S. P. Sackett

“ I do not say that you should necessarily engage a nurse that is educated as a midwife. But such a one is to be preferred even if you have a physician, and then the latter need not be detained from his patients for so long a period of time; and if the last stage of the labor is so rapid that the child is born before the doctor arrives, there need be no trepidation; she will know well what to do. Thousands are born in this country without the slightest assistance from a doctor, he not being at hand nor not being in time, and yet both the mother and babe do well almost invariably. ”

“ MECHANICAL PHENOMENA OF LABOR. The cavity of the uterus and that of the pelvis form a continuous PASSAGE through which the child must be forced in its exit from the womb at birth. The uterus possesses the character of muscularity and is the main agent in the expulsion of the child. By its own muscular action the cavity of the uterus is diminished and pressure made on the fœtus, forcing it down towards the orifice, distending the cervix, and dilating the passage. ”

“ You should be so educated that the physician will feel willing to leave a case of tedious labor in your care, instead of waiting at the bedside of the patient one or two days, and neglecting his other patients. Your educated service will be appreciated at such times by the doctor, as well as by the patient and her friends. You will do the duties of nursing well, and take upon yourself that part of the practice of a physician which he does not desire, and which you can do equally well. ”

“ THE PHYSIOLOGY OF FŒTAL LIFE. The ovule, after it arrives in the uterine cavity, comes in contact at all points with the mucous membrane of the uterus. Its nutrition at first is organic by superficial imbibition; afterwards, probably the villi of the chorion imbibe the fluids there secreted, and transmit them into the space between the chorion and the amnion, thence it transcends through the walls of the amnion, and a portion is conveyed into the fœtus through the umbilical vesicle. ”

“ Secure as much as possible tranquility and equanimity, by guarding against gusts of passion, by keeping from her tales of horror and disaster which have happened to the pregnant, by teaching her that she has nothing to fear in regard to her child from the simple fact that some longing has been ungratified or that she was appalled at some frightful object, as such fears are seldom if ever realized; relieve her if possible of gloomy forebodings by informing her how rarely death happens after a well conducted labor. ”

“ There are certain accidents of parturition so grave in their nature, and attended by symptoms so alarming and urgent that no nurse would attempt to treat the patient except under the direction of a physician. ”

“ He has learned during the forty-five years that he has practiced medicine in a small city and its vicinity, that mother and nurse are often combined in the same person. The important duty of nursing the sick is so generally performed by mothers, that they also, as a class, require some scientific knowledge to be acquired by means of plain, practical instruction. And, in fact, throughout our country, every mother is liable, in an emergency, to be called upon to fill the office of an accoucheur. ”

“ No peril need attend a change from a hot to a cold temperature if the power to evolve heat inherent in the system be entire and active and persistent, not lessened by any of those circumstances which have the effect of weakening it, such as local disease, and fatigue. Cold is dangerous, not especially when the body is hot, but when it is cooling after being heated. At such times taking a large draught of cold water, or cooling the body suddenly some other way might cause death immediately; if not, an inflammation of some internal part of the body might arise. ”

“ If the inflammation increases there are signs of disorder in other parts of the body; the patient may be first chilly and feeble, then the skin may become hot and dry all over the body, the pulse fall hard and frequent, lassitude comes on with headache, perhaps pain in different parts of the body; he has also other symptoms of fever; is restless, sleeps ill, loses his appetite, his tongue becomes white, his mouth is dry, he is thirsty, the secretions of the body are diminished, has what is called inflammatory fever, or sympathetic fever, or pyrexia, the last term being now most generally used. ”

“ The nurse or midwife will not very generally be able to decide any point by auscultation, but she as well as the physician may judge from the appearance of the woman, from her past history, from palpation of the abdomen, and from vaginal touch. She should accustom herself to judging by all these means, that she may be able to decide early whether the help of an accoucheur will be imperatively needed.
No one can decide certainly from simply seeing a patient in the beginning of labor, whether her labor will be natural and spontaneous, or artificial ”

“ If she cannot sleep well, let her get up in good time in the morning, take a bath, or thorough ablution, a stroll in the garden, an early breakfast, and then perhaps a short walk, while the air is cool and exhilarating. ”

“ Prolongation of labor is of comparatively small consequence when the membranes are still intact, as they serve to protect the soft parts of the mother as well as the body of the child from injurious pressure, but the mere lengthening of the labor may become a serious thing when the head has entered the pelvis, when the uterus is strongly excited by reflex stimulation, and when the maternal soft parts as well as the fœtus and cord are exposed to severe pressure. When we find no evil resulting from the delay we need not interfere, but when we can remove the cause of it we are bound to do so. ”

“ Many invalids, especially those who suffer from uterine disease, are distressed to find that they begin to fail to command the services of their eyes. When persons are recovering from any severe illness such as fever, or from protracted exhaustion, or after prolonged lactation, or watching with invalids, or great loss of sleep; where there has been much grief and weeping, or a severe mental strain, or loss of blood, or in severe or chronic dyspepsia, impaired eye power is pretty sure to appear. The essential condition to recovery lies in restoration to vigor, and sound health, and habits. ”

“ It will involve the conduct of the female even before her marriage, as well as during her pregnancy—the various contingencies which effect her in health as well as in disease. Very much depends on her to insure for her child a vigorous constitution, or to prevent a feeble frame in the child. She should not enter into the holy state of marriage with heedless haste; if she does, she will discharge its duties with inexcusable neglect. To constitute a mother, in the best sense of the term, requires a patient endurance of fatigue, and anxious solicitude, which will sorely tax the mother’s strength. ”

“ Gum arabic is not often kept in the house as a medicine, but I think it eminently proper to keep it; scarcely any other medicine is so safe and harmless either in large or small doses, and few are more decidedly useful than this in some cases. Made into an emulsion and taken either alone or in combination with other medicine, or used as food, it is good in every variety of bowel complaint. A teaspoonful of the mucilage stirred into a cup of cold water and drank by the patient, may serve as medicine and drink and sustenance when he can take no other food. ”

“ A patient suffering from a suppurating wound becomes enfeebled from the discharge of pus, and should have his strength kept up by nourishing food. A surgeon will always endeavor to prevent the retention and decomposition of discharges, and to protect from external contamination. He will direct the time and means of dressing the wounds, but the nurse must remember that decomposed animal matter acts as a virulent poison introduced into the system as it may be through any abrasion of the skin. All instruments used about a wound must be thoroughly cleansed before being put away. ”

“ The nurse who can remain with the patient, if the labor should not be concluded in several days, would be more likely to do just what the good of the woman requires. And in such a case a skilled nurse would be peculiarly acceptable to a physician if he chanced to be called, because he would be much more at liberty to leave his patient if it seemed necessary to do so.
When a nurse midwife is called to attend a case, she should carry with her besides disinfectants, a male catheter, some laudanum or other opiate, quinine, and extract ergot, in order to be prepared for emergencies. ”

“ SYMPTOMS OF DISEASE, WITH INSTRUCTION TO NURSES. Symptoms are the signs by which we know that disease is present. Every circumstance happening in the body of the sick person capable of being perceived by himself or others, which can be made to assist our judgment concerning the seat or nature of the disease, its probable course and termination or its proper treatment, is a sign or symptom. ”

“ That state of vigorous health and strength which prepares a woman to bear strong and vigorous children, is attained not by idleness and luxury, and neglect of personal cleanliness, nor by tight lacing, the use of stimulants, nor by irregular modes of sleeping, etc., but by rising early, and taking early walks in the open air, and engaging in household labor, or other exercise during the day, going to bed betimes, living on an abundance of good, wholesome food, by daily ablutions, followed by rubbing the skin thoroughly, and in general by observing the laws of health. ”

“ Soon after the termination of the labor the woman may partake of some light food—tea and toast, panada, or anything of a light, unirritating character. From the very first, under ordinary circumstances, the woman may be permitted to change her position as she may desire, from side to side, or to be propped up in bed. Before going to sleep she ought to urinate—in a lying position, if so inclined, or she can be raised up and supported in a sitting position for a few minutes, if she desires to be. The patient must not be allowed to exert herself, or remain too long in a sitting posture. ”

“ If they can be kept in the cold air, and at the same time be kept feeling warm either by exercise, diversion of the mind, or by clothing, the result as regards the health is good.
The cold bath, and especially the shower bath, is a good means of fortifying the body against cold air. When we take a cold bath in the morning, if the sense of cold does not remain long, and is followed by a glow of warmth, the bath is sure to do good. If, however, after the bath we suffer headache, and continue to be chilly and languid or uncomfortable, it should at once be given up as useless and dangerous. ”

“ I usually instruct some one else to make strong and firm pressure upon the uterus, and I pass two fingers of one hand into the vagina, and learn thereby when the placenta descends, and if necessary assist in its removal. Although we should never hurry in removing the afterbirth, I believe that it always is easily removed if we make the effort very soon after the child is born, and if it is necessary for you to pass your hand into the uterus you can do so then better than at any other time. ”

“ If the cause of the abortion affects the mother instead of the ovum, she generally experiences, at the time of the accident, a sharp pain about the loins or abdomen, which may continue slightly for several days, and then be renewed, with violent uterine contractions, and some serous and then bloody discharges from the vagina.
The progress of a miscarriage is not as regular as a labor at full term. In many cases there are shiverings succeeded by fever for a day or more preceding the hemorrhage. ”

“ During the first stage of labor the patient must not strain or bear down to the pains, but it is my practice when I examine my patient and find that the head has not yet entered the pelvis, at the same time that the touch stimulates the uterus to contract, I direct the patient to bear down during each pain. After the head is fully engaged in the bones, no stimulus to pain is needed ”

“ It is not necessary for me to dwell upon the few ailments that occasionally afflict pregnant women that I have not yet referred to,—a few words must suffice. If a woman who is pregnant is apt to be FAINT, or to FAINT AWAY, I advise that she be laid down—that she lie flat on her back, with a pillow under her head—that tight articles of dress be loosened—windows raised—water should be sprinkled on her face, a few drops of aromatic ammonia may be administered, and perhaps smelling salts or hartshorn held to the nose. If it is simply fainting, it is not dangerous. ”

“ Every article carried out of the sick room must be disinfected; a set of dishes should be kept for the patient’s exclusive use, washed only by the nurse; the bedding, clothing, &c., must be washed by the nurses themselves, after being soaked in a disinfecting solution; dressings and other cloths, such as old cloths used for handkerchiefs, may be burned; all excrementitious and vomited matter must be disinfected; the broom that is used to sweep the room must not be used elsewhere; no current of air must be permitted to pass from the sick room to the rest of the house ”