After cleansing the skin, the nurse sterilizes her hands and dresses the cord. The gauze which was temporarily wrapped around the stump is removed, the cord and adjacent skin washed with alcohol and dried. The stump is powdered above and at the sides with a mixture of equal parts of boric acid and subnitrate of bismuth, and then wrapped in gauze. The band is put on, the temperature taken, and the baby dressed. Some physicians prefer to have the cord dressed in 95 per cent alcohol, which is frequently renewed. The normal separation of the cord takes place through a kind of dry gangrene, which should be favored by dry rather than wet dressings. The 95 per cent alcohol does not remain at 95 per cent after it is exposed to air, hence it does not absorb moisture from the cord as absolute alcohol would. However, the attending man is responsible, and his orders must be followed.
The Umbilicus.—The cord may be severed as soon as the child has cried lustily or the cessation of pulsation may be awaited, in either case the child secures a little more blood, which gives him a better start in life.
Two tapes are tied about the cord, one close to the skin margin of the child and the cord is cut between them. A kind of mummification or dry gangrene normally develops and the stump falls off, as a rule, about the fifth day, leaving a moist, granulating area, which forms the umbilicus.
A metal clamp may be used in place of a tape to compress the cord. The advantage of the clamp is that on account of its greater width and rigidity it does not cut through the cord when applied. Furthermore, it can be made and kept more nearly aseptic. It does not soak up the juices from the cord and form a culture medium for germs. It can be removed on second day. The cord usually comes off a day or so sooner than when the tape is used.
Fig. 113.—The Pettit cord clamp.
The care of the cord is extremely important, as many infections can be transmitted through it to the child. At each dressing the cord is inspected, and whether it is dry or moist, offensive or inodorous, should be noted. These facts, with the falling off of the cord, are put down on the history sheet as they are observed. The binder, after each removal, is not pinned, but sewed on. The sewing should begin below and go up in order to have the tightness low down.
Eyes.—After the first instillation of silver nitrate solution, a reaction appears with redness, swelling, and discharge, which passes off without treatment in two or three days. During the bath, care must be used not to get anything into the eyes nor anything from the eyes or nose upon the navel.
At each dressing the nurse should irrigate the edges of the lids gently with boric acid solution. If the eyes become red, swollen, and have a purulent discharge after the second day, the case is possibly ophthalmia and they must be watched with extreme vigilance. A smear should be taken for the microscope and preparations made for energetic treatment.
The following summary may be of service in memorizing the routine of nursery procedure.