PART III.. Labor.

LABOR.

THE PRECURSORY SYMPTOMS OF LABOR.

448. A day or two before the labor commences, the patient usually feels better than she has done for a long time; she is light and comfortable; she is smaller, and the child is lower down; she is more cheerful, breathes more freely, and is more inclined to take exercise, and to attend to her household duties.

449. A few days, sometimes a few hours, before labor commences, the child “falls,” as it is called, that is to say, there is a subsidence—a dropping—of the womb lower down the belly. This is the reason why she feels lighter and more comfortable, and more inclined to take exercise, and why she can breathe more freely.

450. The only inconvenience of the subsidence of the womb is that the womb presses on the bladder, and sometimes causes an irritability of that organ, inducing a frequent desire to make water.

451. The subsidence—the dropping—of the womb may then be considered one of the earliest of the precursory symptoms of the labor, and as the herald of the coming event.

452. She has, at length, slight pains, and then she has a “show,” as it is called; which is the coming away of a mucous plug, which, during pregnancy, had hermetically sealed the mouth of the womb. The “show” is generally tinged with a little blood. When a “show” takes place, she may rest assured that labor has actually commenced. One of the early symptoms of labor is a frequent desire to relieve the bladder.

453. She has now “grinding pains,” coming on at uncertain periods; sometimes once during two hours, at other times every hour or half hour. These “grinding pains” ought not to be interfered with; at this stage, therefore, it is useless to send for a doctor; yet the monthly nurse should be in the house, to make preparations for the coming event. Although, at this early period, it is not necessary to send for the medical man, nevertheless, it is well to let him know that his services might shortly be required, in order that he might be in the way, or that he might leave word where he might quickly be found.

454. These “grinding pains” gradually assume more regularity in their character, return at shorter intervals, and become more severe. About this time, shivering, in the majority of cases, is apt to occur, so as to make the teeth chatter again. Shivering during labor is not an unfavorable symptom; it proves, indeed, that the patient is in real earnest, and that she is making progress.

455. She ought not, on any account, unless it be ordered by the medical man, to take brandy as a remedy for the shivering. A cup either of hot tea or of hot gruel will be the best remedy for the shivering; and an extra blanket or two should be thrown over her, which ought to be well tucked around her, in order to thoroughly exclude the air from the body. The extra clothing should, as soon as she is warm and perspiring, be gradually removed, as she ought not to be kept very hot, or it will weaken her, and will thus retard her labor.

456. Sickness frequently comes on in the beginning of the labor, and may continue during the whole process. She is not only sick, but she actually vomits, and she can keep little or nothing on her stomach.

457. Now, sickness in labor is rather a favorable symptom, and is usually indicative of a kind and easy confinement. There is an old saying that “sick labors are safe.” Although they may be safe, they are decidedly disagreeable!

458. In such a case there is little or nothing to be done, as the less an irritable stomach is meddled with the better. The sickness will probably leave as soon as the labor is over. Brandy, unless prescribed by the medical man, ought not to be given.

459. She must not, on any account, force down—as her female friends or as a “pottering” old nurse may advise to—“grinding pains:” if she do, it will rather retard than forward her labor.

460. She had better, during this stage, either walk about or sit down, and not confine herself to bed; indeed, there is no necessity for her, unless she particularly desire it, to remain in her chamber.

461. If, at the commencement of the labor, the “waters should break,” even if there be no pain, the medical man ought immediately to be sent for; as, in such a case, it is necessary that he should know the exact presentation of the child.

462. After an uncertain length of time, the character of the pains alters. From being “grinding,” they become “bearing down,” and are now more regular and frequent, and the skin becomes both hot and perspiring. These may be considered the true labor pains. The patient ought to bear in mind then that “the true labor pains are situated in the back and loins; they come on at regular intervals, rise gradually up to a certain pitch of intensity, and abate as gradually; it is a dull, heavy, deep sort of pain, producing occasionally a low moan from the patient; not sharp or twinging, which would elicit a very different expression of suffering from her.”

463. As soon as the pains assume a “bearing down” character, the medical man ought to be in attendance; if he be sent for during the early stage, when the pains are of a “grinding” character, and when they come on “few and far between,” and at uncertain intervals (unless, as before stated, “the waters should break” early), he can do no good; for if he attempt in the early stage to force on the labor, he might do irreparable mischief.

464. Cramps of the legs and of the thighs are a frequent, although not a constant, attendant on labor. These cramps come on more especially if the patient be kept for a lengthened period in one position; hence the importance of allowing her, during the first and the second stages of labor, to move about the room.

465. Cramps are generally worse during the third or last stage of labor, and then, if they occur at all, they usually accompany each pain. The poor patient, in such a case, has not only to bear the labor pains but the cramp pains! Now, there is no danger in these cramps; it is rather a sign that the child is making rapid progress, as he is pressing upon the nerves which supply the thighs.

466. The nurse ought to well rub, with her warm hand, the cramped parts; and, if the labor be not too far advanced, it would be well for the patient to change her position, and to sit on a chair, or, if she feel inclined, to walk about the room; there being of course an attendant, one on each side, to support her the while. If either a pain or a cramp should come on while she is thus moving about, let her instantly take hold of the bedpost for support.

467. I observe, in a subsequent paragraph, that in a case of labor, a four-post mahogany bedstead without a foot-board is preferable to either a brass or an iron bedstead. It will now be seen that this was one of my reasons for advising the old-fashioned bedstead; as the support of a bedpost is oftentimes a relief and a comfort. The new-fashioned mahogany bedsteads made with fixed foot-board, and both the iron and brass bedsteads with railings at the foot, are each and all, during the progress of labor, very inconvenient; as the patient, with either of these kinds of bedsteads, is not able to plant her feet firmly against the bedpost—the foot-board of the former and the railings of the latter being in the way of her doing so. The man who invented these new-fangled bedsteads was an ignoramus in such matters.

468. Labor—and truly it may be called “labor”—is a natural process, and therefore ought not unnecessarily to be interfered with, or woe betide the unfortunate patient.

469. I firmly believe that a woman would stand a much better chance of getting well over her confinement without assistance, than if she had been hurried with assistance.

470. In a natural labor very little assistance is needed, and the doctor is only required in the room occasionally, to ascertain that things are going on rightly. Those ladies do best, both at the time and afterward, whose labors are the least interfered with. Bear this in mind, and let it be legibly written on your memory. This advice, of course, only holds good in natural confinements.

471. Meddlesome midwifery cannot be too strongly reprobated. The duty of a doctor is to watch the progress of a labor, in order that, if there be anything wrong, he may rectify it; but if the labor be going on well, he has no business to interfere, and he need not be much in the lying-in room, although he should be in an adjoining apartment.

472. These remarks are made to set a lady right with regard to the proper offices of an obstetrician; as sometimes she has an idea that a medical man is able, by constantly “taking a pain,” to greatly expedite a natural labor. Now, this is a mistaken and mischievous, although a popular notion.

473. The frequent “taking of a pain” is very injurious and most unnatural. It irritates and inflames the passages, and frequently retards the labor.

474. The occasional, but only the occasional, “taking of a pain” is absolutely necessary to enable the medical man to note the state of the parts, and the progress of the labor; but the frequent “taking of a pain” is very objectionable and most reprehensible.

475. As a rule, then, it is neither necessary nor desirable for a medical man to be much in a lying-in room. Really, in a natural labor, it is surprising how very little his presence is required. After he has once ascertained the nature of the case, which it is absolutely necessary that he should do, and has found all going on “right and straight,” it is better, much better, that he retire in the daytime to the drawing-room, in the night season to a bedroom, and thus to allow nature time and full scope to take her own course without hurry and without interference, without let and without hindrance. Nature hates hurry and resents interference.

476. The above advice, for many reasons, is particularly useful. In the first place, nature is not unnecessarily interfered with. Secondly, it allows a patient, from time to time, to empty her bladder and bowels,—which, by giving more room to the adjacent parts, greatly assists and expedites the progress of the labor. Thirdly, if the doctor is not present he is not called upon to be frequently “taking a pain,” which she may request him to do, as she fancies it does her good and relieves her sufferings; but which frequent taking of a pain in reality does her harm, and retards the progress of the labor. No; a doctor ought not to be much in a lying-in room. Although it may be necessary that he be near at hand, within call, to render assistance toward the last, I emphatically declare that in an ordinary confinement—that is to say, in what is called a natural labor—the only time, as a rule, that the presence of the doctor can be useful, is just before the child is born; although he ought to be in readiness, and should therefore be in the house some little time before the event takes place. Let the above most important advice be strongly impressed upon your memory. Oh! if a patient did but know what a blessed thing is patience, and, in an ordinary labor, the importance of non-interference!

477. Bear in mind, then, that in every well-formed woman, and in every ordinary confinement, nature is perfectly competent to bring, without the assistance of man, a child into the world, and that it is only an ignorant person who would, in a natural case of labor, interfere to assist nature. Assist nature! Can any thing be more absurd? As though God in his wisdom, in performing one of his greatest wonders and processes, required the assistance of man! It might with as much truth be said that in every case of the process of healthy digestion it is necessary for a doctor to assist the stomach in the process of digesting the food! No; it is high time that such fallacies were exploded, and that common sense should take the place of such folly. A natural labor, then, ought never to be either hurried or interfered with, or frightful consequences might, and in all probability will, ensue. Let every lying-in woman bear in mind that the more patient she is, the more kind and the more speedy will be her labor and her “getting about.” Let her, moreover, remember, then, that labor is a natural process—that all the “grinding” pains she has are doing her good service, are dilating, softening, and relaxing the parts, and preparing for the final or “bearing down” pains; let her further bear in mind that these pains must not, on any account whatever, be interfered with either by the doctor, by the nurse, or by herself. These pains are sent for a wise purpose, and they ought to be borne with patience and resignation, and she will in due time be rewarded for all her sufferings and anxieties by having a living child. Oh, how often have I heard an ignorant nurse desire her mistress to bear down to a “grinding” pain, as though it could do the slightest good! No, it only robs her of her strength and interferes with the process and progress of the labor. Away with such folly, and let nature assert her rights and her glorious prerogative! It might be thought that I am tedious and prolix in insisting on non-interference in a natural labor, but the subject is of paramount importance, and cannot be too strongly dwelt upon, and cannot be too often brought, and that energetically, before the notice of a lying-in woman.

478. Fortunately for ladies, there is great talent in the midwifery department, which would prevent—however anxious a patient may be to get out of her trouble—any improper interference.

479. I say improper interference. A case sometimes, although rarely, occurs, in which it might be necessary for the medical man to properly interfere and to help the labor; then the patient must leave herself entirely in the hands of her doctor—to act as he thinks best, and who may find it necessary to use promptness and decision, and thus to save her an amount of unnecessary lingering pain, risk, and anxiety. But these cases, fortunately, are exceptions—rare exceptions—and not the rule.

480. It is, then, absolutely necessary, in some few cases, that a medical man should act promptly and decisively; delay in such emergencies would be dangerous:

“If it were done when ’tis done, then ’twere well It were done quickly.”

481. There are times, and times without number, when a medical man is called upon to do but little or nothing; and there are others—few and far between—when it is imperatively necessary that he should do a great deal. He ought at all times to be, as gentle as a lamb, but should, in certain contingencies, be as fearless as a lion!

482. Should the husband be present during the labor? Certainly not; but as soon as the labor is over, and all the soiled clothes have been put out of the way, let him instantly see his wife for a few minutes, to whisper in her ear words of affection, of gratitude, and consolation.

483. The first confinement is generally twice the length of time of an after one, and usually the more children a lady has had, the quicker is the labor; but this is by no means always the case, as some of the after labors may be the tedious, while the early confinements may be the quick ones.

484. It ought to be borne in mind, too, that tedious labors are oftentimes natural labors, and that they only require time and patience from all concerned to bring them to a successful issue.

485. It may be said that a first labor, as a rule, lasts six hours, while an after labor probably lasts but three. This space of time, of course, does not usually include the commencement of labor pains, but the time that a lady may be actually said to be in real labor. If we are to reckon from the commencement of the labor, we ought to double the above numbers—that is to say, we should make the average duration of a first labor twelve; of an after labor, six hours.

486. When a lady marries late in life—for instance, after she has passed the age of thirty—her first labor is usually much more lingering, painful, and tedious, demanding a great stock of patience from the patient, from the doctor, and from the friends; notwithstanding which, if she be not hurried and be not much interfered with, both she and the baby generally do remarkably well. Supposing a lady marries late in life, it is only the first confinement that is usually hard and lingering; the after labors are as easy as though she had married when young.

487. Slow labors are not necessarily dangerous; on the contrary, a patient frequently has a better and more rapid recovery, provided there has been no interference, after a tedious than after a quick confinement—proving beyond doubt that nature hates hurry and interference. It is an old saying, and, I believe, a true one, that a lying-in woman must have pain either before or after a labor; and it certainly is far preferable that she should have the pain and suffering before than after the labor is over.

488. It is well for a patient to know that, as a rule, after a first confinement she never has after pains. This is some consolation, and is a kind of compensation for her usually suffering more with her first child.

489. The after pains generally increase in intensity with every additional child. This only bears out, in some measure, what I before advanced, namely, that the pain is less severe and of shorter duration before each succeeding labor, and that the pain is greater and of longer duration after each succeeding one.

490. The after pains are intended by nature to contract—to reduce—the womb somewhat to its non-pregnant size, and to assist clots in coming away, and therefore ought not to be needlessly interfered with. A judicious medical man will, however, if the pains be very severe, prescribe medicine to moderate—not to stop—them. A doctor fortunately possesses valuable remedies to alleviate the after pains.

491. Nature—beneficent nature—ofttimes works in secret, and is doing good service by preparing for the coming event, unknown to all around. In the very earliest stages of labor pain is not a necessary attendant.

492. Although pain and suffering are the usual concomitants of childbirth, there are, nevertheless, well-authenticated cases on record of painless parturition.

493. A natural labor may be divided into three stages. The first, the premonitory stage, comprising the “falling” or subsidence of the womb, and the “show.” The second, the dilating stage, which is known by the pains being of a “grinding” nature, and in which the mouth of the womb gradually opens or dilates until it is sufficiently large to admit the exit of the head of the child, when it becomes the third, the completing stage, which is now indicated by the pains being of a “bearing down” expulsive character.

494. Now, in the first or premonitory stage, which is much the longest of the three stages, it is neither necessary nor desirable that the patient should be confined to her room; on the contrary, it is better for her to be moving about the house, and to be attending to her household duties.

495. In the second or dilating stage, it will be necessary that she should be confined to her room, but not to her bed. If the drawing-room be near at hand, she ought occasionally to walk to it, and if a pain should come on the while, lie on the sofa. In this stage it is not at all desirable that she should keep her bed, or even lie much on it. She is better up and about, and walking about the room.

496. In the first and the second stages she must not, on any account, strain or bear down to the pains, as many ignorant nurses advise, as, by robbing her of her strength, it would only retard the labor. Besides, while the mouth of the womb is dilating, bearing down cannot be of the slightest earthly use—the womb is not in a fit state to expel its contents. If by bearing down she could (but which fortunately she cannot) cause the expulsion of the child, it would, at this stage, be attended with frightful consequences—no less than the rupture of the womb! Therefore, for the future, let not a lady be persuaded, either by any ignorant nurse or by any officious friend, to bear down until the last or the complete stage, when a gentle bearing down will assist the pains to expel the child.

491. In the third or completing stage, of course it is necessary that she should lie on a bed, and that she should, as above advised, bear gently down to the pains. The bearing down pains will indicate to her when to bear down.

498. If, toward the last, she be in great pain, and if she feel inclined to do so, let her cry out, and it will relieve her. A foolish nurse will tell her that if she make a noise, it will do her harm. Away with such folly, and have nothing to do with such simpletons!

499. Even in the last stage, she ought never to bear down unless the pain be actually upon her; it will do her great harm if she does. In bearing down, the plan is to hold the breath, and strain down as though she were straining to have a stool.

500. By a patient adopting the rules just indicated, much weariness might be avoided; cramp, from her not being kept long in one position, might be warded off; the labor, from her being amused by change of room and scene, might be expedited; and thus the confinement might be deprived of much of its monotony and misery.

501. Nurses sometimes divide a labor into two kinds—a “back labor,” and a “belly labor.” The latter is not a very elegant, although it might be an expressive, term. Now, in a “back labor,” the patient will derive comfort by having her back held by the nurse. This ought not to be done by the bare hand, but let the following plan be adopted: Let a pillow be placed next to the back, and then the nurse should apply firm pressure, the pillow intervening between the back and the nurse’s hand or hands. If the above method be followed, the back will not be injured, which it otherwise would be by the pressure of the hard hand of the nurse. Where the bare hand alone has been applied, I have known the back to continue sore and stiff for days.

502. During the latter stage of labor, the patient ought always to beep her eyelids closed, or the straining might cause an attack of inflammation of the eyes, or, at all events, might make them bloodshot.

503. Let a large room, if practicable, be selected for the labor, and let it be airy and well ventilated; and, if it be summer, take care that the chimney be not stopped. If the weather be intensely hot, there is no objection to the window being from time to time a little opened.

504. The old-fashioned four-post mahogany bedstead is the most convenient for a confinement, and is far preferable either to brass or to iron. The reasons are obvious: in the first place, the patient can, in the last stage of labor, press her feet against the bedpost, which is often a great comfort, relief, and assistance to her. And secondly, while she is walking about the room, and “a pain” suddenly comes on, she can, by holding the bedpost, support herself.

505. If there be a straw mattress and a horse-hair mattress, besides the bed, let the straw mattress be removed; as a high bed is inconvenient, not only to the patient, but to the doctor.

PREPARATIONS FOR LABOR.

506. I should strongly urge a patient not to put everything off to the last. She must take care to have in readiness a good pair of scissors and a skein of whity-brown thread. And she ought to have in the house a small pot of fresh lard—that is to say, unsalted lard, that it may be at hand in case it is wanted. Let everything necessary both for herself and the babe be well aired and ready for immediate use, and be placed in such order that all things may, without hurry or bustle, at a moment’s notice, be found.

507. Another preparation for labor, and a most important one, is, attending to the state of the bowels. If they are at all costive, the moment there is the slightest premonitory symptom of labor, she ought to take either a teaspoonful or a dessertspoonful (according to the nature of her bowels, whether she be easily moved or otherwise) of castor oil. If she object to taking the oil, then let her have an enema of warm water, a pint, administered. By adopting either of the above plans she will derive the greatest comfort and advantage. It will prevent her delicacy from being shocked by having her bowels opened, without her being able to prevent them, during the last stage of labor; and it will, by giving the adjacent parts more room, much expedite the confinement and lessen her sufferings.

508. The next thing to be attended to is the way in which she ought to be dressed for the occasion. I would recommend her to put on her clean night-gown, which, in order to keep it clean and unsoiled, should be smoothly and carefully rolled up about her waist; then she ought to wear over it a short bed-gown reaching to the hips, and have on a flannel petticoat to meet it, and then she should put on a dressing-gown over all. If it be winter, the dressing-gown had better either be composed of flannel or be lined with that material. The stays must not be worn, as they would interfere with the progress of the labor.

509. The valances of the bed, and the carpet, and the curtains at the foot of the bed, had better all be removed; they are only in the way, and may get soiled and spoiled.

510. “The guarding of the bed.”—This is done in the following way: Cover the right side of the bed (as the patient will have to lie on her left side), with a large piece—a yard and a half square—of waterproof cloth, or bed-sheeting, as it is sometimes called, which is sold for the purpose; over this, folded sheets ought to be placed. If a waterproof cloth cannot be procured, an oil-cloth table-cover will answer the purpose. Either of the above plans will effectually protect the bed from injury.

511. The lying-in room should be kept not hot, but comfortably warm; if the temperature of the room be high, the patient will become irritable, feverish, and restless.

512. Every now and then, in order to change the air, let the door of the room be left ajar; and if, in the early periods of the labor, she should retire for awhile to the drawing-room, let the lying-in room window be thrown wide open, so as to thoroughly ventilate the apartment, and to make it fresh and sweet on her return. If the weather be very warm, the lower sash of the window may for a few inches be opened. It is wonderful how refreshing to the spirits, and how strengthening to the frame, a well-ventilated room is to a lying-in patient.

513. Many attendants are not only unnecessary but injurious. They excite and flurry the patient, they cause noise and confusion, and rob the air of its purity. One lady friend besides the doctor and the monthly nurse is all that is needed.

514. In making the selection of a friend, care should be taken that she is the mother of a family, that she is kind-hearted and self-possessed, and of a cheerful turn of mind. At these times all “chatterers,” “croakers,” and “potterers” ought to be carefully excluded from the lying-in room. No conversation of a depressing character should for one moment be allowed. Nurses and friends who are in the habit of telling of bad cases that have occurred in their experience must be avoided as the plague. If nurses have had bad cases, many of them have probably been of their own making; such nurses, therefore, ought on every account to be shunned.

515. During the progress of the labor, boisterous and noisy conversation ought never to be permitted; it only irritates and excites the patient. Although boisterous merriment is bad, yet at such times quiet, cheerful, and agreeable conversation is beneficial.

516. A mother on these occasions is often present; but of all persons she is the most unsuitable, as, from her maternal anxiety, she tends rather to depress than to cheer her daughter. Though the mother ought not to be in the room, it is, if practicable, desirable that she should be in the house. The patient, in the generality of cases, derives comfort from the knowledge of her mother being so near at hand.

517. Another preparation for labor is to soothe her mind by telling her of the usual safety of confinements, and by assuring her that, in the generality of instances, it is a natural process; and that all she has to do is to keep up her spirits, to adhere strictly to the rules of her doctor, and she will do well.

518. Tell her that “sweet is pleasure after pain;” tell her, too, of the exquisite happiness and joy she will feel as soon as the labor is over, as perhaps the greatest thrill of delight a woman ever experiences in this world is when her babe is first born. She, as if by magic, forgets all the sorrow and suffering she has endured. “A woman when she is in travail hath sorrow, because her hour is come; but as soon as she is delivered of the child, she remembereth no more the anguish, for joy that a man is born into the world.” Keble, in the Christian Year, well observes:

“Mysterious to all thought, A mother’s prime of bliss, When to her eager lips is brought Her infant’s thrilling kiss.”

Rogers, too, in referring to this interesting event, sweetly sings:

“The hour arrives, the moment wished and feared; The child is born, by many a pang endeared! And now the mother’s ear has caught his cry— Oh! grant the cherub to her asking eye! He comes—she clasps him; to her bosom pressed, He drinks the balm of life, and drops to rest.”

519. The doctor, too, will be able to administer comfort to her when he has “tried a pain” or has “taken a pain,” as it is called, and when he can assure her that it “is all right and straight”—that is to say, that the child is presenting in the most favorable position, and that everything is progressing satisfactorily. He will, moreover, be able to inform her of the probable duration of the labor.

520. Let me in this place urge upon the patient the importance of her allowing the medical man to inquire fully into her state. She may depend upon it that this inquiry will be conducted in the most delicate manner. If there be anything wrong in the labor, it is in the early stage, and before the “waters have broken,” that the most good can be done. If a proper examination be not allowed to the medical man whenever he deems it right and proper (and a judicious doctor will do it as seldom as he can), her life, and perhaps that of her child, might pay the penalty of such false delicacy.

521. French brandy, in case it is wanted, ought always to be in the house; but let me impress upon the minds of the attendants the importance of withholding it, unless it be ordered by the doctor, from a lying-in woman. Numbers have fallen victims to brandy being indiscriminately given. I am of opinion that the great caution which is now adopted in giving spirits to women in labor is one reason, among others, of the great safety of the confinements of the present day, compared with those of former times.

522. The best beverage for a patient during labor is either a cup of warm tea, or of gruel, or of arrow-root. It is folly in the extreme, during the progress of labor, to force her to eat: her stomach recoils from it, as at these times there is generally a loathing of food, and if we will, as we always ought to, take the appetite as our guide, we shall never go far wrong.

523. A patient during labor ought frequently to make water; by doing so she will add materially to her ease and comfort, and it will give the adjacent parts more room, and will thus expedite the labor. I wish to call attention to this point, as many ladies, especially with their first children, have, from false delicacy, suffered severely from not attending to it; one of the ill effects of which is inability after the labor is over to make water without the assistance of the doctor, who might in an extreme case deem it necessary to introduce a catheter into the bladder, and thus to draw the water off.

524. I recommended, in a previous paragraph, that the doctor ought to have either the drawing-room or a bedroom to retire to, in order that the patient may, during the progress of the labor, be left very much to herself, and that thus she may have full opportunities, whenever she feels the slightest inclination to do so, of thoroughly emptying either her bladder or her bowels. Now, this advice is of very great importance, and if it were, more than it is, attended to, would cause a great diminution of misery, of annoyance, and suffering. I have given the subject great attention; as I have had large experience in midwifery practice; I therefore speak “like one having authority,” and if my advice in this particular be followed, this book will not have been written in vain.

525. If the patient, twelve hours after the labor, and having tried two or three times during that time, is unable to make water, the medical man ought to be made acquainted with it, or serious consequences might ensue.

CHLOROFORM IN HARD AND IN LINGERING LABOR.

526. Mothers and doctors are indebted to Dr.—now Sir James—Simpson for the introduction of chloroform, one of the greatest and most valuable discoveries ever conferred on suffering humanity.

527. Sulphuric ether was formerly used to cause insensibility to pain; but it is far inferior to chloroform, and is now, in this country, very seldom employed; while the inhalation of chloroform, especially in cases of hard and of lingering labor, is every day becoming more general, and will do so still more extensively as its value is better understood, and when, in well-selected cases, its comparative freedom from danger is sufficiently appreciated.

528. Chloroform, then, is a great boon in midwifery practice; indeed, we may say with Dr. Kidd, that in labor cases “it has proved to be almost a greater boon than in the experimental and gigantic operations of the surgeon.” It may be administered in labor by a medical man with perfect safety. I have given it in numerous instances, and have always been satisfied with the result.

529. The inhalation of chloroform causes either partial or complete unconsciousness, and freedom from pain either for a longer or for a shorter time, according to the will of the operator. In other words, the effects might with perfect safety be continued either for a few minutes, or from time to time for several hours; indeed, if given in proper cases, and by a judicious medical man, with immense benefit.

530. Chloroform is more applicable and useful in a labor—more especially in a first labor—when it is lingering, when the pains are very severe, and when, notwithstanding the pain, it is making but little progress,—then chloroform is a priceless boon.

531. Chloroform, too, is very beneficial when the patient is of a nervous temperament, and when she looks forward with dread and apprehension to each labor pain.

532. It might be asked,—Would you give chloroform in every case of labor, be it ever so easy and quick? Certainly not: it is neither advisable nor expedient, in an ordinary, easy, quick labor, to administer it.

533. The cases in which it is desirable to give chloroform are all lingering, hard, and severe ordinary labors. In such I would gladly use it. But before administering it, I would, as a rule, wait for at least six hours from the commencement of the labor.

534. Oh, the delightful and magical effects of it in the cases here described! the lying-in room, from being in a state of gloom, despondency, and misery, is instantly transformed, by its means, into one of cheerfulness, hope, and happiness!

535. When once a lying-in woman has experienced the good effects of chloroform in assuaging her agony, she importunately, at every recurrence of “the pain,” urges her medical man to give her more! In all her subsequent confinements, having once tasted the good effects of chloroform, she does not dread them. I have frequently heard a lady declare that, now (if her labor be either hard or lingering) she can have chloroform, she looks forward to the period of childbirth with confidence and hope.

536. It might be asked,—Does the inhalation of chloroform retard the patient’s “getting about”? I emphatically declare that it does not do so. Those who have had chloroform have always, in my practice, had as good and as speedy recoveries as those who have not inhaled it.

537. One important consideration in the giving of chloroform in labor is, that a patient has seldom, if ever, while under the effects of it, been known to die; which is more than can be said when it has been administered in surgical operations, in the extraction of teeth, etc. “I know there is not one well-attested death from chloroform in midwifery in all our journals.”

538. One reason why it may be so safe to give chloroform in labor is, that in the practice of midwifery a medical man does not deem it needful to put his patient under the extreme influence of it. He administers just enough to ease her pain, but not sufficient to rob her of total consciousness; while in a surgical operation the surgeon may consider it necessary to put his patient under the full influence of chloroform: hence the safety in the one, and the danger in the other case. “It is quite possible to afford immense relief, to ‘render the pains quite bearable,’ as a patient of mine observed, by a dose which does not procure sleep or impair the mental condition of the patient, and which all our experience would show is absolutely free from danger.”

539. There is another advantage in chloroform,—the child, when he is born, is usually both lively and strong, and is not at all affected by the mother having had chloroform administered to her. This is a most important consideration.

540. The doctor, too, as I before remarked, is deeply indebted to Sir J. Simpson for this great boon: formerly he dreaded a tedious and hard labor; now he does not do so, as he is fully aware that chloroform will rob such a lying-in of much of its terror and most of its pain and suffering, and will in all probability materially shorten the duration of the confinement.

541. Chloroform ought never to be administered, either to a labor patient or to any one else, except by a medical man. This advice admits of no exception. And chloroform should never be given unless it be either in a lingering or in a hard labor. As I have before advised, in a natural, easy, everyday labor, nature ought not to be interfered with, but should be allowed to run its own course. Patience, gentleness, and non-interference are the best and the chief requisites required in the majority of labor cases.

HINTS TO ATTENDANTS IN CASE THE DOCTOR IS UNAVOIDABLY ABSENT.

542. It frequently happens that after the first confinement the labor is so rapid that the child is born before the doctor has time to reach the patient.

543. It is consequently highly desirable—nay, imperatively necessary—for the interest and for the well-doing both of the mother and of the baby, that either the nurse or the lady friend should, in such an emergency, know what to do and what NOT to do. I therefore, in the few following paragraphs, purpose, in the simplest and clearest language I can command, to enlighten them on the subject.

544. In the first place, let the attendants be both calm and self-possessed, and let there be no noise, no scuffling, no excitement, no whispering, and no talking, and let the patient be made to thoroughly understand that there is not the slightest danger; as the principal danger will be in causing unnecessary fears both as to herself and her child. Tens of thousands are annually delivered in England, and everywhere else, without the slightest assistance from a doctor,—he not being at hand or not being in time; and yet both mother and child almost invariably do well. Let her be informed of this fact—for it is a fact—and it will be a comfort to her and will assuage her fears. The medical man, as soon as he arrives, will soon make all right and straight.

545. In the mean time let the following directions be followed: Supposing a child to be born before the medical man arrives, the nurse ought then to ascertain whether a coil of navel-string be around the neck of the infant; if it be, it must be instantly liberated, or he might be strangled. Care should be taken that he has sufficient room to breathe, that there be not a “membrane” over his mouth; and that his face be not buried in the clothes. Any mucus about the mouth of the babe ought, with a soft napkin, to be wiped away, or it might impede the breathing.

546. Every infant, the moment he comes into the world, ought to cry; if he does not naturally, he should be made to do so by smacking his buttocks until he does cry. He will then be safe:

“We came crying hither. Thou know’st, the first time we smell the air We waul and cry.”

547. If the doctor has not arrived, cheerfulness, quietness, and presence of mind must be observed by all around; otherwise, the patient may become excited and alarmed, and dangerous consequences might ensue.

548. If the infant should be born apparently dead, a few smart blows must be given on the buttocks and on the back; a smelling-bottle ought to be applied to the nostrils, or rag should be singed under the nose, taking care that the burning tinder does not touch the skin; and cold water must be freely sprinkled on the face. The navel-string, as long as there is pulsation in it, ought not to be tied.

549. The limbs, the back, and the chest of the child ought to be well rubbed with the warm hand. The face should not be smothered up in the clothes. If pulsation has ceased in the navel-string (the above rules having been strictly followed, and having failed), let the navel-string be tied and divided, and then let the child be plunged into warm water—98° Fahr. If the sudden plunge does not rouse respiration into action, let him be taken out of the warm bath, as the keeping him for any length of time in the water will be of no avail.

550. If these simple means should not quickly succeed, although they generally will, Dr. Marshall Hall’s Ready Method ought in the following manner to be tried: “Place the infant on his face; turn the body gently but completely on the side and a little beyond, and then on the face, alternately; repeating these measures deliberately, efficiently, and perseveringly, fifteen times in the minute only.”

551. Another plan of restoring suspended animation is by artificial respiration, which should be employed in the following manner: Let the nurse (in the absence of the doctor) squeeze, with her left hand, the child’s nose, to prevent any passage of air through the nostrils; then let her apply her mouth to the child’s mouth, and breathe into it, in order to inflate the lungs; as soon as they are inflated, the air ought, with the right hand, to be pressed out again, so as to imitate natural breathing. Again and again, for several minutes, and for about fifteen times a minute, should the above process be repeated; and the operator will frequently be rewarded by hearing a convulsive sob, which will be the harbinger of renewed life.

552. Until animation be restored, the navel-string, provided there be pulsation in it, ought not to be tied. If it be tied before the child has breathed, and before he has cried, he will have but a slight chance of recovery. While the navel-string is left entire, provided there be still pulsation in it, the infant has the advantage of the mother’s circulation and support.

553. If Dr. Marshall Hall’s Ready Method and if artificial respiration should not succeed, he must be immersed up to his neck in a warm bath of 98° Fahrenheit. A plentiful supply of warm water ought always to be in readiness, more especially if the labor be either hard or lingering.

554. Should the child have been born for some time before the doctor has arrived, it may be necessary to tie and to divide the navel-string. The manner of performing it is as follows: A ligature, composed of four or five whity-brown threads, nearly a foot in length and with a knot at each end, ought, by a double knot, to be tightly tied, at about two inches from the body of the child, around the navel-string. A second ligature must, in a similar manner, be applied about three inches from the first, and the navel-string should be carefully divided midway between the two ligatures. Of course, if the medical man should shortly be expected, any interference would not be advisable, as such matters ought always to be left entirely to him.

555. The after birth must never be brought away by the nurse: if the doctor has not yet arrived, it should be allowed to come away (which, if left alone in the generality of cases, it generally will) of its own accord. The only treatment that the nurse ought in such a case to adopt is, that she apply, by means of her right hand, firm pressure over the region of the womb: this will have the effect of encouraging the contraction of the womb, of throwing off the after birth, and of preventing violent flooding.

556. If the after birth does not soon come away, say in an hour, or if there be flooding, another medical man ought to be sent for; but on no account should the nurse be allowed to interfere with it further than by applying firm pressure over the region of the womb, and not touching the navel-string at all; as I have known dangerous, and in some cases even fatal, consequences to ensue from such meddling.

REST AFTER DELIVERY.

557. A lady ought never to be disturbed for at least an hour after the delivery; if she be, violent flooding might be produced. The doctor, of course, will make her comfortable by removing the soiled napkins, and by applying clean ones in their place.

558. Her head ought to be made easy; she must still lie on her side; indeed, for the first hour let her remain nearly in the same position as that in which she was confined—with this only difference, that if her feet have been pressing against the bedpost, they should be removed from that position.

CLOTHING AFTER LABOR.

559. She ought, after the lapse of an hour or two, to be moved from one side of the bed to the other. It ought to be done in the most tender and cautious manner. She must not, on any account whatever, be allowed to sit erect in the bed. While being moved, she herself should be passive—that is to say, she ought to use no exertion, no effort, but should, by two attendants, be removed from side to side; one must take hold of her shoulders, the other of her hips.

560. A patient, after delivery, usually feels shivering and starved; it will therefore be necessary to throw additional clothing, such as a blanket or two, over her, which ought to envelop the body, and should be well tucked around her; but the nurse ought to be careful not to overload her with clothes, or it might produce flooding, fainting, etc.; as soon, therefore, as she is warmer, let the extra clothing be gradually removed. If the feet be cold, let them be wrapped in a warm flannel petticoat, over which a pillow should be placed.

561. A frequent change of linen after confinement is desirable. Nothing is more conducive to health than cleanliness. Great care should be taken to have the sheets and linen well aired.

REFRESHMENT.

562. A cup of cool, black tea, directly after a patient is confined, ought to be given. I say cool, not cold, as cold tea might chill her. Hot tea would be improper, as it might induce flooding.

563. As soon as she is settled in bed, there is nothing better than a small basin of warm gruel.

564. Brandy ought never, unless ordered by the medical man, to be given after a confinement. Warm beer is also objectionable; indeed, stimulants of all kinds must, unless advised by the doctor, be carefully avoided, as they would only produce fever, and probably inflammation. Caudle is now seldom given; but still, some old-fashioned people are fond of recommending it after a labor. Caudle ought to be banished the lying-in room; it caused in former times the death of thousands.

BANDAGE AFTER A CONFINEMENT.

565. (1) This consists of thick linen, similar to sheeting, about a yard and a half long, and sufficiently broad to comfortably support the belly. It ought to be put on moderately tight; and should be retightened every night and morning, or oftener, if it become slack. (2) Salmon’s Obstetric Binder is admirably adapted to give support after a confinement, and may be obtained of any respectable surgical-instrument-maker.

566. If there be not either a proper bandage or binder at hand—(3) a yard and a half of unbleached calico, folded double, will answer the purpose. The best pins to fasten the bandages are the patent safety nursery-pins. The binder requires no pins.

567. A support to the belly after labor is important: in the first place, it is a great comfort; in the second, it induces the belly to return to its original size; and lastly, it prevents flooding. Those ladies, more especially if they have had large families, who have neglected proper bandaging after their confinements, frequently suffer from enlarged and pendulous bellies, which give them an unwieldy and ungainly appearance.

POSITION.

568. The way of placing the patient in bed.—She ought not, immediately after a labor, under any pretext or pretense whatever, to be allowed to raise herself in bed. If she be dressed, as recommended at paragraph 508, her soiled linen may readily be removed; and she may be drawn up by two assistants—one being at the shoulders and the other at the legs—to the proper place, as she herself must not be allowed to use the slightest exertion.

569. Inattention to the above recommendation has caused violent flooding, fainting, bearing down of the womb, etc., and in some cases even fatal consequences.

THE LYING-IN ROOM.

570. The room to be kept cool and well ventilated.—A nurse is too apt, after the confinement is over, to keep a large fire. Nothing is more injurious than to have the temperature of a lying-in room high. A little fire, provided the weather be cold, to dress the baby by, and to encourage a circulation of the air, is desirable. A fire-guard ought to be attached to the grate of the lying-in room. The door must occasionally be left ajar, in order to change the air of the apartment; a lying-in woman requires pure air as much as any other person; but how frequently does the nurse fancy that it is dangerous for her to breathe it!

571. After the affair is over, the blinds ought to be put down, and the window curtains should be drawn, in order to induce the patient to have a sleep, and thus to rest herself after her hard work. Perfect stillness must reign both in the room and in the house.

572. It is really surprising, in this present enlightened age, how much misconception and prejudice there still is among the attendants of a lying-in room; they fancy labor to be a disease, instead of being what it really is—a natural process; and that old-fashioned notions, and not common sense, ought to guide them.

573. The patient should, after the labor, be strictly prohibited from talking; and noisy conversation ought not to be allowed; indeed, she cannot be kept too quiet, as she may then be induced to fall into a sweet sleep, which would recruit her wasted strength. As soon as the baby is washed and dressed, and the mother is made comfortable in bed, the nurse ought alone to remain; let every one else be banished the lying-in room. Visitors should on no account, until the medical man gives permission, be allowed to see the patient.

THE BLADDER.

574. Ought a patient to go to sleep before she has made water?—There is not the least danger in her doing so (although some old-fashioned person might tell her that there is); nevertheless, before she goes to sleep, if she have the slightest inclination she should respond to it, as it would make her feel more comfortable and sleep more sweetly.

575. Let me urge the importance of the patient, immediately after childbirth, making water while she is in a lying position. I have known violent flooding to arise from a lying-in woman being allowed, soon after delivery, to sit up while passing her water.

576. The “female slipper” (previously warmed by dipping it in very hot water and then quickly drying it) ought, at these times, and for some days after a confinement, to be used. It is admirably adapted for the purpose, as it takes up but little room and is conveniently shaped, and readily slips under the patient, and enables her to make water comfortably, she being perfectly passive the while. It should be passed under her in front, and not at the side of the body.

577. If there be any difficulty in her making water, the medical man must, through the nurse, be immediately informed of it. False delicacy ought never to stand in the way of this advice. It should be borne in mind that, after either a very lingering or a severe labor, there is frequently retention of urine,—that is to say, that although the bladder may be full of water, the patient is, without assistance, unable to make it.

578. After the patient, while lying down, trying several times to pass her water, and after, allowing twelve or fifteen hours to elapse, and not being able to do so, it will be well for her to try the following method: Let the pot de chambre be well warmed, let the rim be covered with flannel, let her, supported the while by the nurse, kneel on the bed, her shoulders being covered with a warm shawl; then let her, with the pot de chambre properly placed between her knees on the bed, try to make water, and the chances are that she will now succeed.

579. If she does not, twenty-four hours having elapsed, the doctor must be informed of the fact; and it will then be necessary, absolutely necessary, for him, by means of a catheter, to draw off the water. It might be well to state that the passing of a catheter is unattended with either the slightest danger or pain; and that it is done without exposing her, and thus without shocking her modesty.

THE BOWELS.

580. The bowels are usually costive after a confinement. This confined state of the bowels after labor is doubtless a wise provision of nature, in order to give repose to the surrounding parts—especially to the womb; it is well, therefore, not to interfere with them, but to let them have perfect rest for three days. Sometimes before the expiration of the third day the bowels are relieved, either without medicine or merely by the taking of a cupful of warm coffee. If such be the case, all well and good; as it is much better that the bowels should be relieved without medicine than by medicine; but if, having taken the coffee, at the end of the third day they are not opened, then early on the following—the fourth—morning, a dose of castor oil should be given in the manner recommended at paragraph 281. Either a teaspoonful or a dessertspoonful, according to the constitution of the patient, will be a proper dose. If, in the course of twelve hours, it should not have the desired effect, it must be repeated. The old-fashioned custom was to give castor oil on the morning after the confinement; this, as I have before proved, was a mistaken plan.

581. After a lying-in, and when the bowels are not opened either naturally or by the taking of a cupful of warm coffee, if medicine be given by the mouth, castor oil is the best medicine, as it does not irritate either the patient’s bowels, or, through the mother’s milk, gripe the infant. Aperient pills, as they most of them contain either colocynth or aloes, or both, frequently give great pain to the babe, and purge him much more than they do the mother herself; aperient pills, therefore, after a confinement ought never to be taken.

582. If the patient object to the taking of castor oil, let the nurse, by means of an enema apparatus, administer an enema. This is an excellent, indeed the best, method of opening the bowels, as it neither interferes with the appetite nor with the digestion; it does away with the nauseousness of castor oil, and does not, in the administration, give the slightest pain. If the first enema should not have the desired effect, let one be given every quarter of an hour until relief be obtained. One of the best for the purpose is the following:

Take of—Olive oil, two tablespoonfuls; Table salt, two tablespoonfuls; Warm oatmeal gruel, one pint;

To make a clyster.

Another capital enema for the purpose is one made of Castile soap dissolved in warm water.

583. If the patient object both to the taking of the castor oil and to the administration of an enema, then the following draught will be found useful; it will act kindly, and will neither gripe the mother nor the child:

Take of—Concentrated Essence of Senna, half an ounce; Syrup of Ginger, one drachm; Distilled Water, seven drachms:

To make a draught. To be taken early in the morning.

If in twelve hours the above draught should not have the desired effect (although, if the essence of senna be good, it usually does long before that time), let the draught be repeated. If the bowels be easily moved, half of the above draught is generally sufficient; if it be not so in twelve hours, the remainder should be taken. But let every lying-in woman bear in mind that as soon as her bowels will act, either naturally or by the taking of a cupful of warm coffee, without an aperient, not a particle of opening medicine should be taken.

584. But, after all that can be said on the subject, there is no better method in the world for opening a lying-in patient’s bowels, when costive, than (if the cup of coffee be not sufficiently powerful) by giving her an enema, as advised in a previous paragraph. An enema is safe, speedy, painless, and effectual, and does not induce costiveness afterward, which castor oil, and all other aperients, if repeatedly taken, most assuredly will.

585. An enema, then, is an admirable method of opening costive bowels, both during suckling and during pregnancy, and deserves to be more universally followed than it now is; fortunately, the plan just recommended is making rapid progress, and shortly will, with ladies at such times, entirely supersede the necessity of administering aperients by the mouth.

586. Aperients, after a confinement, were in olden times, as a matter of course, repeatedly given both to the mother and to the babe, to their utter disgust and to their serious detriment! This was only one of the numerous mistakes and follies that formerly prevailed in the lying-in room. Unfortunately, in those days a confinement was looked upon as a disease, and to be physicked accordingly. A better state of things is happily now dawning.

587. When the patient’s bowels, for the first few days after the confinement, require to be opened, she ought to use either the French bed-pan or the bed-pan of the Liverpool Northern Hospital. Either the one or the other of these pans is a great improvement on the old-fashioned bed-pans, as they will readily slip under the patient, and will enable her, while lying down and while she is perfectly passive in bed, to have her bowels relieved, which at these times is very desirable. The French bed-pan or the bed-pan of the Liverpool Northern Hospital is admirably adapted for a lying-in room; indeed, no lying-in room ought to be without either the one or the other of these useful inventions. “A flannel cap for the toe-part, held on by strings round the heel, will afford considerable comfort to the patient.”

“CLEANSINGS”—ABLUTIONS.

588. The “Cleansings.”—This watery discharge occurs directly after a lying-in, and lasts either a week or a fortnight, and sometimes even longer. It is, at first, of a reddish color; this gradually changes to a brownish hue, and afterward to a greenish shade; hence the name of “green waters.” It has in some cases a disagreeable odor. A moderate discharge is necessary; but when it is profuse, it weakens the patient.

589. Some ignorant nurses object to have the parts bathed after delivery; they have the impression that such a proceeding would give cold. Now, warm fomentation twice a day, and even oftener, either if the discharge or if the state of the parts requires it, is absolutely indispensable to health, to cleanliness, and comfort. Ablutions, indeed, at this time are far more necessary than at any other period of a woman’s existence.

590. There is nothing better for the purpose than a soft sponge and warm water, unless the parts be very sore; if they be, a warm fomentation, two or three times a day, of marshmallows and chamomile, will afford great relief, or the parts may be bathed with warm oatmeal gruel, of course without salt. In these cases, too, I have found warm barm (yeast) and water a great comfort, and which will soon take away the soreness. The parts ought, after each fomentation, to be well but quickly dried with warm, dry, soft towels.

591. If the internal parts be very sore, it may be necessary, two or three times a day, to syringe them out, by means of an india-rubber vaginal syringe, with either of the above remedies. Hence the importance of having a good monthly nurse, of having one who thoroughly understands her business.

592. Let the above rules be strictly followed. Let no prejudices and no old-fashioned notions, either of the nurse or of any female friend, stand in the way of the above advice. Ablution of the parts, then, after a confinement, and that frequently, is absolutely required, or evil results will, as a matter of course, ensue.

REST AND QUIETUDE.

593. A horizontal—a level—position for either ten days or a fortnight after a labor is important. A lady frequently fancies that if she supports her legs, it is all that is necessary. Now, this is absurd; it is the womb and not the legs that requires rest; and the only way to obtain it is by lying flat either on a bed or on a sofa: for the first five or six days, day and night, on a bed, and then for the next five or six days she ought to be removed for a short period of the day either to another bed or to a sofa; which other bed or sofa should be wheeled to the side of the bed, and she must be placed on it by two assistants, one taking hold of her shoulders and the other of her hips, and thus lifting her on the bed or sofa, she herself being perfectly passive, and not being allowed to sit erect the while. She ought, during the time she is on the sofa, to maintain the level position.

594. She ought, after the first nine days, to sit up for an hour; she should gradually prolong the time of the sitting; but still she must, for the first fortnight, lie down a great part of every day. She should, after the first week, lie either on a sofa or on a horse-hair mattress.

595. The above plan may appear irksome, but my experience tells me that it is necessary, absolutely necessary. The benefit the patient will ultimately reap from it will amply repay the temporary annoyance of so much rest. Where the above rules have not been adopted, I have known flooding, bearing down of the womb, and even “falling” of the womb, frequent miscarriages, and ultimately ruin of the constitution, to ensue.

596. “Falling of the womb” is a disagreeable complaint, and the misfortune of it is, that every additional child increases the infirmity. Now, all this might, in the majority of cases, have been prevented, if the recumbent posture for ten days or a fortnight after delivery had been strictly adopted.

597. If a patient labor under a “falling of the womb,” she ought to apply to a medical man, who will provide her with a proper support, called a pessary, which will prevent the womb from “falling down,” and will effectually keep it in its proper place.

598. It is only a medical man, accustomed to these matters, who can select a pessary suitable for each individual case. A proper kind of, and duly-adjusted, pessary is a great comfort to a patient, and will enable her both to take her proper exercise and to follow her ordinary employments; indeed, if a suitable pessary be used, it is so comfortable that the patient often forgets that she is wearing one at all. Those pessaries ought only to be employed that can be removed every night, as there is not the least necessity for a patient to sleep in one, as the womb does not usually come down when the patient is lying down. Moreover, a pessary ought to be kept perfectly clean, and unless it be daily removed it is utterly impossible to keep it so. It is a great comfort and advantage to a patient to be able both to introduce and to remove the pessary herself, which, if a proper kind be employed, she can, when once taught, readily do.

599. If “falling of the womb” be early and properly treated, there is a good chance of a patient being perfectly cured, and thus of being able to dispense with a pessary altogether.

DIETARY.

600. For the first day the diet should consist of nicely made and well-boiled gruel, arrow-root and milk, bread and milk, tea, dry toast and butter, or bread and butter; taking care not to overload the stomach with too much fluid. Therefore, either a cupful of gruel, or of arrow-root, or of tea, at a time, should not be exceeded, otherwise the patient will feel oppressed; she will be liable to violent perspiration, and there will be a too abundant secretion of milk.

601. For the next—the second day.—Breakfast,—either dry toast and butter, or bread and butter, and black tea. Luncheon,—either a breakfast-cupful of strong beef-tea, or of bread and milk, or of arrow-root made with good fresh milk. Dinner,—either chicken or game, mashed potatoes, and bread. Tea, the same as for breakfast. Supper,—a breakfast-cupful of well-boiled and well-made gruel, made either with water or with fresh milk, or with water with a tablespoonful of cream added to it.

602. If beef-tea and arrow-root and milk be distasteful to the patient, or if they do not agree, then for luncheon let her have either a light egg pudding or a little rice pudding instead of either the beef-tea or the arrow-root.

603. On the third and fourth days.—Similar diet to the second day, with this difference, that for her dinner the patient should have mutton—either a mutton-chop or a cut out of a joint of mutton, instead of the chicken or game. The diet ought gradually to be improved, so that at the end of four days she should return to her usual diet, provided it be plain, wholesome, and nourishing.

604. The above, for the generality of cases, is the scale of dietary; but of course every lying-in woman ought not to be treated alike. If she be weak and delicate, she may from the beginning require good nourishment, and instead of giving her gruel, it may, from the very commencement, be necessary to prescribe good strong beef-tea, veal-and-milk broth, chicken-broth, mutton-chops, grilled chicken, game, the yelk and the white of an egg beaten up together in half a teacupful of good fresh milk, etc. Common sense ought to guide us in the treatment of a lying-in as of every other patient. We cannot treat people by rule and compass; we must be guided by circumstances; we can only lay down general rules. There is no universal guide, then, to be followed in the dietary of a lying-in woman; each case may and will demand separate treatment; a delicate woman, as I have just remarked, may, from the very first day, require generous living; while, on the other hand, a strong, robust, inflammatory patient may, for the first few days, require only simple bland nourishment, without a particle of stimulants. “And hence the true secret of success rests in the use of common sense and discretion—common sense to read nature aright, and discretion in making a right use of what the dictates of nature prescribe.”

BEVERAGE.

605. For the first week, either toast and water, or barley-water and milk, with the chill taken off, is the best beverage. Wine, spirits, and beer, during this time, unless the patient be weak and exhausted, or unless ordered by the medical man, ought not to be given. All liquids given during this period should be administered by means of a feeding-cup; this plan I strongly recommend, as it is both a comfort and a benefit to the patient; it prevents her from sitting up in bed every time she has to take fluids, and it keeps her perfectly still and quiet, which, for the first week after confinement, is very desirable.

606. When she is weak, and faint, and low, it may, as early as the first or second day, be necessary to give a stimulant, such as either a tumblerful of home-brewed ale or a glass or two of wine daily; but, as I before remarked, in the generality of cases, either toast and water, or barley-water and milk, for the first week after a confinement, is the best beverage.

607. After a week, either a tumblerful of mild home-brewed ale or of London or Dublin porter, where it agrees, should be taken at dinner; but if ale or porter be given, wine ought not to be allowed. It would be well to keep either to ale or to porter, as may best agree with the patient, and not to mix them, nor to take porter at one meal and ale at another.

608. Barreled, in this case, is superior to bottled porter, as it contains less fixed air. On the whole, however, I should prefer home-brewed ale to porter. Either old, or very new, or very strong ale, ought not, at this time, to be given.

609. Great care is required in the summer, as the warm weather is apt to turn the beer acid. Such beer would not only disagree with the mother, but would disorder the milk, and thus the infant. A nursing mother sometimes endeavors to correct sour porter or beer by putting soda in it. This plan is objectionable, as the constant taking of soda is weakening to the stomach and impoverishing to the blood. Moreover, it is impossible, by any artificial expedient, to make either tart beer or porter sound and wholesome, and fit for a nursing mother. If beer or porter be sour, it is not fit to drink, and ought either to be thrown away or should be given to the pigs.

610. Sometimes neither wine nor malt liquor agrees; then, either new milk and water, or equal parts of fresh milk and barley-water, will generally be found the best beverage. If milk should also disagree, either barley-water, or toast and water, ought to be substituted.

CHANGE OF ROOM.

611. The period at which a lying-in woman should leave her room will, of course, depend upon the season, and upon the state of her health. She may, after the first fourteen days, usually change the chamber for the drawing-room, provided it be close at hand; if it be not, she ought, during the day, to remove—be either wheeled or carried in a chair—from one bedroom to another, as change of apartment will then be desirable. The windows, during her absence from the room, ought to be thrown wide open; and the bedclothes, in order that they may be well ventilated, should be thrown back. She should, at the end of three weeks, take her meals with the family; but even then she ought occasionally, during the day, to lie on the sofa to rest her back.

EXERCISE IN THE OPEN AIR.

612. The period at which a lady, after her confinement, ought to take exercise in the open air, will, of course, depend upon the season, and upon the state of the wind and weather. In the winter, not until the expiration of a month, and not even then unless the weather be fine for the season. Carriage exercise will at first be the most suitable. In the summer she may, at the end of three weeks, take an airing in a carriage, provided the weather be fine, and the wind be neither in an easterly nor in a northeasterly direction. At the expiration of the month she may, provided the season and weather will allow, go out of doors regularly, and gradually resume her household duties and employments.