,,ob/etrics ,,= ,,nurses ,,by ,,*>les ,b4 ,,re$1 ,m4,d41 ,ob/etrician to ,wesley ,memorial ,hospital1 ,*icago4 ,,"o ,,hundr$ ,,?irty ,,illu/rations ,,/4 ,,l\is ,c4 ,v4 ,,mosby ,,company #aiag ,,copyright1 #aiag1 ,,by ,c4 ,v4 ,,mosby ,,company ,press ( ,c4 ,v4 ,mosby ,company ,/4 ,l\is ,,to ,,8 ,,loyal ,,fri5d ,,eug5e ,s4 ,,gilmore ,,?is ,,book ,,is ,,affectionately ,,d$icat$ ,,by ,,! ,,au?or ---------------------------------------- -------------------------------- ,,preface ,x might seem t an apology 0 necess>y = pres5t+ a new textbook on ob/etrics = nurses :5 s _m are to be _h = ! ask+4 ,b :5 a tea*] is r>ely or nev] satisfi$ ) 8 own "w x is too mu* to expect t he w ev] fully endorse ! product ( ano!r4 ,x may be !re=e l>gely a p]sonal matt] t none ( ! exi/5t books seem to exhibit ! fullness ( in=mation1 ! concis5ess ( expression1 & ! emphasis due to c]ta9 subjects t ! pres5t writ] w\ld hope to f9d4 ,! necessities app>5tly dem& su* an arrangem5t ( our ob/etrical doctr9e t ! book may s]ve = class in/ruction & at ! same "t be complete en\gh = po/-graduate ref]5ce4 ,to secure ?is mu* discrim9ation is necess>y4 ,! confusion att5dant ^u ov]abundance mu/ be avoid$ z well z ! disc\ragem5t t is n infrequ5tly produc$ by a l>ge book or a p]iphra/ic /yle4 ,hi!rto !re has be5 a t5d5cy to tea* ! nurse too little r ?an too mu* b conditions h *ang$4 ,vocational in/ruction is n only m me?odical & f> rea*+ b x is developm5tal4 ,! pres5t day nurse expects n m]ely to assi/ ! physician & e>n a /ipulat$ rew>d1 b %e is con/antly al]t to atta9 h] own maturity z a pr(essional woman4 ,to be a capable & intellig5t assi/ant x is n suffici5t to h a cle> compreh5sion ( h] p>ticul> duties1 b %e mu/ h a def9$ & critical conception ( :at ! doctor is aim+ to accompli%4 ,?is is especially true 9 ob/etrics :]e ! nurse has ! additional responsibility ( giv+ support & c\nsel to h] pati5t 9 ! v>i\s em]g5cies t arise4 ,moreov]1 to atta9 h] intellectual maturity ! nurse mu/ /rive unremitt+ly to und]/& ! complicat$ processes t take place "u h] obs]vation4 ,%e mu/ coop]ate ) h] doctor ^: associate %e is & secure ! confid5ce ( h] pati5t :o relies ^u h] = guidance 9 ! p]ils %e is fac+4 ,= *ildbir? is a p]il4 ,x is no long] ! normal process x once 04 ,civilization has *ang$ ! %ape ( ! pelvic bones1 alt]$ ! muscles ( p>turition & weak5$ ! n]ve c5t]s t control ! ev5t4 ,! bir? ( a *ild is equal 9 sev]ity & s]i\sness to _m ( ! major op]ations4 ,x is n an affair to be ent]$ ^u lightly nor manag$ )\t ! utmo/ =esight & c>e4 ,! dang]s t are recogniz$ & prep>$ = 9 ?is book by :at may seem to "s to be an extravagant te*nic1 are v real dang]s1 extremely subtle1 & aga9/ !m at times e precaution & e def5se proves unavail+4 ,nev]!less1 skill1 ?\ghtfulness1 & above all1 cleanl9ess1 w av]t ! wor/1 z well z unhappily ! mo/ common ( ^! disa/]s4 ,if our nurses c\ld be conv9c$ ( ?is1 ! difficulties & appreh5sions ( *ildbir? w\ld be greatly dim9i%$4 ,! nurse %\ld see to x t h] pati5t is surr\nd$ by all ! precautions & safegu>ds aga9/ infection t %e w\ld dem& = a memb] ( h] own family4 ,?is means ( c\rse t h] "w w be f> m exact+ & on]\s b also x w save _m nights ( anxiety & n infrequ5tly a life4 ,?is book repres5ts ! ob/etric ideas & te*nic :i* ! writ] has endeavor$ = ye>s to impress ^u 8 /ud5ts & nurses ) su* em5dations & *anges z exp]i5ce & sci5tific progress h sugge/$4 ,x is a selective ess5ce di/ill$ f ! recurr5t h>ve/s t work]s 9 ?is field h br\ght =? dur+ c5turies ( consecrat$ ef=t4 ,to all ^! =]unn]s ! writ] ackn[l$ges a deep p]sonal indebt$ness4 ,9 ! prep>ation ( ! book ?anks are due p>ticul>ly to ,*>lotte ,gregory1 ,head ,nurse ( ! ,wesley ,mat]nity1 ^: r>e ability z tea*]1 te*nician & executive & ^: untir+ vigilance has be5 a lead+ factor 9 secur+ & ma9ta9+ ! high /ate ( effici5cy 9 ?is dep>tm5t4 ,%e has k9dly contribut$ ,*apt]s ,,xxiii & ,,xxiv1 toge!r ) valuable sugge/ions & criticisms 9 o!r portions ( ! text4 ,! au?or also takes pleasure 9 ackn[l$g+ 8 obligations to ,flor5ce ,olm/ead1 ,head ,nurse ( ! ,disp5s>y ( ! ,nor?we/]n ,univ]sity ,m$ical ,s*ool1 ^: long exp]i5ce 9 fe$+ babies gives to h] words an unque/ion$ au?ority4 ,*apt] ,,xxii is almo/ entirely h] "w4 ,to ! v>i\s publi%]s :o h c\rte\sly all[$ ! reproduction ( valuable illu/rations f ! books ( o!r writ]s ?anks are also ext5d$1 & to 8 own publi%]s especially = _! cordial & sympa!tic coop]ation ! au?or wi%es to express 8 w>me/ gratitude4 ,c4 ,b4 ,r4 ,*icago1 #aiag4 ,,cont5ts ,,*apt] ,i ,,page ,,anatomy #ag ,,*apt] ,,ii ,,physiology #cc ,,*apt] ,,iii ,,normal ,,pregnancy #ea ,,*apt] ,,iv ,,hygi5e ,,( ,,normal ,,pregnancy #ff ,,*apt] ,v ,,abnormal ,,pregnancy #gd ,,*apt] ,,vi ,,abnormal ,,pregnancy 7,,cont9u$7 #hi ,,*apt] ,,vii ,,prep>ations ,,= ,,labor ,,& ,,! ,,normal ,,c\rse ,,( ,,labor #ih ,,*apt] ,,viii ,,! ,,me*anism ,,( ,,normal ,,labor #abj ,,*apt] ,,ix ,,! ,,c>e ,,( ,,! ,,pati5t ,,dur+ ,,normal ,,labor #abi ,,*apt] ,x ,,! ,,normal ,,pu]p]ium #aea ,,*apt] ,,xi ,,unusual ,,pres5tations ,,& ,,positions #afe ,,*apt] ,,xii ,,op]ations #agi ,,*apt] ,,xiii ,,m9or ,,op]ations #bjj ,,*apt] ,,xiv ,,complications ,,9 ,,labor #bad ,,*apt] ,,xv ,,complications ,,9 ,,labor 7,,cont9u$7 #bbh ,,*apt] ,,xvi ,,! ,,abnormal ,,pu]p]ium #bdb ,,*apt] ,,xvii ,,infection #bee ,,*apt] ,,xviii ,,! ,,c>e ,,( ,,! ,,*ild #bfe ,,*apt] ,,xix ,,! ,,c>e ,,( ,,! ,,*ild 7,,cont9u$7 #bgh ,,*apt] ,,xx ,,! ,,c>e ,,( ,,! ,,*ild 7,,cont9u$7 #bhg ,,*apt] ,,xxi ,,! ,,c>e ,,( ,,! ,,*ild 7,,cont9u$7 #bih ,,*apt] ,,xxii ,,infant ,,fe$+ #caj ,,*apt] ,,xxiii ,,cleanl9ess ,,& ,,/]ilization #cbc ,,*apt] ,,xxiv ,,diets ,,& ,,=mul #ccj ,,*apt] ,,xxv ,,solutions ,,& ,,!rapeutic ,,index #cdj ,,illu/rations ,,fig4 ,,page #a4 ,! normal female pelvis #ah #b4 ,! planes ( ! brim1 ! cavity1 & ! outlet #ai #c4 ,visc]al relations #bj #d4 ,ut]us & app5dages #bb #e4 ,normal position ( pelvic organs #bd #f4 ,! ext]nal g5itals #be #g;,a4 ,v>ieties ( hym5 #bg #g;,b4 ,v>ieties ( hym5 #bh #h;,a4 ,! excret+ ducts ( ! mamm>y gl& #bi #h;,b4 ,lobules & duct ( ! mamm>y gl& #bi #i4 ,nipple1 areola1 & ! gl&s ( ,montgom]y #cj #aj4 ,sup]num]>y milk gl&s 9 ! axill #ca #aa4 ,! ?ree ages ( ! brea/ #ca #ab4 ,developm5t ( ! ov>y #cd #ac4 ,graafian follicles #ce #ad4 ,human sp]matozoa #cf #ae4 ,! *orionic villi ab\t ! ?ird week ( pregnancy #ch #af4 ,diagram illu/rat+ relations ( /ructures ( ! human ut]us at ! end ( ! sev5? week ( pregnancy #ci #ag4 ,mat]nal surface ( ! plac5ta & membranes #dj #ah4 ,ftal surface ( human plac5ta #da #ai4 ,! egg at t]m ) ut]us remov$ #db #bj4 ,normal attitude ( ftus #dc #ba4 ,ftal skulls %[+ sutures #dd #bb;,a4 & ,b4 ,*ild's head at t]m1 %[+ diamet]s #de #bc4 ,! ftal circulation #di #bd4 ,gravid ut]us at ! end ( ! eigh? week #eb #be4 ,/ri gravid>um #ed #bf4 ,bimanual exam9ation #fj #bg4 ,abdom9al enl>gem5t at diff]5t mon?s ( pregnancy #fc #bh4 ,height ( ! ut]us at v>i\s mon?s ( pregnancy #fd #bi4 ,tw9s #hc #cj4 ,diagram repres5t+ ! sites = ! v>i\s =ms ( tubal pregnancy #ij #ca4 ,abdom9al b9d] ) crosspiece to hold vulv> pads #ajj #cb4 ,t-b9d]1 us$ 9 all cases aft] ! fif? day po/ p>tum #ajj #cc4 ,brea/ b9d] #aja #cd4 ,baby's dress ) w+$ sleeves #ajb #ce4 ,! bag ( wat]s beg9s to act on ! c]vix #aaa #cf4 ,! effect ( ! pa9s4 ,! c]vix be=e labor beg9s #aab #cg4 ,! effect ( ! pa9s4 ,! c]vix beg9s to be 8effac$0 #aab #ch4 ,! effect ( ! pa9s4 ,! c]vix is effac$1 & ! dilatation ( ! os beg9s #aac #ci4 ,! effect ( ! pa9s4 ,! c]vix is effac$ & ! os cont9ues to dilate #aac #dj4 ,! c]vix is effac$ & ! os dilat$ #aae #da4 ,*ild 9 second /age ( labor #aaf #db4 ,! head pass+ ov] ! p]9eum #aag #dc4 ,normal expulsion ( ! plac5ta accord+ to ,s*ultze #aah #dd4 ,! *ild 9 left-occipito-ant]ior position #abb #de4 ,! *ild 9 "r-occipito-ant]ior position #abc #df4 ,! desc5t ( ! head 9 "r-occipito-ant]ior position #abd #dg4 ,int]nal ant]ior rotation & ext5sion ( ! head 9 a left-occipito-ant]ior position #abd #dh4 ,ext5sion #abe #di4 ,ext5sion complet$4 ,expulsion #abe #ej4 ,a cephalhmatoma #abg #ea4 ,po9ts ( greate/ int5sity ( ftal he>t tones #acj #eb4 ,h&l+ =ceps1 kept /]ile 9 a j> ( alcohol #acb #ec4 ,palpation4 ,:at is 9 ! pelvis8 #acd #ed4 ,palpation4 ,:at is 9 ! fundus8 #ace #ee4 ,palpation4 ,:]e is ! back8 ,:]e are ! small p>ts8 #acf #ef4 ,pati5t drap$ = int]nal exam9ation #acg #eg4 ,deliv]y 9 side position #ada #eh4 ,%eet twi/$ into a sl+ #adg #ei4 ,repair ( p]9eum #adh #fj4 ,! progress ( involution #aeb #fa4 ,! bree*4 ,left-sacro-ant]ior position #aff #fb4 ,! bree*4 ,left-sacro-po/]ior position #afg #fc4 ,extraction ( ! bree* #agj #fd4 ,bree* deliv]y4 ,extraction ( ! trunk #aga #fe4 ,bree* deliv]y4 ,deliv]+ ! %\ld] #agb #ff4 ,! deliv]y ( ! aft]-com+ head by ! ,smellie-,veit maneuv] #agb #fg4 ,%\ld] pres5tation #agc #fh4 ,face pres5tation #age #fi4 ,desc5t ( ! *9 9 face pres5tation #agf #gj4 ,deliv]y 9 face pres5tation #agg #ga4 ,exagg]at$ li?otomy position #aha #gb4 ,dorsal position :5 assi/ants are available #ahb #gc4 ,in/rum5ts = artificial deliv]y ( ! head #ahc #gd4 ,=ceps op]ation4 ,introduction ( ! left blade #ahf #ge4 ,=ceps op]ation4 ,! introduction ( ! "r blade #ahg #gf4 ,=ceps op]ation4 ,lock+ ! h&les #ahg #gg4 ,=ceps op]ation4 ,! way ! blades %\ld grasp ! ftal head #ahh #gh4 ,=ceps op]ation4 ,traction on ! h&les #ahi #gi4 ,=ceps op]ation4 ,! deliv]y ( ! head #ahi #hj4 ,v]sion4 ,seiz+ a foot #aij #ha4 ,v]sion4 ,! *ild rotates z pressure is made ^u ! head & traction ^u ! foot #aia #hb4 ,v]sion is complete :5 ! knee appe>s at ! vulva #aib #hc4 ,! ,wal*] position #aid #hd4 ,! ,wieg& compression ( ! *ild's head to =ce x into ! pelvis #aie #he4 ,! ,naegele p]=ator #aif #hf4 ,app>atus = gett+ a /]ile specim5 ( ur9e f an infant #bja #hg4 ,tampon ( ! ut]us #bjc #hh4 ,tampon ( vag9a #bjd #hi4 ,pean =ceps #bjh #ij4 ,h& bulb syr+e2 & ,vorhees bags2 bag roll$ & grasp$ by ,pean =ceps ready = introduction #bji #ia4 ,vorhees bag 9 place #baj #ib4 ,episiotomy #bab #ic4 ,v>i\s =ms ( pelvic de=mity #bae #id4 ,! pelvimet] #baf #ie4 ,! v>i\s diamet]s ( ! inlet #baf #if4 ,measur+ ! di/ance betwe5 ! ant]ior sup]ior sp9es ( ! pelvis #bag #ig4 ,measur+ ! ext]nal conjugate #bah #ih4 ,measur+ ! diagonal conjugate ) ! f+] #bai #ii4 ,v>i\s =ms ( plac5ta prvia #bbi #ajj4 ,! knee-elb[ po/ure #bcf #aja4 ,! knee-*e/ po/ure #bcf #ajb4 ,! exagg]at$ li?otomy position obta9$ ) a %eet sl+ #bcg #ajc4 ,! improvis$ ,tr5del5burg position #bcg #ajd4 ,! dorsal position ) /irrups #bch #aje4 ,dorsal position across ! b$ #bci #ajf4 ,flex$ dorsal position ) feet on ! table #bdj #ajg4 ,! ,sims position #bda #ajh4 ,examples ( imp]fect nipples #bde #aji4 ,a /&>d nipple %ield #bdf #aaj4 ,a /&>d brea/ pump #bea #aaa4 ,g]ms mo/ frequ5tly f\nd 9 cases ( pu]p]al fev] #bef #aab4 ,rubb] ba? tub #bff #aac4 ,! ,pettit cord clamp #bfh #aad4 ,/&>d brea/ pump2 ,/&>d nurs+ bottle2 ! brea/ tray2 ! ,wansbr\gh lead nipple %ield2 ! ,brophy nipple = h>elip & cleft palate #bga #aae4 ,prop] position ( "m :ile nurs+ *ild #bgd #aaf4 ,prop] me?od ( tak+ rectal temp]ature #bgf #aag4 ,me?od ( pass+ ! tra*eal ca!t] #bgi #aah4 ,byrd's me?od ( artificial respiration4 ,ext5sion & inspiration #bhj #aai4 ,byrd's me?od ( artificial respiration4 ,beg9n+ flexion & expiration #bhj #abj4 ,byrd's me?od ( artificial respiration4 ,flexion & compression #bha #aba4 ,me?od ( giv+ gavage #bhd #abb4 ,app>atus = gavage or lavage #bhf #abc4 ,cleft palate nipple #bhh #abd4 ,! device = fe$+ ! *ild ) cleft palate #bhh #abe4 ,device = assi/+ ! cleft palate *ild to nurse #bhi #abf4 ,me?od ( /rapp+ an umbilical h]nia #bij #abg4 ,prop] position = introduction ( a suppository #bii #abh4 ,hydrocephalus #cjg #abi4 ,an5cephalus #cjh #acj4 ,elem5ts ( human milk #cab ,,ob/etrics ,,= ,,nurses ,,*apt] ,i ,,anatomy ,! /udy ( ob/etrics is an inve/igation ( ! passage1 ! pass5g]1 & ! driv+ p[]s ( labor1 z well z ( ! v>i\s complications & anomalies t may att5d ! process ( reproduction4 ,! passage is compos$ ( a bony canal1 call$ ! pelvis1 & ! s(t tissues :i* l9e & almo/ close its outlet4 ,! pelvis is made up ( f\r bones2 ! sacrum1 ! coccyx1 & two o!r l>ge /ructures ( irregul> %ape1 call$ ! hip1 or innom9ate bones4 ,jo9$ by c>tilage & held 9 place by ligam5ts1 !y =m a cavity or bas9 :i*1 9 ! male is deep1 n>r[1 small & funnel-%ap$1 :ile 9 ! female1 slight] bones1 exp&$ op5+s & wid] ar*es make a broad1 %all[ *annel1 ?r\gh :i* ! *ild is born4 ,! bony pelvis is divid$ = description into two p>ts1 ! upp] or false pelvis1 & ! l[] or true pelvis4 ,! upp] pelvis is =m$ by ! w+s ( ! innom9ate bones & has b two functions ( importance to *ild-be>+4 ,x acts z a guide to direct ! *ild into ! true passage1 & :5 measur$ by ! pelvimet]1 x gives in=mation z to ! %ape & size ( ! inlet to ! true pelvis4 ,! true pelvis is ( mo/ conc]n to ! ob/etrician1 because anomalies 9 its size or %ape may imp$e ! progress ( labor or r5d] x impossible4 ,! pelvis is divid$ conv5i5tly into ?ree p>ts3 ! brim1 ! outlet1 & ! cavity4 ,! brim1 inlet1 or upp] pelvic /rait1 is ! b\nd>y l9e betwe5 ! false & true pelvis4 ,x is trac$ f ! upp] bord] ( ! symphysis along ! iliopect9eal l9e on bo? sides to ! promontory ( ! sacrum4 ,! %ape & size ( ?is op5+ v>ies mu* 9 diff]5t races & individuals1 bo? normally & ?r\gh disease2 & :5 pa?ologically alt]$1 bo? %ape & size may ex]cise a m>k$ influ5ce on ! c\rse ( labor4 ,9 ,am]ican wom51 ! outl9e ( ! brim is r\ghly he>t-%ap$1 l an ovoid ) an ind5tation :]e ! promontory ( ! sacrum imp+es ^u ! op5+4 ,illu/ration3 ,fig4 #a4--,! normal female pelvis4 7,ed547 ,! l9es ab & cd divide ! pelvis into ! "r & left ant]ior & ! "r & left po/]ior quadrants4 ab indicates ! ant]opo/]ior diamet] ( ! brim1 cd %[s ! transv]se diamet] :ile gh & ef repres5t1 respectively1 ! "r & left oblique diamet]s4 ,! brim or inlet has f\r important diamet]s to be rememb]$2 important because ! h>d1 r\nd head ( ! *ild mu/ pass ?r\gh !m by accommodat+ its diamet]s z favorably z possible to ^? ( ?is op5+4 ,^! diamet]s are nam$ respectively ! ant]opo/]ior or conjugate diamet]1 ! transv]se1 & ! "r & left oblique diamet]s4 ,! two oblique diamet]s atta9 _! greate/ importance :5 ! pelvis is irregul>ly di/ort$1 b ! o!rs are ess5tial 9 e case :]e labor imp5ds4 ,x is to secure an e/imate ( ^! latt] diamet]s t ! bony prom95ces are measur$4 ,?is upp] op5+ lies n horizontally1 b 9 oblique relation to ! body 9 /&+ position1 & ! weight ( ! abdom9al visc]a re/s l>gely ^u ! bones & 9 consequ5ce does n cr[d into ! inlet unless =c$ 9 by corsets or faulty habits4 ,illu/ration3 ,fig4 #b4--,! planes ( 7a7 ! brim1 7b7 ! cavity & 7c7 ! outlet4 7,ed547 ,pass+ ?r\gh ! brim1 a cavity is f\nd bel[ x1 midway betwe5 ! inlet & outlet1 :i* is ne>ly r\nd 9 %ape4 ,?is is ! 8excavation10 or ! true pelvis4 ,!n comes ! outlet1 b\nd$ 9 front by ! pubic ar* & s(t p>ts1 & beh9d by ! coccyx pu%$ back z f> z x c g4 ,x is ovoid 9 %ape1 b ! long axis ( ?is ovoid lies at "r angles ) ! axis ( ! ovoid inlet4 ,we f9d1 !re=e1 a succession ( ?ree geometric figures or planes ?r\gh :i* ! head mu/ pass by means ( a spiral motion call$ rotation4 ,^! figures are incl9$ to "o ano!r s m>k$ly 9 front t a l9e drawn ?r\gh ! c5t] ( ea* w curve =w>d at bo? ends1 "o end pass+ out ne> ! umbilicus1 ! o!r ?r\gh ! vulva4 ,?is is kn[n z ! axis ( ! pelvis or ! curve ( ,c>us4 ,illu/ration3 ,fig4 #c4--,visc]al relations4 7,r$rawn f ,gray47 ,,! ,,s(t ,,p>ts ,inside ! pelvis are ! organs ( g5]ation ) _! accessory /ructures & support+ tissues4 ,( fir/ importance are ! ov>ies1 tubes & ut]us1 toge!r ) ! vag9a4 ,^! special /ructures are ! true g5ital organs4 ,!y are b\nd$ 9 front by ! bladd]1 beh9d by ! rectum1 above by ! abdom9al visc]a1 & surr\nd$ ev]y:]e by muscul>1 muc\s & fatty tissues1 :i* support !m & aid _! function4 ,! ,vag9a4--,! vag9a is a holl[ organ1 ab\t f\r in*es long1 atta*$ to ! c]vix above & ! vulva bel[4 ,x is an ela/ic %ea? b\nd$ 9 front by ! bladd] & beh9d by ! rectum4 ,"u normal conditions1 ?is tube easily admits "o or two f+]s1 b dur+ labor x dilates enorm\sly to all[ ! head to pass4 ,! vag9a is l9$ ) a ?ick muc\s membrane1 ridg$ & r\gh5$ by folds1 :i* are call$ rug4 ,?us a cont9u\s *annel connects ! ov>y ) ! outside & ?r\gh x pass1 at appropriate times1 ! ovule1 ! m5/rual blood1 ! ut]9e secretions1 ! *ild1 ! plac5ta1 & ! lo*ia4 ,! ,ut]us4--,! ut]us 7womb7 is a pe>-%ap$ organ1 flatt5$ f be=e backw>d1 & compos$ ( un/rip$ or involunt>y muscle cells & connective tissue4 ,normally ! virg9 ut]us measures f two & "o-half to ?ree in*es 9 l5g?1 & weighs ab\t two ounces4 ,x is susp5d$ 9 ! middle ( ! pelvis by /rong ligam5ts1 s t ! fundus incl9es g5tly =w>d aga9/ ! bladd]4 ,:5 ! bladd] fills1 ! ut]us is pu%$ backw>d4 ,mo/ ( ! organ is int]nal1 b a small "p ( ! l[] pole is grasp$ by ! vag9a1 9 :i* ! l[] end ) its invaluable ap]ture1 ! os1 dips & sw+s4 ,! "p above ! vag9a is call$ ! body or fundus1 & is cov]$ ) ! s]\s membrane 7p]itoneum7 t l9es ! abdom9al cavity4 ,bel[ ! fundus is ! c]vix or neck1 :i* lies p>tly above & p>tly )9 ! vag9a4 ,! cavity ( ! ut]us is usually clos$ by ! apposition ( ! walls4 ,! inn] surface is cov]$ ) a peculi> k9d ( membrane call$ ! endometrium1 :i* is highly vascul>4 ,! ut]9e cavity op5s into ! vag9a ?r\gh ! os1 :i* is small & r\nd 9 ! nullip>\s woman1 & slit-%ap$ or gap+ 9 ! woman :o has borne a *ild4 ,illu/ration3 ,fig4 #d4--,ut]us & app5dages4 ,on ei!r side ( ! ut]us w be se5 ! ov>y1 ! fimbriat$ extremity ( ! tube1 ! tube1 & ! r\nd ligam5t4 ,! vag9a lies op5 bel[4 7,l5oir & ,t>ni]47 ,fallopian ,tubes4--,on ei!r side ( ! upp] end ( ! ut]us are ! orifices ( ! ,fallopian tubes1 ?r\gh :i* ! egg1 escap+ f ! ov>y1 f9ds access to ! ut]9e cavity4 ,^! tubes ext5d outw>d f ! ut]us ab\t f\r in*es1 & t]m9ate 9 a bell-%ap$ op5+ ) long1 ragg$ f+]s :i* hang loosely d[n t[>d ! ov>y4 ,! tubes are l9$ by epi!lial cells hav+ hair-l projections1 7cili7 :i* wave automatically t[>d ! ut]us4 ,?us impell$ by a g5tle curr5t1 ! egg moves def9itely along ! tube t[>d ! ut]us & aga9/ ?is curr5t ! sp]matozoa =ce _! way to meet & f]tilize ! egg4 ,! ,ov>ies4--,on ei!r side ( ! pelvis1 close to ! fr+$ end ( ! ,fallopian tube & atta*$ to x1 lies a small1 h>d1 almond-%ap$ organ1 call$ ! ov>y4 ,?is is ! intr9sic sexual gl& ( ! female4 ,x conta9s ! small cells :i* are to rip5 & become eggs4 ,ea* ov>y is said to conta9 ab\t ?irty-six ?\s& eggs1 or ovules4 ,! ,bladd]4--,! bladd] lies betwe5 ! pubic bone & ! ut]us4 ,x is a res]voir = ur9e1 fill$ by means ( two little tubes call$ uret]s1 t run d[n f ! kidneys4 ,x dra9s ?r\gh ! ure?ra :i* op5s j bel[ ! pubic bone 9 front (1 & j above1 ! vag9al op5+4 ,! bladd] %\ld be empti$ frequ5tly dur+ labor4 ,! ,anus4--,! l>ge b[el 7colon7 t]m9ates 9 an op5+ ne> ! middle ( ! g5ital crease4 ,?is op5+ is call$ ! anus4 ,x is clos$ by a contract+ muscle1 ! sph9ct]1 :i* acts l a puck]+ /r+4 ,j inside ( ! op5+ is a gr\p ( l>ge ve9s :i* may become enl>g$1 inflam$1 & ble$ dur+ pregnancy4 ,!y are !n call$ hmorrhoids4 ,! ,rectum4--,upw>d f ! anus & to ! left ( ! ut]us ext5ds ! rectum4 ,?is is ! end ( ! inte/9al canal & is suppli$ ) an abundance ( n]ves4 ,:5 ! head presses ^u x1 x gives ! s5sation ( a b[el movem5t1 & w>ns ! obs]v] ( ! l[ position ( ! head4 ,! anus p\ts z ! head comes d[n & ! ant]ior walls become visible4 ,9 sev]e cases ( labor1 ! sph9ct] is sometimes torn4 ,! b[els %\ld be empti$ by an enema z e>ly z possible 9 ! fir/ /age ( labor4 ,! ,p]itoneum4--,! p]itoneum is a ?91 gli/5+1 s]\s membrane1 :i* l9es ! abdom9al cavity & drops d[n f above ov] ! upris+ tops ( ! bladd] & ut]us4 ,fold+ toge!r at ! sides & ext5d+ to ! walls ( ! pelvis1 x encloses ! tubes & r\nd ligam5ts 9 deep1 flat masses1 call$ ! broad ligam5ts4 ,?is is ! /ructure t becomes s p]il\sly inflam$ 7p]itonitis7 :5 infect$ by g]ms t f9d entrance ?r\gh ! g5ital passage4 ,illu/ration3 ,fig4 #e4--,normal position ( pelvic organs1 se5 f above & 9 front4 ,!y are envelop$ 9 p]itoneum4 7,b\g]y & ,jacob1 9 ,am]ican ,text ,book47 ,,! ,,ext]nal ,,g5itals ,! ext]nal g5itals =m ! vulva4 ,"u ?is "n are includ$ ! mons v5]is1 ! labia majora1 ! labia m9ora1 ! clitoris1 ! ve/ibule1 ! hym5 & ! gl&s ( ,b>?ol94 ,! entire groove f ! mons v5]is to a po9t well up on ! sacrum =ms a deep fold or crevice1 :i* is kn[n z ! g5ital crease4 ,t "p ( ! g5ital crease ly+ betwe5 ! anus & vulva is te*nically kn[n z ! p]9eum 7q4v47 ,illu/ration3 ,fig4 #f4--,! ext]nal g5itals4 7,r$rawn f ,gray47 ,! ,mons ,v5]is4--,! mons v5]is is a g5tly r\nd$ pad ( fat ly+ j above ! junction ( ! pubic bones 7! symphysis74 ,! ov]ly+ integum5t is fill$ ) sebace\s gl&s & cov]$ ) hair at pub]ty4 ,! ,labia ,majora4--,! labia majora are ! l>ge lips ( ! vulva4 ,!y are loose1 d\ble folds ( sk9 ext5d+ d[nw>d f ! mons v5]is to ! ant]ior b\nd>y ( ! p]9eum & cov]$ ext]nally ) hair4 ,normally !y lie 9 apposition & conceal ! vag9al op5+4 ,!y correspond to ! male scrotum4 ,! ,labia ,m9ora4--,! labia m9ora1 or nymph1 are two small folds ( sk9 & muc\s membrane1 t ext5d f ! clitoris obliquely d[nw>d & outw>d = an in* & a half on ea* side ( ! entrance to ! vag9a4 ,on ! upp] side1 :]e !y meet & inve/ ! clitoris1 ! fold is call$ ! prepuce1 b on ! "u side !y con/itute ! frnum4 ,! labia m9ora are sometimes enorm\sly enl>g$ 9 ! black races & are !n call$ ! ,hott5tot apron4 ,! ,clitoris4--,! clitoris is an erectile /ructure analog\s to ! erectile tissue ( ! p5is4 ,! free extremity is a small1 r\nd$1 extremely s5sitive tub]cle1 call$ ! glans ( ! clitoris4 ,ab\t ! clitoris !re =ms a :iti% sub/ance call$ smegma4 ,?is is a good culture m$ium = g]ms & mu/ be c>efully spong$ away :5 ! vulva is prep>$ = deliv]y4 ,! ,ve/ibule4--,! ve/ibule is b\nd$ by ! clitoris above1 ! labia m9ora on ! sides1 & ! vag9al orifice bel[4 ,x conta9s ! op5+ ( ! ure?ra1 :i* is call$ ! meatus ur9>ius4 ,! ,hym54--,! hym5 is a ?9 fold ( membrane :i* closes ! vag9al op5+ to a great] or less] ext5t 9 virg9s4 ,x v>ies mu* 9 %ape & consi/5cy4 ,x is sometimes abs5t1 or x may p]si/ aft] copulation1 h5ce its pres5ce or abs5ce c n be consid]$ a te/ ( virg9ity4 ,:5 torn1 ! edges %r9k up & =m little irregul>ities call$ c>uncul myrti=mes4 ,illu/ration3 ,fig4 #g ,a4--,v>ieties ( hym54 7,am]ican ,text ,book47 ,b>?ol9 ,gl&s4--,b>?ol9 gl&s are locat$ on ea* side ( ! comm5cem5t ( ! vag9a4 ,ea* gl& dis*>ges by a small duct j ext]nal to ! hym54 ,!y are (t5 ! seat ( a *ronic gonorrhal inflammation & mu/ be wat*$ c>efully1 le/ infection ext5d to ! "m aft] labor1 or to ! eyes ( ! *ild 9 pass+4 ,illu/ration3 ,fig4 #g ,b4--,v>ieties ( hym54 7,am]ican ,text ,book47 ,! ,p]9eum4--,! p]9eum is a body ( muscle1 fascia1 connective tissue1 & sk91 situat$ betwe5 ! vag9a & ! rectum4 ,! vag9a b5ds =w>d & ! rectum backw>d1 s a triangul> area is left betwe5 !m :i* is fill$ by ! p]9eal body4 ,x is ab\t two in*es long f be=e backw>d1 & becomes progressively ?9n] ! deep] x ext5ds4 ,illu/ration3 ,fig4 #h ,a4--,! excret+ ducts ( ! mamm>y gl&4 7,l5oir & ,t>ni]47 ,illu/ration3 ,fig4 #h ,b4--,lobules & duct ( ! mamm>y gl&4 7,l5oir & ,t>ni]47 ,! p]9eal body is flatt5$ out & compress$ by ! passage ( ! head & 9 _m cases torn4 7,?irty p] c5t ( primip>as & t5 to fifte5 p] c5t ( multip>as47 ,x %\ld be repair$ imm$iately4 ,! ,mamm>y ,gl&s4--,! mamm>y gl&s are second>y b highly important p>ts ( ! g5ital sy/em4 ,!y are =m$ by a dipp+ d[n ( sk9 gl&s & !y p]=m ! special function ( secret+ milk4 ,! brea/ is made up ( fifte5 or tw5ty lobes1 ea* ( :i*1 l a bun* ( grapes1 clu/]s ab\t & dis*>ges into a s+le tube :i*1 9 turn1 leads to ! nipple4 ,! area betwe5 ! lobes is fill$ ) fat & connective tissue4 ,illu/ration3 ,fig4 #i4--,nipple1 areola1 & ! gl&s ( ,montgom]y4 7,ed547 ,! nipple is p9k or d>kly pigm5t$4 ,x is compos$ ( erectile tissue & "u /imulation1 x rises f ! surface ( ! gl& s t x is easily tak5 into ! m\?4 ,illu/ration3 ,fig4 #aj4--,sup]num]>y milk gl&s 9 ! axill4 ,!y may be f\nd also bel[ ! brea/s4 7,witk[ski47 ,illu/ration3 ,fig4 #aa4--,! ?ree ages ( ! brea/--virg9ity1 maturity1 & s5esc5ce4 7,witk[ski47 ,surr\nd+ ! nipple is a d>kly pigm5t$ area f "o in* to f\r in*es 9 diamet] t is call$ ! areola4 ,x conta9s h>d1 %ot-l nodules1 ! gl&s1 or tub]cles1 ( ,montgom]y4 ,^! (t5 secrete milk & sometimes become infect$4 ,x occasionally happ5s t m ?an two brea/s may be f\nd on ! human female1 & n infrequ5tly pieces ( mamm>y tissue may be discov]$ 9 ! axilla or on ! *e/ or back4 ,! mamm>y gl& is undevelop$ at bir?1 b1 nev]!less x may fill ) milk 7wit*es' milk74 ,at pub]ty1 aft] m>riage1 & dur+ pregnancy1 ! gl& rea*es maturity4 ,x is only aft] deliv]y1 h[ev]1 t ! functional climax is atta9$4 ,,*apt] ,,ii ,,physiology ,ovulation4--,ovulation is ! process :]eby ! eggs are dis*>g$ f ! ,graafian follicle :i* matures & protects !m 9 ! ov>y4 ,! egg is a true cell ) "o1 & sometimes m ?an "o1 nucleus4 ,! rip5+ ( ! eggs1 z well z _! dis*>ge1 is att5d$ ) mu* g5]al di/urbance & great physical *anges4 ,?is ph5om5on beg9s f ! twelf? to ! fifte5? ye>1 dep5d+ on race1 climate1 occupation & temp]am5t1 & m>ks ! transition ( ! individual f *ildhood into maturity4 ,?is p]iod is call$ pub]ty4 ,at ?is "t ! brea/s enl>ge1 ! hips r\nd out1 ! vag9a1 ut]us & ext]nal g5itals increase 9 size4 ,hair appe>s ^u ! vulva1 ! emotions become m evid5t1 & mode/y develops ?r\gh a consci\sness ( sexual diff]5ce & attraction4 ,simultane\sly a new function appe>s-- ,m5/ruation4--,m5/ruation may be def9$ z a process :]e9 a bloody fluid is dis*>g$ f ! ut]us at regul>ly recurr+ p]iods betwe5 pub]ty & ! m5opause1 except dur+ pregnancy & lactation4 ,x is a hmorrhage :i* 9 "s way is closely associat$ ) ovulation1 b x is n kn[n positively :i* is ! prec$5t ( ! o!r1 or :e!r "o causes ! o!r4 ,m5/ruation is n ess5tial to pregnancy1 = pregnancy may occur :5 ! fl[ is normally abs5t1 z be=e pub]ty1 aft] ! m5opause1 or dur+ lactation4 ,nev]!less1 regul>ity ( m5/ruation is ! rule 9 f]tile wom5 & cl9icians agree t :ile conception may occur at any "p ( ! m5/rual cycle1 x is mo/ likely to happ5 j be=e or j aft] ! m5/rual fl[4 ,! be/ au?orities at pres5t support ! !ory t ovulation usually occurs soon aft] ! close ( ! m5/rual p]iod4 ,?is is confirm$ by ! simil>ity ( ! physical *anges t take place 9 ! endometrium dur+ m5/ruation & aft] conception4 ,illu/ration3 ,fig4 #ab4--;,developm5t ( ! ov>y 7aft] ,wi$]%eim74 ,a1 an +r[? ( ! g]m9al epi!lium1 =m+ a cell-cord1 :i* breaks up into primitive ,graafian follicles2 ,b1 a primitive ,graafian follicle1 ) its conta9$ primitive ovum2 ,c1 ,d1 ,e1 lat] /ages 9 ! developm5t ( ! ,graafian follicle4 7,cross547 ,z ! p]iod ( ! fl[ approa*es1 ! l9+ membrane ( ! ut]us becomes hyp]mic & swoll5 ) blood1 s]um1 & gl&ul> secretions4 ,! blood vessels are engorg$1 ! gl&s become long] & m tortu\s1 little hmorrhages appe>1 & ! sup]ficial epi!lium is ?r[n (f4 ,a l>ge am\nt ( mucus is produc$ by ! increas$ activity ( ! gl&s1 & all is dis*>g$ into ! vag9a z a bloody1 incoagulable fl[ ) an odor ( m>igolds4 ,! process cont9ues usually f ?ree to sev5 days1 :5 ! dis*>ge ceases & ! endometrium sl[ly resumes its unconge/$ /ate4 ,illu/ration3 ,fig4 #ac4--;,graafian follicles4 ,"o conta9s two ovules :i*1 if f]tiliz$1 w produce tw9s4 ,if all ?ree ovules are f]tiliz$1 triplets w result4 7,bumm47 ,mean:ile1 ! psy*ic & bodily conditions h n rema9$ unaffect$4 ,! n]v\s sy/em is di/urb$1 ! disposition is irritable & caprici\s & ! head may a*e4 ,! woman takes cold easily4 ,%e is indispos$ to ex]tion f a s5se ( languor & malaise4 ,pa9 may develop 9 ! back1 or cramps 9 ! pelvis1 s sev]e z to keep ! woman 9 b$4 ,frequ5tly ! approa* ( ! p]iod is signaliz$ by sk9 *anges1 su* z a m>k$ odor or an eruption ( acne pu/ules4 ,! fl[ usually returns e tw5ty-eight days1 b x may v>y )9 normal limits f tw5ty-"o to ?irty days4 ,! fl[ cont9ues at su* int]vals regul>ly f pub]ty to ! m5opause 7*ange ( life71 :i* occurs betwe5 ! ages ( =ty-five & fifty4 ,conception1 or ,f]tilization4--,?is is ! process :]e9 ! male elem5t 7sp]matozoon7 meets & unites ) ! female egg4 ,f :at is kn[n f inve/igations ( l[] animals1 ?is meet+ usually takes place 9 ! ,fallopian tube4 ,illu/ration3 ,fig4 #ad4--;,human sp]matozoa4 h1 head2 c1 int]m$iate portion2 t1 tail4 7,williams47 ,! egg expell$ f ! ov>y is c>ri$ into ! op5 end ( ! tube by p]itoneal curr5ts & pass$ on t[>d ! ut]us by ! wav+ action ( ! hair-l outgr[?s ( ! cells 7cili7 t l9e ! tube1 aid$1 possibly1 by ! tubal muscle4 ,! sp]matozoon makes its way upw>d f ! vag9a by means ( its tail4 ,?is activity1 l ! tail ( a fi%1 or snake1 or z a boat is scull$1 drives ! cell =w>d ?r\gh ! ?9 lay] ( fluid t cov]s ! muc\s membranes4 ,! arr[-%ap$ sp]matozoon travels at a rate t completes ! passage to ! ov>y 9 tw5ty-f\r h\rs1 b sp]matozoa may lie 9 wait = ! egg a consid]able "t1 z is %[n by ! fact t !y h be5 f\nd alive 9 ,fallopian tubes remov$ ?ree & a half weeks aft] copulation4 ,z soon z ! male & female elem5ts approa* ea* o!r1 !y ex]cise a p[]ful magnetic attraction1 :i* draws !m toge!r1 & z soon z !y t\*1 ! two cells unite & ! sp]matozoon almo/ imm$iately disappe>s4 ,only "o sp]matozoon is requir$ = ! f]tilization ( an egg1 & h5ce enorm\s numb]s mu/ p]i% )\t a*iev+ _! de/9y4 ,! f]tiliz$ egg has become ! ovum1 & orig9ally #a_/abe ( an in* 9 diamet]1 x n[ beg9s to gr[1 & fill$ ) a new en]gy1 x passes d[n ! tube & ent]s ! ut]us4 ,"h x comes into contact ) ! s(t mucosa & digs a hole = itself--a ne/1 v mu* z a w>m bullet might s9k into ice or sn[--& is soon completely surr\nd$ by a prolif]at+ tissue call$ ! decidua4 ,! woman is n[ pregnant4 ,! m5/rual fl[ does n appe>1 & local & sy/ematic *anges are inaugurat$4 ,! egg enl>ges rapidly4 ,little glove-f+]-l projections 7! villi7 appe> on its surface & dip d[n into ! mat]nal tissues4 ,?r\gh ^! villi ! egg gets n\ri%m5t until ab\t ! twelf? week1 :5 ! plac5ta =ms4 ,ext]nally ! ovum resembles a *e/nut burr4 ,z ! egg gr[s1 ! villi on ! surface f9d x m & m difficult to secure nutrim5t1 & except at "o place1 all gradually %r9k & disappe>4 ,at ?is significant po9t1 !y increase greatly 9 size1 numb]1 & complexity to =m ! ?ick1 cake-l plac5ta4 ,! egg or ovum is simply a gr[+ cy/1 fill$ ) a fluid1 normally /]ile1 9 :i* ! develop+ embryo lives & swims4 ,?is fluid is ! liquor amnii & x is reta9$ by a cy/ic wall made up ( two lay]s--! *orion1 :i* repres5ts ! orig9al cell membrane1 & ! amnion1 :i* develops out ( ! ftus4 ,at maturity1 ! ovum w conta9 f "o to two p9ts ( liquor amnii4 ,illu/ration3 ,fig4 #ae4--,! *orionic villi ab\t ! ?ird week ( pregnancy4 7,edg>47 ,! ,liquor ,amnii4--,! liquor amnii is ( va/ importance to ! *ild4 ,x all[s free movem5t = ! gr[+ limbs & body1 protects ! *ild f sudd5 *anges ( temp]ature1 prev5ts injury bo? f )\t & )91 saves ! *ild f bir?m>ks & de=mities by keep+ x f contact ) ! surr\nd+ walls1 & 9 labor lubricates ! passages = ! advanc+ "p4 ,9 a measure1 too1 x probably s]ves z a food4 ,9 labor x =ms a p\* call$ ! bag ( wat]s1 :i* aids 9 dilat+ ! os4 ,illu/ration3 ,fig4 #af4--;,diagram illu/rat+ relations ( /ructures ( ! human ut]us at ! end ( ! sev5? week ( pregnancy4 7,am]ican ,text ,book47 ,gradually1 z nutrition becomes m abundant at ! site ( ! gr[+ plac5ta1 a /alk-l /ructure ?ru/s out f ! ftal abdom5 & =ms an atta*m5t ) ! =mative plac5ta4 ,?is is call$ ! v5tral /alk & z soon z ! communication ) ! plac5ta is e/abli%$1 x is comb9$ ) o!r p>allel /ructures & becomes vascul>iz$1 to =m ! umbilical cord4 ,illu/ration3 ,fig4 #ag4--,mat]nal surface ( ! plac5ta & membranes4 ,! cord protrudes f ! cavity :i* held ! ftus4 7,edg>47 ,! ,umbilical ,cord4--,! umbilical cord at maturity measures f five to fifty in*es 9 l5g? & f "o-half to "o in* 9 ?ickness4 ,! cord is compos$ ( a gelat9\s connective tissue1 call$ ,:>ton's jelly1 9 ! mid/ ( :i* lie ! twi/$ vessels 7two art]ies & a ve97 t supply ! embryo ) air & food & c>ry (f ! wa/e4 ,! ,plac5ta4--,! plac5ta or 8aft]-bir?0 is an oval or circul> some:at flatt5$ disc1 six to t5 in*es 9 diamet]1 & ?ree-qu>t]s to "o & "o-half in*es ?ick4 ,x weighs ab\t a p\nd & a half4 ,x is ! organ ( respiration & nutrition = ! ftus4 ,illu/ration3 ,fig4 #ah4--;,ftal surface ( human plac5ta4 7,ed547 ,illu/ration3 ,fig4 #ai4--,! egg at t]m ) ut]us remov$ & *ild %[+ ?r\gh ! membranes4 7,edg>47 ,x is =m$ ab\t ! ?ird mon? outside ! membranes cov]+ ! *ild & is m or less loosely atta*$ to ! ut]9e wall4 ,! umbilical cord is atta*$ to its ftal surface1 inside ! ovum4 ,l a flat sponge x takes oxyg51 blood1 & ! n\ri%+ fluids f ! blood vessels 9 ! ut]9e wall1 c>ries !m to ! *ild by means ( ! umbilical ve91 & c>ries back ! c>boniz$ blood & wa/e products by ! umbilical art]ies to ! plac5ta1 & !re returns !m to ! mat]nal blood = disposal4 ,! blood ( ! ve9s is bright r$1 & ( ! art]ies1 d>k & turbid4 ,illu/ration3 ,fig4 #bj4--,normal attitude ( ftus 7complete flexion74 7,b>b\r47 ,!re is no direct communication betwe5 ! mat]nal tissues & ! plac5ta1 h5ce all ! *anges occur by osmosis1 & by ! activity ( ! cells :i* =m ! walls ( ! villi4 ,! liv] ( ! *ild is l>ge & active4 ,! /oma* & inte/9es functionate mildly4 ,! kidneys act1 & ur9e is dis*>g$ into ! liquor amnii1 :i* ! *ild occasionally swall[s4 ,dur+ developm5t1 ! movem5ts ( ! *ild become m & m pron\nc$4 ,arms1 legs1 & entire body p>ticipate 9 turn4 ,p]iods ( re/ are also obs]v$4 ,gradually ! *ild assumes a def9ite attitude 9 ! ut]us4 ,x becomes m & m fold$ & flex$ to accommodate its size to ! limitations ( space4 ,! head b5ds on ! *e/1 ! arms are fold$1 ! ?ighs flex aga9/ ! abdom51 ! legs on ! ?ighs1 & ev5 ! back ultimately becomes convex4 ,x atta9s a complete flexion1 ! normal attitude ( ! *ild4 ,z maturity approa*es1 ! head becomes m & m palpable & seeks its usual location 9 ! l[] pole ( ! ut]us1 re/+ on ! pelvic brim4 ,illu/ration3 ,fig4 #ba4--;,ftal skulls %[+ sutures4 ,note ! diff]5ces betwe5 ! ant]ior & po/]ior fontanelles4 7,ed547 ,illu/ration3 ,fig4 #bb ,a4--,*ild's head at t]m 7f side71 %[+ diamet]4 7,am]ican ,text ,book47 ,illu/ration3 ,fig4 #bb ,b4--,! *ild's head at t]m 7f above71 %[+ diamet]s & fontanelles4 7,am]ican ,text ,book47 ,! ftal skull at maturity 7at t]m7 is /ill incompletely ossifi$4 ,! bones are ?9 & pliable & sep>at$ at _! edges by int]vals ( unossifi$ membrane :i* =m ! sutures & fontanelles4 ,?us ! skull is compressible to a slight degree & capable ( mu* *ange 9 %ape4 ,x c be measurably m\ld$ by ! ut]9e contractions to suit ! pelvis4 ,9 front1 ! two coron>y sutures meet ! frontal & sagittal sutures to produce a kite-%ap$ figure1 call$ ! l>ge or ant]ior fontanelle1 or ! bregma4 ,beh9d1 ! lambdoidal suture meets ! sagittal suture to =m ! small or po/]ior fontanelle4 ,! l>ge fontanelle is made up ( f\r bones & f\r angles2 ! small1 ( ?ree bones & ?ree angles1 & are usually easy to diff]5tiate4 ,fur!rmore1 ! diff]5ce betwe5 ^! fontanelles is ( great importance 9 labor1 s9ce by x ! obs]v] is enabl$ to det]m9e ! position ( ! head4 ,9 ,am]ica1 ! %ape ( ! head is t ( an ovoid ) ! long diamet] ant]opo/]ior 7,dolico-cephalic74 ,?us x happ5s t :5 ! head is completely flex$1 ! smalle/ diamet]s are pres5t$ = deliv]y4 ,! important diamet]s ( ! head1 ) _! measurem5ts & names1 are z foll[s3 ,nape ( neck to c5t] ( bregma1 #i4e cm4--,suboccipito-bregmatic diamet]4 ,occipital protub]ance to root ( nose1 #aa4be cm4--,occipito-frontal diamet]4 ,betwe5 ! em95ces ( p>ietal bones1 #i4be cm4--,bip>ietal diamet]4 ,betwe5 ant]ior ends ( coronal sutures1 #h cm4--,bitemporal diamet]4 ,! smalle/ circumf]5ce is t ( ! suboccipito-bregmatic plane1 :i* comes into relation ) ! brim ( ! pelvis :5 ! flexion ( ! head is complete4 ,x measures #bg4e c5timet]s4 ,! ftus gr[s at a def9ite rate ?r\gh\t ge/ation & s regul>ly t ! increase is r>ely simulat$ by any o!r condition4 ,to f9d ! probable l5g? ( ! ftus at any giv5 "t1 squ>e ! mon? ( ! pregnancy 7up to five7 & ! result is ! ftal l5g? 9 c5timet]s4 ,aft] ! fif? mon?1 multiply ! numb] ( ! mon? by five4 ,?us3 #g? mon? #ece cm41 ! approximate l5g? ( ! ftus at ! lun> mon?4--7,hasse's rule47 ,! ,mature ,ftus4--,al?\gh subject to consid]able v>iation1 ! ftus at t]m w weigh ab\t sev5 & "o-f\r? p\nds1 & measure #ej cm4 9 l5g?4 ,! weight is f> m unc]ta9 ?an ! l5g?1 & !re=e n s reliable z a sign ( maturity4 ,to obta9 an e/imate ( ! weight ( ! *ild at any giv5 mon? ( ! pregnancy1 ! numb] ( lun> mon?s m9us #b1 is squ>$ & divid$ by #b1 & ! result is ! av]age weight ( ! *ild at t "t 9 hundr$s ( grams4 ,?us3 #h? mon? #bf4 #ffcf4 #cfbah1 or 9 hundr$s ( grams1 #ahjj1 ! weight ( ! *ild4--7,tuttle's rule47 ,diff]5ces betwe5 ! mature & immature ftus3 ,mature ,immature #a4 ,sk9 smoo?1 plump1 p9k #a4 ,sk9 lax1 wr9kl$1 dull r$ 9 cov]$ ) v]nix caseosa4 color2 little v]nix caseosa4 #b4 ,g5]\s am\nt ( subcutane\s #b4 ,subcutane\s fat scanty4 fat4 #c4 ,hair abundant & f #a to #b #c4 ,hair on scalp %ort4 in*es long4 #d4 ,lanugo mo/ly abs5t4 #d4 ,lanugo pres5t all ov] body4 #e4 ,nails project f f+] tips4 #e4 ,%ort nails on f+]s & toes4 #f4 ,skull bones 9 contact except #f4 ,skull sutures op54 at fontanelles4 #g4 ,l5g? #ej cm4 born4 #g4 ,moves & cries feebly :5 #h4 ,weight five to eight p\nds4 #h4 ,weight less ?an five p\nds4 #i4 ,c>tilage 9 e> well develop$4 #aj4 ,navel 9 middle ( body4 #aa4 ,te/es h desc5d$ 9 ! male1 & ! labia majora 9 ! female usually cov] ! labia m9ora4 #ab4 ,moves & cries vigor\sly :5 born4 ,! ,ftal ,circulation4--,! plac5ta is an organ ( nutrition z well z respiration1 & ?r\gh ! umbilical vessels ! food mat]ials are br\ght to ! ftus & ! wa/e products remov$4 ,surr\nd$ by ! jelly ( ,:>ton t fills out ! cord1 & runn+ 9 & out betwe5 ! two art]ies1 ! umbilical ve9 passes into ! ftal abdom5 & divides into two bran*es1 "o1 ! l>g]1 %ort-circuits directly into ! inf]ior v5a cava4 ,?is bran* is call$ ! ductus v5osus4 ,! o!r jo9s ! portal ve9 & passes ?r\gh ! liv]1 aft] :i* x also ent]s ! v5a cava4 ,?us ! he>t is f$ ) a mix$ blood1 "p com+ fre% f ! plac5ta & "p com+ up f ! l[] half ( ! ftus4 ,?is blood is p\r$ into ! "r auricle1 :]e x becomes mix$ aga9 ) ! blood com+ d[n f ! upp] pole ( ! ftus ?r\gh ! sup]ior v5a cava4 ,illu/ration3 ,fig4 #bc4--,! ftal circulation4 7,edg>47 ,n[ a small "p goes d[n into ! "r v5tricle & is =c$ into ! pulmon>y art]ies to supply ! lungs4 ,b ! lungs are n functionat+1 h5ce ! great] "p is aga9 %ort-circuit$ ?r\gh ! ductus art]iosus into ! ar* ( ! aorta1 :]e x meets ) ! great volume ( blood :i* pass$ ov] into ! left auricle ?r\gh ! hole 9 ! septum betwe5 ! "r & left auricles1 call$ ! =am5 ovale1 !nce d[n into ! left v5tricle & out ?r\gh ! aorta to supply ! re/ ( ! ftal body4 ,) ! exception ( ! ductus v5osus & ! ductus art]iosus & ! =am5 ovale1 ! circulation is ! same z 9 ! adult4 ,! blood 9 ! desc5d+ aorta aga9 divides & "p goes on to supply ! l[] extremities :ile ! great] "p leaves ! int]nal iliac art]ies by means ( ! hypoga/ric vessels & returns ?r\gh ! umbilical art]ies to ! plac5ta = oxyg5ation4 ,z soon z ! *ild is born1 ! ftal /ructures are alt]$4 ,! *ild brea!s1 ! pulmon>y circulation is e/abli%$ & ! ductus art]iosus is clos$4 ,! plac5tal circulation is aboli%$1 & ! ductus v5osus & ! hypoga/ric art]ies are conv]t$ into solid fibr\s cords4 ,ow+ to ! imm$iate *ange ( pressure 9 ! auricles1 ! =am5 ovale closes & ! circulation assumes ! adult type4 ,,*apt] ,,iii ,,normal ,,pregnancy ,! entire body p>ticipates 9 ! *anges br\ght ab\t by pregnancy4 ,! hips & brea/s become full]1 ! back broad5s1 & ! woman puts on fat4 ,%e becomes mature 9 appe>ance1 b1 ( c\rse1 ! ph5om5a connect$ ) alt]ations 9 ! brea/s & g5itals are mo/ important1 & late 9 pregnancy1 mo/ conspicu\s4 ,! ut]us exhibits ! mo/ m>k$ alt]ation4 ,f an organ t weighs two ounces1 x becomes ! l>ge/ 9 ! body1 & increases 9 size f two & "o-half or ?ree in*es to fifte5 in*es4 ,! typical pe>-%ape becomes sph]oidal ne> ! end ( ! ?ird mon?1 becomes pyri=m aga9 at ! fif? mon?1 & cont9ues ?us until t]m4 ,up to ! f\r? mon? ! walls become ?ick]1 heavi] & m muscul>1 b z pregnancy advances1 m & m tissue is dem&$1 until at ! end1 a muscle wall ( only mod]ate ?ickness protects ! ovum4 ,mean:ile ! muscul> functions ( contractibility & irritability are greatly increas$4 ,at ! f\r? mon? ! womb1 :i* has occupi$ a position ( antev]sion aga9/ ! bladd]1 rises out ( ! pelvis4 ,x is n[ an abdom9al organ & z x gets heavi] & heavi]1 x re/s a c]ta9 am\nt ( its bulk on ! brim ( ! pelvis4 ,ab\t ! six? mon?1 ! upp]mo/ "p ( ! ut]us 7fundus7 is at ! level ( ! umbilicus4 ,at ! eigh? mon?1 ! fundus is f\nd a little m ?an midway betwe5 ! umbilicus & ! ensi=m c>tilage4 ,ab\t two weeks be=e t]m1 x rea*es its highe/ po9t1 ! ensi=m c>tilage1 & !n sometimes s9ks a little l[] 9 ! abdom54 ,! ovum1 or egg1 does n completely fill ! ut]9e cavity at fir/1 b gr[s f its side l a fungus until ! ?ird mon?4 ,!n ! ut]9e cavity is entirely occupi$ & !reaft] ! egg & ! ut]us develop at an equal rate4 ,z ! ut]us rises 9 ! abdom51 x rotates to "o side1 usually ! "r1 =w>d on its v]tical axis4 ,illu/ration3 ,fig4 #bd4--;,gravid ut]us at ! end ( ! eigh? week4 7,braune47 ,! blood vessels & lymphatics also increase 9 size1 numb]1 & tortuosity4 ,_m ( ! ve9s become s9uses z l>ge z ! little f+]4 ,?is increas$ am\nt ( fluid bo? )9 & )\t ! ut]us has a m>k$ effect ^u its consi/5cy4 ,! walls ( ! ut]us1 vag9a1 & c]vix become s(t5$1 infiltrat$ & m di/5sible4 ,!re is also an increase 9 size & 9 numb] ( ! muscle cells4 ,dur+ pregnancy ! ut]9e muscle exhibits a def9ite functional activity4 ,int]mitt5t contractions occur1 feeble at fir/1 b gr[+ m>k$ly /rong] z pregnancy advances4 ,^! are ! contractions ( ,braxton ,hicks4 ,!y are irregul> & pa9less1 b c be felt by ! exam9+ h&4 ,at t]m !y m]ge into1 & are lo/ 91 ! regul>1 pa9ful contractions ( labor4 ,! brea/s c n be said to be fully develop$ until lactation has occurr$1 nev]!less1 ! gl&s %[ pron\nc$ *anges z a result ( m>riage & pregnancy4 ,! size ( ! gl&1 z well z ! size & appe>ance ( ! nipple & areola1 v>ies greatly 9 diff]5t wom52 b "u ! /imulation ( pregnancy ! :ole gl& enl>ges1 includ+ ! connective tissue /roma4 ,ab\t ! f\r? mon? a pale yell[ secretion c be squeez$ f ! nipple4 ,?is is call$ colo/rum4 ,! pigm5tation ext5ds ov] a wid] area & deep5s 9 color1 :ile ! increas$ vascul>ity is %[n by ! appe>ance ( ! blue ve9s "u ! ?9 t5d] sk94 ,light p9ki% l9es sometimes radiate f ! nipple4 ,^! are /ri & are m evid5t 9 blondes4 ,! milk comes into ! brea/s ab\t ! ?ird day aft] labor1 & normally cont9ues to fl[ = six1 to t5 or twelve mon?s4 ,:y ! pregnancy & labor induce su* m>k$ mamm>y activity is n kn[n1 b ! fact is pat5t4 ,! sk9 reacts bo? me*anically & biologically to ! /imulus ( pregnancy4 ,illu/ration3 ,fig4 #be4--,/ri ,gravid>um4 7,edg>47 ,/ri ,gravid>um4--,/ri gravid>um appe> on ! abdom5 simil> to ^? obs]v$ on ! brea/s & are due to ! same cause--me*anical /ret*+4 ,:5 fre%1 !y are p9ki% 9 color & v>iable 9 l5g? & bread?1 b atta9 ! greate/ size bel[ ! umbilicus4 ,occasionally !y ext5d to ! ?ighs & buttocks4 ,aft] labor1 !y become pale1 silv]y1 & sc>-l & are call$ l9ea albicantes4 ,!y are sometimes f\nd 9 o!r conditions ?an pregnancy1 su* z tumors or ascites4 ,increas$ ,pigm5tation4--,pigm5tation is n limit$ to ! brea/s4 ,on ! abdom51 a d>k l9e w appe> betwe5 ! umbilicus & ! pubes4 ,?is is ! l9ea nigra1 & x becomes mo/ conspicu\s 9 ! latt] half ( pregnancy4 ,9 ! gro9s1 ! axill1 & ov] ! g5itals1 ! deposit is common1 & sometimes pat*es appe> on ! face1 ei!r discrete or 9 coalesc5ce1 to =m a cont9u\s discoloration1 call$ *loasma2 or :5 ext5sive1 ! 8mask ( pregnancy40 ,! pigm5tation is absorb$1 or at lea/ greatly dim9i%$1 aft] labor4 ,! sebace\s & sweat gl&s are m active4 ,! hair may fall out & ! tee? decay4 8,) e *ild a too?10 is ! cry ( tradition4 ,^! *anges are due to imp]fect nutrition1 or to ! pres5ce ( tox9s 9 ! circulation4 ,eruptions ( an ery!mat\s1 eczemat\s1 papul> or pu/ul> type are n uncommon2 & it*+1 ei!r local or g5]al1 may make life mis]able4 ,! blood und]goes c]ta9 modifications t are fairly con/ant4 ,! total am\nt is increas$1 b ! quality is poor]1 especially by an increase 9 wat] & :ite cells & a dim9ution ( r$ cells4 ,! am\nt ( calcium is slightly increas$ & ! fibr9 is dim9i%$ up to ! six? mon?1 :5 x rises to normal aga9 at t]m4 ,! he>t is slightly hyp]trophi$ on ! "r side & blood pressure some:at rais$4 ,a m>k$ increase 9 blood pressure is sugge/ive ( eclampsia4 ,! ?yroid gl& enl>ges frequ5tly1 bo? z a consequ5ce ( m5/rual irritation & ( pregnancy4 ,goit]s may %[ an increase ( developm5t1 :i* rema9s aft] labor4 ,! ur9e is dim9i%$ 9 am\nt1 b increas$ 9 frequ5cy ( evacuation4 ,! bladd] is m irritable dur+ ! fir/ & la/ mon?s1 & micturition may be pa9ful & unsatisfactory4 ,! kidneys mu/ be wat*$ c>efully dur+ ge/ation4 ,! n]v\s sy/em is disord]$ 9 mo/ wom51 b especially 9 ^? ( neurotic t5d5cies4 ,irritability1 insomnia1 neuralgia ( face or tee?1 or p]v]sion ( appetite 9 ! s-call$ 8long+s0 are ! m common manife/ations4 ,cramps occur 9 ! muscles ( ! legs1 ow+ to v>icose ve9s or pressure ^u ! lumb> & sacral plexus ( n]ves4 ,! lungs are cr[d$ by ! gr[+ ut]us & ! respiration int]f]$ )4 ,! liv] is enl>g$1 b functionally x is less compet5t1 & con/ipation is common4 ,x is probable t mo/ ( ! *anges enum]at$ above are due to ! circulation ?r\gh ! body ( "s def9ite product ( ftal activity1 :i* is m or less toxic 9 "*4 ,! m pron\nc$ effects ( ?is tox9 w be /udi$ "u ! abnormal conditions ( pregnancy4 ,g5]ally1 if ! pregnancy is normal1 ! :ole body responds to ! /imulat+ influ5ce4 ,aft] ! nausea & vomit+ ( ! e>ly mon?s subside1 ! woman feels en]getic & ambiti\s4 ,%e is eag] to d some?+ at all times & feels fatigue b slightly4 ,music1 lit]ature or h\sework engages h] att5tion & is zeal\sly & joyfully practic$4 ,! _w seems bright & ! ?\ght ( h] labor does n br+ solicitude1 b pleasant anticipations4 ,! body fills out 9 all directions & ! woman takes on ! appe>ance ( maturity4 ,,diagnosis ,,( ,,pregnancy ,! pres5ce ( pregnancy is naturally det]m9$ by ! recognition ( ^? *anges 9 ! mat]nal sy/em :i* ! gr[+ ovum produces4 ,dur+ ! second half ( ! p]iod ! ftus c be made out di/9ctly by palpation1 or by its movem5ts1 & ! he>t tones obs]v$ by auscultation4 ,dur+ ! fir/ half ?is is impossible & ! diagnosis mu/ be made f subjective symptoms elicit$ f ! pati5t & ^u physical signs obs]v$ by ! physician4 ,x is ( extreme practical importance to be able to recognize a pregnancy at all p]iods4 ,! subjective symptoms ( ! fir/ half are--am5orrha1 morn+ sickness1 irritability ( ! bladd]1 discom=t & swell+ ( ! brea/s1 enl>gem5t ( ! abdom5 & quick5+2 b ! appe>ance ( any or all ( ^! ph5om5a is n to be reg>d$ z conclusive1 b m]ely z a presumption t pregnancy exi/s4 ,ei!r ?r\gh ignorance1 int5t to deceive1 or f pa?ological conditions1 any or all ( ^! symptoms may be pres5t1 b n until ! t5? week are ! *anges 9 ! ut]us suffici5tly def9ite to confirm a diagnosis unless ! circum/ances are especially favorable4 ,am5orrha4--,cessation ( ! m5ses is practically inv>iable 9 pregnancy4 ,"o or two p]iods may occur aft] conception1 b c>e mu/ be us$ to exclude o!r causes ( hmorrhage4 ,sudd5 cessation ( ! p]iods 9 a heal?y woman ( regul> habits :o is n ne> ! m5opause1 is /rongly sugge/ive ( pregnancy4 ,:y a develop+ ovum causes an imm$iate arre/ ( m5/ruation is n und]/ood4 ,am5orrha may occur 9 consequ5ce ( *lorosis1 he>t disease1 hy/]ia1 tub]culosis1 fright1 grief1 & "s =ms ( insanity2 a *ange f a l[ to a high altitude1 or an ocean voyage n infrequ5tly causes ! fl[ to rema9 abs5t = "o or m mon?s4 ,9 addition to its value z a presumptive symptom1 ! am5orrha af=ds a common & conv5i5t me?od ( e/imat+ ! date ( conf9em5t4 ,! me?od is fallaci\s b practical1 & w be discuss$ lat]4 ,morn+ ,sickness4--,?is symptom is n inv>iable4 ,x is mo/ frequ5t 9 primip>as1 b n s likely to occur 9 subsequ5t pregnancies4 ,x usually appe>s ab\t ! second mon?1 %ortly aft] ! fir/ p]iod miss$4 ,x v>ies 9 int5sity4 ,"s wom5 h a little nausea on aris+ & no fur!r tr\ble dur+ ! day1 o!rs are nauseat$ & vomit ei!r on ris+ or aft] ! fir/ meal1 & yet o!rs aft] ea* meal2 b ! g5]al heal? is n ord9>ily affect$ & ! tongue rema9s clean4 ,"s cases are ( extreme sev]ity 7hyp]emesis7 & w be discuss$ else:]e4 ,! morn+ sickness is probably toxic 9 orig94 ,x mu/ be rememb]$ t *ronic alcoholism is accompani$ by morn+ sickness1 b ) x ! tongue is furr$4 ,irritability ( bladd] is %[n by a frequ5cy ( ur9ation4 ,x is caus$ by ! conge/ion & /ret*+ ( ! tissues t lie betwe5 ! ut]us & bladd] & hold !m 9 relation to "o ano!r4 ,aft] ! ?ird mon? an accommodation is e/abli%$ & ! symptom does n reappe> until late 9 pregnancy1 :5 ! pressure ( ! heavy ut]us t5ds to keep ! bladd] empty4 ,if especially annoy+1 ?is irritability may be mu* reliev$ by putt+ ! pati5t 9 ! knee-*e/ position night & morn+4 ,enl>gem5t ( ! brea/s is common 9 primip>as1 b ?is1 ) *anges 9 ! areola1 may occur at m5/rual p]iods 9 n]v\s wom54 ,t+l+1 prick+ & %oot+ s5sations may also be not$4 ,enl>gem5t ( ! abdom5 is only noticeable t[>d ! latt] "p ( ! fir/ half1 :5 ! ut]us rises out ( ! abdom54 ,quick5+ means 8com+ to life10 & ref]s to ! fir/ movem5ts ( ! ftus t are felt by ! "m4 ,x is describ$ z simil> to ! flutt] ( a bird 9 ! clos$ h&4 ,x is sometimes accompani$ by nausea & fa9tness4 ,quick5+ usually occurs ab\t ! sev5te5? week ( pregnancy1 & cont9ues to ! end4 ,gas 9 ! inte/9es w sometimes simulate quick5+4 ,! movem5ts are important 9 ! second half z indicat+ t ! *ild is alive4 ,physical ,signs4--,dur+ ! fir/ weeks no conclusive *anges occur t c be detect$ by exam9ation1 & unless conditions are especially favorable1 ! e>lie/ "t = ! def9ite diagnosis ( pregnancy is ! eigh? week4 ,previ\s to ?is x is presumptive only4 ,at ! eigh? week1 ! brea/s may %[ enl>gem5t & t5d]ness1 ) "s secretion4 ,9 ! multip>a1 ?is sign has no significance4 ,secretion is pres5t sometimes 9 ! brea/ ( nonpregnant wom5 ) ut]9e disease 7fibroids74 ,exam9ation ( ! abdom5 at ?is "t is ( little value1 b *anges 9 ! ut]us c be detect$ by c>eful bimanual exam9ation4 ,x is ne$less to say t all int]nal exam9ations %\ld be made ) ! utmo/ c>e & g5tl5ess4 ,s(t5+ ( ! lips ( ! os 7,goodell's sign7 may be f\nd1 b x mu/ n be confus$ ) erosions ( ! os4 ,! os ( a nonpregnant woman feels l ! tip ( ! nose1 & t ( ! pregnant woman l ! lips4 ,illu/ration3 ,fig4 #bf4--;,bimanual exam9ation4 7,edg>47 ,! increas$ size & globul> %ape mu/ also be consid]$ z confirmatory4 ,heg>'s ,sign4--,! upp] "p ( ! ut]us is s(t & di/5d$ by ! ovum1 ! l[] "p is s(t & n fill$ out by ! ovum4 ,betwe5 ! two is an i/hmus t is compressible betwe5 ! f+]s ( "o h& 9 ! vag9a1 & ( ! o!r ^u ! abdom54 ,:5 f\nd1 ?is sign is ( great value4 ,at ! eigh? week1 pregnancy c be reg>d$ z highly probable by ! conjunction ( ! foll[+ symptoms & signs3 ,am5orrha1 morn+ sickness1 irritability ( bladd]1 slight brea/ *anges 9 primip>as1 lips ( os ext]num s(t5$1 ut]9e body enl>g$1 s(t5$1 & ne>ly globul> 9 %ape1 & ,heg>'s sign4 ,abd]hald5's te/ is a s]um reaction bas$ on ! well e/abli%$ pr9ciple t ! introduction into ! blood ( an organic =eign sub/ance leads to ! =mation ( a f]m5t to de/roy x4 ,abd]hald5's plan 0 to discov] :e!r ! blood ( a pregnant woman conta9$ a f]m5t capable ( de/roy+ plac5tal prote94 ,x is a v complicat$ te/1 & subject to _m inaccuracies & num]\s s\rces ( error4 ,at ! same "t1 ! ma9 features ( ?is reaction h be5 confirm$1 & :5 x is work$ out1 x w be ( imm5se value n alone 9 e>ly ut]9e pregnancies1 b 9 extraut]9e pregnancy4 ,?is view v prop]ly dem&s t pregnancy be reg>d$ z a p>asitic disease4 ,x is practicable z e>ly z ! six? week to make a diagnosis1 & x only fails 9 possibly t5 p] c5t ( ! cases4 ,! negative te/ is equally def9ite z elim9at+ pregnancy4 ,sixte5? ,week4--,morn+ sickness & ur9>y symptoms h disappe>$ b am5orrha rema9s4 ,enl>gem5t ( ! brea/s is noticeable1 z well z ! increas$ pigm5tation4 ,! ut]us beg9s to rise above ! symphysis z an ela/ic1 some:at ill-def9$1 boggy mass4 ,! c]vix is s(t]4 ,! *>act]i/ic dull lav5d] coloration ( ! vulv> muc\s membrane is n[ evid5t4 ,x is due to ! conge/ion & is call$ ,jacquem9s' sign4 ,two ,new ,signs4--,irregul>1 pa9less contractions ( ! ut]us 7,braxton ,hicks' sign71 & ballottem5t4 ,! contractions ( ,braxton ,hicks n[ become m easily palpable4 ,ballottem5t consi/s 9 ! detection 9 ! ut]us ( a movable solid body surr\nd$ by fluid4 ,9 a /&+ position1 ! ftus re/s 9 ! l[] "p ( ! ut]us1 j above ! c]vix4 ,! woman /&s ) "o foot on a l[ /ool1 & two f+]s ( "o h& are pu%$ into ! vag9a until !y t\* ! c]vix1 ! o!r h& is plac$ on ! fundus4 ,a sm>t upw>d bl[ by ! int]nal h& is transmitt$ to ! ftus1 & x c be felt to leave ! c]vix1 /rike lightly ! tissues und]nea? ! ext]nal h&1 & return to ! c]vix4 ,x is simulat$ by s few ?+s1 & s r>ely1 t 9 practice x mu/ be reg>d$ z a positive sign4 ,dur+ ! second half1 ! subjective symptoms are ( m9or importance s9ce unmi/akable evid5ce is furni%$ by ! physical signs4 ,! symptoms ( ?is p]iod are mo/ly discom=ts4 ,increas$ intraabdom9al pressure br+s on edema ( ! feet1 cramps 9 ! legs1 v>icose ve9s ( ! legs & vulva1 dyspna1 & palpitations4 ,tw5ty-six? ,week4--,ab\t ! tw5ty-six? week1 or1 at ! end ( ! six? cal5d> mon?1 ! hyp]trophy ( ! brea/s1 ! pres5ce ( secretion1 & ! m>k$ pigm5tation are unmi/akable4 ,! abdom9al protrusion is n[ cle>ly visible1 & ! fundus w be f\nd at ! level ( ! upp] bord] ( ! umbilicus4 ,spontane\s ftal movem5ts appe> & may be felt by ! palpat+ h&4 ,auscultation reveals ! ut]9e s\ffle & ! ftal he>t s\nds4 ,! he>t s\nds & ! ftal movem5ts1 :5 obta9$ by ! obs]v]1 are positive signs4 ,ut]9e s\ffle is a s(t1 bl[+ murmur1 syn*ron\s ) ! "m's pulse4 ,x is be/ he>d at ! l[] p>ts ( ! lat]al bord]s ( ! ut]us4 ,x is due to ! passage ( blood ?r\gh ! greatly dilat$ ut]9e art]ies4 ,x may be he>d also 9 cases ( fibroid tumors ( ! ut]us4 ,illu/ration3 ,fig4 #bg4--;,abdom9al enl>gem5t at ?ird1 six?1 n9?1 & t5? mon?s ( pregnancy4 7,williams47 ,illu/ration3 ,fig4 #bh4--;,height ( ! ut]us at v>i\s mon?s ( pregnancy4 7,bumm47 ,! ftal he>t s\nds are ! mo/ anxi\sly s\ght = ( all ! signs ( pregnancy4 ,!y are conclusive4 ,!y n only det]m9e ! diagnosis1 b af=d valuable in=mation dur+ labor1 & nurse & /ud5t %\ld lose no opportunity ( becom+ famili> ) !m4 ,! he>t tones c be he>d z e>ly z ! tw5ty-six? week1 b !y become m & m di/9ct z pregnancy advances4 ,!y v>y f #adj to #afj beats to ! m9ute at ! tw5ty-six? week1 & at t]m1 f #abj to #adj4 ,:5 !y rise above #afj or s9k bel[ #abj1 "s dang] ?reat5s ! *ild4 ,! ftal he>t tones h no significance z an indication ( sex4 ,funic s\ffle is ! s\nd made by ! passage ( blood ?r\gh ! umbilical cord :5 a loop accid5tally lies "u ! tip ( ! /e?oscope4 ,x is syn*ron\s ) ! ftal he>t tones1 b ( no great practical importance :5 ! he>t tones c be obta9$4 ,det]m9ation ( ! p]iod to :i* pregnancy has advanc$ is sometimes important4 ,?is c be approximat$ by a calculation ( ! "t t has elaps$ s9ce ! la/ p]iod1 or f ! date on :i* quick5+ has occurr$4 ,measurem5t ( ! height ( ! fundus & comp>ison ) su* scales z ,spiegelb]g's1 may be c>ri$ out1 b x is n (t5 requir$4 ,a me?od ( e/imation 9 gross1 t is approximately correct1 9 _m cases dep5ds on ! obs]vation ( ! /eady gr[? ( ! womb4 ,?us1 ! ut]us rises out ( ! pelvis at ! f\r? mon?1 & may be f\nd well above ! symphysis pubis4 ,at ! fif? mon? ! fundus is midway betwe5 ! symphysis & ! umbilicus4 ,at ! six? mon? x rea*es ! umbilical level4 ,at ! eigh? mon? x is a little m ?an midway betwe5 ! umbilicus & ! ensi=m c>tilage1 :i* x atta9s 9 ano!r mon?1 ! n9?4 ,!n x usually s9ks a little1 especially 9 primip>as dur+ ! la/ two or ?ree weeks4 ,?is is call$ light5+4 ,,*apt] ,,iv ,,hygi5e ,,( ,,normal ,,pregnancy ,! "t ( conf9em5t c nev] be accurately det]m9$1 because ! onset ( labor is purely an accid5t1 dep5d5t on _m factors4 ,fur!rmore1 conception does n take place necess>ily at ! "t ( int]c\rse1 & we h no means ( kn[+ :e!r conception occurr$ j aft] ! la/ p]iod pres5t or j be=e ! fir/ p]iod miss$4 ,s !re is always a possible error ( ?ree weeks4 ,pregnancy 9 ! human family normally la/s f #bge to #bhj days1 & ! approximate date ( conf9em5t c be obta9$ by ! foll[+ conv5i5t rules3 #a4 ,take ! fir/ day ( ! la/ m5/ruation1 c\nt back ?ree mon?s & add sev5 days4 #b4 ,or1 assum+ t quick5+ occurs at ! sev5te5? week1 c\nt ahead tw5ty-two weeks f ! day on :i* quick5+ 0 obs]v$4 #c4 ,or1 c\nt two weeks f ! day ( light5+4 #d4 ,or1 ) a pelvimet]1 get ! l5g? ( ! ftus by ,ahlfeld's rule 7measure f symphysis to bree* ( *ild1 subtract two cm4 = ?ickness ( abdom9al wall & multiply by two4 ,! result is ! l5g? ( ! *ild 9 c5timet]s7 & comp>e ) fifty c5timet]s1 :i* is ! av]age l5g? ( a mature *ild4 ,aft] ! sev5? mon?1 ! *ild 9 ut]o gr[s at ! rate ( ab\t #a cm4 a week 7#j4i cm474 #e4 ,or1 by ! tape1 accord+ to ,spiegelb]g's /&>d ( gr[?1 z previ\sly m5tion$4 ,! hygi5ic rules to be obs]v$ dur+ pregnancy are f\nd$ on ?ree basic pr9ciples3 7#a7 ,to wat* att5tively ! diff]5t organs & see t !y functionate normally2 7#b7 ,to elim9ate all ^? conditions t favor ! premature expulsion ( ! egg2 & 7#c7 ,to provide1 s f> z possible1 = ! normal ge/ation & ! physiological deliv]y ( ! *ild4 ,^! factors w be tak5 up 9 detail4 ,! ,diet4--,! appetite is usually some:at increas$1 b x is unnecess>y to indulge ! /oma* on ! gr\nd t ! "m 8mu/ eat = two40 ,long+s1 h[ev]1 %\ld be gratifi$ s f> z ! dem& is n = un:olesome ?+s4 ,food %\ld be simple & pla9ly cook$4 ,meat is p]mitt$ 9 mod]ation unless "s organic *ange exi/s to contra9dicate x4 ,ri* pa/ries & gravies %\ld be avoid$1 b c]eals1 fruits & vegetables %\ld be us$ 9 abundance4 ,x may be bett] to eat f\r times a day in/ead ( ?ree4 ,fluids %\ld be tak5 freely1 f "o to two qu>ts daily4 ,milk is especially valuable1 & alkal9e1 natural & *>g$ wat]s1 su* z ,vi*y & seltz]1 are useful4 ,w9e1 be] & o!r alcohols %\ld n be tak51 or if ! pati5t is habituat$ to _! use1 ! am\nt %\ld be re/rict$ on acc\nt ( dang] to ! pregnancy & dang] to ! *ild4 ,9 contract$ pelves x is sometimes desir$ to furni% a special diet1 ) ! idea ( controll+ ! size ( ! *ild 7see ,pro*[nick's ,diet1 p4 #ccb7 b ?is is an em]g5cy4 ,c]ta9 books on mat]nity1 design$ = popul> read+1 advocate diets t are suppos$1 by depriv+ ! *ild ( lime salts1 to keep its bones s(t & make ! labor easy4 ,if x succe$s1 ! *ild w be injuri\sly affect$4 ,if x does n succe$1 ! claim is false4 ,ex]cise4--,ex]cise %\ld be tak51 b x %\ld n be viol5t1 nor att5d$ by risk4 ,golf1 swimm+1 t5nis1 danc+1 horseback or bicycle rid+ & fa/ driv+ 9 automobiles %\ld be =bidd51 le/ abortion foll[4 ,g5]al exhau/ion mu/ be avoid$ & all conditions t ev5 approximate traumatism4 ,walk+ & sl[ driv+ are be/1 & h\sework is excell5t up to a mild degree ( fatigue4 ,travel %\ld be re/rict$4 ,if ex]cise is n feasible1 massage w furni% ! requir$ /imulation to ! circulation4 ,! m5/rual epo*s are peculi>ly favorable to abortive influ5ces4 ,! ,b[els4--,mo/ wom5 h a t5d5cy to con/ipation dur+ pregnancy4 ,_m times ?is c be correct$ by increas+ ! 8r\gh5+0 9 ! food2 m vegetables & fruits1 bran bread & muff9s1 :ole :eat bread1 sp9a*1 beans1 c>rots1 turnips1 peas & especially potatoes1 bak$ & eat51 sk9 & all4 ,prunes1 figs1 & dates are valuable aids4 ,ag> may be eat5 ?ree or f\r times daily4 ,russian oil 7liquid petrolatum71 tak5 9 tablespoon doses ?ree times daily1 is an adjuvant1 & f9ally1 "s =m ( casc>a or ap]i5t pill may be tak51 if necess>y4 ,viol5t ca?>tics %\ld n be us$ at all1 & enemas z little z possible2 only :5 quick results are necess>y4 ,he>tburn4--,he>tburn is a frequ5t complication1 especially 9 ! lat] mon?s4 ,x is due to an inord9ate secretion ( acid 9 ! /oma*4 ,soda m9t tablets1 bic>bonate ( soda1 & magnesia1 9 cake or z milk ( magnesia1 w relieve4 ,! magnesia is also a laxative4 ,! kidneys require p>ticul> c>e dur+ pregnancy1 & 9 e case ! ur9e %\ld be exam9$ mon?ly1 up to ! fif? mon?1 & e two weeks !reaft]1 until ! la/ six weeks1 :5 a weekly te/ %\ld be made4 ,! am\nt pass$ 9 tw5ty-f\r h\rs %\ld be measur$4 ,?ree p9ts is an av]age quantity4 ,album91 sug>1 & ca/s mu/ be look$ = & report$4 ,album9 may or may n be a s]i\s symptom4 ,ca/s are significant ( nephritis & indicate dang]4 ,sug> may be lactose & be d]iv$ f ! milk secret$ 9 ! brea/4 ,edema ( feet1 h&s & eyelids mu/ always be inve/igat$1 ) ! possibility 9 m9d1 ( he>t & kidney lesions4 ,bl9dness1 dizzy spells1 heada*es & spots be=e ! eyes are always al>m+ symptoms until _! innoc5ce is e/abli%$4 ,?r\gh con/ant wat*fulness ( ! ur9e1 _m cases ( eclampsia may be av]t$4 ,ba?+ is m important 9 pregnancy ?an at o!r times4 ,! m ! sk9 secretes1 ! less ! burd5 on ! kidneys4 ,! sk9 mu/ be kept w>m1 clean1 & active4 ,!n aga91 dur+ pregnancy ! sk9 is (t5 unusually s5sitive & only ! milde/ soaps & bl&e/ applications c be us$4 ,! wat] mu/ be nei!r hot nor cold1 b j a com=table temp]ature4 ,cold ba?+1 :e!r %[]1 plunge1 or sitz1 mu/ be d5i$4 ,sea ba?+ is also unwise4 ,! w>m tub ba? ( pla9 wat] or ) bran answ]s all conditions until ! expect$ labor is ne>1 !n ! w>m %[] or sponge ba? %\ld be sub/itut$1 le/ g]ms f ! ba? wat] ent] ! vag9a4 ,if ! kidneys ne$ aid1 a hot pack may be us$2 b 9 all cases1 frequ5t rubb+ ( ! sk9 ) a co>se t[el %\ld foll[ ! ba?4 ,! dress mu/ be w>m1 loose1 simple & susp5d$ f ! %\ld]s4 ,to prev5t *ill+1 wool or silk1 or a mixture ( bo?1 %\ld be worn next to ! sk91--light 9 summ] & heavy 9 w9t]4 ,! pati5t mu/ be s5sibly clad 9 broad1 loose1 l[-heel$ %oes4 ,!re %\ld be no con/riction ab\t *e/ or abdom54 ,circul> g>t]s mu/ n be worn4 ,if a corset is insi/$ ^u1 x mu/ support ! abdom5 f bel[ & lift x up4 ,no corset is admissible t pu%es d[n on ! abdom54 ,?is is especially true if ! woman has borne "o or m *ildr5 & has a p5dul\s abdom54 ,! brea/s may get heavy & require ! re/ & ease suppli$ by a prop]ly fitt+ bu/ support]4 ,fa9t+ is an annoy+ symptom 9 "s wom54 ,x may come :5 quick5+ is fir/ p]ceiv$1 or f ! excitem5t ( cr[ds1 or f hy/]ia4 ,x usually passes quickly4 ,! pallor is n deep1 ! pulse is n affect$1 & consci\sness is n lo/4 ,x does n affect ! ovum4 ,he>t tr\ble %\ld be exclud$1 & ! daily habits ( dress1 diet1 & b[els inve/igat$4 ,smell+ salts w usually suffice = ! attack4 ,! abdom9al walls may be /r5g!n$ by appropriate ex]cise be=e & aft] ge/ation1 s t ! muscles w pres]ve _! tone4 ,aft] deliv]y nurs+ ! *ild w help greatly 9 ! pres]vation ( ! wai/ l9e & figure1 by aid+ involution4 ,ab\t ! sev5? mon? 9 primip>as1 ! abdom5 gets v t5se & 9 places ! sk9 is /ret*$ until x gives way & =ms /ri4 ,?is tightness c be reliev$ to a consid]able degree by inunctions ( cocoanut oil or albol5e4 ,pa9 9 ! abdom5 at ?is "t may be due to me*anical di/5tion1 to /ra9 on ! muscles1 to /ret*+ ( op]ative adhesions1 to gas1 con/ipation1 or app5dicitis4 ,! physician %\ld be in=m$ ( x4 ,9 e case1 con/ipation1 swell+ ( feet1 h&s or eyelids1 blurr+ ( vision1 r++ 9 ! e>s1 vomit+1 p]si/5t backa*e1 or ! passage ( blood1 no matt] h[ slight1 %\ld be report$ to ! doctor4 ,! ,brea/s4--,!re %\ld be no pressure on ! gl&s & !y %\ld be w>mly cov]$4 ,! nipples mu/ be kept clean & s(t by soap & wat]1 & ab\t a mon? be=e ! labor is expect$1 ! nipple %\ld be ano9t$ ) albol5e or cocoanut oil & rubb$ & pull$ = a few m9utes e night4 ,?is removes ! cru/s & dri$ secretions t collect on ! nipple & prep>e x = ! mac]at+ action ( ! baby's m\?4 ,no alcohol or /rongly a/r+5t wa%es %\ld be us$4 ,injuries mu/ be avoid$4 ,if ! nipples become t5d] !y may be protect$ f ext]nal irritation by ! lead nipple %ield or by a wood5 %ield ) a holl[ c5t]1 su* z ,williams recomm5ds4 ,leucorrha4--,?is is "o ( ! commone/ discom=ts ( pregnancy1 & ! s5se ( uncleanl9ess1 if ! dis*>ge is excessive1 z well z ! result+ irritation1 may dem& att5tion4 ,x mu/ be kept 9 m9d1 h[ev]1 t ! normal vag9al dis*>ge ( a heal?y pregnant woman is /rongly g]micidal & %\ld n be d\*$ away )\t def9ite indications4 ,vag9al d\*es ( w>m boric acid solution w d = cleanl9ess1 b ! d\*e bag mu/ n be high] ?an ! wai/4 ,/rong] & m antiseptic solutions are potassium p]manganate #a3ejjj1 or *9osol #a3ajjj4 ,a suppository may be us$1 consi/+ ( extract belladonna1 gr4 ss2 tannic acid1 gr4 v1 & boroglyc]ide dr4 ss4 ,sexual int]c\rse is di/a/eful to mo/ pregnant wom51 b sometimes ! incl9ation is int5sifi$4 ,coitus (t5 causes mu* pelvic discom=t & may be an influ5tial factor 9 produc+ abortion4 ,x %\ld be =bidd5 dur+ ! e>ly mon?s1 at all m5/rual epo*s1 & = at lea/ two weeks be=e labor4 ,! ut]us may be infect$ by g]ms b5ea? ! =esk9 & hmorrhage may foll[ ! act if ! plac5ta is l[4 ,9 heal?y p]sons1 at ! in/ance ( ! female1 int]c\rse 9 mod]ation is p]missible4 ,! m5tal condition %\ld be placid )\t ei!r excitem5t or fatigue4 ,anxiety %\ld be dissipat$ by *e]ful company & surr\nd+s4 ,judici\s amusem5t is desirable & a cong5ial occupation1 b neighbors :o tell frightful tales ( disa/] 9 labor1 or nurses :o relate ! details ( _! critical cases1 are equally to be avoid$4 ,_m wom5 ( neurotic temp]am5t dread ! labor desp]ately4 ,!y are sure t dea? imp5ds & !y dwell ) tragic int]e/ on ! /ories ( complicat$ cases relat$ by ?\ghtless or malici\s neighbors4 ,! nurse c d mu* to allay ^! appreh5sions by *e]fulness1 optimism1 & g5tl5ess4 ,h] buoyant temp]am5t w drive away ! pati5t's fe>s j z effectively z ! assurances ( ! physician4 ,great all[ances mu/ be made = attacks ( irritability1 = ! *anges go+ on 9 ! woman's pelvis keep h] 9 a caprici\s & :imsical condition4 ,a good book to read at ?is "t is1 ! 8,prospective ,"m10 by ,slemons4 ,! subject ( mat]nal impressions is ! cause ( mu* anxiety dur+ pregnancy4 ,x is safe to assure ! "m t x is ne>ly impossible to m>k h] *ild by emotional /ress4 ,!re is no demon/rable n]v\s communication betwe5 "m & *ild1 & mo/ ( ! de=mities t occur & are attributable to %ock1 etc41 c be expla9$ by our k ( intraut]9e *anges4 ,fur!rmore1 ! same de=mities occur 9 l[] animals1 to :i* x is difficult to ascribe su* high n]v\s organization4 ,_m ( ! bir?m>ks1 suppos$ly due to %ock1 occur too late 9 ! pregnancy to affect ! *ild1 ev5 if x 7 possible1 = ! *ild is completely =m$ be=e ! f\rte5? week4 ,! ,det]m9ation ( ,sex4--,x is n possible to "k 9 advance ( deliv]y :e!r ! *ild w be a male or a female4 ,x is equally impossible to det]m9e or ev5 to influ5ce ! sex ( ! com+ *ild4 ,_m !ories h be5 advanc$1 & mu* tal5t has be5 wa/$ 9 try+ to solve ?is problem4 ,reason+ by analogy f ! facts obta9$ f l[] animals1 ! sex ( ! *ild is unalt]ably decid$ ! mom5t conception occurs4 ,! responsibility = ! decisions seems to lie ) ! male cell4 ,all we really "k is t ! sexes appe> 9 ! ratio ( #ajj girls to #ajf boys4 ,,*apt] ,v ,,abnormal ,,pregnancy ,aft] ! diagnosis ( pregnancy has be5 satisfactorily e/abli%$1 no fur!r int]nal exam9ations are necess>y 9 ! abs5ce ( special indications1 until ab\t ! ?irtie? week4 ,at ?is "t a s]ies ( complete physical exam9ations may be requir$ to det]m9e ! pres5tation & position ( ! *ild1 ! pres5ce & rate ( ftal he>t tones1 ! diamet]s ( ! head1 ! l5g? & approximate maturity ( ! *ild1 z well z ! condition ( ! bony & s(t passages ( ! "m4 ,x is ?us t an appreciation ( ! ob/etrical problem is secur$ & a c\rse laid out = its successful solution4 ,pregnancy is n a disease1 b a normal function2 b ! woman is expos$1 nev]!less1 to _m grave risks t are peculi> to h] condition & to _m complications accid5tal or o!rwise :i* are m s]i\s on acc\nt ( h] pregnancy4 ,! ,toxmias4--,! gr[+ ovum br+s ab\t *anges 9 ! mat]nal metabolism t are manife/$ by *>act]i/ic symptoms :i* 9 o!r bett] kn[n conditions are recogniz$ z due to toxmia4 ,!re=e1 :ile !re is no positive pro( z yet t ^! symptoms1 aris+ dur+ pregnancy1 are toxmic 9 orig91 ! evid5ce goes to %[ t !y are2 &1 !re=e1 %\ld be classifi$ z toxic4 ,po/mortem f9d+s 9 eclampsia & p]nici\s vomit+ su* z ext5sive ?romboses1 cell necrosis1 & int]/itial hmorrhages are v sugge/ive4 ,cl9ical f9d+s 9 reg>d to ! excretion ( nitrog5 7urea1 ammonia1 uric acid1 etc471 ! occurr5ce ( acidosis1 elevation ( blood pressure1 fev]1 dim9i%$ excretion1 coma & convulsions1 all po9t to toxmia4 ,x is ! m9or di/urbances1 h[ev]1 t ! nurse w come 9 contact ) mo/4 ,!y are ne>ly all toxmic 9 orig91 & a brief description ( !m mu/ be giv51 toge!r ) sugge/ions = _! managem5t4 ,salivation or ,ptyalism4--,9 ! majority ( cases1 saliva is n especially noticeable2 b at times ! secretion %[s an enorm\s increase1 & may ev5 dem& abortion4 ,pati5ts w h saliva runn+ con/antly f ! m\?4 ,! am\nt may rea* a p9t or a qu>t a day1 & ! sk9 ( ! l[] lip becomes greatly inflam$4 ,! only satisfactory treatm5t is a rigor\s milk diet on ! !ory t ! di/urbance is an intoxication4 ,9 extreme cases abortion may be indicat$4 ,g+ivitis4--,! gums may become inflam$1 spongy & hmorrhagic dur+ pregnancy1 usually 9 pati5ts ( l[ vitality4 ,if a g5]\s diet & a/r+5t m\? wa%es d n relieve ! condition1 ! milk diet %\ld be consid]$4 ,too?a*e & ,d5tal ,decay4--,! pati5t may be giv5 hypophosphites1 & ! tee? %\ld be put 9 good condition by a d5ti/4 ,con/ipation has already be5 ref]r$ to4 ,/rong ca?>tics %\ld be avoid$ le/ abortion foll[4 ,condylomata ( pregnancy occur mo/ frequ5tly ar\nd ! labia1 p]9eum1 & anus4 ,!y are w>t-l gr[?s t develop sl[ly or quickly & may rema9 discrete or cov] ! entire area ) masses z small z beans or z l>ge z caulifl[]s1 :i* 9 appe>ance !y mu* resemble4 ,! etiology is obscure1 b !y are g5]ally associat$ ) irritat+ vag9al dis*>ges1 su* z an old gonorrha4 ,treatm5t consi/s 9 /opp+ ! dis*>ge or neutraliz+ x1 & 9 keep+ ! gr[?s dry ) a salicylic acid du/+ p[d]4 7,see ,!rapeutic ,index47 ,pruritus is (t5 di/ress+4 ,! it*+ may be limit$ to ! g5itals or appe> on o!r p>ts ( ! body4 ,x may be due to ! irritation ( local dis*>ges or to a condition ( ! n]v\s sy/em1 aris+ f toxmia4 ,a/r+5t d\*es & protective o9tm5ts w relieve "s cases4 ,bromides & milk diet1 bran or alkal9e ba?s give good results1 & local applications ( s$ative lotions & o9tm5ts conta9+ m5?ol1 c>bolic acid or coca9e 7cauti\sly7 w aid4 ,! woman 9 "s in/ances becomes almo/ frantic1 & te>s at ! vulva ) h] nails until x ble$s4 ,! iod9e treatm5t ( ,h5sl] is simple & (t5 effective4 ,if no sk9 *anges are visible & b little leucorrha1 ! vulva is ?or\ghly prep>$ z = a vag9al op]ation1 dri$ & pa9t$ ) a #aj p] c5t solution ( t9cture ( iod9e4 ,g5]ally "o application suffices1 b :5 ! leucorrha is bad1 x may be necess>y to repeat ! treatm5t on ! ?ird & fif? day !reaft]4 ,betwe5 treatm5ts1 ! vulv> surfaces & ev5 ! vag9al walls 7by insufflation7 are kept dry ) z9c oxide p[d]4 ,if all measures fail & exhau/ion is imm95t1 empty+ ! ut]us may be advisable4 ,h]pes is an inflammatory1 sup]ficial eruption1 *>act]iz$ by r$ pat*es1 bli/]s1 or pu/ules4 ,x is accompani$ by burn+1 it*+1 & n]v\s depression4 ,! orig9 is probably toxic & ! t]m9ation may be fatal4 ,milk diet1 soo?+ lotions1 &1 if necess>y1 abortion1 con/itute ! means ( treatm5t4 ,areas ( pigm5tation 7! *loasmata7 are n am5able to treatm5t4 ,!y usually disappe> aft] labor4 ,album9uria ( ,pregnancy4--,album9uria is s common z to be almo/ physiological :5 ! am\nt ( album9 is small4 ,:5 ! am\nt ( album9 9 ! ur9e is l>ge1 x may be due to pre-exi/+ disease1 :i* is fir/ discov]$ :5 ! ur9alysis is made dur+ pregnancy4 7,*ronic nephritis874 ,if x makes its debut dur+ ge/ation & cont9ues z a m]e trace )\t ca/s1 x is spok5 ( z ! album9uria ( pregnancy1 b ! pati5t mu/ be wat*$ ) great c>e1 s9ce ! album9uria may be a premonitory sign ( eclampsia4 ,album9uria & eclampsia mu/ be consid]$ toge!r1 because1 :ile ! two conditions may exi/ sep>ately1 !y are mo/ frequ5tly associat$1 & x is believ$ t !y h a common causation4 ,x is true t mo/ cases ( album9uria t]m9ate favorably1 yet ! high] ! album9 cont5t1 ! great] ! dang] ( eclampsia4 ,album9 appe>s 9 ! ur9e 9 f ?ree to five p] c5t ( all pregnancies4 ,x is m common 9 ! latt] half ( ge/ation & ! attacks diff] greatly 9 sev]ity4 ,symptoms4--,9 ! e>ly /ages ! ur9e %[s an abundant1 pale fluid ( l[ specific gravity4 ,! s]i\sness ( ! case is g5]ally indicat$ by ! am\nt ( album91 al?\gh ?is is n a reliable guide z to ! dang] ( eclampsia4 ,ca/s & r$ & :ite blood corpuscles are occasionally f\nd4 ,! output ( urea usually rema9s normal1 b dim9ution usually occurs 9 connection ) eclampsia4 ,anmia & anas>ca are common1 b x is a hopeful cl9ical sign t ! cases ( ext5sive edema r>ely develop eclampsia4 ,9 album9uria ( pregnancy !re is a l>ge ftal mortality :i*1 to a degree1 is indep5d5t ( eclampsia4 ,! infant dies 9 ut]o or is born feeble1 or prematurely4 ,eclampsia is ! sudd5 appe>ance ( convulsions 9 ! c\rse ( pregnancy4 ,x may prec$e1 foll[1 or accompany album9uria4 ,x occurs r>ely 9 ! abs5ce ( album9uria 9 a woman :o 0 app>5tly 9 good heal?4 ,! two ph5om5a are be/ expla9$ z a consequ5ce ( toxmia due to poisons at pres5t unid5tifi$4 ,treatm5t ( ! album9uria is treatm5t = imp5d+ eclampsia4 ,regul> exam9ation ( ! ur9e is indisp5sable4 ,! pres5ce ( album9 sugge/s toxmia4 ,! daily output ( ur9e & ! output ( urea mu/ be comp>$1 = a fall 9 urea is a premonitory sign ( eclampsia4 ,! b[els & ! sk9 %\ld be /imulat$1 respectively1 by sal9e ca?>tics1 hot ba?s & packs4 ,! dige/ive organs mu/ be sp>$ z mu* "w z possible1 especially ! liv]4 ,wat] is giv5 9 abundance1 & milk is ! /aple diet4 ,k\miss1 butt] milk & ice cream may be all[$4 ,z ! pati5t improves1 vegetables are all[$4 ,! food %\ld be salt-free2 & alcohol1 z well z ri*1 indige/ible ?+s %\ld be =bidd54 ,9 ! mild] cases boil$ fi% & a little *ick5 may be p]mitt$4 ,! c\rse ( ! disease & ! condition ( ! pati5t is det]m9$ by frequ5t exam9ations ( ! ur9e1 :ile 9 all s]i\s cases an exam9ation ( ! fundus ( ! eye mu/ be made to detect a possible album9uric ret9itis4 ,! treatm5t ( eclampsia w be consid]$ "u ! complications ( labor1 :]e ! attack usually beg9s4 ,pyelitis ( pregnancy is an acute1 & r>ely1 a *ronic infection ( ! pelvis ( ! kidney1 due to ! ,bacillus coli4 ,x usually appe>s aft] ! f\r? mon? 7fif? to eigh?7 & attacks by pref]5ce ! "r side4 ,ext5sion to ! kidney sub/ance1 uret]s1 & bladd] is occasionally obs]v$4 ,symptoms4--,sudd51 acute abdom9al pa91 at fir/ diffuse1 b aft] a few h\rs1 becom+ localiz$ 9 ! "r side1 & on ?is acc\nt is (t5 confus$ ) app5dicitis1 especially z vomit+ is n infrequ5t4 ,a *ill may m>k ! onset & ! temp]ature rise to #ajc ,f4 or #ajd ,f4 ,! b[els are con/ipat$1 ! tongue coat$1 & !re is t5d]ness ov] ! kidney4 ,! ur9e is scanty1 turbid1 slightly album9\s & conta9s pus & epi!lium 9 ! ur9>y canal4 ,a culture reveals ! bacillus :i* has obta9$ access to ! kidney1 ei!r by ext5sion ( ! uret] f ! bladd]1 by direct invasion ( ! tissues f ! adjac5t colon1 or ?r\gh ! circulation4 ,treatm5t4--,! diet %\ld be fluid & mo/ly milk1 ! b[els %\ld be mov$ freely & frequ5tly4 ,! ur9e is alkal9iz$ ) sodium citrate1 s9ce ! ,bacillus coli lives only 9 an acid m$ium4 ,z ! symptoms subside1 urotrop9 may be adm9i/]$4 ,if ! pati5t does n improve )9 two weeks1 abortion mu/ be s]i\sly consid]$4 ,nephrotomy is n to be ?\ght ( unless abortion has fail$4 ,hyp]emesis ,gravid>um4--,! nausea & vomit+ ( pregnancy is s usual z to be reg>d$ z normal4 ,x usually ceases f ! f\r? to ! fif? mon? spontane\sly2 has no ill effect ^u ! ovum1 & may respond readily to treatm5t4 ,hyp]emesis comes on at ! same p]iod & exhibits all /ages ( viol5ce1 f ! mild =m above describ$1 to cases t end fatally4 ,?ree classes ( ?is s]i\s disord] may be di/+ui%$ z associat$ 7,ed571 neurotic1 & toxmic vomit+4 ,associat$ vomit+ is ! vomit+ t comes ) ga/ric ulc] or canc]1 *ronic ga/ritis1 cirrhosis ( ! liv]1 & c]ebral disease4 ,^! conditions mu/ be exclud$ 9 diagnosis4 ,neurotic vomit+--sev]e & p]si/5t nausea & ret*+--is common 9 pregnant wom5 ( ! n]v\s type4 ,x does n lead to loss ( fle% ord9>ily2 ! ur9e is some:at dim9i%$ 9 quantity f ! lack ( fluids1 b ! am\nt ( nitrog5 excret$ rema9s normal4 ,?is is important4 ,toxmic vomit+ includes a small b v important class ( cases1 = all are sev]e & intractable & "s end 9 dea?4 ,cl9ical ,features4--,! normal nausea & vomit+ may seem unusually sev]e4 ,x p]si/s & gets worse4 ,!n vomit+ occurs :5 no food is tak5 & no?+ is held on ! /oma*4 ,! vomit is /a9$ ) bile or blood4 ,! tongue rema9s clean1 & ! g5]al condition is good4 ,next1 weight is lo/ & ! pulse quick5s4 ,a p]si/5t pulse ( ov] #ajj is s]i\s4 ,! tongue becomes coat$1 sordes develops1 sleeplessness & muscul> twit*+ appe>1 & ! pati5t compla9s ( epiga/ric pa94 ,abortion may n[ occur & ! condition cle> up4 ,9 its f9al /age1 ! ur9e becomes scanty & album9\s1 ict]us may appe> & ! temp]ature rise to #ajj ,f4 or m1 ?\gh sometimes x is subnormal4 ,! pulse may g to #abj4 ,delirium & coma sup]v5e1 & empty+ ! ut]us is ( no value4 ,fifty p] c5t ( ^! bad cases die4 ,! especially prom95t po9ts to be not$ are ! ur9e1 :i* %[s acetone1 album9 & blood1 ei!r "o or all1 z well z an increas$ am\nt ( ammonia4 ,a p]si/5tly rapid pulse1 m>k$ loss ( fle%1 coat$ tongue1 jaundice & delirium are regul>ly pres5t4 ,treatm5t4--,organic disease mu/ be exclud$ & a diagnosis ( pregnancy /rongly evid5t4 ,= ! neurotic type1 ! pati5t mu/ be segregat$ f h] fri5ds1 & a compet5t1 *e]ful nurse put 9 *>ge4 ,a cool1 d>k5$ room is be/4 ,if ! pati5t c be transf]r$ to a hospital1 ! results are m satisfactory4 ,"h ! isolation f ext]nal int]e/s & irritations c be made complete4 ,! pati5t does n talk1 ev5 ! nurse comes ) food1 att5ds to ! obvi\s necessities1 & dep>ts 9 sil5ce4 ,once a day a s$ative ba? is giv5 7see ,ba?s1 p4 #cbe7 & m$ication 9 k9d & frequ5cy z ! conditions dem&4 ,9 any case1 ! pati5t %\ld be put to b$ & f$ c>efully e two or ?ree h\rs on milk1 peptoniz$ food or b>ley wat]4 ,if ?is is n reta9$1 album9 wat] may be giv5 = tw5ty-f\r h\rs at regul> int]vals1 or rectal alim5tation may be tri$ aft] /opp+ all foods by m\?4 ,ic$ *ampagne1 seltz] or ,vi*y1 ei!r alone or ) milk1 may be tri$4 ,a dry diet is sometimes effective1 rusk1 toa/1 toa/$ %r$d$ :eat biscuit1 crack]s1 etc41 tak5 e>ly 9 ! morn+1 z "o eats *eese4 ,no ex]cise is p]mitt$ except su* muscul> & n]v\s excitation z may be d]iv$ f massage or ! s$ative ba?4 ,drugs are sometimes ( great value--! bromides1 9 full doses1 or #a m4 doses ( t9cture ( iod9e1 well dilut$1 e h\r2 or bismu? ) hydrocyanic acid2 or coca9e or oxalate ( c]ium4 ,occasionally good results are report$ f a capsule ( peps91 #b gr4 & gr4 silv] nitrate giv5 j be=e meals2 & adr5al9 9 #aj drop doses may be consid]$4 ,extract ( corpus lutea has be5 tri$ by ,hir/ ) favorable results4 ,s9apisms to ! epiga/rium & ice bags to ! sp9e h be5 f\nd useful1 & wa%+ out ! /oma* is effici5t at times4 ,9 wa%+ out ! /oma*1 be sure ! /oma* tube is ic$ be=e x is introduc$4 ,:5 ! case gets worse 9 spite ( treatm5t & acidosis sup]v5es1 bic>bonate ( soda may be giv5 9 sixty gra9 doses e f\r h\rs1 by rectum1 if necess>y1 until ! ur9e gives an alkal9e reaction4 ,glucose z a readily assimilable c>bohydrate may be giv5 9 doses up to #aj oz4 ( a #f p] c5t solution 7,ed57 or sug> infusions by rectum1 #ajjj c4c4 9 tw5ty-f\r h\rs by drop me?od4 ,! ob/etric treatm5t is ! empty+ ( ! ut]us4 ,to be effective ! abortion mu/ be done be=e ! condition ( ! pati5t is desp]ate4 ,x is mo/ favorable be=e ! febrile /age4 ,if ! vomit+ p]si/s 9 spite ( treatm5t & is accompani$ by emaciation1 a pulse ( ov] #ajj1 album9 9 ! ur9e1 ) an increase ( ! ammonia output1 ! pregnancy %\ld be t]m9at$ at once4 ,if ! pati5t c n g to a hospital1 ! nurse %\ld prep>e ! room z describ$ = op]ations4 ,aft] empty+ ! ut]us1 ! vomit+ usually ceases b mu* labor is ?r[n ^u ! nurse 9 supply+ n\ri%m5t & c>+ = an exhau/$ & :imsical pati5t4 ,! back mu/ be inspect$ daily = decubitus 7b$ sores7 & h] position *ang$ frequ5tly4 ,a daily rub ) alcohol & wat] 7#ej p] c5t7 foll[$ by an oil inunction w be valuable4 ,! tee? & gums %\ld be clean$ ) gauze1 wrapp$ ar\nd ! f+] & dipp$ 9 solution ( boric acid4 ,no bru% %\ld be us$4 ,illu/ration3 ,fig4 #bi4--,tw9s4 7,l5oir & ,t>ni]47 ,multiple ,pregnancy4--,tw9s occur ab\t once 9 n9ety labors1 triplets1 once 9 sev5 ?\s&4 ,h]$ity & multip>ity seem to be ! only recogniz$ pr$ispos+ factors4 ,! m pregnancies a woman has1 ! m liable %e is to h tw9s4 ,tw9s may occur ?r\gh a division ( ! primitive cell ?r\gh ! f]tilization ( two ova f ! same or diff]5t ov>ies1 or by f]tilization ( a s+le ovum hav+ two nuclei4 7,see ,fig4 #ac74 ,! =m] are call$ b9ovul> tw9s1 & may or may n be ( ! same sex4 ,! latt] are call$ uniovul> tw9s & are always ( ! same sex4 ,tw9s are usually some:at small] ?an a s+le *ild1 & frequ5tly associat$ ) hydramnios4 ,b9ovul> tw9s h sep>ate plac5t & uniovul> tw9s h "o plac5ta1 ) sep>ate cords4 ,tw9 pregnancies usually g into labor e>li] ?an ! s+le *ild1 possibly on acc\nt ( ! ov]-di/5tion ( ! ut]us4 ,! diagnosis is occasionally difficult & at o!r times easy4 ,two sets ( he>t tones mu/ be di/+ui%$ & diff]5tiat$ by _! v>iation 9 frequ5cy1 he>d at ! same "t by diff]5t obs]v]s4 ,! pres5ce ( tw9s may be /rongly suspect$ also :5 ! ext]nal measurem5ts ( *ild & ut]us greatly exce$ ! av]age4 ,9 su* cases a sy/ematic & p]si/5t se>* mu/ be made = ! two ftal he>t tones4 ,! deliv]y is g5]ally uncomplicat$1 unless ! *9s become lock$4 ,displacem5ts ( ! ,ut]us4--,9 mo/ cases displacem5ts ( ! ut]us are a consequ5ce ( conception 9 organs t are previ\sly retr(lect$ or retrov]t$4 ,!y r>ely produce symptoms until ! end ( ! ?ird mon?1 :5 ! att5tion is direct$ to ! bladd]4 ,!re may be absolute ret5tion or a con/ant dribbl+ f a full bladd] 7is*uria p>adoxa71 possibly associat$ ) pa94 ,if recogniz$ e>ly1 an attempt %\ld be made to replace ! ut]us by po/ure 7knee *e/7 & :5 replac$1 to hold x by pess>y or tampon4 ,! prone position 9 b$ w aid4 ,aft] ret5tion has occurr$1 ! pati5t %\ld be put to b$ & ! bladd] ca!t]iz$ regul>ly e eight or t5 h\rs = ?ree or f\r days4 ,z a rule1 ! organ w rise spontane\sly into ! abdom54 ,if x does n1 x is probably inc>c]at$ "u ! promontory1 & ! physician mu/ try to replace ! ut]us by manipulation or by cont9u\s pressure1 b 9 bad cases1 he w empty ! ut]us be=e ! condition ( ! pati5t becomes too s]i\s4 ,9 multip>as ) weak abdom9al walls1 or wom5 ) sp9al curvature or contract$ pelves1 ! ut]us may fall =w>d &1 pass+ betwe5 ! recti muscles1 cont9ue to drop until ! fundus lies l[] ?an ! symphysis pubis4 ,managem5t1 until labor occurs1 may be made m effective by us+ a /rong1 well-fitt+ abdom9al b&age4 ,mal=mation ( ! ut]us may possess an ob/etric int]e/ at times4 ,! d\ble ut]us 7ut]us didelphys7 & ! ut]us ) a rudim5t>y horn 7ut]us bicornis7 are examples4 ,^! are cong5ital conditions1 due to imp]fect developm5t1 & pregnancy may take place 9 "o or bo? sides4 ,if 9 "o side only1 ! o!r half w also exhibit ! s(t5+ & o!r *anges z 9 normal cases4 ,b9ovul> tw9s may be ! result ( a pregnancy 9 ea* side4 ,pressure ,symptoms4--,edema ( legs & sometimes ( ! vulva occurs dur+ ! la/ trime/]4 ,x is due to increas$ intraabdom9al pressure & to direct int]f]5ce ) ! return circulation by ! pressure ( ! heavy ut]us on ! iliac ve9s at ! brim ( ! pelvis4 ,! ur9e %\ld be exam9$ = album9 & ! pati5t put 9 ! horizontal position if ! edema is tr\blesome4 ,v>icose ve9s ( legs & vulva may cause mu* di/ress4 ,! limbs %\ld be b\nd ) flannel spirals or ) rubb] b&ages 9 ! recumb5t position1 or ela/ic /ock+s may be obta9$4 ,op]ation dur+ pregnancy is n to be consid]$4 ,! vulva c only be reliev$ by a d\ble b&age1 :i* is sew$ at ! po9t :]e x crosses ! vulva1 & buckl$ or ti$ to a wai/b& above ! hips1 bo? be=e & beh9d4 ,?is br+s support to ! vulva4 ,if ! ve9s rupture1 ! "p %\ld be elevat$ & compress$ ) an aseptic pad4 ,hmorrhoids may ei!r appe> or gr[ worse late 9 pregnancy4 ,if !y protrude1 !y %\ld be replac$4 ,o9tm5ts & ic$ applications may be us$ & ! b[els kept loose4 ,cramps may occur 9 ! muscles ( ! legs1 due sometimes to ! v>icose ve9s & sometimes to pressure on ! lumbosacral plexus4 ,moles4--,mole is ! "n giv5 to an ovum :i* is de/roy$ by disease ( its cov]+s dur+ ! e>ly mon?s ( ge/ation4 ,two k9ds are kn[n1 ! blood mole 7c>ne\s mole1 fle%y mole1 or hmatoma mole7 & ! hydatidi=m mole 7vesicul> mole74 ,! blood mole results f progressive or recurr5t slight hmorrhages dur+ ! fir/ ?ree mon?s ( pregnancy1 b hmorrhages insuffici5t 9 quantity to produce an abortion4 ,! blood =ms a clot1 :i* may be reta9$ = sev]al mon?s & become solidifi$4 ,hydatidi=m mole is a disease ( ! "y *orionic villi1 *>act]iz$ by ! gr[? ( an imm5se numb] ( irregul> clu/]s & *a9s ( grape-l cy/s f ! v m9ute to bodies f\r-fif?s ( an in* 9 diamet]4 ,! causation is unkn[n4 ,bo? =ms occur 9 ! fir/ half ( ! pregnancy & are *>act]iz$ by undue enl>gem5t ( ! ut]us & hmorrhagic dis*>ge4 ,diseases ( ! ,membranes4--,hydramnios1 or polyhydramnios1 is ! "n appli$ to ! condition :]e an excess ( liquor amnii is =m$4 ,! am\nt normally pres5t v>ies1 b any?+ 9 excess ( f\r p9ts c\ld be call$ hydramnios4 ,six gallons h be5 report$4 ,s9ce ! s\rce ( ! liquor amnii is n positively kn[n1 ! etiology ( hydramnios mu/ be equally obscure4 ,x is occasionally associat$ ) morbid conditions ( ! "m1 su* z hepatic or c>diac dropsy1 b m frequ5tly ) developm5tal anomalies ( ! ftus4 ,s9ce ! "m is usually heal?y & ! ftus frequ5tly de=m$1 ! !ory is advanc$ t ! disease is ftal 9 orig94 ,x frequ5tly occurs ) tw9 pregnancies1 & 9 ! fir/ mon?s x is mo/ plausible t ! liquor amnii is 9 "s way d]iv$ f ! ftus4 ,! disease is m common 9 multip>as4 ,x is g5]ally sl[ 9 onset1 b x may be acute1 & an imm5se am\nt ( fluid may be =m$ 9 a few weeks4 ,! symptoms are ^? due to pressure f ! extremely l>ge ut]us4 ,! treatm5t1 if int]f]5ce ) he>t or lungs becomes pron\nc$1 is puncture ( ! membranes4 ,! *ild ne$ n be consid]$ = x is usually dead or de=m$4 ,oligohydramnios is ! condition :]e ! liquor amnii is defici5t 9 am\nt4 ,x gives no mat]nal symptoms1 b x is ! cause ( _m bir?m>ks & ftal de=mities 7club-foot1 sp9al curvature1 wry-neck1 ankylosis ( jo9ts74 ,amniotic adhesions are usually associat$ ) oligohydranmios & cause de=mities by amputation ( limbs1 /rangulation ( cord1 & production ( six f+]s4 ,! plac5ta may %[ anomalies ( size & %ape4 ,?us1 !re may be two lobes1 or ?ree4 ,!re may be ! ma9 plac5ta & a small out-ly+ mass connect$ by membrane & vessels ) ! l>g] segm5t4 ,! cord may be ins]t$ 9 ! middle or at ! edge & yell[i%-:ite masses call$ inf>cts may be f\nd 9 its sub/ance4 ,unusual size & weight ( ! plac5ta are sugge/ive ( syphilis4 ,abnormal conditions ( ! ftus may arise f prim>y or transmitt$ disease or f errors ( developm5t4 ,! developm5tal errors may be mon/]s1 hydrocephalus sp9a bifida1 etc41 :i* may n influ5ce ! pregnancy4 ,! mo/ commonly transmitt$ disease is syphilis1 :i* may produce abortion1 premature labor1 or a *ild born ) syphilitic sk9 *anges on palms & soles1 z well z int]nally4 ,,*apt] ,,vi ,,abnormal ,,pregnancy 7,cont'd7 ,extraut]9e ,pregnancy4--,?is is a pregnancy :i* occurs outside ! ut]us1 & :ile ! ev5t usually happ5s 9 ! tube1 cases h be5 report$ :]e ! egg develop$ 9 ! ov>y or abdom54 ,! ovum1 ow+ to "s delay 9 passage to ! ut]us1 is f]tiliz$ ei!r 9 ! ov>y or 9 ! tube1 & by reason ( a *ronic inflammation ( ! tube or pelvis1 or ( ov]gr[? does n succe$ 9 rea*+ ! ut]us at all4 ,z ! ovum develops1 ! tube exp&s1 b x does n possess ! p[] ( gr[+ into a l>ge organ l ! ut]us1 h5ce a sudd5 j>1 a /ra91 or a bl[ may cause x to rupture & dis*>ge ! egg into ! abdom5 7ruptur$ tubal pregnancy7 or =ce x out ?r\gh ! end ( ! tube 7tubal abortion74 ,?is ph5om5on may be accompani$ by a sev]e or ev5 fatal hmorrhage2 or ! pro/ration may pass (f 9 a few days or weeks1 & leave ! pati5t well4 ,9 ! e>ly /ages ! ovum is absorb$1 b aft] ! pregnancy becomes m advanc$1 x may rema9 z a tumor1 or require an op]ation = its removal4 ,infection may occur & ! mass ulc]ate its way into neighbor+ organs 7rectum1 vag9a1 or bladd]7 & dis*>ge itself 9 a long1 suppurative process4 ,mo/ cases ( ectopic 7extraut]9e7ge/ation pres5t def9ite & ev5 dang]\s symptoms betwe5 ! second & f\r? mon?4 ,! symptoms are ^? ( pregnancy1 toge!r ) irregul> hmorrhages f ! ut]us1 :i* may result 9 ! expulsion ( pieces ( tissue or ( membrane4 ,besides ?is1 !re is a vomit+ & acute irregul> pa9 on "o side1 associat$ ) a s5se ( fullness4 ,su* symptoms %\ld be br\ght to ! att5tion ( ! physician1 :o w le>n ! true condition ( ! pelvis by int]nal exam9ation1 conduct$ z g5tly z possible s z n to produce rupture4 ,if rupture occurs1 x w be u%]$ 9 by a %>p lanc9at+ pa9 on "o side1 foll[$ by fa9tness1 nausea1 vomit+1 pro/ration1 rapid pulse1 sigh+ respiration1 & collapse4 ,! temp]ature is subnormal & dea? may occur 9 a few h\rs1 unless an op]ation is done4 ,illu/ration3 ,fig4 #cj4--;,diagram repres5t+ ! sites = ! v>i\s =ms ( tubal pregnancy4 #a1 int]/itial pregnancy2 #b1 i/hmial pregnancy2 #c1 ampull> pregnancy2 #d1 infundibul> pregnancy2 #e1 tubo-ov>ian pregnancy4 7,gilliam47 ,9 cases ( tubal abortion 7:]e ! ovum escapes ?r\gh ! end ( ! tube7 ! symptoms are v simil>1 b ! pati5t soon rallies & gradual recov]y takes place4 ,if ! diagnosis is made be=e rupture or abortion ! treatm5t is lap>otomy4 ,if rupture occurs1 ! lap>otomy mu/ be done imm$iately to *eck ! hmorrhage1 :i* ?reat5s ! life ( ! pati5t4 ,9 tubal abortion1 if ! diagnosis is c]ta91 "s delay may be p]mitt$ "u extreme wat*fulness ( ! nurse & physician4 ,9 su* case1 ! nurse w keep ! pati5t absolutely quiet & =bid ex]tion ( any k9d4 ,if op]ation is necess>y1 ! utmo/ g5tl5ess mu/ be us$ 9 prep>+ ! abdom54 ,! t9cture ( iod9e application to ! site ( ! incision is suffici5t prep>ation1 &1 ( c\rse1 an abundance ( /]ile gauze1 cotton1 & t[els %\ld be suppli$1 z 9 e case :]e lap>otomy is done4 ,if ! rupture occurs :ile ! nurse is pres5t1 ! doctor %\ld be notifi$ at once1 & if n at home1 ano!r doctor %\ld be summon$4 ,mean:ile1 ! nurse prep>es ! room1 solutions & ut5sils = an abdom9al op]ation4 ,imm$iate incision to *eck ! hmorrhage & remove ! mass (f]s ! greate/ safety4 ,! aft]-c>e is ! same z = any lap>otomy1 ) ! additional duty ( mak+ up ! lo/ blood z soon z possible by n\ri%+ foods1 normal sal9e solution by rectum1 &1 if necess>y1 by hypod]moclysis4 ,acute fev]s are a s]i\s complication ( pregnancy on acc\nt ( ! dang] ( abortion or premature labor1 :i* may come on ei!r f ! associat$ high temp]ature or f ! transmission ( ! disease to ! ovum4 ,! foll[+ diseases are kn[n to affect ! ftus 9 ut]o3 *ol]a1 yell[ fev]1 small pox1 sc>let fev]1 typhoid1 measles1 erysipelas1 m5+itis & syphilis4 ,,*ronic ,,infections ,tub]culosis does n affect f]tility or ! c\rse ( ! pregnancy1 b ! progress ( ! disease is ha/5$1 & ! mat]nal dea? accel]at$4 ,! "q ( artificial abortion 9 ! e>ly mon?s mu/ be s]i\sly consid]$1 & if ! case goes on to t]m1 ! *ild mu/ n be nurs$ or c>$ = by ! "m4 ,syphilis is ! mo/ frequ5t sy/emic cause ( ! int]ruption ( pregnancy4 ,x is a blood disease1 due to an organism1 call$ spiro*ta pallida1 & x appe>s 9 ?ree di/9ct /ages4 ,! fir/ is ! prim>y /age1 :]e9 a h>d1 nodul> ulc] appe>s on "s "p ( ! body1 z ! vulva1 lips1 gums1 tonsils1 or h&4 ,x is n always v5]eal 9 orig94 ,! second /age beg9s six or eight weeks aft] ! sore1 & is m>k$ by a g5]al eruption ( r$ spots1 *ronic sore ?roat1 fall+ hair1 & rheumatic pa9s 9 ! jo9ts4 ,! ?ird /age is ! "n giv5 to ! lat] conditions ( ! disease :i* affect ! bones1 blood vessels1 & n]v\s sy/em4 ,infection ( ! ovum may usually be trac$ to ! fa!r1 :o may transmit syphilis at any /age ( ! disease4 ,9 ! ?ird /age1 ! *ild alone w be infect$2 ! "m escapes4 ,! "m may or may n transmit ! disease1 dep5d+ on ! p]iod ( pregnancy :]e9 h] infection occurs4 ,if %e gets ! disease at1 be=e1 or j ab\t1 ! "t ( conception1 %e w abort ?ree times out ( f\r1 & ! ovum w %[ def9ite lesions4 ,if infect$ lat]1 abortion occurs less frequ5tly2 & if ! disease is contract$ late 9 pregnancy1 ! *ild may be born app>5tly free f infection4 ,symptoms4--,a *ild ) cong5ital syphilis w %[ ! eruption ( copp]y spots1 bli/]s on palms & soles1 deep cracks on ! feet1 snuffles1 cracks & ulc]s ar\nd ! m\? & rectum1 & ! weakly1 m>asmic condition ( ! body4 ,! diagnosis 9 suspect$ cases c be r5d]$ m c]ta9 by ! ,wass]mann reaction4 ,?is is a laboratory te/ ( ! blood :i* %\ld always be made be=e a wet nurse is all[$ to nurse a *ild1 or be=e a suspect$ *ild is nurs$ by a clean woman4 ,9 all cases ( transfusion ( blood1 x is imp]ative4 ,treatm5t4--,antisyphilitic treatm5t ( an infect$ "m or *ild by salv>san1 m]cury1 & potassium iodide mu/ be c>ri$ out vigor\sly 9 all cases4 ,! syphilitic pati5t mu/ be prev5t$ f spread+ ! infection by hav+ di%es & ut5sils ( h] own1 :i* are kept /]ile4 ,dis*>ges are collect$ & burn$1 & ! nurse 9 *>ge ( ^! cases mu/ c>efully cov] h] h&s ) rubb] gloves1 & see t all cracks & fissures are prop]ly protect$ f contact ) s\rces ( infection4 ,gonorrha is an acute or *ronic disease ( ! muc\s membranes due to a g]m call$ ! gonococcus4 ,beg9n+ ) a %>p inflammatory di/urbance ( ! ure?ra or vag9a1 x may pass sl[ly up ?r\gh ! g5ital passage & produce *ronic & p]man5t disabilities1 su* z /]ility1 pus tubes1 & pelvic p]itonitis4 ,! symptoms are pa9ful ur9ation1 pa9ful inflammation ( ! vag9a1 ) a purul5t dis*>ge4 ,dur+ pregnancy all ^! symptoms are int5sifi$1 & w>ty gr[?s 7condylomata7 may appe> on ! vulva4 ,if infection occurs aft] pregnancy has begun1 ! c\rse ( ! ge/ation is r>ely affect$1 z ! ut]us is clos$ to g]m invasion4 ,dur+ deliv]y1 h[ev]1 !re is a s]i\s dang] ( infection ( m\? or eyes ( ! *ild if !y come 9 contact ) ! dis*>ge4 ,prophylaxis4--,! eyes at bir? mu/ be imm$iately in/ill$ ) a drop or two ( #a p] c5t solution ( silv] nitrate 9 wat]4 ,?is is n neutraliz$ by normal sal9e4 ,great c>e mu/ be us$ t ! dis*>ge does n come 9 contact ) ! eyes ( ! "m or att5dants1 le/ infection foll[4 ,treatm5t4--,scrupul\s cleanl9ess mu/ be obs]v$4 ,d\*es ( potassium p]manganate1 #a3ejjj1 or pa9t+ ! vag9a ) iod9e or solution ( silv] nitrate1 or suppositories ( argyrol or prot>gol furni% ! be/ means ( treatm5t be=e labor4 ,nei!r syphilis nor gonorrhea is necess>ily caus$ by v5]eal infection4 ,!y may be spread by b>b]s1 d5ti/s1 physicians1 & nurses1--by anyone :o is unclean2 & may be acquir$ innoc5tly ev]y:]e4 ,^! diseases %\ld n be discuss$ by ! nurse or physician except ) ! pati5t4 ,c]ta9ly no?+ f ! sick room %\ld be repeat$ else:]e4 ,! valves ( ! he>t are n uncommonly f\nd to be diseas$ 9 pregnancy1 ! mitral be+ ! mo/ (t5 affect$1 ei!r z an insuffici5cy or z a /5osis 7a n>r[+ ( ! mitral op5+74 ,mitral /5osis is ! mo/ s]i\s ( all he>t complications ( pregnancy1 & :]e ?is is pres5t1 a woman %\ld be advis$ to avoid conception4 ,9 o!r mitral lesions1 _m pregnancies may be successfully pass$1 if comp5sation is ma9ta9$2 b e "o br+s fur!r damage to ! already weak5$ he>t1 & r$uces its res]ve ( =ce4 ,if ! he>t breaks d[n e>ly 9 pregnancy1 & does n respond to m$ication1 abortion %\ld be induc$4 ,9 ! second half ( pregnancy1 ! "m %\ld be giv5 ! prior *ance1 b ! *ild %\ld be sav$1 if possible4 ,r5al diseases1 su* z nephritis1 may n only induce abortion by de/roy+ ! ftus1 b ! kidney lesion may be greatly aggravat$ by ! pregnancy4 ,! mo/ c>eful obs]vation ( ! pati5t's condition1 ! regul> exam9ation ( ! ur9e1 & ! sci5tific managem5t ( ! diet is necess>y to relieve ! "w on ! kidneys & keep ! pati5t 9 a mod]ate degree ( heal?4 ,x is ! duty ( ! nurse to protect h] pati5t aga9/ fatigue & *ill1 & to see t ! prop] diet is foll[$2 b o!r symptoms1 su* z heada*e & di/urbance ( vision & develop+ edema1 mu/ be not$ & report$ to ! physician at once4 ,diseases ( ,liv]4--,acute yell[ atrophy is a r>e condition1 :i*1 = reasons unkn[n1 is promot$ by pregnancy4 ,! symptoms are int5se heada*e & pa9 9 ! abdom51 possibly accompani$ by vomit+ & purg+1 :i* are soon foll[$ by coma4 ,!re is g5]ally a c]ta9 am\nt ( jaundice4 ,! ur9e is dim9i%$ 9 am\nt & conta9s album91 ca/s1 & sometimes blood4 ,!re is no kn[n treatm5t1 & ! end is dea?4 ,diabetes is seldom f\nd associat$ ) pregnancy4 ,its pres5ce is unfavorable to conception & to ge/ation4 ,"m & *ild are bo? less secure4 ,abortion or premature labor is ! rule4 ,! hmorrhages ( pregnancy 9 ! fir/ half g5]ally mean abortion1 & 9 ! la/ half1 ei!r plac5ta prvia or premature deta*m5t ( ! normally implant$ plac5ta 7see p4 #bbh74 ,abortion is ! expulsion ( ! ovum be=e ! ftus is viable1 t is1 be=e x is capable ( ma9ta9+ life aft] bir?4 ,?is means ! tw5ty-eigh? week1 or ! sev5? mon?4 ,subsequ5t to ! sev5? mon?1 ! int]ruption is call$ premature labor4 ,abortion is a m9iature labor1 consi/+ ( a /age ( dilatation1 a /age ( expulsion1 & a /age ( involution4 ,! int]ruption ( ! pregnancy may occur spontane\sly or be induc$4 ,9 spontane\s cases ! causes may be s\ght 9 diseases ( ! ovum1 or 9 ! "m1 9 injuries to ! ut]us or its cont5ts1 & su* sy/emic affections z syphilis1 ,bright's disease1 alcoholism1 lead poison+1 etc4 ,abortions happ5 ab\t once 9 e five or six pregnancies1 & m frequ5tly at ! ?ird mon? ?an at any o!r "t4 ,! symptoms are hmorrhage & pa94 ,! dang]s are hmorrhage & infection4 ,infection is mo/ common & mo/ s]i\s 9 abortions t are br\ght ab\t me*anically4 ,hmorrhage1 9 "s degree1 is an inv>iable symptom1 :i* has its orig9 9 ! sep>ation ( ! ovum f ! ut]9e wall4 ,hmorrhage f ! ut]us is s]i\s at :atev] /age ( pregnancy x appe>s4 ,! duty ( ! nurse is to put ! pati5t 9 a cool1 d>k room1 on h] back1 elevate ! foot ( ! b$1 put ice bags on ! l[] abdom51 & summon ! att5d+ physician1 ) ! hope t an abortion c be av]t$4 ,bromides & opium are ! drugs mo/ to be reli$ ^u4 ,opium may be giv5 9 suppository1 #a gra9 night & morn+4 ,if ! hmorrhage is al>m+ly pr(use & ! nurse is skillful & clean1 "u exceptional circum/ances %e may pack ! vag9a ) /]ile cotton :ile wait+ = ! doctor4 ,!n ! room %\ld be set = op]ation4 ,dead ,ovum4--,! ovum may be dis*>g$ 9 pieces or 9 a s+le complete mass4 ,! egg may die at any p]iod ( ! pregnancy1 & be dis*>g$ 9 a few h\rs1 or x may n be expell$ = weeks1 if at all4 ,ftal dea? 9 ! ut]us may h its cause on ! pat]nal side 9 a fa!r too old or too "y1 or affect$ ) su* diseases z diabetes1 nephritis1 tub]culosis1 syphilis1 or *ronic lead poison+2 on ! mat]nal side1 ! same diseases1 plus canc]1 anmia1 insuffici5t food1 & inflammation ( ! ut]us2 on ! "p ( ! embryo1 syphilis or any transmitt$ or prim>y disease ( ! ovum4 ,! results ( ret5tion ( ! dead ovum v>y ) ! case4 ,infection ( ! ovum is r>e1 except :]e ! membranes h ruptur$ & an op5 *annel exi/s4 ,no h>m foll[s ! dea? ( ! ftus1 except 9 ! pres5ce ( infections1 all o!r *anges are b5ign4 ,! embryo 9 ! fir/ & second mon?s may be absorb$1 b at lat] p]iods1 x becomes mac]at$ petrifi$1 or o!rwise alt]$4 ,among ! signs ( ftal dea? are prolong$ cessation ( ftal movem5ts aft] be+ def9itely obs]v$1 *ill9ess1 languor & malaise ( ! "m1 s5se ( weight 9 abdom51 & possibly a bad ta/e 9 ! m\?4 ,fur!rmore1 ! ut]us does n correspond to ! p]iod ( pregnancy1 & may h become small]4 ,retrogressive *anges take place 9 ! brea/s4 ,! diagnosis is only c]ta9 :5 ! he>t tones are p]si/5tly abs5t1 or ! mac]at$ head ( ! ftus is felt ?r\gh ! p>tly dilat$ os z a flabby bag ( bones4 ,treatm5t 9 non9fective cases is expectant4 ,spontane\s expulsion w occur soon] or lat] & !re is no necessit\s indication = int]f]5ce4 ,local signs ( putrefaction1 h[ev]1 make ! imm$iate empty+ ( ! ut]us necess>y4 ,,*apt] ,,vii ,,prep>ations ,,= ,,labor ,,& ,,! ,,normal ,,c\rse ,,( ,,labor ,! ,nurse4--,sci5tific ob/etric nurs+ is a specialty t enli/s ! int]e/ ( exceptional wom5 only4 ,x dem&s a high s5se ( duty1 a /rong physique1 broad tra9+1 unusual judgm5t1 & r>e tact4 ,! nurse mu/ be pr(essionally aseptic & p]sonally clean4 ,%e %\ld keep h]self free f odors1 & ba! at lea/ ?ree times a week4 ,! pres5ce ( pus any:]e on h] body disqualifies h] at once1 & %e %\ld report (f duty4 ,! comp5sation %\ld always be some:at high] ?an = o!r "w1 because !re are two pati5ts to be c>$ =4 ,an ob/etric nurse %\ld specialize 9 h] "w1 & n take infecti\s cases4 ,unhappily ! haphaz>d "* ( ! onset ( labor pres5ts a difficulty4 ,! pati5t frequ5tly c n af=d to h ! nurse = a long "t 9 advance ( labor1 & ! nurse ^: income is limit$ by ! numb] ( h] cases c n af=d to be idle4 ,h5ce1 x is bett] = two nurses to "w 9 alt]nation ) "o ano!r1 s t "o is always available 9 an em]g5cy4 ,bo? doctor & nurse %\ld visit ! ly+-9 room be=e labor beg9s1 & plan its re>rangem5t4 ,at lea/ a week be=e ! expect$ conf9em5t1 ! *amb] select$ %\ld be ?or\ghly clean$ & ! woodwork wip$ (f4 ,curta9s1 drap]ies & bric-a-brac & all useless furniture %\ld be remov$4 ,c>pets mu/ be tak5 up1 or at "t ( conf9em5t1 well protect$4 ,rugs c be easily manag$4 ,a *air1 a b$1 & ! v>i\s tables = in/rum5ts & solutions are all t are requir$4 ,! nurse usually is call$ to ! case fir/1 & ^u h] falls ! responsibility ( ! diagnosis & ! burd5 ( ! prep>ation4 ,z soon z %e arrives & satisfies h]self t ! pati5t is really 9 labor1 %e puts ! f9al t\*es to ! room4 ,9 h] own m9d %e goes ov] all possible em]g5cies & prep>es to meet !m4 ,! foll[+ supplies %\ld be 9 ! h\se = ! labor3 #c h& bas9s1 #aj in*es 9 diamet]4 #c h& bru%es4 #a two-qu>t d\*e bag4 #ae y>ds non/]ile gauze4 #b lb4 ea* ( cotton batt+ & absorb5t cotton = mak+ b$ pads4 #b pieces ( rubb] %eet+ #a by #b y>ds4 #e-yd4 j> ( borat$ gauze4 #d oz4 lysol 7or ziratol74 #ajj c4c4 ( ,squibb's *lor(orm4 #b oz4 gre5 soap4 #b oz4 solid albol5e4 #h oz4 alcohol4 oz4 ergotol4 oz4 bismu? subnitrate & oz4 boric acid p[d] mix$4 #a nail file4 ,nurse's outfit consi/s ( ! foll[+3 ,nail file1 surgical scissors1 ca!t] 7silv] is be/71 hypod]mic syr+e ) tablets ( morph9e1 /ry*n9e1 & digitalis2 two fev] !rmomet]s1 "o = m\? & "o = rectum2 a pair ( tissue =ceps & a razor4 ,"s "t be=e ! labor1 ! nurse %\ld call on ! pati5t & e/abli% a work+ acqua9tance4 ,x adds greatly to h] au?ority & to ! pati5t's confid5ce 9 h]4 ,h] advice w be s\ght on a multitude ( subjects1 p>tly real & p>tly to try h] out4 ,illu/ration3 ,fig4 #ca4--;,abdom9al b9d] ) crosspiece to hold vulv> pads4 ,illu/ration3 ,fig4 #cb4--,t-b9d]1 us$ 9 all cases aft] ! fif? day po/ p>tum4 ,/]iliz+ may be done 9 a hospital1 or1 if ?is is n feasible1 ! nurse %\ld g to ! h\se two or ?ree weeks be=e ! expect$ labor & /]ilize 9 an ,arnold or ,ro*e/] /]iliz] ! foll[+ articles3 doz4 %eets4 #c doz4 t[els4 #b pill[ slips4 #c abdom9al b9d]s ( unblea*$ cotton1 #af 94 wide & #cf 94 long1 fold$ & hemm$4 #d ,t b&ages4 #c brea/ b9d]s4 #b jacket p>ts ( pajama suits4 #c pairs ( long :ite /ock+s4 #c packages ( vulv> dress+s 7see ,prep>ation ( ,supplies1 p4 #cbf74 #b ob/etric pads #a by #cf by #cf in*es4 #a pill[ slip full ( cotton pl$gets = sponges4 #a j> applicators 7cotton twi/$ ab\t too?picks74 #a j> ( gauze pl$gets = p]9eorrhaphy & cord dress+s4 ,ev]y?+ mu/ be neatly wrapp$ & label$4 ,illu/ration3 ,fig4 #cc4--;,brea/ b9d]4 ,illu/ration3 ,fig4 #cd4--;,baby's dress ) w+$ sleeves4 ,infant's ,outfit4-- #ab pla9 slips #bg in*es long ( dimity or na9sook 7) w+$ sleeves74 #c long sleeve %irts1 silk & wool 7size ,no4 #b74 #f p9n+ blankets1 made ( out+ flannel1 if x is a w9t] baby4 #c b&s1 #f by #ah in*es1 clip or not* edges1 d n hem4 #c petticoats1 flannel bottoms & musl9 wai/s1 )\t sleeves & ) small button on %\ld]s4 #c out+ flannel wrapp]s4 #f pla91 s(t musl9 dresses4 #c 7,arnold7 knitt$ night g[ns1 light weight4 #d doz4 light weight cotton diap]s1 #bj x #dj in*es4 ,bird's-eye l95 is ! be/4 ,wa% & dry ^! 9 ! air be=e us+4 #d s(t t[els 7l95 pref]r$74 #b quilt$ pads4 #d s(t wa% clo?s4 #d wool wrapp+ blankets4 #a pair scales t weigh ounces & fractions !re(4 #d oz4 ( olive oil or b5zoat$ l>d4 #d oz4 ( alcohol 7#ie p] c5t74 lb4 boric acid cry/als4 lb4 absorb5t cotton4 #a cake ( ca/ile soap4 #b oz4 solid albol5e4 oz4 subnitrate ( bismu? p[d] & oz4 ( p[d]$ boric acid mix$4 #a b$ pan4 #b bas9s1 hold+ #b qu>ts ea*4 #a papi] ma*e1 rubb]1 or enamel w>e ba?tub4 ,an/hetics4--,excessive pa9 is de/ructive & dis9tegrat+ to ! vital =ces4 ,_m a woman :o has pass$ ?r\gh a p>ticul>ly sev]e labor rememb]s h] exp]i5ce ) a horror t =ev] precludes its repetition4 ,?is is ! day ( relative pa9lessness 9 labor1 & all ! _w is /riv+ to make *ildbir? easi] & less le?al4 ,no woman1 unless %e h]self reque/s x1 %\ld be p]mitt$ to g ?r\gh ! agony ( labor )\t an an/hetic1 judici\sly select$ & c>efully adm9i/]$4 ,pa9-dead5+ ag5ts are num]\s & inexp5sive1 & x is only a matt] ( exp]i5ce & judgm5t to *oose a me?od t w r$uce ! suff]+ ( *ildbir? to a m9imum4 ,! second & fir/ /ages ( labor1 9 ! ord] nam$1 dem& ! mo/ 9 ! way ( relief4 ,a prolong$ fir/ /age ) nagg+1 viol5t & app>5tly useless pa9s may devitalize ! pati5t m ?an %ort1 b acute pa9s ( ! second /age4 ,9 ! fir/ /age1 "u prop] selection ( cases & exp]i5c$ sup]vision1 8,twilight ,sleep0 w be successful 9 sev5ty to eighty p] c5t ( ! cases4 ,by success1 is meant t ! pati5t is relatively free f pa94 ,:5 ! drugs d n relieve pa91 ! case is a failure 7fifte5 p] c5t71 al?\gh 9 no case1 :5 prop]ly giv51 is ! "m or *ild endang]$4 ,morph9e solution gr4 & scopolam9e hydrobromid #a_/bjj gr4 to #a_/aej gr4 is ! cu/om>y dosage = ! fir/ injection4 ,ano!r injection ( #a_/bjj gr4 is giv5 9 a half or ?ree-qu>t]s ( an h\r4 ,! room is d>k5$1 talk+ is =bidd51 & ! family exil$4 ,! pati5t gets r$ 9 ! face & v ?ir/y1 ! pulse is rapid b full4 ,%e answ]s que/ions v sl[ly & dr[sily1 awakes = h] contraction b goes "r (f to sleep aga94 ,9 ?is condition %e is kept ?r\gh bi-h\rly repetitions ( ! scopolam9e until ! deliv]y4 ,x is ?is half wak+ & half sleep+ condition t sugge/$ ! "n ( 8,twilight ,sleep40 ,morph9e & scopolam9e w relieve ! pa9s ( ! fir/ /age )\t greatly protract+ ! labor4 ,! same drugs may & probably w prolong ! duration ( ! second /age4 ,! fir/ dose %\ld be giv5 z soon z ! pati5t is well />t$ 9 labor4 8,twilight ,sleep0 is at pres5t a hospital proc$ure1 & ! te*nic s exact+ z to we>y ! att5dants greatly4 ,x c n be employ$ until ! woman has def9itely gone into labor & is at lea/ ?ree h\rs away f deliv]y4 ,x is n s]viceable :]e ! pa9s are weak & %all[2 & x mu/ be us$ ) wise circumspection1 if at all1 9 ! pres5ce ( complications4 ,= ! second /age1 !re is a *oice ( ?ree drugs3 gas1 *lor(orm1 & e!r4 ,l twilight sleep ea* is op5 to "s objection1 b ea* may be ( ! greate/ assi/ance if us$ "u appropriate indications & conditions4 ,gas has "o advantage1 9 t x 9 no way int]f]es ) ! pa9 activities2 & ,lyn* & ,davis h %[n t ) a prop] admixture ( oxyg51 x may be giv5 ) comp>ative safety = ! two or ?ree h\rs :i* may m>k a normal second /age4 ,to adm9i/] x a compet5t ma*9e = mix+ ! gas is necess>y4 ,x %\ld n be giv5 to pati5ts :o h bad he>ts1 high blood pressure1 or toxmia4 ,nei!r is x a satisfactory an/hetic :5 ! head deliv]s1 = ! "m be+ less relax$ & m rigid1 ! legs & muscle action are h>d] to control & unnecess>y p]9eal lac]ations are liable to occur4 ,! pati5t is in/ruct$ to take sev]al deep brea?s j z ! ut]9e contraction comes on & ! gas bags supply ab\t #ge p] c5t nitr\s oxide & #be p] c5t oxyg54 ,z ! pa9 passes (f ! oxyg5 is increas$ & ! nitr\s oxide dim9i%$ until ! m9d is aga9 cle>4 ,to save ! p]9eum & bett] to control ! pati5t1 :5 ! head is ab\t to pass ! vulva1 x is wis] to ab&on ! gas = *lor(orm or e!r4 ,ob/etrical op]ations1 su* z =ceps & v]sion1 require e!r or *lor(orm1 & n gas4 ,! dang]s v>y ) ! an/hetic *os51 z well z ! am\nt & ! me?od ( adm9i/ration4 ,e!r affects ! respiration1 *lor(orm attacks ! he>t4 ,e!r mu/ n be giv5 ne> an op5 flame4 ,*lor(orm is n explosive b is decompos$ by fire into an irritat+ gas4 ,*lor(orm mu/ be dilut$ ) #ij p] c5t ( air1 h5ce ! mask mu/ be op51 or ! napk9 held free f ! face1 s t pl5ty ( air c ent]4 ,e!r & *lor(orm1 :5 giv5 8a la re9e20 i4 e41 a few drops on ! mask at ! beg9n+ ( ea* pa9 & increas$ up to ! acme1 is relatively free f dang]4 ,!y h ! additional advantage t ! sleep may be in/antly deep5$ if op]ation is requir$4 ,*lor(orm1 x is n[ believ$1 pr$isposes mildly to po/ p>tum hmorrhage4 ,davis has %[n t nei!r e!r1 gas1 nor *lor(orm affects ! *ild injuri\sly if ! adm9i/ration is int]mitt5t & n too greatly prolong$4 ,to summ>ize3 ,morph9e & scopolam9e comb9$ is a fir/ /age analgesic1 :i* has too mu* value to be neglect$4 ,gas1 if an app>atus is to be _h1 may "w well = ! great] "p ( ! second /age1 :ile = op]ations1 or = ! p]iod ( expulsion1 dur+ :i* ! head passes ! p]9eum1 *lor(orm & e!r give be/s results4 ,moreov]1 *lor(orm 8a la re9e0 may be giv5 safely & effici5tly by a compet5t nurse & 9 _m in/ances mu/ be giv5 by ! nurse1 if at all4 ,:5 ! p]9eum bulges1 or ! head becomes visible at ! vulva1 ! nurse %\ld ano9t ! lips1 *eeks & tip ( ! nose ) cold cream or olive oil1 to avoid burn+ ! sk91 & lay two or ?ree ?icknesses ( h&k]*ief or gauze ov] ! nose 7an inhal] is be/74 ,an abundance ( room mu/ be left und]nea? & at ! sides ( ! mask = air to ent]4 ,at ! beg9n+ ( ! pa9 a few drops ( *lor(orm are p\r$ on ! clo? & ! pati5t in/ruct$ to brea! vigor\sly4 ,! clo? is remov$ z soon z ! pa9 ceases & :5 ! next contraction comes on1 ! process is repeat$4 ,z ! head passes ! p]9eum1 ! *lor(orm %\ld be pu%$ to complete an/hesia1 bo? to save suff]+ & to give ! doctor full control ( ! p]9eum4 ,:5 ! nurse gives ! an/hetic1 %e %\ld wat* ! doctor = 8 signal to increase ! vapor or remove ! mask4 ,summ>y4--,cov] ! eyes ) a wet t[el & ano9t ! face ) cream or oil be=e us+ *lor(orm4 ,remove false tee?1 if pres5t4 ,ob/etric degree--a few drops on mask at beg9n+ ( ea* pa94 ,surgical degree--complete an/hesia4 ,wat* pulse & respiration4 ,a nurse %\ld nev] leave a pati5t :o has _h an an/hetic until %e is consci\s4 ,vomit+ is especially dang]\s4 ,normal ,labor4--,labor is ! process by :i* a ftus ( viable age is expell$ f ! ut]us4 ,by normal labor is meant a case :]e ! ftus pres5ts by ! v]tex & t]m9ates naturally )\t artificial aid1 or complications4 ,x v>ies greatly 9 sev]ity1 duration & dang] to "m & *ild4 ,a fir/ labor is m prolong$ & difficult ?an lat] conf9em5ts4 ,a woman 9 h] fir/ deliv]y is call$ a primip>a1 9 subsequ5t cases1 a multip>a4 ,! date at :i* labor comes on is difficult to det]m9e accurately4 ,! av]age duration ( pregnancy is f #bge to #bhj days1 =ty weeks1 or t5 lun> mon?s1 b conception does n occur necess>ily at ! "t ( coitus1 nor is x possible to "k ) any c]ta9ty :5 x does occur4 ,labor may occur two weeks e>li] ?an calculat$1 ) b5efit to ! "m1 & no h>m to ! *ild2 b if ! woman goes ov] "t1 ! *ild becomes mu* l>g] & ! labor h>d] & m dang]\s to bo?4 ,causes ( ,labor4--,:y labor %\ld occur at all is n kn[n4 ,_m !ories h be5 advanc$1 none ( :i* is entirely satisfactory4 ,"s ( ! be/ kn[n are ! gr[+ irritability ( ! ut]us accompani$ by an increase 9 ! frequ5cy & /r5g? ( ! int]mitt5t ut]9e contractions or increas+ di/5tion ( ! ut]us4 ,?us x is believ$ t :5 ! ut]us is di/5d$ up to a c]ta9 po9t1 x w try to relieve itself l ! bladd]1 or a baby's /oma*4 ,x may be t any "o ( ! foll[+ factors1 or all ( !m act+ toge!r1 are influ5tial4 ,dilatation ( ! c]vix by ! pres5t+ "p4 ,increas+ di/5tion ( ! l[] half ( ! ut]us ) pressure on neighbor+ n]ve /ructures4 ,! circulation ( ftal products ( metabolism 7tox9s7 act+ on ! n]ve c5t]s4 ,! m5/rual p]iodicity4 ,h]$ity & habit4 ,physical & emotional causes4 ,! onset ( labor probably is n purely accid5tal1 & yet x is s incon/ant 9 appe>ance & s indiff]5tly e>ly or late1 t x has e appe>ance ( be+ an affair ( *ance4 ,! "t :5 labor w come on is highly speculative 9 g5]al1 b ! ph5om5on is prec$$ by c]ta9 def9ite symptoms3 ,! light5+4 ,false pa9s4 ,%[4 ,rupture ( membranes4 ,! pa9s4 ,light5+4--,ab\t two weeks be=e labor1 especially 9 a primip>a1 ! ut]us & ! head sometimes desc5d into ! pelvis4 ,! body ( ! *ild falls =w>d & ! abdom5 protrudes1 ! /oma* is flatt]1 ! pati5t brea!s easi] & feels1 z %e says1 8light]40 ,b walk+ is m difficult1 ! bladd] is /imulat$ to frequ5t evacuations & ! rectum is compress$4 ,?is occurr5ce is a premonitory sign ( labor1 & also favorable inasmu* z x demon/rates t ?is p>ticul> head is n too l>ge to pass ?is p>ticul> pelvis4 ,false pa9s may appe>1 especially 9 multip>as1 f two to f\r weeks be=e labor4 ,9 "s ( ^! cases ! pa9s may be due to gas or indige/ion & respond to hot applications & enemas1 or !re may be def9ite ut]9e contractions1 z %[n by ! h>dness ( t organ dur+ a pa91 b ! ph5om5a are irregul> & !re=e n typical ( labor pa9s4 ,usually !y pass (f 9 a few h\rs1 b if ! pati5t is n]v\s1 ! doctor or nurse may be call$ ne$lessly4 ,! pati5t1 !re=e1 %\ld be in/ruct$ to h ! pa9s tim$ by ! wat* = half an h\r or an h\r4 ,if !y are regul> dur+ ?is p]iod1 ! physician %\ld be notifi$4 ,^u 8 arrival1 an int]nal exam9ation w reveal ! true "* ( ! di/urbance by ! condition ( ! c]vix & os4 ,! %[ is a dis*>ge ( ?ick1 :ite mucus1 slightly /a9$ ) blood4 ,?is is ! mucus plug :i* occludes ! c]vix dur+ pregnancy & :5 ! os beg9s to dilate1 ! mass is releas$ & passes out4 ,labor usually comes on vigor\sly )9 twelve h\rs4 ,! membranes may rupture be=e labor beg9s & mu* fluid escape4 ,! advantage ( ! dilat+ bag ( wat] & lubricat+ qualities ( ! liquor amnii are ?us lo/4 ,su* a labor is call$ a 8dry bir?0 & is frequ5tly sl[1 exhau/+1 & extremely pa9ful4 ,! pa9s are ! subjective manife/ations ( ! p[]s ( labor4 ,! =ces conc]n$ are ut]9e & abdom9al muscles1 pr9cipally assi/$ by ^? ( ! back1 legs1 & arms4 ,_! con/rict+ action on ! n]ve fib]s 9 ! walls ( ! ut]us is ! cause ( ! pa9s 9 ! fir/ /age4 ,! onset may be viol5t & g on to a quick deliv]y1 b g5]ally ! inception is m insidi\s4 ,! irregul>1 pa9less contractions1 7( ,braxton ,hicks7 t 7 m5tion$ on an e>li] page1 gradually at t]m *ange _! "* & become regul> & pa9ful4 ,at fir/ !y may be slight & vague1 la/+ only half a m9ute & sep>at$ by int]vals ( t5 or fifte5 m9utes & sc>cely attract ! pati5t's att5tion4 ,!y are felt *iefly 9 ! abdom54 ,m or less rapidly !y increase 9 frequ5cy1 sev]ity & duration4 ,!y la/ f a m9ute to a m9ute & a half & come e ?ree m9utes4 ,! :ole ut]us h>d5s & its outl9e is cle>ly def9$ dur+ ! contraction2 x relaxes & becomes s(t 9 ! int]val4 ,! woman is n[ 9 labor4 ,! pa9s become gr9d+ & ! pati5t feels t %e is n accompli%+ any?+1 yet "u ! influ5ce ( ^! contractions ! c]vix is effac$ & ! os is dilat$4 ,! ,c\rse ( ,labor4--,labor is divid$ = conv5i5ce into ?ree /ages z foll[s3 ,! fir/ /age1 f ! beg9n+ ( pa9s until ! complete dilatation ( ! os4 ,! second /age1 f ! complete dilatation ( ! os to ! deliv]y ( ! *ild4 ,! ?ird /age1 f ! deliv]y ( ! *ild to ! expulsion ( ! plac5ta4 ,! fir/ /age is ! /age ( dilatation4 ,usually at t]m1 ! c]vix is column> & un%ort5$1 ! canal intact1 & clos$ at bo? ends1 z %[n 9 ,fig4 #cf4 ,9 multip>as ! out] op5+ w usually admit ! tip ( ! f+]4 ,z labor proce$s1 ! c]vix is effac$1 ! os sl[ly dilates1 & ! bag ( wat]s =ms4 ,! ,bag ( ,wat]s4--,:5 ! c]vix is effac$ & only ! os rema9s1 ! l[] end ( ! egg ) its fluid re/ra9$ by ! membranes1 bulges =w>d into ! canal4 ,! ftal head1 or bree* presses into ! pelvis1 & ! fluid 9 ! membranes1 compress$ betwe5 ! pres5t+ "p above & ! c]vix bel[1 is call$ ! bag ( wat]s4 ,:5 ! contraction comes on ! longitud9al muscul> fib]s ( ! ut]us are drawn upw>d & ! bag ( wat]s becomes t5se & pu%es f>!r & f>!r d[n into ! op5+2 & by its ev5 & univ]sal pressure1 me*anically & sl[ly increases ! size ( ! op5+ :i* ! muscul> traction is pull+ ap>t4 ,at ! same "t1 ! fluid ar\nd ! *ild prev5ts1 = a "t1 direct & injuri\s compression on ! body4 ,:5 no def9ite c]vical projection c be felt1 & :5 ! teat-l protrusion ( ! c]vix has disappe>$1 ! c]vix is said to be effac$4 ,illu/ration3 ,fig4 #ce4--,! bag ( wat]s beg9s to act on ! c]vix4 7,ed547 ,! os n[ beg9s to /ret* & wid51 ! bag ( wat]s becomes m & m evid5t1 vomit+ occurs1 & at la/1 :5 ! os has exp&$ to a diamet] ( f\r in*es 7t5 c5timet]s71 ! membrane c )/& ! pressure no long]4 ,x ruptures1 a c]ta9 am\nt ( fluid escapes1 ! pres5t+ "p comes d[n aga9/ ! op5+1 & l a valve1 prev5ts ! outfl[ ( ! wat]s f above4 ,illu/ration3 ,fig4 #cf4--,! effect ( ! pa9s4 ,! c]vix be=e labor beg9s4 7,bumm47 ,illu/ration3 ,fig4 #cg4--,! effect ( ! pa9s4 ,! c]vix beg9s to be 8effac$40 7,bumm47 ,illu/ration3 ,fig4 #ch4--,! effect ( ! pa9s4 ,! c]vix is effac$1 & ! dilatation ( ! os beg9s4 7,bumm47 ,illu/ration3 ,fig4 #ci4--,! effect ( ! pa9s4 ,! c]vix is effac$1 & ! os cont9ues to dilate4 7,bumm47 ,sometimes ! labor may be prec$$ by "s h\rs 7two or ?ree71 or days 7two or ?ree71 ev5 weeks 7two or ?ree71 by ! rupture ( ! membrane1 & sometimes :5 ! /ructure is ?ick & t\gh1 ! rupture may be delay$ until well into ! second /age1 or ev5 until ! *ild is born4 ,9 ! latt] case1 ! head comes out1 cov]$ ) membrane4 ,9 ! old days1 ?is 0 call$ be+ 8born ) a caul40 ,x 0 suppos$ to be a lucky om51 b x 0 lucky only t ! babe escap$ suffocation4 ,! membrane %\ld be torn op5 quickly4 ,! duration ( ?is /age is v>iable4 ,x is mu* long] 9 primip>as ?an multip>as4 ,x av]ages sixte5 h\rs 9 ! =m]1 & eight h\rs 9 ! latt]4 ,vomit+ dur+ ?is /age is q common1 b ! pulse & temp]ature rema9 normal4 ,! fir/ /age ( labor is usually "u ! entire control ( ! nurse4 ,x is h] responsibility4 ,) complete dilatation ( ! os1 ! second /age1 or /age ( expulsion1 beg9s1 :e!r ! membranes rupture or n4 ,! pres5t+ "p1 usually ! head1 passes f ! c]vix into ! vag9a4 ,! vag9a 9 turn gradually dilates f above d[nw>d until ut]us1 c]vix & vag9a =m a s+le1 wide *annel ( ! same diamet]4 ,! *ild is driv5 =w>d by ! ut]9e contractions1 /rongly re9=c$ by ! abdom9al muscles1 :i* ! pati5t uses vigor\sly4 ,! onset ( ea* pa9 is accompani$ by a deep inspiration1 foll[$ by /ra9+ or be>+ d[n ) ! abdom9al muscles z 9 a highly exagg]at$ b[el movem5t4 ,! pati5t holds h] brea?1 braces h] feet1 fa/5s h] h&s on b$ or att5dant1 & uses all ! trunk muscles 9 ! ef=t4 ,! face becomes conge/$1 ! pulse quick5$1 %e p]spires "s1 & groans deeply dur+ ! contraction4 ,! pa9 is extreme & is due p>tly to ! /ret*+ ( ! vag9a & vulva & p>tly to ! di/5tion ( deep] s5sitive /ructures4 ,:5 ! head rea*es ! pelvic floor1 ! fir/ *ange obs]v$ 9 ! ext]nal g5itals is ! /ret*+ 7bulg+7 ( ! p]9eal body4 ,next1 ! anus becomes turgid1 dilates slightly1 ! ant]ior wall becomes visible1 & ! hairy scalp ( ! *ild appe>s at ! vulva4 ,! actual expulsion ( ! head 9 a primip>a is accompli%$ by a s]ies ( prolong$ & sev]e contractions1 accompani$ by viol5t /ra9+4 ,illu/ration3 ,fig4 #dj4--,! c]vix is effac$1 & ! os dilat$4 ,! second /age beg9s4 7,ed547 ,illu/ration3 ,fig4 #da4--;,*ild 9 second /age ( labor ) bag ( wat]s unruptur$ & pres5t+ at ! vulva4 7,braune1 f ,b>b\r47 ,a %ort pause ensues1 foll[$ 9 two or ?ree m9utes by a return ( ! pa9s1 :i* expel fir/ ! %\ld]s & !n ! trunk4 ,z ! body escapes x is foll[$ by a ru% ( blood-/a9$ liquor amnii4 ,?is is ! fluid t has be5 p5t up 9 ! ut]us by ! ob/ruct+ body ( ! *ild4 ,! second /age la/s ab\t two h\rs 9 a primip>a & f fifte5 m9utes to "o h\r 9 a multip>a4 ,! ?ird /age is ! deliv]y ( ! aft]-bir?4 ,! aft]-bir? sometimes call$ ! secund9es1 consi/s ( plac5ta1 umbilical cord1 & membranes4 ,illu/ration3 ,fig4 #db4--,! head pass+ ov] ! p]9eum4 7,bumm47 ,aft] ! expulsion ( ! ftus1 ! ut]us und]goes a sudd5 dim9ution 9 size4 ,x is ab\t z l>ge z ! *ild's head1 & ! fundus lies ne> ! level ( ! umbilicus4 ,! contractions /ill p]si/ feebly1 b !y are practically pa9less1 & ! pati5t is greatly reliev$1 possibly sleep+4 ,9 f t5 to ?irty m9utes1 ! ut]us becomes small]1 h>d]1 m globul> 9 %ape & m movable4 ,! pati5t br+s ! volunt>y muscles ( ! abdom5 /rongly into action aga94 ,! nurse pres5ts a /]ile bas9 & ! physician su/a9s & sl[ly twi/s ! membranes free f _! f9al atta*m5t & out ( ! ut]us4 ,:5 ! plac5ta passes ! vulva1 a mod]ate siz$ blood clot foll[s x4 ,illu/ration3 ,fig4 #dc4--,normal expulsion ( ! plac5ta l an inv]t$ umbrella accord+ to ,s*ultze4 7,williams47 ,! ut]us is n[ mu* small]1 & h>d & firm 9 consi/5cy1 b = "s h\rs ! contractions are int]mitt5t1 & :ile ?is cont9ues1 !re is risk ( hmorrhage4 ,g5]al ,effects4--,! "m's pulse is quick5$ dur+ ! contraction4 ,! ftal he>t beats m sl[ly & feebly dur+ a contraction1 b quickly recov]s 9 ! int]val4 ,! am\nt ( blood lo/ dur+ labor av]ages f t5 to sixte5 ounces4 ,! temp]ature may be elevat$ "o or two degrees 9 a woman ( mod]ate physique1 :ile "o ) a fragile body may pres5t ! signs & symptoms ( surgical %ock4 ,! *ill1 pallor1 cold limbs & body1 rapid & feeble pulse ) subnormal temp]ature1 sugge/ to ! nurse at once ! prop] treatm5t4 ,heat1 to all p>ts ( ! body1 w>m cov]s & hot milk or c(fee4 ,if hmorrhage is pres5t & ! ut]us relax$1 ! nurse %\ld imm$iately inject pituitr9 7#ae 7 into ! deltoid muscle & notify h] att5d+ physician4 ,,*apt] ,,viii ,,! ,,me*anism ,,( ,,normal ,,labor ,! p[]s ( labor are prim>ily ! ut]9e contractions /rongly aid$ by ! muscles ( ! abdom5 & diaphragm4 ,"s assi/ance is giv5 by ! fixation ( ! legs & arms & sometimes by gravity1 :5 a sitt+ or /&+ position is ma9ta9$4 ,! resi/ances are ! bony pelvis & its relatively s(t cov]+s ( muscle & fascia4 ,! problem is to get ! awkw>dly %ap$ pass5g] ?r\gh ! curi\sly %ap$ passage4 ,9 ! fir/1 & a "p ( ! second /age1 ! ut]9e contractions d n act directly ^u ! body ( ! *ild1 = ! latt] is surr\nd$ by a wall ( liquor amnii4 ,pressure is transmitt$ by a fluid m$ium 9 all directions1 h5ce1 ! weak "p ( ! wall1 :i* is ! c]vix1 mu/ give way4 ,:ile ! membranes rema9 intact1 or :5 suffici5t fluid is reta9$1 no am\nt ( pressure c injure ! ftus4 ,:5 ! membranes rupture1 ! =ce ( ! pa9s is ex]t$ directly ^u ! *ild to drive x =w>d1 & prolong$ pressure may produce injuri\s effects ?r\gh compression ( ftus1 plac5ta1 or cord4 ,! progress ( labor is regi/]$ usually by wat*+ ! advance ( ! ftal head4 ,! relation ( ! head to ! pelvic brim is ( great importance1 z x travels mu* fa/] & easi] 9 c]ta9 positions ?an 9 o!rs4 ,! t]m 8pres5tation0 is us$ to designate t "p ( ! *ild :i* ent]s or t5ds to ent] ! pelvic inlet4 ,! pres5tation is nam$ f ! "p ( ! *ild :i* comes into apposition ) ! brim4 ,?us1 "o speaks ( a v]tex pres5tation1 or a bree* pres5tation1 or a %\ld] pres5tation4 ,! pres5tation is det]m9$ ext]nally by palpation4 ,! v]tex pres5ts 9 #if p] c5t ( all labors4 ,) ! v]tex pres5t+1 ! head may occupy any "o ( f\r positions4 ,! t]m 8position0 is us$ to expla9 ! relation :i* ! mo/ di/9ctive feature ( ! pres5t+ "p be>s to ! quadrants ( ! pelvic inlet4 ,?us1 ! mo/ di/9ctive feature or l&m>k ( ! v]tex is ! occiput1 :i* is ! po9t ( direction1 & s aga91 ! position is ! relation ( ! po9t ( direction to ! brim ( ! pelvis4 ,! po9t ( direction is ! "p t takes prec$5ce 9 ! process ( deliv]y4 ,?us1 9 all cases :]e ! occiput is 9 advance1 ! occiput is ! po9t ( direction & ! position is call$ occipital4 ,:]e ! *9 is 9 advance1 x is m5tal 7m5tum is ,lat9 = *947 ,9 bree* cases1 ! sacrum is ! po9t ( direction4 ,! pelvis is divid$ by ! transv]se & ant]opo/]ior diamet]s into f\r quadrants nam$ respectively ! left ant]ior1 ! "r ant]ior1 & ! "r & left po/]ior4 7,see ,fig4 #a47 ,?us1 9 a v]tex pres5tation ! back ( ! *ild may be 7& 9 #ec p] c5t is7 to ! front & to ! left4 ,! occiput is ! po9t ( direction1 & lies 9 relation to ! left ant]ior quadrant ( ! pelvis1 & is spok5 ( z a left-occipito-ant]ior position4 ,simil>ly a "r-occipito-ant]ior position is nam$1 & "r- & left-occipito-po/]ior positions4 ,^! occur respectively 9 ab\t #ba p] c5t1 #ad p] c5t & #aa p] c5t ( ! cases4 7,ed547 ,9 pass+ ! pelvis1 ! ftus n only foll[s ! curv$ l9e ( ! pelvic axis1 b x describes a c]ta9 s]ies ( movem5ts :i* alt] its relations to ! pelvis4 ,illu/ration3 ,fig4 #dd4--,! *ild 9 left-occipito-ant]ior position4 7,l5oir & ,t>ni]47 ,!re are five ( ^! movem5ts3 flexion1 desc5t1 int]nal ant]ior rotation1 ext5sion1 & ext]nal re/itution4 ,flexion4--,flexion is usually pres5t be=e labor beg9s4 ,t is1 ! head is b5t d[n until ! *9 t\*es ! brea/4 ,?is may be modifi$ by v>i\s conditions1 b s f> z x becomes ext5d$1 ! me*anism is di/urb$ & ! labor complicat$1 s9ce l>ge & less favorable diamet]s are br\ght to deliv]y4 ,illu/ration3 ,fig4 #de4--,! *ild 9 "r-occipito-ant]ior position4 ,%[s ! flexion ( ! head int5sifi$ at ! beg9n+ ( labor4 7,ed547 ,flexion is increas$ by pressure aga9/ ! pelvic brim z labor beg9s4 ,desc5t4--,z ! driv+ =ce ( ! contractions becomes effective1 ! head passes ! inlet & desc5ds to ! pelvic floor4 ,:5 ! l>ge diamet]s ( ! head 7bip>ietal7 h pass$ ! inlet1 ! head is said to be engag$4 ,illu/ration3 ,fig4 #df ,a4--,! desc5t ( ! head 9 "r-occipito-ant]ior position4 ,se5 f bel[4 7,edg>47 ,fig4 #df ,b4--,side view4 ,illu/ration3 ,fig4 #dg4--;,int]nal ant]ior rotation & ext5sion ( ! head 9 a left-occipito-ant]ior position4 7,am]ican ,text ,book47 ,int]nal ,rotation4--,! head mo/ frequ5tly ent]s ! brim ) ! occiput to ! left & ant]ior 7obliquely7 because x f9ds m room & an easi] passage2 b ^u pass+ ?is /rait & ent]+ ! roomy1 true pelvis1 ! head mu/ rotate s t ! long diamet] ( ! head w con=m to ! long diamet] ( ! pelvic outlet1 :i* lies 9 a direction j opposite to ! long diamet] ( ! inlet or brim2 h5ce1 ! occiput turns =w>d "u ! pubic ar*4 ,?is movem5t is due l>gely to ! slop+ pelvic floor & ! necessity ( accommodation betwe5 ! head & pelvis z ! *ild is driv5 =w>d4 ,illu/ration3 ,fig4 #dh4--;,ext5sion4 ,a1 ! *9 leaves ! *e/2 ,b1 ext5sion 9 progress4 7,ed547 ,illu/ration3 ,fig4 #di4--;,a1 ext5sion complet$2 ,b1 expulsion4 7,ed547 ,rotation is mu* ret>d$ or entirely /opp$ :5 ! head is ext5d$ in/ead ( flex$ or :5 x ent]s ! inlet ) ! occiput po/]ior in/ead ( ant]ior4 ,ext5sion4--,aft] int]nal1 ant]ior rotation1 ! head em]ges at ! vulva1 ! occiput com+ out fir/1 !n 9 succession ! v]tex1 =ehead & face & *94 ,z ! *9 rolls out ov] ! p]9eum1 x moves away f ! *e/ wall--x becomes ext5d$4 ,ext]nal ,re/itution4--,:ile ! head is pass+ ?r\gh ! outlet1 ! %\ld]s are ent]+ ! pelvic inlet1 & s soon z ! head is releas$ f ! re/ra9t ( ! vag9a1 x naturally falls into its normal relation to ! ftal back2 h5ce 9 ! position n[ discuss$1 x turns t[>d ! left4 ,!re=e1 we may summ>ize ! me*anism 9 a normal left-occipito-ant]ior position ( ! head by say+3 ,! head is flex$ & =c$ into ! pelvis4 ,x desc5ds to ! pelvic floor4 ,! occiput rotates to ! front ( ! pelvis & imp+es aga9/ ! symphysis4 ,ext5sion ensues 9 consequ5ce ( ! necessity = an accommodation betwe5 ! pelvis & ! advanc+ head1 & dur+ ?is ext5sion1 ! head deliv]s ov] ! p]9eum4 ,ext]nal re/itution foll[s4 ,! ,effect ( ,labor on ! ,ftal ,head4--,z ! head passes ?r\gh ! canal1 x is m\ld$ by contact ) ! resi/ances4 ,! degree ( m\ld+ is proportionate to ! pressure requir$ to drive x ?r\gh4 ,?us1 9 a l>ge head1 or a relatively small pelvis1 ! m\ld+ may be extreme1 & *anges 9 ! scalp are common4 ,caput ,succ$aneum4--,s9ce all p>ts ( ! scalp are 9 contact ) a resi/ant wall1 except 9 ! c5t] ( ! bir? canal1 an effusion ( s]um takes place "h1 :i* is due to ! ob/ruction ( ! v5\s circulation4 ,illu/ration3 ,fig4 #ej4--;,a cephalhmatomata4 ,d n confuse ) caput succ$aneum4 7,bumm47 ,swell+ occurs 9 ! subcutane\s cellul> tissue1 & a tumor =ms--! caput succ$aneum--:i* spontane\sly disappe>s 9 tw5ty-f\r or =ty-eight h\rs4 ,x is useful 9 confirm+ ! diagnosis ( ! position4 ,cephalhmatoma4--,foll[+ labor a tumor is sometimes f\nd ^u ! head1 :i* is (t5 confus$ ) a caput succ$aneum4 ,?is tumor is caus$ by an effusion ( blood b5ea? ! p]io/eum or ! cov]+ ( ! bone--usually a p>ietal bone4 ,x is sometimes s+le & sometimes d\ble1 & x v>ies 9 size f a filb]t to a pea*4 ,! swell+ nev] ext5ds across a suture4 ,! effusion takes place gradually1 & may n appe> = a day or s aft] bir?4 ,! cause is unkn[n1 = x occurs aft] normal & easy1 z well z aft] difficult1 deliv]ies1 & aft] bree*1 z well z v]tex1 cases4 ,at fir/ x fluctuates1 !n becomes h>d1 & 9 a few weeks or mon?s is gradually absorb$4 ,if symptoms ( c]ebral pressure develop1 x mu/ be rememb]$ t hmatoma may occur inside z well z outside ! cranium4 ,no treatm5t is necess>y4 ,puncture is inadvisable4 ,9 extremely r>e in/ances ! tumor may suppurate & require incision4 ,,*apt] ,,ix ,,! ,,c>e ,,( ,,! ,,pati5t ,,dur+ ,,normal ,,labor ,e case ( labor mu/ be conduct$ ) ! mo/ scrupul\s att5tion to surgical cleanl9ess on ! "p ( ! pati5t1 doctor & nurse4 ,pu]p]al infection 9 mo/ cases is due to ! introduction ( disease-produc+ microbes into ! w\nd$ g5ital canal4 ,to be sure1 ! successful en=cem5t ( surgical cleanl9ess is atta9$ only 9 good hospitals1 b x c be approximat$ 9 a private h\se if ! pati5t insi/s ^u deliv]y at home4 ,a nurse or doctor :o is clean ( p]son1 is mo/ apt to h an 8aseptic consci5ce40 ,! possession ( su* a consci5ce may entail f9ancial sacrifices1 b x has _m comp5sations4 ,nei!r ! nurse nor ! doctor is do+ ju/ice to ! pati5t1 nor to ! pr(ession1 :o indiscrim9ately takes pus cases1 contagi\s diseases1 & conf9em5ts4 ,! public w soon le>n t su* a nurse & su* a doctor are unsafe att5dants4 ,h[ may ! nurse "k t ! pati5t is 9 labor8 ,?is is ! f9al assumption t mu/ be confirm$ or refut$ :5 ! nurse is call$ to h] case4 ,x is asc]ta9$ p>tly by ! hi/ory & p>tly by ! conditions f\nd4 ,?us1 ! pati5t may report ! passage ( a piece ( blood-/a9$ mucus1 & ! nurse w obs]ve t ! contractions ( ! ut]us are regul>1 rhy?mical & pa9ful4 ,%e w obs]ve t :5 ! pati5t compla9s ( pa91 ! ut]us gets h>d4 ,%e w also obs]ve ! def9ite regul>ity ( ! contractions by tim+ !m4 ,"u su* conditions1 ! doctor %\ld be call$ at once if ! symptoms develop betwe5 #g ,a4 ,m4 & #aa ,p4 ,m4 ,if ! pa9s beg9 9 ! night1 say f #aa ,p4 ,m4 to #g ,a4 ,m41 ! doctor ne$ n be call$ unless he has reque/$ x1 or1 unless 9 ! judgm5t ( ! nurse or ! anxiety ( ! pati5t1 x is desirable = him to see h]4 ,illu/ration3 ,fig4 #ea4--,po9ts ( greate/ int5sity ( ftal he>t tones4 ,v1 v]tex pres5tations2 ,b1 bree* pres5tations4 7,ed547 ,:5 ! doctor is notifi$ he w want to "k1 & ! well tra9$ nurse w be able to in=m him1 :5 ! pa9s began1 _! /r5g?1 duration & frequ5cy4 ,he w want to "k :e!r or n ! membranes h ruptur$4 ,_m doctors also require1 & a well tra9$ nurse :o specializes 9 ob/etrics %\ld be able to say by ext]nal exam9ation1 :e!r ! head seems high or l[1 z well z ! position & frequ5cy ( ! ftal he>t tones4 ,9 ! hospital ! foll[+ rules = summon+ ! resid5t physician may be f\nd useful3 #a4 ,= multip>a1 :5 pa9s are regul> & five m9utes ap>t4 #b4 ,= primip>a1 :5 pa9s are regul> & two m9utes ap>t1 or :5 head is visible if pa9s are less frequ5t4 #c4 ,if a precipitate is imm95t1 deliv]y mu/ be delay$ until arrival ( att5d+ man by-- 7a7 ,turn+ pati5t on side ) legs /raight2 7b7 ,in/ruct+ pati5t to brea! deeply or to cry out ) m\? wide op52 !n 7c7 ,place /]ile t[el ov] vulva1 & at "t ( pa9 prev5t expulsion by compress+ ! head by means ( lock+ ! h&s ov] a t[el on ! vulva4 ,x is possible ?us to delay deliv]y two h\rs1 or until ! doctor arrives4 ,d n p]mit a precipitate4 ,aft] ! nurse has complet$ h] prelim9>y obs]vation1 %e />ts h] hi/ory1 notes ! "* ( ! pa9s1 ! pulse1 temp]ature & respiration4 ,all unusual ph5om5a %\ld be record$2 & aft] ! visit ( h] att5d+ man1 8 exam9ation1 if any1 & ! conditions f\nd1 are put d[n4 ,!n %e prep>es ! pati5t & sets up ! room = ! deliv]y4 ,prep>ation4--,z soon z ! pati5t is kn[n to be 9 labor1 ! b[els are ?or\ghly cleans$ ) a soapsuds enema4 ,a toilet j> %\ld be us$ & n ! wat] closet4 ,! bladd] mu/ be empti$ at ! "t ( prep>ation & at frequ5t int]vals ?r\gh\t ! labor4 ,z soon z ! b[els & bladd] are empti$1 ! pati5t is giv5 a ba? & ?or\ghly soap$4 ,! %[] is pref]r$ le/ ! wat]1 contam9at$ by bact]ia f ! sk9 & ext]nal g5itals1 %\ld ent] & pollute ! vag9a4 ,illu/ration3 ,fig4 #eb4--;,h&l+ =ceps1 kept /]ile 9 a j> ( alcohol4 ,! hair %\ld be braid$ 9 two braids4 ,! vulva & p]9eum are %av$4 ,no pati5t w object to ?is :5 its importance z a feature ( protection aga9/ blood poison+ is expla9$ to h]4 ,scrub ?ighs1 hips1 & abdom5 z f> z ! navel ) soap & w>m wat]1 !n /]ile wat]1 foll[$ by a #b p] c5t solution ( lysol4 ,c>e mu/ be tak5 to remove ! smegma & dri$ secretions f ! folds ( ! vulva4 ,put on a fre% pad1 a clean g[n1 & long /ock+s4 ,a loose wrapp] ov] all p]mits ! pati5t to move ab\t4 7,see ,*apt] ,,xxiii47 ,gue/s are =bidd51 & ! imm$iate family is kept at a di/ance--if possible4 ,an air ( buoyancy1 composure1 & compet5ce %\ld prevail 9 ! sick room1 & ! pati5t %\ld be *e]$ & enc\rag$ 9 e possible way4 ,dur+ ! fir/ /age1 ! pati5t may be up & ab\t1 z ?is div]ts ! m9d4 ,%e may assi/ 9 ! arrangem5t ( ! room :i* %\ld always be ! be/ room 9 ! h\se4 ,x %\ld be well w>m$ & close to ! ba?room4 ,all unnecess>y furniture & hang+s %\ld be remov$1 z previ\sly describ$4 ,aft] ! room has be5 put 9 ord]1 ! b$ is made4 ,mak+ ! ,b$4--,put mattress pad ov] mattress & cov] ) rubb] %eet or oil clo?1 & spread a %eet ov] all4 ,!n a small] rubb] %eet is put on1 ext5d+ f "u ! pill[s to a c\ple ( feet f ! foot4 ,a pla9 musl9 %eet goes ov] ! rubb]1 !n ! deliv]y pad4 ,:5 ! b$ is ready1 a small table or /& %\ld be plac$ ne> ! head1 on :i* is put ! an/hetic1 ! mask & ! oil or cold cream4 ,! pati5t may be lightly cov]$ ) a %eet or a %eet & blanket4 ,dur+ ! fir/ /age1 light & easily dige/$ food & dr9ks may be s]v$1 ei!r cold or hot1 z ! pati5t pref]s4 ,:5 ! doctor arrives he may want to exam9e ! pati5t ei!r ext]nally or int]nally1 or bo?4 ,s a %eet is ?r[n across ! l[] "p ( ! body & ! night-dress pull$ up z f> z ! brea/s4 ,= ! ext]nal exam9ation ! doctor wa%es 8 h&s 9 w>m wat] & gre5 soap & scrubs ) ! nail bru% = five m9utes4 ,?is p]iod %\ld be prolong$ to fifte5 m9utes1 if1 by any mis*ance1 ! h&s h be5 9 contact ) pus or infecti\s mat]ial4 ,x is extremely difficult to get !m ev5 approximately clean aft] su* an exp]i5ce4 ,illu/ration3 ,fig4 #ec4--,palpation4 ,:at is 9 ! pelvis8 7,ed547 ,he n[ palpates ! abdom51 notes ! location ( ! head & back1 f9ds & c\nts ! he>t tones1 measures ! pelvis & *ild1 e/imates ! desc5t ( ! head & ! "* ( ! pa9s4 ,illu/ration3 ,fig4 #ed4--,palpation4 ,:at is 9 ! fundus8 7,ed547 ,if he ?9ks an int]nal exam9ation is necess>y1 he w n[ return to ! ba?room1 p>e & clean 8 nails1 scrub h&s & arms to elb[s = t5 m9utes 9 runn+ wat] ) gre5 soap & a /]ile bru%1 soak ! h&s 9 lysol solution #j4e p] c5t = five m9utes4 ,bi*loride ( m]cury solutions h no place 9 ob/etrics4 ,!y ru9 in/rum5ts & h&s1 & are valueless = asepsis s9ce ! m]cury unites ) ! album9 ( ! mucoid dis*>ges & =ms an album9ate ( m]cury1 :i* is in]t4 ,! bi*loride solutions also are nonlubricat+1 h>% & a/r+5t1 z well z poison\s1 z soon z ! mucoid protection has be5 remov$4 ,:5 ! doctor takes 8 h&s f ! lysol solution1 !y %\ld be wip$ on a /]ile t[el4 ,a /]ile g[n is put on1 if possible4 ,if x is n available1 he %\ld be c>eful n to t\* any?+ t may de/roy or contam9ate 8 prep>ation4 ,! h&s are p[d]$ & /]ile rubb] gloves pull$ on 7"o w d474 ,illu/ration3 ,fig4 #ee4--,palpation4 ,:]e is ! back8 ,:]e are ! small p>ts8 7,ed547 ,! nurse1 mean:ile1 has wrapp$ ! legs ( ! pati5t 9 ! ends ( a /]ile %eet1 ! bulk ( :i* cov]s ! abdom54 ,! knees are spread ap>t4 ,! vulva cleans$ ) pl$gets ( cotton soak$ 9 lysol solution4 ,"o or two pl$gets are us$ on ei!r side ( ! vulva & ! same numb] = cleans+ ! introitus4 ,! f+]s are n[ introduc$4 ,! int]nal exam9ation may be conv5i5tly po/pon$ until ! wat]s break1 or x may be omitt$ altoge!r if ! he>t tones ( ! *ild rema9 good1 ! labor progressive1 & ! head cont9ually advances into ! pelvis1 z det]m9$ by ! ext]nal exam9ation4 ,! great advantage ( an int]nal exam9ation at ?is "t is ! diagnosis ( ! degree ( dilatation & ! assurance t ! cord has n be5 wa%$ d[n into ! vag9a by ! ru% ( fluid4 ,if ! fir/ /age is prolong$1 ! nurse %\ld try to get ! pati5t to re/1 & %e %\ld h]self snat* a few mom5ts ( repose if possible4 ,illu/ration3 ,fig4 #ef4--,pati5t drap$ = int]nal exam9ation4 7,williams47 ,! condition ( ! os & ! "* ( ! pa9s may make ! doctor feel safe 9 leav+ ! h\se1 b 8 :]eab\ts & telephone numb] %\ld be asc]ta9$ & ! exact "t ( 8 return4 ,second ,/age4--,dur+ ?is /age1 ! pati5t %\ld g to b$ & ! doctor %\ld rema9 ne>by4 ,! nurse may obs]ve ! vulva at int]vals & note bulg+1 if pres5t1 or %e may press a f+] aga9/ ! s(t p>ts outside ! labia & see if ! h>d resi/ant head has come into ! outlet4 ,! pa9s are sev]e & all accessory muscles are call$ into action4 ,p>tial an/hesia %\ld be ma9ta9$ 9 mo/ cases1 :i* %\ld m]ge into complete n>cosis z ! head passes ! vulva4 ,! nurse may h to adm9i/] ?is4 ,:5 ?is /age beg9s1 or is well "u way1 ! pati5t %\ld be prep>$4 ,a /]ile pad %\ld be plac$ "u h]1 !n a /]ile b$ pan4 ,! nurse hav+ prep>$ h] h&s & arms z previ\sly direct$ = ! doctor1 scrubs abdom51 legs1 & vulva ) gre5 soap & w>m wat]1 foll[$ by lysol solution #j4e p] c5t & a r9s+ ) /]ile wat]4 ,! cleans+ ( ! pati5t %\ld take ab\t t5 m9utes4 ,cov] ) a /]ile t[el & put on ! /]ile l954 ,if 9 ! hospital1 ! drums h be5 pack$ = /]ilization s t :5 !y are op5$ ea* article w appe> 9 ! ord] ( its ne$3 ,no4 #a4 7,beg9n+ at ! bottom47 ,a receiv+ blanket1 :i* has a ticket1 m>k$ ) ! weight ( ! blanket1 atta*$ to x4 #a abdom9al b9d] ) pad hold] atta*$4 #a pill[ slip fold$ half way back4 #a g[n = pati5t4 #b surgeon's g[ns4 #c %eets4 #a pair surgical /ock+s fold$ half way4 #a surgeon's g[n = nurse4 ,no4 #b conta9s cotton pl$gets4 ,no4 #c conta9s /rips ( gauze & comb9ation pads4 ,application ( ,/]ile ,l95--,normal ,case4--,/]ile l95 is to be appli$ z foll[s1 by a clean nurse2 #a4 ,lay %eet across foot ( b$ & half way up4 #b4 ,put surgical /ock+ on "o foot & draw %eet up = foot to re/ ^u4 #c4 ,second foot z above4 #d4 ,lay /]ile %eet across b$ "u pati5t1 lett+ ends hang4 #e4 ,lay /]ile %eet ov] abdom5 ( pati5t4 ,9 _m hospitals ! /]ile /ock+s & protective %eet are all made 9 "o piece1 :i* greatly simplifies ! application ( ! l954 ,z soon z ! second /age beg9s1 ! packet conta9+ ! p]9eorrhaphy & cord set1 c>efully /]iliz$1 is br\ght out & plac$ 9 conv5i5t rea* ( ! doctor4 ,?is set conta9s-- #h 94 =ceps4 #b scissors curv$ on ! flat4 #a dissect+ =ceps4 #a duck bill speculum4 #a ne$le hold]4 #a metal ca!t]4 #h gauze sponges4 #a m$ic9e dropp]4 #a cord clamp1 or #b cord tapes4 #b case numb]s1 atta*$4 #ab ne$les1 #d r\nd1 #d half-curv$ c]vix ne$les1 & #d sk9 ne$les4 ,?is is ! /age ( expulsion & ! pati5t may want to pull or pu% on some?+ to aid ! /ra9+ ef=t4 ,unless ! nurse ne$s "t to set up ! room or to get ! doctor1 ?is t5d5cy may be enc\rag$4 ,a /]ile %eet may be atta*$ to ! foot ( ! b$ & ! ends 7corn]s7 giv5 into ! pati5t's h&s z a knot or loop to pull on1 or %e may pu% upw>d aga9/ ! head ( ! b$4 ,"u no circum/ances mu/ %e be p]mitt$ to t\* or contam9ate ! clean l95 9 h] movem5ts1 ei!r consci\sly or unconsci\sly4 ,! h&s %\ld be re/ra9$1 if necess>y1 to avoid ?is4 ,! face may be spong$ & a cold t[el laid across ! eyes4 ,rubb+ ( ! back & legs w br+ great com=t1 & cramps ( ! limbs may be remov$ by /raight5+ ! legs & rubb+ ! muscles und]nea?4 ,ev]y?+ is n[ ready = ! deliv]y4 ,if ! husb& insi/s ^u be+ 9 ! room1 he %\ld take (f 8 coat & ve/ & we> a g[n1 or if ! labor is 9 ! home1 drop a clean night robe ov] 8 clo!s4 ,! prep>$ room w %[ at close h&-rea*1 ! bas9s ( solutions1 ! pl$gets ( cotton1 tape or clamp = cord1 scissors1 nitrate ( silv] solution 7#a p] c5t7 = ! eyes1 ) dropp]1 ! /]ile d\*e c 9 read9ess = hmorrhage & a l>ge res]ve ( supplies4 ,:atev] an/hetic has be5 *os5 = ! second /age1 is n[ adm9i/]$4 ,?r\gh\t ?is /age1 ! he>t tones ( ! *ild mu/ be wat*$1 z well z ^? ( ! "m1 = intra-p>tum dea? may occur at any mom5t4 ,a second exam9ation may be desirable n[ to confirm ! diagnosis & to secure an e/imate ( ! advance4 ,z a rule1 ! exam9ations %\ld be z few z possible on acc\nt ( ! dang] ( infection4 ,?is is ! p]iod ( greate/ responsibility = ! doctor ^: duty x is to wat* &1 if necess>y1 to re/ra9 ! advance ( ! head 9 ord] to protect ! p]9eum f rupture4 ,?is may be done at times mo/ successfully1 or 9 ! case ( too few assi/ants1 mo/ desirably1 by deliv]y on ! side4 ,to secure ?is1 z ! head becomes m & m visible1 ! woman is turn$ ^u h] left side2 a pill[ roll$ tightly & p9n$ 9 a /]ile cov]+ is plac$ betwe5 ! knees1 & a %eet flung across ! body4 ,illu/ration3 ,fig4 #eg4--;,deliv]y 9 side position4 ,! h&s %\ld be glov$ & ! upp] leg rais$ on a h>d cu%ion or pill[4 7,am]ican ,text ,book47 ,! hips mu/ be br\ght to ! edge ( ! b$ :ile ! *e/ & head are pull$ ov] to ! o!r edge ( ! b$1 leav+ ! legs j en\gh space to d\ble up along ! side ( ! b$ p>allel ) its long axis4 ,! doctor may n[ sit on ! edge ( ! b$1 or on a high /ool at ! back ( ! pati5t & fac+ ! buttocks4 ,?is is a mo/ conv5i5t & easily manag$ position4 ,z ! head is born1 ! fcal matt]1 blood & dis*>ges mu/ be spong$ away1 & ! field kept clean1 ) ! :ole p]9eum visible4 ,always sponge f vag9a t[>d rectum & ?r[ away ! sponge4 ,%\ld ! h& t\* non/]ile ?+s or septic mat]ial1 l fces1 ! glove mu/ be *ang$4 ,! h&s mu/ be kept surgically clean4 ,x is a "p ( ! nurse's duty tactfully to w>n ! doctor :5 su* a ?+ occurs1 z x may happ5 accid5tally :ile 8 att5tion is conc5trat$ else:]e1 & a consci5ti\s man w be grateful = ! in=mation4 ,z ! head passes ! p]9eum ! an/hesia %\ld be deep5$4 ,z soon z ! head is born & ! fir/ respiration e/abli%$ 7see ,asphyxia1 p4 #bgh71 ! cord is cut & clamp$4 ,!re is r>ely any necessity = ha/e 9 ?is maneuv]4 ,! eyes are treat$1 & if 9 a hospital1 a numb]$ tape is ti$ ab\t ! wri/ & a tape ) a correspond+ numb] ab\t ! "m's wri/4 ,! baby is n[ plac$ 9 ! receiv+ blanket on its "r side1 ) artificial w>m? at its back & feet4 ,! head mu/ be l[] ?an ! body s any reta9$ mucus c dra9 out ( nose & m\?4 ,mean:ile1 ! doctor 7or nurse7 keeps a h& on ! fundus ( ! ut]us to wat* its contraction1 see t x does n balloon up1 & massage x occasionally if necess>y :ile he awaits ! onset ( ! ?ird /age4 ,?ird ,/age4--,! pati5t is turn$ ^u h] back z soon z ! *ild is deliv]$4 ,! pulse & face mu/ be wat*$ = signs ( hmorrhage4 ,:ile wait+ = ! plac5ta1 ! p]9eum is exam9$ to note ! degree ( lac]ation1 if any4 ,to d ?is1 ! vulva mu/ be spread ap>t ) clean f+]s s z to br+ ! po/]ior wall into view1 & ! dis*>ge is spong$ away ) cotton pl$gets tak5 f ! lysol solution & squeez$ dry4 ,! pati5t may n[ h ! saturat$ dress+s remov$ & clean1 dry ones sub/itut$4 ,! new pads cat* ! ooz+ blood & give an e/imate ( its am\nt4 ,at ?is "t1 if desirable1 ! p]9eum c be repair$4 ,! woman is p>tly unconsci\s1 ! tissues numb$1 & ! ne$le hurts mu* less ?an x w lat]4 ,nev]!less1 an/hesia may be requir$4 ,9 a p]iod v>y+ f a few m9utes to an h\r1 ! h& on ! ut]us w note a h>d5+1 ! mass w become small]1 m globul>1 & rise slightly 9 ! abdom54 ,a gu% ( blood appe>s at ! vulva & usually ! plac5ta foll[s4 ,if x does n1 or if hmorrhage or ! condition ( ! "m requires x e>li]1 ! ut]us may be compress$ 7see ,cr$ expression7 & ! plac5ta con/ra9$ to deliv]4 ,! nurse holds a /]ile bas9 = its reception4 ,z ! mass drops into ! pan1 ! membranes drag aft] & x %\ld be g5tly twi/$1 or ! loose portions drawn ^u until ! end slips out4 ,! plac5ta is set aside = exam9ation1 & ergot or pituitr9 may be giv5 to en=ce ! ut]9e contraction4 ,! process ( expulsion is g5]ally assi/$ by a /rong volunt>y contraction ( ! abdom9al muscles4 ,aft] a %ort re/1 ! blood is wa%$ (f ! g5itals1 clean l95 & clean pads appli$1 & ! abdom9al b9d] or girdle is put on to hold ! pads4 ,w>m blankets are ?r[n ov] ! pati5t & )9 an h\r1 a glass ( hot milk is adm9i/]$4 ,! legs %\ld be kept toge!r1 & 9 case ( hmorrhage1 ! feet cross$4 ,! plac5ta is n[ inspect$ & n only its complet5ess or incomplet5ess not$1 b anomalies ( e k9d %\ld be look$ =4 ,,imm$iately ,,aft] ,,labor ,p]9eorrhaphy mu/ be done if requir$4 ,a lac]at$ c]vix is n to be repair$ at ?is "t1 except 9 case ( hmorrhage1 = ! tissues are greatly swoll51 & if sutures are put 9 tight en\gh to all[ = suffici5t %r9kage1 !y w cut ?r\gh2 :ile if n tight1 !y w be useless 9 tw5ty-f\r h\rs4 ,c>e ( ,"m4-- #a4 ,cleanse g5itals ) lysol solution #j4e p] c5t f above d[nw>d4 #b4 ,put on /]ile pad1 ) pad hold] & b9d]4 #c4 ,wa% face & h&s4 #d4 ,take temp]ature1 pulse1 & respiration4 #e4 ,glass ( hot milk4 #f4 ,keep on back f\r h\rs4 ,wat* ut]us = hmorrhage & keep firm by occasional massage4 #g4 ,put tape ) case numb] on arm4 ,c>e ( ,*ild4-- #a4 ,clamp = ! cord4 #b4 ,place on "r side ) head l[] ?an bree*4 #c4 ,keep w>m & wat* = cord hmorrhage4 #d4 ,treat eyes ) silv] nitrate solution #a p] c5t1 or argyrol solution1 #ae p] c5t4 ,d n neutralize ! #a p] c5t silv] nitrate solution4 #e4 ,put tape ) case numb] correspond+ to "m's on arm4 ,to pres]ve ! p]9eum f rupture is an important duty1 & 9 a def9ite p]c5tage ( cases1 unsuccessful4 ,nev]!less1 x is a duty1 :i*1 9 ! abs5ce ( ! doctor1 may fall ^u ! nurse4 ,h[ %all %e meet x8 ,! greate/ dang] to ! p]9eum comes f a too rapid advance ( ! head2 h5ce1 ! nurse ret>ds ! deliv]y by putt+ ! woman on h] side :]e %e c n be> d[n s successfully1 & in/ructs h] to cry out ) h] pa9s4 ,%e may also delay ! labor by hold+ ! head back ) a clean pad until ! vulva /ret*es to its fulle/ capacity4 ,! rules :i* ! doctor foll[s 9 protect+ ! p]9eum z ! head advances1 may be ?us summ>iz$4 #a4 ,deliv] ! pati5t on h] side4 #b4 ,ma9ta9 flexion ( head4 #c4 ,delay ext5sion ( ! head4 #d4 ,give *lor(orm to ret>d deliv]y & to prev5t precipitate deliv]y4 #e4 ,deliv] betwe5 pa9s1 if possible1 by ,ritg5's maneuv] 7modifi$74 #f4 ,d episiotomy1 if necess>y4 ,p]9eorrhaphy4--,lac]ations ( ! p]9eum occur 9 ab\t #cj p] c5t ( all primip>as & 9 f #aj to #ae p] c5t ( multip>as4 ,!y occur :5 ! *ild is l>ge or too rapidly deliv]$1 & :5 ! orifice is small or ! tissues inela/ic4 ,= conv5i5ce1 ! lac]ations ( ! p]9eum are divid$ = description into ?ree degrees4 ,! fir/ degree involves only ! f\r*ette & a small portion ( ! mucosa4 ,x is r>ely m ?an "o-half an in* 9 dep? & requires no att5tion except cleanl9ess by ! nurse4 ,! second degree may te> a v>iable di/ance into ! p]9eal body1 sometimes s deeply z to expose ! sph9ct] ani4 ,x is usually on "o side1 b may appe> on bo? sides1 & be accompani$ by prolongations into ! vag9a4 ,! ?ird degree passes ?r\gh ! sph9ct] & sometimes well up ! rectal wall4 ,?is is also call$ a complete te>4 ,! lac]ations ( ! p]9eum :i* require sutures %\ld be att5d$ to at once unless ! pati5t's condition is critical4 ,9 su* cases ! repair may wait f twelve to tw5ty-f\r h\rs4 ,= ?is op]ation ! nurse w assemble & boil = fifte5 m9utes3 #b pairs ( scissors4 #b tissue =ceps1 "o ) tee? & "o )\t4 #a bull-dog =ceps4 #c art]y =ceps4 #f ne$les1 #c full & #c half-curv$4 #a dress+ =ceps4 #a ne$le hold]4 ,suture mat]ial ( catgut & silkworm gut %\ld be ready 9 /]ile conta9]s4 ,! catgut %\ld be ! tw5ty-day *romiciz$1 ,no4 #c & #d4 ,ev5 !n ! /r&s are quickly absorb$ :5 ! lo*ial secretions fl[ ov] !m4 ,silkworm gut is bett]1 b h>d to remove f ! vag9a2 h5ce x is cu/om>y to use catgut inside ! vag9a & silkworm gut = ! sutures outside4 ,! nurse r5ews ! supplies ( gauze & cotton sponges4 ,hot solutions are prep>$1 & ! pati5t br\ght into a position on table or across ! b$ s t ! be/ light may be _h4 ,! legs may be held by ! husb& or nurse1 or bo?4 ,if help is inadequate1 a %eet sl+ c be utiliz$4 ,?is is made by twi/+ ! %eet f corn] to corn] & pass+ x rope-l ov] ! %\ld]s1 & back ( ! neck4 ,!n ea* end is ti$ above ! pati5t's knee on ei!r side z ! legs are flex$ 9 an exagg]at$ li?otomy position4 ,! sutures are n[ introduc$ & ti$ loosely f bel[ upw>d & f )9 outw>d4 ,if ti$ too tightly1 !y w cut ?r\gh4 ,! success ( ! op]ation dep5ds on two ?+s3 ! c>e ) :i* ! levator ani1 if torn1 is f\nd & re/or$2 & ! scrupul\s cleanl9ess obta9$ by ! nurse 9 h] aft]-c>e4 ,if ! /it*es become sore1 a few drops ( /]ile glyc]9e %\ld be appli$ ) an applicator4 ,illu/ration3 ,fig4 #eh4--,%eet twi/$ into a sl+4 ,! pati5t lies on ! unroll$ portion4 ,! roll$ cords be>+ aga9/ ! %\ld]s are ti$ to ! legs bel[ ! knees4 ,see ,fig4 #ajb4 7,am]ican ,text ,book47 ,if catgut is us$ inside ! vag9a1 ! c\nt+ ( ! /it*es is gratuit\s1 s9ce !y absorb )\t removal4 ,if silkworm gut is us$1 ! numb] ( sutures mu/ be record$1 le/ "o be ov]look$ 9 removal4 ,b9d+ ! legs toge!r aft] repair is n requir$1 b ! sutures mu/ be giv5 aseptic c>e aft] ea* b[el movem5t1 ea* ur9ation1 & :5 ! pads are *ang$1 if !y h become contam9at$4 ,! sutures are remov$ on ! t5? day4 ,illu/ration3 ,fig4 #ei4--,repair ( p]9eum4 ,sutures 9 place4 7,hamm]s*lag47 ,aft] complete te>s1 ! b[els are kept con/ipat$ = two or ?ree days1 & !n mov$ ) a high enema ( sweet oil1 foll[$ by ca/or oil by m\?4 ,aft] ! b[el movem5t1 ! nurse %\ld wa% out ! rectum ) normal sal9e solution4 ,! nurse mu/ look c>efully at ! /it*es e "t ! pad is *ang$ & note if ! swell+ is increas+ or dim9i%+1 if !re is irritation or t5d]ness1 or if !y are cutt+ out ?r\gh ! tissues4 ,! ext]nal sutures are usually left long & ti$ toge!r 9 a knot1 to prev5t ! ends f /ick+ into ! pati5t4 ,if %e compla9s ( ?is1 ! ends may be wrapp$ 9 /]ile gauze4 ,dur+ ! progress ( ! case ! nurse mu/ wat* = & report any sign ( fluid pass+ f b[el ?r\gh ! vag9a4 ,! p]9eorrhaphy be+ complet$1 ! woman is p]mitt$ to re/ ?\gh ! nurse w make frequ5t exam9ations ( pulse & respiration4 ,%e w note ! look ( ! face & ! h>dness ( ! ut]us4 ,! pad %\ld be wat*$ & ! am\nt ( blood dis*>g$1 duly e/imat$4 ,if ! fl[ does n dim9i% or if ! ut]us %\ld balloon up1 ! doctor %\ld be notifi$ & ! nurse mean:ile %\ld give a dram ( ergot 7fluid extract7 by m\? or an amp\le ( aseptic ergot hypod]mically4 ,! doctor %\ld rema9 )9 call ( ! pati5t = at lea/ an h\r aft] deliv]y4 ,9 ! hospital ! foll[+ rules may be us$ z a concise guide = ! conduct ( ! ?ird /age3 ,,conduct ,,( ,,?ird ,,/age4 ,keep pati5t on back & keep a h& on fundus4 ,note am\nt ( blood lo/1 its "*1 its fl[1 & :e!r /eady or 9 gu%es4 ,! plac5ta %\ld deta* itself normally 9 ?irty m9utes4 ,aft] ?irty m9utes1 expulsion may be assi/$ by-- 7#a7 ,e>ly expression4 7a7 ,massage1 rub & knead ! ut]us1 until x h>d5s "u ! h&4 7b7 ,seize contract$ ut]us by fundus ) full h&1 f+]s beh9d & ?umb 9 front4 7c7 ,pu% sl[ly b firmly t[>d ! pelvic outlet4 7#b7 ,cr$ expression4 ,same maneuv] z above1 except t ! fundus is compress$ betwe5 ?umb & f+]s :ile ! d[nw>d movem5t is progress+4 ,conditions = ,cr$ expression3 7a7 ,ut]us mu/ be contract$4 7b7 ,ut]us mu/ be 9 m$ian l9e4 7c7 ,bladd] mu/ be empty4 ,if n successful1 wait t5 m9utes & !n repeat maneuv]4 ,nev] make traction on ! cord4 ,nev] use ergot until ut]us is empty4 ,if plac5ta does n come away )9 an h\r1 manual removal mu/ be consid]$4 ,9 case ( hmorrhage1 x mu/ be remov$ at once4 ,c>efully inspect plac5ta & be sure x is complete4 7,see ,po/ ,p>tum ,hmorrhage1 p4 #bcb47 ,:5 ! pati5t is put to b$1 ! bloody %eets & t[els are put to soak 9 cold wat]1 & aft] sev]al r9s+s1 may be s5t to ! laundry4 ,drap+s /a9$ ) fcal matt] mu/ be cleans$ sep>ately4 ,,*apt] ,x ,,! ,,normal ,,pu]p]ium ,! pu]p]ium is ! "n giv5 to ! p]iod succe$+ ! bir? ( ! *ild z f> z ! "t ( ! complete re/oration ( ! g5itals4 ,x may la/ f six to t5 weeks1 or ev5 long] if complicat$4 ,:5 ! labor is complet$1 ! mo/ urg5t desire ( ! pati5t is = re/4 ,%e is ?or\ghly exhau/$ 9 n]ves & body4 ,a po/ p>tum *ill may appe>1--a slight %iv] t may la/ a qu>t] ( an h\r4 ,s9ce ! pulse & temp]ature rema9 unaffect$1 ?is ph5om5on may be reg>d$ m]ely z a sign ( pro/ration or n]v\s revulsion4 ,9 ! c\rse ( ! fir/ ?ree days1 ! temp]ature may rise to #ajj ,f4 9 a case entirely normal4 ,x has no pa?ological significance unless p]si/5t or increas+4 ,! temp]ature %\ld be tak5 night & morn+1 & 9 complicat$ cases e f\r h\rs4 ,all temp]atures ov] #ajj ,f41 aft] ! initial rise & desc5t j describ$1 mu/ be reg>d$ z septic4 ,! pulse does n rise ) ! temp]ature ( ! fir/ ?ree days1 b rema9s firm or ev5 falls a little4 ,:5 ! pulse rises & ! temp]ature s9ks1 x means hmorrhage4 ,! ur9e is usually increas$ = ! fir/ few days & !n returns to ! normal = t pati5t4 ,! labor affects ! pati5t l a surgical op]ation4 ,! dige/ion is di/urb$4 ,! appetite is gone1 & ! /oma* mu/ be treat$ g5tly until its tone is re/or$4 ,! body 9 repose is less urg5t 9 its dem&s = food4 ,liquids 9 abundance =m ! /aple diet = ! fir/ two days4 ,= ! next ?ree days1 semisolids may be add$1 & aft] ! milk is well e/abli%$1 a g5]al diet is desirable2 b s long z ! "m nurses h] *ild1 ! liquids mu/ prepond]ate 9 mo/ cases4 ,illu/ration3 ,fig4 #fj4--,! progress ( involution on ! v>i\s days ( ! pu]p]ium4 7von ,w9*kel1 f ,knapp47 ,mean:ile1 c]ta9 *anges are tak+ place 9 ! pelvis t are highly important4 ,involution is ! process und]gone by ! ut]us 9 return+ to its normal nonpregnant /ate4 ,?is %r9kage c be foll[$ abdom9ally & is regi/]$ by ! nurse 9 ! numb] ( f+]-bread?s or c5timet]s above ! symphysis pubis4 ,edg> gives ! rate ( %r9kage z foll[s3 ,aft] deliv]y1 #e4ib 94 long1 or #ae4h cm4 #bnd day1 #d4fc 94 long1 or #aa4cj cm4 #crd day1 #d4cg 94 long1 or #aa4aj cm4 #f? day1 #c4db 94 long1 or #h4dh cm4 #h? day1 #b4ee 94 long1 or #f4dj cm4 #aj? day1 #b4bb 94 long1 or #e4fj cm4 ,! rate ( involution n only v>ies greatly ) diff]5t wom51 b v>ies mu* aft] ! diff]5t labors ( ! same woman4 ,ord9>ily at ! end ( ! fir/ week ! fundus %\ld lie midway betwe5 ! navel & ! pubes1 & %\ld %r9k rapidly !reaft]4 ,! necessity = wat*+ ! rate ( involution is imp]ative = a numb] ( reasons4 ,if involution is sl[1 or /ops1 x may indicate fatigue ( ! muscle f multip>ity or ov]-di/5tion 7tw9s1 hydramnios1 etc47 or x may foll[ a po/ p>tum hmorrhage4 ,sub9volution may also indicate infection1 ! ret5tion ( clots1 or pieces ( plac5ta4 ,x happ5s also :5 ! woman gets up too soon or does n nurse h] *ild & !reby delays ! re/oration ( h] wai/l9e1 z well z dim9i%es h] resi/ance to disease4 ,! b9d] is objectionable to "s doctors on ! gr\nd t x favors retrov]sion ( ! ut]us dur+ involution4 ,?is w\ld be a plausible !ory :5 ! ut]us is high1 if x 7 n t ! v]tebr ( ! pati5t & ! pelvic brim keeps ! ut]us f be+ pu%$ out ( its place & aft] ! ut]us desc5ds into ! pelvis ! g5tle pressure ( ! b9d] ev5ly di/ribut$ ov] ! abdom5 c n affect x appreciably4 ,fur!rmore1 ! ut]us 9 involution %[s a p]si/5t t5d5cy t[>d anteflexion & antev]sion4 ,! b9d] is m]ely a girdle put on j tight en\gh to hold 9 place ! b&age t supports ! p]9eal pads & to all[ ! pati5t m easily to gr[ accu/om$ to ! sudd5 *ange 9 intraabdom9al pressure :i* ! deliv]y ( ! *ild creates4 ,h[ev]1 if ! doctor objects to a b9d]1 x may be left (f ) safety4 ,! ,lo*ia4--,:5 ! plac5ta is deliv]$1 ! ut]us normally closes d[n & all gross hmorrhages cease2 b = ! next two weeks or possibly long]1 a vag9al dis*>ge cont9ues4 ,= ! fir/ few days x is hmorrhagic 9 "* & x is call$ lo*ia rubra1 & consi/s mo/ly ( fluid blood ) occasional small clots4 ,by ! f\r? day1 usually x has become br[n & ?9n]4 ,x is n[ call$ lo*ia s]osa4 ,by ! t5? day1 x is yell[i%-:ite1 & is call$ lo*ia alba4 ,! lo*ia is ! wa/age f ! %r9k+ ut]us1 & is made up ( r$ blood corpuscles1 epi!lial cells1 leucocytes1 & pieces ( brok5-d[n decidu4 ,! entire l9+ ( ! ut]us is loos5$1 dis*>g$ & a new "o =m$ dur+ ! pu]p]ium4 ,! lo*ia is regul>ly infect$ by bact]ia 9 ! vag9a4 ,if involution is sl[1 ! lo*ial dis*>ge may be prolong$4 ,! ,aft]-,pa9s4--,! pu]p]ium is n infrequ5tly accompani$ by pa9ful contractions ( ! ut]us call$ aft]-pa9s4 ,^! are m common 9 multip>as & s]ve a useful purpose 9 ma9ta9+ a def9ite contraction ( ! ut]us4 ,if ! pa9s are at all sev]e1 !y are a sugge/ive symptom ( ! ret5tion ( blood clots1 a fragm5t ( plac5ta1 or ( membrane4 ,?is1 ( c\rse1 w occur ei!r 9 a primip>a or multip>a4 ,9 all cases ! aft]-pa9s mu/ be diff]5tiat$ f gas & f ! pa9s ( pelvic inflammation4 ,gas pa9s c be reliev$ by hot spic$ dr9ks1 asaftida & ! high rectal tube4 ,sub9volution is treat$ by ! adm9i/ration ( fluid extract ( ergot1 9 tw5ty to tw5ty-five drop doses1 ?ree or f\r times daily4 ,?is w br+ ab\t ! dis*>ge ( ! irritat+ fragm5t or clot1 & ! nurse c aid ! process by g5tly massag+ ! ut]us sev]al times daily or by giv+ a hot vag9al d\*e4 ,code9e may be us$ = aft]-pa9s if absolutely necess>y4 ,diet 9 ,normal ,cases4--,!re is no re/riction on ! k9d ( food ! pati5t may take1 s long z %e c dige/ x cleanly & )\t gas4 ,acids or alkalies1 cold or hot1 ri* or o!rwise1 fruits1 meats or vegetables1 all g to ! =mation ( good milk if prop]ly dige/$4 ,! old idea t acids %\ld n be eat5 is fallaci\s4 ,!re is m acid 9 ! /oma* normally1 ?an c\ld be add$ 9 a meal made up entirely ( citrus fruits4 ,at ! same "t1 ! heavy foods %\ld be avoid$ on acc\nt ( ! s]i\s dem& on ! liv] & kidneys 9 ! abs5ce ( ex]cise4 ,on ! o!r h&1 if ! brea/s are engorg$1 ! fluids mu/ be r$uc$ to a m9imum1 & a relatively dry diet en=c$4 ,! pati5t loses ab\t "o-n9? ( h] previ\s body weight 9 ! c\rse ( labor & ! pu]p]ium4 ,! brea/s are made ready = lactation twelve h\rs aft] deliv]y by cleans+ ) /]ile gre5 soap & w>m wat] & ba?+ 9 #ej p] c5t alcohol4 ,next1 ! nipple is att5d$ to1 & ! infant is put to ! brea/4 ,! nipple is prep>$ by cleans+ x ) an applicator soak$ 9 fre% boric acid solution1 & aft] nurs+1 ! same process is repeat$4 ,?is is r\t9e1 :e!r ! "m is 9 b$ or walk+ ab\t4 ,9 ! latt] case1 ! "m mu/ be taught to c>e = h] own brea/s4 ,! *ild is put to ! brea/ e ?ree h\rs & giv5 six fe$+s a day4 ,?is leaves a six h\r int]val at night1 :i* is v necess>y = ! "m's re/ & = ! *ild4 ,if ! babe is feeble1 sev5 or eight fe$+s 9 ! tw5ty-f\r h\rs may be requir$ = ! fir/ two weeks4 ,at fir/ ! brea/ only secretes a ?ick1 yell[i% secretion call$ colo/rum1 ( :i* ! *ild gets f a dra*m to an ounce4 ,x is a mild laxative4 ,! irritation ( ! nipple by ! *ild's m\? is begun z e>ly z possible 9 ord] to /imulate ! brea/s to secrete milk & ! ut]us to contract1 & ?us aid involution & ! pres]vation ( ! mat]nal figure4 ,! milk usually 8comes 90 on ! ?ird day & is accompani$ by a s5se ( di/5tion & mod]ate pa9s 9 ! brea/s4 ,! gl&s may be hot1 h>d & swoll51 b normally !re is no rise ( temp]ature ) ! infl[ ( ! milk1 except ) n]v\s wom5 :o /& pa9 badly4 ,!re is no su* ?+ z milk fev]4 ,if fev] appe>s at ?is "t1 an infection mu/ be suspect$4 ,! engorgem5t ( ! gl&s may become s great t ! nipples are drawn 9 & no?+ is left = ! *ild to grasp4 ,if ! engorgem5t becomes too pa9ful1 fluids are remov$ f ! diet li/1 & sal9e ca?>tics adm9i/]$1 :ile ice packs are appli$ to bo? brea/s4 ,heat %\ld nev] be us$ except = ! purpose ( ha/5+ suppuration4 ,?is engorgem5t1 or s-call$ 8cak+0 ( ! brea/s is n due to ! milk1 b to ! infiltration ( ! connective tissue ar\nd ! gl&s ) s]um & blood :i* /imulate ! gl&s to secrete4 ,! di/5tion usually disappe>s 9 tw5ty-f\r or =ty-eight h\rs1 especially if ! *ild is /urdy4 ,massage ( ! brea/s only increases _! activity & t5ds to make ! tr\ble worse4 ,! weight ( ! gl&s may be consid]able & require ! application ( a light support+ brea/ b9d]4 ,pill[s "u !m w also give relief at times4 ,9 putt+ ! *ild to brea/1 ! "m %\ld lie on ! side ) ! arm rais$ & ! *ild is dropp$ into ! holl[ ?us creat$1 fac+ ! "m 7see ,fig4 #aac74 ,9 ?is position ! nipple w mo/ easily & conv5i5tly slip into ! *ild's m\?4 ,! *ild %\ld nurse fifte5 or tw5ty m9utes & !n be remov$4 ,! toilet ( ! nipple is made by cleans+ ) boric solution z previ\sly describ$1 & !n plac+ n gauze b a piece ( aseptic cotton clo? ov] x1 aft] :i* ! b9d] is readju/$4 7,see ,brea/ ,cov]s1 p4 #cbf47 ,! m5/rual fl[ ceases dur+ lactation z a rule1 b n inv>iably4 ,! fl[ returns 9 f f\r to six weeks aft] deliv]y1 if ! *ild is n nurs+1 & ab\t ! same "t aft] lactation ceases4 ,!re is a popul> idea t conception c n occur dur+ lactation1 & _m wom5 injuri\sly prolong lactation 9 ! hope ( avoid+ ano!r *ild4 ,! !ory is fallaci\s & conception dur+ lactation is n uncommon4 ,! ,b[els4--,a ly+-9 woman is regul>ly con/ipat$4 ,lack ( ex]cise1 a nutriti\s diet1 b "o ) a m9imum ( wa/age1 toge!r ) relax$ abdom9al walls1 contribute to a condition t is prim>ily due to *anges 9 intraabdom9al pressure1 :i* foll[ ! deliv]y4 ,= weeks ! inte/9es h be5 "u pressure & irritation by ! gr[+ ut]us1 & :5 ?is is sudd5ly remov$ ! inte/9es become sluggi%4 ,on ! morn+ ( ! second day ! pati5t %\ld receive an ounce ( ca/or oil4 ,?is dose1 susp5d$ 9 black c(fee1 be]1 orange juice1 or %]ry w9e c be tak5 by ne>ly ev]yone4 ,9 f f\r to six h\rs a normal sal9e1 or soapsuds enema is giv54 ,! enema may be repeat$ daily1 or if ?is is objectionable to ! pati5t1 ! ca/or oil or ,russian oil1 may be giv5 z a r\t9e4 ,sal9e ca?>tics %\ld n be us$ unless !re is an ov]supply ( milk4 ,!re is sometimes a good deal ( gas foll[+ labor1 :i* c be remov$ by ! #a-b-c enema 7see ,enema1 p4 #cce74 ,9 giv+ enemas1 ! nurse mu/ use great c>e to avoid t\*+ or infect+ an injur$ p]9eum4 ,_m wom5 secrete less gas & are agreeably influ5c$ m5tally by a five gra9 pill ( asaftida tak5 ?rice daily4 ,ur9ation4--,"o ( ! commone/ difficulties aft] labor conc]ns micturition4 ,ow+ to ! swoll5 & bruis$ condition ( ! ure?ra & ! n]ves supply+ ! neck ( ! bladd]1 ! usual /imuli d n act & ! woman1 consci\s ( a pa9ful di/5tion1 is unable to pass wat]4 ,! helplessness is increas$ by h] position 9 b$4 ,! nurse mu/ make e ef=t to h ! bladd] empti$ naturally4 ,! process is aid$ by lett+ ! wat] run f ! faucet into ! toilet bas91 by us+ hot applications to bladd] or vulva1 by all[+ w>m1 /]ile wat] to run d[n ov] ! vulva & p]9eum1 by an enema1 by putt+ smell+ salts to ! nose1 by us+ slight pressure ov] ! bladd]1 or by hav+ ! pati5t sit up on ! b$pan4 ,if ^! measures fail & moral suasion is fruitless1 ! bladd] mu/ be ca!t]iz$ at ! end ( twelve h\rs4 ,! two dang]s ( ca!t]ization are injury to muc\s membrane1 & infection4 ,_m cases ( cy/itis h result$ f an unclean ca!t] or ! improp] use ( a /]ile in/rum5t4 ,to ca!t]ize a pati5t1 %e is fir/ giv5 aseptic c>e dur+ :i* p>ticul> att5tion is paid to ! meatus4 ,?is %\ld be cleans$ ) an applicator dipp$ 9 a solution ( boric acid4 ,next1 ! nurse prep>es h] h&s by scrubb+ t5 m9utes 9 hot runn+ wat] ) /]ile nail bru% & gre5 soap4 ,! ca!t] ei!r ( s(t rubb] or glass1 is boil$ = fifte5 m9utes & pass$1 n by t\*1 b by sight1 & ! fl[ is receiv$ 9 a clean bas9 & ! am\nt record$4 ,z soon z ! ur9e ceases to fl[ freely1 ! tip ( ! index f+] is plac$ tightly ov] ! end ( ! ca!t] & ! in/rum5t is g5tly )drawn4 ,! f+] is plac$ ov] ! end ( ! ca!t] n only to avoid ! dripp+ ( ur9e z x is remov$1 b especially to prev5t ! disagreeable s5sations produc$ by ! inru% ( air4 ,usually "o ca!t]ization is suffici5t1 & e "t ! bladd] fills1 ! nurse mu/ take ! "t & tr\ble to make ! pati5t ur9ate spontane\sly1 if possible1 = "s wom5 =m a ca!t] habit1 f :i* x is difficult to break !m4 ,aft] natural ur9ation & aft] ca!t]ization1 ! aseptic c>e %\ld be repeat$4 ,! ,g5itals4--,! vulv> pads %\ld be *ang$ z (t5 z !y are soil$4 ,f\r a day is an av]age numb]1 & six or eight 9 ! fir/ ?ree days is n unusual4 ,e "t ! pad is *ang$1 ! nurse %\ld give aseptic c>e1 & extra att5tion :5ev] ! b[els & bladd] are empti$4 ,! dri$ secretions %\ld be wa%$ (f ) /]ile sponges1 wip+ always t[>d ! rectum & ?r[+ away ! sponge4 ,smegma collects 9 ! folds ( ! labia & ab\t ! clitoris4 ,?is %\ld be c>efully spong$ away4 ,if x becomes dry & h>d1 oil or albol5e w s(t5 x & facilitate its removal4 ,pl5ty ( soap & w>m wat] %\ld be us$1 !n ) a pit*] or d\*e po9t1 ! :ole area is irrigat$ ) a solution ( lysol #a p] c5t4 ,especial c>e is giv5 to ! /it*es if any are pres5t4 ,no traction mu/ be made on ! ends ( ! sutures1 & if unusual sor5ess is compla9$ (1 ! doctor %\ld inspect !m at 8 next visit4 ,! nurse %\ld be c>eful n to get lo*ia on h] h&s z ! dis*>ge conta9s g]ms :i* %e may c>ry to h]self1 to ! baby1 or to ! pati5t's brea/s or eyes4 ,pa9ful swell+ ( ! vulva1 or edema ( ! rectal protrusion may be reliev$ by hot boric dress+s or by ice bags to ! anus4 ,! vag9al d\*e is r>ely employ$ at pres5t except "u specific indications4 ,if ! involution is sl[1 x is saf] to use ergot by m\?1 r ?an ! hot vag9al d\*e1 z sometimes recomm5d$4 ,! d\*e is a frequ5t s\rce ( infection1 z well z a useless proc$ure4 ,nev]!less1 a da9ty woman gets mu* com=t m5tally1 z well z physically1 if %e is kept clean & free f odors2 h5ce if ! lo*ial dis*>ge becomes (f5sive on ! fif? day or six? day1 z sometimes happ5s1 a s+le hot vag9al d\*e may be p]mitt$4 ,a #a3ejjj solution ( potassium p]manganate1 or a teaspoonful ( =maldehyde to a qu>t ( wat]1 or a *9osol solution #a3ajjj may be us$4 ,re/4--,s9ce ! pati5t w be 9 b$ f eight days to two weeks 9 normal cases1 %e mu/ be made z happy & com=table z possible1 & no?+ contributes s mu* to h] satisfaction z a *e]ful1 compet5t nurse4 ,h] m9d is at ease ab\t h]self & h] *ild1 & ! companion%ip ( ! nurse c be made "o ( ! pleasante/ recollections ( h] illness4 ,any pati5t :o is at all reasonable c be manag$ by a tactful nurse )\t ! consci\sness ( be+ oppos$ or direct$4 ,gossip1 hospital /ories1 criticism ( o!r cases1 o!r nurses1 or ( doctors %\ld be avoid$4 ,! pati5t is deeply int]e/$ 9 h] own case1 & ! private tr\bles ( ! nurse d n conc]n h] nor enli/ h] att5tion = m ?an a few polite b unpleasant mom5ts4 ,! n]ves ( ! pati5t are highly s5sitiz$1 & !re=e %e %\ld sleep z mu* z possible at night1 & take an additional nap 9 ! aft]noon4 ,only ! memb]s ( ! family %\ld be all[$ to see ! pati5t ! fir/ week1 & !y b = a %ort "t4 ,x takes ! /r5g? ( ! pati5t unnecess>ily to see gue/s ev5 ?\gh !y be close fri5ds4 ,importunate visitors may be pacifi$ frequ5tly by a view ( ! baby4 ,! pati5t mu/ be sp>$ all h\sehold responsibilities1 & if necess>y1 ! nurse mu/ take *>ge4 ,tact mu/ be us$ to avoid be+ dictatorial1 ei!r to family or s]vants4 ,if any?+ unusual arises1 ! nurse mu/ %[ no surprise1 annoyance1 or bewild]m5t4 ,ev]y?+ is att5d$ to quietly1 firmly1 & )\t friction4 ,gett+ ,up4--,x is a tradition t ! woman is lazy :o does n get out ( b$ by ! n9? day4 ,!re are ?ree factors to be consid]$1 ! progressive involution ( ! ut]us1 ! /r5g? ( ! pati5t1 & ! pres5ce ( /it*es4 ,involution may be complete on ! fif? day1 b ! pro/ration f ! labor may make ! woman indiff]5t to aris+4 ,%e may be /rong en\gh to rise on ! ?ird day1 b ! ut]us is l>ge & heavy1 & ! erect position w put an unnecess>y /ra9 on ! supports :i* may ret>d involution & cause displacem5t or disease lat]4 ,also1 x is n desirable = a woman to sit up until h] p]9eum is well on ! road to re/oration4 ,9 g5]al1 ! woman %\ld n get up until ! ut]us has gone d[n into ! pelvis & is nonpalpable4 ,if ?is is ! case on ! fif? day & %e feels /rong1 %e may get up4 ,if %e is n /rong1 "t w be sav$ by /ay+ 9 b$ until h] vigor returns1 :e!r x is t5 days or tw5ty4 ,gett+ up may be foll[$ by a return ( ! bloody dis*>ge4 ,?is may come f sub9volution1 f a relax$ & flabby ut]us1 f a c]vical te>1 or f *ange 9 po/ure4 ,if !re has be5 a retrov]sion be=e pregnancy1 ly+ prone ) an occasional knee *e/ position = a few mom5ts w aid4 ,massage & passive ex]cises :ile 9 b$ w aid ! pati5t to recov] & to ma9ta9 h] /r5g?4 ,ev5 aft] %e is up & ab\t1 %e %\ld lie d[n frequ5tly dur+ ! day & always :5 nurs+ ! babe1 until %e feels q normal aga94 ,= ! hospital ! foll[+ /&+ ord]s may be foll[$3 ,/&+ ,ord]s--,pu]p]ium ,brea/s3 #a4 ,prep>e = lactation #ab h\rs aft] deliv]y4 7a7 ,clean brea/s & nipples ) soapy wat] & gre5 soap4 7b7 ,sponge ) /]ile wat]4 7c7 ,sponge ) boric solution4 7d7 ,/]ile compresses ov] nipples & adju/ b9d]4 #b4 ,babe to brea/ imm$iately aft] brea/ prep>ation4 #c4 ,e morn+ apply fre% compresses ov] nipples & (t5]1 if necess>y4 #d4 ,cleanse nipples ) boric solution 7use applicator7 be=e & aft] ea* nurs+4 ,to dry up milk3 ,re/rict fluids2 give sal9e ca?>tics2 apply ice bags to brea/s1 z ne$$2 = pa9 give code9e solution to gr4 hypod]mically1 if necess>y4 ,d n massage1 d n b9d1 d n pump4 ,let brea/s alone4 ,:5 brea/ is inflam$3 ,apply ice bags con/antly until pa9 subsides & temp]ature goes d[n4 ,wat* = signs ( suppuration4 ,g5itals3 #a4 ,s4,s4 enema ea* morn+1 foll[$ by aseptic c>e4 ,cleanse f above d[nw>d--#a p] c5t solution ( lysol & cotton pl$gets4 #a pl$get = ea* side4 #a pl$get = c5t]4 #a pl$get = rectum 7la/74 ,ext]nal d\*e ( /]ile wat]4 ,dry /]ile pad4 #b4 ,aseptic c>e foll[+ all b[el movem5ts & ur9ation4 ,r\t9e3 #a4 ,record pulse & temp]ature twice a day1 unless o!rwise ord]$4 #b4 ,bladd] mu/ be empti$ 9 twelve h\rs4 ,if all p]suasive means fail 7may sit up 9 b$71 ca!t]ize4 #c4 ,make daily records ( conditions ( ut]us 7firmness & height71 brea/s & nipples4 #d4 ,no vag9al d\*e unless ord]$4 #e4 ,diet3 liquid two days2 semisolid two days2 !n g5]al4 #f4 ,wat* = hmorrhage4 #g4 ,keep ut]us firm by occasional massage4 #h4 ,all cases to h ca/or oil1 #a ounce )9 ?irty-six h\rs aft] deliv]y 7be=e noon74 #i4 ,woman may get up z soon z ut]us c n be felt above pubes1 if !re is no contra9dication4 ,! hi/ory %eet %\ld be kept accurately & %\ld %[ e incid5t 9 ! c\rse ( ! ly+-9 p]iod4 ,! condition ( ! b[els1 bladd]1 & lo*ia1 ! temp]ature1 pulse & respiration & ! height ( ! fundus above ! symphysis f day to day mu/ be set d[n 9 f+]-bread?s or c5timet]s4 ,= ! hospital1 ! foll[+ sy/em w be f\nd useful 9 e/abli%+ a r\t9e4 ,nurse's ,record ,fir/ ,/age4 #a4 ,:5 pa9s began4 #b4 ,frequ5cy & duration ( pa9s4 #c4 ,"* vag9al dis*>ge4 #d4 ,"t membranes ruptur$4 7a7 ,artificial4 7b7 ,spontane\s4 ,second ,/age4 #a4 ,"t second /age began & end$4 #b4 ,an/hetic4 #c4 ,mode ( deliv]y4 #d4 ,:o deliv]$4 #e4 ,sex ( *ild4 7a7 ,liv+4 7b7 ,dead4 #f4 ,p]9eum4 7a7 ,condition4 7b7 ,repair4 ,?ird ,/age4 #a4 ,me?od4 7a7 ,spontane\s4 7b7 ,e>ly expression4 7c7 ,cr$ expression4 7d7 ,manual removal4 #b4 ,plac5ta deliv]y4 7a7 ,"t4 7b7 ,size4 7c7 ,complete or incomplete4 7d7 ,l5g? ( cord4 #c4 ,note4 7a7 ,hmorrhage4 7b7 ,quantity4 7c7 ,color4 7d7 ,clots4 ,g5]al condition--0 case numb] put on "m & *ild8 ,o!r treatm5ts4 ,m$ications4 ,condition ( ut]us4 ,temp]ature1 pulse & respiration be=e leav+ deliv]y room4 ,sign$ 44444444444444444444444444 7,nurse's ,"n47 ,,*apt] ,,xi ,,unusual ,,pres5tations ,,& ,,positions ,bree* ,pres5tation4--,! pelvic pole ent]s ! inlet fir/1 once 9 ?irty cases & m commonly 9 primip>as ?an o!rwise4 ,etiology4--,any?+ t int]f]es ) or d]anges ! laws ( normal ge/ation w pr$ispose to1 or produce ?is anomaly4 ,?us1 if ! head is too l>ge1 z 9 hydrocephal\s1 or if ! ftus is too movable1 z 9 hydramnios1 or if an ob/acle1 l plac5ta previa1 contract$ pelvis or tumors prev5t ! prop] approa* ( ! head to ! inlet1 ! me*anism w be di/urb$ & a bree* or possibly a %\ld] pres5tation w result4 ,abnormal flaccidity ( ! ut]9e or abdom9al walls1 prematurity or tw9s also contribute def9itely to its occurr5ce4 ,! attitude ( ! *ild g5]ally reta9s its normal aspect ( complete flexion4 ,?is pose1 h[ev]1 is n ma9ta9$ inv>iably = on occasion ! buttocks & g5itals may re/ ^u ! inlet :ile "o or bo? feet may be ext5d$ on ! ?ighs & lie beside ! neck1 or ! ?ighs may be ext5d$ :ile ! knees rema9 flex$1 & :at is kn[n z a knee pres5tation1 or if ! foot comes d[n1 a footl+ pres5tation results4 ,positions4--,! sacrum is ! mo/ prom95t bony l&m>k ( ! bree*1 h5ce ! positions are nam$ f ! relation ?is bone be>s to ! f\r quadrants ( ! inlet4 ,illu/ration3 ,fig4 #fa4--,! bree*4 ,left-sacro-ant]ior position4 7,l5oir & ,t>ni]47 ,we h !re=e 9 _! ord] ( frequ5cy ! foll[+ designations3 ,left-sacro-ant]ior1 :]e ! sacrum lies to ! left ( ! m$ian l9e ( ! "m's body & 9 front2 "r-sacro-ant]ior1 :]e ! sacrum lies to ! "r & 9 front2 "r-sacro-po/]ior1 :]e ! bone lies ne> ! "m's v]tebral column1 & on ! "r side2 & ! left-sacro-po/]ior position1 :]e ! bone occupies a correspond+ place on ! left side4 ,diagnosis4--,! recognition ( ?is pres5tation is mo/ easily secur$ by ext]nal abdom9al palpation 9 pregnancy1 :i* may be re9=c$ dur+ labor by ! int]nal exam9ation4 ,illu/ration3 ,fig4 #fb4--,! bree*4 ,left-sacro-po/]ior position4 7,l5oir & ,t>ni]47 ,ext]nally ! palpat+ f+]s at ! pelvic brim w note ! abs5ce ( ! h>d1 r\nd head1 & feel a mass1 s(t]1 q irregul> 9 %ape1 & less def9$ ?an cu/om>y4 ,movem5ts also may be appreciat$ t w\ld be too f> d[n 9 ! ut]us if ! head 0 pres5t+4 ,next ! h>d1 sph]ical tumor ( ! head c be outl9$ some:]e 9 ! fundus1 & ! he>t tones1 in/ead ( be+ bel[ ! umbilicus w be on ! same level or ev5 high]4 ,vag9ally ! c]vix is n fill$ out1 ! pres5t+ "p does n come d[n1 b aft] labor has begun ! di/9ctive features ( ! bree* gradually become m evid5t1 z !y are driv5 into ! pelvis4 ,"o or bo? feet1 or ! buttocks1 may be recogniz$4 ,! exam9+ f+] may possibly ent] ! anus & be /a9$ ) meconium or p9*$ by ! sph9ct]1 :i* diff]5tiates ?is orifice f ! m\?4 ,"o aft] ano!r ! *>act]i/ic l&m>ks appe> until ! diagnosis c n be d\btful4 ,z soon z ! sacrum is f\nd or ! legs def9itely plac$1 ! position c be nam$4 ,me*anism4--,! hips always ent] ! inlet 9 "o ( ! oblique diamet]s & ! back is turn$ to ! same "p ( ! ut]9e wall z 9 ! correspond+ v]tex positions4 ,! acts describ$ 9 ! me*anism = v]tex deliv]ies %[ a some:at diff]5t ord]4 ,desc5t is fir/1 !n comes int]nal ant]ior rotation1 :i* br+s ! ant]ior hip "u ! symphysis & its deliv]y is quickly foll[$ by ! po/]ior hip1 :i* rolls out ov] ! p]9eum4 ,! body advances1 z a rule1 ) ! back t[>d ! front ( ! "m4 ,! %\ld]s ) arms fold$ move "u ! pubic ar* & !n ! head deliv]s 9 a /ate ( flexion4 ,! head1 ( c\rse1 has no caput & x is n m\ld$4 ,?is me*anism may be greatly imp$$ or complicat$ at any /age ( ! movem5t4 ,! advance may be ret>d$ to a pa?ological degree1 ! belly may be l>ge & z x passes along ! canal "o or bo? arms may be /ripp$ up alongside ! head or ev5 into ! back ( ! neck4 ,! head may be arre/$ at ! inlet by ! arms1 by its degree ( deflexion1 or by pelvic contraction4 ,! rotation may n take place1 or x may be abnormal1 & ! belly ( ! *ild look =w>d t[>d ! "m's4 ,any ( ^! v>iations adds fur!r to ! difficulty ( ! labor & to ! dang] ( ! p>tn]s 9 ! ev5t4 ,artificial aid may be requir$ :i* br+s ) x ! possibility ( sepsis4 ,! ftal mortality :i* av]ages five p] c5t is due mo/ly to asphyxiation4 ,int]f]5ce ) ! supply ( oxyg5 beg9s z soon z ! cord passes ! vulva & ! *ild mu/ be deliv]$ 9 eight m9utes f t "t1 or p]i%4 ,p>tial deta*m5t ( ! plac5ta may also cut (f ! oxyg5 to a fatal degree1 & ! *ild may be unable to brea! :5 born on acc\nt ( mucus suck$ into ! tra*ea by premature ef=ts at respiration4 ,m9or accid5ts also occur1 su* z fractures1 dislocations1 & p>alysis f injury to ! n]ve trunks4 ,managem5t4--,9 ! int]e/ ( ! *ild1 ?is pres5tation is occasionally conv]t$ into a v]tex by ext]nal v]sion dur+ ! la/ weeks ( pregnancy or 9 labor be=e ! membranes h ruptur$4 ,x is difficult1 h[ev]1 to ma9ta9 ! v]tex ov] ! inlet4 ,! woman mu/ be kept quiet 9 a horizontal po/ure & long roll] spl9ts appli$ to ! side ( ! *ild 9 ut]o & b\nd on4 ,9 primip>as1 ?is is ne>ly impossible1 & x is wis]1 9 ! abs5ce ( "s great necessity to w>n ! p>5ts ( ! conditions & dang]s & let !m %>e 9 ! responsibility4 ,illu/ration3 ,fig4 #fc4--;,extraction ( ! bree*4 ,traction on "o leg4 7,hamm]s*lag47 ,:5 ! labor beg9s1 ! bag ( wat]s mu/ be kept f rupture z long z possible & :5 x f9ally breaks1 an int]nal exam9ation %\ld be made to see if ! cord has come d[n4 ,if ?is happ5s x may be necess>y to exp$ite ! deliv]y by ext]nal assi/ance4 ,illu/ration3 ,fig4 #fd4--;,bree* deliv]y4 ,extraction ( ! trunk by pull+ on ! hips4 7,hamm]s*lag47 ,! doctor br+s d[n a foot1 if x is n already d[n1 or pulls on ! bree* until ! feet drop out4 ,compression ( ! cord mu/ be always 9 m9d4 ,x is always compress$ aft] ! umbilicus has pass$ ! navel4 ,! %\ld]s are deliv]$ by seiz+ ! feet ) ! op]at+ h& & sw++ ! body out ( ! way4 ,?is br+s ! po/]ior %\ld]1 :i* %\ld be fir/1 into ! holl[ ( ! pelvis4 ,extraction is !n complet$ by :at is call$ ! ,smellie-,veit maneuv]4 ,! *ild is put a/ride "o arm1 ! fir/ f+] ( :i* is hook$ into ! *ild's m\? to ma9ta9 flexion4 ,! f+]s ( ! o!r h& !n grasp ! %\ld]s ( ! *ild a/ride ! back ( ! neck & traction is made d[nw>d 9 ! axis ( ! inlet until ! head slips into ! excavation4 ,illu/ration3 ,fig4 #fe4--;,bree* deliv]y4 ,deliv]+ ! %\ld]4 ,! body is swung /rongly upw>d & outw>d to br+ po/]ior %\ld] into ! pelvis4 7,hamm]s*lag47 ,illu/ration3 ,fig4 #ff4--,! deliv]y ( ! aft]-com+ head by ! ,smellie-,veit maneuv]4 7,hamm]s*lag47 ,if ! head is delay$ at ! inlet1 x may be necess>y to put ! woman 9 ! ,wal*] position 7q4 v47 & = ! nurse to use ! ,wieg& compression 7q4 v474 ,! feet mu/ n be fa/5$ 9 /irrups = bree* cases4 ,illu/ration3 ,fig4 #fg4--,%\ld] pres5tation4 ,left-scapulo-ant]ior position4 7,l5oir & ,t>ni]47 ,=ceps are n recomm5d$ = application to ! bree* z !y d n fit & are liable to slip (f & injure bo? *ild & "m4 ,! f+]s are be/4 ,=ceps are n recomm5d$ = ! aft]-com+ head unless ! *ild is dead4 ,if ! *ild lives1 ! ,smellie-,veit is m-successful2 & if ! *ild dies1 ! craniocla/1 if possible1 w save ! "m mu* suff]+ & avoid "s injury to ! tissues4 ,transv]se or ,%\ld] ,pres5tations4--,^! are cases 9 :i* ! long axis ( ! *ild lies directly across or obliquely across ! long axis ( ! ut]us4 ,! %\ld] 7scapula7 is ! bony l&m>k1 & ! "p :i* mo/ frequ5tly imp5ds ov] ! inlet4 ,?is pres5tation probably occurs once 9 two hundr$ labors4 ,x is due to ! same conditions t 7 giv5 = bree* cases2 namely1 weak abdom9al or ut]9e muscles1 pelvic contraction1 plac5ta previa1 hydramnios1 & tw9s4 ,x is easily recogniz$ 9 pregnancy1 & mu/ n be neglect$1 = x is impossible ( deliv]y )\t fir/ *ang+ x into a longitud9al pres5tation4 ,if ?is correction is n done1 rupture ( ! ut]us is liable to occur1 ) ! consequ5t dea? ( bo? "m & *ild4 ,! treatm5t is inv>iably v]sion4 ,face & ,br[ ,pres5tations4--,! face pres5ts once 9 ab\t ?ree hundr$ labors4 ,9 ?is case1 ! head is completely ext5d$ s t ! occiput re/s aga9/ ! back ( ! neck4 ,! trunk & sp9e are /raight5$ out :ile ! legs & arms rema9 9 ! normal attitude ( flexion4 ,! causes ( ^! anomalies mu/ be s\ght 9 ^? conditions :i* br+ ab\t ! deflexion ( ! *94 ,! mo/ common are pelvic contraction1 l>ge *ild1 plac5ta previa1 hydramnios1 goit]1 an5cephalus & multip>ity4 ,illu/ration3 ,fig4 #fh4--;,face pres5tation4 7,bumm47 ,face positions take _! names f ! location ( ! *9 7m5tum--,lat974 ,?us ! mo/ frequ5t face position is ! "r-m5to-po/]ior4 ,! diagnosis is n easy & may n be conclusive until ! bony prom95ces ( ! face1 su* z ! nose & orbital ridges c be di/+ui%$ by vag9al exam9ation4 ,illu/ration3 ,fig4 #fi4--;,desc5t ( ! *9 9 face pres5tation4 7,bumm47 ,! deliv]y is protract$ f ?ree to five h\rs beyond ! av]age by ?is complication1 & ! mortality is high] bo? = "m & *ild4 ,! face is badly swoll5 & disfigur$1 b ! normal condition ( ! tissues w be re/or$ by ! end ( a week4 ,mo/ face cases t]m9ate spontane\sly1 b op]ative int]f]5ce is n infrequ5t on acc\nt ( dang] to "m or *ild4 ,v]sion or manual correction ( ! pres5tation may be done be=e engagem5t4 ,=ceps is ! op]ation ( *oice aft] ! head is fix$ 9 ! pelvis1 b x may be necess>y to prec$e ! deliv]y by a prep>atory pubiotomy1 or 9 case ( failure1 to d a craniotomy on ! dead *ild4 ,if ! *9 does n rotate =w>d "u ! symphysis1 ! labor is impossible )\t pubiotomy or ! de/ruction ( ! *ild4 ,9 g5]al1 ! case %\ld be left to nature unless "s def9ite indication to int]f]e develops4 ,illu/ration3 ,fig4 #gj4--;,deliv]y 9 face pres5tation4 7,bumm47 ,! br[ pres5ts mu* m r>ely ?an ! face1 possibly once 9 a ?\s& labors4 ,x is due to ! same conditions z br+ ab\t ! pres5tation ( ! face4 ,! mortality = bo? "m & *ild is high] ?an 9 face cases4 ,! :ole labor is h>d] & long]1 besides be+ m dang]\s to life & to tissues4 ,?is pres5tation1 if recogniz$ be=e ! head is fix$1 %\ld be conv]t$ into a bree* by v]sion1 b aft] ! head comes d[n1 x may be possible by h& or =ceps to deliv] ei!r z a face or z an occipito-po/]ior1 b o!rwise ! craniocla/ mu/ be consid]$4 ,occipito-po/]ior position is ! "n giv5 to v]tex cases :]e9 ! occiput lies 9 "o or ! o!r ( ! two po/]ior quadrants ( ! pelvic inlet4 ,^! labors are necess>ily prolong$1 bo? 9 ! fir/ & second /ages1 because ! me*anism ( deliv]y is d]ang$ by ! l>g] diamet]s br\ght into relation ) ! bony canal & by ! ineffectiv5ess ( ! contractions4 ,! pa9s 9 ! second /age may become viol5t & extremely pa9ful1 b ! labor does n advance appreciably4 ,aft] a little exp]i5ce1 m]e obs]vation ( ! c\rse ( ! labor w cause ! suspicion to arise 9 ! m9d ( a compet5t nurse t ! occiput is po/]ior4 ,! diagnosis w be cle>$ up by ! doctor's int]nal exam9ation1 :i* %[s ! l>ge fontanelle ant]ior & ! sagittal suture runn+ backw>d4 ,! head is p>tially deflex$ & x may n be possible at fir/ to f9d ! small fontanelle4 ,! position t]m9ates by deliv]y uncorrect$1 by spontane\s rotation into an ant]ior position1 or is correct$ by ! doctor4 ,correction %\ld n be attempt$ until x is app>5t t ! anomaly w n "r itself1 :i* x w d 9 f\r cases out ( five4 ,,*apt] ,,xii ,,op]ations ,complications dur+ labor may arise f abnormal positions ( ! head1 su* z face or br[2 f abnormal pres5tations ( ! *ild1 su* z bree*1 transv]se or %\ld]2 f tw9 labors2 or f prolapse ( a "p l ! foot1 arm or cord4 ,! "m may be responsible = "s ( ^! abnormalities ?r\gh hav+ a contract$ pelvis1 a rigid os1 or a rigid pelvic floor4 ,! ut]us1 too1 may functionate abnormally by act+ too vigor\sly1 z 9 precipitate labor1 or too sl[ly1 z 9 ut]9e in]tia4 ,! membranes may rupture prematurely & produce a dry bir?4 ,!re may be hmorrhages be=e labor 7ante p>tum hmorrhage7 dur+ labor 7intra p>tum71 & aft] labor 7po/ p>tum hmorrhage71 or ! labor may be prec$$1 accompani$1 or foll[$ by t extreme example ( toxmia kn[n z eclampsia4 ,face & br[ pres5tations are r>e & come to ! att5tion ( ! nurse only :5 an op]ation is requir$ = _! relief4 ,fur!r conditions may arise1 su* z dang] to "m or *ild1 :i* dem& an accel]ation ( ! labor4 ,if ! head is engag$1 =ceps is ! op]ation mo/ commonly und]tak51 & if n engag$1 ! problem may be solv$ ei!r by an e>ly v]sion & extraction or by =ceps lat]4 ,! dang]s to ! "m are n usually difficult to diagnose if ! case has be5 foll[$ c>efully4 ,signs ( dang] to *ild mu/ be look$ = con/antly4 ,su* are3 7a7 ,alt]ation ( ! he>t tones4 7b7 ,ret>dation ( pulse 9 cord betwe5 pa9s4 7c7 ,escape ( meconium is n significant unless occurr+ 9 ! pa9-free int]val1 :5 x may signify hyp]c>bonization ( blood & a ?reat ( asphyxiation4 ,! prelim9>ies = ! p]=mance ( ^! op]ations may n[ be describ$1 & ! indications & conditions briefly tabulat$4 ,! prep>ation %\ld be /&>diz$ s t ! same set-up ( ! room w d = all ( ! major ob/etrical op]ations1 except ,cs>ean section4 ,! kit*5 table is g5]ally reg>d$ z a satisfactory op]at+ table4 ,its l5g? is suffici5t = deliv]y :5 ! legs are d\bl$ up4 ,! table %\ld be cov]$ ) a blanket or com=t on :i* x laid a clean %eet4 ,a rubb] blanket or piece ( oil clo? is put on1 s fold$ above ! place = ! pati5t's hips1 & s p9n$ at ! sides1 t all dra9age w fl[ (f into a bucket or j> at ! foot4 ,9 front ( ! table is plac$ a /raight-back$ *air ) flat seat4 ,to ! "r ( ! op]ator1 z he faces ! table1 /&s a b5*1 or two *airs1 side by side2 or1 if possible1 ano!r table4 ,?is is cov]$ ) a clean %eet = ! reception ( ! in/rum5ts4 ,to ! op]ator's left1 ano!r table simil>ly prep>$ c>ries ! solutions1 sponges1 etc4 ,e op]ation = deliv]y %\ld h tape & cord scissors )9 easy rea*1 z well z facilities = ! resuscitation ( ! *ild4 ,! light %\ld come f beh9d ! op]ator & fall full ^u ! field ( op]ation4 ,! room %\ld be w>m4 ,! pati5t is laid ^u ! table & h] knees elevat$ 9 ! exagg]at$ li?otomy position4 ,if !re are assi/ants en\gh1 "o c /& on ei!r side & hold a knee1 if n1 a %eet sl+ c be made & slung r\nd ! pati5t's %\ld]s & ti$ to ! knees z previ\sly describ$4 ,illu/ration3 ,fig4 #ga4--;,exagg]at$ li?otomy position4 ,! legs are held by a %eet sl+4 ,! vulva %\ld be %av$4 7,williams47 ,an an/hetic w be requir$4 ,if a doctor c n be _h1 ?is duty w fall to ! nurse4 ,a /]ile d\*e bag hangs ne> ! table4 ,a ba? tub ( hot wat] mu/ be provid$ & a tra*eal ca!t] mu/ be ready = ! removal ( mucus f ! *ild's w9dpipe4 ,an abundance ( hot & cold /]ile wat] mu/ n be ov]look$4 ,9 ! hospital ! foll[+ synopsis = ! plac+ ( ! l95 may be f\nd useful3 ,/]ile ,l95 = ,op]ative ,case4-- ,br+ pati5t to foot ( b$4 ,put 9 ! /irrups4 7,= bree* deliv]ies d n use /irrups47 ,same ord] z = normal case except t feet are put 9 /irrups in/ead ( on b$4 ,illu/ration3 ,fig4 #gb4--;,dorsal position :5 assi/ants are available4 7,hamm]s*lag47 ,/]ile %eet "u pati5t ext5ds n[ f bas9 "u b$ to buttocks4 ,comb9ation pad ov] field ( op]ation4 ,/]ile %eet ov] abdom54 ,! g5itals ( ! pati5t are n[ cleans$ ) all c>e & att5tion describ$ = labor4 ,if ?is has be5 done )9 an h\r1 %e ne$ only be spong$ (f ?or\ghly ) lysol solution 7#a p] c5t74 ,! feet & legs are cov]$ ) /ock+s1 ! body kept w>m1 & protect$ by %eets & blankets1 if necess>y4 ,e op]ative deliv]y is prec$$ by ca!t]ization4 ,all in/rum5ts are boil$ = ?irty m9utes & br\ght to ! table 9 ! same conta9] 9 :i* !y are /]iliz$4 ,! hot wat] has be5 p\r$ (f & a cool1 weak solution ( lysol 7#j4e p] c5t7 add$4 ,illu/ration3 ,fig4 #gc4--;,in/rum5ts = artificial deliv]y ( ! head4 ,a1 ,braun's blunt hook2 ,b1 ,craniocla/ 7,auv>d72 ,c1 ,axis traction =ceps 7,web/]72 ,d1 ,l[ =ceps 7,simpson74 ,=ceps4--,be=e us+ =ceps x %\ld be det]m9$ t ! woman c n deliv] ! *ild unaid$1 or c n be p]mitt$ to d s )\t too great exp5diture ( physical & n]v\s en]gy4 ,! exact conditions mu/ be recogniz$ z to ! location & position ( ! head1 ! condition ( ! ftal he>t tones & ! size ( ! pelvis4 ,:5 ! head is high up1 ! axis traction in/rum5t is employ$ & pati5t put 9 ,wal*]'s position = ! traction4 ,axis traction =ceps are extremely dang]\s to "m & *ild1 & %\ld be avoid$ :]ev] possible4 ,! foll[+ in/rum5ts are requir$3 ,! ob/etric =ceps4 #b eight-in* =ceps4 #f art]y =ceps4 #a vulsellum =ceps4 #a tissue =ceps4 #a ne$le =ceps & #f ne$les4 #b vag9al retractors4 #a pair dress+ =ceps4 #a d\*e po9t4 #a silv] ca!t]4 ,suture mat]ial--bo? catgut & silkworm gut4 ,besides ^! in/rum5ts1 ! nurse w also h solution bas9s z describ$ = normal labor4 ,= op]ations outside ( hospitals1 ! nurse ne$ n be clean1 z h] duties w consi/ = ! mo/ "p 9 *ang+ solutions1 refill+ bas9s1 h&+ t[els1 etc41 all ( :i* c be done ) /]ile =ceps4 ,! foll[+ summ>y may be s]viceable = advanc$ /udy or ref]5ce3 ,,prep>ation4-- ,?or\gh asepsis1 bo? subjective & objective4 ,pati5t %\ld be pull$ d[n to ! foot ( ! labor b$ ) feet 9 ! /irrups1 or put ^u ! kit*5 table or across ! b$ ) ! legs held 9 ! li?otomy position4 7,= bree* cases1 legs %\ld n be fa/5$47 ,bladd] & rectum mu/ be empty4 ,an/hetic is necess>y4 ,! position ( ! head mu/ be accurately kn[n4 ,facilities = ! treatm5t ( asphyxia neonatorum mu/ be at h&4 ,,conditions4-- ,c]vix effac$ & os dilat$1 except :5 mat]nal or ftal life is ?reat5$4 ,bag ( wat]s mu/ be ruptur$4 ,! head mu/ be engag$4 ,! *ild %\ld be liv+4 ,,indications4-- ,insuffici5cy ( ! p[]s ( labor4 ,deep transv]se arre/ ( ! head4 ,complications 9 labor1 su* z3 ,eclampsia4 ,fev]4 ,acute or *ronic disease4 ,h]nia--especially if inc>c]at$4 ,plac5ta previa4 ,prolapse ( ! cord4 ,face & br[ pres5tations4 ,contract$ pelvis4 ,occipito-po/]ior positions4 ,,dang]s ,,f ,,=ceps4-- ,injuries to ,*ild4--,ov]compression1 especially ) axis traction =ceps or 9 contract$ pelvis4 ,cru%+ ( s(t p>ts1 or su* lesions z abrasions1 pressure m>ks1 hmatomata1 swell+ ( face & eyelids4 ,bone injuries3 ,spoon-%ap$ depression :]e ! head has be5 dragg$ ?r\gh a n>r[ inlet2 fissures 9 ! p>ietal or frontal bones2 fractures4 ,:5 axis traction =ceps are appli$ ant]o-po/]iorly1 ! occipital bone may be sprung inw>ds until x cuts ! m$ulla4 ,compression ( ! cord1 especially if x is ar\nd ! neck4 ,hmorrhage f ! middle m5+eal art]y4 ,injury to eye4 ,erb's p>alysis4 ,lac]ation ( e>s :5 ! =ceps are remov$4 ,facial p>alysis f pressure ( ! blade4 ,injury to ,mo!rs4-- ,infection4 ,improp] application ( ! blades outside ! c]vix ut]i4 ,s(t p>ts torn by too rapid extraction4 ,:5 os is n dilat$1 x is fir/ pull$ d[n & !n torn4 ,! te> may ext5d into ! vag9al vault4 ,fi/ul may be produc$4 ,prolapse ( ! ut]us f prolong$ traction4 ,vag9al te>s f ! blades or f malplac$ head4 ,slipp+ ( blades4 ,traction mu/ be n aga9/ ! symphysis1 b d[n4 ,! =ceps commonly us$ 9 ?is c\ntry 7,simpson or ,elliott7 are s made t ! left blade mu/ be introduc$ fir/ on acc\nt ( ! lock4 ,! mortality = ! *ild 9 =ceps cases is ab\t six p] c5t4 ,illu/ration3 ,fig4 #gd4--;,=ceps op]ation4 ,! left blade1 9 ! left h&1 is introduc$ fir/ into ! left side ( ! "m s t ! curve ( ! blade fits ! *ild's head 7inside ! c]vix74 7,hamm]s*lag47 ,! axis traction in/rum5t is us$ b seldom by good ob/etricians1 s9ce ! dang] to "m & *ild 9 ?is op]ation is v s]i\s & x %\ld be res]v$ = em]g5cies ( exceptional "*4 ,pubiotomy may prec$e ! op]ation ) advantage 9 _m cases4 ,asphyxia ( ! *ild & mat]nal hmorrhage mu/ be prep>$ =4 ,illu/ration3 ,fig4 #ge4--;,=ceps op]ation4 ,! introduction ( ! "r blade4 7,hamm]s*lag47 ,illu/ration3 ,fig4 #gf4--;,=ceps op]ation4 ,lock+ ! h&les4 7,hamm]s*lag47 ,illu/ration3 ,fig4 #gg4--;,=ceps op]ation4 ,! way ! blades %\ld grasp ! ftal head4 7,hamm]s*lag47 ,illu/ration3 ,fig4 #gh4--;,=ceps op]ation4 ,traction on ! h&les4 7,hamm]s*lag47 ,illu/ration3 ,fig4 #gi4--;,=ceps op]ation4 ,! deliv]y ( ! head4 7,hamm]s*lag47 ,illu/ration3 ,fig4 #hj4--,v]sion4 ,seiz+ a foot4 7,hamm]s*lag47 ,v]sion 7,turn+74--,v]sion is a maneuv] = alt]+ ! pres5tation ( ! *ild :ile x is /ill 9 ! ut]us4 ,a v]tex may be conv]t$ into a bree*1 a bree* into a v]tex or a transv]se into ei!r a v]tex or a bree*4 ,illu/ration3 ,fig4 #ha4--,v]sion4 ,! *ild rotates z pressure is made ^u ! head & traction ^u ! foot4 7,hamm]s*lag47 ,v]sion usually means t a transv]se or a v]tex pres5tation is *ang$ into a bree* & is foll[$ by ! extraction ( ! *ild4 ,! op]ation is s]i\s & n to be und]tak5 )\t def9ite indications4 ,!re is always ! risk ( sepsis & rupture ( ! ut]us z well z a high probability ( a dead *ild4 ,p]9eorrhaphy is1 if any?+1 m frequ5t aft] ?is op]ation ?an aft] =ceps4 ,illu/ration3 ,fig4 #hb4--,v]sion is complete :5 ! knee appe>s at ! vulva4 7,hamm]s*lag47 ,,prep>ations4--,! room & pati5t are arrang$ z = =ceps1 except t ! /irrups c n be put 94 ,! legs mu/ be held by assi/ants1 = ! deliv]y ( ! aft]-com+ head may be complicat$ & require ! ,wal*] position1 :i* c n be quickly obta9$ if ! legs are fa/4 ,only eight m9utes are all[$ = ! deliv]y ( ! *ild aft] ! navel passes ! vulva1 if x is expect$ to live4 ,! bladd] & rectum mu/ be empty4 ,asepsis mu/ be rigid & bo? subjective & objective4 ,! dorsal position on a table is imp]ative4 ,! diagnosis mu/ be accurate & ! an/hesia c>ri$ to ! surgical degree4 ,facilities = treat+ asphyxia neonatorum mu/ be provid$4 ,! foll[+ summ>y ( ! indications & conditions may be conv5i5t = ref]5ce4 ,,indications4--,contract$ pelvis4 7,consid] pubiotomy47 ,abnormal position ( ! head4 7,face position ) *9 po/]ior47 ,prolapse ( cord or an extremity ) a pres5tation ( ! head4 ,plac5ta previa4 ,transv]se position aft] ! sev5? mon?4 ,any condition requir+ rapid deliv]y4 ,,conditions4--,c]vix effac$ & os dilat$4 ,ut]us n 9 tetanus nor contract$ d[n ov] ! *ild4 ,! ftus mu/ be movable4 ,! head %\ld n be engag$4 ,! ,wal*] position is produc$ by br++ ! pati5t d[n to ! end ( ! table s t ! sacrum re/s ^u ! edge4 ,! ?ighs & legs are all[$ to hang d[n ( _! own weight & ! pati5t is re/ra9$ f fall+ (f by traction upw>ds on ! axill4 ,9 ! ,wal*] position ! diamet] ( ! pelvic inlet is increas$ f to in* 7#a cm47 & !reby ! deliv]y ( heads t o!rwise c\ld n pass becomes possible4 ,9 addition to ! ,wal*] position o!r measures may be requir$ to help ! head ?r\gh4 ,?us1 traction f bel[ may be c>ri$ to ! limit ( safety & 9 spite ( ! ,wal*] position ! head may n pass ! inlet4 ,!n pressure f above is add$4 ,?is maneuv] w h to be execut$ 9 _m cases by ! nurse4 ,! f+]s palpate ! head above ! pubes4 ,!n "o or bo? fi/s are plac$ ^u ! abdom5 ov] ! head & =ce is ex]t$ to cr[d ! head d[n into ! pelvis4 ,?is is kn[n z ! ,wieg& compression4 ,= ! op]ations de/ructive to ! *ild1 craniotomy or decapitation1 ! same arrangem5ts are made4 ,illu/ration3 ,fig4 #hc4--,! ,wal*] position4 7,am]ican ,text ,book47 ,cranioclasis is ! cru%+ ( ! ftal skull s t 9 its r$uc$ condition ! *ild c be deliv]$ & ! "m's life sp>$4 ,9 addition to ! solutions1 ! only in/rum5ts requir$ are ! ,auv>d craniocla/1 a ,naegele p]=ator1 & a d\*e bag ) glass1 or any tip t c be /]iliz$4 ,9 _m ( ^! cases1 bo? "m & *ild c\ld be sav$ if se5 e>ly en\gh to h a ,cs>ean op]ation4 ,decapitation is done to save ! mat]nal life 9 cases ( transv]se or %\ld] pres5tation4 ,! prep>ations are ! same z already describ$ = =ceps & v]sion & ! only in/rum5t ne$$ is a ,braun blunt hook4 7,fig4 #gc47 ,illu/ration3 ,fig4 #hd4--,! ,wieg& compression ( ! *ild's head to =ce x into ! pelvis4 7,hamm]s*lag47 ,cs>ean section is ! deliv]y ( ! *ild ?r\gh an op5+ 9 ! abdom54 ,x is made necess>y by contraction ( ! pelvic bones1 or by ! pres5ce ( a fle%y or bony mass :i* dim9i%es ! size ( ! inlet4 ,x may be requir$ on acc\nt ( ! closure ( ! vag9a or c]vix by sc>s or on acc\nt ( urg5t conditions ( ! "m1 su* z eclampsia1 he>t disease1 & sometimes plac5ta previa4 ,! te*nic is simple1 b good judgm5t mu/ be us$ 9 kn[+ :5 to d x4 ,_m op]ators f9d x s easy t !y pref] x to ! h>d] b saf] ob/etrical op]ations4 ,illu/ration3 ,fig4 #he4--,! ,naegele p]=ator4 7,hamm]s*lag47 ,! "t ( election is :5 ! woman is at t]m b n 9 labor4 ,?is1 ( c\rse1 c be det]m9$ by ! hi/ory1 b m c]ta9ly by c>eful measurem5ts ( ! *ild4 ,:5 x becomes necess>y to op]ate on a woman :o has be5 9 labor a long "t & especially if %e has be5 exam9$ frequ5tly1 ! mortality is disproportionately high4 ,x is a hospital op]ation1 b may be done 9 ! h\se4 ,if n an em]g5cy1 ! b[els are empti$ by a laxative & enema ! day be=e4 ,regul> prep>ations = lap>otomy are made1 plus ! equipm5t necess>y = tie+ ! cord & resuscitat+ ! *ild4 ,a table mu/ be f\nd l>ge en\gh to hold ! pati5t 9 ! horizontal position at full l5g?4 ,solutions ( lysol #a p] c5t & /]ile wat] are plac$ on ea* side ( ! table4 ,! in/rum5t table c>ries t[els & suture mat]ial z well4 ,on a /& beh9d ! op]ator is plac$ ! hot ba? & tra*eal ca!t]4 ,?is c5t] is presid$ ov] by someone skill$ 9 ! treatm5t ( respiratory difficulties 9 ! new born4 ,altoge!r1 five assi/ants are requir$ = ! op]ation3 an an/hetiz]1 a clean nurse1 & a non/]ile nurse to manage supplies1 an op]at+ assi/ant & "o to take *>ge ( ! *ild4 ,rubb] gloves mu/ be worn by ! clean assi/ants4 ,in/rum5ts4-- #b scalpels4 #b scissors4 #h eight-in* =ceps4 #aj six-in* art]y =ceps4 #d sponge c>ri]s4 #d t5aculum =ceps4 #b rat-too!d tissue =ceps4 #d full curv$ r\nd ne$les = ut]9e wall4 #d small] ne$les = ! fascia4 #b ,hag$orn ne$les = ! sk94 #b ne$le hold]s4 #a dress+ =ceps4 ,pl5ty ( suture mat]ial1 bo? catgut 7,no4 #c & #d7 & silkworm gut = ! abdom9al wall4 ,supplies4-- #a doz4 lap>otomy sponges ) metal r+s sew$ 9 or a long tape atta*$4 #f l>ge lap>otomy pads4 #a l>ge pill[ slip full ( /]ile cotton4 ,sponges4 #a lap>otomy %eet4 #a doz5 t[els4 #a pair ( legg9s4 ,g[ns & head dress+s 7gauze w d7 = ! op]ator & assi/ants2 rubb] gloves1 bas9s & accessories4 ,all are /]iliz$4 ,if ! woman has be5 exam9$1 ! vag9a %\ld be spong$ out ) t9cture ( iod9e4 ,! abdom5 is %av$1 scrubb$ ) gre5 soap1 nail bru%1 & hot wat] = five m9utes4 ,x is !n r9s$ ) e!r & pa9t$ ) iod9e4 ,! pres5tation ( ! *ild1 ! pres5ce & location ( ! he>t tones mu/ be det]m9$ be=e op]ation4 ,! pati5t is an/hetiz$ ) e!r1 *lor(orm or gas4 ,! incisions are made2 ! *ild deliv]$ to ! prop] assi/ant2 ! plac5ta & membranes remov$2 ! sponges c\nt$2 & ! ut]us & abdom9al wall sutur$4 ,aft]-c>e4--,! nurse wat*es ! pati5t = sigh+ respiration1 rapid pulse1 pallor1 & o!r symptoms ( hmorrhage1 ei!r ext]nal or int]nal4 ,artificial heat is suppli$4 ,hmorrhage f vag9a %\ld be look$ =4 ,x is normal4 ,salt solution by hypod]moclysis may be requir$4 ,hot wat] by m\? 9 small sips or tap wat] by rectum 7drop me?od7 w relieve ! ?ir/4 ,morph9e may be giv5 if pa9 is extreme4 ,an enema may be giv5 on ! second day or calomel may be />t$ 9 ! morn+ ( ! second day4 ,di/5tion f gas1 ) or )\t nausea & vomit+1 hicc\gh & rise ( temp]ature are all signs ( dang]4 ,no milk %\ld ev] be giv5 on acc\nt ( ! gas x causes4 ,! *ild is put to brea/ z usual aft] twelve h\rs4 ,! /it*es are to be tak5 out on ! t5? or twelf? day4 ,symphyseotomy is a sep>ation ( ! pelvis at ! pubic jo9t & is done ) a scalpel or a specially devis$ knife4 ,pubiotomy is ! division ( ! pelvis1 ?ree or f\r c5timet]s to ! "r or left ( ! pubic jo9t4 ,! division passes ?r\gh ! pubic bone & is usually done ) a s]rat$ wire call$ ! ,gigli saw4 ,x is introduc$ subcutane\sly by a special in/rum5t call$ a pubiotomy ne$le4 ,bo? symphyseotomy & pubiotomy are prep>atory to deliv]y4 ,pubiotomy is ! m desirable & successful op]ation4 ,! ends ( ! sev]$ bones sep>ate f "o & a half to two in*es1 & ! *ild deliv]s easily ?r\gh ! enclos$ op5+4 ,! aft]-c>e is usually simple4 ,in/rum5ts4-- #a scalpel4 #b ,gigli saws4 #a pubiotomy ne$le4 #f art]y =ceps4 #c eight-in* =ceps4 #a ne$le hold]4 #b retractors4 ,suture mat]ial & sponges z usual4 ,! hips are /rapp$ 9 circumf]5ce ) z9c adhesive pla/] to support ! bones4 ,! dang] ( infection ( ! w\nd f ! lo*ia is always pres5t4 ,! ma9 difficulty is 9 mov+ ! pati5t1 :o is m ?an usually helpless4 ,! bony r+ ( ! pelvis is brok5 & %e c n raise h] leg4 ,! repair is c>tilag9\s at fir/1 b solidifies 9 a few mon?s s t locomotion is n impair$4 ,especial pa9s mu/ be tak5 to avoid b$ sores4 ,,*apt] ,,xiii ,,m9or ,,op]ations ,aseptic ,c>e4--,place pati5t on a clean b$ pan4 ,x ne$ n be /]ile4 ,drape ) a %eet & arrange x s ! fold may be easily rais$ by nurse's elb[4 ,h /]ile bas9 ) cotton pl$gets to be fill$ ) solution ( lysol #a p] c5t4 ,lysol mu/ be put 9 bas9 fir/ & ! wat] add$4 ,take to b$side4 ,nurse scrubs h] h&s t5 m9utes ) a /]ile bru%1 hot wat]1 & gre5 soap4 ,use no t[el1 no gloves4 ,keep h&s wet & clean4 ,cleanse vulva ) wet pl$gets f above d[nw>d4 ,apply /]ile pad4 ,/]ile ,specim54--,to get a /]ile specim5 ( ur9e )\t ca!t]1 give aseptic c>e1 tampon vag9a ) l>ge pl$get ( /]ile cotton4 ,h pati5t ur9ate 9 a /]ile bas94 ,remove tampon4 ,/]ile ,specim5 f ,*ild4--,take a glass te/ tube & ?ru/ its r\nd end ?r\gh a hole 9 a squ>e piece ( adhesive pla/]4 ,pu% x d[n until ! pla/] is caught & /opp$ by ! enl>g$ rim at ! m\? ( ! tube1 ) adhesive side ( pla/] on same side z op5+ ( tube4 ,fa/5 ! tube ov] ! male p5is or female vulva by apply+ ! pla/] to ! surr\nd+ sk94 ,leave until full4 ,aseptic ,d\*e4--,boil d\*e po9t & bas94 ,leave po9t 9 /]ile bas94 ,fill d\*e c ) /]ile wat]1 temp]ature #ajd to #aaj ,f4 ,put clean b$pan "u pati5t :o is drap$ ) a %eet4 ,h at h& a /]ile bas9 conta9+ solution ( lysol #j4e p] c5t1 or boric acid #e p] c5t 9 :i* cotton pl$gets are imm]s$4 ,scrub ! h&s z = aseptic c>e4 ,cleanse ! vulva ) cotton pl$gets1 wa%+ always t[>d ! anus1 & use ea* pl$get b once4 ,adju/ ! d\*e po9t & introduce x j inside ! labia4 ,! d\*e c %\ld be only a trifle high] ?an ! pelvis4 ,:5 c is empty1 apply a /]ile pad4 ,illu/ration3 ,fig4 #hf4--;,app>atus = gett+ a /]ile specim5 ( ur9e f an infant4 ,if ! d\*e is to be us$ z a deodorant aft] ! fif? day ( ! pu]p]ium1 ei!r ( ! foll[+ solutions may be employ$3 ,potassium p]manganate1 #a3ejjj2 =maldehyde #a dram to qu>t1 or *9osol #a3ajjj4 ,! vag9al d\*e may be us$ 9 cases ( gonorrhal infection 9 pregnancy dur+ ! la/ weeks1 9 ! hope ( avoid+ infection ( ! *ild's eyes4 ,x is giv5 l ! aseptic d\*e 7q4 v47 ) potassium p]manganate #a3ejjj1 or *9osol #a3ajjj4 ,x %\ld be hot 7#aab to #abj ,f471 & be begun n long be=e t]m1 s t 9 case labor comes on1 ! dang] to ! *ild w be m9imiz$4 ,! res]voir mu/ n be too high1 nor ! d\*e po9t ins]t$ mu* beyond ! labia4 ,! woman %\ld be on h] back & ! d\*e po9t %\ld be rubb] or glass4 ,removal ( ,sutures4--,on1 or ab\t1 ! t5? day ! removal ( sutures is requir$4 ,! nurse w /]ilize by boil+1 #a pair ( long-h&l$1 %>p-po9t$ scissors1 #a pair ( tissue =ceps1 & if ! sutures ext5d f> into ! vag9a1 a vag9al retractor4 ,a bas9 ( lysol solution 7#a p] c5t7 ) cotton sponges1 a /]ile t[el to lay ! in/rum5ts on1 a di% to receive ! soil$ dress+s1 sutures & disc>d$ sponges1 completes ! arrangem5t4 ,! pati5t is n[ drap$ ) %eets z = exam9ation4 ,! doctor prep>es 8 h&s z = op]ation4 ,! nurse holds ! limbs ( ! pati5t 9 li?otomy position & ! op]ation is begun4 ,ut]9e ,tampon4--,pack+ ! ut]us is mo/ly employ$ = hmorrhage aft] labor4 ,! pati5t1 !re=e1 has be5 prep>$ & only fre% spong+ ) lysol solution is requir$4 ,! in/rum5ts are1 #a vag9al retractor1 #a pair ( dress+ =ceps1 #a vulsellum =ceps & a j> ( gauze1 f\r to six in*es wide & t5 or twelve feet long4 ,always use a s+le cont9u\s /rip4 ,a v l>ge quantity is necess>y to fill ! ut]9e cavity4 ,any /]ile gauze may be us$1 b weak iod(orm is satisfactory4 ,illu/ration3 ,fig4 #hg4--,tampon ( ! ut]us4 7,hamm]s*lag47 ,! vag9a is held op5 ) retractors1 ! c]vix seiz$ ) a t5aculum & pull$ d[n1 ! end ( ! gauze /rip is !n c>ri$ into ! ut]us z f> z ! fundus1 ! dress+ =ceps )drawn & a new l5g? c>ri$ 9 until ! cavity is pack$ tightly f ! fundus cle> to ! os4 ,c>e mu/ be tak5 t ! /rip ( gauze is n contam9at$ by vag9al contact dur+ ! introduction4 ,a pad & b9d] are n[ appli$4 ,if no in/rum5ts are at h&1 or !re is n "t to /]ilize1 !n ! nurse c grasp ! fundus ?r\gh ! abdom9al wall ) h] h& & pu% ! c]vix d[n to ! vulva :]e ! gauze c be pu%$ 9 by ! doctor's f+]s1 if necess>y4 ,! tampon acts z a hmo/atic ?r\gh its direct me*anical pressure1 & dynamically by /imulat+ ! ut]us to contract4 ,x %\ld be remov$ 9 f twelve to tw5ty-f\r h\rs4 ,illu/ration3 ,fig4 #hh4--,tampon ( vag9a4 7,am]ican ,text ,book47 ,to tampon ! vag9a ! woman lies on h] back across ! b$1 ) h] feet on ! knees ( ! doctor1 :o sits fac+ h]4 ,a /]ile retractor holds back ! po/]ior wall ( ! vag9a4 ,) a pair ( dress+ =ceps ! doctor seizes ! pl$gets ( cotton or gauze out ( ! lysol solution & c>ries !m "o by "o z f> z !y w g1 9 v>i\s directions ar\nd ! c]vix4 ,"o is pu%$ =w>ds t[>d ! bladd]1 ! next back t[>d ! rectum1 ! next 9 ! middle1 & s on until no m c be introduc$4 ,a pad & b9d] are appli$ tightly4 ,! ut]9e d\*e is sometimes employ$ = hmorrhage4 ,! field ( op]ation & ! doctor's h&s are prep>$ z usual4 ,! nurse cools ! boil$ d\*e wat] d[n to #abj ,f4 & if ord]$1 adds #b drams ( /]ile salt to ea* qu>t4 ,! in/rum5ts are a vag9al retractor1 a long ut]9e d\*e po9t1 & "o vulsellum =ceps4 ,! c]vix is seiz$ & br\ght d[n1 ! long d\*e po9t connect$ ) ! tube f ! res]voir is c>ri$ to ! fundus & ! wat] />t$4 ,c>e mu/ be us$ t ! return fl[ is free & unob/ruct$4 ,?is me?od is mo/ satisfactory 9 ut]9e hmorrhage aft] ! ut]us has be5 entirely empti$4 ,x /imulates a prolong$ & pr(\nd ut]9e contraction4 ,intrav5\s ,injections4--,! ve9 9 ! front ( ! elb[ is usually *os54 7,m$ian basilic or m$ian cephalic47 ,a rubb] b&age or t\rniquet is w\nd tightly ab\t ! middle ( ! upp] arm to make ! ve9s /& out prom95tly4 ,! surface ( ! sk9 %\ld be /]iliz$ = op]ation by scrubb+ ) gre5 soap & hot wat] & r9s+ ) #ej p] c5t alcohol1 foll[$ by #a3bjjj solution ( bi*loride1 or by ! application ( t9cture ( iod9e4 ,! hypod]mic ne$le is !n introduc$ aft] expulsion ( all ! conta9$ air & ! pi/on is drawn up until ! blood ent]s4 ,?is assures ! op]ator t ! ne$le has ent]$ ! ve94 ,! b&age is n[ loos5$ & ! solution ( ! drug is introduc$ v sl[ly4 ,intrav5\s infusion or transfusion is giv5 9 ! same way4 ,! fluid 7normal sal9e87 mu/ be runn+ f ! ne$le z x is introduc$4 ,hypod]moclysis is ! introduction ( normal sal9e solution1 "u ! sk91 or "u ! brea/s4 ,! solution may be transfus$ also into a ve94 ,by ?is op]ation1 ! quantity ( fluid 9 ! vessels is greatly increas$ & a circulatory /imulant is provid$4 ,normal sal9e also promotes diuresis & aids 9 ! removal ( wa/age4 ,! pr9cipal dang]s arise f too great rapidity or too l>ge a quantity ( ! fl[4 ,! sk9 %\ld be /]iliz$ at ! po9t ( attack by a coat+ ( t9cture ( iod9e4 ,! in/rum5ts requir$ are1 a ba? !rmomet]1 a d\*e c 7f\nta9 syr+e7 ) long tubes & an aspirat+ ne$le4 ,a hypod]mic ne$le w d1 b ! res]voir mu/ be well elevat$ s9ce ! calib] is s small4 ,ord9>ily ! res]voir ne$ be held only two or ?ree feet above ! po9t ( dis*>ge4 ,! wat] %\ld be fl[+ ?r\gh ! ne$le :5 x ent]s ! tissues4 ,if ! fluid is to be introduc$ "u ! sk91 ! be/ place is 9 ! loose region betwe5 ! hips & ! ribs 9 front4 ,if "u ! mamm>y gl&1 ! ne$le mu/ g bel[ & "u ! gl& f ! outside edge1 n into ! gl&4 ,if into a ve91 su* additional in/rum5ts w be ne$$ z a rat-too!d tissue =ceps1 a pair ( %>p-po9t$ scissors1 a knife & "s f9e catgut4 ,f f\r to sixte5 ounces ( fluid may be us$ at a temp]ature v>y+ f #aje to #aaj ,f4 ,! op5+s :]e ! ne$les ent]$ are clos$ by cotton & collodion4 ,curettage ( ut]us is done = abortion or pu]p]al sepsis :5 =eign fragm5ts are left 9 ! ut]us4 ,! room is prep>$ z = deliv]y4 ,! in/rum5ts are3 #a vag9al retractor4 #a vulsellum =ceps4 #a long ut]9e d\*e po9t4 #b dull curettes4 #b %>p curettes ( diff]5t sizes1 toge!r ) gauze = pack+ ! ut]us4 ,rubb] gloves %\ld be worn bo? by nurse & physician z mu* = p]sonal protection z = ! pati5t's safety4 ,9 _m cases ( incomplete abortion or ( pu]p]al sepsis ! endometrium is m satisfactorily curett$ ) ! glov$ f+]s4 ,abortion may be indicat$ 9 _m ( ! e>ly complications ( pregnancy1 su* z hyp]emesis1 nephritis1 uncomp5sat$ he>t lesions1 tub]culosis1 insanity1 hydramnios1 inc>c]at$ retrov]sions ( ! ut]us & ! pres5ce ( hmorrhage4 ,^! cases require ! op]ation to be und]tak5 & f9i%$ by ! doctor1 b o!r conditions develop :]e91 )\t volition on ! "p ( ! pati5t or doctor1 ! abortion beg9s4 ,"s may be sav$1 b at times ! attempt is futile4 ,if ! empty+ ( ! ut]us seems inevitable1 ! function ( ! physician is to see t ! process is f9i%$ z quickly & cleanly z possible4 ,?is may be done 9 ! e>ly /ages by pack+ ! c]vix & vag9a ) iod(orm gauze & adm9i/]+ ergot 9 tw5ty-five drop doses ?rice daily4 ,9 case ( dang]\s hmorrhage f spontane\s abortion1 ! vag9a c be tampon$ ) cotton pl$gets or gauze by a clean nurse :ile await+ ! arrival ( ! doctor4 ,:5 ! ut]us has p>tially empti$ itself & ! reta9$ fragm5ts prev5t ! complete contraction & all[ ( s]i\s ble$+1 or if ! fragm5ts are septic1 !n _! removal is requir$4 ,?is is done by ! f+] or curette4 ,! prep>ation ( rooms1 pati5t & doctor are ! same :e!r ! op]ation is = !rapeutic or incomplete abortion4 ,^! h be5 describ$4 ,! in/rum5ts are3 #a pair dress+ =ceps4 #b vag9al retractors4 art]y =ceps4 #b curettes ( diff]5t sizes4 #b vulsellum =ceps4 #a long ut]9e d\*e po9t4 #a pair ,goodell dilators4 #a d\*e c4 ,illu/ration3 ,fig4 #hi4--,pean =ceps4 ,! induction ( labor at or ne> t]m is done = pelvic contraction1 mat]nal disease1 = dang] ?reat5+ "m or *ild1 or to avoid ! bir? ( a po/-mature *ild4 ,a v>iety ( me?ods may be employ$1 b ! ,vorhees bag is be/4 ,te*nic4--,assemble1 & /]ilize by boil+ tw5ty m9utes1 a ,vorhees bag ,no4 #c or #d1 ,simon speculum or vag9al retractor1 #a pair long ,pean =ceps1 #b pairs vulsellum =ceps1 #a dress+ =ceps1 #b pairs compression =ceps1 #a ,goodell dilator1 #a t5aculum =ceps1 ,davidson h& bulb syr+e ) glass tubes & rubb] connections = ! bag4 ,pati5t1 prep>$ z = deliv]y1 is plac$ ^u ! table 9 exagg]at$ li?otomy position4 ,/irrups w s]ve4 ,! vag9a is retract$1 a sme> made f c]vix1 & ! muc\s membrane wip$ clean ) pl$gets ( gauze on =ceps4 ,an/hesia is only occasionally necess>y ev5 9 primip>as4 ,illu/ration3 ,fig4 #ij4--;,a1 ,h& bulb syr+e2 ,b & ,c1 ,vorhees bags2 ,d1 ,bag roll$ & grasp$ by ,pean =ceps ready = introduction4 ,be=e us+1 ! app>atus mu/ be te/$ by =cibly fill+ ! bag ) /]ile solution4 ,"o lip & sometimes bo? are seiz$ by vulsellum =ceps & br\ght d[n4 ,usually1 ev5 9 primip>as1 ! os is suffici5tly patul\s to admit ! bag--if n1 dilate4 ,illu/ration3 ,fig4 #ia4--,vorhees bag 9 place4 ,! bag1 empti$ ( residual air & fluid1 is roll$ up into a compact mass l a cig>ette1 seiz$ ) ,pean =ceps s t ! tips ext5d j to ! end ( ! bag4 ,turn ! concavity ( =ceps t[>d pati5t's left leg & introduce4 ,z ! bag ent]s turn ! mass to ! left--a qu>t] turn--s t :5 op]ation is complet$ ! =ceps curve faces upw>d4 ,release ! lock on =ceps4 ,connect ! tube ( ! bag ) syr+e tube & =ce ! solution sl[ly into bag4 ,pean =ceps may be remov$ z bag fills4 ,remove vulsellum4 ,tie tube ( bag ) tape :5 bag is full--disconnect syr+e4 ,put /]ile pad on ei!r side ( tube4 ,if pa9s d n />t )9 an h\r1 or if compression is desir$ z 9 plac5ta prvia or a m rapid dilatation1 !n a weight ( "o or two p\nds is atta*$ by a tape to ! protrud+ tube & pass$ ov] ! foot ( ! b$4 ,digital dilatation ( c]vix may be indicat$ 9 cases ( rigid os or :]e prolong$ labor or "s dang] to "m or *ild requires ! ha/5+ ( ! deliv]y4 ,no in/rum5ts are ne$$1 b a complete an/hetic is necess>y4 ,?or\gh asepsis mu/ be obs]v$4 ,! pati5t's g5itals & ! doctor's h&s are prep>$ z describ$ = labor1 & rubb] gloves are imp]ative4 ,! glov$ h&s & ! vag9a & vulva are well r9s$ ) lysol solution #a p] c5t4 ,! op]ation mu/ be done c>efully1 pati5tly & g5tly1 le/ ! c]vix be lac]at$4 ,! h& is introduc$ into ! vag9a1 & fir/ ! ?umb & index f+] are introduc$ into ! os & sep>at$ z widely z possible1 !n ! second f+] & s on1 until ! dilatation is complete4 7,hir/'s me?od47 ,ano!r me?od is ! introduction ( ! tips ( bo? index f+]s1 back to back4 ,=ce ex]t$ w dilate ! canal s second f+]s may also be ins]t$4 ,!n pati5tly & g5tly ! rigid r+ ( ! os is ov]come4 7,edg>'s me?od47 ,episiotomy4--,?is is a clean incision ( ! vulva1 :i* is done to avoid an app>5tly inevitable & ragg$ te> ( ! p]9eum4 ,! in/rum5ts requir$ are ei!r a blunt tipp$ knife or a pair ( blunt scissors4 ,! op]ation may be done on "o or bo? sides dep5d+ on ! am\nt ( room requir$4 ,! incision beg9s at a po9t j above ! l[] ?ird ( ! vulv> outlet :5 di/5d$ by ! head1 & passes obliquely d[nw>d & outw>d4 ,?is sev]s unimportant tissues only1 in/ead ( all[+ ! valuable p]9eal body to suff]4 ,x makes a clean w\nd t heals readily1 in/ead ( a ragg$ te> ?r\gh bruis$ tissue4 ,! cut is high en\gh to be free f ! con/ant ba? 9 infecti\s lo*ia1 :i* tr\bles ! heal+ ( ! usual p]9eal lac]ation4 ,illu/ration3 ,fig4 #ib4--;,episiotomy4 7,hamm]s*lag47 ,rectal ,infusion 7,drop ,me?od74--,a d\*e bag conta9+ normal sal9e solution is hung ne> ! b$ & kept w>m ) an electric pad1 a hot flatiron1 or by a hot wat] bag on ei!r side4 ,! tube ends 9 a ca!t] :i* is ins]t$ into ! rectum4 ,! tube is clamp$ s t only a drop ( solution c escape ea* second4 ,wet packs are bo? s$ative & antipyretic & may be employ$ = a local or a g5]al effect4 ,= bron*itis ! pack may be appli$ to ! *e/ only z foll[s3 ,! *ild 7or adult7 is /ripp$ 9 a w>m room 7#ge ,f47 & ! *e/ swa!d front & back ) a ?ick t[el wrung out ( hot wat] 7temp]ature #aje to #aaj ,f47 ,ov] ?is a wool5 %irt may be drawn or a blanket wrapp$1 & ! pati5t put to b$4 ,aft] six or eight h\rs1 ! dress+ is remov$ 9 a w>m room1 a hot ba? adm9i/]$1 & ! body well rubb$ ) alcohol1 & dri$4 ,! treatm5t may be repeat$ if necess>y4 ,d n burn ! pati5t by applications too hot4 ,! g5]al pack is mo/ s]viceable 9 r$uc+ temp]ature & produc+ a diaphoresis to relieve ! kidney & cleanse ! sy/em1 z 9 eclampsia4 ,= ?is purpose ! entire body1 nak$1 is roll$ 9 a %eet wrung out ( hot wat] & !n put betwe5 heavy blankets 9 b$4 ,! pulse %\ld be tak5 frequ5tly & ! temp]ature record$ at int]vals4 ,a cool application to ! head is v soo?+4 ,! pati5t sweats pr(usely & hot dr9ks may be giv5 to promote a m abundant diaphoresis4 ,usually ! pati5t drops (f to sleep z ! fev] subsides4 ,tw5ty to =ty m9utes is ! av]age duration ( su* a treatm5t4 ,:5 ! pack is remov$1 ! pati5t is wrapp$ at once1 )\t dry+1 9 w>m blankets1 & left = an h\r or s4 ,,*apt] ,,xiv ,,complications ,,9 ,,labor ,pelvic contraction is n infrequ5tly ! cause ( difficult or prolong$ labor4 ,! de=mity is mo/ commonly due to rickets 9 *ildhood4 ,!re are _m =ms ( pelvic contraction1 b 9 ?is c\ntry only two are at all common2 ! g5]ally contract$1 & ! flat pelvis4 ,! g5]ally contract$ pelvis is1 9 ! ma91 a well %ap$ pelvis1 only its measurem5ts are small] ?an normal4 ,! flat pelvis is m>k$ by a %ort5+ ( ! ant]opo/]ior diamet] ( ! inlet4 ,x looks z if x _h be5 press$ toge!r f be=e backw>d :ile 9 a s(t condition4 ,^! & o!r de=mities w be recogniz$ 9 advance ( labor by ! r\t9e application ( ! pelvimet]4 ,! value ( ?is in/rum5t is s great1 t no compet5t man does ob/etrical "w at ! pres5t "t )\t us+ ! pelvimet] z a r\t9e4 ,! av]age diamet]s 9 normal pelves may be tabulat$ z foll[s3 ,int]sp9\s--betwe5 ! ant]ior sup]ior iliac sp9es--#be cm4 ,int]cri/al--betwe5 ! iliac cre/s--#bh cm4 ,ext]nal conjugate--tak5 f ! upp] bord] ( ! symphysis to ! depression bel[ ! la/ lumb> v]tebra--#bj4e cm4 ,take #i4e cm4 f ?is to get ! true conjugate4 ,illu/ration3 ,fig4 #ic4--,v>i\s =ms ( pelvic de=mity comp>$ ) ! normal inlet4 7,bumm47 ,! circumf]5ce ( ! hips j bel[ ! iliac cre/s & above ! tro*ant]s--#ij cm4 ,x is tak5 ) a tape l9e4 ,^! are ! usual ext]nal measurem5ts4 ,! int]nal measurem5ts are made ) ! f+]s4 ,illu/ration3 ,fig4 #id4--,! pelvimet]4 ,illu/ration3 ,fig4 #ie4--,! v>i\s diamet]s ( ! inlet ) ! l5g?s giv5 9 cubic c5timet]s4 7,williams47 ,illu/ration3 ,fig4 #if4--,measur+ ! di/ance betwe5 ! ant]ior sup]ior sp9es ( ! pelvis4 7,williams47 ,! diagonal conjugate is ! di/ance f ! l[] bord] ( ! symphysis to ! promontory ( ! sacrum4 ,x %\ld measure #ab4e cm4 ,! fir/ & second f+]s are pass$ into ! vag9a & pu%$ up until ! tip ( ! second f+] t\*es ! promontory ( ! sacrum4 ,! f+] ( ! o!r h& m>ks ! dep? ( ! exam9+ f+]s j bel[ ! symphysis4 ,! di/ance is measur$ :5 ! f+] is )drawn1 & #a4e cm4 is subtract$4 ,! result is ! true conjugate4 ,^! measurem5ts c>efully made & ! d$uction judicially e/imat$1 give "o a fairly approximate idea ( size & %ape ( ! pelvic inlet4 ,! aim ( ne>ly all ! pelvic measurem5ts is to get n only ! size & %ape ( ! inlet1 b s f> z possible1 a work+ e/imate ( ! ant]opo/]ior diamet] ( ! brim1 :i* is ! mo/ important ( all ! diamet]s4 ,9 normal cases ?is %\ld be #aa cm4 ,illu/ration3 ,fig4 #ig4--,measur+ ! ext]nal conjugate4 7,williams47 ,?us1 tak+ #i4e cm4 f ! ext]nal conjugate 7#bj4e cm47 gives #aa cm4 ,subtract+ #a4e cm4 f ! diagonal conjugate z obta9$ ) ! f+]s z above describ$1 7#ab4e cm47 gives #aa cm4 ,! subtraction is made to comp5sate = ! ?ickness ( ! pubic bone & its incl9ation outw>ds4 ,illu/ration3 ,fig4 #ih4--,measur+ ! diagonal conjugate ) ! f+]4 7,ed547 ,a circumf]5ce ( #ij cm4 corresponds to an inlet ( #aa cm4 9 its ant]opo/]ior diamet]1 & e v>iation ( #e cm4 9 ?is circumf]5ce makes a diff]5ce ( #a cm4 7ei!r l>g] or small]7 9 ! ant]opo/]ior diamet]4 ,?us1 #ie cm4 9 circumf]5ce#ab cm4 9 ! diamet]2 & #he cm4 9 circumf]5ce#aj cm4 ,complications increase 9 proportion to ! degree ( contraction 9 ! pelvis4 ,! mo/ frequ5t difficulties sup]9duc$ by ! small pelvis are prolapse ( ! cord1 malpres5tation & malpositions ( ! head1 prolong$ labor1 & a l>ge increase 9 ! numb] ( assi/$ deliv]ies4 ,all ! possibilities & probabilities 9 a giv5 case w be c>efully work$ out be=e labor by ! consci5ti\s ob/etrician1 & ,cs>ean section1 induction ( premature labor1 pubiotomy1 =ceps1 or v]sion & extraction1 w be done ) a sure =ekn[l$ge4 ,prolapse ( ! cord complicates labor once 9 ab\t two hundr$ cases4 ,x is mo/ likely to occur :5 ! pres5t+ "p does n ent] or does n entirely fill ! op5+1 z 9 transv]se or %\ld] pres5tations1 or v]tex pres5tations ) small inlets4 ,! "m is n endang]$ by ?is mi%ap1 b ! babe is lo/ 9 f #ce to #fj p] c5t ( ! cases4 ,! diagnosis is easily made :5 a loop ( cord protrudes f c]vix or vulva1 & ! pulsation w diff]5tiate x f ev]y?+ else4 ,if ! cord does n pulsate1 ! family %\ld be in=m$ t ! *ild is dead & ! case may be all[$ to t]m9ate normally4 ,if x /ill pulsates1 ! woman %\ld be plac$ 9 ! knee-*e/ position = t5 or fifte5 m9utes1 !n ^u ! side1 opposite to t on :i* ! cord has prolaps$1 & back aga9 z soon z possible to ! knee-*e/ position4 ,a *air may be us$ to produce a ,tr5del5burg position by plac+ x s t ! edge ( seat & top ( back re/ on ! b$4 ,!n ! pati5t puts h] legs ov] ! l[] rungs & lies ) h] back aga9/ ! *air back & h] head on ! b$4 ,if ! c]vix is effac$ & ! os p>tly dilat$1 reposition may be attempt$ ei!r ) ! f+] or a male ca!t]4 ,! op]ation w1 ( c\rse1 succe$ mo/ easily if done 9 ! knee-*e/ position1 ) gravity to aid4 ,if ! cord c be pu%$ back1 a ,vorhees bag may be ins]t$ to keep x f com+ d[n aga94 ,?is holds back ! cord1 dilates ! canal & /imulates ! pa9s4 ,:5 ! bag comes out1 v]sion & extraction c & %\ld be done at once4 ,9 g5]al1 ! foll[+ summ>y may be useful3 ,prolapse ( ,cord ,causes4-- ,contract$ pelves4 ,bree* & transv]se pres5tations4 ,malposition ( head1 or face & =ehead pres5tation4 ,hydramnios4 ,accid5t4 ,l[ ins]tion ( plac5ta4 ,diagnosis4-- ,be=e rupture ( membranes c>eful exam9ation w %[ pulsat+ cord 9 advance ( head4 ,aft] rupture ! cord may be felt 9 vag9a4 ,dang]s4-- ,to "m3--,none b ^? due to causative condition4 ,to *ild3--,compression ( ! cord & asphyxiation4 ,contraction ( expos$ vessels ( cord4 ,pati5t may lie on cord4 ,tw5ty-five p] c5t die z a rule "u be/ conditions4 ,fifty p] c5t :5 left to nature4 ,treatm5t ( ,cephalic ,pres5tation4-- ,extraction ( *ild or reposition ( cord1 dep5d+ ^u ! degree ( dilatation4 ,if c]vix is small1 replace & fill c]vix ) ,vorhees bag4 ,:5 c]vix admits h&1 ei!r replace or d v]sion & extraction4 ,) head engag$1 reposition or v]sion is n possible4 ,*ild liv+3--,rapid deliv]y ) =ceps4 ,*ild dead3--,craniotomy or leave to nature4 ,prolapse ( "o or bo? h&s may take place4 ,if ! head is engag$1 no int]f]5ce %\ld be attempt$4 ,if n1 replacem5t or v]sion may be done4 ,! s(t p>ts may also complicate ! labor process4 ,no "t ne$ be sp5t "h on ! r>] =ms ( ob/ruction due to ut]9e or ov>ian tumors4 ,rigidity ( ! c]vix1 or os is n uncommon4 ,?is may be due to a d5se1 almo/ c>tilag9\s consi/5ce ( t tissue1 to premature rupture ( ! bag ( wat]s1 to weak1 ineffici5t contractions 9 ! fir/ /age1 or to a /eel-spr+-l contraction ( ! muscul> fib]s ( ! os4 ,9 all cases ! fir/ /age ( labor is greatly prolong$1 b s long z ! membranes are intact1 ! *ild is 9 no dang]4 ,two k9ds ( cases are met )1 ^? 9 :i* ! pa9s are viol5t1 & ^? 9 :i* !y are weak & %all[4 ,9 ! fir/ class1 z soon z ! condition is recogniz$1 a dose ( morph9e sulphate1 gr4 & scopolam9e hydrobromide #a_/aej gr4 %\ld be giv51 hypod]mically4 ,! rigid r+ relaxes "u ! influ5ce ( ! n>cotic1 & labor proce$s rapidly & almo/ pa9lessly4 ,*lor(orm may be sub/itut$ if ! morph9e & scopolam9e are n at h&4 ,if ! c]vix is effac$ & only ! rigid r+ ( ! os prev5ts ! completion ( ! labor1 or if ! above me?ods fail1 !n ! pati5t may be an/hetiz$ & ! rigidity ov]come by ! f+]s4 ,?is is an em]g5cy t %\ld n be attempt$ until all else has fail$ & "s dang] arises t makes x necess>y to ha/5 ! deliv]y4 7,see ,m9or ,op]ations1 p4 #baa74 ,:]e ! con/riction is due to unusual d5sity ( ! c]vix or to cicatricial tissue1 x is sometimes necess>y to make incisions "u aseptic precautions s t ! rigid r+ may exp&4 ,weak & ineffici5t contractions c sometimes be /imulat$ satisfactorily by ! introduction ( a ,vorhees bag4 ,rigidity ( ! pelvic floor may be due to inadequate ela/icity ( ! tissues z 9 old primip>as or 9 "y wom5 :o h ridd5 horseback = _m ye>s 9 ! cross-saddle position4 ,! head may come d[n to ! pelvic floor b w n advance fur!r4 ,if ! tissues ( ! vulva d n1 or c n yield suffici5tly aft] appropriate "t has be5 all[$1 episiotomy may be done4 7,see ,m9or ,op]ations1 p4 #baa47 ,! ut]us itself may functionate abnormally4 ,precipitate labor is an ov] rapid advance ( ! *ild :]e9 ! /ages ( labor are m]g$ into "o ano!r & ! *ild expell$ 9 two or ?ree pa9s4 ,x may be due to unusual capacity ( ! pelvis1 or to /rong contractions :i* ! pati5t is n aw>e (1 or bo?4 ,^! cases pr$ispose to po/ p>tum hmorrhage & to s]i\s lac]ations ( c]vix & p]9eum4 ,! *ild is usually deliv]$ 9 an undesirable place1 su* z a toilet bas9 or a /reet c>1 & p]i%es f ! fall1 f cold1 f umbilical hmorrhage1 or lack ( facilities = revival4 ,! nurse :o is wat*+ a case is responsible = ! prev5tion ( a precipitate4 ,if ! ev5t imp5ds1 ! woman mu/ be plac$ ^u h] side ) legs /raight1 & %e %\ld be in/ruct$ to cry out ) e pa94 ,*lor(orm may be giv5 & ! head =cibly held back4 ,ut]9e ,in]tia4--,a sluggi% /ate ( ! ut]us may *>act]ize ! labor & ! contractions w be sl[1 %all[ & ineffici5t4 ,! int]vals may be prolong$1 al?\gh ! pati5t compla9s bitt]ly ( pa94 ,! condition is se5 mo/ frequ5tly 9 multip>as & is due to defective inn]vation ( ! ut]us or to imp]fect reflexes1 & 9 primip>as also x may be due to ! newness ( ! function t is sudd5ly call$ into play1 or to contract$ pelvis4 ,_m times ! tr\ble results f ov]fatigue & want ( sleep4 ,if ?is is ! case1 ! rem$y may be f\nd 9 ! adm9i/ration ( morph9e sulphate gr4 & scopolam9e #a_/aej gr4 ,! pa9s are dim9i%$ or abrogat$ :ile ! contractions cont9ue4 ,! scopolam9e may be repeat$ if necess>y4 ,"u prop] indications & conditions ?is treatm5t is h>mless1 bo? to "m & *ild1 b requires sup]vision on ! "p ( ! nurse or physician4 ,if ! pati5t is n ov]ly fatigu$1 ! introduction ( a ,vorhees bag1 z describ$ "u ! head ( ,induction ( ,labor 7p4 #bjh7 w dynamically increase ! /r5g? & frequ5cy ( ! contractions1 me*anically aid ! effacem5t ( ! c]vix & ! dilatation ( ! os1 & %ort5 ! fir/ /age any:]e f six to twelve h\rs4 ,z soon z ! os is dilat$1 pituitr9 may be giv5 "u due precautions1 z h]eaft] indicat$4 ,pituitr9 has b little influ5ce on ! nonfunctionat+ organ1 b acts well on a ut]us :i* is def9itely contract+4 ,x %\ld n be giv5 dur+ ! fir/ /age1 s9ce :5 ! ut]us contracts1 !re mu/ be an adequate op5+ = ! advance ( ! *ild4 ,five to sev5 m9ims is ! usual dose1 inject$ into ! deltoid muscle4 ,! injection may be repeat$ 9 an h\r1 if requir$1 s9ce ! effects1 :i* beg9 ab\t five m9utes aft] ! injections1 w pass (f 9 fifty-five m9utes4 ,by ! use ( pituit9 _m op]ative proc$ures are alt]$ or avoid$4 ,a high =ceps case may be conv]t$ into a case = ! l[ in/rum5ts1 & ! latt] 9 _m in/ances avoid$ altoge!r4 ,! use ( pituit9 may be briefly summ>iz$ z foll[s3 ,pituitr9 7,use no alcohol to cleanse syr+e or sk9 be=e injection47 ,indications4-- #a4 ,in]tia ut]i or weak1 %all[ pa9s 9 second /age4 #b4 ,multip>ity4 #c4 ,po/ p>tum hmorrhage4 #d4 ,to avoid use ( =ceps or to r$uce a high =ceps case to a l[ "o4 #e4 ,cs>ean section4 ,if ! pati5t is a multip>a1 /]ile l95 %\ld be on & att5dants ready = ! deliv]y be=e an injection is giv54 ,conditions4-- #a4 ,c]vix effac$4 #b4 ,os admits ?ree f+]s4 7,bett] if membranes h ruptur$47 #c4 ,head %\ld be engag$4 #d4 ,no me*anical ob/acle to deliv]y su* z tumors or m>k$ly contract$ pelvis1 etc4 ,dang]s ( ,long ,labors4-- ,compression ( cord4 ,vesicovag9al fi/ul4 ,necrosis ( mat]nal tissues4 ,rectovag9al fi/ul4 ,infection--p]itonitis4 ,necrosis ( sk9 ov] skull4 ,necrosis ( cranium4 ,fracture ( skull4 ,dea? ( *ild4 ,mat]nal exhau/ion & prolong$ convalesc5ce4 ,premature rupture ( ! membranes n infrequ5tly occurs f ov]-di/5tion1 :5 tw9s or hydramnios is pres5t1 or at any /age ( ! pregnancy :5 ! membranes are weak4 ,! liquor amnii fl[s (f1 n all at once1 b aft] ! fir/ gu% by int]mitt5t dis*>ges1 dep5d+ on ! pa9less ut]9e contractions & ! accuracy ) :i* ! head fits ! pelvis4 ,labor usually comes on 9 f twelve to =ty-eight h\rs1 b x may be po/pon$ = a mon?4 ,! labor is sometimes m pa9ful & prolong$ on acc\nt ( ! abs5ce ( ! fluid w$ge & ! g5]\s lubrication ( ! *annel :i* is suppli$ by ! liquor amnii4 ,! dang] ( infection ( ! amniotic cavity ) consequ5t dea? ( ! *ild is always to be appreh5d$ aft] ! escape ( ! liquor amnii4 ,also ! ftal p>ts may prolapse & complicate ! labor2 or if ! cord comes d[n1 ! *ild may be imp]il$ by its compression4 ,if ne> t]m1 ! rupture ( ! membranes is n ( great importance ?\gh ! case mu/ be wat*$ att5tively4 ,daily obs]vation mu/ be made ( ! ftal he>t tones1 ! am\nt ( liquor amnii fl[+ away1 & ! pres5ce or abs5ce ( infection4 ,if labor does n det]m9e 9 a few days or if ! he>t tones rise above #afj or g bel[ #abj1 labor mu/ be inaugurat$4 7,see ,induction ( ,labor1 p4 #bjh47 ,rupture ( ! ut]us is ! mo/ s]i\s accid5t t occurs 9 labor4 ,x happ5s ab\t once 9 ?ree ?\s& conf9em5ts4 ,! te> is usually 9 ! l[] "p ( ! ut]us & foll[s a prolong$ p]iod ( labor1 :]e ! *ild is 9 a transv]se pres5tation1 &1 !re=e1 impossible to deliv]1 or ! pelvis is too small or ! *ild too l>ge4 ,x may also foll[ ill-advis$ or unskillful ef=ts to *ange ! pres5tation by ! introduction ( ! h& into ! ut]us4 ,occasionally rupture is produc$ by ext]nal viol5ce1 su* z bl[s or kicks ^u ! abdom54 ,x is imp]ative to be able to recognize ! symptoms :5 rupture imp5ds or actually occurs4 ,signs ( ,?reat5$ ,rupture ( ,ut]us4-- #a4 ,high position ( ! contract+ r+--especially its obliquity4 ,! contract+ r+ is a ridge-l =mation t may be f\nd runn+ across ! ant]ior & l[] portion ( ! ut]us4 #b4 ,high position ( fundus4 #c4 ,t5sion ( r\nd ligam5ts4 #d4 ,rotation ( ut]us ab\t its long axis4 #e4 ,t5d]ness to pressure ( l[] ut]9e segm5t4 #f4 ,contractions p]si/5t ) no pa9-free int]val4 ,signs ( ,actual ,rupture ( ,ut]us4-- #a4 ,hmorrhage is "o ( ! e>lie/ & mo/ significant signs1 & may be ei!r ext]nal or int]nal4 #b4 ,cessation ( ut]9e contractions ei!r abruptly or gradually4 #c4 ,extreme pa9 felt by pati5t4 #d4 ,recession ( pres5t+ "p4 ,! pati5t gives a %>p cry & has ! feel+ t some?+ has giv5 way4 ,signs ( %ock rapidly sup]v5e4 ,a pr$isposition to rupture may be pres5t f ! sc>s ( a ,cs>ean section1 ut]9e tumors1 & deg5]ation ( ! muscle4 ,! treatm5t dep5ds ^u ! degree ( ! injury1 & if inve/igation %[s t ! ut]us has op5$ into ! abdom9al cavity1 imm$iate lap>otomy is done4 ,9 o!r cases1 ! morcellation & removal ( ! *ild by ! natural passage may p]mit ! use ( a ut]9e pack & av]t ! necessity = an abdom9al op]ation4 ,! *ild is usually dead & ne$ n be consid]$4 ,,*apt] ,,xv ,,complications ,,9 ,,labor 7,cont'd7 ,vomit+ 9 labor frequ5tly occurs ne> ! end ( ! fir/ /age4 ,x is due to ! sympa!tic excitem5t ( ! n]ves ( ! /oma* z ! la/ fib]s ( ! os ut]i give way4 ,x requires no treatm5t4 ,hyp]emesis 9 labor is v r>e1 b :5 x does occur1 ! deliv]y %\ld be exp$it$4 ,hmorrhages may occur ei!r be=e1 dur+1 or aft] labor4 ,hmorrhage is always s]i\s4 ,hmorrhage be=e labor arises ei!r f a premature deta*m5t ( a normally implant$ plac5ta or f plac5ta prvia4 ,! fir/ is sometimes call$ 8accid5tal hmorrhage0 to di/+ui% x f ! latt]1 or 8unavoidable hmorrhage40 ,accid5tal hmorrhage may be ! result ( an injury or a bl[1 b 9 _m cases1 !re is no su* hi/ory4 ,! hmorrhage is mo/ frequ5t 9 ! lat] mon?s ( pregnancy1 & may be )\t any app>5t cause4 ,! hmorrhage may be entirely inside ! ut]us 7conceal$ hmorrhage7 or x may appe> ext]nally4 ,! hmorrhage1 :5 conceal$1 takes place back ( ! plac5ta or betwe5 ! membranes & ! ut]9e wall4 ,if ! hmorrhage is conceal$1 x is usually foll[$ by an attempt to expel ! *ild4 ,if ! hmorrhage is pron\nc$1 sy/ems ( %ock appe>4 ,! diagnosis is made by ! symptoms :i* are summ>iz$ 9 diff]5tiat+ ?is condition f plac5ta prvia 7p4 #bca74 ,f ?is affection1 ne>ly all ! *ildr5 & half ! mo!rs die4 ,illu/ration3 ,fig4 #ii4--,v>i\s =ms ( plac5ta prvia comp>$ ) normal atta*m5t ( ! plac5ta4 7,am]ican ,text ,book--,williams47 ,:5 ! hmorrhage is ext]nal & slight1 ! treatm5t may possibly be expectant = twelve h\rs1 if c>efully wat*$1 b usually ! symptoms become s s]i\s t imm$iate empty+ ( ! ut]us is requir$ ei!r by ! ,vorhees bag1 digital dilatation1 v]sion & extraction1 or ,cs>ean section1 ! me?od *os5 be+ dep5d5t ^u ! am\nt ( ! hmorrhage1 ! vigor ( ! "m & ! condition ( ! c]vix1 os1 pelvis1 & *ild4 ,plac5ta prvia is ! "n giv5 to a plac5ta t is atta*$ l[ d[n 9 ! ut]us s t its m>g9 or a l>ge "p ( its mass ov]lies ! os4 ,?is happ5s ?r\gh ! action ( ! egg :i* emb$s itself too f> d[n on ! endometrium--too close to ! c]vix4 ,?ree diff]5t k9ds are kn[n & nam$ f _! mann] ( encroa*+ on ! os1 z m>g9al1 p>tial1 or c5tral implantation ( ! plac5ta4 ,! hmorrhage is f a loos5+ ( ! plac5tal atta*m5t ow+ to ! /ret*+ & gr[? ( ! ut]us4 ,!re is only "o symptom ( plac5ta prvia--sudd51 pa9less1 causeless hmorrhage4 ,! ble$+ seldom appe>s be=e ! tw5ty-eigh? week1 & no suspicion ( a plac5ta prvia may arise be=e ! appe>ance ( hmorrhage1 :i*1 z a rule1 is soon repeat$4 ,labor frequ5tly comes on prematurely & malpres5tations naturally result f ! inability ( ! pres5t+ "p to fit itself into ! pelvis4 ,!re is no bag ( wat]s1 h5ce ! fir/ /age is long] & bloodi] & fraught ) mu* dang]4 ,int]f]5ce is regul>ly indicat$ to save ! life ( ! "m1 :ile ! *ild also has a high mortality4 ,pu]p]al infection is n uncommon4 ,plac5ta prvia is always an em]g5cy4 ,if ! pati5t c be kept "u obs]vation 9 a good hospital1 "o may temporize1 b "u o!r conditions ! ut]us mu/ be empti$ at once1 ev5 if only a s+le hmorrhage has develop$4 ,! indications are1 7a7 to control ! ble$+1 & 7b7 to empty ! ut]us4 ,! life ( ! *ild mu/ be disreg>d$ & ! "m alone consid]$4 ,if ! contractions h n begun1 !y %\ld be /imulat$ by ! introduction ( a ,vorhees bag1 :i*1 at ! same "t1 dilates ! canal & me*anically %uts (f ! ble$+ vessels by compression4 ,9 introduc+ ! bag1 ! membranes may be ruptur$ s ! bag w pass into ! ut]9e cavity4 ,:5 ! implantation is c5tral1 ! f+] mu/ te> a hole ?r\gh ! plac5ta1 & ?r\gh ?is op5+ pass ! bag inside ! ut]us4 ,if ! os is p>tially dilat$1 v]sion may be done1 & a foot br\ght d[n4 ,! leg may !n be pull$ ^u until x compresses ! ble$+ area & ! traction ma9ta9$ ) a sl[ly develop+ pressure suffici5t to *eck ! hmorrhage1 until dilatation is advanc$ en\gh = deliv]y4 ,occasionally good results are obta9$ by tightly pack+ ! c]vix & vag9a ) gauze or cotton4 7,see ,vag9al ,tampon1 p4 #bjd47 ,cs>ean section may be done 9 ! int]e/s ( ! *ild1 z well z ! "m4 ,! ftal mortality 9 plac5ta prvia is said to be #fj p] c5t & ! mat]nal #aj p] c5t4 ,diff]5tial diagnosis betwe5 ,accid5tal hmorrhage & ,plac5ta prvia ,usually occurs 9 lat] mon?s4 ,any "t aft] ! tw5ty-eigh? week4 ,may be conceal$ or op54 ,always op5 & ext]nal4 ,soon foll[$ by labor pa9s4 ,labor ne$ n occur4 ,ut]us becomes l>g] if ble$+ ,ut]us rema9s same size4 is conceal$4 ,ut]us h>d & wood5y4 ,ut]us1 normal consi/5cy4 ,9 sev]e cases1 signs ( %ock ,9 sev]e cases1 signs ( %ock :e!r hmorrhage is ext]nal or foll[ ! inv>iable ext]nal int]nal4 hmorrhage4 ,no plac5ta c be felt4 ,plac5ta c be felt ?r\gh ! os4 ,hmorrhage cont9ues4 ,hmorrhage int]mitt5t4 ,no hi/ory ( previ\s attack4 ,possibly hi/ory ( previ\s attack4 ,no contractions aft] labor beg9s ,contractions z usual4 9 s]i\s cases4 ,no bogg9ess ( c]vix4 ,c]vix boggy4 ,hmorrhages may occur dur+ labor f ret5tion ( ! major "p ( ! plac5ta :ile a portion is deta*$4 ,?is may be due to pre-exi/5t disease1 su* z endometritis1 or f ut]9e in]tia4 ,normally ! plac5ta w sep>ate & be dis*>g$ )9 an h\r aft] labor & 9 ! abs5ce ( hmorrhage x may g ev5 long] ?an ?is ) safety4 ,! occurr5ce ( sev]e hmorrhage1 h[ev]1 requires ! imm$iate clean+ out ( ! ut]us by ins]t+ ! h& & peel+ ! plac5ta f its atta*m5ts4 ,po/ p>tum hmorrhage includes all hmorrhages t occur aft] ! deliv]y ( ! plac5ta4 ,! 8flood+0 z x is call$ by ! laity1 is mo/ apt to come on ei!r imm$iately or )9 an h\r or s aft] labor4 ,if x comes on aft] ! fir/ tw5ty-f\r h\rs1 x is call$ second>y hmorrhage4 ,su* pr$ispos+ causes z ov]-di/5tion f tw9s may be pres5t1 b ! hmorrhage may foll[ a p]fectly easy & app>5tly normal labor s sudd5ly & s pr(usely t ! woman may die 9 half an h\r4 ,!re are f\r causes = po/ p>tum hmorrhage3 namely1 7a7 ut]9e exhau/ion 7atonia ut]i72 7b7 me*anical ob/acles to retraction1 su* z clots or ret5tion ( pieces ( plac5ta or membrane2 7c7 & lac]ations ( "s "p ( g5ital passage1 su* z ! vulva1 vag9a1 c]vix1 or l[] ut]9e segm5t2 & 7d7 ! sy/emic condition kn[n z hmophilia4 8,ble$]s0 7hmophilias7 are wom5 ^: blood lacks coagulability1 ow+ to ! abs5ce ( fibr9-produc+ elem5ts4 ,po/ p>tum hmorrhage is usually an ext]nal hmorrhage1 b ! woman may ble$ to dea? into h] own ut]us4 ,besides ! ext]nal signs1 ! pati5t may %[ ! symptoms ( acute anmia1 su* z ! rapid pulse1 hurri$1 %all[ respiration1 pallor1 cold sweat1 yawn+1 dizz9ess1 etc4 ,ne>ly all ^! cases c be sav$ by prompt recognition & effici5t treatm5t4 ,! fir/ /ep is to grasp ! ut]us4 ,if ! hmorrhage is due to a te> l[ d[n1 ! ut]us may be h>d1 b g5]ally x is relax$ & requires vigor\s massage ) bo? h&s be=e x %[s any signs ( contraction4 ,9 ! abs5ce ( ! doctor1 ! nurse mu/ "k h[ to und]take ?is maneuv]4 ,! ut]us1 aft] labor & especially :5 relax$1 is sometimes difficult to id5tify & ! nurse c only make deep massage 9 ! pelvis until ! organ responds & its h>d globul> mass c be appreciat$4 ,z soon z ! ut]us contracts1 clots & conta9$ blood are expell$1 & 9 _m cases its ble$+ ceases at once4 7,see ,conduct ( ,?ird ,/age1 p4 #adi47 ,x may be necess>y to keep ! ut]us contract$ by manual massage 9 ?is way = sev]al h\rs4 ,z soon z possible1 ! nurse1 or someone :om %e directs1 prep>es a hypod]mic ( pituitr9--#aj to #ae 4 ,an injection ( ergot may foll[ because its effect is m la/+ ?an pituitr94 ,next1 a hot d\*e is made ready & ! mat]ials = pack+ ! ut]us are assembl$4 ,:5 ! doctor arrives1 he /]ilizes 8 h&s1 puts on gloves & introduces two f+]s or ! :ole h& into ! ut]us to remove clots or any reta9$ fragm5ts ( plac5ta4 ,! hot intraut]9e d\*e may foll[1 & if ! contraction is n firm & ! hmorrhage *eck$1 ! ut]us mu/ be pack$ ) gauze4 ,if hmorrhage comes f c]vix1 x %\ld be grasp$ ) long =ceps1 pull$ d[n1 & sutur$4 ,if f p]9eum1 pack fir/1 & aft]w>d sutures may be introduc$4 ,if ! pati5t is exsangu9at$1 ! foot ( ! b$ is rais$1 c(fee giv5 by m\?1 camphorat$ oil hypod]mically1 & normal sal9e transfus$ "u ! brea/s4 ,pituitr9 may be cont9u$ 9 l>g] doses4 #a c4c4 w raise ! blood pressure v def9itely4 ,adr5al9 also may be employ$ = ?is purpose4 ,! foll[+ summ>y may be f\nd conv5i5t3 ,po/ ,p>tum ,hmorrhage ,etiology1 ,functional4-- ,atony ( ! ut]us1 especially aft] rapid artificial or natural empty+ ( ! organ4 ,m common aft] ut]us has previ\sly be5 greatly di/5d$4 ,premature v]sion & extraction4 ,hydramnios & tw9s4 ,imp]fect developm5t ( ut]9e musculature4 ,precipitate labors4 ,ha/e or improp] managem5t ( ?ird /age4 ,etiology1 ,me*anical4-- ,ret5tion ( plac5ta--p>tial1 total or solit>y cotyl$ons4 ,inv]sion ( ! ut]us4 ,plac5ta succ5turiata4 ,inflammation ( decidua s]ot9a4 ,conduct ( ?ird /age1 i4e41 wait until plac5ta sep>ates4 ,etiology1 ,sy/emic1 ,hmophilia4-- ,k9d ( hmorrhage4 ,hmorrhage be=e expulsion ( plac5ta due to lac]ation ( ! s(t p>ts1 or ,p>tial release ( plac5ta & failure ( ut]us to contract1 or ,plac5ta may be atta*$ to p]iph]y or to "o side4 ,attempts to expel plac5ta )\t wait+ = ut]9e contraction are sometimes productive ( hmorrhage4 ,hmorrhage aft] expulsion ( plac5ta4 ,hmorrhage 9 int]val betwe5 pa9s--comes f plac5tal site4 ,hmorrhage 9 /ream n *eck$ by ut]9e contraction is due to lac]ation ( ! canal4 ,hmorrhage 9 abnormal quantities at beg9n+ ( pa9s4 ,pure atony--comes e>ly4 ,hmophilia aga94 ,diagnosis4-- ,palpation ( ut]us ?r\gh abdom54 ,plac5tal site exclud$ f contraction 7p>alysis74 ,view ( vulva4 ,injuries4 ,fl[ cont9u\s1 fluid & bright r$1 %[s art]ial orig91 probably f c]vix4 ,exam9e4 ,atony--ble$+ at int]vals1 clott$ & d>k4 ,hmorrhage f a te> beg9s at once4 ,ut]us contract$ & hmorrhage cont9ues4 ,look = te>4 ,if hmorrhage does n beg9 )9 t5 or fifte5 m9utes aft] labor x is n f a te>4 ,always h hmophilia 9 m9d4 ,managem5t4-- ,?ird /age mu/ be conduct$ prop]ly4 ,be=e expulsion ( plac5ta--e>ly expression4 ,cr$ or manual removal--!n secure contraction by massage4 ,pituitr91 ,ergot1 or bo?4 ,aft] ,?ird ,/age4-- ,re/ore an inv]t$ ut]us4 ,repair lac]ations4 ,see t cavity is cle> & clean4 ,massage1 intraut]9e hot wat] d\*e1 h& 9 ut]us & h& outside & rub1 ergot4 ,pituitr9 hypod]mically4 ,pack ut]us ) /]ile gauze or weak iod(orm gauze4 ,/rict asepsis = all intraut]9e maneuv]s4 ,treat anmia ) transfusion1 elevation ( foot ( b$1 c(fee1 ext]nal heat1 hot rectal enemas1 /imulation1 b&ag+ ( legs4 ,/ry*n9e sulphate1 adr5al91 or camphorat$ oil may be requir$ 9 usual dosage4 ,hypod]moclysis4 7,see ,m9or ,op]ations1 p4 #bjf47 ,aft] ! ble$+ /ops1 ! food mu/ be mo/ nutriti\s--milk1 eggnog1 ri* s\ps1 *ick5 & mutton bro?s1 oy/] /ew1 & beef /eak z soon z %e c take x4 ,a diet ( fluids & /imulat+ foods t raise ! blood pressure w mo/ quickly relieve ! symptoms4 ,illu/ration3 ,fig4 #ajj4--,! knee-elb[ po/ure4 7,bumm47 ,illu/ration3 ,fig4 #aja4--,! knee-*e/ po/ure4 ,eclampsia occurs 9 ! la/ ?ree mon?s ( pregnancy z a rule1 & mo/ frequ5tly j be=e or dur+ labor4 ,9 ab\t "o six? ( ! cases only1 ! attack may foll[ labor4 ,! attack is *>act]iz$ by viol5t convulsions1 :i* come on ) little or no w>n+ unless ! ur9e has be5 c>efully wat*$4 ,illu/ration3 ,fig4 #ajb4--,! exagg]at$ li?otomy position obta9$ ) a %eet sl+4 7,am]ican ,text ,book47 ,illu/ration3 ,fig4 #ajc4--,! improvis$ ,tr5del5burg position4 7,am]ican ,text ,book47 ,! prodromal symptoms h already be5 describ$ "u album9uria 9 pregnancy 7p4 #gg74 ,! m>k$ features may be repeat$ = emphasis3 p]si/5t heada*es1 disord]s ( vision1 spots be=e ! eyes1 bl9dness1 edema ( *eeks1 eyelids1 feet & h&s1 pa9 at ! pit ( ! /oma*1 dizz9ess1 nausea & vomit+ & r++ 9 ! e>s4 ,sudd5ly ! convulsion occurs1 ! facial muscles twit*1 !n ! limbs & body are %ak5 by viol5t muscul> spasms4 ,! body becomes rigid1 ! tongue protrudes & ! face is livid & cyanotic4 ,! spasm usually la/s f "o to five m9utes & is succe$$ by coma t la/s an h\r or m4 ,9 "s in/ances !re is no return to consci\sness be=e ! next attack1 :i* comes on e h\r or half h\r1 ?\gh occasionally only "o seizure is not$4 ,illu/ration3 ,fig4 #ajd4--,! dorsal position ) /irrups4 7,dorl&'s ,diction>y47 ,! blood pressure is greatly increas$ & ! ur9e is dim9i%$1 ! temp]ature rises to #aja or #ajb ,f4 ,:5 dea? ensues1 x is mo/ frequ5tly due to edema ( ! lungs or c]ebral hmorrhage4 ,! great] ! numb] ( convulsions1 ! m s]i\s ! outlook z to life1 & x is said t aft] tw5ty seizures fifty p] c5t ( ! mo!rs die4 ,"u ! be/ treatm5t approximately fifty p] c5t ( ! babies die4 ,illu/ration3 ,fig4 #aje4--;,dorsal position across ! b$4 7,bumm47 ,!re is no r\t9e treatm5t = eclampsia4 ,! pr9ciples ( managem5t = ! attack are 7#a7 to empty ! ut]us1 on ! !ory t ! disease is a toxmia ( ge/ational orig91 7#b7 to elim9ate ! poison1 & 7#c7 to control ! convulsions4 ,! album9 9 ! ur9e & o!r eclamptic symptoms dem& urg5t att5tion 9 prophylaxis4 ,= ! pre-eclamptic p]iod 7see ,album9uria ( ,pregnancy1 p4 #gg7 a rigid milk diet is indicat$4 ,! b[els1 kidneys1 sk9 & blood vessels mu/ all be br\ght into s]vice4 ,9 ! full blood$ pati5t1 v5esection may be done & aft] draw+ (f t5 or twelve ounces ( blood1 an equal am\nt ( normal sal9e may be p\r$ into ! same ve94 ,illu/ration3 ,fig4 #ajf4--;,flex$ dorsal position ) feet on ! table4 7,am]ican ,text ,book47 ,subcutane\s transfusion or ! submamm>y introduction ( sal9e solution may be done4 ,! sk9 is /imulat$ by hot wet packs & ! b[els by sal9e ca?>tics & frequ5t irrigation ( ! colon4 ,dur+ ! attack1 ! pati5t mu/ be kept f injur+ h]self4 ,a spoon wrapp$ 9 gauze or a small1 long roll] b&age %\ld be slipp$ betwe5 ! tee? to keep ! tongue f injury4 ,! clo?+ mu/ be loos5$ or remov$4 ,no food1 b only wat] is giv5 by m\?1 until ! pati5t is consci\s4 ,! convulsions are controll$ by morph9e1 *loral1 or bo?4 ,morph9e sulphate1 gr4 is giv5 hypod]mically1 foll[$ 9 an h\r by #cj gr4 ( *loral by m\?4 ,two h\rs lat] ! morph9e is repeat$ & six h\rs aft] ! fir/ dose ( *loral1 x is repeat$4 ,9 ?is me?od 7,/rogan(f's71 f\r doses ( *loral & six ( morph9e are giv5 9 tw5ty-f\r h\rs4 ,t is all4 ,:5 ! /oma* w n reta9 ! *loral x may be giv5 by rectum 9 milk4 ,if a g5]al an/hetic is us$1 x %\ld n be *lor(orm1 b e!r4 ,illu/ration3 ,fig4 #ajg4--,! ,sims position4 7,kelly47 ,! labor1 if begun1 %\ld be exp$it$ by =ceps1 or v]sion & extraction4 ,ble$+ dur+ deliv]y %\ld be look$ ^u z desirable4 ,if m rapid measures ( deliv]y seem dem&$ & ob/acles exi/1 su* z pelvic contraction1 imp]fect dilatation1 or ! prospect ( a prolong$ fir/ /age1 ,cs>ean section or =cible deliv]y 7acc\*m5t =c7 may be attempt$4 ,if ! labor has n begun1 :5 ! convulsion occurs & a quick deliv]y by ! normal passage does n seem feasible1 !n ! ,cs>ean op]ation may be ! be/ treatm5t4 ,,*apt] ,,xvi ,,! ,,abnormal ,,pu]p]ium ,! practice ( ob/etrics has _m features t are v gratify+ to ! nurse & physician4 ,in/ead ( a surgical op]ation1 :i* has come unexpect$ly & undesir$2 a disa/] 9 :i* "s "p ( ! body is remov$ or alt]$ by means ( a proc$ure associat$ ) extreme pa91 m5tal tribulation & l>ge exp5se1 a mu*-wi%$ = addition is br\ght to ! family1 ) pa91 to be sure1 b a pa9 t is soon =gott5 9 ! g5]al joy4 ,?is is ! normal condition t causes ! nurse & ! doctor to rejoice t su* a delightful specialty has be5 *os54 ,!n comes a case 9 :i* ! labor may be complicat$ by "s dreadful anomaly1 or ! pu]p]ium burd5$ or disord]$ by "s unwelcome invasion t tortures ! s\ls ( ! family & may co/ ! life ( ! "m1 or *ild1 or bo?4 ,at su* a "t ! nurse & ! doctor feel ! full weight ( _! responsibility1 & aft] a s]ies ( anxi\s days & sleepless nights1 !y wond] :y !y did n *oose g>d5+ or a cl]ical position = _! life "w4 ,! disord]s ( ! pu]p]ium are _m & v>i\s1 b naturally ! brea/s & ! pelvic organs are mo/ frequ5tly affect$4 ,! brea/s ( ! human female are n res]voirs ( milk l ! c['s1 b a pair ( highly s5sitive organs t functionate & produce only z ! dem& is made4 ,x foll[s t :5 ! milk comes 91 ! brea/s become engorg$ & all ! neighbor+ /ructures are involv$ 9 ! new process4 ,h[ev]1 x is n milk t is ov]fill+ ! brea/s1 b s]um1 lymph & v5\s blood1 :i* conge/ ! tissues surr\nd+ ! gl&s & produce a h>d pa9ful mass4 ,! brea/s become heavy1 hot1 & pa9ful2 sup]num]>y gl&s 9 ! axill enl>ge1 b !re is no fev]4 ,!re is b little m reason = a fev] :5 ! mamm>y gl& beg9s to functionate ?an :5 ! lungs fill = ! fir/ "t except 9 ! case ( n]v\s pati5ts :o be> discom=t badly4 ,if fev] appe>s simultane\sly ) ! milk1 ! cause mu/ be s\ght 9 "s atrium ( infection1 possibly 9 ! brea/s1 b usually else:]e4 ,!re is no su* ?+ z 8milk fev]40 ,! enl>g$ gl&s1 ! t5se mottl$ sk9 on :i* blue ve9s run visibly "h & !re1 ! nipple1 flatt5$ & drawn into ! swell+1 s t ! *ild c n grasp x ) ! m\?1 all produce a s5se ( disord] t ought to be associat$ ) fev]--b is n4 ,?is is ! 8cak$ brea/0 ( ! laity1 & if let alone1 ! hyp]mia subsides & ! function rema9s4 ,! temp]ature 9 possibly two cases out ( five may rise to #ajj ,f4 = tw5ty-f\r h\rs1 b x promptly subsides4 ,^! temp]atures g5]ally occur 9 neurotic wom54 ,if ! brea/s are irritat$ by b9d]s1 brea/ pumps1 or massage1--l ! blacksmi?'s arm1 ) ex]cise--! tr\ble1 if n increas$1 is at lea/ mu* sl[] 9 disappe>+4 ,x is report$ t ! "y virg9s ( "s ,african tribes nurse ! babies 9 ! family1 ! brea/s be+ /imulat$ to produce milk l>gely by massage4 ,if ! condition ( ! brea/s becomes too pa9ful1 ! liquids by m\? are r$uc$ to ! la/ degree1 sal9e ca?>tics are giv5 until frequ5t wat]y /ools result1 "o or m ice bags are appli$ to ea* brea/ & code9e sulphate may be giv5 at night4 ,! *ild nurses e f\r h\rs only4 ,williams 0 ! fir/ to %[ t no tight b9d] is necess>y1 b only a support+ b&age4 ,! tight b9d] is a cruel & useless b>b>ism t has be5 ab&on$ by progressive physicians4 ,no massage is all[$2 no pumps2 no irritation :atev]1 & 9 tw5ty-f\r h\rs ! tr\ble has disappe>$4 ,hot dress+s to ! brea/ are equally ar*aic4 ,!y %\ld nev] be appli$ to any brea/ unless x is desir$ to ha/5 suppuration4 ,if ! *ild dies1 or = any reason c n nurse 7inv]t$ nipple1 cleft palate1 h>elip7 & x becomes necess>y to dry up ! milk1 ! treatm5t = 8cak$ brea/0 is cont9u$4 ,aft] tw5ty-f\r h\rs ! brea/s are com=table & r>ely give tr\ble aga94 ,cracks1 ,fissures & ,abrasions ( ! ,nipple4--,! c>e ( ! nipples %\ld be inaugurat$ ab\t six weeks be=e labor1 z else:]e describ$3 ,! nipple mu/ be inspect$ & its possibilities det]m9$1 e>ly 9 pregnancy1 if possible1 = _m v>ieties ( badly %ap$ & ill-develop$ nipples exi/ :i* may make nurs+ difficult or impossible4 ,imp]fect nipples especially are pr$ispos$ to fissure & crack1 & w require extreme c>e on ! "p ( ! nurse4 ,%e %\ld inspect !m be=e & aft] ea* nurs+ & s$ul\sly use cleanl9ess & asepsis 9 h] managem5t4 ,9 normal & tranquil z well z 9 neurotic wom51 ! nipple may become s sore z absolutely to preclude nurs+1 & ?is entails mu* additional "w on ! nurse & "m1 z well z consid]able p]il = ! *ild4 ,! condition usually beg9s z a fissure or crack1 & is accompani$ by mu* pa94 ,x is s]i\s1 fur!rmore1 9 ano!r aspect s9ce all breaks 9 ! surface ( ! nipple are av5ues ( infection t may result 9 ma/itis4 ,! *ild may produce fissures or abrasions by rubb+ ! nipple ) 8 m\?1 by pull+ too h>d1 or by ! habit ( hold+ x 9 8 m\? & mac]at+ x ) 8 gums :5 he has f9i%$ nurs+4 ,illu/ration3 ,fig4 #ajh4--;,examples ( imp]fect nipples4 7,am]ican ,text ,book47 ,! *ild mu/ n be left at ! brea/ aft] he has nurs$1 b ! nipple %\ld be g5tly remov$ f ! *ild's m\? by pass+ "o f+] 9 beside ! nipple4 ,fissures & abrasions usually occur )9 t5 days if at all4 ,abrasions or erosions are due to ! we>+ away ( ! epi!lial cov]+ ( ! nipple 9 pat*es m or less ext5sive4 ,?9-sk9n$ blonde wom5 suff] m ?an ^? ) d>k1 d5se oily sk9s4 ,a fissure is a di/9ct sep>ation ( tissue t goes deeply into ! und]ly+ sub/ance4 ,a crack is a long abrasion :i* may deep5 into a fissure4 ,bo? fissure & crack may affect ! top1 ! side ( ! apex1 or ! base ( ! nipple4 ,!y may be ei!r longitud9al or circul>4 ,! entire nipple mu/ be kept "u obs]vation & ! in/ant a raw surface is detect$1 treatm5t mu/ beg94 ,illu/ration3 ,fig4 #aji4--;,a /&>d nipple %ield4 7,am]ican ,text ,book47 ,comp\nd t9cture ( b5zo91 lib]ally appli$1 is a favorite & successful rem$y4 ,our r\t9e is to apply a pa/e made ( equal p>ts ( ca/or oil & subnitrate ( bismu?4 ,?is is put on aft] ! *ild nurses1 & mu/ be remov$ c>efully be=e ! next nurs+4 ,sometimes ! *ild's /ools become black & con/ipat$ & ! tr\ble may be trac$ to imp]fect removal ( ! bismu? prep>ation4 ,:atev] m$ication is us$1 ! nipple mu/ be protect$ f injuri\s friction by ! clo?+4 ,?is is be/ done by ! hat-%ap$ lead nipple %ield1 :i* is plac$ ov] ! nipple & held 9 place by a light b9d]4 ,! %ield %\ld be boil$ be=e use4 ,to protect ! nipple dur+ nurs+1 a glass %ield may be us$ = a day or s1 b n long en\gh = ! babe to get accu/om$ to x1 else he w =m a habit h>d to break4 ,?is %ield mu/ be tak5 ap>t aft] use1 wa%$ & kept 9 saturat$ solution ( boric acid until ! next nurs+4 ,if all ^! measures fail1 ! fissure mu/ be t\*$ ) a nitrate ( silv] /ick once1 or h a #b p] c5t solution ( nitrate ( silv] appli$ night & morn+4 ,x may be necess>y to take ! *ild f ! brea/ = a day or s1 9 :i* case he nurses ! o!r brea/ & ! side ) ! bad nipple is pump$4 ,! c>e ( ! nipple is highly important s9ce ! appreh5sion & ! actual pa9 ( ea* nurs+ may prev5t sleep1 de/roy ! appetite1 & dim9i% ! milk4 ,if begun e>ly1 mo/ fissures w heal 9 tw5ty-f\r to =ty-eight h\rs4 ,ma/itis4--,f ?ree to five p] c5t ( ly+-9 wom5 h ma/itis 9 ! ,european cl9ics1 b ! records 9 ,am]ica %[ a mu* small] numb]4 ,! disease occurs mo/ frequ5tly 9 blondes & 9 primip>as4 ,x is mo/ apt to appe> dur+ ! fir/ two weeks1 :5 ! conge/ion accompany+ ! new mamm>y function produces a /asis t favors ! gr[? ( g]ms1 :i* may ent] ?r\gh ! abrasion or fissures ( ! nipple produc$ by zeal\s activity ( ! *ild's gums4 ,b x may also occur :5 ! *ild's fir/ tee? come & ! nipple is aga9 expos$ to injury4 ,at times x is impossible to f9d a plausible excuse = its occurr5ce4 ,ma/itis is usually describ$ 9 ?ree =ms3 ,! 7a7 p>5*ymat\s or gl&ul> type1 :i* affects ! sub/ance ( ! gl& or ! envelop+ connective tissue2 9 7b7 subcutane\s ma/itis ! connective tissue b5ea? ! sk9 is attack$2 & 9 7c7 ! sub-gl&ul> v>iety1 ! infection f9ds a lodg+ betwe5 ! gl& & ! *e/ wall4 ,ma/itis is always due to ! pres5ce ( microorganisms :i* 9 _m cases ga9 access to ! gl& ?r\gh fissures or abrasions by means ( ! lymphatics4 ,9 o!r in/ances ! g]ms may be 9 ! blood & a local /asis may enc\rage ! infection4 ,/ill aga91 !y seem to ent] ?r\gh ! normal nipple op5+s4 ,symptoms4--,! p>5*ymat\s inflammation beg9s ) a *ill1 & ! temp]ature promptly rises to #ajb to #aje ,f4 ,! pulse is high4 ,! pati5t compla9s ( heada*e & ?ir/4 ,exam9ation reveals h>d1 t5d] nodules 9 "s "p ( ! gl&4 ,! sk9 may or may n be r$d5$4 ,if ! tr\ble has begun 9 ! connective tissue1 ! sk9 w be diffusely r$d5$1 ! nodule ill-def9$1 ! temp]ature w rise gradually & ! *ill may be abs5t4 ,treatm5t4--,! brea/ is put at re/4 ,no tight b9d] is appli$1 no brea/ pump1 no massage4 ,no heat is all[able4 ,ice bags surr\nd ! gl& night & day4 ,! liquids by m\? are re/rict$ & sal9e ca?>tics giv54 ,code9e may be adm9i/]$ = pa94 ,usually ! symptoms subside )\t suppuration 9 f "o to two days4 ,%\ld ! inflammation p]si/ = m ?an two or ?ree days1 9 mo/ cases ! tissue w break d[n & =m a mamm>y abscess4 ,:5 x is evid5t t suppuration has begun1 heat may be appli$ to ! gl& & ! process accel]at$4 ,! abscess may be sup]ficial or deep & w be diagnos$ by a bogg9ess 9 a circumscrib$ area or by fluctuation4 ,! abscess mu/ be op5$ z soon z possible4 ,! nurse /]ilizes a bi/\ry & a pair ( long art]y =ceps4 ,lysol solution & cotton sponges are made & /]ile gauze = pack+4 ,! h&s are surgically prep>$ & rubb] gloves worn4 ,if an an/hetic is requir$1 gas may be us$1 or *lor(orm4 ,! incision is made radially f ! nipple s z to m9imize ! injury to ! milk ducts4 ,a gauze dra9 may be requir$ = a few days4 ,9 ! aft]-c>e1 ! nurse mu/ be scrupul\sly clean & n convey contagion f ! brea/ to ! woman's g5itals1 to ! *ild's eyes1 navel or vag9a1 nor to h] own p]son4 ,excess ( milk is r>e1 b may be obs]v$ = a %ort "t aft] ! gl&s fill4 ,x seldom requires treatm5t1 b sal9e ca?>tics1 re/riction ( fluids1 & putt+ ! *ild on a f\r-h\r s*$ule w r$uce x4 ,pads may be worn if x runs away freely4 ,sc>city ( milk is only too common4 ,!re may be en\gh at fir/ & ! quantity gradually dim9i%1 or x may be defici5t f ! v beg9n+4 ,! faulty secretion may be due to ! age ( ! "m1 to disease 7anmia71 to bad nutrition1 or to ov]work4 ,x may foll[ a premature *ild4 ,compression ( ! brea/s by corsets or tight dresses may prev5t developm5t4 ,! am\nt ( gl& tissue is v important4 ,_m wom5 h l>ge1 fat brea/s1 b a small gl&ul> developm5t4 ,m5tal conditions1 su* z fright1 worry1 & anxiety1 w dim9i% ! fl[ ( milk or /op x altoge!r4 ,symptoms4--,! *ild is fretful1 goes to sleep aft] nurs+ b soon wakes up1 or may nurse a:ile1 & !n f9d+ x useless1 w cry & refuse ! nipple4 ,he loses weight & :5 weigh$ be=e & aft] fe$+1 ! scales sc>cely v>y4 ,no secretion or v little c be squeez$ f ! brea/s4 ,! *ild may be giv5 a bottle aft] :i* he goes to sleep4 ,treatm5t4--,:5 ! gl& tissue is defective1 no treatm5t c succe$4 ,! appetite mu/ be improv$ by bitt] tonics & ! m9d reliev$ ( its anxieties1 if possible4 ,*ange ( sc5]y may help4 ,! fluids mu/ be increas$1 milk1 cocoa1 *ocolate & gruel mu/ be pu%$1 & su* vegetables add$ z corn & beets4 ,oy/] /ews1 clams1 lob/]s1 & crabs w help4 ,! diet mu/ be full & nutriti\s ) especial /ress on ^? foods t raise ! blood pressure4 ,malt dr9ks or *ampagne may avail 9 "s cases4 ,ex]cise 9 mod]ation is desirable4 ,artificial /imulation ( ! brea/ sometimes succe$s4 ,massage w irritate ! gl&s1 increase ! conge/ion1 & promote functional activity2 or a ,bi] vacuum app>atus may be put ov] ! gl& sev]al times a day & ! air pump$ out4 ,! brea/ %\ld be kept di/5d$ = fifte5 to tw5ty m9utes4 ,!re is difficulty 9 ?is c\ntry 9 gett+ glass bells ( suffici5t size4 ,galactorrha is ! "n appli$ to an abundant secretion ( milk poor 9 quality t[>d ! end ( a long lactation or aft] ! *ild is wean$4 ,! symptoms are an almo/ con/ant fl[ ( milk ) resultant anmia4 ,treatm5t4--,elix4 ( iron1 qu99e & /ry*n9e ) compression ( ! gl&4 ,a dry diet & ! avoidance ( all irritation ( ! brea/s w aid4 ,to 8dry up ! milk10 foll[ ! treatm5t = 8cak$ brea/40 ,illu/ration3 ,fig4 #aaj4--;,a /&>d brea/ pump4 7,am]ican ,text ,book47 ,quality ( ! milk may be su* t ! *ild w n take x or1 if tak51 x fails to n\ri%4 ,9 "s cases ?is is due to ov]long1 or to irregul>1 p]iods betwe5 fe$+s2 = :5 ! nurs+ int]val is too %ort1 ! milk becomes too ri*1 :5 too long1 x becomes ?9n] & less nutriti\s4 ,fright1 anxiety or ang] may *ange ! "* ( ! milk s t colic1 vomit+1 & di>rha & indige/ion are produc$ 9 ! *ild4 ,a wet nurse becomes homesick & ! milk dries up4 ,x may become extremely indige/ible1 z %[n 9 cases :]e a wet nurse qu>rels ) h] husb& & h] fo/] *ild develops gre5 /ools4 ,if ! "m's milk does n agree1 ! *ild may be put on fe$+s = tw5ty-f\r or =ty-eight h\rs1 :ile ! milk1 pump$ f ! brea/1 is s5t to a laboratory = analysis4 ,if a return to ! brea/ is unsatisfactory1 artificial fe$+s or a wet nurse mu/ be suppli$4 ,removal ( ! *ild f ! brea/ may be requir$ = a v>iety ( reasons4 ,?us1 ! "m's addiction to alcohol or opium is good gr\nd = tak+ away ! *ild4 ,ars5ic1 bromides & iodides ( potassium1 sal9e ca?>tics1 salicylates1 alcohol1 opium & belladonna mu/ be giv5 to ! "m ) great caution dur+ lactation1 = !y pass ov] into ! milk4 ,acute diseases1 su* z erysipelas1 pneumonia1 diph!ria1 typhoid1 mal>ia1 pron\nc$ pu]p]al sepsis or p]si/5tly high fev] f any cause1 usually dries up ! milk2 :ile c>diac lesions1 unless well comp5sat$1 *ronic anmia & tub]culosis1 obvi\sly dem& ! removal ( ! *ild = ! sake ( bo?4 ,sometimes a new conception1 especially :5 ! milk becomes poor 9 ! la/ half ( ge/ation1 compels ! "m to wean h] babe4 ,a syphilitic woman may nurse h] own *ild1 provid$ h] condition is good & ! *ild also is syphilitic4 ,!oretically1 ! return ( m5/ruation 9 no way affects ! nurs+ *ild1 unless ! blood is lo/ to ! po9t ( anmia4 ,yet cases d occur 9 :i* ! *ild has indige/ion1 colic & bad /ools1 z well z loses weight1 :5 ! "m is m5/ruat+4 ,! quality ( ! milk is sometimes alt]$1 b only = a day or s1 & ! *ild %\ld cont9ue at ! brea/ unless "s def9ite indication = removal arises4 ,wean+ ord9>ily is complet$ by ! n9? mon?1 b ! *ild %\ld nev] be c>ri$ beyond ! twelf? mon? on acc\nt ( *anges 9 ! "* ( ! milk4 ,:5 a *ild is wean$1 ! sub/itution ( an artificial food may be made gradually1--a bottle a day1 two bottles a day1 etc41 until1 9 a c\ple ( weeks1 ! brea/s are at re/4 ,! excessive prolongation ( lactation is %[n ^u ! "m by impairm5t ( ! heal?4 ,! pati5t is pale1 weak1 anmic1 fretful1 & ?94 ,heada*es1 dizz9ess1 loss ( appetite1 & con/ant fatigue w be compla9$ (4 ,! treatm5t is to remove ! *ild at once & put ! "m on /imulat+ drugs & foods4 ,a *ange ( air & sc5]y1 if possible1 w be highly b5eficial4 ,! wet nurse is always a tribulation1 :i* mu/ be endur$ until ! *ild c be put on artificial food4 ,%e %\ld h a ,wass]mann te/ be=e ent]+ ^u h] duties4 ,syphilis1 tub]culosis1 & gonorrha mu/ be gu>d$ aga9/4 ,%e mu/ be kept l ! family c[1 9 a placid frame ( m9d1 f$ on nutriti\s food t is n too ri*1 & ex]cis$ en\gh to keep ! blood circulat+4 ,light h\sework & duties t take h] out ( doors "p ( ! "t are advisable4 ,h] moral "* c only be assur$ ?r\gh ^? :o h kn[n h]4 ,if %e br+s h] own *ild ) h]1 %e w ne$ wat*+ to provide = an equable di/ribution ( ! milk4 ,! fir/ few days is nev] a crit]ion ( a wet nurse's effectiv5ess4 ,*ange ( food & surr\nd+s may int]f]e ) h] usefulness4 ,gas may complicate ! pu]p]ium aft] ,cs>ean section1 & ev5 aft] normal labor4 ,a rectal tube ( s(t rubb] may be pass$ z high z possible into ! b[el & left = "s "t1 or enemas ( ,s4 ,s41 turp5t9e1 asaftida1 or milk & molasses may be giv54 ,by m\? calomel or mag4 cit4 is valuable4 ,heada*e 9 ! pu]p]ium %\ld be wat*$ c>efully1 & ! cause discov]$4 ,pa9 9 ! head may be a habit ) ! pati5t1 or x may be a symptom ( "s complication ei!r pres5t or develop+1 su* z toxmia1 eclampsia1 or acute yell[ atrophy ( ! liv]4 ,9 g5]al1 x is due to mild] conditions l exhau/ion1 too _m visitors1 excitem5t1 n]ves1 or insomnia4 ,aft]-pa9s4--,sometimes pati5ts are greatly annoy$ by aft]-pa9s4 ,! pa9 may be due to a clot reta9$ 9 ! ut]us or possibly a /imulation ( ! ut]us :5 ! *ild goes to brea/4 ,g5tle massage ( ut]us1 or ergot1 qu99e1 or code9e may be requir$ to br+ ab\t ! expulsion ( ! clot or to control ! pa94 ,a reasonable degree ( aft]-pa9 is ( favorable significance4 7,see p4 #aed47 ,,*apt] ,,xvii ,,infection ,pu]p]al fev] is a w\nd infection4 ,! conditions ( ! pelvic organs dur+ labor & po/ p>tum1 are well adapt$ to receive & develop microorganisms1 = ! heal?y antimicrobic p[] ( ! vag9al secretion is abs5t or dim9i%$4 ,a long & exhau/+ labor1 possibly accompani$ by hmorrhage1 or t]m9at$ by an op]ation1 has dim9i%$ ! immunity & brok5 ! resi/ance ( ! tissues to a dang]\s degree4 ,! muc\s membrane ( vulva & vag9a are torn & bruis$1 ! vitality l[]$1 & ! surface cov]$ ) bloody lo*ia1 :i* is an excell5t nutritive m$ium = microbic developm5t4 ,! ut]us is a va/1 op5 w\nd1 fill$ ) fibr91 blood clot1 & decompos+ tissue1 :ile ! :ole pelvis is ma9ta9$ at exactly ! prop] temp]ature = g]m propagation4 ,?r\gh ^! w\nds1 tox9s are c>ri$ into ! circulation1 & g]ms1 n\ri%$ ^u ! abundant & favorable culture m$ia1 pass ?r\gh ! ut]9e walls or by way ( ! lymph *annels fir/ into ! adjac5t tissues & !nce to all p>ts ( ! body4 ,c]ta9 def9ite organisms rea* ! dis9tegrat+ tissues & produce a putrefaction4 ,!y d n1 h[ev]1 once _! "w is done1 pass into ! body4 ,b 9 produc+ putrefaction1 !y also produce injuri\s poisons1 call$ tox9s1 :i* d ent] ! body & cause an absorptive fev] kn[n z saprmia4 ,illu/ration3 ,fig4 #aaa4--;,g]ms mo/ frequ5tly f\nd 9 cases ( pu]p]al fev]4 7,kelly's ,gynecology47 #a1 /reptococci 79 *a9s72 #b1 gonococci2 #c1 tub]cle bacilli 7n a s\rce ( pu]p]al infection72 #d1 bacillus coli communis2 #e1 /aphylococcus pyog5es aureus2 #f1 bacillus a]og5es capsulatus4 ,o!r organisms are ! pus microbes1 :i* beg9 _! gr[? 9 any favorable location & cont9ue to spread & fl\ri% onw>d & inw>d by blood vessel1 tissue or lymphatic1 until ov]p[]$ by ! resi/ances ( ! body1 or until by g5]al sepsis1 !y h kill$ ! pati5t4 ,^! are ! /reptococcus1 /aphylococcus1 bacillus coli & bacillus pyocyaneus4 ,^! are ! g]ms t ! nurse or ! doctor may br+ to ! pati5t on h&s1 clo?+1 or hair4 ,^! are ! organisms aga9/ :i* our scrupul\s asepsis & antisepsis is direct$4 ,x is aga9/ !m & _! activities t ! doctor & nurse prep>e by ! long & pa9ful scrubb+ ( ! h&s & elb[s1 ! rubb] gloves1 by ! %av+ & scrubb+ ( ! pati5t1 & by all ! p>aph]nalia & equipm5t t g to furni% ! mod]n ly+-9-*amb] or deliv]y room4 ,x is on acc\nt ( ^! g]ms t ! consci5ti\s doctor or nurse lies awake nights & pa9fully reviews 8 te*nic :5 8 pati5t has a temp]ature1 & x is on _! acc\nt t he %udd]s at ! call\s disreg>d ( human life t is %[n by ^? :o d n obs]ve ! kn[n laws ( asepsis4 ,x is true t _m wom5 escape :5 ! att5dant is unclean1 b ?is is due to a spl5did immunity1 & 9 no way absolves ! man or woman :o neglects 8 asepsis & has pati5t aft] pati5t runn+ temp]atures1 "s ( :om are b\nd to die or be crippl$ = life4 ,x is = ?is reason t a surgeon %\ld d surg]y & n g5]al practice2 x is = ?is reason t an ob/etrician %\ld limit himself to ! c>e ( wom5 9 *ildbir? & n endang] !m by tak+ cases ( sc>let fev]1 erysipelas1 & unclean surg]y4 ,9 c\ntry practice1 all k9ds ( "w mu/ be done s9ce !re are n en\gh m5 to specialize1 b x is inexcusable 9 ! city :]e a man c always be clean & keep clean1 if he is will+ to =ego ! income d]iv$ f att5dance ^u septic & infecti\s cases4 ,any article n surgically clean may contam9ate ! pati5t by contact2 b ulc]s1 suppurat+ w\nds1 abscesses1 & h&s improp]ly or insuffici5tly clean$ are ! deadlie/ causes ( po/ p>tum temp]ature4 ,infections are said to be ei!r self-produc$ or br\ght to ! pati5t f )\t4 ,! only organism t is demon/rably self-infecti\s is ! gonococcus1 :i* may be pres5t 9 ! vag9a be=e labor & may infect ! pu]p]al woman2 b x is wis]1 saf]1 & m ne>ly accords ) ! facts1 to reg>d all infections z ali5 borne1 z br\ght to ! pati5t & introduc$ by ! unclean h&s or in/rum5ts ( h] m$ical att5dants4 ,prev5tion4--,a consci5ti\s & capable nurse or doctor w n g f an infect$ case to a conf9em5t4 ,bo? w keep _! bodies clean1 ! tee? fill$1 & pyorrhz scrap$ & treat$4 ,! occurr5ce ( pus any:]e on ! body is suffici5t reason = ! doctor to give up 8 conf9em5ts = a "t1 & ! nurse to report (f duty4 ,no raw1 & b few muc\s surfaces %\ld be t\*$ by ! f+]s ( ! att5dants1 :]e a /]ile in/rum5t c be us$4 ,! nurse %\ld nev] make vag9al exam9ations unless an em]g5cy exi/s1 & !n only :5 h] in/ruction has be5 ?or\gh & h] exp]i5ce great4 ,e exam9ation is a possible s\rce ( dang]1 no matt] h[ c>efully ! h&s & pati5t are prep>$4 ,! nurse is n to *ange ! pads )\t wa%+ h] h&s1 & %e mu/ wa% h] h&s always aft] *ang+ ! pads1 be=e dress+ ! navel ( ! *ild4 ,! navel or eyes ( ! *ild may be infect$ easily by ! h&s ( nurse1 doctor1 or pati5t4 ,! brea/s ( ! "m may be infect$ by ! h&s ( nurse1 doctor or pati5t4 ,! vulva & vag9a ( ! pu]p]al woman is highly susceptible to infection f ! h&s ( nurse1 doctor or pati5t4 ,rule4--,all temp]atures aris+ 9 ! pu]p]ium are due to infection1 unless satisfactorily expla9$ by f9d+ ! s\rce4 ,! possibility ( a slightly elevat$ temp]ature f insignificant causes may be kept 9 m9d1 b su* temp]atures are transi5t & yield quickly to appropriate treatm5t or to none at all4 ,pu]p]al infection is mo/ apt to appe> dur+ ! fir/ week ( ! ly+-9 p]iod1 & x g5]ally develops ab\t ! ?ird or f\r? day po/ p>tum4 ,if ! symptoms come on lat] ?an ?is1 !re is always a hope t ! infection has tak5 its orig9 9 some?+ else ?an ! labor4 ,symptoms4--,9 mild cases1 a rapid pulse1 heada*e1 & a temp]ature ( #aja or #ajb ,f4 may be ! only symptoms4 ,sev]e cases beg9 ) a *ill1 foll[$ by a m>k$ rise ( temp]ature4 ,! temp]ature is always irregul> & g5]ally remitt5t4 ,! pulse rises to #abj or #acj beats a m9ute1 heada*e & pro/ration appe>1 occasionally associat$ ) vomit+4 ,! fl[ ( lo*ia may be ei!r increas$ or dim9i%$ & ei!r (f5sive or free f odor4 ,f\l-smell+ lo*ia is a sign ( putrefaction b n necess>ily ( sepsis4 ,at ! same "t !re is "s t5d]ness 9 ! l[] "p ( ! abdom51 usually mo/ m>k$ at ! sides ( ! ut]us4 ,! ut]us is l>g] ?an x %\ld be1 & n h>d1 b d\ghy & s5sitive to t\*4 ,! involution is arre/$1 except 9 cases ( pure septicmia4 ,?is is an important reason = ! daily obs]vation & record+ ( ! regul> desc5t ( ! organ4 ,! disease runs a v>iable & m or less prolong$ c\rse & ! prognosis is always d\btful until ! ev5t4 ,signs ( grave import are3 repeat$ *ills1 insomnia1 pulse above #abj1 p]si/5t vomit+ & meteorism1 ) dry1 br[n tongue4 ,treatm5t4--,mild cases )\t *ill :5 ! ut]us is l>ge & ! lo*ia sometimes (f5sive1 are usually saprmic4 ,free ca?>sis1 ergot 9 full doses1 & a half-sitt+ position to aid dra9age w cause ! symptoms to subside 9 two or ?ree days4 ,9 ! sev]e type1 ! treatm5t is mo/ly a case = c>eful nurs+4 ,! m en]getically ! doctor acts1 ! m liable he is to d h>m4 ,! pati5t ne$s all h] /r5g? to fight ! disease1 & %\ld n be requir$ to fight ! consequ5ces ( injudici\s int]f]5ce4 ,!re is /ill "s discussion ab\t ! advisability ( assur+ oneself t ! ut]us conta9s no remnants ( ! labor4 ,"s feel t ?is %\ld be det]m9$ by curett+ ! ut]us ) f+] or in/rum5t & foll[+ ! op]ation ) an intraut]9e d\*e4 ,if ?is is ! view ( ! att5d+ man1 ! nurse mu/ aid1 = ! responsibility is 8 & n h]s4 ,on ! o!r h&1 ! weight ( au?ority at pres5t seems incl9$ to ! view t any remnant ( ! labor w dra9 out naturally or be expell$ by ergotdriv5 contractions )\t ! necessity ( op5+ up new raw surfaces by int]f]5ce & ?us spread+ ! infection4 ,! ma9 idea is to promote dra9age 9 e way possible4 ,no curette1 no d\*e1 no ut]9e pack+4 ,nev]!less1 ! vulva may be cleans$ & ! vag9a c>efully retract$ & by appropriate means a culture obta9$ f ! ut]us4 ,if ?is %[s /reptococci1 all local treatm5t is to be ab&on$ at once4 ,9 g5]al1 ! food mu/ be fluid1 & z nutriti\s z possible4 ,?is means milk1 beef & mutton bro?s1 oy/] /ew1 etc4 ,! n\ri%m5t mu/ be pu%$ artfully & +5i\sly4 ,alcohol is n indicat$4 ,! b[els are kept op54 ,normal sal9e1 drop me?od1 by rectum1 w promote diuresis1 sk9 action1 & supply ! body ) ! mu* ne$$ fluid4 ,sub9volution is controll$ by ergot 9 full doses4 ,! room mu/ be light & z _m w9d[s op5$ z ! wea!r w p]mit4 ,frequ5t *ange ( po/ure1 f side to side1 f dorsal to prone & especially to ! half-sitt+ position1 w give ! pati5t com=t & prev5t decubitus 7b$ sores74 ,! daily ba? ) an alcohol rub1 keeps ! sk9 9 good condition & eases ! m9d4 ,! *ild %\ld be tak5 f ! brea/1 because ! milk is poor 9 quality & quantity & x may be infecti\s4 ,besides1 ! "m ne$s all h] /r5g?4 ,nature usually solves ! problem by dry+ up ! milk4 ,all pads soil$ by ! pati5t %\ld be collect$ 9 pap] bags or roll$ 9 newspap]s & burn$4 ,%eets1 t[els1 & pill[ slips mu/ be boil$ 9 ! h\se & n s5t to ! laundry4 ,!y %\ld be soak$ = half a day 9 a #b p] c5t solution ( lysol be=e be+ wa%$1 & expos$ to ! hot sun = a day or s aft]w>d1 if possible4 ,no com=ts %\ld be us$ on ! b$1 & ! blankets mu/ be left susp5d$ 9 ! room :5 x is fumigat$ at ! conclusion ( ! case4 ,all di%es & ut5sils c be boil$4 ,pl5ty ( air & sun%9e are ess5tial = ! cure ( ! pati5t & to prev5t ! spread ( ! disease4 ,! nurse mu/ use e precaution to avoid c>ry+ ! infection to h]self or o!rs4 ,rubb] gloves %\ld be worn :ile *ang+ ! dress+4 ,x is bett] to h ! *ild c>$ = by ano!r nurse4 ,! nurse mu/ get h] re/ & "s ex]cise out ( doors e day4 ,x rejuv5ates h] & reacts to inspire ! pati5t4 ,:5 %e leaves ! case ! nurse %\ld boil h] l95 & wa% h] hair ) soapsuds & hot wat]1 & ba! frequ5tly4 ,milk ,leg4--,?is is an infection *>act]iz$ by swell+ ( "o1 or r>ely1 bo?1 limbs1 f ! foot to ! gro94 ,! leg is :ite f ! edema1 & z ! condition is associat$ ) fev] & s9ce ! milk dim9i%es or disappe>s ab\t ! same "t1 x 0 ?\ght 9 =m] days t ! milk w5t to ! leg4 ,! cause ( ! swell+ is a phlebitis ( ! ext]nal iliac or femoral ve9 :i* becomes ?rombos$ or s fill$ ) clots t ! return circulation is imp$$4 ,symptoms4--,! attack is signaliz$ by a rise ( temp]ature to #ajb to #ajd ,f4 ,!re is heada*e1 pa9 9 ! affect$ limb1 & g5]al pro/ration4 ,x is a true sepsis4 ,! disease appe>s usually 9 ! latt] "p ( ! second week ( pu]p]ium1 :5 ! pati5t has begun to congratulate h]self t all dang] is ov]4 ,9 _m cases ! doctor has yield$ to importunity & let ! pati5t get up be=e involution 0 suffici5tly advanc$ & ! pati5t w report t %e got up too e>ly4 ,! limb mu/ be immobiliz$ & kept w>m4 ,! immobility %\ld be ma9ta9$ = at lea/ t5 days aft] ! fev] has subsid$ & ! pa9 gone4 ,! convalesc5ce may be protract$ ov] weeks & mon?s4 ,b$ sores may complicate a long convalesc5ce4 ,ba?+ ) alcohol or alcohol & alum1 & ! frequ5t *ange ( ! pati5t's position w usually prev5t !m4 ,rubb] r+s & %eet+ %\ld n be us$ if x c be avoid$4 ,o9tm5ts conta9+ z9c are ( great value 9 ! cure ( ?is affection4 ,phlebitis1 9 m9or degree or 9 localiz$ sections1 may occur 9 ! ve9s ( ! leg & ! site ( ! invasion w be outl9$ z r$ l9es or z irregul> nodules4 ,"s fev] may att5d ! condition4 ,re/ ( ! affect$ memb]1 ) ice bags = ! pa91 con/itute ! treatm5t4 ,b$ sores mu/ be gu>d$ aga9/4 ,sudd5 dea? 9 ! pu]p]ium is a %ock+ disa/]4 ,rapid dea? may foll[ ! complications ( labor accompani$ by hmorrhage1 su* z plac5ta prvia1 rupture ( ! ut]us1 etc42 b dea? may be sudd51 )\t w>n+1 f pulmon>y embolism1 acute myoc>ditis1 fatty deg5]ation ( ! he>t1 or ! entrance ( air into ! ut]9e ve9s4 ,?is may happ5 sev]al days aft] labor 9 a woman :o is pass+ ?r\gh a convalesc5ce app>5tly normal 9 e respect4 ,su* an ev5t is probably due to a ?rombus :i* may =m 9 any ( ! ve9s ( ! body1 b m frequ5tly 9 ^? ( ! pelvis & legs4 ,9 ! latt] x may be recogniz$ by h>d lumps t =m some:]e along ! c\rse ( ! ve9s 9 consequ5ce ( a phlebitis4 ,!re is always ! m5ace t "s fragm5t ( ?is mass1 :i* is m]ely a h>d clot ( blood1 may become deta*$ & float (f 9 ! circulation to o!r p>ts ( ! body1 su* z he>t1 lungs1 or bra9 7embolism71 & by int]f]5ce ) ^? /ructures1 produce p>alysis or in/ant dea?4 ,:5 a ?rombus is diagnos$1 ! affect$ "p mu/ be kept z quiet z possible4 ,no massage is p]missible4 ,t9cture ( iod9e or #bj p] c5t i*?yol may be appli$4 ,! woman %\ld rema9 quiet = at lea/ t5 days aft] ! app>5t disappe>ance ( ! symptoms4 ,,*apt] ,,xviii ,,! ,,c>e ,,( ,,! ,,*ild ,hi!rto ! "m & ! complications & *anges peculi> to h] condition h be5 selectively consid]$1 to ! neglect ( ! *ild2 b ! labor be+ ov]1 & ! nurse hav+ assur$ h]self t ! ut]us is h>d1 t !re is no hmorrhage1 & t ! "m is re/+1 n[ turns to ! *ild ly+ 9 its blanket4 ,a hot wat] bag1 c>efully te/$1 %\ld lie at its feet wrapp$ 9 t[el+ or napk9s4 ,! eyes h already receiv$ ! ,cr$ treatm5t1 #a p] c5t solution ( silv] nitrate or possibly a #ae p] c5t solution ( argyrol = prev5tion ( oph?almia1 & a ?or\gh cleans+ comes next4 ,9 a w>m room1 away f drafts1 ! nurse takes ! *ild 9 h] lap1 or on a table1 ) a blanket und]nea?4 ,%e fir/ ano9ts ! *ild all ov]1 ei!r ) b5zoat$ l>d1 liquid albol5e1 /]ile vasel9e1 or olive oil4 ,?is s(t5s ! v]nix caseosa t cov]s ! *ild & aids its removal4 ,! sk9 is wip$ c>efully ) cotton or a s(t clo?1 pay+ p>ticul> att5tion to ! folds ( ! gro91 ! arm pits1 & ! g5itals4 ,! no/rils are g5tly wip$ out ) applicators dipp$ 9 oil4 ,! *ild mu/ be cov]$ z mu* z possible dur+ ! op]ation & ! "w f9i%$ quickly4 ,! :ole p]iod %\ld n exce$ tw5ty m9utes4 ,dur+ ! cleans+ process ! nurse %\ld look closely = anomalies or anatomical imp]fections1 l an imp]=ate anus or ure?ra1 sup]num]>y digits1 etc4 ,! ,ba?4--,daily1 until ! cord comes (f1 ! baby is spong$ ) oil$ pl$gets1 foll[$ by a spray ba?1 or a spong+ ) lukew>m wat] & ca/ile soap4 ,! *ild mu/ n be put into a full ba? tub on acc\nt ( dang] ( infect+ ! umbilicus4 ,! ba? wat] 9 a tub or bas9 quickly becomes fill$ ) bact]ia f ! surface ( ! *ild's body & may be convey$ q easily to a raw w\nd4 ,illu/ration3 ,fig4 #aab4--,rubb] ba? tub4 ,all dis*>ges mu/ be wip$ away1 & ! buttocks cleans$ ) oil4 ,if ! sk9 becomes irritat$ by ur9e or o!rwise1 ! *ild %\ld be well cov]$ ) talcum p[d]1 especially 9 ! folds ( ! gro9 & 9 ! g5ital crease4 ,all infants are b5efit$ by a little mild massage aft] ! ba?4 ,if o!r babies are h&l$1 a *ild ) infect$ eyes1 or sk9 eruptions1 mu/ be qu>ant9$ & c>$ = sep>ately by a special nurse4 ,! color ( ! sk9 %\ld be p9k1 *ang+ "u manipulation to r$4 ,if !re is mucus 9 ! m\?1 x may be wip$ out ) an applicator1 if 9 ! ?roat1 ! *ild may be held up by ! feet & ! head drawn back = a few m9utes s t gravity w aid ! dis*>ge ( ! ob/ruction4 ,aft] cleans+ ! sk91 ! nurse /]ilizes h] h&s & dresses ! cord4 ,! gauze :i* 0 tempor>ily wrapp$ ar\nd ! /ump is remov$1 ! cord & adjac5t sk9 wa%$ ) alcohol & dri$4 ,! /ump is p[d]$ above & at ! sides ) a mixture ( equal p>ts ( boric acid & subnitrate ( bismu?1 & !n wrapp$ 9 gauze4 ,! b& is put on1 ! temp]ature tak51 & ! baby dress$4 ,"s physicians pref] to h ! cord dress$ 9 #ie p] c5t alcohol1 :i* is frequ5tly r5ew$4 ,! normal sep>ation ( ! cord takes place ?r\gh a k9d ( dry gangr5e1 :i* %\ld be favor$ by dry r ?an wet dress+s4 ,! #ie p] c5t alcohol does n rema9 at #ie p] c5t aft] x is expos$ to air1 h5ce x does n absorb moi/ure f ! cord z absolute alcohol w\ld4 ,h[ev]1 ! att5d+ man is responsible1 & 8 ord]s mu/ be foll[$4 ,! ,umbilicus4--,! cord may be sev]$ z soon z ! *ild has cri$ lu/ily or ! cessation ( pulsation may be await$1 9 ei!r case ! *ild secures a little m blood1 :i* gives him a bett] />t 9 life4 ,two tapes are ti$ ab\t ! cord1 "o close to ! sk9 m>g9 ( ! *ild & ! cord is cut betwe5 !m4 ,a k9d ( mummification or dry gangr5e normally develops & ! /ump falls (f1 z a rule1 ab\t ! fif? day1 leav+ a moi/1 granulat+ area1 :i* =ms ! umbilicus4 ,a metal clamp may be us$ 9 place ( a tape to compress ! cord4 ,! advantage ( ! clamp is t on acc\nt ( its great] wid? & rigidity x does n cut ?r\gh ! cord :5 appli$4 ,fur!rmore1 x c be made & kept m ne>ly aseptic4 ,x does n soak up ! juices f ! cord & =m a culture m$ium = g]ms4 ,x c be remov$ on second day4 ,! cord usually comes (f a day or s soon] ?an :5 ! tape is us$4 ,illu/ration3 ,fig4 #aac4--,! ,pettit cord clamp4 ,! c>e ( ! cord is extremely important1 z _m infections c be transmitt$ ?r\gh x to ! *ild4 ,at ea* dress+ ! cord is inspect$1 & :e!r x is dry or moi/1 (f5sive or inodor\s1 %\ld be not$4 ,^! facts1 ) ! fall+ (f ( ! cord1 are put d[n on ! hi/ory %eet z !y are obs]v$4 ,! b9d]1 aft] ea* removal1 is n p9n$1 b sew$ on4 ,! sew+ %\ld beg9 bel[ & g up 9 ord] to h ! tightness l[ d[n4 ,eyes4--,aft] ! fir/ in/illation ( silv] nitrate solution1 a reaction appe>s ) r$ness1 swell+1 & dis*>ge1 :i* passes (f )\t treatm5t 9 two or ?ree days4 ,dur+ ! ba?1 c>e mu/ be us$ n to get any?+ into ! eyes nor any?+ f ! eyes or nose ^u ! navel4 ,at ea* dress+ ! nurse %\ld irrigate ! edges ( ! lids g5tly ) boric acid solution4 ,if ! eyes become r$1 swoll51 & h a purul5t dis*>ge aft] ! second day1 ! case is possibly oph?almia & !y mu/ be wat*$ ) extreme vigilance4 ,a sme> %\ld be tak5 = ! microscope & prep>ations made = en]getic treatm5t4 ,! foll[+ summ>y may be ( s]vice 9 memoriz+ ! r\t9e ( nurs]y proc$ure4 ,nurs]y ,rules #a4 ,keep temp]ature ( nurs]y #fh to #gb ,f4 #b4 ,dur+ ba?1 keep temp]ature ( nurs]y #ge to #hj ,f4 #c4 ,temp]ature ( ba? wat] #ih to #ii ,f4 #d4 ,nev] use a diap] t has n be5 laund]$4 #e4 ,tie case numb] on *ild's arm be=e leav+ deliv]y room4 #f4 ,wat* cord = hmorrhage4 #g4 ,record temp]ature1 /ools & ur9e4 #h4 ,give wat] freely betwe5 fe$+s4 #i4 ,put to brea/ twelve h\rs aft] bir?1 & e ?ree h\rs !reaft] until ! *ild beg9s to ga91 !n "o & possibly 787 two night fe$+s may be omitt$4 #aj4 ,*ange b9d] daily4 #aa4 ,oil ba? fir/1 !n %[] ba? on subsequ5t days4 #ab4 ,dress cord ) alcohol #ie p] c5t1 dry & apply bismu? subnitrate & boric acid p[d] 7equal p>ts7 into crevices b5ea? clamp or tape & "u edges ( ! cru/4 ,*ange dress+ daily4 ,cord %\ld fall (f fif? day4 ,report failure to d s4 #ac4 ,clamp may be remov$ on second day4 ,r\t9e = ! ,*ild4-- #a4 ,temp]ature4 #b4 ,undress4 #c4 ,weight4 #d4 ,%[] ba?4 #e4 ,dress cord--record condition4 #f4 ,b9d] daily until dis*>g$4 #g4 ,diap] & dress4 #h4 ,sponge eyes ) boric solution4 #i4 ,cleanse no/rils ) albol5e4 #aj4 ,bru% hair4 #aa4 ,dr9k ( w>m wat]4 #ab4 ,obs]ve case numb] daily4 ,clo?+4--7,see ,infant's ,outfit1 p4 #aja47 ,! clo?+ mu/ be light1 loose1 w>m1 & n irritat+ to ! sk94 ,! outside g>m5t %\ld h w+ sleeves :i* p]mit free motion ( ! h&s1 b d n p]mit !m to rea* ! eyes4 ,! b& ( pla9 out+ flannel %\ld always be worn = ! fir/ few weeks4 ,birds-eye l95 makes ! be/ diap]s on acc\nt ( its sup]ior absorb5t qualities4 ,! feet mu/ be kept w>m by /ock+s1 & artificial heat1 if necess>y4 ,on hot days mu* ( ! clo?+ may be remov$ & ! %irt1 b& & diap] may be all t are ne$$4 ,! c>e ( ! %irts & b&s is "p ( ! daily duty ( ! nurse4 ,!y mu/ be wa%$ daily1 ei!r by ! nurse h]self or "u h] sup]vision1 z !y are easily injur$4 ,aft] wa%+1 9 s(t wat]1 if possible1 & ) wool soap1 !y mu/ be dri$ on a /ret*]4 ,diap]s mu/ be put directly into cold wat]4 ,fces may be bru%$ (f ) a :isk broom1 & ! napk9 r9s$1 boil$ & aga9 r9s$4 ,no diap] %\ld be us$ a second "t until ?is has be5 done4 ,no blu+ may be us$ on ! diap]s & ! soap mu/ be mild1 o!rwise *af+ & int]trigo w foll[4 ,! infant's toilet basket mu/ conta93 #d s(t ba? t[els4 #a p\nd ( absorb5t cotton4 #a doz5 wa% clo?s ( s(t mat]ial4 #a small hair bru%4 #a pair nail scissors4 ,talcum p[d]4 ,ba? !rmomet]4 ,hot wat] bottle4 ,albol5e4 ,ca/ile soap4 #h oz4 boric acid solution4 #h oz4 b5zoat$ l>d4 ,pap] bags = wa/e4 ,pit*]s & bas9s4 ,illu/ration3 ,fig4 #aad4--;,a1 /&>d brea/ pump2 ,b1 /&>d nurs+ bottle2 ,c1 ! brea/ tray2 ,d1 ! ,wansbr\gh lead nipple %ield2 ,e1 ! ,brophy nipple = h>elip & cleft palate4 ,weight4--,! weigh+ ( ! *ild %\ld prec$e1 = conv5i5ce1 ! fir/ clean+ ( ! sk9 & ! daily ba?4 ,! *ild is ei!r put on ! scale nak$ or weigh$ 9 a blanket1 & ! weight ( ! blanket1 asc]ta9$ be=e or aft]1 is subtract$4 ,! daily weight record is j z important z ! temp]ature4 ,a scale t regi/]s ounces & fractions !re( mu/ be us$1 & ! *ild %\ld be gu>d$ f fall+ dur+ ! p]=mance4 ,usually ! *ild loses f eight ounces to a p\nd ! fir/ week1 b x %\ld ga9 back to its bir? weight1 by ! end ( ! second week4 ,if ! *ild does n ga91 x may be due to lack ( milk f ! brea/1 & ! weight may be tak5 be=e & aft] fe$+ to v]ify or refute ! suspicion4 ,! m\? %\ld be inspect$ ea* morn+1 b n cleans$ ) ! boric acid solution unless def9itely indicat$4 ,spots or any unusual appe>ance %\ld be report$4 ,! ,g5itals4--,! vulva ( ! female infant usually requires b little c>e besides cleanl9ess4 ,!re is sometimes a :iti% dis*>ge :i* disappe>s spontane\sly 9 a few days4 ,x is a dra9age ( v]nix1 smegma & epi!lium f ! vag9a & labia4 ,) a male1 ! prepuce mu/ be inspect$ :5 ! *ild is ab\t a week old4 ,if x is long & ! orifice small1 circumcision may be sugge/$4 ,"u any circum/ances1 ! =esk9 mu/ be retract$1 ! adhesions brok5 up1 & ! smegma remov$4 ,?is mu/ be repeat$ daily until ! adhesions d n recur4 ,! maneuv] %\ld be done ! fir/ few times by ! physician1 = fe> ( a p>aphimosis4 ,sleep 9 ! newborn is normally q deep & almo/ cont9u\s1 probably tw5ty-two h\rs a day1 = ! fir/ week4 ,! r fa/ respiration ( ! *ild1 ev5 :5 sleep+1 is no cause = al>m4 ,a heal?y infant brea!s ab\t tw5ty-five times a m9ute4 ,! *ild %\ld n be rock$1 c>ri$ ab\t1 exhibit$1 or h&l$ m ?an necess>y4 ,x %\ld n sleep ) ! "m1 le/ x become too hot or too cold1 be ov]:elm$ by b$d+1 or ov]laid by ! "m4 ,b[els4--,! fir/ /ools are black & t>-l1--?is is meconium4 ,x disappe>s by ! end ( ! fir/ week4 ,! pres5ce or abs5ce & ! "* ( an evacuation1 z well z ! numb] 9 tw5ty-f\r h\rs1 mu/ be daily record$4 ,= a brea/-f$ *ild1 !re %\ld be ?ree or f\r a day1 = ! fir/ t5 days & ! numb] %\ld gradually dim9i% until a r\t9e ( two a day is obta9$4 ,! diap] ( bird's-eye l95 %\ld be l>ge & ?ick2 two may be us$ if requir$4 ,!y %\ld be c>efully wa%$ aft] soil+4 ,blu+ mu/ n be us$1 because :]e ?is sub/ance comes 9 contact ) ! sk91 irritation foll[s4 ,wean+ %\ld be br\ght ab\t by ! gradual sub/itution ( o!r foods1 some:]e betwe5 ! six? & twelf? mon?s4 ,ur9ation %\ld be copi\s4 ,! *ild is always wet1 & frequ5t *anges are necess>y to keep ! sk9 f gett+ raw & sore4 ,bo? b[els & bladd] %\ld be empti$ )9 ! fir/ tw5ty-f\r h\rs4 ,failure to d s %\ld be report$1 z an imp]=ate anus or ure?ra may exi/4 ,frequ5tly a piece ( ice :ittl$ out l a lead p5cil & pass$ into ! rectum w /imulate ur9ation4 ,ca!t]ization is practically nev] necess>y4 ,! *ild may g ?ree days )\t injury1 b ! condition ( ! bladd] above ! pubes mu/ be att5tively wat*$ & its degree ( fullness appreciat$ by p]cussion4 ,nurs+4--,! *ild %\ld be put to ! brea/ twelve h\rs aft] bir? & e ?ree h\rs !reaft]--no m & no less )\t def9ite reasons4 ,if ! *ild is /rong & vigor\s1 only "o fe$+ may be giv5 at night1 & ev5 ?is may be omitt$ 9 "s cases :]e ! *ild gets an abundance ( food4 ,six or sev5 fe$+s a day are en\gh4 ,! *ild %\ld /ay at ! brea/ f fifte5 to tw5ty m9utes1 dep5d+ on its activity & ! rapidity ( ! milk fl[1 & !n be remov$4 ,x mu/ n be p]mitt$ to sleep at ! brea/4 ,illu/ration3 ,fig4 #aae4--,prop] position ( "m :ile nurs+ *ild4 7,witk[ski47 ,c>e mu/ be us$ t ! *ild gets ! nipple ov] ! tongue & n "u x4 ,_m infants h to be taught to nurse4 ,?is may be due to a lack ( /rong animal in/9ct 9 _m cases4 ,!re may be an abundance ( milk & a good nipple1 b ! *ild w n le>n to nurse )\t a va/ exp5diture ( "t1 pati5ce1 & en]gy on ! "p ( ! nurse4 ,squeez+ a little milk into ! m\? or fill+ a nipple %ield ) milk w sometimes aid 9 educat+ ! infant1 or ev5 />t+ ! supply ) a pump1 z _m nurses d1 is advantage\s4 ,c]ta9 drugs1 l ca/or oil & turp5t9e1 tak5 by ! "m1 may affect ! ta/e ( ! milk1 & be reason en\gh = ! refusal ( ! *ild to take hold4 ,o!r drugs l m]cury1 ars5ic1 potassium iodide1 & alcohol may g ov] 9 ! milk to ! nurs+ *ild4 ,if ! *ild is weak or premature1 ! milk mu/ be pump$ f ! brea/ & f$ to x until /r5g? comes4 ,! difficulty ab\t ?is is ! bad habit acquir$1 b !re is no way to avoid x4 ,a *ild %\ld get at ea* fe$+ half an ounce ( milk to ea* p\nd ( weight4 ,! capacity ( ! /oma* at v>i\s mon?s is giv5 by ,hir/ z1 fir/ week1 oz42 second week1 #b oz42 ?ird & f\r? week1 #c oz42 ?ird mon?1 #e oz42 fif? mon?1 #i oz42 n9? mon?1 #ab oz4 ,holt says t ! capacity at bir? %\ld be "o ounce1 & increase at ! rate ( an ounce a mon? up to ! six? mon?4 ,z hung] /imulates ! ga/ric & saliv>y gl&s1 s ! sight ( ! *ild ar\ses "s emotional c5t] 9 ! "m1 :i* />ts ! milk1 & ! m\? ( ! *ild provides an additional /imulus ( great p[]4 ,ab\t f\rte5 ounces is secret$ by ! sev5? day1 & aft] ! second mon? ! daily av]age rises to ?ree or f\r p9ts4 ,milk secretion is favor$ by drugs & foods t raise ! blood pressure & dim9i%$ by sub/ances t l[] ! blood pressure4 ,!re may be too little milk 9 ! brea/s1 & if s1 ! *ild w lose weight daily2 also ! *ild w wak5 be=e nurs+ "t1 fret1 refuse wat]1 b gre$ily seize ! nipple if x is pres5t$4 ,x w cont9ue to nurse long aft] its "t is up & cl+ & cry :5 remov$4 ,! brea/ itself may seem flabby & loose1 & no milk1 or v little1 c be press$ f ! nipple4 ,normally1 ! brea/s feel full & t5se1 bo? to pati5t & nurse1 j be=e fe$+ "t4 ,! real te/1 h[ev]1 is 9 tak+ ! weight ( ! *ild be=e & aft] fe$+4 ,:]e ! milk is insuffici5t1 ! scales w n v>y1 & aft] a few repetitions ! nurse c be c]ta94 ,an infant %\ld be h&l$ z little z possible aft] fe$+ le/ ! milk be vomit$4 ,illu/ration3 ,fig4 #aaf4--,prop] me?od ( tak+ rectal temp]ature4 ,temp]ature ( ! newborn *ild v>ies f #ih to #ii ,f4 ,x %\ld be tak5 morn+ & ev5+1 or (t5]1 if complications are suspect$4 ,! temp]ature (t5 goes up on ! ?ird or f\r? day1 & may /ay up = sev]al days4 ,?is ph5om5on is call$ by "s a />vation or inanition fev]4 ,! temp]ature may g to #ajf ,f4 & ! rise is g5]ally associat$ ) a hot dry sk91 dry lips1 weak pulse1 re/lessness1 & great pro/ration4 ,! fontanelle may be sunk5 & ! cry s9ks to a fretful1 feeble :9e4 ,x is important t ! fev] %\ld be recogniz$ & treat$1 s9ce ! condition may t]m9ate fatally4 ,! etiology is obscure4 ,! fev] %\ld n be conf\nd$ ) pyog5ic infections1 = ^! r>ely beg9 be=e ! fif? or six? day4 ,! treatm5t is simple4 ,give wat] regul>ly e two h\rs by m\?1 & rectal flu%+s ( normal sal9e twice daily4 ,! symptoms rapidly subside if ! *ild is prop]ly n\ri%$4 ,h5ce ! brea/s %\ld be inspect$ & ! *ild weigh$ be=e & aft] fe$+4 ,usually ! milk is poor & scanty4 ,if ! temp]ature does n soon fall ! *ild %\ld be put to ano!r brea/ or artificial fe$+s %\ld be in/itut$4 ,,*apt] ,,xix ,,! ,,c>e ,,( ,,! ,,*ild 7,cont'd7 ,he>t4--,! he>t tones :ile 9 ! ut]us may v>y betwe5 #ach & #aej p] m9ute1 b :5 high] ?an #afj or l[] ?an #abj1 dang] is ne>4 ,aft] deliv]y1 ! he>t runs f #acj to #adj1 & dur+ ! fir/ ye> gradually drops to #aae1 approximately4 ,asphyxia neonatorum is a condition1 :]e91 = "s reason1 ! *ild fails to brea! aft] deliv]y4 ,out ( e "o hundr$ babies born1 ab\t six w die at bir? or )9 ! fir/ t5 days1 & a l>ge proportion ( !m f asphyxia 9 "s =m4 ,asphyxia is f\nd 9 two degrees3 asphyxia livida 7blue7 & asphyxia pallida 7:ite74 ,9 ! fir/1 ! *ild is deeply cyanos$4 ,?is may be due to pat5cy ( ! =am5 ovale1 & yet x is a "q :e!r ?is cyanosis is n really a normal process4 ,! *ild does n und]take its fir/ respiration because x ne$s oxyg51 b because an excess ( c>bon dioxide 7,,co#b7 9 ! blood acts z a /imulant to ! respiratory c5t]1 :i* is ?us set to "w1 ) ! result t oxyg5 is tak5 94 ,! blue asphyxias1 !re=e1 may be only ! fir/ /ep 9 ! physiological process ( respiration4 ,9 ^! cases1 ! pulse is /rong & full1 & ! muscul> tone is pres]v$1 z well z ! s5sibility ( ! sk94 ,9 ! second degree1 ! condition is q diff]5t4 ,! face is pale ?\gh ! lips may be blue4 ,! he>t is irregul> & _m times c n be felt4 ,! cord is s(t & flaccid1 ) its vessels ne>ly empty4 ,! reflexes are aboli%$1 ! sk9 & extremities cold4 ,a few convulsive ef=ts at brea?+ may occur1 b !y soon cease4 ,treatm5t is direct$ fir/1 to op5+ up ! respiratory passage4 ,! *ild is held up by ! feet s ! mucus1 blood1 & fluids may escape f ! m\?4 ,compression ( ! *e/ wall w aid4 ,! tra*eal ca!t] is pass$ into ! tra*ea & ! mucus suck$ out4 ,next1 ! sk9 reflexes are /imulat$ by slapp+ ! back1 or buttocks1 & by bl[+ ^u ! face4 ,illu/ration3 ,fig4 #aag4--,me?od ( pass+ ! tra*eal ca!t]4 7,hamm]s*lag47 ,! *ild at ?is "t may be dipp$ 9 a tub ( v w>m wat]1 7#aab ,f47 & ! *e/ & face spr9kl$ ) cold wat]4 ,mean:ile1 ,laborde's me?od ( traction on ! tongue may be tri$4 ,! tongue is seiz$ ) tongue =ceps 7h&k]*ief1 napk91 or piece ( gauze w d7 & rhy?mically drawn out & releas$ ab\t t5 times p] m9ute4 ,fur!r1 ! ,byrd me?od ( artificial respiration mu/ be employ$4 ,illu/ration3 ,fig4 #aah4--;,byrd's me?od ( artificial respiration4 ,ext5sion & inspiration4 7,edg>47 ,illu/ration3 ,fig4 #aai4--;,byrd's me?od ( artificial respiration4 ,beg9n+ flexion & expiration4 7,edg>47 ,! back ( ! *ild is held 9 ! "r h&1 s t ! ?umb & =ef+] grasp ! neck loosely1 ! o!r h& holds ! buttocks f beh9d & ! body is sl[ly b firmly flex$ betwe5 !m until ! ?orax is compress$1 !n ! grip is relax$ & ! body widely ext5d$ to all[ ! air to ru% into ! lungs4 ,?is maneuv] %\ld be repeat$ ab\t twelve times p] m9ute4 ,:5 ! he>t ceases to beat1 ! *ild is dead & respiration c n be e/abli%$4 ,illu/ration3 ,fig4 #abj4--;,byrd's me?od ( artificial respiration4 ,flexion & compression4 ,note position ( *ild :i* aids ! escape ( fluids f ! m\? & nose4 7,edg>47 ,! same treatm5t is employ$ = ! apnic *ild born 9 ,cs>ean section & ! oligopnic *ild born "u 8,twilight ,sleep40 ,! me?od call$ 8,s*ultze ,sw++0 is n to be recomm5d$ g5]ally1 on acc\nt ( ! *ill+ :i* is s necess>ily associat$ ) ! exposure4 ,! nurse %\ld le>n to practice all ^! me?ods ( resuscitation4 ,aft] ! *ild brea!s x mu/ be wat*$ c>efully = at lea/ =ty-eight h\rs1 le/ ! symptoms recur1 & ! *ild die4 ,asphyxia ,neonatorum-- 7a7 ,livida--body conge/$--blue4 7b7 ,pallida--body limp & pale4 ,rememb] possibility ( pat5t =am5 ovale4 ,etiology4-- ,too long compression ( cord4 ,dim9i%$ irritability ( m$ulla4 ,compression ( bra9 dur+ extraction4 ,%ock dur+ v]sion4 ,aspiration ( mucus4 ,treatm5t4-- ,hold *ild by heels ) head pull$ back to /raight5 ! tra*ea1 & wipe out m\? & ph>ynx g5tly ) cotton w\nd ab\t ! f+]4 ,/imulate sk9 reflexes by slapp+ & bl[+4 ,tra*eal ca!t]1 artificial respiration 7,byrd7 #h to #aj times p] m9ute4 ,hot & cold ba? alt]nately--rub ! sk9 & knead ! muscles4 ,laborde's me?od ( traction on tongue #aj to #ab times p] m9ute4 ,cont9ue ef=ts s long z he>t beats4 ,convulsions occur n infrequ5tly dur+ ! fir/ few weeks4 ,!y may develop z a result ( injuries to ! head dur+ labor1 or z a symptom ( toxmia4 ,!y may arise f con/ipation1 f inte/9al indige/ion ) curds1 f fev] or f hmophila4 ,m5+itis & o!r infections are associat$ ) ?is symptom1 & occasionally atelectasis4 ,!y may also be ! manife/ation ( a spasmophilic dia!sis4 ,! attack may beg9 ) su* premonitory ph5om5a z re/lessness1 muscul> twit*+1 & />+ ( ! eyes1 b m frequ5tly ! onset is )\t w>n+4 ,! facial muscles are contract$1 ! neck ?r[n back1 ! h&s cl5*$ & ! extremities spasmodically cramp$ & tight5$4 ,!re may be fro?+ ( ! m\? & consci\sness is lo/4 ,respiration is feeble1 %all[ & irregul>4 ,! face is discolor$ & /range rattl+ noises come f ! l>ynx4 ,! b[els & bladd] may move involunt>ily4 ,! attack la/s f a few m9utes to half an h\r4 ,convulsions are n s]i\s 9 all cases4 ,! responsibility = ! managem5t ( ?is complication usually falls ^u ! nurse4 ,%e calls ! doctor1 to be sure1 b ! attacks 9 _m cases h ceas$ & ! *ild may ei!r be dead or out ( dang] ( a recurr5ce be=e 8 arrival4 ,! hot ba? is a univ]sal rem$y & q z effici5t z any?+4 ,! temp]ature %\ld be tak5 & ! b[els wa%$ out4 ,if ! fontanelles are t5se :5 ! doctor arrives1 a sp9al puncture may relieve ! t5sion4 ,a specim5 ( ! blood is drawn ?r\gh a ne$le & s5t to ! laboratory = exam9ation4 ,! cause mu/ be f\nd1 if possible1 & remov$4 ,a *ange ( food may be all t is requir$4 ,cod-liv] oil may be add$ to ! diet 9 dram doses1 ?ree times a day1 & milk curds1 susp5d$ 9 arr[-root wat]4 ,= ! acute condition1 *loral hydrate is be/4 ,x is giv5 by rectum1 "o or two gra9s 9 an ounce ( wat]1 & may be repeat$ 9 f\r h\rs4 ,atelectasis is ! "n giv5 to a failure ( ! lungs :olly to exp& dur+ ! ef=ts at respiration4 ,! *ild may live = weeks ) ?is affection1 b usually x expires )9 a few days4 ,9 ?is condition1 ! *ild has a con/ant t5d5cy to get blue1 ! color deep5s1 & dea? may occur 9 spite ( e aid4 ,! treatm5t may be p]man5tly efficaci\s 9 "s cases1 b 9 mo/1 ! revival is only tempor>y4 ,aga91 ! *ild may live1 b 9 a weakly1 decl9+ /ate = days1 until dea? comes4 ,aside f ! physical signs ( dullness elicit$ by p]cussion ov] ! lungs1 ! mo/ conspicu\s symptoms are ! cyanosis & ! int]mitt5t b p]si/5t :9+ cry4 ,illu/ration3 ,fig4 #aba4--,me?od ( giv+ gavage4 7,grulee47 ,treatm5t is by daily or h\rly spank+1 & by alt]nat+ hot & cold ba?s1 by spr9kl+ ) cold wat] or by massage to /imulate ! sk9 reflexes4 ,! treatm5t may h to be repeat$ e tw5ty or ?irty m9utes1 & ! e>li] x is in/itut$1 ! m p]si/5tly c>ri$ out1 ! m *ance ( success4 ,ex]cise is j z important to ! infant z to ! adult4 ,! kick+ ( ! legs1 mov+ ( ! arms & lu/y cry are all means ( /imulat+ ! circulation1 ! muscul> developm5t1 & ! expansion ( ! lungs4 ,! position %\ld be *ang$ occasionally 9 ! crib f back to side & f side to back4 ,also ! *ild's legs & back %\ld be rubb$ & massag$ until ! sk9 is r$ e "t ! ba? is giv54 ,flu%+s4--,! *ild is laid across ! lap1 or on a table4 ,a rubb] %eet is s arrang$ t ! dis*>ge w dra9 away4 ,a s(t rubb] ca!t]1 ,no4 #ah-bj ,fr5* scale1 is atta*$ to a small funnel4 ,! app>atus is boil$ & fill$ ) normal sal9e1 or /]ile wat]1 at a temp]ature ( #he ,f4 to #ie ,f4 ,half a p9t to a p9t may be requir$4 ,! ca!t] is oil$ & pass$ into ! rectum j beyond ! sph9ct]4 ,x mu/ n g f>!r4 ,! funnel is !n rais$ & ! fluid fl[s into ! b[el4 ,?is flu%+ mu/ n be confus$ ) ! adm9i/ration ( an enema = con/ipation1 = :i*1 h[ev]1 x is (t5 an excell5t sub/itute4 ,gavage is =c$ fe$+ by means ( a tube4 ,a s(t rubb] ca!t] or tube1 ab\t ,no4 #g1 ,fr5* scale1 is lubricat$ ) albol5e1 vasel9e or sweet oil4 ,! upp] end is connect$ ) a small tube or glass funnel hold+ two or ?ree ounces4 ,! *ild is laid ^u its back 9 ! arms ( "m or nurse1 ! baby's arms are held & ! head /eadi$4 ,9 case ( diph!ria or sc>let fev]1 ! tube may be pass$ ?r\gh ! nose & d[n ! ph>ynx & into ! sophagus five or six in*es1 or ev5 into ! /oma*4 ,x is m conv5i5t & easi] :5 possible to pass x ?r\gh ! m\? directly into ! /oma*4 ,! food is !n p\r$ into ! funnel1 :i*1 by elevation1 empties itself into ! /oma*4 ,if regurgitat$1 m food mu/ be giv54 ,:5 )drawn1 ! tube %\ld be p9*$ to prev5t leakage into ! tra*ea4 ,illu/ration3 ,fig4 #abb4--;,app>atus = gavage or lavage4 7,tuley47 ,! great dang] 9 ^! cases is ! ease ( ov]fe$+4 ,lavage or wa%+ ( ! /oma* may be p]=m$ 9 ! same way ) ! above app>atus1 :5 necess>y4 ,z soon z ! /oma* is fill$1 ! tube is l[]$ & ! fluid siphon$ out4 ,,*apt] ,,xx ,,! ,,c>e ,,( ,,! ,,*ild 7,cont'd7 ,tongue-tie is n met ) s frequ5tly z 9 ! old days4 ,if ! *ild c suck & nurses en]getically1 ?is complication c be exclud$4 ,x may1 h[ev]1 occur4 ,9 su* a case1 ! frnum is unusually broad & seems to ext5d cle> to ! tip ( ! tongue1 :i* app>5tly is b\nd d[n to ! gum & to ! floor ( ! m\?4 ,! ?9 membrane may be snipp$ ) ! scissors close to ! tongue & !n torn back ) ! f+]4 ,h>elip & cleft palate int]f]e ) nurs+ & require cont9ual att5tion to keep mucus out ( ! ?roat4 ,brophy has a rubb] flap plac$ ov] ! nipple ( ! bottle 9 su* a way z to occlude ! split tissue & ?us enables ! *ild to get n\ri%m5t4 ,^! babies mu/ be f$ sy/ematically by gavage1 if necess>y1 until ! de=mity c be repair$4 ,h]nia at ! navel is a common complication ( infancy4 ,x is n due to cry+1 to improp] ty+ ( ! cord1 nor to neglect by ! nurse1 z frequ5tly *>g$4 ,x is a cong5ital fault1 :]e9 ! cord op5+ does n close1 & 9 "t1 cry+ & /ra9+ w drive ! inte/9es out ( ! ap]ture l a p\*4 ,! defect is reveal$ by ! bulg+ outw>d ( ! navel :5 ! *ild cries4 ,ord9>ily ! brea* w close ( its own accord4 ,illu/ration3 ,fig4 #abc4--;,cleft palate nipple4 7,brophy47 ,illu/ration3 ,fig4 #abd4--,! device = fe$+ ! *ild ) cleft palate at ! brea/4 7,brophy47 ,treatm5t consi/s 9 fold+ up ! sk9 ( ! abdom5 s t ! groove w be ov] ! umbilicus & include x4 ,!n adhesive tape is put on to hold x4 ,! surfaces ( sk9 ?us com+ 9 contact %\ld be du/$ ) rice p[d] or /e>ate ( z9c4 ,ano!r me?od ( treatm5t is to place a wood5 button =m1 r\nd side d[n1 on cotton1 ov] ! op5+1 & b9d x on ) a z9c adhesive pla/]4 ,! dress+ %\ld be *ang$ at lea/ once a week4 ,+u9al h]nia usually heals spontane\sly also1 b a truss may be requir$4 ,illu/ration3 ,fig4 #abe4--;,device = assi/+ ! cleft palate *ild to nurse4 7,brophy47 ,hmorrhage ( ! newborn is ei!r accid5tal or spontane\s4 ,accid5tal hmorrhage may arise f an imp]fectly ti$ cord1 or x may be an effusion1 ?r\gh compression or rupture1 into any ( ! int]nal organs1 su* z ! bra91 lungs1 or abdom9al visc]a4 ,^! latt] conditions r>ely give rise to symptoms1 & are seldom recogniz$ dur+ life4 ,!re is no treatm5t4 ,! intracranial hmorrhages are op5 to diagnosis ?r\gh ! pres5ce ( pressure symptoms1 b ^!1 too1 are imp]vi\s to treatm5t unless a vessel c be ti$1 l ! middle m5+eal art]y4 ,spontane\s hmorrhages may develop dur+ ! fir/ few days ( life f sepsis1 syphilis1 ,buhl's disease1 hmophilia1 & true melna neonatorum4 ,! fragile condition ( ! blood vessels1 ! great *anges 9 ! blood & circulation aft] bir?1 z well z con/itutional dyscrasias1 are etiological factors ( importance4 ,all ! causes are n z yet kn[n4 ,illu/ration3 ,fig4 #abf4--,me?od ( /rapp+ an umbilical h]nia4 ,! blood may come f ! umbilicus1 ! muc\s membranes ( ! eyes1 nose1 m\?1 /oma* & inte/9es4 ,x may be effus$ into ! tissues b5ea? ! sk91 or into any organ ( ! body4 ,m>k$ noseble$ is g5]ally syphilitic 9 orig94 ,z a rule hmorrhages 9 ! newborn are mo/ common 9 males1 & /rongly h]$it>y4 ,! t5d5cy to ble$ la/s only a few weeks1 & if recov]y takes place1 x is p]man5t4 ,9 "s cases1 h[ev]1 :]e hmorrhage has develop$ 9 ! bra91 clots may =m 9 important c5t]s1 & ! *ild be p]man5tly p>alyz$ 9 spee*1 sight1 he>+1 or intellig5ce4 ,symptoms ( hmorrhage beg9 dur+ ! fir/ week & almo/ nev] aft] ! twelf? day4 ,! appe>ance ( blood is ! e>lie/ & ! mo/ def9ite sign4 ,! ble$+ may come fir/ f ! umbilicus1 or f ! /oma*1 or f ! inte/9es 7melna neonatorum74 ,! am\nt lo/ is small1 b ! ooz+ is cont9u\s4 ,! temp]ature may be high or subnormal1 & may or may n be due to ! hmorrhage4 ,! sk9 is pale1 ! pulse feeble1 pro/ration m>k$1 & weight is lo/ rapidly4 ,convulsions are n infrequ5t4 ,! diagnosis ( ! condition is simple4 ,x is only necess>y to be c]ta9 t ! blood is really effus$1 & n a tempor>y or accid5tal ev5t su* z ! regurgitation ( swall[$ blood4 ,black t>ry /ools w %[ blood if plac$ 9 wat]4 ,! prognosis is n good4 ,ab\t two-?irds ( ^! babies die4 ,! treatm5t is to /op ! hmorrhage by ligature1 suture1 or compression if possible & to alt] ! "* ( ! blood by add+ to its fibr9 cont5t4 ,?is is br\ght ab\t1 if at all1 by ! adm9i/ration ( coagulose1 coagul5 ciba1 or by transfusion f an adult--pref]ably ! fa!r4 ,p>alysis ( ! face 7,bell's p>alysis7 may foll[ ! use ( =ceps4 ,! prognosis is favorable4 ,p>alysis ( ! n]ve 9 ! neck 7musculospiral7 is sometimes kn[n z ,erb's p>alysis4 ,x happ5s 9 consequ5ce ( difficult bree* deliv]ies or ( v]tex labors :5 mu* =ce is requir$ to extract ! %\ld]s4 ,! deltoid1 biceps1 & o!r muscles are affect$ s t ! arm c n be rais$4 ,! failure to raise "o arm w be ! symptom t w attract ! att5tion ( ! nurse4 ,"s cases recov] 9 a mon? or s1 ei!r spontane\sly or by ! aid ( electricity4 ,if n1 ! injur$ n]ve mu/ be cut d[n ^u & its cont9uity re/or$4 ,oph?almia neonatorum is an infection ( ! eyes ( ! newborn by ! gonococcus4 ,! infection occurs z ! *ild passes ?r\gh ! vag9a or vulva1 or :5 an unclean f+] is put into ! eye4 ,! reaction is viol5t4 ,! dis*>ge at fir/ is ?91 !n ?ick1 pus4 ,if untreat$1 ! eyesight may be lo/ by ulc]ation4 ,9 ! asylums tw5ty-five p] c5t ( ! inmates are bl9d f ?is infection2 & z late z #ahif1 sev5 p] c5t ( ! bl9dness 9 ! /ate ( ,new ,york c\ld be trac$ to ?is avoidable disease4 ,! prev5tive treatm5t consi/s 9 ! frequ5t d\*+ ( ! vag9a be=e labor ) potassium p]manganate solution #a3ejjj1 or *9osol #a3ajjj4 ,aft] labor1 a drop or s1 ( #a p] c5t solution ( nitrate ( silv] is dropp$ into ea* eye & n neutraliz$4 ,aft] ! infection has occurr$1 ic$ compresses are appli$ to ! eye1 night & day1 & a solution ( argyrol #ae to #bj p] c5t in/ill$ into ! out] corn]1 twice a day4 ,9 female infants ) oph?almia1 ! vag9a mu/ be wat*$ = dis*>ge :i* does n fail to appe> 9 mo/ cases4 ,argyrol 7#bj p] c5t7 %\ld be inject$ ) a m$ic9e dropp] & left to dra9 out spontane\sly4 ,all dress+s us$ ab\t ! *ild %\ld be de/roy$1 & ! nurse %\ld use ! mo/ scrupul\s cleanl9ess & c>e ( h] own p]son4 ,sep>ation ( ! cord may be delay$ 9 puny babies & 9 cases :]e ! cord is l>ge & ?ick4 ,"s ( ^! cases are d\btless due to a pat5cy or fi/ul\s condition ( ! ura*us4 ,usually ! sep>ation may be ha/5$ by t\*+ ! con/rictur$ "p ) silv] nitrate4 ,or1 if ! cord does n sep>ate be=e ! second week1 x may be desirable to cut (f ! hang+ fragm5t & t\* ! base ) silv] nitrate or du/ ) alum p[d]4 ,granulations may protrude l a mulb]ry f ! /ump ( ! navel 78pr\d fle%074 ,^! are t\*$ ) nitrate ( silv] /ick4 ,m5/ruation may appe> occasionally f ! vulva ( ! newborn4 ,x is really a hmorrhage1 a m5/rual fl[1 :i* is associat$ ) ut]9e activity1 b r>ely significant4 ,!re is no treatm5t4 ,x disappe>s spontane\sly4 ,! brea/s ( ! newborn may fill ) milk & become indurat$ & t5d]4 ,no?+ %\ld be done to !m4 ,let !m alone & ! swell+ w subside 9 a few days & ! milk 78wit*es' milk07 disappe>4 ,ict]us may develop f ! ?ird to ! six? day4 ,! *ild becomes yell[ & /ays yell[ = a week1 :5 ! color gradually leaves4 ,x is ?\ght to be due to ! lib]ation ( "s embryonic residue 9 ! ftus1 b no?+ is kn[n c]ta9ly4 ,= ! simple =m no treatm5t is requir$4 ,recov]y is prompt & unev5tful4 ,h[ev]1 jaundice is associat$ ) o!r conditions t prove fatal1 h5ce e ict]us %\ld be wat*$ c>efully until x disappe>s4 ,*ild's ,nails4--,! nails are frequ5tly r\gh & ragg$ at ends & sides4 ,!y %\ld be smoo?ly trimm$ le/ !y become infect$ at ! junction ) ! sk9 & give rise to p>ony*ia4 ,if infection does occur1 ! sk9 & fle% may be pu%$ back ) a /]ile applicator1 & ! po9t t\*$ ) p]oxide ( hydrog54 ,a syphilitic hi/ory may be trac$ 9 "s ( ! babies4 ,?ru% is a =m ( contagi\s sor5ess1 *>act]iz$ by :ite flakes or pat*es on ! muc\s membrane ( m\? or anus :i* look l milk1 b c n be wip$ (f4 ,x is due to a vegetable fungus & occurs mo/ frequ5tly among anmic or poorly n\ri%$ babies or ^? suff]+ f h>elip4 ,x is associat$ ) symptoms ( indige/ion4 ,x may always be prev5t$ by keep+ ! m\? & nipples clean1 z direct$ on ano!r page1 & by keep+ ! bottles & rubb] nipples 9 a solution ( boric acid :5 n 9 use4 ,:5 ! disease appe>s1 ! m\? mu/ be swabb$ ?ree or f\r times a day ) an applicator soak$ 9 saturat$ solution ( boric acid4 ,?is is curative4 ,aph? or /omatitis is ! "n giv5 to :iti% vesicles1 foll[$ by sup]ficial ulc]s t occur ^u ! inside ( m\? & lips ( ! infant4 ,x is r>e 9 ! newborn *ild4 ,boric acid solution is cleans+1 & /ick alum1 frequ5tly appli$1 w effect a cure4 ,:eals1 urtic>ia or 8/oma* spots0 appe> z g5]ally di/ribut$ small spots ab\t ! size ( a split pea1 ) a :ite c5t] & a r$ p]iph]y4 ,!y appe> ab\t ! ?ird day & la/ tw5ty-f\r h\rs4 ,!y may be mi/ak5 = insect bites & !y may1 or may n1 be accompani$ by temp]ature1 :i* is probably only a co9cid5ce4 ,! :eals disappe> spontane\sly )\t treatm5t4 ,b$n>'s disease is *>act]iz$ by ! appe>ance ( two ulc]s on ! h>d palate1 "o on ei!r side & j above ! spot :]e ! la/ too? w erupt4 ,x is mo/ liable to occur 9 sickly infants & suppos$ly arises f ! abrad+ ( ! muc\s membrane by a rubb] nipple or ?r\gh ! r\gh cleans+ ( ! m\?4 ,x is v resi/ant to treatm5t4 ,! *ild mu/ be put 9 good condition by att5tion to ! n\ri%m5t & ! spots t\*$ ) t9cture ( iod9e on an applicator4 ,! exudative dia!sis is indicat$ sup]ficially by a def9itely b\nd$ r$ pat* on ei!r *eek1 :i* is n reliev$1 or only tempor>ily1 by ! common o9tm5ts & p[d]s4 ,! "m says ! 8face is *app$10 or t ! baby has a 8milk eczema40 ,o!rwise ! sk9 is pale4 ,^! *ildr5 are frequ5tly fat1 b ! tissue is flabby4 ,! ur9e is sometimes ammoniacal4 ,!re is no m>k$ di/urbance ( temp]ature4 ,fretfulness & con/ipation are ! pr9cipal symptoms4 ,! condition is due to too mu* fat 9 ! food4 ,a skimm$-milk diet is be/ = a "t4 ,! fat c be add$ gradually until ! limit ( tol]ance is f\nd4 ,if *alky masses appe> 9 ! /ools1 ! fat mu/ be r$uc$ aga94 ,occasionally ! *ild mu/ be tak5 (f ! milk entirely1 & a s\p or gruel diet sub/itut$4 ,= local application1 ! foll[+ =mula is sometimes b5eficial3 7,grulee47 ,naph?al5e i ,/>* iv ,z9c /e>ate iv ,m4 ,sig4 ,apply frequ5tly4 ,! 8cradle cap0 is a frequ5t sign ( ! exudative dia!sis 9 its mild] /ages4 ,! t]m is appli$ to a yell[i%-gray pat* ov] ! l>ge fontanelle4 ,! "m calls x 8dirt10 :i* %e f9ds h>d to remove & x always recurs4 ,! mass is compos$ ( dry scales1 :i* gradually *ange into an eczema4 ,vasel9e or sweet oil left on ov] night makes ! removal ( ! scales q easy ! next day4 ,if a raw surface is left1 z9c o9tm5t %\ld be appli$4 ,! diet mu/ be *ang$ z previ\sly describ$4 ,ery!ma1 especially ( ! diap] region1 is sometimes a manife/ation ( cong5ital syphilis4 ,x is usually limit$ to ! inn] side ( ! ?ighs1 ! p]9eum1 scrotum or vulva1 & buttocks4 ,x mu/ be associat$ ) o!r & m *>act]i/ic signs1 h[ev]1 su* z snuffles1 ca*exia1 etc41 be=e x becomes diagno/ic ( syphilis4 ,mo/ ery!mas ( ?is area are due to irritation f moi/ or soil$ diap]s1 b o!r factors may be important4 ,blu+ 9 ! diap]1 ga/ro9te/9al tr\bles1 & circulatory di/urbances are contribut+ causes4 ,! local treatm5t is ! same z = int]trigo4 ,if ! *ild is syphilitic1 sy/emic measures mu/ be in/itut$4 ,int]trigo1 or *af+1 is a =m ( eczema due to moi/ure1 blu+ 9 ! diap]s or uncleanl9ess4 ,! *ild %\ld be clean$ ) oil in/ead ( wat]1 & well p[d]$ ) /e>ate ( z9c or z9c o9tm5t may be us$4 ,talcum p[d] :i* conta9s boric acid is contra9dicat$4 ,pemphigus neonatorum is an eruption ( bli/]s or blebs :i* seem to foll[ infection f ! mat]nal passages or to be communicat$ by o!r babies :o h ! disease4 ,f ?ree to f\rte5 days aft] bir?1 ! blebs develop on ! abdom51 neck or ?ighs1 & %[ a t5d5cy to spread to o!r p>ts ( ! body4 ,! vesicles v>y 9 size f "o-f\r? ( an in* to two in*es 9 diamet]1 & conta9 a s]\s1 purul5t1 or bloody fluid4 ,o!r signs ( g5]al sepsis may appe>4 ,9 diagnosis c>e mu/ be us$ to exclude syphilis1 :i* also exhibits blebs1 b usually on ! soles ( ! feet or ! palms ( ! h&s4 ,besides1 a nonsyphilitic *ild is g5]ally bett] n\ri%$4 ,! prognosis is unfavorable if ! *ild is weakly1 if ! blebs spread rapidly ov] a l>ge area1 or if ! infection attacks ! umbilicus4 ,treatm5t4--,a rigid qu>ant9e mu/ be en=c$4 ,9 ! hospital no new cases c be admitt$4 ,! alim5tation mu/ be increas$1 ! bli/]s evacuat$1 & ! surfaces clean$ & cov]$ ) a #be p] c5t o9tm5t ( i*?yol1 or an o9tm5t ( ammoniat$ m]cury #b p] c5t4 ,/rophulus1 r$ gum1 or mili>ia rubra are names appli$ to an inflammation ( ! sweat gl&s :5 _! secretion is reta9$4 ,x is a 8sweat ra%0 *>act]iz$ by an eruption ( scatt]$ r$ papules or small vesicles :i* commonly appe> on ! *eeks or neck ( "y infants1 or :]e sk9 surfaces come 9 contact4 ,x is due to excessive clo?+ or heat4 ,x is really a prickly heat4 ,! treatm5t consi/s 9 ! removal ( ! cause1 & a g5]\s use ( /e>ate ( z9c p[d] or rice p[d]4 ,,*apt] ,,xxi ,,! ,,c>e ,,( ,,! ,,*ild 7,cont'd7 ,con/ipation 9 ! newborn may come f _m causes4 ,! am\nt ( food may be s inadequate t no residue is left1 & ! b[els move only once 9 =ty-eight h\rs4 ,ov]-/imulation ( ! b[el by ca/or oil or colonic flu%+s 9 ! e>ly weeks ( life to correct colic may dim9i% its s5sitiv5ess & produce atonic con/ipation4 ,9 ! artificially f$ infant too mu* fat 9 ! food is a v common cause ( ! tr\ble4 ,treatm5t4--,correct ! am\nt ( fat 9 ! milk4 ,if ! *ild is brea/-f$1 ! "m's diet %\ld be non-nitrog5\s & vegetables %\ld prepond]ate4 ,drugs %\ld n be giv5 until all else has be5 tri$4 ,glut5 suppositories w furni% a mild irritation to ! rectum4 ,orange juice & prune juice may be giv51 or ,mell9's food or oatmeal wat] add$ to ! milk4 ,milk ( magnesia to #a teaspoonful1 or ,husb&'s magnesia1 9 same dosage1 may be giv5 daily4 ,s5na is also efficaci\s4 ,di>rha is g5]ally significant ( an error 9 diet :i* is usually a pla9 indige/ion1 ?\gh !re may be too mu* sug> 9 ! food4 ,! /ools are m frequ5t & always s(t] ?an usual1 possibly fluid4 ,di>rha means increas$ inte/9al action due to irritation f some?+4 ,x may be due to indige/ion1 to ! pres5ce ( h>d curds1 to acidosis1 or x may accompany almo/ any disease ( infancy z a symptom m]ely4 ,! odor is due to gases =m$ 9 ! canal by bact]ial action4 ,!re is b little odor 9 f]m5tation1 b mu* 9 putrefaction4 ,mucus appe>s ei!r z balls or /r+s4 ,! balls come f ! small inte/9e1 /r+s f colon4 ,blood indicates ulc]ation at "s po9t 9 ! b[el1 or an erosion j above ! sph9ct]4 ,illu/ration3 ,fig4 #abg4--,prop] position = introduction ( a suppository4 7,grulee47 ,fatty curds may be ei!r :ite1 granul>1 s&-l masses1 or small1 s(t1 & yell[4 ,! prote9 curd is l>ge & smoo?1 or :ite & bean-l4 ,bo? occur only :5 ! artificially f$ infant is giv5 raw milk 7,br5neman74 ,if ! milk is boil$ = two m9utes ^! masses w n =m4 ,! cause mu/ be det]m9$4 ,! frequ5t /ools1 h[ev]1 are exhau/+1 & may h to be *eck$ ) opiates or me*anical a/r+5ts4 ,:5 due to indige/ion1 all food by m\? may be /opp$ = two or ?ree days & only b>ley wat] adm9i/]$4 ,9 a brea/-f$ *ild1 di>rha is sometimes *eck$ by dilut+ ! milk ) a little b>ley wat]1 giv5 j be=e nurs+4 ,) ^! infants1 n mu* *ange 9 ! sug> cont5t c be made by alt]ations ( ! mat]nal diet1 b :]e artificial food is us$1 ! am\nt ( sug> is easily r$uc$ to a satisfactory degree4 ,colic is a cramp-l pa9 ( ! b[els4 ,previ\s to ! attack ! *ild is re/less1 expels "s gas1 & has ! 8colic smile10 :i* leads ! "m to believe ! *ild is q well4 ,:5 ! attack comes on1 ! ?ighs are flex$ on ! abdom51 & ! legs on ! ?ighs4 ,! *ild has a %>p cry1 t is ne>ly cont9u\s1 b 9 "s way relat$ to ! nurs+ p]iod1 = ! attack comes on a few m9utes1 & sometimes an h\r1 aft] tak+ ! brea/4 ,! belly is rigid1 ! arms wave aimlessly4 ,di>rha may be pres5t1 & ! movem5ts are accompani$ by mu* flatus4 ,di/5tion is ne>ly always pres5t4 ,:5 ! belly is tapp$ x gives a drum-l note & ! *ild bel*es gas1 sometimes accompani$ by milk1 :i* seems to relieve4 ,treatm5t4--,colonic flu%+s to relieve ! b[el ( irritat+ curds4 ,! *ild may be laid face d[n ) a bag ( hot wat] "u ! belly4 ,mixture ( asaftida gtts4 xx to xl1 or :iskey & hot wat] %\ld be giv5 = ! attack1 foll[$ lat] by a full dose ( ca/or oil4 ,! diet %\ld be rigor\sly inve/igat$4 ,vomit+ may or may n be s]i\s4 ,! *ild may nurse too rapidly or too mu*1 & ! ov]-di/5d$ /oma* simply empties itself4 ,_m infants 8spit up0 _! excess ( milk1 & ?us relieve !mselves4 ,?is is a simple regurgitation1 usually ( un*ang$ milk1 ?\gh x may be acid f admixture ) ! ga/ric juice4 ,vomit+1 9 a brea/-f$ *ild1 may come dur+ an attack ( colic :5 ! eructations ( gas appe>4 ,x may be a symptom ( ga/ro9te/9al intoxication1 ( too mu* fat 9 ! food1 too %ort int]vals betwe5 fe$+s1 or too mu* sug> 9 ! food4 ,projectional vomit+ awak5s suspicion ( a pyloric /5osis or m5+itis1 & mu/ be report$ to ! physician at once4 ,vomit+ :i* occurs )9 tw5ty m9utes aft] fe$+s is n s]i\s ord9>ily1 ev5 ?\gh gas & l>ge curds are expell$1 b all vomit+ lat] ?an ?is1 is significant ( a pa?ology4 ,treatm5t4--,regulation ( ! h\rs ( fe$+ is mo/ important1 & next1 ! "* ( ! food4 ,if ! *ild vomits an h\r or s aft] nurs+1 x may be t ! milk is too ri* 7fat74 ,try a long] int]val1 or give an ounce or s ( c]eal wat] be=e putt+ ! *ild to ! brea/4 ,prematurity exposes ! *ild to ?ree di/9ct dang]s1 :i* arise1 respectively1 f atmosph]e1 food1 & infection4 ,v few *ildr5 born be=e ! sev5? mon? survive4 ,a *ild born at ! eigh? mon?1 or ) a weight ( ?ree p\nds1 or m1 c be sav$ almo/ always4 ,! premature *ild up to ! "t ( bir?1 has be5 protect$ v c>efully aga9/ temp]ature v>iations by ! liquor amnii1 & :5 sudd5ly precipitat$ into a new environm5t1 :i* its vitality b>ely tol]ates1 ! consequ5ces are s]i\s4 ,^! infants h a poor heat production1 & ! natural w>m? ( ! body mu/ be pres]v$4 ,?is is be/ done by incubators1 :i* supply air & moi/ure 9 /able & appropriate am\nts4 ,*ill+ ( ! *ild = ev5 a few mom5ts may be fatal4 ,a room may be fitt$ up to produce ! necess>y conditions ( light1 air1 heat & moi/ure4 ,! *ild1 wrapp$ 9 %eets ( cotton1 except ! face1 is !n cov]$ ) a blanket1 & surr\nd$ by a temp]ature v>y+ f #hh to #ie ,f41 :i* is gradually l[]$ to #hj ,f4 z ! *ild ga9s /r5g?4 ,an occasional :iff ( oxyg51 z prescrib$ = an atelectatic *ild1 is sometimes advantage\s4 ,ba?+4--,premature infants mu/ n be ba!d1 b ! sk9 %\ld be cleans$ ) cotton & w>m sweet oil or albol5e4 ,all unnecess>y h&l+ is to be avoid$4 ,food4--,brea/ milk is ! secret ( success ) ^! cases4 ,s9ce mo/ ( ! infants are too weak to take ! nipple1 ! brea/s mu/ be pump$1 & ! *ild f$ ) spoon or pipette4 ,! int]val betwe5 ! fe$+s dep5ds a little on ! am\nt tak51 b x %\ld n be less ?an "o & "o-half h\rs1 nor m ?an two h\rs4 ,z ! *ild ga9s1 ! int]val may be l5g!n$ to ?ree h\rs4 ,lack ( suffici5t n\ri%m5t is %[n by cyanosis & loss ( weight1 & ov]fe$+1 by vomit+ & di>rha4 ,! *ild mu/ be f$ by h& until /rong en\gh to nurse ! brea/4 ,9 c]ta9 cases ( prematurity1 z well z 9 diseases l pneumonia1 sc>let fev]1 & diph!ria1 ! *ild mu/ be f$ by gavage4 ,nutritive inunctions ( b5zoat$ l>d or cod-liv] oil are also valuable1 n only = ! passive ex]cise suppli$1 b = ! absorption ( a c]ta9 am\nt ( ! ungu5t4 ,m>asmus means wa/+1 b ! t]m is appli$ to infants t /eadily lose weight4 ,! bodies ( infants are s l>gely compos$ ( fluid1 t loss ( weight occurs q easily & rapidly4 ,loss ( weight may be sudd5 or gradual4 ,x comes on rapidly aft] acute di>rha1 ei!r ) or )\t vomit+1 or x may foll[ p]si/5t vomit+ )\t di>rha4 ,malnutrition f defective fe$+ is ! mo/ common cause ( wa/+ 9 infants4 ,?is may be f lack ( suffici5t food or lack ( prop] +r$i5ts1 z well z irregul>ity ( int]vals1 & disease4 ,rickets1 cong5ital /5osis ( ! pylorus1 cong5ital syphilis1 & tub]culosis are all possible factors 9 ! etiology4 ,9 any case1 no treatm5t c be in/itut$ until ^! conditions h be5 confirm$ or exclud$4 ,pyloric /5osis 7! acc\nt foll[s ,grulee7 may be a ?ick5+ ( ! muscul> coat ( ! outlet ( ! /oma* 7pylorus7 or a spasmodic contraction4 ,! condition is mo/ frequ5t 9 males & 9 ! fir/ born4 ,symptoms usually beg9 be=e ! second week4 ,!re is con/ipation ) small ribbon-l /ools1 & ! ur9e is scanty4 ,! mo/ m>k$ sign1 h[ev]1 :5 x is pres5t1 is ! excessive1 uncontrollable vomit+1 :i* ord9>ily occurs fifte5 to ?irty m9utes aft] eat+1 b may be delay$ = sev]al h\rs4 ,! vomit+ may be ( ! common type1 b m frequ5tly x is projectile 9 "*1 l t se5 9 m5+itis4 ,! cont5ts ( ! /oma* are viol5tly expell$1 sometimes sev]al feet4 ,physical exam9ation may reveal ! /oma* bulg+ "u ! ar* ( ! ribs & p]i/altic waves mov+ back & =? across its surface4 ,! pylorus itself may sometimes be felt z a lump or tumor4 ,prognosis4--,ab\t fifty p] c5t die4 ,treatm5t4--,dietetic & surgical4 ,grulee recomm5ds small am\nts ( food1 poor 9 fat1 be giv5 at %ort int]vals4 ,if ?is fails1 op]ation is requir$4 ,pneumonia 9 ! newborn mo/ frequ5tly results f ! aspiration ( mucus out ( ! mat]nal passages z ! *ild is born4 ,?is may happ5 :5 ! cord is compress$1 or at any "t :5 a p>tial asphyxiation impels ! *ild to try to brea!4 ,x may also come on :5 a feeble *ild has be5 *ill$ by a prolong$ fir/ ba?4 ,! disease develops ab\t tw5ty-f\r h\rs aft] bir? 9 a *ild app>5tly well4 ,! temp]ature rises1 respiration becomes rapid1 & c\gh develops4 ,! *ild is fretful1 re/less1 refuses ! nipple1 & gasps = brea?4 ,x may become cyanotic4 ,! prognosis 9 newborn infants is v s]i\s4 ,treatm5t is /imulation4 ,a mu/>d ba? w b5efit :]e ! respiration is rapid & ! *ild blue4 ,t9cture ( digitalis may be adm9i/]$ 9 drop doses e ?ree or f\r h\rs4 ,c>bonate ( ammonia1 gr41 9 mucilage ( acacia1 half a dram1 may be giv5 = c\gh4 ,*ild mu/ be f$ on "m's milk pump$ f brea/4 ,snuffles may be due to improp] clo?+1 to drafts ( air1 or to syphilis4 ,if due to cold1 camphorat$ oil may be rubb$ on ! nose & ! passages kept clean ) an applicator soak$ 9 albol5e4 ,if ?is fails1 a small pellicle ( an/hone may be plac$ 9 ea* no/ril1 & ! *ild laid ^u its back until ! o9tm5t melts & runs back into ! ph>ynx4 ,furuncles 7boils7 may be num]\s4 ,!y come f irritation ( ! sk9 by atmosph]e1 soap1 wat]1 & clo?+1 :]eby infection ent]s4 ,?is is especially liable to occur 9 ! hair4 ,keep ! boils wa%$ ) boric acid solution & op5 !m z soon z ! focus1 or head1 appe>s4 ,phimosis is su* a close adju/m5t ( ! prepuce to ! glans p5is t x c n be retract$4 ,9 "s cases !re may be ob/ruction to ! outfl[ ( ur9e1 b g5]ally a t9y portion ( ! glans c be se54 ,! prepuce may or may n be r$undant4 ,?is condition makes cleanl9ess impossible & balanitis may result4 ,on acc\nt ( ! /ra9+ requir$ to ur9ate1 prolapsus ani1 h]nia1 & hydrocele ( ! cord sometimes develop4 ,symptoms may arise f preputial adhesions1 z well z phimosis4 ,frequ5t or difficult micturition1 nocturnal incont95ce1 priapism1 pruritus1 & ma/urbation may develop out ( ! irritation1 z well z n]v\s manife/ations1 su* z insomnia & night t]rors4 ,! condition %\ld be recogniz$ & correct$ 9 infancy4 ,if ! adhesions are d5se1 an incision c be made d[n ! dorsum ( ! prepuce1 ! tissue =cibly sep>at$ f ! glans1 & ! flaps cut (f4 ,/it*es may be requir$4 ,9 o!r cases circumcision may be necess>y4 ,p>aphimosis4--,:5 a prepuce ) a small orifice is =cibly retract$ ov] ! glans1 x occasionally happ5s t x _c be pull$ =w>d aga94 ,if all[$ to rema9 ?is way1 ! p>ts w swell1 & ! p5is become /rangulat$ z if ) a ligature4 ,! dang] arises f ! /oppage ( ! circulation1 :i* may be foll[$ by ulc]ation & gangr5e4 ,r$uction mu/ be br\ght ab\t by manipulation1 if possible1 b :]e ?is fails1 ! con/rict+ b& mu/ be cut ?r\gh & s$ative applications us$4 ,balanitis is inflammation ( ! prepuce f ! decomposition ( smegma1 :i* collects "u a tight =esk94 ,! condition is quickly reliev$ by cleanl9ess & a few applications ( vasel9e or z9c oxide o9tm5t4 ,circumcision %\ld n be done until ! inflammation has subsid$4 ,circumcision1 ei!r z a physical necessity or z a religi\s rite1 is frequ5tly p]=m$4 ,! nurse prep>es a table ) /]ile l951 a bas9 ) antiseptic solution & sponges1 /]ile t[el1 & /]ile vasel9e1 ) a roll ( gauze b&age an in* wide4 ,! object ( ! op]ation is to remove ! prepuce & leave ! glans expos$4 ,! in/rum5ts ne$$ are a pair ( %>p scissors1 a pair ( dissect+ =ceps1 two pairs ( art]y =ceps1 small1 full curv$ ne$les1 & f9e catgut4 ,! nurse gives ! *ild "s gauze to suck1 :i* has be5 soak$ 9 br&y & sug>-wat]1 br&y "o dram to an ounce ( wat]4 ,!n tak+ h] place at ! *ild's head1 %e flexes ! ?ighs back ^u ! abdom51 & widely sep>ates !m4 ,! field ( op]ation is ?or\ghly wa%$ ) soap & w>m wat]1 ! prepuce is !n retract$ & ! smegma wip$ away4 ,!n ! body & limbs %\ld be cov]$ ) clean l951 except ! p5is1 or a /]ile t[el may be us$ ) a hole 9 x ?r\gh :i* ! p5is is drawn4 ,! r$undant tissue is remov$ & f9e catgut sutures put 94 ,! op]ation be+ complet$1 ! w\nd is cov]$ ) /]ile vasel9e & wrapp$ ) a /]ile gauze b&age1 leav+ ! end ( ! glans expos$4 ,illu/ration3 ,fig4 #abh4--;,hydrocephalus4 7,bumm47 ,! gauze & vasel9e are *ang$ :5ev] saturat$ ) ur9e4 ,heal+ ought to be complete by ! sev5? day4 ,! nurse %\ld exam9e ! dress+ at frequ5t int]vals dur+ ! fir/ tw5ty-f\r h\rs1 s9ce s]i\s hmorrhages may occur f vessels t h n be5 includ$ 9 ! sutures4 ,priapism is a condition ( functional fullness & firmness ( ! p5is t is m ?an ord9>ily con/ant4 ,its importance lies 9 ! fact t x may be a symptom ( sp9al irritation1 balanitis1 worms1 or phimosis4 ,sp9a bifida is ! mo/ common cong5ital de=mity4 ,x is *>act]iz$ by a fluid tumor1 :i* protrudes f an op5+ 9 ! v]tebral column4 ,x may appe> any:]e along ! sp9e1 b is f\nd mo/ frequ5tly 9 ! lumb> or c]vical region4 ,! de=mity is suppos$ly due to an arre/ ( developm5t4 ,x is ne>ly always fatal inside ( two weeks1 ?\gh cases h be5 kn[n to rea* mature ye>s4 ,illu/ration3 ,fig4 #abi4--;,an5cephalus4 7,williams47 ,!re is no treatm5t except protection f injury4 ,hydrocephalus is sometimes1 b n necess>ily1 associat$ ) sp9a bifida4 ,! v5tricles ( ! head are fill$ ) c]ebrosp9al fluid1 & ! fontanelles are widely sep>at$4 ,! cause ( ! anomaly is unkn[n4 ,?is condition may r5d] labor difficult or impossible until ! diagnosis is made & ! skull p]=at$4 ,rupture ( ! ut]us may result f ! futile ef=ts to expel ! *ild4 ,if born alive1 ! *ild ne>ly always dies1 or if x gr[s up1 ! intellig5ce is imp]fect 9 mo/ cases4 ,an5cephalus is a mon/]1 hav+ a body1 b only a "p ( a head4 ,! eyes protrude1 ! tongue may hang f ! m\?1 & ! bra9 is "u-develop$4 ,sudd5 dea? ( infants t are app>5tly heal?y comes ) a %ock to ! physician z well z ! p>5ts1 & 9 "s in/ances1 no plausible reason c be assign$ = x4 ,apoplexy1 pneumonia & /oppage ( ! tra*ea by milk curds may expla9 "s cases4 ,suffocation by ly+ on ! face 9 wet b$d+1 or ov]ly+ by ! "m w acc\nt = o!rs4 ,int]nal hmorrhage into lungs1 pleura1 /oma*1 or bra9 is also kn[n to be causative4 ,,*apt] ,,xxii ,,infant ,,fe$+ ,a well f$ infant is a happy little animal1 :o sleeps approximately tw5ty-two h\rs a day1 & ga9s f f\r to six ounces a week4 ,if prop]ly f$ at ! brea/1 ?is condition is easily obta9$2 b if artificial food is necess>y1 ! res\rces & skill ( ! att5dants may be tri$ to ! utmo/ be=e ! welcome result is br\ght ab\t4 ,! fe$+ ( infants may be consid]$ "u ?ree heads1 7#a7 ! brea/2 7#b7 brea/ & bottle comb9$ 7mix$ fe$+72 & 7#c7 artificial1 :i* is really modifi$ c['s milk4 ,brea/ fe$+ has be5 tak5 up else:]e1 b ! same c>e %\ld be tak5 9 fe$+ f ! bottle z 9 fe$+ f ! brea/1 s f> z conc]ns ! int]vals betwe5 ! fe$+s & ! duration ( ! same4 ,s9ce x takes f "o to two h\rs long] = c['s milk to dige/ ?an x does = "m's milk ! long] int]val ( ?ree or f\r h\rs betwe5 fe$+s is bett] = ! artificially f$ *ild4 ,) su* an int]val !re w be less vomit+1 less colic1 less t5d5cy to ov]fe$1 & a bett] natur$ baby4 ,"o fe$+ %\ld be omitt$ at night1 & if possible1 two4 ,l5g? ( "t = tak+ ! bottle dep5ds some:at on ! *ild1 b x %\ld n exce$ fifte5 m9utes1 z a rule4 ,supplem5tal ,fe$+4--,a "m :o has too little milk may h x supplem5t$ by a modifi$ mixture 9 "o ( two ways4 ,fir/1 ! quantity furni%$ by ! brea/ mu/ be det]m9$ by weigh+ ! infant be=e & aft] fe$+1 & !n ! total am\nt = tw5ty-f\r h\rs c be d$uc$4 ,) ?is in=mation1 x is n difficult = ! doctor to "k h[ mu* c['s milk to prescribe4 ,! supplem5tal fe$+ may be giv5 by alt]nat+ ! bottle & ! brea/1 or by giv+ ! brea/ & foll[+ x imm$iately ) ! bottle4 ,9 ! meantime1 ! "m mu/ be put on tonics ) an abundance ( fluids1 & a g5]\s diet t w raise ! blood pressure1 9 ! hope t ! milk w increase suffici5tly to enable h] to fe$ ! *ild entirely f ! brea/4 ,:5 x becomes necess>y to sub/itute "s o!r food = ! brea/ milk1 x means t ! milk ( "s o!r mammal mu/ be modifi$ = ! purpose4 ,! mo/ conv5i5t & abundant s\rce ( supply is ! c[4 ,:ile 9 _m respects c['s milk is simil> to "m's milk1 x is 9 reality q a diff]5t product4 ,"m's milk is tak51 undilut$1 directly f ! brea/1 :ile c['s milk is giv5 f a bottle1 h\rs aft] milk+1 & n only mu/ x be dilut$1 b c]ta9 +r$i5ts mu/ be add$ to aid its dige/ibility4 ,:5 tak5 into ! /oma* 9 its natural /ate1 "m's milk is a liquid1 :ile "u ! same conditions1 c['s milk =ms a semisolid gelat9\s mass4 ,x is ess5tial t ! milk %\ld be z fre%1 clean1 & free f bact]ia z possible1 & ?is c be approximat$ only 9 c]tifi$ milk4 ,?is milk is requir$ by law to h its con/itu5ts def9itely /&>diz$4 ,?us1 !re mu/ be #d p] c5t ( fat1 #d p] c5t ( prote91 & #d p] c5t ( sug>1 & x mu/ be s free f bact]ia t n m ?an #aj1jjj p] cubic c5timet] c be f\nd4 ,! cattle also are tub]cul9 te/$4 ,! foll[+ comp>ison is f ,holt3 ,"m's ,milk ,c['s ,milk ,sp4 ,gr4 av4 #a4jca av4 #a4jca4 ,fat #d4 ,fat #d4 ,prote9 #a4ej ,prote9 #c4ej ,sug>s #g4 ,sug>s #d4ej ,salts 4#b ,salts 4#ge ,wat] #hg4c ,wat] #hg4c ,reaction ,alkal9e ,reaction ,acid ,bact]ia ,v few ,bact]ia ,_m ,bo? range f #a4jbf to #a4jf4 ,illu/ration3 ,fig4 #acj4--;,elem5ts ( human milk4 7,ed547 ,! fats are sub/antially ! same1 b ! fat ( c['s milk is less easily dige/$ ?an ! fat ( "m's milk4 ,! prote9 ( "m's milk is virtually half lactalbum9 & half case91 :i* is only slightly coagulat$ into s(t floccul5t curds by ! action ( r5n9 & acids1 :ile ! case9 ( c['s milk is ne>ly ?ree times great] 9 am\nt ?an ! lactalbum9 & is coagulat$ into co>se1 t\gh curds4 ,! sug>s 9 bo? cases are lactose 9 solution1 b "m's milk conta9s a mu* high] p]c5tage4 ,c['s milk conta9s ?ree times ! quantity ( salts f\nd 9 human milk1 b ! wat] is ! same 9 bo?4 ,s1 :ile ! two milks seem 9 comp>ison to be mu* alike1 9 reality !y are q diff]5t2 h5ce x is necess>y to modify c['s milk 9 su* a way z to make x n l "m's milk *emically1 b to make x act l "m's milk4 ,x is extremely difficult to br+ up an infant on artificial food1 & inasmu* z half ! infants t die dur+ ! fir/ ye>1 p]i% f inte/9al disord]s1 x is imp]ative t e res\rce %\ld be exhau/$ be=e ! brea/ fe$+s are ab&on$4 ,x is fallaci\s to believe t anyone c fe$ a baby1 or t fe$+ consi/s m]ely 9 try+ "o food aft] ano!r until "o is f\nd to agree4 ,only a compet5t physician %\ld prescribe ! food1 & he %\ld /udy 8 problem & make 8 modifications j z he w\ld alt] 8 m$ic9es = a p>ticul> disease4 ,h[ev]1 x is necess>y = ! nurse to "k h[ to c>ry out ! doctor's ord]s intellig5tly & h[ to report to him ! conditions pres5t4 ,9 prescrib+ = ! *ild1 ! doctor usually has "s def9ite outl9e 9 8 m9d1 su* z ,age & weight4 ,example3 #c mon?s old2 weight #aj p\nds2 #g fe$+s2 #a e #c h\rs4 ,int]val1 ?ree h\rs4 ,am\nt 9 ea* bottle1 f\r ounces4 ,=mula3 ,milk1 #ab oz4 ,dilu5t1 #af oz4 7,c]eal wat] or pla9 wat]47 ,sug>1 oz4 ,fl\r ball1 if any1 oz4 ,boil if ord]$4 ,! infant %\ld n take m ?an two ounces ( milk to a p\nd ( weight 9 ea* tw5ty-f\r h\rs4 ,propriet>ies4--,baby foods are n to be recomm5d$ nor condemn$4 ,!y are plac$ on ! m>ket z sub/itutes = "m's milk ) def9ite in/ructions z to prep>ation4 ,!y are also v exp5sive4 ,!y are n to be condemn$1 because _m ( !m are invaluable :5 us$ 9 connection ) c['s milk4 ,sometimes a *ild w n tol]ate any?+ b malt$ or cond5s$ milk1 or ,ne/le's food1 = example4 ,! malt sug>s1 su* z ,horlick's & ,mell9's1 are easily assimilat$1 fatt5+1 & laxative4 ,all foods 9 ! modification ( milk %\ld be ( ! be/4 ,! /&>d sug>s are ,m]ck's milk sug>1 ,mead's ,dextri ,maltose1 ,nhrzuck]1 cane sug>1 & ,mell9's & ,horlick's foods4 ,rob9son's b>ley fl\r or ,johnson's are ! be/ kn[n4 ,imp]ial granum is a p>tially dextr9iz$ fl\r & corresponds to ! home-made 8fl\r ball40 ,,food ,,prep>ation ,butt]milk ,made f a ,culture4--,br+ two qu>ts ( milk to a boil1 cool to ! temp]ature requir$ = inoculation 7#hj to #ajj ,f41 dep5d+ on ! culture employ$74 ,introduce ! culture1 & all[ x to /& at ! temp]ature ( ! room until a solid clabb] =ms4 ,place on ice1 :ip ) an egg beat] or break up ) a *urn be=e us+4 ,if a fat-free butt]milk is desir$1 use skimm$ in/ead ( :ole milk4 ,!re are _m k9ds ( butt]milk cultures on ! m>ket1 b ,hans5's is consid]$ "o ( ! be/1 because x is n too acid1 besides :i*1 x has a good flavor1 & ! culture c be utiliz$ ov] & ov] = a week or t5 days4 ,9 prep>+ a subsequ5t portion1 x is only necess>y to use two or ?ree ounces ( ! fir/ butt]milk1 :i* may be res]v$ = ! purpose4 ,?is am\nt is introduc$ into ! fre%ly boil$ milk1 in/ead ( ! orig9al p[d]1 & ! prep>ation is cont9u$ exactly z describ$ = ! "m culture4 ,9 e case ! mixture mu/ be plac$ on ice z soon z ! clabb] =ms1 z x becomes too s\r o!rwise4 ,eiweiss ,milk4--,heat "o qu>t ( :ole milk to #ade ,f4 & coagulate ) peps91 r5n91 or *ymog51 :i* is #aj p] c5t r5n94 ,let x /& until clabb]$1 :i* takes ab\t t5 m9utes4 ,p\r into a gauze bag & let x /& until all ! :ey is dra9$ (f4 ,to ! dry curd1 add ounce ( fl\r ball1 & "o p9t ( skimm$ butt]milk1 ! :ole to be rubb$ ?r\gh a v f9e wire me% sieve 7z f9e z a tea-/ra9]1 at lea/71 ?ree sep>ate times2 or1 x may be gr\nd twice ?r\gh a special mill to break up ! curd z m9utely z possible4 ,add a p9t ( wat] & measure4 ,!re %\ld be a qu>t & ?ree or f\r ounces ov]4 ,place ^u a sl[ fire & br+ to a boil :ile /irr+ con/antly4 ,boil two m9utes1 !n cool1 /ra91 measure1 & add wat] to make up = evaporation4 ,%ake well be=e measur+1 z ! curd is heavy & settles to ! bottom4 ,peptoniz$ ,milk4--7,see p4 #cch47 ,:ey4--,to a p9t ( fre%1 w>m c['s milk1 add r5n9 z peps91 or *ymog51 & /ir until mix$4 ,let x /& until coagulation is complete4 ,!n ! curd %\ld be brok5 up ) a =k1 & ! :ey dra9$ (f ?r\gh co>se musl94 ,?is removes ! coagulable prote9s f ! milk4 ,a t5 p] c5t cream c be _h at home by all[+ a qu>t ( milk to /& = six h\rs & !n us+ ! upp] "o-f\r?4 ,:ey-,cream ,mixture4--,make :ey z describ$ & mix ) cream1 9 ! proportion ( :ey #a ounces to cream1 #a dram = ea* fe$+4 ,b>ley ,wat]4 ,no4 #a4--,use "o ounce ( b>ley pe>ls to a qu>t ( wat]4 ,wa% ?or\ghly1 put on a sl[ fire & boil = six h\rs4 ,add wat] to make up = evaporation1 & add a p9* ( salt4 ,/ra9 & cool rapidly4 ,b>ley ,wat]4 ,no4 #b4--,use "o heap+ teaspoonful ( ,rob9son's pat5t b>ley fl\r to ea* p9t ( cold wat]4 ,boil tw5ty m9utes & add wat] to make up = evaporation4 ,add a little salt1 /ra9 & cool rapidly4 ,o!r c]eal wat]s1 l rice & oatmeal1 are made l b>ley wat] ,no4 #a1 & 9 ! same proportion4 ,fl\r ,ball4--,take f\r cups ( ord9>y :eat fl\r & wrap x 9 a piece ( musl91 & tie x tightly4 ,drop ! mass into boil+ wat] & boil six h\rs4 ,!n take x out1 cool x & remove ! out] peel+ ) a %>p knife4 ,break into small pieces1 ! size ( an ,engli% walnut1 & dry ?or\ghly 9 a sl[ ov54 ,pulv]ize 9 a mill or meat-gr9d]1 sift & keep 9 a dry place4 ,milk may be /]iliz$1 pa/euriz$1 or boil$4 ,/]ilization kills bo? g]ms & spores1 b x is n ne>ly s necess>y z x is to h ! "r proportion ( sug> & fats4 ,place 9 an autoclave & keep at a temp]ature ( #afj ,f4 = an h\r4 ,pa/eurization is desirable :5 a good1 clean milk is n atta9able4 ,x kills ! g]ms1 b n ! spores4 ,! process mu/ be c>efully att5d$ to1 or ! milk w s\r m easily4 ,heat a qu>t ( milk to #afj ,f4 = tw5ty m9utes4 ,cool rapidly to #dj ,f4 ,boil+ milk = two m9utes kills all bact]ia1 & r5d]s ! case9 m easy ( dige/ion & prev5ts ! =mation ( curds4 ,,putt+ ,,foods ,,toge!r ,:ole milk conta9s #d p] c5t fat1 & mu/ be ?or\ghly %ak5 be=e x is measur$1 = o!rwise "o *ild w get all ! fat & ano!r all ! skimm$ milk4 ,fat-free1 or skimm$ milk1 conta9s ab\t #j4a p] c5t fat4 ,! cream has be5 remov$ by a siphon or c5trifuge4 ,if unable to get a fat-free milk f a dairy1 ! cream c be remov$ f a qu>t ( :ole milk q easily ) a siphon4 ,sug>s & fl\rs %\ld be weigh$ :5 us$1 = !y v>y greatly 9 volume4 ,9 us+ fl\r ball or imp]ial granum1 ! fl\r mu/ be mix$ ) wat] or c]eal wat]1 to make a smoo? pa/e & br\ght to a boil4 ,if ! milk is to be boil$ also1 add ! milk to ! pa/e & boil all toge!r4 ,cool & /ra94 ,all baby fe$+s %\ld be /ra9$1 z t9y lumps ( food w clog ! rubb] nipple & ! nurse may ?9k ! baby is n tak+ its fe$+s well4 ,! foll[+ is a typical =mula3 ,:ole milk #ae oz4 ,b>ley wat] #ae oz4 ,sug> oz4 #efd ,fl\r ball oz4 ,boil two m9utes4 ,weigh ! sug> & fl\r ball & make a pa/e ) ! b>ley wat]4 ,%ake ! :ole milk1 measure out #ae oz4 9 ! graduate1 & add ! b>ley wat] mixture4 ,boil two m9utes4 ,cool 9 runn+ wat]1 /ra9 bottle & put on ice4 ,! figures at ! side mean t five fe$+s ( six ounces ea* are to be giv5 at f\r-h\r int]vals4 ,x is necess>y to cool all fe$+s z soon z modifi$1 & keep !m on ice = pres]vation until us$4 ,! only accurate way is to make up ! :ole quantity = tw5ty-f\r h\rs1 put into sep>ate bottles ! exact am\nt ( ea* fe$+ & give at ! "t ord]$1 aft] ! bottle has be5 prop]ly w>m$4 ,9 w>m+ ! food1 c>e mu/ be us$ to get x nei!r too hot nor too cold2 #ajj ,f41 or :5 x feels w>m to ! back ( ! h&1 is ab\t "r4 ,! *ild %\ld be held 9 ! arms :ile tak+ ! bottle4 ,a butt]milk fe$+ mu/ n be heat$ to m ?an #ajj ,f4 because x curdles & c n be us$4 ,! rubb] nipples %\ld be wa%$ ?or\ghly aft] use1 boil$ once a day1 & kept 9 boric acid solution4 ,! necess>y articles = home modification ( milk c be obta9$ any:]e4 ,"o set ( ut5sils %\ld be kept = ?is purpose exclusively & boil$ ea* "t be=e ! food is prep>$4 ,a li/ is conv5i5t3 ,a #af ounce glass graduate4 ,"o tablespoon & "o teaspoon may be us$ = measur+ purposes1 if unable to get a satisfactory scale4 #a #b-qu>t alum9um cook+ di%4 #a long-h&l$ alum9um spoon4 #a f9e wire me% /ra9]1 ?irty holes to ! in*4 #a doz5 bottles1 #e ounce size if ! *ild is small1 & #aj ounce if ! *ild takes l>ge fe$+s4 ,! bottles %\ld h wide m\?s1 /raight sides1 & r\nd bottoms1 :i* clean easily4 ,pap] caps or corks t fit tightly %\ld be us$ in/ead ( cotton /opp]s4 ,close rubb] caps are be/1 =1 z ! milk cools1 a vacuum is creat$1 ! rubb] is drawn 9 & ! milk rema9s air-tight until op5$4 ,if infants are kept on a milk diet alone = too long at a "t1 !y d n ?rive s well1 h5ce z e>ly z six mon?s1 o!r ?+s may be giv54 ,at ?is /age1 ! mo/ desirable additions to ! food w\ld be c]eal1 f>9a or cream ( :eat1 orange juice1 vegetable bro?1 toa/ crumbs1 etc4 ,! adm9i/ration ( orange juice %\ld be />t$ :5 ! *ild is only a few weeks old4 ,! quantity ( all ^! foods may be increas$ z ! *ild gets old]1 & by ! end ( a ye> ! diet is broad5$ /ill fur!r4 ,beside a qu>t ( :ole milk1 x may h ?ick5$ s\ps1 vegetables1 su* z caulifl[]1 sp9a*1 c>rots1 cream$ cel]y & a little bak$ potato4 ,fruits1 orange juice1 grape fruit juice1 prune sauce1 apple sauce & scrap$ apple may be giv51 b no bread4 ,9 place ( bread1 use toa/1 ,huntley & ,palm] waf]s & biscuits1 & soda or oatmeal crack]s4 ,sweet dess]ts %\ld be avoid$1 b flavor$ junket or simple cu/>d is unobjectionable4 ,no meats are p]mitt$ until ! *ild is eighte5 mon?s old1 except1 p]haps1 a little crisp bacon1 or a bone to suck4 ,none ( ^! supplem5tal foods %\ld be giv5 betwe5 meals1 b always at ! fe$+ h\r4 ,! above li/ supplies a diet>y s v>i$ t no *ild w tire ( x4 ,9 report+ ! condition ( ! infant to ! physician1 ! foll[+ =m may be us$ to advantage4 ,x is a cle> cut1 concise summ>y ( :at he wi%es to "k4 ,infant's ,daily ,report #a4 ,food3 ,does baby take x all8 ,is he satisfi$8 #b4 ,b[el movem5ts3 ,h[ _m 9 la/ #bd h\rs8 ,:at is ! color8 ,are !y h>d1 s(t1 or wat]y8 ,any odor8 ,any curds8 ,any slime8 ,any blood8 ,any colic8 ,mu* gas8 #c4 ,does baby vomit8 ,:58 ,h[ mu*8 #d4 ,does baby sleep well8 ,is he good natur$8 #e4 ,any fev]8 ,:at is ! weight8 ,significant ,symptoms & ,conditions4--,9 an artificially f$ baby1 ! normal condition ( ! b[els is con/ipation4 ,! /ools are =m$1 alkal9e 9 reaction1 r h>d1 & usually only "o a day4 ,! /ools %\ld h a *>act]i/ic color1 accord+ to ! food tak54 ,?us3 ,sug> or />* w color ! movem5t a d>k br[n1 l vasel9e4 ,too mu* fat gives a pale yell[ /ool1 almo/ :ite1 l putty4 ,eiweiss fe$+s %[ z a pale yell[1 some:at l ! fatty /ools1 b con/ipat$4 ,b>ley wat] gives a br[n liquid /ool4 ,/>vation /ools are ?91 slimy1 d>k br[n or gre54 ,! consi/5cy ( ! movem5ts is also important4 ,too mu* sug> or />* means di>rha1 ) ?91 gre51 acid /ools1 & mu* gas & regurgitation1 or1 sometimes foamy1 muc\s dis*>ges4 ,di>rha may also be due to indige/ion4 ,mucus 9 ! /ools usually signifies inte/9al irritation4 ,con/ipation may exce$ ! normal limits ( ! artificially f$ *ild :5 ! food conta9s too mu* fat4 ,bad odors ( ! /ools result f putrefaction4 ,colic means imp]fect dige/ion ) gas4 ,!re is less colic :5 ! int]vals betwe5 ! fe$+s are l5g!n$4 ,curds are ( two k9ds4 ,! s(t friable ones due to fat1 & ! h>d bean-l masses ( prote94 ,curds occur ) fe$+s ( raw milk only1 & ?\gh associat$ ) symptoms ( indige/ion1 !y signify ov]fe$+4 ,if ! sug> cont5t ( ! food is l[1 ! *ild w ga9 v sl[ly4 ,vomit+ is an important ph5om5on4 ,x may be due to ov]fe$+1 to excess ( sug> or fat 9 ! food1 or to pyloric /5osis4 ,excess ( fat is %[n by vomit+ & regurgitation ( small quantities ( food "o or two h\rs aft] fe$+4 ,x may be associat$ ) con/ipation4 ,if vomit+ occurs imm$iately aft] fe$+1 x is probably due to ! tak+ ( an excessive am\nt1 or to ! too rapid +e/ion ( ! regul> bottle4 ,if ! vomit+ takes place lat] ?an tw5ty m9utes aft] fe$+1 x is probably pa?ological4 ,x may be ! result ( indige/ion1 m5+itis1 or ( pyloric /5osis 7q4 v474 ,= ! fir/ weeks ( life1 "m's milk %\ld be obta9$ at all haz>ds1 if possible1 b if ?is is n to be _h1 ! artificial fe$+s may be />t$4 ,a desirable milk modification = ! fir/ weeks ( life %\ld beg9 ) a l[ food value4 ,= example1 a *ild "o week old weigh+ sev5 p\nds1 %\ld />t on a =mula l ?is3 ,:ole milk #g oz4 ,wat] #g oz4 ,cane sug> oz4 ,boil two m9utes4 ,?is w make sev5 fe$+s ( #b oz4 ea*1 & "o is giv5 e ?ree h\rs ) "o fe$+ omitt$ at night4 ,cane sug> is less liable to produce colic ?an sug> ( milk4 ,lime wat]1 or sodium citrate may be add$1 if ! *ild vomits1 or if o!r indications arise4 ,bo? are alkalies4 ,! /r5g? ( ! mixture1 z well z ! quantity1 mu/ be increas$ z ! *ild gets old] & x is se5 t ! =mula w agree4 ,! p]c5tage ( prote9 is kept d[n by dilution1 ) pla9 or c]eal wat]1 :ile fats 7z cream7 & sug>s are add$ to make up ! /r5g? lo/ by ! dilution4 ,,*apt] ,,xxiii ,,cleanl9ess ,,& ,,/]ilization ,! nurse is call$ to a case on acc\nt ( h] special qualifications1 b also %e %\ld lead h] pati5t 9 all ?+s1 ev5 9 g5tility4 ,x is h] "p to anticipate ! wants ( ! pati5t1 & reg>d x z a reproa* if ! pati5t has to rem9d h] t x is "t = food1 m$ic9e1 ba?1 or = *ild to come to ! brea/4 ,regul>ity1 promptness1 & ?\ghtfulness mu/ be supreme4 ,be on h& :5 ! doctor calls & /ay until he goes4 ,be z *e]ful z ,m>k ,tapley1 h[ev] dre>y ! prospect1 & d n make noises ei!r by ! swi% ( ov]/>*$ skirts1 ! squeak ( %oes1 or ! mov+ ( equipm5t4 ,above all ?+s1 ! nurse mu/ keep h] pati5t's room1 h] pati5t1 & h] own p]son rigor\sly clean4 ,%e %\ld n all[ h] h&s to t\* infecti\s mat]ial )\t protection by rubb] gloves4 ,?is is z necess>y = h] own safety z = ! pati5t & family4 ,h] h&s %\ld be manicur$ frequ5tly1 h] hair %ampoo$ at %ort int]vals1 & h] tee? kept 9 ord]4 ,if ! h&s get h>d1 take a teaspoonful ( sodium c>bonate & "o ( *loride ( lime1 mix 9 ! palm ( ! h& ) en\gh wat] to make a cream1 & rub well into palms & ab\t ! nails4 ,r9se 9 clean wat]4 7,weir47 ,! nurse's dress %\ld be neat1 always m5d$1 & c>efully adju/$4 ,! nurse :o is slov5ly 9 appe>ance w be slov5ly 9 h] m9d & slov5ly 9 h] "w4 ,%e %\ld n we> h] uni=m on ! /reet4 ,x is bad ta/e1 unpr(essional1 & unsanit>y4 ,%e %\ld ba! at lea/ ?ree times a week4 ,!re is always "s odor ( p]spiration ab\t ! body1 & especially ar\nd ! axill>y spaces :i* are fill$ ) hair4 ,no?+ is m (f5sive & nauseat+ ?an be+ lean$ ov] & wait$ on by a p]son :o has a /rong body smell4 ,! prodigal use ( w>m wat] & soap w aid1 b !re are l>ge sebace\s gl&s 9 ! armpits & _! decompos+ excretions are reta9$ by ! hair s la/+ly t m radical measures are necess>y4 ,! axill %\ld be %av$ at lea/ once a mon?1 & !n ! soap & wat] becomes m efficaci\s4 ,aft] ?or\gh cleans+1 ! armpits %\ld be dr$g$ ) ,babcock's ,motiya p[d]1 & ! annoy+ & (f5sive odor w disappe>4 ,if ! pati5t is a ref9$ & da9ty woman1 :o may happ5 to be afflict$ ) ! same mis=tune1 %e w be deeply grateful to ! nurse :o tells h] h[ to get rid ( x4 ,t "s doctors1 un=tunately1 h /rong odors ab\t ! p]son--! mix$ effluvia ( tobacco1 alcohol1 bad tee?1 & uncleanl9ess--is no excuse = ! nurse4 ,! doctor %\ld "k bett]1 b at all ev5ts1 8 (f5se r>ely ne$s to be suff]$ m ?an a few m9utes at a "t1 :ile ! nurse is 9 con/ant att5dance4 ,! tra9$ nurse %\ld be polite to1 b n famili> ) s]vants1 z %e is look$ ^u z ! highe/ type ( ! pr(essionally educat$ g5tlewoman1 & %e mu/ be con/antly al]t t h] reputation 9 ?is respect is n dim9i%$4 ,,ba?s ,hot ,ba?s4--,temp]ature f #ih ,f4 to #abj ,f4 ,wat] %\ld be tepid at fir/ & ! hot wat] gradually add$ until ! requir$ degree is obta9$4 ,w>m ba? #ib ,f4 to #ih ,f4 ,tepid #he ,f4 to #ib ,f4 ,cold #cc ,f4 to #fe ,f4 ,s$ative ,ba?4--,! pati5t is /ripp$ & /&s = an h\r 9 ! hydro!rapy room1 :ile a hot spray is play$ up & d[n ! sp9e4 ,! temp]ature ( ! wat] is #ajd ,f4 to beg9 )1 & gradually increas$ to ! po9t ( tol]ation4 ,an alkal9e ba? is prep>$ by add+ an ounce ( sodium c>bonate to ea* gallon ( wat]4 ,bran ,ba?4--,add two ounces ( bran to ea* gallon ( wat]4 ,mix ! bran 9 a small am\nt ( boil+ wat] & add to ! ba? wat]4 ,mu/>d ,ba?4--,to ?ree gallons ( wat] at a temp]ature ( #aje ,f4 add a tablespoonful ( mu/>d4 ,leave ! *ild 9 ! wat] = five m9utes1 all ! :ile rubb+ & /rok+ ! limbs & back4 ,!n wrap nak$ 9 a w>m blanket & leave = half an h\r4 ,,/]ile ,,dress+s--,,antiseptic ,,solutions--,,/]ilization ,,( ,,in/rum5ts ,! prep>ation ( /]ile dress+s1 antiseptic solutions & ! /]ilization ( in/rum5ts1 is p>ticul>ly ! "w ( ! nurse1 :e!r 9 ! hospital or 9 a private home4 ,! foll[+ directions are !re=e desirable3 ,z soon z ! nurse is sure h] pati5t is 9 labor1 %e boils a milk bottle1 fills x two-?irds full ( #ie p] c5t alcohol1 puts a pl$get ( /]ile cotton 9 ! bottom & !n boils a pair ( dress+ =ceps1 :i* are plac$1 h&le up1 9 ! alcohol4 7,see ,fig4 #eb1 page #acb47 ,) ?is =ceps1 %e h&les all clean dress+s1 in/rum5ts1 & rubb] goods t may be contam9at$ by t\*4 ,dress+s & ,supplies4--,! necess>y dress+s & supplies may be prep>$ "o or two weeks be=e labor accord+ to ! foll[+ in/ructions3 ,five ,y>d ,pack+4--,draw ?reads at ei!r end ( five y>d l5g?s ( gauze to its full wid?4 ,fold ! cut edge across until x lies "o-?ird ! di/ance f ! opposite side4 ,next1 fold ! d\ble edge ov]1 & br+ x to ! outside edge ( ! fir/ fold4 ,keep x p]fectly /raight4 ,:5 fold$ full l5g?1 roll f ! end & wrap 9 /rong musl9 wrapp]s4 ,/]ilize 9 ! autoclave or ,arnold /]iliz]4 ,pads = ! ,vulva4--,unroll a :ole bale ( common cotton & cov] x ) a in* ?ickness ( absorb5t cotton4 ,cut 9 l5g?s ( #ab 94 by #d 94 wide4 ,cov] ) gauze cut #ab by #ad in*es1 & fold ! ends ( gauze ov] absorb5t cotton4 ,roll f ! end1 wrap 9 pap]1 seal1 & /]ilize4 ,pl$gets4--,te> two y>d /rips1 l5g?wise ( ! roll ( absorb5t cotton1 pull f ^!1 ?ree in* pieces1 roll !m 9 ! h&s until r\nd1 place 9 clean bags1 & /]ilize4 ,brea/ ,cov]s4--,squ>es ( old1 s(t musl9 #d by #d in*es1 ) all /r+s remov$1 make ! be/ dress+s = ! nipple4 ,d n use gauze1 because ! papill ( ! nipple may get caught 9 ! me% & :5 x is tak5 (f1 ! t5d] nipple is irritat$ or abrad$4 ,brea/ ,b9d]s4--,^! are made ( s+le mat]ial1 because !y w\ld be too w>m o!rwise4 ,!y are sleeveless & jacket-%ap$ & measure #af in*es f %\ld] to wai/1 #dj in*es long1 & #aj in*es = ! arm scallop4 ,a b9d] ( ?is size1 if prop]ly adju/$1 w fit a pati5t ( any size4 ,?ree w be suffici5t = ! case4 ,abdom9al ,b9d]s4--,! abdom9al & brea/ b9d]s are worn dur+ ! b$ p]iod only4 ,! abdom9al b9d] is made ( unblea*$ musl91 d\ble mat]ial1 #ad by #dj in*es1 & hemm$4 ,9 ! c5t] ( ! back1 on ! l[] edge1 a curv$ space1 six in*es wide1 is cut out to prev5t ! b9d] f gett+ soil$4 ,to ?is curv$ edge1 ! pad hold] is atta*$ by two safety p9s1 "o on ei!r side4 ,! abdom9al b9d] is adju/$ by p9n+ firmly above ! fundus1 & loosely bel[4 ,pad hold]s are made ( unblea*$ musl91 & measure #f by #af in*es4 ,cord ,dress+s4--,cut squ>es ( surgical l9t #d by #d in*es1 & cut ?r\gh to ! c5t] on "o side4 ,gauze may be us$1 b x is n ideal4 ,nurs]y ,cotton4--,te> absorb5t cotton into n>r[ l5g?s & pull out small "o in* pieces4 ,roll !m1 place 9 a clean bag & /]ilize4 ,applicators4--,use absorb5t cotton & too?picks4 ,te> (f small pieces ( cotton1 moi/5 ! too?pick po9t ) wat]1 place 9 ! middle ( ! cotton1 & roll firmly4 ,gauze ,sponges4--,cut gauze into squ>es #f by #f in*es1 & fold f ea* side to ! c5t]4 ,?is br+s all ! ragg$ edges inside4 ,fold into squ>es1 place 9 j>s1 & /]ilize4 ,/]ilization ( ,in/rum5ts4--,place scalpels 9 c>bolic acid #ie p] c5t = t5 m9utes4 ,lift ) /]ile =ceps1 & put 9 a bas9 ( #ie p] c5t alcohol = t5 m9utes4 ,9 ! abs5ce ( c>bolic acid & alcohol1 ! scalpels may be dropp$ 9 a #b p] c5t solution ( lysol = tw5ty m9utes4 ,cleanse ) hot /]ile wat]4 7,d n boil scalpels2 x dulls ! %>p edges47 ,all o!r in/rum5ts may be plac$ 9 a /]iliz] 7di%pan or wa% boil]7 ) en\gh wat] to completely cov] !m2 boil tw5ty m9utes4 ,cool 9 /]ile pan1 :i* may be set 9 cold wat]4 ,d n use soda on ! in/rum5ts dur+ /]ilization1 z x makes a ?ick1 gummy precipitate on ! metal4 ,! /]ile h&l+ =ceps mu/ be imm]s$ at all times = two-?irds _! l5g? 9 #ie p] c5t alcohol4 ,bru%es4--,aft] us+1 all bru%es %\ld be ?or\ghly wa%$1 boil$1 & dri$1 wrapp$ 9 wax$ pap]s1 & /]iliz$ 9 ! autoclave4 ,9 ! abs5ce ( ! autoclave1 boil ?irty m9utes4 ,bas9s1 pit*]s1 & d\*e pans are /]iliz$ by wrapp+ 9 /rong musl9 bags & put to boil = =ty-five m9utes 9 ! bas9 boil] or wa% boil]4 ,!y w n rema9 /]ile long] ?an "o week1 ev5 :5 kept 9 a clean place & well wrapp$4 ,b$pans %\ld be wa%$ 9 a /rong solution ( soap & wat]1 r9s$ e morn+ & boil$ = ?irty m9utes4 ,/]ilization ( ,rubb] ,goods4-- ,tra*eal ,ca!t]s4--,drop 9 a solution ( bi*loride #a3ejjj & leave = tw5ty m9utes4 ,lift ) /]ile =ceps into a bas9 ( w>m /]ile wat] & leave = t5 m9utes1 or until us$4 ,vorhees ,bags4--,boil tw5ty m9utes4 ,! bags & ca!t]s may be giv5 a long] life by keep+ !m 9 a #be p] c5t solution ( glyc]9e & wat] :5 n 9 use4 ,k]os5e vapor is also pres]vative4 ,rubb] ,ca!t]4--,boil tw5ty m9utes4 ,hot ,wat] ,bags1 ,ice ,caps1 ,rubb] ,b$ ,r+s4--,soak 9 #aj p] c5t lysol solution = two h\rs1 wa% ) w>m wat]1 & dry ?or\ghly4 ,! inside ( ! ice caps c be du/$ ) p[d]4 ,nev] leave rubb] gloves 9 a damp place or ly+ 9 a solution4 ,x /ret*es !m & weak5s ! rubb]4 ,to /]ilize1 !y mu/ be wa%$ 9 a /rong solution ( soap & wat]1 dri$1 & pair$4 ,!n !y are wrapp$ 9 a heavy clo? cov]+ & put 9 ! autoclave = tw5ty m9utes4 ,wet ,process = ,rubb] ,gloves4--,wrap 9 gauze or clo? & boil = ?irty m9utes4 ,lift ) /]ile =ceps & place 9 lysol solution #a p] c5t until us$4 ,!y are easily drawn on by fill+ !m ) ! solution z ! h& goes 94 ,! autoclave is n always available1 b an ,arnold or ,ro*e/] /]iliz] is readily portable1 & takes ! place ( ! hospital ma*9e4 ,fumigation ( rooms is sometimes necess>y4 ,remove all curta9s1 b$ l951 & o!r wa%able fabrics f ! room4 ,op5 ! draw]s ( dress]s1 doors ( closets1 & loos5 up & sep>ate ev]y?+ left s ! air c get to x4 ,close ! w9d[s & seal ! crevices ) cotton & make ! room z air-tight z possible4 ,place a l>ge pan conta9+ six ounces ( potassium p]manganate cry/als 9 ! c5t] ( ! room4 ,p\r ov] ?is twelve ounces ( =mal91 close & seal ! outside doors ( ! room & leave = twelve h\rs4 ,if ! case has be5 a v septic "o1 x is always a good plan to wa% ! walls ( ! room be=e us+ aga94 ,! insides ( ! draw]s & ! b$ %\ld be ?or\ghly wa%$ ) wat] & gre5 soap4 ,a =maldehyde lamp is also q satisfactory if obta9able4 ,,*apt] ,,xxiv ,,diets ,,& ,,=mul ,! nurse %\ld s]ve ev]y?+ 9 ! mo/ cleanly & appetiz+ way if x is only a cup ( tea2 & all wa/e1 soil$ di%es1 napk9s1 & excreta mu/ be remov$ z delicately z possible4 ,diet = ,pregnancy4--,fre% fi%1 boil$1 broil$ or bak$2 & %ell-fi% raw or cook$1--any way b fri$4 ,meat1 once or twice a day1 except :5 contra9dicat$ by condition ( ! kidneys4 ,veal is be/ omitt$4 ,all f>9ace\s foods & vegetables may be eat5 freely4 ,dess]ts %\ld be pla91 b tempt+4 ,no alcohol is tak5 )\t direct p]mission f ! doctor1 & c(fee & tea %\ld be limit$4 ,diet = ,pu]p]ium4--,fir/ two days1 milk1 butt]milk1 s\p1 gruel1 cocoa1 toa/ & tea1 *ick51 oy/] & clam bro?4 ,9 ! next two days1 "u ord9>y conditions1 ! diet is increas$ & made some:at heavi]4 ,semisolids are add$ l milk-toa/1 eggs1 poa*$ or boil$ s(t1 oy/]s1 clams & boil$ fi%4 ,aft] ! milk comes 91 ! woman is put on a g5]al diet z fa/ z %e c dige/ x4 ,f>9ace\s diet--melons & oranges4-- ,breakfa/4--,c]eal1 c(fee ) milk & sug>1 if desir$1 bread & butt]1 corn bread1 rolls1 toa/1 muff9s1 hom9y1 c]eal ) cream4 ,lun*4--,vegetable s\ps1 bread1 butt]1 potatoes1 beans1 rice1 mac>oni & c]eal1 peas1 butt]milk1 pudd+1 su* z rice1 tapioca1 bread corn/>*1 jellies1 fruit juices1 pumpk91 squa%1 turnips1 tomatoes1 etc4 ,d9n]4--,bread1 butt]1 milk-toa/1 hom9y1 rice1 cel]y1 fruit salads1 lettuce1 apples1 pe>s1 prunes1 /ew$ fruits or fre% melons1 etc4 ,! foll[+ diets are r\t9e at _m hospitals3 ,g5]al ,diet4--,full tray ( food 9 season z furni%$ by ! hospital4 ,?ree meals daily4 ,light ,diet4--,foods f ! foll[+ li/ may be select$1 & s]v$ ?ree or five times daily1 z desir$3 ,s\ps ( all k9ds4 ,:5 legum9\s foods are employ$1 _! out] cov]+s mu/ be remov$ by rubb+ !m ?r\gh a sieve or col&]4 ,vegetables ( all k9ds1 except gre5 vegetables 7provid$ !y h be5 r$uc$ to a pa/y consi/5cy74 ,^? ) excess ( fib] or cellulose1 su* z turnips1 cel]y1 asp>agus1 & cabbage1 %\ld be *opp$ aft] ?or\gh boil+1 !n ma%$1 :ile ^? hav+ tunics %\ld be siev$ or col&]$4 ,gra9 foods ( all k9ds ?or\ghly cook$1 except+ corn prep>ations conta9+ mu* cov]1 z hull$ corn4 ,prep>$ foods su* z tapioca1 mac>oni1 & v]micelli1 require prolong$ cook+4 ,meats1 scrap$ beef4 ,eggs1 s(t boil$1 raw or s(t poa*$4 ,bread ( all k9ds1 /ale1 home-made4 ,pudd+s1 ices4 ,bev]ages1 all k9ds unless o!rwise ord]$4 ,=c$ ,diet4--,?is includes ! g5]al diet ) ! addition ( "o qu>t ( :ole milk & f\r eggs4 ,! milk may be giv5 pla9 or z an eggnog at sev51 t51 ?ree1 & eight o'clock4 ,! eggs may be giv5 raw or cook$ s(t 9 any =m4 ,milk ,diet4--,twelve ounces ( :ole milk 7#cge c4c47 may be giv5 e two h\rs2 i4 e41 at six1 eight1 t51 twelve1 two1 f\r1 five1 & eight o'clock1 or ! pati5t may sip x at h] pleasure4 ,! milk may be giv5 raw1 boil$1 dilut$ ) pla9 wat]1 lime wat]1 ,vi*y1 seltz]1 or ,apoll9>is to ta/e4 ,! daily am\nt %\ld include ?ree qu>ts ( :ole milk4 ,k\miss1 butt]milk & milk s\ps are sometimes all[$4 ,note ! exact am\nt tak51 & give reasons = failure4 ,wat* ! /ools = undige/$ milk4 ,liquid ,diet4--,:ole milk1 butt]milk1 k\miss1 beef tea1 or beef1 *ick51 mutton1 oy/]1 or clam bro?1 9 eight ounce portions1 or two ounces ( beef juice1 e two h\rs4 ,lemonade1 orangeade1 ice cream1 or fruit ices1 at int]vals & am\nts z desir$4 ,ulc] ,diet4--,:ole milk & cream1 equal p>ts1 ?ree ounces e two h\rs4 ,sodium bic>bonate1 ?irty gra9s1 9 a small am\nt ( wat]1 to be giv5 be=e & ?irty m9utes aft] fe$+4 ,album9 wat]1 s(t boil$ eggs1 scrap$ beef1 cu/>d1 & cream s\ps to be add$ lat] by direction ( ! physician4 ,no season+ except salt is all[$4 ,pro*[nik ,diet4--,?is diet is advis$ :]e "s necessity exi/s = prev5t+ a l>ge *ild4 ,x is adm9i/]$ 9 ! la/ six weeks ( pregnancy only4 ,breakfa/4--,small cup ( c(fee1 two slices ( toa/ 7#a ounce74 ,lun*4--,small piece ( meat1 fi% or an egg1 a little sauce4 ,a vegetable prep>$ ) fat1 lettuce1 a small piece ( *eese4 ,d9n]4--,same z lun* ) ?ree slices ( bread & butt]1 & a little milk4 ,a p9t ( wat] daily is all[$2 tak5 9 sips x la/s long]4 ,s\p1 wat]1 be] 7all fluids7 & sug>1 pa/ry1 & potatoes are =bidd54 ,skimm$ ,milk ,diet 7,k>ell74--,skimm$ milk1 to :i* a p9* ( salt is add$1 #c to #f ounces1 ?ree or f\r times daily1 increas+ ! am\nt gradually1 tak5 sl[ly to all[ ?or\gh mixture ) saliva1 w>m$ 9 w9t]1 room temp]ature 9 summ]4 ,acute ,nephritis ,diet4--,:ole milk1 #ajjj c4c42 cream1 #bej c4c42 wat]1 #aej c4c42 /ew$ fruit1 well sweet5$1 #ej c4c4 ,bread1 well butt]$1 may be toa/$1 #aej gm4 7equal to ?ree slices74 ,gre5 salad ( lettuce1 cel]y1 apple1 pe> or grape fruit1 & s]v$ ei!r ) olive oil1 or ) a mayonnaise dress+ made f olive oil1 egg & lemon juice1 ) salt 7b no pepp] or condim5ts7 may be giv5 9 two small portions daily4 ,cook$ c]eals 7cream ( :eat1 etc47 ) cream & sug>1 "o portion equal to ab\t two ounces1 once daily4 ,! above repres5ts a daily fluid intake ( ab\t #aejj c4c4 ,! diet is to be giv5 9 8?ree meals10 at eight1 "o1 & six o'clock1 ) fluid n\ri%m5t at elev51 ?ree1 & n9e o'clock4 ,,rectal ,,fe$+ ,nutri5t enemas %\ld be giv5 e six h\rs1 unless o!rwise ord]$4 ,x is necess>y to cleanse ! l[] b[el ) a sal9e or soapsuds enema at lea/ once a day4 ,! cleans+ enema %\ld be giv5 "o h\r be=e ! nutri5t enema is to be giv54 ,! prop] quantity = ! nutri5t enema is f\r to six ounces = an adult1 & "o to ?ree ounces = a *ild4 ,nutri5t enemas %\ld be giv5 sl[ly at v l[ pressure1 ! level ( ! fluid 9 ! c be+ n ov] eight to t5 in*es above ! level ( ! rectum4 ,if ! inject$ mat]ial is ?ick1 a pi/on syr+e may be requir$4 ,! pati5t %\ld be plac$ ^u ! left side ) ! hips well elevat$ & %\ld be kept 9 t position = fifte5 to tw5ty m9utes aft] ! enema has be5 giv54 ,! tube %\ld be oil$ & n be ins]t$ m ?an ?ree or f\r in*es4 ,! temp]ature ( ! enema %\ld be ab\t #ih degrees4 ,if !re is a /rong t5d5cy to evacuate ! enema1 pressure %\ld be made aga9/ ! rectum ) a pad4 ,! foll[+ nutri5t enemas may be ord]$ by "n4 ,glucose ,enema4--,glucose 7dextrose1 grape sug>7 #a ounce1 normal salt solution #e ounces4 ,! glucose %\ld fir/ be dissolv$ 9 hot wat]4 ,! am\nt ( glucose may be increas$1 ^u ord]1 if no irritation is produc$4 ,pancreat9iz$ ,milk ,enema4--,add #a tube ( peptoniz+ p[d]1 or #a to #b drams ( 8,pancreatic solution0 to #a p9t ( skimm$ milk4 ,/ir well & place 9 a w>m wat] ba? = "o-half h\r4 ,add #a dram ( salt4 ,milk & ,egg ,enema4--,?or\ghly beat ! :ites ( #b eggs1 add dram ( salt1 & #f ounces ( skimm$ milk4 ,add "o tube ( peptoniz+ p[d]1 or #a to #b drams ( 8pancreatic solution10 /ir well1 & place 9 a w>m wat] ba? = "o-half h\r4 ,milk1 ,egg1 & ,beef ,juice ,enema4--,mix ! beat5 :ites ( #b eggs1 #b ounces ( fre% beef juice1 #f ounces ( skimm$ milk1 & dram ( salt4 ,add #a tube ( peptoniz+ p[d]1 or #a to #b drams ( 8pancreatic solution10 /ir well1 place 9 a w>m wat] ba? = "o-half h\r4 ,milk & ,glucose ,enema4--,add #a tube ( peptoniz+ p[d] to #f ounces ( skimm$ milk1 /ir well1 place 9 a w>m wat] ba? = "o-half h\r4 ,add #c drams ( glucose & dram ( salt4 ,,elim9ative ,,enemas ,impaction ,enema4-- ,ca/or oil or olive oil1 #a ounce4 ,soapsuds 7#ajj ,f471 #a qu>t4 ,mix z ?or\ghly z possible1 add "o dram ( spirits ( turp5t9e beat5 up ) ! yoke ( "o raw egg4 ,s4 ,s4 & ,g4 ,enema4-- ,soapsuds1 #a qu>t4 ,glyc]9e1 #a ounce4 ,asaftida ,enema4-- ,milk ( asaftida1 #h ounces4 ,wat]1 #h ounces4 #a-b-c ,enema4-- ,magnesium sulphate1 #a ounce4 ,glyc]9e1 #b ounces4 ,wat]1 #c ounces4 ,milk & ,molasses ,enema4-- ,milk1 ord9>y cook+ molasses 9 equal p>ts1 possibly #h ounces ( ea*4 ,heat1 b d n boil4 ,turp5t9e ,enema4-- ,soapsuds1 #a p9t4 ,turp5t9e1 #a dram4 ,x acts quickly & effectively4 ,all enemas %\ld be giv5 ?r\gh a colon tube4 ,! pati5t %\ld be on ! left side & ! temp]ature ( ! injection %\ld be ab\t #ajj ,f4 ,,diet ,,li/ ,album9 ,wat]4--,take :ite ( #a egg1 /ir until sep>at$4 ,add a little lemon juice & #a p9t ( wat]4 ,ice & s]ve4 ,sug> or salt may be us$4 ,b>ley ,wat]4--,wa% #b ounces ( b>ley ) cold wat]4 ,boil = #e m9utes 9 fre% wat]4 ,/ra94 ,!n cov] ) #b qu>ts ( wat] & cook sl[ly d[n to #a qu>t4 ,flavor ) ?9ly cut lemon r9d & sug>4 ,d n /ra9 unless pati5t reque/s4 ,beef ,juice4--,cut into cubes #a in*es ea*1 #a p\nd r\nd /eak4 ,place 9 a clean1 ungreas$ pan1 & fry "o & "o-half m9utes on ea* side4 ,p\r into hot meat press & apply pressure4 ,9 abs5ce ( a press1 a potato ric] may be us$4 ,season ) salt & pepp]4 ,may be s]v$ ic$ or heat$ by putt+ 9 d\ble boil] & /irr$ all ! "t4 ,d n all[ to curdle4 ,beef ,tea4--,put #a p\nd ( f9ely *opp$ r\nd /eak into a qu>t glass j>1 fill ) cold wat]4 ,place j> 9 kettle ( w>m wat]4 ,leave ov] sl[ fire = f\r h\rs4 ,/ra91 season ) salt & pepp]4 ,*ampagne ,:ey4--,boil #h ounces milk = fifte5 m9utes4 ,/ra9 ?r\gh *eeseclo?4 ,add #a ounces *ampagne4 ,*ick5 ,bro?4--,sk9 & *op 9 small pieces "o small or "o-half l>ge f[l4 ,boil bones & all ) "o blade ( mace1 a sprig ( p>sley1 & #a tablespoonful ( rice1 #a cru/ ( bread & #a qu>t ( wat]1 = "o h\r4 ,skim f "t to "t4 ,/ra9 ?r\gh co>se col&] & season to ta/e4 ,c9namon ,wat]4--,"o-half ounce /ick c9namon1 #b cups boil+ wat]4 ,break /icks 9 small pieces4 ,add wat]1 boil tw5ty m9utes4 ,/ra9 & s]ve hot or cold4 ,clam ,bro?4--,wa% ?or\ghly #f l>ge clams 9 %ell4 ,put 9 kettle ) #a cup ( cold wat]1 br+ sl[ly to boil1 & keep temp]ature = "o m9ute4 ,p\r (f bro? & s]ve hot4 ,add salt & pepp]4 ,eggnog4--,beat an egg1 :ite & yolk sep>ately4 ,add to ! yolk #a dram ( vanilla extract1 a p9* ( salt & #d oz4 fre% milk1 & #a dram ( sug>4 ,add dram ( sug> to :ite ( egg1 /ir a portion into ! glass & heap rema9d] ^u top ( glass4 ,egg ,cordial4--,"o egg :ite1 #a teaspoon sug>1 #a tablespoon br&y1 #b gra9s salt1 #b tablespoons cream4 ,beat :ite until /iff4 ,add cream1 cont9ue beat+1 add o!r +r$i5ts1 & s]ve cold4 ,egg ,lemonade4--,beat #a egg & #a teaspoonful ( sug> until v light1 add cake ( yea/ dissolv$ 9 "o-f\r? cup ( wat]1 two tablespoonfuls ( sug>1 p\r into bottles ) pat5t /opp]1 fill bottles only two-?irds full1 cork tightly4 ,%ake well4 ,all[ to /& on ice tw5ty-f\r h\rs4 ,flaxse$ ,tea4--,"o ounce ( :ole flaxse$1 #a ounce p[d]$ sug>1 ounce licorice root1 #a ounce lemon juice4 ,p\r ov] ^! mat]ials #a qu>t ( boil+ wat] & all[ to /& f\r h\rs4 ,/ra9 (f liquor4 ,gum ,arabic ,wat]4--,dissolve #a ounce ( gum arabic 9 #a p9t boil+ wat]4 ,add ounce sug>1 a w9eglassful ( %]ry1 & juice ( "o lemon4 ,s]ve ) ice4 ,junket4--,take p9t ( fre% milk 9 a saucepan4 ,add #a teaspoonful ( ess5ce ( peps91 /ir j en\gh to mix4 ,p\r into cu/>d cups4 ,let /& until firmly curd$4 ,s]ve pla9 or ) grat$ nutmeg4 ,%]ry may be add$4 ,k\miss4--,heat f\r cups ( milk1 !n cool2 :5 lukew>m1 add cake ( yea/ dissolv$ 9 "o-f\r? cup ( wat]1 two tablespoonfuls ( sug>1 p\r into bottles ) pat5t /opp]1 fill bottles only two-?irds full1 cork tightly4 ,%ake well1 all[ to /& on ice tw5ty-f\r h\rs4 ,milk ,%ake4--,:ite ( #a egg1 #a ounce sug>1 #a ounce *ipp$ ice1 #a ounce cream4 ,%ake 9 milk %ak] two m9utes4 ,add milk to fill glass4 ,flavor ) vanilla & lemon4 ,mutton ,bro?4--,boil sl[ly #a p\nds ( lean lo9 mutton1 includ+ ! bone4 ,add a little salt & onion4 ,p\r bro? into a bas94 ,skim (f fat :5 cool4 ,w>m z us$4 ,oatmeal ,gruel4--,"o teacup oatmeal flakes1 cov] ) #a qu>t cold wat]4 ,place on sl[ fire & soak ?ree h\rs4 ,/ra91 add #d teaspoonfuls ( sug> & #a teaspoonful ( salt4 ,oatmeal ,wat]4--,cov] #a teacupful oatmeal ) #a qu>t cold wat]4 ,let x /& two h\rs4 ,/ir (t54 ,/ra94 ,s]ve ) salt1 sug> & ice4 ,peptoniz$ ,milk4 ,w>m ,process4--,dissolve ! cont5ts ( ,fair*ild's peptoniz+ tube 9 #d tablespoonfuls cold wat]4 ,add to #a p9t ( milk4 ,put 9 glass j>1 & place j> 9 vessel ( w>m wat]4 ,heat sl[ly to #aae ,f4 ,/ir sl[ly & all[ x to rema9 ?irty m9utes4 ,place on ice at once to *eck fur!r dige/ion4 ,peptoniz$ ,milk4 ,cold ,process4--,9 a clean qu>t bottle1 put "o peptoniz+ p[d] 7,fair*ild74 ,add #a teacupful ( cold wat]4 ,%ake4 ,add #a p9t fre% cold milk4 ,%ake well4 ,place on ice4 ,d n heat be=e us+4 ,rice ,wat]4--,pick ov] & wa% #b tablespoonfuls ( rice4 ,put 9 a saucepan ) #a qu>t ( boil+ wat]2 simm] two h\rs4 ,:5 rice is dissolv$1 /ra94 ,add teaspoonful salt4 ,s]ve w>m or cold4 ,%]ry may be add$4 ,rum ,pun*4--,two teaspoonfuls p[d]$ sug>1 #a egg well beat51 w>m milk1 #a l>ge w9eglassful2 #d ounces ,jamaica rum4 ,flavor ) nutmeg4 ,scrap$ ,beef4--,place on breadbo>d a r\nd /eak4 ,scrape ) table-knife b d n take any %r$s ( muscle4 ,salt & pepp]4 ,spread on ?9 slices ( bread4 ,place 9 toa/] until se>$4 ,toa/ ,wat]4--,?ree slices ( /ale bread well br[n$1 b d n burn4 ,put 9 a pit*]1 p\r ov] !m #a qu>t boil+ wat]4 ,cov] closely1 & all[ to /& until v cold4 ,/ra94 ,w9e & sug> may be add$1 to /imulate4 ,w9e ,:ey4--,put #a qu>t new milk 9 a saucepan & place ov] fire4 ,/ir until ne>ly boil+4 ,add #b ounces ( %]ry w9e4 ,boil sl[ly = fifte5 m9utes4 ,skim (f curds z !y arise4 ,add #a tablespoonful %]ry4 ,skim aga91 !n /ra9 ?r\gh gauze4 ,,*apt] ,,xxv ,,solutions ,,& ,,!rapeutic ,,index ,acid1 ,boric4 #e dr4 9 a p9t ( wat] makes a #d solution1 or #a3be4 ,acid1 ,c>bolic4 #ae 9 a qu>t ( wat] makes a #j4a solution1 or #a3ajjj4 #e dr4 to ! qu>t makes a #b solution2 & #a oz4 to ! qu>t1 a #e solution4 ,*9osol4 #ae gr4 to ! qu>t ( wat] makes a solution ( #a3ajjj4 ,=mal94 #a dr4 to ! qu>t ( wat] makes a solution ( ab\t #a3ejj4 ,m]cury ,bi*loride4 #ae gr4 to ! qu>t ( wat] makes a #j4a solution1 or #a3ajjj4 #a gr4 to ! qu>t makes a #j4ja solution1 or #a3aj1jjj4 ,normal ,salt ,solution4 #b dr4 ( salt to ! qu>t ( wat]1 or #j4i4 ,physiological ,salt ,solution4 ,take normal salt solution z giv5 above & to e #c oz4 add #ae gr4 ( c>bonate ( soda4 ,potassium ,p]manganate4 #b dr4 to ! qu>t makes a #a solution4 #c gr4 to ! qu>t makes a #a3ejjj solution4 ,silv] ,nitrate4 #d gr4 to ! ounce ( wat] or #a gr4 to #a-g_/aj dr4 makes a #a solution4 ,ziratol4 #b teaspoonfuls to a qu>t ( wat] makes a #a solution4 ,= g5]al ref]5ce ! foll[+ valuable table is app5d$3 ,,p]c5tage ,,solution ,,table ,,by ,,alfr$ ,i4 ,,cohn1 ,,ph>4 ,d41 9 ,m]ck's ,report ,quantity ( solution ,,gra9s ,,( ,,salt ,,or ,,drug ,,requir$ ,,to ,,make ,,solutions ,,( to be ,,p]c5tage ,,/r5g? ,,indicat$ made #j4e #a #b #c #d #e #f #h #aj fl4 oz #a4ae #b4c #d4f #f4i #i4c #aa4g #ad4a #ai4 #bd4 #a fl4 oz #b4c #d4f #i4b #ac4i #ah4f #bc4d #bh4b #cg4i #dg4i #b fl4 oz #d4f #i4b #ah4d #bg4h #cg4b #df4h #ef4d #ge4h #ie4h #c fl4 oz #f4i #ac4h #bg4f #da4g #ee4h #gj4b #hd4f #aac4g #adc4g #d fl4 oz #i4b #ah4d #cf4h #ee4f #gd4d #ic4f #aab4h #aea4f #aia4f #e fl4 oz #aa4e #bc4 #df4 #fi4e #ic4 #aag4 #ada4 #ahi4e #bci4e ,quantity ( solution ,,gra9s ,,( ,,salt ,,or ,,drug ,,requir$ ,,to ,,make ,,solutions ,,( ,,p]c5tage to be ,,/r5g? ,,indicat$ made #ae #bj #be #ej #a3ejj #a3ajjja3bjjja3cjjja3djjja3ejjj fl4 oz #cf4h #ej4b #fe4 #aea4b #j4df #j4bbh #j4ab #j4jge #j4jf #j4je #a fl4 oz #gc4e #ajj4c #acj4 #cjb4e #j4ia #j4def #j4bc #j4ae #j4ab #j4ji #b fl4 oz #adg4 #bjj4f #bfj4 #fje4 #a4h #j4ia #j4df #j4c #j4bc #j4ah #c fl4 oz #bbj4e #cja4 #cij4 #ijg4e #b4g #a4cg #j4fh #j4df #j4cd #j4bg #d fl4 oz #bid4 #dja4b #ebj4abaj4 #c4fd #a4hb #j4ia #j4fa #j4df #j4cf #e fl4 oz #cfg4e #eja4e #fej4aeab4e #d4ee #b4bh #a4ad #j4gf #j4eg #j4df ,! table %[s ! quantity ( drug requir$ to yield a giv5 volume ( solution ( ! p]c5tage /r5g? desir$4 ,?us1 to make "o fluid ounce ( a #e p] c5t solution x is m]ely necess>y to dissolve #bc4d gra9s ( ! salt 9 suffici5t wat] to make "o fluid ounce4 ,,!rapeutic ,,index ,"y's ,rule = ,dosage3 ,! age ( ! *ild is divid$ by ! age ( ! *ild plus #ab1 & ! result is ! appropriate dose = ! *ild4 ,! doses giv5 bel[ are = ! adult unless o!rwise specifi$4 ,absorb5t4 ,a m$ic9e or dress+ t promotes absorption1 su* z potassium iodide1 ,tr4 iod9e1 glyc]9e1 or hot vag9al d\*es4 ,adr5al94 ,! blood-rais+ pr9ciple ( ! supr>5al gl&s4 ,x is hmo/atic & a/r+5t4 ,acts some:at l digitalis on ! he>t4 ,uses4--,vomit+ ( pregnancy1 increas$ gl&ul> activity1 hmorrhage1 inflammation ( muc\s membranes4 ,dose4--,int]nally1 #e-aj m4 ( ! #a3ajjj solution4 ,ext]nally1 ! solution ( #a3ajjj or #a3aj1jjj may be appli$4 ,albol5e4 ,an oily :ite sub/ance obta9$ f petroleum4 ,x is us$ on ! nipples & sk9 ( ! "m & to remove ! v]nix caseosa f ! sk9 ( ! *ild4 ,alo91 ,/ry*nia1 & ,belladonna4 ,a laxative pill :i* usually conta9s alo9 gr41 /ry*nia sulph4 #a_/fj gr41 & ,belladonna #a_/ab gr4 ,ammonia ,c>bonate4 ,antispasmodic1 /imulant1 & expectorant4 ,uses4--,/imulant to he>t4 ,/imulat+ expectorant 9 pneumonia & bron*itis4 ,dose4--#e-bj gra9s 9 mucilage or syrup4 ,an/hone4 ,a mixture ( adr5al9 *loride 7#j4a7 & *lorotone 7#e7 9 an o9tm5t base ( wool fat & petrolatum4 ,a/r+5t1 antiseptic1 ane/hetic & g]micide4 ,useful application to swoll5 muc\s membranes or 9 coryza4 ,argyrol 7,silv] ,vitell974 ,antiseptic & g]micide4 ,uses4--,l ,silv] ,nitrate1 b less irritat+ to ! tissues4 #c-e solution 9 wat] is an injection = gonorrha4 #ae solution dropp$ 9 ! eyes ( ! newborn may prev5t oph?almia4 #be solution may be us$ twice a day z a rem$y = exi/+ oph?almia1 b ! /r5g? %\ld be r$uc$ aft] ?ree or f\r days4 #aj-ae solution is us$ z an injection 9 cy/itis4 ,an ounce or m ( ! solution may be left 9 ! bladd] until ! next evacuation4 ,asaftida4 ,a fetid gum res94 ,c>m9ative1 antispasmodic1 mild /imulant1 & expectorant4 ,uses4--,gas pa9s ( adults & infants4 ,hy/]ia & indige/ion4 ,dose4--#e-aj gr4 t4i4d4 ,= infantile colic1 an emulsion call$ ! mi/ura ( asaftida may be us$ 9 #b-d dram doses4 ,= adults #a-b tablespoonfuls4 ,belladonna4 ,n]v9e1 mydriatic1 s$ative1 n>cotic1 antispasmodic & anodyne4 ,makes ! ?roat dry & dilates ! pupils4 ,uses4--,night sweats1 n]v\s c\gh1 pa91 incont95ce ( ur9e & to re/ra9 gl&ul> activity4 ,dose4--,fl4 ext4 #a-c 2 dry ext4 -#a gr4 ,t9cture #h-bj 4 ,solid ext4 gr4 ,all = adults4 ,= infants1 proportionately less4 ,see ,rule = ,dosage4 ,b5zo94 ,antiseptic & ext]nally a /yptic & protective = sores4 ,uses4--,sore nipples & urtic>ia4 ,l>d is also b5zo9at$ = use 9 remov+ v]nix caseosa4 ,comp\nd ,tr4 ( b5zo9 conta9s1 b5zo91 purifi$ aloes1 /orax1 balsam ( ,p]u1 & alcohol4 ,b5zo9al4 ,albol5e mix$ ) b5zo94 ,bismu? ,subnitrate4 ,a :ite heavy p[d]4 ,antiseptic & a/r+5t4 ,uses4--,subacute ga/ritis1 pyrosis1 di>rha & vomit+ ( pregnancy4 ,p>ticul>ly desirable 9 infancy because x is free f ars5ic1 lead & silv]4 ,dose4--#e-fj gr4 9 ! adult4 ,boric ,acid 7,boracic ,acid74 ,a :ite cry/all9e p[d]4 ,antiseptic4 ,uses4--,z a dress+ & lotion = eyes1 navel1 m\?1 nipples1 & all muc\s surfaces4 ,9 solution to pres]ve ! /]ility ( rubb] nipples until !y are ne$$4 ,dose4--,int]nally1 #e-ae gr4 ,solutions are usually ab\t #d or #e4 ,a saturat$ solution 9 wat] is ab\t #f4 ,9 hot wat] #be4 ,boroglyc]ide4 ,an antiseptic pa/e ( boric acid & glyc]9e4 ,:5 an excess ( glyc]9e is pres5t ! prep>ation is call$ boroglyc]ol4 ,uses4--,an oxydiz] 9 endometritis4 ,x is appli$ to ! c]vix on cotton tampons4 ,calcium 7,lime74 ,/oma* s$ative1 soo!s ! irritat$ or burn$ sk91 corrects hyp]acidity1 increases ! clott+ p[] ( ! blood 7874 ,lime wat] is a saturat$ solution ( calcium hydrate & is us$ = nausea1 to break up ! curds ( milk1 & to increase its dige/ibility4 ,x is mildly con/ipat+4 ,calomel4 ,see ,m]cury4 ,camphor4 ,a solid volatile oil4 ,n]ve s$ative4 ,anaphrodisiac4 ,antispasmodic4 ,/imulant4 ,uses4--,! monobromat$ camphor is giv5 int]nally = hy/]ia1 neuralgia1 & z a hypnotic4 ,dose4--#a-aj gr4 ,camphorat$ ,oil4 ,a solution ( camphor 9 cottonse$ oil4 ,rubefaci5t & /imulant4 ,uses4--,int]nally 9 collapse4 ,ext]nally z an application to ! *ild = colds ( *e/ & nose4 ,dose4--#e-bj hypod]mically 9 collapse4 ,! injection %\ld be made deep into ! muscle4 ,c>bolic ,acid 7,ph5ol74 ,d]iv$ f coal t>4 ,antiseptic1 deodorant & local an/hetic4 ,uses4--,vomit+ ( pregnancy1 pruritus1 eczema1 /]ilization ( in/rum5ts4 ,usual solution is #b to #e4 ,= /]ilization ( knives1 scissors & o!r %>p in/rum5ts ! #ie is us$4 ,9 pruritus1 ! foll[+ wa% w aid3 c>bolic acid1 #ab dr41 glyc]9e #b dr41 alcohol1 #d wat] q4s4 #a pt4 ,apply4 ,casc>a ,sagrada4 ,/imulant laxative1 & ca?>tic4 ,useful 9 pregnancy1 b aft] labor !re is evid5ce t x may g ov] 9 ! milk to ! *ild4 ,dose4--,fl4 ext4 #aj-bj 4 ,! ,h9kle pill conta9s casc>a4 ,ca/or ,oil4 ,oil express$ f ! se$s ( ! ca/or plant4 ,a ca?>tic4 ,acts 9 f\r or five h\rs4 ,dose4--,= adults1 oz4 to #a oz4 ,= infants #aj to #fj drops giv5 ) a dropp]--n ) a spoon4 ,ca/or oil cocktail4--,r9se out ! glass ) lemon juice or :iskey4 ,p\r 9 teaspoonful ( lemon juice & a teaspoonful ( :iskey1 add ca/or oil 9 am\nt requir$1 cov] ) :iskey & give4 ,a pa/e is made f ! mixture ( ca/or oil & bismu? subnitrate 9 equal p>ts1 :i* is an excell5t prep>ation = sore nipples4 ,c]ium ,oxalate 7& ,c]ium ,val]ianate74 ,s$ative & n]ve tonic4 ,! oxalate is a :ite cry/all9e p[d]1 odorless & ta/eless4 ,uses4--,vomit+ ( pregnancy1 seasickness4 ,dose4--#b-aj gr4 sev]al times daily4 ,*>coal4 ,adm9i/]$ 9 tablet =m or z a p[d] betwe5 two slices ( butt]$ bread4 ,uses4--,acid /oma*4 ,vomit+ ( pregnancy4 ,*9osol4 ,nonpoison\s1 nonirritat+ & odorless4 ,antiseptic deodorant1 /yptic & analgesic4 ,dissolves in/ead ( coagulates secretions4 ,uses4--,antiseptic solutions = h&s & sponges1 deodoriz+ wa% = vag9a po/ p>tum1 intraut]9e d\*e1 wa% = gonorrha & cy/itis4 ,dose4--,= d\*e or h& solution #a3ajjj or #a3ejjj4 ,= du/+ p[d]1 #a "p to #aj or #bj ( />*1 talcum1 boric acid1 or bismu? subnitrate4 ,*9osol w corrode unplat$ /eel4 ,x may be mix$ ) salt1 b n ) soap4 ,*oral ,hydrate4 ,:ite cry/al masses4 ,pung5t 9 odor & ta/e4 ,hypnotic1 antispasmodic1 antiseptic & analgesic4 ,uses4--,insomnia1 eclampsia1 convulsions1 & to re/ra9 secretion ( milk4 ,dose4--,by m\?1 #aj-cj gr4 ,by rectum1 n to exce$ #fj gr4 ,9 infants #a-b gr4 by rectum 9 an ounce ( wat]4 ,*ymog54 ,a prep>ation ( r5n9 7#aj7 made by ,arm\r ,company4 ,coagul5 ,ciba4 ,a physiological nontoxic /yptic1 prep>$ f ! natural coagulants ( ! blood4 ,a #aj solution 9 wat] w ha/5 ! beg9n+ & end ( coagulation4 ,may be appli$ to ble$+ surfaces directly1 or giv5 "u ! sk91 into ! muscle1 or into a ve94 #c to #e solution 9 di/ill$ wat]1 %\ld be /]iliz$ by boil+ #b-c m9utes4 ,d n filt]4 ,inject4 ,coca9e ,hydro*lorate4 ,an/hetic1 s$ative1 anodyne1 anti-pruritic4 ,uses4--,vomit+ ( pregnancy1 ) caution4 ,dose4--,int]nally -#a gr4 ,ext]nally a #d-aj solution 9 wat]4 ,code9e4 ,alkaloid ( opium4 ,less n>cotic ?an morph9e4 ,uses4--,aft]-pa9s & pa9 ( ov]-di/5d$ brea/s4 ,dose4--#a gr4 by m\?4 - gr4 hypod]mically4 ,comp\nd ,licorice ,p[d]4 ,see ,s5na4 ,condylomata4 ,use-- ,acid4 ,salicyl4 gr4 x ,acid ,boric4 gr4 xxx ,calomel4 i ,m4 ,sig43 ,apply twice daily4 ,digitalis4 ,c>diac tonic4 ,diuretic4 ,/imulant4 ,uses4--,weak he>t4 ,syncope4 ,collapse4 ,dose4--,= adult3 ( ! t9cture1 #e-ae 1 fl4 ext4 #a-c 1 ext4 gr4 #a_/f4 ,digipuratum4 ,a prep>ation ( digitalis f :i* ! inactive sub/ances h be5 remov$4 ,x is us$ 9 ! same conditions z digitalis4 ,dose4--,! tablets conta9 #a gr4 & "o is giv5 f\r times daily until t5 are tak54 ,!n /op4 ,hypod]mically4 ,ea* viol conta9s #a c4c4 ( fluid & equals #a gr4 ( digipuratum4 ,ea* dose conta9s en\gh ( ! active pr9ciple ( digitalis to kill a #cj gm4 frog4 ,ergot 7,fungus ( ,rye74 ,contracts un/rip$ muscle fib]4 ,uses4--,to *eck hmorrhage aft] labor4 ,to promote involution4 ,mu/ n be giv5 9 labor until ! ut]us is empty4 ,dose4--,by m\? #ae-fj ( ! fl4 ext4 ,hypod]mically1 #aj-bj 4 ,ergotole1 ,ergot9e4 ,conc5trat$ solutions ( ergot1 #b times z /rong z ! fluid extract4 ,!y are /]iliz$ & pres]v$ 9 glass amp\les4 ,uses4--,see ,ergot4 ,dose4--#cj-fj 4 ,gre5 ,soap4 ,a soap made ( l9se$ or o!r oil1 pota%1 alcohol & wat]4 8,! adoption by ! ,u4 ,s4 ,ph>macopoeia ( ! t]m ,sapo ,viridis 7gre5 soap7 is un=tunate1 s9ce s(t soap ev5 if made f gre5 hempse$ oil w become br[n-yell[ unless artificially color$40--,u4 ,s4 ,disp5satory4 ,hmophilia4 ,a condition ( ! blood :]e9 its clott+ p[] is dim9i%$ or abs5t4 ,coagul51 horse s]um1 or diph!ria antitox9 may be giv5 hypod]mically4 ,direct transfusion ( blood f ano!r is be/4 ,hyosc9e1 ,morph9e1 & ,cact94 7,h4 ,s4 ,c4 ,tablets74 ,a propriet>y comb9ation ( drugs4 ,! action is said to be simil> to t ( morph9e & scopolam9e4 ,iod9e1 ,t9cture4 ,uses4--,to /]ilize ! sk9 be=e op]ation4 ,9 vomit+ ( pregnancy x is sometimes effective4 ,drop doses may be giv5 well dilut$4 ,ext]nally x is appli$ to ulc]s1 z 9 ,b$n>'s disease1 & sometimes z a dress+ = ! cord4 ,9 pruritus vulv x is a valuable application4 ,iron4 ,tonic emm5agogue4 ,uses4--,to increase ! numb] ( r$ blood corpuscles4 ,to raise blood pressure & to increase ! secretion ( milk4 ,dose4--#c-e gr4 ,blaud's pill conta9s ! c>bonate 9 a =m t is easily assimilat$4 ,laxatives4 ,laxatives are unirritat+ & excite mod]ate p]i/alsis4 ,sulphur1 magnesia1 cassia1 manna1 casc>a sagrada1 ! ,h9kle pill1 & ! ,a1 ,b1 ,s pill are usually mild 9 action4 ,lysol4 ,dis9fectant & antiseptic = h&s & in/rum5ts4 ,x is a br[n syrupy fluid made f coal t> oil1 :i* is di/ill$ & mix$ ) fat1 soap1 etc4 ,x has a creosote odor & conta9s #ej cresol4 ,readily soluble 9 wat]4 ,prep>$ 9 -#d solutions4 ,magnesia1 ,calc9$4 ,antacid & ca?>tic4 ,comes 9 :ite cakes4 ,uses4--,acid /oma*1 vomit+ ( pregnancy1 8he>tburn10 & con/ipation4 ,dose4--#cj-abj gr4 ,magnesia1 ,milk (4 ,a mixture ( magnesia & wat]4 ,has ! same prop]ties z ! above4 ,dose4--,= adults1 #b-c teaspoonfuls4 ,= infants1 -#b teaspoonfuls4 ,magnesia ,sulphate 7,epsom ,salts474 ,sal9e ca?>tic4 ,uses4--,! pr(use wat]y /ools produc$ by magnesia are valuable aids to elim9ation :5 ! kidneys are ov]work$ or defective4 ,9 conge/ion ( ! brea/s & ?reat5$ eclampsia1 or 9 any case :]e x is desirable to dra9 (f wa/e or dehydrate ! sy/em4 ,dose4--#a teaspoonful daily 9 hot wat] be=e breakfa/4 -#a oz4 z a s+le dose or #a oz4 by rectum1 z 9 ! #a-b-c enema4 ,m5?ol 7,m9t ,camphor1 ,japanese ,pepp]m9t74 ,analgesic1 antiseptic1 an/hetic1 & vascul> /imulant4 ,uses4--,9 pruritus vulv1 vomit+ ( pregnancy1 & hmorrhoids4 ,dose4--,by m\? #c-e gr4 ,9 tampons1 "o "p to five ( oil4 ,9 o9tm5ts "o "p to sixte54 ,to ! vulva = pruritus1 use ! spirits 9 #e solution4 ,m]cury 7,hydr>gyrum74 ,ca?>tic1 alt]ative1 antisyphilitic1 antiseptic & dis9fectant4 ,readily absorb$ by ! unprotect$ muc\s surface & relatively in]t :5 ! membrane is cov]$ by a dis*>ge4 ,solutions ( ! bi*loride :5 us$ z a lotion unite ) ! album9 ( a muc\s dis*>ge & =m an album9ate ( m]cury1 :i* is inactive4 ,bi*loride solutions h small place 9 ob/etrics4 ,!y are h>d on ! h&s & de/ructive to in/rum5ts4 ,o!r ag5ts l lysol1 ziratol & *9osol h satisfactory g]micidal prop]ties & 9 addition are nonpoison\s1 lubricative & cleans+4 ,m]cury %\ld only be giv5 to ! infant 9 ! =m ( calomel 7! mild *loride74 ,! dose is #a_/ab- gr41 repeat$ if necess>y4 ,morph9e4 ,alkaloid ( opium4 ,antispasmodic1 hypnotic1 analgesic & n>cotic4 ,uses4--,to relieve pa91 produce sleep1 *eck di>rha1 & to control ! pa91 z well z ! contractions ( abortion4 ,to relax a rigid os4 ,dose4--,9 8,twilight ,sleep0 & rigid os ! fir/ dose is ,morph4 sul4 #a_/f gr4 & scopolam9e ,hydrobromid #a_/bjj-a_/aej4 ,! scopolam9e to be repeat$ if requir$1 9 "o-half or ?ree-qu>t]s ( an h\r4 ,! usual dose ( morph9e hypod]mically is #a_/ab gr4 ,nitroglyc]9e 7,glono974 ,vasomotor dilator1 art]ial /imulant4 ,uses4--,= ! pro/ration foll[+ hmorrhage4 ,dose4-#jj-a_/ej gr4 hypod]mically4 ,novoca9e4 ,local an/hetic1 simil> to coca9e1 b less toxic4 ,= local an/hesia 9 solutions ( #j4be to #b usually 9 association ) adr5al9 7#e-aj drops ( ! #a3ajjj solution to ea* #aj c4c4 ( novoca9e solution74 ,nux ,vomica4 ,! plant f :i* /ry*nia is d]iv$4 ,tonic1 /oma*ic1 & /imulant to muscle1 n]ve1 & he>t4 ,uses4--,bitt] tonic & /imulant4 ,vomit+ ( pregnancy & agalactia4 ,dose4--,t5 drops ( ! t9cture 9 wat] be=e meals4 ,opium4 ,! concrete juice ( ! poppy4 ,relieves pa94 ,con/ipates4 ,uses4--,hmorrhoids 9 adults1 colic & di>rha 9 infants4 ,dose4--,"o gra9 9 suppository night & morn+ = adult4 ,= infant1 z p>agoric only4 ,two to five drops only1 n repeat$4 ,*ildr5 be> opium badly4 ,peps94 ,a f]m5t 9 ! ga/ric juice t dige/s prote9s4 ,9 comm]ce x is obta9$ f ! pig4 ,uses4--,imp]fect dige/ion4 ,dose4--,= adult1 #aj-ae grs4 ,= infant1 #b gr4 ,ph5olph?ale94 ,a non(ficial coal t> d]ivative4 ,mild laxative4 ,dose4--#b-c gr4 ,ph5olax & *ocolax are prep>ations ( ! drug4 ,pituit>y ,extract 7,pituitr974 ,a sub/ance d]iv$ f ! infundibul> portion or ! po/]ior lobe ( ! hypophysis c]ebri4 ,nontoxic1 /imulant to un/rip$ muscle4 ,uses4--,ut]9e in]tia1 po/ p>tum hmorrhage1 ,cs>ean section & tympany4 ,w n produce abortion nor premature labor4 ,may be tri$ 9 acute anmia to raise ! blood pressure4 ,dose4--#e-ae 4 ,repeat$ if necess>y4 ,potassium 7or ,sodium7 ,bromide4 ,:ite granul> p[d]4 ,soluble1 #a to #e 9 wat]4 ,s$ative1 hypnotic1 antiepileptic4 ,uses4--,neura/h5ia1 convulsions1 nymphomania1 vomit+ ( pregnancy4 ,dose4--#bj-fj gr4 ,9 enema ) *loral4 ,pot4 bromide #dj gr4 & *loral #bj gr4 9 sev]al ounces ( wat] or milk4 ,potassium ,iodide4 ,alt]ative emm5agogue4 ,uric acid solv5t4 ,uses4--,syphilis rheumatism1 swell+s1 sl[ inflammations1 excessive secretion ( milk4 ,dose4--#b-aj gr4 increas$ z requir$4 ,potassium ,p]manganate4 ,d>k purple opaque prisms4 ,soluble 9 wat] #a to #af4 ,dis9fectant1 deodorant1 antiseptic1 a/r+5t4 ,uses4--,z an injection 9 leucorrha & gonorrha1 #a3ejjj solution4 ,purgatives4 ,simple purgatives produce free dis*>ges f ! b[els ) "s grip+4 ,s5na1 aloes1 rheub>b1 ca/or oil1 & calomel are examples4 ,sal9e purgatives are foll[$ by pr(use wat]y evacuations4 ,magnesia sulphate1 & citrate1 potassium & sodium t>trate1 & sodium phosphate belong to ?is class4 ,dra/ic purgatives br+ ab\t a viol5t action ( ! b[els ) mu* grip+ & t5esmus4 ,su* are jalap1 colocyn?1 elat]ium1 & croton oil4 ,hydrogogue purgatives comb9e ! results ( ! sal9es & dra/ics4 ,!y h mu* grip+ ) pr(use wat]y /ools4 ,! hydrogogues are elat]ium1 gamboge1 croton oil1 & potassium bit>trate4 ,qu99e ,sulphate4 7,d]iv$ f ,c9*ona b>k47 ,antipyretic1 tonic1 antip]iodic1 antiseptic1 emm5agogue & ecbolic4 ,uses4--,valuable /imulant 9 a sl[ fir/ /age4 ,x is comb9$ ) ca/or oil to br+ on labor at t]m4 ,ca/or oil #a oz4 & qu99e sulphate #aj gr4 is giv5 z ! fir/ dose1 foll[$ 9 an h\r by ano!r #aj gr4 ( qu99e1 & an h\r lat] by ano!r4 ,dose4--#b-bj gr4 ,regul94 ,a mixture ( ag>-ag> 9 dry =m ) extract ( casc>a sagrada4 ,uses4--,a laxative 9 *ronic con/ipation4 ,dose4--,teaspoonful to tablespoonful 9 /ew$ fruit or ma%$ potatoes1 once daily4 ,russian ,oil 7,liquid ,petrolatum74 ,laxative 9 pregnancy & pu]p]ium4 ,acts me*anically & z a lubricant4 ,n unpleasant to take4 ,dose4- oz4 at b$time1 &1 if necess>y1 be=e ea* meal4 ,may be giv5 to brea/-f$ babies 9 doses ( gtts4 xv ?ree times daily4 ,s5na4 ,laxative & purgative4 ,acts especially on ! l>ge inte/9e4 ,sometimes passes ov] 9 ! milk to ! *ild4 ,dose4--,fl4 ext4 #a-d teaspoonfuls4 ,9 comp\nd licorice p[d] ! dose is #cj-hj gr4 7ab\t #aj gr4 ( s5na to ! dose74 ,silv] ,nitrate4 ,cau/ic1 antiseptic1 /imulant1 irritant & antigonorrhic4 ,table salt neutralizes x4 ,uses4--#b solution 9 wat] = pruritus vulv4 #a solution dropp$ into ! eyes ( ! newborn to prev5t oph?almia neonatorum4 ,d n neutralize ! #a solution4 gr4 silv] nitrate ) #b gr4 ( peps9 9 capsule = p]nici\s vomit+ ( pregnancy4 ,sodium ,bic>bonate 7,bak+ p[d]74 ,antacid1 antirheumatic4 ,uses4--,g\t1 dyspepsia1 acid /oma*1 acidosis1 vomit+ ( pregnancy4 ,soo!s ! sk9 :5 burn$4 ,sodium ,*loride4 7,salt47 ,= normal sal9e use #aj gr4 to #c oz4 ( wat]4 ,= physiological salt solution1 add #ae gr4 ( ,sod4 ,c>b4 to e #c oz4 ( normal sal9e z made above4 ,sodium ,citrate4 ,a :ite odorless1 granul> p[d] ) cool+ salty ta/e4 ,uses4--,diuretic1 antipyretic & refrig]ant4 ,ret>ds ! coagulation ( album9 9 milk & aids ! dige/ibility ( prote9s4 ,may be indicat$ 9 g\t & cy/itis4 ,dose4--,int]nally1 #ae to #fj gr4 ,9 ! modification ( c['s milk ab\t two gra9s %\ld be us$ = ea* ounce ( ! mixture4 ,spirits ( ,nitre1 ,sweet 7,_s ,nitr\s ,e!r74 #d solution ( nitr\s e!r 9 alcohol4 ,diaphoretic1 diuretic1 antipyretic1 /imulant1 antispasmodic4 ,uses4--,fev]1 dropsy1 vomit+ ( pregnancy1 colic1 anuria4 ,dose4--,= adult1 #bj-fj gtts4 ,= infants small doses (t5 repeat$4 ,/ramonium 7,jimson ,we$74 ,hypnotic1 n>cotic1 antispasmodic4 ,uses4--,= hmorrhoids take ,ung4 ,/ramonii & ,ung4 ,galli 9 equal am\nts & apply4 ,urotrop94 ,a :ite p[d] soluble 9 wat]4 ,ur9>y antiseptic1 diuretic4 ,uses4--,cy/itis1 typhoid bacilli 9 ur9e1 g\t4 ,x makes ! ur9e irritat+ly acid :5 giv5 long4 ,x does n act 9 alkal9e m$ia4 ,dose4--#g-aj gr4 well dilut$4 ,val]ian4 ,anodyne1 /imulant1 antispasmodic & n]v9e4 ,uses4--,hy/]ia1 hypo*ondriasis1 heada*e4 ,dose4--#cj-fj ( ! fl4 ext4 by m\?1 or by rectum #b oz4 ( ! foll[+ mixture may be us$ ,p4,r4,n4 = hy/]ia3 ,pot4 ,brom4 #a oz4 ,ext4 ,val]ian fl4 dr4 vi4 ,normal sal9e q4s4 oz xii4 ,v]atrum ,viride 7,hellebore74 ,s$ative1 emetic1 diaphoretic1 diuretic4 ,ret>ds ! he>t's action )\t weak5+ x4 ,uses4--,eclampsia4 ,dose4--#a to #d ( ! fl4 ext4 is giv5 h\rly until ! pulse comes d[n to #hj4 ,v]onal4 ,safe1 reliable hypnotic4 ,uses4--,insomnia f hy/]ia1 neura/h5ia1 & m5tal di/urbance4 ,dose4--#e to #ae gr4 dissolv$ 9 hot tea1 milk1 or wat]4 ,may repeat4 ,z9c4 ,tonic1 a/r+5t1 antispasmodic4 ,uses4--,/e>ate ( z9c is a valuable dress+ 9 excoriations ( buttocks & ext]nal g5itals4 ,z9c ,o9tm5t4 ,x is indicat$ = b$sores 7decubitus7 eczema1 h]pes1 & int]trigo4 ,z9c o9tm5t conta9s "o "p ( z9e oxide to f\r p>ts ( b5zo9at$ l>d4 ,ziratol4 ,a mixture ( ph5ols 9 soap1 wat]1 & glyc]9e4 ,antiseptic1 deodorant & g]micide4 ,relatively odorless1 easily soluble & does n injure h&s1 in/rum5ts1 or rubb]4 ,x is said to be only z toxic z c>bolic acid4 ,us$ 9 solutions ( #j4e up to #e4 ,,gloss>y ,adapt$ f ,dorl& & ,/&>d ,diction>ies ,ab-normal4 ,n normal2 contr>y to ! usual /ructure or condition4 ,a-bortion4 #a4 ,! expulsion ( ! ftus be=e x is viable4 #b4 ,premature /oppage ( a morbid or a natural process4 ,ab-rasion4 #a4 ,a rubb+ or scrap+ (f4 #b4 ,a spot rubb$ b>e ( sk9 or muc\s membrane4 ,abscess4 ,a localiz$ collection ( pus 9 a cavity =m$ by ! dis9tegration ( tissues4 ,ac-c\*e-m5t4 ,deliv]y 9 *ildb$2 conf9em5t4 ,ace-tone4 #a4 ,a colorless liquid f\nd 9 pyro-acetic acid & 9 naph?a4 #b4 ,any memb] ( ! s]ies to :i* ! normal or typical acetone belongs4 ,aci-dsis4 ,acid intoxication ( ! sy/em f ! elaboration or too mu* acid by faulty metabolism or ! imp]fect disposition ( normal am\nts ( acid4 ,a-cinus1 pl4 ac9i4 ,"o 7ac9i1 m ?an "o7 ( ! smalle/ lobules ( a comp\nd gl&4 ,albo-l5e4 ,an oily :ite sub/ance d]iv$ f petroleum4 ,albu-mi-nuri-a4 ,! pres5ce ( album9 9 ! ur9e4 ,alka-l9e4 ,hav+ ! reaction ( an alkali4 ,am5-or-rha4 ,abs5ce or abnormal /oppage ( ! m5ses4 ,am-moni-a4 ,a colorless alkal9e gas1 ,,nh#c1 ( p5etrat+ odor1 & soluble 9 wat]1 =m+ ammonia-wat]4 ,ammoniacal ur9e conta9s ammonia1 :i* is "o =m ( nitrog5 excretion4 ,an-mi-a4 ,a condition 9 :i* ! blood is defici5t 9 quantity or 9 quality4 ,ans-!si-a4 ,loss ( feel+ or s5sation1 especially loss ( tactile s5sibility1 ?\gh ! t]m is us$ = loss ( any ( ! o!r s5ses4 ,ans-!tic4 #a4 ,)\t ! s5se ( t\* or ( pa94 #b4 ,a drug t produces an/hesia4 ,anal-gesi-a4 ,abs5ce ( s5sibility to pa94 ,an-aphro-disi-ac4 ,a drug t allays sexual desire4 ,ana-s>ca4 ,an accumulation ( s]um 9 ! cellul> tissues ( ! body4 ,anen-cephal-ous4 ,hav+ no bra94 ,anky-losis4 ,abnormal rigidity or /iffness ( a jo9t4 ,ano-dyne4 ,a m$ic9e t relieves pa94 ,ante p>tum4 ,lat9 = 8be=e deliv]y40 ,an-teri-or4 ,situat$ 9 front (1 or 9 ! =w>d "p (4 ,anti-peri-odic4 ,a drug t t5ds to prev5t recurr5t attacks ( disease4 ,anti-septic4 #a4 ,prev5t+ decay or putrefaction4 #b4 ,a sub/ance de/ructive to poison\s g]ms4 ,a-peri-ent4 ,mildly ca?>tic4 ,ap-na4 ,! abs5ce ( respiration--especially t =m :i* occurs 9 a *ild deliv]$ by ! ,cs>ean op]ation4 ,a-reo-la4 ,! d>ki% r+ ar\nd ! nipple4 ,z-cites4 ,dropsy 7an accumulation ( fluid7 9 ! abdom54 ,a-sepsis4 ,abs5ce ( septic matt]1 or fre$om f infection4 ,z-phyxi-a4 ,suffocation4 ,z-tr9g5t4 #a4 ,caus+ contraction & arre/+ dis*>ges4 #b4 ,an ag5t t arre/s dis*>ges4 ,ate-lec-tasis4 ,imp]fect expansion ( ! lungs at bir?2 p>tial collapse ( ! lung4 ,aton-y4 ,lack ( normal tone or /r5g?4 ,atri-um4 7,l41 a hall47 ,! po9t ( entrance ( a bact]ial disease4 ,atti-tude4 ,a po/ure or position ( ! body4 ,! relation :i* ! v>i\s p>ts ( ! *ild's body be>s to its own long axis4 ,! attitude ( ! ftus normally is complete flexion4 ,auscul-tation4 ,! act ( li/5+ = s\nds )9 ! body4 ,bac-teri-a4 ,! vegetable microorganisms 7,s*izomycetes7 especially ! %ort-rod =ms4 ,balan-itis4 ,inflammation ( ! glans p5is4 ,x is usually associat$ ) phimosis4 ,bal-lottem5t4 ,! diagnosis ( pregnancy by pu%+ up ! ut]us by a f+] ins]t$ into ! vag9a s z to cause ! embryo to rise & fall aga9 l a heavy body 9 wat]4 ,b>?o-l9 gl&s4 ,! vulvo-vag9al gl&s4 ,bleb4 ,a sk9 vesicle fill$ ) fluid4 ,a bli/]4 ,bregma4 ,! po9t on ! surface ( ! skull at ! junction ( ! coronal & sagittal sutures4 ,c-sare-an section4 7,nam$ f ,julius ,cs>1 :o is said to h be5 ?us born74 ,deliv]y ( ! ftus by an incision ?r\gh ! abdom9al & ut]9e walls4 ,caput4 ,any head1 or head-l /ructure4 ,caput succe-dane-um4 ,a swell+ =m$ on ! pres5t+ "p ( ! ftus dur+ labor4 ,x is due to ! effusion ( fluid into ! subcutane\s tissues ( ! scalp & its ret5tion !re4 ,c>-m9a-tive4 ,drugs t /imulate ! circulation1 ! m5tal faculties1 & inte/9al p]i/alsis4 ,asaftida1 camphor1 capsicum1 c>damon1 *lor(orm1 e!r1 g+]1 hors]adi%1 mu/>d1 & ! oils ( anise1 cloves1 spe>m9t1 nutmeg & val]ian are c>m9atives4 ,c>ne-ous4 ,fle%y4 ,ca?e-t]1 tra*e-al4 ,a long sl5d] tube design$ = introduction into ! babe's tra*ea z a means ( suck+ out mucus4 ,ca?e-t]-ize4 ,to introduce a tube & draw (f fluid1 z ur9e or mucus4 ,caul4 #a4 ,! great om5tum4 #b4 ,a piece ( amnion :i* sometimes envelopes a *ild's head at bir?4 ,cell4 #a4 ,any "o ( ! m9ute protoplasmic masses :i* make up organiz$ tissue4 ,ceph-alic4 #a4 ,p]ta9+ to ! head4 #b4 ,a m$ic9e = ! head4 ,cephal-h-ma-toma4 #a4 ,a tumor or swell+ fill$ ) blood b5ea? ! p]icranium4 ,c]vix4 ,! neck or any neck-l "p4 ,*lo-zma4 ,! yell[i% br[n spots or pat*es t appe> on ! sk9 ( pregnant wom54 ,cica-tricial4 ,p]ta9+ to1 or ( ! nature (1 a cicatrix4 ,ci-catrix4 ,a sc>2 ! m>k left by a sore or w\nd4 ,cili-a4 #a4 ,! eyela%es4 #b4 ,m9ute la%-l processes t *>act]ize c]ta9 cells4 ,climac-t]ic4 ,a p>ticul> epo* ( ! ord9>y t]m ( life at :i* ! body is believ$ to und]go a radical *ange--especially appli$ to ! m5opause4 ,cli-nicians4 ,m5 :o tea* & expla9 diseases by %[+ actual cases4 ,clito-ris4 ,! s5sitive organ ( ! female1 homolog\s ) ! p5is 9 ! male4 ,coccyx4 ,! small bone situat$ at ! end ( ! sacrum4 ,! v la/ portion ( ! sp9e4 ,col-lapse4 ,a /ate ( extreme pro/ration & depression ) failure ( circulation4 ,colles' membrane4 ,a lay] ( t\gh s5sitive fascia back ( ! p]9eum & on ei!r side ( ! vag9a4 ,co-lostrum4 ,! fir/ fluid secret$ by ! mamm>y gl&s aft] functional activity beg9s4 ,x conta9s case9 & m album5 ?an milk1 z well z num]\s fatty globules4 ,colpeu-rynt]4 ,a dilatable bag1 us$ to di/5d ! vag9a4 ,coma4 ,pr(\nd /upor occurr+ 9 ! c\rse ( a disease or aft] sev]e injury4 ,coma-tose4 ,p]ta9+ to1 or affect$ )1 coma4 ,compli-cation4 ,a disease or diseases concurr5t ) ano!r disease4 ,con-ception4 ,! fecundation ( ! ovum4 ,condyl-oma4 ,a w>t-l excresc5ce ne> ! anus or vulva4 ,x may be z l>ge z a caulifl[]4 ,con-g5i-tal4 ,born ) a p]son2 exi/+ at or be=e1 bir?4 ,conju-gate4 ,! ant]opo/]ior diamet] ( ! pelvic inlet4 ,coro-nal4 ,p]ta9+ to ! cr[n ( ! head1 z ! coronal suture4 ,cradle cap4 ,! dirty look+ pat* ( epi!lial scales & sebace\s mat]ial t develops ov] ! ant]ior fontanelle ( babies :o h ! exudative dia!sis4 ,crani-oto-my4 ,! cutt+ 9 pieces ( ! ftal head to facilitate deliv]y4 ,cre-d ,expression4 ,! maneuv] 9 :i* ! ut]us is grasp$ 9 ! holl[ ( ! h& & squeez$ & press$ d[n ^u to aid 9 ! expulsion ( ! plac5ta4 ,cre-d ,treatm5t4 ,! in/illation ( a #a solution ( nitrate ( silv] into ! eyes ( ! newborn to prev5t oph?almia4 ,curd4 ,! coagulum ( milk1 consi/+ ma9ly ( case94 ,cyan-osis4 ,blu5ess ( ! sk91 (t5 due to c>diac mal=mation caus+ insuffici5t oxyg5ation ( ! blood4 ,cys-titis4 ,inflammation ( ! bladd]4 ,de-cidu-a4 ,! membran\s /ructure produc$ 9 ! ut]us dur+ ge/ation & ?r[n (f aft] p>turition4 ,d4 reflexa1 ! "p ( decidua :i* is reflect$ ^u & surr\nds ! ovum4 ,d4 s]ot9a1 ! late decidua2 ! "p ( ! decidua v]a :i* becomes ! mat]nal portion ( ! plac5ta4 ,d4 ,v]a1 ! true decidua2 ! portion ( ! decidua :i* l9es ! ut]us4 ,de-cubi-tus4 #a4 ,an act ( ly+ d[n4 #b4 ,a b$-sore4 ,de-hydrate4 ,to remove ! wat]4 ,dia-betes4 ,a disease m>k$ by an habitual dis*>ge ( an excessive quantity ( ur9e & ! pres5ce ( sug> !re94 ,diaph-o-resis4 ,p]spiration1 & especially pr(use p]spiration4 ,diaph-o-retic4 #a4 ,/imulat+ ! secretion ( sweat4 #b4 ,a m$ic9e t increases ! p]spiration4 ,di-a?e-sis4 ,natural or cong5ital pr$isposition to a special disease4 ,diff]-ential4 ,p]ta9+ to a diff]5ce1 or diff]5ces4 ,dis-crete4 ,sep>ate lesions :i* d n bl5d or coalesce4 ,diu-resis4 ,increas$ secretion ( ur9e4 ,dorsum4 ,! back or any "p correspond+ to ! back z ! dorsum ( ! p5is or foot4 ,ductus ve-nosus4 ,a ftal blood vessel connect+ ! umbilical ve9 ) ! po/-cava4 ,dys-crasi-a4 ,a deprav$ /ate ( ! sy/em1 & especially ( ! blood1 due to con/itutional disease4 ,dysp-na4 ,difficult or labor$ brea?+4 ,dys-toci-a4 ,pa9ful or sl[ deliv]y or bir?4 ,ec-bolic4 ,an ag5t t accel]ates labor4 ,e-clampsi-a4 ,a sudd5 attack ( convulsions1 especially "o ( a p]iph]al orig94 ,ec-topic4 ,out ( ! normal place4 ,e-dema4 ,swell+ due to effusion ( wat]y liquid into ! connective tissue4 ,embo-lism4 ,! plugg+ ( an art]y or ve9 by a clot or ob/ruction :i* has be5 br\ght to its place by ! blood-curr5t4 ,embry-o4 ,! ftus 9 its e>li] /ages ( developm5t1 especially be=e ! end ( ! ?ird mon?4 ,em-m5a-gogue4 ,a drug t aids or /imulates m5/ruation4 ,e-mulsion4 ,an oily or res9\s sub/ance divid$ & held 9 susp5sion ?r\gh ! ag5cy ( an adhesive1 mucilag9\s1 or o!r sub/ance4 ,end-metri-um4 ,! muc\s membrane t l9es ! cavity ( ! ut]us4 ,en-gagem5t4 ,! head is said to be engag$ :5 ! l>ge/ diamet]s h pass$ ! inlet4 ,ensi-=m4 ,%ap$ l a sword4 ,epi-si-oto-my4 ,surgical incision ( ! vulv> orifice lat]ally = ob/etric purposes4 ,e-rosion4 ,an eat+ or gnaw+ away4 ,ery-!ma4 ,a morbid r$ness ( ! sk9 due to conge/ion ( ! capill>ies1 ( _m v>ieties4 ,eti-olo-gy4 ,! /udy or !ory ( ! causation ( any disease4 ,ex-cori-ation4 ,any sup]ficial loss ( sub/ance su* z t produc$ on ! sk9 by scrat*+4 ,exos-mosis 7,ex-os-mose74 ,diffusion or osmosis f )9 outw>d4 ,ex-sangu9-ation4 ,an exhau/ion ( ! blood f a "p or ! :ole ( ! body4 ,ex-traction4 ,! process or act ( pull+ or draw+ out1 p>ticul>ly ! removal ( a *ild by pull+ ei!r ) h&s or =ceps4 ,extra-ut]-ine4 ,situat$ or occurr+ outside ( ! ut]us4 ,exu-dative di-a?e-sis4 ,a cong5ital pr$isposition to eczema 9 v>i\s p>ts ( ! body1 z well z to infections ( ! respiratory tract4 ,fces 7or feces74 ,! excrem5t or undige/$ residue ( ! food dis*>g$ f ! b[els4 ,f5es-tra-t$4 7,l41 f5e/rum1 a w9d[47 ,pi]c$ ) "o or m op5+s1 l w9d[s4 ,f]m5t4 ,any sub/ance t causes f]m5tation 9 o!r sub/ances ) :i* x comes 9 contact4 ,fibr94 ,a sub/ance :i*1 becom+ solid 9 %$ blood1 plasma & lymph1 causes ! coagulation ( ^! fluids4 ,fillet4 #a4 ,a loop-%ap$ /ructure4 #b4 ,a loop1 z ( cord or tape1 = mak+ traction4 ,fissure4 ,a cleft or groove1 normal or o!r4 ,fistu-la4 ,a deep1 s9u\s ulc]1 (t5 lead+ to an int]nal holl[ organ4 ,fluid extract4 ,a conc5trat$ solution ( ! active pr9ciple ( a drug 9 su* /r5g? t #a c4c4 ( ! product equals #a gr4 ( ! crude drug4 ,! fluid is a mixture ( alcohol1 wat] & glyc]9e 9 v>y+ proportions4 ,"o may be omitt$4 ,ftus 7or fetus74 ,! unborn (fspr+ ( any animal t br+s =? liv+ prog5y2 ! *ild 9 ! womb aft] ! ?ird mon?4 ,fonta-nelle4 ,any "o ( ! unossifi$ spots on ! cranium ( a "y infant4 ,x is s nam$ because x rises & falls l a f\nta94 ,fo-ram54 ,a hole or p]=ation1 especially a hole 9 a bone4 ,f\r-*ette4 ,! fold ( muc\s membrane at ! po/]ior junction ( ! labia majora4 ,frnum 7or frenum74 ,a fold ( ! integum5t or ( ! muc\s membrane t *ecks1 curbs1 or limits ! movem5ts ( an organ 9 "p--z ! frnum ( ! tongue4 ,function4 ,! normal or prop] action ( an organ or set ( organs4 ,function-al4 ,( or p]ta9+ to a function4 ,fundus4 ,! base or "p ( a holl[ organ remote/ f its m\?4 ,ga-lactor-rha4 ,excessive secretion ( milk4 ,ga-vage4 ,fe$+ by ! /oma* tube2 also ! !rapeutic use ( a v full diet4 ,g5x-als4 ,! reproductive organs4 ,g]mi-cide4 ,an ag5t t de/roys g]ms4 ,ges-tation4 ,pregnancy4 ,glans cli-tori-dis4 ,! di/al or outside end ( ! clitoris4 ,glans penis4 ,! head1 or t]m9al end1 ( ! p5is4 ,gon-or-rha4 ,a contagi\s cat>rhal inflammation ( ! g5ital muc\s membrane4 ,graafi-an folli-cle4 ,any "o ( ! small sph]ical ov>ian bodies1 ea* ( :i* conta9s an ovum4 ,hmo-phili-a4 ,a condition ( ! sy/em :]e9 ble$+ occurs readily1 & ! blood clots sl[ly or n at all4 ,hmor-rhage4 ,a copi\s escape ( blood f ! vessels2 ble$+4 ,accid5tal h41 hmorrhage dur+ pregnancy1 due to premature deta*m5t ( ! plac5ta4 ,po/ p>tum h41 t :i* occurs soon aft] labor1 or *ildbir?4 ,unavoidable h41 t :i* results f ! deta*m5t ( a plac5ta prvia4 ,hmor-rhoid4 ,a pile1 or vascul> tumor ( ! rectal muc\s membrane4 ,hy-datid4 ,an ency/$ vesicle conta9+ an ency/$ fluid4 ,f ! ,greek 8,hydatis10 mean+ a drop ( wat]4 ,hy-dati-=m4 ,resembl+ a hydatid 9 =m4 ,hy-dramni-os4 ,dropsy ( ! amnion4 ,hydro-cepha-l\s4 ,a fluid effusion )9 ! cranium4 ,?is disease is m>k$ by enl>gem5t ( ! head1 ) prom95ce ( ! =ehead1 atrophy ( ! bra91 m5tal weakness1 & convulsions4 ,hygi5e4 ,! sci5ce ( heal? & ( its pres]vation4 ,hym54 ,! membran\s fold :i* p>tially or :olly occludes ! ext]nal orifice ( ! vag9a1 at lea/ dur+ virg9ity4 ,hyp]-eme-sis4 ,excessive vomit+4 ,h4 gra-vi-darum1 excessive vomit+ ( pregnancy4 ,hyp]-mi-a4 ,excess ( blood 9 any "p ( ! body4 ,hy-p]tro-phy4 ,! morbid enl>gem5t or ov]gr[? ( a "p4 ,hyp-nic4 ,a drug t induces sleep4 ,hypo-d]-mocly-sis4 ,! introduction1 into ! subcutane\s tissues1 ( fluid 9 l>ge quantity4 ,hypo-gastric4 ,( or p]ta9+ to ! l[] ant]ior region ( ! abdom5 9 ! middle l9e ( ! body4 ,! hypoga/ric art]ies arise f ! int]nal iliac 9 addition to ! bran*es giv5 (f f ^? vessels 9 ! adult4 ,hypo-phosphite4 ,any salt ( hypophosphor\s acid4 ,ict]-u4 ,jaundice4 ,idi-o-syncra-sy4 ,an effect abnormal to ! "o usually produc$4 ,an effect peculi> to ! individual4 ,im-muni-ty4 ,! condition ( be+ immune or exempt f disease1 especially ! condition aris+ f inoculation1 or f a peculi> resi/ance ( ! organism4 ,impreg-nation4 #a4 ,! act ( fecundation or ( r5d]+ pregnant4 #b4 ,! process or act ( saturation1 a saturat$ condition4 ,9f>ct4 ,a mass ( sub/ance extravasat$ ei!r into ! sub/ance ( an organ or into a vessel due to ! ob/ruction to ! circulation4 ,9fan-tile pelvis4 ,a pelvis :i* has n respond$ to ! developm5tal /imulation ( ! sexual gl&s at pub]ty1 & !re=e rema9s 9 its infantile %ape4 ,a mascul9e pelvis4 ,9fan-tile ut]-u4 ,an undevelop$ ut]us4 ,9-fection4 ,! communication ( disease f "o p]son to ano!r1 :e!r by effluvia or by contact1 m$iate or imm$iate2 also ! implantation ( disease f )\t4 ,9fil-tration4 ,to cause a liquid or gas to p5etrate or ent] by pores or int]/ices4 ,9flam-mation4 ,a morbid condition *>act]iz$ by pa91 heat1 r$ness & swell+4 ,9-nom9-ate4 ,n hav+ a "n1 z ! innom9ate bone4 ,9-somni-a4 ,inability to sleep2 abnormal wakefulness4 ,9t]-/itial4 ,p]ta9+ to1 or situat$ 91 ! int]/ices or int]spaces ( a tissue4 ,9t]-trig4 ,a *afe1 or *af$ pat* ( ! sk92 also ! ery!ma or eczema t may result f a *afe ( ! sk94 ,9-troi-tus4 ,! entrance to any cavity or space4 ,9-v]sion4 ,a turn+ inw>d1 inside out1 upside d[n1 or o!r rev]sal ( ! normal relation ( a "p4 ,9vo-lution4 #a4 ,a roll+ or turn+ inw>d4 #b4 ,! return ( ! ut]us to its normal size aft] p>turition4 #c4 ,a retrograde *ange1 ! rev]se ( evolution4 ,is-*uri-a p>-a-doxa4 ,a condition 9 :i* ! bladd] is ov]-di/5d$ ) ur9e1 al?\gh ! pati5t cont9ues to ur9ate1 g5]ally 9 dribbles4 ,jaundice4 ,yell[ness ( ! sk91 eyes1 & secretions1 due to ! pres5ce ( bile pigm5ts 9 ! blood4 ,labi-a4 ,lip-%ap$ organs4 ,! ext]nal folds ( ! vulva1 labia majora1 & ! int]nal folds ( ! vulva1 labia m9ora4 ,lace-ration4 #a4 ,! act ( te>+4 #b4 ,a w\nd made by te>+4 ,lac-tation4 #a4 ,! secretion ( milk4 #b4 ,! p]iod ( ! secretion ( milk4 #c4 ,suckl+4 ,lan-ug4 ,! f9e hair on ! body ( ! fetus4 ,lav-age4 ,! irrigation or wa%+ out ( an organ1 su* z ! /oma* or b[el4 ,lesion4 ,any hurt1 w\nd or local deg5]ation4 ,leucor-rha4 ,a :iti%1 viscid dis*>ge f ! vag9a & ut]9e cavity4 ,lighten-+4 ,! s5se ( lightness & easi] brea?+ t foll[s ! desc5t ( ! head into ! pelvis dur+ ! la/ ?ree weeks ( pregnancy4 ,x is mo/ likely to occur 9 primip>as4 ,lo*i-a4 ,! vag9al dis*>ge t takes place dur+ ! fir/ week or two aft] *ildbir?4 ,lymph4 ,a transp>5t slightly yell[ liquid ( alkal9e reaction :i* fills ! lymphatic vessels4 ,mal-aise4 ,an uneas9ess or indisposition1 discom=t or di/ress4 ,malpo-sition4 ,abnormal or anomal\s position4 ,mamma4 ,! mamm>y gl&2 ! brea/4 ,mamma-ry4 ,p]ta9+ to ! ,mamma4 ,ma-rasmus4 ,progressive wa/+ & emaciation1 especially su* a wa/+ 9 "y *ildr5 :5 !re is no obvi\s or asc]ta9able cause4 ,mas-sage4 ,! sy/ematic1 !rapeutic friction1 /rok+ & knead+ ( ! body4 ,mas-titis4 ,inflammation ( ! brea/4 ,me-atus4 ,a passage or op5+1 z ! meatus ur9>ius4 ,me-lna ne-o-na-torum4 ,! passage ( d>k pit*y /ools conta9+ blood pigm5ts & blood t has be5 extravasat$ into ! alim5t>y canal ( ! newborn babe4 ,membrane4 ,a ?9 lay] ( tissue :i* cov]s a surface or divides a space or organ4 ,m5o-pause4 ,! p]iod :5 m5/ruation normally ceases2 ! *ange ( life4 ,mis-c>riage4 ,abortion2 premature expulsion ( ! ftus2 bir? ( ! ftus be=e ! tw5ty-eigh? week4 ,milk leg 7,phlegmasia ,alba ,dol5s74 ,a condition develop+ 9 "o1 & r>ely1 9 bo?1 legs1 aft] deliv]y4 ,x is due to occlusion ( ! ve9s ( ! pelvis & leg by ?rombosis or to septic inflammation ( ! pelvic connective tissue4 ,mole4 #a4 ,a fle%y mass or tumor =m$ 9 ! ut]us by ! deg5]ation or abortive developm5t ( an ovum4 #b4 ,a nevus2 also a br[ni% spot on ! sk94 ,mons v5er-is4 ,a r\nd$ prom95ce at ! symphysis pubis ( a woman4 ,mor-bidi-ty4 ,! condition ( be+ diseas$ or morbid4 ,morcel-lation4 ,division & piecemeal removal4 ,mucus4 ,! viscid wat]y secretion ( ! muc\s gl&s4 ,mul-tipar-a4 ,a woman :o has borne m ?an "o *ild4 ,mummi-fi-cation4 ,dry gangr5e2 also ! dry+ up & %rivell+ ( ! ftus4 ,mydri-atic4 ,a drug t dilates ! pupil4 ,nause-a4 ,t5d5cy to vomit2 sickness at ! /oma*4 ,ne-crosis4 ,dea? ( a tissue1 especially ( a bone4 ,ne-phritis4 ,inflammation ( ! kidney4 ,neu-rotic4 #a4 ,p]ta9+ to or affect$ ) a neurosis4 #b4 ,p]ta9+ to ! n]ves4 ,neutra-lize4 ,to r5d] neutral or ineffective4 ,nitro-g54 ,a colorless gase\s elem5t f\nd free 9 air4 ,nodu-l>4 #a4 ,l a nodule or node4 #b4 ,m>k$ ) nodules4 ,nucle-u4 #a4 a sph]oid body )9 a cell1 =m+ ! ess5tial & vital "p4 #b4 ,a mass ( gray matt] 9 ! c5tral n]v\s sy/em4 #c4 ,9 *emi/ry1 ! c5tral elem5t 9 ! molecule ( a comp\nd4 ,nutri-ent4 ,n\ri%+2 af=d+ nutrim5t4 ,nymph4 ,! labia m9ora4 ,ob-/etrics4 ,! art ( manag+ *ildbir? cases2 t bran* ( surg]y :i* deals ) ! managem5t ( pregnancy & labor4 ,ob-/e-trician4 ,"o :o practices ob/etrics4 ,occi-put4 ,! back "p ( ! head4 ,oli-g-hy-dramni-os4 ,scant9ess ( ! liquor amnii4 ,oli-gop-na4 ,a delay foll[+ ! bir? ( a *ild be=e ! fir/ respiration is e/abli%$4 ,oph-?almi-a4 ,sev]e inflammation ( ! eye or ( ! conjunctiva4 ,organ4 ,any "p ( ! body hav+ a special function4 ,os4 7,l41 a m\?47 ,! orifice 9 ! ut]us or vag9a4 ,os-mosis4 ,! passage ( a fluid ?r\gh a membrane4 ,ova4 ,lat9 plural ( ovum1 egg4 ,ovu-lation4 ,! =mation & dis*>ge ( an unimpregnat$ ovum f ! ov>y4 ,ovule4 #a4 ,! ovum )9 ! ,graafian vesicle4 #b4 ,any small egg-l /ructure4 ,ovum4 #a4 ,an egg4 #b4 ,! female reproductive cell :i*1 aft] f]tilization1 develops into a new memb] ( ! same species4 ,oxy-diz]4 ,any?+ t comb9es ) oxyg54 ,pal-pation4 ,! act ( feel+ ) ! h&2 ! application ( ! f+]s ) light pressure to ! surface ( ! body = ! purpose ( det]m9+ ! consi/5ce ( ! p>ts b5ea? 9 physical diagnosis4 ,p>-aly-sis1 ,erb's4 #a4 ,same z bir?-palsy4 #b4 ,p>tial p>alysis ( ! bra*ial plexus affect+ v>i\s muscles ( ! arm & *e/-walls4 ,x is reveal$ by an inability to lift ! arm t[>d ! head4 ,p>-aly-sis facial 7,bell's74 ,p>alysis ( ! face1 due to lesion ( ! facial n]ve or ( its nucleus4 ,p>a-me-tritis4 ,inflammation ( ! p>ametrium1 or cellul> tissue ab\t ! ut]us4 ,p>a-phi-mosis4 ,retraction ( a n>r[ or inflam$ =esk9 :i* c n be replac$4 ,pa-r5*y-ma4 ,! ess5tial or functional elem5ts ( an organ z di/+ui%$ f its /roma or framework4 ,pa-rie-tal4 ,(1 or p]ta9+ to1 ! walls ( a cavity4 ,p>o-ny*i-a4 ,infection & suppuration ab\t ! junction ( nails & sk94 ,p>ox-ysm4 ,a sudd5 recurr5ce or sudd5 int5sification ( symptoms4 ,pa?-o-logic4 ,p]ta9+ to pa?ology4 ,pa-?olo-gy4 ,t bran* ( m$ic9e :i* treats ( ! ess5tial nature ( disease1 especially ( ! /ructural & functional *anges caus$ by disease4 ,pel-vime-t]4 ,an in/rum5t = measur+ ! v>i\s diamet]s ( ! pelvis4 ,pel-vime-try4 ,! act ( det]m9+ ! dim5sions ( ! pelvis by means ( a pelvimet]4 ,p]i-ne-orrha-phy4 ,suturation ( ! p]9eum1 p]=m$ = ! repair ( a lac]ation4 ,p]i-neum4 ,! space or area betwe5 ! anus & ! g5ital op5+4 ,pe-riphe-ry4 ,! outw>d "p or surface4 ,p]i-to-neum4 ,! s]\s membrane :i* l9es ! abdom9al walls4 ,p]i-to-nitis4 ,inflammation ( ! p]itoneum4 ,p]i-/alsis4 ,a worm-l movem5t by :i* ! alim5t>y canal propels its cont5ts4 ,p]-nici\s4 ,t5d+ to a fatal issue4 ,phe-nome-non4 ,any rem>kable appe>ance2 any sign or objective symptom4 ,physi-o-logic4 ,p]ta9+ to physiology4 ,physi-olo-gy4 ,! sci5ce :i* treats ( ! functions ( ! liv+ organism & its p>ts4 ,phi-mosis4 ,tightness ( ! =esk9 su* t x c n be drawn back ov] ! glans4 ,phle-bitis4 ,inflammation ( a ve94 ,pigm5-tation4 ,! deposition ( color+ matt]4 ,pla-c5ta prvi-a4 ,a plac5ta :i* int]v5es betwe5 ! intraut]9e cavity & ! inn] orifice ( ! c]vical canal4 ,pla-c5ta succ5-turi-ata4 ,an accessory or subsidi>y plac5ta4 ,pl$get4 ,a small compress or tuft z ( wool or l9t4 ,ple?o-ra4 ,a condition m>k$ by vascul> turgesc5ce1 excess ( blood & fullness ( pulse4 ,po-dalic4 ,p]ta9+ to1 or accompli%$ by means (1 ! feet4 ,poly-hy-dramni-os4 ,excess 9 ! am\nt ( ! liquor amnii 9 pregnancy4 ,po-sition4 #a4 ,! attitude or po/ure ( a pati5t4 #b4 ,! relation ( ! pres5t+ "p ( ! ftus to ! quadrants ( ! mat]nal pelvis4 ,pos-teri-or4 ,situat$ beh9d or t[>d ! re>4 ,po/ p>tum4 ,aft] deliv]y4 ,prema-ture4 #a4 ,occurr+ be=e ! prop] "t4 #b4 ,an infant born be=e its prop] t]m1 b viable4 ,prema-turi-ty4 ,! condition ( a *ild t has be5 deliv]$ be=e t]m1 & be=e maturity or rip5+ has tak5 place4 ,pre-moni-tory4 ,s]v+ z a w>n+4 ,prepuce4 ,! fold ( sk9 cov]+ ! glans p5is2 ! =esk94 ,presen-tation4 #a4 ,! appe>ance 9 labor ( "s p>ticul> "p ( ! ftal body at ! os ut]i4 #b4 ,t "p ( ! ftal body :i* fir/ %[s itself at ! os 9 labor4 ,pri-mipa-ra4 ,a woman :o has giv5 bir?1 or :o is giv+ bir?1 to h] fir/ *ild4 ,prodro-mal4 ,premonitory4 ,indicat+ ! approa* ( an ev5t1 ph5om5on1 or disease4 ,prog-nosis4 ,a =eca/ z to ! probable result ( an attack ( disease2 ! prospect z to recov]y f a disease af=d$ by ! nature & symptoms ( ! case4 ,pro-jection-al vomi-t+4 ,sudd5 viol5t emesis4 ,pro-lapse4 ,! fall+ d[n1 or s9k+1 ( a "p or viscus4 ,pro-lepsis4 ,! anticipation & nullification ( complications be=e !y arise4 ,promon-tory4 ,a project+ em95ce or process4 ,prophy-laxis4 ,! prev5tion ( disease4 ,prote-94 ,any "o ( a gr\p ( nitrog5iz$1 noncry/allizable comp\nds simil> to ea* o!r1 widely di/ribut$ 9 ! animal & vegetable k+doms1 & =m+ ! *>act]i/ic con/itu5ts ( ! tissues & fluids ( ! animal body4 ,!y are =m$ by plants1 ! animal organism receiv+ !m z food & trans=m+ & assimilat+ !m4 ,!y all conta9 c>bon1 hydrog51 nitrog51 oxyg5 & sulphur4 ,"s ( ! mo/ important are album91 case91 legum91 fibr91 myos9 & glut94 ,psy*ic4 ,p]ta9+ to ! m9d4 ,pubes4 ,t "p ( ! l[] c5tral hypoga/ric region :i*1 9 ! adult1 is cov]$ ) hair4 ,! pubic region4 ,pubic4 ,p]ta9+ to ! pubes1 or os pubis4 ,pub]-ty4 ,! age at :i* ! reproductive organs become functionally op]ative4 ,pubi-oto-my4 7,he-boste-otomy47 ,! op]ation ( cutt+ ?r\gh ! pubic bone1 lat]al to ! m$ian l9e4 ,pu-erpe-ral4 ,p]ta9+ to *ildbir?4 ,puer-peri-um4 ,! p]iod or /ate ( conf9em5t4 ,! pu]p]ium is ! "t succe$+ labor :i* is necess>y = ! re/oration ( ! g5itals to _! condition previ\s to pregnancy1 or z ne> x z possible4 ,x v>ies f #f weeks to sev]al mon?s4 ,puru-l5t4 ,consi/+ ( or conta9+ pus4 ,py-mia4 ,blood-poison ( microbic orig94 ,pye-litis4 ,inflammation ( ! pelvis or ! kidney4 ,pyor-rha4 ,a dis*>ge ( pus1 especially f infection ar\nd ! roots ( ! tee?4 ,py-rosis4 ,he>tburn4 ,acidity ( ! /oma*4 ,eructations ( acid4 ,reflex-es4 ,reflect$ actions or movem5ts4 ,impulses receiv$ & transmitt$ by ! n]v\s sy/em )\t consci\s volition4 ,involunt>y responses to irritation4 ,automatic movem5ts4 ,re-frige-rant4 ,reliev+ fev] & ?ir/4 ,a cool+ rem$y4 ,acidul\s dr9ks & evaporat+ lotions are refrig]ant4 ,re-gurgi-tation4 #a4 ,! ca/+ up ( undige/$ food4 #b4 ,a backw>d fl[+ ( ! blood ?r\gh ! left auriculo-v5tricul> op5+1 on acc\nt ( imp]fect closure ( ! mitral valve4 ,relax-ation4 #a4 ,a less5+ ( t5sion4 #b4 ,a mitigation ( pa94 ,renal4 ,p]ta9+ to ! kidney4 ,resti-tution4 #a4 ,an act or process ( re/oration4 #b4 ,! rotation ( ! pres5t+ "p ( ! ftus outside ( ! vag9a4 ,retro-gressive4 ,go+ or mov+ backw>d4 ,pass+ f a bett] to a worse condition4 ,retro-v]sion4 ,! tipp+ ( an entire organ backw>d4 ,rickets4 7,ra-*itis47 ,a con/itutional disease ( *ildhood 9 :i* ! bones become s(t & flexible f ret>d$ ossification1 due to defici5cy ( ! e>?y salts4 ,ro-tation4 ,! process ( turn+ ar\nd an axis4 ,r\ghen-+4 ,any r\gh1 co>se food t gives bulk to ! inte/9al cont5ts )\t mu* nutrition4 ,rube-faci-ent4 ,an ag5t t r$d5s ! sk94 ,rug4 ,wr9kles or folds4 ,rupture4 #a4 ,=cible te>+ or break+ ( a "p4 #b4 ,h]nia4 ,sacrum4 ,! triangul> bone situat$ at ! end ( ! sp9e4 ,x is =m$ ( five v]tebr1 amalgamat$ & w$g$ 9 betwe5 ! two innom9ate bones4 ,sagx-tal4 ,%ap$ l1 or resembl+1 an arr[4 ,sali-vation4 ,an excessive dis*>ge ( saliva4 ,salp9-gitis4 ,inflammation ( an oviduct or ( ! eu/a*ian tube4 ,salv>-san4 ,a comp\nd inv5t$ by ,ehrli* = ! treatm5t ( diseases caus$ by ! ,spirill1 su* z syphilis & recurr5t fev]4 ,x is popul>ly call$ #fjf4 ,sa-prmi-a4 ,poison+ ( ! blood by ! absorption ( tox9s f localiz$ infections z f ! ut]us4 ,scapu-la4 ,! %\ld] blade4 ,scrotum4 ,! p\* :i* conta9s ! te/icles & _! accessory organs4 ,se-bace\s4 #a4 ,p]ta9+ to sebum or suet4 #b4 ,secret+ a greasy lubricat+ sub/ance4 ,se-cretion4 #a4 ,! process or function ( sep>at+ v>i\s sub/ances f ! blood4 #b4 ,any secret$ sub/ance4 ,secun-d9es4 ,all t rema9s 9 ! ut]us aft] ! bir? ( ! *ild is call$ secund9es--plac5ta1 membrane & cord4 ,sem54 #a4 ,a se$ or se$-l fruit4 #b4 ,! ?ick :iti% liquid fecundat+ secretion produc$ 9 coition4 ,%ock4 ,sudd5 vital depression1 due to an injury or emotion :i* makes a s9i/] impression ^u ! n]v\s sy/em4 ,%[4 ,! appe>ance ( blood t =]uns a labor or m5/ruation4 ,s9a-pism4 ,a pla/] or pa/e ( gr\nd mu/>d-se$2 a mu/>d pla/]4 ,s9ci-put4 ,! portion ( ! head ly+ 9 front ( ! ant]ior or l>ge fontanelle4 ,sinus4 #a4 ,a recess1 cavity or holl[ space4 #b4 ,a dilat$ *annel = v5\s blood1 f\nd *iefly )9 ! cranium & ut]us dur+ ge/ation4 #c4 ,an air-cavity1 9 "o ( ! cranial bones1 especially "o communicat+ ) ! nose1 su* are ! e?moidal frontal maxill>y & sph5oidal s9uses4 #d4 ,a suppurat+ *annel or fi/ula4 ,smegma4 ,a ?ick1 *eesy1 ill-smell+ secretion f\nd "u ! prepuce & ar\nd ! labia m9ora4 ,s-lution4 #a4 ,! process ( dissolv+4 #b4 ,a liquid conta9+ dissolv$ matt]4 ,sordes4 ,! d>k br[n matt] :i* collects on ! lips & tee? 9 l[ fev]s4 ,spasmo-philic di-a?e-sis4 ,is a condition *>act]iz$ by an increas$ elective irritability & a t5d5cy to spasm1 l contractions ( "o or m gr\ps ( muscles4 7,grulee74 ,spe-cific4 #a4 ,p]ta9+ to a species4 #b4 ,produc$ by a s+le k9d ( microorganism4 #c4 ,a rem$y specially indicat$ = any p>ticul> disease4 ,sp]ma-to-zoon4 ,! motile g5]ative elem5t ( ! sem5 :i* s]ves to impregnate ! ovum4 ,spina bifi-da4 ,cong5ital cleft ( ! v]tebral column ) m5+eal protrusion4 ,spiro-*te4 ,a g5us or =m ( flexile spirobact]ia4 ,/asis4 ,a /oppage ( ! fl[ ( fluid 9 any organ or any "p ( ! body4 ,/e-nosis4 ,n>r[+ or /ricture ( a duct or canal4 ,/]ile4 ,nonf]tile4 ,/]il-i-zation4 ,! act or process ( r5d]+ /]ile4 ,/ill-bir?4 ,! bir? ( a dead ftus4 ,/imu-lant4 #a4 ,produc+ /imulation4 #b4 ,an ag5t or rem$y t produces /imulation4 ,/repto-coccus4 ,a g5us or =m ( bact]ial organism1 :i* gr[s 9 consecutive l9ks1 l a *a94 ,/ria1 pl4 /ri4 ,/reaks or l9es4 ,/roma4 ,! tissue :i* =ms ! gr\nd sub/ance1 framework1 or matrix ( an organ4 ,/yptic4 ,a/r+5t1 an ag5t = arre/+ hmorrhage4 ,sub9-vo-lution4 ,incomplete involution2 failure ( a "p to return to its normal size & condition aft] enl>gem5t f functional activity4 ,sup-posi-to-ry4 ,an easily fusible m$icat$ mass to be introduc$ into ! vag9a1 rectum1 or ure?ra4 ,suture4 #a4 ,surgical /it* or seam4 #b4 ,! l9e ( junction ( adjac5t cranial or facial bones4 ,symphys-e-oto-my4 ,! division ( ! fibroc>tilage ( ! symphysis pubis 9 ord] to facilitate deliv]y by increas+ ! ant]opo/]ior diamet] ( ! pelvis4 ,symphy-sis4 ,! l9e ( junction & fusion betwe5 bones orig9ally di/9ct4 ,! symphysis pubis4 ,syn*ro-n\s4 ,occurr+ at ! same "t4 ,syphi-lis4 ,a contagi\s v5]eal disease lead+ to _m /ructural & cutane\s lesions1 due to a microorganism call$ ! spiro*ta pallida4 ,tampon4 ,a plug made ( cotton1 sponge1 or oakum4 ,te-nacu-lum4 ,a hook-l in/rum5t = seiz+ & hold+ tissues4 ,te-nesmus4 ,/ra9+1 especially ineffectual & pa9ful /ra9+4 ,?rombus4 ,a plug or clot 9 a vessel rema9+ at ! po9t ( its =mation4 ,t9cture4 ,! solution ( m$ic9al sub/ances 9 fluids o!r ?an wat] or glyc]9e4 ,!re is usually ab\t "o "p ( ! drug to eight ( alcohol4 ,tissue4 ,an aggregation ( cells1 fib]s & v>i\s cell-products =m+ a /ructural elem5t4 ,tox-mi-a4 ,blood poison+4 ,tox94 ,any poison\s album9 produc$ by bact]ial action4 ,trauma4 ,a bl[1 w\nd1 or o!r viol5t injury4 ,trauma-tism4 ,a condition ( ! sy/em due to injury4 ,tumor4 #a4 ,swell+2 morbid enl>gem5t4 #b4 ,a neoplasm4 ,a mass ( new tissue :i* p]si/s & gr[s indep5d5tly ( its surr\nd+ /ructures1 & :i* has no physiologic use4 ,tympa-nitis4 ,di/5tion ( ! abdom5 f gas4 ,um-bili-cal4 ,p]ta9+ to ! umbilicus4 ,um-bi-licus4 ,! navel4 ,ura-*us4 ,a cord t ext5ds f ! apex ( ! bladd] to ! navel4 ,x repres5ts ! rema9s ( ! canal 9 ! ftus :i* jo9s ! bladd] ) ! allantois4 ,u-rea4 ,a :ite cry/allizable sub/ance f ! ur9e1 blood & lymph4 ,u-ret]4 ,! fibro-muscul> tube :i* conveys ! ur9e f ! kidney to ! bladd]4 ,u-rmi-a4 ,! pres5ce ( ur9>y con/itu5ts 9 ! blood & ! toxic condition produc$ !reby4 ,u-re?ra4 ,a membran\s canal convey+ ur9e f ! bladd] to ! surface & 9 ! male convey+ ! sem9al ejaculations4 ,ur9-aly-sis4 ,! *emical analysis ( ur9e4 ,ut]-u4 ,! holl[ muscul> organ :i* provides lodgem5t = ! ftus f conception to bir?4 ,! womb4 ,ut]-u bi-cornis4 ,a womb :]e9 ! two sides h be5 incompletely jo9$ dur+ developm5t1 & two horns1 or protrusions1 appe> on ! fundus4 ,ut]-u di-delphys4 ,a womb 9 :i* !re has be5 sep>ate developm5t & incomplete fusion ( ! two sides4 ,ut]-u duplex4 ,a d\ble ut]us4 ,ut]-u septate4 ,a ut]us t is divid$ by a p>tition or septum4 ,v>i-cose ve9s4 ,( ! nature (1 or p]ta9+ to1 a v>ix4 ,! p]man5t dilatation ( a ve94 ,v5e-section4 ,! op5+ ( a ve9 = ! purpose ( lett+ blood4 ,v5tral /alk4 ,an embryonic process :i* is ! rudim5tal precursor ( ! umbilical cord4 ,x is kn[n z ! v5tral /alk because some:at lat] 9 ! c\rse ( developm5t x becomes atta*$ to ! v5tral 7abdom9al7 surface ( ! embryo4 ,v]nix case-osa4 ,a fatty sub/ance t cov]s ! sk9 ( ! ftus4 ,v]sion4 ,! act ( turn+1 especially ! manual turn+ ( ! ftus 9 deliv]y4 ,ext]nal v41 t :i* is p]=m$ by outside manipulation4 ,int]nal v41 v]sion p]=m$ by ! h& introduc$ into ! ut]us4 ,braxton ,hicks' ,v]sion1 a v]sion done ) ! :ole h& 9 ! vag9a & two f+]s ent]+ ! ut]us ?r\gh ! p>tially dilat$ os4 ,vesi-cal4 ,p]ta9+ to ! bladd]4 ,via-bili-ty4 ,able to live aft] bir?4 ,villi4 #a4 ,! f+]-l projections t develop on ! outside ( ! egg & connect x vascul>ly & o!rwise ) ! ut]us2 a vascul> *orionic tuft4 #b4 ,a m9ute club-%ap$ projection f ! muc\s membrane ( ! inte/9e4 ,vul-sellum4 ,a =ceps ) tee? on ! ends ( ! jaws4 ,wal*er's position4 ,! pati5t on ! back ) ! hips at ! edge ( ! table & ! legs hang+ d[n4 ,:>ton's jelly4 ,! s(t pulpy connective tissue t con/itutes ! l>ge/ "p ( ! umbilical cord4 ,womb4 ,same z ut]us4 ,,index ,a ,abd]hald5 te/ = pregnancy1 #fa ,abdom53 c>e (1 #gj *anges 9 pregnancy1 #ei weakness (1 #he ,abortion1 #ie etiology1 #bjg managem5t1 #bjg ,accessory articles ( diet1 #cai ,accid5tal hmorrhage1 #bbh ,aft]-bir?1 #da1 #aag ,aft]-pa9s1 #aed1 #bed relief (1 #aed ,album9uria1 #gg 7see ,eclampsia7 ,am5orrha1 #eg dur+ lactation1 #aeh 9 ! nonpregnant1 #eh ,amnion1 #ch adhesions1 #hg ,an/hetics1 #ajc1 #ach1 #adb ,an5cephalus1 #cji ,anus1 #bc ,aph?1 #bid ,areola1 #ca ,asepsis 9 deliv]y1 #adb ,aseptic c>e1 #bjj ,asphyxia neonatorum1 #bgh me?ods ( resuscitation1 #bgi ,atelectasis1 #bhc ,attitude ( *ild1 #afe ,b ,baby3 an5cephalus1 #cji aph?1 #bid asphyxia1 #adb1 #bgh balanitis1 #cjf ba?1 #bff b[els1 #bgc brea/s1 #bic c>e aft] deliv]y1 #add c>e at bir?1 #adb circumcision1 #cjf cleans+1 #bfe clo?+1 #bgj colic1 #bii con/ipation1 #bih convulsions1 #bhb cradle cap1 #bie di>rha1 #bih ex]cise1 #bhd eyes1 #bfh furuncles1 #cje flu%+s1 #bhe gavage1 #bhe g5itals1 #bgb hmorrhage1 #bhi h>elip & cleft palate1 #bhg he>t1 #bgh h]nia1 #bhg hydrocephalus1 #cjh ict]us1 #bic lavage1 #bhf m>asmus1 #cjc m5/ruation1 #bic m\?1 #bgb nails1 #bhi nurs+ p]iods1 #bgc1 #aef p>aphimosis1 #cje phimosis1 #cje pneumonia1 #cjd prematurity1 #cja priapism1 #cjh respiration1 fir/1 #adb r\t9e =1 #bgj significant symptoms & conditions1 #cbj sleep1 #bgb snuffles1 #cjd sp9a bifida1 #cjh temp]ature1 #bgf ?ru%1 #bid tongue-tie1 #bhg toilet basket1 #bga umbilicus1 #bfg urtic>ia1 #bid vomit+1 #cjj weight1 #bga ,bag ( wat]s1 #ci1 #aaj ,balanitis1 #cjf ,ballottem5t1 #fb ,b>ley wat]1 #caf ,ba?s1 #fi1 #cbe ,b$1 mak+1 #acc ,b$-l951 c>e (1 #aej ,b$ sores1 #bfc ,b$n>'s disease1 #bid ,bi*loride solution1 #ace ,bir?m>ks & de=mities1 #gb1 #hg ,b9d]1 #aec ,bladd]1 #bc aft] deliv]y1 #aei 9 pregnancy1 #ef1 #eh ,ble$]s1 #bcb1 #bij ,blood1 9 pregnancy1 #ee ,b[els1 9 pregnancy1 #fh 9 pu]p]ium1 #aeg ,brea/ milk1 quantity1 #bge ,brea/s1 #cj cak$1 #aef1 #bdc c>e (1 #ga *anges due to m>riage & pregnancy1 #ec1 #ei infl[ ( milk1 #ec massage1 #aef nurs+ p]iods1 #aef ( pub]ty1 #cc prep>ation = lactation1 #aee removal ( *ild1 #beb1 #bfa s5sations 9 pregnancy1 #ei sup]num]>y1 #ca ,bree* pres5tation1 #afh ,br[ pres5tation1 #agg1 #agi ,butt]milk1 #cad ,c ,cs>ean section1 #aie ,caput succ$aneum1 #abg ,case record1 nurse's1 #aca ,ca!t]ization1 aft] deliv]y1 #aei be=e op]ations1 #ahc ,caul1 #aad ,cephalhmatoma1 #abh ,c]vix1 effacem5t1 #aaj repair1 #add1 #baa ,*ild 7see ,baby7 ,*ill 9 pu]p]ium1 #aea ,*loasma1 #ee ,*lor(orm 9 labor1 #ajc ,*orion1 #ch ,circumcision1 #cjf ,clamp = cord1 #bfh ,clitoris1 #bf ,coitus1 #ga ,colic1 #cjj ,colo/rum1 #ec ,conception1 #cf ,condylomata1 #ge ,conf9em5t1 e/imat+ date1 #eh1 #ff ,con/ipation1 #fh1 #bih ,contraction ( pelvis1 #bad ,contractions ( ,braxton ,hicks1 #ec1 #fb1 #aji ,convulsions1 ( *ild1 #bhb ( "m1 #bcf ,cord1 umbilical1 #dj atta*m5t to plac5ta1 #db cutt+1 #adb granulations (1 #bic prolapse (1 #bbj1 #acg sep>ation1 #bib ,c['s milk vs4 brea/ milk1 #caa ,cradle cap1 #bie ,cramps1 #ef1 #hf ,cranioclasis1 #aid ,curettage ( ut]us1 #bjf 9 abortion1 #bjg ,curve ( ,c>us1 #bj ,d ,decapitation1 #aid ,deliv]y1 asepsis dur+1 #adb c>e ( "m aft]1 #add on side1 #adj ,diabetes & pregnancy1 #ie ,diap]s1 #bgj1 #bgc blu+ on1 #bgj1 #bif ,di>rha ( *ild1 #bih ,diet 9 pu]p]ium1 #aeb1 #aee ,diets1 #ccf ,doctor1 #acj :5 to call1 #aca :at to report1 #aca1 #cai ,d\*e1 vag9al1 #bjb aseptic1 #bjj 9 pregnancy1 #ga1 #afj intraut]9e1 #bje1 #bcc ,dress 9 pregnancy1 #fi ,drugs affect+ ! milk1 #bge ,dry bir?1 #bbe ,ductus art]iosus1 #di v5osus1 #dh ,e ,eclampsia1 #gh blood pressure 91 #ee symptoms & managem5t1 #bcg wet packs 91 #bca ,ectopic pregnancy1 #hi ,edema1 #fi ,enemas1 elim9ative1 #cee nutri5t1 #ccd ,episiotomy1 #baa ,ergot1 #adc aft] deliv]y1 #aej 9 abortion1 #bjg 9 po/ p>tum hmorrhage1 #bcc ,eruptions on ! sk91 #ee ,ery!ma1 #bif ,e!r 9 labor1 #ajc ,exam9ation ( pati5t1 #acd1 #adj ,excavation ( pelvis1 #ai ,extraut]9e pregnancy1 #hi ,exudative dia!sis1 #bie ,eye symptoms 9 pregnancy1 #fi ,f ,face pres5tation1 #agd1 #agi ,fallopian tubes1 #bb ,fa9t+1 #gj ,fev]s & pregnancy1 #ia ,fl\r ball1 #caf ,flu%+s1 #bhe ,ftus1 attitude1 #dd circulation1 #dh diamet]s ( head1 #df fontanelles1 #df he>t tones1 #fc1 #ahj movem5ts1 #dd1 #fb rate ( gr[?1 #df rule = e/imat+ l5g?1 #dg rule = e/imat+ weight1 #dg signs ( dang] to1 #ahj signs ( dea?1 #ig signs ( maturity1 #dg ,food mix+s1 #cag prep>ation = infants1 #cad ,=am5 ovale1 #ej ,=ceps1 application1 #ahf conditions =1 #ahe dang]s (1 #ahe 9 bree* cases1 #agc 9 face pres5tations1 #agf indications =1 #ahe prep>ations =1 #ahc ,fumigation1 #cbi ,furuncles1 #cje ,g ,galactorrha1 #bej ,gas analgesia1 #ajd ,gas pa9s1 #aed1 #aeh1 #bec ,gavage1 #bhe ,g5ital crease1 #be ,g5italia1 c>e aft] deliv]y1 #adb1 #adh prep>ation = deliv]y1 #aca prep>ation = op]ation1 #ahb ,gett+ up1 #afa ,g+ivitis1 #ge ,gl&s1 ,b>?ol91 #bg mamm>y1 #cj ,montgom]y1 #ca ?yroid1 #ef ,gloss>y1 #cea ,glycosuria1 #fi ,gonorrha & pregnancy1 #ic ,goodell's sign1 #fj ,gossip1 #afa ,graafian follicle1 #cc ,gums 9 pregnancy1 #ge ,h ,hmorrhage1 accid5tal1 #bbh 9 abortion1 #bjg 9 labor1 #add1 #aai1 #adc 9 ! newborn1 #bhi 9 pregnancy1 #ie po/ p>tum1 #bcb1 #bcd unavoidable1 #bbh ut]9e d\*e =1 #bje ,hmorrhoids1 #hf ,hair1 #ee1 #acb ,h&s1 c>e (1 #afj1 #cbc /]ilization (1 #acd ,h>elip & cleft palate1 #bhg ,head1 desc5t1 #abc expulsion (1 #aae effect ( labor on1 #abf ext5sion1 #abf ext]nal re/itution1 #abf flexion1 #abc int]nal rotation1 #abd ,heada*e1 #bcg1 #bed ,he>t *anges 9 pregnancy1 #ee lesions 9 pregnancy1 #id ,he>t tones1 ftal1 :]e he>d1 #acj significance1 #acg :5 membranes rupture prematurely1 #bbf ,heg>'s sign1 #fj ,h]nia1 #bhg ,h]pes 9 pregnancy1 #gf ,hospital drums1 pack+1 #ach ,hott5tot apron1 #bf ,hydramnios1 #hg & malpres5tations1 #age & tw9s1 #hd ,hydrocephalus1 #cjh ,hym51 #bf ,hypod]moclysis1 #bjf ,hyp]emesis gravid>um1 #gi ,i ,ict]us1 #bic ,induction ( labor1 #bjh ,infant fe$+1 #caj outfit1 #aja ,infection1 #bbf1 #bee ,injections1 elim9ative1 #cce intrav5\s1 #bje nutri5t1 #ccd ,insomnia1 #ef ,int]trigo1 #bif ,involution1 #aeb1 #afj1 #afa ,j ,jacquem9s' sign1 #fb ,jaundice1 ( *ild1 #bic ( "m1 #ie ,k ,kidneys ( *ild1 #dd ( "m1 #ef1 #fh1 #ie ,l ,labia majora1 #be m9ora1 #bf ,labor1 c>e dur+1 #adj induction (1 #bjh precipitate1 #bbc prep>ations =1 #acj1 #ach1 #cbf signs (1 #abi vomit+ 91 #bbh ,lactation & m5/ruation1 #aeg ,lavage1 #bhf ,leucorrha1 #ga ,light5+1 #fe1 #ajh ,l9ea albicantes1 #ee nigra1 #ee ,liquor amnii1 #ch 9 disease1 #hg ,liv]1 ( *ild1 #dd ( "m 9 pregnancy1 #ef1 #ie ,lo*ia1 #aed & ! h&s1 #afj ,long+s1 #ef ,lungs 9 pregnancy1 #ef ,m ,malna neonatorum1 #bij ,m>asmus1 #cjc ,mask ( pregnancy1 #ee ,ma/itis1 #bdg ,mat]nal impressions1 #gb ,membranes1 #aaj premature rupture1 #bbe relation ( rupture to labor1 #aad rupture (1 #aji1 #aad ,m5/ruation1 def9ition (1 #cc dur+ lactation1 #aeg 9 infant1 #bih physiology (1 #cd relation to conception & pregnancy1 #cc sy/emic effects1 #ce ,milk fev]1 #bdc ,milk1 elem5ts ( human1 #cab excess (1 #bdi fat-free1 #cag infl[1 #aef peptoniz+1 #cch pa/euriz+1 #caf quality1 #bea sc>city1 #bdi /]ilization1 #caf to dry up1 #afc :ole milk1 #cag ,milk leg1 #bfb ,m9d 9 pregnancy1 #gb ,moles1 #hj ,mon/]s1 #hh1 #cjh ,mons v5]is1 #be ,morn+ sickness1 #eh ,multiple pregnancy1 #hc ,n ,nausea1 #eh ,n]v\s sy/em1 #ef ,neuralgia1 #ef ,nipple1 #cj c>e (1 #ga cracks & fissures1 #bdd imp]fect1 #bde prep>ation = lactation1 #aee rubb]1 #cah ,normal labor1 #ajg am\nt ( blood lo/1 #aai causes (1 #ajg c\rse (1 #aaj date ( onset1 #ajg duration ( fir/ /age1 #aad duration ( second /age1 #aad g5]al effects1 #aah me*anism1 #abj subjective ph5om5a1 #aae ,nurse1 #ih & cleanl9ess1 #abi1 #cbc & hi/ory %eet1 #aca 9 ob/etrics1 #ih 9 pu]p]al fev]1 #bfb outfit1 #ii qualifications1 #cbc /]iliz+1 #aja ,nurs]y rules1 #bfi ,nurs+ p]iods1 #aef ,nurs+ ! *ild1 #bic ,o ,odors ( p]son1 #cbd ,oligohydramnios1 #hg ,op]ations1 prep>ations =1 #ahj :y requir$1 #agi ,oph?almia neonatorum1 #ic1 #adb1 #aib ,os1 digital dilatation1 #baa physiology ( dilatation1 #aaa rigidity (1 #bbb ,ov>ies1 #bc ,ovulation1 #cc ,ovum1 #cc dea? (1 #if f]tilization1 #cf implantation1 #cg mode ( progress1 #bc relation to ut]9e cavity1 #eb ,p ,packs1 wet1 #bac ,pa9s1 aft]1 #aed cause (1 #aji "* (1 #aae1 #aca1 #ach false1 #ajh f gas1 #aed regul>ity (1 #aaj1 #acj ,palpation1 #acd ,p>alysis1 facial1 #bia ( %\ld] 7,erb's71 #bia ,p>aphimosis1 #cje ,pati5t1 c>e (1 aft] deliv]y1 #add dur+ second /age1 #acg exam9ation (1 #gd1 #acc 9 fir/ /age1 #acc loss ( weight po/ p>tum1 #aee prep>ation (1 #aca1 #ach re/1 #afj visitors1 #acc1 #afa ,pelvic floor rigidity1 #bbc ,pelvis1 #ag brim1 #ah contract$1 #bad diamet]s1 #bad false1 #ag measurem5ts1 #bad quadrants (1 #aba %ape1 #ah true1 #ag upp] /rait1 #ah ,pemphigus neonatorum1 #bif ,p]9eorrhaphy1 #add in/rum5ts1 #aci1 #ade1 #adf aft]-c>e1 #adg ,p]9eum1 #bh1 #be head on1 #aae pres]vation1 #ade repair1 #adc1 #add torn 9 labor1 #cj ,p]itoneum1 #bd ,p]itonitis1 7see ,infection7 ,phimosis1 #cje ,phlebitis1 #bfc ,physical signs ( pregnancy1 #ei ,pigm5tation1 #ee1 #gg ,pituitr91 #adc1 #bbd ,plac5ta prvia1 #bi ,plac5ta1 #da anomalies1 #hh e>ly expression1 #adi inf>cts1 #hh conditions = ,cr$e expression1 #aej manual removal1 #aej ,pneumonia 9 *ild1 #cjd ,po9t ( direction1 #aba ,position1 occipito-po/]ior1 #agh ( bree*1 #afe ( face1 #age ( head1 #aba ,wal*]1 #aic ,pregnancy1 ,abd]hald5's te/ =1 #fa age (1 #fe album9uria 91 #gg at f\r? mon?1 #fa b[els 91 #fh ca?>tics 91 #fh condylomata1 #ge con/ipation 91 #ge cramps1 #hf diabetes 91 #ie diagnosis1 #eg duration (1 #ff1 #ajg extra ut]9e1 #hi fev]s &1 #ia g5]al effects1 #ef g+ivitis1 #ge gonorrha1 #ic hmorrhages1 #ie hmorrhoids 91 #hf he>t disease &1 #id he>tburn1 #fh h]pes1 #gf hydramnios 91 #hg hygi5e (1 #ff hyp]emesis 91 #gi kidneys 91 #fh local effects1 #ea mat]nal *anges1 #ea m5tal conditions 91 #gb pressure symptoms1 #he probable signs1 #fa pruritus1 #gf pyelitis1 #gi salivation1 #ge signs at #bf? week1 #fb syphilis1 #ib too?a*e1 #ge toxmias1 #gd tub]culosis1 #ib v>icose ve9s1 #he vomit+ 91 #gi ,prematurity1 #cja ,pres5tation1 def9ition1 #abj frequ5cy ( v]tex1 #aba ( bree*1 #afe ( face & br[1 #agd transv]se1 #agd ,pressure symptoms1 #he ,priapism1 #cjh ,propriet>y foods1 #cad ,pruritus 9 pregnancy1 #gf ,ptyalism1 #ge ,pub]ty1 #cc ,pubiotomy1 #aih aft]-c>e1 #aii ,pu]p]al fev]1 #bee disposal ( excreta1 #bfa etiology1 #bee nurse &1 #bfb prev5tion1 #beh symptoms1 #bei treatm5t1 #bfj ,pu]p]ium1 #aea diet 91 #aeb laxatives1 #aeh /&+ ord]s =1 #afb ,pulse 9 pu]p]ium1 #aea ,pyelitis1 #gi ,pyloric /5osis1 #cjc ,q ,quick5+1 #ei ,r ,rectal fe$+1 #ccc ,rectal infusions1 #bab ,rectum1 #bc 9 labor1 #bc1 #adb ,r$ gum1 #big ,r5al disease1 #ie ,re/1 #afj ,room1 sett+ up1 #acj1 #ahj ,rubb] gloves1 #acf ,rubb] nipples1 #cah ,s ,salivation1 #ge ,second /age ( labor1 #aad ,sex1 det]m9ation (1 #fe1 #gb ,sexual relations1 #ga ,%eet sl+1 #adf1 #aha ,%[1 #aji1 #abi ,sk91 *anges1 #ed c>e (1 #fi eruptions1 #ee pigm5tation1 #ee1 #gg /ri gravid>um1 #ed ,snuffles1 #cjd ,solutions1 #cdj p]c5tage table (1 #cda ,s\ffle1 funic1 #fe ut]9e1 #fc ,sp]matozoa1 #cf ,sp9a bifida1 #cjh ,/&+ ord]s = nurse1 #afd = pu]p]ium1 #afc ,/>vation fev]1 #bgf ,/]ile l951 application1 #ach1 #ahb ,/]ilization1 #aja1 #cbc dress+s1 #cbe in/rum5ts1 #cbg rubb] goods1 #cbh ,/it*es1 c>e (1 #afj removal1 #bjb ,/oma* capacity ( *ild1 #bge ,sub9volution1 #aee1 #bfj1 #bfa ,subjective signs ( pregnancy1 #eg1 #ei ,sudd5 dea? ( infant1 #cji ( "m1 #bfc ,sug> 9 ur9e1 #fi ,sug>s & fl\rs1 #cag ,supplem5tal fe$+s1 #caj ,supplies = h\se1 #ii = /]ilization1 #aja prep>ation (1 #cbf ,symphyseotomy1 #aih ,syphilis & ftus1 #hh & pregnancy1 #ib ( plac5ta1 #hh ,t ,tampon ( ut]us1 #bjb ( vag9a1 #bjd ,temp]ature 9 pu]p]ium1 #aea ,?ird /age ( labor1 #aag1 #adb1 #adc conduct (1 #adi ,?rombus1 #bfc ,?ru%1 #bid ,?yroid gl&1 #ef ,toilet basket1 #bga ,tongue-tie1 #bhg ,too?a*e1 #ge ,toxmia1 #gd ,transfusion1 #bje 9 eclampsia1 #bdj ,tub]cles ( ,montgom]y1 #ca ,tub]culosis & pregnancy1 #ib ,twilight sleep1 #ajc ,tw9s1 #hc ,u ,umbilicus1 #bfg ,unavoidable hmorrhage1 #bbh ,ur9ation1 aft] deliv]y1 #aeh ( *ild1 #bgc ,ur9e1 #ef 9 pregnancy1 #gg 9 pu]p]ium1 #aea /]ile specim51 #bjj /]ile specim5 f *ild1 #bjj ,urtic>ia1 #bid ,ut5sils = milk modification1 #cah ,ut]us1 anatomy1 #ba *anges 9 pregnancy1 #ea1 #ei curettage1 #bjf displacem5ts1 #hd height at v>i\s mon?s ( pregnancy1 #fd in]tia1 #bbc mal=mations1 #he rupture1 #bbf ,ut]9e s\ffle1 #fc ,v ,vag9a1 anatomy1 #ba atta*m5ts1 #ba di/5sibility1 #ba ,vag9al tampon1 #bjd 9 abortion1 #bjg ,v>icose ve9s1 #he ,v5tral /alk1 #dj ,v]sion1 #aij1 #aib1 #aic ,ve/ibule1 #bf ,vessels ( cord1 #dh ,villi1 #cg ,visitors1 #acc1 #afa ,vomit+1 #cjj1 #cba 9 pregnancy1 #gi 9 labor1 #bbh uncontrollable1 #gi ,vorhees bag1 #bbd1 #bcj ,vulva1 anatomy1 #bd c>e (1 #adc prep>ation1 #acb ,w ,wal*] position1 #agc1 #aic ,wean+1 #beb1 #bgc ,wet nurse1 #bec ,:>ton's jelly1 #dj ,:ey1 #cae ,wieg& compression1 #agc1 #aid ,wit*'s milk1 #cb ---------------------------------------- -------------------------------- ,,transcrib]',s ,,notes #a4 ,sil5tly correct$ typographical errors & v>iations 9 spell+4 #b4 ,ana*roni/ic1 non-/&>d1 & unc]ta9 spell+s reta9$ z pr9t$4 #c4 ,enclos$ italics font 9 und]scores4 #d4 ,enclos$ bold font 9 equals4