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Care of Child

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CHILDBED.—In a limited sense childbed embraces the time needed for the healing of the wounds of the internal generative organs, caused by childbirth ; in a broader sense it embraces the time needed for the complete involution of the pelvic and abdominal organs, which generally takes six weeks. After this space of time the first menstrual period begins, unless delayed by nursing, which happens in the large majority of cases.

As in the case of other wounds, not neglected nor infected, the wounds caused by childbirth heal without fever or material pains. After child birth the woman is exhausted from the exertion attendant thereon, and needs rest ; and this being necessary for quite a long time, it is important to lay her in a clean and comfortable manner. The duration of childbed of a healthy woman may last in some cases only a few days, while in others it may take from three to four Aveeks. The former is too short a period for most women, and the latter too long, causing relaxation ; nine to twelve days is the best average time. At the beginning, the woman should lie on her back ; later, on her side. The mattress must be protected by a rubber sheet, four feet square, covered by a sheet in which to take up the discharges ; over this another folded linen-cloth should be drawn across the bed, under the sacrum. The bedding must be absolutely clean and dry. The lochial discharge is caught in gauze napkins, and should not smell badly. If it is offensive, it contains foul germs which ought not to occur. During the first few days the discharge from the interior of the womb is bloody ; then it becomes watery, until the end of the first week, and then white. If it is bloody for a longer time, it is a sign of faulty contraction of the womb. Severe hammr rhages are caused by remnants of placenta or by inflammations. Further more, there may be abnormal discolorations (like burnt raspberry-jelly) ; or, in very severe cases, a sudden cessation of the lochia, without changes in the odour, may occur.

The excreta of a confined woman should be taken up in bedpans (Fig. IoI), as she should not leave the bed. The urine should be passed twice daily from the very beginning, as the bladder is paralysed at times and may become distended by retention of urine. Women in childbed, who cannot urinate when lying on the back may be assisted to sit up in bed, hut this should be done slowly and carefully.

There is another advantage in the sit ting posture in that the lochial dis charge can flow more readily from the vagina. It is wise to make attempts to urinate while lying on the hack before the time of childbirth. Laying the hand over the bladder is at times helpful for the patient who cannot urinate. The paralysis of the bladder may often be overcome by the

application of hot towels, by spraying the opening of the urethra, or by the use of an enema. If these means are not successful, the practised hand of the nurse or physician must insert a catheter, after disinfection of the mouth of the urethra. The catheter should be boiled before use.

On the third or fourth clay after confinement there should be a move ment of the bowels, and this may be furthered every third day by adminis tering a dessertspoonful of castor-oil, or by enemas. To overcome the intestinal inertia, the patient should take cooked fruit, fresh vegetables, a predominantly liquid diet, brown bread, honey, and butter. The enemas must measure about a quart (not much more), to which may be added a teaspoonful of cooking-salt, five tablespoonfuls of salad-oil, or a piece of glycerine-soap the size of a walnut. If there is flatulence, peppermint and fennel tea may be given in addition to the enemas. After each evacuation of the bladder and of the intestine, the external genitals must be washed clean and sprayed. Sponges must not be used tor this purpose, as they are never free from disease-germs ; but absorbent cotton or sterile gauze should be used in their place. For disinfecting the genital organs, creosol (half tea spoonful stirred well into two quarts of boiled water) or lvsoi (one part to roo of water) may be used. These directions also hold good in cases of miscarriage or of premature birth, and the various necessaries should, there fore, he in readiness before the time of expected confinement ; the infant's clothes need not be ready before the eighth month. Clean water is not neces sarily free from germs, and therefore must not be used for washing the genitals before it has been boiled. The addition of a disinfectant is not as effectual as boiling. The sacral region must be kept very clean, and it necessary it must be treated with vinegar-water or with a desiccating powder. so that the patient will not get sore. If this condition does occur, zinc salve should be applied to the part, and an air-cushion placed under the patient. Generally, bodily cleansing is necessary once or twice daily, and is effected by a lukewarm bath of the entire body, including the back and the sacrum. The additional treatment of the skin for the restoration of elasticity may be effected by abdominal massage, which must be given only by a practised hand, and only in cases which are free from fever. The massage-treatment also tends to stimulate the circulation of the blood in the mammary glands, and to encourage the flow of milk.

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