4 quart Sterilized Douche Bag with gla.s.s nozzle.

Douche Pan, Sterilized.

Sterilized Nail Brush.

2 Agate Basins, Sterilized.

Safety Pins.

2 Tubes Sterilized Petrolatum.

1 Tube K-Y Lubricating Jelly.

Boric Acid, Powdered.

100 grms. Chloroform (Squibb's).

Fl. Ext. Ergot.

Tinct. Green Soap.

Bichloride Tablets.

Lysol.

Tube Sterilized Tape.

Sterilized Soft Rubber Catheter.

Sterilized Gla.s.s Catheter.

Stocking Drawers, Sterilized.

Talc.u.m Powder.

Bath Thermometer.

PRICE $19.50.

These materials, being cleansed and sterilized, are ready for use at any time.

These complete outfits are packed in neat boxes, thus enabling the contents to be kept intact until needed.

THE POSITION AND ARRANGEMENT OF THE BED.--The bed should be a substantial single bed. If a double one is used, prepare the side for the confinement which will permit the physician to use his right hand,--that will be the right side of the patient as she lies in bed. One objection to a double bed is its tendency to sag. This tendency can be obviated however by placing an ironing board under the spring from side to side, or by using shelves from a book case. This expedient will support the mattress, thereby rendering the bed firm and free from any sagging tendency. The position of the bed in the room should be such that the patient will not directly face the window light, nor be in a direct draught between the window and the door. It [65]

should be so arranged that the nurse can get easily to either side, consequently it must not be pushed against the wall.

HOW TO PREPARE THE ACCOUCHMENT BED.--Over the mattress place the rubber sheet so that its center will be exactly under the hips of the patient. Pin with large safety pins each corner of the rubber sheet to the mattress; now put the sheet on exactly as you do when making an ordinary bed. On top of the sheet, and in the middle of the bed (again where the patient's hips will rest), place a draw sheet. A draw sheet is a sheet folded once, placed across the bed, and pinned tightly with large safety pins to the mattress at each side. The advantage of this sheet is, that it can be removed when necessary, leaving the original clean sheet on the bed, without disturbing the patient. Be particular not to have the top of the draw sheet higher than the middle of the patient's back. Place the pad,--previously prepared for the purpose,--on the draw sheet and level with the top of the draw sheet.

Most physicians carry with them to all confinements a _Kelly pad_. A Kelly pad is a rubber pad with inflated sides, which is put under the patient's hips, and which retains all the discharges incident to a confinement so that when it is removed the bed is clean and fresh. The advantage of the Kelly pad is twofold; first, it ensures a clean, compact, systematic confinement; second, its use subjects the patient to the least necessary movement at a time when movement is distressing, painful, and frequently dangerous. If a Kelly pad is not used, it is desirable to place under the pad (between the pad and the draw sheet) a piece of oil cloth or rubber sheeting, or a number of newspapers will do. This will prevent, to a considerable degree, the discharges from soaking through the pad on to the draw sheet and sheet and mattress below.

After the confinement is over and the patient is clean, remove the Kelly pad, and the pad below if necessary, or the pad and newspapers if these are used,--place a clean pad under the patient and you are ready to place the binder on if a binder is to be used. [Page 66]

SHOULD A BINDER BE USED?--Medically a binder is not necessary, neither is it objectionable from a medical standpoint. It is supposed to hold the flaccid, empty womb in place. This it does not do and we are of the opinion, that it, in many instances, according to how it is put on, compresses the womb out of place. The binder is certainly appreciated by most patients because of its snug, comfortable feeling; and in cases when the abdominal wall is fat and the muscles soft, it holds them together in a way that is impossible by the use of any other device. To claim that the binder prevents hemorrhages is absurd. Our personal rule is to put one on if the patient wants one, or if she has previously had one. To be effective, in any sense, the binder should extend from the waist line down to halfway between the hips and knees and should be snugly, but not too tightly pinned.

SANITARY NAPKINS.--These can be purchased already prepared in most drug stores, or they can be made in the following manner: Take an ordinary grade of cheese cloth, wash it, and when dry, cut it into half yard squares. In the center of each square place a strip, six or eight inches long, of absorbent cotton and fold the gauze lengthwise over it so as to make a pad.

These can be used as napkins, and after they are soiled can be burned. It is absolutely wrong to use rags or any old cloths for napkins, as the patient can be infected and made seriously sick by this procedure.

HOW TO CALCULATE THE PROBABLE DATE OF THE CONFINEMENT.--The duration of pregnancy extends for 280 days from the end of the last menstruation. Add seven days to the date of the last menstruation, and from that date count ahead nine months, or backward three months and you may have the probable date of the confinement. Should you pa.s.s this time you will probably go on for two additional weeks. The reason for this is that the most susceptible time for conception to occur is either during the week following menstruation or a few days before menstruation. If, therefore, you pa.s.s the above probable date which was calculated from the end of the last menstruation, it shows that conception did not take place during the [67]

week following that menstruation; and the a.s.sumption will be that it took place a few days before the next menstruation, which will be about two weeks later than the date as calculated above.

If, for example, a pregnant woman was last sick from January 1st to 5th we add seven days to the 5th, which is the 12th, to which we add nine months, which will give us, as the probable date of confinement, October 12th.

Should she go a few days over the 12th, the probability is that the confinement will take place on October 26th.

TABLE FOR CALCULATING THE DATE OF CONFINEMENT ----------------------------------------------------------------- JAN. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 OCT. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 ----------------------------------------------------------------- JAN. 21 22 23 24 25 26 27 28 29 30 31 OCT. 28 29 30 31 1 2 3 4 5 6 7 NOV.

----------------------------------------------------------------- FEB. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 NOV. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 ----------------------------------------------------------------- FEB. 21 22 23 24 25 26 27 28 NOV. 28 29 30 1 2 3 4 5 DEC.

----------------------------------------------------------------- MAR. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DEC. 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 ----------------------------------------------------------------- MAR. 21 22 23 24 25 26 27 28 29 30 31 DEC. 26 27 28 29 30 31 1 2 3 4 5 JAN.

----------------------------------------------------------------- APR. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 JAN. 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 ----------------------------------------------------------------- APR. 21 22 23 24 25 26 27 28 29 30 JAN. 26 27 28 29 30 31 1 2 3 4 FEB.

----------------------------------------------------------------- MAY. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 FEB. 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 ----------------------------------------------------------------- MAY. 21 22 23 24 25 26 27 28 29 30 31 FEB. 25 26 27 28 1 2 3 4 5 6 7 MAR.

----------------------------------------------------------------- JUNE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 MAR. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 ----------------------------------------------------------------- JUNE 21 22 23 24 25 26 27 28 29 30 MAR. 28 29 30 31 1 2 3 4 5 6 APR.

----------------------------------------------------------------- JULY 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 APR. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 ----------------------------------------------------------------- JULY 21 22 23 24 25 26 27 28 29 30 31 APR. 27 28 29 30 1 2 3 4 5 6 7 MAY ----------------------------------------------------------------- AUG. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 MAY 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 ----------------------------------------------------------------- AUG. 21 22 23 24 25 26 27 28 29 30 31 MAY 28 29 30 31 1 2 3 4 5 6 7 JUNE ----------------------------------------------------------------- SEPT. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 JUNE 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 ----------------------------------------------------------------- SEPT. 21 22 23 24 25 26 27 28 29 30 JUNE 28 29 30 1 2 3 4 5 6 7 JULY ----------------------------------------------------------------- OCT. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 JULY 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 ----------------------------------------------------------------- OCT. 21 22 23 24 25 26 27 28 29 30 31 JULY 28 29 30 31 1 2 3 4 5 6 7 AUG.

----------------------------------------------------------------- NOV. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 AUG. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 ----------------------------------------------------------------- NOV. 21 22 23 24 25 26 27 28 29 30 AUG. 28 29 30 31 1 2 3 4 5 6 SEPT.

----------------------------------------------------------------- DEC. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SEPT. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 ----------------------------------------------------------------- DEC. 21 22 23 24 25 26 27 28 29 30 31 SEPT. 27 28 29 30 1 2 3 4 5 6 7 OCT.

[68]

The foregoing table affords us a handy means of finding the probable date of confinement at a glance.

Find the date of the last day of the last menstrual period in the upper row; the date immediately below it is the probable date of confinement.

For example if the last menstrual period was from Jan. 1st to 5th, we find January 5th and below it we note October 12th as the probable date of confinement.

WHEN SHOULD A PREGNANT WOMAN FIRST CALL UPON HER PHYSICIAN?--The earliest indication of pregnancy is the interruption of menstruation. When menstruation fails to appear at its regular time in a young married woman whose past menstrual history is good,--i.e., she has been sick every month regularly and without pain since she began menstruating as a girl,--the a.s.sumption would naturally be that she was pregnant. Menstruation may however "miss" one month for other reasons than pregnancy just at this time, as is explained elsewhere, so it is wise to defer a positive a.s.sumption on such an important matter. When the second menstruation does not appear, and there are no specific reasons for its failure to appear, it may be safely a.s.sumed that pregnancy has taken place. A visit to the family physician one week after the second menstruation should have appeared, or at least long enough to feel absolutely certain that the sickness is not coming around, is not only necessary, but is the essential and correct step to take for a number of very good reasons. If a woman for example has not had a baby, how does she know she can have one? It is quite possible to become pregnant and yet it may be wholly impossible to give birth to a child. It is necessary to be constructed normally, or as near what is regarded as normal as is possible, in order safely to a.s.sume the responsibility of carrying a pregnancy to a successful completion. No one but a physician, who is skilled and familiar in the knowledge of what const.i.tutes the proper size, and shape, and quality, and relations, one with another, of your bones, and ligaments, and muscles, can tell [69]

whether you can safely be permitted to carry a pregnancy to term or not. If the anatomical conditions are not just right; if circ.u.mstances from a medical standpoint are not favorable; if your personal risk is too hazardous; if, in other words, medical science should decide that you are one of the very few women who cannot have a baby, is it not of very great importance that you should know this as soon as possible? Does not that fact alone render your early call upon your physician imperative? A physician can bring out facts, relating to the personal and family history, and habits, of the prospective mother, which will enable him to formulate advice which will prove of the highest value from the very beginning of pregnancy. Instructions carried into effect at this early date, as to personal conduct, exercise, diet, etc., will have a distinctly beneficial influence, not only on the patient's health and the character of her confinement, but on the physical vitality of the coming baby.

REGARDING THE CHOICE OF A PHYSICIAN.--This is a matter that should receive the most careful consideration. While it is just to admit that every physician is capable of successfully conducting maternity cases, there are certain characteristics in the individual temperament that would seem to indicate that some physicians are better adapted to this special work.

Trustworthiness is an imperative essential in a physician who a.s.sumes the responsibility of confinement engagements. He must be clean in his personal habits as well as morally. He should possess the virtue of patience and be tactful, and above all he should be made to feel that he has your implicit confidence. If you will a.n.a.lyze these qualifications you will understand just what they imply. The physician who has the reputation of having the largest practice is not necessarily the man you want, nor does it imply that he is the best fitted to conduct your case to your satisfaction. The fact that he is a very busy man may be distinctly detrimental to your best interests. If the physician has the reputation of being an excellent doctor, but, "You can't always depend on him,--he may be out of town, or he may send his a.s.sistant, or subst.i.tute," you don't want him; it is too [70]

important an event to you to take a chance with. Rely rather upon the man who, though his charge may be a little higher, is known to be trustworthy; who will take a personal interest in you, and is known to be patient and capable.

THE SELECTION OF A NURSE.--A choice must be made between having a trained nurse and what is known as a maternity, or monthly, nurse. The choice may be dictated by the financial means of the patient. A trained nurse is paid from $25 to $30 per week, while a maternity nurse usually gets $15 per week.

A trained nurse is a graduate from a hospital where she has successfully completed a course of training. She is to be preferred, if she can be afforded, for the reason that she has been trained to obey absolutely the orders of a physician, and because she has the requisite knowledge to detect emergencies, and the necessary skill and experience to enable her to act intelligently of her own initiative in any emergency.

The maternity nurse, on the other hand, has not had an adequate training and is absolutely helpless, so far as medical knowledge is concerned, in a real emergency. Her experience is limited to what she has picked up in the various cases she has had. She, as a rule, has chosen this means of obtaining a living as a result of some domestic financial affliction. She does not understand the laws of sterilization and has not been trained to obey, without question, the instructions of a physician. The maternity nurse follows a routine which she is incapable of modifying to suit the particular case. She has old-fashioned ideas and notions which she carries out as a matter of course, and she overestimates the great importance of her experience to the extent of wholly disregarding the advice of the physician. She a.s.sumes the care of the patient and baby, and regards this as her right, and as a result she is frequently responsible for much injury to the mother and child. Despite these objections we have worked with many of these nurses who were to be preferred to trained nurses. It is the individual after all that counts, and if a maternity nurse, though technically untrained, is adaptable, tactful, and will consent to be [71]

instructed to the extent of obeying without argument, she can become invaluable, and her skill and experience will carry her creditably over many trying incidents. The objection of the medical profession to an untrained nurse is based, not so much on her lack of ability, as upon her propensity to indiscriminate and indiscreet talk,--they have not been trained to know the value of professional silence, nor have they had the necessary education which would have enabled them to acquire through their experience the knowledge that "silence is golden" at all times. A trained nurse possesses the requisite knowledge, but may have an objectionable individuality. An untrained nurse may have sufficient knowledge, and what she lacks she may make up for in being congenial and adaptable. While the trained nurse strictly attends exclusively to the mother and the baby, a maternity nurse as a rule attends to the household duties in addition. She cooks the meals of the entire family, and dresses and cares for the other children if there is no one else to do it. The duties of a maternity nurse can be specified and agreed upon, and the terms arranged when she is engaged. The duties of a trained nurse are fixed by nursing laws and medical rules and cannot be changed or modified by private agreement. These laws and rules, however, are not sufficiently arbitrary to make it impossible for the nurse to be obliging, courteous, and sincere,--qualifications which every patient has a right to expect, and a right to insist upon from every graduate nurse.

The selection of a nurse should receive careful consideration. She should be known to be honest, honorable, competent, healthy, and personally clean in habits and dress, and she should be tactful, obliging, and she should attend to her own affairs strictly. She should not be a gossip; she should not shirk her work or pry into family affairs that do not concern her; and she should not drag into the conversation her own personal or family secrets.

The nurse has certain rights which the patient should willingly recognize.

She is ent.i.tled to a comfortable bed, sufficient sleep, good food, and exercise in the open air every day. These are essential in order that [72]

she maintain her own health, as well as keep at the highest point of efficiency.

When you select your physician consult with him regarding your nurse. If you know personally a capable nurse, there is no objection to selecting her, and no physician will oppose this procedure if you a.s.sume the responsibility of her capability.

There are many advantages, however, in permitting the physician to provide a nurse. He a.s.sumes the responsibility of the nurse's capability, and it is safe to a.s.sume he will not recommend one whom he knows to be personally objectionable, or professionally incapable. Every physician acquires certain individual methods in the conduct of maternity cases, which experience has taught him to be successful. A competent knowledge of these methods by the nurse greatly facilitates the details and ensures a harmonious conduct of the entire case,--facts which accrue to the comfort and the well-being of the patient.

It is not out of place here to warn a young wife against being advised by a neighbor or a busybody, as to whom she should select as physician or nurse.

You must not depend upon the gossip of the neighborhood. The physician or nurse whom you are told by one of these irresponsible individuals not to take, may be the one above all others whom you should take. When you hear a gossiping woman decry a physician, depend upon it, she owes him something,--most often it is a bill, but it may only be a grudge. There is no cla.s.s of men in any community who are maligned and abused so much as are physicians. They seem to be the choice victims of the enmity and spite of every malicious feminine tongue. A woman should think twice before she utters a criticism regarding the work of a physician. She would, if she but knew how quickly she brands and advertises herself as irresponsible and lacking in ordinary courtesy and good breeding, as she is not qualified to criticise the professional capability of a physician, nor is she qualified to estimate the extent of the wrong she perpetrates. There is no cla.s.s of men who do more conscientious work, day after day, than do physicians, [73]

and there is no cla.s.s of men who are more deserving of the commendation of the entire community than the thousands of self-sacrificing, underpaid members of the medical profession. Be suspicious therefore when you hear a criticism, and be very, very sure before you utter one,--rather give him the benefit of the doubt and you will do no wrong, and it may be at some future date you will be thankful you did not criticise.

[75]

CHAPTER VII

THE HYGIENE OF PREGNANCY.