Mother's Remedies Part 141

[OBSTETRICS OR MIDWIFERY 535]

THE CHILD.

The eyes should be washed soon and normal respiration established. If the child does not breathe well, cold water may be sprinkled in the face and chest and if this fails, immersions in hot water at 106 degrees F., and sprinkling with cold water must be resorted to. If necessary, artificial respiration must be given. Slap the child on the back and move the arms up and down by the side a few times, or breathing into the child's mouth.

Another method.--Face the child's back, put an index finger in each arm-pit and the thumbs over the shoulders, so that their ends over-lap the collar-bone and rest on the front of the chest, the rest of the fingers going obliquely over the back of the chest. The child is suspended perpendicularly between the operator's knees. Its whole weight now hangs on the first fingers in the arm-pit; by these means the ribs are lifted, the chest is expanded and inspiration is mechanically produced. The infant is now swung upward till the operative's hands are just above the horizontal line, when the motion is abruptly, but carefully, arrested. The momentum causes the lower limbs and pelvis of the infant to topple over toward the operator. The greater part of the weight now rests on the thumbs, which press on the front of the chest, while the abdominal organs press upon the diaphragm. By these two factors, the chest is compressed and we get expiration, mechanically. After five seconds the first position is resumed again, and the lungs expand and fill with air. This process may be repeated several times until the breathing seems to be going naturally, and with delicate infants it should be the last resort.

After the breathing has been established the child should be wrapped in a warm flannel with hot water bags or cans near it, and left until the mother has been cared for. Infants at birth are covered with a white greasy substance, vernix caseosa, or cheesy varnish; it is removed by applying olive oil, vaselin or fresh lard, and afterward rubbing the skin gently with a soft cloth. The eyes and mouth should be washed out with pure warm water--or a saturated solution of boric acid, used. Separate squares of soft linen being used for this purpose. If the baby is born too soon or is very small, weak and undeveloped, it should be given an oil bath, only, and then wrapped in cotton wool and kept at a temperature of not less than 80 degrees F., for ten days or two weeks.

[536 MOTHERS' REMEDIES]

To a fully developed child the first bath may be given at once. Have everything ready before beginning, a foot tub, warm soft towels, warm water, castile soap, olive oil or vaselin, small squares of muslin or linen, dusting powder, a dressing for the navel and clothing, the latter consisting of a diaper, a flannel band, a shirt, long woolen stockings, a loose long sleeved flannel petticoat and a simple soft white outside garment, the two last, long enough to more than cover the feet. The infant should be wrapped in flannel and only the part which is being bathed at the moment should be exposed. The eyes are first bathed separately and with different cloths, and afterward the face, no soap being used; the head is then washed with warm water; very little soap should be used with infants as it is more or less irritating, and it is likely to injure the fine texture of the skin. Next, one should carefully clean the parts behind the ears and the crevices of the neck, arm-pits and joints and those between the b.u.t.tocks and the thighs, and it is well to notice if all the natural openings are perfect; finally the baby is put down into the tub of warm water at about 96 degrees F., and washed off, with the head and back firmly supported with the left arm and hand during the bath. The baby is lifted out in a minute of two, held face downward for a moment and rinsed off with clean warm water. It is then wrapped in a warm towel and flannel and dried by patting, not rubbing. It is best to do all this on a table, instead of on the lap, and it should be large enough to hold a bath tub, every thing necessary for the bath and a pillow upon which to place the baby. Everything then can be done without stooping and with greater comfort to the child. Powder should not be used except where there are signs of chafing, when stearate of zinc is the best to use.

The navel is then dressed. A hole is cut in the center of a square of sterilized lint or linen which is slipped over the cord and folded about it; the cord is then laid toward the left side, and over it is put a small sterilized cotton pad which is held in place by the flannel bandage and just tight enough to hold. The binder may be kept on by sewing it smoothly with half a dozen large st.i.tches, thus doing away with any danger of being injured from the pins. A binder should only be tight enough to hold the dressing for the navel. After the cord drops off the looser knitted band should be used. The infant is not bathed in the tub again until after the cord has been dried up and ready to drop off, which usually occurs on the fifth or sixth day, although it may not drop off for nine days. The cord should not be redressed in the meantime. (See Baby Department for further directions).

THE MOTHER.

The first duty of the physician, following the third stage of labor, is to see that the womb is well contracted and control of this organ should be continued for at least one hour after delivery. This generally prevents excessive loss of blood. If necessary to promote womb contraction one teaspoonful of ergot can be given. After the womb has been kept in a state of contraction, the room should be rid of all evidences of labor and the woman made comfortable. The b.u.t.tocks and thighs which have been soiled during the labor should be bathed with warm water and soap and the external genitals sprayed with an antiseptic solution, then dried with sterile gauze or cotton, the dressing applied to the v.u.l.v.a and the temporary bed removed, her night dress pulled down and the patient thus lying in a clean, comfortable bedding. The woman may then have a cup of weak tea, hot milk or broth and be left to rest; but during the first sleep the womb should be carefully watched lest it relax and serious, if not fatal, bleeding occur. In a normal confinement the dressings need not be changed, as a rule, oftener than six times in twenty-four hours, for the first few days. As soon as convenient after the first toilet is finished the physician sterilizes his hands and with the patient on her left side introduces one finger into the r.e.c.t.u.m and the thumb into the v.a.g.i.n.a to discover the condition of the perineum. Washing out of the v.a.g.i.n.a is not necessary as a rule.

[OBSTETRICS OR MIDWIFERY 537]

The binder is considered indispensable, and should be made of unbleached muslin and wide enough to extend from the pubic (bone) to the breast-bone, and long enough to go around the patient's body and slightly lap. The binder should be pinned or sewed tightest in the middle, but it should not be so tight as to press upon the womb and crowd it backward or to either side. It acts as a splint to the muscles and a.s.sists in resting them to their natural condition.

Rest.--Complete rest of the body and mind is essential to the well being of the lying-in woman. She is better off without any company, and should see no one except her family for the first week or two. Outside visitors should be prohibited. The lying-in room should be kept free from noise and confusion, and the patient should be protected from annoyances of every kind. She should remain lying on her back for a few days and immediately following delivery she should not have a pillow for her head. Sleep is very necessary and desirable, and mild medicines should be given to produce it, if necessary. It is best not to sit up in the bed until the womb shall have had time to become smaller, and has resumed its natural position behind the pubis. Among the upper cla.s.ses, when it takes the womb longer to regain its normal size, three weeks is a good rule to go by before sitting up in the room, and she should remain in her room until the end of the fourth week. Among healthy women of the laboring cla.s.s, whose muscular system has not been injured by "culture" and social excesses, the womb and appendages regain their normal proportions more rapidly; but even they should remain in bed two weeks.

AFTER-PAINS.--Women who have borne children frequently suffer from the after-pains, occurring at irregular intervals, for two or three days and they may give rise to much distress. A few drops of spirits of camphor on a lump of sugar will often give relief when they are not severe. Also a drop of tincture of blue cohosh taken every two or three hours is valuable.

THE BLADDER.--If the patient is not able to pa.s.s urine it should be drawn once in eight or twelve hours or oftener if required. A No.7 rubber catheter is best. After it has been used, it should be sterilized by boiling and then kept in a bichloride solution (1-2000). It should be washed off with boiled water again before being used to remove the bichloride solution and greased with sterile oil. The parts should be exposed to pa.s.s the catheter, the l.a.b.i.a separated by the finger and thumb, and the opening of the urethra and surrounding parts bathed clean with an antiseptic solution; unless you are clean decomposing discharges from the v.a.g.i.n.a may be introduced into the bladder and a cyst.i.tis set up. The care of the bladder is very important. It is not so sensitive after the labor and the woman may have urine when she does not think so. Sometimes she pa.s.ses a little after trying and then thinks there is no more in the bladder. Even the attendants are deceived sometimes. I once had a case where the mother was the nurse. At each visit I inquired as to the amount of urine pa.s.sed. I was told each time it was sufficient. She suffered severely the second day in the evening. I went to see her and against the protests of the mother I used the catheter and took away an enormous quant.i.ty of urine. In such cases the bladder should be emptied slowly to save the woman from shock.

A physician cannot always depend upon the patient's knowledge of her condition even in such matters and sometimes even the nurse is at fault.

[538 MOTHERS' REMEDIES]

THE BOWELS.--There should be a movement of the bowels the second or third day, and a soap and water enema containing a small teaspoonful of spirits of turpentine and one-half ounce of glycerin, will usually be sufficient.

Later cascara cordial, castor oil, etc., may be used. Should the b.r.e.a.s.t.s be much swollen and painful and fever arise, saline laxatives are needed for two or three days, such as citrate of magnesia, roch.e.l.le salts, hunyadi water or seidlitz powder may be given.

Care of the b.r.e.a.s.t.s.--Careful attention should be given them from the first. The nipples should be bathed after labor, with an antiseptic lotion (bichloride, 1-2000), dried and then covered with castor oil, a small square of clean sterile gauze being laid over each to protect the clothing. Bathe the nipples before and after each nursing with a warm saturated solution of boric acid and dry them carefully. The b.r.e.a.s.t.s may be supported by a binder, made of a strip of muslin sufficiently wide to extend from above to well below the b.r.e.a.s.t.s. If they are heavy and sagging place a layer of cotton at the outer border of each breast and they should be raised toward the middle line, the binder being pinned only tight enough to hold without pressing upon them. The b.r.e.a.s.t.s should not be pressed upon by anything. Shoulder straps can be pinned or sewed on the binder if it has a tendency to slip down. Should the b.r.e.a.s.t.s be much swollen relief can be obtained by ma.s.sage with warm olive oil and by the use of a breast pump. The tips of the fingers only should be used in giving ma.s.sage and the stroke should be light, from the circ.u.mference to the center. Roughness and pressure must be avoided.

INFLAMMATION OF THE BREAST, Abscess; Broken Breast.--This usually results from germs. The breast inflames, the milk tubes are choked and distended, there may be fever. There is sometimes severe local pain, hard swelling and an abscess forms and if this breaks it is called broken breast.

[OBSTETRICS OR MIDWIFERY 539]

Treatment, Preventive.--Support breast with a binder. The milk should not be allowed to acc.u.mulate and cake. The b.r.e.a.s.t.s and nipples should be kept clean and dry. Breast pump should be used if necessary to get out the surplus milk. If the lumps continue and are painful, put cold applications to the breast. Have child nurse at the other breast. If it continues and will suppurate, apply moist heat, such as fomentations or poultices, and then open thoroughly. Poke root makes a splendid poultice for caked b.r.e.a.s.t.s. I have great faith in it. At the same time I give of the tincture one drop doses every hour. It is a splendid remedy and the poultice and remedy frequently stop the trouble. Inflammation of the b.r.e.a.s.t.s sometimes occurs in babies, generally in the first weeks. The swelling can be reduced by mild rubbing with warm carbolized oil used every day. Do not rub hard enough to hurt the baby. After the rubbing, absorbent cotton with carbolized oil should be applied and cover all with a thick layer of cotton held on with adhesives. If the b.r.e.a.s.t.s form pus they must be opened.

MOTHERS' REMEDIES. 1. Sore b.r.e.a.s.t.s, a Never-Failing Remedy for.--"Take a pint of raw linseed oil and four ounces tincture of camphor, mix and apply a cloth saturated in the liniment to the affected parts, taking care that the whole surface of the inflamed parts is covered with the liniment. When the b.r.e.a.s.t.s become swollen or painfully inflamed, apply the liniment often to prevent gathering." Even if they have gathered it is an excellent outward application. It allays pain, is extremely soothing and seldom fails to effect a cure.

2. Swollen b.r.e.a.s.t.s, an Herb Treatment for.--"Chamomile flowers one ounce, marshmallow roots one ounce, bruise and boil in one quart of water down to a pint. Foment the breast with this liquor as hot as can be borne; and then place the flowers and roots in a cloth and apply as a poultice."

3. Sore b.r.e.a.s.t.s, a Hot Poultice for.--"Apply hot pancakes made of sour milk, saleratus and wheat flour, large enough to cover affected parts.

Keep them changed often enough, so they will not be cold. This is an excellent remedy to steam out the inflammation." This is an old tried remedy and one to be relied upon. The steaming relieves the swelling and inflammation and gives relief quickly.

4. Caked b.r.e.a.s.t.s, Fresh Hops for.--"Fry one pint of fresh hops in a half cup of lard until the lard is a rich brown, then strain, set away to cool and use as a salve."

5. Sore b.r.e.a.s.t.s, a Poultice of Peach Leaves for.--"Take enough peach tree leaves to mix well with meal and water to the consistency of a poultice."

This poultice should be applied hot, but should only be used in cases where the breast has matter or pus in it.

MOTHERS' REMEDIES.--l. Sore Nipples, a Good Wash for.--"Brandy and water mixed together and put on the nipples will harden them but should be washed off before the child nurses. If they are cracked, apply glycerin with starch, or arnica ointment."

2. Sore Nipples, Good Family Ointment for.--"Four ounces of white wax, one ounce bayberry wax, three ounces of spermaceti, one pint olive oil. Mix briskly over a slow fire, taking care to stir it briskly until cool." This is an excellent ointment for mothers when troubled with sore nipples; it moistens the skin and forms a coating. It is good for dry, scurvy, chapped hands, blotches on the face and all sores which require a mild ointment, but should be a.s.sisted with internal remedies when the case requires it.

[540 MOTHERS' REMEDIES]

The Lochia.--By this term is meant the discharges from the womb and soft parts after labor. They are mixed with blood at first and contain dark clots, mucus, shreds of the after-birth and pieces of the membrane. They become paler in color from the end of the third to the sixth day. After this the color is yellow, greenish and contains pus and fatty cells, with a little blood. This discharge varies in different women. In those who menstruate freely and do not nurse they are usually copious; when decomposed, they smell badly and the odor is penetrating. The flow may cease entirely between the second and sixth week. It is increased by exertions at about the time the patient begins to move about.

Diet.--This should consist at first of liquid, unstimulating food, given in small quant.i.ties and frequently. If the baby does not nurse, the liquids should be restricted. Some women on the first day can take milk, milk toast, or if desired, dry or b.u.t.tered toast with coffee, tea, weak cocoa, according to the patient's taste. Water may be given if desired. On the second and third days, simple soups or any of the following may be added to the dietary: Meat broths, beef tea, soft boiled or poached eggs, raw or stewed oysters (no vinegar or spices) and some simple dessert, such as boiled custard or junket. During the next few days, chicken (white meat), sc.r.a.ped beef or mutton in small quant.i.ties, baked potato, rice and cereals may be given and by the end of the week a gradual return to the ordinary diet may be made. Should there be any tendency to constipation, the bowels should be opened by a simple enema (as before stated) or glycerin enema, etc.; or by one or more doses, 2 drams, of the compound licorice powder repeated in three or four hours, if necessary; or a half ounce of castor oil, or a half gla.s.s of hunyadi water. Cooked fruits for the constipation may also be given.

Bleeding After Delivery, Post-Partum Hemorrhage.--Bleeding from the womb occurring six hours after delivery is called post partum and after that time, is known as puerperal child-birth bleeding or hemorrhage.

Causes.--A relaxed condition of the womb, the retention of clots or parts of the membranes, etc., in the womb, a full r.e.c.t.u.m or bladder, fibroid tumors, deep tears of the cervix.

Symptoms.--If the bleeding is profuse, the pulse is fast, the woman looks pale, anxious and feels cold, restless, gaping, usually it comes from a relaxed, softened and enlarged womb.

[OBSTETRICS OR MIDWIFERY 541]

Treatment.--In severe forms no time must be lost in securing contraction of the womb and the method employed for expelling the after-birth should be employed to expel clots. Grasp the womb over the abdomen, employ firm but gentle kneading, pressing downward. The pillows should be removed, the foot of the bed elevated twelve to eighteen inches, a preparation of ergot given by the mouth or hypodermically in the thigh. If these measures fail the hand and arm should be sterilized and inserted in the womb, all clots, etc., removed and pressure made over the abdomen on the womb while the hand is still there. This pressure and presence of the hand close the bleeding vessels in the womb. The hand should remain, while the kneading goes on externally, on the womb.

This kneading should be kept up until the womb contracts. The hand can then be removed from the v.a.g.i.n.a, while gentle kneading is slowly kept up over the womb. The womb should be closely watched for hours after.

Bleeding very seldom occurs again, but it might. If the bleeding is more of an oozing, an injection of very hot water, 120 degrees F., through a long douche nozzle, directly into the womb cavity may be given. This is very effective for any kind of bleeding. Lemon juice or boiled vinegar can be added to the injection. Everything used must be perfectly clean or child-bed fever may be caused by these measures. After the womb has thoroughly contracted, it is sometimes of benefit to place a rubber bag filled with cold water over the pubic bone to prevent subsequent relaxations of the womb. Weakness can be met by hypodermics of whisky or brandy and strychnine, one-thirtieth of grain, injected hypodermically to stimulate the heart.

Pulse and Temperature.--The temperature may rise one to one and one-half degrees without the case being abnormal. The pulse falls after labor, ranging between sixty and seventy. A rise of temperature, a rapid pulse, a flushed face, a chill, pain or tenderness of the abdomen, and abnormal increase or decrease of the discharge, bleeding, or offensive odor of the discharge should cause suspicion of child-bed (puerperal) fever. This is a grave condition and results from infection which has taken place during labor or afterward. The septic matter may be carried in on the fingers or instruments by the physician or attendants, etc. The most usual sources are unclean hands, instruments and clothing which come in contact with the woman's genitals. The attack is usually ushered in during the second to the fourth day by a chill, or chilly sensations, etc., rise of temperature, rapid pulse, accompanied by headache and a feeling of weariness. The discharge may be increased at first, but later diminished and may cease; or it may be abundant, frothy and of a very fetid odor.

Secretion of milk may fail, the bowels are usually constipated, pain in the abdomen develops.

Treatment.--If the interior of the womb is smooth, a single antiseptic womb injection should be given; if it contains foreign material or is rough, it should be sc.r.a.ped and then a douche given. This must be done carefully and with absolute cleanness. Turpentine stupes should be placed hot on the abdomen for the pain, or where cold feels more grateful the ice bag or cloths wrung out of cold or ice water should be applied over the abdomen, and covered with several thicknesses of flannel and changed as soon as they become heated. Medicines to relieve the pain may be given.

Hot and cold sponging may be given to reduce the temperature, a little alcohol can be added to the water or the cold or hot pack may be used.

[542 MOTHERS' REMEDIES]

Diet.--This should be nourishing and supporting, and at first, liquid and consist largely of milk; but concentrated broths, jellies, and liquid beef, peptonoids, are useful. Stimulants should be given in these septic conditions. From one to two ounces of whisky may be given every three to four hours in the form of milk punch and, if possible, as much red or port wine also. Women in this condition can stand this treatment. Salines (salts) should be given to keep open the bowels.

CONVULSIONS. (Eclampsia).--All forms of convulsions may occur during pregnancy. They may occur during pregnancy and during labor. These are usually the result of kidney trouble. The attacks occur most often during the last three months of pregnancy. Their frequency is one to three hundred to one to five hundred cases. It occurs oftener in the first pregnancy, three to one.

Treatment.--Inhalation of chloroform to control the convulsion. Morphine in one-half grain dose can be given if no chloroform is handy. Place the patient in a hot water or vapor bath, or wrap blankets wrung out of hot water around her, and pile the bedding on until a profuse sweat is started. The sweating aids in eliminating the poison. Change the hot wet blankets as often as necessary. If the convulsions do not cease the womb must be emptied of its contents. If the convulsions occur during labor they should be treated in the same manner. The mortality then is about seven per cent. Chloral hydrate in thirty to sixty grain doses in three ounces of water may be injected into the r.e.c.t.u.m if the other remedies fail.