The educated physician will explain to her what symptoms are normal and what are pathologic, and often he will be able to entirely cure the latter. It is now a well-established fact that the most serious complications of the pregnancy, and of the labor itself are caused by severe congestion or disease of the kidneys. The condition of the kidneys can only be determined by frequent examinations of the urine; during the early months of pregnancy these examinations are made once a month, and during the last month they are made every week. The amount of urine passed in the normal condition is three pints a day.

Nowhere, perhaps, is the constant vigilance of the physician so well rewarded as in the careful oversight of the pregnant woman. She goes through her entire pregnancy feeling well, and often the greatest discomfort that she suffers is due to her size; her labor and her lying-in are normal, and she gives birth to a healthy child.

Engagement of the Nurse.— This is generally left to the physician in charge of the case, since he is responsible for the safe delivery of the woman; but if the patient has any decided choice in the matter, it is acceded to unless there should be some very valid objections, and the physician always sends the nurse in view for that case to see the patient in order to ascertain if she is personally agreeable to the patient.

Choice of Room for the Confinement and Lying-in.— The room should be light, sunny, and well ventilated; it should not be too near a water-closet. In the city as quiet a room as possible should be selected, and one that is well removed from the rest of the house, so that if necessary perfect quiet can be maintained. The room should be as cheery as possible.

The dress of the mother during the lying-in consists of a merino undervest, with high neck and long sleeves, and a nightgown, which shall be open all the way down the front. The gowns should be made of light muslin or of cambric; and there should be a sufficient number so that they may be changed every day.

Six abdominal bandages should be provided. These are made of light muslin, and they should be eighteen inches wide and long enough to go once and a third around the patient's hips at the sixth month of pregnancy, or about one yard and a quarter long; they may be made straight or to fit the patient at the sixth month. This bandage is fastened down the front; it is applied directly after the labor, and adds greatly to the patient's comfort during the lying-in.

The vulvar pads used during the lying-in are the antiseptic absorbent pads which can be obtained at any place where surgical dressings are sold; they are made of absorbent cotton, covered with cheesecloth, and sterilized.

There must be a sufficiently generous supply of sheets so that they can be changed every day, and the drawsheet as often as may be required. Nothing is so important to a good lying-in as to have a clean, well-ventilated room, and plenty of fresh bed-linen. Cleanliness is the first requisite to antisepsis, and this is the secret of avoiding puerperal fever.

Articles to be provided for the confinement are:

  1. An oblong douche-pan of agate-ware.
  2. An agate bed-pan.
  3. A bath thermometer.
  4. Two pieces of rubber sheeting; one, one yard square, and the other two yards square.
  5. Two sterilized bed-pads, 30 inches square by 3 to 4 inches thick.
  6. Three dozen antiseptic absorbent pads.
  7. One pound of sterilized absorbent cotton; twelve yards of cheese-cloth.
  8. Six abdominal bandages, eighteen inches wide, preferably made to fit the figure at the sixth month of gestation.
  9. Two hand-scrubs.
  10. Four ounces of the tincture of green soap.
  11. Bottle of corrosive sublimate tablets.
  12. Four ounces of powdered boric acid.
  13. Half a pint of good whisky.
  14. Two ounces of aromatic spirits of ammonia.
  15. Two ounces of aqua ammonia.
  16. One pint of alcohol.
  17. Two tubes sterilized white vaselin.
  18. Plenty of large and small safety-pins.
  19. Hot-water bag.
  20. New fountain syringe, to hold four quarts; with glass nozle.
  21. One small basin for vomited matter.
  22. Two very large agate basins or wash-bowls for washing doctor's hands and for antiseptic solutions.
  23. Vessel for after-birth.
  24. Three large pitchers; one for boiling water, one for cold boiled water, and one for antiseptic solution.
  25. Tumbler for boric acid solution for washing baby's eyes, with fine old linen sterilized.
  26. One dozen freshly laundered sheets, and two dozen towels.
  27. Stocking-drawers, muslin.
  28. Change of night-clothing warmed for the mother.
  29. A warm blanket to receive the baby.
  30. An infant bath-tub.
  31. A large piece of oil-cloth to protect the floor.*