ternal
part and especially the parts near the anus. If the cervix is found to be
long and the canal still undilated, or only slightly so, and especially if
it is the first child (primipara), the physician's presence is not needed
and he may safely leave for an hour or two. But if the mouth (os) of the
womb is dilated to the size of a silver dollar he should on no account
leave the house.

Frequent examination of the vagina should not be made. In ordinary cases
during the first stage, the woman should be up and encouraged to walk
about the room, to sit or assume any comfortable position. During a pain
she may stand beside the bed resting her hands upon something or kneel in
front of the bed or chair. The standing position assists in the birth. The
bladder should be emptied frequently, as a distended bladder retards labor
and may even stop the womb contractions. The pains become more frequent
and severe as the end of this stage approaches and each contraction is now
accompanied by straining or a bearing down effort on the part of the
woman, and as a rule the membranes rupture spontaneously about this time.
An examination of the vagina should now be made with the woman in bed, and
if the membranes have not broken and the womb is completely dilated as
shown during the pain, they may be ruptured by pressing against them with
a finger-nail during a pain. Sometimes we use every means to retain the
membranes intact, but that is when protection for the child is needed for
sometime longer. If the suffering is very severe, during this stage,
fifteen grains of chloral hydrate, well diluted with water, may be given
every fifteen or thirty minutes until sixty grains have been given. (This
medicine should never be given to a person with heart trouble). I find one
drop doses of the tincture of Gelsemium every fifteen to thirty minutes of
benefit, especially if the womb does not dilate well, or the patient is
very nervous. The patient may receive and can receive light nourishment
during this stage.

[532 MOTHERS' REMEDIES]

Management of the Second Stage.--After the rupture of the membranes the
labor proceeds faster and a termination may be expected within a
reasonable time. There is a short lull in the pains, usually, after the
waters have escaped and during this time the patient should remove her
clothing and put on a night dress, and to prevent its being soiled roll it
well up under the arms and retain it there. After labor it can