[67] [Dr. Dewees recommends the woman to be placed for labour on her left side at the foot of the bed, in such a manner as will enable her to fix her feet firmly against one of the bed-posts; her hips within ten or twelve inches of the edge of the bed; her knees bent, her body well flexed upon her thighs; her head and shoulders will then be near the centre of the bed, where pillows should be placed to raise them to a comfortable height. This is the position we believe in which the patient is very generally placed in the United States.—Ed.]
[68] [See an interesting paper “on Laceration of the Perineum during Labour; by Wm. M. Fahnestock, M. D.,” in American Journal of the Med. Sc. for Jan. 1841. Editor.]
[69] See a case of central perforation of the perineum, Med. Gaz. p. 782. Aug. 19, 1837.
[70] “The practice of using force to hurry the shoulders and body of the child through the os externum as soon as the head was born, is very generally laid aside. There can be no doubt that this imprudent conduct often brought on a retention of the placenta.” (See White, on Lying-in Women.)
[71] “A ligature upon the navel string is absolutely necessary, otherwise the child will bleed to death; and when tied slovenly, or not properly, it will sometimes bleed to an alarming quantity. As we take such vast care to secure the navel string, you will naturally ask how brutes manage in this particular? I will give you an idea of their method of procedure, by describing what I saw in a little bitch of Dr. Douglas. The pains coming on, the membranes were protruded; in a pain or two more they burst, and the puppy followed. You cannot imagine with what eagerness the mother lapped up the waters, and then, taking hold of the membranes with her teeth, drew out the secundines; these she devoured also, licking the little puppy as dry as she could. As soon as she had done I took it up, and saw the navel string much bruised and lacerated. However, a second labour coming on, I watched more narrowly, and as soon as the little creature was come into the world I cut the navel string, and the arteries immediately spouted out profusely; fearing the poor thing would die, I held it to its mother, who, drawing it several times through her mouth, bruised and lacerated it, after which it bled no more. This, I make no doubt is the practice with other animals.” (Dr. W. Hunter’s Lectures, MS. 1752; from Dr. Merriman’s Synopsis, p. 21. note.)
[72] Carus’s Gynakologie, vol. ii. p. 138. This assertion, however, must be qualified, somewhat, as we know of several cases where flooding has come on after labour during sleep.
[73] “I have observed,” says Dr. Hunter, “in women who do not give suck, and in nurses after they leave off suckling, that the axillary glands become painful, swell, and sometimes suppurate. Is not this owing to the acrimony which the milk has acquired by long stagnation in the breast, and affecting the gland through which it must pass in absorption? I have observed that they are at the same time liable to little fevers of the intermitting kind, which come on with a rigour, and go off with a sweat. Are not such fevers raised by absorption of acrid milk?” (Hunter’s Commentaries, p. 59.)
[74] [The best application we have ever tried, is the vinegar and water as is commended by Dr. Dewees. See his admirable chapter on Milk Abscess. Treatise on the Principal Diseases of Females.—Am. Ed.]
[75] [Sore nipples is an affection, of so very frequent occurrence, often so exceedingly obstinate, and sometimes productive of such extreme torture to the patient, that some additional remarks relative to its treatment may be acceptable to the practitioner.
The solution of nitrate of silver, two grains to the ounce of water, is highly extolled by Mr. Allard (American Journ. Med. Sc. Feb. 1837,) and Dr. Churchill says that he has found it the most effectual application. (Diseases of Pregnancy and Child-bed.) This solution should be applied every time the child is taken from the breast, care being taken to wash the nipple previous to the next application of the child. We have frequently found this treatment very efficacious, but in some cases it entirely fails. Dr. Hannay says, that the solution is inferior to the solid nitrate of silver, and asserts that the latter never fails to afford relief and ultimately effect a cure. He uses it as follows. The nipple is to be gently and carefully dried, then freely touched with a sharp pencil of nitrate of silver, care being taken to insinuate the pencil into the chaps or chinks. The nipple is then to be washed with a little warm milk and water. The pain though smart soon subsides, and all that is necessary, according to Mr. H. to heal the sore, is a little simple ointment, or one made with the flowers of zinc. When the pain from the application is very severe, relief should be given by the administration of thirty drops of the solution of morphium. In some cases it is necessary to apply the caustic more than once. (Am. Journ. Med. Sc. Feb. 1835, p. 527.)