Anon - "The Diary of a U boat Commander"

M. E. Braddon - "The Golden Calf"

Elias Owen - "Welsh Folk Lore"

J. B. Salmond - "My Man Sandy"

Annual Bibliography of Commonwealth Literature 2007
This paper argues that discourses of love in Ghanaian market literature for youth offer a view into complex negotiations of agency and empowerment. Drawing on Deborah Durham's notion of youth as "social `shifters'" and Francis Nyamnjoh's conception of the "interconnectedness" of agency, I take Ghanaian market literature as one specific case of how African literature for youth foregrounds questions of continuity and change as African societies enter into increasingly complex global relations. In this literature for youth, received notions of love, often constructed out of impressions from American pop and hip hop music, carry new notions of agency that compete with existing "domesticated" forms. Authors like Ike Tandoh and Evelyn Tay employ discourses of love to offer youth alternative avenues for empowerment in a context of socio-economic disenfranchizement. In a creative process of "straddling", this writing both reveals and reproduces the contradictions that obtain in youth configurations of agency.

The Mother and Her Child

W >> William S. Sadler >> The Mother and Her Child




When the pains begin to take on regularity and gradually grow heavier
and it is near the appointed time for the labor, the patient should
prepare to start for the hospital; or, if it is to be a home delivery,
the physician should be called. As noted above, the first subjective
symptom may be the rupture of the bag of waters, and it is imperative
to prepare at once for the labor. It is far better to spend the day at
the hospital, or even two days waiting, rather than to run the risk of
giving birth to the child in a taxicab or street car; or, in the event
of a home labor, to have the child born before the doctor arrives.


WHAT TO DO IN THE ABSENCE OF A DOCTOR

It is often the case that when we need our physician the most, he is
busy with another patient and cannot come, or perhaps an automobile
accident detains the man of the hour. The hospital delivery always
possesses this advantage over the home--physicians are always on hand.
We deem it wise to relate in detail the method of procedure during the
rapid birth of a child; that the husband or nurse may give intelligent
and clean service.

After the patient has been given the enema and has been shaved and the
bath has been administered as previously directed, the helper most
vigorously "scrubs up." There are three distinct phases to the
"scrubbing up": First, the three-minute scrubbing of the hands and
forearms with a clean brush and green soap; to be followed by, second,
the trimming and cleaning of the finger nails, for it is here, under
the nails, that the micro-organism lives and thrives that causes
child-bed fever or septicemia; and, third, the final five-minute
scrubbing of the fingers, hands, and forearms. An ordinary towel is
not used to dry the well-cleansed hands, but they are now dipped in
alcohol and allowed to dry in the air.

And now if the pains are returning every three to five minutes or if
the bag of waters has broken, the patient should go to bed. She will
lie down on her back with the knees drawn up and spread apart. The
patient, having had the cleansing bath, is now washed with the
disinfectant bath (2 antiseptic tablets to 11/2 pints of water), from
the breasts to the knees. Another member of the family takes the outer
wrappings off the sterilized delivery pad and the "clean" helper
places the sterile delivery pad under the expectant mother, who is
directed to "bear down" when her pains come. She may be supported
during these pains by pulling on a sheet that has been fastened to the
foot of the bed.

The _clean_, helper then sits by her constantly until the baby is born
but under no circumstances should touch her until after the head
appears. Immediately after the birth of the head, the shoulders
usually follow with the next pain, which ought to occur within two or
three minutes. Occasionally the face turns blue, in such an instance,
the mother is directed to strain vigorously and presses down heavily
on the abdomen with both her hands, this usually hurries matters
materially, and the body of the child follows quickly. The baby should
cry at once. If the child does not show signs of life, quick, brisk
slapping on the back usually brings relief. During the birth of the
head it is imperative that, in the event of liquid passing at the same
time, no water or blood be sucked into the mouth by the baby. Great
care must be exercised in this matter. Should the baby remain blue,
lay it quickly upon its right side near the mother, and after the
pulse of the cord has stopped beating the clean helper ties the cord
twice, two inches from the child and again two inches from this tying
toward the mother, and then the cord is cut between the two tyings
with scissors that have been boiled twenty minutes.

Should there be more difficulty with the breathing of the new born
child, if slapping it on the back brings no relief, its back (with
face well protected) may be dipped first in good warm water, then
cold, again in the warm, again in the cold--this seldom fails. The
child should then be kept very warm, lying on its right side.


CARE OF THE MOTHER

All this time, a member of the family has been firmly grasping the
mother's abdomen, and within an hour the afterbirth passes out through
the birth canal. If the physician has not yet arrived, all dressings,
the pad, the afterbirth, must all be saved for his inspection.

The inside of the thighs and the region about the vagina is now washed
with bichloride solution, the soiled delivery pad removed, a clean
delivery pad is placed under her; an abdominal binder is applied and
two sterile vulva pads are placed between the legs, and hot water
bottles are put to her feet, as usually at this stage there is a
slight tendency toward chilliness. She should now settle down for
rest. Fresh air should be admitted into the room. There may be some
hemorrhage, and if it is excessive, grasp the lower abdomen and begin
to knead it until you distinctly feel a change in the uterus from the
soft mass to a hard ball about the size of a large grape fruit; thus
contraction has been brought about which causes the hemorrhage to
decrease. If the doctor has not yet arrived put the baby to the
breast, and place an ice bag for ten or fifteen minutes on the abdomen
just over the uterus. Should there be lacerations, the doctor will
attend to their repair when he comes. One teaspoonful of the fluid
extract of ergot is usually given at this time, if possible get in
touch with the physician before it is administered.


CARE OF THE BABY

After the mother is comfortable, your attention is directed to the
baby; the condition of the cord is noted; should it be bleeding, do
not disturb the tying, but tie again, more tightly just below the
former tying, and with the long ends of the tape, tie on a sterile
gauze sponge or a piece of clean untouched medicated cotton, thus
efficiently protecting the severed end of the cord. No further
dressing is needed until the doctor arrives.

Grave disorders have arisen from infection through the freshly cut
umbilical cord.

Should the doctor be longer delayed, one drop of twenty per cent
argyrol should be dropped in each of the infant's eyes and separate
pieces of cotton should be used for each eye to wipe the surplus
medicine away.

This application must not be long neglected, for a very large per cent
of all the blindness in this world might have been avoided had this
medicine been placed in each eye soon after birth.

The warmed albolene is now swabbed over the entire body of the infant
(this is done with a piece of cotton), the arm pits, the groins,
behind the ears, between the thighs, the bend of the elbow, etc, must
all receive the albolene swabbing. In a few minutes, this is gently
rubbed off with a piece of gauze or an old soft towel, and the baby
comes forth as clean and as smooth as a lily and as sweet as a rose.

The garments are now placed on the child--first the band, then shirt,
diaper, stockings, flannel skirt, and outing flannel gown--and it is
put to rest after the administration of one teaspoonful of cooled,
boiled water. In six to eight hours it will be put to the breast.




CHAPTER IX

TWILIGHT SLEEP AND PAINLESS LABOR


In recent years much has appeared in both the popular magazines and
the medical press concerning the so-called "twilight sleep" and other
methods of producing "painless childbirth." Many of these popular
articles in the lay press cannot be regarded in any other light than
as being in bad taste and wholly unfortunate in their method and
manner of presenting the subject; nevertheless, these writings have
served to arouse such a general public interest in the subject of
obstetric anesthetics, that we deem it advisable to devote two
chapters to the brief and concise consideration of the subjects of
pain and anesthetics in relation to the day of labor.


THE PAIN OF LABOR

First, let us briefly consider the question of pain in connection with
childbirth. Many women--normal, natural, and healthy women--suffer but
comparatively little in giving birth to an average-sized baby during
an average and uncomplicated labor. Like the Indian squaw, they suffer
a minimum of pain at childbirth--at least this is largely true after
the birth of the first baby; and so there is little need of discussing
any sort of anesthesia for this group of fortunate women; for at most,
all that would ever be employed in the nature of an anesthetic in such
cases, would be a trifle of chloroform to take the edge off the
suffering at the height or conclusion of labor.

But the vast majority of American mothers do not belong to this
fortunate and normal class of women who suffer so little during
childbirth; they rather belong to that large and growing class of
women who have dressed wrong; who have lived unhealthful and sometimes
indolent lives; who are more or less physically and temperamentally
unfitted to pass through the experiences of pregnancy and the trials
of labor.

The average American woman shrinks from the thought and prospect of
suffering pain; she is quite intolerant with the idea of undergoing
even the few brief moments of physical suffering attendant upon
childbirth. She refuses to contemplate the day of labor in any other
light than that which insures her against all possible pain and other
physical suffering.

And it is just this unnatural and abnormal fear of labor-pains--this
unwomanly dread of the slightest degree of physical suffering--that
has indirectly led up to so much discussion regarding the employment
of "twilight sleep" and other forms of obstetric anesthesia.

While the authors recognize the great blessing of anesthesia to the
woman in labor--and almost unfailingly make use of it in some
form--nevertheless, we also recognize that it would be a fine form of
mental discipline and mighty good moral gymnastics, if a great many
self-centered and pampered women would "spunk right up" and face the
ordeal of labor with natural courage and normal fortitude. It would be
"the making of them," it would make new women out of them, it would
start them out on the road to real living. At the same time we do not
mean to advocate that women should suffer unnecessary pain in
childbirth any more than we allow them to suffer in connection with
surgery.


PREPARATION FOR LABOR

While so much is being written about "twilight sleep" and "painless
labor," it might be well to remind the American mother that much can
be done to lessen the sufferings of the day of labor by one's method
of living prior to the confinement.

We believe that child-bearing is a perfectly normal physical function
for a healthy and normal woman--that it is even essential to her
complete physical health, mental happiness, and moral well-being.
Theoretically, child-bearing ought to be but little more painful than
the functionating of numerous other vital organs--stomach, heart,
bladder, bowels, etc.--and, indeed, it is not in the case of certain
savage tribes and other aboriginal people, such as our own North
American Indian.

But we must face the facts. The average American woman does suffer at
childbirth; and she suffers more than we are disposed to allow her, or
more than she, as a general rule, is willing to suffer. So, while we
discuss appropriate methods of lessening the pain of labor and the
pangs of childbirth by the scientific use of anesthetics, let us also
call attention to certain things which may aid in decreasing the
amount of pain which may reasonably be expected to attend child
bearing.

To assist in bringing about this preparation for decreased pain at
childbirth, mothers should teach their daughters how to develop,
strengthen, and preserve their physical, mental, and moral resistance.
The young mother should be taught by both her mother and her physician
how to dress, how to work, and how to eat. Every care should be given
to the hygiene of pregnancy and labor.

The expectant mother should have plenty of fruits and fruit juices,
and if not physically well endowed to give birth to a large babe, she
should have her diet restricted in meat, bread and milk, as well as
the cereals. Overeating during pregnancy should be carefully guarded
against, as emphasized in an earlier chapter. Deformities of the
pelvis, etc., should rule out a consideration of pregnancy.

While artificial painless childbirth by means of "twilight sleep" and
other similar methods all have their place; nevertheless, these
procedures should not lead to the neglect of those natural methods and
preventive practices which aid in preparing the normal expectant
mother for nature's relatively painless labor. When so much anesthesia
has to be used in a normal labor, it cannot but strongly suggest that
both patient and physician have neglected those common but efficient
methods which contribute indirectly to lessening the pangs of child
bearing.


WHAT IS TWILIGHT SLEEP?

"Twilight sleep" is a recent term which has become associated in the
public mind with "painless labor." The reader should understand that
"twilight sleep" is not a new method of obstetric anesthesia. While
this method of inducing "painless labor" has been brought prominently
before the public mind in recent years by much discussion and by
numerous magazine articles--being often presented in such a way as
sometimes to lead the uninstructed layman to infer that a new method
of obstetric anesthesia had just been discovered--it has,
nevertheless, been known and more or less used since 1903. Later known
as the "Freiburg Method," and as the "Dammerschlaf" of Gauss, and
still later popularized as "twilight sleep," this "scopolamin-morphin"
method of obstetric anesthesia, has gained wide attention and acquired
many zealous advocates.

"Twilight sleep" is, therefore, nothing new--it is simply a revival of
the old combination of _scopolamin_ and _morphin_ anesthesia. While
many different methods of administering "twilight sleep" have been
devised, the following general plan will serve to inform the reader
sufficiently regarding the technic of this much-talked-of procedure.

The scopolamin must always be fresh, although different forms of the
drug are used. It tends quickly to decompose--forming a toxic
by-product--and, according to some authorities, this decomposed
scopolamin is responsible for many undesirable results which have
attended some cases of "twilight sleep." Various forms of morphin are
also used, as also is narcophin.


TECHNIC OF "TWILIGHT SLEEP"

The "twilight-sleep" injections are not started until the patient is
in the stage of active labor. The initial injection consists of the
proper dose of scopolamin and morphin (or some of their derivatives),
while the patient's pupils, pulse, and respiration are carefully
noted, as also are the character of the uterine contractions and the
character of the fetal heart action.

Usually within an hour, a second dose of scopolamin is given, while
the application of so-called "memory tests" serves to indicate whether
it is advisable to administer additional injections. Some leading
advocates of this method claim that the majority of the unfavorable
results attendant upon "twilight sleep" are the direct result of
failure to control the dosage of the drug by these "memory tests;" and
they call attention to the large percentage of "painlessness" as proof
of probable overdosing. If the patient's memory is clear and she is
not yet under the influence of the drug, a third dose is soon given.
If, however, the patient is in a state of amnesia (lack of memory),
this third injection is not commonly given until about one hour after
the second injection. The amount of amnesia present is used as a guide
for repeated injections at intervals of one to one and a half hours.
As a rule, the morphin is not repeated.

It must be evident that the success of such a method of anesthesia
must depend entirely upon thoroughgoing personal supervision of the
individual patient by a properly trained and experienced physician;
and it is for just these reasons that "twilight sleep" is destined to
remain largely a hospital procedure for a long time to come.

Experience has shown that those cases of "twilight sleep" that are not
under the influence of scopolamin over five or six hours do vastly
better than those under a longer time. When employed too long before
labor this method seems to favor inertia and thus tends to increase
the number of forceps deliveries.

The number of injections may run from one to a dozen or more, and
patients have come through without accident with fifteen or more
doses, running over a period of twenty-four hours.


THE CLAIMS OF "TWILIGHT SLEEP"

While "twilight sleep" as a method of anesthesia is not altogether
new, many of the claims made for it by recent advocates are more or
less new; and, to enable the reader clearly to comprehend both the
advantages and disadvantages of this method, both the favorable and
unfavorable facts and contentions will be summarized in this
connection. The favorable claims made for "twilight sleep" are:

1. That eighty to ninety per cent of all women who use this method can
be carried through a practically painless labor.

2. That there is practically no danger to the mother (some degree of
danger to the child is admitted by most of its champions) other than
those commonly attendant on the older and better known methods in
general use.

3. That "twilight sleep," being almost exclusively a hospital
procedure, would result in more women going to the hospital for their
confinement--if it were used more; and would, therefore, tend to bring
about more careful supervision and individual care on the part of the
attending obstetrician.

4. That by lessening the dread of labor and the fear of painful
childbirth, there will probably occur an increase in the birth rate of
the so-called "higher classes of society"--the social circles which
now show the lowest birth rates.

5. That it is of special value in the cases of certain neurotic women
and those of low vital resistance; especially those patients suffering
from certain forms of heart, respiratory, kidney, and other organic
diseases.

6. Some authorities maintain that "twilight sleep" is of value even in
threatened eclampsia, although they admit it tends to produce a rise
in blood-pressure.

7. It is supposed to shorten the first stage of labor--by facilitating
the dilation of the cervix--owing to the painless stretching; although
the majority of its special advocates admit that it lengthens the
second stage of labor, during which the patient must be very closely
watched.

8. That even in those cases where the sense of pain is not entirely
destroyed, the patient seems to possess little or no subsequent memory
of any physical suffering or other disagreeable sensations.

9. That the method is of special value in sensitive, high-strung,
nervous women of the "higher classes," who so habitually shun the
rigors of child bearing--especially in the instance of their first
child.

10. That the action of scopolamin is chiefly upon the central nervous
system--the cerebrum--that it diminishes the perception of pain
without apparently decreasing the contractile power of the uterus;
labor may, therefore, proceed with little or no interruption, while
the patient is quite oblivious to the accompanying pains.

11. That the physical and nervous exhaustion is quite entirely
eliminated--especially in the case of the first labor--that patients
who have had this method of anesthesia appear refreshed and quite
themselves even the first day after labor.

12. That there is decidedly less "trauma" (appreciable injury) to the
nervous system and therefore less "shock;" and that all this saving of
nervous strain tends greatly to hasten convalescence.

13. And, finally, that "twilight sleep" does not interfere with the
carrying out of any other therapeutic measures which may be deemed
necessary for a successful termination of the labor.


DANGERS OF TWILIGHT SLEEP

While we are recounting the real and supposed advantages of "twilight
sleep"--especially in certain selected cases--it will be wise to pause
long enough to give the same careful consideration to the known and
reputed dangers and drawbacks which are thought to attend this method
of anesthesia in connection with labor cases.

We desire to state that these expressions, both for and against
"twilight sleep," are not merely representative of our own experience
and attitude; but that they also represent, as far as we are able to
judge at the time of this writing, the consensus of opinion on the
part of the most reliable and experienced observers and practitioners
who have used and studied this method in both this country and Europe.
The dangers and difficulties of "twilight sleep" may be summarized as
follows:

1. That this method tends to weaken the mental resistance of many
women; to lessen their natural courage and to decrease that
commendable fortitude which is such a valuable feature of the
character endowment of the normal woman.

2. That "twilight sleep" is essentially a hospital method and is,
therefore, inaccessible to the vast majority of women belonging to
the middle and lower classes of society, as well as to those women who
live in rural communities.

3. That in fifteen or twenty per cent, the method fails to produce the
desired results--at least, when administered in amounts which are
deemed safe.

4. That this method does decrease the baby's chances of living; that
the second stage of labor is definitely prolonged; that from ten to
fifteen per cent of the babies are sufficiently under the influence of
the anesthesia when born as to be unable to breathe or cry without
artificial stimulus.

5. That it is a method requiring special training and experience; that
it will be many years before the average practitioner will become
proficient in its use; and that the older methods are probably far
safer for the average physician.

6. That the method requires more care in its administration than can
be expected outside of the hospital in order to avoid the dangers of
fetal asphyxiation--which danger has led not a few obstetricians to
abandon it.

7. That a satisfactory technic is almost impossible of development;
that every patient must be individualized; that the chief dangers are
connected with the over dosage of morphin; that the method is not
adaptable to the general practice of the average doctor.

8. That by prolonging the second stage of labor and by sometimes
giving too much morphin, the number of forceps deliveries is greatly
increased, with their attendant and increased dangers to both mother
and child.

9. That the prospects of passing through labor which may be rendered
painless by artificial methods, tends to produce an attitude of
carelessness and indifference towards those natural methods of living
and other hygienic practices which so greatly contribute to naturally
painless confinements.

10. That this method as sometimes practiced greatly increases the
dangers of a general anesthetic, if such should be found necessary
later on during the labor.

11. That "twilight sleep" is contra-indicated (should not be used) in
the following conditions: primary inertia (abnormally delayed and slow
labor); expected short labor--especially in women who have already
borne children; when the fetal head is known to be large and the
mother's pelvis small; placenta praevia (abnormal placental
attachment); accidental hemorrhage; absent or doubtful fetal heart
beat; when labor is already far advanced; and in threatened
convulsions and eclampsia.


CONCLUSIONS REGARDING TWILIGHT SLEEP

Having presented the evidence both for and against "twilight sleep,"
it may be of assistance to the lay reader to have placed before her
the personal conclusions and working opinions of the authors. We,
therefore, undertake to summarize our present attitude and outline our
practice as follows:

1. "Twilight sleep" as a method of obstetric anesthesia in certain
selected cases and in well-equipped hospitals, and in the hands of
careful and experienced practitioners, has demonstrated that it is a
scientific reality--and has probably come to stay--at least until
better and safer methods of affecting a relatively painless
confinement are discovered; although we are compelled to state that it
is not the panacea the lay press has led many of our patients to
believe. (That we believe a much better and safer method has been
devised, the next chapter will fully disclose.)

2. We do not expect this method ever to become general in its use; we
do not look for a chain of special "twilight hospitals" to stretch
across the continent and then to overrun the country. We expect much
of the recent forced enthusiasm to die down, while scopolamin-morphin
anesthesia takes it proper place among other scientific methods of
alleviating the pangs of labor.

3. We know that standard and fresh solutions--as already noted--are
absolutely essential for the success of this method.

4. We are certain that no routine method or technic can be developed.
Each patient must be individualized. The method does not consist in
injecting scopolamin every so often. The patient's mental and physical
condition--as also that of the unborn child--must control the
administration of "twilight sleep."

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