blood out from the end next the child. The scissors for this purpose are preferably dull, as the more ragged wound thus produced favors the closure of the bloodvessels. This lesson may be learned from nature, the lower animals gnawing off the cord after giving birth to their young, and thus no doubt decreasing the danger of bleeding.

Position for Delivery of Afterbirth.-The best position for the mother during the delivery of the afterbirth is on her back, hence she may be turned after the nurse has satisfied herself that the baby is in good condition.

Twins. Very occasionally, on placing her hand over the abdomen, after the delivery of the child, the nurse may feel another child there. In this case she must simply keep the womb well contracted by rubbing it gently through the abdominal walls, and wait for nature to go on with the work of expulsion. This baby must be cared for as the other.

The afterbirth generally comes away within twenty minutes after the child's birth. Two or three pains occur, during which the nurse should keep the womb in the middle line of the abdomen and make gentle pressure backward and downward. With her right

hand she should seize the afterbirth and membranes and twist them around several times to make a cord of the membranes, so that they may not tear, but all be expelled at once. A discharge of blood and some clots generally follows the delivery of the afterbirth.

The

nurse's left hand should still be kept carefully over the womb, which should feel hard and firm and should not reach above the navel. If it does not feel firm, rubbing over the lower part of the abdomen should again be resorted to until the round, hard body is felt.

If the afterbirth does not come for an hour, and the physician has not yet come, send for another doctor.

After the afterbirth has come, it should be put in a clean vessel, and, if detached from the baby, put in an adjoining room for the doctor to examine when he comes. Insist upon his seeing it, to find out whether it is all there. Have the baby removed to its crib and placed on its right side and properly covered.

After-care. Watch the womb carefully until the doctor comes. If it be firmly contracted, and no more blood be flowing from the vagina, place some dry napkins or a clean sheet under the patient, and wash off the thighs and surrounding parts with warm water containing bichlorid in the strength of 1-4000, and dry with a soft cloth.

Slip the soiled clothing from under the patient, and then apply the binder and dressings, and make her comfortable.

As soon as the doctor comes, report to him the exact time when the waters broke, when the baby was born, and when the afterbirth came. It is always best for a nurse to keep a written report with a statement of what she did. She should not, however, neglect her patient for the purpose of perfecting her report.

Breech Delivery.—Sometimes a nurse has the misfortune to be the only attendant at a breech delivery, that is, instead of the child's head coming first, the breech passes out from the birth-canal. Delivery in this manner is very dangerous to the life of the child. The nurse should do absolutely nothing here, as she would only make matters worse in trying to assist. These deliveries are long enough, as a rule, to give ample time for the summoning of some doctor to take charge of the case. In all breech cases the child is apt to need to be resuscitated, if it is alive at all; hence plenty of warm water, etc., should be ready for the bath.

Hemorrhage.-Flooding from the womb, or " uterine hemorrhage," is apt to occur either within the first twenty-four to forty-eight hours after the birth, when it is called "primary hemorrhage; " or, it may occur some days after, when it is "secondary hemorrhage." The appearance of blood, either a constant oozing or a sudden gush from the vagina, is, of course, the earliest symptom.

A pulse of over 100 in a patient freshly confined should make the nurse exceedingly watchful in this respect, as it betokens a liability to hemorrhage. Should the flow continue, the patient becomes pale, faint, restless, gasps for breath, and finally dies unless the hemorrhage is checked. A nurse should, of course, have the physician sent for at once, although he may have just left the house, or another doctor should be summoned.

In the meantime, her first thought should be of the uterus and its probable condition of relaxation. The bandage, if applied, should be hastily removed, and the hand placed over the lower part of the abdomen. If the womb is not felt, rub vigorously until it contracts and is felt again as a round, hard body. Keep on rubbing and holding. The nurse should never take her hand off the

abdomen until the doctor comes.

Direct some one else

to take the pillows from under the patient's head, have the foot of the bed elevated, to keep the blood in the head and prevent fainting, which induces heart-clot. Have the foot of the bed placed on the seats of chairs. The patient may be fanned, cold water given her to drink, hartshorn to smell. She should not be allowed even to turn in bed or lift her head. If the doctor has

left ergot, one teaspoonful of the fluid extract may be given in a tablespoonful of water. The patient should receive this without lifting her head. Plenty of hot water should be on hand, the water in the tea-kettle boiling. If the physician delays his coming and the flow continues, repeated hot-water injections of about 115°120° should be given into the vagina.

Convulsions may come on during the labor as during the pregnancy. Their management would be the same. as that suggested for convulsions during pregnancy.

Other accidents, such as rupture of the uterus, or the coming down of an arm or hand, or the navel-string in advance of the usual part to come first, are conditions in which the nurse can do nothing, except to keep the patient as quiet as she can, and meddle as little as possible until the doctor comes, for whom, of course, she must at once send.

Deportment. At no time, in the management of a case, should a nurse express surprise or consternation, nor should her manner indicate that she has such feelings. Like a true soldier, she must bravely and quietly face the most critical situations and meet their demands. She should by her manner give the mother to feel that all life's vicissitudes are best met by a quiet self-control.

Fortunately, deaths during delivery in this enlightened age are few; for the methods of averting accidents at such times have been so thoroughly studied, that accidents themselves are very rare.

Obstetric Operations. As operative procedures