Chapter XXIV: A Final Word

It will be well for us now to take a retrospective view of the
various functions of the nurse which are associated with the
phenomena of pregnancy, labor, the puerperium and the beginning of a
new life. As we see these in perspective, our attention is fixed by
a few important principles which stand out from the picture as a
whole in clear and shining relief.

We see, for example, that no matter what else may become vague and
unimportant, be changed or discarded, there remains the conspicuous,
unalterable requirement that the nurse shall do clean work
throughout this entire series of experiences. All maternity patients
and all babies need scrupulously clean care no matter what else they
may have or may lack.

But also must they all be watched throughout these transitional
stages, in order that impending disaster may be apprehended and
warded off. And that this watchfulness be intelligent, the nurse
must of necessity know something of the normal physiological changes
which occur during these momentous periods in the lives of her
patients, lest she fail to detect evidence of abnormality, should it
appear.

Since this invariable cleanliness and close watchfulness are needed
by all patients, whether of high or low degree, and by those in the
care of doctors with widely varied methods, the nurse must be able
to make adaptations to each patient’s environment and temperament
and to the doctor as well, if all of her patients are to be well and
happily nursed. She must be clean, then, and watchful in her work,
and adapt it to every conceivable condition. These features stand
out clear and bold in the perspective. But to make these offices
effective to their utmost, the nurse’s attitude and her care of her
patient must be mellowed by an always deepening sympathy and
understanding. She must endeavor, in each instance, to imagine the
mental experience of the bewildered and timid expectant mother; of
the terrified woman in labor and the discouraged young mother—these
she must appreciate if she is to give of her best. And so, in the
end, the character of the nurse’s work will be influenced, in fact
almost determined, by her awareness of her patient’s needs, mental
and physical, and the earnestness with which she tries to relieve
them. More than this, the nurse whose skill is warmed by a sincere
desire to give of her best will, by virtue of this very desire,
learn something from each patient, and will be steadily enriched and
broadened by her experiences. She will have more to give, and
accordingly will derive increasing satisfaction from her service to
each succeeding mother and baby that she takes into her care.

One word more. The maternity nurse almost inevitably becomes deeply
attached to her baby patient, whether he is sick or well, and she is
eager to protect him and safeguard him as long as possible. She may
continue to serve him, even after he has passed from her trained
hands, if she will teach his mother how to take care of him, should
she be inexperienced, particularly if the young mother is to have
full charge of her baby after the nurse leaves, or is to have only
the assistance of a partly trained nursery maid. In such a case the
nurse may often perform her most valuable and enduring service to
the baby by gradually teaching his mother how to prepare the milk
with cleanliness and accuracy, if he must be bottle-fed; how to give
his bath deftly and comfortably, and impressing upon her the
importance of fresh air and of regularity in the baby’s daily
routine. All of these things, and also how to do the thousand and
one other things that seem so trivial and yet mean so much to the
baby’s immediate health and future well being.

The first day after the nurse leaves, and the first few after that
are often very dark ones for the inexperienced young mother, and if
she is alone they are likely to be filled with fear and misgivings.
The nurse may rob these days of much of their discouragement by
anticipating them; trying to imagine the young mother’s possible
perplexities and then teaching her how to meet them. This teaching
is perhaps not a part of the nurse’s professional obligation but it
is one of the privileges, one of the gratifying by-paths of nursing
that she may take for the sheer joy of it.

Not infrequently the young mother is so filled with awe over
possessing anything so wonderful as her own baby that she is afraid
to handle the exquisite little body; is fearful of harming it; and
because of her timidity and inexperience she fails to give him the
care that he needs, and that she wants to give. On the other hand,
all too many young mothers have a blind confidence that the mere act
of having a baby vests one, in some instinctive way, with the
requisite knowledge and skill to care for it, and in this belief
they are supported by a legion of women friends and relatives.

It would be difficult to imagine a single factor that works more
destruction among babies than this one of ignorant motherhood. And
the damage is equally great whether the ignorance arises from
timidity or from overweening confidence.

“Is it not preposterous,” says Herbert Spencer, “that the fate of a
new generation should be left to the chance of unreasoning custom,
impulse, fancy, joined with the suggestions of ignorant nurses and
the prejudiced counsel of grandmothers? To tens of thousands that
are killed, add hundreds of thousands that survive with feeble
constitutions, and millions that grow up with constitutions not so
strong as they should be, and you have some idea of the curse
inflicted on their offspring by parents ignorant of the laws of
life.”

The nurse is in the most effective position possible, to help in
dispelling maternal ignorance, during the long days of pleasant
intimacy which she and the young mother spend together in devotion
to the baby. And by helping the inexperienced young mother to give
skilful care to her baby, with all of the gentleness and tenderness
that a mother can lavish, the nurse will not only serve the baby;
she also will awaken for many a young woman, an interest that will
be ever fresh and absorbing, and point the way to unexpected joys
and delights in her motherhood.

“Can there be any higher work than this?
Can any woman wish for a more womanly work?”

INDEX

Abdomen, changes in, during pregnancy, 102
enlargement of, during pregnancy, 98

Abdominal binders, in pregnancy, 122
in puerperium, 349

Abdominal palpation, 226

Abdominal pedicle, 76

Abdominal supporters, in pregnancy, 122

Abdominal wall, in puerperium, 321

Abnormalities of newborn, 540

Abortion, 165, 166
attempted, 151
causes of, 166
complete, 170
early signs of, 142
incomplete, 170
induced, 309, and _see_ Induced abortions
missed, 170
prevention of, 168
symptoms of, 167
therapeutics, 171
threatened, 170
treatment of, 170
complete, 170
incomplete, 170
threatened, 170

Abscesses, in breast, 344

Accidental hemorrhage, 178

Accidents of pregnancy, 164

Accouchement forcé, 309, 313

Acidosis, 525

Acute yellow atrophy of liver, during pregnancy, 207

Advice for mothers, 427

After-birth, _see_ Placenta

After-care, immediate, of patient, 281

After-pains, 318

Air, fresh, during pregnancy, 129

Albumen in urine, tests for, 118

Alcohol, during pregnancy, 127

Amenorrhea, 56

Amnion, 70
development of, 70

Amniotic fluid, 71

Analgesia, nitrous oxid gas, 291

Anatomy of pelvis and genitalia, 19

Anesthesia, à la reine, 288
chloroform, 287, 288
complete, 292, 293
ether, 289, 290
light, 288
nitrous oxid gas, 291
obstetrical, 286, 288
scopolamin and morphin, 292
unfavorable signs in, 294

Animal foods, allowed during pregnancy, 128

Ante-partum hemorrhage, 174

Areola, 43

Artificial feeding of baby, 489

Attitude of fetus, in utero, 217

Auscultation of fetal heart, 231

Axis-traction forceps, 301

Baby, and _see_ Infant, and New-born
basket for, while travelling, 507
care of, by visiting nurse, 437
during summer, 514
immediate, 265
while travelling, 507
feeding, 486, and _see_ Baby’s food
artificial, 489
breast, 486
giving bottle to, 495
method of holding, for eye examination, 537
nutrition of, 368
preparations for, 162
supplies for, 428
sore eyes of, 533
toilet tray for, 417

Baby’s food, articles used in preparing, 492
commercial, 503
ingredients of, 498
proprietary, 504

Baby basket, for travelling, 507

Ballottement, 100

Barley water, preparation of, 505

Bartholin’s glands, 40

Bath, bran, preparation of, 517
in puerperium, 329
soda, preparation of, 517
starch, preparation of, 517

Bathing, during pregnancy, 119

Baudelocque’s diameter, 25, 27

Bed exercise, in puerperium, 349

Bed, position in during puerperium, 326
preparation of for labor, 248

Beef juice, preparation of, 506

Beri-beri, 376

Binders, abdominal, during pregnancy, 122
in puerperium, 349
for breast, 123, 345, 347

Birth, changes in fetal circulation at, 84, 87

Bladder, 37
care of in puerperium, 332

Blastodermic vesicle, 65, 66

Bleeding, _see_ Hemorrhage

Bones, changes in, during pregnancy, 104

Bottle, giving of to baby, 495

Bowels, care of in pregnancy, 120
care of, in puerperium, 331
of fetus, 88

Bradycardia, puerperal, 322

Bran bath, preparation of, 517

Bread, allowed during pregnancy, 128

Breast, and _see_ Lactation, and Nursing
abscess in, 344
anatomy of, 41, 42
binders, in pregnancy, 123
in puerperium, 345, 347
caked, 344
care of, during pregnancy, 131
in puerperium, 339
changes in, in pregnancy, 96, 103
drying up of, 366
feeding, 486, and _see_ Nursing, Lactation
contraindications, 357
infusion under, 202
stripping, 348
supporting, in puerperium, 343
supports for, in puerperium, 343, 345

Breast tray, 417

Breath, shortness of, during pregnancy, 140

Breech extraction, 298

Bregma, 89

Broad ligament, 33, 38

Broths, preparation of, 506

Cæsarean section, 305
conservative, 307
extra-peritoneal, 307
indications for, 306
radical, 307

Caked breasts, 344

Cane sugar, 498

Canned milk, 504

Caput succedaneum, differentiated from cephalhematoma, 541

Cardiovascular system, changes in pregnancy, 103

Care of baby, by visiting nurses, 437
in traveling, 507
during summer, 514
immediate, 265
of mother, by visiting nurses, 437

Carriage, in pregnancy, 105

Catheterization, 333

Cephalhematoma, 541

Cereals allowed during pregnancy, 128

Certified milk, 490

Cervix, changes in pregnancy, 99, 102
during labor, 234

Champetier de Ribes’ bag, 311

Childbirth, deaths in, 112, 405

Chloasma, 97, 105

Chloroform anesthesia, 287, 288

Chorion, 68
development of, 68
frondosum, 70
læve, 70
primitive, 67
villi, 68, 70

Circulation, fetal, 84, 85
changes in at birth, 84, 87

Cleft palate, in new-born, 542

Climacteric, 56

Clinic assistant, duties of, 431

Clinic equipment, 432

Clitoris, 40

Clothes, during pregnancy, 121

Club foot, in new-born, 541

Coccyx, 20

Colic in infants, 528

Colonic irrigations in eclampsia, 195

Colostrum, 103

Commercial baby foods, 503

Complete abortion, 170

Complicated labors, 295

Complications of pregnancy, 164
early signs of, 141, 143
of puerperium, 391

Concealed hemorrhage, 178

Conception, 62

Condensed milk, 504

Confinement, to calculate date of, 93, 94

Constipation, during pregnancy, 120
in infants, 529

Contracted pelvis, measurements in, 29

Convulsions, in infants, 531

Cord, umbilical, 76
development of, 61
ligation of, 272
prolapsed, 285

Corpus luteum, 49
false, 49
of menstruation, 49
of pregnancy, 49
verum, 49

Corsets, during pregnancy, 121
front-lace, 122
maternity, 122

Cow’s milk compared with mother’s milk, 491

Cramps in legs, during pregnancy, 140

Cravings, during pregnancy, 127

Cul-de-sac of Douglas, 36, 39

Dämmerschlaf, 292

Date of confinement, to calculate, 93, 94

Deaths in childbirth, 112, 405

Decidua basalis, 66
gravidatis, 65
reflexa, 66
serotina, 66
vera, 66

Deficiency diseases, 372, 378

Delivery, dressings required for, 159
patient draped for, 262
preparation of dressings for, 155, 158
of equipment for, 155
of room for, 155
requirements of mother for, 158
of physician for, 161
room ready for, 258, 259

Detachment of placenta, 241

Desserts allowed in pregnancy, 128

Development of cord, 61
of embryo, 61, 76, 78, 80
of fetus, 61, 76, 78, 80
of membranes, 61
of ovum, 61
of placenta, 61, 72

Diameters of fetal head, 90, 91
of pelvis, 25, 26, 27, 28

Diarrhea, during pregnancy, 136

Diarrheal diseases of infants, 518

Diastasis of rectus muscles, 102

Diet during pregnancy, 125, 128
during puerperium, 329
of nursing mother, 363

Digestive tract, changes in during pregnancy, 104
during puerperium, 321

Discoloration of skin during pregnancy, 97

Discomforts during pregnancy, 134

Discus proligerus, 48

Distress during pregnancy, 136

Douches, vaginal, in puerperium, 338

Douglas, cul-de-sac of, 36, 39

Dressings, post-partum, 336
required for delivery, 155, 158, 159

Dried milk, 505

Drugs excreted in milk, 331

Dry labor, 235

Dry pack, hot, in eclampsia, 197

Ductless glands, changes in during pregnancy, 105

Duncan’s mechanism of placental separation, 239, 242

Dysmenorrhea, 56

Eclampsia, 190
colonic irrigations in, 195
frequency of, 190
mortality of, 191
nursing care in, 193
symptoms of, 191
treatment of, 193

Ectoderm, structures derived from, 67

Elevated Sims’ position, 139

Embryo, 67, 68
development of, 61, 76, 78, 80

Embryonic area, 66
development, 67

Emotional changes during pregnancy, 105

Endometrium, 32
pre-menstrual swelling of, 49

Enema, to give to infant, 530

Engagement of presenting part, 224

Engorgement of breasts, in newborn, 541

Entoderm, structures derived from, 67

Episiotomy, 298

Equipment, preparation of for delivery, 158

Esbach’s test for albumen in urine, 118

Ether anesthesia, 289, 290

Evaporated milk, 504

Examination of eye, method of holding baby for, 537
of urine, in pregnancy, 117
rectal, during pregnancy, 231
vaginal, in labor, 248, 252
in pregnancy, 230

Excretions during pregnancy, 117

Exercise, bed, during puerperium, 349
for nursing mother, 364
in pregnancy, 129

Expectant mother, 109
mental hygiene of, 145

Extra-uterine pregnancy, 82

Face presentation, positions in, 223

Fallopian tubes, anatomy of, 33

Fallopian tubes, changes in during pregnancy, 102
fimbriæ of, 34

Fat soluble A. vitamines, 371, 377

Feeder, for premature babies, 513

Feeding, 486
artificial, 489
breast, 486
mixed, 503
percentage, 499, 500, 501

Feet, swelling of during pregnancy, 137
varicose veins of during pregnancy, 138

Fertilization, 62

Fetal circulation, 84, 85
changes in at birth, 84, 87

Fetal head, 88, 90
circumference of, 91
diameters of, 90, 91
fontanelles of, 89, 90
rotation of during birth, 236
sutures of, 89

Fetal heart, auscultation of, 231

Fetal heart beat, sign of pregnancy, 99

Fetal mortality, 112

Fetus, 68
at term, 80, 218
attitude of in uterus, 217
bowels of, 88
development of, 61, 76, 78, 80
growth of, 84
head of, 88, 90, and _see_ Fetal head
kidneys of, 88
maturation of, time required for, 68
movements of, as sign of pregnancy, 99
palpation of, 224
as sign of pregnancy, 99
physiology of, 84
position of, 217
presentation of, 217, 220
presenting part of, 220

Fimbria ovarica, 34

Flatulence during pregnancy, 136

Follicle, primordial, 47

Fontanelles of fetal head, 89, 90

Foods for baby, commercial, 503
proprietary, 504

Forceps, 300
axis-traction, 301
high, 303
indications for, 301, 302
low, 303
Simpson’s, 301
Tarnier’s, 301

Fornix of vagina, 35

Fossa navicularis, 40

Fourchette, 40

Frank hemorrhage, 178

Fresh air during pregnancy, 129

Front-lace corset, 122

Fruits allowed during pregnancy, 128

Funis, 76

Gastro-enteritis, acute, 519
nursing care in, 519
symptoms of, 519
treatment of, 519

Gavage, 524

Genitalia, anatomy of, 19
external, 39
internal, 30

Germinal spot, 48
vesicle, 47

Gonorrhea complicating pregnancy, 212

Gonorrheal vaginitis in infants, 540

Graafian follicle, 34, 48

Gymnastics during pregnancy, 130

Harelip in newborn, 541

Head, fetal, 88, 90
circumference of, 91
diameters of, 90, 91
fontanelles of, 89, 90
rotation of during birth, 236
sutures of, 89

Health, general, during pregnancy, 106

Heart, fetal, auscultation of, 231
lesions of complicating pregnancy, 209

Heart beat, fetal, sign of pregnancy, 99

Heart burn, during pregnancy, 135

Heat and acetic acid test for albumen in urine, 118

Hebotomy, 303

Hemorrhage, accidental, 178
ante-partum, 174
concealed, 178
during pregnancy, 143
during puerperium, 391
frank, 178
post-partum, 286, 391
causes of, 391
treatment of, 392

Hemorrhoids during pregnancy, 140

Hernia, in newborn, 542
inguinal, 543
umbilical, 542

Hot dry pack in eclampsia, 197

Hygiene, of nursing mother, 363
of pregnancy, 116

Hysterotomy, vaginal, 305

Icterus, in newborn, 540

Ignorance, dangers of, 546

Ilium, 19

Impetigo, 540

Impregnation, 62

Inanition, 518

Incomplete abortion, 170

Indian binder for breasts, 347

Induced abortion, 309
indications, 309
methods, 310

Infancy, abnormalities of, 518
disorders of, 518
infection in, 533

Infant, and _see_ Newborn
colic in, 528
constipation in, 529
convulsions in, 531
diarrheal diseases of, 518
enema for, 530
gonorrheal vaginitis in, 540
syphilis in, 538
vaginitis in, 540
vomiting in, 532
wasting diseases in, 518

Infantile scurvy, 374

Infection, in infancy, 533
puerperal, 393
nursing care in, 399
prevention of, 399
symptoms of, 396
treatment of, 399

Infusion, of orange peel, preparation of, 506
saline, in eclampsia, 200
under breast, 202

Inguinal hernia, in newborn, 543

Injection of salines, in eclampsia, 200

Innominate bones, 19

Instructions to patients, 427

Intestinal irrigations, 522

Invalidism, due to lack of obstetrical care, 112

Involution of uterus, 317

Irrigations, colonic, in eclampsia, 195
intestinal, 522

Ischium, 20

Itching of skin, during pregnancy, 141

Jaundice, in newborn, 540

Kidneys, during pregnancy, 117
of fetus, 88

Labia majora, 39
minora, 40

Labor, cause of, 232
cervix during, 234
complicated, 295
course of, 232
definition of, 232
dry, 235
duration of, 233
first stage of, 23
nurses duties during, 245, 256
mechanism of, 232
nurses duties in, 243
during first stage, 245, 256
during second stage, 256
during third stage, 278
when doctor is delayed, 283
onset of, 232
pains of, 232
premature, 172
causes of, 172
induced, 309, 310
treatment, 173
preparation for, 248
of bed, 248
of room, 248
signs of, 232
second stage of, 236
nurses duties during, 256
stages of, 232
symptoms of, 232
third stage of, 240
nurses duties during, 278
vaginal examination in, 252
when to call physician, 247

Lactation, 320, 342

Lactose, 498

Lacerations, perineal, 296
repair of, 297

Lavage, 524

Layette, details of, 162
recommended by Maternal Centre Association, 416

Leg, cramps in during pregnancy, 140

Leg, milk, 400

Leg straps, to improvise, 296

Leggings, for delivery or operation, 304

Ligaments, broad, 33, 38
ovarian, 34, 38
round, 38
uterine, 38

Ligation of cord, 272

Linea nigra, 197

Lineæ albicantes, 102

Liquor amnii, 71
folliculi, 48

Liver, acute yellow atrophy of during pregnancy, 207

Lochia, 319
alba, 319
rubra, 319
serosa, 319

Longitudinal presentations, 221

Loss of weight during puerperium, 319

Lutein, 49

Malnutrition, 369, 387, 518

Maltose, 498

Mania, puerperal, 400

Marasmus, 518

Marital relations during pregnancy, 133

Masque de femmes enceintes, 105

Massage during pregnancy, 130

Mastitis, 345

Maternal mortality, 112

Maternity Centre Association, 410
baby’s supplies, 428
clinical equipment, 432
clinical routine, 429
doctor’s duties, 431
duties of clinical assistants, 431
forms and routines used by, 423
instructions to patients, 427
mother’s supplies, 428
nurse’s duties, 429
nursing visits, 424
orders for nurses, 434
post-natal follow up, 435
records, 427, 431
requirements, 432

Maternity Centre Nurse, 413

Maternity Centre orders for nurses, 434
ante-partum, 434
post-natal, 435
post-partum, 435

Maternity corsets, 122

Maternity Protective Committee of the Woman’s City Club, 411

Maternity records, 427, 431

Maternity Service Association of Physicians and Hospital
Superintendents, 411

Maternity service for rural communities, 422

Maternity nursing, visiting, in Montreal, 445

Maternity work of Visiting Nurses Society of Philadelphia, 439
delivery routine, 441
equipment for bags, 439
routine after delivery, 442
routine in home, 440
routine technique, 439

Maturation of fetus, time required for, 68

Mauriceau’s maneuver, 299

Measurements, in contracted pelvis, 29

Meatus urinarius, 37

Membrana granulosa, 48

Membrane, vitelline, 47

Membranes, development of, 61
examination of, 280

Menopause, 56

Menorrhagia, 56

Menstrual cycle, 50

Menstruation, 50
cessation of, sign of pregnancy, 96
corpus luteum of, 49
difficulties of, 54
during puerperium, 320
modifications of, 56
painful, 54
relation to ovulation, 55
vicarious, 56

Mesoderm, structures derived from, 67

Mental changes during pregnancy, 105
hygiene during pregnancy, 145

Micturition, frequent, as sign of pregnancy, 97

Migration of ovum, 61

Milk, canned, 504
certified, 490
condensed, 504
cow’s compared with mother’s, 491
dried, 505
drugs excreted in, 331
drying up of, 366
evaporated, 504
mixtures, formulas for, 500, 501, 503
mother’s compared with cow’s, 491
pasteurized, 494
powders, 505
preparation of for baby, 494
reconstructed, 505
top, 499
whole, 499

Milk leg, 400

Miscarriage, 165
early signs of, 142

Missed abortion, 170

Mixed feeding, 503

Mons Veneris, 39

Montgomery, tubercles of, 43

Morning sickness, 97, 135, 142, 181

Mortality, fetal, 112
maternal, 112

Morula, 64, 65

Mother, advice for, 427
care of by visiting nurses, 437
expectant, 109
mental hygiene of, 145
milk of compared with that of cow, 491
nursing, 357
bowels of, 364
diet of, 363
exercises for, 364
hygiene of, 363
recreation for, 365
rest for, 364

Mother, nutrition of, 368
requirements of for delivery, 158
supplies for, 428

Movements of fetus a sign of pregnancy, 99

Multipara, definition of term, 219

Multiple pregnancy, 82

Nausea, during pregnancy, 134

Nephritic toxemia, during pregnancy, 203
nursing care of, 205
symptoms of, 204
treatment of, 205

Neurotic vomiting during pregnancy, 183

Newborn baby and _see_ Infant
abnormalities of, 540
bathing of, 463
behavior of, 459
bowels, training of, 482
cephalhematoma in, 541
characteristics of, 451
chest, 455
cleft palate in, 542
clothes for, 472
club foot in, 541
cord, 458
dressing of, 469
crying of, 484
development of, 452
diapers for, 475
ear pulling, prevention of, 483
engorgement of breasts in, 541
exercise for, 480
fontanelles, 455
fresh air for, 477
growth of, 453
harelip in, 541
head, 455
height of, 455
hernia in, 542, 543
icterus in, 540
inguinal hernia in, 543
jaundice in, 540
nursing care of, 461
resuscitation of, 273
ruminating, prevention of, 484
schedule for, 462
size of, 452
skin of, 459
sore eyes in, 533
stools of, 456
tears of, 459
teeth of, 455
thumb-sucking, prevention of, 482
training of, 482
umbilical hernia in, 542
urine of, 456
weight of, 452, 453

Newborn baby, weight chart, 454

Nipples, 41
care of, during pregnancy, 132
care of, in puerperium, 340, 342
cracked, care of, 342
flat, 132
retracted, 132
toughening, 132

Nipple shields, 340, 341, 342

Nitrous oxid gas anesthesia, 291

Nullipara, definition of term, 219

Nurses’ bag, contents of, 434

Nurses’ duties, in clinic, 429
during labor, 243
first stage, 245, 256
second stage, 256
third stage, 278
maternity centre orders for, 434
ante-partum, 434
post-natal, 435
post-partum, 435
Plunkett, 408
requirements of for delivery, 161
visiting, care of mother and baby by, 437
work of in prenatal case, 112

Nursing mother, 357
bowels of, 364
diet of, 363
exercise for, 364
hygiene of, 363
recreation for, 365
rest for, 364

Nursing of baby, _see_ Lactation and Nursing mother
frequency of, 361
methods of, 358

Nursing care in puerperium, 323, 326

Nursing visits, 424

Nutrition, 369
of baby, 368
of mother, 368

Oatmeal water, preparation of, 506

Obstetrical anesthesia, 286, 288
operations, 295

Oöcyte, 47

Operating table, to make, 295

Operations, destructive, 309
obstetrical, 295

Ophthalmia neonatorum, 533
nursing care of, 535
symptoms of, 534
prevention of, 534
treatment of, 535

Orange juice, preparation of, 505

Organized prenatal work, 405

Organs of reproduction, female, 30

Ossa innominata, 19

Ova, 34, 47

Ovarian ligament, 34, 38

Ovaries, 34
changes in during pregnancy, 102

Ovulation, 47
relation to menstruation, 55

Ovum, 47, 68
development of, 61
migration of, 61
segmentation of, 64, 65

Pack, to give, 521, 522

Palpation of fetus, 224
sign of pregnancy, 99

Pasteurized milk, 494

Pellagra, 380

Pelvic cavity, 22

Pelvic examination in puerperium, 329

Pelvimetry, 19, 25, and _see_ Diameters of pelvis

Pelvis, anatomy of, 19
brim of, 22
contracted, measurements of, 29
diameters of, 25, and _see_ Diameters of pelvis
false, 23
female, 19, 21, 30
inferior strait, 23
inlet, 22
male, 21, 30
measurements of, 25
normal female, 19, 30
outlet of, 23
rachitic, 30
true, 23

Pemphigus, 540

Percentage feeding, 499, 500, 501

Perineal dressings, in puerperium, 336
lacerations, 296
repair of, 297

Perineum, anatomy of, 40
care of in puerperium, 335

Peritoneum, 34

Pernicious vomiting of pregnancy, 134, 181
classification, 182

Phlegmasia alba dolens, 400

Physician, requirements of for delivery, 161
when to call in labor cases, 247

Physiology, 45

Pigmentation, in pregnancy, 103, 105

Placenta, 68, 72
delivery of, 279
detachment of, 241
development of, 61, 72
examination of, 280
function of, 73
origin of, 72

Placenta, separation of, 239, 279
mechanism of, 239, 241, 242
premature, 178
size of, 75
weight of, 75

Placenta prævia, 174
causes of, 176
central, 176
complete, 176
frequency of, 174
incomplete, 176
marginal, 176
mortality in, 174
partial, 176
symptoms of, 176
treatment of, 177

Plunkett nurses, 408

Poncho, Sutton’s, 479

Position of fetus, 217
definition of, 221

Position, elevated Sims, 139
right angled, 138

Positions, in face presentations, 223
in transverse presentations, 223
in vertex presentations, 222

Post-natal follow-up, routine for, 435

Post-natal work of Maternity Centre nurses, 419

Post-partum care by visiting nurses, 437
dressings, 336
hemorrhage, 286, 391
causes of, 391
treatment of, 392

Potato water, preparation of, 505

Pouting umbilicus, 103

Powders, milk, 505

Pre-eclamptic toxemia, 187
prevention of, 188
nursing care in, 189
symptoms of, 187
treatment of, 189

Pregnancy, abdominal binders during, 122
abdominal changes in, 98, 102
abdominal enlargement, sign of, 98
accidents of, 164
acute yellow atrophy of liver during, 207
alcohol during, 127
bathing during, 119
bones, changes in during, 104
bowels, care of during, 120
breasts, care of during, 131
changes in a sign of, 96
changes in during, 96, 103
breast-binders during, 123
cardio-vascular system, changes in during, 103

carriage in, 105
cervix, changes in during, 99, 102
softening, a sign of, 99
cessation of menstruation, a sign of, 96
clothes, during, 121
complications of, 164
early signs of, 141, 143
constipation during, 120
corpus luteum of, 49
corsets during, 121
cramps in legs during, 140
cravings during, 127
diarrhea during, 136
diet during, 125, 128
digestive tract, changes in during, 104
discoloration of skin, as sign of, 97
discomfort during, 134
distress during, 136
ductless glands, changes in during, 105
duration of, 93
emotional changes during, 105
excretions during, 129
exercise during, 129
extra-uterine, 82
fallopian tubes, changes in during, 102
fetal heart beat, a sign of, 99
fetal movements a sign of, 99
flatulence during, 136
fresh air during, 129
gonorrhea complicating, 212
gymnastics during, 130
health, general, during pregnancy, 106
heartburn during, 135
heart lesions complicating, 209
hemorrhage during, 143
hemorrhoids during, 140
hygiene of, 116
itching of skin during, 141
kidneys in, 117
marital relations during, 133
massage during, 130
mental changes during, 105
mental hygiene during, 145
micturition, frequent as sign of, 97
morning sickness during, 97, 135, 142, 181
multiple, 82
nausea during, 134
nephritic toxemia in, 203
neurotic vomiting in, 147
nipples, care of during, 132
flat, 132
retracted, 132
ovaries, changes in during, 102
palpation of fetus, sign of, 99
pernicious vomiting of, 134, 181
physiology of, 93, 100
pigmentation in, 105
positive signs of, 99
premature termination of, 165
early signs of, 142
presumptive signs of, 96
pressure symptoms during, 137
probable signs of, 98
pulmonary tuberculosis complicating, 209
psychoses during, 147
pyelitis complicating, 212
quadruplet, 82
quickening, as sign of, 98, 99
to calculate date of confinement from, 94
quintuplet, 82
rectal examination in, 231
respiratory organs, changes in during, 104
rest during, 130
sextuplet, 82
shoes during, 124
shortness of breath during, 140
signs of, 93
positive, 99
presumptive, 96
probable, 98
skin, care of during, 118
changes in during, 104
itching of during, 141
stretching of during, 141
sleep during, 130
spurious, 96
stocking supporters during, 124
supporters, abdominal, during, 122
stocking, during, 124
swelling of feet during, 137
symptoms of, 93
syphilis, complicating, 207
teeth in, 104, 133
temperature of body in, 105
thyroidism, complicating, 210
toxemias of, 142, 179
early signs of, 142
travelling during, 133
triplet, 82
twin, 82
umbilicus, changes in during, 103
urinary apparatus, changes in during, 104
urine in, 117
tests for, 118
uterus, changes in during, 101, 83
sign of, 98, 99
vagina, changes in during, 102
vaginal discharge during, 140
examination in, 230
varicose veins during, 138
vomiting during, 134, 181

Premature baby, 508
bed for, 512
care of, 509
feeder for, 513
feeding of, 510, 513
heat required for, 511, 512
size of, 508

Premature labor, 172, 165
causes of, 172
early signs of, 142
induced, 309, 310
indications for, 310
methods, 311
treatment of, 173

Premature separation of normally implanted placenta, 178
causes of, 178
symptoms of, 178
treatment of, 179

Premature termination of pregnancy, 165
early signs of, 142

Premenstrual swelling of endometrium, 49

Prenatal care, 111
work of nurse in, 112

Prenatal work, organized, 405

Prenatal visits, routine for, 423

Preparations for delivery, 155, 158

Presentation of fetus, 217
definition of, 220
face, 223
longitudinal, 221
transverse, 221, 223
vertex, 222

Presenting part, definition of, 220
engagement of, 224

Pressure symptoms during pregnancy, 137

Prickly heat, 516

Primigravida, definition of, 219

Primipara, definition of, 219

Primordial follicle, 47

Prolapsed cord, 285

Proprietary baby foods, 504

Protein milk, preparation of, 506

Pseudocyesis, 96

Psychoses during pregnancy, 147

Puberty, 45

Pubiotomy, 304

Pubis, 20

Pudendal crease, 39

Puerperium, 317
abdominal binder, in, 349
abdominal wall in, 321
bath in, 329
bed exercise in, 349
bladder, care of during, 332
bowels, care of during, 331
bradycardia during, 322
breasts, binder for, 345, 347
care of during, 339
supports for during, 343, 345
complications in, 391
diet in, 329
digestive tract during, 321
douches, vaginal during, 338
hemorrhages during, 391
infection in, 393
nursing care of, 399
symptoms of, 396
treatment of, 399
loss of weight during, 319
mania during, 400
menstruation during, 320
nipples, care of during, 340
nursing care in, 323, 326
pelvic examination in, 329
perineal dressings in, 336
perineum, care of during, 335
physiology of, 317
pulse during, 322, 335
position in bed during, 326
respiration in, 335
sitting up in, 328
skin in, 322
temperature in, 321, 335
urine in, 322
uterus, changes in during, 317
height of during, 327, 328

Pulmonary tuberculosis complicating pregnancy, 209

Pulse, in puerperium, 322, 335

Pyelitis complicating pregnancy, 212

Quadruplet pregnancy, 82

Quickening, as sign of pregnancy, 98, 99
to calculate date of confinement from, 94

Quintuplet pregnancy, 82

Rachitic pelvis, 30

Reconstructed milk, 505

Records, maternity, 427, 431

Recreation, for nursing mother, 365

Rectal examinations, during pregnancy, 231

Rectum, 37

Reflex vomiting during pregnancy, 182

Reproduction, organs of, 30

Respiration, in puerperium, 335

Respiratory organs, changes in during pregnancy, 104

Rest, during pregnancy, 130
for nursing mother, 364

Resuscitation of newborn baby, 273

Richardson Y binder, 345, 347

Rickets, 381
symptoms of, 382
treatment of, 385

Right angled position, 138

Room for delivery, preparation of, 155, 258, 259

Rotation of fetal head during birth, 236

Round ligaments, 38

Routine for prenatal visits, 423

Rubber gloves, sterilization of, 253

Ruminating cap, 485

Rumination, prevention of, 484

Ruptured uterus, 307
causes of, 308
frequency of, 308
symptoms of, 308
treatment of, 308

Sacro-coccygeal joint, 20

Sacro-iliac joints, 20

Sacro-vertebral joint, 22

Sacrum, 20

Saline infusion, in eclampsia, 200

Schenck’s theory of sex determination, 63

Schultze’s mechanism of placental separation, 239, 241

Scopolamin and morphin anesthesia, 292

Scorbutus, 373

Scurvy, 373
infantile, 374

Segmentation of ovum, 64, 65

Separation of placenta, 239, 279
mechanism of, 239, 241, 242

Sex, determination of, theories of, 63

Sextuplet pregnancy, 82

Shoes, during pregnancy, 124

Shortness of breath, during pregnancy, 140

“Show,” 235

Sims’ elevated position, 139

Simpson’s forceps, 301

Sinciput, 89

Sitting up, during puerperium, 328

Skin, care of in pregnancy, 118
changes in, during pregnancy, 97, 104
discoloration of as a sign of pregnancy, 97
in puerperium, 322
itching of, during pregnancy, 141
stretching of, during pregnancy, 141

Sleep, during pregnancy, 130

Society for the Health of Mothers and Children, 408

Soda bath, preparation of, 517

Soups, allowed during pregnancy, 128

Spermatozoa, 61, 62

Sphincter ani, 37

Spinach, preparation of, 505

Sprue, 539

Spurious pregnancy, 96

Starch bath, preparation of, 517

Stocking supporters during pregnancy, 124

Stretching of skin, during pregnancy, 141

Striæ, 97, 102
gravidarium, 102

Stripping of breast, 348

Subcutaneous injection of salines in eclampsia, 200

Sucking of thumb, prevention of, 482

Sugar, 498

Summer, care of baby during, 514
complaint, 519
diarrhea, 519

Supplies for baby, 428
for mother, 428

Supporter, abdominal, during pregnancy, 122

Supports for breasts, in puerperium, 343, 345

Sutton’s poncho, 479

Sutures of fetal head, 89

Swelling of feet during pregnancy, 137

Symphysiotomy, 305

Syphilis, complicating pregnancy, 207
in infants, 538

Tarnier’s forceps, 301

Teeth, care of during pregnancy, 133
in pregnancy, 104, 133

Temperature, in pregnancy, 105
in puerperium, 335

Tests for albumen in urine, 118

Theca folliculi, 48

Therapeutic abortion, 171

Threatened abortion, 170

Thrush, 539

Thumb sucking, to prevent, 482

Thyroidism complicating pregnancy, 210

Toilet tray, baby’s, 417

Tomato juice, to prepare, 506

Top milk, 499

Toxemia, nephritic, 203
nursing care in, 205
symptoms of, 204
treatment of, 205
pre-eclamptic, 187
nursing care of, 189
prevention of, 188
symptoms of, 187
treatment of, 189

Toxemias of pregnancy, 142, 179
early signs of, 142

Toxemic vomiting, during pregnancy, 184

Transverse presentations, 221
positions in, 223

Travelling, baby basket for, 507
care of baby in, 507
during pregnancy, 133

Triplet pregnancy, 82

Tubercles of Montgomery, 43

Tuberculosis, pulmonary, complicating pregnancy, 209

Twilight sleep, 292

Twin pregnancy, 82

Umbilicus, changes in during pregnancy, 103
pouting, 103

Umbilical cord, 76, and _see_ Cord

Umbilical hernia, in newborn, 542

Ureters, 37

Urethra, 37

Urinary apparatus, changes in during pregnancy, 104

Urine, albumen in, to test for, 118
in pregnancy, 117
examination of, 117
in puerperium, 322
to obtain specimen of from baby, 526, 527

Uterus, anatomy of, 30
blood supply of, 32
body of, 32
cervix of, 32, 33,
changes in during pregnancy, 83, 98, 101
as sign of pregnancy, 98
changes in during puerperium, 317
contractions of as sign of pregnancy, 99
cornua of, 33
external os, 33
fundus, 32
height of in puerperium, 327, 328
internal os, 33
involution of, 317
ligaments of, 33, 38
multiparous, 32
ruptured, 307, and _see_ Ruptured uterus
virgin, 32

Vagina, changes in during pregnancy, 102
fornix of, 35

Vaginal discharge during pregnancy, 140
douches during puerperium, 338
examination in labor, 248, 252
in pregnancy, 230
hysterotomy, 305
opening, 40

Vaginitis, in infants, 540

Varicose veins during pregnancy, 138

Vegetables allowed during pregnancy, 128

Venesection in eclampsia, 200

Version, 299
cephalic, 299
combined, 300
external, 300
indications, 299
internal, 300
podalic, 300

Vertex presentations, positions in, 222

Vestibule, 40

Vicarious menstruation, 56

Villi, chorionic, 68, 70

Visiting nurses, care of mother and baby by, 437

Vitamines, 371
fat soluble A., 371, 377
water soluble B., 371, 377
water soluble C., 371, 373

Vitelline membrane, 47

Vomiting during pregnancy, 134, 181
pernicious, 134, 181
neurotic, 147, 183
reflex, 182
toxemic, 184

Vomiting in infants, 532

Voorhees’ bag, 312

Vulva, 39
cleansing of, 249
varicose veins of during pregnancy, 139

Wassermann’s reaction, in obstetrics, 208, 209

Wasting diseases of infants, 518

Water soluble B., 371, 377

Water soluble C., 371, 373

Weaning, 365

Weight, loss of, during puerperium, 319

Weight of newborn baby, 452, 453
chart, 454

Whey, preparation of, 506

Whole milk, 499

Woman’s Municipal League, 409

Xerophthalmia, 377

-----

Footnote 1:

In the generally contracted pelves, all of the external measurements
are shorter than normal, the diagonal conjugate being 11.5 cm., or
less. In simple flat pelves, on the other hand, the external
measurements are normal, but the diagonal conjugate is 11 cm., or
less.

If the distance between the tuber-ischii is only 8 cm., or less, the
patient has some kind of a funnel pelvis; simple, if the inlet
measurements are normal, but if they also are shortened, the pelvis is
described as a generally contracted funnel.

The rachitic pelves present certain characteristic features, one
being less difference between the inter-spinous and inter-crestal
measurements than is found in a normal pelvis. Another, that the
distance between the tuber-ischii is always of normal length and may
even be greater than normal. The peculiar deformity of the sacrum,
however, is the most characteristic abnormality of the rachitic
pelves. The concavity from above downward is markedly increased, in
some cases almost forming an angle, while the horizontal concavity is
nearly or quite obliterated. The commonest type of a rachitic pelvis
is one in which all of the inlet measurements are shortened, the
inter-tuberous distance normal, and the sacrum characteristically
deformed. This is called the generally contracted, rachitic pelvis. In
the flat rachitic pelvis all of the inlet measurements are normal,
except the diagonal conjugate, which may be shortened to 11 cm., or
less, and the sacrum presents the deformity described above.

Footnote 2:

The Prospective Mother, by J. Morris Slemons.

Footnote 3:

“Obstetrics,” by J. Whitridge Williams.

Footnote 4:

“The Practice of Obstetrics,” by J. Clifton Edgar.

Footnote 5:

“The Value of the Wassermann Reaction in Obstetrics, Based upon the
Study of 4,547 Consecutive Cases.” Johns Hopkins Hospital Bulletin,
Oct., ’20. “The Significance of Syphilis in Prenatal Care and in the
Causation of Infant Death.” Johns Hopkins Hospital Bulletin, May,
1921.

Footnote 6:

Routine preparation of hands at Johns Hopkins Hospital.

Footnote 7:

Written especially for this book.

Footnote 8:

From _puer_, child, and _parere_, to bring forth.

Footnote 9:

“The Practice of Obstetrics,” by J. Clifton Edgar.

Footnote 10:

Alfred F. Hess, M.D., and Lester J. Unger, _American Journal of
Diseases of Children_, April, 1919.

Footnote 11:

Alfred F. Hess, M.D., _The Journal of the American Medical
Association_, Sept. 21, 1918.

Footnote 12:

“The Nursing Mother as a Factor of Safety in the Nutrition of the
Young.” E. V. McCollum and N. Simmonds, _The American Journal of
Physiology_, June, 1918.

Footnote 13:

“The Life of Pasteur,” by Vallery Radot.

Footnote 14:

The Committee consisted of Drs. J. Clifton Edgar, Ralph Lobenstein and
Philip Van Ingen.

Footnote 15:

“Obstetrics,” by J. Whitridge Williams.

Footnote 16:

“Acidosis,” by John Howland, M.D., and W. McKim Marriott, M.D.,
_Pennsylvania Medical Journal_, April, 1918.

Footnote 17:

“The Diseases of Infants and Children,” by J. P. Crozer Griffith,
M.D.

------------------------------------------------------------------------

TRANSCRIBER’S NOTES

1. p. 88, changed “this is spite of” to “this is in spite of”.
2. Silently corrected typographical errors and variations in
spelling.
3. Retained anachronistic, non-standard, and uncertain spellings as
printed.
4. Footnotes have been re-indexed using numbers and collected
together at the end of the last chapter.
5. Enclosed italics font in _underscores_.

End of Project Gutenberg's Obstetrical Nursing, by Carolyn Conant Van Blarcom