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