PART II. PREGNANCY. (continued 2)

418. But remember—the most valuable distinguishing symptom is the absence of “show” in false labor pains, and the presence of “show” in true labor pains. It might be said that “show” does not always usher in 185the commencement of labor. Granted; but such cases are exceedingly rare, and may be considered as the exception and not the rule.

419. Treatment.—A dose of castor oil is generally all that is necessary; but if the pains still continue, the patient ought to be abstemious, abstaining for a day or two from beer and from wine, and rubbing the bowels every night at bedtime either with camphorated oil, previously warmed, or with laudanum (taking care not to drink it by mistake). Either hot salt, in a flannel bag, or a hot-water bag applied every night at bedtime to the bowels, frequently affords great relief.

420. If the pains be not readily relieved she ought to send for a medical man. A little appropriate medicine will soon have the desired effect.

421. These false labor pains might go on either for days, or even for weeks, and at length may terminate in real labor pains.

PERIOD OF GESTATION—“THE COUNT.”

422. The period of gestation is usually^[76] two hundred and eighty days—forty weeks—ten lunar or nine calendar months.

186423. It will be well for a lady, in making her “count,” to commence her “reckoning” about three days after the last day of her being “unwell.” The reason we fix on a woman conceiving a few days after she has “ceased to be unwell” is that she is more apt to do so soon after menstruation than at any other time.^[77]

424. A good plan to make the “reckoning” is as follows: Let forty weeks and a few days, from the time specified above, be marked on an almanac, and a lady will seldom be far from her calculation. Suppose, for instance, the last day of her “ceasing to be unwell” 187was on January the 15th, she may expect to be confined very near October 23d.

425. Another plan, and one recommended by Dr. Tanner, to make the “count,” is the following: “To effect this readily, we cannot do better than follow the plan of most German obstetricians, who learn the probable day of delivery thus: the date of the last menstruation being given, they calculate three months backward and add seven days. For example, suppose the 20th January to be the last day of the last menstrual period, labor will be due about the 27th October—i.e. on the 280th day.”^[78]

BEING OUT IN THE RECKONING.

426. A lady, sometimes, by becoming pregnant while she is suckling, is put out of her reckoning; not being unwell at such time, she consequently does not know how to “count.” She ought, in a case of this kind, to reckon from the time that she quickens—that is to say, she must then consider herself nearly half-gone in her pregnancy, and to be within a fortnight of half her time; or, to speak more accurately, as soon as she has quickened, we have reason to believe that she has gone about one hundred and twenty-four days: she has therefore about one hundred and fifty-six more days to complete the period of her pregnancy. Suppose, for instance, that she first quickened on May the 17th, she 188may expect to be confined somewhere near October the 23d. She must bear in mind, however, that she can never make so correct a “count” from quickening (quickening takes place at such various periods) as from the last day of her being “unwell.”

427. A lady is occasionally thrown out of her reckoning by the appearance, the first month after she is enceinte, of a little “show.” This discharge does not come from the womb, as that organ is hermetically sealed; but from the upper part of the vagina, the passage to the womb, and from the mouth of the womb, and may be known from the regular menstrual fluid by its being much smaller in quantity, by its clotting, and by its lasting generally but a few hours. This discharge, therefore, ought not to be reckoned in the “count,” but the one before must be the guide, and the plan should be adopted as recommended in page 186, paragraph 423.

“IS IT A BOY OR A GIRL?”

428. It has frequently been asked, “Can a medical man tell, before the child is born, whether it will be a boy or girl?” Dr. F. J. W. Packman, of Wimborne, answers in the affirmative. “Queen bees lay female eggs first, and male eggs afterward. In the human female, conception in the first half of the time between menstrual periods produces female offspring, and male in the latter. When a female has gone beyond the time she calculated upon, it will generally turn out to 189be a boy.”^[79] It is well to say generally, as the foregoing remarks are not invariably to be depended upon, as I have had cases to prove. Notwithstanding, I believe that there is a good deal of truth in Mr. Packman’s statement.

MONTHLY NURSE.

429. It is an important, a most important, consideration to choose a nurse rightly and well.

430. A monthly nurse ought to be middle-aged. If she be young, she is apt to be thoughtless and giggling; if she be old, she may be deaf and stupid, and may think too much of her trouble. She should have calmness and self-possession. She must be gentle, kind, good-tempered, and obliging, but firm withal, and she should have a cheerful countenance. “Some seem by nature to have a vocation for nursing; others not. Again, nursing has its separate branches; some have the light step, the pleasant voice, the cheering smile, the dextrous hand, the gentle touch; others are gifted in cookery for the sick.”^[80] The former good qualities are essential to a monthly nurse, and if she can combine the latter—that is to say, “if she is gifted in cookery for the sick”—she will, as a monthly nurse, be invaluable. Unless a woman have the gift of nursing, 190she will never make a nurse. “Dr. Thynne held that sick-nurses, like poets, were born, not made.”^[81]

431. She ought neither to be a tattler, nor a tale-bearer, nor a “croaker,” nor a “potterer.” A tattler is an abomination; a clacking tongue is most wearisome and injurious to the patient. A tale-bearer is to be especially avoided; if she tell tales of her former ladies, my fair reader may depend upon it that her turn will come.^[82] But of all nurses to be shunned as the plague is the “croaker,” one that discourses of the dismal and of the dreadful cases that have occurred in her experience, many of which, in all probability, she herself was the cause of. She is a very upas-tree in a house. A “potterer” should be banished from the lying-in room; she is a perpetual worry—a perpetual blister! She is a nurse without method, without system, and without smartness. She potters at this and potters at that, and worries the patient beyond measure. She dreams, and drawls, and “potters.” It is better to have a brusque and noisy nurse than a pottering one—the latter individual is far more irritating to the patient’s nerves, and is aggravating beyond endurance. “There is one kind of nurse that is not uncommon in hospitals [and in lying-in rooms], and that gives more trouble and worry than all the others together, viz., the ‘pottering’ nurse. Of all nuisances, defend us from a potterer.... The woman always 191has the very best intentions in the world, but is totally devoid of method and smartness. You never know when she has begun anything, and you certainly will never know when she has finished it. She never does finish it, but she sometimes leaves off.... She seems incapable of taking in a complete and accurate idea of anything, and even while you are speaking to her it is easy to see that her attention cannot be concentrated, and that her mind is flying about among half a dozen subjects. If she is in the least hurried, she loses what little intellect she ordinarily possesses, moans feebly in a sotto voce monotone, fetches the wrong articles, does the wrong thing at the wrong time, and is always in the way.”^[83]

432. Some monthly nurses have a knack of setting the servants at loggerheads, and of poisoning the minds of their mistresses toward them. They are regular mischief-makers, and frequently cause old and faithful domestics to leave their situations. It will be seen, therefore, that it is a momentous undertaking to choose a monthly nurse rightly and well.

433. Fortunately for ladies the class of nurses is wonderfully improved, and the race of Sairey Gamp and Betsey Prig is nearly at an end.

434. She ought to be either a married woman or a 192widow. A single woman cannot so well enter into the feelings of a lying-in patient, and has not had the necessary experience. Moreover, a single woman, as a rule, is not so handy with an infant (more especially in putting him for the first time to the breast) as a married woman.

435. She must be sober, temperate, and healthy, and free from deafness and from any defect of vision. She should have a gentle voice and manner, but yet be neither melancholy nor hippish. She ought to be fond of children, and must neither mind her trouble nor being disturbed at night. She should be a light sleeper. “Scrupulous attention to cleanliness, freshness, and neatness” in her own person, and toward the lady and the infant, are most important requisites.

436. A fine lady-nurse that requires to be constantly waited upon by a servant is not the one that I would recommend. A nurse should be willing to wait upon herself, upon her mistress, and upon the baby with alacrity, with cheerfulness, and without assistance, or she is not suitable for her situation.

437. As the nurse, if she does her duty, devotes her time, her talent, and her best energies to the lady and infant, a mistress ought to be most liberal in the payment of a monthly nurse. A good one is cheap at almost any price, while a bad one, though she come for nothing, is dear indeed. A cheap nurse is frequently the ruin of the patient’s and of the baby’s health, and of the peace of a household.

193438. The monthly nurse ought to be engaged early in the pregnancy, as a good nurse is caught up soon, and is full of engagements. This is most important advice. A lady frequently has to put up with an indifferent nurse from neglecting to engage her betimes. The medical man at the eleventh hour is frequently besought to perform an impossibility—to select a good nurse; and which he could readily have done if time had been given him to make the selection. Some of my best nurses are engaged by my patients as early as two or three months after the latter have conceived, in order to make sure of having their favorite nurses. My patients are quite right; a good nurse is quite of as much importance to her well-doing as a good doctor; indeed, a bad nurse oftentimes makes a good doctor’s efforts perfectly nugatory.

439. It is always desirable, whenever it be possible, that the doctor in attendance should himself select the monthly nurse, as she will then be used to his ways, and he will know her antecedents—whether she be sober, temperate, and kind, and that she understands her business, and whether she be in the habit of attending and of following out his directions, for frequently a nurse is self-opinionated, and fancies that she knows far better than the medical man. Such a nurse is to be scrupulously avoided. There cannot be two masters in a lying-in room; if there be, the unfortunate patient will inevitably be the sufferer. A doctor’s directions must be carried out to the very letter. It rests with the patient to select a judicious medical man, 194who, although he will be obeyed, will be kind and considerate to the nurse.

440. A monthly nurse ought to be in the house a week or ten days before the commencement of the labor, in order that there may be neither bustle nor excitement, and no hurrying to and fro at the last moment to find her; and that she may have everything prepared, and the linen well aired for the coming event.

441. She must never be allowed, unless ordered by the medical man, to give either the patient or the baby a particle of medicine. A quacking monthly nurse is an abomination. An infant who is everlastingly being drugged by a nurse is sure to be puny and delicate.

442. A monthly nurse ought to understand the manner of putting on and of tightening the bandage after a confinement. This, every night and morning, she must do. The doctor generally does it the first time himself, viz., immediately after the labor. It requires a little knack, and if the nurse be at all awkward in the matter, the medical man will only be too happy to show her the way, for he is quite aware the support, the comfort, and the advantage it will be to his patient, and he will be glad to know that the nurse herself will be able to continue putting it on properly for some weeks—for at least three weeks—after the lying-in.

443. If nurses better understood the proper method of bandaging patients after their labors, there would 195not be so many ladies with pendulous bellies and with ungainly figures. It is a common remark that a lady’s figure is spoiled in consequence of her having had so many children. This, provided efficient bandaging after every confinement had been properly resorted to, ought not to be. But then, if a monthly nurse is to do those things properly, she ought to be properly trained, and many of them have little or no training; hence the importance of choosing one who thoroughly knows and will conscientiously do her duty.

444. A monthly nurse who thoroughly understands her business will always have the lying-in room tidy, cheerful, and well ventilated. She will not allow dirty linen to accumulate in the drawers, in corners, and under the bed; nor will she allow any chamber utensil to remain for one moment in the room after it has been used. If it be winter, she will take care that the fire in the grate never goes out, and that it is never very large, and that the room is kept as nearly as possible at one temperature—namely, at 60° Fahrenheit. She will use her authority as a nurse, and keep the other children from frequently running into the room, and from exciting and disturbing her mistress; and she will make a point of taking charge of the baby, and of keeping him quiet while the mother, during the day, is having her necessary sleep.

445. A good monthly nurse fully comprehends and thoroughly appreciates the importance of bathing the external parts concerned in parturition every night and 196morning, and sometimes even oftener, for at least two or three weeks after a confinement. And if the medical man deem it necessary, she ought to understand the proper manner of using a vaginal syringe. If the nurse be self-opinionated, and tries to persuade her mistress not to have proper ablution—that such ablution will give cold—she is both ignorant and prejudiced, and quite unfit for a monthly nurse; and my advice is, that a lady ought on no account to engage such a person a second time.

446. In another part of this work I have entered fully on the vital importance of ablution after a confinement, and I need not say more than again to urge my fair reader to see that the monthly nurse properly carries it out, and that, if there be any objections made to it by the nurse, the medical man be appealed to in the matter, and that his judgment be final. Assured I am that every doctor who understands his profession will agree with me, that the regular ablution of the parts after a labor is absolutely indispensable. The nurse, of course, will take care to guard the bed from being wet, and will not expose the patient unnecessarily during the process; she will be quick over it, and she will have in readiness soft, warm, dry towels to speedily dry the parts that have been bathed. The above is most important advice, and I hope that my fair inquirer will engage a monthly nurse that will do her duty in the matter.

447. Before concluding a list of some of the duties 197of a monthly nurse, there are four more pieces of advice I wish to give both to a wife and to a monthly nurse herself, which are these: (1) Never to allow a nurse, until she be ordered by the doctor, to give either brandy, or wine, or porter, or ale to the patient. (2) I should recommend every respectable monthly nurse to carry about with her an india-rubber vaginal syringe. One of the best for the purpose is Higginson’s syringe,^[84] which is one constructed to act either as an enema apparatus, or, by placing the vaginal pipe over the enema pipe, as a vaginal syringe. She will thus be armed at all points, and will be ready for any emergency. It is an admirable invention, and cannot be too well known. (3) I should advise a monthly nurse while on duty, whatever she may do at other times, to doff her crinoline. A woman nursing a baby with a stuck-out crinoline is an absurdity, and if it were not injurious both 198to the mother and to the infant (as the nurse in crinoline cannot do her duty either to the one or to the other) she would be a laughable object. A new-born baby pillowed in steel! (4) I should recommend every monthly nurse, while in the lying-in room, to wear either list slippers or the rubber slippers, as creaking shoes are very irritating to a patient. “Nurses at these times should wear slippers and not shoes. The best slippers in sick-rooms are those manufactured by the North British Rubber Company, Edinburgh: they enable nurses to walk in them about the room without causing the slightest noise; indeed, they may be called ‘the noiseless slipper’—a great desideratum in such cases, more especially in all head affections of children. If the above slippers cannot readily be obtained, then list slippers—soles and all being made of list—will answer the purpose equally as well.”^[85]

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