t>u- » VJ* •"«/ °** fr J &°* Jf V^V; TIT- # ^TT^ JJ * ,# >* .4 °^ <£ ^ -.,-/ ** ^ ^c? W ■ W "^o* "'W *. "^0* \W: C &%> ^# ^ & ^ * * / ,\%„ ^ ^ V** % cP' .% G o^ ,<* ^ &s " If prudery is shocked at my poetry of truth, — the only pure poetry, — it is of no consequence to me. I do not ask the advice of those shame-Saces, who would be chaster than nature and -'.purer than God." Price of this volume, bound in cloth . , $1.25 " " " " paper 1.00 Sent free, by mail, on receipt of price, by M. CHARLES & CO., PUBLISHERS, 87 Hanover Street, Boston. THE PHYSIOLOGY OP WOMAN AND '7/0 HER DISEASES FROM INFANCY TO OLD AGE : INCLUDING ALL THOSE OF HER CRITICAL PERIODS, PREGNANC1 AND CHILDBIRTH J THEIR CAUSES, SYMPTOMS, AND APPROPRIATE TREATMENT, WITH HYGIENIC RULES FOR THEIR PREVENTION, AND FOR THE PRESERVATION OF FEMALE HEALTH: ALSO, THE MANAGEMENT OF PREGNANT AND PARTURIENT WOMEN, BY WHICH THEIR PAINS AND PERILS MAY BE GREATLY OBVIATED. TO WHICH IS ADDED, % ($n?atis£ on Momanliood and Jpanhood, LOVE, MARRIAGE, AND HEREDITARY DESCENT: BEING THE MOST APPROVED VIEWS OF MODERN TIMES, ADAPTED TO THE INSTRUCTION OF FEMALES AND PROFESSIONAL READING. IN THREE BOOKS — COMPLETE IN ONE VOLUME. BY C. MORRILL, M.D. Author of Sundry Medical Essays, Lectures on Popular Physiology, etc. FIZFTH BDITIOWaC .BOSTON: M. CHARLES & COMPANY, 87 Hanover Street. 1868. Entered according to Act of Congress, on the twenty-ninth day of May in the year 1868, by M. CHARLES & CO., In the Clerk's Office of the District Court of the United States, for the District of Massachusetts, TO THE WOMEX OF AMERICA, AND TO ALL OTHERS WHO FEEL INTERESTED IN THE WELFARE AND IMPROVEMENT OF OUR RACE, Khis -SHta* IS RESPECTFULLY INSCRIBED BY THE AUTHOR. FALSE DELICACY AND NOTIONS ON ANATOMY AND PHYSIOLOGY. Some persons think it wrong to exhibit plates and models illustrating different partsof the female, particularly to youth. But this is an im- proper view of the subject : it is the result of false delicacy, and arises from ignorauoe. The more we attempt to conceal from children or oth- ers, the greater is their curiosity, and the stronger their desire to gratify it unobserved. Such is the law of perverted nature. The best way is to inculcate no secrecy, by restricting a knowledge of any part of the system, but allow every part to be studied, and let children be taught very little reserve. It is not the most fastidious who are the most virtu oils, and we should suspect such, much sooner than others. It is only by an early study of physiology that the mind can be disenthralled from the false notions which are so common on these subjects. An excellent method to curb the veneral appetite, and to elevate and refine the char* acter is, to study well every part of the human system, and recognise the Divine Architect in its wonderful mechanism. "To the pure" says the apostle, " all things are ?ureu w ** I am glad the time has come," observed a sensible lady of Philadelphia, " when people are not iSHAMED OF GrOD B OWN WORK." — Beach, CONTENTS, FAOI Dedication, , „ 3 False delicacy and notions on Anatomy and Physiology. . . 4 INTRODUCTION. Woman, the companion of man — an object of the highest interest. One of the most essential objects of creation. — Her beauty and charms depend on her health. . 7 The normal woman, the most beautiful object of creation. — Her influence an undying stimulus to man. Why she should pre- serve her loveliness. — Consequences of losing her health. . 8 Perpetuation of the species the great end of woman's existence. She requires perfection of organization, and to be instructed. Ignorance the cause of her suffering. # 8-9 Never intended that human life should be prematurely extin- guished — its prolongation depends on our own conduct — illus- trations of ignorance • . . . d Melancholy consequences of a want of knowledge concerning her own constitution 10-11 Modes of imparting instruction — plan of this work — deficiencies of others 11-12 Not intended that the female shall be her own physician ; impart- ing information the true way of suppressing quackery. . . 13 BOOK I. THE PHYSIOLOGY OF WOMAN. AND HER DISEASES. PART I. ANATOMY OF ORGANS PECULIAR TO THE FEMALE. CHAPTER I. PECULIARITIES OF THE FEMALE SYSTEM. The organization of the female distinct from the male. . . 17 Hermaphrodites. ... ... • • .18 Peculiarities numerous. 18 Muscular, Nervous, Circulatory and Gellular systems. « "9 Vt CONTEXTS. »AOS The Tel vis— tvt of. . .20 BImWcr, Vagina, Uterus- -tleftori pi ions o£ • . , . 7\ View of I ho organs ol the female Pelvis. • . » .S3 Rectum, etc. t • . 23 CHAPTER II. REPRODUCTIVE ORGANS. External genmtal organs— Mons Veneris, Labia Mnjora and Nymplue. . .2/ Clitoris Hymen. 25 Internal genital organs — Fallopian Tubes. • ^6 View of the Vagina and Uterus -Ovaria. • . . , 27 Mammas or Breasts. ....... .28 Sympathy between the Breasts and Uterus. • • « 29 PART II. DISEASES OF THE EXTERNAL GENITAL ORGANS. CHAPTER I. DISEASES OF THE LABIA MAJOR A. Inflammation and swelling of . . • • , 9ft Abscesses of— Causes. Symptoms and Treatment. , • .21 Encysted and Warty Tumors of. 31 Growing together ofthe Labia — Treatment. ... • 32 CHAPTER II. DISEASES OF THE KYMPI1JS. Enlargement — "Warts — Excoriation of— Treatment. • • • 32 CHAPTER III. DISEASES OF THE CLITORIS. Cancer — Malformation — Enlargement of— Treatment. * . 33 CHAPTER IV. IMPERFORATION AND TOO GREAT DENSITY OF THE HYMEN. Causes, Symptoms and Treatment. . ... .33 CHAPTER V. INFLAMMATION OF THE VULVA. In children, producing Infantile Leucorrhea — Causes, Symptoms and Treatment . . 54 la Adults .35 CONTEXTS. VII PAGE CHAPTER VL PRURITUS, OR ITCIIIXG OF THE VULVA. Symptom*! Causes, and Treatment. ,..•.. • 36-6 Other Ureases of the External organs, . «... 37 PART III. PHYSIOLOGY OF THE INTERNAL GENITAL ORGANS MENSTRUA- TION NATURE TIME OF OCCURRENCE AND QUANTITY- IMPERFECT PUBERTY, WITH HYGIENIC RULES FOR ARRIVING AT HEALTHY MENSTRUATION. CHAPTER I. PHENOMENA OF THE PHYSIOLOGICAL AND MORAL CHANGES WHICH OCCUR DURING CHILDHOOD AND AT PUBERTY, WITH HYGIENIC RULES FOR THE NORMAL DEVELOPMENT. Worthy of our attentive meditation. .... .38 Affections to which the infant is most liable — not to be lost sight of— Errors in rearing children. 33 Sad picture of the result of such errors— Changes at the approach of Puberty. . * ...... .40 Period of gentle pleasures — Expansion and elegance of the form at Womanhood. ......... 41 Great changes throughout the whole economy — In her gestures, feelings, tastes, enjoyments, etc. — The sympathetic irradiations of the Uterus give rise to new desires. ... .42 Causes which retard or hasten puberty 43 Hygienic rules for the normal development of puberty — Dangers of ignorance among girls — The mothers duty to in- form them concerning the Menstrual discharge. . . . 43-4 Vegetable Diet — Cooling Drinks — Bathing — Exercise — Walking, riding, frictions, etc .44 Tardy appearance of the Menses — Remedies — Dangers of read- ing romances — The theatre — The fatal evii of Masturbation. 45 Management of erotic exaltation — Of the cold and apathetic 46 CHAPTER II. THE APPROACH OF MENSTRUATION. Definition — Early and late appearance. . , . .47 Depends on the development of the constitution — Moral and physical changes. .48 Duty of mothers to inform their daugnters — Symptoms of its approach. . . ... . . , . . . 49 Troublesome symptoms — Time of contmnance. . . .50 VIII CONTENTS. PAGE CHAPTER III. THE PHYSIOLOGY OF MENSTRUATION. Source of the Menses — Cause — Different opinions. . • . 51 Cause to be found in the Ovaries. ...... 52 Purpose of Menstruation • 53 Changes produced in the Ovaria — Nature of the discharge — con- stitutional. .j .54 Opinions of the Ancients. • . . • • . • • 55 CHAPTER IV. TIME OF OCCURRENCE AND QUANTITY OF THE MENSTRUAL DISCHARGE HYGIENIC RULES FOR MENSTRUOUS WOMEN. Menstruation divides the life of the female into three periods. . 55 Variation in the time of appearance. .... .56 Influence of warm and cold climates. 57 Quantity discharged. .58 The health and beauty depend on the regularity of this discharge — Sad picture of obstructions .59 Hygienic rules for menstrous women 59 Cold — Napkins — Diet — Bleeding — Medicines — Clothing, etc. • 60 CHAPTER V. IMPERFECT PUBERTY WITH THE CAUSES AND TREATMENT OF PRECOCIOUS MENSTRUATION. The Menstrual discharge constitutional 61 Changes wrought in the organism. .62 Causes which retard or precipitate Puberty — Masturbation. • 63 Connection between precocious menstruation and scrofula. • 64 General conclusions. ........ 65 Treatment — constitutional vigor better than medicine — Exercise — «Food,etc 66-9 CHAPTER VI. GENERAL HYGIENE FOR WOMEN, BY WHICH THEY MAY SECURE TO THEMSELVES HEALTH AND PERSONAL BEAUTY. Medicine as a developing and curative agent 69 Obedience to the physiological laws necessary. • • .70 1. Surrounding Circumstances — Air. • • • • • 71 Odors — perfumes, etc., dangers of • 72 2. Applicata — Clothing. 73 Cleanliness — Bathing. . • . . . . . . . 74-5 Cosmetics — Rouge — Dentifrices — Care of the Teeth — Hair — Depilatories 75-9 3 Idgesta — Food — Drinks, etc. — Simple — highly seasoned food. 79-83 4. Excerta — Excretion of the menses, -urine, sweat, etc. . 80-1 5. Grsta — Exercise, late hours, sleep, rest, etc. • . . 81-3 6. Percept a, passions, intellectual labors, etc. . • • 83-5 CONTENTS. IX PAGE. PART IV... DISEASES OF THE INTERNAL GENITAL ORGANS DERANGED MENSTRUATION, WITH OTHER FUNCTIONAL DISORDERS AND ORGANIC DISEASES. SECTION L FUNCTIONAL DISORDERS. CHAPTER I. SYMPATHIES OF THE WOMB, WITH PRELIMINARY OBSERVA- TIONS UPON DISEASES OF THE INTERNAL ORGANS ; THEIR GENERAL CAUSES, DIAGNOSIS AND TREATMET. Sympathies of the Womb — Curious opinions of the Ancients. • 85-6 With the Breasts— Stomach — Brain, etc S7-8 Preliminary observations on diseases of the Uterine System — Functional— Organic. 88-90 Changes which the Uterus and its Appendages undergo at the great epochs of female life — before Menstruation — during ges- tation . . . , , 00 After delivery, in elderly women. ....... 91 General Causes. . . . . • , • . . 94 Diagnosis and Treatment 93-4 CHAPTER II. SUPPRESSION OF MENSTRUATION AT PUBERTY, OR TARDY APPEARANCE OF THE MENSES FOUR DIVISIONS CAUSES SYMPTOMS AND TREATMENT. 1. When there is little or no development of tJie female system at the age of puberty — Management . . . . . 95-6 2. Wlten tliere are indications of development, which is but slowly taking place — Causes , ... 97 Treatment. . . 9 . . . . . . 98-9 3. Wlien this development is prevented by a cJironic affection oj some other pan —Treatment 100 4 When t/ie most perfect development has taken place yet, the menses do not appear — Treatment. . . . . . . 100-1 CHAPTER III. AMENORRHEA, OR SUPPRESSION OF THE MENSES, OR ITS INTERRUPTION AFTER HAVU^G BEEN ESTABLISHED — ACUTB AND CHRONIC CAUSES SYMPTOMS AND TREATMENT. Acute Sujrpression — Causes — Symptoms — Treatment * . 10*2-5 Chronic Suppression — Causes — Symptoms. , % . . 106 Treatment, medical and hygienic. , • . « • . .107-12 X CONTENTS. PAGE, CHAPTER IV. TICARIOUS MENSTRUATION NATURE— CAUSES AND TREAT- MENT. Causes — Treatment. ....... .112-13 CHAPTER V. MENORRHAGIA, OR EXCESSIVE MENSTRUATION TWO DIVI- SIONS CAUSES SYMPTOMS AND TREATMENT. First division — Symptoms — Causes. - 114-15 Treatment. . . • ,116 Second division — Symptoms — Causes 117-18 Treatment, medical, hygienic. , , • . • « J. 19-20 CHAPTER VI. DYSMENORRHEA, OR DIFFICULT AND PAINFUL MENSTRUATION SYMPTOMS CAUSES AND TREATMENT. Symptoms — Causes. ........ .121-22 Treatment — during tlue attack and interval, .... .123-24 Treatment of the mechanical species 124 CHAPTER VII. BECLINE, OR CESSATION OF MENSTRUATION CONSTITUTIONAL EFFECTS TREATMENT WITH HYGIENIC RULES FOR WOMEN AT THIS PERIOD. The circumstances attending the decline of the menses adapted to excite our interest — Greater liability to menstrual irregu- larity 125 The occurrence, of incapacity for child-bearing founded in the highest wisdom — Symptoms ofthe approach of. 126 Illusions — Physical changes — in the Womb, Skin. Hair. Voice. . 121 Moral changes — in the temper — Sensibility — Passions — Tranqui- lity of life afte/ the "change." 128 False apprehensions cf danger from the supposition of vicious humors being retained — Fewer women die at this age than men — Liability to cancer. 129 Temporary allections at this period — Treatment. . . . . 130 Hygienic riles for women at the change of life — Quack ^ health pills, etc. . , . . . . f . .131 Exercise — Atmospheric vicisitudes — Sleep. . . . , . 132 The passions — Love — Prospect of many happy days beyond this period 133 Medicines— Constipation, laxatives, — Bathing, etc. , , .134-35 CONTENTS. XI PAGE CHAPTER VIII. LEUCORRnCE" NATURE VARIETIES SYMPTOMS CAUSES TREATMENT. Definition — Synonymous with the whites — Nature of the dis- charge — Origination 135 Lcucorrhea very prevalent — In children — Temperament most lia- ble. ....... 136 Scat of the discharge, Uterus, Vagina- 137 Circumstances under which it occurs. 137-3S Symptoms— Acute— Chronic. . 13S-40 Causes— Local, cold, violence, quack medicines, abuse of venery, etc 140-11 Constitutional causes — Temperament — Location, atmosphere, occupation— rHabits of life — Diet, etc.— Erotic reading — Vicious habits— " Drugging/' . 142-44 Duration — Not contagious, , , 144 Treatment — Acute stage . .145 U J — Chronic — Preliminary care. ... . 146 Diet— Exercise, etc. — Medicines — Cleanliness — Bathing, etc. .147-50 CHAPTER IX. CHLOROSIS NATURE SYMPTOMS CAUSES AND TREATMENT. Definition— Nature— Seat. ' 150 Symptoms — Peculiar paleness — Indigestion — Depraved appetite etc .150-02 Cavses — Predisposing, temperament, privation and abuse of love, deranged menstruation, emotions, etc. . . . . lf>2 General causes, bad situations, indigestible food, fatigue, etc. .153-04 Treatment — Purgatives — Iodine — Iron — Vegetable tonics, etc. General hygiene. . • . • . ,151-56 ^^^^^^ • CHAPTER X. HYSTERIA NATURE SYMPTOMS CAUSES VARIETIES COMPLICATIONS TREATMENT MORAL AND PREVENTA- TIVE MANAGEMENT. Definition — Influence of the Uterus. . • . .157 Seat — Various opinions — Uterine system — Period of life — Tem- perament. • . . . . . . .15S-59 Symptoms — " Protean shapes" of the diseases — globes hystericus, etc., etc. ....... .159-60 VARiEriES — Peritonitis— Pains in the side — Palsy — Cough — Affec- tions of the spine and joints, etc. . . . .161-65 Complications— Catalepsy — Ecstasy — Animal magnetism, Tran- ces. ....... .165-67 Causes— Predisposing, emotions, bad diet, abuse of stimulants, over-education, etc. ..... .1CS-G9 Exciting causes, deranged menstruation, emotions, improper food, worms, odors, sounds, etc. . . . .169-72 XII CONTESTS. PAGE, Treatment — During the paroxysm, medical and moral. . J 72-74 Darir.g the interval— Medicine — Hygiene. . . .174-76 CHAPTER XI. NYMPHOMANIA, OR FUROR UTERINUS — MATURE CAUSES SYMPTOMS AND TREATMENT. Definition— Seat. ...... .176-77 Causes — Predisposing, excitement of the brain, voluptious read* ing and conversation, etc. - . . . .179 Exciting causes — Masturbation, abuse of venery. . 179 Symptoms — Encouraging proposals — Delirium, etc. .. .178-79 Treatmeni — Hygienic — Medical . • . ,179-SG CHAPTER XII. HYSTERALGIA, OR IRRITABLE UTERUS SYMPTOMS— C*.#S£S AND TREATMENT. Definition — Attacks all temperaments. • 181 Symptoms — Causes. ..... .181-83 Treatment — To relieve the pain — to restore the health. • .182-83 Irritable Vagina* •••••• 18& SECTION n. ORGANIC DISEASES. CHAPTER I. » INFLAMMATION OF THE UTERUS FALLOPIAN TUBES AND OVA- RIES ACUTE AND CHRONIC CAUSES SYMPTOMS TER- MINATIONS AND TREATMENT. Preliminary observations. .183-84 Intlammation of the uterus — Acute — Causes — Symptoms. . 184 Chronic form — Causes — Symptoms." . .185-86 Terminations — Treatment .186-87 Inflammation of the Fallopian tubes and Ovaria. • . J. 87-88 CHAPTER II. SIMPLE ULCERATION OF THE NECK OF THE UTERUS— CAUSES SYMPTOMS AND TREATMENT. ilppearance through the Speculum — Causes— Symptoms — Diag- nosis. .188-89 Treatment. ..,...••• .150 CONTElfTS. XIII PAGE. CHAPTER III. PROLAPSUS OF THE UTERUS — NATURE— CAUSES SYMPTOMS AND TREATMENT. Preliminaiy observations on displacements. • • • , 191 Definition — Different degrees of. . • • . . 1 92 Causes — Relaxation of the pelvic muscles, pregnancy, ill-man- aged labors, improper diet, dress, etc. ..... J.93-94 Symptoms — Pain in the loins, etc.— May be seen externally. .195-96 Treatment — Result of neglect 197. Imperfect prolapse — Mode of reduction — Hygienic means for restoration 198 Complete prolapse — Management — Pessaries — Mode of intro- duction — Hygiene ..... . 199-202 CHAPTER IV. INVERSION OF THE UTERUS— -CAUSES SYMPTOMS AND TREATMENT. Description of 1 — Varieties. • 202 Causes— Connected mostly with child-bearing. . . • . 203 Symptoms — Sinking— Bleeding — Diagnosis from an examination per vaginam, . * . . . 203--4 Treatment— Mode of reduction — After-management • . 204-6 CHAPTER V. RETROVERSION AND ANTREVERSION OF THE UTERUS CAUSES SYMPTOMS AND TREATMENT. Causes — Over-distention of the bladder and rectum, etc. . . 207-8 Symptoms — Pain in the loins, etc. — Mode of distinguishing the two affections. .208-10 Treatment — Preliminary efforts — Modes of reduction — Hygienic management. ► , ,210-11 CHAPTER VI. OTHER DISPLACEMENTS OF THE UTERUS, OVARIA, OF THE BLADDER AND URETHRA, OF THE VAGINA, AND OF THE REC- TUM CAUSES SYMPTOMS AND TREATMENT. Curvature — Causes — Symptoms and Treatment '*«.'■•• 212 Inclination and obliquity of the Uterus. . . . # . 213 Elevation and Immobility. . . , » ' • ' • • . 214 Hernia of the Uterus. . 215 Hernia and displacement of the Ovaria. . . . , . 216 Displacement of the bladder 217 Prolapsus of the mucous membrane of the urethra— Displace- ment of the intestines into the vagina. . . . . . 218 Prolapsus of the vagina— Invagination of the vagina. , .219-20 XIV CONTENTS. PAGE Prolapsus of the rectum, hemorrhoids, piles, costiveneness — Causes — Symptoms and Treatment. . . , • , 2*20 Description of— External and internal piles. . . , . 221 Causes — Costiveness, bad diet, etc., purgatives 221-22 Symptoms— Prolapsus ofthe rectum— Piles. . .^ . .222-23 Treatment — Mode of reducing tailing ofthe rectum — After-treat- ment-Piles, 223-21 Hygienic treatment —Wholesome and unwholesome food. . 224 Innutricious material necessary with our food. . . . 225 Unbolted, wheat bread— Fruits — Natural drinks of mankind- Tea and coffee, etc., etc 220-27 CHAPTER VII. UTERINE DROPSY CAUSES SYMPTOMS AND TREATMENT. Description of, etc. 227 Causes— Symptoms and Treatment 228 CHAPTER VIII. MOLES, HYDATIDS, ETC. OF THE UTERUS. Causes — Result of conception 230 Symptoms — Treatment. * • • • 231 CHAPTER IX. FIBROUS TUMORS OF THE UTERUS AND OVAR1A NATURE CAUSES SYMPTOMS AND TREATMENT. Nature of 1 -- Varieties , , • . 231 Causes — Irritation. ..••%«••• 232 Symptoms — Treatment. ....... .233-34 Fibrous tumors of the Ovaria 234 CHAPTER X. POLYPUS OF THE UTERUS CAUSES SYMPTOMS AND TREAT- MENT WITH OTHER MORBID COLLECTIONS IN THAT ORGAN. Description of— Causes. ...,»,.. 235 Symptoms — Diagnosis. ..,..#. ,236-37 Treatment — Different plans. , % 237 Calculous or Stone. % • % . 233 Osseous or cartilaginous formations — Physometra, or Uterine Tympanites, 239 CHAPTER XI. CAULIFLOWER EXCRESSENCE OF THE UTERUS NATURE SYMPTOMS AND TREATMENT. Description of — Causes — Symptoms. , , • • • 240 Treatment .241 CONTENTS. XV PAGK CHAPTER XII. CORRODING ULCER OF THE UTERUS NATURE SYMPTOMS DIAGNOSIS AND TREATMENT. Description of— Symptoms. • , . • • , • • 24*4 Treatment ,243 CHAPTER XIII. CANCER OF THE UTERUS AND OVARIA NATURE CAUSES SYMTOMS AND TREATMENT. Description of — Time of occurrence. . . . , » 244 Nature — Stages — Causes. . 245-46 Symptoms — Pain — Hemorrhage — Discharge — Lamentable ter- mination. . . . .246-43 Treatment — Scirrhus stage — Cancerous stage. • . .249 -51 Cancer of the Ovaria, , • . 251 CHAPTER XIV. CANCER OF THE BREAST CAUSES SYMPTOMS AND TREAT- MENT. Nature of— Causes. ..,..,, . 252 Symptoms. . . 253 Treatment — Preventative — Curative — Exposure of quackery — Palliative. 253-57 Other Tumors of the Breast. , . 257 CHAPTER XV. DISEASES OF THE OVARIA AND FALLOPIAN TUBES— ENCYSTED DROPSY CAUSES SYMPTOMS AND TREATMENT. Preliminary observations. 258 Nature of— Encysted Dropsy — Causes. ... . 253 Symptoms. 260 Treatment— Medical - Hygienic— Tapping— Remarkable case of 260-61 Conclusion of Book I — Women may avoid the diseases to which tiiev are incident fcv living according: to the physiological laws. 262 TVI CONSENTS. BOOK II. THE PHYSIOLOGY AND DISEASES OF PREGNANCY AND CHILDBIRTH. View of the Foetal Circulation. .... 264 Introductory remarks — Pregnancy a physiological not a diseased state. ....... .265-66 SECTION 1. PHYSIOLOGY OF PREGNANCY CHAPTER I. HIGIENIC RULES FOR THE NORMAL UNION OF THE SEXES, WITH REMARKS ON VICIOUS CONFORMATIONS OF THE FEMALE GENITALS, WHICH PROHIBIT THE APPROACH OF THE SEXES. Marriage one of the chief objects ot the meditations of philoso- phers — Age at which it should be consumated — Opinions oi the Ancients — French laws, etc. . . . .267-68 Sad consequences of premature marriages — Evils of the abuse of pleasures — Modes of remedying them. . . .269-70 Deformities and diseases which render marriage impracticable — Mode of distinguishing them . . . .270-71 CHAPTER II. VICIOUS OR ABNORMAL CONFORMATION OF THE FEMALE PEL- VIS, AND GENITAL APPARATUS CAUSES AND TREATMENT. Deformity of the Pelvis — Causes — Treatment. . . .271-73 Occlusion and abnormal conformation of the external sexual organs — Union of the Labia — Causes — Treatment. . . 274 Excessive development of the Nymphse — Unnatural growth of the Clitoris — Remarkable case—Treatment. . . . 275 Imperforation of the Urethra. ..... 276 Faulty conformation of the internal organs — Imperforate Vagina. 277 Narrowness of the Vagina — Of the neck of the Uterus— Obstruc- tion of the Fallopian Tubes. ..... 278 Absence and malformation of the internal organs — Womb — Vagina, etc. . . . . . , .278-79 CHAPTER III. STERILITY AND IMPOTENCE CAUSES AND TREATMENT. Definitions. . ...... 280 Causes — Diseases, malformations, climate, disparity of age, etc.2S0-83 Treatment— Caution- Hygiene. f .284-85 CONTENTS. . xvn CHAPTER IV. THE ORIGIN OF HUNAN LIFE CONCEPTION. The female arrives to a happy state — Love of offspring the purest happiness of which she is in possession. . .2S5-S6 Definition of Conception — One of the most astonishing phenome- na of Nature — Numerous hypotheses of— Spermatists — Ovists Syngenesis — Epigenesis — Absorption — Positive theory. .2S6-S7 Ten fundamental laws concerning generation — Three additional laws. ............. 388 Recent theory. ....... 289 Review of certain arguments in favor of conception taking place in the Womb. . • . . . . .259-90 CHAPTER V. THE ORIGIN OF HUMAN LIFE PREGNANCY OR UTERO GESTATION. Descent of the egg into the "Womb — formation of the membranes. chorion, amnion — Afterbirth. .... .291-92 Progressive development of the foetus — Eighth day — Twelfth — Twenty-first — Thirtieth — Six weeks- — Two months — Three — Four— "Five— Six— Seven—Eight— Nine. . . .292-93 Progressive increase in the size of the Womb. . . ,293-94 The placenta or after-birth — Umbilical cord — Deciduary mem- brane — Liquor amnii. . . . . . .294-9') Fcetal Circulation. . . . . . . 296 View of the cniid hi irfero. ..... 297 Enormous size of the gravid uterus — position of the child — Dura- tion of pregnancy — Least time in which the child is capable of surviving/ ". . . . . . .295-99 Abnormal pregnancy — Extra Uterine pregnancy — Superfoeta- tion. ........ .299-390 Mole pregnancy — Deformities — Monstrosity and Marks. . 301 False pregnancy — Is it possible to procreate either sex at pleas- ure? ........ 305 CHAPTER VI. THE SIGNS AND PHENOMENA OF PREGNANCY. Changes in the face. eyes. etc. ..... . 303 Cessation of menstruation — Morning sickness — enlargement of the Breasts, areola, etc. — Salivation — Enlargement of the abdo- men— Of the uterus — Quickening— Beating of the foetal heart. 304 The urine — Appetite— Moral condition — Extraordinary changes. 3U6 Signs may decieve — Lamentable consequences. . . 300 Diseases supervene and are suspended during pregnancy . 306 rV in CONTENTS. BAGS CHAPTER VII. HYGIENE AND MANAGEMENT OF PREGNANT WOMEN. Atmosphere— Clothing, corsets— Bathing— Bleeding— Diet. . 307-8 Caprices of appetite— Excretions 309 Exercise— Moral management .310 Longings — Care necessary. 311 SECTION II. DISEASES OF PREGNANCY. Powerful sympathies called forth by pregnancy — Often take on a diseased appearance — Divisions. . . . • .312 CHAPTER I. ABORTION OR MISCARRIAGE CAUSES SYMPTOMS AND TREATMENT. Definition — Frequency 312-13 Causes— Predisposing, temperament, tight-lacing, affections of the uterus, etc. 313 Exciting causes, emotions, violence, medicines, etc. , . 314 Difficulty of producing it — Criminal attempts — Dangers of. .31 5-1 5 Symptoms — Chills — Hemorrhage, etc. 316-17 Treatment— Hygienic— Medical. .... .318-19 CHAPTER II. DISORDERS OF THE CHYLOPOIETIC VISCERA OR THE DIGESTIVE FUNCTIONS CAUSES SYMPTOMS AND TREATMENT. Nausea and vomiting. * .319-20 Salivation or Ptyalism. ...... . 320 Odontalgia or Toothache — Capricious and Fastidious Appetite. 321 Heartburn or cardialgia. ..,..,.. 322 Difficulty of swallowing — Vomiting of blood — Jaundice — Cramp of the stomach and bowels, etc. ,..,.. 323 Constipation or cpstiveness , • • • 324 Diarrhoea, Dysentery and Tenesmus. . • . 325 CHAPTER III. DISORDERS OF THE CIRCULATING SYSTEM CAUSES SYMPTOMS AND TREATMENT. Sanguine Plethora 321 Palpitation of the Heart— Syncope or Fainting. . 327 23 CONTENTS. XIX PAGE. CHAPTER IV. DISORDERS OF THE RESPIRATORY ORGANS CAUSES SYMP- TOMS AND TREATMENT. Dyspnoea or Difficulty of Breathing — Cough 329-30 Hemoptysis or spitting of Blood, and Epistaxis or Bleeding from the nose. . . . . . ■ * • • • .330-31 CHAPTER V. DISORDERS OF THE NERVOUS SYSTEM AND SENSES. Insomnia or Sleeplessness . 331 Hypochondriasis or Despondency, and disorders of the Intelli- gence, Moral inclinations and affections, , . , Cephalalgia or Headache. Puerperal convulsions. . . . . . • Nervous affections of the Eyes and Ears. 332-33 334 ,335-36 337 CHAPTER VI. EISORDERS ARISING FROM MECHANICAL PRESSURE OR DIS- TENSION. Hemorrhoids or Piles • 338 Incontinence of Urine — Disuria and retention of. . . . 339 Varicose or Distended Veins. ...... . 310 (Epama or Anasarca, and ascites, or dropsy during pregnancy, .341-42 CHAPTER VII. DISEASES OF THE GENITAL ORGANS DURING PREGNANCY. Pruritus ofthe Vulva — QEdema of the Labia — Inflammation and Rheumatism of the Uterus — Menstruation during Pregnancy.343-44 PART II. THE PHYSIOLOGY AND DISEASES OF CHILDBIRTH. . SECTION I. PHYSIOLOGY OF CHILDBIRTH. Definition — The birth of man 345 CHAPTER I. CAUSES OF LABOR. Opinions of Hippocrates and the Ancients— Periodicity of all the uterine functions — Efficient cause — Contractions ofthe uterus —Power of the will. 345-47 XX CONTENTS. CHAPTER II. PAO* THE MECHANISM AND PHENOMENA OF SPONTANEOUS OR NATURAL LABOR. Definitions— Presentations— Requisites lor a natural labor— Pro- portion of! Mechanism of labor — Divided into stages — Preliminary signs. First stage — Phenomena of— Second stage. Third stage — Duration of labor, etc., etc. • • Labor pains. . Dilatation of the passages. Discharge of glairy mucus — Bag of waters. . • 34743 349 350-51 352-53 353 354 ,354-55 CHAPTER III. IS PAIN IN CIIILEBIRTH A MORBID SYMPTOM ? A question of great moment — Facility of labor in the African women — Indian — Greenland — Perversion of our nature. .35S-&3 Facility of labor in animals — Is the art of the accoucher necessa- ry ? — Illustrations, etc., etc. • 357-58 CHAPTER IV. HYGIENE AND MANAGEMENT OF WOMEN IN CHILDBIRTH. Very little to do in a natwal labor — Danger of interference- Hygienic management — Room — Food and drinks. . .359-60 Excretions — Moral state--Lying-in bed, etc. . . .361 62 Touching the woman — Diagnosis. .... • 362 Conduct of the woman — Conduct of the attendant. . . . 363 Receiving the child — Separating the child. ... . 364 Delivery of the afterbirth — Management of the child when it does not breathe — Tumors of the scalp—Bleeding of the cord.365-66 CHAPTER V. MANAGEMENT OF DIFFICULT LABOR. Description of— Causes. . . S67 Treatment — Time and patience, ergot of rye, etc. . . .367-68 Rigidity of the passages — Toughness and weakness of the mem- branes — Obliquity of the uterus — Retained placenta— Hem- orrhage or bleeding — Convulsions .368-70 Powerless or Instrumental labor. . 370 CONTENTS. XXI SECTION II. DISEASES OF CHILDBIRTH. CHAPTER I. CONDITION OF THE PATIENT AFTER DELIVERY MANAGEMENT OF WOMEN IN CHILDBIRTH, WITH VARIATIONS FROM ORDI- NARY CONVALESCENCE. Changes in the general system— Uterus — Vagina — Abdomen — After-pains — Lochia, or cleansings. .... .371-72 Management ol'ihc woman — The room, posture, washing, bed- clothes — Breasts Die: — Exertion, etc. . . . .372-74 Variations from ordinary convalescence — Nervous shock — The pulse — Uterus — Lochia- Milk fever — Lacerations, Infiltations.374-76 CHAPTER II. PUERPERAL FEVER, INCLUDING PERITONITIS, UTERINE AND CRURAL PHLEBITIS CAUSES SYMPTOMS AND TREATMENT. Description — Causes — Sporadic form — Epidenic. . • .377-78 Symptoms 378-79 Treatment. 379-80 CHAPTER III. PHLEGMASIA DOLENS OR MILK-LEG CAUSES SYMPTOMS AND TREATMENT. Description — Causes — Symptoms — Treatment. . • .381-82 CHAPTER IV. SORE NIPPLES SCANTY AND PROFUSE SECRETION OF MILK MILK CONSUMPTION RETENTION AND ALTERATION OF THE MILK. Treatment of sore nipples — Exuberance of milk. • • .382-83 Milk consumption. ......... 3S3 Retention of the milk — Alterations of • • • • 334 CHAPTER V. INFLAMMATION AND ARSCESS OF THE BREASTS CAUSES- SYMPTOMS AND TREATMENT. Causes — Symptoms. • 385 Treatment — Preventative — Remedial. • , . • • 3S6 XXII CONTENTS. PARTIII. INFANCY. CHAPTER I. IN WHAT MANNER THE CHILD MAY BE INFLUENCED BEFORE ITS BIRTH BY HEREDITARY CAUSES. The child before its birth influenced by the same causes which affect the mother — Diseases transmissible— By the father — By the mother — Modes of obviating these evils. **• • • .387-89 CHAPTER II. INFLUENCE OF CERTAIN CONDITIONS IN THE MOTHER ON THE HEALTH AND CHARACTER OF HER OFFSPRING DURING PREG- NANCY. The mother's mark — Causes, which, acting upon her, will affect - her offspring — Interesting examples of. ... .389-90 Direct relation between the mother and her child — Longings- Customs of the ancient Greeks for affecting favorably their children unborn. . . • . . i 391 Directions for the mother — Hygiene. • • . - , .392-93 CHAPTER III. HYGIENE AND MANAGEMENT OF INFANCY AND CHILDHOOD. The infant wisely denied the power of action. • . ♦ 393 Clothing 394 Food — Drink — Appearance of the teeth — Weaning. . .395-96 Exercise— Air— Sleep—Bathing — Intellectual and moral train ing.396-98 Conclusion — The laws of health fixed and never varying — Fe- males may hope to ascertain them and avoid most of the dis- eases to which they are incident. . , 399 CONTENTS. XXIII BOOK III. ELEMENTS OF WOMANHOOD AND MANHOOD— LOVE MARRIAGE, AND HEREDITARY TRANSMISSION. CHAPTER I. ELEMENTS OF REPRODUCTION IN THE SEXES — WOMANHOOD — MAN- HOOD. PAGE Elements of Reproduction — Object of Sexual Distinction- Knowledge Required . . 403-4 Sexual Elements — Formation of the Soul and Body . . 404 Do not waste the Sexual Element — Solitary Indulgences . 405 Evil of— Sad effects of Sexual Abuse 406-407 CHAPTER IL LOVE AND MARRIAGE. The Family rests upon Love — Love, the natural aim of Woman — Rescue the Woman 407 She will rescue you — Marriage less expensive than living single — A wife, a fortune 408 Menstruation — Cause — Purity of— Knowledge required . 409 Should be acquainted with each other — Love ; Passion — Sexual Instinct . . 410-11 Incapacity must be known 411 Oneness Required — Initiate the Daughter — Dutv of the Hus- band . \ 412 Create your Wife — Love, a necessity in Woman— Confide in each other — She loves but one 413 Love not in a crowd — Woman, an invalid . . . . 414 Time of Conception — Period of Barrenness — Time of Mar- riage — Nobility of Love — Effect of Variety .... 414 The wife Renews the Man ■ 415 Adultery of the Woman — Fearful consequences of — Respon- sibility of Woman — Her Bosom, our Sanctuary . . . 415 CHAPTER m. PARENTAGE — HEREDITARY TRANSMISSIONS, Heroes born of the most exalted Love — Union of Opposite Elements . . . 416 Union of the Same Elements— Marriage of Relatives — Cross- ing of Qualities 416-18 The Husband's Duty — Period of Barrenness . . . 418 Fecundation extends long into the future, and transforms woman in a lasting manner 419 XXIV CONTENTS. PAGE Hereditarj' Tendency to Diseases 419-20 Inheritance may descend from either or both Parents . 420-21 Venereal Diseases Transmissible 421-22 Consumption and many other diseases Transmitted . . 422 Influence before Birth 422-23 The child of Love 423 Time of Sensuous Intercourse 423 Retain the Sexual Element 423 Conduct of the Parents 424 Acquired Diseases Transmitted 424-25 Druukenness — Sexual Abuse — Solitary Sexual Abuse . 425-26 Sexual Abuse during Pregnancy — Effect of Abortion . . 426 Mental Conditions during Pregnancy — Effects of Lactation — Alcoholic Spirits — Anger and Terror .... 426-427 Tranquillity Required-— Substitutes ..... 427-28 Importance of the foregoing facts 428 Disease an Effect — An evil to be prevented .... 428 Physicians should be Clergymen, or Clergymen, Physicians 428-29 The True Physician 429 DIETETIC PREPARATIONS AND ADDITIONAL FORMS OF PRESCRIPTION. Barley-Water — Rice-Water — Vegetable soup — Panada — In- dian gruel — Mutton, chicken, veal, and beef broth — Beef and chicken tea — Tapioca — Arrowroot and sago — Wine whey — Caive's feet jelly — Tapioca, sago, and rice gruel . 431-32 Forms of Prescriptions 432-33 INTRODUCTION, Feeble and sensitive at birth, remarks LTsere, and destine*. by nature to give us existence and to preserve us afterwards, by means of her tender and watchful care, woman, the most faith- ful companion of man, may be regarded as the very comple- ment of the benefits bestowed upon us by the Divine Being; as an object fitted to excite our highest interest, and presenting to the philosopher, as well as to the physician, a vast field of contemplation. We have but to reflect a moment upon her social condition, in order to observe that the female is one of the most essential objects of creation : — that man without the influence of her charms would become a degenerate creature, and the world made desolate. The value of her influence, of course, much depends upon the perfection of her organization, physical and mental, on the refinement and elevation of her character, and on the delicacy and proper direction of her charming loveliness. Where health is not maintained, beauty soon disappears, and charms are lost ; indeed, health or perfection of physical devel- opment in the female, is almost synonymous with beauty and everything that is charming in her character: they are both found associated. The normal woman, as she came from the hand of the Creator is the most beautiful object of creation ; upon her frame is traced the most exquisite lines of grace, the resplendence o: which, has always formed a halo of angelic perfection, a sub- ject for the song of the poet, the fancy of the painter, and the skill of the sculptor. The constitution of the female mind and" character, widely differs from the male ; and it is impossible, in this state of existence, for the sexes perfectly to compre- hend each other; — thus, each is eminently constituted to divert the other. It is the love of woman — her attractive charms, which act as an undying stimulus to man, for "weal or woe,' 7 in all his efforts — in his toils, his dangers and his privations ; by these is the student, pale and wasted by midnight study, cheered and comforted ; by these is the mariner sustained in his perilous voyages across the stormy, trackless deep; by these, also, is the soldier inspired with courage to face the cannon's mouth ; in fine, it is the charming loveliness of woman, 8 INTRODUCTION. which sustains man in innumerable sacrifices and employments For the purpose of courting her favor, he lays at her feet the fruit of his toils, and finds in her acceptance and smiles, his happiest reward. Therefore, as the influence of woman is great, and effected through her charms, it becomes her duty to herself, to her family, and to the world to preserve her health, upon which the reality of her beauty depends. There are other and more important reasons why woman should preserve the charms of her own loveliness, or in other words her health. By losing it, she not only makes a wreck of her own expectations and happiness, but as a daughter, her premature death may fill the bosoms of her parents with never-ending sorrow. When she comes, according to the intention of nature, to fulfil the duties of a wife, she may reduce to despair her husband, her house to indigence, and convert to a sick-bed, what should have been one of comfort. The most important relation of her social condition remains yet to be told : an awful responsibility is attached to the title of " mother;" the healthy constitution of her offspring par* ticularly depends on the good health of the mother. Upon the originally healthy organization of the child, also, will very much depend the success of a well directed course of physi- cal education in after life. Confirmed ill health in the mother is sure to entail debility or disease on her offspring. A little timely knowledge might very often, to say the least, obviate these sad and afflicting results. The greatest end and object of woman's existence is, evi- dently, to perpetuate the species. The fatigue and anxiety of childbirth and nursing, the responsibility of educating her chil- dren, require, for their due performance, besides perfection of physical organization, qualities both rare and estimable, and an endurance of fatigue, as well as a submission to privations, which nothing renders supportable, but the love of offspring which a kind Providence has so deeply implanted in the nature of the female. But how can a vigorous woman even fulfill these important duties unless she be instructed % We are told by some that nature is to guide her! Such do not reflect that in her present social condition, she is subjected to an artificial mode of existence — a state that is continually opposing the native dispositions of the animal economy; but such is the case, and we must be satisfied, until some change is wrought, •vith seeking by the aid of philosophy for artificial substitutes, which harmonize with the nature of the female constitution. It is not too much to aver, that it is mainly owing to igno- rance of her own constitution, that woman in passing through her critical periods, or while fulfilling the endearing duties of the great end of her existence so often falls a premature victim to some of the numerous ills that beset her. INTRODUCTION. 9 It was never intended by a bountiful Deity that human life should be prematurely cut off, or extinguished at its very dawn. That its prolongation depends on our own conduct anil management, is proved by the following circumstance : We frequently observe the feeble and delicate cluld, with proper care, become healthy and vigorous ; while the robust and heal- thy infant, under unfavorable circumstances, becomes enfee- bled in health, and unfit for the contingencies of life. It is quite uncommon to meet with a mother, who, before becoming such, had received the least instruction concerning the true object of those mysterious powers by which the species is reproduced : and, " will it be believed, that in more than one instance, in a class of life where fortune conferred its choic- est blessings, a young mother has learned, for the first time, from her physician, even when the pains of labor were upon her, that she was not to be subjected to a surgeon's knife, before she could be blessed with the darling object of her love? What does the feeling heart say to this? It can say but one thing: — truths which so nearly concern the welfare of those we love, can never be withheld without culpa- bility.'' Upon its mother the infant depends for that cherishing care which its delicate frame, at this period, so much requires. She it is according to the design of nature, who is to watch over its tender years, provide its nourishment, and attend to all its wants. But to what extent has her previous education fitted her for the correct discharge of these duties ? We find in the majority of instances, that she has contracted the marriage re- lation, and become a mother, without a suspicion of her defi- ciency in knowledge concerning the development birth, and bringing up of the new being which she is to cherish. It is true that she is deeply afflicted when she witnesses the suffer- ings of her babe, and bitterly laments her own inability to afford it relief. When it finally falls a victim to mismanage- ment, she piously submits to what she believes to be a dis- pensation of Providence; but which in reality is all owing to the want, on the part of the mother, of a little timely knowledge. The parent, remarks a medical writer, enters upon the im- portant charge entrusted to her care with less previous prepara- tion for its proper fulfilment, than if it were a plant or flower which God had committed to her management, instead of a living being in whose existence and happiness her whole soul is centered; for if a rare or curious flower be presented her, she will enquire minutely in regard to the best means of rear- ing it, and will act upon the information; but when a human being is confided to her care, the same person accepts of the trust, without asking a single question about the necessary treatment. B tO INTRODUCTION. "Who that has a heart to feel, or a judgment to weigh the consequences of those great and acknowledged errors of her physical training, can forbear to wish her enlightened on those immutable laws upon which her happiness so entirely de- pends] Who can suppress the sigh that involuntarily arises on beholding a family of attenuated offspring, too feeble to resist the encroachments of infantile disease, bending and withering beneath the slightest vicissitudes of atmospheric change, and constantly exciting the fears of an invalid mother for their very existence, whilst she herself, the unconscious cause of most of their ills, is scarce able, from exhaustion, to assert her position as their natural protector. " I envy not the heart of that man who can witness, without emotions deep-felt and sincere, and an instant conviction of his duty to the sufferer, the slow and insidious approach of dis- ease that is to deprive the helpless objects of a mothers love. I claim no sympathy from him who can day after day ap- proach the bed-side of the invalid, and console himself that she who has failed to receive at his hands the anticipated benefit, is beyond the reach of his skill from vices inherent in her organism. Is it his sole duty to dole out the pitiful pill or potion, that is absurdly expected to restore her to health? to make the rose revisit that sad cheek, blanched into prema- ture decay, from a total want of knowledge of the everlasting and immutable laws of her nature? Shall she fondly rely upon her chosen medical counsellor to lead her through the perilous paths of gestation and childbirth, when, from defi- cient education, she is often utterly ignorant of its natural progress? • Will he whose heart and head are better adapted to his high and responsible calling, from an absurd subjection to blind conventialism, oppose a sincere and honest effort for her instruction ? Look, for one moment, at those horrid and revolting outrages that have been committed in our midst, by those female fiends, the abortionists ! Could such things be, if women were properly instructed in the laws of their physical existence ? Would those registers of vice, that may emphat- ically be. called the dial-plates of infamy and corruption, dare to announce the occupations of these wretches, if the com- munity themselves were not in a state of moral apathy and heartlessness? " Which of our number, who values his character for truthfulness, dare to say, that he makes even the most ordinary prescription with more than a faint hope that it is understood, or will be carried out according to his wishes? It is well known to the physician, that very little reliance can be placed upon the best domestic aid our country affords; and that the prescription of the nurse or the patient (often of no mean de INTRODUCTION. 1 1 gree of power) frequently accompanies, or precedes his own, Would this be so, if the patient possessed a guide for her con- duct, in the perilous situations in which she is often placed? Can it be improper to tell a rational mother, how to break to her child the end and object of those mysterious powers, which are to place her in a situation to fulfil the duties which her very instinct tells her she will be called upon to perform V 1 It has been alleged by some physicians, that females re- quire no knowledge concerning their physical organization, because medical aid is always at hand to correct the evils of their ignorance. But what shall we say of the mere physic- giving physician, — he who sees nothing of the dangers which beset the female in her present condition ; who disre- gards the influence of a bad diet and air ; improper clothing ; want of exercise, proper ventilation and cleanliness ; and who expects in a day, by some paltry drug, to destroy the conse- quences of years of transgression, and that while the depressing cause still continues in action. A medical man is rarely con- sulted till the health is gone; and even if he were, intelligence on the part of the patient is needed, in order to second his efforts at restoration. Great evil not unfrequently results from the physician's prescription being misunderstood, untimely, or improperly administered. It must be conceded, then, that woman ought to be educated in the physiology and nature of her organization, and the dis- eases to which she is incident. Her own welfare requires this ) and not her own merely but the good of her offspring ; and in fine, the proper development of the physical and moral powers of our whole race depends upon the conduct of the female before marriage, during pregnancy, suckling, and afterwards. How is she to be instructed? We answer, by putting within her reach those truths concening her organ- ization which have been elicited by the patient investigations of the accomplished medical men, who have in every age of the world devoted their lives to these subjects, and to whom we are indebted for nearly all we know concerning the preven- tion and cure of disease. There are two ways by which this knowledge may be communicated; the first and most impoi- tant is, by putting into her hands works which shall be suffi- ciently extensive and perspicuous for the purpose ; the second is ? by frequent and free converse w T ith educated medical men. Our profession abounds in numerous valuable treatises upon the physiology and diseases of females, which contain information of the greatest moment to the sex. Why should it be withheld ? The author of this work makes no pretensions to originality; he has endeavored in presenting to the female a complete treatise on the Physiology of Woman axd her Dis- 12 INTRODUCTION. eases, not to leave anything important unincluded; he has given the most approved views and treatment of modern times, and has made it an especial point to instruct females in the phy- siology of their system, and the mode of preventing disease, by dwelling at length on the causes and symptoms, and on special as well as general hygiene ; he has also labored, as far as con- sistent with a truthful exposition, to avoid shocking the preju- dices or delicacy of the reader. Within a few years, since' the author first contemplated the production of this work, a knowledge of her own system has been considered more indispensable as a part of the education of the female than formerly. Consequently, several books on this subject have made their appearance : some of these are of a character highly objectionable, and are purchased because there is a desire for such information as they profess to contain, and because their real character is not known ; — such are those "private medical companions" which are heralded through the country, by their empirical and mercenary origina- tors. Some others there are, by authors of respectability and science, and which might be read with profit; but in general, they are not sufficiently copious, treating only of a few dis- eases, without giving the treatment; or, they are not made suffi- ciently interesting, from being unembellished by topics of in- terest as well as of importance. Finally, others there are, of pocket size merely, but whose authors have the vanity to occu- . py some pages in giving the names of authors consulted in preparing their works ! ; and who also have the effrontery to say that they have sufficiently explained every female disease ever heard of! After thus alluding to the works of others, designed for the instruction of females, I will say nothing in favor of my own attempt ; in the body of the work itself, must be looked for its merits, and I leave it to stand or fall by its own worth. As I have before intimated, I make no pretensions to new dis- ' coveries, but have in preparing this work freely consulted the most approved authors, whenever I believed the reader might be benefitted by so doing. The frequent acknowledgments and references to authors that I have had occasion to make throughout the volume, will, I hope, save me from any ac- cusation of illegitimate depredations. It will be seen that I have made free use of the able treatise of Colombat de LTsereon the Diseases of Females, translated by Dr. Meigs: to him I am much indebted for remarks on Hygiene, as well as the causes and symptoms of disease. The excellent works of Dewees, Churchill, Denman, Velpeau, Meigs, Dixon, Twee- die, Combe, Watson, and many others, have, also, been freely consulted. 1MR0DUCTI0N. 13 In giving the proper treatment of tire various affections to which the female is obnoxious, I do not wish to be under- stood as advocating the ideas of some, who believe that every one may become capable of doctoring himself. The domes- tic administration of medicine, as at preseut practiced, with- out a knowledge of the system, of the power of remedies, or of the diseases which they are designed to remove, is a great evil. There is at present such a thirst among all classes of community for all kinds of knowledge, that it is worse than useless to try to deprive them of it; the more physicians inveigh against these abuses, without imparting correct informa- tion, the more will " affectionate mothers and aunties' ; re- sort to dosing, or allow themselves to be influenced by quack- ery. On the contrary, the author believes, that if the commu- tvwere informed in regard to the proper treatment of disease, of the extensive acquirements necessary to constitute the edu- cated physician, and of the onerous duties he has to per- form, they would have a more just appreciation of his de- mands upon their patronage, repudiate quackery, and conse- quently receive more benefit from our noble and humane profession. The plan of our work will be seen from an examination of the table of contexts. After giving the anatomy of or- gans peculiar to the female, we have commenced with the PHENOMENA AND HYGIENE OF CHILDHOOD AND PUBERTY. Then we have treated of the physiology and all the diseases pecu- liar to every stage of Woman's existence. We have closed With the HYGIENE AND MANAGEMENT OF INFANCY thus making the whole subject complete by embracing every period of the life of the female. The intelligent woman will see the necessity of having in her confidence a capable physician; as it is impossible for her, as indeed it is for the physician, himself, to be a proper judge of her own diseased condition. To make our effort still more useful we have added, at the end of the book, directions for making dietetic prepa- rations, and a few additional forms of prescriptions; also a Glossary for the purpose of assisting the reader in under- standing the medical terms which we have found it neces- sary to introduce into the work. THE AUTHOR PREFACE TO THE FIFTH EDITION. The very flattering reception of the earlier editions of this work by the public, has, after the elapse of several years, induced the author to issue this improved edition. He has been influenced by another consideration : Since the first production of this work, the evils besetting the lives of females have in nowise abated, but rather increased. At the present time, there seems to be a desire as well as a great need among women, of such information as is contained in this volume. In conse- quence, the market has been flooded with several pretentious works — mere catchpennies, issued by physicians, so-called, merely for the purpose of advertising their noxious nostrums, and calling attention to their vile avocations as abortionists. In conse- quence, the public ought to be infortned in regard to these matters, and have within their reach a true and reliable work upon which they can depend in all emergencies. There are no literary pretensions here. The author asks nothing for himself, but every thing for Science, History, and Natural History. By these, the great revelation has been made. Woman has been explained to us. The science of ovology has revealed all. What was formerly called an impurity in her, is her holiest, her most poetic crisis. Nature gives woman to man, feeble, depending constantly upon the need of being loved and protected. She is glad to rest upon some one. She loves beforehand him to whom nature seems to lead her. To stop her, she must have more virtue and strength of mind than man. Where the world does not spoil her, she is good, and docile, and ennobling to man. What a duty, what a privilege for us ! Cherish, then, love her, protect her. To a true woman, one moment of genuine love is worth more than all the glories of the world. The Author. BOOK I. THE PHYSIOLOGY OF WOMAN. AND HER DISEASES, INCLUDING AIL THOSE OF HER CRITICAL PERIODS. "When Conscience, History, and Natural History accord — Believe.- 3 •»- THE PHYSIOLOGY OF WOMAN, AND HER DISEASES. PART I. ANATOMY OF ORGANS PECULIAR TO .THE FEMALE. CHAPTER I. PECULIARITIES OF THE FE3IALE SYSTEM, WITH THE ANATOMY OF .ORGANS PECULIAR TO THE SEX. There has been a popular belief, which exists to some extent in our day, that the human female is almost a dif- ferent being from the male. Yet, in fact, although the Deity, for the purpose of preserving certain moral and phy- sical differences, has imposed a distinctness of organization upon the sexes, and allotted to each respective duties which cannot be changed, this dissimilitude, though great, is not so distinctive as is a by many supposed. In the formation of man, it would be idle, by any process of reasoning, to decide to which sex is assigned the most important part in fulfilling the intentions of nature; they cannot evidently be fulfilled by one sex alone. • Much may be done through the influences of education and modes of life, in varying the female constitution, but they are not able to deprive it of its distintive peculiarities. When these great agents have been employed under equal circumstances, an approximation of similarity has been observed ; yet they have never been able to alter the character of the female so much, as to leave a doubt to which sex the individual belongs.. In those rare cases of malformation, where there is a complete absence of the B* 18 PECULIARITIES OF THE FEMALE SYSTEM. ovaria, t'le mind and body present an extraordinary assimi- lation with those of the male. The delicacy and gentleness peculiar to the female is exchanged for the superior firm- ness and steadiness of purpose of the male. The differ- ence in personal appearance, and fancy for rude sports, are also apparent. From these peculiarities, connected with certain derangements of structure, occurring some- times in females, they give rise to the impression that both sexes are combined in the same person, and thus forming what have been called hermaphrodites. We need only say, that no such being has ever been known to exist in the human species ; although there have been many curi- ous cases of malformation. We have, however, in this place, only to explain the peculiarities that distinguish the female from the male, which impose upon her, functions and diseases altogether her own. For her organization and temperament particu- larly adapt her for the contingences connected with the processes of conception, delivery and suckling, which she is destined to perform. Besides being liable to most of the diseases of the male, she is, from the age of puberty, subject to irregularities of her own peculiar function, menstruation, from which she severely suffers.* The anatomical and physiological peculiarities of the female are numerous. One of the most evident differ ences of the sexes, is the inferiority in stature of the female. The bones of her whole system are more deli- cate and less extended. Those of the cranium are smaller, as also is the space destined to be filled with the brain. The connection of the bones with each other, in articulating, differ from those of the male, in being better concealed. The chest is more elevated, in consequence of the ribs forming nearly right angles with the spine. This dispo- sition of the ribs renders the chest shorter, though its upper part is larger. Of the differences in the bones of the pelvis we shall speak hereafter. * An eminent medical writer is of opinion, that most of the causes which degenerate the human race, originate with the female; he re- marks : " The degeneration of the species always begins in nature with the female; to study the diseases of them is to arrive at the source of all that belong to the human species." PECULIARITIES OF THE FEMALE SYSTEM. 19 The muscular system also differs ; its activity is much greater ; and the whole of the fibres of the female, pos- sess greater tenuity and sensibility. The nerves are smaller and of more delicate structure ; they possess greater sensibility, and hence the increased susceptibility of impressions', from physical and moral causes; hence, also, the rapidity of contraction of the muscles, and less permanency of impressions. And thus the organization of the muscular and nervous systems, con- tribute to render the female more liable to spasmodic dis- eases, and exposed to inordinate stimulation from internal and external, moral and physical causes. In the circulatory system are united the peculiarities of the muscular and nervous systems. The circulation is carried on with more rapidity, but less force ; the arte- ries are smaller, more excitable, and less easily calmed when inordinately excited. The veins are more strongly marked upon the surface of the body, thus offering less resistance to the distension of the blood. The cellular system is more abundant and more flexi- ble. From its abundance about the articulations of joints and large foldings of the body, a roundness and beauty is given to parts which in the male are sometimes un- sightly. The texture of the skin is much finer in the female, more highly polished and transparent, and is, of itself, almost an object of beauty. Its sensibility is much greater, and its sympathies are more vivid than in the male. It will be seen, by the peculiarities which we have now pointed out, that the female constitution is of a marked and in many respects distinct character. There are other physical peculiarities contained within and about the pelvis which we shall soon describe, endowed with an extent of influence that belongs to none of those yet mentioned. Notwithstanding the aversion of females, from innate and becoming feelings of chastity, for every allusion to the organs destined for the continuation of the species, yet, from the importance and actual necessity of their having a knowledge of those organs, they being the seat of nu- merous diseases and accidents, it is unavoidably incum- 20 ANATOMY OF ORGANS PECULIAR TO THE FE3IALE. bent upon me to give such information in these descriptions. While doing so, I 'shall sympathize deeply with her feel- ings, and endeavor that no expression shall fall from my pen, which may raise a single blush upon the cheek of any modest and intelligent woman. the pelvis . By the term pelvis, from a Greek word, signifying ba- sin, is indicated that portion of the abdominal cavity in- cluded within the bones of the pelvis, which are four in number : the ossa innominata or hip bones, the sacrum and Fig. 1.* * A front view of the female pelvis. 1. 1. The ossa innominata, or hip bones. 2. The sacrum, perforated with two rows of holes for the transmission of nerves. 3. The symphysis pubis, or ospubis. 4. The coccyx. 5. 5. Articulations for the thigh bones. The anteropos- terior diameter of the brim, from symphysis pubis to middle of sacrum, measures four inches and a half. The transverse, from the middle of the brim on one side to the same point on the opposite, five inches and a quarter. The oblique diameter measures about five inches. The an- tero-posterior and transverse diameters of the outlet measure each four inches. The cavity of the pelvis measures in depth, one inch and a half in front, and four inches and a half posteriorly. ANATOMY OF ORGANS PECULIAR TO THE FEMALE. 21 coccyx ; which in the adult are firmly united by what are called the symphyses. The triangular space between these bones is known as the cavity of the pelvis. It is usually divided by anatomists into the brim or inlet, cavity, and outlet. The brim is the superior part, and in the female, is of an oval form, corresponding with the child's head. The outlet is of an irregular form and is the inferior part. The cavity lies between them. See Fig. 1. In the female,the bones of the pelvis are lighter and more delicate than in the male. The inlet, outlet and cavity, are larger in the former than in the latter. The contents of the female pelvis are, the bladder, va- gina, uterus, with its appendages, and the rectum. The bladder (4, Fig. 2,) is situated in front, and has the uterus immediately behind, from which it is usually sepa- rated by a convolution of small intestines. The urethra, passage from the bladder, is about an inch and a half in length, and passes downwards and forwards to the meatus urinarius, opening for the urine, which is situated in the vagina, immediately below the symphysis pubis, and be- hind the nymphce. See Fig. .2. The vagina (12, Fig. 2,) is a membranous canal, lead- ing from the external parts to the uterus or womb, and cor- responds in direction with the axis of the outlet of the pel- vis. It is constricted at its commencement, but becomes considerably dilated near the uterus. Its length is varia- ble, though it is generally five or six inches. It is in- serted into the neck of the uterus, which projects into the upper extremity of this canal. The uterus (17, Fig. 2,) is a flattened organ, somewTiat of a triangular shape, w T ith the base directed upwards and forwards, and the apex downwards and backwards, in the line of the axis of the inlet of the pelvis. In the natural unimpregnated state it is about three inches in length, two in breadth at its broadest part, and one in thickness, and is divided into fundus, body, cervix or neck, and os uteri or mouth of the uterus. At the period of puberty this or- gan weighs about one ounce and a half; after child-bear- ing from two to three ounces ; and at the ninth month of pregnancy from two to four pounds. The membrane lining the abdomen, called the per iloneum, envelopes the 22 ANATOMY OF ORGANS PECULIAR TO THE FEMALE. upper part of this organ, forming the broad ligaments, which serve with the. round ligaments, which are muscu- lar cords situated between the layers of the broad liga- ments, in retaining the uterus in its proper position. The Fig. 2.* * A side view of the organs of the female pelvis. 1. The symphysis pubis. 2. The abdominal coverings. 3. A collection of fat forming the mons Veneris. 4. The urinary bladder. 5. The entrance of the left ureter (passage from the kidney.) 6. The canal of the urethra. 7. The meatus urinarius. 8. The clitoris divided through the middle. 9. The left nymph*. 10. The left labia majora. 11. The meatus of the vagina. 12. The canal of the vagina. 13. The wall of separation be- tween the bladder and the vagina. 14. The wall of separation be- tween the vagina and the rectum. 15. The perineum (space between the vagina and anus.) 16. The os uteri. 17. Its neck. 18. The fun- dus. The body of the uterus is seen between the two last figures. 19. Th^ rectum. 20. The anus. 21. The upper part of the rectum covered with the peritoneal membrane. 22. The recto-uterine fold or the peritoneum. 23. The uterine fold of the same. 24. The reflec- tion of the peritoneum over the bladder to the internal walls of the ab- domen. 25. The la>t vertebra of the back. 26. The sacrum. 27. The coccyx. 28. The left thigh. ANATOMY OF ORGANS PECULIAR TO THE FEMALE. 2S appendages of the uterus are also enclosed in this fold of the peritoneum. They are the Fallopian tubes and takes place, forming fibrous tumors ; they are found of different degrees of consistence, flabby, soft and dense, and occasionally containing portions of calcareous matter. The womb is subject, also, to malignant diseases, in the form of fungous growth, ulcerations, and of morbid depositions. The fungous, denominated cauliflower excres- cence, is nothing more than a mass of enlarged and dis- eased vessels, with their cellular substance. Malignant ulcerations, or corroding idcer first attacks the neck of the uterus, and then spreads with varying rapidity to the body of that organ, and frequently to the vagina. Cancerous deposition may take place in the neck of the uterus, in its body, or in both places at once. It may, also, take place in the cellular tissue which connects the uterus to neighboring parts. The uterus is, also, subject to various accidents, such E* 90 PRELIMINARY OBSERVATIONS. as rupture, displacement, etc.; the first is generally the consequence of violent labor pains. Displacements of the uterus are of different kinds, and are consequent upon a re- laxation of the usual supports of that organ. We may have inversion, retroversion, anteversion, prolapsus, etc. The Fallopian tubes and ovaria undergo morbid changes similar to those which take place in the uterus ; the most common of these are : obliteration of their canals ; disten- sion by serous effusion, tubepcula or encephaloid matter; adhesion, and cancerous deposition. Some additional light may, perhaps, be thrown upon these diseased conditions, and the period of their occur- rence, if we briefly consider the anatomical changes which the uterus and its appendages undergo at the great epochs of female life,' and the predisposition thence arising to certain disorders. Before menstruation has commenced, the uterus is of a very dense structure, with vessels and nerves of a size only sufficient for its nutrition. The ovaries are small, pale, and undeveloped. Up to this period, diseases of the internal organs are extremely rare. After menstruation, we shall find that the womb has undergone a change. It has increased in size and is of a softer texture ; the vessels are enlarged and carry more blood. The nerves, too, if not much enlarged, are more excitable. The mucous membrane is of a florid, red color, and a train of pathological phenomena commences. First, we may have various functional disturbances and local congestions with a discharge of blood. Then, neuralgia of the uterus, hysteria, leucorrhea, or inflammation, with its consequences, although the latter is more frequent at a later period. The establishment of menstruation exercises an important sympathetic influence over other and distant organs. The brain and nervous system, the stomach and intestinal canal, the glandular system, etc., are exposed to- new, energetic, and morbid influences. After conception and dicing gestation, a further change of structure takes place. The mucous membrane lining the uterine cavity, becomes more vascular, and is quick- ened into increased action, for the purposes of pregnancy. DISEASES OF THE INTERNAL ORGANS. 91 The walls of the uterus lose their density, and are much enlarged, for the accommodation of the blood vessels, which are very much increased in size, carrying many times the ordinary quantity of blood. The lymphatics and nerves are, also, proportionally developed. The ova- ria are more vascular than usual, and increased in volume. The uterine disorders which occur during gestation, are in accordance with the anatomical condition of the organ ; there may be irregular distribution of blood, as congestion, inflammation, hemorrhage, etc., neuralgic pains and spas- modic difficulties. The canals of the Fallopian tubes are subject to obliteration, and the ovaria to distension, by the formation from inflammation of serous, and purulent matter. After a safe delivery, these peculiarities lose their promi- nence, but the uterus is not left in the same state as be- fore impregnation — and every succeeding pregnancy de- velops still more these changes. Now the diseases which prevail during the child-bearing period, answer exactly to these changes ; from the increased amount of blood in circulation, and exaltation of the nervous influence, we have frequent hermorrhage, and nervous difficulties, and in- flammation of the substance and lining membrane is more frequent than previously. We seldom see ulceration to any great extent, or lesions of nutrition, till towards the latter part of this period. In elderly women, after the child-bearing period, the vessels and nerves of the uterus are found diminished in size ; the lining membrane is thicker than at an earlier age, and pale; but the substance has acquired, through- out, nearly its primitive density, and considerably more at the neckof the uterus, presenting, in fact, a cartilaginous appearance. The canal leading to the uterus is nearly, and in many cases quite obliterated, the vagina and uterine ligaments are greatly relaxed, and the ovaries very much shrivelled. In accordance with this change, active inflam- mation and hermorrhage are much more rare, but destruc- tive and organic diseases are more frequent; asflbrous and fleshy tumors, morbid fungous growths, and cancerous de- position. From the obliteration of the canal of the neck, an accumulation of mucus in the uterine cavity, some- 92 PRELIMINARY OBSERVATIONS. times leads to rupture of that organ ; and the relaxation of the supports of the uterus readily admits of prolapse. The ovaria, also, at this period are subject to lesions of nutri- tion, giving rise to various solid and fluid deposits, and ma- lignant fungoid diseases, similar to those of the uterus. As the diseases of the vagina are often closely connect- ed with those of the uterus and its appendages, we shall include them all under the same head. Causes. — All circumstances of evil influence, or which deviate from the design of nature, may be regarded as causes of the various genital affections. They may, in reference to particular diseases, generally, be divided into the predisposing and exciting; which distinction we shall make, when practicable in speaking of individual disorders. Among these circumstances, as most promi- nent, we may mention abusus coitus, masturbation, conti- nence, celibacy, sterility, laborious labors, abortions, and drying up the milk. Those females who reside in large cities and live in a state of opulence, are afflicted with a greater number and variety of diseases, than those of the country and less exalted rank ; this is doubtless ow- ing to the latter being less under the influence of those perturbing causes, to which those who reside in cities, and the opulent, are perpetually subject. On account of the sympathies that exist between the genitalia, and other parts of the economy, as we have seen, should be reckoned among the most common causes of the diseases of females in large towns, and among the opulent classes — the impurity of the atmosphere ; disregard of the laws of hygiene ; cold and astringent cosmetic lotions for the vulva, during, or soon after the menses ; the use of emmenagogues protracted vigils ; the use of foot-warmers, exciting dishes and the immoderate use of tea, coffee, wines and ices ; excitements and commotions ; illicit enjoy- ments ; viewing theatrical representations and reading works of fiction ; indolence ; jealousy, disappointed love, and loss of fortune ; and, in short, all the violent emotions and passions of the mind. All of these, and other similar causes act more powerfully among city women, because they are, in general, endowed with the liveliest imagina- DISEASES OF THE INTERNAL ORGANS. 93 tion, and extremely nervous and impressionable — espe- cially those of the elevated class. In country women and among the less opulent classes, these affections often depend upon different causes : such as a marshy residence, a damp and badly-lighted dwelling ; violent exertion, blows and falls ; atmospheric vicissitudes, sitting on the cold ground, and the immersion of the hands or feet in cold water ; the continued use of too unnutricious food, and alcoholic drinks; the use of emmenagogues; meddlesome midwifery ; sedentary labor in cellars and low damp work-shops ; finally, rage, libertinism, drunkenness, filthiness, etc. Diagnosis. — The diagnosis of uteiine disease is of great importance, and often requires great care and skill. Tke information for this purpose is derived from three sources: 1. From the symptoms. 2. From a manual or tactile examination, as touching per vaginam, per rectum, etc. 3. From a visual examination by the speculum. All of these means will be detailed at length 2 for the purpose of distinguishing individual diseases, when we come to speak of them. When there is any doubt in regard to the nature or lo- cation of a disease of these organs, the most delicate female should not object to such examination as may lead to a knowledge of the cure of a disorder, which otherwise might prove speedily fatal. It is needless to say, that the greatest gentleness should be, and is used by every gentleman, and the examination repeated as seldom as possible. Treatment. — As we shall dwell at length upon the treatment, when speaking of individual diseases, we need barely advert to the subject in this place. There are some medicines that are regarded as emmenagogues : such as the ergot, iron, strychnine, aloes, electro-magnetism, cantha ri- des, etc., which seem to act directly upon the uterine system. Preparations of iodine have latterly been successfully used, particularly the iodide of potash. Calomel and opium exert a remarkable power over uterine inflammation ; and 5* 94 TARDY APPEARANCE OF THE MENSES. cupping the loins, or the application of leeches to the vulva, anus, or over the pubis, are highly useful. Of late years, blood has been extracted directly from the neck of the uterus, by means of the speculum, with leeches and scarification. By the same means caustics may be ap- plied to the part affected without injuring the vagina : as nitrate of silver and mercury, butter of antimony, efc, in ulcerations and excoriations. In diseases of the vagina and neck of the uterus, injec- tions of various substances may be thrown up by a sy- ringe — as astringent decoctions and infusions, solutions of sulphate of zinc and copper, nitrate of silver, etc. Emol- lient and anodyne injections, as well as those of simply warm and cold water, are, also, very useful. An appropriate system of hygiene, is one -of the most important means of cure, and should never be neglected. A proper diet, the judicious employment of the external application of cold and tepid water, counter irritation, the use of anodyne plasters, etc., etc., are all of great import- ance, and will be pointed out when their several virtues are required in different diseases. SECTION I. FUNCTIONAL DISORDERS. CHAPTER II. SUPPRESSION OF MENSTRUATION AT PUBERTY, OR TARDY AP- PEARANCE OF THE MENSES FOUR DIVISIONS CAUSES- SYMPTOMS AND TREATMENT. It has been stated, that in this climate the average period of puberty in the female, is from the fourteenth to the fifteenth year — which is indicated by the menstrul dis- charge. If, however, the usual period arrives and we have, or have not, the signs as enumerated in Chapter I. TARDY APPEARANCE OF THE MENSES. 95 and II. of Part III., and the mensesdo not occur, or if they have been established, and disappeared again from other causes than those of pregnancy, suckling and old age, the individual is said to labor under suppression of the men- ses. There are two forms of suppression, each of which is important, as being intimately connected with its proper understanding and treatment. The first form is that, when from age or personal de- velopment, it is judged that the proper period of puberty has arrived — and it does not appear at all — known as tardy appearance of the menses. This form originates mostly fioni constitutional causes, and is the subject of this chapter. Tb'3 second form is that, in which it has appeared, but is infer • upted after having been established ; this is the proper Amenorrhea or suppression of the menses, of au- thors, and will form the subject of the next chapter. There are several divisions of the first form, or tardy appearance of the* menses, which we shall notice in order. The first, is when at the usual age of puberty, there is little or no development of the female system. The second, is when th.are are indications of development, which is but slowly taking place. The third, is when this develop- ment Is interrupted by a chronic affection of seme other part. The fourth, is when the most perfect development of tha female constitution has taken place, yet it does not appear. 1. When there is little or no development of the female sytem at the age of puberty. This is easily detected by the absence of all the signs which should characterize the appearance of womanhood ; the breasts do not enlarge, and in fine, none of those changes occur which are enu- merated in Chapter I. and II. of Part III. The cause may be, imperfect development, or malformation — as ab- sence of the ovaria, or uterus. It is evident that in such a condition, it would not only be useless, but it would be inhuman and cruel to torture a girl's system with stimu- lating emmenagogues, which may be in good condition, merely because she has attained her fourteenth or fifteenth year. We have spoken plainly on this point, at page 68 and 69, and shown that when it is practicable time, etc., 96 TARDY APPEARANCE OF THE MENSES. is all that is required, to effect the anxiously hoped for change. In this condition, if the mother or friends of the female are rational and informed upon the subject, they will see the entire insufficiency of medicine to produce the desired end. But, they sometimes act in open defiance of knowl- edge, even after possessing it, to the imminent risk of the destruction of the poor girl who is the object of their solicitude. Dr. Dewees mentions a parallel case to that mentioned at page 69, of the sad fate of a " most amiable and interesting young creature," for whom he was re- quested to prescribe for the expected menses. She was in perfect health, and had not a mark of womanhood — though she was fifteen years of age — and this was all that could be urged by the mother in favor of an attempt to " bring down her courses." He relied upon the good sense of the parent, freely explaining to her that no medicine was needed, and heard nothing more of the girl for six months. At the end of this time, he was suddenly summoned again to attend her ; he found her alarmingly ill, throwing up large quantities of blood, and she died a few days after from the excess of this discharge. It seems that the mother, with the view of producing the menstrual discharge, had procured some medicine of a quack, which, upon giving according to his directions, produced fever, loss of appetite, and vomiting ; she again called upon the " Doctor," and he encouraged her to per- severe with the medicine,, saying that the fever, etc., was an effort of nature for the end proposed — " she persevered, fatally persevered ; for in a few days more she lost her lovely and only daughter." The medicine upon exam- ination proved to be the oil of savin. 2. When there are indications of development, which is but slowly taking place. This condition is known by the partial occurrence of those changes before mentioned, that indicate puberty. There is slight enlargement of the breasts, some expansion of the body, etc. The gen- eral health seems to suffer, especially if the girl have passed the fifteenth year ; the face is pallid, and only flushed upon occasions of sudden and violent mental ex- citement, or physical exercise, which soon oppress and TARDY APPEARANCE OF THE MENSES. 97 exhaust the system. She is assailed by a train of nervous svmploms, as they are called, such as palpitation of the heart, ringing in the ears, headache, loss of appetite or a desire for the most opposite and inconsistent articles of diet. This constitutes very nearly what is called the .lymphatic temperament: or, that in which the vessels are filled with lymph or thin blood. This condition is sometimes accompanied by leucorrhea, (see that chapter ;) which particularly deserves notice when the health appears to suffer. A distinguished French writer, in speaking of the causes of this affection, remarks : " The general debility which is so often the cause and attendant of suppression, does not always derive its origin in the primitive constitu- tion of the female ; it is often the unfortunate consequence of a number of debilitating causes, such as living in a low, humid situation, deprived of the light of the sun ; aliment of a bad quality ; warm watery drinks ; insuffi- cient nourishment; want of exercise, or the fatigue pro- duced by labor beyond the. strength ; tedious disease and convalescence; leucorrhea; the abuse of sanguine evacu- ations ; disappointment and all the depressing passions ; and finally, all the causes which impoverish the blood, and render it incapable of imparting to the organs the energy indispensable for the full exercise of the functions. [^ the contrary excess, that is to say, the state of plethora (sanguine temperament) produces an analagous effect, it is because the blood, too rich in fibrine, forms an obstacle to itself, and opposes the periodical exhalation which con- stitutes menstruation. " These lamentable causes are continually in operation, among a great portion of the human family. The health of females employed in factories, even in our favored country, from their constant deprivation of fresh air, con- finement to repulsive and monotonous labor, and general restraint of .the natural impulses and desires, must seri- ously suffer. We think there can be no doubt, that in the vast proportion of individuals thus employed, serious and often lasting injury is done to the constitution. In the treatment of this form of tardy appearance of the menses, our exertions must be directed to the invigor- 28 TAttDY APPEARANCE OF THE MENSES. ation of the system in general, and to the development of the uterine system in particular — though to effect the former is much assisting the latter. The first should be attempted by free exercise in the open air, riding on horse-back, when practicable, if not, in an open wagon ; walking in proper weather, and when the weather will not permit of exercise abroad, skipping the rope within doors ; dancing moderately, with care o f not over-heating, and cooling too suddenly; all such means are useful in giving a healthful impetus to the mind and body. By proper attention to dress : clothing enough must be worn at all times to ensure a constant state of comfort ; wearing flannel next to the skin in cool weather, and properly protecting the feet and legs against cold ; carefully avoiding damp and wet places, and currents of cold air, especially when warm. The diet should be moderate and consist of easily digestible substances both of the vegetable and animal kind ; using very cautiously stimulating drinks, such as wine, spirits, beer, etc. All depressing emotions, whether originating in domestic unhappiness, or careless indifference to the welfare of her children, must be dissipated by the mother and her asso- ciates ; under the influence of her presence all unhappi- ness should disappear ; home must be a happy place, or the health of the female inmates will suffer. In short, all those hygienic rules mentioned in Chapter VI., Part III., are here applicable, and to them the reader is directed. All exercise should be taken before evening, and care should be taken not to carry it to the point of fatigue. The practice of invalids riding out before breakfast, or after tea, should not be permitted, unless great care be taken to preserve an even temperature and equable warmth of the skin. The invalid should retire to rest upon the first approach of drowsiness, never suffering herself to be detained by visitors. If it be understood that she is *an invalid, no person can be annoyed at her departure. Par- ticular attention must be given to ventilation, without danger from a current of air; an open door or fire place must be principally relied on for this purpose. Tepid water and a rough towel should be used for frequent ablu- tion — only a part of the body being exposed at a time TARDY APPEARANCE OF THE MENSES. 99 in cold weather, with care to dry thoroughly, and rub into a glow before resuming the garments. The second, or when our exertions are directed in par- ticular to the development of the uterine system, must be accomplished by such medicines as have direct or indi- rect action on the uterus itself; of the direct kind, the tincture of cantharides* seems to be an efficient one, and is particularly applicable when leucorrhea attends ; thirty drops may be given three times a day and the dose gradu- ally increased till this discharge ceases, or is converted into the menstruous. The various preparations of iron and iodine, in apropri- ate doses, are always used with success, particularly when there is much general debility of the constitution ; the best form of the latter is the tincture with the iodide of pot- ash — from ten to thirty drops may be. given from two to four times a day. Of the iron, the sub-carbonate, in ten grain doses, and the wine of iron in the dose of a drachm, are the best forms. If the patient should be of a full habit and any degree of plethora be present, with symptoms indicating uterine effort, a small bleeding will very often afford relief; or, perhaps a better mode of abstracting blood, is by leeches to the vulva, or cupping the loins. Brisk purging is occa- sionally necessary ; and of the indirect remedies for this purpose, aloes combined with rhubarb, seems to be the most certain ; — it should be given in very small doses, and perseveringiy continued. Dr. Dewees thinks it preferable — combined as in the following F0R3I — to the tincture of cantharides, when leu- corrhea does not attend : — Gum Aloes, half a drachm. Pulv. Rhubarb, . . .one do. Oil of Cloves, four drops. Venet. Soap, eight grains. Syrup Rhubarb, q. s. *lt will be understood that no medicine which has a direct action upon the uterus, is admissible in this condition, unless there is uterine effort ; till there are symptoms of the vessels of the uterus being loaded v>ith their secretion, the remedies before noticed, should be continued, to the exclusion of specifics. If the cantharides produce strara?uary, difficulty of passing the urine, it should be discontinutd until these symptoms subside, when it may be agam resumed 100 TARDY APPEARANCE OF THE MENSES. Mix, and make into sixty pills. One of them may be given every night, or night and morning, or every other night, as they may affect the bowels — the object being merely to keep the bowels free. Electro-magnetism, also, is a valuable remedy, and deserves a trial. At the time medicines are used, the same regard must be paid to air, exercise, and diet, as before recommended. 3. Where this developement is prevented, by a chronic affection of some other part. This condition is readily de- tected by the presence of any such disease as may be ca- pable of interrupting this discharge after it has been well established; such as pulmonary consumption ; chronic inflammation of the liver, and spleen ; dropsy, etc. The existence of either of these diseases will be most certain to interrupt the development of the organs essential to the formation of the menstrual discharge, however favorably this expansion may have commenced. In such cases, of course, no treatment will be availing but that directed to the removal of the original disease; of such diseases we shall not speak in this treatise, as they are not peculiar to females. Although the administration of medicine is often necessary in such cases, it is only to be used as an adjuvant and subordinate remedy to the great natural medicines — diet, air, exercise, and cheer- fulness. In such cases as we have now been discribing, it will be seen by the reader, that it would not only be the height of folly, but highly injurious to the patient, to administer medicines for the purpose of " bringing down the menses" as it is termed. The disease, itself, whatever it be, must first be subdued by the use of proper remedies, when the most gentle efforts may be made to favor nature in her attempts to establish, or re-establish this function. 4. When the most perfect development of the female constitution has taken place, yet the menses does not make its appearance. This condition is recognised, by the young female having all the outward indications of woman- hood ; the general character of the constitution is remark- able for its robustness ; the appetite and strength are good, and although the complexion has not its proper trans- parency, nor the eye its proper lustre, the blood-vessels TARDY APPEARANCE OF THE MENSES. 101 seem distended with their contents, and the eruption of the menses is all that is wanting to fit her for the duties she is destined to fulfil. It seems that in this condition, the fibrine of the blood is out of proportion to the serum, thus ctogging, as it were, the secreting surface of the uterus. It constitutes the sanguine temperament in contradistinc- tion to the lymphatic, or that in which the vessels are filled with lymph or thin blood, spoken of in the second division of this subject. It is sometimes, though less often than in the other case, attended by leucorrhea. In the treatment, a moderate bleeding is serviceable, either from the arm, or by leeches to the vulva, or cup- ping the loins. The menses frequently appear a few hours after such abstractions of blood ; this may be assist- ed by hip and foot baths. In less plethoric cases, and par- ticularly where leucorrhea attends, the tincture of can- tharides as directed in division second of this subject, will rarely fail to produce the discharge if given steadily for two or three weeks; the combination of aloes there men- tior.ed will, also, be found very useful. In cases where there is much irritability of the system, madder, from its possessing^ no general stimulating properties, has been highly recommended. A strong decoction, made by pour- ing a pint of boiling water upon an ounce of this substance, in fine powder, with a scruple of bruised cloves, then boiling gently fifteen minutes and straining when cool, seems to be the best mode of using it ; the dose is a wine- glass full every three hours. These remedies, if judiciously applied, are generally all that is necessary. The diet of the "young girl should be of the mildest kind — mostly vegetable, and exercise may be moderately taken. It will be noticed by the reader, that most of the cases of tardy appearance of the menses come under two grand divisions — those that are characterized by the lymphatic temperament, of a lax fibre, and deficient vitality, and those of the sanguine temperament, of an excessive vitality and rio;id fibre ; — the treatment varies accordingly — it is to be more stimulating in the former, and antiphlogistic in the latter. 6 102 SUPPRESSION OF THE MENSES ACUTE AND CHRONIC. We sometimes have tardy appearance • of the menses from malformation. When the uterus, or ovaria, or both, are wanting, of course there is no menstruous secretion ; but in those rare cases of faulty conformation, where the neck of the uterus is impervious, the vagina is wanting, or its sides adherent, or its orifice closed by false membrane, or an imperforate hymen ; — the secretion sometimes takes place and distends the uterus to an alarming extent ; also, subjecting the young female to unjust suspicion. In these cases, the outward signs of puberty are present, and great care must be taken to discover the cause of suppression. In the treatment, the obstacles which prevent the escape of the menses must be overcome ; if this be too long delayed, serious consequences may result. If the canal of the neck be impervious, an artificial one must be made with a trocar, and a probe passed into the uterus. When the canal of the vagina is obliterated, a new one may be formed between the rectum and vagina ; when this is not possible, the uterus must be punctured through the rectum. When adhesions unite the sides of the vagi, na, or imperforate hymen prohibit the emission of the menses, we should first attempt to rupture them, by separa- ting the labia ; if we fail, the knife or trocar, must be used, great care being taken to avoid injuring the neigh- boring parts. CHAPTER III. AMENORRHEA OR SUPPRESSION OF THE MENSES, OR ITS INTERRUPTION AFTER HAVING BEEN ESTABLISHED ACUTE AND CHRONIC CAUSES SYMPTOMS AND TREATMENT. We next come to consider that condition wherein the flow of the menses, after having been for a longer or shorter time established, has been arrested without being interrupted by pregnancy, suckling or old age. This may happen at any period of menstrual life ; and it may take place suddenly, or very gradually, or, in other words, it may be acute or chronic. i SUPPRESSION OF THE MENSES SYMPTOMS. 103 1. Acute suppression of the menses may occur from various causes, such as sudden exposure to the cold and damp air, the immersion of the feet or hands in cold water, cold ablutions of the genital organs, sitting upon the ground, or a stone bench, etc., during the menstrual flow ; the eating and drinking of ices and very cold drinks, especially when taken while the body is in a state of per- spiration; a violent bleeding; the application of a large blister; the employment of purgatives, .of emetics, of strong odors; coition during the flow, fever, or any severe disease sitting in at that period. Also, a bodily or mental shock received just previous to, or during the menstrual flow, may produce it ; the vivid emotions of the soul, as anger, disappointed love, celibacy, despair, jealousy, im- moderate joy, the sudden reception of bad news, a sudden fright, extreme fear, or a sudden disappointment ; and finally, all circumstances capable of suddenly determining the blood in other directions than towards the uterus, may give rise to this condition. The most common cause, perhaps, is cold applied to the feet. The majority of women pay so little regard to this period, that they are exposed to frequent derangements from this agent, by standing in thin shoes or sitting upon cold and damp ground, and going too lightly clothed ; some are so reckless of consequences as designedly to stop the flow by putting their feet into cold water, when engaged for a ball or party. Dr. Frank mentions the case of a lady, who, because she expected her lover, put her feet several times into cold water during the flow of the men- ses, which very soon arrested it ; an inflammation of the uterus followed, and she was brought dying into the hos- pital at Vienna. So much evil has resulted from such and similar impropriety, that the female cannot be too careful when the " manner of women" is upon her. The symptoms consequent upon sudden suppression, vary. Most commonly there is fever, with a sensation of heat, weight and pain in the pelvis, uterine colic, disa- greeable tension of the loins and upper part of the thighs ; enlargement of the breasts and abdomen ; lassitude ; nausea, vomiting ; dizziness, headache, ringing in the ears, frequent palpitations, burning of urine, etc. Or there may 104 SUPPRESSION OF THE MENSES TREATMENT. be symptoms of local inflammations either of the lungs, brain, intestinal canal, or of the uterus itself. Occasionally instead of inflammation, there are severe neuralgic pains of the womb : or a species of hysteria, (see that chapter,) simulating inflammation, and changing from one organ to another, as soon as remedies are brought to bear upon it. Attacks of apoplexy and paralysis have also been known to result from sudden suppression ; as also, loss of voice, curious derangements of vision, and cutaneous disorders. These secondary attacks may be mitigated in severity, by the occurrence of vicarious menstruation, discharge of blood from some other part, (see the next chapter) by which the temporary plethora is relieved, without any re- turn of the uterus to a healthy state ; or by uterine leucorrhea, which appears to afford relief, and more nat- urally, since there is a sort of action of the uterus, which, though faulty, seems to be better than having it remain perfectly indifferent. On account of the secondary attacks to which it gives rise, sudden suppression is a much more serious disorder than any other form of menstrual derange- ment. There can generally be no difficulty in ascertaining the fact of suppression ; if, in irregular cases, there should be any doubt as to their nature, they should at first be treated as simply inflammatory. Attempts are sometimes made by unmarried females, with the view of avoiding exposure of character, to deceive physicians, in regard to one of the causes of menstrual suppression. The well-instructed phy sician needs no caution on this point ; and to those who are disposed to this course, we would advise a careful attention to the chapter on abortion, in Book II. Treatment. — The acute form is more easily cured than the chronic. First, we should endeavor to recall the discharge ; and for this purpose the patient should take a warm bath, or put the feet into warm, water, and swallow a bowl of hot drink, as whey, thin gruel, etc.* Rest in bed * The following potion has been found efficacious : take of distilled balm-water, and of orange flower water, of each, two ounces; spirits of Mindererus, three drachms; tincture of saffron thirty drops; syrup of tolu and orange-peel, of each one ounce — of which a table spoonful ma/j SUPPRESSION OF THE MENSES TREATMENT. 105 should be prescribed, and warmth may be applied to the legs and thighs, by means of hot flannels, or bottles filled with warm water. Gentle purging will be useful ; but if it be induced to any extent the object will be defeated ; as copious discharges of any kind, by relieving the consti- tution, supersede menstruation, and prevent effort on the part of the uterus. The spirits of turpentine combined with castor oil — a teaspoonful of each, or more at a dose, will often succeed. If these means fail to recall the discharge, and there is a general state' of plethora, relief will be obtained by loss of blood. If adopted early it may prevent the local disor- ders to which we have referred ; when they arise they must be treated according to the usual method for such diseases. The hysterical affection of the different organs should be combatted with what are called antispasmodic medicines, such as assafcetida, musk, castor, camphor, etc. Should there be severe pain, an injection of a gill of thin starch with a teaspoonful of laudanum and a little cam- phor, will generally give relief; or if it be complicated with hysteria, the use of three teaspoonsful of tincture of assafcetida, instead of the camphor, may be useful. If there is colic (after bleeding, should the pulse have indi- cated it) the most certain relief will generally be found, by half ounce doses of the tincture of aloes and myrrh, every three hours, in warm sweetened milk, till the bowels are open. (Dewees.) Upon the approach of the next period, great attention should be given to the patient, and every means used likely to facilitate the natural secretion. The bowels should be kept open — the surface comfortably warm, and the hip, or foot bath, used alternate nights. The strength; if necessary, must be supported by a generous, but not stimulating diet. If, at the proper time, the menses be re-established, our object will be accomplished ; but, if merely a white dis- charge appear in its stead, we must again, during the interval, put into action all those means mentioned under division second, of the tardy appearance of the menses. be taken every half hour. Dry cupping to the loins and upper part of the thighs may, also, be applied with advantage. 106 SUPPRESSION OF THE MENSES — SYMPTOMS. (See Chapter II., Part IV.) If the white discharge persist during the interval, it must be treated simply as leucor- rhea, (see that chapter.) But if no discharge appear, neither red nor white, recourse must be had to those means mentioned in Chapter II. Part IV., and to those remedies soon to be enumerated for chronic suppression, according to the condition of the patient. 2. Chronic suppression of the menses may be the con- sequence of an acute attack, from neglect or impossibility of cure, or it may arise from gradual depression of the bodily powers, from causes before mentioned, giving rise to delicate health. It may also arise from diseases of the ovaria, uterus and other parts of the body, as inflammation, induration, ulceration, hydatids, etc., of the uterus and its appendages ; anteversion, retroversion, and incomplete prolapsus of the womb. It may also be produced by pulmonary consumption, disease of the heart, scrofula, particularly of the bones, inflammation of the brain, the spinal marrow, the stomach, the spleen, the liver, the lungs, the pleura, the peritoneum, and any irritation in the sys- tem which retains the blood and prevents it from being directed upon the uterus. The quantity of the secretion may gradually diminish, and the time become irregular and uncertain, till at length the uterus altogether ceases to act ; or, winch is perhaps more frequent, the menses diminish in quantity and become of a paler color, with shorter intervals, until leucorrhea becomes permanently established in its stead. The symptoms which arise from chronic suppression are various, being often the same (though less marked) as those mentioned under acute suppression. The features of the young woman, heretofore brilliant with freshness and health, are observed to assume the impress of feebleness, depression, and languor ; the roses upon the countenance fade; the fire of her eyes is extinguished, and a dark circle surrounds them ; finally, the most frequent symp- toms are, habitual headache, dyspnoea, dizziness, pains in the back, sides, limbs and joints ; deficient appetite, and a genernal failure of the vital powers, ending in a con- firmed state of ill-health. The moral alteration is, also, great ; sometimes there is an excessive sensibility, which SUPPRESSION OF THE MENSES — TREATMENT. 107 renders the female impatient and irascible ; at others, her ideas are sad, her imagination is sombre ; sometimes the patient seeks for solitude, and sheds causeless tears ; again, on the contrary, she becomes passionately fond of music, and amusements of all kinds. The general health rarely suffers before three or four successive periods have passed, unless it be accompanied by considerable leucorrhea. If the menses do not occur after suckling, and the health of the individual appears to suffer, an examination should be instituted to ascertain the state of the parts. There may be an obstrustion or obliteration of some por- tion of the canal in the neck or mouth of the uterus, or of the vagina, in consequence of inflammation following delivery. The introduction of the finger will satisfy as regards the vagina, but the permeability through the neck of the uterus, can only be determined by passing up a moderate sized bougie (a slender gum elastic instrument). Some care is necessarv to distinguish between chronic suppression and pregnancy ; as the patient, if she be in a situation to have children creditably, may mistake the sup- pression for the first symptoms of pregnancy. The arrest of the menses, occasioned by conception, is shortly follow- ed by the morning sickness, and an alteration in the breasts, etc. (see pregnancy, Book II.) Treatment. — The remedies for this form of suppres- sion, will vary according to the cause which has given rise to it, and the state of the system. When it is conse- quent upon disease of the genital system, or of some other part, we shall find that, upon the patient's recovery from such disease, the menses will generally return. When the menses have been superseded by leucorrhea the pro- per treatment of it will generally restore the uterine functions. The reader will particularly notice from what we have heretofore remarked upon this point, that every deviation in regularity is not i*, legitimate reason for medical inter- ference ; in many cases, with young girls, especially those who began precociously to menstruate, there will be a want of regularity in return, that must not be mistaken for disease. So, also, it may happen with hale, robust young women, that a temporary suspension takes place 108 SUPPRESSION OF THE MENSES TREATMENT. from cold, passions or emotions* of the mind, which, after a certain time, will return without medical treatment. The rule on this point should always be, never interfere, unless there be some evidence that the health is suffering from the absence of this discharge. In chronic suppression, the general health rarely suffers so as to require medicine, before three or four successive periods have passed • up to this time, we should do well to put in requisition those hygienic means mentioned in Chapter VI., of Part III., for regulating the diet, habits of the patient, etc. If we find that the'pulse manifests a ten- dency to excess of action, the treatment should be com- menced with such^ remedies and regimen as will reduce it to a proper standard, before we proceed to the adminis- tration of those medicines which have a direct tendency to produce the menstruous discharge ; such as small bleed- ings, or the application of leeches to the vulva, or dry cupping of the loins ; by purging and by a strict vegeta- ble diet. Under such circumstances, senna and salts an- swer as good a purpose as any other purge. After having, with great care, in this manner prepared the system, and ascertained that no organic disease of the uterus or other parts exists, we may resort to those reme- dies known as specifics. The madder should be given as recommended in Chapter II., of Part IV., for tardy ap- pearance of the menses ; should this fail, resort may be had to the tincture of cantharides, as there directed, or to the volatile tincture of guaiacum, which, according to Dr. Dewees, has succeeded when all other remedies have failed. It is more stimulating than the others — therefore more care is necessary to have the system properly pre- pared for its exhibition. The mode of using it, is a tea- spoonful every morning, noon and evening in a wine-glass full of sweetened milk ; the dose must be gradually in- creased, when a prolonged use is necessary. Should it disturb the bowels too much, a few drops of laudanum may be added to the dose ; but if on the contrary they * A lady in the country informed us that while menstruating she was much frightened, while riding in a carriage, by the running of the horse; and from that moment the discharge was suspended, which did not re« appear till the next period. SUPPRESSION OF THE MENSES TREATMENT. 109 should not be sufficiently opened, the addition of a little rhubarb will be an improvement. At the same time that these remedies are used, currents of electricity from an electro-magnetic machine, may be passed through the pel- vis daily, or it may be applied alone. Upon the use of electricity, in suppression of the men- ses, we find the following in Copland's Medical Dictionary, added in a note by the editor : " Galvano-electricity, or electro-magnetism, deserves more particular attention as an emenagogue remedy. We have succeeded in some chronic cases of amenorrhea, that had resisted all other means, by daily sending a current of electricity through the uterus, or by inserting one conductor in a tub of warm water, in which the feet were immersed, and applying the other over the cervical vertebrae, thus transmitting the fluid through the spinal axis. Dr. Ashwell states, that Dr. Goldincr Bird has recently employed the same remedy with extraordinary success in the treatment of out patients at Guy's Hospital (London.) In some of the cases, where, after the condition of the alimentary canal had become healthy, the amenorrhea continued with slight pallor and weakness, electric shocks passed through the loins, quickly induced menstruation. In others, its continued repetition three or four times a week, led to a similar result ; and instances were not wanting, when a shock suddenly pro- duced the flow. It is. however, a powerful remedy, and should be employed cautiously, lest it may depress the nervous system, and thus protract the disease ; when mod- erately applied, it often rouses into activity the energy of torpid organs and parts ; but, when used in excess, it may altogether destroy their excitability. It should not be emplo\ ed in cases of local congestion or general plethora, nor during pregnancy, and' it should seldom be used alone." By referring to the chapter on the physiology of men- struation, it will be observed, that according to the late theory of menstruation, the efficient cause of this periodi- cal discharge, is to be found in the ovaria : that there is a monthly evolution or ripening and discharge of an ova?, upon which this function depends. Deranged menstrua- a 3 then, it would seem, must depend more or less upon 110 SUPPRESSION OF THE MENSES TREATMENT. some irregularity of the ovaria. Indeed, it is found ill suppression, that the flow may often be re-established by remedies applied to the groins, over the ovaries ; such as simple frictions, stimulating poultices and liniments, leeches or small blisters, etc. Other remedies have been used with success, such as iodine in the form of syrup or compound tincture, which is particularly adapted to scrofulous constitutions ; the various preparations of iron ; the ergot of rye which should always be used with great caution, in doses of from five to ten grains of the powder, two or three times a day ; and strychnine, first used for this purpose by Dr. Bardsley of England, and applied by 'him with great success — the dose is one tenth of a grain three times a day, to be gradually increased to one fourth of a grain ; it must be suspended for some days if it give rise to headache or twitching of the muscles. Aloes and myrrh, turpentine, savine, sulphate, carbonate and citrate of iron, are all useful when judi- ciously applied. Very few of these remedies, except the preparations of iron and iodine, are applicable in the suppressions of feeble, nervous women, of a scrofulous constitution, or lymphatic temperament — until means have been first made use of to improve the general health. Directly contrary to the condition before spoken of, when there is excess of action, and the system is prepared for them by antiphlogistic remedies in this, there is want of action and vitality, and the system must be prepared for them by such remedies as gradually raise the powers of life. All those means before mentioned must be put in requisition — a nutricious and stimulating diet, with a cautious use of wine, hip and foot baths, attention to the happy influences of cheerful and varied society and scenes, music, dancing, etc. This process may be very much assisted by the use of tonic medicines ; the various preparations of iron, and iodine, seem to be best adapted for this purpose. Of the former, the best, are carbonate, tartrate, lactate, and citrate of iron, in the dose of eight or ten grains of any one of them, combined with bitter extracts or infusions, as of columba, gentian, quassia, and dandelion. Of the latter, the best form is that of the tincture of iodine in combina- SUPPRESSION OF THE MENSES TREATMENT. Ill tion with the iodide of potash — dose, from ten to twenty drops, three times a day, to be increased. This is particu- larly applicable, as we have remarked, in those of scrofu- lous constitution. When the general health becomes improved without any effort on the part of the uterus to re-establish its function, a resort must be had to the reme- dies mentioned above for this purpose. As a last resource for the girl laboring under obstinate suppression of the menses, marriage has been recommend- ed by eminent physicians from the time of Hippocrates downwards — though of late with less confidence than for- merly. Simulating the plan of cure by the animating influence of love and the physical effects of a rational indulgence of the desires, by which the species is re-prc- duced, has been originated an artificial irritant by injection of a solution of ammonia into the vagina. Dr. Lavagna, the originator, remarks : " There is hardly a physician, however limited his practice, to whose lot it has not fallen to observe young females, who, at the age of puberty, were dull, languid, pale and laboring under scanty men- struation, suddenly restored to bloom, animation and vigor, and to the salutary sanguineous evacuation, by an oppor* tunity being afforded them of participating in conjugal duties. Whenever I reflected on this fact, and considered the numerous cases by which it was established, T never doubted that any stimulating medicine which might have the effect of determining an increased sanguineous afflux to the matrix, (uterus) would succeed in exciting suppressed menstrual evacuations." The mode of use, is, to throw up the vagina, by means of a female syringe, ten drops of pure water ammonia in an ounce of warm milk or water, several times a day. According to his account, the action of the ammonia was very prompt in relieving many cases of suppression. Another remedy has been proposed and applied with success, viz : stimulating the external surface of the mamma, with sinapisms, a few leeches or slight blisters. In the chronic form of suppression, when practicable, we should always direct a residence in a fresh and dry atmosphere, a mountainous country is preferable, the use of nourishing food, such as rich soups, light meats, etc. ; 112 VICARIOUS MENSTRUATION. bitter infusions and gently excitant drinks ; mineral spring waters; dry frictions ; flannel next to the skin; cold bathing and swimming ; exercise on foot, in a carriage, on' horse-back ; a variety of games, jumping, dancing, etc. We should remark in conclusion, that the moral condition of the patient merits as close attention as the medical treat- ment. If we neglect to attend to the state of the mind, menstrual disorders depending upon certain mental condi- tions, as profund dejection, resist all the resources of the healing art; they are mostly powerless in opposing the suppression of a young girl who is tormented by a disap- pointed or unfortunate love ! It is to the persuasive eloquence and counsels of friend- ship, the consolations of a prudent, enlightened mother, and especially the gratification of the affections by marriage, when there is not extreme prostration, that we are to look, in these cases, for arresting the disease at its source. CHAPTER IV. VICARIOUS MENSTRUATION NATURE, CAUSE AND TREATMENT. In cases of suppressed menstruation, where the monthly menstrual effort occurs, without secretion on the part of the uterus, and where the system generally is suffering from the consequent plethora or irregular distribution of blood, an attempt is made by the natural powers to afford relief by a discharge of blood from some other part ; gen- erally, one which is already diseased or enfeebled. This is called vicarious menstruation ; and has taken place from the nostrils, eyes, ears, gums, lungs, stomach, armpits, bladder, nipples, toes, fingers, from the stumps of ampu- tated limbs, from ulcers, and from the surface of the skin, generally. The mucous membranes, however, of the lungs, stomach and intestines, are the most common seats of the discharge. This discharge generally comes on suddenly and con- tinues at intervals for several days. In most cases it seems to relievo the constitutional distress consequent EXCESSIVE MENSTRUATION. 113 upon suppression, but does not favor the natural establish- ment of the function during the interval. In general, it is not followed by more serious consequences than those resulting from the loss of blood. The most dangerous form is when it proceeds from the lungs. Treatment. — If the attack commenced without previ- ous warning, little can be done during the flow. If the discharge be from the lungs, or stomach, opium, alone, or in combination with sugar of lead may be given, to mode- rate the evacuation. (Opium, one grain, sugar of lead, two grains.) If there be grounds for expecting an attack of this kind, means for avoiding it should be at once used, and if possible, at the same time, to stimulate the uterus into activity. If there be much plethora, one good bleeding from the arm; otherwise, cupping over the sacrum, or leeches to the vulva, and mild purging, will answer both indications at the same time. During the interval, the patient must be treated much in the same way as before recommended for suppression. Where there is debility, tonics, vegetable or mineral, particularly the preparations of iodine and iron, should be given, in doses before directed ; and if these means are not successful, and there are no counter-indications to their use, some of those remedies which act more directly upon the uterine system may be given. When leucor^hea is vicarious of the menses, the treat- ment is very nearly the same ; much good is to be expected from the exhibition of iron and the bitter tonics, with a well-regulated hygiene. CHAPTER V. MENORRHAGIA, OR EXCESSIVE MENSTRUATION TWO DIVI- SIONS—CAUSES SYMPTOMS, AND TREATMENT. The term Menorrhagia has been used by some writers to signify merely an increase of the menstrual flow, with- out any mixture of other fluids; others, include by it all 114 EXCESSIVE MENSTRUATION DIVISIONS. discharges of blood which may acompany or succeed the menses. We shall follow the latter signification, without including those floodings and uterine hemorrhages con- nected with pregnancy and parturition, which will be else- where considered. Excessive menstruation may occur in. various ways; the menses may return too frequently or too copiously, or at unusual periods. The nornial quantity of fluid dis- charged at each monthly evacuation varying in different women, this condition only exists when there is a dispro- portion between the loss and the power of replacing it. It is the relative qantity lost, and not the absolute, which constitutes the disease ; so that seeming derangement should only be considered excessive menstruation, when it has an injurious effect upon the general health. We shall include every variety of the disease under two divisions, which have reference principally to its severity. In the first, although the discharge may be considerable, and occasionally mixed with clots of blood, there is no change in the condition of the mouth of the uterus. In the second, there is great loss of blood, with a marked change in the size and condition of the mouth of the uterus, from the severity of the disease. 1. In the first division, it often commences with a sud- den gush from the vagina, after which, it may stop for some hours, and then recur; and this alternation may continue during the usual period of menstruation. On the other hand, sometimes the discharge goes on regularly, but instead of being over in three or four days, lasts for ten days, or a fortnight, or even three weeks ; or it may return in usual quantity every two or three weeks; this variety, more frequently than the other, is connected with that state of the lining membrane of the uterus which gives rise to leucorrhea. In this condition, there may be more or less discharge of clots of blood along with the proper secretion, though it rarely occurs in young or unmarried females. The subjects of it are generally women of the leucophlegmatic temperament, whose constitutions have been impaired by disease, or frequent child-bearing. One or two small clots appear at first, with an'interval, and then return in in- EXCESSIVE MENSTRUATION SYMPTOMS, CAUSES. 115 creased quantity. It is not known in these cases whether the discharge is altered in quantity or quality. The symptoms, are languor, exhaustion, weakness across the loins and hips, paleness of the countenance, headache, ringing in the ears, and giddiness ; these occur more or less in the slighter cases. If the disease continue, and especially if leucorrhea be present, all these symp- toms become very much aggravated — the languor in- creases, the face becomes sallow, there is an aching pain across the loins, extending round the abdomen, repeated and severe headaches, derangement of the stomach and bowels ; finally, there is extreme exhaustion with a feeble pulse, melancholy, nervous symptoms, ending in dropsy and even epilepsy. The causes of this disease are often the same as those enumerated as giving rise to suppression, and other derange- ments of menstruation — though they here act in a different way, viz : errors of physical education ; the bad results of an ill-regulated diet ; want of proper ventilation ; and the depressing influences of grief, terror, etc. Anything which determines the blood to the uterus in undue quan- tities, acts as a cause — as heated rooms, too much cloth- ing, warm bathing in excess, etc. A prominent cause, in this physic-taking community, of this disease, as well as of many other ills in both sexes, is the enormous consumption of quack pills and potions of every variety. These so called medicines for the most part contain ingredients that operate violently upon the lower part of the intestines, near the uterus, and thus de- termine an excessive quantity of blood to that organ, besides debilitating the bowels and frequently producing piles. Of the causes, at a more advanced period of life, child- bearing, and over-suckling are perhaps the most frequent ; the latter is often carried to a great extent among the poor, for the purpose of preventing a too rapid increase of the family ; which it does very effectually, when it gives rise to this disorder, but at the expense of much suffering, and loss of health to the mother. Excessive coition sometimes causes, and always aggravates, this affection. In the severer cases of this disease, conception does not take place, but it may in the milder ones. The disease 118 EXCESSIVE MENSTRUATION TREATMENT. may or may not return after delivery. There is always a great liability to abortion, if the patient become preg- nant, and also from the relaxation produced, a disposition to prolapsus of the uterus and vagina. (See chapter on prolapsus.) Treatment. — The first indication, is to remove the cause, if possible. If it proceed from over-suckling, the child should be immediately weaned, and the patient should live for some time absque marito. During the attack, in persons of a full habit of body, and when the affection is recent, it may be necessary to cautiously take blood from the arm, cup the loins, or ap- ply leeches to the anus. The patient should repose con- stantly in the horizontal position upon a mattrass with the hips elevated. The drinks should be cold and refreshing, such as water, lemonade, mucilages or whey, decoction of rice with nitre, of apples, oranges sweetened, syrup of currents, mulberries, cherries, quinces, etc. When the discharge is copious, a dose of opium, or the sugar of lead in combination with opium, will often diminish the quantity ; one grain of the opium, or a half grain with two grains of the lead, may be given at a dose, to be re- peated once in an hour or two, if necessary. When these remedies have not succeeded, the ergot of rye, given in five grain doses, three times a day, has seldom failed. Other astringent medicines internally have been recom- mended, such as large doses of sulphuric acid, (ten to twenty drops) largely diluted in infusion of roses, decoc- tion of logwood, of the roots of black current and the roots of the dewberry, etc. In severe cases, cold to the vulva has been found very useful, either by cloths wrung out of ice water, or by its being poured from a height upon the hips and abdomen ; during these applications the feet should be kept warm. Vaginal injections of cold water and astringent solutions have been recommended, but should be used with great caution during the attack ; and as a last resort, plugging the vagina ; — if used, the plug should be removed in ten or twelve hours, and if necessary, a fresh one may be in- troduce d. This is the mode of treatment during the attack ; much EXCESSIVE MENSTRUATION TREATMENT. 117 may also be done during the intervals by local and general remedies and a prudent regulation of the diet. It is of the greatest importance that the bowels be kept open, which must be done mostly by a laxative diet ; as stewed fruits, bran bread, etc. A blister may be kept on the loins with great advantage ; vaginal injections, at first of tepid and afterwards of cold water, will be found useful. The distressing weakness of the loins may be much re- lieved by daily sponging the lower parts of the body with cold salt water. Tonics, especially the mineral ones, should be given, as directed in the last chapter. The muriated tincture of iron, as well as the carbonate, will be found particularly useful. The food, in the sanguine temperament should dp exclusively vegetable. Tea and coffee, with every kind of warm drinks, sleeping on feather beds, foot stoves and stimulating food and drinks, should be avoided. In the lymphatic temperament, the food may consist of fish and fowl ; even porter and wine may often be given with advantage. Every kind of excitement of the uterine sys- tem must be avoided. The invalid should live in a dry atmosphere, and very moderate exercise should be taken throughout the interval. No melancholy companions must be allowed with the patient, and all mental emotions should be carefully avoided. 2. In the second division of excessive menstruation, the discharge is more profuse, and its effects more severe, than in the first ; it is accompanied by alterations in the condi- tion and size of the mouth of the uterus; occurs at a later period of life, and is more difficult of cure. The attack commences much in the same way as in the former, though generally not so suddenly : it is not con- fined to any particular kind of temperament, although it occurs more often in the sanguine, than in the debilitated, or melancholic. This form rarely appears under the a^e of forty, or after the cessation of the menses. There is, for some time previous to the attack, irregularity, as to time, quantity, and duration of each menstrual period, with occasional leucorrhea during the intervals. When the menses have flowed naturally for about twenty- four hours the bloodv discharge apDears ; large clots are now 6* 11.8 EXCESSIVE MENSTRUATION CAUSES. expelled, and there is a great increase in the fluid dis^ charged. The attack at first lasts but eight or ten days ; - but in long standing cases, it has been known to continue during the interval. The quantity lost is some times very large, producing excessive exhaustion, and weakness of the loins. It is accompanied with a sense of weight and pain in the pelvis, and difficulty of discharging the urine. The general health of course suffers much — the bowels become constipated, the face blanched, and the strength . much reduced. Exactly what change always takes place in the uterus, or its vessels, is not known. Upon examination its mouth is found lower in the pelvis, the neck is more or less swollen and is tilted forward so as to press upon the bladder, thus producing the above named symptom in that organ. There is sometimes tenderness upon pressure in the neek and body of the uterus, the vessels of which, are evidently very much congested, or engorged with blood. So that the discharge is not the result of secretion, but of the rup- ture of some of the vascular twigs, which ramify on the lining membrane of the uterus. The disease, unless the organic changes be considerable, is not generally very obstinate; it may subside in consequence of remedies, or spontaneously, in two or three months, or it may continue for two or three years. The causes are often the same as those mentioned as producing the first kind. Women who live indolent lives, with little or no exercise ; who are intemperate in the use of stimulants, hot drinks, as tea and coffee ; who dance inordinately and keep late hours ; who are too prodi- gal of the joys of wedlock, and have borne many children ; who are in the habit of tight lacing, and who yield too 3*eadily to passions and emotions of the mind, are those most subject to this disease. This kind of excessive menstruation is easily distin- guished from the flow of blood, dependent upon organic diseases of the uterus, as corroding ulcer, cancer, polypus, etc., by the irregularity of its occurrence in those diseases, and its persistence after the usual period of this excretion has expired. Treatment. — At first, all those means mentioned for EXCESSIVE MENSTRUATION TREATMENT. 119 the treatment of the first kind, may be tried. If the opium and lead fail, as they frequently will in this form, as well as the application of cold as there directed, and plugging the vagina — the ergot of rye must be mostly relied upon ; in short, it seems to be the only remedy which has the power of controlling this discharge. It may be given in doses of five or ten grains, two or three times a day. Du- ring an attack, the patient should be kept in a perfect state of rest — on a hard mattrass, covered rather lightly with bed clothes. All her drinks should be cool and unstimulating unless she become faint, when a little wine or brandy may be allowed. At the same time that the ergot is given, cold must be persevereingly applied over the lower part of the abdomen, by cloths wrung out of ice-water, or the douche. The precaution of keeping the feet warm, should always be attended to. If the discharge be not arrested, it is a question how far we should be justified in the use of vagi- nal injections of cold water and astringent solutions. Some authors have highly recommended them, but they would seem attended with danger during the period of attack. As soon as the discharge ceases, not a moment should be lost in the employment of remedies for the cure of the disease. Dry cupping to the loins, and the application of a blister, which is to be kept open, or repeated, are always useful ; they relieve the pain in the back, and diminish the white discharge. But the most powerful means which we possess, at this stage, are vaginal injections of cold wa- ter and a solution of sugar of lead, and other astringents, two or three times a day. An almost immediate improve- ment is perceptible ; the swelling of the uterus becomes less, the leucorrhea disappears, and the patient is soon able to walk without inconvenience. The patient is always liable to relapse ; consequently, one or two menstrual periods should be passed, notwith- standing the great improvement, with rest and great cau- tion, before she resumes her usual duties. Should a re- lapse unfortunately occur, the symptoms must be again mi't by the same remedies. During the intervals, the same treatment must be pur- sued, as directed under the first form of this disease. The bowels must be kept free, at the same time, purging shoul I 120 EXCESSIVE MENSTRUATION TREATMENT. be avoided. Tonics, as before directed — iodine in scrofu- lous constitutions, and iron in all others, are peculiarly beneficial. We may, also, employ with benefit, the mine- ral spring waters, decoction of catechu or kino, extract of cinchona and columbo. A nutritious diet may be allowed, and if the patient be much weakened, porter or wine. Moderate exercise in the open air, will be very service- ahlo, while all causes of excitement, especially of the ute- rine system, must be studiously avoided. For some time the patient (if married) should live absque marifo. Women who wish to moderate a too great abundance of the inrnses, should abstain, during the period of their flow, from all violent exercises, and sometimes even maintain a horizontal position, in such a way that the pelvis may be rather more elevated than the head and trunk : those of strong constitution should make use of a milk and vege- table diet; of diluent, cooling and acidulated drinks — as currant water, whey, weak lemonade, decoctions of barley or dog's grass with nitre, mucilage of gum Arabic, flavored with lemon syrup or with vinegar. Women of a nervo- lymphatic temperament, must be nourished with tonic ali- ments, principally roast meats, and they ought to use for drink, during their repasts, water mixed with a little gene- rous wine. There might, also, be directed for them with advantage, narcotics and antispasmodics, administered in minute doses during the continuance of the function; the use of cool, or, if the season forbid, of warm baths, in the interval ; in either case, small revulsive bleedings from the arm,, a few days after the menstrual discharge, to be repeated between each periodical epoch, will contribute powerfully to moderate the discharge of blood from the uterus. CHAPTER VI. DYSMENORRHEA, OR DIFFICULT AND PAINFUL MENSTRUA- TION SYMPTOMS— CAUSES, AND TREATMENT. The most prominent and distinctive mark of this disease is the pain. We may have scanty menstruation as we have seen in " suppression." or profuse, as in " excessive men- struation," and sometimes about the usual amount, but in addition, severe pain attending the secretion and discharge of the menses. It is characterized on each return of the monthly period, by successive pains in the loins, com- mencing a few days before, or just previous to the men- strual eruption ; it may occur only for a few periods, but occasionally continues throughout the whole of menstrual life. The pains vary much in character and intensity, accord- ing to the consititution of the individual ; they may be moderate and lasting but a few hours each time, or they may be so agonizing as to cause fainting. The stomach and bowels become irritable, producing vomiting, or diar- rhea, with scalding of urine ; or, in the severer forms, the nervous system may become much disordered, giving rise to hysterical convulsions, and even catalepsy. These symptoms suddenly or gradually cease upon the eruption of the menses. This disorder may be divided, according to the consti- tution of the individual, into two species, — the inflamma- tory, when it occurs in females of a full habit and san- guine temperament, — and the neuralgic, when it is con- 'fined to those of a nervous temperament and of a thin, delicate habit of body. A third kind may be added, when there is a mechanical difficulty and it arises from some impediment in the passage leading to the uterus. These distinctions are only important in the treatment, as the causes are generally the same. Symptoms. — This disease may attack females at any 122 PAINFUL MENSTRUATION CAUSES. age, and is more commonly observed in unmarried women, and in married women who have never borne children. For a day or two previous to the monthly paroxysm, there is a general sense of uneasiness, feelings of cold, and headache which alternates with the pain in the back ; the latter pain is often severe and of a bearing down charac- ter, simulating that of labor. In plethoric constitutions, there is frequently a flushed face, hot skin and full pulse. In all, there may be severe pain, which is mitigated when menstruation becomes fully established. The period be- tween the commencement of the pain and the flow of the menses, is very uncertain ; it may be but a few hours, or it may be a day or two. When the menses appear, sometimes the eruption is slow and scanty, at others it is in slight gushes. The dis- charge may be unchanged, but frequently we find it paler than usual, or mixed with small clots of blood. In many cases there is a peculiar membrane discharged, which is supposed to be secreted by the lining membrane of the uterus ; it generally has the form of the cavity of that organ, although it may be discharged in shreds. The dis- charge of this membrane by the unmarried, has sometimes given rise to unjust suspicions of conception. Its expul- sion is accompanied by severe pains, resembling those of labor. Dr. Denman regarded the secretion of this mem- brane as a mark of sterility, and says that he never knew a* female conceive in whom it was formed. Subsequent observation informs us, that, although conception is not impossible, it does. not often take place. The causes of this form of menstrual disorder, though various, do not seem to be connected with any derangement of uterine structure. They are often the same as those repeatedly enumerated as giving rise to other irregulari- ties of this function, and in general, all such as excite the nervous system, and more especially, such as exalt the sensibilities of the uterus, as the emotions of terror and joy, have been known to produce it; it has, also, been known to follow the consummation of marriage. Perhaps the most common cause is cold, taken during menstrua- tion, or soon after miscarriage, or delivery. These may give ri«e to sudden contractions, which, in some cases, if PAINFUL MENSTRUATION TREATMENT. 123 unrelieved, may produce hardening and alterations in the neck and mouth of the uterus ; thus giving rise to barren- ness and a disposition to cancer. The majority of cases are curable, although a few resist all the known means of alleviating the malady, and are only cured when the func- tion of menstruation ceases. Treatment. — The requisite treatment is applicable to the period of attack and the interval* At first, we must administer such medicines as relieve pain ; and our principal reliance is upon sedatives, as opi- um, camphor, etc. Opium may be given in grain doses, every second hour, commencing with the first pain in the back and continuing until relief be obtained. Camphor may be combined with opium, or given alone. If the opi- um should disturb the stomach, it may be given in form of laudanum, in a glyster of starch, or mucilage of any kind. If the patient be plethoric, and feverish, we should at the same time extract blood, by cupping the loins, or by ap- plying leeches to the thighs ; the bowels may be moved by saline purgatives, and cooling drinks exhibited. Care should be taken lest the amount of depletion altogether su- percede menstruation. If the head be affected by the opium, morphine, hyosciamus, or conium may be substi- tuted. The liquor acetate of ammonia, in doses of from a half to a table-spoonful, properly diluted, once in three hours, will be found particularly serviceable when there is fever. Warm local applications, or the warm bath, will be found very serviceable. Drs. Dewees and Gooch gave with success, the ergot, in five grain doses, three times a day, two or three days before the expected attack. Electro- magnetism, -also, may prove beneficial in giving relief. During the interval, every effort should be made to strengthen the patient, and lessen the local and general irritability, as repeatedly recommended in other forms of menstrual derangement. The diet should be generous ; with wine, if there be much debility ; and exercise in the open air should be taken daily. A blister or caustic issue to the sacrum, is often very useful, and much benefit may be derived from the daily use of vaginal injections of tepid or cold water, till the approach of the next period, when 124 PAINFUL MENSTRUATION — TREATMENT. warm water must be used ; and for two or three nights previously, the patient should take a hip or foot bath. One chief reliance during the interval, for medicine, must be placed upon tonics, as the preparations of iron, etc. A good mixture is, equal parts of wine of iron and Hoffmans' anodyne liq., of which, from a half to a tea- spoonful, may be taken two or three times a day. Dr. Dewees relies most confidently upon the tincture of guaia- cum, in doses of half a tea-spoonful three times a day. For a change, some of the vegetable tonics may be admin- istered, as gentian, quassia, cascarilla, etc., combined with senega. The bowels must be kept free, with mild purga- tives, and if any return of symptoms show themselves, upon the approach of the monthly period, cupping the loins may be useful in warding off the attack. The treatment of painful menstruation of the mechani- cal species — caused by a narrowing or stricture of the neck of the uterus, from inflammation or malformation, must consist in dilating the stricture by the cautious intro- duction of elastic bougies. During this operation, the patient may be upright, or in bed. One of a small size should be commenced with, gradually increasing till one can be passed the size of a male catheter. The instru- ment should be allowed to remain a few minutes at a time, and its frequency of use must depend upon the irritability of the patient ; — two or three times a week will be often enough. It will be well to use daily vaginal injections of warm water, and if necessary, the patient must be kept under the influence of sedative medicines, with an occa- sional mild cathartic. It is perhaps unnecessary to say, that no force should be used in passing the instrument. CHAPTER VII. DECLINE, OR CESSATION OF MENSTRUATION- — CONSTITUTIONAL EFFECTS TREATMENT, WITH HYGIENIC RULES FOR WOMEN AT THIS PERIOD. If at her introduction to the menstruating period, woman is calculated to enlist our sympathy, the circumstances attending its final departure, are still more adapted to ex- cite our earnest desire for her welfare. In youth, she is surrounded with scenes that please the fancy and excite the imagination, and has neither judgment nor precedent to guide her anticipations of good or evil. During the period in which she is fulfilling the great object of her being, she is occupied by the cares and joys of domestic life, and has neither leisure nor desire to reflect upon the approach of that important change, in which she is to undergo the anxieties of a transition to the closing phase of her existence. But when that period approaches, her apprehensions are often painfully excited : it is, indeed, her " critical period." Whether she is to enjoy the re- mainder of her life, free from some of the severer diseases incident, to her sex, or to sink under their accumulated force, when nature has been too severely taxed in youth to retain power enough to repel them, depends much upon the manner in which she has passed through the child- bearing period. — Dixon. We have before stated that, as a general rule, the period during which woman is capable of bearing children, ex- tends from about the fourteenth or fifteenth, to the fortieth or forty-fifth year, depending much upon the constitution and habits of the individual. The nearer a woman ap- proaches the latter named period, all other things being equal, the greater her liability to menstrual irregularity. We have remarked that females delicately brought up, whose nervous systems have been prematurely excited by habits of a certain kind, menstruate earlier than others ;. 126 DECLINE OF THE MENSES PHENOMENA. such persons, also, arrive earlier to the period of the cessa- tion of this function than those of a contrary constitution and habits, without any injurious consequences following. In- deed, many such individuals are never free from seveie suffering till this change of life exempts them from irregu- larity of the menses. On the other hand, we find many cases on record, in which this discharge continued regu- larly much longer than the usual period ;* till beyond even the seventy-fifth year. The occurrence of incapacity for child-bearing in the female at this time of life, seems to be founded in the highest wisdom and beneficence. Besides being incapa- ble at this age of transmitting perfection of organization and vigor to her offspring — the mother, not being able to extend her care to the child, would be obliged to leave it to the management of strangers, at a time when its help- lessness would most require a mothers devotion to its necessities. Sometimes the " change of life" is so silent in its ap- proach, that the woman scarcely notices the change in her condition ; at others the approach is so gradual that the diminished quantity first gives warning that the dis- charge is about to take its leave forever ; while again, the irregularity may be so great, both in time and quantity, as justly to give alarm, as well as to produce the most serious danger. We may remark, as a general rule, that when a woman approaches near her forty-fifth year, her menses become irregular, both in the period of return, and the quantity of fluid evacuated ; being sometimes in advance, and at others not appearing until long after the accustomed time. There may be also, some alteration in the health ; she perhaps becomes pale, debilitated, and nervous. As in the commencement, so in the cessation, there is generally a gradation ; the courses may return two or three times in a month, then cease for a few months, afterwards returning with great profuseness ; this state may continue for a year, or longer, when the discharge gradually be- * M. Orfila has informed us that a woman who had had seven child ren, became pregnant of her first child at the age of forty-seven, gave biith to her last at sixty, was regular to her ninety-ninth, and died at 114. DECLINE OF THE MENSES PHENOMENA. 127 comes pale, then of a white serous nature — and ceases, to return no more. Should the menses not have returned foi a few periods, the woman may become the victim of illusions ; the most common of which is,— as the abdomen and breasts enlarge, the appetite becomes capricious, etc. — she may suppose herself to be pregnant. But this hope, if it have been cherished, is soon for ever destroyed ; for the menses be- fore long return in overwhelming quantity. At this period she may be said to exchange her own constitution for that which is appropriate to the male. The womb having laid aside those vital properties which fitted it for the act of reproduction, gradually ceases to act upon the general economy, and takes its place in class among the other organs whence it emerged at puberty. It di- minishes in size, becomes more dense, its neck undergoes a sort of atrophy, and little by little is effaced ; its mouth becomes indistinguishable, or disappears entirely. As the blood no longer retains its habitual determination towards the organs of reproduction, it flows more freely towards the superior regions of the body, when it gives rise to vertigo, headache, epistaxis, and hot flushings. The face acquires a purplish hue, the eyes are red and injected. The pulse being full and bounding, indicates a plethoric state ; the beatings of the heart are effected with a sort of distress, the respiration is not easy, and the sleep often broken by frightful dreams, does not serve as usual to repair the wasted strength. In fine, a sort of uneasiness and restlessness of the limbs, come to indicate a state of great irritability, conjoined with extreme exhaustion. The pains that she feels in the loins and in the lower part of the abdomen, are accompanied with intolerable and vexatious itching about the vulva and fundament. The skin rapidly loses its color and suppleness, becomes wrinkled and sallow ; the hair falls off or turns grey, the breasts, which at first become flaccid and pendulous, at length disappear entirely ; the voice changes and resem- bles more nearly that of the male, and all the graceful and soft contours of the gentle sex disappear, to be replaced by a wrinkled surface. The moral character of the female is sometimes even 128 DECLINE OF THE MENSES — PHENOMENA. more affected by the change than her physical constitu- tion. She becomes sad, restless and taciturn ; she regrets her lost power to please ; the enjoyments that are gone forever, and the future, which she views clothed in the most sombre hues. Some among them, who were always good, sweet tempered and patient, become sour, excitable, irrascible ; often falling into passion without provocation, they become unjust towards every body ; they issue their orders with sharp tones, and treat every body about them with severity. In others the sensibility increases as it did at puberty, and they are pestered with vapours and hysterical poroxysms, or, tyrannised by the memory of past love, seek to extinguish their ardor in new sources of enjoyment. This resurrection of the desires and pas- sions almost always leads to bitter remorse, and to the most formidable results. In spite of the loss of her physical advantages, the aged woman who is endowed with sense and wit, and who re- nounces all vain pretensions, and lays aside all coquetry, finds it in her power, by numerous admirable qualities, to become more worthy than ever of the warmest friendship and confidence of the male to whom she is a sincere and consolatory friend. At this period the qualities of her soul are greatly perfected ; the passions that long agitated her bosom have purified her heart, which becomes steady, so that her friendship is immovable, and capable of the greatest sacrifices. Together with a new existence, she regains a new dominion over all that surround her, and her empire, which was previously circumscribed by the narrow circle of a few men, now comprehends within its circumferance even the women who have ceased utterly to be classed among her rivals. (Colombat.) Those women who were always thin and delicate before this period, from menstrual irregularities, have the con- stitution so completely changed, and so greatly strength- ened, that they are restored to the most perfect health and elegance of form, which they enjoyed in the spring-time of their youthful days. The unhappy victims of a life of celibacy, however, those whose lives have been agitated by the liveliest passions, by numerous vexations, or excess of pleasures, are generally more violently and painfully DECLINE OF THE MENSES PHEXOMENA. 129 shaken, at this crisis, than such as have made a better use of their existence. Some females as they approach this period, entertain the most gloomy, apprehensions of danger from the suppo- sition that vicious humors may be retained in the blood ; and thus come in requisition " medicines to purify the blood," as they are termed, in the form of nostrums, purg- i ing pills, etc., which are highly injurious. But females should know that all this is very absurd, and only a theory of the vulgar. As the menstrual blood is derived from the general mass, if one be pure, the other must be so likewise. There is a great difference in the cessation of this discharge at the proper time, and the suppression of it during the menstrual period. In the one instance it is a natural process, equally so as its commencement, and is effected by the inherent powers of the system ; but in the other, the suppression of it, there is a derangement of the intentions of nature, which must of course be followed by deleterious consequences. The common error (for such it is) that there is a great- er mortality among females at this period of life, than of any others, or among the other sex, is replete with evil, and should be exploded. For it appears that fewer women die between the ages of forty and fifty, than men, or in- deed, at any other period of their lives, after puberty ; and further, that if this change be effected without much disturbance, that they live not only longer than men, but are freer from morbid inconveniences. (Boinision.) That they are sometimes liable to a disease at this time, and that disease, one of the most terrible in the long list of human infirmities, we admit ; but, nevertheless, must in- sist that cancer, the disease alluded to, is more rare in the uterus, than in certain other portions of the body — for- instance the mamma. If latent disposition to disease, either in the uterus or other parts, become active about this period of life, it is not because the declining menses excite them ; but because the disease is slow in develop- ing itself, and is, perhaps, kept in check for a long time, by the menstrual discharge relieving the engorgement of the vessels, which acts, not as a specific discharge, but as a mere depletion : or, in other words, that if an equal G 130 T)LCLINE OF THE MENSES TREATMENT. quantity of blood could have been by any other means as certainly abstracted from the uterus, the same favorable result would have followed. (Dewees.) If the patient escape the more serious affections, there is a liability to seizures of a temporary nature in various parts. The most common of these, are hemorrhages from different surfaces, local inflammations in delicate parts, dizziness, hysterical paroxysms, colic, rheumatism, piles, cutaneous eruptions, ulcers of the legs, dyspepsia, leucor- rhea, palsy, apoplexy, etc. In extremely rare instances, sudden death has occurred at this period. After the sys tern has been for so many years accustomed to the men strual discharge, even though nature intends it shall cease it may be regarded as the somewhat sudden stoppage of a constitutional drain, which in other instances is observed to have similar results. The degree of danger in these attacks, seems to depend upon the abruptness of the men- strual cessation. Treatment. — Nothing will be so effective at this period in guarding the female against the occurrence of danger- ous irregularities of the menstrual discharge, as a well regulated diet, exercise, management of the passions and emotions of the mind, etc. Those women who live in the country and are in the habit of exercising freely in the open air, and have passed the child-bearing period, according to the intentions of nature, by suckling their own children ; who do not pam- per their systems by luxurious and stimulating food and drinks ; who do not relax their bodies by long confine- ment in hot rooms, and too long indulgence in bed, have little or no suffering at this epoch. There are two conditions of this period, which, when they occur require particular treatment. First, when there is a diminution in quantity of the proper discharge ; and second, when there is an excess of it. The first, requires to be treated in the same manner as " Suppression of the Menses," of which we have already spoken. (See that chapter.) The second, requires much the same manage- ment as directed for " Excessive Menstruation," which it is not necessary to repeat. The variety of affections which show themselves at the HYGIENE FOR WOMEN AT THE CHANGE OF LIFE. 131 period we are now considering, require no peculiarity of treatment, though the loss of the menses and tendency to plethora must always be kept in view. Notwithstanding the hysterical, and other symptoms, are sometimes severe ; yet, they very soon disappear when the system becomes accustomed to the change of the circulating fluid, and it becomes more equally distributed over the other parts of the system. The following hygienic rules from the emi- nent French physician, before several times named in this work, will be found to embrace important directions for the management of the female at this epoch of her life. HYGIENIC RULES RELATIVE TO THE CHANGE OF LIFE. This great revolution, this remarkable epoch of life, which most commonly happens between the age of forty and fifty years ; but which is subordinate to the influences of climate, constitution and mode of life, to the social posi- tion and the healthful or morbid condition of the patient, requires such cares and precautions, of a hygienic nature, as may serve, as far as possible to prevent the evils to which women are then known to be liable. The first counsel they ought to receive is, an advice to reject all sorts of drugs and preparations, to which are attached such titles as " health pills," " elixir of long life," or " elixir of propriety "; and all the receipts that are loudly proclaimed by ignorance, puffed by charlatanism and old-womanism, accredited by the attractions of a vogue, and by millions of so-called miraculous cures : the approach of the critical period less, perhaps, than any other epoch, admits cf any infractions as to regimen, dress, bodily exercise, sleep and watching, the various excretions and, also, the affections, and passions of the soul. The diet, which ought not to be too nutritious, may be composed of white meats,, veal, chickens, fresh- water fish, vegetables, such as succory, spinach, acidulous fruits, cooked, and raw fruits very ripe. Such a person should reject all spiced dishes, ragouts, black and salted meats, coffee, tea, spiritous liquors, and, in fine, all stimulating and indigesti- ble food. Plethoric women, who are subject to copious menstrual discharges, should renounce late suppers, should 132 HYGIENE FOR WOMEN AT THE CHANGE OF LIFE. .drink whey, cooling beverages, infusions with succory ; and acidulous mineral waters. All such women ought to make it a rule to take moderate exercise, with a vfew to distribute throughout the entire system, the excitability which is thus withdrawn from the reproductive system. Exercise taken in attending to household affairs, is so much the more favorable, as it is proportioned to the physical strength, and superadds, to the natural effects of toil, the internal satisfaction arising from the fulfilment of duty. Lastly, riding out in the country, where one may go to inhale the bracing air of morning ; the cares demanded for the proper culture of flowers ; short- excursions into pleasant regions of country, where the land is high and dry, especially in agreeable company, also constitute the kinds of exercise from which may be derived the happiest results. Women who have reached their critical period of life, should, with more than usual care, withdraw themselves from the influences of atmospherical vicisitudes, and especially from that of a cold, damp atmosphere,* which often gives rise to catarrhal discharges, leucorrheas, 3tc. They would, also, do well to avoid, especially at those periods at which they are accustomed to menstruate — they would do well, we say, to avoid large assemblies, theatres, heated, close rooms, where only impure air can be breathed ; they ought, also, to eschew all low and damp situations, to give up the use of foot- warmers ; they ought not to sleep upon feather beds, nor on any bed that is too soft and too warm, for such are attended with the disad- vantage of promoting plethoric accumulations, and dispo- sing the system to attacks of uterine hemorrhage, of causing contispation of the bowels, and exciting the geni- tal organs, which should henceforth be kept; as far as pos- sible, in a state of inaction. Sleep, if prolonged beyond six or seven hours, long watchings, too much exercise of the mental faculties ; sensations, whether too acute or too * Among washer-women, and other females habitually exposed to damp cold, the cessation of the menses is, for the most part, distressing r*nd tempestuous: such women, likewise, are more liable than others to leucorrheal discharges, chronic inflammations, and cancerous affections of the womb. HYGIENE FOR WOMEN AT THE CHANGE OF LIFE. 133 profound ; wrath, love of play, and all sorts of passionate sentiments, — these are especially hurtful to a woman about the close of her menstrual life. Love, a sentiment so gentle and so natural to the female, a passion which is, so to speak, the sole dominant passion of the sex., may, at the critical age, produce the greatest disturbance in the nervous system ; on this account, the use of venery could not be too moderate at this period of life, and should, in case of the appearance of any signs, be placed under complete interdict. Under such an event, it is the dictate of prudence to avoid all such circumstan- ces as might tend to awaken any erotic thoughts in the mind, and reanimate a sentiment that ought rather to be- come extinct, such as the spectacle of lascivious figures, the reading of passionate novels, and, in fine, every thing calculated to cause regret for charms that are lost, and enjoyments that are ended forever. Most women, as we have remarked, exaggerate to them- selves, the dangers of the critical age, representing the future in the most sombre hues ; they should be reassured upon this point, and disabused of the false idea they gene- rally form, that their menses are designed to purge the body of some virus or impure principle, and that the ces- sation of the flow is about to become the source of numer- ous disorders. They should be reminded, that when this short period is once past, their sex has a better chance of long life than ours. The persons who live with them ought to turn aside their sad thoughts, and avoid all occasions of strong feelings, and seek, indeed, to inspire them with none but complacent affections : assisted by the counsels of medicine, and of friendship combined, and arming them- selves with courage for the conflict, the sex may hope to spend many happy days, far beyond an age at which they suppose there is no further hope of happiness for them. How great soever may be the advantages of the hygienic measures we have just proposed, the health of many dif- ferent females, still demands the rigorous observation of many precautions, and the employment of certain thera- peutical agents, among which, we may mention venesection, issues, enemata, baths, and purgative medicines; bleed- ing is indicated on account of the plethora which gene- 134 HYGIENE FOR WOMEN AT THE CHANGE OF LIFE. rally succeeds the final cessation of the menses. Re- course should be had to it at an early period, and it should be repeated from time to time, and at intervals, greater or less, according to circumstances. Bleeding at the arm is always preferable, because it should be rather derivative than spoliative. Bleeding-in the foot ought to be rejected in these cases ; as well, likewise, as the application of leeches to the vulva and thighs. This lisst method of ab- stracting blood is objectionable, as tending to increase the local irritation and plethora, which it is so desirable to remove. However, there are cases, very rare ones to be sure, in which leeches may be advantageously applied to the hypogaster, and even to the vulva; such are the cases when the lower belly and the pelvic viscera are affected with acute pain, that venesection at the arm, even when several times repeated, has been found incapable of alle- viating. Constipation ought to be combatted by the use of injec- tions, sweetened with honey, or prepared with the addition of a teaspoonful of olive oil. Suppositories of beurre de cacao, the use of the plunge bath and of gentle laxatives, such as Seidlitz water, ptisans with prunes, tamarind whey, veal broth or vegetable broth, infusions of wild succory, and other drinks of the same sort, containing a weak so- lution of sulphate of soda, are proceedings to be instituted with andvantage to the patient. Drastic cathartics, espe- cially aloetic purgatives, ought always to be rejected, for they excite the viscera of the pelvis, especially the womb and the rectum, too much, accumulating in that direction congestions that frequently lead to attacks of menorrhagia and obstinate hemorrhoidal disorders. For similar rea- sons, we ought to abstain from purgative injections invari- ably, as well as from hip-baths, nor have recourse to com- mon injections without care in the employment of them, and only in cases of absolute necessity. Those women, who, in early life may have been sub- ject to swellings of the joints, or of the lymphatic gangli- ons, to ophthalmias, and to cutaneous eruptions ; and "those, lastly, who happen to labor under chronic, mucous, or parenchymatous inflammation, etc., will act prudently by establishing some point of derivation upon the skin by an LEUCORRHE A— NATURE. 135 • issue, and especially by a blister. Petit Radel has justly remarked, that the last named exutory is preferable to the former kind, because it acts upon a more extended sur- face, and the irritation produced by it may be easily in- creased or diminished. Let us close by remarking, that the cessation of the menses, which is a physiological phe- nomena, as natural as the first appearance, would almost always terminate well, were it not that former excess, careless dieting, and a treatment not unfrequently foreign to the principles of the art, intervene and oppose its pro- gress. We cannot, therefore, too loudly proclaim to the sex, that infractions of the laws of hygiene may lead them into the arms of death, at a period which would have been for them, the commencement of a more tranquil life, and an existence exposed to much fewer dangers. CHAPTER VIII. LEUCORRHCEA NATURE VARIETIES — SYMPTOMS CAUSES, AND TREATMENT. . The term leucorrhcea is derived from two Greek words, signifying white flow, which is synonymous with flu or albas and the English word whites, and is applied to designate the discharge of a white or colorless fluid from the vagina, unconnected with structural disorganization of the parts. Though the discharged fluid may vary in color, consist- ency and quantity, depending upon the stage of the dis- ease ; — in color, from a white, to that of a green, brown, or slightly redish tinge ; — in consistence, from that of limpid water merely, to that of a ropy substance, mixed with a thinner liquid ; — in quantity, from a slight increase of the natural secretion, to several ounces in the tw T enty-four hours. This discharge originates in the minute blood-vessels which line the cavity of the vagina and uterus, probably often the same as those engaged in secreting the menses ; though upon this point authors are not positive. These vessels, are minute and countless in number. 136 LEUC0RRHE A— NATURE. forming a complete membrane, similar in structure to the mucous membrane of the mouth, nose, and throat ; they both secrete a mucus very similar in consistence and ap- pearance, and that of the former like unto that of the lat- ter, under various states of disease, may become gluey or puriform and tinged with blood. These mucous disorders have a general resemblance to each other, whatever be their seats or sources. Leucorrhea is so very common, that it is, perhaps, as rare to meet with a woman who has never had some form of it, as to find one who never in her life had a cold in the head or the slightest increase of discharge from the nose. (Meigs.) It may attack females of all ages, a more chronic form occurring in advanced life ; it is most com- mon, however, during the period comprised between the ages of fifteen and forty-five, rarely appearing after that time, unless it be symptomatic of organic disease of the uterus, as cancer, etc. Children and even infants are subject to acute attacks, with more or less local inflam- mation ; here, the mucous membrane of the vagina only shares in the general susceptibility of this class of organs at this period of life, in which also, the intestinal surface, that of the lungs, throat and nostrils, participate, being more active than at any other stage of existence, and the seats of maladies unfrequent or unknown at a later age. Leucorrhea, occurring in infancy is generally a catarrh of the vagina, and often sympathetic of intestinal irritation. This disease is observed in women of every tempera- ment, according to the peculiar cause: In the lymphatic, in whom, from deficient power the uterus is unequal to the secretion of the florid menses, or from constitutional caus- es, the vessels of the mucous membrane lining the womb are in a state of unusual activity ; — in the melancholic, where mental depression aids in the aggravation of what originally might have been a slight congestion, their fears being actually alive to any disorder of these parts ; and in the plethoric and robust, in whom the circulation, rapid and energtic, throughout the whole system, is peculiarly so in the sexual organs during their functional life. Though it is far oftener observed in the lymphatic temper- ament, than in the sanguine, or in those of a debilitated LEUCORRHEA NATURE. 137 constitution, than in those who have an active circulation. In the higher orders of society, where from luxurious ex- citements, the nervous system is so much, and the muscu- lar so little exterted, this malady is particularly common. There are few disorders of the general health unaccompa- nied by irregularity of the vaginal secretion ; and any thing that tends to over-excite or debilitate the uterine system will produce it. In regard to the seat of this disease, it is known that pregnant women, in whom the orifice of the uterus is closed, are subject to it, proving that in these instances, it is exclusively vaginal. On the other hand we are equally certain that irritating causes may give rise to unhealthy secretion from the lining membrane of the uterus — also, when irritated by structural disorder, the matter discharg- ed is sometimes not to be distinguished from that of common leucorrhea. It is even probable that the Fallopian tubes do sometimes afford a part, and even a considerable por- tion of the matter discharged. (Meigs.) In the majority of cases, however, it is believed that the vagina is the seat of the discharge. (Ferguson.) The most common circumstances, according to Churchill, under which uterine leucorrhea occurs, are the following : 1.. In young females of delicate constitution, there may be a secretion of whites at one, two, or three of the month- ly periods preceding the appearance of the menses, and vicarious of them. By the discovery that the uterine system is already in action, though giving rise to a morbid discharge, the treatment must be modified accordingly. (See " Suppression of the Menses. ") 2. In suppressed menstruation, the subsequent monthly periods may be marked by a white discharge, nearly the same in quantity, and continuing as long as the natural secretion. 3. The intervals of menstruation may be occupied by leucorrhea ; in these cases the discharge increases just before the appearance of the menses, and re-appears in in- creased quantity afterwards ; ultimately the leucorrhea may entirely supersede the menses. 4. Excessive menstruation is sometimes caused, and often accompanied bv the white discharge, which increases G* 138 LEUCORRHEA SYMPTOMS. just before and after the menstrual periods, and may oa cupy the intervals. 5. At the period of " decline of the menses," the few last returns may be marked by the occurrence of whites, instead of the proper menstrual discharge. 6. In chlorotic patients, leucorrhea may be vicarious of the menses. 7. After abortion a white discharge may be secreted, either constantly, or occasionally for some months, which predisposes to successive abortions. 8. After child-bearing, when the lochia has disappeared, the white discharge may appear and continue for a month or two, or longer, till superseded by the appearance of the menses. Vaginal leucorrhea may be present, or complicated with any of the foregoing cases, though perhaps the uterine disorder predominates, modifying all the symptoms. No one or even all of these cases, are near as frequent as a chronic form of simple vaginal leucorrhea, as this is one of the most common diseases to which females are subject ; few, as we have remarked, escaping an attack of it at one time or other of their lives. The forms of leucorrhea are either acute or chronic. Symptoms. — Sometimes from its brevity and slight devel- opment the acute state may have passed unnoticed , though, there is generally a greater or less degree of con- stitutional excitement, or local suffering present. The pulse is quickened, the skin is hotter than natural, there is some thirst, and the patient is liable to hysteric par- oxysms. There is a sense of heat and pain in the vagina, with slight swelling and tenderness ; and at first a thin exudation, like that in common catarrhal inflammation of the mucous membrane of the nose ; it then becomes thick- er, and afterwards thin pus, with the formation of which the pain and swelling abate. The irritation may be com- municated to the bladder, giving rise to retention of urine. If the attack be violent there will be weight and pain in the lower part of the abdomen, extending down the thighs. In the chronic form there is a variation in the symp- toms, corresponding with the quantity and quality of the discharge. In the slighter and more recent cases, but LEUCORRHEA SYMPTOMS. 139 little distress is experienced ; there is a degree of languor, occasional weakness in the back and loins, headache with a paler complexion than natural, and an unusual degree of moisture about the external parts of generation. But when the discharge increases, the symptoms become more severe. There is constant pain in the back and loins, signs of debility, and dyspepsia, with nervous excitability. The discharge of matter is generally imperceptible, and continuous, often, however, flowing in slight gushes, or mixed with masses of ropy mucus. The following pas- sage from Dr. Vigarous, gives a clear and succinct ac- count of the symptoms and progress of this disease, to its termination : At first, the patient perceives a discharge of mild mat- ter, almost white, which moistens the vagina and escapes drop by drop. She experiences no inconvenience, no pain, nor any morbid sensation, (unless there be weight in the loins with colic pains). Hence, women, prevented by an excess of modesty, take no precautions in this stage, and neglect a disease, which, at this period, is of easy cure, but which soon becomes obstinate. Women pass several years in this way before the danger is exhibited by severe symptoms. After the lapse of some time, more or less, and after all precautions and all remedies have been neglected, the urine becomes thick, and, according to Hyppocrates, similar to that of mare's, jumentosa. The pulse is vermicular ; the discharge becomes so abundant as to soak through the napkins which she employs, (it seems to attract to itself the sources of all the other excre- tions) ; the matter becomes, successively, greenish, yel- low, black, and similar to washings of flesh ; it becomes acrid, and occasions pain, excoriations, ulcers of the womb; the woman takes an aversion to coitus ; the face becomes pale, bloated ; the eyes swell, and are surrounded by a yellow circle, as in dropsical people, they loose their lustre and become heavy and dull ; the appetite is lost, (or de- praved with nauseous eructation from acidity of the sto- mach); grief and sorrow take possession of the patient ; (there is almost constant pain in the spine and loins, the hips and stomach ;) the senses are weakened, particularly vision ; sighing and lassitude, upon the slightest exertion, 140 • LEUCORRHEA CAUSES. indicate the greatest debility. Gradually the smell of tho matter becomes insupportable ; (there is obstinate consti- pation of the bowels, with nausea and acid vomiting;) the menses flow irregularly, often are suppressed ; and hectic seizing the patient, soon drags her to the grave. {Tom. I., page 235 — translated by Meigs.) This may be thought a highiy wrought picture, but it is the sad termination of occasional cases, whose cure has been entirely neglected. It shows the importance of timely attention to the treat- ment of a disease which may be so calamitous. Upon examination, it is sometimes found, though rarely, that there is slight enlargement of the body of the uterus, with some tenderness in the acute form ; also, the mouth of the uterus is found swollen and tender, and rather more open than in the healthy state. Upon using the speculum, is discovered the mucous membrane of the neck, pale, slightly rose colored, deep red, or spotted ; these red points are probably the inflamed orifices of muciparous glands, which are numerous in the canal of the neck, and are supposed, in a peculiar form of this disease, to give rise to an albuminous fluid, resembling the white of eggs. This sort of discharge is to be met with in women who do not bear children ; the quantity is small and seems to have but one inconvenience, and that is, of rendering the woman barren. All means of cure have been employed in vain, in some obstinate cases of this form of the affection. The Fallopian tubes are sometimes discovered to have undergone a change : they are found very much enlarged, and filled with puriform mucus and blood. In a great proportion of cases, however, upon exami- nation with the speculum, though the individuals have made loud complaint of the troublesomeness of the discharge, no inflammation or ulcer has been discovered, — nothing but an abundant, then mucus, bathing the vaginal surfaces. The causes of leucorrhea are very various and nume- rous ; they may all, however, be included under two classes, the local and constitutional ; the latter of which are by far the most common and important. The local causes are, cold, violence from rape or instru- mental delivery, excessive coition, abortion,' inflammation spreading internally from the vulva, the use of quack LEUCORRHEA CAUSES. 141 emmenagogue medicines, stimulating injections, the irri- tation arising from worms in the rectum, or a pessary al- lowed to remain too long in the vagina, displacements, etc. Women who too freely indulge in the gratifications of love, who, from their necessities, or calling, are exposed to the ahuse of vener-y ; and especially those who indulge in solitary or selfish abuse of this enjoyment, are always obnoxious to leucorrhea. " Nature, for the wisest purpo- ses, has implanted in the sexes the passion of love ; it pre- sides like a guardian angel over every sentiment that is pure and holy in our natures; it warms the heart and kindles the affections with a flame of vestal purity ; but let the reader beware of the premature excitement of a passion that was only designed by the Creator to ensure the great end of our existence, viz : the perpetuation of the species. " What a proof of the entire purity of purpose on the part of nature, when unsullied by art, is the affection of a mother for her child ! Think of the strength and dura- tion of that passion — compare it with an impure emotion, and then ask if we should not blush to lose sight of an impulse so lovely, for the indulgence of a base and selfish gratification." In treating of "deranged menstruation," we had occa- sion to refer to the evils of the miserable quack composi- tions, heralded by their unprincipled inventors as specifics for menstrual derangements. The infirmity which We are now considering, is often closely complicated with the other and produced by the same causes, and we often have to deplore the alarming mischief produced by the futile ef- forts of the ignorant pretender, to cure this disease by powerfully drugging the system with physic. Dr. 1 Mei^s mentions a considerable number of cases of leucorrhea that came under his observation, in which the disease was produced by the irritation of pessaries, (in- struments to support the uterus — see prolapsus of that organ) which had been allowed to remain in the vagina. Of course, all attempts to cure must fail till such causes be removed. The constitutional causes of leucorrhea, we have re- marked, are both numerous and important. Most of those 142 LEUCORRHEA CAUSES. errors in diet, regimen, physical education, etc., so often referred to in our remarks upon menstruation and its de- rangements, act here with equal force. So that all we have there said upon the operation of these great agents in forming the human constitution, is equally applicable in relation to this disease. The following circumstances are found to act powerfully in the production of leucor- rhea : — ' 1. Original constitution or temperament : there is a de- ficiency of secretive energy, as exhibited in those cases when leucorrhea is vicarious of, or introductory to, the menses. This condition exists mostly in those of a scrofu- lous habit, either hereditary or acquired, and the lympha- tic tempei ament ; they are generally characterized by a relaxed fibre, fair skin, and light hair. 2. Location, atmosphere, and occupation: thus, women who reside in a damp and cold climate, where there is a humid, impure air ; also, those of sedentary and luxurious habits, who live in indolence, in large cities, are almost sure to have this complaint. 3. Habits of life, and the quality, and quantity of nour- ishment : they affect all constitutions and temperaments. Those who indulge much in bed, who keep late hours, who over stimulate, who indulge in emotions and passions of the mind, who drink immoderately of thin unnourish- ing drinks, as tea and coffee, who use the warm bath, or " foot-stove" to excess, rarely escape it. 4. Habits in regard to cleanliness ; the -neglect of this physical virtue, will be almost sure to produce it, even in those who are not otherwise disposed to the disease. Women in the lower walks of life, especially in cities, are more exposed to many of the predisposing causes of "leucorrhea, and consequently are more obnoxious to the disease. It is pretty sure to follow nervous and hysterical affections, especially if there be great irritability of tem- per. Those who have suffered from frequent and difficult labors and over suckling, those who have relaxation of the system generally, and of the uterine particularly ; who have become debilitated from menorrhagia, diarrhea, he- morrhoids, or who labor under irregularity or suppression of the menses, are ever prone to this complaint. LETTCOREHEA CAUSES. 143 In' fact, the constitutional causes of this disorder are so numerous, that the majority of authors we have consulted upon the subject of leucorrhea, make it a constitutional disease. It has been thought by some to be hereditary. Some ladies are not constantly afflicted with it, and only have a discharge when their systems are excited ; as by fever, anger, alarm, or joy ; others,, upon taking a glass of wine, eating highly seasoned victuals ; others, again, when their stomachs are acid, or otherwise irritated, will ■ have this discharge more abundantly ; very many are only sensible of its existence just before the menses are about to appear, or immediately after they have ceased. Most women, who are subject to leucorrhea, will have an in- creased discharge when pregnant; while some will have it at no other time ; and all, perhaps, will have it more abundant after too great venereal indulgence. (Dewees.) In speaking of the causes of this disease, an eminent French physician remarks: "The mode of life to which the social condition condemns women in large cities, delivers them over, so to speak,, defenceless against the numerous causes of the chronic inflammation of the utero- vaginal mu- cous membrane. Thus, in populous cities, idleness, effemi- nacy, or sedentary life, the constant contact of the sexes, and the frequenting of places where every thing inspires pleasure; prolonged watching,- excessive dancing, frivo- lous occupation, and the study of the arts that give too great activity to the imagination ; erotic reading ; the perni- cious establishment of an artificial puberty ; the prema- ture shock of the genital system ; the concentration of the sentiments and thought? on objects which keep the genital system in a slate of permanent excitation ; finally, a num- ber of vicious habits, and excesses of all kinds, which, by introducing modifications more or le*s profound into the general constitution, re-act more particularly upon the sensibility of the womb, which, in the fern a e, is not only the organ most apt to lend itself to the fhwionary move- ments, but, likewise, the centre towards v^hicli all the morbific actions seem principally to tend." We have before adverted to the injurious effect of an habitual indulgence in the excessive use of tea and coffee ; and all physicians can bear witness to the pernicious influ- 1 44 LETJCORRHEA C AUSES, ence of these articles, of which our country women are so fond, and which they so generally use in excess. We are well satisfied that they exhaust the nervous system, weaken the stomach and derange digestion. In before ad. •verting to the warm bath as a debilitating cause, we shall be understood as referring only to its excessive use in the higher classes of society, as they are termed ; for in the lower, it is not abused, since, alas ! it is seldom sufficiently used. When properly applied it is a powerful means of preventing disease, but may be, if perverted, an equally efficacious agent in its production. Over five minutes indulgence in a warm bath at the temperature commonly used, is likely to be followed by exhaustion ; it should be immediately followed by the shower bath, and friction with a rough towel — which produce an agreeable reaction and establish a healthful circulation in the skin. The application of cold from dampening the feet, sitting on the damp ground, etc., is a very different thing from, its application by the shower bath, and is productive of the worst consequences. Also excessive warmth, as too close confinement in hot rooms, too much clothing, sleep- ing too warm on feather beds, etc., by causing exhaustion, will produce the same result. " The constant drugging of unprincipled pretenders, many of whom, we grieve to say, are provided with their legal warrants under our degrading system of medical education, is equally productive of the disease. The tone of the body is impaired, by the incessant irritation of the bowels with every variety of qauck pills and potions, un- til the whole vascular system becomes exhausted, and the blood-vessels of the uterus open their mouths, as it were, like dead creatures, and suffer the blood first to escape in large quantities, constituting excessive menstruatio n ; then, as we know by observation, they take on that pecu- liar action, productive of the leucorrheal secretion. " The duration of leucorrhea is variable. Those cases connected with the menstrual function are generally the most prolonged. The question has arisen as to whether the discharge of this disease, (not venereal) may not give rise to a gonorrheal discharge, or sores in the male. There have boon sn^miri.t? eases m confirmation of such a fact, LEUCORRHEA TREATMENT. 145 but Dr. John Hunter and other authors, are of opinion that it never takes place ; though when very acrid it is often observed to give rise to a temporary mucous discharge. In the treatment it is necessary to distinguish the simple leucorrheal discharge from that which is caused by local disease, as polypus, prolapsus, ulcerations and excressen- ces. (See the symptoms of those diseases wider their pro- per chapters. Treatment. — This of course must have reference to the cause which produced the disease, to the state of the constitution, and that of the uterus and vagina. It is con- solatory to know that it is generally successful, if the proper remedies are applied in season and persevered in. The parts must be regularly washed in warm water three or four times a day — and if the patient be plethoric, or if in the acute form and plethora be not present, local depletion* is required ; this may be done by cupping tho loins, or applying leeches to the vulva. During this stage, which is short, the patient should be confined to the hori- zontal position, and be purged with saline cathartics ; tho diet should be very spare and all possible causes of ex- citement avoided. Vaginal injections of warm water, and occasionally a hip bath are powerful adjuncts in abating the inflammation. If by these means, or a neglect oi them, the disease is not cured, it very soon assumes the chronic form, which is vastly more common than the other. Before speaking of the medication necessary in the chronic form, we shall • give directions concerning diet, regimen, etc., which are quite as important. As we are writing partly for the instruction o'f females, it will have been observed, that in our descriptions we de not always follow the usual systematic order found in medical books. We have endeavored to show that this disease has its origin in deep-seated causes — no less than an abuse of the great laws of nature. The intelligent physician well understands the absurdity, by the administration of medi- cine alone, of attempting to change the long continued and *Dr. Dewees recommends that a strict antiphlogistic plan be con- stantly pursued during the cure of either stage of this "omplamt, till we are assured the discharge is maintained by habit." ! 45 LEITCORRHEA TREATMENT. unhealthy action of parts, that have not for years performed their natural functions, while the cause by which it was produced remains still in action. It is evident that there is no alternative but for the female, perseveringly to re- trace and reform her errors befor there can be any hopes of a restoration to health. The remarks already made upon hygiene in Part III., are here particularly applicable. If the female would escape, or be rid of this affection, " the mind must be kept pure, and free from improper associations. Such is the wonderful influence upon the uterine system, that, as we have shown, any of the more intense emotions will pro- duce it, if the patient be predisposed from debility to the disease. " Far more certain in its influence, because, alas ! much more common, is that state of prurient excitement of the imagination, so often produced by the wretched and demoralizing flood of " cheap literature" as it is called by its unprincipled publishers. Were the statute against obscene publications and prints, properly enforced, our families would be rid of these loathsome and filthy produc- tions, and society freed from a curse that is sapping it in the most vital part, viz : the moral purity of its daughters and mothers. In leucorrheal discharge of the chronic form we must first be assured of the absence of polypus, excr essences, etc. in the vagina and uterus ; next we must ascertain that the discharge is not a symptom of oppressed circulation, or of disease in the rectum, or other neighboring parts. . If, upon examination, any of these diseases be found to exist they must be treated as elsewhere directed. When it is made out that the malady is dependent on a local state, combined with disorder of the general health, the treat- ment for the chronic form will be safely applied. In a great majority of cases hysteria, in some of its- various forms will be found to accompany the discharge. In some, there is inordinate nervous sensibility, in others, torpor and inactivity ; while again with general debility, there is much nervous irritation in the uterine system, constant pruritus, or aching which is more intolerable than pain itself In all of these grades of the disease, the uterus LEUCORRHEA TREATMENT. 147 and vagina do not fail to draw into their sympathies the digestive organs. Strict attention, therefore, must be given to diet, exer- cise, and mode of life. The food should be devoid of all excitement, simply nourishing without stimulating the stomach; pure air, and absence from those habits of late hours, entailed by a city life are essential to a speedy cure ; and with these, all that regimen so well known as the dyspeptic should be resorted to. When proper attention, then, has been given to the re- duction of the pulse, and evacuation of the bowels, as mentioned under the acute form, a blister may be applied to the sacrum and repeated if necessary ; we must then proceed to exhibit some of those medicines which act upon the utero- vaginal membrane through the general system. The best are balsam copaiba, cantharides, cubebs, and the various turpentines. The copaiba may be given in in- creased doses, commencing with fifteen drops three times a day, or if the stomach be delicate, it may be made up into pills. The tincture of cantharides, according to De- wees, is very efficacious ; he says, " of this I direct thirty drops every morning, noon and evening, in a little sugar and water, increasing the dose every third day, five drops at a time, until strangury, (difficulty of passing the urine) is produced, unless the disease be arrested, which is not unfrequently the case, before this symptom appears." The patient should desist from the use of the medicine as soon as she feels the approach of strangury, and if neces- sary resume it when all uneasiness has disappeared. If the strangury be severe, free use should be made of flax- seed tea, gum Arabic or barley water — and the patient may take, upon going to bed, twenty five drops of lauda- num. The cubebs may be used in doses of from ten to thirty grains every six hours — if not speedily useful it should be discontinued'. Any of the turpentines may be given in doses of from a scruple to a drachm, in pills, or in mucilage of gum Arabic. Extreme cleanliness must be observed, or little good will be derived from the best plan of treatment. As soon as a change is observed in the discharge, by its becoming thinner and more copious, astringent injec- 148 LEUCORRHEA TREATMENT. tions may be employed with the happiest results ; they should only be used as long as no tenderness, or sense of weight in the pelvis be produced by them. In the milder cases a decoction of Peruvian, or oak bark, or catechu may be used ; but in general the best astringent injections are the sulphate of zinc, in proportion of five or six grains to the ounce of water : or, from twenty to thirty grains of the sulphate of copper to eight ounces of water ; alum may be used (20 grains to 6 ounces of water.) A so- lution of nitrate of silver (4 grains to the ounce of water,) is very useful. Vaginal injections of soap and water should be used previous to any one of these, which may be employed three times a day. When the leucorrhea is accompanied with sensibility, . pruritus, etc., of the vagina and uterus, anodyne injec- tions are indicated: as twenty-five or thirty drops of laudanum in mucilage or water, poppy decoction, etc. When the leucorrheal discharge is profuse, and becomes yellowish, or pus-like, . astringent medicines internally, synchronous with their local application, will be found very useful ; the decoction of logwood, gum kino, or catechu, etc., are applicable. A very absurd idea is occasionally entertained, that this discharge is a healthful evacuation, and ought not to be interfered with. We need not say that it is of the greatest injury to the constitution, and should be cured as soon as possible without a too sud- den suppression. The following formula will be found a very useful astringent : Take of gum kino one part, Canadian turpentine four parts, as much of the powder of tormentilla as may be necessary to form a mass ; divide the same into pills of five grains each, and take from three to half a dozen of them night and morning. At this stage of the disease, the ergot of rye has been highly recom- mended in five grain doses, three times a day. At this period, as well as during the whole course of the disease, the bowels must be kept open by a laxative diet, and the occasional use of cathartics.* Electro-magnetism may be tried along with the other remedies. * In obstinate cases, much reliance has been placed by some physi cians, upon revulsive determination towards* the intestinal mucous- mem- brane by the use of purgatives ; rhubarb, in small doses is the best, as it is at the same time purgative, tonic and astringent. LEUCORRHEA TREATMENT. 149 In addition to the local and constitutional treatment already noticed, where there is much debility, as there generally is, the class of remedies known as tonics are not to be dispensed with. The vegetable ones, such as bark, gentian, quassia, cascarilla, etc., may be used ; but the preparations of iron and iodine are most to be relied on. Of the former, the carbonate, or citrate may be adminis- tered in the usual doses ; but, perhaps, the best form is the sulphate, combined as follows: sul. iron, one scruple, balsam copaiba and liquorice powder, of each sufficient to form a mass of proper consistency, which is to be divided into forty pills, of which three or four may be taken three times a day. The use of iodine has been highly praised, and in those cases of leucorrhea which are so common in scrofulous constitutions, this remedy is preferable to all others. The compound tincture may be given in doses of from ten to twenty drops, three times a day, or the syrup of iodine, or of the iodide of iron, in doses of two tea spoons- ful three or four times a day, in some appropriate infusion. In those cases of leucorrhea characterized by an albu- minous discharge, and dependent on an inflamed and sensi- tive condition of the mouth and neck of the uterus, the means of cure are, rest, moderate use of leeches to the mouth itself, purging and injections of warm water and soap and mucilages, aided by the judicious employment of blue mass and anodyne enemata. Those cases which are complicated with menstruation, must be treated with reference to that discharge. Coni- um, hyosciamus, or opium may be given if there be much, local or general irritation. Cleanliness, as before remark- ed, is of the utmost importance ; the external parts should be washed with tepid water, or milk and water, two or three times a day and carefully dried. When the disease is on the decline, benefit will be derived from sponging the back, loins, and lower part of the abdomen with tepid or cold salt . water. Sea bathing, with proper precautions, may be allowed ; and benefit will probably be obtained from a residence at, and the use of waters of mineral springs. The state of the stomach and bowoly should be particu- larly attended to — frequent but gentle purging is generally 150 CHLOROSIS SYMPTOMS. useful. If there be any excoriation, the use of a sugar of lead lotion, or black wash will probably remove it. Leucorrhea dependent on prolapsus of the uterus often requires for its cure the use of the pessary — which will be explained when we come to treat of that subject. CHAPTER IX. CHLOROSIS NATURE SYMPTOMS CAUSES AND TREATMENT. The term chlorosis is derived from a Greek word, signifying green, — called " green sickness," from the pe- culiar pale or greenish complexion of those afflicted with it. It is. a disorder of the general health, and arises as the consequence of retention of the menses, excessive menstruation, long continued leucorrhea, and other de- pressing and exhausting diseases, bad nutrition, etc. The organs of digestion and assimilation are often the seat of the disease, which occasionally appears in the male as well as the female. The blood, in this affection, has often been found very much changed in its natural constituents. Symptoms. — No disease inspires more tender interest, or more touching compassion, than the state of paleness, suffering and languor, observed in a young chlorotic girl ; like some delicate plant, deprived of the beneficent rays of the sun, she is a flower which withers and droops away, even before its blossoming. The approach of chlorosis is marked by a state of habit- ual inertia and melancholy ; the patient becomes • sombre and taciturn, weeps without cause, and sighs involuntarily; the face becomes bloated ; the expression is, as it were, veiled ; the eyes sad and languishing ; the eyelids, which are swollen, especially in the morning, are encircled by a blackish areola, strongly contrasting with the pearl-white color of the schlorotic coat and the pallor of the lips ; the skin, particularly of the extremities, is dry and cool ; the pulse frequent, rather large and less easily compressed ; the respiration is difficult ; digestion is deranged ; the alvine dejections become white, hard, and sometimes fluid ; CHLOROSIS — SYMPTOMS . 151 palpitations and fits of yawning make their appearance, while debility, lassitude, a desire for sleep, or rather for repose, as well as the whole collection of symptoms aug- ment from day to day. The patient feels frequent incli- nation to make deep and very strong inspirations, a symp- tom which is excited and increased by walking, by ascend- ing, and, finally, by any mental emotion. The impulse of the heart is generally stronger than natural ; and the ca- rotid arteries, which beat with great force, are the seat of certain abnormal sounds. Blood drawn from the venous system and from leech bites, is pale and aqueous ; the clot is soft and diffluent ; the animal heat is diminished ; the lips, nose, hands, and all the organs situated at a distance from the centre of circulation, are cold and almost icy ; the general cellular tissue becomes the seat of a serous tur- gescence which is especially observable about the eyelids and face. The inferior extremeties, particularly the ankles, become edematous, a condition which is more marked to- wards evening, and which differs from that of common dropsy, in not retaining the impression of the fingers. As this disease progresses, the functions of the stomach are more and more deranged ; the strangest and most de- praved tastes manifest themselves ; the patient prefers the most sapid substances, such as salt, vinegar, green fruits ; they often seek, with avidity, indigestible substances, and such as are In no way nutritive, as charcoal, plaster, earth, ashes, spiders, flies, and other equally disgusting insects. The appetite gradually diminishes, until complete anorexia is established ; at other times, on the contrary, it is in- creased beyond measure, while the ingestion of food is followed by a sensation of weight at the epigastrium, by nausea, and sometimes by vomiting. The tongue is gene- rally large and covered with a mucous coat ; acid regur- gitations, and frequent nausea occur, especially in the morning; a feeling of heat and weight in the epigastric region, and sometimes nervous pains in the course of ihe esophagus, and extending through to the shoulders, make their appearance. Finally, the patient experiences alter- nations of constipation, and watery diarrhoea. The alvine dejections are white, while the urine, small in quantity, is \>ale and limpid, as in all the nervous affections. The 152 chlorosis — causes. genital organs are commonly affected with abundant leu- corrheal discharge ; most generally there is a failure or suppression of the menses ; at other times, they persist and last longer than natural ; which gives rise to the most diverse nervous disorders, uterine colics, pains in the loins, great depression and stupidity. The patient now, more than ever, seeks solitude, sighs involuntarily, and weeps without cause ; she is tormented by sinister ideas ; her temper is capricious, odd and irascible ; for her, all thought of happiness is gone, and in her despair, she often speaks of suicide ; finally, the night, far from procuring repose, brings her only broken slumbers and frightful dreams. When the progress of the disease is not arrested, the symptoms become more and more agravated ; there is ringing in the ears, vertigo, partial loss of sight, tremors of the limbs, neuralgia of the teeth, neck and head, ana hysterical symptoms ; the skin assumes a greenish or earthy hue ; the abdomen is hard and tumid ; thirst arises, the dispncea, faintness and palpitations are increased ; diar- rhea, as well as hectie fever creep in ; daily exacerbations occur, and the emaciation makes rapid progress. Finally, general infiltration, extreme feebleness, invincible repug- nance to all kinds of exertion, alteration of the features, and a pale, violet color of the lips, forbode approaching death ; which comes at last, without shock and almost with- out pain, surprising the patient under a complete state of marasmus. We have compiled the foregoing symptoms of this dis- ease from M. Colombat, whose descriptions are always so accurate as to leave nothing important unincluded. We should state that the duration of chlorosis has no fixed limit, but that when properly treated, it commonly termi- nates by a return of health in from one to two months. The causes of chlorosis may be divided into the predis- posing and general. Among the former, may be ranked hereditary predisposition, rapid and premature growth, a . feeble, melancholic constitution ; a lymphatic, nervous, or scrofulous temperament; the privation of the physical enjoyments of love, or their abuse ; the state of widowhood ; onanism ; sudden and continued suppression of the men- ses, and their too great abundance \ frequent hermorrha- CHLOROSIS CAUSES. 153 ' ges ; depressing moral emotions, disappointments, grief, sadness, captivity, and the melancholy which accompa- nies unfortunate love, etc. The general causes, are living in low, damp, and cold situations, secluded from the solar rays, as in quarries, mines, dungeons, the cellars of weavers, in low work shops, in valleys of great depth, which are shaded by wood, and in the sombre, narrow, and badly ventilated streets of large cities. Periods of famine, continued use of heavy indigestible and decomposed food ; the indulgence in warm aqueous drinks, or in the excessive use of vinegar, of green fruit, and all crude articles ; excessive fatigue, and finally, the want of exercise, and a sedentary, easy, volup- tuous mode of life, are all causes of the nervous debility, which give rise to the derangement of the functions, con- stituting chlorosis. Dr. Marshall Hall observes : " It is quite obvious, on trac- ing the succession of symptoms, that the first link in the chain is constipation, and that the subsequent links are the effects of the continued operation of this cause. Ser- vants, and especially cooks, are particularly liable to chlo- rosis. But the delicate and inert habits of the rich, not less frequently lead to this affection. In aril these, there is the same defective digestion, assimilation and formation of blood.' 5 " Under the many exciting and depressing influences of society, as constituted in our country, and the unexampled rapidity with which children become men and women, con- stant derangements of health are occurring ; and although years are advancing, the constitution suffers great draw- backs ; the body does not advance to its full and proper evolution at the time nature intended it to attain that con- dition. During these intervals of sickness the powers of digestion are feeble ; and very delicate and careful preparation of the food is necessary, if we would not oppress them and greatly hinder recovery. " If this be true when comparative facilities exist, what shall we say of the condition of those who constitute the working classes of our population; whose every day brings with it its stern demands of nature for attention to all her laws, and the entire time is occupied w 1 '^ toilsome labor ? H 154 CHLOROSIS — TREATMENT. The damp cellar, or the stifling attic chamber, in the foul atmosphere of some by-lane or street, are not adapted to produce appetite, and the wretched occupant, even if for the time possessing the means, has no leasure to pay atten- tion to the wants of the body. Thus it is from day to day that inattention to the unalterable laws of nature, is fol- lowed by a condition of listless and wretched indifference, and the final appearance of this melancholy disease." Chlorosis is not easily confounded with any other dis- ease or condition of the body, excepting that arising from the loss of much blood. Treatment. — As this disease is more or less complica- ted with a disordered digestion, much stress has been laid upon the efficacy of purgative medicines — and certainly they are of great value in assisting a cure. Aloes and rhubarb, in combination with iron, are found to be the most useful. Dr. M. Hall prescribes a pill, composed of equal parts of aloes and sulphate of iron. At first a due evacuation of the bowels must be daily secured. An injection of a pint of warm water into the rectum two or three times a week, is useful in aiding the peristaltic action, and removing collections from the large intestines. The compound decoction of aloes with the compound tincture of cardamoms ; the compound aloetic pill, with the oil of cassia ; or the wine of aloes with the compound tincture of rhubarb, in appropriate doses, are the best forms of purgatives. (Ashwell.) The preparations of iodine have been highly recom- mended in this disease, and are particularly adapted to patients of a strumous or scrofulous habit of body, who have glandular swellings. The iodide of iron may be given in two grain doses, in solution, two or three times a day, or it may be given in form of syrup. But perhaps the best form is the compound tincture of iodine, in doses of from ten to twenty drops three times a day. These prepa- rations should never be taken upon an entirely empty stomach, as they are liable to produce heat and oppression. Other mineral and vegetable tonics will often be found useful. The following form has been used successfully : Sub-carbonate of Iron, one ounce. Carbonate of Soda, one drachm. CHLOROSIS TREATMENT. 155 Pulverized Nutmeg, two drachms. do Liquorice root,.. two do do Ginger, one drachm and a half. do Cinnamon, one do do do White Sugar, half an ounce. Oil of Anise, four drops. To be thoroughly mixed and pulverized. Dose, a tea- spoonful, two or three times a day, in milk. Of all medical agents, iron has gained the greatest repu- tation in this disease. Dr. Blaud has recommended the fol- lowing form as a specific, and all who have given it a trial, speak highly in its favor: Sulphate of iron and sub- carbonate of potash, of each, half an ounce ; reduce them separately to a fine powder ; then mix thoroughly, little by little ; add a sufficient quantity of mucilage of gum tragacanth ; beat strongly in a mortar, and make a mass, to be divided into forty-eight boluses. A mutual decom- position of the two salts takes place, which adds much to the efficiency of the remedy. A pill should be taken early in the morning, and in the evening upon retiring, during the first three days. On the fourth, fifth and sixth days, a pill should be added at mid-day ; to go on increas- ing, till at the sixteenth day, four pills may be taken three times a day. It is, according to Dr. Blaud, to be continu- ed in this last mentioned dose long enough to dissipate the symptoms of the disease, when it should be gradually left off. Dr. Meigs speaks highly of the following form, to be used much in the same manner as the above : Citrate of Iron, two drachms, Sulphate of Quinine, half a drachm, Water, one fluid ounce. Mix and take from twenty to thirty drops at a dose, in syrup or water, about half an hour after each meal. Any one of the vegetable tonics may be given with ad- vantage, such as Peruvian bark, cascarilla, gentian, quas- sia, etc. Counter irritation by blisters, according to the various functional disturbances, and medicines mentioned in the last chapter, which act upon mucous membranes, are not 1 56 CHLOROSIS TREATMENT. to be omitted. Menstruation may be regarded as a de- sirable occurrence, and as soon as the constitution shall have been somewhat rallied by these remedies, we shall be justified in using some of those medicines mentioned in the chapter upon the " suppression of the menses," which act directly upon the uterus. The ammonial injection, composed of one drachm of the pure liquor ammonia to a pint of milk, daily injected into the vagina, has proved very efficient. (Ashwell.) It is said that chlorosis is frequently cured by marriage. The patient should be comfortably clothed with flannel next to the skin and take a moderate amount of exercise in the dry, pure, open air. The diet should be generous, adapted to the condition of the digestive organs ; a free use of tamatoes, cooked to the liking, will, from its altera- tive properties, be found a good article of food. A mode- rate quantity of wine may be allowed, according to cir- cumstances. Riding in a carriage and on horse-back, in a pure air, are proper modes of exercise ; and pleasant con- versation, in addition to the charms afforded by diversity of views and landscapes. Boating excursions, music, sea- bathing and swimming, etc., are hygienic means which cannot be too highly recommended to sad, nervous and melancholic women. Travelling, also, and the use of mineral waters, taken at the springs, are great advantages. The use of tight corsets ought to be forbidden ; sleep should not be protracted beyond eight or nine hours, and the bed should be neither too warm nor too soft. Exciting drinks should be prohibited, as, also, highly nutritious food, vivid emotions, the frequenting of balls and shows, the reading of high-wrought romances, the examination of lascivious pictures, and, in short, all circumstances capable of exciting the sensibilities too strongly, should be avoided. Sedative drinks, frictions upon the surface of the body, and constant diversion, are to be kept constantly in view. CHAPTER X. f HYSTERIA NATURE SYMPTOMS CAUSES VARIETIES — * COMPLICATIONS TREATMENT MORAL AND PREVENTIVE MANAGEMENT. The term hysteria is derived from a Greek word, signi- fying womb — from which the disease was formerly suppo- sed to arise. Many modern authors suppose the term to have been applied with some degree of vaguenesss, and that it suggests a theory of the disorder which is some- what questionable. It has been handed down from Hippocrates, Galen, Van Helmont, and many others, that the uterus exercises a su- perior power over every other system ; that it presides over them with a sway no less capricious than powerful. That it not only forms and governs the moral character of the female, but creates, exalts, or modifies disease, and regu- lates all the physical movements, in every portion of her body, etc.; hence the declaration of Van Helmont: On account of the uterus, woman is what she is ; and of Hip- pocrates : On account of the uterus, woman is all disease. In modern times, a superior knowledge of anatomy and physiology, as well as of disease, has given us a more ra- tional view of the condition and influence of the uterus. It is now regarded in importance, only as a viscera of the first order. And although its healthy condition is every way necessary to the general health of the system, it does not seem to exert much more influence, either in a state of health or disease, over other portions of the animal econo- my, than the stomach and some other important organs. The influence of the uterus is greatest during menstrua- tion and gestation. The seat of hysteria, instead of being the uterus, would seem to be in the brain and nervous system ; but the exact condition of these organs, necessary to give rise to the va- rious phenomena of this affection, is not known. There 158 HYSTERIA — NATURE. is no doubt that a certain morbid condition of the nerves of the uterus, may give rise to it ; but that every derange- ment of function, or even lesion of this organ will produce it, there are unquestionable reasons for denying. Indeed, the uterus may be seriously affected, as in cancer, with an absence of those distressing symptoms, called "nervous;" so, also, in acute inflammation of this organ, there is al- most always an exemption from the symptoms constituting hysteria. So, it would seem, that there must exist some pe- culiar morbid condition of the nerves of an organ, before the brain, or nervous system are called into sympathy with it. (Dewees.) Dr. Good remarks : " With a morbid con- dition of this organ, indeed, hysteria is in many instances very closely connected, though it is going too far to say, that it is always dependent upon such condition ; for we meet occasionally with instances, in which no possible con- nection can be traced between the disease and the organs, and sometimes witness it in males as decidedly as in females." The majority of modern authors seem to be inclined to the belief that the cause of this malady is to be sought for in lesions of the nervous apparatus of the uterine system. M. Colombat observes : " If it be allowed us to put forth an opinion, as to the probable source of the disease, found- ed upon the cases which have fallen under our own obser- vation, and which we have compared together, and with a great number of others reported by different authors, we should say that hysteria, properly so called, has its princi- pal seat in the nervous system of the uterine apparatus, and that it consists of a special and sui generis mode of excitation and perversion of this system,, reacting sympa- thetically upon the general nervous system ; we state fur- ther, that this peculiar excitation, this morbid modifica- tion of the uterine innervation, may itself have for its ori- gin, either a local irritation, often inappreciable, or a sym- pathetic one, resulting from a moral cause, or from the pathological condition of some organ or different appara- tus with which the uterus has bonds of union more or less direct." Dr. Meigs coincides with him in the above opinion, and remarks : " Even admitting that the uterus itself, or the HYSTERIA— SYMPTOMS. 159 ovaria, is not at the foundation of the malady, nor the disturbing force in the malady, we may readily conceive it is in the reproductive tissue, and the reproductive influ- ence or power, that is situated the fons et er'igo of the evil. I conceive the question to be, not so much whether hysteria arises from a disturbing power of the womb, as from a disturbing power of the reproductive agencies im- planted in the economy ; and I conceive that deviations of that power, or those agencies, whether in the male or the female, may alike be regarded as ipsissimas causas in these maladies." Hysteria occurs in females, mostly, during the child- bearing period ; it is very rare before the age of puberty and after the cessation of the menses. It is observed to occur more frequently in single, than in married life, and the first attack is oftener at about the period of menstrua- tion than any other. Those women of a delicate habit, whose nervous sys- tems are extremely sensible, are most subject to hysterical affections; it also attacks the sanguine and plethoric. There is usually a susceptibility, which is acquired by inactivity and a sedentary life, grief, anxiety of mind, a suppression or obstruction of menstruation, excessive evacuations, and a long continued use of an unnutricious diet, or of crude unwholesome food. Those who possess this susceptibility, are apt to pursue objects with ardor, exaggerate grievances, and under the influence of ordina- ry emotion are prone to hurried breathing, or to sighing, sobbing or laughing. Symptoms. — What peculiar condition of the brain exists in hysteria, can neither be named, or demonstrated ; yet, there is no part of the body that may not have its nerves to sympathize with it, calling forth powerful — nay awful, phenomena, and a numerous train of symptoms peculiar to the part thus sympathizing. Hence, the " Protean shapes" this disease is said to assume. It is proper here to remark what we wish to have distinctly understood, that it is believed females can generally by observation of their own peculiarities and by mental discipline, after obvious difficulties have been removed, do far more to prevent an \ttack, than a physician can do for its relief 160 HYSTERIA SYMPTOMS. The disease attacks in paroxysms, known as "hysterical fits." " These are sometimes preceded by dejection of spirits, anxiety of mind, effusion of tears, difficulty of breathing, sickness at the stomach, and palpitations of the heart ; *but it more usually happens that a pain is felt on the left side, about the flexure of the colon, with a sense of distention advancing upwards, till it gets into the sto- mach, and removing from thence into the throat, it occa- sions, by its pressure, a sensation as if a ball was lodged there, which by authors has been called globus hystericus. The disease having arrived at this height, the patient appears to be threatened with suffocation, becomes faint, and is affected with stupor and insensibility ; while, at the same time, the trunk of the body is turned to and fro, the limbs are variously agitated; wild and irregular actions take place in alternate fits of laughter, crying, and screaming ; incoherent expressions are uttered, a tempo- rary delirium prevails, and a frothy saliva is discharged from the mouth. The spasms at length abating, a quan- tity of wind is evacuated upwards, with frequent sighing and sobbing, and the woman recovers the exercise of sense and motion, without any recollection of what has taken place during the fit; feeling, however, a severe pain in her head, and a soreness over the whole body. " In some cases, there is little or no convulsive motion, and the person lies seemingly in a state of profound sleep, without either sense or motion. Hiccup is a symptom which Hkewise attends, in some instances, on hysteria; and now and then it happens that a fit of hysteria consists of this alone. In some cases, of this nature, it has been known to continue for two or three days, during which it frequently seems as if it would suffocate the patient, and proceeds, gradually weakening her, till it either goes off or else occasions death by suffocation ; but this last is ex- tremely rare. Besides hiccup, other slight spasmodic affections, sometimes wholly form a fit of hysteria, which perhaps continue for a day or two, and then either go off themselves, or are removed by the aid of medicine. In some cases the patient is attacked with violent pains in the back, 'which extend from the spine to the sternum, and at length become fixed upon the region of the stomach, being HYSTERIA VARIETIES. 101 evidently of a spasmodic nature, and often prevailing in so high a degree as to cause clammy sweats, a pale* cadave- rous look, coldness of the extremities, and a pulse hardly perceptible." Sydenham, as well as most of authors, have remarked the numerous varieties and forms under which this disease appears, " resembling most of the distempers wherewith, mankind are afflicted. 7 ' In whatever part of the body it be seated it gives rise to symptoms peculiar to that part ; so that if the hysteric ''susceptibility*' be not discerned,' such symptoms may be mistaken for some essential dis- ease of that particular organ. Thus, if the nerves of the stomach be the seat of the sympathy, we shall have eruc- tations, sour belchings, pains in that region, indigestion, capricious appetite, globus hystericus, etc. If the intes- tines, we have spasms, tympanitis, diarrhea or costiveness, contractions of the abdominal muscles, etc. If the liver, pain in the right side, obstructions or a change in secre- tion and flow of the bile, etc. If the kidnies, an immode- rate, or diminished secretion and flow of urine, very high colored, and sometimes offensive, with severe pain in the parts — bloody urine, etc. If the bladder, in continence or retention of urine, mucous discharges, etc. If the heart, palpitation, faintness, etc. If the scalp, a sense of heat on the back part of the head, coldness on top, great ten- derness to the touch, etc. Or, if the muscular system be the seat, we shall have violent convulsions, twitchings, etc. Certain parts, mentioned in this affection, sympathise with the brain more constantly and extensively than others ; it may be said that the stomach, esophagus, the heart, scalp, and kidnies, almost always participate in the affection. All of these parts may not be simultaneously affected, but they may present themselves separately, and • alternately ; in either case, this peculiar disease is betrayed and the plan for relief indicated. The combination of melancholy and depressing symp- toms, which precede hysterical attacks, should serve to protect the female from those unkind observations so often made by her associates. The predisposing causes, it will soon be seen, are most often such as are well calculated painfully to excite our symapthy. We have already 11* 102 HYSTERIA — VARIETIES. spoken of certain departures from moral purity, and they may often be the exciting cause of this disease ; but wh.n we see it brought upon a delicate and sensitive female, from causes originating in domestic unhappiness — it may be an unkind or drunken husband, an obstinate child, or disappointed affection — we can but most keenly feel for her unfortunate condition, and regret the present depart- ure from Christian principles, which characterizes our social organization. • The recurrence of hysteric paroxysms, in those predis- posed to them, is generally irregular ; they may at any time be developed upon the application of occasional, and when the predisposition is great, . slight causes. Violent attacks are generally, though not always, accompanied with unconsciousness ; at their conclusion, females will frequently express a knowledge of the circumstances that transpired and lament their inability of the least control of themselves. We have spoken of some of the variations in this dis- ease, but there are yet others more important. Almost every kind of serious disease may be simulated by what we must call hysteria. And sometimes it requires much skill and reflection in order to determine the true import of the symptoms, and the real nature of the case. One of the diseases which is often copied by hysteria, is inflammation of the peritoneum. We find the patient complaining of acute pain in the abdomen, aggravated by the slightest pressure ; she may have too, a hot skin, and a quick pulse. It will be well in such cases, before re- sorting to bleeding and the application of leeches, to ascer- tain whether all this suffering may not be simply nervous. If she be found to have had similar attacks before; if she has been known to have hysterical fits ; and if the tender- ness be felt as much upon the slightest touch, as when firmer pressure is made — after purging the patient, and the administration of an assafoetida enemata — the peritonitis will soon vanish. There are other pains which infest females of the hys- teric constitution, which are apt to be erroneously regard- ed as inflammation ; " stitches" and pains in the side are the most common; There is another, a pain occupying HYSTERIA VARIETIES. 163 some one point in the head, often just' above the eyebrows, known as clavus hystericus. In these cases, leeching, blistering, etc., for supposed pleurisy or chronic inflam- mation of the liver or spleen, may well be spared, since they serve to rivet the complaint. Palsy is also simulated by this disease. Its being mixed up with hysterical symptoms will generally disclose the true nature of the affection. Such affections referred to the throat are very common ; for example, a loss of voice, laryngitis, inability to swallow, etc. In cases of the " hysterical breast," the mammae become, painful and ten- der ; the girl's fear is excited, and if not understood, her attention is anxiously fixed upon it, by local applications ; whereas the treatment should be general, and the local uneasiness disregarded, or the attention of the sufferer be drawn from it. Among such affections of the air-passages, there is a loud harsh, dry, barking cough ; it occurs in paroxysms, and is more annoying to hear than to suffer. Hysterical eructation and vomiting are very common. There is also bloody expectoration, and even vomiting of blood. None of these are dangerous, and the attention of the sufferer should be diverted from them as much as possible. Hysterical affections of the joints, and bones of the spine are also common. Such patients complain of pain and tenderness ; and it is now notorious that scores of young women have been unnecessarily confined for months, and even years, to a horizontal position, and have had their backs seamed with issues for supposed disease of the bodies of the vertebrae, who had in reality nothing the matter with them but hysteria, and who would proba- bly have soon ceased to complain, if, instead of being restricted to that unnatural imprisonment and posture, they had taken a daily gallop on horse-back. It is very curious to notice how the mind is apt to become affected in these cases ; after the patient has been lying supine for months, she is unable to stand or walk; simply because she thinks she is unable. The instant she makes a fair effort to use her limbs again, she can, and does use them. ( Watson.) In these cases there is no alternative, and we 164 HYSTERIA — VARIETIES. generally succeed in making them walk ; and then they are convinced that they may do so with impunity. Dr. Bright was called to see a young lady in affluent circumstances, who had been confined to her bed for many months. If she attempted to move, she was thrown into excrutiating agony, and had nearly lost the use of the lower extremities. Dr. Bright being satisfied that it was a case of hysteria, substituted bread pills for the medicine that she had been long taking, with the same tranquil izing effects. He attempted to get her shifted gently from the bed to the sofa,, but it was impossible ; the paroxysm almost overcame her. " I called" he says, " after an absence of nearly a month ; her sister met me at the door with a smiling face to tell me that our patient was quite well ; and on enquiry, she related how three mornings before, under a deep religious impression, she had com- pletely recovered all her powers ; and I found her sitting up, working and amusing herself, as if she were completely convalescent from some ordinary illness." Such cases as these suit the purposes of miracle-mong- ers. Dr. Watson relates, that a few years ago, the reli- gious Journals of a certain party in England, were full of an instance of miraculous cure. The patient was a young woman with supposed paralysis of the lower extremities ; an enthusiastic preacher had influence enough with her to make her believe that if on a certain day she prayed for recovery with a strong faith, her prayer would be suc- cessful, she would recover ; she did so. Many of these pseudo-diseases terminate suddenly under strong moral emotion. A fall, a fire in the house, overwhelming terror, etc., are often found equally efficacious. Some of the shapes assumed by this Protean disease, are hideous and disgusting. Sometimes paralysis, or spasm of the musclar fibres of the bladder, really occurs; but it is a common trick of these patients to pretend that they labor under retention of urine. No doubt the diffi- culty is sometimes real, but it is proved to be oftener feigned or exaggerated. It will often disapper, upon the pa- tient's being left without pity, to her own resources. Such patients are deceitful and obstinate, practising, or attempt- ing to practice, the most aimless and unnatural impositions. HYSTERIA COMPLICATIONS. 165 They have been known to swallow their urine and vomit it up again, to induce the belief that the secretion had taken place in an unnatural way. They have produced fragments of common gravel, asserting that these were voided with the urine. And a young woman in an English hospital, after contriving to make the surgeons believe that she had stone in the bladder, actually submit- ted to be placed upon the operating table, and tied up in the posture for lythoto?ny, before a theatre full of students, when the imposture was detected. The state of mind evinced by many hysterical women, especially when its morbid propensities drive them to such acts as these, entitle them to our dee-pest com- miseration ; — and, indeed, it is quite impossible for ra- tional minds not to pity the unhappy victims of this wretched disorder. In distinguishing these aped affections from those that are real — if the patient be a young unmar- ried woman; if she have any disorder or irregularity of the uterine functions; if she have had any former hysteri- cal symptoms ; and especially if she be subject to fits of hysteria — we may be pretty well assured that the affec- tion is hysterical. It is very important, in the treatment, not to overlook real disease, when it is mixed with, and marked by such symptoms. Hysteria is sometimes complicated with those strange forms of nervous disorder known as catalepsy and ecstacy. These conditions are rare and wonderful : so much so that weak and superstitious persons have referred them to su- pernatural interposition in human affairs; and stronger minded individuals who never have witnessed them, regard their occurrence as fabulous, and laugh at them as the tricks and cheatings of imposture. They happen mostly in the same class of persons as hysteria, seem to be pro- duced by similar causes, and resemble it, in seldom being attended with danger to life ; their treatment is, also, the same. Cataleptic attacks occur in paroxysms, and sometimes alternate with well-marked hysteria: there is a sudden suspension of thought, of sensibility, and of voluntary motion; the patient remaining, during the paroxysm, in tfic position in which she happened to be in at the instant 8* 166 HYSTERIA — COMPLICATIONS. of attack, or in the position in which she may be placed during its continuance. Dr. Gooch describes a case of it, as he witnessed the disease in a patient who had long been subject to the common forms of hysteria.' He thus de- scribes it : "A few days after our first visit, we were summoned to observe a remarkable change in her symp- toms ; the attendants said she was dying, or in a trance. She was lying in bed, motionless and apparently senseless. Her eyes were open but no rising of the chest, no move- ments of the nostrils, no appearance of respiration could be seen ; the only signs of life were her warmth and pulse ; the latter was, as we had hitherto observed it, weak, and about 120. The trunk of the body was now lifted, so as to form rather an obtuse angle with the limbs (a most uncomforta- ble position,) and there left with nothing to support it ; there she continued sitting while we were asking questions and conversing, so that many minutes must have passed. One arm was now raised, then the other ; and where they were left, there they remained. It was now a curious sight to see her, sitting up in bed, her eyes open, staring lifelessly, her arms outstretched, yet without any visible sign of animation. She was very thin and pallid, and looked like a corpse that had been propped up, and had stiffened in this attitude. We now took her out of bed, placed her upright, and endeavored to rouse her by calling loudly in her ears — but in vain. She stood up, but as inanimate as a statue. The slightest push put her off her balance. No exertion was made to regain it. She would have fallen if I had not caught her." Dr. Gooch records, that she went into this state three several times. The first attack lasted fourteen hours, the second, twelve hours, the third, nine hours, with intervals of one and two days between them. The patient after- wards recovered. There is another and milder form of this condition, in which the patient is unable to move or speak, but is con- scious of all that is going on around. It has been called the day mare. In what is called ecstasy the state is different. As the term imports, the patient is lost to all external impressions HYSTERIA COMPLICATIONS. 167 and is wrapt and absorbed in some high object of imagi native contemplation. The muscles are sometimes rigid, at others relaxed ; these patients often walk, speak and sing. This condition is not uncommon as forming a part of religious insanity. An eminent English writer re- marks : " Nervous and susceptible persons are apt to be thrown into these trances under the influence of animal magnetism ; and grave authors assure us that the intelli- gence which then deserts the brain, concentrates itself in the epigastrium ; or at the tips of the fingers ; that people in that state read letters which are placed upon their sto- machs, or applied to the soles of their feet ; answer oracu- larly, enigmatical questions ; describe exactly their own internal organic diseases ; and even foretell future events. " I take it for granted that they who were in the habit of speaking, a few years since, in some of our places of worship, in what they called unknown tongues, were either gross imposters, and deserved to be publicly whip- ped, or persons laboring under this disease, and wanting physic." It is a curious fact that many of the Italian Improvisator! are in possession of their peculiar faculty only while they are in a state of extatic trance ; and that few of them enjoy good health, or consider their gift oth- erwise that morbid. Hysteria has been confounded with hypochondriasis, but the two diseases differ in quite a number of particu- lars. Hysteria attacks the sanguine and plethoric as well as those of a delicate habit ; comes on soon after puber- ty ; its attack is sudden and violent, with globus hystericus, etc. We find the reverse in hypochondriasis; it seldom occurs till after the age of thirty-five, and attacks the mel- ancholic ; comes on gradually ; is a tedious disease and difficult to cure ; its effects are mostly confined to the canal of the intestines ; and it generally terminates in confirmed melancholy. Hysteria is much relieved by advancing age, whereas the other is usually aggravated. Hysteria is not likely to be confounded with syncope or apoplexy, as. the peculiar symptoms which attend it, do not occur in either of those conditions. In syncope there 18 an entire cessation of the pulse, and a ghostly counte- 168 HYSTERIA CAUSES. nance ; in apoplexy there is a sort of snoring, and a quick pulse ; which do not occur in hysteria. This affection differs from epilepsy, in that this arises from a more decided change in the brain ; there is a greater distention in the blood vessels of the brain ; a more frightful expression of the countenance, and drawing of the mouth to one side, rolling of the eyeballs, and grinding of the teeth ; while in hysteria the cheeks are red, but at rest, and the eye is fixed and quite natural. Occasionally, hysteria is combined with some one or all of these diseases, and sometimes they are Jie cause of unfortunate results ; as persons have remained so long in the paroxysm, as to be thought dead, and have actually been buried* when life was not extinct. The causes of hysteria, are the 'predisposing, or such as give to the constitution a susceptibility to the disease, and the exciting, or those which more immediately bring on a paroxysm, when the susceptibility already exists. 1. Predisposing causes. It has been observed, that whatever destroys the general tone of the system, and in particular of the nervous system, especially if this be gradually produced, disposes the body to hysteria. Hence a too sedentary life ; over- stimulating diet, or much care ; the various emotions resulting from social, or unsocial life, as it should be called : as disappointed hope, prolonged anxiety ; the culture of belles-lettres ; great development of the intellect ; a vivid imagination; the abuse of per- fumes ; exciting drinks, alcoholic, tea and coffee, etc. ; abused affection ; grief; terror, etc., are the most promi- nent causes of this kind. Some of these causes act by too much exhausting the nervous §ystem, others by taxing its sensibilities too highly, and preventing it from acquiring its proper tone. Parents who have acquired disease, or de- bilitated constitutions, from these causes, are apt to engen- * In the year 1745, Lady Russel remained for eight days without giv- ing the slightest appearance of life, or the least sign of alteration. She was aroused by the sound of the bell of a neighboring church, whilst her husband, who vehemently opposed her inhumation, was holding her hand and bathing it with his tears ; she lived many years after thi3 event. J. Raulin, speaks of an hysterical girl, whose funeral he post- poned, because her color had not entirely changed. The author adds that in the course of a few hours the supposed corpse recovered her consciousness. HYSTERIA CAUSES. 169 der this susceptibility in their offspring. Yet the condition is more owing to defective physical and moral education in early life. From the influence of luxury, indolence, and sentimen- tal reading, the hysterical susceptibility is becoming a common characteristic of the female inhabitants of cities, and gaining increased prevalence among the country population. A medical writer remarks : " Hysteria is undoubtedly mostly due to an indolent, luxurious, and enervating mode of life ; and w T e may thank for this those (well-meaning though short sighted) persons, who so stu- diously oppose every effort for enlightening females upon the laws which govern their being, while they fill their hands and heads with mawkish and sentimental trash, yclept, ' the light literature 5 of the day. This absorbs their sleeping and waking moments, to the frequent exclu- sion of even a proper attention to the duties of exercise and cleanliness. What, then, can be expected, in our enervat- ing climate, but a predisposition to nervous diseases ? It must and does follow, and may be traced directly to such causes." Nothing is more true than this description, and . il is sometimes, though rarely, produced in males by the same causes. „ . The causes of plethora sometimes induce the suscepti- bility to hysteria in nervous habits, particularly the con- vulsive form of the complaint ; but more frequently f he suceptibility is produced by the causes of debility before enumerated. In addition to those particularly noticed, may be mentioned others — as attacks of fever, excessive evacu- ations, or the long-continued use of sedative, depletory, or irritating remedies. 2. Exciting causes. When the susceptibility of the nervous system above described exists, a slight excitement is often sufficient to induce a hysterical paroxysm. It should be remarked that this susceptibility varies in dif- ferent individuals ; while some have a '< fix " provoked by the slighter causes, others require that they should be powerful, or long-continued. This condition is more common in women and children, than in men ; and more common in all persons when in a state of weakness. It is most common in young women, / 170 HYSTERIA CAUSES. in whom, with a debilitated constitution, the process oi menstruation is in some way or other disordered. So that we find a greater predisposition at the time of the menstru- al periods, and immediately after delivery. Consequently, sudden suppression of the menses, excessive, and altered menstruation as in leucorrhea, may be reckoned as com- mon exciting causes, also forced continence, abuse of coitus, masturbation, and all circumstances capable of producing, maintaining or increasing irritation of the uterus and espe- cially of the ovaria. Many of those causes, also, enumerated as the predis- posing, when they act suddenly, are conspicuous as excit- ing causes. Among them may be mentioned, emotions of the mind of whatever kind, as sudden grief, anger, fright, Joy, or surprise of any kind, unrequited affection, jea- lousy, disappointment, reading of novels, erotic conversa- tion, the sight of ghastly* and bloody spectacles, sombre or too animated music; finally all the causes that produce violent emotions, or suddenly recall painful and lasting impressions. The exciting causes of irritation in some important or- gan, are perhaps the most important in reference to the treatment, as they are more under the control of remedies than emotions of the mind. Food, improper in quantify and quality, is perhaps the most common cause of irritation ; as highly seasoned and exciting dishes ; very salt meat and fish ; iced creams, etc. Also, the use of iced and very hot drinks, as tea and coffee ; alcoholic drinks, aromatic substances. The old proverb, " What is one man's meat", etc., is here partic- ularly apposite. The human stomach, at times, is ex- tremely capricious, while at others, it will suffer great abuses, and for a long time without resistance. In many nervous and dyspeptic patients, experience alone, is the only safe guide by which the food can be regulated. One of the most common symptoms attending hysteria is the formation of wind and gas in the stomach and bow- els, which is the effect of a certain condition of these parts ; one is occasioned by relaxation, which suffers them to be distended by the disengaged air, during an imperfect digestion ; the other, perhaps, is caused by the secretion, HYSTERIA CAUSES. 171 or elimination of gas from the extremities of the vessels terminating upon the internal surface of the stomach and intestines. Worms in the intestinal canal, and cancerous, as well as other-obstructions, as of the liver, spleen, kidnies, etc., may act as exciting causes. Those who labor under this idiosyncracy of the nervous system, no matter how they arrived to it, are peculiarly unfortunate ; as they are constantly liable to be affected by slight causes, which have no influence on others. Be- cause these affections are not often dangerous, and the sub- ject of them often enjoys otherwise very good health, she too often becomes the object of cruel and ill-directed ridicule. Authors mention instances in which such women have been thrown into "fits" by the odors of musk, ambergris, and even by the rose and lilac, when they could easily bear the stronger smell of tobacco. Others have been made, violently sick by the very name of rhubarb, Peruvian bark, and even coffee. Boyle relates the case of a lady who, upon hearing the sound of a bell, or any loud noise, would swoon so deeply as scarcely to be distinguished from death. Another case is recorded of a young lady who always had a hysterical attack if she heard the clock strike five — her father having died at that hour. Such and simi- lar cases are very numerous. The force of imitation is very remarkable in propaga- ting this affection : instances in hospital practice are nu- merous, wherein a whole ward-full of patients, upon view- . ing a hysterical paroxysm, have themselves been attacked so violently by it, as to require the most active means for rostoring them. There is no doubt that certain females, sometimes pre- tend hysteric attacks, for the purpose of exciting sympa- thy and obtaining the gratification of some desire ; as coveted luxuries, compelling the parents consent to desir- ed marriages, etc. This is certainly a mortifying disco- very, and such cases are easily detected by the physician ; they usually declining treatment, particularly if of a disa- greeable character. Notwithstanding hysteric paroxysms may sometimes be extremely awful to behold, they are seldom accompanied 1 72 HYSTERIA TREATMENT. with danger, and the disease never terminates fatally, un- less it be complicated with more serious maladies. Treatment.- — The treatment of hysteria is divided into that which is proper in the paroxysm, and that which is re- quired in the intervals, for the purpose of modifying the predisposition and removing the exciting causes. I. In the 'paroxysm it is important to adopt such mea- sures as may be necessary to prevent the patient from sus- taining injury during the violence of the struggles. She should be in a cool and airy apartment, and have all tight dress loosened about her person. When the paroxysm is very severe it is not possible to administer remedies by the mouth ; but cold water dashed on the face, or the cold douch to the head, applied by pouring water from a height, from the spout of a tea-pot or other convenient ves- sel, will often be useful in rousing the nervous system and abridging the paroxsym. For the same purpose, prepara- tions of ammonia may be held to the nose, unless there be much determination of blood to the head, when it may be injurious. As soon as the patient is able to swallow, the attack may be shortened by the administration of half an ounce of mixture assafoetida, frequently repeated ; or half a tea-spoonful of ether, with ten or fifteen drops of lauda- num ; or a draught containing a tea-spoonful of the ammo- niated tincture of valerian. When the patient cannot be made to swallow, great good may be effected by enemata : as two drachms of assafoetida and half a tea-spoonful of laudanum with half a pint of water, mixed by means of the yolk of an egg ; or half an ounce of turpentine, pre- ' pared in the same manner; or the same quantity of cold water thrown into the rectum, and applied externally to the abdomen, will often bring the fit to a speedy termina- tion. There is almost always costiveness, or other de- rangements of the bowels, for which active purges are requisite : the infusion of senna, and castor oil are to be preferred. When there is a formation of much wind and a tympanitic state of the abdomen, there is no remedy bet- ter than the oil of turpentine, by the mouth and rectum. Blood-letting has been recommended, but requires to be used with caution. When decided signs of plethora exist, with much determination of blood to the head during the HYSTERIA TREATMENT. 1?3 paroxysm, the system is put in a better condition for the above mentioned antispasmodics, by the previous loss of a few ounces of blood. Dr. Whytt thinks that there is no remedy so effectual as the warm foot bath, which should ' be used along with the other remedies. When the parox- ism depends upon indigestible food in the stomach, an emetic should be given as soon as the patient can swallow. When vomiting attends the attack, it should be encouraged by draughts of tepid water, until the stomach be cleansed. In lingering cases, it becomes necessary to apply sinapisms to the feet, and sometimes blisters to the calves of the legs. Also, when there is tenderness about the spinal cord, coun- ter irritants are very useful. When the patient has warning of the approaching par- oxysm, it may frequently be interrupted by a timely dose of laudanum, assafoetida, or Hoffman's anodyne liquor. When landanum disagrees, morphine may be substituted, in doses of one- fourth of a grain. In those cases where hysteria depends upon a suppres- sion of the menses, excessive menstruation, or leucorrhea, the treatment must be modified as elsewhere directed. (See those chapters.) The patient often receives injury , from the violence of by-standers in attempting to unclench the hands, etc.; such attempts are highly improper, as they are every way calculated to do mischief, and never to do good. There should be in attendance a sufficient number of persons to control the movements of the patient, with- out violence. Every thing should be done quietly, and no aggravating remarks should be made to irritate the affected person. [n the treatment of that long catalogue of affections, which are not real, but simulated by hysteria, the cold douche is a most valuable resource. Those cases where- in limbs are incapable of motion, from having been perma- nently contracted for a long time, will generally yield af- ter a few •minutes application of cold water. Dr. Clark cured a case of locked jaws, after all other remedies had failed, simply by placing the head of the patient over a tub and pouring cold water on her face. It often requires some determination to put this expedient into practice, as the patient is apt to look upon the author of it as a mon- 9 174 HYSTERIA-— TREATMENT. sler of cruelty. - The transmission of electrical shocks through the part affected is, also, sometimes effectual. In the moral management of hysteria, it is important to temper kindness with firmness, and to avoid a parade of ^ sympathy. Of all the spasmodic affections, this is most readily propagated by sympathy. If, in the large ward of a hospital, one girl goes off in a "fit," half a dozen others perhaps, or all who happen to possess the hysteric suscep- tibility, will have a strong inclination to follow her exam- ple. A stern nurse, or an order that the cold affusion, or some more disagreeable application, shall be employed, will keep the complaint greatly in check ; and on the other hand, great sympathy with such patients has a striking effect in encouraging the paroxysms. These facts show that the "fits" are not wholly wilful, neither are they wholly conquerable. (Watson.) 2. Respecting the management of hysteric patients in the intervals — after having spoken of the remedies most beneficial for giving tone and firmness to the system in treating of deranged menstruation, leucorrhea and chloro- sis — we have here but little to say. The great object to be aimed at, is the restoration of the nervous system to the requisite degree of stability, necessary to overcome the acquired susceptibility. The mind, if possible, should always be diverted from the contemplation of the ills of the body. A due inter- course with society, in such a manner as to divert without exciting, is desirable. The patient should be aware, that for a cure, vastly more depends upon her judicious man- agement of the moral faculties, and proper employment of the physical powers, than can be effected by medicine ; she should be informed how much depends upon herself, by not yielding to sudden impulses, emotions of the mind, and destructive forebodings. The physical, exciting causes, improper practices, or whatever they may be, should also be avoided. The remedies must be directed to the nervous system, through the medium of the stomach, skin, and the mind. They will consist of tonics, antispasmodics, the cold bath, and agreeable impressions «on the mind. The tonics will consist of the various bitters, preparations of iron, iodine HYSTERIA TREATMENT. 175 and food ; such as Peruvian bark, sulphate of quinine, gentian, orange peel, columba and quassia ; the carbon- ate, sulphate, citrate and wine of iron ; the compound tincture and syrup of iodine, etc. The antispasmodics, are asafoetida, valerian, ether, castor, etc. The food should be only such as agrees and is easy of digestion ; such as poultry, mutton, venison, soft boiled eggs, tomatoes, and bread made from unbolted wheat flour. Much good may be expected from the steady employ- ment of the shower bath. The bowels must be kept regu- lar, by the employment of aperients composed of aloes and rhubarb ; a constant attention to this is most important. An attention to the following points is also of great conse- quence : a well regulated course of exercise, both on foot and on horse-back*; the avoidance of hot rooms and late hours, both in respect to going to bed, and to rising from it ; the avoidance of moral emotions, of novel reading and of all the other numerous modes of mental and bodily dis- sipation, which accompany and lessen the blessings of civilization. Marriage sometimes proves a cure ; when this is the case it is probably by satisfying the affections of the heart. The susceptibility to hysteria, may be more -easily pre- vented than cured ; in a great majority of instances it is the result of injudicious management in early life. Pa- rents do not foresee the misery they are laying up for their daughters, in pampering them with stimulating food, allow- ing modes of dress which unduly compress the most im- portant organs of life, and filling them with fashionable accomplishments. Too much time is devoted to sedentary employment, and the perusal of works of fiction is too often substituted for more solid attainments, which pro- duce a fondness for injurious excitement. We will close this chapter by quoting some remarks made upon this point by Sir B. Brodie. After remarking that no better service can be rendered society, than by explaining to parents how much the ordinary system of education tends to engender the disposition to this disease among their female children, he says : " The boys are sent at an early age to school, where a large portion of their time is passed in taking exercise in the open air ; L76 NYMPHOMANIA NATURE. while their sisters are confined to heated rooms, taking little exercise out of doors, and often none at all, except- ing in a carriage. Then for the most part, the latter spend much more of their time in actual study than the former. The mind is over educated at the expense of the physical structure ; and after all, with little advantage to the mind itself; for who can doubt that the principal ob- ject of this part of education ought to be, not so much to fill the mind with knowledge, as to train it to a right exer- cise of its intellectual and moral faculties ; or that other things being the same, this is more easily accomplished in those whose animal functions are preserved in a healthy state, than it is in others. CHAPTER XL NYMPHOMANIA, OR FUROR UTERINUS NATURE — CAUSES- SYMPTOMS AND TREATMENT. By nymphomania or furor uterinus, is understood, an exaggerated, voluptuous sensation, accompanied by vene- real desire, which is irresistible and insatiable. We have spoken of a complaint, (Chapter VI. Part 11.) pruritus of the vulva, which has been often confounded with this affec- tion, though it is of a very different character. Some authors have placed the seat of this disease in the brain, while others fix it in the genital organs. Modern authors, however, amongst others, M. Colombat, in whose opinion we ourselves agree, regard it as resulting from a simultaneous irritation of the brain and sexual organs. The above named author, observes : " This morbid exag- geration of the venereal appetite, this cestus eroticus, is less a disease than a symptom, for the manifestation of which, is required the concurrence of the brain and the organs to which erotic sensations are referred. The point of depart- ure is sometimes in the brain, and sometimes in the uterus and its appendages. In the former case, the disease is developed under the influence of moral causes which secondarily irritate the genital parts, and in the latter, it NYPHMOMANIA NATURE. . 177 is a primary irritation of the organs of generation reacting sympathetically upon the brain, and especially on the cerebellum. u The affection, which may appear at all ages, gener- ally attacks women of an original uterine temperament, which is determined by the predominence of the sanguine system, and extreme irritability of the abdominal viscera. Women of this constitution have certain characteristics ; their stature is small, their skin dark, and their complex- ion highly colored ; in them the breasts and all the attri- butes of puberty have been developed at an early period ; the clitoris and the nymphae, which are generally of abnormal length, are endowed with exquisite sensibility. Young widows, who have to regret frequent engorgements, public girls who have been suddenly deprived by forcible seclusion of venereal pleasures, to which they had aban- doned themselves to excess, ardent women, married to men whose cold and feeble constitutions prevent often- repeated sexual connexion, and finally those who are attacked with some chronic cerebral affection, are most exposed to this frightful disorder, especially when they inhabit warm climates, in which the passions are most vivid and the imagination most exalted." The genital organs of some women, acquire such a preponderance, as to make it always impossible for them to control the intensity of the erotic flame which devours them ; such was the young girl of whom Buffon speaks : * I have seen, and I have regarded her as a singular phe- nomenon, a girl of twelve years of age, a dark brunette, of a bright and highly colored complexion, of small sta- ture, hut already fully formed, with a rounded neck and embonpoint, perform the most indecent action at the simple appearance of a man ; nothing could control her in this, neither the presence of her mother, nor remonstrances, ncr punishments. Yet she did not lose her reason, and the attack, which was carried to such a point as to be frightful, ceased the moment that she remained alone with women.'' Such also, was the shameful and disgusting Messalina, who was accustomed to escape during the night from the bed where slept her stupid lord, the Emperor Olaudius, and disguised in the dress of a courtezan, I 178 . NYMPHOMANIA CAUSES AND SYMPTOMS. hastened to encounter the brutality of the vilest debauch- ery. Causes. — These may be divided into the predisposing and exciting, or those which act upon the brain, and second- arily the sexual organs, and those whose action is felt primarily upon the uterus and its appendages. In the former, should be included all circumstances capable of producing an exaltation of excitement in the brain and nervous system; such as the reading of lasci- vious and impassioned works, viewing of voluptuous paintings, romantic conversations, associating with corrupt companions, frequent visits to balls or theatres ; disap- pointed love ; the too assiduous cultivation of the fine arts ; the influence of imitation on beholding it in others ; the abuse of aphrodisiac remedies, or of spirituous liquors, or of aromatics and perfumes which excite too much the brain and general sensibility. The causes whose action is directly upon the genital organs, and which may afterwards react sympathetically upon the brain, are masturbation, the abuse of coition, pruritus of the vulva, inflammation of the nymphse, clitoris, neck of the uterus and ovaries; we may add, the irrita- tion of ascarides in the rectum ; and finally the use of drastic purgatives, and the internal or extensive, external employment of cantharides. Symptoms. — At first the female experiences venereal iesires, especially at the periods of menstruation, which her prudence induces her to conceal. The care which she takes at this period to hide the obscene ideas that con- . stantly disturb her imagination, renders her sad, taciturn and melancholy ; she loses her appetite and sleep, and seeks solitude. After the disorder has made some pro- gress, far from seeking to hide her irresistible passion, the patient employs all her address to make it known by frequent sighs, by encouraging proposals, by voluptuous attitudes, and finally by complete forgetfulness of all modesty. At the sight of one of the male sex her pulse is agitated, her face becomes more animated; her respira- tion hurried, her senses are obscured, she makes indecent gestures and proposals ; finally, when the paroxysm is at its height, she strikes and tears everything that opposes NYMPHOMANIA TREATMENT. 179 her, and at last falls into furious delirium. There are certain other symptoms, as a sensation of pruriginous heat in the loins, hypogastrium and breasts ; the genital parts, which are red, swollen and constantly irritated from hand- ling and illicit manoeuvres, are generally the seat of a fetid, and sometimes a purulent discharge. Finally, there is ardent thirst, grinding of the teeth, spasm of the eso- phagus, and, in some cases hydrophobic symptoms. The attacks of furor uterinus frequently follow each other with great regularity, and sometimes terminate fatally ; espe- cially is this the case when there is organic disease of the uterus or its appendages. We remarked that nymphomania had been confoundec with pruritus ; but they are generally easily distinguish a ble. In the former there is a voluptuous sensation, ac- companied by venereal desire. Pruritus on the contrar)* is characterised by an indomitable itching, seldom accom- panied by voluptuousness ; indeed, there is most often, great repugnance to venery. Treatment. — This is to be applied, according to the seat of the malady, to the brain and nervous system, to the reproductive organs, or to both. In general, greater good may be expected from hygiene than from drugs, which are not. so successful in opposing a disease whose source lies in moral causes. Some means of diversion should therefore be devised, capable of turn- ing aside her imagination from lascivious thoughts ; for this purpose, should be recommended constant occupation of some kind, travelling, walking, etc. The reading of romances ; balls and shows, the society of men ; the view- ing of voluptuous statuary; and every thing capable of producing erotic excitement, should be avoided with the greatest care. Their thoughts, if possible, should always be employed with something foreign to their passion, and they should be allowed only to associate with persons of their own sex ; they should take frequent and prolonged warm baths, with cold affusions to the head, while in the bath. They should use cold and sedative drinks, emul- sion of almonds and marsh mallows with nitrate of potash, or a few grains of camphor, and enemata of the same na- ture ) finally, whey, broths made of beets and sorrel, and 1 80 NYMPHOMANIA TREATMENT. of chicken or veal with nitre 3 lemonade ; a milk and vegetable diet, etc. General bleeding, and the application of leeches to the back of the neck, or behind the ears, are useful, especially when the brain is considerably affected. Frequent saline purging, is also not to be neglected. When the disease depends upon local causes, as vene- real excitement, masturbation, leucorrhea, prurigo, the presence of worms, etc., in addition to the above, seda- tives may be applied with good success ; as injections of starch or mucilage with laudanum, decoction of poppy- heads, of cicuta, of hen bane, etc.; or cloths saturated with any one of these may be applied to the genital parts. Also the employment of enemata of milk with a few grains of camphor, and the careful internal administration of camphor and opium will be found useful. Finally, for the purpose of quelling the erotic desires, Dr. Coster has proposed the employment, internally of tartar emetic, one or two grain* in a pint of water, to be taken in teacupful doses, ever}' hour, so as to excite nausea, without occa- sioning vomiting. Everything capable of exciting the genital organs must be studiously avoided ; soft mattrasses, feather beds, and beds of down must be forbidden, and those made of straw or simple hair mattrasses, substituted. In desperate cases it is sometimes necessary to use an apparatus, a sort of wire work, whose meshes are so close as to prevent the passage of the finger. Let us repeat, that the strictest regimen should be observed, a milk and Vegetable diet, with abstinence from stimulating food and drinks of every description. During the intervals of calm, the patient should be reminded of her duty to herself and family, which is dishonored by her shamefnl practices, and, also, how much depends upon her own efforts in controlling her propensities. Though marriage has sometimes proved a remedy for nymphomania, it is a means that should only be resorted to when we are fully assured of its applica- bility. CHAPTER XII. HYSTERALGIA, OR IRRITABLE UTERUS SYMPTOMS CAIUi^ AND TREATMENT. This disease, known, also, as neuralgia of the uterus, is principally characterized by pain in that organ ; it was first described by Dr. Gooch, who defines it, " a painful and tender state of the uterus, neither attended by, nor tending to produce change in its structure." By writers anterior to his time, it was confounded with, and regarded as a kind of chronic inflammation. This disease occurs in females of every temperament, and may appear at any time within the menstrual age; the young and middle aged, however, are most subject to it — the aged being rarely attacked. Symptoms. — This affection, at times, is one of extreme suffering. There is pain in the lower part of the abdomen and loins, which usually comes on a few days before or after menstruation, and from which the patient is never quite free. It is subject to aggravations, from mental excitement and bodily exertion ; hence the patient is in- duced to give way to the relief afforded by repose. The result is, that by the pain, the want of exercise and fresh air, the general health is broken ; and a languid circula- tion, constipation and dyspepsia are super-induced. Upon examination, the uterus is found tender from slight pressure. Sometimes the neck and body are slightly swollen, but not hard; the mouth of the uterus, and vagi- na are found healthy. The disease may continue for months or years, it may be subdued by medical treatment, or it may subside spontaneously. It is a sure cause of barrenness, but it does not terminate in organic disease of the uterus, or endanger life. Leucorrhea sometimes, though not always, accompanies this disease. It may be distinguished from acute and chronic inflammation of the uterus, by the absence of 182 HYSTERALGIA CAUSES AND TREATMENT. heat and throbbing, and by the stationeriness and long- continuance of the symptoms, without a tendency to dis- organization of the organ. From " painful and difficult menstruation" it is distinguished by a continuance of the pain, more or less severe, throughout the interval. From displacements of the uterus and vagina, by the natural po- sition of those organs in this affection. From a comparison of this malady with long-continued and painful affections of other parts of the frame, it must be inferred to be nervous. Thus, the breasts, the spine, and the various joints, may be the seat of acute pain, which may endure for many years without being accom- panied by organic change. The causes of this disease are often obscure. The most appreciable are, bodily exertion during menstruation, or too soon after abortion and delivery ; excessive coition, and an improper use of astringent injections. It may, also, come on after great fatigue merely, such as long journies, dancing, dissipation, late hours, etc. Treatment. — There are few diseases so tedious of cure and*liable to relapse, as this. The indications are — 1. to relieve the pain ; 2. to restore the constitutional condition. 1. The violence of the pain must be allayed by abso- lute rest during the paroxysm, and narcotics, such as opi- um, hyosciamus, morphine, etc., either alone or in combi- nation, with camphor or asafcetida. If the stomach be too irritable, they will be found equally as efficacious by injection into the vagina or rectum. Opium and bella- donna plasters, or hop and poppy fomentations, to the sa- crum and abdomen, are also useful. Counter irritation should be practiced by means of small blisters or dry cup- ping to the loins. Much relief will be afforded by vaginal injections of warm water alone, or a solution of morpnine (two grains to the ounce,) if the pain be severe. The warm hip bath, will often procure relief. The bowels should be kept open, by the mildest means, as all active purgation in this disease is invariably injurious. 2. Athough, during a severe paroxysm of pain, close confinement is indispensible, in the horizontal posture, this should not prevent the patient from being often carried into the open air and taking moderate carriage exercise, IIVSTERALGIA — TREATMFNT. 183 particularly as soon as there is an abatement of the most violent symptoms. A generous diet, but so as not to burthen the stomach, fresh air, and a gradual course of tonic medicines, (iron preparations are preferable,) are the best means of treating the constitutional condition accompany- ing this obstinate disorder. There is another affection of the uterus, much resem- bling this, which might be, perhaps, more properly named rheumatism of the womb. The plan of treatmeat is the same as above recommended. There is a painful state of the vagina sometimes met with, analagous to the affection of the uterus just described ; and which might be termed Irritable Vagina. It is char- acterized by extreme tenderness, when the lining mem- brane is touched by the finger, and a hysteric attack not unfrequently follows coitus. In some it is developed by mar- riage, and in others by child-bearing, or both. The treat- ment is. mainly the same as above directed for Hysteralgia. SECTION II. ORGANIC DISEASES. CHAPTER I. INFLAMMATION OF THE UTERUS FALLOPIAN TUBES AND OVARIES ACUTE AND CHRONIC CAUSES SYMPTOMS TERMINATIONS. AND TREATMENT. The diseases of the internal genital organs which w r e have hitherto considered, are the functional ; and are not attended with structural changes of so serious a nature as to prevent a complete restoration. The line of distinc- tion between the functional and organic is not always so apparent as might at first appear. This arises from the complications to which all of these disorders are more or 184 INFLAMMATION OF THE UTERUS CAUSES. less subject, which give them a tendency to produce dis- organization. The diseases of these organs now to be con- sidered, are the organic ; and though mostly curable in their earlier stages, they are far more serious than the other class, often, for a long time, resisting the best appli- ances of art for their relief. Inflammation of the acute form, in the unimpregnated uterus is a rare disease; chronic varieties, however, are frequently met with. It may attack the mucous or serous coats alone, or in connection, the proper tissue of the ute- rus ; it may occupy the body or the neck, or both. Its occurrence is very rare, till after marriage, and it scarcely ever appears before the age of puberty. Causes. — Blows externally and local contusions most frequently give rise to it; it is oftener produced soon after marriage, than at any other period. Cold taken during menstruation by improper exposure, may, by suppressing the secretion, convert the periodic congestion which pre- cedes the eruption of that discnarge, into active inflamma- tion. Dr. Colombat enumerates the following causes : " Irri- tating injections ; suppression of the discharge of piles ; leucorrhea ; the use of violent medicines to force the menses, or to procure abortion ; too frequently repeated coitus ; relative disproportion of the organs ; solitary en- joyment; celibacy; widowhood; sudden cooling of the extremities ; cold bathing of the lower parts of the body ; cold general baths, and iced drinks, especially during menstruation; fatigue walks; violent exercise on horse- back, or in carriages without springs ; excessive dancing ; loss of sleep ; wounds ; the application of a pessary ; heat- ing and stimulating food ; spirituous drinks ; coffee ; wine ; and strong moral disturbances, which may suspend the flow of the menses, of the lochia, etc. Symptoms. — In the acute form, the attack commences with chills, succeeded by feverishness, heat and uneasiness in the pelvic region, and pain in the back and lower part of the abdomen, extending to the groins, and down to the thighs. There is more or less tenderness on pressure. Upon examination, the uterus will generally be found INFLAMMATION OF THE UTERUS SYMPTOMS. 185 increased in size, and often somewhat depressed in the pelvis ; the mouth more open than natural, and the neck tender to the touch. The constitutional symptoms vary ; there is seldom much fever, and though the pulse may be somewhat quicker, than usual, it is very often unaffected. The menses sooner or later become suppressed, when we have all the symptoms consequent upon that condition. The local irritation is soon imparted to the neighboring organs ; the vagina, rectum, urethra and bladder partici- pate, giving rise to pain and difficulty in discharging the faeces and urine. Distant organs also sympathize ; the breasts swell and become painful ; there is nausea with a diminished appe- tite ; the bowels become constipated ; and the general health differs very much. Chrome inflammation of the uterus is much more im- portant than the acute ; not only from its more frequent occurrence, but also from its being often found complicated with various other organic diseases of this organ, adding to the distress, and accelerating their progress. It is often very insidious, giving irregular indications of its presence ; we may have nearly all the symptoms enumerated under the acute form, but they are less marked. The causes of the chronic form, may be divided into predisposing and exciting ; the latter are the same as enu- merated under the acute form. The predisposing causes, are depressing moral emotions, a scrofulous constitution, or lymphatic temperament, syphalitic diathesis, a cancer- ous predisposition, improper aliments, dwelling in low, damp and unventillated places, tight corsets, and reading novels which produce uterine phlogosis. Menstruation is more or less disturbed, and there is often a vaginal discharge. This slow inflammation, from the sympathetic influence of the uterus when irritable may give rise to a variety of nervous symptoms ; the female becomes fretful and capricious, and often hysterical. Such symptoms may also indicate otheT serious affections of an obscure character, and comparitive rare occurrence ; so that it often becomes necessary for the female to sub- mit to a manual examination, for the purpose of ascertain. I* 188 INFLAMMATION OF THE UTERUS TREATMENT. ing the real condition of things. No female should neg- lect to submit at once to a step so necessary for her proper treatment; as, of course, the utmost propriety is observed by every gentleman who is obliged to resort to such an examination. " We may often justly suspect the existence of this slow inflammation of the uterus, from the fretful and capricious disposition of females who have previously been of an equable and happy temperament. It was said by the an- cient physicians, that the i uterus was an animal within an animal, 5 so well were they convinced of its surprizing power over the affections and sentiments. Nor does it seem at all inconsistent with the perfect harmony of na- ture's laws that it should be so. When we reflect on the inconceivable wonders of its functions — that within its cavity, nature, with her plastic hand, gives the first evi- dence of her power to attach an immortal spirit to those very elements of which the meanest insect, or even a blade of grass is, also, formed — we may, with great propriety demand why the whole organism should not respond to its slightest affection." Inflammation of the uterus frequently terminates in reso- lution. There are other conditions, however, consequent upon this disease, which, though rare, from their import- ance, deserve notice. The uterus may become indurated or enlarged, either temporarily or permanently ; the former is supposed fre- quently to give a disposition to cancer. This augmenta- tion in volume, may, from its pressure upon the bladder and rectum, give rise to incontinence of urine and consti- pation. It, also, favors displacement of the organ. This disease may, also, terminate in softening of the substance of the uterus ; in abscess and gangrene — though rarely. It may be distinguished from other organic dis- eases of this organ by a thorough examination, and inves- tigation into all the symptoms. Treatment. — The activity of the treatment will depend upon the severity of the attack and upon the constitution of the patient. Venesection will only be necessary where there is considerable fever. In the acute form, cupping the loins, or leeches to the INFLAMMATION OF THE OVARIA AND TUBES. 157 vulva, to be repeated if necessary, will be found useful. Or the leeches may be applied directly to the uterus itself by means of the speculum, as advised by French authors. Mild saline purgatives will, also, be necessary to evacuate the bowels. Benefit has been derived in this form from the administration of opium and tartrate of antimony in combination (one grain of opium to one-fourth grain of the antimony, in pill) repeated every hour or two, till sleep was obtained. Diaphoretics are always useful, as liquor acetate ammonia, and Dover's powder. Local poppy fo- mentations^ and hip baths, frequently repeated, are. also, useful ; as, also, are vaginal injections of decoction of poppies with a small quantity of laudanum. In all chvonic cases, as well as acute, after the employ- ment of antiphlogistic remedies, much benefit may be de- rived from counter irritation to the loins, by means of mustard poultices, croton oil, etc. If blisters be used, the flies should be carefully removed before the vesication takes place, or tissue paper interposed, to prevent stran- gury. The application of leeches, or scarification at the mouth of the uterus is, also, very useful in this form. When permanent thickening, or enlargement of the uterus has taken place, along with a proper dietetic regulation, great benefit may be expected from the exhibition of iodine. The use of it, in some of its various forms should be per- severingly prolonged. The diet must be simple yet nour- ishing. The patient, if married, must live absque marito, and strenuously avoid excitement of every description. At an advanced stage, all means should be employed which are calculated to improve the general health. Inflammation of the Fallopian tubes and ovaria, sometimes occurs independently of affections of the uterus ; most freqeuently, however, from their proximity to the latter, they are anvcted by an extension of the more acute disorders of the uterus. Under these circumstances, no good would result -from giving an extended description of the disease, as the causes, symptoms and treatment are about the same as just enumerated. The exact seat of the affection can rarely he detected till after death. The Fallopian tubes may be attacked by acute inflam- 188 SIMPLE ULCERATION OF THE UTERUS. mation, which may pass into the chronic form and terminate in the formation of pus ; the abscess may open into the peritoneum and prove fatal, or it may discharge externally ; or, the inflammation may give rise to adhesions and oblite- ration of the canal of the tubes, — thus cutting off all com- munication between the uterus and ovaria, rendering the woman barren. The ovaria are, also, liable to attacks of inflammation which may terminate in softening or abscess. Under these circumstances, there is more or less pain, tenderness and swelling of the side ; and from five to ten quarts of pus have been discharged. The abscess may burst into the peritoneum and prove fatal ; but it more frequently estab- lishes- a communication with the uterus, bladder or rectum, and thus escapes externally. During the acute stage of these attacks, active antiphlo- gistic remedies and fomentations must be employed accord- ing to the severity of the symptoms ; in the chronic form, we should have recourse to counter irritation, the use of iodine internally, etc. — as directed under " inflammation of the uterus." CHAPTER II. SIMPLE ULCERATION OF THE NECK OF THE UTERUS CAUSES, SYMPTOMS AND TREATMENT. There is a chronic inflammation of the neck of the ute- rus followed by simple ulceration, which is much more common than inflammation of the womb generally, des- cribed in the last chapter; though it is not often that the symptoms become so marked as to excite the fears of the patient, till after the ulcerative process has commenced. If an opportunity be afforded at an early period,, of ex- amining with the speculum, a circle of a deep red color, having a puffy feel, with small superficial specks of ulcera- tion, will be observed around the mouth of the uterus. The disease is not confined to any one temperament, but occurs mostly during uterine activity, and more frequently SIMPLE ULCERATION OF THE UTERUS TREATMENT. 189 after sexual commerce has given the uterus additional ir- ritability. The ulceration is mainly confined to the neck, and is often owing to local irritation from shocks to which this part is exposed ; and, as might be expected, prosti- tutes are particularly obnoxious to it. The causes are, local irritations from pessaries, contri- vances to prevent conception, etc. In addition to these, cold taken during menstruation, from insufficient clothing and wet feet ; the improper use of astringent injections ; masturbation, etc., are prominent causes. The symptoms, during the inflammatory stage, are occa- sional shivering, alternating with heat ; a dull pain and weight in the loins and lower part of the pelvis, with itch- ing of the external parts ; and sometimes the abdomen ap- pears swollen. The presence of leucorrhea, especially later in the disease, is not uncommon. The mouth of the uterus is found more open than natu- ral, and tender upon pressure ; marital intercourse is attended with severe pain. All these symptoms are aggra- vated upon the occurrence of ulceration. Upon examination, by passing the finger carefully over the ulcerated surface, a degree of roughness, with depres- sion will be felt, unless it be very superficial'. When the finger is withdrawn it will generally be covered with a yellowish white matter, sometimes streaked with blood. . The disease is distinguished from the corroding ulcer by the limited depth and extent of ulceration, absence of hemorrhages, by the discharge being inodorous and the constitutional symptoms not severe ; whereas, in corrod- ing ulcer, we find an aggravation of all these symptoms. What constitutes the difference between these affections, or whether the conversion of simple ulceration into corro- ding ulcer ever occurs, it is at present impossible to say. This we know, that the former is comparatively of trifling moment, while the latter is of such malignancy as to des- troy a great part of the uterus, despite of all our efforts. It is distinguished from cancer by a comparative mild- ness of all the symptoms. Also, from syphilitic ulcer by the irregular boundaries and rough edges of the latter. Treatment. — During the inflammatory stage, active measures may anticipate ulceration. Cupping the loin?, 9* 190 SIMPLE ULCERATION OF THE UTERUS TREATMENT. or the application of leeches to the vulva, or to the neck of the uterus itself, should be immediately resorted to. This should be followed by hip baths, emollient vaginal injections, and the exhibition of saline laxatives; and when this is done, counter irritation to the sacrum, by blisters, etc. By these means, the swelling and tenderness of the neck may often be lessened. When ulceration has taken place, emollient vaginal injections should first be used; then the milder astrin- gent ones may be tried ; such as sugar of lead, sulphate of zinc, copper, etc. Or astringent ointments may be applied directly to the ulcers by means of the speculum; such as the sugar of lead, etc. If the disease resist milder remedies and have made con- siderable progress, it will be necessary to cauterize the ulcerated surface. This is best done by the use of the Speculum, when the caustic* may be applied to the seat of the disease, without injuring healthy parts. The nitrate of silver, butter of antimony, nitric acid, or caustic iodine may be applied in this manner, great care being taken to limit the application to the parts affected. Some have been very successful in the use of the per-nitrate of mercury, applied by the means of a camel-hair pencil. These medicines judiciously employed rarely fail of giving relief. Occasional bathing will be useful throughout the dis- ease. The bowels must be kept in a soluble condition by mild aperients, without purging. When the general health appears to suffer, the internal exhibition of sarsa- parilla, and other alteratives should not be neglected, though the principal reliance must be placed upon local applications. *])r. Lisfrank hns mentioned the following circumstances as forbidding the us** of caustic : 1. If there be much engorgement of the uterus; 2. If there be HufHcieril inflammation to give rist to pain; 3. The caustic ii not to be applied within four or five duys of the appearance of die menses, nor for three or lour days afterwards. CHAPTER III. PROLAPSUS OF THE UTERUS NATURE — CAUSES — SYMPTOMS AND TREATMENT. The situation of the uterus and its mode of support,, when maintained in the normal condition, are admirably adapted to the functions it has to perform. It possesses four ligaments, which are broad expansions of the peritoneum, fixing it to the sides of the pelvis, which are of necessity elastic, being adapted to the purposes of child-bearing. These very circumstances, though sufficient under the con- ditions designed by nature for retaining it in place, in our present perverted state of existence render it peculiarly liable to displacement. Most, or all of the debilitating causes so often adverted to in this volume, to which females are subject, are concerned in giving rise to a state of sys- tem decidedly favorable for the supervention of this condi- tion. In addition, the uterus is subject to the impulses and pressure of the abdominal and pelvic viscera. The bladder, with which it is so intimately connected, may . exceed its natural fulness and push the uterus backwards ; while the rectum when excessively loaded may act in the same manner in the opposite direction. The vagina, an organ of diversified function, may become relaxed and permit a descent within or through its canal of the prolap- sed womb. Add to these causes the relaxation of the perineal muscles and abdominal walls and the weight, and alteration of position of the uterus, during pregnancy, in- dependently of tumors, and there can be no wonder that the uterus, of all the organs of the body, is most exposed to displacement. It may be thought somewhat out of place to treat of some of the displacements of the womb in this place, they being so intimately connected with pregnancy and partu- rition ; but we think, that the convenience of not separat- ing the discussions on these subjects, more than counter 192 PROLAPSUS OF THE UTERUS NATURE. balance any considerations of this nature, and have preferred to give them all in one view. In this chapter we shall speak of prolapsus of the uterus, which is the most common form of displacement to which the womb is subject. The other forms will be treated of in succeeding chapters. This displacement of the uterus has been designated by various terms : Prolapsus, Procidentia, and "falling down of the womb" are the most common. It consists simply in a depression of the uterus below its natural level in the pelvis. To an adequate understanding of all the circum- stances which may influence this condition, it is important to be acquainted with the natural situation of the womb, and its relation to surrounding organs. See Figs. 2 and 3 with descriptions at page 22 and 27. The uterus is situated nearly in the centre of the cavity of the pelvis, its mouth being from four to six inches from the external parts. Its body is supported by the broad and rounded ligaments, while its neck rests upon the vagina ; so it is evident that this organ cannot descend without a rupture, or extension of its ligaments (the latter takes place) and except by pushing the vagina before it, or by passing itself into the canal of the vagina. Prolapsus may be divided into imperfect and perfect, for the purpose of indicating different degrees of displacement. By the former is signified, that though the uterus has advanced considerably downwards it continues to remain within the cavity of the vagina ; by the latter, that it has descended below the orifice of that canal so as to com- pletely protrude beyond the labia, turning the vagina in- side out. The symptoms- of each differ little, except in intensity. Every degree of prolapsus of the uterus is met with, from those cases in which the mouth of the uterus descends a little lower than its natural situation, to others wherein the mouth of the organ projects th rough the external parts, dragging with it the vagina, and forming a large tumor between the thighs of the woman equal in size to a ki.'ge melon." Tin's will cause an alteration in the relative situation of the parts within the pelvis and of the abdo PROLAPSUS OF THE UTERUS CAUSES 193 minal viscera, both regarding each other, and also, the containing parts, as the parietes of the abdomen and the bones of the pelvis. Tiie bladder instead of being retained in the pelvis, falls down into the external tumor dragging with it the meatus urinarius ; so that in order to introduce a catheter into the bladder, the point of the instrument must be turned towards the knees of the woman. The rectum instead of following the curve of the sacrum, first dips down into the posterior part of the tumor, and after- wards ascends into the pelvis. The Fallopian tubes and ovaria will of course, be dragged down with the uterus, and the centre of the tumor will be filled up by the small intestines which hang down into it (the messentary being stretched) — whilst the omentum will occupy any vacant space which may be left. (Clark.) It occurs in all ranks, and most frequently in females be- yond the middle age, who have borne children. (Churchill.) It has been met with in women who have not borne children, and even in maids. (Capuron.) Dr. Monroe mentions a case which occurred in a child three years of age. Of all the chronic diseases arising from a local cause, to which women in civilized society are liable, prolapsus uteri, or displacement of the womb, 'is perhaps the most frequent. (Hamilton.) Causes. — The immediate causes of this disease are — 1. Relaxation of the broad and round ligaments above. 2. A want of due tone in the vagina below. By the first the uterus is permitted to fall, and by the second the uterus is allowed to be received into the cavity. (Clark.) The relaxation of the muscles at the floor of the pelvis, and of the vagina is probably the more important cause. After repeated leucorrhea, monorrhagia, repeated child- bearing, etc., the levator-ani muscles, and the canal of the vagina, become much debilitated and the walls of the uterus with its ligaments become less resisting than before. Weakness and loss of power of the supporting muscles of the floor of the pelvis, and of the abdomen, in consequence of general debility of the system are unquestionably the most prominent causes. These muscles from their rigidity and contractile powers, are essential aids in keeping the organs of the abdomen and pelvis in their relative position 194 PROLAPSUS OF THE UTERUS— CAUSES. and sustaining them against the contractions at stool during labor, and of the diaphragm above. Every time we breathe, sneeze, cough, etc., the diaphragm is forced downwards, which presses the intestines upon the uterus and bladder; and if the natural supports of these organs be any way weakened it is easy to conceive that their displacement is inevitable. In addition to the causes of prolapsus, incident to a married life, such as increased weight of the uterus in pregnancy, ill-managed labors, walking too soon after delivery or abortion, etc., a prominent place in the list, is due to those causes referred to in almost every chapter of this volume, which exhaust and debilitate the female constitution in early life ; they are defects in physical education ; precocious excitement, physical and mental ; masturbation ; too early marriage ; improper diet, dress, etc., etc. " The mania that exists for precocious education and marriage, causes the years that nature designed for corpo- real development, and corresponding intellectual vigor, to be wasted in the restraints of dress, the school and the ball-room. With a body not half clothed, and a mind intent on pleasure, the hours designed for sleep are per- verted by the midnight revel. * * When one is finished, another in perspective keeps the mind morbidly sensitive to impression, whilst the constant restraint of fashionable dress absolutely forbids the exercise indispensable to the attainment of organic strength. Exposure to midnight air with a- body reeking from the effect of dancing in an overheated room, produces its inevitable effect ; and at last, an early marriage and premature confinement, cap the climax of her misery ; and the unfortunate female, hitherto regardless of the plain dictates of unerring nature, becomes an unwilling subject for medical treatment. " The barbarous corset is a powerful cause of produc- ing the disease. It presses the bowels directly upon the uterus, and prevents a proper and healthful circulation of blood in the lungs ; thus reducing the general health, and causing congestion and leucorrhea. Frequent abortion is likewise a fertile cause ; excessive dancing, and various improprieties heretofore alluded to. Nothing is more ?Tlo. APSUS, 01 IHE UTERDS SYMPTOMS. 195 common amongst those who work in mills and manufac- turing establishments, where the fresh air is shut out, and the body overworked in constrained and awkward posi- tions." Symptoms. — These are sympathetic in the earlier stages, and afterwards mechanical, arising from the displacement of other organs, and the pressure of the prolapsed uterus upon them. Those women of irritable constitutions, who have been tenderly and luxuriously brought up, 4 suffer much even from slight sinking of the uterus; while strong women almost entirely disregard these early inconveniences, and complain but little even when the organ is entirely pro- lapsed, of large size, and ulcerated. Dr. Ashwell, upon this point, remarks : "A lady, wealthy and self-indulgent, from over-exertion in dancing, while the catamenia were present, displaced the uterus very slightly, so slightly that in a day or two it was only just resting on the perineum ; yet she never stirred off the sofa for a month. At the same time, I had under my care a poor woman, earning her living by carrying vegetables on her head to and from market, whose uterus, as large as a good sized melon, was entirely out of the vagina, and ulcerated. She merely wanted to be relieved from the acrimony of the discharge, scarcely complaining at all of the mechanical inconveni- ence of weight and position. Doubtless, relaxation of the organ frequently exists without being recognized, as the early symptoms of lumbar weight and uneasiness, are too common to be soon attributed to displacement. But when these have continued long, nausea^ loss of appetite, constipation and flatulence being added to them, suspicion is excited. It is then found that standing or walking ag- gravates the symptoms, and that the recumbent posture alone gives certain and immediate relief. Aimost constant leucorrhea and occasional stranguary, claim attention. Thus, week after week passes away, and remedy after remedy is tried ; the patient ultimately soliciting an ex- animation, that the disease being accurately made out, something more curative may be tried." Menstruation, though sometimes disturbed, is often regu- lar and rarely complicated with hemorrhage. As long a* 196 PROLAPSUS OF THE UTERUS SYMPTOMS. the uterus is retained in the vagina, there is no impedi- ment to impregnation; cases even, are on record, where impregnation and delivery have been safely effected while the uterus was beyond the vulva. If the womb descend to the external orifice, and espe- cially if it protrude, there is much pain and distress in the pelvic region, and difficulty in voiding the urine and faeces; in some cases, this can only be accomplished by the woman's first lying down and returning the uterus to its natural situation. The recumbent position gives relief from the distressing sensations, but not from the prolapse. The patient is seldom free from leucorrhea, which gradu- ally diminishes her strength. Attacks of menorrhagia occasionally occur, but are rare. The appetite becomes irregular, or is totally lost; the stomach and bowels lose their tone, and become greatly distended with air ; the spirits are depressed ; every em- ployment becomes irksome, and life itself is considered scarcely desirable. There are, however, a variety of shades in the degree of this sympathy. (Clark.) Upon examination, in imperfect prolapsus, the womb can be felt by passing the finger through the vaginal orifice ; its mouth will be discovered at the bottom of the tumor ; and the vagina will be found relaxed, dilated and thrown into folds. If the prolapse be perfect, the uterus will be discovered by separating the labia ; it is usually conical or pear-shaped. The tumor is seldom very large in those cases where the patient, upon lying down, is in the habit of returning it into the pelvis ; but when this is neglected, or not possible, it sometimes attains a very large size. In all cases of prolapse, the mouth of the uterus will be found at the lower part of the tumor; attention to this fact will always serve to distinguish it. If there be any doubt in i\gard to it, from its resemblance to polypus tumors, ire can make sure of its being the mouth of the womb by the careful introduction of a bougie. The protruded • organ will have lying on its anterior wall the bladder, the whole being covered by the everted vagina. Generally, the tumor is firm and elastic to the touch ; it preserves its delicate pink color when frequently returned into the pelvis; but when long exposed to the external air, it bo- PROLAPSUS OF THE UTERUS TREATMENT. 197 comes dark red, or brown. It is peculiarly exposed to irritation and pressure, giving rise to superficial ulceration, forming additional distress to the already severe sufferings of the patient. Such ulcerations have been known to as- sume a gangrenous apppearance, and cases are on record, in which the uterus has been completely separated and came away, and yet the patient recovered. The sack formed behind the prolapsed uterus and vagina often acts as a receptacle for the fluid discharges. Treatment. — When left to nature alone, prolapsus of the womb may soon become quite incurable, for its ten- dency is always to increase, and the chances of success are always more unfavorable as the case is of longer date, the descent greater, and the concomitant circumstances more disadvantageous. As the simple depression of the womb, or prolapsus in the first stage, generally produces but slight inconvenience, it happens that the natural, but unreasonable delicacy of the female makes her fearful of confiding her complaint to the medical attendant, prefer- ing to leave in the hands of nature the care of a malady of whose evil tendencies she is ignorant. There are w t o- men, it is true, who conceal this painful infirmity for years together, and even attain to an advanced age Without any very serious symptoms. And there are others, in whom the- womb cannot be reduced, either in consequence of its hav- ing been delayed so long as to give rise to adhesions, or from its containing within its cavity a foetus of several months, or from other insurmountable obstacles, or such at least as are connected with circumstances that may lead to the sudden death of the patient. This disorder might, per- haps, never compromise the life of the patient, were it not that by neglect the mischief has a tendency to increase and extend — simple depression soon becoming a positive falling, and finally, a complete prolapsus — and for certain complications that always aggravate the prognosis, which of itself is bad enough ; thus, a descent and relaxation of the vagina; a deformity of the pelvis; a dropsy; a state of marasmus ; the presence of a cancer upon the neck of the uterus, or of polypus in the cavity of the womb, or of a foetus ; a stone in the bladder, are so many complications changing the indications of treatment always 10 198 PROLAPSUS OF THE UTERUS TREATMENT. to the disadvantage of the patient, and liable to become fatal, not only by preventing the reduction of the tumor, but, also, by necessitating certain operations and certain peculiar cares. (Colombat.) In the treatment, there are two principal indications : the first is, to replacet he organ in its natural position ; and the second is, to prevent the recurrence of the displace- ment. In the milder cases, we can often succeed by act- ing medicinally upon the mucous membrane : in the se- verer ones, we are obliged to have recourse to mechanical support. In imperfect prolapse, it is generally an easy matter to restore the uterus to its natural position ; all that is neces- sary is, to have the patient lie upon her back, with the pelvis elevated somewhat higher than the head, allowing the abdominal muscles to relax as much as possible. The reduction may be often facilitated by the introduction of two fingers into the vagina, and gently pushing the womb towards its natural place. After the reduction, along with rest in the horizontal posture, providing no signs of inflammation appear, should be prescribed, with a view to the radical cure, the use of cold astringent injections to be repeated two or three times a day, and hygienic means for the restoration of the gene- ral health. The lower part of the abdomen, the genitals and the back may be sponged with cold water, and an injection (a pint) of cold water may be thrown up the vagina morning and evening. The patient should remain in the recumbent position, and receive the injection gently and slowly, by means of an appropriate syringe, or an elastic bottle. Various kinds of astringents have been recommended, all of which should be used with care. The most useful are, the decoction of oak bark, green tea, galls, rind of pomegranite, infusion of roses, etc.; the sul- phate of copper or zinc, (half a drachm to a pint of water,) nitrate of silver, (from one to ten grains to the ounce of water,) alumn, (half a drachm to the ounce,) etc. The improvement of the general health always has a marked and favorable influence upon this affection ; there- fore, our attention in all cases should be carefully directed to it. Aromatic purgatives, with alteratives, tonics, and PROLAPSUS OF THE UTERUS TREATMENT. 199 an appropriate diet, will be useful, and a well directed course of diversion in the country. In complete prolapsus of the uterus, or where it protrudes through the external parts, its reposition is more or less difficult. As preliminary, the patient should empty the bladder and rectum, either spontaneously or by means of the catheter, and common enema. If the uterine tumor be found swollen and painful, as frequently happens, from the action of the air, the urine, and the clothing, emollient poultices should be applied to it, and the swelling may be reduced by fomentations, baths, venesection, dieting, dilu- ent drinks, laxatives, etc., according to circumstances. The parts having been brought into a proper condition and the patient placed as before, the uterus should be gently though firmly pressed upwards by the hand, (pre- viously well oiled,) and when within the vagina, one or two fingers should be introduced in order to push the womb into the cavity of the pelvis. Should there be considerable difficulty in the reduction, all efforts ought to be suspended till there is some diminu- tion in the sensibility and size of the tumor ; this may be brought about by prolonged rest in the horizontal posture and a continued application of the remedies above men- tioned. No matter how severe or of how long standing, all hopes of reduction should not be soon renounced ; yet it should be remembered that there may be cases in which it is impossible, and that ill-advised and severe efforts have brought on fatal inflammation. If reiterated efforts should render it evidently impossi- ble to restore the womb to its proper place, we must be content with giving due support to the tumor, by means of a proper suspensory bandage, which should be anointed with cerate ; a bandage of oiled silk, doubled, seems best to answer this purpose. Should an irreducible prolapsed uterus be attacked by extensive gangrene and sloughing, the propriety of amputating the womb at the neck, must be decided upon, which, though a formidable operation, has been safely performed. The circumscribed ulceration which frequently takes place, should be treated by emol- lient poultices and astringent applications. When prolapsus takes place at an advanced stage of 200 PROLAPSUS OF THE UTERUS— -TREATMENT. pregnancy, the reduction should, nevertheless, be attempt- ed as before ; it may be easily effected at an early stage. The bladder and rectum should be evacuated as before directed, and it must not be forgotten that the introduction of the catheter is frequently no easy matter, from the dis- tortion of the parts ; in some cases, recourse must be had to the male catheter, as the female instrument will not at all answer the purpose. When pregnancy is so far ad- vanced as to render such attempts imprudent, all we can do is to give proper support to the womb, by means of a -suspensoiy bandage, and advise the patient to observe the horizontal posture, in bed ; and when her full period has arrived, the delivery of the child should be facilitated, by sustaining the prolapsed organ, and assisting the dilatation of the mouth of the uterus. After the child is born the reduction may be easily effected. There is one important point which it is necessary for pregnant females afflicted with this malady to understand. The prolapsed womb, from its pressure on the bladder, almost always gives rise to suppression of the urine ; this may be^obviated by passing up a finger behind the symphy- sis bubis, and pushing back the womb so as to relieve the urethra and bladder of such pressure. We have now spoken of the mode of reducing prolapsus of the uterus under different circumstances; there always yet remains an indication, that of retaining the womb in its proper position, by the use of pessaries ; which are of different shapes, dimensions and materials. Where the affection is recent, this supporting instrument is not abso- lutely indispensable, but it is for the most part so, when the woman is of a large size, and the disorder is of long standing or considerably advanced. Pessaries of various kinds are used, either of sponge, glass, cork, boxwood, ivory, gold, silver, or of gum elastic. Those in common use are flat, round, oval, or globular, with a hole in the centre, to allow the escape of any dis- charge. The best, are probably the globe, and flat or rath- er, the disc-like, pessaries made very light, either of gold or silver washed with gold. The glass pessary sometimes answers a very good purpose. "A good pessary, 5 ' remarks Dr. Clark, " should combine firmness, lightness, and close- PROLAPSUS OF THE UTER r JS — TREATMENT. 201 ness of texture : firmness, that it may not yield to pres- sure ; lightness, that it may not incommode by weight ; and closeness of texture, that it may not imbibe the secre- tions of the vagina." The mode of introducing a pessary is very simple. After the evacuation of the bladder and rectum, as previ- ously directed, the patient should lie upon her left side, with the knees drawn up, and a pillow between them. The pessary should be dipped in olive oil, and pressed against the external mouth with a gentle force, occasionally sus- pended, so as to give time for the vagina to dilate. Some time should be required to place it at the mouth of the uterus, for if it enter too readily, or with too little force, it is liable to be expelled at the first bearing down in evacu- ating the rectum or bladder. It would be well for the female, awhile after the introduction, not to go out with- out the ?iapkin, lest in some sudden fit of coughing, sneez- ing, or laughter, the instrument might be forced from its place, to her mortification and dismay. The irritation excited by the introduction of a pessary should be counteracted by rest, diet, baths, enemata, emol- lient and opiate injections ; if these be not sufficient, the instrument should be temporarily suspended. Women should remember that the presence of such an instrument in the vagina requires the most scrupulous attention to cleanliness. They should bathe frequently, and have recourse to the daily use of vaginal injections of cold wa- ter. It should be withdrawn once in three or six months, or if there be much discharge, once in two or four weeks will not be too often. When from any cause, pessaries cannot be made use of, there are other resources, the principal of which, is the use of some one of the numerous patterns of utero- abdominal supporters, sold in almost every village through- out the Union. An operation has been proposed for the permanent cure of this affection, which resembles the one adopted for prolapsus of the anus.' It consists in removing a portion of the vaginal mucous membrane, and uniting the opposite edges of the wound, so that when healed, the calibre of the canal shall be diminished. We should remark that the plan of treatment, by rest in 202 INVERSION OF THE UTERUS. the horizontal posture very long continued, is apt to exhaust the muscular force of the patient, and thus prove an injury instead of being a benefit. In slight cases of prolapse, a method calculated to invigorate the general health, would be far more likely to produce a cure, than dependence upon a pessary, which is, perhaps indispen- sable at an advanced stage. Hence, such patients should take exercise in the open air, live upon a nutritious diet, with wine and malt liquor ; avoiding all depressing and injurious circumstances, disregarding as much as possible the annoying sensations proceeding from the prolapsus ; tonics and aperient enemata may also be necessary, as well as vaginal injections of astringent solutions ; and when the general health improves, the local disorder will generally lessen, and finally disappear. Some authors have recommended a subsequent preg- nancy, as a means of obtaining a radical cure of this malady ; and indeed, women are frequently restored to perfect health by it, who have been much distressed by prolapsus of the uterus for several years. i \ CHAPTER IV. INVERSION OV THE UTERUS — CAUSES — SYMPTOMS AND TREAT- MENT. Inversion of the uterus differs widely from prolapse ; for, while the organ is equally depressed in both cases, in the former, the womb is turned inside out ; the fundus losing its position, sinks perpendicularly inwards and down- wards, till it passes through the mouth, forming a tumor between the thighs; while in prolapsus the mouth is always at the lower part of the tumor. The ovaries, Fallopian tubes and intestines occupy the space formerly filled by the womb, and the sack is lined internally, by peritoneum, while it is covered externally, by the mucous membrane of the uterus. Inversion is the most dangerous of the uterine displace- ments, but happily the most rare. Writers have recog- INVERSION OF THE UTERUS CAUSES. 203 nised three varieties of the disease. A simple depression which takes place when the top or fundus of the womb is somewhat indented like the bottom of a glass bottle. 2. Incomplete inversion, when the uterus has descended into the vagina. 3. Complete inversion, where the uterus protrudes externally with the mouth above, and the fun- dus below. Authors have also divided the malady into acute and chronic. Causes — These are mostly connected with child-birth. It has* been observed to follow very quick labors, espe- cially if the patient be delivered standing, or make too violent efforts : or, it may occur after a natural labor, as the result of a peculiar condition of the uterine fibre. The most common causes are violent extraction of the placenta ; forcible pulling of the cord, while the placenta is still attached to the womb, and the pressure of the intestines upon the fundus at the same time ; prolonged efforts at bearing down, with the view of more speedily expelling the placenta ; and shortness of the cord, or its being twisted around the child's head or body. This affection may also arise from, or follow dropsy of the womb ; the walls being relaxed, thin and weakened, yield readily to the impulsion of the bowels by'the contrac- tion of the diaphragm, and of the abdominal muscles. A large tumor of the fundus may, by its weight, descend through the mouth of the uterus, dragging the fundus along with it, and thus producing complete inversion. Symptoms. — These are always serious and alarming, indicating the important nature of the accident. Immedi- ately after the inversion there is sudden exhaustion and sinking ; the countenance becomes deadly pale, the voice weak, the pulse rapid, small and fluttering, accompanied with nausea, vomiting, and the patient is threatened with the immediate loss of life. These symptoms often depend upon the loss of blood which takes place, but not always. There are sometimes nervous symptoms, and even con- vulsions. Hemorrhage to a very large amount not un frequently occurs ; violent uterine contraction almost always takes place, immediately preceding, or accompanying the inver- 204 INVERSION OF THE UTERUS TREATMENT. sion ; there is also great pain, with a dragging sensation from the loins, and occasional retention of urine. Upon examination per vaginam, a tumor will be found either in the cavity of the pelvis, or hanging through the vulva. This tumor will be globular, and possess a rough bleeding surface. If the displacement be not reducible, it sometimes happens that the tumor becomes strangulated, running on to gangrene, and ending in the death of the patient. If the inversion be complete, we may acquire further information from a visual examination ; the tumor is at first red, but gradually becomes of a dull brown. The foregoing are the most prominent symptoms of acute inversion ; those which characterise the chronic stage of the disease, are of course much less formidable. Inversion is easily distinguished from prolapsus of the uterus : in the former there is no mouth of the uterus infe- riorly, but a rough and bleeding surface. As we have before intimated, inversion of the womb is a dangerous accident, that may prove speedily fatal, if there be the least delay attending its reposition. Not- withstanding some women have been known to live a long time with a complete inversion, unreduced, it generally happens that the few who do survive, drag out a misera- ble existence, and perish at last from profuse leucorrhea and repeated attacks of flooding. The reposition of the inverted organ becomes more and more difficult the longer it is delayed, and often becomes wholly impossible. There are examples, however, going to show that the re- Sosition has been performed as late as the fifth and eighth ays, and even much later ; also, the organ after being long inverted has been known to reduce itself spontane- ously. Treatment. — The first object should be to reduce the displaced organ instantly ; and if it be attempted as soon as the accident occurs, it is in general not very difficult. Every hour increases the difficulty ; and the lapse of four or five days may render it impossible ; though there is a great difference, according as the inversion is complete or incomplete. It has been spontaneously reduced even when the displacement was complete. But no anticipation of such a result will justify our INVERSION OF THE UTERUS TREATMENT. 205 losing a moment in attempting to replace the uterus. The fundus of the protruded uterus should be indented, and passed in through the vaginal orifice, follwed by the hand, (previously well oiled) in the form of a cone, up through the neck and mouth of the uterus; the hand should be made to press mainly upon the fundus of the organ, and should not be withdrawn till the vagina shall have been put upon the stretch, when, if still further pressed it some- times suddenly starts from the hand like an india-rubber bottle when turned inside out, and the organ is restored to its natural position. The hand, which is now in the cavity of the uterus, should not be withdrawn, but be allowed to-be expelled by the uterine contraction; we should first, however, be sure that the restoration is com- plete. When the placenta remains attached to the womb at the period of inversion, it will often be found impossible to reduce the uterus, until it is removed; this should be done bv pealing it off with the fingers, acting from the edges towards the centre. When the tumor is in danger of strangulation, from powerful contraction of the neck of the uterus, it has been recommended to divide it with a bistoury. Unless the reduction be attempted at the mo- ment the accident occurs, the bladder and rectum should be previously evacuated. If the inverted womb and the neighboring parts should be much swollen, or if the patient be feverish, it may be necessary to apply leeches and poultices or foment the parts before attempting the reduc- tion. Notwithstanding the disease be of seme days standing, we should not look upon the reduction as hopeless ; no means likely to effect so desirable an object, should be left untried, as attempts have been successful, after days and even weeks have elapsed. It should be remembered, however, that there is a point, beyond which, a continu- ance of the attempts would only be injurious to the patient by aggravating all the symptoms. Sometimes it happens that the inflammation may be resolved by palliating the distress of the patient, and the organ remains irreducible without giving her any great inconvenience. After we succeed in restoring the uterus to its natural 206 RETROVERSION AND ANTEVERSIOX. action, great care is requisite to avoid a recurrence of the accident. The patient should remain for some time in the horizontal position, with the pelvis elevated, the knees bent and the head low. Opium should be administered, and stimulants, according to circumstances. When reduction cannot be effected, and the disease runs on to gangrene, the suppuration should be promoted and the symptoms allayed by emollient fomentation and injec- tions of cinchana, camphor, chloride of soda, and tonics, internally. But should the symptoms be so severe as to greatly endanger life, the womb may be removed, either by the ligature, or direct amputation. The operation by ligature is most often preferred,' and consists in applying a cord, (silk is preferable) or silver wire, around the tumor at the highest part, and gradually tightening as the patient may be able to bear it, until the tumor is entirely detached. Or two ligatures may be used, passed through the centre of the neck of the tumor, each one including half. The pain, nausea and vomiting must be treated with sedatives, and when violent, the liga- ture should be temporarily loosened. The strength of the patient must be maintained by a nutricious, though not stimulating diet. We need not remark that this is a dangerous operation, and should not be resorted to on slight occasions. We should observe that when inversion is complicated with polypus, the latter must first be treated as elsewhere directed. (See that chapter.) CHAPTER V. RETROVERSION AND ANTEVERSION OF THE UTERUS CAUSES, SYMPTOMS AND TREATMENT. The terms retroversion and anteversion, have been applied to those cases in which the fundus of the uterus has been found displaced posteriorly and anteriorly. As the causes, symptoms and treatment of these two displace- RETROVERSION AND ANTEVERSION CAUSES. 207 rnents are very nearly the same, we have thought best to speak of them under one head. In retroversion of the womb, the fundus is earned to- wards, and lodged in the hollow of the sacrum, while the mouth is brought forwards, and upwards behind the gym- is pubis. In anteversion, the fundus is directed towards the symphysis pubis, and the mouth towards the sacrum. The former is frequent, while the latter is much more rare. Retroversion is most frequently met with in pregnant women ; anteversion, on the other hand, is rare in preg- nancy, and is not very frequent in the unimpregnated ute- rus, though both diseases may occur at any age of female life after puberty. Causes. — The causes that predispose to gradual dis- placements, are a natural mobility of the womb, a certain smallnessof the pelvis, or a largeness of the same, a deep curvature of the sacrum, and the pressure of the bowels upon the fundus, and upon one of the sides of the Where the retroversion takes place suddenly, it is caused by over-distention of the bladder with urine ; vio- lent and sudden contraction of the abdominal muscles and diaphragm, from vomiting, or the expulsion 'of the urine and feces ; external violence, as a fall, a blow, and sud- den fright, causing a violent convulsive movement of the diaphragm. A woman who allows her bladder to become enormous- ly distended, will render herself liable to retroversion during its continuance, especially if she happen to be engaged in a fit of laughter, sneezing or coughing. A jump from a carriage step, or a chair, or a trip on the pavement, while the womb is pushed backwards by the full bladder, may suddenly and even instantly jam the uterus under the promontory of the sacrum, which is fol- lowed by bearing down efforts, every repetition of which aggravates the mischief. If the woman be unimpregnated, perhaps she will empty the bladder, and the womb raised upwards again by its ligaments is not suspected to have been retroverted ; but if she be pregnant, at two and a half or three and a half months, and the fundus be once jammed below the promontory, it will probably remain 208 RETROVERSION AND ANTEVERSION SYMPTOMS, there, even after the bladder shall have been perfectly emptied by the catheter. Let a woman, two and a half months gone, get into a stage or rail car, having neglected to evacuate the bladder beforehand, if she get off on her ride with eight or twelve ounces in the organ, and is pre- vented for some hours from relieving herself, she will hardly reach her journey's end without having retrover- sion ; arid when she attempts to relieve the bladder, is found to labor under a total suppression of urine, or at least, a most painful dysuria. (Meigs.) The causes of anteversion, are increased weight of the fundus of the uterus in consequence of an engorgement ; constipation, giving rise to large collections in the rectum ; painful labor ; vomiting ; great fatigue and violent shocks. The mechanism of anteversionof the womb is extremely simple ; if the bladder be empty, and a sudden expulsive force exerted at the same time, it may be easily tilted over anteriorly, especially if it be increased in weight from thickening of its walls, or its ligaments have been relaxed by frequent child-bearing; the process is much assisted, also, by accumulations in the rectum. Symptoms. — From the size of the uterus after the fourth month, it follows that neither of these displacements can occur after that period ; but when retroversion has already existed for some time, the rectum, the neck of the bladder, and the urethra, must be compressed, giving rise to reten- tion of the faeces and urine ; the wonlb, also, being con- fined within the hollow of the sacrum, as it enlarges, be- comes engorged and inflamed. The severity of the symptoms depend upon whether these displacements take place suddenly or gradually. Supposing the womb to be non-gravid, and the cavity of the pelvis of the ordinary dimensions, if the displacement take place gradually, the patient begins to feel an incon- venient sense of pressure within the pelvis ; then the groins, the loins, and thighs are affected little by little with dragging pains, which become more and more annoying. To these symptoms, there is always added a sense of pres- sure or weight at the bladder and rectum, giving rise to frequent desire to urinate and go to stool. During the flow of the urine, the jet is soon checked or suddenly ar- RETROVERSION AND ANTEVERSION SYMPTOMS. 209 rested, and as the displacement always increases in pro- portion to the efforts made to expel the urine and fasces, the symptoms are greatly augmented in intensity by those attempts. At length, a complete suppression of urine and stool is produced. In cases where the size of the womb is augmented by pregnancy or engorgement of the organ, the symptoms are less equivocal, the constipation and sup- pression of urine become complete in a very short time ; this is most likely to happen between the third and fourth months of pregnancy. However, cases are related by authors, in which it has taken place at the fifth, and even the seventh month. It is easy to understand why the displacement of the uterus in pregnant women, is more rapid in its progress, and followed by severer consequences, than in the unim- pregnated. When retroversion happens in a pregnant woman, the orifice of the urethra is carried so far behind the pubes, that it becomes difficult to find the meatus, and the urethra is so forcibly pressed against the bone that it is often impossible to pass up a catheter, even a flat one. The escape of the urine which occasionally takes place in jets, is in most cases completely suppressed, so that the distention of the bladder has taken place to the extent of bursting the organ. The rectum, also, is so much compressed that the small- est portion of faecal matter cannot escape through the in- testine ; and the patient is unable to receive enemata. Coincidentally with these symptoms, there is found a pain- ful tumefaction of the external genitals; and in perform- ing the touch per vaginam, the womb is found higher up than usual, the anterior wall, of the vagina being very tense, while the posterior one is relaxed, and even thrown into folds. The size of the womb continuing to increase with the progress of the pregnancy, it is soon attacked with inflam- mation ; the organ being now locked between the sacrum and pubis is so powerfully compressed, in some instances, that after death it cannot be extricated without dividing the pubis. In these cases, the inflammation extends along the peritoneum to the bladder, and death has followed either from these extensive inflammations, or from the mpture of J* 210 RETROVERSION AND ANTE VERSION TREATMENT. the uterus itself, or the giving way of the bladder. In rare cases, however, even where the patient has been abandoned to nature alone, the womb has spontaneously reposited itself, all the symptoms disappearing, and preg- nancy has gone on to its full term. Retroversion and anteversion are to be distinguished from other affections of these parts by the characteristic symptoms before named, retention of urine, and of the fe- ces. They are to be distinguished from each other, upon examination, by the position of che mouth of the uterus ; in the former, it will be anteriorly ; in the latter, it will be posteriorly. Sometimes, the diagnosis is attended with difficulty, and the greatest care and precision is necessary in analysing all the symptoms. Treatment.— -When the case of displacement is one of long standing, before attempting the reposition, we should endeavor to remove the inflammatory symptoms by means, when it is indicated, of general and local blood-letting ; by hip-bathing ; fomentations ; and mucilaginous injec- tions. By the judicious employment of antiphlogistics, we are often enabled to effect the reduction of cases, in which all preceding attempts had failed. As preliminary to the reposition, we should evacuate the rectum and bladcler, when it is possible to do this ; enemata and supposatories should be resorted to for the former purpose, and the catheter for the latter ; the flat catheter, under these circumstances, is preferable. An- other mode should be tried, viz : by raising up the mouth of the uterus. After these means having been success- fully applied, the organ has in many cases resumed its natural position ; and particularly after the evacuation of the contents of the uterus. Some authors have recom- mended, when these means fail, for relieving the bladder, that it should be punctured below the pubes. To reduce the womb, the patient should lie upon the back with the thighs at right angles with the body, so as to relax the abdominal muscles. An attempt should then be made to restore the mouth of the uterus, with one or two fingers bent into a hook shape, whether it be anteriorly or poste- riorly. If this measure fail, let two fingers of one hand be carried into the rectum, in order to push up the fundus, RETROVERSION AND ANTEVERSION TREATMENT 211 while with one or two fingers of the other hand j assed into the vagina, we try to pull the neck downwards. When the mouth of the uterus is high up, there is an advantage in the use of the spoon-like hook. When these attempts fail, success is often obtained by letting the patient place herself upon her knees and elbows, instead of the other position, by which the pressure of the abdominal viscera is less upon the rectum. ' Another plan has been recommended, that of introducing tne whole hand into the rectum, and then push up the fun- dus of the womb, which should be assisted by a couple of fingers within the vagina, to act at the same time upon the neck ; or a strong catheter, flattened at its extremity, may be passed into the bladder, to be used as a lever in depressing the mouth of the uterus. Still another means has been recommeded, viz : the in- troduction of a bladder into the vagina, and its inflation by means of a stomach pump with an air tight piston. It is very rare that no one of these means succeeds. The general and local irritation that arises from these attempts, should be treated by rest, antiphlogistics, and opiates. After the reduction has been effected, to prevent a relapse, the woman should keep herself in a horizontal- posture for several weeks, or months, according to circum- stances, to be followed by river or sea bathing and a gene- ral system of hygiene. If there be any disposition to a return of the retroversion, the patient should place herself on her knees and elbows, once or twice a day, and remain for an hour or more at a time ; she should avoid constipa- tion, and never suffer the accumulation of urine in the bladder to any extent. Pessaries have, also, been recom- mended, particularly in ante version. Lastly, when attempts at reduction fail in pregnant women, it has been recommended to pass a sound through the mouth of the uterus, (if possible,) for the purpose of inducing abortion ; this is sometimes the last hope of safety for the female. When the sound cannot be introduced, a trocar may be plunged into the uterus, through the vagina or rectum, so as to discharge the waters of the ovum, and thus excite abortion. This operation has been performed with success at the sixth month, thus saving the life of the mother. CHAPTER VI. OTHER DISPLACEMENTS OF THE UTERUS, AND OVARIA, OF THE BLADDER AND URETHSA, OF THE VAGINA, AND OF THE RECTUM CAUSES SYMPTOMS AND TREATMENT. Some authors have noticed other displacements, of which we shall speak but briefly, as they are mostly of rare oc- curence, and often connected with those already described. RETROFLEXION AND ANTEFLEXION OR CURVATURE OF THE UTERUS. These have hitherto attracted but little attention from either writers or practitioners of medicine, on account of their having been confounded with other displacements. Where the curvature is a retroflexion, the neck retains its natural position, while the fundus of the uterus is turn- ed backwards into the hollow of the sacrum, like unto what occurs in retroversion. In anteflexion, the fundus is inclined forwards, behind the symphysis pubis, similar to what happens in anteversion; but the neck, as in the for- mer case, retains its natural position. Sometimes the body and neck are directed towards the same point, while the fundus preserves its natural situation. Curvature of the womb is said to be sometimes congeni- tal, when one side of the organ is more completely develop- ed than the other. But the general causes, symptoms and treatment, differ very little from those of retroversion and anteversion. While, on the one hand, sterility may depend upon this condition, so a pregnancy, on the other hand, may bring about a speedy and permanent cure. As soon as the delivery is completed, to prevent a relapse, we should hasten to procure a perfect contraction of the womb, now restored to its natural position, by means of frictions over the organ, and by preventing too great an accumulation of OTHER DISPLACEMENTS OBLIQUITY. 213 the uterine and feces. The woman should lie with the pelvis higher than the shoulders. INCLINATION AND OBLIQUITY OF THE UTERUS. By inclination, is meant where the womb leans in any direction ; when it inclines backwards or forwards, it may be regarded as the first stage of retroversion or antever- sion. When it leans to one side, it is a lateroversion, and in such a state, the neck of the womb, which rises higher than its natural level, inclines its orifice towards one of the sides of the vagina, and the patient has in various degrees the symptoms of anteversion. When the inclinations occur during pregnancy, they are known as obliquity of the womb ; they can only take place to the sides and the front, distinguished into right lateral, left lateral, and anterior obliquity; a posterior obliquity cannot occur in a well- formed woman. Obliquities may be ascertained to exist by the projec- tions, and resistance of the neck of the uterus against the abdominal walls. In the anterior obliquity, the fundus is directed forwards, and the mouth of the uterus against the sacrum. The inclination increases with successive preg- nancies ; in some women it is so great, that the abdomen falls down over the external genital organs, sometimes covering the thighs. It is the one most frequently met with, and is caused by relaxation from de'bility of the abdo- minal walls ; deformity of the spinal column ; the accu- mulation of feces in the colon ; and, finally, by any thing capable of inclining the womb fprwards. The lateral obliquity forms a prominence at one side of the abdomen, the mouth of the uterus being directed to- wards the opposite side. The right lateral obliquity is much more frequent than the left, and besides the faulty direction of the pelvis has been assigned to a variety of causes, such as shortness of one of the uterine ligaments ; the habit of sleeping always on one side, particularly the right one ; and, finally, the existence of a tumor in the abdomen or one of the ovaries. While the inclinations of the uterus thai take place in the unimpregnated stute are of but little consequence, 10* 214 OTHER DISPLACEMENTS ELEVATION, ETC. those that occur during pregnancy are of importance, as they are a prominent cause of difficult parturition. Cer- tain inconveniences during gestation may be remedied by means of a suspensory bandage to the abdomen. Asa measure for obviating barrenness, which might arise from a continued obliquity of the uterus, the female should lie on the side opposed to the inclination of the neck, durante coitu ; and the same precaution should be taken during the conduct of a labor. When this is insufficient its reduc- tion should be attempted as directed for retroversion and anteversion. ELEVATION OF THE UTERUS. This sometimes takes place to such an extent, that the mouth becomes almost inaccessible to the touch, and its pos- terior surface wholly so from the rectum. This condition, which is rare in the unimpregnated state, may arise from an insufficiency of the ligaments, abscess of the ligaments, dropsy of the ovaria, extra uterine pregnancy, retrover- sion and anteversion, and hydatids or other foreign bodies of the uterus. It is, also, the normal effect of pregnancy from the fourth to the eighth month. Of course it requires no treatment excepting that which is applicable to the dis- orders of which it is a symptom. When the elevated state of the uterus is a permanent one, it may act as a cause of barrenness. ABNORMAL IMMOBILITY OF THE UTERUS. This, in addition to the obstruction it causes to the pro- per dilatation of the bladder and rectum, prevents the rising of the womb from the cavity of the pelvis during pregnancy. Among the causes, may be mentioned adhesions that follow attacks of peritonitis, and inflammation of neighboring or- gans, which is the principal one. Tt has been remarked that scrofulous women, and those of a lymphatic tempera- ment, those girls who abandon themselves to habits of mas- turbation, and those who are subject to constipation, are more liable than others to unnatural adhesions. OTHER DISPLACEMENTS IMMOBILITY HERNIA. 215 Although sterility, that is often caused by adhesions of the Fallopian tubes, is to be regarded as a misfortune, conception, in such a condition, is a vastly more serious one, since it may give rise to the most important symptoms by originating a new inflammation, caused by stretching of the ligaments of the expanding womb, as it continues to rise higher and higher during the pregnancy. This gives the woman violent pain, and dragging in the pelvis, and a feeling of lassitude in the thighs. Abscesses often form in the vagina and rectum, and in most cases, the death of the patient, which is inevitable, is preceded by abortion, which may be expected about the third or fourth month, upon some attack of violent uterine inflam- mation, or profuse hemorrhage. (Colombat.) Similar accidental causes may, also, produce adhesions during pregnancy,, when the womb is very high up in the abdomen, sometimes giving rise, at parturition, to the most lamentable results, on account of the laceration of the adhesions. HERNIA OF THE UTERUS. This is a very rare affection. The principal signs of its existence are the following : the vagina is stretched, and curved towards one of the groins ; the mouth of the uterus, which is very high up in the pelvis, is pointed towards the sacrum, or disappears by having been lodged within the hernial tumor. The tumor is hard, form round- ish, and is very little reducible. There are three kinds of this affection : called Inguinal, when the tumor makes its appearance in the groin ; Crural, when it appears down on the thigh ; and Ventral, when it takes place in the graved uterus, through an accidental separation of the abdominal muscles. The causes may be attributed to weakness or relaxation of the ligaments of the womb, and of the abdominal muscles; to a violent blow, or contusion, etc. The reduction, which should be promptly attempted, with great care, cannot be effected, except the hernia be a recent one, or without ad- hesions, and of small size. A relapse should be prevent 216 OTHER DISPLACEMENTS — OF THE OVARIA. ed, after the reduction, by a large compress, supported by a bandage, or a common truss. HERNIA AND DISPLACEMENT OF THE OVARIA. These sometimes occur, though the former is extreme- ly rare ; notwithstanding, six kinds have been described by authors, according to the situation of the protrusion : 1. The Inguinal, when the tumor appears in the groin. 2. The Crural, when it appears upon the thigh. 3. The Ischiatic, when it appears near the loins. 4. The Umbili- cal, when the protrusion takes place at the navel. 5. The Ventral, when it occurs through the abdominal muscles. 6. The Vaginal, or vagino- rectal, when it takes place in- to those organs. Cases have been met with on one side alone, and on both sides at the same time. The causes are, the predisposing, and exciting. The former are dropsy of the abdomen ; sudden emaciation ; immoderate use of warm relaxing drinks; and various displacements of the womb. The exciting causes of ova- rian hernia are, circular compression just above the hips, either by badly constructed corsets, or a belt ; wounds and abscesses of those regions. In infancy, it may arise from the careless application of bandages for the support of the navel ; loud crying, continued for a long time, etc. The symptoms are about the same as those connected with hernia of the uterus ; the most distinctive sign is, the correspondence of motions impressed upon the uterus, by the finger introduced into the vagina or rectum, with those which are felt in the tumor itself, by the patient or practi- tioner. It is probable that assistance might be derived from the monthly increase of the tumor, if observed at the menstrual period. Treatment. — An attempt should be made as soon as possible to reduce the hernia, though it will often fail. If there be symptoms of strangulation, recourse must be had to the operation for strangulated hernia ; after the strangu- lation is relieved, if compatible with gentle pressure, the ovary should be returned into the abdomen — otherwise, a compress and bandage need only be applied, without inter- fering with the displacement. OTHER DISPLACEMENTS OF THE BLADDER. 217 The displacements to which the ovaria are obnoxious, are mostly connected with those of the uterus, and con- sequently surpassed by a greater evil ; the more serious ones are congenital. displacement of the bladder. This may occur in various directions ; its protrusion in- to the vagina and external labia, will only be noticed here, its other displacements not being peculiar to females. By referring to Fig. 2, Book I., and observing the connection of the vagina and bladder, it will be easy to understand the mechanism of hernia of the bladder into the vagina ; the urinary sac being pushed against the anterior wall of the vagina by a sudden descent of the diaphragm and vio- lent contraction of the abdominal muscles, gives rise to a fluctuating tumor, that projects within the vagina, or even appears at the external labia. The 'predisposing causes are, too large a pelvis ; nu- merous pregnancies ; a lymphatic temperament ; an erect position too frequent and too long continued ; too violent exertion of the muscular powers ; leucorrhea ; retention of Urine, and the habit of discharging it too seldom ; abusus coitus; an abuse of warm bathing; foot-warmers; tight lacing, and the use of busks; general debility; and a pe- culiar conformation. The principal exciting causes are, parturition ; violent exertions ; tight lacing ; coughing, vomiting, violent dancing, etc. It is more common in women who have borne children. It is known by a tumor presenting itself either within the canal of the vagina, or outside of the orifice of the vulva. The tumor is blueish, rounded with a polished surface when the bladder is distended; otherwise, it is uneven, wrinkled and soft. In the former case, it is fluc- tuating, and disappears upon pressure. Long standing, and violent exercise increases its size, while rest diminish- es it. This affection produces difficult and painful mictu- rition, and sometimes a tense and enlarged abdomen ; sleeplessness and dragging of the stomach, etc. It is fre- quently complicated with various inflammations and dis- placements of the uterus. When it occurs in a pregnant 218 OTHER DISPLACEMENTS URETHRA BOWELS. woman, it may become so large as to obstruct the passage of the foetus. Treatment. — After the employment of antiphlogistics, if indicated, there presents two indications : to reduce, the tumor, and prevent future displacement. When the her- nia is small it may be easily restrained by means of a sponge cut into a cylindrical shape, or a sachet of fine linen ; the former to be impregnated with some astringent solution, and the latter filled with oak bark, soaked also in some astringent solution, and retained in place by means of a bandage. When the tumor is large, the treatment should be commenced by the introduction of the catheter — a male catheter; if this be not successful, and particularly if the patient be in labor, it will be necessary to plunge a trocar into the tumor ; when the urine is discharged a catheter may be left in the bladder. We should remark that upon first using the catheter without success, the tumor must be compressed, so as to compel the urine to flow towards the open end of the instrument. PROLAPSUS OF THE MUCOUS MEMBRANE OF THE URETHRA. This is a very rare disorder, which it is only necessary to notice. It is owing to a relaxed and thickened state of this membrane, and is known by a small redish tumor projecting from the orifice of the meatus urinarius. DISPLACEMENT OF THE INTESTINES INTO THE VAGINA. This sometimes takes place. The predisposing causes are partly the same as those of other hernias, repeated preg- nancy and delivery, etc. The exciting causes are, also, about the same, and may act in a slow and gradual man- ner : they are, falls, violent efforts of any kind, at stool, etc. This affection exhibits all the general characters of the other kinds of hernia. The tumor, which is not trouble- some unless very large, is of a soft consistence, and par- tially or wholly disappears when the patient lies down. Upon examination, the mouth of the uterus is found free and in its natural position ; this will distinguish it from most other tumors of the vagina. OTHER DISPLACEMENTS OF THE VAGINA. 219 In the treatment, the reduction must be effected if possible. The rectum should be evacuated with injections, and the woman placed with the legs drawn up, and the pelvis elevated. When successful, the hernia should be kept reduced, by a cylindrical pessary. If strangulation take place, it has been recommended to cut down upon the tumor and dilate the opening. Sometimes the intestine finds its way down into the labia, when the management is similar. — prolapsus of the vagina. By this is meant an inversion of the internal lining membrane of the organ. It is divided into complete and incomplete ; in the former, the tumor projects more or less beyond the vulva, while in the latter case, it merely ap- pears within the mouth of the vagina. The predisposing causes are, a lymphatic temperament ; chronic leucorrhea ; frequent child-bearing or abortion ; the abuse of hot-bathing, and of warm, relaxing drinks ; bad nutrition and all the causes of a debilitated body. Among the direct causes, should be enumerated abusus coitus; masturbation; injury from the child's head and instruments during labor ; external violence ; violent* efforts of every kind ; leaping, laughing, vomiting, etc. Symptoms. — In a partial prolapsus, the tumor is round- ed, double, or forms a circular cushion, varying accord- ing as the descent implicates both the anterior and posterior walls, or extends to the whole surface of the tube. There is a feeling of weight and uneasiness about the vagina and fundament; and dragging sensations in the lumbar region. When the falling is complete, there is a puru- lent discharge, obstinate constipation, and stranguary of urine. The action of the urine upon the surface of the tumor, and friction in walking, often produce painful in- flammation and excoriations. This affection is very troublesome, and may become even dangerous during labor ; though the prognosis, gene- rally, is not bad. Treatment. — This consists in incomplete prolapsus, in the use of antiphlogistics, local fomentations, and poultices, 220 OTHER DISPLACEMENTS VAGINA RECTUM. to be continued till the inflammatory symptoms are over- come ; then, tonics, if the constitution require them, and astringent lotions and injections. Recourse may, also, be had to counter irritation to the loins with advantage. In complete falling, after a preliminary antiphlogistic treatment, the reduction should be effected as soon as pos- sible; then, should be employed tonics internally, and astringent lotions and injections, as above directed ; also, the introduction of sponges, impregnated with astringent solutions, or by sachets filled with proper ingredients. It is said that pessaries, also, may be used with advantage. A well regulated system of hygiene, with tonics and mine- ral waters, should be put in requisition for the restoration of the patient. When the disorder is of long standing and the tumor irreducible, its extirpation by means of the scissors and knife, has been recommended. INVAGINATION OF THE VAGINA. This consists in a displacement of the upper part of the tube, which, being carried downwards by the womb in a prolapsed state, becomes intussuscepted in the lower part of the vagina. This disorder is a lesion secondary to, and symptomatic of, the prolapse of the uterus, which is its direct cause. It is important not to confound this with the prolapse merely of the vaginal mucous membrane, last treated of. The treatment, of course, is the same as that directed for prolapsus of the uterus. PROLAPSUS OF THE RECTUM, HEMORRHOIDS, PILES, COSTIVE- NESS, CAUSES, SYMPTOMS AND TREATMENT. We 'shall include in our description of this affection, hemorrhoidal tumors or piles, which often occur in this part. There are two divisions of prolapsus of the rectum ; the one is the falling down of the rectum proper ; the other is a protrusion of the mucous membrane alone. Hemorrhoids are certain excrescences or tumors, which arise about the anus or inferior part of the rectum. They sometimes discharge blood, particularly in straining at COSTIVENESS, PILES, ETC. CAUSES. 221 stool, when they are commonly known as bleeding piles ; but when there is no discharge, they are called blind piles. They are often distinguished as external and internal, according as they appear externally or not. Both of these affections (for they may be regarded as distinct ones) often run into each other, being produced by about the same causes, operating on different constitutions, or on the same constitutions at different periods of life. Prolapsus is seen most. commonly in infancy and old age ; while piles occur most often at a middle period of life, and are more fre- quent in women than in men. Causes. — These are predisposing and exciting. The former, are a sedentary and luxurious life, producing general plethora and acostive habit ; habitual constipa- tion ; drastic purgatives ; frequent pregnancies and diffi- cult labors ; obstructions in the liver, or venous circula- tion ; a lymphatic temperament ; masturbation, and gen- eral debility from any cause. The exciting causes, are the accumulation of faeces in the colon and rectum ; thd determination of blood to the rectum, from the operation ol powerful cathartics ; straining at stool from constipation ; and long continued dysentery. 11 When we reflect that, in an ordinary state of health, we consume each day an amount of food that we know, from occasional intervals in which the bowels perform their proper functions, should yield, without effort, five or six times the quantity of the customary discharge ; the immense consequence of a sufficient daily evacuation of the bowels is too plain, for us to view its constant deficiency without alarm. It is true, we observe many persons who i seem to enjoy a pretty fair state of health, who never have, more than two or three evacuations a week ; yet a criti- cal investigation would show a very different state than that of health, in such individuals. A fevered tongue,, an aching head, and inability for active bodily or intel- lectual effort, is an almost invariable attendant on this state ; and its next result will almost to a certainty be, either piles, a permanent weakness or falling of the rec- tum, or an abscess, and fistulous opening at its side. " Anatomy informs us that the length of the intestinal tube is nearly six times that of the entire body ; and that 11 222 COSTIVENESS, PILES, ETC. CAUSES. four-fifths of it is appropriated to the reception, from the stomach, of the nutritious parts of the food and the bile ; while the lower fifth, ending in the rectum, is designed to contain the waste parts, or that which is to be thrown out of the body. " The general character of our diet, and experience, is such as to assure us, that at least one-quarter of the food we swallow is excrementitious ; or intended by nature to be evacuated from the system. The experience of persons who are habitually constipated, proves that no such amount, or indeed any approach to it, is ordinarily dis- charged. What then becomes of it ? There can be no question, that it is re-absorbed into the system ; for there are a sufficient, number of absorbents opening into the lower intestine to effect this mischief if the bowels remain long unmoved. It is unnecessary for us to point out the injurious effect of this poisoning of the blood, with a sub- stance so different from that pure fluid found in the upper tract of the intestines. " It is not wonderful, that designing and knavish indi- viduals, should avail themselves of the indolence of that half enlightened and physic-consuming class of society ; those who, having a mere suspicion of the truths they occa- sionally hear from physicians, and from partial observa- tion of their own systems, dare not entirely neglect this most important function, but console themselves by taking enormous quantities of quack pills. These are all made of stimulating substances, which act by forcing the intes- tines to throw out from their surfaces so large a quantity of the serum, or watery part of the blood, as to liquefy the hard contents of the bowels. By the excessive irritation they cause the whole nervous system of the bowels, they force them to contract, and throw off their contents, leav- ing the whole tract in a partial, and eventually in a state of permanent inactivity." Symptoms. — 'First, of prolapsus of the rectum : the slightest degree is indicated by a sense of bearing down and smarting, especially when at stool. After the evacuation of the rectum has been effected, the protruded portion, either returns itself, or with very slight pressure. If, however, the affection be neglected, the protrusion becomes COSTINENESS, PILES, ETC. — TREATMENT. 223 greater and greater — from one to two, and even six or ten inches — when it is not easily replaced. The tumor is constantly exposed to the air, and friction from the clothes and sitting, by which it becomes inflamed and ulcerated, and often fungous and varicose, exhaling blood and an offensive matter. In all cases the pain is more severe during defecation, and while standing ; the protruded membrane is of a dark red color, and sometimes almost black. The symptoms of hemorrhoids are, first, a sense of full- ness, itching, throbbing, heat, tenderness, and dull pain, about the anus ; then, a mucous or sero-mucous discharge, and hemorrhage. The small tumors, when first protruded have but little sensibility ; but when inflamed or strangulat- ed, become exquisitely tender. They vary in size from a pea to a pigeon's egg ; when small they may be felt thickly studding the rectum as far as the finger can reach. Some- times a single swelling only projects, resembling either a red currant, or a small purple grape ; these tumors vary much in size and number. They are, generally, simply varicose or enlarged veins, which often bleed very pro- fusely, and are much aggravated in character by the straining at stool, attendant upon constipation, which is most often the cause and accompaniment of this disorder. Treatment. — First, of falling of the rectum : the patient being placed on the back, gentle pressure should be applied to the tumor, by means of the thumbs, previ- ously dipped in oil ; or the patient may be placed on the face, the thighs separated and the nates pressed together. Sometimes it is necessary to introduce (previously well oiled) the fore finger into the rectum to remove the stric- ture. In children, where the irritation is kept up by diar- rhoea, from worms or other cause, those affections must be removed, and the bowels should be kept open by the mild- est laxatives, or by enemata. A recurrence of the disor- der may be guarded against by the use of astringent in- jections and fomentations, of a decoction of oak bark, a solution of alum, etc., and the application of an appro- priate system of hygiene. When there is considerable swelling and inflammation of the protruded part, as pre- liminary to the attempt at reduction, leeches, cold, poulti- 224 COSTIVENESS, PILES, ERC. HYGIENIC TREATMENT. ces, etc., according to circumstances, may be applied with great advantage. When all means fail, it may be neces- sary for the surgeon to remove the protruded portion by the knife. The treatment of hemorrhoids or piles, is divided in- to the medical, surgical, and the hygienic. When the loss of blood is considerable, cold water, or ice, and astringents, as a solution of alum, sulphate of zinc, iodide of iron, or creosote, should be resorted to; or continued pressure may be made for the same purpose. Internal astringents, joined with opium, if there be- much pain, will, also, be found useful. Great care must be taken, however, to guard against constipation ; for this purpose, mild laxatives are to be used, as sulphur in com- bination with cream tartar, castor oil with oil of turpen- tine, manna and senna, with an appropriate diet, which will soon be noticed. Should the parts be much inflamed, leeches may be ap- plied, and lead lotions used ; also, poppy fomentations, aqueous solution of opium, etc., especially where there is much itching. When there is general fever, the treat- ment should be antiphlogistic ; besides a low diet, and clear- ing the bowels, Dover's powders and antimonials may be given. When the disease is chronic, and without much inflammation, great good may be expected from local as- tringents and stimulants; such as an ointment of galls with opium, and the addition of acetate of lead if there be a tendency to inflammation ; decoction of oak bark ; lotions of sulphate of zinc and sugar of lead, with extract of hen- bane. The balsam copaiba, or some of the turpentines appli- ed locally and taken at the same time internally, have been found useful. The bowels should always be kept open ; rhubarb, either alone or combined with a minute portion* of aloes, answers a good purpose. We need not remark that all quack pills and other nostrums should be avoided. Lastly, when all these means fail, permanent relief can only be obtained by extirpation of the tumor or tumors, by means of caustic, ligature or the scissors. The nitrate of silver, in all cases, first deserves a trial. Hygienic treatment. — The painful diseases last con- sidered, are most commonly the result, as has been re- WHOLESOME AND UNWHOLESOME FOOD. 225 marked, of constipation ; this is the result of unnatural diet and want of exercise ; — so we have at once the origi- nal cause of these affections before us, and the means of prevention and cure. It was evidently the design of na- ture that there should be a daily movement of the bowels; where this does not occur, as we have shown, evil conse- quences follow. We have so often spoken of hygiene in this work that we purpose here to notice only the subject of diet, briefly. It is a law of the nature of our constitution, that the ingestion of innutritions as well as nutritious material, is necessary for the health and well being of the same. As the intestines require their appropriate stimulant, which is the residual portion of our food, if the article taken be concentrated by preparation and almost wholly nutriment, it is easy to understand, that inactivity and derangement of the bowels must be the consequence. Therefore, fine flour, rich jellies, etc., saying nothing of the absurd modes of cookery, catering to a pampered appetite, in vogue at the present day, must be a mighty scourge to the human race ! Yea, almost as great an evil as war, pestilence and famine ! The food of man should have blended with it innutri- tions or residual material, no matter what it may be ; it is best as nature has fitted, it for us, with as little change by cookery as possible. But better would it be for us to partake (with our own) of the food of the stall, and even saw dust, than to pamper the taste, as is practiced by a great portion of refined society. For it has been proved by direct experiment, that animals will live and thrive by mixing saw dust with the same food, upon which they could exist but a short time without it. It would be highly impolitic to prescribe a diet for every body ; indeed, the proverb, " what is one man's meat," etc., here becomes particularly apposite. It is well known that different constitutions and different employments re- quire a difference in adaptation of the quality and quantity of food. Those who labor can take with impunity food that would much distress a sedentary individual ; the for- mer evidently require more food, that which is more solid and nutritious, than the latter. Dr. Warren remarks : K 226 WHOLESOME AND UNWHOLESOME FOOD. " Let those who are compelled to sedentary pursuits, sea- sonably lay aside one-third of their ordinary food ; and they will experience no loss of time in combatting the hor- rors of dyspepsia." Even by those who labor, meat should be taken moderately, and but once a day ; the sedentary generally do not need it. It should be cooked, always exposed to the free admission of air. Bread should be made of grain in its natural condition, that is, without sepa- rating the bran from the flour ; or it may be mixed with Indian corn. It should be made properly at home, and never purchased of a class of men who are often so un- principled as to disregard law and feeling, and tamper with the public health, by adulterating it with stale and sour flour, as well as with vile and astringent drugs. The rule should be, no article of food or drink to be in- dulged in, that is known to disagree with the stomach or bowels. Food may disagree in various ways : it may re- main too long before being digested, when it will occasion eructations, a sense of oppression or pain about the stomach, palpitation of the heart, dizziness, headache, constipa- tion, diarrhoea, nausea, or vomiting. It may become acid, giving rise to wind, burning in the stomach, known as " heart-burn, " pain, regurgitations of the contents of the stomach, oppression, distention of the abdomen, etc. It may either produce costiveness, or diarrhoea ; but in what- ever manner it disagrees with the individual, it should be laid aside, and some other articles substituted. For guarding against costiveness, then, nothing is near as good as dieting ; though medicine may be necessary where obstructions already exist, cathartics should never be long continued for the cure of this affection. For this purpose, bread made from the unbolted wheat flour, regu- larly persevered in, by making it the substitute for all other bread, will rarely fail. We may, also, have recourse to ripe fruits, which are almost all more or less aperient ; a few, however, are astringent and should be rejected. Generally, they are more wholesome uncooked, unless the cooking consist in plain stewing. We should name toma- toes, either raw or stewed, as an article of food well adapted for all costive individuals. Milk and water are the natural drinks of mankind ; bu UTERINE DROPSY. . . 227 not too much of these, even, should be used. The inges- tion of drinks, to a certain extent, seems to be an acquired habit ; particularly their use with our food. If mastica- tion and insalivation were perfect, they would not be need- ed ; for in chewing, carried on moderately, the salivary glands are excited to action, and throw out sufficient saliva to moisten the food without the use of fluids. Hence, the use of tea, coffee, and other fluids with our meals, is in- jurious in several ways: 1. by hastening the swallowing of food, before well masticated ; 2. by moistening the ali- ment with liquid instead of the saliva, which is needed in digestion ; 3. by diluting the gastric juice in the stomach, which is the essential agent in the digestive process ; it thus becomes weakened, and consequently unfitted to ful- fill its important purpose. We have before sufficiently dwelt upon the injurious qualities of tea and coffee ; it may be added, that they are decidedly constipating, particularly the former. Let us close by adding, that the temperature of our drinks and food is another point worthy of attention : very hot and very cold things are unfavorable to a healthy action of the stomach ; the former, by diminishing the tone of this organ, and the latter, by suppressing its secretion. Ice, iced water, and ice cream, are objectionable as articles of daily food, but are often valuable remedies in the hands of the physician. All kinds of stimulating drinks are, also, pernicious: 1. by diluting the gastric fluid, as above stated ; 2. by overstimulating the stomach. All alco- holic drinks have the property of preventing the decompo- sition, and, of course, retarding the digestion of food. CHAPTER VII. UTERINE DROPSY— CAUSES SYMPTOMS AND TREATMENT. Uterine dropsy consists essentially in the excessive secretion of fluid by the lining membrane of the uterus, and its accumulation, in consequence of the obliteration oi the canal of the mouth and neck. It also arises in con 228 UTERINE DROPSY CAUSES SYMPTOMS. sequence of ulcerous discharges within the cavity of the uterus, which are retained in the same manner. It occurs most frequently in married women of middle age — also, during pregnancy. When the accumulated fluid arises from the lining membrane of the uterus, it is of a serous or mucous character ; but where it arises as the result of organic disease, or when it has been long retain- ed, it is frequently dark-colored and offensive. The quantity of the fluid accumulated varies ; most generally, when it amounts to more than one or two pints, a passage is forced for its discharge. Occasionally, how- ever, the uterus becomes distended to an alarming extent ; authors mention cases in which from 50 to 18U lbs., have been found. The* causes of this disorder have been .attributed to blows upon the abdomen, but more generally to debility of constitution, and a universel dropsical diathesis. Symptoms. — After the disease has existed for some time, the tumor of the enlarged uterus, may be perceived at the lower part of the abdomen ; it is moveable and fluctuat- ing and gives a dull sound when percussed. When the accumulation becomes large, there is inconvenience from its size, with tenderness, and a dull pain in the tumor. The menses are almost always suppressed, but leucorrhea is sometimes present. There is often sympathetic enlarge- ment of the breasts, with occasional secretion of milk. In the advanced stage of the disease there is general debility of constitution, with loss of appetite, irregular bowels, etc. Uterine dropsy is distinguished from pregnancy by the absence of quickening and the greater roundness and soft- ness of the tumor. It is also distinguished from other diseases of these parts by comparing symptoms. If the mouth of the uterus be completely closed and the accumu- lation continue to increase, death from rupture of the uterus will result, unless relief be afforded by art. Treatment. — The endeavor should be to evacuate the contents of the uterus.. This may sometimes be done by inducing coughing, sneezing or vomiting. If this does not succeed, if possible, a canula must be passed into the cavity of the womb. Should the neck be impervious, it must be punctured MOLES, HYDATIDS, ETC., OF THE UTERUS. 229 with a trocar or other suitable instrument ; this operation is nut unattended with danger, but there can be but little doubt as to its propriety. After the evacuation of the uterus, the next object will be to produce a change in the secretion of the mucous membrane by diuretics, purgatives and alteratives. Counter-irritation to the sacrum, and uterine injections of mineral waters or astringents will probably be found useful. The general health must by no means be neg- lected. A suitable diet, air, and exercise without fatigue, will be of great service. • CHAPTER VIII. MOLES, HYDATIDS, ETC., OF THE UTERUS. The term mole has been applied by some authors to a variety 'of shapeless masses, discharged from the uterus, whether detached polypus, clots of blood or blighted con- ceptions. To make the term more significant and intelli- gible we shall confine it to the latter, which we shall divide into three species — excluding from the list polypus, to be described elsewhere — 1. False conceptions. 2. Fleshy Moles. 3. Hydatids. The two latter species may be • regarded as mere varieties or transformations of the first. 1. In blighted conception the vitality of the Jwtus, having been destroyed, it remains as a foreign substance. In most of these cases, but slight traces of the foetus are to be found, as' a portion of the umbilical cord — the remain- der having been dissolved in the liquor amnii. The whole mass is observed to be a good deal changed in size and form, as well as structure, by the effusion of blood and formation of coagula. The causes are very slight which may destroy the life of the foetus at an early period of its existence : such as mental and bodily shocks and irregularities even of the nervous and circulatory systems. It is seldom retained in the womb more than two or three months, but if not ex- pelled it becomes transformed into the fleshy mole. 230 MOLES, HYDATIDS, ETC., OF THE UTERUS. 2* The fleshy mole is a degeneration of the formei species ; it has become more shapeless and of a denser texture ; the oa^gnla seems to have become gradually- organized. These moles are found in solid masses, and with a central cavity, in which there remains some of the liquor amnii. The larger ones, which are the solid moles, are about the size of the two fists. 3. Hydatids, or the vesicular mole. The development of these hydatids have been accurately traced. They are found in small numbers growing upon the outside of the ovum and placenta, as yet unchanged in form. They are observed gradually to encroach until the figure Ot the foetus is altogether obliterated. The hydatid varies in size, from a pin's head to a grape ; and in shape, from an oval to a round and elongated form. The quantity of these contained in the uterus varies ; some- times reaching to a large amount and resembling a cluster of grapes upon the stern. These hydatids were formerly believed to be animals, possessed of an independent existence ; but this supposi- tion is abandoned by all recent writers. They generally remain longer in the uterus before their expulsion takes place, than the other species ; and they have been known to be five or six years in accumulating. There has been a question which involves an important point in legal medicine, whether moles are the result of conception? After excluding coagula and polypus from the list, among all modern authors, there is scarcely a dissenting voice from the affirmative. Dr. Churchill re- marks : " We may, therefore, conclude that moles, properly so called, whether blighted conceptions, fleshy moles, or hydatids, are truly consequent upon sexual intercourse and impregnation ; but in the practical application of this judgment to forensic medicine, we must not forget that this does not imply criminality or impropriety in every case ; as for instance, a widow may have conceived during the lifetime of her husband, and the death of the embryo not having been followed by the expulsion of the ovum, it may remain in utero until after the death of the husband, and then be discharged without the slightest suspicion attach- ing itself to her conduct." FIBROUS TUMORS OF THE UTERUS. 231 The symptoms, for the first few months, exactly resemble those of pregnancy. The menses are suppressed, the ab- domen enlarges, the breasts increase, and secrete a milky fluid, etc. But it may be distinguished by the absence o! foetal movement, pulsation of the foetal heart, and the con- tinuance of the abdominal swelling beyond the period of utero- gestation. The health of the patient, generally speaking, does not suffer more disturbance than is depend- ent upon pregnancy. Treatment.- — The womb, sooner or later, makes an effort to expel its contents, when the usual phenomena of labor, or abortion occurs ; there is a preliminary mucous discharge from the vagina, labor pains, etc., when the mole is expelled. The process will not require interference, unless there be considerable hemorrhage, which may be arrested by applying cold, or plugging the vagina, as directed in the chapter on menorrhagia. Should it be deemed necessary, the ergot of rye may be given, in scruple doses ; or, should the uterine distention be equal to pregnancy at the seventh^ month, the hand may be introduced and the mole brought away. Subsequently, the patient should be managed as after ordinary labor, but with special reference to the flooding. CHAPTER IX. FIBROUS TUMORS OF THE UTERUS AND OVARIA NATURE CAUSES SYMPTOMS, AND TREATMENT. This appellation is applied to a species of fleshy tumor,, which does not ulcerate, nor is it malignant, and is of in- convenience only from its mechanical effects. Such tu- mors consist of a mass of irregular fibres, often collected into a number of separate lobules, which are connected together by loose cellular tissue. These tumors have been divided, according to their mode of attachment to the uterine structure, into those which have a pedicle, and those which have not ; the pediculated 232 FIBROUS. TUMORS OF THE UTERUS— CAUSES. tumor is the proper polypus and will form the subject of the next chapter. The non~pediculated tumor is the subject of this chapter. Fibrous tumors may either be imbedded in the uterine structure, or formed immediately beneath the serous or mucous membranes ; in the latter case, they project ex- ternally or internally, causing an alteration in the figure, and diminution of the capacity of the womb. These tu- mors vary in number and size. Several of them are often found in different parts of the uterus, excepting the neck, where they are rarely seen ; they are found of all sizes, from that of a pea to that of a man's head; in rare in- stances, they have been known to weigh as much as thirty or forty pounds. They are generally composed of a white or gray fibrous tissue, surrounded with a celluiar struc- ture ; here and there may be seen portions softer and harder than the general mass, and sometimes interspersed with calcareous matter, consisting of phosphate and carbo- nate of lime, with animal matter. %Their form is usually more or less globular, but they may he very irregular ; the color, when cut into, may be dull, with numerous white lines, or resplendent. Causes. — Various theories have been proposed to ex- plain the formation of these -tumors ; by some, they have been regarded merely as lesions of nutrition, by others, as a species of concretion around a nucleus of blood or pus. Among the predisposing causes have been men- tioned a lymphatic or scrofulous temperament, chronic * leucorrhea, ct, ibacy, barrenness, abortion, certain seden- tary employments, as those of the cook, seamstress, etc. Period of life seems to have an influence upon their de- velopment ; the age from thirty to forty, and that from .forty to fifty years, are the terms in which they are most frequently met with. The exciting causes are equally obscure. It may, as a general rule, be correct to say that the essential cause consists in a certain mode of irritation, whose persistence, at a given point of the uterus most affected, determines at that point a new mode of nutrition and vitality, the precise nature of which, it will be forever impossible to explain, but which may to a certain extent, be compared with the FIBROUS TUMORS OF THE UTERUS TREATMENT. 233 ligneous excressence arising from punctures made by. the Cynips Gallce, on the oak twigs that produce the nut-gall ; such as punctures, fissures, excoriations, abusus coitus, and injury during labor. (Colombat.) Symptoms. — In most cases, the patient complains of a weight in the pelvis, bearing down, and aching in the loins. From the pressure of the tumor upon the bladder and rectum, the evacuation of their contents may be im- peded, and a frequent desire produced to void the urine and faeces ; cramps in the legs and thighs may occur, or dropsy of the lower extremities. If the tumor be large it may give rise to retroversion, or other displacements of the uterus. Menstruation is often interfered with; it may become suppressed, or excessive ; the latter is rare. There is sometimes a mucous discharge, but the tumor is rarely ulcerated. Conception may take place, but abortion is extremely liable to occur at the third or fourth month ; if pregnancy go on to the full period, at parturition .there is danger of flooding. In some cases there is sympathy of the breasts, which become swollen. There are, sometimes, constitutional dis- turbances, which are secondary to those local ones men- tioned. If the patient be thin, the tumor if sufficiently large, may be detected through the walls of the abdomen, or by a vaginal examination ; the two modes conjoined is better, or, by the rectum, since by depressing the tumor • felt in the abdomen, a shock will be given to the finger in the vagina or rectum. The enlargement of these tumors is extremely slow : months and even years may elapse, with little or no increase of inconvenience. It should be remarked that the investing membrane becomes occasion- ally ulcerated without participation of the tumor. Fibrous tumors are sometimes gradually converted into polypus, by a change in their attachment, from various causes. The prognosis, in general, is not very unfavorable. They may be distinguished from other uterine degenera. tions by comparing symptoms. Treatment.: — The treatment of fibrous tumors. is little more than palliative. It has been supposed that iodine and mercury have the effect of reducing them, but the latter 234 FIBROUS TUMORS OF THE UTERUS — TREATMENT. is now scarcely ever used for that purpose. Iodine may be resorted to with the hope, in many cases, of checking their further development, but little more can be expect- ed. It may be used internally in the form of syrup and the compound tuiGture ; but the most eligible mode of ex- hibiting it, in this condition, is, in form of ointment, exter- nally, over the tumor. An excellent ointment is composed of five grains of iodine and a drachm of iodide of potash, to an ounce of lard ; to be rubbed in, as above, two or three times a day. The patient should avoid as much as possible, the deter- mination of blood to the uterus, and when inflammation occurs, it may be subdued as directed in the chapter on Inflammation of the Uterus ; any hemorrhage that may arise must be treated as directed under Menorrhagia. Other symptoms must be met as they arise ; — in particu- lar, the evacuation of the rectum and bladder must be assisted, if necessary, by art. Cupping the loins and leeches to the vulva, are useful, according to circumstances. These tumors have occasionally been spontaneously ab- sorbed, and oftener, separated from their connections by ulceration, and discharged by the vagina. Operations, imitating these efforts of nature, are resorted to for the relief of the patient, which will be described under Polypus of the Uterus. It is surprising how common these morbid growths are, and how rarely they are productive of bad consequences ; as has already been remarked, they are of inconvenience, principally, from their bulk and weight. Fibrous tumors are found attached to, and imbedded in the substance of the ovaries, as well as the uterus ; they are often coincident in both organs. These tumors are identical in structure, are produced by about the same causes, give rise to nearly the same symptoms, and the treatment, also, is the same with those of the uterus. They may be distinguished by an examination per rectum. Com- plete relief may sometimes be given by pushing the tumor up beyond the brim of the pelvis. CHAPTER X. POLYPUS OF THE 'UTERUS CAUSES SYMPTOMS, AND TREAT. MENT WITH OTHER MORBID COLLECTIONS IN THAT ORGAN. The term polypus of the uterus is used to designate a class of tumors, of the fleshy kind, which grow from the inner surface of this organ, and are attached to it by means of a pedicle or neck. These morbid productions do not much differ in structure, from those noticed in the preceding chapter ; there is, however, a difference of form, situation, and in the symptoms resulting. Polypus is found attached not only to the body of the uterus, but, also, to the funJus, neck and mouth of the organ. They vary in shape, size, color, etc. They are generally of a pyriform shape, but are often found of an oval form. They are found no larger than a pea, and then again, of an enormous magnitude. Some are quite white, others reddish, and others dark brown ; their surface is generally smooth. Sometimes, instead of being attached by one stock only, two, and even three, are found. Polypus, at the commencement of its growth, is enclosed within the cavity of the uterus ; but, as it increases, it gradually dilates the neck and mouth, passing insensibly through them, and protrudes itself, more or less, completely into the, vagina. The expulsive force of the uterus some- times detaches the polypus altogether, and entirely ex- pels it. Sometimes veins are discovered on the surface of these tumors, but in general, they are scantily supplied with blood vessels ; and as the circulation in them is not very active, it is difficult to explain the occurrence of the dan- gerous hemorrhages which often take place in them. Causes. — These are the same as those mentioned in the preceding chapter, as giving rise to fibrous tumors, and to them the reader is referred. As polypus has been ob- s« rved to occur after abortion and parturition, it has been 236 POLYPUS OF THE UTERUS SYMPTOMS. conjectured that a portion of placenta, or clot of fibrine may have been retained, which served as a nucleus for organization : undoubtedly some degree of irritation is requisite for their production. They occur most frequent- ly in those of a lymphatic temperament, and of a sedentary life. They are not common before the middle age, but attack equally the single and married. Symptoms. — At an early stage of the formation of poly- pus, the symptoms are extremely obscure ; but when the disease is considerably advanced, they assume a distinct and formidable character. The mucous secretion is in- creased and often becomes purulent, constituting a con- stant leucorrheal discharge, which varies much in quantity and quality at different periods. This discharge is follow- ed, sooner or later, by a mixture of blood from the surface of the polypus. This hemorrhagic discharge occurs ir- regularly, as to time and quantity, seeming to depend upon the determination of blood to the uterus, from any cause ; it is the most formidable symptom of the disorder, and is often sufficient to reduce the patient to a dangerous con- dition. The appetite becomes impaired, the bowels relax- ed ; dropsy of the extremities occurs, etc. The blood may be discharged in a fluid state, or in clots, some of them being accurate moulds of the polypus ; it may, also, be retained till it becomes putrid. It would seem that small polypi bleed quite as profusely as large ones. These symptoms are liable to be mistaken for those of leucorrhea, or menorrhagia simply. As the polypus increases, the symptoms become aggra- vated. Menstruation is very uncertain, as regard^ time and quantity. There is weight, dragging sensations, and pain in the back and loins; vomiting, with an increase of the dyspeptic symptoms ; finally, great debility, and the patient may sink under the continued discharge, unless the bearing down pains that occur, break the stalk and expel -the polypus, which sometimes happens — when the symptoms abate. When the tumor is large, there is pres- sure on the bladder or rectum, producing dysuria and tenesmus. The presence of polypus does not prevent conception, unless it be quite large, but there is a constant liability to POLYPUS OF THE UTERUS TREATMENT. 237 abortion. When a very large one descends into the cavity of the pelvis, it is a serious obstacle to delivery, and re- quires instant removal. Polypus has been known to occa- sion prolapse and inversion of the womb. We should re- mark, that no case of uterine hemorrhage ought to be passed over without making a vaginal examination ; the tumor may at once be discovered, if it be not retained in the uterine cavity, by its being rounded, smooth, and in- sensible, and generally pear-shaped ; the stalk most often may be traced up to, or through the mouth of the uterus. If the polypus still remain in the cavity of the uterus, that organ will be enlarged in proportion to the size of the tumor. Great care should be taken to distinguish polypus from, 1. pregnancy; 2. vaginal hernia ; 3. hernia of the blad- der ; 4. cancer; 5. cauliflower excr essence ; 6. prolapsus of the uterus; and 7. inversion of the womb, by diligently comparing all the symptoms. Treatment. — We are first to determine whether the polypus be within reach or not, by a vaginal examination. When it is not, and in those cases where the evidences of its existence are slight, we must be satisfied-with pallia- tive measures, in attending to dangerous symptoms, sup- porting the constitution, and assisting the descent of the polypus. • The hemorrhage must be treated by the horizontal pos- ture, cold astringent injections, plugging the vagina, coun- ter irritation, astringents with opium internally, etc. Nutritious food and tonics should be given, and wine or brandy, if necessary, to support the patient. The ergot, given .at this period, may be useful in two ways, viz: by restraining hemorrhage, and by assisting in expelling the tumor. But when the polypus is within reach, nothing short of removal should be attempted, as that alone will save the patient. There are three principal modes of doing this; the one should be selected best adapted to the circum- stances: 1. By torsion, or twisting it off. 2. By ligature, the polypus being allowed to slough off. 3. By excision, with the knife. Crushing has been added, that is, by breaking the polypus to pieces, either bv forceps or the 11* 288 CALCULUS OR STONE. fingers, and then extracting it. Cauterization, formerly proposed, is now never applied. The two plans most often prefered are, by ligature, and by excision ; the peculiar advantages of either of which, the experienced physician will be able to appreciate in particular cases. When the polypus is so large as to be wilh difficuly forced through the passages, the free appli- cation of belladonna ointment has been recommended ; also, the division of the tumor, and even incision of the neck of the uterus. After the operation of removal, whatever it may be, emollient injections should at first be used, to be succeeded by slight astringent and tonic ones ; if inflammatory symp- toms appear, they should be treated as directed for inflam- mation OF THE UTERUS. OTHER MORBID DEGENERATIONS OF, AND COLLECTIONS IN, THE CAVITY OF THE UTERUS. Degenerations and morbid collections, other than those mentioned, and of minor importance, sometimes occur in the uterus. CALCULUS OR STONE. Althouh this is a rare affection, a sufficient number of cases are on record to entitle it to notice. M. Louis, an eminent French physician, has collected most of the cases that have been recorded by authors for the last few centu- ries. He mentions one that weighed nine drachms and a half; another, which weighed four ounces, but might have weighed a pound, had the material not been so porous. One of the most curious cases, is that mentioned by Bar- tholin, wherein a rough, black calculus weighed four pounds; another, equally remarkable, is reported by Ruysch, where he removed from the womb forty-two stones of different sizes. The causes of the formation of uterine stone are some- what obscure. Louis supposed that they proceeded from the degeneration and aggregation of the morbid secretions of the organ, in the same manner as urinary and biliary PHYSOMETRA, OR UTERINE TYMPANITES. 239 stone is formed in the bladder and ducts of the liver; quite recently, the more general opinion has obtained, that they are produced by the changes undergone by fibrous tumors, which have been detached from their place of formation. They may, also, arise from fragments of an embryo, or mole, and in short, from any foreign body in the womb, which may constitute a nucleus for concretion. These calculi may exist in the uterus a long time with- out giving rise to much inconvenience. The symptoms are very obscure ; sometimrs there is a sense of weight and dull pain in the back and loins ; sometimes an intoler- able itching of the vulva, with discharges from the vagina. Sometimes bearing-down pains come on, and the calculus is spontaneously discharged ; this may be assisted by baths and emollient injections. When a calculus gives rise to inconvenient symptoms from its size, its extraction should be attempted by long narrow forceps made for the purpose. OSSEOUS AND CARTILAGINOUS FORMATIONS. These occur mostly at an advanced period of life ; either from similar causes as the preceding formation, or from a degeneration of a part or nearly the whole of the coat of the uterine vessels, producing sometimes complete obliteration of the mouth of the organ. PHYSOMETRA, OR UTERINE TYMPANITES. This has been applied to the accumulation of a gaseous fluid in the cavity of the womb, which is said to take place under different circumstances : it may be a secretion of the mucous membrane, or arise from the decomposition of a portion of the placenta, a clot, or of some of the lochia. This affection is so extremely rare, that many modern authors are disposed to doubt its existence. We have some remarkable accounts of it from the ancients, who supposed that the accumulation might take place to an alarming extent ; but they are now regarded as somewhat fabulous. It is true, that immediately after delivery, the womb in its alternate contractions and expansions may draw up air, 2 10 CAULIFLOWER EXCRESSENCE OF THE UTERUS. which is expelled again with an explosive report from the vagina ; and it is probable that gas may be generated from decay of a portion of the placenta, or be secreted by the lining membrane. But these are of little consequence, as long as the mouth of the uterus remains open for its dis- charge ; should it by any accident become closed, it is easy to conceive how distension of the womb might take place. But, as we have already remarked, this occurence is so rare that many physicians doubt its ever taking place. CHAPTER XI. CAULIFLOWER EXCRESSENCE OF THE UTERUS — -NATURE, SYMP- TOMS AND TREATMENT. The term cauliflower excresscence, has been given to a morbid growth, from a part, or the whole, of the cir- cumference of the mouth of the uterus ; it is sometimes, though rarely, found upon the surface of the uterine cavity. It is met with in females of all ages, and all temperaments, in the married and unmarried, without regard to habits, or residence. (Churchill.) „ Its causes are extremely obscure ; it cannot be consid- ered the result of injuries, and Dr. Clark thinks that the disposition to it is hereditary. Symptoms.— The tumor is very vascular, of a bright fleshy color, with a smooth or slightly granulated surface, upon which are numerous small projections. The struct- ure is somewhat firm, and disposed to bleed ; it is covered with a delicate membrane, which gives rise to a copious watery discharge. This discharge is the first symptom noticed by the patient, which sometimes becomes enor- mous. Soon, it is observed to be mixed with blood, and hemorrhage occurs to an alarming extent, producing all the symptoms of constitutional exhaustion. At this period bleeding may be produced by slight causes, as coitus, defecation, and even an examination ; during the intervals the watery discharge goes on as before. The stomach and bowels become much disordered, vomiting occurs, CAULIFLOWER EXCRESSENCE OF THE UTERUS. 241 and the patient may die of dropsy, or effusion into some of the great cavities of the body. An examination per vaginam, reveals the appearance of the tumor as above described ; it is insensible and varies in size, from that of a strawberry, to that of a bulk suffi- cient to fill the whole vagina and protrude at the vulva. The tumor, if extirpated, is liable to be reproduced. It may be distinguished from polypus by its soft and granulated surface, and by its disposition to bleed when touched, and by the absence of a pedicle; from cancer, by the difference of symptoms, and by its insertion into the lip of the mouth of the uterus. Treatment. — It is doubtful whether the progress of the disease can be arrested, except by excision. We should direct a recumbent posture ; an avoidance of determina- tions of blood to the uterus ; a mild, unstimulating diet ; and an avoidance of mental and sexual excitement. The patient should, of course, live absque marito. Derivatives to the lumbar region are often useful. We should en- deavor to arrest the watery discharge and hemorrhage, by cold sponging the loins and vulva, by the douche, and by astringent injections ; for this purpose, any of the astringent decoctions, or solutions may be used. When the tumor fills the vagina, it has been recommended to pour the as- tringent lotion into that organ, while the patient is lying on her back, with the hips elevated ; or lint, dipped in the lotion may be applied. The bowels must be kept free. Dr. Churchill has met with complete success, in curing this affection, by first removing it with the ligature, and then applying strong caustic (muriate of antimony) to the spot from whence it was removed. And, if we do not succeed in arresting the hemorrhage, by the means above mentioned, there is no doubt of the practicability of this method, even if the tumor grow again, as it frequently will ; for the patient, if left to herself, must certainly very soon die. Any one of the ligatures in common use may be applied, and when the tumor is separated, astringent in- jections must be used, which will check the disposition to reproduction. Lastly, we should remark, that amputation of the neck of the uterus has been recommended as a permanent means of cure for this disorder. CHAPTER XII. CORRODING ULCER OF THE UTERUS — NATURE — SYMPTOMS DIAGNOSIS, AND TREATMENT. Corroding ulcer of the neck of the uterus is a malig- nant disease, and may extend to the fundus, implicating the whole organ, as well as, occasionally, the bladder, vagina, and rectum. It commences upon the mucous membrane, in the form of a small ulcer, gradually de- stroying the uterus, if not arrested, and with it, life. It has often been mistaken for cancer, and is doubtless very similar to that disease. It attacks females of the lymphatic temperament, especially ; rarely appears before the age of forty, and most often about the period of the cessation of the menses, or soon after. Symptoms. — In some cases, this grave disease is preced- ed by uneasiness and pain in the pelvis, and by leucorrhea ; but in other cases, attention is first directed to it from the profuse hemorrhage, which may be mistaken for menorrha- gia simply. But upon examination, ulceration of the neck is discovered to a greater or less extent; with a rough, granu- lar surface, which may be but slightly tender, or very painful. The hemorrhage and pain are not continuous, but the ulceration continues to spread. At this period, during the intervals of bleeding, a thin, profuse and offensive discharge takes place from the vagi- na. There is now weakness, weight and pain in the back and loins ; the patient becomes emaciated ; there is sick- ness of stomach, with loss of appetite ; the bowels are irregular; the skin becomes dry and sallow, and a low fever sets in, with a quick small pulse. The distress of the patient is often increased by excoriations of the vulva, caused by the acrid discharge. The disease may now advance rapidly, and destroy life, or it may continue for years without producing that event. When the discharges are augmented, all the above CORRODING ULCER OF THE UTERUS TREATMENT. 243 symptoms become aggravated, and the patient ultimately sinks from exhaustion, or is carried off by peritonitis, from the extension of the ulceration to that membrane. There is great similarity of this disease to cancerous ulceration; but preceding the latter, there is .extensive deposition in and about the uterus, rendering it immova- ble ; whereas, in corroding ulcer, no deposition having taken place, the uterus can be -moved by gentle pressure. By examination per rectum, as well as per vaginam, and taking into consideration the above facts, the true nature of the malady need not be mistaken. The prognosis of this disease is always unfavorable, there being but little hope of a permanent cure. Treatment. — Should the disease be detected early, which is seldom the case, the abstraction of blood from the part by leeches has been recommended ; hip-baths may, also, be serviceable at this period. Bat if ulceration have commenced, we should make applications calculated to arrest its progress, and excite a healthy action, although there is seldom but little hope of doing either. The appli- cations of caustic iodine, nitric acid, deuto-nitrate of mer- cury, nitrate of silver, muriate of antimony, etc., have been recommended for this purpose by different authors ; those first mentioned have been found the most useful. They should be applied through the speculum, and followed by the use of emollient and opiate injections. If these remedies fail of arresting the disease, we must rest satisfied with palliating the more distressing symp- toms : for this purpose, morphine, opium, hyosciamus, etc., may be given to alleviate the pain ; astringent injections may be made use of to check the discharges; and mucila- ginous, aqueous, and anodyne ones, to cleanse the vagina and assist in relieving the pain. Extreme cleanliness should be observed by washing the external parts two or three times a day, with tepid milk and water ; and the bowels must be kept free by mild laxatives or enemata. The diet should be nutricious but not stimulating. It has been suggested that excision of the neck of the uterus is the more appropriate remedy ; and it might be successful if practiced early, before the health becomes much impaired, or the ulceration extensive. CHAPTER XIII. CANCER OF THE UTERUS AND OVARIA NATURE CAUSES- SYMPTOMS AND TREATMENT. Cancer is the most fearful and destructive disease to which the female genitive apparatus is obnoxious ; it is the most fatal in its progress, and the least controllable by remedies. Although it is frequently met with, it is, com- paratively, not a common malady. It may be defined to be a disease arising from various causes, which are often obscure : frequently from hereditary predisposition, in tha the middle or advanced periods of life ; commencing with a local hardness, consisting of a morbid deposit in gland- ular parts, which subsequently ulcerates, most commonly in its centre, destroying surrounding parts, and ultimately contaminating the constitution — being attended with ema- ciation, and generally considerable, and not unfrequently intense pain. It most often attacks the uterus in the glands of the neck, at about, the period of the cessation of the menses, and single women, or those who have borne no children, seem to be most obnoxious to it ; young persons being mostly exempt from its ravages. The following table, from Madam Boivin and M. Duges, throws much light upon the time of occurrence of this disease. Out of 409 cases of cancer of the uterus, there were : Under 20 years of age, 12 From 20 to 30 " 83 " 30 " 40 " 102 Following the course of the disease, from its commence- ment by a hard morbid deposition, that after some time, longer or shorter, ulcerates by softening in the centre, there are two distinct stages, which we shall consider separately : 1. That of hardness, known as scirrhus, or ron i 40 to 50, 201 a 50 " 60, 7 u 60 " 70, 4 CANCER OF THE UTERUS CAUSES. 245 cancer. Some authors have included diseases, which we have more properly described under other heads (corrod- ing ulcer and cauliflower excressence) as varieties of cancer, which has given rise to much discrepancy and confusion. Other authors have made a distinction, into cancerous ulcer and ulcerated cancer; in the former the ulceration being the primary affection, and the morbid deposition secondary ; we should remark, that though this species has occurred, it is extremely rare. 1. Scirrhous stage : At the commencement, it is distin- guished by hardness, coldness, insensibility, paleness, and a. deficiency of red blood-vessels — all indicating a low degree of vitality. When fully developed, it consists of a hard, firm, incompressible and unequal mass, the limits of which are not distinctly definable ; its color is generally of a light grey, and when cut into thin slices, semi-trans- parent. Upon close examination, it is found to consist of two distinct substances : the one which composes the chief part of the diseased mass, is hard, fibrous and organised ; the other is soft, and apparently inorganic. At the commencement of scirrhous disease of the ute- rus, the organ, for sometime preserves its natural aspect and color, being changed merely in volume and density ; as the disease advances, the tissue of the organ becomes more obscure, until it entirely lose-s its normal character. 2. Cancerous stage : Soon, portions of the scirrhous mass begin to soften, and pass into a state of unhealthy ulceration. The soft or inorganic substance, above no- ticed, forms a thin ichorous matter ; the establishment of this condition appears to arrest the deposition, as the uterus increases but little in bulk after this period. Cancerous tumors always have a tendency to extend to, and contaminate the glands in their vicinity. Conse- quently we find, that after a while the glands in the pel- vis, and even those in' the groin, often participate in the disease. The vagina, bladder, and rectum, and even the ovaria and tubes, may also become affected. Causes. — The predisposing causes, are heredetary pre- disposition, age, constitution, mode and habits of life. It will be seen by referring to the statistical table before given, that cancer of the uterus is mexo frequent in pro- 12 246 CANCER OF THE UTERUS SYMPTOMS. portion as that organ is in a greater state of activity, and particularly just before and after the " change of life." Badly regulated women ; those who are nervous and sub- ject to vivid emotions ; those of an erotic temperament, who give themselves up to masturbation or venery ; those who pass their lives tumultuously in fashionable society ; those in whom an habitual leucorrhea, and neuralgic or rheumatic pains have suddenly ceased ; finally, women who have borne many children, or have had numerous abortions, are more subject than others to cancer of the womb. We should also mention as belonging to this class, sterility, celibacy, violent grief, strong paroxysms of anger and joy, etc. Although no temperament is exempt, it would seem that women of high color and sanguinous con- stitution, are its most frequent subjects. The exciting causes, are all those w r hich give rise to inflammation of the uterus, mechanical violence, as blows, long-continued and inordinate local pressure; criminal attempts to prevent conception and to procure abortion ; the presence of a foreign body in the vagina ; contusions, from disproportion of the organs in married people ; mas- turbation and venery before puberty and after the critical age; and finally, all causes capable of producing inflam- matory and congestive engorgements of these organs. Symptoms. — 1. Scirrhus : The symptoms, at first, are so very slight, as not to excite uneasiness, till the disease has made considerable progress. Then, the menses may be deranged, either by augmentation, diminution, tran- sient suppression, or frequent and irregular return ; there may be a leucorrheal discharge, with a redder tint after coitus ; sensations of pressure, weight and dragging in the loins, and about the anus ; and painful sensations during the expulsion of the urine and fseces. Some women ex- perience a sort of voluptuous pruritus in the genital parts ; marital connexion, generally, though not always, causes more or less acute pain ; to these symptoms are added acute pains in the breasts and different parts of the body, melancholy, hysterical attacks, disgust for food, and strange longings. When such symptoms as these occur, it is of the great- est importance to make an examination, to ascertain the CANCER OF THE UTERUS SYMPTOMS. 2-17 nature of the evil ; delay might expose the patient to irremediable danger, as this is the only period in which the disease is, in the least, amenable to treatment. The mouth of the uteres is found more open than usual, tume- fied, hard, warm, and painful, and sometimes softened, and uneven at different points ; the posterior lip is found larger and more projecting than the anterior ; and the finger, when withdrawn, is commonly found covered with bloody mucus. It may often be difficult to distinguish the first stage of cancer from chronic inflammation, but in either case not a moment should be lost in the application of remedies. It is certainly very remarkable, that so grave a disease should admit, during its progress, of the possibility of con- ception: this, however is the fact, for several such cases are on record. 2. Cancerous stage : How long the first stage may continue is uncertain : in some patients, it may last for years, and in others, for a much shorter period. There are three symptoms at this stage which deserve particular attention, viz : the pain, the hemorrhage, and the dis- charges. 1. The pain: The pain in cancer of the uterus is quite distinctive ; it is described as lancinating, as though knives were being plunged into the body. It, however, varies, being sometimes burning, and occasionally, there is very little of any kind. Its location is through the pubes and loins, and down to the anus and thighs ; some- times it is situated in distant organs. 2. The hemorrhage : This occurs very soon after the ulceration commences ; in many cases it precedes the pain and is the first symptom that excites the alarm of the patient. It is frequently mistaken for monorrhagia ; but its real character must be ascertained by a vaginal examination. The amount of blood lost varies a good deal in differ- ent persons ; it is some times very large. The progress of the ulceration appears to be arrested, and the pain relieved for a short time after each flooding : though the weakness of the patient is much increased. 3. The discharge : The moment ulceration commences 248 CANCER OF THE UTERUS SYMPTOMS. the odor of the discharge becomes fated and almost insup portable ; its color varies from a dirty white to a dark brown, green, or black, occasionally tinged with blood, Besides being a great annoyance to the patient it now almost forbids that degree of attention from friends which is so consoling to the sick. It is also extremely acrid, giving rise to extensive excoriations around the mouth of the vagina, and extending to the anus. After some time,- the bladder and rectum become still more affected, producing much suffering from dysuria and tenesmus ; and when the ulceration reaches those organs causing their contents to be discharged into the cavity of the pelvis, and even reaches to the external organs, the measure of the sufferings of the patient is full. • When a woman reaches this frightful period of the dis- ease, she presents the most heart-rending picture of human misery ; in fact, the functions of assimilation are exhaust- ed ; appetite is gone, digestion is deranged in a thousand ways ; emaciation, more or less rapid, sometimes passes into mai*asmus ; the osseous system participating in the disease, becomes fragile, and breaks of itself, as it were. The skin, which is dry, swollen, wrinkled, and adherent to the bones, assumes the dull, white color of wax, or the yellow straw color which characterizes cancerous affections ; the attitude has a peculiar character in this diseased condition ; the sad and drooping expression bears the impress of suf- fering and depression ; the eyes sunken in their orbits, the livid and singularly contracted lips, the fuliginous teeth, the drawn hippocratic face, furrowed with deep wrinkles, give to the patient the aspect of a corpse : finally, colliquative diarrhoea, symptomatic of intestinal ulceration, vomiting, general dropsy, hectic fever, insomnia, intoler- able sufferings, profuse hemorrhages, despair and death come to complete this sad and afflicting scene. (Colombat.) Although the order of symptoms we have described, are observed in most cases of cancer of the womb, yet, of course, there is more or less variation ; in rare cases, as we have remarked, there will be little or no pain, and in others, but little hemorrhage. The prognosis is extremely unfavorable. Care must be taken to distinguish this dis- ease — 1. from simple induration and ulceration; 2. from CANCER OF THE UTERUS TREATMENT. 249 Jibrous tumors, moles, and hydatids; 3. from corroding ulcer. Treatment. — Whether this formidable disease is curable, even in its earliest stages, is, to say the least, questionable. Notwithstanding, many able men have employed certain remedies against what they supposed to be cancer, and, according to their testimony, with beneficial results: those who have flattered themselves that they have succeeded in curing it, have probably been deceived by their success with ulcers resembling the one in question. The reme- dies which have been used at different periods with appa- rent success, are cicuta, bitter tonics, with alkalies, bella- donna with rhubarb, hydrochlorate of baryta, cyanuret of lead, oxyde or muriate of gold, iodine, etc. All our means should have for their object, to arrest and crush the disease at its origin ; to remove all exciting causes, and prevent its return by the most attentive care. There seems to be good reason to suppose that the primary source of cancer of the uterus, is chronic inflammation of that organ ; therefore, to avoid and cure this disease, upon which cancerous engorgement often, to say the least, depends, is to save the woman from the most frightful of diseases. Even when we can do no more, so' long as the complaint can be kept in the first stage, the life of the patient is in no immediate danger, and her comfort but slightly interfered with. 1. Scirrhus: The treatment of the first stage of cancer is nearly the same as that directed for chronic inflammation, and simple ulceration of the uterus. (See those chapters.) The indications are, revulsive bleedings, exutories, and a soothing regimen ; a milk diet should be directed, white meats, repose, baths, emollient, narcotic and astringent in- jections, enemata, poultices of the same nature, and the other remedial agents, and hygienic directions, already mentioned. The diet should be restricted and simple ; the patient should be gradually deprived of about one half of her ordi- nary food. Milk and vegetables should principally com- prise the articles used ; white meats and fish may be cau. tiously used, if milk does not agree ; bread, rice, Indian, or rye mush, or that made from the unbolted wheat, are L 250 CANCER OF THE UTERUS TREATMENT. particularly applicable, as they obviate costiveness. Everv thing stimulating must be prohibited, whether food or drinks. The fruits of the season may be allowed, with tapioca, oat meal, sago, Indian meal, gruel, etc. Let it be remembered that a low diet is an important means in the treatment of cancer. Bleeding should be employed, with care, where pletho- ra exists; bleeding from the arm", if the pulse indicate it, otherwise, cupping the loins, and the application of leeches to the vulva and thighs. Tepid, general bathing is very useful ; and mild purging, with neutral salts, rhu- barb, etc., must not be neglected. Tlie injections must be sometimes emollient, as starch, mu- cilage, etc., at others narcotic, or slightly astringent, accord- ing to circumstances. Irrigations, or prolonged injections, either simple or medicated, are still more powerful means. Absolute repose must be directed-, and during the day on a matress thrown upon the floor. Narcotics, internally, as morphine, opium, hyosciamus, and cicuta, and by injections of decoction of poppy heads, hyosciamus, etc., to relieve pain, will be found useful. Also, iodine should be perseveringly given : lime water, extract of cicuta, and the ergot have been recommended. The foetor of the discharge may be destroyed, or much lessened, by injections of a solution of chloride of soda and creosote. For the purpose of moderating the profuse watery discharge and hemorrhage, we must resort to cool- ing astringents, internally, and by injection ; but it should be remarked that their suppression invariably hastens the progress of the ulceration. Lastly, we should mention among the means of relieving the sufferings, and prolong- ing life in these disastrous cases, the use of the catheter for the purpose of relieving the bladder; and, also, in con- stipation, the use of mild laxatives, as decoctions of tama- rinds and prunes, as well as enemata of honey and olive oil, etc., and by appropriate suppositories. Constant atten-. tion to cleanliness is to be observed throughout the disease. 2. Cancerous stage: The treatment now becomes more complicated, but less effective in relieving the patient. The rapidity of the progress of the disease is greatly increased and all we can expect to do by the power of medicine is, CANCER OF THE OVARIA. 251 to give temporary relief by a sedulous application of all those means just mentioned for the first stage. The ques- tion of calling in the aid of surgery must now be decided, as no remedy is supposed to be too desperate, which offers the slightest chance of relief; according to the extent of the destruction, either excision of the neck, or extirpation of the whole uterus has been proposed ; but of these formid- able operations, it does not come within our purpose to speak, in this volume. — — Cancer of the ovaria is, without doubt, the most seri- ous disease to which those organs are exposed. It is quite as frequent as cancer of the breast, which we are soon to notice, and nearly as much so as cancer of the uterus. Its time of occurrence varies a little from the last named disease, appearing more frequently during the middle period of female life. There are very few circumstances in which this malady differs from the one last described ; it presents about the same characters and symptoms, which only vary in the first stage on account of the difference in location. Its progress, particularly in the first stage, is slower, and it attains a much larger size ; it frequently occupies years in forming, and is in its last stage often associated with uterine cancer. It probably originates from, and follows, as in the uterus, chronic inflammation. Indeed, when we reflect upon the activity of the ovaria, and the derange- ments to which their function is subject, (which we have enumerated,) at every epoch of menstrual life, it is not wonderful that they are liable, at a later period, to more serious disease. Its treatment, when fully established, is only palliative, the same as previously mentioned for cancer of the uterus, by which life may be much prolong- ed. It is unnecessary here to repeat those cautions of at- tention on the part of the female to earlier derangements, that we have so often pointed out in the course of this work, by which, without doubt, these more serious mala- dies might be often avoided. CHAPTER XIV. CANCER OF THE BREAST CAUSES SYMPTOMS AND TREAT- MENT. - It is a sad reflection that woman, who is destined by- nature to give us existence, while in the performance of those high duties, should become the victim of the most fearful diseases. Cancer of the breast, from its being more easily observable, and accessible, has excited more attention, and is more within the reach of the healing art, than the occurrences of it already described. Nothwithstanding the mammary glands are originally the same in both sexes, this disease but rarely attacks the male, while it is a common affection of the female, occur- ring most frequently in those in whom the peculiar func- tion of the breasts has been brought into action by child- bearing. Its most frequent occurrence being connected with the great afflux of blood to the breasts for the secre- tion of milk, it may be reasonably supposed the result of a chronic inflammation there generated from various causes, which we shall more particularly describe when we speak of inflammation of the breasts, in Book II., of this volume. Cancer of the breast has been met with at the age of twenty and of thirty, but much more frequently at a more ad- vanced period. There are several varieties of this dis- ease, which it is unnecessary for us to dwell upon. Causes, — First, among the exciting causes of this for- midable disease, may be mentioned, the pressure of tight corsets, adjusted with a view of pushing the breasts up- wards, or, on the other hand, to flatten them and lessen their apparent size ; the inconsiderate use of discutient applications to the breasts, when inflamed or affected with simple and chronic engorgements ; the sudden impression of cold air, especially soon after a confinement, and the astringent applications designed to check the secretion of milk ; in short, any thing which has the effect of irritating CANCER OF THE BREAST TREATMENT. 253 this organ, and giving rise to milk or congestive engorge- ments, produces a condition which may degenerate into cancer. Other internal causes may be mentioned, as irregu- larities and suppression of the menses ; the cessation of a chronic leucorrhea, an old issue, or piles, and certain cu- taneous eruptions ; the metastasis of gout, rheumatism, erysipelas, etc. — all of which may give rise to cancer, particularly when a certain predisposition to it already exists, known as the cancerous diathesis. Symptoms. — As these do not vary, excepting in a few slight particulars, from the general course of those enu- merated under cancer of the uterus, we shall only mention the following unmistakable characteristics : the tumor, which is seated upon some part of the breast, is hard, un- equal, indolent, insensible to pressure, movable with the fingers, and the skin is of a natural color ; if this tumor have existed for some time, and particularly if it have resisted the treatment for scrofula and chronic inflamma- tion, and become the seat of sudden, lancinating pains, its character need not be doubted. By degrees, the tumor increases, and at length it soft- ens in some place or places ; the glands of the axilla be- come swollen, hard, painful, and filled sometimes with cancerous matter ; the tumor breaks, perhaps through the skin, and presents the shocking spectacle of "open can- cer ;" the general health gives way, and the skin presents a straw colored tint. During this process, unless the patient die prematurely, or the original disease be removed by a surgical operation, cancerous tumors form in one or in several of the internal organs, and give notice of their presence by appropriate symptoms. (Watson.) Our space will not allow of our pursuing the subject further, in paint- ing the horrors of its progress and termination ; neither is it necessary, and we shall close the subject by pointing out the most appropriate remedies for its relief. Treatment. — The treatment of cancer of the breast is divided into the preventive, the curative, and the palliative. 1, The preventive: This consists in combating and re- moving by the most suitable means, certain diseases and derangements of the functions which, it is supposed, may Prove to be the sources of cancer ; such as milky engorge- 554 CANCER OF THE BREAST TREATMENT. ments, and the different acute and chronic inflammations of the breasts, scrofulous swellings, so called, etc. Time- ly attention to these various affections is of the utmost importance. The preventive treatment, therefore, is nothing more than the curative treatment of the pre-exist- ing disease. It is by this method that many distinguished physicians, having dissipated the various chronic engorge- ments of the breasts, have believed that they have cured cancer, when, in fact, they have only prevented it. The treatment of such engorgements and tumors of the mammae, consists, first, in removing the causes, when they are discoverable, and then resorting to the employment of different means, which will be more particularly pointed out in Book II., under inflammation of the breasts. We remark here, that if the disease be in the acute stage, and the woman plethoric, a general bleeding will be useful; then the application of leeches about the tumor, which should afterwards be covered with an emollient poultice. An observance of the following directions will very mnch contribute to a cure : a mild diet, the same as mentioned under cancer of the uterus ; demulcent and diaphoretic drinks } bathing and frictions of the skin ; moderate ex- ercise, avoiding violent movements of the upper extremi- ties, so as not to interfere with the diseased gland ; resi- dence in a dry and well aired situation ; gayety, with quiet and agreeable amusements ; and, finally, a perfect performance of all the functions of the economy. As soon as the tumor ceases to be painful, by the em- ployment of these various means, and not before, discutients, and resolvents, may be made use of, with the precaution, however, at first, of associating them with emollients, lest they produce inflammatory action. Poultices of flax-seed, etc., with elder flower water, infusions of camomile, de- coction of roses, or soap and water, may be used ; then, stimulating liniments, and plasters, as the camphorated, ammoniated, and mercurial ; and, lastly, great good may be expected from the use of the tincture of iodine, exter- nally, as well as internally. At the same time, the bowels must be kept free by mild aperients, and some of the bit ter tonics and alteratives should be exhibited. Small blis< CANCER OF THE BREAST TREATMENT. 255 ters, and the occasional application of leeches to the part affected, have, also, been recommended. 2. The Curative: Whatever designing individuals may. say to the contrary, confirmed cancer is incurable by the resources of medicine alone ; it is so regarded by almost all the eminent physicians of modern times ; there is no other remedy than the knife. We cannot better present and fortify our sentiments upon this subject, than by mak- ing the following extracts from Dr. S. Cooper, of London : " When the breast is affected with scirrhus, or ulcerated cancer, the imprudence of tampering with the disease cannot be too severely censured. Were the disorder un- attended with a continual tendency to increase, some time night be. properly dedicated to the trial of internal reme- dies and external applications, which have acquired any character for doing good in these unpromising cases. But, unfortunately, by endeavoring to cure the disease by medi- cine, we only afford time for it to increase in magnitude, and at length attain a condition in which, even the knife cannot be employed to take away the whole of the diseased parts. When the case is marked by the characteristic features of scirrhus, noticed in the article cancer, the sooner the tumor is cut out the better. " There are, also, some malignant kinds of sarcoma, (fleshy tumors,) to which the female breast is subject, which cannot be removed at too early a period after their nature is suspected or known. Indeed, though there is not equal urgency for the operation in many other tumors, yet, as the most of them are continually growing larger, and little success attends the attempt to disperse them, the practitioner should never devote much time to the trial of unavailing medicines and applications, and let the swelling attain a size which would require a formidable operation for its excision. It is, also, to be remembered, that many simple, fleshy, indolent tumors, are accompanied with a ijertain degree of hazard of changing into very malignant brms of disease." Experience proves that, most often, when cancer is removed in its early stages, it is successful in preserving the patient from a lingering and awful death. Even if the disease return after a few years, as it occasionallv will, £56 CANCER OF THE BREAST TREATMENT. the condition of the patient is far better, and the suffering inconceivably less, by submitting to the operation ; and now, that it can be done while the patient is wholly un- conscious — under the influence of sulphuric ether — she ought not to hesitate. For the purpose of guarding our readers against a certain class of empirics who infest the country, professing to cure cancer, we quote the following sensible and very true remarks of Dr. Dixion's, upon the subject of "cancer plasters": "It is a deplorable reflec- tion, that human cupidity can be found of so base a char- acter, as not to scruple to speculate upon the infirmities and lives of the unfortunate : but so it is. We are con- stantly reminded of the weakness of our moral nature, by the facility with which the unfortunate are induced to use remedies boldly announced as capable of curing cancer, aided by the attestations of others, who corroborate their assertion, from ignorance of the disease. " If the mind, under suffering, only retained its calm- ness, there could not be so much error on this subject. None of these empirics pretend that their remedies do not produce pain ; they are all employed to ' eat out the can- cer.' Several weeks' application is often necessary, ac- cording to their own account ; and then, should the sore heal up, it is certainly evidence that it could not have been cancer ; for> in the name of reason, how could the plaster evince such discerning powers, as to select the diseased parts and leave the sound flesh? The surgeon uses the greatest care to include, in his rapid incisions, every parti- cle of the ' hardness,' well knowing if he does not, the disease must return. Arsenic, mercury and lead, in some of their forms are the basis of these plasters ; and the in- expressible agony — as we have been told by those who have undergone their application, and, after all, been obliged, when too late, to submit to the operation — is far greater, each moment of their action, than the knife ; and this continues for days, and often weeks together. It i» but a short time since the coroner was called to inspect the body of the unfortunate mother of a family in this city, who had been poisoned by the absorption of arsenic from a plaster applied by one of these wretched traffickers in human life. We were called to see another, who had CANCER OF THE BREAST TEEATMENT. 257 lost an eyelid by the corrosive action of a similar prepa- ration ; and this, too, as she assured us, for a trifling en- largement of a little blood-vessel — ' a mere speck, the size of a pm's head,' as she expressed it — that had remained from infancy to her twenty-fifth year ! What more con- clusive evidence that it was not a cancer, could there be? Cancer never attacks an infant, as every one knows." These cases, and similar ones,, are numerous all over the Union : sufficiently so, it would seem, to demand the at- tention of Government, to prohibit such fatal practices. Palliative treatment : When cancer of the breast, from extensive destruction of the parts, is no longer in a condi- tion for an operation, or, when the patient refuses to sub- mit to the operation, certain remedies are useful in pro- longing life, and in more gently conducting her to the grave. With this view, a milk and vegetable diet, with the white meats only, should be allowed. The pain and nervous symptoms must be opposed by opiates and anti- spasmodics, in the form of potions, pills, enemata, etc.; also, anodyne, fomentations, and cerates to the part ; and, finally, the use of baths, and the occasional application of leeches, are not to be neglected ; and happy for them, if they can add to the oblivion of their ills, the sweet illusions of hope .' There are a variety of other fumors of the breast, that require about the same treatment as cancer ; the principal of these are, the encysted, and fibrous tumors ; which, from their liability to degenerate into malignancy, should, with- out hesitation, be extirpated. Finally, scrofulous tumors of this part, which are sometimes followed by ulcers of cancerous appearance, but readily distinguished by the absence of shooting pains, etc., rarely resist the anti-scrofu- lous treatment, which is by the internal and external exhibition of the preparations of iodine. CHAPTER XV. DISEASES OF THE OVARIA AND FALLOPIAN TUBES ENCYSTE1 DROPSY CAUSES SYMPTOMS AND TREATMENT. Diseases of the ovaria and Fallopian tubes are, in general, so obscure, that we need not, in this work, enter intimately into their description. In treating of the disor- ders of the uterus, we referred to similar affections of these organs, for the purpose of showing their connection; such as acute and chronic inflammation, fibrous tumors , displace- ments, and cancer ; all of which, are more or less com- mon to all these organs, and occur under similar circum- stances. We now refer to them for the purpose of their inclusion in one view, and of showing their relation to an important disorder, which is the subject of this chapter. Chronic inflammation of the ovaria, from causes which will soon be pointed out, is now charged with the agency of producing these abnormal degenerations, as well as those which we are now to mention* The organs that are now under consideration, have been found, in making dis- sections, to contain hair, portions of bone and teeth, which are sometimes supposed to be relics of abortive concep- tions, and at others, of monstruous or unnatural formations, inasmuch as they have been found in other parts of the body, and even in males, and virgins before puberty. Such preternatural products have often been met with, but as they rarely grow to a large size, their existence is seldom suspected during life. Chronic inflammation, too, besides ending in abscess, induration, and the diseases above mentioned, very often gives rise to encysted tumors, known as dropsy of the ovaria. Encysted dropsy of the ovaria is one of the diseases to which the female is most liable : although it has been known to attack young females who have not menstruated, it is far more frequent during the period in which the ENCYSTED DROPSY OF THE OVARIA CAUSES. 259 ovaria are in the full performance of their functions. The disease consists merely in a morbid accumulation of fluid in one or more of the Graafian visicles, or in the Fallopian tubes. Notwithstanding, it is probable that the formation of these cysts is-always the same, it has been divided into several varieties, which it is not necessary to notice, they having reference principally to the number of cysts, or sacks, that contain the morbid fluid, of which the disease consists. The texture of an ovarian cyst is fibrous : sometimes very thin, and at others, on the contrary, very thick. The fluid is generally serous ; it may be limpid, ropy, albumi- nous, gelatinous, sanguinous, purulent, of a chocolate color, or like coffee grounds, etc.: it sometimes undergoes putre- factive decomposition. The quantity of this fluid varies very much in different cases ; at first, the accumulation is scarcely perceptible, but it may become enormous : from fifty to one hundred pounds, and even more, has been men- tioned as having been found. At first, but one of the ova- ries is generally affected, but when it is of long standing, both almost always become implicated. It should be re- marked, that this disease is often combined with a cancer- ous state of the cyst. Causes. — The disease rarely occurs before puberty, or after the "change of life," and most commonly at that period of life during which the genital organs are most active ; which is from the twentieth to the forty-fifth year ; and particularly in women who have borne children. So, that age may be said to be a predisposing cause. The exciting causes are the same as those enumerated as giving rise to inflammation of the uterus : the principal of which are, external violence, such as blows and falls ; irritation and excitement of the reproductive system by masturbation, and excessive coitus; deranged menstruation; passions and emotions of the mind, etc. Symptoms. — The symptoms of this disease, at first, are very obscure. When it becomes advanced, they so much resemble the signs of pregnancy, that the female often supposes herself in that situation : there is a gradual en- largement of the abdomen, as well as of the breasts ; the menses are suppressed; there is vomiting, capricious ap- 260 ENCYSTED DROPSY OF THE OVARIA SYMPTOMS. petite, etc. The progress of the tumor is generally very slow — often requiring several years to make it perceptible externally. Before it becomes sensible to the touch, the woman, most often, has a dull pain and a sensation of weight in the groin and hip ; soon after which, the tumor may be felt near one of the groins, generally character- ised by fluctuation. When the encysted tumor attains a considerable magnitude, the adjoining viscera being more or less displaced, and inflamed by the pressure, attract adhesions with each other, as well as with the tumor itself; this gives rise still more to dragging sensations upon any change of position by the patient. The uterus, also, is variously displaced ; it is sometimes pressed over to the side of the pelvis — at others, deeply depressed by the weight of the tumor. When the cyst becomes large enough to push the bow- els and stomach upwards against the diaphragm, the pow- ers of digestion, as well as the respiration, are embarrass- ed. Obstinate constipation, and sometimes dysuria, now supervene ; the fluctuation becomes more evident, and the fluid, which appears to occupy the whole abdomen, often leads to a belief that the case is one of ascites or general dropsy of this region. Sometimes, when the tumor has arrived at this stage of its development, it remains station- ary for several years ; but, generally, when the encysted tumor becomes very large, the patient is incapable of much motion, from the great disorder of the functions, caused by its pressure ; and lastly, there is imminent dan- ger of sufFocationj painful and obstinate constipation, sup- pression of urine, and a hectical form of fever is liable to supervene, which is the forerunner of approaching disso- lution. Before the tumor descends from the cavity of the pel- vis, it may be discovered, by an examination per vaginam and per rectum, between those two organs. After its as- cent into the abdomen, an examination will reveal the elevation of the uterus. In order to distinguish it from other affections of this region, a close attention is neces- sary to all the circumstances attending the progress of the abdominal tumor. Treatment. — At an early period of the disease, whilst ENCYSTED DROPSY OF THE OVARIA — TREATMENT. 261 the tumor is in the cavity of the pelvis, there is some hope in a palliative course of treatment, though the suc- oess heretofore, has been very limited. A great number of remedies have been employed, which are at present abandoned. At first, alterative diaphoretics may be used, such as sarsaparilla, guaiacum, and the preparations of iodine, internally as well as externally, in the form of ointment; also, sea bathing or salt water baths; and antimonial friction, or small blisters and bleedings upon the abdomon. Diuretics may be useful, as squills, nitre, etc. And lastly, purgatives deserve a trial, in connection with the other remedies, such as rhubarb, aloes, croton oil, etc., in small doses. These, with a low diet, and compression of the abdomen, are about all the means that can be resorted to with a prospect of producing absorption of the effused fluid. Sometimes relief may be obtained by pushing or assisting the tumor out of the pelvis, into the abdomen. When the cause of the disease can be de- tected, it must, of course, be instantly removed ; an ap- propriate system of hygiene, also, should not be neglected. When the tumor has ascended into the abdomen, it is generally ackisable to postpone surgical interference as long as possible ; but when it becomes so large as to much interfere with the vital functions, the fluid should be evacuated by the operation of tapping, which, though somewhat dangerous, is not very often fatal. This opera- tion is resorted to as often as becomes necessary from a re-accumulation of the fluid. A remarkable case of this kind, is on record in the Philosophical Transactions of England for the year 1784, wherein the complaint began after a miscarriage, at the age of twenty-seven. From the year 1757 to 1783, when she died, she had been tap- ped eighty times, and had in all, evacuated 6631 pints of fluid, or upwards of thirteen hogsheads. The largest quantity taken away at any one time was 108 pints. Finally, we should remark, that from time to time, ■tirg< ons of talent have attempted the removal of diseased ovinia by the knife, which has been done with success. Still, when we compare the chances of its being success- ful with the great number of deaths that have resulted prom it, and consider the formidable nature of the opera- 12* 262 CONCLUSION OF BOOK PIRST. tion we cannot forbear being unfavorably impressed in regard to its practicability. It is our opinion, that in the majority of cases, the chances of life for the female, are in favor of a palliative course of treatment ; this will often enable her to arrive at the allotted age of life, under comfortable circumstances. We here conclude our remarks upon this part of our subject, viz. : the physiology of woman and her dis- eases, INCLUDING ALL THOSE OF HER CRITICAL PERIODS ; by which, is understood, of course, the physiology and dis- eases peculiar to females ; those relative to pregnancy AND CHILDBIRTH, WITH THE MANAGEMENT OF PREGNANT AND parturient females, which figure in our Title Page and Table of Contents, are sufficiently numerous and impor- tant, to constitute a separate consideration, and will form the subject of Book II., of this volume which immediately follows. Though it is evident from the sad and lengthened pic- ture we have just traced in enumerating the various mali- dies to which woman is subject, that there is truth, though exaggerated in the declaration of Democrittis in his let- ter to Hippocrates, in which he says " Uterus sexcentarum cerumnarum in mulieribus causa" — and that though many of them are extremely serious — it is also evident, that we may generally hope for their prevention and cure, by applying in due time, the various hygienic and remedial agents at the same time enumerated. It was never intended by a beneficient Deity that wo- man, one of the most beautiful objects of creative power, should become the subject of numerous and painful diseases. We have no hesitation in saying, in conclusion — being greatly impressed of its truthfulness — what is of the greatest importance for females to understand that, in general, women may avoid most, if not all, of the disorders to which they are incident in their present condition by con- forming to the intentions of Nature in their creation, or in other words, by living physically and mentally according to the normal organic and moral laws. BOOK II. THE PHYSIOLOGY OF PREGNANCY AND CHILDBIRTH WITH THE DISEASES INCIDENTAL THERETO. 363 THE FGETAL CIRCULATION.* * The child is represented with the trunk and abdomen laid open, and the placenta or after-birth, with the umbilical cord consisting of two arteries and one vein j the mode of connection is seen between die placenta and child, for the nourishment of the latter. 1. 1. The placenta. 2. The umbilical cord or vessels — their union with the placenta is seeu. 3. 3. The umbilical arteries. 4 4. The THE PHYSIOLOGY AND DISEASES OF PREGNANCY AND CHILDBIRTH. PART I. INTRODUCTORY REMARKS. Notwithstanding the term disease has been applied to designate the various sympathies which are called forth by pregnancy, it is retained only for the purpose of giv ing a more intelligible explanation of the temporary com plaints that arise in by far the greatest majority of women while in that condition. The state of pregnancy, may be regarded as an altered, but cannot with propriety be termed a morbid state ; on the contrary, it is well known, that in order to have this process carried on agreeably to the arrangement of nature, it is essential that -the fetus and uterus, both retain, almost perfectly, their healthful integrity. For if either the one or the other become dis- eased to any extent, the intentions of nature of forming a umbilical vein. 5. The ascending vena cava which discharges into the right auricle of the heart, carrying the placental blood into the circula- tion of the child. 6. The left lobe of the liver. 7. The heart. 8. The aorta. 9 The descending aorta artery. 10.10 The iliac arteries — the commencement of the umbilical veins is seen, which return the blood to the placenta. The blood is brought from the placenta, (which during gestation is ad- herent to the uterus of the mother) by the umbilical vein ; much of it is spent in its passage through the liver — the remainder is carried into the left hepatic vein, and from thence by the ascending vena cava into the right auricle of the heart. During foetal life, there being a passage fioin the right to the left side of the heart by the foramen ovale, much of the blood passes through that opening, the communication by the lungs not being established till respiration takes place. From the left side of the heart the blood is discharged into the aorta; finally, it passes down- wards to the iliac arteries, and is conveyed from thence back to the pla- centa by the umbilical arteries. 266 INTRODUCTORY REMARKS. new and living being, will certainly be frustrated. Still, while they are preserved in the most healthy state, they possess the power of exciting deranged, and, under certain circumstances, diseased action, in other parts ; and Dr. Denman remarks, what most practitioners of midwifery have observed, that those women are less subject to abor- tion, and ultimately fare better, who have such symptoms as generally attend pregnancy, than those who are ex- empt from them. Pregnancy, then, should be regarded as a physiologi- cal condition, which sometimes borders so closely on the pathological, that it is difficult to distinguish between them ; this derangement is mostly owing to a disregard of hygiene, and infraction of the organic laws, by the fe- male. Before proceeding to the consideration of this con- dition, for the purpose of imparting progressive knowledge, we shall notice the hygiene of marriage, and certain mal- formations and conditions, which, when they are present, prevent altogether, or render the occurrence of, gestation extremely perilous to the female. We shall, then, proceed to point out certain hygienic rules relative to the normal union of the sexes, which will be the substance of what C. L'Isere says upon the subject, an observance of which, is of immense consequence to the human family ; this, with malformation oj the pelvis and genital organs of the female will form subjects for the first two chapters. We shall afterwards, and before speaking of pregnancy, treat of impotence and sterility. The dis- eases of pregnancy wiL be included in a separate section. SECTION I. PHYSIOLOGY OF PREGNANCY. CHAPTER I. HYGIENIC RULES FOR THE NORMAL UNION OF THE SEXES, WITH REMARKS ON VICIOUS CONFORMATIONS OF THE FE- MALE GENITALS, WHICH PROHIBIT THE APPROACH OF THE SEXES. If, on the one hand, the condition of virginity, in our civil institutions, is a state of violence against the impul- sions of nature, very different from the free state of the young females of animals who are subjected, at the period of their loves, to the yoke of passion ; and if, on the other hand, it is generally admitted that marriage is the state most favorable to the happiness, well-being, and health of man, it is important to respond to the call of nature, as soon as the complete development and perfect conforma- tion of all the organs allow. In the infancy of the world, the sexes obeyed in their union only the natural sentiment which attracts them towards each other ; but philosophers, physicians and legislators, made marriage one of the chief objects of their meditations. Seeking to determine the more or less advantageous influence which might result from it to the people, whose happiness they sought to assure, all agreed that the most serious inconveniences might flow from the premature union of the two sexes. In order to prevent the evil effects of marriage before the full development of the constitution, legislators have determin- ed its epochs. Lycurgus and Plato fixed it at seventeen years for girls, and Aristotle at eighteen. Among the Romans, women were authorized by the Poppcean law, to marry at the age of twelve years ; lastly, the Athenians, 268 HYGIENE FOR THE NORMAL UNION OF THE SEXES. less scrupulous, permitted marriage as soon as the indi- viduals believed themselves fit to fulfill its end. This law, fatal to population in general, and especially danger- ous for women, accorded with the customs and warlike policy of the people of Athens. As it would be both use- less and fastidious to«citeall the 'aws and opinions relative to marriage, we shall confine ourselves to saying, that the period ought to vary with the difference of the place, of climate, of people, and with the degree of civilization — since these several circumstances may hasten or retard the first appearance of the menses and the age of complete nubility. The French laws, before the Revolution, forbade legal union, for girls, before the age of twelve years ; but, by the present code, they eannot enter into the conjugal tie until they have reached the age of fifteen complete. The French legislators have permitted marriage at this early period after birth, because they deemed it necessary for the interest of good manners, inasmuch as accidental con- nections between the sexes might occur at that period, to leave some means by which to repair a fault, and legiti- matise children, who, but for this provision, would have a false, and unhappy position in society. Moreover, if it be recollected that marriage is the most effectual means of removing the evils resulting from the violent desires which are often excited in young girls, at an early period, by the education they received, and by the prevailing cus- toms of society, it will be agreed, undoubtedly, that the civil code has been digested with the utmost wisdom. Nevertheless, regarding woman only in her physiological aspect, we think that from eighteen to twenty-jive is the age at which women may marry most advantageously for them- selves and for their children. Besides, there is a rule by which we may always guide ourselves, which is to place at least two years between the time of marriage and tlie first appearance of the menses. It is rare for the constitution to have acquired, before this period, the development necessary for the reproduc- tion of the species. M. Lachaise, in his Hygiene, re- marks : " If the indispensable process of nature, occupied with the completion of its organization, are broken in HYGIENE FOE THE NORMAL UNION OF THE SEXES. 269 upon by the premature enjoyments oF marriage, the female will be exposed to a thousand risks, in her new position ; — become pregnant, she will be unable to support, without the greatest difficulty, and at the expense of her health, the innumerable and unavoidable inconveniences of that condition ; she will be liable to abortions and he- morrhages, and the pangs of childbirth may cost her, per- haps, her life ; — become the mother of delicate and siokly infants, she will pass her youth in uneasiness and tears ; give to the offspring of her love an impoverished milk ; yield herself in order to rear them, to cares and watch- ings beyond her strength ; hasten for them the approach of old age, and tear herself, perhaps, from life at a period when she is ordinarily strongest and most active." Though premature marriages are not invariably followed by such fatal consequences, we may say that they always influ- ence more or less, the physical and moral condition, and hasten the termination, already too precipitate, of youth and beauty. In women who are well formed and fully developed, the first enjoyments generally produce a favorable impres- won upon the constitution ; never heless, it sometimes happens that the genital organs become the seat of inflam- mation, or that newly-married persons suffer from some spasmodic disorders which readily yield to absolute repose of the organs, to the employment of general baths, seda- tive drinks, narcotic and emollent enemeta and lotions ; lastly, to general depletion, where the pulse is full and the reaction very violent. While a moderate enjoyment in the marital embrace generally produces useful effects, when too often repeated it occasions lassitude, feebleness and general depression ; the beauty is soon destroyed, the grace and freshness of youth are soon withered ; finally, when the abuse of coi- tus is kept up, it may determine inflammations and ulcera* tions of the vagina and uterus, leucorrhea, uterine hemor«* rhage, disorders of the digestive and nervous apparatus, acute and chronic gastritis, attacks of hysteria and nym- phomania, feebleness of all the senses, loss of memory, stupidity, moral inferiority, caries of the vertebrae, aneu- 13 270 HYGIENE FOR THE FORMAL UNION OF THE SEXES. risms, especially of the heart, pulmonary consumption, marasmus and death. Under all circumstances, young married persons ought to proportion their pleasures to their forces, and should recollect that the first conjugal approaches require certain cares and precautions, the forgetfulness of which might lead to the most unhappy results. When the consumma- tion, of the marriage meets with too great resistance, especially when there is disproportion between the organs, the husband, young, full of vigor, and sometimes inexpe- rienced, instead of abandoning himself to' all His trans- ports, should seek to overcome the obstacles with care and circumspection. In general, the difficulties which the first essays of marriage present, are least during the period of the menses and for some days afterwards. We may remark, also, that the use of unctuous substances of emollient fomentations, and of general baths, and that the effusion of blood, even, which generally follows the first attempts may determine a useful relaxation in cases of difficulty. Nevertheless, if too great a resistance should be met with, far from making violent efforts that might endanger the life of the female, some unnatural conforma- tion ought to be suspected, and the assistance of a surgeon be envoked against an obstacle, which he, alone, can sur- mount without risk. As conception is the most natural consequence of the marital connexion, and though the reproduction of the species is the chief end of the institution of marriage, they are yet certain circumstances, which, however im- perious the senses, and however powerful the laws of the social condition, should be held as authoritative enough to forbid the sexual approach, as regards some women, in whom it threatens to become the fruitful source of dan- gerous diseases, and often, indeed, the cause of death itself. Among the number of deformities which contra- indicate marriage for such persons, we should place in the first class those which are capable of preventing the act of generation, or that of parturition, such as insufficient capacity of the pelvis, or absence of the vagina. The first-named fault of conformation would place the woman under the cruel alternative of undergoing the Caesarian DEFORMITY OF THE PELVIS. 271 operation, or that for the section of the symphysis pubis ; or, at least, of seeing her offspring sacrificed and extract- ed piecemeal. In general, we may presume that there is vicious con- formation of the pelvic cavity, whenever we find a curve in the vertebral column, which allows the last lumbar vertebra to sink in towards the posterior and upper part of he ] elvis ; where the haunch bones are not very appa- eh\ and are very much elevated on one side ; where the nigl^ are closely approximated to each other, and, in fine, whoie a curve in the long bones and swelling of their articular extremities indicate a general rachitic condi- tion. It is true, however, that we have seen some hor- ribly deformed women, with a well formed pelvis, and lyin^-in very easily ; while there are others, who, with all the appearance of a regular conformation, cannot bring their children into the world, and almost inevitably perish, because they have the superior strait of the pelvis with an antero-posterior diameter of not more than two inches. Parents who should suspect the existence of such pelvic deformity in their children, ought never to consent to their marriage, without first taking the opinion of a capable physician ; for though an examination into the facts of such a case gives a shock to the modesty of the female, such a sentiment ought not to be put in balance against the life both of a mother and her child. Among the disorders that ought to be admitted as obsta- cles to a legal union, we place, pulmonary consumption, aneurism of the large arterial trunks, idiocy, insanity, and even epilepsy, where that disease continues after the age of puberty. CHAPTER II. YICIOUS OR ABNORMAL CONFORMATION OF THE FEMALE PEL- VIS, AND GENITAL APPARATUS CAUSES AND TREATMENT. The pelvis as well as most or all of the femalo genital organs are subject to malformation, either congenital or 272 DEFORMITY OF THE PELVIS. accidental. And, although some of these are beyond tne resources of art, as absence of the womb, vagina, ova- ries, etc., there are many susceptible of remedy ; as for example, cohesion of the labia and nymphae, obliteration and narrowness of the vagina, etc. DEFORMITY OF THE PELVIS. By deformation of the pelvis is understood, when it is sufficiently altered, either in its form or dimensions, to render delivery difficult, dangerous, or impossible. All deformities of this cavity, are usually classed under three heads ; excess of amplitude , narrowness, and faulty direc- tion of its axes. It would seem before examination that a very large pel- vis ought to be rather an advantage to child-bearing, than the contrary : but observation proves that this is not the case. This conformation, besides conducing to displace- ment of the uterus in almost any direction, also favors the descent of the womb and consequently prompt termination of labor, exposing the woman to those accidents that fol- low rapid delivery — the principal of which are inversion of the uterus and hemorrage. There may be simply a want of amplitude, or, which is much more common and dangerous, partial narrowness, changing the diameters of the inlet, cavity, or outlet ; or several of these deformities may be conjoined. (See the normal pelvis at page 20.) These different abnormal con- formations give to the pelvis a great variety of forms, which our limited space will not permit us to dwell upon. These various faults of conformation change more. or less the planes and axes of the pelvis. The most com- mon deformity of this kind, is projection of the sacrum to- wards the pubis, the hollowness of the lumbar region or back, being augmented. The effects of all these faulty conformations are, to ren- der labor either painful, tedious and difficult, or impossible. We should remark that those of the second class, or nar- rowness from deformity, are the most embarrassing. As we spoke sufficiently in the last chapter of the manner of detecting these deformities, and it not coming within our DEFORMITY OF THE PELVIS TREATMENT.. 273 purpose to speak of the modes of "mensuration" of the pelvis, we shall pass on to the causes. Causes. — Deformities of the pelvis may take their rise in childhood, or may be produced after adult age. In the former case they are commonly the result of rickets, where there is softening of the bones : the child by too much standing upon the feet, sitting, or lying upon the back, fa- vours that part to give way which is least resistant. The action of the powerful muscles which surround the pelvis, also, in certain cases, favor the production of this condi- tion. In the latter .case, or after the first periods of child- hood, these deformities are generally the result of mollities ossium, either general or partial, of irregular action of the muscles, and of bad attitudes. Young girls, who, for the purpose, as they suppose, of obtaining elegance of form by increasing the prominence of their hips and the depth of the lumbar hollow, keep the head and pelvis thrown strong- ly backwards while they project the abdomen and breast as far forwards as possible, never think that they run the risk of never being able to become mothers, without ex- posure to the greatest danger. A diseased hip wearing an artificial limb, fractures, etc., also, sometimes give rise to this condition. The treatment of course consists only in avoiding the causes as far as possible, and of avoiding when necessary the social relation in which the female exposes herself to become pregnant, and consequentty to the Caesarian sec- tion, or some other painful operation. Women have not been afraid to become pregnant again, after having under- gone this formidable operation. Dr. Velpean says, in speaking of the grounds of opposition to pelvic mensura- tion : is it really the attraction of pleasure that always in- duces them to yield to the brutal husband that the law has given them ? Is it fair to compare a woman who fears above all things to lose the affections of a man to whom she is united for life, to a young girl, who, free from all entanglements, ought to think first, and above all, of her own safety ? M 274 COHESION OF THE LABIA — TREATMENT. OCCLUSION AND ABNORMAL CONFORMATION OF THE EXTERNA! SEXUAL ORGANS. 1. Union of the labia is sometimes found to exist in female children at birth. When it is complete, nothing iu to be seen but a seam, the vagina, clitoris urethra, etc., being all enclosed. This condition is announced soon after birth, by the crying of the infant, when a fluctuating tumor may be detected above the pubes, and there is all the symptoms of suppression of the urine ; death will soon be the consequence, unless measures be taken for reme- dying the difficulty. In some cases the cohesion is not complete, and the urethra is sufficiently open to give free passage of the urine ; in others, the obstruction is such, as only to admit of its escap- ing drop by drop. In the former case, it is of no inconve- nience till the period of puberty, when it obstructs the flow of the menses ; but of this we have already spoken. (See Tardy Appearance of the Menses.) This condition is not always congenital ; it may be occasioned by inflammation, brought on by laborious labor, a burn, a wound, or a laceration ; by excessive coitus, and finally, in children, by excoriations from acrimony of the urine, friction, want of cleanliness, etc. It is said that some of the Ethiopian tribes make sure of the virginity of the female by uniting the sides of the labia as soon as they are born, with silken thread, leaving only sufficient space for the natural discharges; when married their lords make the necesary section for their restoration. Cohesion of the nymphse always accompanies that of the labia, but it may exist independently of the latter. Its causes and treatment are the same. Treatment.— The treatment consists in an operation suitable for the restoration of the parts, as nearly as possi- ble, to their normal condition. In all cases it should be performed as soon as discovered, particularly when the cohesion is complete. In infancy, as we have elsewhere stated, the knife is not necessary, unless the union be firm. But at a more advanced period, the operation must be performed by means of a bistoury guided with a direc- tor. To prevent reunion, a piece of lint, or a compress EXCESSIVE GROWTH OF THE NYMPHS CLITORIS. 275 spread with cerate, sh3uld be interposed until the cure is oomplete. Strict cleanliness must be observed, to assist which, recourse should be had to emollient baths and lotions, according to circumstances. 2. Excessive development of the nymphs, which we have already adverted to, at page 32, Book I., may- arise to such an extent as to interfere with the functions of the female, and be a source of inconvenience and pain, in consequence of excoriations from friction in walking : in such cases their excision is sometimes necessary. Many travellers have stated that in several countries of the East, this operation is a very common one — being re- sorted to by some as a rite, and by others for the purpose of preventing a pretended deformity. It has, also, been stated, that certain women and men, whose sole business it is to excise exuberances of the genitalia, go about the streets crying aloud, " Here is a good circumciser /" etc. A sharp knife and a pinch of ashes comprise the whole apparatus for carrying out this strange custom. 3. Unnatural growth of the clitoris, as we have remarked at page 33, has given rise to the supposed ex- istence of hermaphrodites. During the first month of uterine life, this organ is much larger than at birth — at which time it is still considerable, but is found diminished at the age of puberty. In some women, however, it attains a much greater development, than is ever found in early life. It has, occasionally been found from one to six inches in length,* when it may become the source * Dr. Harris of Philadelphia has recorded an interesting case of this kind, which, for the purpose of illustrating what has been mistaken for the fanciful being, known as hermaphrodite, we will give a brief abstract of: A child was born in Chester county, Penn., of doubtful gander. The gossiping women present, were called to inspect an unusu- ally large clitoris, and to decide the infant's sex, when the little stranger was pronounced a female, and named Elizabeth. As she advanced in years, the clitoris enlarged, and in appearance and size resemdleb, the penis masculinus; she also, grew robust, assumed a masculine appear- ance, delighted only in the labors of the field and manly sports. At eighteen years of age, she was nearly six feet, had moustaches on the upper lip, reversed the descision in regard to her sex at birth, and ex- changed the female attire for man's apparel, and her name for Rees n at the same time threatening summary vengeance against any person 276 UNNATURAL GROWTH OF THE CLITORIS. of disgraceful and disgusting depravity. It is reasonable to suppose from the intense sensibility of this part, that it is often the cause of unnatural excitement, masturbation, etc., leading to the most degrading immorality. In the treatment of such enlargements, cooling and astringent applications with saline purging should first be resorted to — at the same time avoiding exciting food, indo- lence, improper associations, sentimental reading, etc. When these fail, amputation of the salient organ should always be recommended, which is performed without sub- sequent inconvenience to the female, and with producing very little pain. Thus, it is consoling to reflect, that the female may be rid of a djsgusting infirmity, which some- times gives rise to uncontrolable depravity, with perfect safety. Instances are not wanting, in which, girls have been entirely cured of masturbation by this operation, which had resisted all other means. In such cases a competent surgeon should always be consulted. 4. Imperforation of toE female urethra is gene- rally a consequence of complete cohesion of the labia, but exists sometimes by itself, from its being covered by a thin and delicate membrane. When its existence is sus- pected, no time should be lost in giving relief by punctur- ing the membrane,, by means of a suitable instrument. When there is a narrow opening through which the who should venture from that time to speak of her as a female. She now abandoned all female duties, and was employed on a farm, perform- ing all the duties of a husbandman. She never menstruated : at the age of twenty-five had a very strong beard ; was industrious and enterprising, and increased rapidly in wraith, by the purchase and sale of farm stock. Being remarkably athletic and impetuous in her temper, she was the terror of the whole neighborhood, and was always victorious in personal conflicts. About this time she purchased a large aud fertile farm, and married a woman whose name was Elizabeth. In the marrige state, she manifested some affection for her companion, and professed peat enjoyment in con- nubial pleasures — the clitoris having now attained the enormuos length of six inches. It is needless to say that there could be no offspring; indeed, she often said to her companion, "I have no generative power, and if you ever become pregnant. I will put you to death." This extraordinary female lived until she was upwards of fifty years of age, and died in possession of a large estate, which she had accumulated by industry and enterprise. She came to an untimely end by arsenic administered by the hand of her treacherous companion. IMPERF0RAT10N OF THE VAGINA— TREATMENT. 277 urine escapes with difficulty, it should be overcome by the daily use of bougies, beginning with one of a small size. When there is occlusion of the urethra through a great part of its extent, the bladder must necessarily be punc- tured ; if this be too long delayed the child will inevitably perish. FAULTY CONFORMATION OF THE INTERNAL ORGANS. 1. Imperforation of the vagina may be congenital, or it may arise from accident in after life. It produces no inconvenience till the age of puberty arrives, when there is great distress, from secretion and accumulation of the menses. An imperforate hymen is the most common cause ; but sometimes other membranes are formed be- neath it; and occasionally the walls of the vagina are adherent throughout its whole extent, forming, instead of a tube, a solid body. It is sometimes produced by inflam- mation in consequence of injuries from childbirth, or criminal attempts at abortion. At puberty, when the menses accumulate, the symp- toms so nearly resemble those of pregnancy, that learned physicians have repeatedly pronounced it thus, while, in fact, the patient was still a virgin. There is enlargement of the abdomen, pain in the back and loins, swelling of the breasts, nausea, vomiting, etc. All of these symptoms are greatly increased at each menstrual epoch. If relief be not obtained, the accumulation becomes enormous, giving rise to the most painful and dangerous symptoms — hyste- ria, convulsions, etc. If there be absence of the womb or ovaria conjoined, with an imperforate vagina, there is no menstrual secretion, and consequently no inconvenient symptoms. Treatment. — When there is an obstructing hymen some authors have recommended that it be ruptured by the point of the finger ; but very often it will be necessary to resort to the knife or trocar for puncturing it. The ope- ration should be carefully performed, so as to give the pa- tient the advantage of the moral importance attached to the hymen. When the walls of the vagina are adherent, their 278 ABSENCE OF THE INTERNAL GENITAL ORGANS. separation requires great care and skill. We have before spoken of these subjects ; (see Book I., page 34, and 102.) 2. Narrowness op the vagina may be congenital or arise from various accidental causes. Instances are met with in which this organ is barely pervious, being.but a few lines in diameter. It, of course, does not admit of the uses for which it was designed by nature. This difficul- ty may be often overcome by dilating the passage with bougies, commencing with a very small size, as we have directed at the close of the chapter on Painful Menstrua- tion, Book I. Narrowness of the vagina does not always prevent con- ception, although its effects are extremely embarrassing. Several cases are on record in which dilatation was effected after a tedious labor, and others wherein the process was assisted by incisions. We should remark also, in conclu- sion, that this condition always produces difficult and pain- ful menstruation,-^-when an examination should be insti- tuted, for the purpose of ascertaining the exact nature of the difficulty. Narrowness and complete closure of the neck of the uterus sometimes occur, while the vagina itself may be perfectly free from obstruction. It may generally be detected by the touchy and the plan of treatment is about the same as that directed for the vagina, though more diffi- cult, in consequence of its being less easily accessible. Obstruction of the Fallopian tubes, either complete or incomplete is sometimes met with after death. It may be congenital, but is more often accidental from inflamma- tion. This affection is beyond the reach of art. 3. Absence and malformation of the internal or- gans. — The records of medicine contain no instance of the complete and simultaneous absence of all the internal gen- ital organs. In extremely rare cases, one ovary only with its tube has been found, and half of a womb. Both ovaries have been found absent, while the remainder of the organs remained in a natural condition. ABSENCE OF THE INTERNAL GENITAL ORGANS. 270 The womb alone has been found absent and also coinci- dently with absence of the vagina, with a perfectly natural appearance of the external genitals. In such cases of course there is no menstrual secretion ; but when the uterus and its appendages are present, with absence of the vagina, the secretion may take place, and give rise to all of those symptoms mentioned when speaking of Imperf oration of the Vagina. Under such circumstances relief has been af- forded by forming an artificial canal between the rectum and bladder. These cases are extremely rare. The womb has also been found divided into two equal or unequal parts, either partially or entirely— constituting what has been called a double uterus. The vagina has been met with double — that is, divided by a septum into two canals ; and only one third of its usual length and diameter ; it has been also wholly want- ing, as we have before intimated, with the bladder and urethra in immediate contact with the rectum. In ex- tremely rare instances, an unnatural vagina has opened into the bladder, the urethra, the rectum, and externally upon the anterior surface of the abdomen. These defor- mities are not incompatible with health, and may remain unknown till the menstrual secretion takes place, and is discharged by these unnatural routes. It has long been observed that those females who have an absence of the ovaria, whether it be combined with ab- sence of the uterus or not, approach in character to the male ; the delicacy of mind and body is exchanged for the firmness, and an approach to the physical peculiarities of the male. They have very small breasts, hard features, more or less beard, and are fond of manly sports and ex- ercises. There may be, however, serious faulty confor- mations, as absence of the uterus only, or of the vagina, or obstructions of the latter named organ, in which there is, to every external appearance, perfection of the female frame. It would be highly imprudent to say the least, for such an individual to contract the marriage relation, for which she is wholly unfitted. Every mother should know sufficiently of her daughter, and of the existence or non-existence of such grave difficulties, to avoid an event 280 STERILITY AND IMPOTENCE CAUSES. which is sure to bring only disappointment and misery to the bosom not only of the female but also to her partner. In all cases marriage should be postponed until after the eruption of the menses ; or, at least, until a proper inquiry and examination shall have decided in regard to the fitness of the subject to assume the responsible duties and func- tions of the marital relations. CHAPTER III. STERILITY AND IMPOTENCE CAUSES AND TREATMENT. Woman, before the period of puberty, and after the change of life, according to the design of nature, is inca- pable of fecundation ; there may be some exceptions to thi3 rule, which are to be regarded only as departures from the normal condition. During suckling also, when the vital forces are concentrated upon the organ of lactation, the fe- male is generally found to be barren, particularly for the first few months following the birth of the child ;— -though the exceptions here are more numerous than in the former case. But there are many diseases and abnormal circum- stances, which, when they occur, independently of these circumstances, render the female sterile during the child- bearing period. By sterility, is understood an incapacity for fecundation, notwithstanding there is nothing to prohibit copulation, which is, apparently, accompanied with all the conditions necessary for conception ; — depending, probably, upon lorpor or weakness, or absence of seme of the internal organs. Impotence, on the other hand, indicates a want of power, or inability for copulation, either depending upon some physical impediment or abnormal conformation, or upon weakness of the generative apparatus. Causes. — Among the causes of impotence may be enu- merated absence of the vagina, or its accidental oblitera- tion, from inflammation, narrowing of that canal, from con- traction or a tumor, etc. ; cohesion of the labia or nymphse; STERILITY AND IMPOTENCE CAUSES. 281 too great firmness of the hymen, or the existence of any other membrane in the vagina ; excessive enlargement of the clitoris; prolapsus of the uterus or vagina, etc., many of which, as has been seen in the preceding chapter and elsewhere, are amenable to treatment. The causes of sterility are often very obscure : it is probable that they are often connected with some abnor- mal condition of the ovaria — either their absence, want of development, or with diseases of these organs, producing degeneration of structure ; absence or obliteration of the Fallopian tubes ; absence, occlusion, curvature, or chronic inflammation of the womb ; and other malformations and disorders of the genitalia which give few or no signs of their existence during life. Diseases of the uterus, such as cancer, polypus, displacement, dropsy, etc., act sometimes, but not 'invariably, as causes of sterility, as we have re- marked when treating of those various disorders. Dysmenorrhea, menorrhagia and profuse leucorrhea, par- ticularly that species which affects the glands of the neck of the uterus ; impermeability of the neck ; suppression or absence of the menses, etc., are also frequent causes. The latter, or absence of the menses, has been regarded as a sure sign of barrenness ; but it is well - known that there are exceptions. Notwithstanding, the presence of the menstrual discharge has always properly been regarded as the most certain indication of an ability for fecundation. Sterility has been observed to be more common in hot and very cold countries, than in temperate latitudes. De- bility, either of the generative powers alone, or of the whole system from any cause, and particularly when induced by masturbation and an abuse of venereal pleasures, is a com- mon cause in all climates, but more especially in warm ones, where there is a greater excitability of temperament. It is well known that the whole class of prostitutes are bar- ren from this cause. Also absence of voluptuous desires, from this cause, or from an approach in resemblance of the female to the male ; such as is observed in women with small breasts, and who have a general masculine appearance, strong hoarse voices, and brown skins, with more or less beard, and hair in unusual places for the sex ; 282 STERILITY AND IMPOTENCE CAUSES. an excessive embonpoint, and finally, too frequently re- peated and too violent transports. Unsuitable marriages, as to disparity of age, as well as to a similarity of temperament in the parties, often prove unfruitful. It frequently happens that a young couple who are both very vigorpus and passionate, will have no children ; also that a couple who are both lymphatic, cold, and one where both are highly intellectual, are sterile. This seems to be wisely ordered in nature for the purpose of preventing parents from transmitting to their offspring undesirable or monstrous constitutions. Such connections after having been broken asunder by divorcement, and each party made new engagements, have repeatedly prov- ed that the fault was neither in the one or the other ; for they have both had children by being united to their op- posites in temperament. This was the case with Napole- on Buonaparte and Josephine, who, as Larrey has re- marked, were both too highly intellectual to produce the necessary excitement — thus the coldness of each repulsed the other ; yet when separate, they gave proof that the de- ficiency was in neither, but only in their unfitness for each ojher. It is known that Catherine de Medicis brought forth the first one of her ten children, after having been married ten years to her husband, Henry II. ; also, that Anne of Austria gave birth to Louis XIV., after twenty- two years of barrenness. It has been observed in Europe that fewer children are born in Provinces where the inhabitants are poor, idle, weakly and wretched ; also, generally, that in years of famine or scarcity, public calamities, epidemics, fasts and privations, the number of births are sensibly diminished. On the contrary, it is known that many more children are born in a fine and healthy climate ; in countries where the arts and sciences, industry and commerce flourish ; where the earth is fertile and the air salubrious. It is recorded by Dr. Hecker that after the rage of the great epidemic of the fourteenth century, called the " Black Plague," a greater fecundity of women was every where remarkable. During the three years of its prevalence, the mortality is computed at 25,000,000 souls. Those women who live in a state of opulence, are habituated to a too stimulating STERILITY AND IMPOTENCE CAUSES. 233 diet, abuse the use of stimulants, as wine, spirits, tobacco, etc., are very often unfruitful ; — this extreme being quite as unfavorable as the opposite — that is, where there is en- tire destitution. Notwithstanding all these occasional causes, it frequent- ly happens that there are no certain signs by which to ascertain the cause, or to distinguish a barren from a fruitful woman. The late discoveries, however, concern- ing the development of the ovaria, mentioned under the subject menstruation, enable us much better to understand such obscure cases. It is very probable that the ovaria of some women are not properly developed ; that though they may menstruate largely, these essential organs are not normally evolved ; or, that being ripened, the ovae are almost immediately discharged with the menses, on ac-" count of some organic deficiency of power. M. Pouchet is of opinion that the precise time wherein fecundation is impossible, can be correctly indicated, as there is a time between the periods of the menses when no developed ovum will remain. The question is not settled whether the rupture of the Graafian vesicle and escape o£ the ovum takes place antecedent to, in the midst of, or at the close of the menstrual flow ; and it is very probable that this period is variable, and can never be fixed upon. It has been supposed that conception is more likely to occur immediately after the menstrual flow, but this point does not seem to be sufficiently established ; however, as there is more activity in the genital apparatus about this period, qvJ the mouth of the uterus is more open, and as the ovum may not be discharged with the menses, it is proba- ble that conception is more liable to occur immediately before, just after the discharge has disappeared, or several days after it has ceased. Let us remark in conclusion, that too early marriages, and self abuse or masturbation, are frequent causes of sterility, as also are marriages against the inclination ; and although voluptuous desire on the part of the female very much favors conception, perfect indifference is not absolutely incompatible with that event ; finally, intense mental application, depressing emotions, certain humid 284 STERILITY AND IMPOTENCE TREATMENT. localities and states of the weather, are found to exercise a very unfavorable influence. Treatment. — When barrenness depends upon faulty conformation, displacement or disease of the womb, we may hope to obviate it, as we have seen in the preceding and other chapters of this work, by operations, or by medi- cal treatment appropriate to the disease : as we have treated of all these conditions in preceding pages, and as the cure is often evident from the various causes just pointed out, an extended notice of the treatment here can- not be necessary. We should remark in the onset, for the purpose of shield- ing the reader from imposition, that there is no greater fraud practiced upon the credulity of the public, than that of blazoning forth specifics for the cure of barrenness. The ■" Lucina Cordials," "Tinctures," etc., so absurdly sold for this purpose, it is well known, are composed of a few ingredients, which, although they act as- a temporary irritant, in the end serve to prostrate still more those very powers designed to be restored. Cantharides and phos- phorus can rarely or never be employed with advantage in this condition, under the most favorable circumstances. When there is indifference to the joys of wedlock, from a lymphatic and cold constitution, or from debility, gener- al or partial, the cause, if known, must first be suspended ; then resort should be had to a generous diet, tonic baths and drinks, as sea or fresh cold water bathing, and min- eral spring waters ; the diet should be substantial, as black meats, eggs, oysters, jellies, with a cautious use of good wine, chocolate, sage, mushrooms, celery, vanilla, and the various nourishing and exciting articles. Finally, where there is approach to impotency from loss of power on the part of the female, might be recommended in addi- tion, the reading of erotic romances, and frequentaion of the ball-room and theatre — all to be timely employed so as to excite without debilitating. On the other hand, if sterility depends upon excessive ardor and voluptuous- ness, as frequently happens in newly married individuals, a directly opposite course should be pursued, as cooling drinks, cold milk, light, emollient food, cold bathing, long walks, labor, etc., with an abstinence from all indulgen- THE ORIGIN OF HUMAN LIFE. 285 ces. I* 1 of two strong a constitution, recourse n ay be had in addition to venesection. When it is supposed that barrenness arises from defi- ciency of action of the ovaries, electricity may be tried with some hope of success, with stimulating lotions and frictions to the loins and groins. Where the woman is excessively fat, exercise and excitation of the mind as well as the body will be useful : as romance reading, the internal use of spices, mint, aloes, nutmeg, etc. ; also, frictions and stimulating lotions to the groins, thighs and loins. In all cases we should recommend the sexual approach just before and after the menstrual flow, with proper intervals of rest. In conclusion, we should remark that when sterility is supposed to depend upon excessive sensual gratification, the parties should moderate their desires, either by a temporary separation, or by self con- trol. None of the means we have now recommended should be expected to produce an immediate change, but they should all be timely and continuously applied with particular attention to the stomach, bowels, and general health ; by following out this course many remarkable cures have been nerformed, with little or no aid from medicine. CHAPTER IV. THE ORIGIN OF HUMAN LIFE CONCEPTION. The establishment of. the function of menstruation, as we remarked when treating of that subject, is the evidence that nature has designed and is now ready, to produce an independent and living being : or, in other words, that the phenomena of that discharge is but a prelude to the more important function by which the species is reproduced. This is the period, remarks L'Isere, in which woman is called to the fulfillment of her most important task. With- out ceasing to love, the female arrives at length to a calmer and happier state ; having become both wife and parent, she finds new duties, she experiences new sentiments ; 13* 296 ork;l\ of human life — conception. thus, the love of offspring, her conjugal tenderness, the education of her children, the management of her domes- tics, are the sole objects that attract her regard and fill up her happy existence. It is then that she has come to the possession of the purest happiness, a happiness connected with the love of her family and secured by the moral qualities inherent in her sex. By the term conception is understood the formation of an embryo or the rudiments of a new being. There are several other terms used to designate the same event, which strictly speaking, are only applicable to different stages of the process : as generation, fecundation and re- production ; but this distinction, it is not necessary here to make. Reproduction in the human species constitutes one of the most astonishing phenomena of nature. Jt has, in every age of the world, engaged the attention of the great- est physiologists, and been perseveringly investigated by the most celebrated philosophers. Indeed, can anything in the universe interest man so much — the only being on this earth whose prerogative it is to think — as his own origin, and to ascertain its mechanism ? But many of the investigations so ably and resolutely conducted have only served to show how deep is the mystery that veils the ori- gin of life ! At different periods of past time have been entertained numerous speculations and opinions relative to this mar- velous process. Drelincourt, who lived in the seventeenth century collected from the writings of his predecessors two hundred and sixty -two " groundless Iiypotlieses" con- cerning generation ; and it is certain, observes Biumen- bach, that Drelincourt 's own theory formed the two hund- red and sixty-third ! Most of these theories may be divid- ed, according as the germs were supposed to proceed from the male or female parent, into classes : first, exclusively from the male, which is the theory of the Spermatists ; secon d, exclusively from the female, which is that of the Ovists ; third, from a union of the male and female germs, which is the theory of Syngenesis. Other modifications of these classes of theories at a later day give us that ©f Evo- ORIGIN OF HUMAN LIFE CONCEPTION. 287 lution, or the supposition that the germs, which are sub- sequertly unfolded, already exist perfectly formed in the female ; and the theory of Epigenesis, which assumes thai the seed of the two sexes unite in the womb upon chemi- cal principles, mutually attracting and combining with each other. Without stopping to dwell upon these theories, many of which are exceedingly curious and interesting, we should remark that that of absorption has also more re- cently been advocated ; this theory maintains that the seminal fluid of the male is absorbed from the vagina, carried into the circulation, and is subsequently deposited in the ovaria impregnating one or more of the ova. Last- ly, the theory which has more recently and universally obtained, and which is still believed by those who have not received the new doctrine, is as follows : the semen of the male upon being deposited in the vagina, passes through the uterus and one of the Fallopian tubes, and is thrown upon the ovaria by its fimbriated extremity, when impregnation takes place ; — in about one week afterwards (by this time the ovum being increased in size) the fim- bria seizes the egg or product of conception, and conveys it along the tube into the cavity of the uterus, where its growth takes place. Our limited space not allowing us to discuss the plausi- bility or unplausibility of this theory, we shall satisfy ourselves by stating that the latter approaches nearer the truth than most of the preceding opinions, and that, though no one of them is wholly destitute of foundation, all have recently been superceded by a positive theory, founded upon close observation, multiplied researches and experiments, embracing all the preceding, and the truth of which is not doubted by any one who has given it an examination. These observations, which are still pro- gressing, were made by M. Gendrin, and M. Negrier of France, Raciborski of Germany, and Robert Lee of Lon- don ; we have before spoken of them, when treating of menstruation, by which that phenomena is satisfactorily explained. (See the Physiology of Menstruation, Chap. III., Part HI., Book I.) ' M. Pouchet in his Theorie Positive de la Fecondation des Mammiferes, etc., Paris — lays down certain funda- 288 ORIGIN OF HUMAN LIFE CONCEPTION. mental physiological laws, concerning generation, an addi. tion to which is made by Dr. Meigs, as follows : Law I. There is no exception in favor of the human race ; the phenomena of human generation obey laws anala* gous to those of the mammalia. Law II. In all animals, generation is effected by means of ova: some inferior creatures only furnish exceptions to this law. Law III. In all the animal series, ovula pre-exist to fecundation. Law IV. Physical obstacles prevent the seminal fluid from coming into contact with the ovula while within the Graafian vesicle. Law V. In the entire series of animals, the ovary incon- tesfibly emits ova independently of fecundation. Law VI. In all animals, the ovary emits ova at deter- minate epochs, connected with a periodical sur-excitement of the genital organs. Law VII. Fecundation never takes place in a mammal, except where the emission of ova coincides with the pre- sence of the menstrual discharge. Law VIII. The emission of the menstrual discharge in women corresponds with the phenomena of excitation ob- servable in the mammalia during the rut of the zoological species, and particularly in the females of the mammalia. Law IX. Fecundation has a constant relation to the discharge of the menses. It is, moreover, easy to point put the inter-menstrual period, wherein conception is physically impossible; and also that wherein it is prob- able. Law X. There are certainly no ovarian pregnancies, properly so called. Additional Physiological Laws, by Meigs. Law I. Fecundation in mammals, when normal, occurs in the wjmb. Law II. Abdominal and tubal pregnancy do not prove that fecundation takes place in the ovary, nor that this is what determines the emission of the menses. Law III. The Fallopian tubes do not normally con- tract, except from the interior towards the exterior, for the transmission of the ovum to the uterus. ORIGIN OF HUMAN LIFE — CONCEPTION. 259 The conclusion, from the foregoing, is evident : con- ception takes place in the human female in the same man- ner as it is observed. to occur in the females of most ani- mals, particularly the mammalia order. The ovaria of the female, when fully developed at adult age, contain a large number of vesicles or eggs. They were formerly supposed to be only ten or fifteen in number, which were contained in " Graafian vesicles/' ' and that one of these escaped at each impregnation. But it is now ascertained that they are very numerous — in fact, that the ovaria is nearly composed of them. As long as they remain imbeded in their primitive condition, they are very minute in size. But one or more of them at a time, is continually being ripened, when it attains about the size of a pirns head ; this occurs monthly, and its dis- charge takes place giving rise, as we have elsewhere re- marked, to menstruation. Or, if a vesicle be ripe, it is liable to burst every time the sexual congress takes place, when the ovum which it contains is taken up by the fim- bria of the tube, which at this time is erected, and is car- ried into the uterus, and escapes through the vagina, un- less it meet in its passage through the uterus some of the seminal fluid of the male. If this latter occur it becomes impregnated and is retained ; thus we have the whole pro- cess of conception. The time occupied in its passage is supposed to be about seven days ; though of this- we are not certain, and some believe that the ovum immediately descends and is brought in contact with the semen of the male, at the time, or very soon after the marital embrace. Its growth now takes place, and the menstrual fluid is re- tained for the formation and growth of a membrane to en- velop the child, as will be explained hereafter. If, by any irregularity, two vesicles be detatched, twins is the re- sult ; if three, triplets, and so on. Before closing this chapter it may be well to take a brief view of the principal reason adduced in favor of conception taking place in the ovaria instead of the uterus ; it is this, that occasionally, the ovum has been retained, and its growth taken place, either in the ovary. Fallopian tube, or the cavity of the abdomen, arising, as is alleged, 290 OUIGIN OF HUMAN LIFE CONCEPTION. from some interference in the process of nature in carry- ing the germ to the cavity of the uterus. If there are really any well-authenticated cases of- extra-uterine preg- nancy on record, as there appear to be, their occurrence must be otherwise explained than has been heretofore at- tempted. As most or all (?) of such conceptions have been imperfect or diseased, may we not reasonably suppose them to be depraved ovse merely, that have been devel- oped in, or escaped from the ovaria, during some abnormal excitement of the female ? Or, which is quite as reason- able as the other, the embryo may have escaped from the cavity of the uterus soon after conception had there taken place. Or, if the semen of the male has sometimes found its way into the tubes, and conception abnormally taken place, it may be regarded as an unnatural occurrence. Other arguments might be adduced of greater force than the preceding to prove the fallacy of ovarian concep- tion as a natural process. According to this theory the Fallopian tubes must perform a double action ; that of carrying the semen to the ovaria, and then of propelling the ovse in an opposite direction, to the uterus — thus not only performing a double action, but two directly opposite actions. According to some experiments mentioned in the Medical and Physical Journal, vol. ix., p. 36, it appears that females of an erotic temperament, and who indulge in lascivious practices, may have something similar to con- ception, an escape of ovse, while in a virgin state withou ever having known the sexual congress. Several instan ces are recorded in which hair, teeth and bones have been discovered in young women, who there was the strong- est reason to believe had had no sexual commerce with men! Finally, we should remark, that after conception has taken place, the mouths of the uterus and Fallopian tubes become closed by the formation of the deciduary membrane, leaving a corpus luteum in the ovaria in place of the de- tached egg — which is larger and more permanent when the expulsion of the ovule is followed by conception, than that which happens at the ordinary menstrual period. CHAPTER V. THE ORIGIN OF HUMAN LIFE PREGNANCY OR TJTERO-GES- TATION. We are greatly indebted to recent discoveries for infor- mation concerning the primitive development of the em- bryo : there is probably no other department of physiology which has been so remarkably enriched by modern inves- tigations as this. All these researches tend to establish the fact that the early development of the human embryo takes place upon a plan analagous to that of animals much lower in the scale of formation than man. At first, the ovum exists in the uterus as a small mem- braneous egg, filled with a drop of transparent fluid known as the vitellum. Its sides are composed of two delicate membranes, the outer one of which is called the chorion, and the inner one the amnion. The deciduary membrane which we adverted to in the last chapter, is semi-fluid and opaque, being secreted immediately after conception takes place, and lines the whole uterine cavity. When the ovum arrives at the extremity of the tube, it finds the ori- fice closed by this material, which- it pushes away as it advances into the cavity of the uterus. The ovum is thus placed between the side of the womb and the deposit, the latter of which it turns back and reflects. That part of it which remains in contact with the uterus is called de- cidua vera, and that part of it which is pushed away be- fore the advancing ovule decidua rejlexa. The latter, at first, is just large enough to enclose the ovum which is no larger than a small pea ; while the former is as large as the whole uterine cavity. In process of time the embryo is found to have grown large enough to fill up the whole cavity of the womb ; and as it always carries the reflect- ed part of the decidua along with it, it follows that at last the two are brought into close contact, and from the pres sure become completely glued into one. 292 ORIGIN OF HUMAN LIFE — PREGNANCY. The ovum, upon passing into the uterus, generally at- taches itself to that organ at a point near the tube by which it entered ; but in some instances it becomes moved to the fundus, or falls down to the neck, attaching itself there ; but wherever it happens to fix itself there is the seat of the placenta. The ovum, as has been remarked, during the earlier period of pregnancy, lies between the deciduary membrane and the uterus, with the chorion in contact with its naked surface. At the end of the fourth or sixth week the entire surface of the chorion is found to be furnished with numerous villi by which it is attached to the uterus, ultimately forming the placenta or after- birth. The following account of the progressive development of the foetus, is from Dr. Severn, of London : Impregna- tion having taken place, and the ovum conveyed to the in- terior of the uterus, its presence may be demonstrated as early as the eighth day, when a mucilaginous semi-trans- parent drop will be found adherent to the interior of the uterus, generally towards its fundus. At the twelfth or thirteenth day, it is increased in size, and forms a vesicle filled with a turbid, flocculent fluid, in the centre of which will be seen a dark spot, the punc- tum saliens, or heart of the foetus. At the twenty-first day, the embryo is increased to the size of a large ant. At the thirtieth day, it resembles in size and figure a maggot, curled up. At this time, the budding projec- tions of the limbs are visible, but their shape is not de- fined. At six weeks, the size of the foetus is about that of a bee ; the clavicles, scapulae, and other bones, are tracea- ble ; the limbs are not yet formed, but are still rounded prominences, not having acquired their relative length, or definite shape. The nose, the eyes, and the mouth, are distinctly visible, and the head is larger than the rest of the body. At two months, the various parts are so much developed that we can sometimes decide upon the sex; the features are enlarged ; the heart, and the course of the larger ves* seis, can be traced. ORIGIN OF HUMAN LIFE PREGNANCY. 293 At three months, the foetus is still further developed : its length is three inches, and the genital organs are suffi- ciently formed to enable us to distinguish its sex. The liver is large in proportion to the other abdominal viscera, the lungs small, the bones of the extremities are forming, as well as those of the head and spine. At four months, the parts are all progressively increas- ed, and the length of the foetus is rather more than five inches ; a small quantity of meconium is found within the intestines, and the movements of the foetus are felt by the mother, although very feebly and indistinctly. At five months, its length is from six to seven inches, the nails are beginning to be formed, the muscles are tracea- ble, and the mother perceives that its movements are grow- ing gradually stronger. At six months, it is from eight to nine inches in length, meconium is found throughout the wiiole of the intestinal canal ; and if an abortion takes place, the child is some- times born alive, but seldom breathes more than a few minutes. At seven months, it is between eleven and twelve inches long ; and if now expelled, it is called a premature birth, and the child is capable of being reared. At eight months, it measures from fourteen to fifteen inches. At nine months, it is from eighteen to twenty-two or twenty-three inches in length. The increase in the size of the womb commences at the fundus, immediately after the descent of the ovum. The organ, during the first four months, remains in the cavity of the pelvis ; after which time it begins to rise, and at nbout the fifth month reaches midway between the pubes and umbilicus or navel, and gives a fulness to the lower i>art of the abdomen ; at the end of the sixth month it reaches the umbilicus, which it protrudes ; it continues to ascend, and during the seventh month arrives midway between the navel and ensiform cartilage of the sternum ; at the end of the eighth month it reaches the ensiform cartilage, fills the abdomen, pushing the intestines up- wards and backwards, and often interferes with the func- tion of respiration : during the ninth month instead of 14 294 ORIGIN OF HUMAN LIFE FRETJNANCT. ascending, it increases somewhat in size and becomes a little lower than previously. During the first three months,' the mouth of the uterus is lower in the pelvis, and directed a little more forwards than usual ; when the uterus rises above the brim of the pelvis it is directed backwards ; at the sixth month it is said to lose one-fourth of its length; at the seventh, one-half; at the e-'ghth, three-fourths ; and at the ninth, it is obliterated, so that upon examination the finger comes in contact with the rounded lower end of the uterus. The Placenta or after birth, (see page fronting Book II.) is a vascular, spongy mass, of a circular form, and generally measures about six inches in diameter, though its form and size vary in different subjects. It is an inch or more in thickness in the middle, and becomes gradu- ally thinner towards the edges. Its outer surface is un- even and adheres to the lining membrane of the uterus , from which it receives blood for the nourishment of the child, which is transmitted by the umbilical vein. Its inner surface is smooth, excepting the slight eminences formed by the bloodvessels, and is covered by the same membranes, the amnion and chorion, which envelope the foetus and umbilical cord. It consists essentially of ar- teries and veins connected by cellular substance, and is formed from the chorion. As soon as the ovum reaches the uterus, the chorion being in contact with that or- gan, begins to give out villi which increase relatively with the growth of the embryo till they become blood ves- sels and form the substance of the placenta as above re- marked. The use of this organ is to form a reservoir of blood for the nourishment of the child. There is gene- rally a placenta for each child, but not invariably. The umbilical cord or navel string, (see page fronting Book II.) consists of two arteries and one vein which con- nect the foetus to the placenta, carrying blood for the nourishment of the former. Its length though variable, is generally from one and a half to two feet. Cases are recorded in which it was four and six feet, and others in which it was only a few inches in length : but these are extremely rare. It is sometimes thicker and some- ORIGIN OF HUMAN LIFE PREGNANCY. 295 times more slender, but generally about the size of the little finger. The three vessels of which it is com- posed are lengthened continuations of the villosities which are given out by the ovum upon its reaching the uterus. The vein commences in the placenta by numerous branch- es, and passes into the circulation of the child through the navel. The two arteries pass from the hypogastric arte- ries of the child, through the naval to the placenta, which ihey penetrate. These vessels are inclosed within their covering, and twisted around each other. If by any ac- cident the cord is severed, the foetus dies. Two cords have been met with, connected with one placenta, and vice versa. In other instances the vessels are supernumerary or deficient. When the cord is wholly wanting, the em- bryo must of course be imperfect : it is either soon ex- pelled, or degenerates into a mole covered frequently by hydatids. The decidua ry~ membrane consists of two layers, the decidua vera, or externa, which is in immediate contact with the uterus, and the decidua reflexa, which is next to the chorion. At first they are separated by a fluid ; but as pregnancy advances, this is absorbed, and the two membranes become closely adherent. It is highly vascu- lar, receives its blood from the uterine vessels, and seems to be designed to assist in the nutrition and preservation of the embryo before the elaboration of the placenta. The chorion and amnion are thin, transparent mem- branes, very much resembling each other, enveloping and affordim: coverings for the embrvo. The former is exter- rial, and assists the latter in forming a bag of waters, which is secreted by the amnion, and called the liquor am nii. The liquor amnii is a fluid enclosed by the above no- ticed membranes, in which the foetus floats. It varies much in different subjects ; — in quantity, from a few ounces to a gallon, or more; in quality, from a clear, in- odorous fluid, to one that is turbid and somewhat putrid. It was formerly supposed to be concerned in giving nutri- ment to the foetus ; but its real use appears to be, to pro- tect the embryo from injuries, and form a soft wedge to 296 0RTGIN OF HUMAN LTEE PREGNANC7. dilate the passages during labor, without injury to the child or mother. The placenta, cord, and membranes, now described, constitute what is called the secundins or after-birth, which are products of pregnancy, and of no use after the termination of gestation; consequently, they are then discharged. The fcetal circulation, obviously, has a> different route from that which is established at birth after respiration takes place. (See the Figure fronting Book II.) The stomach of the embryo digests no food, nor do the lungs inspire air, neither of w r hich is needed, as the blood that nourishes the child is derived directly from the uterus of the mother, which is propelled thither by the maternal heart, and after circulating through the foetus, is returned by the veins through her lungs, for the purpose of being purified, to the heart again, to take the same course. The child, in fact, may, with propriety, be considered a part of the mother's body during its foetal life. The umbilical vein of the cord, is formed by the con- vergence of innumerable branches in the placenta, which unite into one vessel ; this vein passes into the abdomen of the child at the navel, distributing blood to the vessels of the liver, and connects by the ductus venosus, directly with the vena cava inferior. The latter, also receives the blood from the liver by the vena porta, and transmits the whole to the right auricle of the heart, which also receives the superior. cava. During foetal life there is a commu- nication by a valve, called the foramen ovale, from the right to the left side of the heart, which becomes closed and obliterated after respiration is established. Through this valve much of the blood passes into the left side of the heart. From' the left ventricle, it escapes into the aorta, and from the right ventricle into the pulmonary ar- tery ; this latter, instead of conveying all its blood to the lupgs, disposes of about three- fourths of it through the ductus arteriosus to the descending aorta. A portion of the blood is sent from the aorta to the head and upper ex tremities ; but the remainder passes downwards to the iliac arteries, and what is not distributed to the lower extremi- ties, is returned to the placenta by the umbilical arteries ORIGIN OF HUMAN LIFE PREGNANCY. 297 of the cord, which pass from the internal iliac arteries, and join the vein of the cord at the umbilicus or navel. •The pulsation of the foetal heart varies from one hundred and thirty to one hundred and forty beats oer minute. (See the Foetal circulation.) Fig. 5.* As soon as the child is born and respiration established, the circulation is admitted through the lungs, and the foramen ovale becomes permanently closed. If by any irregularity it should remain open, the whole surface of the body of the child becomes of a leaden or blue color, which results from the non-oxygenization of the blood ; if this state continue, the child dies, sooner or later, asphyx- iated. Those vessels which were alone subservient to the *The child in utero at full term. Its position is represented in the ute- rus, the front walls of which, are laken away ; the intestines are pushed upwards and backwards, to give it room. * 298 ORIGIN OF HUMAN LIFE PREGNANCY. f(jetal circulation, soon become obliterated, existing only as ligaments, and the last vestiges of the foetal peculiari- ties are at an end. When we compare the gravid uterus, or full period of pregnancy, with the unimpregnated organ, we can but be astonished at the change, in size, which has taken place during gestation. The virgin uterus is from two and a half to three inches long, about two broad, and one inch in thickness, with a cavity about the size of the kernel of an almond ; its superflees are about sixteen inches. But at the end of the ninth month of gestation it has attained a length of twelve or fourteen inches, a breadth of from nine to ten, and a thickness of from eight to ten inches ; its superfices is now estimated at 339 inches, having in- creased more than 519 times its original size ! As'we have already given the progressive development of the foetus, we have only to remark, that this augmenta- tion in volume takes place more gradually in the earlier months of pregnancy, than after the fifth month ; particu- larly during the last three months its growth is very rapid. The increase in size is not so much owing to the addition of muscular fibre, as to the enlargement of the uterine vessels ; indeed, the walls of the uterus maintain about the same degree of thickness throughout every stage of pregnancy, as existed before conception took place. The blood-vessels, however, are very much enlarged, carrying torrents of blood ; the lymphatics and nerves, also, are increased in size. The position of the child in utero, at full term, is seen in the above representation. During the whole period, the foetus is bent forwards upon itself so as to form a kind of circle ; but, until near the close of gestation, its posi- tion is not stationary. As the child floats nearly loose in the liquor amnii, the laws of gravity, principally, deter- mine its position. The natural duration of pregnancy in the human spe- cies is commonly said to be nine months ; but it may be more accurately estimated at forty weeks, or 280 days. Yet many instances are recorded, which are undoubted, of its continuing ten months, and even longer. Some au- ORIGIN OF HUMAN LIFE ABNORMAL PREGNANCY. 299 thors mention pregnancies of twelve, thirteen, fourteen, fifteen, and even eighteen months, the correctness of which may be doubted. Dr. Merriman, of London, has given a table of the births of 114 mature children, from which we learn the following: three were born in the thirty- seventh week ; thirteen in the thirty-eighth week ; four- teen in the thirty-ninth week ; thirty-three in the fortieth week ; twenty-two in the forty-first week ; fifteen in the forty-second week ; ten in the forty-third week ; and four m the forty-fourth week ; of which latter, one was born at three-hundred and three days, one at three hundred and five days, and two at three hundred and six days. The instances are common in which children born at seven months complete, live ; instances are recorded wherein they have survived at six months complete, but such cases are comparatively rare ; those which are men- tioned as having lived at the fifth month, are somewhat ircredible. The law recognizes six months co?nplete, as being the least time in which they are capable of sur- ABNORMAL PREGNANCY. By abnormal pregnancy is indicated all those which deviate from the natural order, whether as to place, time, appearance, or form. By extra-utertne pregnancy, is understood those which occur out of the womb ; the embryo, generally im- perfect, has sometimes been found in the ovaria, some- times in the Fallopian tubes, and sometimes in the cavity of the abdomen. Another species may be added known as interstitial pi m egnancy, when the foetus is developed in the midst of the fleshy fibres of the uterus. This, how- ever, strictly speaking, does not belong to the class we are now considering. We adverted to these cases when speaking of the theories of conception in the last chapter : the remarks there made need not be repeated. Much that has been written upon this subject can only be regarded as fabulous. The phenomena attending them, and the length of time that they have been known to continue. 300 ORIGIN OP HUMAN LIFE — ABNORMAL PREGNANCY. which has been sometimes many years, and their occur., rence in virgins, render it impossible to regard them oth- erwise than as utterly different from ordinary pregnancy. Instances are mentioned in which the foetus has been re- tained in this manner for upwards of fifty years. They are cf such rare occurrence that these strange deviations from the intentions of nature have been doubted altogether The tubal species seems to be the best substantiated, being more common than the others. The cause of extra-uterine pregnancy, is very obscure. All those who have attempted to assign one, have imputed its occurrence to some irregularity in the detachment of the ovum ; either that it arises from unnatural excitement in the female without sexual congress, or, that it is occa- sioned by fright during coitus. When the child has been found in the abdomen, it has by many been supposed to have escaped from the womb. In almost all such cases the foetus has been found very imperfectly developed. It is happily of rare occurrence, but when it takes place the termination is often unfavorable. By superfoetation, is meant the impregnation of a woman already pregnant. As it is well known that the mouth of the uterus is closed soon after conception has taken place, by the secretion of the decidual membrane, it.appears unreasonable that such an event should hap.pen ; and many distinguished physicians doubt its occurrence altogether. Still, it is well known that females in twin-de- liveries, have produced infants of different sizes, and va- rious colors, and within a few weeks, and even months of each other. We believe that these cases are mostly ex- plainable in the following manner : the expulsion of a twin may take place before its full term, while the other is carried till the ninth month ; or one of the germs may prove to be a blighted conception, and have the appear- ance, when born, of being a foetus of several months. When they have been of different colors, it is known that the mother received the embraces of a white and black man within a very short time of each other. Or it may be the result of a double uterus. Finally, then, it would appear that if superfoetation be ORIGIN OF LIFE ABNORMAL PEGNANCY. 391 ever possible, the second embrace must take place almost contemporaneously with the first ; and even then it might, perhaps, be more properly regarded as a case of twkis simply, whether they belong to one or two fathers. Mole pregnancy results from the destruction of the vitality of the embryo during the first few weeks of its existence. If. its expulsion does not take place, it may be retained and continue to grow till it forms a fleshy mass known as mole or false conception. See chapter on Moles, Hydatids, etc., Book I., where this subject is fully ex- plained. Deformities, monstrosity and marks, called also lusus natural, are of various kinds. They may consist of defi- ciency, excess or misplacement of parts, or members of the body. For example, we frequently meet with persons who have an extra toe and finger, and more commonly those who have the naivus maierna, or mother's mark. The nose, the palate forming hair lip, one or more of the limbs, etc., have been wanting. In short, almost every part of the body, in different cases, has been found wanting, in excess, or misplaced. Some -of these mon- strosities are, of course, incompatible with life, others are so slight as to permit a continuance of life, while others aie capable of being remedied by operations. A variety of opinions are entertained in regard to the causes of these deviations from the original intention of nature . while a majority regard them as the product of the imagination of the mother, others trace them to a variety of injuries during gestation : as blows on the abdo- men, the pressure of corsets, etc. If we add to these, frights, unpleasant sights, severe mental agitation, and other similar impressions, we probably have what are often, at least, the true causes. All twin monsters are simply the rpsult of the growing together of the embryos, probably from some slight cause. That all these irregularities of nature are produced from comparatively slight causes, appears evident from the fact that monsters in chickens, may be produced at plea- 302 ORIGIN OF LIFE — ABNORMAL PREGNANCY. sure, only by a slight increase of the heat of the eggs during incubation. By false pregnancy, is indicated a variety of affections that may simulate true pregnancy ; some of them are products of conception, while others are quite independ- ent thereof. We may mention among these, moles, am- enorrhea, dropsy, tympanites, polypi, cancer of the womb, ovarian dropsy, etc. As we have treated of these various affections in sepa- rate chapters in Book L, of this volume, and shown where- in their symptoms differ from those of true pregnancy, we have here only to recommend the reader to study them in connection with the signs of pregnancy, which follow in the next chapter. . Is IT POSSIBLE TO PROCREATE EITHER SEX AT PLEASURE ? The answer to this important question has been sought for, from the time of Hippocrates downwards. The. fa- ther of medicine taught that, as the strongest side belongs to the strongest being, in both animals and the human species, the right testicle and the right ovary produce male germs, while female germs come from the left. And thus has arisen the grave expedient of lying on the side where the germ of the sex desired is to be found, dur- ing a fruitful congress. We have only to remark that it has been demonstrated, that the basis of this hypothesis is entirely false. Without following out the different suppositions by which physiologists hoped one day to be able to ascertain the conditions which cause one sex to be born rather than the other, we should state that it has been demonstrated by experiment upon animals, that the stronger the male at the period of fecundation, the greater is the chance of obtaining males. Consequently, it is probable, as Vel- peau remarks, that the nature of the sex is determined by that one of the couple, whose prolific power, whether ab- solute or relative, is greatest at the moment of concep- tion. We have thus, by adverting to this point, included eve* ORIGIN OF LIFE SIGNS OF PREGNANCY. 303 rything of any importance connected with this part of our subject, and shall proceed to consider the signs of preg- nancy, and afterwards its diseases. CHAPTER VI. THE SIGNS AND PHENOMENA Of PREGNANCY. Hippocrates remarked, that first, the female feels a dis- position to faintness, slight shivering, colic pains, with a rumbling sensation, first in the uterus, and then through- out the whole abdomen. This first condition, which is not constant, neither is it noticed by all females, is suc- ceeded by pregnancy, and its signs. The eyes lose their brilliancy and become languishing ; the eyelids become dark, and are surrounded by a livid or leaden circle ; the nose becomes sharper, the mouth wider, the chin more prominent; thence becomes pale and covered with red- dish spots of various sizes and numbers, — sometimes of a milk color, — finally it may be said to become masked. The general state of a woman in this condition, is ple- thoric, as is indicated by the pulse, which is quicker and fuller than ordinary. The blood, upon being drawn, is found to have the buffy coat, indicating an increase of fibrine. Sympathies are excited in distant organs, which are often distressing, giving rise to various caprices of dis- position and taste. We should remark, before proceeding further, that the diagnosis of early pregnancy is often no easy task, but one which requires great care and discrimi- nation. The following are the principal signs to be re- lied on : 1. Cessation of menstruation is one of the most im- portant signs, if the female have previously been regular, and there is no evidence that this function is suspended by cold, serious disease in other parts of the body, depressing emotions and passions, or a low state of the general health ; when any of these affections supervene, they give rise to dizziness of the head, etc, (see Suppression of the Men- ses, Book 1.,) by which they may be distinguished from 304 ORIGIN OF LIFE — SIGNS OF PREGNANCY. pregnancy. In extremely rare cases menstruation has been known to continue for a month or so after impregna- tion, the discharge being produced by the lower part of the uterine "cavity, which is not yet occupied by the decid- ual membrane ; in still more rare cases, the menses have been known to flow throughout the whole period of utero- gestation ; — but these are exceptions. If, at the second period, the menses are absent, it may be deemed conclu- sive, or very nearly so, that conception has taken place. 2. Morning sickness, and sometimes vomiting, is pre- sent in most cases, but not all. 3. Enlargement of the breasts, areola around the nipples, and secretion of milk, are good symptoms, but are sometimes, as has been seen, produced by uterine disease. 4. Salivation is often produced by the irritation of pregnancy, when there is a frequent disposition to spit. 5. Enlargement of the abdomen, which might be supposed one of the best signs, taken by itself, is one of the worst, and is not to be relied on. This arises from the fact that it may be produced by numerous other causes ; and very unjust and painful suspicions have been attached to unmarried females from this doubtful symptom. 6. Enlargement of the uterus is a symptom of more value, when estimated by a prudent physician, than the preceding ; early in pregnancy its neck becomes lower in the vagina, and as pregnancy advances, the neck shortens, until at full term, nothing is left of it but a narrow ring, 7. Quickening, or movement of the child, is the only infallible sign of pregnancy — when we are assured that it is not the result of the woman's fancy. This may oc- cur at any time after the third month, though the fourth is the most common. It may be felt by bareing the abdo- men, and applying the hand over the tumor, previously dipped in very cold water. 8. Beating of the fcetal heart, is another infallible sign. By the use of the stethescope, or even by applying the ear directly to the abdomen, it may be heard beating at the rate of one hundred and thirty or forty per minute. These signs, of course, do not exist till after quickening, and not then if the child be dead. If it be a twin preg. nancy, two fcetal hearts may be heard. ORIGIN OF LIFE SIGNS OF PREGNANCY. 305 9. The urine is more abundant, more pale and limpid than ordinary. 10. A capricious appetite generally exists ; sometimes there is an entire loss of it, at others it becomes ravenous, then again the female has a desire for the most indigesti- ble articles, such as ashes, clay, lime, charcoal, unclean insects, etc. The moral condition of the. pregnant female, is also sub- ject to many changes. Some who were before naturally gay, and amiable, now become melancholy, cross, unsocia- ble, and vice versa, " In a good many women," remarks Velpeau, " the passions, although previously moderate, ac- quire an extraordinary violence, cannot be subdued, and cause the commission of the most attrocious crimes ; in others, there are merely some singular desires, such as to eat a particular kind of fruit, meat, or game, or some par- ticular dish, no matter at what price ; an irresistible ten- dency to steal objects of small value, or for which they have no use, and corruption of their manners or charac- ter. There are some whose wit is never more lively, more penetrating, more agreeable ; while others fall into a sort of stupidity and apathy, quite unnatural in them. In general, the activity of the intellectual faculties is augmented, whether in the whole, or only in part ; in one case the memory, or a taste for the arts and sciences, is modified ; in others the judgment becomes exquisite, or the imagination is exalted to such a degree, that some women have, during their pregnancy, attained to a sur- prising degree of perfection in those works of genius, those arts or sciences, which they had previously cultivat- ed with indifference, and without success ; some lose their senses and become insane, always at the same period of their pregnancy ; others are seen in whom mania never disappears, and who never become composed except dur- ing this function." Notwithstanding the multitude of signs of pregnancy already noticed, in some cases the most skilful, in estimat- ing them, are deceived. This arises from the fact that certain affections and conditions of the uterus, intestines and abdomen, may take on nearly all these symptoms. Numerous cases are on record in which false decisions in 306 MANAGEMENT OF PREGNANT WOMEN. pronouncing young females pregnant, have led to the most melancholy and lamentable results ; the errors have only been discovered when it was too late to remedy the evils produced. Whole families have been broken up, characters destroyed, and women have been driven to sui- cide to escape the taunts of their associates, or had their whole lives embittered, when their perfect innocence has appeared. These evils have, in part, originated from the fact, that young women, illegitimately pregnant, generally deny the fact, maintaining that they are slandered, thus producing error in the opposite direction: this has led many skilful physicians to disregard entirely the asser- tions of the subject, and rely altogether upon appearances, which may be deceptive. As during pregnancy, there exists a much greater de- gree of vitality in the uterus, than previously, there occur a variety of modifications, both anatomical and physiologi- cal. Many diseases supervene, are suspended, or disap- pear. It has been noticed that an advanced stage of pul- monary consumption, and a number of other different dis- eases, such as obscure chronic inflammations, and even serious organic lesions, seem to retrograde during preg- nancy, and often give place to a flourishing state of health. After parturition, some of these do not return, and 'are found to be permanently cured; while, again, many of them thenceforth progress towards a fatal termination with increased and frightful rapidity. CHAPTER VII. HYGIENE* AND MANAGEMENT OF PREGNANT WOMEN. While a pure atmosphere is of the highest importance to health at all periods of existence, it is during the preg- nant state, especially, that it becomes indispensable. Hip- pocrates, and many others, have remarked the bad effects of a damp or too dry an atmosphere, upon pregnant wo- men, and assert that it predisposes to abortions and to * Being a continuation of M. Colombat's remarks upon this subject. MANAGEMENT OF PRDGNANT WOMEN. 307 premature labors. They ought, therefore, as far as possi. ble, to breathe an atmosphere which is pure and exempt from all extremes of cold or heat, dryness or humidity. Their clothing should be loose, and so arranged as to avoid all pressure upon the breasts, chest, abdomen, and stomach. Pressure upon these organs may interfere with the growth of the mammse and the development of the nipples ; it may augment the embarrassment of respira- tion, prevent the enlargement of the uterus and its ascent in the abdomen ; and, lastly, become a cause of abortion, or of displacement of the gestative organ. Pregnant wo- men should especially avoid the use of corsets with busks or whalebones, which are very hurtful, while the pressure they exert from above downwards acts upon the uterus, forces it to develop itself in a dependent situation, and be- comes a powerful cause of prolapsus of the uterus, and according to some authors, a cause of deformity of the foetus, even. They ought to wear, therefore, elastic and very large corsets only ; for which should be substituted, after the fifth month, an equally elastic binder, which, embracing the abdomen in every direction, maintains the uterus in a normal position, and, as far as possible, pre- vents the wrinkles and cracks which are generally the result of pregnancy. During winter, pregnant women ought to take care to wear flannel drawers, in order to escape the action of the cold upon the thighs and external organs, which are more exposed to it because of the prominence of the abdomen, which shortens the under clothes, and pushes them forwards. They ought to endeavor, likewise, to protect the mammae, the shoulders, and the superior extremeties, from cold. Inattention to this precept has sometimes occasioned very extensive in- flammation of the breasts, followed by abscesses, which have not generally been cured till after delivery. Circular compression of the inferior extremities is no less danger- ous, especially towards the latter months of gestation, for, by retarding the flow of the fluids, they produce cedema- tous engorgements and varicose dilatations of the inferior extremities. The use of warm baths, which Wkire always proscribed by the ancients, in pregnant women, is nevertheless very 303 MANAGEMENT OF PREGNANT WOMEN. useful. As they promote the cutaneous perspiration, relax the tissues, and cleanse the skin, they are suitable for primiparous women, and especially for those of advanced age, whose soft parts are hard and resisting, and whose uterine and abdominal parietes are distended with difficul- ty ; they are prescribed, also, for the purpose of relaxing the symphyses of the pelvis, of softening the external parts of generation, of preventing lacerations, and to fa- cilitate labor. The use of baths is suitable also for ner- vous and irritable women, who are very subject to colics and convulsions ; they are injurious in those who have much embonpoint, in those o£ lymphatic temperament, and who are subject to edema and hemorrhages. Persons of the latter description, should make use of them only for purposes of cleanliness, therefore, and should remain in them as short a time as possible. In some cases, cold baths may be proper. Foot-baths ought to be allowed, only for the purposes of cleanliness. Bleeding ought to be avoided, unless some accident hap- pen, or unless called for by some particular indication. It sometimes becomes necessary, at all periods of preg- nancy, in plethoric women, in whom the pulse is strong, full, and accelerated, and who suffer from insomnia, from excessive agitation, from headache, or from nasal, pulmo- nary, or uterine hemorrhages. Bleeding at the arm in these cases, is generally preferable to any other mode of abstracting blood. The derangements of the digestive functions, and the state of sanguine plethora, which are the general results of pregnancy, sufficiently indicate that pregnant women ought, especially during the early months, to make use only of light food, containing but little nutritious matter, of easy digestion, and selected chiefly from amongst the vegetables. Nevertheless, towards the middle of gesta- tion, the period at which the appetite re-appears, and the digestive functions are generally re-established, it becomes proper to relax the severity of the regimen, and allow of more food at each repast ; with the precaution, however, of renewing the latter often enough to supply sufficient nourishment, without overloading the stomach. The reprehensible custom of making pregnant women eat for MANAGEMENT OF PREGNANT WOMEN. 309 two, as it is vulgarly expressed, is the more pernicious, because it occasions a super-excitation of the digestive organs, which is generally followed by more or less obsti- nate vomiting, colic or diarrhoea. We must remark, however, that the tastes and desires of the patient should be respected, provided they do not concern articles evi- dently injurious. Though it is wrong to yield to all their caprices of appetite, it is also wrong to resist desires which often persist in spite of them, and which are sometimes the indications of nature itself. It is proper to remark, moreover, that the excessive use of warm drinks may be hurtful, by debilitating and relaxing the stomach ; and that the abuse of fermented drinks, of liquors, of tea and coffee, and of irritating condiments, is equally pernicious, by increasing the already too great excitation of pregnant females, from which may result convulsions, uterine hemorrhages and abortions. The use of ice drinks, which is often one of the best means of allaying gastralgia and vomiting, may also become a cause of abortion. In some women, we find disorders of the intestinal ex- cretions, and of the urinary secretion. Emollient enemata will be useful to calm, not only intestinal and vesical ir- ritations, but also to facilitate digestion, to' prevent and overcome vertigo and cerebral congestions, and even to aid in the primipara, the dilatation of the genital parts, at the moment of delivery. Nevertheless, their habitual use should be restricted to the well-ascertained cases that re- quire them ; for they may lead to constipation and intes- tinal torpor, and an abnormal relaxation of the genital or- gans. One ought especially to be very circumspect as to the use of purgative injections, w T hich, in consequence of the relations existing between the rectum and womb, may bring on contractions of that organ, and thus give rise to miscarriage. As a general rule, purgatives ought to be rejected upon the same considerations ; and the conduct of those who prescribe what are called 'precautionary pur- gatives, cannot be too much condemned. The use of emetics ought also to be proscribed ; and notwithstanding they are often taken, without effect, by women who de- sire to make a criminal use of them, still they should never be resorted to except in cases of absolute necessity. 14* BIO MANAGEMENT OF PREGNANT WOMEN. Exercise, which ought never to be carried to the extent of fatigue, is very useful for pregnant women ; it main- tains a regular action of all the functions, prevents the at- tack of many diseases, and is often a means of cure. The most suitable mode of exercising for such persons, is walking, both morning and evening, during the fine weather, and at noon during the winter. The length of the walks should be calculated agreeably to the state of the strength and habits of the woman ; yet there are women who cannot go out their full time except on the condition of keeping perfectly still, and in a horizontal pos- ture. Riding on horseback, or in a carriage, and dancing, exposes her to shocks that are the frequent causes of hemorrhages and abortion. Moreover, women in a state of pregnancy, ought to enjoy protracted sleep, which, in that state, they require more than at any other period of their lives. We ought, therefore, to treat the state of in- somnia and agitation to which they are liable, especially in the last months of pregnancy, by baths, exercise, and blood-letting, and by some gentle narcotic, such as distill- ed lettuce-water, and orange-flower water, to which may be added some drops of sulphuric ether. The prepara- tions of opium do not always succeed so well. The exalted state of the sensibility in pregnant women, rendering their sensations more acute, and their emotions more energetic, they ought to shun the occasions of vio- lent impressions upon the physical and upon the moral constitution ; and all objects capable of affecting the ima- gination, should be cautiously kept out of their way ; such as tragical spectacles, the sight of mutilated people, of the lame, and of all persons affected with loathsome diseases. As they are, in general, persuaded, that the sight of such an object may give rise to a similar deformity in the child in utero, they are violently agitated whenever they meet with it. Besides, the records of disease are full of cases of serious disorders, as convulsions, hemorrhages and abortions, brought on by the sight of some repulsive ob- ject, by fright, by a paroxysm of anger, a fit of joy, of hate, of jealousy, or other acute emotion of the soul. From among the numerous histories of this sort, we shall quote only one, from (he writings of Sue. It is the case MANAGEMENT OF PREGNANT WOMEN. 311 of a woman who was so much affected by the prediction of a gipsy, who foretold that she would die, that she made her will, and died in the eighth month. It would seem ridiculous, to believe in the injurious ef- fects of longings and desires, and the prejudices which pretend that the woman's imagination may exercise a pow- erful influence upon her child, and that when she longs for any thing, or is powerfully affected by any object, there is established a deformity resembling the object of her fright, upon that part of the infant's body that corres- ponds to the part of her own surface which she happens first to touch with her finger, after experiencing the sen- sation. However, as these various causes may produce violent agitation in credulous females, and exert an injuri- ous influence upon the foetus, it is requisite to pay great attention to the state of her mind, so that she may be treated with gentleness and respect, and especially with indulgence as to her caprices and oddities, which are for the most part involuntary. As abortion is often the con- sequence of the voluptuous and tumultuous ecstacies of the venereal indulgence during pregnancy, the conjugal embrace ought to be interdicted during the early months, particularly to newly-married women, and to those who have already been subject to abortion. In case, however, of excessive desire in both parties, there might be more inconvenience in resisting, than danger in gratifying it, with moderation. As, during the last six months of ges- tation, the danger is much less than in the first three months; the indulgence of the habit maybe enjoyed with less restraint* section n. DISEASES OF PREGNANCY, Soon after conception has taken piace, the uterus as* sumes new strength, and radiates to other parts of the economy, the most extraordinary sympathies, and the most powerful re-actions. Some of these have been mentioned as the signs of pregnancy, most of which require no other attention than a regulation of the habits of the individual ; but others that are sympathetic or physiological, which often take on a pathological appearance, and are known as the diseases of pregnancy, may be divided, for con- venience, into classes : the nervous, the plethoric, and the mechanical — which take place at different periods of ute- ro-gestation. We shall somewhat modify these divi- sions — I. Treating of abortion or miscarriage ; 2. Disor- ders of the chylopoietic viscera or the digestive functions ; 3. Disorders of the circulating system ; 4. Disorders of the respiratory system ; 5. Disorders of the nervous sys- tem and senses; 6. Disorders arising from mechanical pressure or distention ; 7. Diseases of the genital organs during pregnancy. We shall, then, proceed to treat of them, according to these divisions, in as many chapters. CHAPTER I. ABORTION OR MISCARRIAGE CAUSES SYMPTOMS AND TREATMENT. By abortion is understood the expulsion of the foetus from the uterus before it has attained a sufficient degree of development to enable it to exist independently of the mother ; if it occur before full term, and the child have ABORTION OR MISCARRIAGE CAUSES. 313 acquired an organization sufficiently perfect to enable it to live, it is called a 'premature labor. It should always be regarded an " untoward event," as it generally exerts an unfavorable influence upon the health of the female. Abortion has been observed to occur most often in the early months of pregnancy ; consequently, as it becomes advanced, the chances of this accident taking place are lessened. According to the records of Drs. Collins, Beatty, Deubel, and Madam Lachapelle, out of 41,699 de- liveries, 530 were premature births or abortions ; making 1 in 78 1-2. Causes. — These we shall divide into the predisposing and exciting. The efficient cause, of course, is constitut- ed by the contractions of the womb, assisted by the mus- cular power of the mother. The predisposing causes may exist in the woman or in the ovum ; most often in the former. According to Vel- peau, women who are plethoric, who menstruate abun- dantly and regularly, who are irritable, excessively sensi- tive, nervous, hysterical, lymphatic, of a fair complexion, weakly, sickly, who have large eyes and a bluish scleroti- ca ; persons affected with syphilis, scurvy, rickets ; those who have a badly formed pelvis, some Organic lesion, or any chronic disease; those who are asthmatic, dropsi- cal, affected with cancer ; those who are badly nourished, and those who compress themselves by lacing, or wear their clothes too tight, miscarry more frequently than others. Marshy and unhealthy countries ; certain atmospheric constitutions, formerly noticed by Hippocrates, which ren- der abortions really epidemic at some seasons ; watch- ings and fatiguing occupations are also classed among the predisposing causes of miscarriages. On the part of the reproductive organs, all the chronic affections to which they are subject, might be mentioned ; as adhesions, dis- placements, cancer, polypus, profuse uterine leucorrhea or dropsy, etc. Many of the diseases to which the child is liable after birth, may manifest themselves before — thus giving a dis- position to abortion ; ulceration and disorganization of the head, lungs, liver, peritoneum, and in fine, of every part of the body has been observed as early as the third month. 314 ABORTION OR MISCARRIAGE CAUSES. Circumvolutions of the cord around the child's neck, its shortness, excessive length, or its containing knots, may also cause the death of the child, when it will be, sooner or later, expelled. Exciting causes. The predisposing causes that we have mentioned, are, alone, very often sufficient to bring on the expulsion of the ovum ; when this occurs the abor- tion is said to be spontaneous. Notwithstanding, it is al- most always attributed, and often erroniously, to some ac- cident or particular circumstance which is known as the exciting, and passes as the principal cause ; as great ex- ertions, yawning, coughing, sneezing, vomiting, the act of voiding the faeces and urine ; the impressions of joy, dis- appointment, sorrow, anger ; strong odors of any kind ; coitus, violent dancing and other movements, riding in a carriage or on horseback, leaping ; and in fine, all vio- lent commotions of the body, and blows or falls upon the abdomen. To these may be added all acute diseases, as fevers, inflammations, especially of the womb ; dysentery, colic, constipation, convulsions, etc. Now, although many of these causes seem frequently to give rise to abortion, it should be understood by the reader, that they would rarely produce it without the an- tecedent existence of some one of the predisposing causes above enumerated ; and that they most commonly are merely coincidences. The same may be said of emetics, drastic purgatives, and emmenagogues, taken for criminal purposes ; blood-letting, from the foot or otherwise ; hip and foot baths. Mechanical means which have been re- commended in cases of deformity of the pelvis, acupunc- ture, and certain manoeuvres acting directly upon the ovum, but which, unfortunately, are resorted to by infa- mous people, it will soon be seen, are often no more suc- cessful than the foregoing, and attended with the greatest danger. It has been thought that many of these causes act by detaching the placenta ; but if it be considered that the ovum is perfectly filled with the foetus and liquor amnii, and that the uterus is filled exactly by the ovum, it will be evident, as Dr. Velpeau remarks, that motions impressed on the womb by external shocks, are as incapa- ble of separating the placenta from the womb, as thev ABORTION OR MISCARRIAGE CAUSES. 315 would be to separate two bladders, one contained within the other, and the inner one full of fluid ; the most active and imprudent women, those who give themselves up to the most violent exercises, do not, on that account, fail, most generally, to go their full term ; while many others are found to abort in spite of the most minute precautions, and the most persevering attention. Dr, Mauriceau relates the case of a woman, seven months gone with child, who, in order to escape from her chamber, which was on fire, got out of a third story win- dow, when she fell on to the stones and fractured her arm ; but her pregnancy was not disturbed. Madam Lachapelle mentions that a female who was pregnant, and a fleeted with deformed pelvis, threw herself from the top of a stair, with the view to bring on abortion, and thereby avoid the Cresarian section : she died a few days after- wards from her injuries, but there was no abortion. Mari- ceau also speaks of a woman who was bled eighty-six times in one pregnancy, and who, notwithstanding, at the end of it, was delivered of a fine large child. Delmotte saw powerful evacuants produce gastritis, peritonitis, and even death, without being followed by abortion ; Velpeau had the care of a young female who, with the design of concealing her dishonor, had produced a violent abdomi- nal inflammation by taking medicines to procure abortion : she died on the eighth day without any symptoms of mis- carriage. We should add, however, that where some pet culiar predisposition exists, these powerful means may produce that event, while in others they may give rise to monstrosity or malformation of the child. There is a predisposition to abortion common to all women ; that is, at the menstrual periods, — an epoch when a fluxion towards the womb occurs, which disposes the de- tachment of the ovum. Finally, those women who are so unfortunate as to acquire the habit of aborting, are rarely afterwards aWe to carry the foetus beyond the period at wlfich they are accustomed to miscarry; the oftener this is repeated, the more difficult it is for them to carry it to full term. Such individuals are doubly unfortunate ; it nQt only prevents their becoming the mothers of living 316 ABORTION OR MISCARRIAGE SYMPTOMS. children, but also gives rise to a state of bodily debility from which they severely suffer. A great number of medicines are supposed capable of producing miscarriage ; but there is no certainty in their action, however powerful they may be. She who resorts to them, is guilty of tampering with her own life, in addi- tion to the crime actually intended. The remarks of Dr. Velpeau are particularly apposite in illustrating our views upon other means that are sometimes resorted to: "the mechanical causes, or certain manoeuvres recommended by some authors, in cases of deformity of the pelvis, and which, in the midst of our refined society, are also em- ployed by degraded wretches, not less criminal than the unnatural women, who are not ashamed to submit to their disgusting ministrations, must be arranged among the same class, with emmenagogues and drastic purgatives. Those who make use of them most frequently fail of at- taining their object, and succeed only in seriously injuring the womb. I once prescribed for a female, in whom such attempts had brought on a flooding which conducted her to the verge of the grave ; she suffered horribly from pain in the interior of the pelvis for two months, notwithstand- ing which abortion did not take place, and she is now a prey to a large ulcer of the neck of the womb. I opened the body of an unhappy creature who suffered from the like attempts, which did not succeed any better than the one above mentioned. M. Girard, of Lyons, mentions a similar instance. Very recently a young woman, who be- came pregnant against her wishes, succeeded by such ma- noeuvres only in producing an organic lesion of the ute- rus, which, after frightful sufferings, led her to the com- mission of suicide. 55 The same, also, applies to bleeding and all other unnatural attempts to bring about a prema- ture expulsion of the foetus. Symptoms. — These vary according to the stage of the pregnancy, and the nature of the causes which produced it. During the first two months of gestation, and when the result of some disease, the ovum, then of small size, is often expelled with little or no pain or hemorrhage ; this kind of miscarriage does not much differ from a slight attack of hemorrhage, or a difficult menstruation. When ABORTION OR MISCARRIAGE TREATMENT. 317 pregnancy is farther advanced, however, the expulsion of the foetus may produce the phenomena of an ordinary labor ; but it is generally preceded by weakness, chills, languor, paleness of the face, palpitation, fetid breath, swelling and dark color of the eyelids, loss of appetite, nausea, thirst and pains in the loins. There may be also, elevation of the pulse, the breasts become faccid and se- crete a serous liquid instead of milk ; there is a discharge from the vulva, at first of a thin humour, then of blood ; absence of the movements of the child ; and lastly, falling of the abdomen, uterine pains which gradually become stronger and more frequent, till the mouth of the uterus is dilated, when the ovum is expelled, which most often puts an end to the hemorrhage. When abortion is the result of some powerful exciting cause, the action of such cause is immediately followed by an abundant, and frequently dangerous flow of blood, that does not cease till the discharge of the foetus and its appendages takes place, which is accomplished by severe pains ; these symptoms resemble those of labor the more closely in proportion as the age of the foetus is more ad- vanced ; the same is true in regard to the lochial discharge and milk fever. When the child has ceased to live it is generally soon expelled from the uterus ; it may, however, remain for several weeks or months, and even years — if the mem- branes remain unbroken, and no air have penetrated the uterus — passing sometimes into the state of adipocire ; or, it may degenerate into zjleshy mole. (See that Chapter in Book I.) Abortion is much more dangerous than a natural labor ; the least dangerous, is that which is produced by disease of the ovum, and the most so, is that which is forced, without the existence of any predisposing cause. The danger of tne female is also less in proportion as the preg- nancy is more recent, and the neck of the womb is more yielding. It often disposes the womb to chronic inflam- mation, ulcers, and other organic lesions. Treatment. — This presents two indications : first, to prevent it by every possible means; and second, if this 15 318 ABORTION OR MISCARRIAGE TREATMENT. be impossible, to hasten its termination and attend to the state of the mother. If the female be irritable and nervous, she should be protected from moral and physical commotions ; she may avail herself of travelling, and if weakly she should take strengthening food, repose, and moderate exercise only ; tonic medicines may be often advantageously used. She should avoid violent exercise, indigestible food, tight dress, emotions of the mind, and unpleasant weather. If there be a disease of the uterus or other organs, it should be carefully attended to. When signs of plethora and con- gestion exist, blood taken from the arm will be useful, which may be repeated near the time of the menstrual period, according to circumstances. But this latter reme- dy should not be indiscriminately resorted to in all cases, as is practised by some physicians. According to Dr. Physic of Philadelphia, if the patient have had repeated miscarrage she may employ with the greatest success, an anodyne enemata, consisting of a wine glassful of boiled starch, mixed with forty drops of laudanum, to be taken at bed time, and repeated every night till quickening takes place. (Meigs.) When hemorrhage occurs, the patient should immedi- ately assume the horizontal posture and maintain absolute rest upon a hard and fresh matress. Cold, astringent and ascidulated drinks should be exhibited, external revul- sives, the application of ice ; antispasmodics and anodyne preparations ought to be employed, if there exist symp- toms of nervous agitation or convulsions. . Should there be much congestion, bleeding from the arm may be resort- ed to, but with great caution. Bathing should be avoided so long as there is hope of opposing the abortion. When the hemorrhage is great, resource should be had to the tampon or plugging the vagina ; this may arrest the bleeding and the abortion too — or by the accumulation of blood which it causes in the uterus, it may determine the contractions of that organ and thus assist in the expulsion of the ovum. The ergot should only be used as a last resort as it generally hastens the expulsion of the foetus. •When all these means fail and abortion is known to be inevitable by the dilating of the mouth of the uterus, the NAUSEA AND VOMITING. 319 delivery of the woman should no longer be retarded. Composing, anodyne drinks should be administered, and belladonna ointment to the neck of the uterus, or emolli- ent anodyne injections into the vagina will be useful. Should the ovum be detained too long in the neck, the finger may be introduced to assist its escape ; the uterine contractions may be excited by frictions to the abdomen, etc. The subsequent treatment, delivery of the placenta, and care of the female, is the same as that of an ordinary labor. CHAPTER II. DISORDERS OF THE CHYLOPOIETIC VISCERA OR THE DIGESTIVE FUNCTIONS CAUSES SYMPTOMS AND TREATMENT. NAUSEA AND VOMITING. Nausea and vomiting so frequently accompany preg- nancy, that their existence is generally the first sign of the occurrence of that condition. The former, although but .the first stage of the latter, often exists alone and is more distressing than vomiting itself. They are caused by the sympathetic action of the impregnated uterus upon the stomach. They generally come on soon after con- ception, and cease after the third or fourth month. Some- times, however, they continue throughout the whole preg- nancy, while again they cease at the usual time, but re-appear in the latter months. In some patients they never occur. The vomiting most commonly appears in the morning ; it may take place, also, in the course of the day, and par- ticularly just after meals. Some are able to retain little or no food, while others are relieved by taking it. It sometimes causes much emaciation and debility, and if the vomiting be frequent and violent, it may excite abortion. It is always important to carefully distinguish whether it is produced by pregnancy or gastric derangement. Though 320 SALIVATION OR PTYALISM. sometimes the vomiting is exceedingly distressing, the prognosis is not often unfavorable. Treatment. — The woman should compose her diet of the lighter articles of food, and those that are found by her to be most easily digested. When there is a desire for those which are unsuitable in appearance, it may be bet- ter for them to be taken than no food at all. Some wo- men find relief from a little Madeira wine, brandy, or some other liquor, either after meals or before ; others, from mineral waters, bitter tonics, as columba root, a few drops of laudanum or ether, mint-water or syrup of poppy heads, extract of cinchona, and quinine. Counter irrita- tion has been found useful, either by cups or mustard over the stomach, or to the spine. The application of an opium plaster, or a cloth wet with laudanum, to the pit of the stomach, will often give relief. It is frequently ne- cessary, also, to exhibit mild purgatives, such as rhubarb, castor oil, a Seidlitz powder with syrup of senna, or man- na, and emetics even. The amployment of some of these with a spare diet, and the use of acidulated and gummy drinks, lemonade, baths, and emollient enemata, accord- ing to circumstances, will rarely fail of benefitting the patient. Finally, we should remark, that when there is much plethora present, bleeding from the arm, and after- wards the employment of antispasmodics and opium, will be an advantage. SALIVATION OR PTYALISM. This is characterized by an excessive secretion from the salivary glands ; it generally appears soon after con- ception, and ceases about the fourth month ; but in some cases lasts throughout gestation, or does not appear till a short time before labor. It is far more inconvenient than dangerous, and seems to depend upon the increased vitali- ty of the uterus. When it is slight, nothing need be done but to regulate the habits of the patient ; when it is ex- cessive, the bowels should be kept free by laxatives, ene- mata, and a suitable diet ; counter irritation by mustard or leeches may be resorted to, and slightly astringent gar- gles, as well as draughts of balm, mint and canella water. ODONTALGIA AND CAPRICIOUS ArPETITE. 321 ODONTALGIA OR TOOTHACHE. This affection is generally a dental neuralgia which is more common during the earlier months of pregnancy ; it commences with more or less violent pains along the low- er jaw, or in individual teeth when any are diseased. Its effects upon the female are often very distressing ; — she loses her sleep and appetite, digestion becomes impaired, and if not relieved, abortion may result. In the treatment, sub-carbonate of iron, with rhubarb, has been recommended, with anodyne lotions and poultices. Relief is often obtained from the application of a blister behind the ear on the affected side, and leeches or scarifi- cation to the gums ; when the pain is intermittent, quinine with opium should be tried. In addition to these, when there is any inflammation, mild purging with saline ca- thartics, low diet, diaphoretic drinks, warmth and vapors to the head and mouth, should be used. When there is a carious tooth, it must be at once extracted, unless the pa- tient be so irritable as to make us fear abortion ; under such circumstances relief may often be obtained from the essential oils, creosote and opium. CAPRICIOUS AND FASTIDIOUS APPETITE. During the earlier months of pregnancy, the appetite diminishes, or is altogether lost ; but in the third or fourth month, it generally returns, and sometimes becomes vora- cious. But the most remarkable peculiarity met with, is when there is a disgust in the female for the articles of diet of which she was previously fond, and a desire for the most unreasonable substances : such as chalk, plaster, charcoal, flies, spiders, etc. The old writers abound in strange stories of the longings of pregnant women : Cas- tro relates that a female who took a fancy to a bite of a baker's shoulder, could not be satisfied till his consent was purchased. Langers mentions a woman who satisfied her depraved appetite by killing her husband, making a meal ©f a part of him, and salting the rest. Others are men- tioned as having devoured pepper, brown paper, and bro- ken stones. These caprices are more common in the O 322 CAPRICIOUS APPETITE — HEARTBURN. early months of pregnancy, and although many of such accounts are fabulous, it is well known that sometimes their wonderful tastes are carried to an excess amounting to monomania. In the treatment, as it is often useless to try to divert them from their caprices, there is no reason for denying them any thing, or for refusing to yield to a well-marked appetite, unless, indeed, the substances longed for are evi- dently hurtful. It is readily conceivable, that a disap- pointed wish, and an ungratified longing, carried to a certain extent, may produce dangerous consequences to the mother, and thus interfere with the formation and de- velopment of the embryo. (Colombat.) This condition is generally accompanied with gastric derangement for which purgatives and often emetics are requisite ; antispasmo- dics, opium; ether, etc. ; and if there be plethora, bleed- ing ; and finally, bitter infusions with a little wine. Ex- ercise should be taken, and excessive eating and drinking must be avoided. HEARTBURN OR CARDIALGIA. This affection may occur at a very early period of pregnancy, but in general, is not troublesome till towards the latter part. It consists of a sensation of burning pain in the stomach, with an eructation of a disagreeable acrid fluid, and commonly occurs in women who make use of heavy, indigestible food, fried dishes, alcoholic drinks, etc. In the treatment, a change of diet, exercise, purging, with slight counter irritation to the pit of the stomach, or a dose of magnesia, will often remove it ; also the sub- carbonate of soda and potash ; or n spoonful or two of lime-water, in half a cup of milk, two or three times a day, may be used. To these should be added a somewhat restricted diet of easily digestible substances, a residence in the country, .with moderate exercise, and bitter tonics when the stomach is enfeebled, with an occasional purge of rhubarb and aloes, or colocynth and emetics. • When alkalies fail, acids are often found to give relief. In addition to the affections of the stomach during preg- VARIOUS AFFECTIONS OF THE STOMACH. 323 nancy now considered, we sometimes find others of a simi- lar character : indeed, we may have almost every variety and shade of affections ever met with in this organ ; such as dysphagia or difficulty of swallowing, characterized by spasmodic contraction of the esophagus ; hozmatemesis or vomiting of blood ; jaundice ; and finally, there may be every variety of dyspeptic symptoms. The treatment of these various affections is very sim- ple ; in general it is necessary to do little or nothing for them as they commonly cease after the fourth moruh of pregnancy : when some of these conditions of the stom- ach last longer, they seem to become the means by which nature prevents plethora, a state most likely to exist dur- ing pregnancy. The patient may, for the dyspeptic symptoms, employ bitter infusions, as gentian, camomile, wormwood, mint, and rhubarb, with a little wine, or mine- ral waters ; at the same time taking food only in small quantities, and of proper quality; also a few grains of nitre in lemonade, a little ether, or other antispasmodic, taken frequently and in small quantity. The difficulty of swallowing, if treated, may be met with counter irrita- tion by mustard, blisters, etc., and by antispasmodics as ether and fluid extract or infusion of valerian ; also by warm bathing. For the vomiting of blood, may be given slight astringents, with opium, purges and acids, with counter irritation (over the stomach) by blisters. For jaundice, the state of the stomach and bowels should be attended to on general principles — purging once in two or three days will be beneficial ; also alteratives, diapho- retics, opiates, and tonics, according to circumstances. GASTRALGIA AND CRAMP OF THE STOMACH AND BOWELS. This affection is characterized by acute pain in the re- gion of the stomach, and by a dragging sensation at the epigastrium, known also as nervous colic* It seems to de- pend upon an affection of the stomach and bowels brought on by errors in diet and mental emotion ; when violent, the patient is obliged to sit down, bend herself forwards, and press the epigastrium and bowels. It has sometimes caused abortion. (Burns.) 324 CRAMPS OF THE STOMACH COSTIVENESS. The treatment does not much differ from some of the foregoing affections. During the paroxysm, a large flax- seed poultice, sprinkled with mustard, should be applied hot to the epigastrium. At the same time, a table spoonful of the extract or tincture of valerian, syrup of ether or poppey heads, opium, or some other antispasmodic, should be taken internally. The return of the paroxysm may be prevented by baths, enemata, warm and stimulating drinks, warm external applications, gentle purging, tonics, four t>r five grain doses of the sub-nitrate of bismuth, and the sub-carbonate of iron, with valerian. Finally, with these should be associated a regimen composed of ali- ments of easy digestion, which should be taken only in small quantities, with a little wine. Moderate exercise should be taken, and the whole habits of the patient must be properly regulated. CONSTPIATION OR COSTIVENESS. Constipation is a very common affection in pregnant females, and is generally caused by the pressure of the womb upon the intestines during the latter stages of preg- nancy ; it may also depend upon sympathetic irritation. When it exists to any extent, it produces loss of appetite, headache, indigestion, restlessness, sadness, sleeplessness, and capricious temper ; lastly, it may give rise to piles and even abortion. As to the treatment, we have already mentioned the most approved methods, at pages 224-28, Book I, to which the reader is referred. It is best always to avoid drastic purgatives, and depend upon a mild and laxative regimen. The following, from Colombat, embraces all necessary di- rections : white meats, dressed vegetables, particularly sorrel, lettuce, spinach ; cooked or very ripe fruits, such as cherries, melons, grapes, prunes, strawberries, and or- anges. We should add to. these, the employment of warm baths, the use of vegetable or veal soup, lemonade, or cream of tartar water, decoctions of tamarinds, prunes, etc., sweetened with honey. The bread of the patient should invariably be made from the unbolted wheat flour ; or Indian corn and rye may be used. DIARRHAGEA. DYSENTERY AND TENES3IUS. 325 Should these measures fail, recourse must be had to emollient and laxative enemata of molasses or honey, with castor oil or senna, or suppositories. It may be necessa- ry to take internally, manna, castor oil, or Seidlitz pow- ders. Lastly, we should remark that sometimes the faecal matters become so impacted as to render it necessary to extract a portion of the mass with a scoop, spoon-handle, or the finger. DIARRHOEA, DYSENTERY AND TENESMUS. Although, as has been seen in the preceding section, the majority of pregnant women are more or less affected with constipation ; yet there frequently exists an opposite condition from about the same causes. Some are habitu- ally subject to diarrhoea or loose discharges from the bowels, others to periodical attacks of it, while again it may alternate or co-exist with constipation ; for we occa- sionally find the discharges fluid in consequence of irrita- tion in the lower portion of the intestines, while accumu- lations are taking place above it. When the evacuations are mixed with blood, it is called dysentery ; and when there is a constant and painful desire to go to stool, the affection is known as tenesmus. The last named condition depends upon the diarrhoea and dysentery ; and when ac- companied by fever and colic, has been known to produce abortion. Treatment. — When diarrhoea is slight and occurs at the commencement of pregnancy, the female retaining her appetite and strength, it may be treated simply by a care- ful diet, rice water and other bland articles, and emollient enemata. If it do not subside, a gentle purge of rhubarb and cream tartar may be taken, with baths, fomentations, and in severe cases the application of leeches to the anus ; or enemata with laudanum, and Dover's powders at night, and during the day tonic bitters, as gentian or camomile with a little ipecacuanha. If it run into dystentery the treatment must be more energetic ; while opium is given internally, or chalk mixture with kino or catechu, the diet should be simple as above ; or twenty drops of laudanum may be given in an enemata of starch and repeated several 323 DIARRHCEA AND SANGUINE PLETHORA. times a day according to circumstances. When tenes- mus is present the treatment is the same. With the in- ternal use of the bitter tonics and ipecac, the greatest good is to be expected from a proper diet, such as rich soups, feculent substances, white meats, fresh eggs, and other substances easy of digestion ; at the same time the bowels must be kept free by the use of castor oil and emollient enemata. CHAPTER III. DISORDERS OF THE CIRCULATING SYSTEM CAUSES SYMP- TOMS AND TREATMENT. SANGUINE PLETHORA. We have elsewhere remarked that the general condi- tion of the system during pregnancy is that of 'plethora : some physicians have believed that this state is the sole cause of the diseases of pregnant women — which opinion to a certain extent only is true, as we sometimes observe the opposite condition. It seems to be caused by the direct effect and sympathy of the gravid uterus and the disorders of other organs, upon the circulation ; also, other causes which concur to produce it, independent of the menses, are the increased nutrition during gestation, a want of exercise, Md too much and too nutricious food. The symptoms of plethora are generally more marked- towards the sixth or seventh month ; they are fulness and hardness of the pulse ; the face is highly colored ; the lips, eyes and nostrils are red and injected ; the gums are painful ; the veins are swollen ; there is dizziness, ringing in the ears, bleeding at the nose, etc. The treatment, principally consists in the use of a vegetable diet containing but little nourishment ; laxa- tives, diluent drinks, emollient enemata, and moderate ex- ercise. When there is a disposition of the constitution to relieve itself by a discharge of blood from any part, bleed- VA^PtFAiZOn OF THE HEART FASTING. 327 ing from the arm should be carefully employed, as the most dangerous consequences may be apprehended from hemorrhage in some vital organ. PALPITATION OF THE HEART. Most of women suffer at some period or other of their pregnancy from palpitation ; nervous and hysterical fe- males are the most subject to it, and the pulsations of the heart are sometimes so strong as to arouse the patient suddenly from sleep, or oblige her to stand still if she be walking. She feels the heart strike violently against the ribs which shakes the whole body ; sometimes there is a frequent and marked intermission ; the respiration be- comes named with giddiness, imperfect vision, and noise in the ears. The cause of palpitation depends upon a nervous constitution and sympathetic irritation of the ute- rus ; it is very often also, connected with plethora. The exciting causes are errors in diet, mental emotions and passions. It often constitutes a troublesome and painful inconvenience. Treatment. — During a paroxysm the patient should be placed in a position that affords the greatest relief; if there be much plethora, blood may be cautiously abstract- ed ; then she should be treated by antispasmodics, as opium, ether, and asafoetida. During the intervals atten- tion should be given to the bowels ; enemata, mild purging, tonics, a suitable diet, and moderate exercise in the open air, with an avoidance of tight dress and mental emotions, will much aid in relieving and restoring the patient. She should sleep with the head elevated, eat but moderately, and abstain from wine, tea, coffee, liquors, and all excit- ing articles. SYNCOPE OR FAINTING. Syncope consists in a complete and generally sudden loss of sensation and motion, with a suspension of respira- tion. It occurs most frequently at the time of quickening, ' and sometimes periodically with an interval of se/eral days or weeks. The attack generally lasts only four or 328 FAINTING DIFFICULT BREATHING. five minutes, during which the countenance, lips and mouth, lose their color, and there is a complete loss of con- sciousness ; it terminates by an insensible return of the respiration and pulse, when frequently the contents of the stomach are discharged. It seems sometimes to be a con- sequence of palpitation, and arises from the same causes carried further. It also sometimes results from plethora and the opposite state anemia ; motion of the child ; strong emotions ; sudden sounds ; certain odors, and tight dress. Treatment. — The woman should be immediately plac- ed in the horizontal posture, be relieved of all dress that might obstruct the motions of her breast, abdomen, neck, and limbs ; should be made to inhale strong odors, as of ammonia, burnt feathers, etc. ; frictions should be made over the region of the heart and other parts by dry cloths, or cloths wrung out of brandy or alcohol ; fresh air should be freely admitted, and cold water sprinkled on the face ; finally, sinapisms may be applied to the arms and legs. When she recovers her consciousness, she should swallow a little wine or other alcoholic drink diluted with water. During the intervals, the state of the bowels should be at- tended to, tonics and antispasmodics exhibited, with a light and nourishing diet ; also moderate exercise should be taken in the open air, and all exciting causes strictly avoided. CHAPTER IV. DISORDERS OF THE RESPIRATORY ORGANS CAUSES SYMP- TOMS AND TREATMENT. DYSPN03A OR DIFFICULT BREATHING. Difficulty of breathing may occur at any period of pregnancy ; first, in the early months from nervous irri- tation ; second, about the middle of gestation from ple- thora ; third, during the latter months from mechanical pressure of the gravid uterus against the diaphragm, DIFFICULT BREATHING COUGH. 329 which is more common in women with narrow chests and contracted pelves. The presence of organic disease of the lungs may also give rise to it. The exciting causes, are excessive fatigue, mental emotions, and the impres- sions of certain odors. The oppression is sometimes so great as to produce a state bordering on suffocation, when the patient is obliged to maintain a vertical position, or place herself for relief on the knees upon cushions with the elbows on other and more elevated cushions, and in this way obtain sleep, or at least repose. Treatment. — During the early months of pregnancy, dyspnoea may be relieved by antispasmodics or diffusible stimulants, such as valerian, ammonia, ether, syrup of poppies, asafoetida, etc., with tonics during the interval. Wheji the attack arises from plethora, venesection should be resorted to, with purgatives, low diet and enemata. When it depends- upon mechanical pressure, the patient must take a position most favorable to respiration : to pre- vent suffocation, bleeding may be resorted to ; the food should be taken only in small quantities at each meal so as to prevent distending the stomach, while every thing difficult of digestion, and which produces wind, as well as all tight dress, must be avoided ; laxative drinks and ene- mata will be found useful in diminishing the size of the abdomen. Lastly, when organic disease of the lungs ex- ists, the treatment must have reference to such disease. COUGH. Freouently connected with the preceding described affection, but often independent of it, is a dry, troublesome cough, either constant or recurring in paroxysms, occa- sioning much distress. The cough which is peculiar to pregnancy, is of a nervous character, unaccompanied by mucous expectoration, occurs in the earlier months, and is caused by the sympathetic influence of the womb ; but there is another, much more dangerous, which it is import- ant to distinguish, produced by pulmonary engorgement or catarrh, characterized by mucous, and sometimes bloody expectoration, and often soreness of the throat; this may be caused in the earlier months by cold, and in the latter 0* 330 COUGH AND SPITTING OF BLOOD. by lessening of the thoracic cavity on account of the gra* vid uterus pushing up the diaphragm and intestines. The former is of little moment compared with the latter, whicb may give rise to fever, headache, haemoptysis, etc. In all cases, cough should be immediately attended to, as it may excite abortion, and determine or increase pulmonary inflammation. Treatment. — For the relief of the nervous cough, opi- ates and antispasmodics, with mild expectorants and counter irritation, will generally succeed. But when it depends on pulmonary engorgement, particularly if ple- thora be present, it will be necessary, in addition, to ab- stract blood. Mucilaginous drinks with syrup of poppies or morphine, Dover's powders and paregoric, with counter irritation, may be resorted to with success. The bowels must be kept free, by laxative enemata and aperients. HEMOPTYSIS OR SPITTING OF BLOOD, AND EPISTAXIS OR BLEEDING FROM THE NOSE. Haemoptysis, though a rare affection, sometimes occurs both in the earlier and latter months of pregnancy ; it is one of the most dangerous complications of the pregnant state. Women of sanguine temperaments, and those who wear tight clothing, are the most obnoxious to this affec- tion. There may be. an expectoration of blood simply, secreted from the bronchial, mucous membrane, which occurs more- frequently at the commencement of pregnan- cy, or, the blood may be derived from the rupture of some small arterial vessel in consequence of coughing while the lungs are engorged with blood ; or lastly, it may de- pend upon organic disease of the lungs, as phthisis. These latter kinds are always unfavorable to the patient, parti- cularly if she had been much troubled with cough before conception. This affection is to be distinguished from vomiting of blood, before adverted to, by the blood coming from the stomach being black, grumous and often mixec with the food ; while that which comes from the lungs, on the contrary, is vermillion in color, frothy and almost pure. Treatment. — This consists, first, in the emulovment oj TNS0MNIA OR SLEEPLESSNESS. 331 bleeding and counter irritation, to relieve the local pie. thora ; and then in the use of opiates, and antispasmod- ics, as directed under the preceding affection, for the pur- pose of quieting the cough and irritation ; to these should be added astringent, cold and acid drinks, low diet, and perfect quiet, both of body and mind. Epistaxis, or bleeding from the nose, occurs more fre- quently in pregnant women than the preceding, but should be regarded rather as a healthful evacuation than as a disease. When it is excessive, however, it may be arrest- ed by keeping the head elevated and covered with cloths wet with cold water and vinegar, or by keeping the arms elevated, and applying cold between the shoulders. It is sometimes necessary to resort to plugging the nasal pass-, ages. CHAPTER V. DISORDERS OF THE NERVOUS SYSTEM AND SENSES. INSOMNIA OR SLEEPLESSNESS. Sleeplessness is one of the most troublesome com- plaints to which pregnant women are subject. It most often affects females of a nervous or hysterical habit, though it is sometimes the result of plethora : the latter, however, generally gives rise to the opposite condition or drowsiness. It may occur at any period of pregnancy, but is most common during the latter months, and seems often to be caused by heated rooms, too little exercise and motions of the child . If it continue for any great length of time, the stomach and bowels become deranged, and the patient complains of great weakness and misery. Sometimes the rest is disturbed by frightful dreams, and at others, the female is unable to sleep during the night, but obtains rest during the day ; this latter should not be confounded with the want of sleep. 332 SLEEPLESSNESS DESPONDENCY. Treatment.- — This should be commenced by freeing the bowels, a soothing and light diet ; anodyne enemata may then be used, or, the fluid extract or tincture of va- lerian ; and in confirmed cases, small doses of morphine or some other opiate, may be taken at bed time. Spong- ing the whole body with cold water before going to bed, especially in warm weather, may be successful ; and lastly, if there be much weakness, tonics should be ex- hibited combined with sedatives and antispasmodics ;• or if there be much plethora, venesection should not be omitted. HYPOCHONDRIASIS OR DESPONDENCY, AND DISORDERS OF THE INTELLIGENCE, MORAL INCLINATIONS AND AFFECTIONS. Women of uncommon delicacy and impressionability, from ignorance of the condition of pregnancy and partu- rition which are only natural processes, and would always terminate favorably were nature allowed its course un- hindered, are apt to represent to themselves the most alarming danger ; the various symptoms that arise, cer- tain impressions made by hearing of the accidents of others, often excite fears of something being wrong, and anticipations of serious consequences, when in reality, there is nothing unusual, and not the least danger, if the patient but quiet her alarm. So that when a pregnant fe- male becomes melancholy and unhappy, which is often evinced by tears, we should sympathize with her, and moreover inform her the exact truth concerning her con- dition, lead the mind away from its morbid reflections, and comfort her affected sorrow with the blessings and joys which await her, when she will be " blessed among wo- rn-en," by becoming a mother. How deplorable, remarks Dr. Montgomery, must be the condition of the mind in a woman, who, led astray by the profligate from virtue's paths of pleasantness and peace and then abandoned, is compelled to consider her preg- nancy a curse instead of a blessing, and has, in addition to the ordinary troubles of that state, to bear up against the agony of disappointed hopes, of affections misplaced and cruelly misused, to endure the present srwn of socie DISORDERS OF THE INTELLIGENCE. 533 ty, and the anticipation of a still increasing shame, for which she is to find no u sweet oblivious antidote" of pow. er to " pluck from the memory a rooted sorrow," or " raze out the written troubles of the brain !" How often has such a state of mind been followed by convulsions, or ending in insanity, has armed with the weapon of suicide the once gentle hand of her who, to use the words of W. Hunter, " might have been an affectionate and gentle wife, a virtuous and honored mother, through a long and happy life." Who can help being interested in such unfortunate beings, and instead of assisting in pushing them down- wards, of lending a helping hand for their consolation and restoration to happiness and joy ? Cases of disordered intelligence, and of the moral in- clinations and affections, are extremely rare, and have been greatly exaggerated : pregnant women have been known to become thievish, to have elevation of the intel- lect, becoming poetical or musical, while others have lost all intellectual activity. Goubelly knew a woman who never had a sound judgment except when she was preg- nant ; but she then lost her memory, which, after parturi- tion, she recovered but at the expense of no judgment. Baudelocque mentions one who ate nothing with so much pleasure as the articles of food that she had stolen, while going to market for her provisions. We have already ad- verted to the case of a woman who, taking a fancy to eat a piece of the flesh of her husband, whom she tenderly loved, assassinated him, and satisfying her depraved appe- tite, salted the rest for the purpose of prolonging the pleasure. Vives speaks of a woman who would, perhaps, have miscarried, had she not been allowed to bite a young man's neck, one of her acquaintances. Finally, Colom- bat speaks of a woman who threw three of her children into a well, and then plunged to the bottom herself; she had two absent children : happily for them, the youngest had not been sent to her in time, agreeably to her order, and the elder child did not eat any of the poisoned cake that she sent it. Treatment. — As to the moral management of the me- lancholic woman, the honest truth should be told her, concerning her suffering and danger, which is far more 15* 334 DISORDERS OF THE AFFECTIONS HEADACHE. effective than attempting to make light of her case. At- tention should be given to the bowels, exercise, cheerful society, and above all the female should be informed how- unfounded are her fears, and how much a happy termina- tion of parturition depends on a composure of mind. Generally,, the above noticed caprices and maniacal states, disappear after delivery without treatment. When there is congestion of the brain with a hot skin and quick pulse, no time should be lost in bleeding the patient, applying counter irritants, and purging her. CEPHALALGIA OR HEADACHE. Headache, next to nausea and vomiting, is, perhaps, the most common complaint of pregnant women. There are three varieties : the first is of a nervous character, arises in delicate constitutions, occurs in the early months from sympathy with the uterus, or may be brought on by vivid emotions of the mind and grief; the second depends upon plethora, occurs in robust constitutions and generally at a later period than the first ; the third variety depends upon disorder of the stomach or bowels, as constipation, which is caused by errors in eating and drinking. When the headache is purely nervous, there is little % danger ; but when it depends on congestion it requires immediate atten- tion, lest it give rise to convulsions. A temporary form of paralysis has been observed connected with the nervous variety. Treatment. — Nervous headache may generally be relieved by antispasmodics or diffusible stimulants ; such as valerian opium, camphor and ammonia, with laxatives or enemata and baths ; by eau de cologne applied to the head, and counter irritants ; and lastly, by rest and sleep. When there are symptoms of plethora the treatment should be active ; blood-letting and purgatives are principally relied on, and should be repeated until the pain be reliev- ed ; blisters to tne nape of the neck and enemata, are also, useful. The diet should be vegetable and mild, and the bowels kept in a soluable state ; air and exercise are also indispensable, particularly in the last named variety- with an avoidance of all stimulants and emotions. HEADACHE CONVULSIONS. 335 PvUERPURAL CONVULSIONS. Convulsions may attack the female daring pregnane), parturition, and after delivery. We shall here depart somewhat from our proposed order, as it would be very inconvenient to describe in this place the convulsions of pregnant women, and those which occur during parturi- tion in another part of the work ; we shall therefore in- culde them all under this article. Convulsions, incident to the pregnant and parturient state a-re of three varieties, the hysteric, the epileptic, and the apoplectic. The hys- terical attack does not differ from that described in Book I. (See Chapter, X, Part IV.) Epileptic convulsions are much more frequent than either of the others ; according to the reports of several physicians in England, out of 38,308 cases of labor, there were 79 cases of convulsions ; or one in about 485. Wo- men of all temperaments are subject to the attack, but the sanguine and those with their first children, particu- larly those with short necks, and of short, square forms,- are the more liable. (Collins.) First among the causes of these convulsions is the irritation of the uterus, which be- stows power upon many other causes that in the common course of life give a predisposition to convulsive disorders, but would not alone, always produce them : women in their first pregnancy ; those of plethoric constitutions, or who have rachitic and deformed systems ; those who are intemperate in eating and drinking, or the use of stimu- lants ; those who wear tight dress or corsets, and give themselves up to venereal pleasures, passions and emotions of the mind ; and, in fine, those who, in any way trans- gress the laws of hygiene, and thus engender an irritable condition of the system, are most subject to this formida- ble affection. Convulsions may also be prodced by severe labor, pains, lacerations, exposure to cold, and walking about too soon after delivery ; they are also, sometimes, brought on by the power of imitation, or from fright by seeing another affected. The symptoms are almost identical with those of ordi- nary epilepsy. After a premonitory stage, longer or shorter, of headache, ringing in the ears, obscure vision, 338 PUERPURAL CONVULSIONS. giddiness, flushed face, temporary loss of sensation, nau- sea and vomiting, the patient loses all consciousness ; the countenance assumes a bluish tint, the eye becomes fixed, the angles of the mouth are drawn backwards, there is a discharge of froth, the hands are clenched, the body be- comes rigid, the head turns over backwards, and the tongue is protruded through the half-open mouth ; the respiration which at first was hurried, becomes suspended and the action of. the heart sometimes almost entirely ceases. The duration of the attack varies from three to five and even ten minutes, when the respiration and cir- culation gradually resume their natural course, the ri- gidity is followed by complete relaxation-»-and accom- panied by stertorous breathing and moanings, conscious- ness is gradually restored without any recollection of what transpired during the paroxysm. It almost always happens that there is a repetition of the attack — the fre- quency of which increases the danger — the torpor and sleep being prolonged in proportion as they are more frequently repeated ; in some cases, they recur at deter- minate periods. Death sometimes takes place during the convulsion, or the stupor which follows it ; and when the woman sur- vives, the life of the child is endangered : the 'prognosis is always very serious, as it is liable to give a permanei: shock to the brain or nervous system. Apoplectic convulsions, rarely or never occur exce towards the termination, or after the conclusion of labor, and they are then, as we have remarked, very rare. They arise from about the same causes as the preceding variety. There may occur nearly the same premonitory symptoms, but the convulsions are much less marked ; there is no frothing at the mouth, little or no distortion of the face, and the patient lies in a torpid state, with sterto- rous respiration and flaccid muscles, from which she rarely recovers. Treatment. — At whatever time the attack takes place, all physicians are decided upon the propriety of immedi- ately letting blood in large quantity, which is to be re* peated according to circumstances ; leeches may also be employed. At the same time cold water is to be poured NERVOUS AFFECTION OF THE EYES, ETC. 337 upon the face, while the patient should be properly held by assistants, without violence ; the tongue, when pro- truded, should be pushed back into the mouth, and a piece of fine cork may be made use of to retain it there, lest it be seriously lacerated. Great benefit will be derived from the administration of a strong purgative, for exam- ple, calomel and jalap; if they cannot be given by the mouth, enemata should be resorted to. Emetics should not be prescribed, unless the convulsions depend upon an overloaded stomach. Cold should be applied to the head by a bladder filled with ice, and the patient put into a warm bath, if there be one at hand. After the lapse of some time, blisters may be applied to the neck and ex- tremeties ; this is particularly necessary when the stupor is prolonged ; they should, however, be removed before vesication takes place. Finally, after the paroxysm has somewhat subsided, an opiate, combined with an antispas- modic, may be given. This mode of treatment applies whether the convulsions occur previous to, during, or aftei labor. The process of gestation or parturition, need not be interfered with more than usual, unless there be some particular indication for such a course ; when the woman is in labor, however, it is always desirable to effect de- livery as soon as practicable. NERVOUS AFFECTIONS OF THE EYES AND EARS. When" we consider the many irritations that arise in different parts, during pregnancy, it is not surprising that the eyes and ears should not escape. When the eyes are affected, it appears to the patient as though surrounding objects were moving in various directions, or she fancies that she sees objects in the air, flashes of light, and a great variety of imaginary forms ; she sometimes sees every thing double, or lastly, vision becomes indistinct or is entirely lost. The sense of hearing may become ob- * tuse, either in one or both ears, or, on the other hand, it may be more acute than usual ; there may be singing and other noises in the ears, or, lastly, the sense of hear- ing may be entirely lost. There may be also derange- ment of the sense of smell. In the majority of cases 338 HEMORRHOIDS OR PILES. these various affections are purely nervous ; but they sometimes depend upon plethora or congestion of the brain. They are generally merely temporary. Treatment. — When they are nervous, very little need be done ; the bowels should be attended to, a small blister may be applied behind the ears, and antispasmodics, as valerian, united with tonics, and sometimes opiates may be prescribed with benefit. The diet should be mild and vegetable, with an occasional enemata. If there be evi- dence of congestion, blood-letting will be necessary, the application of leeches, and one or two brisk purgatives. CHAPTER VI. DISORDERS ARISING FROM MECHANICAL PRESSURE OR DIS- TENSION. Under this chapter should be arranged, when they oc- cur during pregnancy, hernia of the womb, prolapsus, retroversion and anteversion, obliquity, etc., which we have treated of in Part IV. Book I. of this work, to which the reader is referred. HEMORRHOIDS OR PILES. We have already treated of this disease in Chapter VI. Part IV. Book I. ; as the symptoms and treatment are the same when the affection arises during pregnancy, a pro- longed description here is unnecessary. The disease oc- curs most often in women of a feeble and lymphatic con- stitution, during the latter stages of pregnancy, and is caused by the pressure of the gravid uterus ; it also arises in the early months from the use of drastic purga- tives, errors in diet, and constipation. There is frequent- ly considerable fever, tenesmus, bleeding and excoria- tions j the disease is a source of great suffering, and may be so severe as to produce abortion. Treatment. — First, the bowels should be freed by a mild laxative, as sulphur and cream tartar, or electuary INCONTINENCE AND RETENTION OF URINE. 339 of senna, after which, anodyne enemata may be used, and leeches applied around the anus ; emollient and narcotic fomentations and ointments are also very useful. The diet should be liquid, and the drinks cooling. To check the bleeding, if profuse, astringent fomentations and injec- tions, pressure, and plugging the rectum, should be resort- ed to, according to circumstances. (See Chapter VI. Part IV. Book /.) INCONTINENCE OF URINE. By this term is understood an inability to retain the urine ; there is a frequent and painful desire to discharge the water, and, if not instantly gratified, it is passed in- voluntarily. The patient's sufferings are often intense from scalding, itching, and pain of the external parts. Incontinence arises during the early months from irrita- bility, in consequence of the sympathy of the uterus ; at a later period, it is owing to the pressure of the enlarged uterus upon the bladder. Treatment. — During the early months, the bowels should be kept free, leeches may be applied to the lower part of the abdomen, or warm anodyne fomentations, which often, alone, give relief. At the same time opium or hyosciamus may be given internally, with mucilaginous drinks ; injections of a solution of borax or alum, are, also, often very useful. At a later period, little can be done, except to await patiently the termination of gesta- tion ; cold, local sponging may be useful, 'and when ex- coriations arise, they are to be treated with mucilaginous fomentations and astringent lotions. Gentle laxative med- icines and enemata should be occasionally exhibited. The diet should be vegetable and unstimulating. DYSURIA AND RETENTION OF URINE. There may be a difficulty in voiding the urine, or it may be impossible to evacuate it from the bladder ; this may occur either during the early or latter months of pregnancy. In the early months, it is caused by a sym- pathetic irritation of the neck of the bladder, and after- 340 DISTENTION OF THE VEINS. wards, by the pressure of the uterus upon the same ; it may also be caused by displacement of the uterus. Treatment. — When dysuria arises from irritation, re- lief may be obtained from the application of leeches, from anodynes, mucilaginous drinks, and warm fomentations. When the retention depends upon compression, it may sometimes be avoided by changing the position ; if it be complete, the catheter 'must be used, and repeated as fre- quently as may be necessary. Attention should also be given to the bowels and diet. VARICOSE OR DISTENDED VEINS. . Dilatation of the veins, though not a very dangerous or troublesome affection, is one of the most frequent to which pregnant women are subject. It is found most of- ten during the latter half of gestation, and generally af- fects the veins of the lower extremities, and more rarely those of the labia majora, the vagina and mouth of the uterus ; occasionally the veins of the whole body are im- plicated. It generally affects one side more than the other, and occurs, mostly, in women of a lax and plethor- ic habit ; the principal if not sole cause, is the pressure of the gravid uterus upon the large venous trunks of the body. Varicose veins appear under the form of indolent, oblong, round and uneven knots, which generally disap- pear under pressure, but immediately return again ; they diminish by rest in bed, and increase upon resuming a vertical posture. The bleeding from rupture of a small varicose vein is easily suppressed by pressure, but not al- ways so when it occurs in a large vessel. After delivery the veins gradually return to nearly their natural size, ' unless the disposition to the affection be kept up by re- peated pregnancies. It should be remarked that there is a great liability to inflammation of a portion of these veins after delivery. Treatment. — The affection cannot often be cured till after delivery, when it generally subsides spontaneously. The disposition to it, however, may be lessened by keep- ing the bowels in a soluable state, by rest in the horizontal posture, and by means of a laced stocking or bandage DROPSY DURING PREGNANCY. 341 firmly applied in the morning when the veins are least distended. When but one limb is affected, the patient should recline on the opposite side ; when the rupture of a vein takes place, firm pressure will generally control the hemorrhage; the diet should be mild, and constipation carefully avoided. If the affection persist after delivery, the resources of surgery are generally successful in giv- ing relief. (EDEMA, ANASARCA AND ASCITES, OR DROPSY DURING PREG- NANCY. (Ebema or anasarca, signifies a dropsical state of the lower extremeties ; while by ascites is understood, dropsy of the abdomen : the former generally exists with the lat- ter, but often exists independently of it ; and occasionally there is an edematous state of the whole body. Dropsy is most common in women of a feeble and lymphatic body, and is caused by the pressure of the gravid uterus during the latter months of pregnancy ; there is also another and more active kind depending upon plethora. It is often confined to the feet and legs, but is liable to involve the thighs, vulva and hips. The limb appears swollen, semi- transparent, pits upon pressure, increases towards night, and is found diminished in the morning. That which arises as the consequence of pregnancy is not dangerous, and disappears after parturition ; it gives rise merely to sensations of weight, and when the effusion is extensive, interferes with sitting and walking. Sometimes, however, there is fever with much tenderness, and an attack of erysipelatous inflammation may end in abscess. When oedema is complicated with ascites or effusion into the abdomen, which is rare, all the symptoms pecu- liar to abdominal dropsy will be present, which is liable to interfere with the development of the ovum. Treatment. — For dropsy dependant on pressure, it will perhaps be sufficient to keep the bowels in a soluable state by mild purgatives, to which diuretics may be ttdded, with rest in the horizontal posture. Dry firictions and arromatic lotions as well as gentle compression by a roller bandage, may, also, be tried. When the swelling 16 34i JPAINS IN THE BREASTS, AND OTHER PARTS. is large and where the size of the labia offers an impedi- ment to labor, and particularly when abscess is aprehend- ed, the fluid should be evacuated with the point of a lancet ; if an abscess form, it must, also, be punctured. When the dropsy is general and accompanied by fever, the treatment must be more active ; brisk purging and blood-letting are to be principally relied on. On the con- trary, when the patient is feeble and debilitated, a gene- rous diet and tonics will be necessary. Lastly, when there is dropsy of the abdomen, it is sometimes necessary to resort to tapping. PAINS AND CRAMPS IN THE BREASTS AND OTHER PARTS, DURING PREGNANCY. The breasts of some women, on account of the sympa- thetic influence of the uterus, become painful and swollen in the early months of pregnancy; in others, pains come on towards the close of gestation from the distention of the skin from secretion of milk. These pains, generally, require no medical treatment ; in the more serious ones, however, relief may be obtained from applying warmth, emollient fomentations, and opium or belladonna plasters. The bowels should be attended to, and all the habits of the patient carefully regulated. Cramps and irregular pains in various parts of the lower half of the body are not uncommon in pregnant women during the time intervening between the fourth month and delivery ; they attack the sides, back, abdomen and low- er extremeties, being caused by the pressure of the gravid womb upon the nerves or stretching of the ligaments. They sometimes commence by a sensation of numbness or pricking, and are very severe : when they come on suddenly, they cause the patient, sometimes, to fall. These pains, no doubt, are increased by deranged diges- tion, constipation, fatigue, mental irritation, etc. Treatment. — The patient may often find relief by assuming the horizontal posture, and by rest ; also, by friction with some stimulating lotion ; the application of anodyne plasters, or opium internally ; baths ; a flannel bandage to support the abdomen ; by attention to the con- AFFECTIONS OF THE GENITAL ORGANS. 313 dition of the stomach and bowels ; and finally, by patience, which is quite as important a remedy as any other — for these affections are ail temporary, and terminate with the pregnancy. CHAPTER VII. DISEASES OF THE GENITAL ORGANS DURING PREGNANCY. There are several affections to which the reproductive organs are obnoxious during the pregnant state, the man- agement of which does not differ from that already men- tioned for their occurrence in the unimpregnated condition ; we here mention them for the purpose of including all the diseases of pregnancy and thus making this part of our subject complete. Such are uterine hemorrhages oc- curing during pregnancy, which are less dangerous to the mother than to her child ; for the treatment, see chapters on Abortion and Menorrhagia, Pruritus or itching of the vulva is not of unfrequent occurrence, as we have already remarked; see Chapter VI., Part II. , Book I. (Edema of the labia sometimes occurs independently of dropsy of the lower extremeties, but is oftener associated with that affection, and is produced by the same causes : the management does not differ from that directed in the preceding chapter for dropsy during pregnane!/. Vaginal leucorrhea may be excited during pregnancy by any of its ordinary causes, but in addition by the irri- tation of gestation : see Chapter on Leucorrhea, Part IV., Book I. Discharge of watery fluid, requires much the same management. Inflammation and rheumatism of the pregnant ute- rus, are produced by the same causes as in the unimpreg- nated state : for the treatment of the former see chapter on Inflammation of the Unimvregnated Uterus ; for the latter see chapter on Irritable Uterus. Menstruation during pregnancy is a very rare occur- rence : females are stated to have menstruated once or twice after conception, during the fivsi four, five and six 344 AFFECTIONS OF THE GENITAL ORGANS. months, and even throughout the whole period of gesta- tion ; and what is still more remarkable and rare, women have menstruated during pregnancy and at no other time. These occasional occurrences are well established by acute observers and physicians of eminence, but they may be regarded as departures from the normal course of na- ture ; thedischarge may proceed from the lower portion of the uterine cavity before the ovum is sufficiently large to fill it, or from the vessels of the neck, or from the vaginal mucous membrane. It, in general, requires no particular medical treatment ; it may be well for the patient to preserve the recumbent posture during the continuance of the discharge, for the purpose of guarding against miscarriage ; her clothing should not be too warm ; her diet should be moderate but not stimulating, and her occupations cheerful ; in fine, in this, as well as all the affections of pregnancy, let the female guard her interesting condition against the evils to which she is obnoxious, by an appropriate system of phy- sical and mental hygiene. PART II. the Physiology and diseases of childbirth. SECTION I. PHYSIOLOGY OF CHILDBIRTH. "VThen pregnancy has passed through all its stages, ac- cording to the design of nature, and the foetus has attained its last, and a sufficient degree of maturity, to enable it to exist independently of the mother, " the birth of man takes place ;" the phenomena attending the expulsion of the foetus from its maternal connection, which may be likened to the effort by which a tree casts off its fruit when fully ripe, is called childbirth, parturition, or labor. This, as has already been seen, generally, occurs at the end of nine calendar months and a week — ten lunar months — forty weeks, or 280 days : a few days may be allowed either way. If labor take place at the time here indicated, it is said to be at term; if pregnancy extend beyond this period, it is said to be tardy or retarded ; if it take place between the seventh and ninth month, it is known as 'premature or precocious ; finally, if it occur before the seventh month, it is called miscarriage or abortion. Labor, in all these cases, is accompanied by about the same phenomena. 345 CHAPTER L THE CAUSES OF LABOR. Hippocrates, with all the ancients, believed that the child was born by its own efforts. Numerous opinions, respecting the cause of labor, were formerly held, which have no connection whatever with the true cause. An Arabian physician of the eleventh century, contents him- self by saying : " At the proper time, labor comes on at the command of God ;" and in modern times, a physician of our own country, remarks : " We know no more of the immediate, exciting cause of labor, than we do why straw- berries ripen in June, and peaches in August. It is a law established by the Creator : that is all we know about it." But while the exciting or determining cause of labor yet remains unknown, the same periodicity which char- acterizes the other uterine functions, is observed here also. Abortion and premature labor, when not the result of ac- cident, generally occur at what, but for conception, would have been a menstrual period. It has been remarked by Stark and others, that the normal period for childbirth, also, corresponds to a menstrual period ; and it is well established, that labor takes place at about the tenth peri- od after the last appearance of the menses — there being, sometimes, a variation of a few days, which depends up- on, whether conception took place immediately before or after menstruation. We know, from direct observation, that the efficient cause of labor, is principally constituted by the contrac- tions of the uterus. If the hand be applied over the womb during a pain, its contractions may be distinctly felt ; when, from necessity, we are obliged to introduce the hand into the cavity of the uterus, it often happens that we are compelled to suspend progress during each con- traction ; and sometimes the hand of the operator, for a 346 THE PHENOMENA OF NATURAL LABOR. 347 short time, becomes "paralyzed, losing all power, and is soon forcibly expelled. Several cases are reported, in which pregnancy occurred in a prolapsed womb, and the labor terminated spontaneously, while the uterus was be- tween the thighs of the mother. Though it is seen by these examples that the contractions of the uterus are suf- ficient for the expulsion of the child, nevertheless, in most cases the womb is sustained and assisted by the action of the diaphragm and abdominal muscles. The function of parturition is almost entirely involun- tary ; many women have been unconsciously delivered, by spontaneous efforts alone, while in a deep sleep, or lethargy, produced by criminal attempts. A female may, however, by the power of the will, retard or delay labor for a few hours, and in this sense, it may be considered partially voluntary, like unto the excretion of stool, and the emission of urine ; so, also, on the contrary, a woman who bears down, or enforces her pains will sooner get rid of the product of conception. When the womb has reached its enormous and last de- gree of distention, it, by gradual and slight contractions, dilates its neck ; when the orifice is sufficiently large, the uterus, redoubling its own efforts, rarely fails to receive the assistance of all the muscles of the body, and particu- larly of the diaphragm and abdominal muscles. CHAPTER II. THE MECHANISM AND PHENOMENA OF SPONTANEOUS OR NATURAL LABOR. The term natural labor has been applied, by some authors, to those cases in which the head of the child pre- sents, and the process is concluded, in due time, by the unaided powers of nature, with safety to the mother and child ; other authors have classed, as spontaneous, all la- bors that terminate under the sole influence of the powers of the organism, whether the head present ; the breech, in- cluding the hips and loins ; the inferior extremeties> in- 349 THE PHENOMENA OF natural labor. eluding the knees and feet; the superior extremities^ including the shoulder, elbow and hand ; or other presen- tations, such as the back, abdomen, sides, etc., which are extremely rare. On the contrary, those labors that are difficult, in any way endangering the life or health of the mother or child, are known as difficult, troublesome or complicated. Notwithstanding, the latter classification would seem to be more philosophical and convenient, there is no denying that the head of the child ought to present and be deliver- ed first; and that when any other part descends first, it may, strictly speaking, be regarded as unnatural ; yet in any of the presentations above noticed, the labor may be spontaneous and' fortunate. We shall, however, follow this division, as it is believed that all discrepancy disap- pears by substituting the word spontaneous for natural. Any part of the head may present, constituting a variety of positions, and the same may be said of the other pre- sentations, which it is not necessary for us to dwell upon. Head presentations form a very large proportion of the sum total ; out of 20,517 cases of labor, recorded by Madam Boivin, there were 19,810 head presentations, 372 breech presentations, 238 of the inferior extremeties, and 80 presentations of the superior extremeties. In order that a labor may be spontaneous, or terminate without foreign aid, perfection of form and a healthy con- stitution, are requisite on the part of the woman ; and on the part of the child, it is important that it be normally developed, that one of its extremeties present, and that it be not of a size disproportioned to the. capacity of the pel- vis. Notwithstanding the number of these conditions, difficult parturition is comparatively rare ; while sponta- neous childbirth constitutes a very large proportion of the whole number of labors. Out of* 20,357 labors that took place at the Maternite of Paris, 20,183 were brought to a conclusion by the hand of nature alone. The mechanism of labor is an ingenious contrivance, and consists in the application of mechanical principles to the accomplishment of delivery. The child, instead of descending in a strait line from the uterus, as might be supposed by ©ne unacquainted with the anatomy of the THE PHENOMENA OF NATURAL LABOR. 349 parts, lias to pass through a crooked, bony canal ; it, in fact, during its passage, describes a perfect half circle. When the head presents, it enters the brim of the pelvis diagonally, with the vertex turned towards one acetabulum, generally the left ; after, in this manner, passing through the superior strait, it makes a quarter turn, so that the face lodges in the hollow of the sacrum ; this motion brings the long diameter of the foetal head to correspond with the long diameter of the outlet, which is exactly the reverse of that of the superior strait. The head now passes the inferior strait, (at the same time the shoulders are passing the superior) when it makes another quarter turn so as to bring the long diameter of the shoulders to correspond with that of the inferior strait. And thus this spiral progression continues, from the moment the head engages in the superior strait, until the body of the child is expelled from the mother. For the convenience of description, it is customary to divide the process of labor into stages, some making more, and others less : we shall make three stages. The first, extending from the commencement of labor to the com- plete dilatation of the mouth of the uterus ; the second, ends with the delivery of the child ; the third, is occupied by the expulsion of the afterbirth. Another period may be added, called the 'preliminary signs of labor. The preliminary signs, in some women, are scarcely noticed ; in others they are but slight, while in many they are well marked. From two to fifteen and even twenty days before parturition, the abdomen diminishes in size, from sinking down of the womb ; the motions of the child are increased ; the external labia become swollen, and sometimes painful ; the respiration, appetite and digestion are better; the female regains her former gaiety, is more disposed to activity, and is often induced to believe that her term is further off than she had supposed. There is a sense of weight in the pelvis, a frequent disposition to stool, and to void the urine, caused by the pressure of the uterus ; the pelvic cavity becomes relaxed and softened ; there is a more active secretion of mucus in the genital passages, and a glairy matter, more or less abundant, escapes from the vagina. 350 THE PHENOMENA OF NATURAL LABOR. Towards the close of gestation, there is painless con- traction of the uterus, by which the neck of that organ becomes insensibly dilated. Sometimes, however, from over-fatigue of the patient, indigestion, constipation, cold, etc., these contractions become painful, simulating the pains of labor ; they are known as false or spurious pains, and may occur at any period of gestation, but are not common until towards its termination. They may be dis- tinguished from the true pains by the following differen- ces : they commence in the upper part of the abdomen, are of limited extent, recur at irregular intervals, but are not attended with the glairy mucous discharge, do not di- late the mouth of the uterus, or protrude the bag of waters ; true pains, on the contrary, are accompanied by phenome- na quite the reverse of this. These pains should be treat- ed by aromatic purgatives, sedatives, and by regulating the habits of the patient. The first stage of labor, at length, begins: it ia marked by slight colic pains, which gradually, and at con- siderable intervals, become more intense ; the external genitals are moistened by the secretion of glairy mucus. The pains now increase, while the womb contracts, com- pressing the foetus, and forcing it downwards. The woman is now frequently troubled with evil forebodings ; she becomes low-spirited, loses all courage, weeps, and sometimes says she is going to die. It is said that animals, also, fall into this state of fear at the commencement of labor, refuse to eat and drink, seeming to be occupied with some threatening danger. The pains not only increase in severity, but at the same time become longer and more frequent ; the dis- charge of mucus increases, and streaks of blood are found mixed with it ; the mouth of the womb by degrees dilates, and the lower portion of the foetus is protruded into the upper part of the vagina, and is known as the bag of wa- ters ; the woman becomes irritable, impatient, and difficult to control ; the pains are preceded by rigors, there is heat, quickness of the pulse, a flushed face, aud great thirst; nausea, vomiting, and cough ; and in irritable women, the anguish and restlessness are so great as to resemble deli- rium. When a contraction is over the restlessness ceases. THE PHENOMENA OF NATURAL LABOR. 351 the mouth becomes moist, the pulse, the skin, and in fine, everything, returns to its natural state ; the bag of waters has returned into the cavity of the uterus; and though the nausea is suspended, the abdomen, often remains more or less tender. Each pain produces the same series of phenomena, but the remission, which grows shorter and shorter, is more complete. The mouth of the uterus, gradually yields, and becomes sufficiently dilated for the passage of the child's head, which terminates the first, the longest, and most fatiguing stage of labor ; though not always the most dangerous. In the second stage of labor, the contractions become stronger, last for a longer period, are not so far apart, but are followed by a more decided calm. The courage of the woman returns, and they sometimes sleep during the short interval between the pains. The bag of waters be- ing more and more compressed in the upper part of the vagina, at length, in the midst of one of the most violent pains, bursts ; and the child, forced downwards by the same contraction, takes the place of the membranes and prevents the escape of the rest of the waters. Soon, the pains succeed each other with greater rapidity, each one being ushered in with a shiver ; the severest ones are often preceded by another which is milder ; or they may alternate with each other. The woman, now, almost in spite of herself, is compelled to second her pains by con- tracting the abdominal muscles, and making the most violent efforts ; she lays hold of the sides of the bed, or anything within her reach, plants her heels upon the matress, draws a long breath, and contracts the muscles of the abdomen with her whole power while the dia- phragm is pushed downwards with great force, and all the muscles of the body act with the same energy ; the neck and face become engorged with blood, the eyes sparkle, sweat pours from the skin, and at length this great con- traction ends in rapid sobs, which soon restore calmness. After a short time another pain comes on, followed by the same phenomena ; and soon again, another, which is somewhat stronger, and pushes the head of the child into the vagina ; the bearings-down are now redoubled ; there are cramps in the thighs and legs ) the vagina is unfold- 352 'THE PHENOMENA OF NATURAL LABOR. ed and enlarged in every direction. As the head ap- proaches the inferior strait, the coccyx is pushed back- wards, the perineum is elongated and becomes thinner, the labia are put on the stretch and completely unfolded : na- ture now rallies her remaining muscular power, and by a few contractions, still more powerful than the former, tri- umphs over all resistance, and the head, or presenting part, escapes through the vulva ; this is followed, gener- ally after a few minutes, by the body of the child, which is expelled by a moderately strong contraction. The second stage is now finished, and the state of intense suf- fering is exchanged for perfect ease. The third stage of labor includes the detachment and expulsion of the placenta or afterbirth. In mo.°t rases it is partially or whollv detached by the same contractions which expel the child, remaining in the uterus or vagina ; sometimes, however, it is expelled with the child. In the former case, after an interval, varying from a few min- utes to an hour and a half, the average being fifteen or twenty minutes, the uterus again actively contracts, but much less forcibly, and expels it along with a gush of clots of blood. The labor is now concluded. One of the most melting scenes, remarks Velpeau, a scene best adapted vividly to affect the human heart, is presented to the eyes of the philosophical accoucher. To those piercing cries and vio- lent agitation, to those transports of despair, those exces- sive efforts, which seem to be intolerable, instantly suc- ceeds a delicious calm, full of charms, and interrupted only by the happy idea of being a mother. The new- born child cries, and all the sufferings of the mother so courageously borne, are forgotten ; passionate expressions of satisfaction are substituted for those of pain ; sobs of happiness succeed to the sobs of despair ; and this sudden transition from the extremest dread, from a frightful state of anxiety, to the height of joy and of the tenderest affec- tions, is, in sensible, amiable women, one among those appearances which most imperiously demand our admira- tion for a sex whose other claims to it are so numerous ! We should remark, that the foregoing phenomena are not found in all women, or in all labors of the same women ; but chiefly in those who are young, vigorous, THE PHEX03IENA OF NATURAL LABOR. 353 and in labor for the first time : in different cases are found a great variety of appearances. The duration of labor is much shorter in savage than in civilized life ; in hot, than in cold countries. Labor, in this country, lasts from four to eight or twelve hours ; the average term may be stated at from four to six hours. Out of 15,850 cases recorded by Dr. Collins, of England, 13,012 were terminated at the end of six hours, 2,072 re- quired twelve hours, 262 eighteen hours, 240 twenty-four hours, and 264 required for their termination over twenty- forr hours. The most essential phenomena of labor require further notice : they are, as has been seen, the contraction of the uterus, or pain, the dilatation of the neck, the formation of the bag of waters, and the discharge of glairy rnucus. Labor-pains. Common use has rendered the word pain synonymous with uterine contraction ; and although it is true that they begin, progress, and cease together, and that it is generally by the pain that we estimate the strength of the contraction, yet we are sure that the one is not wholly dependent on the other. For, although, no labor can be terminated without contraction on the part of the uterus, it is known that many have taken place without pain. The pains, at first slight, and known as little 'pains, commence in the loins, gradually extend round to the abdomen, and down the thighs : when the labor is fairly set in, they are known as grinding pains. During the first stage, the ac- tion of the womb is involuntary, and it can receive no as- sistance from bearing-down efforts till the foetus be forced into the cavity of the pelvis. During the second stage, however, nature employs all her efforts for the expulsion of the child ; the pains now are changed in character, and are known as great or bearing-down pains. At first, each pain continues less than half a minute, and the interval of calm is about fifteen minutes ; towards the close of labor, however, the duration of the pain increases to a minute or a minuce and a half, while the interval of calm is re- duced to four or five minutes. The cause of labor pains has been supposed to be the contractions of the uterus : they have also been attributed r* 354 THE PHENOMENA OF NATURAL LABOR. to other causes. But the majority of writers at the pre- sent, day are of opinion that no normal muscular contrac- tion was designed to give rise to pain, and are agreed with Dr. Churchill, that the cause of suffering is, first, the for- cible distension of the neck, next the pressure of the fibres during contraction upon the nervous filaments, and lastly, the dilatation of the passages. Madam Boivin, who speaks from what she has experienced in her own person, advocates this idea, and thinks that the contractions of the womb are not more painful than those of the bladder and other muscular organs. It should be remarked that the amount of suffering much depends upon the habits of life ; among savages it is slight, but it is excessive in civilized life. The dilatation of the passages. The process of dilata- tion, which depends upon the contractions of the uterus, is slow at the commencement of labor, but is effected with rapidity towards its close ; it has been remarked that more time is required to enlarge the mouth of the uterus to the size of a crown piece, than to completely dilate it, — when its diameter is about three inches. The real cause of it, as we have intimated, is the contraction of the uterus : by this the foetus is pushed against the orifice which acts like a wedge, and the membranes containing the liquor amnii, known as the bag of waters, are protruded into the upper part of the vagina ; when the waters are discharged, the child takes its place, and assists, also, in completing, suf- ficiently for its passage, the dilatation. This constitutes the first stage of labor, the length of which, depends upon the amount of resistance to be over- come ; it is greatest with first children, and in women of advanced age ; the mean time may be stated at from three to four hours. Discharge of glairy mucus. This term is given to a clear, yellowish, white colored matter, which escapes from the vagina during labor ; it sometimes resembles the white of eggs ; it escapes in small masses during the contrac- tions, and sometimes appears several days before labor commences. The quantity discharged is sometimes very small, and at others, very large ; when it is wholly want- ing, the labor is said to be a dry one ; when red streaks THE PAINS OF CHILDBIRTH OBVIATED. 355 are observed in it, it is called by the women a show. This glairy matter is secreted by the mucous membrane of the vagina, and its use is to lubricate the surfaces over which the child is to pass. The bag of waters. This name has been given to the protrusion of the membranes of the foetus, containing the liquor amnii, into the upper part of the vagina, during labor. It is round, ovoid or globular, its shape varying according to the opening through which it escapes. Dur- ing a contraction, the bag is tense and elastic ; after this is over, it becomes wrinkled, or is found to have disappear- ed. It is formed by the contractions of the uterus, and its use, as has been seen, is to dilate the mouth of the ute- rus, without injury of the parts. It generally breaks and discharges its contents, near the close of the first, or at the commencement of the second stage of labor ; but it some- times happens that it is ruptured before the commence- ment of labor, and at others, that it is not ruptured at all. When its rupture is delayed till it nearly reaches the vulva, and it does not break in the centre, the head of the child carries away a portion of it, and is born covered with what is called a caul. It was anciently predicted that a child born in this way would be lucky if the caul happened to be of a certain color ; talismanic powers, have, also, been absurdly attributed to it. CHAPTER III. IS PAIN IN CHILDBIRTH A MORBID SYMPTOM ? Childbirth or parturition is a natural function ; and why the human female of civilized life suffers more dur- ing the performance of this function, than she does in sav- age life, or more than the female of the brute* creation, is a question of deep interest and of the greatest moment to our race. It is generally known that among the Indian tribes of our country, the women not only c?o not require the assistance of art in their delivery, but as labor ap- proaches, they re f ire alone to some secluded spot, near a 356 THE PAINS OF CHILDBIRTH OBVIATED. stream of water, where nature, true to her intentions, does not forsake them ; after having washed the infant, and bathed themselves, they almost immediately return to their usual occupatious ; — thus presenting a spectacle very sim- ilar to what is observed in the inferior animals. The same facility in labor exists among many of the Eastern and African nations ; also an approach to the same is observed among a certain class in our own country, — those, who, from their necessities, exereise much in the open air, and live a natural life. Washington Irving, who travelled among the Indians, relates that, " a squaw belonging to the company, who was pregnant, one day left the company, and the next day overtook us on her horse, with her infant in her arms, and rejoined our party." Long, remarks : " One evening, I asked an Indian where his wife was. ' He supposed she had gone into the woods to set a collar for a partridge.' In about an hour she returned with a new-born infant in her arms, and coming up to me said in Chippeway, * Oway, Saggonash, payshik shomagonisli /' — Here, Englishman, is a young warrior." Other instances of this kind are not wanting but these are sufficient for our purpose. What a striking difference is here, compared to the great preparations and management, during a labor of a fash- ionable American woman ! "In a state of natural simplicity," says Crantz, "women in all climates bear their children easily and recover speedi- ly. The Greenlanders, mostly, do all of their common business just before and after delivery ; and a still-born or deformed child is seldom heard of. in proportion as we remove women from a state of simplicity to luxury and refinement, we find that the powers of the system become impaired, and the process of parturition is rendered more painful." A medical writer still further remarks : " To what else, but the perversion of our nature, is the origin of these difficulties to be ascribed ? — by deviating from her estab- lished laws in our habits, customs, and fashionable way of living — our erroneous diet, want of exercise, tight lac- ing, and various other fashionable vices common to civi- lized society: to these is woman indebted for the chief THE PAINS OF CHILDBIRTH OBVIATED. 357 portion of the pains of labor, as is proved by those who live more agreeably to Nature's laws." Dr. Dewees has the following, to our subject, very ap- posite remarks : " With respect to the facility of labor, it would be wrong to suppose that the labor of the female brute is performed upon different principles from that of the human female, because she is, for the most part, exempt from pain ; for truly the same general process occurs in both, and in each the uterus exerts the same kind of action. The only difference is, the one is per- formed with pain, and the other without. Whatever difference, therefore, there may be in the pain of each, must arise from artificial causes. This would seem to be proved by the consequences which seem everywhere to follow civilization and refinement. The consequences of domestication may be traced in those animals which par- ticipate with man in his departure from his original sim- plicity ; for we are informed that the artificial condition in which the cow is placed, in our large cities, subjects her to more difficult and dangerous labors than those in the natural or less artificial state. 55 We shall here leave this subject, allowing the reader to decide whether the question at the head of this chapter is answered, and close the chapter with the following judicious remarks from Dr. Velpeau : Inasmuch as spontaneous parturition is a natural func- tion and not a disease, are we thence to conclude that the art of the accoucher is unnecessary, and that women in labor need no assistance ? Some physicians, misled by mistaken philanthropy, have thought so. In animals, say they, pregnancy brings no inconveniences, and delivery is almost unattended with pain. The wives of the Osti- acks, who are still strangers to the refinements of Euro- pean civilization, are delivered of their children upon the spot where they happen to be, and immediately resume their accustomed occupations, or continue their march, if they happen to be on a journey. I, like Roussell, have seen a young girl who found means to conceal from her parents both the humiliating proofs of her weakness and the operation that delivered her from it. What practi- tioner is there who has not had an opportunity of making 16* 358 THE PAINS OF CHILDBIRTH OBVIATED. the same observation ? The pregnancies of these poor creatures being illegitimate, it would seem as though they had no right to be sick ! But these remarks in no wise prove that women ought to be left to themselves during parturition. In the first place, it is false to say that parturition in animals never requires any assistance, and is never accompanied with serious accidents : sows, mares, cows, etc., are even, in general, quite ill, in bringing forth their young, and coun- try people are by no means ignorant of the fact. Does it follow, because some women, when compelled by imperi- ous motives to deliver themselves in private, or without taking the least precaution, escape from the serious dan- gers with which they supposed themselves to be threaten- ed, that all others may imitate them without exposure to more imminent perils ? If there be some whose health is not disturbed by such painful experiments, how many others are there who become the victims of their temerity ? Will people never be tired of referring us back to a period of primitive nature, that everybody talks about, and no- body understands ? By attempting to substitute the ex- ception for the rule, we inevitably fall into absurdity, and that is what happened to the elegant Roussell. The busi- ness of the accoucher, doubtless, is not to put himself in nature's place where a labor is natural ; but somebody ought to be with the woman who is able to give her proper directions, to forsee accidents, to recognise them, and to remedy them when they do take place ; to apply the re- sources of art when necessary, and at the opportune mo- ment ; who, by the confidence he inspires, calms all her fears, and gives courage and resignation, by tranquil izing her in regard to the future ; but who differs more and more from the mere spectator, in proportion to the extent of his knowledge and skill. CHAPTER IV. HYGIENE AND MANAGEMENT OF WOMEN IN CHIIJ)BIRTH. * It cannot be too frequently repeated, nor too strongly- impressed on the minds of all women and practitioners of midwifery, that in a natural labor, there is very little to do, — notwithstanding the sufferings of the patient may be severe : the accoucher has only to calm the woman's fears, endeavor to fortify her patience, regulate her diet and evacuations, check improper efforts, receive the child, tie the cord, and assist in delivering the after-birth, in the most cautious manner. The intelligent and prudent prac- titioner is well aware of the impropriety and danger of any interference for Me purpose of shortening or hasten- ing the natural process of delivery. I am fully convinc- ed, remarks Dr. Denman, that in the far greater part of really difficult labors to which I have been called — and I must not conceal the truth on this occasion — many of those which have been under my care originally, were not of that description from unavoidable necessity, but were rendered such by improper management in the com- mencement, or during the course of labor. It must not be inferred from this that women in labor never need assist- ance ; but it often requires great care and much knowl- edge to decide when nature can no longer be trusted, and it is necessary to call in the assistance of art. Hygienic management. In cities, for a lying-in cham- ber, a quiet, well-aired, back room should be preferred ; one sufficiently spacious, and with facilities for giving it a moderate and agreeable degree of warmth, only. Plants, flowers, and odors of all kinds, should be dispensed with, and every thing disagreeable to the woman, including all useless persons, should be removed from the apartment. Food and drinks. If a rapid delivery be expected, all kinds of aliment will be injurious, as the digestive powers are, temporarily, suspended. On the contrary, if the la- 359 360 MANAGEMENT OF PARTURIENT WOMEN. bor progress slowly, light broths or pottage may be allow- ed ; bat, in general, meats, bread, fruits, strong tea, coffee, chocolate, spirits, etc., should be prohibited : this applies more particularly to strong and healthy women ; some- times a female who is feeble but in tolerable health, may, • with advantage, at the commencement of labor, take a moderate breakfast. Most women, under such circum- stances, have but little desire for food, and readily per- ceive that they ought not to eat ; but not so with drinks ; on account of the excessive heat observed in most labors, there is a constant desire for the ingestion of fluids. Any simple drink may be allowed ; either water, or decoctions and infusions of elm, marshmallows, barley, gum, dande- lion, etc ; in general, all acids, wines, aromatic and heat- ing drinks, should be prohibited. It is only in debilitated constitutions, that a few spoonsful of wine may be given, providing there be no counter-indication from nervous ex- citability. * Excretions. The state of the foecal and urinary excre- tions always require attention. Constipation may act in- juriously not only by retarding labor, but by promoting the formation of hemorrhoidal tumors ; the labor may also be protracted by the accumulation of urine. Therefore, the woman should be directed, naturally, to evacuate the rectum and bladder while she is able to do so ; if her eft forts be insufficient, for the former purpose, a mild laxa- tive may be taken, or, what is better, an enemata of tepid water, or a decoction of marshmallows or flaxseed ; for the latter purpose, the catheter should be employed i some- times a male catheter answers a better purpose. The moral state. Parturition, remarks M. Velpeau, is a function that seeks the shade, that may be obstructed by indiscrete looks, and which as far as possible is made a mystery of by modest women. The accoucher ought to understand that the mother, the aunt, grand mother, or sister, are not always considered as the most agreeable attendants in this painful moment. As a discreet, as well as a circumspect and prudent interpreter, he ought to dis- miss without distinction, every one whose presence is not desired by the woman. How careful should he be him- self! impassible and firm, of an impurtable coolness, he MANAGEMENT OF PARTURIENT WOMEN. 361 must, notwithstanding, know how to compassionate the distress of which he is a witness, encourage, console, amuse ; inspire her with boundless confidence, and great familiarity by the affability of his conduct, by reasoning that everybody can understand, by his patience, the amenity of his temper and the gravity of his manners ; he should be able to procure obedience without restraint, and by all the means which are suggested by moral philoso- phy, his own understanding and education, incessantly combat the discouragement and dread of all sorts, and sadness and alarms to which the most resolute as well as the most timid women sometimes give way. Dress, lying-in bed, etc. The dress during labor, should be light, and only of moderate warmth ; it should be loose and so arranged as not, in the least, to compress the abdo- men, breasts, neck, or limbs. The best lying-in bed is one with a tight, sacking bottom, covered with a matress. with bolsters, pillows, etc., so as to form an inclined plane. In the country, a bed is often made by tying together, face to face, six or eight chairs. A strong and well-formed woman may be delivered on any kind of a bed, or even on the floor, and in almost any posture. There are some who prefer being delivered standing, with the elbows resting on the mantel piece, a tabie or chair ; or, on their knees upon the floor. The object should be, to assume a position, comfortable, and one not likely to be interrupted. There can be no fixed time at which a woman should place herself on the lying-in bed. It is not necessary for her to lie down until the membranes are ruptured, unless it be for the purpose of rest as often as she feels fatigued ; she had better do so as soon as the head engages in the passage ; but where the pains are weak and far apart, even if the membranes have given way, she had better move about as long as her strength will permit. Again, should the pelvis be a very large one, and the mouth of the uterus be dilated without rupture of the membranes, or should the labor progress too rapidly, she should lie down early. We should remark that the woman, during die pains, may lie on her left side with the thighs drawn up, and a pillow between the knees, or on her back 5.HJ.2 MANAGEMENT OF PARTURIENT WOMEN. • with the thighs half flexed, and the feet resting on the bed ; the former is the most common position in this country ; during the intervals she should be left to choose her own posture. 'Touching the woman. The touch is performed at dif- ferent periods of labor, for the purpose of ascertaining whether labor has commenced, what part of the. child pre- sents, how far the labor has advanced, etc. Rigorously speaking, says Velpeau, it would be sufficient t9 touch three times during a labor; once at the commencement, to learn whether the womb is contracting ; a second time, just as the waters break, to make ourselves positively sure of the position ; and a third, when the pains and efforts have acquired a certain degree of strength, in order to see whether the parts engage properly in the excavation ; but, generally speaking, unless the vulva and vagina are irritable, we may repeat the operation more frequently. Touching, although it may be annoying to the woman, cannot, safely, be dispensed with. Almost every physi- cian has been, frequently, kept out of his house all night lor the purpose of being near a patient supposed to be in labor, having been refused the privilege of making an ex- amination ; upon its being acceded to, the mouth of the uterus has been found closed, and sometimes he has been obliged to announce that the woman had not reached her full term by two or three weeks. It is extremely vexa- tious to be thus baffled by the backwardness of the patient to submit to an operation that is inevitable. In perform- ing the operation, the finger had better be oiled and intro- duced during a pain ; when a remission takes place we should minutely examine the parts. The diagnosis is thus briefly stated by Churchill : The head may be known by its hardness, by the sutures and fontanelles. The breech, by its softness, by the cleft be- tween the buttocks, the anus, or coccyx, scrotum, or vul- va. The knee, by its rounded form, by the condyles ot the femur. The foot, by its long form, its being at right angles with the leg, the nearly equal length of the toes, the narrow heel, etc. The elbow, by the olecranon pro- cess rendering the joint sharper than the kne*. The hand MANAGEMENT OF PARTURIENT WOMEN. 333 by its shortness, the unequal length of the fingers,and the divarication of the thumb. Conduct of the woman. The courage and will of the patient may exert great inflnence on the progress of labor. The by-standers, and sometimes the practitioner, very wrongly direct the patient to bear down, as soon as the pains become somewhat strong ; such conduct can only be the fruit of ignorance, for before the membranes are bro- ken or the os uteri dilated, such efforts only exhaust the woman to no purpose. But at the end of the first stage, or as soon as the child engages in the passage, the womb powerfully contracts, and there is felt a desire to bear down independently of the woman's will ; now that the general muscular power is solicited, she should bear down with all her might — suspending all effort, however, as soon as the womb ceases to act. - There are some timid women,- who are restrained from assisting the contractions for fear of making their pains too sharp ; such should know that nothing can save them from the pain, and that by so doing the period of delivery is protracted. Others there are, who give themselves up to immoderate efforts ; &ach should be informed, that they expose themselves to serious consequences, such as congestion of the brain, bursting of the large veins, hernias, etc. Conduct of the attendant. We are told by authors of accouchers, who. placing themselves between the knees of the woman, with the coat off and sleeves tucked up, forcibly dilate the passages under the pretext of accelerat- ing the labor ! ; and that sometimes females themselves, not knowing the dangers to which they are thereby ex- posed, are the first to ask for it ! This can never be done with safety ; and the poor creatures who submit to such procedures, run the risk of having a natural labor con- verted into a complex one, which may prove fatal not only to the child, but to the mother. Sometimes, when there is much rigidity and irritability of the parts, it may be useful to introduce one or more fingers for the purpose of applying some mucilage or belladonna ointment ; but further than this, interference is not permissible. When the efforts are violent, and just as the head reaches the vulva, it has been recommended to support «>>4 MANAGEMENT OF PARTURIENT WOME.X. the perineum by pressing against it with the hand or fin- gers, for the purpose of preventing laceration ; but this is not necessary, unless the contractions be extremely vio- lent, — and even then it may prove an evil instead of a benefit, unless care be? taken not to prevent the descent of the child. Receiving the child. As the head passes through the vulva, it should be received into the right hand, allowing it to make the usual rotation, and carrying it forward as the pains expel the shoulders and body of the child ; the left hand should be employed in clearing its mouth of any mucus or membrane that may be there, and before the shoulders are expelled, in feeling to ascertain whether there be any coil of the cord around the child's neck, as occasionally happens to the imminent risk of its life. When the child is born it may-be laid on one side with its back to the mother. Separating the child, If the child be in good condition, it will cry very soon after being born ; when respiration is established, it should be brought into view, and after tying the cord, separated from the mother, rolled in flan- nel, and given to the nurse. The ligature, which should have been previously prepared, may consist of a piece of fine tape, or several pieces of thread, which, after waiting until pulsation in the cord has ceased, should* be placed around it at about one inch from the navel : the cord is then to be cut by the scissors. Some authors recommend the application of a second ligature about an inch from the first, and the cutting of the cord between them ; and this becomes always necessary when there are twins. Be- fore the child is dressed, the end of the cord should be ex- amined, and if any oozing of blood be observed, another ligature should be applied nearer the navel ; this frag- ment of the cord withers, and generally falls off in five or six days. l The hand should now be placed over the womb, for the purpose of ascertaining (from the size of the uterus) whether there are twins ; if not, the binder may be appli- ed, which should extend from the chest, embracing the whole abdomen and hips ; if another or other children be MANAGEMENT OF THE CHILI*. 365 found, their delivery must be proceeded with in the same manner as the first. Delivery of the afterbirth. After the uterus contracts and detaches the placenta, (which it generally does within ten or twenty minutes after the expulsion of the child) it is commonly very soon expelled into the vagina ; this may be ascertained by making gentle traction on the cord, when it will come away. But if it be not yet detached, no force should be used ; all that is required, is patience, . with occasional frictions by the hand over the uterus. After the placenta has been delivered, the binder, if ne- cessary, may be tightened, the soiled sheets and clothing should be removed, and the vulva and other soiled parts, cleansed, without any exertion on the part of the woman. Stimulants and sedatives should be dispensed with, unless there be some particular indication ; in general, rest and quiet are the best and only necessary restoratives. The pulse and uterine tumor may be examined from time to time in order to see whether all is right. Management of the child. The child at birth is found covered with an unctuous matter, which adheres closely to the skin ; this is more easily washed off with a weak solution of soap and water, or wiped off by a napkin, af- ter being diluted with a little olive oil, mucilage, or grease of any kind. Some persons recommend that the child be plunged into a cold bath ; but such conduct, to say the least, is extremely questionable and dangerous in a being so frail as that of a new-born infant : the same may be said of alcoholic or strengthening baths. There is, how- ever, no objection to a tepid or moderately warm bath of water simply. After wiping the child dry, the bandage or binder for the support of the navel, is next to be applied. A light compress, with a hole in the centre, should be placed over the navel, with the end of the coru put through the open- ing ; over this and around the abdomen, a bandage should be passed, long enough to go once and a half round. This band, if too tight, would do harm ; on the contrary, if too loose, it would slip off and do no good. It may be con- tinued a week or two, and even a few months, if the na- vel project too much. The dress of the child, whatever 17 3G6 MANAGEMENT OF THE CHILD. the style may be, should be loose, and not too warm or cumbersome. It does not need " molasses and water," or any thing else, to expel the meconium, excepting the mother's milk ; the child should be put to the breast ill a few hours. When the child does not breathe. The child may be born in a state of defective vitality, syncope, or apoplexy. The former conditions may be produced by uterine he- morrhage, too early detachment of the placenta, or defect- ive nutrition : there is very little pulsation in the cord, • only feeble efforts at inspiration, and but little action of the heart. In such cases, we should defer the division of the cord, apply warm flannel and rapid frictions, with or without stimulants, to the body and extremeties. Or, a warm bath may be tried, sprinkling with cold water, tick- ling the nose or fauces with a feather, electricity, and slightly stimulating enemata ; and lastly, inflation may be tried by a proper tube introduced into the larynx, or pass- ed through the nose. Apoplexy of the child may be caused by prolonged la- bor, pressure from a narrow pelvis, etc. In such cases, the surface is blue, the face livid, action of the heart la- bored, with but feeble pulsation in the cord. The treat- ment consists in relieving the circulation by dividing the cord, allowing from a half to an ounce of blood to escape before tying it. If this does not succeed, cold sprinkling, warm baths, friction or inflation may be tried. Our ef- forts, in such cases, should be continued for a considera- ble length of time. Tumors of the scalp of the child, which we should ad- vert to, most often subside without treatment : they are caused by pressure during labor, and consist of the effu- sion of serum and blood under the scalp. When they persist several days, spirits or stimulating lotions may be used, and if unsuccessful, the tumor should be punctured, and simple dressings applied. Bleeding of the cord from incomplete closure of its ves- sels after the falling off of its remains, is difficult to ar- rest, but fortunately, is not of frequent occurrence. The' navel should be filled with alum, or some other astringent, and retained by a compress and bandage. Dr. Churchill MANAGEMENT OF DIFFICULT LABOR. 267 suggests that the naval should be stretched open, and fill- ed with plaster of Paris, either dry or moistened, which would probably become solid in spite of the hemorrhage. CHAPTER V. MANAGEMENT OF DIFFICULT LABOR. Br difficult or tedious labor, is indicated those cases which terminate without manual or instrumental assist- ance, but are prolonged beyond the usual time, and are attended with unusual suffering. The danger of a pro- longed labor depends upon the stage in which the delay occurs : thus, delay in the first stage, involves little or no danger, either to the mother or child, notwithstanding it may continue for several days ; while delay in the se- cond stage, which must be vastly shorter, is of more seri- ous consequence. The continued suffering may produce a great degree of fatigue and depression of spirits, and the patient often expresses a great dread of the result and importunes for assistance ; but the strength is seldom much impaired, and the condition of the patient is not un- favorable : — the nervous shock not being severe in the first stage. The most common cause of delay, is inefficient action of the uterus, and occurs mostly in delicate, feeble women, those of lymphatic temperament, and who are confined for the first time ; it may also arise from a de- rangement of the digestive organs, mental depression, ple- thora, etc. In the treatment of these cases, nature needs very little or no assistance ; time and patience are the principal reme- dies. The patient should be encouraged, cheered and amused : all depressing circumstances must be kept from her ; she should keep up and walk about during trie day as much as possible, resting occasionally on a sofa. The bowels, if necessary, must be freed by a dose of castor oil, or enemata, and the diet should be nourishing but bland. When there is much plethora, blood may be abstracted with advantage. After this, if there ba much 368 MANAGEMENT OF DIFFICULT LABOR. irritability and exhaustion, opium may be given for the purpose of procuring sleep. Such means are very often successful in inducing uterine contraction. After all obstructions, in this manner, are removed, and the action of the uterus is not vigorous enough, almost all accouchers agree in regard to the propriety of adminis- tering the ergot of rye, providing no counter indication exist. The circumstances under which it may be given are the following : 1, if the mouth of the uterus be soft and dilatable ; 2, if there be no obstacle to a natural de- livery ; 3, if there be no head symptoms, nor excessive irritability. On the other hand it should be prohibited : 1, if the mouth of the uterus be hard and rigid ; 2, if the pelvis be deformed, or if there be any serious obstacle to delivery in the soft parts ; 3, if there be head symptoms, or much irritability. The powder of the ergot is generally preferred, and may be; given in fifteen or twenty grain doses ; half a drachm to a drachm of the tincture, or from five to ten grains of the extract ; any one of which may be given with an in- terval of twenty minutes, until three doses shall have been administered, unless the effect be produced sooner. > If it succeed, the pains are found to grow stronger soon after its exhibition. We should remark, that it ought not to be resorted to on slight occasions, and that, although it may often anticipate the use of the forceps, it sometimes pro- duces disagreeable consequences. Stimulating purgative enemata, and stimulating frictions externally, are also, often very beneficial in assisting uterine contraction. Rigidity of the passages. Labor sometimes becomes difficult, particularly in women with the first child, and those of advanced age, in consequence of a rigid state of the mouth of the uterus, and of the soft parts. There are very few cases, if left alone, that would not overcome these obstacles, though at the expense of considerable fatigue, and in a few cases of slight laceration of the neck. The most effectual remedy for rigidity is venesection ; but it can be often obviated without resorting to this : by warm mucilaginous injections ; warm hip-baths ; and lastly by nauseating the patient with tartar emetic, which rarely MANAGEMENT OF DIFFICULT LABOR. 389 fails. Patience, here also, is one of the most important means. Toughness and weakness of the membranes. The mem- branes generally give way as soon as the mouth of the uterus is fully dilated ; but they sometimes, from abnor- mal firmness, remain entire, thus causing delay. On the other hand, they may be ruptured at too early a period ; this may occur from weakness of the membranes, from violence, careless examinations, etc. In the former case, the membranes may be ruptured : but the delay should not be attributed to this cause on slight grounds. In the latter, all that is necessary is time and patience. Obliquity of the uterus. This may occur during preg- nancy from the position in which the patient lies, either one way or the other; and the relaxation of the walls o*f the abdomen may cause " pendulous belly." These cases sometimes occasion delay and may be remedied by placing the patient on her back, or in other positions according to circumstances ; also, when it becomes necessary, by raising up and supporting the tumor of the abdomen by a bandage. Retained placenta. If the afterbirth be retained beyond from four to six hours, notwithstanding the use of those means directed in the preceding chapter,, its delivery re- quires assistance. It may be retained for want of uterine contraction, or on account of a firmer adhesion than usual to the uterus. In the former case gentle traction on the cord, frictions to the abdomen, and exhibition of the ergot rarely fail ; in the latter, it sometimes becomes necessary to cautiously introduce the hand (previously oiled ) w tne form of a cone, and gently detach the placenta by ^raau- ally pealing it off, acting from the edge towards the cen- tre: the hand should then be allowed to be expelled along with the afterbirth by the contractions of the uterus. Hemorrhage or flooding, complicated with, or after de- livery, requires to be treated essentially in the same man- ner as directed in the chapters on Abortion and Menorrha- gia. In the former case the patient must be kept perfect- ly at rest, the vagina plugged, cold applied, and opiates with astringents given internally: when the proper period arrives, the labor should be terminated as soon as practi- cable ; either by the use of the ergot or instruments, ac- ta, 370 MANAGEMENT OF .DIFFICULT LABOR. cording to circumstances : the latter is rarely necessary. When flooding occurs after delivery, the placenta should be extracted as soon as possible : the ergot is here useful in two ways : by bringing on contraction, and arresting the bleeding ; in addition, all those means above mention- ed should be resorted to for arresting the hemorrhage. Labor, complicated with convulsions, is to be treated as directed in Chapter V. Section II. Book II. There are certain classes of labor, (happily of rare oc- currence) of which it does not come within our purpose to speak in this work : such as powerless, obstructed or com- plicated, and instrumental labors. These arise from dif- ferent causes, the principal of which are the following : great debility of constitution ; tumors, and other diseases of. the uterus and pelvis ; narrowness of the vagina and os uteri ; deformed pelvis ; ovarian tumors, etc. Obstetric operations may be divided into three kinds : 1, those which . are not intended to injure the mother or child, as induction of premature labor, version or turning, the use of the vectis and forceps; 2, those which involve the destruction of the child, but which are not intended to injure the mother, as craniotomy ; and 3, those in which danger is involved, both to the mother and child, as the Caesarian section. The use of instruments and manual operations are not unattended with danger : neither should be resorted to, and particularly the former, except in aid of nature, or unless the life of the mother or child can be saved by their employment. SECTION n. DISEASES OF CHILDBIRTH. CHAPTER I. CONDITION OF THE PATIENT AFTER DELIVERY MANAGEMENT OF WOMEN IN CHILDBIRTH, WITH VARIATIONS FROM ORDI- NARY CONVALESCENCE. Upon examination of a woman a few hours after deli- very, we observe considerable change both locally and generally. The nervous system is found to have received a shock more or less severe, there is disturbance of the respiratory and circulating systems, the secretions are al- tered, and there is great exhaustion. When these effects are moderate, they gradually subside, providing the pa- tient be kept from all disturbance and excitement, and ob- tain a few hours sleep. The uterus, after delivery, contracts more or less firm- ly : this is beneficial in emptying the uterine cavity, di- minishing the mouths of the uterine vessels, and prevent- ing hemorrhage. The same as during labor, so following it, after a short period of contraction, there is an interval of relaxation ; this, gradually, reduces the size of the uterus, and about the eighth or tenth day, it becomes small enough to descend into the pelvis. The mouth of the uterus, after remaining open for some days, gradually closes. The vagina, which was enormously distended, and more or less inflamed and sore, shortly becomes re- duced in size, and the outlet resumes its natural capacity in a shorter time than would have been supposed possible. The integuments of the abdomen, remain flaccid and loose for a considerable length of time ; but if it be properly 371 372 MANAGEMENT OF WOMEN IN CHILDBED. bandaged, neither too tight nor too loose, they return to their natural condition in the course of a month or two. Women in a first confinement, do not often suffer from after pains ; but in subsequent labors, the contractions of the uterus above noticed are accompanied by pains more or less severe : they generally come on in about half an hour after delivery, and may continue thirty or forty hours, or longer. The discharge of blood which accompanies labor, con- tinues for some time after : soon, its character changes, when it is known as the lochia, or in popular language the " show" or " cleansings." This watery discharge con- tinues of a red color for three or four days, when it be- comes greenish or yellowish, and generally ceases in three or four weeks ; though sometimes it ceases within a few days after, delivery. The breasts, generally, begin to en- large about twenty-four hours after delivery, which is ac- companied by stinging pains : at about the end of the second day, they become large, tense, and sore. The se- cretion of milk now takes place, which soon becomes abundant ; that which is first secreted, often acts as a pur- gative upon the child. Frequently, though seldom with first children, milk is secreted during labor, and the woman can give suck immediately afterwards. Management of the woman* After having given a de- scription of the condition of the female, we shall now re- cur to her management. The room in which the woman is put to bed should be slightly darkened ; she should be kept perfectly quiet, very few persons should be allowed with her except the nurse, little talking should be allowed, and no whispering. The horizontal posture must be pre- served, all mental emotion and excitement avoided, and the patient be kept calm and cheerful, and allowed to sleep. The state of the pulse should be narrowly watch- ed, as it is often the first evidence of wrong. Very soon after the conclusion of labor, (after having cleansed the parts with tepid milk and water, containing a small portion of spirit,) a warm napkin should be applied to the vulva, which should be changed at short intervals. The washing, for the sake of cleanliness and to aid in restoring the parts, should be repeated twice a day. The MANAGEMENT OF WOMEN IN CHILDBED. 373 after-pains require no treatment, unless the patient be de- prived of sleep, when an aromatic purgative, or a dose of laudanum may be given. The only attention which the lochia requires, is, that the napkins should be changed sufficiently often, and applied warm, as the impression of cold might be followed by its suppression. The patient, who is generally in a state of perspiration, should be allowed to cool gradually ; the bed-clothes should be light but comfortable, the room kept cool and fresh. Let it be remembered that the female cannot assume the upright posture without the risk of hemorrhage and dis- placement of the womb ; so it should, on no account, be permitted. The patient should be reminded to void the urine within six or eight hours after delivery, or sooner ; if she be not able to do this, after having applied a cloth wrung out of warm water, the catheter must be used. It is quite as well that the bowels remain unmoved for twelve or fifteen hours after delivery ; after this, if necessary, a discharge should be procured by a dose of castor oil, senna and salts, or rhubarb. When the breasts become tense and painful, the best remedy is the application of the child ; the sooner this is done the better, as the secretion and escape of milk will be facilitated, and engorgement, perhaps inflammation, of the breasts avoided. Relief may, also, often be obtained by friction with warm oil, or emollient fomentations, and at the same time giving an aperient dose. They should not be kept excessively warm, and all compression and astringent applications with a view of preventing the com- ing of the milk, are dangerous in the highest degree. The diet, during convalescence, is of great importance. The patient, for the first four or five days, should be con- fined to bland articles — gruel, whey, arrow-root, panada, milk, etc., with a little toast or biscuit. After the milk fever has subsided, she may take, providing there be no counter-indication, some broth, and on the eighth or ninth day, some fowl or fish. All that concerns the diet, and the assumption of the upright position, or making exertion, is of the utmost im- portance. The patient should not leave her bed : even to 374 VARIATIONS FROM ORDINARY CONVALESCENCE. have it made, before the fourth day ; and she should make very little or no exertion for the space of eight or nine days : in some cases, fifteen and even twenty days' con- finement, is indispensable. Most of the diseases which affect a woman in child-bed, remarks Velpeau, may be at- tributed to the thousands of visits of friends, neighbors, or acquaintances, or the ceremony with which she is too of- ten oppressed : she wishes to keep up the conversation ; her mind becomes excited, the fruit of which is headache and agitation ; the slightest indiscreet word worries her ; the slightest motives of joy agitate her in the extreme ; the least opposition instantly makes her uneasy, and I can affirm that among the numerous cases of peritonitis met with at the Hospital de Perfect ionnement, there are very few whose origin is unconnected with some moral com- motion. VARIATIONS FROM ORDINARY CONVALESCENCE. 1. The nervous shock is sometimes severe, which is known by the great exhaustion, hurried breathing, dulness of the senses, and anxious and suffering expression of the countenance. Reaction is long in taking place, or it may take place imperfectly or excessively. The best remedy in these cases is opium, given in a large dose, or in small and frequently repeated ones ; stimulants, also, in moder- ate quantities, will be very useful ; as ammonia, musk, or, wine or brandy and water, which should be discontin- ued when reaction takes place; the diet should be nutri- tious, but bland. 2. The state of the pulse should be attentively estimat- ed, which requires great care, as it indicates the general condition of the patient : it will be quickened when a large coagulum is contained in the uterus, when there is distur- bance of the bowels, and when inflammation exists. Soon after delivery, the pulse falls, but becomes more frequent when reaction takes place : . if it exceed one hundred, no time should be lost in ascertaining the difficulty. 3. The uterus, instead of gradually decreasing in size, occasionally, at the fifth or sixth day, becomes less firm and increased in bulk, which threatens an attack of in VARIATIONS FROM ORDINARY CONVALESCENCE. 375 flammation. Under such circumstances, hot fomentations should be applied to the abdomen, and a warm purgative given, which will favor the expulsion of clots, if any there be, and diminish the tenderness. The vagina may be attacked with inflammation more or less severe, when it requires about the same treatment; extreme cleanliness should be observed, and vaginal injections of warm water may be tried. 4. The after-pains. Instead of the after-pains coming on half an hour or an hour after delivery, being moderate, and ceasing after a short time, they occasionally com- mence with great severity as soon as the labor is termi- nated, and are of long continuance. The best remedy, is the application of hot flannels, emollient fomentations, and a full dose of opium, to be repeated if necessary. They sometimes continue at intervals unusually long, and are increased by applying the child to the breast : relief may be obtained by enemata, aromatic purgatives and opium. 5. The lochia. Although variations in the quantity and quality of this discharge generally excite the alarm of the patient, yet, great differences often occur, without any evil result. The discharge sometimes ceases a few hours after delivery, particularly after the , birth of imper- fectly developed and still-born children ; on the contrary, it may continue unusually long; or, again, be excessive, or diminished, and continue the. usual time. A sudden suppression of the lochia may take place from violent and sudden impressions or emotions, cold, and the use of astringent injections, which commonly gives rise to serious affections ; such as inflammation of the uterus or perito- neum, and nervous disorders. The treatment of sudden, suppression of the lochia, consists in the employment of a hot foot-bath with mustard, the application of hot fomentations and emollient poultices to the lower part of the abdomen and vulva, and injec- tions and enemata of the same sort. Blood-letting, when indicated by the state of the pulse, or where plethora ex- ists, the application of leeches to the thighs and labia, cupping the loins, arid sinapisms to the feet and limbs are valuable remedies. In nervous women, antispasmodics 376 VARIATIONS FROM ORDINARY CONVALESCENCE. must be used ; in those of feeble constitutions, stimulants are necessary. When the lochia is excessive, or continues beyond the usual time, tonics, as bark, iron, etc., should be allowed, with a better diet. When it ends in the establishment of leucorrhea, it should be treated as directed in that chap- ter. If it become acrid, and excoriate the external parts, strict cleanliness must be observed, with the use of astrin- gent lotions and vaginal injections of warm water. Lastly, W this discharge become offensive, as it sometimes does from the decomposition of a small portion of the afterbirth, it should be treated by injections. of warm water or a very weak solution of chloride of lime. 6. The milk fever. -The variations of the period at which the milk is secreted are of little or no consequence. If the fever be excessive, it must be moderated by emollient fomentations, purgatives, and the frequent application of the infant to the breasts. In some rare cases no secretion of milk takes place, then the child will require a wet nurse. When the nipples are imperfect, they should be drawn by an adult, or the breast pump ; if these do not succeed, the effects of the secretion of milk must be ob- viated by tartar emetic, saline purgatives, and fomenta- tions. Laceration of the perineum, when they occur, generally get well of themselves ; all motion should be avoided, and the woman kept mostly on her side so as to favor the discharge of the lochia and pus. A longer confinement than ordinary must be observed, and sometimes it becomes necessary to apply caustic, take up certain points with the needle, etc., which belong more properly to surgery. The same may be said of lacerations of the vagina, {con- stituting vesicovaginal fistula) of the neck, body, and fun- dus of the womb, which are of extremely rare occurrence. Infiltration of the external genitals, from injuries in the passage of the child, may be so extensive as to pre vent the discharge of the lochia. If the swelling be lym- phatic and not painful, it will generally disappear upon making a few punctures. When there are signs of in- flammation, resource should be had to emollient poultices fomentations, and if necessary to leeches. PUERPERAL FEVER. 377 There are other accidents and diseases incident to the lying-in ; invasion and prolapse of the womb and vagina, ant i- version and re-troversion of the uterus, inflammation, etc., of the vagina and womb — all of which we have treated of in Book I. The other diseases of parturition are, puerperal peritonitis, uterine and crural phlebitis, me- tritis, phlegmasia dolens, cutaneous eruptions, injlamma* tion of the breasts, etc., which we shall now proceed to treat of. CHAPTER II. PUERPERAL FEVER, INCLUDING PERITONITIS, UTERINE AND CRURAL PHLEBITIS— CAUSES SYMPTOMS AND TREATMENT. Puerperal fever is not of rare occurrence, and is, perhaps, the most fatal disease to which lying-in women are exposed. It is more frequently accompanied with in- flammation of the peritoneum, though it may commence from inflammation of the uterus and its appendages, of the veins and absorbents of the uterus, and ,of the crural veins ; in either case, if the inflammation continue a suffi- cient length of time, the peritoneum generally becomes implicated, and a train of symptoms arises, very similar in character, which, by the common consent of authors, is called puerperal fever. This disease may commence a few hours after delivery, but rarely occurs after the first two or three days. It may be accidental and sporadic ; or it may prevail as an epidemic, when it is a most dread- ful and deadlv affection, seeming to be contagious. Although differences of opinion still exist in regard to the contagious quality of certain forms of this disease, it is well known that the epidemic form may arise in the way of contagion : this horrible malady, remarks Dr. Watson, may be communicated from one lying-in woman '© another by the intervention of a third person ; and loubtless it is so carried and propagated, in many instan- .v>s by midwives and accouchers. Causes. — The sporadic form of this disease is supposed Q* 878 PUERPERAL FEVERS-CAUSES — SYMPTOMS. to arise from difficult labors ; from clots, or fragments of the placenta retained in the uterus ; suppression of the lochia ; arrest of the secretion of the milk ; constipation ; diarrhoea; violent mental emotions; stimulants; cold; binding the abdomen too tight ; violence during labor ; exertion too soon after labor, and from an attack of ery- sipelas. The epidemic form of puerperal fever is produced by contagion, or by a distempered state of the atmosphere. In 1831, a physician of London, examined the body of a woman who died a few days after delivery, from peritoni- tis; the next morning he safely delivered a woman, who, two days afterwards, was attacked with severe rigors, acute pain of the abdomen, a rapid, feeble pulse ; she died four days from the period of attack. The same phy- sician, soon afterwards, attended two other patients, both of whom fell victims to the same disease; he also bled a young woman for pleurisy : an erysipelatous inflammation extended from the wound up the arm, and the patient died in four or five days of phlebitis. Similar cases to the foregoing have not been uncommon either in this country or Europe ; it has repeatedly prevailed as an epi- demic in lying-in hospitals, when most of those attacked !\a.M! died ; in private practice, it is less fatal. A physi- cian of Philadelphia, extensively engaged in obstetrical pmciH e, lost almost every patient that he attended for Cftpcrnl weeks ; he left the city, exchanged every article df It I;? wearing apparel, and, after appropriate ablutions, pw! remaining away a week, returned; but to his great ^rJC*tf;ernatbn, the first case he attended, terminated fatal- .Ij? from an attack of puerperal fever ! He was now sat- M'rvi lhat the disease, in his. case, was not transmitted by ji-vi Corson or clothes, but was propagated by atmospheric f>iJ(nenoe. Other physicians, under similar circumstances, hrn'e hern successful in divesting themselves of the poi- «?ir> i-v such »i rings and purifications, and no more cases bfcW3 occurred in their practice. Hyp.TiTOMs. — The attack generally commences within iVty-eight hours after delivery ; there are, however, some exceptions: its occurrence may be delayed some days, or it mpv, in rare cases, commence before labor. There is, PUERPERAL FEVER TREATMENT. 379 usually, a rigor, or shivering fit, succeeded by hot fever, terminating in perspiration, with a rapid pulse, tenderness upon pressure, and pain low in the abdomen ; soon, a uni- versal swelling takes place, and the womb can no longer be felt. The lochial discharge is most often .arrested ; but sometimes it is undisturbed. The urine, which is voided in small quantities at a time, and with pain, is tur- bid ; there is usually tenesmus, vomiting of green or yel- low, bitter matter, which at last becomes black.. The brain and nervous system is, sometimes, involved, produc- ing delirium and stupor; finally, there is extreme pros- tration, ulceration of the mouth and throat, and the dis- ease may terminate in resolution, which is the most favorable ; in suppuration, when fluctuation of the matter is usually perceptible ; and lastly, in mortification, which is accompanied by a treacherous calm, in lh<\ midst of which, the patient expires. * We should remark, that puerperal fever may arise ana progress without being attended by any acute symptoms. The disease usually runs its course in three or four days ; it may, however, be protracted, from five to ten or twelve days. The epidemic is the more malignant form — one- half, two-thirds, and even more, of those attacked, dying; the accidental or sporadic form, is much less fatal. Treatment. — Of all acute diseases, remarks Dr. Gor- don, the plague excepted, the puerperal fever is, perhaps,, the most dangerous. But this can only be true in refer- ence to the most malignant form, for, generally, not more than one case in ten has proved fatal ; and some physi- cians have attended many cases, during a long practice, without losing a single patient. The majority of writers recommend copious bleedings and it cannot be denied that this is the appropriate treatment' for most cases ; yet, there are some cases, characterized by an absence of acute symptoms, that do not well bear this. When the pulse is quick and firm, there is no time to be lost ; blood-letting, from the arm. is the proper remedy. Dr. Gordon recommends, at the beginning, the abstraction of from twenty to twenty-four ounces, to be repeated if necessary; but the quantity taken must depend, in all cases, on the condition of the patient. Also a large num. 380 PUERPERAL FEVER — TREATMENT. ber of leeches to the abdomen — fifty or more, may be ap- plied, according to circumstances, and followed by fomen- tations, or a large, light, bran poultice. The next anti- phlogistic of considerable power, is calomel, in combina- tion with ipecac and opium, which may be given in large doses, or smaller ones, frequently repeated : when the bowels are affected, the opium should be continued alene ; this remedy may be used after bleeding, or instead of it, where, the abstraction of blood is inadmissible. If the bowels be constipated, an enema of turpentine and cas- tor oil should be given ; or, they may be given by the stomach, combined, if necessary, with Dover's powder. When the diarrhoea i's copious, it may be restrained by opiates and astringents. The use of emetics has been recommended, and may be useful in the earliest stages of the disease. Blisters to the abdomen are useful as soon as the acute stage is pass- ed. Mercurial ointment may be used externally to the abdomen at the same time that calomel is given internally ; sinapisms to the feet should also be tried. Some physi- cians have met with great success in the use of copious purging — with the oil of turpentine, calomel and jalap, etc. Nitre, ipecac, Dover's powder and opium, should be used as diaphoretics, and to assuage pain. Finally, as soon as the inflammatory symptoms subside, the patient must be supported by the use of wine and porter, bitter infusions, quinine, and a nourishing but bland diet. From our remarks upon the contagious character of puerperal fever, the necessity will be seen for every pos- sible precaution, particularly in the epidemic form, by ab- lutions, change of dress, fumegations, ventilation, white- washing and painting ihe rooms, etc. CHAPTER U:. ■ PHLEGMASIA DOLENS OR MILK-LEtf CArfSteS -StM?TG*!S, AND TREATMENT. This disease consists in a swelling of one or both le^tf a few days after delivery, accompanied with pain and ten- derness. It rarely involves both limbs at once, and it is said that the left leg is more frequently affected than the right. This affection was called milk-leg from its having been formerly supposed to be caused by a metastasis and deposit of milk ; but it is now believed to depend on ob- struction of. the venous circulation of the lower extreme- ties, which arises from difficult labor, the impression of cold, and uterine irritation. It most commonly commences in the calf of the leg, though sometimes it begins in the pelvis ; in either case, there is generally a chill, followed by intense fever and pain, which gradually affects the whole limb : sometimes, however, it is confined to a part of it. The limb soon be comes enlarged, and sometimes reaches an enormous size. The affection ordinarily lasts from four to six weeks, when the limb gradually becomes smaller ; but it sometimes ends in suppuration and death : the part affected most of- ten remains somewhat enlarged through life. The con- stitution suffers considerably during the attack : there is thirst, a quick pulse, loss^of appetite, derangement of the bowels, and general restlessness. Treatment. — In the acute stage, antiphlogistics are in- dicated : the application of leeches in the vicinity of the pain, to be followed by poultices, saline purging, bleed- . ing, if there be much plethora, cooling drinks, and Do- ver's powder, to relieve the pain. When the acute symp- toms subside, the limb should be gently supported by a flannel bandage, and a slightly stimulating linament may be employed : blisters, also, have been highly recommend- 17* 381 382 SORE NIPPLES SCANTY SECRETION OF. MILK. ed. Tonics will be required internally, as bark and qui. nine, with wine or porter, and a nourishing diet. After some time recourse should be had to slight exercise, air, sea-bathing, and a general system of hygiene. CHAPTER IV. SORE NIPPLES SCANTY AND PROFUSE SECRETION OF MILK" MILK-CONSUMPTION RETENTION AND ALTERATIONS OF THE MILK. Sometimes, particularly in females with first children, the nipples become excoriated or " chapped." This arises from forcible sucking of the infant, from the state of moisture in which these parts are kept, and from friction of the clothes. To prevent, as well as to cure, this affection, the nip- ples should be washed twice a day with soap and water, and dried ; for the excoriation, a lotion of borax, or some other astringent, should be frequently applied, and fol- lowed by a little powder of elm bark. Should there be much inflammation, emollient fomentations and poultices will be necessary, which may be followed by some sim- ple cerate — the popular remedy of wax, and fresh butter answers a good purpose. Certain shields, made of india •rubber and other substances for the child to draw through, will often relieve the irritation. The child may be nurs- ed, notwithstanding the use of remedies, and care should be taken that the milk be not -allowed to accumulate too much, which may give rise to inflammation and abscess of the breasts. Exposure to cold air and friction of the clothes should be avoided. The quantity of milk secreted varies much in different women ; there are some who cannot support one child, while others can nurse several. When there is an exu- berance of milk, it is of no consequence, unless the wo- man's health be affected. The secretion may fail, either wholly or in part, in consequence of a want of develop- MILK CONSUMPTION. 333 rnent of the mammary gland, debility, violent emotions, hemorrhages, leucorrhea, bad digestion, abuse of venery, menstruation during the lactation, chronic disease, as phthisis, the application of astringents to the breast, and acute diseases ; — these causes may lessen or completely arrest the secretion of milk. In many instances, a failure of this secretion is beyond the resources of art; in others, as where the woman is weak and emaciated, the difficulty may be often removed by means of tonics, a nutricious diet, and by means of frictions to the breasts, either dry or aromatic. At the same time the condition of the stomach and bowels must be atteuded to, and any known cause or disease that ex- ists, removed. Where all proper means are unsuccessful, the woman should abstain from nursing her child. Very young women, and those who are advanced in years, give milk in smaller quantity, and that which is not so good as others. The secretion of milk is often suspended, and sometimes completely dried up, from the effects of anger, fright and violent grief. By m;lk-consumption is designated & too abundent se- cretion of milk, which is accompanied by emaciation and loss of strength on the part of the mother. There may be merely an exuberance of milk attended, perhaps, by pains in the back, slight lassitude, loss of sleep, and thinness of the milk, which is digested badly by the child : this may, in^general, be remedied by exercise, a vegetable diet, the use of pure water simply, a less frequent application of the child to the breast, slight purging, and by diuretic and sudorific drinks. The practice of eating for two, as it is termed, during lactation, is highly pernicious. Cut when the profuseness of milk is preceded by loss of appetite, pain in the chest, burning sensations in tho stomach and throat, and lastly, by loss of strength and emaciation, it is known as nurse's consumption, and may result in serious consequences, unless obviated. It generally appears in those who nurse too long, or those who persist in suckling when the constitution is unfit for it. This may be remedied by weaning the child, the use of food of easy digestion, moderate exercise and agreeable 384 RETENTION OF THE MILK ALTERATIONS. diversion, slight purging, mineral waters, frictions to the mammae, bathing, the use of sedative drinks and tonics, according to circumstances. Involuntary discharge of the milk, requires the use-; of tonics, astringent applications to the nipples, and when there is excessive sensibility, of sedative drinks. Retention of the milk — This sometimes happens in consequence of excessive secretion without augmentation of the excretion, and again, when there is malformation of the nipple which is generally incurable. The breasts become distended and painful, and contain hard lumps : true inflammatory engorgement may supervene, unless prevented by appropriate treatment. The indications are, first, to have the breasts emptied by a vigorous child, or an adult, or else by a young puppy, or lastly, by the breast pump. The breasts should be kept warm and at rest, the patient restricted to a low diet, and laxatives with diuretic and diaphoretic drinks should be used. Should inflamma- tory symptoms appear, emollient poultices must be ap- plied ; and finally, if the female be entirely incapable of suckling, active purging in addition will be necessary, to obviate, as far as possible, the secretion of milk. Alterations of the milk — It assumes a yellowish color in inflammations of the breast, a saltish taste in general inflammatory diseases, and after nervous affec- tions, becomes thin like water or of a greenish color. • It contracts the odor and color of certain substances when eaten by females : as garlic, madder, etc. Menstruation during lactation renders the milk thin while pregnancy renders it thick and unnourishing for the child. Salt meats, highly-seasoned food, salad and fruits, render the milk «more abundant, but thinner; spirituous drinks, excessive sleep, late hours, and abundant excretions, on the con- trary, diminish this secretion ; very young and aged wo- men always have milk of inferior quality. All these variations have an unfavorable influence upon the child, and are the cause of the destruction of a large number of children in all classes of society ; they should,, '^refore, be obviated as soon as possible. This -may, in INFLAMMATION OF THE BREASTS. 38fc> general, be effected by changing the diet of the nurse ; by curing the affections which give rise to alterations ; by an appropriate system of general hygiene ; and, lastly, by changing the nurse, or by weaning the child when of proper age. CHAPTER V. INFLAMMATION and abscess of the BREAST CAUSES SYMPTOMS AND TREATMENT. Inflammation of the breast occurs most often four or five days after delivery ; it may, however, be developed at any time during lactation, or at the period of weaning. It makes its appearance mostly in those who have a great flow of milk, who endeavor to avoid suckling, who wean suddenly, and in those who have too long or too short nip- ples ; — and is caused by'the engorgement of milk where its excretion is difficult from any cause, the action of cold, excessive heat, astringent applications, mental emotion, and violence. Generally, but one breast is affected ; but sometimes both are attacked at the same time, or again, successively. The severity of the symptoms will depend upon the extent of the inflammation : there are generally, chills, heat, local pain and soreness, with a circumscribed hardness, a quick and full pulse, headache, thirst, etc. Simple engorgement, generally, terminates in resolu- tion ; but the more inflammatory kind is liable to end in the formation of abscess; it also, sometimes, passes into cancerous induration. (See Cancer of the Breast, Book I.) The formation of matter is marked by shivering, throbbing pains, and fever of an intermitting character ; there is fluctuation in the tumor, which generally points in the neighborhood of the nipple, and if left to itself a sufficient length of time, discharges. New abscesses sometimes form beneath the first, which dispose to others even, and the patient may sink from protracted suffering. Treatment. — The preventative treatment consists in the eariy application of the child to the breast, and in the 386 INFLAMMATION OF THE BREASTS TREATMENT avoidance and removal of causes ; or the breasts should be drawn by art adult, or by the glasses made for that purpose ; by purging ; keeping the breasts warm ; by frictions of oil, or a poultice of flax-seed meal and water, containing soap, and a little sub-carbonate of potash. Nothing astringent should ever be applied. When there is much inflammation, with heat, pain, etc., recourse should be had to venesection, followed by the ap- plication of leeches, and the use of cold emollient and narcotic poultices or lotions ; saline purging, with a little tartar emetic ; rest in bed ; a low diet ; and in nervous females, by sedatives ; the milk should be drawn at inter- vals, and the breasts supported in a sling. These means have for their object, to prevent the formation of matter. But when, notwithstanding these exertions, suppuration takes place, we should facilitate the piocess as much as possible by the application of warm emollient poultices — of elm, flax-seed, or bread, which should be frequently repeated. The bowels must be kept free, and opium given to relieve pain and procure sleep. When the for- mation of matter is perceptible from the fluctuation, an opening should be made for its discharge, lest it spread and form sinuses in different directions; a little lint may be introduced to prevent its closing too soon. The poul- tices, with the addition of soap and alkaline solutions, may be continued for some time longer. We should here remark, that if the engorgement terminate in induration, it should be treated as directed under Cancer of the Breast. (See that Chapter.) Finally, the patient should be sup- ported by a nourishing diet, and if necessary, by the use of tonics, as bark, quinine, or bitter infusions, and wine or porter. If other abscesses form, they must be treated fa the same manner. PART III. INFANCY. CHAPTER I. IN WHAT MANNER THE CHILD MAY BE INFLUENCED BEFORE ITS BIRTH BY HEREDITARY CAUSES. We remarked, when speaking of the development of the foetus, that the child, before its birth, may be consid- ered as a part of the mother's organization. Although no direct nervous connection has been observed to exist be- tween them, it is known that the life and growth of the child are wholly dependent on its maternal system ; the same blood, whether pure or impure, which circulates in her blood-vessels, also carries nutrition and growth to the child. These processes are so closely connected in the two beings, that when the maternal source of supply is cut off by cessation of her functions, the child also dies ; and every powerful impression made upon her system, every change in her health, extends to her offspring in em- bryo. These are important facts, and of the greatest moment to the human race : the reality of hereditary influence is no longer doubted. The child receives its organization, either good or bad, physical and mental, from its parents. It is well known that a father whose system has become debilitated, or impressed by any disease, communicates a similar affection to his offspring : the mother, also, trans- mits her infirmities in the same manner, and seems to have a more marked influence upon the organization of the child than the other parent. The most prominent and fearful diseases in the list, which are thus transmissible, 387 388 HEREDITARY INFLUENCE ON THE CHILD. are tubercle or scrofula, only one form of which is pul- monary consumption ; insanity, dyspepsia, gout, and can- cer ; and there is no doubt in our own mind that the pre- disposition to most of the obstinate chronic diseases which afflict mankind, are imparted in the womb ; the parents first impressing their own systems with diseases by in- fringement of the organic laws, and then transmitting them to future progeny : thus, in the language of Scripture, " the sins of the parents are visited upon their offspring, even to the third and fourth generation ;" and we might ajld, much beyond, unless the disease be arrested by cross- ing the races, and then by much care in after-life, — or the race become exterminated, which is the tendency of such flagrant infraction of the laws of nature. Infirmities, or debility of constitution in parents, then, are transmissible to their offspring. Parents frequently live over again, remarks Dr. Gregory, in their offspring. For children certainly resemble their parents, not merely in countenance and bodily conformation, but in the gene- ral features of their minds, and m both virtues and vices. Combe remarks, that those who desire bodily and mental soundness in their offspring, ought carefully to avoid in- termarrying with individuals who are either feeble in con- stitution, or strongly predisposed to any very serious disease: and above all, the greatest care should be taken against the union of the same morbid predisposition in both father and mother. By improving the health of the parents, when such unfortunate circumstances exist, the future offspring, will, of course, participate in their in- creased vigor. Besides the direct inheritance of an infirm constitution, • there are many other causes which may deteriorate the race. The union of parents too nearly allied in blood, is a prominent cause, as is seen among some of the royal families of Europe, and also, in private life. Marriage before the full maturity and development of the constitu- tion, particularly in delicate females, as well as great disproportion in age between the parents, are prominent causes of infirm health in children. The state of the parents at the time of conception, has also been observed to permanently influence the health of their offspring. It INFLUENCE OF THE MOTHER ON HER CHILD. 389 is highly probable that even temporary disturbance of health at this time, will have this effect. u Anxiety of mind or unusual depression of spirits in the father," re- marks Dr. Combe, M have been found imprinted in inef- faceable characters on the organization of the child ; and not a few instances are known, in which idiocy in the offspring has been the result of accidental intoxication on the part of a generally temperate father. I have lately heard of an unequivical case of this kind ; and a stronger motive to regularity of living, and moderation in passion, can scarcely be presented to a right minded parent, ihan the simple statement of their permanent influence on Tiis future offspring. Many a father has grieved over, and perhaps resented, the distressing and irreclaimable follies of a wayward son, without suspecting that they actually derived their origin from some forgotten irregularity of his own." Also, besides temporary affections, drunkenness, de- pression of spirits, habitual dyspepsia and bilious com- plaints, in either or both parents, we should mention as among the most important causes which affect the condi- tion of the future infant, the health, state of mind and conduct of the mother during pregnancy. These are so important that we shall devote a separate chapter to their consideration. CHAPTER II. INFLUENCE OF CERTAIN CONDITIONS IN THE MOTHER ON THE HEALTH AND CHARACTER OF HER OFFSPRING DURING PREG- NANCY. Although popular belief has gone beyond the real truth in always ascribing moles, or the mother's mark, as it is called, to her imagination, as it may be produced by other causes (as we have before shown,) yet, there are many proofs of the reality of the mother's influence on the con- stitution of her child unborn : some of these we alluded to in the last chapter. It is known beyond a reasonable 18 390 INFLUENCE OF THE MOTHER ON HER CHILD. doubt, that strong mental emotion, distressing anxiety, violent agitation of body or mind, may and do prevent a proper development of the foetus. If the lungs, brain, stomach, intestines, or other parts be but imperfectly form- ed, they will in after life, be liable to be affected by dis- ease from causes which, otherwise, would have no influ- ence. This shows the importance of pregnant females, leading a tranquil life and avoiding all violent, mental and bodily agitation. We believe there are but few mothers who would not deny themselves of impulses and gratifica- tions, were they convinced that in proportion as they in- dulge, in the same ratio, is the chance of injury to be sustained by the new being within their bosom ! That severe mental perturbation in mothers during pregnancy, frequently gives rise to a morbid timidity oi character, and even to nervous and epileptic diseases in their children, is proved by numerous well-known instan- ces. A single member of a family is sometimes observed to be thus affected, which cannot be otherwise accounted for. The constitutional aversion to weapons, and danger of every kind, shown by James I., of England, is ascribed, and not without reason, to the constant anxiety and apprehension under which Mary lived during the period of gestation. So, the philosopher Hobbs ascribed his own excessive nervous sensibility and timidity to the fright in which his* mother lived, on account of the threatened Spanish inva- sion, which upon news of the approach, brought on pre- mature delivery. The last case in illustration of this subject, which we shall mention from among many simi- lar ones, is that recorded by Baron Percy, an eminent French military surgeon, as having occured after the siege of Landau, in 1793. The women of the town were kept for some time in a constant state of alarm, by a violent cannonading, when the arsenal blew up with a terrific ex- plosion. Out of 92 children born within a few months afterwards, Percy states that sixteen died at birth ; thir- ty-three languished for from eight to ten months, and then died ; eight became idiotic, and died before the age of five years ; and two came into the world with numer- ous fractures of the bones, caused by the convulsive starts INFLUENCE OF THE MOTHER ON HER CHILD. 391 of the mother excited by the fright. So that about two out of every three, were actually killed through the me- dium of the mother's alarm ! These instances, with much other evidence, are suffi- cient to establish the existence of a direct relation between the general condition of the mother, and the general con- stitution of her child. This, indeed, is not wonderful: as the child in the womb is virtually a component part, for the time, of her own body, it necessarily follows that whatever affects the general health and action of the sys- tem, must affect all its parts. If by anxiety of mind, or neglect of her health, digestion be impaired, and her blood rendered impure, how can it be otherwise than that the health of the infant must suffer, seeing that it is nourished by the same deteriorated blood which is insufficient for her own health ? It was believed for a long time, and is at present by some, that the longings or imagination of the. mother, is the principal cause. of the marks and deformities with which some children are born ; but it has been shown that in many cases, there is, in reality, no coincidence between the object longed for and the nature of the deformity. In many cases, longing is followed by no mark in the child, while the latter sometimes occurs where no particular longing was experienced by the mother. And though de- formity may occur in consequence of a strong impression made by some dreadful object upon the mother, in gene- ral, the true cause is of a deeper kind, affecting the whole economy. It is in this manner that good or bad temper, sound or broken health in the mother, exert a constant and positive influence on the offspring. The ancient Greeks seem to have understood this : pregnant females were by them held sacred ; no one, under a severe penal- ty, was allowed to disturb or vex them ; their chambers were provided with the most beautiful specimens of sculp- ture and painting, such as the figures of Apollo, Narcis- sus, Castor and Pollux, etc., that they might dwell upon their fine proportions, with that complacency of spirit, which beautiful objects always inspire. For the same reason, the Spartans took their wives to the battle field, 392 INFLUENCE OF THE MOTHER ON HER CHILD. that their children unborn, might be influenced by the songs and triumph of victory. An eminent medical writer has made the following very true and judicious remarks : " By many women, pregnan- cy is regarded with alarm, as a period full of danger, and worse than doubtful in its result. But it is a consolation to know, that this period is not naturally fraught with danger, but is rendered perilious only, or chiefly, by neg- lect or mismanagement. From the moment of conception, if there is one duty more paramount than another, it is the obligation. on the part of the mother to secure for her- self by every possible means , the highest state of mental and bodily health of which her constitution is susceptible ; and this is the more binding upon her, that its performance involves no sacrifice which is worthy of the name, and none which is not amply cdmpensated to her by its favora- ble results. 55 The condition of the mother, then, exercising a marked influence upon the health and intellect of her offspring, it behooves her to contribute, by a well regulated system of physical and mental hygiene, to her own health, cheer- fulness, and comfort — at the same time avoiding the indul- gence of appetite, indolence, the excitement of passion, violent exercise, and in short every kind of excess and social dissipation. There is nothing of so much conse- quence for a pregnant woman, as to observe moderation and simplicity of diet, and avoid the use of heating food and stimulants. Next to this, it is important that the mother engage in some healthy and invigorating occupa- tion, which shall properly employ her intellectual, moral and physical faculties, and divert her attention from her- self. Gloomy and harrassing impressions should be guarded against ; she should breathe a free and pure air ; sleep in a large and well-ventilated room, on a bed neith- er too soft nor hard, and without curtains ; she should give great attention to cleanliness ; take regular exercise in the open air ; and, finally, dress loose, avoiding every species of compression of the breasts, waist, and abdomen. As we have treated of these subjects elsewhere, further remark here is unnecessary. (See Chapter on Hygiene, and Management of Pregnant Women.) HYGIENE OF INFANCY. 393 Before closing this chapter we should advert to the prevalent notion, that an unusual supply of food is requir- ed during pregnancy, on account of the growth of the new being, derived from the maternal system. Now, although it is true that the mother imparts nourishment to the foetus, yet nature herself has made provision for that demand by the suppression of the menses, to which women are at other times subject. When, therefore, during pregnancy, the health is good, there is no need of increasing the quantity or changing the quality of food, unless it be made more simple, which is, indeed, generally required ; noth- ing but evil can result from attempting to sustain strength for two, by too nutricious a diet. Yet, it is proper to re- mark that the opposite extreme should also be avoided, that is, an insufficient diet. "Child-bearing is a natural and not a morbid process ; and in the facility with which healthy, regular living women pass through it, we have abundant evidence that the Creator did not design it to be necessarily a time of suffering and danger. Where the mode of life and the habitual occupations of the mother are rational, the more nearly she can adhere to them dur- ing pregnancy, the better for herself, and consequently the better, also, for her infant." CHAPTER III. HYGIENE AND MANAGEMENT OF INFANCY AND CHILDHOOD. Ushered into a world where everything is absolutely new to it, and where its safety depends at every instant on its proper treatment, the infant is thrown at first entirely upon its mother for support and protection, and these are secured to it by the strongest feeling which woman can experience, — that devoted love of offspring which seldom fails even amid the agonies of death. Ignorant of its own nature, and of everything around it, the infant is wisely denied a power of motion or action which it could use only to its own detriment. Unable as it is to act for itself, ripened consciousness would have added miseries to its R 394 HYGIENE OF INFANCY CLOTHING. lot, without a single compensating advantage ; and, there- fore, it passes its earlier days in sleep, and dozing, and wakes up only for a moment to satisfy its predominating instinct, — the appetite for food, on which its future deve- lopment depends. — Combe. As we have previously spoken of the development of the child before its birth, and pointed out the causes which may influence it, also the mode of detaching it from the mother, and its treatment at birth, there only remains for us to consider briefly, the clothing, food, exercise, air, sleep, intellectual and moral training, etc., which are best adapted to secure a healthy childhood, and lay the founda- tion for a vigorous maturity. CLOTHING. The principal qualities required in the dress of infants, are lightness, looseness, softness, and warmth. The for- mer practice of swaddling the infant like a mummy, is so inconsistant with known principles, that we need scarcely mention it. Whatever tends to compress the body, legs or arms, should be emphatically forbidden. The dress should always admit of being easily applied and changed ; and while it affords protection to the whole body, it ought to admit of the fullest expansion of the chest and abdomen, and freedom of motion in the limbs and joints. For dress in winter, flannel is preferable, but not next to the skin. For the first few months, the clothing should be long and flowing so as to protect. the feet; but after there is desire for motion, this should be changed and the feet dressed in warm stockings and easy shoes. The neck, shoulders, and anus should not be left bare, as is practiced by many, for it is attended with the greatest risk and actual danger. The head is commonly kept too warm : the thinnest possible covering is sufficient, except- ing when the child is carried into the open air. Our remarks concerning dress apply equally to the bed-clothes to be used during the many hours of sleep, which are very often injurious from overheating the child. The evils of tight-lacing having been generally made known, we shall here take leave of this subject by re- MANAGEMENT OF IXFACNY FOOD. 395 marking that the principles of dress here laid down, what- ever may be the style, should not only be observed dur- ing childhood, but throughout life. FOOD AND DRINK WEANING. The natural food of the infant, from the time of birth until its teeth appear, is the milk of its mother : " She who to her babe her breast denies. The sentient mind, the living man destroys." When from any cause, the mother is forced to desist from nursing, she had better procure a substitute. A nurse should be selected with sound health, free from hereditary taint ; who is temperate, cheerful, orderly ; one whose child is of about the same age, and who is of a tempera- ment similar to the mother's. We have already spoken of the quality of milk which is best adapted, and that which is least so, for the nourish- ment of the child, and of the means, of obviating all al- terations. (See Chapter IV., Section II., Part II., Book II.) The same general regimen should be observed by a woman who is giving suck, as has been directed for her during pregnancy. (See the Hygiene and Management of Pregnant Women.) Her diet should be simple but nourishing, with an avoidance of highly-seasoned food and stimulating drinks. She should also take sufficient exercise and sleep ; attend to all the bodily functions, and avoid excessive emotion and passions, as they may prove hi^hlv detrimental to the child which she is nourishing. If the mother or nurse be able to supply milk in abund- ance, and the child continue healthy, more solid food will be injurious until the appearance of the teeth. After this event, which occurs from the seventh to the tenth month, and before, if the nourishment derived from nursing be insufficient, boiled milk, diluted with one-third or half tepid water, according to the age, and slightly sweetened, may be used ; or, recourse may be had to thin barley- water, arrow-root, tapioca or panada. The administration of medicines to infants is a frightful source of mortality, and should not be resorted to without the advice of a com- petent physician. 396 MANAGEMENT OF INFANCY EXERCISE, ETC. As a general rule, the child should be weaned at the age of nine or ten months ; — before, if the mother be af- flicted with scrofula or any other disease, or it should not nurse at all ; — *but later, if the infant be. weakly or sickly. After weaning, the diet should consist of the above named articles, to which may be added pulverized crackers or portions of bread and simple liquids. Care should be taken not to overload the stomach. By degrees (it should never be hurried') the stomach is brought to bear more solid substances. " Regulation of the food," remarks Dr. Warren, " is of primary consequence towards the formation of a good constitution. The most common error in relation to it, consists in the use of too much. Parents are uneasy when their children eat but little, and would encourage them to eat against their inclination. No mistake can be more pernicious to health ; and if persevered in, disease will, infallibly result from it. .When the child wants ap- petite, instead of bemg compelled to take food, it must be compelled to take exercise, unless positively ill, and then it muBt be compelled to take medicine. The quantity of liquid given to young persons is decidedly injurious. Ani- mal food should be sparingly taken by young persons who use little exercise ; and children generally do not need it. Bread and milk, and fruit, are the best articles for those who do not labor. Wine is highly pernicious to young persons. It is a slow but certain poison. Before the body has attained its full growth, there is an overplus of excitability ; and if to this is added the powerful agency of wine, or any other stimulating drink, the constitution cannot fail to be hurt. Females are more injured by stim- ulating drinks than males, because their svstem is more susceptible to physical excitement." EXERCISE, AIR, SLEEP, BATHING, INTELLECTUAL AND MORAL TRAINING, ETC. The powers of the system during the first month or two of infant life be;'ng occupied in nutrition, the time of the child is principally spent in sleep and taking nourishment. Exercise, during this period, of course, can only be of a MANAGEMENT OF CHILDHOOD — AX£-~GA?HJNG.. 397 passive kind. There should never be any haste to excite a child to premature exertion, or to endeavor to make it sit and stand. During the early months, therefore, exer- cise should consist in carrying the infant gently about the nursery, or into the open air, and in gentle friction with the hand over its whole surface. Afterwards, with pro- per precautions, it may, in pleasant weather, ride in a carriage. The length of time spent in sleep should be left mostly to the natural inclination of the child : repose should not be too much enforced by rocking, or moving lullabies. The quack " cordials" and " anodynes," given for the purpose of procuring sleep, are ofteu highly inju- rious, and ought to be dispensed with. Pure air is quite as essential, to the formation of a good constitution as proper food ; and it would seem even more so, when we consider that the influence of the air we breathe never ceases for a single moment of our lives. Vitiation and deprivation of air, are justly reckoned among the most common causes of scrofulous disease and mor- tality in infants. The nursery, and rooms devoted to sleep, should, therefore, be elevated, large, airy, and easi- ly ventilated. The practice of crowding several children and nursery maids into a small room, in which also wash-- ing and cooking are sometimes carried on, is highly inju- dicious, and at variance with the duty of parents to the welfare of their children. Overheating such rooms is also very injurious. For the same reasons care should be taken that the infant does not slip beneath the bed- clothes, and thus cut off the most important source of vi- tality during its sleep : the head should always remain uncovered. Plants, flowers, and perfumes ought to be wholly banished from a sleeping apartment. We need not remark that the night and bed clothes should be, daily, thoroughly aired. Frequent bathing in infancy is of the first importance to health. The whole surface of the body, and particu- larly the foldings of the skin and joints, should be care- fully washed every morning in tepid water, and diied by gentle rubbing with a soft napkin. The best time for such ablution is when the child is first taken out of bed : in hot weather, it may be repeated with advantage in the evening. Cold water for this purpose has been justly 308 MANAGEMENT OF CHILDHOoi)— EXERCISE, ETC. condemned, as exposing the infantile frams to a sudden- change of temperature, which it is not able to bear. The strictest cleanliness must be observed in immediately re- moving every soiled article of dress. Sufficient exercise and pure air are indispensable condi- tions of health. As soon as children are able to creep and walk, they should* not be in the least restrained— though care ought to be taken to guard against improper exposure. In fine weather a child cannot be too much in the open air, exercising .its muscles in its own way. Ear- ly attempts at walking, by the aid of an attendant, as we have before intimated, ought to be forbidden. Had we room, we should here speak of the' depressing influence of parental severity. That most abused of all sayings, "Spare the rod," etc., often leads to the most de- plorable results. Stern language even, and restraint of motion, song, laughter, and sport, in children, are the causes of much suffering and permanent injury. We should also advert to the influence of an upright form and full chest on the health, which are to be acquired by an appropriate system of physical education. Too much of the time of young persons is devoted to literary pursuits and sedentary occupations, and too little to the acquisition of corporeal vigor. 'For further information on these sub- jects, we must refer the reader to Combe on Infancy, Warren on the Preservation of Health, and Dewees on Children, all of which are excellent works, and should be read by every mother. " If more time were devoted to air and exercise, and less to mere accomplishments — if less strenuous efforts were made to cram much ill-assorted knowledge into the mind in a very limited period — than usually is the case in the present day, an improved state of nervous energy and of constitution generally would result. There would, consequently, arise a race of females possessed of stronger minds, and better able to make good wives and healthy mothers, than those too frequently met with in the easiei* ranks of life. Of all the physical influences by which the human constitution is permanently impressed in early age, there are none so powerful as light, air and exercise. Females, while the frame is being developed, should strictly observe early hours,- so that the period of repose MANAGEMENT OF. CHILDHOOD CONCLUSION. 399 L, /M. never be prolonged much after the dawn of morn- ing. The propriety o? deeping in a large, well-ventilatea room, cannot be diluted. It will be prudent, where more than one mv I sleep in the same apartment, to have separate beds, each no larger than is necessary for one person. v We should add that walking, dancing, riding on horse hack, the use of the triangle, the plays at ball with both hands, dumb bells, and battledoor, are the best rwues of exercising, where useful occupation is insuffi- cient ; — to be employed so as to urn *rate without ovcr- fatiguing. Young persons ought n<5ver to sleep with the aged, or infirm. For a bed, a matress, not too soft, is the best : the bed-clothing should be light. The constant use of frictions and bathing in cold water, over the wnole sur- face of the body every morning, should not be neglected. The food should be simple, and contain a sufficient quan- tity of unnutricious matter. There are other cares which the young girl requires as she approaches the period of puberty ; but of these we have already spoken at length. (See Chapter I., Part III., Book I.). We will conclude by entreating the attention of moth- ers and others to a revision of our present .modes of living. Our organization, both physical and mental, is regulated by unchangeable laws ; — laws as fixed and never-varying, as those which regulate the motions of the planets in their orbits. Let females timely make friends of worthy phy- sicians,— those men, who, in every age of the world, have with untiring zeal labored for the good of mankind, and to whom we are indebted for all our knowledge concern- ing the prevention and cure of disease. At the same time let the female avoid empiricism in all its alluring forms ; and by the. aid of the educated physician she may hope, not only to be able to ascertain the laws of health, — but by an early resort to the preventative and curative means, which experience has proved to be efTic^c.ous,^ — she may also hope to bt able to cure most of the diseases l/s which she is incHent : Principiis obsta : sero medevwa parat&* cum muia per longas involucre moras. — Ovid* *The principles of art are hindered ; medicine is furnishe J too lat% when disease is aggravated by long delay. BOOK III. ELEMENTS OF WOMANHOOD AND MANHOOD: LOVE, MARRIAGE, AND HEREDITARY TRANSMISSION. 11 A book about marriage for the family ? Scandalous I Rather write thirty romances about adultery — something imaginative, something amusing. You will be much better received." — Michelet. ELEMENTS OF WOMANHOOD AND MANHOOD. CHAPTER I. ELEMENTS OF REPRODUCTION IN THE SEXES. — WOMANHOOD. — MANHOOD. THE MASCULINE AND FEMININE ELEMENTS OF REPRODUC- TION pervade the universe, extending alike to the animal and vegetable kingdoms. The blending of these two elements con- stitutes the creative or reproductive power of plants and flowers as well as insects and animals, and is subject to certain fixed natural laws. These laws must be known and observed, in order, by culture, to produce a more beautiful, healthy/ and perfect model in plant or animaL . The object of sexual distinction in the human race, is the reproduction of human beings as perfect, physically and intel- lectually, as belong to the species. Plants, flowers, and fruits, also domestic animals, are improved and perfected by culture ; and why not the human race ? Man alone is neglected, or, rather, neglects himself. Knowledge Required. — To improve, beautify, and ennoble fchfi human race, and produce a more exalted manhood and woman- hood, ought to be the object of science and religion. What power have parents over the organization of their children — their bodies as well as their souls ? Look, ye fathers and mothers, at your deformed and suffering progeny ! This is your work ! Will you transmit to your children healthy or diseased bodies ? What kind of souls — true or false, loving or hating ? (403) 404 ELEMENTS OF WOMANHOOD AND MANHOOD. It is conceded that man needs a certain amount of knowledge to enable him to cure disease. How much more important, then, that he should be educated so as to be able to prevent disease! Where there is no violation of natural laws, there is no disease. A perfect organization and development is the right of every child to demand of its parents. To the Laws of Reproduction must we look for the improvement of our race, to expel disease from the body and soul. No religious, social, or political prescription will avail anything. A new man- hood and womanhood must precede the reorganization of society. How health, beauty, and strength can be substituted for disease, feebleness, and deformity both of soul and body, we shall proceed to indicate. Sexual Elements. — The distinctive characteristic of a woman is such as to qualify her to become a mother, and that of a man to become a father. Neither sex can reproduce without the other. The ovum," or germ, as has been seen, is already formed in the matured female ; but it is the semen secreted by the male organism, which, by coming in contact with the ovum in the womb, impreg- nates it, and causes it to become a living being. These are known as the sexual elements ; and this process is called conception, and is contributed to alike by each, man and woman. Take away the sexual element from a man, and he is no more attached to a woman than to a man, and vice versa. It constitutes the great attraction of one for the other, and is the ever present bond which binds them together. Each needs the aid of the other, not only to reproduce, but as the basis, when properly directed, of the most exalted social relations. The reproduction of the species, then, is the object of sexual distinction, and to satisfy the social wants of man and woman. Formation of the Soul. — The process by which the body of the child is formed during gestation, or pregnancy, is quite plain and obvious, after reading the chapters of this work devoted to those subjects. The agency of the parents is made visible, and connec- tion between the mother and child* actually known. But from ELEMENTS OF WOMANHOOD AND MANHOOD. 405 whence comes the human soul? Is it also derived from the parents, as is the body ? If so,, is not its constitution more or less influenced by, or under the control of, its progenitors 1 According to the modern Spiritual theory, the soul is a substance, though composed of matter so refined as to be invisible, like electricity. Do not Waste the Sexual Element. — At the period of puberty, then, the semen, otherwise known as the spermatic fluid of the male, and ovum or germ of the female, are secreted and elaborated in their natural organs, for the purposes of reproduction. These elements of procreation are the most refined product of every portion of the human functions, body as well as soul, and require for their perfect formation, the utmost harmony and vigor of our entire organization. The retention of these elements in the system is necessary to produce perfection of health and beauty in man and woman. They constitute the manhood and womanhood of the soul as well as body. The expenditure of these elements, except for procreation, is useless ; and when done for sensual gratification, particularly before the maturity of all the organs, the energies of the body and soul are blasted ; the brain and nerves become ex- hausted, and transmit weakness to the muscles and disorder to all the functions of mind and body. Thus result loss of memory, loss or want of the affections, imbecility of body and soul, idiocy, and insanity, Says the sensualist, What ! am I to enjoy this expenditure but rarely during life ? We answer, The retention of this element in the system is an ever-present enjoyment. In case not wasted, it becomes re-absorbed into the system, carrying health, beauty, energy, and life everywhere, and giving a capacity for enjoyment in body and soul, little dreamed of by the victim of passion. Solitary Indulgence. — He or she who expends this life- element in solitary indulgence, sinks below the brutes, who never practise it. And what shall we say of the lewd and lustful, whether legally so or not (married or unmarried) ? Which does the greatest violence to nature? There is, perhaps, little distinction between the two. How manv husbands and wives ruin their own health by 18* 406 ELEMENTS OF WOMANHOOD AND MANHOOD. . yielding to this sensualism, bringing desolation upon homes other- wise full of life and beauty ! How much disease, deformity, and weakness transmitted to the bodies and souls of their children ! The following case of an erring clergyman and his wife, reported by a physician, is here introduced to illustrate our subject, and is only one of constant occurrence : — "He, a bright young man, educated in a New-England college, graduated with honor, and, after a course of theological studies, entered the ministry, was ordained, and settled. She, the daughter of a merchant, had received a polished education, and was the pride of the family. They were married. He was beloved and admired for his eloquence. But, after a while, irregularities were discovered in his appearance and conduct; something seemed to be wrong with him, which was attributed to his devotion to his profession. Finally he became insane, was sent to an asylum, grew worse, pro- nounced incurable, and again taken to his friends. " As for the wife, soon after the husband's insanity, she became insane, and was sent to an asylum in another state. She became much improved, and returned to her father's house. " Upon an investigation by the friends of each, it was discovered that the husband had long and fearfully abused his manhood, and had long lost the power of self-control, and that it was unsafe for him to see his wife, who also felt the same necessity. 41 The result of this marriags was two children, — a son and daughter. The son was a perfect picture of him, and the daughter of her. Both were in feeble health, and the most perfect specimens of nervous excitability, — the natural and necessary result of the great wrong done by their father to himself and their mother. " Contrary to all expectation, and contrary to the usual result in such cases, after careful and long nursing and treatment, this min- ister improved in health, body, and mind, and recovered sufficiently, after a long time, to again form a re-union with his wife and chil- dren, and resume his profession a wiser man." " As the cause of his insanity and unhappiness, he related the fol- lowing circumstances: When quite young, at school, in common with other scholars, he acquired the habit, and nightly pursued the practice of, solitary indulgence by self-abuse. 1 his he continued through his collegiate course and theological studies, up to the time of his marriage. Several times his health gave way, which was imputed to hard study. After marriage, he indulged his sensuality so excessively, that his insanity became complete; and his wife, pure and healthful when married, became the victim of his lust, and also insane. " The children begotten under these circumstances were irritable, nervous, and weakly, — monuments of sexual abuse, and victims of the violated laws of reproduction in their parents." LOVE AND MARRIAGE. 407 Husbands and wives, fathers and mothers, listen to the voice of experience and reason. Would you assist in eradicating disease and darkness from the earth, and causing it to be peopled by a nobler type of beings ? If so, remember, " Knowledge is power." Instruct your fellow-beings, particularly the young, and first your own children. Teach them the noble uses of all their organs of the body, and show them the destruction which awaits any viola- tion of their tender nature. Thus, in a word, become ministers of grace and angels of mercy to a corrupt and bewildered world. CHAPTER II. LOVE AND MARRIAGE. The Family rests upon Love, says Michelet, and society upon the family. Hence, love goes before every thing. In natural history, we notice birds and animals tending towards the married state. Love, the Natural Aim of Woman. — In the human species, we see that the natural aim of woman is to first love ; second, to love but one : third, to love always. As for man, the increasing use of spirits, tobacco, and other nar- cotics, obscure his mind, isolating him from love and home, and giving him a preference for solitary enjoyment and the dreary pleasures of a polygamic life, which impose upon him little or no responsibility. This state of things, enervating to man, is debasing to woman, he profiting by her misery. Woman, unless hindered, is more pure and faithful than man, her love continuing in an equal course, like the flowing of a beau- tiful river — forever. Rescue the Woman. — Happy he who, seeking a companion, a partner, or mate for life, rescues a woman from her loneliness, and frees her from the weakness and misery of seclusion, and elevates her, strengthens her, and makes her his own. In delivering her, he also delivers, strengthens, and elevates himself. 408 LOVE AND MARRIAGE. She will Rescue You. — When once set free by you, from what will she not rescue you in return ? From the servitude of your base passions ! You will not leave home to seek the abodes of infamy, nor wander in the streets in quest of love or intoxica- tion. Look at that feeble, pitiable, young, old man, so pale, dis- eased, melancholy, and debased ! True love will preserve you from this, and might have preserved him. He who has with him a reliable and loving wife, goes to his daily toil strong in purpose and inspired with cheerfulness and content. He leaves at home one beloved, to whom he can always return and find an open and loving heart ready to greet him and sympathize with his disappointments. Non-Expensiveness of Marriage. — Many remain single, frightened at the expensiveness of matrimony; yet they expend much more, after all, than if married. They live expensively at the restaurants; frequent the theatres; smoke, and often resort to intoxication ; or they contract temporary marriages, secret and shameful, lasting sometimes for months, but often only for a week or an hour. These, while completing the utter degradation of the woman, ruin also the man, physically, morally, and mentally. Those infamous diseases infecting the haunts of vice, when con- tracted, complete the picture of ruin and despair. We say, then, as a rule, that marriage is less expensive than living single ; in other words, two persons spend less than one. And if the wife be not incited to extravagance in dress by female friends, she expends almost nothing ; and we might say, with truth, that " four persons spend less than one;" for she supports the two children besides. A Wife a Fortune. — Young man, if you have a good wife and a good trade, you are free. Free from vice and extravagance, you can laugh at the hosts of uneasy millionaires. You can say, "Let them wear out their lives in amassing riches. I love ; and in that, I have found mine." "Do not fear that you will tire of her, for she will ceaselessly change. Do not fear to confide in her, for she will never change.'" — Michelet. LOVE AND MARRIAGE, 409 Menstruation : Cause ; Purity of. — The period of puberty in females, announced by the appearance of the menstrual discharge, occurs, in this country, usually between the thirteenth and sixteenth years. It is hastened by a warm climate and certain modes of life 1 n cities, and retarded by a cold climate and living in the country, free from the excitement of city life. Seepages 38-84. It was believed by the ancients, that woman is impure; that her monthly sanguineous discharge was a purgation. Hence, the com- mand of Moses, that man should not approach her at a certain period of the month. But it has been proven by science, that she is pure ; the blood is the same as found elsewhere. It has been established that the ovaries exist in woman, and that, each month, an ovum or ova matures, burst their envelopes, and make their way into the uterus ; so that, every month, this ovarium is ruptured or torn, and then subjected to the healing process. Instead of being any thing shameful, this periodical function is the most essential of her organism ; and upon its regular and healthful appearance, depends her health, beauty, and happiness. "What you call a purgation, you fools ! is the sacred wound of love, in which your mothers conceived you." Although a natural and as essential a function of her organism as breathing, yet, imperfectly organized as women are in civilized life, the recurrence of the menses is generally a period of physical and mental prostration. The week preceding this event is. one of trouble, more or less ; and in the few days which follow it, there exist languor and weakness, now known to be caused by the healing of an internal wound. So that woman is an invalid one week out of every four ; that is, every woman who does not blot out her sex by excessive labor, as the peasant women of some conntries do. It is at this time that her nature calls for the tenderest love and sympathy of man. Knowledge Required. — In early life, men, as well as women, should be taught to understand the reproductive functions and the relations they bear to her health, beauty, and happiness. They ought to know that, upon the regular recurrence of the menses, depend her qualifications to become a wife and mother. It should 410 LOVE AND MARRIAGE. be understood by every husband, father, son, brother, and lover. Such knowledge would save woman from much suffering, and bind the sexes in a tenderer and holier union. Should be Acquainted. — Man and woman, previous to entering the marriage relation, should be acquainted with the mental as well as physical conditions of the person with whom they are to be united. Let each ask, Is his or hers a fit physical and mental organization to be united and blended with mine ki our children ? For the souls of the parents, in their leading tendencies, as a general rule, will pass into the souls of their children. No man or woman, then, should enter the conjugal relation until they become acquainted with the physical and mental constitution of the one with whom he or she seeks to be united. It may be accounted an insult to inquire into this matter, which is, however, of too much importance to be neglected. If your own soul be pure, it will shrink from a union with a person deformed with passion, mean, cowardly, and avaricious, whose appetites are unnatural, and who aspires merely to the gratification of an animal nature. Shun such an one for a companion, though they possess untold wealth and faces and forms of unsurpassed beauty. Such a marriage will crush your moral nature and entail upon your children an eternity of degradation. Love ; Passion. — As an element of marriage, the passional nature should here be adverted to. That there is a distinction between love and passion, is obvious. Although marriage love is the deepest and tenderest sentiment of the soul, it may not exist without passion. Still, they are essentially different unless there is a defective organization. In a perfectly organized man and woman, the desire for sexual gratification would exist only as the effect of pure love, and thence the passional nature would be in abeyance and under the control of wisdom and reason. Instead of this, however, it is lamentable that love is generally subject to animal passion. Men and women — most often, the former — are fearfully diseased in this respect. They indulge and seek to stimulate this LOVE AND MARRIAGE 41) passion to the utmost without love. Reason, conscience, wife, children, and life even, are all sacrificed to sensual desire ! The inevitable consequence is physical and mental degradation in the man and woman and their offspring This instinct, when once aroused (even though very obscurely felt J, acts upon the mental faculties and moral feelings, and thus bec-omes the source, though almost unconsciously so to the indi- vidual, of the tendency to form that kind cf attachment towards one of the opposite sex, which is known as love. This tendency cannot be regarded as a simple passion or emotion, since it is the result of the combined operations of the reason, the imagination, and the moral fCeliugs ; and it is the engraftment, so to speak, of the psychical attachment upon the more corporeal instinct, that a difference exists between the sexual relations of man and those of the lower animals. In proportion as the human being makes the temporary gratification of the mere sexual appetite his great object, and overlooks the happiness arising from spiritual communion, which is not only purer but more permanent, and of which a renewal may be anticipated in another world, does he degrade himself to the level of the brutes that perish. Yet, how lamentably frequent is this degradation ! — Carpenter, Incapacity must be Known. — We have before remarked that woman is evidently designed, by her physical and mental constitu- tion, to fulfil the relations of a wife and mother: also the husband, of a father. Particularly, the man, if well organized and truly developed, will seek a woman for a wife capable of crowning him with the dignity of progeny. But neither has a right to attract the other into the relation of marriage, knowing their incapacity to fulfil this deep and holy want of their natures, without a full ac- knowledgment of the fact. They may meet as friends, and, if they choose, may sacrifice this part of their being to their beloved, but have no right to cause this sacrifice by concealment. In the case of woman, in a perfect nature, desire does not, at first, take so distinct a form as in man : and there are many, perhaps, who would marry with a knowledge of incapacity in their husbands. "Well would it be for husbands full of passion and vigor, to remember this fact, and, when they first approach the loved ones of their hearts, not demand a rude consummation of their desires, until, by endearing expressions, they induce a cheerful compliance with this con- 412 LOVE AND MARRIAGE. centrated expression of their love. Through sweet tenderness, such charming favors will be granted as otherwise might not have been conceded. Oneness Required. — In true marriage, there is ordained a oneness of the flesh — a perfect unity. Lovers should create in themselves, by a lifelong study, a common basis of ideas and an alliance of their two wills. There should be a free union of hearts — an absolute interchange of lives. Initiate the Daughter. — Parents should prepare their daugh- ter for marriage both physically and mentally. They should and generally do watch over her virtue, that she may be found a virgin by her husband. Marriage being consent, the daughter beforehand should be initiated into what she is about to undergo : that her husband may assume the right to constitute himself the judge of her past morals, virtue, and purity. Duty of the Husband. — The husband ought not to emulate ancient barbarism, under any circumstances, by beginning the union with distrust, by debasing or humiliating a poor, innocent girl. When she has had a misfortune, even a weakness, he may be sure that she will love him who rescues and adopts her, instead of the ingrate who deceived and outraged her. How would it be if she should inquire about the previous morals of her husband ? Her whom he esteems sufficiently to confide to her his future life, he ought to place confident in at once and for all past time. " He takes her for better or worse." Have pity on her ! Be kind and gentle to her ! Appreciate her situation ; care for her , re-assure her. Let her know that you are not her enemy ; on the contrary, a most devoted friend, entirely at her service. Be discreet, full of tact, understanding and respecting her situation. Encourage her to the utmost. Tell her this: — "I am thine. I am a part of thee. Take me as thy mother and thy nurse. Confide wholly in me. Thou art my wife and my child also." LOVE AND MARRIAGE. 413 Create your Wife. — The girl or young spouse, after being born again (into the kingdom of love), desires nothing better than to be taught and remodelled by her lover or husband. She adopts his creed and people, confiding her body and soul to him. She believes in him. He should therefore endeavor to separate her from all evils surrounding her, from any faults of education or association she may have ; in a word, re-make, re-create her. " Love loves more what it makes. 11 Just before or after the time of the monthly crisis (if not too painfully near), is the time to be chosen to make lasting impressions upon her. This profound renewing which she suffers with so much pain, makes her the gentlest and most pliable of beings. "As soon as you love her, envelope her, isolate her from bad influences. Every folly of woman is born of the stupidity of man." Love, a Necessity in Woman. — Woman cannot live without man. It has been truly said, that all her ailments proceed, either directly or indirectly, from ihe womb, the organ of love and ma- ternity. What causes her headache, colic, etc.? Not being loved enough. It is different with man : excepting climate, his maladies proceed mostly from the digestive organs. He eats and drinks too much, carrying invigoration to excess. Confide in Each Other. — As in matters of business, also in matters of the heart, the wife and husband should cousult and confide in each other ; should deliver up their last secret, by telling each other every thing. A wife is a fortune, especially whon she is poor. Then, though she has nothing, she brings you every thing. If you wish to ruin yourself, marry a rich wife. She Loves but One. — Woman is the mortal enemy of polygamy. She wishes for the love of one only, and to give herself to one alone — her husband — and belong to him forever. At all times, when fatigued and having exhausted or lost his mental vigor, man takes in a new supply from woman, from her soothing presence, her chaste bosom. In his dark moments, when he is in trouble and seeks in vain his star in the heavens, he looks toward woman, and, behold! his star is in her eves. 19 414 LOVE AND MARRIAGE. Love, not in a Crowd. — What influence can you have over a woman in society ? None at all ; in solitude, every influence. " Do not sow seed by the wayside ; Do not plant trees in the torrent ; Do not love amid the crowded haunts of men." A Poor Worker. — Woman, so often interrupted by sickness, is a very bad worker; particularly, during the week of the menses and the period when she is enciente, is she an invalid. It is the paradise of marriage, that the man shall work for the woman; spare her the hardships of labor and rude contact with the world. Time of Conception. — After long investigation, it has been proven by science, that conception only takes place at the time of the menses ; that is to say, near the time when the discharge an- nounces the appearance of the ovum, or ova — a little after, or a little before. Hence, there is barrenness during a part of the month. Time of Marriage. — During the week of the sanguinous crisis, for obvious reasons, marriage should not take place. Dur- ing this period of relaxation, languor, and it may be suffering, nothing should be done to unduly excite a mind already confused and terrified as if by an approaching tempest. Nobility of Love. — Love in woman is an exalted and noble thing. She stakes her life upon it. Love creates love, and augments it. The secret of loving each much is, to occupy ourselves much one with the other ; to live much together. Every time woman consents and yields to man's desire, she testifies her willingness to die for him. Effect of Variety. — Man, wearied, bewildered, palled, and disgusted with the mania for variety and hurly-burly of life, which robs him of all his strength, takes cowardly refuge in a different but more fatal enervation; in a dull narcotism; in vague and barren dreams ; the fumes of tobacco : the stupefaction of alcohol. But he who lives according to reaso , will understand that woman con- LOTE AND MARRIAGE. 415 stitutes the best narcotic and the best stimulant. The two alter- nated intoxications, the two opposed deliriums, which bestow bal- ance of reason, are found healthful and vivifying in the breast of woman rather than in ail this false life. The TTife Renews the Max. — The wife is a true sister to the man in the labors of life : more than sister and more than wife to console him. and to rest his weary head at night. She comforts his fatigue — a nurse ; she lulls him to sleep, and. taking him again into her bosom, brings him forth with renewed life, forgetful of all things, and rejuvenated for the joyous waking of the morn. Such is the power of marriage, but not of transient pleasure. The longer it lasts, the more is the wife a mother to the husband: the more her sou. It is their guaranty of immortality. United thus, who shall disunite them ? Adultery of the Woman. — Are the adultery of the woman and the adultery of the man equally guilty \ Yes. as an infidelity, a violation of vows. Xo, in a thousand other resj : Fearful Consequences. — This treachery of the woman car- ries with it fearful consequences : that of the man does nor. The woman does not simply betray her husband; sb.€ up his honor and his life. She makes him gossipped about, ridi pointed at, hissed. She puts him in peril of death: of eithei ing a man. or remaining a butt: it is almost as though she let an assassin into the bouse by night. He will Buffer a moral assassination all the rest of his life : never knowing whether her child i» his child, obliged to rear and provide for a doubtful progeny, or to amuse the public by a trial which, wbeth. r he gains or loses, makes his name a by-word and a jest. Responsibility of Woman. — It is folly to say that the woman has no more responsibility than the man. He. by his activit strength, supports the family: but she is its heart. She alone knows its mysteries : she alone holds the secret of domestic happiness, the whole assurance for the future; she alone can attest a legitimate inheritance. A wife's falsehood may falsify history for a the years. What is the bosom of woman, if not our living temple, our sanct- uary, our shrine, where burns the light of God forever, where we each day are re-created ? If she delivers this up to the enemy: if she permit^ this lire, which is her husband's life, to be stolen, it is more dreadful than to plunge a knife into his heart. No punishment could be severe enough, if she knew what she had done : but she is, nearly always, very far from ever dreaming of 416 HEREDITARY TRANSMISSIONS. CHAPTER III. i PARENTAGE — HEREDITARY TRANSMISSIONS. Heroes Born op the Most Elevated Love. — Woe unto the children of darkness, the sons of drunkenness, who were, nine months before their birth, an outrage on their mothers. He who is born of a nocturnal orgy, of the very forgetfulness of love, of a profanation of the beloved one, will drag out a sad and troubled life. On the contrary, it is a sublime, a mighty blessing to be conceived in the light; when a man's love is directed not to the sex indiscrim- inately, not to any woman whatsoever, but to this single woman; to this heart which belongs to him, sajing, u She, and no other;" when it is mirrored in her smile, in her beautiful, quiet eyes, which reflect the dawn on him ; in her charming surprise and her artless impulse, which say, " Yes, yes ; I was dreaming of you." The profound and perfect harmony of the heart, the exquisite sense that love, in its most obscured moments and in its hidden light, preserves of the loved object, is that which produces divine fruit — a son of liberty and of light. Both are desirous. It is, doubtless, of the most elevated voluntary love that heroes have been born. — Michelet. , Union of Opposite Elements. — It has generally been pro- mulgated, in modern times, that persons should marry their oppo- sites in order to produce a superior progeny; that the qualities, physical and mental, should be crossed. There is, doubtless, more attraction in individuals between opposite or contrary qualities of body and mind. This is true, also, to a certain extent, with races, the most ener- getic of which have sprung from opposite or seemingly opposite elements. According to a recent French author, the blending of the white man with the black woman produces a race of extraordi- nary vigor. " Such is the virtue of black blood," says he, " that wherever a drop of it falls, everything revives. No more old age — a young and puissant energy; it is the very fountain of youth." See pages 387-393. Union of the Same Elements. — However plausible the doc- trine of crossing the races may have been, it is now pretty certainly HEREDITARY TRANSMISSIONS. 417 settled, that the highest degree of vigor may be attained by a con- centration of the energetic races. It is proven, that the blood of all races cannot be blended with impunity; a degradation follows. There must be a strong sympathy, in order to be successful, though seemingly opposed. - The progeny of the strong and perfect, result- ing from a union with the weak and inferior, will be but of an ordinary quality; while that resulting from a' union of strength and perfection on both sides, will be a concentration of vigor and genius. This principle is understood and practised in breeding and rear- ing horses and other animals. The famous race-horse Eclipse was produced by a successive union cf the accumulated blood of a pure race, unimpared by combining. Marriage of Relatives. — In regard to the marriage of rel- atives, it has been said, that if wedded love be added to the love of kindred, there will be too much love. But the contrary is seen among the Hebrews, who, notwithstanding being allowed to marry their cousins, and sisters even, were seen running after the daughters of the Philistines. The Greeks married their half-sisters until thi3 custom was abolished by the laws of Solon. This race was regarded as the most beautiful in the world, though not very productive. But Greece looked only for heroes, not numbers, which, in a short time, exhausted the race by too great a concentration. The Romans married no closer than their cousins. Much has been written of late upon the subject of marriage be- tween relatives; and we are forced to the conclusion, not only from experience of the ancients, but also from our own times, that such unions are productive of strength in the progeny of the strong; while that of the weak will further degenerate. Care should be taken that the same disease or morbid tendency do not exist in both husband and wife. Crossing of Qualities. — As : ' like produces like," it is obvious that persons of extreme characteristics should not seek to further accumulate and enhance such personal qualities in their offspring. For instance, the tall should marry the short ; the corpulent, the lean; the passionate, the gentle; the studious and gloomy, the 418 HEREDITARY TRANSMISSIONS. sprightly ; the timid, the brave ; the weak, the strong, and so on ; and the extremes in the parents will be corrected in their offspring. By the same rule, the fair-complexioned and red-haired should seek to marry brunettes. It is a- known fact, that "like love not their like" so well as something different. Still, the dispositions of married people must assimilate in some particulars. The sanguine and warm-natured ought not to be united with the cold and phlegmatic, or there is danger that the continued soft caresses of love might excite disgust. So, in marrying opposites, the nature and disposition must be such as to divert and excite, not shun each other This crossing of the most prominent qualities in partners is an admirable arrangement, establishing, as it does, an equilibrium, and preventing extremes; for the union of dwarfs produces dwarfs, and the union of giants produces giants. Also the children of parents alike irritable, alike lymphatic, alike diffident, etc., inherit the con- centrated qualities of both to such an extent as to become seriously disagreeable. The uniting and blending, however, of all races in one universal marriage, a beautiful dream of love, were it possible, would prob- ably result in a certain colorless, faded element, fatal to love itself. The Husband's Duty. — The wife should not be made the passive means cf pleasure to the husband. Unless shared in by her, there should be none for him. The selfish impatience of the man, desiring only self gratification, excites and irritates her only to be disappointed. Can the man be satisfied with the brief pleas- ure taken by force from cold marble? The children of such a marriage are to be pitied. Marriage exists only in the interchange of sentiments of the heart and those mutual, salutary raptures which console and renew life. Period of Barrenness. — Woman should never be impreg- nated without her consent. It is for her to say, if feeble, or ill, or badly formed, whether she will accept that risk of death. At her request, the husband should refrain, especially at the time of the HEREDITARY TRANSMISSIONS. 419 development of the ovum (during menstruation and the week following). Is she sterile during the intermediate period? She ought to be, up to within a few days of the menses, as the ovum is wanting, though it may be produced or developed by passion. Fecundation Extends long into the Future. — Impreg- nation in woman transforms her in a lasting manner. The widow frequently bears to her second husband children resembling the first. It is the same with animals. The bee is impregnated for a year; the hen, for her whole brood ; and most insects, for several genera- tions. The mare once impregnated by an ass, ever after presents nothing but asses, or, at best, colts of an awkward appearance, thus betraying the inferiority of the first love. This law among animals, which devotes the female to her first love, seems to be the same in the human species. The first love and the first child appear to extend to those of the future; tlie father of that child extending his paternity to those which the woman may have by a second husband or by a lover! In former times, it was observed that adulterous women had children resembling the husband. Hence, the adage that " The son of adultery pleads for his mother." It has' also been seen that widows, impregnated during their first marriage, have afterwards had children by a second and dearly beloved husband, resembling the first husband, long dead and but little regretted. Here, neither fear nor love had any influence. . " If it were always thus, if the first impregnation infallibly modified the woman forever, adultery would be impossible (at least in its results). The possession of the husband being unalterable, the only one deceived would be the lover." Hereditary Tendency to Disease. — In addition to our own diseases, which may be said to be accidental, we frequently have to cope with those which we get from our ancestors, which lie awaiting the day of our weakness. The purest, the most virtuous, and the most beautiful, may none the less possess a germ in her blood which may, ere long, develop itself. As we often resemble our parents in external forms, says Dr. 420 HEREDITARY TRANSMISSIONS. "Wood, so also do we inherit their internal peculiarities, and conse- quently all the morbid tendencies growing out of them. It is not diseases, \ generally speaking, that are inherited ; it is only the peculiarity of structure or constitution which serve as predispo- sitions to disease. We are not born with the scrofula, gout, rheumatism, 6tc, of our parents, but only with that condition of system which favors the development of those affections when •other causes operate. The inherited diathesis, however, is often efficiently strong to lead ultimately to the disease without other cause. We see this fact constantly illustrated in consumption and gout. Nay, the hereditary disease will often be developed, notwith- standing the most determined measures to prevent it which sagacity and experience can suggest. The inheritance may descend from either parent, or both. It has been supposed, that the peculiar diseases of the mother are more apt to be found in the son, and those of the father in the daughter; but the accuracy of the opinion may be doubted. When only one parent is affected, it often happens that the offspring escape en- tirely, taking after the healthy parent exclusively; but when both are diseased, and in the same way, the chances of escape on the part of the children are greatly diminished. Hence the danger of constant intermarriages between near connections, who may be sup- posed to have the same defects of constitution. The morbid ten- dencies thus go on, accumulating from generation to generation, until families, and even races, become extinct. Sometimes the hereditary malady passes over one generation, to fix upon the next. The child escapes, but the grandchild is affected. This fact admits of easy explanation. It is only the tendency that is received from the parents. This may remain latent from the ab- sence of causes calculated to call it into action ; or, counteracting circumstances may exist, which shall prevent its development. The tendency is, nevertheless, handed down to the next gener- ation, which may be less fortunate in relation to the influences that bear upon it. Occasionally we observe family predispositions to disease which have no prototype in the immediate or even remote ancestors. One child after another falls a victim to the same disease, from some HEREDITARY TRANSMISSIONS. 421 inherent vice of constitution ; and parents themselves of sound health may thus be completely stripped of their offspring. This sometimes happens from a vicious system of physical education and is much more frequent among the rich than the poor. But in other instances, the defect is received from the parent, and exists from birth. In such cases, however, the disease cannot, in strict- ness, be said to be hereditary. Complaints dependent upon inherited peculiarities of system are apt to appear earlier in life than similar complaints of a different origin. The most common hereditary diseases are scrofula or con- sumption, cancer, rheumatism, or gout, and insanity. Although none of these diseases are always hereditary, being also produced by other causes, still it is known, that by far the greater percentage are of that class. Dyspepsia and many other chronic diseases are also often hereditary in character. Venereal Diseases are often the primary cause of hereditary tendency to disease. They may be ranked as among the most ter- rible curses of the human race, and arise from inoculation, gener- ally intercourse with a diseased person. They are of two kinds, syphilis and gonorrhoea, the former of which is by far the most fatal. A few days after coition, a slight pimple forms, accompa- nied by itching, followed by an ulcer, called a chancre. When properly treated, these sores are immediately destroyed by the application of caustic, or there is danger of extensive erosion and destruction of the parts affected. There are also swellings in the groins, forming buboes. After a few months, secondary symptoms set in, and there are ulcerations of the mouth and throat, and scaly eruptions on the skin in various parts, culminating sometimes in the destruction, not only of the organs of generation, but of the nose and mouth. In other cases, even when the disease seems to have been cured, after the lapse frequently of many years, it re-appears, acting with great violence upon various parts, extending even to the bones. Health, beauty, and life itself, are frequently destroyed by this terrible malady, contracted mostly by the young in a thoughtless moment, for the want of a little timely knowledge and advice. 422 HEREDITARY TRANSMISSIONS. Syphilis is Transmissible from the parent to the child. It may be inherited from one or both parents. It is very common for a man, who does not himself display a single symptom of any kind, and who appears to be in perfect health, to beget a syphilitic child. — Hutchinson. In all stages of constitutional syphilis, the taint may be transmitted to the child, the degree of severity depending upon the period which has elapsed since the presence of active symp- toms. Syphilis may affect the foetus at an early period, and is the cause of miscarriage in the mother ; or, in case the child lives, it may be imperfectly organized; and, in consequence, may result diseases of the lungs, liver, kidneys, and other organs, too numerous to mention. Consumption, etc., Transmitted. — That the tuberculous constitution is transmitted from parent to child has long been a popular belief, and regarded as fully established. Parents whose digestive organs are habitually disordered, who suffer from gout, the injurious influences of metallic and other poisons, such as mercury, malaria, syphilis, chlorosis, or the debility of advanced age, so that a cachectic state is induced, entail upon offspring begotten during such morbid states of the parents to an extent still undetermined, but obvious and appreciable ; a tendency to the tuberculous constitution not necessarily to be expressed by the growth of tubercle in the lungs, but certainly and surely by various forms of dyspepsia, and a precarious state of health. — Aitlcen. Or, similar causes may also produce cancer, insanity, etc. A disordered state of the health of the mother, resulting from disease, or unhealthy mode of life, depressing passion, etc., influ- ence the state of the child in utero to a great extent. There are many other causes, such as debility, resulting from impure air, improper quantity and quality of food, etc., etc. So long as pov- erty and misery exist on the one hand, or dissipation and enervating, luxuries on the other, so long will the causes be in operation which induce numerous diseases. Influences before Birth. — It is certain, that nature de- signed that the race should be perpetuated and perfected here. And HEREDITARY TRANSMISSIONS. 4'23 to this end exists the sexual clement in man and woman, impelling them to comply with the requirements of their being. In repro- duction it is necessary that the affections and moral powers should take a prominent part. In case animal instinct only is concerned, the result must be a progeny morally inferior. The period of utero gestation is an important one for the child. It is at this time that it is constituted for good or evil. It then receives the elements of character, of body and soul, and natural tendencies, which, in a measure, guide it afterwards, when it enters upon its independent existence. Children often struggle into existence against the wishes of their parents. "When the soul of the mother rebels against the existence of the new life within her, and does not hesitate to use every means to destroy it, to prevent the development of her child instead of promoting it, what must necessarily be the character and disposi- tion of that child ? Is it a wonder that such a child lives to curse the day of its birth, and those unnatural parents who gave it being ? "What a state of society is that which prompts woman to hate her unborn babe, and to seek its destruction ! Most unnatural and brutal, though called Christian and civilized. The Child of Love. — Love should watch over the child prev- ious to its birth and afterwards. Its every stage of development, from the first to the last, should be hailed with joy, hope, and faith. How infinitely is a love origin to be desired ! How above all price is a love ancestry! Talk not of an ancestry of princely title; of knightly deeds in war and slaughter: talk not of a parentage of wealth, of station and dignity, in church or state. More to be valued is a lineage of love than an ancestry of untuld wealth, or of the most honorable titles and standing. This love lineage is a foundation on which the soul may build for eternity. — Wright. Retain the Sexual Element. — The husband has no right to demand sensual intercourse with the wife unless acquiesced in by her, and never under the following circumstances : during the san- guineous discharge; during gestation and lactation; and never unless the pleasure is reciprocated by each, with a desire for children. 424 HEREDITARY TRANSMISSIONS. Retain, then, the sexual element, and expend it only for offspring. This is the voice of reason. When so retained, it conduces to ihe health, beauty, strength, and activity of the body and mind ; to the nobleness and energy of the soul; to the refinement and social enjoyment of home ; and to the progress of the human race. Conduct of the Parents. — Whatever circumstances or dis- eases affect the parents must also affect their germs, as being a portion of their systems. Consequently each, the father and mother, impresses upon the child its own peculiar conditions of body and soul, whether disease and deformity, or health and beauty. A great obligation, then, rests upon parents, to see, so far as they can, that everything is done to give perfection of existence or organization to their future progeny. For some time previous to blending the two elements in which the child is to originate, parents should abstain as much as possible from artificial stimulants ; adopt a simple diet, keeping aloof from all occasions and scenes calculated to produce unusual excitement of the mind, and, by calmness, endeavor to call into activity the most ennobling elements of their nature. Let perfection of offspring be the ruling motive, instead of sensual gratification. The woman, after receiving into herself the life-germ of a new being, should forego all practices and indulgencies which conflict with her own health and the perfection of the child. During the period of pregnancy, let the wife be surrounded with tender care and happy influences. Let her avoid stimulants; adopt a plain diet; avoid excessive toil and fatigue; and be kept from depressing gloom, anxieties, and irritations. Above all should she abstain from all arousing of the sexual instinct and carnal intercourse with her husband. Acquired Diseases Transmitted. — Bad conditions in the parents are as likely to be transmitted to children as good tenden- cies. We have already spoken of the many diseases capable of being transmitted, and alluded to acquired tastes and tendencies which are also transmissible. Some, whose organizations were originally quite sound, acquire diseased conditions by unnatural HEREDITARY TRANSMISSIONS. 425 indulgence and practices. Prominent among these causes, besides sexual abuse, are the use of alcoholic spirits, opium, and the ex- cessive use of tea and coffee; and, last, but not least, miscarriage or abortion, often criminally produced, though not without carrying a long train of evils to the suffering victim. Drunkenness. — A woman of wealth and fashion, naturally healthy, became addicted to strong drink, and exceeding passionate. She had four children. They were all either deformed, deaf and dumb, or diseased, and died early of consumption. One was a demon of temper and a drunkard. In another case, the wife was healthy, accomplished, and beauti- ful. Her husband became a sot, and when drunk, sought and obtained intercourse with his wife. An idiotic child was the result. Sexual Abuse. — A man and woman, both healthy at marriage, afterwards, by abuse of their sexual nature, became debilitated and diseased. They had five births; the first, an abortion produced by sexual abuse during pregnancy. The living children were all diseased at birth, and died young of scrofula and consumption. Solitary Sexual Abuse. — Unfortunate is the woman and her children, who marries a man addicted to this vice. If he was unable to control his passion before marriage, he will not do it afterwards. Before, he only ruined himself: now, he implicates also a wife, and brings into the world a weak and suffering progeny. A young man, by self-abuse from childhood, wore out his vital powers of body and mind at the age of twenty-one. His memory left him ; he became incapable of studying, and lost all relish for society and the world. In accordance with the advice of friends, he married. The result was an idiotic, imbecile child. The father paid the penalty of his outraged nature by a short, miserable life by dying early with consumption. A young girl at school early acquired the habit of solitary abuse. Her spiritual life left her; her digestion became impaired, and the period of puberty was not announced by the usual developments of the breasts, etc. Still she was tormented with an insatiable 426 HEREDITARY TRANSMISSIONS. sensuality, which could not be appeased. She married, but, receiv« ing little pleasure from the usual marital relation, resorted yet to artificial abuse as a means to appease her unnatural desires, until complete exhaustion, insanity, and death, terminated her useless life. There was no conception in her case. Sexual Abuse During Pregnancy. — A man and his wife, when married, possessed vigorous constitutions. The husband gave himself up to an unnatural passion, and insisted upon con- nection with his wife very frequently during pregnancy. He often forced her to yield, regardless of her tears and entreaties to spare her for her child's sake. The child was born, but lived only a few weeks. There was another conception, followed, in this instance, by an abortion produced by the husband's insisting on his legal right. Within a week after this event, he still insisted upon sexual intercourse with his wife. The man and wife both afterwards died of consumption; he, the victim of passion, and she, the victim of his lust, under the sanction of law and religion in a civilized (?) country ! Effects of Abortion. — A young lady, in an unguarded mo- ment, yielded to the embraces of her lover, and conception followed. Instead of their marrying, she thought to avoid dishonor by pro- curing abortion. This was successfully accomplished by an abortion doctor, though not without great injury to the health of the lady She afterwards married the same lover. Several conceptions were followed by miscarriage as often, at the same period as the first one was produced, until the lady finally succumbed to debility, and died. In another case, a married lady, who had successfully given birth to four children, destroyed the fifth conception. This she again repeated, destroying the sixth. She then conceived again, but could not succeed this time in procuring abortion. The child was born fearfully diseased, and lived but four months. Shortly after, the mother died also, the victim of self-abuse and violence. Mental Conditions During Pregnancy. — Medical books abound in facts showing that the physiological as well as the psy- HEREDITARY TRANSMISSIONS. 427 etiological conditions of the mother during pregnancy, may and do affect the child, producing deformities, such as marks on the skin, absence of a limb, etc. To avoid such dangers, women should be educated to habits of calmness and presence of mind under sudden emotions and in the presence of exciting scenes and deformed objects. The development and happiness for life of her unborn babe may depend upon her calmness and self-possession. Anxiety, terror, or emotion, prolonged for some time, is likely to prove more injurious than a sudden impression. Effects of Lactation. — It is fully established, that nursing infants are affected by the physical and mental condition of the mother during lactation, and often exposed to suffering, and even death, by some great terror or emotion of the parent. No secretion so evidently exhibits the influence of the emotions of the mind as that of the breasts; which is, doubtless, owing partly to the fact of the delicate digestive system of the infant. Alcoholic Spirits, as well as strong tea and coffee immod- erately used during nursing, have been known to cause great rest- lessness and suffering in the child, and are thought to impress permanent excitability and derangement upon its nervous system. Effect of Anger and Terror. — Children have frequently been thrown into convulsions, after having been nursed by mothers while excited by an ungovernable anger. A child in the most per- fect health has been known to die upon its maternal bosom while being nursed, after the mother's experiencing great fear and terror. Also, an infant has been known to die in a convulsion, in conse- quence of being nursed by a mother after hearing of the death of a dear friend. Tranquillity Required. — The secretion of milk proceeds best in a tranquil state of mind and cheerful temper; then it is abundant, and agrees well with the child. A fretful temper lessens the quantity of milk, and causes it to produce fever and griping in the child. Anger has a similar, though still greater effect. Grief 428 HEREDITARY TRANSMISSIONS. anxiety of mind, as well as fear and terror, — all, as before remarked, have a powerful influence. Substitutes. — Taking in view all these circumstances, infants often should not be nursed at all by their mothers, but by another woman of placid temper; or, other aid may be necessary for the nourishment of the child. This is also often necessary in conse- quence of ill-health or diseased conditions in the mother. We should also remark, that those passions which are generally sources of pleasure, when carried to excess, alter and even entirely check the secretion of the mammae, or breasts. Also, a diet dis- agreeing with the mother is known to disagree with the child. Important Facts. — Let all deeply ponder upon the foregoing facts. It is certain that the conditions of the parents, particularly those of the mother before and during gestation and lactation, have a lasting effect upon the welfare and happiness of their children, as well as themselves and their homes, forever. Let the mother, then, be guarded from all unnatural excitements and unhappy emotions Let her condition be one of sweet serenity, and holy love and reverence for the new life which is being developed within her own. The True Physician. — Disease is an effect, not a cause; an evil to be prevented. Physicians are designed to minister also to the spiritual principle. They should be clergymen, or clergymen should be physicians. Their pursuits should be essentially prophy- lactic. They must banish consumption, scrofula, erysipelas, rheu- matism, contagious diseases, and every species of individual afflic- tion, by commencing at their foundation. They must ascend the pulpit, and teach the inhabitants of the earth concerning hereditary impressions ; explain how parents influence their children while in the embryotic state ; explain how the human mind and body are under the control of surrounding circumstances ; how the entire individual can be manufactured perfect or imperfect; how the spir- itual principle acts upon the organization. They must teach the philosophies of anatomy, of physiology, of chemistry, of median- HEREDITARY TRANSMISSIONS. 429 isin, of electricity, of magnetism, and of psychology. If clergy- men will not teach these fundamental truths of nature, and of true religion : if they combine their intellectual and pecuniary powers against the promulgation of these principles on the Sabbath ; if they clamor about desecrating the holy institutions of antiquity, — then congregations must arise in their strength and demand the true physician. The true physician places his band upon moral as well as upon physical disease. He cures the maladies of future generations by closing the floodgates of individual excesses ; he manufactures good and healthy organizations by improving and perfecting the indi- viduals by whom future generations are developed. This is the mission of the true physician. — A. J. Davis. 19* DIETETIC PREPARATIONS AND ADDITIONAL FORMS OF PRESCRIPTIONS. Barley water. — Wash clean some pearl barley, and to two ounces of barley add one quart of water. Add a few raisins, or some lemon peel aad sugar, and boil slowly till reduced one half. Then strain and sweeten. As nourishment in inflammatory diseases- Rice water. — Wash well two ounces of rice, and add two quarts of water. Boil for an hour and a half, and then add sugar and nutmeg to liking. This, mixed with milk, forms an excellent diet for children. Vegetable soup. — Take one potato, one turnip, and one onion, with a little celery. Shce, and boil in one quart of water for an hour ; add as much salt as is agreeable, and pour the whole upon a piece of dry toast. To be used when animal food would be improper. Panada. — This may be made by boiling some slices of soft bread for five minutes in a quart of water ; then beat the bread smooth and mix with it a little of the water, a bit of fresh butter, and sugar and nutmeg, according to circumstances. Or, it may be made by grating some bread or pounding a few crackers; then pour on boiling water, beat it well, and add sugar and nutmeg or cinnamon. Indian gruel. — Pat three large table-spoonsful of Indian meal, sifted, in a quart of water; wash with several waters, turning them off as the meal settles ; boil for twenty minutes, stirring all the while : then add a little salt. It may be strained, sweetened, a little butter added, wine or nutmeg, according to circumstances. Oat meal, and other kinds of giuel may be prepared in the same manner. Mutton, chicken, veal and beef broth. — To one pound of either of these, lean, allow one quart of water; add a little salt, parsley, or an onion, and put in large pieces of the crust of bread. Boil slowly, and skim for two or three hours* Barley, rice, etc., may be added, if expe- dient. Broth may be made more speedily by slicing and pounding tlifl meat ; it is, also, made more palatable by first broilivg it. Beef and chicken tea. — Cut into shreds one pound of lean beef, or take quaner of a chicken with all the fat striped off and bones broken ; 431 432 ADDITIONAL FORMS OF PRESCRIPTIONS. boil for twenty minutes, skimming, and add a little salt. The former is very nourishing. Tapioca, arrowroot and sago, are prepared by washing thoroughly, and then boiling sufficiently; then a little wine, nutmeg, or milk maybe added according to the fancy and circumstances. Wine whey. — To a pint of milk, while boiling, add a large wine-glass of Sherry or Maderia wine ; after it again boils, remove it from the fiie and let stand a few minutes. Then remove the curd, pour the whey into a bowl, and sweeten it. Calves" feet jelly. — Totwo calves' feet add one gallon of water, and reduce bT boiling to a quart; strain, and >vhen cold, skim. Add the whites of six or eight eggs well beaten, a pint of wine, half a pound of loaf sugai , and the juice of four lemons — all to be well mixed. Now, boil thev hole for a few minutes, stirring constantly, and strain through flannel. The wine, when objectionable, should be omitted. Tapio* a, sago, and rice jelly. — These are made by taking a proper quantity >f any one of them, washing and soaking in water sufficiently; then boil gently till they form a glutinous mass, and add lemon juice and peel, wine, sugar, and cinnamon ; or, season according to fancy. Arrow root and bread jelly are made in much the same manner ADDITIONAL FORMS OF PRESCRIPTIONS. PURGING ENEMA. Soft Soap one ounce, 0.1 re Oil one ounce, Colocynth two scruples, EpsomSalts half do Water ■ one P int * g uo - ar 9 one ad twelve grains, Mix. Tonic. One or two table- Pulv. Opium one do Spoonsful to be taken two or three Gum Arabic and Syrup, of each a times a day. A piece of iron wire sufficient quantity to make six should be kept in the phial. <* */7Ta %£ ^ ♦t't^ a g^ ■* ° ^ %.o< :^mja- ^c$ ^$ ^o^ / °- V v 1 -. .-OX V ^ ^0* * • CI V -\"^ ° A* »^ S ^° „ <* *-<7YA ^ G <- */?Ta A&* ft s \v & Q^- ^ \nt ^ ^ ^iV'JV'"' 1 n>*V •». V' 7V ^ %■ ^ - ^ iK ^ <3* *W CT * "^d* 7^ C -. ^^ ^o^ ^ ^ ^

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