The physician who is called to attend a case of labor must always have with him, especially in the country, a certain number of drugs and instru ments, the necessity for which may arise at any moment. The obstetri cal bag must always contain a pair of forceps, a complete catheter (male and female), a laryngeal tube, a stethoscope, linen or flannel bandages one and a quarter inches in width, chloroform, laudanum, and ergot. Since ergot in substance may undergo change and lose all activity when long powdered, we much prefer solutions of ergotin, among which that prepared by Yvon seems to us infinitely superior to all the others. Its strength is such that a cubic centimetre of the solution represents exactly one gram of ergot of rye (or one minim equals one grain). Again, should the solution be intended for subcutaneous injection by means of Colin's syringe,which holds exactly one cubic centimetre (15 70 of distilled water, the dose given will be known. Ergot, when injected under the skin, acts after one and a half to two and a half minutes, while by the mouth it requires from six to ten minutes to manifest its activity; moreover, the solution (by injection) causes neither vomiting nor consecutive abscesses. For these reasons we prefer subcutaneous injections to all other modes of administration of the drug, and during the three years that we have em ployed them we have had only good effects. Arrived at the bedside, the obstetrician ,must assure himself that everything is, in readiness for the baby: thread for ligating the cord, small compresses and bands to hold the funis in place, warm water for the bath, clothing for the in fant, etc.
The obstetrician must first ascertain the hour when the contractions commenced, their character, assure himself of the facts by remaining near the patient, and not until some time has elapsed should he proceed to internal examination, which will give him definite information as to the degree of dilatation, the integrity or rupture of the bag of waters, the presentation, position, the conformation of the pelvis. We have said above that the accoucheur should assure himself of the latter points dur ing the last months of pregnancy. At this time it is important for him to ascertain that the woman is really in labor, and how far it has pro gressed. The 'fact of labor being established, the accoucheur has the woman placed in the largest, best aired and lighted room of her dwelling, the temperature of which should be moderate, 50° to 61° F. He should clear the room of all persons who are not indispensable, or whose presence is not demanded by the patient. It is best for the patient, and, we may say, for the acconcheur, if the parturient be alone with him and the nurse, but it is impossible to lay down absolute rules. The obstetrician must divine, comprehend, who are the persons by whom the patient desires to be surrounded; he must demand, if need be on the strength of his author ity, that the husband, the mother, mother-in-law, sisters, leave the room if the patient desire it; therein lies an extremely delicate point of prac tice on which we need not lay stress.
The patient must be dressed loosely; in the beginning, a wrapper or skirt suffices. Later, before the patient takes to the bed, the chemise suffices, but it should be raised as much as possible behind, to prevent its being soiled by the blood and liquor amnii which will escape. It is the rule to give an enema at the onset of labor, so as to clear the intestine. This will save the patient the annoyance of being soiled with !local mat ters at the end of labor, an accident which fills her with repugnance, and may so worry her, in certain cases, that the attendant is obliged to tell her not to mind this annoyance, which, with certain women, is so great that they restrain the necessary expulsive efforts. But in spite of all these precautions, women often feel the necessity, especially toward the end, of using the commode. It is advisable not to permit them to do so; on the one hand, because the sensation is generally illusory, and due to the pressure of the head on the rectum; on the other hand, especially in mul tiparse, because this sensation often indicates the presence of the head at the external orifice of the genital passages, The patient should be told, therefore, to avail herself of the bed-pan or basin instead, but should never be permitted to go far from the spot where she is to be confined. The state of the bladder must likewise be carefully watched, for, although a number of women urinate frequently, there are others in whom the pressure exerted by the head on the bladder causes an actual retention of urine,which requires to be relieved by the use of the catheter. If the female catheter fails, as it frequently does, we must try either a male metal catheter or one of soft rubber. On eleyating the head a little, we usually succeed in overcoming this difficulty, at least when the bead is not too far engaged. Indeed, retention of urine is not without effect on the uterine contractions, not to mention graver accidents which may supervene.
It is not necessary to make the woman lie down at the onset of labor, but here again the wish of the patient should be respected. In some cases in particular, if the dorsal decubitus be assumed too early by the patient, it seems to induce a diminution in the frequency of the pains. In that event, it will be advisable to make the woman rise and walk about a little, but not to the extent of fatiguing her, for, as we shall see, there are other preferable means of regulating and stimulating the pains.