B477018






144 Ig






H',-OM(EOPATHY
AS ArPL[E.D TO THEf1'
]DISEASES OF FEMALES
AND THE
MOST IMPORTANT DISEASES
OF


EA RLY


CHILD HO 0D..


BY
THOMAS R. L.EADAMvl, M.D., M.IRC.S.E.
Surgeon-A4ccoucheur to the London Biommoopathic Hospital;
Ifonoranj Secretary to the British IHornaopthic Society, i-c. ý-c..LONDON:
JAMES LEATH, 9, VERE STREET, OXFORD STREET, W.;
AND
5, ST. PAUL'S CHURCH-YARD, E.C.


1857.



11Multi Medici, qui reriim qum manifest6 conspiciuntur, causas reddere nequentes,
eais esse omnino negant."-GALRN, De loci3 offectis.
Multuns adhuc restat operis, multumque restabit; nec alii nato, post nillie
secula, prvecludetur occesio, aliquid adhuc adjicieedi."-SENECA.
J. N. ADLARD,? PRINTER, BAeRTHOLOMsEW CLOSE.


I



PREFACE.
WITH extreme diffidence the author has ventured upon
the publication of the following work, which embraces a
series of diseases of the greatest interest and importance, to
which justice could scarcely be done in a much larger volume;
but he was induced to attempt this practical treatise upon
the Homoeopathic treatment of Pregnancy, Labour, and the
Puerperal State, and the various derangements and accidents
to which they are liable, in conjunction with the Functional
and Organic Diseases of the Womb, because it appeared to
him  that, as the progress of Homoeopathy is undeniably
rapid, and its study daily becoming more extended, especially since the establishment of two Hospitals in the Metropolis, and of one in Manchester, a great hiatus would be found
to exist in this department of Practical Medicine; at least, it
was an exigency which, some years back, pressed itself upon
his own mind, when first studying and testing the novel and
startling doctrines of Hahnemann.
This work is intended to answer the twofold purpose of a
Manual for the Homoeopathic student and Volume of Reference for the experienced practitioner, who would refresh his
memory in respect of the remedies which are most in correspondence with the symptomatology of the diseases treated of.
The author, in attempting this difficult task, has felt deeply
the necessity of compressing his observations respecting the



vI


PREFACE.


diseases and their symptoms into as concise a form as
possible, in accordance with the scope and intention of the
work; and is therefore sensible of the limited nature of the
physiological and pathological observations which accompany it.
On this point, however, he is somewhat relieved by the
consideration, that so many excellent Treatises have been
written on the diseases to which he refers, the pathological
accounts of which leave so little to be desired, and with
which all medical practitioners are supposed to be acquainted,
that a simple account of what is known of each disease,its mode of invasion, course, and termination, its consequences and pathological conditions, is all that is necessary
to give opportunity for an exposition, in a convenient
manual, of the Homoeopathic treatment.
The author has also to acknowledge, generally, the use
he has made of the labours of others in preparing his work.
He has diligently compared his own experience with theirs;
and whilst he refers with gratitude and pleasure to the light
thrown upon these diseases by the writings of Gooch, Clarke,
Churchill, Montgomery, Burns, Simpson, Bennett, Ashwell,
and others, he is compelled to avow what experience has
proved to him,-namely, that the Homoeopathic Treatment
has an immense superiority over the severe, local applications,
in all the Diseases of the Womb.  The next grand improvement in the management of these diseases is undoubtedly
that introduced by Dr. Simpson of Edinburgh, in the treatment of certain kinds of displacement of that organ.
The portions of the work devoted to Pregnancy, and the
Diseases of Childhood, are written with the view of being also
useful to mothers, who, having been accustomed to Homoeopathic treatment, and made sensible of its value, find themselves out of the reach of a practitioner of that school.  A



PREFACE.


vii


detailed exposition of the Symptoms of Pregnancy has been
omitted, because it would involve only a physiological analysis, and have no therapeutical bearing.
The Obstetric Art being divided into three parts, viz.,
Manual, Instrumental, and Medical, has obtained only a
partial consideration. The first two divisions are not here
touched upon, because they have been so fully and elaborately
treated of in the various manuals devoted to that subject;
and have been, and continue to be, ably taught from the
academical chairs established for that purpose. It has not
been thought necessary to recapitulate in this work what
has been so perfectly studied and so frequently published,
the more especially as it admits of little change, and does
not affect the medical treatment.
The author has, therefore, confined himself to the third
division, which pertains to the Medical Management, and
has included whatever relates to the moral and physical wellbeing of the pregnant female.
In treating of the Pregnant State, the several conditions
of Abortion, Hoemorrhage, Labour, &c., come under consideration, and, as a natural consequence, the Treatment of
the Infant.  And, seeing that it would be incomplete, if
the diseases to which women are most liable during the
puerpeal state were omitted, Mania, Convulsions, Puerperal
Fever, &c., are arranged under that division.
The period of Infancy is usually considered to terminate
at two years of age.  During that period the eruptive and
other diseases, especially those connected with Dentition,
are liable to occur, although, in the majority of instances,
they may perhaps happen after; but as that portion of Childhood is not exempt from such diseases, the work would be
deficient if it did not also include them.  Some of 'the most
important and common have, therefore, been added, which,



viii


P REFACE,


although they attack children of all ages, not unfrequently
prevail during the first two years.
The author has also consulted the works of Hahnemann,
Jahr, Laurie, Bcenninghausen, Hartmann, Croserio, Teste,
and others.
In recording the application of the remedies to the several
forms of Disease, he has carefully compared the characteristic symptoms of the remedy with those of the disease,
and given the special indications.  In some instances, it has
been only necessary to refer to the names of the medicines,
either because the sympathetic symptoms of the disease are
vague and uncertain, or so similar to those attendant upon
other diseases of an analogous character, as to render the
repetition useless or tiresome.
Again, it not unfrequently happens, that a single symptom affords the clue to the selection of a particular remedy,
whose curative effect confirms the propriety of the choice.
This usually depends upon an idiosyncrasy in the individual
which has exalted the sympathetic symptom into a commanding influence over the rest. As these examples are not a part
of the natural history of the disease, but rather of that of
the individual, it is scarcely possible to present so complete
a list of the remedies, as should include every peculiarity
of this kind.   The practitioner must therefore monsult
Bcenninghausen's Manual of Therapeutics, with Jahr's, in
order to select the most appropriate medicine.  A list of
the remedies most approved, from their relations with the
disease, or "ab usu in morbis," is also added in many instances which may assist the memory of the more experienced practitioner.
It is presumed that a certain insight into the mode of
applying the remedies has been attained by the student of
Homceopathy before he can advantageously use this work;



PREFACE.


all detail on that head, whether as descriptive of the remedies themselves, or of their application, has therefore been
omitted.
With these prefatory observations, the author commits
his work to the public, with the earnest and sincere hope
that those members of the profession who are still blinded
by prejudice, or whose analytic tone of mind is opposed to
the reception of a curative fact, the modus operandi of which
cannot be palpably demonstrated, and stand aghast at the
very threshold of Homoeopathy, awed by the simplicity of
nature, which is its characteristic, may ere long find the
scales fall from their eyes, and be able to see the many
blessings which this method of cure is capable of conferring
upon humanity.
But he exhorts inquirers, whether of the Homceopathic
or Allopathic school, not to neglect the study of the Materia
Medica pura, and to use this volume, if it should be thought
worthy, only as a guide to that admirable compendium of
the pathogenetic relations of remedies.
12, WYNDHAM PLACE, BRYANSTONE SQUARE, W;
June 16, 1851.



PREFACE TO THE SECOND EDITION.


THE call for a Second Edition of this work affords a
further example of the increasing interest which is accruing
to the subject of Homoeopathy, and testifies to the wide
diffusion of the practice of that law of healing, and of that
therapeutic axiom embodied in the phrase "similia similibus
curantur."
The steady and continuous glare of that light which was
evoked by Hahnemann, will ere long most assuredly chase
away the mists of prejudice through which the reformed
medicine is viewed by the profession and the public; and if
hitherto this great medical truth may have suffered a partial
eclipse, all who have become acquainted with it know full
well that, ultimately, it must prevail, and take the place of
the present uncertain, indefinite, and injurious regime.
The object of this work is to fan the flame which
Hahnemann lighted, and to concentrate more positively
upon one most important class of disorders much that is
diffused through the Homceopathic literature.


February, 1857.



INTRODUCTION.


HOMOOPATHY being no longer a novelty, and having survived the contempt which is ever cast upon medical innovations, it may seem undignified, as well as unnecessary, to meet
the assailants of that method with the language of defence;
because such language on the part of its advocates would imply
a weakly or incomplete development of those principles which
they believe to be true, and, therefore, worthy of universal
acceptation. But it should be remembered, that science is a
plant of gradual though immortal growth.  Homeopathy is
now an established branch of medical science, the discovery
of which marked an epoch in medical progress, and associated
with Hahnemann the glories of a pure and imperishable
renown.   Like that of almost every other great discovery, its
adoption has not been commensurate with its importance,an unfortunate fact, we admit, but far from discouraging to
the Homceopathist, who knows that science, in perfect
analogy with the civilization of which it is the outward and
visible sign, must have its infancy before it can arrive at
maturity, and pass from the one to the other state by almost
inperceptible degrees.  That the Homoeopathic law was
known to the ancients, we have conclusive evidence.1 It was
enunciated by Democritus, and recognised by Hippocrates;
and therefore, although the genius of Hahnemann elucidated
SIoinomopathy and the Ancicnts; ' Brit. Journal of lHouimcopathv,' No. xxxiii.
1



2


INTRODUCTION.


and applied the principle similia similibus curantur, and
proved it to be the expression of a general law in medicine,
the principle existed just as much as that of gravitation did
before its discovery by Newton.    Had the discovery of
Homoeopathy been shrouded in the mystery of Charlatanism,
and imposed upon the world heralded by advertisements
obviously intended to delude the ignorant and entrap the
unwary, or paraded with pretensions, the value of which
could not be proved, it might well have provoked the scorn
and contempt of the learned, the benevolent and the privileged.  Homceopathists appeal not to argument or theory
alone, but to that practical observation by which they are
anxious, and ever have been anxious that their method should
be tried. That the all-important principle of Homoeopathy
should be scouted, rejected in toto, and treated with insult
by the so-called scientific part of a profession that deems
itself liberal and enlightened, is truly lamentable, and may
be quoted as an edifying example of those deflections of the
human intellect which result from educational bias.
Has Homoeopathy any of the characteristics of Charlatanism?  Does faith in the principle-similia similibus
curantur-involve contradiction or absurdity? Is such faith
confined to a few minds? Are there no works in which the
truths of Homceopathy are made patent to the world, so that
he who wills may study and appreciate? Are the powerful(!)
arguments dealt out against those truths the efforts of enlightened individuals, who have examined the Hahnemannic
method of cure, and put it to the test in a fair and legitimate
spirit, with sufficient knowledge of the principles involved,or do they proceed from that wilfully blind class who will
not condescend to make themselves acquainted with "the
German conceit," as it has been called, which they think
proper to abuse?



INTRODUCTION.


3


The medicine of Hahnemann is the medicine of experience,
and the logic of his disciples is the logic of facts:-Homoeopathy is no abstraction of the closet-no chimerical hypothesis-no fanciful influence of metaphysical agencies.   By
inexact writers it is called an invention and a system;-but
it is neither an invention nor a system, but a discovery and
a method.   For all practical purposes Hahnemann was the
discoverer of that heterodox truth similia similibus curantur;
to him, also, we are indebted for a method of cure at which
the tyro laughs, and the accomplished physician launches
his sarcasms, but which experience has shown to be both
simple and efficient.
Dishonest men, loud in their deprecation of a science of
which they have just enough knowledge to misunderstand it,.often commit themselves most egregiously in their statements
concerning Homoeopathy.     Their excessive anxiety to confound the disciples of Hahnemann makes them regardless of
such trifling matters as sense and consistency.
For some time past these opponents have seriously set
themselves to the task of proving that dangerous poisons are
used in the globules administered by Homoeopathists, in
utter obliviousness of their own oft-repeated declaration, that
Homceopathic doses are doses of nothing. How can they
reconcile these two assertions?  Would it not be far better
to confess their entire ignorance of those principles, in opposing which they contradict themselves.    Poisons indeed!
What are Calomel, Corrosive Sublimate, Arsenic, Digitalis,
Prussic Acid, Laudanum, &c., which the Allopaths so freely
prescribe, and in poisonous doses too?-Are not all the most
valuable medicines potent poisons?  We know that poisons
are most liberally dealt out by the old school of medicine,
but we do not know that infinitesimal doses of those poisons
when prescribed apon the admirable principle of similia



4!


INTRODUCTION.


similibus curantur, ever did or ever can produce the terrible
results ascribed to them by these imaginative defenders of
allopathy.
It is in Homoeopathic therapeutics alone that we obtain
any positive and accurate knowledge of the capacity of
medicines to affect the different organs of the animal
economy, as well as the special structures of which those
organs are composed. From the same source we derive experience as to the mode in which medicinal substances
influence individual and associated organs.  Moreover, we
have in Homoeopathic therapeutics proofs of the temperaments in which different remedies develop their peculiar
action;-for example, on referring to the pathogenetic properties of Pulsatilla, we find that it has been proved to exert
its action particularly upon the venous system and the
mucous membranes, producing increased excretions,-on the
fibrous tissues of the joints and fascia,-on the nervous
system, disturbing the general sensibility,-on the skin and
stomach in their separate or associated functions,-on the
brain and nerves, producing wakefulness, fever, delirium,
dreams, a form of intermittent fever, also fever of a typhoid
character, attended with nervousness, irregular circulation,
the peculiar irregularities and perturbations of the nervous
system which often accompany pregnancy, affections of the
senses, toothache, catarrhal affections of different organs,
congestions of the viscera, diarrhoea, disorders of the pelvic
organs, especially of the female, and during pregnancy,
menstrual difficulties, suppression of the uterine and mammary secretions, hemoptysis, biliary disorders, nervous
debility, and dropsical effusions.
In this Category we possess a mirror of the remedy,
positive and unchangeable, which no theory can subvert,
no experiments contradict. In this mirror we have reflected



INTRODUCTION.


the pathological condition, the morbid effects, and the express
features of various diseases.  Here is a chart, which directs
us in the track of morbid action so often manifested in the
animal economy; and, if the pathogenesis of Pulsatilla be
taken up by the student of any disease, for which it is the
remedy, and he should compare the symptoms developed by
both, the least that can happen will be that it will excite in
his mind a feeling of astonishment.  If he were told that
this correspondence indicates Pulsatilla to be the required
remedy, he would naturally inquire what proof there is, that,
because its morbid action is shown uniformly to occupy a
certain track in the healthy body, it is the remedy which
ought to cure similar effects produced by other causes?
What evidence can there be but that of putting it to the
test?  The possibility of such being a fact first startled the
mind of Hahnemann, when he found that Bark, taken in a
healthy state of the body, produced the kind of ague for
which it was well known to be a cure. He then put this
great idea to the test; and having verified it by experience
in thousands of cases, and the test being daily repeated
in Europe, Asia, Africa, and America, let those who glory
in the title of "legitimate" as opposed to philosophical
medicine also put it to the trial, and thus complete the link,
which, to their intelligence, is wanting, in the chain of
evidence. But, in so doing, let sound philosophy prevail.
If a remedy, such as Pulsatilla, is found to produce symptoms
so closely resembling a certain disease, as to lead to the inference that it might be a curative agent as regards that
disease, in putting it to the test, would it not be a natural supposition, that, if a dose were given powerful enough to produce
any of the ascertained pathogenetic effects, an increase, and
not a diminution of the symptoms ought to be expected? and,
consequently, would it not be wise to administer a small



6


INTRODUCTION.


portion only of such dose, in order fairly to test its curative
efficacy? Here, then, is the whole theory of Homoeopathic
infinitesimals, exemplified in practice. And, if this small dose
of such specific remedy should be found sufficient to produce
a slight reaction in the organism, a curative effect is the
result:-just as when a burnt finger is held at a certain
distance from the fire, the pain and inflammation are sooner
removed-though at first rendered more acute-than if it be
plunged into cold water. What can be plainer than this?
The action is pathologically and physiologically in harmony
with the laws of nature: that is to say, iti correspondence
with, or having a clear relation to, the existing morbid
state.
Disease is often only a derangement of the function of an
organ,-an excess, or deficiency of the dynamic vital powers,
or, in other words, of the moving powers of life.
Functional disease, long continued, induces organic disease, and may be either acute or chronic.
Altered nutrition, (a most important function,) combined
with other functional irregularities, may be the cause of the
worst form of organic disease; so that we come at last to
impairment of the moving powers of life, as the "fons et
origo" of disease.    Where, then, is the sound physiology
which can sneer at Homoeopathy, and apply powerful disease-producing remedies to a healthy organ, in one part of
the body, in order to cure a disease existing in an organ at a
distant part? Is the probably healthy liver to be punished,
because the kidneys have failed in their function,-or is a
muco-gastritis to be engendered, in order to get rid of a
cutaneous eruption,-or is a Dysentery to be relieved-a
feat the performance of which I have witnessed-at the
expense of caries of the bones?
Yet this is Allopathy. By a violent revulsive action



INTRODUCTION.                     7
upon one organ, or set of organs, it attempts the relief of
others, forgetting that the end cannot be attained, without
diminishing the vitality, or deteriorating the tissues of the
organ which is attacked by the pseudo-remedy.
Again, an organ under the influence of disease is rendered sensitive and irritable, so that a small, fractional dose
ivill affect it, when the remedy is selected in accordance
with its proved relation to that organ; while a large and
potent dose, whose action is directed to a distant organ, will
not affect it.' Let us illustrate this.  Light is the appropriate stimulus to the eye; but, if that organ be affected with
ophthalmia, can it bear the same amount of light as when its
healthy condition was unimpaired? or will not a single pencil
of light aggravate the symptoms?
If the auditory nerve be inflamed, or affected with a
morbid sensibility, do not the ordinary wavelets of air,
which are the natural vehicles of sound, strike upon the
ear like the roaring of the sea?
What would be more absurd than to cause the eye to
weep, by the application of a morbid stimulus, because the
organ of hearing was affected, or to drum the latter to
deafness, because the former was diseased.
If it be said, there is no correlative action between the
eye and the ear,-no correspondence of function from which
we might infer that the one would be relieved at the expense
of the other,-we ask, where is the greater correspondence
between the liver and the mucous membrane of the intestines? or between that organ and an erysipelatous leg?
And yet, under the old system, the unfortunate Liver is
made out to be an universal disturber of the peace, in the
animal economy, who can only be kept in order by perpetual chastisement with calomel. This would be very
amusing if it were not often followed by such direful results;



8


INTRODUCTION.


or, as a great opponent of Homceopathy has said, "if
sacfty, life, and health, were not the stakes.1"
Caries of bones is the not unfrequent consequence of
dosing delicate scrofulous children with calomel and grey
powder, according to the rules of what is termed " legitimate
medicine."
The professional mind has lately run riot in chemical
philosophy, under the guidance of some clever but unpractical
physicians.  Because it is demonstrable that acid secretions
at times superabound in the body, and that an acid is
neutralized by an alkali out of the body, it has been considered a curative indication-in the treatment of diseases in
which the former condition prevails-for the administration of
alkalies.  But the acid secretion is only the effect of a perverted function. The imperfect organic vital action, which
allowed of the formation of an excess of acid, is the disease
which ought to be attacked. The cause, and not the effect,
should be dealt with. As well might we attempt to interrupt
the current of electricity passing along the wire to the positive
side of a galvanic battery, by adding an alkali to the water
in which its extremity was immersed, as to cure a dyspepsia
by the administration of carbonate of soda.  But we have
been taunted by one, who, though he has done good service
in experimental physiology, sometimes writes with greater
vehemence than wisdom, on what he is pleased to call the
" disguised nothingness of Homeeopathy."
If we object that our Aconite has a benign influence over
the vascular and nervous systems, such as no bloodletting
can have,-and that Bryonia can be satisfactorily shown so to
reduce the heart's action as to render acute pleurisy a most
tractable disease,-then it is charged upon us, as a heavy
crime, that we use poisonous agents under the guise of


I Observations in Medicine, by Dr. M. Hall. Vide Preface.



INTRODUCTION.


9


homoeopathy; on the other hand, should we declare that a
hitherto unknown and inert substance, has been proved to
possess a most happy power in certain chronic affections-as,
for instance, Sepia in diseases of the womb-then it is that we
imagine a virtue which does not exist, and delude ourselves and
our patients, by descanting upon effects which are attributable
to the vis medicatrix nature.  Nevertheless, we know these
things to be facts, and are content to bear the obloquy.
"Magna est veritas et prevalebit."
One of the gravest errors, in the practice of the old school
of medicine, is committed in the exhibition of purgatives in
the puerperal state; yet, strange to say, it is here where they
declare the necessity of this opprobrium therapeuticum to be
the most absolute.
It is unfortunately not uncommon for a woman to be
attacked, on the fourth or fifth day after delivery, with inflammation of the bowels, immediately after the exhibition
of the usual purgative,-whether this be senna and salts or
simply castor oil.  The patient is bled and purged still more,
to overcome the resistance which the inflammatory condition
of the muscular coat of the intestine offers to the passage of
the alvine contents.  The result is too frequently fatal in
from twenty-four to forty-eight hours. After death, inflammation and mortification of the coats of the intestine are
traced, with, now and then, a collection of feculent matter
impacted in the tube, at the seat of the disease. This is
held up, with wonderful gravity, as a climax of proof that
purgatives are imperative; but we reason differently.   The
truth is, that freces will occasionally become impacted in some
part of the intestinal canal, during pregnancy, in spite of
purgatives, in consequence of a loss of tonicity or contractile
power in the gut,-induced by pressure of the gravid uterus,
or by some other cause.   When delivery has taken place, the



10


INTRODUCTION.


gut does not necessarily recover its normal condition immediately; this depends upon the extent of the local
paralysis. As nothing is done (allopathically) to remedy
this condition by medicine,-partly because it is not recognised, and partly because there are no allopathic means applicable to this purpose,-the condition continues until disturbed
by the absolutely necessary purgative on the third day.  This
paralysed portion of the intestine, then, with its impacted
scybala, is isolated, and resembles, as far as the action of
purgatives is concerned, any inert tube or channel.    They
pass along it, but fail to excite its contractions, and the
scybala therefore remain. But this is not all; although the
purgative does not always excite the normal contractions of
the temporarily paralysed portion of the canal, it does excite,
irritate, and inflame that portion in immediate proximity,
and the inflammation directly involves the portion whose
vitality is already impaired; mortification of this part is the
consequence,-all of which is most unjustly laid to the presence of scybala, which had lain there, probably for weeks,
without exciting inflammation or even irritation.
It may be asked, how does Homoeopathy propose to remedy
this?   We answer, by a rational and physiological view of
the actions of remedies, and of the organs upon which they
operate.
Homoeopathy shuns remedies administered in doses capable of exciting disease.
Homoeopathy manifests the real virtues of medicines, by
proving in the healthy individual, upon what organs and
tissues they are capable of exerting specific action.
Homceopathy selects, in pursuing the curative intention,
such remedies as are known to act upon the organ or tissue
which is under morbid influence, and to develop in that
symptoms similar to the disease. For example, Nux vomica



INTRODUCTION.


11


is known to act upon the nerves of sensation and motion, in
particular, and to paralyse muscular action, by exhausting the
irritability.  This is part of its general action.  Its particular action, among other developments, operates upon the
intestinal canal, in promoting venous congestion, and diminishing peristaltic action.
Veratrum is another remedy, whose property is to diminish
irritability, and to induce a paralytic state of parts of the
muscular system.   Now, we take these two remedies as illustrative of the point in question.    In the puerperal state,
the Homoeopathist, instead of applying an irritating drug to
the sensitive intestine, administers, probably,-if relief from
the bowels should not occur naturally,- a dose of Nux vomica,
one property of which is to act upon the irritability, and, therefore, the peristaltic action of the intestinal canal.  If paralysis, or torpor of an isolated portion has taken place, and
impacted faeces exist, it elicits and arouses the normal irritability of the part, which, if not actually extinct, (and we need
hardly say that this is never the case at the period to which we
refer,) responds to the harmonic touch, and vibrates into life
and action at once. A large dose would augment the paralysis, but the infinitesimal just excites reaction; gradual
propulsion of these fomites morbi is the result, and the
peristaltic action is restored, without the dangerous consequences, which almost inevitably result from the use of purgatives.  Again, if from deranged nervous influence, or congestive torpor, the rectum is at any time so paralysed that it
allows of an enormous dilatation from accumulated fieces,
which purgative medicine cannot expel, the Homoeopathist administers Veratrum, whose pathogenetic property is to paralyse
the muscular tissue, generally or locally; and the infinitesimal
dose soon elicits the responsive action, because it operates
upon the nervous filaments of the muscular tissue of the



12


INTRODUCTION.


part, and makes them vibrate with harmonious action,
arousing the irritability of the same fibrils, whereas, in a
large quantity, it would have extinguished it.
Thus it is that Homceopathy, by being able to trace the
exact course of the operation of a remedy, throughout the
several organs and tissues of the body, is capable of applying
it upon the precise spot, organ, or tissue, whose morbid condition requires its influence.
If the remedy were. given in a large dose, it would not
only morbidly affect a more extensive sphere, but would
aggravate the part already excited by disease; but, when
administered in a minute dose,--and the exact quantity
required can only be determined by experience,-it silently
elicits, in the precise organ or tissue, a medicinal reaction,
which takes the place of that which is morbid, and soon
leads to health.
In describing the diseases of the Uterus and its associated
organs, for the purpose of drawing attention to the more
successful and less severe treatment by Homceopathic remedies, it is presumed, that the practitioner is acquainted with
the diagnostic signs, offered by their anatomical relations, as
well as their pathological characters, in order that he may
detect the presence of the several forms of ulceration, and
distinguish carefully between a malignant and a non-malignant growth.
It might, at first, be supposed unimportant to the practitioner of Homceopathy, whose choice of remedies is guided
solely by the symptoms manifested externally, whether there
existed any special form of dyscrasia in the constitution of
his patient, to which the symptoms were referable, but it is
not so.  On the contrary, it is equally important to the
Homoeopath as to the Allopath:-for I am not aware that the
latter has ever professed to have discovered a power that will



INTRODUCTION.


13


eradicate the cancerous diathesis; and we know      that the
course of the most malignant diseases is greatly mitigated,
and that life is prolonged by the Homoeopathic treatment.
The prognosis of a case, then, will be greatly assisted by
a correct pathological observation, and not seldom will the
choice of a remedy be influenced by it; for, as in the case
of ulcer in other parts, the application of our remedies is
guided in some measure by the objective symptoms,-or the
kind of ulcer:-whether it be deep and excavated, clear or foul,'on the surface, surrounded by active, healthy inflammation,
or by that of a phagedenic and destructive character, with
the appearance of a low degree of vitality; whether the discharge from it is serous, ichorous, sanious, or purulent;
whether it is of an offensive odour or not; if the granulations
are florid andvigorous, or redundant and expanded; if the latter
are irritable and painful, or torpid and without sensation; if
they bleed on contact, or not:-so is it with the organic diseases
which affect the womb; observation is absolutely necessary
to identify their character; and a knowledge of pathology
cannot be dispensed with, to guide and correct our observation,-more particularly, as, in these diseases, the subjective
or sympathetic symptoms afford us so little assistance in discriminating the different structural lesions.
The same modus probandi is also attainable; the same
argument holds good with respect to internal diseases, whose
actual pathological state has been verified by dissection, and
so compared with the corresponding symptoms. But, as
regards the host of ailments and diseases which occur in
every variety of form and in every combination of diversified
temperament, no such accuracy can result from pathological
inquiry or hypothesis.  How often has it not happened, that
a certain train of symptoms has been manifested, bearing all
the marks of an inflammatory condition, which has been



14


INTRODUCTION.


proved to be purely the result of excessive nervous irritation?
How proved? By the effects of the remedies administered
empirically;-proved, too, in this way, by the most sagacious
of our profession.  Had these cases been treated in strict
reference to the symptoms,-in their relation with the supposed
pathological condition of the internal organs,-bleeding, blistering and poly-pharmacy would have been in accordance
with the legitimate practice, and, perhaps, death the legitimate conclusion; but by deviating from the course of exclusive pathological diagnosis, a more fortunate result has been
obtained. No one, I apprehend, would be bold enough to
argue, that such was a pure example of true pathological
induction. If so, I would ask, where are the delineations
of morbid anatomy on which such pathological theories of
nervous irritation are founded?
A more careful analysis of symptoms developing themselves in the nervous, vascular, and lymphatic systems, as
well as in the muscular, fibrous, and cellular tissues:-or, a
more perfect combination of causes and effects, as exemplified
in the objective and subjective symptoms, can scarcely be
found, than that which Hahnemann and his followers have
given to the world; and, in studying them, we find, not only
the expression of diseases uniform in their general characteristics and effects, but likewise their diversified character,
as manifested in various constitutions and temperaments.
It is this which brings Homceopathy so much nearer to
perfection in the healing art, than anything which is to be
found in Allopathy, and enables it to defy the regimental
routine which distinguishes the latter mode of treatment.
Amongst the writers on diseases of the uterus, there are two,
who seem to attribute the origin of those general symptoms,
and the delicacy of health from which females suffer so much
and so long, and which are not connected either with ulcer



INTRODUCTION.


15


ation or malignant disease, to different causes. Dr. Simpson
has discovered the frequency of displacement of the organ,
in the unimpregnated state, and the relief, by reposition, of
those distressing symptoms which so often paralyse the
energies of women, and render their lives miserable.
Dr. Bennett has traced the same functional and sympathetic derangements, to inflammation of the os and cervix,
and directs the cure by local depletion and cauterization.
It appears to me, that these morbid conditions are,
generally, combined in the inverse order to that indicated by
Dr. Bennett; but, it is a question which, with great candour,
he has described "as very difficult to unravel;" and, in the
face of his learning and experience, I would hesitate, to
advance a contrary opinion, but for that of Dr. Simpson,
whose   experience must be equally great.    The frequent
occurrence of inflammation of the os and cervix, in unmarried
women, is not so easily accounted for, unless it be a result of
general uterine congestion, or chronic metritis, with subsequent displacement. Congestive hypertrophy of the whole or
part of the body of the uterus which has been thus produced, is
aggravated by the venous engorgement which takes place at
every monthly period; and these patients, therefore, usually
complain of feeling worse just before, and better just after
the catamenial flow; and by repeated distension of the venous
capillaries above, chronic inflammation is set up and perpetuated in the os and cervix, which are the most dependent
parts, and such inflammation is materially aggravated, if not
induced by displacements of the organ.
So that, in the first place, we may have hypertrophy or
engorgement, of the whole or part of the body of the uterus;
in the second, dislocation, such as anti- or retro-version;
and, in the third, chronic congestion or inflammation of the
os and cervix.



16


INTRODUCTION.


The Homceopathic treatment of these diseases, may,
nevertheless, be as lightly thought of as was the more
humane method of tying the arteries with delicate ligatures
after surgical operations, in the time of Ambrose Par6.'
Up to the close of the sixteenth century, there were no
means of arresting the bleeding, consequent upon the
division of the blood-vessels, in amputations of the limbs, &c.,
but by the immediate application of the actual cautery (red hot
iron). This great improvement (the ligature) which added so
much to the safety of the patient, and so greatly diminished his
sufferings, was new and an innovation upon the established
practice, and was, therefore, regarded as an insult to the intellect of those eminent men, who had hitherto been satisfied with
the knowledge which they possessed. The College of Physicians of Paris attacked Pare as a subverter of the "legitimate"
practice, and attempted, by the authority of the French
Parliament, to suppress the publicaticn and dissemination of
his observations; and it was a century before this new
method-which is now the custom of the day,-was allowed
to be taught in the schools of medicine and surgery.  Such is
the fate of medical and surgical, as well as of other great discoveries.  We cannot, therefore, expect better things for
Homceopathy, even in this enlightened age. For my own part
then, I would rather possess the truth with the few, than be
in error with the multitude.


I Vide Cooper's Dict. of Pract. Surgery, art. Amputation.



HOMUEOPATIIY
AS APPLIED TO TIRE
DISEASES PECULIAR TO FEMALES.
PRELIMINARY OBSERVATIONS.
DISEsASES of the Womb are divided into Functional and
Organic.  The former comprise those which are connected
with disorders of Menstruation, as well as of the pregnant
and parturient states.  The latter include all diseases which
are associated with change of structure, whether of a simple
or m-alignant character.  The function of menstruation is
generally more or less disturbed during the progress of
organic disease; but this does niot always happen, for although a natural correspondeuce exists between regularity
of function and the healthy condition of the organ, very
serious disease sometimes becomes developed, and increases
without any material alteration in the performance of that
function.
The same holds good with respect7 to another of the
proper functions of the uterus, namely, Pregnancy. It may
proceed uninterruptedly to the full term, in spite of an
amount of organic disease which is sufficient to destroy life,
and which may prove fatal, as soon as delivery is accomplished.
Inflammation of the substance of the uterus, of its os or
cervix, may likewise coexist with tolerable perfection of
functional action, so that although organic disease and
menstrual irregularity in some measure depend one upon
2



18


DISEASES OF THE WOMB, ETC.


the other, their separate existence is sufficiently obvious to
distinguish them in connection with uterine pathology.
In accordance with this natural division, I shall notice,
in separate parts, the subjects to which I have limited myself
in this volume.
Part I-will include the function of Menstruation, with
those deviations from its normal condition, which are incompatible with health.
Part II.-Pregnancy, and the Parturient State, with the
morbid affections to which they are liable.
Part III.-The Puerperal State, or that immediately succeeding delivery, with the diseases incident thereto.
Part IV.-Organic Diseases of the Uterus and Ovaries.
Part V.-The Management of the Infant and the Diseases of Childhood.
In this way the Homceopathic Treatment of the most
important diseases peculiar to women will be brought under
review, together with the management of Pregnancy, Labour, and the Infant; and it will be my endeavour to
render a correct image of these diseases with as much
conciseness as possible, in order that the morbid conditions
and symptoms may be compared with the therapeutic indications afforded by the remedies.
According to the calculations of Dr. Lever, the functional
diseases of the uterus occur in the proportion of 65-2 per
cent.; the organic in that of 34"7 per cent.:-or rather
more than one half as many of the one as of the other. But
the power of control which medicine possesses over the former
is so much greater than over the latter, that the interest pertaining to any medical-inquiry necessarily preponderates in
favour of organic disease.



MENSTRUATION.                1


19


PART I.
DISEASES OF THE WOMB, &C.
MENSTRUATION.
THE function which occupies a peculiar and important
place in the female economy, and is marked by a periodical
monthly discharge of sanguineous fluid from the vagina, is
termed menstruation, and the secretion itself catarnenia, or
menses.
This fluid is eliminated from the uterine vessels, and is
generally considered to be a secretion; but its mode of
appearance is more like an exudation upon the surface of
the lining membrane of the uterus, -since an injection, sent
into the arteries of the uterus., also, readily transudes through
the lining membrane. Its first appearance is indicative of
the attainment of puberty, when womanhood is established
and the female is capable of conception; whereas, its disappearance marks the conclusion of this faculty. At first the
discharge is pale-red; but after a few returns of the monthly
period, it assumes a darker and more sanguinolent character.
The effects of the establishment of menstruation upon the
general system are very characteristic. The mind, as well
as the body, acquires a rapid development. The perceptions are sharpened, the tastes chastened, the pursuits more
elevated; the manners are more reserved; at the same time,
the form assumes a plumpness and proportion, which give
elegance and grace to the general figure, and the, nascent
feelings of womanhood make the carriage more erect..
When the discharge appears at the ordinary _periods, in
the usual quantity, and of a proper quality, a female is said
to be "Iregular."



20


DISEASES OF THE WOMB, ETC.


The ordinary period for its recurrence is once in twentyeight days, and its duration occupies from three to eight days,
the average being about five days. Many women, however,
menstruate about every three weeks, others every five.
The quantity of discharge varies with the constitution
of the individual, and with the climate; but in temperate
regions, from four to eight ounces is about the usual loss
during each period, although some women habitually lose
double this quantity.  It is at its height ordinarily on the
third day; after which it gradually declines, changing colour
towards the last.
The character or quality of the fluid differs in many
respects from blood. In the first place it does not coagulate,
and is not separable into two portions, as fibrin and serum,
when left to stand, for it contains no fibrin: it has a peculiar,
faint odour, sui generis: it does not readily decompose, is
thin and of a dark-red, venous colour.
In some women menstruation is always attended with
more or less pain, and sympathetic disturbance; coagula
also appear in the discharge; and, if in great excess, the
red particles of the blood, and blood itself may pass as in
menorrhagia.
The age at which the function commences in temperate
climates is between twelve and fifteen years.     In hot
climates it begins much earlier; as a general rule, the sooner
the discharge commences, the earlier it ceases.
The period of decline is, in this country, commonly between forty and fifty: this is called " the turn or change of
life," and is preceded by irregularity and occasional interruption.
The symptoms which precede and accompany the first
menstruation are manifested in a trifling, almost unobserved,
derangement of system, in some cases, whilst in others they
are more distinctly pronounced.     A   certain  degree of
languor and lassitude, apathy and indifference, fatigue after
exertion, variable spirits, a dark circle around the eyes,
colics and affections of the stomach and bowels, pain about
the back and pelvis, and some hysterical symptoms are ob



MENSTRUATION.               2


21


served;- or it may be ushered in by febrile excitement, with
headache and fl-ushings of the face.
When the flow takes place, the symptoms are relieved;
but the' girl still complains of weakness, and is pale. Should
there be a want of vigouar in the system generally, or in the
uterine nerves in particular, several efforts of this kind may
be made by the system without the appearance of the
menses, or with a white discharge only. This, however,
may be remedied by a little care, and by nourishing diet.
Without this care, the white discharge may become an
established disease, constituting leucofrhrcea.  Regularity in
the return of each catamenial period would seem to be more
important than the quantity or quality.
It is arrested during pregnancy and lactation, as a general
rule, although sometimes women are found to menstruate
duriing the greater portion of the period of pregnancy and
whilst suckling; but the milk is always deteriorated, and
does not nourish the child so perfectly.
During the existence of menstruation, the system of the
female is more irritable than at other times, so that all exposure to sudden or irregular checks of transpiration should
be avoided., as well as every kind of mental or corporeal
agitation, otherwise the process may be impeded, and
hysterical or other troublesome affections excited.
It has been observed by Dr. Butler Lane, that irritation
of the bowels," producing diarrhcea, is with the great majority
of women a concomitant of menstruation., whilst., in a few
cases, constipation attends its periodical establishment, and,
in a fewer still, there is no variation from their -usual condition. He argues from this a correspondence of action
between the uterns and liver, a physiological hepaticouterine relation, by which the functions of the two organs
often become subservient one to the otherJ-or, in other
words, diminution of the normal secretion in the one is often
dependent upon excess of it in the other. With this brief
review of the function of menstruation., we will pass on to the
consideration of the derangements to which it is subject.



22


DISEASES OF THE WOMBB, ETC.


THE DISORDERS OF MENSTRUATION.
The derangements of the function of menstruation have
been divided into three classes; viz., amenorrhoea, dysmenorrhoea, and menorrhagia.
1. Amenorrhocea, or an absence of the menstrual flow, is
also usually divided into emansio mensium, the retention, or
where the secretion has never taken place; and suppressio
mensium, the suppression, where the secretion has appeared,
but has been checked or obstructed by external or internal
morbid influences.
The former of these must not be confounded with a mere
delay of the menses, as the difference of age at which the
change may occur, the greater or less development of the
body, and the state of health in other respects, will indicate
the fact of protracted or impeded function.
The retention of the menses may depend upon malformation of the sexual organs, a deficiency of the ovaria, imperfect development of the uterus itself, or a special want
of energy therein. On the other hand, the uterus may be
originally endowed with a normal amount of vital, power,
which may be exhausted in consequence of an impairment
of the general assimilating and nutritive functions, and the
debility occasioned thereby, which may equally retard the
appearance of the catamenia,  Retention of the menses beyond the period indicated naturally in the individual, by
the development of the other parts of the system, is attended
by two classes of symptoms.
First, the Entonic form, is distinguished by an active state
of the nervous and circulatory organs, with deternlination of
blood to the head, causing headache and giddiness, drowsiness, flushing of the face, a full pulse, palpitation, weight in
the loins, constipation, and occurs usually in robust girls.
This is readily relieved by
Aconitum, 6.
Three globules mixed in a wineglassful of water.  A tea



THE DISORDERS OF MENSTRUATION.


23


spoonful to be given every three or four hours.   Should the
symptoms be only partially relieved,
Belladonna, 30,
may be used in the same way. If, after the employment of
these means, there should continue a confined state of the
bowels, with stitches in the sides of the chest, irritability of
temper, and occasional vertigo,
Bryonia, 30,
should be given in like manner.
Nux v., Op., Plat., Puls., Cham., Con., Cocc., Magn. m.,
Lyc., Phos., Sab., Sep., Sulph., Ver., will also assist in removing the obstruction.
The hygienic rules will consist of the use of the warm hip
or foot bath, active exercise in the open air, when the acute
symptoms are removed, a light and unstimulating diet,
abstaining from wine, beer, and meat, until the excitement
is subdued; clothing the body in a manner suitable to the
season; taking special care to avoid exposure to wet, or
getting the feet damp, and a general adherence to the
homoeopathic regimen.
Secondly, the Atonic form, in which the failure of the
uterine organs in their attempts to establish the periodical
function, instead of producing that powerful reaction in the
organism which has just been described, results in a torpor
of these organs (which are exhausted for a time of their vital
energy), in which remote organs slowly but extensively
sympathise.
In the early stage of this form of amenorrhoea, when the
sexual development of the system generally is complete, and
yet medical aid is required, some of the following remedies
will afford the greatest assistance.
Puls., Caust., Calc., Graph., Ars., Chin., Con., Nux v.,
Cupr., Natr. m., Kali c., Lach., lod., Sep., Sulph.  It is well
to begin the treatment with a few doses of Sulphur.
The symptoms which are gradually evolved, under these
circumstances, more frequently occur in fair and delicate
girls, with lymphatic temperaments, and become merged in
those of chlorosis.



24


DISEASES OF THE WOMB, ETC.


Suqppressio mensium may be sudden; the effect of getting
the feet wet during the catamenial flow, or of some mental
or moral shock, or of the invasion of an acute disease; in
which cases it usually assumes an acute form, and is followed
by more or less febrile action in the system; headache,
thirst, a hot skin, and quick pulse prevail; various local
inflammations or congestions may result, as of the brain,
lungs, intestinal canal, or the uterus itself.  Attacks of
hysteria, simulating inflammation, may occur; neuralgia, or
mania; also derangements of the organs of sense, as amblyopia, or of the voice, as aphonia, &c.
Treatment.-In the first place it is well to administer a
remedy antidotal to the exciting cause, and afterwards some
other adapted to the condition of the symptoms.
The remedies chiefly indicated under the circumstances
related above are:-first, as to the cause, Dulc., Nux Mosc.,
Puls., Cham., Ign., Coff., Lyc., Acon., Bry., Hyos., Opi., Coloc., c.
Dulc.-if the suppression should have been the result of
getting the feet wet.
N. mosc. or Puls.-if from a chill.
Acon. or Lyc., should any sudden fright, or emotion be
the cause.
Bry., Cham. or Coloc.-if preceded by a fit of passion.
Cof'. or Op.-if by excessive joy.
Ign., Hyoscy., Phos. ac., Helleb.-if caused by dissappointed
love.
Acon., Bell., Col., Ignat., Platina, Puls., Staph.-if from
mental mortification, or contradiction.
Secondly, the treatment of the relative and combined
derangements, which emanate from    or are associated with
the suppression of the catamenia, must, after the attention
has been directed to the exciting cause, be effected by
remedies applicable to the peculiar states which may be
found to exist; bearing in mind that the arrest of the
uterine function is the most important indication in the
choice of the remedy.
When the attack is ushered in by febrile symptoms,
Aconitum should be given, followed, if necessary, by Belladonna, which will relieve the symptoms appertaining to local



THE DISORDERS OF MENSTRUATION.


25


inflammation. The same remedies will be applicable, if
symptoms of mental alienation exhibit themselves, with the
help also of Sep., Con., Lyc., Magn. m., Sil., Natr. m.
Inflammatory or Congestive Affections of the Brain, must
have their symptoms compared with those of Acon., Bry.,
Bell., Calc., Cupr., Ferr., Op.:Of the Chest,-Acon., Bry., Bell., lod., Kal. c., Puls.,
Merc., Phos.:
Of the Stomach and Intestinal Canal,-Ars., Bry., Calc.,
Chin., Ferr., Lye., Merc., Puls., Sulph:Of the Uterus or Ovaries,-Acon., Bry., Bell., Chami.,
Canth., Lach., Merc., Nat. m., Nux v., Puls., Sep.
Should the consequence of the sudden suppression be
reflected in the nervous system  more particularly, and produce hysterical symptoms or severe neuralgic pains, it is of
the greatest importance to distinguish accurately between
that form of local disturbance of the ganglionic system and
inflammation, which often requires the nicest discrimination,
although in Homceopathy there is not such danger to be
apprehended from the treatment which may depend on this
or that diagnosis, as there would be under the old system
of medicine; nevertheless, the prognosis will be materially
affected by it.  I have witnessed under allopathic treatment the most dangerous results from bleeding and leeching
patients, under these circumstances; and this is one of the
instances in which our system pre-eminently surpasses the
old; a circumstance which becomes more especially apparent
when we consider that the chain of morbid actions we are now
alluding to, is developed usually in the most delicate and
susceptible individuals.
Ign., Cocc., Coff., Calc., Caust., Chin., Con., Cupr., Graph.,
Lyc., Natr. m., Nux m., Op., Puls., Sep., Sul., Ver., are the
principal remedies which must be carefully compared with the
symptoms, and will generally be found successful in the various
disturbances of the nervous system under this form of disease.
Sudden suppression of the menses may also terminate in
chlorosis, when the treatment detailed under that head will
be appropriate. Chronic suppression of the menses may



26


DISEASES OF THE WOMB, ETC.


exist as the sequel of an acute attack; or may arise from
the gradual impairment of the health, from organic disease,
or congestion of the uterus, ovaries, etc.; or it may occur
as the termination of the function.      It is also liable to
be associated with epilepsy, mental derangements, chorea,
dropsy, &c. When it is dependent on simple congestion
of the vessels of the uterus, and its associated organs, the
cure is more readily effected, than where it results from a
marked debility of those organs. When it occurs in young
women of an irritable and delicate fibre, various functional
and sympathetic disturbances spring up, all of which have
to be taken into consideration in selecting the remedies with
a view to a restoration of the secretion, and it is in these
cases more especially that a prolonged antipsoric treatment
is imperative.
The ordinary relief of chronic suppression of the menses,
is to be attempted by some of the following remedies, chosen
in accordance with the general moral and physical condition
of the patient, as manifested in the symptoms.
In plethoric individuals:-Acon., Bell., Bry., Nux v.,
Op., Plat., Sab., Sul.
In irritable, debilitated, or cachectic individuals:-Amm. m.,
Ars., Chin., Cocc., Con., Cupr. m., Graph., Ignat., lod., Lyc.,
Natr. in., Puls., Sep., Sul., Sil., Val.
When the menses are feeble, but not entirely suppressed:
-Caust., Calc., Con., Graph., Kali, Lyc., Magn., Natr. m.,
Phos., Puls., Sil., Sul., Ver., Zinc.
In the more complicated forms alluded to above, reference must be made to some of the following:Acon., Ars., Bry., Calc., Caust., Chin., Cocc., Con., Cup.,
Dig., Ferr., Graph., Hyos., lod., Kali c., Lyc., Merc., Mez.,
Natr. in., Nitr. ac., Nux m., Op., Puls., Sab., Sep., Sil.,
Sul., Ver., Val., Zinc.
If the symptoms of suppression occur in conjunction
with a scanty flow of the menses only, the following are the
most useful:-Graph., Con., Kali, Natr. m., Phos., Puls.,
Sl., Lye., Magn., Sili., Ver., or Zinc.
Cocclus,-if violent abdominal spasms happen at the
time when the menses should make their appcarancc, especi



THE DISORDERS OF MENSTRUATION.


27


ally if attended with pressure on the chest, oppression of
breathing, anxiety, moaning, excessive weakness, inability to
speak loud, relaxed state of the muscles of the extremities,
tottering gait, convulsive movements, weak pulse.
Cuprum metal. or acet.-The Metallicum is generally considered the best.  It is analogous to the former remedy,
and is applicable where there are spasms in the abdomen, of
a severe character, extending to the chest; or if there be
loathing, retching, vomiting, cramp, and contractions of the
extremities, epileptic spasms, &c.
Causticum is useful where hysterical spasms prevail, with
pinching pain in the sacrum and spasms in the abdomen,
with yellowish, earthy complexion.
Pulsatilla,-when spasms occur in consequence of delay of
the menstrual discharge.
Cicuta, Terebinthina, Zincum,-if, together with suppression
of the menses, there be swelling of the breasts.
Calcarea Carb.,-when there is great general fulness along
with the suppression.
Graphites,-if there be roughness of the voice, cephalalgia,
oedema of the feet, chilliness, heavy, contractive pains in the
small of the back.
Natrum mur.,-if there be a scanty flow at protracted intervals, with sadness.
Strontiana is said to be useful when the menses are delayed
and the discharge is first serous and afterwards lumpy.
I need scarcely say, that all local applications, such as
stimulating injections, leeches to the parts, &c., are highly
injurious, or useless, for the disorder can only be remedied
by general and constitutional means.
Vicarious menstruation is that abnormal condition of the
system when, in connection with a scanty flow or entire suppression of the menses, there is a periodical appearance of
blood or bloody serum at other outlets.  It is recorded to
have taken place from the nostrils, eyes, ears, gums, lungs,
stomach, anus, bladder, nipples, the ends of the fingers and
toes, from  different joints, from  the  axillre, from  the
stump of an amputated limb, from ulcers, from varicose
tumours, and from the surface of the skin generally.



28


DISEASES OF THE WOMB, ETC.


The most extended portions of the mucous membrane
are, however, most frequently the seat of the discharge.  It
appears to be sometimes blood, at other times it has the
character of the catamenial fluid, being dark-coloured, thin,
and not coagulable.  The repetition of this discharge may
appear at the regular period, or it may intermit; and it does
not appear that any serious result follows, even when delicate
organs are the seat of it.  Sooner or later the uterus resumes
its functions, and the attack ceases.
I have under my care a young lady who is subject to
the oozing of spots of blood from the upper surface of all the
toes a few days prior to each return of the catamenia, which
are always very scanty.
Also a young woman, married, but who has never been
pregnant, in whom there is great irregularity in the return
of the periods, which varies from three to five weeks, who
finds at first serum, and then blood, ooze out of the right
nipple during the interval: this I witnessed myself, and cured
it by means of Lycopodium. Another patient, who has had
hmmoptysis for a year or two, with suppression of the catamenia, had, previous to the occurrence of the spitting of
blood, an oozing of that fluid from the scalp, just above the
forehead; this was repeated two or three times, and so alarmed
the friends of the patient that they ran off with her to a
medical practitioner at the time when the blood was trickling
down her forehead. In most of these cases Ferrum is the
Homoeopathic remedy.
There sometimes occurs, in the place of the menstrual
discharge, a vicarious leucorrhoea, which is periodical and
coexistent with a menstrual effort; it consists of a flow of
colourless, transparent mucus, and    occurs, usually, in
delicate, susceptible girls, or in women who have become
weak and exhausted from haemorrhfages, or long suckling.
It does not affect the health, and is therefore only to be
considered as an imperfect action of the organs, to be
remedied by generous and plain diet, change of air, and
medicines which tend   to restore healthy sanguification.
Calc., Ferrum, and China are the principal, to which may be
added Borax, Mag1n., Graphiles, and Phosphorus.



CHLOROSIS, OR GREEN-SICKNESS.


29


CHLOROSIS, OR GREEN-SICKNESS.
Chlorosis is a disease intimately connected with a state of
anaemia, or want of blood, and is characterised by a dull
complexion, the skin having a dingy, dirty-white, or greenish
hue, whence the name of green-sickness, and by an universal
and decided debility of the whole frame, with a torpor of
particular organs.
There is not only general weakness of the muscular
system, but weariness and langour of body, with listlessness
of mind, and childish caprice: dull headache, dullness of
the eyes, puffiness of the eyelids, flaccid state of the skin,
which is wanting in warmth, as in colour, prevail. The
patients are very sensitive to a low temperature, chills, and
crave for warmth; the extremities are cold, the lips and
tongue partake of the same exsanguine character, and are
pale and blanched, the latter is often covered with a thick,
tenacious mucus.   The pulse is small and weak; often, but
not always, quick: it is easily fluttered, and palpitation
readily indubed; the veins appear half empty and of a pale
rose colour; the respiration is oppressed; there is a sort of
half sighing, general malaise, difficulty of breathing, not from
obstruction but from nervous exhaustion, and throbbing of
the carotids.  Along with the palpitation of the heart there
is arterial murmur, or bruit-de-soufflet, characteristic symptoms of the disease which are the last to disappear, and
which reappear on the least impairment of health afterwards.
The appetite is diminished, the patient loathes food, or is
sick after eating, or much troubled with flatulence and
gastrodynia.   Often there is a desire for indigestible substances, particularly chalk, magnesia, or even cinders. The
bowels are costive, and often not relieved for several days in
succession, or if they are, the stools are dark and offensive.
The catamenia, if not already suppressed, will soon cease to
flow; the abdomen is generally tumid, but very variable in
size. The hands and feet frequently swell at night, and the
eyelids, if not the whole face, are puffy in the morning.
The urine is scanty, but usually clear. Whilst the strength



30


DISEASES OF THE WOMB, ETC.


and the flesh fail, other symptoms may be added; such as
acute pains, headache, with throbbing and a sense of fulness,
intolerance of light and sound; paroxysms of dyspncea and
hysteria also occur, and sometimes a cough ending in
consumption; or the patient may be affected with a general
dropsy.    It is satisfactory, however, to know, that many of
these fearfully foreboding symptoms, dependent rather upon
sympathetic irritation than upon actual organic disease, are
capable of being removed, and are amenable to homoeopathic
treatment.
Chlorosis, then, may precede or accompany the establishment of the menstrual function, or it may occur at any
time during its progress, in connection with a suppression, a
diminution, or even an excess of the secretion itself, or of
some vicarious discharge which may have taken its place.
If the disease make its appearance before the age of
pubescence, menstruation does not become established at
the proper time.     If, however, the menses had already
appeared before the disease set in, they then become irregular as regards time, duration, and quantity: sometimes a
mere appearance of the discharge takes place, either alone,
or in the form of coloured mucus, lasting for a day, or a day
and a half; and occurring at intervals of four, five, or six
weeks. At other times, a vicarious leucorrhoea takes the
place of the ordinary discharge, showing a local effort which
augments the general debility.
The predisposing causes of chlorosis are to be found
amongst all classes of society, either in the vitiating habits of
social life, where these have been of a sedentary and indolent
nature, in the frequenting of hot and crowded rooms, or
excessive indulgence in warm bathing, in the use of soft
beds, too much sleep, tight-lacing, &c.; or, in the humbler
classes, the constant inhalation of an impure atmosphere, with
close and sedentary employment; the abuse of diluents, acid
drinks, or spirituous liquors in early life; poor living, or
over fatigue; in fact, anything that impairs the vigour of
the nervous energy which regulates and sustains the faculty
of nutrition, the imperfection of which is the mainspring of
chlorosis.



CHLOROSIS, OR GREEN-SICKNESS.


31


The exciting causes are most commonly the depressing
passions and affections; unrequited love, " the hope deferred
that maketh the heart sick;" the reading of exciting novels,
sudden mental and moral shocks, introverted feelings, sudden
suppression of the menses at the age of puberty, getting the
feet wet during the flow, excessive menstruation, &c.
The disease may show itself all at once from a sudden but
deep impression made upon the nervous system, or it may
be gradually developed; in the former case it may be connected with an abrupt arrest of the catamenial flow; in the
latter, with a gradual and partial suppression, during which,
from some unusual fatigue or sudden emotion, the disease
becomes at once completely established.
It happens more frequently in spring and autumn than in
summer and winter; relapses occur in those seasons, as damp
and cold weather favours the disease.
Recovery takes place gradually; the face loses its pale
or unhealthy hue; the lips and tongue become red; the
pulse is fuller; the temperature of the body equable; the
spirits more cheerful; and the feeling of strength which the
patient now enjoys, aie sure signs of recovery. The menses
become gradually established and regular, and it is important
to protect the body well against the ill effects of damp and
cold weather. When the disease becomes inveterate from
neglect, improper treatment, or the continued operation of
its causes, it becomes dangerous from the morbid complications and associations which are manifested. Anmmia
is one of the immediate accompaniments of the chlorotic
state, nutrition and sanguification being from the first to
the last impaired, owing to the unhealthy tone of the
digestive organs, causing an insufficient quantity of healthy
chyle to be supplied to the blood, and the imperfect sanguification of that which is supplied. Hysteria, swelling of
the glands, neuralgia, chronic cutaneous eruptions, humatemesis, and melana; diseases of the heart or of the lungs;
dilatation of the right ventricle, or phthisis; disorganisation
of the spleen by atrophy or induration, either of which may
lead to dropsy, congestions of the liver, hemoxrhoids, melan



32


DISEASES OF THE WOMB, ETC.


choly, idiocy, and nymphomania, are amongst the secondary
diseases which accompany, or remain after, a neglected
chlorosis. Although chlorosis does not often prove directly
fatal, it may do so indirectly through any of the secondary
diseases which result in the course of its disturbing influence
upon the various organs of the body.
Treatment.-The first step is to remove, or counteract, the
mental or moral causes, as far as possible. A proper regulation of the diet must be enjoined. Avoidance of everything that can relax or enfeeble the mind or body must be
rigidly adhered to, such as sleeping too long, or lying upon
feather beds, or under too much clothing; late hours; hot and
crowded rooms; the exciting or depressing passions; novel
reading; rich and highly seasoned food and drink, &c.
"I Hamorrhages and profuse menstruation should be treated
with the remedies recommended under the several heads in
question; and if debility remain, from whatever cause, China
should be administered.   If the os tince or the vagina be
closed, a surgical operation will be necessary; after which it
will appear, whether such a mechanical difficulty was the
only cause of the chlorosis."
" The slow and gradual development of the disease shows
its more than ordinary hold in the deep recesses of the
organism, and the greatest care is therefore required to
remove it. All stimulants, wine, brandy, spices, &c., should
be abjured."
Pulsatilla.-At the commencement of the disease, when
the menses are feeble or retarded, the complexion pale, and
the muscles flabby.
Cocculus.-Particularly when the patient complains of
spasms deep in the abdomen, with irregular menstruation.
Nux vomica.--If the patient be of a vehement, passionate
temperament; the menses frequently appearing, but flowing
irregularly; if there be symptoms of gastric derangement,
vomiting, and constipation: or if the patient has indulged in
coffee or tea; to the latter circumstance Pulsatilla and
Ignatia are likewise adapted.
China.-(Ed.ematous swelling of single limbs, particularly
of the feet; puffiness of the eyelids; distension of the abdo



CHLOROSIS, OR GREEN-SICKNESS.


33


men, costiveness; acute pains; drawing, tension, or creeping
in the abdomen; bad digestion, sour eructations, morbid
cravings, and depraved appetite.
Arsenicumn-if the above symptoms are accompanied by
trembling, frequent fainting, and extreme debility.
Conium.   Entire suppression of the menses, great sensitiveness of the external and internal pudendum   every
four weeks; constant, dry heat of the body without thirst,
anxious dreams, and feeling of heaviness in the limbs;
whining mood, restlessness, anxious care about everything,
stitching in the region of the liver, which sometimes continues several days and weakens the body very much.
Phosphorus-the menses not being entirely suppressed,
but appearing irregularly; nausea, sour vomiting; oppression
of the breathing; vertigo, and erethism of the system.
Natrum mur. - frequent, ineffectual indications of the
appearance of the menses, accompanied with great sadness,
oppression, and anxiety, fainting spells; coldness of the pelvis,
and internal heat; heat in the face, weight in the abdomen,
teasing toothache, frequent burning, and' cutting in the groins.
Plumbum   has been greatly lauded by Dr. Winter as a
remedy in chlorosis.  He traces the resemblance between
its pathogenetic symptoms, or, as he calls them, the lead
cachexia, and those of the disease.  H'e considers that it
favours the action of iron, and that its action is rather uj)on
the vegetative system and the venous blood, while the relation of iron is stronger towards the vitality of the blood, and
especially to the arterial.  Hence the lead must precede the
iron, when the chlorosis takes place in early life; but when it
results from great loss of blood, the iron must be exhibited
first.
The cases of chlorosis in which the lead was used were
marked by orthopnoea, constipation, cedema of the feet, and
unusual muscular debility.
Sulphur is an important remedy in chlorosis.  It may be
alternated with Pulsatilla.
Sepia exhibits many general indications for chlorosis, and
comprises, moreover, various morbid conditions of the sexual
organs under its pathogenesy; as, for instance, a painful press3



34


DISEASES OF THE WOMB, ETC.


ing in the inner pelvis from above downwards, occasionally
accompanied with discharge of mucus, sometimes of a jerking,
darting in the vagina from below upwards, or of a stitch in
the vagina, with occasional discharge of single drops of blood.
If no blood be discharged, the patient complains, at particular periods, of aching pain in the abdomen, swelling in
the pudendum, or even discharge of mucus.
Belladonna and Platina should be carefully compared with
Sepia.
Borax will sometimes succeed when the disease has resulted from a sudden check of the catamenia, a remedy
being first given in accordance with the exciting cause.
Nitric acid, Lycopodium, and Graphites deserve consideration.  Ferrum   is the best remedy for inveterate cases of
chlorosis, " and it should be continued," says Hartmann,
" until every vestige of arterial murmur has disappeared;
but it must be given in massive doses.  Calc., Dig., Helleb.,
Kali, Spig., Val., Carb. v., Caust., Phosph. ac., Sabina,
Suilph. ac., Zinc., are also amongst the remedies sometimes
useful in chlorosis.
LEUCORRH(EA.
In the natural and healthy condition of the female
organs, the lining membrane of the fallopian tubes, uterus
and vagina, is lubricated by a thin, transparent, glairy fluid,
for the double purpose of obviating the effects of friction,
and of preserving the channels free and smooth, and void of
the risk of adhesion.  There is also that regulated balance
between absorption and secretion which prevents an accumulation of the latter; but, when, from accidental causes
operating either directly 'upon the organs themselves, or by
remote sympathy through other organs, this secretion is
augmented and the healthy absorbent action overpowered,
the secretion becomes a source of great discomfort to the
female, and is then called leucorrhoea, or fluor albus, which, if
not remedied, sooner or later affects her general health.
The secretion is first simply increased in quantity, but soon



LEUCORRHCEA.


35


changes to a milky character, and, under these circumstances,
may depend upon a relaxed condition of the exhalents of
the mucous surface, as a consequence of deranged health.
But it may become purulent, from aggravated morbid action
in the glands about the os and cervix uteri, or of some
part of the vaginal passage,-just as the character of the
secretion is changed under a catarrh of the bronchial mucous
membrane. It is sometimes observed to be clear, colourless,
and viscid, resembling the white of an egg; it is usually
found to exude from the cavity of the uterus, and may be
only an increase of the natural secretion of that part; but
under a sub-inflammatory condition of the membrane, it is
found to be yellow, or thick, opaque, and jelly-like; it is
more ropy and tenacious than the other kinds. The character of the secretion which comes from the cervical canal
is not very evident; first, because the secretions from the
cavity of the uterus necessarily pass along it; and, secondly,
because inflammation of the cervical canal is seldom observed without some morbid action of contiguous structures; but the copious secretion which is poured out during
labour by the mucous glands or follicles of that part, and
the extensive secretory surface afforded by the palmme
plicatme, render it probable that some forms of leucorrhoea
have their origin in that structure.
When erosion, ulceration, or other more grave morbid
condition of the uterus or its neck co-exists, the discharge
is found occasionally to be streaked with blood, ichorous
or watery, ahd may be serous, green, dark or sanguineous,
or purulent and fetid.   It is often greenish, brownish, or
exhibits a yellow tinge. Another appearance presented by
it is that of a white or cream colour, or resembles starch
diffused in water; this was first noticed by Sir C. M. Clarke,
and described by him as pathognomonic of inflammation of
the cervix uteri. It is sometimes homogeneous; at others
the pearly white portion of the discharge is imperfectly
mixed with the clear transparent viscid mucus with which
it has come in contact, and is then stringy or ropy. The
one seems to come from the exterior of the cervix, while
the other, or clear gelatinous portion, has descended from



36


DISEASES OF THE WOMB, ETC.


within the cavity.  I think it may be concluded that when
the discharge is thin, copious, and milky, or puriform, it
generally proceeds from the lacune of the vagina; when it
is pearly or starch-white or thick, yellowish, or fetid, or
streaked with blood, it comes from the glandular apparatus
about the os or cervix; and when it is viscid, or like jelly,
either translucent or opaque, its origin is the cavity of the
uterus or the cervical canal.
Leucorrhoea often commences as an inflammatory affection
of the vagina, attended with local heat, painful micturition,
excoriation and irritation of the external parts, and general
febrile disturbance, which soon subsides, the disease passing
into the chronic form.    The vaginal lining is the most
common source, especially early in life.
Leucorrhcea is more general than any of the affections
peculiar to the sex, and not unfrequently commences before
menstruation, especially when that is retarded, and is one of
the symptoms in amenorrhcea.
It may exist in connection with a robust and plethoric,
or with a relaxed and debilitated state of the system.
It has been supposed to depend often upon irritation of
the spinal marrow at the origin of the sacral nerves, and
this is very probable, more especially in those cases which
occur at the early periods of menstruation.    As well as
occasionally preceding that function, it sometimes takes the
place of it, where there has been obstruction, the leucorrhcea
becoming more abundant at the monthly period, and attended with pain in the back. Of this vicarious leucorrhcea,
notice has been taken at page 19.
With regard to the local symptoms associated with leucorrhoea, there may be morbid heat of the vagina, with
tenderness of the os and cervix, or even of the body of the
uterus, enlargement of the mucous glands or follicles, the
os uteri feeling soft and tumid, occasionally patulous, and
often bathed in discharge. There is often painful or difficult
micturition, irritation of the bladder or rectum, a sense of
burning in the vagina, and the external parts become heated
and excoriated by the acrid, corrosive nature of the discharge.
This is not unfrequent in young women, and is generally



38


DISEASES OF THE WOMB, ETC.


symptoms referable to the morbid condition of the organs,
whether it be a displacement or other structural disease.
The causes of leucorrhcea are:-cold and moisture, frequent excitement resulting in debility, excessive indulgence,
frequent pregnancies, abortions, haemorrhages, protracted lactation, irritation of a pessary or of injudicious local applications, prolapsus uteri, polypi, or other tumours of the
uterus or vagina, ascarides or haemorrhoidal affections,
congestions of the os and cervix, scrofulous taint of constitution.
Treatment.-In order properly to fulfil the curative indications, it will be well to bear in mind the characteristics which
mark the three forms of the disease which have been alluded
to, namely:
1. The acute and mild conditions of the simple form.
2. The aggravated or chronic.
3. The symptomatic.
Here, instead of applying stimulating injections, which so
often augment the evil, or cauterizing the vagina, or operating violently upon the stomach or bowels, we have in
Homoeopathy much more simple and efficient means, by
which we can remove or limit the discharge. The hygienic
rules to be adopted, with a view to aid the action of the
medicines, consist for the most part in observing a simple,
nutritious, unstimulating diet, regulated in its quantity and
quality, by the extent of the inflammatory symptoms present.
The patient should not be exposed to cold or damp, or to
endure fatigue, or to much standing, and should avoid too
much excitement, late hours, and hot rooms.
The remedies calculated to relieve the different kinds of
leucorrhoea, are:In the more simple form,-Alum., Amm. c., Bor., Baryt. c.,
Calc., Con., Graph., Kreos., Lye., Merc., Puls., Sep., Sulph.;
In the acute,-Acon., Amm. c., Borax, Calc. c., Carbo v.,
Con., Kali c., Lyc., Phos., Puls., Plat., Sab., Sep., Sil.,
Sulph. ac.;
In the aggravated and chronic form,-Alum., Amm. c.,
Ars., Carb. a., Carb. v., Caus., Canth., Chin., Cham., Con.,
Ign., Kali c., Kreos., Lach., Lye., Mere., Mez., Magn. c.,



LEUCORRH(EA.


39


Natr. m., Nitr. ac., Phos., Puls., Ruta, Sep., Sil., Sul.,
Sulph. ac., Stan., Zinc.;
In the symptomatic, -Alum., Amm. c., Ars., Amb., Calc.,
Caps., Carb. veg., Cham., Chin., Con., Graph., Kali, Kreos.,
Lyc., Mag. c., Merc., Mez., Natr., Natr. m., Nit. ac., Nux v.,
Phos., Puls., Sass., Sab., Sep., Stann., Tart., Thuja, Zinc.:
When fetid,-Chin., Kreos., Natr., Nit. ac., Nux v.,
Sabina, Sep.
The following from Boenninghausen gives a more succinct
arrangement of the remedies applicable in leucorrhoea:In general:-Acon., Alum., Ambr., Amm., Amm. m.,
Anac., Ant. cr., Ant. tart., Ars., Bar., Bell., Bor., Bov.,
Bry., Calc., Cann., Canth., Carb. an., Carb. v., Caust., Chain.,
Chin., Cocc., Coff., Con., Dros., Ferr., Graph., Guiac., Hep.,
Ign., lod., Kali, Kreos., Lyc., Magn., Magn. m., Mang.,
Mere., Mezer., Mur. ac., Natr., Natr. m., Nitr. ac., Nitr.,
N. mosc., N. vom., Petr., Phosph., Ph. ac., Plat., Plumb.,
Puls., Ran. bulb., Ruta, Sabina, Sass., Scill., Sec. corn.,
Seneg., Sep., Sil., Stann., Stront., Sulph., Sulph. ac., Thuja,
Viol. tr., Vit., Zinc.
Yellow colour:-Acon., Alum., Ars., Bov., Carb. an.,
Carb. v., Chamin., Kali, Kreos., Lye., Natr., N. vom., Ph. ac.,
Sabina, Sep., Sulph.
Brown:-Amm. mur., Nit. ac.
Green:-Bov., Carb. v., Merc., Puls., Sep.
Fetid odour:-Chin., Kreos., Natr., Nitr. ac., N. vom.,
Sabina, Sep.
Watery nature:--Amm., Ant. cr., Ant. t., Carb. an.,
Carb. v., Cham., Chin., Graph., Kreos., Magn., Magn. m.,
Mere., Mez., Nitr., Puls., Sep., Sil., Sulph.
Thick:-Ambr., Ars., Bov., Carb. v., Magn. m., Natr.,
Natr. m., Puls., Sabina, Sep., Zinc.
Milky: --Amm., Calc., Carb. v., Con., Ferr., Graph.,
Kreos., Lye., Natr. m., Phos., Puls., Sabina, Sep., Sil.,
Sulph., Sulph. ac.
Purulent:-Calc., Chin., Cocc., Ign., Kreos., Mere.,
Sabina, Sep.
Mucous:-Alum., Ambr., Amm. m., Ars., Bell., Bor., Bov.,
Bry., Calc., Canth., Carb. an., Carb. v., Cocc., Con., Ferr.,



40


DISEASES OF THE WOMB, ETC.


Graph., Guiac., Kreos., Magn., Mere., Mezer., Natr. m.,
Nitr., Nitr. ac., N. vom., Petr., Phos., Plumb., Puls., Sabina,
Sass., Seneg., Sep., Stann., Sulph., Sulph. ac., Thuja, Zinc.
Bloody:-Alum., Ant. t., Ars., Canth., Carb. v., Chin.,
Cocc., Con., Kreos., Lyc., Magn. m., Nitr. ac., Sep., Sil.,
Sulph. ac.
Viscous:-Acon., Amm. m., Bor., Bov., Mez., Phos.,
Ph. ac., Sabina, Stann.
With burning:-Amm., Ars., Bor., Calc., Canth., Carb. an.,
Con., Kali, Kreos., Puls., Sulph. ac.
Itchiness:-Alum., Anac., Ars., Calc., Chin., Ferr., Kali,
Kreos., Mere., Phos. ac., Sabina, Sep.
Corrosive:-Alum., Amm., Anac., Ant. cr., Ars., Bov.,
Calc., Cann., Canth., Carb. an., Carb. v., Cham., Chin., Con.,
Ferr., Hep., Ign., Iod., Kali, Kreos., Lyc., Magn., Magn. m.,
Mere., Mez., Natr. m., Nitr. ac., Phosph., Ph. ac., Puls.,
Ranun. bulb., Ruta, Sep., Sil., Sulph., Sulph. ac., Thuja.
DYSMENORRH(EA.
Menstruation is sometimes attended with difficulty and
pain of a distressing kind, which is referred to the lower
part of the abdomen, or the back, and often causes- the
person to remain in bed, where she rolls about in agony,
and is troubled with nausea, or sickness, loss of appetite,
diarrhoea, and chilliness. This state is, however, seldom attended with febrile excitement. Painful menstruation occurs
at all ages, from the first establishment of the function to its
cessation, but it may be cured by treatment.  It happens to
the married as well as the single, and is not unfrequently a
cause of sterility; on the other hand, it is often cured by
pregnancy.    The pain sometimes begins only an hour or
two before the flow; at others it is troublesome for a day or
two previously, and is relieved by the discharge. The
menses may commence regularly, and continue for a few
days, either diminishing after the first day or ceasing abruptly, and all the while being accompanied by a great deal
of suffering. Small clots or shreddy membranaceous matters
escape along with the discharge, which is usually scanty,



DYSMENORRH(EA.


41


although in some few instances it is excessive. In some sanguine and plethoric subjects the formation of a mass taking
the shape of the uterine cavity occurs, which consists of a
membrane appearing, upon superficial observation, not unlike the decidua of pregnancy, inclosing a coagulum; this is
expelled with  a good deal of pain.      It has been called
spurious abortion, and often leads to painful suspicions, from
the supposition that pregnancy existed.   Dr. Simpson consicers it to be a separation of the lining membrane of the
womb, analogous to what takes place from the intestinal
canal, from the circumstance of its being perforated with holes
which correspond to the mucous follicles of the uterine surface. When an individual is subject to this deviation from
the healthy function, she is apt to have a recurrence of it,
either monthly or at occasional intervals, and the period is
then attended with febrile symptoms, with sympathetic distension of the breasts, and expulsive (forcing) pains.
Dysmenorrhoea has been distinguished by the pathological
states which accompany it into the neuralgic, the inflammatory, and the mechanical forms.
Neuralgic Dysmenorrhcea occurs at all ages, but is said to
be most frequent after the thirtieth year.  It is chiefly met
with in subjects of a nervous, irritable temperament: it
sometimes lasts only for the first day or two of the catamenial flow, when, after the escape of a small clot, the discharge becomes free, and relief is obtained.  At other times
the whole period is one of continued suffering.
The symptoms which prevail in these cases, and which
must direct the choice of remedies, are:-sharp, lancinating
or dragging pains in the uterus and vagina, extending into
the iliac regions; lumbar pain running down the sacrum
into the groins and thighs; pains of expulsion (forcing) like
labour pains, during the emission of the discharge; sympathetic pains in the breasts; there is nervous, but little vascular excitement; irregularity of the bowels, at one time
constipation, at another the reverse; capricious and small
appetite; loathing of the food; pallor of countenance; coldness of the extremities; emaciation; loss of physical strength;
leucorrhoea; the menstrual discharge is often paler than is



42


DISEASES OF THE WOMB, ETC.


natural, is occasionally mixed with small clots and shreds,
and occurs either scantily and slowly, or in sudden, slight
jets.
Inflammatory or Congestive Dysmenorrhoea.-The subjects
in whom this form of dysmenorrhoea is developed are the
robust and plethoric, with dark    hair, florid complexion,
turgid constitution, and in whom the sanguineous or the
melancholic temperament prevails. The period is usually
preceded by symptoms of restlessness, feverish heat, with
rigors, flushing of the face, and headache, intolerance of light
and sound, and sometimes delirium: as the function commences, weariness and aching of the limbs, weight in the
loins, hot skin, full and quick pulse, are added, together with
bearing-down pains, cutting and contractive pains in the
abdomen, violent expulsive (forcing) efforts like those uf
labour, which, however, are not subject to remission, until
-after a paroxysm of great suffering-a small clot, or a
portion of membranous substance, is passed.      Sometimes
the discharge is profuse as well as painful, and mingled with
several small coagula; but more generally it is scanty, when
the difficulty of emission is very great: or the more inflammatory symptoms may be absent, and the period be accompanied by symptoms of passive congestion of the uterus and
its appendages, such as weight and pain in the loins and
pelvis, as if the parts were dropping through, constipation,
and frequent micturition; aching of the thighs, an incapability of maintaining long the upright posture, &c. Intense
paroxysms of pain occur, as though something were contained
in the uterus, and must escape: these are temporarily relieved by the passage of a small clot; but full relief is not
obtained until the catamenial period has passed over. The
flow is generally sluggish, and the discharge dark. The
pulse is rather weak and quick; there is often a cool and
perspirable skin. There are, frequently, pain and swelling of
the breasts, and uterine leucorrhoea during the interval.
The constitution is not often much affected by the severe
attacks, unless they continue unmitigated for a considerable
period.
Mechanical Dysmenorrhca.-Painful or difficult men



DYSMENORRH(EA.


43


struation may occur from a narrowing of the cervical canal
of the uterus in some part of its course.  This stricture has
been relieved by the use of bougies, or the sound, but the
dysmenorrhoea has not always been cured in consequence.
The painful operations which have been had recourse to
in these cases, for the purpose of dilating the cervical canal
by means of the uterine sound, have frequently done more
harm than good, and are to be greatly reprobated as general
applications; they should at any rate be omitted until all
other means fail, and then only employed in urgent cases.
The principal remedies which are suggested by their correspondence with the symptoms manifested in these varieties
of dysmenorrhoea, and with the general condition of those
subject to them, are,-Coffea, Chai., Cocc., Crocus, Graph.,
Phos., Puls., Sep., Sulph., and Am. carb.
Coffea will be found serviceable when the subjoined symptoms prevail:-great nervous excitability; headache; continuous pinching pain in the iliac regions; dartings in the
sides of the abdomen; pains like those of labour; loathing
of food; colic, with coldness and stiffness; pressure on the
bladder; frequent desire to pass water, &c., with increased
menstrual discharge.
Chamomilla, when the symptoms are as follow:-sympathetic swelling of the breasts, with intolerable labour-like
pain, incisive pains in the sides of the abdomen, during the
flow of the menses, which are profuse or lumpy, with relaxed
bowels.
Crocus, when, previous to the appearance of the menses,
bearing-down pain in the groin, sharp lancinations in the
abdomen, colic, &c., occur as the predominant symptoms.
Cocculus, when the discharge is irregular, fitful, scanty,
and attended with uterine spasms and pressing pain in the
groins; or with copious discharge of coagulated blood, followed by hemorrhoids, and painful efforts; shivering over
the mammme; gastric disturbances, and bilious vomiting, with
aversion to food; constipation.
Graphites.-Scanty and thin discharge, with violent pain
in the back, attended with morning sickness; chilliness;
colic; constipation previous to the catamenia, diarrhoea



44


DISEASES OF THE WOMB, ETC.


after; much rumbling in the intestines, with a burning and
bearing-down pain; distension after a meal, with nausea;
heartburn and water-brash; dull headache.
Phosphorus.-When the menses occur too early and are
scanty, or too profuse and continue too long, being attended
with pains in the back and abdomen; cutting in the abdomen, with pain in the back and vomiting, colic, chilliness, with cold hands and feet; dull headache, stitches in
the mammme; constipation; feeling in the back and limbs as
if bruised and broken; sour eructations and vomiting; sick
feeling towards evening; great weakness with blue margins
round the eyes, and anxiety after the menses.
Pulsatilla.-In a retarded state of the catamenia, the discharge being black, with coagulated blood, or pale and
serous, with colic; abdominal spasms; sacral pains; tenesmus of the rectum and bladder; gastric disturbance, nausea,
and qualmishness; megrim, vertigo, shiverings, pallor, tearfulness, anguish, sadness, and melancholy.
Sepia.-Menses premature and scanty; pressing down of
the uterus, with colic; violent colic just before the menses,
with faintishness; shuddering all over the body; burning and
frequent stitches in the vagina; disturbed sleep owing to the
feeling of tearing in the back; chilliness and heat, thirst and
painful constriction in the chest; contractive pain in the
vagina; violent stitches from the pudendum to the umbilicus; costiveness, headache, toothache, and leucorrhoea.
Sulphur,-when the catamenia appear too early and are
too profuse, the discharge being thick and black, with burning in the vagina. During the menses, cutting and contractive pain in the hypogastrium, violent pain in the small
of the back, and colic, with bloatedness, the flow being
scanty. Violent pain in the abdomen, with heat, chilliness,
and a sort of epilepsy.   Aversion to meat, dyspeptic symptoms, flatulence, constipation.
Ammon. carb., - when the catamenia are premature,
abundant, and preceded by griping, colic, and want of
appetite; when the discharge is blackish, in clots, and passes
off with spasmodic pain in the abdomen, with constipation
and' tenesmus, paleness of face, sadness, and toothache;



DYSMENORRHCEA.


45


violent tearing in the abdomen and vagina; intense pain in
the small of the back, and great coldness.
Belladonna is applicable to the treatment of cases characterised by the following symptoms and conditions: congestive enlargement of the uterus, or prolapse of that organ;
menstrual spasms shortly before the catamenia, with drawing
labour-like pains from the small of the back to the thighs
and calves, extending to the umbilicus, with pressure downwards. Vascular excitement, turgid countenance, with cold
extremities, &c.
Bryonia is especially useful in treating the inflammatory
or congestive variety; the symptoms are as follows:chilliness, congestion of the head, and cough, bleeding at the
nose, and leucorrhoea.
Calcarea is to be preferred when indicated by such conditions and symptoms as follow:-in delicate, scrofulous, full,
and irritable subjects more particularly:-a too frequent and
too copious flow of the catamenia, with vertigo when stooping, or rush of blood to the head, and heat in the head, with
toothache; aching and burning soreness of the organs,
leucorrhoea; griping and spasmodic pain in the back; violent
colic; anorexia, nausea, &c.  This remedy is especially suitable to the lymphatic and venous plethoric constitution.
Ignatia,-in the neuralgic form of dysmenorrhcea, when
the menses are scanty, and the blood is dark; when coagula
are passed; or there are uterine spasms and lancinations,
contractive colic, palpitation of the heart, languor unto fainting; or uterine spasms relieved by pressure and the recumbent posture.
Nux vomica is appropriate for the treatment of subjects of
an irritability of temper, in whom the menses appear too
early, but are scanty and attended with uterine spasms; a
griping and digging, with coagula; burning heat of the
vagina; faintings on the appearance of the menses in the
morning, preceded by spasmodic movements in the abdomen,
and succeeded by languor and chilliness; cold hands; constipation; frequent desire to pass water; yellowish leucorrhoea during the intervals.
Platina is most useful for the treatment of individuals



46


DISEASES OF THE WOMB, ETC.


who are subject to nervous and vascular erethism; it may
also often be used with advantage in alternation with Belladonna when the menses are profuse and attended with
cutting, pressing, labour-like pains in the abdomen, small of
the back, and thighs; the discharge being dark, with lumps
or pieces intermingled; constipation, and frequent micturition, anorexia, restlessness, and tears.
Secale, when the menstrual discharge is too frequent and
continues too long, attended by tearing and cutting colic,
coldness of the extremities, cold perspiration, great weakness, small pulse.
MENORRHAGIA.
When the menstrual discharge recurs too frequently, or
too copiously, or if it be in excess at periods when it is usually
absent, as during gestation and suckling, menorrhagia is considered to exist; but it must be borne in mind, that climate
or constitutional idiosyncrasy may determine an excess, without the general health becoming thereby affected.   Three
varieties of menorrhagia are met with in practice.  In the
first, the discharge is normal in character, but the quantity,
or the frequency of recurrence, is greatly increased; or in
some cases both the quantity and the frequency are subject
to these deviations from   the normal condition.   In the
second, the discharge is great, and is accompanied by pure
blood: in neither of these forms is there any change in the
body or neck of the womb perceptible to the touch.  In the
third variety, there is, in addition to the great augmentation
of the discharge and the appearance of blood and coagula, also
a perceptible change in the size and position of the uterus.
Married women are more liable to menorrhagia than
single; and it is rare for these, if otherwise healthy, to have
uterine haemorrhage.
Leucorrhoea is rarely absent in these cases during the
intervals of menstruation.
The first variety of menorrhagia, although the simplest
form, is the most rarely met with, and from the impercep



MENORRHAGIA.


47


tible degrees by which it undermines the health, is, perhaps,
the least often paid attention to. It occurs either by violent
and sudden gushes from the vagina, stopping and recurring
during the whole menstrual period, or the usual free discharge may continue uninterrupted for one, two, or three
weeks; or again it may, after lasting for the ordinary time
of four or five days, return before the proper period, and be
repeated every two or three weeks, leucorrhcea succeeding
and continuing during the whole interval between the
periods.
The effects of this irregularity and excess of function soon
become apparent.    Exhaustion, languor, indisposition    to
exertion, weakness across the loins and hips, and at the
lower part of the abdomen, nervous headaches, throbbing of
the temples, tinnitus aurium and giddiness, chilliness of the
surface and extremities, palpitation of the heart, and all the
symptoms of confirmed anaemia, followed, if not relieved, by
the distressing and serious disorders of the various organs and
functions of the body necessarily consequent upon that condition; such as mental hebetude, or morbid irritability, or
even epilepsy; derangements of the stomach and bowels,
diarrhoea, anasarca, and various nervous symptoms. An
examination per vaginam discloses nothing but the os uteri,
perhaps, slightly open.
The causes of this derangement are, chiefly, frequent
childbearing and miscarriages, over-suckling, cold, mental
emotion, and sexual excess.
The second variety, characterised by the discharge of
blood, in addition to the usual menstrual secretion, and accompanied by the expulsion of coagula, generally occurs in
married women and those of leuco-phlegmatic temperament.
This form is of a more acute kind, and may occur in the
robust or the delicate.  The discharge is more profuse from
the beginning, and induces disturbance of the general health
more rapidly, and therefore sooner attracts attention.
When it occurs in the robust and plethoric, it is attended
by an active state of the heart and arterial system, or, at
times, by febrile symptoms, the menstrual flow being preceded by a sense of weight and tension in the region of the



48


DISEASES OF THE WOMB, ETC.


uterus, a fulness and throbbing within the pelvis, the external parts being often tumid and painful. The following
manifestations also occur: swelling and tenderness of the
breasts, and headache; violent pain in the womb, loins, and
thighs; burning heat in the pelvis; quick and hard pulse.
The discharge often comes on in violent gushes, with relief
when febrile symptoms are present; or a sudden profuseness
takes place sufficient to cause fainting, and accompanied by
large masses of coagula.   This continues several days, at the
end of which time the patient is weak and exhausted.       A
few repetitions of these attacks will impair the health, and
reduce the patient to a state of anaemia; or, if the morbid
condition be kept up by an injudicious use of stimulants,
during the interval, with the intention of quickly regaining
the lost ground of health, a passive form of menorrhagia is
induced, and all the evil consequences referable to anaemia
may be incurred. When this form occurs in delicate and
hysterical, or scrofulous females, the concomitant symptoms
are more of a nervous than of an inflammatory character.
In the place of such symptoms as the congestive headache,
throbbing pulse, and general excitement, the case is usually
characterised by the following manifestations:-tendency to
spasmodic affections, contractive pain in the uterine region,
the discharge coming away by gushes, quick and irritable
pulse, chilliness, faintness, pallid and anxious countenance,
sleeplessness, &c.
The third variety occurs generally in the middle and later
periods of life, and is either connected with climacteric cessation of the menstrual function, or may lead to the inference
that disease of the uterus itself exists.  It is not peculiar to
any one temperament.     The discharge is more profuse than
in the other varieties, and the effects, if possible, are more
severe.  It continues for a long period, at times in alarming
excess, and is often preceded and followed by a watery, or
leucorrhoeal discharge.  During the attack, which sometimes
lasts throughout the whole period of the ordinary interval,
or occasionally even for several months in succession,-interrupted only by temporary intermissions from time to time,
during which the aqueous or leucorrhoeal discharge takes its



MENORRHAGIA.


49


place, and becomes slightly or offensively odorous,-the
patient may complain of pressure, or aching, or lancinating
pain in the uterus, weight and pain in the uterine and lumbar regions, faintness and exhaustion, dysuria, loss of appetite,
nausea, constipation or diarrhoea,-further characterised, if
the complaint be of long duration, by a sunken, cadaverous,
careworn countenance, quick and weak pulse, coldness of
the extremities, and oedema.
In these cases the uterus is found enlarged, with the os
more or less patulous, lower down than usual in the pelvis,
and tilted back towards the sacrum; the cervix as well as
the body of the uterus is swollen, and tender to the touch.
The danger in all these varieties is dependent upon the
state of anaemia induced by the drain upon the system; and
the prognosis must therefore be guided by the effects already
produced; unless, as in cases of the last kind, in addition to
the state of the uterus described above, there exists serious
organic or malignant disease.
Treatment.-If any of the above causes, which have been
enumerated as productive of this complaint, continue to
exist, they must be removed as a preliminary step to the
medical treatment; after which some of the medicines from
the annexed list, chosen in relation to the symptoms of the
individual, will be found most efficacious in correcting the
tendency to the disorder, and arresting the immediate attack.
The recumbent posture with light clothing, and as much
fresh air as the season or the circumstances of the patient
will admit, a tolerably cool apartment, and a hard bed or
couch, must be prescribed.   In the interval, everything
which can add to the fortifying of the system generally,change of air, light, nutritious diet, salt water baths, sponging
with salt water over the loins and lower part of the abdomen, and an avoidance of pregnancy for a time, must be
adopted.
In the first variety, the following medicines are particularly applicable to the treatment:-Belladonna, Bryonia,
Calcarea, Ignatia, Natr. mur., Nux v., Phosphorus, Sabina,
Secale, Sepia, Lauro-cer.  In the second, -Acon., Bell.,
Bryon., Calc., Cham., China, Crocus, Ferr., Hyosc., Ignatia,
"4



50


DISEASES OF THE WOMB, ETC.


Iodium, Ipecac., Kreos., Magn. m., Nux v., Phosph., Platina,
Puls., Sec., Sep., Sab., Sulph., or Carbo veg., Ratanhia, Ruta,
Veratr.   In the third,-Acon., Arsen., Arn., Bell., Cham.,
Calc., China, Carb. veg., Crocus, Ferr., lod., Ipec., Kreos.,
Phosph., Puls., Secale, Sep., Sabin., Sulph., Veratr.
Besides the treatment which may be requisite during the
attack, when every effort must be made, by a careful selection of remedies homceopathic to the individual case, to
arrest the catamenial excess, it is important to proceed
during the interval with such antipsoric treatment as shall
restore the system to a healthy balance, and so regulate the
functions that the return of the menses at the future periods
shall be normal. This course may be commenced immediately after the cessation of the superabundant flow, or so
soon as the constitution shall have rallied from its effects, or'
on the first day after the cessation of the menses. The plan
most likely to effect this, is that adopted by Dr. Hartmann,
which is to administer, first, a dose of Nux vomica of the
6th or 9th dilution, in the evening; and, thirty-six hours
after that, a dose of Cinchona of the 6th or 3d dilution.
On the evening of the fourth day, that is, thirty-six hours
after the foregoing dose of Cinchona, a second administration
of Nux v., followed as before by Cinchona, after a similar
interval. After this, Tinct. sulph. of the 6th or 3d dilution,
and, two days later, Calc. carb., continuing the administration
of these two alternately until the return of the catamenial
period.   The result of this treatment is most satisfactory, as
even in cases of long standing there is steady improvement
in the general health, and the regular return and course of
the subsequent menstrual periods.
A brief outline of the symptoms and conditions which
more especially indicate the medicines chiefly applicable to
the treatment of this complaint will perhaps suffice here,
leaving the reader to study the rest, by accurate investigation
of their respective pathogenetic properties, for the treatment
of rarer cases, as they may present themselves.
Aconite, Belladonna, and Bryonia are applicable to cases
in which there is arterial excitement or great irritability.
Belladonna corresponds to a discharge of dark and partly



MENORRHA GIA.


51


bright-red blood; constant pressure in the vagina, as if the
uterus would prolapse; pains in the back, as if it would
break, &c.
Chamomilla is to be preferred when the discharge of blood
is dark, blackish, and coagulated, and occurs in gushes, with
pressure in the uterus like labour pains, frequent desire to
pass water, and drawing or tearing pains in the thighs and
legs; quarrelsome humour, fainting fits, coldness of the extremities, paleness of the face, thirst.
Excessive menstruation is said to be frequently caused by
the abuse of Chamomile tea, in which case its effects should
be neutralised by the administration of Nux v., Ignatia, or
China. According to the particular constitution and temperament of the patient and the circumstances of the case,
Coffea cruda may be employed to remove great nervous
sensibility.
China is useful when the discharge is black and clotted,
occurring at intervals, with pressure at the uterus and jerking movements of the body, proceeding from depletion
rather than spasm, and with painful tension of the abdomen;
or when, from great loss of blood in the most serious cases,
the subjoined symptoms and conditions characterise the case:
sense of weight of the head, vertigo, dullness of sensibility,
syncope, coma, the patient being cold and blue: it may be
given, also, after the attack has passed over, or in the interval
of the catamenia, as part of the constitutional treatment.
Calcarea is very useful when the menses are too profuse
or too frequent in their recurrence, when the patient exhibits a scrofulous diathesis; but Hahnemann says, it is
never given with benefit when there is a deficiency of the
catamenia.  It is, however, more advantageous when given
during the interval, in order to correct that condition of the
system on which the abnormal state of the function often
depends, and in which cases it may be given alone, or in
alternation with Cinch., Nux v., and Sulphur.
Crocus is a very excellent remedy in cases of haemorrhage
from the uterus. Its employment is indicated by the escape
of black, lumpy, viscid blood, increased by the least movement, with cutting pains, deep in the abdomen, extending



52


DISEASES OF THE WOMB, ETC.


to the small of the back: its characteristic symptom is the
sensation of something alive in the abdomen in the form of a
ball, when the huemorrhage is active; it is suitable in attacks
of menorrhagia, which have arisen from dancing or taking
stimulating drinks when the catamenia were present; or
when palpitation, anxiety and melancholy, jerking and
creeping in the limbs, thirst, heavy dreams, and starting on
going to sleep, prevail.
Hyoscyamus.-One of the primary effects of this drug is
uterine hemorrhage.     It is indicated when the subjoined
symptoms characterise the case:-profuse menses, accompanied by delirium, the blood being bright-red; or spasms,
interrupted by jerks or startings of single limbs, followed by
rigidity of the joints; or preceded by hysteric pain or hysterical laughter, attended with spasmodic pains and trembling
of the hands and feet; difficult micturition, with pressing;
fainting fits, with convulsive movements; or restlessness, the
body being hot, with swelling of the veins, a full and quick
pulse, dullness of the senses, obscuration of sight, delirium.
Ferrum is applicable when the blood is at times fluid, at
others black and lumpy, with labour pains in the abdomen
and groins, great vascular excitement and a hot, red face,
the pulse being hard and full.   (China is said to be useful,
sometimes, after Ferrum.)
Ignatia may be given when the menses come away in
lumps of coagulated blood, with a crampy pain in the uterus
like labour pain, and with a tendency to spasms.
Ipecacuanha is indicated when there is much weakness and
the hmmorrhage is of a passive character, with a cutting pain
at the umbilicus, a pressing towards the uterus and anus, with
coldness, shivering, paleness of face, and heat within the
head, the discharge being bright-red.
Kreosotum corresponds with the following state:-discharge of a large quantity of dark blood, followed for some
days by the discharge of a bloody ichor with a pungent
odour; corrosive itching and smarting of the parts; then the
menorrhagia recommences, consisting of coagulated pieces
of blood, accompanied with buzzing, and pressing in the head
from within outwards.



MENORRHAGIA.


53


Lauro-cerasus is sometimes useful when there is a profuse
discharge of liquid blood, with pain, hysteria, and nightly
tearing in the vertex.
Platina is most beneficial when the patient is of a
haughty temper and irritable, the discharge consisting of
dark, thick, but uncoagulated blood, and when the following
symptoms prevail:-pressive pain, extending from the small
of the back to the groins; forcing outwards through the
organs, great excitability of these parts, with sensitiveness.
Pulsatilla, although so important a remedy in amenorrhcea,
is nevertheless very useful at times in menorrhagia, when
the blood is thick and black, or pale and watery, and flows
by fits and starts; or when it is profuse, especially at the
critical age, and when the following symptoms occur:headache, noise in the ears, sadness and melancholy, or
when there is irritation of the nerves.
Sabina corresponds to the discharge of black, deepcoloured, clotted blood, with labour-like pain in the lumbar
vertebrae and uterine region; or to paroxysmal discharges of
bright-red blood, particularly during motion; or again it is
appropriate for the treatment of women who have frequently
suffered from abortion, and are at the time of life when
menstruation ceases.
A patulous state of the os uteri is an indication for the
use of Sabina.'
Thlapsi Bursa Pastoris.-Dr. Lange has observed the
greatest benefit to result from the use of this plant in
menorrhagia occurring in persons of a relaxed constitution.
It entirely cured the disposition to excessive discharge at the
periods.
Secale is, as might be supposed, a valuable agent in
menorrhagia; it is indicated in the congestive form, when
the menses are profuse, especially at the climacteric period,in weak, cachectic, and exhausted individuals, with cold
extremities, pale face, small pulse, and with apprehensiveness,
and despondency.    It should be used at a low attenuation.
Sepia is very serviceable when the menorrhagia accompanies induration of the os and cervix uteri, with transient
shootings and spasmodic colic,



54


DISEASES OF THE WOMB, ETC.


Veratrum, in cases in which menstruation occurs too
early, is too profuse, and attended with diarrhoea; or more
especially when buzzing in the ears, bleeding at the nose,
pain in all the limbs, and great thirst prevail.
MENSTRUAL CLIMACTERIC.
MENSTRUAL CLIMACTERIC, or the period of cessation of the
menses, varies in different women from the age of 35 to that
of between 60 and 70 years, but the average period is from*
40 to 50.   This event, which is called "the turn or change
of life," is marked by a variable state of the catamenia as to
quantity and frequency, for a longer or shorter period previous to their total cessation.  It is sometimes effected in a
few months, whilst in other instances, and more generally,
it occupies two years or even longer.
At this critical period, women are apt to suffer, especially
where a predisposition to disease exists, from derangements
of the nervous, vascular, or digestive organs, owing to the
altered condition of this one important function. Nervous
irritation of the brain, or increased action with venous congestions of one or more of the important organs, takes place;
morbid affections of the secretory functions of the liver, skin,
and mucous membrane, and development of malignant action,
are more likely to take place at this period, especially if there
had previously existed any morbid condition of the uterus,
or breast.  It is important, therefore, that the earliest deviations from health, at this time, should be promptly submitted
to medical care. When there is no tendency to local disease,
it is very common for women, after the menses cease, to
become corpulent, and sometimes they enjoy better health
than formerly.
Swellings of the abdomen, sickness, loathing of food,
palpitation, flutterings in the abdomen occur at this time,
which are often mistaken for pregnancy. The.patient, anxious,
perhaps, for the first or the last time, to become a mother,
and finding herself enlarged about the abdomen, at the same
time that she passes over the periods without a return of the



MENSTRUAL CLIMACTERIC.


55


catamenia, imagines that she must be with child, and- consults her accoucheur.   She complains of a weightiness of
the breasts, especially when she first rises in the morning;
they are increased in volume and firmness, but there is no
difference in the areola, nor is there any moisture from
the glands surrounding the nipple; at times, however, these
are somewhat enlarged; she has an obscure feeling of motion
below the umbilicus, dependent upon flatulence; there is
nausea-but not actual retching-on rising, from the existence of some dyspeptic symptoms, or she may possibly have
bilious vomiting at times; she may complain of spitting of
blood, an evidence of the congestion that has taken place in
the lungs, on the arrest of the menstrual secretion. In such
a case it is highly important accurately to distinguish the
symptoms present from those of pregnancy, so as not to be
deceived by the often very accurate description which the
fond imagination of the patient will trace.
In these cases of suspected pregnancy, Nux vomica or
Pulsatilla, Aconitum or Bryonia, according to their several
indications, will generally relieve the symptoms; and as
these arise, most frequently, in women of more than ordinary
susceptibility, a moderate dose of the middle or higher
attenuations will be found to answer best.  For this purpose one drop of the tincture at the 12th dilution may
be added to a wineglassful of water, and one teaspoonful of
this solution given at intervals of 6, 12, and 24 hours.
The commencement of the great " change or turn of life"
is sometimes manifested by a febrile state of system, in which
there is a combination of the vascular and nervous irritation.
The patient is affected with headache, of a hammering,
beating character, with roarings or whistlings in the ears;
she is extremely sensitive to sound and light, has a quick pulse,
and desires to sit away from her family for quiet; she dwells
upon nervous apprehensions and anxieties, everything is a
care to her, she is frequently weeping without cause, and
fretful or peevish and irritable, or pre-occupied with desponding ideas about herself; there is vacillation of feelings and
spirits, conjoined, perhaps, with dyspeptic symptoms. Constipation is often present; some hysterical symptoms may



56


DISEASES OF THE WOMB, ETC.


occur, and the menses may be too frequent and in excess.
In this state, during the prevalence of the increased vascular
action, Aconite is the best remedy; and in consequence of
the extreme sensibility of the nervous system, all the medicines
should be given at a medium or high attenuation; aggravations frequently occur after the medicine.  Stimulants mustbe rigidly avoided, as delirium or mania would readily be
induced.
After Aconite has subdued the inflammatory irritation of
the heart and arteries, Ignatia, Pulsatilla, or Sepia will be
found useful, the latter especially, if there is any reason for
supposing the existence of disease of the womb. Chamomilla
is also useful in the earlier stage, as well as Belladonna.
In those instances in which nervous irritability or cerebral
derangement occurs at the cessation of the menses, the most
soothing and kind treatment should be adopted, abstinence
from stimulating beverages enjoined, plenty of exercise in
the open air, and some homoeopathic remedy prescribed corresponding to the symptoms of the individual.   In nervous
subjects, alternate doses of Aconite and Coffea, with an occasional dose of Ignatia and Pulsatilla, are the most serviceable; but of all medicines Aconite is the most soothing at
the climacteric period, especially when the individual is
robust and plethoric, or if there be any evidence of local or
general increased action.
If there be congestion of the head or abdomen, with ful.
ness, tension, and pressure internally, attended with lumbar
and sacral pains, Belladonna is the best remedy, in some
cases followed by Hepar. sulph., and Sulphur when indicated.
If there be burning sensation in the head, bleeding at the
nose, &c., Crocus should be given, the administration of
Carbo veg. being subsequently adopted to complete the cure.
If there has been menorrhagia from congestion of the
uterus, and great debility has resulted, which not unfrequently predisposes the patient to the development of
Carcinoma, China should be given, followed by Kreosotum,
or Coniumn, Sepia, and Sulphur.
If nervous faintness and exhaustion are present, a selection should be made, in conformity with the symptoms



HYSTERIA.


57


which occur, from amongst the subjoined medicines:-Coffea,
Valeriana, Veratr., Viola odor., Acon., Nitri ac., Sulphur,
and especially Kali carb. and Moschus.
If dyspeptic symptoms prevail, the administration of Nux
v., or Puls., or Bryon., will be beneficial.
The falling off of the hair, when caused by the frequent
congestions of the head, is best met by a few doses of
Lycopodium.
Lachesis is also one of the most serviceable medicines at
the climacteric period of women; when general disturbance
of the excito-motory nerves exists, especially when constipation is distinguished as a prominent attendant symptom.
Cocculus is of use in spasmodic attacks in the hypogastrium, whether of the uterus or ovarium, with bilious
vomiting or nausea.
Ruta is also recommended for the pains in the sacrum
and os coccygis.
HYSTERIA.
Hysteria is one of those anomalous diseases which it is
very difficult to describe; it assumes such varied forms, and
simulates so many affections of the different organs of the
body, as not unfrequently to deceive the practitioner by its
close resemblance to them.    This arises from one peculiar
feature of the disease, consisting in a morbid sensibility of
the terminal branches of the nerves, which depends upon
some kind of irritation existing at their origin, the precise
condition of which has hitherto escaped the researches of the
pathologist. At one time it is distinguished as a single, distinct, unmistakeable paroxysm, or succession of paroxysms of
a convulsive character; at another it has a local and limited
action, and appears so unconnected with other general symptoms, that any one inexperienced in close observation fails
to detect its relations.  It is almost peculiar to the female
sex, although a few instances of it have been met with in
men of an extremely irritable and susceptible organisation.
It is essentially a disorder of the nervous system, characterised by extreme mobility of the nervous fibre, which



HYSTERIA.


59


periodical tendency as so closely to resemble true epilepsy,
that it is often very difficult to distinguish in the diagnosis
between the one and the other.     It is, however, very rare
for patients in the hysteric fit to bite the tongue and foam
at the mouth, although a state of cerebral congestion is not
unfrequently met with in connection with it. In epilepsy
those symptoms are very common, there is a vacant look,
and the fits are followed by a deep sleep. In hysteria,
moreover, a state of syncope occasionally occurs, which to all
appearance is of an alarming nature.       The heart beats
feebly, the pulse is scarcely to be felt, the respiration is
hardly perceptible, and a state of collapse takes place, in
which life appears to be ebbing away. It is under these
circumstances that persons have been laid out and supposed
to be dead.   Hysteria is in some degree associated with the
uterine function, nevertheless some of the most aggravated
instances have occurred, where there has been no irregularity
of menstruation, and even after the decline of the function
altogether.  It is more frequently dependent upon a state
of anaemia. One of the leading characteristics of hysteria
is a morbid sensibility of the surface, which leads often to
the belief, when circumscribed in its extent, that inflammation
exists.  In these cases, however, if the hand be approached
gently and imperceptibly, there will be found toleration of
firm pressure-if gradually applied,-although just before,
perhaps, the patient had shrunk with alarm from the least
contact.
It has been said that hysteria simulates the diseases of
various organs; this applies more especially to the inflammatory and spasmodic conditions.
Dr. M. Hall, in his 'Memoirs on the Diseases and Derangements of the Nervous System,' has specified the
different parts, which, from their dependence upon or immediate connection Wvith the true spinal system of nerves,
are liable to be secondarily affected in this multiform disease.
1. Those parts which    are supplied with excito-motory
filaments from the pneumo-gastric branch or its accessory,
such as:a. The pharynx,-producing dysphagia; globus hystericus;



60


DISEASES OF THE WOMB, ETC.


b. The larynx,-producing the irritation of croup, with
apparently imminent suffocation;
c. The bronchial tubes and lungs,-inducing dyspnoea
and cough;
d. The cardia and stomach,-inducing hiccough, retching,
vomiting, &c.
2. Those parts which are supplied from the posterior
spinal nerves, such as:a. The general surface,-inducing spasms of the diaphragm,
and of the intercostal and abdominal muscles;
b. The sphincters of the anus, cervix vesicae, and cervix
uteri;
c. The Fallopian tubes, uterus, &c;
d. The muscular system    generally,-inducing trismus,
tetanus, spasmodic contractions of the hands and feet, wry
neck, &c.
Thus, according to Dr. M. Hall's explanatory table, a
morbid condition of the incident nerves, produced by gastric,
intestinal, or uterine irritation, will induce general hysteria,
as well as other spasmodic diseases.
A morbid condition of the spinal marrow itself will produce convulsions, tetanus, trismus, &c.
A morbid condition of the reflex or motor nerves will
produce spasms and contractions of the muscles, spasmodic
tic, &c. " The rest relates to emotion, which is the greatest
part of hysteria."
A state of anaemia, or bloodlessness of the brain and spinal
cord, is therefore a condition favorable to the development
of the disease in its most aggravated form; and any slight
cause which operates to disturb the balance of the nervous
system is capable of inducing an attack, in those who possess
the hysterical diathesis:-such as a chill, exposure to wet or
cold, which shall excite a catarrh, or an attack of bronchitis.
Under these circumstances, when the system is so fully prepared for it, a migratory form of hysteria is not uncommon,
and assumes a painful and aggravated character; a sudden
development of the disease is produced, and it transfers its
seat from one organ or set of organs to another, until it has
spasmodically affected almost every muscle in the body, at



HYSTERIA.


61


one time paralysing the muscles of the throat and windpipe,
at another producing rigid contraction of the extremities.
When submitting this form of the disease to treatment, it is
found that if one part be relieved, another soon becomes
affected, until the constitutional irritability is removed by
the slow process of improving nutrition and restoring the
tone of the nervous system. For although it is absolutely
necessary to apply the remedies most suitable to the particular symptoms of trismus, dysphagia, eclampsia, &c. &c., as
they arise, still very little influence is exerted by such means
over the general hysteric constitution, the local disorder
being relieved without much impression being made upon
the general health.   It is therefore requisite so to arrange
the administration of the remedies, that the permanent cure
of the hysteric disease may not be lost sight of, the difficulty
of which is greatly enhanced by the repeated attacks of the
local spasms, which are induced by such trifling causes,
emotional or physical, and which make it appear as though
no advance was being effected in the eradicative and fundamental cure of the disease.
By gradually restoring the general health, improving the
functions of sanguification and assimilation, and removing,
as far as possible, all exciting causes of disorder, while the
local symptoms are relieved as they arise, it will be found
that the attacks will become shorter and more distant as the
strength improves, and the normal condition, as to quantity
and quality of the blood, becomes re-established.
A remarkable instance of the migratory form of hysteria
was lately to be seen in the London Homoeopathic Hospital.
A young girl of twenty years of age, exhibiting the anmmic
and chlorotic conditions of some months' standing, caught
cold, and was received into the hospital suffering from pneumonia to a moderate extent.     In two or three days this
inflammatory attack was subdued; but the debility connected
with it, superadded to her previous anamic condition, so
depressed her, that the debility was extreme, and her countenance ghastly. An explosion of hysteria then took place;
there were spasmodic contractions of the muscles of the jaw,
producing perfect trismus and dysphagia, which lasted many



62


DISEASES OF THE WOMB, ETC.


days at a time, eclamptic convulsions, rigid contractions of
the arms and hands, first of one side, then of the other,
which also endured many days at a time; excessive tenderness of the abdominal surface (simulating peritonitis), and
of the uterine region; considerable distension of a portion
of the colon, which, from  its being thrown into a paralytic
condition, allowed the air within to distend it in the form of
a large globular body, which was excessively sensitive to the
touch. At another time a violent, harsh, convulsive cough
came on, and lasted for a day or two, then trismus returned,
the hands being clenched, and the following symptoms also
occurred:-loss of vision; opisthotonos; and paralytic condition of the rectum, which allowed of the accumulation of
the fieces to an enormous extent, so that artificial aid was
required to remove them. This was so effectually relieved,
when it occurred a second time, by Veratrum, as to produce
a perfectly natural action.   During the persistence, however, of the inertia recti, the spasmodic attacks kept off; but
when evacuations occurred, they returned immediately. The
remedies applied (she was a patient of Dr. Quin's) produced
considerable relief to the various spasmodic symptoms as they
occurred, and in some instances operated with magical effect,
but still the migratory character of the disease continued for
a long time, shifting its site continually; and when she was
beginning to walk about the ward, she was suddenly prostrated by a renewed attack. Nevertheless she was gradually
being restored by a well-directed regimen and appropriate
medicines; although, until her health and strength should be
sufficiently established to resist the operation of trifling disturbing causes, such attacks as have been described would
reasonably have been expected to recur, from time to time, as
circumstances occurred calculated to operate upon the constitutional susceptibility.  Under the use of Bell., Verat.,
Cupr., Puls., Nux v., Ferr., Coff., Stramon., Hyosc., Ignat.,
and a few other intercurrent remedies, the intervals between
the fits lengthened; and at the same time that the attacks
became less frequent, she gained flesh by degrees until she
finally recovered and left the hospital.
Hysteria is often imitative in its nature and origin, for it



HYSTERIA.


63


has happened, when other females have been in the same
room or ward with a person who laboured under the disease
in an intense form, that the recurrence of the fits has so
agitated their nervous systems, already rendered susceptible
by illness, as to induce attacks of hysteric convulsion, in one
after another successively, until some remedy was adopted
which operated powerfully upon their minds, through fear.
Boerhaave, as related by Dr. Quin, in his Lecture upon this
subject, was once troubled by a number of patients in the
hospital in this way. At length, finding that as management,- medical or otherwise, had not the effect of putting a.
stop to it, he directed some stoves to be brought into the
ward, and a number of irons to be made red hot. He then,
with the utmost gravity, stated that as all other remedies
had failed, there was only one which, although extremely
painful, was always effectual, and that was the application of
the red hot iron to the arm at the commencement of the
attack, leaving directions for its immediate application to the
first case that should occur.  This had the desired effect,
and the infection ceased.
Hysteria may occur during the course of other diseases;
or in the stage of convalescence upon their subsidence; or
during pregnancy, when it will occasionally lead to premature
delivery, or abortion; or it may occur during the progress,
or at the termination of natural labour.
" Sometimes the paroxysms set in without any known
cause; in other instances they are excited by emotion, cold,
or dietetic transgressions; sometimes they are not very severe,
and recur every week or month; as the patient grows older,
the paroxysms become more frequent and more intense;"
when the hysteria occurs in persons of a full habit, they
generally look healthy and well.
"The mental phenomena are very characteristic.    Hysteric females are capricious, their emotions and feelings are
very changeable; from   deep grief, they pass over to the
liveliest mood; they look for pity and sympathising attention; they often affect to be sick in various ways; their eyes
are humid, and half closed; their nerves sensitive, and their
idiosyncrasies more strikingly developed."



64


DISEASES OF THE WOMB, ETC.


Treatment.-When the hysteric fit occurs, the patient is
to be laid in an easy posture, a free access of cool air is to
be promoted, the clothes are to be loosened, so as to remove
all girths from around the body and throat, the face is to be
sprinkled with cold water, or the head may be held over the
side of the bed with a pan beneath, and the water poured
over it from a height.
The medical treatment of hysteria must necessarily vary as
infinitely as do the forms assumed by the disease. The pheno-,
mena exhibited by this malady are so evanescent, that it seems
impossible positively to indicate certain remedies as appropriate
for them. Nevertheless the nervous symptoms and the physical
sufferings of the patient will point to some of the following.
FOR THE HYSTERIC FIT.
Nux moschata.-This medicine       corresponds with paroxysms of spasm and debility; or is appropriate when
the following conditions occur:-fitful mood; sudden change
from "grave to gay, from lively to serene;" excessive tendency to laughter; vertigo, with reeling; gradual rigidity
and insensibility; enormous distension after meals, with
nervous irritation of the intestinal canal; retarded catamenia, preceded by pain in the small of the back, as if a
transverse piece of wood would be pressed out, with headache, languor, cardialgia, water-brash, pain in the liver;
menstrual blood thick and dark; vicarious leucorrhoea in
place of the menses; great languor on the least exertion.
Belladonna should be given in the congestive form, or
when during the fit, the face is red and turgid, the veins of
the neck are swollen, &c., with other symptoms of determination of blood to the head, and spasms.
Valeriana is appropriate when the following symptoms
prevail:-tremulousness, fearfulness, palpitation of the heart;
when the senses are morbidly affected, are too acute, and
appreciate objects wrongly.  A tickling deep in the throat
with cough, accumulation of saliva, disposition to vomit,
a feeling of something warm rising from the epigastric
region, and arresting the breathing; sensation as if a thread
were hanging down the pharynx.



HYSTERIA.


65


Viola odorata has been recommended, and is indicated in
cases in which the following symptoms and conditions prevail: much weeping, without knowing why, nervousness,
constant distress in the chest, painful dyspnucea, laboured
and painful breathing, with anxiety, and palpitation. It
may also be useful in the hysterical affection of the knee
and wrist which is sometimes met with.
Secale cornutum is applicable to the treatment of those
spasmodic convulsions which are dependent upon derangements of the uterine function; the convulsions are attended
with changeful conditions of the mind and spirits, alternately laughing and crying; at times, great depression of
spirits; despondency inducing thoughts of self-destruction;
spasms of the bladder,;.retention of the urine, with violent
efforts to urinate, &c.
Aurum is indicated when hysterical spasms occur, sometimes with tears and laughter; when morbid sensibility to
pain, or religious melancholy, hypochondriacal humour,
despair of oneself, oppression at the chest, almost to suffocation &c., are the predominating features; a fine eruption
around the lips or the face and forehead, is also an indication
for this remedy.
Pulsatilla is suitable to females of a fearful disposition, or
if there be silent melancholy; when the nervous paroxysms
are connected with disordered menstruation, and there is a
disposition to be easily moved to laughter and tears, alternately, with general nervous sensibility.
Moschus is suitable in that form of hysteria attended with
syncope, when there is diminished irritability of the muscular
and vascular systems; also when convulsions of the extremities are present; or spasmodic affections of the pneumogastric nerve; general, indefinite pain of the whole body;
nymphomania, great desire for brandy, or beer; or when
there is a generaL sensation of coldness.
Conium is indicated byweak conditions of the body accompanied by excessive irritability, spasms, trembling of the limbs;
hysteric fit with chilliness; menstrual derangements,suppression; induration of the os uteri; leucorrhcea of an
acrid nature with uterine colic; hysteric asthma; and when
5



HYSTERIA.


67


and chilliness with heat of the face; sensation, in different
parts of the body, as if they had gone to sleep; vivid, fanciful
dreams during a light sleep; somnambulistic rising and walking in the room; sadness, grief, whining mood, melancholy,
irresolution, great absence of mind, sudden disappearance
of the headache with nausea; clavus in the left side of the
head; the menses delay, and decrease more and more."
Calcarea carb.-when the hysteria approaches to epilepsy,
and when the case is characterised by excess or too frequent
recurrence of the menses, with anemiated countenance,
great nausea and loathing; faintings occasionally, constrictive spasm of the oesophagus, &c.
Asafetida corresponds more particularly with cases in
which there is a morbid condition of the abdominal nerves,
characterised by the globus hystericus; burning stitchings
in the limbs at different points; restless, unrefreshing sleep,
with frequent waking; nausea and fulness at the epigastrium, &c.
Sepia.-In persons of a sad, desponding disposition, easily
excited, with sensation as of a lump in the throat; involuntary fits of laughter and weeping; sense of coldness between the shoulders, followed by coldness over the whole
body, suffocative spasm in the chest for several minutes, with
clonic convulsions of the right side, and twitching of the
right leg and arm when held; tremor of the lower extremities; the nightly sleep is disturbed by attacks of anxiety;
sudden fainting, with profuse sweats and undisturbed consciousness, without, however, being able to speak or stir, &c.
Magnesia muriatica is indicated when the patient readily
takes cold, has frequent attacks of pain, as if bruised,
throughout the whole body, fainting fits at table, with
anxiety, nausea, pale face, photopsia, (green and red colours,)
trembling of the whole body, relieved by eructations, uterine
spasms, pain in the small of the back and leucorrhoea: these
last symptoms become more violent as the menses diminish;
they appear periodically, and the spasms finally extend down
the thighs and upwards, involving the whole abdomen,
causing a painful hardness of that part, &c.
Nitri acidum.-" Drawing sensation in the back, every



68


DISEASES OF THE WOMB, ETC.


day once or twice, changing to a griping in the sides, whence
it passes along under the ribs to the pit of the stomach,
where the patient experiences a twisting sensation, and feels
relieved after eructations.  This attack is most violent towards evening, particularly when the weather is changeable;
the patient constantly complains of a feeling of illness and
fainting, slight tremor through the whole body; sad, whining,
and melancholy mood. The globus hystericus, the several
symptoms of abdominal hysteria, menstrual irregularities,
spasms in the chest, &c. should likewise be present."
The foregoing remedies for the hysteric constitution or
disease, are most applicable when the individual and peculiar
symptoms detailed under the head of each, respectively, are
present, in addition to the usual characteristic symptoms of
the remedy. The local forms of hysteria are referable to
the different organs affected by the hysteric disease, which
are characterised by morbid sensibility and irritability, with
morbid actions in correlative organs and functions.
CEPHALALGIA HYSTERICA (HYSTERIC HEADACHE).
Headache, the pain usually occupying a part of the forehead, or one half of the head, or the top, as a violent, burning
sensation, is a very common form of irregular hysteria.
Sometimes the pain is periodical, and is relieved by a fit of
vomiting.
Aurum is useful in cases of this kind when further characterized by dejection of spirits, disposition to suicide, pain
over the forehead, tumult in the head, roaring in the ears,
with extreme sensibility to every kind of pain, &c.
Cofea is more especially indicated when the hysteric sensitiveness co-exists with general excitability, and the pain is
as if a nail were driven into the side of the head. Menses
in excess.
Ignatia is required for paroxysmal headache, as though a
nail were pressed into the brain; frequent change of feelings; chagrin, &c.
Platina is appropriate for the treatment of violent, crampy
pain in the anterior part of the head, at the root of nose,



HYSTERIA.


69


with heat and redness of the face, self-exalting and contemptuous feelings, or depression of spirits, whining, and
fearfulness; generally the menses in excess.
Opium is more especially indicated by stertorous breathing; open mouth; distorted, open eyes; sopor.
Antimonium cr. is useful when there is irresistible drowsiness in the day time and evening.
Valeriana is more especially indicated if the pain consists
of a sensation of pressure over the orbits, alternating with
sticking pains.
Belladonna is appropriate in cases in which there is a
periodical headache of a nervous character.
Mercurius is usefully administered for a tight, constrictive
pain across the forehead, worse of an evening.
Phosphorus is indicated by nervous morning headaches,
sometimes preceded by evening nausea.
Hepar sulph.is useful in megrim of females-a boring headache in the root of the nose-when a pain sets in at night,
when moving the eyes, as if the forehead would be torn out.
China is indicated by pressive pain, sensitiveness to noise,
sleeplessness, and hunger.
Sulphur is more especially useful when the headache is
periodical, returning every eight days, of an aching, stupefying character.
Chamomilla, Cicuta, Colocynth, Nux v., Puls., Sepia,
Kali carb., are also, at times, of service in cases of hemicrania.
HYSTERICAL AFFECTION OF THE SPINAL MARROWIs characterised by extreme tenderness of one or more points
along the vertebral column, with morbid sensibility of the
cutaneous surface, &c.  If the pain should be attended by
spasmodic contractions of the muscles, cramps in the calves,
&c., Ipecac., Cuprum, or Secale may be useful.
If the pain should be attended with paralytic conditions,
neuralgic affections of the thoracic and intercostal nerves, or
of the nerves of the articulations, &c., Dulcamara, Rhus tox.,
Plumb., Stannum, Squilla, or Puls., Ign., Arsen., Mosch.,
Caust., and Cicuta.



70


DISEASES OF THE WOMB, ETC.


Hysteria laryngea.-This variety chiefly requires Aeon.,
Spong., Hepar.   In cases in which the voice is low and
lisping, with occasional want of voice, Bellad., Phosph., Plat.,
Ignat., Angust., Spong., Puls., Ant. cr. may be enumerated
as the medicines from which an appropriate selection shall
be made.
Hysteria dysphagia-principally requires Ignat., Bellad.,
Hyoscyam., &c.
Hysteria pulmonalis-(including hysteric asthma, palpitation, syncope, &c.) principally calls for Nux v., Ars., Sulph.,
Lobelia, Ipec., Moschus, Sambuc., Aeon., Bell., Cham., Coff.,
Ign., Puls., Stram., Con., Cup., Lach., Phos., Stann., Sulph.
If there be a want of animal heat, with whining disposition, Puls. or Veratr.
Hysteria vesicalis-principally requires a selection from:Canth., Merc., Hepar, Bell., China, Mezer., Coloc., Zincum,
if there be burning pains, and from:-Zincum, Lyc., Canth.,
Dulc., Sulph. ac., if there be stitching pains in the region
of the kidneys.
Hysteria muscularis.-When the convulsions bear a resemblance to Tetanus, and affect the muscular system, producing symptoms of lock-jaw, or other forms of tetanic
rigidity, contractions of single members, &c., the most suitable remedies to select from are:-Cuprum, Aur., Bry., Aeon.,
Angust., Bell., Hyoscy., Ign., Lach., Laur., N. vom., Plumb.,
Rhus, Sec., Stramon., Verat., or Camph., Cham., Ipec.,
Mosch., Op., Plat., Caust., Cocc., Cic., yc.
HYSTERIC STATES OF THE MIND.
Sometimes the patients are affected with peculiar modes
of speech during the fits, which may distinguish a remedy
from amongst the following:For loquacity, Ars., Bell., Hepar s.
For a difficulty of speech, either from want of words or
voice, Cannabis, Bell., Phosph.
For a feeble, imperceptible, heavy, stuttering speech, Secale.
For difficulty of speech, with jerks of the head and arms
when uttering words, Cicuta virosa, Hyoscy.



HYSTERIA.


71


A melancholy mood in hysteric females requires, according
to the characteristic symptoms, either Veratr., Hyosc., Stram.,
Bell., Helleb., Anacard., Opium, Aur., or Plat.
Nymphomania, which sometimes occurs in this anomalous
disorder of perverted actions, may be relieved by Platina,
Bell., Chin., Veratr., Zinc., or Gratiola, Con., Anac., Staph.,
Aur., Thuja, Merc., Ign., Nux v., Hyosc., yc.
In connection with this part of the subject, a form of
mania may be noticed, dependent, frequently, upon a disordered condition of the menses; but as it is not always
associated with suppression, it may be described under the
head ofHYSTERICAL MANIA.
Perhaps the more proper term for this peculiar derangement of the nervous system would be menstrual mania; but
inasmuch as hysteria seldom exists with a normal state of
menstruation, it partakes somewhat of its character in this,
as well as in the presence of other hysterical symptoms.  I
have found it to occur in the single and in the married:
when in the latter, generally in the absence of child-bearing;
when in the former, connected with a peculiar state of
mental constitution.  Its characteristic features are that it
is seldom permanent, but is apt to recur under similar conditions of the bodily organs.   Usually there is irregular,
scanty, or else suppressed menstruation; but this may be too
frequent and in excess. The mind is low and desponding,
with a disposition to suicide or weeping; in some cases the
humour is taciturn, or in other instances loquacious. The
patient imagines people are talking loud into her ear, over
her shoulder; she looks sullen and suspicious, and flushed;
and these symptoms are associated with headache and fits of
syncope; the pulse is quick and the feet are usually cold;
she has perhaps been getting corpulent; is troubled with
flatulence, to a great extent, and globus hystericus; or complains of heavy weight in the loins, and of constipation.
Stimulants aggravate the symptoms. The remedies most
applicable to the treatment of cases of this nature are:Aconit., Bell., Aurum, Nux v., Puls., IHyosc., Ign., Lack., &c.



72


DISEASES OF THE WOMB, ETC.


HYSTERALGIA; OR, IRRITABLE UTERUS.
Hysteralgia consists in a morbidly irritable state of the
uterus, which is painful and tender to the touch,-either at
the os and cervix, or, when the body of the organ is pressed
at any part of its circumference,-independently of inflammation.   It is usually unaccompanied by any functional or
structural change; but the augmented sensibility, which is
its characteristic feature, has been supposed, of late, occasionally to result in induration and ulceration of the cervix,
although this has not been proved by a conclusive assemblage of facts.  It is an extremely obstinate affection, and
will exist for many years, the patient being rendered nervous, thin, and irritable, abounding in complaints, and, more
frequently than not, confined to the sofa, and incapable of
any exertion without an aggravation of suffering. Perhaps
the most proper nomenclature of the disease would be, that
of local Hysteria, or Neuralgia of the womb; but it is not
always attended with general hysterical phenomena.
The symptoms which distinguish the disease are:-pain,
referrible to the pelvis, with aching, dragging sensations in
the back; or a tight feeling in the hypogastrium, from hip
to hip, as of a cord stretched across the pelvis at the brim,
extending to the groins, at times down the thighs, and often
to the foot on one side.  The pelvic and sacral pain is more
or less constant, though worse during the monthly period;
in simple Dysmenorrhmea, however, it is only urgent at that
time. The pain is aggravated by movement, and relieved by
the recumbent posture, but is never altogether absent, and
occurs in paroxysms of more or less severity.    Sitting is
sometimes painful; and the vibration, caused by riding in a
carriage over a rough road, or by any other jar, occasions
great suffering, which lasts for hours.    The bowels are
sometimes affected by it, being irritable, with frequent motions, especially on first rising of a morning; or, if constipated, pain is felt on evacuation taking place; spasms, apparently in the terminal bowel, but, in reality, in the womb,



HYSTERALGIA, OR IRRITABLE UTERUS.


73


are apt to occur immediately after a motion; and there is
frequent desire to pass water, which is sometimes prevented
by spasmodic stricture at the neck of the bladder. There
is usually some prolapse of the organ; and sometimes the
os uteri-rather tumid, short, and expanded,-is found to rest
against the recto-vaginal septum, or even upon the perineum,
which will account for much of the irritability,-especially
of that connected with the terminal bowel, or of that which
results from vibratory movement.
The os and cervix uteri are found free from morbid vascularity, the cervical canal being generally normal, and not
admitting the uterine sound through the coarctation at the
ostium  internum  into the cavity of the womb; a glairy
mucus exudes from the uterine orifice,-which is simply
an excess of the ordinary secretion from the cavity of the
womb,-and leucorrhoea may be present.    Pressure against
the walls of the uterus gives much pain, at one part,
perhaps, more than at another. The pain, which is induced
by an examination, often lasts for hours.    The vaginal
parietes are sometimes inflamed    and  tender.   In  addition to these local symptoms, those of indigestion supervene,-the appetite fails, and manifestations, such as the
following, ensue: nausea, retching, distracting nervous headache, thirst, flatulent distension, irregular bowels, irritability
of temper, great depression of spirits, and restless sleep, with
yivid, fanciful, or horrid dreams. Thus the patient passes
her time in almost constant pain, having occasional febrile
symptoms superadded.
Causes.-Over exertion during the menstrual period,
either from walking, dancing, or standing too long-moving
about prematurely after delivery or miscarriage-violent concussion of the body, or the vibration caused by riding over
a roughly paved road-the application of cold to the uterine
region, or any sudden arrest of the menstrual functions, etc.
These causes appear to be capable of inducing the affection in very sensitive individuals, particularly in those who
are subject to Dysmenorrhoea; and this complaint may influence the pregnant state, during the earlier months of
which, great suffering from sickness and faintings may ensue



74


DISEASES OF THE WOMB, ETC.


from contact, and from the motion of the child, which
causes sharp, darting pains, which are very distressing.
Prognosis.-The oft-observed fact, that this affection may
last for years, without any appearance of organic disease, affords the best ground for anticipating its favourable termination sooner or later.  It is evidently a deranged condition
of the nerves which supply the uterus, and can scarcely be
called either a functional, or a structural disease of the
organ itself; although, for convenience, it must be ranked
amongst the former.
Relapses are common after a period of presumed recovery,
and may at any time be occasioned by imprudent, or excessive exercise.  It occurs amongst single, as well as amongst
married women, and generally ceases at the decline of the
catamenia. There is likewise a form of Hysteralgia which
occurs after labour, and which depends upon some sudden
malposition of the uterus taking place after the expulsion of
the placenta, and which occasions spasm of the organ, and
exhibits features resembling those which characterise metritis; but the absence of inflammation soon becomes evident,
and establishes the distinction.  The same state may also
occur during the earlier months of pregnancy, in consequence
of exposure to some of the exciting causes.  It is marked by
severe pain in the lower part of the back and abdomen, sickness, faintness, frequent and feeble pulse, and is sometimes
accompanied by discharges, or succeeded by the expulsion of
a coagulum, but there is seldom shivering. If there is any
displacement of the organ, the first thing to be done is, of
course, to replace it in situ proprio.
Treatment.-When the state above described, as in connection  with pregnancy, occurs, Arnic., Chamn., Nux v.,
Puls., and Cocc., are the remedies which will be found the
most serviceable.
For the general treatment of the disease, independently
of that condition, recourse may be had to some of the following:-Cocc., Con., Ignat., Magn. m., or, Bell., Bry., Cham.,
Caust., Hyosc., Natr. m., Nux v., Nux mos., Plat., Sep.,
Stann.
The reader may also refer to the remedies mentioned



HYSTERALGIA, OR IRRITABLE UTERUS.         75
under the head of Dysmenorrhcea, with which it is so often
associated.
In some cases great relief has been obtained from the use
of a small, box-wood, pawn-shaped pessary, with a cup-shaped
top to receive the os uteri.  The support which it affords to
the generally prolapsed organ, takes off the pressure from
the rectum, and removes the dragging pain in the back.



76


PART II.
PREGNANCY, PARTURITION, AND THE
PUERPERAL STATE.
PREGNANCY, a function indispensable for the preservation
of the species, is, in the uncivilised state of the human
race,1 no doubt, free from    most of the maladies of which we
shall have to speak. In the unfettered exercise of the bodily
organs, without the restraint of habits and dress which
civilised society entails upon its members, the various functions of the body pursue a tolerably harmonious cdurse, and
derangements which, in the one case, demand the watchful
care of the physician, are, in the other, rectified by the inherent vigour of the vital energy alone, the tendency of
whose actions is conservative of health.
In the latter instance, pregnancy is a natural function,
whose course interferes little with the general health; but in
the former the contrary might be supposed to be the case,
since we find it more or less resembling a disease,-the ordinary functions of the body becoming morbidly affected and
I In proportion as the method of living, or, to use the common expression, as
the habits approximate more closely to the aboriginal conditions, or the state of
nature, the function of pregnancy, like those, perhaps also, of digestion, exhibits
more distinctly than any others, by comparison, the mischiefs which are incidental to artificial methods of living. This distinction is already strikingly
evinced in the comparison between the pregnant female amongst the peasantry,
and the same conditions of the sex under the more artificial circumstances of
life. Amongst the rustic population, even of highly civilised countries, it is no
uncommon occurrence for women to pass almost immediately from the vigorous,
and, apparently, easy exercise of severe manual toil, to a regular, safe, and speedy
delivery; whilst it is no more uncommon for females, under other conditions, to
be ailing (if not worse) during the greater portion or the entire course of the
period of utcro-gcstation.



PREGNANCY.


77


disturbed, in consequence of the changes which take place
during the progress of utero-gestation. Whether this arises
from the amount of innervation or nervous influence, which
is directed to the uterus at this time, in correspondence
with the recent development of that organ, for the purpose
of sustaining the vitality of the ovum, and which deprives
the other parts of the animal economy of the normal supply
which is requisite for the perfect exercise of their functions,or whether it depends upon a general excitation of the
nervous system produced by those changes, we do find that,
in weak and delicate individuals, the power of resistance to
morbid impressions,, and of adaptation to adverse influences,
is impaired, whilst, in many persons of great nervous energy,
or in whom the activity of the nervous function is vigorous,
there is an increase of health during the same period.
The presence of a newly awakened but natural process,
appears, in this case, to act upon the periphery of the nerves
in a morbid constitution, precisely in the same manner in
~which a morbid process would act upon the sentient extremities of the nerves in a healthy organism.  It produces
functional derangements in remote organs, and interferes
with the ordinary condition of health.  It is not surprising,
therefore, that any chronic disease which existed prior to the
occurrence of pregnancy should be aggravated during its
progress.
It becomes, then, the duty of the physician to lay down
such rules of management as shall tend to diminish these
evils, and thereby to add not only to the comfort of the mother
during pregnancy, but materially to aid the healthy and
vigorous development of the offspring.
"When it is considered how great an influence the moral
and physical temperament of the mother exercises upon the
organisation of the child:-how passing events, if crowding
with intensity upon the mind of the one, have been followed
by kindred impressions, developed in the evolving organisation of the other:---how the growth of the new being is
impaired, interrupted, or arrested by whatever violently impairs, interrupts, or arrests the elimination of nervous fluid
in the parent:-how hereditary disease often searches every



78


PREGNANCY.


atom and fibril of the minute being, whose simple elements
have just received the first impulse of vitality:-how. morbid
affections, or morbid habits, occurring during the period of
utero-gestation, often become attached and convey their
characteristic impression to the foetal organs, as is witnessed
in the convulsions to which those children are liable whose
parents have been addicted to stimulating drinks, in the inanity which frequently follows mental perturbations,-the
syphilitic and scrofulous taint,-and the smallpox, which
attacks the infant in the womb:-when, moreover, we observe how often malformations and deformities of the foetus
are connected with certain mental shocks, which have been
experienced by the mother, at some early period of her pregnancy, and which were at the time associated with special
physical sensations, such as a constriction of the cutaneous
surface, commonly called goose-flesh, and a feeling of horror
or disgust at the object which created the impression,-it
demands the utmost caution on the part of the mother to
avoid all exciting emotions, and all disgusting objects, as
much as possible, and to adopt every means, by frequent
and regular exercise, in the open air, of invigorating the
system, and of thus rendering it less liable to be affected by
currents of feeling.   For although the relation between
cause and effect, in these instances, cannot be proved by
positive demonstration, the coincidences are sufficiently frequent and clear to arrest our attention, and to call for continued observation of correlative facts.  In this, as in many
other instances, the popular belief is, probably, not far from
the truth,-that there is a connection between powerful
mental impresssions produced during pregnancy, and the
interruptions of foetal development, which are observed at
birth.
These are results or consequences of what we may term
involuntary causes, but there are other effects which may be
less prominent,-being certainly not so alarming,--although
they are scarcely less important to the moral development of
the being which is destined to be a source either of comfort
or of anxiety to the parent. They are such as depend upon
the due and vigorous control of the Will.



PREGNANCY.


79


The influence of a watchful, determined, and elevated
exercise of the Will, on the part of the mother, is potent
to the accomplishment of more benefit than is usually
supposed.
The bodily organs are more or less affected by the mode
in which they are acted upon, by means of the aliment which
feeds the circulation.  Habits of living may so modify their
conditions as to create permanent alterations in their sensibility, tendency to disease, or actual organic structure; and
the extent to which these structural changes may become
permanent cannot be foretold; but, for aught we know, the
first serious impression which thus occurs in the economy of
an individual through the careless persistence in injurious
habits, may be the first impulse to the formation of hereditary disease in one or more particular organs, which,
receiving a renewal of the same exciting cause, in each successive generation, ultimately becomes indelibly fixed, and
assumes a constitutional and permanent character.
So is it with the mental faculties;-what the morbid influence of unwholesome or too stimulating aliment is to the
body, the repeated excitement of the passions is to the mind.
Every one knows that, by a continual yielding to the
slightest impulses of feeling,-as of grief, joy, love, hatred,
avarice, ambition, anger, &c.,-the power of resistance is diminished, the mastery of the Will is impaired, and the habit
more firmly established; the emotions, as they become less
transient, are more fixed, and form part of the characteristics
of the individual.
The molecular change, which silently goes on in the organisation of the brain under these circumstances, it is true,
cannot be traced; but since we find insanity, which is a more
complete and decided subversion of the mental faculties, to
be hereditary, is it not probable that the gradual, though at
first, imperceptible operation of emotions or passions uncontrolled by the exercise of volition, may be the first link in
that mysterious chain of sequences, which eventuates in
hereditary disease?
Habits, or trains of thought, are the silent streams which
supply the nourishment either of good or evil to the mental



80


PREGNANCY.


faculties, and whose perpetual tide modifies and arranges the
permanent characteristics, in a manner analogous to that in
which the elementary constituents of the food, circulating in
the blood, influence the bodily organs, and produce a temporary or permanent bias.   Just as, in early life, the habit
of regulating the emotions and sentiments determines the
future character-so, in after life, does the same discipline
exercise its influence over the character of the offspring.
The irritable nerve, that frets at every emotion or contradiction, becomes, in time, permanently deranged; and thus the
simplest infirmities of the mind, equally with those of the
body, may, at first, be merely incidental and temporary; or,
they may become periodical or recurrent, and at last constitutional and permanent.   Who can say at what precise stage
these may lapse into insanity, or become constitutionally impressed upon the organisation?-For as it has been so beautifully expressed by Abercrombie:-" The first volition by
which the mind consciously wanders from truth, or the moral
feelings go astray from virtue, may impart a morbid influence
which shall perpetuate itself, and gain strength in future volitions, until the result shall be to poison the whole intellectual and moral systems."
Such permanent influences cannot fail to be revived and
perpetuated in the character of the offspring. When a
woman finds, during pregnancy, that any morbid feelings, to
which she was liable, become exaggerated-that her mind
becomes unstable or fickle-that trifles disturb her-and
that she is irritable and easily vexed, her sensations being
morbidly affected;-that she is oppressed with care, without
any additional causes of grief or anxiety-that her senses
are unnaturally acute-her limbs beset with langour and
malaise-and that there is a general disposition to yield to
self-indulgence, which is, perhaps, augmented by the ordinary
sympathies and cares of those about her;-then it is her duty
to reflect calmly upon her condition-to examine her feelings
-to seek a higher consolation, and to fortify herself by the
consideration, that the present is but a temporary condition,
and, by arousing her moral energies, to provide that her
will shall control every symptom of irritability or annoyance



RULES TO BE OBSERVED.


81


which may, from time to time, disturb her.  By this effort
she will acquire that mastery over herself, which will not
only give peace and comfort to her household, but will indelibly fix its impress in the nervous organisation of her offspring.
HYGIENIC RULES TO BE OBSERVED              DURING
PREGNANCY.
From the earliest period at which a woman may have
reasonable grounds for believing herself to be pregnant,
either in the presence of such symptoms as indicate pregnancy, or in the suspension of such other symptoms as
are usually manifested from time to time, in the absence of
that condition, she ought to divest herself of every part of her
dress which exerts any compression upon the abdomen, and
should exchange the usual firm, resisting stays, for others made
with elastic webbing, with a thin yieldinrg busk, and whalebone merely at the back. The evils which may result, both to
the mother and child, from the tightening of the waist during
pregnancy, are incalculable; and amongst such consequences
the following may be enumerated:-miscarriage, diseases
of the womb, heart, lungs, and brain; varicose veins; false
positions, which render the confinement afterwards so dangerous; hydrocephalus of the infant, &c. All these derangements may be produced by an interference with the free
circulation of the blood of the vena porte, and of the large
arterial and venous trunks of the abdomen, by the habitual
compression of the ordinary description of stays.  For the
same reasons, the patient should wear easy, loose clothing,
which in no-wise restrains the expansive movements of the
abdomen, and which, moreover, is adapted to the season of
the year.
The necessity of furnishing subsistence to the new life
which is being developed in the womb, demands, on the part
of the mother, a substantial diet, which is nourishing, and
easy of digestion; since, owing to the sympathies which
exist between the stomach and the uterus, the pressure and
6



82


PREGNANCY.


restraint which the digestive organs experience, by the vast
increase of volume acquired by the womb, alter the relative
position of these organs and impair their power, whereby digestion is often rendered slow and painful. Boiled or
roasted meats, farinaceous vegetables, and the fruits of the
season, perfectly ripe, in proper quantities, will constitute the
best aliments, and pure water the best drink.  Spices, wine,
and above all, coffee, green, and sometimes even black, tea,
must be rigorously proscribed. The nervous sensibility is so
exalted in pregnant women, that these substances are even
more injurious in that state, than under ordinary circumstances.
It is well to guard against the allowance of unwholesome
articles of diet to women so situated, under the impression
that their peculiar cravings, or longings, should be satisfied.
On the other hand, it is better not to refuse things which
are longed for, provided they be not directly hurtful to the
mother or child.
Sufficient exercise in the open air is also very necessary
during pregnancy; and walking (short of great fatigue) is
the best.  It contributes to strengthen the constitution, to
preserve health, and tends very much more towards an easy
labour, than the baths sometimes prescribed.
Baths should only be had recourse to for the cleanliness
and comfort of the skin; but when too prolonged, or repeated
too often, they induce debility, and are, consequently, hurtful
to pregnant women.
It would be an offence to the intelligence and to the
humanity of my readers, were I to adduce reasons against
the bloodlettings heretofore recommended during the middle
period of pregnancy. To bleed a woman who is pregnant
is a double sin, since it is often productive of injurious consequences both to the mother and to the child.
Pregnancy operates in a sensible manner upon the moral
temperament of a woman, who becomes, in consequence, very
susceptible of impressions; the imagination is more vivid;
and she is more subject to alarm.  It is important, therefore,
that she should avoid all violent emotion, as well of pleasure
as of pain; that she should repress inordinate curiosity,-often



DISORDERS OF PREGNANCY.


83


so aggravated during this state,-especially when bearing upon
subjects which may make too vivid an impression, such as
the exhibition of wild animals, of feats of strength, &c., since
they may be productive of as much injury to the mother as
to the infant.  For the same reason she should be guarded
from the sight of monstrous objects, and serious wounds, as
well as from the relation of terrible or alarming events.
Observation of the laws of nature points to the negative
in respect of the propriety of connubial intercourse during
utero-gestation; physiology also supports the opinion, and
experience has demonstrated, that infractions of this rule are
often followed by grave accidents, such as hemmorrhages and
miscarriages; the contrary is, however, observed daily. We
can only reply that wise nature is stronger to preserve than
our passions to destroy; and the counsel is none the less
essential which enjoins great caution, especially when the
woman is of a highly nervous and susceptible temperament,
and is subject to leucorrhoea, or to menstruation which is
profuse, too frequent, or too prolonged, or when there is a
tendency to miscarriage.
DISORDERS OF PREGNANCY.
The extensive sympathetic relations which exist between
the uterus and the other parts of the animal economy,
suscitate the various disorders which occur from the first
moment of pregnancy up to the period of delivery, and which
are dependent upon that state.   These effects vary, both in
degree and in the nature and combination of the symptoms,
according to the constitution of the woman and the natural
or acquired irritability and sensibility of different organs.
In a few cases, a salutary change is produced on the whole
system, so that the person enjoys better health during
pregnancy than at other times.     But, in most instances,
troublesome or inconvenient symptoms are excited, which
are called the disorders of pregnancy; and which, in some
women, proceed so far as not only to deprive them of all



84                     PREGNANCY.
enjoyment and comfort, but even to produce considerable
fear for their safety.
The uterus, which was almost a passive organ, performing
a simple periodical function, to assist in preserving the
general health and its own powers, acquires, after conception,
an entirely new life; and such a development in all its
tissues, as well as in its vital action, that it becomes the
centre of most important operations and sympathies, and
draws, as it were, the whole economy within its sphere.
Nevertheless, in the normal state, the whole of that immense
revolution in the female organism ought to be accomplished
without any troubles, and without entailing a necessity for
artificial and remedial interference.  It too often happens,
however, that this change of condition in the uterus is not
effected without very severe sufferings in the organ itself, or
in other organs or systems which possess the greatest
amount of sympathy with it, such as the digestive apparatus, the respiratory, the circulatory, the cerebro-spinal,
and ganglionic.
DISTURBANCF4 CONSEQUENT UPON INCIPIENT PREGNANCY.
During the first weeks, or even the first days of pregnancy, a woman may experience morbid feelings, produced
by the afflux of blood to the uterus, and the resistance which
the fibres of this organ oppose to the development necessary
for its new function: she is sensible of a weight in the lower
portion of the belly, behind the pubes, and of a painful
sense of tension, often very severe, in that region; frequent
calls to pass water; lassitude in the limbs, anxiety, palpitations, and a change in the moral state.  The allopathic
system has only the direful resources of the lancet and the
relaxing action of warm baths to oppose to these sufferings;
as if the action of warm water could relax the tissue of the
living uterus, in the same manner as when that organ is
subjected to maceration after being removed from the dead
body! or, as if bloodletting could withdraw the blood from
its course to the uterus, whither it tends more abundantly



DISORDERS OF PREGNANCY.


85


for the accomplishment of the function of perfecting the
growth of the new being which is being developed in its
interior.  The absurdity of such theories must be too apparent to need further comment.     Hippocrates has said that
women who bleed at the nose abort; and, from want of a
better remedy, it has been advised to draw a considerable
quantity of blood from a pregnant woman, without considering the necessary consequences which that abstraction of
blood would entail upon the embryo, which exists and is
nourished only by the blood of the mother!         If bleeding
be afault in all diseases, and under all circumstances, it is
a crime in disorders which result from    pregnancy, because
in these it tends to the destruction of the infant.  We must
therefore submit an imperative and invariable objection (and
one which is subject to no reservation) to bloodletting, as
an appliance in the medical treatment of diseases of pregnant
women; and, hfortiori, under the conditions above mentioned,
in which nature unassisted is ordinarily adequate to perform
the cure.
This derangement, associated with incipient pregnancy,
may, however, be characterised by symptoms of a more
severe or even urgent description; and in such instances may
terminate in a miscarriage, if not properly treated.       The
observance of a simple regimen, as described in the hygienic
rules, suffices ordinarily to avert that accident; if, however,
the morbid symptoms continue, we have a very efficacious
remedy in the following---
Nux vom., 30.
Three globules, to be dissolved in six teaspoonfuls of water,
and one teaspoonful of the solution taken every night.'
If the patient be of a lymphatic temperament, delicate,
SWhen the administration of medicines thus dissolved extends over a period
of more than two days, (that is, when the solution would require to be preserved
for such a time,) four drops of proof spirit should be added to this quantity of
water. In very hot or changeable weather, this precaution should be observed
with medicines kept in aqueous solution twenty-four hours. Another and preferable method, however, is, perhaps, to assume the above prescription as that
conveying the requisite proportions, and to prepare afresh solution thus every
twenty-four hours.



86


PREGNANCY.


and with a pale, white complexion, of a very gentle and
timid disposition,
Pulsatilla, 30,
may be given in preference to Nux vomica.
Belladonna, 30,
will be advisable if there should at the same time be redness
and heat of the face, with a determination of blood to the
head.
FEBRILE ACTION.
Soon after the commencement of pregnancy, we often
find that a moderate degree of fever is manifested by the
increased heat of skin, especially of an evening; a quickened
pulse; heat about the entrance of the vagina, with increased
desire to pass water; a white tongue and thirst. In the
latter months of pregnancy, this febrile state is often very
troublesome; the pulse is permanently accelerated, but more
so towards night; the skin is hot, and the woman restless;
she cannot sleep, but tosses about till day-break, when she
procures some short, unrefreshing slumber, occasionally accompanied with a partial perspiration.  In the morning the
febrile symptoms are found to have subsided, but in the
afternoon they return, and the following night is spent alike
uncomfortably. There is usually more emaciation than
happens in pregnancy under different circumstances; and
although this state will sometimes last throughout the whole
period, it is astonishing how well the strength is kept up, in
spite of the want of rest, and of the general uneasiness,
which results apparently from the morbid increment of heat,
especially about the organs of generation.  This condition
is best met by the administration ofAconitum, 30.
Three globules, to be dissolved in six tablespoonfuls of water,
one to be taken every night,' in the milder cases, or every
six hours in the more severe. This may be followed, if
nccessary, by Pulsatilla prescribed in the same manner.
' Refer to the note respecting doses at p. 85.



DISORDERS OF PREGNANCY.


87


These remedies will be found far more advantageous than
the bleedings, and purgatives with saline medicines, usually
prescribed by physicians of the old school.
SICKNESS.
Vomiting is one of the earliest indications of pregnancy;
and, with an occasional exception, troubles all women, more
or less; it most commonly happens on first rising in the
morning, although with some it does not occur until the
afternoon.  There is a sense of nausea, with inclination to
vomit, which generally continues until the period of quickening, after which it decreases or goes off; but sometimes it
remains during the whole period of gestation. In the earlier
weeks, this nausea passes off on eating; but as pregnancy
advances it continues after and even during the repast: this
is followed by efforts to vomit, and then by vomiting of
glairy fluid, with or without effort, and even by vomiting of
the food itself, especially after breakfast.  For the relief of
these symptoms, which render pregnancy so painful to many
women, Nux vomica offers in the assemblage of its primary
symptoms, a certain indication: we therefore prescribeNux vomica, 30.
Three globules, to be dissolved in a wine-glass of water; a
teaspoonful to be taken two or three times a day.
The relief afforded by this is often so great and immediate,
that the patient will go through the remainder of her pregnancy without much inconvenience.
Pulsatilla may be given in the same way in some instances, where the disposition of the individual is particularly
mild and gentle.
When the vomitings are almost continual, so that even
the food is in a great measure rejected, and bile, pure or
mixed with glairy mucus, is expelled, we giveIpecacuanha, 6.
Three globules, dissolved in three teaspoonfuls of water, one
to be taken three times a day until relief is obtained.



88                     PREGNANCY.
In some very rare cases the vomitings resist these medicines; we then administerSepia, 30.
Three globules, in eight teaspoonfuls of water, one to be
taken every morning, especially if there occur, in the
vomitings, a milky mucus, and if the patient be of a sad
disposition; or if she had been subject to megrim, or to any
derangement of the uterus.   In the latter case, recourse
may be had also toConium,
in the same manner. This medicine succeeded very well
with a lady whose case is reported by Dr. Croserio, and who
was almost cured of a scirrhous state of the neck of the
womb after eighteen months of treatment, when she became
enceinte.  During her former pregnancies, she continued to
vomit throughout the whole period, in spite or by reason of
the four or six bleedings which allopathic treatment had
inflicted upon her. Nux vomica and Ipecac. had only allayed
the symptoms for a time, when a dose of Conium completely
relieved them.
Arsenicum, 30,
is appropriate for excessive vomiting after food, with attacks
of fainting, great debility, and emaciation.
Natr. mur., 30,
is sometimes successful in cases which are very obstinate.and do not yield to the above, especially when a great flow
of limpid mucus is regurgitated, or constantly running from
the mouth, as if the patient were salivated, with crampy
pain at the pit of the stomach, and tenderness; acidity;
loss of taste and appetite.
Aconitum, 30,
is useful when the subjoined symptoms prevail:-thirst,
with disinclination for food; dryness of the mouth and
tongue; ptyalism, with stitches in the tongue; vomiting,
with nausea, thirst, heat and perspiration, and incontinence



DISORDERS OF PREGNANCY.


89


of urine; scraping sensation up the throat, and rising of
sweetish water into the mouth; heartburn; vomitings of
mucus, or of grey, watery liquid, or of bitter, greenish bile.
It is adapted to sanguine and plethoric subjects; and if
the symptoms have been aggravated by chagrin or fright.
Ferrum, 12,
is more especially appropriate for morning vomiting of water
and mucus-renewed after eating-sour and acrid vomiting;
sense of repletion; vomiting at midnight; worse when lying.
The other remedies, the characteristic action of which corresponds with some indications which occur in this affection,
are:-Coccul., Kreos., Lach., Magn. in., N. mosch., Petrol.,
Phosph., Veratr.
Women who are subject to vomiting should strictly
observe the dietetic rules; that is to say, to live chiefly on
roasted and boiled meats, eat few vegetables, and abstain
from fruits. A small glass of old sound wine after dinner
may be allowable or advantageous in some cases.
HEARTBURNoften occurs very early after conception, but sometimes not
until after the fourth month; it consists of a burning sensation
up the throat, either alone, (in which case it depends upon
the morbidly irritable state merely of the nerves of sensation,) or accompanied by the constant rising of acid fluid
into the mouth, an evidence of disordered secretion; and
there is sometimes also spasm of the stomach, when it is
called pyrosis (water-brash). These symptoms are worse
after eating; and are materially aggravated by fat or burnt
articles of food, the brown of meat, raw fruit, &c.  Water
even sometimes turns acid, and is regurgitated immediately.
Port wine and tea are particularly obnoxious.
For these symptoms we prescribeNux vomica, 30.
Three globules, in six teaspoonfuls of water; one teaspoonful
to be taken three or four times a day until relief is obtained;
or Pulsatilla and Sulphur may be used in the same way.



90


PREGNANCY.


Phosphoric acid is also a very serviceable remedy in these
cases.
Ars., Bell., Calc., Kali c. are sometimes useful.
CRAVINGS OR LONGINGS.
It is not uncommon during gestation for the woman to
have a strong desire to eat things which are hurtful in
themselves, or for which, even, under other circumstances
she almost entertains a repugnance. As before remarked,
it is not necessary, from fear of any morbid influence upon
the child, to sanction the use of articles of food which are
positively injurious; on the other hand, where the desire is
for any article of diet, it may safely be accorded.  In most
of these fantastic tastes, Sulphur is the best remedy; however, if there is an excessive desire for vinegar, Arnica should
be given; if for chalk or plaister, Acid. nitric.; if for
brandy, Arsenic., Pulsat., Sulphur., Lachesis; if for coal,
cinders, &c., Cocculus; or if for common salt, Carbo veget.
SPASMS OF THE STOMACH.
Towards the end of the period of pregnancy, women are
apt to suffer from spasm in different parts of the abdomen,
or in the flank, or at a point below the false ribs.
Nux vomica, 30,
given as before recommended, generally succeeds in dispersing
the pains in a few days. If the patient is of a lymphatic
temperament, Pulsatilla is to be preferred.
CONSTIPATION.
CONSTIPATION is almost a natural consequence of pregnancy; but is more especially obnoxious to women who live
in towns and lead a sedentary life. Although constipation
is less injurious on the whole than a contrary state, it should
be remedied, as far as possible, either by an alteration of diet,
in augmenting the proportion of vegetables and fruits, or by



DISORDERS OF PREGNANCY.


91


drinking a glass of fresh spring water, either on going to bed
or on rising in the morning, and by proper exercise; if these
do not succeed in obviating the disposition, the patient should
use a lavement enema, with a quarter of a pint of warm water
every night, and solicit nature every morning.  If the constipation has produced any troublesome symptoms, such as
heat of the abdomen, headache, pressure at the fundament,
&c.; we should giveNux vomica, 30,
two globules, and await its action four or five days.  If the
desired effect should, not, however, ensue, we giveSulphur, 30,
three globules, dissolved in six teaspoonfuls of water; one
teaspoonful to be taken every night.'
Or, if the constipation be very obstinate, we may giveBryonia, 30,
three globules, in four dessert-spoonfuls of water, a spoonful
on first awaking in the morning, and repeated every two
hours, until the desired effect is produced.
Pulsatilla would be indicated, if the constipation were
caused by the abuse of fat and indigestible food.
Also Lycopodium, Opium, Sulphur.
DIARRHUEA.
The bowels instead of being costive, may be relaxed; or
the one state may alternate with the other.  In all cases of
continued diarrhoea, it is useful to have the surface kept
warm with flannel; and sometimes a flannel roller, bound
gently round the abdomen, gives great relief. Diarrhoea
often induces abortion, wherefore it should not be neglected.
The patient should be advised to partake only of light food,
and of that in small quantities at a time.  If the stools are
slimy, greenish, and watery, and. preceded by colicky pains,
the mouth being clammy, and bitter, without thirst; and


I Refer to the note on the subject of the doses at p. 85.



PREGNANCY.


there are chills; and especially ~if the evacuations occur
principally in the night,Pulsatilla, 12,
one drop of the tincture, or six globules, dissolved in a wineglass of water; a teaspoonful to be taken every four or six
hours.
Dulcamara, 12,
may be given, if the diarrhoea was induced by getting cold,
and if there be mucous, or greenish stools, and colics.
If, besides the stools being yellow or green, or like broiled
eggs, the following symptoms occur:-very bitter taste, great
thirst, desire to vomit; or bilious vomitings with sharp pains
in the stomach or belly, distension and escape of wind, we
should giveChamomilla, 12.
If the diarrhoea has become chronic,Sulphur, 30,
(six globules, dissolved in a wine-glassful of water; a teaspoonful to be taken every night,) is useful in most cases.
After this medicine,Calcarea should be given, if the diarrhoea continues, notwithstanding such previous treatment, and especially if there
be hunger.
To these medicines, in cases such as have just been described,
the following may also be added as of service, viz:-Antim.
crud., and Lycopodium.
H2EMORRHOIDS.-(PILES.)
PILES are a frequent attendant upon Constipation during
pregnancy, and depend partly upon the torpor of the bowels
incidental to that state; but chiefly on the interruption to
the venous blood in its return from the bowels, caused by the
pressure of the womb, and its contents, upon the vessels of
the pelvis; and when great Constipation does occur, this
assists in aggravating the evil, by the mechanical pressure
of the contents of the bowels.  Piles consist of one or more



DISORDERS OF PREGNANCY.


93


small tumours at the verge of the anus. They enlarge to
the size of marbles or filberts, and appear at times clustered
around the part like a bunch of grapes; they are of a purplish
colour, painful, hot, or burning, and tender to the touch.
When they are within the bowel, and not visible, except during the act of straining, they are called Inward Piles, and
when they protrude, Outward Piles. If blood escape from
them, they are termed Bleeding Piles; if there is no discharge, they are called Blind Piles. Some women suffer from
them during pregnancy; but at no other time.   They are
apt to become inflamed, either from their over-distension,
from cold, or owing to errors of diet; and the patient is then
attacked with paroxysms of pain, commencing with a heat
and itching at the part, which increases to a burning and
aching, with shooting pain up the bowel, or into the back;
increased pain when the bowels are evacuated; a feeling as
of frequent inclination, without the power to relieve, and
heat in passing water,-or, at times, obstruction of that function.  Sitting and standing are painful; the horizontal position is therefore best for patients suffering severely from
this affection.
When the pain causes great inconvenience, the application
of hot water, either as a fomentation, or by sitting over it,
so that the parts may receive the steam, will afford considerable relief; or, sometimes a napkin, folded and moistened
with cold water, applied as a pad, with a dry one over it,the application being renewed, as occasion requires,-will act
beneficially. Temporary relief will sometimes be obtained
by applying any animal oil, or a mucilage, made by infusing
quince seeds in water; but for permanent advantage, recourse must be had to some of the following medicines, according to the prevailing indications.
Aconitum is appropriate when the subjoined symptoms
occur:-inflammatory irritation, with or without the discharge
of blood, with stinging and pressure in the anus; tensive,
aching, and colicky pains, with a feeling of fulness deep in
the abdomen; bruised feeling in the lower part of the back,
and a sense of weakness in the bowels.
Belladonna is particularly suitable to women, and may be



94


PREGNANCY.


given for hemorrhoidal constipation, attended by violent pains
in the small of the back; discharge of blood for several
days; urgent tenesmus, with itching of the anus, and constrictive sensation; constant pressure and bearing down of thebowel.
Capsicum is most suitable where there is a tendency to
irritability of the gastric and intestinal mucous membrane;
blind or flowing hemorrhoids, with burning heat and itching
at the anus; or smarting, stinging pain in the anus during
diarrhoea, with pain and heat during micturition.
Chamomilla may be given-when the varices are very painful-for blind and flowing haemorrhoids; itching pain at the
anus, with burning; urgency to stool, with diarrhoeic evacuations, and fissures; and when there is anguish and heat in
passing water.
Ignatia is more especially indicated when there are
hemorrhoidal sufferings during soft stools; pain in the anus
immediately after evacuations; constrictive and smarting pain
at the rectum, especially when touched, or when sitting or
standing. Cutting pain high up in the rectum. Creeping
as from worms; itching at the part, with discharge of blood;
also when there is constipation, with ineffectual efforts, and
protrusion of the hemorrhoids.
Nux vomica is particularly applicable to the treatment of
persons who have indulged in coffee, or stimulating drinks,
or who have led a sedentary life, when there are inflamed tumours, with copious discharge of blood; or when the following
symptoms and conditions prevail: spasmodic closure of the
anus, with burning and stinging pains; difficulty of passing
the faeces, accompanied with a constant urging to stool,
bruised pain in the small of the back, on making the least
movement,-and with jerking, dull stitches, in the small of
the back, and ischia; painful urination: the symptoms are
worse after meals, and during mental labour.
Pulsatilla should be given to delicate and sensitive individuals, when there are discharges of blood and mucus, or
when painful swelling and pressure in the hmmorrhoidal
tumours, pains in the back, and a feeling of faintness, with
tendency to diarrhoea occur; smarting, sore pain of the anus;
retention of urine; worse of an evening.



DISORDERS OF PREGNANCY.


95


Sulphur is a very important remedy in hwemorrhoids; it
is indicated by alternate constipation and diarrhoea. Chronic
constipation with piles; frequent protrusion of the bowel,
and of the swellings, with burning, pricking at the anus,
and dull stitches, with tenesmus, colic, pain in the small of
the back: painful micturition.   It may follow Nux v. or
Pulsatilla.
Lycopodium, Silicea, Cantharides, Sabina, Millefolium,
Carbo veg., Arsenicum, Phosphorus, Acidum-sulph., Graphites,
Ant. cr., Cup., Ac. mur., Calc. carb., Sepia, Caust., Aloes, 8c.,
may also be referred to, and will be found occasionally
beneficial.
The foregoing medicines may be given once a day, or
every few hours, if the suffering is severe, or once daily, for
a week, according to circumstances.   In obstinate cases, a
dose of Nux v. and of Sulphur may be given alternately
every night, or night and morning.     Three globules may
be dissolved in eight teaspoonfuls of water, and one teaspoonful of the solution given at each dose.1
COLIC.
Spasm from flatulent distension of the bowels is apt to
occur, either as a consequence of improper diet, or of cold.
Chamomilla will generally be sufficient to obviate this derangement, especially if there be a loose state of the bowels;
but if the contrary condition prevail, recourse must be had
to Nux vomica.   If the violence of the colic prevents the
patient from resting in one place, and if walking about
soothes the pains of the belly, Colocynth should be given.
In these ailments the medicines should be given in plenty
of water. Three globules may be dissolved in a wine-glass
of water, and one teaspoonful of the solution given at intervals, more or less frequent, according to the violence of the
pains.
PAINS IN THE LOINS.
Pregnant women are very subject to pains in the loins.
The bearing of the trunk backwards-the efforts made to
SRefer to the note in respect to the doses at p. 85.



96                     PREGNANCY.
support the weight of the abdomen, and to maintain the
equilibrium, and the various circumstances pertaining to this
state-are sufficient to account for these sufferings.
Nux vom. is usually the best medicine; it will be especially efficacious if the patient experiences the greatest pains
on going to bed.   If the lumbago has been caused by an
effort, or by fatigue, recourse may be had to Rhus; but
Arnica may be preferable in the last case, if the pains are
principally felt in coughing, or walking about.
URINARY DIFFICULTIES.
The bladder is often affected in pregnancy.  It is sometimes torpid in its action, allows of considerable distension
before it contracts upon its contents to expel the water,-and
subsequently, this contraction takes place with difficulty,
owing to the tunics of the bladder being weakened by the
over-distension.  This state requires attention, because by
the pressure of the distended bladder upon the uterus, retroversion may be occasioned.
The patient should in such case make regular efforts to
pass the water; and if she fail in her endeavours, and any
tumefaction, distinct from the uterus, be found above the
pubes, the catheter must be used at certain intervals, until
the medicine shall have restored the contractile power to the
organ.
Nux vom. is here especially indicated, and should be given
once daily, until the bladder has recovered itself, which will
generally happen in about a week.
But it more frequently occurs that the bladder is morbidly
irritable, especially about its neck; there are frequent calls
to pass water, with pain, perhaps, during the act, or urging
in the bladder, without any alteration in the colour of the
urine.
Nux vom. is also often successful in relieving this state;
or otherwise, Pulsatilla, Cocculus, Phosph. ac., or Sulphur.
If the urine escape involuntarily, (a very troublesome and
painful affection, more frequent towards the end of pregnancy, owing to the pressure from the increased volume of



DISORDERS OF PREGNANCY.


97


the uterus,) Camphora may be given; or if the patient should
be feeble, very sensitive, and of a gentle and timid disposition, with habitually scanty and painful menstruation, Pulsatilla should be chosen.   Belladonna, Cina, Silicea, and
Stramonium may be tried under particular circumstances.
JAUNDICE.
Pregnant women will sometimes be suffused with a yellow
hue, during the earlier months, from some functional derangement of the liver, dependent, for the most part, on abdominal obstruction, and attended with dyspeptic symptoms,
which generally increase after the appearance of the jaundice.
It may be very slight, and last but a short time; or it may
be deep and long-continued, and connected with considerable
derangement of the stomach and bowels.
It may also occur at the end of gestation, from pressure
upon the gall bladder.  If it be dependent upon disease of
the liver itself, (in which case it may occur at any period of
pregnancy,) it is then fraught with danger.     The more
simple form is easily relieved by a few doses of Mercurius 12,
or Chamomilla 3, or Nux v. 30.   If it has been caused by
anger or chagrin, Cham., Nux v., or Lach. and Sulph. may
be given.
When the more severe form connected with disease of the
liver co-exists with pregnancy, recourse must be had to a
careful anti-psoric treatment, of which the following remedies
will be the foundation: viz. China, Merc., Acon., Calc.,
Arsen., Digit., Carbo veg., Nitr. ac., Puls., Bell., Nux v.,
Lach., Hepar s., &c.
PALPITATION OF THE HEART.
Palpitation is often a very distressing symptom with pregnant women, and may occur in conjunction with symptoms of
plethora; or from debility in delicate, sensitive women, in
whom it is brought on by the slightest emotion; and in those
who have a tendency to abortion, it sometimes occasions that
event.  It may occur repeatedly during the day, or only. at
night, on lying down, or at regular or irregular periods, at
intervals of two or three days.  In one lady, a patient of
O1.



98


PREGNANCY.


mine, the attack was most violent, and recurred every ten
days, lasting about twelve hours.
In those cases in which nervous susceptibility is the cause,
Pulsatilla, 30, suffices, ordinarily, to relieve this troublesome
symptom, or Nux vom., 30.    Moschus is also suitable to this
condition, especially if attended with faintness.
When dependent on a plethoric state of the system, Aconit.,
30, or Bellad., 30, followed by Nux v., will be the best.
When there is reason to suspect a more serious affection
of the heart, either from the symptoms having existed for a
long period, or from   the presence of the physical signs
peculiar to one or other of the organic diseases of that
organ, Sulphur, 30, is the medicine which has generally
afforded most relief, or else, Arsenicum, 30, alternated with
Aconitum.
SYNCOPE.
Syncope is a frequent occurrence in persons with sensitive
nervous systems, and occurs at all periods of pregnancy.
Sometimes this inconvenience troubles the patient from the
first period of conception, without her being able to assign
any other cause for it; in other instances it attends upon a
weakened state of the system, either from relaxation of the
bowels, or an alternation of this condition with constipation;
or in consequence of sleeplessness, or intense toothache.  In
the absence of decided symptoms, the choice of the remedy
must be directed by the constitution and moral condition of
the patient.  If she be feeble, melancholy, and disposed to
weep upon apparently trivial provocation or even without
any apparent cause, Ignatia, 30, should be given. If, on the
contrary, she is lively, gay, and passionate,Chamomilla, 12, is to be preferred; if with this temperament she be subject to constipation, and is too sedentary in
her habits, Nux vomica, 30.
It is advisable to give these medicines, in all cases, in a
large quantity of water, by teaspoonfuls every morning,1 to
moderate the intensity of action which patients, in such cases,
are prone to experience.
SSee the note respecting doses at page 85.



DISORDERS OF PREGNANCY.


99


If the faintings be the result of great weakness produced
by previous disease, by haemorrhages, or by privation of
nourishment, China, 12, should be administered, followed two
days afterwards by Sulphur, 30; after which we must be
guided by the nature of the symptoms.
Sometimes syncope, in pregnant women, is the effect of a
species of plethora. Moschlus, 12, is a useful medicine when
sudden faintings occur with vertigo, or tendency to hysteria,
spasms, &c., in which last case, however, the means indicated
in the article devoted to the consideration of that subject
must be employed; especially Aconitumn, prescribed according
to the necessity of the case.
Sometimes it is the effect of wearing the dress habitually
too tight; here it is a punishment for the infraction of the
hygienic laws applicable to the pregnant state.  The treatment will then consist first of the removal of the exciting
cause, after which Aconite may be given, followed by
Arnica, 30.
There is a kind of syncope which is dependent upon some
organic disease of the heart.  It generally prevails in the
earlier months, and sometimes proceeds to a fatal termination; it has been known also to prove fatal so late as the
sixth month of pregnancy. Its connection with serious
organic disease must, of course, be detected by means of
physical diagnosis or mediate auscultation.
DYSPN(EA AND OPPRESSION.
In the latter months of pregnancy, the pressure of the
fundus of the uterus upon the diaphragm and the organs of
digestion interferes with the functions of these organs, and
induces shortness of breath, panting, difficult digestion, &c.
Immediately after a substantial meal, the patient is inconvenienced by a determination of blood to the head, with
redness of the face, and a sense of anxiety and suffocation.
Nux vormica, 30,
is the most suitable medicine for these sufferings, and it is
rare that it is not followed by a prompt and complete relief.



100


PREGNANCY.


If the oppression is more permanent, and there be habitual
redness of the face, with heaviness of the head, vertigo,
anxiety, beatings at the heart, and nightmare,Aconitum, 12,
may be given;-six globules being dissolved in a wineglassful of water, and one teaspoonful of the solution given
every two or three hours, diminishing the nourishment at
the same time.
In such cases these means, together with exercise in the
open air, will usually suffice to dissipate the symptoms.
Should the oppression be accompanied with paleness of
the countenance, or swelling, or a blueish appearance, wheezing at the chest, general weakness, impossibility of remaining in the recumbent posture, oedema of the lower extremities, regurgitation of food or of water, &c., recourse may be
had toArsenicum, 30.
Six globules, dissolved in a wine-glassful of water, one teaspoonful to be taken every three hours.
This medicine may, in some cases, be alternated with
Ipecacuanha, especially if there be absence of thirst.
If the patient experiences pains in the chest on deep inspiration, so as to lead one to infer more active disease of
the lungs, Bryonia, 12, or Phosphorus, 12, may be given in
the same manner.
SLEEPLESSNESS.
If, notwithstanding proper diet and exercise, the woman
passes sleepless nights, and the sufferings that are induced
thereby require medical interference, a dose of Coffea, 6,
given at bedtime, often suffices to produce sleep, if she has
not been accustomed to the use of coffee as an habitual
beverage. If, on the other hand, she has been used to
take coffee constantly, more benefit will be obtained from
Chamomilla, 12.    If sleep is prevented by night-mare,
Sulphur, 30, should be given in the same manner.



DISORDERS OF PREGNANCY.


101


PLETHORA-HEADACHE.
Women, in the earlier months of pregnancy, are apt to
suffer from Headache, which is an alarming symptom, when
it is severe, constant, and accompanied by symptoms of
plethora. The head is giddy, the eye suffused, there is
weight over the eyes, or within the skull; the giddiness is
aggravated by stooping, or lying down; there may be
drowsiness, ringing in the ears, flashes of light in the eyes,
indistinct vision, and heaviness of the limbs.  In some
instances there is a fixed pain in one part of the back,
accompanying or preceding the affection of the head.
Tetanic convulsions, or coma, may follow, if these indications are not attended to.
All these symptoms are speedily relieved byAconitum, 30.
Six globules, dissolved in eight dessert-spoonfuls of water,
of which solution one dessert-spoonful should be taken
every two or three hours.
If the pain and heat of the head continue after this,Belladonna, 30,
may be given in the same manner.
All headaches, however, are not attended with such severe
symptoms, nor do they prognosticate such grave results; but
often proceed from derangement of the digestive functions,
and, in such cases, may be relieved by the exhibition-ofNux vomica, 30,
given at intervals of two or three days.
Opium is useful when the following symptoms and conditions prevail:-vertigo on rising from a seat, with a stupid
feeling in the head; imperfect sleep, fanciful dreams, visionary ideas, &c., or dull insensibility of the nervous system.
TOOTHACHE.
This affection frequently attends upon pregnancy, and is
often the earliest symptom, from the presence of which that



102:


PREGNANCY.


state is suspected.  The tooth ought never to be extracted,
for abortion has been known to follow the operation. The
suffering may be removed or alleviated by the same agents
as are commonly applicable to the treatment of the Toothache, which are as follow:
Coffea, if the attacks of pain occur suddenly, and are so
violent as to extort cries.
Chamomilla, if the suffering is most violent at night, so
as to oblige the sufferer to rise from bed, or if the cheek is
swollen.
Pulsatilla, if the pain commences towards evening, and
gets worse at night, and the patient be of a gentle disposition.
Nux vomica, if the pain becomes aggravated to a great
degree by exposure to the open air, by wine and coffee, or
by mental application, and is soothed by warmth. A shooting in the teeth and gums, extending into the bones of the
head and face; a sense of boring, raking, or drawing in a
carious tooth, are indications for this remedy.
Belladonna, if, in addition to the toothache, there be determination of blood to the head.
Sepia is useful in the toothache of pregnancy, as well as
in all other sympathetic affections of the uterus.
Staphysagria succeeds in a great number of cases of toothache associated with caries; wherefore it will be well to try
it in all cases in which the first medicine given has not
taken effect.
In toothache the remedy may be changed about every
half hour, if that which has been administered should not
have relieved the pain.
SALIVATION.
This symptom sometimes occurs during the earlier months
of pregnancy, and ceases about the fourth or fifth month.
It scarcely requires any interference; but if it should be
very troublesome, recourse may be had to a small dose of
Mfercurius solubilis.
If it be accompanied with nausea and repugnance for



DISORDERS OF PREGNANCY.


103


food, Pulsatilla may be given; if with general coldness and
debility, Veratrum.
If, however, this symptom should continue in a troublesome degree, notwithstanding such treatment, the subjoined
medicines will usually prove of service.
Sulphur, 30.
Three globules dissolved in six teaspoonfuls of water, of
which solution one teaspoonful should be taken every night.'
Natrum mur., if it be obstinate, and is connected with a
cachectic habit, bad digestion, soreness of the mouth and
tongue, and aggravation after food, with a constant craving,
which is allayed by the smallest quantity.
Arsenicum will also be beneficial in some instances.
PAIN AND TENSION OF THE BREASTS.
The sympathetic irritation which is set up in the breasts
by pregnancy, and which determines a flow of blood to those
organs for the purpose of preparing the mammary glands for
the secretion of the milk, excites in them more or less uneasiness or pain: these pains often become exceedingly
troublesome, very sharp and insupportable, especially with
women who expose the breasts to much compression with
ill-constructed stays.
When there is a pricking sensation without inflammation,
administerBryonia, 30.
Six globules, dissolved in six dessert-spoonfuls of water,
of which solution one dessert-spoonful should be taken three
times a day; but when there is erysipelatous redness, heat,
hardness, &c.Belladonna, 30; or Hepar sulph., Trit. 3, gr. j.
in the same manner.
The sudden abatement of the tension, and fulness of the
breasts, and a diminution of size, are unfavorable circumstances, indicating either the death of the child, or a feeble
action of the womb.
I See the note respecting (loses at page 85.



104


PREGNANCY.


(EDEMA OF THE EXTREMITIES.
As gestation advances, women frequently suffer from cedematous swelling of the lower extremities; and after a time,
the thighs, or even the labia pudendi, are involved in it.
This is partly owing to the pressure of the uterus; but in
some instances would appear to be dependent upon a peculiar
weak state of the vascular system, connected with pregnancy,
as it occupies the upper parts of the body also.
The first-mentioned result often occurs in those women
who take little exercise, and this hygienic error is then soon
remedied by a good walk; but if the swelling shall have
reached the thighs so as to impede locomotion, if there be
no other complications, the following may be administered.
Bryonia, 30.
Six globules, dissolved in six dessert-spoonfuls of water, of
which solution one dessert-spoonful should be taken every
night and morning.
If at the end of a week, improvement be not perceptible,
Sulphur, 30,
may be prescribed in the same way.
If the patient had been subject to eruptions, pimples, or
other affections of the skin, which have disappeared during
the pregnancy, the treatment should be commenced by the
latter medicine.
Occasionally there exists an infiltration of the cellular
tissue of the labium pudendi, without the more general
oedema of the extremities.  This happens most frequently in
women who possess a superfluity of fat. It is not of any
serious moment; but if it should proceed to such an extent
as to interfere with walking, then either a few punctures
may be made in the tumour to relieve it of the fluid, or the
treatment above mentioned may be resorted to.
MORAL IMPRESSIONS, &c.
It is very important during pregnancy to avoid all causes
of alarm, such as excessive fear, anger, joy, or grief, as far



DISORDERS OF PREGNANCY.


105


as possible. These operate powerfully upon the aroused
susceptibility of the nervous system, and affect both the
mother and child in an unfavorable manner.        It is not
uncommon    for the commencement of pregnancy to be
marked by a general apprehensiveness, a morbid dread which
produces trembling of the body, weakness of the limbs, loss
of appetite, disturbed sleep, frightful dreams, nightmare,
dissatisfaction with everybody and everything, &c., nervous
irritability, melancholy; the cares of life, its ordinary duties,
and the prattle of her children, can scarcely be borne by the
patient, who despairs of life, and wishes herself dead. In
such cases, there is 'no medicine which produces so satisfactory a change in the whole system, asPulsatilla, 30.
Six globules may be dissolved in a wine-glassful of water,
and a teaspoonful of this solution given two or three times a
day.
But if a sudden fright should have produced anxiety,
oppression at the chest, tremblings, &c.
Opium, 30,
must be given directly; or, if some time has elapsed since
the occurrence, Aconite.
If the same effects have been produced by sudden joy,
Coffea, 1., may be given; if they were the consequence of
violent anger, Chamomilla, 3.     If Chamomilla does not
speedily relieve, Bryonia, 12, is then advisable. Nux vomica
and Colocynth may also be useful in this case.
If the morbid impression was the effect of sudden or continued grief, Ignatia should be preferably selected.
CRAMPS.
Pregnant women are often much troubled with cramps
in the calves of the legs and feet, which come on in the
night or day. A dose of Veratrum, 30, given on going to
bed will often obviate this painful affection. In nervous
subjects, Nux vomica or Coffea, given in the same manner



106


PREGNANCY.


will sometimes avail better.  If these means do not succeed,
the following may be advantageously selected:Sulphur, 30.
Three globules, dissolved in a wine-glassful of water, and
one teaspoonful of this solution, to be taken three or four
nights in succession on going to bed.1
VARICES.
In addition to the dilatation of the ehmmorrhoidal vessels,
causing piles, the veins of the lower extremities are liable to
enlargement from the pressure of the gravid uterus upon the
iliac vessels and inferior cava.  It generally happens, that the
dilatation is greater on one side, but both may be equally
affected.  Sometimes the foot is quite purple, from the congestion of the minute vessels, and the veins in the thigh and
leg acquire an enormous size. The recurrence of this local
congestion during successive pregnancies, leaves the vessels
tortuous and bunchy, with small knotty points here and
there, which remain blue, and in after-life burst, and give
rise to wounds and discharge of blood. A bandage equally
applied from the foot upwards to the part immediately above
the knee, and the removal of all ligatures, such as garters,
&c., and preserving, as much as possible, the horizontal posture, are the best auxiliaries to the medical treatment,which consists in the administration ofPulsatilla, 30.
Six globules, dissolved in a wine-glassful of water, one
teaspoonful of which solution should be taken every night.'
This may be repeated at occasional intervals, if required.
If this medicine should not afford relief, and the patient
be of an irritable temperament, Nux vomica may be given
in the same manner; or Lycopodium, if the affection be accompanied by an unhealthy state of the blood, a phlegmatic
constitution, or a deficiency of animal heat.
Sulphur is often required after either of the above remedies.
I Refer to the note respccting doses at p. 85.



108


PREGNANCY.


Aconitum, (tinct.) 6,
two drops being added to half a tumblerful of water;
of which mixture a dessert-spoonful should be given every
four hours. If the intensity of the cough, only, is removed
by this medicine, Nux vomica, 12, may be given in the same
manner.
If the attacks are most frequent at night, Belladonna will
be preferable to Nux v.  If the cough is followed by efforts
at vomiting, or vomiting of glairy mucus, Ipecac., 6, should
be prescribed.  Should it be very obstinate, and accompanied
by a tickling in the throat and chest, Conium, 12, or Sepia,
12, should be administered.
When the cough becomes looser, and there is much expectoration, Sepia and Pulsatilla may be given in alternation.
UTERINE HIEMORRHAGE.
Although the menstrual function ceases during pregnancy,
it sometimes happens that a sanguineous, or sanguinolentmucous discharge takes place at the ordinary monthly period,
during the first few months.. Occasionally an excess of the
catamenia happens at the time of conception, and then ceases.
These circumstances are of little consequence, and demand
no interference; but now and then there is an issue of blood,
at a time distinct from what would have been the menstrual
period, and with a sudden and copious flow. This may arise
from some fright or accident; or, in delicate women, it may
even occur without any apparent cause. Whenever such a
casualty occurs, it should receive immediate attention; as, if
not arrested, it will often be followed by miscarriage, and
may endanger the life of the woman. The patient should
be put to bed immediately, so as to preserve the horizontal
position, until the complete cessation of the discharge, and
all danger of its return is past: she should also keep her
mind tranquil; and those about her should take care to secure
her from any bustle, or necessity for moving or exciting
herself. Cold drinks and spare nourishment should be given,
and the body should be kept cool-the bed-covering being
light, and the temperature of the apartment moderate.-If



DISORDERS OF PREGNANCY.


109


the hoemorrhage should ensue, as the consequence of a muscular effort to raise or carry something, a violent exertion of
the arms, a mis-step, a fall, or a blow upon the stomach or
loins, we prescribe,
Arnica, (tinct.) 3,
two drops being added to four table-spoonfuls of water;
of which mixture, one teaspoonful should be given every
ten or fifteen minutes, more or less frequently, according to
the urgency of the case.
If the flow of blood is copious, and continues in a uniform
manner, with pains at the navel, bearing-down efforts, and
pressure towards the uterus and fundament, with chills or
general coldness, at the same time that there is heat towards
the head and face, with considerable lassitude, and disposition
to lie down, we prescribe,Ipecacuanha, (tinct.) 6,
two drops to four table-spoonfuls of water; of which mixture,
one teaspoonful is to be taken every ten or fifteen minutes.
Chamomilla should generally be employed when, in addition to these symptoms, the pains are like those of labour,
and when, after a short period, no improvement is manifested.
Bryonia is given when the patient loses a considerable
quantity of deep-red blood, and there are, at the same time,
pressive pains in the loins and head, especially about the
temples.
China is very serviceable in the severe cases, where there
are heaviness of the head, vertigo, loss of ideas, somnolence
with feebleness and disposition to faint, coldness of the
limbs, paleness of face, jerks about the mouth, contraction
of the eyes; the countenance and hands become blue, and
there are tremors of the body.   Under these circumstances
the danger is great; and napkins soaked in cold vinegar and
water, may be applied to the genitals and lower part of the
abdomen, and cold fresh air let into the apartment.
China is also indicated when the blood flows by jets, and
there are, at the same time, pains in the womb, and in the
direction of the os coccygis, with augmented discharge upon
every violent return of pain.   Also, when there arc abdo



110


PREGNANCY.


minal pains, with frequent desire to micturate, and painful
tension of the lower portion of the belly. This medicine
also operates beneficially in overcoming the weakness and
indisposition which follow great loss of blood.
Hyoscyamus is indicated when there are pains like labour,
with draggings in the loins and sacrum, or limbs; general
heat, with accelerated or full pulse; swelling of the veins upon
the hand, or in the face; great agitation, excessive vivacity,
trembling in the whole body, or stiffness of the limbs, absence of sensation, obscure vision, delirium, play of the
tendons, or jerking of the limbs, alternating with rigidity of
the joints.
Belladonna should be given when the discharge is neither
very clear nor very black, and the following symptoms occur:
pressure towards the genital fissure, as though the womb
would force out; violent pains at the sacrum, as if it would
break.
Platina, 6, is especially indicated when the blood is black
and thick, but not coagulated and grumous; the pain in the
sacrum is not as if bruised, but more of the nature of a
dragging sensation from the back to the groins, and as if,
by this pain, the internal parts were pressed downwards; at
the same time, the genital parts being excessively tender to
the touch.
Ferrum, 6, is required when the blood discharged is sometimes black and grumous, and sometimes liquid, the discharge being attended with pains, as of labour, ordinarily
with redness of the face; after this medicine, China is often
useful.
Crocus is indicated when the blood is very black, clotted,
and viscid.
Sabina is very useful when the discharge is of a brightred hue, occurring in jets, or even in clots, and the discharge
is attended with pains extending from the loins round to the
groins.
Secale corn. is to be selected when the blood is black and
liquid, and when the discharge is especially excited by movement, or when the patient is feeble, and trembling of the
limbs or cramps occur.



iii


MISCARRIAGE.


SIn general, when the symptoms are at all urgent, the
proportion of each medicine (as especially stated in the foregoing prescriptions) should be mixed in a wine-glassful of
water, and a teaspoonful of the mixture given every ten
minutes, (or less frequently, according to circumstances.)
When the hmemorrhage shall have been arrested, the patient
must keep perfectly at rest for four or five days, and then
take exercise very gradually, observing all proper precautions
against a renewal of the accident.
MISCARRIAGE.
MISCARRIAGE, or ABORTION, is the term applied to expulsion of the ovum before the sixth month; PREMATURE
LABOUR, to its expulsion at any intermediate period between
the sixth and ninth month, the natural term of pregnancy.
But in accordance with the limited object of this work, I
will not make distinctions which have no practical advantage;
although some authors have described separately, the course
and treatment of abortion, as it occurs in the earlier or later
months. When premature labour takes place at the seventh
or eighth month, its progress and treatment need not differ
much from that of labour at the full time. As, however,
the end to be attained is, in either case, the prevention of
the premature expulsion of the ovum, the means to be used
for this purpose, as well as to guard against the dangerous
consequences of haemorrhage, are similar,-although in the
simple premature confinement there are fewer evils to contend with.
Abortion must be considered as a very serious accident;
for it not only deprives the mother of the product of her
pregnancy, and disappoints her hopes, but often places her
life in jeopardy.
The causes of abortion are divided into predisposing and
exciting. Among the former we may enumerate a particular
fault inherent in the mother, a constitutional delicacy, evidenced in morbid irritability of the uterus; great rigidity of
the fibres of the uterus, which interferes with the due ex



PREGNANCY.


pansion of the organ, in proportion to the growth of the
foetus: a plethoric, or congestive state of the uterine vessels,
from determination of blood to the pelvic organs, beyond the
demands of pregnancy: hereditary, or acquired constitutional
taint; relaxed condition of the neck of the womb, or atony
of the uterus, from long-continued leucorrhoea; tumours of
the uterus; polypi; cysts; diseases of the ovaria and contiguous parts; chronic inflammation of the uterus; dropsy;
scanty or excessive menstruation; sanguine, or plethoric
temperament; a disposition to haemorrhage; hysteria; the
acquired tendency to discharge the contents of the womb
prematurely, from previous abortions, &c., &c.;-all causes
dependent on change in the vital powers, produced by the
presence of one or more of these morbid conditions in the
system;-or even habitual errors of regimen, or hygiene,such as prolonged watching; excesses of all kinds; tight
garments,-especially such as exert undue compression upon
the abdomen, &c.-Besides these, there are others which
appertain to the foetus itself, such as its own weakness of organisation; monstrous conformation; slender attachment of
the placenta to the uterus; its position over the os uteri;
shortness of the umbilical cord, hydatids, &c.
The exciting causes are very numerous. To detail all
the exciting causes of abortion, would be to recite all the
functions of the female, and all the hygienic or morbific
agents by which she is surrounded. Thus we may enumerate,
amongst the exciting causes:-acute diseases, especially
those of the uterus and abdominal viscera; mechanical injuries,-such as falls and blows;-the common actions and
conditions of riding in a carriage, fatigue, over-excitement,
coition; mental disturbances,-such as anger, grief, and other
violent emotions; medicines which operate especially upon
the uterus,-such as emmenagogues, &c.:-in fact, all circumstances which directly or indirectly excite abnormal contractions of the uterus, and thereby produce expulsion of its
contents;-or which determine a congestion of blood towards
the uterus, or induce such an alteration of the vital force as
precludes the accomplishment of its functions.  From  such
causes operating upon the womb, the fruit falls before it is



114


PREGNANCY.


tissues of the uterus, or by errors of hygiene, will admit of
a more or less favorable prognostication, according to the
greater or less control which can be exercised over these
causes--or to the facility or difficulty of obviating or removing them. The nature and gravity of the accidental
causes, will also greatly influence the nature of the prognosis.
At all times the means which Homoeopathy offers for
combating these causes, or at least their effects, are so potent
and often certain, that the practitioner ought not to pronounce a miscarriage inevitable, except in cases in which the
foetus shall already have presented at the os uteri; he should
not despair of his patient's completing the term of her
pregnancy, in consequence either of an alarming haemorrhage, the escape of the liquor amnii, or the supervention
of convulsions.  The death of the foetus cannot always be
recognised by any certain signs; doubtful symptoms of this
accident need not, therefore, deprive him of all hope of a
fortunate result.
The insertion of the placenta over the os uteri, although
frequently productive of consequences fatal to the continuance of utero-gestation, by the repeated hemorrhages
which ensue, may yet be rendered less hazardous by the proper
treatment of these results with Sabina.
The prognosis with regard to the effect of abortion itself,
or of its consequences, is more favorable in the case of the
Homoeopathic practitioner, since he possesses means which
act upon the uterus and its appendages more directly, and
with greater power and certainty, than any Allopathic
resources, as well in facilitating the expulsion of the ovum,
when that is inevitable, as in remedying haemorrhage, convulsions-which often prove fatal-or inflammatory or other
accidents which may follow miscarriage. In general, under
all circumstances, abortion induced by a sudden cause, is
more serious, and more painful than that produced by a
cause which has acted long upon the organism of the female
previous to the misfortune, because the neck of the womb,
in the latter case, is more easily relaxed and dilated for the
passage of the foetus.  However, even in this case, Homoeopathy can protect the women from many dangers.



MISCARRIAGE.


115


The treatment which abortion requires, has for its primary
object the prevention; and aims secondarily, in cases in
which it cannot be avoided, at conducting its course with
less danger and pain to the mother; and, finally, labours to
remedy or prevent the accidents which sometimes accompany or follow that evil.
In order satisfactorily to fulfil the first part of the treatment of abortion, the predisposing or occasional causes must,
as far as possible, be removed. It should be ascertained, if
these are incidental to faults of hygiene, whether in dress,
habitation, avocation, or injurious moral causes, &c. The
treatment should then tend, by suitable medicines, (which
will be pointed out further on,) to remedy the dynamic
effects of these causes.   It then   becomes necessary to
investigate the patient's state of health anterior to her pregnancy, to be informed of any antecedent maladies; and to
ascertain if there have been former pregnancies, or abortions,
and under what circumstances; and especially the habitual
state of the menstrual function.  From these different indications, the nature of the patient's constitution and the
dynamic causes, predisposing or occasional, may be deduced.
If, in consequence of previous miscarriages, an habitual
plethoric condition, or of great and general debility, an
abundant leucorrhoea, habitual pain in the region of the
uterus, &c., a predisposition to abort is recognised, this
tendency should be combated without loss of time, by an
appropriate regimen, and such medicines as are indicated by
the state of the patient.
If she be plethoric, subject to a very profuse menstruation,
to leucorrhoea, pains in the breasts, colics, pains in the loins,
megrim, congestion of blood to the head or the chest, vertigos, &c., recourse must be had to
Calcarea, 30.
Three globules, dissolved in six teaspoonfuls of water; one
teaspoonful of this solution being taken every morning for a
week.1
S Refer to the note respecting doses at p. 85.



MISCARRIAGE.


117


or railroad, - which is apt to be exceedingly injurious,
owing to the jarring communicated to the pelvis and its
contents,-and she should ascend and descend the stairs
with caution.
Absolute rest, by weakening the constitution, adds a fresh
cause to the predisposition already existing.
A substantial nourishment should be enjoined, avoiding
too much at any one time: it would be better to divide it
into several small repasts, regulated by the principles laid
down by Hahnemann. Abstinence from coffee is here a
rigorous and absolute necessity.
Matrimonial intercourse must be avoided.
When symptoms of abortion from one or more of the
causes previously enumerated are manifested, such as pains
of the abdomen bearing downwards, or labour-like pains
recurring with regularity, accompanied with slight sanguineous discharge, &c., the woman ought to preserve a perfect
quietude, extended upon the bed, and to abstain from food
and hot drinks, so as to avoid everything which can increase
the movements of the abdominal viscera: the most appropriate medicine should then be sought for, to neutralise the
effects of the exciting cause of the symptoms present:-for
instance, if the accident has been produced by a blow on the
abdomen, a fall, a struggle, or any other mechanical cause
which has in any way disturbed the uterus, the following
should be given:Arnica, (tinct.) 3,
two drops in a wine-glassful of water, one teaspoonful of
the mixture being taken every two hours.
This should be administered as soon as possible after the
accident.
If the accident has been occasioned by an effort to
raise a heavy weight, by a wrench in the loins, or a
false step,Rhus, (tinct.) 3,
two drops, must be given in the same manner; or, if the
haemorrhage accompanying it is more violent,



118


PREGNANCY.


Cinnamomum, (tinct.) 0,
in the like proportions.  If the symptoms have been the
result of a moral emotion, the medicine most suitable to
counteract the effects of such a cause, as indicated under
the head of "' Moral Affections," must be immediately given.
When, notwithstanding this, the expulsive effort continues,
a medicine operating specifically, as regards the existing
symptoms, must be employed.
Ipecacuanha is to be given, if there has been a fearful
hemorrhage of red blood, which continues, with pains about
the navel, violent pressure at the uterus and rectum, chills,
great debility, pallor, and nausea.
Sabina should be preferably selected, if the blood is less
red, a little deep-coloured, emitted in large lumps, the discharge being attended with labour-like pains in the abdomen
and loins.
Pulsatilla is indicated when the discharge is arrested for
a few minutes, to return with greater violence afterwards,
and is attended with expulsive pains, and deep-coloured
blood mixed with clots.
Belladonna exercises a very special action upon the uterus.
It is particularly indicated when there are violent pains of
the belly, of a tight and pressive character, with a sense of
obstruction in that region, and a kind of pressure downwards to the genital parts, as if the bowels would fall
through; violent pains in the loins, as if the sacrum were
being broken.
Chamomilla is indicated when the pains are so severe as
to extort cries from the patient, as if the sacrum were being
divided in two, and like aii urgent desire to pass water or
go to stool, occurring in fits, as in labour, followed by the
discharge of a deep-red or black and fetid blood with clots;
weakness, loss of vision, ringing in the ears, or fainting.
Hyoscyamnus is an excellent remedy, if the labour-like
pains  are  accompanied   by convulsive movements    and
stiffness of the limbs, agitation, increased vivacity, or
rigidity of the muscles, with loss of sense, obscure vision,
delirium, &c.



M ISCARRIAGE.


1.19


Ipecacuanha may be given also in the case of convulsions,
and- should be chosen in preference to the medicine last
named, if there be not entire loss of consciousness, and if the
pains are about the navel, &c.
Secale cornutum must not be forgotten, when miscarriage
imminently threatens; if the woman is very feeble, and of
a cachectic constitution, having a wan, fearful countenance,
the pulse being almost extinct, with fear of death, copious
flow of black, liquid blood, and disposition to convulsive
movements.
Nux vomica is sometimes useful when there is continued
constipation, with habitually profuse and long-lasting menstruation: and also if chills in the morning prevail, with a
crampy pain in the region of the uterus, followed soon by
pains in the loins, passing round to the belly, and downwards to the vulva, and afterwards by the escape of some
drops of blood from the vagina; the uterus is felt contracting and relaxing under the hand at each recurrence of the
pains.
In the article on Metrorrhagia will be found other medicines, which may sometimes be indicated by the occurrence
of such symptoms as are therein detailed.
The medicines, in the case of threatened miscarriage, may
be given in the lower or medium dilutions, attenuated in a
considerable quantity of water, and in small portions at a
time.  Besides observing the most absolute repose, the
patient should avoid all agitation of mind, much speaking,
and hot drinks, especially coffee and tea; the diet should be
exact and rigorous, the restrictions of which may be relaxed,
as the threatening indications of abortion are removed.
When all the symptoms have subsided, the patient should
continue the horizontal position for eight days.  If she has
been much enfeebled by the great loss of blood, she must
haveChina, 12 or 30.
Two globules, in a teaspoonful of water.  When, from the
state of the os uteri, or from other symptoms, the effort of
abortion has proceeded so far as to remove all hope of



120


PREGNANCY.


arresting it, homoeopathy can then render the greatest
assistance in facilitating the complete expulsion of the contents of the womb, and in a manner void of danger. For this
purpose, the instructions given under the head of Labour
will suffice.  The treatment to be adopted in the two conditions is similar, except that in the case of Miscarriage it
is more necessary to avoid any manual effort of traction, &c.,
with a view to expedite the termination of the abortion,which is more unnecessary here, inasmuch as the Homoeopathic remedies adapted to this state are so much more safe,
efficacious, and specific.
The expulsive (forcing) efforts, during the process of
abortion, in the earlier months are often much more painful
than in labour at the ordinary period, and sometimes so
violent and intolerable that convulsions are brought on,
in nervous and excitable subjects, particularly when it has
been the effect of a sudden and recent exciting cause.  In
these cases,Coffea, 6,
will be of great service.  Six globules, dissolved in a wineglassful of water, one teaspoonful of the solution being given
every ten minutes.
Another important point is not to separate the foetus from
the secundines, by division of the cord, when it shall escape
first, but to allow it to exert the slight traction which results
from its connection, in order to facilitate the extrusion of
the whole.   After the completion of the delivery, repose
and quiet are necessary for a few days, more or less, according to the seriousness of the circumstances which have
attended upon the miscarriage, as well as to the period of the
pregnancy at which it has occurred; and the after-treatment
must be managed according to the rules prescribed for the
puerperal state, a dose ofArnica, 6,
being given immediately.



FALSE PAINS.


1121


EPHELIS.
Pregnant women are often subject to yellow or dingy
stains, which occur in patches over the face, around the lips,
or on the forehead or cheeks: they convey no sensation,
and only produce inconvenience by the disfigurement which
they occasion. This development of Ephelis is essentially the
same as the pityriasis, which happens independently of the
pregnant state, and, like that, sometimes assumes the form
of a saddle across the nose. The same treatment is here
indicated, and will be found successful, viz.Sepia, 30.
Three globules, dissolved in a wine-glassful of water, a teaspoonful of the solution being taken night or morning.
If this does not suffice to remove it,Sulphur and Lycopodium
should be given after the same manner, or the Sepia repeated
after a week's interval.
FALSE PAINS.
Towards the close of the term of pregnancy, women are
apt to suffer from pains like small labour-pains, which come
on at a certain time every day or at night, but they have no
effect upon the os uteri, which remains closed.   If the
period of labour has not arrived, a dose of Pulsatilla, 12,
will be sufficient to put a stop to this abnormal action; and
if it has, the same remedy will change the irregular into
natural and effective pains.  The condition of the pregnant
woman being one of extreme susceptibility to impressions,
it is reasonable to suppose, that remedies, selected in accordance with their specific relation to the symptoms developed
by accidental or occasional causes, during such state, would
possess a greater activity than at other periods, or when this
augmented sensibility of the entire organism is absent.  On
this account, it is highly important to abstain from  the



122


PREGNANCY.


administration of medicines, except when there is a positive
necessity, to lay them aside as soon as the results are obtained, and as a general rule to prescribe them in the higher
attenuations.  One exception may, however, be quoted
against this suggestion, namely:-that, as in certain constitutions it sometimes happens that the higher dilutions create
invariably a perturbation or general disturbance, rather than
a subsidence of the symptoms, I have in those instances
given the lower dilutions with considerable effect, taking
care to omit them as soon as possible.  For the same reason
the medicine given in a single dose, instead of being divided
into several, answers better.
The two following cases, illustrative of the ill-effects of
the lower dilutions in somewhat large and repeated doses,
during the pregnant state, are related by Dr. Croserio.
"A young woman, twenty years of age, consulted him.
She was tall, strong, and well built, with black hair and
eyes; she complained of heaviness of the head; a stunned
sensation, especially on stooping, and on raising herself
afterwards; her countenance was red, the pulse full and
regular; there was no other complaint but that the menses,
which were usually abundant and lasted four or five days,
were delayed a week.    Attributing the indisposition to
a plethoric state produced by the arrest of the function,
and considering the whole of the symptoms, especially the
constitution of the patient, he thought that a dose of Aconite
would put an end to the disturbance: he put two drops of
the 3d dilution into a wine-glass of water, and directed her
to take a teaspoonful of the mixture every three hours.
After the tenth spoonful, a very considerable discharge of
blood took place from the uterus, together with the expulsion
of an ovum, containing an embryo of four or five weeks.
The ill-effects of the medicine require no comment. If pregnancy had been suspected, he would have given a dose of the
medicine much more attenuated, and the morbid phenomena
would, most probably, have been dissipated without the adverse
occurrence of hoemorrhage, which is to be found among the
rest of the symptoms characteristic of the medicine.
"The second case was that of a married woman at the



PROPHYLACTIC TREATMENT.


128


eighth month of pregnancy, who was prematurely confined
at seven months in the preceding one, and for this reason
was restrained to the sofa in a state of perfect quiet by her
medical adviser.  She consulted him for constipation, loss
of appetite, with thirst, agitation, and want of sleep at night,
and cramps in the calves of the legs. These symptoms
sufficiently indicated Nux vomica.  He prescribed three or
four globules of the 30th dilution in a glassful of water, to
be taken by teaspoonfuls, one every night on going to bed.
From the first dose a favorable effect was produced; the
sleep was better, and the next day the meals were taken
with more relish; the medicine, notwithstanding this amelioration, having been continued, two days afterwards there
supervened slight pains in the loins and pinchings in the
belly: in a few days more the waters broke, and labour
came on, when she was delivered of a healthy child, before
the ninth month, which happily lived. If the medicine had
been suspended after the first effects, as the patient was
forewarned, it is probable that the accident would never have
happened, for in place of the primitive effects, which are
proper to Nux vomica, such as, 'in the morning pressing
through the genital organs, with contractive cramp in the
abdomen and uterus, the menses four days too soon, menorrhagia,;c.,' the Nux vomica would have excited only a
salutary reaction, that is to say, the re-establishment of the
functions of the organs of digestion; and if she had observed
the hygienic rules, her pregnancy would have continued to
the natural term."
THE PROPHYLACTIC TREATMENT APPLICABLE TO CHRONIC AND
HEREDITARY DISEASES.
In order to diminish the evils which afflict humanity, and
break in upon those hereditary disorders which are transmitted from parent to child, it is absolutely necessary to
act upon the germ tlýrough the organism of the mother.
Homceopathy alone possesses this power, for it is only by
infinitesimal doses that the deeper recesses of the animal
economy can be specifically operated upon, and a new direc



124


PREGNANCY.


tion given to the vital processes of the reproductive organs.
Allopathy, on the other hand, exhausts its influence upon
the superficial tissues of the body, and, except in the cases
in which the poisonous effects of mercury and other minerals
are manifested, the organism is never penetrated by its
remedies at all, and consequently no curative power can be
exerted over the vices of the embryotic organism.
Numerous observations have been made of mothers, who,
having lost their children at an early age, or having seen
them afflicted with serious scrofulous affections, have submitted themselves throughout their pregnancy to the conservative prophylactic treatment, and have thereafter borne
robust healthy children, whose growth was regularly and
unusually progressive; and who have even been insensible
to the influence of the vaccine virus, and equally unaffected
by the ordinary diseases of childhood. It has been remarked,
repeatedly, that very robust and continuously healthy children have been born of excessively sickly and unhealthy
parents, (yet susceptible of the impression of the vaccine
virus,) when the mothers had submitted to the ordinary
homceopathic treatment for the indispositions which they
had experienced during their pregnancy. The advantage
cannot be too strongly enforced of paying the greatest attention to the constitution, and to the slightest symptoms of a
pregnant woman whose health has been invaded by disorders
of any peculiar or specific character, and to the administration of the medicines suitable to these circumstances, because
by such means not only would the mother be relieved, but
the constitution of the future infant would be ameliorated,
and its robust health, in many cases secured, or at all events
enhanced.   It is thus that the enlarged views of the great
Founder of Homoeopathy can be carried out and perfected,
and the human race be regenerated,-by the cure of chronic,
and the obliteration in embryo of hereditary disease.
Sulphur, 30, and Calcarea, 30, should be given to the
mother alternately, from time to time, at different periods
of her pregnancy, and at distant intervals, (immediate treatment of intermediary acute symptoms, requiring other medicines, excepted,) in order to purify the foetus from the psoric



TREATMENT DURING LABOUR.


125


or scrofulous disposition which it may inherit from its parents,
whenever any symptoms indicative of the presence of these
miasms are present either in the parents or in previous
children.  But if there be any suspicion of the syphilitic
taint, as evidenced by the present or past history of the
individuals, Mercurius solubilis should be given in a high
degree of attenuation.  On the other hand, however, to administer the medicines to the mother, without any indication
afforded by symptoms past or present, during so susceptible
a period as that of pregnancy, would be to act contrary
to the principle,, similia similibus curantur, and would
probably provoke the manifestation of the primary symptoms
of the drug, which might have the most serious consequences,
such, for example, as haemorrhage and abortion.
TREATMENT DURING LABOUR.
Delivery by art would seem to be one of the results of
civilisation; whether the latter is to be condemned for this
appliance, (as one amongst other evils which have followed
in its train,) we will not stop to inquire, but we may consider it a fortunate circumstance that art has kept pace with
the necessities which the habits of civilised life have created;
and at the same time that we witness the comparative
simplicity with which the processes of nature are carried on
and completed amongst the subordinate animals, or in savage
life, we may be grateful for the succours that enable us to
meet the former difficulty.
The necessity which exists for the tutored skill of the
accoucheur is, however, most apparent in the two extremes
of civilised society. The soft and careful training, and the
luxurious habits of the affluent, expose them to disordered
actions of the vascular and nervous systems during the period
of labour; the privations and laborious mode of life which
weigh upon the poor, dispose them to alterations of structure,
and to painful or inflammatory derangements, which obstruct
or complicate this otherwise natural process; but the middle
class, possessing only so much of the exposure and activity



126


PARTURITION.


of the latter as amounts to active exercise and healthful
recreation, and no more of the conservative habits of the
former than suffice for the prevention of evil, have advantages
which are not to be found any where else, and although
even here it sometimes happens that art is requisite to assist
nature in her operations, the instances are not common, and
the homoeopathic practitioner can do much to prevent the
necessity for manual or instrumental interference.
We pass over the details of preparation, so well known to
the accoucheur, and explained in the ordinary works on
Practical Midwifery, and proceed to the consideration of the
different stages of labour, and of the homceopathic treatment
applicable thereto.   In order that the expulsion of the
foetus may take place without accident, it is necessary, first,
that the orifice of the uterus be sufficiently open to afford
free passage to its contents; secondly, that the contractions
of the muscular fibres of the body of the uterus, aided by
those of the diaphragm and abdominal muscles be sufficiently
strong for the expulsion of the child; thirdly, that the
channel through which the child has to pass does possess the
necessary dimensions to afford it a free passage; fourthly,
that the size of the child be proportioned to the capacity of
the passage which it has to traverse, and that it should
present those parts of its own body which offer corresponding
diameters.
The opening of the orifice of the uterus is gradually
effected by the action of pains which are called preparatory.
The accoucheur should watch for the time when these pains
assume a regular character.
When he is called upon to attend a woman who is suffering
from these pains, he will assure himself as to whether or not
the term of utero-gestation is completed; and if not, he should
be guided by the instructions heretofore laid down in respect
of False Pains, p. 121.  If the history and the state of the
os uteri indicate that the proper time for delivery has arrived,
and the pains progress with regularity, he will, of course, let
nature take her course.  If the pains do not progress, he
should inform himself by the touch of their nature, and if
he does not feel the os uteri contract and relax during



TREATMENT DURING LABOUR.


127


the pains, this will be a sign that they are false and
evanescent.
He may administer a dose of Pulsatilla to disperse these
pains if they are false, or to augment their force and regularity if they are premonitory of labour.
When, in spite of the pains being sufficiently strong and
frequent, the distended membranes do not present, some
deviation from the normal position of the infant may be
suspected, or a shortening or twisting of the cord may exist.
It is then important to ascertain by a careful examination,
without risking the premature rupture of the membranes,
the actual position of the child.
If a malposition be recognised, it will be prudent to administer a dose of Pulsatilla, before the rupture of the membranes, and without allowing the pains to proceed further.
It has not unfrequently happened that an unfavorable
presentation has been by this means converted into a
favorable one, by the simple induction of the more natural
and instinctive action of the uterus.
When the earliest pains are experienced, especially with
first children, the patient is frequently seized with a certain
dread or anxiety: -she experiences a sort of trembling, which
should not be confounded with that which is manifested at
the moment when the pains become expulsive. This alarm
and anxiety are usually dissipated by a calm and assured
manner in the accoucheur, and in the other persons who surround the bed. All whispering or signs should be avoided,
as the patient is very susceptible at this period, and is ready
to imagine every kind of evil.  If the symptoms continue,
a dose of Aconite, 30, should be given.
To keep the patient marching about at this time, is not
always prudent; but this must be determined by the circumstances and condition of the patient.
If, notwithstanding the continuance of the pains, the os
uteri continues closed with thick, pad-like edges, a dose of
Belladonna, 30, may be given.
If this does not alter the condition of the os uteri, and
the pains still continue, a dose of Pulsatilla may be given,
ascertaining, as far as possible, the position of the child.



128


PARTURITION.


The formation of the pouch or bag of waters is subject
to the same varieties; and, from like causes, the same treatment may be adopted to facilitate the process.  Notwithstanding the indications which he may have discovered of
the position of the child before the rupture of the membranes, the accoucheur will not fail to ascertain it with more
precision after that has taken place.
When notwithstanding the administration of the remedies
above named, the membranes are slow to break, the os uteri
being sufficiently expanded, and the protrusion of the membranes being considerable,-the uterine efforts yet fail in
producing an effect upon the descent of the child, in
proportion to their severity,-then it will abridge the
duration of the labour and greatly relieve the patient, to
rupture the membranes.
With regard to the indications for manual or instrumental
delivery, they are well known, and are treated of in other practical works upon that subject, being equally applicable as
associated with Homoeopathic treatment; but it may be borne
in mind, that in all the positions of the head and inferior
extremities of the child, the natural powers, aided by the
administration of the suitable Homoeopathic remedies, will
generally accomplish the desired end.
HYGIENIC TREATMENT DURING LABOUR.
During the progress of labour, which may last from one
to twenty-four hours-or even longer-the woman demands
care and attention, to assist her in comfortably supporting
the fatigue, suffering, and anxiety, which are induced by it.
When a woman is first seized with the premonitory
symptoms of labour, she should remove all strings or ties,
which may bind the body or the neck; should remain in a
well-aired and moderately warm apartment; abstain from all
indigestible food; and preserve, as much as possible, a cheerful and composed state of mind.  Gentle exercise about the
room will assist the operations of nature; but during the
pains she should take up a convenient position, which may
favour the efforts which she is constrained to make. After the
escape of the waters, if not before, she should be placed in



TREATMENT DURING LABOUR.


129


the position, in which she intends to be delivered: the bed
being properly prepared, she should lie on the left side, with
the head and shoulders raised, and the body slightly on an
inclination. During the first stage of labour, it will not be
necessary to make frequent examinations; but during the
other stages, it is important to watch the progress closely.
The accoucheur should remove from the vicinity of his patient, every kind of odorous substance, aromatics, orangeflower water, Eau-de-Cologne, &c.
The best drinks for her will be gruel, sago, barley-water,
toast-water, milk and water, a cup of weak black tea; or, if
the labour is protracted, panado, beef-tea, or light vegetable
soups.   Light food, however, is apt at this time to turn
sour, and create heartburn.     All spiced   gruel, cordials,
stimulants, coffee, &c., should be forbidden.
MEDICAL TREATMENT DURING LABOUR.
The condition of the mother may likewise exert some
influence on the progress of the labour, by causing either a
diminution or cessation of the pains; fainting, cerebral congestion, convulsions, and haemorrhage.
When the pains are too feeble and slow, and do not augment progressively, as they ought to do, if the child presents
one of the extremities at the longitudinal axis, and if the
patient be in other respects well, the accoucheur need not
be precipitate in administering a remedy, as in this case
the medicine might induce a sudden augmentation of the
uterine action, and rupture of the perinweum might possibly
ensue, as the consequence.   But if the waters have escaped
for some length of time, and if the patient be feeble, the
pains failing to increase in force or frequency, the best
means to excite and render them effective is to give Pulsatilla, 30. Two globules, dissolved in half a wine-glass of
water, will generally suffice. The effect of Ergot of Rye
(Secale cornutum), is not to be compared to that of Pulsatilla, in the generality of cases; but is preferable in some. In
about ten minutes the pains return, become strong, expulsive, and recur with successive augmentation, until the end.
9



130


PARTURITION.


However, if the patient should     be very feeble, and be
troubled with cramps in the legs and feet, and if she has
already had several children, Secale cornutum, 30, may be
given;-three globules being dissolved in a wine-glassful of
water, and a teaspoonful of the solution being administered
every half hour, until the pains are developed.      Secale
cornutum, given in Allopathic doses, has often been productive
of serious results.
Inflammation of the uterus; rupture of the perinmeum;
death of the child; suicidal disposition in the mother, are
amongst the ill-effects that have followed the use of that
drug in the old method; but it was never known that these
were some of the primitive effects of the drug.
When the pains settle principally in the back, without
effectively promoting the progress of the labour, Pulsatilla
will again be found very serviceable.
If the pains have been arrested by a moral cause, such as
bad news, anger, &c., the remedy suitable to the cause
must be immediately administered.
If, after having proceeded regularly for some time, the
pains should   be suddenly arrested, without any specific
cause, and heaviness of the head, drowsiness, &c., stiffness
and trembling of the limbs should ensue, we prescribeOpium, (tinct.) 6,
two drops in four table-spoonfuls of water; of which mixture
a teaspoonful should be given every half hour, until the
cessation of the symptoms and the return of the pains.
The pains may also be ineffectual, in consequence of the
excessive nervous sensibility of the patient, the severity of
whose sufferings would seem to arrest the complete development of the uterine contractions.  In this case, the patient
cries much, is agitated, and finds the pains insupportable.
A dose of Coffea, 6, will moderate this exalted sensibility,
and restore the pains to their regular course. If the relief afforded by this medicine be of short duration, or if the patient
has been accustomed to the use of coffee as a beverage,
Aconite should be given. When these insupportable pains are
accompanied by a constant desire to have a motion, or to pass



TREATMENT DURING LABOUR.


131


water, attended with ill-humour, impatience, or disposition
to grieve, we give Nux vomica. If the violent pains are accompanied by nervous anxiety and agitation, with shakings
in the limbs, inquietude, fear, tears and despair, Chamomilla
should be given.  If these means have not produced a sensible relief at the end of an hour, Belladonna must be administered.
Fainting is an unfavorable occurrence during labour, and
sometimes a very serious one, as it may indicate the occurance of an internal haemorrhage, which is not perceptible
by external discharge, and might cause the death of the
mother and child. When the patient feels faint and ill, if
it be the effect of inanition, nourishment must be givensuch as beef-tea, or a little sound wine;-if the disposition
to faintness does not depend on this cause, Nux vomica is
the most suitable medicine; and this remedy will also be the
more efficacious, if the patient is feeble, subject to pains
in the stomach,-or has nausea, with pallor, anguish, and
trembling.
Veratrum will be preferable when the fainting happens
on the least movement, and the patient experiences anguish,
dejection of spirits, or some convulsive disposition, with
general coldness.
Aconite, 30,-three globules, dissolved in a wine-glass of
water, of which solution a teaspoonful should be given every
hour-is appropriate, if the faintness is attended by violent
palpitations of the heart, flow of blbod to the head, &c.
If the Faintness is judged to arise from internal hmmorrhage, recourse must be had either to rupture of the membranes, or to the remedies indicated under that head, which
will induce more active contractions of the uterus, and terminate the labour speedily, and so prevent a recurrence of
the faintness.
Pulsatilla and Secale cornutum will fulfil these indications
very well, especially the latter, if the haemorrhage has already
been considerable, and continues; in this case, two drops of the
tincture (30th dil.) should be mixed in a wine-glassful of water,
and one teaspoonful of the mixture given every five minutes,
until the complete expulsion of the contents of the uterus.



132


PARTURITION.


In dangerous cases, the practitioner should be ready to
terminate the delivery by the feet, if the medicines do not
very speedily show some decisive action.
OBSTACLES IN THE MATERNAL PASSAGES WHICH OPPOSE
DELIVERY.
These consist in deformities of the pelvis, which narrow
the diameters; or in osseous tumours, which produce the
same effect; or in tumours developed in the body, the neck,
or orifice of the uterus,-or in the membranes of the vagina,
-or at the vulva;-and in a congenital or accidental, and
morbid contraction of the vagina, or vulva.
The accoucheur ought to ascertain, as soon as possible,
during pregnancy, (but especially during labour, if he has
not done so before,) the state of the pelvis, and the passages
through which the child has to pass; to decide whether delivery can take place naturally, or if there be any obstacles
which demand the aid of artificial means, that they may be
removed before or during the process of labour, or be overcome in case they cannot be removed,-or that he may be
prepared to resort to ulterior measures, if such obstacles be
evidently insuperable.
Malformation of the pelvis, or the existence of tumours
which leave only two inches and a half of diameter, require
of the accoucheur only patience and attention to sustain the
expulsive powers of the mother, by the means before pointed
out, since delivery may, after all, take place without instrumental interference; but if the labour should have continued
thirty, or, as sometimes happens in these cases, sixty hours, and
the pains begin to fail, Secale cornutum, 30, should be administered,-six globules being dissolved in a wine-glassful of
water, and a teaspoonful of the solution given every ten
minutes;-this will often re-excite the uterine contractions,
and expedite the delivery. Tumours of the soft parts ought
to be treated during pregnancy, if they be made known to
the practitioner: during labour, he can only endeavour to
remove them by manipulations suitable to the parts; and if
he cannot thus accomplish his object, he should administer



OBSTACLES TO DELIVERY.


133


such medicines as will aid the uterine contractions to overcome the obstacle.
If that obstacle should be a vaginal hernia, a dose of Nux
vomica will probably produce a reduction of it, and render
any further treatment unnecessary.
The escape of the umbilical cord will require, likewise, the
employment of Pulsatilla, if one cannot succeed in maintaining its reduction in situ proprio.  When contraction of
the vagina is congenital, and occurs without induration, or
any other morbid organic alteration, the efforts of nature
ordinarily suffice to'overcome the obstacles to delivery.
If the contraction of the vagina is produced by a tumour
in its parietes, or surrounding tissues, it must be remedied
according to the necessity of the case, as long as possible
before the period of delivery.  This injunction is equally
applicable to the obstacles presented by the narrowing, or
contractions of the vulva.
When the hymen has continued un-ruptured, it will be
destroyed by the gradual dilatations, or by an incision made
before the termination of the pregnancy, in order to prevent
the tearing of the membrane, which might involve that of the
perinmeum, during the passage of the head.
In cases of inflammation, with swelling of the vagina and
vulva, the medium dilutions of Mercurius solubilis will avail
greatly to reduce them: the dose should be repeated every
four or six hours.  Thuja is likewise,very useful in these cases.
Sometimes, especially with primapari, the vulva, although
it has a normal conformation, seems to offer an insurmountable obstacle to the delivery, owing to the too rapid distension demanded by the activity of the pains: this circumstance
arrests the expulsive efforts, and threatens to produce convulsions.  The pomade, or other greasy material, with which
the parts are usually lubricated, is of no real use.
Coffea, 6,-three globules being dissolved in a wine-glassful
of water, and a teaspoonful of the solution given every ten
minutes,--will calm the pains, and give time to the tissues to
yield to the distension necessary for the passage of the infant.
In order, under these circumstances, to preserve the perinseum
from rupture by the passage of the lhead, it is prudent to



134


PARTURITION.


support it with the hand,--not applied directly upon the distended skin of the part,-but by endeavouring to draw, or
bring together, the skin of the neighbouring parts towards
the perinmum, to relax it as much as possible, and so facilitate the distension, by means of the fingers and thumb
pressed upon the contiguous fold of the thighs: a pressure
made upon the parts, at this moment, weakens the resistance
of the fibres, and facilitates, rather than prevents, the laceration.
The obstacles offered by the infant to delivery are very
little under the influence of medicine. False positions, if
they have not been changed by the treatment advised heretofore, require manual assistance.  Enlargement of the head,
hydrocephalus, and other deformities, are also in the same
category, if the practitioner does not consider, that the dynamic action of Pulsatilla, or Secale, will be sufficient to put
nature in a condition to expel the whole.
The evils resulting from a short umbilical cord, may be
obviated by the use of Homoeopathic remedies.  When there
is reason to suppose that this cause is operating counter to
the advance of the labour, as indicated by the usual signs,
-such as, the undue tardiness with which the head advances
during the uterine contractions, the prompt retraction which
takes place the instant that the expulsive effort is passed, the
sudden suspension of the contraction, just when it seems to
have attained its highest degree, a dragging sensation felt
about the umbilicus by the woman during the pain, and an
anxiety as if the parts would be plucked out,-Pulsatilla
should be given as heretofore pointed out, and the labour
will proceed so as to prevent all accident to the mother and
child.
When the child is known to be dead, particularly if it has
been dead for some time, a certain degree of debility with
which the mother is impressed, if not the absence of resistance
on the part of the child to the expulsive efforts of the uterus,
induces a protracted and tardy labour.  In this case the administration of China, 18,-six globules being dissolved in a
wine-glassful of water, and the solution being given by the
teaspoonful every hour or two,-will dissipate the symptoms.



OBSTACLES TO DELIVERY.


135


Then, if the pains still continue inefficient, a dose of Secale
or Pulsatilla may be given as before directed.
Dr. Kollenbach of Berlin has stated, that he never experienced any advantage from the use of Pulsatilla or Secale,
when administered with a view to produce the expulsive contractions of the uterus during labour.  This assertion of that
intelligent physician can only be explained by the fact, that
he administered usually from   three to five drops of the
mother tincture, and never exhibited either of these medicines above the third dilution.  He gave five drops of the
mother tincture of Pulsatilla to a parturient woman; she
experienced after it only considerable malaise, but without
any augmentation of the pains! The extreme susceptibility
of the constitution of the woman at this time prevents the
reaction of the remedy taking effect, when overpowered by
so potent a dose; or, in other words, the vital powers being
already much exhausted by the pains and other circumstances
of the labour, are overpowered, so far as their reactive capabilities are concerned, by the low potency; whereas a higher
dilution just ensures a gentle and adequate reaction.  It may
be asked, how can the extreme susceptibility of the system be
reconciled with the exhausted vitality here supposed? I reply,
-in the same manner in which a high degree of vascular
action is reconciled with little power, as constantly occurs in
febrile, nervous states of the body. It is, moreover, the predominant condition in- the puerperal and suckling states.
It is well known, too, that parturient women are readily
affected by the slightest odour, from the exalted state of their
nervous susceptibility.  It was common for a celebrated accoucheur to advise his pupils not to bear about with them
odoriferous substances; because, one day, he was visiting a
patient in labour, who, almost immediately after he was
seated, was observed to faint away, although she had been
perfectly well till that time; and he discovered that this
casualty had been occasioned by the scent of a violet which he
had in his button-hole.  To so sensitive a condition of the
system, is it not more suitable to apply remedies as attetnated as possible?



136


PARTURITION.


TREATMENT AFTER DELIVERY.
It often happens that the uterus is affected with irregular
muscular contractions after the birth of the child, which
either cause a disposition to haemorrhage, or a retention of
the placenta by the hour-glass contraction.    This more
especially takes place in nervous or irritable subjects, who have
been more or less exhausted by the course of the labour.
The best means to avert this disposition, is to administer the
following, immediately after the child is separated:Arnica, (tinct.) 3,
two drops in four table-spoonfuls of water; a teaspoonful of
this mixture being administered every five or ten minutes.
It will be found to soothe the system so satisfactorily, that
the placenta is thrown off more perfectly, and the uterine
contractions are effectively completed.  I uniformly adopt
this practice, as it cannot always be predicted when haemorrhage will occur, and I have found it avert the evil which,
in former labours, had invariably ensued. It may also be
given at longer intervals during the first day, unless it be
found necessary to administer the remedies recommended
for After-Pains.
RETENTION OF THE PLACENTA.
Shortly after the expulsion of the child, the mother complains of some slight pains in the abdomen, accompanied by
an expulsive effort, which is followed by the extrusion of the
placenta and membranes of the ovum, (or after-birth.)  This
occurrence occasionally takes place at the same time with the
birth of the child, the last expulsive pain detaching and
expelling the secundines along with the infant. But the
time usually varies from a quarter to half an hour: sometimes, however, a longer time elapses; no pains are felt which
indicate the renewed uterine contractions; and on passing
the fingers up along the cord it is traceable into the cavity
of the uterus, and the placenta is not to be felt in the vagina.
In this case, traction of the cord is unadvisable; but light



HJEMORRHAGE AFTER DELIVERY.


137


frictions of the abdomen may be practised, and if these fail
to induce the requisite contractions, Pulsatilla should be
given, as before directed. This will generally reanimate
the uterus; and if the placenta is retained by any irregular
contractions of the uterine walls, it will determine a more
equable and perfect action of the muscular fibres.
If the patient should be very feeble, from the nature or
circumstances of the preceding labour, Secale cornutum, 30,
is to be preferred, and may be given in the same manner.
HAEMORRHAGE AFTER DELIVERY.
This is the most dangerous accident to which a woman
can be subjected after delivery. When the child is born,
or during the separation of the after-birth, a small quantity
of blood escapes, which varies in proportion to its slow or
rapid detachment. The accoucheur should never lose sight
of this discharge, to be assured that it does not exceed the
proper quantity.   If it be too abundant, he will seek for
the cause of this casualty, in order to correct it at once by
suitable means.   If the hoemorrhage be produced by adherent placenta, or by inertia of the uterus, and the absence
of the contractions of this organ necessary to close the
mouths of the vessels which have been exposed by the partial
or entire detachment of the placenta, recourse must be had
to Pulsatilla or Secale cornutum.    In this case, as in all
those in which there is a continued loss of the fluids of the
body, the dose must be repeated very frequently, (every five
or ten minutes,) until the huemorrhage diminishes, and then
the intervals may be prolonged in proportion. The same
remedies will be indicated, if a coagulum, being arrested, at
the orifice of the womb, interferes with its due contraction,
and so admits of the continued flow of blood.
Occasionally, the blood poured out by unclosed vessels is
collected and retained within the uterine cavity, which continues to be additionally dilated by the augmentation of its
contents, and gives rise to faintings and other symptoms
indicative of danger, without any outward escape of the
blood.   This internal hiemorrhage is apt to be overlooked,



138


PARTURITION.


until the state of the patient excites alarm.  This modification of uterine haemorrhage is also under the control of the
medicines which exercise a specific action upon the muscular
fibres of the uterus, and which, at the same time, correspond
to the hoemorrhage; here, again, the two remedies previously
mentioned, Pulsatilla and Secale cornutum, are most useful;
but sometimes Sabina, Belladonna, or Nux vomica, may be
substituted for them, if in more exact accordance with the
symptoms.
Sometimes after delivery the haemorrhage is frightful,
occurs at a moment, with a continuous stream of red and
liquid blood; in this case Ipecacuanha, 6, is the remedy best
indicated, especially if the haemorrhage is accompanied by
pains in the umbilical region, with pressure in the uterus
and towards the rectum, chills, heat of the head, great
debility, paleness of face, and nausea.
The administration should be regulated, as follows:Ipecacuanha, (tinct.) 6,
two drops in four table-spoonfuls of water; a teaspoonful of
this mixture being given every three or five minutes.
Sabina is likewise very useful when the blood is grumous,
and the discharge is attended with pains in the belly and
loins, resembling the pains of labour.
Crocus is indicated, here as in epistaxis, when the blood
is black, viscid, and mixed with large clots; also when the
woman feels movements in the belly, as if there were a ball,
or something alive, and when yellow countenance, anxiety,
disturbed vision, and frequent fits of fainting are manifested.
Chamnomilla is required if the blood be of a deep-red
colour, and escapes by jets, the discharge being attended
with expulsive pains in the belly, violent thirst, coldness of
the limbs, paleness or redness of the face alternately, or of
one cheek, and attacks of fainting.
Belladonna will be preferable when the pains are violent,
compressive, and tight; with sensation of constriction or
compression in that region; and a kind of pressure at the
genital parts, as if the womb would pass out, with a pain in
the sacrum, as though it would break.



THE PUERPERAL STATE.


139


Hyoscyamus is useful under much the same circumstances
as Ipecacuanha. When, however, the hoemorrhage is attended
by convulsive movements, and even by real convulsions; especially likewise when the subjoined symptoms occur:-great
agitation, extraordinary vivacity, general trembling or stiffening of the limbs, confusion of sight, loss of sense, delirium,
twitchings of the tendons, or convulsive shakings in the
limbs, which alternate with a tetanic rigidity; general heat,
with fulness and frequency of the pulse; swelling of the
veins of the hands and face.
Ferrum will be successful when the woman shows symptoms of excitement of the arterial system, with headache,
vertigo, red, turgid face, full and hard pulse; if the blood
escapes in abundance, partly liquid, partly mixed with black
clots, and the discharge is attended with pains in the loins
and expulsive pains in the belly.
China, 18, may be given, if the loss of blood has been
considerable, or does not cease on the administration of
other remedies; even where the exhaustion of vital power is
extreme, and there are apprehensions of a fatal result; or
again when there are the following symptoms:-dizziness of
the head, loss of vision, weariness, faintness, coldness of the
limbs, paleness of the face, or blueish colour of the face and
hands, with convulsive shocks.
THE PUERPERAL STATE.
The great errors which have been committed in the treatment of the diseases of pregnancy and the puerperal state,
have arisen from a want of duly studying and taking into
consideration the several peculiar and special conditions incident to those two states. Whilst on the one hand, they
differ materially in their essential features, not only with
regard to each other, but also in comparison with the ordinary diseases to which the organs are subject, apart from the
parturient or puerperal condition; on the other hand, they
agree in being connected with a peculiar manifestation of
the nervous and vascular systems which obtains at those



140


THE PUERPERAL STATE.


periods, and which rules and controls the character of
disease.  In pregnancy, if one might make the distinction,
we should say that the development of the vascular system
prevails most, and consequently lends the type to the diseases
to which the female economy is liable during that period.
In the puerperal state, the nervous system, rendered still
more susceptible by the various circumstances attending
parturition, exercises a more prevalent influence over the
diseases of that period.
But in the parturient state, the combined operation of the
two regulates or controls any morbid operations which may
be going on during its continuance.
Individual idiosyncrasy, or peculiarity of temperament,
will undoubtedly exert a powerful influence over the character of disease developed during either of these important
periods; but these instances are rare, and form exceptions to
the rule.
It may readily be conceived, that the predominant action
of the nervous system, in a delicate and irritable subject,
would, under the operation of exciting causes, more easily
induce neuralgims of various kinds in the pregnant state; in
the parturient, convulsions of an hysterical or epileptic character; or, in the puerperal, intestinal irritation, mania, or
melancholia; whilst in a robust, plethoric, and entonic or
sanguineous subject, the same abounding influence of the
vascular system would more surely determine the development of congestions or inflammations in the first; the more
alarming form of cerebral convulsions in the second; and
phrenitis in the third.
Nevertheless, the peculiarity which marks the puerperal
state would seem to depend upon a modification of the
nervous system, characterised especially by increased, susceptibility to impressions, and increased mobility, closely allied
to that state, which exists during morbid or protracted lactation, in fact in diminished sensorial power.  The aroused
susceptibility, which is thus developed throughout the entire
animal economy, gives occasion to that series of morbid
actions in distant and apparently dissimilar organs, which we
often find to prevail in the puerperal state, and which are



GENERAL REMARKS.


141


held together by the extensive sympathetic and associated
relations, as by an invisible link whose existence under
ordinary circumstances is so little patent to observation.
Under these circumstances, it requires no reasoning to
prove, that a moderate degree of local irritation would produce a dangerous extent of vital exhaustion, as is witnessed
in intestinal irritation during the puerperal state; or in the
effect of suckling, when the system is not in a condition to
bear it.
The converse is also observed, when a total failure of the
lacteal secretion takes place, owing to a general morbid
irritability of the system, which absorbs all the nervous
influence, and thereby prevents the establishment of the
temporary function.
"In puerperal diseases it is more especially true, that observation of the disease throws more light on its morbid
anatomy, than its morbid anatomy on the nature of the
disease. The symptoms illustrate the morbid appearances
better than the dead morbid appearances do the living
symptoms."1
These just remarks of Dr. Gooch can only be explicable
on the ground, that the diseases to which the puerperal state
is most obnoxious are diseases of the nervous system, the
proximate causes of which are, to a great extent, involved in
obscurity.  In estimating correctly the various affections of
the puerperal state, it is essential, then, to bear in mind this
peculiar modification of nervous susceptibility or power by
which that state is characterised, by doing which we shall
avoid many of the errors of hygiene, regimen and medicine,
which have too often led to fatal consequences.
The uterus, having been duly supplied with an augmentation of vascular and nervous tissue, and consequently also of
energy, both of which have been subservient to the purposes
of utero-gestation, becomes suddenly altered in its condition
by the act of parturition.  It may appear astonishing that
the accumulated supply of the vascular and nervous structures, solid and fluid, which has been the work of months,
should, in the brief space of an hour or two, be disposed of,
' Gooch on ' Diseases of Women.'



142


142         THE PUERPERAL STATE.


and reduced to its former ordinary limits; but this is one
of the arcana of nature., and proves "'how fearfully and
wonderfully we are made." The vascular supply escapes
by the normal discharges from the uterus, -during and after
parturition, both in the actual loss of blood at the time,
which in some cases is considerable., as well as in the lochia
which follow. The nervous supply is exhausted, partly by
the parturient efforts, to which I think it may fairly be
attributed., and partly in consequence of the exhaustion
caused by the haermorrhage and lochial discharges, both the
blood-vessels and nerves being for the time obliterated, by
the contraction of the uterine fibres.
The immediate effect of this process is what has been
denominated "the shock."
For the most part, after a labour of great difficulty, even
if the patient be of a sound constitution, only a moderate
perturbation of the system is produced, and two or three
hours rest, especially if accompanied by sleep, is sufficient to
restore the equilibrium. In other cases, however, an imperfect reaction takes place, symptoms of depression or
exhaustion are manifested., or reaction occurs too forcibly,
passes beyond the boundaries of health, and induces proximate and remote evils.
The susceptibility of the organism, during this condition,
is very great; slight causes operate unfavorably upon it, and
a strong predisposition to morbid action exists.
The form which this morbid action may tak~e, when lit up
in the system, under such circumstances, is determined by a
variety of causes.  First: the state of health of the individual prior to parturition;-secondly: the degree of exhaustion or inanition which has ensued upon it;-thirdly:
the operating causes;-fourthly: the individual temperament;
-fifthly: the state of the organs themselves, and of others
associated by sympathetic relations with them.
1. The state of health previous to parturition may materially influence the recovery after that event. The practitioner
should, therefore., take care that, as far as possible, the different
functions of the body, if disordered, be restored to a tolerably
healthy condition. The state of the abdominal and thoracic



GENERAL REMARKS.


143


organs, of the brain, and of the nervous system, should be
carefully inquired into; all congestions speedily removed,
and tendencies to irregular actions, whether of the circulatory
or nervous functions, watched and controlled.   It is not
uncommon for passive congestions, or subacute inflammations
of the abdominal viscera, to exist in a dormant state during
the latter periods of pregnancy, and to become developed
when the reaction from the shock of parturition has taken
place: in the same manner a morbid irritability of the brain
and spinal marrow may be acquired during the pregnant
state, and may give rise to convulsions evoked by an exhausting hmemorrhage. The uterus may undergo change
during pregnancy, from subacute inflammatory action, which
may induce a state of softening, and this may predispose to
rupture, or haemorrhage, or inflammation of its substance,
phlebitis, peritonitis, or puerperal fever.
2. Exhaustion of the vital power, either from hmemorrhage
or long-continued suffering, is often productive of present
and remote effects of a dangerous character; convulsions;
syncope; morbid lactation; and all the ill-effects of loss of
blood.
3. It is important to avoid or remove all causes which
have a tendency to excite, keep up, or to predispose to morbid
action; such as the various mental emotions, the elevating
or depressing passions, errors of regimen or diet, the influence of close, impure, and miasmatous air, foul exhalations,
imperfect ventilation, and infectious effluvia. These, for the
most part, conduce to the production of mental diseases; colics
and diarrhoeas,-and of the peritoneal or puerperal fevers.
4. The individual temperament,-if sanguineous and plethoric,-may dispose to the developing of phrenitis or acute
mania, to inflammatory conditions of different organs, to
active congestions;-if nervous or melancholic,-to melancholia, to intestinal or uterine irritation, and to passive
hoemorrhages.
5. The uterus may contain within its cavity sources of
irritation, which can be the exciting causes of disease; such
as coagula, morbid lochia, displacement of the organ, &c.
In the category of associated actions and sympathies we have



144,


THE PUERPERAL STATE.


the influence of lactation upon the puerperal state; this too
is very important.  If, in the ordinary state of health, the
establishment of this function gives rise to little inconvenience, it is yet well known how slight a cause will disturb
it; and in some instances, where a morbid state of the
constitution exists, the febrile irritation which accompanies
its access is fraught with dangerous consequences. A lady
upon whom I was attending, and whose nervous system was
unusually impressible, had a morbid      pregnancy, which
commenced with severe vomitings; then followed violent
periodical palpitations, and, in the latter months, an attack
of hysteritis.  She was confined of a living child, without
any casualty during or immediately after labour. Three
days passed over without any appearance of the milk;
in other respects she seemed to be doing perfectly well;
there was no other morbid symptom.      On the fourth day,
however, a rush of milk occurred, which was attended with
such an amount of irritation, that she was immediately
attacked with pain in the abdomen, and acute inflammation
of the womb set in. The approach of the milk caused a
violent thrill through her frame, which was followed by rigor.
The hysteritis proceeded; the milk, which was so abundant
for one day, disappeared: she slowly recovered from the
attack; but the heart then took up a morbid action, and
"dropsy terminated her life some months afterwards.
Dr. Gooch relates an analogous case, in which mania was
the disease developed at the time when the lacteal secretion
was expected.
There is no doubt, that in the puerperal state, as well as
in the peculiar condition of system, which sometimes obtains
during protracted or morbid lactation, there is a predisposition to the occurrence of mania, melancholia, and some
corporeal diseases; the former, it may be inferred, more
especially depends upon the proneness to ready exhaustion
of the sensorial power, which prevails in these subjects, while
the latter may have the same relation, with a constitutional
predisposition to exhaustion of other parts of the nervous
system, co-operating with some local irritation.   In illustration of this, we have an interesting and instructive lesson



GENERAL REMARKS.


145


afforded us in the paper published by Dr. John Clarke,' on
the morbid influence of oysters, taken during the puerperal
state, upon the brain.  In all the cases related by him  the
convulsions occurred after delivery; and in some instances
after the patient had resumed her domestic duties, in the
third or fourth week. The first indication of the deleterious
influence of this article of food was invariably a pain in the
head of a congestive character, which did not yield to ordinary remedies.   In one case death ensued, in the others
recovery took place after severe treatment.
The After Pains may be excessive, or irregular and spasmodic, or the contractions of the uterus may be deficient;
in the one case an inflammatory condition of the organ may
be excited, especially if there should have been a previous
febrile state of the system, or the pains may be mistaken for
those of an inflammatory kind.    In the other case hoemorrhage or excessive lochial discharge may result.
The lochia may be in excess or otherwise, or abnormal in
quality, irritating or offensive, &c.  The several secretions
and excretions of the body, such as the perspiration, urine,
feculent matters, milk, &c., may, from      various morbid
conditions, be sources of irritation.  The pulse affords a
tolerable indication of the normal or abnormal condition of
the patient's system.   It has been said by Dr. J. Clarke,
and confirmed by other authorities, that whenever the pulse
is above 100, the state of the patient is not one of safety;
but occasionally, in very sensitive individuals, the pulse continues much accelerated and above 100, for the first ten days
after delivery, owing to the excessive nervous irritability,
which is sustained, until the lacteal secretion is perfectly
established and the system has become accustomed to the
performance of the new function.   Thus it will be seen, that
it is very important to observe well all the different functions
of the body, both permanent and temporary, as well as the
temperament and idiosyncrasy of the individual, in order
fully to appreciate the influence of exciting causes upon the
puerperal state.


STransactions of the College of Physicians, vol. v, p. 109.
10



146


THE FUERPERAL STATE.


With these preliminary, and, as regards the importance
of the subject, brief and imperfect remarks, I will pass on
to the consideration of the disorders of the puerperal state.
TREATMENT OF THE PUERPERAL STATE.
It is natural to suppose, that the augmented sensibility
developed during pregnancy would be materially increased,
while the vital powers would, at the same time, be impaired
by the fatigues, the violent pains, and anguish attending on
delivery, and by the loss of blood which accompanies it.
The return of the great mass of the uterus to its normal
state of vacuity, the lacteal secretion, the emotions caused
by the presence of a new object of affection, are all important circumstances which have been already dwelt upon, as
producing a great revolution in the female economy, which
renders it in a high degree sensitive to morbid impressions,
and less capable of resisting their influence. This fully
accounts for the more serious character of the diseases of
the puerperal state, and for the greater mortality which
attends them.
But happily for man- and woman-kind, Homceopathy not
only operates effectually to obviate many of the evils by
which the puerperal state is encompassed, but when serious
disease does occur, its resources are so great, and its treatment so successful, that the prognosis is materially modified,
and rendered by far more favorable.
The treatment, therefore, which is demanded for a woman
in the puerperal state, may be divided into the Hygienic
and the Medical.
Hygienic Treatment.-After delivery the patient should
be left as quiet as possible, for about two hours, covered
up to prevent the occurrence of chills; the abdomen
being tightly encircled by a broad binder; warm napkins
being applied to the genital parts; and a little warm gruel
or sago being administered. During this time instructions
should be given to watch the countenance, and if any change
is perceptible, to ascertain the quantity of discharge that
is going on.



HYGIENIC TREATMENT.


147


At the end of two hours the patient should be cautiously
attended to, made dry and comfortable, and sponged with a
little tepid water, to which a few drops of the Tincture of
Arnica have been added; and this application should be repeated once or twice, in place of the lard or pomade, or
any other of the herbaceous decoctions which are usually
employed. She may then be moved up into the bed, without
raising her from the supine position.
The room ought to be shaded, and silence preserved as
much as possible, so that no excitement be induced. The temperature should be moderate, consistently with the season
of the year, the feelings of the patient, and the disposition
to chills or perspirations; good ventilation should be secured,
taking care that the patient is not exposed to any draught;
all scents must be removed, and a tendency to sleep encouraged, as the best of restoratives after the fatigues of labour.
The simplest nourishment should be administered for the
first few days, until the excitement caused by the perfect
establishment of the lacteal secretion has passed over. This
may consist of gruel, panado, sago, arrow-root, bread, light
broths or beef tea, (if demanded by any unusual debility of
the patient,) boiled rice, &c. After the milk-fever has gone
by, which is generally the third or fourth day, she may have
stronger broths made from chicken, beef, mutton, or veal,
with rice or vermicelli, or fish and chicken in the substantial
form,-and, when the bowels have acted, such other kinds
of animal food as are suitable to her condition.  The administration of some plain solid food after the third day,
unless counter-indicated by any special circumstances, will
tend (as has already been remarked), to assist the peristaltic
action of the bowels.
The diet must be a little modified, if the patient should
not perform the duties of a mother, either from necessity or
will; in this case the diet must be more sparing, until the
milk ceases to accumulate in the breasts.
Tepid milk-and-water is the best drink for the lying-in
woman when she requires anything to allay her thirst. In
no condition is mental calm more necessary than in the
puerperal state.



148


THE PUERPERAL STATE.


A gentle moisture of the skin should be preserved; but
abundant perspirations, if possible, avoided, or watched
with care.
The horizontal posture should be maintained during eight
or nine days, and a feeble or delicate woman should not
walk for a month.
Medical Treatment. --The phenomena which demand
the consideration of the accoucheur after delivery are:first, the lesions suffered by the genital parts during
the passage of the child;-secondly, the phenomena produced by the return of the parietes of the uterus to its
former condition;-thirdly, the secretion of milk and its
consequences,-if the mother does not nurse her offspring,and the state of the breasts;-and fourthly, the reparation
of the powers of life, which have been more or less exhausted by the fatigues and depletions which the woman has
sustained.
The accidents which sometimes result from the expulsion
and passage of the child, are:-Inversion of the Womb,
contusion and consecutive inflammation of the Vulva, rupture of the Perinaeum, Retention and Incontinence of Urine,
and HI-amorrhoidal swellings.
INVERSION OF THE WOMB.
This unfortunate accident seldom amounts to complete
inversion, as the lips of the os uteri are generally dependent,
even in the most severe cases; but when it occurs, it may be
that the fundus only is depressed, and cannot be felt behind
the pubes; or it may be inverted so as just to reach the
outlet; or it may be protruded externally, forming a globular tumour, like a child's head.  The vagina is drawn
down, or partially inverted at the same time. The symptoms
which indicate the occurrence of this accident are:-sudden
and great pain after the birth of the child, accompanied with
a bearing-down effort, by which a partial inversion is sometimes rendered complete; a sudden sense of weakness, pale
countenance, feeble, scarcely perceptible pulse, hEemorrhage,
which is sometimes profuise;-this, however, is greatest when



INVERSION OF THE WOMB.


149


the inversion is partial;-a sense of dragging at the stomach,
and as if the bowels were pulled out; fainting or convulsions.
Together with these symptoms, a firm fleshy mass is to be
felt either within the vagina or protruding from it, whilst no
uterus can be discovered in the hypogastric region.
Causes.-The causes of inversion of the womb are, principally:-extraction of the placenta by the hand; violent
tractions of the umbilical cord; a precipitate delivery;
shortness or twisting of the cord around the neck of the
child, operating so as to cause a jerk of the fundus, at the,moment of the child's birth; violent labour-pains, &c.
Whatever may have produced it, however, the accoucheur
must proceed immediately to its reduction, by pressing the
hand firmly, and steadily on the centre of the protruded or
everted tumour, until it recedes, and the hand passes within
the cavity; should the placenta still be adherent, it must
not be removed, until after the reduction of the organ, when
the uterine contractions may be excited to throw it off.  If
the uterus cannot be returned, it must at any rate be passed
into the vagina.  It is doubtful whether it can be reduced
after it has been down more than four hours. If the accident has occurred some time after the delivery, and the
organ be swollen and inflamed, then the symptoms must be
relieved before any attempt at reduction is made. After the
reduction has been effected, the woman should be kept quiet.
The following prescription is of service for simultaneous
exhibition:
Arnica, (tinct.) 3,
two drops added to four table-spoonfuls of water, of which
mixture a teaspoonful should be administered every five
minutes; and, if the placenta be not detached, the accoucheur
should carefully watch for its expulsion.  If this is delayed,
Pulsatilla may be given. The patient must then be kept in
a recumbent position for a month or six weeks, with the
pelvis a little elevated above the trunk; and the following
medicine prescribed:Nux vomica, 30,
three globules, dissolved in a wine-glassful of water, of



150


150         THE rUERPERAL STATE.


which solution a teaspoonful should be taken every six hours,
for eight days, if no particular symptoms should supervene
to indicate the suspension or change of treatment.    In
cases in which the administration of another medicine becomes temporarily requisite, we may subsequently resume the
exhibition of Nua vomica, when the symptoms which required
the interposition of the other remedy shall have ceased.
This plan will generally be effectual to perfect the cure and
to restore the tonicity of the ligaments.  If, however, after
the lapse of fifteen days, the woman should feel, on rising, a
certain weight in the region of the uterus, the following is
to be prescribed:
Sepia, 30,
six globules being dissolved in two table-spoonfuls of water,
and a teaspoonful of the solution given every morning;'
returning after an interval of eight days to the use of Nux
vomica, as before.
It will be proper for the patient to avoid all straining at
stool; and if the evacuations should be tardy or difficult,
notwithstanding the action of the medicine, a lavement or
enema of tepid water should be used every time the patient
requires to pass a motion. All local supports to the vagina
or uterus should be avoided.
CONTUSION OF THE VULVA.
This accident is usually overcome without any medical
aid; nevertheless, the addition of a few drops of Tincture Of
Arnica, to the water employed to wash the parts, will facilitate the recovery, and prevent inflammation. If this should
be developed by any cause, it will be successfully combated
byMercurius solubilis, 12,
two drops added to four table-spoonfuls of water, and a
teaspoonful of this mixture being given every two, three, or
six hours,-without any emollient, local application, which
IRefer to the note respecting doses at p. 85.



LACERATION OF THE PERIN&EUM.


151


only augments the affiux of blood to the inflamed parts.  If
this medicine does not entirely remove the evil,
Thuja, 30.
should be administered in the same manner.
Aconite will be indicated if the extension and activity of
the inflammation should produce febrile symptoms with
chills.
LACERATION OF THE PERIN.EUM.
Rupture or laceration of the Perinmeum, is an accident
which threatens the woman with a distressing infirmity for
the rest of her days.  Sometimes the- laceration only extends to the verge of the anus: sometimes the septum
between the rectum and vagina is torn, as well as the sphincter ani. There is considerable pain and hmmorrhage at the
time, and prolapsus uteri is, in some instances, a consequence
of the laceration.  It may be caused by too solicitous endeavours to dilate the outlet, before the birth of the head,
or by the too rapid expulsion of a large child by the natural
efforts.
Arnica and Calendula are powerful means of relief in cases
in which this distressing misfortune occurs.
When, therefore, the accident is recognised, the patient
must be speedily attended to, the parts cleansed, and washed
with dilute Arnica lotion, consisting of forty drops of the
concentrated tincture of Arnica to six ounces of water.
The edges of the wound are then to be brought together,
and covered with a thick and large pledget of lint dipped in
the pure Tincture of Arnica or Calendula, and the union of
the wound maintained by thick compresses, moistened with
the weaker lotions, over which two rollers are to be crossed,
which, after being fixed laterally to a broad belt-which
must have been placed firmly around the pelvis, as well to
afford a fixed point for the former, as to keep the pelvis immovable,-are brought down over the thighs and so bring
them together, being made to cross at the perinwum, and
then pass upwards to be attached to the bandage around
the body above the groin of the opposite side.  The patient



152


THE PUERPERAL STATE.


must be kept perfectly still and immovable on one side,
and on whichever side is most convenient to her. During
the first days the dressing must be renewed frequently to
facilitate the escape of the lochia; afterwards, it will be
sufficient to renew them, whenever the patient desires to
pass water.
The pledget of lint which is next applied to the wound
should be steeped in the pure tincture, because the abundant
discharge of fluids from the uterus is rapidly imbibed by it,
and the action of the remedy is consequently less sensible.
When the lochia are diminished the Arnica or Calendula may
be diluted with equal parts of water. This dressing and
these precautions ought to be continued during six weeks,
that the cicatrix may have time to consolidate.  It will be
prudent to aid this local treatment by the administration
of Arnica, internally, during the first week,-if no more
urgent indications point to some other remedy.        The
patient's diet should be regulated as much as possible, so
as to eat and drink little, that she may not be disturbed by
the necessity to evacuate, either by the bladder or rectum.
In less serious cases of laceration of the Perinameum, however, it may not be necessary to do more than to apply a
poultice, made with a diluted lotion of Arnica or Calendula,
and to take measures to keep the patient's thighs as closely
approximated as possible; since experience has proved that
the union of the parts is readily effected.
RETENTION OF URINE.
After a severe labour, a distressing strangury sometimes
occurs, in consequence of the pressure which the head of the
child exerted upon the urethra, and neck of the bladder,
during its passage through the pelvis, producing contusion
and inflammation of the urinary passage. Although this
trouble is evidently produced by a mechanical lesion, Arnica
is, nevertheless, not the specific remedy in such cases.
Belladonna, 30,
(three globules being dissolved in six teaspoonfuls of water



HAEMORRHOIDS AFTER LABOUR.


153


and one teaspoonful of the solution given every two or three
hours) will be found the most effectual.
INCONTINENCE OF URINE.
The same cause that produced retention, will also produce
incontinence of urine, if the labour has been protracted, or
if much exertion has been made by the woman. A prolonged or violent pressure upon the neck of the bladder
may produce paralysis, and render her incapable of holding
the water.
Arnica will be of more benefit in this case, because, besides
being adapted to the cause, it has in its pathogenesy, the
involuntary discharge of urine. After this medicine, given as
above, if the inconvenience has not entirely ceased, Belladonna
may be employed; the doses being repeated at intervals of
twelve hours, if it be necessary.
If the disorder should become chronic, and does not yield
to these two medicines, Sulphur or Sepia should be given.
These medicines may be administered in single doses, under
such circumstances, and their action suffered to develope its
influence fully. Thus the alternate administration of both
may be conducted by administering first a single dose of the
one and then of the other, at intervals of from eight to
fifteen days.
HAEMORRHOIDS AFTER LABOUR.
Sometimes this troublesome disorder shows itself after
delivery, owing to the prolonged pressure of the head or
the breech of the infant upon the outlet, during a protracted
labour.  Under these circumstances, owing to the great
disturbance of the functions of the pelvic organs, the lochia
become suppressed, there is difficulty in voiding urine or
stool, and the severe pain and agitation which they cause
deprive the patient of sleep.  The most extensive development of piles I ever saw occurred after a severe labour.
Homoeopathy has, in Pulsatilla, a most efficacious remedy
for the relief of this condition.



154


THE PUERPERAL STATE.


A small and delicate woman, two hours after a long and
painful labour, with her fourth child, had a mass of
haemorrhoids of the size of the thumb, which surrounded the
fundament; she had constant desire to pass water without
being able to do so; the lochial discharge was arrested;
sharp pains occurred which produced a feverish excitement
and effectually interfered with repose; and she could not
bear the least touch of the parts which were so distended.
Pulsatilla, 30, was prescribed to be administered thus:a few globules to be dissolved in a wine-glassful of water
and a teaspoonful of the solution to be given every two
hours.
Ten minutes after the first spoonful, the pains were
appeased, and a copious discharge of urine took place without suffering. The lochia were restored at the same time,
and without repeating the dose, the swellings subsided, and
the patient afterwards went on as usual.
AFTER-PAINS.
The return of the uterus to its normal condition, can only
take place by means of successive contractions of its muscular fibres, and the expulsion of the fluids which are contained within its cavity and tissues.  These contractions are
attended with more or less pain; they are least severe after
a first labour, and are most acute in nervous and sensitive
women. They usually come on very soon after delivery, and
last for a day or two, being sometimes so severe as to disturb
the patient's rest.  The blood and other fluids which are
evacuated from the cavity of the womb, after the expulsion
of the placenta, constitute, what are termed, the Lochia.
The pains which accompany the first discharges, mixed
with coagula, are termed After-Pains; they are felt in the
belly and loins, and are sometimes severe; they seem to be
necessary to ensure the speedy and safe return of the uterus
to its pristine condition, and an entire absence of them may
not be desirable.
Arnica, given immediately after delivery, is of great service.
If it does not diminish or prevent after-pains, it at any rate



LOCHIA.


155


diminishes the tendency to hoemorrhage, by its soothing
effect upon the system at large, in a far superior manner to
the Opium of the old school. If the pains are moderate,
they may be left to nature; but if they are violent, or frequent, so as to deprive the patient of rest, Coffea or Chamomilla will soon calm them, and procure the rest so much
desired.
Coffea will be preferable for very nervous and excitable
women, to whom the pain seems insupportable, if they are
sleepless, or have been used to chamomile tea.
Chamomilla, on the other hand, ought to be given when
the woman is accustomed to coffee-drinking, if she is of a
quick temperament, and is troubled with thirst.
Nux vomica is useful if the pains bear upon the fundament,
producing a sensation as of desire to go to stool;-especially if the patient be of a quick and determined character:
if, on the contrary, she is soft and gentle, with predominance
of the venous constitution, Pulsatilla will be advisable.
LOCHIA.
After delivery, the vessels of the uterus continue to pour
out a small quantity of blood, which gradually diminishes,the serous, or watery parts, predominating,-until they are
ultimately closed by the contractions of the uterine parietes,
and become retracted within its tissue. This discharge is
mingled with the mucosities which escape from the mucous
lining, in the progress of its return to its ordinary dimensions. The discharges thus formed and excreted, are termed
the Lochia.
The character of this discharge is, in some measure, an
index of the healthy or unhealthy condition of the uterus,
and may be either more or less abundant than is natural, or
may be altered in quality.
The quantity varies in different women, and must therefore, be considered relatively, and estimated in connection
with the general state of the patient.  The same amount of
discharge which, occurring in a full, plethoric woman, would
be consistent with a healthy recovery, in a pale and delicate,



156


THE PUERPERAL STATE.


or weak and nervous individual, would be attended with
dangerous consequences.   In general, the lochia go on diminishing, with an occasional aggravation, until the third
week, when they cease; or else they intermit until the period
for the return of the menses, and then stop. After the first
week, the colour changes to a dark or greenish hue, and is
more watery, from which the discharge, at that time, has
been called, the green waters.  Occasionally, the smell is
fetid; but this usually depends upon inflammatory or some
other derangement of the uterus.
A sudden diminution or suppression of the Lochia, is
ordinarily the symptom of some other disorder; wherefore,
when such a circumstance occurs, the attention of the
accoucheur should immediately be directed to the state of
the uterus. But sometimes it may happen as the effect of
a moral cause, or in consequence of a chill-the first impression of which has been upon the still open orifices of the
vessels of the uterus.  In this case, if the discharge be not
restored by the appropriate remedy, the altered function
becomes a source of disease in the organ, and of general
reaction in the system.
The choice of the remedy will depend, then, partly on the
exciting cause, and partly on the nature of the discharge,
whether it be composed of almost pure blood, or whether
the character of blood had almost disappeared at the time of
the occurrence.  If caused by a moral impression, the remedies indicated under that head may be given at once, in
accordance with the specific cause which produced the
change.
Aconite, however, is entitled to a preference, when the
suppression has occurred at a period soon after delivery, and
the discharges still contain blood, and when the patient
experiences pains in the belly, with anxiety, and a disposition to vascular congestion in the chest, abdomen, or
head.
This is also the remedy, if the suppression or diminution
has been produced by a chill,-when fever, heat of the face,
quickened pulse, &c., prevail.
Chamomilla is to be preferred, if there be diarrhoea,



LOCHIA.


157


colicky pains, nervous distress of the head and teeth, with
febrile heat, etc.
Coffea, Nux vomica, Dulcamara, Bryonia, Pulsatilla, Calcarea, Rhus tox., or Platina, may also be indicated by the
supervention of symptoms characteristic of one or more of
these medicines.
If the suppression is not removed by the action of the
medicines suitable to the exciting cause, and if it has induced
any other morbid symptoms,-which not unfrequently happens, especially when it has occurred at a period long after
delivery,-these must be treated according to the usual
principles, by selecting a remedy in harmony with the totality of the symptoms.
Aconitum, Belladonna, or Mercurius will be chosen according to the indications pointed out, under the head of Puerperal
Peritonitis,- or Metritis, if the symptoms should lead to the
apprehension of inflammation of the pelvic viscera.
Bryonia is useful when the Lochia are suppressed, and
this suppression is attended with headache, fulness and
heaviness of the head; sensations of pressure in the forehead and temples; throbbing pains in the head, increased by
movement; back-ache, with scanty emission of hot urine,
etc.
Colocynth should generally be preferred, if the suppression
is accompanied by violent colics, or with tympanitic swelling
of the abdomen and diarrhoea.
Pulsatilla will be indicated if the milk has disappeared
from the breasts.
Belladonna or Hyoscyamus should be selected if there are
violent pains in the head, with redness of the face, frightful
visions, delirium, &c.  If the loss of consciousness is more
complete, Hyoscyamus will be more especially applicable.
Platina is appropriate when dryness, and over-sensitiveness
of the sexual organs prevail, as attendant upon suppression,
or when that condition has resulted from some mental
emotion.
Secale or Nux vomica may be useful under some circumstances, when the Lochia are scanty, and are characterised
by a fetid odour.



158


THE PUERPERAL STATE.


Diminution of the Lochia may take place without a complete suppression. This must be determined by the experience
of the accoucheur, as well as the habits and constitution of
the patient: when it occurs, the restoration of the flow must
be effected by the same treatment as is required for cases of
absolute suppression, which is only an aggravation of the
diminished discharge.
AUGMENTATION OF THE LOCHIA.
This may take place either by a flow of pure blood, or by
an increase of the mucous, or watery discharge.  It differs,
also, in relation to the immediate or more remote preoccurrence of parturition; and it may depend upon moral or
accidental causes, such as,-excited or disturbed emotions;
a chill; imprudence in getting up to walk too soon; abuse
of stimulants; hot drinks; over-heating of the body by
clothing; or keeping the temperature of the room too
high, &c.
The remedies, indicated by the moral causes, have been
already mentioned. If there has been a chill, Aconitum or
Nwr vomica should be employed.   Aconitum will be appropriate, if the patient has a full pulse, a red face, weight and
fulness of the head, with other symptoms which are characteristic of this remedy.
Nuv vomica, 30, if the pulse is small and tight, and there
be paleness of face, pains in the loins, and weight at the
anus, chills and heats alternating; or if the increase has
been caused by an abuse of hot, alcoholic, spiced drinks,
coffee, or chamomile tea.
Arnica, 30, should be administered, if the morbid derangement of the Lochia has resulted from fatigue; at the
same time, absolute repose must be observed.
Coffea should be given-sometimes before Nux v.-when
the augmentation of the Lochia (produced by the causes
mentioned above, such as abuse of stimulants, etc.) is accompanied by great agitation, and exalted nervous sensibility.
If Coffea does not suffice, Lachesis may be employed. If the
injury has been effected through taking spiced drinks, the



LOCHIA.


159


same medicines will be useful, with the addition of China in
some cases.
When the increased flow of the Lochia is so great and
sanguineous, as to approach to haemorrhage, the treatment
directed under the head of Metrorrhagia must be adopted.
Calcarea, 30, is indicated, when the discharge continues
long, without being profuse, and weakens the patient by its
duration, producing derangement of the digestive functions,
etc. It may be given as follows, and the most decided
benefit will be derived from it:
Calcarea, 30.
Three globules dissolved in a wineglassful of water, of
which solution, a teaspoonful should be taken every night
and morning.'
The same medicine will be advantageously used when the
discharge is mucous, watery, and abundant, and is attended
with abdominal sufferings, such as distension from wind,
pains, difficult digestion, disposition to diarrhcea, diminution
of milk, etc.
Pulsatilla will often be indicated, when the discharge is
thick and mucous, and is attended with pains in the loins,
and a sad and plaintive humour.
Sepia bears some analogies to Pulsatilla in these cases, and
may be given, if the last-named medicine does not suffice
to stop the discharge: or if it is liquid and serous; or
acrid and excoriating to the genital parts; or again, if there
exist any induration of the neck of the uterus, and especially
if the patient be of a sad, morose, and grieving disposition.
Mercurius must be given, when the discharge is most
abundant at night, and when there is a disposition to inflammation of the abdominal organs, or genital parts.
Sulphur is to be administered in a single dose, if the
discharge continues to enfeeble the woman, and does not
yield to the other remedies, the characteristic symptoms of
which, nevertheless, correspond with those of the disorder.
After awaiting the action of this medicine for a few days,
the former medicine may be re-employed.
Refer to the note respecting doses at p. 85.



160


THE PUERPERAL STATE.


Secale cornutum is a valuable medicine, when the patient
is much enfeebled by the discharge.
Under these circumstances, a nourishing diet must be
prescribed in accordance with the condition of the patient,
and the air of the apartment must be kept as pure, and
frequently changed as possible; or if she is in a state for
removal, she should be transferred to a different and healthy
locality.
When the Lochia are morbid in their character, without
any other symptoms being present indicative of inflammatory
or organic disease, the following summary may simplify the
indications for treatment.  If the sanguineous character
should return, without the discharge being too abundant, no
medicine is required; but if the contrary condition should
transpire, recourse may be had to Calcarea, or Sepia,-or to
Conium,-if the discharge corrodes the parts considerably.Sometimes the Lochial discharge suddenly becomes black,
almost like ink, which alarms the patient and nurse; if the
discharge is unaccompanied by any fetid or putrid odour, we
have evidence of the dissolution of a portion of the secundines,
or of some coagula which have remained in the uterus, and
the Lochia will resume their normal colour, when the whole
is removed by the uterine discharges.
If the Lochia become purulent, Sepia will generally
be the most serviceable medicine. The Lochia sometimes
give off a fetid or insupportably putrid odour.   If this
smell should not be the consequence of the neglect of
hygienic rules, it must be considered as a very serious
symptom of a morbid condition of the uterus or passages,
demanding the prompt attention of the accoucheur. If,
however, there are no discoverable indications of disease,
beyond the fetid odour of the discharge, which is very
annoying to the patient, Sepia, and especially Kreosote, 30,
will generally be found efficient, bearing in mind, that the
utmost cleanliness should be observed.
THE STATE OF THE BOWELS.
Contrary to the ordinary practice of interference with the
operations of nature, adopted by the old school of medicine,



STATE OF THE BOWELS.


161


Homoeopathy does not recognise the necessity of acting
freely upon the bowels on the third day after delivery.
When the system is so remarkably susceptible to morbid
impressions, and occupied in establishing a new function,
which is to transfer the vascular and nervous erythism from
one part of the female. economy to another, where is the
wisdom in disturbing the whole organism by a forcible
interruption of the process, which in some constitutions
nature has scarcely power to effect? At such a moment the
most passive condition of the system is that which every
good physician should study to secure, and not by the
administration of active purgatives to set up new and morbid
actions, the issue of which no one can foresee. This unphilosophical practice, adopted from age to age by the
intelligent physicians of the old school, fully accounts for the
direful consequences which so frequently invade the puerperal state, particularly in delicate and sensitive women.  It
is for this reason that I so entirely condemn it, and hope to
see it abolished in the practice of the accoucheur.
If the first passages, as no one can doubt, are more or less
bruised and injured by the act of parturition, what is more
irrational than to excite irritation in the vicinity of those
parts, instead of allowing repose until their perfect recovery.
If purgatives are given on the second or third day, their
effect must necessarily be to disturb these parts and increase
the irritation already existing; but, in addition to this, there
is the reaction liable to be excited in the system  by a medicinal substance.
On the other hand, when the patient is not acted upon
by drugs which tend to produce constipation, no harm whatever can ensue, even should no evacuation take place during
the first eight days.
If any tension of the belly should exist, a simple lavement may be given after five days; but this is not necessary;
for, if we recollect, that for several days the patient has,
perhaps, not taken solid food, the intestinal tube has not
received the usual amount of stimulus by which its coats are
excited to contract upon and propel the contents, and so
keep up its vermicular or downward action.   It is for this
]11



162


THE PUERPERAL STATE.


reason that I do not hesitate to advise, albeit with all due
caution in regard to the state of the individual, solid but
plain and unstimulating food, after the third or fourth day,
without waiting for the occurrence of alvine evacuations,
because the pressure of solid matter will be more likely to
facilitate this object in a natural manner, than a persistence
in liquids.
But, if at the end of a week it seem desirable to aid the
operations of nature, by exciting reaction in the alimentary
canal, the following should be prescribed:
Bryonia, 30,
three globules dissolved in a table-spoonful of water, and
a teaspoonful of such solution given every two hours.
If there is a desire to go to stool without the power of
relieving herself, as if hindered by an obstruction in the
rectum; if there be haemorrhoidal swellings, or a tumid
abdomen, with loss of appetite, Nux vomica should be
given.
Opium,-if a heavy weight or pressure is felt at the anus,
without a strong inclination to evacuate, accompanied by
heaviness of the head, &c.
Sulpkur, should be given if the patient suffers from habitual constipation, and especially after Nux v., if the latter
has not produced the effect.  The enema lavement is mostly
required when the action of the bowels is arrested by a
collection of hardened freces in the rectum.
Veraftrum will be useful in the latter case, when inertia
recti exists.
Diarrhira.-One would think, from the evil habit of giving
purgatives soon after delivery, that a diarrhoea was desirable,
or was the curative process of nature; but, on the contrary,
it is an evil of no small magnitude: when it occurs, its effect
is to derange the uterine and lacteal secretions; its immediate correction is, therefore, most important.  The first step
should be to ascertain the cause.
Pulsatilla will be indicated, if it has arisen from  some
error of diet.
Antioniium c., if it be accompanied by marked gastric



164


MILIARY FEVER.


Treatment.-During the febrile stage, the most appropriate
remedy is Aconitum, 30, which will often be sufficient to
remove the disease.
Bryonia, 30, may be given, if the itching continues
troublesome.
Ipecacuanha, if the perspirations are excessive, or the
patient is affected with nausea.
Mercurius, 12, when the eruption presents pustular heads,
and does not disappear with the febrile symptoms.
Arsenicum, 30, is most serviceable in the miliaria alba,
which is attended with little fever.
Belladonna may be given when the rash puts on the
appearance of scarlet fever, and the papille of the tongue
are turgid.
Valeriana will be useful, when the eruption is accompanied
by watering of the eyes, oppression at the chest, diarrhoea,
bad taste and smell, with tremulous and creeping chilliness,
and occasional sweats.
PENDULOUS STATE OF THE ABDOMEN.
The repeated distension of the abdominal parietes, in
consequence of successive pregnancies, is apt to leave the
woman with a permanently enlarged abdomen. Sometimes
this happens to so great an extent, that she looks, after confinement, as though still pregnant; and it even falls so as to
rest upon the thighs. Besides the bandaging and mechanical
supports which may be used in these cases, we can sometimes
restore the contractility of the weakened tissues by medicines.
Sepia, 30, given and repeated at the end of fifteen or
twenty days, will tend much to diminish or remove this state
of the abdominal coverings. Sometimes, however, the specific action of this medicine fails to accomplish so much as
we desire; it will then be necessary to compare all the
accessory symptoms, and choose some anti-psoric medicine
which may be in relation with them.
Calcarea carb. or Silicea will often be found suitable; but
whichever medicine is selected, it must be allowed to act for
five or six weeks, and be given at a high degree of attenuation.



SUCKLING.


165


Moderate exercise on foot should be enjoined; a nutritious diet, without much stimulus, and gentle compression
of the abdomen; for in this case violent compression would
destroy, while moderate pressure will excite reactive muscular
contractions.
FALLING OFF OF THE HAIR.
Sometimes, especially in females, whose circulation is
feeble, the hair falls off after confinement.  It most frequently occurs when the woman has suffered from profuse
perspirations about the head.  If it can be ascribed to any
prominent cause, then there is a distinct indication at once
for the choice of a remedy; but in the absence of this, it
will be found generally among the following, namely:Sulphur, Calcarea, Natr. muriat., Lycopodium, Hepar.
sulph., Silicea. If the patient has suffered much from
haemorrhage, China should be given before Sulphur and
Calcarea.
SUCKLING, &c.
The breasts augment in hardness and volume during the
early period of pregnancy, in correspondence with the changes
going on in the womb, and secrete a serous fluid which is
preparatory to the secretion of the milk which is to follow
in due season. Care should be taken to avoid all compression
of these organs, especially of the nipples, that they may be
duly developed, for the greater facility of being seized by
the infant.   If, notwithstanding these precautions, the
nipples do not expand after delivery, it will be proper to
have recourse to a shield, until by the practice of the infant,
and the elongation of the nipple, the difficulty is overcome.
The best kind of shield is the French one, made of ebony
or box-wood, with a small straight india rubber nipple fixed
into a circular rim. Shortly after delivery, generally within
twenty-four hours, a pricking sensation is felt in the breasts,
which gradually swell and harden during the next day or
two, until they occupy almost the whole anterior part of the



166


SUCKLING.


chest, and feel very weighty to the mother. Sometimes this
is accompanied by a rigor, and a slight febrile action in the
system, which is called the milk fever. When more disturbance than ordinary is produced in the system by the
establishment of this function, the patient experiences, on
the second or third day, headache, pains in the loins, chills
alternating with heat, succeeded by burning heat, and redness
of the face, sense of fulness in the forehead, thirst; there is
a full and firm pulse, white tongue, and diminution of the
lochia. This febrile movement not being accompanied by
pain or tenderness in the region of the womb, will distinguish
it from puerperal peritonitis. Within twelve hours after the
commencement of this fever, if not aggravated by any imprudent exposure, the skin usually gives way, a general perspiration breaks out, the breasts subside, the milk finds vent
at the nipples, the lochia flow as usual, and the system is
restored to its natural condition.
Generally, it is not requisite to administer any medicine
for these symptoms; all that is necessary is to supply the
woman with some warm, simple drinks, and to protect her
from the chance of a chill, or of any mental excitement.
The child should be applied to the breast early,-as a
general rule, twelve hours after delivery,-which is the best
means of preventing or speedily terminating this fever; because, so soon as the current of the secretion of milk is fully
established, the system is relieved and the symptoms subside.
With women who do not intend to nurse their offspring,
the fever is more violent and lasting, and in this case requires
further attention. If the pulse be full and strong, and there
is much pain in the head, we giveAconitum, (tinct.) 6,
two drops added to four table-spoonfuls of water,-a teaspoonful of this mixture being given every two or three
hours. By this means the vascular excitement will be
diminished, and perspiration induced. If the afflux of milk
be very considerable, and the breasts greatly distended, so as
to produce an oppression at the chest, the following should
be prescribed:



SUCKLING.


167


Bryonia, (tinct.) 12,
two drops added to four table-spoonfuls of water,-a teaspoonful of this mixture being given every two or three
hours. This will be found speedily to relieve the tumid
breasts, and check the fever.
But if, during this fever, through the operation of any
unfavorable circumstances, there should be violent pains in
the head, with slight delirium, glistening eyes, &c., indicative
of cerebral disorder, after a few doses of Aconite, the following
should be prescribed:Belladonna, (tinct.) 3,
two drops, added to four table-spoonfuls of water; a teaspoonful of such mixture being given every three hours, until
the head-symptoms are subdued: after which all medicine
may be set aside, unless the state of the breasts require the
medicines previously pointed out.
If the labour should have been severe, with lesion of the
genital parts, and if the use of Arnica immediately after
delivery has been neglected, a dose of this remedy, alternated
with the Aconite, should be administered, to diminish the
sympathetic action of the injured passages upon the arterial
system, and to moderate the fever.
The child, as before observed, ought to be applied gently to
the breast, within twelve hours after its birth, and afterwards
from time to time, as the state of the mother permits, until
the full supply is established.  The febrile state above described need not interrupt this duty; for it will relieve the
mother, by keeping under the redundancy of milk, without
injury to the child.
Those mothers who do not nurse, suffer longer than others;
after the cessation of the fever, the milk continues to accumulate in the breasts; it may become the cause of engorgement of the mammary gland, or even of abscess. The duty of
the accoucheur is to diminish the morbid afflux, by enjoining
low diet, during the necessary time, and by tepid drink, so as
to promote the action of the skin and kidneys. When these
means do not suffice to reduce the flow of milk into the
breasts, if there be no counter-indication, Pulsalilla, 30,



168


SU'CKLING.


should be given.  A dose every morning.     This will generally succeed in dispersing the milk.
Sometimes in lymphatic or leucophlegmatic subjects, this
medicine does not prove sufficient; in such cases, Calcarea,
Carb., or Lycopodium will be more successful.
When the milk delays in appearing at the proper time, the
breasts remaining soft and pendulous, it sometimes depends
upon diminished sustenance during a protracted labour, in
which case a proper supply of aliment will remedy the deliciency; but the more general cause would seem to be a
lymphatic constitution, a feebleness of arterial action, or of
the vital energies; or a general constitutional debility produced by moral causes, by the depressing passions, or by an
unhealthy pregnancy. In these cases, the most useful remedy
is as follows:Agnus castus, (tinct.) 12,
two drops, added to four table-spoonfuls of water; a teaspoonful of this mixture being given every three hours.
If the woman is desirous of nursing, and the signs of milk
are not apparent thirty-six hours after delivery, this medicine
should be given at once.
It is equally useful when, in the course of.nursing, the
milk diminishes or disappears without any appreciable cause,
or becomes impoverished; but if the cause is recognised, the
remedy should be given in respect of it: if it has been
caused by a fit of anger, Chamomilla; if by grief, Ignatia;
if by jealousy, Hyoscyamus, or Phosphori acid.; if it was
the effect of a chill or of taking cold, Dulcamara, &c.
Pulsatilla and Calcarea, by the alternative effect which
they possess in common with some other homoeopathic
remedies, often succeed in the case of disorders opposed to
their primary action.  In this way they have been found
successful in diminution or suppression of the milk.
Dr. Kallenbach, of Berlin, having remarked, in some
observations in an allopathic journal, that when Assafetida
plasters had been applied to the epigastrium   of hysteric
females for a long time, they were sometimes followed by
swelling of the breasts, which oozed out a milky fluid, thought



SECRETION OF MILK.


169


that the same substance might be employed with advantage
against suppression of the milk of nurses; and, to convince
himself, he prescribed it in four cases, which he relates.
I have tried this remedy with decided results, and found
it materially increase the flow of milk, improve its quality,
and cause the child, which before was pining and constantly
disturbed by flatulent colics, to thrive and cease crying.
But the milk may be poor and serous, altered in its
quality rather than its quantity, and unfit for the proper
nourishment of the infant, and may even be rejected by it.
In the first case, Sulphur, 30, will be of service, followed
eight days afterwards by Calcarea carb., 30, if the Sulphur
should not improve the character of the milk. Regard should,
however, be had to the causes of the morbid lacteal secretion
in the mother.
When the milk is rejected by the child, Mercurius vivus,
12, should be given, or else Silicea, 30, two or three globules
being dissolved in a small wineglass of water, and a teaspoonful
taken to the mother every four hours.
After the third teaspoonful, the child usually takes the
breast with avidity.
Cases1 showing the Action of Assafetida on the Secretion of
Milk.
1. A lady, thirty-four years of age, of robust habit of
body, the mother of six children, had never been able to
nurse any of them, from the disappearance of the milk within
three weeks of her delivery.   In April of 1843, she was
delivered very easily; ten days afterwards, the milk became
diminished in quantity, and on the fourteenth day only a few
drops could be squeezed out with difficulty. Dr. Kallenbach
ordered her Tinct. Assafcet. gtt. j, in a drachm of alcohol;
five drops of this mixture to be taken three times a day.  On
the second day after the use of this medicine, the flow of milk
was copious. As the milk was rendered offensive to the
child by the Assaftetida, he tried the third dilution, and
found it answer as well.
SReported by Dr. Kallenbach.



170


170              SUCKLING.


After the medicine had been discontinued for some weeks,
the suppression returned, and was again cured by the third
dilution.
2. A healthy female, twenty-one years of age, found a decided diminution of milk in the sixth week after her first
confinement, so that her strong and healthy child could -not
obtain enough of nourishment.    She was ordered Tinct.
Assaf. at the third dilution; and, after the use of this, she
continued to suckle her child to the ninth month.
3. A woman., thirty-four years of age, who had hitherto
nursed her own children, but always required the assistance
of the bottle., was confined on the 16th of September; and
when seen on the 17th of November, she complained that
already the secretion of milk was much diminished, and that
she had required to feed the child with the bottle for three
weeks. The mamma was relaxed, and only a few drops of
milk could be pressed out of the nipple. She took Assafteida
at the third dilution for eight days without any improvement.
She was then ordered to take it at the first dilution, which
was at first unpleasant from the smell and taste; but she persevered for five days, and at the end of that time there was
an abundant secretion of milk. On the 28th of December
there was again some suppression; and now the third dilution
was administered with such complete success, that she was
able, soon afterwards, to dispense with the bottle altogether.
She had made no change in her food.
SORE NIPPLES.
The nipples acquire a certain development during pregnancy, which is necessary in order to afford to the infant's
mouth a sufficient grasp in its attempts to suck.  If they
should not be sufficiently prominent, recourse must be had
to a shield, as before mentioned.  But the first attempts at
suckling often produce a tenderness, which in some cases
subsides as they become accustomed to the pressure of the
infiant's mouth; but in others increases and proceeds to a
crackiugc of the extremity, which gives intolerable pain
whenever the child is put to the breast.  Occasionally, the



ABSCESS OF THE BREASTS.


171


repeated application of the child so enlarges the cracks that
they gape and bleed, the surrounding skin inflames, and
ulcerations take place at the base of the nipple. This state of
things often lasts for a long time, causing distressing anguish
to the mother, and rendering the period of suckling one of
protracted misery, in the place of a comfort and enjoyment.
There are certain constitutions particularly obnoxious to
these evils; and these are far more effectually relieved by
Homoeopathy, than by the old plan of local appliances.
The best means to obviate the occurrence of tender nipples is to pay attention to them during pregnancy, and
to harden them by the daily application of brandy-or of a
decoction of green tea and brandy,-equal parts of each;nevertheless, it sometimes happens, that nursing cannot be
persevered with in consequence of the severity of the pain
induced by the excoriations.
When, in the first days of suckling, the woman complains
of pain after the child has been to her, the nipples should
be assiduously dried, by means of a soft piece of cambric,
and bathed several times a day, with a lotion prepared as
follows:
Arnica, (tinct.) 0,
ten drops, mixed with a tumblerful of water.
Before giving the nipple to the child, it should be washed
with tepid water or thin mucilage.
Chamomilla, 12, may be given, when the nipples are simply
inflamed, or cracked, and ulcerated; the inflammation extending to the surrounding skin.
Sulphur, 30, if the cracks are deep and painful, bleed or
burn, with ulcerations around the base.  If the complaint is
obstinate, this may be followed byGraphites, 30, for the same symptoms, or Calcarea, 30,
followed by Lycopodium.  Ignatia is sometimes useful; and
so likewise are Mercurius and Silicea.
ABSCESS OF THE BREASTS.
Inflammation of the breast, with a strong tendency to suppuration, frequently occurs at various periods of the puer



172


SUCKLING.


peral state, either from a draught of air passing over the
breast, or from exposure to a chill, or from the milk collecting in large quantities, and unduly distending the breast,when the child does not suck sufficiently, and there is no
spontaneous escape,-or from obstruction of the milk-tubes,
or mechanical violence.
If during the first hours, when pain and other symptoms
which indicate the attack have been observed, and before
the swelling has acquired any great development, we administerAconitum, (tinct.) 3, -
two drops being added to four table-spoonfuls of water, and a
teaspoonful of this mixture being given every two hours, and
make the infant take the breast frequently,-the attack will
probably be terminated at once.    But if the collection of
milk is considerable, and the swelling great, the breast being
large, red, tense and painful, with pulsating or shooting
pains, and burning heat in it; the following should be
given:Bryonia, (tinct.) 6, -
two drops, added to four table-spoonfuls of water,-a teaspoonful of such mixture being given every three hours, until
the complete resolution of the swelling. If the tumid breast
exhibits a surface with erysipelatous redness, and is glossy,
Belladonna should be given in the same manner; and when,
after twelve hours improvement does not ensue, Bryonia and
Belladonna should be alternated every three hours.  If these
do not materially improve the symptoms, recourse must be
had to Mercurius, 12, especially if transient chills or throbbings indicate the probable formation of matter.
Hepar sulph. is indicated after Mercurius has diminished
the inflammatory character of the swelling, if signs of suppuration are still present.  The advantage of this medicine is,
tlhat if the abscess is already formed, it expedites the bursting,
and therefore also the termination of the disease. It is often
advisable, in this case, to give a single dose, and leave it to
act, until the disease terminates, either by resolution or opening of the abscess.



ABSCESS OF THE BREASTS.


17'3


Phosphorus is another very successful remedy in the treatment of abscess of the breast, when the inflammation is
active, and rapid suppuration threatens. It should be given
every four or six hours at a medium attenuation, and will
be found quickly to relieve the excessive pain, and to hasten
the termination of the disease: if suppuration does take
place, it may still be continued, as it facilitates the opening,
and subsequent healing of the abscess, without much scar.
Phosphorus is likewise very efficacious in curing a fistulous
condition of the breast, which now and then occurs after
allopathic treatment, as well as the induration of the mammary gland left after an abscess has been opened by the
lancet.
Sulphur should be given if the suppuration be profuse, with
chilliness in the forenoon, and febrile symptoms, flushed
cheeks, &c., in the after-part of the day.
The Homoeopathist need not trouble himself to puncture
these abscesses of the breast, but may safely leave them to
the action of the medicines, which will save his patient much
pain, considerable emotion, and a disagreeable cicatrix.
In the fistulous openings, attended with serous discharge,
Silicea, 30, is sometimes indicated.
The local treatment should be confined to the suspension
of the breast by a broad handkerchief, so as to take off the
weight, which aggravates the sufferings so much, and the
application of spongiopiline, dipped in hot water, to the part,
-which will assist in allaying the pain, by causing a gentle
transpiration.



174                    WEANING.
WEANING.
From the observations made upon the subject of morbid
lactation, it will be understood, that no definite period can
be fixed as a rule for the mother to give up nursing.  So
far as she is concerned, her capacity to supply the necessary
quantity of healthy secretion, without any apparent deterioration of health, might be safely taken as the guide; but
for the child, if no other cause were present for changing its
mode of nourishment, the progress of dentition would suffice
for an index, inasmuch as it ought to be accustomed to take
other nourishment than that derived from its mother, as
soon as the teeth make their appearance, so that by the time
the molar teeth come through, it may be capable of eating
some animal as well as vegetable food.
The ordinary or average period, however, for weaning, is
about the ninth month; and the time that the child is in
good health, and free from the irritation of teething, should
be selected as the most appropriate.  If the infant is robust,
and especially, if it has been already accustomed to little
varieties of food, the weaning may take place at once; and
if the mother has moral courage, she should take the child
just as usual,---whether in the night or in the day,-and
only deny it the breast; taking care to supply its cravings
with some of its ordinary food, or with milk and water. But
if it be delicate and fretful, it may be advisable to wean it a
little more gradually, taking a few days to do it. It is not
uncommon to see a mother, with impaired health, and a
small supply of innutritious milk, lingering over the weaning
of her infant for many weeks; both mother and child
suffering by its continuance.  In this case, the mother is
in reality, harsh as such an interpretation may appear,
acting a most selfish part;-she is yielding to her own weak
and sensitive feelings, at the expense of her child's health.
Weaning may, however, be imperative, from the sufferings
endured by the mother, in consequence of chapped     or
ulcerated nipples; but of this hereafter.



WEANING.


175


The symptoms which indicate that nursing is injurious to
the mother are:-the return of the menses, with a diminution of milk; a state of debility, as announced by painful
drawings at the stomach, especially whenever the infant
sucks; a faintness and vacuity felt at the epigastrium; loss
of appetite, or voracious hunger, with a sense of emptiness
very soon after; faintings; giddiness; loss of vision; absence
of thought; palpitation, &c.
When weaning is decided upon, and commenced, the
mother should remaiii perfectly quiet for a few days, if not
in bed, in order that the swollen breasts may not suffer from
the motion of the arms, or the pressure of stays, and that
the system may be free from excitement.     She should take
very light nourishment; eat dry food; abstain from salted
meats, that her thirst be not aggravated; drink as little as
possible, and that cold water; keep the breasts covered with
some light, warm material,-such as muslin, or cotton; and
take the following medicine:Bryonia, (tinct.) 3, -
two drops, added to four table-spoonfuls of water,-of which
mixture, a teaspoonful should be given every night and
morning.
If the flow of milk continue superabundant during the
first few days, a little may be drawn off daily, just to relieve
them, should it not run away of itself; or some nippleglasses may be kept applied; light friction with the hand,
smeared with sweet oil, or oil and brandy, may also be had
recourse to, for softening the skin.
If there be much painful distension of the breasts, Belladonna may be given.
If the draught continue to fill the breasts, Pulsatilla is
most to be recommended, or Rhus tox., in order to arrest the
secretion of milk.
Should these fail, and there be debility of constitution,
with lax fibre, and bad condition of the system, Calcarea will
be mostly indicated.



176


PUERPERAL CONVULSIONS.


PUERPERAL CONVULSIONS.
This is one of those fearful accidents of the parturient state,
which may well terrify the attendants, and attract the most
vigilant and intelligent co-operation of the accoucheur. Puerperal convulsions may occur before, during, or after the
phenomena of labour have set in, indeed, at any period
during the latter months of pregnancy. The paroxysms,
though usually sudden in their appearance, are sometimes
preceded by symptoms premonitory of the attack.   If these
are immediately taken notice of, and medical treatment
adopted, the effect will not unfrequently be to ward off, or at
least to diminish, the violence of the convulsive fit.  If they
should be transient, or momentary, no opportunity may be
offered; but this shows the necessity of the accoucheur being
always prepared with his pocket remedies.
In nervous and timid subjects, a general tremor is often
observed from the first commencement of the pains; but in
courageous women, even at the time that the head of the child
begins to engage in the brim of the pelvis, and the pains
become expulsive, another kind of trembling sometimes
happens, which recurs at every pain; this is a nervous state,
a species of light convulsion, occasioned by the violence of
the uterine contractions, and the distension of the pelvic
cavity. If the mind be calm, and the accoucheur, by his
composed air, suppresses the slight agitation which then
exists, the labour proceeds favorably; but, if from any
accidental cause-whether it be the undue violence of the
later pains, or a moral emotion, or sudden cerebral congestion-the natural course of the labour be arrested, the
countenance changes, the eyes become brilliant, the speech
short and sharp, and violent convulsions manifest themselves,
with loss of consciousness and delirum. In such cases,
much may be done at the onset by the moral influence of
the accoucheur; when those indications of spasms first appear,
if the more serious premonitory symptoms are absent, and
the patient be of a nervous, hysterical disposition, he should



PUERPERAL CONVULSIONS.


177


observe a firm and composed manner, assure her mind
by quietly impressing her with the necessity of pain, and
the absence of danger, and, by administering some gentle
cordial, arouse and strengthen the physical and moral energy.
The premonitory symptoms of the congestive form are
generally among the following, and they may show themselves days, or hours, or only minutes before the seizure:Headache and flushings of the face, between the pains,
dullness and general torpor; twitchings of some of the muscles, particularly of the face; drowsiness, or disturbed sleep;
dimness of sight, with black spots before the eyes: noise
in the ears; a turgid condition of the superficial vessels of
the head and neck; with tumultuous movements of the
heart; inability to stoop without a rushing of blood towards
the head, pulsation of the carotids; alienation of mind, with
morbid taste and smell; stiffness of the tongue, with imperfection of speech; cramps, tingling of the fingers, or numbness of the upper and lower extremities: aura frigida, from
some part of the body, ascending to the head; extreme sensitiveness to the movements of the foetus; irritability of
temper; vexation, and, at times, derangement of the stomach
with nausea and bilious vomiting, soon indicate the approach
of convulsions.
These symptoms may be developed by various causes, such
as distress of mind, sudden occasion of joy or sorrow, which
gives rise to an abnormal mobility of the cerebro-spinal system, excess of any kind, whether of aliment or stimulating beverages, inducing plethora, or hyper-excitation; -also
by inflammatory conditions of the uterus or its appendages, or
by injuries affecting these organs.
Whatever may be the exciting cause, however, if the premonitory symptoms are quickly followed by the full development of the convulsive stage, or if although present, they
shall have been so lightly thought of as to escape notice,
the state which then occurs is one of considerable danger
and difficulty. It is, therefore, of the deepest importance to
interpose during this premonitory stage, such remedies as
shall at once relieve the patient, and avert so fearful a consequence. When the convulsive attack is sudden, there is
12



PUERPERAL CONVULSIONS.


179


intervals until the birth, which, therefore, is an event looked
forward to with great anxiety; and it has happened that
labour has proceeded, even to the expulsion of the child
and secundines, without the surrounding attendants being
aware of it, in consequence of the convulsions so obscuring
the parturient efforts that there was no outward manifestasion of the labour. This shows the duty of ascertaining,
without doubt, the actual condition of the uterus by a
proper and timely examination.  If delivery,-whether it be
at the full time, or riot,-be inevitable, and if, in spite of the
application of 'appropriate remedies, the convulsions continue
or increase, then it will be a matter of serious consideration whether the birth of the child can be expedited by
manual or instrumental interference, with safety to the
mother.   The sooner the child is born, the sooner may we
reckon on the probable cessation of the convulsions, and
the safety of the mother; although they do not always terminate when that desirable object is accomplished.
The occurrence of hbemorrhage, a not unfrequent complication, is another circumstance that would make the termination of labour of the greatest importance, and must
be considered one more reason for delivery by art, provided
the other conditions for such interposition be present. Any
interference, however, with a view to expedite delivery is not
admissible, so long as the convulsions can be mitigated or
relieved by other means, and then only in those cases which
admit of easy manipulation, from the position of the ovum,
the relaxed state of the os uteri, and other favouring conditions, so that no additional irritation may be caused.
Convulsions, also, sometimes take place after delivery, and
are then attended with greater danger.    The individuals
most liable to convulsions, are those either of a weak
and nervous temperament, or of a full, plethoric habit.
Besides the causes previously noticed, there are others of a
debilitating character which predispose to convulsions, such
as:-great losses of blood, whether from hemorrhage or
the lancet, depressing emotions, &c.
Some paroxysms, moreover, partake of the hysterical
character, so that several modifications are observed, depend



180


PUERPERAL CONVULSIONS.


ing on the predominance of the apoplectic, the epileptic, or
the hysterical conditions.  Attentive observation of these
several complications is highly important, as the accessory
symptoms which accompany the convulsions will often determine the choice of the remedy, since the convulsions are
sometimes connected with plethora and sometimes with
debility and inanition.
It has been said that paralysis rarely, if ever, results
from puerperal convulsions, but I knew a lady, who had
repeated attacks, in several confinements, and who always
experienced a paralytic condition of one side, the leg dragging after her, and remaining cold and weak for many
months.
This is one of those diseases in which the superior efficacy
of homoeopathic remedies is beyond doubt. The extreme
severity of the attack, the imminent danger, and the fearful
consequences, would daunt the moral courage of any man,
who had not perfect confidence in his remedial agents; and
the contrast between the action of the vis medicatrix nature
which must be slow, and the rapid effects which follow the
application of the Homoeopathic remedy, is sufficient, here,
at any rate, to determine to what influence recovery is due.
When, too, we compare it with the formidable and awkward apparatus medicamentorum, with its auxiliaries of bloodletting, to so awful an extent as is said to be indispensable
in these attacks, and remember, (for thank God they exist
only as delusions of the past,) the evils attendant upon loss
of blood and salivation, which are the sheet anchors of the
Allopathic practitioner, the wonderful blessings, as well as the
simplicity and power of Homoeopathy, at least excite our
gratitude and astonishment.
Treatment. This must first be hygienic.    If there be
time, all ligatures must be speedily severed; pure and fresh
air should be admitted, at the same time carefully preserving
the warmth of the body.     Cold evaporating lotions, or ice
may be applied to the scalp, and warmth to the feet. The
rectum may be emptied by an enema, and the bladder by
the catheter.  If the convulsions are sudden, all external
aids must give place to the immediate application of the



PUERPERAL CONVULSIONS.


181


homoeopathic remedies, which can also be had recourse to in
the premonitory stage.
The remedies to be used with perfect confidence in these
attacks are, Aconitum, Arnica, Belladonna, Chamomilla, Coffea, Hyoscyamus, Opium, Pulsatilla, Stramonium, Ignatia,
Lachesis, while Nux v., Bryonia, Secale, yc. may be useful
for adjuvants occasionally.
Aconitum.   When the premonitory symptoms begin with
pain in the head, redness and turgescence of the face, hot
skin, and accelerated pulse, the remedy may be given
as follows:
Aconitum, (tinct.) 3,
two drops to a wine-glassful of water, of which mixture a
teaspoonful should be given every hour, or even every half
hour, in very urgent cases.
This may be continued at more or less distant intervals,
according to the effects, and until all danger of congestion has
disappeared; draughts of cold fresh water may be given, and
abstinence from all nourishing food should be enjoined. If
the convulsion has commenced, Aconite is not sufficient, andBelladonna must be had recourse to.  If the practitioner
has been called too late, or if the earlier symptoms have
been brief, or overlooked, or the convulsion momentary,
Belladonna (tinct.) 3,
should instantly be placed within the lips, or if possible,
dropped upon the tongue. The effects will at times be astonishing; a subsidence of the involuntary movements takes
place, the patient recovers the more natural aspect, the eyes
open, a deep sigh escapes, and a calmness of the system
ensues.  Its chief indications are: a stunned sensation or
effect, loss of conciousness and of speech, with convulsive
movements in the limbs and muscles of the face, paralysis,
especially of the right side, paralysis of the tongue, difficult
or impossible deglutition, dilated pupils, red or livid and swollen countenance, &c.; or paleness and coldness of the face,
with shivering, fixed or convulsed eyes, foam at the mouth,
involuntaryj escape of feces and urine; deep, anxious respi



182


PUERPERAL CONVULSIONS.


ration; renewal of the fits at every uterine contraction;
agitation and tossing between the fits: or deep sleep, with
grimaces; starts and cries, with frightful visions.  It is
suitable to all the forms of convulsion, and may be given in
the same manner as prescribed for Aconite.
Arnica may be given when, with a violent impulse of
the heart, sending the blood forcibly to the head during the
pains, especially if the pulse be full and strong, there are
symptoms of paralysis of the left side particularly, loss of
consciousness, swelling, involuntary discharge of stool and
urine, dullness of the head, &c.
This medicine   may precede Belladonna under these
circumstances.
Opium is indicated when there is, or has been vertigo,
and weight of the head, especially of the right side, sleeplcssness, or heavy sleep, a tendency to stupor, with stertorous
breathing, or incoherent wandering, a convulsive rigidity of the
body, with redness, swelling, and heat of the face, heat of the
head with sweats, redness of the eyes, with dilated and insensible pupils, slow and noisy respiration, convulsive movements
and trembling of the limbs, froth at the mouth, &c.
Hyoscyamus, in cases where there is a general commotion
or perturbation of the nervous system, if the countenance
is blueish and bloated, if there are convulsive movements of
the whole body, jactitation of the limbs, excessive anguish,
involuntary micturition, or profound sleep, the patient being
comatose and snoring; delirium, and in the intervals of the
convulsions, agitation and disposition to laugh at every
thing.
Stramnoniumn is advantageous when tetanic symptoms
present themselves, opisthotonos, or convulsive movements of
the limbs, particularly of the upper part of the body, the
sardonic grin, stammering or loss of speech, countenance
pale, stupid, or puffed and red, loss of conciousness and of
sensibility; sometimes cries, frightful visions, laughter, groaning, singing, attempts to escape; the fit being renewed by
contact, or the sight of brilliant objects.
Chaimomilla acts as a sedative upon the nervous system.
As well as Belladonna, it will be serviceable in patients whose



PUERPERAL CONVULSIONS.


183


nervous excitability is great, and who are of a susceptibletemperament.    If a fit of anger has been the exciting cause,
and when there is a great desire to extend the limbs, with
convulsive movements of the limbs, eyes, eyelids, or tongue;
shocks during sleep, red and bloated face, or red on one
side and pale on the other, dry and burning skin, with
urgent thirst, warm perspiration of the head and face, quick,
anxious, and rattling respiration, great impatience and disposition to anger, with diarrhoea and flatulent distension.
Ignatia is mostly indicated in the hysterical temperament,
when the symptoms are more of the nervous than of the congestive character, and there are convulsive movements of the
limbs, eyes, eyelids, and face, throwing back of the head;
the countenance is puffy, pale or very red, or is pale on one
cheek and red on the other, or there are alternations of
redness and pallor, paroxysms of dyspnoea, frequent yawnings,
loss of consciousness, &'c.
Lachesis may be required when the convulsions are attended
with cries, cold feet, vertigo, cephalalgia, paleness of face, palpitations, heavy drowsiness, nausea, &c.
Pulsatilla should be given when the countenance is cold,
clammy, and pallid; and when there are loss of consciousness,
motion, stertorous breathing, feeble pulse, as in asphyxia, and
dysuria; or when the labour-pains are deficient, irregular,
or sluggish. The sprinkling of cold water on the face, and
applying it to the hands frequently.during the fit is an
excellent adjuvant.
Secale may also be administered in the case of its being
necessary to assist the uterine action as in the former
instance.
Coffea is useful, if the patient is not accustomed to the use
of coffee as a beverage, to calm the nervous excitability,
which is often a prelude to convulsions.
Nux vomica may be given during the premonitory or
post-partum period, when there is great torpor of the intestinal canal, with irritable disposition.
Bryonia during the same period if there is abdominal
tenderness with full pulse, and perspiration.
Mercurius, China, Cuprum, Ipecacuanha, &c., are remedies



184


PUERPERAL PERITONITIS.


which might occasionally be indicated, but I must refer the
reader to the Materia Medica for their pathogenetic properties.
Convulsions occurring at any time during the period of
utero-gestation are amenable to the same treatment as above
described.
PUERPERAL PERITONITIS.
There are two forms of peritoneal inflammation to which
women are liable in the puerperal state:-the ordinary, and
the epidemic.
The distinction is important, inasmuch as the former is
an example of common inflammation occurring at a period
when the nervous system is abnormally irritable, and readily
exhausted, while the latter has a malignant character, results
either from an epidemic or endemic cause, is marked by
greater virulence, exercises a more depressing effect upon
the vital powers, passes on to a rapid termination, and possesses a contagious or infectious character.
A few remarks upon the epidemic peritonitis will not be
out of place here, the more especially as it is my intention
to discuss the treatment of both conjointly, since their symptoms have a certain correspondence, and the treatment
must therefore be similar.
Peritonitis puerperalis epidemica, or puerperal fever, as
it is more generally termed, usually attacks the patient on
the second or third day after delivery. The disease is generally ushered in by a very rapid and weak pulse; there may
be a severe rigor, but this is more frequently absent; there
is sudden heat, and profuse perspiration; tenderness and
excessive distension of the abdomen; apprehensiveness of
death; vital prostration; peculiar and characteristic anxiety
of countenance, deeply expressive of pain, with contracted
brow, and drawing of the upper lip against the teeth, and fear
of breathing deeply and thereby distending the abdomen:



186


PUERPERAL PERITONITIS.


essentially different from simple peritonitis, and is of an
erysipelatous character.
This explains most satisfactorily the reason that women
who are attacked with this formidable complaint, so much
more frequently recover under Homoeopathic treatment.
Dr. Rigby has stated that during an epidemic in the
General Lying-In Hospital, the child of every woman who
died of the disease, perished of erysipelas, which ran its
course in a few hours.   Many instances are recorded of
women having nursed patients that died of this fever being attacked with erysipelas of the leg; and likewise of practitioners
who have gone from visiting patients affected with erysipelas
to attend lying-in women, finding the latter to be attacked
by puerperal fever, which has proved fatal. The nurse of
one of these was attacked by erysipelas of the hand, which
was looked to by another surgeon; one day after having
made an incision and dressed the wound, he was called to
attend a case of midwifery; the patient was taken with
puerperal fever and died.
Since Dr. Gordon's account of it, many others have written
upon the same subject, and the erysipelatous form of puerperal fever is now very generally acknowledged.
The far greater success with which epidemic Erysipelas
has been known to be treated, by the adoption of Homoeopathic principles and remedies, is a hopeful circumstance in
the consideration of this lamentable disease; and it is for
this reason that I have laid some stress upon its erysipelatous
character, and have separated it, so far, from simple, puerperal
peritonitis.  The statistics of the Homoeopathic treatment
of puerperal fever, afford ample evidence of the truth of this
connection.
Puerperal peritonitis may occur in consequence of a chill,
caught during 'the act of parturition, or from the use of
damp or wet linen, or may be occasioned by violence, exciting inflammatory action in the uterus, thence extending
along the fallopian tubes, to their fimbriated extremities,-the
only point at which the mucous and serous surfaces come in
contact,-and so by contiguity, to the peritoneum.  Or, the
attack may be primary, from some of the above causes. Pre



PUERPERAL PERITONITIS.


187


vious indisposition is not an unlikely cause.  From the first
shock of delivery, the pulse may be quick, and pain be felt
in different parts of the abdomen, with some degree of tenderness and tension; nausea, or vomiting, being complained
of; and a distinct rigor, or chills, followed by burning heat.
The pulse increases in rapidity, is wiry and small: the pain
extends all over the abdomen, but is sometimes circumscribed,
and shoots into the hips and thighs: it becomes intense, of
a burning, acute character; the belly becomes swollen and
tense; the tongue is white and dry,-there are thirst and
occasional vomitings, an irregular state of the bowels, at
first costive, but afterwards relaxed or bilious.  The Lochia
and milk are diminished or suppressed; the breasts become
flaccid; and the patient is lying on her back, with her knees
raised, because extension aggravates the pain.
If the uterus have been the channel through which the
efficient cause acted, the attack is more insidious, and at first
the abdominal pain may be mistaken for after-pain, from
the remissions that occur.
Dr. M. Hall states, that violent rigor, great heat of
surface,-often followed by profuse perspiration, frequency
of pulse, and affection of the head,-denote the addition of
intestinal irritation to the state of inflammation,-rigors
certainly do not invariably accompany the first symptoms of
puerperal peritonitis.  Rattling of the breathing, with
enormous distension of the abdomen, are fatal symptoms.
The treatment of Puerperal peritonitis, whether of the
epidemic, malignant, or simple form, demands the closest
investigation on the part of the practitioner.  The first dawn
of the disease ought to be recognised, and a careful examination of the abdomen instituted, upon the least suspicion,
as tenderness on pressure is the pathognomonic sign by
which to distinguish peritonitis from intestinal irritation or
after-pain, and the cure is more sure and easy, in proportion
as the treatment is begun early.  For this reason, a puerperal female should be watched during the first four or five
days after delivery, as a fatal illness may possibly be averted,
by an immediate arrest of incipient symptoms of inflammation.



188


PUERPERAL PERITONITIS.


But if, in spite of a due surveillance, or in the absence of
the practitioner, the phenomena of peritonitis shall have
declared themselves, the following prescription must at once
be had recourse to:Aconitum, (tinct.) 3,
two drops in four table-spoonfuls of water; a teaspoonful
of such mixture being given every hour, or half hour,
according to the intensity of the symptoms. This must be
continued for a few hours, till some relief is obtained
to the abdominal tenderness, the acute pain, the fever,
vomiting, &c. If, at the end of twelve hours, the symptoms
have given way, the doses may be extended to every two or
three hours.  If the case be one of the more simple form
of peritonitis, this remedy will often be found sufficient to
accomplish the cure; but if, after six or twelve hours, -and
especially in the case of the malignant, puerperal fever,notwithstanding that the febrile symptoms are diminished in
violence, the abdominal symptoms remain the same, Belladonna, or Bryonia,-whichever appears most suitable to the
state and constitution of the patient,-must be substituted.
Belladonna is suitable, especially when the pain is violent
and cramp-like, as if a portion of the intestines was squeezed
between two stones, with tumefaction of the abdomen; or,
if the pains are forcing towards the genital organs, as if the
parts would fall through; with excessive sensibility of the
abdomen to the touch; chills in some parts, with heat in
others, at the same time; or burning heat, especially of the
head and face; redness of the face and eyes; compressive
pain of the forehead, with pulsation of the carotids; dry
mouth, with red tongue and throat; sleeplessness, with
agitation, or sleepy eyes; wild delirium, or other cerebral
symptoms; diminished lochia, which are aqueous or fetid;
or even metrorrhagia, with escape of red, fetid blood; the
breasts swollen and inflamed, or flaccid and empty; constipation or diarrhoea; and particularly if the disease be of
erysipelatous origin.
Bryonia is especially indicated, when the abdomen is
swollen equably; is very sensitive to the touch,-the pains



PUERPERAL PERITONITIS.


189


being aggravated by the slightest movement, with constipation;
-the fever of the distinct inflammatory kind, with burning
heat over the whole body, ardent thirst, and desire for cold
drinks; irritable humour; disposed to anger; or restlessness
and apprehensiveness as to the result, &c.
Chamomilla may be given when the breasts are flaccid and
without milk, and there is diarrhoea, with white motions;
tympanitic distension of the abdomen, which is sensitive to
pressure; pains in the belly, like the pains of labour; general
heat, with redness of face, and great thirst; aggravation of
symptoms at night, followed by sweats; great agitation,
impatience, and nervous irritability,-and, especially, when
the peritonitis is the consequence of a fit of anger.
Colocynth is, at times, of great service, even in desperate
cases, when the abdomen is greatly distended and the pains
are insupportable; the patient draws the thighs up as close as
possible to the belly; diarrhoea, with colicky pains, every
time she drinks.    The first effect of the Colocynth will
be, the relief of the colic and diarrhoea, and the belly becomes
less sensitive.
Mercurius solubilis is also a precious medicine in puerperal
peritonitis, of the simple kind, especially during the inflammatory state, or when there are symptoms of effusion in the
peritoneum; it is particularly indicated when, along with
the general symptoms of the malady, there is a dejected,
affrighted countenance, burning, inextinguishable thirst, flow
of saliva in the mouth, burning and lancinating pains in the
belly, with desire for stool without effect, or with mucous and
sanguineous dejections; deep-coloured, very offensive urine;
general, debilitating sweat, without relief, and     marked
aggravation of the symptoms at night.
Nux vomica is suitable at the commencement of the
attack, when the lochia have been suddenly arrested by a
contrariety, or contradiction, which has produced a mental
depression; or, if the same cause has produced an increased
flow, with sense of heaviness, and burning in the genital
parts, and in the belly: but it is more especially suitable for
metritis.
Rhus is a medicine almost indispensable, when, in the


/



190


PUERPERAL PERITONITIS.


course of the disease, the nervous system is much implicated;
when the least contradiction aggravates the symptoms, and
the lochia, from having changed, become again sanguinolent,
with the discharge of clots of blood, and the fever is of the
low, or typhoid, kind.
Arsenicum is most useful when there are anguish, sudden
prostration, sunken countenance, sallow or livid complexion,
extreme restlessness, and want of sleep, burning pains in the
abdomen; burning heat and thirst, with dry, parched lips,
vesicles on the lips and in the mouth, nausea or vomiting,
oppression of the chest, giddiness, headache, delirium, small,
feeble and intermittent pulse.
Arnica is applicable, if the inflammatory condition resulted
from injuries which occurred during the progress of delivery,
and may be given before any of the foregoing remedies.
IHyoscyamus is indicated by spasmodic symptoms, jerkings
of the extremities, frequent discharge of coagula, a typhoid
state, with delirium,-especially if the symptoms are due to
emotional disturbance.
Stramonium is analogous to Hyoscyamus.
Platina will be suitable in irritable constitutions, if, during
the convalescent stage of the disease, discharge of thick
blood takes place, with painful forcing down of the uterus
and vagina, sexual irritation, internal chills, &c.; pressive
pain in the forehead, which is increased by every movement
of the head; also, if hysteric symptoms, discontent, discouragement, and self-exaltation are apt to prevail.
Besides these medicines, there are others which are of great
utility, in those cases where effusion into the peritoneum
cannot be prevented, and which should be had recourse to,
according as the symptoms of the remedy correspond with
those of the patient,-for which, reference must be made to
the Materia Medica.   These are, Arsenicum, Carbo veget.,
Asaf., China, Bellad., Lachesis, Sulphur; or Puls., Rhus t.,
Ipec., Coff., Hyoscy., Stramn., Arnic., Nux v., Plat., Sepia,
Crocu"s, tic.
In treating patients affected with puerperal fever, the
most absolute repose of body and mind should be secured;
all noise should be shut out, the chamber darkened, and a



WHITE LEG.


191


moderate temperature retained; the room should be well
ventilated, so as to have the air changed without admitting
a cold draught.  Privation of all aliment must be enforced,
and the thirst allayed by teaspoonfuls of cold water, which
may be iced in summer or if the vomiting be troublesome.
All local applications should be avoided, on account of the
excessive sensibility of the abdomen, and the disposition to
faint from the aggravated pain, which often accompanies
every movement.     If the lochia are suppressed, flannels
wrung out of hot water may be applied to the vulva;-or a
tepid enema may be employed, in case of great constipation;
but it must be in small quantity, so as not to disturb the
bowel much. The infant should be removed, and fed upon
cow's milk with water, until the patient is out of danger.
PHLEGMASIA ALBA DOLENS, OR WHITE LEG.
This painful affection commences sometimes between the
fourth and the twelth day after delivery,-at other times even
much later,-by a sense of stiffness, with more or less pain
and tenderness in the region of the womb, and in the groin,
or iliac fossa; or, an occasional shooting pain is sometimes
felt, which extends from the pelvis down to the foot.  After
this a sudden pain is experienced in the middle of the calf, or
about the knee, when the swelling of the thigh commences,
and febrile symptoms set in.
As the swelling rapidly increases it assumes a white,
shining, tense appearance, which is the peculiar characteristic
of the disease.
Whenever it takes place the whole constitution is speedily
affected by it.  The pulse becomes quick and feeble; rigors
occur succeeded by heat of skin, with white and furred
tongue, pale and anxious countenance, headache, nausea,
prostration of strength, and thirst.  The lochial discharge is
ill-conditioned, dark, and often fetid, or perhaps arrested;
the milk is likewise diminished or suppressed. The urine



192


WHITE LEG.


is thick, muddy, and scanty; the bowels being costive, with
pale or clay-coloured evacuations.
After the first febrile symptoms have passed, there is
often profuse perspiration, with debility, perhaps diarrhoea,
or quick and irritable pulse, and sleeplessness.  The swelling
sometimes begins at the groin, and proceeds downwards; but
in most cases commences at the calf of the leg, and runs
upwards. It is attended with considerable pain and aching,which is somewhat diminished when the swelling takes place,and with a powerless condition of the limb.   The pain is
aggravated by a depending position, and by the application
of dry heat; great tenderness and a cord-like hardness are
felt along the course of the femoral vessels.  The gluteal
region is also enlarged and tumid, and the superficial veins
become distended and apparent.    The temperature of the
leg is increased, but the foot is more generally cold.
The patient cannot bear the least touch or movement of
the affected limb, and often cries out with the agony.
The vagina, os uteri, and pelvic muscles are tender, the os
patulous.
If the skin be punctured no serum escapes, and there is no
pitting, on pressure; but, as the tension becomes relieved by
the subsidence of the disease, and recovery commences, there
is often a certain amount of oedema, as the result of debility
of the vessels and tissues of the limb.
It not unfrequently happens that while a certain degree
of amendment is going on in the limb attacked, pain and
swelling will occur in the other, without always affording
relief to the former.
When the disease has occurred in an unhealthy constitution, signs of a depressed state of the vital powers may
present themselves, such as low delirium and coma, or a
disposition to gangrene or hectic symptoms may appear.
Occasionally the disease is very mild and attended with little
swelling.
It is sometimes prognosticated by a pain darting down
from the pelvis to the foot, which is felt just before the
expulsion of the child, or accompanying the after-pains.
The disease is very uncertain in its duration, always



WHITE LEG.


193


tedious, the febrile irritation and pain gradually subsiding;
the swelling and sense of weight in the limb lasting for a long
period.  It frequently degenerates into a chronic condition,
and relapses occur from walking or standing too soon, or
getting cold in the foot.
It is sometimes fatal from previous hemorrhage and the
violence of the constitutional symptoms, from sudden change
to the upright posture, or from purulent formations. Infiltrations of fibrin and pus are found after death in the limb, and
the course of the vessels within the pelvis; purulent deposits
have likewise been formed in remote organs. Phlebitis of
the crural and iliac, as also of the uterine veins, is the
chief pathological condition.
The predisposing causes of phlegmasia dolens are,-pressure of the gravid uterus upon the vessels and nerves of the
pelvic cavity during the latter period of utero-gestation,
violence done to those parts and to the uterus by difficult
labours, the use of instruments, hemorrhage or depletion,
an anaemic or cachectic state of the constitution, with exhaustion and debility.
The exciting causes are injuries by the use of instruments; the retention of portions of the placenta or coagula,
or roughness in the removal of the placenta; morbid lochia;
hysteritis; exposure to cold; a draught of cold air reaching
the parts; too early standing, or placing the foot upon cold
oil-cloth, getting the feet damp, or the use of damp linen.
Treatment.-The first thing to attend to is a proper
position of the limb, which should be kept semiflexed, with
the foot raised above the level of the thigh, so as to favour
the return of the blood, and give ease to the patient; the
foot and leg must be enveloped in carded cotton or wool,
and moderately nourishing diet administered, according to
the greater or less activity of the inflammatory and febrile
symptoms.
The principal remedies to be had recourse to are:Arnica, Aconitum, Belladonna, Bryonia, Pulsatilla, Mercurius, Rhus, Sulphur, Arsenicum, Nux vomica, Chamomilla,
China, Calcarea, Lycopodium, Veratrum, also Antimonium,
Sabina, lodium, Sepia, and Silicea.
13



194


WHITE LEG.


Arnica is most useful in the earliest stage, especially when
the pain has commenced at the time the child's head was
passing out of the pelvis, exerting more than ordinary
pressure upon the vessels and nerves; it is likewise occasionally serviceable in the chronic stage.
Aconitum should be used in the febrile state, when distinct
inflammatory fever is present, with hot skin, dry tongue,
parched lips, thirst, quick and hard pulse.
Belladonna is useful after Aconite, or in any subsequent
stage, to relieve the crampy pain of the calf, together with
the swelling and inflammation of the blood-vessels and absorbents.  Its chief indications are:-tearing pain in the
lower extremity, rending in the joints, &c.; weight in the
thighs; drawing in the left thigh, pressure in the right;
lancinations as with knives; besides its homoeopathicity with
the diseases of the uterus and its appendages.
Bryonia is of advantage after Aconite or Belladonna when
the swelling continues in a chronic state, or with crampy
pain in the calf, &c. Its principal symptoms are:-drawings
in the hips and lower extremity; shootings from the hips or
haunches to the foot, sometimes with general sweat, and
impossibility of bearing the least touch or movement; drawing sensation as if the menses were coming on; painful,
tensive stiffness; swelling of the thigh without redness, &c.
It is most suitable when vascular irritation is present, and in
plethoric subjects.
Pulsatilla, besides its great sympathy with the sexual diseases of females, exercises a specific action upon the venous
system, as indicated in the swelling of the vessels of the
hands and legs in many of its symptoms, and in its producing varices; consequently it has a specific action upon
phlebitis and puerperal phlebitis, when accompanied by suppression of the lochia.
R us is indicated when there is powerlessness of the limb,
with chronic swelling, or a typhoid condition of the system.
ArscnicIum, when   the system   is much   depressed, the
limb tumid, and medematous,-the constitution cachectic, exhibiting an impaired vitality,-when the pain is worse at
night and of a burning character. If typhoid symptoms



WHITE LEG.


195


occur, with low delirium; or if there be slow hectic, with melancholy, excessive anguish, and apprehensiveness at night.
Mercurius is useful after Belladonna or Bryonia; it promotes absorption, and is indicated when suppuration threatens
or is present, and in the hectic fever which accompanies it.
China may be given when there is great debility of the
system, a cachectic constitution, with tumefaction of the limb,
especially if the patient has suffered much from haemorrhage.
Sulphur is very useful intermediately with any of the
above, if any latent constitutional taint is supposed to exist.
It assists the action of the other medicines and promotes
absorption. It should be given whenever the numbness,
heaviness, and powerlessness of the limb are great.
Antimonium is indicated when the swelling is considerable,
is in a chronic state, and the red lines of the absorbents are
traceable upon the skin, and a disposition to dry gangrene
shows itself.
Calcarea is applicable when the disease occurs in a
strumous or cachectic constitution.
Iodium will be useful under similar circumstances.
Sepia is best indicated when the disease is connected with
congestion, or chronic inflammation of the uterus.
The other remedies are occasionally beneficial, and may
be studied in the Materia Medica, where the pathogenetic
indications which guide their application to particular states
will be found.



196


PUERPERAL INSANITY.


PUERPERAL INSANITY.
Puerperal insanity comprises-the two forms of phrenitis
and mania, to which may also be added the melancholia,
which more frequently arises from morbid or protracted
lactation.
Phrenitis is a rare disease in childbed.  All the circumstances attendant on the parturient and puerperal states, the
peculiar condition of nervous susceptibility, and easy exhaustion, are opposed to the occurrence of inflammatory
excitement of the brain; on the other hand, the same conditions must be considered as favorable to the development
of mental perturbation and emotional excitement.  In determining the production, then, of either form of disease,
the physical temperament may have considerable influence.
The same exciting cause which, in the timid or lively, yet
enervated and susceptible individual, would lead to mania,
in the robust and plethoric would probably excite phrenitis.
The mania which occurs soon after delivery is more dangerous than the melancholia which happens as the effect of
morbid lactation several months after.   Mania is a less
durable disease than melancholia; it is more dangerous to
life, but less dangerous to reason.
The causes of puerperal insanity are predisposing, such as:
-hereditary predisposition; a nervous, susceptible temperament; pregnancy, and the puerperal state; uterine hoemorrhage, or any other exhausting process; puerperal convulsions;
loss of blood from improper treatment; morbid or protracted
nursing; weaning; low diet; functional disturbances of the
abdominal viscera. Or exciting, such as:-anger; depressing
passions; any sudden fright or other mental agitation; disorder of the digestive organs; uterine disease, &c.
From numerous observations it is now well understood
that puerperal mania does not always depend upon inflammation of the brain.  Dr. Gooch has truly characterised it
as a disease of excitement without power; and patients
generally die with symptoms of exhaustion, not with those of



PUERPERAL INSANITY.


197


oppressed brain.  The state of health previous to the occurrence of parturition often influences the state of the brain
afterwards. In illustration of that fact, Dr. Gooch has related
the case of a lady, who had jaundice at the time of her first
confinement, and became maniacal after. She had jaundice
again slightly during her second confinement, and suffered
again from an attack of mania, which was, however, excited
by witnessing an alarming fire, some of the burning materials
of which flew past the window out of which she was looking.
Previous to a third confinement she was again the subject
of jaundice, which this time was removed by treatment,
before delivery, and she escaped her mental derangement.
Puerperal insanity seldom becomes permanent, although it
may last for weeks or months; nor does it invariably recur
at a future confinement, but, on the contrary, if great care
be observed, calm and quiet composure of mind be secured,
and all exciting circumstances avoided, the probability is
that it will not be repeated; but a sudden or painful excitement is almost sure to reproduce it.
The symptoms of puerperal insanity vary a good deal in
different individuals, being  dependent chiefly upon the
temperament, the exciting cause, and the state of the bodily
vigour.
In phrenitis there are, in addition to the raving delirium,
dull headache, with thirst, throbbing in the head, and giddiness, beating of the carotids; flushed face, hot skin, and
quick pulse; a vivid vascularity or suffusion of the eye;
aversion to the light; increased sensitiveness to sound.  At
times questions are answered correctly, at others with incoherency; watchfulness, and a hurried manner, with confusion of
thought, great irritability, and vehemence of temper, or rambling about absent things and persons usually prevail. The
general incoherency and delirium often alternate with sullenness.  The lochia are not suppressed; the secretion of milk
ceases; the bowels are not constipated, although an imperfect
evacuation of their contents, allowing of a lodgement of illconditioned fieculent matter, often prolongs the disease.
If the active symptoms are not speedily subdued, furious
delirium  comes on,-with rapid and vociferous talking,



198


PUERPERAL INSANITY.


violent gesticulations, and wild expression of countenance.
The patient may be destructive,-spitting, pulling the hair,
&c.   Spasmodic twitchings of the muscles, tremulousness of
the hands, strabismus, grating of the teeth, stammering
speech, are present; and often the muscular strength is
inordinately excited, the patient making violent efforts to
get out of bed, and failing in the attempt, sinks back apparently in a state of exhaustion. Paralysis follows, and
the patient sinks into a low, comatose state; the extremities
becoming cold, the breathing laborious, with convulsions
and death.
The other form of puerperal mania exhibits the mental
symptoms in a more prominent manner. These generally
show themselves rather suddenly,-a few days after delivery,
if the disease has been excited by some sudden agitation,or, may be, at the end of a fortnight or later; but more
gradually if it arises spontaneously,-the patient perhaps
awakening from a slumber impressed with a terrifying
dream; or, without apparent cause, appears sullen, or abrupt
in her speech all at once, with an unnatural look and demeanour, or pale face, soft and not very quick pulse, and
hallucinations of various kinds.
Then there may be incessant incoherent talking, profuse
perspirations, and involuntary evacuations; or there are, from
the first day after delivery:-restlessness at night, a quick
pulse, irritability of temper, scolding   about the merest
trifles, and a perverse determination to scrutinise her domestic concerns; suspicions about her husband; violent
passions; perpetual wakefulness; a general apprehensiveness
of manner; every variety of deranged emotion, and perverted
feeling, with delusions of every sort.   In some cases the
passions are all violent; in others all gloomy. The hallucinations partaking often of the circumstances or object
which was the first cause of excitement. A rapid succession
of delusions is sometimes noticed, and the disposition is
completely changed.    In these cases when the pulse is rapid,
it is an unfavorable sign; but if the pulse be moderate, however great the cerebral disturbance, life is seldom in danger.
MELANCHOLIA is a form of insanity which often results



PUERPERAL INSANITY.


199


from the exhausting effects of uterine haemorrhage and
morbid lactation.  It is generally preceded by some of the
symptoms indicative of that state, which are referred to in
another article: such as impaired vision after nursing, so
that the patient cannot read; inability to command the
attention; loss of memory; she forgets one minute what she
was going to say just before,-or rings the bell to give directions, which she forgets immediately; she betrays apathy
and indifference about the concerns of life; she is not desirous
of living; she thinks her death would be an advantage to those
around her; she loses flesh; her milk fails; and she is continually imagining she is going to die; a vacant look, profuse
perspiration, and distracted feelings in the head prevail, as
if she would lose her senses: she becomes incoherent, or
sullen, gloomy and desponding. All these symptoms indicate a failure of power in the sensorium to eliminate the
nervous influence. At the outset the mind is often right
enough to detect that it is deranged.  She expresses a wish
that she could hold her tongue, when sitting up in bed,
perhaps, and talking incessantly.
Or, the eye is fixed upon some object intently, the patient
is sullen and silent, spasmodic catchings of the hand occur, as
though she was attempting to pick up something which she
fancies she sees on the bed. Or, she is excited by some
imaginary resemblance, which disturbs her; or, the questions
of the physician are all repeated by the patient, like an
echo.
Again, the patient, if she be given to reading, and is
intellectual, will be at times reciting poetry, and again incoherent.  The abdominal secretions are imperfect, the
functions of the liver morbid, the evacuations being dark
and offensive;-those of the intestinal canal and the bladder
being voided in bed. The tongue under the former circumstances may be foul,-covered with a dark fur;-the
pulse being above 100, with a hot skin, and sleeplessness for
many nights, with violent efforts to get out of bed. During
convalescence entirely opposite symptoms may exist, such as
timidity, and an unnatural avoidance of conversation; selfaccusation, remorse for some supposed crime, and disposition
to suicide, are frequent symptoms in melancholia; this state



200


PUERPERAL INSANITY.


is at first accompanied by intervals of coherency, during
which the patient is conscious of the absurdity of her
notions, and struggles against them; but relapsing again
becomes violent, even ferocious, and full of hallucinations.
Hysteria or the cataleptic state may usher in the earlier
symptoms of melancholia, attended perhaps by the suicidal
disposition.  The closest vigilance is requisite in these cases,
lest in an unguarded moment the patient destroy or seriously
injure herself.
HYGIENIC TREATMENT.
The moral management of such patients must be regulated by a mild but effectual control, which is better secured
by strangers and those used to the care of such patients.
A close watchfulness must be constantly observed, and every
thing be removed by which any injury can be committed,
as handkerchiefs, garters, stockings, &c., knives, scissors,
and other like articles; the windows should be kept locked;
exclusion of the husband and of all relatives and friends, as a
general rule is advisable; all discussion or argument should
be avoidec.
The straight-waistcoat is sometimes absolutely necessary to
prevent the patient from injuring herself, and to keep her in
bed.
The diet should not be too. low; it may be composed of
nutritious and unstimulating fluids; gruel and milk, or
gruel and good veal broth, or milk alone. The broth can be
with diminished temperature of the skin exist, a little wine
omitted if there be any thirst and heat of skin. If pallor, and
water may be allowed. After some days, in cases of simple
mania, a little solid meat may be given in small quantities.
In melancholia during lactation, a more generous diet must
be prescribed.  In phrenitis it must be still more restricted.
THE MEDICAL TREATMENT.
The remedies which are indicated in the treatment of the
several kinds of cerebral disorder connected with the puerperal state, are as follow:
For phrenitis:--Acon., Bell., Bryon., Hyos., Opium, Stra



THE MEDICAL TREATMENT.


201


mon., Sulphur; or, in addition, Canth., Cupr., Cic., Camph.,
Cina, Dig., Helleb., Lach., Mere.
For mania, or erethism   of the brain, the most common
form of puerperal insanity:-Acon., Bell., Platin., Puls.,
Stram., Veratr.; or, Cupr., Lach., Merc., Sulph., Zinc.
For melancholia:-Ars., Aur., Bell., Ign., Lach., Puls.,
Sulph.; or else, Calc., Caust., Coccul., Con., Graph., Helleb.,
Hyos., Lycop., Merc., Natr. m., N. vom., Petr., Silic., Stram.,
Veratr.
For nymphomania:-Platina and Veratrum are chiefly
serviceable.
The principal indications of a few of the medicines most
generally used will be advisable here.
Aconitum should be given whenever there is increased
vascular action, as in phrenitis, or, in some instances, in the
second form.    It may be repeated every hour, for a few
hours, more or less, depending on its effect upon the febrile
symptoms. It is also indicated when the disease has supervened upon mental alarm; when the patient is in despair, and
is morbidly apprehensive about the result, being fearful, &c.,has dread of ghosts, is affected with catalepsy, or nightmare;
or when she declares she is going to die, and fixes the time
of her death, has startings, as if affrighted, is of a sensitive
temper,-dull, desponding, sullen, or else changeable and
fitful,-alternately laughing and crying, with occasional vehemence. Palpitation of the heart, with anxiety; delirium,
especially at night, and cold perspiration appearing on the
forehead, whilst the pulse becomes scarcely perceptible, &c.,
are additional indications for Aconitum.
Belladonna is particularly applicable to the various forms
of mania with delirium   after Aconite.  Its indications are
expressed-when the disease has occurred as a consequence of
fear, fright or chagrin,-by anguish, anxiety and agitation;
incoherent speech with constant delirium, incessant restlessness; congestion of the brain with loss of consciousness;
pain or heat in the head, protruded eyes, redness of the face,
jactitation of muscles; rage, and desire to die when it is
passed over; crazy delirium, foolish jesting, obscene talking, talking of dogs, visions of ghosts, bulls, war, devils,



202


PUERPERAL INSANITY.


soldiers, &c.; disposition to spit, bite and tear; stammering,or in fact, every variety of mental hallucination and delusion,
and love of solitude.
Bryonia is useful after the former in the second stage of
phrenitis, or when there is great irritability, fear of death,
anxiety and apprehensiveness, determination to be busy
about a number of things, forgetfulness, with chills, perspirations and constipation.
Hyoscyamus. -Paroxysms     of  mania, alternately   with
epileptic fits, absence of sleep with constant loquacity, delirium, anguish and fear, especially at night, with dread of
being poisoned or betrayed, and desire to run away; visions
of dead persons, jealousy, fury, with impulse to strike or
kill; ridiculous gesticulations, ravings about domestic matters,
and trembling of the limbs, &c.
Opium.-When the derangement is the result of fright and
fear,-with delirium, painful delusions, and the patient thinks
there are ghosts, devils, and masks present; or, her fancies
are of mice, scorpions, &c., from which she tries to escape;
or when she loses all consciousness of where she is,-thinking
herself away from home. When there is lethargic drowsiness,
with sopor, desire to sleep, but inability to do so, anguish
and fury; constipation with erethism, congestion in the head,
with redness of the face, &c.
Stramonium.-Mental derangement, violent         headache
with dilated pupils; excessive delirium; loss of sight and
hearing; striking about with the head and feet; slow pulse;
delirium with frightful visions; fear, and impulse to run
away;-or with prayers, devout air, and other religious indications;-or with loquacity, lascivious ideas, affected manners,
air of importance, conversation with spirits, dancing, laughter
and blows; or ridiculous antics,.alternately with gestures
expressive of sadness and melancholy; or ungovernable fury,
with impulse to bite, spit, strike and kill; desire for light
and society; aggravation of the moral affections in solitude
and darkness, and also at the autumnal equinox; redness and
bloatedness of the face, with silly and smiling expression, &c.
Sulphur.-When a psoric taint is suspected, or there has
been a tendency to eruptions, which have been suppressed,



THE MEDICAL TREATMENT.


203


when the following symptoms prevail:-despondency, apprehensiveness; disposition to weep without cause; obstinacy
and perverseness without knowing why; anxiety with heat
in the head and cold feet; not knowing what to do.    The
patient is confounded with the remembrance of disagreeable
occurrences, accompanied with boldness, great disposition to
philosophise and talk of religion; or she imagines she has
fine dresses, and that any old rags are new and beautiful
things, &c. Stupefaction in the head, feeling as though she
had lost her senses. This remedy acts best when the symptoms are aggravated at the wane of the moon.
Cantharis.-In inflammatory irritation of the brain, with
unconsciousness and sudden starts; striking about in rage,
with cries; tossing about with clonic spasms, or a barking
noise.  Great restlessness; noisy, insolent, and contradictory
temper. Paroxysms of rage, like phrenzy; dread of water;
convulsions, which are excited by touching the larynx or
abdomen; dysuria, delirium, or absence of mind; dullness
and weight in the head.
Cuprum.-Melancholia, belief in approaching death; fearful timidity, absence of thought, weakness of memory; inability to use the senses; delirious, incoherent talk and
laughter; delusions about change of character; craziness,
with red, inflamed, and wild-looking eyes. Attempt to bite,
spit, &c. The attack of rage ending in sweat.
Cicuta.-Suspicious and fearful disposition; sudden delusions as to change of condition; sense of strangeness and
alarm; visions of all sorts without feeling bodily ill; moaning
and sadness; tendency to be easily startled even by a loud
word. Feeling of heat after a sleep, with red face, sudden
jumping out of bed; dancing and clapping of hands, and
laughing buffoonery.
Camphora.-In cases where the irritability of the system
is low, the patient tosses about in bed with constant weeping, foaming rage, disputatious disposition, hasty, hurried
manner, vertigo, with loss of consciousness, vanishing of the
senses, &c.
Digitalis.-Melancholia, with very slow pulse; disposition
gloomy, peevish, irritable, silent, with sad apprehensiveness.



204


PUERPERAL INSANITY.


Helleborus.-Silent melancholy, involuntary sighs and
moans, anguish at the heart with nausea; vehement if
opposed; emptiness of the mind; seclusion.
Lachesis.-When the patient is loquacious, jumps from
one set of ideas to another rapidly, with bodily languor; exhibiting a superior choice of expression; ecstatic mood with
tears, mistrust and suspicion of those around, weakness of
the will, apprehensiveness, or despondency; great nervous
irritability, with susceptible feelings; easily affronted, and
then vehement; jealous fits, &c.    This remedy is not so
suitable to the sanguineous temperament.
Platina.-In maniacal erethism, with uterine haemorrhage;
melancholia with wakefulness, anguish at the heart, fearfulness, dread of death; shrieking and muttering, trembling of
the limbs, red face, small, feeble pulse; sadness, melancholy,
absence of mind, indifference of feeling, and disregard of the
most natural objects of affection; delusions with exalted selfesteem, taciturnity and weeping; constipation; fits of contemptuous feelings; alternation of cheerful and sad mood; disposition to whistle and sing; morbid sexual instinct; vehement
and quarrelsome disposition to beat unoffending people.
Pulsatilla.-In mania and melancholia, characterised by
moroseness, crying and apprehensiveness,-especially when
there has been retrocession of milk; crying and laughter
alternately, anxiety about domestic affairs; religious melancholia, fears of salvation, constant praying; anguish and
sleeplessness, anxiety and palpitation of the heart and epigastrium, with disposition to suicide,-imagining she has been
unfaithful to her husband; suspicious, taciturn, reserved, with
visions; heat in the face with thirst, erethism of the brain,
and disorder of the digestive organs; mischievous turn,
"general tremor, distress, nervous pains and tremblings; disturbed sleep, dreams, &c.; silent mood, sitting vacantly, with
folded hands, and not speaking.
Mercurius may be useful in the phrenitic form of the
disease, when symptoms of inflammatory action still exist,
when there is fearfulness with delusion of seeing water;
desire for death, with apathy towards those who are dearest;
also if the mind is.affected with peevishness, instability and



THE MEDICAL TREATMENT.


205


quarrelsomeness, regarding others as enemies,--suspicious and
distrustful, or disputacious, quarrelsome and bold, crazy,
absurd talking, and wanton manners, destructive mania;
failure to recognise her own friends; plays with her saliva;
filthy acts, looking pale and sunken, with languor; blood in
the evacuations, &c.
Veratrum has been found useful in the various forms of
insanity; and Hahnemann says, that it will cure at least onethird of the cases that occur. It is appropriate when there are
paroxysms of pain,in various parts of the head, as if bruised, or
the effect of pressure; the patient being taciturn, never speaking unless irritated, and then scolding with anger; irritable at
the least trifle; she is reproachful, disconsolate about her imaginary troubles, moans and weeps, with lamentations; pretends
to be pregnant, or in labour; is wanton, has suppressed lochia,
nymphomania, rage, lasciviousness and filthy ways; is destructive, or laughing and moaning, singing and whistling alternately, screaming and running about, with blueness of the
face, tendency to fearfulness and starts; there may be redness of the face with great thirst and diuresis; great prostration of strength.
Zincum.-In    melancholia, with remorse as if guilty of
crime, with visions of devils; aversion to people, with dread;
night watchfulness, with alternation of heat and coldness of
the body; dark redness and heat of the face, sunken countenance, vertigo, unsteady gait; loss of appetite, constipation;
red, turbid urine, with languor, &c. or taciturnity, and indifference to persons and objects; sullen, peevish, angry,
easily-excited changeable mood; sometimes with intense,
obstinate pain in the brain; and great irritability.
Anacardium.-When there is great weakness of the understanding; dementia; indifference and want of feeling;
irritable and contradicting mood; laughs when she ought to
be serious, and is serious when incongruous absurdities present
themselves to her; loquacious dementia; disposition to use
bad language, and belief that she is possessed.
Arsenicum is useful in melancholia, with excessive anguish
of the heart and mind; dread of ghosts, thieves, &c.,-also of
vermin, which the patient fancies are about her; in gloomy and



206


PUERPERAL INSANITY.


religious melancholy; when there is suicidal disposition;
great indecision; great censoriousness, complaining of every
thing and every body; great sensitiveness and tenderness
of feeling; a loss of sensation, consciousness, and speech;
delirious mania, with open eyes, anguish, headache, ringing
in the ears, imagining she was a person hung, and disposition
to self-destruction; writing unmeaning characters, with restlessness and trembling, &c.
Aurum.-In melancholia, with suicidal disposition; loathing of life; rushing of blood to the head; seeking solitude;
dissatisfied with every thing; tremulousness; apprehensiveness; howling and screaming, with belief that she is lost;
sullen and taciturn; easily offended, unsociable, alternation
of spirits, &c.
Ignatia is suitable in melancholia from fright, grief, and
anguish; with despair of salvation; believes herself unfaithful; weeping; with constipation, cold extremities, spasms, and
changeable mood, full of emotion, &c.
Conium.-When the patient is melancholy; sunk in reverie,with great apprehensiveness about the present and future,
and love of solitude; superstitiousness; thoughts of death;
loss of memory; dullness of mind; insensibility and indolence,
or abundance of fancies in the morning. This remedy will
be found especially useful, if any uterine disease exist at the
same time.
Lycopodium.-In melancholia, with desire to be alone;
avoids her own children; absence of mind; loss of thoughts,
and confused talking; anxiety, fearfulness, and timidity,
with confusion of sight; distrustful and suspicious; insolent
and self-willed; disputes with absent persons; frenzy and madness; breaking out in reproaches, envies, and self-exaltation;
wantonly merry; involuntary laughter and whistling, &c.
Nuv vomica.-In melancholia, with desire to destroy oneself, with anxiety to leave the house, when combined with
disorder of the digestive organs, or after vexation, in quick,
irritable subjects; the patient is readily affected by external
objects applied to the senses; she is anxious and inconsolable, weeps, reproaches and complains, her cheeks being
very hot and red, without thirst.



IMPROPER AND UNDUE LACTATION.


207


Natrum mur.--When sadness prevails, especially if the
menses return; desire to weep and indulge in grief; involuntary crying; the patient is apprehensive for the future;
imagines she looks wretched; and laughs violently at things
that are not ridiculous.
Silicea.-Especially if the symptoms are aggravated when
the moon is on the increase; ideas fixed on one object;
compunction about trifles; the patient considers small faults
as crimes; using the wrong words continually; is whimsical
and fault-finding; startlish and restless; is irritable though
cheerful; loud conversation is inconvenient; is thinking of
needles; dreads them, and counts them cautiously; want
of memory; obstinacy.
IMPROPER AND UNDUE LACTATION.
The morbid consequences which result from undue lactation are deserving of the study of the practitioner, and should
obtain his patient and considerate attention.  To analyse
and trace to their proper source the various functional
disorders which are found associated with morbid lactation,
will put him at once in the track of recovering his patient
from a distressing, if not perilous condition, and will prove
an enquiry fruitful in beneficial results.
To witness a young mother of delicate organisation, strugling to afford that nourishment to her child which nature
has ordained, and yet at every successive effort feeling wild
with nervous irritation, or fainting with exhaustion, while
the little sufferer, by its piercing cries, expresses forcibly that
the feeble fountain which the mother so anxiously supplies
to it, is incapable of satisfying the cravings of its system,is a painful sight, and elicits the sympathy of friends at the
same time that it agitates the mother, and causes her continually to exclaim, " Why cannot I nurse my infant as well
as others?"
The organic nervous system which presides over the
functions of absorption and secretion, exists in a different
ratio of power in different individuals, while it regulates and
supplies the numerous sympathetic relations which obtain



208


PUERPERAL INSANITY.


between distant and associated organs.   If the vital power
be inherently deficient, and this want be mainly exhibited in
the system of organic nerves, the function of nutrition
would be impaired; and we have then that condition of the
female economy which forms the basis on which rests the incapacity of which we are now speaking; or, if any symptoms of
imperfect nutrition have shown themselves before marriage,
by the patient being the subject of chlorosis, &c., or any
accidental cause of debility have occurred since,-such as
haemorrhage, abortion, or exhausting leucorrhoea, the same
result may ensue; and immediately a continual demand is
made upon the system, as in the process of suckling, the
powers of the constitution begin to fail.
Anaemia then, as Dr. Marshall Hall has shown,-with all
the functional and even organic derangements which result
from that condition,-is the state of system     induced by
undue lactation. But these morbid consequences do not
depend alone upon protracted lactation.
Undoubtedly the more frequent, and sometimes the more
dangerous cases, are the result of this long-continued drain
upon the system; but, it very often happens that the evidences of morbid lactation present themselves at the very
outset; and, it is here, where those vain efforts to overcome
the deficiency create such an intense struggle between the
maternal feelings and the physical weakness, as at times well
nigh to prostrate the mind.    The effects, moreover, are
exhibited in the child, by emaciation, colic, diarrhoea and
cries.
The majority of women enjoy perfect health during the
period of suckling; many indeed are never so well as when
that process is going on, in consequence of the greater
activity of the assimilative functions, which prevails at that
time, induced,on the one hand, by the greater amount of
nutriment taken into the stomach with appetite,-and, on
the other, by the demand made upon the system by the child.
The process of conversion is, therefore, more than usually
rapid, and this cannot take place in a part of the animal
economy without the whole partaking of the benefit.
Many women, however, go on well in this way up to a



IMPROPER AND UNDUE LACTATION.


209


certain point, and then begin to droop, while others fail at
the outset.  The fear of losing the milk, under these circumstances, often leads to the abuse of stimulants.  The
function is attempted to be forced by repeated supplies of
fermented liquors; beer, wine, and spirits are had recourse
to in increasing quantities, producing a temporary excitement and apparent power, which, without benefiting the
child, only tend to the more perfect exhaustion of the
mother.  It is in these cases that mania is so likely to
happen, and therefore it cannot be too strongly condemned
as unnatural and unreasonable to expect that a large
quantity of stimulus can accomplish that which the powers
of the constitution are evidently unable to support.
The duration of suckling should have reference to the
constitution of the mother, to her condition in relation to
the length of time the function has been going on, and to
the state of the infant.  If the mother should early complain of any of the symptoms hereafter detailed, in spite of
a good supply of plain nourishing food, and a moderate
quantity of stimulants, and the symptoms should increase,
her state ought to be carefully watched, and if partial
weaning does not remedy the evil, the infant should be
entirely removed; on the other hand, if many months of
suckling have been endured, weaning must take place at
once.
The symptoms which indicate that lactation is morbidly
affecting the mother, are:-  a sinking and faintness at the
epigastrium, with a sense of emptiness, which lasts a long
time, and soon returns even after food has been taken; a
general weariness and fatigue; a want of refreshment from
sleep, an aching and dragging in the loins, and pain between
the blade-bones or in the side, beneath the left breast; distressing exhaustion after the infant has been at the breast;
the pulse is quick and feeble; the extremities cold; there are
dyspncea and palpitation on making the least exertion, or
ascending the stairs.  If the cause is continued, headache
and vertigo, noises in the ears, numbness of the extremities, impaired vision, exciting fears of amaurosis, loss of
memory, irritability and despondency, with thirst, dryness
11



210


PUERPERAL INSANITY.


of the tongue, and night perspirations ensue. Pulmonary
consumption may be developed; the general appearances of
anemia, menorrhagia, leucorrhoea, oedema of the face and
extremities, and neuralgic affections of various kinds supervene, and mania has not unfrequently formed the sequel.
Thus organic disease of the brain, lungs, and uterus, may be
added to the evils attendant on undue lactation.
Treatment.-The consequences of undue lactation, must
be met by remedies suitable to the symptoms that are found
to prevail, which will differ according to the degree of impression made upon the constitution, and the period during
which the function has been carried on.     The first step,
however, must be directed to the withdrawal of the cause,
and nothing short of this will, in general, be of the least
use.  When it has been accomplished, some of the following
remedies will prove of immense advantage, and tend to
recover the patient much more speedily and satisfactorily,
than any others.
China is one of the first remedies to which recourse may
be had, when the agalactiai is significant of exhaustion; and
especially if any accidental causes of debility have occurred,
as hemorrhage, leucorrhoea, &c.; or for palpitation of the
heart; pain between the shoulders, and oedema.
Calcarea,-when want of vital energy is apparent; or a
scrofulous constitution; or previous chlorosis has existed;
or leucorrhoea: it is suitable, too, for the hemicrania, weakness of memory, anxiety, and low spirits; incapability of
reflection; impaired vision; or ulcerations which evidently
depend upon deficient nutrition: the jactitation and nervous
or epileptic seizures, which, at times, accompany this state;
or the numbness of the extremities: threatenings of phthisis;
inward fever, attended by thirst, dryness of the tongue,
burning sensation of the hands and feet, loss of appetite,
emaciation, etc.
Causticum may be given when the patient is irritable, easily
vexed, or affected with inertia; or vehement, and resolutely
opiniated; if the memory is impaired; or there is nervous
and fearful anxiety, with despondency; throbbing headache,
' Deficiency of milk.



IMPROPER AND UNDUE LACTATION.


211


with pulsations and noises in the ears; threatened amaurosis;
great appetite, but a sense of emptiness soon after eating;
jerkings and twitchings in different parts of the body, with
excessive leucorrhoea.
Lycopodium may be given under similar circumstances, as
Calcarea, especially when there are symptoms threatening
phthisis.
Pulsatilla is suitable, when the mucous membrane becomes
affected by long-continued suckling; or when the nervous
system begins to be'disturbed-the patient being harassed
by distressing apprehensions, sleeplessness, and melancholy;
-cephalalgia; affections of the mind, in mild, amiable
dispositions; general nervous irritation, and restlessness,
morning languor, &c.; the sleep being disturbed by anxious
and frightful dreams; affections of the eyelids, and dimness
of sight; leucorrhoea.
Rhus is more applicable, when the mind evinces symptoms
of derangement, with thoughts of suicide; or fits of anxiety
and uneasiness, with dryness of the throat: or when great
debility, ensues, with thirst and dryness of the tongue; or
if dyspeptic symptoms indicate the failure of the gastric
functions.
Coffea may be used in the earlier periods, to quiet the
nervous excitability, and obviate the sleeplessness.
Bryonia will be useful, if symptoms of tubercular irritation
manifest themselves, with chills, and free perspirations, and
wasting of the flesh.
When symptoms of insanity threaten, the treatment recommended    under Puerperal mania will be the most
appropriate, from the similarity existing between the two
conditions. If there is any hereditary tendency, the difficulty
of management will be greater, and the prospect of recovery
more doubtful; but permanent insanity is rare from this
cause, although its return, after a subsequent accouchment,
is not unfrequent, if suckling be again persisted in,
The important point will be, to distinguish the form of
insanity which arises in the hyperoesthetic condition of the
nervous system, induced by over-lactation, whether it be of
the sub-inflammatory type, or the purely nervous derangement.



212


PUERPERAL INSANITY.


In the former case, Aconitum, Belladonna, Bryonia, Cupr.,
Hyoscy., &c., will be indicated; in the latter, Aurum,
Anacard., Pulsatilla,Arsen., Lachesis, China, Cicut., Stramon.,
Lyc., &c. &c.
Should the general debility influence the uterus, and
haemorrhage, with excessive leucorrhoea, occur, the remedies
indicated under Menorrhagia and Leucorrhoea may be referred to.
Or if the sight be so impaired as that amaurosis is dreaded,
from debility of the optic nerve, China, Anacardium, Calcar.,
Ignat., Lycop., Led., Ruta, Secale, &c. &c., may be referred
to; in this case, the general condition of the patient will be
the best indication for the selection of the remedy.
When the lungs exhibit any symptoms of threatened
disorganisation or tubercular irritation, Bryonia, Cham.,
Carb. veg., Arsenic., Calc., China, Phosph., Pulsat., Hyoscy.,
lod., Ipec., Sulphur, &c. &c., may be chosen from.
If epilepsy, or hysteria, or muscular jactitation, supervene,
Belladonna, Ignat., Nux vom., Op., Cham., Cic., Hyoscy.,
China, Calc., Lach., Silic., Cupr., Caust., Ars., Stramon.,
and the other remedies pointed out under these respective
diseases, must be compared with the state of the patient.
When a deficiency of milk is first observed, benefit will be
derived by administering the remedies which suit that
condition, as Assafcet., Agnus cast., Calc., Caust., lod., Chin.,
Nuw mn., Dulc., Zinc., Puls., Rhus, &c.



213


PART III.
ORGANIC DISEASES OF THE WOMB, ETC.
HAVING treated of the disorders of menstruation, and
other functional derangements of the uterus, at the commencement of this work, and subsequently of the pregnant
and puerperal states, with their occasional and peculiar
diseases, we shall proceed to consider some of those affections
of the female organs, which wear a more serious aspect, and
are accompanied by change of structure.
The interest which attaches to this part of the subject
is not diminished by the circumstance, that many of the
diseases are of that destructive and uncontrollable character
which defies the power of medicine. On the contrary this
well-known fact must stimulate our inquiries, and make us
seize hold of every aid which mechanical or chemical, mineral
or vegetable discovery may be able to afford us.  In many
of the diseases about to be referred to, some are the result
of simple inflammation, and are amenable to treatment equally
with the same conditions, when presented to observation in
other parts; but in some there is combined a malignant or
specific action, as it has been termed, which betokens a vice
in the deeper recesses of the organism, which no remedy
has yet been able to eradicate.  It is owing to this inherent,
and sometimes hereditary predisposition, that diseased action
set up in an organ, as the uterus or ovary for example,
assumes a character of malignancy; and all the efforts of
medicine are utterly powerless to cure, what may be called
the external disease, so long as the deeper-seated taint is
beyond our reach.



214


ORGANIC DISEASES OF THE WOMB, ETC.


It is true that cancerous ulcerations, scirrhous infiltrations,
or malignant growths have, happily, never been developed as
the results of medicinal experiments upon healthy individuals;
and therefore the practical or accidental provings of remedies, exhibit no distinct correspondence in their symptoms
with these affections; but there are, nevertheless, many
drugs, whose pathogenetic properties approach very nearly
to the effects produced in the organism, by the latent poisons
of cancer or scrofula, however ignorant we may be of their
real essence.
The induration, ulceration, and sinking of the vital powers,
which mark so inevitably the slow, though sure progress of
malignant disease, are strikingly portrayed in the pathogeneses of Arsenicum, Belladonna, Mercurius, Thuja, lodium,
Nitr. acid., Aurum, Argent. nitric., Conium, Carbo an.,
Carb. veg., Chamomilla, Silicea, &c.; whilst the symptomatic
indications are also exhibited in China, Sepia, Lachesis,
Calcar., Staphysagria, Nux vom., Hepar, Puls., Arnica,
Cannab., Sulphur, &c.
The objective symptoms are most characteristic in the
former, while the subjective seem more related to the latter.
With respect to Arsenicum, it has been observed that the
putrefactive powers of this drug are shown in the bodies of
those who have been poisoned by large doses of it; whilst the
smaller doses have produced a process of transformation, by
which the adipose tissue has been converted into a mass,
resembling lard or cheese, and the substance of the muscular
fibre been rendered papescent.   This is not very dissimilar
to the softening of cancerous indurations.
lodium has been known to accelerate the metamorphosis
of induration of the cervix into cancer, and one of its
properties, is to cause the disappearance of the cellular and
adipose tissue.
Conium, again, in its pathogenetic relations, is a type of
the dyscrasia of cancer,- as Baryta, Calcarea, and lodium
are of scrofula.
Thus it is not alone in the prominent symptoms that we
find these remedies closely to correspond with the developments of malignant morbid action, but also with the deeper



216


ORGANIC DISEASES OF THE WOMB, ETC.


without some women appearing among the patients at the
London    Homoeopathic    Hospital, whose complaints      are
directed to various symptoms of Dyspepsia, combined with
headache, nervous affections, &c., and who, if it be incidentally extracted from them, that they suffer from leucorrhoea,
with some slight symptoms referable to the uterine region,
still persist in laying all their stress upon the sympathetic
affections, and go on receiving partial relief, until some suspicions of more serious mischief in the womb, leads to a
further examination of that organ, by means of the speculum,
when the origin of all the symptoms is often proved to be in
some morbid     action, either inflammatory    or ulcerative,
about the os and cervix uteri, or in some displacement of
the organ. The speculum alone enables us to ascertain the
existence of simple erosion, which from its superficial character
is not always to be detected by the touch; the character of
the ulceration, whether it be simple, herpetic, granular,
phagmedenic, or specific; the exact quality of the discharge,
and its locale, whether it issues from the cavity of the
uterus, or the glands about the os, or whether it proceeds
from the external part of the neck, and the vaginal lining.
Any enlargement of the glands about the os and cervix, or
small tumours, become also visible by the means of this
instrument.
THE TOUCH may likewise assist us materially in deciding
upon the nature of the derangements going on in the body
of the uterus, or its os and cervix, and may sometimes be
all that is required.  It informs us of the condition of the
vagina and os, as to temperature and sensibility.      By it
alone we can often ascertain the existence of ulceration, any
induration of the glands about the os and cervix, the hardness or softness of the os,-its closed or patulous state,its smoothness or cedematous condition, if the circumference
be even or fissured, whether any morbid growths, as polypi,
or tubercles are connected with, or issue from it,-its state
of enlargement.
The touch may be practised "per vaginam aut rectum," in
order that the exact condition of the organs may be properly
appreciated.   By this means we may be better enabled to



METHODS OF INVESTIGATION.


217


determine the existence of pregnancy or its absence, or the
quality of other contents of the womb, its degree of enlargement, the state of prolapse or version, the bearing of the
os, and the local influence of the organ upon the rectum or
bladder; whether the uterus is fixed or moveable. By the
external application of the hand, the general volume of the
organ is determined, its freedom from tumours of the parietes,
or not, the sensibility which denotes inflammation, or hysteria, &c.
The influence of temperament has not escaped the writers
upon cancerous diseases, and Dr. Ashwell remarks, that "out
of thirty-three cases of Carcinoma uteri, which occurred
among the patients at Guy's Hospital, twenty-three were of
a dark complexion."
THE PECULIAR ASPECT of women affected with this disease has also attracted much attention; although the idea
of any given disease expressing itself so legibly in the countenance has been much ridiculed, on account of the difficulty
of describing it; nevertheless, every one familiar with that
disease cannot fail to recognise in the features a particular
expression beyond that of mere pain.  It may be, that perpetual suffering, or the gradual impairment of the powers of
nutrition, and the consequent emaciation and anoemiated
condition of the blood-vessels, or the sinking of the vital
powers, may, singly or collectively, be reflected in the lineaments of the sufferer's countenance; but of this I feel certain,
that no disease short of cancer affords so distinct a portraiture.  There are certain symptoms which have no special
indications from being common to various affections of the
uterus, whilst there are others which have a particular
bearing.
PAIN is one of the former; yet special kinds of pain are,
to a certain extent, pathognomonic.
The pain which is the effect of enlargement, prolapsus,
or other displacements of the uterus, is of a bearing-down,
aching, dragging, and pressive character,-is much aggravated by the upright position, especially standing,-extends to
the groins and sacrum, and is relieved by the supine posture.



218


ORGANIC DISEASES OF THE WOMB, ETC.


That which attends on inflammation or ulceration is of a
burning, sore nature, and accompanied by local heat.
The pain of scirrhus or carcinoma, is lancinating, intense,
agonising, as well as dragging; it occurs at intervals, and is
worse at night.
THE DISCHARGES indicate, more or less, the character of
the morbid changes; the various degrees of leucorrhoea or
menorrhagia may throw some light upon the kind of disease
going on in the uterus.
If there should be a fetid, offensive discharge of blood
and pus, or if a dark, sanious fluid pass off, with hemorrhages,
we may infer that malignant ulceration, either carcinomatous
or fungoid, is present, especially if the discharge is acrid
and excoriating.
When the discharge is of a white, creamy character, we
may, as Sir C. Clarke accurately described, consider it pathognomonic of inflammation of the os and cervix uteri; but a
simple, or even puriform mucus, may be only an excess of
the ordinary vaginal secretion.
Nevertheless, the discharges do not afford that definite
indication of morbid action, which will allow us to use them
as efficient guides to diagnosis.
E1JACIATION commonly attends organic and malignant
diseases of the womb, but does not take place to any extent,
until the disease is so far advanced as to involve destruction
of tissue.
When induration becomes softened, and the organs of digestion impaired, then the impoverished body begins to shrink,
and the pale and haggard countenance is made apparent.
THE STETHOSCOPE.-The examination of the uterus by
the stethoscope affords some assistance as to the existence of
pregnancy in doubtful cases, as this state may co-exist with
carcinomatous tumours of the uterus.
If the pulsations of the foetal heart, or the placental
murmur, be distinguished, it will materially affect the treatment as well as the prognosis; since, in the case of such a
complication, the indication of premature labour would be
distinguishable, and the prognosis anything but favorable.
But even under these unfavorable circumstances, pregnancy



METHODS OF INVESTIGATION.


219


has not unfrequently been concluded with safety to the child,
although in most cases, either from the unavoidable pressure
on the tumours themselves, or lacerations of the neighbouring
structures, in consequence of the unyielding nature of the
diseased parts, the cancerous ulceration has been developed,
and the fatal termination hastened.
In the early stages of uterine and ovarian disease, the
sympathetic symptoms which are excited bear so close a
resemblance to the accessory symptoms of pregnancy, that
this is not unfrequently presumed to be the case without
pausing to inquire further; but even retroversion of the
uterus will sometimes induce similar accidental phenomena.
In addition to the usual symptoms of pregnancy, pain at a
limited spot below the left mamma is more commonly
attendant on diseases of the uterus, whether functional or
organic.
The mode of treating engorgement, hypertrophy, and
induration of the os and cervix uteri, by the actual cautery,
as practised by M. Jobert, or by deep cauterisation by means
of the Vienna paste, (a compound of caustic potash and
quicklime,) as practised by M. Gendrin, and recommended
by Dr. Bennett, is, besides being barbarous, so in harmony
with the erroneous medical doctrines which have prevailed,
and tends so much to perpetuate the error,-namely, that this
or any other class of diseases can be considered as purely
local affections, or are capable of being permanently cured
by local treatment alone, the converse of which was so
philosophically and powerfully advocated by Hahnemann,
that the homoeopathist cannot be too much on his guard
against yielding to the specious arguments of those who
advocate so harsh and unnecessary a practice, and endeavour
to reconcile it with the homceopathic theory, instead of
seeking, among the riches of the materia medica, for some
other remedies whose pathogenetic effects are more closely
analogous to the morbid conditions of the diseased organ.
Dx. Madden has recently published a collection of cases
of uterine disease,' from the results of which he has, in my
opinion, too hastily deduced the inference that the local
IBritish Journal of Homceopathy, No. xxxv.



220


ORGANIC DISEASES OF THE WOMB, ETC.


treatment of these diseases by means of acid-nitrate of
mercury,' nitrate of silver, and potassa fusa, is more efficient
than their treatment by the homceopathic constitutional
method; and, in order to reconcile this apparent discrepancy,
he has endeavoured to prove the homoeopathicity of those
applications.   Such a plausible ex post facto argument is too
transparent to stand a scrutiny; and I certainly cannot accede
to his somewhat hasty conclusions, as they neither accord with
my experience or with reason. When Dr. Madden is willing to
allow that ulcers in the extremities are incurable, except by
local means, we may be induced to search further for the cause
which places Hahnemann and himself at so wide a distance.
However, in Dr. Madden's sixth proposition,' he appears
to me to let in a little light upon the error of his fundamental doctrine.     He there states, "that the local disease
may be cured by purely local treatment, without any immediate relief to the constitutional disturbance.       But once
the local mischief is remedied, the constitutional treatment
becomes more facile, and affords a much better prospect of
complete success."
Now, inasmuch as the constitutional disturbance depends
solely upon the original hypertrophy or engorgement of the
os and cervix uteri, which precedes and gives occasion to
the state of ulceration, what room is there to expect that
such general and sympathetic symptoms will disappear just
because a superficial ulceration of the surface of the os has
' The application of the nitrate of silver, or acid-nitrate of mercury, is,
however, admissible at times, but simply as an escharotic; because various local
circumstances render the healing of an ulcer of the os uteri difficult; but the
crust formed by the caustic affords that protection to its surface which allows
the healing process to go on undisturbed.
"2 Another objection to the correctness of Dr. Madden's inferences rests upon
the imperfection of the data.
The number of cases reported is 180, of which 43 only were examined by the
speculum, whilst 104 were not examined at all, and 21 only by " touch."
Again, as near as I could reckon, among these 180, Lycopodium was prescribed
only for 6, Hepar, 0; Calcar., 3; Kreasot., 3; Aeon., 3; Thuja, 2; China, 11;
Graph., 15; Platina, 12; Lachesis, 16; Arsenicum, 16; Bell., 47; Sepia, 59;
Sulph., 60; Puls., 72. Calendula was not used at all. Lycopodium, Hepar, and
Calendula are among the most valuable medicines in the treatment of congestion
and ulceration of the os uteri.



INFLAMMATION OF THE VAGINA.


221


been made to cicatrise by the application of caustic?  The
very inference he has drawn proves that the cases upon
which it was founded were not permanent cures; for, if the
ulceration were the entire disease, why should the healing
of it "afford" only "a much better prospect of complete
success?" It ought to ensure immediate success.
INFLAMMATION OF THE VAGINA,
SIMPLE, PUSTULAR, AND PAPULAR.
There is no practical utility in making separate observations on the varieties of inflammation attacking the mucous
membrane of the vagina, or vulva. I have, therefore, thought
it best to consider the whole under one head, pointing out,
in the course of my remarks, the different expression which
the diseases assume in relation to one another; and this not
so much, because they do not differ in their strict pathological condition; but because the same remedies apply more
or less to the several conditions, and it will, therefore,
obviate the necessity of useless repetition.
Simple inflammation may occur independently of pregnancy; and, if early noticed and attended to, will resolve
itself by the application of warm water and rest. It is
marked by heat, redness, and swelling of the parts, and is
accompanied by increased mucous secretion.
Pustular, or vesicular inflammation of the vulva, or eczema,
is more frequently than not, symptomatic of pregnancy. It
may be confined to the labia; or may extend itself up the
vagina, causing great pain and suffering, and intense irritation.
There is a burning itching of the part, which nothing seems
to allay; and, on examination, pustulations are seen here
and there, on the inside of the labia, or within the vagina,
surrounded by a fiery, red circle, with superficial excoriations,
and exuding a puriform ichor, of an irritating quality;
sometimes it has an aphthous appearance, like what is seen
' Loco citato.



222


ORGANIC DISEASES OF THE WOMB, ETC.


in the throat; there is more or less swelling of the part, and
micturition causes great suffering.  It is usually a concomitant with derangement of the digestive organs.
The papular form    is more common at the decline of
menstruation, and is termed prurigo.        It is generally
dependent on an inflammatory condition of the blood at this
period; and the intense irritation it excites, often so occupies
the mind of the patient, that it amounts to nymphomania.
Its situation is more frequently upon the external parts;
but it also exists within the labia, and in the neighbourhood
of the urethral orifice.
This pruriginous affection is often symptomatic of serious
disease of the uterus, or its appendages; in which case, its
removal can only take place in concert with relief to the
graver malady.
Treatment.-In the management of these sympathetic
affections, great attention must be paid to diet,--inasmuch as
they are frequently associated with disordered functions of
the stomach;-and to local ablutions,-the want of which
is occasionally the sole cause;-to rest, and the avoidance
of local irritation of every kind.
The remedies indicated are:Mercurius sol. for simple inflammation and swelling of
the vagina: this also relieves the eczematous condition of the
mucous membrane, and consequently the burning itching;
it is equally applicable to the pruritus of the papular form.
Nitri acid. may be usefully prescribed in the papular
pruritus; or in the excoriations of the vagina, or labia,
which resemble ulcerations.
Calcarea c. is indicated in inflammation of the vaginal
lining, especially in strumous subjects, and in excessive pruritus.  It may be prescribed with advantage after Nit. ac.
Sepia may be administered when there is burning and
itching, with redness, swelling, and humid eruption, within
the labia, symptomatic of uterine disease.
Carbo veget., is indicated in herpetic pruritus, without
pain; and in the eczematous or aphthous condition of the
pudendum with burning itching of the part; it corresponds
also with disorder of the digestive organs.



INFLAMMATION OF THE VAGINA.


223


Conium is indicated for the pruritus of the vagina, with
discharge of white, acrid mucus, or if the irritation is symptomatic of uterine disease.
Kali carb. for the pruritus of the labia pudendi during
the flow; with nausea and other dyspeptic symptoms, and
premature menses.
Lycopodium for the itching and burning of the vagina,
accompanied by dryness; and with abdominal flatulence.
Natrum. mur. is in relation with the papular pruritus of
the external organs, especially if at the menstrual decline,
and attended with sadness, anxiety, and fainting.
Silicea when there is itching, with soreness and eruption
about the thighs, with anguish and despair, at the decline
of menstruation.
Kreasotum is applicable to the aphthous or inflammatory
state of the vagina and external organs, when symptomatic
of disease of the uterus, &c., at the climacteric period.
Graphites is indicated when there is pruritus from papular
or pustular irritation of the pudendum, in association with
disease of the uterus or ovaries.
Sulphur is useful in all the forms of troublesome itching
of the pudendum, whether simple or accompanied by ulcerative vesicles.
Ambra, Magn. c., Phosphorus, and Staphysagria have
also been used and recommended, at different times, with
advantage.
We also occasionally meet with an inflammatory condition
of the mucous glands of the vagina, as well as of the curunculae
myrtiformes.   I have observed it, not only in connection
with cancerous disease of the uterus, but with polypoid
growths within the cavity of the organ. The mucous glands
enlarge, have a knotty or warty character, are collected in
little bunches, at times ulcerated, and under the aggravation
of intercourse become inflamed and irritable, secreting a
copious, thin, ichorous discharge, or an acrid leucorrhoea.
The irritation caused by this state is excessive, almost
maddening, there is burning heat with intolerable itching.
Mercurius, Thuja, internally as well as locally, and Sepia
afford the greatest relief.



224


ORGANIC DISEASES OF THE WOMB, ETC.


CONGESTION OF THE WOMB.
This primary and frequent form of disease often exists
for a considerable period unnoticed, on account of the little
inconvenience it at first produces; and it is only when the
inducing causes have been operating for some time, that the
symptoms assume any prominency. As there is a periodical
determination of blood, more or less, to the uterus and ovaries in the healthy state, it is easy to comprehend how, from
an arrest or deficiency of the natural function, to which this
is accessory, there should arise a torpor of the circulating
action in this organ, by which permanent distension of the
coats of the blood-vessels is occasioned, and the frequent repetition of which, together with the continual absence of relief
by the natural secretion, will give rise to a congestive
enlargement of the organs.   The same state of things will
happen more frequently, where there exists a constitutional
tendency to disease of the womb, producing an inherent
weakened state of the vessels.  In such cases the relief of
the congestion is found to be only temporary; and the
obstinate return of this morbid condition is expressive of
the constitutional weakness with which the organ is affected.
On the other hand, both acute and chronic diseases of
the womb are rendered more permanent and intractable by
these repeated congestions, which frequently retard or preclude recovery.
Symptoms.-The uterus, in its normal state, gives no evidence of its anatomical position; but when any change occurs
in its vascular or nervous tissues, its site is plainly indicated
by various local and sympathetic symptoms.
In uterine congestion there is a sense of weight behind
the pubes, and in the vagina, with dull pain, not aggravated
by pressure, but sufficient to create a constant uneasiness,
and sense of fulness; slight pressure at the neck of the
bladder and anus; occasional hmmorrhages, especially after
any of the exciting causes, or a tardy flow of the catamenia,
which is also dark and thick.



CONGESTION OF THE WOMB.


225


When, as often     happens, it occurs in women whose
menstruation   is natural and regular, the symptoms are
relieved for the few days after the flow, while for a few
days prior to the following period, there is an exacerbation,
attended with leucorrhoea, and a feeling of greater weight
and malaise. This state of congestion not unfrequently leads
to chronic inflammation of the cervix, or to follicular inflammation of the os. In the former instance, it is accompanied
by the white, cream-like discharge peculiar to that affection,
in the latter it is rather a yellowish or greenish leucorrhoea.
It is also more frequently than not, attended by hlemorrhoids,
which afford an additional indication of the state of the
uterine vessels.
The general symptoms may be insignificant; or there may
be slight febrile attacks every now and then, marked by shivering, flushes of heat, headache, nausea, and despondency. The
breasts are painful and swollen, and hysterical symptoms
sometimes prevail. The appetite is also impaired, and a
general languor and lassitude prevails, and the faint sinking
at the pit of the stomach, with or without occasional
cravings, or sense of emptiness, which so constantly attend
on diseases of the uterus. This train of symptoms is most
frequently found associated with displacements of the organ,
or chronic engorgement, consequent upon metritis. At the
critical period the symptoms are more active, there is more
febrile movement in the system, and a greater disposition to
hoemorrhage.
Examination, "per vaginam," affords indications of the
uterus being distended irregularly; the organ feels soft and
bunchy; is voluminous, and somewhat tender to pressure.
There is more or less prolapse, the cervix is dense, and
where there has been pregnancy, or cervico-metritis, the os
is patulous, as well as being doughy and uneven; but there
is no great increase of heat.
When examined by the speculum, the parts appear injected,
shining, and purplish; or the fine superficial veins tortuous
and varicose, with small pustules or vesicles filled with mucopus on the surface of the os uteri; these form tender points
when touched with the finger, and have an inflamed base.
15



226


ORGANIC DISEASES OF THE WOMB, ETC.


When this state has persisted for any length of time, it
is apt to pass into chronic inflammation and even ulceration of the os and cervix, upon exposure to any of the
ordinary causes.
The causes of congestion of the womb, are such as produce
an unusual determination of blood to the organ, which is
not relieved by a corresponding secretion, either during, or
in the intervals of menstruation,-as excessive sexual excitement and indulgence, mental emotions, too much riding on
horseback, fatigue in the erect posture, frequent abortion,
congestions of the abdominal viscera, &c.
The treatment of this disease must consist in enforcing
the horizontal posture; in the use of the cold sitz-bath
every morning for about 10 or 20 minutes, and some of
the following remedies, in accordance with the constitutional and local symptoms of the patient. It is often found
to be a very troublesome disorder, owing to the fact which
observation  has confirmed, viz.:-that it is a condition
premonitory of a tendency to serious organic disease, especially at the decline of menstruation.
The remedies whose pathogenetic powers recommend them
as most suitable in this form of disease, are:Belladonna, which corresponds to the symptoms of febrile
chills and flushings, with headache, nausea, swelling of the
breasts, pressure and fulness in the hypogastrium and
prolapsus, with dull, painful drawing in the circumference of
the pelvis; pressure in the region of the uterus early in the
morning, (with distension of the abdomen,) and subsequent
oozing of white mucus from the vagina; dull pressure in the
region of the bladder; weariness of the thighs and legs,
with disposition to change their position constantly; irregular
or scanty   menstruation;   despondency, and    dejection of
spirits.
Sepia is particularly indicated in venous congestions; it
may be given alternately with Belladonna, where there is
prolapse of the uterus and vagina; when there is a feeling
of fulness or stiffness in the region of the uterus; a pressure
in the passages, with colic; or a sense of the necessity of
crossing the legs to prevent a prolapse, this being followed



CONGESTION OF THE WOMB.


227


by an exudation of jelly-like secretion.  Sepia is moreover
frequently indispensable at the critical age, if there be swelling
of the pudendum, weariness and weakness; also, if there is
a discharge of blood "post coitum;" nausea and faintness
upon every movement of the body; violent heat and redness
of the face after a walk; hysterical spasms; or if despondency
and sadness prevail.
Calcarea will be indicated where the patient has been
subject to menstrual irregularities, generally in excess, or too
frequent, in venous lymphatic subjects; or in plethoric individuals who have suffered from amenorrhoea or dysmenorrhcea.
Where there is, in addition, sadness with apprehension on
account of the person's health; or in cases where the disease
has seemed to result from frequent abortions; where there
are varices of the pudendum; swelling and tenderness of
the breasts; pressure of the prolapsed uterus, with aching
of the thighs, as after a long walk; hysterical spasms, &c.,
and occasional haemorrhage.
China is indicated by congestions of blood to the uterus,
with sense of fulness, and painful pressing to the genital
organs, particularly when walking; by painless indurations
of the neck of the uterus; the patient is low-spirited, sad,
and gloomy; or in hysteric females, in whom a change of
humour is always accompanied by a new, and frequently
painful sensation in the uterus, when a troublesome feeling
of fulness is experienced in the pudendum, and an anxious
uneasiness through the whole body.
Nux vomica is in especial relation to the congestions of
the uterus, with a varicose state of its veins, swelling of the
os uteri, prolapsus of the uterus and vagina; sickness with
abdominal spasms; hypochondriasis, with great nervous irritation; uterine congestions, arising from obstruction of the
abdominal circulation and a varicose condition of the vessels;
when there is a sense of contraction in the hypogastrium,
and a pressure towards the genital organs when walking in
the open air; aching pain in the region of the pubic bones;
haemorrhoids.
Pulsatilla is indicated by-drawing, tensive or contractive
pains in the uterus, with pressure on the rectum or bladder



228


ORGANIC DISEASES OF THE WOMB, ETC.


abdominal spasms.. The menstrual secretion is thick and
black, and flows by fits and starts; or is slow, and ceases at
night.  White leucorrhoea, either thin or thick.  Chilliness
and paleness of face, oppression in the pit of the stomach,
cardialgia, &c.
Lachesis is useful in uterine congestion, at all times, but
especially at the critical period of life.  It may be given
when the menses are tardy, accompanied by pains in the
back and abdomen, with bruised feelings in the hips; downward-pressing pains; leucorrhoea before the menses, which is
greenish, or if the menses are too copious, when Pulsatilla
and Belladonna have not relieved. It is likewise useful for
the faint sinking at the epigastrium, and for general muscular
relaxation, with despondency.
Platina is characterised by melancholia; anxiety; hysteria; lowness of spirits; nervous debility; pressure in the
S  hypogastrium, with qualmishness; painful pressing towards
the genital organs: sometimes accompanied with desire for
stool; painful sensitiveness and continuous pressure in the
region of the mons veneris, and in the genital organs, with
internal chills and coldness, except in the face; painless
pressure in the lower' part of the genital organs, with a
relaxed feeling  and   stitches in  the fore  part of the
head; pressing in the hypogastrium, with ill humour and
hmemorrhage.


*4



METRITIS.


229


METRITIS.
INFLAMMATION OF THE WOMB.
Inflammation of the womb is met with under two forms,
viz.: the acute and the chronic. Acute metritis may happen
as one of the morbid sequelme of parturition, or at other
periods independent of it, but the symptoms and treatment
are much the same under both circumstances. Puerperal
metritis usually attacks the patient during the first ten days
after confinement.
The inflammation may be moderate and circumscribed,
occupying the lining membrane of the uterus, or its substance, and is then less disposed- to extend, the symptoms not
being severe or alarming. This often happens when a
patient has caught a cold just previous to the commencement of labour, the impressibility of the organ being then
considerable. The symptoms, in this case, show themselves
the day after delivery; the after-pains are found unusually
acute; there are chilliness, febrile heat and thirst; the pulse
being 90 or 100; headache; tenderness on pressure of the
uterus through the abdominal parietes; pain on movement
of the body; and, on turning over to the side, a feeling as of
a large body falling over in the pelvis, causing pain; the
lochia are scanty, or suppressed; pain is also excited on
extending the lower limbs; there is painful micturition, and
defmecation; the after-pains are increased on putting the
child to the breast, and are aggravated if Secale c. be given.
Aconitum, (tinct.) 3,two drops added to four table-spoonfuls of water; a teatspoonful of this mixture being given every three hours,will generally be found sufficient to subdue this form in a
few days.
But the inflammation may also attack the external surface
of the uterus, involving the peritoneal covering, along which
it extends over the abdomen.  The symptoms here are more



230


ORGANIC DISEASES OF THE WOMB, ETC.


intense, indicating acute inflammatory action, and the sensation of a weighty body falling from side to side is not so
prominent. The pulse ranges about 100; there is pain in
the lower belly increased by contact, which gradually increases in violence, subject to occasional aggravations when
the after-pains recur; tension of the pubic region, pain in
the back, shooting to one or both groins, with a sense of
weight; a difficulty in voiding the urine, or complete suppression, or a distressing degree of strangury; heat in the
vagina; suppression of the lochia, also of the milk.  The
constitutional symptoms are co-eval with the local; the
patient shivers, is sick, vomits bilious fluid at times, and
has headache. The skin is dry and hot, the pulse quick;
the tongue white, and dry, or red and fiery; the urine highcoloured and turbid; bowels obstinate, and there is a disposition to faint. The abdomen swells and is tense in proportion to the spread of the peritoneal inflammation.  If the
patient is speedily relieved, these symptoms gradually abate,
the secretion of milk and the lochial discharge are restored,
and she is soon recovered.  Sometimes, however, the symptoms continue more or less acute, the pulse becoming
smaller and more frequent, after having been full, and a
throbbing pain exists in the uterine region; renewed shiverings, and sleepless nights, with profuse perspirations, and
hectic symptoms. In this state the disease either proves
fatal or suppuration takes place.  The latter may occur in
the substance of the uterus, or between it and its peritoneal covering within the pelvis; or, an abscess may form
among the fibres of the abdominal muscles, as I have myself
seen, outside the abdominal cavity, above the uterus; I need
scarcely add that this, though s tedious, is a most satisfactory
result.
Metritis, however, may occur in the unimpregnated uterus
at any period of life.  The symptoms are less severe, and
the acute stage more transient, and more readily passing
into the chronic state; it most frequently happens about the
period of the decline of the menses, and is more frequent in
married than in single women. It is occasionally attended
with the formation of matter.  The history of the case, in



UTERINE PHLEBITIS.


2381


connection with the local and general symptoms, as above
detailed, will determine its existence, if carefully inquired
into.
Metritis might be mistaken for inflammation of the bladder, but examination per vaginam will readily determine the
question.  The causes of metritis are, cold caught either
just before or during the delivery; cold drinks given too soon
after; exposure to a draught of air; rough management
during labour; uterine haemorrhage predisposes to an attack;
as also do mechanical lesions of the uterus; sudden suppression of the lochia from any cause, or, of menstruation, from
getting wet feet or from violent emotion; too stimulating diet
soon after delivery; the exhibition of powerful drugs to procure
abortion: it has also occurred not unfrequently from the use of
Secale cornutum during delivery, under the old system of
medicine. This is a fact illustrated by Dr. Lever.1
UTERINE PHLEBITIS.
UTERINE PHLEBITIS is a form of metritis which is difficult
to describe by any set of symptoms peculiar to itself.   Inflammation of the veins of the uterus may occur as a simple
form of disease, but it seldom continues without the complication of disease of contiguous structures. It usually attacks
the vessels exposed by the removal of the placenta, and may
be confined to that side of the uterus, and extend to the
fallopian tubes and ovaries, or it may occupy the veins of
both sides of the organ, and be limited to their coats.  In
some instances it is extended to the iliac veins, or even to
the vena cava itself; softening of the muscular structure of
the uterus, alterations in the condition of the veins, and the
formation of pus, are the morbid consequences of uterine
phlebitis. It is generally caused by difficulties during
labour; cold air finding its way to the organs immediately
after the separation of the placenta: the decomposition of
a portion of adherent placenta, or of coagulum retained in.the uterus, and the consequent contamination of the blood
in the adjacent vessels; while its predisposing causes are the
I Diseases of the Uterus.



f232


ORGANIC DISEASES OF THE WOMB, ETC.


ordinary exhaustion and susceptibility attendant on the
puerperal state, a varicose condition of the uterine vessels,
-with flooding, and the depressing emotions.
The especial symptoms which may be said to belong to
this disease, when it occurs as an idiopathic affection, arerigors, with dull pain in the uterus, which is tender on
pressure, and a sense of weight in the pelvis: suppression,
or great diminution of the lochia or milk; frequent pulse;
uneasiness, with depression, nausea, vomitings, and headache.  The skin becomes hot, the pulse soft and expanded,
not contracted and hard, as in peritonitis; bilious vomitings
occur; incoherency, or a tendency to delirium, a certain
agitation, with extreme exhaustion, followed by drowsiness
and insensibility. With these there are also dysuria, scanty
or suppressed urine, irregular state of the bowels; and, as
the disease advances, typhoid symptoms set in, with petechiae,
&c., evidencing all the conditions of a dangerous malady.
When complicated with inflammation of the peritoneum, or
of the lining membrane of the uterus itself, the symptoms
of those conditions are so mixed up with those now described,
that an accurate diagnosis, founded upon the several pathological phenomena is most difficult.  For this reason I may
refer the reader for the treatment of uterine phlebitis to
the remedies and their special indications pointed out for
MIetritis.
TREATMENT OF METRITIS.
In the febrile stage Aconitum must be relied on to relieve
the tension of the pulse, and the high degree of vascular
excitement which exists.  It may be given in the form
above prescribed, and repeated every one or two hours, for
the first twelve, especially if the attack was ushered in by
violent chills, followed by excessive heat, with a full pulse
and flushed face, beating headache, or a feeling as if the
head was too full and would burst, and if it was caused by
a fright or a chill.
Nux vomica may follow Acon., and is considered by Hartmann as a most successful remedy.  It is indicated by the
following symptoms:



TREATMENT OF METRITIS.


233


Severe aching pains in the uterine region, aggravated by
pressure or internal contact; violent pains in the loins;
stinging and bruising pain of the abdomen during movement, cough, or sneezing; heat in the vagina, with swelling
and tenderness of the os uteri; constipation or hard stools,
attended with pain; pain in passing water, or retention:
the symptoms are worse of a morning.
It may be exhibited in the same manner as Acon., or at
a higher attenuation, if the symptoms are moderated and
recur less frequently.
Belladonna will be applicable when the metritis has been
developed after a retention of the placenta, (Arnica is presumed to have been given immediately after the delivery,)
with suppression of the lochia; or if the latter be of a fetid,
ichorous nature, with a sense of heat and fulness in the
vagina; dragging in the uterine region, often like a bearing
down, as if the parts would force out; a sharp and burning
pain above the os pubis, and a pain in the back as if it were
broken; acute pains in the hip joints, rendering motion or #
contact intolerable.  Hartmann says that Aconite and China
may likewise prove serviceable for those symptoms.
This may be given at the same attenuation, &c., as Nux
vomica.
Mercurius solubilis has the greatest analogy to the preceding in this disease, and may be given after it with
advantage, especially when the pain is of a lancinating,
aching, or boring kind, and if there be chills and perspiration.
Bryonia may be indicated when the most acute febrile
symptoms are subdued, and inflammation of the peritoneum
exists, in the earlier or in the later stages of the disease,
when absorption is required;-if there be anxiety about
recovery, dread of the future, a turgid state of the breasts,
headache, pain in the small of the back, sensation deep in
the abdomen, as of a lump there, with heat, vomiting of
bilious liquid, obstinate constipation; or if rheumatic symptoms co-exist.
Cantharis is analogous to Aconitum and Belladonna, where
there is much vascular erethism, with    delirium, great



284


ORGANIC DISEASES OF THE WOMB, ETC.


sensitiveness of the abdominal parietes, dysuria, heat of the
vagina, tendency to gangrene, &c.
Rhus is useful, when there is a disposition to assume
a typhoid state; dry, brown tongue, tremulous tongue,
nervous debility, physical depression, and general agitation,
with petechike, &c.
Hepar sulph. may be useful in uterine phlebitis, when
suppurative symptoms threaten, and there is headache, with
bilious vomiting, dull pain in the pelvis, and chills with
heats, &c.
Chamomilla will be indicated when the attack is the
consequence of anger, with disposition to uterine hemorrhage of dark and coagulated blood, or a simple increase of
the lochial discharge.
When there has been an abuse of Chamomile, in the
shape of Chamomile tea, which produces a tendency to
menorrhagia, the practice of drinking which is not prevalent in this country, Nux vomica, Ignatia, and Pulsatilla are
more especially indicated.
If the disease has been excited by a sudden, unexpected
joy, the exhibition of Cofea will best relieve the symptoms.
If the local reaction has not been too violent, it may at any
rate precede other remedies.
China is recommended after heavy labour, if the patient
should have lost much blood, or if an excessive quantity of
milk be secreted, causing great debility, or there be a discharge of fetid, sanguineous, purulent matter.
Arsenicum and Secale will afford great assistance in scrofulous subjects, when the disease evinces a strong tendency
to degenerate into gangrene, with sinking of the vital powers,
collapse, &c.
Secale may be alternated with China under these circumstances, to assist in sustaining the powers of life.
Pulsatilla will be found especially indicated in uterine
phlebitis, and must not be lost sight of, from its marked
relation with diseases of the venous system, as well as of
the orgaus of generation in the female.



CHRONIC METRITIS.


235


CHRONIC METRITIS.
CHRONIC METRITIS is sometimes a sequel of the acute
form; at others it arises as a slow and insidious disease,
often bringing into operation malignant action; for, although
chronic inflammation cannot be said to originate cancer of
the womb, it often accompanies its development, and forms
the groundwork upon which the latter is established: during
its course, moreover, fibrinous depositions take place, which
are apt to mislead the inattentive or inexperienced practitioner.  It is therefore of the highest importance to watch
this disease closely, and patiently to persevere in the treatment
from which we may hope for the most satisfactory results.
When once the diagnosis is sufficiently clear, and the
absence of malignant action determined, the patient must
be encouraged in every possible way to continue in the
treatment necessary for her restoration: tedious and protracted it must be, but, generally speaking, the prognosis
under these circumstances may be favorable, especially if
there be no evidence of hereditary taint.
The results of chronic inflammation are,hypertrophy,ulceration, suppuration, and indurated enlargement of the whole
or part of the substance of the uterus, and especially of its
neck.
The symptoms of chronic metritis are much of the same
kind as those detailed under the acute form, though differing in degree: there are weight and pressure behind the
pubes, uneasiness or dull pain in the region of the uterus,
a sense of dragging and bearing down in the vagina; sometimes the pain in the pelvis is of a burning character;
pressive pain on the bladder, urging to frequent micturition,
or upon the rectum, urging to evacuation of the bowels, or
laterally causing an aching in the groins; or there are darting pains through the uterus: occasionally hoemorrhage
occurs, or a simple excess of mucus is observed to issue from
the vagina, or a more viscid, opaque discharge; at other
times a muco-purulent fluid is passed. Moderate and irregular febrile symptoms prevail; the bowels are irregular in



236


ORGANIC DISEASES OF THE WOMB, ETC.


their action, at one time diarrhoea at another constipation
prevails; tenesmus is often a troublesome symptom; nausea
or vomiting occasionally occur.  After the continuance of
these symptoms for some time the countenance becomes
sallow, the appetite and health fail, emaciation occurs; the
uterus, externally, is felt enlarged, firm, and with some
degree of tenderness; if examined by the vagina it is found
weighty and indurated, either at a circumscribed spot or in
the body generally, which may be smooth or nodulated; or
the os and cervix may be indurated and hypertrophied from
fibrinous infiltration.  Sometimes there is found a distinct,
elevated state of the mucous follicles of the os and cervix,
like millet seeds, filled with pus. The leucorrhoeal discharge
which accompanies inflammatory induration of the cervix
has been described by Sir C. M. Clarke as like starch disseminated through water.  The causes of chronic metritis
are the same as those heretofore noticed; but it generally
takes place in cachectic or strumous constitutions.
TREATMENT OF CHRONIC METRITIS.
The TREATMENT must depend very much upon the varied
symptoms, which may be found associated in the individual
case.
Aconitum must be given, if marked febrile symptoms are
present, which is very rare.
Bryonia is indicated, by pain and heat in the uterus,
with general chilliness; painful and frequent micturition;
metrorrhagia; diarrhoea and constipation alternating; indurations, &c.
Cantharis is useful in the different stages of acute or
chronic metritis, when there are:-dysuria, or strangury;
aching pains in the groins; distension above the pubes;
tenderness; pressure of the rectum; qualmishness; swelling
of the neck of the uterus, attended with burning in the
bladder, pain in the abdomen, &c.
Sepia is one of the most useful remedies in this disease;
it is suitable to the chronic indurated condition of the uterus,
its cervix and os, whether simple or malignant.   It cor



, TREATMENT OF CHRONIC METRITIS.


287


responds with symptoms of bearing down, and pressure on
the bladder and anus; purulent, or muco-purulent discharge;
heat in, the womb, with slight pain there and in the back.
Kreasotum is also a very useful agent in chronic indurations
of the uterus, with fibrinous deposits, and with lancinating
pains from the umbilicus through to the vagina; frequent
chilliness; spasmodic pains in the rectum, with urging; and
frequent, troublesome micturition, &c.
Arsenicum  may often be used with advantage, in the
latter stages of the disease, when an aphthous condition of
the mucous membrane exists, or a cachectic and low state of
the system: depressed powers; feeble pulse; collapsed
features; cold surface, and a tendency to gangrene, with
vesical and anal tenesmus; shooting or burning pain in the
hypogastrium, &c.
Iodium is very analogous to Arsenicum; but is more especially suitable to strumous subjects: it is indicated by much
the same symptoms, but should be used earlier in the disease,
since it corresponds less with the depressed state of the
vital powers.
Hepar sulph. is useful, when there is congestion, or
chronic inflammation of the os and cervix, with or without
ulceration, with burning pain, fetid discharge, the part
readily bleeding when touched; yellow skin and complexion;
weakness, haemorrhage, &c.
Secale is beneficial in chronic, or sub-acute metritis, with
burning pains, sense of bearing down, irritability of system,
despondency, &c., and may be given in alternation with the
following:Carbo veget. corresponds to crampy pains in the hypogastrium: aching, or pinching in the iliac region, with white
leucorrhoea; aphthae about the pudendum; heat and redness,
with itching, the menses being dark, thick, and acrid;
drawing pain from the pubes to the sacrum; languor,
weariness, and physical depression towards noon, with faintness and hunger.
China, Ignatia, Lachesis, Pulsat., Platina, and Rhus, have
also been recommended in different stages of the complaint.
The Homoeopathic practitioner, whether he be a believer



238


ORGANIC DISEASES OF THE WOMB, ETC.


in Hahnemann's theory of Psora or not, will find in the
treatment of puerperal diseases, the advantage of administering a dose of Sulphur, when the medicines which seem to
be the best indicated by the symptoms, produce no sensible
effect, or, at the most, imperfect results.  Sulphur, under
such circumstances, will not unfrequently perfect the cure.
GENERAL ACCESSORY MANAGEMENT.
The dietetic and hygienic treatment of puerperal metritis,
consists in a withdrawal of all nourishing articles, if the
patient does not nurse; and, if she does, in the allowance of
very light aliment, tepid aqueous drinks, and an absolute
repose of mind and body. The application of a warm, very
soft and thin poultice of bran, rice-flour or potato-starch,
over the region of the uterus, in facilitating the establishment
of the cutaneous transpiration, is a means of which Homoeopathy need not fear to avail itself; since, in soothing local
pain, it assists the tendency to healthy action, incited by the
medicines internally administered.
Warm baths, so much advocated by some, in chronic or
sub-acute metritis, are injurious, by the fatigue and debility
which they cause to the patient.
The infant should be applied to the breast as soon as
there is any milk, as the suckling causes a revulsive action,
which is advantageous to the mother, and not hurtful to the
child.



DISPLACEMENTS OF THE UTERUS.


239


DISPLACEMENTS OF THE UTERUS.
The uterus, having some latitude-of motion in its natural
condition, is liable, from its actual, as well as its relative
position in respect to neighbouring parts, to an abnormal
amount of descent and change in its bearing, from various
causes.  Some of these are inherent to its proper and
peculiar functions; while others are dependent on alteration
of form or size, or on morbid growth, or relaxation of
contiguous structures, or organs.
The first class of causes includes,-difficult labour; hasty
or unskilful extraction of the placenta; too early getting up
after delivery, or walking too soon; frequent parturition;
dancing too much; long walking, or ascending heights
during menstruation; congestion of the womb.
The most important of the other causes are,-a relaxed,
or debilitated habit, straining, lifting heavy weights, relaxed
vagina, the abuse of purgatives,-which act, I think, more by
their relaxing effects upon the perineal muscles and fascia,
the levator ani, and the pelvic fascia, than in any other way;
-ascites; dropsy of the ovary; chronic metritis; local
adventitious tumours in the neighbourhood of the uterus;
polypus; a loaded rectum, or bladder; stone in the bladder;
or it may be the result of a fall, or of any violent, physical
exertion. Leucorrhoea may also, by diminishing the contractile power of the vagina, favour a descent; but it is more
commonly a consequence than a cause.
FALLING OF THE WOMB is attended with a greater
amount of suffering and inconvenience in women of the
upper ranks of life, who have been brought up luxuriously,
and thereby rendered delicate and susceptible, nervous and
relaxed, than in those who are hard-working and laborious:
although the disease is more frequent in the latter. It is a
common and well-observed fact, that uterine prolapsus often
exists without that disturbance of the general health, which
we should expect from the extensive sympathies of the organ
itself.  It occurs more often in married than single women;



240)


ORGANIC DISEASES OF THE WOMB, ETC.


but virgins are obnoxious to it from physical causes, and
complete procidentia is not impossible even in them.
Three degrees of descent of the womb are recognised:
viz., relaxation, where the slightest descent has happened;
prolapsus, where it exists to a greater extent; procidentia,
when there is protrusion through the external parts.    A
slight relaxation often exists a long time, without attention
being called to it; but the longer proper management is
delayed, of course the greater does the evil become, and the
more troublesome to treat.
Weariness, and aching in the back, hypogastrium, and
groins, with indisposition to stand, and a sense of debility
in those parts, may be all the patient complains of; but as
the  relaxation  increases, the symptoms become more
pronounced and distressing.  In addition to the pain in the
back, groins, and behind the pubes, there is a sense of
bearing down, and all these are much aggravated by walking;
leucorrhceal discharge, increased menstruation, and frequent
micturition occur.  In a more advanced stage, there is
strangury, or the urine is obstructed; the latter, when the
prolapse is complete.  In young single women we often find
it has the effect of confining them to the sofa for a long
period, not knowing what is the matter, but feeling that
they cannot stand, or go about as others do.  Sometimes a
fulness or tumour is felt in the orifice of the vagina, with a
sensation as though the contents of the pelvis would fall
through, which obliges the patient to sit down, or cross the
legs as if to prevent the protrusion.   A  great sense of
weakness is experienced.    General symptoms, at times,
attend this altered condition of the organ, which are more
likely to attract the attention of the practitioner, than the
real complaint; the patient is reduced to a state of great
debility, and her health is undermined.
These consist of sympathetic affections, for the most part,
which, in the mind of the patient, constitute the disease
from  which she is suffering.     The nervous   system  is
disturbed, general malaise and sleeplessness prevail; there
is a sense of soreness of the whole body, every fibre being
sensitive; irritability of temper, morbid sensibility of the



DISPLACEMENTS OF THE UTERUS.


21.1


organs of sense, headaches, dyspeptic symptoms, chilliness,
vomiting, flatulence, constipation, dysury, &c., all of which
are aggravated at every catamenial return, which often
happens too frequently, and is, at times, attended with the
passage of coagula.  In married women, and when it takes
place after delivery, a weight and uneasiness is felt at the
pubes, and in the hypogastric region, with an irritation about
the urethra and bladder, and sometimes a tenderness in the
course of the urethra, and at the vulva; a dull, dragging pain
at the groins, and a sense as of something full and pressing
when the patient stands or walks; pain and aching in the
thighs and back.    The recumbent posture relieves these
pains to some extent.  On examination by touch, the uterus
is felt to be lower than usual, the os resting against the
rectum, or upon the perinaeum, or reaching down to the
outlet, obstructing the passage of the finger at once. In
the less severe form of simple relaxation, the uterus may
not have lost its central position; but when it has descended
so as to rest on the rectum or perinmum, it, of course, has
ceased to project in the centre of the pelvic cavity, and the os
is found more posteriorly placed than is natural; on the other
hand, in complete prolapsus, the os is carried down in the
direction of the axis of the outlet, or forwards.  Examination
should be made in the upright posture, to give a correct
idea of the extent of the prolapse. The vagina is more or
less relaxed, and inverted.
In procidentia, the uterus is projected externally, with
the vagina completely inverted, and forming a tumour between
the thighs. The intestines or bladder may be carried down
at the same time, and form part of the tumour, giving it
a sensation of elasticity.  The procidentia is accompanied
by the ordinary local symptoms of prolapsus uteri, and also
with difficulty in voiding or retaining the urine, tenesmus,
and pain in the tumour.   After a long continuance of the
extrusion, the lining membrane of the vagina becomes hard
and dry, like the common integuments, ceasing to secrete;
ulcerations are not unfrequent in this state, the existence of
which causes great pain in sitting down, from the contact
to which the surface is then subjected.
16



242


ORGANIC DISEASES OF THE WOMB, ETC.


Treatment.-The first step is to replace the uterus in
sitdl, which should be done in the recumbent posture, with
the hips elevated, and the thighs bent upon the pelvis, by
gentle pressure of the thumb and fingers at the upper part,
while the body of the tumour is gradually urged upwards
in the palm of the hand: this is generally effected with
tolerable ease, although sometimes the return is prevented
by the great swelling, or from the presence of inflammation
in the organ.  If this should be the case, it will be better
to wait until, by the exhibition of suitable remedies, this
condition shall be relieved. If the displacement be in the
earlier stages, the uterus may be elevated by the pressure
of two fingers upwards, and a small piece of sponge
immediately applied to support it, which may be left in at
first for twenty-four hours at a time, or longer, if it does
not excite irritation.
In the more severe form of the disease, the uterus will
not always remain in its place, after being returned. When
this is the case, in addition to the sponge, or globular
pessary, an abdominal support may be used; the box-wood
pessary should be introduced some time after the reduction.
Many years ago I cured a patient, who had been afflicted with
procidentia for twenty-five years, entirely by the sponge
pessary.  There was ulceration of the protruded surface;
and after applying the sponge, and keeping her lying down
for some days, the sponge, not yielding readily, was left in,
where it continued for three weeks without the      least
inconvenience: it then came away, when the patient was
relieving the bowels,-a fetid discharge followed for a few
days, which soon stopped,-and she never had any return of
the procidentia.  Since then, I have several times had
recourse to the same process with success, adhesions forming
between the ulcerated surface and the walls of the vagina,
and affording a good support to the uterus.
The sponge should always be as small as possible, to effect
the desired object, because it necessarily swells as it imbibes
the moisture from the vagina, and then, if large, it tends to
dilate the channel, and induce a further descent. It may-be
removed, and pared down gradually, at intervals, as the cure
advances.



DISPLACEMENTS OF THE UTERUS.


243


The recumbent posture must then be preserved for a long
period, to allow time for the parts to recover their natural
tone and contractility.    Procidentia, however, is frequently
irreducible. Other hygienic rules must also be attended to,
such as the avoidance of any compression of the abdomen
by stays, riding on horseback, lifting anything heavy, and a
properly regulated diet.'
The medical means best adapted to restore the parts to
their natural condition, and to accomplish the recovery of
the general health, are the daily use of a sitz-bath,-for 10,
20, or 30 minutes, according as it can be borne,-at first
tepid, and afterwards cold; and the administration of some
of the following medicines, from which the greatest benefit
will be derived:Aconitum may be given for a few hours, if there be any
inflammatory symptoms which interfere with the reduction.
Belladonna is indicated by pressure in the hypogastrium,
as from a heavy load; frequent micturition; tenesmus of
the rectum; dryness of the vagina; pressing early in the
morning, as if all the contents of the abdomen would fall
through, with abdominal distension; leucorrhcea; menorrhagia; cramp-like pain at the os coccygis; drawing pain in
the whole circumference of the pelvis; heaviness of the thighs,
&c.,-general weariness and debility; excessive sensibility
and irritability of the organs of sense;        spasms;    pains
aggravated by contact.
Arnica or Rhus may be given at first, if the prolapsus be
the consequence of a fall, contusion, or strain.
Calcarea may be indicated by aching in the vagina;
general relaxation of the muscular system, or of the vagina in
particular; pain in the hypogastrium; weight and drawing
' Although the pressure of the ordinary stays from above aggravates the symptoms of prolapsus uteri, great relief and assistance will be obtained by an
abdominal support, which exerts a pressure upwards, above the pubes. An
instrument made by Sparkes, of Conduit Street, having a metal spring pad, which
is placed as much below the umbilicus as is possible, the ends of which compass
the hips and fasten behind, having a strap underneath, effects the object of
giving good support to the abdominal viscera, and thereby removing the pressure
from the uterus more satisfactorily than anything else I have met with.



244


ORGANIC DISEASES OF THE WOMB, ETC.


in the groin; desire to urinate, especially when walking;
dragging in the small of the back; weariness in the thighs;
too frequent or too copious menstruation.-Calcarea does
not agree where there is a tension of the muscular fibre
generally, or diminished menstruation, and is suitable to
nervous, weak, delicate, or excitable constitutions, as well
as to the plethoric.
Nux vomica is a very useful remedy in prolapsus uteri;
its chief indications are present when there is varicose congestion of the uterine vessels, which is alone a cause of the
descent; and when there is prolapsus of the vagina as well;
pressure towards the genital organs when walking; drawing
pain and aching in the back; drawing pains from the
abdomen to the thighs; great weariness after motion; inclination to lie down; general muscular debility.   In addition
to its application to the local symptoms, Nux v. is adapted
to many of the accompanying complaints; to the symptoms
of dyspepsia; constipation; flatulence, &c.; to irritation in
every part of the cerebro-spinal and ganglionic system of
nerves; hyper-sesthesis of the nerves of sense; spasms, &c.
It is most beneficial when the menses are too early and too
profuse. If used for the congestion of the womb, it should
be followed by Sulphur.
Sepia is also a medicine which may be given with great
advantage, in alternation with the foregoing, when the
prolapsus is attended with great irritability and disposition to
faint, or depends upon leucorrhoea; or when the menses are
fitful in their appearance, occurring two or three days before
the time, flow with interruption, and are attended with loss of
appetite, loathing, nausea, obstinate constipation; with
bearing down after exercise, slight pain in the hypogastrium
and back, and sometimes heat in the womb; continual
desire to urinate; pressing in the uterus, as if the contents
of the pelvis would fall through; the patient being obliged
to cross the legs, as it were, to prevent it.  Sensation, as if
the pudendum were enlarged; drawing pains in the thighs, &c.
Sepia is especially applicable to women of feeble and delicate
frame with sensitive skin; for nervous affections; and in
constitutions in which the muscular system is easily strained.



246


ORGANIC DISEASES OF THE WOMB, ETC.


ANTIVERSION, ANTIFLEXION, RETROVERSION AND RETROFLEXION
OF THE UTERUS.
Antiversion, antiflexion, retroversion, retroflexion, and
hernia of the uterus occasionally occur.   The first four
displacements have been said by eminent authorities to
happen more frequently than is generally supposed; and the
uterine sound has been invented by Dr. Simpson, of Edinburgh, for the purpose of diagnosing and rectifying the
derangement. They frequently result from partial, circumscribed, chronic metritis affecting one or other of the walls
of the uterus, or from congestive engorgement of these parts,
in addition to the other causes, which have been described
as productive of prolapsus uteri.  But it has been observed
by Dr. Simpson, that enlargement or hypertrophy is not
necessary to retroversion, and that he has known it coexist
with a natural, or even less than normal size of the organ.
There can be no doubt that congestive engorgement of the
womb generally is not an unfrequent cause of the latter;
and Dr. Madden, following Dr. Simpson, has recently well
shown 1 the course taken in cases of retroflexion from the
above cause, when the fundus uteri presses upon the rectum,
producing an obstruction of fieculent matter, which accumulating above the point of pressure, depresses the fundus still
more; the thickened portion of the posterior wall, in consequence of its inelasticity, is thus squeezed into a projection
just behind the os uteri internum, and is felt by the finger
in the vagina, immediately beyond the os and cervix uteri,
which are in this case tilted forwards against the pubes, the
tumour itself being apt to be mistaken for the fundus.
WVhen anti- or retroversion takes place, the subjective
symptoms differ very little from those of prolapsus; and it is
only by an exact, internal examination, that it can be properly
appreciated.
The toucher, or the proper application of the uterine
sound, will indicate the direction which the uterus has taken.
It can then be replaced by the same instrument; and if it be


' Vidc, ' British Journal of Homccopathy,' No. xxxv.



ANTIVERSION, ETC.


247


so engorged, as readily to fall back into its abnormal position,
the stem pessary of Dr. Simpson will preserve it in situ,
until, by medical treatment, such as I have described as
applicable to congestion of the womb, it shall be restored to
its healthy condition.
Previous to this change from the morbid to the healthy
state, the os uteri is very liable to ulceration, in consequence
of the varicose state of its vessels; and if this be healed up
by the application of caustic, the relief is a very temporary
expedient, as no permanent cure can be effected, until the
organ has resumed, its natural positiofi and size, and the
varicose state of the vessels has been cured: this is to be
effected by the administration of the suitable homoeopathic
remedies.
The same series of constitutional derangements is evoked
as when prolapsus exists; general nervous irritation and
local inflammatory or congestive conditions of the organ,
accompany or follow the displacements, all of which have
received that attention under their several heads, or in the
last article, which the scope and extent of this work at
present admits. As, therefore, the medicinal treatment of these
is similar to that recorded under the head of prolapsus, chronic
metritis, or congestion of the womb, I need not recapitulate;
but I will just remark, that I found very great benefit in a
case of antiversion of some years' standing, from Nux, Sepia,
Belladonna, and Secale, given alternately, at intervals, for
some time.
The patient was a lady, 34 years of age, who had
over-fatigued herself by dancing and walking at the time
of the catamenia.   She had been confined to the sofa for
several years; all the additional symptoms of disordered
function of the nervous system, and all the organs of the
body, made her life one of seclusion; examination by touch
disclosed the uterus lying across the pelvis, the fundus behind
the pubes, and the os tilted against the posterior wall of the
vagina.   The organ was larger and firmer than is natural,
from engorgement. The catamenia were in excess and too
frequent, and the nervous sensibility highly exalted. The
malposition was rectified, as far as could be, at the moment,



248


ORGANIC DISEASES OF THE WOMB, ETC.


and a small sponge tent introduced to support it. This she
declined the use of, and would not allow of any further
mechanical operations; so the sound was not used.      With
the homceopathic remedies just named, however, she became
so much better in a few months, that she went several miles
to a wedding with little inconvenience.     Coffea was very
useful in relieving the watchfulness, and a dose of Calcarea
cured the irregularity of the menstrual function.
The mechanical treatment of these accidents by the use
of the uterine sound, &c., will be found fully detailed in
recent works on that'subject. I have only further to observe,
that the constitutional symptoms seem to me to be more
intense, the general distress and nervous irritation greater,
in cases of retroversion and retroflexion, than in prolapsus;
and, moreover, that inasmuch as inflammation of the os and
cervix uteri is not, in all cases, the cause of these distressing
constitutional symptoms, there is good reason for believing,
in the absence of positive evidence, that the latter pathological condition is most commonly associated with them in
the relation of effect, since chronic metritis and uterine
engorgements, which are the most frequent causes of retroversion, &c., must necessarily be greatly aggravated by the
malposition of the organ, and so induce that inflammatory
condition of the os and cervix, which Dr. Bennett has
considered as the " fons et origo malis."
I am likewise disposed to think, that wrong conclusions
arc not unfrequently drawn, in applying the sound for the
purposes of diagnosis, &c.    In the first place, it is not
easy to pass the sound into the uterine cavity, especially in
the virgin, or non-impregnated uterus. It is often altogether
impossible; the sound may traverse the cervical canal, but
becomes stopped by the coarctation existing at the os
internum.    In such cases, the sound, being turned, may
have sufficient hold upon the organ to revert it, without its
ever having entered the cavity of the uterus at all; but this
can only occur if the uterus is of moderate size.   Further,
I believe that retroversion is frequently supposed to exist
when there is only prolapsus, together with a voluminous
engorged condition of the os and cervix, which falling down



ANTIVERSION, ETC.


249


against the recto-vaginal septum, bulges in the wall of the
bowel, and diminishes its caliber.    On making the examination per anum, the finger immediately comes in
contact with this rounded tumour, which has all the sensation
of the uterine body. If this occurs in connection with
hysteralgia, the sufferings of the patient are very intense.
I have several times found this enlargement and bulging
in the rectum so considerable, as to excite great doubts of
the possibility of its being only the os and cervix; but by
tracing the sound through the septum, and also noting the
distance of the knob from the aperture of the os, the doubt
has been set at rest.
Again, in pursuing this diagnosis, if the cervix uteri
happens to be long, and open as far as the coarctation,
described by Dr. Bennett as the result of cervico-metritis,
the point of the sound may be felt through the rectum at
the extremity of this tumour, by which it is presumed to be
within the uterus. On then reversing the instrument, the
tumour being moved round, escapes gradually from the
finger, which is in the rectum, and the retroversion of the
uterus is supposed to be reduced; whereas the os and cervix
only have been turned away from the recto-vaginal septum
into the central axis of the pelvis, and the uterus elevated
by the process, again to fall, upon the patient resuming the
upright position.  This appears to me an important point
for attention, as it is so easy to fall into the error of supposing
that a tumour, bulging into the rectum, must be a retroverted
uterus, and of then applying the sound repeatedly, and in
reality uselessly, which I need scarcely urge is a manifest
injury to the patient, and disappointment to the practitioner.



PROLAPSUS OF THE VAGINA.


251


have lost its contractility, the catheter must be frequently
applied at first, in order to prevent the occurrence of distention; and afterwards the patient must, by the natural
efforts, prevent the accumulation of the urine.  If all other
means fail, an oval vaginal pessary, formed of caoutchouc, or
a simple one, formed of a roll of linen, covered with oiled silk,
must be had recourse to.    It is necessary to prescribe the
horizontal posture in all troublesome cases.  The remedies
applicable to the relief of prolapsus vaginae are:-Arnica,
Mercurius, Nux vomica, and Kreasotum.
Arnica is to be given at first, if any violent straining shall
have preceded or been the cause of the prolapsus, or when
there is retention of urine.
Mercurius is useful when there is prolapsus with feeble
micturition, or irritation of the vaginal lining; also in cases
where ulceration has taken place on the exposed membrane.
Nux vomica is always serviceable, especially if connected
with descent of the uterus; or if dyspeptic symptoms prevail;
also when a burning pain attends the internal swelling of
the vagina; or when there is pain at the pubic bones, and
difficult micturition; or an inactive rectum.
Kreasotum   has been   recommended    by  Hartmann    in
prolapsus of the vagina, I should suppose from its producing
irritation and swelling of the vagina, with itching and
urinary irritation.
Sepia is also indicated in prolapsus of the vagina as well
as in that of the uterus.



252


ORGANIC DISEASES OF THE WOMB, ETC.


SIMPLE INDURATION AND ULCERATION OF
THE OS AND CERVIX UTERI.
INDURATION of the os and CERVIX UTERI is the result of
chronic inflammation of the deeper structures either of those
parts alone, or, as is more generally the case, concomitant
with inflammation of the entire organ. It may be detected
by the touch, the part having a firm, unyielding, but smooth
surface, instead of the unctuous and elastic feel which is
presented in its normal condition, and differs from the
hardness produced by malignant action in not being nodulated or apparently divided by septa.
There is usually some tenderness on pressing the finger
against the part, and the vaginal discharge is creamy, or
like starch diffused through water, as before mentioned.
This complaint is not uncommon after matrimony, but is
very rare in the young and single.      Ulceration often
accompanies or is induced upon an indurated condition of
the os, and when this happens, it can scarcely ever be
detected by the touch alone, and without the use of the
speculum may continue to exist to the great discomfort and
loss of health of the patient. The suffering, however, is
often greatly disproportioned to the extent of the ulceration,
a result supposed to depend, in a great measure, upon the
extreme tolerance of pain possessed by some women. There
is generally a sense of heat in the vicinity of the os and
upper part of the vagina, or referable to the hypogastrium;
sometimes there is vaginitis, scalding micturition, great
tenderness of the walls of the vagina, which are irritable
under the introduction of the speculum; profuse or scanty,
and perhaps acrimonious leucorrhoea, swelling of the vulva,
and occasionally of the inguinal glands, pain in coitu, or
when the uterus is pressed; pain in the back of an aching
and dragging kind, referable to the sacrum, with pain sometimes in the hip or groins; or there may be darting pains
through the womb, weight and bearing down on standing,



ULCERATION OF THE OS AND CERVIX UTERI.


253


tenesmus of the bowel as if piles were present; the menses
may be regular, but the flow is generally gradual, and the
discharge dark and thick.    Headache, with faintness and
sinking at the epigastrium, irritability of temper, indisposition
to exertion, and impaired appetite, are amongst the attendant
symptoms.
On examination by touch, there is usually found morbid
heat about the os and cervix, the latter feeling less elastic,
while the lips of the os are more tumid than is natural, and
pressure causes pain. For some time before ulceration takes
place there is a congested state of the organ, which produces
considerable enlargement of the os, and the development of
pustulations here and there upon the lips, which give to the
touch the idea of a granular spot, very sensitive and painful.
After a continuance of this state for a longer or shorter
period, from some cause or other, a sudden exacerbation
takes place, and the speculum discloses on one or both lips
of the os a spot, generally very red and abraded, varying in
size in different cases. This is termed erosion or abrasion by
most authors; it is darker than the membrane around and
very shallow, which is the reason of its not being perceptible
to the touch. The surface of the os is highly vascular, sometimes presenting fine tortuous vessels ramifying over it, and
one or more of the pustulations before alluded to may be
occasionally seen elevated upon it, and often remain unbroken for a considerable time.
The first stage of inflammatory ulceration of the os and
cervix uteri is characterised by a florid patch, of a brighter hue
than that of the surrounding mucous membrane, and studded,
apparently, with very minute granules, which are probably
produced by the hypertrophied state of the mucous follicles,
their mouths being obstructed by the tumefaction of the
membrane. The disc of diseased structure is thus elevated
somewhat above the surface, and well defined in its circumference. It may occur on one lip of the os uteri, or form a
circle around the aperture; and, in either case, may extend
to the margin, and enter the cervical canal, or be limited to
a portion only of the os.  The part is exceedingly tender to
the touch, and the condition of the proximate surface is that



254


ORGANIC DISEASES OF THE WOMB, ETC.


of vascular congestion,-dusky red, or bright vermilion,
shining, and giving rise to a thick, creamy mucosity.
If the disease continues, the raised portion soon becomes
stripped of the epithelemium,-it falls off like a crust, the
granular appearance is lost, and the spot is marked by a
dark depression or erosion, more or less deep, which has a
distinct edge. The ulceration may then extend, broader
and deeper, until it covers the os or traverses the cervical
canal.
If general and local means are adopted to restore the
part to a healthy action, the depression becomes filled up,
and minute granulations are soon visible, which gradually
coalescing, the margin contracts and the part heals. This
has been variously termed granular inflammation, erosion,
follicular inflammation, inflammatory ulceration, &c.    The
latter term is, perhaps, the most appropriate; since it is the
result of chronic congestion and inflammation.
If the disease progress, the appearance which is presented
is what has been termed the granular ulcer, a name objected
to by many. I believe it to be only an advanced stage of
the simple superficial ulceration or erosion. The surface,
instead of being smooth and dusky in its colour, is elevated
and of a florid red, looking rough or composed of closelypacked minute granulations, which are extremely painful,
and often bleed when touched.
The ulceration sometimes extends over the os, is perhaps
confined to one side, entering into the cervical canal,
which is rendered patulous,-the lips of the os being tumid
and everted, tender on pressure, and evidently the seat of
chronic inflammation; the rest of the surface is red, smooth,
and shining, with enlargement of follicles filled with mucopus here and there. The ulceration may even extend along
the cervical canal into the uterus itself, but this cannot be
detected by the speculum.    Sometimes ulceration occurs in
small detached spots, so superficial that the touch cannot
detect them; but when the speculum is used they are observed scattered over one lip of the indurated os, like small
pin-hole ulcers.  By degrees these coalesce and ultimately
cover the lip, and destroy it.  Such examples usually turn



ULCERATION OF THE OS AND CERVIX UTERI.


255


out to be connected with malignant induration of the os and
cervix. They heal up very kindly under Homoeopathic
treatment, even though the induration remains for a time.
Occasionally the os uteri is found to be fissured, or affected
with rhagades; in which case the part is very tender, feels
raw and uneven, and looks, when observed by means of the
speculum, as if the epithelemium had been stripped off, without any further loss of substance, the part appearing more
red than the rest.    It is sometimes connected   with an
anaemic condition of system.
The discharge which accompanies the several forms of
this disease is purulent or ichorous, varies considerably in
quantity, and is often attended by hoemorrhage; the quantity
of the leucorrhoeal discharge would seem to depend upon the
degree to which the inflammatory condition of the vagina
exists; there is no fetor if cleanliness be observed.    It
more frequently occurs at the period of the cessation of the
menses.
A third form is the ulcer with soft granulations, which is
more destructive, but would appear to be a variety of the
former, and depends for its inveteracy upon some dyscrasia
of the constitution, a scrofulous diathesis, or old metritis
chronica.
The causes of ulceration of the os and cervix uteri are
cold, insufficient clothing, wet feet during menstruation,
the improper use of astringent injections, painful intercourse,
inflammation of the uterus, acute or chronic, delicacy of
tissue in the individual, neglected leucorrhoea, &c.
Treatment.-Belladonna is indicated by a sense of fulness
and pressure in the vagina, making it difficult for the patient
to stand long, with pains in the hypogastrium and sacrum;
frequent hbemorrhages from the uterus, nervousness, &c.
Platina is useful in induration of the womb, with cramp
and stinging pains; if there is a burning sensation at the
left side, and cutting pain in the hypogastrium; painful
pressing towards the genital organs; menorrhagia with discharge of coagulated blood; with pressive labour-like pains
in the small of the back, and extending to the thighs and
groins.



256


ORGANIC DISEASES OF THE WOMB, ETC.


Bryonia and Ignatia are useful for occasional symptoms of
an inflammatory or spasmodic kind with metrorrhagia.
Calendula has been used with marked success, in induration of the uterus, by Dr. Schneider; it is likewise particularly serviceable, as a local application, when simple erosion
exists, as well as in the more aggravated ulcerations, the
constitutional state on which they depend being rectified at
the same time.
Sepia is very serviceable in removing the chronic inflammatory condition which precedes or accompanies induration;
or, if there be constant menorrhagia, with pain in the
groins; or any prolapse of the uterus, with acrid leucorrhcea.
Clematis is a remedy specifically indicated in cancer of the
breast; but it is so useful also in indurations of the testis in
man, that it may be worthy of trial in simple induration of
the os.
Lachesis may be useful when ulceration of the os sets in
at the critical age, with emaciation, &c., after the menses
have ceased to flow;-also when syphilitic ulceration exists.
It is likewise indicated by the faint sinking and cravings at
the epigastrium, which so constantly accompany diseases of
the uterus.
Coniurm acts generally upon the glandular organs of the
female; and is especially useful when spasms of the uterus
exist, with induration and vaginal itching; and if there be
gastric symptoms, such as sour retchings, desire for various
things, &c.
Kreasotum is in relation with the simple indurated state
of the uterus or tubercular scirrhus, where there are stitches
in the vagina from above, causing the patient to start,
sensitiveness of the os to contact, causing pain; burning and
swelling of the internal and external labia; premature
menses, with discharge of dark, lumpy blood, and sacral
pains, succeeded by an ichorous, bloody discharge, with
corrosive smarting; also if there are spasmodic pains in the
rectum, extending to the groin; urging to urinate, turbid
dark urine; lancinating pains in the rectum, &c.      The
menses intermit for hours or days, after which they return in
a more fluid form, with severe colic.



ULCERATION OF THE OS AND CERVIX UTERI.


257


Arsenicum is useful in every form of chronic uterine
disease.  If there be induration attended by continual discharge of an acrid mucus from the vagina, with burning;
tenderness of the os; irritation of the bladder, with burning
and dark urine; painful micturition, diarrhoea, with agony at
every attempt either to relieve the bladder or rectum; lancinations in the rectum; aphthous condition of the mouth and
throat; unquenchable thirst; anguish in the chest, &c. The
pains are aggravated towards midnight.
Sulphur should be used with a view to act upon the
general cachexia, 'or prepare the way for other remedies,
especially for the burning in the vagina, &c., with thick, yellow
or acrid leucorrhoea.
Cocculus may be given as an intermediate remedy if
spasmodic contractions take place in the region of the uterus
with nausea, sickness, &c., or for the faint-sinking at the pit
of the stomach.
Nux vomica for constipation-occasionally.
Lycopodium is one of the most valuable medicines in
non-malignant ulcerations of the os and cervix uteri.  It
speedily induces a change in the character of the ulcer,
and removes the chronic inflammation which surrounds it.
It is indicated-mostly in mild, melancholy, leuco-phlegmatic individuals - by   burning in   the vagina, painful
intercourse, darting  or gnawing   pains in  the uterine
region, pruritus of the vulva, a feeling of illness before the
menses, profuse leucorrhoea, dull headache and dyspeptic
symptoms.
Hepar s. is also highly useful in the same form of the
disease, especially in scrofulous subjects.
Calcarea c. will be found serviceable likewise in similar
cases with the last.
Chamomilla, if menorrhagia of dark, coagulated blood
should occur, with labour-like pains.
lodium corresponds with induration, or ulceration of the
os and neck of the uterus, preceding cancerous degeneration;
profuse, long-flowing menorrhagia, unusually violent, with
pains in the small of the back, and violent pressing in the
hypogastrium towards the pudendum; emaciation and shrink17



258


ORGANIC DISEASES OF THE WOMB.


ing of the breasts, brownish-yellow complexion, languor,
spasms, and disposition to faint; scrofulous diathesis.
Graphites has been prescribed by Dr. Wahle, of Rome,
when there was heat and pain in the vagina; swelling of the
lymphatic vessels and mucous glands; induration      and
tumescence of the os and cervix uteri; agglomerated tubercles on the side of the neck, which were painful: on rising
up there was great weight deep in the abdomen, with increase
of pain; debility and tremor of the lower extremities;
increased suffering just before and after the menses; which
occur every six weeks; the blood being black, lumpy, and
offensive; sense of a heavy load in the abdomen, with violent
lancinations in the uterus, extending down the thighs like
an electric current; burning and lancinating pains; bad
appetite; evacuations slow and attended with much straining;
livid complexion; frequent chills; frequent and hard pulse;
sad, anxious, and desperate mood.
Thuja is also recommended by Dr. Hartmann for the case
of induration and rhagades of the os and cervix uteri, and
in the cauliflower, readily-bleeding excrescences, which have
a sharp and pungent smell; or in dry, warty excrescences,
with severe stinging pain and burning during micturition.
Nitri. acid. may be given when the patient complains of
pressure in the abdomen, and pain in the small of the back;
spasmodic pains as if the abdomen would burst; pressure
outwards of the vagina; drawing in the hips and thighs;
excessive debility obliging the patient to lie down, and inability to talk; particularly when   the symptoms    are
complicated with mercurial poisoning, or syphilis, with ulceration, &c.
Sabina may be useful for the heavy weight, the labourlike, contractive pain in the uterine and sacral regions, copious
discharge of coagulated blood; the os uteri open.
Mercurius is given with advantage, occasionally, as an intermediate remedy in similar cases as Acid. nitric.; especially
when there are-prolapsus of the vagina and inflammatory
swelling, with heat, redness and soreness of the membrane,
with or without herpetic ulcerations; with pains in the pelvic
bones and femora.



ULCERATION OF THE OS AND CERVIX UTERI.


259


Staphysagria is also an occasional remedy for the pains in
the hips and thighs, with spasmodic pains in the pudendum
and vagina; with stinging itching of the parts; the pains
are more intense when sitting.
Carbo veg. relieves an intolerable, burning pain, deep in
the pelvis, setting in at regular periods in the day time,
increasing gradually and then decreasing again: two or
three doses are sufficient to remove it: or an aphthous
state of the pudendum, with sanious, mucous discharge from
the vagina; faint sinking sensation at the epigastrium at
noon.
Carbo animalis is indicated by induration of the neck,
with tearing pain across the ossa pubis, through the pudendum, to the anus; with thin watery leucorrhoea; burning
during micturition; burning in the groins, with bearing
down; flatulent distensions, &c.
Kali carb. may be useful when an acrid, offensive, altered
condition of the menstrual blood exists, with chilliness and
spasmodic pains in the hypogastrium.
Secale is useful in softening or decomposition of the
uterus, with great depression of the vital power, involuntary
movements of the body or extremities, uterine spasms, &c.
China may be given for the debility that follows the
exhausting hmemorrhages which sometimes occur.
Aurum is useful in chronic induration of the uterus,
simple or malignant, with prolapsus and melancholia; with
labour-like pains in the abdomen; especially in scrofulous
or mercurialised individuals.
Magnesia muriat. is indicated in scirrhous induration of
the uterus, amongst hysteric and spasmodic subjects; with abdominal spasm and violent bearing down upon the rectum
and the genital organs, accompanied by lowness of spirits
and ill humour; frightful cuttings in the abdomen suddenly;
pressure on the rectum, with constipation.
Cicuta may be of use in cases analogous to those requiring
lodium, but although indicated by the cancerous diathesis,
is not specifically so for cancer of the womb.   The same
observations are applicable toSilicea, Rhus, Phosphorus, Calcarea, ýyc., which have been



260


ORGANIC DISEASES OF THE WOMB, ETC.


found useful under certain circumstances during the progress
of uterine disease.
I have been thus extensive in reference to the treatment of
this class of diseases, on account of the frequently intractable
nature of many whose malignant character is not perfectly
distinct, but which, from peculiarity of constitution, assume
the worst appearances.
In addition to the medical treatment pointed out for these
diseases, the patient must be kept in the horizontal posture
as much as possible, though not confined to bed; she must
have pure air, plain and wholesome diet, and avoid intercourse.   The hip bath may be occasionally used.      I have
seen great benefit derived from the injection of a weak
solution of Thuja two or three times a day, especially in the
herpetic form of the disease; and I would strongly recommend the use of Calendula as an injection, in ulceration of
the os and cervix, of whatever kind.   It affords great relief,
and materially assists the production of healthy granulation.
The strength of the solution may be about ten drops to two
ounces of water.    It will not succeed, however, without
givifig the constitutional remedy applicable to the case at
the same time, for ulceration of the os uteri cannot be permanently cured if treated simply as a local affection.
CORRODING ULCER OF THE UTERUS.
The corroding or phagedenic Ulcer of the Uterus, first
described by Dr. John Clark, is an exceedingly rare disease,
and when it occurs, is so rapidly destructive and intractable
that its fatality is considered to be as certain as that of cancer.
It commences in the membrane covering the os, and gradually
extends until almost the whole substance of the uterus is
destroyed, and it sometimes invades the neighbouring parts.
Its early stages are marked by hemorrhages, heat in the
region of the uterus, pain which is often agonising, and
compared to a burning coal, fixed, and constant; the discharge is copious, purulent, sanious, and fetid, alternating
with hlemorrhage; pain and weakness in the back, small but
frequent pulse, sometimes swelling of the inguinal glands, and



CORRODING ULCER OF THE UTERUS.


261


emaciation usually prevail.   Examination by the speculum
brings into view the destructive ulceration:-an uneven,
broken surface, granular, florid, with inflammatory redness
and livid appearance of the adjacent parts of the uterus,
without induration; the uterus itself is mobile, which is not
the case in cancer, from which it could not be distinguished
but by the aid of the speculum.
Constitutional symptoms attend upon this disease in the
form of dyspepsia, irritative fever, constipation, or diarrhoea.
This kind of ulceration has been supposed in some instances
to have a syphilitic origin.
Treatment.--This disease has so successfully withstood
the treatment of the old school of medicine, that it is
very difficult to select any remedies which may afford    a
certain prospect of redeeming it from amongst the opprobria
medicorum. Nevertheless, as it is not deemed malignant
in the specific sense of the term, we may hope to obtain
more favorable results in    this as in  other severe and
acute diseases, which have been successfully treated by
homoeopathy. I will therefore point out, as far as possible,
the treatment which    is indicated in this acute form   of
ulceration.  We have, then, in Arsenicum such a powerful
auxiliary in other diseases and ulcerations of a destructive
kind, and in phagaedenic ulceration of the penis, which
closely resembles this in its appearances, that without being
too sanguine as to the results, we may safely choose that
remedy in preference to any other. Arsenicum offers to us
the following indications for its use in this fatal disease.
First, its peculiar action upon the ganglionic system and its
terminal branches, with consequent disposition to decomposition and gangrene, sudden sinking of the vital energies,
and destructive ulceration of the organic tissues; inflammatory conditions terminating in mortification; cancerous or
pseudo-cancerous dyscrasiPe; its tendency to produce erysipelas ending in gangrene; varicose phagcedenic ulcers;
putrid ulcers with fetid, badly-coloured pus, or with thin,
blackish, copious, and fetid ichor, violent fever, burning pains,
&c.; disorganised conditions of the uterus and ovaries, &c.
It would appear to be more especially indicated, in the



SCIRRHO-CANCER OF THE UTERUS.


263


Leucorrhoea, alone or combined with menorrhagia, is
among the earliest symptoms; aching of the back; a sense
of heaviness in the hypogastrium; dull pain at the top of
the thighs; with bearing down;-then, there occurs darting, lancinating pain betwixt the pubes and sacrum, or, in
the course of the vagina, with a sensation of glowing heat,
more or less frequently experienced, and often attended
with dysuria, and    mucous deposition   from   the urine.
Itchiness of the vulva, which is affected with a kind of
flabby swelling, or with erysipelatous inflammation, is not
uncommon; there is pain in coitu; dyspeptic symptoms
prevail, such as flatulence, heartburn, sometimes vomiting,
and sympathetic cutaneous eruptions. The general health
soon suffers, the countenance becomes sallow, the pulse
quickens, the strength declines, and the body wastes. A
fetid, purulent, or bloody matter is sooner or later discharged,
which indicates that the disease has proceeded to ulceration;
repeated hemorrhages are now apt to take place, and hectic
fever sets in.  The pain is constant, subject to frequent aggravations, and the weakness increases.  In the course of the
disease, retention of urine frequently occurs, requiring the
use of the catheter; or incontinence of urine may take
place; or the rectum suffers from the contiguous pressure, or
ulceration, and bloody and fetid discharges pass.     The
thigh and leg swell, and become hard and tense. Pain,
fever, want of rest, discharge, and loss of blood ultimately
exhaust the patient, and death terminates her sufferings.
At first, examination by the touch discloses the uterus
enlarged, the cervix apparently expanded, and the os uteri
hard, open, irregular, more sensible to the touch; a little
blood is often observed on the finger after examination;
after this, the os uteri becomes turgid, with irregular projections, as if it contained small cysts, and soon it is felt to
be ulcerated, excavations being formed, the sides of which
are everted, so as to make the surface broader.
The cervix uteri is sometimes totally indurated, and considerably enlarged, before ulceration takes place; but, in
other cases, the augmentation is often much greater after
ulceration, than before it.  Sometimes a circumscribed in



26 i


ORGANIC DISEASES OF THE WOMB, ETC.


duration is found imbedded in the substance of the cervix,
which is apparently healthy, although it does not long continue so.   This may become as large as the fist, adhering
to the pelvis, and causing immobility of the uterus, and
pressing upon the bladder or rectum, thereby obstructing
their functions.
The uterus itself is seldom inordinately enlarged, but
occasionally it is so, and can then be felt above and- behind
the ossa pubis.  The fallopian tubes and ovaria often participate in the disease.
Treatment.-Medicine, whether of one system or another,
affords very little consolation in this malignant disease. True
cancer has always been considered incurable; and, until the
light of knowledge burns brighter than it does, even at the
present time, we can only hope to palliate and soothe the
symptoms of this painful malady. Homoeopathy, however,
frequently affords incalculable relief.  It is, during its painful progress, of great importance to pay attention to any
morbid conditions which may develop themselves at the decline of menstruation, which, if not subdued, materially
expedite the cancerous development, when the dyscrasia
exists, and the predisposition is strong.
The following remedies are applicable to different conditions, which present themselves in the course of the
disease:Aconitum and Nux vomica for the cerebral or other congestions, in plethoric women.
Belladonna, Hepar s., and Sulphur, Aconitum and Coffea,
Ignatia and Pulsatilla, for many symptoms which show themselves in nervous persons. The last medicine is said by Rau
to be a valuable palliative in cancer of the womb.
Crocus and Carbo veget., if, with cerebral congestions,
there is bleeding at the nose, &c.
China and Kreasotum for the menorrhagia, which often
predisposes to Carcinoma.
Coqffea, Veratrum, Valeriana, Viola odor., Acon., Nitr. ac.,
Sulphur, and Kali c., if the debility be purely nervous.
The remedies which are to be looked to for the purpose
of confronting, if that be possible, or of exercising some



266


ORGANIC DISEASES OF THE WOMB, ETC.


without excluding any other of the medicines above cited, if
they should correspond to the symptoms.
HARD TUMOURS OF THE UTERUS.
Tumours of a firm or cartilaginous hardness are sometimes found occupying different situations in the uterine
walls.  They vary from the size of a pea to that of a child's
head, or even larger.  They are sometimes situated on the
abdominal or outer aspect of the organ, and are then closely
invested by the peritoneum; or they arise from the internal
surface immediately beneath the mucous membrane, and
projecting towards the cavity of the uterus, obtain their
covering from its lining membrane.
These tumours are generally considered of the carcinomatous growth; they are indolent in their nature, and do
not materially interfere with the general health during the
earlier stages, or even with the sensible condition of the
uterus itself, unless some accidental cause should produce an
activity in the disease, or in the contiguous structures, when
inflammation, which may terminate in gangrene or abscess,
is developed.
I once attended a lady, single, and about forty years of
age, who, after some unusual exertion in walking, was
attacked with hxmorrhage of an alarming nature.      On
examination, I found an enlarged uterus reaching to the
umbilicus, which externally felt of a stony hardness, and was
studded over its entire surface with tumours of various sizes,
giving to the organ a nodulated character; there was no
projection to be felt in the vagina.  After a slow convalescence from the exhausting effects of the hmmorrhage, she
recovered sufficiently to follow her occupation of teaching,
and was alive several years afterwards; when I last heard of
her, having had no return of the haemorrhage.
Menstruation is not necessarily arrested by these morbid
growths, and pregnancy often occurs during their development; but this is frequently a very inopportune circumstance;
for the afflux of blood to the uterus, which is coeval with
pregnancy, is likely to excite morbid action in or about the



HARD TUMOURS OF THE UTERUS.


267


tumours, and lead to adhesions or suppurations in them, or
to softening of the uterine tissues about their origin.  The
consequence of this is highly dangerous as pregnancy
advances. Under these circumstances, or where the size of
the tumour is so great as to make it doubtful if a child can
pass through the pelvis with safety either to itself or to the
mother, the proper course is to induce premature labour;
but even in this case, a bruising of the tumour may take
place, which might lead to serious consequences. Uncontrollable haemorrhage has been recorded as a result of the
presence of these tumours.  Nevertheless, the existence of
these morbid deposits is not a bar to a safe and natural
delivery, and they have been felt by Montgomery, Lever,
and others, after labour; and with the exception of remaining
rather tender for a few days, have not interfered with the
convalescence, or prevented subsequent conception.
That these cancerous growths are incurable, or, if cured
in one organ, are apt to be deposited in some other, and so
ultimately to destroy life, has long been acknowledged.
Mr. Travers has recorded, that the solution of Chloride
of lime effected the absorption of a large tumour, in the
course of some months, regarded by competent authorities
as scirrhus, in a lady whose other breast had been extirpated
for that disease. Not long afterwards, she died of asthma
from diseased lungs: the scirrhous tubercle appearing not
only in the chest, but in several of the abdominal viscera.
Although the curability of such a disease may be reckoned
impossible, even in our present advanced state of Therapeutical knowledge, it is yet most advisable to sustain the
hopes of our patient, under such trying circumstances; for
the extreme depression, which would naturally and inevitably
attend upon the abrupt announcement to a patient, that
she had cancer, would instantly plunge her into a more
dangerous condition, and probably hasten the termination,
which, by judicious means, it may yet be possible to protract.
It is a singular fact, that the only treatment which has
been used by Allopathic practitioners, with the effect of
palliating this form of disease, has been the administration
of remedies which have a remarkable hommoopathicity.  In



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ORGANIC DISEASES OF THE WOMB, ETC.


all the works on the Materia Medica Pura, those remedies
are considered as the most safe and satisfactory:-they are,
Calcarea, Conium, Mercurius,lodium, Aurum, Arsenicum, Belladonna, Sepia, Lachesis, Carbo. an. et veget., Clemat., Magn. m.,
Silicea, Staphysagria, Sulphur, or, as traced out by Jahr,1. Bell., Con., Sep., Sil.;-2. Carb. an., Carb. veg., Phosph.,
Staph.,Sulph.;-3. Bryon., Cham., Chin., Graph., Lyc., Mag.m.,
Puls., Rhus;-4. Agn., Arn., Kali, Merc., Natr., Nitr. ac.,
Scill., Thuja.
MOLES OF THE UTERUS.
The term mole has been indifferently applied to substances formed within the cavity of the uterus, which have
some connection with its lining membrane, and ultimately
become expelled by the contractions of the organ, which are,
after a time, excited by their presence.  The expulsion of
these is attended by pain, as of labour, and hiemorrhage.
Their structure is various, and their mode of formation very
obscure.  They are sometimes the product of conception, or
they may occur irrespective of pregnancy, and even in virgins,
although the latter is a rare circumstance; but in this case,
they are apparently composed originally of a fibrinous clot,
such as often accompanies dysmenorrhoea, condensed and
covered by lymph, the product of inflammation; this, again,
may become more or less organised, giving to the mass a
fleshy appearance.  Others contain some membranous formation, indicating an attempt at conception which had
failed, and hence called a false conception or they may
consist of portions of an embryo which has been early
blighted, leaving a mass of irregular form, condensed and
solidified by the adventitious covering of lymph.  There is
also what has been termed the hydatid mole, although this
is usually described as a separate disease.  It consists of
grape-like vesicles, containing a clear fluid, which adhere in
bunches by narrow stalks or processes, one to another,
varying in size, and forming altogether sometimes a large
mass, having a central, solid support, around which the
hydatid vesicles are clustered.



MOLES OF THE UTERUS.


269


They are at times co-existent with conception, and
attached to the decidua by small vessels, or they may be
connected with a retained portion of placenta; but when
they occur independently of this, they grow       from  an
adventitious membrane,-a sort of spurious decidua, through
which they are in connection with the uterine vessels. When
they continue within the uterus for the space of three or
four months, they grow rapidly, and enlarge the uterus to
such an extent, as to induce symptoms resembling pregnancy;
but there is a flaccidity of the abdomen, instead of the
firm resistance offered by a foetus in utero, and the abdominal enlargement is abnormally rapid.      They seldom
remain longer than a few months, and their expulsion takes
place spontaneously, accompanied by haemorrhage.
The presence of hydatids may sometimes be certified by
the use of the speculum.    In a case that recently came
under my observation, some slight uterine symptoms, or
bearing-down pain, weight behind the pubes, with great
enlargement and varicose state of the veins of the leg and
thigh, first attracted attention.  The patient was married,
but had never been pregnant.    Upon examination, I found
a considerable distention of the uterus behind the pubes,
and a fleshy substance protruding through the os. The
speculum showed it to be a bunch of four or five red, fleshcoloured vesicles, like so many large, flattened currants,
attached by slender pedicles, and coming through the centre
of the os: on removing one, a little sanguineous discharge
escaped, and what remained of it was only a shrivelled
vesicle.  Slight coloured discharge went on for a week. No
hammorrhage had previously occurred. The catamenia were
regular: and when I next examined the patient, the entire
bunch had disappeared; but the enlargement of the womb
continues, and now and then similar portions find their way,
with some pain in the back, through the os, and come away.
Although these several varieties of moles are pathologically
different in their organisation, still as their presence is rarely
to be diagnosed by any certain subjective symptoms, it
accords with the limits of this volume, and serves equally
for all practical purposes, to consider them under one head,



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ORGANIC DISEASES OF THE WOMB, ETC.


for the reason, likewise, that their existence is often first
made known by their efforts at expulsion, and by the
haemorrhage which attends these efforts.
That form of mole which is called a false conception,
deserves more especial notice here, inasmuch as its cause
and nature are more clearly defined.  It is a degeneration
of the ovum, either from an early blight of the embryo, or
from a morbid development of the placenta, or from disorganisation and retention of the embryo itself.
As stated above, this degeneration of the ovum can only
be suspected, but offers no characteristic indication of its
presence before  expulsion; consequently, medicinal aid
cannot effect anything before this occurrence. The practitioner's attention should, therefore, be directed to the
relief of the sufferings experienced by the patient.
Any attempt to excite its expulsion, before the uterus
has given evidence of its necessity, by some natural efforts,
would be to expose the patient to the risk of hemmorrhages,
or other accidents, without, perhaps, attaining the end.
When its continued existence within the uterus becomes
incompatible, the natural irritability of the organ causes it
to contract upon its contents, and expulsion takes place with
pains like those of an ordinary labour. If that expulsion
takes place slowly, and is accompanied by hemmorrhage, we
can assist the uterine efforts by the administration ofPulsatilla, (tinct.) 30,
one drop being mixed in four table-spoonfuls of water, and a
teaspoonful of this mixture given every five minutes.
Or Secale may be given in the same way. The expulsion
of the mole is commonly followed by considerable haemorrhage;
knowing this, it is therefore prudent not to await its entire expulsion, before administering the medicines above-mentioned,
in order to prevent the evil.  If the patient is low spirited,
apprehensive about her condition, and of a timid disposition,
Pulsatilla may be preferred; if she is very pale and weak,
and shows a disposition to cramps or convulsions, Secale had
better be given.
If Homoeopathy is at all useful in this disease, it is in



POLYPUS UTERI.


273


enter the orifice, but is attached to a part of its edge or lip;
hence a distinction of polypus of the fundus, polypus of the
neck, and polypus of the orifice." These remarks apply
chiefly to the fibrous polypi.
Thus polypi differ in their texture and consistency; some
being hard, firm, fibrinous or cartilaginous; whilst others
are soft, glandular, vesicular, mucous or cellular; some,
moreover, although fleshy, are at the same time hollow, possessing cavities which may contain cerebriform matter,
fungous substance, blood, glairy or fatty matter alone or
mixed with hair.
Polypi take their rise either in the fibrous structure, or in
the sub-mucous tissue of the uterus, and are covered by the
mucous membrane lining the womb, which is elongated for
that purpose. They are mostly insensible when touched or
scratched, but often bleed upon the least contact. They vary
in size from that of a nut, or even less, to that of a child's
head, and are commonly pyriform, being narrowest at their
junction with the uterus. They are attached by a peduncle
of variable size, sometimes being connected by a slender stalk
like that of a leaf, at others by a fleshy attachment of considerable circumference. Polypi are also coniform, or smallest
at the free extremity, globular, elongated, or club-shaped.
The above brief description of their site and structure, will
be found of practical importance, when the propriety of applying the ligature, or of removing them by excision, is being
considered; but as the object of this work has been declared
to be, to pourtray the symptoms of disease, so far as they can
offer a chart of comparison with the pathogenetic properties
of the remedies, which are indicated for their cure or palliation, on the principle, "Similia similibus curantur," I will
confine myself to the Homoeopathic treatment, and leave
the detail of the time and manner of applying the ligature
or the knife, to be sought for in other more elaborate works;
but I would first interpose the remark, that we do not
attempt to supersede the use of the above-named surgical
means, which    are often absolutely necessary.    Some resource may, however, be found in homoeopathy, when these
are impracticable, or before the polypus has left the cavity of
18



274


ORGANIC DISEASES OF THE WOMB, ETC.


the uterus, when time is often allowed for medical interference.
The symptoms which accompany the presence of polypus
of the uterus, are:-mucous or muco-purulent discharge,
excessive menstruation, or sudden and occasional gushes of
haemorrhage; this state of things is followed, after a longer
or shorter period, by an impaired state of the general health,
paleness or sallowness of countenance, dyspeptic symptoms,
loss of appetite, vomiting, uneasiness in the pelvis, a variable
swelling of the abdomen, aching pain in the back, bearing
down pains, sometimes of a very severe and cutting character,
perhaps retention or incontinence of urine, tenesmus, or
obstinate and continued costiveness, and a dragging sensation
at the loins, with dyspnoea. The discharge from the uterus,
not unfrequently, becomes fetid. The blood coagulates
around the polypus, and at times is observed to come off
like a ring.
The uterus is sometimes so distended by the growth, that
it produces symptoms resembling pregnancy, which indeed
may occur during the existence of polypus; but Dr. Ashwell
says, that he has never seen it take place after removal of
the polypus by operation. Dr. Blundell has, however, shown
this to be the case sometimes.
As the disease advances, if it be not within the reach of
instrumental aid, great constitutional disorder takes place,
debility, emaciation, pallor of the countenance, frequency
of pulse, oedema of the extremities, and death, or dropsy
into some of the cavities.
Treatnment.-The cure of polypus by medicinal agency
cannot be accomplished by the old school of medicine, consequently extraction, excision, the ligature, or cauterisation
are the sole resources; but Homceopathy has rendered results
which prove the curative power of its remedies.
Staphysagria and Calcarea are those which have been
recommended, principally, to remove the state of dyscrasia
upon which the formation of polypi depends. These may
be given at long intervals, when the disease exists; but if
the polypus is within reach, and of that nature which admits
of the successful application of the ligature, this operation



POLYPUS UTERI.


275


should be adopted, unless excision promises a more speedy
recovery. Nevertheless, although the treatment of polypi by
medication may not effect a cure as rapidly as the more
severe methods, there are many cases in which it is a much
more desirable, or, may be, the only practicable plan.
The treatment of the different varieties of polypi is not
equally easy. When a polypus has existed a long time, and
is of the fibrous, mucous, or sarcomatous kind, it requires,
as stated by Jahr, the employment of the highest dynamisations, and the. prolonged action of a single dose, as the
sine qud non of success. And, in every case, the examination
of all the symptoms, and the morbid conditions presented
by the patient, is almost always indispensable to determine
definitively the choice of the medicine. The remedies
which are pointed out by Jahr, as being generally related to
the different kinds of polypi, are:1, Calc., Lye., Puls., Staph.;-2, Con., Merc.;-3, Phosph.
ac., Puls.;-4, Aur., Mezer., Petrol., Silic., Thuja;-5,
Ambr., Ant., Bell., Graph., Hep., Natr. m., Nitr. ac., Sep.,
Sulph., Sulph. ac.; and in particular,Against the sarcomatous: 1, Staph., Thuja, and perhaps,
also,-2, Lyc., Merc., Nitr. ac., Phosph.;-and 3, one or
other of the medicines indicated above.
Against the granular: 1, Nitr. ac., Staph., Thuja;2, Calc., Lycop., as well as some of the medicines cited
above.
Against the fungous: 1, Calc., Lye., Mere., Nitr. ac.,
Staph., Thuja;-2, Phosph., Sep., Sil., Sulph.
Against the fibrous: 1, Calc., Staph.;-2, Puls., Teucr.;
-3, Ars., Lyc., Petr., Phosph., Sep., Silic., Thuja.
The following history may perhaps tend to check, or keep
within reasonable limits, those who are over-ardent in the
attempt to cure rapidly by the ligature a disease that is
incurable.
I was requested, in May 1850, by a physician, to visit a
patient who had been suffering from repeated and frequent
hbemorrhage. She was also the subject of diabetes mellitus,
and had derived considerable benefit in this disease from his
treatment.  I found her a person of about 55, the mother



276


ORGANIC DISEASES OF THE WOMB, ETC.


of a large family, of a mild and benignant aspect; her hair was
grey, and her countenance sallow and exsanguine. She had
been passing coagula of blood from the uterus every five or
six weeks, with a constant discharge of a warm, colourless,
watery fluid during the intervals.  There was fixed pain in
the left side of the hypogastrium, and at intervals lancinating
pains shot through the womb. She was sensible of a large
body in the pelvis; the abdomen varied in size a good deal
at times; she suffered greatly from constipation, indigestion,
and thirst; the tongue was white and moist. After the
birth of the third child there had been adherent placenta.
Five years before she was affected with irregular and copious
discharge, connected with the cessation of the menses. Two
years before, for the first time, she had an alarming
hemorrhage, which required plugging of the vagina.  A year
before she was examined by a most eminent physicianaccoucheur, who said there was nothing wrong. All this
time she has been getting more and more enfeebled. Her
mother died of cancer.
On examination, "per vaginam," I found the cervix uteri
quite obliterated, as at the early stage of labour.  The os,
open to the size of half a crown, was occupied by a soft, fleshy
mass, which yielded, and allowed my fingers to pass round:
it bled upon being moved about.  The body of the uterus,
felt through the abdominal parietes, was as large as a fotal
head. The cavity was occupied by the large spongy mass,
or soft bleeding fungus, which was attached anteriorly to
the interior of the uterus, just within the os, by a very
broad base, which my fingers could not compass. The
speculum exhibited the os uteri blanched, thin, and perfectly
smooth. It contracted and relaxed during the manipulation,
and the true character of the fungoid polypus was visible.
I gave my opinion that at present a ligature was not possible,
from the complete enclosure of the tumour within the uterus,
and the breadth of the attachment; and, moreover, that if a
ligature could be applied, the mass would yield to it, and it
would cut rapidly through, and produce no curative result.
A month afterwards she consulted a physician-accoucheur
of some renown. He told her that he would tie it, and get



TYMPANITES UTERI.


277


her well in three weeks.  She submitted.   He attempted,
but failed, after a long trial, to apply the ligature.  He
made a second attempt, a week or so after, aud while he
was manipulating a sudden gush took place, and she died
instantly!  No post-mortem took place.
PHYSOMETRA, OR TYMPANITES UTERI.
The cavity of the womb is occasionally distended by a
collection of air, This is sometimes idiopathic, the air
being secreted by the uterine vessels, in which case it will
escape with a noise; but at other times it is consequent upon
the decomposition of some contained substance or fluid, such
as a mole, a portion of a placenta, or retained menstrual secretion. It may give rise to symptoms of distention in the
hypogastric region, and is generally attended by hysteria.
Phosphoric acid has been found by Hartmann to effect a
copious discharge of wind, followed by recovery.
Ljcopodium is also recommended, either when the former
remedy fails of success, or alone.
When it is dependent on the process of putrefaction, the
uterus should be washed out by an injection of lukewarm
water.



DROPSY OF THE WOMB.


279


logical condition of the uterus or its lining, as has been stated
above, and although coexisting with pregnancy, may, in
reality, have no connection with it, as to cause and effect.
The latter, however, has been supposed to depend upon an
inflammatory condition of the ovum, or its enveloping membrane, from the vascular condition of the membrane and the
inflammatory redness which has been observed in some cases
after death.
It is not very easy to ascertain the existence of hydrometra during pregnancy.    But if it be present, the abdomen is found to enlarge more rapidly than usual in that
state, after the first months, as is likewise the case with
hydatids; the lower extremities, and even the face and
hands, are sometimes oedematous; the ballottement of the
foetus is feltper vaginam and by percussion of the abdomen;
the patient experiences great debility, and all the inconveniences which accompany so great a volume of the abdomen; difficulty of walking, and a great sense of oppression,
which causes her to pass her nights in a chair. It is
impossible to tell beforehand whether the effusion is within
or without the membranes.
A lady, pregnant with her fifth child, of a delicate, lymphatic temperament, suffered much from excessive vomitings
during the earlier months, after which, her size was greater
than usual, from which twins were anticipated. At the
seventh month pains occurred, with the discharge of a
quantity of clear fluid, per vaginam; the pains however subsided, her feet and legs became excessively cedematous, there
were cough, and constipation; labour came on a fortnight
before the expected period, by the sudden discharge of the
liquor amnii in a proper quantity without pain, just as she
was preparing to go to bed. The pains, however, soon
followed; the labour was gradual, no more liquor amnii
escaped until after the birth of the child; the bed was then
inundated by the discharge of a quantity of yellowish curdly
fluid, which preceded the expulsion of the placenta.
The causes of hydrometra are those common to all dropsies;
-of which lymphatic temperament, losses of blood, frequent
parturition, great fatigue, a sedentary life, privations, living



280


ORGANIC DISEASES OF THE WOMB, ETC.


in humid situations, and moral affections, especially misfortunes, are the most ordinary.
The prognosis is favorable for the mother, but often the
disease is destructive of the life of the infant, especially
when the dropsy is developed several months before the
termination of pregnancy, when the excessive distention of
the uterus may induce contractions, and the consequent
expulsion of its contents before the normal period; when,
even, parturition occurs at the usual time, the infant is
mostly pale and very feeble.
There is also another kind of serous exudation from the
womb, which I have met with two or three times, and which
occurs a few days after delivery.  There is, in the place of
the lochia, a profuse watery discharge complained of, which
soaks through everything.  It appears at the time that the
colour of the lochia changes, and is at first like dirty water,
and in a day or two becomes clear. It seems to be a simple
weeping of the uterine vessels, which do not allow the
passage of the grosser parts of the blood, the place of which
is occupied by the excess of serum.   It usually occurs in
lymphatic, relaxed, and languid subjects; and in two of the
cases which came under my own observation, there had been
previous haemorrhage at the time of delivery, in consequence
of a want of contractile power in the uterus.  This was
speedily cured by Secale, followed by remedies that improved
the general health.
Treatment.-Homceopathy affords more efficacious treatment in this disease than the old system of medicine. After
having remedied any hygienic errors which may be found, the
previous conditions of the patient, together with the symptoms
which prevail apart from the actual abdominal enlargement,
must be carefully examined, and that medicine should be
chosen which is best adapted to them.
In the commencement, if the disease has been produced
by grief, Ignatia should be exhibited: if it has been the
effect of misfortune, and want of nourishment, China; if the
abdominal swelling is attended by frequent desire to urinate,
constipation, difficult digestion, vomitings of food, Nux
omnica; if, together with these symptoms, there is a relaxed



DROPSY OF THE WOMB.


281


state of the bowels, Pulsatilla; and Sulphur, if the medicines
do not produce the effect desired: Aconite will be given with
advantage in alternation with the medicines just indicated at
the commencement of the disease.    When hydrometra is
accompanied, in its more advanced stage, with oedema and a
sense of suffocation, so as not to be able to lie down in bed,
Arsenicum will be found of the greatest advantage.  In this
state, also, the Apis may be tried.  Under the influence of
Arsenicum, a.woman, in the sixth month of pregnancy, with
cedema of the extremities, and who was forced to pass whole
nights upon a chair, with scanty and thick urine, &c., progressed most favorably; the symptoms diminished by degrees,.respiration became more easy, so as to permit her to pass
her nights in bed, labour came on at the proper period; and
the child, although delicate, has lived.  In this period of the
disease Sulphur is also indicated, and may be alternated with
the medicines we have before quoted.
Calcarea may also be useful in restoring the general
health; Sambucus for the relief of the dropsical effusion.
Sepia, Secale, Phosphorus, and Sulphur, correspond to many
of the conditions which characterise the different forms of
the disease.



282


ORGANIC DISEASES OF THE WOMB, ETC.


FUNGUS HAEMATODES UTERI.
Although this is a rare disease, and exceedingly intractable, it deserves mention here, in common with other
malignant disorders of the    womb, which     occasionally
come under Homoeopathic treatment. It is a variety of
cancer, and has received different names: such as, cerebriform cancer, medullary tumour, encephaloid tumour, spongy
or fungoid tumour, bleeding fungus, &c.
The essential character of the disease is that of malignant
growth, abounding in cells, and separated into lobes, either
by dense septa, or by a fine attenuated membrane like the
pia mater, with innumerable small bloodvessels ramifying
upon it.  The cells contain either grumous blood, or medulSlary matter, the latter being of a pinky hue, from the diffusion
through it of the minute vessels, which, from the extreme
tenuity of their coats, are frequently ruptured, and hence the
appearance of coagula in the masses. Occasionally a portion
of the brain-like substance remains white and unaltered.
As the disease progresses, the medullary matter is softened
down, and assumes the consistence of thick cream. The
diseased growths vary in size, from that of a pea to a potato,
and exist in the encysted form, or diffused among the tissues
of an organ, and are found in different parts of the body
after death.  Unlike true cancer, it attacks the body of the
uterus, and not the os and cervix in the first instance, the
latter becoming involved during its progress.  In the early
stage of the disease, when the uterus is little enlarged, and
remains still within the pelvis, its existence is not observed;
but when the tumour rises above the pubes, and the general
health begins to suffer, the attention of the practitioner is
directed to it.  When examined externally, it is found to
consist of a soft, elastic, tight swelling, not uniform, but
made up of several smaller ones of different sizes, having a
connecting medium between them; the whole can be traced
down to the pubes.
Their connection with the womb is made clear on exa



FUNGUS H&EMATODES UTERI.


283


mination per vaginam, by pressing upon the tumour externally
at the same time.
It is distinguished from cancer by its softness and elasticity, by the absence of pain up to a very advanced stage,
and its rapid increase after ulceration has commenced, as
well as by its tendency to generate spongy excrescences.
The disease commences obscurely, with less pain than
scirrhus; the catamenia become deranged, dyspeptic symptoms prevail, with irritability of system and a quick pulse.
There is soon a discharge from the vagina, either of serous,
sanguinolent, or of yellow, greenish, and fetid fluid; weight
and bearing down, with the ordinary pelvic symptoms which
accompany serious diseases of the womb; strangury, and
tenesmus, from the adhesions which silently form. Emaciation slowly comes on, the tone of the system becomes
lowered, the complexion, after awhile, changes to a pale and
yellow hue, the discharges become more sanious, or watery
and offensive, ulceration commences in some part of the
tumour, and    then  the  disease makes rapid    progress.
HRemorrhage occurs frequently, with sharp lancinating pains
coming on in paroxysms; nausea, vomiting, diarrhoea, sleeplessness, oedema of the extremities, great prostration and
despondency, convulsions, night sweats, dyspnoea, restlessness, hectic fever, marasmus, and death, or the patient is
carried off by a violent haemorrhage.
During the progress of these symptoms the ulcerated
tumour developes fungoid excrescences, which protrude into
the vagina, or make way externally to the uterus towards the
abdominal cavity, and even through its parietes, involving in
its course destruction of the contiguous organs and structures. When the fungous growth passes inward, there is
frequent haemorrhage; it bleeds upon the least touch, and
the discharge is grumous and fetid; when it extends outward,
inflammation, adhesion, and ulceration of the adjacent tissues
and organs take place.
Dr. Quin has met with several cases of this disease, and I
am indebted to a paper on 'Fungus Hwematodes, and its
Treatment by Homoeopathy,' read by him before the British
Homoeopathic Society, on the 3rd of June, 1817, for the



284


ORGANIC DISEASES OF THE WOMB, ETC.


account of a most interesting one, in which life was prolonged upwards of eighteen months with comparative comfort
under his judicious management, when every hope of the
patient's existence beyond a few weeks had disappeared; all
the usual resources of allopathic medicine in the most skilful
hands having been exhausted. In this case the eminent
accoucheur, who had immediately preceded Dr. Quin in the
treatment of the patient, occasionally examined and reported
on the improved condition and partial subsidence of the
malignant growth, during the progress of the Homoeopathic
treatment. At the end of the period above-mentioned,
when at the sea-side, sudden hemorrhage recurred, from
the consequences of which she died.
Treatment.-The remedies which are suggested by their
pathogenetic correspondence with the essential and concomitant symptoms of fungus haematodes are chiefly,Arsenicum, Belladonna, Carbo an., Merc. viv., Phosphor.,
Thiuja, Silicea, Sulphur, Calcarea.
For the sympathetic symptoms:Ipecac., Bryon., Veratr., for the nausea, heaving, and
vomiting.
Aconite for the attacks of fever.
Belladonna for the pains in the hypogastrium, back, and
thighs.
Aconitum and Mosehus, frequently repeated, for the fits of
fainting.
Coffea, Acon., Phosph., and Cham., for the want of sleep
and restlessness.
Hyoscyamus for the violent hysterical symptoms.
Nux vom. and Arsen. for the spasms in the stomach.
Ipec., Bryon., Puls., for the disgust at food.
Acon., Crocus, Cham., Ars., for the violent and terrific
flooding.
Opium and Nux v. for the constipation.
Merc. and Ledum for the alternate diarrhoea and constipation.
The following brief details of a most extraordinary case
of fungus h.matodes occurring in the eye are so interesting,
that I may perhaps be pardoned for introducing them here,



FUNGUS HIEMATODES UTERI.


285


as they afford, analogically, some ground for hope, that the
same disease, when situated in the uterus, might, if early
recognised, possibly admit of cure. Count Radetsky, the
present Austrian field-marshal, had been pronounced by a
consultation of physicians to be incurable of a fungus
hlematodes of the eye.     The disease occupied the cellular
tissue within the orbit, and was rapidly increasing, protruding
the eye, and showing itself in front between the lids, but
vision was not quite destroyed. The tumour was of a blue
colour, and presented itself as a spongy, elastic, granular,
pale red body; it fixed the globe of the eye, and was
attended by haemorrhage. He now placed himself under
the care of Dr. Hartung,' through whose patient and careful
selection of remedies this malignant disease was arrested,
and ultimately cured.    I can only here point attention to
the remedies used, and refer the reader for more complete
information to the Materia Medica.'
After the use of 1. Acon., 2. Baryta c., 3. Zinc., 4. Anac.,
5. Calc. c., 6. Euphr., 7. Merc. s., 8. Merc. corr., 9. Ant. cr.,
10. Digit., the disease not being arrested, the following
remedies were tried, namely, Arsen., 30, 6 globules; Psorin,
30, 6 globules; Herpetin, 30, 6 glob.; Carbo an., 30, 6 glob.
Until the last medicine the fungus continued to increase
and bleed, but now its growth was somewhat arrested.
Thuja occid., 30, given three times a day for ten days,
followed by Carbo an., alternated afterwards every eight days,
with the local application of the same remedies, succeeded
in perfecting the cure of this malignant affection,
I One of the surgeons-in-chief attached to the army in Italy, under the command of Field-Marshal Radetsky, who had long been a convert to the doctrines
of Hahnemann, and a successful practitioner of Homoeopathy.
2 Vide, also, ' British Journal of Homoeopathy,' vol. i, No. ii.



286


ORGANIC DISEASES OF THE WOMB, ETC.


RAMOLISSEMENT OF THE UTERUS.
This is a very rare and obscure disease, having a malignant
character, and running its course rapidly. It is sometimes
present as one of the terminations of acute inflammation of
the substance of the uterus, but it likewise occurs without
any evidence of such a previous condition of the organ, and
is chiefly distinguished from common inflammation by the
early and rapid sinking, and the absence of marked inflammatory symptoms.      The disease may commence before
labour, or appear almost immediately after delivery, or not
for some days.
When the uterus is so affected, the whole substance of
the parietes of the organ is occupied by it, the tissues are
red or purpled, soft, and almost gelatinous; sometimes they
are converted into a brown or black unorganised pulp. The
inside of the womb is covered with a fetid, brown, or blackcoloured mucus. The putrescence may be confined to the
surface, the substance of the organ being healthy, or may be
altogether limited to the cervix and os. It has been considered as a peculiar condition, independent of gangrene,
and little under the control of medicine.
I have witnessed two cases in the course of my practice.
In the first, on the fourth day after delivery, there was sudden,
unaccountable sinking of the vital powers, there had been no
symptoms of inflammation, the milk was suppressed; the
patient was weak, delicate, and cachectic, the powers of life
gave way without any imaginable cause, and she died in a
few hours. On inspection of the body, nothing was found
but a soft black spot at the site where the placenta had been
attached. The child had been born dead.
The second case was a premature delivery of a still-born
child. Unusually acute after-pains had occurred, and, unfortunately, powerful doses of Opium were given to allay
them. I saw the patient within twenty-four hours after
delivery.  She was then under the influence of the narcotic,
a pale and cachectic-looking person, very fair and sensitive;



RAMOLISSEMEtNT OF THE UTERUS.


287.


she complained of nothing but the after-pains. Four days
after this I was called, and found her dying, without any
additional symptoms previous to the collapse in which I
found her. A sort of half-conscious bewilderment was about
her, and she died in five or six hours.  The lochia had been
fetid for two days without any local pain or abdominal
tenderness; she had passed scarcely any water, and there
was hiccup, which had troubled her at intervals from the
day of her delivery, and rapid exhaustion. Although I was
not able to verify' this case by post-mortem inspection, it so
closely resembled the one above related, that I have no
doubt of its identical character.
The means offered by Homceopathy for the relief of such
cases are necessarily very limited; for the developnient of
this condition is so unexpected, and so little indicated by
symptoms, that when one is made aware of it, the patient is
sinking. When, however, a very impaired state of the vital
powers, or a general cachexia is observed to exist throughout
a pregnancy, especially if acute neuralgic pains pass from
the uterus to the head and back again, at intervals, the
nervous system being morbidly sensitive as well as weak,
and when, moreover, premature delivery of a dead foetus
happens in conjunction with these circumstances, a close
observation of the general symptoms, and of the lochial
discharges, may possibly announce to us the presence or
proximity of this disease. Under any circumstances, however, we can but anticipate a fatal termination.
Secale cornuturn, Arsenicum, and China are the remedies
which would be indicated by the accident; but better than
curing would be the prevention of this disease by rectifying,
during pregnancy, the morbid condition of the system, with
which it is intimately associated.



288


ORGANIC DISEASES OF THE WOMB, ETC.


OVARITIS.
INFLAMMATION OF THE OVARIES.
The ovaries, being the organs in which the first impulse
of conception takes place, are necessarily liable to be implicated in many of the diseases, connected with menstruation
and parturition; they are also subject to diseases peculiar to
themselves, as well as to some which equally affect distant
organs.
Inflammation may attack the ovaries, either in an acute or
chronic form. The former is most frequently met with in the
puerperal state; the latter under circumstances disconnected
with pregnancy or parturition.
From their intimate connection, anatomical and functional,
with the uterus, it is often difficult to localise an inflammation
of one or other of these organs; and it is, therefore, rare
to find the ovary affected, without the uterus being, more or
less, implicated. Ovarian disease, however, is said to be less
frequent than uterine. One or both ovaries may be the seat
of the morbid action, but this rarely happens before puberty.
Ovaritis has been mistaken for metritis; this might be
supposed readily to occur in cases where the peritoneal
covering was the seat of the inflammation, but it has even
happened when pus has been found deposited in the parenchymatous structure of the ovary itself.
Acute ovaritis is characterised by the following symptoms:
-pain, swelling, and tenderness in the hypogastric region,
laterally; the pain is increased, by the patient suddenly
rising up; the pain being just above the groins, where,
sometimes, an enlargement may be felt; numbness of the
thigh of the affected side; symptomatic fever, nausea, or
vomiting; constipation; frequent micturition; or retention,
with scanty, high-coloured urine. If the tumour is large, it
may, probably, be felt by passing the finger into the vagina
or per anum.   Hysterical symptoms prevail to a great extent;
the mind and temper are, more or less, affected, and there is,



INFLAMMATION OF THE OVARIES.


289


occasionally nymphomania, or furor uterinus, with irritation
of the internal parts; but I believe this distressing derangement to be very rarely associated with ovaritis. In the puerperal state, the symptoms vary with the prevailing epidemic,
and with the extent of uterine disease associated with it.  It
is also marked by a greater amount of vital depression, at that
time. When the peritoneal covering is affected, the symptoms
are very acute, and of the character of general peritonitis.
Chronic ovaritis is usually an insidious, slowly progressing
disease, and may be confounded with hysteria, for some
time, before its distinctive character becomes apparent;
organic structural change may even have taken place before
the attention of the practitioner is called to it.  If early
recognised, the symptoms above detailed will be found, upon
examination, to exist in a less active form; there is obscure
pain in the iliac region, radiating over the pit and down to
the thigh; stiffness and pain on moving the leg of the
affected side; weight in the pubic region and perinueum; the
catamenia will be diminished or suppressed, and the local pain
rather augmented at the period of their occurrence, and after
bodily exertion; slight febrile action; the mind and temper
will be variably affected, hysterical and nervous symptoms
predominate, the moral phenomena, perhaps, attracting most
attention.  It is apt to occur in scrofulous subjects, when it
most commonly results in suppuration.    The tumour is not
felt distinctly at the first.
The consequences of ovaritis, if it does not terminate by
resolution, are:-suppuration in the parenchyma of the organ;
softening of the body of the ovary; induration; effusion of
puriform lymph or serum, or of gelatinous lymph; extension
of the inflammation to neighbouring organs or tissues, and
sterility.
When suppuration takes place in an ovary, it may possibly
happen, that the pus shall find its way, through the fallopian
tube, into the uterus, and so pass per vaginam. Although
it is very rare for extensive disease of the ovaries to exist,
without closure of the fallopian tubes, the escape of pus
per vaginam does not, therefore, necessarily indicate, that it
proceeds from the uterus originally.
19



290


ORGANIC DISEASES OF THE WOMB, ETC.


The predisposing causes of ovaritis are:-mental and
moral, connected with voluptuous excitement of the imagination; disappointed hopes, &c.
The exciting causes are:-exposure to cold; getting the
feet wet during the catamenial flow, producing sudden suppression; injuries received in the neighbourhood of the organs;
inordinate excitement; indulgence in alcoholic drinks, &c.
Treatment.-This must be aided by the rigid avoidance
of all known causes, on the part of the patient.     In the
acute form, as febrile symptoms always exist, it will be
necessary to have recourse, in the first instance, toAconitum, (tinct.) 3,
two drops being mixed in four table-spoonfuls of water, and
a teaspoonful of this mixture given every three hours; and
when the tension of the arterial system is relieved, the
remedy most in harmony with the cause of the attack, or
with the prevailing symptoms, must be given.
Nux vomica,-should the disease have been induced by the
habitual use of alcoholic liquors, or by too sedentary a life.
China,-when debilitating causes have preceded the attack:
Staphysagria and Phosphor. acid. are useful, under similar
circumstances.
Bryonia,-in    the absence of any distinct indications,
favouring the selection of any of the preceding remedies, is
generally the most specific, and should follow     Aconite,
especially when motion aggravates the pain.
Rhus may be given, if the pain, &c. is relieved by movement.
Conium is useful in subacute or chronic inflammation of
the ovary, particularly when there is induration and enlargement, attended with gastric symptoms, as nausea, vomiting,
cructations of wind or phlegm, with lancinating pains and
inflation of the abdomen, acrid white or slimy leucorrhoea,
with labour-like contractive pains in the iliac regions.
Lachesis is recommended by Hering and others, in chronic
enlargement of the ovaries, either with      induration  or
suppuration, and is successfully followed by Platina.
Cantharis will often be found useful, especially in the
more severe form of the disease, when there are symptoms



292


ORGANIC DISEASES OF THE WOMB, ETC.


HYDROPS OVARII.
OVARIAN DROPSY.
The   most common form     of ovarian tumour     is the
" Encysted Dropsy of the Ovary." This consists of an
enlargement of one or more of the vesicles of De Graaf, the
coats of which are thickened, greatly dilated, and become
filled with a fluid, while the intermediate structure becomes
atrophied, as the vesicle or vesicles enlarge, until the fibrous
tunic of the ovarium, covered by the peritoneum, forms the
boundary of the tumour.    Sometimes the tumour is formed
by one of the vesicles alone; while others exist in various
intermediate stages, from the size of a hazel-nut, to that of
a child's head.  These, from  some cause, are arrested in
their progress; they may contain a small quantity of fluid,
or become condensed in their substance, or else their original
growth is sarcomatous. When the principal cyst is formed
of the entire ovarium, it often happens that the vesicles,
having partaken of the morbid disposition, form a series of
smaller cysts or cells, which are developed within the parent
cyst, and occasionally communicate with each other by
considerable openings, the tumour obtaining an immense
size, so as to occupy almost the whole abdomen.       The
thickness of the parietes of the cysts differs much; they
are often as thin as a bladder, but, at other times, of a
substance as thick as the hand.
The fluid secreted within the cysts may be serous, like
that of ordinary dropsy, or mixed with slimy matter, or it
may be a thick, ropy fluid, or gelatinous; different cysts in
the same tumour will sometimes contain different sorts of
fluid.  Pus is occasionally found in one or more of the cysts,
mingled with the other fluid, a consequence of inflammation
having occurred in the cyst.
The colour of the fluid contents likewise varies, and is
either a straw colour, like the serum in ascites, or dark,
like muddy coffee, or brown and gelatinous.  The external



OVARIAN DROPSY.


293


surface of the tumour may be firm, lobulated, smooth, or
tuberculated; the interior is commonly smooth, like a
serous membrane, now and then irregular and mammillated,
or divided by incomplete partitions.
Different matters are occasionally found as contents of
some of the cysts, such as hair, bone, fatty matters, &c.
The disease is more frequent, on the whole, in single
than in married, and in sterile than in parturient women, and
rarely occurs before the age of 17 or 18, although it has been
known to commence at the period of puberty.   Both ovaries
are not often affected at the same time. The complication of
schirrus of the ovary, with dropsy, is not uncommon.
The symptoms of ovarian dropsy usually commence with
an uneasy sensation in one or other of the iliac regions,
attended by a sense of weight or pressure, with a certain
amount of numbness of the thigh, some derangement of the
catamenial function, irritation of the bladder, nausea and
syncope. When the disease is first induced by a blow, or
other mechanical injury, the symptoms at the onset are more
acute and well-marked.
Sympathetic pain, or distension of the breast, is sometimes
felt; there is some enlargement of the abdomen, at times
swelling of the feet, or of one foot; constipation; haemorrhoids; and either too frequent or difficult micturition.
The urine is not often diminished.      It is said by Dr.
Seymour, that the catamenia are always absent when both
ovaria are affected; but when one only is diseased, there is
generally irregularity or suppression.  The catamenia are,
however, in   some cases, profuse   at first.   Hysterical
symptoms occur at times, and help to mask the early
progress of the disease. The tumour is seldom to be felt in
the early stages; but when it has existed some time, it can
be detected of the size of an orange, just above the brim of
the pelvis.  It may   sometimes, though    not always, be
ascertained through the rectum or vagina; in the latter case,
a smooth, rounded prominence is felt alongside the uterus,
just at the reflection of the vaginal lining, which, by moving
the uterus aside by means of the sound, is found to be
distinct from that organ. As the ovarium increases in size,



DISCRIMINATIVE INVESTIGATION.


295


probably by pain or injury at that part; its gradual enlargeiment, more on one side than on the other, the comparatively slight impairment of health, the swelling not being
affected by change of position; the irregularity at first
without suppression of the catamenia, will assist in determining the existence of the disease.   There is likewise
an absence of the oedema of the feet and ancles, which so
often attends ascites, and there is pain and numbness of the
thigh of the affected side.   There is scanty secretion of
urine, with frequent desire.  An examination, per vaginam
aut rectum, will facilitate the diagnosis.
But if ascites be complicated with it, the difficulty of
accurately distinguishing is very greatly increased.  When
this is the case, examination of the patient, in the recumbent
posture, will cause the fluid of ascites to gravitate towards
the hypochondriac and lumbar regions, and the limits of
the ovarian tumour rendered more clear.
The causes of this disease are:-injury during parturition,
blows, falls, strains, fright, sudden application of cold,
undue excitement, &c.
Treatment.-The treatment is very uncertain, but as it is
rare that any benefit is derived under the old system of
medicine, it is satisfactory to know, that occasional mitigation
has occurred underhomoeopathic treatment, and the casewhich
is appended will show that a cure has resulted therefrom.
The remedies which offer the greatest probability of success
in the earlier periods of the disease, are:-Sulphur, Iodium,
Arsenicum, Acid. Phosph., Sepia, Platina, Graphites, Dulcam.,
Sab., Cantharis, Prunus spinosa, Mercur., Staphysagria,
Cannabis, Cocculus, Hepar, Nux vom., Bryonia, Lachesis,
Lycopod., Kali c., Silic., &c.
These, given in accordance with the indications which may
characterise the individual case, in addition to other medicines
which may be required to combat particular states or
symptoms, which often arise during the progress of ovarian
dropsy, must be studied carefully for that purpose.



296


ORGANIC DISEASES OF THE WOMB, ETC.


CASE OF OVARIAN DROPSY CURED.
(Reported by Mr. Phillips.)I
"Emma Southward, aged 20, silk-winder.     Lymphatic,
nervous temperament.    Has been delicate for some years.
Four years past the menses appeared; three or four months
after she complained of a dull pain in the right side, which
increased, and in a short time felt a small hard tumour,
with shooting pains in the right iliac fossa, which gradually
enlarged to the size of a hand, when the abdomen became
swollen, attended with a uterine discharge, which increased
as the abdomen enlarged.    In the end of June, 1843, I
examined her carefully; she was greatly swollen; the
abdomen, quite hard and tense, measured 40 inches round,
and she complained of the following symptoms:" Burning pains in the stomach, with nausea after food;
fulness in the epigastrium; much oppression at the chest,
with difficulty of breathing and palpitation, flatulence,
vertigo, heavy eyes, headache; bowels very costive, had been
kept open by medicine; great soreness of the bowels, with
pain in the right iliac fossa; urine free, but scanty and
high coloured; catamenia profuse every fortnight, with much
pain in the sacrum and down the thighs; coldness of the
back and extremities; has a constant discharge, with a
bearing-down pain; in spite of various medicines and
rubbing-in of ointments, the abdomen is still enlarging.
" She was ordered China, to be taken every day for a little
while after Helleborus.
"On the 17th July she was reported a little better;
swelling the same, not increased; passes urine freely;
flatulence less; still the pains in the stomach; catamenia
more regular, discharge less. China to l repeated.
" 24. Swelling the same; slight nausea after food; bowels
quite regular; discharge less.-Helleborus.
"28. Not so well; discharge has come on profusely, with


' British Journal of Homceopatlh, No. vii.



CASE OF OVARIAN DROPSY CURED,


297


great pain, and black, clotted blood; pain also in the chest
and stomach, with bearing down.--China.
"30. Was much better.-Continue China.
"August 4. Discharge much less; strength improved.China every morning.
" 7. Has shooting pains all over the abdomen; most in
right iliac fossa; catamenia appeared profuse, with gastric
symptoms.-Nux v. at night; China in the morning.
"24. Much better; bowels costive; took Sulphur: she
gradually improved till the 8th Sept., when the menses
appeared at the regular time, but more profuse than ever,
clotted, and with a disagreeable, putrid smell; sharp, cutting
pains in the abdomen, with a violent bearing down.Platina to be taken twice the first day, afterwards at night.
" 13. -Catamenia ceased two or three days; skin covered
with a clammy sweat of an unpleasant smell; urine free;
violent pain all through the abdomen, chiefly in the right
side.-Nux vom.
"18. Has made much more water; abdomen less swollen;
pains continue violent, also in the back; skin the same.Continue.
"20. Abdomen much less swollen, it is six inches less;
pain slight; tumour cannot be felt distinct.
" 25. Very much less swollen (eleven inches); makes much
more water; pains in the bowels violent.-Cocculus and
Mercurius.
" 29. She reported herself free from all pains; feels nearly
well, but weak.-Nux v. et Sulphur.
"Oct. 6. Is now of natural size; still feels weak.-China.
"On examination per vaginam, the os uteri is found
perfectly natural.  She rapidly improved, and    gained
strength till the 25th of December, taking occasionally Nux
v., Ars., Bryon., and Merc., for slight symptoms complained
of, when she ceased&taking medicine.
"I have seen her several times since she has returned to
her work; she menstruates regularly; complains of no
discharge, and is in perfect health."



298


ORGANIC DISEASES OF THE WOMB, ETC.


CASE OF OVARIAN DISEASE.
(Reported by Dr. B. Kingdon.)
"Dec. 26, 1849. Mary S-, rwt. 38, has not been well
for several years.  In March last, a swelling was manifest
in the right side of the abdomen, which was at first moveable,
and has gradually enlarged. She is now of enormous size,
and unable to walk without assistance. Her sufferings are
ceaseless, and almost drive her to distraction; constant
pressing forward, cutting, tearing pains; is quite unable to
lie down on account of the agony. Catamenia every fortnight, very pale and abundant; incontinence of urine;
bowels costive; appetite bad, worse towards evening.
13,. Sepia, 12,
six globules, a sixth part night and morning.
"30. Feels better, and in less pain.-IRepeat medicine.
"Jan. 6, 1850. Altogether much better; suffers no pain
in the least, and can lie down comfortably; much smaller,
and walks with more ease.
PR. Sulphur, 30,
seven globules, a third part at night.
"23. So much smaller, that she has taken in her dress
three quarters of a yard, and even now it is a good deal too
large. Has stood to a day's washing; can do her work well;
walks better than for five years, and has not felt a pain since
the first week of being under treatment.  Catamenia have
not appeared for five weeks, instead of every fortnight;
bowels costive.  The prescription was as follows:
Nux vonica, 12,
nine globules, a sixth part night and morning.
" From this date I saw no more of this interesting case;
but I have every reason to believe, that she continued to gk
on favorably, as I should certainly have seen her again had
there been any relapse."



299


PART IV.
CHLOROFORM.
IN the year 1847, in consequence of the successful introduction of the inhalation of Ether, for the purpose of
abolishing sensation during painful surgical operations, and
subsequently during natural parturition, Dr. Simpson was
led to try the effects of various other respirable chemical
compounds, to ascertain how zfar they were capable of
accomplishing the same object, in order to avoid some
of the inconvenient and disagreeable objections to which
sulphuric ether was liable.  In the course of his inquiries
and experiments, he found that three compounds possessed
the power, when inhaled into the lungs, of superinducing
a state of anoesthesia, or insensibility to pain, namely,
Nitrous Oxide, Sulphuric Ether, and Perchloride of Formyle,
or Chloroform.
Their elementary chemical composition is, however, entirely different, and, of the three, the last was found to be
far more efficacious than the others.
Chloroform, as a chemical compound, is not a new discovery, for it has been known and used for certain purposes since
the year 1831, when Souberain, and afterwards Liebig, discovered and described it, although its composition was not
accurately determined till 1835, when the French chemist,
Dumas, published an analysis. It is a curious circumstance,
also mentioned by Dr. Simpson, that M. Dumas, who was
casually passing through Edinburgh at the time, was present
at the first public operation performed on a patient, in the



300


CHLOROFORM.


Royal Infirmary, under its influence. At first its discoverers
never imagined it would be of any practical utility, much
less that it possessed the power of inducing a state of anesthesia, or would become a general agent for diminishing
pain under such various circumstances; but were pursuing
an investigation in philosophical chemistry when the new
product came under their notice, and, with the exception of
its existence among a class of chemical compounds, and
being occasionally used internally in very attenuated doses,
as a medicine, in spasmodic asthma, &c., its most valuable
property was unknown until Dr. Simpson proved it, and gave
the results of his experiments to the world in several
pamphlets.
The chloroform, in general use, is prepared by the distillation of alcohol with chloride of lime, according to the
following formula, which is extracted from Dr. Simpson's
pamphlet, and is that recommended by Dumas:R  Chloride of lime in powder, lb. iv;
Water, lb. xii;
Rectified spirit, f. 3xii.
Mix in a capacious retort or still, and distil as long as a dense liquid, which
sinks in the water with which it comes over, is produced.
The resulting Perchloride of Formyle consists of two
atoms of Carbon, one of Hydrogen, and three of Chlorine.
Its specific gravity is much greater than that of water, being
as high as 1-480.  The last I used had a specific gravity of
1-497.
The odour of chloroform is fragrant and agreeable, when
very pure, and something of the naphtha smell when less so.
It is a dense, colourless liquid, evaporating quickly, and has
a sweetish taste.
In order to test the purity of chloroform, Souberain, its
first discoverer, proposes a mixture of equal parts of strong
sulphuric acid and water; and, when cool, a few drops of
chloroform, poured into the fluid, ought to sink to the
bottom, if sufficiently pure for medical use; but if they
float on the surface, the chloroform should be rejected.
The exhibition of chloroform in natural or preternatural



CHLOROFORM.


301


labour, has, like all other novelties, had its advocates and
opponents.   By the former, its brilliant results have been
published far and wide, and its difficulties and dangers
overruled; by the latter, its dangers have been magnified,
and its benefits decried as opposed to the designs of the
all-wise Creator.  Nevertheless, its progress has been rapid;
for in these days of general enlightenment, no newly-discovered truth in medicine or science, no improvement in
arts or manufacture, can escape the discussion and appropriation of the community at large; and whatever class or
professional prejudices obstruct the propagation of the truth
it matters little, 'for the public will analyse, test, and adopt
any theory or practice which offers a probable immunity
from  suffering or disease.    That chloroform, though so
powerful an agent, may be given with an amount of safety
almost incredible, has been proved beyond doubt, by the
vast number of cases in which it has been used, and the few
accidents which have resulted. So great are the advantages
it possesses over ether, that now we scarcely ever hear of
the latter; it had a brief though brilliant reign, but seems
to be quite superseded.
The superiority of chloroform consists in its not irritating
the air passages so much,-a smaller quantity being necessary, and, consequently, its greater portability,-its more
speedy effect, and, when the soporose state is induced, its
longer continuance,-avoidance, for the most part, of the
stage of excitement which was so frequent an accompaniment of the ether inhalation,-the facility with which it is
applied, and the more rapid evaporation and removal of the
stupefying or secondary effects.
But as it would be unfair to speak only of its favorable
qualities, we will state the evils which are said to be
associated with, or result from, its use.
These, however, are more in posse than in esse, for, notwithstanding the thousands of persons to whom this agent
has been administered during labour, no one case of fatality,
or even serious consequences, has been reported.
In truth, so few have been the accidents attending its



302


CHLOROFORM.


use, that one of the objections urged against it is, that we
possess scarcely any data which may serve as a guide to
the limit of its application.
Independently of the occasional occurrence of vomiting,
of excitement, and of a powerful action of the muscular
system, there is only one evil of any serious import which
deserves attention, and that is, such a depression of the
heart's action as shall indicate danger to life.
The first may be prevented by not administering the
chloroform soon after a meal; the second, which depends
upon the induction of a condition short of anesthesia, or
the complete abolition of sensation, may be overcome by
increasing the dose, or applying the inhaler more closely to
the mouth and nostrils; the third is of the same nature as
the last, and admits of the same remedy.
With respect to the more serious evil, it would seem to
result from peculiarity of temperament, or some organic
defect in the heart.  Now it is not supposed that any practitioner would indiscriminately make use of so powerful an
agent, in order to relieve pain, without previously examining
his patient with due caution; and if he found any circumstance
to contra-indicate its use, he would, of course, hesitate to
incur so great a risk.
The morbid conditions which are most opposed to the
employment of chloroform are:-organic disease of the heart,
whether of hypertrophy or dilatation; or a weak state of the
organ.   These are more or less frequently attended by fits
of syncope.
A congested state of the brain, or tendency to convulsions,
would likewise be strong objections to its use.
Some have, indeed, declared that the infant is not free
from its ill-effects; but as syncope of the mother from loss
of blood has so little influence upon the child, there can be
no grounds for supposing that the anesthesia induced by
chloroform can at all affect it.
On the other hand, it cannot be doubted that whatever
diminishes the duration of labour diminishes, in some degree,
the danger, as well as the liabilities to disease in the puer



CHLOROFORM.


308


peral state; and in abating the intensity of the throes of
labour, especially of the last agony, it tends to the same
good results.
The advantages of chloroform in labour are thus enumerated:1. It unquestionably diminishes the duration of labour.
This would seem to be effected by its relaxing the parts,
and checking the irregular and spasmodic pains which are
apt to retard the proper parturient efforts.
2. It diminishes the shock of parturition upon the nervous
system, and thereby removes one source of danger in the
puerperal state.
3. It affords rest after the labour is concluded, by which
the patient appears quite refreshed, and almost unaffected
by the powerful efforts which have been made.
4. The cry of anguish and distress, which has been
described as evincing an extremity of suffering almost beyond
endurance, is saved to the patient as well as to those about
her.
It has been urged, that in the application of medicinal
agents with the object of preventing the pangs of labour by
abolishing sensibility, we are acting in direct contravention
of the primeval curse passed upon our first mother, "In
sorrow shalt thou bring forth;" that it is therefore opposed
to our duty as Christians and believers in the truth of
Scripture to do anything that shall directly or indirectly
render void the express declaration of the Almighty, and so
make the word of God of no effect.
If such could be made clear, we would at once renounce
the use of such a panacea, however apparently advantageous
its application might be; but, to our mind, there is nothing
in holy writ, either expressly declared or dimly hinted, which
prohibits man from  making use of such faculties as He
has planted in him, for the purpose of assuaging pain or
mitigating sorrow; on the contrary, although we are told'
that " the wages of sin is death," that disease is a punishment
for sin, yet our Lord and his apostles went about healing
the sick, and no one ever argued that to heal diseases by



304:


CHLOROFORM.


the use of remedies was an impious interference with the
decrees of Providence; and yet every kind of care and
attention paid to a woman, every application of the medical
art before, during, and after labour, is made with a view to
abridge, allay, or diminish the pangs of travail, therefore
every effort to cure disease must equally be regarded as an
attempt to set aside the decrees of Heaven.   This is my
humble but sincere opinion upon a subject which has
brought into active play the faculties of some of the wisest
and best of men, who believe that nothing in God's word is
opposed to man's duty; and that He who has made all
things to work together for good, has everywhere planted
the bane side by side with the antidote.
The statistical returns of operations performed under the
use of anmesthetic agents prove that the danger is considerably
lessened, and it is tolerably certain, as Dr. Simpson believes,
that they will be found to diminish and remove also, in some
degree, the perils as well as the pains of labour.
Out of 73 cases of severe operations, performed at eight
of the London hospitals upon patients in a state of anaesthesia,
14 were fatal, which gives a mortality of 19 per cent.
According to a collection of cases made by Mr. B. Curling
of operations of a similar nature, without chloroform or ether,
out of 134 there were 55 fatal cases, giving a mortality of
41 per cent.
Another table, obtained by the same gentleman, of 186
cases operated on without the anaesthetic agent, gives 69
deaths, or 37 per cent.
While Dr. Simpson's return of 324 cases of similar
operations has 72 deaths, or only 22 per cent.
These statements afford ipretty satisfactory testimony of
the value of anmstlietic agents, and at the same time explain
the importance of publishing any accidents or misadventures,
if such there be, in the use of chloroform during parturition.
The following are, according to Dr. Simpson, the conditions
necessary to produce the complete anmsthetic and soporific
effects of cllloroform:1. The chloroform vapour must always be exhibited as



806                    CHLOROFORM.
If fainting, or such a reduced action of the heart should
occur, the most efficient means of relief are:-to remove
the handkerchief instantly,-to blow upon the face of the
patient,-admit fresh air,-sprinkle cold water,-and excite
artificial respiration, by alternate compression and expansion
of the chest, but in no wise to administer stimulants or any
liquid by the mouth.
Strong ammonia or smelling salts may, however, be held
to the nose.



ANTIPSORIC PROPHYLACTIC TREATMENT.


309


The child should, in the first instance, be washed in warm
water; but, after the month, the water ought to be tepid in
winter, and cold in summer; and, when the period of dentition is passed over, a cold bath should always be used,
unless any peculiar delicacy exists in the child, which renders
it advisable to omit it.
ANTIPSORIC PROPHYLACTIC TREATMENT.
Dr. Gastier, of Paris, has entered largely into the subject
of the prophylactic treatment of children, with the view of
preventing the development of the hereditary dyscrasia,
which come under the denomination of Psora.  He has also
declared, that the vaccine virus does not usually take effect
in those subjects whose constitutions have been acted upon
by this treatment, and that they are, a fortiori, unsusceptible of the smallpox.  This may be open to dispute;
but experience alone can decide the question.  If observation should confirm it, it will evidence a renovating and
conservative power in the homoeopathic remedies which
Hahnemann himself could scarcely have dreamt of.
The plan recommended by those who have paid particular
attention to the subject, is to administer to the infant, soon
after birth, two globules of a high dynamisation of Sulphur,
200th, by placing them on the tongue,-and to repeat this
same dose at the end of four or five weeks, if no morbid
symptoms demand any other medicine. After this, at about
the third month, a similar dose of Calcarea is to be given,
which has the advantage of facilitating, in a surprising
manner, the development of the teeth.  Under this treatment, the infant expands and thrives with a physical and
moral energy which indicates health; while the root of
much bitterness has been destroyed by the prophylactic
treatment above named.



SLEEPLESSNESS.


311


tissues, the remedy which is known to exert its peculiar
action upon the parts affected, will, by restoring the normal
action (of the vital force?) in those tissues, cut off, or obtain
a resolution of, the deformities.
If the deviation has occurred in the osseous tissues, after
the above-named medicines, Silicea should be given, at a
high attenuation, and at distant intervals.
MATERNAL MARKS.-The marks or spots which appear at
the periphery of the body of the new-born infant, are the
result of a failure in the organic tissues of the skin, and
usually of an excessive development of the capillaries or minute
terminal vessels.
The same medicines which have been recommended in the
preceding article will be found equally useful in this, and the
earlier they are given the more successful will they prove.
Calcarea carb. is the most beneficial medicine of the class,
and is the one to be preferred, if no particular indications are
present. It may, however, generally be preceded by Sulphur.
CYANOSIS.-When the septum which divides the two sides
of the heart at the auricular part is not perfectly closed, as
it should be, by the obliteration of the foramen ovale, the
continued mixture of the black and red blood causes the circulation of an imperfectly-oxygenised fluid.  This circumstance produces a blueness of the surface, which gives rise to
the term  "blue disease."  It generally destroys life at an
early period; but sometimes the adult age may be reached,
with some distress and impaired health.  Here also Sulphur
and Calcarea are the remedies, which should be administered
as soon after birth as possible. Afterwards Digitalis highly
dynamised may be given, alternated with Calcarea at two or
three months' interval.
HERNIE.-Rupture may occur at, or soon after birth,
when it is found to be either umbilical or inguinal.  It may
be cured in a few weeks by Sulphur, 30.  If, after fifteen
days, the swelling still shows itself, Nux vomica, 30, is to be
given, and eight days after, Sulphur.  When the rupture is
connected with diarrhoea, Chamomilla will be found very
successful, even in causing a permanent reduction of the



312


DISEASES OF INFANCY AND CHILDHOOD.


hernia. In the same manner, any remedy directed against
the accidental or accompanying symptoms, will often be
attended by a successful result.
INDURATION OF THE CELLULAR TISSUE.-This disease,
which chiefly occurs in children of the poor who are much
exposed, will yield readily to a few doses of Aconite, 3, followed by Bryonia, 30; and if it is obstinate, to be followed
by Sulphur, and return again to Aconite.
SWELLING AND HARDNESS OF THE BREASTS.-The absurd
practice that some nurses have of squeezing the breasts of
new-born infants is the cause of this painful affection.
Nurses often impose upon the mother's feelings by telling
them the child (if a female) will not be able to perform its
maternal duty in after-life, if the milk is not squeezed out,
than which nothing can be more erroneous.    In fact, observation has proved, that the swelling and hardness, and, if
roughly treated, the subsequent gathering of the breasts of
infants, occur rather more frequently in male than female
infants.  It therefore cannot be too strongly opposed, as the
vulgar prejudice often gives rise to abscess, and consequent
suffering to the little patient.
Arnica, 12, will disperse it, if no redness has yet appeared.
Chamomilla or Bryonia, if the surface is already inflamed.
Belladonna, if the redness is of an erysipelatous character.
Aconite should precede these medicines, if the inflammation
is vivid and hot.
Hepar s., if there is formation of matter; and the cure
should be completed by Silicea, 30.
HIccOUGH.-This is to be remedied by a globule of
Belladonna, 30, or Nux vom., 30, placed upon the tongue, if
the ordinary domestic applications fail to relieve.
CORYZA, OR COLD IN THE HEAD.-If the infant's nose is
stopped up so as to hinder breathing while at the breast, it
should be anointed with cold cream or some other simple
unguent, and a globule of Nux vomica, 30, given. Should
relief not be obtained in twenty-four hours, Sambucus, 30,



CONSTIPATION.


313


may be administered. If the nose should run, Chamomilla
is to be given.   When the coryza is aggravated of an
evening, Carbo veget. is advisable; and if it return every time
the child is exposed to the air, Dulcamara.
OPHTHALMIA OF NEW-BORN INFANTS.- This affection of
the eyes is sometimes very troublesome and obstinate, and
has proceeded to loss of vision, owing to the opacity of the
cornea, which has resulted from the continuance of the
inflammation.   Ulceration-of the centre of the cornea has
even taken place, and the contents of the globe escaped,
which has of course been followed by a shrinking of the
eyeball, and permanent blindness and deformity.    It is,
therefore, of the deepest importance, to arrest speedily this
complaint, and thereby avert remote evils of such magnitude.
A slight weakness of the eye, with agglutination of the lids
and intolerance of light, are first perceived about the second
day after birth, the usual application for which is warm water;
but if the disease increase, the weeping of the eye becomes
puriform, and the conjunctival membrane lining the eyelids,
as well as that covering the globe, is red and inflamed.
Aconitum, 30, should be given immediately, and repeated
after twelve hours.
Dulcamara, 12, may be made to follow Aconite.
Belladonna should be given if the eyes look bloodshot or
bleed, and the intolerance of light is great.
Chamomilla, if the eyelids swell and are closed of a
morning.
Euphrasia, when there is much weeping of the eyes, and
they are gummed up, with intolerance of light.
Rhus tox., when the lids are chiefly affected, and the
child is scrofulous.
Sulph. tinct., if the disease has made considerable progress,
and proves obstinate, especially if there is a scrofulous disposition in the family. This should be followed by Calcarea,
30; or, Arsenicum, 30.
CONSTIPATION.-If the bowels are rather tardy, but the
evacuations of a natural colour, it is better not to be too
solicitous about them.  Nature will generally restore them



314


DISEASES OF INFANCY AND CHILDHOOD.


to their proper course, if not interfered with.  It sometimes
depends upon the diet of the nurse being too stimulating.
If that is the case, the course to be pursued is clear.  But
if not, the infant may have a globule of Bryonia, 30, or Nux
vomica, 30.  If these medicines do not answer the purpose,
Opium, 12, may be given.    Should the constipation soon
return, a dose of Sulphur, 30, will be proper.
Alumina is likewise very serviceable in some obstinate cases.
DIARRHLEA. The diarrhoea of infants sometimes depends
upon the milk of the nurse, or her diet. If the mind of
the mother is agitated by emotions or anxieties, the milk is
thin and gripes the child, giving rise to relaxed motions.
Chamomilla, 12, may be given if the motions are watery,
greenish, or resemble chopped egg, being worse at night;
also if the child cries a good deal, and is flatulent.
Rheum, if attended by acidity, cries, colics, and straining;
the evacuations being sour and frothy or slimy.
Ipecac., 6, is very generally useful in this disorder,
especially if the evacuations are watery, greenish or slimy.
Dulcamara, 30, if the diarrhoea returns at every exposure
to the cold air.
Bryonia when it is produced by the heats of summer, and
is attended by much thirst.
Belladonna when the child is unquiet, but sleeps a good
deal, the motions are greenish, and there is paleness of face.
Antimonium, if the tongue is coated white, or yellow and
the evacuations are frequent, and watery or pupescent.
Arsenicum, 30, may be given if the infant should be very
pale and feeble, the motions hot, irritating, and watery.
SLEEPLESSNESS.   This will often be the consequence of
moral affections or errors of diet on the part of the nurse.
If she drink coffee habitually, or green tea, it will frequently
affect the infant.  This must be corrected; and if the wakefulness does not depend upon the coffee-drinking of the
nurse, then a globule of Coffea, 12, may be given.
Ch'amomilla should be given if the child suffers at the
same time from flatulence and stomachache.



INTERTRIGO, OR CHAFINGS.


315


Opium, 12, if the face is red and turgid.
Belladonna, if the child cannot sleep, though drowsy, and
starts up with cries, &c.
CRIES OF INFANTS. When a child is in health it seldom
cries, and a happy state of smiling innocency betokens the
calm of the body; therefore, the cause should be sought for
diligently, which will generally be found in the state of the
bowvels. These will either be troubled with flatulence, or the
fecal contents are of an irritating and griping character;
this will be evidenced by the child drawing up its knees
forcibly to the belly every time it cries, and a tumid state of
the abdomen, or there may be pain in the ears, or the head.
Aconitum, 30, should be given, if the face is red and the
body burning hot, which may be repeated after six hours,
if the state persists.
Coffea, if the cries are violent, and attended with agitation, which nothing will calm, or else Chamomilla.
RETENTION OF URINE.     Infants are sometimes reported
by the nurse to have passed no water for, perhaps, twentyfour hours.  If no mechanical or corporeal impediment is
found to exist, the child should be allowed to smell Tincture
of Camphor.
Aconitum may be given afterwards in the course of an
hour or two, as follows:Aconitum, 30.
Dissolve three globules in six teaspoonfuls of water, and
give one every two or three hours.
If that does not prove successful, give Pulsatilla or Nux
vomica in the same way.   The latter if constipation exists.
PROFUSE URINATION. When there is a copious emission
of pale, colourless urine, causing the child to be fretful and
look pale, Phosphoric acid or Silicea are the most suitable.
INTERTRIGO, OR CHAFINGS.-This troublesome affection,
which consists in a soreness or excoriation of the nates, the
groins, the back of the ears, the arm-pits, or folds of the



316


DISEASES OF INFANCY AND CHILDHOOD.


neck, may generally be prevented by great attention to
cleanliness.  It depends upon the excretions either from
the bowels, the bladder, or the skin, remaining too long in
contact with the parts, and setting up irritation, which
sometimes proceeds to ulceration.   The removal of this
cause is, therefore, the first essential part of the treatment.
The part should be kept well washed with tepid or cold
water, without soap, and then powdered with unscented hairor fine starch-powder.
It is sometimes dependent upon acid secretions in the
prime vime (or bowels), which render the excretions unusually
irritating, and the excoriated parts not unfrequently discharge matter copiously.
The child should not be kept so hot as to make it perspire too freely, and it should be frequently changed.
Sulphur, 30, may be administered first.   Two globules,
dissolved in a table-spoonful of water, a teaspoonful to be
given every night.
Chamomilla, 12, should then be given in the same manner
if the child is irritable, and passionate, or cries much.
Graphites, 30, or Lycopodium, may be selected after this,
if the chafings are not healed.
Calcarea, 30, is suitable after the former, if required,
especially if the ears are bad; but a proper interval must be
allowed between the remedies.
APHTHIE, OR THRUSH.    This often attacks the infant in the
second week, and is characterised by the mouth and tongue
being covered with minute white blisters, which are rubbed
off by the action of sucking.  A succession of these vesicles
is constantly taking place so long as the disease lasts, which
is sometimes five or six weeks.
It is often predicated by a red granular appearance of the
tip of the tongue a few days after birth, which is caused by
enlargement of the papille.
The thrush often runs in families, and is a disease of
debility; but is generally caused by irritating secretions in
the alimentary canal, from bad digestion or improper food.
When it once occurs in the mouth, it more generally



JAUNDICE.


317


traverses the whole length of the alimentary canal, and
appears at the anus, with redness and excoriation; but this
is not necessary to take place before it is cured, as is frequently supposed. Neither is it important that the child
should have it at birth, from the idea if it does not, it must
at its death, which, differently interpreted, means that it will
die from it at some time or other.  This is a vulgar notion,
which nurses indulge in.
The infant should not be smothered up too much in the
mother's bed, but be allowed to get as much pure air as is
suitable for its tender age; and, if it is fed, care must be
taken to avoid food of too great consistence.
Treatment.-Sulph. ac., 3; two globules put into a wineglassful of water, a teaspoonful to be given every three or
four hours, or a globule may be placed upon the tongue.
Muriat. ac., 12, is likewise an excellent remedy.
Mercurius vivus, 12, is also specific in this disease, and
can be given in the same manner, especially when there is
much saliva in the mouth.
Sulphur, 30, two globules should be administered in the
same way, if the disease has not disappear~ed in five or six days.
Borax, 30, has sometimes succeeded, when the abovementioned remedies have failed.
Bryonia, Nux vomica, Chamomilla, and Arsenicum are
occasionally required.
JAUNDICE.   The infant often turns yellow   a few days
after birth, which, if it has been previously very red, is
simply the transition stage before the skin acquires its
natural whiteness.   When this yellow   tinge is unaccompanied by any other symptom of derangement, as sickness,
&c., there is no need of interference; but if the evacuations
are white, and the urine stains deeply, and there be drowsiness, sickness, a tumid state of the abdomen, and the child
appears ill, a globule of Chamomilla, 12, should be given.
This may be followed in twelve hours by Mercurius sol., 12.
Aconitum, 30, is most suitable if feverish symptoms attend.
Three globules to be dissolved in a wine-glassful of water, one
teaspoonful to be given every three or six hours, until cured.



318


DISEASES OF INFANCY AND CHILDHOOD.


SPASMS OP INFANTS.     Sometimes infants are seized with
a difficulty of respiration, or apparent suffocation, which is
attended with paleness of the face, intermittent pulse, and
general distress.  AdministerIpecac., 6.
A globule placed upon the tongue, and repeated in half an
hour, if not relieved.
When this does not succeed, Sambucus nigr., 30, may
be given in the same way.
CONVULSIONS.
Children are liable to be attacked with convulsions from
various causes, some of which originate in the brain itself,
others result from an affection of distant organs, which, by
exciting a morbid irritation in the brain, by means of the
sympathetic relations which exist between that organ and
the part affected, induce the convulsion.  The former are
termed primary or idiopathic, the latter symptomatic.  The
first arc undoubtedly the most dangerous, although when a
convulsion is induced, from whatever cause, it is often the
commencement of important changes in the brain, which
may terminate in inflammation, or water in the head.
Thus, convulsions may arise from-1st, difficult dentition; 2dly, worms in the intestinal canal; 3dly, violent
hooping-cough; 4thly, eruptive or typhoid fevers; or, 5thly,
from primary disease of the brain.
But, to enumerate more distinctly the principal exciting
causes, they are:-Improper or thick food; the irritation of
dentition; frights of the wet nurse; impure air, and want of
cleanliness of the infant; a feverish state of the mother's
milk; worms in the alimentary canal; a morbid state of the
secretions in  the bowels, manifested chiefly by acidity;
sudden suppression of a cutaneous eruption, or morbid dis



CONVULSIONS.31


319


charge; irregular circulation in the brain from some occult
disease, frights, falls upon the head, &c.
Children under four years of age are more susceptible of
morbific agents than at a later period, and therefore require
more care.  Besides the ordinary attentions to cleanliness,
the mother should be careful never to nurse the child
immediately after any violent emotion, as of anger, grief:,
fright, &c.
Children who have a tendency to convulsions are best
preserved from the attacks by the use of the cold bath, and
frequent change, of air.
Convulsions that occur at the termination of other diseases, inasmuch as they depend for' their relief upon the
subsidence of that disease, are more likely to be fatal.
When convulsions occur, the child should have its feet and
legs immediately put into hot water, and the head sponged
with cold water,, after which the cause of the attack must be
sought for.
Treatment.-When the cause is discovered., a remedy
suitable to it must be administered., asArnica., if it be a mechanical injury.
Opium, if from fright.
Belladonna, if from, congestion of the brain, depending
on other causes.
These medicines may be given by placing two globuales on
the tongue, which is done with facility, and by this means a
convulsive fit will often be cut short.  The most favorable
time for administering the medicines is when the fit is just
passing off; but if the fits succeed each other with rapidity,
no time must be lost.
If there be aggravation after the medicine, the effect
should be watched.   If the first dose does not produce a
prompt and sensible effect, a second may be given as soon
as another paroxysm begins to show itself. If the following
attack is less violent., await the result without administering
more medicine; but if the paroxysm changes its character.,
another remedy must be chosen.
Smelling Spirits of Camphor will often calm a powerful
convulsion instantly.  The principal remedies against con



322


DISEASES OF INFANCY AND CHILDHOOD.


DENTITION.
The period of teething is one of great anxiety and
interest.  Children are liable to have several of the diseases
excited by dentition, the characteristics and treatment of
which have been already detailed; and owing to the great
susceptibility of the system at this time, the diseases which
occur are more than ordinarily dangerous. Various sufferings
of the nature of sympathetic affections are found to accompany the process, such as irritation of the brain, lungs,
or bowels, disturbance of the digestive functions, febrile
heat, &c.
If the child is healthy and strong, and the mother or
nurse careful in her regimen, avoiding stimulating beverages,
(especially spirits,) and late hours, the process is carried on
without much trouble, except what arises from restlessness,
the symptoms being confined to those of simple irritation;
but if from delicacy of organisation, or errors of diet, or
undue exposure to cold, additional excitement is created in
the system, symptoms of excessive irritation or inflammation
are developed in the brain, chest, or abdomen.
Usually from the fourth to the sixth month, the commencement of dentition is manifested, by the child thrusting its
fingers into the mouth, rubbing the lower gums, which feel
hot and begin to spread, and by dribling of the saliva.
Sometimes this stage is protracted to the eighth, ninth, or
tenth month, and in these cases dentition is accomplished
with more difficulty, since it is an evidence of some deficiency
in the vital powers connected with the formative processes.
The cutting of the first sixteen teeth is generally accomplished
by about the eighteenth or twentieth month, after which
there is a pause for a few months, when the four other
double teeth come through, completing the first set of twenty.
The phenomena, which frequently accompany painful
dentition, and may require medical aid, are:-eruptions on
the skin, especially on the face and scalp; griping; relaxed
motions; stools of a green, pale, or leaden colour, at times



FEVERS OF CHILDHOOD.


325


FEVERS OF CHILDHOOD.
The fevers of childhood are, for the most part, symptomatic; such as, those which accompany dentition, inflammation of various organs, acrid secretions in the stomach
and bowels, (usually termed bilious or remittent,) worms,
glandular diseases, the eruptive diseases, and exposure to cold.
Experience proves, that young children are not so liable
to take the ordinary fevers as adults; indeed, it is not uncommon to see an infant remain at the breast during the
continuance of a fever, by which the mother is prostrated,
without taking it, or to see them escape in the midst of a
general epidemic.  On the other hand, they are subject to
the fevers above mentioned, which are peculiar to their
early age.
These symptomatic fevers are, at their onset, chiefly under
the control of Aconitum or Chamomilla, which, in some
cases, will be found sufficient to check the disease altogether;
but when the febrile symptoms continue, until relieved by
the outward manifestation of the especial form of fever, of
which they were but premonitory, these remedies must give
way to others, which are indicated by the character of the
new symptoms.
The catarrhal fevers will be known by their following
exposure to cold, and the nasal and bronchial catarrh, which
accompanies them.
The inflammatory are distinguished by the great heat of
skin, and excitement of the heart and arteries, in connection
with other local signs, indicative of distress, either of the
brain, chest, or abdomen.   4
The eruptive have some peculiar features incidental to
each, which, together with the prevalence of an epidemic
contagion, excite suspicion of their origin.
The fevers which are connected with wcrms, dentition, or
glandular disease, are generally made easy of diagnosis, by
the presence of those exciting causes; and if a child is found
labouring under fever, dependent upon none of the above



INFANTILE REMITTENT FEVER.


327


these a remedy may be found among Ars., Bov., Bor., Con.,
Calc., Merc., Nux, Rhus, Dulc., Sulph., and Sulph. ac.
Stiffness and pain in the muscles of the neck, at the
nape, or the side under the jaw, are also observed to occur
during convalescence, and more generally depend upon the
enlargement of a gland, which, if not soon dispersed, will
evince a disposition to suppurate.  This may be obviated
and relieved by Dulc., Bell., Hepar., Caust., Chin., Guiac.,
Baryt., Kali c., Calc., or Sulph., &c., according to the character of the pain or the temperament of the individual.
The convalescence from fevers is most rapid in children,
when once the concomitant affections are removed; but if
any sources of debility are inherent in the child, which
render recovery tardy, China may be given with advantage
two or three times a day.
INFANTILE REMITTENT FEVER.
This is a frequent form of fever after two or three years
of age, and is distinguished by the occurrence of remissions
during the day and exacerbations at night. It occurs most
frequently in the autumn, and runs a course of from three
to five weeks, unless it be cut short by remedies at an earlier
stage.  It commences with languor and debility, the child
lies about, and appears ailing and out of spirits for a week
or two, during which there are loss of appetite, slightly
furred tongue, and irregular bowels. The more active febrile
symptoms are then ushered in with shivering and flushes of
heat, the pulse becomes quick, there is sickness, with pain in
the head, drowsiness, or a heavy appearance about the eyes,
moaning or crying out in the sleep, startings, delirium; the
furred tongue becomes morbidly red at the tip, sometimes
dry; there are-thirst; flatulent distension and tenderness
of the abdomen; the urine is orange-coloured and scanty;
the evacuations are frequent, of a morbid character, and
offensive; either green or dark and watery, and worms arce



328


DISEASES OF INPANCY AND CHILDHOOD.


often present; there is usually a dry, hacking cough, with
accelerated respiration, and intense heat of the body and
burning of the palms; the temper is irritable, and the child
during the remissions is constantly picking its fingers, lips,
or tongue, and picking or boring at the nose until it makes
blood come.   An occasional partial perspiration takes place,
which lasts but a short time, and frequently a longer
remission occurs about the eleventh or fourteenth day, after
which the fever goes on again. During the progress of the
fever great exhaustion and emaciation take place, so that
the child is reduced to a mere skeleton.
The pulse varies from 120 to 160, and as the fever abates,
this gradually diminishes in frequency, the tongue begins to
peel, the exacerbations are milder, the urine deposits a
sediment, and the heat of the skin declines, whilst there is
a more general softness and moisture upon it.
This fever is sometimes complicated with enlargement of
the mesenteric glands and worms, and has been called
" tworm fever." Diarrhoea, aphthous condition of the lips and
tongue, bronchitis or pneumonia, and symptoms resembling
hydrocephalus or phthisis, with typhus, not unfrequently
present themselves.
The chief causes are exposure to cold, during a damp,
unhealthy state of the atmosphere, or dwelling in a low,
damp locality, with a predisposition to derangement of the
gastric and abdominal secretions.
The treatment of infantile remittent must be such as
shall diminish the fever and correct the morbid secretions of
the prime vime.
Aconilum, 12, will be required if the febrile symptoms be
already developed, and there is quick pulse, hot, dry skin, and
thirst.  It may be administered if there is bilious vomiting,
but not if the intestinal secretions, chiefly, are deranged.
Ipecac., 6, should be given for a day or two in the
precursory stage, when gastric symptoms prevail, nausea or
vomiting, loss of appetite, with thirst, headache, and chilliness.
Pulsatilla, 12, is often usefull in the premonitory stage of
this fever, before the febrile paroxysm  has occurred, when
there is a sense of illness, without thirst.  It may likewise



INFANTILE REMITTENT FEVER.


329


follow Aconitum, when the bilious symptoms predominate,
with low spirits and weeping, diarrhoea, &c.
Nux vomica, 12, corresponds to the same symptoms as the
former, except that it is more suitable when constipation
exists, with great irritability of temper.  It may be given
when there is considerable heat in the face, burning of the
eyes, dryness of the lips, pain in the forehead, oppression at
the chest, flatulence and pinching in the stomach, restlessness, &c.
Antimon. cr., 6, may be administered with advantage when
there are vomiting, diarrhoea, cutting pains in the abdomen,
with fetid flatulence, and evacuations of undigested food.
Belladonna, 12, will be necessary, if the cerebral irritation
predominate, with flushing of the face, a yellowish or white
coated tongue, thirst, dry heat, especially of the head, &c.
Tart. emeticus, 6, when the gastric irritation is considerable, with violent nausea and vomiting day and night,
drowsiness along with the fever; red itching rash on the
body or chest; diarrhoeic evacuations, &c.
Bryonia, 12, is one of the most important remedies in
bilious fever, with subacute inflammation of the mucous
membrane. It may be used after Aconitum, if the previous
remedies are not particularly indicated, when there is great
febrile heat, with chills, nightly exacerbations, pain in the
head and irritability, thirst, dry tongue, tenderness in the
hepatic region, hiccup, and retching or bilious vomiting,
colic, and constipation. It is also useful if typhoid symptoms
set in, or the cough be troublesome.
Colocynth, 12, may be given with advantage when cutting,
griping pains in the abdomen, with diarrhoea and sickness,
exist.
Chamomilla, 3, is indicated when there is great general
heat, burning of the face, urgent thirst, vomiting of bilious
matters, yellowish coating on the tongue, distension of the
abdomen, with diarrhoea of watery, green-yellow evacuations,
restless sleep, excessive irritability, and sensibility to pain,
shortness of breath, &c.
Mercurius, 12, will be advisable when there is diarrhoea
with green slimy stools, preceded by colic; pain or sensitive



330


DISEASES OF INFANCY AND CHILDHOOD.


ness in the region of the liver, yellowish tinge of the
countenance, dark and offensive urine.
Rhus tox., 12, will be suitable if typhoid symptoms occur,
the tongue being brown and dry, tremulousness of the
hands, great debility, confusion of head, cough, &c.
Arsenicum will likewise be advisable if symptoms of
nervous exhaustion occur, with black diarrhoeic motions,
vomiting, intense heat, dry lips and tongue, unquenchable
thirst, burning in the bowels, restlessness at night, or clammy
perspirations, cool extremities, aphthae of the mouth, &c.
Phosphorus, 12, is occasionally beneficial in the typhoid
condition, when there is diarrhoea, with abdominal distension.
Cina, 6, may be given when worms accompany the fever,
and there are cerebral symptoms, dilated pupils, squinting,
shrieking and starting in the sleep, alternate paleness and
redness of the face, rubbing or boring at the nose, colic,
costiveness, and vomiting.
Ac. mur. is the remedy suitable when intestinal ulceration
occurs in the course of the fever.
China will be of service during the convalescence.
The medicines should be administered either in tincture
or globules, according to the urgency of the case.  For the
most part, one drop of the tincture or six globules may be
dissolved in a wine-glassful of water, and one teaspoonful
given every two, three, or four hours, or at more distant
intervals, according to circumstances.



EIRYSIPELA S.


331


I      ERYSIPELAS.
Infants are sometimes the subjects of an erysipelas which
runs over the body, attacking different parts in succession.
It may be termed migratory erysipelas.  It commences at
some one spot, usually of the arm, in a day or two leaving
the part first occupied, and passing on a little further, then
quitting the arm, and occupying the side of the chest, the
hip, thigh, leg, and foot of that side; after which it traverses to
the other foot and passes upwards, till it reaches the hand of
the same side, when it will often retrace its steps, going the
round again; the child all the time appears very ill and feverish,
and the erysipelatous parts are, more or less, indurated,
swollen and tender.  The disease is very lingering, and it
ultimately terminates by resolution, by suppuration, or
death.
Treatment.-Bryonia, 12, is the best remedy    for this
affection.  It should be given as follows
Bryonia, 12,
six globules dissolved in four table-spoonfuls of water, and a
teaspoonful of the solution being administered every three
hours.
Aconitum, 12, may be given first,'if the fever is violent.
Belladonna, 30, and Rhus, 12, may be given separately,
or in alternation, if Bryonia should not answer the purpose.



332


DISEASES OF INFANCY AND CHILDHOOD.


CRTTSTA LACTEA, OR MILK CRUST.
Children of a lymphatic constitution, are those usually
attacked with Impetigo Capitis, or Crusta Lactea, which may
show itself at the second month; but it more generally
occurs during dentition.  It commences by the eruption of
small pustules on the brow and cheeks; or may be first on
the top of the head, and as they extend, ultimately occupy
the forehead and cheeks.  These small pustules, or achores,
have an acuminated form, contain a straw coloured fluid or
ichor, rest upon an inflamed base, and are succeeded by a
thin brown, or yellowish scab. The disease is attended by
great irritation, heat of the scalp, and itching; the discharge
is sometimes very profuse, and when this is the case, there
is not time for scabbing to take place, but the whole surface
of the scalp is raw and excoriated,-perhaps cracked and
bleeding,--and the discharge oozes out in drops, so that you
see a mattery discharge at one part, while in another
there is an escape of clear fluid, like drops of water.
As the discharge trickles down, it excoriates the forehead
and sides of the face, exciting the disease in those parts, so
that sometimes the top of the head is one crust, and the
face appears covered by a mask.   The child is continually
crying, and tries to scratch itself a great deal. Its sudden
repulsion is to be guarded against, as it is either induced by
acrimonious secretions in the intestines, or the irritation of
teething, and is not unfrequently followed by hydrocephalus.
It lasts a long time, and requires the nicest management,
and the utmost attention to cleanliness, as the discharge is
often most offensive, and breeds vermin.
Treatment.-On the principle that prevention is better
than cure, the antipsoric prophylaxis is the best means
to accomplish this.    But, if it does break out, Viola
tricolor, 3, will often remedy it in the earliest stage.  This
is a remedy which was formerly recommended by Strack and
Stoll, in the form of decoction, but its specific nature was not
known.    It went out of repute, like many other good



336


DISEASES OF INFANCY AND CHILDHOOD.


Coffea, 12, if there is much restlessness from nervous
irritation, without oppressive anxiety.
Ipecac., 6, when there is profuse perspiration and diarrhoea;
or sighing and oppression at the chest.
Bryonia, 30, when constipation exists, with swelling of
the abdomen.
Chamomilla, 12, should be exhibited when there are
symptoms of bowel irritation, with watery, greenish, or egglike evacuations, which corrode the anus, and when the
child suffers from being kept too warm.
Sulphur, 30, is advisable when Chamomilla has been given
without avail, and there is excoriation of the fleshy parts.
Belladonna, 30, may be required in case of retrocession
of the eruption, and determination of blood to the head.
Arsenicum, 30, if there be great restlessness and anxiety,
the child constantly changing its position.
Calcarea carb., 30, is of service when the eruption is
critical; or when, from constitutional debility, the eruption
is imperfectly and slowly developed.
MEASLES.
This eruptive disease often prevails, as an epidemic, in the
spring, and under ordinary circumstances is not attended
by much danger, if proper care be taken to preserve the
children in a warm and uniform temperature.    The sequele,
or consequences of measles, are often more serious than the
disease itself, as the irritation which is excited throughout
the system, by the development of the eruption, stirs up
consumptive or scrofulous symptoms, and various affections
of the mucous membranes, or a cachectic state of the
constitution.
The first symptoms of measles are generally redness and
watering of the eyes, intolerance of light, sneezing,-perhaps
increased secretion from the nose,-hoarseness, sore throat, a
short and dry cough, more or less fever, white tongue with



MEASLES.


337


red edges, headache, and restless sleep.  These symptoms
usually appear about the tenth day after exposure to infection, and on the thirteenth or fourteenth day the eruption
shows itself.  The precursory fever and cough increases for
-a few days before the rash comes out.   If there is much
pulmonic irritation, it increases as the disease progresses.
The eruption is characterised by small, red, slightly
elevated spots, which appear first on the neck under the ear,
on the forehead, and face; then on the trunk and extremities.
These extend, coalesce, and form patches, which are flat, and
assume irregular 'figures with crescentic outlines.  The face
and hands swell. Very soon, larger patches appear, mixed
with the distinct spots, and exhibiting the'same semilunar
edge.  The eruption is sometimes slight, especially in young
children, and the febrile and catarrhal symptoms transient,
-on the other hand, these may be very acute, and the
irritation of the lungs proceed to inflammation of the air
tubes (bronchitis), or of the structure of the lungs (pneumonia).
The eruption is sometimes pale and indistinct from the first, or
it may be imperfectly developed, or may suddenly and prematurely recede, all of which circumstances are unfavorable.
The eruption, in its ordinary course, lasts about three
days, and then turns pale, terminating by desquamation, or
peeling off of the cuticle, which is less perceptible than in
scarlet fever.  The catarrhal symptoms usually abate on
the fourth day; but sometimes they continue or increase.
It may terminate critically by a copious perspiration or
deposit in the urine, or by diarrhoea, which, if carefully
regulated, often concludes the disease.
Bleeding from the nose is apt to occur towards the end,
and soreness of the margins of the eyes to remain after.
The consequences to be dreaded after measles, are:-hectic
fever, pneumonia, hydrothorax, or water in the chest, spitting
of blood, pain in the ear, with deafness, glandular swellings
of the neck, disease of the mesenteric glands, chronic
eruptions, phthisis, &c.; occasionally the eruption exists without the catarrhal symptoms, or the latter alone may be present;
but such a partial appearance of the disease cannot be
depended on as a security against a future attack.
22



338


DISEASES OF INFANCY AND CHILDHOOD.


Treatment.-If measles prevail in the house, it is well to
administer to those who are not yet affected,Pulsatilla, 30,
three globules dissolved in a wine-glassful of water, one teaspoonful every two days, as a preservative.
Aconitum, 30, is generally indicated at the commencement,
and should be given when the febrile and inflammatory
symptoms are acute, the face red, with dry, hot skin, and
thirst, anguish, drowsiness, and cough. A warm, uniform
temperature should be preserved, and diluent drinks given,
if the child is not at the breast.
A globule every six hours, or less frequently, as the
disorder abates.
Pulsatilla is considered by many as the true specific for
measles.  It is indicated in the early as well as the more
advanced stage; and will often arrest the disease at once.
It is more especially suitable when diarrhoea is present.
A globule, in a teaspoonful of water, every four or six
hours.
Sulphur should be given for a few doses, if Aconite fail to
amend the symptoms after the third dose.
Ipecac. is of service when the eruption is tardy in appearing,
and is thrown out with difficulty, and there is tightness of
breathing, with oppression at the chest, or vomiting.
A globule every two or three hours in a teaspoonful of
water.
Bryonia is also useful when the eruption is imperfectly
evolved, and there are agitation, thirst, a violent, noisy, and
hollow cough, &c.
Chamomilla may be given under similar circumstances as
Ipecac., after the eruption has died off.
Arsenicum is a valuable remedy, if the previous medicines
do not succeed in reproducing the eruption, when it has
disappeared prematurely, with depression of the system.
Euphrasia is useful in the catarrhal stage, when there is
great weeping from the eyes, with photophobia, or intolerance
of light and coryza.
For the morbid consequences of measles, the following



SCARLET FEVER.


339


remedies will be found most serviceable, according to their
special indications.
Aconitum, Arsen., Bryonia, Belladonna, Hepar s., Galcarea,
Sulphur, Phosphorus, Pulsatilla, Rhus, Chamomilla, Cina,
Ipecac., Dulcam, Mercurius, Drosera, lodium, Nux v., Carb.
veg., Chin., Hyoscy., Ignat., Sepia, Stramon.
In all cases the tinctures may be used in place of the
globules, when preferred, when the average strength may
be two drops to a wine-glassful of water, one teaspoonful for a
dose.
SCARLET FEVER.
Scarlet fever is distinguished by a bright red eruption,
the colour of a boiled lobster, which extends all over the
body, the skin being smooth and shining, the redness disappearing for a moment, and leaving a white mark when
the finger it pressed upon it.    This characteristic efflorescence indicates the difference between this disease and the
scarlet rash, with which it is sometimes intermingled.
Pure unmixed scarlet fever is, however, very rarely met
with. It is attended also by inflammation and ulceration of
the throat.   Scarlet fever is usually described as of two
kinds, the simple and the malignant; the former is connected with an inflammatory, the latter with      a low   or
malignant fever. Both are highly contagious. The epidemics
of scarlet fever differ very much in the dangerous nature of
the disease. In one, the symptoms are generally mild, in
another altogether as severe and fatal.
There is a greater extent of redness and swelling of the
throat, moreover, in the simple than the malignant form;
in the latter it is of a dusky red, and covered with sloughs.
Even in the simple form, the throat may exhibit a variety
in appearance; in some cases it is very little affected,
although the inflammatory and eruptive symptoms are very
acute, while in others there is considerable tumefaction of



SCARLET FEVER.


343


spite of the administration of the former medicine, or if
ulceration has begun in the throat, with increased secretion
of mucus.
In the angina without the rash, Belladonna, followed by
Mercurius, will be quite successful in most cases.
Aconitum is indicated at the onset of the disease when
the inflammatory fever runs high, the heat of the skin
being intense, and the pulse full and bounding.  It also corresponds more strictly than Belladonna with that form of
the disease in which elevated papulous spots are intermingled
with the smooth; glossy eruption, and should be persevered
with in preference, as long as improvement results. The
redness not disappearing on pressure of the finger, is another
indication for Aconite.
If the genuine scarlet fever rash should be found combined with the purple rash, and a high degree of fever, it
will be advisable to administer the Aconite and Belladonna
alternately, allowing a longer interval to elapse after each
dose of Belladonna than after the Aconite.
Cofea may be given between the doses of Aconitum, if
there is much agitation and sleeplessness.
Opium is indicated when, in the course of the fever, there
are symptoms of oppressed brain coma, or drowsiness; restless
agitation with vomiting, costiveness or diarrhoea, convulsions, &c.
Ammon. carb. is applicable to the depressed and torpid
condition of the system, with tendency to gangrenous ulceration, which is found in the severer forms of the disease
in weak and lymphatic subjects, when the rash continues
out beyond the ordinary period.
Ipecac.-An intermediate dose may be required occasionally, when nausea or vomiting, with restlessness and
moaning, are present, with increase of fever in the evening.
Pulsatilla is sometimes required after Ipecac., if the
vomiting is relieved, and diarrhoea persists, with chilliness.
Arsenicum will be requisite'in those cases in which depression of the system is most evident, when there is a
disposition to coldness of the surface or extremities, faintings,
great failure of strength, rapid sinking, small, quick, and



344


DISEASES OF INFANCY AND CHILDHOOD.


feeble pulse, burning thirst, dryness, with dark appearance of
the lips; the ulcers in the throat being gangrenous and fetid.
Nux vomica may be given, when typhoid symptoms are
threatening, with prostration, dryness of the mouth, and
thirst; the mouth and fauces being affected by numerous
small ulcers, which are fetid; difficult deglutition, with collection of mucus in the mouth and fauces, or flow of saliva in
the mouth; the uvula and tonsils being inflamed, swollen,
and painful.
Pulsatilla is useful in such cases when the throat looks.of
a dusky colour, as from venous congestion.
Baryta carbonica, 12, is an excellent remedy when, in
severe cases, the throat is much affected, and the tonsils
have a dull, rosy, or livid appearance, instead of the bright
red indicative of Belladonna; there is fetor of the breath,
with external tenderness and enlargement of the parotid and
submaxillary glands; coldness of the feet, and especially
when the symptoms occur in a scrofulous constitution, with
irregular and ill-digested evacuations and ptyalism.
Sulphur should be given if the patient is of a cachectic,
strumous, or psoric constitution, liable to eruptions; the
scarlet fever rash being intensely hot, universal, and itching;
it may be alternated with some of the other remedies,
when they fail to act well, although apparently indicated.
Nitri acid. is indicated by the presence of nervous or
typhoid fever, with faintness; numerous little fetid ulcerations of the mouth and throat, continual thirst, and great
dryness of the mouth.
Phosphorus is useful when the eruption suddenly disappears.
Bryonia is administered with advantage under the same
circumstances as phosphorus.
Carbo vegetabilis and Lachesis may be useful when the
angina continues after the eruption has disappeared; also
Sulphur.
SEQUELUE OF SCARLET FEVER.-The sequele of scarlet
fever are chiefly to be treated by the following remedies:Bryonia and Sambucus, or Helleborus, Arsenicum, Rhus, and
Digitalis will be found eminently successful in the different



THE SCARLET RASH.


347


it to resemble measles.  Desquamation takes place after the
third day, and is a long process.  The danger does not seem
to depend on the extent of the effloresence, but is less in
proportion to the freedom of the internal organs from
morbid action.
Treatment.-When scarlet rash appears, the patient should
be kept in bed, in order that the eruption may not be driven
from the skin by any variation of temperature.    Warm or
tepid drinks should be applied, and the usual fever diet.
Aconitum is the specific reniedy in this disease, and not
Belladonna; although when it occurs in complication with
scarlet fever, these two remedies may be given alternately,
as already mentioned. The following may be the mode of
prescription:Aconitum, (tinct.) 12.
Two drops being added to four table-spoonfuls of water,
and a teaspoonful of the solution being administered every
3 or 4 hours. If globules are used, one may be given in a
teaspoonful of water, at similar intervals.
Coffea will be necessary when there is excitability, restlessness, whining or moaning, and wakefulness. It may be
occasionally alternated with Aconite, if necessary.
Ipecac., 6, should be given when the fever is moderate;
the eruption delaying; and the patient affected with anxiety
and restlessness, or nausea and sickness.
Bryonia, 12, will be required, if symptoms of internal
inflammation present themselves.
Mecurius, 12, will be useful, when, combined with the
scarlet rash, there is affection of the fauces.
Dulcamara has been serviceable in some epidemics.
Ammon. carb. is useful, if typhoid symptoms set in.
Calcarea carb. is indicated by swelling of the parotid glands.
Solanum nigr. or Opium for vomiting, followed by Sopor.
Sulphur.-When the patient is scrofulous and uniformly
red, and there is tingling of the skin, or, if the heat continue
intense in spite of the administration of Aconite.
Kali carb., Senega, Puls., Zincum, Camphora, Phosphor.,
and Rhus, have also been found useful at times.



348


DISEASES OF INFANCY AND CHILDHOOD.


SMALLPOX.
Smallpox, from its loathsome appearance and its fatality,
is necessarily a much-dreaded disease.
The premonitory symptoms are:-chilliness and languor,
pain in the back and loins, headache, bleeding at the nose,
nausea or sickness, febrile state, thirst, a quick pulse,
oppression of the breathing, white furred tongue, restlessness,
and more or less prostration.  These last two or three days,
when the eruption appears in the form of granular spots,
with an inflamed base, feeling like a hard seed in the skin,
over the forehead, face, neck and arms, the development of
which gives immediate relief to the constitutional phenomena.
The spots occur either separately, at distant intervals, or
closely aggregated, the former mode indicating the distinct
variety, the latter the confluent. Some authors have thought
that the mild or severe form of the disease could be prognosticated by the character or extent of the pain in the
loins, the situation of the pain high up the back or its
absence being significant of a mild- attack, and the intensity
of the pain indicating a severe one.
The eruption is at first papular, then vesicular,, and ultimately pustular.
About the second day of the eruption the papulae have
their summits slightly transparent, becoming vesicular, and
on the fourth or fifth day they are found to be depressed in the
centre and indented; there is a distinct areola around each,
and on the sixth day the contents turn opaque, and gradually
distend until the eighth, when maturation is complete, the
intervening skin swelling to some extent, and becoming tense
and red. Suppuration of the vesicles first commences on the
face, and thence passes on over the rest of the body, first
affecting those parts where the skin is thinnest, wherefore
the hands and feet are the last parts to be occupied.
When the vesicles are so closely collected together as that
thevy run one into the other, the disease is said to be
confluent, and this is the most dangerous form. When they



SMALLPOX.


351


administering agents which, by increasing the action of the
cutaneous vessels, augment the development of the vesicles.
It is necessary, therefore, to preserve a cool temperature of
the room, especially during the eruptive period, and to give
cool and not warm drinks; to change the linen frequently;
and adopt every means of securing a free ventilation.
The patient should be confined to bed, with the room
darkened, and treated as one under the influence of a fever,
except that sweating is not desirable.
As to the local treatment of the face, where the pustules
congregate most freely, in order to prevent the disfigurement
which frequently happens in this most exposed part of the
body, it will favour the healing of the ulcerations to bathe
the parts often with barley decoction, and if any excoriations
occur, to dust the spots immediately with powdered starch.
In this way the pits and scars will be much diminished.
The secretions about the eyes, nose, and mouth should be
constantly removed in the same manner, and care must be
taken that the child does not pick or scratch the face.
Various methods have been recommended with the object
of arresting the progress of the eruption, to obviate thereby
the evils resulting from the cicatrisation, after the pustules
have dried off, such as,-inserting the point of a stick of
lunar caustic, or nitrate of silver, into each pustule, or
painting the face over with a solution of the caustic at the
commencement of the eruptive period.
Puncturing the pustules is another plan, derived from the
Arabian physicians, which has been adopted with some
success. The application of Sulphur, Mercury, &c. to the
face during the period of evolution, has been found to produce
resolution of the eruption, which has consequently miscarried
or ceased to progress, while the febrile symptoms have
pursued their usual course; but as this practice cannot be
applied to the eruption which is developed on the mucous
membranes, it is very questionable whether the forcible
prevention of its evolution on the cutaneous may not cause an
increased accumulation of pustules on the mucous surface,
or produce serious congestions of the internal organs.
There is, however, sufficient evidence to prove the great



SMALLPOX.


353


Arsenicum, 30, should be administered when the eruption
is developed tardily, with excessive anxiety, thirst, burning
of the skin, vomiting, &c. or if the pocks suddenly fade,
with livid areole, and the mouth, lips, and tongue look
black, with burning thirst and great exhaustion.
A globule may be given every two or three hours.
Rhus tox. may be given under similar circumstances.
Opium, 30, will be useful when there is much sopor.
Vaccinia, 30, repeated two successive days, has been
reported by Dr. Gross and others to arrest entirely the course
of the disease.
Thuja, 30, has been    proclaimed by Bcenninghausen,
indefatigable in his researches into the very heart of the
materia medica, as the true specific for variola.    The
eruption described in its pathogenesy is pustular, surrounded
by a red areola,     It is recommended in the early and
suppurative stages, and either in the distinct or confluent
form.   It arrests the disease speedily, and shortens its
course.
Hepar sulphuris is useful in the suppurative stage, as well
as Nitric acid.
Camphor should be given when, from the disappearance
of the swelling of the face and sudden desiccation, a fatal
termination is prognosticated.  In such a case the body
should be washed here and there with Spirits of Camphor,
as well as administering it internally, in order to arouse the
vital energy.
Acid. muriat. will be indicated, if the pock turns black
and typhoid symptoms appear.
Stramonium is useful in accelerating the appearance of
the eruption, and curtailing its progress.
Belladonna and Chamomilla may be required in cases of
congestion or excitement of the brain or bronchial lining.
Phosphorus, if inflammation of the lungs should set in.
Zincum will be useful, if convulsions occur with absence
of fever, which are of a purely spasmodic and nervous
character, with cold feet, and pale urine.  It is also said
by Teste to be a preservative, if given before the eruption
appears.
23



354,


DISEASES OF INFANCY AND CHILDHOOD.


Rapon advises Mercurius as the most successful remedy
in all the stages of smallpox.
Teste prefers the Mercur. corros., 30, in alternation with
Causticum, 30, and states that they may be given at any
period of the disease with great success.
To conclude, we will append the summary of Jahr, which
may assist the reader's memory in complicated cases.
Principal remedies: 1, Thuja;-2, Ars., Mere., Rhus;
-3, Acon., Bell., Bry., Camph., Chin., Sulph.
In the premonitory stage: Acon., Cof., Bry., Merc., Rhus,
Puls., Tart. em.
In the febrile: 1, Acon., Bell.;-2, Op., Ars.
In the eruptive: 1, Thuja;-2, Merc., Sulph.;-3, Ant.,
Stram.
In the suppurative: 1, Thuja;-2, Merc.
In the desiccatory: 1, Acon., Bell., Cham., Puls.;-2, Bryon.,
Rhus, (Merc., Sulph.)
When the pustules are black: 1, Ars., Carb. veg., Chin.;
-2, Bell., Hyos., Lach., Rhus, Sec., Sil.
VARIOLOID       DISEASES.
This term is applied to those diseases which resemble
smallpox, and are more or less dependent upon the same
epidemical constitution of the atmosphere for their production.  They comprise:1. Variola verrucosa, or spurious smallpox.
2. Variola vaccinia, or cow-pox.
3. Varicella, or chicken-pox.
4.,,    globularis, or hives.
5.,,    coniformis, or swine-pox.
6.,,    papularis, or horn-pox.



VACCINATION.


359


the organism upon it, the true principle of curing diseases was
at once made manifest; and it is strange that this circumstance
did not form the basis of Homoeopathy, and open out to a
mind like that of Jenner's, the great fact which Hahnemann
got sight of, just at the same period of time, though from a
different point of view. But Jenner limited all his thoughts
and operations to the curing and preventing smallpox.
Vaccination, however, is the best and simplest illustration of
the Homoeopathic law.
The best time for having a child vaccinated, is just at the
completion of the third month, when the system is sufficiently
developed to receive and retain the impression, and before it
is disturbed by the irritation of dentition.
The mode of doing it is not material; but the lymph
should be taken from a healthy child, free from any cutaneous
affection, on the eighth day after the puncture.  If it be
not taken until the ninth day, it is apt to be opaque and
purulent, especially if the vesicle has been developed early.
The progress of the disease is as follows:--The virus or
lymph having been conveyed into contact with the derma,
or true skin, becomes mixed with the fluids of the tissues,
and absorbed into the system.  On the third day, a little
red spot is to be seen on the side of the puncture, which is
the first local indication of its having taken effect.  There
is a slight hardness in the centre of the spot, which is the
development of a papula, or the first stage of the eruption.
On the fifth and sixth days, a small vesicle is formed upon
this, which is white and pearly, of a round or oval figure,
and depressed in the centre. At the eighth day the vesicle
is fully distended, and has attained its complete development.
At this period there is generally no areola, unless the
vesicle is prematurely evolved; but on the ninth day, the
vesicle becomes flattened on the surface, sometimes more
raised in the middle than at the circumference, divided
internally into cells, which contain a clear, limpid fluid, and
is surrounded by a vivid, red circle, which is hard and tumid,
as well as hot and painful. It has, at this time, been
described as the pearl upon the rose. The areola gradually
extends to about two inches.  Occasionally a small vesicle



CROUPii.


361


It now and then happens that a child is totally insuscep -
tible of the influence of vaccine, and resists a second or
third vaccination.  In this case the operation should be
repeated every three months until it succeed, as there is no
positive indication to direct us to the knowledge when the
system recovers or acquires its susceptibility.  It is satisfactory to know, however, that the receptivity for smallpox is
absent whenever this state of constitution exists.  I have
known a child,, whose system had refused to be inoculated
with the cow-pock, sleep in the same bed with its brother,
who was labourin'g under smallpox, without receiving the
disease.
Vaccination will, often, as smallpox does, arouse any
latent dyscrasia that exists in the system, which is used as
an objection to the operation; whereas it is but the natural
consequence of introducing a new morbid irritation into an
unhealthy organism. After the infant has passed through
the vaccination, that is, about the twelfth day, a dose of
Sulphur, 30, should be given', which will help to clear the
system  of any eruptive tendencies.  Nothing in. the shape
of aperient medicine should on any account be given.
CROUP.
The croup consists in an inflammation of a peculiar kind
which attacks the mucous membrane lining the windpipe, its
chief characteristic being a tendency to produce an exudation
of plastic lymph or fibrin, called false membrane, which fills
up the larynx, and if not separated and ejected before the
patient is too far exhausted, causes death by suffocation.
It is well known that other portions of the mucous
membranes are liable to be affected with the special kind of
inflammation which produces this fibrinous exudation on their
surface-as that of the bowels, mouth, and uterus;-thcse
are not attended with any important or dangerous symptoms;
but it may be easily supposed, that when such an occurrence



CROUP.


363


and whistling: soon-especially in those cases attended with
much fever and flushing of the face,-drowsiness comes on,
from which the patient is frequently aroused by fits of
cough and suffocation, with great agitation; the lips become
livid; a cold sweat covers the forehead; the embarrassment
increases, convulsions succeed, with coma and death: or there
may be intervals of comparative ease, but the paroxysms
returm'n more and more strongly, until at length the larynx
becomes entirely closed, and the patient dies in a state of
asphyxia.
From time to time, perhaps, small portions of the false
membrane are detached and expectorated, with some marked
remission of the symptoms; but this is often illusory, and
unless the fever abates, and the respiration becomes more
easy, the aspect more natural, and the congestion removed,
the lull is but momentary, and all the distressing symptoms
of threatened suffocation recur with augmented intensity,
until death closes the scene.
But if it should so happen that the child coughs up a
membranaceous substance of a tubular form, as is occasionally the case, the general symptoms subside, and the
restoration to health is speedy; the disease is at an end.
The voice remains harsh for some time after, and the
larynx tender to the touch.
The greatest care is at this time required to prevent a
relapse, which may be caused by errors of diet, or improper
exposure to cold.
The spasmodic form of croup is important to be distinguished, as it presents nearly the same symptoms, but is
attended with less danger.  The distinction is much more
important under Allopathic treatment, because the severity
of this treatment for the one kind must materially aggravate
the other; but in Homceopathy, the harmonious action of the
remedies which subdue the disease perfectly, and correct the
tendency thereto, are free from the exhausting influence of
the allopathic treatment.  The distinction between the two
forms of the disease is certainly not at all times easy, inasmuch as in the true croup the catarrhal symptoms are
occasionally absent.  In  spurious croup, the attacks are



CROUP.


365


interrupted, but awakes after a while with a cough which is
manifestly less strong; it soon becomes looser, and the
violence of the disorder is appeased. If it has been necessary
to have recourse to the Spongia, and after twenty-four or
thirty-six hours' use of it, the cough remains deep and heavy,
with suffocative fits, followed by efforts to vomit, the voice
being hoarse, with loose phlegm,Hepar sulph. is to be administered. This may be alternated with Spongia every two hours, or the one may be
given for four or six hours in succession, and then be followed
by the other in the same way.
Sambucus nigr. is indicated, when, notwithstanding the
diminution of the paroxysms of cough, the threatenings of
suffocation continue.
Bromine is a remedy whose pathogenesy strikingly indicates its power over croup.  Spasm of the larynx; suffocative cough; hoarse, whistling, croupy sound with great effort;
rattling  wheezing; gasping impeded respiration; heat of
face; formation of a false membrane in the larynx and
trachea.
It is highly commended by Attomyr as being the only
one among the croup medicines which is characterised by
the production of false membranes in the larynx and trachea.
lodium will often be found useful in croup. I have tried
it with benefit in the chronic form.  It is indicated less by
the paroxysms of suffocation, than by the hoarse catarrh.
Elwest recommends Aconite, alternated with lodium    or
Spongia.
Gross speaks most highly of Hepar sulph., 1st or 3d
triturations following Acon. 3; or, Hepar and Spongia alternately.
Hering advises Hepar when the cough is hollow and
whistling, and after this Samb., Hyosc., Cina, &c., during the
first stage; but when the paroxysms of suffocation supervene,
Tart. em., followed by Spongia, &c.
Hartmann employs the same medicines as Hering in the
first period, after which he administers, during the paroxysms,
Acon., Spong., Hep., lod., Phosph., Merc., Rhus, &c.
Teste sets aside all these remedies, and places reliance on



BRONCHITIS.


36i7


harsh mucous or sub-crepitant rales are heard at different
parts, giving evidence of the extension of the inflammation
along the air-tubes.
This continues to extend until the smaller tubes are
occupied by the disease, the secretion becomes increased,
and general mucous rales heard throughout. The child
refuses to take the breast, or is interrupted by its cough at
every attempt, and the symptoms are aggravated towards
evening.
As the disease subsides, the mucous rales are found to be
less diffused, assume a softer character, the respiratory
murmur which was harsh and loud, or scarcely distinguished
in consequence"of the general prevalence of the other sounds,
becomes natural, and a soft crepitus alone is heard in situations where the inflammatory action has been most intense.
The breathing is rendered more free, and the cough loose
and easy.
In children the phlegm is always swallowed, and sometimes
appears in the evacuations, which are either white, chalky,
or slimy and mucous, or have the appearance of chopped
eggs.
W-hen the disease occurs in the most acute form, the
catarrhal symptoms are frequently absent, and the attack
sudden; on the other hand, a low form of subacute bronchitis, which has originated in a slight catarrh or influenza,
is often a protracted and dangerous form of the disease. It
is very common, when the attack has commenced with a
cold, for the symptoms to retrograde in the order in which
they supervened, the inflammatory irritation receding along
the mucous membrane lining the larger bronchial tubes, the
larynx, and throat, terminating as it began, in a common
inflammatory sore throat.
If it happen to be the concomitant of measles, or any
other eruptive fever, it differs not essentially from the
ordinary form of the disease, except in the greater amount
of hoarseness and debility which results from the constitutional affection.
Bronchitis in young children may terminate by resolution,
or if not speedily reduced, may pass into the chronic form,



PNEUMONIA.


369


laboured, with mucous rAles and sore throat, and especially
when cerebral symptoms present themselves.
Chamomilla, 3, is one of the most useful remedies in the
affections of the chest in very young children, when the
wheezing is great and the breathing hurried, with symptoms
of catarrh; when there is redness of one cheek and pallor of
the other, with white or egg-like evacuations, &c.; or if
suffering from dental irritation.
Hepar s. c., when there is hoarseness, with loose rattling
mucus in the chest, which is easily detached; or when the
attack is complicated with symptoms of croup, &c.
Calcarea carb. is very beneficial in a chronic form of
bronchitis, when the symptoms are not thoroughly dissipated,
and an irritable condition of the bronchial membrane remains, as in delicate or scrofulous children.
Silicea is advantageous under similar circumstances.
Coffea is useful when   a child suffers from   bronchial
irritation in connection with dentition.
Cina, when the same state is dependent upon the presence
of worms in the alimentary canal.
Arsenicum, 30, will be found highly successful in the
bronchitis which accompanies an attack of influenza.
Dulcamara, Pulsatilla, Ipecac., Drosera, Ignat., Tart. em.,
Sulph., are very serviceable in some cases, and may be
applied where the symptoms correspond.
PNEUMONIA.
INFLAMMATION OF THE LUNGS.
Inflammation of the parenchyma or substance of the
lungs is a much less frequent disease in childhood than
bronchitis; indeed it is rarely idiopathic, but is occasionally
a complication with that disease, or with typhus, some of
the eruptive fevers, or hooping-cough.    It is often very
difficult to distinguish the two, one passing almost imperceptibly into the other. The expectoration which, in adults,
is one of the principal symptoms pathognomonic of the
disease, it is quite evident, cannot be a guide in the case of
24



370


DISEASES OF INFANCY AND CHILDHOOD.


infants; and the physical signs afforded by the ear or the
stethoscope are less distinctly marked, from the circumstance
that when the inflammation is seated in the minute capillary
bronchial tubes, there is no distinguishing the fine mucous
rale from th& ordinary pneumonic crepitus.
Moreover, the restlessness and cries of the infant are
great hindrances to a clear diagnosis.
The general symptoms of pneumonia resemble to a great
extent those of bronchitis, but there are a few which are
peculiar and pathognomonic.
The cough is less violent, though frequent and short, and
is unattended by the rattling of mucus. There is great
difficulty in expanding the chest; the respiratory murmur is
inaudible at different parts, or at one circumscribed spot,
over which there is dullness on percussion. If the disease
subsides, the air is heard to permeate these portions, or the
ordinary crepitant, succeeded by a soft mucous rAle, occupies
the site. These changes are more frequently to be discerned
at the posterior of the thorax.
The heat of skin is more pungent and persistent, but
there is a brighter and less livid hue; the shortness of
breathing is more decided, and the pulse occasionally intermittent.  If complicated with bronchitis, the mucous and
sibilant rAles may possibly obscure the other indications.
There is often circumscribed redness of the cheek of the
same side as the affected lung, and the child prefers lying
upon that side.
There is a greater rapidity of exhaustion in pneumonia,
and the disease is very fatal among children, especially when
associated with hooping-cough or influenza.
Treatment.-The treatment of pneumonia differs somewhat
from that of bronchitis. When the febrile symptoms are
active, Aconitum will be the first remedy to be employed, and
will often arrest the disease at the commencement; but if
the first stage of the disease is passed, the best and most
efficient remedy isPhosphorus, 12. This may be given every one or two
hours, alone or in alternation with Aconite, until all the
symptoms of pneumonia have disappeared.



372


DISEASES OF INFANCY AND CHILDHOOD.


paroxysmal character, the successive short expirations, closely
following each other, is sufficient, even without the whoop,
to mark the approaching disease.     The longer it exists
before the whoop is developed, the more favorable is the
disease likely to be.
When the hooping-cough is fully formed, the paroxysm
is preceded by a sense of suffocation, which excites alarm in
the child, who runs or clings to its nurse, or to a chair, to
secure some support during its continuance, and is silent
and sad for a few minutes; the cough then sets in, which is
at last relieved for an instant by a violent, full and loud,
noisy inspiration or whoop, after which the quick spasmodic
expirations recommence, and continue until a quantity of
phlegm is coughed up or vomited, alone or with the contents
of the stomach, and this usually terminates the paroxysm.
During the fit, the child appears almost suffocated; it
chokes, tears run from its eyes, the face becomes turgid
and purple, perspiration breaks out over the forehead, the
extremities get cold, the nose often bleeds, or blood may be
coughed up, and the whole frame is much agitated. The
fits vary in intensity and duration, occur most frequently at
night, and are excited by crying, by the action of eating or
drinking, by walking, or any hasty or sudden movement, as
well as by anger or other emotions.
After the fit is over, except when the disease is complicated
with any other affection, the child appears tolerably well,
and eats its meals with renewed appetite.
This disease is often dangerous to young infants, by inducing suffocation from spasm of the glottis, or convulsions.
In older children, inflammation, or emphysema of the lungs
and consumption, are most to be apprehended.
The decline of the disease is generally marked by
symptoms of bronchitis; but in some irritable constitutions,
in consequence of the connection which exists between the
specific nature of the disease and the brain and medulla
spinalis, a spasmodic cough, of a very obstinate character, is
left behind.
Treatment.-The relief afforded in this disease by the
Homoeopathic treatment is, as compared with the old system,



HOOPING-COUGH.


373


astonishing, and the old notion, that it must last until May
is over, may, very justly, be exploded.  The disease has been
divided, for the better regulation of its treatment, into three
stages, namely:-the catarrhal or febrile,-the spasmodic,and the nervous, or stage of debility. The two last, however,
are often merged one in the other.
In the first or catarrhal stage,Aconitum, 12, may be given, when the ordinary febrile
symptoms are distinct, or the patient is robust and excitable,
and grasps at the throat, as if in pain, with a dry cough. A
dose of Aconite may be given every day, in addition to
other remedies.
Belladonna, 30, will be advisable after the former remedy,
and is indicated by a dry cough, with spasmodic constriction
of the windpipe, and preceded by crying, It is, sometimes,
very useful in alternation with Cina.
Conium, 30, will be found serviceable in hooping-cough,
when the fits of coughing occur most frequently at night,
and are violent, suffocative, and attended with flushes of redness in the face and bloody expectoration, especially in
scrofulous subjects.
Dulcamara, 12, will be most useful, when the catarrhal
stage has been induced by exposure to cold and damp, the
expectoration being loose and moist, with slight hoarseness.
Pulsatilla, 12, corresponds to the same symptoms, especially
if vomiting be present; also, when the disease assumes the
character of an ordinary bronchitis.
Ipecac., 6, is often very beneficial in this stage, when
there is an accumulation of phlegm at the chest, with threat
of suffocation and sickness; also when the cough continues
after the convulsive attacks are dissipated.
Chamomilla, 3, will be required, when the disease is
ushered in by bronchitis, and attended by irritation in the
windpipe, with a dry cough.
Pulsatilla, Mercurius, Hepar s., Nux vomica, and Phosphorus, may be required in various complications of the
disease, the latter especially, when pneumonia exists. Dose:
-One drop of the tincture may be stirred up in two
table-spoonfuls of  water, and   one  tea-spoonful given



374


DISEASES OF INFANCY AND CHILDHOOD.


every three, four, or six hours, according to the urgency of
the case.
In the second or convulsive stage,Drosera, 9, should be given, when the catarrhal symptoms
are removed; it is especially suitable against the paroxysms
of coughing, with the usual accompanying symptoms, and
when there is a hoarse and long cough. Drosera is said by
Hartmann to be ineffectual in the case of scrofulous patients.
A globule may be given every two or three hours, until
relief of the characteristic sound, or of the paroxysmal
character, is obtained.
Arnica, 12, should be given, when bleeding from the nose
takes place, or if the paroxysms set in with weeping.
Corallium rubr., 12 or 30, is highly extolled as a successful
remedy in this stage, and may be given at the earliest period
that the convulsive character declares itself.  It should be
administered for three or four days together.
A globule should be given every four or six hours.
As soon as this medecine ceases to improve the symptoms,
probably at the end of four or five days,Chelidonium majus, 6, may be given, and continued until
the hooping cough is converted into a simple bronchitis, unless
the spasmodic fits of coughing, or cerebral convulsions, or
spasms of the windpipe, should return,
Pulsatilla, 12, will be required when the disease has
assumed the character of an ordinary bronchitis, with loose
and easy cough, diarrhoea, and slight hoarseness.
Veral4um, 30, is indicated in the convulsive stage, as well
as in the nervous, if the child is debilitated, suffers from
cold perspirations, especially of the forehead, with vomiting,
involuntary emission of urine, a small, quick, and weak pulse.
Cuprum aceticum, 30, is indicated when the child is convulsed during the paroxysms, remains stiff and without
consciousness, and if the vomiting is troublesome. - It is often
more successful than Drosera against the wheezing and
hooping.
Cina, 9, is indicated when the child appears ravenous, or is
affected with worms, thrusts its fingers into the nose, or if there
are convulsions. It is especially suitable to scrofulous children.



HOOPING-COUGH.


375


In the third or nervous stage,Besides the remedies previously indicated, some of which
may be resumed under the present circumstances, recourse
may be had toLachesis, 30,-if extreme faintness and debility be manifested, together with a bronchial cough, &c.
Causticum, 30,-when at the decline of the disease, a little
dry cough remains.
Arsenicum, 30,-when, symptoms of great nervous de.
bility present themselves, with pallor and coldness of the
surface, &c.
Veratrum or Carbo veget. are also likely to be useful in
this stage.
Tinct., Sulph., Sepia, and other anti-psorics, are required
when chronic ailments are aroused by the disease.
The diet of the patient must be regulated according to
the circumstances of the case, and the period of the disease.
If no inflammatory complications exist, the child should
have plain, nutritious food throughout, as the violence of the
paroxysms tends greatly to reduce the strength.     In the
last stage, more particular care must be paid to this, and
change of air is one of the best auxiliaries we can have, in
the work of completely recovering the patient.



DROPSY IN THE HEAD.


377


or scrofula, and would appear to be not unfrequently dependent upon family predisposition.
Children with large heads and vivacious intellect are
perhaps more predisposed to the disease than others.
Cases have occasionally occurred in which -all the symptoms of hydrocephalus have been present, but, on examination after death, no fluid has been found effused within the
cranium.
In these instances evidences of inflammation of some
part, mostly the membranes, together with venous congestion
of the brain, have been observed.
Acute hydrocephalus presents two varieties, namely, one,
wherein the effusion takes place within the ventricles of the
brain; and the other, in which it happens externally to 1the
brain, but within the bag of the arachnoid membrane. 'The
latter is a rare form of the disease; but it occurs sometimes
cotemporaneously with the dropsy which follows scarlet
fever, and is therefore worthy of notice.
It is marked by disorder or abolition of the functions of
the brain, squinting, dilated pupils, loss of sense, convulsive
movements of the head, the muscles of the face, and extremities; jactitation of the limbs, coma, and insensibility;
the bowels are inactive and the urine scanty; the pulse is
small and rapid, or scarcely perceptible; the countenance
pale and oedematous.     The   general anasarca   which   is
present is sufficient to indicate the cause of the cerebral
disorder.
The acute internal dropsy of the brain is a disease of a
more obscure and complicated nature. It is divided into
the gradual, the sudden or violent, and the secondary, according to the mode of attack or the cause.
Whilst all three may present the same symptoms when
they have become fully developed, the manner in which they
successively appear differs, and this has given rise to the
variety of description which we meet with in different
treatises on the subject.
The complicated origin of the disease also accounts for the
obscurity of the earlier symptoms, for it is found that in some
instances the disease appears to result from certain derange



ATROPHY.


381


jerking of the limbs, watery diarrhoea, with redness of the
face, wild, staring look, throbbing of the carotids, thirst, &c.
Stramonium   corresponds to similar symptoms, with wild
delirium, and violent congestion of the head; strabismus, &c.
- Digitalis is recommended by Hempel, in hydrocephalus;
and is indicated by bilious vomiting, white evacuations, and
slow or irregular pulse, but is chiefly indicated in the second
stage of the disease.
Arnica, as an intercurrent remedy in the paralytic state,
or the stage of effusion; or, at the onset, when the disease
has originated in a fall or blow.
Staphysagria and Ferr. chlor., are recommended to be
used alternately in the chronic form for fourteen or fifteen
days.
Camphora to be given daily for several weeks.
Puls., Calc., Chamin., Rhus, Artemisia, Ipecac., Ignatia,
Moschus, Indigo, are also among the remedies which have
corresponding relations with different phases of the disease.
ATROPHY.
Atrophia Lactantium, or the atrophy of infants at the
breast, generally arises either from deficiency or impoverishment of the milk of the mother or nurse, and commences at
the second or third month. The infant gradually pines and
wastes, is constantly uttering cries of distress, and drawing
up its legs from the pain produced by the flatulent state of
the intestines. To make up for the imperfect supply of the
mother, thick food is frequently given which adds to the
suffering by inducing more flatulence and probably diarrhoea
in addition.
But atrophy may also arise from other causes, such as
enlargement and induration of the mesenteric glands, the
irritation of dentition, or of worms, and improper medication.
It is well understood that calomel is a not unfrequent cause



382


DISEASES OF INFANCY AND CHILDHOOD.


of this enlargement of the mesenteric glands and consequent
atrophy, by irritating the mouths of the lacteal vessels where
they open upon the intestinal mucous membrane. The
morbid action hereby excited is conveyed along these channels to the glands through which they pass, and enlargement
and induration is the consequence.  Nevertheless, mothers
who indulge in the lauded powers of calomel are continually
inflicting this heavy misfortune upon their children, through
being over solicitous about the liver and bowels.  The disease is most frequent in scrofulous children, to whom
mercury is poison.
The symptoms which generally precede or accompany
atrophy are,-frequent bellyache, with irregular bowels, the
motions being too frequent and variegated, or clay-coloured
and watery; acid odour, not only of the evacuations, but
also of the breath and perspiration; fickle appetite, and
much thirst; the urine is often turbid and white; the child
is fretful or quiet, sullen, and indifferent, less playful than
usual, and cries peevishly. The countenance changes colour
frequently, and the tongue is creamy, or morbidly clean and
red.  There is swelling and hardness of the belly, with
emaciation; sometimes irregular small tumours are to be
felt through the abdominal parietes; the skin becomes
shrivelled, the complexion earthy, the appetite voracious;
diarrhoea supervenes, if it has not existed throughout; there
is slow, continual, or remittent fever, augmenting towards
evening, with flushing of the cheeks, a hot, dry skin, and
incessant cough, extreme restlessness, increasing debility,
and finally hectic.  In this form of scrofulosis, the bowels
and the secretion poured into them require to be regulated,
not by purgatives, however, but by remedies which are consonant with the general state of the patient.
The resolution of glandular enlargements has to, be
accomplished, and the scrofulous diathesis to be corrected,
before the slow and wasting decay can be arrested. Without this can be done, chylification and sanguification, or the
formation of the chyle and blood, are prevented; or these
elements of vitality carry with them into the system crude
and ill-elaborated fluids, which obstruct the glandular system



ATROPHY.


383


in all directions, the consequence of which must be sooner
or later fatal.
The slow and silent march which characterises the earlier
stages of atrophy from disease of the mesenteric glands, often
prevents it being recognised until it is too late; and pathology
fails to point to us any indications by which we may know
it at a time when remedies might be of the most signal
service.
Treatment.-In the management of this disease diet is of
essential importance, not only in order that a due and
proper supply of nutritious and easily-digestible aliment
should be afforded to the weak and irritable digestive
organs, but likewise, that what is given should not interfere
with the curative reaction to be established by the remedies.
With this view, if the nurse's milk is not perfect, asses or
goat's milk should be substituted, or veal broth be given, as
an occasional addition.  If the child is older, strong broth,
beef tea, and vegetables should be given, to the exclusion of
solid meat, which the digestive organs are not in a condition
to convert into healthy chyle.
The remedies which are best adapted to meet the several
and varied conditions presented by mesenteric scrofulosis,
are:- Tinct. sulph., Calcarea, Chamomilla, Arsenicum, Hepar
s., Cina, China, Nux v., Bryonia, Belladonna, Pulsatilla,
Rhus, Mercurius, Magnes. carb., Phosphorus, Phosph. acid.,
Baryta carb., Conium, Sepia, Petroleum, lodium, Sarsaparilla,
Aloes, Colchicum.
The accidental symptoms must be met by the apsorics,
while the scrofulous diathesis will be rectified most successfully by the antipsorics.
Tinct. sulph., 5,
a teaspoonful three times a day.
This medicine is one of the first, if not the first, to be
used in this disease. It is peculiarly applicable to the earliest
symptoms, and to the scrofulous dyscrasia which is at the
root of it.
Calcarea, 6, is equally suitable to. the constitutional



384


DISEASES OF INFANCY AND CHILDHOOD.


dyscrasia, and should be given after the Sulphur has been
used for one or two weeks.    In cases where the disease is
diagnosed early, and not rapidly developed, these two
remedies, alternated weekly, for a month or two, are often
effectual to the complete cure of the disease.
The same dose as indicated for Sulphur.
When the disease is further advanced, and the above
remedies are either not perfectly homoeopathic to the
symptoms, or have produced a certain amount of benefit and
then ceased to improve the condition of the patient, the
following three medicines may be used with the greatest
effect, and have been highly extolled by a French author as
exercising a powerful influence over the disease:Sarsaparilla, 18, Aloes, 6, and Colchicum, 12.
They may be given alternately in this order, in the same
manner.as directed for Sulphur and Calcarea.
Baryta carbonica is another remedy of great service in
the scrofulous diathesis, when the abdominal glands are
enlarged, with extreme sensitiveness to touch, and dysenteric
or diarrhoeic stools.
Conium  mac. is indicated in this disease when there
exists hardness and distension of the abdomen, with sour
eructations, and exhausting watery evacuations, and burning
pressure in the anus.
Hepar sulph. has also a distinct effect upon the glandular
system; and may be given for the sour smell, with constant
fetid and white evacuations.
Chamomilla, 3, is most useful in relieving the gastric and
abdominal irritation, which so often proves an exciting cause
of the disease, or accompanies its early development. It
may be given with great advantage when the following
symptoms exist:-frequent bellyache, diarrhoea, variegated
motions, furred tongue; fickle, variable, or entire absence
of appetite; the natural flow of spirits is checked- frequent
change of colour, &c.  It may be given at any period of the
disease.
Cina, 6, is the best remedy when ascarides are present in the
evacuations, and there is paleness of face, voracious appetite,
&c.   It may be given before or in alternation with Calcarea.



ATROPHY.


385


China, 12, ispreferable when the abdomen is very sensitive,
the appetite voracious, the stools frequent, whitish, and
papescent, and the patient languid and feeble.
Nux v., 30, may be given if there be constipation, with
gastric disorder; also when the child looks sallow and
bloated, is emaciated, craves for bread; if there are thirst,
irritability, languor, with occasional vomiting, &c.
Arsenicum, 30, is indicated by severe colic, diarrhoea, with
acrid evacuations; canine hunger which is not relieved by
Nux, Bryonia, China; prostration, quick breathing, &c.
Pulsatilla, 12, may be administered when there is canine
hunger, with slimy evacuations, which are papescent rather
than watery, and occur particularly at night.
Rhus tox., 12, is sometimes useful when there is canine
hunger, which alternates with indifference to food; and
diarrhoea with colic which occurs after midnight.
Mercurius sol. or corros., 12, when the rachitic character
prevails, with enlarged glands, and a hectic or suppurative
fever, exhausting night sweats, especially on the upper part
of the body; greenish, fetid, or sour smelling evacuations;
also a short, exhausting cough, which induces retching.
Magnesia carb. is indicated when acidity prevails in the
gastric and abdominal secretions.
Phosphorus or Phosphor. acid. will be found useful against
the diarrhoea when it does not yield to some of the other
remedies already pointed out.  They are also homoeopathic
to glandular indurations.
Sepia, Petroleum, Lycopodium, lodium, are likewise occasionally indicated.


25



CANKER.


387


must be immediately carried out, if possible, and then a
healthy reaction must be attempted to be excited in the
system by the following remedies:Secale cornutum, 6, which corresponds to dry gangrene of
various tissues.
lodium, 6, which has a distinctive relation with the
malignant tubercle on the cheek, with the state of the mouth,
the swelling and inflammation of the mucous membrane,
and the fetid secretions.   The medicines ought to be
administered frequently, and at low potencies.
Kali hydriodicum is also applicable for the same reasons
as the former.
Anthracin has been recommended by Gross, if Secale does
not succeed.
Mercur. corros., Helleborus, Kreasotum, Acid. mur., Tart.
em., Carbo veg., Chlorine, have also been proposed by very
competent authorities as being indicated by the symptoms.
Some children are also subject to a fretting inflammation
of the lining of the labia pudendi, attended with mucous or
sanguineo-mucous discharge, and an eruption of minute
vesicles.  It causes great irritation, ahd makes the child
rub herself or move about in the chair in a peculiar manner.
It is generally connected with disordered stomach, and occurs
in delicate or scrofulous children.  Sometimes it depends
upon the irritation of teething.    It is also frequently
accompanied by the same kind of affection in the nostrils
and upper lip.  It is of very little consequence, although it
is sufficiently so to attract the anxieties of the mother.
The remedy for it isCalcarea, 12, alone or preceded by Sulphur, 30.



388


DISEASES OF INFANCY AND CHILDHOOD.


WORMS.
Intestinal worms are found at every period of life, and
are always connected with a deranged state of the secretions
of the alimentary canal; and, consequently, are considered
rather as a symptom of certain morbid conditions, to the
correction of which all therapeutic operations should be
directed; or, in other words, the product of disease, and not
the disease itself.  This is fundamentally true; nevertheless, the presence of worms in the bowels gives rise to certain
phenomena which are added to those that anticipated their
production, and which require palliative remedies occasionally, at the same time that the main treatment must be carried
on against the morbid state of the system which favours their
continued generation.
How these entozoa come to exist in the human body,
whether they are the result of what is called equivocal
generation, which is described as "the formative effort of a
living principle in substauces in which life has confessedly
ceased to exist;" or, as is much more probable, whether the
germs are always received from without, by the air and food
taken into the body, is matter of controversy.  That which
is most important in a practical point of view, is, as observed
by Cloquet, to endeavour to discover, by what concurrence
of circumstances favorable to their development the germs of
entozoa, whose presence had never been suspected, are suddenly animated in the human body, especi-lly in the
intestinal canal, where they are engendered with great facility,
preventing it fulfilling its natural functions, and thereby
acting injuriously upon the whole economy.
The worms which infest the human intestines are chiefly
of four kinds, namely:
Oxyures, or ascarides vermiculares-maw or thread-worms.
Ascarides lumbricoides-long round worm.    Tcenia latabroad tape worm.    Solium-long tape worm.      Trichuris
vulyaris- long thread-worm.
The taenia lata is very rarely met with in this country, but



390


DISEASES OF INFANCY AND CHILDHOOD.


long, and two thirds of this form a tail like a hair; the body
is about the sixteenth of an inch thick, and the worm is
white, like the ascaris. It exists in the rectum, and sometimes as high as the ilium.
The taenia consists of many flat-jointed portions, and is of
considerable length, commonly several feet, but frequently as
many yards.    It generally passes in separate portions, and
occupies the whole length of the intestinal tube. But as this
is seldom found in early life, any further description is out of
place here.
These several kinds of worms have not unfrequently been
found in the intestines at the same time.  The one kind is
not therefore an antidote to the others, as some have
supposed.
The evacuations produced by castor-oil sometimes have
the appearance of a mass of thread-worms. Frank, who has
written upon these animalculse, states, that he was once
requested to see a prince who had been attacked with epilepsy.   His physician, a respectable old man, assured him
that he could make him void at pleasure thousands of filiform worms. As he was neither able to define the genus or
species of these worms, the quantity of which, from his
account, seemed to be prodigious, Frank requested to be a
witness of the phenomenon. The physician administered a
dose of castor-oil, which procured many stools, in which were
thousands of whitish filaments similar to small eels; but, on
an attentive examination of these pretended worms, they
were found to consist entirely of the castor-oil in a state of
coagulation.
The general symptoms which may be said to indicate the
presence of worms, all of which never occur in one individual,
are very numerous and varied, dependent upon the morbid
state which has in the first place favoured their development;
secondly, upon the locality they have adopted; and thirdly,
upon the degree of irritation and secondary affections to
which they have given rise: all of these circumstances combine to form the general outline of the disease of which the
worms are the most distinctive feature: some children, however, are in the habit of passing worms freely, without much



WORMS.


391


inconvenience to their general health, while others, on the
contrary, suffer considerably, with apparently few worms.
Independently, then, of the appearance of worms in the
evacuations, their existence in the intestines may be prejudged by some of the following symptoms, many of which
are equivocal.
Sudden and frequent change of colour in the face, which
is sometimes red, sometimes pale, or lead coloured: dark
blueish circle under the lower eyelids; augmentation or
diminution of the brightness of the eyes; unsteady look,
dilatation of the pupils; itching of the nose, with frequent
picking or boring in it; bleeding from the nose, headache
after meals; flow of saliva, especially during the night;
tongue dryish, with red tip and edges; faint odour of the
breath, which is fetid, especially of a morning; bad state of
the gums; thirst; fickle, variable appetite, sometimes it is
voracious, or it may be null; uneasiness after food; swelling
and hardness of the abdomen, with sharp pains now and then,
either pinching or twisting; rumblings in the belly; vomitings; costiveness, or irregular diarrhoea, with slimy stools;
itching at the anus; emaciation; short, hacking, dry cough;
dullness and peevishness; restless sleep, with startings, and
grinding of the teeth; sometimes even convulsions, tetanus,
epilepsy, and partial palsies of the lower extremities; St.
Vitus's dance, wry faces, and odd gestures, hiccough, and
small pulse; fever, with affection of the head, &c.  An
cedematous swelling of the upper lip and of the nostrils has
been noticed as a frequent accompaniment of worms.    A
lingering fever is not unfrequently terminated by the evacuation of a large round worm, which had probably been
driven out by the morbid heat of the bowels, or absence of
nutriment.
Worm   affections are observed to increase and decrease
with the moon.     Any general derangement of health,
which induces morbid secretions in the stomach and bowels,
will cause a return of these parasites.
The diagnosis of worms is sometimes very difficult to
accomplish.  The predisposing causes are: general debility,
hereditary or acquired, of the digestive organs; a scrofulous



392


DISEASES OF INFANCY AND CHILDHOOD.


habit; a sedentary and idle life; poor or improper diet;
unhealthy damp atmosphere, or locality, &c.
Treatment.-A multitude of remedies correspond in their
pathogenesy to the symptoms of Helminthiasis, or worm
disease, from which one or two may generally be selected
appropriate to the condition of the patient, even when there
has been no ocular demonstration of the worms themselves.
It is nevertheless very desirable to watch for their appearance
in the evacuations. The following is a summary of those
medicines which have been most recommended:-Acon.,
Bellad., Cina, China, Carb. v., Digit., Ferrum, Asar., Calc. c.,
Filix mas., Graph., Ignat., Ipecac., Marum v., Mere., Nux v.,
Pulsat., Lach., Sabad., Spigel., Stram., Stann., Silic., Valer.,
Verat., Viola od., Sulph., Urt. ur., &c.
Cina, 12, and Sulphur, 30, enjoy the greatest repute when
worms appear in the evacuations, with boring at the nose,
unquiet sleep, cephalic symptoms, paleness of the face,
dilated pupils, white turbid urine, &c.
They may be given alternately once a week.
Sulphur is particularly useful if given at the full or wane
of the moon, when the symptoms are aggravated at that time.
Viola odorata, 6, is preferred to Cina by some, when the
worms pass with the stools.   It should be given several
times a day.
Stannum, 30, is indicated when nervous symptoms accompany the presence of worms, such as-melancholy, sadness,
violent cough, sudden faintings, tetanic rigidity, partial or
general convulsions, attacks of epilepsy, &c.  It should be
given only once a day.
Aconitum, 12, may be given once or twice a day, when
the itching at the anus is very troublesome and is worse at
night, with fearfulness, or when vascular excitement exists.
Belladonna is useful when the cerebral functions are
disturbed, with starting during sleep, thirst, involuntary
evacuations, &c.
Ignatia, 12, when Aconite does not relieve those symptoms, or elseIpecac., 6.
Nux vomica is indicated when there is constipation, with



WORMS.


393


distension of the abdomen, and yellowness around the
mouth, &c.
Silicea, 30, may be given with advantage when the
symptoms are aggravated at the new moon; if given just
at the change, its action is more decided.  It is often most
successful in eradicating the disposition to worms. For this
purpose Sulphur should be given at the full moon, or just
at the wane, in alternation with the Silic.  Three globules
may be dissolved in six or seven teaspoonfuls of water-one
to be taken every morning. Should there be no amelioration
at the full of the moon following,Calcarea, 30, may be given in the same manner.      This
remedy is also very useful in correcting the tendency to
worms, in scrofulous and lymphatic subjects, and is often
sufficient to eradicate the disease.
Teucrium marum ver. is sometimes useful when the itching
and creeping are intolerable, with loss of appetite, restlessness at night, irritation of the nose, &c.
Urtica urens corresponds to the same symptoms.
China is often beneficial when there is diarrhoea, fulness
of the abdomen, distension after every meal, tremor, and
debility.
Ferrum acet., if there is much vomiting and flow of water
in the mouth.
Valeriana, when there is nightly itching, and muscular
spasms, sleeplessness, &c.
Mercurius for the violent diarrhoea and tenesmus, especially if the evacuations are streaked with blood.
Spigelia, if there is palpitation of the heart, pinching
pains in the abdomen, nausea of a morning, coldness, and
diarrhoea, craving and thirst, sense of crawling up into the
throat, &c.
Chamomilla, Hyoscyamus, Stramonium, will be useful if
convulsive actions are combined with the presence of worms.
Stramonium if there are partial spasms of the abdominal
muscles, and ineffectual urging to stool.
Cicuta virosa, 12, where there is fever with colic and
convulsions.
Lycopodium, 30, Veratrum, 18, Ipecac., 9, have been



394.


DISEASES OF INFANCY AND CHILDHOOD.


strongly recommended to be given in succession. The first
for two days; after waiting two more, the second remedy
to be given for four days; after pausing again, the third
remedy to be administered for three or four days.     Three
globules of each to be dissolved in eight teaspoonfuls of
water-one to be given three times a day.
These are the principal remedies which have been most
successful in the treatment of the Ascarides and Lumbricoides; for the Taenia recourse may be had also to Aconitum,
Cina, Filix mas., Punica gr., Argent. nitric.
In  addition  to these remedies, some relief may be
obtained, when the worms occupy the rectum in great
quantities, thereby exciting troublesome irritation, by giving
an enema of olive oil, or salt and water, or lime water.
The diet should be carefully regulated; nourishing and
substantial food may be taken, except when febrile symptoms
are present.  Meat is preferable to liquid food; and pastry,
puddings, vegetables, and raw fruits ought to be avoided.
STROPHULUS, OR RED GUM.
This affection is common to infants at the breast, and
shows itself on the face, neck, and extremities.  It consists
of an eruption of red or white papulous spots on different
parts of the body, which are firm to the touch, vary in size
from a small pimple to that of a pea, sometimes exist singly,
at others a number coalesce together and form larger spots,
which itch considerably, and terminate by a slight desquamation   of the cuticle.   The white ones are generally
surrounded by a small areola. The disease has been divided
into several varieties from the appearance, distribution, and
colour of the spots, as, Strophulus intertinctus, confertus,
volaticus, albidus, candidus.
The first kind is called red gum, and occurs during the
first month.  It is indicative of acidity in the primm vime.
The others, termed for the most part tooth rash, are seen at



396


DISEASES OF INFANCY AND CHILDHOOD.


PITYRIASIS, OR DANDRIFF
Is characterised by a dry, scurfy eruption, which forms upon
the forehead and head of infants, and consists of a bran-like,
powdery exfoliation  of the   cuticle, sometimes red, but
generally leaving the parts affected whiter than when in
their natural state.
The different well-defined forms of this disease are:-the
simple;-the red;-the black;-and the variegated; and
these occur on different parts of the body, and at all ages;
but the first is that which is met with in infancy, and of
which we have to speak in this place.
It is often a very troublesome affection, and excites a
great deal of irritation, by the itching which accompanies it.
The forehead is usually covered with a thick, white scurf; but
farther back on the head, it forms into larger scales.
Pityriasis is distinguished from the exfoliations of cuticle,
which occur after fevers and other morbid states of the skin;
by the furfuraceous scales which follow it; and by its being
always dry.
Treatment.-The treatment of pityriasis consists in the
administration of remedies in accordance with the general
symptoms, constitutional and accessory, which the patient
may present.   The medicines most generally useful, are,Mercurius sol., 30.
Two globules to be dissolved in six teaspoonfuls of water,
-one to be taken every night and morning.
This may be followed, after a few days or a week, bySulphur, 30,
in the same manner.
The effects of this last medicine may then be watched;
and if other remedies should be required,Cantharis, 30,
should be given; after which, the following may be selected
from, if the disease has not yielded:-Arsen., Bryon., Calc.,
Kreas., Sil., Sulph., Dulc., Graph,, Lye., Phos., Sepia.



400


DISEASES OF INFANCY AND CHILDHOOD.


M. Gruby, to be vegetable parasites, resembling the "mould,"
and belonging to the genus Mycodermis of the crytogamous
class.
He has closely analysed its production and growth by4
means of the microscope, and described the cellular and
vegetable character with great minuteness; but however
clearly it may seem to be demonstrated to the satisfaction
of microscopic observers, there is too close an analogy between the earlier forms of animal and vegetable development
to fix our assent to the correctness of this theory; but practically it has little value.
Treatment.-When the disease appears on the scalp, the
hair should be cut close, the parts washed frequently with
plenty of soap and water, after which no local application is
requsite.  The treatment of this affection is a triumph for
Homoeopathy.
The medicine which merits the first attention in this
disease is,Sulphur.  In almost all cases the following perscription,
persevered in for some time, with the occasional interposition of a dose of Mercurius, will suffice to cure the disease.
Sulph. (Tinct.) 5,
two drops added to six table-spoonfuls of water, and a teaspoonful of the mixture being given three times a day.
Viola tricolor, 30, may be given alone or alternated with
the Sulphur, when there is much itching.
Dulcamara, 12, is also very useful.
Oleander is said by Hartmann to be very successful, when
the eruption is characterised by much painful itching, and
burning heat, which is insupportable at night, after the
heads are scratched off; and if, at the same time, there are
symptoms of disease of the mesenteric glands.
Hepar s., 30, is indicated when the eruptions, instead of
being confined to the head, invades the face and neck. Also
when it is complicated with ophthalmia.
Arsen., Phosph., Baryt., Brom., Calc., are often useful in
obstinate cases.


FINIS.



INDEX.


Abscess of the breasts during lactation, 171.
Abdomen, pendulous state of the, after
delivery, 164.
Abortion, or miscarriage, 111.
predisposing causes of, ib.
exciting causes of, 112.
Accessory management of pue'rperal metritis, 238.
Accumulation of air in the uterus, 277.
Acid-nitrate of mercury in the treatment of
uterine disease, 220.
Aconite, remarks on, 8. -
Action of assafsetida on the milk during
suckling, 169.
Advantages of chloroform, 301.
Affection, hysterical, of the spinal marrow,
69.
of the mind, 70.
After-birth, retention of the, 136.
After-pains, 145, 154.
After-effects of scarlet fever, 344.
Air, collection of, in the uterus, 277.
Air-passages, inflammation of the; of children, 366.
Albus, fluor, 34.
Amenorrhcea, 22,
Anaemia of the brain and spinal cord favorable to hysteria, 60.
Ancient medical doctrines as regards Homceopathy, 1.
Antiflexion of the uterus, 246.
Antipsoric prophylactic treatment of the
infant, 309.
Antiversion of the uterus, 246.
Aphtha, or thrush of infants, 316.
Apparent death of the infant, 310.
Appearance of patients affected with disease
of the womb, 217.
Argumentative inconsistency of those who
write against Homceopathy, 2,3.
Aspect, peculiar, of patients affected with
disease of the womb, 217.
Asphyxia of the infant, 310.
Assafeetida, cases illustrating its action on
the milk during lactation, 169.
Atrophy of infants and children, 381.
Augmentation or excess of the lochia, 158.
Bennett (Dr.), opinions of, respecting diseases
of the uterus, 15.
Blood, redundancy of, incidental to pregnancy, 101.
discharges of (uterine haemorrhage)
ditto, 108..  discharge of, after delivery, 137..-spots on the scalp of the infant, 310.


Blue disease of infants (cyanosis), 311.
Bowels, state of the, after labour, 160..  looseness of the, of infants, 314.
Breasts, tension  or tightness of the, in
pregnancy, 103.
abscess of the, during suckling, 171.
hardness and swelling of, of infants,
312.
Breath, shortness of, incidental to pregnancy, 99.
Bronchitis of children, 366.
Bryonia, remarks on, 8.
Calves, cramps in the, during pregnancy,
105.
Cancer (scirrhous) of the uterus, 262.
cerebriform  (fungus haematodes) of
the uterus, 282.
Canker of children, 386.
Carcinoma of the uterus, 262.
Case of ovarian dropsy cured, reported by
Mr. Phillips, 296.
reported by Dr. B. Kingdon,
298.
Catamenia, 19.
quantity, quality, periods of
life, &c., of the, 20.
Cellular tissue, induration of, of infants, 312.
Cephalalgia hysterica, 68.
Cerebriform cancer of the uterus, 282.
Cervix and os uteri, simple induration and
ulceration of the, 252.
Chafings of infants, 315.
Change or turn of life, 54.
Chemical composition, &c., of chloroform,
299, 300.
Chicken-pox, 354.
Childhood, management of the diseases of,
307.
Childhood and infancy, diseases of, 310.
fevers of, 325.
Chloroform, 299.
its chemical composition, properties, and purity, 300.
its advantages, 301..   methods of use and conditions
requiring it, 304.
Chlorosis, 29.
predisposing causes of, 30.
exciting causes of, 31.
progress and Issue of, ib.
Chronic and hereditary diseases, prophylactic treatment of pregnancy
against, 123.
metrilis, 235.
Circinnatus herpes, 397.
26



402


INDEX.


Clarke, Dr. J., remarks on the puerperal
state, 145.
Climacteric, menstrual, 54.
Cold in the head of infants, 312.
Colic, incidental to pregnancy, 95.
Collection of air in the uterus, 277.
Congestion of the womb, 224.
causes of, 226.
Constipation, incidental to pregnancy, 90.
Constitution, hysteric, treatment of the, 66.
Contents, table of, xi-xvi.
Contusion of the vulva in delivery, 150.
Convulsions, puerperal, 176.
of infants, 318.
Corroding ulcer of the uterus, 260.
Coryza of infants, 312.
Cough during pregnancy, 107.
Cough, hooping-, 371.
Cow-pox, 354.
Cramps in the calves during pregnancy, 105.
Cravings or longings incidental to pregnancy, 90.
Cries of infants, 315.
Croup, 361.
inflammatory, 362.
spasmodic, 363.
treatment of, 364.
Crust, milk-, 332.
Crusta lactea, 332.
Cure of ovarian dropsy, reported by Mr.
Phillips, 296.
reported by Dr. B. Kingdon,
298.
Cyanosis of infants, 311.
Dandriff, 396.
Deformities at birth, 310.
Delivery, labour, treatment of, 125.
obstacles in the maternal passages
against, 132.
treatment after, 136.
haemorrhage after, 137.
inversion of the womb after, 148.
contusion of the vulva in, 150.
laceration of the perinaeum  in,
151.
retention of urine after, 152.
incontinence of urine after, 153.
hmemorrhoids after, ib.
state of the bowels after, 160.
pendulous state of the abdomen
after, 164.
falling-off of the hair after, 165.
Democritus and Homoeopathy, 1.
Dentition, 322.
Diagnosis in ovarian dropsy, 294.
Diarrhoea incidental to pregnancy, 91.
of infants, 311.
Diathesis, hysteric, 58.
Difficulties, urinary, incidental to pregnancy, 96.
Discharge,. menstrual, quantity, quality,
periods, age, &c., 20.
of blood   during   pregnancy,
108.
of blood after delivery, 137.


Discharge, lochial, and suppression of, 155,
156.
lochial, augmentation of, 158.
characteristic of organic  disease of the womb, 218.
Discoveries of Pard, and their success, 16.
Discriminative  investigation of ovarian
dropsy, 284.
Disease, blue, of infants, 311..    of the heart (organic) of infants, ib.
"Diseases of the womb, division of the, 17.
chronic and hereditary, prophylactic treatment of pregnancy
against, 123.
organic, of the womb, 207.
of infancy and early childhood,
management of, 307.
of infancy and childhood, 310.
eruptive, of childhood, 334.
Disorders of pregnancy, 83.
Displacements of the uterus, 239.
Disturbance consequent on incipient pregnancy, 84.
Doctrines, ancient, as regards Homceopathy, 1.
Dropsy of the womb, 278.
three varieties of, ib.
treatment of, 280.
of the ovaries, 292... discriminative investigation of, 294.
in the head of children, 376.
Dysmenorrhcea, 22, 40.
neuralgic, 41.
inflammatory or congestive,
42.
mechanical, ib.
operations resorted to, allopathically, in, 43.
Dyspncea and oppression incidental to pregnancy, 99.
Early childhood, management of the diseases
of, 307.
Ecchymosis on the scalp of the infant, 310.
Emaciation, characteristic of organic disease
of the womb, 218.
of infants and children (atrophy),
381.
Emansio mensium, 22.
Encephaloid tumour (fungus heematodes) of
the uterus, 282.
Ephelis, 121.
Errors of Dr. Madden's treatment of and
conclusions respecting uterine and ovarian
disease, 219.
Eruptive diseases of childhood, 334.
Erysipelas of infants, 331.
Excess of the lochia, 158.
Extremities, oedema of the, in pregnancy, 104.
Eye, fungus haematodes of the, case of
Marshal Radetsky, 284.
Eyes, inflammation of the, of new-born
infants, 313.
Fainting, incidental to pregnancy, 98.



INDEX.


403


Falling-off of the hair after confinement, 165.
Falling of the womb, 239.
False pains, 121.,
Febrile action consequent upon incipient
pregnancy,,86.
Fever, miliary (puerperal), 163... iinfantile remittent, 327..miliary, of children, 335.. scarlet, 339.
sequelme, orafter-effects of, 344.
Fevers of childhood, 325,
Fibrous polypus of the uterus, 272.
Fits, hysteric, treatment of the, 66.
Flooding (uterine  haemorrhage), during
pregnancy, 108.
Fluor albus, 34.
causes of, 38.
Fretfulness and cries of infants, 315.
Fulness of blood incidental to pregnancy,101.
Fungoid tumour of the uterus, 282.
Fungous polypus of the uterus, 272.
Fungus haematodes of the uterus, 282.
bleeding of the uterus, ib..bleeding, sympathetic symptoms of,
284..  of the eye, case of Marshal
Radetsky, 284.
Gendrin, his local treatment of uterine
disease, 219.
General remarks on the puerperal state, 139... of Dr. Gooch, 141.
and accessory management
of puerperal metritis, 238.
Gooch, Dr., his remarks on the puerperal
state, 141.
Granular polypus of the uterus, 272.
Green sickness, 29.
predisposing causes of, 30.
Hsemorrhage,uterine, during pregnancy, 108.
Haamorrhoids, incidental to pregnancy, 92.
after labour, 153.
Hair, falling off of the,after confinement, 165.
Hard turnours of the uterus, 266.
Hardness and swelling of the breasts of
infants, 312.
Hartung, Dr., his treatment -of fungus hoematodes of the eye, in Field Marshal
Radetsky, 284.
Head, cold in the, of infants, 312..   dropsy in the, of children, 376.
Headache, hysteric, 68.
incidental to pregnancy, 101.
Heart, palpitation of the, incidental to
pregnancy, 97..organic disease of, of infants, 311.
Heartburn consequent upon pregnancy, 89.
Hereditary and chronic diseases, prophylactic
treatment of pregnancy
against, 123.
treatment of the infant
against, 309.
Hernia of infants, 311.
Herpes circinnatus, 397.
Hiccough of infants, 312.


Hippocrates and Homoeopathy, 1.
Hives, 354.
Homoeopathic Law and ancient opinions, 1..   Hospital, Golden Square, cases
of hysteria at the, 60.
Homceopathy and ancient medical opinions,1
empty charges against, 2..   its accurate investigation of
medicinal properties, 4.
Hooping-cough, 371.
Horn-pox, 354,
Hospital, London Homoeopathic, cases of
hysteria at the, 60.
H ydatids of the uterus, 269.
Hydrocephalus, 376.
Hydrometra, 278.
Hydrops ovarii, 292.
Hygienic Rules to be observed during pregnancy, &c., 81.
treatment during labour, 128.
Hysteralgia, 72.
Hysteria, 57.
migratory, cases of, 60, 61.
favoured by anemia, 60.
S  simulating inflammatory or spasmodic   affections  of  other
organs, 59.
sympathetic affections dependent
upon, 59, 60.
Hysteric diathesis, 58, 66.
paroxysm, ib.
treatment of the, 64...   headache, 68.
affection of the spinal marrow, 69.
states of the mind, 70.
mania, 71.
[104.
Impressions, moral, peculiar to pregnancy,
Improper and undue lactation, 207.
Incipient pregnancy, disturbance consequent
upon, 84.
Inconsistency of the opponents of Homceopathy, 3.
Incontinence of urine after labour, 153..    of infants, 315.
Induration and ulceration of the os and
cervix uteri, 252.        [312.
S  of the cellular tissue of infants,
Infancy, management of the diseases of, 307.
Infancy and childhood, diseases of, 310.
Infant, management of the, 307..treatment of, against hereditary
disease, 309..asphyxia of the, 310..  cchymosis on the scalp of the, ib..diarrhoea of, 314.. sleeplessness of, ib..cries and fretfulness of, 315..retention of urine of, ib..profuse urination of, ib..intertrigo or chafings of, ib..aphthm, or thrush of, 316..jaundice of, 317..spasms of, 318..convulsions of, ib.
Infantile remittent fever, 327.



INDEX.


405


Modified or spurious smallpox, 354, 355.
Moles of the uterus, 268.
Monstrosities, 310.
Moral impressions peculiar to pregnancy, 104.
New-born infants, inflammation of the eyes
of,, 313.
Nipples, sore, during suckling, 170.
Nitrate of silver, in the local treatment of
uterine disease, 220.
acid of mercury, ditto, ditto, ib.
Noma of children, 386.
Nux vomica, remarks on, 10, 11.
Nymphomania, 201.
Obstacles in the maternal passages which
oppose delivery. 132.
(Edema of the extremities during pregnancy, 104.
Ophthalmia of new-born infants, 313.
Opinions, medical, which have prevailed in
remote periods, as regards Homoeopathy, 1.
Oppression incidental to pregnancy, 99.
Organric disease of the heart (cyanosis) of
infants, 311.
Organic diseases of the womb, 213.
methods of investigation of
the, 215.
of the ovaries, methods of
treatment of, 219.
Os and cervix uteri, induration and ulceration of the, 252.
Ovarian disease, opinions as to the treatment
of, by Jobert, Gendrin, Bennett,
and others, 219..dropsy,292.. case of, cured, reported by
Mr. Phillips, 296..by Dr. B. Kingdon,
298.
Ovaries, inflammation of the, 288.
suppuration of the, 289.
Ovarii hydrops, 292.
Ovaritis, 288.
chronic, 289.
consequences of, ib.
predisposing causes of, ib.
Pain as an index of disease of the womb, 217.
Pains in the loins incidental to pregnancy, 95..in the breasts incidental to pregnancy,
103.
Sfalse, 121.
Safter delivery, 145, 154.
Palpitation of the heart incidental to pregnancy, 97.
Pard, his discoveries and success, 16.
Paroxysm, hysteric, 58.
Parturition, pregnancy, &c., 76, 125.
Passages, maternal, obstacles to delivery in
the, 132.
Pathogenesy, remarks on, of Pulsatilla, 4, 5.
of Aconite, Bryonia,
and Sepia, 8, 9.
of Nux vomica and
Veratrum, 10, 11.


Peculiar aspect of patients affected with
organic disease of the womb, 217.
Pendulous state of the abdomen after delivery, 164.
Perinaeum, laceration of the, in delivery,
151.
Peritonitis, puerperal, 184.
Pertussis, 371.
Phillips (Mr.), cure of ovarian dropsy reported by, 296.
Phlebitis, uterine, 231.
Phlegmasia alba dolens, 191.
Phrenitis, puerperal, 196.
Hygienic treatment of, 209.
medical treatment of, ib.
Physometra or tympanitis uteri, 277.
Piles incidental to pregnancy, 92... after labour, 153.
Pityriasis or dandriff, 396.
Placenta, retention of the, 136.
Pneumonia of children, 369.
Polypus of the uterus, 271.
cases of, 275.
Porrigo favosa, 398.
Potassa fusa, in the local treatment of uterine
disease, 220.
Preface, v.
Pregnancy, parturition, and the puerperal
state, 76.
general remarks on, 77.
general precautions and duties
to be observed in, ib.
Hygienic rules to be observed
during, 81.
disorders of, 83.
disturbance consequent in incipient, 84.
urinary difficulties, 96.
pains in the loins, 95.
Haemorrhoids, piles, 92.
constipation, 90.
spasms of the stomach, ib.
febrile action in the early stage
of, 86.
sickness, 87.
heartburn, 89.
cravings or longings, 90.
diarrhoea, 91.
colic, 95.
jaundice incidental to, 97.
palpitation of the heart,ditto, ib.
syncope-fainting-ditto, 98.
dyspnoea, shortness of breath
and oppression, ditto, 99.
sleeplessness, ditto, 100.
plethora, headache, ditto, 101.
toothache, ditto, ib.
salivation, ditto, 102.
pain and tension of the breasts,
ditto, 103.
cedema of theextremities, ditto,
104.
moral impressions, ditto, ib.
cramps in the calves, ditto, 105.
varices-swollenveins, ditto, 106
purple spots, ditto, 107.



INDEX.


407


Treatment, prophylactic of pregnancy as
against chronic and hereditary
disease, 123.
during labour, 125.
hygienic, during labour, 128.
medical, during labour, 129.
after delivery, 136.
of the puerperal state, 146.
of metritis, 232.
antipsoric prophylactic, of the
infant, 309.
Tumours, hard, of the uterus, 266..  medullary, fungoid or spongy, of
the uterus, 282.
Tympanitis uteri, 277.
Ulcer, corroding, of the uterus, 260.
Ulceration and induration, simple, of the
os and cervix uteri, 252.
Undue and improper lactation, 207.
Urinary difficulties incidental to pregnancy,
96.
Urination, profuse, of infants, 315.
Urine, retention of, after labour, 152.
incontinence of after labour, 153...  retention of, of infants, 315.
profuse discharge of, of infants, ib.
Uterine hemorrhage during pregnancy, 108.
disease how treated by Jobert, Gendrin, Bennett, Madden, and others,
219.
phlebitis, 231.
Uterus, irritable, or hysteralgia, 72.
inversion of the, after delivery, 148.
displacements of the, 239.
falling of the, ib.
S  relaxation, prolapsus, and procidentia of the, 240.
antiversion, antiflexion, retfoversion, and retroflexion of the, 246.
simple induration or ulceration of
the os and cervix of the, 250.
corroding ulcer of, 260.
scirrho-cancer or carcinoma of the,
262.
hard tumours of the, 266.
moles of the, 268.
hydatids of the, 269.
polypus of the, 271.
tympanitis of the, 277.
Fungus hmmatodes- bleeding tumour or fungus of the, 282.
ramolissement of the, 286.
Vaccination, 358.
Vaccinia variola, 354.
Vagina, inflammation of the, simple, pustular and papular, 221.
inflammation of the, pustular, ib.
inflammation of the, papular, 222.
prolapsus of the, 250.
Varicella, or chicken-pox, 354.
globularis, or hives, ib.
coniformis, or swine-pox, ib.
papularis, or horn-pox, ib.
Varicellae, 357.


Varices during pregnancy, 106.
Variola verrucosa, or modified smallpox,
354, 355.
vaccinia, 354.
Varioloid diseases, 354.
Veins, swollen (varices), during pregnancy,
106.
Veratrum, remarks on, 10, 11.
Verrucosa variola, 354.
Vesicular polypus of the womb, 272.
Vesicular ringworm, 397.
Vicarious menstruation, 27..  leucorrhcea, 28.
Vulva, contusion of the, in delivery, 150.
Weaning, 174.
White leg, 191.
Whites, 34..    causes of, 38.
Whooping-cough, 371.
Womb, diseases of the functions of the, 17.
inversion of the, after delivery, 148.
organic diseases of the, 213.
investigated by the speculum, 215.
touch, 216...      general aspect,
217.
stethoscope, 218.
evidenced by pain, 217.
discharges, 218.
peculiar aspect, 217..     emaciation, 218.
congestion of the, 224..  inflammation of the 229......    chronic, 235..  veins of the,
231.
general and accessory
management of, 238.
displacements of the, 239.
falling of the, ib.
relaxation, prolapse, and procidentia
of the, 240.
antiversion,antiflexion,retroflexion,
and retroversion of the uterus, 246...   and neck of the, simple induration
and ulceration of the, 252.
corroding ulcer of the, 260.
scirrho-cancer or carcinoma of the,
262.
S hard tumours of the, 266.
moles of the, 268.
hydatids of the, 269.
polypus of the, 271.
Scollection of air (tympanitis) of the,
277.
dropsy of the, 278.
bleeding fungus of the, 282.
ramolissement of the, 286.
Worms, 388.
varieties of, &c., 388, 389.
S general symptoms indicating, 390.
characteristic variations of the, derangements resulting from, 391.
investigation of, 1b.
treatment of, 392.



C-AND 1. ADLARD, PRINTERS, BARTHOLOMEW CLOSE.