= ine Case: . aoe: a é J ~ 2 98 Jy : ‘are ia Fitiekcie a bebstch eat StS 2 ee 3 508: Yaee epetetetets, Sites hips atyt b oS Breas rere eee ieee er sig, aes eit be beats Ff Bioriiti sta ae sat . ist He Pe) Seagp HE hsbh F ECA aes ad Sade EN odes heh bt plat Senses ata pee Mista pee DT RSIS BEN Soke BE BLS CS Beth podenehabeyes MAH aatel) Dect he iasle |2) SEN RNRD A ebd me etong “Stat bp att cps MRo Ra asedhtH bine 4 ay ris R > : Bais, tt) 1) De. Tie hh ol Mrayss wit he abt Jk Ae * ae ad “s i + +, “ae “ s ri S a ee = "ts os “ wd Se oe hy oe * et. tid An, wa. ¥ x Ds * cot a Sak me Mi C44 Se OBS TE ERIC NOTE BOOK. diel CAMERON Mi Prof. of Obstetrics and Diseases of Infancy, MeGill University. SIXTH EDITION. MONTREAL: E. M. Renour, Publisher, St Catherine & University Sts. 1906. Entered according to Act of Parliment of Canada, in the year one thousand eight hundred and ninety-six, by E. M. RENOUF, in the Office of the Minister of Agriculture. Piss b A Cie. Want of success in Obstetric Work is traceable to carelessness and lack of method on the part of the obstetrican rather than to ignorance and incom- petence. It is well therefore for the student to learn from the very outset how te make a careful, systematic examination of his patient. to know what he should observe during labor and the puerperium, and to learn how © report what he observes. The methods which he learns asa student are apt to be those which he will use as a practitioner, and he should remember that six or eight cases thoroughly worked up and well reported will be more profit- able than a much larger number observed in a careless manner. At the present«ay great attention is being paid to external palpation and pelvimetry as means of diagnosis. The cuts of the various presentations and positions will aid the student in mapping out the foetal members, and gaining a mental picture of the attitude of the foetus and its relations to the uterus and pelvis. Strassmann’s excellent outline-diagrams which are used in Berlin for recording the results of external palpation, have been appended, and the blanks for the case-reports have been arranged somewhat after the model of those used in the Montreal Maternity. A number of useful tables have been added, which will be found serviceable for reference and comparison. Some formulz’for infant feeding from Dr Holt’s excellent little book, “The Care and Feeding of Children,’? have been added; these will be found useful when artificial feeding is necessary or when early weaning is desirable. As the metric system is coming rapidly into general use, the student is re- commended to record measurements in centimetres, weights in grammes, and capacities in c.c,, placing the English equivalents in brackets. It would be well also to put in brackets the equivalents in C. of the ordinary F. tempera- ture, when writing up the case-reports. He will thus familiarize himself with both systems and the methods of converting the one into the other, THERMOMETER TABLE, CENTIGRADE) FAHRENHEIT SCALE, SCALE. cont TOES OUNCES) GRAMS =o MINIMS | CUBIC R 0 0 ae 0 = RIMETE 8 1 = ° _— — 06° 10 ; er 106 2 —|— I A ar: 20 Wika! e 199 j— 105 6 - it . 40° —\— 104 o— ra an 3 ej 60 +— 103 m Lft.ar.=60 7 — 4 ih eres 9 lr 102° 70 er 80 6 i— ]9g]° as Spe 9 2 6 ~i— 100° DE ACHMS CeNTimeTeRs 280 SOY Ss. | ) Pelvimetry on the Living Patient. Between the ant. sup. spines, 26 centimetres (10.24 in.) Maximum distance between the crests, 28 " (11.02 in.) External conjugate, - - - 19% to 20% ‘* (7.68:to 8.07 in.) Diagonal si : 2 “i (4.92 in.) True cg : (4-33 in.) ‘) get the conj. ver. from the conj. diag. subtract 1.5 to 2 cm. ( »9 to 79 in.), according to the depth of the Symphysis, the height of the promontory and the angle be- tween the symphysis and conjugate. Circumference of pelvis over the symphysis, under the crest of the ilium and over the middle of the sacrum behind, - : - go centimeters setween the ischial tuberosities, ; - II és Between the trochanters, . : . : 31 From the lower margin of the symphysis to the tip of the sacrum, : - 5 Weights & Measures—English & Metric Equivalents. WEIGHT—I gramme = Is, 432 grains (15% nearly.) I centigramme = .OI gramme = 0.15432 grains (2/13 nearly.) I milligramme = .oor ec = Os “* (1/65 nearly.) I kilogramme (kilo)= 1000 grammes = 15432.3487 grains = 2.2046 Ibs (2 1/5 lbs. 2. ) lb, avoirdupois = 16 oz. = -7000 grains = 453.593 grammes, es aa cal ad a 2 ” yr 02. 437-5 *£ = 28.3495 grain §$ : : 0648 = ce CAPACITY—I litre = 1000 grammes = 1 1/18 quarts (35 & fl.oz. and 11 minims. ) I centilitre=100 *- =¥ ff oz, (Clinic: ally 1 fl, oz.= 30 Ce, is sufficiently accurate in most cases and is easy to calcu- late. If greater accuracy is required, 1 fl oz, = 29.52 Ce, millimetre (cubic centimetre) = measure of 1 gramme of water = 1/30 fl. oz. = 15% sb LENGTH—I metre — 39- 370432 mee ks ae in.) (x . approx, ) millimetre = 03937 ** (1/32 in. approx.) 5 a a 3% / centimetre — 30 37 = foot =12inches — 304.79726 millimetres (.305 metre. ) inch_s- : 25.39977 és (.0254 metre.) NORMAL URINE. Colour. Pale Yellow. Quantity in 24 hours. 36 oz. (1100 Ce.) | Odour, Aromatic. . Miser Oo a BER Ea 2 Reaction. Acid. / Spec. Grav. IOI 5—1020 / Total Solids. 926 grs. (60 Gm.) : | | Urea. 3f0-—460 grs. (20-30 Gm.) Albumin. Absent. | Sugar. Absent. Acetone. Absent. | Diacetic Acid. | Absent. Indican, Small quantity. 1 Phosphoric Acid. 1.5-2 Gm. in 24 hours. The urine in pregnancy may vary considerably in a ee Tee ~ Ayv.goo-1100 grs. (58~71 Gm.) URINE IN PUERPERIUM. | | URINE IN PREGNANCY. Pale Yellow. 30-80 0z, (900-2400 Cc.) Red, or reddish brown. 50-65 oz, (1500-1950 Cc.) Often has the odour of drugs. Aromatic. / | } | | | Acid. LOIO—1030. Acid or slightly alkaline. Av. 1014, 1020~—1030 | 500-1100 grs. (32-71 Gm.) 926-1650 grs. (60-107 Gm.) 310-540 grs. (20~35 Gm.) | 310-556 grs. (20-36 Gm.) Present in 5 % of cases. Present in 60 { of cases. | Lactose sometimes present. | Lactose sometimes present. | Absent. Absent. Absent. Absent. | Absent. Absent. | 0.13-2 Gm. in 24 hours, etn | I.5-5 Gm. in 24 hours. | | the quantity and quality of its various constituents and still be within normal limits, i.e., no constitutional symptoms may occur and pregnancy may terminate favourably for mother and child. TO CoLour. —Varies with the quantity—concentrated urine is high coloured ; dilute urine is pale. Bile gives a greenish yellow colour; blood, a red or reddish brown colour. (JUANTITY.—Varies greatly according to season, diet, exercise, Ac. ; warm weather and little liquid in the diet tend to lessen the quantity of urine. Cool weather and diminished perspiration increase the quantity. The amount usually increases markedly after confinement. Opour.—As in health. Specially noticeable are the ammoniacal odour of al- kaline decomposing urine, sweetish odour of urine containing acetone, and the odour of drugs given during labour or the puerperium. Reaction.— Same as in non pregnant state and subject to same variations. Spree. GRavity.—Generally lower in pregnancy and higher in puerperium. Tora Sottps.—The normal amount of solids in the urine is about 4/7. The chief components are urea and common salt; but the proportion of solids to water varies much in health and more in disease. To ascer- | tain the total solids in urine clinically, 3 methods are commonly used ; Traupp.—Multiply the last two figures of the sp. gr. by 23; the result gives approximately the number of grammes in 1000 Ce. of urine. Haeser.—Multiply the last two figures of sp. gr. by 2.33 to get the number of grammes of solids in 1000 Ce. of urine, Haines.—Multiply the last two figures of the sp. gr. by the total number of oz. passed in 24 hours; multiply the product by I.1, and the result will give the number of grains of solids in 24 hours. UREA is the most important of the solids. It is formed by the liver chiefly from nitrogenous matters in the food, but also to a certain extent some- times from the destruction of red blood corpuscles in the liver, and from other tissues. Its formation is diminished by fasting, and by diseases or drugs which depress the functions or destroy the substance of the liver. Its elimination is diminished by whatever diminishes the amount of urine. The quantity of urea usually increases rapidly after confine- ment, reaching sometimes to 20 or 30 Gm. daily, although it may have been very scant before labour. Practically, no concern need be felt where the daily excretion of urea is 400-500 grs. ; 300 grs, or under should call for dieting and eliminative treatment. Albumin is very important in pregnancy. An amount of .o5 % or over e) should lead to frequent periodical examination of the urine. ~ II SuGar.—Lactosuria occurs occasionally in pregnancy and the puerperium ; it is not considered pathological. Glycosuria is always pathological ; it is sometimes of nervous origin; especially in the puerperium. ; ACETONE AND Ditaceric Acip.—A trace is found in 30 % of pregnant women and has no particular clinical significance unless it is present in large amount (,005~-.01 7%) and ts associated with Diacetic Acid. It is then supposed to indicate profound toxaemia. Its frequence notably in- creases in diseases complicating pregnancy and the puerperium. In puerperal Eclampsia, it is found in max frequency and intensity, without being dependent upon convulsive acts. It is generally more marked in cases of Syphilis. It cannot be considered as a certain sign of the death of the Foetus. INDICAN is found normally in all urine. It occurs in excess in Eclampsia and in threatened Eclampsia, in constipation, typhoid fever, dérangement of the central and peripheral nervous system, in cancer, etc. PHOSPHORIC ACID is usually diminished, the amount varying from .13-2.17 Gm, The normal amount in the non-pregnant state is about 2 Gm. The sample of UTane for examination should hy taken from the mixed urine of the 24 hours. This is important. In private practice, it may not be convenient to get a sample of the 24 hours urine for examination ; in such a case it will be usually accurate enough to mix the morning urine with that of the previous evening, and examine a sample of the mixed urine as early as possible during the course of the day. [In converting fl.oz. into Cc., it is sufficiently accurate to calculate 30 Cc. 1 fl. oz. If greater accuracy is required, 29.52 Ce I fl. oz. 1,.—VERTEX PRESENTATION.—lIst position. Occipito—Left— Anterior. 2,.—VERTEX PRESENTATION.—2nd position. O ie) ww Occipito—Right—Anterior. . " - ce is Tee bet Ln ee < eo) RTEX PRESENTATION.—3rd position. Occipito—Right -Posterior. 4.—VERTEX PRESENTATION.—4th position, Occipito—Left—Posterior. ~ = . aa | ' : . F a . > OD ATM Am - = ee | 2—FACE PRESENTATiON.—lIst position. | | Mento—Left— Posterior. ; = | | . | f | : 6—FacrE PRESENTATION.—2nd position, | Mento—Right— Posterior. . s f zs <> 72 4 iy SE Ste , < 7.—FAcE PRESENTATION.—3rd position. Mento—Right— Anterior. 8. Face PRESENTATION.—4th position. Mento—Left—Anterior. 10—BREAcH PRESENTATION.—2nd Sacro—Right—Anterior. position, i ys —BREECH PRESENTATION.—3rd_ position. Sacro—Right— Posterior. vii\ vy ( f u/ vA { mt Mi it Key ayuat fh ees rt Irn Lene i ow 2.—BREECH PRESENTATION.—4th position. Sacro—Left—Posterior. or ——— a a 13—-SHOULDER PRESENTATION.—lst position. Scapula—Left— Anterior. 14—_SHOULDER PRESENTATION.—2nd position. Scapula—Right— Anterior. Cone: a¥ ees 15.—SHOULDER PRESENTATION.— 3rd _ position. Scapula—Right— Posterior. 16.—SHOULDER PRESENTATION.—4th position. Scapula—Left— Posterior. RECORD °OF CASES. ae Gao SE. Name and Age... me or AAS... Lon t Seether Family History ............ 7 - . Occupation..., — - ee Oe fi. ye Personal History— ee, S PICROS oi OER” SER Se Admitted .5 2 2H. Bos, MM... eb J OC Pai oe Delivered 5.4.5.7 P2.Mx.3¥ Duration | Aprende ‘piesa Re: saree ae of Preg. | Diphtheria Accident | Cs ESS NES Sciatic aia taal -Seeediaaat n 7 Nephritjs RN, a ema eesaa : Spas AN Ahearn BP se Bez) Phys. Hxam.—Heart.................. Pb’ se Sy tags Rs i ie MM eo. a hue Se ; Spleen : ARR i es ee ee a et ie Menstruation.— Began at./ 4 year ; Interval 2% days ; Duration 4-S days ; Pain 4¥@..;) During. 4 Mewdhowete. a Profuse. Previous Pregnancies.—-No. 10; Full lterm 6; Premature....& | At what month . {20S Sttwttfrg. Pre kak ee iene O. state YORMOGR Giyas............. oe FACOG... Edema Other symptoms ROS e Rega a: es ee Previous Lie Norma ese. Sci ditty SE aR Ree Une ee e a Bee is BM tie a Ya gS Soe y Ch ld | Born Alive ..“%(€-0.%@ Weight Peppers Seite) Lea SERRE ONG CSN FO er Coe on NT Re Tosco Wicthadiad f Amount BAS OG ss. x. ft Vagin. ¢.,, i? | Mother’s condition bre Fe as | Douche } lena Why? Neem salt Regs a) | | 3 ae Temp. 9S, Pulse...7% @.....Resp. @f.Rm. ; Amount............. | | laa | Fundus f 4 20 PCI), .....8.ctae | ( Tieat:..2...= - ote, A. ae LK ~. | U. during interval ot Oe es a | | } OPHBRATION. Forceps.— Kind...... Operation | Indication High, Medium, Low, ae Dorsal. Position of patient. a Lateral. Lower Blade............ .m@- Locked 3 A.M. Re Fea a.m. | Before Upper -* p.m, Removed P.M. ; Afte Traction Version.—Kind.., 7 “ “ Indication rs —— a Position of patient...... so Began......3.3.0..... | Ended---3 pad... Difficult..... sliver eo ott Spontaneous.. Delivery..3..3 7 PET UIMCIGL oe... 8 . . ‘ Lowe Breech.— Diagnosis by pnt Exam. * ( Ext. Position si / . _ { Dorsal. uring extraction - Position d g | Lateral. Breech delivered..................... Oe my Avis. — A012 .e.........<5.-0.. AM. P.M. ig A.M. RAGE ee AM. Head A.M. — sl saa M. - CZ REMARKSG....... VA ae 5 i b. o, Easy, Difficult, iM E)M EM B) Me O. Offensive. = | ms | P, Pale Br. Brown M iM & ;. Pink. {| bq | i] ~ : 101 i Be ‘ | 100 Sst | ; ES EE Soe ae et : Fa | ; i 99 «| ssl | SQ] ” i queyussees 1 ~—e Z yy i | re) f ; | | 3 | 98 sf = q ; ~ ———_—__—_ See ee - 8 f = 97 as — r = MEM | Davy P. a ? Paitom Nw; bh | £9 Sl. Slightly. Time | No, of Abbreviations. —F. Free. Prefix.—V. Very. x —_ “~ Ver REM Vs is 3 é | 7 a: . B st <<. 4 —2 - 7 “if 2-7 ac £2! pez CASE No. 1. _ 7 4 ~as o ~— a = - 7, = o2) “ o) " . . ~ , ie = : potas ome eta a oe) - 2 4 ohn Day P.P. KUNDUS. LocHIA. bo ~ a Examination ................days p p.; Sutures removed... Perineum........... ; Cervix General Condition =— U mae FP Bet U ie. | BLADDER. BRRKASTS. | | | | : Hise, RRA ae a eat par involuted ; Lf 5 EON ss ceca eae aabce na : Treatment fay fr yer c- . tet - Name and Age. ZI, baw CSAS INO. 2. Y, ne ._ Lamily History Act’ 5 Occupation ated" sal AF. Personal History— : S Re | : , P a S Rickets Admitted... cee Pl PO) eee Delivered 02° Aw)... 2éde.2.%/09 Duration ie ’ of Pres... iphtheria pe See 8 cckecs Phys. Hxam.— Heart Syphilis... Heart . Lungs Accident or Injury eee tae . Scene: == ||. ROR Re ete aa Sea ee sts 9 mR 3. ae Menstruation.— Began at.|.4_ year ; Interval 2 days ; Duration 2 days ; Pain. me} leering | Moderate jE ne Prefuse. Previous Pregnancies._-No.*".; Full term“*2¢ Premature” we At what month .......... ; Os. VORVGee. |... Eleadmehe ... Gidema Other symptoms ; ? ? Normal...... A ee a Oe ities Fok. | ? ET eee oS Cotee.:........... MMMM, cS lM aa Born Aliv 0 ay ‘malities Child { ie... . gh . ReerOTIOM NGS wn! cee oe Medicinal Treatment } Operative CASH No. 2.—(Continued.) Previous Puerperiums.—Fever Breasts . Nursing Complications { - and lreatment } aes). OO Last Menstruation Began... ; Ended NM, a. eee PaO eee sesveees Present Pregnancy.—Quickening safe ; Vomiting—From Ve ec i\ to Crs ct Mddeaéai f 4224; ne “zat ; Headache. yy, Sa ; (Edema } Ie Cot yum, Albuminuria ( Constipation Ou . | Diarrhoea 1er oy S . a per Amel: 4 Hemorrhoids. ss an reatment: , . ¢ Vaginal Discharge _ KL4 A A_vy rt lew | Tension___ onan anne himmetdde se © : ae x : : c om : EHxamination.— Date ele YC? ; Breasts farce hee 2 Nipplegw$ oe spo: Oo Milk ae fet Cy fo~a-asd te ; r as es Abdomen.—Shape | ; Umbilicus... | ; Fundus.®)....... (cm. In.) above S ; F. H Pelvis.— | Perineum.— Vagina.— Cervix.— Urine in 24 hrs.— | Cr, em.(.......in.)} —_f Intact..... Size f Intact Reaction A«<< hi . . ) ) . 7 > ieee 4 i) Me ris) de ad, cea \ Repaired Length \ Repaired | Sp. gr. 102 i? Vom Ext. ( in.) f Long... td Secretion f Long | Album. ASA i; Conj. Diag. Bafta in.) ( Short t Short Sugar 0 | ER, Meh ae in.) { Rigid. f Ext. Os. Casts Mtyahusnt , Gra Cf tad ) B.I. ssivompntl ners aa ) \ Dilatable (Int. Os. Urea Ae SU Secretion ¢ ASS 5. { a ih ee ON She OR AL) Sete Total Solids i - A NT ian oy Wee ee ? Labour began, + V8 a Ae el 19.8 ~ 7a 8) Eset 19 2 ; % J oh J 2nD STAGE.—Pres.. JT tae... : Position... RE gatatt ert Se TT FR. | 7 meemp. @@. oF Cn C.); Pulse Ga: Resp : v8 PO Oe S 70 am ee | ( “| Memb. Rupt. cnt F Ba ee Ree ye 19 =..; Pains #4 TYNE... yy eee RB an © a ‘ 3rd Stage ended...... Bis oss A.M... a Pe wees | he ’ {DO - judd. ‘ Pi A M. | Placenta Expelled ar 4 “ae Srd. eee Spont. Easy. ° j my Lo ne “A o . “oo Hours in Labour. 6..4........!... FSi en Kn Ola bes AD Laie \ aerenf. effet: eS ie nies fad (oo. Ist STAGE.—Pres.. Wea? ; Position ; Pains.77%%.87% oe | F.H : 4 In Brim. Lapeee || eet Cervix i Vagina Dilatable g TUTTLE TPP PTrTrririe rt CO he ee. Sa « ps o, ar - Head AVOVE ae In Brim. BE ae . Attitude _ Posture oo aa Obstet, degree { Comtrmrorsty By Sithere | Surgical ‘ . oo CI ae Intermittingly 7 Jyetiee Betety Tee Titre 4 * we ¢ /f From......40..* AM / 's BEN Nae ee , 2® Bi Total . ; r by le , To _A.M. Bee SS on ee do LBA BOU RR .—(Continued.) ORD STAGE. a aa eerete . uy ' Placenta.—Pres. (#4 sewrso ; ts iti, re Weight. fe ene, { eee oo /) f 7 Complete Membrane — breomptete _ Condition... aA OA ee ee Cord.—Length. i... CM.) Corsi... 1D.) >} Eee | a gan 1 vie y, * fe 4 a | ‘ : ta NI a . a ae She & fA j ¢ N\A Around Neck 3. times { Tight Tre: De , Body ) keaece PCA... igeetrartansters ee AB emcee . é | se f | Ruptured | aoe vs Be: ee Perineum.—,~"* Cause ; Sutures { Perin. ..#..... Kind seseeeeestencess : f PAT Gene Stight AAs ig Hemorrhage, ; Medesate When.&@7? | Cers ...; How controlled ee age he, F Severe , ' Curs CP") Weighed - (=p C . et 8 | Amount ee © ln ke i Estimated j{ \ i | Vagin. 4, ae | Mother’s condition hrs. P.P. / i | Douche a Wey? eh: Seas Kind Uterin. je | emp. Ce ke) pa Ne | Amount | | a bis | Fundus ! y, t aay / PRIUD. «icoudegie | H Treat. 29 he Geoze) otf — U. during interval... ecu ~~ ~ —_ - : ‘4 fe ‘ > - ‘ pore c y oc ' ne ¢ : EB. 5 7 iam ee f | | ) : Ke pie, a LSS eo = Fs cs wet ae t~_—_ pp. = . ™ oe A &S fe cba ; Uv ae tS — Ens fre. : : Jae $ PL ee a a ‘ et fae Pag & dy. | bf ve ¢ (, y® ks ba iz « ont os i "4 ane C we a Plepy. tere. al © 7, He__ LG Family History Occupation... ‘~/ ltz2e.. LetrTWe . y M. Personal History— A Rickets =. . DEPRES Soo Ns Admitted __ AEA 2 Lf] paovecren east Scarlatina PHAR uae Delivered AL, 2 Yfo aera’ Duration | mreneies a oR Weis TM fcoreeveltecttee fi. Z of Prey. Diphtheria Accident — Discharged... Yi SO Se fo}. Se | Nephritis ....—.. shal ss’ ee Re 3 pee ; RO eae 7 Phys. Exam.—Heart > Lupgs...uae ee ey i) Os esa ; Spleen & | Pe eee “<7 oo er Menstruation.— Began at /9 year ; Interval. 7@days; Durations days ; Pain 222.5) Daring eo: Borsa’ e PPCM ese. ) | Profuse. Mo Previous Pregnancies._-_No._.; Full term.....; Premature .) At what month 0, ae S| nn Te 1 aS AC omneR RENT or Vomiting... .... Headache. .........« Gidema . Other symptoms ? ’ ? : i ee} a. Previous Laban. | Normal... emer iicationg oo... aac ee ll | A | RRS Child { Born Alive... vn Peemeot.............0 PeMOTIMG US... cite, 5 aa a I Bs ...... ; Medicinz a OS dic 3 a ll a. | Oa Sy oo — ioe a a a @ a. — ——— SS — ——""— a HW OCOASEH No. 3.—-(Continued.) Previous Puerperiums.—Fever Breasts . Nursing ’ ? Complications | -s------s-ce-c-ecceccceeceeereseeeeeeereeesceeneceetcsntnnnanennescee RG tre Tie a .Sesneon Last Menstruation Began th: ; Ended ee ; Amount Present Pregnancy.—Quickening - Vomiting—From . /@eace..... to. td ( Headache Av hh: (Hdema A COWU-E _; Albuminuria "| Examination.— Date... Th 2%. ; Breasts. Van uw /c«<£4£.; Nipples SP bene Abdomen.—Shape Onn ; Umbilicus .../ be ....; Page: (cm. Pelvis.— | Perineum.— Vagina.— Cervix.— Cr, 4 7.cm.(.......in.)| _f Intact... ae f Intact | ano i 2.495... ( in.) L Repaired _ Length \ Repaired Cont, Ext. 2iok..46) | LAM. Secretion f Long COME SIMs a (Oe in.) L Short i Short COM i NOT is on. as in.) f Rigid. f Ext. Os. B.D cated... 0 A.....€ ce A it Dilatable es oe ae Remarks... ..4 5 IPL hg OD SGT WTA op Cte moeretiom Slight. Moderate. Severe. Milk...77 in. shoves e Jey © Urine in 24 hrs.— Reaction Sp. gr. Album. Sugar Casts Urea Total Solids hte ee CQ UT EW. Labour began Y AM. Ach. 2. Sf 19 O7 | Temp. IS ok Ae Rass ot C.); Pulse HOE. ; Resp 2 PMs Be 4 A.M. : Ist Stage ended Bygone jo Bs.) q 2? 5 y of Ul Ol |. Sa Sees A.M. Boe NS Ce Q nent Sa ‘ sp A 2nd Stage ended .. iM 1 | Memb. Rupt. HN ott 3 A Eg 34.19) ord Stage ended). i..........1..2..3 a AN Se 1S 2 ‘ pain | Placenta Expelled ......./9, 4 ae 1st. 2nd. 3rd. Total. o . 79 2 { Spont. } Kasy. Hours in Labour. ea ier eX oe ee Lda Vhe | Tet ( Head ( Above Ist STaGE.—Pres. ape ; Position 4, 4 Pains ee Be Brim. Breech | Below Cervix _| ER aa Treat. .... 2% AE. oe ee i . ry - a ? H Above 2np StacE.—Pres. Ver Le 4Z._; Position C Of Pains dap, ie eS Pe ses Breech | Brim. ¢ HM Below Mechanism direc. te For L< m Attitude Ga ee pee .,..60-1... ee , Posture # Chlorof. { Obstet, degree { Continuously i, pf ae ; PTOM...w. essen > i. Total Eithes. | Surpicat—+ lntermittingly To... eee. AM. aes e- Ses Ge (ee. |...) a } ‘se “f? & * DLA BOU RR .—(Continued.) 3RD STAGE. Placenta.—Pres. MM jtOra- af a *. Weigh. .....:..canein | AR) Pete be ‘ Complete . . at Membranes.— les Condition... Sere ere tt) oe Ae oy) ee i Cord.—Length oo. cm. ( in.) ; Te Neck imes f{ Tight . Around ¢ 9¢.,.0.0------ times 8 Tre Body ) Loose , Dreat...... pee tee) es Vag. “or Ruptured 5 is Perineum.— | Cause ; Sutures Pert. (...5-. KIN _. ee ites csases Ueruptered ; ie: ae ae Shyht P sg Hemorrhage, { Moderate When...A Secor LM: SOR 7 How controlled Severe ° = ets ees Weigney 2 Amount OZ Estimated f ERE OG ee og ee ee e g @ ie \ | Mother’s condition f bo hrs. P.P, Vasine:... ae Douche pA | Epa Re Se ie! ETT | Uterin. oe Ae RR et ed I 6 tc oe oa EEA ean PMOL 5: | : | Fundus.. TO, tigi coches | oe U. during interval .............. at SS ry q | iy im | ; | rR — CJ so" eee 2 LOO IN. Forceps.— Kind [Eesti 4) ee Sn ae Af fpr Co { Dorsal. t Lateral. Position of patient. Lower Blade.............4% Locked. A.M. aa a.m. | Before Bae Upper ‘“

* vo x DO. & ; c » | D v 1) re Qe | ——- ----—— —————_———— — ---~-—— —_--—-— }————_} i| Loohia. |4@.| 47 | FC | E74 | a ft & ta ‘Tongue. | che. 6- = a ee pit CASE No. 3. cL eee hy ; Hy CASE No. 3. Ae | AM(a vise ® berm- Get 19 / ug - p wees a eet —— f7 f a4 YR (O42 42 ¢ Sf Q gp nA 24 A @ En. Amz LG y L 5 ee Oe eal Ag Se Mag 279 Gk GF Nex K0.a ' L te a €£ — eo Ae © CA nok hot a2 Aad farx) To. Gs fel r9fe ) 4 JPA: Pa 4s ky, pp Be ig git Zul | Hi Sek vA ee : boy - Fe J. “Ly fF j dj x) ; UY{A G prin eo fi 130 8 J % PE he gs Miho Ab rail” ALD fom | re ga Pe kl C4 As : a Slade 4 PIAA gle > . | a ) ; oe | ’ & 44 }‘)- i : Ln frrd @ fi >) OF ee Pee! Bee ree V4 P if Lh A. tf he ts a lg f Cian Br 4 a | © th 28 ee "ger & Tere - > fay" a So cargch Avs of » b> @) oY Mave Ne Pom | fri jt. ko: Axa t IO I YA Ce { 4 wT af Gar “¢ 7 " of her — CASE No. 2 q) Waa a/ Ss Qq 2H Cex Van Lo d Z. a Cttnrne - se : i/o 2 ) ri 2 ag < : vA J Gre fe JS2A_- 4 C44 S<. . ee ——o (¥) La a. : on —~ ay ne 20 : ns cz &. WW aN , i of 70) 0 SS flo « bee f* Lge - aa = : \é; wy ca. 4 ta NF = » le ho-« on CerS a Du ve 4 > Ft ~~ a f P Py 7. L ave f ce fr, : S ol ade _ Le CA. Sr i 7 7A 7 aa 7 vA - A f. L on. ce, fh oss a. * i AE Sa a / 4 tart ‘ Ww oe C Get RAZ r ig ee st oo ae my ony ot JAYV vs -, | 7 3 Ll db fla’ meet em C2 ‘a. g Fs Le A A f for y CASE No. 3. : ¢ A egret , po oe At coe oa Wr CO foante, Dh f.2 => ae eS Y = es i “i Burs pet 4Fnt Peet FURee Pe eRTUM. Day P.P. FUNDUS. | | — is Le OCHIA. | BLADDER, BREASTS. as dis fiat } Mee ser Se ee! | -) . < ss i e pnt, | hos i _Ucn.. Ve Ler | ia S 4 , 2 ee g* | Fur ie fi ab cf — o e¢ | | > aa @¢ Joe 4. ~, e 4 ef .-7 @ « hf ato A v Of | | eS ; 5 | _ Fen t ’ ee om 6 “7 ye “i era a led ¢y | 7 j i. ‘ ¢ e ( | GS AA a 4 ey | > er ~ 8 | = | a fe 2 man. “7 } 9 9 “ € a " ) (¢ e | o- . Cy ¢ 10 Z 11 Vq ey « Sf | 9 : lz " ¢¢ ” q 14 | tq 2 “7 2 ; : : a : Examination. /@ days p p.; Sutures removed a : Uterus... ALL LE involuted ; | Perineum.. L 3, eee KouF. LE Kekenss Discharges.. eee | General Condition ns fore ; Treatment Wfed.: Hi b Py a neared SE ta L” P « “if » = & . : ye o J 4 Ps 7 F Y CASH INo. <. Name and Age....... J scetteteteiet.... hf ttle... kere 1 Family History . heeegteonatne sees SR SEE Nae Sra ! M. Personal History— ; ( S a ee Seat De NI a a an | Scarlatina “® ME |S CSS eto NS Se a ee Duration | Si te ee Heel seeenerestecceseceeeccssasesens bi of Pres... | Diphtheria ef ccident SEES oe LS af Nephritis . ey} ee Phys. Haam.— Heart ; Lungs... jee OS SS ae oe ; Spleen Ge 7 Pe oe eee i oe ior - (Scanty. Menstruation.— Began at.fi@.year ; Interval #4 days ; Duration 4). days ; Pain. Meee; 4 During .......... | Madarte After ..» | Buofuse. Previous Pregnancies._-No..#..; Full term..4..; Premature : a ee le SCRE SSIS ON eee Vomiting NetéwS up Uae [. Fennec ee pemeerna...... . Other symptoms. _ ? ’ ? eo ita Pee . ft Deevious LQ Normal oss. sesant ieeeeplications .................. re Complicated... RR NERS SS "Ne Child Bore yume... weight ..............2aam Abnormalities................... C8 Ss on bhoPOOG er : Medicinal .............. a |e Treatment } edicinal ee CCC I RII TRIER Cet ho OS ee eee eo ee. cap ret rah eM I Ns acd a OAS E Previous Puerperiums.—Fever Complications { -------- and Treatment | A Last Menstruation Began. fhe ° oe 7 a “=f Present Pregnancy.—Quickéning CTCF... as f i, ‘ Headache “f/f! (Edema ( Constipation ......49............, "4 Diarrhoea Other Symptoms Hemorrhoids. and Treatment: 1 Vaginal Discharge [ Tension. _ 7 : : Tet Examination.—Date. td . ae ¥ oF eee Abdomen.—Shape..s >\ Umbilicu Pelvis.— | | Perineum.— Cr. Wn Me 8 ae in.)| ff Intact... OP gh ck | 8.. Con}. Ext... yg.-( in.) f Long....... Conj. Diag. fp foo Sic im.)| § Sbort....: GN WOR Ee ives in.) f Rigid. 3 oe oh ae, Dilatable Remarks.........4 oY (a Pt CR.toere "7 No. +.—(Continued.) Breasts ; Ended ; Amount ; Vomiting—From ....//ré.... to ec Albuminuria Slight. Moderate. Severe. be \ Te) 0.9. \4¢4lNipples ry oP4e Milk... | ~ " 4 tat ~ 9 OY ‘ S. ; Fundus.|3.)9.tem: in: abdove S; F. H. Vagina.— fy, | Cerviz.— tf +4 Urine in 24 hrs.— Size f Intact ue ’ Reaction i ete aoe 7 oO tees ; Length \ Repaired fe op. gr. Secretion OAi« f Long Album. J Ext. Os. Peiee EE 4 aan eae, F Urea — a Secretion’ ~ é.4 #4 , at ; Total Solids | RE Ee RE Sa a, =a ieee Ce) Ly Ee. Labour began../ # hw Ate £ 19-0 } ‘Temp. Jp Qise::. Ist Stage ended nage one oede ADEE Lon ceeseesseseony Mi at - or, ‘ 2nd Stage ended Mémb. Rupe Spent. 7. °° seme PoM. ord Stage ended | Placenta Expelled I rrniehs PM. { Sypn@iter Total, Hours in Labour. 7 “J ate \ Artif. be Bey lst Stace.—Pres. GVYCSP . Position d aie ketetel Cervix Dilatable - 4 > } or H Above % Ate oy fa aE fy , 2 ead 2ND STAGE.—Pres. hele 5 Position..A—#.f +... ; Pains ° gta¥ HA. ASB Basar: In Brim. 4 - Below Mechanism hte ‘ Mtl : By Chlorof. { Obstet=degree ( Continuously wrer. | Surgical ‘“ eee | ~ ne ae. DLA BOU R.—(Continued.) | 3RD STAGE. | * ; ‘¢ aT : ‘ e 4 Placenta.—Pres. #@ && pl ; Complete Weight. i Gm. ( OZ.) bLreomrptete , , Complete ™~ Pas a. Membranes.— | it, Lasik Condition... (y ®K Ee) EO OLS IEA MRE RE A i RNIN ' Cord.—length 0... cin. ( See ..in.); Tasersen...... th ind Neck times { Light . | AVS} Around bestia... OOS: Sie Tres ansaglieres | Body Loose . Pr@Gt. aes 2 . | or a f ; Ruptured ag . —— up a vy ae eP | Perineum.—,, : d Cause Ut | i. Li & ; Sutures Perin. .. S vee Kind / 0. ¢ J / Cr SK“ (lo Rect -- Hemorrhage, { Moderate When...itb... aver ; How controlled [ ie OE ee. ie bases \ Weighed, | Mey Amount....... Jb ieee. Estimated f Mgne : a At deen: ae Vagoin. x, i | Mother’s condition.....9. hrs. P.P.. ff Douche eee Why? eee. Kind | K It. ry) “= C Temp. gg. })... Pulse rT Amount.)..268 | A: as Fundus. J44As« r os i les See | ‘ = : , Er¢at, 0c, 4 ; p..... Ofer B..... Cod. en a | U. during interval 'S, Gg ~ Jf © . — I, QE EVAL LON. ei... (High | Easy, Forceps.— Kind . Operation eee Difficult, Indication........ . { Dorsal. Position of patient. r I ateral Lower Blade pa Locked Upper “ oo Removed ..... . Ae. delivery, RAeUD a0. o..... Baden ; Compression Version.— Kind Indication. a AE EL LS Position of patient..................... Began en ae sg f HKasy Ended----- - 9 ( DMHOUNE. 5... haliviwe 2 ee (enem 5 ~™ | Artificial Breech.— Diagnosis by Int. Exam. Ext. Position J Dorsal. Position during extraction ) Lateral Breech delivered..............c...0.00.08. oy Arms.— Lett x.....0ccc..5..-00005: A.M. P.M. 21 A.M. Right Pa. 7), Al. ae nae Head. A.M. P.M. RRMARKSG....o. S| : i < v : 2. & 2 8 “ O. CASE No. 4. ee, + Cc 7, ws wD < 0 CASE No. 4. 4. CASE No. PUBRPBRIUM. Day P.P. FuNDUS. LocHIA. BLADDER. BRKEABTS. - ~ m 9 ed 3 | 6 | “J 8 10 11 12 13 | | 14 PE re Se Tecra) Sa rar, Pea naw, | Examination ..................days p p.; Sutures removed............. ot AMM ac ciciclipshasbeshesd loi A OME | Perineum............... ee) 6 Cee... ener ; Discharges... General Condition........... | ; Treatment CASE No. 5S. Name and Age Family History... Personal History— Rickets .... Admitted Scarlatina Occupation Measles Diphtheria Nephritis Norueee............. Complicated iN Child { Born Alive Mrempht............:2ccae : ‘ Dead Medicinal Treatment Operative Sere ............ (a Syphilis Heart Accident ) or Injury } Scanty. During Moderate. Profuse. CASH No. 5.—(Continued.) Previous Puerperiums.—Fever Complications { and Treatment ) Last Menstruation Began . Present Pregnancy.—Quickening Headache... ; GOtdema ( Constipation Diarrhoea Other Symptoms wet Hemorrhoids ssi and Treatment: : Vaginal Discharge | Tension ____ SVE Examination.— Date. ; Breasts... Abdomen.—Shape Pelvis.— Perineum.— Cy. cm.(......im,)| _f Intaet.... Foie +4 ee) \ Repaired ae: ( in.) ( Long ae (....in.)| Short Conj. Ext. Conj Diag. Conj. Ver... es Seis eck in.) J Rigid Sy RCE ite (EM BP Remarks ; Umbilicus... Breasts 7 . Nursintagg. ? ? Ended ; Amount. me Slight. Vomiting—From a Moderate. | Severe. _; Albuminuria ; Nipples oes : Byundte...........feme, in.) above S; F. H. Vagina.— Cervixz.— Urine in 24 hrs.— Size § Intact Reaction ceoeees Length \ Repaired Sp. gr. + Secretion f Long Album. i Short | Sugar f Ext. Os. Casts \ Int. Os. Urea Secretion | Total Solids A EE ES SESE rs cote b CD LB Labour began. ee eis tacoma eS LOE, Ist Stage ended 2nd Stage > Me. eS He Spont. Be Slage ended .M. | Memb. Rupt. ieee ord Stage ended y | Placenta Expelled Spont. Easy. Artif. Difficult. Head ( Abeve wear In Brim. TeEech ({ Below \ ENN ante ENGR Cae Gs ; Rigid Cervix Dilatable Treat.. Head {in In Brim es ‘ Breech Below Attitude Posture Ether. Sieg Obstet, ae Continuously Surgical ‘ Intermittingly y 2 SSI Tie lea Ke ae. Oo ees ee Oe a DLA BOU RR .—(Continued.) 3RD STAGE. Placenta.—Pres. ; Complete Weight... atom. -( Incomplete , . Complete ‘ Membranes.— | ' Conditior , _ Incomplete OU. a I) eae Cord.—Length. wu... CM. a. in.) AR ee Neck imes f{ Tight Around 1] m times © Tre: ie rae 1 Body 1 Loose STOCK cee es Vag. Ruptured "in: r: Perineum.— E > Cause ..... ; Sutures { Perin. ... Kind | Unruptured | Oe Sa Slight, Hemorrhage, Moderate When............. ; How controlled mevere Weighed, ( , nt Estimated f * caine : os Vavini u, ie | Mother’s condition hrs Douche f Dae ORRIN Be oo _Kind | \ Uterin. : ae POT a Se. Amount............. | ne | Fundus POM De so ged "ERR a a as ane ae 0 és U. during interval Oz. ) Se ee SE EE TT Sues nee OFS. 'L LOIN: : 2 | free is Forceps.— Kind | Operation { Medium, a fe ( req difficult, Indication. “eee Eee ee ee { Dorsal. Position of patient. 1 ‘Lateral Lower Blade.............<..- py Locked... oe. ae Am. \ Before, .. Upper ‘“ ~m. Removed PM.) After Uelivery, Traction... | ; Compression Version.— Kind Indication | A 2 ee Position of patient... Iaqa A.M. BS ates Began Gi oe PM f Kasy ..... Se cabdecanes z 0 A M. AY ©: fea Ended 7 ( Difficult...... Delivery a.m. | Spontaneous oS P.M Me. Artificial. Breech.—Diagnosis by Int. Hxam, : xt. ; “ ; Position .... | 9 : : Dorsal. Position during extraction 3 5 | Lateral. | Breech delivered................-..-::0+ aor De so ead © | ee ee A.M. P.M. ’ A.M. Right... ora ee a ae Head A.M. P.M. eae Ck 2 ee i | —_ eee ie SS eae ———_ —— 96 | PULSE, || ar | Amount of Urine, | | iy No, of Stools, } ' } eat Asie ~ » NY © oOo © Ve) wo Qo © a oo om wo ~~ + C on N WN — — _ — a 4 [aml ome Tel es ~ 116 +--+. EIM £ iM £\M E | | uw El ff M E|M E 100 E|/M E| RATERS —— oe CTE it he ee Se Ete 5 ee et Pink. Offensive, Brown... FP. Pale. O. Br. Pk. y. KR. Red. Scanty. - >. Moderate. M. Sl. Slightly. Fr ef, Abbreviations. —F. Prefix.—V. Very. 16 7, 4 <{ Oo + t ex i: =~ ene 4 . So =, - ee —_—— * oo temas 2 eS —————— CASE No. 5. Ye } Z, ea 0) “ 0 = U ase eR U Bee Day PP. | FUNDUS. LOcHIA. BLADDER. BREAB8TS. 1 bo Hm 9 Examination ................days p p.; Sutures removed... : Uterus Perineum.......... fi REM a OD A at ; Discharges... General Condition......... 7 bd ; Treatment a a a a SS SS EN Se _—— ——* ) CASE No. C. Name and Age Se Family History... Occupation : vs Personal History— eee ss Rickets... Syphilis Scarlatina 3 Heart Measles 2.) og Admitted Delivered Duration . 7 of Preg Diphtheria Accident ) sas or Injury § Discharged Nephritis Phys. Exam.—Heart ‘ ; Lungs s i Moderate. Profuse. can Previous Pregnancies._-_No____; Full ; Premature ...... _{ At what month One... Headache... .... Ci@ema: Normal... Complicated ..... Child { Born Alive. ‘¢ Dead Treatment Operative OASEHE No. 6.—(Continued.) Previous Puerperiums.—Fever. no... Breasts + NUPSieae..... Complications seecencnsnsesseeesseescsseesensevennnssnanasnsetees sevsnnethanhtabidebecsscesoessscescnee sonsenenannnenanntanasge seasixe oe Me Tatra eel ME ccna ncn Socccet tees ebesnpnnnsccandeneetictasttnpneseneeosonn+00ss0e0> nae anneal ana Last Menstruation Began - Ended 2 Se a OUR | re Be diet | | Slight. Present Pregnancy.—Quickening 0. eceeeceesseeeeeeee-- 3 WOmiting—From ......... to ussusss-.4 Moderate. Severe. Headache............ = Sa <- >. =, stones ; Albuminuria PERG RTOR, cee ©... :-.-.-.:--ncncendccrnsnhanmhteramnanseen ! e eek Other Symptoms athe | : 4 Bemorrhoids. |. and Treatment: ; | | Vaginal Discharge... ee Rg abe oO Cie aa 8 Ge A Me : Excamination.— Date........0....c.ccceccccceseeee-- MO cs eae _3 Nipples at Abdomen.—Shape............... -TPeaeeeus.. SPOR eit an. (em.:.):\c4am.) above S ; F. Fi. Pelvis.— | Perineum.— Vagina.— Cervix.— | Urine in 24 hrs.— PE eee 8 Ra Size | f Intact Reaction Bie. cig ee: (.......10s) \ Repaired... 4....... Length \ Repaired Sp. gr. OF" ae. Saran ( in.) | FNS ae ane ae Secretion a | Album. Conj Diag. PI in.) Short....... Short | Sugar Smee a (cia) f Rigid... Ext. Os. Casts ee PRE Lah! Sa! in.) \ Dilatable %: Be ne Urea . ih be OREN LS ME AOR LEIS 2 Mee BENNO By NRE EATS Secretion | Total Solids...... pee GP A ER Labour began................... ne eee | Lemp. Ist Stage ended . 2nd Stage ended M. + SASS Spont. 2 -M. | Memb. Rupt. J 5] | Artif. 3rd Stage ended | Placenta Expelled Spont. Easy. Artif. Difficult. Hoursin Labour, | Ist STAGE.—Pres. ; ee. Nee Oe Ee 3rim. Head “ohh ) n Breech Below Rigid Cervix Dilatable Head Above Breech In Brim. ITEC Below Attitude Posture ! Obstet, degree { Continuously By ; | “PM: Total Ether. Surgical ‘ Intermittingly 7 ; LA BOU BR.—(Continued.) 3rD STAGE. ymplete se rmeentd.— PES. cai... nt : Complete W eng. es... Gm. ( OZ.) Incomplete , Complete c ie Membranes.— _.. . Of. | keene. Sic ennai oy ho amare so ar Incomplete , cpere,.——Lengt Ca Tae .:'.....: in.); Insertion. | Neck ‘mes | Light Around : times 5 oer ME a. wana: ee ees Body Loose , POAC. esses sseesssecseneeecceensenennsnnnnnsssenne Vag. , Ruptured | re * | Perineum.— E { Cause - Sutures Perin. Kind Unruptured | ; OE Se Bie Slight, Hemorrhage, Moderate When............. > How controlled ........---..:--eecceeeeeee eects eteenetteee Severe W ° leighed Mbit anaphe fT Sea REESE A DRA arte OZ. wi ‘ ‘iy ae é ) Vagiie i ; Ttaetion.......... te. ; Compression ...4..0. P ‘. ie. 2 s. { Version.—Kind.. Cie i 4 ei a io i - . i Began by stl Sida scien é eae Easy : i eee q Ended +" em. ( Difficult... ! : i Delivery . _ A.M. opontaneous Buscke twee eesaaee ATTICA... asa. . b yep Breech.—Diagnosis by a hxam. rat. Position f Dorsal. siti uring extraction Position d ge ) Lateral. Breech delivered...........cck.mene ny Foe 1 teed 0 | eae A.M. P.M. 2 1 y A Le Right i eae a Si: ere A.M PM. CN a ie ee ee i? ort. ne tie — --—_—- +- -_—— + —— —-+— - e. ensiv Off O. ale. P P. Brown. - r. B k. Pink. I y. S. Scant Moderate. M. | ie | | Sl. Slightly. 1] PULSE. || 3 ey . 1 we Th = | i + " Abbreviations. —F. Free. Prefix. —V. Very Btools. } | ty in | | ; : ia) 7 a - RE Ve , CASE No. 6. = —_— >i a FEES = SS en a a ee CASE No. 6. iw awe BOT UM. Day P.P. Funpus. LOCHIA. BLADDER. BREASTS. Examination ..............days p p.; Sutures removed... : Uterus... involuted ; Perineum..........:, eer warts COTVIX Gineeate 5 ERC PROR i ixccscitstcncomerero ang ee General Condition ........... ae ; ; Treatment Se 5 SP errr te ye CASE No. 6. © 3 7, = PD ~ eo) CaSsE No. 6. ——s Te Se ee = ares = mae em RECTAL : ATE PULSE. DATE. RMP. REspP. MOorTIONS. URINE. EYES. Corp. AM. | Pe { | W EIGHT. | A.M. | M. | Day | Night lb. oz ) Examination .. J Right nyes \ Left ; Genitals Nursing Feeding a A An i= = ae ’ ie ie = ee ee me . ——S Seta ate a ne 2 2 MEASUREMENTS. DIAMETERS. Occipito-frontal tee . ee. Se - mental... | Se ae a a ee Sub-occipito-bregmatic... i ef in. ) Bi-parietal........ E | a | in.) Shoulders . whl = in. ) Hips ....... sail . tf in. ) CIRCUMFERENCES. Occipito-frontal] eke on, eS oat Geel in. ) Occipito-mental..... : ~ e nase in.) Sub-occipito-bregmatic | nt in. ) Lents OF CHG ne = ns in. ) —— :0>——_ GENERAL REMARKS. Se SS a — eee ee z —_ = . CASE NO. 6. _—_—_——— RECORD OF CHILD. ee eee Ai roe ee ne See : ¥ , Weight ah go sm. ote at ee ts OR IP Ta - 1Q..... e ).. en OZ P.M. Becener's Natle 48d gee... oe ee oes DOTA, Epenithi... oases ee see Previous History......... sacenunpsnsiibans GAGE. in Caput Suectdantum.......0. 0 eee Pimbilical Cord...................26 22 2 a nee DA 5 nnn Duration...........hrs. .... mins. NOTES AT TIME OF BIRTH. a Soper Spont. } . ; Primary Respirations J | a3 eee o 4 Sere ey, min. | Artif. oer... Circulation . - Pulse { Head Injuries ne ee eee _ Body Tongue-tie EY CS ciceosrn acne : ABUS:...5. gnental..........:. nCiS aee ted eo se ee in. ) Sub-occipito-bregmatic...........---.- | ee on ee in.) Bi-parieta .............-.... A al ERR CR ae —e Shoulders — opigiertiae ti aca cae De in. ) Hips...... * nae a niet se in. ) CIRCUMFERENCES. Occipito-frontal ... | | Re) fs ata Cam. (ae Occipito-mental..........---...::---- Been eieagehs ae OE aa in.) Sub-occipito-bregmatic 00... | see we Se in.) Length of child......+...........:......- =) a eee in.) 0 GENERAL REMARKS. CASE No. 4. RECORD OF CHILD. : os necinden a eae , Weight 8 ie ee AeM. © ate ore lbs. OZ. Born P.M. Mother’s Name and age... (cage para. Health Previous History Caput Succedaneum.........2.002:2.. Umbilical Cord... 5 ee ERS Duration........... hrs. ........... Mins. NOTES AT TIME OF Primary Res sirations / Spont. } ; y ) Artif, Pp a. 7 Circulation .. ; Pulse. { Head. a Injuries { Face | | Body BIRTH. Tongue-tie ......... r ; Eyes ; Anus Umbilicus............. - Genitals ‘Temperature aE Acct c.) Taken in rectum 5 mins. after birth. Temperature 6 hrs after birth Ef CASE NO. 3. an g oe D ~ 3S) REcTAL DATE. | ; PULSE TEMP. : Asa. P.M. | A.M. ie OF Examination days after birth. Eyes : 6 ; Umbilicus Nursing. . Feeding ; Sn NT = ae APR mt eI EE a RS cae Morions. | Day | Night URINE. Corp. ; Genitals poe re ee RS ch Re 6 WEIGHT. gM ( lb. Oz ) MEASUREMENTS. DIAMETERS. Occipito-frontal Pte 2 LS gn. ( ¢ -menta........ Sa ewe) Ale” d 1. Sub-occipito-bregmatic...................---. cs in.) Bi-parietal ea in.) / ¢ Shoulders sk ae CL Oh ines BS Hips =" | Sohom, huiies CIRCUMFERENCES. Occipito-frontal.... £2 fy cm. (. In.) Occipito-mental it LOR EI a mae eee in.) Sub-occipito-bregmatic cng cote eet... “Aa in. ) Length of child.......... 4%f......cm. (.........in.) —_——— GENERAL REMARKS. CASE No. 3. RECORD OF CHILD. A rine Se et a |S Sex ee wn ehh Seats om, A.M. Weight S BOTT wenn an enn n arene cctcecntns cnn cn besorgen cesvscueneneeenens gies ©. ‘os lbs. OZ a >.M. “ Mother’s Name and age fs os, OO oo oo ceo! | SS, en |. |<) Sera eene eee nae nee | Sanne wn mn eocmh Ls Previous History..................... ‘ ‘i | Brenrert) TORE C PC MINORS 8s Se = 2 . Suabineal Cord ..........c MGA NOe I se \§ gs a eee ee REE chia inner iaa is Ee eee Duration........ hrs. mins. NOTES AT TIME OF BIRTH. a 7 n ~ S )1 : . . Primary Respirations J Spc es in otis ce | Artif. re. ...... Circulation , A A FH : i ’ —— -_ OC FY QL f- ZV |} A= . ; nl > a) 4 . dy 7 i)» 4 Jf * 3 | # tA J J FG ee, Go “ V4 ba 6 A 4 eX: 44 ie Feeding DATR, : PULSE. TEMP. A.M | P.M. | A.M P.M. P “| AM. | P.M. | Day Se 2 es ee Se Resp. | MorIons., URINE. | Night ma a yy Ga.” (Corel « Ree,| 4 i Fi 4 _-éd ' 4 ae » € fA -~J “Zs of 4 t_ ~¢2._— j _.1n.) in ) in.) in. ) in.) in. ) in ) CASE No. 2. fi REGORD OF CHILD. F its ily ra ST xemst | Ai is Sex 25 7? % gO Weight™™ oi, ade Born 02 wc PE h.. eM: ame 19.<27 P.M. ra. lbs. OZ. Mother’s Name and age... Oe. FE Pare ya ae Speen ee Fe ae z.... para, ~Mealth-..2.....1 OD. teissianae starr ame SeeeOue PLIStOLY cosine CAI I ) : . ’ A Z i LF : J/ st, ' Bolivery........:..7 60 2441 Duration............hrs. -..... mins. NOTES AT TIME OF BIRTH. F 4d pont. }) . Primary Respirations } 6 hia in... ee) a s eh “gf A Circulation... 2 - Pulse | Head. Injuries { Face. A . | Body SS ‘Tongue-tie 2 ; Eyes 6 NM. : ; Anus 6] Umbilicus .........@-A1......... ; Genitals i | eee Temperature... Fe (eh C€ ) Taken in rectum 5 mins. after birth. Temperature 6 hrs after birth eee Sule tig eres : i} \ [: | | en a Se CasE No. 1. CASE No. 1. CASE No. 1. CASE No. 1. iS — f+ fe 2? Gee. ies 2707. a ee ee ee ee a = eee Gor Gy. (ak FL Dat hhak Use Ala. aa hr 4K at W355 me Ge ane tne Olas Ee st OC 9. ite of Le (poo ,... +a fest Rewer eh. ls) ghrp > GCHeW. «+2 Gf af: FP £ itd € face 9 aie S? 25 Ja : Jo ¢ * H Der Ard i) f a“ - f 7} PA tay 2 pit >: Je eee 0A — £ wr yé f , . ii d Ad K >) UAL i | | | | | | | | | | | | | | | | | | | | | | | | | | | | | " ¢ RECTAL : PULSE. TEMP. DATE. See CO By ee RESP. | Motions. A.M. | P.M. | Day | Night : Buttocks A.M. | P.M. | AM. | P.M. | _ emanate days after birth. Right mF Eyes < ; . I S YES) Tee mcs ; Umbilicus Nursing Feeding. : General URINE. | | condition EYES. CorD. W EIGHT. . gm ( Pei. OF ) ) | ‘ Nome | i | | | | | | | DIAMETERS. os | | MEASUREMENTS. | J. 7. Cm ee Occipito-frontal . << ~ -yaental. 7. - 4. cae ha. S wee in.) | Sub-occipito-bregmatic : ae eT In. ) | Bi-parietal 7. an ee Shoulders oD 4 (een Hips 497 +t CIRCUMFERENCES. Occipito-fronta! 24. cin. toe Occipito-mental , Ot 2. Sub-occipito-bregmatic D3 © {oe : ag Length of child.. “47s oe Ne in.) ! :0: GENERAL REMARKS. i —io7_ -~ Injuries Face 7 ra . Body Tongue-tie......-A/#2........; Eyes ae «fC ee ) + “4° L ‘ rs = a Umbilicus bs ; Genitals Pemperature =.............:....-..- Be Jae eaten me or ee C ) Taken in rectum 5 mins. after birth. Temperature 6 hrs after birth.......... ES hi eee ee CASE No. 1. ‘ RECORD OF CHILD. Caput Succedaneum Pmmpiiest Cor. ......... 8 Te Ene ee Duration........ hrs. .... mins. —_:0:-— NOTES AT TIME OF BIRTH. Primary Respirations 2 = (5, _ 6-2 rd min. Artif. Cry... ZO. 47 CG % “4 Circulation... beens Sos Kiva. POSE GK, Af Head : (a AGE. Birth, 1 day 2 days, 66 wn & Ww month, months, .. 6é OnN AMP Ww HK AN sé ceé é¢ 6é 9 cé 10 es II as I year, Table Showing Growth in Height and HEIGHT. “eee eee 625 on Sagee tt. jG iss ee. pee Weight of Child. yt W BIGHT. << toe ae ‘* 1 oz.—Lost 5 02. : 6 sé 834 be <3 2% ‘ec 6 “a o3{ * —Regained I oz, 0% - 6 ‘6 Il ‘““ « 1% 6s / rd a/ 6 sé 12% sé ‘é 1% sé 6 a: 14 sé as 14 sé of s ....-- Original weight. 8 ee 2. es gil LD en Gained I oz. a day. fie “7 a Ss at Gained 5 oz. a week. » MEET G oe ee eS ... Double the original weight. ; 15 ¢é ) a: S 17 eé adh Se cee Gained 1 lb. and % inch a month. 19 e< 20 24 ge “ER Capacity of stomach of infant at birth =1/100 body-weight approximately. Average quantity of food at each meal at birth I OZ. Average rate of increase (each feeding) 3 iss. each week for first six months. subsequently somewhat less. Intervals between feedings—z hours at birth, increased gradually to 3 hours by the end of the 3rd month. Temp. of food for young infants, 100° F. Formula, Fat, Sugar. Proteids. Age of child. 5 2 6 0.6 From 3rd to 14th day IT. 2.5 6 0.8 ** 2nd to 6th week. rE: 2 6 I “« 6thtototh ‘¢ IV. = ” 1.5 ** roth week to sth month. V. 4 +4 2 «5th to roth month. A sufficient quantity of food for 24 hours is prepared in the morning, the amount for each feeding being put into a sterile glass bottle and closed with a plug of absorbent cotton. The bottles are put on ice or ina cool place till re- quired. The following table gives the proportions of the various ingredients to make a day’s food of the different formule. Ifa larger amount is reguired, the quantity of each ingredient must be increased in proportion. Formula. I. iI. I1I. LV. Ve Milk in ounces, I 2 3 8 11 Cream, er ge I 2 3 3% 3% Limewater, ‘* ‘* 34 1% 1% 1% 1% Water, ce a, 94% 14% 16% 15 13% Milk-Sugar, “ even tablespoonfuls, 1% a ok Total in ounces, [2 02, 20 02. 24 oz. 28 oz. 30 02. If top-milk is preferred, the quantity used should be equal to that of the milk and cream Formula combined. In Formlua I., II., III., a 12 i, top- milk is used (upper 1/5 after standing 4-5 hours) ; in Formula [V., ¥V.,3n 8% top-milk is used (1% after standing 4-5 hours. ) No. Feedings yapeiden No. Night Quantity Quantity Formula. Age. eahinca Feedings for one for 24 hours. ‘i ae 10 p.m.-7 a.m. Feeding. 24 hours. I. 2-14 days. 10 2 hrs, 2 I-2% oz. 10-25 oz. pw , ~ ‘sé > r 5 1/ ‘ r 5 as, 2-5 wks. 10 2 2 2-34 ° 20-32 ° o ri-c 2 I | FA “+ ‘ III, 5-10 wks. 8 2% I 3-44 24-36 IV. 10 wks,-—4 mos 7 3 : I Fo ES 25-42 ** V. 4-9 mos. 6 | OR O 5-8 * 30-48 * INFANT FEEDING. Comparison of Breast and Cow’s Milk. Percentages. Fat. Sugar. Proteids. Reaction. Sterility. Breast Milk... 4 7 1.50 Alkaline. Sterile. Cow’s Milk... 4 4.50 4 Acid. Not sterile when it reaches the child, The modification of cow’s milk to make it a suitable food for infants is based upon 3 essential] principles :— 1. The milk must be diluted with water, to reduce the proteids. 2. Sugar and cream must be added, to restore the sugar and fat which have been diminished by the dilution with water. 3. The milk must be made alkaline and sterile, SuGAR is sestored by dissolving milk-sugar, or cane-sugar, (granulated) in the water used for dilution. -( milk-sugar to 8 oz. of food. 1 even tablespoonful of ! { cane-sugar to 12—160z. ** Dissolve the sugar in boiling water, and if the solution is not clear, fil- ter it through % in. of absorbent cotton in a funnel. Fat is restored by using for dilution a mixture of equal parts of ordinary cream (29 % fat) and plain milk. Instead of the cream and milk, an equal quantity of 12 % top milk may be used. ‘This is obtained by putting a quart of fresh milk into a tall glass fruit jar or milk bottle, and stand- ing it on ice or in a cool room for four or five hours. At the end of thet time, the upper 1/5 (6 oz. from the quart) contains: Fat, 12 %; Proteids, 4 %. Ifthe milk is very rich, the upper % (8 oz.) may be used, ‘This upper 1/5 or 4 is skimmed off and is used as the primary formula for dilution, being equivalent to the same bulk of a mixture of equal parts of milk and cream. ALKALINITY is secured by adding to | Lime water, I oz. 16-20 oz. of food - or | Sod, Bicarb., 4 of an even teaspoonful. a CHILD, Average weight, R , ; 3000 to 3600 grammes (6.6 to 7.9 Ibs.) height, ; : 48 to 54 centimetres (18.9 to 21.26 in.) Umbilical cord, av. length, 5° centimetres (19.69 in.); 0 to 200 cm. (0 to 78.74 in. Placenta, av. weight, 1/5 weight of child, i.e., 600-1000 grammes (1.32 to 2.2 lbs.) DIAMETERS, — Head—Occipito-frontal (O.F.) 11.5 to 12 cm. (4.53 to 4.72 in.) Occipito-mental (O.M.) 13 cm. (5.12 in.) Sub-occipito-bregmatic (S.O.B.) 9% cm. (3.74 in.) Biparietal, (B.P.) 9 %-94 cm. (3.64-3.74 in.) Bitemporal, (B.T.) 8 cm. (3.15 in.) Shoulders, . 12 cm. (4.72 in.) Hips, : . ; 9.5-10 cm. (3.74-3.94 in.) CIRCUMFERENCES,— Occipito-frontal, ; : 32-34 cm. (12.6-13.39 in.) Sub-occipito-bregmatic, 32 “(4226 in.) Occipito-mental, 36 oe CRG Fie) Normal Pulse and Respiration per Minute. PULSE. RESPIRATION. At birth, . ; : 130 to 150 ) i : set month. _ 120to140 | 30 to 50, average about 44. I to 6 months, . about 130 | ) x. Stes * , : ce SRO f #5 40 35 Sl Ito 2 years, . : I1o to 120 -about 28. core ot ; ’ », DEO, jos set ee. 6 ” ; ; ‘ 100 | 8 St ‘ : - F 8$ 20 to 25. 14 6é . : : 87 | Adult, . ; . 72 | —16to 18. SS Se < hs Con see tye i oe ey ae : : ane ty Pele TE SER IO, stati cpraat a oes PT AS rr ete “4 FACIES RM, hg” 0-028 mies ss tee ~ ie ‘= were} tw we . ~ - Pet Set ae Da tesesete te Nistecasecec steer epee toe : SS Site Lotecs Sts nosecee ce ordoceseree: ; © . * ea Ooms »+ wes PSE as tes SMe oad eae trey a tesa eee faa - “ AD ote AN 6 OS Bre Ove ew 4 8 SS IA, ae i aes oe, TE SE eee eat eener eens: VATE Be dations SPOR ‘. Pipdehes we Wi sast oe Sa =; iLAry CSI PS SPSS eae ar — BP Soe ie Today Ae Pt od ee - ‘ foené: @) Ps .. “4 RS eae eg mM at gee aes Fe eo i es sAbopey Sedalia ede den etea Sea peet oat Peas ect sie oi ase se ara Satglcthctge sgtateydlaty, pe he or the ub ok yee << va s 1 er ore rate o ey. 2 - 5°. . cee: Ry Ste He ot ote Tea Md al ee oo bo et wr ee f usd ps Seto 4 4. ey Pye dane eee eel. rae: S veers 5