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If you attend a woman to whom the physician has already been called, you will thereafter be subject entirely to his orders. Whatever your opinion is, notwithstanding you have this book or any good authority for your opinion, if it seems to conflict with his directions, obey him; on him rests the responsibility and he is presumed to know what is best. But it is best that you should confide in each other—be on such relations that you can communicate to him anything you have learned about the case; be free to ask of him explicit directions and instructions. But your duties may precede his as well as accompany them, and I wish now to give special directions in regard to things that first demand your attention.

1. A nurse may properly provide a soft rubber catheter and also a syringe; this should be constructed so that it acts as an enema apparatus when one pipe is used, and as a vaginal syringe when the other pipe is applied. The holes in this pipe should be made so that the fluid injected is thrown backward.

It is important that this last direction be observed. I know of one instance where the vaginal pipe of a Davidson syringe was used, yet the fluid injected passed through the cavity of the uterus and through the Fallopian tube and entered the cavity of the peritoneum, causing severe pain and inflammation.

Besides the things already mentioned, I advise that there be furnished for use if needed a small blanket to receive the baby, a little bath tub, two chamber vessels, a bed pan, carbolic acid, fluid extract of ergot, and chloroform.

2. Being employed as a monthly nurse, do not (except very rarely indeed in an emergency) give any medicine at all or any stimulant that has not been ordered by the attending physician. Many women do not consider that labor is a natural process; it is painful indeed, and often lingering and tedious, but will go to a safe termination ordinarily without interference; any medicine given, unless very wisely administered, is much more likely to do harm than good.

3. Be still and noiseless as possible in doing necessary duties when your patient is trying to sleep, or when she is in special need of sleep. Sleep may be of great importance to her, and it may be put to flight by a little carelessness in renewing the fire, or in walking if you wear heavy and creaking shoes. Nurses at these times should wear slippers and not shoes.

4. If you attend the lady for a week or more before the doctor is called, there may be different ailments which you ought to note, at least enough to know their true significance. Perhaps she has false pains, and suffers so much that she believes that labor has commenced. You will decide partly from the character of the pains. False pains are colicky, though they may shift occasionally from the bowels to the back and loins and may extend to the hips and thighs. They come at irregular intervals, are sometimes violent and sometimes feeble, and they are particularly troublesome at night.

Spurious pains are often caused by disordered stomach and may be somewhat relieved by attention to the diet and by mild aperients (F. 108, 109), or by applying a flannel bag of hot salt. If quite severe send for the doctor; do not give stimulants.

5. You may benefit the patient at this particular time when labor is approaching, perhaps without giving her medicine. Possibly she may feel very well for a day or two, and you will need to direct her exercise so that she does not do too much. You may keep from her unpleasant sights and seeming dangers; keep her room from being overheated; see that she does not have late suppers, too great a quantity of food, or anything that will produce a costive state of the bowels. See that her clothing is not too light, that she does not have strong tea or coffee, and that she does not lie too much in the bed. Secure as much as possible tranquility and equanimity, by guarding against gusts of passion, by keeping from her tales of horror and disaster which have happened to the pregnant, by teaching her that she has nothing to fear in regard to her child from the simple fact that some longing has been ungratified or that she was appalled at some frightful object, as such fears are seldom if ever realized; relieve her if possible of gloomy forebodings by informing her how rarely death happens after a well conducted labor.

6. If you give any medicine at this time give only that which is unirritating and mild.

7. Notice all the indications of approaching labor, the sinking down of the uterus in the pelvis, the contractions of the womb that come on without pain, or with slight pain, the change in the mind and temper of the lady, the augmented mucous secretion, &c.

8. Although there is usually a sensation of buoyancy and lightness accompanying or preceding the setting in of labor, there may be on the other hand a feeling of anxiety and depression of spirits. Be very careful that you are not betrayed into any manifestations of impatience; no words but those of gentleness and encouragement and hope should fall upon her ear.