain to press my finger against the head of the child4 ,i do this believing that the anterior lip is caught between the head and symphasis pubis1 and that it will be better retracted while support is given to the head4 ,,powerless ,,labor4 8,,definition4 ,the labor is prolonged in the second stage by causes which act on the uterine powers primarily or secondarily1 rendering the pains feeble and inefficient or totally suppressing them40 ,in consequence of the stage at which the delay takes place1 certain symptoms arise which render speedy delivery imperative4 ,the second stage may continue twenty hours or more without any bad symptoms1 but usually if it exceeds twelve hours some of the following symptoms may be observed3 ,the pains become irregular as to recurrence and force--perhaps become weaker--there may be rigors or shiverings--the vomiting may be distressing--there may be constant restlessness and fever--the vagina and uterus may be hot and tender to the touch--and the pressure of the child's head may prevent the evacuation of the bladder4 ,the same causes 7weak constitution1 mental emotion1 disease1 c471 which in the first stage rendered the labor tedious without bad symptoms1 now occasion these and perhaps even more alarming indications4 ,if an experienced accoucheur now arrives to take charge of the case he will be likely to apply the forceps1 but it would have been better if he had been there and applied them sooner1 before the patient had undergone so much suffering2 and the midwife who attends a woman in the first stage of the labor should ascertain if any of the following causes of powerless labor exists3 ,is there a weak constitution or one exhausted by disease8 ,is it a first labor and the woman of advanced age8 ,has the patient had very many children8 ,is there excess of liquor amnii8 ,is there malposition of the uterus8 ,no midwife should undertake to manage such a case alone4 ,,obstructed ,,labor4 8,,definition4 ,the progress of the labor is impeded by some mechanical obstruction in the passages connected with the soft parts1 which by causing delay in the second stage leads to the developement of symptoms of powerless labor40 ,the symptoms that arise and that cause anxiety are the same as in a case of powerless labor1 except that while in the latter kind the pains are feeble1 in the case of obstructed labor the pains may be vigorous and severe but ineffective in consequence of obstacles4 ,i may say1 however1 that these obstacles have not been often met with in my practice4 ,since ,i commenced the practice of midwifery three thousand cases of pregnancy have been under my observation for treatment1 and ,i have not yet met with any of the following causes of obstructed labor3 ,occlusion of the os uteri1 cancer of the os uteri1 undilatable vagina1 tumors in the pelvis1 or diseased ovary1 stone in the bladder1 imperforate hymen1 hernial protrusion into the vagina1 or blood effusions1 or swelling of the soft parts4 ,i have met with one case of excessive dematous effusion of the vulva1 which ,i relieved by puncturing the skin2 one case of cystocele which ,i relieved by first drawing the water and then returning the bladder1 before the head of the child descended into the pelvis2 one case of ovarian tumor that was not at that time in the pelvis2 one case of small fibrous tumor on the neck of the uterus1 which did not much obstruct the labor2 and numerous cases where hardened feces in the rectum was an obstacle until they were removed by the use of enemata4 ,in cases of obstructed labor the skilled nurse will show her wisdom by detecting the obstructions and sending for an accoucheur4 ,,deformed ,,pelvis4 8,,definition4 ,the progress of the labor impeded by abnormal deviations in the form of the pelvis1 giving rise to delay in the second stage1 or rendering the descent of the child impossible without assistance1 or altogether impracticable4 ,the symptoms are those of powerless labor40 ,the ,,equally ,,enlarged ,,pelvis1 enlarged in all its parts1 is not often met with1 and is of no obstetric importance4 ,if in any case this condition is diagnosed preceding or during labor1 the patient should be watched by the nurse lest labor close so precipitately that the child falls to the ground4 ,,the ,,equally ,,contracted ,,pelvis--equally contracted in all its diameters1 generally renders the labor difficult and tedious but not impracticable1 by the natural powers4 ,other distortions such as has often been caused by rickets1 c41 offer great obstruction to the passage of the child4 ,in some cases a modification of the position of the child allows it to descend1 but in many cases it is necessary to interfere and terminate the labor artificially4 ,the nurse should not wait for unfavorable symptoms to appear before she sends for a man that is able to use the forceps1 c4 ,,malposition ,,and ,,malpresentation ,,of ,,the ,,child4 ,unnatural or abnormal labor may be caused by some peculiarity on the part of the child1 in the position or presentation4 ,these cases demand the services of the skilled accoucheur1 and ,i do not intend to hint that the nurse should ever attempt to do what an educated physician should be called to do in these cases4 ,,face ,,presentations sometimes retard the labor so much in the second stage as to give rise to unfavorable symptoms4 ,in cases where the action of the uterus is so energetic as to finally expel the child1 the sufferings of the mother are severe and prolonged4 ,i have in my practice met with four cases1 three of which were delivered by the natural powers1 the children living2 in one case craniotomy was performed4 ,the mothers all lived4 ,the diagnoses of face presentations is not easy at an early stage of labor4 ,the finger first touches the forehead1 which may be mistaken for the vertex4 ,when the membranes are ruptured we may be able to make out the presentation4 ,we may distinguish the edges of the orbits1 the prominence of the nose1 the mouth1 c4 ,the bridge of the nose is the best guide1 it being prominent1 firm1 and unlike any part of the breech or vertex4 ,the face becomes tumefied during the labor1 and the cheeks pressed together to resemble the nates1 and it may be mistaken for a breech presentation4 ,but in either presentation the proper course for the nurse is to leave the case alone in the expectation that the natural efforts will be sufficient to complete delivery4 ,the child when born has a frightful appearance from the swelling and discoloration of one cheek1 c41 but the injuries pass away in a day or two4 ,,the ,,forehead ,,towards ,,the ,,arch ,,of ,,the ,,pelvis at the time of delivery is not favorable1 but unless the pelvis is proportionately small no interference is necessary4 ,the ,,breech may present at the brim in different positions1 and the breech is distinguished by its roundness and softness1 by the cleft between the buttocks1 by the arms and by the organs of generation4 ,in some cases the labor is concluded as quickly as if the head descended1 in others it is more tedious4 ,the results as regards the mother are as favorable as in head presentations4 ,the danger to the child is in direct proportion to the length of time between the birth of the body and that of the head4 ,when the body is expelled so far as the umbilicus1 the danger to the child commences1 for at this time the cord may be pressed between the body of the child and the pelvic walls4 ,a loop of the cord should be pulled down1 and if it freely pulsates the child can probably be delivered alive4 ,generally a judicious traction on the part of the accoucheur1 combined with firm pressure through the abdomen applied by an assistant1 will effect delivery of the head before the delay has had time to prove injurious to the child4 ,if the arms of the child are above at the side of the head1 the doctor will bring one down by passing a finger over the shoulder as near as possible to the elbow1 and then drawing it across the face and chest until it arrives at the external orifice1 but all this time it is the part of the nurse to continue to make effective pressure upon the abdomen of the mother--also while he delivers the shoulders--and while he perhaps introduces two fingers into the vagina of the mother to reach the upper jaw of the child and make pressure upon it1 so as to depress the chin and facilitate the expulsion of the head4 ,,presentation ,,of ,,the ,,knees and ,,presentation ,,of ,,the ,,feet is identical in its progress with breech cases1 and the treatment of breech cases applies to footling presentations1 but it is best to avoid pulling on the foot or feet that come down1 as it is safer for the child if the lower part of the body is delivered quite slowly4 ,even if the nurse should in an emergency deliver the child1 she should help principally by pressure on the mother's abdomen4 ,the only rule that ,i would have the skilled nurse adopt in regard to these cases1 is that it is necessary that she should discover as early as possible if the labor is not a natural one1 and if it is unnatural1 should obtain the services of a physician as soon as possible4 ,the same rule applies to cases of placenta previa hemorrhage1 but ,i shall have more to say of these hereafter4 ,a case of compound presentation where the hand and arm presents with the head1 or in which the feet and hands1 or one of each present together1 also imperatively demand the services of an experienced accoucheur without delay4 ,the nurse will be impotent to give any efficient help until the doctor arrives4 ,presentation of the ,,superior ,,extremities will receive from me a full and complete description1 because ,i believe that under certain circumstances the nurse should be prepared to operate by turning4 ,as this radical opinion may perhaps be opposed by my medical brethren1 ,i offer the following reasons for it which ,i consider a sufficient justification4 #a4 ,cases of this class commence with the ordinary symptoms of labor2 their peculiar character cannot usually be distinguished until the os is well dilated1 and this is the only favorable time to perform the operation of turning4 #b4 ,although in cities and villages generally1 a physician's services can in most instances be immediately obtained1 in the country it is not always practicable to obtain them within an hour or two of time4 #c4 ,such knowledge as is necessary for the performance of this operation may be obtained from such description and instruction as can be given in books4 #d4 ,there are some women who possess the necessary traits of character1 the complete exercise of their faculties1 with the perfect coolness which is demanded of the operator in such a case4 #e4 ,i do not advocate trusting the operation to a nurse when the services of an accoucheur can possibly be obtained within the proper time4 #f4 ,the services of a physician1 if obtained one or two hours after the arm is first thrust down in the vagina1 may not be of any use because the time for turning is passed4 #g4 ,the operation of turning1 performed by a properly instructed nurse1 does not involve the least danger to the mother or child4 #h4 ,the only danger connected with this operation arises from the size of the hand of the operator1 and the woman's hand is small4 #i4 ,it is a historical fact that at one period practitioners overrated the performance of turning1 and extended its use to unsuitable cases1 and after the invention of the forceps1 they fell into an opposite error4 ,it is possible that we may be in error if we hold that the nurse cannot be instructed to perform the operation of turning4 #aj4 ,i do not advise that the nurse should ever attempt to turn in those cases in which the membranes have been long ruptured--the shoulder and arm pressed down into the pelvis1 and the uterus contracted around the body of the child4 ,i once succeeded in a case that two experienced physicians had tried in vain for several hours to turn1 and ,i never had very much difficulty in turning1 but there have been many cases where excellent operators could not succeed in turning4 ,in cases of ,,presentation ,,of ,,shoulder1 ,,arm ,,or ,,trunk1 delivery by the natural powers is quite exceptional1 though the natural powers have occasionally succeeded in expelling the child4 ,the safety of the mother and child depend upon the early detection of the abnormal position of the ftus1 and upon their receiving proper treatment before labor has been long in progress4 ,the position of the child is one intermediate between the long and transverse diameters4 ,it may lie with its back towards the abdomen of the mother or with the back towards the spine of the mother1 and the head of the child may be towards the right or the left of the mother4 ,the existence of a shoulder presentation is not commonly suspected until the first examination is made during labor4 ,suspicion will arise from finding on examination that we are not able to reach the presenting part1 and that the os uteri does not dilate as usual1 and that when it becomes dilated the bag of membranes protrude of a conical form1 but this is common to all malpresentations4 ,when the shoulder has descended a little it is recognized as a round1 smooth prominence1 rounder than the elbow1 and we may be able to reach the axilla1 c4 ,the elbow may be recognized by the sharp prominence of the bone1 and the hand can be distinguished from the foot by the fingers being wider apart and more readily separated from each other than the toes1 and by the thumb which can be carried across the palm4 ,the situation of the thumb and the aspect of the palm of the hand will mark whether it is the right hand or the left4 ,as soon as the nurse ascertains or suspects from an external palpation or a vaginal examination1 that it is a cross birth she should send for the doctor1 who ought to be there as soon as the membranes are ruptured1 and the nurse must not be very persistent in making examinations lest she rupture the membranes prematurely4 ,she may perhaps give a small dose of morphine1 but ,i would not advise that she give chloroform as it is not necessary4 ,the right time to turn the child is when the os uteri is dilated1 either before or immediately after the rupture of the membranes1 and if a doctor cannot be soon obtained1 it is better that a skilled nurse should turn the child1 and if she is properly instructed1 she should do it carefully and slowly1 but without any fear and confidently4 ,she can assure the patient that she will be able in a short time to relieve her sufferings4 ,in ,england the ordinary position for turning is on the left side4 ,i prefer that the patient be placed across the bed on her back with her legs drawn up and supported by assistants4 ,i now describe my own mode of operating4 ,i bare my right arm and hand 7sometimes the left71 lubricating it freely4 ,if the waters have only recently escaped1 and the os be dilated1 the operation is performed with ease1 especially after we have determined the position of the child4 ,i press the fingers together in the form of a cone1 the thumb between the fingers--slowly and carefully press them into the vagina in an interval between the pains1 and constantly and slowly press the hand in1 only when the contractions of the uterus remit2 never using any force1 gently pass the fingers into the os2 gently open the fingers a little occasionally to dilate the os sufficiently1 and when it is expanded pass the hand into the uterus1 make out the presentation accurately1 so as to keep my hand to the abdomen of the child2 always keep the hand still during a pain2 when there is an interval between the pains1 carefully search for the feet2 when one of the feet is found1 clasp the leg at the knee with one finger2 flex the leg at the knee so that the finger has a good hold of it1 draw it down in the absence of a pain2 as the knee approaches the os when it is drawn down over the abdomen of the child1 the shoulders and head recede towards the fundus1 and when the head has reached the fundus and the knee is brought through the os1 the case is converted into a knee presentation1 and ,i deliver slowly but without needless delay--making a little traction during each pain1 the management being conducted as in feet presentations1 and the whole process being assisted by pressure made on the uterus by my left hand1 or by the hand of an assistant4 ,possibly these directions will be better understood if ,i use the language of another who directs3 #a4 ,that the patient be placed on her left side near the edge of the bed4 #b4 ,the os externum is then to be dilated with the fingers reduced into a conical form1 acting with a semi rotary motion of the hand4 #c4 ,when the hand is passed through the os externum it must be slowly conducted to the os uteri4 ,we may perforate the membranes with the finger if they are not broken4 #d4 ,the hand must then be passed along the thighs and legs of the child until we come to the feet4 ,if both the feet lie together we must grasp them firmly with one hand1 but if they are distant from each other we may deliver by one foot4 #e4 ,before we begin to extract we must be sure that we do not mistake a hand for a foot4 ,the feet must be brought down with a slow1 waving motion into the pelvis1 when we are to wait till the uterus contracts1 still retaining them in the hand4 #f4 ,the feet are to be brought down with each return of the pain1 and the labor may be finished partly by the efforts of the mother and partly by art4 #g4 ,if the toes are turned towards the pubis the back of the child is towards the back of the mother which is an unfavorable position4 #h4 ,if the toes are towards the sacrum1 the back of the child is towards the abdomen of the mother1 and this position is advantageous when the head comes to be extracted4 #i4 ,when the feet of the child has passed through the os externum1 wrap them in a cloth and holding them firm wait till there is a pain1 during the continuance of which gently draw down the feet4 ,when the pain ceases we must rest1 we merely assisting the efforts of the patient4 #aj4 ,when the child is brought so low that the funis reaches the os externum1 a small portion of it is to be brought out to slacken it1 and from this time the operation is to be finished as speedily as it can be with safety1 but if the circulation of the funis be undisturbed1 there is no occasion for haste as the child is in safety4 #aa4 ,if the child should stick at the shoulders the arms must be successively brought down4 #ab4 ,when both the arms are brought down the body of the child must be supported upon our left arm and hand1 the fingers on each side of the neck1 and if the head should not come easily away1 we must introduce the forefinger of one hand into the mouth of the child to render the position of the head more convenient for passing4 #ab4 ,when a child has been extracted by the feet1 the placenta usually separates very easily1 but in the management we are to be guided by the general rules4 #ac4 ,in these cases the child usually needs to be resuscitated1 and the nurse should arrange so that hot and cold water may be at hand if required4 ,in these descriptions of the operation ,i have mentioned both the back and side as good positions for the mother1 because some accoucheurs prefer one position and some the other4 ,some prefer to have the patient on the hands and knees4 ,but if the nurse have the instructions here given well in her mind1 she can operate in either position4 ,if she ascertains at first how the child lies she may sometime reach its abdomen better if she introduces her left hand1 but the main point is to proceed slowly and carefully4 ,she should be careful in passing in her hand to change the direction of it in accordance with the pelvic axis1 and should not use much force at any time4 ,the danger to the mother is very small indeed2 the danger to the child arises1 as in breech presentations1 from the compression of the funis1 which commences about the time the buttocks appear at the os externum4 ,but the safety is only when the operation is performed at the proper time4 ,the nurse must never operate if the services of a physician can be obtained at that time1 but when it is necessary she may proceed to turn1 doing it slowly and properly1 but fearlessly and confidently4 ,if the doctor that is sent for is informed before he arrives that it is a case of hand presentation1 he will come dreading the difficulties that he may encounter1 and if he can have the satisfaction of knowing when he comes that the woman is safely delivered1 he will be exceedingly glad4 ,,chapter ,,vi4 ,,concluding ,,instructions ,,in ,,midwifery4 ,what ,i shall say of ,,plural ,,births1 and ,,monsters1 of ,,children ,,affected ,,with ,,hydrocephalus1 ,,or ,,ascites1 of ,,excessive ,,size ,,of ,,the ,f,,tus1 of ,,defects ,,in ,,the ,,formation ,,of ,,the ,f,,tus1 of ,,prolapse ,,of ,,the ,,funis1 c41 will be compressed in a few words4 ,i am not instructing the nurse to attempt to conduct a case of even natural labor without having a physician if he can be obtained1 but she should consider the services of a trained practitioner imperatively necessary in these unusual cases4 ,in either instance there may be a safe delivery by the natural powers alone1 and the nurse may act in an emergency1 but it would not be consistent with the plan of this work for me to describe in detail the various operations that are sometimes performed in these several cases1 or to give instructions in the use of instruments1 which ,i advise the nurse never to use4 ,in regard to those instances where it seems as if it would be necessary to use instruments1 ,i quote the following rules adopted by accoucheurs3 #a4 ,meddlesome midwifery is always bad4 #b4 ,in no case need we interfere when the obstacles to be overcome can be overcome in a reasonable time by nature or without an operation4 #c4 ,cases in which instruments are to be used are exceptions to the general rule1 and no instrument should be used in a clandestine manner4 #d4 ,we should not have such an aversion to the use of instruments that we too long delay that assistance we have the power of affording with them4 ,,placental ,,presentation4 ,,placenta ,,previa will never be treated by the nurse1 but she should know its nature1 know that it is this that causes unavoidable hemorrhage1 and she should not fail to obtain a skillful physician early1 to attend the case4 ,the flooding is the necessary consequence of the dilatation of the os uteri1 by which the connection between the placenta and uterus is separated1 and the more the labor advances1 the greater the disruption1 and the more excessive the hemorrhage4 ,the woman usually passes through the early part of pregnancy without any sign that denotes the peculiar attachment1 but the placenta can easily be distinguished from the membranes or coagulated blood as soon as the os uteri is a little opened4 ,when a hemorrhage comes on from this cause the patient is never free from danger till she be delivered4 ,often the medical man is obliged to free the patient from imminent danger by artificial delivery1 but ,i can conceive of no circumstance in which a nurse would be justified in turning for unavoidable hemorrhage4 ,before1 during1 and after the delivery1 the appliances used in other cases of hemorrhage may be used with some advantage1 but ,i would hardly advise the nurse to do any thing before the doctor arrives4 ,,accidental ,,hemorrhage4 ,that form of ,,flooding that arises from a partial and accidental separation of the placenta which occupies its usual position1 must here be briefly referred to1 as the nurse may be called on to do something in an emergency4 ,the immediate cause of the flow is the separation of some portion of the placenta from the womb1 and the laceration of the vessels4 ,the hemorrhage is at first internal1 is accompanied with dull pain at the spot where it takes place1 it generally becomes external1 it may or may not be attended with the discharge of coagula from the os uteri1 and when the discharge commences it varies in quantity from a few ounces to an amount that is alarming4 ,it is generally necessary to make a digital examination1 to distinguish the accidental from the unavoidable hemorrhage4 ,until the doctor arrives the patient should be kept in bed on a hard mattrass and very lightly covered with bed clothes4 ,the temperature of the room should be kept very low1 and nothing but cold water allowed4 ,the danger from hemorrhages that occur at or near the full period of utero gestation1 may often be estimated by the absence or degree of pain1 as well as from the quantity of the discharge4 ,hemorrhages are much more dangerous with sudden than with slow discharges of blood1 and women are always in greater danger when they are not accompanied with pain4 ,puerperal convulsions1 whether of the hysteric1 epileptiform1 or apoplectic variety will always demand and almost always receive the prompt attention of the physician4 ,while the nurse is waiting for the doctor to arrive she might possibly administer a cathartic1 thirty grains of bromide of potash1 and an enema1 but as a general rule she should not give anything4 ,she might insert a wedge or roll of linen between the teeth to prevent injury to the tongue1 and she should remove every thing out of the way1 by striking against which1 the patient might hurt herself4 ,,part ,v4 ,,tiology1 ,,symptomotology1 ,,medication1 ,,nursing4 ,,chapter ,i4 ,,causes ,,of ,,disease4 ,the causes of disease are spoken of by authors as predisposing1 and exciting4 ,by proximate cause of disease is meant the cause of the symptoms present2 this cannot appropriately be dwelt upon here4 ,by exciting cause is meant the immediate cause of a disease1 and the distinction from predisposing cause arises from the fact that when two persons are exposed to something injurious to the health1 they may not be equally affected4 ,it has been said that if twenty persons undergo hardship and exposure from shipwreck1 the effect of the wet and cold may be in one to cause catarrh1 in another rheumatism1 in a third pleurisy1 in a fourth opthalmia1 in another inflammation of the bowels1 and fifteen may escape without any illness at all4 ,a predisposing cause is defined to be anything whatever1 which has had such an influence on the body as to have rendered it unusually susceptible to the exciting cause of the particular disease4 ,in most cases the distinction is obvious1 but it is sometimes difficult to say of a given cause whether it ought to be ranked among the predisposing or the exciting causes4 ,disease is often warded off notwithstanding the presence of the exciting cause1 when we ascertain and prevent the predisposing cause of it1 and it may sometimes be averted in despite of strong predisposition1 if we know and can guard against the agencies by which it is capable of being excited4 ,when we enumerate causes of disease we see among them many that under ordinary circumstances minister to life1 health1 and enjoyment2 and ,i can hardly refer at all to the varying circumstances under which they become the medium of pain1 disease and death4 ,these circumstances are so various1 so many of them are apt to be put in operation at the same time1 and so little power have we of excluding them one after the other1 so as to ascertain the exact efficiency of each1 that our observation respecting their actual effects are open to much fallacy4 ,we cannot for instance in a given case estimate accurately the effect of impurities in the atmosphere such as organic and inorganic dust1 nor the effect of differences in degree of its natural qualities such as extremes of heat and cold1 sudden variations of temperature1 excessive moisture or dryness1 different electric conditions1 differences of pressure1 a deficiency of light1 and the amount of ozone1 c4 ,,of ,,heat ,,and ,,cold ,,as ,,external ,,agencies ,,causing ,,disease4 ,the range of temperature compatible with human life is very great2 men live in the hottest and the coldest climates1 where the earth produces any sustenance for them4 ,it requires more care to preserve life under intense cold than under intense heat4 ,tropical climates are thickly peopled where the thermometer ranges from #hj to #ajj for a long time together4 ,in arctic countries on the other hand where the thermometer sinks to #dj or #ej below zero1 we still find inhabitants1 but they are few and thinly scattered4 ,it is probable that at a degree of temperature a little greater than that of the equator or a little less than that of the poles men would perish4 ,man is capable of existing under certain circumstances for a short time1 and enduring a much higher degree of heat than the general atmosphere attains in the hottest portions of the earth1 but there are generally some deleterious effects from hot climates or continued hot weather4 ,the effect of ,,heat is to stimulate the organic functions of the body1 but when considerable heat is applied for some time together its effect is to cause languor and lassitude1 want of energy1 a disinclination for exertion both bodily and mental2 it has a depressing effect generally upon the animal functions or the nervous system1 and there are some forms of disease that are distinctly traceable to heat as a cause4 ,we all know the effect of hot weather in causing perspiration1 and when the operation of high temperature is continued for some time it has a marked influence upon the liver1 increasing the quantity of bile that is secreted1 and altering its sensible qualities2 this is sometimes followed by inflammation of the liver4 ,in this country those attacks of vomiting and diarrha which are so common towards the latter end of summer or in autumn are the effects of a succession of hot days4 ,in tropical climates the morbific effects of external heat are still more conspicuous1 tending to violent disorders of the stomach and intestines1 and also to acute inflammation of the liver and to acute abscesses in that organ4 ,in these cases the heated atmosphere unduly stimulating the secreting function of the liver creates the predisposition to the disease1 while the exciting cause of the inflammation may be exposure to cold4 ,there may be deleterious effects from exposure to cold where the climate is quite hot4 ,for instance a man may after the heat occasioned by the employments of the day1 undress and lie opposite a window1 his shirt wet with perspiration1 to enjoy the sea breeze at night1 and though the thermometer may be as high as #hj he may have a sensation of cold4 ,if there is real chilliness it may be deleterious4 ,heat sometimes acts as an exciting cause of disease--it produces sunstroke1 or it may produce an eruptive disease such as prickly heat1 c4 ,the effect of extreme ,,cold 7,i use the term cold in the popular acceptation71 when its application is continued1 is that of a sedative upon the organic functions4 ,though at first causing pain in the extremities1 if continued it causes sleep or overpowering drowsiness4 ,before this complete stupor comes on there may be a blunting of the sensations and confusing of the intellect1 giving to the person exposed to it1 the appearance of one intoxicated4 ,when persons in this state are suffered to sleep1 and the operation of the cold continues1 they become less and less sensible to external impressions until death closes the scene4 ,but the effect of cold upon the body within certain limits of intensity and duration is that of a tonic4 ,when its refrigerating and sedative properties can be sufficiently counteracted by exercise and warm clothing1 cold is stimulating1 refreshing1 and invigorating to mind and body1 it clears and sharpens the faculties1 bestows alacrity and cheerfulness of spirits1 and may become a curative agent4 ,yet exposure to cold is one of the most common causes of various complaints4 ,as a rule it is true that there is danger from sudden vicissitudes of temperature1 although the proposition requires limitation4 ,no peril need attend a change from a hot to a cold temperature if the power to evolve heat inherent in the system be entire and active and persistent1 not lessened by any of those circumstances which have the effect of weakening it1 such as local disease1 and fatigue4 ,cold is dangerous1 not especially when the body is hot1 but when it is cooling after being heated4 ,at such times taking a large draught of cold water1 or cooling the body suddenly some other way might cause death immediately2 if not1 an inflammation of some internal part of the body might arise4 ,every thing that has the effect of weakening the system and so diminishing the power of evolving heat1 favors the morbific effect of cold1 and is a predisposing cause of disease4 ,the most common of these debilitating circumstances are fasting1 evacuations1 fatigue1 a last night's debauch1 excess in venery1 long watching1 much study1 and rest or inaction immediately after it1 or after great exercise4 ,the faculty of evolving heat is weak in old persons and in the newly born1 and these are often the victims of the power of cold4 ,the bad effects of cold depend very much upon the duration of the sensation4 ,even slight feelings of chilliness1 if long protracted1 are apt to terminate in some form of disease4 ,cold is more likely to prove injurious when it is applied by a wind or currant of air1 and the injurious operation of cold is augmented when it is accompanied with moisture--wetness is the worst way in which cold can be applied4 ,the contact of wet or damp clothes with the skin1 both increase and prolong the sensation of cold4 ,a foggy atmosphere is more prejudicial than a clear one of the same temperature4 ,while we are asleep1 also1 our power of resisting the effects of cold is diminished4 ,the power of habit enables a person to resist the effect of cold1 and we may sometimes turn our knowledge of it to good account in gradually fortifying the system against the influence of cold that cannot be avoided4 ,but we must not1 while we fear to render our children effeminate by over care and much clothing1 run into the opposite extreme and endanger their health by exposure4 ,the process of hardening is doubly dangerous when it is attempted with children who were originally delicate1 and should never be tried on any child or any person who is unsound1 who shows any signs of present or approaching disease1 or any marked predisposition to future1 and especially to scrofulous disease4 ,an abiding sense of chilliness must never be permitted even when we are endeavoring to accustom a child to cold4 ,if they can be kept in the cold air1 and at the same time be kept feeling warm either by exercise1 diversion of the mind1 or by clothing1 the result as regards the health is good4 ,the cold bath1 and especially the shower bath1 is a good means of fortifying the body against cold air4 ,when we take a cold bath in the morning1 if the sense of cold does not remain long1 and is followed by a glow of warmth1 the bath is sure to do good4 ,if1 however1 after the bath we suffer headache1 and continue to be chilly and languid or uncomfortable1 it should at once be given up as useless and dangerous4 ,,effects ,,of ,,the ,,season ,,upon ,,health4 ,in this country1 generally1 catarrh and coughs and pectoral complaints of all kinds1 are most apt to prevail in the winter and spring months1 while bowel complaints are more numerous and distressing in the summer4 ,the mucous membranes of the air passages sympathize with the skin under the agency of external cold2 those of the stomach and intestines under that of heat4 ,the thoracic disorders which commence or grow worse in the winter are often fatal1 and there are various other maladies that are aggravated by cold1 so that the mortality of winter is greater than that of summer4 ,bowel complaints are more prevalent at the latter part of summer or early fall1 when moderately cold days succeed a long period of hot weather1 the high diurnal temperature being the predisposing cause1 and the cold exciting or bringing on the disease4 ,i shall not refer to other causes of disease except to say that if two persons marry each other who have a hereditary predisposition to disease1 their children1 if they have any1 will probably not be healthy4 ,,chapter ,,ii4 ,,symptoms ,,of ,,disease1 ,,with ,,instruction ,,to ,,nurses4 ,symptoms are the signs by which we know that disease is present4 ,every circumstance happening in the body of the sick person capable of being perceived by himself or others1 which can be made to assist our judgment concerning the seat or nature of the disease1 its probable course and termination or its proper treatment1 is a sign or symptom4 ,these phenomena are the evidence upon which the whole art of the physician proceeds4 ,it is important that the nurse should know how to note the symptoms1 not only that she may know how and report to the doctor changes that occur in his absence1 but that she may be able also to minister to those who are suddenly attacked with sickness1 and to judge whether in cases of slight indisposition it is necessary to send for a physician4 ,by arranging and comparing symptoms1 and by noting the circumstances under which they occur1 the physician can distinguish the disease1 and learn what are the indications of treatment--this belongs especially to him4 ,but it is very important that a nurse should know how to note all changes as they occur1 and sometimes it is best she should keep a written record of them4 ,an important point in a trained or skillful nurse is that of her ability to observe accurately and describe intelligently what comes under notice in the absence of the physician4 ,she should cultivate the habit of strict observation1 and simple and truthful statement--neither deficient1 exaggerated1 or perverted1 stating facts and not opinions4 ,symptoms or phenomena which accompany disease may be subjective1 those which are evident only to the patient1 or objective which are observable by others4 ,both sorts of symptoms shed mutual light on each other1 and as the statements of the patient are not always trustworthy1 the nurse should be careful not to let anything pass unseen that can by vigilance be noted4 ,the following directions will help the nurse to cultivate the habit of observing symptoms3 ,try to learn all you can of the previous history of the case2 you will sometimes get information which the patient would not be likely to communicate to the doctor in person4 ,note the patient's apparent age with any indications of disguised age1 signs of weakness--whether corpulent or bloated2 note any deformities1 swellings or wounds1 and notice the attitudes and expression of the countenance4 ,a sufferer instinctively takes ,,the ,,position most conducive to ease4 ,when one lung is affected the patient lies on that side1 that the healthy one may have the greater freedom of motion4 ,when there is peritonitis 7inflammation of the bowels71 he lies on his back with his knees drawn up to relax the abdominal muscles4 ,if there is colic alone he may lie on the abdomen1 as pressure may relieve his pain4 ,when a patient has been persistently on his back1 if he turns onto his side it is a sign of improvement4 ,inability to breathe termed ,,orthopn,a1 occurs in affections of the heart1 and also in asthma4 ,lying quietly in bed is usually a favorable sign4 ,restlessness and slipping to the foot of the bed1 in low stages of fever1 are bad signs4 ,of the uneasy1 morbid symptoms1 pain is the most important1 and most common4 ,pain occurs in nearly all inflammations1 and it may occur where there is no inflammation at all4 ,bones1 muscles1 tendons1 ligaments1 the bladder1 the kidneys1 the uterus1 all modify in a manner that is peculiar to themselves the pain that is produced by injury or disease4 ,such terms as the following are used to express a peculiar character of pain3 ,it is said to be sharp1 shooting1 growing1 burning1 dull1 heavy1 tearing1 and so on4 ,if pain is felt in any part when pressure is made upon it the heightened sensibility is called ,,tenderness1 the part is said to be tender4 ,a part may be both painful and tender1 as it usually is if the pain continue for a time2 it may be tender without being painful as it is usually1 if pain continued for a time and then ceased4 ,itching is an uneasy sensation allied to pain4 ,it often affects the natural outlets of the body4 ,it occurs about the rectum from the motions of little worms that nestle there1 and other causes2 and this itching of the rectum1 and likewise of the pudendum1 are distressing complaints1 harassing the patient continually1 preventing sleep and requiring medical treatment 7,f4 #aie74 ,the tingling and pricking often felt in the windpipe1 and provoking coughing1 has some analogy to itching4 ,,nausea is sometimes a direct symptom of gastric disorder1 at other times it is a very important indirect result of disease at some distance from the stomach4 ,the nausea which is so troublesome to pregnant women1 is an instance of a morbid sensation1 sympathetic of irritation in a distant organ4 ,,dizziness or vertigo results sometimes from disease within the head1 and sometimes it is the indirect result of disease of the stomach or of mere debility4 ,a sensation of sinking1 sensations of weight and lightness1 of drowsiness1 tenesmus1 strangury1 heartburn1 and various conditions of the special senses are mostly ,,subjective ,,symptoms4 ,one of the first symptoms of diabetis is a preternatural keenness of appetite1 but in most diseases the appetite is lost or impaired or perverted4 ,,thirst is generally great in diabetis1 and there is commonly considerable thirst in inflammatory complaints4 ,the above named symptoms are mostly subjective1 but are accompanied by others that are objective1 that show that the functions of certain parts are disturbed or suspended2 and it is of especial importance to notice the ,,pulse1 as this is a valuable guide in treating disease4 ,each contraction of the heart sends out a wave which distends the blood vessels1 and they by their contractility or elasticity carry it on through the entire arterial system4 ,this periodical distention is the pulse4 ,the ,,pulse ,,beats can be felt wherever an artery approaches the surface2 it is usually taken and counted at the wrist2 in children it can be best taken at the temporal artery during sleep4 ,to take the pulse accurately place two or three fingers on the artery making moderate pressure1 and note particularly its frequency1 its regularity1 its forces and its fullness4 ,the ,,rate varies with varying circumstances4 ,the average number of pulsations in a healthy adult is from #gj to #ge1 but there are some persons who1 when they are quite well have a pulse of #hj or #ij to the minute1 and there are others in whom it seldom rises above #fj4 ,it is usually more rapid in women than in men1 is much more frequent in early life than in old age1 and the average rate in a healthy child is #abj4 ,in disease1 the pulse may acquire a great degree of frequency4 ,it may reach #aej or even #bjj1 but in such cases it is generally feeble and can hardly be counted4 ,besides observing the frequency of the pulse1 its character in other respects must be noted4 ,,irregularity ,,of ,,the ,,pulse generally indicates disease1 and there are two varieties of it4 ,in most instances of irregular pulse1 succeeding beats differ in length1 force and character2 in the other variety a pulsation is from time to time left out2 the pulse is said to intermit4 ,in the ,,dicrotic ,,pulse a secondary wave or undulation can be felt4 ,it is often met in typhoid fever1 and an inexperienced person might be led to count double the number of beats4 ,another important quality of the pulse is its hardness or compressibility4 ,the hard pulse ordinarily1 though not always1 indicates inflammation4 ,this hard pulse may be known by pressing pretty hard with one finger1 while we observe with the others whether we arrest or abolish the pulse4 ,a pulse is said to be full or large if it is felt to strike a large portion of the finger2 other departures from the normal standard are spoken of as soft1 quick1 or sharp1 throbbing1 bounding1 thready1 wiry1 flickering1 c4 ,,of ,,the ,,temperature4 ,the normal standard of the temperature of a healthy person is #ih4d4 ,there is some variation1 and indeed a daily cycle of variations1 so that in the morning it is #ii or at least #ih and in the evening #ig1 but the range is small1 and if the variation is more than that1 it is indicative of disease4 ,there is only a deviation of about #ae within which life can be sustained2 a temperature of more than #ajg or less than #ic will almost certainly prove fatal4 ,every mother who can1 as well as every nurse1 ought to own a clinical thermometer1 as thereby she may detect the beginning of a disorder before there are other marked signs of indisposition4 ,she should use it upon the first suspicion of a departure from health and frequently afterwards1 until she knows that the temperature is normal4 ,an increase1 especially if beginning each day a little earlier1 is a bad indication2 a decrease from a high temperature each day is a sign of improvement4 ,in pneumonia and generally in such disorders as are initiated with a chill1 the rise is sudden and rapid4 ,in typhoid and some other fevers1 the elevation is slight at first and gradually rises4 ,the exacerbations and remissions or other deviations can only be recognized by taking the temperature frequently1 and it should be taken at the same hour each day to exhibit the cycle of changes4 ,an irregularity of temperature in the course of a disease that has a regular type may indicate a complication1 or it may depend upon local causes1 such as constipation1 bad air1 c4 ,the decline of fever and of temperature may be gradual1 or it may drop to a steady normal within a few hours4 ,before using the thermometer the index must be thrown down to a point below the normal4 ,hold it with the bulb down and shake till it falls sufficiently4 ,the part 7the axilla7 should not have been exposed for washing for at least half an hour before taking the temperature1 and it is a good precaution to keep the axilla 7or mouth7 closed for ten minutes before putting the bulb of the thermometer into it1 and a little time may be saved by slightly warming the bulb in the hand before its introduction4 ,if we are careful and see that the axilla is first dried from perspiration1 and that the clothing is not in the way1 and that the thermometer is held firmly in position a sufficient time1 we may get a correct axillary temperature1 unless in a very emaciated person4 ,if taken in the mouth the lips must be closed during the process4 ,the rectum gives the most reliable temperature1 and this method is employed for infants4 ,the thermometer should be oiled and introduced for about two inches4 ,unless the presence of feces prevent1 the thermometer will be half a degree higher than if taken in the axilla4 ,it will sometimes take ten minutes or more to obtain the temperature1 but some thermometers will do the work in less than five minutes4 ,,the ,,respiration4 ,that respiration and circulation are intimately connected1 and that whatever modifies the pulse usually effects the breathing is a fact generally known4 ,that the proper performance of the function of every organ in the body depends somewhat upon proper respiration1 is a fact not so generally known and recognized1 and as this is an important topic we may properly here enlarge upon it4 ,by the muscular action of the diaphragm and intercostal muscles1 and the consequent contractions and expansion of the lungs1 the alternate inspirations and expirations are produced which we call breathing4 ,the lungs are not completely filled and emptied by each respiration1 and a certain amount of air remains stationary in them4 ,were this air which remains stationary constantly in a particular portion of the lungs1 the same without change1 we would derive no benefit from that portion of the lungs4 ,practically1 however1 it is believed that the additional supply breathed in and out is diffused through and alters the character of the whole4 ,a healthy adult ordinarily breathes about eighteen times per minute1 taking in each time about twenty inches of air4 ,it is said that it takes at this rate sixteen respirations to completely renovate the air4 ,this is probably true of our ordinary breathing1 but the renovation of the air depends upon our manner of breathing4 ,it is possible for us to breath so that at one expiration we almost displace the air from every portion of our lungs1 and then by a full1 deep1 prolonged inspiration1 7throwing forward the chest1 throwing back the shoulder1 and keeping the body erect17 fill the lungs fully with air and thus not only change the air in our lungs1 but change in some degree the character of our blood so as to increase its purity4 ,in order to test this let me ask anyone who is suffering from any slight indisposition1 if it be headache1 nausea1 pains in different parts of the body1 or any sickness1 to try to breathe in this manner for half an hour1 and observe if they do not feel better1 being careful at the same time that the air breathed is good and pure4 ,this point is of so much importance that ,i will refer to it again hereafter4 ,the character of the respiration is an important diagnostic symptom and should always be noted4 ,the rate of respiration varies as does that of the pulse1 but the former is partly under the control of the will4 ,the respirations are more rapid in women than in men1 in children than in adults2 it is modified also by position1 exertion1 excitement1 and other conditions4 ,we may count the respirations by observing the rise and fall of the chest1 but it is well to put our hand on the stomach where the motions may be felt4 ,breathing is in man mostly abdominal1 in woman mostly thoracic1 but inflammation in the chest or abdomen will affect its character4 ,,dyspn,a1 difficulty of breathing1 arises when from any cause the amount of air entering the lungs does not correspond to the amount of blood sent by the heart for purification4 ,the air may be unfit for its work1 or disease in the lungs1 or air passages may shut it out4 ,asphyxia results if the supply of air is in any way cut off4 ,,of ,,the ,,air4 ,in this connection ,i will say to the nurse1 give the patient pure air4 ,learn how indispensable this is to life1 or health1 or comfort2 how indispensable to any person1 and especially to the sick2 how liable the air in the room is to be contaminated by the air breathed or expired by those in the room2 by lights burning in the room2 by exhalations from the bodies of the sick2 by excreta left for a time in the room2 by the inevitable floating dust from the floors and walls2 from clothing1 bedding1 and furniture2 and from the presence of organic matter in increased quantity1 and of most deleterious quality in and around the sick4 ,a thousand feet of air space where the air is constantly renewed1 is necessary for a healthy adult2 a sick person should have two or three times as much1 because with them there is increased susceptibility to draughts4 ,be very careful that the sick are not placed so that a direct current of air can blow on any part of the body1 but either by the use of fans or in some other way the air must be renewed around their bed4 ,,ventilation4 ,the problem to be solved is1 how can fresh1 pure air be best supplied8 ,the inequalities of temperature within and without the room produces some natural ventilation1 as this sets the air in motion and effects an exchange of air1 if there are some apertures around the doors and windows4 ,this1 however1 is seldom sufficient1 and artificial ventilation is often necessary4 ,an open fire is a good apparatus for this purpose4 ,the draught which it creates carries the air from the room up the chimney1 while a fresh supply is drawn in to take its place4 ,this supply should be from the outward air1 or from an adjoining room in which the air is not contaminated4 ,the inlets and outlets for air should be of equal capacity1 on opposite sides of the room1 and of different heights to secure thorough ventilation4 ,they should be as far as possible from the patient and from each other4 ,in cold and damp weather great care is necessary to keep the air fresh and wholesome and at the same time to avoid chilling the patient4 ,but even in cold weather the doors and windows may be thrown open for a minute at a time1 if the patient is at the time protected by additional clothing4 ,however1 during the night and in cold and wet weather1 the principal supply of air will be from an adjoining room1 air that is warmed1 but it should be as pure as possible4 ,when the weather is cold1 and especially the latter part of the night1 have more heat in the room and not less fresh air2 if needed give your patient additional clothing and foot warmers4 ,the windows may be thrown open once or twice a day in cold weather1 if the patient is protected by putting additional clothing on the bed1 and using some sort of a screen1 7an umbrella may be used for a screen71 as a protection from the cold and direct draughts4 ,but as the contamination of the air continues1 the purification of it should be equally so1 and some fresh air must constantly be admitted--some device used for the purpose4 ,the window may be raised two or three inches and the aperture closed with a board1 then the air will find admittance through the opening between the two sash2 or when the window is raised three inches1 a board six inches wide may be placed on the window sill a little inside of it2 thus there will be an aperture both at the top and bottom of the lower sash4 ,or the upper sash may be lowered a little4 ,the current of air which comes in 7this is usually the lower one7 should be directed upwards4 ,in the summer a lamp may be kept burning in the fireplace or grate2 flues must in some way be kept heated or they will not draw4 ,stoves assist ventilation to some extent1 but furnaces and radiators do not assist at all to ventilate1 and the air is thereby especially dry4 ,a pan of water may be kept boiling in the room1 or perhaps merely setting on the stove1 or a towel or two may be hung near a radiator and kept constantly wet2 these will dampen the air by evaporation1 and this is often necessary when the rooms are kept warm by artificial heat4 ,about #ff is a proper temperature for a sick room in most cases1 but #fj to #fe is suitable for fever cases2 feeble and emaciated persons require a temperature of #gj to #ge4 ,be careful to have the room warm when the patient is out of bed4 ,,the ,,symptoms ,,of ,,inflammation4 ,the ordinary symptoms which characterize inflammation may be known if we observe what takes place when an external part is injured4 ,let us suppose that a healthy man has a piece of glass stuck in his arm4 ,he soon has pain1 then redness in that part of his arm1 then swelling1 which is hard near the injury1 and increases so that some swelling may be observed1 though not so hard at a little distance1 and the part is quite tender and hot4 ,these are the ordinary symptoms of inflammation3 pain1 redness1 heat1 and swelling1 with tenderness that is manifested when the part is pressed4 ,if the inflammation increases there are signs of disorder in other parts of the body2 the patient may be first chilly and feeble1 then the skin may become hot and dry all over the body1 the pulse fall hard and frequent1 lassitude comes on with headache1 perhaps pain in different parts of the body2 he has also other symptoms of fever2 is restless1 sleeps ill1 loses his appetite1 his tongue becomes white1 his mouth is dry1 he is thirsty1 the secretions of the body are diminished1 has what is called inflammatory fever1 or sympathetic fever1 or pyrexia1 the last term being now most generally used4 ,these phenomena1 this inflammation1 ends in two or three different ways4 ,if measures have been taken for subduing the inflammation--in the supposed case of the arm--if the glass has been removed1 it will probably happen that the symptoms above named will disappear4 ,this is to end in what is called ,,resolution4 ,when the inflammation goes on until pus is formed it is said to end in ,,suppuration4 ,the symptoms grow more severe for several days1 the swelling at length assumes a more pointed form1 the skin in its centre begins to look white1 and the swelling there gets softer2 there is throbbing pain1 perhaps the patient has chills or rigors2 then when the swelling is cut open or the cuticle breaks a yellow creamlike fluid is poured out which is pus1 and there is generally an abatement of the symptoms4 ,if1 however1 the suppuration or discharge of pus continues for some time1 other symptoms are manifested such as frequent shiverings1 followed by flashes of heat which end in perspiration2 this is ,,hectic ,,fever4 ,when the inflammation is still more intense it sometimes ends in ,,mortification1 the part dies by the violence of the disease1 the red color changing to a livid or purplish1 or greenish black hue1 the flesh losing its sensation and having an offensive odor4 ,of course inflammation may be in an organ or structure that is internal1 and we determine the seat of the disease1 partly by the character of the pain4 ,sometimes the pain is sharp and piercing2 this is its character generally in serous membranes such as the pleura or peritoneum 7membranes covering the lungs and intestines47 ,there is less pain when the inflammation is in the mucous membrane1 or in the parenchymatous structure of organs1 such as the lungs1 liver1 and spleen4 ,there is generally an aggravation of pain upon pressing a part that is inflamed4 ,pain caused by air distending the bowels and stretching the nerves may be relieved by pressure4 ,spasmodic contractions of the muscles will cause pain without much tenderness4 ,,of ,,heat ,,as ,a ,,symptom ,,of ,,inflammation4 ,the temperature of an inflamed part exceeds that which belongs to it in health4 ,in inflammation as in fever1 it has been known to rise to #ajg4 ,the increase of heat depends upon an influx of arterial blood1 and therefore of oxygen into the part4 ,there is probably always some increase of heat1 though it may not always be noticed in every case of inflammation4 ,there is more ,,redness than is natural in a part that is inflamed4 ,there is more blood than usual in the vessels that carry red blood1 and the red blood enters into the small vessels where the red particles cannot commonly be seen4 ,all the minute vessels seem to be enlarged4 ,the redness often remains sometime after the inflammation has ceased4 ,the degree of ,,swelling in different cases depends partly on the nature and structure of the part affected and partly on the intensity of the inflammation2 in some instances there is so little that it is not appreciable4 ,almost all the swelling results from the presence of matters thrown into the inflamed part4 ,in the central hard portion the hardness is to be ascribed to an effusion into the areolar tissue of it1 of a fluid which is transparent at first1 afterwards becoming opaque1 called coagulable lymph4 ,serum is effused into the areolar tissue of the softer swelling at the circumference4 ,,dema1 ,,dropsy1 ,,anasarca4 ,even under moderate inflammation some amount of effusion takes place into the texture or from the surface of a part4 ,this effusive serous fluid called also serosity1 resembles and probably is the scrum of the blood4 ,when this passes into the areolar structure of a part it is called dema1 7though this is not always by inflammation7 and if the serosity passes out extensively over the body1 the disease is called anasarca or general dropsy4 ,if a considerable amount of this serous fluid is poured out in a short time from the peritoneum1 it is a form of ascites or abdominal dropsy4 ,if it is thus poured into the pleura it causes apna1 or difficulty of breathing1 and requires aspirating4 ,,chapter ,,iii4 ,,diagnosis ,,of ,,diseases ,,in ,,children1 ,,early ,,treatment1 ,c4 ,it is not often that a correct diagnosis can be made of a disease by a single symptom1 but there are marked and characteristic symptoms which indicate some diseases in children with considerable certainty4 ,a strongly marked nasal or palate sound in the child's cry indicates an abscess behind the pharynx4 ,when this nasal tone is heard we should palpate with the finger on the throat to ascertain the degree of soreness4 ,a long drawn1 ten times lengthened1 loud sounding expiration with normal inspiration1 and no dyspna is sufficient for the diagnosis of ,,chorea ,,major 7,st4 ,vitus dance47 ,a high thoracic continually sighing inspiration1 the upper part of the thorax doing the work of breathing1 and with a sighing or groaning sound1 shows the commencement of ,,heart ,,weakness1 ,,cardiac ,,paralysis ,,or ,,fatty ,,degeneration ,,of ,,the ,,heart1 and will probably be followed by such symptoms as cyanosis1 coldness of the extremities1 c4 ,strongly marked diaphragmatic expiration accompanied by a fine1 high whistling sound1 points to ,,bronchial ,,asthma4 ,this sound1 however1 resembles that made in croup4 ,if there is a pause between the end of expiration and the beginning of inspiration1 croup may be excluded4 ,sleepiness1 lasting twenty-four to thirty-six hours1 occurring without fever or other disturbance to account for it1 is an initial symptom of ,,meningitis1 though it might be caused by narcotics or uremia4 ,a prominent1 firm fontanelle means increase in quantity of the contents of the cranium-exudation of some sort4 ,it cannot be caused by fullness of the vessels alone if it is firm and resisting4 ,we know that we have cerebral disease with ,,dropsy or exudation 7,hydrocephalus74 ,when the fontanelle is deeply sunken1 it points to loss of blood or other nutritive juices1 as in cholera1 c4 ,a sharp1 shrill cry1 accompanied by an expression of fright or great anxiety1 and occurring about an hour after the child has fallen asleep1 is the only symptom of the 8,,alp0--night terrors1 sudden awaking from bad dreams4 ,periodical crying1 lasting from five to ten minutes1 should always make us think of spasm of the bladder or ,,painful ,,urinations4 ,violent crying at stool with fear of the act1 and general avoidance of it1 points to ,,fissure ,,of ,,the ,,anus1 and is usually accompanied with constipation4 ,a violent cry full of pain and almost continuous1 with the throwing about of the head on the pillow and grasping it with the hands1 means ,,otitis or ,,earache4 ,weakness or immobility of the child1 after a comparatively slight or short illness1 points to ,,spinal ,,paralysis4 ,delayed ossification of the cranial bones is an early sign of ,,rickets1 as is crying continued for weeks 7increased on touch of the extremities71 accompanied with fever and incessant sweating4 ,vomiting of all kinds of food continued for weeks in children of closed cranium but with large cranial measurements1 when there is no fever1 pain1 idiopathic disease1 or a cerebral tumor1 indicates chronic ,,hydrocephalus with an acute onset4 ,congestion of the cheeks in children1 excepting in cases of cachexia and chronic disease1 indicates an ,,inflammation or a febrile condition4 ,congestion of the face1 ears and forehead of short duration1 strabismus with febrile reaction1 oscillation of the iris1 irregularity of the pupil with falling of the upper lids1 indicates a brain affection4 ,enlargement of the spongy portions of the bones indicates ,,rickets4 ,a thick and purulent secretion between the eyelids may indicate great ,,prostration of the general powers4 ,passive congestion of the conjunctival vessels indicates approaching ,,death4 ,long continued lividity1 as well as lividity produced by excitement or exercise1 the respirations continuing normal1 are indices of ,,fault ,,in ,,the ,,formation ,,of ,,the ,,heart1 or great blood vessels4 ,a temporary lividity indicates the existence of a grave acute disease1 especially of the respiratory organs4 ,irregular muscular movements1 which are partly under the control of the will1 indicates the existence of ,,chorea 7,st4 ,vitus dance74 ,the contraction of the eyebrows1 together with a turning of the head and eyes to avert the light1 is a sign of cephalalgia 7headache74 ,when the child holds its hand upon its head1 or strives to rest the head upon the bosom of the mother or nurse1 it may be suffering from ear disease4 ,when the fingers are carried to the mouth1 and there is besides great agitation apparent1 and when it turns its head from one side to another1 there is probably some obstruction or some abnormal condition of the larynx4 ,a feeble and plaintive cry indicates a trouble in the abdominal regions4 ,if the respiration is intermittent but accelerated1 there is capillary bronchitis4 ,in bronchitis the cough is clear and distinct4 ,a hoarse and rough cough is indicative of true ,,croup4 ,when the cough is suppressed and painful1 there is ,,pneumonia or ,,pleurisy4 ,in diseases of the stomach1 liver or bowels we have usually a coated tongue2 a white tongue indicates ,,febrile disturbance or some ,,throat trouble2 a brown moist tongue1 ,,indigestion2 a brown dry tongue1 ,,depression1 ,,blood ,,poisoning or ,,typhoid ,,fever2 a red moist tongue1 ,,inflammatory ,,fever2 a broad1 pale flabby tongue accompanies a ,,dropsical ,,condition of the system2 a tremulous1 moist and flabby tongue indicates ,,feebleness1 ,,nervousness2 a pale flabby tongue which shows the pressure of the teeth1 a generally relaxed condition of the system2 the irritable or strawberry tongue with its red papilla1 points to an irritated stomach1 and is met with in ,,scarlet ,,fever2 a furred and dry tongue is indicative of ,,violent ,,local ,,inflammation2 if afterwards clean1 red and dry1 protracted ,,inflammatory ,,fever4 ,wheezing cough and wheezing breathing indicates ,,asthma2 dull1 heavy aching pain at the base of the chest1 ,,acute ,,bronchitis2 urgent desire to go to stool1 ,,dysentery2 diminished secretion of urine1 ,,inflammatory and ,,febrile ,,disorders2 cold hands and feet1 ,,nervous ,,diseases and low states of the blood4 ,in general1 the diagnosis of diseases of children is easy if we simply compare the objective symptoms with those which should obtain in a healthy child of the same age4 ,but we must remember that with children symptoms which appear very grave are often evanescent1 and on the other hand the indications of very serious disease may be disregarded on account of their natural vivacity and recuperative powers4 ,in each case each child should be studied by itself considering its antecedents1 its peculiarities1 its surroundings1 and its relations to them4 ,the mother has the best chance to know these2 she sees the child when awake and asleep1 when dressed and undressed2 she knows its history1 what has been its diet1 what her own health has been1 her own habits1 her surroundings and occupations1 and whether there may or may not have been anything to cause sickness of the child in her own toils or trials4 ,the nurse and the mother should note all the facts1 for their own guidance and for the guidance of the physician if he is called4 ,,early ,,treatment ,,of ,,infantile ,,diseases4 ,very few of the symptoms heretofore mentioned can be neglected with impunity4 ,while some cases of sickness may be left to the powers of nature to restore health1 others require judicious early treatment1 and a physician should be called4 ,we should generally enjoin rest1 but we should act by our medicines to meet every positive indication4 ,we are the assistants of nature2 we must act by removing the causes where they can be reached2 we must relieve pain1 but we must not by officious kindness do too much and interfere with the natural return to health4 ,remember that drugs are not all powerful1 that time1 rest1 diet and numberless little things are the means by which we aid in the fight against disease4 ,it is an excellent plan not to continue medicine too long4 ,place the child on the road to health and see if it will not with a little supervision improve--still1 however1 using proper rest1 diet1 c4 ,but as the apparently trifling symptoms of to-day may become the full fledged attack of to-morrow1 we must pay attention to every untoward symptom4 ,parents are liable to be unnecessarily scared1 and afterwards go to the other extreme and neglect calling a physician until serious injury has occurred4 ,i will here give you a few aphorism and general rules3 ,treatment of the sick should be according to the patient as well as according to the disease4 ,adult males are not so sensitive as females2 young children1 whether male or female1 are sensitive1 tender and excitable1 and alive to every irritation4 ,but young children differ in their constitution1 and some have peculiarities or idiosyncracies so that medicines of ordinary activity act very powerfully or even violently4 ,small children are always sensitive to the action of medicine1 and small doses only are required for them4 ,and in consequence of the activity of the vital powers1 and the quickness and force of the circulation1 there is a remarkable susceptibility to inflammatory action1 disease sometimes running on rapidly to organic and incurable mischief4 ,in treating children employ the mildest remedies at first1 and aid their action by regimen4 ,when an emergency demands1 use those articles which experience has shown to have power to meet such an emergency4 ,exhibit such medicine in the minimum dose and increase or repeat until the desired effect is produced4 ,be very careful not to fill the child with nostrums for some imaginary ill1 lest you thereby make it ill4 ,always remember that the first step in treatment is to change the conditions which produced the disease--remove the cause and assist nature to repair the injury4 ,,chapter ,,iv4 ,,treatment ,,of ,,inflammation ,,in ,,its ,,incipient ,,stages4 ,usually the nurse or the mother does not treat disease1 or administer medicine except under the direction of a physician1 and it is not always necessary for her to know the principles that guide in their administration1 or why particular medicines are given4 ,but it is sometimes necessary for the nurse or mother to decide what shall be done1 and to act before the doctor can be consulted4 ,accidents and emergencies occur1 distress and sickness may suddenly attack some member of a family at any time1 and little ailments are complained of every day by some of them2 the question arises1 what shall be done8 ,it is not necessary every time to send for the physician1 and he cannot at a moment's notice be obtained4 ,for many ailments the mother prescribes1 and many times the early and judicious use of medicines or regimen not only relieves present suffering1 but also prevents the developement of serious1 and protracted and dangerous maladies4 ,this is especially true in regard to incipient inflammation1 and ,i shall here speak particularly of its treatment4 ,what has heretofore been said about inflammation gives us some guide to enable us to know whether the case calling for our care is one of an inflammatory character4 ,if the pulse is full and hard and a little more frequent than usual1 and there is restlessness and some pain we may conclude that there is ,,irritation that precedes inflammation at least1 before such symptoms as depression1 chilliness followed by heat1 headache1 a furred tongue1 loss of appetite1 and apparent weakness come on4 ,but if any of these symptoms are present we should search for the cause4 ,perhaps if the inflammation is external we shall be able to ascertain what produces the trouble4 ,in every case we ought to know the cause if possible1 as we thus have more clear indications for treatment4 ,but we may use the sedative treatment in all cases where these symptoms come on in a person who has previously been healthy4 ,of course you will not bleed--that1 if done at all1 should be done by the doctor4 ,but all sources of irritation ought to be removed1 so that the patient may enjoy perfect quiet2 the sick room should be ventilated1 and kept at the temperature of about #fj2 let the diet be light2 allow ice and cold water freely1 and if there is much febrile excitement use sedatives and saline refrigerants4 ,the best sedative is veratrum viride1 and the following is a convenient way of administering it3 ,drop #cj drops of the fluid extract of veratrum in #cj teaspoonfuls of water and give #a teaspoonful every two hours4 ,to adult subjects if there is considerable fever two drops of the extract1 or two teaspoonfuls of the diluted preparation may be given at first and the dose may be repeated in an hour1 but it will not be best to continue such large doses4 ,aperients may be given if there are fecal accumulations in the bowels4 ,although quinine is a tonic1 six to ten grains of it are sometimes given with good effect in a case of inflammation4 ,opium is a good remedy judiciously given2 one dose 7#a grain for an adult7 is good in a case of catarrh or cold2 successive doses are necessary in a case of peritonitis or enteritis1 but this should be given on a physician's advice4 ,it acts probably by quieting the nerves--by sustaining the faltering action of the heart1 and by keeping the inflamed part at rest4 ,sometimes cold1 and sometimes hot applications are made to inflamed parts1 and it is said that the sensations of the patient are the best criterion of their usefulness4 ,except1 however1 in cases of inflammation of the brain1 and perhaps even then1 ,i think that hot applications are the best4 ,when we wish to promote suppuration hot fomentations should be applied4 ,,counter ,,irritants relieve inflammation of the deeper parts by drawing the circulating fluid and the nervous energy to the surface4 ,the milder kinds called rubefacients1 produce merely local warmth and redness2 these may often be used advantageously4 ,mustard applied so as to redden the skin is generally useful4 ,,vesicants1 epispastics1 or blistering agents are safe appliances but they are distressing1 and their use may be deferred until a physician advises them4 ,i have said that the diet should be light while the pulse is hard and full4 ,afterwards when the pulse is natural1 or if it becomes irregular or small1 good broths or other nutrients are to be given1 milk1 cream1 and even raw eggs may be administered4 ,in general food should not be pressed upon a patient4 ,,of ,,topical ,,applications ,,for ,,inflammation4 ,i have mentioned counter irritants and ,i think it best at this time to advert to all the various topical applications1 irritating1 soothing and protective1 and to give such instructions as ,i can in regard to them4 ,counter irritants are frequently applied over or near the seat of the disease1 and often also at a remote part to obtain what is called revulsive action4 ,in both instances1 however1 their action may be revulsive4 ,if applied to the thorax or chest1 for example in a case of pneumonia1 the cuticle to which it is applied is almost as remote from the lung by the way of the circulation1 as is the cuticle of the wrist or ankle4 ,but practically a sinapism may be very useful applied at either place--possibly more useful if applied over the seat of the inflammation1 because there is a sympathy between the parts--they may be used very beneficially in domestic medication4 ,in a few succeeding pages ,i give some directions to the nurse who acts under the doctor's orders4 ,,ammoniacal ,,liniments1 and other washes and embrocations that are sufficiently irritating to produce redness when rubbed on the skin1 should be rubbed on briskly so as to produce considerably increased circulation in the capillaries1 c4 ,one of the most commonly used rubefacients is mustard4 ,to make a mustard plaster1 or sinapism1 take one part of powdered mustard1 and about three times the quantity of flour and mix into a paste with tepid water1 and spread it evenly between two pieces of thin muslin4 ,as hot water or vinegar weakens the active principle of mustard1 tepid water is best1 even if it seems cold when applied to the patient4 ,good sinapisms are conveniently made also by doubling brown paper several thicknesses1 wetting it and sprinkling on the mustard alone4 ,the mustard must not be left on long enough to vesicate2 usually it should be taken off within half an hour 7or moved17 except when applied to the soles of the feet1 when they may commonly be left on for several hours4 ,their action must be carefully watched upon an insensible or delirious patient1 or a little child4 ,in mixing the plaster for children glycerine may be used1 and then the plaster may remain on longer4 ,confine in place by a bandage4 ,if the patient complain of the burning or smarting after the plaster is removed1 dust the part with starch or fine flour1 or dress with vaseline to exclude the air4 ,you may make a cayenne pepper plaster in the same way that a mustard plaster is made1 or you may sprinkle pepper upon a thin slice of pork4 ,this makes good draughts for children and may be useful sometimes for sore throat if applied to the neck4 ,but capsicum plasters1 c41 can be bought at the drug store4 ,in the country it is generally convenient to obtain and apply horse radish leaves2 these are good rubefacients4 ,in order to produce immediate ,,vesication ,i have known a doctor to heat an iron spoon until it was sufficiently hot1 and then rub it over a small space of skin2 and a small blister may be quickly made by saturating a bit of cotton with hartshorn1 putting it in a top thimble and applying it to the skin to remain seven or eight minutes4 ,but the agent most commonly used to produce vesication is the ,,cantharideal ,,plaster4 ,if you are to produce a blister with this1 the part should first be washed and dried1 shaved if there is any hair upon it1 then if you wish the blister to rise soon wet the plaster and also the skin with vinegar2 apply1 and secure the plaster in place by a bandage4 ,most commonly it will rise in from four to eight hours1 but without waiting for it to rise fully you may remove the plaster and apply a poultice which will produce the desired effect4 ,do not tear the skin in taking the plaster off4 ,when the blister is well raised make a slight incision or two for the escape of serum1 and dress with vaseline or tallow4 ,this is the usual way1 but in some cases the physician may direct differently1 perhaps may leave the blister undisturbed and allow the fluid to be reabsorbed4 ,strangury and congestion of the kidneys sometimes follow the prolonged use of cantharides2 to prevent this1 it is sometimes recommended that tissue paper be well oiled and interposed between the plaster and skin4 ,and as camphor corrects the action of cantharides upon the bladder1 it is recommended that in case of a child particularly1 a solution of camphor in ether be sprinkled upon the plaster4 ,if a blister is applied to a young child1 it should be carefully watched and not allowed to remain too long4 ,in two or three hours the skin will be well reddened1 and the plaster may be removed and a poultice applied4 ,,tincture ,,of ,,iodine is sometimes applied as a counter irritant1 but several coats and repeated applications are necessary to produce a blister4 ,local stimulation can be obtained from bits of cantharideal plaster kept on for an hour or two1 and removed or changed before the point of vesication is reached4 ,the same effect follows the rapid passage of a hot flat iron over a piece of brown paper or flannel laid upon the skin4 ,it is generally best that the flannel should be wet first2 and should an emergency arise when from hemorrhage or some other cause there is danger of immediate collapse1 the application of heat in this way may rouse the sufferer and prevent immediate death4 ,this or the actual cautery is sometimes used to relieve lumbago1 or rheumatism4 ,if you have thereby a slight burn1 you may dress it in a solution of bicarbonate of soda and cover from air with rubber tissue4 ,if a ,,seton is inserted in the skin1 the silk should be moved daily and the matter well cleared out4 ,,wet ,,cups are applied to relieve congestion and to abstract blood1 the skin being first scarified4 ,,dry ,,cupping is most practiced for the relief of pain and to draw the blood away from an inflamed organ4 ,small tumblers may be used in the absence of cupping glasses1 if the edges are smooth4 ,when you apply the cups have at hand also a lamp1 a saucer of alcohol1 a bit of sponge or a wad of lint fastened to the end of a stick4 ,have the cups perfectly dry1 dip the sponge in the alcohol which you will ignite from the lamp1 7they being near the patient71 and let it burn for an instant in the inverted glass1 then withdraw and extinguish it1 and rapidly place the cup over the intended spot4 ,as the heated air in the glass condenses in cooling1 the skin will be forcibly sucked up1 and the blood drawn towards the surface4 ,each cup will remain on from three to five minutes4 ,do not attempt to apply them to a bony and irregular surface1 and be very careful not to burn the patient by getting the edges of the glass too hot4 ,to remove the cup press with the finger close to the cup so that air will be admitted4 ,,wet ,,cupping will be attended to by the physician1 who will provide the scarificator1 and adhesive straps4 ,see that plenty of soft towels are provided4 ,there are two varieties of ,,leeches used in this country1 the ,american and the foreign4 ,the latter differs from the former in having five or six stripes down its back instead of three1 and it will draw from five to six times its own weight of blood as it is larger and more voracious than the ,american variety4 ,the domestic variety is sometimes preferred for children1 as it will draw a sufficient amount of blood usually4 ,leeches should not be applied over any large vessel1 and preferably should be over a bony surface where pressure can be made to stop the blood if it continues to run4 ,the leech should not be handled1 it may be washed and dried in the folds of a towel4 ,to induce them to bite1 the part to which they are to be applied must be perfectly clean1 and it may be best to pick or scratch the skin so that the leech has first a taste of blood2 or you may put the leech in a wine glass1 test tube1 leech glass1 or small bottle filled with water2 cover with a cord and invert over the place2 hold it close and slip out the paper4 ,the leech will then probably take hold and the glass can be taken off1 and the water absorbed by a towel4 ,if one is to be applied inside the mouth or nostril1 put a thread through its tail to prevent its being swallowed4 ,if such an accident should occur have the patient drink freely of salt and water1 and induce vomiting4 ,if the leech seems sluggish when applied stroke it gently with a dry towel4 ,when full it will drop off4 ,if you wish to take them off sooner1 do not remove by force1 but put a little salt on their heads4 ,if the bleeding from the orifice continues too long it may be checked by a compress of lint1 an application of ice1 or by touching with nitrate of silver1 or carbolic acid4 ,leeches not used may be kept in a jar of water with sand in the bottom1 and a perforated cover1 or it may be covered with a linen cloth4 ,the water in which they are kept should be changed twice a week in winter and oftener in summer4 ,salt will make a leech disgorge the blood with which it is filled1 but if kept afterwards it is liable to be diseased1 and to cause disease in those that are with it4 ,by ,,fomentations or stupes is commonly meant the application of flannels or towels wet with hot water or some medicinal decoction4 ,if hot water only is used1 they are a convenient means of applying warmth and moisture1 but they require constant attention1 needing to be changed every ten or fifteen minutes4 ,they are chiefly of use in relieving pain and inflammation1 and in promoting suppuration when that is desirable4 ,two pieces of flannel should be at hand each doubled to the desired size2 they are to be saturated with boiling water and wrung out dry as possible4 ,to wring it out without scalding one's fingers1 put it inside a towel1 and this may be made with a hem at the end so that a stick can be thrust through it4 ,wring the flannel so dry that it will not make the bed or bed clothing wet4 ,cover with oiled muslin a little larger than the fomentation1 and over that lay some dry flannel or cotton4 ,if the stupe is put on hot1 and frequently changed1 it derives or draws blood towards the skin1 and is often useful in relieving spasm and pain2 and the continued use of them prevents suppuration4 ,medicaments are sometimes added to make them more irritant or sedative2 then they are not changed so often1 but they must not be allowed to get cold4 ,after the fomentations are discontinued1 carefully wipe the parts dry to which they have been applied1 and cover with a warm1 dry flannel4 ,i subjoin a few useful fomentations in which decoctions or medicines are used4 #a4 ,add one ounce muriate of ammonia and two ounces spirits of camphor to #a quart of boiling water just before dipping the flannel into it4 #b4 ,for a fomentation to the bowels1 chest1 c41 of a child1 take #a oz4 paragoric1 #a oz4 ,jamaica ginger1 and #d ozs4 hot water4 #c4 ,twenty drops spirits turpentine may be sprinkled over each stupe1 but be careful about blistering the skin or making a sore4 #d4 ,a decoction of chamomile flowers1 hops1 or conium1 may be used for the fomentation instead of water4 #e4 ,twenty drops or more of laudanum may be dropped over each stupe4 ,this might soothe pain without causing stupor4 ,,poultices1 like stupes1 are means of applying warmth and moisture4 ,if applied early1 it is believed they may prevent the formation of pus1 as they bring about a resolution of the inflammation4 ,when suppuration has commenced they facilitate the passage of matter to the surface1 and lessen the extent of the disease4 ,when applied to an inflamed part or swelling they should extend over considerable surrounding surface1 but for a suppurating wound they should be but little larger than the opening4 ,avoid putting them on very hot in a case of paralysis and also upon children1 though they should be applied quite hot usually4 ,to make ,,bread ,,poultices pour boiling water on slices of bread without crust1 simmer a few minutes1 then beat up the bread quickly and spread it upon a piece of muslin previously cut of the desired size1 leaving about two inches of margin upon each side4 ,then put on the poultice some lard or oil or vaseline to keep it from getting dry and hard1 and to make it less likely to stick4 ,it will be well to put on it a cover of thin muslin or mosquito netting1 or tulle1 or illusion1 and then fold over like a broad hem the edges of both the covers4 ,the poultice should be evenly spread about a quarter of inch in thickness and may be carried to the patient on a small tray or board1 and if you are changing the poultice you should also have a small basin to carry away the old ones4 ,after applying the poultice cover with some impervious material 7oiled muslin or rubber cloth7 to keep in the heat4 ,such a poultice as this will keep warm for five or six hours1 but it should not be allowed to become cold and hard4 ,milk should not be used in making poultices as it quickly sours4 ,,poultices ,,are ,,made ,,of ,,various ,,materials4 ,flax seed meal1 starch1 powdered slippery elm1 ,indian meal1 and oat meal are used4 ,they should all be made of such a consistence that they will be tenacious as possible1 and should have at least a little oil on them to prevent their getting dry4 ,for ,,putrid ,,sores some disinfectant solution may be used instead of water in making the poultice1 such as a weak solution of chlorinated soda4 ,,yeast ,,poultices are used to hasten the separation of gangrenous sloughs4 ,mix six ounces of yeast with the same quantity of water at blood heat4 ,stir in fourteen ounces of wheat flour and let it stand near the fire until it rises4 ,apply while fermenting1 or1 8,take of wheat flour a pound1 yeast half a pint1 mix1 and expose the mixture to a gentle heat until it begins to rise40 ,the following are old officinal forms for poultices3 ,,alum ,,cataplasm4 ,take the whites of two eggs1 of alum a drachm1 shake them together so as to form a coagulum4 7,a common mode of preparing the alum poultices is to rub the whites of two eggs briskly in a saucer with a lump of alum till the liquid coagulates47 ,the curd produced by coagulated milk with alum is sometimes used as a substitute4 ,the alum cataplasm is sometimes employed in incipient or chronic opthalmia as an astringent application4 ,it is placed over the eye enveloped in folds of cambric or soft linen4 ,,cataplasm ,,carbonis ,,ligni4 ,take a sufficient quantity of wood charcoal red hot from the fire1 and having extinguished it by sprinkling dry sand over it1 reduce it to very fine powder and incorporate in the simple cataplasm in a tepid state4 ,charcoal recently prepared has the property of absorbing those principles upon which the offensive odor of putrefying1 animal substance depends4 ,in the form of poultice it is an excellent application to foul and gangrenous ulcers1 correcting their fetor and improving the condition of the sore4 ,it should be frequently renewed4 ,,conium ,,cataplasm4 ,take of extract of poison hemlock 7conium7 two ounces1 water a pint4 ,mix and add of bruised flax seed sufficient to produce a proper consistence4 ,this cataplasm may be advantageously employed as an anodyne in cancerous1 scrofulous1 and other painful ulcers1 but its liability to produce narcotic effects in consequence of the absorption of the active principle of the hemlock must not be overlooked4 ,sometimes a bag is made to contain a poultice1 and such a bag should be used if we desire to apply a large poultice to the chest or abdomen4 ,one can be made for the breast and for the back at the same time1 and two straps over the shoulder may unite them4 ,a hop poultice is a thin bag loosely filled with hops and wrung out of hot water4 ,,dry ,,fomentations are sometimes employed4 ,thin bags filled with heated sand1 ashes1 salt1 bran1 or hops are used1 to keep the heat applied to the skin2 and to warm the feet and quicken the circulation in the extremities1 hot bricks1 bottles filled with water1 c41 are applied4 ,these should be rolled in hot flannel or at least enveloped in something4 ,,of ,,the ,,application ,,of ,,cold4 ,cold applications are sometimes used to subdue inflammation in the early stages4 ,they are not good when matter is forming1 or during sloughing4 ,when they are used they ought to be continuously applied so as to keep up a constant cooling effect4 ,sometimes either water or some lotion is used with the design of cooling by evaporation4 ,if a part is wet with water1 alcohol1 vinegar1 a solution of muriate of ammonia1 or other fluid1 and left uncovered1 the effect will be to cool it4 ,when you design to cool by evaporation do not lay on more than one thickness of muslin or lint1 and this must be wet so often that it does not get nearly dry4 ,but a part may be cooled by several folds of muslin wet in ice water1 and changed for fresh ones before they get warm4 ,it is important that they do not become warm1 and hence they should be frequently changed2 alternate cooling and reaction is hurtful rather than beneficial4 ,a steady cold stream of water is one means of cooling1 and another device is to carry across a part a long strip of muslin or lamp wicking1 having one end in a vessel of cold water higher than the bed1 and the other leading to a basin below it4 ,protect the bed well with ,india rubber cloth so that both the patient's clothing and the bed are kept dry4 ,rubber bags are made to contain ice1 and these are made in different shapes to be adapted to different parts of the body4 ,they should not be more than half filled1 and as soon as the ice melts the supply must be renewed4 ,the ice used should be finely broken2 this may be done by wrapping it in a fine cloth and pounding it4 ,if mixed with one-third saw dust the ice will keep longer4 ,a fold of muslin should be interposed between the ice bag and the skin1 and they should be kept in their place by a bandage or some other means4 ,an ice bladder for application to the head can be kept from pressing on the head by being folded in a napkin1 which may be attached to the pillow by a pin4 ,a cup shaped sponge may answer in the place of the ice cap to contain the ice2 this must be wrung out before it is saturated1 so that the pillow may not become wet4 ,,collyria are best applied to the eye at the outer angle2 a glass dropper or a camel's hair pencil may be used--this same one should be used for nothing else4 ,draw down the lower lid1 and tell the patient to look up at the same time that the drop of eyewater is slid in4 ,do not leave moist cloths bound upon the eye as they become hot and may do harm4 ,if you rub in liniment with your hand1 wash the hand carefully before touching a sensitive spot1 as some of the ingredients may cause smarting or other injury4 ,,chapter ,v4 ,,duties ,,of ,,the ,,nurse ,,in ,,various ,,circumstances1 ,,contagion1 ,,death1 ,c4 ,the fact that certain diseases are contagious is one that throws some grave responsibilities upon the nurse1 and on account of the importance of the subject1 ,i will here discuss it in the light of modern science4 ,infectious diseases are supposed to be propagated by the agency of minute living parasites given off from the body of the sick and conveying the specific virus4 ,the germ thereby includes this for the cause of all the zymotic diseases--diseases that are contagious and produced by some morbid principle or germs acting on the system like a ferment4 ,they are claimed to be a vegetable growth of a fungoid nature1 and the theory is that during the process or period of each--a period of growth like mildew--the victim is a sufferer from a more or less violent fever2 that the period varies2 in typhoid it is twenty-one days1 in other forms of fever perhaps a shorter time1 till the microscopic fungoid growth may be said to effloresce and shed its spores4 ,some diseases also that are not contagious are believed to be caused by organisms in the air4 ,there are various kinds2 monads1 bacteria1 vibriones1 c41 are among the substances found in the atmosphere of a large city1 and elsewhere4 ,a very great variety of these forms called fungoid growth have been seen and distinguished1 and it is demonstrated clearly that certain forms cause certain diseases4 ,for example1 cholera or choleraic symptoms have been induced in animals by the introduction of the cholera bacillus into their intestines1 and almost invariably the dead animals showed a great abundance of the characteristic bacillus in the intestinal tract4 ,the diseases which are now known or believed to be caused by such virus are very numerous1 and directions for preventing a disease from spreading are based upon this theory2 epidemic and endemic diseases are generally attributed to such a cause4 ,the list of germ diseases is about as extensive as the list of contagious diseases4 ,,epidemic ,,diseases are those that act upon numbers of people at the same time4 ,probably there is generally1 though not always1 disease organisms diffused through the air4 ,,endemic ,,diseases are confined to particular localities4 ,sporadic cases of disease are those occurring singly1 or scattered considerably4 ,,disinfectants are such substances as act upon the specific germs or minute living particles to destroy them4 ,,antiseptics are such as prevent decomposition or putrefaction4 ,,septic ,,germs are generally destroyed when widely diffused in the air4 ,it is believed that oxygen acts as a disinfectant1 at least dry air is not favorable to their growth4 ,a dry heat of #cjj degrees will destroy them1 and they are generally killed by a freezing temperature4 ,against communicable diseases the chlorine class of antiseptics including iodine1 iodoform1 bromine1 and sulphur are the most effectual1 and chlorine and sulphuric acid may without danger be used in the sick room to a sufficient extent to do some good4 ,the most rapid and powerful of the disinfectants is the solution of the bichloride of mercury 7corrosive sublimate74 ,the solution most commonly used is of the strength of fifteen grains to the quart4 ,it can be applied directly to floors1 beds1 walls1 sinks1 drains1 vessels1 c4 ,for clothing use a solution of common salt and sulphate of zinc1 two ounces of the salt and four ounces of the sulphate to a gallon of hot water2 soak the clothes in this and then boil them in water with borax1 or soap or soda4 ,when a disease is known to be very contagious and dangerous1 especial care is necessary to avoid contact on the part of patients and nurses with outsiders4 ,all superfluous things must be taken out of the room before the patient is put into it1 and care will be necessary continually to make the quarantine effectual4 ,every article carried out of the sick room must be disinfected2 a set of dishes should be kept for the patient's exclusive use1 washed only by the nurse2 the bedding1 clothing1 c41 must be washed by the nurses themselves1 after being soaked in a disinfecting solution2 dressings and other cloths1 such as old cloths used for handkerchiefs1 may be burned2 all excrementitious and vomited matter must be disinfected2 the broom that is used to sweep the room must not be used elsewhere2 no current of air must be permitted to pass from the sick room to the rest of the house2 and it is well also to hang about the room cloths wet with some disinfectant solution2 hang over the doorway a sheet similarly disinfected2 and the nurse should cover her head with a close cap4 ,lest the confinement and isolation make the nurse sick she must take care of her own health4 ,two nurses should be employed for every such case1 so that neither may be obliged to sleep in the same room with the patient1 and each should change her clothes and go out of doors for a time every day and take a brisk walk in the open air4 ,the ventilation is of especial importance in contagious diseases1 as no disinfection can render the air entirely pure4 ,to prevent the infectious particles that are thrown off the skin in cases like small pox and scarlet fever1 from polluting the air of the room1 the clothes should be frequently changed1 and the patient's body be washed and anointed with some ointment4 ,charcoal placed about the room in shallow vessels does some good by means of its property of absorbing gas2 and solutions of carbolic acid1 chloride of lime1 soda1 and zinc are germicides1 but the chief use of the carbolic acid family is where suppuration is going on1 to prevent the spread of septic infection4 ,it is also a means of disinfection perhaps1 if the spray is used in malarial disease4 ,condy's fluid and sulphate of iron are used as antiseptics1 but these stain clothing4 ,chlorine should not be used with sulphuric acid1 or carbolic acid4 ,either copperas or chloride of lime may be thrown dry into water closets4 ,a little disinfectant should be kept standing in all sputa cups1 urinals1 and bedpans1 and in cases of typhoid1 and cholera1 the stools must be carefully disinfected4 ,these diseases are not only directly infectious1 but the germs in the discharges may multiply and spread the disease4 ,cover the bottom of receiving vessels for stools with copperas or chloride of lime1 and after use add crude hydrochloric or sulphuric acids in quantity equal to half the bulk of the discharge4 ,cover closely and carry from the room1 and empty into a trench prepared to receive them1 at a distance from the water supply1 and all clothing and bedding soiled by the discharges must be disinfected and boiled4 ,after a case is ended the room must be subjected to a cleaning and fumigation4 ,everything that can be so treated should be either boiled or subjected to a heat of #bbj in a disinfecting oven4 ,rubber sheets and aprons may be cleaned with bichloride solution1 and the floors1 woodwork1 and perhaps the walls should also be washed with a solution of bichloride of ,mercury4 ,while the room is being fumigated1 drawers and closets should be open and things not thoroughly disinfected should be hung up in it4 ,a good way to fumigate the room is to burn sulphur in it1 but you may evolve chlorine from common salt in the following way3 ,mix an equal bulk of common salt and black oxide of manganese in a shallow earthen dish1 add two pints of sulphuric acid previously diluted with two pints of water1 and stir with a stick4 ,it is best in using this to have also steam in the room4 ,to fumigate a room have the doors1 windows1 and fireplace closed1 and paste paper carefully over the cracks4 ,if sulphur is used put it in iron pans1 allowing two pounds to every thousand cubic feet of space2 set the pans on brick1 so that they will not burn the floor2 pour a little alcohol on the sulphur and ignite1 then leave the room quickly so that you do not breathe the gas2 paste up the door when you go out2 keep it closed for twenty-four hours1 then open all the windows and let the room air4 ,those directing the disinfection should always remember the bleaching and corroding power of chlorine and sulphurous acid gas4 ,when a patient has died from any infectious disease the body should be washed in some disinfectant solution1 or soap should be used containing bichloride of mercury1 and a sheet should be wrapped around the body wet with the same4 ,saturate also a large wad of cotton with it and leave it under the hips4 ,the burial should be soon and private in these cases4 ,,of ,,the ,,nurse',s ,,duties ,,in ,,caring ,,for ,,the ,,dying ,,and ,,dead4 ,certain duties devolve upon the nurse in cases of ,,death from any disease1 and ,i prefer to refer to those duties here4 ,among the signs that indicate approaching dissolution are a peculiar sharpness of the features2 coldness of the toes1 fingers and nose2 a dusky shade about the finger nails2 cold perspiration1 restlessness1 and muscular twitchings or stupor4 ,when you are sure that the end is near it is best that the friends should be informed4 ,while there is slight grounds for hope do not give up all efforts1 but do not disturb the dying by useless ministrations4 ,note the exact time at which death takes place2 this is usually1 though not always1 obvious4 ,there may be a rise of temperature1 and the body be quite warm a short time after death2 this is produced by chemical changes1 but after a short time its temperature corresponds with that of the room in which it is lying4 ,then the peculiar stiffening of the muscles called ,,rigor ,,mortis sets in which lasts for a time and then disappears4 ,before rigor mortis comes on prepare the body for burial by washing it 7using a weak solution of chlorinated soda or carbolic acid71 closing the eyes1 arranging the lips naturally1 and combing the hair4 ,bandage the jaws closely1 stuff all the orifices of the body with absorbent cotton to prevent discharges1 and bind a cloth around the hips4 ,a clean night dress or shroud or any other clothing desired can be over this1 then cover the face and all with a sheet4 ,the arrangements can be put in the hands of an undertaker1 but it is quite likely the friends will wish you to superintend them4 ,if the body is to be kept for several days it must be packed in ice1 and after twenty-four hours the face has a more natural appearance4 ,the dark discoloration of the skin observable a few hours after death on the neck and sides and more dependent parts1 is caused not by mortification1 but by the blood settling or gravitating downwards4 ,slight discolorations about the face can be made less conspicuous by dusting them with toilet powder4 ,after the body has been taken from the house1 the bedding must be sent out to be disinfected1 all the appliances of sickness removed1 the room put in order1 and the windows left wide open for several hours4 ,,some ,,general ,,lessons ,,in ,,nursing4 ,rule #a4 ,do not get out of temper1 but try to make the sick chamber the pleasantest and yet the quietest room in the house4 ,do not appear anxious however great your anxiety4 #b4 ,do not converse in whispers2 invalids generally are suspicious and will imagine all sorts of things if they see their friends conversing in this manner4 #c4 ,do not urge the invalid to eat and drink when she does not feel like it4 #d4 ,do not ask a convalescent if she would like this or that to eat and drink1 but prepare the delicacies and present them in a tempting way4 #e4 ,do not allow the nauseating medicine bottles to stand in the sight of the patient4 #f4 ,study all the peculiarities of your patients1 and instead of opposing them by arguments or otherwise1 humor them whenever they do not interfere with the physician's orders or instructions4 #g4 ,in all cases keep everything that is used by the patient perfectly clean4 #h4 ,if the patient is not allowed to drink as much as she desires1 give her the limited quantity instead of a full glass4 ,if she is allowed to drain the glass she will probably be satisfied4 #i4 ,do not allow flowers or plants to remain in the room over night1 and always remove flowers from the sick chamber as soon as they become stale4 #aj4 ,in all cases the patient should have baths so often that the skin is kept clean1 and the pores are not stopped up4 #aa4 ,take care not to chill or fatigue a patient while bathing4 ,a sponge bath can be given in bed1 the bed being protected by an extra draw sheet4 #ab4 ,the mouth should be often washed and the teeth brushed or wiped off with a soft cloth4 #ac4 ,the hair should be combed at least once daily4 ,the ladies' hair is braided or twisted on top of the head so that she will not have to lie on a knot4 #ad4 ,do not light a sick room at night by means of a jet of gas burning low4 #ae4 ,preferably use sperm candles4 #af4 ,do not have the temperature of the sick room much above #fj4 #ag4 ,do not allow offensive matters to remain2 but in a case of emergency where these cannot be removed at once1 you can wring a heavy cloth out of cold water and use as a cover1 placing over this ordinary paper4 #ah4 ,do not neglect during the day to attend to necessaries for the night1 that the rest of the patient and family be not disturbed4 #ai4 ,to avoid making a noise by throwing coals on the fire1 place it in paper bags and lay them on the fire4 #bj4 ,do not lean or sit upon the bed1 if this is disagreeable to the patient4 #ba4 ,always remember that nothing which contributes to the welfare of those who require the nurse's care1 is too trivial to demand her attention4 #bb4 ,the following may by some be called little matters1 but attention to them will add materially to the well being of the sick3 ,refrain from constant enquiries of patients as to how they feel1 for sick people are easily annoyed2 anticipate the wants of your patient if possible2 never tiptoe about the room2 if the patient is very sick have the courage to tell the friends who call that the invalid cannot see friends1 if able to see them their stay must not be prolonged2 do not allow a patient to sit up in bed without covering the shoulders with some light wrap2 support them properly with pillows1 or a chair and pillows2 when obliged to leave the room take something with you which is no longer needed1 and bring back necessary articles1 thus saving annoyance to the patient and labor to yourself4 #bc4 ,to ,,avoid ,,mistakes ,,in ,,giving ,,medicine it is a good rule to always read the label before and after measuring the dose2 no medicine should ever be given in the dark2 tie a ribbon on bottles that contain remedies for external use2 shake a bottle before opening it2 do not leave a bottle uncorked2 generally keep medicines in a dark closet which is cool as possible2 have every medicine that is dangerous taken internally labeled 8poison02 keep them under lock and key4 #bd4 ,the nurse should know the ordinary doses of medicines and the symptoms of overdosing4 ,every unusual and inordinate action of a drug may be a good reason for omitting a dose or two till the physician is seen and new directions are given1 otherwise be always regular and prompt in the administration of medicines4 #be4 ,but in general the nurse can best display her knowledge and exercise her skill by faithfully carrying out the instructions she has received from the physician4 ,if the directions are not what she would expect1 it may be an exceptional case2 the doctor and not the nurse is the judge as to what is exceptional2 she must obey his orders4 ,do not receive orders from the physician in silence1 and when he is gone refuse to obey them4 ,the nurse should never hide anything from the doctor1 even if she has done wrong2 it is a serious thing to think that life should be risked in order to conceal wrong doing4 ,never be afraid of troubling the doctor2 he will always be glad to hear anything that will help in the diagnosis or treatment of the case4 ,the nurse has much to do with an art whose end is the saving of human life2 any neglect to act openly and intelligently becomes a crime4 #bf4 ,remember that kindness and tenderness as well as faithfulness are needful to successful nursing4 ,,bedsores4 ,every precaution should be taken by the nurse to avoid bedsores on her patient4 ,these appear most frequently upon the hips1 but may develop elsewhere in parts subjected to pressure4 ,to harden the parts they must be frequently washed with soap and water and thoroughly dried4 ,a draw sheet should be placed under the patient that can be changed as often as it becomes wet and damp4 ,be careful to keep the sheet free from wrinkles and inequalities1 and the patient's clothes must be kept smooth under her4 ,occasionally rub on the skin oil or vaseline1 and then dust on some fine powder such as oxide of zinc1 fine starch1 or toilet powder4 ,plasters that are entirely unirritating may be applied either before or after there is an evident sore1 and if change of position is not possible1 it may be necessary to obtain air cushions or a water bed4 ,an air mattrass or air cushions may be put on any bed1 but a water bed must be put in a trough or wooden frame made of just the right size4 ,the water in a bed of this kind should be of a temperature of #gj and renewed every two weeks4 ,to prevent a water bed from sticking to the boards some old cloths must be interposed4 ,reddening and roughening of the skin1 and pain on pressure indicate an approaching bedsore before there is an abrasion of the skin4 ,those washes that cause smarting must be discontinued1 and sulphate of zinc ointment1 and unirritating plasters used4 ,if a part is dead and likely to slough off1 apply charcoal or yeast or chlorinated poultices until the gangrenous parts can be removed4 ,after the separation of the slough you can apply lint smeared over with carbolated cosmoline or whatever application the surgeon or doctor may direct4 ,the sore must be washed and applications renewed each day1 and at each time it may be covered with a piece of oiled silk or muslin1 or rubber tissue confined in place by adhesive straps4 ,,baths4 ,the ,,sponge ,,bath or washing can be done partly under the bed clothes1 and but a small part of the body need to be exposed at a time4 ,do not bathe immediately after a meal4 ,always have a bath of the temperature directed by the doctor4 ,the following terms are used to indicate different temperatures3 ,,bath4 ,,water4 ,,vapor4 ,,air4 ,cold1 #cb to #fe ,fahr4 ,cool1 #fe to #ge ,temperate1 #ge to #he ,tepid1 #he to #ib #ij to #ajj #if to #ajf ,warm1 #ib to #ih #ajj to #aae #ajf to #abj ,hot1 #ih to #aab #aae to #adj #abj to #ahj ,to put a feeble patient in a bath wrap her in a sheet and lower her gently down in it4 ,when she is taken out wrap her in a warm dry sheet and over this fold a blanket4 ,after a few minutes' rest and a little wiping with a soft dry towel the clothes may be put on4 ,do not give a cold bath when the patient feels chilly1 when there is perspiration1 or there is inflammation or congestion of an internal organ4 ,the temperature of the body may be lessened by means of the wet pack in cold water1 or by means of a sheet wrung out of cold water wrapped around the patient1 and changed every ten or fifteen minutes1 or by applying towels from the neck downwards1 wrung out of cold water4 ,for the wet pack the sheet may be wrung out of either hot or cold water4 ,spread a comforter and two blankets on the bed and over these a sheet wrung out of the water4 ,remove all the patient's clothing1 lay her in the middle of the sheet1 then draw over one side after another of the blankets and comforter1 wrapping her from the neck to ankles2 apply something to the feet to keep them warm1 give plenty of drink1 and put a wet compress on the forehead4 ,if this is intended to induce perspiration or repose1 the patient may remain in the pack two or three hours4 ,a ,,blanket ,,bath is used as a means of sweating4 ,a blanket is wrung out of hot water and wrapped around the patient4 ,she is to be packed in three or four dry blankets and allowed to rest quietly for thirty minutes4 ,then the surface of the body must be well rubbed with warm towels1 and the patient made comfortable in bed4 ,,cold ,,or ,,tepid ,,sponging is sometimes directed when there is a fever4 ,commence at the head and sponge downwards1 then wrap in a blanket and leave her undisturbed for an hour or more4 ,the effect of the ,,hot ,,bath if long continued is to induce languor and weakness4 ,watch by the patient while she is in the water1 and take her out if there is any sign of fainting4 ,do not give a hot bath during a menstrual period4 ,a hot foot bath is one of the best means of revulsion to relieve the head4 ,let the water come nearly to the knees1 cover both the patient and tub with a blanket1 keep the feet in the hot water for about twenty minutes4 ,if a ,,hot ,,air ,,bath or a ,,vapor ,,bath is given1 some device should be used to keep the blankets from pressing upon the patient4 ,two half hoops may be tied together so that they answer the purpose4 ,by the same means steam may be diffused around her1 if hot bricks wrapped in wet flannel and put on dishes are placed in the bed beside her1 or steam can be conducted from a boiling teakettle under the blankets4 ,or place the patient in a large cane seated chair1 and surround both completely with blankets1 letting them extend to the floor and be secured about the patient's neck4 ,under the chair1 place a basin of hot water with an alcohol lamp beneath it2 bring the water to boiling1 and the patient will soon be in a perspiration which may be carried to any extent4 ,for a ,,bran ,,bath1 boil two pounds of bran in a gallon of water and add to the bath4 ,for a ,,salt ,,bath1 add one pound rock salt to every four gallons of water4 ,for a ,,sulphur ,,bath1 add twenty grains sulphuret of potassium to a gallon of water4 ,used for skin diseases and rheumatism4 ,in cases where there is a high fever1 especially in children1 the warm water bath is given to reduce the temperature4 ,if a child that has a temperature of #ajd is immersed in water heated only to #ih for fifteen or twenty minutes1 it will part with some of its heat4 ,,bathing ,,of ,,infants4 ,the bath for very young infants should be quite warm--about #ig4 ,some nurses ascertain if it is an agreeable warmth by dipping an elbow in the water4 ,the temperature may from week to week be lowered gradually to #he or #hj4 ,two baths a day may be given4 ,the evening bath should be warmer than the morning4 ,a brisk1 gentle rubbing after the bath is beneficial4 ,if a child gets blue and shivers the bath is too cold4 ,the warm bath will often serve to put a restless and feverish child to sleep4 ,to bathe an infant support its head on your hand and arm1 dip the baby into the bath2 then rub the whole surface of the skin rapidly with a soft sponge or piece of flannel soaped2 next again immerse the body in the water1 then quickly and thoroughly dry with a fine warm towel4 ,before giving a bath have every thing likely to be needed at hand1 and the room warm4 ,,changing ,,clothing4 ,before raising up a patient to put on a chemise or night dress1 pull up the soiled one towards the neck1 and as soon as the head and shoulders are raised1 the soiled garment can be slipped off over the head and a clean one put on2 then pull this down smoothly under the back before laying the patient down4 ,if two garments are worn one can be slipped inside the other1 and they can be slipped on as one4 ,,chapter ,,vi4 ,,surgical ,,nursing4 ,before ,i dwell particularly upon surgical cases and wounds of all kinds1 ,i will refer to some general duties of the nurse who attends during a surgical operation4 ,generally the patient to be operated on should have a bath the previous night1 and perhaps an enema on the morning of the operation2 if the operation is on the female genital organs a warm douche should be given4 ,prepare the room by having it well cleaned and aired and of a temperature of about #he4 ,such things as are likely to be needed2 for example1 vaseline1 carbolic acid1 basins1 sponges1 towels1 scissors1 needles1 pins1 ice1 hot and cold water1 should be provided4 ,if you have to make bandages1 an old cotton sheet is good material from which to tear the strips4 ,to join the strips lay two ends flat on each other overlapping for an inch1 and baste together all four sides4 ,a roller bandage may be from two to twelve yards long2 it must be rolled as tightly as possible2 the selvage and all loose threads must be trimmed off4 ,the proper cleaning and preparing of sponges is important4 ,if one has been used it should be well washed and left in a solution of sal soda1 and then kept for several days in a five per cent4 solution of carbolic acid4 ,new sponges should be prepared with twice as much care4 ,in a case where there is to be an operation upon the female genitals1 a ,t bandage may be required2 this should be put on before the ether is given1 at least the part above the hips1 the other part may be left free till after the operation1 to be then brought between the thighs and attached to the other in front4 ,only a little light food should be taken for three or four hours before etherization4 ,prepare the patient for going to the room by having her hair combed and braided1 artificial teeth must be taken out1 and all tight bands loosened4 ,arrange the clothing so that it will be protected1 and so that it can be changed afterwards easily4 ,see that she passes the urine the last thing before taking her place for the operation4 ,have a bed ready that is properly made and protected1 to which she can be moved when the doctors allow it1 and where she can be kept quiet4 ,if there is nausea and vomiting1 the effects of the ether1 you may quiet it by letting her sip a little hot water or by putting a hot1 dry cloth on her neck and chest4 ,during the operation you had simply to wait on the surgeon1 now the patient will be principally in your care4 ,you will receive instruction from the surgeon in regard to things needing peculiar watchfulness and every point must be carefully noted4 ,as the wound may need to be watched during the first twenty-four hours for hemorrhage1 it must be so arranged that it can be looked at without waking the patient4 ,the danger to which surgical cases are liable are1 #a4 ,shock2 #b4 ,hemorrhage2 #c4 ,erysipelas2 #d4 ,pyemia2 #e4 ,tetanus4 ,if there is ,,traumatic ,,erysipelas the edges of the wound are red and swollen1 the secretion of pus ceases1 and by the next day the skin around the wound becomes of a peculiar red color4 ,there will be fever1 headache1 nausea1 and a coated tongue4 ,,erysipelas can be generated by inattention to sanitary laws4 ,it is infectious and spread by fomites1 and the virus of erysipelas may give rise to puerperal fever4 ,it is not proper for a nurse that has had the care of a case of erysipelas1 to soon be the nurse of a lying-in woman1 even if she is careful about using disinfectants on her hands and changing her clothes4 ,certain influences augment the susceptibility of the body to the agency of the poison4 ,among the influences are intemperance1 low spirits1 anxiety1 insufficient nourishment1 and foul air4 ,there should be great care in regard to ventilation1 and clearing and cleaning the room where it has been present4 ,the disease cannot be cut short by active remedies1 but may be made to terminate favorably by the use of the perchloride of iron1 c4 7,f4 #agg47 ,,tetanus 7lockjaw7 may follow slight wounds4 ,at first the muscles of the jaw are rigid1 but the rigidity or spasms may extend all over the body4 ,it may result from exposure of the wound to cold1 and some cases of tetanus in infants have been attributed to the funis1 in instances where as much as three or four inches were left attached to the umbilicus4 ,in a case of tetanus the patient should lie in a darkened room1 and noise should also be excluded4 ,,incised ,,wounds1 made in the flesh by sharp cutting instruments1 of course may be trivial cuts1 or deep incisions1 and may sometimes be treated by the nurse1 either because they are slight injuries or because a surgeon cannot immediately be obtained4 ,if there is not much bleeding there will not be very much to do4 ,it is well to have a little carbolic acid in the water with which it is washed4 ,the bleeding will soon cease if only small vessels are divided4 ,if there is any extraneous matter on the surface of the wound it must be removed4 ,then put the surface of the lips of the cuts together1 and take measures to keep them in this state till they have become firmly healed4 ,if sutures are necessary take one or more stitches4 ,the most common method of keeping the surface of divided parts in contact is by strips of adhesive plaster4 ,apply them after having put the wounded parts in a position favorable for bringing the edges of the wound together1 then while one holds the lips of the wound evenly together secure them in this position by strips of adhesive plaster applied across the line of the wound4 ,leave a little interspace between each two strips of plaster4 ,it is not best to bind it up so that there is no passage or exit for blood4 ,but slight wounds may become serious if some poison or virus gets into it2 you may need to put on lint or a compress over the strips of plaster and then a roller or bandage4 ,but some incised wounds instead of being immediately dressed and bound up1 demand that immediate attention should be paid to the hemorrhage4 ,we may usually know whether the bleeding is arterial1 venous or capillary4 ,if the wound is open1 blood from an artery will spurt out in jets and is of a bright red color4 ,unless the artery is very small a surgeon will be needed1 but you may be required to act very promptly to suppress for a time a dangerous flow of blood4 ,if a large artery is cut or punctured the hemorrhage may be fatal in a short time4 ,the application of heat or cold1 and the elevation of the part injured1 may suffice in slight cases1 but in these severe cases other means are necessary4 ,first endeavor to arrest the rapid flow of blood by pressure upon the wounded artery with your thumb4 ,then if the wound is in a limb let some one tie a handkerchief loosely around the limb1 and if you know the course of the artery have the knot directly over it and between the heart and the wound4 ,then put a stick in under and twist the handkerchief so that it is tight enough to compress the artery4 ,the hemorrhage can thus be checked until the surgeon arrives4 ,if the wound is over a bone in the head or body1 the bleeding may probably be checked by binding on a hard compress where the artery is cut1 thus making direct pressure upon it4 ,a ligature upon a limb ought not to remain very tight more than an hour4 ,if the hemorrhage is from a leg below the knee it may be checked by putting a firm roll of cotton in the flexed joint1 and pressing the lower part of the leg against the thigh2 this will compress the artery4 ,,contused ,,wounds are not often attended with serious hemorrhage4 ,if there is in the bruised part only slight subcutaneous laceration1 nature may soon repair the injury4 ,but if there is considerable contusion indicated by the ecchymosis where small blood vessels have been lacerated and the blood extravasated into celular tissue1 causing the dark discolored spots and other evidences of severe injury1 there will be subsequent inflammation1 perhaps suppuration1 demanding treatment4 ,a proper mode of dressing at first is to bind on a compress saturated with a four per cent4 solution of carbolic acid1 and for the fever and inflammation one drop doses of ext4 veratrum may be given4 ,but in all cases where wounds are severe the services of a physician will be required4 ,a ,,punctured ,,wound signifies one made with a sharp pointed instrument1 the external opening being small compared to its depth4 ,it is a good rule in these cases to leave a free vent for any discharge that may be set up4 ,the danger in these cases is from serious injury to the deep seated parts1 and from suppuration which may burrow and extend still deeper if there is not free exit for the pus4 ,one mode of treating ,,poisoned punctural wounds 7serpent bites1 c471 which of course are peculiarly dangerous1 is by applying cups over the wound4 ,any wound that suppurates much or sloughs causes a cavity to be filled up1 and the process by which the wounds and sores heal is called granulation1 and cicitrization4 ,the wound is gradually filled up to the surrounding level by new tissue appearing in the form of small red granules bathed in pus4 ,healthy granulations on an exposed or flat surface rise nearly even with the surrounding skin1 and often a little higher1 but when they are much higher1 and take on a growing action1 they are what is called proud flesh4 ,their growth may be checked by the application of active astringents2 nitrate of silver or burnt alum may be used1 or adhesive straps may be applied4 ,the skin with which it is covered when healed is formed from the surrounding skin1 and the process which is called ,,cicitrization does not go on well except when the granulations are nearly level with the adjacent skin4 ,the centre of a sore has power to form new skin when there is a particle of live skin there1 and for this reason skin is sometimes grafted in4 ,a patient suffering from a suppurating wound becomes enfeebled from the discharge of pus1 and should have his strength kept up by nourishing food4 ,a surgeon will always endeavor to prevent the retention and decomposition of discharges1 and to protect from external contamination4 ,he will direct the time and means of dressing the wounds1 but the nurse must remember that decomposed animal matter acts as a virulent poison introduced into the system as it may be through any abrasion of the skin4 ,all instruments used about a wound must be thoroughly cleansed before being put away4 ,dressings which have been next the wound should be burned2 those which are to be washed should be disinfected4 ,avoid soiling your own hands with discharges2 protect with a bit of plaster every place where there is any cut1 or scratch1 or sore4 ,if you fear that any virus has got in where there is any sore1 or where the skin is broken1 touch it with carbolic acid4 ,,fractures ,,and ,,dislocations4 ,one of the signs of a ,,fracture is crepitus1 the sound made by the rubbing of the ends of broken bones together4 ,this sound cannot always be obtained1 even when the bone can be moved so that the ends rub each other1 and as such motion causes considerable pain the nurse should not seek for it1 except as she harkens when the limb is accidentally or necessarily moved4 ,the separation and inequalities of the ends of the fracture 7when the bones are superficial71 the change in the form of the limb1 and the shortening of it1 are circumstances communicating information in very many cases1 and the diagnosis is made pretty certain if there is unnatural mobility of the limb4 ,in other cases there is loss of motion or immobility1 swelling and pain in the injured part1 c41 but it will possibly require the services of the skillful surgeon to detect the existence and character of a fracture2 and generally the coaptation or setting of the bone1 can be deferred until he arrives4 ,the nurse can do something in the meantime--can have the patient and fractured limb put in as easy a position as possible2 perhaps have something ready for bandages and splints4 ,a splint may be made of anything that will hold the bone securely in place2 it should be longer than the bone that is broken4 ,sole leather is sometimes used2 cut the required size1 softened in hot water1 moulded to fit the part and left on until dry1 when it will be of the desired shape4 ,plaster of ,paris bandages are sometimes used4 ,these are prepared by rubbing into the ordinary muslin rollers dry plaster4 ,they are then rolled4 ,when they are applied1 soft flannel bandages are first put on the broken limb1 then the one containing plaster is 7after being dipped in water1 and some of the water squeezed out71 applied over the flannel4 ,it takes ten or twelve hours for this to set and become hard1 and the broken limb must be kept still during the time4 ,dust the part over with toilet powder before the bandage is applied4 ,the success of the surgeon depends very much on the good constant care of the nurse4 ,if it is necessary to move the limb keep up some extension on it and do not twist it4 ,be very careful that the directions of the surgeon are carried out1 and it will probably be necessary to keep up extension all the time1 otherwise the deformity may return and the limb be shortened4 ,,dislocations are not so easily reduced as fractures1 but after the setting and reduction of a dislocated joint the action of the muscles tends to keep it in place4 ,there is always some laceration of the ligaments and sufficient injury to the soft parts to excite a little inflammation1 but the pain is relieved as soon as the bones are replaced4 ,in general recent dislocations are easily reduced1 but when the head of a bone has been out of its place for several days the reduction becomes exceedingly difficult1 and as a rule the difficulty of reduction arising from the muscles is proportioned to the length of time that has elapsed from the period of the accident4 ,for this reason a person who has a little general knowledge on the subject of dislocations1 should sometimes make an attempt at reduction immediately after the accident4 ,the signs of dislocations are pain1 incapacity of motion in the limb1 change in the length of the limb and in the direction of its axis4 ,sometimes the dislocated limb is nearly incapable of any motion1 and sometimes the destruction of the means of union1 allows the limb to obey any extraneous influence4 ,the replacing of the dislocation would require very little effort or force were it not for the resistance of the muscles and tendons attached to them4 ,in reducing a luxated bone the main point is to apply force until the head of the bone dislocated can be slipped into its place1 which is generally when it is nearly to a level with its socket4 ,this is easily effected immediately after the accident1 because at that time the resistance of the muscles is not great2 it may be best to attempt it1 but there should be no delay in sending for a surgeon4 ,i recommend that an attempt be made to set a ,,dislocated ,,thumb or ,,finger by making extension on the lower member and at the same time pressing the head of the bone towards its natural situation4 ,if the reduction is effected1 the thumb or finger should be rolled with tape and surrounded and supported with pasteboard2 and the hand and forearm put in a sling4 ,a surgeon may be necessary even in a case of dislocated thumb or finger1 but bones out of joint are so much more easily set at first1 that it is best to attempt to set them then1 and the same may be said of some larger bones4 ,for instance1 if there is a ,,dislocation ,,of ,,the ,,elbow1 the patient being settled1 let one man take hold of his arm near the shoulder1 to make counter extension while another makes extension at the wrist4 ,you yourself being seated grasp the elbow with your two hands by applying your fingers to the anterior part and your thumbs to the posterior1 press on the projecting point of bone downwards and forwards4 ,you will generally be successful1 but ,i do not advise five minutes' delay in sending for a surgeon4 ,i only advise that an effort be made immediately4 ,after thus reducing a dislocation of the forearm backwards at the elbow1 apply a bandage in the form of a figure of eight2 apply some lotion or liniment1 and keep the arm in a sling4 ,at the end of seven or eight days when the inflammation has subsided1 the articulation can be gently moved1 and the motion may be increased every day4 ,the figure of eight bandage is a roller applied alternately above and below a joint1 the roll being carried obliquely over a central point4 ,the art of putting on a roller bandage is an important one for a nurse to acquire1 and ,i may here give a few general principles though no exact directions can be given4 ,in applying a bandage care must be taken that it is put on tight enough to fulfil the object in view1 without running any risk of stopping the circulation4 ,a bandage must lie smoothly1 without wrinkles1 and making an even pressure4 ,for bandaging an arm or leg a roller from two to three inches wide may be used2 a few turns may first be given on the hand or foot1 and after this every circle is to be applied so as to ascend up the limb in a gradual spiral form and cover about one-third of the turn of the roller immediately below it4 ,to accommodate it to the shape of the limb reverses are made4 ,the bandage is doubled back by placing a finger on the lower edge to hold it firmly1 and turning the bandage downward over itself1 at such an angle as properly shapes its direction1 and these turns can be made as often as is necessary4 ,,part ,,vi4 ,,remedies ,,and ,,regimen4 ,,chapter ,i4 ,,hints ,,in ,,regard ,,to ,,the ,,treatment ,,of ,,common ,,diseases4 ,it is my design in a subsequent part of this work1 under the head of emergencies1 to refer to those exceptional cases in which there is peculiar danger1 where some prompt action1 something done immediately may either save life or save from protracted disease4 ,in such cases the well instructed nurse may often do something without assuming undue responsibility4 ,but ,i now intend to give such instruction in regard to the treatment of minor ailments and complaints which are liable to arise in every family daily1 as will enable the mother or nurse to often relieve present distress1 and prevent future sickness and suffering4 ,but ,i hope it is fully understood that while ,i give such instruction as is founded upon many years of study1 and experience1 and observation1 ,i do not expect that any one can become a doctor by the perusal of this small treatise1 or that the student of this book will ever set herself in opposition to those who have devoted years to the study of the healing art4 ,with the understanding1 then1 that the mother is to prescribe medicine only in such cases as mothers usually do prescribe1 ,i will now give some directions that will enable the nurse or mother to act with promptness and assurance and efficiency4 ,some medicine should be kept in every house1 and ,i suggest the following as a good list3 ,aconite1 veratrum1 paregoric1 aromatic ammonia1 spirits camphor1 essence peppermint1 spirits nitre1 syrup ipecac1 witch hazel1 adhesive plaster1 chlorate of potash1 gum arabic1 compound licorice powder1 carbolic acid1 and the sanguinaria powder4 ,the last1 which is the medicine that ,i always use in diphtheria1 may be prepared according to the following formula3 ,take of pulverized blood root ounce1 ,ferri sulphas ,exsiccata ounce4 ,triturate together4 ,dose1 #a grain put on the tongue dry every four hours4 ,the medicine should be kept dry and is best kept in a phial corked4 ,all the medicines should be labeled with the name and ordinary dose4 ,a small quantity of medicine will suffice to keep in the house4 ,i suggest the following amounts and labels3 oz4 tinct4 aconite4 ,dose1 #a_/bj of a drop 7or less7 every hour4 ,poison4 oz4 veratrum viride4 ,dose1 drop every two hours4 #a oz4 paregoric4 ,dose1 #a drop to a teaspoonful4 #a oz4 aromatic ammonia4 ,dose1 #bj drops diluted in water4 #a oz4 ess4 peppermint4 ,dose1 #aj drops4 #a oz4 spirits camphor4 ,dose1 #a to #e drops4 #a oz4 syrup ipecac4 ,dose1 #e drops to a teaspoonful4 #a oz4 spirits nitre4 ,dose1 teaspoonful in water4 oz4 fld4 ex4 witch hazel4 ,dose1 #a drop every hour4 oz4 chlorate potash4 lb4 compound licorice powder4 ,dose1 #a teaspoonful4 #a oz4 gum ,arabic4 yd4 adhesive plaster4 #a oz4 carbolic acid and glycerine4 ,poison4 #a oz4 sanguinaria powder4 ,dose1 #a grain4 ,i will now give my treatment of diphtheria which is mostly by the use of the ,sanguinaria powder1 as this very well illustrates the benefit of having some mild safe medicine in the house1 and using it early in the disease4 ,nearly thirty years ago ,i was so well satisfied of the efficacy of this medicine1 that ,i advised all the families with which ,i was acquainted and where ,i was their physician1 to keep the powder in the house and use it whenever any of them had sore throat2 very many of them did so1 and it has happened that so far as ,i know1 there has not been a fatal case of diphtheria among them4 ,i advise that it be given in all cases of sore throat1 for although it is not so important a remedy in all these cases1 it will very generally be useful in a greater or less degree1 and as the sore throat is usually the first thing complained of in diphtheria1 its early application is thereby assured4 ,a very small dose will suffice1 but there is no objection to taking two or three grains for a dose every #d hours1 except the disagreeable taste4 ,i advise that it be taken alone1 and not covered up1 as ,i believe that it acts locally perhaps directly upon the organism or germ that is the cause of the disease4 ,i have not1 however1 relied exclusively upon the one medicine1 but have always directed that they should give about a teaspoonful of the saturated solution of chlorate of potash every hour1 and that they keep kerosene applied on the outside of the throat or neck4 ,give plenty of milk and other nourishing diet1 and but little other medicine is usually required4 ,the ,,sanguinaria 7bloodroot7 ,,powder is properly given in other cases besides diphtheria4 ,a small dose given three times a day is not only a good worm medicine1 but will prevent the subsequent developement and growth and multiplication of worms for some time4 ,it is also a cure for a cough that is dependent on an irritated state of the fauces4 ,three grains taken after each meal is a good remedy in chlorosis or suppression of the menses4 ,in these cases it can be taken covered up in wafers or in rice paper1 thereby avoiding the bitter taste4 ,,aconite should be kept in the house1 and very small doses given in cases where there is a little feverishness1 and no marked symptoms of disease4 ,it is useful when there is an ordinary cold1 and may be given two drops of the tincture in half a glass of water1 one teaspoonful every hour4 ,these small doses may be given to a little child1 and yet they have some effect upon older persons4 ,,ordinary ,,colds1 however1 require more efficient treatment1 and ,i often direct the following3 ,a teaspoonful ginger1 a teaspoonful cream of tartar1 and three large teaspoonfuls of sugar in a small glass of water1 to be drank as one draught after being stirred4 ,heat the feet and keep them warm especially at night4 ,the combination of ginger1 cream of tartar1 c41 opens all the secretions so that the lungs1 liver1 bowels1 skin1 and kidneys act in a natural manner1 and there is immediate benefit4 ,,veratrum has already been mentioned as a remedy in inflammation4 ,if good extract or tincture is used it can always be relied on to reduce the force and frequency of the pulse4 ,it is frequently applicable because in most of our diseases the force and frequency of the pulse is increased4 ,the pulse should be counted when it is first given1 and counted occasionally afterwards1 and when the pulse becomes less frequent the dose must be diminished or omitted4 ,if an overdose is given it is commonly vomited1 otherwise it might be dangerous4 ,ordinarily half a drop every two hours of the fluid extract is sufficient1 but for adults two drops may sometimes be given and repeated in an hour4 ,we have so many maladies that are inflammatory1 where the pulse is full and hard1 that the indications for its use are frequent4 ,even in the commencement of fevers1 when the pulse is full and quick--where it was formerly the practice of physicians to bleed1 veratrum should be given till it has a decided effect upon the pulse4 ,in intermittent fever the effect of this sedative upon it1 given at the commencement of the fever or hot stage1 is as salutary as is the effect of quinine given during the intermission4 ,moderate doses are not liable to do harm except to those who have become quite weak and low4 ,a convenient way of administering it is to prepare twenty drops of the extract in twenty teaspoonfuls of water1 and the dose can be easily regulated4 ,croup may generally be cured if veratrum is given early and in efficient doses4 ,it is of no avail to administer it at an advanced stage when there is apna2 the pulse becoming feeble and intermitting1 the lips blue1 the skin losing its heat2 and when drowsiness1 coma or other fatal symptoms are coming on4 ,when cough1 hoarseness1 catarrh1 and loss of voice are noticed in a young child1 it should be narrowly watched and protected against all circumstances likely to aggravate inflammation2 it should be kept in the house1 and a warm1 moist air should be kept in the room 7about #fe71 its diet should be milk or farinaceous food2 the functions of the bowels and skin should be attended to2 some aconite should be given2 if there is a slight1 ringing cough1 place the patient in a warm bath for ten minutes1 then confine it to bed2 keep the air of the room moist by the evaporation of boiling water2 give castor oil or other physic1 and small doses of syrup ipecac1 and spirits nitre4 ,if the respiration becomes sonorous and difficult1 the voice hoarse and gruff1 the cough croupy and brassy as it is called1 you have the characteristic symptoms of croup4 ,but the peculiar breathing1 making a sort of crowing sound with each inspiration1 will always distinguish it1 and there will always be some fever attending it4 ,croup sometimes commences with sore throat1 and ,i believe that the sanguinaria powder will usually be efficacious in its cure2 but prompt doses of veratrum are still more effectual4 ,at the early stages you may give two drops of the extract1 and the dose may be repeated in half an hour1 and perhaps repeated afterwards4 ,if there is not evident improvement an ounce of syrup of ipecac or a teaspoonful of sugar and alum pulverized together1 may be given if necessary to make the child vomit4 ,in the meantime hot fomentations should have been applied to the throat4 ,a sponge the size of a large fist1 dipped in water as hot as can be borne1 should be squeezed half dry and applied under the child's chin so as to cover the larynx1 and the temperature maintained by resoaking it every two or three minutes4 ,baths may be used during the second stage of the croup2 if the child has a temperature of #ajd1 a warm bath ought to be administered1 and the child immersed in it up to its chin for fifteen or twenty minutes4 ,after the breathing is relieved1 still give small doses of syrup of ipecac1 or alum1 or veratrum1 sufficient to keep up nausea for a time4 ,after there is a decided amelioration of the symptoms1 give the following3 ,to a teacupful of ginger tea add a teaspoonful of aromatic ammonia1 and a teaspoonful syrup of ipecac1 and give a teaspoonful every hour4 ,,veratrum is the medicine upon which you must rely in croupy cases2 this disease requires vigorous treatment1 but vigorous measures in the start will generally save the life of the patient4 ,,paregoric is a useful medicine for pain1 diarrha1 cough and restlessness1 and may generally be given advantageously when two of these symptoms are present4 ,opium has some beneficial effect in inflammation1 and very generally paregoric can be given where there is febrile excitement4 ,i would never give it when the child is only cross and irritable1 as a bad habit may thereby be engendered4 ,there is always danger of giving an overdose of any opiate2 and although an adult may sometimes take as much as two ounces of paregoric when he is suffering severe pain1 ,i do not advise that it be given to children often in doses that exceed five drops4 ,,diarrh,a may be treated in the following manner3 ,to four ounces of ginger tea add one teaspoonful paregoric1 one teaspoonful aromatic ammonia1 one teaspoonful ess4 peppermint1 one half teaspoonful spirits camphor1 and two ounces of mucilage of gum arabic1 and shake the whole together4 ,this is good medicine for all forms of summer complaint1 diarrha1 dysentery1 or cholera morbus4 ,one-half teaspoonful of this is a dose1 but it can be given efficiently in a larger or smaller dose4 ,it acts by correcting the disordered state of the stomach1 and it is upon this usually that these diseases depend4 ,if the diarrha continues for a day or two1 some mild astringent may be given2 perhaps three drops every two hours of the extract of witch hazel4 ,the diet is important1 and it is well in these cases to have some wheat flour boiled4 7,f4 #dg47 ,the flour grated from it and sifted1 and made into a gruel1 may be profitably used with milk4 ,a thin solution of ,,gum ,,arabic with milk affords both food and drink1 and is one of the most useful1 and safe1 and efficient remedies4 ,such medicines as ,f4 #gd1 #gg1 #gi1 #hj1 may be given in almost every case with benefit4 ,the alkalies neutralize the acids in the stomach1 and the aromatics have a grateful action4 ,if the pain continues1 a warm bath may be given4 ,should the gums be swollen1 they should be cut down to the teeth4 ,but there are many cases of diarrha where my prescription would be the following3 ,give no kind of food save that of the milk of the mother1 and that only once in four hours4 ,should the thirst require more fluid to satisfy it1 give from time to time a teaspoonful of cold water2 put flannel on its body1 and woolen stockings on its legs2 rub the abdomen three or four times a day with the bare warm hand2 do not ever wake the child when asleep2 when awake give it five drops paregoric every two hours4 ,in the preliminary stage of ,,cholera ,,infantum1 besides giving the diarrha mixture with ar4 ammonia1 ,i would enjoin absolute rest in the recumbent position1 with warmth to the surface and extremities2 perhaps total abstention from mother's and cow's milk1 and would order either condensed milk or arrow root prepared with water4 ,i would also make counter irritation over the abdomen by poultices and sinapisms4 ,,dysentery when first coming on is attended with more fever than diarrha is4 ,it will be distinguished by the character of the pain and the discharges4 ,the patient is tormented by a sensation as if there was some excrement to be dislodged2 he goes often to the night chair1 and strains to get rid of the irritation2 he discharges but little1 and what is voided is either a jelly like or bloody mucus2 perhaps mixed with films and membranous shreds4 ,the pulse is hard and frequent1 the skin hot1 the face flushed1 and the patient complains of headache and thirst4 ,you may give some veratrum at first2 one-half drop of the extract every two hours for one day2 and to allay the thirst1 give cold water in which some wheat flour has been stirred4 ,my principal remedies if the diarrha mixture does not cure1 is to give the sour drops 7elixir vitriol71 and either large or small doses of ipecac4 ,i also use injections of starch and laudanum1 and rectal suppositories4 7,f4 #aee1 #afj47 ,you may find much benefit from some domestic remedies4 ,give either occasional doses of strong table tea1 or spoonful doses of vinegar and table salt1 or freshly prepared melted mutton suet4 ,,aromatic ,,spirit ,,of ,,ammonia is useful in hysteria1 flatulent colic and nervous debility4 ,it is not a powerful medicine to overcome disease1 but it is a medicine that ought to be at hand to relieve many little ailments that are liable to occur1 when much medicine cannot be given4 ,i advise those that are suffering from sick headache to take #cj or #dj drops of it as a stimulant antacid4 ,it may be well also to take a teaspoonful of paregoric1 and to lie down till sleep gives relief4 ,,fainting ,,fits or ,,fainting may demand a remedy1 and #ae drops ar4 spts4 ammonia may give the desired relief1 if the sufferer lie down and a little cold water be sprinkled in her face also4 ,this medicine is a grateful antacid in cases of ,,sour ,,stomach1 and it will usually give some relief in the flatulence and distress of ,,dyspepsia4 ,it may often be used as a slight stimulant1 but as it is an alkaline remedy it should not be given conjoined with acids4 ,,essence ,,peppermint and ,,spirits ,,camphor are often used in ailments similar to those in which ,i use aromatic ammonia1 and this may be given in combination with them4 ,some persons have a decided preference for essence cinnamon1 or wintergreen1 and these may be substituted for peppermint2 aromatics also1 such as sweet flag1 will have a similar effect4 ,spirits nitre is often a grateful stimulant to the stomach1 but it is also used in febrile affections1 and inflammatory complaints4 ,four parts of spirits nitre to one of ar4 ammonia is diuretic1 diaphoretic1 and is well suited to certain states of febrile disease4 ,when given to promote the action of the kidneys1 a half teaspoonful or more may be given every two hours in a spoonful of water4 ,scanty and high colored urine1 especially when it is acrid and burning1 is an indication for its use4 ,,syrup ,,of ,,ipecac is used as an expectorant and emetic in colds and coughs4 ,if given to a child1 one teaspoonful is an emetic dose1 to be repeated every fifteen minutes till it operates4 ,if given to loosen a cough1 five or six drops repeated every half hour will suffice2 but it may be given in much larger doses4 ,it is often given in combination4 7,f4 #acg1 #aci47 ,,witch ,,hazel4 ,pond's ,extract ,hamamelis is kept by many people in the house1 and as it is usually accompanied with directions1 ,i shall refer to it very briefly4 ,the ordinary fluid extract is perhaps five times as strong as ,pond's extract1 and when used may be diluted accordingly4 ,it is astringent1 and a medicine of that kind is often useful both internally and externally4 ,a few drops taken each day may prevent bleeding1 when there is a tendency to hemorrhage1 although ergot would be a more efficient remedy if given for immediate effect4 ,,chlorate ,,of ,,potash is very generally given in diphtheria1 and is generally safe2 no harm can come from the advice to keep it constantly in the house2 it is not very soluble1 and the saturated solution is not too strong for use4 ,it is a good way to put a half teaspoonful of it in a glass1 and keep a little water on it all the time1 and give ten or twelve teaspoonful doses of the solution a day for any kind of sore throat or mouth4 ,,compound ,,licorice ,,powder 7,f4 #ajh7 is a mild laxative1 and may be given to a young child in half teaspoonful doses4 ,in larger doses it will serve well for older persons for physic4 ,while ,i think it well to keep this in the house and to occasionally administer it1 some other sort of cathartic may at times properly be preferred4 ,a great variety of this sort of medicine is attainable1 no one kind is always the best2 this powder is however a good laxative1 in doses of a teaspoonful repeated in eight hours if necessary4 ,,gum ,,arabic is not often kept in the house as a medicine1 but ,i think it eminently proper to keep it2 scarcely any other medicine is so safe and harmless either in large or small doses1 and few are more decidedly useful than this in some cases4 ,made into an emulsion and taken either alone or in combination with other medicine1 or used as food1 it is good in every variety of bowel complaint4 ,a teaspoonful of the mucilage stirred into a cup of cold water and drank by the patient1 may serve as medicine and drink and sustenance when he can take no other food4 ,it may properly be added to expectorant and diuretic medicines2 but the beneficial effects are most obvious when it is administered for inflammatory affections of the gastric and intestinal mucous membrane4 ,slippery elm and flaxseed tea have a similar effect1 but are not so decidedly beneficial4 ,,carbolic ,,acid nine parts and ,,glycerine one part may be kept mixed together2 not because the glycerine assists or modifies the action of the carbolic acid1 but because it renders the acid soluble in the water1 so that the solution may be of any strength desired4 ,,carbolic ,,acid is not much used internally2 it is so powerful that it ought to be regarded as a poison2 its effect is good1 however1 if given in small doses very much diluted4 ,it is believed to be destructive to disease germs1 and may very properly be given in bad cases of diarrha and dysentery4 ,two drops of the acid in a glass of water is a weak solution1 and may be given without harm2 a half teaspoonful every two hours4 ,there is not space in this work to describe particularly the various cases in which it may be used externally4 ,a solution one part in #ajj of water1 may be applied advantageously to any inflamed part or to any ,,cutaneous ,,eruption1 or may be used as a wash or gargle in any ,,sore ,,mouth or ,,sore ,,throat4 ,to cure sores or eruptions1 however1 it is often necessary to apply it much stronger4 ,i apply a #a to #e solution to the sores once or twice1 and to burns a solution #a to #cj for a few days4 ,i will give more particular directions for its use in ,,hemorrhoids or ,,piles4 ,apply the acid and glycerine 7#i to #a7 to the piles by dropping #c drops upon a bit of tissue paper and pressing it against the tumors1 and into the anus4 ,repeat this each day for three days1 then use a mild ointment or suppositories4 7,f4 #bjf47 ,a few doses of the compound licorice powder will be useful for piles if the bowels are not regular4 ,i have already given some specific directions in regard to some diseases in very young children2 what further instructions ,i give will be of a general character4 ,,home ,,remedies ,,and ,,appliances ,,for ,,sick ,,children4 ,,dentition predisposes to sickness1 if it does not cause it1 and it may call into activity latent tendencies to disease4 ,it may cause such symptoms as the following3 redness1 heat1 and tenderness of the gums2 an increase of saliva2 starting as if in fright2 restlessness1 or interrupted sleep2 eruptions on the head or body2 derangement of the digestive organs1 and sometimes convulsions4 ,during the period of dentition1 be especially careful that the child has its food and sleep regularly1 and that it is restricted to suitable quantities of food at a time4 ,keep the head cool and the feet warm2 wash the child daily in cold water1 and allow it to be much in the open air4 ,if a child is worrisome and irritable it will be necessary to cut the gums4 ,lance them at the elevated points1 cutting them down to the teeth4 ,at the same time1 aconite can be given1 and perhaps a warm bath2 and if there is considerable fever give ordinary doses of veratrum4 ,these remedies are so generally useful where there is fever1 that ,i will venture to recommend them when either ,,thrush1 ,,measles1 ,,german ,,measles1 ,,mumps1 ,,scarlet ,,fever1 ,,chicken ,,pox1 or ,,whooping ,,cough is coming on or suspected4 ,each of these diseases have a natural course which they must run before they terminate1 and it is best1 as in diphtheria1 not to give medicines powerful enough to interfere with the natural course of the disease4 ,do not give physic4 7,f4 #aba1 #abb47 ,so in ,,opthalmia it is better to have nothing but a little salt in the water than it is to use harsh things to bathe the child's eyes4 ,do not rub the eyes2 let a small stream of tepid water trickle onto them1 and wipe the discharges away with a soft rag4 ,burn the rag1 wash your own hands1 and keep them away from your own eyes1 on account of the danger from contagion4 7,f4 #baj1 #baa47 ,,constipation cannot be treated in all cases without giving some aperient medicine4 7,f4 #ajh1 #aji47 ,oat meal gruel as a diet may be helpful2 and fresh vegetables--cabbages1 turnips1 onions1 ripe fruit2 oatmeal porridge with molasses1 and brown bread may be taken freely4 ,infants may be partly fed on corn starch1 and older children may have cracked wheat 7,f4 #ce71 or peas1 beans1 squashes1 and other fresh vegetables and fruits in their season4 ,a good draught of water on rising and retiring is advisable2 and a teaspoonful of soda and molasses mixed together and taken daily for a week may cure a costive habit4 ,a suppository of castile soap may induce a movement in a child1 or it may be best to give an injection of tepid water1 or soap and water4 ,for ,,chafings bathe the parts well in tepid water1 dry with soft cloths1 and apply by means of a soft sponge1 ,f4 #bab4 ,the following diseases are inflammatory1 and demand at first mild treatment with aconite1 veratrum1 and warm baths3 ,in ,,tonsilitis 7quinsy71 use the blood root powder and bicarbonate of soda4 ,the patient can apply the bicarbonate of soda to the inflamed tonsil with his finger1 or it can be blown into his throat through a quill1 or through a hollow roll of stiff paper that contains a few grains4 ,for the chronic form of tonsilar enlargement use ,f4 #bac4 ,,coryza or snivels is an inflammatory affection of the mucous lining of the nose1 attended with an abnormal secretion4 ,sometimes the child can only breathe through its mouth2 in such cases you may draw the breast milk1 and feed the child by means of a spoon4 ,give aconite1 and as a local application the inside of the nose may be often smeared with vaseline1 or cold cream1 or carbolated cosmoline4 ,bronchitis1 pneumonia1 pleurisy1 and other inflammatory diseases1 may not show their distinctive character in their incipient stage1 but there will be at first sufficient fever to indicate the need of aconite1 veratrum1 and perhaps the warm bath4 ,accessary means may be used1 such as the following3 the patient should be placed in a warm room 7about #fe7 and have only light bed clothing2 if the child is taken out of bed he must have on a warm wrapper1 or be otherwise well covered2 he should not lie flat in bed1 but he should be somewhat propped up with pillows2 and it may be best to keep on a continuous poultice to the chest in front and back4 ,the patient should be kept very quiet1 have mucilaginous drinks and farinaceous diet2 and the air of the room should be moistened by steam or the evaporation of wafer2 and the ventilation of the apartment must not be neglected4 ,they must have frequent sips of cold water to allay thirst1 besides marshmallow1 slippery elm1 or flaxseed tea1 and revulsives must be used as well as poultices and fomentations4 ,by the aid of a ,,clinical ,,thermometer many diseases may be distinguished even in the incipient stage4 ,if a person without any premonitory symptoms is seized with a chill1 followed by rapid breathing1 a dull pain in the chest1 cough1 high fever1 and comparatively slow pulse2 if the thermometer indicates a temperature of #ajd or #aje1 and the pulse does not beat over #aaj a minute1 the case is one of ,,acute ,,pneumonia4 ,sometimes the temperature is below #ij2 if it exceed #abj it is almost certain to be fatal4 ,,ague4 ,,chills recurring regularly for a few days indicate the intermittent nature of a disease4 ,but during the first chill if the thermometer is applied1 we may know that a case is one of fever and ague1 if while the skin is yet cold the thermometer rises to #aje1 and later to #ajg1 and during the stage of sweating the instrument shows a decline of #b every fifteen minutes till it has reached #ih4 ,this rapid rise and decline is due only to malaria1 and quinine is indicated4 7,f4 #ahb47 ,,tubercular ,,phthisis4 ,if a patient has been losing flesh of late and been troubled with a short1 dry cough1 take his temperature at about six ,p4 ,m4 for a few evenings4 ,if the thermometer records #ii to #ajj1 and no other cause exists for this regular nightly increase of temperature1 the case can be put down as one of incipient consumption1 especially if tuberculosis has been in the family4 ,endeavor to improve the general nutrition by attention to the quantity and quality of the food 7as generous diet as can be taken without disturbing the stomach or increasing the feverish symptoms72 by enjoining a residence in a healthy climate2 by exercise in the open air2 by warm clothing2 by daily tepid sponging1 with friction of the skin2 and by cod-liver oil or petroleum emulsion with hypophosphites4 ,an animal diet is generally necessary4 ,if digestion fails and there is acidity of the stomach1 give pepsin4 7,f4 #gb47 ,add a teaspoonful of sweetened lime water to a tumbler full of milk1 and if this agrees with his stomach1 he can take that amount four times a day4 ,in ,,typhoid ,,fever the patient may complain of lassitude1 headache1 pain in the back1 etc41 for several days before he is feverish4 ,then his temperature is #ii1 and it may be one degree higher each night1 until on the sixth and seventh evening it is #ajd2 it being each morning one degree less than at night4 ,even if there is no diarrha1 tympanitis1 or eruption1 we may by observing the temperature1 feel sure that we have a case of typhoid fever4 ,if it is a moderate case the temperature will be #ajd at night1 and #ajc in the morning1 till the fourteenth day1 when it may decline one degree in the morning1 and half a degree or one degree in the evening4 ,after that it may decline regularly till on the #bast day it may be #ih4 ,relapse or chest difficulty may modify this regular decline1 and the nurse must carefully note and report to the physician the temperature each morning and night4 ,in ,,typhus ,,fever the temperature reaches its height1 #ajd or #aje1 within thirty-six hours4 ,it continues at that height1 with morning remissions of one-half degree1 till the eleventh or thirteenth day1 when it rapidly falls to the normal2 a sweat or a long sleep ushering in the favorable termination4 ,,scarlet ,,fever4 ,if a child is suddenly taken ill with a chill1 vomitings1 very rapid pulse1 and the thermometer records #aje or more1 very early in the disease1 it denotes scarlet fever2 and from this sign alone1 even without any sore throat or eruption1 a diagnosis may be made4 ,this disease may very frequently go on well without any danger till the eruption subsides1 but danger arises from exposure of the child to cold any time during the subsequent four weeks4 ,,hysteria4 ,there may be pain perhaps in the bowels1 abdominal tenderness1 and vomiting2 or there may be symptoms of inflammation in some other part2 if the thermometer does not register more than #ih it is probably hysteria4 ,assaftida1 valerian1 and such remedies will probably cure4 ,,apoplexy4 ,in this disease the thermometer soon after the attack shows a temperature of only #ig1 and lower still if there should be a second effusion to still more compress the brain4 ,on the contrary1 in a fully developed case of sunstroke1 the thermometer will not record less than #ajg4 ,it would be a good thing if every nurse and every mother kept a clinical thermometer4 ,,chapter ,,ii4 ,,emergencies1 ,,accidents1 ,,sudden ,,sickness4 ,the diseases last named were there mentioned because their distinctive character could be determined by the thermometer4 ,they are1 however1 examples of the kind of cases that ,i design now to speak of particularly2 where there is apparent cause for alarm1 and where there is apparent necessity that something should be done immediately4 ,these cases demand the services of a physician1 and my design is only to instruct you what to do before the doctor arrives2 or rather ,i should say1 the instructions that ,i give are not intended to supercede medical advice1 though some cases may be of a kind in which little or nothing can be done4 ,these emergencies are of every variety1 and ,i shall bring the different kinds before you as fully as ,i can4 ,ordinarily it is not at first apparent what the real malady is4 ,we will suppose that during the heat of summer a man drops down unconscious4 ,at first no one knows whether it is apoplexy or ,,sunstroke4 ,do not get excited and do things that are rash2 if you do not know what ought to be done1 do nothing2 if you are not excited you may at least use what knowledge you have acquired4 ,send a message to the doctor1 giving a description as far as you can of the case1 so that he may come prepared to treat it4 ,secure plenty of fresh air and room1 and get rid of those who are around1 who cannot be useful2 if respiration is suspended1 and there is immediate danger1 something may be done at once2 at least to know if the man has merely fainted4 ,have him laid in a horizontal position2 you may soon have him carried to the nearest house4 ,for this something should be provided on which he can lie horizontally2 instruct the bearers to avoid unnecessary jolting2 have a bed ready to put him on2 if the case is supposed to be fainting give aromatic ammonia or a little stimulant of some kind2 do not raise the head1 but keep it low as the feet4 ,if it is a severe case of sunstroke1 the skin is hot and the pulse weak and fluttering2 there may be convulsions1 but probably there will be no movement2 remove the clothing with as little disturbance as possible2 do not cut anything that can be ripped2 throw cold water on the head and chest1 or put the patient in a cold bath of about #gj at first1 and gradually reduce the degree of cold2 give a cup of good table tea2 do not give alcoholic stimulants without medical advice4 ,if consciousness returns and the temperature again rises1 repeat the cold applications to the head1 neck1 and chest2 give ice water or ice tea2 it may be best to rub the head and body an hour longer1 and to give stimulant enemata4 ,,apoplexy can be distinguished from syncope by the pulse1 which beats perhaps with unnatural force2 the face instead of being pale is generally flushed1 and turgid1 and the respiration goes on though it may be labored and stertorous4 ,the condition of the sensorial functions is much the same as it is in narcotic poisoning1 or when a man is dead drunk4 ,the nurse should make all necessary enquiries so that she can furnish the physician with a full history of the case to help him in his diagnosis4 ,in apoplexy the pulse is rather slow though full1 and the pupils of the eyes1 one or both1 dilated4 ,there may be paralysis of one side4 ,loosen the clothes1 elevate the head and chest1 apply cold water to the head1 and heat to the extremities1 and perhaps sinapisms also4 ,giving physic may be deferred until the doctor arrives2 and in general you may pursue a similar course whether the case is one of ,,concussion ,,of ,,the ,,brain1 or ,,compression or narcotic poisoning2 cold may be applied to the head by means of pounded ice in a bladder2 keep the head cool and the feet warm4 ,many of this class of cases require still very careful nursing after the dangerous symptoms are relieved4 ,the skin should be kept healthy by daily friction and bathing4 ,the bowels must not be permitted to become costive2 the diet should be light1 the food well chewed1 the mind kept cheerful and free from excitement4 ,,poisons4 ,in cases of poisoning no time is to be lost in administering relief1 and it is important that the nurse should be familiar with all the usual antidotes4 ,most commonly in a case of poisoning1 speedy free vomiting should be induced by those articles that are at hand1 and that are quick and prompt in their effects4 ,even if the poison has been taken hypodermically1 emetics may be given2 these will do no harm3 ,sulphate of zinc 7white vitriol71 is very prompt in its action1 and may be used when it can be procured 7,f4 #acd72 and if vomiting be present1 we may aid it by giving warm water1 or perhaps pulv4 ipecac1 or some other vegetable emetic4 ,but either common salt or mustard is nearly always at hand and may be given4 ,stir up a tablespoonful of salt or a teaspoonful of mustard in a cup of warm water1 and give immediately1 and repeat until a pint is swallowed2 do not stop to stir them very much1 but give as quickly as possible4 ,you may tickle the throat with a finger or a feather to induce immediate vomiting4 ,do not give tartar emetic2 do not give fluids so as to distend the stomach too much2 some bland fluid may be given with or immediately after giving mustard and salt2 either milk1 lime water1 white of egg1 flour and water1 gruel1 drinks sweetened with honey or sugar4 ,oil should not be given unless ordered4 ,before naming the antidotes for particular poisons ,i wish to instruct the nurse to not only note the symptoms1 but also to examine every article of a suspicious nature1 7such as phials1 boxes1 or papers containing powders71 and preserve them4 ,preserve also all vomited matter and everything that may afford a clue to the poison for after inspection1 if the nature of the poison is likely to be a subject of after inquiry4 ,in regard to the symptoms it may be well to know that ,prussic acid1 cyanide of potassium1 strong ammonia1 pure carbonic acid gas1 or pure carbonic oxide may ,,kill almost at once1 as indeed almost every poison may if taken in a very large dose2 strong acids1 alkalies1 aconite1 antimony1 arsenic1 tobacco1 or lobelia may cause ,,speedy ,,collapse4 ,belladonna1 hyoscyamus1 strammonium1 canabis indica1 alcohol or camphor1 may cause ,,delirium4 ,nux vomica1 strychnine1 antimony1 or arsenic may cause ,,tetanus or tonic contraction of the muscles4 ,antimony1 arsenic1 carbonic oxide1 aconite1 strong acids or alkalies may cause ,,convulsions4 ,gelsemium1 conium1 aconite1 arsenic1 or lead may cause ,,paralysis4 ,belladonna1 atropine1 hyoscyamus1 or strammonium causes ,,dry ,,skin2 and opium1 aconite1 antimony1 alcohol or lobelia causes ,,moist ,,skin4 ,the skin is almost always moist in collapse4 ,belladonna1 atropine1 hyoscyamus1 stammonium1 aconite1 alcohol1 chloroform or conium may cause ,,dilated ,,pupils4 ,opium or chloral may cause ,,contracted ,,pupils1 especially during sleep4 ,prussic acid1 laudanum1 alcohol1 carbolic acid1 acetic acid1 ammonia1 chloroform1 creosote1 iodine1 phosphorus1 camphor1 or nitro benzole can often be smelled in the ,,breath4 ,belladonna1 atropine1 hyoscyamus1 strammonium or opium cause the ,,mouth and ,,tongue to be ,,dry4 ,arsenic1 ammonia1 cantharides1 jaborandi or mercury cause ,,salivation4 ,arsenic1 antimony1 corrosive sublimate1 cantharides1 digitalis1 colchicum or colycinth causes ,,vomiting and ,,purging4 ,lead1 colycinth1 copper1 or arsenic causes ,,colic4 ,arsenic1 antimony and lead cause ,,croup4 ,,acids ,,of ,,an ,,irritating ,,character4 ,these include ,,acetic1 ,,citric1 ,,muriatic1 ,,nitric1 ,,oxalic1 ,,sulphuric1 and ,,arsenious acids4 ,their irritating and corrosive character depend upon their strength and concentration1 or the amount taken1 some or all of them being salutary in small diluted doses4 ,their injurious effects are severe the moment they are swallowed1 as they excoriate the throat and gullet at the time of swallowing4 ,but antidotes will lessen their power on the stomach and bowels if given soon1 and if given with the emetic will render the vomited matter less irritating4 ,their corrosive character causes severe pain1 which may be followed by symptoms of shock4 ,alkalies are the antidotes4 ,give some one that is at hand1 either calcined magnesia1 a solution of soda or soap1 lime water or whiting4 ,at the same time the emetics and alkalies are taken1 give demulcents1 such as milk1 mucilage1 gruel1 flaxseed tea1 etc4 ,of course the inflammation consequent on the poison must be treated4 ,carbolic acid might be included among those above named2 the same treatment would be proper1 except that strong alkalies are ineffectual as antidotes4 ,besides emetics give milk1 demulcent drinks1 and carbonate of magnesia1 with a little paregoric in water4 ,secure rest and warmth to the body1 use counter irritants externally4 ,,arsenious ,,acid is included in the above list4 ,the antidote for this is hydrated peroxide of iron1 recently prepared1 and given in large doses4 ,it is prepared by the addition of liq4 ammonia to muriated tinct4 of iron1 or liq4 ferri sulph41 which yields the hydrated peroxide of iron as a dense precipitate2 and this should be given in tablespoonful doses every five minutes until the symptoms are relieved4 ,the nurse and attendant's duty1 however1 is to give emetics and demulcents freely4 ,,alkalies are like the acids1 irritating2 if strong they excoriate the fauces and esophagus4 ,,caustic ,,potash1 ,,lye1 ,,soda ,,and ,,hartshorn are examples4 ,in these cases give acids such as vinegar and lemon juice as antidotes1 and oils also to unite with the alkali and render it less irritating4 ,demulcent drinks must be given with the emetics1 and acids must be continued afterwards4 ,for ,,lunar ,,caustic 7nitrate of silver7 give two teaspoonfuls of salt in a pint of water1 also the white of egg with other demulcents4 ,,corrosive ,,sublimate4 ,for this poison the antidote is white of egg and milk1 or a mixture of wheat flour and water and soap1 which may be given with emetics1 or after them2 before if no emetic is at hand4 ,the attendant nervous symptoms may be alleviated with paregoric4 ,,tartar ,,emetic of itself produces vomiting1 but this may be kept up by giving mucilage and such astringent infusions as common tea1 c4 ,,copper4 ,the sulphate or acetate of copper might act as an emetic1 but small quantities remaining in the stomach might act as irritant poisons4 ,give large doses of simple syrup as warm as can be swallowed2 give also the whites of eggs and large quantities of milk2 and as an antidote the hydrated peroxide of iron4 ,for ,,bismuth1 ,,iodine1 or ,,copperas taken in an overdose1 give the same emetics and demulcents as for copper4 ,,zinc and ,,tin4 ,the sulphate of zinc and the salts of tin when not vomited entirely1 produce severe irritating effects on the stomach4 ,besides milk and albumen give carbonate of soda in solution4 ,,colycinth1 ,,croton ,,oil1 and ,,savine ,,oil may produce like the above1 vomiting1 diarrha1 and also constriction of the throat4 ,give copious doses of barley water1 etc42 give opium and perhaps stimulants4 ,these cases and all the rest of the above may be benefitted by taking freely of gum ,arabic mucilage1 and may demand treatment for inflammation4 ,,cantharides may produce severe pain in the bowels1 bloody evacuations1 strangury1 burning thirst and fever4 ,give emollient drinks with enemata1 to which some laudanum may be added1 and also camphor2 oil must not be given in cases of poisoning by cantharides or phosphorus4 ,,toadstools1 ,,agaric1 ,,aconite1 ,,belladonna1 ,,conium1 ,,colchicum1 ,,hellebore1 and ,,alcohol1 are acro-narcotics which may cause severe irritation of the throat and stomach1 and such symptoms as burning heat of the esophagus and stomach1 thirst1 violent nausea1 purging1 dryness and constriction of the mouth and throat2 and be followed by such symptoms as are produced by narcotic poisons3 vertigo1 headache1 perversion of vision1 sense of suffocation1 disposition to sleep1 numbness or paralysis of the limbs1 prostration of the strength1 cold extremities1 feeble pulse1 and stupor4 ,,strammonium1 ,,camphor1 ,,chloral1 ,,digitalis1 ,,bitter-,,sweet and ,,hyoscyamus may be called narcotic poisons4 ,give prompt emetics1 demulcents1 witch hazel1 active purgatives1 strong coffee2 keep the patient roused1 use electro-magnetism1 cold douche1 and employ friction4 ,for ,,phosphorus1 which a child sometimes obtains from the ends of matches1 give emetics1 and administer big doses of magnesia in water and mucilage4 ,there are a few other poisons which might be classed as irritant1 such as nitrate potash 7salt petre7 which need the same class of remedies as those already named4 ,for nitre give also stimulants freely4 ,,opium and ,,belladonna are antidotes to each other1 and if a person has taken an overdose of one1 the other should be given if it is at hand4 ,evacuate the stomach perhaps by tickling the fauces2 give also strong coffee1 active stimulants1 witch hazel2 employ friction1 perhaps electro magnetism1 and keep the patient moving4 ,morphine of course demands the same4 ,for ,,nux ,,vomica and ,,strychnine1 besides giving an emetic give aromatic spirits ammonia1 and also chloroform internally in drachm doses diluted4 ,give tannin and also animal charcoal1 milk and spirits camphor in large doses4 ,,carbonate and ,,acetate of ,,lead sometimes act as poisons4 ,give sulphate of zinc as an emetic1 and epsom or glauber salts as a cathartic4 ,a mixture of syrup and persulphuret of iron may be given as an antidote to any mineral poison4 ,,hydrocyanic or ,,prussic ,,acid1 ,,laurel ,,water1 and ,,cyanide ,,of ,,potash cause immediately extreme prostration1 nausea1 giddiness1 pale countenance1 slow breathing1 and paralysis4 ,dash cold water on the face to produce a shock1 taking care not to soak the clothes of the patient2 we may produce a more decided effect if we alternate cold and hot effusions4 ,have the patient inhale steam containing liquor ammonia or hartshorn2 give internally aromatic ammonia and chloroform2 use friction1 especially along the spine and feet2 artificial respiration may be necessary4 ,give chlorine water of the strength of two drachms to the ounce4 ,,animal ,,poisons4 ,for ,,bites ,,of ,,serpents apply a ligature above the wounded part2 use carbolic acid or any active caustic2 apply cupping glass 7or mouth1 when there is no sore in the mouth74 ,bisulphite of soda in large doses is said to be an antidote4 ,give stimulants in large quantities4 ,,mad ,,dog ,,bites4 ,a person having been bitten by a mad dog1 or one suspected of rabies1 the wound must first be made to bleed1 then washed1 and finally cauterized4 ,enlarge the wound so that the blood may flow out freely2 press out still more blood1 and you may safely suck out some if you do not have any sore on your mouth or lips4 ,after tying a bandage above the wound it must be washed until cauterization can be effected4 ,this can be made either with ,vienna paste1 butter of antimony1 chloride of zinc1 or a red hot iron4 ,if the dog can be secured and shut up it is better than that he should be immediately killed4 ,if the dog does not prove to be mad1 the person bitten should know the fact1 as this may prevent the alarming fears that of themselves sometimes prove disastrous4 ,the bitten person should have his mind diverted as much as possible4 ,,carbonic ,,acid ,,gas4 ,a person having been poisoned by inhaling choke damp or the fumes of burning charcoal1 loosen the clothing1 dash cold water on the head and face1 give plenty of fresh air1 stimulants1 and inhalations of ammonia4 ,employ artificial respiration if necessary4 ,if the body is cold employ hot applications4 ,,other ,,emergencies1 ,,persons ,,asphyxiated ,,from ,,drowning1 ,,hanging1 ,c4 ,when a person is asphyxiated treat him instantly4 ,give all the fresh air possible2 remove all light clothing from the chest and neck and face2 try to restore respiration first2 clear the throat by placing the patient on the face with one arm under the forehead2 the tongue falls forward and leaves the windpipe free2 then wipe and cleanse the mouth4 ,,to ,,excite ,,respiration turn the patient on his side and apply some stimulating agent 7as camphor or ammonia7 near the nostrils1 and dash cold water1 or hot and cold water alternately on the chest1 which may have been previously rubbed briskly4 7,the effort to promote warmth and circulation by rubbing should be kept up continuously as far as possible47 ,should there be no respiration immediately you can use ,,marshall ,,hall',s ,,method to imitate respiration4 8,turn the patient again on his face1 raising and supporting the chest well on a folded coat or other article of dress2 make gentle pressure on the back1 after which turn him over on his side2 then again on his face1 and again press a little2 repeat these motions at the rate of fifteen a minute4 ,during the operation let one person attend to the movements of the head and the arm placed under it40 ,if there is respiration and consequent life1 dry the hands1 in cases of drowning2 and as soon as you can1 strip the body and gradually reclothe or cover it2 but if the breathing is not satisfactory1 after continuing these same efforts to restore respiration for about fifteen minutes1 you may use ,,sylvester',s ,,method4 8,place the patient on the back on a flat surface1 inclined a little upward from the feet2 raise and support the shoulders and head on a cushion or a folded article of dress2 draw forward the patient's tongue1 and keep it projecting beyond the lips1 by having a band or string around the tongue and chin1 or by raising the lower jaw so that the teeth retain it2 standing at the patient's head1 grasp the arms near the elbows and draw them steadily upward above the head1 and keep them stretched upwards for two seconds2 then turn down the patient's arms and press them gently and firmly against the chest for two seconds2 repeat the movement alternately about fifteen times every minute until a spontaneous effort to inspire is perceived2 then proceed ,,to ,,induce ,,circulation ,,and ,,warmth40 ,rub the limbs upward with energy1 and continue the friction under the blanket and over the dry clothing2 promote the warmth of the body by applying flannels1 bottles of hot water to the pit of the stomach1 the armpit1 the thighs1 and the sole of the feet2 then if the power of swallowing has returned1 stimulants and coffee should be administered4 ,a ,,stroke ,,of ,,lightning may cause immediate death by its effects on the nervous system4 ,sometimes it produces unconsciousness without being fatal4 ,in attempting resuscitation employ artificial respiration1 and if there are any signs of life treat as directed for shock4 ,if there are burns complicating the case1 of course the burns must be treated4 ,when there is ,,shock the patient lies in an apoplectic state1 the surface pale2 there is faintness1 trembling1 cold perspiration1 low temperature1 feeble pulse1 and probably nausea and vomiting4 ,keep the patient's head low1 give aromatic ammonia1 and apply heat to the extremities and to the stomach4 ,strong beef tea should be given1 and hot tea and coffee4 ,there are but few exigencies that generally occasion more alarm than ,,convulsions4 ,fits may come on without premonitory symptoms2 there is sudden loss of consciousness1 accompanied by irregular and powerful contractions of the muscles4 ,all the voluntary muscles may be affected1 or there may be only spasm of the features1 or of one side1 or of a single limb4 ,during a general paroxysm the countenance is distorted1 and the face pallid or livid2 generally there is stertorous breathing1 and as the attack subsides a disposition to sleep4 ,it is seldom fatal in adults1 unless caused by brain or kidney disease4 ,do not attempt too much treatment1 but you may put the patient in such a condition as to help his recovery4 ,his dress is to be loosened1 and all clothing about his neck removed2 place him where he can breathe pure and cool air1 and you may prevent his falling out of bed2 if the face is flushed1 cold may be applied to the head and warmth and sinapisms to the extremities4 ,if occurring in a young child you may give a warm bath1 or a warm hip bath4 ,if there is ability to swallow1 give bromide of potassium1 either alone or simultaneously with the administration of chloroform and ether4 ,,giving ,,anesthetics4 ,if you give chloroform you may pour a few drops on a handkerchief and hold it an inch from the patient's nose and lips4 ,ether and chloroform together may be poured1 a teaspoonful at a time on a little cotton inside a cone of paper made large enough to fit over the mouth and nose1 the air being nearly shut out4 ,the head of the patient must be kept low while he is under the influence of it4 ,observe the pulse while giving it2 a feeble pulse is a sign of danger1 and if the pulse is growing weak1 or the face is growing livid or pale1 stop giving the chloroform2 if the symptoms continue1 and there is no natural respiration1 draw the tongue forward so that it will not obstruct the trachea2 have plenty of fresh air2 apply friction by rubbing the limbs1 and if necessary artificial respiration4 ,,clothes ,,on ,,fire4 ,accidents from fire are very likely to cause a panic1 but possibly you may by effort so cultivate coolness and presence of mind1 as to act wisely and deliberately even then1 even if your own clothes are on fire4 ,if you are able to think at all1 the question will be if there is water within reach that can be used to extinguish it immediately2 if there is not1 how can it be smothered8 ,possibly the burning portion can be enveloped in that part of the dress that is not burned2 or a rug may be within reach1 or some woolen thing that may be used to stifle it1 without pressing it against the person's flesh4 ,but very probably the best that the person can do is to lie down on the floor and roll on the carpet4 ,if you see another woman on fire1 do not scream or run away2 grasp her clothes all together1 if you can without pressing the fire against her person2 or if you can immediately put out the fire by catching up a rug or some heavy woolen thing and enveloping her in it1 do so4 ,remember at the same time to avoid inhaling much of the flames or setting fire to your own clothes4 ,,burns ,,and ,,scalds4 ,there are various modes of treating burns1 but one good general rule is that the dressings should be so applied as to exclude the air4 ,if the skin is not destroyed or removed1 either the bicarbonate of soda may be applied dry1 or in a strong solution2 or wheat flour may be applied dry1 and the burn covered with a thick layer of cotton batting2 or the white of egg may be spread over it1 and another layer put on as soon as one dries1 until some six or eight layers are applied4 ,if the skin is abraded either olive oil or vaseline or carbolated cosmoline applied and covered with cotton or wool is a good dressing4 7,f4 #ahg1 #bad47 ,,burns ,,produced ,,by ,,strong ,,acids should be first bathed with some alkaline solution such as soda or ammonia2 on the contrary if lime or caustic potash cause the injury1 neutralize the alkali by applying acid diluted2 a teaspoonful of vinegar or lemon juice in a teacupful of water would suffice4 ,if a ,,bad ,,scald is occasioned by a child falling backward in the water1 carefully undress the child2 lay it on a bed on its breast if the burn is on its back2 then dust over the parts with bicarbonate of soda2 lay muslin or cotton wool over it1 and so arrange the bed by means of two boxes and a board that the covering cannot press on the scald4 ,if a ,,fragment ,,of ,,lime ,,gets ,,into ,,the ,,eye1 bathe it immediately with a weak solution of vinegar or lemon juice4 ,if something like dust or dirt gets in the eye1 it may be cleaned out by taking hold of the eye lash and pulling the upper lid down1 and forcibly blowing the nose4 ,you may sometimes wipe the dirt from the eye with a soft handkerchief4 ,always wipe the eye towards the nose4 ,when something like a ,,pea or ,,cherry ,,pit ,,is ,,in ,,the ,,nostril direct the patient to draw in a full breath1 then close the mouth and the other nostril and try to blow the offending object out4 ,if he fails you can probably remove it by means of a hair-pin2 or while the other nostril is closed1 blow forcibly into the mouth and dislodge the object4 ,remove insects from the ear by oil or tepid water4 ,a little oil or glycerine may first be dropped into the ear2 and then it may be syringed with warm or tepid water1 taking care not to close the opening with the nozzle of the syringe4 ,this may be tried if the substance in the ear is hard4 ,if a child is choked let it get on all fours and cough4 ,anything stuck or lodged in the throat may sometimes be worked out with a hair-pin or bent wire4 ,if a ,,crochet ,,needle',s ,,hooked ,,point ,,is ,,in ,,the ,,flesh make certain on which side the hook is1 then put an ivory bodkin or any similar article down to the hook1 and draw both out together4 ,if a ,,finger ,,or ,,thumb ,,is ,,cut in two1 without any crushing of the parts1 the severed portion should be immediately applied to its place2 if the cut is clean1 the hewn off part may be made to unite1 possibly if it has been off for two hours4 ,the wound should be washed with carbolic solution if that is immediately procurable1 and the severed parts should be accurately fixed by sutures 7stitches7 in their normal position1 and a splint applied4 ,life is sometimes destroyed suddenly by persons drinking a large quantity of cold water when greatly fatigued4 ,to avoid all danger in these cases1 a small quantity should be sipped at a time2 and washing the face1 hands and temples before drinking is a good precaution4 ,but if by drinking cold water the system is severely chilled so that prostration takes place1 endeavor to secure warmth by giving a teaspoonful paregoric1 and rubbing the hands and body briskly2 and if the patient can be brought sufficiently to his senses he should be made to drink enough warm water to induce vomiting2 this excites circulation and perspiration1 and determines towards the surface4 ,warm applications should be made to the feet and to the region of the stomach1 and the body should be warmed as soon as possible4 ,,chapter ,,iii4 ,,slight ,,hurts ,,and ,,ailments4 ,there are a hundred little accidents liable to occur in a household which a very little surgical skill would suffice to set right4 ,besides medicines1 there are several handy articles which should be always kept ready in a clean drawer1 should an emergency arise that demands their use4 ,have a little case containing a lancet1 scissors1 pins1 needles and thread2 have also one or two bandages1 some lint and oiled silk1 a bit of lunar caustic 7nitrate silver71 and some strips of adhesive plaster1 a stimulant lotion1 an eye lotion1 a liniment1 and one or two kinds of ointment4 ,use the lancet to open small abscesses or gum boils2 the pins are handy for fastening bandages1 c41 and should be of different sizes2 the thread should be strong and white2 the needles of fair size1 with good large eyes2 charpie may take the place of lint2 it is made by scraping old linen2 it is often useful2 for instance1 to heal old sores1 dip ,,lint or ,,charpie in clean1 cold water1 to which a few drops of carbolic acid has been added2 then apply it to the sore1 which it must more than cover2 then apply oiled silk and a retaining bandage4 ,the lint may be used for water dressings to wounds1 and these may take the place of poultices in treating swellings which we wish to reduce or soothe4 ,keep the best ,,adhesive ,,plaster procurable2 and it ought to be cut up into different breadths4 ,when it is necessary to use this plaster1 see that the wound is perfectly clean1 and apply long narrow slips4 ,warm the plaster by holding it against a can of boiling water for a few seconds1 then apply it across the wound4 ,in case of scalp wounds the hair must be cut off before the plaster is applied4 ,in a case of fractured ribs1 strapping should be applied to the injured side4 ,,lunar ,,caustic is used to cauterize dog1 or cat1 or skunk bites that are supposed to be ,,poisonous4 ,an excellent ,,lotion for ,,headache and other pain is made of a quart of water1 a teacupful of common salt1 one ounce of hartshorn1 and a half ounce of spirits of camphor2 mix and keep in a bottle tightly corked2 saturate a cloth and apply to seat of pain4 ,that form of conjunctivitis 7sore eyes71 which occurs in new-born infants1 is in the vast majority of cases1 easily removed by lukewarm water1 or by such simple astringents as alum and borax4 7,f4 #aic1 #bae1 may be properly kept in the house for ordinary sore eyes47 ,of course severe cases require skilled treatment1 but in all ordinary cases careful wiping away of the secretion1 the use of the alum solution1 and the greasing of the skin to avoid excoriations1 are in order4 ,for dematous inflammation with little purulent or mucous secretion1 but with the tissues loaded with serum1 a dilute wash of the witch hazel extract acts very beneficially4 ,the teeth of children when they are pressing on the gums and trying to make their way out1 should sometimes be lanced by cutting the gums4 ,cut down to the new tooth until it is felt under the lancet2 for incisors and cuspids a straight line2 for molars a cross cut4 ,the best way to do it is--let the operator and nurse sit opposite each other1 close together2 the child is laid down face upwards1 its head in the operator's lap1 and its feet in the nurse's lap2 the nurse holds the limbs of the child quietly2 with his left hand the operator takes the jaw between his fingers1 and then slowly and firmly does the cutting4 ,as the child is still1 there is no false cut4 ,,sprains caused by a twisting of the ankle cause very much pain1 although there is no displacement of bone4 ,when it first occurs1 put the foot and ankle in hot water and let it remain for an hour in water as hot as can be borne2 then wrap the part in several folds of flannel which have been wrung out of hot water1 and cover it with a dry bandage1 and let it rest for several days1 keeping it elevated as high as may be comfortable4 ,when first used again1 support the joint by strapping4 ,strips of adhesive plaster cut an inch wide1 may be applied both above and below the joint4 ,it may be best to renew the straps every day1--the hair should be shaved off before the plaster is applied4 ,there are many ,,little ,,ailments that may be cured or relieved by regimen2 or by such articles as are in every house4 ,,water4 ,a glass of ,,hot ,,water taken in the morning before breakfast washes off a coating which is sometimes adhering to the lining membrane of the stomach1 and affecting the digestion4 ,,hot ,,water after continuous application renders great service to the ,,weary ,,eye and cures the slighter maladies of the eye4 ,if an eye is contused and blackened1 foment the parts continually with hot water until the pain ceases1 then keep the eye wet with a lotion1 or bind on a bit of lean1 fresh beef1 to remove the dark discolored spot4 ,the itching of pruritis may be much relieved by the application of a cloth wet in hot water4 ,the ,,hot ,,foot ,,bath is especially efficacious for some ,,headaches4 ,if the head is filled with blood and the temples throb1 soak the feet in very ,,hot ,,water in which a spoonful of ground mustard or of salt has been stirred4 ,the blood will be drawn from the head and relief obtained4 ,for those who are troubled with ,,excessive ,,sweating1 tepid sponging of the neck1 face1 chest and hands with equal parts of vinegar and water at bedtime is useful and agreeable4 ,,convulsions may frequently be cut short by turning the patient on the left side2 but as soon as possible put the feet in a basin of warm water in which is a little mustard1 and apply a cloth saturated with cold water to the forehead4 ,a woman who suffers acute pain in the pelvic region a few days antecedent to the menstrual flux1 should take a ,,warm ,,sitz ,,bath of fifteen minutes' duration before retiring at night4 ,the ,,enema ,,of ,,tepid ,,water may be useful in constipation1 and in looseness of bowels1 in spasmodic colic1 and in painful menstruation2 also for piles4 ,the temperature of the enema should be agreeable to the patient4 ,the itching that accompanies many skin diseases is much reduced by a warm bath containing a handful of borax1 and a handful of bicarbonate of soda1 in about thirty gallons of water4 ,those who practice daily bathing1 and indulge freely in ,,cold ,,water1 are seldom troubled with a cold4 ,frequent bathing1 the head being well dipped1 will brace the system and render a person proof against draughts4 ,there are many obstinate affections of the head that have been known to give way to affusion of ,,cold ,,water upon the part4 ,for inflammation of the brain1 headache1 earache1 drunkenness1 delirium tremens1 the delirium of fever1 epilepsy1 rheumatism of the head1 diseases of the eye1 deafness1 loss of smell and taste1 and in nose bleed this remedy may be brought to bear4 ,one mode of taking the ,,head ,,bath is for the patient to lie down1 placing the back of his head in a shallow dish filled only an inch or two with water4 ,the ,,wet ,,girdle is a useful medical appliance to give tone and strength to certain parts4 ,two and a half or three yards of good toweling with tapes arranged at one end1 the corners of which have been turned over so as to form a point1 is a good girdle4 ,it should pass about three times around the body2 one-half having been wet and put on so as to have two thicknesses of the wet part upon the abdomen and one upon the back4 ,the girdle may be worn every day1 but the folded wet sheet is used for a time in febrile diseases1 such as inflammation of the lungs1 or of the bowels1 colic1 cholera morbus1 c4 ,fold a common coarse sheet four double2 wet two thicknesses of this in cold water to come next the body2 have the patient lie in bed with the four thicknesses around her1 using warm bricks1 bottles1 c41 for the feet4 ,a table spoonful of ,,charcoal powdered1 stirred into a glass of water and drank at once1 is excellent in many cases of headache from ,,sour ,,stomach1 ,,flatulence1 c4 ,children who complain of choking sensations in the throat 7caused by worms71 may find relief from swallowing salt and water4 ,those who are suffering from ,,dysentery should have a little ,,wheat ,,flour stirred into the water that they drink4 ,,tar ,,water4 ,every body ought to have ,,tar ,,water in the house4 ,it is made by adding one pint of wood tar to four pints of cold water1 mixing thoroughly and shaking frequently during twenty-four hours1 and then filtering the water which may be poured from the tar4 ,given internally it is stimulative in its action1 and acts somewhat upon the kidneys2 is useful for cough and hoarseness1 and for incipient urinary difficulty2 locally applied it is slightly astringent1 antiseptic and disinfectant2 and by destroying the putrefactive germs1 it prevents or restrains the process of suppuration4 ,it is especially useful in puerperal septic diseases1 as it is antiseptic and disinfectant2 the resinous principle which it contains1 exerts a healing action upon the genital lesions1 and suppuration is prevented4 ,it may be used three times a day as a vaginal wash during the lying-in period1 and cloths used to protect the vulva and receive the discharges should be moistened with it4 ,it is a useful local application in the treatment of various diseases of the vulva and vagina1 especially for the horrible itching of pruritis4 ,its use renders innocuous the irritating discharges1 and its sedative and alterative action restrains and stops the morbid process4 ,it has a curative value in skin diseases1 and in general it may be used in the various cases where carbolic acid is usually prescribed4 ,other medicine may be dissolved in it4 ,,salt ,,water4 ,salt is a promoter of health and longevity1 and people generally who like salt1 vinegar1 c41 should be allowed to gratify their taste4 ,if the blood is too rich1 salt may restore it to a normal condition2 and may restore to it the needed elements if the blood is impoverished4 ,one of the best remedies for ,,spitting ,,of ,,blood is to drink a little salt water4 ,for persistent bleeding from the nose1 cut a piece of raw fat salt pork1 about four inches long1 and near half an inch thick and over half an inch wide1 wedge shaped at the ends1 and force it through the nostril clear back to the pharynx4 ,a teaspoonful of salt taken just before a fit of the ague may effectually break up an intermittent fever1 and prevent a recurrence of the chills4 ,a spoonful of vinegar with salt in it is an excellent remedy for dysentery4 ,,carbonate ,,of ,,soda ,,and ,,water4 ,probably the anesthetic1 antiseptic1 and disinfectant property of bicarbonate of soda is due to the ready disengagement of carbonic acid from it4 ,for ,,burns ,,and ,,scalds where the skin is not broken1 powdered bicarbonate of soda may be strewn over the burned parts4 ,if the burns are deep and attended with much suppuration1 linen rags sprinkled with a solution of the soda 7#a to #ej7 should be laid on1 and as soon as these rags become dry1 they should be replaced by others1 or be moistened again in the solution4 ,but for most burns the rags should be kept on constantly1 and moistened by pouring the solution over them1 as changing the compresses would cause more suppuration and delay the healing process4 ,if a hand or foot is burned1 and soda1 c41 is not obtainable1 it may be kept immersed for a considerable time in cold water with a salutary effect4 ,a teaspoonful of baking soda taken each day1 dissolved in a pint of water1 is a good remedy for habitual constipation4 ,,honey ,,and ,,tar4 8,for the ,,bites ,,of ,,reptiles 7rattlesnakes1 moccasins1 c471 give the patient about a gill of strained honey every ten or fifteen minutes until vomiting is produced40 ,a table spoonful of powdered charcoal mixed with honey1 milk1 or cold water1 and taken every morning will tend to cure any one who is troubled with either constipation or diarrha4 ,,oil4 ,the application of ,,oil to the whole surface of the body is a simple method of treatment of such infantile complaints as ,,atrophy1 ,,bronchitis1 ,,convulsions1 ,,diarrh,a1 and ,,febrile ,,disturbance generally4 ,smear ,,salad ,,oil all over1 from the crown of the head to the toes1 three or four times a day4 ,for ,,pruritis ,,ani rub on linseed oil freely at bedtime each night4 ,,spirits ,,nitre4 ,for ,,rhus ,,poisoning 7poison oak7 apply sweet ,,spirits ,,of ,,nitre4 ,where the discharge of urine is attended with heat and pain1 pound a handful of melon or pumpkin seed with a lump of white sugar1 add a quart of boiling water1 then add half an ounce of spirits of nitre and rub them together4 ,a teacupful may be taken every two hours by adults4 ,,other ,,remedies1 ,,regimen1 ,c4 ,for ,,strangury use bee tea made by pouring a pint of boiling water on fifteen or twenty honey bees4 ,for ,,erysipelas apply cranberries locally1 either cooked or uncooked4 ,another good local application for erysipelas is ,,elderflower ,,tea4 ,linen cloths wet with the cold infusion should be applied1 and before they are dry should be wrung out of clean water1 then dipped in the infusion and reapplied4 ,the patient should also drink some of the elder flower tea4 7,f4 #agg47 ,for ,,bee and ,,wasp ,,stings apply the tincture of arnica1 or sweet oil4 ,,lean ,,fresh ,,meat is the best absorbant substance to apply to relieve the pain of a ,,wasp ,,sting4 8,to give relief to a child that has the ,,earache close the mouth and blow into the nose40 ,children suffering from whooping cough should inhale the vapor of turpentine4 ,place this on plates and allow these to stand in the room4 ,where there are suppurative ,,discharges ,,from ,,the ,,ear1 the dry dressing with ,,absorbent ,,cotton1 after dry cleansing with the same1 protects the wound from the air1 and attracts the discharge from the middle ear4 ,it is mildly stimulant and conduces to healing4 ,for ,,soft ,,corns wear loose shoes1 and every morning place a little ,,absorbant ,,cotton between the toes4 ,for mosquito bites apply a mixture of carbolic acid and glycerine in the proportion of one of the former to twenty of the latter4 ,for the vomiting which often complicates cases of ,,consumption and chronic ,,bronchitis1 give three or four grains of alum in a little ginger tea every three or four hours4 ,,inhalations ,,of ,,steam are useful in quinsy2 and all affections of the throat that are painful1 are much relieved by inhaling steam impregnated with the oil of peppermint4 ,,tea ,,and ,,coffee are of some value in nervous headaches produced by cerebral congestion1 and are indicated when the face is flushed4 ,a weak solution of ,,common ,,salt snuffed up into the nose daily1 is a remedy for ,,chronic ,,catarrh2 if a decoction of ,,green ,,tea is snuffed up immediately afterward the remedy is more effectual4 ,cold tea is a good mild astringent application to sore eyes4 ,patients who suffer at night from cramps may find relief by having the head of the bed raised4 ,cause the head of the bed to be raised the thickness of two bricks4 ,those persons who are troubled with dizziness after smoking early in the morning1 may avoid it generally by not smoking until after eating4 ,to remove needles1 nails1 c41 from the extremities1 make a small incision at the place of entrance through the skin1 and with an obtuse pointed stick1 and the stronger solution of carbolic acid on the end of it1 by a boring action penetrate to the necessary depth1 occasionally making search with a metalic probe to learn of its whereabouts4 ,when reached remove with small forceps4 ,for ,,pruritis ,,pudendi1 ,,neuralgia1 ,,toothache1 ,,sickness and vomiting1 when these are due to the pregnant state1 apply a blister to the back1 over the fourth and fifth dorsal vertebra4 ,children who are exceedingly ,,short ,,sighted1 may by ,,wearing ,,glasses be benefitted1 not only physically but mentally2 becoming more active and lively and less reserved and taciturn4 ,a child may be thought a dullard1 and to have no aptitude for observation or learning1 because his misfortune is to have bad sight2 and such a character may be fastened upon him for life1 because in his young days he was cut off from the enjoyment of the visible world which his fellows were favored with4 ,oculists say that when with the arrival of middle life the focusing power of the eye declines so far that at the usual distance for reading1 a sufficient adjusting force no longer exists1 it is the preferable thing to put on ,,weak ,,magnifying ,,glasses1 to take off strain1 rather than to postpone their use as long as possible4 ,my own opinion is that when a man can1 by sitting with his back to the window and holding a book in the light1 at the usual distance from the eye1 read the fine print of the newspapers1 it is better to avoid wearing magnifying glasses4 ,but we should always be careful to have the light shine on the paper1 and not on our eyes when we are reading4 ,many invalids1 especially those who suffer from uterine disease1 are distressed to find that they begin to fail to command the services of their eyes4 ,when persons are recovering from any severe illness such as fever1 or from protracted exhaustion1 or after prolonged lactation1 or watching with invalids1 or great loss of sleep2 where there has been much grief and weeping1 or a severe mental strain1 or loss of blood1 or in severe or chronic dyspepsia1 impaired eye power is pretty sure to appear4 ,the essential condition to recovery lies in restoration to vigor1 and sound health1 and habits4 ,they can probably develop and recover their ocular energy by the graduated use of their eyes1 beginning with short periods and advancing by small additions4 ,ladies that suffer from painful menstruation should not read in bed at the time of the menstrual flow4 ,weakly persons should not read while lying down2 and to them umbrellas1 and parasols1 and colored glasses become needful as protection from the sun and wind4 ,for such it is hurtful to read in railway cars or in carriages2 and to them an atmosphere of smoke1 or the air of an ill ventilated1 crowded1 or brightly lighted room is injurious4 ,for ,,sleeplessness the best remedy is to so ,,regulate ,,the ,,breathing that it shall induce the right circulation in the brain1 and the repose of the faculties4 ,in breathing have the inspirations and expirations of equal length1 and it will at least conduce to the repose of the brain4 ,for a ,,slight ,,illness all that you need to do very often is to breathe full1 so as to make deep inspirations for half an hour2 and you can rear healthy children if you can secure to them good round chests4 ,to do this1 first measure each of them with a tape2 then teach them to practice forced inspiration through the nostrils several times a day2 offer a prize for the first inch gained in circumference4 ,flat chested children will soon grow round and full1 and the breathing space large4 ,the result will be good health of the children4 ,a child not more than four years old is sometimes afflicted with ,,diabetis2 this is usually due to farinaceous food1 and the child should be debarred from starchy food and sugar4 ,one important means to arrest ,,bleeding ,,from ,,the ,,nose is to put a tight ligature on a finger or on a larger limb4 ,an attempt may also be made to check the hemorrhage by firmly grasping the nose with the finger and thumb1 so as to prevent any air from passing through the cavity4 ,a ,,gargle of strong ,,black ,,pepper ,,tea used freely will sometimes be an effectual remedy for ,,aphonia1 when the patient is not able to speak louder than a whisper4 ,,chapter ,,iv4 ,,dietetics--,,food ,,for ,,children4 ,but little pure milk can be obtained in cities1 and a substitute may sometimes be used2 but where good milk can be obtained1 it may usually be made the principal food of young persons4 ,the mother's milk1 if the mothers are healthy1 is the best food for infants2 and those that nurse should not as a general rule be weaned during the summer months1 when diarrhas most prevail4 ,when the mother has a sufficient quantity of milk1 an infant requires and should receive no other food but breast milk until the sixth and perhaps the ninth month1 when other food than breast milk must be provided4 ,new-born babies until the age of twenty-one days should be fed with one part of milk to three of water2 between the ages of three and six weeks1 with one of milk and two of water2 from six weeks to three months1 two of milk to three of water2 at three months1 half milk and half water2 at six months three of milk and one of water4 ,it should be good new milk1 and the water should be warm1 or only hot enough to bring the temperature to that of breast milk4 ,this diet is better than any variety of starch food1 but if the best milk that is obtainable does not agree well with the child1 a light gruel made from any of the derivatives of starch may be substituted for water in the above admixtures4 ,if a feeding bottle is used1 the food should be given at regular intervals1 as has been heretofore directed in regard to nursing4 ,as soon as the child's meal is over1 the tube should be removed from its mouth4 ,the bottle and teat should be thoroughly washed after each meal1 and the former always kept in a basin of cold water when not in use4 ,a sweet feeding bottle is of great importance1 and neglect of scrupulous attention to it is a frequent cause of sickness in a child4 ,a few more general directions will be given to afford some guide under varying circumstances4 ,the degree of dilution of the milk may vary with the richness of the milk used4 ,when the mother gives evidence of feebleness it may be best to wean the child at six months1 or even sooner if the mother evidently suffers from lactation4 ,if the mother's health is robust it may be well to nurse it to the twelfth or thirteenth month1 but we should always endeavor to know whether the child thrives best on the mother's milk4 ,before the twelfth month she should gradually diminish the allowance of the breast1 and increase the supply of suitable food2 perhaps suckling the child twice in the twenty-four hours1 and otherwise feeding it at proper intervals4 ,if the child is weaned at seven or eight months or later1 it may take for a meal a breakfast-cup full of milk to which is added a teaspoonful of lime water1 or a weak solution of soda2 and sometimes it may take the yolk of an egg well beaten up in a teacupful of milk1 or a dessert spoonful of pearl barley jelly dissolved in a breakfast-cup full of warm milk1 and slightly sweetened with white sugar4 ,,food ,,for ,,infants ,,or ,,for ,,the ,,sick should neither be rewarmed nor kept warm on a stove or in an oven1 especially if either sugar or salt has been added to the composition2 it is better to prepare no more than is required at once1 but if any should remain and be used1 let it be brought to a proper warmth by the addition of a little hot water1 broth1 or gruel1 as the case may be4 ,food made of bread so as to constitute pap or ,,panada has a great tendency to become sour1 and a quantity only sufficient for a single meal should be made at a time4 ,,oatmeal and ,,indian ,,meal have a loosening effect upon the bowels1 but these as well as wheaten bread1 contain more nutritive matter than sago1 tapioca1 and similar substances which may be regarded as modifications of starch4 ,for the sick have hot things very hot1 and cold things very cold4 ,food should never be prepared in the presence of the sick1 nor so that the smell of cooking be allowed to reach them if it can be avoided4 ,never taste of the patient's food in her presence or with her spoon2 give food regularly1 but in most cases the patient should not be roused from sleep for food2 some light food at night will often serve to send the patient to sleep4 ,rice forms an excellent diet for the sick and for convalescents4 ,,cooking ,,for ,,the ,,sick ,,and ,,for ,,young ,,persons4 ,,preliminary ,,remarks4 ,cleanliness is eminently essential in cooking for the sick and for infants4 ,the vessel in which milk or gruel is boiled should not be used for anything greasy or seasoned2 a sauce pan in which broth has been made1 flavored perhaps with onions or parsley1 unless very nicely cleaned will impart a disagreeable taste to delicate food4 ,whatever vessel is used the food should not be allowed to remain in it1 but should be poured out as soon as done1 and the vessel put to soak in cold water4 ,if it is of tin it should soon be cleansed with wood ashes1 but enameled sauce pans or granitized iron ware may be washed clean2 when taken down for use wipe with a clean1 dry cloth4 ,for stirring use either a silver or wooden spoon2 not one of iron or other metal4 ,the earthenware dishes1 basins or whatever else may be used for keeping food already cooked1 or for milk1 should be scalded after using1 made perfectly dry with a clean cloth1 and left to become quite cold before milk broth or whatever it may be1 is put into them4 ,for preserving liquids 7broth1 gruel1 or milk71 a wide1 shallow vessel is better than a thin1 narrow one2 milk should never be kept in a jug2 cooked food should not be shut in with a lid2 a hair sieve1 or wire cover1 or common colander may preserve from cats1 mice1 slugs1 c4 ,the cake of fat which collects on the top of broth tends to preserve the liquor while it remains unbroken2 but if the skin or fat at top is broken1 and if the broth or gruel is designed for use at a subsequent meal1 the fat should be removed1 and the remainder should be transferred to a clean1 dry vessel4 ,,food ,,for ,,convalescents4 ,many questions in regard to diet are left by the physician to the nurse1 especially while she has the care of convalescents4 ,i give for her guidance a few more aphorisms and directions3 #a4 ,while it is true that as a general rule people who like salt1 vinegar1 c41 ought to be allowed to gratify their taste1 and that the cravings of a sick person are not always to be denied1 yet appetite and taste were intended to govern the choice and quantity of food in health2 and even then1 they should be guided by reason and experience4 ,such articles as fruit1 jam1 cake1 cheese1 butter1 and milk may generally be taken if there is a craving for them1 but if they are not digested1 the stomach must be consulted1 and not the cravings4 ,milk and eggs are important articles of food1 but they must not be forced upon the patient2 cheese is sometimes craved2 it is concentrated nutriment1 but in some person's stomachs it is digestible1 and it may perhaps favor digestion of other food2 do not entirely disregard the desires and taste of the patient2 as a rule if meat is craved it is allowable1 and it is better to chew and swallow it1 than it is to chew it and spit out its nutritive contents4 #b4 ,during convalescence1 as soon as ,,animal ,,food can be taken with impunity1 that which is most digestible should be selected4 ,with the exception of poultry the flesh of middle aged animals affords the most digestible food4 ,keeping animal food for a certain time before it is cooked lessens the density of the fibre and renders it more tender1 but the utmost caution is requisite to prevent the change from advancing so far as to present the slightest trace of taint in the food4 #c4 ,,gellatine in the form of ,,bouillon or concentrated broths is valuable in fevers1 c41 as an addition to other diet1 as it prevents or rather retards the process of denutrition4 #d4 ,,sour ,,milk is to some sick persons and convalescents an agreeable beverage1 and in cases of atonic dyspepsia and many other cases1 it is a good adjuvant in the treatment of slow digestion1 where flatulence and a sensation of cramp in the stomach are prominent symptoms4 ,the good effects of drinking a tumbler full or half a tumbler full of ordinary cold sour milk or ,,buttermilk1 is probably owing in a measure1 to the lactic acid which it contains4 ,it may be taken regularly half an hour after each meal1 in cases of weak stomach4 #e4 ,,milk is digestible when it is drunk immediately after it is drawn from the udder of the cow or that of the goat1 but it is often necessary in convalescence to dilute it in water4 ,it may be kept for some time from souring in warm weather by adding to each quart fifteen grains of bicarbonate of soda4 ,when there is evidence of over-acidity of the stomach1 lime water may be added in any proportion up to one-half4 #f4 ,,raw ,,egg somewhat in the form of an emulsion1 has been useful in certain diseases4 ,four raw eggs may be beaten up in a pint of cold water1 a little flavoring and sugar added1 and the patient may take it by sips during the day4 ,this is a light and nutritive diet1 but eggs are much less digestible in this form than when they are lightly boiled4 #g4 ,,raw ,,oysters are somewhat nutritive1 but are not easy of digestion4 ,,lobsters1 ,,crabs1 ,,prawns1 ,,crayfish1 ,,scallops1 and other shell fish are more objectionable than oysters4 ,,fish1 especially of the white kind1 is not stimulating2 if it is simply boiled it is admissable for convalescents1 and for those laboring under some acute diseases4 ,in the decline of fevers some animal food may be given2 first beef tea1 chicken broth1 and mutton broth1 and other liquid animal decoctions2 then white fish and a more generous diet4 #h4 ,the value of soups depends upon the freshness of the meat1 the manner in which they are boiled1 and the delicacy with which they are seasoned2 for the latter any of the vegetable condiments may be used according to the taste of the consumer4 #i4 ,the nurse should know that certain articles in a certain form cannot be digested in the stomach1 because they cannot be dissolved in the fluid contained there4 ,rich pastry1 pieces of hard potato1 rich puddings and dumplings1 hard stringy meat1 and greasy fibred meat1 new bread1 and rolls that are not well baked are1 in general1 indigestible4 ,pie is not essentially indigestible2 indeed indigestibility cannot be affirmed of any article of food1 apart from a consideration of the digestive capacity of the particular stomach1 the powers of which are to be tested4 #aj4 ,some mild ,,esculent ,,roots are fitted for the use of the sick if they are boiled in two waters1 but they are not well adapted to those who are liable to sour stomachs4 ,some vegetables1 on account of their peculiar qualities1 have peculiar effects as remedies4 ,it is asserted that spinach and asparagus act as diuretics1 dandelion as a tonic and laxative1 tomatoes as a cholagogue1 beets and turnips as a tonic1 onions1 garlic1 and leeks as stimulants and narcotics1 the red onion as a narcotic in neuralgia and insomnia1 and cabbages1 tomatoes1 and other salad material as anti-scorbutics4 #aa4 ,,fruits produce the most diversified effects2 but peaches and nectarines1 very soluble pears if they are ripe1 apples if they are roasted1 the orange if it is fully ripe1 grapes if the skin be rejected1 strawberries and mulberries are pretty generally admissible4 ,,fluid ,,aliments4 #ab4 ,fluid food can in most cases be taken more conveniently by suction through a ,,bent ,,glass ,,tube4 ,after feeding1 dry the mouth if the patient cannot well do it for herself4 #ac4 ,water is demanded in every disease in which a dry skin and an elevation of temperature is present4 ,the temperature of the water may be from #fj to #ej4 ,small bits of ice swallowed whole are excellent to control nausea4 ,it is refreshing and harmless4 ,to keep a small piece of ice from immediately melting3 ,cut a piece of flannel six inches square1 snip one or two holes in the centre for water to run through2 confine it by an elastic band about the edge of a tumbler or goblet2 depress the middle of the flannel1 and a small piece of ice may be kept in it for some time2 bits of ice may be split off from it with a knife4 ,ice and water should be pure4 #ad4 ,toast water when properly prepared forms a useful beverage in the sick room4 ,as it contains a small proportion of gluten it is slightly nutritive4 #ae4 ,while febrile symptoms are present1 farinaceous matters such as barley water gruel1 arrow root1 mucilage or sago acidulated with lemon juice1 and sweetened to the taste of the patient1 are most commonly suitable1 but water is the most salutary diluent4 #af4 ,gruel is less mild and demulcent than barley water1 and is more likely to sour1 but it is nutritive food4 #ag4 ,tea is refreshing1 and may be taken in moderate quantity1 provided it be not strong4 ,coffee may be taken largely combined with milk4 #ah4 ,beer1 brandy1 and other stimulants should be given only after proper medical examination and advice4 ,,recipes ,,for ,,beverages ,,and ,,food4 ,,formula #a4 ,,food ,,for ,,infants4 ,take of new milk1 warm water1 of each equal parts2 table salt1 sugar1 of each a small quantity1 to salt and sweeten it slightly2 warm the milk by the water1 so that it will be of the same temperature as the mother's milk--about #ij2 the proportion of milk may be a little less than this when the infant is newly born1 and should be increased as it grows older1 but water must always be given with the milk4 ,give by means of a feeding bottle that has been properly cleansed4 #b4 ,,gum ,,arabic ,,mucilage4 ,take of gum ,arabic one ounce1 boiling water one pint2 after the gum ,arabic is dissolved1 add two table spoonfuls of sugar and the juice of a lemon2 cool and add ice4 ,this may be taken as a drink in diarrha4 #c4 ,,infusion ,,of ,,flax ,,seed4 ,take of flax seed two table spoonfuls1 water one pint1 sugar two table spoonfuls2 steep for an hour or more and strain1 then add the juice of a lemon and set on ice4 ,use as a demulcent drink4 #d4 ,,milk ,,and ,,cinnamon ,,drink4 ,take of cinnamon one teaspoonful1 boiling water one pint2 steep for a few minutes1 sweeten with sugar1 and mix with half a pint of milk4 ,good in diarrha4 #e4 ,,vinegar ,,whey4 ,take of milk one pint1 vinegar one ounce2 boil for a few minutes and separate the curd4 ,good in dysentery1 and may be taken freely4 #f4 ,,decoction ,,of ,,bran4 ,take of wheat bran one pint1 boiling water three pints2 let the mixture stand in a covered vessel for two hours2 strain and serve1 with sugar and cream4 ,this is slightly laxative4 #g4 ,,sage ,,tea4 ,take of the dried leaves of sage half an ounce1 boiling water one quart2 infuse for half an hour and then strain4 ,sugar and lemon juice may be added in the proportion required by the patient4 ,in the same manner balm and other teas may be made4 #h4 ,a ,,refreshing ,,drink ,,in ,,fevers4 ,boil one ounce and a half of tamarinds1 three ounces of cranberries1 and two ounces of stoned raisins1 in three pints of water till the water is reduced to two pints2 strain and add a bit of lemon peel1 which should be removed in an hour as it gives a bitter taste if left long4 #i4 ,,toast ,,water4 ,take slices of toast nicely browned1 enough hot water to cover them1 cover closely and let them stand until cold2 strain the water1 sweeten to taste1 and put a piece of ice in each glassful4 ,if the physician thinks it safe add a little lemon juice4 ,good for nausea and vomiting4 #aj4 ,,apple ,,water4 ,take three juicy pippins or other fine flavored apples1 one quart cold water2 pare and quarter the apples1 but do not core them2 stew the apples to pieces in a tin or porcelain sauce-pan1 closely covered2 strain the liquor at once1 closely pressing the apples in the cloth2 sweeten and ice for drinking4 ,slightly laxative4 #aa4 ,,slippery ,,elm ,,bark ,,tea4 ,break the bark into bits1 pour boiling water over it1 cover and let it infuse till it is cold4 #ab4 ,,jelly ,,water4 ,take one large teaspoonful currant or other kind of jelly1 one goblet ice water2 beat up well4 ,a good drink in fever1 and if of wild cherry or blackberry jelly it is very good for those suffering from diarrha4 #ac4 ,,corn ,,tea4 ,take a cupful of dry corn1 parch it brown1 grind it1 or pound it in a mortar2 pour over it two cups of boiling water1 and steep for a few minutes4 ,this is nutritious4 #ad4 ,,tartar ,,whey4 ,take of milk one quart1 cream of tartar half an ounce2 boil until the curd separates4 ,this is somewhat laxative4 #ae4 ,,herb ,,teas4 ,take of the dried or green leaves about one ounce1 boiling water one pint1 and let them stand until cold4 ,catnip tea is good for colds and coughs in infants2 spearmint and peppermint tea is good for disordered stomach and bowels2 pennyroyal for a cold if recently taken2 chamomile tea is a good tonic1 blackberry root tea is good for summer complaint1 raspberry leaves 7green7 for dysentery1 sweet apple tree bark tea for a child's cankered sore mouth1 pumpkin seed and parsley tea for suppression of urine2 mullien leaf tea is good in kidney complaints2 mullien leaves infused in milk makes a medicinal drink in a case of phthisis4 #af4 ,,milk ,,and ,,isinglass 7,,gelatin47 ,dissolve a little gelatin in water and mix with half a pint of milk4 ,boil and sweeten to taste4 #ag4 ,,effervescing ,,lemonade4 ,take the juice of a large lemon1 two or three teaspoonfuls of sugar1 half a pint of spring water2 add half a small teaspoonful of carbonate of soda4 ,stir and drink while effervescing4 #ah4 ,,indian ,,meal ,,gruel4 ,take of ,indian meal one small teacupful1 wheat flour one table spoonful1 boiling water two quarts2 wet the meal and flour to a smooth paste1 and stir into the water while it is boiling4 ,boil slowly for thirty or forty minutes1 frequently stirring from the bottom2 salt to taste2 add sugar and nutmeg if you like2 if too thick reduce with boiling water to the desired consistency2 if a laxative effect is desired omit the flour4 ,raisins may be boiled with the gruel1 and cream may be added if desired4 #ai4 ,,oatmeal ,,gruel is made in the same way as the above4 ,gruel drank warm at bed time is a soothing remedy for a bad cold4 #bj4 ,,milk ,,and ,,rice ,,gruel4 ,take boiling milk one quart1 ground rice two table spoonfuls wet with cold milk1 salt one salt spoonful2 stir in the rice paste and boil ten minutes1 stirring constantly4 ,season with sugar and nutmeg1 and eat warm with cream4 #ba4 ,,tapioca ,,jelly4 ,take of tapioca two spoonfuls1 water one pint2 boil gently for an hour1 or until it assumes a jelly-like appearance4 ,add sugar and nutmeg with lemon juice to suit the taste of the patient4 #bb4 ,,rice ,,gruel4 ,take of ground rice one ounce1 cinnamon one drachm1 water one quart2 boil for thirty minutes1 adding the cinnamon near the conclusion4 ,strain and sweeten it4 #bc4 ,,panada4 ,take of wheat bread one ounce1 cinnamon one drachm 7or if preferred a little mace71 water one pint2 boil without stirring until they mix and turn smooth4 ,then add a grate of nutmeg1 a small piece of butter1 and sugar according to taste4 ,some add a table spoonful of wine4 #bd4 ,,bread ,,jelly4 ,steep stale bread in boiling water1 and pass through a fine sieve while still hot4 ,this is a light1 nourishing diet for a weak stomach1 which may be taken alone1 or after being boiled with milk4 #be4 ,,rice ,,cream4 ,steep a quarter of a pound of whole rice in milk1 and put in a sieve to drain and cool2 mix the rice with a gill of cream whisked to a froth1 and a little powdered sugar1 and a teaspoonful of lemon juice4 ,some add wine but it is not necessary4 #bf4 ,,to ,,make ,,fat4 ,the diet to be prescribed when the aim is to produce increased weight should include such articles as fat meats1 butter1 cream1 milk1 cocoa1 chocolate1 bread1 potatoes1 peas1 parsnips1 beets1 farinaceous and flour puddings1 pastry1 almond puddings1 and biscuit1 custards1 oatmeal porridge1 sugar and sweets1 porter1 c4 #bg4 ,,milk ,,porridge4 ,take wheat flour two table spoonfuls1 milk one pint1 water one pint2 mix the flour with cold water to form a thin paste2 put the milk and water over the fire1 and when they come to a boiling point add the paste1 carefully stirring4 #bh4 ,,french ,,milk ,,porridge4 ,stir some oatmeal and water together1 let the mixture stand to clear1 and pour off the water2 then put more water to the meal1 stir it well and let it stand till the next day2 strain through a fine sieve and boil the water1 adding milk while so doing4 ,let the proportion of milk exceed one-half4 ,with toast this is good diet for the sick4 #bi4 ,,lime ,,water ,,and ,,milk4 ,take of lime water one to two ounces1 milk four ounces4 ,this will sometimes be retained on the stomach when other food is rejected4 ,the addition of fifteen grains of bicarbonate of soda has a similar effect if added to a quart of fresh milk1 and prevents milk from turning sour for several hours4 #cj4 ,,mush ,,and ,,milk4 ,take of ,indian meal one coffee cupful1 water two quarts1 salt to taste2 when the water is boiling1 stir the meal into it1 adding meal gradually till it thickens so that it is difficult to stir4 ,it should be permitted to remain where it will cook slowly for twenty or thirty minutes1 stirred often with a pudding stick4 ,eat with milk4 #ca4 ,,lemon ,,jelly4 ,soak half a box of gelatin in a cup of cold water2 steep the grated or pared rind of two lemons in a pint of boiling water for ten minutes1 add the gelatin1 one cup of sugar1 and four table spoonfuls of lemon juice4 ,when all is dissolved1 strain and place in a vessel to cool4 #cb4 ,,alum ,,whey4 ,take alum one teaspoonful1 milk one pint2 boil together and strain to separate the curd4 #cc4 ,,table ,,tea4 ,allow a small teaspoonful of tea to each half pint of water4 ,after rinsing the teapot with boiling water put in the tea1 and let it stand a few minutes in the steaming pot2 add the water freshly boiling1 and let it stand where it will keep hot three or four minutes4 #cd4 ,,nutritious ,,coffee4 ,take one pint of nearly boiling milk1 and add half an ounce of freshly ground coffee1 and boil together for three minutes4 ,clear it by pouring into a cup and dashing back4 ,add a little isinglass dissolved in water and leave to settle4 ,if preferred1 beat up an egg with sugar and pour the coffee upon it4 #ce4 ,,nutritious ,,laxative4 ,take one table spoonful of lump magnesia1 pulverized1 one teaspoonful of saleratus or soda1 sugar and salt as desired1 and stir them in a quart of hot milk porridge made in the usual way4 ,this will operate as an antacid and as physic if taken during the day2 at the same time it is nourishing4 #cf4 ,,potus ,,imperialis4 ,take half an ounce of cream tartar1 the juice of one lemon1 and two table spoonfuls of sugar2 pour on them a quart of boiling water1 and let it stand on ice till cold4 ,if this is drank it will increase the action of the kidneys4 #cg4 ,,vegetable ,,soup4 ,take one potato1 one turnip1 one onion2 let them be sliced and boiled in one quart of water for an hour4 ,add as much salt and pepper as is agreeable1 and pour the whole upon dry toast4 ,add butter if desired4 #ch4 ,,sweet ,,ptisan1 ,,for ,a ,,drink ,,in ,,dysentery4 ,take of sheep's suet two ounces1 milk one pint1 starch half an ounce1 water one pint2 boil slowly for fifteen minutes4 #ci4 ,,mucilage ,,of ,,starch4 ,take of starch one ounce1 powdered cinnamon one drachm1 gum ,arabic one ounce1 boiling water three pints2 boil until reduced to two-thirds and strain4 ,this is a useful drink in dysentery4 #dj4 ,,boiled ,,flour4 ,take of fine wheat flour a pound1 tie it up in a linen cloth1 boil until it becomes a hard dry mass4 ,a table spoonful of this may be grated off and used to make milk porridge4 #da4 ,,toast4 ,the bread must be cut thin1 the crust trimmed off1 and then the slice held in a toaster over a bed of coals1 and turned from side to side till all the moisture is removed1 then allowed to become a golden brown4 ,serve it on a hot plate as soon as it is done4 #db4 ,,very ,,nice ,,panada4 ,take three ,boston crackers1 split them and arrange them in a bowl in layers1 sugar and salt scattered among them2 cover with boiling water1 and set in a warm place with a close cover over the bowl1 to remain one hour4 ,a little nutmeg should be added1 and it should be eaten from the bowl4 #dc4 ,,how ,,to ,,prepare ,,arrow ,,root4 ,put two teaspoonfuls of the powder into a basin1 mix them smooth with a few teaspoonfuls of cold water1 and let another person pour boiling water over the mixture while you continue to stir it until it forms a starchy looking substance4 ,it may be used in the same manner as gruel1 a little milk and salt being added to it4 #dd4 ,,arrow ,,root ,,custard4 ,take two teaspoonfuls arrow root1 wet them up with a little cold milk2 stir for three minutes in a cup of boiling milk1 take from the fire and stir in an egg1 already well beaten2 boil two minutes longer1 flavor with vanilla or rose water1 and pour into moulds4 #de4 ,,boiled ,,rice ,,and ,,cocoa-,,nut4 ,take one teacupful of rice1 one heaping teaspoonful of cocoa-nut1 and the milk from the centre of the nut2 one quart of water1 one pint of milk1 and salt to taste2 boil three or four hours in a double boiler4 ,if it boils away too much add more water4 ,serve with canned strawberries for sauce4 #df4 ,,bread ,,jelly ,,for ,,children ,,weaned4 ,take a quantity of the soft part of a loaf1 break it up1 cover it with boiling water and allow it to soak for several hours2 the water is then to be poured off completely1 and fresh water added2 place the mixture on the fire and allow it to boil until it becomes smooth4 ,the water is then to be pressed out1 and the bread on cooling will form a thick jelly4 ,mix a portion of this with sugared milk and water as it is wanted4 #dg4 ,,how ,,to ,,cook ,,rice4 ,erratum4 ,on page #bfh1 bottom line1 for #dg read #dj4 ,in preparing it only just enough cold water should be poured on to prevent from burning at the bottom of the pot1 which should have a close fitting cover1 and with a moderate fire the rice is steamed rather than boiled until it is nearly done2 then the cover is taken off1 the surplus steam and moisture allowed to escape1 and the rice turns out a mass of snow white kernels4 #dh4 ,,oyster ,,broth4 ,take half a pint of oysters1 cut into small pieces1 put them into a gill of water and let them simmer for eight or ten minutes4 ,skim and strain1 then add a little new milk1 salt1 and pepper4 #di4 ,,poached ,,egg4 ,a fresh egg broken into boiling water and cooked till the white is congealed1 then laid on a piece of newly toasted bread dipped in hot milk and buttered1 is an appetizing dish for convalescents4 #ej4 ,,chicken ,,tea4 ,to relieve the nausea and vomiting of cholera morbus3 ,kill a chicken1 and strip off the feathers as soon as possible after it is killed2 boil the wings and legs in a little water4 ,this1 if simply seasoned with a little salt1 will be acceptable to the stomach4 #ea4 ,,restoration ,,soup ,,for ,,invalids4 ,take one pound of newly killed beef or fowl1 chop it fine2 add one-half pint of pure water1 and perhaps four or five drops of pure muriatic acid1 one-half teaspoonful of common salt1 and stir well together4 ,after three hours the whole may be thrown in a sieve1 and the fluid allowed to pass through on slight pressure2 on the flesh residue in the sieve pour slowly one-half teacupful of water1 and let it run slowly through the sieve while squeezing the meat4 ,there will thus be obtained about ten ounces of cold juice 7extract of meat71 having a pleasant taste of soup1 of which a wineglassful may be taken at pleasure4 ,if preferred one part of meat may be taken with two parts of white sugar1 one teaspoonful every three hours4 ,the two may be pounded in a mortar4 #eb4 ,,beef ,,tea4 ,take one pound of beef minced very fine1 and put it in a common earthenware pot with a pint and a half of cold water2 stand the pot on the stove1 so that it may simmer for at least three hours4 #ec4 ,,chicken ,,broth4 ,when it is desired that chicken broth should be very nutritious1 take an old fowl2 cut up and break the bones with a mallet2 cover with three or four pints of cold water1 and add some rice or tapioca2 salt to taste and boil for two hours4 #ed4 ,,mutton ,,and ,,veal ,,broth4 ,take of either mutton1 beef1 or veal one pound and a half1 cold water two quarts1 rice two ounces2 simmer for four hours1 boil for a few minutes1 strain and serve4 #ee4 ,,eggs1 ,,cream1 ,,and ,,extract ,,of ,,beef4 ,wash two ounces of the best pearl sago until the water poured from it is clear1 then stir the sago in half a pint of water until it is tender and very thick2 mix with it half a pint of good boiling cream1 and the yolks of four fresh eggs1 and mingle the whole carefully with one quart of good beef tea1 which should be boiling2 serve4 ,good in cases of lingering convalescence after acute diseases4 #ef4 ,,beef ,,tea ,,made ,,nutritious4 ,to a pint of beef tea add bread crumbs1 and boil for five minutes2 or mix a table spoonful of cooked oatmeal or rice with two of boiling water1 add a cupful of strong beef tea and boil a few moments4 ,serve with toast4 #eg4 ,,mutton ,,broth4 ,to a pound of meat cut in small pieces put a quart of cold water1 boil slowly three or four hours in a closely covered kettle till the meat falls to pieces2 strain1 remove all fat1 and put in two table spoonfuls of rice that has been soaked half an hour2 simmer until the rice is well cooked1 season with salt1 and serve with toasted cracker4 #eh4 ,,beef ,,tea4 ,take lean beef1 cut into shreds one pound1 cold water one quart2 boil for thirty minutes1 taking off the scum as it rises2 when it grows cold1 strain4 #ei4 ,,essence ,,of ,,beef4 ,take of lean beef sliced1 one pound2 put into a bottle or fruit jar1 cork it loosely and place it in a pot of cold water 7attaching the neck by means of a string to the handle of the vessel47 ,boil for two hours and then decant the liquor and skim it4 #fj4 ,,beef ,,juice4 ,take a nice juicy steak1 remove all the fat1 broil it over a bright coal fire long enough to heat it through2 then with a meat or lemon squeezer press out the juice into a cup2 set in hot water4 ,remove any fat that may be in it2 shake the salt box slightly over it and serve4 ,i shall not refer to the different alimentary preparations now thrown in the market1 which come with printed directions on the packages1 farther than to say that ,i have a favorable opinion of ,carnrick's ,soluble food for infants4 ,i have tested it well4 ,,chapter ,v4 ,,the ,,art ,,of ,,prescribing4 ,the nurse will not often prescribe medicine1 but it may be of use to know how to read the prescriptions of others1 and to know a few of the general rules or principles upon which physicians act in trying to produce the greatest curative effect with least possible inconvenience4 ,,the ,,doses ,,of ,,medicine4 ,generally in the following prescriptions the ordinary dose for an adult is stated4 ,the young require a smaller dose than older persons1 or those at maturity2 and the very aged cannot bear as large doses as the middle aged4 ,the following is designed to exhibit the dose proportioned to the age2 the dose for a person of middle age being one drachm3 ,that for a person from #ad to #ba will be #b scruples4 ,that for a person from #g to #ad will be a drachm4 ,that for a person from #d to #g will be #a scruple4 ,that for a person of #d years will be #ae grains4 ,that for a person of #c years will be #aj grains4 ,that for a person of #b years will be #h grains4 ,that for a person of #a years will be #e grains4 ,there are some medicines however which require to be given to children in much larger proportioned doses than those stated above4 ,for example1 a child of three years might require half as much castor oil for a dose as an adult4 ,females usually require smaller doses than males1 and those of sanguine temperament than the lymphatic and phlegmatic4 ,idiosyncracies sometimes exist in individuals rendering them peculiarly susceptible to the action of certain remedies1 or causing a medicine to act on an individual in a manner wholly different from the ordinary mode4 ,in general the susceptibility to the action of a medicine is diminished by its frequent use2 some medicines are of variable strength1 and all these considerations should lead to great care in prescribing2 some medicines require more care than others1 however1 and such formula will be selected for insertion here as may be pretty generally used with safety4 ,i believe they do not require more effort to adapt them to particular cases than ordinary patent medicines4 ,,mode ,,of ,,administering ,,medicine4 ,medicines given together should be combined with a definite purpose in regard to each article in the formula4 ,remedies of the same general character may be given together in order to increase their efficacy4 ,in ,f4 #gd there are several aromatics because a small amount of each when combined1 will be more certain in their action than a large amount of one kind1 and at the same time they will be less irritating4 ,the effects of one medicine are in many cases increased by the influence of another in augmenting the natural susceptibility of the system to its action4 ,one medicine is given with another to counteract the more disagreeable effects of the more active one4 ,one medicine is sometimes given as a vehicle for another2 perhaps to cover the disagreeable taste or odor and to render the medicine acceptable to the stomach4 ,for example1 the aromatics and ammonia in ,f4 #gd are much more agreeable to the stomach than either of them would be separately4 ,in the mixing of medicines care should be taken that they are neither chemically nor physiologically incompatible4 ,when the action of an acid is desired1 an alkali should not be given at the same time1 as they unite to form a compound different from either4 ,a soluble salt should not be given with another1 or with an acid that would decompose it1 and produce an inert compound4 ,if medicines are given that have an apparent physiological incompatibility1 it should be with a full understanding of their effects1 and with reference to them4 ,the ,,form in which medicine is given must vary according to the nature of the medicine1 the taste of the patient1 or the condition of his stomach1 as it is always desirable to have it so that it can be swallowed without difficulty4 ,the physician should always write his prescription with neatness1 order and precision1 but it will be found an advantage to the nurse to have a ready comprehension of the symbols and abbreviations used in writing prescriptions4 ,hence ,i have appended a table designed to explain the signs and abbreviations habitually used4 ,ordinarily the ,roman numerals are employed1 and follow always the symbols to which they relate4 ,a glossary which will include some latin terms will hereafter be added4 ,sign or ,abbreviation4 ,,latin ,,word4 ,,english ,,word4 ,libra or libr4 ,a pound or pounds4 ,uncia or unci4 ,an ounce or ounces4 ,drachma or drachm4 ,a drachm or drachms ,scrupulus or scrupuli4 ,a scruple or scruples aa4 ,ana4 ,of each4 ,add4 ,adda4 ,add to it4 ,ad4 saturand ,ad saturandum4 ,until saturated4 ,ad4 lib4 ,ad libitum4 ,at pleasure4 ,alt4 hor4 ,alternis horis4 ,alternate hours4 ,ante ,cib4 ,ante cibum4 ,before food4 ,aq4 ferv4 ,aqua fervens4 ,hot water4 ,aq4 pluv4 ,aqua pluvialis4 ,rain water4 ,aq4 pur4 ,aqu pura4 ,pure water4 ,aq4 tepida4 ,aqua tepida4 ,tepid water4 ,bis die4 ,bis die4 ,twice a day4 ,bull4 ,bulliat4 ,let it boil4 ,cap4 ,copiat4 ,let him take4 ,coch4 mag4 ,cochlear magraum4 ,a large spoonful4 ,coch4 parv4 ,cochlear parvum4 ,a tea spoonful4 ,colent4 ,colentur4 ,let them be strained ,collyr4 ,collyrium4 ,an eye water4 ,comp4 or ,co4 ,compositus4 ,compound4 ,contus4 ,contusus4 ,bruised or crushed4 ,cong4 ,congius or ,congii4 ,a gallon or gallons4 ,decoct4 ,decoctum4 ,a decoction4 ,det4 ,detur4 ,let it be given ,dil4 ,dilutus4 ,dilute4 ,div4 in p4 q4 ,divitur in partes ,divide in equal parts qualis4 ,duo4 ,duo4 ,two4 ,ft4 ,fiat4 ,let them be made4 ,garg4 ,gargarisma4 ,a gargle ,gr4 ,granum or gran4 ,a grain or grains4 ,gtt4 or gut4 ,gutta or gutt4 ,a drop or drops4 ,haust4 ,haustus4 ,a draught4 ,ind4 ,indico4 ,daily4 ,infus4 ,infusum4 ,an infusion4 ,inject4 ,injectio4 ,an injection4 ,min4 or ,m4 ,minim4 #a-fj of a fluid drachm ,m4 ,misce4 ,mix ,mass4 ,massa4 ,a mass ,mist4 ,mistura4 ,a mixture4 ,pil4 ,pilula or pilul ,a pill or pills4 ppt4 ,preparata4 ,prepared4 ,pulv4 ,pulvis4 ,a powder4 ,p4,r4,n4 ,pro re nata4 ,as occasion requires4 q4 s4 ,quantum sufficit4 ,a sufficient quantity4 ,recipe4 ,take4 ,rad4 ,radix4 ,a root4 ,s4 or ,sig4 ,signatur4 ,write4 ss4 ,semisis4 ,a half4 ,tinct4 ,tinctura4 ,a tincture4 #b dis4 ,duo dis4 ,every two hours4 f4 or fl4 ,fluid uncia or unci4 ,fluid oz4 or ounces4 ,the succeeding chapter is composed of formul giving numerous examples of the different forms in which prescriptions are written4 ,good taste requires that all directions should be in the ,english language1 and that hieroglyphics and absurd abbreviations should be discarded as much as possible4 ,very many physicians write the directions in latin1 and the druggist is expected to write the same in ,english and attach a label thus written to the bottle containing the medicine4 ,i have given some examples of the old-form prescriptions written entirely in latin1 and also some where the new notation 7figures1 c47 is used4 ,whoever reads them over will learn how to read prescriptions2 but ,i have given none but such as ,i value highly1 and ,i have used almost every one in my practice1 and tested its excellence4 ,i advise people to obtain these rather than those patent medicines whose composition is secret4 ,the person who desires one of these prescribed medicines can obtain it by copying the formula accurately and taking it to a druggist4 ,i adopt the usual ,,classification ,,of ,,remedies4 ,,antacids neutralize acids existing in the alimentary canal1 or circulating with the blood2 ,,antiseptics counteract putrefaction2 ,,antispasmodics relax spasm and calm nervous irritation2 ,,astringents cause vital contraction of the organic textures2 ,,anthelmintics destroy worms1 or expel them from the bowels2 ,,cathartics act on the bowels1 producing a purgative effect2 ,,caustics destroy the life of the part upon which they act2 ,,diaphoretics increase the cutaneous discharge2 ,,diuretics produce an increased flow of urine2 ,,emetics produce vomiting2 ,,expectorants augment the secretion from the pulmonary mucous membrane2 ,,enemata cause evacuations from the rectum1 c42 ,,emmenagogues excite the menstrual secretion2 ,,narcotics affect the cerebral functions2 ,,tonics exalt the energies of the whole system4 ,i shall give examples of remedies which are designed to produce these several effects1 besides some belonging to other classes4 ,where the word teaspoon is used it signifies one holding about #ee drops of water j4 7one drachm72 #a table spoon about half an ounce1 and this is written ss2 one wineglass equals two ounces1 written ij2 one teacup equals four ounces1 written jv42 one coffee cup equals eight ounces1 and is written viij4 ,the gramme of the ,,french ,,metric ,,system equals about #ae grains1 and this is the unit of weights4 ,the system is of the decimal character and the latin prefixes deci1 centi1 milli1 c41 are used to indicate its subdivisions1 and the ,greek deca1 hecto1 kilo1 myria1 c41 are its multiples1 always on the scale of ten4 4#jja gramme #a milligramme4 4#ja gramme #a centigramme4 4#a gramme #a decigramme4 #a gramme #aj gramme #a decagramme4 #ajj gramme #a hectogramme4 #ajjj gramme #a kilogramme4 ,physicians1 many of them1 prefer to employ latin names to designate the ingredients of their prescriptions1 and to write the directions to the druggist in latin4 ,i will first give a few latin prescriptions with the translation4 ,,chapter ,,vi4 ,,medical ,,formulary4 ,formula #fa4 ,,fiat ,,haustus4 7,let a draught be made47 ,magnesi sulphatis drachmas duas4 ,infusi senn fluidunciam4 ,syrupi rhei fluidrachmam4 ,misce et fiat haustus1 in jusculo calido1 parttis vicibus sumendus4 ,the above prescription translated into ,english would read3 ,take of sulphate of magnesia two drachms4 ,infusion of senna one fluid ounce4 ,syrup of rhubarb one fluid drachm4 ,mix and let a draught be made to be taken in divided doses in warm broth4 ,the following is a convenient form and one not liable to mistakes3 ,magnesi sulph4 ij4 ,syr4 rhei f j4 ,infus4 senn4 f j4 ,m41 et fiat haustus4 ,s4 ,to be taken in divided doses in warm broth4 #fb4 ,,for ,,colic4 ,magnes4 alb4 ust j4 ,tinct4 ftid gtt4 lx4 ,tinct4 theb gtt4 xx4 ,aq4 font j4 ,translation4 ,take ,calcined magnesia #bj grains4 ,tincture of assaftida #fj drops4 ,laudanum #bj drops4 ,water #a ounce4 ,mix4 ,s4 ,dose4 #bj drops for a child1 in sweetened water4 #fc4 ,,for ,,cholera ,,infantum ,,and ,,dysentery4 ,sal tart4 vel carb4 sod gr4 xxx4 ,gum ,arabic4 ,sacch4 ,alb aa4 j4 ,tinct4 theb gtt x4 ,aq4 ,font iij4 ,translation4 ,take salt of tartar or soda #bj grains4 ,gum ,arabic and loaf sugar each #a drachm4 ,tincture of opium 7laudanum7 #aj drops4 ,water #c ounces4 ,to the above a drop of oil of cinnamon may be added and it may be given in doses of one teaspoonful in lime water and milk1 when cholera morbus is followed by diarrha and dysentery4 #fd4 ,,for ,,croup1 ,c4 ,tr4 phytolac dec gtt4 vj4 ,tr4 aconit gtt4 iij4 ,aqua4 iv4 ,m4 ,translation4 ,take ,tinct4 of poke root #f drops4 ,tinct4 of aconite #c drops4 ,water #d ounces4 ,mix4 ,dose a teaspoonful every five or thirty minutes1 as is necessary4 ,for a case of mammary abscess it may be given internally1 and also rubbed upon the breast in the forming stage4 #fe4 ,,for ,,chronic ,,enlargement ,,of ,,the ,,spleen4 ,errata4 ,on page #dd1 for #ab1 #ah1 #bc1 #eb1 #ed1 #eg1 #fa1 #fb1 #fe1 read #aj1 #af1 #ah1 #ai1 #bj1 #bc1 #be1 #bh4 ,on page #dc1 last line1 for #fe read #eh4 ,tinct4 cinch4 comp4 viij4 ,aq4 menth4 pip4 xij4 ,ammon4 murias j4 ,m4 ,translation4 ,take of ,compound tincture of ,peruvian bark #h ounces4 ,peppermint water #ab ounces4 ,muriate of ammonia #a ounce4 ,mix ,s4 ,dose one teaspoonful three times a day1 one hour before meals4 #ff4 ,,chronic ,,rheumatism4 ,pulveris guaiaci resin1 ,potass nicratas aa4 j4 ,pulveris ipecacuanh gr4 iij4 ,opii gr4 ij4 ,fiat pulvis in charletas sex dividendus4 ,translation4 ,pulverized gum guiac1 ,nitrate of potash of each #a drachm4 ,powdered ipecac #c grains4 ,opium #b grains4 ,mix4 ,divide into six powders4 ,s4 ,one powder to be taken every three hours in syrup or molasses4 #fg4 ,,for ,,sciatica ,,and ,,for ,,the ,,kidneys4 ,ol4 cubeba1 ,ol4 copaiba aa4 f4 jv4 ,ol4 tenebinth4 f4 ij4 ,spts4 nit4 th4 f4 vj4 ,mucilagio acacia f4 ij4 ,m4 ,translation4 ,take oil of cubebs1 ,oil of copaiva of each four fluidrachms4 ,oil of turpentine two fluidrachms4 ,spirits of nitric ether six fluidrachms4 ,mucilage of gum ,arabic two fluid ounces4 ,mix4 ,mark4 ,one teaspoonful three times a day4 #fh4 ,,for ,,gastric ,,ulcer4 ,morphine sulphatis gr4 j4 ,bismuth subnitratis ss4 ,m4 ,s4 ,ft4 ,chart4 ,no4 vj4 ,translation4 ,take morphine #a grain4 ,sub nitrate of bismuth drachm4 ,mix4 ,make six powders4 ,mark4 ,one powder to be taken every four hours4 ,,antacids4 #fi4 ,,carbonate ,,of ,,magnesia4 ,magnesia carbonatis grs4 #hj4 ,extracti opii liquidi min4 #cj4 ,spiritus etheris fl4 drs4 #c4 ,aqua mentha viridis ad fl4 oz4 #f4 ,mix4 ,one fourth part occasionally4 ,useful where there is much oppression from flatulency4 #gj4 ,,chalk ,,mixture ,,and ,,hops4 ,tincture lupuli vj4 ,tinct4 cardamomi compositae fl4 jv4 ,vini ipecacuanh fl4 ij4 ,extractii opii liquidi min4 xxx4 ,mistura creta ad4 fl4 vj4 ,m4 ,translation4 ,take tincture of hops #f drachms4 ,compound tinct of cardamom #d fluidrachms4 ,wine of ipecac #b fluidrachms4 ,liquid extract of opium #be minims4 ,chalk mixture 7add to it7 #f fluid ounces4 ,mix4 ,mark4 ,one teaspoonful every three or four hours4 ,useful in diarrha due to acidity in the stomach4 #ga4 ,,for ,,heartburn4 ,liquor magnes4 carb4 ss4 ,sp4 lav4 comp4 ij4 ,m4 ,ft4 haust4 ,translation4 ,take liquor of carbonate of magnesia ounce4 ,compound spirits of lavender #b drachm4 ,make a draught4 ,take immediately and repeat if necessary4 #gb4 ,,for ,,acidity ,,of ,,the ,,stomach4 ,pepsin #e grains4 ,sub nitrate bismuth #e grains4 ,glycerine ounce4 ,m4 ,sig4 ,after each meal4 #gc4 ,,for ,,infantile ,,colic4 ,magnesia carb4 ij4 ,tinct assaftida min4 xx4 ,aqua4 ij4 ,m4 ,sig4 ,thirty drops and repeat every half hour until relieved4 #gd4 ,,for ,,disordered ,,stomach4 ,aqua ammonia ij4 ,essence cinnamon ,tinct4 ginger aa4 ss4 ,tinct4 pimento j4 ,alcohol ij4 ,water viij4 ,mix4 ,of this one teaspoonful may be put in a glass of water1 of which the patient may take a teaspoonful every hour4 #ge4 ,,nausea ,,and ,,vomiting4 ,no4 #a4 ,bicarb4 potass4 grs4 xxx4 ,water f4 ij4 ,bromide potass4 grs4 xxx4 ,m4 ,no4 #b4 ,citric acid4 j4 ,water jv4 ,syrup f4 x4 ,m4 ,add a table spoonful of ,no4 #b to a teaspoonful of ,no4 #a and drink immediately4 #gf4 ,a ,,powder ,,for ,,heartburn4 ,magnesia calcinat ss4 ,bicarbonate sod ,pulveris zinziberis aa4 j4 ,m4 ,sig4 ,a small teaspoonful occasionally4 #gg4 ,,chalk ,,mixture4 ,prepared chalk jss4 to ij4 ,white sugar ,pulv4 gum ,arabic aa4 q4 s4 ,peppermint water vj4 ,m4 ,sig4 ,a table spoonful for a dose every two hours4 ,when administered for diarrha1 astringents and laudanum may be added4 #gh4 ,,cholera ,,mixture4 ,chalk mixture j4 ,spirits chloroform xx4 ,tinct4 opium min4 jv4 ,m4 ,to be taken every four hours4 #gi4 ,,neutralizing ,,cordial4 ,bicarbonate of potash ,pulv4 rhei aa4 ij4 ,mix and add of ,boiling water f4 viij4 ,let it stand for two hours1 filter and add ,brandy f4 j4 ,essence peppermint f4 j4 ,add white sugar to an agreeable sweetness4 ,highly useful in diarrha1 dysentery1 summer complaint1 c41 especially of children4 #hj4 ,,for ,,diarrh,a ,,and ,,dysentery4 ,oil cinnamon ,oil cloves ,extract ginger aa4 ss4 ,morphine grs4 ij4 ,rhubarb grs4 xx4 ,aqua ammonia ij4 ,spirits camphor ij4 ,alcohol viij4 ,water iv4 ,m4 ,s4 ,dose1 teaspoonful every two hours1 in water4 #ha4 ,,soda ,,mint ,,for ,,nausea1 ,c4 ,sod bicarbonas j4 ,aqua ,menth4 pip4 xvj4 ,spirits ammon4 arom4 ss4 ,m4 ,dose4 #a table spoonful4 #hb4 ,,for ,,flatulent ,,dyspepsia4 ,salacylate of bismuth #b parts4 ,calcined magnesia #c parts4 ,oil of anise #a part4 ,m4 ,of this powder a small teaspoonful may be taken before a meal4 ,,antiseptics4 #hc4 ,,lavender ,,and ,,camphor4 ,spirits of camphor min4 xx4 ,spirits of lavender f4 j4 ,gum trugacanth mucilage f4 vij4 ,make a draught4 ,to be taken every six or eight hours by a nervous attendant in a sick room4 #hd4 ,,solution ,,of ,,chlorinated ,,soda4 ,liquoris chlorinat j4 ,tinct4 opii min4 xv4 ,camphon aqu f4 xij4 ,m4 ,a table spoonful three times a day relieves the fetor1 and is otherwise useful in low cases of fever1 gangrene of the lungs1 c4 ,,antispasmodics4 #he4 ,,ammonia ,,mixture4 ,aromatic spirits of ammonia fl4 j4 ,dilute hydrocyanic acid min4 ij4 ,syrup ginger min4 f4 j4 ,caraway water fl4 vj4 ,make a draught4 ,to be taken twice or three times a day if there be flatulence or languor4 ,in dyspepsia1 debility1 irritable stomach1 c4 #hf4 ,,for ,,asthma4 ,tinct4 lobelia j4 ,ammon4 iodide1 ,ammon4 bromide aa4 ij4 ,syrup tolu4 iij4 ,m4 ,sig4 ,a table spoonful every one1 two1 three1 or four hours4 #hg4 ,,for ,,whooping ,,cough4 ,aluminis ijss4 ,syrup zinzib4 j4 ,syrup acaci j4 ,aqua j4 ,m4 ,sig4 ,one teaspoonful three times a day4 #hh4 ,,for ,,asthma4 ,ext4 ,jamaica dogwood fl4 ij4 ,syrup ipecac fl4 j4 ,syrup aurant4 cortex ss4 ,m4 ,sig4 ,a teaspoonful every hour until the paroxysm should cease4 ,afterwards every four hours for the day4 #hi4 ,,asiatic ,,mixture ,,for ,,cholera4 ,gum opii1 ,gum camph4 aa4 j4 ,ol4 caryoph4 f4 j4 ,capsicum 7cayenne7 j4 ,sp4 th sulph4 ,co4 ,oij4 ,digest #ae days4 ,dose for an adult1 #bj to #fj drops every #b1 #c1 or #d hours4 #ij4 ,,for ,,dysmenorrh,a4 ,tinct4 gelsemium1 ,tinct4 camphor1 ,tinct4 opii deodorized aa4 ij4 ,m4 ,s4 ,dose #bj drops every two hours until relieved4 ,useful in dysentery after the operation of ,epsom salts4 #ia4 ,,hoffman',s ,,anodyne ,,and ,,laudanum4 ,liquoris anodyne ,hoffman's iij4 ,tinctur thebiac gtt4 lxxx4 ,aqua cinnamomi vj4 ,fiat ,mistura4 ,signa1 ,a teaspoonful every hour in hysteria1 c4 ,may sometimes be taken in a dose of a table spoonful4 #ib4 ,,for ,,after ,,pains4 ,morphia sulphas gr4 j4 ,pulv4 camphor1 ,creta preparata1 ,pulv4 glycerhiza aa4 j4 ,m4 ,given in #aj grain doses and repeated1 when required1 every #d hours4 ,,astringents4 #ic4 ,,for ,,dysentery4 ,acidi tanici gr4 xxx4 ,tinct4 camphor comp f4 j4 ,aqua cinnamomi ad4 f4 viij4 ,m4 ,label4 ,one sixth part three times a day1 about an hour before each meal4 #id4 ,,cinnamon ,,mixture4 ,tinct4 cinnamon f4 ij4 ,cinnamon water f4 j4 ,m4 ,make a draught to be taken thrice daily4 ,in menorrhagia especially1 but also in other varieties of passive hemorrhage4 #ie4 ,,chloroform1 ,,opium1 ,,and ,,castor ,,oil4 ,chloroform min4 x4 ,tinct4 camph4 comp4 f4 ij4 ,castor oil f4 iij4 ,make a draught to be taken immediately4 ,in choleraic diarrha4 #if4 ,,for ,,hemorrhage ,,of ,,the ,,urethra1 ,c4 ,tinct4 ergot1 ,oil of turpentine aa4 f4 ij4 ,tinct4 chloride of iron1 ,laudanum aa4 f4 j4 ,gum ,arabic mucilage f4 viij4 ,m4 ,sig4 ,take one table spoonful hourly4 #ig4 ,,in ,,hemoptysis 7,,bleeding ,,from ,,the ,,lungs47 ,fld4 ext4 ergot1 ,paregoric1 ,syrup tolu equal parts4 ,m4 ,s4 ,half a table spoonful every hour if necessary4 #ih4 ,,for ,,phthisis ,,when ,,night ,,sweats ,,and ,,cough ,,are ,,bad4 ,acidi sulphurici diluti gtt4 x4 ,tinctur opii deodorat gtt4 x4 ,syrupi hypophosphatis f4 j4 ,extracti ,pruni ,virginiani fluidi f4 ij4 ,m4 ,for a dose ter4 die4 ,it will be more convenient to have the above put up according to the following form3 ,elixir vitriol iij4 ,deodorized laudanum jss4 ,syrup hypophosphitis f4 xv4 ,fld4 ext4 wild cherry f4 xxx4 ,m4 ,sig4 ,take nearly a table spoonful three times a day4 7,for an adult47 #ii4 ,,for ,,infantile ,,diarrh,a4 ,sub4 nitrate bismuth ij4 ,laudanum min4 ij4 ,gum ,arabic mucilage jv4 ,mix4 ,s4 ,a teaspoonful every two hours4 #ajj4 ,,for ,,cholera ,,morbus4 ,spirits am4 arom4 j4 ,spirits lav4 co4 j4 ,tinct4 opii camph4 ss4 ,mix4 ,s4 ,a teaspoonful in water every two hours or oftener1 until relieved4 ,in cholera morbus1 colic1 dysentery1 c4 #aja4 ,,for ,,cholera ,,infantum4 ,bismuthi sub carbonatis gr4 xvj4 ,pulv4 ipecacuanha comp4 gr4 j4 ,pulv4 sacchari albi grs4 xij4 ,mix4 ,for viij4 powders4 ,one to be taken every three hours in the mother's or cow's milk4 #ajb4 ,,for ,,chronic ,,dysentery4 ,sod bicarbonas ss4 ,zinci oxide ij4 ,m4 ,sig4 #f grains every six hours4 #ajc4 ,,for ,,prolapsis ,,uteri4 ,fld4 ext4 nux vomica f4 j4 ,fld4 ext4 blue cohash f4 ss4 ,fld4 ext4 ergot ij4 ,simple syrup ij4 ,chloroform min4 x4 ,m4 ,s4 ,one-half a teaspoonful three times a day4 #ajd4 ,,astringent ,,powder4 ,sub4 nitrate of bismuth grs4 xij4 ,pulv4 geranium root grs4 jx4 ,dover powder gr4 j4 ,m4 ,divide into six powders4 ,give one powder every six hours4 ,,cathartics4 #aje4 ,,the ,,white ,,mixture ,,for ,,rheumatism4 ,epsom salts jss4 ,carbonate magnesia ij4 ,peppermint water f4 viij4 ,wine of colchicum f4 ij4 ,m4 ,one-sixth part early every morning4 #ajf4 ,,for ,,dysentery4 ,syrup of rhubarb f4 ij4 ,syrup of ginger f4 iij4 ,tincture of opium f4 j4 ,oil of cloves gtt4 xxx4 ,m4 ,s4 ,one teaspoonful every two or three hours4 #ajg4 ,,for ,,vomiting ,,of ,,pregnancy4 ,rad4 columbo 7columbo root71 ,rad4 ginger 7ginger root71 aa4 ss4 ,fol4 senna 7senna leaves7 j4 ,boiling water ,oj4 ,sig4 ,wineglassful before meals4 #ajh4 ,,compound ,,licorice ,,powder4 ,powdered senna leaves1 ,powdered licorice root aa4 vj4 ,powdered fennel seed1 ,powdered sulphur aa4 iij4 ,powdered sugar xvj4 ,m4 ,dose one teaspoonful as a mild laxative4 #aji4 ,,as ,a ,,laxative ,,for ,,antipartem ,,administration4 ,senna leaves iij4 ,sulphate of magnesia xx4 ,bruised ginger x4 ,boiling water cong4 j4 ,let the mixture stand over night2 filter4 ,dose1 two or three ounces4 #aaj4 ,,for ,,piles4 ,magnesia sulp41 ,magnesia carb41 ,sup4 tart4 potass41 ,sulphur sublim4 aa4 j4 ,mix thoroughly4 ,sig4 ,one1 two1 or three teaspoonfuls of the powder before eating in the morning4 #aaa4 ,,for ,,dysentery4 ,mucilaginis tragacanth fl4 ij4 ,aqua cinnamomi fl4 iij4 ,olei ricini fl4 xij4 ,tinct4 rhei1 ,syrup aurantii aa4 fl4 vj4 ,tinct4 opii min4 xxx4 ,mix4 ,s4 ,one-eighth part for an adult every three hours4 ,in dysentery where there are scybala in the rectum4 ,also where an aperient with a sedative is needed4 ,,anthelmintics4 #aab4 ,,to ,,expel ,,the ,,round ,,worms4 ,santonin gr4 #c4 ,sacchari lactis gr4 #aj4 ,make a powder to be taken early in the morning in a table spoonful of milk or cream4 ,its exhibition should be followed at the end of six hours by mild physic4 #aac4 ,,for ,,tape ,,worms4 ,oil of turpentine #d drachms4 ,gruel 7not too thick7 #c ounces4 ,mix well4 ,abstain from supper2 take a mixture on waking in the morning1 and lie down until it operates4 #aad4 ,,for ,,worms4 ,santonin #af grs4 ,flu4 ext4 spigelia #af drops4 ,simple syrup #b ounces4 ,mix4 ,sig4 ,teaspoonful morning and night4 ,,caustics ,,and ,,rubefacients4 #aae4 ,,chromic ,,acid4 ,acidi chromici grs4 #fj4 ,aqua fl4 drs4 #d4 ,m4 ,apply directly to warts1 c41 to destroy them4 #aaf4 ,,iodine ,,paint4 ,iodini grs4 xl4 ,potassai iodidi ss4 ,spirits vini rectificati f4 j4 ,m4 ,to be applied with a camel's hair brush4 #aag4 ,,burnt ,,alum4 ,the alumen ustem is made by depriving the alum of its water of chrystalization by heat4 ,it is applied in powder to fungous granulations of ulcers1 and mixed with sugar is used to remove nebulous spots on the cornea4 #aah4 ,,for ,,prickly ,,heat4 ,sulphate of copper grs4 xx4 ,water ij4 ,m4 ,apply daily by means of a camel's hair brush or a sponge4 ,it is applied after a morning bath1 after the skin has been well rubbed with a towel1 and it must be allowed to dry on the skin before dressing4 ,,diaphoretics4 #aai4 ,a ,,pleasant ,,diaphoretic ,,in ,,fevers4 ,citratis potas preparat ij4 ,aqua distilat jv4 to vi4 ,olei limonis gtt4 ij4 ,sacchari alba j4 ,misce4 ,s4 ,a table spoonful to be taken every two hours4 ,spirits of nitre may be added4 #abj4 ,,infusion ,,of ,,boneset4 ,eupatorii perfoliati j4 ,aqua bulientis ,oj4 ,infuse for thirty minutes in a covered vessel2 then decant and take a wineglassful every hour till there is free perspiration4 ,the infusion must be taken hot as it can be drunk1 otherwise it may produce vomiting4 #aba4 ,,decoction ,,of ,,barley ,,water ,,with ,,nitre4 ,decocti hardei ,oj4 ,nitratis potass ij4 ,succi limonis j4 to ij4 ,fiat potus4 ,translation4 ,take barley water one pint4 ,salt petre two drachms4 ,lemon juice one ounce to two ounces4 ,make a drink to be drank warm by the patient4 #abb4 ,,modified ,,diaphoretic4 ,errata4 ,on page #agb for 7,f4 #abb7 read 7,f4 #ajh47 ,opii pulv j4 ,ipecac pulv ss4 ,camphor pulv ij4 ,saccharum iv4 ,mix thoroughly4 ,this and the following prescriptions in doses of from two to eight grains may be used as a #abc4 ,,substitute ,,for ,,dover ,,powders4 ,morph4 sulph4 j4 ,camphor1 ,oreta prep41 ,saccharum aa4 xx4 #abd4 ,,diaphoretic ,,and ,,expectorant4 ,potass citrat4 j4 ,suc4 limonis f4 jss4 ,syr4 ipecac4 f4 ss4 ,tr4 opii camph4 f4 iij4 ,syrupi q4 s4 ad4 f4 iij4 ,m4 ,s4 ,dessert spoonful every two hours4 ,for colds and coughs4 ,,diuretics4 #abe4 ,,nitre1 ,,juniper1 ,,and ,,ether4 ,potassa nitratis grs4 #fj4 ,spiritus juniper f4 dr4 #a4 ,spiritus theris nitrici f4 dr4 #c4 ,decocti chimaphil ad4 f4 oz4 #h4 ,mix4 ,one-sixth part every six hours4 #abf4 ,,diuretic ,,and ,,laxative4 ,potass tartratis iij4 ,infus4 buchu f4 viij4 ,mix4 ,s4 ,one-sixth part three times a day4 #abg4 ,,for ,,cystits--,,irritable ,,condition ,,of ,,the ,,bladder4 ,acidi benzoici1 ,sodii biboratis aa4 gr4 x4 ,inf4 buchu ij4 ,m4 ,sig4 ,this amount three times a day4 #abh4 ,,infusion ,,of ,,uva ,,ursi4 ,uva ursi foliorum j4 ,aqua bulientis ,oj4 ,pour the water boiling hot on the leaves and let them macerate for several hours4 ,to be taken cold1 from half a pint to a pint daily4 ,chiefly used for irritable bladder and strangury4 #abi4 ,,for ,,subacute ,,and ,,chronic ,,rheumatism4 ,potass iod4 ij4 ,vin4 calc4 rad4 f4 ij4 ,tinct4 guiac ammon4 f4 iij4 ,fld4 ext4 belladonna min4 xx4 ,aqua cinnamon iij4 ,m4 ,a teaspoonful in water three times a day4 #acj4 ,,for ,,muscular ,,rheumatism4 ,potasii iodide j4 ,vini colchici rad4 f4 ij4 ,morphia sulphatis gr4 iij4 ,syrupi f4 j4 ,aqu f4 iij4 ,m4 ,s4 ,a teaspoonful three times a day4 #aca4 ,,for ,,dropsy4 ,fld4 ext4 apocynum ,canabinum ij4 ,spts4 lav4 comp4 ss4 ,syrup simplex iij ss4 ,m4 ,s4 ,a teaspoonful every three or four hours4 #acb4 ,,for ,,urethraitis4 ,tinct4 gelsemii ss4 ,potassii bromidi ijss4 ,potass4 bicarb4 ss4 ,aqua iv4 ,m4 ,s4 ,dessert spoonful in water three times a day4 ,,emetics4 #acc4 ,,powder ,,of ,,ipecac4 ,pulvis ipecacuanha ij4 ,divide into two doses4 ,signa4 ,one to be taken in a little sweetened water or warm water4 ,if one powder does not produce the desired effect within thirty or forty minutes1 the second to be taken in like manner4 ,it may be followed by a draught of tepid water after vomiting commences4 #acd4 ,,powder ,,of ,,sulphate ,,of ,,zinc4 ,sulphate of zinc #aj grs4 to ss4 ,signa4 ,to be taken in syrup1 and followed by a draught of warm water4 #ace4 ,,emetic ,,for ,a ,,child4 ,very young children in some instances suffer from indigestion4 ,if delicate give five grains ipecacuanha1 and after that sickens the child give a dose of castor oil to remove the offending matter from the stomach4 #acf4 ,,emetic ,,used ,,in ,,capillary ,,bronchitis ,,of ,,children4 ,zinchi sulphatis gr4 iij4 ,pulveris ipecacuauha gr4 ij4 ,m4 ,for one dose2 to be repeated every ten minutes until emesis is produced4 ,,expectorants4 #acg4 ,,sedative ,,cough ,,mixture4 ,vinum ipecacacuanha fl4 dr4 #a4 ,spiritus etheris nitrosa fl4 dr4 #f4 ,infusi senega ad4 fl4 oz4 #h4 ,mix4 ,one-sixth part every six hours4 ,in chronic bronchitis when an expectorant and sedative is desired4 #ach4 ,,infusion ,,of ,,flaxseed1 ,c4 ,seminum lini j4 ,radicis glycerhiza ss4 ,aqua bulientis ,oij4 ,macerate for two or three hours near the fire in a covered vessel1 strain1 and add lemon juice sufficient to make it agreeable4 ,this may be given as a common drink in catarrh4 #aci4 ,,cough ,,syrup4 ,errata4 ,on page #abc1 for #aci1 #adj1 read #ha1 #ajg4 ,morphine grs4 viij4 ,fld4 ext4 ipecac4 f4 jss4 ,tinct4 bloodroot f4 j4 ,water vj4 ,simple syrup f4 xxv4 ,chlorate potash ss4 ,muriate of ammonia j4 ,m4 ,s4 ,dose for an adult1 a teaspoonful three times a day and after each fit of coughing4 #adj4 ,,tar ,,water4 ,picis liquida ,oij4 ,aqua ,cong4 j4 ,m4 ,stir them together with a wooden rod for ten minutes1 then let the tar subside4 ,strain the water and keep in well corked bottles4 ,a pint may be taken daily4 #ada4 ,,for ,,whooping ,,cough4 ,ammon4 bromide j4 ,tinct4 strammonii1 sem4 gtt4 xx4 ,syrup simplex ij4 ,aqua ij4 ,m4 ,sig4 ,a teaspoonful three times a day for a child4 #adb4 ,,for ,,pneumonia4 ,syrup senega ss4 ,spirits nitre1 ,tinct4 digitalis aa1 f4 ij4 ,morphine gr4 ij4 ,simple syrup f4 ij4 ,m4 ,sig4 ,dose1 a half teaspoonful every three hours or oftener4 #adc4 ,,pneumonia4 ,tinct4 aconite gtt4 xxx4 ,fld4 ext4 jaborandi1 ,spirits nitre dulcis aa4 ij4 ,aqua jv4 ,m4 ,sig4 ,a teaspoonful every four hours for an adult4 #add4 ,,for ,,cough4 ,syrup wild cherry iij ,tinct4 sanguinaria j4 ,morphine grs4 ij4 ,chlorate potash grs4 xv4 ,muriate of ammonia grs4 x4 ,aqua j4 ,m4 ,sig4 ,dose1 a teaspoonful every six hours1 and after each spell of coughing4 ,,enemata ,,and ,,injections4 #ade4 ,,for ,,ascarides4 ,sulphuric ether #e to #bj drops4 ,water pint to a pint4 ,m4 ,inject into the bowels4 #adf4 ,,injection ,,for ,,ascarides ,,or ,,pinworms4 ,acid carbolici j4 ,potassa chloratis ij4 ,aqua ,oj4 ,m4 ,warm to #ih and inject into the bowels4 #adg4 ,,injection ,,for ,,the ,,vagina4 7,,this ,,may ,,be ,,used ,,diluted ,,with ,,water47 ,tannin j4 ,zinci sulphatis ij4 ,aqua tepidi ,oj4 ,m4 ,inject with a ,davidson or a fountain syringe4 #adh4 ,,enema ,,for ,,pinworms4 ,argenti nitratis 7nitrate silver7 cryst4 #h grs4 ,aqua distilat #f oz4 for an enema4 ,repeat this each day for four or five days4 ,this will stain clothing4 #adi4 ,,enema ,,to ,,move ,,the ,,bowels4 ,ol4 ricini 7castor oil7 f4 ij4 ,ol4 terebinth4 7spirits turpentine7 f4 i4 ,aqua fervent ,oij4 ,to be administered at once4 #aej4 ,,for ,,ascarides ,,causing ,,vaginal ,,discharge4 ,tinct4 ferri chloridi ss4 ,aqua calcis ,oj4 ,ft4 injectio4 ,inject one-half into the rectum at night and the other half the next morning4 #aea4 ,,emmenagogue ,,enema4 ,aloes barbadensis gr4 x4 ,tepid milk f4 ,m4 ,to be injected twice a day when the menstrual flow is due1 for one or two days4 #aeb4 ,,for ,,irritable ,,uterus4 ,bromide potash j4 ,water ,oj4 ,m4 ,use as a rectal injection4 ,where there is pain in the part1 one drachm of the tincture of opium hyoscyamus or conium may be used in the same way4 #aec4 ,,vaginal ,,injections4 ,errata4 ,on page #he for 7,f4 #aec1 #aii7 read 7#afc1 #bad74 ,the vaginal injections most used when disinfection is the special object1 and the usual proportions are the following3 ,corrosive sublimate1 #a to #ajjj or #bjjj2 carbolic acid1 #e or #aj to #ajjj2 thymal1 #a to #ajjj2 sulphite of soda1 #e to #ajjj2 permangenate of potash1 #e to #ajjj2 liquor sodii chlorinat 7,labaraques solution71 #a to #b2 chlorine water1 #a to #b2 salacylic acid1 #a to #ajjj hot water4 ,for medicinal astringent vaginal injections1 give alum1 sulphate of zinc1 or lead1 copper1 and iron1 salts of the strength of one or two per cent4 ,the permangenate of potash1 silver nitrate1 and iron solutions all make almost indelible stains on the linen4 ,if the injections are corrosive1 a large straight glass syringe should be used4 #aed4 ,,injection ,,for ,,leucorrh,a4 ,alum1 ,sulphate of zinc1 ,borate of soda1 ,pure carbolic acid aa4 jss4 ,water ,oij4 ,m4 ,of this two table spoonfuls in a pint of water4 #aee4 ,,vaginal ,,injection4 ,zinci sulphatiz1 ,aluminis exsiccata aa4 j4 ,acidi tannici ij4 ,mix4 ,label4 ,half a teaspoonful to be mixed with a pint of tepid or cold water to form an injection4 #aef4 ,,injection ,,for ,,dysentery4 ,mucilage of gum ,arabic or starch ij4 ,laudanum gtt4 xx4 ,m4 ,for an injection4 #aeg4 ,,injection ,,for ,,fetid ,,leucorrh,a4 ,chlorate of potash j4 ,laudanum f4 j4 ,tar water ,oij4 ,m4 ,s4 ,three table spoonfuls to be added to the pint of warm water as a vaginal injection4 ,,emmenagogues--,,uterine ,,therapeutics4 #aeh4 ,,stimulant ,,emmenagogue4 ,potassa bromide j4 ,tinct4 cantharides f4 jss4 ,tinct4 cinnamomi f4 jv4 ,aqua q4 s4 ad4 f4 jss4 ,m4 ,s4 ,teaspoonful three times a day for amenorrha and hysteria4 #aei4 ,,for ,,chlorosis4 ,tinct4 ferri per chloridi f4 jss4 ,potassa chloratis jss4 ,tinct4 actea racemosa f4 jv4 ,infusi serpentaria ad4 f4 ,m4 ,sig4 ,one-eighth part three times a day4 #afj4 ,,rectal ,,suppositary4 ,ext4 opii aq4 #c grains4 ,ext4 belladonna #a grains4 ,buteri cacao q4 s4 #a ounces4 ,m4 ft4 suppos4 ,no4 #ab4 ,s4 ,apply one to relieve pain in the region of the uterus or rectum4 #afa4 ,,for ,,painful ,,menstruation4 ,ferri carbonate pulv4 iij4 ,ext4 conii mac4 ijss4 ,ol4 cinnamon4 min4 xx4 ,syrup tolutani ij4 ,syrup simplici1 ,aqua aa4 vij4 ,m4 ,s4 ,dose1 a table spoonful four times a day4 ,to be given for a week or ten days before the menstrual period4 #afb4 ,,fomentation ,,for ,,pain ,,in ,,the ,,bladder ,,and ,,uterus4 ,errata4 ,on page #ij for 7,f4 #afb7 read 7,f4 #afc47 ,flores chamomel #c ounces4 ,pulv4 semen lini #c ounces4 ,herb hyscyami1 ,herb belladoni1 ,herb strammonii aa4 #a ounce4 ,m4 ,sig4 ,make fomentations4 ,to be applied topically and covered with oiled silk to retain heat and moisture4 #afc4 ,,vaginal ,,suppositary4 ,zinci oxide vel bismuth carbonatis jss4 ,extracti belladonn ss4 ,olei theobroma j4 ,olei oliv ij4 ,m4 ,divide into eight pessaries4 ,used in chronic leucorrha1 vaginitis1 c4 ,,narcotics ,,and ,,sedatives4 #afd4 ,,for ,,headache4 ,morphi sulphatis gr4 ss4 ,sodii bromidi gr4 xj4 ,m4 et fiant4 charlutas ,no4 ij4 ,sig4 ,take one powder dissolved in a wineglass of water1 to be repeated in an hour if necessary4 #afe4 ,,for ,,subacute ,,rheumatism4 ,vinum colchici rad4 f4 j4 ,morphia sulph4 gr4 v4 ,magnesia sulph4 j4 ,potassa iod4 iv4 ,aqu f4 iij4 ,m4 ,sig4 ,half a teaspoonful in water4 #aff4 ,,epileptical ,,seizures ,,at ,,the ,,menstrual ,,period4 ,potassa bromide grs4 xx4 ,tinct4 belladonna min4 ij4 ,syrup1 ,aqua q4 s4 ad4 ft4 jv4 ,m4 ,s4 ,one dose three times a day4 #afg4 ,,ovarian ,,neuralgia4 ,ammon murias ij4 ,tinct4 aconit4 j4 ,syrup aurant4 cort4 xij4 ,m4 ,s4 ,one teaspoonful three times a day4 #afh4 ,,soothing ,,nervine ,,and ,,tonic4 ,pot4 bromide ss4 ,ferri pyrophos j4 ,elixir humuli1 ,aqu aa4 jv4 ,m4 ,sig4 ,table spoonful three times a day4 #afi4 ,,for ,,headache4 ,ammonia murias iij4 ,morphia acetat4 gr4 j4 ,caffeine citrat4 ss4 ,spts4 ammon4 aromat4 j4 ,elixir guarana1 ,aqua ros aa4 jv4 ,m4 ,sig4 ,dessert spoonful every ten or twenty minutes4 #agj4 ,,toothache ,,drops4 ,chloroform #d parts4 ,mastich #h parts4 ,bals4 ,peru #e parts4 ,m4 ft4 sol4 ,sig4 ,place two or three drops in cavity of tooth4 #aga4 ,,for ,,functional ,,palpitation4 ,tr4 digitalis v4 ,tr4 veratrum ij4 ,tr4 aconite j4 ,tr4 ginger ijss4 ,m4 ,s4 ,one teaspoonful three times a day4 #agb4 ,,stimulant ,,emmenagogues4 ,ferri phosphatis ij4 ,manganesii phosphatis gr4 xxx4 ,tinctur columb fl4 j4 ,syrupi zinziberas fl4 ij4 ,m4 ,s4 ,one teaspoonful in a wineglassful of water three times a day4 #agc4 ,,for ,,neuralgia1 ,c4 ,tinctur aconiti min4 xx4 ,spiritus theris fl4 jv4 ,mistura guaiaci ad4 fl4 viij4 ,m4 ,s4 ,one table spoonful every four hours4 #agd4 ,,for ,,nervous ,,depression ,,with ,,constipation4 ,spiritus ammoni aromatic fl4 iv4 ,extracti cinchon flav liquidi fl4 jss4 ,tinct4 rhei fl4 jv4 ,infusi rhei ad4 fl4 viij4 ,m4 ,s4 ,two table spoonfuls three times daily4 #age4 ,,acid ,,mixture4 ,acidi sulphurici aromatici fl4 ij4 ,syrup aurantii fl4 j4 ,tincturi cinchon composit fl4 vj4 ,infusi cinchon flav fl4 viij4 ,m4 ,s4 ,one table spoonful before each meal in depressing disorders2 if there is hemorrhage1 give larger doses4 #agf4 ,,for ,,leucorrh,a4 ,water1 one pint2 sulphate of magnesia 7epsom salts71 as much as the water will dissolve2 sulphate of iron1 one drachm4 ,mix and add aromatic sulphuric acid1 one fluid drachm4 ,dose1 a table spoonful or a sufficient quantity to relax the bowels4 #agg4 ,,for ,,erysipelas4 ,spiritus etheris nitrici f4 ij4 ,tinct4 ,ferri chloridi ij4 ,quinia sulphatis grs4 xvj4 ,m4 ,s4 ,a teaspoonful every three hours after the action of a cathartic4 #agh4 ,,aromatic ,,infusion ,,in ,,dysentery4 ,errata4 ,on page #afd for 7,f4 #agh1 #agi7 read 7,f4 #aec1 #aed47 ,bruised calamus root iij4 ,coriander seed j4 ,black pepper ss4 ,water ,oj4 ,boil to twelve ounces and cool4 ,s4 ,dose for an adult1 an ounce1 three times daily2 for a child1 one to three teaspoonfuls4 ,sweeten if preferred4 #agi4 ,,incontinence ,,of ,,urine4 ,tinct4 belladonna ss4 ,tinct4 ignatia amara ss4 ,tinct4 cantharides ss4 ,tinct4 cinchonia comp4 jv4 ,m4 ,sig4 ,one teaspoonful in water three times a day4 #ahj4 ,,hop ,,bitters4 ,tinct4 of ,hops f4 ss4 ,tinct4 of buchu f4 iij4 ,tinct4 of senega f4 iij4 ,podophyllin1 dissolved in spts4 of wine ss4 gr4 j4 ,tincture of cochinael gtt4 xx4 ,distilled water ad4 xvj4 ,m4 ,this is said to be the same as the nostrum which is sold for one dollar 7costing only a few cents74 #aha4 ,,tonic ,,in ,,neuralgia4 ,cinchonidia grs4 #e4 ,ferri carb4 grs4 #aj4 ,m4 ,one to be taken every four hours1 and when the pain is severe give a little opium or ,dover powder4 #ahb4 ,,for ,,chronic ,,chills4 ,cinchonid vj4 ,acid sulph4 q4 s4 ad4 solv4 ,ol4 piper niger ss4 ,ol4 limonis j4 ,alcohol q4 s4 ad4 solv4 ,m4 ,e4 adde4 ,aqua q4 s4 ad4 ,oj4 ,syrup ,oj4 ,m4 ,sig4 ,one table spoonful every four hours4 #ahc4 ,,for ,,st4 ,,vitus ,,dance4 7,,chorea47 ,zinci sulphatis gr4 xxx4 ,ext4 valerian 7fluid7 j4 ,syrup limonis fl4 iij4 ,m4 ,s4 ,a half teaspoonful three times a day1 gradually increasing the dose4 #ahd4 ,,tonic ,,after ,,severe ,,hemorrhage4 ,tinct4 ferri chloridi1 ,tinct4 nucis vomic aa4 f4 ij4 ,spiritus etheris nitrosi f4 iij4 ,misce fiat mistura4 ,s4 ,take a teaspoonful in plenty of water three times a day4 ,,lotions1 ,,liniments1 ,,collyria1 ,,ointments1 ,,salves1 ,c4 #ahe4 ,,for ,,scirrhous ,,tumors4 ,ext4 eucalyptus #b drachms4 ,vaseline #a ounce4 ,acid salacylic #d drachms4 ,ft4 ,unguent4 ,apply to tumor and wear it constantly4 ,use also for indolent ulcerations where stimulation and purification is needed4 #ahf4 ,,to ,,remove ,,cloasma1 7,,brownish ,,discolorations ,,of ,,skin47 ,hydrarg4 bichlor4 #h gr4 ,boracis pulv4 #b drs4 ,acidi acetic #b oz4 ,alcohol #b oz4 ,aqua #d oz4 ,m4 ,if it roughens the skin too much omit its use and apply sweet cream4 ,sig4 ,apply locally to the spots4 ,poison4 #ahg4 ,,salve ,,for ,,burns1 ,c4 ,yellow wax melted and strained f4 j4 ,linseed oil raw f4 iij4 ,tannin j4 ,sub nitrate of bismuth j4 ,mix as follows3 ,heat the wax in a clean tin vessel1 add the oil and stir till they are thoroughly incorporated2 then set off the fire and continue to stir until cold1 adding first the tannin and then the bismuth4 #ahh4 ,,to ,,cure ,,sore ,,eyes4 ,sulph4 zinc1 ,rock salt aa4 j4 ,white sugar ij4 ,soft water xij4 ,mix and use as an eye water4 #ahi4 ,,liniment ,,used ,,in ,,cerebro ,,spinal ,,meningetis4 ,oil sassafras ss4 ,chloroform ss4 ,aqua ammonia ss4 ,oil cloves ij4 ,tinct4 camphor ss4 ,alcohol1 strong jv4 ,m4 ,s4 ,apply the whole length of the spine4 #aij4 ,,for ,,whooping ,,cough4 ,rectified oil amber1 ,tinct4 opium1 ,hartshorn1 ,olive oil aa4 ss4 ,m4 ,s4 ,rub well the whole length of the spine two or three times a day1 until there is tenderness of the skin4 #aia4 ,,ammoniacal ,,gas ,,for ,,dysmenorrh,a4 ,spirits of ammonia j4 ,put a teaspoonful of this in a chamber and have the patient sit for one or two minutes over it4 ,in cases of severe tenesmus1 or strangury1 or dysmenorrha1 relief may be obtained in about two minutes if the first pungent effects of the gas can be borne4 #aib4 ,,anodyne ,,lotion4 ,tinct4 aconite fl4 drs4 #ab4 ,aqua ad4 fl4 oz4 #d4 ,mix4 ,for acute superficial pain1 pruritis1 hyperesthesia of the skin1 gout1 c4 #aic4 ,,cooling ,,lotion ,,for ,,inflamed ,,eyes4 ,pulv4 borax ounce4 ,aqua camphor #a ounce4 ,aqua cherry laurel q4 s4 #d ounces4 ,m4 ,s4 ,drop in the eyes ad4 lib4 ,a good vehicle for the addition of one or two grains atropia sulphate when indicated4 #aid4 ,,anal ,,troubles4 ,stramonium ung4 #a ounce4 ,extract conium drachm4 ,sod salicyl4 #aj grains4 ,m4 ,sig4 ,use quite within the anal folds once or twice a day4 #aie4 ,,lotion ,,for ,,pruritis ,,ani4 ,soda bibor4 ij4 ,morphia muriat4 gr4 xvj4 ,acid hydrocyan4 dil4 ss4 ,glycerine ij4 ,aqua ad4 f4 viij4 ,m4 ,s4 ,for external use4 #aif4 ,,lotion ,,for ,,tinea ,,capitis4 7,,scald ,,head47 ,acid carbolici ss4 ,acid acetici ijss4 ,aqua distilata ijss4 ,m4 ,sig4 ,apply pro re nata4 #aig4 ,,ointment ,,for ,,skin ,,affections4 ,carbolic acid chrys1 ,sulphate soda aa4 j4 ,sulphur sublim4 j4 ,adipis j4 ,m4 ,s4 ,apply two or three times a day4 ,this is effectual for scald head1 and either with or without the sulphur is good for the eruption of poison oak1 foul ulcers1 c4 #aih4 ,,for ,,sore ,,nipples4 ,aqua ros1 ,glycerin aa4 ij4 ,acid tanica ij4 ft4 lotion4 ,soak lint in the solution and apply to the nipples4 #aii4 ,,turpentine ,,liniment4 ,olei terebinthan ij4 ,olei olivarum ij4 ,tinct4 camphor j4 ,aqua ammonia j4 ,m4 ,fiat ,linamentum4 #bjj4 ,a ,,good ,,liniment4 ,oil lavendar ss4 ,alcohol jv4 ,m4 ,digest then add4 ,sulph4 ether iij4 ,laudanum ij4 ,m4 ,apply externally4 #bja4 ,,belladonna ,,and ,,opium4 ,errata4 ,on page #hh for 7#bja1 #bjb7 read 7#agb1 #agc47 ,extract belladonna1 ,extract opium aa4 j4 ,laurel water jv4 ,m4 ,to be painted over painful or inflamed parts4 ,a sheet of tissue paper may be laid over this1 and then a hot fomentation4 #bjb4 ,,ointment ,,for ,,mammary ,,abscess4 ,unguentum tabaci ij4 ,pulv4 camph4 ij4 ,ext4 belladon4 jss4 ,m4 ft4 ung4 #bjc4 ,,for ,,pain4 ,sweet oil1 ,laudanum aa4 ij4 ,rub on the affected parts4 #bjd4 ,,balsam ,,for ,,wounds4 ,balsam fir1 ,true ,venice turpentine1 ,oil of almonds aa4 ij4 ,add carbolic acid ss41 previously dissolved in warm glycerine ij4 ,apply with a camel hair brush1 having previously cleansed the wound with very warm water4 #bje4 ,,for ,,boils4 ,tr4 arnica flowers j4 ,tannic acid ss4 ,gum ,arabic pulv4 ss4 ,m4 ,let the inflamed surface and all around it be painted with the medicine every fifteen minutes4 ,it should be used as soon as prepared4 #bjf4 ,,for ,,hemorrhoids4 7,,piles47 ,powdered opium grs4 xxx4 ,tannin j4 ,carbolic acid gtt4 xv4 ,oil of tobacco gtt4 x4 ,sol4 of sub acetate of lead gtt4 xx4 ,vaseline j4 ,mix intimately4 ,apply at night and morning4 #bjg4 ,,for ,,tender ,,nipples4 ,sulphate zinc gr4 j4 ,cologne water j4 ,m4 #bjh4 ,fld4 ext4 pinus canadenses may be used topically for tender nipples4 #bji4 ,,piles ,,ointment4 ,acidi tannici gr4 xx4 ,morph4 sulphatis gr4 v4 ,ext4 belladonn1 ,ext4 strammonii aa4 ij4 ,ungt4 petrolei ij4 ,m4 ,after bathing and cleansing1 rub well on the parts once or twice a day4 #baj4 ,,for ,,sore ,,eyes4 ,ferri sulphas exsiccata grs4 vj4 ,rain water jv4 ,m4 ,s4 ,use as a collyria4 7,eye water47 #baa4 ,,for ,,opthalmia4 ,sulph4 zinc grs4 ij4 ,sulph4 morphia gr4 j4 ,glycerine jv4 ,rose water xij4 ,m4 ,s4 ,for eye water4 #bab4 ,,chafings4 ,finely pulverized native carbonate of j4 zinc ,finely pulverized starch ij4 ,m4 ,to be dusted on the parts4 #bac4 ,,for ,,enlarged ,,tonsils4 ,zinci sulphatis gr4 xx4 ,syrupi mori fl4 jv4 ,glycerina fl4 j4 ,infusi krameria ad4 fl4 viij4 ,mix4 ,s4 ,use as a gargle4 #bad4 ,,for ,,burns4 ,beeswax melted and strained j4 ,flaxseed oil and sweet oil ij4 ,tannic acid j4 ,mix as in formula #ahg1 and after adding the tannin1 add #f or #h drops of carbolic acid to the ounce4 #bae4 ,,astringent ,,collyria4 ,zinci sulphatis gr4 jv4 ,aluminis exsiccata gr4 jv4 ,tinct4 arnica min4 x4 ,aqua distilata f4 j4 ,m4 #baf4 ,,for ,,tetter ,,and ,,ringworm4 ,borax ss4 ,tar water ij4 ,m4 #bag4 ,,for ,,pruritis ,,of ,,vulva4 ,borax ij4 ,morphine grs4 jv4 ,tar water f4 vij4 ,m4 ,sig4 ,apply three times a day to the affected parts by means of a sponge1 c4 ,first wash with warm water and soap1 and dry before applying the lotion4 #bah4 ,,dandruff ,,lotion4 ,tinct4 of cantharides ij4 ,glycerine ij4 ,rose water iij4 ,m4 #bai4 ,,sulphate ,,of ,,iron ,,in ,,erysipelas4 ,ferri sulphas pulverized j4 ,aqua ,oss4 ,apply to affected cuticle with a cotton cloth well wetted in the solution every thirty minutes till the inflamed part is restored4 #bbj4 ,,prurigo ,,vulva4 ,soda bicarb4 ss4 ,morph sulph4 gr4 vj4 ,rose water viij4 ,m4 ,s4 ,apply locally4 #bba4 ,,mammary ,,swellings4 ,gum camphor j4 ,sulph4 ether1 ,tinct4 opii aa4 ij4 ,aqua ,oj4 ,dissolve the camphor in the ether1 then add the opium and the water4 ,wet linen or cotton cloths and keep applied to the breasts4 #bbb4 ,,for ,a ,,blackened ,,eye4 ,muriate of ammonia ij4 ,water1 ,vinegar aa4 ij4 ,first foment the part with hot water if there is much pain1 then keep the contusion wet with the lotion4 #bbc4 ,,chloral ,,liniment4 ,chloral hydrat4 j4 ,liniment saponis f4 jv4 ,m4 ,sig4 ,for external use4 ,do not apply so as to cause much soreness4 #bbd4 ,,barber',s ,,itch4 ,hydrarg4 ammoniat4 #aj grains4 ,bismuth4 subnit4 #a drachm4 ,liq4 carbonis deterg4 #a drachm4 ,lanolin #f drachms4 ,m4 ,sig4 ,to be applied night and morning4 #bbe4 ,,comedones4 ,sulphuric ether #h drachms4 ,ammonia carbonate #a drachm4 ,boracic acid #bj grains4 ,water1 to make #af drachms4 ,m4 ,sig4 ,apply twice a day4 #bbf4 ,,ointment ,,for ,,freckles4 ,subnitrate of ,bismuth #b drachms4 ,simple ointment #b ounces4 ,apply to the skin at night and remove in the morning with a little cold cream previous to washing4 #bbg4 ,,chilblains4 ,acidi carbolici #a drachm4 ,tinct4 iodini #b drachms4 ,acidi ,tannici #a drachm4 ,cerat simp4 #d ounces4 ,misce bene ut ft4 ungt4 ,sig4 ,apply two or three times a day4 ,errata4 ,on page #aff for 7,f4 #bcd7 read 7,f4 #bja47 ,,glossary4 ,,abdomen4 ,the belly2 the portion of trunk between the diaphragm and pelvis4 ,,abnormal4 ,unnatural2 out of the usual rule or order4 ,,abortion4 ,premature expulsion of the ftus4 ,,abrasion4 ,a breaking or rubbing off4 ,,abscess4 ,a collection of pus or matter4 ,,acapuncture4 ,to insert needles into the skin or flesh4 ,,accoucheur4 ,a skillful man midwife4 ,,acetated4 ,combined with acetic acid4 ,,acetabulum4 ,the cotyloid cavity that receives the head of the thigh bone4 ,,acid4 ,a substance that can combine chemically with alkalies and alkaline oxides4 ,,acini4 ,small granular masses4 ,,actual ,,cautery4 ,cauterization by red hot iron4 ,,acute1 ,,sharp4 ,an acute disease1 has rapid progress and short duration4 ,,adhesion4 ,a sticking or growing together4 ,,adipose4 ,fatty4 ,,adjuvants4 ,medicines which assist the action of other medicines4 ,,tiology4 ,the science of causes4 ,,ala4 ,a wing4 ,,ala ,,nasi4 ,the cartilaginous sides of the nose which move during difficult breathing4 ,,albuminoid4 ,resembling albumen4 ,,albuminaria4 ,the presence of albumen in the urine4 ,a kidney disease4 ,,alkalies4 ,substances that have the power of forming salts with acids4 ,,alimentary ,,canal4 ,the passage from the mouth to the anus4 ,,alterative4 ,a medicine that has power to gradually change or improve a disease4 ,,alveoli4 ,the bony sockets of the teeth4 ,,amenorrh,a4 ,a suspension or absence of the menses4 ,,anaemia4 ,a lack of red particles in the blood2 bloodlessness4 ,,anal4 ,relating to the anus or rectum4 ,,anasarca4 ,dropsy of the celular tissue4 ,,anesthetic4 ,capable of producing insensibility4 ,,angina4 ,an inflammation of the throat4 ,,antacid4 ,a remedy against acidity4 ,,anterior4 ,in front1 or placed before4 ,,anthelmintic4 ,a remedy against worms1 destroying or expelling them4 ,,antiflexion4 ,bending forwards4 ,,antilithics4 ,substances that prevent the formation of calculi4 ,,antiphlogistics4 ,such medicines as reduce an inflammatory habit4 ,,antiseptic4 ,preventing or resisting putrefaction4 ,,antispasmodics4 ,such medicines as reduce spasms4 ,,anti-,,version4 ,turning forwards4 ,,anus4 ,the opening at the inferior extremity of the rectum4 ,,aorta4 ,the great artery of the body1 going from the heart4 ,,aperient1 ,opening4 ,mildly purgative4 ,,aphonia4 ,loss of voice4 ,,apth4 ,small white ulcers of the mucous membrane4 ,,apophysis4 ,a bony process2 a prominence on the bone4 ,,aqua4 ,water4 ,,areola4 ,a circle around the nipple4 ,,areolar ,,tissue4 ,the tissue that connects various compound parts of the body4 ,,articulation4 ,the joining or union of bones4 ,,artery4 ,a vessel carrying blood from the heart4 ,,ascarides4 ,pin worms4 ,,ascites4 ,abdominal dropsy4 ,,asphyxia4 ,apparent death2 suspended animation4 ,,assimulation4 ,the process by which nutriment is converted into the substance of the body4 ,,asthenia4 ,want of strength2 exhaustion2 debility4 ,,astringent4 ,having the power of contracting organic textures4 ,,atrophy4 ,wasting4 ,,auscultation4 ,listening1 observing the sounds in the thorax1 c4 ,,autopsy4 ,a post mortem examination4 ,,axilla4 ,the arm pit4 ,,axis4 ,a line passing through the center of a body4 ,,bacteria4 ,a kind of microscopic organism4 ,,ballottement4 ,the falling back of the displaced ftus4 ,,basis4 ,that part upon which anything rests4 ,,benign4 ,of a mild character4 ,,bile4 ,the secretion of the liver2 the gall4 ,,biology4 ,the science of life in general4 ,,bistoury4 ,a small narrow bladed knife used in surgery4 ,,blastoderm4 ,the membrane enclosing the yolk of the ovum4 ,,bougies4 ,an instrument for dilating mucous canals4 ,,bronchi4 ,the branches from the windpipe leading to the lungs4 ,,bulientis4 ,boiling4 ,,bulimia4 ,abnormal appetite4 ,,cachexia4 ,a generally depraved condition of the system2 a constitutional tendency4 ,c,,sarean ,,section4 ,the operation of removing a ftus from the womb through the abdomen4 ,,calculus4 ,a stone in the bladder or some part of the body4 ,,canula4 ,a small tubular instrument4 ,,capillaries4 ,the smallest division of blood vessels4 ,,capillary4 ,hairlike2 small4 ,,capsicum4 ,the red pepper4 ,,capsule4 ,a membranous sac2 a gelatinous envelope in which medicine is taken4 ,,carbonic4 ,pertaining to carbon or charcoal4 ,,carcinoma4 ,a cancer4 ,,cardiac4 ,pertaining to the heart4 ,,cardiac ,,orifice4 ,the upper or left orifice of the stomach4 ,,caries4 ,ulceration of the bone or teeth4 ,,carminative4 ,a medicine which tends to expel flatus4 ,,cartilage4 ,gristle1 a substance softer than bone4 ,,catamenia4 ,menstrual discharges4 ,,cataplasm4 ,a poultice4 ,,catarrh4 ,a discharge of secretion from a mucous membrane4 ,,cathartics4 ,medicines causing discharges from the bowels4 ,,catheter4 ,a tubular instrument for introduction into the urethra4 ,,caustic4 ,an escharotic 2 a burning application4 ,,celular ,,structure4 ,a tissue composed of minute cells4 ,,cellulitis4 ,inflammation of celular or connective tissue4 ,,cephalalgia4 ,pain in the head4 ,,cerebellum4 ,the lesser brain2 the posterior portion of brain4 ,,cerebral4 ,relating to the brain4 ,,cervix4 ,the neck4 ,,chalybeates4 ,a liquor or medicine containing iron4 ,,charta4 ,a paper or powder4 ,,chest4 ,the body from the neck to the abdomen4 ,,chirurgery4 ,surgery4 ,,cholagogue4 ,medicine increasing the flow of bile4 ,,chloasma4 ,liver spots2 brownish discolorations of the skin4 ,,chol,,mia4 ,bile existing in the blood4 ,,cholesterine4 ,a fatty substance4 ,,chorea4 ,st4 ,vitus dance2 a disease4 ,,chorion4 ,an envelope of the ovum4 ,,chronic4 ,of long duration4 ,,chyle4 ,a milky fluid made from chyme4 ,,chyme4 ,the pulp into which food is changed in the stomach4 ,,cicatrix4 ,a scar remaining after a wound is healed4 ,,cilia4 ,hairlike appendages4 ,,clinical4 ,at the bedside2 pertaining to a bed4 ,,clitoris4 ,a little erectile tubercle at the front part of the vulva4 ,erratum4 ,on page #ff sixth line from the bottom1 for g4 vagina1 read g4 clitoris4 ,,clonic4 ,contracting and relaxing4 ,,clyster4 ,an enema2 an injection into the bowels4 ,,coagulum4 ,a clot4 ,,coaptation4 ,fitting together properly4 ,,coccyx41 ,oscoccygis2 a small bone at the lower end of the sacrum4 ,,collapse4 ,a sudden failing of the vital powers4 ,,colliquative4 ,causing rapid exhaustion4 ,,collyrium4 ,an eye water4 ,,colostrum4 ,the first milk secreted after delivery4 ,,colon4 ,a portion of the large intestines4 ,,coma4 ,a profound sleep2 lethargy4 ,,commissure4 ,a point of union between two parts4 ,,compound ,,fracture4 ,one which communicates with the surface2 a fracture where the bone has protruded through the skin4 ,,condyle4 ,a protuberance on a bone4 ,,confluent4 ,blending2 running together4 ,,congenital4 ,dating from birth4 ,,congestion4 ,an unnatural fullness or accumulation of blood4 ,,conjunctiva4 ,the membrane covering the eyeball and lining the lid4 ,,contagion4 ,the transmitting of disease by contact4 ,,continuity4 ,an uninterrupted connection4 ,,contra ,,indication4 ,an indication against certain treatment4 ,,contusion4 ,bruise4 ,,convalescence4 ,a period of regaining of health4 ,,convulsions4 ,involuntary contractions of muscular parts4 ,,copulation4 ,joining together2 coition4 ,,comedones4 ,black spots on the face4 ,,coronal4 ,belonging to the crown or top of the head4 ,,cortex4 ,the peel2 bark4 ,,cornea4 ,the transparent membrane of the front part of the eye4 ,,coryza4 ,an acute catarrh2 the snuffles4 ,,counter ,,irritation4 ,irritation excited in one part of the body to relieve another part4 ,,cranium4 ,the skull2 the brainpan4 ,,crassamentum4 ,clot2 the thick part of the blood4 ,,crepitus4 ,creaking or grating sound4 ,,creta4 ,chalk4 ,,crisis4 ,the turning point or change of a disease4 ,,cumulative4 ,increasing by successive additions2 augmenting4 ,,cutaneous4 ,belonging to the skin4 ,,cuticle4 ,the scarf skin2 epidermis4 ,,cyanosed4 ,made blue2 blue jaundice4 ,,cystitis4 ,inflammation of the bladder4 ,,cystocele4 ,descent of the bladder4 ,,decidua4 ,afterbirth membranes4 ,,decoction4 ,to prepare by boiling2 the results of such boiling4 ,,decomposition4 ,separation of a body into its component parts4 ,,demulcent4 ,of a bland1 mucilaginous nature4 ,,dentition4 ,teething4 ,,deodorant4 ,destroying odors4 ,,depurating4 ,cleansing from impurities4 ,,dens4 ,a tooth4 ,,desquamation4 ,a scaling of the cuticle4 ,,determination4 ,unusual flow to any part4 ,,dexter4 ,the right4 ,,dia4 ,in a day4 ,,diagnosis4 ,determining or distinguishing one disease from another4 ,,diaphoretic4 ,a medicine which excites perspiration2 sweating4 ,,diastole4 ,the dilatation of the heart on entrance of the blood4 ,,diathesis4 ,a peculiar bodily constitution or predisposition4 ,,dietetics4 ,the branch of medical art that relates to food4 ,,digestion4 ,conversion of food into chyme and chyle4 ,,digital ,,examination4 ,examination by the finger1 or by touch4 ,,dilatation4 ,dilation2 expansion2 enlarging4 ,,diluents4 ,medicines or fluids that increase the fluidity of the blood4 ,,disinfectants4 ,substances that destroy septic germs4 ,,dislocation4 ,displacement2 out of joint4 ,,distal4 ,farthest from the heart4 ,,diuresis4 ,an unusual secretion of urine4 ,,diuretics4 ,medicines that produce an increased flow of urine4 ,,dorsal4 ,pertaining to the back4 ,,douche4 ,a column or current of water4 ,,duct4 ,a tube or canal which conducts a fluid4 ,,duodenum4 ,the part of the intestines next the stomach4 ,,dyspn,a4 ,a difficulty of breathing4 ,,dysuria4 ,difficult1 painful1 and burning urination4 ,,ecchymosis4 ,an effusion of blood into the celular structures4 ,,eclampsia4 ,puerperal convulsions4 ,,eczema4 ,an eruption of minute vesicles upon the skin4 ,,edema4 ,swelling from inflammation of the celular structure4 ,,effervesce4 ,to foam from the escape of gas4 ,,effluvia4 ,exhalation from putrescent matter4 ,,effusion4 ,the escape of a fluid from out of its natural vessels4 ,,electuary4 ,a medicinal confection4 ,,embolus4 ,a clot or some plug obstructing a blood vessel4 ,,embryo4 ,the ftus in its early stage of developement4 ,,emmenagogue4 ,promoting the menstrual discharge4 ,,emollients4 ,substances that soften the animal fibre4 ,,emphysema4 ,air escaped into the celular tissue4 ,,emulsion4 ,a mixture of oil and water with some other substance4 ,,endermic4 ,through the skin4 ,,enema4 ,an injection thrown into the rectum4 ,,enteric ,,fever4 ,typhoid fever2 intestinal fever4 ,,epidemic4 ,prevalent among the people4 ,,epidermis4 ,the scarf skin2 outer layer of the skin4 ,,epiglottis4 ,the cartilage that shuts over the windpipe in swallowing4 ,,epigastrium4 ,the region of the stomach4 ,,epilepsy4 ,falling sickness4 ,,epiphysis4 ,a union of bone by cartilage4 ,,epithelium4 ,a layer of minute cells covering a membrane superficially4 ,,epispastics4 ,substances which cause a blister4 ,,errhines4 ,substances which cause sneezing4 ,,eructation4 ,raising or belching gas from the stomach4 ,,erythema4 ,a skin disease with rose colored patches4 ,,eschar4 ,the dead part1 killed by caustic or mortification4 ,,escharotic4 ,a substance that burns or destroys animal tissue4 ,,etherization4 ,the state of the system under the influence of ether4 ,,exanthemata4 ,the eruptive or breaking out fevers4 ,,excoriation4 ,a wearing off or abrasion of the skin4 ,,exfoliate4 ,the act of throwing off of dead bone in scales4 ,,expectant4 ,waiting for the efforts of nature4 ,,extend4 ,to stretch2 to pull out4 ,,exiravisation4 ,the effusion of the contents of vessels into the surrounding tissues4 ,,extra ,,uterine4 ,outside the uterine walls4 ,f,,ces4 ,excrement2 evacuations from the bowels4 ,,fallopian ,,tubes4 ,two ducts or tubes floating in the abdomen4 ,,fascia4 ,fibrous membrane covering muscles4 ,,febrifuge4 ,sedative2 assuaging fever4 ,,femur4 ,the thigh bone4 ,,fibre4 ,an organic filament or thread4 ,,filament4 ,a thread-like appendage4 ,,fissure4 ,a deep1 narrow depression4 ,,flatulence4 ,afflicted with gas in the alimentary canal4 ,,flexion4 ,the act of bending4 ,,fluctuation4 ,the undulation of fluid when pressed4 ,f,,tus4 ,the young viviparous animal in the womb4 ,,follicle4 ,a small secreting sac4 ,,fomentations4 ,the application of hot cloths wet with hot water or medicated liquors4 ,,forearm4 ,the part of the upper extremity between the elbow and hand4 ,,formication4 ,a sensation like that of the creeping of ants4 ,,formula4 ,prescriptions2 given forms4 ,,fossa4 ,a depression in a bone4 ,,frenum4 ,a bridle2 a binding or restraining membrane4 ,,fundus4 ,the larger part of a cone shaped organ4 ,,funis4 ,the umbilical cord2 the naval string4 ,,furuncle4 ,a boil4 ,,gall-,,stones4 ,concretions formed from the bile4 ,,ganglion4 ,an enlargement in the course of a nerve4 ,,gangrene4 ,partial death2 mortification4 ,,gargles4 ,solutions applied to the throat4 ,,gastric4 ,pertaining to the stomach4 ,,genital4 ,pertaining to generation4 ,,germ4 ,an undeveloped point of growth4 ,,gestation4 ,the period of pregnancy4 ,,ginglymoid4 ,hinge-like4 ,,globus4 ,a globe or ball4 ,,globus ,,hysterious4 ,a sensation in the throat said to be like a ball4 ,,glottis4 ,the opening into the windpipe4 ,,gramme4 ,the ,french unit of weight2 a little over fifteen grains4 ,,granulations4 ,small red elevations looking like grains4 ,,gutta4 ,a drop4 ,,gynecology4 ,the science of the diseases of women4 ,,heartburn4 ,a hot sensation in the throat or stomach4 ,,hematemesis4 ,vomiting of blood4 ,,hemoptysis4 ,raising blood from the lungs4 ,,hemorrhage4 ,a flow of blood4 ,,hemostatic4 ,an agent to stop bleeding4 ,,hematosis4 ,sanguification2 furnishing blood4 ,,hemicrania4 ,pain in one side of the head4 ,,hemiplegia4 ,paralysis of a lateral half of the body4 ,,hepatic4 ,pertaining to the liver4 ,,hernia4 ,a protrusion of a part that has escaped from its natural cavity4 ,,homogeneous4 ,consisting of similar elements or parts4 ,,hydrocyanic ,,acid4 ,prussic acid4 ,,hydatids4 ,a mass of watery vesicles4 ,,hydrargyrum4 ,mercury4 ,,hydrocephalus4 ,dropsy of the brain4 ,,hydrops4 ,dropsy4 ,,hygiene4 ,science which treats of the preservation of the health4 ,,hymen4 ,the virginal membrane at the orifice of the vagina4 ,,hyper,,mia4 ,an excess of blood in an organ4 ,,hyperesthesia4 ,exalted sensibility4 ,,hypertrophy4 ,augmented bulk2 enlargement4 ,,hypnotic4 ,sleep producing2 soporific4 ,,hypochoridrium4 ,the region under the floating ribs4 ,,hypogastrium4 ,the lower part of the abdomen1 near the pubis4 ,,ichor4 ,thin1 watery1 and acrid discharge4 ,,icterus4 ,jaundice4 ,,idiopathic4 ,primarily affecting2 not secondary or symptomatic4 ,,idiosyncracy4 ,peculiarity of constitution or susceptibility4 ,,ilium4 ,the upper part of the hip or haunch bone4 ,,ileum4 ,the lower two-fifths of the small intestines4 ,,impacted4 ,wedged in or driven close4 ,,imperforate4 ,having no opening4 ,,inanition4 ,exhaustion from want of food4 ,,incompatible4 ,cannot be properly employed together4 ,,incontinence4 ,inability to hold4 ,,incisor4 ,a fore or front tooth4 ,,incubation4 ,hatching2 the maturing of contagious virus4 ,,index ,,finger4 ,the fore finger4 ,,induration4 ,the act of hardening4 ,,infection4 ,the communication of virus4 ,,inferior4 ,the lower of two parts4 ,,infusion4 #ast4 ,the steeping of a substance in a fluid2 #b;d4 ,the liquor resulting from the steeping of a substance in a fluid4 ,,inguinal4 ,pertaining to the groin4 ,,inhalations4 ,gas or vapor to be inspired into the lungs4 ,,innominata4 ,nameless4 ,,inspiration4 ,breathing in2 inhalation4 ,,intercostal4 ,between the ribs4 ,,integument4 ,the skin2 that which covers the muscles4 ,,inunction4 ,anointing2 rubbing in an ointment4 ,,involution4 ,the reducing of a part to its natural condition4 ,,irritation4 ,increase of vital movement and sensibility4 ,,ischium4 ,the inferior part of the os innominatum4 ,,labial4 ,relating or belonging to the lips4 ,,labia ,,majora4 ,two cutaneous folds that bound the opening of the vulva externally4 ,,laceration4 ,a tearing2 a breach made by rending or tearing4 ,,lactation4 ,suckling2 the period of giving suck4 ,,lacteals4 ,the chyliferous vessels2 conveying chyle4 ,,lamina4 ,layers4 ,,laparotomy4 ,opening the bowels by an incision4 ,,larynx4 ,the top of the windpipe2 the cavity which contains the vocal ligaments4 ,,latent4 ,concealed2 not apparent4 ,,lateral4 ,towards the side4 ,,laxatives4 ,medicines which render the bowels more relaxed than usual4 ,,leech4 ,a cotyloid worm used for the local abstraction of blood4 ,,lesion4 ,a morbid change in the texture of an organ4 ,,leucorrh,a4 ,a whitish discharge from the vagina2 the whites4 ,,ligament4 ,a fibrous band4 ,,ligate4 ,to tie2 to secure with a string or band4 ,,ligature4 ,a cord or string4 ,,liquor ,,amii4 ,the fluid in which the ftus is developed4 ,,liter4 ,a ,french measure2 #b4aac pints4 ,,litmus4 ,a vegetable dye2 it is turned red with acids4 ,,lobe4 ,a division1 or projection of an organ4 ,,lochia4 ,evacuations from the vagina following childbirth4 ,,loins4 ,the lateral parts of the lumbar region4 ,,lumbar4 ,pertaining to the reins or loins4 ,,luxation4 ,dislocation1 or putting out of joint4 ,,lymph4 ,the colorless fluid contained in lymphatics1 c4 ,,lymphatics4 ,lymph ducts2 certain vein-like vessels4 ,,maceration4 ,the act of softening or soaking a thing4 ,,malaria4 ,noxious air from decomposed matter4 ,,mammary4 ,pertaining to the breasts4 ,,manipulation4 ,handling skilfully4 ,,marasmus4 ,a wasting of flesh2 a tuberculous disease of the mesenteric glands4 ,,massage4 ,kneading and softening of the muscles1 c4 ,,meatus4 ,a passage larger than a duct2 a channel4 ,,meconium4 ,the first fces of an infant4 ,,median ,,line4 ,an ideal line dividing the body longitudinally4 ,,medulla ,,oblongata4 ,the upper or cranial portion of the spinal cord4 ,,meningitis4 ,inflammation of the meninges or membranes of the brain4 ,,menorrhagia4 ,profuse menstruation4 ,,mesentery4 ,a portion of the peritoneum attached to the small intestines4 ,,metastasis4 ,a sudden removing of disease from one part to another4 ,,metritis4 ,inflammation of the womb4 ,,miasm4 ,infection floating in the air4 ,,micturation4 ,the act of urinating1 or evacuating the bladder4 ,,minim4 ,the smallest liquid measure2 a drop4 ,,monad4 ,the simplest kind of minute animalcule4 ,,mucus4 ,a viscid fluid secreted by a mucous membrane4 ,,multipara4 ,a woman who has had two children or more4 ,n,,vus4 ,a birth mark4 ,,narcotic4 ,producing sleep and stupor4 ,,nares4 ,the passage through the nose2 the nostril4 ,,nates4 ,the seat2 the buttocks4 ,,necrosis4 ,death of the bone4 ,,neuralgia4 ,painful affection of the nerves4 ,,neurilemma4 ,the sheath investing a nerve4 ,,normal4 ,regular2 natural2 as it ought to be4 ,,nymph4 ,the labia interna2 two lateral folds of mucous membrane within the labia externa4 ,,obstetrics4 ,midwifery4 ,,obturator ,,foramen4 ,an opening between the pubic and ischiatic arches closed by a membranous ligament4 ,,occiput4 ,the hinder part of the skull or head4 ,,odontalgia4 ,toothache4 ,,dema4 ,swelling from the presence of serum in the areolar tissue4 ,,sophagus4 ,the gullet4 ,,officinal4 ,authorized by the ,pharmacopia4 ,,omentum4 ,the caul2 a peritoneal fold covering the bowels4 ,,onychia4 ,a small abscess at the side of the finger nail4 ,,opthalmia4 ,inflammation of eyes4 ,,opthalmia ,,neotorum4 ,inflammation of the eyes of new born children4 ,,optic4 ,relating to the vision4 ,,orbit4 ,the bony cavity containing the eye4 ,,orthopn,a4 ,difficulty of breathing1 especially on lying down4 ,,os4 #ast mouth1 #b;d bone4 ,,osmosis4 ,the passage of a fluid through a porous membrane4 ,,os ,,sacrum4 ,the posterior bone of the pelvis4 ,,ossification4 ,conversion into bone4 ,,os ,,uteri4 ,the mouth of the uterus2 the os tinc4 ,,oviduct4 ,a duct in the ,fallopian tube4 ,,ovulation4 ,the formation and discharge of eggs or ovules4 ,,ovum4 ,an egg2 an embryo and its membranes4 ,,oxytocic4 ,having power to increase uterine pains4 ,,oz,,na4 ,fetid ulcer in the nose4 ,,palmar4 ,pertaining to the interior of the hand4 ,,palpation4 ,exploring diseased parts by touching and pressure4 ,,papilla4 ,minute nipple shaped elevations in the skin and mucous membrane4 ,,paraplegia4 ,paralysis of the lower half of the body4 ,,parenchyma4 ,the mass or principal part of organs like the lungs or liver4 ,,parietal4 ,relating to the walls4 ,,paroxysm4 ,an exacerbation of severity1 in a disorder4 ,,parturition4 ,delivery2 the act of bringing forth4 ,,pathology4 ,the science which treats of the nature of disease4 ,,pectoral4 ,pertaining to the chest or breast4 ,,pediluvium4 ,a foot bath4 ,,pelvis4 ,the bony structure of the lower extremity of the body4 ,,percussion4 ,the act of striking on a body to elicit sounds4 ,,perineum4 ,the space between the tuberosities of the ischium1 the anus1 and the genitals4 ,,peristaltic4 ,vermicular or wormlike4 ,,peritoneum4 ,a serous membrane lining the abdominal cavity4 ,,pertussis4 ,whooping cough4 ,,pessary4 ,an instrument to support the uterus when introduced into the vagina4 ,,petechia4 ,spots which appear on the skin in malignant fever4 ,,pharmacop,,ia4 ,a treatise describing the preparation of all kinds of medicine4 ,,pharynx4 ,the upper part of the sophagus4 ,,phthisis4 ,consumption4 ,,physiology4 ,the science of the properties and functions of living beings4 ,,placenta4 ,the after birth4 ,,plasma4 ,the colorless fluid of the blood4 ,,plethora4 ,overfullness of blood2 repletion4 ,,pleura4 ,the serous membrane covering the lungs4 ,,pleuritis4 ,pleurisy4 ,,pneumogastric4 ,belonging to the lungs and stomach2 the eighth pair of nerves4 ,,post ,,mortem4 ,after death4 ,,presentation4 ,the part that presents4 ,,primapara4 ,a woman who bears her first child4 ,,process4 ,a projecting part of bones4 ,,prognosis4 ,a prediction as to the course and event of a disease4 ,,prolapse4 ,a falling down or falling out of a part4 ,,prophylactic4 ,a preventive4 ,,proximal4 ,nearest the heart4 ,,pruritis4 ,itching4 ,,puerperal4 ,pertaining to childbirth4 ,,pubis4 ,the anterior part of the bony pelvis4 ,,pulmonary4 ,pertaining to the lungs4 ,,purgative4 ,cathartic4 ,,purulent4 ,having the character of pus or matter4 ,,pus4 ,the creamy liquid produced by suppuration4 ,,pustule4 ,elevations of the skin containing pus4 ,,pyrexia4 ,fever2 the febrile condition4 ,,pyrosis4 ,water brash4 ,,quarantine4 ,inhibition of intercourse2 isolation4 ,,quartan4 ,recurring every fourth day4 ,,quickening4 ,the first motion of the ftus felt by the mother4 ,,rales4 ,sounds produced in the lungs when there is mucus in the air passages4 ,,ramus4 ,a branch4 ,,rectum4 ,the terminal part of the large intestines4 ,,reduction4 ,the restoring of displaced parts4 ,,refrigerant4 ,cooling medicines which lessen the heat of the body4 ,,regimen4 ,the systematic use of the necessaries of life4 ,,remission4 ,temporary abatement of symptoms4 ,,renal4 ,pertaining to the kidneys4 ,,resection4 ,taking out a portion of bone4 ,,resolution4 ,gradual subsidence of a disease4 ,,retroflexion4 ,being bent over backwards4 ,,retroversion4 ,turning or falling backwards4 ,,revulsives4 ,appliances which remove a disease by causing a determination to some other part4 ,,rhythm4 ,measured beat or movement4 ,,rickets4 ,a disease of the bones4 ,,rigor4 ,a slight tremor and chilliness4 ,,rigor ,,mortis4 ,stiffening of the body after death4 ,,rubefacient4 ,making red and warm4 ,,rupture4 ,a protrusion of any of the contents of the belly through the parietes4 ,,saccharum4 ,sugar4 ,,sacrum4 ,the os sacrum or os basilaire4 ,,sagittal4 ,the name of a suture that unites the parietal bones4 ,,salt4 ,a compound of an acid and a base combined chemically4 ,,sanative4 ,curative2 sanitary4 ,,sanguineous4 ,full of blood4 ,,sanies4 ,a thin fluid discharged from an ulcer1 having some of the properties of pus and blood4 ,,sarcoma4 ,a tumor of a fleshy consistence4 ,,sordes4 ,an accumulation of foul secretions upon the teeth4 ,,saturation4 ,the union of one substance with another till no more can be received4 ,,scarifications4 ,making small incisions4 ,,sciatic4 ,pertaining to the hip4 ,,scirrhus4 ,a hard1 knotty1 cancerous tumor4 ,,scybala4 ,hard lumps of feces4 ,,secretion4 ,the vital action by which substances are separated from the blood4 ,,secundines4 ,the placenta and membranes2 the afterbirth4 ,,sedatives4 ,medicines which diminish the action of the heart and nerves1 and which are quieting4 ,,septic4 ,having power to promote putrefaction4 ,,septicemia4 ,blood poisoning by putrid infection4 ,,sequel4 ,morbid phenomena supervening after disease4 ,,serous4 ,watery4 ,,serum4 ,watery animal fluids4 ,,shock4 ,sudden depression of the vital powers4 ,,sialagogue4 ,a medicine producing an increased flow of saliva4 ,,sinapism4 ,a mustard draught4 ,,singultus4 ,continued hiccough4 ,,sinus4 ,an elongated cavity or abscess1 having a small orifice4 ,,situ4 ,situation4 ,,slough4 ,a dead or mortified portion4 ,,solution4 ,the preparation made by dissolving a solid in a liquid4 ,,speculum4 ,an instrument for dilating a passage or facilitating an examination4 ,,sphincter4 ,a circular muscle for contracting a natural opening4 ,,spinal ,,cord4 ,a continuation of the brain through the vertebral column4 ,,sporadic4 ,occurring singly or scattered4 ,,stercoraceous4 ,mixed with fcal matter4 ,,sternutatory4 ,causing sneezing4 ,,stethoscope4 ,an instrument for conveying sound from the body to the ear4 ,,strabismus4 ,squinting2 an affection causing what is called cross-eye4 ,,strangury4 ,a painful discharge of urine4 ,,stricture4 ,contraction of a portion of a duct or tube4 ,,stupe4 ,a fomentation by means of hot cloths4 ,,styptic4 ,strongly astringent4 ,,subcutaneous4 ,beneath the skin4 ,,subjective4 ,pertaining to one's own consciousness4 ,,subsultus4 ,twitching of the muscles4 ,,sudamina4 ,small vesicles caused by profuse sweating4 ,,sudoriferous4 ,sweating4 ,,sudorifics4 ,medicines which produce a flow of perspiration4 ,,superior4 ,the upper of two parts4 ,,suppositary4 ,medicine in a solid form1 intended for introduction into the rectum1 or vagina4 ,,suppression4 ,stoppage of a discharge4 ,,suppuration4 ,the process of forming pus4 ,,sutures4 #ast4 ,the seams that unite the bones of the skull4 #b;d4 ,stitches to hold the edges of a wound together4 ,,symphasis4 ,a peculiar kind of articulation4 ,,symptoms4 ,signs or phenomena which accompany disease4 ,,synchondrosis4 ,union by cartilage or gristle4 ,,syncope4 ,a fainting or swooning4 ,,systemic4 ,pertaining to the system or body generally4 ,,systole4 ,the contraction of the heart4 ,t,,nia4 ,a kind of long intestinal worm2 a tape worm4 ,,tampon4 ,a plug designed to arrest hemorrhage4 ,,taxis4 ,pressure made by the fingers to return a hernial tumour4 ,,tendon4 ,a cord or bundle of fibres attaching muscle to bone4 ,,tenesmus4 ,a straining at stool2 a painful sensation in the lower part of the rectum4 ,,tent4 ,a cylinder designed for dilating a part4 ,,tertian4 ,occurring every third day1 or every forty-eight hours4 ,,tetanus4 ,a disease characterized by continuous muscular contractions2 a lockjaw4 ,,therapeutics4 ,the application of remedies for diseases4 ,,thorax4 ,the cavity containing the lungs and heart2 the chest4 ,,thrombosis4 ,the obstruction of a blood vessel by a small coagulum4 ,,tincture4 ,spirit containing medical substances in solution4 ,,tone4 ,a proper state of firmness4 ,,tonic4 ,a strengthening medicine4 ,,topical4 ,local2 applied to a particular part4 ,,tormina4 ,twisting1 griping pains in the bowels4 ,,tourniquet4 ,an instrument for ligating a limb and making pressure on an artery4 ,,transudation4 ,passing of a fluid through the pores or interstices4 ,,traumatic4 ,resulting from a wound or lesion4 ,,trismus4 ,lockjaw2 tetanus4 ,,trituration4 ,the act of reducing to a fine powder4 ,,tuber ,,ischii4 ,the tuberosities of the ischium4 ,,tumefaction4 ,enlargement2 swelling4 ,,tympanitis4 ,flatulent distention of the belly4 ,,type4 ,peculiar form of disease4 ,,ulcer4 ,a sore1 discharging pus4 ,,umbilicus4 ,the naval4 ,,unctuous4 ,fat2 oily4 ,,urea4 ,a nitrogenous constituent of the urine4 ,,urethra4 ,the canal that conveys the urine from the bladder out of the body4 ,,urinometer4 ,an instrument for obtaining the specific gravity of urine4 ,,utero ,,gestation4 ,pregnancy4 ,,uterus4 ,the womb4 ,,varicose ,,veins4 ,veins that are morbidly enlarged4 ,,vascular4 ,full of blood vessels4 ,,vein4 ,a vessel carrying blood to the heart4 ,,vena ,,cava4 ,a name given to two great veins of the body4 ,,vertebra4 ,a joint of the spinal column1 or back bone4 ,,vertigo4 ,dizziness4 ,,vesicants4 ,blistering agents4 ,,vesicle4 ,an elevation of the cuticle containing serum2 a bladder4 ,,vessel4 ,a tube or canal for fluids4 ,,viable4 ,sufficiently developed to be capable of living4 ,,vibriones4 ,a family of minute organisms4 ,,vicarious4 ,taking the place or office of another4 ,,villi4 ,minute papillary elevations on a membrane4 ,,virus4 ,organic poison2 the contagion of disease4 ,,viscera4 ,the contents of the abdomen1 thorax1 or head4 ,,visuos4 ,one of the internal organs4 ,,vital4 ,pertaining to life4 ,,vivisection4 ,the dissection of an animal while alive4 ,,volatile4 ,capable of easily evaporating4 ,,vulva4 ,the labia externum4 ,,whitlow4 ,a felon2 an inflammation near the bone at the end of the finger4 ,,wisdom ,,teeth4 ,the last of the molars to appear4 ,,wound4 ,a hurt or breach of the skin and flesh of an animal4 ,,zymotic4 ,caused by something that acts as a ferment4 ,,index4 ,abbreviations used in writing prescriptions1 #ccj4 ,abdomen1 pain in1 #bc4 ,ablutions after labor1 #dd4 ---- in pregnancy1 #bj4 ---- of the sick1 #bih4 ,abortion1 may be accidental1 #abj4 ---- may become a habit1 #abj4 ---- premonitory symptoms1 #abj4 ---- prevention of1 #abb4 ---- in the beginning of pregnancy1 #abj4 ---- treatment of1 #abc4 ,abscess1 #aff1 #cfj4 ,accidents1 #bgi4 ,accidents of labor1 #afh4 ,acidity of the stomach1 #be1 #ccf4 ,acetabulum1 #eg4 ,acetate of copper1 poisoning by1 #bhe4 ---- lead1 #bhg4 ,acid poisons1 #bhd1 #bhg4 ,aconite1 #bfe1 #bhc4 tiology1 #aif4 ,afterbirth1 function of the1 #ajb4 ---- structure of1 #ajj4 ---- retained1 #afa4 ---- how delivered1 #aca4 ,afterpains1 #afb1 #cdj4 ,age suitable for marriage1 #ad4 ---- at which menstruation begins1 #ga4 ,air should be fully breathed in1 #baj4 ---- ---- fresh1 #bab4 ---- ---- not contaminated1 #baa4 ,albuminaria1 #aci4 ,alcohol1 #bhc4 ,aliment1 #di1 #eb1 #bbe1 #cac4 ,alp1 #bah4 ,alum whey1 #cbj4 ,amenorrha1 #hg4 ,ammonia mixture1 #cci4 ,ammoniacal gas for dysmenorrha1 #ceh4 ,ammoniacal liniments1 #bbf4 ,amusements1 #ag4 ,anasarca1 #baf4 ,anatomical peculiarities of the ftus1 #aaj4 ,anatomy of the pelvis1 #ee4 ,animal poisons1 #bhh4 ,anodynes1 #cdj1 #ceh4 ,anodyne lotion1 #ceh4 ,anatomy of the pelvis1 #fj4 ,antacids1 #ccf4 ,antidotes1 #bhe4 ,anthelmintics1 #cdd4 ,anteversion of the uterus1 #he1 #hf4 ,antiflexion of the uterus1 #hc4 ,antimony1 poisoning by1 #bhc4 ,antiseptic dressings1 #aff4 ,antiseptics1 #bch1 #cch4 ,antispasmodics1 #cci4 ,aperients1 #cdc4 ,apoplexy1 #bha4 ,apparent death1 #bhj1 #bhh4 ,apple water1 #caf4 ,apth1 #age4 ,areola1 #aje4 ,arm presentations1 #ahg4 ,aromatic spirits of ammonia1 #bgj4 ,arrow root custard1 #cbc4 ,arrow root1 how to prepare1 #cbb4 ,arsenic1 poisoning by1 #bhd4 ,arteries1 #bee4 ,art of prescribing1 #cbf4 ,articles wanted at childbirth1 #cb4 ,artificial respiration1 #bhi4 ,ascarides1 #aej4 ,asphyxia1 #afj1 #bhh4 ,asphyxiated persons1 #bhh4 ,asthma1 #bag1 #bbj1 #cci4 ,astringents1 #cdj ,atropine as a poison1 #bhc4 ,auscultation1 #ajh1 #adj4 ,bacteria1 #afi4 ,ballottement1 #ajg4 ,bandages1 applying1 #bfa4 ---- making1 #bea4 ---- after confinement1 #da4 ,barber's itch1 #cfc4 ,bathing1 #ai1 #bej4 ---- of infants1 #ec1 #ed4 ---- short rules for1 #bej4 ,baths1 blanket and hot air1 #bdi4 ---- cold and cool1 #bdh4 ---- salt and sulphur1 #bej4 ---- sitz1 #bih4 ---- temperate and tepid1 #bdh4 ---- warm and hot1 #bdh4 ,bearing down pains1 #aeh4 ,bedrooms1 #bdf4 ,bed sores1 #bdf4 ,beds1 in confinement1 #cg4 ,bee stings1 #cjc4 ,bee tea1 #cjb4 ,beef-juice1 #cbf4 ,beef tea1 #cbe1 #cbf4 ,belladonna1 poisoning by1 #bhc1 #bhg4 ,beverages1 #dd4 ,bismuth1 #bhe4 ,bites of mad dogs1 #bhh4 ---- venomous snakes1 #bhh4 ,bitters1 hop1 #cej4 ,blackened eye1 #big4 ,bladder1 state of1 after confinement1 #afc4 ,bleeding from the nose1 #cja4 ,blisters1 how dressed1 #bbg4 ---- why used1 #bbf4 ,blood root powder1 #bfd4 ,body presentations1 #ahg4 ,boiled flour1 #dj4 ,boiled rice and cocoa-nut1 #cbc4 ,boils1 #cfj4 ,bones of the ftal head1 #ajh4 ---- ---- pelvis1 #ef4 ,bowel complaints of children1 #bfh4 ,bread jelly1 #cai1 #cbc4 ,bread poultices1 #bcb4 ,breast1 care of1 #dh1 #afe1 #aff4 ---- gathered1 #aff4 ,breathing exercise1 #cjf4 ,breech presentation1 #ahd4 ,brim of the pelvis1 #fj4 ,broken bones1 #beg4 ,bronchial asthma1 #bag4 ,bronchitis1 #bbj4 ,broths1 #bdh ,brown discolorations of the skin1 #ceg4 ,bruises1 #bee4 ,burns and scalds1 #bib1 #bic4 ---- dry1 #bib ---- salve for1 #ceg4 ,cantharides1 poisoning by1 #bhf4 ,carbolic acid1 #bgc1 #bhd4 ,carbonic acid gas1 poisoning by1 #bhh4 ,care of infant children1 #agj4 ,care of mother during confinement1 #db1 #dc1 #afc4 ---- ---- ---- labor1 #da1 #aeg4 ,catamenia1 #gj4 ,cataplasm1 #bcc4 ,cathartics1 #cdb4 ,catheter1 introducing the1 #gh4 ,catheterization1 #gh4 ,causes of disease1 predisposing1 #aif4 ---- ---- exciting1 #aif4 ---- ---- heat and cold1 #aig4 ---- ---- the season1 #bjb4 ,causes of tedious labor1 #adb1 #aea1 #aee1 #agi4 ,caustics1 #cdd4 ,cervex uteri1 #ff4 ,cessation of menses1 #gb4 ,chafings1 #aga4 ,chalk mixture and hops1 #ccf4 ,change of life1 #gc4 ,changing clothing1 #bea4 ,charcoal1 #bdj1 #bii4 ,chicken broth1 #cbe4 ,chicken tea1 #cbd4 ,chilblains1 #cfc4 ,children1 diseases of1 #bag4 ,chlorate of potash1 #bgb4 ,chlorosis1 #bfe1 #ceb4 ,cholera infantum1 #agd1 #ccd4 ,cholera mixture1 #ccg1 #cci4 ,cholera morbus1 #age4 ,choosing food for infants1 #cjg4 ,chorea1 #bag1 #bah1 #cef4 ,cicitrization1 #bef4 ,cinnamon mixture1 #cdj4 ,circulation of blood in the ftus1 #aaj4 ,classification of medicines1 #cca4 ,cleanliness in cooking1 #cji4 ,climate1 #aih4 ,clinical thermometer1 #bgf4 ,clothes on fire1 #bib4 ,clothing for the lying in woman1 #cg4 ---- ---- ---- pregnant woman1 #ai4 ---- ---- ---- infant1 #ec ---- how to change1 #de4 ,coccyx1 #ei4 ,coffee1 #cjc1 #cba4 ,cold applications1 #bbe1 #bce4 ,cold as a cause of disease1 #aig1 #aii4 ,cold bath1 #bja4 ,cold in the head1 #bgf4 ,colds1 #bfe4 ,cold water1 #bce4 ,colic1 #ccc1 #ccg4 ,collyrium1 #bcf1 #cfb4 ,coma1 #bha4 ,common diseases1 #bfc14 ,compound licorice powder1 #bgb4 ,compression of the brain1 #bha4 ,conception1 nature of1 #id4 ---- signs of1 #aab4 ,concussion of the brain1 #bha4 ,conduct of mother after marriage1 #ag4 ---- ---- during pregnancy1 #ah4 ,confinement1 preparations for1 #cb1 #cg4 ---- bed for1 #cg4 ---- dress for1 #cg4 ,conium1 poisoning by1 #chc4 ,constipation1 #bc4 ,contagion1 caused by germs1 #bcg4 ,contagious diseases1 #bcg4 ,contused wounds1 #bee4 ,contusions1 #bee4 ,convalescence1 #afc4 ,convulsions1 infantile1 #bij1 #cjb4 ---- puerperal1 #aid4 ,cookery for the sick1 #cji4 ---- ---- young children1 #cji4 ,cool bath1 #bdh4 ,cooling lotion for inflamed eyes1 #ceh4 ,corns1 #cjc4 ,corn tea1 #cag4 ,corsets1 #ai ,coryza1 #bgf4 ,costiveness1 #bb1 #aga4 ,cough1 #bbj4 ,cough syrup1 #cdh4 ,counter irritants1 #bbe1 #bbf4 ,cracked nipples1 #afh4 ,cramps1 #bf4 ,cravings1 #bie4 ,critical period of life1 #gc4 ,croton oil1 #bhf4 ,croup1 #bff1 #ccd4 ,cupping1 dry and wet1 #bbi4 ,cutting the gums1 #bgd1 #bif4 ,cystitis1 #afc4 ,cystocele1 #adb1 #cdf4 ,dandruff lotion1 #cfb4 ,dead1 care of1 #bdb4 ,death1 #bai1 #bdb4 ,decoction of bran1 #cae4 ---- ---- barley water1 c41 #cde4 ,deformed pelvis1 #ahb4 ,dentition1 #bgd4 ,depression of spirits during suckling1 #di4 ,development of the uterus in pregnancy1 #ie4 ,developement of the ftus in pregnancy1 #aje1 #ajf4 ,diabetis1 #cjf4 ,diagnosis1 #bag1 #bgg4 ---- by palpation1 #adj4 ---- of artificial labor1 #abf1 #ach4 ---- of diseases in children1 #bag ---- of pregnancy1 #aab4 ---- by vaginal touch1 #abf4 ,diameter of the pelvis1 #fa4 ---- ---- child's head1 #ajg4 ,diaphoretics1 #cde4 ,diarrha prescriptions1 #bfh1 #cch4 ---- in a child1 #aga1 #bfg4 ---- in pregnancy1 #be4 ,dietary after labor1 #dd1 #dg4 ---- during suckling1 #dd4 ---- of a pregnant female1 #ai4 ---- of the young wives1 #ag4 ,diet for infants and children1 #cjg4 ---- ---- the sick1 #cji4 ,dietetics1 #cj4 ,differences of pelves1 #fc4 ,difficult labor1 #agg4 ,digital examinations1 #adj4 ,diphtheria1 #bfd1 #bfc4 ,diphtheria powder1 #bfc1 #bfd4 ,directions for domestic medication1 #bfb4 ,directions to the monthly nurse1 #cc1 #dc4 ---- things to be provided1 #cc4 ---- care of the mother2 rest1 #dc4 ---- diet1 #dc4 ---- beverages1 #dd4 ---- the lochial discharge1 #dd4 ---- ablutions1 #dd4 ---- clothing1 #de4 ---- retention of urine1 #dg4 ---- mother's breasts1 #dg4 ---- care of child's food1 #di1 #ea1 #eb4 ---- ---- sleep1 #ec4 ---- ---- the naval1 #ec4 ---- ---- clothing1 #ec4 ,diseases of children1 #bag4 ---- infants1 #aga4 ---- pregnancy1 vomiting1 #aba4 ---- morning sickness1 #ba4 ,diseases of the throat1 #bfd4 ,disinfectants1 #bch1 #bci4 ,disinfection1 #bda4 ,dislocations1 #bei4 ---- of elbow1 #bfj4 ---- of thumb or finger1 #bfj4 ,disorders of menstruation1 #hg4 ---- amenorrha1 #h-4 ---- dysmenorrha1 #hh4 ---- menorrhagia1 #ib4 ,displacements of the uterus1 #gf4 ,diuretics1 #cdf4 ,domestic medication1 #bfb4 ,domestic management of colds1 #bfe4 ---- ---- diarrha1 #bfh4 ---- ---- fevers1 #bff4 ---- ---- dysentery1 #bfi4 ---- ---- cramp1 #bff4 ---- ---- croup1 #bff4 ---- ---- fainting fits1 #bgj ,doses for children and adults1 #cbg4 ,dress for labor1 #cg4 ,dressing the child1 #dj1 #da4 ,dropsies1 #baf1 #cdg4 ,dropsy of the head1 #bah1 #bai4 ,drowning1 #bhh4 ,drugs1 list of1 #bfc4 ,duration of pregnancy1 #abd4 ,duties of a wife1 #ai4 ---- ---- skilled nurse or midwife1 #ade4 ---- making examination1 #aef4 ---- how to act as midwife1 #adi4 ---- turning the child1 #ahe4 ---- care of the child1 #agj4 ---- post partem hemorrhage1 #afj4 ---- adherent placenta1 #afa4 ---- after pains1 #afb4 ---- retention of urine1 #afb4 ---- ,shock1 #afc4 ---- the lochia1 #afd4 ---- the milk1 #afe4 ---- care of the breasts1 #afe4 ---- convulsions1 #add4 ---- mania1 #afi4 ---- septicemia #afi4 ---- care of infant children1 #agj4 ,duties of a nurse in various circumstances1 #bcg4 ,dysentery in the infant1 #aga4 ---- ---- children #bbj1 #bfi1 #cch1 #cdj4 ,dysmenorrha1 #hh1 #hi1 #ia1 #cdj4 ,dyspepsia1 #bgj4 ,ear1 foreign substance in1 #bic4 ,earache1 #bah1 #bai4 ,early treatment of disease1 #bba4 ,effects of the season upon health1 #bjb4 ,effervescing lemonade1 #cag4 ,elbow joint1 dislocation of the1 #bhj4 ,elbow presentation1 #ahe4 ,elm1 slippery1 #bgc4 ,embryo1 #ajc4 ,emergencies1 #bgi4 ,emetics1 #cdg4 ,emmenagogues1 #ceb4 ,emotion1 influence of on child1 #ba4 ,enema apparatus1 #cc4 ,enema for pinworms1 #cej4 ,enemata1 #bih1 #cdi4 ,epidemics1 #bch4 ,epileptical seizures1 #bij4 ,epistaxis1 #cjf4 ,erect carriage1 #cjf4 ,ergot1 #aee4 ,eruptive fevers1 #bgh4 ,erysipelas #bec1 #cfb4 ,essence of beef1 #cbf4 ,etherization1 #bia4 ,excessive sweating1 #bih4 ,exercise during pregnancy1 #ai1 #bf1 #ce4 ---- before breakfast1 #bb4 ,expectorants1 #cdh4 ,extra uterine pregnancy1 #id4 ,eye lotion1 #ceg1 #cfa1 #cfb14 ,face presentations1 #adc1 #ahc4 ,fainting1 #be4 ,fainting in pregnancy1 #be4 ,falling of the uterus1 #gf4 ,fallopian tubes1 #fg4 ,false labor pains1 #cd1 #abc4 ,father's influence1 #ae4 ,fecundation1 #id4 ,feeding infants1 #di1 #cjg1 #cad4 ,febrile disorders1 #bbj4 ,female weakness1 #gg4 ,fire1 clothes catching1 #bib4 ,fissure of the anus1 #bah4 ,fits1 #bij4 ,flatulence1 #ch4 ,flatulent colic1 #ccc1 #ccg4 ,flaxseed1 #cae4 ,flexions and versions of the womb1 #ge4 ,flour boiled1 #cbb4 ,fluid aliments1 #cac4 ,ftal circulation1 #ajd1 #aaj1 #aaa4 ---- life1 #ajc4 ,ftus its development1 #aje1 #ajc4 ---- size at term1 #ajf4 ,fomentations1 #bca1 #bcd1 #ceb4 ,fontanelles1 #afi4 ,food1 during pregnancy1 #ai4 ---- for a child1 #ej1 #cjg4 ---- for convalescents1 #caj4 ---- milk and eggs1 #cab4 ---- rules for giving1 #caj4 ---- varieties of1 #caa4 ,foot bath1 #bih4 ,foreign matter in a wound1 #bed4 ---- ---- in the ear1 #bic4 ---- ---- ---- ---- eye1 #bic4 ---- ---- ---- ---- nose1 #bic4 ---- ---- ---- ---- throat1 #bid4 ,formul for food1 #cad4 ,formul for medicines1 #ccb4 ,fractured ribs1 #bif4 ,fractures1 nurses duties1 #beh4 ,fractures1 signs of1 #beg1 #beh4 ,friction1 #bfi4 ,fruits1 #cac4 ,fumigation1 #bda4 ,fundus of the uterus1 #fe4 ,gargles1 #cjf4 ,gathered breasts1 #aff4 ,gelsemium1 #bhc4 ,generation1 #ic1 #id4 ,germ diseases1 #bcg4 ,gestation1 period of1 #id1 #abd4 ,giving medicines1 #bde4 ,giving anesthetics1 #bia4 ,graafian vesicle1 #ge4 ,granulations1 healthy1 #bef4 ,green sickness1 #bcg4 ,gum ,arabic1 #bgb1 #cae4 ,hardening infants1 #bja4 ---- nipples1 #bg4 ,haunch bone1 #eg4 ,head of the ftus1 #ajh4 ,head presentations1 #adj4 ,headache1 #bai1 #ced4 ,health1 #ad4 ,health of wives1 #ad4 ,heartburn1 #be1 #ccf4 ---- in pregnancy1 #bd4 ,heat as a cause of disease1 #aig4 ---- a symptom of inflammation1 #aae4 ,hematuria and menorrhagia1 #ib1 #cda4 ,hemoptysis1 #cda4 ,hemorrhage1 unavoidable1 #aic4 ---- during labor1 #aic1 #aid4 ---- internal1 #aid ---- post partem1 #afa4 ---- from cuts and incisions1 #bee4 ,hemorrhoids1 #bge1 #cfj4 ,herb teas1 #cag4 ,home remedies for ague and fever1 #bgg4 ---- ---- apoplexy1 #bgi4 ---- ---- opthalmia1 #bge4 ---- ---- bronchitis1 #bgf4 ---- ---- constipation1 #bge4 ---- ---- diarrha1 #bfh4 ---- ---- dysentery1 #bfi4 ---- ---- hysteria1 #bgh4 ---- ---- pneumonia1 #bgf4 ---- ---- scarlet fever1 #bgh4 ---- ---- typhoid fever1 #bgh4 ,honey1 #cjb4 ,hop bitters1 #cef4 ,hot baths1 #bdh4 ,hot foot baths1 #bih4 ,hot water1 #big4 ,how to breathe1 #baj4 ,how to cook rice1 #cbc4 ,how to prepare arrow root1 #cbb4 ,how to use injections1 #cea4 ,hydrocyanic acid1 poisoning by1 #bhg4 ,hyoscyamus1 #bhc4 ,hypermia1 ,hysteria1 #bgh4 ,hypnotic suppositary1 #ceb4 ,ice1 #bce4 ,ice bags1 #bce4 ,iliac fossa1 #eg1 #eh4 ,impacted feces1 #adb1 #aea4 ,incised wounds1 #bed4 ,incompatible marriages1 #af4 ,incontinence of urine1 #cee4 ,indian meal gruel1 #cah4 ,indigestible food1 #big4 ,inefficient action of uterus1 #aea4 ,infant1 care of1 #dj4 ,infant feeding1 #agd4 ,infection1 #bch4 ,inflammation1 symptoms of1 local heat1 #bae4 ---- ---- pain1 #bae4 ---- ---- redness1 #baf4 ---- ---- swelling1 #baf4 ---- ---- tenderness1 #bad4 ---- general symptoms1 skin1 ---- ---- ---- pulse1 #bbc4 ---- terminations1 resolution1 #bad4 ---- ---- suppuration1 #beh4 ---- treatment of1 general1 #bbc4 ---- ---- topical1 #bbe4 ,inflammation of the breast1 #afe4 ,infusion of flaxseed1 #cae4 ,infusions1 #cag4 ,inhalations1 #cjc4 ,injections1 #bih4 ,injections for the vagina1 #cea4 ,innominata1 #ef4 ,instructions to a woman before labor1 #bf4 ,instructions to nurses1 labor1 #adg4 ---- tedious labor1 #aea1 #agh4 ---- breech presentations1 #ahd4 ---- knee or foot presentations #ahe4 ---- shoulder1 body or head presentations1 #ada4 ---- face1 #ada4 ---- inefficient action of the uterus1 #aea4 ---- excess of liquor amnii1 #aeb1 #agi4 ---- powerless labor1 #ahj4 ---- obstructed labor1 #aha4 ---- deformed pelvis1 #ahb4 ---- adherent placenta1 #afa4 ---- placental presentation1 #aic ---- to wife and mother1 #ac4 ,instructions to nurse midwife1 #ade1 #aef1 #aib4 ---- to the mother before labor1 #bf4 ,internal organs of generation1 #ff4 ---- uterus1 #fe4 ---- ,fallopian tubes1 #fg4 ---- ovaries1 #fh4 ---- vagina1 #fh4 ---- ligaments of the womb1 #fi4 ,introducing of catheter1 #gh4 ,introduction1 #i4 ,inversion of uterus1 #afh4 ,ipecac1 #bga4 ,irritable uterus1 #cej4 ,irritation1 #bbi4 ,itchings1 #bih4 ,jaundice1 #agf4 ,jelly water1 #caf4 ,joints of the pelvis1 #ei4 ,knee chest position1 #hj4 ,labor1 difficult1 #agg4 ---- directions for conducting1 #ci1 #adi1 #aef4 ---- false1 #cd4 ---- true1 symptoms of1 #cf4 ,lactation1 #afe4 ,laxatives1 #cdc4 ,leeches1 #bbi4 ,leucorrha1 #cea4 ,light1 effects of1 #df4 ,lightning1 #bij4 ,lineo ilio pectinea1 #fj4 ,liniments1 #bbf4 ,liniment used in cerebro spinal meningetis1 #ceg4 ,liquor amnii excessive1 #aeb4 ,lister's dressing1 #aff4 ,little ailments1 #big4 ,lochia1 profuse1 #afe4 ---- scanty1 #afd4 ---- fetid1 #afe4 ,lochial discharge1 #de1 #afd4 ,locked jaw1 #bec4 ,longings in pregnancy1 #ai4 ,lotion for pruritis1 #cfb4 ,lotion for tinea capitis1 #cei4 ,lotions1 #ceg4 ,mad dog bites1 #bhh4 ,mammary abscess1 #aff1 #cfb4 ,mammary inflammation1 #afe4 ,manner of feeding infants1 #cac4 ,marriage should not be at too early an age1 #ad4 ,marshall ,hall's method1 #bhi4 ,measles1 #bgd4 ,meatus of the urethra1 #fd4 ,measures1 #fa4 ,mechanical phenomena of labor1 #acc4 ,mechanical presentations and positions1 #ace4 ---- how distinguished1 #abf4 ,meconium1 #aga4 ,meddlesome midwifery1 #aib4 ,medicines1 classed1 #cca4 ---- in pregnancy1 #bh4 ,medicated bath1 #bej4 ,meningitis1 #bah4 ,menorrhagia symptoms and varieties1 #ib4 ---- treatment of1 #ic4 ,menses1 cessation of1 #gc4 ,menstruation1 retarded1 #gb4 ---- its disorders1 #gc4 ---- painful1 #ij1 #ia4 ---- profuse1 #ib4 ,midwifery1 #adj1 #ade4 ,milk1 as food1 #cab4 ---- fever1 #afe4 ---- in the breasts of new-born infants1 #aga4 ---- mother's influence of diet on1 #agb4 ---- porridge1 #cai4 ,miscarriage1 cause of1 #aba4 ---- flooding in1 #aba1 #abc4 ---- prevention of1 #abb4 ---- treatment of1 #abc4 ,mismenstruation1 #hg4 ,mistakes in giving medicine1 #bde4 ,mode of administering medicine1 #cbh4 ,morning sickness1 #aje4 ,morphine1 poisoning by1 #big4 ,mother1 #ai4 ,mucilage of starch1 #cbb4 ,mumps1 #bgd4 ,mush and milk1 #cbj4 ,mustard plasters1 #bbf4 ,mutton broth1 #cbf4 ,mutton soup1 #cbe4 ,narcotic poisons1 #bhf4 ,narcotics1 #cec4 ,natural labor1 #adi4 ,nausea1 #ccg4 ,naval1 soreness of1 #agj4 ,naval string1 #aja4 ,naval string1 dressing of1 #ec4 ,nervous disorders1 #bbj4 ,nervous shock1 #afc4 ,neuralgic dysmenorrha1 #hi4 ,night nursing1 #bde4 ,night sweats1 #cda4 ,nipple1 cracked and sore1 #cfj4 ---- retracted1 #da4 ---- to harden1 #bf4 ,nose bleed1 #cja4 ,nutricious coffee1 #cba4 ---- laxative1 #cba4 ,nurses1 duties of1 #cc4 ---- general rules1 #bdc4 ---- qualifications of1 #cj ---- responsibilities of1 #cc4 ---- should be well paid1 #ca4 ---- skilled1 #ade4 ,nursing1 rules for1 #cc4 ,nux vomica as a poison1 #bhc1 #bhg4 ,oatmeal gruel1 #cah4 ,observation of symptoms1 #bba4 ,obstructed labor1 #aha4 ,obturator foramen1 #eg4 ,oil1 #cjb4 ,ointment for skin affections1 #cei4 ,operation cases1 #bea4 ,opium1 #bbd4 ---- for labor1 #aee4 ---- poisoning by1 #bhg4 ,opthalmia1 #cgc4 ,ordinary hurts1 #big4 ,organs of generation1 #fd4 ,os coccygis1 #ei4 ,ossa innominata1 #ef4 ,os sacrum1 #ee4 ,os tinc or os uteri1 #ff4 ,outlet of the pelvic canal1 #fb4 ,ova1 #ih4 ,ovarian neuralgia1 #hi1 #cec4 ,ovaries1 #fh1 #fi1 #gd4 ,ovum1 its development1 #ih4 ,oyster broth1 #cbd4 ,oysters1 #cab4 ,pains1 #abh1 #abi4 ,palpation for diagnosis1 #adj4 ,palpitation of the heart1 #bf1 #ced4 ,panada1 #cah1 #cbb4 ,paralysis1 #bag1 #bah4 ,paregoric1 #bfh4 ,parotitis1 or mumps1 #bhj4 ,parturition1 #abc1 #abe4 ,passion1 ill effects of during pregnancy1 #ba4 ,pelvis1 #ee1 #fj1 #fb4 ,percussion1 #ajf4 ,perineum1 #fe4 ,period of gestation1 #abd4 ,persons asphyxiated1 #bhh4 ,phthisis1 tubercular1 #bgg4 ,phosphorus1 poisoning by1 #bhf4 ,physician should be selected1 #bh4 ,physiology of ftal life1 #aji4 ---- of uterus and ovaries1 #gj4 ,physiological phenomena of labor1 #abf4 ,piles in pregnancy1 #bd1 #bgc4 ,piles ointment1 #cfa4 ,placenta1 #ajj1 #aja4 ---- adherent1 #aca1 #afj4 ---- previa1 #aic4 ,placental presentations1 #aja1 #aic4 ,pleurisy1 #bbe4 ,pneumonia1 #bbj4 ,poached eggs1 #cbd4 ,poisons and their antidotes1 #bha1 #bhd4 ,position of patient during parturition1 #adh4 ,position of the ftus in utero1 #ajg4 ,post partem hemorrhage1 #afa4 ,potus imperialis1 #cba4 ,poultices1 alum1 #bcc4 ---- bread1 #bcb4 ---- charcoal1 #bcd4 ---- conium1 #bcd4 ---- yeast1 #bcc4 ,powerless labor1 #ahj4 ,precocious unions1 #ad4 ,precursory symptoms of labor1 #ce1 #cf4 ---- ---- the menses1 #ga4 ,pregnancy and confinement1 #ac4 ---- disorders incident to1 #bb1 #aci4 ---- duration of1 #abd4 ,premature infants1 #ed4 ---- labor1 #abj4 ,premonitory symptoms of labor1 #abf4 ,preparation for labor1 the bed1 #cg4 ---- ---- ---- ---- dress1 #cg4 ---- ---- ---- ---- room1 #ch4 ---- of food1 #cji4 ,presentation of the face1 #ada1 #ahc4 ---- ---- feet or knees1 #ahe4 ---- ---- head1 #adj4 ---- ---- shoulder1 #ahe1 #ahg4 ---- ---- side1 #ahe1 #ahg4 ---- ---- superior extremities1 #ada1 #ahe4 ,presentation and positions1 #ace1 #abf4 ,process of generation1 #ic4 ,procidentia1 #gf4 ,profuse menstruations1 #ib4 ,prolapsis1 #gf4 ,pruritis vulva1 #bf1 #cfb4 ,puberty1 the age of1 #ga4 ---- the change it works1 #ga14 ,pubis1 #eh4 ,puerperal convulsions1 #aid4 ,puerperal mania1 #afi4 ,puerperal septicemia1 #afi4 ,pulse4 ,the rate1 #bjf4 ---- ---- regularity1 #bjg4 ---- ---- hardness1 #bjg4 ,pure air1 #baa4 ,purgatives1 #cdb4 ,pus1 #aff4 ,pies1 #cac4 ,pyemia1 #bec4 ,qualities transmitted by parents1 #cae4 ,quickening1 #aaf4 ,quinsy1 #bge4 ,quiet after confinement1 #dc4 ,recipes for sick cookery1 #cad4 ,reckoning1 how to make the1 #abd4 ,regimen1 #bfb1 #cjb4 ,remedies for common use1 #bfb4 ,remedies to prevent costiveness1 #cjb4 ,removal of the placenta1 #ci4 ,reproduction1 #ic4 ,restorative soup for invalids1 #cbd4 ,respiration1 #bji4 ---- a diagnostic symptom1 #baj4 ,retention of the urine1 #dg1 #aeb1 #agd4 ,retroflexion of the uterus1 #hc4 ,rheumatism1 #cce1 #cdg1 #cec4 ,rice gruel1 #cah4 ,rice cream1 #cai4 ,rickets1 #bah1 #bai4 ,rigid os uteri1 #aed4 ,rigid perineum1 #aee4 ,rigor mortis1 #bdb4 ,ringworm1 #cfb4 ,rubeola1 measles1 #bgd4 ,rules in nursing1 #bdc4 ,rules of diet for convalescents1 #caj4 ,rupture of the naval1 #agj4 ,sacrum1 #ee4 ,sage tea1 #caf4 ,sagittal suture1 #ajh4 ,salt water1 #bii1 #cjj4 ,sanguinaria powder1 #bfc4 ,saucepans1 #caj4 ,scalds1 #bib4 ,scarlatina or scarlet fever1 #bgh4 ,sciatica1 #cce4 ,secretion of milk1 #afe4 ,sedatives1 #bbd1 #cec4 ,septicemia1 #afi4 ,setons1 #bbi4 ,shock1 #afc4 ,show1 a sign of labor1 #abh4 ,shower bath1 #bja4 ,sick headache1 #bgj4 ,sick room1 #ch4 ,signs of approaching labor1 #ce1 #abg ,signs of death1 #bdb4 ,signs of pregnancy1 #aac1 #aah4 ,size of the pelvis1 #fa4 ,size of the ftus1 #ajf4 ---- ---- ---- head1 #ajg4 ,skilled nursing1 #ade4 ,sleep during pregnancy1 #ba4 ---- position in1 #ba4 ,sleeping rooms1 #bj1 #bab4 ,sleeplessness1 #cjc4 ,slight hurts and ailments1 #bie4 ,slippery elm bark tea1 #caf4 ,soda and water1 #cja4 ,soda mint1 #cch4 ,solution of chlorinated soda1 #cea4 ,sore mouth1 #age4 ,sore nipples1 #bg1 #cei1 #cfj4 ,soup1 #cab1 #cba1 #cbd4 ,sour stomach1 #bgj1 #ccf4 ,sour milk1 #caa4 ,spirit vapor bath1 #bdi4 ,sponge baths1 #de1 #bdi4 ,sponges1 #beb4 ,sprains1 #big4 ,spurious labor pains1 #abd4 ,stays1 #ai4 ,strangury1 #cjb4 ,strapping1 #bed4 ,stupes1 #bca4 ,subacute rheumatism1 #cec4 ,suckling the child1 #dh4 ,summer complaints1 #bfh4 ,sunstroke1 #bhj4 ,suppositories1 #agc1 #ceb4 ,surgical cases1 #bea4 ,surgical nursing1 #bea4 ,sutures1 sagittal1 #ajh4 ---- coronal1 #ajh4 ---- lambdoidal1 #ajh4 ,sweating1 excessive1 #bih4 ,symphasis pubis1 #fa4 ,symptomotology1 #aif4 ,symptoms of disease1 subjective1 #bjd1 #bjf4 ---- ---- objective1 #bjf4 ---- ---- character of the pain1 #bje4 ---- ---- tenderness1 #bje4 ---- ---- itching1 #bje4 ---- ---- nausea1 #bje4 ---- ---- thirst1 #bjf4 ---- ---- the pulse1 #cjf4 ---- ---- ---- temperature1 #bjh1 #bae4 ---- ---- ---- respiration1 #bji4 ---- asthma1 #bag ---- hydrocephalus1 #bah1 #bai4 ---- hysteria1 #bgh4 ---- earache1 #bah4 ---- brain affections1 #bai4 ---- chorea1 #bai1 #bag4 ---- bronchitis1 #bbj4 ---- sunstroke1 #bhj4 ---- inflammation1 #bad4 ---- poisoning1 #bhb4 ,syncopes fainting1 #bgj1 #bha4 ,syrup of ipecac1 #bfg1 #bga4 ,table tea1 #cbj4 ,table of abbreviations1 c41 #ccj4 ,tampons1 #hj1 #ha4 ,tartar whey1 #cag4 ,tar water1 #de1 #cjj4 ,teething1 #bif4 ,tedious labor1 #aea1 #agh4 ,temperature of the patient1 #bjg4 ---- ---- sick room1 #bac4 ---- ---- baths1 #bdh4 ---- how taken1 #bjh4 ,temperaments1 #af4 ,temperate bath1 #bdh4 ,tepid baths1 #bdh4 ,tetanus1 #bec4 ,the first few months after marriage1 #af4 ,thermometer1 #bgf4 ,throat diseases1 #bfd4 ,tenderness1 #bec4 ,terminations of inflammation1 #bae4 ,tin1 poisoning by1 #bhe4 ,tieing the cord1 #ci4 ,tinea capitis or scald head1 #cei4 ,tincture of iodine1 #bbh4 ,thirst1 #dd4 ,thrush1 #age4 ,tongue1 coated1 #bbj4 ,treatment of infantile diseases1 #bag4 ,treatment of inflammation in emergencies1 #bbd4 ---- ---- ---- in the incipient stages1 #bbc4 ---- ---- ---- by veratrium1 #bbd4 ---- ---- ---- by aperients1 #bbd4 ---- ---- ---- by opium1 #bbd4 ---- ---- ---- by counter irritants1 #bbe4 ---- ---- ---- by vesicants1 #bbe4 ---- ---- ---- by topical applications1 #bbe4 ---- ---- ---- by liniment1 #bbf4 ---- ---- ---- by mustard1 #bbf4 ---- ---- ---- by blisters and cupping1 #bbg4 ---- ---- ---- by leeches1 #bbi4 ---- ---- ---- by fomentations1 #bca4 ,toast1 #cbb4 ,toast water1 #caf4 ,tonics1 #cee4 ,tonic in neuralgia1 #cef4 ,toothache drops1 #ced4 ,touch1 #abf4 ,turn of life1 #gb4 ,tuber ischii1 #eh4 ,tubercular phthisis1 #bgg4 ,typhoid fever1 #bgh4 ,typhus fever1 #bgh4 ,ulcer1 gastric1 #ccd4 ,umbilical cord1 #aja4 ,umbilical artery and vein1 #aja1 #aaa4 ,undilatable os uteri1 #aed4 ,urethra1 #fd4 ,urinary and generative organs1 #fe4 ,urine1 incontinence of1 #cee4 ---- retention of1 #dg4 ---- should be examined1 #bi4 ,uses of the pelvis1 #fc4 ,uterine derangements1 #fe4 ,uterus1 description of1 #fe1 #ff1 #fg1 #gj4 ---- displacement of1 #gf4 ---- antiflexion of1 #hd4 ---- anti-version of1 #he4 ---- retroflexion of1 #hc4 ---- retroversion of1 #he1 #ha4 ---- prolapsis of1 #gg4 ,utero gestation1 #ie4 ,vagina1 #fh1 #adb4 ,vaginal cystocele1 #adb1 #ahb4 ,vaginal injection1 #cea4 ,vaginal touch1 #adj4 ,vapor baths1 #bdh4 ,vegetable soup1 #cba4 ,ventilation1 #bj1 #bab4 ,ventilation of bedrooms1 #bac4 ,veratrium viride1 #bbd1 #bfe4 ,versions of the uterus1 #he4 ,vesical calculi1 #adb4 ,vesicants1 #bbe1 #bbg4 ,vinegar whey1 #cae4 ,vomiting1 #cbd4 ,vomiting in pregnancy1 #bb4 ,warm baths1 #bdh4 ,warm water1 effects of1 #bej4 ,washing the child1 #dj1 #eb4 ,waters1 breaking of the1 #aeb4 ,water1 cold1 #dd1 #bih4 ---- hot1 #big4 ,water bed1 #bdg4 ,weaning1 #cjh4 ,wet girdle1 #bii4 ,wet cups1 #bbi4 ,wet nurse1 #ea1 #agd4 ,wet pack1 #bdh4 ,wet sheet pack1 #bdh ,whites or leucorrha1 #cee4 ,whooping cough1 #cjc1 #cci4 ,witch hazel1 #bga4 ,woman1 and her diseases1 #ge4 ,womb1 #ff4 ,worms1 #cej4 ,wounds1 incised1 #bed4 ---- contused1 #bee4 ---- punctured1 #bef4 ---- poisoned1 #bef4 ,,the ,,end4 ---------------------------------------- -------------------------------- ,,transcriber',s ,,notes #a4 ,p4 #bj1 changed 8out to be0 to 8ought to be04 #b4 ,p4 #afj1 changed 8dark lived color0 to 8dark livid color04 #c4 ,p4 #bgg1 changed 8pulse is below #ij0 to 8temperature is below #ij04 #d4 ,made corrections mentioned in the ,errata sections4 #e4 ,changed all double period 7447 ditto marks in the ,index to #b em dashes 7----74 #f4 ,silently corrected typographical errors4 #g4 ,retained anachronistic and non-standard spellings as printed4 #h4 ,enclosed italics font in underscores4