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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 rectum 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 vagina, 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 scraped 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 rectum if the other remedies fail.

MILK LEG.—This is due to infection. It usually arises from an extension of a blood clot (thrombosis) of the womb or pelvic veins, to the thigh (femoral) vein, resulting in a partial or complete obstruction of the vein. It may come in less frequent cases, from a lymphatic infection.

Symptoms.—They may develop at any time between the tenth and thirtieth days or even later. These are general feelings of weariness, stiffness and soreness of the leg, especially when it is moved. There may first be pain in the region of the groin; or pain from the ankle to the groin and followed by swelling. The skin of the leg becomes markedly swollen, white and shiny. Later there is pitting on pressure, but not at first, because the skin is extremely stretched. Fever may accompany the attack, but it will subside long before the swelling of the leg has disappeared.

The vein may be felt as a hard lash-like cord, a red line of inflammation marking its course along the inner and under side of the thigh. The disease may last weeks, depending upon the severity of the trouble. The affected leg is disabled for a number of months after recovery. Recovery takes place as a rule. Absorption of the clot takes place, or the vessel remains closed, and another (compensatory) circulation is established.

[OBSTETRICS OR MIDWIFERY 543]

Treatment.—The patient should lie in bed with the leg elevated and swathed in flannel or cotton wet with some quieting lotion. The following is a good lotion:—

    Compound Soap Liniment 6 ounces
    Laudanum 1-1/2 ounces
    Tincture Aconite Root 1/2 ounce
    Tincture Belladonna 1/2 ounce

Wet the flannel or cotton with this. After the acute symptoms have passed the following ointment may be put on the leg:—

    Ichthyol 45 grains
    Iodide of Lead 45 grains
    Chloride of Ammonium 10 grains
    Alboline 1 ounce

The parts should not be rubbed lest a clot be loosened and travel in the general circulation and thus endanger life.

Diet.—Should be supporting. Salts for the bowels.

[544 MOTHERS' REMEDIES] ALL ABOUT BABY QUESTIONS AND ANSWERS

Preparation, Outfit, Nursing, Formulas for Preparation of Milk
for Bottle-Fed Infants; Weaning, Teething, Diet Through
Childhood, All the Baby Diseases, etc., from the Best Medical
Authority, Infant Hospitals and Nurses.

How long does pregnancy usually last? Two hundred and eighty days.

How can the time be reckoned? Count back three months from the first day of the last menstruation and add seven days to the date thus obtained. To be more accurate, you should add only six days in the months of April and September, five days in December and January, and in February four days.

What time of pregnancy does the form begin to change? It changes a little the first two months. It is flatter and lower down. After the third month there is a progressive enlargement.

What is quickening, and when first felt? It is a motion, of the foetus (child) in the womb, imparted to the abdominal walls, and is felt from the sixteenth to the twentieth week. It has been said to have occurred earlier in some cases.

Can you foretell twin pregnancy? Not to a certainty.

Can a mother influence her child as to character and temperament before birth? Authorities differ very much upon this point. The child inherits the physical characteristics of its parents. The frame of the mother's mind, some think, can be given in some degree to her offspring.

Will nervousness be inherited by the child? Not invariably; if the mother is fretful, irritable, cross, repining, etc., her child may be puny, cross and irritable, etc.

[ALL ABOUT BABY 545]

Do you believe in influences transmitted before birth (parental influences?) All must admit that there is a great deal in heredity, and the characteristics of parents are shown in their children.

Can a mother mark her baby? This is another disputed question.

When should the family physician be informed of the woman's condition? The first month.

Why? So that the woman will know how to live properly, and also that he will be given the urine twice each month to examine. This is for her protection and is necessary, because anything that may be wrong with the kidneys can be corrected much easier, and diet, etc. can be arranged to prevent future trouble.

What kind of diet should a pregnant woman have? She should eat only healthy articles of food. Stimulating, highly seasoned, rich, greasy foods should be avoided. Constipation is frequently present and the diet must be chosen with reference to that also. She should not restrict herself to one line of diet unless it is necessary.

Should she take a daily bath, if so, what kind and when? Yes, if it does her good. The pores of the skin should be kept open so that the kidneys will have less work to do. Spray and baths should be taken cold or lukewarm. Hot baths or Turkish baths are to be avoided. The time should be at the woman's convenience. Morning is preferable, if she does not feel the need of sleep.

Should she take a daily nap and when? Yes, one or two hours in the forenoon, and also in the afternoon.

Should she take exercise? Yes, exercise is necessary. This promotes the proper circulation of the blood, favors rest and sleep, relieves the "blues," tones the whole system, gives her good wholesome air and makes everything look better. It should not be violent. Slow walking and riding in an easy carriage. She should not ride a horse, run, jump, dance, or do any jerky or violent exercise; no heavy lifting or reaching up.

What about clothing? The clothing should be perfectly loose and comfortable. Garters and corsets are injurious, especially when the pregnancy has reached four or five months. The weight of the clothing should be borne by the shoulders instead of the hips. Special waists can be made for pregnant women. There should be no pressure on any part, especially on the womb and breasts.

What is the meaning of the word enciente? The Roman women were accustomed to wear a tight girdle about their waists which was called a cincture. This they removed when they were pregnant. They were then said to be incincta, or unbound. The term enciente is derived from this, and is frequently used to indicate pregnancy.

What are the main symptoms of miscarriage? Pain and bleeding.

[546 MOTHERS' REMEDIES]

Does it usually come on suddenly? Not as a rule. There are premonitory symptoms such

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