A PRACTICAL APPLICATION 
OF THE 
Science of Obstetrics 
BY 
T. RIDGWAY BARKER, M.D., 
Demonstrator of Obstetrics, and Assistant in Clinical Gynaecology in the 
MedicoChirurgical College, Philadelphia. 
Reprinted from The Times and Register, February 8, 1890. 
PHILADELPHIA : 
Medical Press Company, Limited, 
1890, A PRACTICAL APPLICATION OF THE 
SCIENCE OF OBSTETRICS. 
By T. RIDGWAY BARKER, M.D., 
Demonstrator of Obstetrics, and Assistant in Clinical Gynaecology in the 
Medico Chirurgical College, Philadelphia 
IT is with a feeling of sympathy, mingled with a 
desire to relieve the anxiety which arises in the 
mind of every practitioner when called to attend his 
first few cases of confinement, that I take this oppor- 
tunity to express, with brevity and perspicuity, the 
simple yet all-important methods employed in the 
lying-in chamber. In the department of obstetrics, 
no less than in every other branch of scientific medi- 
cine, it is the attention to minutiae which ultimately 
wins for the faithful the crown of success. Prompted 
by this thought, rather than with the idea of present- 
ing anything new, permit me to proceed to a consid- 
eration of the subject. 
Having been summoned to a case of confinement, 
the attendant should provide himself with a pair of 
long obstetric forceps, suitable for application at the 
brim ; uterine dressing forceps ; sound ; applicator ; 
a surgical case, and a supply of absorbent cotton. 
Besides these articles, some corrosive sublimate 
tablets, a solution of carbolic acid, and several ounces 
of a reliable preparation of fluid extract of ergot. 
Soap and nail-brush must, of course, be included, for 
without the latter, asepsis is well-nigh impossible. 
On reaching the patient's dwelling, his arrival 
should be announced as quietly as possible, lest loud 
talking and confusion annoy her. It is not expected 2 
that |he will tramp up the stairs as if marching to 
battle, nor yet slam the door with such violence that 
the house is shaken to its foundation. 
The realization of the fact that one is in the cham- 
ber of a female, with a nervous system as delicate 
and sensitive as a galvanometer, upon whose index 
-the brain-is registered every sound and awkward 
movement, will assuredly check any tendency on the 
part of physician or nurse to jocularity. Be the 
normal nervous tension what it may, during gesta- 
tion and parturition there is always a decided rise, 
amounting, oftentimes, to a condition of hyperaes- 
thesia. 
To dispel, therefore, the gloomy forebodings and 
depressing sense of impending danger, are among 
his primary duties. 
By gracefulness of manner and gentlemanly bear- 
ing the obstetrician can alone hope to command the 
patient's respect and confidence, demonstrating there- 
by that he is not present to increase her distress by 
idle conversation, but rather to assist in relieving her 
suffering. 
By giving his undivided attention to the clinical 
history of the case, he will secure an opportunity to 
overcome his embarrassment, which is certain to 
assume an aggravated form on entering the patient's 
apartment. 
That the presence of an officious and loquacious 
nurse is to be deplored, none can deny, but upon no 
consideration must the attendant encourage this 
weakness, lest, by opening the flood-gates controll- 
ing her humor, he should be drowned in the freshet 
of his own making. Questions relative to the pa- 
tient's general condition, state of bowels, appetite, 3 
onset of pains, character and amount of urine voided, 
are very proper, and lie within her province. 
The error of asking prematurely for the privilege 
of making a digital vaginal examination is very com- 
mon. This is always to be regretted, for it is likely 
to occasion embarrassment on the part of both physi- 
cian and patient, which may materially hamper the 
efforts of the former. 
Any attempt on the part of the obstetrician to ex- 
aggerate the gravity of his patient's condition with 
the idea of magnifying his own skill, is worthy alone 
of severe condemnation and censure, since it is calcu- 
lated to unnecessarily excite and alarm her. 
If he frighten her, his position is a deplorable one,, 
for she trembles at his very approach. L,et her re- 
fuse his requests and his supremacy at the bed-side 
is irretrievably lost-a condition of affairs quickly 
recognized by the nurse, who, if she is like the ma- 
jority one meets in the first few years of obstetric 
practice, will not fail to appreciate and take advan- 
tage of his altered position. 
Therefore, if only to preserve his own professional 
dignity, it is very important he should not consider 
these apparently trivial matters unworthy of consid- 
eration. 
The desired result can only be secured by asking, 
rather than commanding ; requesting, rather than 
demanding; yet every sentence delivered in a tone 
indicative of firmness, tempered with kindness. By 
such means he will be able to gain every desired 
point without engendering the slightest fear. 
Having counted her pulse, noted its strength and 
regularity, and made the above inquiries of the nurse, 
it is now desirable that he [proceed to interview the 4 
patient.. At what time did the pains come on ? Have 
they been increasing in frequency and duration ? 
Where felt most severely ? Has there been an evac- 
uation of the bowels ? If the reply to the question 
in regard to a movement of the bowels be negative, 
then he may direct the introduction of a glycerine 
suppository, which, by exciting the secretory and 
muscular apparatus of the intestinal canal, will 
cause the expulsion of the faeces in from ten to 
twenty minutes. Failing to procure a suppository, 
one may have recourse to an enema of one-half 
drachm of pure glycerine, .repeated, if necessary ; but 
a larger quantity than this at one time is injudicious, 
for it is apt to be followed by tenesmus and a sense of 
burning, and pain in the rectum. Occasionally the 
medicament excites, in addition, spasm of the blad- 
der. As a substitute for the methods already sug- 
gested, one may give an enema of hot soap-suds- 
one half to one pint, with or without sweet oil, as 
seems most expedient. 
The bladder, if distended, and micturition difficult 
and painful, should be relieved by the employment 
of the female catheter. 
Interrogating the patient still further, he should 
endeavor to learn if there has been any escape of 
amniotic fluid, " the waters," thus gauging in a crude 
way the probable duration of the labor. Though 
answered affirmatively by the patient or nurse, he is 
not warranted in concluding that therefore the mem- 
branes have ruptured, for, as is well known, it is not 
infrequent that one finds fluid, amniotic in character 
(''vitriform body"), escaping from between the 
amnion and chorion, previous to rupture of the 5 
former. While this condition simulates rupture, it 
is inot to be accepted as conclusive. 
After duly considering the foregoing facts, the 
attention of the accoucheur should be given to an 
inspection of the mammae. Beginning with the 
nipples, he should note their appearance - size, 
shape, prominence, sensibility. If depressed, his 
efforts must be directed to elevate them from their 
abnormal situation, by gentle traction. If excoriated 
or fissured, the employment locally of ol. morrhuae 
several times daily, after drying, or unguentuni bel- 
ladonnae, two drachms, ung. zinci ox., one ounce, 
applied freely, will afford decided relief. 
Local applications are of little service if the nip- 
ples are allowed to be irritated by the clothing, or 
subject to pressure. They must be kept dry and 
perfectly free from discharges, which, if allowed to 
continually bathe them, cannot fail to destroy the 
cuticle and excite inflammation. 
The mammary .glands.-As to their size, fullness, 
temperature, tenderness, existence of indurations, 
presence of- milk. The advisability of extending 
his examination to include a physical exploration of 
the abdomen is sometimes doubtful, owing to the ob- 
jections made by the patient; but when permissible, 
should never be omitted. . For, by such means, the 
obstetrician is enabled, to mab»e out the position, 
whether the occiput is presenting (96 per cent.) an- 
terior, or posteriorto the right or left side; or 
whether it is. the breech which occupies the lower 
segment of the uterus. 
Further, an opportunity is afforded to ascertain the 
size of the external pelvic- diameters (normal, "ex- 
ternal conjugate, seven inches, transverse, between 6 
anterior superior spines of ilia, ten inches; at high- 
est point on crest, ten and one-half inches"). The 
knowledge to be gained by auscultation of the abdo- 
men is very important, for by such means it is possi- 
ble to hear and count the number of heart beats, 
" 120-140" per minute. 
The sound is well described as closely resembling 
the ticking of a watch beneath one's pillow, only it 
is vastly fainter- 
Should the foetus occupy the R. O. A. position, as 
the attendant will have discovered by abdominal pal- 
pation, then the sound will be heard loudest on the 
left side, at a point midway between the umbilicus 
and the anterior superior spine of the ilium. 
On the other hand, if in the R. O. A. position, 
then at a corresponding point on the right side; while 
in the case of breech presentations, in the neighbor- 
hood of the umbilicus. 
The recognition of the foetal heart sounds serves 
not only to confirm the presumptive and probable 
signs of pregnancy in the early stage of gestation, 
but also establishes beyond peradventure the fact that 
the foetus is alive. Having reached this point in the 
history of the case, the attendant is prepared to make 
a digital utero-vaginal examination. The position 
most comfortable for the patient during this ordeal is 
the recumbent, which may be dorsal or lateral, to suit 
her convenience. She should be instructed to lie on 
the right side of the bed, so that the obstetrician can 
use his right hand to the best advantage. 
Absolute cleanliness of his hands is of vital im- 
portance. They should be washed thoroughly in a 
hot solution of corrosive chloride of mercury, 1-1000, 
and a nail-brush freely applied. 7 
Finger rings should be removed, as they are very 
likely to carry infectious material in their interstices. 
It is taken for granted t^at where one has been en- 
gaged in dissecting, or attending post-mortems, or 
cases of contagious diseases, he will peremptorily de- 
cline to serve in the capacity of accoucheur. 
His hands having been rendered aseptic, they are 
to be carefully dried, and the index finger of the 
right hand anointed with some simple unguent, as 
petrolatum, unguentuni zinci oxidi, or lard, if no- 
thing better is procurable. 
The patient being covered by a sheet, he introduces 
his index finger into the vulva, at the posterior com- 
misure (one to two inches in front of anus), carries 
it directly backward until it impinges upon the 
sacrum, whereupon it is to be slightly withdrawn, 
and then elevated until the cervix is felt. 
This procedure is very simple if one wall but bear 
in mind that the vaginal canal at its inferior extrem- 
ity is parallel with the plane of the pelvic brim, 
which makes an "angle of sixty degrees" with the 
horizon, while the superior portion corresponds to the 
axis of the pelvis, as indicated by "an irregular 
parabolic line, representing the sum of the axes of 
an indefinite number of planes taken at various 
levels of the pelvis." 
The cause of embarrassment is usually due to a 
failure on the part of the examiner to carry his finger 
sufficiently far back before elevating. It should be 
remembered that the normal vault of the vagina is 
increased during the first stage of labor by the de- 
scent of the cervix further into the canal, induced by 
the weight of the foetus and uterine muscular con- 
tractions. Hence, the finger, if not properly guided, 8 
is almost certain to enter either the anterior or pos- 
terior pouch, where the os is sought for in vain. 
Realizing the condition of affairs, one has only to 
sweep the finger forward or backward (depending 
upon whether it has entered the anterior or posterior 
pouch), when it will be felt rising over a fleshy ridge 
-the cervical wall-and dipping into a pit-like de- 
pression-'he external os. 
At the bottom of this shallow cavity, bordered by 
the lips of the cervix, the finger comes in contact 
with a thin, perfectly smooth, serous-like structure, 
the foetal membranes, which cover the orifice of the 
the cervical canal. 
Pressing upon this elastic tissue, one recognizes the 
presence of a hard, oval body, which, while capable 
of temporary displacement upward, immediately re- 
turns on removal of the disturbing force. That it is 
osseous is evident, and by a longitudinal groove, the 
sagittal suture, running over the convex surface, one 
correctly concludes that it is the foetal skull-a vertex 
presentation. The effort necessary to discern the lo- 
cation of the fontanelles at this stage of labor, and 
so -verify the diagnosis made after physical explora- 
tion of the abdomen, is not devoid of danger, as the 
vertex is engaged at the superior strait. 
Further, the likelihood of rupturing the membranes 
would be considerably increased, which should be 
avoided, as the escape of the amniotic fluid-which 
serves as a dilating wedge-would retard the labor. 
When the attendant has satisfied himself as to the 
all-important diameters, transverse at brim ; oblique 
of cavity, and antero-posterior at outlet; the ex- 
pansibility of the vaginal walls, the presentation and 
the progressive dilatation of the cervix-he may 9 
allow the patient unrestricted liberty in regard to the 
position she shall assume during this first stage. 
Should he, on the contrary, have ascertained that 
the external os is completely surrounded by bands of 
cicatricial tissue, the result, in the case of multipara 
of repeated lacerations, rendering further dilatation 
impossible, then, after waiting some hours to make 
sure that such is the case, he may employ forced dila- 
tation by the introduction of the hand ; this failing, 
he can, with a blunt-pointed tenotome, divide care- 
fully the constrictions. 
This operative procedure must be performed with 
due consideration for the anatomy of the parts, and 
the incisions not carried deeply, nor above the utero- 
vaginal junction, lest rupture follow. 
The existence of an unruptured hymen sometimes 
occasions confusion in the course of a vaginal exam- 
ination. 
While this muco-muscular fold is usually ruptured 
in the first coition, it is not universal; especially is 
this true of the annular variety, which most fre- 
quently persists. It is just such cases which perplex 
the unexperienced. 
One is easily led to believe that the edges of the 
tense hymen are the lips of the dilating cervix, 
strange as it may seem to those who have long 
since forgotten that there ever was a time when they 
knew absolutely nothing about the art of obstetrics, 
it is none the less true. But the problem is readily 
solved, for, by carrying the finger further into the 
canal, one recognizes by tactile sensation the os be- 
yond, with presenting part in position. As the tense 
hymeneal membrane is likely to interfere with deliv- 10 
ery, it is well to rupture it by forcible dilatation, or 
divide with a suitably guarded knife. 
On concluding the examination, he should imme- 
diately inform his patient as to the probable course 
and duration of her labor, thereby speedily relieving 
her fears. 
It is neither requisite nor necessary that he ac- 
quaint the patient with any doubts or misgivings he 
may have, unless they are of such a serious nature 
that allowing her to remain in ignorance would be to 
her detriihent. The garments to be worn during her 
confinement should be as few and simple as possible, 
for a multiplicity of clothing is in the way and likely 
to become soiled. 
An undershirt, nightgown, and long stockings are 
quite sufficient, and ensure the least exposure of the 
person. Chemise, drawers, and petticoats are not to 
be tolerated for a moment. If the patient's limbs 
seem cold, a heavy flannel petticoat may be buttoned 
under the mammae, which, reaching to the knees, 
will serve to keep the abdomen and thighs warm. 
The making of the bed.- Perhaps no simple proce- 
dure is susceptible of such variety as the arrangement 
of the parturiant's couch. Individual peculiarities 
and early training have so much to do with the 
method employed that one is naturally led to be- 
lieve that his way is the best-and perhaps it is best 
for him, for he has mastered its principles and accus- 
tomed himself to it. Notwithstanding this diversity 
of opinion and practice, the conscientious attendant 
has only to consider and carry out the means neces- 
sary to keep his patient warm, her clothing and bed- 
ding free from contamination by the discharges, thus 
ensuring her safety and comfort. 11 
The plan which seems to fulfill these conditions 
most perfectly, is as follows : Remove everything 
from the bed except the mattress. On the right side, 
a little below the center, lay a folded, clean com- 
forter ; upon this a rubber cloth, one yard square. 
If the cloth be not procurable, then one may have 
recourse to newspapers. These should be spread 
out over the comforter, and allowed to overlap. 
Having arranged these protectives to avoid soiling 
the mattress, one takes a sheet and folds it length- 
wise. Spread this smoothly on the right side, from 
head to foot. Tuck in both halves below, but only 
the under at the head. Care must be exercised in 
carrying out this plan, otherwise the free margins of 
the folded sheet will not be on the outer side, and 
the patient unable to get in her bed without great 
exertion. 
Over the sheet is thrown a light blanket, and a pillow 
placed at the head. The right side, where the pa- 
tient is to be confined, being prepared, one has only 
to raise the blanket and upper fold of the sheet to 
allow her to get in. 
The left side of the bed is similarly arranged, save 
that a second rubber cloth is not required, as the dis- 
charges will be absorbed by the napkins. In employ- 
ing this method, one practically divides the bed in 
half, confining the female on the right side, while 
the left is reserved clean and warm for her reception 
immediately after delivery. Another method, which 
has the advantage of greater simplicity, is, instead of 
folding the sheet, to roll it up under the patient's 
shoulders. 
After removal of . the secundines and blood clots, 
this is to be drawn down and tucked in at the foot. 12 
A second sheet is thrown over the patient, when she 
is allowed to rest. 
The labor having advanced considerably during 
the time consumed in the preparation of the bed, 
the female may be permitted now to assume the lat- 
eral or dorso-recumbent position, as best suits her 
fancy. Up to the present she has been granted per- 
fect freedom, sitting or kneeling, as affords greater 
relief. It is neither necessary nor desirable that she 
lie down before dilatation is complete. 
The wisest course is not to insist upon the patient's 
occupying any arbitrary position, but rather seeking 
to discover what position gives her most comfort. 
In regard to this point most text-books are mis- 
leading, for careful and thorough investigation has 
only served to further encourage the belief that there 
does not exist what might be designated as a phys- 
iological position common to the parturiant. Expe- 
rience clearly teaches that no two women assume, 
throughout their labor, identically the same posi- 
tion. Nor does the same female, in subsequent 
labors, choose always the position she occupied in 
preceding confinements. 
Some prefer to pass the stage of dilatation on their 
knees, the body bent forward, head supported by 
hands. Others squat; still others lie on their side 
or back. Occasionally a ventral position is more sat- 
isfactory, seeming to moderate the pain referable to 
the loins. The natural position, if the phrase is 
allowable, is the most unnatural. Having put the 
patient to bed, the attendant should again examine 
the cervix, to make sure that dilatation is progress- 
ing. 13 
Everything being normal, and the head well en- 
gaged, he may direct his attention to the garments 
prepared for the coming offspring. 
A bandage of soft flannel, about five inches wide 
and eighteen inches long, with safety pins in abun- 
dance, must be at hand. 
Flannel underwear should be near the fire to warm. 
In addition, he will require thread to tie the cord 
(several strands of strong spool-cotton, or black silk); 
also vaseline, or some other simple unguent, with 
which to anoint the infant, thereby facilitating the 
removal of the vernix caseosa. Hot water has not 
been forgotten, nor a suitable tub in which to bathe 
the child. Soap, of a non-irritating character-as 
glycerine-will further assist in relieving the body- 
surface of this sebaceous deposit. Care must be 
exercised, however, to prevent getting it into the 
infant's eyes. The room, if kept at a temperature of 
70 ° F., will usually be found sufficiently warm ; but 
the degree should vary according to the feelings of 
the individual. All dejecta must be immediately 
taken from the room. It is, moreover, the duty of 
the obstetrician to see that it is done. 
A change of linen for the female should be kept 
warm and ready for use in case of emergency. 
All spectators and other busybodies must be po- 
litely but promptly excluded. 
Napkins.containing aseptic cotton, or other absorb- 
ent material, rendered so by impregnation with some 
antiseptic,, should be within reach. If the patient 
express a desire to have an abdominal bandage ap- 
plied after delivery, the attendant need not offer any 
objections, as the disadvantages so loudly proclaimed 
by some practitioners wTould seem to be open to 14 
serious question. Thus far the attendant has been 
engaged in preparing for the coming offspring ; now, 
however, he must be ready to receive it. He has 
already noted that the expulsive pains are more forci- 
ble and prolonged ; that the membranes are bulging 
from the external os. Suddenly the latter rupture, 
and a quantity of the liquor amnii escapes. A pain, 
more violent than any heretofore experienced, quickly 
succeeds, and the female distinctly feels the resisting 
presenting part move through the cervical canal into 
the vagina. The occiput, at the same time, he will 
find, has rotated from the transverse at the brim, to 
the oblique of the cavity, to be followed, on reaching 
the outlet, by rotation into the antero-posterior. 
The occiput, in the "first position," he will notice, 
emerges from under the pubic arch, while the face 
sweeps over the perineum when the head is born. 
A finger, if pushed up into the armpit of the infant, 
and traction made, will materially assist in the de- 
livery of the trunk. 
The perineum, if inelastic and abnormally tense- 
like an old piece of india rubber-is almost sure to 
tear from over-distention, in spite of all the multi- 
tudinous methods devised for prevention. 
While experience only too clearly proves the truth 
of this statement, it is not offered as an excuse for 
lacerations due to a lack of care on the part of the 
attendant, nor to cases where there has been undue 
haste in delivery by the employment of mechanical 
or medicinal means. 
The advantages of chloroform by inhalation, in 
difficult and tedious labors, are very great, especially 
when there exists a tetanic state of the muscular 
walls of fundus and body of the uterus before dila- 15 
tation is complete. Here it has a most happy effect, 
allaying the excitement of the patient, and relieving 
the spastic contraction of the circular fibers of the 
cervix. The danger which attends the administra- 
tion of chloroform in surgery, it would appear, is 
absent or very slight in obstetrics; one should, 
however, bear in mind that this drug is somewhat 
uncertain as to the degree of its activity, and may, 
when least expected, give rise to alarming symptoms. 
Appreciating this fact, it is more judicious to await 
positive indications for its employment before having 
recourse to such a fickle friend. 
After delivery of the head, there is not usually any 
difficulty in expulsion of the trunk, though the bis- 
acromial diameter averages four inches, hence greater 
by three-quarters of an inch than the sub-occipito- 
bregmatic. This apparent discrepancy is, however, 
easy of explanation, if one will but pause and con- 
sider the tissues in this region. They are principally 
muscular, not osseous, as in the skull, and therefore 
susceptible of greater compression and resultant re- 
duction in dimensions. 
The child having been delivered, it is advisable for 
the attendant to carefully remove, by means of a 
soft towel, the discharges which have accumulated 
in the mouth and nose of the infant in its passage 
along the canal, as they are likely to interfere with 
respiration. 
Division of the umbilical cord by the scissors or 
knife is not to be recommended before pulsation of 
its vessels has ceased. 
Should delivery be prevented on account of an 
abnormally short funis, or to its being coiled several 
times around the infant's neck, it then becomes 16 
obligatory to sever promptly, and hasten expulsion. 
The foetal portion of the cord should measure from 
an inch to an inch and a half in length, which will 
allow plenty of room for ligation. By expressing 
"Wharton's jelly,'' one lessens the amount of organic 
matter included in the ligature, thus rendering sepa- 
ration more rapid. 
It is a matter of slight importance whether the at- 
tendant apply a ligature or clamp to the material end 
of the cord, as the bleeding is rarely profuse ; at the 
same time it is of some advantage, for the persistent 
oozing from the severed vessels is very likely to soil 
the patient's person and bed. 
While as yet the evidence is not sufficient to war- 
rant one in declaring that tying of the material end 
of the cord hastens separation and expulsion of the 
placenta, yet there are not a few trustworthy observ- 
ers who incline to this view. 
Having tied the cord, the attendant hands the child 
to the nurse, who should proceed to anoint it and 
prepare the bath. 
The attention of the obstetrician should now be 
directed to securing firm contraction of the uterus. 
He should place his hand on the abdomen immedi- 
ately over the fundus, in order to stimulate uterine 
contractions. 
He feels the uterus diminish gradually in volume, 
until it is reduced to the size of a cricket ball, and 
scarcely less firm and resisting, rising about two 
inches above the pelvic brim. There has, of course, 
been some blood expelled with the foetus, but, unless 
excessive, need occasion no. alarm. The amount of 
blood appears greater than it really is, being mixed 
with a large amount of amniotic fluid. If the attend- 17 
ant will only see to it that the uterus is well con- 
tracted he need have no fear of post-partuni hemor- 
rhage. The third stage of labor, delivery of the 
afterbirth, is usually a very simple one ; especially is 
this true where the placenta and membranes are ex- 
pelled. 
It is not w'ise for him to attempt to shorten this 
stage by meddlesome interference, lest he induce the 
very complications he most desires to avoid. By 
waiting fifteen, or even twenty minutes, before intro- 
ducing his hand into the uterus to separate and 
remove the placenta, he will more perfectly ensure 
the prompt recovery of his patient. 
In many cases where the placenta is not expelled, 
it will be found folded and lying half within and half 
without the uterus. 
He should exercise great care in his examination 
of the afterbirth, to assure himself that no portion of 
the placenta is left adherent to the uterine wall, as 
such a condition of affairs would be very likely to 
be followed by putrefactive changes and attendant 
septicaemia. 
Though the attention of the accoucheur has been 
directed to the care of the child and the condition of 
the uterus, he should not fail to watch the effect of 
such a prolonged strain upon the mother. 
If she should feel faint he must administer a few 
drops of the aromatic spirits of ammonia in water, 
or inhalation of the vaporized carbonate. 
If nausea and vomiting occur, a drachm or more 
of one of the effervescing bromides, or a cup of hot 
tea without milk, will serve to allay the gastric irri- 
tability. Pain and swelling of the vulva in some 
females occasions great distress, which can be con- 18 
trolled by the application of hot wet or dry cloths to 
the parts. Should there be any prolapse of the 
bowel, the result of straining during the labor, the 
mucous membrane should be oiled and gently re- 
turned. The dressing of the cord, while a very sim- 
ple matter, is one susceptible of a considerable display 
of skill. 
A method worthy of more general adoption is as 
follows : Take a piece of old, clean, soft linen, five 
inches long (may be of more than one thickness), 
and three inches wide. Cut a hole the size of the 
cord a half inch nearer the end, which is to be the 
lower when applied. Through this hole pass the 
cord, fold in the sides over it lengthwise, so that they 
overlap. Now turn up the lower end and down with 
the upper, much as one would fold a powder paper. 
Bach day a smaller piece of linen is to be cut and 
passed under the first. Any irritation of the skin 
beneath may be allayed by dusting with pulverized 
carbonate of zinc or boracic acid. The nurse having 
applied the binder and fastened it with safety pins, 
the child should be laid in a warm situation until the 
mother is prepared to receive it in the bed with her. 
The attendant, while supervising the dressing of the 
infant, must not forget to watch the mother's condi- 
tion. 
Should her face become blanched and syncope be 
threatened, he must at once examine for hemorrhage 
and assure himself that no such complication exists 
before giving up his search. 
Uterine hemorrhage can scarcely occur if firm con- 
traction of the organ be attained, unless there co- 
exist laceration. This is easy of comprehension, 
if we study the arrangement of the vessels and distri- 19 
bution of the layers of muscular fibers which com- 
prise such a large part of its tissue. 
The successful treatment of post-partum hemor- 
rhage (a very common complication after delivery 
and in the vast majority of cases due to uterine in- 
ertia), demands prompt and decided measures on the 
part of the attendant, or his patient will be a corpse 
before he awakens to a realization of the facts. The 
attendant must at once apply to abdomen and uterus 
ice or hot water ; turn out all clots from the latter ; 
never tampon the vagina, as it only converts the 
uterus into an elastic sac into which all the life blood 
will quickly drain. Astringent injection of vinegar, 
or diluted Monsell's salt, if simpler means fail. In- 
ternally, extractum ergotae fluidum, in full doses, 
repeated every few minutes. Failure of circulation 
must be met by aromatic spirits of ammonia, brandy, 
whiskey. Hypodermically, one drachm of ether in 
thigh, or abdomen. Introduction of the hand into 
the relaxed uterus will not infrequently excite 
contraction. Patient's head must be kept low; 
elevate foot of bed; but above all get the uterus 
to close the lumen of the vessels by contraction of 
its muscular fibers. Having avoided post-partum 
hemorrhage by care and judicious management, or 
controlled the flow, nothing will so quickly revive 
the patient's exhausted vitality, the attendant will 
find, as an abundance of pure, fresh milk, with or 
without brandy, as seems most expedient. Absolute 
quiet is essential to the patient's recovery, and the 
room should be darkened somewhat that she may 
not be annoyed by the glare of sunlight and also 
secure much needed rest. The binder may be applied 20 
only sufficiently tight to give comfort, and fastened 
with safety pins, 
A fluid diet is to be given the female for a few days, 
jvhen a full but selected dietary may be substituted. 
The obstetrician should see his patient again in some 
five to six hours ; longer than this is not to be rec- 
ommended. Directions must also be left to notify 
the attendant if hemorrhage recur, or any alarming 
symptoms arise. The nurse takes a record of pulse, 
respirations and temperature, as directed, and uses 
the catheter at stated intervals. With a parting in- 
junction to the nurse to call him immediately if hem- 
orrhage occur, the attendant should bid adieu to his 
patient, even as we must this subject, leaving experi- 
ence to teach him what no pen can write, nor tongue 
can tell, so eloquently as those little multipolar cells 
in each individual brain.