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5. (a) How soon after the birth of a child would you ligate the umbilical cord? (b) How would you ligate and dress it? 6. (a) What indication would induce you to insert your hand into the uterus during or after labor, and (b) what precautions would you observe?
7. What are the dangers in the use of forceps in delivery, and how are they avoided?
8. What care would you give the mother after labor? 9. What is phlebitis and how would you guard against it while managing a case of labor?
10. Give the symptoms and treatment of mammary abscess. Answers.
1. By the hygiene of pregnancy is meant the care which should be observed by the pregnant woman for the preservation of health and strength both of herself and of the fetus. The pregnant woman should take moderate exercise in the open air; in the last month massage may take the place of exercise. Daily bathing in tepid water, care of the teeth, regularity of the bowels, ample sleep in a well-ventilated room, plenty (but not too much) of simple, nourishing and easily digested food, at regular hours, clothing not too tight, especially about the abdomen and breast; attention to the nipples, regular examination of the urin, and the restriction of marital relations are the main points to which advice should be directed.
The usual signs of pregnancy are present.
The patient is generally in good health, with an increase of body-weight; there is no characteristic facies.
The abdominal tumor is hard, non-fluctuating, situated in the median line, and reveals the fetal signs.
There is generally a suppression of menstruation.
The cervix is soft (Goodell's sign).
There is history of exposure to the possibility of impregnation, with rapidly developing enlargement in the median line.
There is an absence of the chief sign of pregnancy, as a general rule.
In advanced cases the ovarian facies is present-a pale, drawn expression, with yellowness of the skin and general emaciation.
The abdominal tumor is soft, fluctuating, showing usually more or less growth to one or the other side, and does not reveal the fetal signs.
Continuance of menstruation is the rule, although it may be altered in character; suppression has been noted.
The cervix is probably not altered.
The history is obscure, with a slowly developing tumor beginning on one or the other side.
-Dorland's "Obstetrics." 3. "Puerperal eclampsia is an acute morbid condition, occurring during pregnancy, labor, or the puerperal state, and is characterized by tonic and clonic convulsions, which affect first the voluntary and then the involuntary muscles; there is total loss of consciousness, which tends either to coma or to sleep, and the condition may terminate in recovery or death. The causes may be: Uremia, albuminuria, imperfect elimination of carbon dioxid by the lungs, medicinal poisons, septic infection; predisposing causes are renal disease and imperfect elimination by the skin, bowels, and kidneys.
Symptoms: Headache, nausea, and vomiting, epigastric pain, vertigo, ringing in the ears, flashes of light or darkness, double vision, blindness, deafness, mental disturbance, defectiv memory, somnolence; symptoms easily explained by the circulation of toxic blood through the nerve centers. These may be preceded by lassitude, and accompanied by constipation or by diarrhea. Headache is perhaps the most significant and common warning symptom. In bad cases the urin is reduced in quantity (almost supprest), very dark in color, its albumin greatly increast, so that it becomes solid on boiling. Next comes the final catastrophe of convulsions. The convulsiv fit begins with twitching of the facial muscles, rolling and fixation of the eyeballs, puckering of the lips, fixation of the jaws, protrusion of the tongue, etc., soon followed by violent spasms of the muscles of the trunk and limbs, including those of respiration; hence lividity of the face and stertorous breathing, biting of the tongue, opisthotonus, etc. The fit lasts fifteen or twenty seconds, ending in partial or complete coma, possibly death; or consciousness may return, to be followed by other convulsions."-(King.) 4. Management of inevitable abortion: "Two methods of treatment have been advised for these cases. The first is the expectant plan: Place the patient in bed, and if the bleeding is profuse insert a tampon of iodoform gauze (one yard) well up against the cervix. If this fails to control the hemorrhage, reinforce it by another yard or two of gauze and a perineal pad and binder. Small doses (3%) of the fluidextract of
ergot should now be given every two or three hours. At the end of from eight to twelve hours remove the tampon, when the ovum may be found extruded from the cervix; if not, a vaginal douche of mercuric chlorid (1:4000) must be given, and another tampon introduced. If, upon the removal of this second tampon at the end of ten or twelve hours, the ovum is not discharged, then more vigorous methods to secure its expulsion must be adopted. Activ plan: The physician's hands and instruments are sterilized; the patient is etherized and placed on an appropriate table; the genitalia are thoroly cleansed and a vaginal douche of mercuric chlorid (1:4000) is given; the anterior lip of the cervix is brought down to the vulvar orifice; the cervix is dilated if necessary; the placental forceps is introduced into the uterus, and as much as possible of the ovum is removed; the uterus is thoroly curetted, and an intrauterin douche of steril water is given. A light tampon of iodoform gauze is placed in the vagina; the patient is then returned to bed. A strip of gauze may be placed in the uterus in cases of sharp retroflexion, to secure free drainage, and occasionally an intrauterin tampon will be necessary, when the uterus refuses to contract and hemorrhage persists after the use of the curette."-("Pocket Cyclopedia.") The dangers are: Sepsis, hemorrhage, and subinvolution.
5. Ligature of the cord.-"As soon as respiration is well establisht, lay the child on the bed on its back. Wait for a few minutes until the cord shows signs of ceasing to pulsate. Then take the cord at a spot about 2 inches from the umbilicus, squeeze away the Wharton's jelly so as to make it a thin cord, and apply a ligature, and tie tightly with a surgical or reef knot. Apply a second ligature about 3 inches from the vulva. The second ligature is not necessary unless there is a second child in the uterus, when it may save its life if the circulations of the two children communicate. Cut the cord between the ligatures half an inch from the umbilical ligature. Take care to hold the cord up on the fingers when cutting, otherwise you may easily injure the infant. When the child has been bathed and is ready to be drest, the cord should be carefully dried; it should be seen that it is not bleeding; then it may be powdered with boric acid and starch powder and wrapt in a small dressing of dry steril gauze."-(From Johnstone's "Midwifery.")
6. The hand may be passed into the uterus: To aid in version, to extract an adherent placenta, to remove a piece of placenta which has remained behind, to stop a postpartum hemorrhage. Except in the last case (when there is no time to be lost) the hand should be made as steril as possiblé, and a steril glove should also be worn.
7. The dangers in the use of forceps are: Sepsis, injuries to the soft parts or to the child, and hemorrhage. All antiseptic and aseptic precautions should be observed, extraction should not be made too rapidly, the utmost care must be employed, compression on the fetus (particularly on the skull) must not be too prolonged, the mother's bladder must be emptied, and traction should be exerted only during the pains.
8. Care of mother during puerperium: "During the first week the patient keeps the bed, but after the first few hours she has considerable license. She may assume the sitting or half-sitting posture to take her meals and to nurse the baby, and, if necessary, for evacuation of the bladder and rectum. She should assume the lateroprone posture both right and left, several times a day, and lie upon her abdomen for at least an hour daily. Frequent change of position favors uterin drainage and massages the uterin supports. During the second week she has greater liberty, while the greater part of her time is spent on the bed or lounge. She may sit up for her meals, to urinate, and for bowel movements, and she should spend at least half an hour, twice daily, in abdominal and leg exercises to keep up her muscular tone. The third week she may be moved to a chair for a part of the day, having the liberty of the room. After sitting up for any length of time she should be instructed to take the genupectoral position before lying down. Prescribed exercises for the legs and abdominal muscles are to be taken daily. The fourth week, if all goes well, she may leave the room and have the benefits of air and sun. Physical exercises should be continued. The duration of the lying-in period and the degree of freedom to be given the patient after the second week must, however, depend on the character and amount of the lochia, the general progress of her convalescence, and the rate of the uterin involution."-(Polak's "Obstetrics.")
9. Phlebitis is inflammation of a vein, and is due to infection during labor or the puerperium. The most rigid asepsis and antisepsis must be observed by physician and nurse; and nothing which is not as near steril as possible should be allowed to come in contact with the genital tract of the parturient or puerperal woman.
10. Mammary abscess is characterized by pain, swelling, tenderness, feverishness. Sometimes it begins with a chill, fluctuation may be elicited, the neighboring lymphatic glands may enlarge. Treatment consists in making an incision radiating from the nipple, and drainage, though antiseptic and aseptic precautions must be observed; the breast should be put at rest for a couple of days; saline cathartics may be necessary, also supportiv measures.-Medical Record.
(To be concluded.)
OUR MONTHLY TALK.
I do not need to talk this month. Others with higher authority and who can talk better than I can, have been doing it for me.
The Federal Commission on Industrial Relations held hearings recently in New York, at which some very noted witnesses were summoned. Daniel Guggenheim, president of the American Smelting and Refining Co., we used to consider a stand-patter and conservativ of the extremest type. Let us hear him:
"I favor the democratization of industry absolutely and whatever intelligent legislation may be directed to that end. The industrial worker does not want merely an increase in wages. He wants something more-something higher.
[THE MEDICAL WORLD
idea that to succeed we must ruin our competitors; that business is a warfare ending in the survival of the fittest, and that because of competitiv conditions wages must be kept down to the bottom notch. ***
"I favor legislation providing that the Government and the State shall help the unemployed man to find employment, and that it shall see that when he is ill and incapitated he shall be properly cared for.
"But legislation cannot accomplish all this alone. There must be the co-operation of the employer, the employed, and the public-spirited citizen. ** "No man should be without a job if he is physically fit and willing to work, and it is, or ought to be, the business of the Government or the State to see that he gets one. The Government also should see to it that every injured man is cared for, and that every incompetent, whether from old age or other causes, has proper support. They may call me a socialist, gentlemen, but those are
"Talk" may be separated from THE WORLD by cutting this and the next leaf on this line.
Thus "Talk" without the medical part may be passed among lay friends, or given to the editor of the local paper to copy fr
"He wants a better degree of participation in the comforts and even the luxuries of life for himself and his family. And he will get these things. He should have them. ***
"I feel intense sympathy for the workingman, particularly under the increast cost of living that has added so materially to his burden during the recent years.
"I believe in the right of the industrial workers to organize. The capitalist when he is permitted to have too much power is apt to become arbitrary, and so is the labor union. Both need legal restraints, but the laborer has as much right to protect his interests by organization as has the capitalist.
"Industrial unrest, in my opinion, is on the increase. To alleviate that condition of unrest much is being done, but we are still a long way behind Germany and England in solving the problem. Progress will be made, because the employers of labor have recently undergone a great awakening. We are getting away from the old
Remember who these words come from-not from a socialist agitator. And you know who John D. Rockefeller is. He is certainly not a "populist." He said:
"I believe that a prime consideration in the carrying on of industry should be the well-being of the men and women engaged in it, and that the soundest industrial policy is that which has constantly in mind the welfare of the employees as well as the making of profits, and which, when the necessity arises, subordinates profits to welfare. (Continued over next leaf.)
The value of creosote in tuberculosis, bronchitis and pneumonia has long been recognized.
Thompson (Text Book of Practical Medicine, page 272) says: The creosote treatment of tuberculosis is a curious revival, after more than sixty years, of the use of a drug which fell into disfavor after its original trial. It is, on the whole, the most satisfactory drug for tuberculosis."
The use of creosote has been limited because of difficulty of administration. A combination that overcomes many objections to creosote is known as:
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"In order to live, the wage-earner must sell his labor from day to day. Unless he can do this, the earnings from that day's labor are gone forever. Capital can defer its returns temporarily in the expectation of future profits, but labor cannot. If, therefore, fair wages and reasonable living conditions cannot otherwise be provided, dividends must be deferred, or the industry abandoned. I believe that a corporation should be deemed to consist of its stockholders, directors, officers and employees; that the real interests of all are one, and that neither labor nor capital can permanently prosper unless the just rights of both are conserved."
Before the Industrial Relations Commission began its New York hearings its Chairman, Mr. Frank P. Walsh, of Missouri, created something of a sensation by a speech before an East Side audience. He said in part:
"We have to realize in our problem that toil and toil alone produces wealth, and the toiler is no better than a slave unless he has for himself a compelling voice in fixing conditions under which he is compelled to work, his wages, his hours of labor, and conditions as to safety and sanitation. Low wages and the resulting evils that arise from them are at the heart of our problems to-day. ***
"Even without changes in the laws as they are to-day we can do much to solve the problem of unemployment and the kindred problems that go with it. We can, for instance, take back for the people vast fortunes that have been embezzled from the people. I mean the fortunes taken from coal lands illegally filed upon in the West. A thief never gets a true title. ***
"Is there any person who will not challenge a $100,000,000 Foundation, exempt from taxation and to be used in a way the people do not dominate? There are no limitations on those funds. Suppose all of these Foundations should concentrate their resources in the securities of one industry, where the toilers were making a fight for democratic control. They could crush down the defenses of the fight for industrial justice. They
bring the great necessities of life under their control. ***
"We cannot go on with autocracy in business. The fact that a majority of the employing power in America is lodged in Manhattan Island is a menace to the perpetuity of our institutions, for it is but a step from the autocratic control of industry to tyrannical control in government.'
A TEXT-BOOK OF DISEASES OF THE NOSE AND THROAT.
By D. Braden Kyle, A.M., M.D., Professor of Laryngology and Rhinology, Jefferson Medical College, Philadelphia. Fifth edition, thoroly revised and enlarged. 856 pages, 272 illustrations, 27 in colors. Philadelphia and London: W. B. Saunders Co., 1914. Cloth, $4.50, net.
New articles appearing in this issue are Vaccine Therapy; Lactic Bacteriotherapy in Atrophic Rhinitis; Salvarsan in Treatment of Syphilis of the Upper Respiratory Tract; Sphenopalatine Ganglia Neuralgia; Negativ Air Pressure in Accessory Sinus Disease; Chronic Hyperplastic Ethmoiditis; Congenital Insufficiency of the Palate; Lactic Bacteriotherapy in Pharyngeal Affections; Removal of Plate of Artificial Teeth from Esophagus. (Continued on page xxiv.)
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