of a warm towel. Dry thoroughly, especially about the joints, but without much rubbing.

Take special care to see that the eyes are clear. Dust with fine toilet powder under the arms and between the legs, and look to see if the anus and urethra are open, and the child in a normal condition all over. Dress the cord with a bit of soft linen dipped in vaseline, having a hole in the center. Put the cord through the hole and lay it on the left side of the body, over it two or three folds of dry linen. Keep the dressing in place by a flannel band about the abdomen, tight enough not to slip, but not tight enough to impede the child's respiration. All the garments should be warm and not too tight. Put one inside another, and the whole on over the feet rather than the head, turning the child no more than is necessary. The child must be bathed, and the cord dressed daily until it falls off, which it will do in about a week or ten days. A compress moistened with oil must still be kept over the umbilicus, until it is depressed and of the same color as the surrounding skin. Milk will sometimes be seen in the child's breasts for a few days after birth. If they are swollen and hard, rub them very gently toward the nipple with vaseline, and the condition will gradually disappear.

After the mother has rested a few hours, and the child has been washed and dressed, it is well to put it to the breast. The first milk, the colostrum, is of quite different quality from the later secretion, and has a purgative effect upon the child, clearing the intestines of the meconium, a dark viscid matter with which they are loaded at birth. The suckling of the child helps to secure contraction of the uterus, often occasioning quite severe after-pains; it excites fuller secretion and draws out the nipple. Indeed, it is quite as much for the

mother's sake as the child's that it is put to the breast thus promptly. The baby will not suffer if it has no food at all for the first twenty-four hours. The colostrum is scanty but quite sufficient for the need. Nothing else should be given unless, perhaps, a little, very little, warm water and sugar. The milk does not appear in abundance until about the third day. There is almost always some pain and rise of temperature accompanying it, and, if the breasts are not properly relieved, milk fever and mammary abscess may .ensue. If the child can not empty the breast sufficiently, the milk should be drawn off by a breast-pump. A good substitute for a breast-pump is a champagne bottle with a smooth edge; fill it with hot water, let it stand a moment, then pour it out quickly, oil the edge, and apply the mouth of the bottle over the nipple. As the heated air condenses, the milk will be sucked out into the bottle. The condensation may be increased by wrapping around the bottle a towel wet in cold water. The same method is useful to draw out a retracted nipple, which the child has difficulty in grasping. In putting the child to the breast, see that the nostrils are not obstructed, otherwise it can neither breathe nor suck; alternate the use of the breasts. They should be protected by an extra covering, as they are very sensitive to cold. If the nipples are tender, bathe them in spirits, and wash them off carefully before and after each nursing. They may be hardened by daily bathing with alcohol, for some time previous to the confinement. If they become excoriated and fissured, nipple-shields may be necessary.

If the child, for any reason, is not to nurse, the secretion of milk must be checked. This is usually done by bandaging the breasts closely, supporting them by pads of cotton at each side, so that the pressure will be made

evenly. The bowels must be kept open, and the amount of fluid taken into the system limited as far as possible. Belladonna is sometimes employed to help dry up the secretion, usually in the form of an unguent rubbed in gently. Rubbing of the breasts must always be toward the nipple. In the absence of the mother's milk, that of a suitable wet nurse is the best food for the child. She should be a healthy and not nervous woman, whose own child is nearly the age of the one she is to nurse. If cow's milk is used for the child, it must be at first diluted with twice as much water and slightly sweetened. The proportion of water may be gradually lessened, until after six months the milk may be given pure. Condensed milk is perhaps of more even quality than the ordinary, unless the milk of a single cow can be secured. If the child is not to nurse its mother, it may be given half a teaspoonful of the syrup of rhubarb soon after birth to remove the meconium, as it will miss the purgative action of the colostrum. The meconinm ought to be cleared out and water passed during the first twenty-four hours. If the latter fails to occur, apply a hot stupe over the kidneys. The napkins should be changed as soon as wet, and not used again without washing. The bowels may be expected to move once or twice daily. Digestion in the infant takes place in little over an hour. The child should be fed during the first two months, at intervals of two hours, regularly. The mouth should be washed out after each nursing. It should not be allowed to go on sucking indefinitely after it has had food enough, or to suck an empty feeding bottle, its own fingers, or anything else. This may keep it quiet for a time, but ultimately makes matters worse, by getting its stomach overloaded or full of wind. A baby need not be assumed to be hungry because it

A TEXT-BOOK OF NURSING.

cries, but something is the matter with it, and it is the business of the nurse to find out what. It does not cry unless it is in some way uncomfortable. month old should sleep twenty hours out of the twentyA child a four without being rocked or carried about. will be easily acquired even at this age. The child Habits should sleep in a crib, and be taught to go to sleep by itself. Let it lie on either side, not directly on the back, as there is danger in this position that the milk may regurgitate and get into the trachea. Do not have a strong light in the room, as the eyes of both mother and child are weak.

The mother during the puerperal state requires the most careful nursing. She should be kept in bed for ten days or two weeks, not being allowed to sit up for any purpose, or in any way to exert herself. It is of the greatest importance that she and everything about her be kept clean. She should have a carefully given sponge-bath all over every day, and the vulva should be washed two or three times daily. If the lochia has a disagreeable odor, a vaginal douche may be given morning and night of carbolic solution, 1-80. There should be no odor perceptible on entering the room. Have plenty of fresh air, but at the same time be careful to avoid chilling the patient, especially when she first gets up. The catheter must be used every six or eight hours, if the bladder can not be otherwise emptied. There is often temporary paralysis of the urethra following labor. An emollient enema should be given on the third day, and every second day thereafter, until the bowels move naturally. The diet should be fluid for the first day or two, light and unstimulating for the first week, after that, if the patient is progressing favorably, she may return to her usual diet. .

Hæmorrhage immediately after delivery is known as post-partum hæmorrhage; occurring two or three days later, it may be called secondary. It may follow even a perfectly natural labor, profusely enough to endanger life. There is little fear of it while the uterus is firmly contracted. If it is felt to be swelling, it is a sign of danger, and every effort must be made to induce contractions, which prevent the escape of blood by lessening the caliber of the blood-vessels. This symptom, and other indications of internal hæmorrhage, as pallor, coldness of the extremities, feeble pulse and respiration, must be watched for, especially when the patient is asleep, for fatal post-partum hæmorrhage may occur without any great show of blood. If the pulse gets above 100 at this time, some complication is threatening. If hæmorrhage occurs, elevate the pelvis somewhat, keeping the head low. Make pressure upon the fundus uteri, endeavoring to induce contractions of that organ. Make ice-cold applications externally, and inject hot water into the vagina. Give ergot.

Another peculiar danger to which this state is liable is that of puerperal fever, a form of blood-poisoning most commonly established within three or four days after labor, resulting either from absorption of the decomposing matter produced by the woman herself, or from infection brought to her from some external source. After the raw surfaces are healed over, and the os uteri closed, the danger is less, but antiseptic precautions ought still to be kept up. The disease is commonly initiated by chills, followed by high fever, the temperature rising to 102°, 103°, or even, in severe cases, to 106°. The pulse is rapid, the countenance sunken and anxious; there is a sickly odor to the breath, and usually diarrhoea and vomiting. The