which is not nutritious. If, on the contrary, the infant is allowed to be irregular in the hours for feeding, bathing, and sleeping, it grows fretful, wakeful, and capricious in its appetite. One word of caution is necessary about the infant's bath. The temperature of the water should be about 90°; certainly not much higher, nor, on the other hand, too low. Nurses are often extraordinarily insensitive to hot water. The temperature of the bath, therefore, should not be tested by their hands, but by a bath-thermometer. The bath should be given about midday, in the warmest part of the room, preferably in front of an open fire. There are many apparently small, but really important, details in the preparation for and management of labor and the puerperium, which might easily be forgotten. I find it convenient, therefore, to give to my patients and nurses the appended list of instructions. DIRECTIONS FOR THE MOTHER. Send a specimen of urine (mixed night and morning), about four ounces, every two weeks until the last month, then every week. Report at once scanty urination, severe headache, swelling of the feet or face. Have ready for the labor: towels, ether (one-half pound), brandy (two ounces), vinegar (four ounces); four ounces tincture of green soap; a bottle of antiseptic tablets (corrosive sublimate); a large, coarse, new sponge; a skein of bobbin; a fountain syringe; bed-pan ; new, soft-rubber catheter; a small package of absorbent cotton; a one-ounce bottle of carbolized vaselin; two yards unbleached muslin (for binder); a one-pound package of salicylated cotton; five yards of carbolized gauze; eight yards of nursery cloth. The last is to be boiled for half an hour in clothes-boiler, dried thoroughly, pinned up in a clean sheet, and put away out of the dust. A mackintosh or rubber cloth is necessary to protect the mattress; two yards of rubber cloth, one yard wide, is sufficient. Prescription No. 11 is to be procured about four weeks before expected confinement. It is to be applied to the nipples, night and morning, with absorbent cotton. Prescription No. 22 is to be obtained about a week beforehand and kept in readiness. Four flannel night-skirts. day-skirts. Four to six white day-skirts. Six to ten slips. dresses. All skirts to be made with waists instead of bands. Material for four or five flannel bands (45- to 50-cent flannel). Knit wrapping blankets. Sacques, wrappers, bibs, caps, blankets, veils, etc. Give rectal enema as soon as pains begin (pint of soapsuds, dram of turpentine). Have the patient wash the external genitals thoroughly with soap and warm water. As soon as labor begins, fill three pitchers with water that has been boiling for half an hour; tie clean towels over their tops. This water is to be used for all purposes about the patient and for making the antiseptic solutions. No vaginal injection to be given unless ordered. Take the temperature three times a day,-morning, noon, and evening. Place pad of nursery cloth under patient; change it when soiled. Occlusive bandage to be made up of salicylated cotton and carbolized gauze, with clean hands, and to be changed, for the first five days, every four hours. The external genitals to be washed off four or five times a day with warm corrosive sublimate solution, 1 : 4000, made up with boiled water. Use absorbent cotton for this purpose. If, at the end of twelve hours, the bladder can not be emptied naturally, use a catheter. Afterward, if necessary, catheterize patient three times a day. The patient is to lie on her back; she may be moved from one side of the bed to the other several times a day; her limbs may be rubbed with alcohol and water or bathing-whisky once a day. The nurse's hands are to be washed with a nail-brush, soap, and water, and rinsed in a 1: 3000 sublimate solution before catheterizing the patient or cleansing the genitals or breasts. Diet.-First 48 hours.-Milk (11⁄2 to 2 pints a day), gruel, soup, one cup of tea a day, toast and butter. Second 48 hours.-Milk toast, poached eggs, porridge, soup, cornstarch, tapioca, wine-jelly, small raw or stewed oysters, one cup of coffee or tea a day. Third 48 hours.-Soup, white meat of fowl, mashed potatoes, beets, in addition to above. After sixth day, return cautiously to ordinary diet,—that is, three meals a day, meat at one of them, of an easily digested character,-white meat of fowl, tenderloin of beef, etc.,—and a glass of milk at least three times a day, between meals and before going to sleep at night; also a glass in the middle of the night. Child. After being well rubbed with sweet-oil, the child is to be washed on the nurse's lap. The bath-tub may be used by the end of the first week. The cord is to be dressed with Water not over 100° F. salicylated cotton. Ob serve carefully for bleeding. A good dusting-powder for the navel is salicylic acid 1 part, starch 5 parts. The child should be bathed daily, about midday, in the warmest part of the room. Use Castile soap and a soft sponge; avoid the eyes. Diapers changed often enough. For chafe, use cold cream and talcum powder. Nursing. The child is to be put to the breast every four hours for the first two days. No other food is to be given it. After the second day it should be nursed every two hours, from 7 A. M. to 9 P. M., and twice during the night (I A. M. and 5 A. M.). After every nursing the nipples are to be carefully dried and then smeared with a little sweet-oil for the first week or two, applied with fresh pledgets of absorbent cotton. PART III. THE MECHANISM OF LABOR. THE mechanism1 of labor is the manner in which a fetus and its appendages traverse the birth-canal and are expelled. It takes into account the complicated structure of the maternal and fetal parts, considering their movements and the mechanisms of their motions. It is necessary to define, further, certain terms that will be used constantly in the study of the mechanism of labor. By presentation is meant that part of the fetal body which presents itself to the examining finger in the center of the plane of the superior strait. The term position may be applied to the position of the child in utero, whether it is longitudinal, oblique, or transverse; or, in another sense, it is the varying relations which the presenting part of the fetus bears to the surrounding maternal structures at the plane of the superior strait. The presentation and position of the fetus are determined by abdominal palpation, by auscultation, and by vaginal exami nation. Abdominal Palpation. For this kind of obstetrical examination the woman should be placed on her back, with the abdomen exposed. The examiner, standing to one side of the patient, by a series of stroking, patting, and rubbing motions with his hands, determines the height of the fundus uteri, the tension of the abdominal walls, the irritability of the uterus, the quantity of liquor amnii, the size of the fetus, its position, and its presentation. It has been claimed that in favorable cases the placenta can be felt, and that its position can thus be diagnosticated (Spencer). It is further asserted that if the greater bulk of the uterus is anterior to the insertion of the tubes, the placenta is anterior, and vice versà (Leopold). 1 From the Greek unxavý, contrivance, machine (from root μixos, a manner, a way, a means). The Diagnosis of Fetal Position and Presentation by Abdominal Palpation. The examiner stands alongside the patient, facing her head; the tips of the fingers of both hands, moving together and at equal distances, are carried up the sides of the abdomen by a series of tapping movements; and upon one side (for example, the left, in the L. O. A. position) is noticed a firm, Fig. 222.-Abdominal palpation: locating the fetal back. Fig. 223.-Abdominal palpation: finding the lower extremities of the fetus. broad, even sense of resistance, contrasting with the cystic, tumorlike sensation of the other side, with the occasional encounter of firm, irregular bodies,-the fetal extremities. This firm, broad, even resistance is produced by the fetal back, and, to confirm this fact, the extremities are felt for by a rubbing motion with one outstretched hand on the opposite |