Some of these cases may demand the interference of art in the first stage of labor, but delay at that time involves very little danger; as a rule neither the mother nor child is in danger (except when there is hemorrhage or convulsions) on account of labor before the membranes are broken. If the nurse can ascertain the cause of the delay and finds that time is what is especially needed, she must exercise patience herself and encourage her patient to do so. It is hardly possible to predict beforehand in what cases convulsions will occur, but if there is much headache in the commencement of labor and if there has been considerable albumen in the urine of the patient, we have especial reason to apprehend trouble of that kind. The history of the case is important in forming an opinion as to whether there may be severe hemorrhage. Some women are naturally predisposed to flowing. PART IV. SKILLED NURSING AND MIDWIFERY. CHAPTER I. PRELIMINARY INSTRUCTION TO THE NURSE MIDWIFE. It is my design in giving the following instructions to prepare the student of this work to be a skilled or skillful nurse, not to be simply a midwife; to act in conjunction with, not in opposition to, physicians; to conform to, and not to violate laws which regulate the practice of medicine; to officiate in cases of easy, natural labor sometimes, but never in cases requiring the use of instruments; to be prepared to act in emergencies until the doctor can come and take the case; not to treat the case when the services of a physician can be obtained and is desired or needed; in short to act intelligently in all cases in which women now act perhaps blindly, hurriedly and ignorantly. The present state of feeling among our people, and especially among the medical profession in this country, would not sanction an effort to educate women solely as midwives. But there is a general feeling or sentiment that every young lady ought to have that kind of education which may render her useful; that she should be prepared in some way to minister to the desires, wants and needs of her fellow creatures, and that some part of that knowledge or skill should be of that kind which would be available if these persons were thrown on their own resources; hence I would have some of you to be, not only nurses of the sick, but skilled nurses of lying-in women. And should some young lady after studying this work, decide to pursue the study of medicine thoroughly and become a physician, the knowledge here obtained would be available. PRELIMINARY INSTRUCTIONS. 1. Do not stop short of a thorough knowledge of this book, every part of it.