William Bligh - "A Narrative Of The Mutiny, On Board His Majesty's Ship Bounty; And The Subsequent Voyage Of Part Of The Crew, In The Ship's Boat"

Gotthold Ephraim Lessing - "Gespraeche fuer Freimaurer"

Ludovic Lazarus Zamenhof - "Dua Libro de l' Lingvo Internacia"

Various - "The Continental Monthly, Vol. 2, No 3, September, 1862"

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




3. That the scopolamin-morphin method of inducing "twilight sleep" has
its place--in the hands of experts--and in the hospital; and that in
many cases it probably represents the best method of obstetric
anesthesia which can be employed.

4. That as a general rule and in general practice, the safest and best
method of inducing the "twilight" state of freedom from severe pain,
is by the use of nitrous oxid or "laughing gas"--the "sunrise slumber"
method. It has been our practice to start all general ether
anesthetics with "gas" for a number of years, while we have been doing
an increasing number of both minor and major operations with "gas"
alone.

5. That we still employ general ether or chloroform anesthesia in
Cesarean sections and other major obstetric operations, although
several operators are beginning to use "gas" in even these heavy
cases.

6. That the intelligent and careful use of pituitary extract in
certain cases of labor serves greatly to shorten the second stage;
that it is of great value in certain "slow cases," and serves greatly
to reduce the use of low forceps.

We have treated the subject of obstetric anesthesia in this full
manner, because of the fact that so much has appeared in the public
press on these subjects, and, further, because we desired that our
readers should have placed before them the facts on all sides of the
question just as fully as a work of this scope would permit.




CHAPTER XI

THE CONVALESCING MOTHER


Popularly spoken of as the "lying-in period," and medically known as
the puerperium, this time of convalescence immediately following
childbirth is usually occupied by two important things: the
restoration of the pelvic organs to their normal condition before
pregnancy, and the starting of that wonderfully adaptative mechanism
concerned with the production of the varying and daily changing food
supply of the offspring.

The uterus, now more than fifteen times its normal size and weight,
begins gradually to contract and assume its normal weight of about two
ounces; and it requires anywhere from four to eight weeks to
accomplish this involution. In view of all this it is obvious that
there can be no fixed time to "get up." It may be at the end of two
weeks, or it may not be until the close of four or five weeks, in the
case of the mother who cannot nurse her child; for the nursing of the
breast greatly facilitates the shrinking of the uterus. Extensive
lacerations may hinder the involution as well as other accidents of
childbirth, so it must be left with the physician to decide in each
individual case when the mother may enter into the activities of life
and assume the responsibilities of the care of the baby and the
management of her home.


THE NURSE

During this period of the puerperium a member of the family, a
neighbor, a visiting nurse, a practical nurse, or a trained nurse,
looks after the mother and gives to the babe its first care; whoever
it may be, certain laws of cleanliness must be carried out if
infection is to be guarded against. If there are daily or semi-daily
calls made by the physician, a member of the family may be trained to
care for the mother with proper cleanliness and asepsis; but it is far
better for the mother, if possible, to secure the services of a
trained nurse, or the visiting nurse, in which instance she will call
each day, wash and dress the baby, clean up the mother and care for
the breasts. She is not supposed to clean the room, make the bed or
prepare the food. If a trained nurse can be in charge, the
convalescing time is usually shortened as the responsibilities are
taken from the mother, her mind freed from care and it is her's to
improve, rest, and wait for the restoration of the pelvic organs, when
she may again go forth among her family.

The nurse may have to sleep in the same room; but, if it be possible,
she should occupy an adjoining room, she should have a regular time
each day for an hour's walk in the fresh air, she should be served
regular meals, and be allowed some time out of the twenty-four hours
for unbroken slumber. In return she will intelligently cooperate with
the physician in bringing about the restoration of body and upbuilding
of the mother's nerves.


REST AND EXERCISE

From a monetary standpoint there can be nothing so wasteful or
extravagantly expensive in the home as to allow the mother to drag
about from day to day and week to week with chronic weakness or
invalidism because she did not have proper care during her already too
short puerperium, or because she got up too soon.

Having a baby is a perfectly normal, physiological procedure. It is
also, usually, downright hard work; and, beside the hard laborious
work, there is not only a wearied and severely shocked nervous system
to be restored, but there is also a certain amount of uterine
shrinkage which must take place--and this requires from four to eight
weeks; and so our mother must be allowed weeks or even a month or two
to rest, to enjoy a certain amount of well-directed exercise, to have
an abundance of fresh air, to be wheeled or lifted out of doors if
possible into the sunshine, that she may be the better prepared for
the additional duties and responsibilities the little new comer
entails. Sunshine and fresh air are wonderful health restorers as is
also a well-directed cold water friction bath administered near the
close of the second week of a normal puerperium. During the second
week a few carefully selected exercises such as the following are not
only beneficial, but tend to increase circulation and thus to promote
the secretion of milk and the shrinking of the uterus.

1. Head raising, body straight and stiffened.
2. Arm raising, well extended.
3. Leg stretching, with knees stretched and toe extended.
4. Massage, administered by the nurse.

A splendid tonic circulatory bath may be administered at the close of
the second week (in normal puerperium), known as the "cold mitten
friction," which is administered as follows: The patient is wrapped in
a warm blanket, hot water bottle at feet, and each part of the
body--first one arm then the other; the chest, the legs, one at a
time--is briskly rubbed with a coarse mit dipped in ice water. As one
part is dried it is warmly covered, while the next part is taken, and
so on until the entire body has been treated. The body is now all
aglow, the blood tingling through the veins, and the patient refreshed
by this wide-a-wake bath. Properly given, the cold-mitten friction
bath is one of the most enjoyable treatments known and under ordinary
conditions, if intelligently administered, may be given as early as
the eighth day.


AFTER PAINS

After the birth of the first baby the uterus usually is in a state of
constant contraction, hence there are no "after pains;" but after the
birth of the second or third child, the uterine muscle has lost some
of the tone of earlier days--there is a tendency toward relaxation--so
that when the uterine muscle does make renewed efforts at contraction,
these "after pains" are produced. They usually disappear by the third
day. Nothing should be done for them, indeed they should be welcomed,
for their presence means good involution (contraction) of the uterus.


THE TEMPERATURE

Careful notations of the temperature should be made during the first
week. A temperature chart should be accurately kept and if the
temperature should rise above 100 deg. the physician should be notified at
once. The third day temperature is watched with expectancy, for if an
accidental infection occurred at the time of labor, it is usually
announced by a chill and sudden rise of temperature on the third day.
This may be as good a place as any to mention the commonly met night
sweating. This is due to a marked accentuation of the function of the
skin. It is not at all unusual for a sleeping mother in the early
puerperium to wake up in a sweat with night gown very nearly drenched.
The gown should be changed underneath the bedding, while alcohol is
rubbed over the moistened skin surface.

These sweats will disappear as soon as the mother begins to regain her
strength. A vinegar rub administered on going to bed may often prevent
these sweats.


THE TOILET OF THE VULVA

Immediately after the birth of the baby and the expulsion of the
afterbirth, the thighs and vulva are cleansed as follows: Into a basin
of warm, boiled water are dropped four small antiseptic tablets of
bichlorid of mercury; this gives a proper antiseptic wash. Into this
solution are placed four pieces of sterile cotton Two of these are
used, one at a time, without being returned to the solution to wash
each inside of the thigh, the remaining two to cleanse the vulva.
Without drying the vulva, two sterile pads are applied and pinned to
the binder. These pads are changed every hour during the first day or
two because of the profuse lochial flow.

After each urination and bowel movement, a lysol solution (prepared by
putting one teaspoonful of lysol in a quart of sterile water) is
poured from a clean pitcher over the vulva into the bed pan, and fresh
pads applied. This toilet continues until the close of the second week
or longer, if there is a lochial flow.

These sterile pads not only absorb the lochia but also, among ignorant
or thoughtless mothers, prevent contamination by the patient's hands.


URINATION

The patient should be encouraged to urinate during the first few hours
after labor; catheterization should not take place until every effort
has been made to bring about normal urination; or, until there is a
well marked tumor above the bony arch of the pelvis in the lower part
of the abdomen. It is far less harmful to the patient for her to sit
up on the jar placed on the edge of the bed, than to undergo the risk
of inflammation of the bladder which so often follows catheterization.


THE LOCHIA

The first few days the lochia is very red because of the large amount
of blood which it contains. After the third or fourth day it is paler
and after the tenth it assumes a whitish or yellowish color. During
the three changes it should always smell like fresh blood. Any foul,
putrifying odor should be promptly reported to the physician.

If on getting up at the close of the second week the lochia should
resume its red color, the patient should return to bed and notify her
physician.


THE ABDOMINAL BINDER

After the tenth day, the abdominal binder may be pinned as tightly as
the patient desires, but prior to the tenth day many physicians
believe the exceedingly tight binder causes misplacements of the
enlarged, softened, and boggy uterus. It should be pinned snugly; but
not drawn as tight as possible with the idea of keeping the uterus
from relaxing, for at best, it does not do it; while tight
constriction may produce a serious turning or flexion of the uterus.
The breast binder is applied during the first twenty-four hours to
support the filling breasts, loosely at first, and as they increase in
size, as the glands become engorged, the binder is drawn more tightly.
A sterile piece of gauze is placed over the nipples.


THE BOWELS

On the morning of the second day a cathartic is usually given--say one
ounce of castor oil or one-half bottle of citrate of magnesia. The
bowels should move at least once during each twenty-four hours; if
they are obstinate, a simple laxative may be nightly administered.
Certain constipation biscuits, sterilized dry bran, or agar-agar may
be eaten with the breakfast cereal. Prunes and figs should be used
abundantly. Bran bread should be substituted for white bread. The
enema habit is a bad one and should not be encouraged; however, the
enema is probably less harmful than the laxative-drug habit. Mineral
oil is useful as a mild laxative, and does not produce any bad after
results.


CARE OF THE NIPPLES

Fissures of the nipples should be reported to the physician at once.
There are many good remedies which the physician may suggest; in his
absence, Balsam Peru may be advantageously applied. Boracic acid
solution should be applied before and after each nursing from the very
first day; in this way much nipple trouble may be prevented through
cleanliness and care. The nipples should be kept thoroughly dry
between nursings Nipple shields should be used where fissures persist.


THE DIET

For the first three days a liquid and soft diet is followed such as
hot or cold milk, gruels, soups, thin cereals, eggnog (without
whiskey), eggs, cocoa, dry toast, dipped toast, or cream toast. There
should be three meals with a glass of hot milk at five in the morning
(if awake) and late at night; nothing between meals except plenty of
good cold water. After the third day, if temperature is normal, a
semi-solid diet may be taken, such as baked, mashed, or creamed
potatoes, soups thickened with rice, barley or flour, vegetables
(peas, corn, asparagus, celery, spinach, etc.); eggs, light meats,
stale breads, toast, bland or subacid fruits (sweet apples, prunes,
figs, dates, pears, etc.); macaroni, browned rice (parched before
steaming), etc.; ice cream, custards, and rice puddings for desserts
after the seventh day. Three good meals a day, at eight and one and
six, with a couple of glasses of hot milk or cocoa or an eggnog at
five A.M., to be repeated at 9 or 10 P.M., with plenty of cold water
between the meals, will abundantly supply the necessary milk for the
growing babe. Tea and coffee are not of any special value in
encouraging a flow of milk.

The constant coaxing of the mother with "Do drink this," and "You must
drink this, or you won't have any milk," not only saddens her but
seriously upsets digestion and thus indirectly interferes with normal
lactation.


GETTING UP

Everybody should stay at home and away from the mother and her new
born child until after the seventh day, and then, if our patient is
normal, visitors may call, but should not stay longer than five
minutes. The convalescing mother will improve faster without the
neighborhood gossip, or the tales of woe so often carried by
well-meaning, but woefully ignorant acquaintances.

When the hard ball-like mass can no longer be felt in the lower
abdomen, when the lochia has passed through the three changes already
mentioned, and the flow is whitish or yellowish, scanty and odorless,
the patient may sit up in a chair increasingly each day. Such
conditions are usually found anywhere from the tenth to the fifteenth
day. The patient first sits up a little in a chair--she has already
been exercising some in bed--and this enables her to sit up with ease
for a half-hour the first day, increasing one-half hour each day
during the week following. At the end of three weeks, she may be taken
down stairs providing there is ample help to carry her back up stairs.
After another week (at the close of the fourth), if the lochia is
entirely white or yellow, with no blood, she may begin carefully to go
about the house. There should be no lifting, shoving, pulling,
wringing, sweeping, washing, ironing, or other heavy exercise for at
least another two weeks, better four weeks. Any variance from this
program usually means backache, lassitude, diminished milk supply, and
frequently a general invalidism for weeks or months--sometimes years.


COMPLICATIONS

_Cystitis_, or painful urination, is avoided by tardy "getting up;"
quietly, slowly moving about; abundant water drinking; and the
avoidance of catheterization.

_Hemorrhage._ Notify the physician if it occurs at any time. The
treatment is heavy kneading of the abdomen until the uterus again
becomes like a hard ball. Cold compresses over the lower abdomen may
sometimes help.

_Infection_ is manifested by chilly sensations or a distinct chill
followed by fever, usually on the third day. Take a cathartic; notify
the physician at once and follow his directions.

_Mastitis_, inflammation or caking of the breasts. Very hot
fomentations wrung out of boiling water, alternating with ice-cold
compress, should be applied to the breast for an hour or more, three
or four times a day. Cathartics should be administered, and
eliminative measures instituted such as the hot-blanket pack.

_Pneumonia._ Keeping the arms and chest well protected by a
long-sleeved coat of warm texture, should help in preventing this
serious complication. Pneumonia complicating labor is usually the
result of carelessness and exposure.




PART II

THE BABY





PART II

THE BABY




CHAPTER XII

BABY'S EARLY DAYS


Happy is the mother and fortunate is the home that possesses the
intelligent services of a trained attendant during the early days of
the baby's career. A century or more ago skilled nurses were unheard
of, and both mothers and babies seemed to thrive on the unskilled but
faithful and sympathetic care given by the willing neighbor who
"thought I'd just run over and help out." Who of us cannot remember
the days when mother was "gone to a neighbor's" to give this same
willing but unskilled care at the time of "confinement."


MODERN METHODS

And why are we so concerned today about asepsis, sterilization, etc.,
when a generation ago they were not? We used to live more slowly than
we do now. Then it took the entire day to do the marketing for the
week, now we take a receiver from the hook and a telephone wire
transmits the verbal message. Our days are literally congested with
events that were almost impossibilities a century ago. The ease and
leisure of former days are unknown and unheard of today. The
artificial way in which we live exerts more or less of a strain upon
the present generation; the average woman's nervous system is keyed up
to a high pitch; her general vital resistance is running at a low ebb;
while child-bearing brings a certain added stress and strain that
requires much planning to avoid and overcome.

For many days and ofttimes weeks the mother is unfit--physically
unable--properly to care for her child, and so whether it be the
trained assistant in constant attendance or the visiting nurse in her
daily calls, or the kind, willing, but unskilled neighbor--each helper
must acquaint herself, in varying degrees, with the physical, nervous,
and mental needs of the child, as well as take into account and
anticipate the numerous habits and wants of the new born babe, such as
urination, bowel movement, pulse, respiration, temperature, etc.


THE HEAD

At birth, the head is remarkably large as compared to the rest of the
body, for, surprising as it may seem, the distance from the crown to
the chin is equal to the length of the baby's trunk; and, too, if
birth has been prolonged this large head has also been pressed or
squeezed somewhat out of shape. This state of affairs, however, need
give no cause for either alarm or anxiety, for the head will shape
itself to the beautiful rotundity of the normal baby's head within a
few days.

The general shape of the baby's head, as seen from above is oval. Just
back of the forehead is formed a diamond-shaped soft spot known as the
anterior fontanelle which should measure a little more than one inch
from side to side. On a line just posterior to this soft spot and to
the back of the head, is found another soft spot somewhat smaller than
the one in front. Gradual closure of these openings in the bones
occurs, until at the end of six or eight months, the posterior
fontanelle is entirely closed; while eighteen months are required for
the closure of the anterior fontanelle.

These "soft spots" should not be depressed neither should they bulge.
The head is usually covered with a growth of soft, silky hair which
will soon drop out, to be replaced, however, by a crop of coarser hair
in due season. The scalp should always be perfectly smooth. Any rash
or crusts or accumulation of any kind on the scalp is due to
uncleanliness and neglect, and should be carefully removed by the
thorough application of vaseline followed by a soap wash. The vaseline
should be applied daily until all signs of the accumulation are
entirely removed. The eyes of all babies are generally varying tints
of blue, but usually change to a lighter or darker hue by the seventh
or eighth week. The whitish fur which often is seen on the baby's
tongue is the result of a dry condition of the mouth which disappears
as soon as the saliva becomes more abundant.


CHEST, ABDOMEN, AND LEGS

The baby's chest, as compared to the size of the head and abdomen,
appears at a disadvantage, while the arms are comparatively short and
the legs particularly so, since they measure about the same as the
length of the trunk. They naturally "bow in" at birth so that the
soles of the feet turn decidedly toward each other. All these apparent
deformities, as a rule, right themselves without any help or attention
whatsoever.


PULSE AND RESPIRATION

The pulse may be watched at the anterior fontanelle or soft spot on
top of the head while the child quietly sleeps and should record, at
varying ages, as follows:

At birth 130 to 150
First month 120 to 140
One to six months about 130
Six months to one year about 120
One to two years 110 to 120
Two to four years 90 to 110

The above table is correct for the inactive normal child. Muscular
activity, such as crying and sucking, increases the pulse rate from 10
to 20 beats per minute.

The respiration of the baby often gives us no small amount of real
concern at the first. The baby may be limp and breathless for some few
moments at birth, and this condition calls for quick action on the
part of the nurse and doctor.

The utmost care to avoid the "sucking in" of any liquid or blood
during its birth must be exercised, for this often seriously
interferes with the breathing. Sometimes this condition is not
relieved until a soft rubber catheter is placed in the throat and the
mucus is removed by quick suction. When you are reasonably sure that
there is no more mucus in the throat, then sudden blowing into the
baby's lungs (its lips closely in touch with the lips of the nurse or
physician) often starts respiration. Slapping it on the back also
helps, while the quick dip into first hot then cold water seldom fails
to give relief.

A quiet-sleeping infant breathes as shown below at varying ages. An
increase of six to ten breaths per minute may be allowed for the time
it is awake or otherwise active.

At birth and for the first two or three weeks 30 to 50
During the rest of the first year 25 to 35
One to two years about 28
Two to four years about 25


THE WEIGHT

The normal weight of the average baby is seven to seven and one-half
pounds. Its length may range anywhere from sixteen to twenty-two
inches.

There is an initial loss of weight during the first few days; however,
after the milk has been established the child should make a weekly
gain of four to eight ounces until it is six months old, after which
time the usual gain is from two to four ounces per week.

If the weight has been doubled at six months and the weight at one
year is three times the birth weight, the child is said to have gained
evenly and normally.


THE SKIN

At birth the skin of the baby is red and very soft owing to the
presence of a coating of fine down. A blue-tinged skin may be
occasioned by unnecessary exposure or it may be due to an opening in
the middle partition of the heart which should close at birth. As soon
as the baby is born, it should be placed on its right side while the
cord is being tied, as this position facilitates closure of this
embryonic heart opening. With the provision for a little additional
heat the blue color should disappear, if it is not due to this heart
condition. At the close of the first week the red color of the skin
changes to a yellow tint due to the presence of a small amount of bile
in the blood. This sort of jaundice is very common and is in no wise
evidence of disease. The "down" falls off with the peeling of the
skin which takes place during the second week; by the end of which
time, the skin is smooth and assumes that delightful "baby" character
so much admired.


THE CORD DRESSING

The cut end of the tied umbilical cord is swabbed and squeezed with a
sterile sponge saturated with pure alcohol. It is then wrapped in a
sterile dressing made as follows: Four or five thicknesses of sterile
cheese cloth are cut into a four-inch square with a small hole cut in
the center and one side cut to this center. This is slipped about the
stump of the cord and wrapped around and about in such a manner as
entirely to cover the stump of the cord. The wool binder is then
applied and sewed on, thus avoiding both pressure and the prick of
pins. If it remains dry this dressing is not disturbed until the
seventh or eighth day, when the cord ordinarily drops off. Should it
become moistened the dressing is removed and the second dressing is
applied exactly like the first.


THE EYES

The closed eyes of the newly born child are generally covered with
mucus which should be carefully wiped off with a piece of sterile
cotton dipped in boracic acid solution, in a manner not to disturb the
closed lid. A separate piece of cotton is used for each eye and the
swabbing is done from the nose outward. The physician or nurse drops
into each opened eye two drops of twenty per cent argyrol, the surplus
medicine being carefully wiped off with a separate piece of cotton for
each eye. The baby should now be placed in a darkened corner of the
room, protected from the cold.

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