during the course of a delivery may have to be resorted to very suddenly and unexpectedly, a nurse should have things in readiness should the emergency arise. The especial preparations necessary will consist in the making of a cone of stiff paper, into which a towel is fitted, for the purpose of giving the patient ether; arrangements for an abundant supply of hot water, to be had at a moment's notice; facilities for making up antiseptic solutions quickly; a small pitcher containing a warm two per cent. creolin solution for the physician's instruments; some kind of grease, as carbolized cosmolin, for lubricating these instruments when desired; English rubber catheter and urinal conveniently at hand; a basin with a two per cent. carbolic solution for needles, sutures, and scissors; absorbent cotton in small pads, or soft linen rags dipped in an antiseptic solution, to be used instead of sponges; sufficient protection for the floor at the side of the bed; and preparations for resuscitation of the infant.

The position of the patient for most obstetric operations will be across the bed, with her hips well over the edge. This is called a "cross-bed." Physicians generally call simply for a cross-bed, in desiring the nurse to make preparations for an operation, and she should understand that this refers to the arrangement of protectives and sheets, adjustment of pillow, and placing of patient in proper position. Should there not be a sufficient number of persons to have one hold each leg, chairs should be placed in such a way at the side of the

bed as to support the widely separated feet. A chair for the physician should be placed between these, facing the bed. As there is usually some assistant to give the ether, the nurse will need no help in keeping the limbs apart and in giving the physician any other aid she can in the supply of the various articles as they are needed. Should the physician desire her to give the ether, her whole attention should be devoted to administering the anesthetic and seeing that the patient keeps in good condition. Strict watch should be kept over the respirations and the pulse. Difficult breathing, or a stoppage in the respirations, weakness or irregularity of the pulse, blueness of the face and lips, should at once be called to the physician's notice, the ether cone being removed from the patient's face. After the patient is once well under ether, it takes but little to keep up the anesthesia, so that the nurse should use the ether sparingly; a few drops every few minutes upon the towel are, as a rule, sufficient. After etherization the patient may vomit, and there will be greater tendency to bleeding because of the relaxation induced by the anesthesia, hence the nurse should exercise special watchfulness and care over the patient. The vomiting is often relieved by a mustard paste over the stomach, while the bleeding may be controlled by the hand placed over the lower part of the abdomen, which, by making pressure over the womb, insures good contractions. After the nausea is relieved, ergot, if prescribed by the physician, may be given.

CHAPTER XI.

MANAGEMENT OF THE LYING-IN.

Immediately after the delivery it is necessary that the patient should have rest. The room should be kept exceedingly quiet and the shades drawn down so as to subdue the light.

The patient may be allowed to sleep, but the nurse, during this time, should watch her very carefully, as there is a liability to bleeding when the sleep is too deep, owing to the general relaxation induced by sleep. She should draw the bedclothes up at one side from time to time, to see how much blood is lost.

There should be no unpleasant smell about a confinement room, plenty of fresh air should be allowed to enter, and all discharges should be at once removed from the room.

While the patient sleeps, and after the child has received proper attention, the nurse should place the soiled sheets, towels, and all articles stained with blood in cold water to soak.

The afterbirth, also, should be disposed of. If in the country, it should be buried in a hole dug in the yard, two or more feet deep. It should never be thrown

down a water-closet or privy. In the city it is best to burn it at night. It may be put in the range or stove and well covered up with coals. Clots of blood may safely go down the water-closet, as they readily dissolve.

To return to the soiled clothing left after a confinement -though a trained nurse will not often be called upon to attend to the washing of these articles, there will be times when it would be better that she should do so, both to save the patient expense and trouble and to prevent their lying about too long. At any rate, she should know how it should be done. Should the clothing be put to soak before the blood has dried into it, and allowed to remain for a few hours, the water being changed as often as needed, the washing will not be difficult.

As a rule, it is not best that a nurse should leave her patient or the baby long enough to attend to this wash, hence it is advisable to have it put out or done by some one else in the house. The soaking ought, however, always to be attended to by the nurse, because it facilitates the subsequent washing.

In the after-care of the patient the nurse should attend to the washing of the mother's and baby's napkins. She should, if needed, wash the baby's flannels and slips. Visitors. For a week a newly-confined patient should see no visitors. Even the husband should not remain in the room long at a time. No painful or exciting news should be communicated to the patient, as a distressing form of mental trouble to which lying-in women are

prone may be thus induced. peral mania."

This is known as "puer

Food. After the patient rouses from her first sleep she is generally hungry. The nurse should have learned from the physician before he left what he would prefer her having. A cup of warm milk or tea-not too hotmay be given directly after the confinement when ether has not been taken, and this followed in three or four hours by a light meal, as toast and tea or gruel. With regard to the diet of the lying-in, nurses must be prepared to follow the rules of the physicians for whom they work. Some physicians allow considerable variety in the food from the beginning.

The following directions concerning the diet are given to the nurses of the Woman's Hospital: "It should be remembered, in the diet of the lying-in woman, that the amount of liquids, should the breasts or nipples threaten to give trouble, must be limited, not only until after the secretion of milk, but also until the supply of milk adapts itself to the demand, for the first five or six days after the confinement.

As soon as the patient is made comfortable after the birth, she should have a cup of warm milk or weak tea, or warm water and milk.

First meal-time: Plate of milk toast or bowl of oatmeal gruel, or saucer of wheat germ or boiled rice.

Second meal: Cup of weak tea or warm milk, dry toast, or milk toast, or water toast, or soda crackers soaked in hot milk.