This book represents the obstetric ideas and technic which the writer has endeavored for years to impress upon his students and nurses with such emendations and changes as experience and scientific progress have suggested. It is a selective essence distilled from the recurrent harvests that workers in this field have brought forth during centuries of consecrated effort. To all these forerunners the writer acknowledges a deep personal indebtedness.

In the preparation of the book thanks are due particularly to Charlotte Gregory, Head Nurse of the Wesley Maternity, whose rare ability as teacher, technician and executive and whose untiring vigilance has been a leading factor in securing and maintaining the high state of efficiency in this department. She has kindly contributed Chapters XXIII and XXIV, together with valuable suggestions and criticisms in other portions of the text.

The author also takes pleasure in acknowledging his obligations to Florence Olmstead, Head Nurse of the Dispensary of the Northwestern University Medical School, whose long experience in feeding babies gives to her words an unquestioned authority. Chapter XXII is almost entirely her work.

To the various publishers who have courteously allowed the reproduction of valuable illustrations from the books of other writers thanks are also extended, and to his own publishers especially for their cordial and sympathetic cooperation the author wishes to express his warmest gratitude.

C. B. R.

Chicago, 1917.

CONTENTS

CHAPTER I
PAGE
Anatomy[17]
CHAPTER II
Physiology[33]
CHAPTER III
Normal Pregnancy[51]
CHAPTER IV
Hygiene of Normal Pregnancy[66]
CHAPTER V
Abnormal Pregnancy[74]
CHAPTER VI
Abnormal Pregnancy (Continued)[89]
CHAPTER VII
Preparations for Labor and the Normal Course of Labor[98]
CHAPTER VIII
The Mechanism of Normal Labor[120]
CHAPTER IX
The Care of the Patient During Normal Labor[129]
CHAPTER X
The Normal Puerperium[151]
CHAPTER XI
Unusual Presentations and Positions[165]
CHAPTER XII
Operations[179]
CHAPTER XIII
Minor Operations[200]
CHAPTER XIV
Complications in Labor[214]
CHAPTER XV
Complications in Labor (Continued)[228]
CHAPTER XVI
The Abnormal Puerperium[242]
CHAPTER XVII
Infection[255]
CHAPTER XVIII
The Care of the Child[265]
CHAPTER XIX
The Care of the Child (Continued)[278]
CHAPTER XX
The Care of the Child (Continued)[287]
CHAPTER XXI
The Care of the Child (Continued)[298]
CHAPTER XXII
Infant Feeding[310]
CHAPTER XXIII
Cleanliness and Sterilization[323]
CHAPTER XXIV
Diets and Formulæ[330]
CHAPTER XXV
Solutions and Therapeutic Index[340]

ILLUSTRATIONS

FIG. PAGE
1.The normal female pelvis[18]
2.The planes of the brim, the cavity, and the outlet[19]
3.Visceral relations[20]
4.Uterus and appendages[22]
5.Normal position of pelvic organs[24]
6.The external genitals[25]
7A.Varieties of hymen[27]
7B.Varieties of hymen[28]
8A.The excreting ducts of the mammary gland[29]
8B.Lobules and duct of the mammary gland[29]
9.Nipple, areola, and the glands of Montgomery[30]
10.Supernumerary milk glands in the axillæ[31]
11.The three ages of the breast[31]
12.Development of the ovary[34]
13.Graafian follicles[35]
14.Human spermatozoa[36]
15.The chorionic villi about the third week of pregnancy[38]
16.Diagram illustrating relations of structures of the human uterus at the end of the seventh week of pregnancy[39]
17.Maternal surface of the placenta and membranes[40]
18.Fœtal surface of human placenta[41]
19.The egg at term with uterus removed[42]
20.Normal attitude of fœtus[43]
21.Fœtal skulls showing sutures[44]
22A. and B.Child’s head at term, showing diameters[45]
23.The fœtal circulation[49]
24.Gravid uterus at the end of the eighth week[52]
25.Striæ gravidarum[54]
26.Bimanual examination[60]
27.Abdominal enlargement at different months of pregnancy[63]
28.Height of the uterus at various months of pregnancy[64]
29.Twins[83]
30.Diagram representing the sites for the various forms of tubal pregnancy[90]
31.Abdominal binder with crosspiece to hold vulvar pads[100]
32.T-binder, used in all cases after the fifth day post partum[100]
33.Breast binder[101]
34.Baby’s dress with winged sleeves[102]
35.The bag of waters begins to act on the cervix[111]
36.The effect of the pains. The cervix before labor begins[112]
37.The effect of the pains. The cervix begins to be “effaced”[112]
38.The effect of the pains. The cervix is effaced, and the dilatation of the os begins[113]
39.The effect of the pains. The cervix is effaced and the os continues to dilate[113]
40.The cervix is effaced and the os dilated[115]
41.Child in second stage of labor[116]
42.The head passing over the perineum[117]
43.Normal expulsion of the placenta according to Schultze[118]
44.The child in left-occipito-anterior position[122]
45.The child in right-occipito-anterior position[123]
46.The descent of the head in right-occipito-anterior position[124]
47.Internal anterior rotation and extension of the head in a left-occipito-anterior position[124]
48.Extension[125]
49.Extension completed. Expulsion[125]
50.A cephalhæmatoma[127]
51.Points of greatest intensity of fœtal heart tones[130]
52.Handling forceps, kept sterile in a jar of alcohol[132]
53.Palpation. What is in the pelvis?[134]
54.Palpation. What is in the fundus?[135]
55.Palpation. Where is the back? Where are the small parts?[136]
56.Patient draped for internal examination[137]
57.Delivery in side position[141]
58.Sheet twisted into a sling[147]
59.Repair of perineum[148]
60.The progress of involution[152]
61.The breech. Left-sacro-anterior position[166]
62.The breech. Left-sacro-posterior position[167]
63.Extraction of the breech[170]
64.Breech delivery. Extraction of the trunk[171]
65.Breech delivery. Delivering the shoulder[172]
66.The delivery of the after-coming head by the Smellie-Veit maneuver[172]
67.Shoulder presentation[173]
68.Face presentation[175]
69.Descent of the chin in face presentation[176]
70.Delivery in face presentation[177]
71.Exaggerated lithotomy position[181]
72.Dorsal position when assistants are available[182]
73.Instruments for artificial delivery of the head[183]
74.Forceps operation. Introduction of the left blade[186]
75.Forceps operation. The introduction of the right blade[187]
76.Forceps operation. Locking the handles[187]
77.Forceps operation. The way the blades should grasp the fœtal head[188]
78.Forceps operation. Traction on the handles[189]
79.Forceps operation. The delivery of the head[189]
80.Version. Seizing a foot[190]
81.Version. The child rotates as pressure is made upon the head and traction upon the foot[191]
82.Version is complete when the knee appears at the vulva[192]
83.The Walcher position[194]
84.The Wiegand compression of the child’s head to force it into the pelvis[195]
85.The Naegele perforator[196]
86.Apparatus for getting a sterile specimen of urine from an infant[201]
87.Tampon of the uterus[203]
88.Tampon of vagina[204]
89.Pean forceps[208]
90.Hand bulb syringe; and Vorhees bags; bag rolled and grasped by Pean forceps ready for introduction[209]
91.Vorhees bag in place[210]
92.Episiotomy[212]
93.Various forms of pelvic deformity[215]
94.The pelvimeter[216]
95.The various diameters of the inlet[216]
96.Measuring the distance between the anterior superior spines of the pelvis[217]
97.Measuring the external conjugate[218]
98.Measuring the diagonal conjugate with the finger[219]
99.Various forms of placenta prævia[229]
100.The knee-elbow posture[236]
101.The knee-chest posture[236]
102.The exaggerated lithotomy position obtained with a sheet sling[237]
103.The improvised Trendelenburg position[237]
104.The dorsal position with stirrups[238]
105.Dorsal position across the bed[239]
106.Flexed dorsal position with feet on the table[240]
107.The Sims position[241]
108.Examples of imperfect nipples[245]
109.A standard nipple shield[246]
110.A standard breast pump[251]
111.Germs most frequently found in cases of puerperal fever[256]
112.Rubber bath tub[266]
113.The Pettit cord clamp[268]
114.Standard breast pump; Standard nursing bottle; the breast tray; the Wansbrough lead nipple shield; the Brophy nipple for harelip and cleft palate[271]
115.Proper position of mother while nursing child[274]
116.Proper method of taking rectal temperature[276]
117.Method of passing the tracheal catheter[279]
118.Byrd’s method of artificial respiration. Extension and inspiration[280]
119.Byrd’s method of artificial respiration. Beginning flexion and expiration[280]
120.Byrd’s method of artificial respiration. Flexion and compression[281]
121.Method of giving gavage[284]
122.Apparatus for gavage or lavage[286]
123.Cleft palate nipple[288]
124.The device for feeding the child with cleft palate[288]
125.Device for assisting the cleft palate child to nurse[289]
126.Method of strapping an umbilical hernia[290]
127.Proper position for introduction of a suppository[299]
128.Hydrocephalus[307]
129.Anencephalus[308]
130.Elements of human milk[312]