Copyright N?._ IGjfLf s book for the is that of our ^plying :ct and to add rescrip- terially ,s now 's Mit- forms, tly the results > is sold COPYRIGHT DEPOSIT. prepaid, or six packages or boxes tor $5.00, postage prepaid. Full instructions for preparing and using the Mitchella Compound accompany each package or box. Caution: — Do not allow anyone to sell you anything that is said to be just as good as Dr. J. H. Dye's Mitchella Compound, for we can assure you that there is nothing else that can take its place, no matter if the original com- bination is imitated. The Mitchella Compound must be carefully and scientifically prepared according to methods known to us alone. The materials must be fresh, not more than six months or at the most a year old. The herbs and plants that we use are gathered each year, and the old stock is destroyed as worthless. We have received thousands of testimonials from those who have derived almost miraculous benefit from the use of Dr. J. H. Dye's Mitchella Compound and the instructions given in these pages. Very respectfully, DR. J. H. DYE MEDICAL INSTITUTE. Buffalo, N. Y. ILLUSTRATED EDITION OF PAINLESS CHILDBIRTH OR Healthy Mothers AND Healthy Children A BOOK FOR ALL WOMEN BY JOHN H. DYE, M. D. BUFFALO, N. Y. NINETEENTH EDITION Revised and Enlarged by Members of the Staff of the Dr. J. H. Dye Medical Institute Buffalo, N. Y. Copyrighted, 1912, by Dr. J. H. DYE MEDICAL INSTITUTE SEP 171914 A- JO, try it that pain in childbirth is unnecessary. CHAPTER IV CAUSES OF PAIN The causes of pain at childbirth are various and may depend upon the condition of the mother or upon the condition of the child. These causes may be either remote or proximate, direct or indirect. In some cases the causes will have ceased long ago, but their effects will remain. Unhygienic customs beget morbid conditions and thus render natural processes painful. Any cause that can retard or oppose delivery and protract labor in- creases the suffering of the mother and, if continued beyond a certain point, endangers the life of both mother and child. Childbirth to be proper and painless requires that the shape of the mother be perfect; every organ must be developed and the pelvic bones be anatomically correct in shape. No deformity is admissible. The distance from the junction of the pubic bones to the sacrum must be sufficient to permit the passage of the child without too great a degree of pressure. There must not be any unnatural obstructions. The abdom- inal, pelvic and uterine muscles must possess sufficient power that they may complete the process without 40 PAINLESS CHILDBIRTH undue delay when expulsive efforts begin. The nervous system must be quiet and the mind must be at ease. Every tissue must be healthy; no morbid conditions present. Then the child must not be de- formed, too large, nor its bones too much ossified. Secure these conditions and labor will be materially shortened in duration and the suffering reduced to a minimum. Modern social customs impose upon woman arti- ficial modes of life that impair her constitutional vigor, deform her body, pervert her functions, render her an easy prey to uterine diseases and to prolonged and painful childbirth. These customs are indirect or re- mote causes of pain, because they create conditions of life which, in their turn, render pain unavoidable. The uncivilized mother uninfluenced by fashion, with the abdominal and pelvic muscles well developed by the exercises to which her life subjects her, her hips broad and deep to support the burdens she must often carry, her nervous system not rendered acutely sensi- tive by debility or disease almost entirely escapes the pains and perils of childbirth to which the society woman falls a victim. Bring the matter nearer home, and let us compare the slavery of the two classes — the one woman a slave to fashion and society, the other a slave to physical necessity. The first, malformed by dress, the muscles undeveloped and the sensory nerves made intensely sensitive by disease and her manner of life, suffers long and severely at such times, while the other, well formed by nature, developed by the exercises her position in life necessitates, with no irritable or inflamed nerves to annoy her, pays no attention to it further than the CAUSES OF PAIN 41 inconvenience occasioned by a few days' absence from work and the additional tax upon her resources for the maintenance of her child. Again, during pregnancy and probably for some weeks after delivery, the suffer- ing of the fashionable woman has been continuous, while the other has scarcely noticed her condition. There is a noticeable difference in the degree of the anterior curvature of the spinal column at its lumbar portion, between the lower ribs and the hips, in the two classes of women — the society lady's back bending inward or forward considerably the most, so that the power of the vertebral pile to support weight from above downward with ease is diminished on account of the greater angle, giving rise to the sensation of " backache as if it would break in two." This is one of the results of tight-lacing and insuffi- cient physical culture, and to anyone who will consider physical laws its influence in producing female diseases, in prolonging labor and increasing its pain must be obvious. This increased curvature throws the abdo- men forward beyond the direct line of the body and, in childbirth, much of the abdominal muscular effort, particularly of the diaphragm, is lost, because it is expended in the direction of a line with the pubic bones instead of the cavity behind them, the pubic bones opposing a force that no muscular effort can overcome, even were such a result desirable. In such cases the labor is protracted on account of the improper direction of the muscular force which is often feeble on account of the customary inactivity of the muscles preventing their natural development. The woman who in her daily labors is compelled to perform such exercises as develop all her muscles, 42 PAINLESS CHILDBIRTH particularly the erector muscles of the spine, to sup- port the heavy weight she is often obliged to carry, by developing a natural condition prevents the extra curvature the other sustains, so that when labor comes upon her the abdominal muscles acting in harmony Figure 1 Position of organs in women with natural waist. Position of organs in women with waist deformed by tight lacing. with the efforts of the uterus, effect an easy and quick birth, because no force nor effort is lost by being directed in a line deviating from the direction the child must take to make its exit. Another way in which tight-lacing becomes a cause of painful childbirth is by confining the movements of the diaphragm so as to enfeeble it; at the same time CAUSES OF PAIN 43 the abdominal viscera are compressed into a space too small for the healthy performance of their functions, and being prevented from escaping upward naturally gravitate downward and by their pressure displace the organs of the lower abdomen into the pelvis. The circulation is thus rendered defective, and the vitality of the pelvic organs being impaired they become con- gested, sore, tender, irritable, painful, diseased — a condition of things that necessarily causes pain at childbirth. Deformities of the bony structures of the pelvis necessarily increase suffering and imperil the lives of both mother and child in a direct ratio with the degree of deformity. In such cases child-bearing should not be attempted, for when the deformity is so great that instrumental delivery is impossible but one of two alter- natives remain: Embryotomy or Csesarean section — the first of which sacrifices the child, and the second is pretty certain to sacrifice the mother. Tumors within the pelvis retard and endanger de- livery according to their situation, size and structure, and if they involve or press upon nerve filaments they occasion very great agony. Their removal must be effected before delivery. Inflammatory diseases of the womb necessarily in- crease the suffering. This organ is profusely supplied with nerves which are involved in the inflammatory process, and thus become acutely sensitive, as every woman who has been affected by it can testify. It is so sore and tender that the slightest touch is pain- ful, much less the severe efforts of parturition. In- flammation also gives rise to another source of pain, a change in the structure of the tissue inflamed by which 44 PAINLESS CHILDBIRTH its elasticity is greatly diminished. Occurring in the neck of the womb it is easy to see how this may cause pain by interfering with the dilation of the mouth of the womb — a condition that must take place before the birth can occur. In its natural state the circular muscular fibres that exist here are capable of great distention, but when rendered inelastic by the products of inflammation the dilation is intensely painful and may rupture the fibres. The employment of caustics and incisions in the neck of the womb for the cure of disease or removal of strictures is apt to be followed by cicatrices which, being inelastic, are liable to unequal dilation and an increase of pain. Necessary as these practices may be they are certainly open to this objection, high authori- ties to the contrary notwithstanding. Anyone having a scar or cicatrix on their person knows that it will not stretch like other tissues and is often very sensi- tive. Some writers have labored hard to prove that the tissues of the uterus were not subject to the same laws as tissues in other parts of the body and, conse- quentty, the results of inflammation, caustics and inci- sions would not affect the womb unfavorably, but it is certainly presuming very much upon the healing power of nature, to say the least. Any cause that can render any part of the generative apparatus sore, sensitive and tender, whether inflam- mation, ulceration, swellings, common leucorrhoea, diseases of the bladder, piles and, in fact, anything that impairs the integrity of any tissue, whether of the generative organs themselves or adjacent struc- tures, necessarily increases the suffering at the time of birth. Undue dryness of the passages may also be Figure 2 The Muscular System 1 and 2, muscles of upper part and side of head; 3, muscles of the eye; 4, muscles si the mouth; 5, muscles of the side of the face; 6, muscles of the side of the neck; S, muscles of the breast; 9, muscles of the shoulder; 10 and 11, muscles of the upper arm; 12-19 muscles of the forearm; 17, avicular ligament of wrist; 18, 19, 20, mus- cles forming front and sides of abdomen; 21, hip muscles; 22, 23, 24, muscles of ront and outer side of thigh; 28, 29, 30, muscles of inner side of thigh; 25, 26, mus- ses of outer side of leg; 31, 32, muscles of inner side of leg; 27, bandlike ligament )f ankle. 46 PAINLESS CHILDBIRTH considered a cause, and can usually be overcome by artificial means. Any emollient or unirritating oily substance applied freely will answer. Anything that increases morbid irritability increases the suffering, which may be rendered intensely acute even though not the slightest change of structure be visible. This increased sensibility is probably due to some change in the nerves themselves which, in the present state of pathology, we are not able to appre- ciate. One thing, however, is certain; that morbid irritability is a concomitant of exhaustion, and if the nervous system has been debilitated and irritated by masturbation or sexual excesses an increase of suffer- ing will be pretty likely to occur. Rigidity of the perineal muscles is apt to cause pain in the latter stages of the labor. Sometimes the rigid- ity is so great that the perineum will rupture instead of relax, for the prevention of which slight superficial incisions have been recommended. In this condition, anaesthetics are beneficial and so are relaxants, if the management previous to this time has not been proper or effectual. (See subsequent chapters.) From the time when labor begins until it terminates there is usually more or less continuous suffering of variable intensity, so that speedy delivery is desirable as a means of ending the suffering. The labor, however, should not be so short as to occasion the dangers al- luded to in a previous chapter. The condition of the child as a cause of pain remains to be considered and is of the very greatest importance, because we have it in our power to control the condi- tion of which we are about to speak without danger or detriment to the child or mother. CAUSES OF PAIN 47 The average weight of the newly-born child is said to be seven pounds — some are considerably smaller, others much larger. I have seen children live and thrive that did not exceed five pounds, and I have been present at several confinements when the child's weight ex- ceeded ten pounds, and one instance when the child weighed fifteen pounds. Births are said to have oc- curred when the child has weighed eighteen pounds, but such instances are exceedingly rare and must cer- tainly be difficult and painful. The reasons are obvious. Beyond a certain size, as the weight of t the child increases under ordinary circumstances, the pain and difficulty of the labor increases. Dropsy of the head increases the trouble. Wherever the head will pass, if there is no deformity, the rest of the body will pass, the passage of the foetal head always being the most difficult and painful part of the entire process of partu- rition. The larger the child, of course, the larger the head will naturally be, so that it is a proper consid- eration to inquire how we may, with safety to both mother and child, control the growth of the child in utero, and we introduce the subject here because it has a direct bearing upon the suffering of the mother. It requires no argument to convince anyone that while a small child may be born with little or no difficulty or pain, the same mother may find it absolutely im- possible to give birth to a large child — to a child with a large head or a deformed child. We now come to consider the bony development of the child as a cause of pain and difficulty at child- birth. It is often a subject of remark that the formation of bone in the skulls of some infants at birth is not Figure 8 The Skeleton and Outline of the Body 1, skull; 2, lower jaw; 3, vertebrae of neck; 4, collar bone (clavicle); 5, shoulder joint; 6, breast bone (sternum); 8, humerus or bone of upper arm; 9, ribs; 12, spinal column; 13, the radius or large bone of forearm; 14, the ulna or small bone of forearm; 15, the hip bone; 16, lower part of spinal column; 17, hip joint with its ligaments; 18, the femur or thigh bone; 19, the knee cap or patella; 20 and 21, the knee joints with their ligaments; 22 and 24, fibula, or small bone of leg; 23, tibia, or large bone of leg; 25, 26 and 27, ligaments of ankle and feet. CAUSES OF PAIN 49 nearly as far advanced as in others, and yet such chil- dren thrive equally well. At birth the bones of the cranium have not been united by the ossific process, but admit of considerable mobility, so that by pressure the shape of the head may be materially changed, temporarily, without injury. Applying these observations to the transit of the child through the maternal passages, and we speedily arrive at the conclusion that the softer, more spongy, cartila- ginous these bones are at birth the more compressible the head will be and the more readily it will adapt itseif to the passage, changing according to the neces- sity, while if the process of ossification — bony develop- ment — is well advanced, such adaptability cannot take place, the labor will be more difficult, greater pressure will be necessary and more pain experienced. Everybody is well aware that a soft body or sub- stance the same size as a hard one will readily pass through an opening or tube through which the hard body cannot pass at all or only with great difficulty. In the early stage of development, bones are soft and flexible, being composed of animal matter (gristle) but gradually become hard by the deposits of calca- reous matter (lime) within their structure. All bones do not undergo this hardening process simultaneously, but it is completed in different bones at different periods of life. There seems to be no good reason why the,bony system should have progressed beyond the cartila- ginous stage of development at birth, for there is plenty of time after this event for osseous development before any very great necessity for the presence of bone will be experienced by the child. 50 PAINLESS CHILDBIRTH It is a well-established fact in physiology and thera- peutics that when bony development is tardy and the bones are incapable of supporting the weight of the body, protecting its cavities or preserving its symme- try, even when the process of teething is delayed, the administration of some of the preparations of lime as a medicine or the selection of a diet containing consid- erable lime is productive of good results. The lime administered artificially as medicine or naturally as a food supplies the deficient constructive element, and the development of bones goes on to completion. This being the case the questions naturally arise: If we can increase the supply of bone-producing material when deficient, can we not diminish it if excessive? If we can hasten development, can we not retard it? If we can retard it after birth, can we not before birth? If we can retard ossification before birth, then why can we not absolutely control the condition of the child's head and keep the bones sufficiently flexible to admit of easy delivery? All these queries can be answered in the affirmative. Experiment has proven that such results are not only possible, but that they are safe and practicable. Nervous excitement may be a cause of pain. It is well known that some persons suffer far more from the same cause than others, and it is reasonable to suppose that the more nervous the woman is during gestation and delivery the more intensely she will suffer. It is those who lead artificial lives or chose whose consti- tutions have been shattered by disease that are troubled with " nervousness" and, if no precautions are taken, CAUSES OF PAIN 51 it is reasonable to expect that such persons will suffer most at childbirth. Having briefly considered the most important causes of pain, in the subsequent chapters we shall endeavor to instruct the reader how to render these causes in- operative and to remove the parturient female from their influence. CHAPTER V CONCEPTION AND PREGNANCY The union of the male generative element — the spermatozoid— with the matured female ovum or egg is known as conception, fecundation, fertilization, im- pregnation. In the ovum as soon as fertilization occurs there begins a series of wonderful changes that result in the formation of a new being — the baby; every organ and tissue of the expectant mother is also grad- ually prepared for the new duty of reproduction. The limits of our book will not allow a minute description of these changes and we must, therefore, content our- selves with a brief consideration of the most important ones. They will be most easily understood if taken up in the following order: 1. The ovum (embryo, foetus). 2. Local changes — uterus, breasts, abdomen. 3. General changes — heart, blood, lungs, urine, stomach, weight, skin, nerves. Changes in the Ovum: First Month. — Starting as a tiny, gelatinous mass that can hardly be seen with the naked eye, the ovum at the end of the first month is about the size of a pigeon's egg. (Fig. 3) CONCEPTION AND PREGNANCY 53 Second Month. — The ovum is as large as a hen's egg, and the embryo or foetus about 1% inches long. The eyes look like small black specks on the side of the head, and the limbs like little buds projecting from the hodcy. Figure 4 Semi-diagrammatic section of gravid uterus, showing con- tained ovum of about five weeks. 1, muscular wall of womb ; 2, cavity of womb; 3, wall of womb; 4, cavity of womb; 5, neck of womb. Third Month. — The ovum is about the size of a goose egg, the foetus 3 to 3^ inches long. The placenta has formed and the cord is about 3 inches long. Fourth Month. — Length 5 to 6 inches; weight 4 to 6 ounces. Hair appears on the scalp and scale- like nails on the fingers and toes. The sex can be Figure 5 Early human embryos, all enlarged about two and one half times. 1-4 from twelfth to fifteenth day; 5, 6, from eighteenth to twenty-first day; 7, 8, from twenty-third to twenty-fifth day; 9-12, from twenty-seventh to thirtieth day; 13-17, from thirty-first to thirty-fourth day; am, amnion; uv, umbilical or vitelline vesicle; afo, allantoic or abdominal stalk; c c, brain vesicles; h, heart; va, visceral arches; o, optic vesicle; ot, optic vesicle; ol, olfactory pit; I, I, upper and lower extremities; s, somites; cd, caudal process; u, primitive umbilical cord. CONCEPTION AND PREGNANCY 55 distinguished by the middle of the fourth month. The muscles have sufficiently developed to cause slight movements of the limbs (foetal movements, quickening) . Fifth Month. — Length about 10 inches; weight 10 ounces. The whole body is covered with fine, soft hair (lanugo) and the skin coated with a greasy substance known as vernix caseosa. A child born at the end of the fifth month may breathe and cry and move its limbs, but usually dies in a few hours. Sixth Month. — Length 12 inches; weight 1 pound. Eyelashes and eyebrows have started to form; skin is very wrinkled. If born at the end of the sixth month the child may live for a few days, but usually dies within a very short time. Seventh Month. — Length 15 inches; weight 3 to 4 pounds. This is known as the viable age, because it is generally held that a child born before this time cannot survive. But with the aid of the incubator and scientific artificial feeding we are now able to save the lives of many babies born even earlier than this. Eighth Month. — Length 16 inches; weight 4 to 5 pounds. An eighth-month baby is usually weaker, less active and more drowsy than a full-term child and, therefore, requires greater care and attention. Ninth Month. — The full-term baby weighs on the average from 6 to 7 pounds and measures about 20 inches in length. The body is plump, the hair on the scalp 1 to 2 inches long, the eyes usually of a dark steel gray color, the finger nails' extend beyond the finger tips. Very soon after its entrance 56 PAINLESS CHILDBIRTH into the world the child, by loud and lusty cries and active movements of the limbs, announces its arrival and shows that it is very much alive. ATTITUDE OR POSITION OF CHILD IN THE WOMB During its life in the womb the child lies head down- ward (Fig. 4), the body curved, the chin bent upon the breast, the forearms crossed in front of the chest, the legs flexed on the thighs and the thighs drawn up on the abdomen. In the space thus formed between Figure 6 Semi-diagrammatic section of uterus, showing relations of fcetal and maternal placenta. 1, muscular wall of womb; 2, placenta (afterbirth); 3, cord; 4, bag of waters; 5, neck of womb. the legs and arms the cord containing the bloodvessels that carry food and life-giving blood to the develop- ing child is placed so that it may be out of harm's way and not pressed upon or otherwise injured. CONCEPTION AND PREGNANCY 57 Boy babies are as a rule heavier and longer than girls. Ten-pound babies are uncommon and twelve- pounders rare, notwithstanding many reports to the contrary. It is, however, recorded that Mrs. Captain Bates, a Nova Scotian giantess, gave birth to a child (still-born) that weighed 23% pounds. A mother's first child usually weighs less than those she bears subsequently. Mothers between 30 and 35 years of age have the heaviest children — young mothers the smallest and lightest. LOCAL CHANGES a. The Uterus. From a small, pear-shaped organ about 23^ inches long and one ounce in weight the uterus or womb at the end of pregnancy has grown to be a big, muscular sac, 12 to 15 inches long and weighing about 2 pounds. Every element that goes to make up the structure of the womb takes part in this growth. The bloodvessels, nerves, lymphatics and mucus membranes become bigger and larger, and the muscular fibres are so in- creased in both size and number that at the time of childbirth the womb has become such a strong, powerful organ that it is able by the contractions of its muscles to expel both child and afterbirth easily and gently, just as nature intended. b. The Breasts. During pregnancy the breasts are prepared by Mother Nature for the very important duty they must perform after the baby comes into the world. A feeling of uneasiness or fullness of the breasts, with a little tenderness of the nipples is experienced by some women almost at the very start of pregnancy. The breasts begin to enlarge in the second month and grow steadily 58 PAINLESS CHILDBIRTH '■'*%-. :■; Figure 7 until the end of gestation. The nipples, unless flattened as a result of tight corsets or other pressure, become larger and more prominent and often covered with small, branny scales. The areola or pigmented ring around the nipple becomes darker in color, the shade or tint varying according to the woman's complexion from a light brown in blondes to a deep black in bru- nettes. The areola also becomes moist and slightly raised and on its surface are seen from ten to twenty glands — the glands of Montgomery — that look like little seeds under the skin. In some women at about the fifth month there appears on the edge of the areola a row of round spots lighter in color than the surround- ing skin; this is called the secondary areola. As the breasts become fuller and larger, reddish, bluish or whitish lines form in the skin — these are the lineae abicantes or striae and are exactly similar to those CONCEPTION AND PREGNANCY 59 found on the abdomen of pregnant women. The blue veins can be easily seen coursing through the skin, and when they are big and tortuous are declared by many to prophesy an abundant supply of milk. In the last few weeks of pregnancy the breasts often droop a little, so as to be better adapted for suckling. In many cases even as early as the third month it is possible to press or squeeze from the breasts a little mucoid fluid known as colostrum. The presence of this fluid in the breasts is often a very valuable sign in the diagnosis of pregnancy. c. The Abdomen, Pelvic Cartilages and Navel. In the later weeks of pregnancy, reddish or bluish streaks — striae gravidarum — are found in the skin of the abdomen. They are due simply to stretching of the skin and may also result from tumors, dropsy and other causes. They last for quite a while after preg- nancy, but gradually become whiter and look like scars. d. The Cartilages between the bones of the pelvis become thicker and softer to allow them to spread and expand at the time of delivery. The navel at the end of pregnancy is prominent and elevated. GENERAL CHANGES Though pregnancy is a normal physiological process, almost every organ and tissue of the woman's body undergoes changes, because she must now provide nutriment, breathe, excrete and secrete not only for herself but also for her unborn babe. a. The heart becomes slightly enlarged and the pulse more rapid. More blood is formed and it coagu- lates or clots more readily — a wise precaution of nature to prevent unnecessary hemorrhage at confinement. 60 PAINLESS CHILDBIRTH 6. The shortness of breath so distressing to many pregnant women is caused by the enlarged and growing uterus preventing full expansion of the lungs. In the last two or three weeks the child settles — lightening — and breathing becomes freer and easier. c. A greater quantity of urine is passed and it often contains traces of sugar or albumen. During pregnancy the urine should be frequently examined chemically and microscopically by a physician. d. To sustain her own strength and to provide nutriment for the developing child the pregnant woman requires more and better food than at other times. In the early part the appetite may be capricious and the stomach irritable, but later on as a rule both appetite and digestion become better and the general condition greatly improved. e. Notwithstanding the nausea and vomiting there is usually a gain of about ten pounds in weight during pregnancy. /. The darkening of the areolae of the breasts during pregnancy has been described on page 58. Simi- lar pigmentations, usually most marked in dark-haired women, are found in many other parts of the body — the face, abdomen, armpits, navel. Dark rings under the eyes are common and the face is often marked with patches or blotches of pigment of all sizes and shapes; these are -popularly known as moth patches or liver spots and technically as chloasma. Occasionally the greater part of the face becomes discolored — the so- called mask of pregnancy. The discolorations of the skin usually fade after confinement, but do not always entirely disappear. CONCEPTION AND PREGNANCY 61 g. The whole nervous system of the pregnant woman is in a state of tension and the nerves are more sensi- tive and excitable. No two women feel the same whilst carrying a child, and we meet with every grade from the deepest depression to the highest exhilaration. Some women say that they feel better, healthier and happier during pregnancy than at any other time. In others, however, the whole character is changed, so that a woman of a bright, kind and lovable disposition becomes irritable, fretful, peevish, jealous and even despondent. Neuralgia, especially of the face and teeth, fainting spells, dizziness and hysterical outbreaks are quite common, but should not cause unnecessary worry, as they usually are purely functional in character and disappear quickly after confinement. FALSE OR SPURIOUS PREGNANCY This is a peculiar condition that occasionally occurs in nervous, hysterical women about the time of the change of life, and in single women who have been ex- posed to possible conception. Such cases at times are very deceiving, because many of the ordinary symptoms of pregnancy may be present. Menstruation may cease, the abdomen enlarge, sensations like foetal move- ments be felt, the breasts enlarge and milk form in them, vomiting and morning sickness may occur. In addition to that, such a woman at the end of what she has believed to be pregnancy may have all the symp- toms of labor itself — but no child. To remove all doubt and satisfactorily clear up such a case the physi- cian must carefully study and consider the objective symptoms and not rely upon statements made by the woman herself or by others. 62 PAINLESS CHILDBIRTH HOW TO FORETELL THE DATE OF CONFINEMENT Every pregnant woman is naturally anxious to learn just when to expect her baby. To aid her in making such calculation several methods have been devised by means of which she can with a fair degree of accuracy foretell the date of her coming confinement. We will describe three methods: 1. Put down the date of the first day of the last menstruation. From this date count nine months for- ward or, what is the same thing, three months back- ward, and add seven days to the date thus obtained. For example, suppose the last menstrual period came on January 5th. By counting nine months ahead or three months back you get October 5th. Now add seven days and you have October 12th as the probable date of confinement. 2. Quickening usually occurs at four to four and a half months. If then you count forward four and a half or five months from the date on which quickening or life was first felt you have approximately determined the time of the coming confinement. Quickening does not appear at the same fixed time in all women, and on that account this method is not always satisfactory. It is of special use in calculating the date in those cases where conception has occurred in nursing women, because in them menstruation is normally suspended and cannot, therefore, be used as a basis for calculation. 3. The table given on page 63 is a simple and con- venient method. CONCEPTION AND PREGNANCY 63 CO < ©H co ©CO cm 00 CO O© CO ©10 CM OQH CM nco CM ©CM CM l«H CM O© CO ©iO CM O0H cm n-co cm ©CM CM LOi-I CM ©N CO ©© CM CM CM ©ro CM OCM CM H_< CM CO o© CO ©iO CM 00H CM n.co CM ©IN CM IOtH CM o© CO ©io CM 00H CM t>CO CM ©CM CM CM CO o© CO ©iO CM OQH CM n-co CM ©CM CM lOi-C CM SCO T3 -u>© 290 < z a Ok .2 © 2 St 9 ^ © — •— I r- Q CO© HCM CM© i-iOO ©t- ©© 00 iO t>H ©CO lOCM H^, co© H CM© 00 ^ '-'CM i-H CM ©CO i-H CM *OCM HCM H_< i-HCM coo i-i CM CMC! hqo on ©© 00 iC Nrf ©CO *OCM H^ co© CM© HQ0 co oo MN HO ©iO ©H 00 CO t>CM ©H o© 1—1 HO 'cOOO CMI> HO COOO (NN ^o ©iO ©H 00 CO l>CM CDh iC© HO COOO CMN- HO ©co -•CM 00 CM HCM «CM )o •* CM iO© TfOO CO|> CMO Hi© ©H ©co 00 CM I>H o© »o© HQ0 CON- CM© ©o HCM 00 iC HCM 1>H HCM SO© HCM CMOS H00 ©N ©o 00 iO t>H ©CO *OCM H,H CO© CM© H00 oo ©iO 00"* l>CO ©CM lOH i-l HO CO© CM 00 *3C ©N ©o 00 iC N-H ©CO *OCM i—i H^ CO© CM© HCO CMO hoc ©i> ©© 00 iO NH ©CO *OCM H- CO© CM© HCO CO© HCM CMO HX ©N- ©© 00 iO N»h ©CO lOCM i—i H_| co© CM© H00 CMO HX ©t> ©© I>h ©CO *OCM H^H coo CM© CO© 1-HlH CM CO HN o© ©iO XH NM ©CM lOH H HO CO© CM CO HN I^O fig 02h- CHAPTER VI SIGNS AND SYMPTOMS OF PREGNANCY There are so very few positive symptoms of preg- nancy in the early months that it is sometimes quite difficult to decide whether a woman is or is not preg- nant — in fact, a positive diagnosis of pregnancy before the second month is almost impossible. The signs and symptoms of pregnancy are: 1. Cessation of menstruation. In a woman previously regular, stoppage of the menses is the first symptom that leads her to suspect that she is pregnant. It is by no means a positive sign of pregnancy, because anaemia, taking cold, exhaus- tion, change of climate may account for the absence of the menses. Menstruation may recur for the first two or three months or regularly or irregularly during pregnancy. Many women become pregnant during lactation, though at such times menstruation is nor- mally absent, and conception has occurred in young girls before the menses appeared and in women who had passed the change of life. 2. Irritability of the bladder. SIGNS AND SYMPTOMS OF PREGNANCY 65 The pressure of the growing womb upon the bladder often causes in the early weeks of pregnancy an almost constant desire to void urine. Many women consider this to be an early and sure sign of pregnancy. It is, however, by no means reliable, since it may result from many causes other than pregnancy. 3. Changes in the breasts and nipples. These have been described on pp. 57-59. 4. Morning sickness, nausea and vomiting of preg- nancy — salivation. This is usually an early symptom of pregnancy, and whilst in most women it is a comparatively mild ail- ment, in others the vomiting may be so severe and persistent as to seriously affect the health. It often occurs immediately after conception has taken place, but as a rule it first appears about the fifth or sixth week and lasts until the time of quickening (fourth month). Occasionally it continues through the whole pregnant period and in some cases it disappears after the first few weeks, to reappear during the last few w r eeks. It is usually first felt when the head is raised from the pillow or on getting out of bed in the morning, and varies from a slight nausea or the spitting up of a little frothy mucus to actual vomiting (possibly with retching) of sour, bitter fluids or food itself. Sometimes the nausea lasts throughout the day and is often made worse by eating or even seeing or smelling food and by sexual excesses. Nausea or vomiting is apt to be a marked symptom in the first pregnancy of nervous women. Singular as it may seem, well-authenticated cases 66 PAINLESS CHILDBIRTH have occurred in which the husband experienced the morning sickness instead of the wife. In the severe cases of morning sickness there is apt to be an increased amount of saliva (cotton spitting) , even to the extent of constant dribbling from the mouth. Considered alone, morning sickness is just a suspi- cious symptom of pregnancy, but when added to other symptoms the probability of pregnancy existing is greatly increased. 5. Enlargement of the abdomen. In the first two months of pregnancy the abdomen is flatter than usual, because the uterus, now heavier than usual, sinks or settles down in the pelvis. In the fourth month the uterus can be felt as a smooth, round swelling in the lower part of the abdomen. (See Figure 8 . ) At the sixth month the top of the enlarged uterus is on a level with the navel; in the seventh month it is two inches higher; in the ninth month it has reached the edge of the ribs. The enlargement may, of course, be due to a tumor, but when it is possible to palpate the child or detect the foetal movements it becomes a positive sign of pregnancy. 6. Softening of the neck of the womb. This sign can often be detected by a skillful hand about the middle of the second month. An old rule but a good one says: "If the mouth of the womb feels as hard as the tip of the nose the woman is not pregnant, but if as soft as the lips she is pregnant." This is a valuable sign of pregnancy, especially when associated with other symptoms. SIGNS AND SYMPTOMS CF PREGNANCY 67 7. Quickening — Foetal movements. The term " quickening" arose from the erroneous belief that it was not until the child moved that it l! w V«- 9th month hsW\ «- 7th month *- 6th month // / «-5th month r ^- 4th month Figure 8 The size and height of the womb in successive months of pregnancy. The numbers indicate weeks. became quick or alive. Foetal movements or quicken- ing are usually first felt by the mother about the middle 68 PAINLESS CHILDBIRTH of the fourth month, but the exact time varies greatly in different women. But even earlier than this some women have peculiar sensations described as fluttering, creeping or pulsating and called by them " feeling life. " Faintness or other unpleasant nervous symptoms are very liable to occur when the movements are first felt, especially in a young, nervous woman in her first preg- nancy. The force and frequency of the movements vary not only during pregnancy, but also in different women. At times they are so strong and violent as to cause actual suffering to the woman; in others they are absent or so weak and feeble that doubts may arise as to whether the child is living or dead. To the physi- cian foetal movements constitute a valuable and posi- tive sign of pregnancy. 8. Foetal heart sounds. The beats or pulsations of the heart of the baby in the womb can be heard any time after the middle of the fifth month by the trained ear of the skillful physi- cian through an instrument called the stethoscope. It is an absolute and positive sign of pregnancy, and because the heart beats slower in boys than in girls it is by many considered possible by this means to predict the sex of the child before birth. Ballotement, Hegar's sign, Braxton Hick's con- tractions, uterine murmurs, are other positive and absolute signs of pregnancy, but are so scientific and technical that they are quite beyond the scope of our book and hence the mere mention of them must suffice. Symptoms that indicate death of the foetus: When the child or foetus dies while still in the womb the woman's health deteriorates, she suffers from chilly sensations and a heaviness or feeling of weight in the SIGNS AND SYMPTOMS OF PREGNANCY 69 abdomen; she no longer feels life or movements; the womb ceases to grow and the breasts become shrunken, soft and flabby. In addition to those symptoms the physician, even after repeated examinations, cannot hear the foetal heart sounds or recognize any move- ment of the child. Plural births — twins — triplets, etc. : Twins occur once in about eighty-five cases, triplets once in about seventy-five hundred. A few quadruplets are born and there are recorded about a dozen cases of five at a birth. Certain women are more likely to bear twins than others; this tendency may be heredi- tary and at times is almost a family characteristic. The chances of twins are greatest in women who have previously born children, but also strong in the first pregnancy of women who marry late in life. In twin births a boy and a girl is the most frequent combina- tion, next two girls, then two boys. Twins and triplets are usually smaller and weaker than other children, and one may be larger than the others. CHAPTER VII HYGIENIC MANAGEMENT The object of hygiene is to secure the most perfect health possible and prevent sickness. To this end it may be necessary to place certain restrictions upon our customary habits. We say restrictions, because many of the habits we may have developed by artifi- cial modes of life are apt to be inconsistent with per- fect physical development. The special object in introducing the subject here is to secure for the mother the most perfect physical standard and, at the same time, endow her unborn child with a perfect constitution. The pregnant woman should avail herself of every possible means to improve her physical health and avoid every influence that can possibly fret, annoy, distress or in any way injure her. The husband and those who habitually must asso- ciate with her should endeavor to preserve the tran- quility of her mind, remove all sources of anxiety, relieve all annoyances and by every possible means contribute to her vigor, cheerfulness and happiness. Her associations should be of the most cheerful, pleas- ant, graceful and happy character, so as to remove HYGIENIC MANAGEMENT 71 from her mind gloomy forebodings, anxiety, fear and selfishness. She should never be surrounded with any imperfections, nor be annoyed with the contemplation of misery, deformity or unhappiness. She should never be compelled to hear stories of horror which Dame Grundy so much delights to tell. Before important surgical operations are performed, more or less time is generally spent in putting the patient in the most perfect physical condition possible, that the system may be better able to bear the shock of the operation, a change that will result in diminish- ing pain and danger and hasten recovery. If physical perfection is a matter of so much consequence under such circumstances how much more important is it when the welfare of two beings is at stake? If conception occurs while the woman is nursing another child it should be weaned at once, for her physical forces will rarely, if ever, enable her to main- tain both without impairing their vitality and injuring herself. EXERCISE The pregnant woman should not lead a life of indo- lence, nor should she, on the other hand, indulge in prolonged or violent exercise. Much must depend upon the natural vigor she possesses. Owing to the extreme liability of some women to miscarriage they will find it necessary to avoid motion almost entirely. This no doubt proceeds from some local weakness or irritability that is aggravated by motion. Fortunately, such cases are rare, and the best treatment is quiet, with passive motion. This condi- tion frequently disappears after a certain period of gestation has been reached. 72 PAINLESS CHILDBIRTH With this rare exception exercise is always benefi- cial if moderately indulged and is most beneficial when carried on in the open air, but should never, under any circumstances, be so active or long continued as to induce fatigue. Probably walking is the best form of exercise that can be taken, although when the preg- nancy is far advanced it may become so difficult and painful that it may be omitted. When for any reason walking is not advisable, riding in an easy carriage may be substituted. No matter whether she is to walk or ride, care should be taken that it is agreeable and pleasant. There should be some agreeable, animating object in view. The woman must not be made to realize that the walk or ride is a forced routine. The mind as well as the muscles must be diverted, else the exercise becomes monotonous and tiresome — a damage instead of a benefit. The same road or path should not be selected each day; the mind is to be occupied by new attractions; a variation of scenery and circumstances. The exercise should be frequently repeated and not too long continued and should be carried on in the open air in the sunshine. By exercising in the forenoon we get the use of the best physical strength and at a time when every organ is in the best condition to profit by it. It is then that exercise is a pleasure. In the morning, exercise is apt to refresh. In the afternoon it is liable to fatigue. In the forenoon we are most apt to have sunshine and the air is purest and most exhilarating. A gently active life is best calculated to preserve the health of the mother and her unborn child. The object is to increase and conserve the physical forces — to invigorate. Violent or prolonged exercise is to be HYGIENIC MANAGEMENT 73 avoided. Running, dancing, rowing, lifting, carrying heavy weights, as well as riding in uncomfortable or uneasy carriages over rough roads or upon horseback are objectionable. Railway travel is unwise, the con- tinuous jar of the cars being equally as dangerous as violent jolting. The nearer delivery approaches, the more repose and quiet may be indulged. The use of the sewing machine should be discontinued. THE LIVING ROOMS Pure air and plenty of it is the rule, and not only should the exercise be taken out of doors as much as possible, but the air of the rooms she occupies should be free from impurities. The air should be frequently changed and is best done when the rooms are unoccu- pied. Give them frequent airings and avoid extremes of heat and cold. Perfect ventilation does not imply that the rooms are to be turned out of doors or the tem- perature reduced to the freezing point. A small opening at the top and bottom of the rooms will secure a con- stant change of air — a constant admission of oxygen and escape of carbonic acid gas — and yet the tempera- ture may be maintained at an agreeable pitch. It is a mistaken notion that cold air only is pure. The apartments do not want to be dark. Let in the rays of the sun; receive their vivifying influence. Plants will not thrive in the dark, and neither mother nor child can flourish without sunlight. Sun baths are decidedly beneficial. Sit in the sun half an hour or more daily. Feeble women will find it an agreeable tonic. BATHING Bathing is beneficial when properly employed, but 74 PAINLESS CHILDBIRTH extremes must be avoided; there is no sense in soaking a person to death on the one hand nor completely obstructing the pores of the skin with dirt on the other. The temperature of the bath, the time of its employ- ment and the object to be attained must always be considered. It is folly to suppose the same kind of bathing will answer every purpose, for bathing implies something more than mere cleanliness; the temperature materi- ally influences the result; and while one woman may be greatly benefited by a cold bath another will be injured by it. Those who have an abundance of vital- ity will find the cool or even cold bath beneficial and agreeable, while those of a feeble constitution may be so chilled and injured by it that, reaction failing to occur, serious internal congestions and even fatal con- sequences may follow. As a rule, bathing should be agreeably tempered to suit, varying from cold to hot, partial or complete, plunge, tub, sponge, douche, sitz, etc. Probably the temperate or tepid bath will be suitable for the greatest number. Immediately after emerging from it the bodjr should be rubbed thoroughly dry with a coarse towel, that proper reaction be induced. Usually the bath may be continued from three to ten minutes, and the lower the temperature the shorter duration. Cool baths are most beneficially employed in the fore part of the day, the object being mainly to secure its invigorating effect, while the warm bath on account of its soothing, calming influences is most beneficial in the latter part of the day or evening. Women who have previously been in the habit of 30° to 60° 60° to 75° 75° to 85° 85° to 92° 92° to 98° 98° to 110° HYGIENIC MANAGEMENT 75 cold, plunge or shower baths should not discontinue them now; but if they have never accustomed them- selves to them it is doubtful if it is best to begin them while in this condition, lest the shock they occasion cause miscarriage. The temperature of the different kinds of baths varies considerably, as will be seen from table: Cold bath - 30° to 60° Fahr. Cool bath - - - Temperate bath - - Tepid bath - Warm bath - - Hot bath - Nervous women will find that a warm bath taken just before retiring will allay irritability, nervousness and induce agreeable sleep. It moderates pain and soothes the entire system; and if not continued too long will not debilitate, but rather invigorate. Bathing should not usually be indulged in w^hile digestion is going on. Baths may be medicated or not, as desired. For the purpose of cleanliness, the tepid sponge bath is most available, though the sponge employed briskly in the morning, moderately cool and followed imme- diately by a brisk rubbing is to be recommended; and those who have not the facilities for immersing the whole body will find it an excellent way to apply the tepid or warm bath at night. THE SITZ BATH With reference to the employment of the sitz bath we cannot do better than quote from the well-known author, Dr. Shew: Pregnant women receive much benefit from a constant use ot this bath. A small tub of sufficient size set upon a very low 76 PAINLESS CHILDBIRTH stool or anything by which it can be raised a few inches is quite sufficient. Unpainted wood is the best material, metal being unpleasant and cold. The water is used from one to five or six inches deep. The length of time this bath is used varies from a few minutes to two hours or more. To avoid exposure to cold it is best to uncover only the part of the person to be exposed to water. This bath has the effect of strengthening the nerves, of drawing the blood and humors from the head, chest and abdomen, and of relieving pain and flatulency and is of the utmost value to those of sedentary habits. It is sometimes well to take a foot bath, tepid or cold, at the same time. If a large quantity of cold water were used in this bath it would remain cold too long, and thus drive the blood to the head and upper part of the body, which might be very injurious; but the small quantity of water used at once becomes warm and thus admits of speedy reaction. In some local diseases of the lower parts when there is inflammation and the cold water feels most agree- able the water is frequently changed. If there is any inclination to headache or too much heat in the head a cold bandage upon forehead and temples is good. It is often well to rub the abdo- men briskly during this bath. The sitz bath may be used by any person whether in health or otherwise without the slightest fear of taking cold. Let those subject to giddiness, headache or congestion of blood in the upper regions try this and they will at once perceive its utility. In those troublesome itchings which often afflict pregnant women this application may be made as often as the symptoms occur and will be found a sovereign remedy. It is not desirable that any shock should be given the system, and the temperature at which the bath is begun should usually be about that of the tepid bath. It can be employed at any time of day, and when taken in the evening is quite agreeable to those who do not use the warm general bath. SLEEP Plenty of refreshing sleep is essential to the welfare of both mother and child. At least eight hours is advis- able. It favors the tranquility of both mind and body HYGIENIC MANAGEMENT 77 and not only relieves the uneasiness and inconvenience sometimes attending this condition, but is a potent preventive of habitual miscarriage. A regular hour for retiring is advisable and the sleeping room should be quiet and airy, neither too warm nor too cold; the bed moderately hard; the covering light but sufficient to prevent chilliness; mattresses of hair or other firm material are to be preferred and feathers prohibited. Occasionally a nap during the day is admissible and frequent rests desirable; but in resting it is not best to sit on cushions, for, by the warmth of the body they occasion, they induce congestion of the pelvis, a condi- tion particularly to be prevented. THE CLOTHING The dress should be loose and comfortable and so arranged that unequal pressure is avoided. It should be suspended from the shoulders instead of the waist and hips. Stays and corsets if worn at all must be loose enough to admit of perfect freedom of the abdominal muscles, and after the fifth month had better be laid aside. It would be better for all women if they would never wear corsets, for they impair the power of the muscles they surround. Any attempt to conceal her condition by lacing, stays or tight dresses cannot be too severely condemned and will be certain to be! followed by bad results which, in many instances, will not admit of a remedy. The Spartan law directed that pregnant women should wear large dresses, so as not to prejudice the free develop- ment of the precious charges of which nature had rendered them the momentary depositories. In those women in whom the abdomen is un- usually bulging or pendulous much relief is obtained 78 PAINLESS CHILDBIRTH from wearing a properly fitting abdominal bandage. Care should be taken that the breasts are not pressed upon nor injured in any way. Flannel underclothing is always best, unless in the few SmfgmM nm Figure 9 Position of the child and the womb in case of enlarged and pendulous abdomen, exceptional cases where the skin is exceedingly sensitive. HYGIENIC MANAGEMENT 79 In no case should tight garters if indeed any be worn, on account of their tendency to obstruct the circu- lation and cause cold feet and the knotted condition of veins that give so much trouble subsequently. SEXUAL RELATIONS In many pregnant women considerable pain in the lower abdomen and even abortion result from sexual intercourse; when too freely indulged in it exhausts the mother and impairs the vitality of the child. The greatest moderation should therefore be observed. The mind should be kept free from the subject and every circumstance that has a tendency to promote desire should be studiously avoided. In the early months (first two or three) when so many abortions occur and in women who easily abort or in whom symptoms of threatening miscarriage are present, and also in the later weeks of pregnancy, separate beds and even separate sleeping rooms are to be recommended. On the other hand, ungratified desires, where so great as to gain control of the mind, are liable to mark the foetus with an insatiable appetite. It is for this reason we counsel moderation and believe the moderate gratifi- cation of any appetite when consistent with reason is. better than absolute denial. Temperance is the best conservator of health and pleasure. MATERNAL IMPRESSIONS— MOTHERS' MARKS Although there is a great diversity of opinion about how mothers' marks are produced, yet the very fact that they do exist is evidence that there must be some cause. We will, no doubt, always be confronted with instances in which these marks cannot be traced to any assignable cause and, on the other hand, " assign- able causes" will have proved inoperative. 80 PAINLESS CHILDBIRTH Some writers have urged that there is no nervous communication between the mother and child. While we will not debate this point we are certain there is a direct communication through the blood, which is sufficient, were we to leave " sympathy " entirely out of the question, and if one quality may be transmitted through this medium why may not others? No one will attempt to deny that during pregnancy the mother is unusually susceptible to external im- pressions; and in view of the accumulated evidence we regard it safe to state that any external circum- stance that is capable of making a profound or prolonged impression on the mother may, through the blood or sympathy, affect the child in utero. We might bring forward numerous instances to sub- stantiate our views, but we regard them as entirely unnecessary. Every neighborhood has its examples. The prospective being is really a part of the mother herself and will be subject to a very great extent at least to the same influences. The impressions or marks on the child vary from the smallest naevi (mothers' marks) to the greatest physical or mental deformity. The whole subject, however, is still in the world of speculation and theory, and we must therefore content ourselves with the facts given in the preceding paragraphs. A practical conclusion suggested by this considera- tion is to remove the prospective mother as far as possible from the operation of those influences that may make unfavorable impressions upon the fragile structure of the unborn, and surround her with such influences as create a healthful, cheerful and agreeable state of mind. This should be remembered by husband, HYGIENIC MANAGEMENT 81 attendants, associates and all who are brought in con- tact with her. The mind should be agreeably occupied — refinement, pure emotions, noble sentiments, equanim- ity should be cultivated, together with everything that contributes to good nature, enjoyment and serenity. Avoid ,the presence of unsightly and disagreeable objects and as quickly and quietly as possible divert the mind from them. Gratify unnatural "longings" as far as is consistent with reason and circumstances and thus terminate their influence. Do not worry yourself about something you can not help, nor anticipate trouble that may never come to pass. Cultivate control over the will. Dismiss unpleasant thoughts and un- reasonable fancies as quickly as possible; think of something else; do not listen to the horrible and terri- fying stories which neighboring gossips delight to tell, nor be kept in a state of terror and anxiety about the termination of the conception by the yarns of those meddlesome old grannies who are always ac- quainted with some case that was just like yours and something happened. Every community is unfortunately cursed by such busybodies. Heed them not; they are no more capable of judging of your condition or predicting the future than they are to be President, and their tales are nearly always imaginary. Contemplate grace and beauty, and by such a course you will not only be likely to avoid mothers' marks, but to beget healthful, talented, beautiful children. Culti- vation of mental qualities is worthy an effort. If it is desired that the unborn excel in some branch of learning or profession let the mother exercise her mind 82 PAINLESS CHILDBIRTH in that direction. In a word, keep the mind free from unpleasant subjects, unhappiness, anxiety, anger, etc., but filled with agreeable fancies and charming images. Cultivate graceful attitudes, remembering that her course now must be reflected in the future character of her unborn babe. The ancient Greeks surrounded pregnant women with statuary, paintings and engrav- ings, and with good results. DETERMINATION OF SEX— CAUSE OF SEX OF CHILD Is there any way by which one sex can be produced in preference to the other? In other words, can a boy or girl be produced as the parents may wish? From the oldest times scientists have tried to discover means to accomplish such a result. Many ways have been suggested, but none have stood the test. All are but mere theories that further experience has shown to be wrong or even absurd. One theory held that con- ception occurring just before the menstrual period pro- duced a boy, but after the period a girl. Schenk claimed that sex depends upon the nutrition of the mother and the state of her blood — that in a woman abundantly nourished during the first four months and in whom the blood is made rich and red the chances are strongly in favor of a girl baby, and vice versa. Science has not yet solved the problem as to what causes the sex, and the question must therefore for the present remain as one of nature's hidden secrets. CHAPTER VIII DIETETIC MEASURES Sincf the composition of different kinds of food has been determined by chemical analysis the influ- ence of diet upon physical conditions is capable of comprehension, and there no longer remains any doubt of the importance of a well-selected diet in pregnancy. It has been proved that at least some of the unpleasant phenomena attending this condition can be overcome or avoided by a properly regulated diet. We have already had occasion to allude to the influ- ence bony development of the foetus exerts upon the ease or difficulty of childbirth, and it is now appro- priate that we consider the relation of diet to bony or osseous development. It is well known to physiolo- gists that the various structures of the body are elabo- rated from the materials supplied by the food, and that if certain nutritive elements are deficient those struc- tures into the composition of which they enter must necessarily be defective. Bones are composed very largely of calcareous or earthy matters, and the process of ossification is not completed in all the bones until the individual has reached adult life. 84 PAINLESS CHILDBIRTH In the early stages of foetal life, what afterwards becomes bone is in a state closely resembling gristle, and it is not until several months have elapsed that the deposit of earthy matters takes place in this gristly substance, but so rapidly does it then take place that at birth some of the bones have acquired considerable hardness and thus preserve the form and shape of the child. This bony development, therefore, we desire to retard in order to render the birth easy; and as the earthy substances that form bone as well as the ma- terials that compose the other structures of the child must necessarily be derived from the blood of the mother, and her blood in its turn be supplied by her food, the question naturally presents itself: Why cannot the food of the mother be selected so that there shall be a sufficiency of all the nutrient materials except that which occasions the hardening of bones? So far as we know, this subject was first brought to public notice by an English chemist named Row- botham, by the publication of a small pamphlet in 1841. This pamphlet is now out of print, but the prin- ciples it contained have been made the central idea of a treatise entitled, Parturition Without Pain, by M. L. Holbrook, M. D., to which very valuable little work I am greatly indebted for many important suggestions. Mr. Rowbotham's idea originated from reading the physiology of the development of the foetus, from which he reasoned that the calcareous substances being deposited from the mother's blood, a diet deficient in this element would materially affect the character of the birth. His wife having suffered severely in two previous births he determined to try the experiment of a restricted diet with the hope of relieving her DIETETIC MEASURES 85 suffering, and the result being so satisfactory he made it public in the pamphlet referred to above. She had, on this occasion, two years and a half after the last delivery, advanced full seven months in pregnancy before she commenced the experiment at her husband's earnest instance. Her legs and feet were, as before, considerably swelled, the veins distended and knotty and her health diminishing. She began the experiment in the first week of January, 1841. She commenced by eating an apple and an orange the first thing in the morning and again at night. This was continued for about four days, when she took just before breakfast in addition to the apple and orange the juice of a lemon mixed with sugar and at breakfast two or three roasted apples, taking a small quantity of her usual food, viz.: wheaten bread and butter. During the forenoon she took an orange or two and an apple. For dinner she took fish and flesh in small quantities and potatoes, greens and apples — the apples sometimes peeled and cut into pieces, sometimes boiled whole, along with potatoes, sometimes roasted before the fire and afterwards mixed with sugar. In the afternoon she sucked an orange or ate an apple or some grapes, and always took some lemon juice mixed with sugar or treacle.. At first the fruits acted strongly on the stomach and intestines,, but this soon ceased and she could take several lemons without inconvenience. For supper she had again roasted apples or a few oranges, and rice or sago boiled in milk; sometimes the apples: peeled and cored were boiled along with the rice and sago. On several occasions she took for supper apples and raisins or figs N with an orange cut among them, and all stewed together. Two, or three times a week she took a teaspoonful of a mixture made of the juice of two oranges, one lemon, half a pound of grapes; and a quarter of a pound of sugar or treacle. The sugar or treacle served mainly to cover the taste of the acids, but all saccharine matters are very nutritious. The object of giving these was to, dissolve as much as possible the earthy or bony matter she had taken with her food during the first seven months of her pregnancy. She continued in this course for six weeks when, to her surprise and satisfaction, the swelled and prominent state of her veins which had existed before she began had entirely subsided; her 86 PAINLESS CHILDBIRTH legs and feet which were also swelled considerably had returned to their former state and she became so light and active she could run up and down a flight of more than twenty stairs with more ease than usual when she was perfectly well. Her health became unwontedly excellent and scarcely an ache or a pain affected her up to the night of her delivery. Even her breasts which, at the time she commenced the experiment as well as during her former pregnancies were sore and tender, became entirely free from pain and remained in the very best condition after her delivery and during her nursing. At nine o' clock on the evening of March 3d after having cleaned her apartments she was in the adjoining yard shaking her own carpets, which she did with as much ease as anyone else could have done. At half-past ten she said she believed her time had come and the accoucher was sent for. At one o'clock the surgeon had left the room. He knew nothing of the experiment being made, but on being asked on paper by the husband two days afterward if he " could pronounce it as easy and safe a delivery as he generally met -with," replied on paper: "I hereby testify that I attended Mrs. Rowbotham on the third instant and that she had a safe labor and more easy than I generally meet with. " On his asking the female midwife if she thought it as easy as usual, replied: "Why, I should say that a more easy labor I never witnessed; I never saw such a thing and I have seen a great many labors in my time." "The child — a boy — was finely proportioned and exceedingly soft, his bones were all in gristle, but he became of large size and very graceful, athletic and strong as he grew up. The diet of his mother was changed on his birth and she ate bread and milk and all articles of food in which phosphate of lime is found and which had been left out before. She also got up from her con- finement immediately and well. After her last delivery, in July, 1838, full ten days elapsed before she could leave her bed and then she swooned at the first attempt. On this occasion, March, 1841, she left her bed on the fourth day and not only washed but partly dressed herself. Had she not been influenced by custom and somewhat timid she might have done so sooner. To be assisted appeared like a burlesque to her, not to say annoyance. She had no assistance from medicine. In the former pregnancy DIETETIC MEASURES 87 she had subsisted very much on bread, puddings, pies and all kinds of pastry, having an idea that solid food of this kind was necessary to support and nourish the foetus, and it is quite right to suppose that nutritrious food is necessary for this purpose, but nutritious food can be had without that hard and bony matter which is so large an ingredient in wheat en flour. For instance, the West India grains, sago, tapioca, rice, etc., have little of it; and Mr. Rowbotham made a table of substances with the proportion of phosphate of lime in each so that it may be avoided in the food during pregnancy and used afterwards in nursing when the bones and teeth are made. Wheat contains most earthly matter. " Beans, rye, oats, barley, have not so much earthly matter as wheat; potatoes and peas not more than half as much; flesh of fowls and young animals, one-tenth; rice, sago, fish, eggs, etc., still less; cheese, one-twentieth; cabbage, savoy, brocoli, arti- chokes, coleworts, asparagus, endives, rhubarb, cauliflower, celery and fresh vegetables generally, turnips, carrots, onions, radishes, garlics, parsley, spinach, small salad, cucumbers, leeks, beets, parsnips, mangel-wurzels, mushrooms and all kinds of herbs and flowers average less than one-fifth; apples, pears, plums, cherries, strawberries, gooseberries, raspberries, cran- berries, blackberries, huckleberries, currants, melons, olives, peaches, apricots, pineapples, nectarines, pomegranates, dates, prunes, raisins, figs, lemons, limes, oranges and grapes, on an average, are two hundred times less ossifying than bread or any- thing else prepared of wheaten flour." With such an extensive list of non-ossifying edibles to select a dietary from, and the culinary ingenuity of most women, it does not seem that the appetite for preparations of wheat would be very difficult to appease. A varied diet is absolutely essential to health, and an occasional meal of which wheat bread forms a part may be permitted, more particularly in the early months of gestation, but in the three latter months when ossification is going on, the more carefully the diet is selected to exclude phosphate of lime the better. PAINLESS CHILDBIRTH There is no danger of injury to the mother or child by this dietetic course, for it is impossible to exclude all calcareous matter, yet the quantity can be so dimin- ished as to retard instead of favor ossification. The list as quoted above may not be absolutely correct, yet as the fruits that are most advised contain so much acid that they probably hold the calcareous matters in solution and prevent their deposition, consequently the list is practical and the results satisfactory. As regards drinks, in many sections the water con- tains in solution considerable quantities of lime — the water is hard — consequently rain or snow waters are best. Boiling such hard water before using will cause the precipitation of considerable of the lime, as may be observed by the formation of the crusts in the tea- kettle. When it is necessary to use hard water it should be boiled and cooled before using for cooking or drink- ing. Tea and coffee may be moderately indulged in, and of the two tea is least objectionable. Cocoa contains less lime than coffee, though coffee is a good nutriment with this one exception. Lemonade or drinks made of acid fruits, jellies, etc., are unobjectionable, and the acids they contain will to a certain extent hold the earthy or calcareous bony matters in solution and oppose their deposition. Women living upon the foregoing diet will have little desire for much drink of any kind. Swelling of the feet and limbs rarely occurs when the fruit diet is employed, and cases suffering from such difficulty when the diet is begun will generally experience decided relief. There has been no objection offered to animal food. Indeed, we would advise that it form at least a small DIETETIC MEASURES 89 portion of the diet, particularly in debilitated and feeble women, but in those of full habit it had better be sparingly eaten, as it is heating while the acid foods are cooling. Lamb, veal, chicken and fish are the most appropriate meats for this condition. Inordinate and capricious appetites for improper and noxious articles should, of course, be opposed, but when the longing can safely and properly be in- dulged it should be gratified. With the diet list advised very little if any annoyance is to be apprehended. The benefits to be secured by a well-regulated diet are not merely hypothetical, but have been fully sub- stantiated by experiment. Soon after the publication of the pamphlet referred to, an English lady of high respectability resolved to profit by the idea and as soon as she thought she was pregnant she abandoned bread, potatoes and milk and subsisted on the West Indian grains, rice, tapioca and sago, fruits of all kinds and vegetables and when she ate meat she ate that which was young, drank lemonade and tea, both of which were made of distilled water. She did not suffer an hour's inconvenience during the whole time, the birth was easy and the child though very soft at first grew rapidly and became large and strong. Numerous others have tried it that we know of and have been reported by others, and not a few have come under our own observation, in all of which the results are mainly the same. Several have tried the plan at my suggestion and the results have in every instance been highly satisfactory. Those nations among which childbirth is compara- tively easy, subsist mainly on a diet in which bony materials are very limited. Females of tropical 90 PAINLESS CHILDBIRTH climates where the diet is very largely fruit suffer very little at childbirth. The American Indians eat very little wheat and the same is true of the colored slaves of the South. It is a very popular but erroneous idea that the mother must gorge herself throughout pregnancy in order to support and nourish the unborn — that she must "eat for two. " This is a very great mistake. On the con- trary, instead of eating more than she wants she should be governed by the dictates of hunger and never eat an extra mouthful. The amount of nourishment the foetus requires day by day is very trifling indeed. As a result of such a mistaken notion she disorders the stomach, becomes heated and feverish, is troubled with headache and dizziness and lays herself liable to numerous intestinal disorders; and if assimilation is active in proportion to the increased amount eaten she becomes extremely fleshy and uncomfortable and will be liable to much annoyance from swelling, cramp- ing or numbness of the extremities. Figure the matter out for yourselves: The average duration of pregnancy is two hundred and eighty days; the average weight of the child and placenta (after- birth) does not exceed ten pounds and generally not over eight; then ten pounds give one hundred and sixty ounces, or but little more than half an ounce a day is required. Admitted that during the first four months the amount required will be much less than in the last four, as we more nearly approach delivery the greater will the amount required become; nevertheless, the average remains the same. Laying the question of average aside there is no use of the mother commencing DIETETIC MEASURES 91 to lay in a surplus for at least the first six months, though during the last three the amount of nourish- ment might be slightly increased. She should also bear in mind that if by excessive eating she increases the nutrition of her child she increases its growth, and for every ounce she increases its development beyond a given point she unwisely diminishes the ease of delivery. Numerous authorities might be cited on the subject, but we do not regard them necessary; the proposition is too easy of comprehension to require argument and unless morbid conditions supervene to require a modifi- cation of the amount eaten for therapeutic purposes the dictates of hunger will be by far the best guide how much will be best, always bearing in mind, let modera- tion in all things prevail. CHAPTER IX REMEDIAL TREATMENT Although the measures already advised are of the utmost importance and will certainly exert a powerful influence over the ease and safety of delivery, the mother's recovery and the future welfare of the child, there remains to be considered other agencies in the efficacy of which we have almost unlimited confidence — agencies which exercise a positive curative influence over those abnormal conditions that so frequently attend or co-exist with pregnancy and which so often complicate and increase its difficulties. These agencies — therapeutic in character — may be employed in conjunction with the hygienic and diet- etic measures already detailed, and will act in perfect harmony with them and mutually increase the value of each other. We have seen the dietetic and hygienic measures employed alone with the most decided benefit; and have in other cases tried the therapeutic treatment we are about to advise — when the other could not be made available — with the effect of rendering the labor short, easy and safe, as well as controlling any un- pleasant symptoms that presented during the progress Df the pregnancy. REMEDIAL TREATMENT 93 All women are not affected in the same manner- all constitutions are not alike — and we will often ob- serve pathological conditions occurring during preg- nancy which had their origin long before the concep- tion took place; or pathological conditions may be developed during gestation. There may be abnormal conditions which do not depend for their present exist- ence nor are in way connected with pregnancy, yet, if allowed to proceed will seriously militate against a short, easy or safe delivery. Again, these morbid condi- tions may have an intimate connection with the gesta- tory or pregnant state. The present and future welfare of both mother and child necessarily depends greatly upon our ability to control or remove these conditions^ At the risk of seeming inconsistent or of appearing to lack confidence in what I have already WTitten and advised in the preceding chapters I shall consider those remedial agents which have in my hands and in the hands of my professional acquaintances accomplished so much for the relief of suffering women. There is a tradition that the Indian women of this country for two or three months prior to delivery resort to drinking an infusion of a plant known as squaw vine or partridge berry in order to render their delivery easy and safe. Whether this tradition has any foundation in fact or not, I do not know, nor does it seem that I need care, so long as the tradition has developed a knowledge of a remedy of the greatest possible conse- quence to the parturient female. Whether the squaws drink it or not, there is nothing more certain to my mind than that it does possess the truly wonderful and benefi- cent properties ascribed to it. 94 PAINLESS CHILDBIRTH In the American Dispensatory, by Dr. John King, we find the following reference to it: It is said that the squaws drink a decoction of the plant for several weeks previous to their confinement for the purpose of rendering parturition safe and easy. ******** Partridge berry is parturient, diuretic and astringent, used in dropsy, suppression of urine and diarrhoea. It seems to have a special affinity for the uterus and is highly beneficial in all uterine diseases. It appears to exert a powerful tonic and alter- ative influence on the uterus. Dose of the strong decoction, from two to four fluid ounces two or three times a day. The berries are a popular remedy for diarrhoea and dysuria. It is highly recommended as a remedy for sore nipples, used as fol- lows: Take two ounces of the herb, fresh, if possible, and make a strong decoction with a pint of water; then strain and add as much good cream as there is liquid of the decoction; boil the whole to the consistency of a soft salve and, when cool, anoint the nipples with it every time the child is removed from the breast. Hale, in his New Remedies, says: I would recommend it for false pains, uterine irritability, scanty and delaying menses, dysuria and scanty urine with profuse sediment. In procuring this remedy it is best to obtain it by its botanical name, Mitchella Repens, as there are several plants known in different parts of the country by the name of squaw vine, squaw berry, squaw mint, partridge berry and other similar names which would have a tendency to confuse anyone not familiar with botany, and it is necessary to get the right plant. An infusion is always the best form for administra- tion and will be found most efficacious, for I must confess, though I have tried several specimens of fluid extracts, they have failed to afford the satisfaction I have derived from the infusion of the recently gathered plant. It is advisable not to rely on the plant that has REMEDIAL TREATMENT 95 been gathered more than a year, as it is apt to lose its strength and become inert if kept longer. The action of this remedy either alone or in combi- nation is to act gently upon the kidneys and urinary organs, relieving irritability and moderately increasing the flow of urine. It cleanses the blood, soothes any nervous excitement that may exist, removes pain and soreness and effectually overcomes any morbid inflam- matory conditions of the female reproductive organs, strengthens the uterus and establishes such a healthy condition as results in an easy and safe delivery. When the lower extremities are swollen as is often the case after the pregnancy is well advanced, owing to an obstruction of the circulation, I have seen this remedy produce the most decided and speedy relief. I have given it in the treatment of various uterine disorders with the most satisfactory results, but the consideration of those complaints having been made in this edition the subject of a separate chapter, further allusion to such use of it at this time is unnecessary. There is another plant that possesses a similar and deserved reputation, and I have frequently combined them with the happiest results. I allude to blue cohosh, the botanical name of which is Caupolhyllum Thalic- troides, also known as squaw root, of which Dr. Hale in his recent popular work on New Remedies says: The aborigines and early settlers claimed for it the power of preventing tedious and painful labors. This testimony has been substantiated by many prominent and trustworthy physicians of the eclectic school as well as of the homoepathic. A few of our school have denied it such power, but the weight of evidence is against them. Dr. A. E. Small is sure from the observations of many years that it actually prevents the usual sufferings which many women undergo. He also testifies to the singular 96 PAINLESS CHILDBIRTH fact that many women who have taken it for such purposes have overrun their time to the extent in some cases of ten or twelve days. The cases referred to, however, all had very easy labors and a good recovery. My experience has been so uniform and conclusive on this point that I do not hesitate to assert that it prevents not only a too painful labor, but it prevents those premature labors which are so common among the weakly women of this age. I have repeatedly used a combination of the two with the most satisfactory results. I obtained the fresh materials and administered them in the form of a sweetened infusion, sometimes adding other agents that seemed specially demanded. In very many in- stances have I made use of these remedies in cases which had hitherto undergone the most terrible suffer- ings at parturition, with the effect of enabling the mother to have a very speedy delivery, almost abso- lutely free from pain. In those females who had taken it there was very little of the inconvenience usually experienced in the latter months of gestation; the mothers made a wonderfully speedy recovery and in some instances were entirely relieved of uterine dis- orders to which they had for .several years previously been subject. While practicing medicine in the central part of the State of New York so favorable were the results attained by using the foregoing remedies in the form of sweet- ened infusions which I then prepared, the remedy ac- quired such a reputation that very many parturient women procured it that they might go through child- birth without pain; and though it was taken in hun- dreds of cases where I could not attend the confinement I have never known of a single instance of failure; but, on the contrary, received many testimonials of REMEDIAL TREATMENT 97 its efficacy and thanks for the benefits derived from it. There are many women who will remember taking what I then termed the " mother's cordial," the com- position of which I did not reveal to them, but which consisted mainly of an infusion of the squaw vine and blue cohosh preserved with sufficient sugar and alcohol to render it palatable and secure its preservation while being used. In using an infusion of these plants an ounce of the squaw vine and half an ounce of blue cohosh should be steeped in a pint of water and the whole taken in the course of three or four days. When one is used alone a greater quantity should be employed than when both are used together. A very convenient and agreeable combination may be made thus : Squaw Vine, .... 3^ pound Blue Cohosh, % pound Bruise them thoroughly and add one gallon of water and let them stand over night. Then heat them nearly to the boiling point and gradually reduce the quantity of liquid (occasionally letting it come to a boil) to one half, strain and press out all the liquid, which should measure three pints, add 1 pound of loaf sugar and dissolve; then add spirits to make the whole meas- ure two quarts. The dose should be a tablespoonful three to five times a day. The spirits are only added to preserve the preparation and need not be added when the infusion is made in small quantities to be used before it would sour. In cold weather a less quantity of spirits will suffice. Whisky, gin or alcohol may be used. There is still another plant that is indigenous to this country which enjoys a growing reputation, not only for the relief of those morbid conditions that render ges- tation and delivery painful and tedious, but as a remedy 98 PAINLESS CHILDBIRTH to expedite delivery. I refer to the black cohosh or Cimi- cifuga Racemosa also known as macrotys. Given in small doses for two or three weeks there can be little doubt that it has the power of rendering the labor very short and easy. Dr. Scudder of Cincinnati, editor of the Eclectic Medical Journal, speaks positively on the subject as follows : Pregnancy is a physiological condition and there should be little or no pain, ache or unpleasantness associated with it. If there is it should be looked after at once and removed. These unpleasantnesses can and should be relieved for the comfort of the mother and more especially because this will probably ren- der the labor easier and the getting up better. Let me again call attention to macrotys as partus preparatory though doubtless most of our readers have tested it. If there are pains and aches in the region of the uterus, tenderness on pressure or soreness at any part of the uterine globe; if the movements of the child are painful or there is pain in the pelvic articulations or, finally, if during the last month there are false pains, macrotys is likely to be a remedy. I have used it time and again in these cases with relief and in others during the last six or eight weeks of gesta- tion simply to facilitate and make the labor easier, and I am satisfied with good results. In Hale's New Remedies the author makes the fol- lowing allusion to it: Dystocia (difficult labor) is one of those abnormal conditions which come under the domain of homeopathic medication. It is useless to cling to the antiquated superstition that a woman must suffer the " pangs of childbirth." Dystocia is always the result of an abnormal condition of the tissues concerned in the functions of childbearing. *********** I have attended many women whose previous labors had been exceedingly painful — almost unendurable without ether — but, owing to the administration of cimicifuga during the last weeks of pregnancy they suffered very little. So many of these cases have occurred in my practice and in that of my colleagues that REMEDIAL TREATMENT 99 it is not proper to affect skepticism or unbelief. As a rule, first labors are painful and protracted, while subsequent ones are less so; but if five or six are very painful and each one seems to be more painful than the last we cannot expect the seventh to be painless except from some remedial interference. Now, if in such cases cimicifuga, caulophyllum or viburnum is given and the woman's next labor is easy, what are we to think? Evidently, that the medicine effected a change of condition from abnormal to normal. In such cases give the cimicifuga at least two weeks previous to the expected date of labor, in doses of one to ten drops two or three times a day, the doses repeated oftener as the date ap- proaches. The preparation alluded to by Prof. Hale is the homeopathic mother tincture and when it can be ob- tained will represent very certainly the virtues of the' drug. An infusion of the root, one half ounce in a pint of boiling water of which the dose may vary from a teaspoonful to a tablespoonful repeated three or four times a day, will also answer. The fluid extract, when reliable, in doses of from three to eight drops may be used. When the homeopathic tincture cannot be readily obtained the following procedure will answer: Black Cohosh Root, }4 pound Alcohol, ..... 3^ pint Bruise the cohosh as fine as possible and put it in the alcohol, cork and let it stand a week or two, occasionally shaking the same. At the end of this time it may be strained and used in doses as advised for homeopathic tincture. Dr. J. H. Dye's Mitchella Compound contains both cohosh and squaw vine as well as other ingredients. It should be taken daily for as many months of preg- nancy as possible. Thousands of testimonials bear wit- ness to the wonderful healing and pain-relieving powers of Mitchella Compound. 100 PAINLESS CHILDBIRTH CONSTIPATION Every effort should be made to keep the bowels open and regular. A daily evacuation of the bowels is essential to health, and to neglect for several days together the performance of so important a function is highly prejudicial, for if long continued it sooner or later develops a variety. of ailments often of a serious character, among which we may notice feverishness, loss of appetite, indigestion, wakefulness, headache, horrible dreams, sickness of the stomach, bearing down pains, piles, etc. This troublesome complaint is more easily prevented than cured, though a cure can almost always be effected. Habit has very much to do with its development and cure. The habit of evacuation should be encouraged daily, and the best time is in the morning, soon after breakfast; the bowels having then been quiet during the night are stimulated to activity by partaking of food and consequently have a natural tendency to act at this time, and whether the desire is felt or not the attempt should be made, which may be aided by an injection of tepid water. The influence of the diet and exercise which have already been recommended is exceedingly beneficial in preventing and curing cos- tiveness. A glass of water drank at night and another the first thing on rising, and ari orange eaten before breakfast will work wonders. If the woman is of full habit and costive I would advise a small quantity of Epsom salts daily, just enough at a dose to produce a free, natural evacuation. They cool the system, re- lieve determination of blood to the head, with dizziness, swelling of the feet, etc., prevent nausea and a host of the disorders that attend constipation. We are REMEDIAL TREATMENT 101 well aware the taste of salts renders them objectionable to very many. When such is the case they may be dis- guised and their value enhanced by dissolving them in hard cider in the proportion of half a pound of the salts to a gallon of old cider of which the dose will be two to four ounces once or twice a day. The object being to maintain a natural condition, the dose must necessarily be varied accordingly. Other saline laxatives may be used in their stead, such as Rochelle salts, seidlitz powders, citrate of magnesia, Carlsbad salts, sodium phosphate or mineral water, etc., in quantities sufficient to regulate the bowels. It so happens that women who are not plethoric are often troubled with constipation; indeed, constipa- tion in them is a very common condition and is often a source of very great trouble. Such women should eat abundance of cereals, fruits and vegetables — oranges, apples, prunes, figs, tomatoes, spinach, beans, peas, etc. A soap and water enema, a glycerine suppository or the injection into the bowel of four to six ounces of olive oil may be used occasionally for temporary relief, but strong, violent purgatives should be scrupulously avoided. Mild tonic laxatives, however, maybe needed, and of these the best are Cascara Sagrada, Phenoph- thalein and Compound Licorice Powder. From five to thirty drops of the fluid extract of Cascara Sagrada or one or two teaspoonfuls of the cordial taken in a little water morning and night will usually be followed by happy results. If preferred a two or three-grain Cascara tablet may be taken at bedtime. Phenophthalein is best taken in the form of a one- grain tablet two or three times a day after meals. Many 102 PAINLESS CHILDBIRTH Figure 10 women find a teaspoonful of Compound Licorice Pow- der in half a glass of milk at bedtime a very mild and satisfactory laxative. THE KIDNEYS The condition of the kidneys must always be remem- bered and any irregularity corrected. When the REMEDIAL TREATMENT 103 kidneys are not kept sufficiently active the general health suffers, and if this condition occurs about the time of delivery it renders convulsions liable. Inactivity of the kidneys is sometimes the cause of the swelling and dropsical condition of the lower extremities, though such a condition is usually due to pressure of the en- larged uterus upon the returning current of blood through the veins into general circulation. The total amount of urine passed in twenty-four hours should be estimated from time to time, and a sample sent to the physician for examination. This is particularly advisable when such symptoms as puffi- ness of the eyes or swelling of the hands, feet or ankles appear. Convulsions at the time of confinement are very often the result of kidney disease. The diet we have recommended will usually keep both bowels and kidneys in a normal condition and Dr. Dye's Mitchella Compound being diuretic is generally all that will be needed; but, should the urine become scanty, the following may be relied upon and will restore the kidneys to a healthy condition: Acetate of Potash, ... 1 dram Sweet Spirits of Nitre, . . 3 drams Simple syrup to make, . . 2 ounces Dose — one teaspoonful in water three to six times a day. MORNING SICKNESS Much good may be anticipated from the dietetic and hygienic advice already given, for among those who have tried it the absence of this annoyance was particularly noted. I am led to believe that the sick- ness and vomiting of pregnancy depend more upon those unnatural conditions developed by the imposi- tions of modern social customs than upon any natural relation to reproduction. 104 PAINLESS CHILDBIRTH The power of Dr. Dye's Mitchella Compound to control irritable conditions of the uterus renders it a very effectual remedy in the nausea and vomiting of pregnancy, though its action on the stomach directly is of no consequence. When the sickness and vomiting occur immediately on getting up they may be prevented by taking the breakfast while lying quietly in bed. Small pieces of ice slowly dissolved in the mouth and swallowed, often have an excellent effect, and so do cold compresses applied over the stomach or back of the neck. Innumerable remedies have been recommended for the relief of morning sickness, but there is no known specific and it is often necessary to try one remedy after another, because that which will relieve or cure one may utterly fail in another. The bowels should be kept open and if solid food seems to increase the nausea or vomiting, liquid foods such as milk, plain or mixed with soda water or lime water, or well strained broths should be given in small quantities at frequent intervals. Relief sometimes comes from abstaining from all kinds of food for several hours or even for a whole day. A cracker eaten dry before the head is raised from the pillow is a simple remedy well worth a trial. So are pop corn, ice cream, scraped beef, junket, spruce chewing gum and iced champagne. A sour stomach and heartburn are often helped by equal parts of milk and lime water in tablespoonful doses every hour, Vichy water or bicarbonate of soda. The mustard or capsicum plaster is worthy of a trial, as is also a plaster composed of various spices applied over the pit of the stomach. M REMEDIAL TREATMENT 105 The acid fruit diet generally controls the sickness and arrests or prevents the vomiting, and for this purpose lemon juice is often valuable. It may be taken in doses of a tablespoonful mixed with an equal part of water. The effervescing solution of citrate of potassa or magnesia is sometimes very efficacious and acts as a laxative at the same time; and being an agreeable drink will often be tried before other means are resorted to. It will be in harmony with the principles of the fruit diet. When headache and nervousness are prominent symp- toms, bromide of potassium is an efficient remedy and may be given as follows: Bromide of Potassium, . . 2 drams Cinnamon Water, ... 3 ounces Dose — two teaspoonf uls in a wineglassf ul of water two or three times a day. If previous instructions are obeyed, this prescription will very rarely be needed. Should the stomach reject this it can be given as a rectal injection. Thirty to sixty grains dissolved in three ounces of liquid starch injected and retained in the bowel is the proper amount. Many cases are relieved by taking 10 to 15 grains of subnitrate of bismuth three times a day or 5 grains of the oxalate of cerium before each meal, or one drop of the wine of ipecac in one half teaspoonful of water every hour, or 5 to 10 drops of the tincture of mix vomica in water three times a day. When the stomach becomes so irritable that all kinds of food and medicine no matter how given are rejected, the general nutrition fails and weakness or 106 PAINLESS CHILDBIRTH exhaustion supervenes. In such cases it is necessary to feed by the bowel — rectal feeding. This is done as follows: Wash out the rectum by irrigating it with plain warm water from a fountain syringe. Then intro- duce high up in the bowel through a rubber tube or catheter from 4 to 6 ounces of peptonized milk or broth or the whites of two or three eggs in water. To pre- vent its ejection the woman should remain quiet and a slight pressure made against the anus for a few minutes. LONGINGS— CRAVINGS— DEPRAVED APPETITE Depraved appetite is regarded by many as a signifi- cant sign of pregnancy. The woman may be seized with a desire for some unnatural substance, and will often eat chalk, magnesia, charcoal, slate-pencil, etc. She often wants some article of food which she may have previously disliked, and often such articles will be found acceptable. When it can be done without too great an inconvenience this morbid appetite or longing may be gratified, but when it cannot, the woman should dismiss it from her mind. We do not place as much stress upon the gratification of these unnatural appe- tites and desires as many, yet, as they afford a comfort to the mother we suggest that when reasonable and practicable they may be indulged. A healthy condi- tion of every function will soon do away with them, and to this end we should seek to improve the woman's condition by every possible means, rather than attempt to relieve such desires by special means alone. The course already prescribed will generally soon overcome longings, and to give her some unexpected article of diet will often break the " longings/' If a morbid condition exists in the stomach let it be met with REMEDIAL TREATMENT 107 appropriate remedies. Diseases of the stomach not be- longing to this treatise must be omitted. LOSS OF APPETITE If the appetite fails, let the woman abstain from eating for a meal or so; or if her strength fail on ac- count of it let the appetite be " coaxed " by some unexpected delicacy, and small quantities of highly nutritious food be tried. Those who try our hygienic, dietetic and remedial plan will seldom be annoyed by loss of appetite or such morbid conditions; but should they fail, change of climate, scenery or surroundings will often work wonders when combined with the treat- ment recommended for morning sickness. Should they fail, it will be advisable to consult a physician. FLATULENCY— GAS IN STOMACH AND BOWELS Flatulence generally comes from a bad state of the digestion and is often associated with colic. In such cases it will be found better to eat a little and often than to eat at long intervals and much at a time. Certain articles of diet will induce an attack and when they are known should be avoided. Allowing a weak or irritable stomach to go long empty and then filling it to repletion will generally provoke an attack of colic if anything will. Avoid indigestible articles of diet, chew the food thoroughly, and if remedies are needed a grain or two of cayenne pepper will often relieve, or ten to fifteen drops of tincture of capsicum and myrrh (No. 6) in sweetened water. They act by increasing the power of natural digestion. A little peppermint or camphor water or a soda mint tablet will generally expel the wind and give relief. An injection to move the bowels will succeed. Some of these plans are generally 108 PAINLESS CHILDBIRTH available and can be had on short notice, but as a remedy nothing can excel the following: Tincture of Colocynth, . . 15 drops Water, ..... 4 ounces Dose — A teaspoonful repeated every fifteen to twenty min- utes during the attack and, afterwards, to break up the tendency of the trouble to return, a teaspoonful three or four times a day for several days. VARICOSE VEINS The veins of the lower extremities frequently be- come distended, knotted and painful. They do not often show themselves in the first pregnancy, but are apt to appear later in life and become worse with each successive pregnancy. They are very much aggravated by tight garters and corsets, neither of which should be worn during this condition. They are caused and aggravated by any circumstance that is capable of impeding the return of venous blood from the extremi- ties. A free action of the kidneys, skin and bowels has a tendency to relieve them and I have seen them greatly benefited by Dr. Dye's Mitchella Compound. Rubbing the extremities towards the body aids in emptying them and is beneficial. A well-adjusted laced or elastic stocking is one of the best remedies and can be obtained from a druggist or surgical-instrument maker. A roller bandage applied from the toes to the body answers the same purpose, but is difficult to apply so as to make an even pressure and admit of freedom of locomotion. An elastic perforated bandage is easily applied and retained in place. When neither of these means is available, and the veins are troublesome, the woman should remain in the recumbent position as much as possible or sit with the feet well elevated. An REMEDIAL TREATMENT 109 abdominal bandage so adjusted as to raise the uterus and its contents upward and thus remove the pressure from the large veins as they pass upward through the pelvis will also be effectual. HEARTBURN Pregnant women are frequently troubled a good deal by the distressing symptom called heartburn, for which it is customary to resort to alkalies. They merely neutralize the acid that is in the stomach, but do not arrest the causes to which it is due. The use of alkalies interferes with the principle of fruit diet and should be avoided if possible. Heartburn is generally due to an impairment of digestion and in too many cases to ' over-eating — the food fermenting instead of digesting. The proper treatment is to avoid it by abstemious liv- ing but, if it occurs, try fasting — or skip a meal occa- sionally. I have found those remedies that aid digestion to be the most valuable in relieving it. Five to ten grains of pepsL. just before or after a meal will often succeed. Charcoal will be found available in many cases and is less objectionable than alkalies. Five grains of sub-nitrate of bismuth repeated three to six times a day is an effectual remedy. I have often found acids among the best remedies. The following is usually a successful prescription: Dilute Nitro-Muriatic Acid, . 3^ ounce Water, ..... 4 ounces Dose — A teaspoonful in a wineglassful of water after eating. It may be greatly aided by diminishing the quan- tity eaten and also by avoiding saccharine and starchy food. PILES This distressing complaint is one of the frequent 110 PAINLESS CHILDBIRTH annoyances of gestation and may be caused by pro- longed constipation or anything that obstructs the hemorrhoidal veins. Those women of a full habit are especially liable to them. Ordinarily, the pile tumors are small and are of little consequence beyond the annoyance they occasion; but when they are large, painful and become inflamed they require the services of a physician, for while an operation for their radical cure is seldom justifiable during pregnancy every effort to obtain relief is a duty. In treatment the first point to be looked after is to secure and maintain a moderate- ly open condition of the bowels. This may be secured by the fruit diet, exercise, bathing and injections. Senna tea is a favorite laxative in this condition. Avoid straining at stool. A piece of absorbent cotton saturated with witch hazel and inserted just inside the anus after stool is a simple remedy worth trying. Wash the parts thoroughly in cool water and apply the following ointment : Gall Ointment, .... 1 ounce Stramonium Ointment, . . 1 ounce Directions — Apply locally morning and night, at the same time inserting a little of the ointment just inside the bowel. When very painful, relief is sometimes obtained by elevating the foot of the bed a few inches and apply- ing hot fomentations to the affected region. A physician may be needed to open the pile and turn out the small blood clot. The abdominal bandage should be worn. Piles often disappear entirely after confinement. DIARRHOEA Looseness of the bowels often occurs as a sequel of constipation or in alternation with it. Some women are troubled with it more or less the entire term, while REMEDIAL TREATMENT 111 others are afflicted with frequent attacks sometimes coming on without any assignable cause. When it occurs as a sequel of the constipation it is generally of a watery character secreted by the lining membrane of the bowels as an effort of nature to discharge the retained waste matter. When not severe it is salutary and relieves headache, heartburn, nausea, etc., and usually regulates itself when the offending materials are discharged. When, however, it is severe or pro- longed it should receive proper attention, for then it weakens and predisposes to piles and abortion. Ordinarily, very little medicine need be given, for rest in the recumbent position and a strict diet will be sufficient. Should the diarrhoea continue give a dose of castor oil and after it has operated use the following: Tincture of Catechu, . 6 drams Laudanum, .... 40 drops Chalk Mixture to make . . 4 ounces Dose for an adult — One tablespoonful three times a day. The following mixture will be found equal to almost any case, having been repeatedly tested by myself and others, and is appropriate to a great variety of cases ■ Chloroform, .... 2 drams Tincture Opium, ... 1 dram Tincture Camphor, ... 2 drams Tincture Rhubarb to make . 2 ounces Dose — one half to one teaspoonful, repeated according to the severity of the attack from one to four hours, until relieved. It may be preceded or followed by a mild dose of castor oil, with advantage. HEADACHE AND NEURALGIA A very large proportion of pregnant women are troubled with headache and neuralgic pains in the face,. 112 PAINLESS CHILDBIRTH breast or side of the chest. The causes are numerous. The influence of pregnancy upon the nervous system contributes to the production of headache by inducing determination of blood, constipation, indigestion and is liable to aggravate neuralgic, rheumatic and consti- tutional headache. We can usually do more to cure headache by attention to diet, exercise and overcoming the causes that occasion it than by any special remedies addressed to the head. If it persists after the appre- ciable causes are removed it will be best to consult a physician. Those who carry out the advice already given in this and the two preceding chapters will not be troubled much with these aches and pains. Bromide of potash and ammonia in solution, as recommended for convulsions, in teaspoonful doses every three or four hours will be apt to relieve these headaches. For the neuralgic pains in the chest, face or breast use mustard plasters, hot fomentations, hot water bag, hot salt bag or a liniment containing camphor and chloroform. Painful spots may be painted with iodine. COUGH A troublesome cough sometimes occurs, but unless it becomes so severe as to prevent sleep or endanger miscarriage by the violent concussion of the abdomen it produces it seldom requires attention. A teaspoonful of paregoric occasionally repeated will usually afford relief, but as I do not desire to use opiates when they can be avoided, before resorting to the use of paregoric I would try a teaspoonful of either of the following: Tincture Colinsonia, ... 1 dram Water, ..... 4 ounces Mix. REMEDIAL TREATMENT 113 Or Tincture Drosera, 2 drams Water, .... 4 ounces Mix. Or Tincture Red Clover, 1 dram Mix. Water, .... 4 ounces Or, an infusion of red clover may be drank in small quantities. This does not apply to diseases of the lungs, as con- sumption or bronchitis. Such diseases need experienced professional advice. PRURITUS, OR ITCHING Some women will be troubled with intolerable pruritus, or itching, of the genitals and adjacent parts. While it is occasionally met among women not pregnant it is more often an accompaniment of gestation. It frequently occasions the most exquisitely excruciating agony. The desire to rub or scratch the parts may be almost irresistible even during sleep, and the skin may become excoriated and sore. The itching may be purely nervous in origin, but may also result from irritating and acrid vaginal discharges and from such diseases as diabetes, jaundice or Brights disease. Absolute cleanliness — the frequent use of water — is one of the first requisites of relief, and to this end we can heartily endorse Dr. Shew's advice in regard to the use of the sitz bath. Maintain the most perfect cleanliness of the vagina and those structures that can be in any way influenced by its secretions. The sitz bath may be used as often as the itching returns — several times a day. After the bath a lotion of borax in water may be ap- plied, say one ounce of borax to a pint, or two teaspoon- fuls of aromatic spirits of ammonia in a glass of water, 114 PAINLESS CHILDBIRTH or sulphite of soda, one ounce to the pint, applied freely. These lotions may be applied successively until relief is obtained. The following lotion used after bathing the parts will often succeed when others fail. Borax, ..... 2 drams Oil of Peppermint, . . . 6 drops Hot Water, .... 1 pint Directions — Use locally as a lotion. Nervous women suffering from local pruritus should take asafoetida or valerian pills, but when the trouble is caused by constitutional diseases she should place herself in the care of her family physician for proper treatment. Occasionally there is an itching of the whole body without any rash or eruption on the skin. Relief can often be obtained by a prolonged soda or alkaline bath followed by a smearing of the skin with plain or car- bolized vaseline. FAINTING It may occur at any period of gestation, especially when tight lacing is indulged in or the woman has to remain long in heated rooms or bad air. It is especially liable to occur at " quickening. " It is to be treated the same as when it occurs at other times. Lay the patient in an easy position, the head low, and loosen the clothing; allow the cool air to blow in the face; sprinkle a little water in the face or have her inhale the fumes of ammonia or " hartshorn" as it is more commonly called. Camphor may be rubbed upon the face and neck. Avoid excitement or alarm. She should remain in a recumbent position until entirely recovered. '. REMEDIAL TREATMENT 115 In the interval between the attacks a 3-grain pill of asafoetida after meals should be given to nervous, hysterical women in whom fainting spells are most likely to occur. PALPITATION This is a frequent annoyance and is most liable to occur in nervous women and those who pay too little attention to the rules we have already prescribed. In the early months it is generally sympathetic, but later on is usually caused by the enlarged womb inter- fering with and embarrassing the action of the heart. Pale, nervous women suffering from palpitation need fresh air, easily-digested food and a good iron tonic. Asafoetida sometimes does good and a belladonna plaster applied over the heart often gives relief. The bowels should be regular. Palpitation often disappears at the time of lightening — about two weeks before confinement. MOTH OR LIVER SPOTS When these spots occur on the face they are very an- oying to some. The general supposition is that they cannot be removed. Painting them once or twice with the compound tincture of iodine (LugoFs solution) will usually remove them. Those who would object to the color of the iodine while it remains may try the colorless tincture of iodine. Apply thoroughly. A good lotion is: Corrosive Sublimate, ... 1 grain Tincture of Benzoin, . . J^ dram Almond Emulsion, ... 1 ounce Directions — Apply to discolored spots night and morning. Warning — Corrosive Sublimate is very poisonous, and care should be taken that none of the lotion gets into the eyes. 116 PAINLESS CHILDBIRTH Many cases have been cured with the following ointment : Ammoniated Mercury, . . 1 scruple Subnitrate of Bismuth, . . 1 dram Vaseline, ..... 1 ounce Directions — Apply to spots night and morning. TOOTHACHE The frequent occurrence of toothache in pregnancy explains the origin of the old proverb "For every child a tooth." Warm applications and other home remedies should be used until a dentist can be consulted. In the average case there is no good reason why a tooth should not be treated or extracted or a cavity filled during preg- nancy just as at other times. But long, tedious opera- tions on the teeth, such as crown and bridge work, should be postponed until after confinement. IRRITABILITY OF THE BLADDER Many women suffer during the entire term of preg- nancy from an almost constant desire to empty the bladder, compelling them to urinate every few minutes, passing a few drops at a time with pain and burning. In the early months it may be due to mechanical irritation from pressure of a displaced uterus against the neck of the bladder, and later on from pressure upon the body of this organ. In numerous other instances, however, it cannot be attributed to any such mechanical cause, but is due to some abnormal condition of the bladder itself. Usually, the urine is not increased in quantity, but rather diminished and often scalding. The measures already advised in the chapter on hygiene and diet will usually prevent this trouble, or the employment of Dr. Dye's Mitchella Compound REMEDIAL TREATMENT 117 will overcome it, but occasionally a case may resist these means. I would then advise: Fluid Extract Populus, . . 1 dram " Water, ..... 2 ounces A teaspoonful every two or three hours till relieved, to be. renewed if the trouble occurs again. I have also found the homeopathic remedies, can-- tharis or apis, to relieve this condition. I have employed them by putting five drops of the mother tincture in half a glass of cold water and giving a teaspoonful every hour until relieved. As soon as relieved stop* taking them. A tea made of couch grass, slippery elm or flaxseed drank freely is a very efficient remedy for this complaint. Five drops of the tincture of nux vomica in a little water three times a day for a week or two is a useful remedy. If the bladder be inflamed a five-grain tablet of urotropin should be taken three rimes a day and a physician consulted as to the advisa- bility of washing out the bladder. NERVOUSNESS Those who are subject to nervousness know what it is without any special description. The nervous system is impaired, irritable, and though there may not be any pain the sensation is even worse; no posi- tion seems the proper one; a general uneasiness pre- vails without nausea; no special organ appears to blame, and yet in the majority of cases there is a general impairment of function. We can accom- plish much in improving the general condition by the dietetic and hygienic means already laid down; but the peculiar nervousness will, in many cases, de- mand special prescriptions. Do not resort to opiates 118 PAINLESS CHILDBIRTH or Dover's powders, morphine, or chloral hydrate, lest you become habituated to their use. When these drugs are used it should be under the supervision of a competent physician. Dr. Dye's Mitchella Compound is an excellent remedy to allay nervousness. An infusion of lady slipper or American nervine is often used, with good results. Under the influence of either of these medi- cines quiet sleep is encouraged and a general improve- ment is induced. A pill of asafoetida three times daily after food often does much good. When the above remedies are employed it is seldom indeed that narcotics will be required. CONVULSIONS It is not best to rely upon unprofessional advice in case of convulsions, though until the physician arrives the following may be given in teaspoonful doses every half hour or hour: Bromide of Potash, . . . 1 dram Bromide of Ammonia, . . 1 dram Water, ..... 1 ounce Mix. A host of remedies have been tried in this ailment and many plans advised, but as professional aid must be employed we do not think it best to advise, particu- larly as it does not come within the scope of a popular work. SWELLING OF THE HANDS AND FEET The same causes that operate to produce varicose veins may give rise to swelling of the feet and hands and in rare cases of the whole body. The swelling of the extremities will usually be of a dropsical char- acter, pitting upon pressure. Obstruction to the return REMEDIAL TREATMENT 119 current of blood through the veins causes an infiltra- tion into the cellular tissues of a watery fluid and is quite a common ailment of pregnancy. During the night or while lying down it usually diminishes con- sider ably, to reappear when the extremities are again placed in the most dependent position. Of course, it may be induced by diseases of the heart, liver and kidneys, but when these maladies are not present it is pretty safe to suppose that it depends upon pregnancy and will disappear entirely after delivery. It seldom requires any special attention further than what can be secured by bandaging as advised for varicose veins , the recumbent position, the fruit -diet and the use of Dr. Dye's Mitchella Compound. I have seen the latter perform wonders, almost, in this ailment and it is safe and applicable to the general aspects of the woman as well as to a special symptom. The free action of the kidneys favors relief. There are very many of the more vigorous diuretics which can be employed with benefit, but as they will be so rarely needed when the hygienic, dietetic and remedial measures already prescribed are employed I will leave their employment should neces- sity for them arise to the physician who sees the case. For my own part I have found the directions I have already given to be equal to the necessity, even if they are simple. LEUCORRHOEA Leucorrhoea, an exceedingly prevalent affection, is usually due to the existence of some disease of the uterus or vagina of which it is a symptom. When it has existed prior to conception it is very apt to continue and often gives rise to very great annoyance from the debility, soreness or irritation it causes. 120 PAINLESS CHILDBIRTH The treatment will be essentially the same as when it occurs in those who are not pregnant, though instru- mental treatment will be inadmissible. Absolute clean- liness is essential; the sitz bath is excellent. The de- composition of the perverted secretions gives rise to irritation and must be overcome by ablutions, injec- tions, etc. Injections may be made of tepid water or soap suds or they may be medicated. They should be used daily or oftener to be of any use, and no force should be permitted. An infusion of white pond lily root is an injection in which many have great confidence. Carbol- ic acid, five grains to a pint of water used at a sitting, is an excellent disinfectant and exerts a control over the abnormal discharge. Common soda, a teaspoonful in a pint of water is good; astringents in the form of infusions may be used. Hemlock bark, oak bark, golden seal root, crane's bill are all applicable, but should not be used too strong. As a rule, an ounce or less to a pint of hot water standing till cold and used after the proper steps to secure cleanliness will be about the strength adapted to the majority of cases. The list of remedies for this complaint could be greatly enlarged, but as some of them might have a tendency to cause miscarriage I have purposely avoided them. The discharge being a symptom of disease of some portion or portions of the reproductive organs the proper time to pay the most attention to its cure is when the delivery has passed; hence, simple means only are recommended, first and foremost of which is cleanliness. REMEDIAL TREATMENT 121 SLEEPLESSNESS— INSOMNIA Inability to sleep is particularly annoying to preg- nant women and should receive prompt attention, for if long continued it may give rise to serious consequences. It may be due to lack of exercise or too steady confine- ment in heated rooms. Dyspepsia is a common cause and should be overcome by a well regulated diet and avoidance of late suppers. Tea and coffee may be reck- oned among the causes and should not be taken in the afternoon or evening by those who are apt to be wake- ful. Reading anything exciting in the evening, writing or any severe exercise of the mind has a tendency to prevent sleep. Incorrect living is the underlying cause and to correct it is the first step towards cure, and if the cause can be appreciated and understood we shall succeed. The sleeping room should be well ventilated and quiet — neither too warm nor too cold. A regular hour for retiring is advisable. A glass of hot milk before retiring may aid in inducing sleep, and a warm bath taken at ninety to ninety-six degrees just before going to bed will often prove a valuable remedy. A rapid sponging and rubbing the surface of the body has much the same effect. It is not advisable to take opiates if possible to avoid them, and for this reason we will not give any recipe for them nor for those other abused drugs, chloral hydrate, sulphonal and trional. When taken let their use be sanctioned and directed by a physician who can observe their effects. The remedies recommended in the beginning of this chapter usually control any unnatural excitement, allay irritability and nervousness and produce sleep. 122 PAINLESS CHILDBIRTH CRAMPS— HIP-ACHE— SCIATIC PAINS Some women are very much annoyed by cramps or spasms in the lower extremities, often worse at night, resulting from pressure of the enlarged uterus on the sacral nerves. The pain sometimes shoots down the thigh as far as the knee or may be localized in the hip- joint (hip-ache). Women w^ho suffer from habitual constipation or displacement of the womb and those in whom the child is large and heavy are as a rule more bothered with cramps than others. The bowels if constipated must be thoroughly emp- tied by laxatives and copious rectal injections of soap- suds containing castor oil, Epsom salts, glycerine or turpentine. The womb if displaced or tilted should be restored to its proper position by a physician. If the cramps are due to a large and heavy child the woman should wear loose clothing and when lying down should turn frequently from one side to the other, so that the pressure shall not be too long continued upon those nerves that are distributed to one or the other extrem- ity, and avoid lying on the back long at a time as that position is most apt to bring pressure upon the large blood vessels and plexuses of nerves. Frequent changes and brisk friction with the hand are better than drugs. A properly constructed abdominal bandage so arranged as to support the enlarged abdomen and rather lift it by straps from the shoulders will often put an end to this disagreeable symptom. Much benefit often comes from assuming the knee- chest position. Pale anemic women will get gradual relief as the health improves under the influence of fresh air, generous diet and a good iron tonic. Nervous REMEDIAL TREATMENT 123 women should take bromide of potash or asafoetida in the way advised in other parts of this book. SALIVATION When the saliva is formed in such excess as to prove annoying, the bowels should be kept quite free with Epsom or Rochelle salts, a lozenge containing tannic acid or chlorate of potash allowed to dissolve slowly in the mouth every few hours, and tincture of iodine painted over the salivary glands at the angle of the jaw. Bromide of potash taken internally produces the best results. THE BREASTS AND NIPPLES During pregnancy the breasts and nipples should be prepared for the very important duty they must per- form after the baby is born. They should have ample room to grow and enlarge and should be protected from pressure or injury. They should be washed twice a day with soap and warm water, great care being used to remove as gently as possible crusts and branny scales from the nipple. After being thoroughly dried they should remain uncovered and exposed to the air for twenty or thirty minutes. In the last month or two a little cocoa butter, castor oil, borated vaseline, cold cream or albolene should be smeared over the nipple at bedtime to soften the skin. If the nipples are small or sunken they should be gently drawn out two or three times a day during the last month or two of pregnancy, but no unnecessary force should be used, as rough manipulation may cause cracks or fissures in the nipple. Every effort should be used to keep the nipples soft and pliable and no attempt should be made to harden them by the use of alum, tannic acid, alcohol or other astringent, as was the 124 PAINLESS CHILDBIRTH former custom. In those exceptional cases, however, where the skin is thin, tender and sensitive there is no objection to the use of witch hazel or the following lotion for a week or two: Tannic Acid, .... 1 dram Glycerine, . - . . . J^ ounce Rose Water, . . . . }/£ ounce Directions — Apply daily to nipples and surrounding skin. CHAPTER X MISCARRIAGE The interruption of pregnancy by the expulsion of the child before the seventh month is called a mis- carriage or abortion, and when it occurs at any time from the seventh month up to about two weeks before full term it is known as a premature birth. Miscarriages are most likely to occur in the early months, usually at a time corresponding with what would have been a menstrual period, and often pass unrecognized. They are most frequent in women who have previously had children. Women who marry late in life are more prone to miscarry than those who marry early in life. Some women are habitually liable to miscarriage when they reach a certain stage of gestation, and a woman who has been once the subject of this accident is much more liable to a repetition of the occurrence than one who has not. In early married life the idea often obtains that children are not desirable, for some reason or other, and not succeeding in preventing con- ception a worse crime is resorted to. How many women have found to their sorrow that the damage they then do lays the foundation for a miscarriage at every 126 PAINLESS CHILDBIRTH succeeding pregnancy. For this reason alone hundreds of homes are lonely and desolate. CAUSES OF MISCARRIAGE Some miscarry at a certain time without any assign- able cause. Any violent exertion, anything that occa- sions a shock or spasmodic action of the abdominal muscles, the irritation of piles, excessive sexual indul- gence, a blow, a fall, violent emotion, nursing, riding over rough roads, missteps, running a sewing machine, stretching the arms above the head, tripping, heavy lifting, hot sitz and foot baths, tight lacing, hot vaginal injections, abuse of cathartics, disease and displace- ment of the womb, affections of the ovaries, the occur- rence of fevers and eruptive diseases, excessive vomiting, weakness, plethora — any excitement that is capable of exciting contraction of the uterus is liable to terminate in miscarriage. The occurrence of this accident in the first pregnancy is very apt to establish the habit. SYMPTOMS OF MISCARRIAGE These are rather variable, of longer or shorter dura- tion, from a few hours to several days, and the conse- quences are equally various. Symptoms that give warning of an approaching miscarriage sometimes occur and, therefore, when a pregnant woman has more or less severe aching pain in the back, nausea or vomiting, frequent urination, pains shooting through the bowels, languor, uneasiness and a mucous or watery discharge from the womb she should remain quiet in bed and send for her physician so that prompt and proper treatment may be given. In the majority of cases hemorrhage or bleeding from the womb is the earliest symptom of miscarriage. It varies greatly in amount — sometimes being very MISCARRIAGE 127 slight, in other cases so sudden and profuse as to cause the greatest anxiety. The bleeding may continue steadi- ly or interruptedly for hours or even days before the pains come on, and large clots of blood are often passed before the foetus is expelled. The pains are caused by the contractions of the muscles of the womb and at first are usually slight, of short duration and recur at long intervals. Later on they become more frequent and regular and so strong and forceful that, aided by the voluntary expul- sive efforts of the woman, the foetus with membranes and afterbirth is expelled. Sometimes the pains are like those of actual labor and many women have de- clared that miscarriage pains are more severe, harder to bear and less easily forgotten than those of labor itself. The mouth of the womb for physiological reasons is not as readily dilated as at the full term and, in consequence, more prolonged efforts are usually necessary and greater suffering experienced. Sometimes the foetus will be expelled with little pain, scarcely any hemorrhage and a quick recovery. In other cases it may come on with hemorrhage, and after a protracted and painful labor the foetus will be expelled. The placenta or afterbirth or the mem- branes may remain and not come away for several days. So long, however, as the placenta or membranes or any part of them remains in the womb there is danger of hemorrhage and blood poisoning. Preceding, accompanying and sometimes following the miscarriage there may be alarming hemorrhage. It may be internal or external. When external, the patient and friends may be deceived until a fatal termi- nation is the result. When internal, the patient gets 128 PAINLESS CHILDBIRTH pale and faint, exhausted; the pulse becomes quick and thread-like; there will be headache, shivering, pain; the abdominal cavity fills up and becomes larger than the stage of pregnancy will warrant; after a time the membranes give way, the floodgates of life are opened and the vital current escapes with a gush. The woman may die from internal hemorrhage without its escape. The more nearly the woman has approached the natural term for delivery the less the danger. Ordi- narily, the hemorrhage constitutes the primary danger and it usually cannot be perfectly and permanently controlled after the progress of the labor has well ad- vanced until the contents of the womb are expelled and the organ has contracted. The hemorrhage is sometimes alarming, profuse, fatal. MANAGEMENT OF MISCARRIAGE Three indications present themselves from which a selection is to be made: First, to prevent its occurring, if possible. Second, to arrest it. Third, to carry the patient safely through the proc- ess, provided it cannot be prevented or averted. If aware that a patient is in the habit of aborting I should advise the hygiene and diet already recom- mended and a Mitchella Compound Tabule before each meal and at bedtime. This, with perfect rest in the recumbent position, a cool room, absolute quiet, a calm, unruffled mind, unstimulating food, regularity of bowels and the avoidance of sexual relations are the essentials of success. If we can carry the patient past the fifth month we shall generally succeed. Regulate the bowels with some MISCARRIAGE 129 of the means already mentioned and, if the irritability of the uterus continues, we must resort to opium — a grain in powder or pill every four hours until all pain is relieved, to be repeated if it recurs. The action of the opium is as positive as anything can be and, if the symptoms are active, alternate it with the fluid extract or strong infusion of cramp bark. This is as its name implies a potent remedy and has stood the test of years. It may be given freely. It is said that the planters of the South formerly compelled their preg- nant slave women to drink an infusion of it in order to frustrate their attempts at abortion. When hemorr- hage and pains occur together there is very little chance of preventing threatened miscarriage. Should our efforts fail in preventing the miscarriage it must be managed like a case of labor (which see). Hemorrhage being the greatest danger, if it becomes too free I would give five grains of gallic acid in a wine- glass of cinnamon water and repeat as often as may be necessary or, if cinnamon water or tea is not at hand, I would not wait, but use plain water. Cinnamon is, however, valuable of itself. Care must be taken to assure the entire removal of the placenta and membranes. There will be danger until everything "has come away." Should bleeding persist or the discharges acquire an offensive odor it may be necessary for the physician to scrape or curette the womb. The greatest possible cleanliness should be observed. The external genitals should be frequently washed with soap and hot water and an antiseptic solution, and diapers and bed linen kept scrupulously clean. A woman should receive the same care after a miscarriage as 130 PAINLESS CHILDBIRTH after a full term delivery and should remain in bed for ten days or two weeks. If this advice were more generally followed there would not be nearly as many women suffering from so-called " female weakness/' It we can ascertain the cause of abortion we can usu- ally overcome it or remove the patient from the sphere of its operation. It is not expected that the unprofessional reader is going to rely implicitly upon the directions we have given. In cases that are alarming or troublesome a physician must be called — one who can determine the questions that may present obstacles to others. Our wish is to furnish means of prevention, and aid the physician in arresting or conducting the process of miscarriage. Among the results to the mother other than death from either accidental or artificial miscarriage are the whole train of ailments of the reproductive organs of women. Displacements, inflammations, ulcerations, deformities, ovarian disorders, leucorrhoea, irritation of the bladder, barrenness, mental disturbance, general ailments, etc. Although many women are subject to these diseases who do not miscarry, it is nevertheless true that they are the bane of woman's existence. They are often regarded as incurable and under the old regime they generally were, but in the light of a proper understand- ing of the principles of these ailments and the remedies at our command I have been able to cure many after they had been pronounced incurable by others. Abhorring the harsh treatment of the past it will doubtless be a source of comfort to many an afflicted MISCARRIAGE 131 woman to know that by properly considering the consti- tution, the disease and its complications we can gener- ally send medicines to use at their homes that will restore them to health. Symptoms are the language of diseases and for the most part are intelligible. Know- ing this it will place a cure at the disposal of thousands who could not travel hundreds of miles to consult the physician of their choice. Although this may appear incomprehensible to some and be opposed by those specialists who can do nothing without the " speculum and caustic" it is none the less true that applying these principles to practice I am constantly curing patients whom I have never seen, many miles away. CHAPTER XI PREPARING FOR CONFINEMENT ARTICLES TO BE PROVIDED FOR CONFINEMENT To save unnecessary confusion at the time of labor every expectant mother should, some weeks before her expected confinement, get together those things that will be needed for the proper care of herself and her child. The following is a fairly accurate list of neces- sary articles and it is a good plan to place all of them in a specially prepared box or dresser drawer reserved for this one purpose: 1 Rubber sheet or oilcloth as large as the mattress. 1 Small rubber sheet, 1 yard wide and 2 yards long, to be used under the hips. 2 Porcelain or granite basins. 1 Porcelain or granite bedpan. 1 Two-quart fountain syringe. 1 Pail or slop jar. 6 Towels. 2 Water pitchers. 1 Small bottle of antiseptic tablets (corrosive subli- mate). 1 Pound absorbent cotton. 1 Can (5 yards) borated or carbolized gauze. 20 yards sterilized cheesecloth for pads or napkins. 2 Abdominal binders. 2 Breast binders. PREPARING FOR CONFINEMENT 133 4 T-bandages for pads or napkins. Narrow tape (bobbin) or braided silk for tying the cord. 2 Dozen safety pins (large). Castile soap. 4 Ounces whiskey or brandy. 4 Ounces lysol. 4 Ounces saturated solution of boracic acid. 4 Ounces Cacao butter, sweet oil or albolene. 1 Small blanket in which to place the baby. 1 Crib or basket for the baby. Baby clothing. CONFINEMENT OR LYING-IN ROOM The average confinement occurs in the room ordi- narily occupied by the expectant mother as a bedroom. But when a choice of several rooms can be made it is advisable to select one that is large, easily ventilated and with a sunny exposure. An open fireplace is very desirable. The nurse should see to it that the room is at all times pleasant and cheerful and that all unnec- essary draperies and furniture are removed. A confine- ment should never occur in a room recently occupied by a person suffering from scarlet fever, measles, ery- sipelas or other contagious or infectious disease unless the room has been thoroughly fumigated and disin- fected. CLOTHING WORN DURING LABOR When symptoms of labor appear, the woman should take a tub or sponge bath and change all her linen. A clean nightgown should be put on and, over it, during the first stage, a loose wrapper or kimona. The chemise and nightgown should button in front and not be too long, so that they can be readily changed 134 PAINLESS CHILDBIRTH when soiled. No clothing should be worn suspended by bands at the waist. THE CONFINEMENT BED When it can be had, a lounge or cot-bed properly- arranged is the most convenient couch on which de- livery can take place, for it permits to the best possible advantage the assistance of the attendants; can *be readily moved to suit any necessity, and preserves the bed in which she must subsequently lie dry and com- fortable. This temporary bed should be moderately hard and firm, so that it may not sag downward beneath the hips of the woman; the head should be a little the highest, and the foot provided with a convenient, narrow footboard at an agreeable angle of inclination, against which she may press with her feet during her expulsive efforts. A sheet should be twisted into a cord and fastened to the foot-piece for her to grasp in her hands and pull upon during the " bearing down pains. " It is needless to add that this temporary bed should be of sufficient width for convenience, that she may turn herself from one position to another to lessen the fatigue of unnecessary restraint. HOW TO PREPARE THE BED The large rubber sheet is placed on the mattress and tightly pinned at each corner. This is covered with a linen or cotton sheet and also a draw-sheet tightly tucked under the mattress. Over the draw-sheet are placed the small rubber sheet and a second draw- sheet (made by folding an ordinary sheet into four thicknesses) that should be tightly pinned at each corner so that it may not be easily pulled out of place. After labor,the small rubber sheet and the upper draw- sheet can be easily removed with the other soiled clothes. PREPARING FOR CONFINEMENT 135 THE ABDOMINAL BINDER OR LYING-IN BANDAGE Though some physicians declare that the bandage or binder is useless or even harmful, we always advise that one be put on, because if properly fitted it certainly adds to the comfort of the newly-made mother by over- coming the feeling of emptiness that exists after the baby is born. Two of these binders should be made from unbleached cotton or muslin some weeks before confinement. The binder should be a yard and a quar- ter long and half a yard wide or wide enough to reach from the hip bone to the lower part of the breast bone. When first put on it should be pinned from below up- ward and be fairly tight. When there is any tendency to excessive hemorrhage or flooding, a pad or compress made of two or three folded towels should be placed over the womb beneath the binder. The binder is rarely needed after the first week or ten days. THE BREAST BINDER A binder or bandage is often needed to make pres- sure on the breasts or to hold poultices, fomenta- tions or other applications in place. The Murphy Figure 11 breast binder is an excellent one, and is made from a double fold of muslin long enough to go around the body and wide enough to reach from the neck to the waist. The edges should be stitched and 136 PAINLESS CHILDBIRTH on one edge notches cut for the neck and each arm. Small safety pins are used to pin it in front and over the shoulders and to form darts under the breasts. A breast bandage made like a Y from three toilet napkins is preferred by many. Pin two napkins to- gether to form a V and fasten them to the middle of one end of the third napkin. Pass the single napkin across the back; carry the two napkins over the chest, one above and one below the breasts, and pin to the single napkin. This bandage is often used to support or hold up the breasts. BABY'S BASKET Figure 12 It is a great convenience to have a basket or box in which to place all those things needed for the care and PREPARING FOR CONFINEMENT 137 toilet of the baby. Many stores carry many different styles of such baskets, but one that will prove in every way suitable can be easily and cheaply made at home. A basket with a lid — hamper style — 2^ feet long, 15 inches wide and 8 inches deep, is about the right size, and when covered and lined with some dainty materi- al is both attractive and useful. Pockets may be placed at the corners and a pincushion on the under side of the cover. The basket should contain the following articles: Castile soap, bath thermometer (Fig. 13), pincushion, Figure 13 several sizes of safety pins, washcloths, powdered stearate of zinc, toilet powder, bottle of pure olive or sweet oil, jar of cacao butter or well washed lard, solution of boracic acid, absorbent cotton, some old Figure 14 linen handkerchiefs or pieces of soft linen, baby comb and brush, infant's syringe (Fig. 14), medicine dropper (Fig. 15). Figure 15 138 PAINLESS CHILDBIRTH BABY'S BATHTUB A large porcelain basin will answer very nicely for baby's first sponging, but for later baths a porcelain or white enamel baby bathtub should be provided. BABY'S WARDROBE The quality and amount of clothing will necessarily vary according to circumstances, and the following list is therefore intended simply as a guide to the expect- ant mother : 2 Flannel binders 18 inches long and 5 inches wide, with piiked edges. These are used for the first two months. 2 Knitted bands with shoulder straps. They should be made of wool in the winter time, of cotton in summer. 6 Shirts — wool for winter, cotton for summer. 4 Flannel petticoats. 4 Muslin petticoats. 8 Slips or dresses. 6 Nightgowns made of light weight flannel. 6 pairs socks. 4 dozen diapers of cotton diaper cloth. 2 Flannel or knitted blankets for wrapping about the baby. BABY'S BED A wicker bassinet or even a clothes-basket is the best bed for a new-born infant. The possibility of the child being smothered or rolled upon and the harm that might result from too frequent nursing consti- tute strong reasons why the babe should not sleep in the same bed as the mother. When the baby is four months old it may be placed in its own bed or crib. PREPARING FOR CONFINEMENT 139 The hair mattress should be protected by a rubber sheet on which is placed a bed pad made of a yard- square piece of mattress covering. The bed sheet should be large enough to allow it to be well tucked under the mattress. The pillow should be of fine curled hair and large enough to support both head and shoulders. Light-weight flannel blankets and wool or cotton comforters will be all the bed covering that is required. Good habits should be taught from the first, and the baby should not be taken up every time it cries nor quieted with so-called soothers, pacifiers or hushers. CHAPTER XII MANAGEMENT OF LABOR At the expiration of nine calendar or ten lunar or menstrual months or, more definitely, two hundred and eighty days after conception the foetus having advanced far enough in physical development to maintain an independent existence is separated from the mother by a natural process termed labor or childbirth. It is possible for the foetus to survive if this process should occur at an earlier period, and instances are not uncommon of survival at the end of the seventh month or even earlier, and instances are reported where the infant has survived birth at the end - c W~~- 2 r j f 1 ; 1"™". : h s^y CHAPTER XVI DISEASES OF WOMEN The distinguishing characteristics of woman's organi- zation render her liable to certain diseases from which men are exempt. As these ailments are not necessarily associated with gestation, both married and single are subject to them. A consideration of these matters does not form a necessary part of this book, but I have been so repeat- edly solicited for a book on diseases of females that I have concluded to add this chapter. Social customs impose on woman unhygienic condi- tions that impair her constitutional vigor and favor the development of uterine diseases. Many of them are primarily local, but they exert such a profound influ- ence on remote parts through the medium of the sym- pathetic nervous system that the whole constitution suffers; the functions of various organs are perverted and the social faculties are deranged to such an extent that the woman who was formerly happy and cheerful now becomes one of the most miserable of beings. In this way derangements of the stomach, liver and kid- neys are caused; affections of the brain and nervous DISEASES OF WOMEN 209 system are produced, dyspepsia supervenes with innu- merable symptoms, the blood-making process is im- paired and often fatal consumption results. All healthy females are subject to a peculiar function that recurs periodically about once in twenty-eight days, between the ages of thirteen and forty-five. It is called the catamenia or menses from mensis, a month, and is characterized by the elimination and discharge Figure 2S The pelvic organs, showing the womb, ovaries, fallopian tubes, bladder, and ligaments. of a sanguineous fluid. This period of menstrual ac- tivity is subject to variation in different climates, and in even our own, 43 degrees north latitude, remarkable instances are recorded where it has appeared much earlier or continued much later. It defines the prolific period of woman's life, and upon the regular occurrence of the function and its proper performance her physical 210 PAINLESS CHILDBIRTH welfare materially depends. The derangements of menstruation are divided into three classes, viz.: Ammenorrhoea, Dysmenorrhoea, Menorrhagia. AMMENORRHOEA Ammenorrhoea signifies the absence of menstruation from other causes than gestation or the natural cessa- tion at the end of the prolific period. When menstrua- tion fails to appear at the proper age it is called reten- tion; when it does not appear at the* proper time after having been once established it is called suppression. Retention is usually due to a delicacy of the consti- tution, in which the proper amount of vital stamina or nervous energy is absent, diseases of the lungs, liver, kidneys, anemia, etc.; or it may be due to disease or absence of the ovaries, uterus or vagina. The secretion may be prevented from escaping by an imperforate hymen. A certain amount of physical force is necessary for the performance of any function, and if at the time the girl should develop into woman- hood anything occurs to lower her vitality it will tend to prevent the development of menstruation. Every mother should be solicitous for the welfare of her daughter at this critical period, for carelessness then may cost her life. She should be instructed what she may expect at such a time, lest suddenly surprised she may do something to her disadvantage. The symptoms necessarily depend more or less on the cause of the retention. If the ovaries or uterus are absent, no menstruation will ever occur, no matter what treatment may be tried. If there is imperforate hymen or occlusion of the mouth of the uterus there DISEASES OF WOMEX 211 will be the usual monthly disturbance, but the secre- tion cannot escape. In such cases there will be local pains and, as it goes on, a fullness, distention, a sen- sation of bursting, straining at stool and when urina- ting, enlargement, etc., etc. The obstruction being of a mechanical character, surgical measures to establish the passage will be needed and must not be delayed too long. When due to constitutional causes there will be a pale, sallow, waxy, sodden, sickly appearance of the complexion, the tongue furred, breath offensive, appe- tite variable, morbid cravings, nausea, general debility, easily fatigued, languor, pain in the back and limbs or bowels, cold feet, wasting of flesh, dyspeptic symptoms, constipation, palpitation, despondency, vertigo, head- ache, noises in the ears, and perhaps leucorrhoea, nose- bleed, etc., etc. Debility is the type of this condition, and remedies to invigorate — to build up — must be employed. At the same time we must attend to the correction of any functional disturbance that may occur. The blood is impoverished, there is anemia, and iron is generally needed, and as digestion is usually weak and the appe- tite poor it can be combined with a bitter tonic with advantage. A good and pleasant formula is: Elixir calisaya iron and strychnia, a teaspoonful before each meal, or compound elixir of phosphates is a good form in the same doses. They may be changed, giving one for a week and then the other. In some cases the addi- tion of a little arsenic in the form of Fowler's solution materially increases the beneficial influence of the medicine. My prescription then would be: 212 PAINLESS CHILDBIRTH Compound Elixir of Phosphates, 8 ounces Fowler's Solution, ... 1 dram Dose — A teaspoonful before each meal. Aloes has for many years enjoyed an excellent repu- tation in such cases; it improves nutrition, overcomes the constipation and favors the development of men- struation. Its disagreeable taste is the greatest objec- tion. The following formula is a good one, not unpleas- ant and can usually be procured anywhere: Sulphate of Cinchona, . . Y^ dram Red Carbonate of Iron, . . 1 dram Aqueous Extract of Aloes, . 5 grains Sugar in powder, ... 1 dram Mix thoroughly and make thirty powders and take one three times a day. If palpitation is annoying, in addition give three to five drops of the homeopathic tincture of cactus grandiflorus in water three or four times a day. When the nutrition and blood-making process has been improved by the foregoing agents, we may begin the use of remedies that have a direct influence on the uterine functions, as the senecio gracilis — also called female regulator, life root, squaw root, unkum, etc. It may be given in an infusion or fluid extract or homeopathic tincture ten to twenty drops three times a day in water or syrup. Dr. Dye's Mitchella Com- pound is, however, the best of all tonics for the womanly organs and we always advise that it be used in cases of this kind. Forcing medicines are not advisable. All through the treatment give a nutritious diet that is easy of digestion, out-door exercise, pleasant scenery, riding, etc. Abstain from labor, study or anything that exhausts. DISEASES OF WOMEN 213 Suppression may arise from various causes, the most frequent of which are pregnancy or sudden cold. It may also be due to debility, to plethora, fevers or various diseases. When due to pregnancy it is not to be regarded as a disease. Suppression may occur in the most robust constitutions as well as in the weakly, while retention is almost always a consequence of de- bility. When suppression is developed gradually, the derangement increasing from month to month, it is generally due to some other disease, as consumption, etc., and the treatment must be selected with a view to overcome those conditions as well as to regulate menstruation. Abrupt exposure to cold, getting wet at the period, violent mental emotions cause sudden suppression. The flow may be suddenly arrested or, these causes occurring at the end of the period, the next return of the same may not take place at the proper time. Such cases require prompt and efficient measures. When sudden cold is the cause, the uterus and ovaries are in a state of congestion and we should employ remedies to relieve the circulation. A hot hip bath, alcoholic vapor bath, hot mustard foot bath and hot appli- cations to the lower abdomen are always beneficial; then internally give: Tincture of Aconite, . . . 15 drops Tincture of Belladonna, . . 5 drops Tincture of Pulsatilla, . . 60 drops Water, ..... 4 ounces Dose — Give a teaspoonful every hour and alternate with a tea of serpentaridj also known as Virginia snake root. Usually in a few hours there will be sweating, relief from the fever and pain, and the flow will be re-estab- lished. 214 PAINLESS CHILDBIRTH If due to plethora, the use of laxative medicines, such as Epsom salts, to act on the bowels, and repeated frequently is almost always advisable. At the same time give : Bromide of Potassium, . . 1 ounce Fluid Extract Black Cohosh, . 3^ ounce Fluid Extract Ergot, . . 3^ ounce Syrup and Water, each, . . 3 ounces Making in all eight ounces, and take a teaspoonful three or four times a day throughout the interval, and as the time for the flow approaches give aconite in one-half drop doses every two hours for two or three days till the flow is established. In lymphatic constitutions give : Iodide Potash, .... 1 ounce Fluid Extract Black Cohosh, . 3^2 ounce Fluid Extract Senecio, . . 1 ounce Simple Elixir, .... 6 ounces Mix. Take a teaspoonful three or four times a day. In anemia give the remedies advised for retention — iron, good diet, etc. In such cases a woman does not menstruate because she has not the blood to spare. Menstruation is frequently irregular both as to the time of occurrence and the quantity and quality of the discharge. It may be too frequent or too long delayed. It may be too much or too little, and some- times there will be at the period a colorless fluid instead of the natural discharge. These deviations from a natural standard are symptomatic and are to be treated accordingly. When too frequent, the ovaries and uterus suffer from an irritable or excitable condition and are apt to be congested by slight causes, and I would advise : DISEASES OF WOMEN 215 Tincture of Belladonna, . . 15 drops Tincture of Apis, 10 drops Water, ..... 4 ounces Take a teaspoonful four times a day. Avoid too long-continued exertion on the feet, ex- citement, etc., and use the cool hip bath daily. If the ovaries are sore and painful on making pressure just inside the point of the hips alternate the above pre- scription with : Bromide Potash, ... 1 ounce Tincture Blue Cohosh, . . J^ ounce Tincture Nux Vomica, . . 1 dram Simple Elixir, to make 8 ounces Dose — A teaspoonful three or four times a day. When the menses are delayed and scanty, showing ovarian and uterine torpor, remedies to stimulate this function are necessary, and if there is debility or anemia combine them with iron: Fluid Extract Helonias, . . 1 ounce Fluid Extract Senecio, . . 1 ounce Fluid Extract Aloes, . . 1 dram Simple Elixir, .... 6 ounces Dose — A teaspoonful three times a day. If anemia exists give: Citrate of Iron and Quinine, . 1 dram Simple Elixir, .... 4 ounces Dose — A teaspoonful after meals. When the period should occur, a tea of mother- wort (also known as leonurus cardica) may be drank freely for several days, or, better still, Dr. Dye's Mitchella Compound may be used according to direc- tions for such cases. DYSMENORRHOEA Dysmenorrhoea signifies difficult or painful men- struation. A very great proportion of the women of 216 PAINLESS CHILDBIRTH the present experience pain at this time, varying in intensity from a slight uneasiness to the most excru- ciating agony. The character and even the location of the pain varies greatly in different persons and is materially influenced by the cause. There are four varieties of the disease, known as neuralgic, inflamma- tory, membraneous and mechanical, and cases are often met in which the three varieties seem to be blended in one. The neuralgic variety is most likely to be met in women of nervous temperament, in delicate health, and may occur at almost any period of menstrual life. The pain is often referred to the ovary, perhaps ex- tends to the back and thighs and is often intense. Cold, mental emotions, sexual abuses, shocks and any- thing that excites or exhausts the nervous system may induce the attack. The treatment consists in relieving the pain at the attack and improving the general condi- tion during the interval. The relief of the pain usually requires hot sitz baths, hot vaginal douches and some- thing of a narcotic or anodyne character, and as much as I object to the indiscriminate employment of such drugs, the relief they afford must, when necessary, be the excuse for their administration. Five grains of phenacetin every four hours for three or four doses usually relieves the pain, or the following prescription may be tried: Tincture of Belladonna, . . 15 drops Tincture of Pulsatilla, . .30 drops Water, ..... 2 ounces Give a teaspoonful every hour until relief is obtained or the belladonna manifests its characteristic effect by dryness of the throat or dilatation of the pupil of the eye, when it should be suspended or given at longer intervals. DISEASES OF WOMEN 217 The hypodermic injection of one sixth or one quarter grain of morphia given by a physician is almost always reliable when all else fails. A suppository may be intro- duced into the rectum or vagina containing: Opium, . . . . . J^ grain Extract of Belladonna, . . 3^ grain Cocoa Butter, . . . .10 grains This will generally give speedy and lasting relief. During the interval an effort must be made to improve the constitution so that another attack may not occur. Avoid tea and coffee and all stimulating diet, excite- ment, sexual relations, etc. Take salt water baths with friction, plenty of out-door exercise, etc., etc., and use this tonic : Compound Syrup of the Hypophosphite, 7 ounces Tincture of Cimicifuga, . . . .5 drams Tincture of Nux Vomica, . . .1 dram Dose — A teaspoonful three or four times a da}'. During the week immediately preceding menstrua- tion give the above prescription of belladonna and Pulsatilla in teaspoonful doses three times a day or, better still, Dr. Dye's Mitchella Compound. In the inflammatory variety there will be more or less of the general symptoms considered under chronic inflammations of the womb. The pain generally be- comes worse when the flow is being established, grad- ually increasing till it reaches its height, and as the flow depletes the vessels of the uterus it subsides. There is generally more or less constitutional disturbance, dragging pain in the hips and back that is not entirely relieved between the periods, headache, leucorrhcea, etc. This form is often associated with a rheumatic condition. 218 PAINLESS CHILDBIRTH The treatment of this form of the disease will be more fully explained when the consideration of chronic inflammation of the womb is reached. Among the other means employed will be the hot sitz bath, hot mustard foot-bath, hot vaginal injections, hot appli- cations to abdomen, the use of opium and belladonna suppository at the period and just previous to the men- strual return, the glycerine and cotton tampon, medi- cated or not as may be desired. In using the injection use a fountain syringe, which f^very lady should have, and continue the flow as hot as it can be borne for half an hour or longer. It usually gives great relief. In the use of the tampon it should be begun three or four days before the anticipated trouble and continued until the flow begins. (For a further description see chronic inflammation of the womb.) For a week before the period commences take the following: Tincture of Cimicifuga, . . 2 drams Tincture of Aconite, . . .15 drops Tincture of Belladonna, . . 10 drops Water, ..... 4 ounces Dose — A teaspoonful four or five times a day. The cure must be effected in the interval, as the measures adopted at the period can only palliate at best. Membraneous dysmenorrhoea is attended with great suffering, and with various modifications consti- tutes a large proportion of all the cases of painful men- struation. It is characterized by the formation and expulsion of clots of dark blood, shreds of membrane and in some cases of complete casts of the lining of the womb. The suffering in such cases usually comes on from one to five days before the flow begins, with f everishness and constitutional disturbance, headache, backache, DISEASES OF WOMEN 219 pain in the pelvis, and as it progresses becomes periodic and labor-like and is in some cases more severe than ordinary childbirth and the female not unfre- quently becomes unconscious. The pain is often spas- modic, expulsive and tenesmic and continues until the flow is fully established and the membrane or clot is expelled. As the pain goes on month after month local inflammation is developed and adds to the difficulty. The general health suffers, the ovaries become con- gested, enlarged, extremely sensitive, the nervous sys- tem becomes weakened and irritable and the condition is one of abject misery. The successful treatment of this form requires an unusual amount of tact and skill, associated with per- severance. Affecting as it does a class of persons among whom there is a w T ide diversity of constitutional pecu- liarities, the treatment will have to be varied to meet the conditions presented by each individual case. The advice already given for relief at the period may be used and will no doubt palliate; but it will usually be found necessary to resort to opiates or narcotics to obtain very marked relief. The following prescrip- tion I have found suitable in nearly all cases, affording temporary relief when other measures had failed. I give the forms of the remedies most generally obtained at any and all drug stores: Fluid Extract Blue Cohosh, . 3 drams Fluid Extract Viburnum. . . 1 ounce Simple Elixir, enough to make 4 ounces Dose — A teaspoonful every hour till relieved. It should be employed before the pam becomes so exceedingly severe, and will prevent untold suffering. 220 PAINLESS CHILDBIRTH If it is carried too far, drowsiness and prostration, inability to open the eyes, double vision, etc., will occur, when it should be stopped for some hours, till these symptoms wear off. It is during the interval that the treatment must be directed to a cure. Dr. Dye's Mitchella Com- pound is the remedy to use because it goes right to the seat of the trouble and removes the cause of the pain. The following prescription will benefit the ma- jority of cases: Fluid Extract Black Cohosh, . 1 ounce Fluid Extract Squaw Vine, . 1 ounce Fluid Extract Colchicum Seed, . 34 ounce Iodide of Potass, ... 1 ounce Simple Syrup or Simple Elixir, . 5 ounces Dose — A teaspoonful three times a day. If there is debility give in addition to the above a good iron tonic or some syrup of hypophosphates containing quinine, iron and strychnine that can be got at any drug store ready prepared. Some of the prescriptions already given containing iron will do. If rheumatism is the predominating trouble, in addi- tion to the prescription containing colchicum it will be well to give alkalies, as the bicarbonate of soda in ten or fifteen grain doses several times a day, dissolved in a little water. Throughout the treatment of such cases a course of hygiene is to be carried out looking to the improvement of the general health, regular hours, warm clothing, baths, good nutritious diet, avoidance of excesses, etc., etc. Marriage has often been urged as a means of cure, but with little propriety, for seldom has a person been benefited when this form of disease exists. Mechanical dysmenorrhoea is due to the presence DISEASES OF WOMEN 221 of an obstacle to the exit of the flow. This obstruction may depend on a stricture or narrowing of the uterine canal or a curvature of the same to such an acute angle as to close the passage, to displacement, to the presence of a tumor or polypus within the passage or any other cause that tends to close the passage. These conditions cause sterility as well as dysmenorrhoea. In such cases the cramp-like pains will be severe, the flow scanty or it may escape in clots or gushes; ovaries become tender and irritable and the whole system often takes on an irritable condition that is extremely unpleasant and annoying. A positive diag- nosis can be made only by a proper examination. Treatment consists in measures to render the canal pervious by the removal of whatever obstruction may exist, the dilatation of the passage by dilators, or inci- sions to straighten and enlarge the same. Of course such measures can be resorted to only by a competent physician, so there is no need to enlarge on the subject here. The use of warm baths is always useful. Thirty drops of fluid extract of viburnum prunifolium every three or four hours will give relief, and the use of the belladonna prescription already given and Pulsatilla are always temporarily useful. In using Pulsatilla, give two to five drops every two or three hours. If the lining membrane of the womb is inflamed it should be curetted or scraped — a. very simple operation when done by a competent physician. MENORRHAGIA Menorrhagia signifies profuse menstruation and also applies to the unnatural and unusual frequency of its return. It may occur at any period of life from puberty to old age. It affects all varieties of constitutions, 222 PAINLESS CHILDBIRTH although the sanguine are most liable. Excessive exer- tion, debility, organic diseases of the womb and ovaries, sub-involution, are fruitful causes. A defibrinated con- dition of the blood and plethora are among the most frequent sources of the disease. It may also be due to such diseases as anemia, tuberculosis, Bright's disease, affections of the spleen and liVer, heart or lung disease, prolonged nursing, anger, grief, passion, excessive exertion at the period, sexual excesses, inflammation of womb, cancer, tumors and polypi. The symptoms vary with the nature of the disease. In mild cases there may be more or less debility, a sense of languor, palpi- tation, dizziness on exertion, etc., with an increased frequency or quantity of the flow. In the severer cases the hemorrhage becomes excessive, the countenance pale, blanched, great prostration, fainting, feeble and rapid pulse, uneasiness, every exertion causing the blood to start freely, etc. The treatment must be directed to modifying the flow at the time and to averting its repetition. During the flow, the recumbent position should be enforced and a bandage applied around the pelvis and abdomen. Then give a tea made of equal parts of cinnamon bark, hemlock bark and witch hazel leaves steeped strong. Give a tablespoonful every half hour or hour, lengthening the intervals as the urgency of the symptoms subside. Five to ten grains of gallic acid in a tablespoonful of water, either alone or in alternation with the tea. Ten drops of the oil of erigeron (fleabane) on sugar may be used with the same fre- quency of repetition. Either of these three remedies is reliable and may be used singly or in alternation. DISEASES OF WOMEN 223 Hamamelis, cannabis indica, aconite, etc., of the homeo- pathic school are excellent remedies. Large doses of ergot are good in cases where the uterus is large and flabby. Give a teaspoonful at once. During the interval, measures adapted to the pecu- liarities of the case should be instituted. If there be anemia or a lack of fibrin in the blood, iron is neces- sary. If Bright's disease or affections of the spleen exist, treatment appropriate to them is necessary. If there is syphilis, an alterative and tonic course is needed. If it is due to sexual excesses or abuses it must be abandoned, and remedies adapted to over- come the nervous prostration associated with this condi- tion are to be used. Such conditions should receive the attention of a competent physician, as they are so variable that prescriptions given here may need to be varied more or less. A large proportion of cases need a uterine combined with a constitutional tonic, and for such the following will be found excellent: Fluid Extract Helonias, . . J^ ounce Fluid Extract Senecio, . . 1 ounce Fluid Extract Trillium, . . 1 ounce Fluid Extract Nux Vomica, . 1 dram Simple Elixir, . . . . 5 ounces Dose — A teaspoonful three times a day. Give a nutritious but not stimulating diet, cold hip baths, sponge baths, moderate out-door exercise. Avoid all excitement. If the patient be plethoric she should be given free cathartics frequently. If tumors or polypi exist, the proper surgical treatment for their removal is necessary. VICARIOUS MENSTRUATION If at the time when the menstrual period arrives a sanguineous discharge from some other part takes 224 PAINLESS CHILDBIRTH place it is called vicarious menstruation. It may occur from any part, but usually comes from a mucus mem- brane like that of the mouth or nose, but it may also come from the nipple or an open sore. It presents all the characteristics of the menstrual flow and is usually due to a watery condition of the blood. When the uterine function is re-established, this vicarious func- tion ceases. The treatment generally required is to re-establish the natural function, and for this purpose emmenagogue remedies are needed, among which cotton root in one or two teaspoonful doses of the fluid extract three times a day for several days at the ap- proach of the period is a good remedy. Also senecio gracilis and other remedies advised under ammenor- rhcea. If the discharge takes place from the lungs or stomach, remedies to control the hemorrhage as well as to bring on menstruation may be required. Of course any other perverted function should be corrected. LEUCORRHOEA Leucorrhoea (fluor albus, or "whites," as it is more generally called) is one of the most common of female complaints. It is characterized by a discharge from the female genitals, varying in color from whitish or colorless, to a yellowish or light green, to a reddish or brownish or even bloody; in consistence, from thin and watery to a thick, tenacious, ropy substance; in quantity, from a slight increase of the natural secretion to several ounces in twenty-four hours. It is so general that there are few females who are not affected by it at some period of life. It is even met with in infancy. It may be so bland as to occasion little or no inconvenience, or it may become so acrid and corrosive that it will excoriate every tissue with DISEASES OF WOMEN 225 which it comes in contact; and when the virulent form occurs in the married it may cause in the husband an affection known as balanitis, which bears such a strong resemblance to gonorrhoea that unjust suspicions arise and occasion much domestic unhappiness. The diagnosis of a virulent leucorrhoea from true gonorrhoea is made with difficulty and has often given rise to serious inquiry regarding the chastity of the female. A diagnosis, however, being possible by com- petent physicians, hasty or unjust conclusions should not be indulged. When this secretion is profuse or acrid it is very apt to cause sterility, and not infre- quently is the cause of the most excruciating agony during the connubial relations. For the most part, leucorrhoea is regarded as symp- tomatic of some disease of the uterus or vagina of either a functional, inflammatory or organic character, or it may be indicative of some disorder of the general health. CAUSES Anything capable of lowering vitality predisposes to leucorrhoea. It is generally present as a symptom or complication of almost every form of uterine disorders. Influences that cause inflammation, ulceration, con- gestion, laceration and displacement of the uterus, menstrual derangement, etc., give rise to and perpetuate this disorder. Among the most common causes we may mention are luxurious living, sedentary habits, exces- sive sexual indulgence, masturbation, abortions, un- cleanliness, piles, abnormal growths, prolonged nursing, pregnancy, too rapid child bearing, injuries, gonorrhoea, cold at the menstrual period, etc. 226 PAINLESS CHILDBIRTH SYMPTOMS Among the early symptoms are generally a sense of heat and soreness, amounting to pain or smarting, and a sense of swelling followed by the development of the discharge which may be a white, greenish, yellow, brown or reddish hue. The sufferer becomes pale and emaciated, her eyes look dull and heavy, there is severe and prolonged pain in the back and loins; the functions of the skin, stomach and bowels become de- ranged, the circulation is impaired, the head hot and feet cold; there is a loss of strength and energy, languor, pain in the stomach, failure of appetite, headache, dyspepsia, nervousness and hysteria. As the disease progresses, the blood becomes impov- erished and the female weak and emaciated; the feet and ankles swell, urination becomes frequent and pain- ful, the mind is dejected, the victim becomes appre- hensive, despondent and melancholy. This state of things produces displacements; sterility and impoten- cy result, and the sufferer is reduced to .abject misery. The disease may be uterine or vaginal or it may be a combination of both, and the character of the dis- charge as well as the symptoms will depend materially upon the cause, the location of the disease and the amount of inflammation. TREATMENT The successful treatment of this affection will depend largely upon the recognition and removal of the dis- turbance that occasions it, the inculcation of proper hygienic regulations and the employment of appro- priate remedial agencies. It will therefore be seen that the treatment must necessarily vary to suit the indi- vidual case. We must have an avoidance of sexual DISEASES OF WOMEN 227 excesses, while the mind must be withdrawn from all lascivious obj ects. Overexertion, fatigue, heated rooms, must be prohibited. The most perfect cleanliness of the parts must be enforced or our efforts will fail. Daily and thorough syringing is essential to success. The morbid secretion is more or less irritating of itself, and if allowed to remain undergoes decomposition, becomes acrid and offensive and is extremely prejudi- cial to the integrity of the mucous membrane lining these parts. ^Ye must seek by every means at our command to invigorate and improve the condition of the general health. Plenty of exercise in the open air, good, nutri- tious diet and regular habits are necessary, and when other diseases co-exist they must receive appropriate attention. The employment of injections of tepid water, soap- suds, medicated or otherwise, for cleanliness alone are necessary and should be repeated at least once a day with a fountain syringe that will allow a continuous stream to thoroughly irrigate the parts and effectually wash away every particle of secretion. HOW TO TAKE A VAGINAL DOUCHE The woman should lie on her back with knees drawn up and the hips raised on a pillow or resting on a douche pan. The fountain syringe should be about two feet Figure 24 228 PAINLESS CHILDBIRTH above the level of the hips and the douche water warm or hot (never cold). The tube or nozzle should be large and curved with three small openings on the side near the tip. Vulcanite or hard rubber nozzles are the best. Before inserting the nozzle in the vagina allow the water or medicated solution to run through it to expel the air. Care should be taken that the water does not get into the womb, as that might cause an attack of uterine or womb colic. When given to cure inflamma- tion in the pelvic organs the douche water should be quite hot, so as to contract the blood vessels and subdue the inflammation. A simple cleansing douche may be taken at any time, but when only one hot douche is needed each day it should be taken just before retiring. Much inconvenience and trouble will be saved by taking the vaginal douche whilst reclining in a bath tub. As an injection, water medicated with carbolic acid, ten to fifteen drops to a pint, once a day is excellent. When the smell of carbolic acid is objectionable, per- manganate of potash may be substituted, half a dram to a quart, used freely. When the disease is confined to the vagina, astrin- gent antiseptic lotions are desirable, of which the fol- lowing will usually meet the indications: (1) Sulphate of Zinc, ... 1 ounce Powdered Golden Seal, . . 3 ounces Mix. Put a heaping teaspoonful in a pint of hot water and let it stand till lukewarm, and use at once, repeating it at least every day. (2) Sulphate of Zinc, . • • K ounce Borax, ..... 2 ounces Directions — One teaspoonful dissolved in one quart of luke- warm water and used as a vaginal douche at bedtime. (3). One or two teaspoonfuls of lysol in one quart of water makes an excellent cleansing and antiseptic douche. DISEASES OF WOMEN 229 Constitutional treatment is essential. Tonics and alteratives are needed. At the same time if any func- tion is perverted it must be corrected by proper means. Give: Fluid Extract Stillingia, . . 1 ounce Fluid Extract Life Root, . . 1 ounce Fluid Extract Black Cohosh, . y% ounce Fluid Extract Buchu, . . 1 ounce Simple Elixir, . to make 8 ounces Take a teaspoonful three times a day between meals and at night. If it has been brought on by sexual abuses and the mind full of lewd thoughts, the nervous system irri- table, add an ounce of bromide of potass to the above. Alternate the above prescription with a good tonic before meals. Elixir of calisaya bark and iron already mentioned is very appropriate. CHRONIC INFLAMMATION OF THE WOMB This is a very common affection and one which, while it exerts a very important influence on the uterine system, is very imperfectly understood and often passes unnoticed and neglected. Modern society imposes upon woman certain un- hygienic customs that impair the vigor of her consti- tution and give rise to a variety of imperfect physical conditions that are extremely liable sooner or later to develop an inflammation of the womb. The disease once established, the whole economy suffers; all the vital processes are so much modified that a spontaneous recovery is very rare. Through the medium of the sympathetic nervous system the morbid influence is propagated to remote organs, causing complications that are often mistaken for the real disease and, as may be supposed when such is the case, the treatment 230 PAINLESS CHILDBIRTH is thus rendered a failure. Indeed, so great is the influence exerted by this organ on all parts of the body that few patients escape these sympathetic phenomena. The inflammation may attack any part of the organ, and the symptoms will necessarily vary with its loca- tion and severity, and as the disease continues un- checked or without modification by appropriate reme- dial agencies it results in changes in its structure and position that occasion a new class of painful and un- happy symptoms. The causes of this affection are numerous and may operate directly to cause the trouble or, by indirectly influencing the functional activity of the pelvic organs, excite the disease; anything that lowers the vital standard predisposes to it. Among the most fruitful causes I may mention excessive sexuality, masturbation, prevention of conception, improper reading, lascivious thoughts, heated rooms, habitual use of cushioned seats, stimulating diet, cold at the menstrual period, uncleanliness, constipation, sedentary habits, violent exertion, tight lacing, abortions, improper manage- ment at childbirth, getting up too soon after con- finement, piles, inflammation of the bladder, etc. SYMPTOMS The most prominent local symptoms experienced are pain in the back and loins, inability to stand or walk, pain in the side and region of the bladder, sense of weight and bearing down in the pelvis, sometimes so severe as to occasion the most intense agony, and irri- tability of bladder. Leucorrhcea is at first light colored, but as the disease progresses to ulceration it becomes thick, yellow, green, offensive and often bloody. There is pain at menstruation, derangement df the flow, DISEASES OF WOMEN 231 cramps, sterility and abortion. The inflammation in- creases the weight of the womb beyond the supporting power of its attachments, consequently displacements occur, occasioning new symptoms and increasing the difficulty. The womb becomes very sensitive to the touch, tender and painful. By pressure upon the rectum it causes constipation, sometimes alternating with diarrhoea, piles, etc. As the disease goes on, the ner- vous system becomes involved, abnormal sensations are experienced in various parts of the body. There is excruciating headache, backache, spinal tenderness, hysteria, numbness, fainting, palpitation, difficulty in breathing, pain under the breast and side, feet and hands cold, skin dry and sallow, the stomach and liver become deranged, the tongue coated, breath offensive, the sufferer becomes feeble, cough develops and there may be rapid decline. Sometimes the breasts are af- fected. There will be perversion of the intellectual faculties, and the victim becomes despondent, nervous, fretful and suspicious. Sterility is a frequent consequence of the disease. The mucous membrane may undergo ulcerative degen- eration, and displacements almost invariably supervene if it continues unchecked for any great length of time. TREATMENT Much diversity of opinion exists as to the procedure necessary in such cases and it is really an open question whether gynecology, as the science of uterine diseases is called, is really a benefit or a damage to the sex. If the treatment was confined to competent practitioners the question would not admit of debate, even if differ- ences of opinion existed; but in the hands of the un- skillful, as is too often the case, not only is there no 232 PAINLESS CHILDBIRTH benefit obtained from their treatment, but the disease may be aggravated and perhaps serious complications induced. It has become a fashion for physicians to make a specialty of " diseases of women/ ' and every profes- sional tyro believes it is "his forte." He knows such ills are prevalent — that they admit of good fees for " examinations' ' and "treatment," and that woman has been schooled to the belief that it takes a good while to cure, hence they have unlimited opportunity to prey upon the unfortunate. If the majority of such doctors were submitted to an examination they could neither explain the anatomy of the parts nor diagnose the ailment, much less cure the disease. It is for this reason gynecology is in danger of losing caste, and opens the door to debate whether the harm done by the unscientific is not infinitely greater than the good the skillful can accomplish. Local applications are doubtless good in their place, but the indiscriminate 'employment of caustics and what not cannot be too severely condemned. When other organs become diseased they are fortunately out of the reach of such torture and are cured by other and more agreeable means, and many may wonder if the liver and kidneys can be cured by other means why uterine diseases may not also escape the necessity of local torture. The reader may think this is begging the question and, while I admit it may be so in some cases, the parallel is often but too obvious. The object of local applications is for the most part to excite healthy action by changing the conditions that exist and at the same time modify pain and irri- tability. DISEASES OF WOMEN 233 We can excite a change in the condition of the uterus, relieve its dilated blood vessels and materi- ally lessen its weight by the application of glycerine, which may be medicated or not as desired. The glyc- erine is to be applied on a pledget of cotton and should be renewed every day or every other day. Take a piece of cotton wool about the size of an egg, saturate it with glycerine and apply it well up against the neck and mouth of the womb and allow it to remain. A small string may be attached to the tampon to facili- tate its removal, and it will be most conveniently applied with a pair of dressing forceps through an ordi- nary tubular speculum. Many succeed in applying it themselves without. The cotton should not contain so much glycerine that it can be squeezed out in a stream. The result of this application will be to excite a profuse watery discharge that will deplete the uterine vessels and induce a change in the circulation, reliev- ing the congestion with all its dragging and disagreeable consequences. When it is removed, thoroughly syringe the parts, removing every particle of morbid secretion, and repeat the application. In long-standing cases, when the womb has become enlarged, a little tincture of iodine may be added to the glycerine in the proportion of one dram to the ounce and applied in the same manner. After the congestion and inflammation have been reduced by this treatment it will be necessary to follow up the advantage gained by the use of astringents and tonic applications which may be applied on cotton in the same manner. The fluid extract of golden seal or witch hazel or pinus canadensis may be mixed with glycerine in about equal parts of whichever one is 234 PAINLESS CHILDBIRTH selected and used. As these applications stain the clothing, proper precautions to prevent such a conse- quence should be taken. This is easily done by a small pad of absorbent cotton placed just inside the vagina or by wearing a napkin. Sitz baths may be employed with great good, but in their use it may be necessary to accustom the patient to them. They may be begun warm or tepid and the temperature gradually lowered until in a few days they are employed cold. They should be followed by brisk rubbing to excite vigorous reac- tion. When, however, they are intended to relieve pain, soreness or excitement they should be used warm or even hot. The employment of local applications must not, however, be regarded as the sine qua non. We have several medicines about the remedial influence of which on these parts there cannot be any doubt, and their employment must not be overlooked. Their combi- nation or alternation with agents that control special symptoms and conditions that are outgrowths of the main disease must constitute an essential feature of the treatment. The black and blue cohosh, the squaw vine, Pulsa- tilla, lady slipper, bromide of potash, etc., may be used singly or in combination, for their influence in diminishing pain, controlling inflammation and re- lieving reflex-excitability. They overcome the nervous- ness that almost invariably attends inflammation of the womb. Dr. Dye's Mitchella Compound gives quicker and surer relief than any other medicine that can be used. The following prescription is a good one. Take, of DISEASES OF WOMEN 235 the homeopathic tincture or fluid extract, the tincture being preferred, thus: Tincture of Pulsatilla, . .1 dram Tincture of Black Cohosh, . 2 drams Water or Simple Elixir, . . 4 ounces Mix. Dose — A teaspoonful three or four times a day. After it has been taken two or three weeks substi- tute the following : Fluid Extract Mitchella Repens, 1 ounce Fluid Extract Caulophyllum, . 34 ounce Fluid Extract Cypripedium, . 3^ ounce Bromide Potass, *•'•-- 54 ounce Simple Elixir, enough to make 4 ounces Mix. Take a teaspoonful three or four times a day. The use of nux vomica given alternately with either the above, on the same day, is advisable. To avoid too many medicines it may be given in combination with other remedies if any are being given at the same time. If there is much breaking down of the system in general it may be combined with irxxi and quinine in form of a pill or syrup or, where the nervous symp- toms predominate, with phosphorus, thus: Tincture Nux Vomica, . . 1 dram Quinine, ..... 30 grains Syrup Hypophosphites, . . 4 ounces Dose — A teaspoonful three times a day, just before or after eating. It is not usually advisable to continue any prescrip- tion too long without a change, or the beneficial effect will be lost. For that reason I seldom give large pre- scriptions, except the patient lives at considerable distance, when I give enough to last a month at a time. Special symptoms must always be considered in making 236 PAINLESS CHILDBIRTH prescriptions, and in this disease they are so exceed- ingly numerous that not a little tact and judgment must be exercised. Constipation is a very frequent symptom and one that should not be overlooked. Many of the cathartics usually employed increase the determination of blood to the pelvis and, therefore, should be avoided in all cases. The nux vomica in many cases will be all that is necessary. When it is insufficient, salines like Rochelle salts, seidlitz powders, citrate of magnesia or even some of the laxative waters are advisable. Common Epsom salts in small doses every morning in some cases do great good. The fol- lowing makes a very good aperient and tonic: Epsom Salts, . . . .2 ounces Sulphate of Iron, • • • M ounce Cider, ..... 1 pint Mix. Dose — A tablespoonful once to three times a day. The cider relieves the unpleasant taste of the salts. The iron may be left out if the patient is full blooded. Trouble with the bladder often demands relief temporarily while the real disease is being treated. The smarting and burning and frequent desire to uri- nate can usually be relieved by: Tincture Cantharides, . . 10 drops Water, . . . . . 4 ounces Dose — A teaspoonful every two or three hours. As soon as relief is obtained it should be omitted. The headache will generally yield when the cause is removed, but during a severe attack thirty grains of bromide of potass dissolved in a wineglassful of water may be taken and repeated in two hours if need be. The sitz bath is an agent of great value and should always be employed as an adjunct to other measures. DISEASES OF WOMEN 237 The directions given for its use in this and in a preced- ing chapter are equally appropriate. Copious hot water douches should be taken morning and night. A change of habit is beneficial. Indolence must not be tolerated and, on the other hand, excessive labor should be avoided. Rest, especially during menstruation, is very helpful. Heavy lifting is to be prohibited, as it would be very likely to cause displacement. Marital relations must be suspended entirely or nearly so and care must be exercised to avoid any circumstance that could cause any form of sickness on account of its liability to aggravate the disease being treated. Perseverance is necessary for success, and as improve- ment progresses carelessness cannot be indulged. I have seen the slightest indiscretion cause a relapse as severe as the original disease. Occasionally there will be cases so obstinate or complicated as to demand the greatest professional skill, and no general rule can be written that will suit all. I have endeavored in this chapter to avoid advising such measures as would be impracticable and have necessarily confined myself to more simple and easily applied forms of treatment, and should any one find the directions inadequate to meet all the contingencies that grow out of so varied and troublesome a disease I will be pleased to consider the case in its individuality and render such service or advice as may lead to its cure. I have purposely omitted a discussion of the varie- ties of inflammations and their divisions by localization, as such a consideration could only result in confusing the unprofessional. To them the fine distinctions as to whether the inflammation is limited to the mucous 238 PAINLESS CHILDBIRTH membrane of the uterine neck or to the deeper struc- tures, whether these conditions are confined to the neck of this organ or whether they extend to and involve the whole or only a part of its body is a matter of no practical value, as the symptoms would not enable them to diagnose or even treat the matter with any material difference; for this reason they have been omitted, and not because, as some critical individuals may claim, on account of carelessness or indifference. ULCERATION This is a frequent result of inflammation and pre- sents several varieties, varying from a slight abrasion to a deep-seated intractable sore. It may be limited to a superficial ulceration or erosion of the mucous mem- brane of the neck or mouth of the womb, or it may extend into the body of the organ and into the deeper tissues. This is one of the great hobbies of the so- called " specialist" and if the patient's financial capa- bility admits, " ulceration " is found. Do not understand me as denying the existence of such a disease, but that it is not always present. It is likely to result when the inflammation has continued for a long time unchecked or been improperly treated. It indicates impairment of vitality, either local or general or both. The degen- eracy of tissue may be local, but cannot exist long without more or less injury to the general health if, indeed, the general health has not been materially impaired before the ulceration occurs. The symptoms will necessarily differ, according as the ulceration is superficial or deep, limited or extensive, and will accord more or less with those already described under chronic inflammation. There will be leucorrhoea, varying from slight milky, watery or colorless to thick, DISEASES OF WOMEN 239 tenacious, purulent, green, lumpy or bloody. There will be pelvic and sacral pains, backache, ovarian irritation, dyspepsia, irregular menstruation, menor- rhagia, neuralgia, pains in various parts, irritation of the bladder and rectum, debility and more or less dis- turbance of the general health. A positive diagnosis without the speculum is impossible, the employment of which reveals the presence or absence of the ulcer and its character. A celebrated writer has said: Treatment of uterine ulcer is one of the most important and difficult in the whole range of medical science. We must be guided by the character and extent of the ulcer, the existing inflammation and the state of the general health. The employment of local measures is necessary. Caustics, stimulants, astringents, etc., must be selected with care. In mild cases, carbolic acid applied full strength or nitric acid applied on a pine stick dipped in the acid and allowed to dry before applying, will generally suffice; but in more deeply seated sores more vigorous treatment may be neces- sary — caustic potash, solid nitrate silver, chromic acid, etc. When applying them, the adjacent parts must be carefully protected. It is always best to employ a physician who understands such diseases and who is provided with proper facilities and who w r ill necessarily conduct the subsequent treatment. In mild cases, fluid extract golden seal or pinus canadensis may be applied on lint and changed daily, with injections to thoroughly cleanse the parts, and then repeat the applications. Daily vaginal douches of lysol solution (one teaspoon- ful of lysol to one quart of water) are cleansing and antiseptic; healing injections of an infusion of white pond lily root, golden seal and witch hazel with chlorate 240 PAINLESS CHILDBIRTH of potash one half ounce to the quart are useful and may suffice in the milder cases. Some physicians apply an iron devised for the pur- pose, heated to a white heat. Some apply tincture of iodine and follow with the glycerine and cotton dressing already described under inflammation. The plans of treatment are as various as physicians are numerous, and as the afflicted are not apt to try it themselves minute description is not necessary. Whatever local measures are adopted, the plan is to destroy the ulcer and make a healthy sore, or to so stimulate the tissues in which it is seated as to bring about a healthy action. As already remarked we will usually find an impair- ment of the general health which must be built up or we cannot hope to succeed. It is impossible for a sore to heal while the blood is impoverished and impure, the fluids of the body perverted and the nervous sys- tem morbidly acute. Inculcate thorough hygiene, open air exercise, salt water baths, generous but unstimu- lating diet, regular habits, avoidance of fatigue and sexual relations, then take the following: Fluid Extract Corydalis, . Fluid Extract Cypripedium, Fluid Extract Hydrastis, . Fluid Nux Vomica, . Simple Elixir, . Dose — A teaspoonful before meals three times a day. This may be advantageously alternated with ten to fifteen drops of dialized iron in water three times a day. Build up the vital forces by every possible means. At the outset, understand, time and perseverance are necessary. The foregoing are but a few of the many 1 ounce 1 ounce 1 ounce 1 dram 5 ounces DISEASES OF WOMEN 241 remedies at our command which come under the gen- eral classifications of alteratives and tonics and are useful in depraved conditions of the system, but as these cases seldom undertake to conduct their own treatment they are probably sufficient to indicate the character of the treatment needed in a general way. DISPLACEMENTS There are three principal varieties of uterine dis- placement: Downward (prolapsus), backward (retro- version), forward (ante-version). A slight deviation from the normal position may occur without occasioning any very serious trouble, but as the degree of deviation is increased the trouble arising from such displacement is augmented. Displacements to one side may occur, but are not so frequent. Two other forms of displacement are met with in which the neck remains in its natural position and the body is displaced. This, of course, necessitates a bending of the neck. When the body is tipped backward it is called retro-flexion; forward, ante-flexion. Displacements are usually complications and effects of inflammation, lacerations or tears of womb, sub-in- volution after labor or miscarriage, tumors, although they may be produced by getting up too soon or at work too early after confinement, heavy lifting or jump- ing, or falling from a height and striking on the feet. The nature of the displacement involves the condi- tion of other organs, and the symptoms necessarily depend in a measure on the character and degree of displacement. When the displacement is downward, (prolapsus) which is the form most frequently observed, there is painful dragging and bearing down, sometimes so 242 PAINLESS CHILDBIRTH severe that it seems as if the whole of the contents of the pelvis would be forced outside of the body, backache, headache, pain in the limbs and perhaps swelling of the feet. The pressure on the rectum causes piles and constipation, and on the bladder, frequency or difficulty in urinating. A sinking and sense of goneness in the stomach and all the symp- toms that accompany the inflammatory troubles already described are usually present. When it is backward (retroversion), in addition to the symptoms of prolapsus which generally are present, Figure 25 Figure 26 Anteversion Retroversion the pain in the back is greater and often extends to the head, and the pressure on the rectum may be so great as to render an evacuation of the bowels almost impossible. An examination reveals the mouth of the uterus pointing toward or pressing against some part DISEASES OF WOMEN 243 of the bladder, and the body may be felt lying in the hollow of the sacrum. If the case is one of ante-version the body of the womb presses forward and downward upon the bladder, while the mouth is turned backward in the hollow of the sacrum. The bladder becomes very irritable and the suffering is often intense. Usually the symptoms are so plain that a diagnosis can be made from the statement of the patient, but there is a possibility of error. Tumors constitute the principal causes of mistake. In the flexions (anteflexion and retroflexion) in addi- tion to the foregoing symptoms, the neck of the womb Figure 27 Figure 27a Anteflexion Retroflexion being bent on itself backward or forward as the case may be is likely to obstruct the canal and become an impediment to the exit of the menstrual discharge on the one hand or the ingress of spermatozoa on the 244 PAINLESS CHILDBIRTH other, causing in the first instance dysmenorrhoea, in the other barrenness. Take the finger of a glove in your hand up to the middle and allow the hand to fall over and you have a fair idea of the operation of a uterine flexion. As I have already remarked, these displacements are usually directly or indirectly caused by inflammation in some form or other. If this pathological fact is borne in mind it will be of great value in understanding the treatment. As already stated, inflammation is the most potent cause of uterine displacement. Congestion operating in the same way is also a fruitful cause. They act as causes by increasing the weight of the uterus beyond the power of its supports to hold it in place. Anything that increases its weight predisposes it to displacement; violent exertion or even long continuance in the erect posture under such circumstances cause it to settle into displacement. When congested or inflamed, jumping, jolting, lifting, straining, dysentery, etc., etc., displace it. The sufferings caused by it can be appreciated only by those who have experienced it. In some the devia- tion has been gradually effected and they do not seem to suffer acutely; others are unable to walk or stand. When it has occurred suddenly, as a result of a strain or fall or lifting a heavy weight, the suffering is often described as acute. Very seldom, however, if ever, does it occur without causing more or less suffering and constitutional disturbance, and when it has once occurred it is very apt to recur. The inflammation extending to adjacent structures sometimes causes adhesions that securely fasten the DISEASES OF WOMEN 245 organ in its false position and entail lifelong trouble. This one circumstance points out the importance of early efficient treatment. There are few troubles that assail human beings the treatment of which have received more attention than this. Supporters without number have been devised. When they have been arrayed for examination it would almost seem as if the ingenuity of man had been ex- hausted. Every conceivable form and shape, from a ball to a horse shoe; from a simple cup to the most complicated receptacle; light and heavy, large and small; some easily adjusted, others that cannot be; indeed, a large majority of them seem to have been built without any regard whatever to the purpose they were intended to serve. Many of them relieve one pain to cause another. It would take the whole book were I to attempt to describe them. Probably they will always be in demand; almost all physicians use them. Indeed, it is fashionable. No physician wants to show his ignorance by admitting he doesn't understand one or know how to apply it. Of course, anyone can apply one, even if it is adjusted wrong side up! There is a principle involved in the cure of these troubles that it will be well to remember. The effect of inflammation and congestion is to increase the size and weight of the womb so that it is disposed to fall from its natural position by its own gravity when its supports have become weakened. A supporter may elevate it to its natural position, but it does not over- come the increased density nor strengthen the supports. If properly adjusted the supporter may afford relief, but not cure. At best they are but an auxiliary, and 246 PAINLESS CHILDBIRTH those who rely on them as curatives can but meet with disappointment. The indications then are to arrest the inflammation, remove the extra weight occasioned by it and strengthen its supports. Were I writing this chapter especially for the profession I should consider the physiological and pathological conditions involved more at length; as it is, probably it is unnecessary. We will frequently find cases where the inflammation has subsided and its consequences alone remain; again, the inflammation continues. In either case we must adapt the treatment to the needs of the individual. Replace the womb and if there is inflammation proceed as advised under that head, using the cotton tampons properly applied instead of a supporter. Medi- cate it if necessary. The cotton will not cause the pain a hard instrument will, while it can be made a medi- cated appliance to cure the inflammation instead of increasing it, as is sometimes the case with solid sup- porters. By adapting the size, shape and position of the cotton supporters the uterus can be maintained in position. When the inflammation does not require special medicines for its control, alteratives to overcome the adventitious deposits that increase its weight are to be administered. Take: Fluid Extract Corydalis, . . 1 ounce Fluid Extract Ergot, . . 1 ounce Fluid Extract Black Cohosh, . K ounce Nitrate Potash, . . . * . }/& ounce Simple Elixir, . . to make 8 ounces Mix. Give a teaspoonful three times a day. DISEASES OF WOMEN 247 Overcome the muscular weakness of the uterine supports by tonics, exercise, etc., thus: Fluid Extract Nux Vomica, . 3^ dram Fluid Extract Golden Seal, . 2 drams Elixir, to make 4 ounces Dose — A teaspoonful at meals. The existence of other symptoms that demand at- tention may require that other agents be added to these prescriptions to fulfill the special indications. Cold sitz baths, hot vaginal douches, regular bowels, thorough rubbing, are advisable. Exercise that brings the relaxed muscles into play and develops their strength should be employed; carefully at first, increasing as it will answer. We must remember that the contents of the abdomen are disposed to press the contents of the pelvis down- ward and thus interfere with the cure of displacement. Many females of a lax muscular habit are thus affected to a great extent and should be aided by an external band or support, as it will afford relief from many dis- tressing symptoms. They should, however, remove this artificial support at stated intervals and take such exercise as will bring the muscles involved into action and thus develop them. Nearly any treatise on calis- thenics will give the information needed on these points. Any muscle that has its function suspended for any considerable length of time becomes weakened and attenuated; hence, I say supporters cannot cure their debility and I wish to avoid them. A great deal of discretion, however, is needed to determine when and to what extent supports should be used. No absolute rule can be laid down. We must be governed by the circumstances and conditions present. 248 PAINLESS CHILDBIRTH Tonic and astringent medicaments are required as applications with the cotton tampons and injections during the time to overcome the relaxation of the pelvic tissues, and the pinus canadensis, the golden seal, witch hazel, etc., may be used as already suggested in the treatment of chronic inflammation, after the inflammatory symptoms have yielded. Much care will be needed to adjust the tampons properly to secure the greatest benefit from their use. They should be changed daily. To replace a displaced uterus is not always as easy as may be supposed, and many who have tried it and been disappointed in the success of their efforts will often regard themselves as unequal to the task. If there are no adhesions binding it firmly in its mal- position it can be easily accomplished. First remove the weight of the abdominal viscera; take advantage of the law of gravity, secure the aid of atmospheric pressure if needed and accomplish the rest by manipulation. The first and second steps are accomplished *by the knee-chest position. Let the patient kneel upon a table or some unyielding surface — lounge, sofa or even the floor — then bending the body forward until the chest and abdomen lie upon the table, tilt the body slightly to the left so the left side of the face and shoulder are upon the table, the arm thrown behind her, the hips being kept elevated as high as the length of the limbs from the knee to the hip will admit. This position relaxes the abdominal muscles and the contents of the abdomen gravitate toward the chest, entirely removing their previous weight from the pel- vis. The contents of the pelvis are now at liberty to DISEASES OF WOMEN 249 gravitate toward the abdomen and in some cases will do so without any help, resuming their natural position. If now an effort is made by manipulation to replace the uterus, the air fills the vagina and by its pressure crowds the pelvic organs towards the abdomen. In simple prolapsus or downward displacement this will usually be sufficient, but if there are adhesions, of course, no change will be effected. Sometimes when the case is one of retroversion the uterus is wedged into the hollow of the sacrum so securely that manipulation will be necessary, and the operator will often be surprised to find the uterus sud- denly leave his fingers and resume its normal position, even in cases where all previous efforts had been un- availing. If an unprofessional person cannot effect a replace- ment by this method there is little use of trying further. If now a supporter has been selected it should be adjusted at once, otherwise the cotton tampon should be inserted before the woman changes her position and while the womb is in its natural position, or perhaps a little higher up than natural, after which let her lie down and rest a little while before she makes an at- tempt to get upon her feet. In -chronic cases there will be a disposition to get out of place, but the woman has it in her power to relieve herself at any time when she finds herself in agony-from a sudden displacement if she will but make endeavor as above described. This plan may have to be repeated in long-standing cases many times, and at the same time there should be a constant endeavor to invigorate the whole system, to renew the supporting power of the attachments so 250 PAINLESS CHILDBIRTH that they can hold the organ in its proper position without the aid of any artificial devices. Instrumental supports seek to hold the organ in its place independent of change in the condition of the organ itself or im- provement of its muscular attachments. They do not cure but substitute. By the plan I have just described, to the originality of which I make no claim, we seek to make a perma- nent cure, using mechanical aid only as an adjunct and to temporarily effect what we endeavor by this and other means to make lasting. Although I have argued against artificial supporters (instrumental), I do not wish to be understood that they are useless; such a position would be extremely ridiculous in the face of their employment by some of the brightest lights of the profession. I am aware that there are cases in which there is nothing left but to use them, and it is certainly better to do so than to have the woman suffer. I, however, wish to avoid them when possible. I wish to cure instead of simply relieve and am confident that properly managed cases can be cured by the foregoing plan in which the artifi- cial treatment has previously failed. Should medicines, position and pessaries fail to cure the case a surgical operation to shorten the ligaments or even remove the womb may be needed. SUB-INVOLUTlON During gestation, to accommodate the development of the foetus, the uterus is necessarily increased in size. The walls do not become thicker, but more extensive. The return to its former size after delivery is termed involution. If this process is arrested before it is com- plete, the uterus is left in a state termed sub-involution. DISEASES OF WOMEN 251 The cause of this arrest is generally inflammation, the degree of which is various. It may or may not be attended with febrile symptoms, the contractions are feeble and inefficient, the muscular wall loses its power to effect the shrinkage necessary. While this condition lasts there is danger from hemorrhage. As time wears on and the acute are succeeded by chronic symptoms the danger of sudden hemorrhage may subside; but there remains more or less disturbance of the uterine function, liability to displacement, etc. Women are often heard to say they have never been right since their baby was born. In many of such cases the process of involution has doubtless been arrested before completion. The best time to correct this is when it occurs. If the womb remains large and flabby, if hemorrhage continues, with pain, weight, heat in the lower abdomen and pelvis, it should receive at- tention. If the inflammatory symptoms run high, use aconite or veratrum or Pulsatilla in small and frequently re- peated doses, say fifteen drops of either, or each, in a glass two thirds full of water and take a teaspoonful every hour or two. Alternate this with : Fluid Extract Ergot, . . K ounce Fluid Extract Black Cohosh, . 34 ounce Water, ..... 2 ounces Dose — A teaspoonful every four hours. After the case has become chronic (and they are met with months or years after the delivery), a course of treatment must be instituted to remove adventitious deposits and restore the natural functions of the womb and ovaries, together with such local applications as 252 PAINLESS CHILDBIRTH shall excite a new and more vigorous activity in the absorbents of these parts. Take: Fluid Extract Corydalis, . . 1 ounce Fluid Extract Phytolacca, . . J^ ounce Fluid Extract Pipsissewa, . • . K ounce Simple Syrup or Elixir, . . 2 ounces Dose — A teaspoonful three or four times a day. If there is a disposition to hemorrhage or profuse menstruation, substitute an equal quantity of fluid ex- tract of beth root (trillium) for the Phytolacca (poke root). If there is anemia, give tonics, some of the formula already given will answer. Local applications are valuable. Iodine may be used either applied to the womb directly and followed by the glycerine and cotton tampon or it may be applied mixed in the glyc- erine as advised in chronic inflammation. An external supporter made to fit evenly and moderately compress the abdomen will be found useful. Out-door exercise to invigorate, bathing, etc., should be thoroughly carried out. The bowels should be kept regular and hot vaginal douches morning and night. Usually these cases require great perseverance. UTERINE TUMORS All organized growths that occur within the uterine walls or are attached to any of its surfaces are properly called tumors. Several varieties exist — polypus, fibroid, fibro-cellular, vesicular, cellular or mucus, vascular and encysted. They are variously distinguished by position and relation to the different parts of the uterus. Polypi are pendulous growths attached to some por- tion of the uterine mucous membrane by a narrow neck, varying in density and causing a variety of symp- toms that depend to a considerable extent upon the seat of their attachment. When located within the DISEASES OF WOMEN 253 cavity of the uterus they are apt to derange men- struation, rendering it profuse, causing weakness, anemia, leucorrhoea, dragging pain; being out of reach they may not be detected for months and years. The neck may become elongated and the body be expelled outside the uterus where it hangs till removed by surgical means. They may occur in the canal and obstruct the menstrual flow, causing great pain and making the flow exceedingly profuse. In such position they can cause absolute sterility. They may be at- tached to the mouth of the uterus within easy reach. Their only treatment is removal by surgical means. Figure 28 , Fibroid tumors are by far the most frequent, diffi- cult to manage and dangerous. They may occupy any part of the uterine substance, but are oftenest found in the posterior wall, (Fig. 28) and are generally round or oval in shape. The size varies very considerably. 254 PAINLESS CHILDBIRTH Increasing the size and weight of the uterus, they cause displacement. The great danger is from hemorrhage, which does not by any means bear a definite relation to the size of the tumor. The menstrual function is deranged, often with great pain and profuse flow, and the pressure of the tumor on the pelvic nerves frequently causes neuralgic pain and numbness. Constipation and irritability of bladder may occur. Sterility is likely to result, or if conception takes place abortion will be very likely to follow. The diagnosis is not easy. Recurring hemorrhage causes suspicion of their presence, particularly if there be existing displacement. Careful manipulation is necessary, and the use of the sound will be required before a diagnosis is certain. Skill is needed to make certain the existence of the tumor, its location, etc. The treatment of these affections is very difficult. To control hemorrhage is one of the first things to be considered. If we cannot cure we can prolong life. The removal of the tumor is the only way to effect a permanent cure. This is often very troublesome and in some cases impossible. A knowledge of the character, location and attachments of the growth are necessary before we can form an opinion of the success of the treatment or the plan to be pursued. To arrest the hemorrhage, boldness and energy are often required. Give ten-grain doses of gallic acid in water and repeat every half hour; twenty drops of the oil of erigeron on sugar repeated every half hour; a strong tea of cinnamon, hemlock and witch hazel barks, given quite freely and often repeated; if the struc- ture of the womb is soft, lax and flabby, teaspoonful DISEASES OF WOMEN 255 doses of the fluid extract of ergot repeated as often as necessary from twenty minutes to four hours are among the most prompt and convenient remedies. Keep the patient in a recumbent position, in a cool room, allow nothing but cold drinks, lower the head and elevate the pelvis. Local measures must not be overlooked. When there is much leucorrhoea or bloody discharge, antisep- tic vaginal douches should be used. A firm vaginal packing of antiseptic gauze or cotton, changed every day or two as necessary, wdll often prove an excellent means of controlling the bleeding for the time being. Astringent injections may be used; fill the vagina with cloths or cotton steeped in some astringent — alum or vinegar if nothing else is at hand. Be thorough, a life may be sacrificed by delay. Apply ice to the pelvis. A gum-elastic air bag, if at hand, may be introduced and inflated, completely plugging the pas- sage and preventing the escape of the blood. Some of these means can always be employed while waiting for remedies administered internally to take effect. Various plans have been advocated for the removal of these growths. If it is polypoid and in reach its removal may be effected by grasping with forceps and twisting its neck from its attachment, and dressing with astringents. If the growth is of a mushroom character, growing from the mucous membrane, in which case bits like " proud flesh" may be expelled occasionally, the womb must be dilated and removal effected by instruments adapted to the purpose. Fibroid and other tumors require surgical treatment. Electrolysis has been successful in some cases. The 256 PAINLESS CHILDBIRTH injection of iodine and other substances into the tumor with an instrument invented for this special purpose has been employed. Various other means have been resorted to, but as all forms of them are attended with great difficulty and require patience and skill I need not detail their modus operandi here, as it is not ex- pected their removal will be attempted by other than competent physicians. Such various means as have already been recom- mended to build up and strengthen are always in order, among which acids are most appropriate, as they coun- teract the hemorrhagic tendency, to some extent. CANCER A consideration of this disease is of too much gravity to enter into a work intended for public guidance. The disease must be dealt with promptly and thoroughly, Figure 29 DISEASES OF WOMEN 257 if at all, and no one should tamper with it unless quali- fied by clinical experience and armed with the necessary means to carry out whatever procedure is determined upon. Cancer of the womb occurs most frequently between the ages of forty and fifty. Frequent child bearing and tears or lacerations of the neck of the womb seem to predispose to cancer. A consideration of the symptoms may, however, be appropriate, as they may induce some of the afflicted to seek proper relief before it is too late. Hemorrhage is usually the first symptom. The oc- currence of hemorrhage in a woman who has passed the change of life should always arouse suspicion of cancer. Discharges, pain and fetor are the symptoms that most generally attract attention; and when these three are present the case is most generally an advanced one. The pain is characteristic — lancinating, darting, twinging. The discharge consists of blood, limpid serum, minute sloughs. The blood and serum do not cause the fetor; it is the disintegration of the sloughs- cancer cells. In women who are still menstruating, the first discharge is the blood, then an increase of the menstrual flow, then blood between times — all from the mucus membrane of the uterus. Later, however, when the hemorrhage is constant and is attended with fetor it is effused from the eroded vessels upon the ulcerated surface- — in the one case the result of turgessence, in the other disintegration of tissue. Limpid, inoffensive serum is almost always observed, after the menstrual period, in women about the change of life, and very gradually this transparent 258 PAINLESS CHILDBIRTH liquid becomes colored with blood; after a while it becomes fetid, etc. Lancinating pain, sero-sanguineous discharge, pe- culiar fetor, persistently continuing for days and weeks, are distinctive of cancer. With these we have the peculiar constitutional condition known as the cancer- ous cachexia. Cancerous anaemia,with the straw-colored translucency of the skin known as the cancerous cachexia, with the impairment and failure of function in a long struggle with pain, loss of blood, anxiety and inaction, together with debility, indigestion, palpi- tation, restlessness, neuralgia, constipation in the early stages and colliquative diarrhoea in the latter, apthse, night sweats, wandering of the mind, together with pain and exhausting discharges, are the destroying agencies. As already stated, I will not advise as to treatment. I know of no specifics or anything approaching to them, but, do what you may, I beg of you to steer clear of cancer quacks and incompetent physicians. CHANGE OF LIFE After years of menstrual activity the woman under- goes another change and she ceases to menstruate. The age at which this occurs varies greatly. Forty- five is considered the average, but numerous cases occur in which it is continued for several years later. The cessation of this function is often attended with phenomena that demand attention, and while it often terminates the existence of previous illness it may also be the commencement of various afflictions. In some parts of the country there is a sort of prov- erb that women who have previously been weakly become healthy and robust, while those who had before DISEASES OF WOMEN 259 been healthy and strong now become sickly. While in some the climateric change does not occasion any symptoms requiring attention, in others serious conse- quences develop that tax the skill and tact of the physician. Too often these phenomena are passed without attention or the symptoms are referred to as the "turn of life" and the woman told she must wait until this period has passed before she can expect to be better. Not only does this refer to the sympathetic phenomena arising from the arrest of a physiological function, but to pathological conditions that develop independently of it. The suffering endured at this time is too often re- garded as a sort of necessary affliction and is passed as a "must be," while the truth is, nothing is farther from right, for the more attention we give to the modification of symptoms, the arrest of disease and the preservation of the health at this time the greater will be the chances for the enjoyment of perfect health afterwards. From fifteen to forty-five, sooner or later, according to the peculiar vivacity and vital stamina of the patient, she has men- struated regularly, and now the germ production has gone forever. There is no longer the monthly periods; the ovaries have ceased to produce germs; but, though this has happened, the affections of the soul have but matured ; her power to love remains in full force and ardor, and also the desire and capacity for sexual en- joyment. Some women continue beautiful and attractive until they are seventy. The cessation of the menses at this period is a wise provision of nature, for if women went on producing off- spring till a ripe old age the result would be a puny race. The generative power disappears as she passes the period of maturity, and women who have borne children have a compensation for their privations and cares. — Buchanan. 260 PAINLESS CHILDBIRTH This period is ushered in in various ways. Men- struation seldom ceases all at once unless some acci- dent occurs by which it is arrested. It usually becomes more or less irregular. It may recur too frequently or it may be delayed several weeks or even months and then return too profusely — perhaps be regular a few times and then cease altogether. There is usually lassitude, debility, headache, nervousness, aching in the back and limbs, flashes of heat, deranged secre- tions, dyspepsia, etc. Temperament modifies symptoms materially, but hot flashes are present in nearly all cases. Plethora or anemia develops. The blood itself, no doubt, under- goes some change, a host of symptoms are present. She becomes fanciful, even hysterical; she imagines everything ails her, and this morbid imagination^ often leads to her neglect. That class of symptoms termed " nervous " prevails, producing an endless variety of phenomena, distressing to the patient and annoying to her family. Mental aberration often occurs. The patient suffers both mentally and physically. The treatment for obvious reasons must be consid- erably varied. A wide range of conditions may be developed each of which may require to be met and subdued. Whatever function is deranged, whatever organ suffers, should receive attention. The hygienic measures already advised for various ills will contrib- ute more or less to the establishment of a healthful condition. Plethoric women suffer from rush of blood to the head, vertigo and frequent attacks of hemorrhage. They make blood too fast. They need spare diet, DISEASES OF WOMEN 261 exercise and, if the bowels are sluggish, saline cathar- tics, they bear purges well; then if the circulation is excited give veratrum, a drop of the fluid extract in water every hour or two. Such cases generally derive much benefit from bromide of potash in infusion of squaw vine; ten grains of the bromide in an ounce of the infusion three or four times a day is good treatment. If anemia prevails, the blood gets impoverished, is thin and watery, is not manufactured fast enough to supply the waste, there will be headache, etc., etc., we must give tonics and nervines, and avoid excite- ment. An infusion of the squaw vine and ladies' slipper in tablespoonful doses three or four times a day is excellent; alternate with a good iron tonic. If the bowels are irregular, the remedies already mentioned may be employed. Displacements are often annoying, with all the rest. The kidneys and skin most be kept active. Dr. Dye's Mitchella Compound probably fills as many or more indications than any other remedy and suits nearly all cases. The range of probabilities being so great and complications so numerous my space will only admit of generalizing the treatment. Should cases arise that do not yield to these remedies I will advise more specifically. Yet if these directions are followed such necessity will seldom occur. UTERINE STRICTURE As a result of inflammatory disease, non-develop- ment or the improper use of caustic applications, the canal leading to the cavity of the uterus is sometimes narrowed to such an extent that it may cause the most terrible dysmenorrhcea on the one hand or absolute sterility on the other; the passage being too small to 262 PAINLESS CHILDBIRTH allow the exit of the menstrual discharge or admit the sperm cells. The consequences of this condition have already been alluded to in the consideration of sterility and mechanical dysmenorrhoea, and operate by closing the canal, though differently from flexion and polypi. The symptoms are very similar to those tioubles, but can only be determined from them by a careful exploration. The treatment consists in dilating the passage or in dividing the stricture. Dilation usually succeeds temporarily, but is not apt to give permanent results, owing to the disposi- tion of the stricture to contract again. Division when skillfully performed is more permanent. The operation is effected with instruments for the purpose, but re- quires great care after its performance to render it successful. If the incised surfaces are allowed to come in contact they are very apt to unite and render the trouble worse than before. The operation itself is accompanied with little danger, but must be attended to daily for some time or failure results. It should never be undertaken by anyone other than a qualified physi- cian provided with all the necesary facilities for effectu- ally executing all the various steps of the operation and the subsequent treatment. VAGINISMUS Professor Sims applied this name to a spasmodic sensitiveness of the vagina. It occasions in many cases the most intense agony when anything is brought in contact with it. The existence of such an impedi- ment to the consummation of marriage often gives rise, and many times unjustly, to domestic unhappi- ness, jealousy, divorce or suicide. There is nothing DISEASES OF WOMEN 263 more certain than that the woman afflicted with it suffers exceedingly. It may exist in the unmarried or be developed after marriage. It is usually due to inflammation of the vagina, self abuse or to sexual debauchery. Tilt says: I have seldom known this state to exist except as a symptom of vaginitis or of chronic metritis; and, like Scanzoni, by treat- ing these complaints I have been able to cure spasmodic stricture of the vagina.' There is no doubt in my mind that in some of these cases the man is more at fault than his mate. A complete discussion of the subject, however, is scarcely appropriate in a work of this kind. I will, however, on application by the afflicted, explain the matter, more fully and advise as the case presenting may demand. Tilt, Sims, Hood and many others have resorted to forcible instrumental dilatation to overcome the trouble, applying it under anesthesia. The first step seems to be to ascertain if there be inflammation present and if so, cure it, when the morbid sensitiveness will usually yield. There is no need of the- suffering experienced from such cases, for it will yield to proper treatment; but for the reasons men- tioned above I will refrain from further discussion of the subject. THE OVARIES Situated in the cavity of the pelvis at either side of the uterus, communicating with it through the fallopian tubes, are two small organs, analogous to the testes in the male, called the ovaries. In them the germ cells are developed and when matured are passed through the fallopian tubes to the uterus and unless arrested there are expelled. The completion of this 264 PAINLESS CHILDBIRTH process occasions the phenomena of menstruation. If, however, the sperm cells of the male come in contact with the germ cell under favorable circumstances during some part of the passage from the ovary to the womb conception occurs. It is truly wonderful the influence these little organs exert upon the life and happiness of woman. An author in endeavoring to illustrate their importance has said: It would seem as if the Almighty had taken two ovaries and built up a human being around them. These organs are liable to congestion, inflammation, neuralgia, enlargement, displacement, or may be the seat of tumors that grow to enormous size. They are influenced by colds, self-abuse, sexual excesses, uterine disease and displacements. Either as a cause or effect, the ovaries in women who suffer from derangement of menstruation become swollen, painful and tender. They can often be felt when swollen, except the woman be fleshy, through the walls of the abdomen, inside and just below the points of the hips. The congestion often gives rise to the most intense pain, not infrequently causing spasms, hysterical phe- nomena, etc. Menstruation may be deranged and is apt to be profuse, the sufferer becomes weak, anemic, nervous, fretful. Sexual debauchery predisposes to these troubles and is often the cause of the most in- tense neuralgia. Women of nervous temperament are most subject to these affections. I have seen the most troublesome menstrual disorders occasioned by con- gested ovaries; the menses were profuse and recurred every two weeks, resisting all treatment until the cause DISEASES OF WOMEN 265 was discovered and treatment addressed to its removal. Usually one ovary is affected, though both may be. The congestion may persist for a long time, being worse just before menstruation, disappearing after the flow has well begun, to reappear again at the next period. The location of the pain and soreness will usually be sufficient to indicate the trouble. Begin a week before the expected trouble and take a teaspoonful three times a day of the following: Tincture Belladonna, . . 5 drops Water, ..... 4 ounces Mix. At the period it may be taken every two hours. In the interval, measures to improve the general health and the avoidance of all sexual excitement; sitz baths, outdoor exercise and the following: Bromide of Ammonia, . . 4 drams Quinine, ..... 30 grains Tincture Cinchona Compound, . 1 ounce Syrup of Orange, . • . . 3 ounces Dose — A teaspoonful three times a day. In inflammation of the ovaries there will be fever ushered in with chills, pain in the ovarian pulse, rest- lessness and general symptoms of inflammation. Rest quietly in bed, keep bowels open with Epsom salts and apply mustard, followed by hot applications to the abdomen, and hot foot baths. Then give: Tincture of Aconite, . . 10 drops Tincture of Gelseminum, . . 10 drops Water, . . . . .4 ounces Mix. Dose — A teaspoonful every two or three hours. If it occurs at the time when menstruation should appear, let an infusion of serpentaria or Virginia snake root as it is generally called be drank. It will usually 266 PAINLESS CHILDBIRTH cause sweating. It may be combined with motherwort in a small quantity. At the same time alternate the fever mixture above mentioned with drop doses of Pulsatilla every two hours. If an abscess forms, the ovary should be removed without unnecessary delay. A consideration of ovarian tumors in a work of this kind could be of no use to the general reader and will be omitted. SMALL AND SHRUNKEN BREASTS Next to facial beauty does woman pride herself on a proper development of her breasts. If too large or too small they render her figure imperfect and materi- ally impair her attractiveness. Not only is perfection here essential to beauty and happiness, but it is also necessary for the perfect per- formance of that function to which all true women aspire — maternity. But, alas! these organs so doubly essential to the health, happiness and usefulness of women are prone to disease. They may be arrested in their develop- ment or, after having been developed, they may under- go retrograde metamorphosis and become shrunken, shrivelled, unsightly; development may proceed so far that they become too large and burdensome. They are often the seat of tumors, cancers, etc. Again, they are liable to inflammation and abscesses. Any departure from a natural size and firmness constitutes a disease, and may as appropriately be regarded so and subjected to proper treatment as any other organs that more intimately influence the proc- esses of life. DISEASES OF WOMEN 267 The breasts are properly to be considered as a part of the reproductive system, and menstrual and uterine diseases are often manifested by diseases of the breasts. In fact, uterine disease is in a large proportion of cases manifested by wasting of the breasts. Atrophy or non-development of the breasts, like other diseases, admits of a cure, and women whose forms are imperfect and who habitually resort to arti- ficial means can have the defect overcome by a proper course of treatment. The cause must be considered and the relation of the wasting to the other diseases must be studied and such treatment devised as shall bring about the most perfect state of the general health, then remedies to increase the nutrition and cell develop- ment locally. will succeed in all cases. The matter has received much attention during the past few years, and several remedies have been found that exert an efficient curative influence over this condition. I will, however, omit explaining them, because were I to do so it would open a field for quacks to operate in, who would take advantage of woman's desires to be attractive and flood the country with nostrums that would necessarily disappoint as many or more than were gratified. There are no specifics. We must consider conditions present and apply the remedies in accordance with those physiological and therapeutic laws that govern scientific treatment in other diseases. Any woman wishing further informa- tion on this subject should write to Dr. Dye's Medical Institute without delay. CANCER OF BREAST The strong disposition of cancerous disease to locate in the female breast, necessarily causes alarm at the 268 PAINLESS CHILDBIRTH discovery of any bunch or tumor in this locality. The diagnosis is not easy except when the disease is well advanced, and physicians often find it difficult to dis- tinguish between benign and malignant tumors. A few points, therefore, may not be amiss. The form of cancer found here is generally very hard and is frequently called stone cancer in common parlance, while in professional language it is scirrhus. It is very hard, knotty to the feel, there is darting, gnawing, lancinating pain, and when well advanced becomes immovable, the surface discolored, the nipple drawn backward into the mass, the glands in the armpit enlarge and the whole complexion gradually develops that peculiar waxy, sallow hue known as the cancerous cachexy. On the other hand, benign tumors do not present these characters, but may become much larger than a real cancer. The treatment is surgical — extirpation — and should be resorted to before the whole system is impregnated with cancer cells. If there is no pain or soreness, take time and do not be scared into doing what will do no good. If it presents the characteristics of cancer, early removal is advisable. The consideration of cancer, however, is not within the intention of this work, and though my space has necessitated the curtailment of many subjects it is the earnest hope of the author that the hints expressed will point many who are in search of health to the recovery of that desirable boon. CHAPTER XVII STERILITY In obedience to a Divine mandate it is natural for woman to yearn for motherhood, for it is the ideal state of every woman who has not already arrived there. Although it is not uncommon to meet young married women w T ho wish to defer the assumption of maternal responsibilities for a time, there are few women indeed who will voluntarily pursue life's journey with- out the companionship of one or more of those little blessings to enliven her sympathies and increase her enjoyment in the noonday of life and to comfort her declining years. Marriage is the consummation of love; yet without offspring its object is but half attained. The coming of children strengthens the ties already existing between man and wife and renders happy and harmonious lives that would otherwise be passed in estrangement and discord. The yearning of the wife's heart for children is a natural instinct that is largely shared by the husband. Although they may conceal their desires from one another, and even publicly assert that they entertain an intense hatred for children, in the privacy of the 270 PAINLESS CHILDBIRTH professional consultation confessions are made which prove that nature is true to herself. With many females the grave is looked forward to with more cheerfulness than a childless longevity, and not a few husbands would rather die in the prime of manhood and leave an heir than to live to gray old age and be considered incapable of reproduction. So great is the regard of offspring by both husband and wife (and I do not consider it a betrayal of pro- fessional confidence when I assert that I am very often consulted on the subject either in person or by letter), the question is often asked by both male and female, "Am I capable of becoming a parent?" and when disappointed in the realization of their desires, though perhaps charging the fault upon the other, they se- cretly and without the knowledge of the other seek professional advice and remedy. In other cases both parties seek advice together, hoping by so doing that the true cause of the barrenness may be ascertained and the proper remedy obtained. There are very few subjects that give men or women more anxiety than this, for to go through life with the self-consciousness of procreative inability is indeed a source of very great unhappiness. Quacks have taken advantage of this and made the subject the basis of numerous "Marriage Guides/' in which the authors have sought to impress the unmarried with a belief in their own incompetency in order to wring from them large sums of money for pretended restoration. According to the observations made by English investigators nearly one married woman in eight is barren. Barrenness, however, cannot be considered as absolute, even without interference, for it is known that STERILITY 271 women who have borne children may become sterile, while on the other hand women who have been sterile for years subsequently become fertile. It has not, however, transpired in the course of these investi- gations how far the sterility may be the fault of the husband. Nor is it likely that such an inquiry can ever receive more than an approximate answer, for the very reason that people will never consent to have their private matters become public property to the extent necessary to form a close estimate, based upon statistics. Having made chronic diseases of the reproductive functions of both sexes a specialty for years I trust I may be pardoned for saying that the subject of pro- creation concerns gentlemen far more than is generally supposed. In connection with the subject of sterility it may not be any breach of professional confidence when I say that the extensive prevalence of sexual abuses and excesses of the young, and even of the middle-aged, render them liable to certain disorders which so inti- mately concern the married state that I am consulted daily either in person or by letter by both sexes as to the propriety of marriage. I mention the matter here to illustrate the causes of sterility as being sometimes the husband's fault, for which the wife is generally blamed. If the male party to a marriage contract has by vices and pernicious practices despoiled his manhood and finds the union unhappy or unproductive in conse- quence, it is fully as proper that he seek professional assistance as for the wife to bear the odium of barren- ness. Happily, I am able to offer those who consult me in these matters very decided assistance, these 272 PAINLESS CHILDBIRTH disabilities being for the most part amenable to proper treatment. The average time elapsing between marriage and the first child is about seventeen months. The first three years may be permitted to lapse before the woman can practically consider herself sterile, though if she has not made use of any preventive during that length of time and conception has not occurred the chances are as thirteen to one against her, for she will be likely to remain unfruitful except she receive assistance from art. In considering this subject it is to be remembered that it does not always follow because a marriage is fruitless the wife is to blame; nor does it follow because a woman has not borne living children that she is always sterile; not is it certain that if she is barren the first few years of married life that she will never have children. Women sometimes become fecund after years of sterility. The mother of Louis XIV was sterile for twenty-two years before his birth; the wife of Henry II became the mother of ten children after a period of ten years of barrenness. Dr. Tilt, of England, men- tions a case of a healthy woman who had married a healthy man at eighteen, but did not bear a child until she was forty-eight. Numerous instances are on record where a marriage has been unproductive, divorce followed with subsequent marriage of the man and wife to another woman and man, respectively, and the subsequent unions were blessed with offspring. The causes of sterility are various, and in a very large per cent of cases can be remedied. A careful investi- gation of each individual case will usually reveal the cause of sterility, so that I can point out the indica- tions of cure. STERILITY 273 Among the causes most frequently met are the following: Chronic inflammation of the neck or body of the womb, stricture of the neck of the womb, flexure or elongation of the neck of the womb, tumors, growths, polypi or other obstructions of the neck of the womb, displacements, uterine tumors, ovarian diseases, pro- fuse and acrid vaginal secretions, uterine catarrh, leucorrhoea, imperforate hymen, sexual excesses, uter- ine and ovarian debility, membraneous dysmenorrhoea, menstrual derangements, sexual frigidity, nursing, late marriages, disease of husband causing imperfect devel- opment of spermatozoa, temperamental incompati- bility, imperfect development of the womb and ovaries, displacement of the ovaries, stricture of the fallopian tubes, adhesion of the fimbriated extremity of the fallopian tubes, etc., etc. From this list of causes it will be readily inferred that with the exception of the last three or four, all are amenable to treatment when properly understood, because they are dependent upon conditions which the best authorities of the present unite in declaring curable. Formerly, the causes of sterility were shrouded in mystery, and the treatment speculative and empirical, but light has been let in upon the subject by modern investigators, and barrenness is now known to be occa- sioned by certain conditions capable of removal. Much of what is known of the diagnosis and treatment is due to the labors of Drs. Sims, Thomas, Emmet and a few others who have stripped the subject of its mys- tery and made the treatment more than a mere matter of conjecture and guesswork. 274 PAINLESS CHILDBIRTH It will be seen that a very large per cent of these causes act in a purely mechanical manner by prevent- ing the entrance of the spermatozoa into the womb or beyond it, where it may by uniting with the germ cell occasion conception. Numerous theories have been advanced as to the manner in which conception takes place. It is now understood that the sperm cell of the male and the germ of the female must come in contact before it can occur, and that this union must occur beyond the mouth of the uterus and under certain conditions. How these cells influence each other is not at present definitely known, but upon their union the germ ac- quires a disposition to unite itself to some tissue from which it may receive nourishment and support. The tissue which is most favorable for this purpose is the lining of the cavity of the womb, though it sometimes occurs in the fallopian tubes or at the ovary. The cavity of the uterus appears to be the most favorably designed for the reception, protection and development of the fecundated germ, and the question seems settled that the sperm cell — the spermatozoon — must penetrate the reproductive passages of the female as far as this cavity, or fecundation cannot take place. So far as I have been able to ascertain no instances are recorded where conception has taken place between the cavity of the uterus and the external generative organs. So far as the penetration of spermatozoa to the cavity of the uterus is concerned it is entirely mechanical and may occur without the female experiencing any of the sensations due to the generative act whatever, although recent developments show beyond a doubt, such experience on her part favors such penetration. STERILITY 275 Instances have been known in which the spermatozoa have penetrated the uterine cavity and passed through the fallopian tubes to the ovary, but it is not satisfac- torily determined that it must always be so in order that conception occur. After the union of these two infinitesimal cells has taken place, certain other favor- able conditions are necessary to their development, and it is upon these conditions that the success of the impregnation depends. If the sperm cells are unhealthy or imperfectly developed, although the maternal parts are prepared for their reception, their death instead of their development will occur. If the interior of the womb is in an unhealthy condition the fecundated germ may be unable to effect its adhesion and consequently be thrown off. Recent authors claim that a catarrhal condition of the lining membrane of the womb is to a very great extent to blame for all the cases of sterility not due to mechanical obstruction. Chronic inflammation of the mucous membrane will always be associated with a catarrhal discharge. The membrane being bathed in a secretion of its own mucus, while it may not destroy the germs by any poisonous qualities, prevents their lodgement and nutrition, and thus effectually pre- vents conception. If the ovaries are diseased, the germ cells may not be able to maintain life and perform their part. Thus failure may be due to some defect in the sperm cell, in the germ cell or in the condition of the uterus. In addition, disciples of the electro-magnetic and the temperamental doctrines would have us believe that the failure may be due to defective magnetic 276 PAINLESS CHILDBIRTH conditions, temperamental incompatibilities, etc., which perhaps even they themselves cannot clearly explain. Among the causes of sterility, doubtless the most important are those which oppose the entrance of the spermatozoa into the uterine cavity where conception can take place; these are anything that obstructs the uterine canal, and may exist before a child has been born, or may be acquired afterward; thus, imperforate hymen, displacements, tumors, polypi, granulations or other growths within the neck of the womb, angular curvature of the uterine neck, stricture of the same and chronic inflammation, to which might be added, tech- nically, occlusion of the mouth of the womb. Imperforate hymen, as anyone who will consult a work on anatomy will readily see, necessarily prevents the entrance of the spermatozoa; indeed, it does not permit them to even reach the mouth of the womb at all. At one time the hymen was considered as the test of virginity, but, thanks to the enlightenment of the present, it is no longer so. There are many ways in which this membrane may be ruptured without in the least compromising the virginity of the female. It may be ruptured by the use of a female syringe which every female who respects cleanliness will use, occasionally at least. It may be so fragile as to be ruptured by the menstrual flow and in other ways; while on the other hand it may be so powerfully devel- oped that all attempts at copulation will be futile. There may be a small orifice through which the menses may escape and through which it is possible the sperma- tozoa may enter, but not probable. When this is the case, nothing short of a surgical operation will suffice for its removal. STERILITY 277 On the one hand the woman is blamed if this exceed- ingly uncertain test of chastity does not exist, and on the other she will be blamed for the sterility its exces- sive development occasions. In the first place, none but the ignorant, prejudiced and exacting will be dis- appointed if it does not exist. In the second, a profes- sional consultation will allay any unhappiness and anxiety. Let our readers bear in mind that in medical jurisprudence the presence of this membrane is not an absolute proof of chastity, nor does its absence prove immorality. Uterine displacements may occasion sterility. The manner in which they operate is either to turn the mouth of the uterus in such a direction that the sperma- tozoa cannot reach it, which might be the case in ante- version, a displacement in which the body of the uterus is tipped forward and downward and the neck and mouth carried upward and backward, the central at- tachment acting as a pivot upon which the uterus very nearly turns bottom upward by tipping forward. This condition is usually associated with more or less trouble with the bladder and is exceedingly difficult to cure, mechanical means being usually essential to success. In retroversion the uterus tips backward instead of forward, the body of the organ falling backward into the hollow of the sacrum, while its mouth is carried forward and upward behind the bladder, turning the mouth persistently away from the spermatozoa. By the pressure of the uterus in this condition upon the lower bowel, constipation and backache are occasioned. This form of displacement is more frequently met than anteversion. It may be cured by mechanical measures to overcome the mal-position and the employment of 278 PAINLESS CHILDBIRTH remedial agents to so tone its supports that the natural position may be maintained. Very often this displace- ment is associated with an enlargement and increase in weight of the organ which must be overcome before a permanent cure can be expected. These mal-positions very often result in sterility. Another form of displacement known as prolapsus or falling of the womb is often a cause of barrenness. In such cases the mouth of the uterus often rests upon the floor of the pelvis and is buried in the soft tissues covering the perineum or vaginal walls which form as it were by the pressure a complete covering for the mouth of the womb, preventing the entrance of any- thing. To overcome this trouble has taxed the inge- nuity of the profession for years. In such cases there are a great variety of symptoms, sympathetic dis- turbance, etc. The indications of cure are to reduce the increased weight of the organ, replace it and, by increasing the power of its supports or otherwise, main- tain the proper position. This is often difficult to do and we often hear a physician saying, "If you could only have a child it would cure you." The truth of it is, if they could only cure the patient she would be very apt to have a child. We cannot in the space allowed this subject consider the methods of cure, nor would many be likely to succeed without professional assistance. Artificial supporters are necessary in many cases, while in others they make the trouble worse and are so painful that no woman can wear them. Tumors, growths, etc., when occurring in the uter- ine neck, form a mechanical obstruction to the entrance of the spermatozoa and, as conception cannot occur in the vagina, they become efficient causes of sterility. STERILITY 279 By blocking up the canal of the uterus they interfere with the escape of the menstrual flow, causing severe pain at the menstrual period and, by modifying this function, are often the cause of profuse hemorrhage. A careful examination is necessary in order to correctly diagnose the nature of the trouble. On the introduction of a speculum the trouble may be at once apparent or it may require the dilatation of the uterine mouth and neck before the source of trouble becomes visible. Very often the morbid growth will be so small as to escape notice, yet it is a very efficient source of trouble. The growths most frequently met with are granulations, or polypi, though tumors may be present. The measures to be employed for their removal necessarily vary with the nature of the growth, size, location, etc., etc. Granulations and small polypi will usually disappear with appropriate treatment, and large polypi may be removed by forceps, snare, ligature or scissors. Hemorrhage may be troublesome, but usually in the hands of one who understands his business there will be little trouble or pain in their removal. The removal of tumors may be effected with a knife, liga- ture, caustic, injection or electricity. No one but a skillful surgeon has any business to touch them. When either of these troubles has caused sterility, their removal will be likely to be followed by conception. It may be proper to place in this division another form of abnormal development that is sometimes met as a cause of barrenness. It is when the posterior lip of the uterine mouth is unnaturally long and folds over the entrance of the womb like a valve, forming an effec- tual barrier against the entrance of anything into the 280 PAINLESS CHILDBIRTH womb, but is no impediment to the escape of the men- strual flow. Such a condition might pass entirely un- noticed because it would not be attended by any other troubles that would be likely to lead to its recognition, and unless the female came under examination to ascertain the cause of her sterility it would probably never be known, and even then unless the examiner was on his guard it might easily escape detection. This cause can be easily remedied by a surgical operation. Curvature of the neck of the womb is a fruitful cause of sterility and is a frequent source of painful men- struation. The body of the womb may be bent upon its neck in such a manner as to obstruct the canal suffi- ciently to prevent the entrance of spermatozoa or exit of menstrual matters in the same way that a finger of a glove may be bent as to prevent the passage of even water. The curvature may be so great that the axes of the neck and body of the womb will intersect at nearly right angles. Take a hollow tube and bend it upon itself to a right angle, or even an obtuse angle, and you have a good illustration. When the curvature is forward it is called " anteflexion"; if backward ' ' retroflexion ' ' ; if sideways ' ' Lateral-curvature ' ' . These deviations from normal position are often more easily recognized than cured. Several forms of treatment are in vogue, one of which is to cut or divide one side of the neck, before or behind according to the flexion, in order to establish a straight and free passage. When properly performed it is generally successful. It is not very painful, though there may be some hemorrhage. The subsequent treat- ment must be thorough, or the divided portions may unite and leave it worse than before. Another plan is STERILITY 281 to dilate the neck of the womb and introduce an instru- ment that will hold it straight until the curvature is effectually overcome. Uterine supporters are also em- ployed, but the surgical treatment is by far the most successful, though the dislike many entertain for the knife will often lead to a trial of the other measures. Many cases are recorded in which the successful treat- ment of curvature by one or the other of these methods has been followed by a realization of the highest hopes — a child! Stricture causes sterility in a manner very similar to curvature, the uterine canal being narrowed by constriction so as to prevent the easy passage of the menses from within or spermatozoa from without. An examination by the touch or by speculum will often reveal nothing, but when an attempt is made to intro- duce a uterine sound, the trouble becomes apparent. This trouble is therefore very often overlooked and the sterility attributed to other causes. There is very little excuse, however, for overlooking this condition when a thorough investigation is being made. The treatment of this difficulty consists in perma- nently enlarging the canal, which may be done either by stretching or dilating it with steel dilators, or by a single or double incision. The operation of dilating should be thorough, so that there may be no tendency to return to the previous condition. The incision, performed in much the same manner as for curvature and properly attended until the incised surface has healed up, is almost always successful and occasions little pain, though the woman must remain in bed a few days. There are few cases but that remain perma- nent if the operation has been made with the requisite 282 PAINLESS CHILDBIRTH amount of skill. The performance of this operation and the frequency with which it has been followed by conception, as well as relief from the most intense sufferings at the menstrual period, reflects very great credit upon the name of Dr. J. Marion Sims. Elongation of the neck of the womb is also a source of barrenness and painful menstruation, and its suc- cessful amputation has been effected. When the neck is unusually long there is generally a corresponding narrowness, and the treatment is made for the purpose of enlarging the canal to facilitate the passage of the spermatozoa. It makes little difference, in the result, which of the operations, as for stricture, are made, if properly performed, but, of course, skill will be necessary and no one must attempt it without a clear under- standing and the requisite facilities. Occlusion, by which a complete closure of the neck of the womb is meant, may be due to congenital mal- formation, or to ulceration which in healing has resulted in uniting the edges in such a manner as to completely obliterate the canal. The improper use of caustics may also produce this result, and nothing can enter the uterus nor escape from its cavity. Such a condition will be far more likely to demand interference on ac- count of the trouble arising from the retention of the menstrual discharge than for the relief of sterility. The establishment of an artificial opening by surgical means is necessary and gives speedy relief. Such cases are rare. Chronic inflammation may be confined to the neck of the womb, to the body or to both, and may involve only the mucus membrane lining, or extend to deeper structures. It is a frequent affliction of civilized women, STERILITY 283 and on account of its frequency becomes one of the fruitful causes of barrenness. An endless variety of symptoms accompany this ailment which are not only referred to the reproductive organs but, through, sympathy, may extend to every part of the body. This ailment is not an absolute preventive of conception, but it is not very probable that the woman that is afflicted with it will bear children. In this trouble the neck of the womb may be much larger than natural and the membrane very much re- laxed; but there will be formed in the neck a plug of thick, tenacious mucus so completely filling the canal that it constitutes a mechanical barrier to the entrance of the spermatozoa. When this is not the case it will be so acid as to destroy the vitality of the spermatozoa and the sterility is as certain as if they did not reach the locality at all. I have known many physicians to fall into error in the matter because they were misled about the possibility of the mechanical impedi- ment when the canal was so much larger than normal. A cure of this ailment is essential to the fruitfulness of the female and can be effected by a proper and per- sistent course of treatment, but to give a course of treatment so that it would be available would require more space than is at our present disposal, and the patient is referred to works on the subject. Consti- tutional treatment alone will not always be successful, and local measures are often demanded. The internal employment of Dr. Dye's Mitchella Compound already mentioned may succeed and is worth a trial. Its effect may be aided by injections, more particularly for clean- liness, and the use of pieces of cotton batting, saturated with glycerine and placed against the neck of the womb. 284 PAINLESS CHILDBIRTH The action of the glycerine is to set up a drainage of the watery elements of blood contained in the minute blood vessels of the uterine neck and thus relieve the turgescence and stagnation. They are to be repeated daily or at least every other day for a considerable time, but omitted at menstruation. Medicating the glycerine with one eighth part of tincture of iodine, golden seal, calendula, etc., sometimes increases the efficacy. It is scarcely necessary to allude to malformations or anatomical defects other than those already con- sidered, for the public are aware of their influence on fecundity. Some may, however, be remedied by surgi- cal means, and we would urge all women whose happi- ness depends upon their anatomical perfection not to be discouraged until they have consulted some good surgeon. It would be the part of wisdom, however, when a malformation exists not to enter matrimony until a surgeon has been consulted. The foregoing causes of sterility are mechanical in their operation and the removal of the cause by medi- cal or surgical means will usually be followed by relief of the maternal disability. Should the sterility con- tinue more than two years after the removal of any of the causes already considered, some other cause will have to be sought, among which the most frequent are the following: Acrid vaginal discharges, membraneous dysmen- orrhea, menstrual derangements, uterine and ovarian debility, sexual excesses, sexual apathy, ovarian dis- ease, late marriages, imperfect development of ovaries, displacement of ovaries, stricture of fallopian tubes, STERILITY 285 temperamental incompatibility, disease of husband, nursing, etc., etc. Acrid vaginal discharges prevent conception by destroying the spermatozoa before they reach the germ cell. Usually this trouble will be considered as leu- corrhoea and properly enough so, yet experts assure us that some forms of leucorrhoea, or " whites, " do not cause barrenness, while others do. Facts of the kind are within the knowledge of nearly every observing person. The leucorrhoeal secretion is not always the same, but admits of a great variety of modifications, and some forms are so very acid that they are as de- structive to cell life as a solution prepared in the labora- tory of a chemist could be. In such cases, particularly if long continued, there will usually be soreness of the parts caused by the corrosive character of this dis- charge. While a cure is always desirable it is not always so easily effected. A lotion of permanganate of potash, ten grains in a pint of water, used freely, is very valua- ble; still there may be constitutional troubles on which the discharge depends that will need attention as well as the local trouble. The sepia of the homeopathic school I have found exceedingly valuable in such cases as an internal remedy. Locally, a great variety of remedies have been employed, but as it is only as a cause of sterility we are considering it we may say that if the spermatozoa can escape the deadly influence of this secretion and enter the uterus, conception may be effected. The use of injections before the sexual act, to remove as much as possible of this secretion, will increase the probability of success, and if after the use of an injection of warm water, which is made for 286 PAINLESS CHILDBIRTH the purpose of cleanliness, an injection of milk is used, the probabilities of success are enhanced, the object being to protect the male element in its passage to the womb by removing the vaginal secretions or by render- ing them harmless. Membraneous dysmenorrhoea is that form of painful menstruation in which the flow is expelled with shreds of tough membrane, or perhaps with complete casts of the interior of the uterus. Although it does not always cause barrenness, it is likely to do so. Its pathology is not well understood. It causes sterility by preventing the united sperm and germ cells from securing an attachment to the walls of the uterus so that development can occur or carries them away with it when it is expelled. It is difficult to cure. When conception does occur it must take place soon after menstruation. It may exist in the single. When the disease is removed, among the married, pregnancy results. It has been thought that pregnancy would cure it, but instances have come to knowledge where the women had borne more than one child and still did not get relief from this trouble. Menstrual derangements usually cause sterility, particularly when the flow is profuse, by washing away the impregnated ovum. When there is menstrual de- rangement, a functional disease of the womb or a disease of the ovary is apt to co-exist, which may pre- vent the perfect development of the germ cells and thus cause the union of the male and female elements to be futile. The use of Dr. Dye's Mitchella Compound will be found of great value in these cases. Rectify the derangement and pregnancy may then occur. There is a plant known as senecio aureus, or life root, which STERILITY 287 may be used with Mitchella Compound in infusion or syrup. Sometimes the derangement results from a low grade of vitality on the part of the woman, and when such is the case the preparations of iron are of value. If from congestion with dragging down, aching, etc., the use of small doses of belladonna may so far over- come it as to favor conception. Fifteen drops of the homeopathic tincture in four ounces of water and a teaspoonful taken every four or five hours often suc- ceeds in overcoming this latter condition. Uterine and ovarian debility causes sterility by im- perfectly developing the germ cells or by imperfectly nourishing them after they are fecundated. Where there is no constitutional debility we may attribute the sterility to purely local debility or inertia. In case there is constitutional debility a course of tonics are proper. Iron, squaw vine, life root, quinine, nux vomica, etc., in proper doses will often be followed by the de- sired results. In case of a purely local inertia or de- bility, the use of electricity, passing the current through the body from the lower part of the back to the point over the pubes, may succeed. The use of an electrical current passed into the uterus by one pole of the battery being introduced into it, the other over the back, is sometimes successful, and so is the application of a strong child to her breasts. There is a sympathy between the breasts and womb and ovaries, and by the reflex influence the natural function is so acted upon that conception at that time may be effected. Sexual excesses exhaust the vitality of both parties to such an extent that the germ and sperm cells may not be sufficiently viable to perform their part in repro- duction. By a wise provision of nature such devitalized 288 PAINLESS CHILDBIRTH elements are frequently unproductive, and it is well that it is so. The remedy lies in modifying the indul- gences to a frequency consistent with vitality, correct- ing the debility with a judicious course of tonic medi- cines and, if necessary, such a course of local treatment as has been advised under the preceding section — electricity, cold bathing, sea bathing, etc. Sexual apathy, while not an absolute cause of ster- ility, may properly be considered as one of them. Many women bear children who do not experience the least sexual desire; yet others are barren on that ac- count. When such is the case, an inquiry into the causes of the sexual apathy is necessary and the case treated according to such indications as may be rendered appa- rent by the investigation. The fact that sterility is not always caused by the absence of sexual senses leads us to the presumption that it is only in certain forms of this condition that sterility results, consequently the course of treatment selected will have to be dependent upon the cause. The use of tonics, electricity, injec- tions of stimulating substances, as ammonia (weak), tincture of myrrh, etc., are sometimes valuable, as is the internal administration of musk, phosphorus, iron, quinine, etc., in proper doses, which may be deter- mined from any work on Materia Medica. Ovarian diseases prevent conception by preventing the development of the germ cells entirely, or by causing them to be so imperfectly developed that they cannot perform their part. The consideration of dis- eases of this kind is not within the scope of this work, while displacement of the ovaries, their imperfect development, together with stricture of the fallopian tubes, are of such a nature that a consideration of STERILITY 289 them would be of no value to the sterile woman, for nothing she can do will be likely to afford her relief, and we must refer them to those who make such ail- ments a specialty. The period of the greatest fecundity occurs on an average between the ages of twenty and twenty-four, and the farther the latter period has passed without the woman becoming a mother, the greater are the chances that she never will be thus favored. This is more particularly the case where no organic disease of the womb or ovaries exists as the prime cause. There are very many notable exceptions to this rule, and if some other cause may not be determined we would not advise the woman to be discouraged, for possibly nature may bring about some mysterious (?) change that will result in her maternity. Horseback exercise has sometimes been beneficial in these cases, partic- ularly when carried to excess. Just before or a few days after the menstrual period conception is most apt to occur, particularly if total abstinence is practiced in the interval. Nursing is a fruitful cause of unfruitfulness, though not absolutely certain, for instances are constantly coming under observation in which conception occurs during nursing. It is supposed the reason is because the vitality of the woman is expended in supporting the child at the breast, by the secretion of the milk, during which time the ovarian and uterine function is suspended. After weaning, conception is very likely to occur, particularly if the mother has not seriously deteriorated in health. Very often the woman is blamed for unfruitfulness when she is entirely innocent and the husband is the 290 PAINLESS CHILDBIRTH real culprit. Knowing as I do the extensive prevalence of self-abuse and its ruinous consequences on not only the reproductive organs but the general system, I can easily understand how the spermatozoa may be so defective that they cannot impregnate the germ cells of the woman, no matter how perfectly developed and matured these may be. The seminal fluid of the male does not always contain perfect spermatozoa, and if no good cause can be assigned for the sterility on the part of the wife it is well to inquire into the condition of the husband before the wife is subjected to censure. The husband may have had some disease at some time of his life that has impaired the functions of the testicles, or he may have done so by leading a lecherous life, and I am satisfied after years of experience in the treatment of these affections that many a wife has been unjustly blamed in the matter. Temperamental incompatibility is a cause often mentioned and, while it is possible, it is too little under- stood to be very often considered in the question of reproduction farther than to the inheritance of pecu- liar constitutions; electro-positive and electro-negative conditions are essential to the harmony and procrea- tive success of a matrimony. It may appear a little far-fetched, when we consider that the polarity of organs or bodies may be more or less modified or changed by circumstances, excitement, etc., yet an inquiry into the causes of sterility could not very well evade its consideration, and if both parents are similar in temperamental and magnetic qualities they may be unfruitful, while the same parties united to others would be fertile. STERILITY 291 No better illustration of this subject is needed than the well-known one of the first Napoleon and Josephine. She had had children in her first marriage; he became a father in his second. True, there may arise a question of Josephine's fertility with another husband .at the time — a question that will no doubt always remain open. It is, nevertheless, a recognizable fact that certain parties are illy adapted to each other, socially at least, and though the question of temperaments has furnished a fine field for quackery, but little as yet is definitely known of it as a cause of sterility. There are many questions that rise before me as I write, but their consideration might lead in some cases to domestic infelicity without doing much to unravel the mystery, and it is best that its consideration be made the subject of a private consultation in which all the peculiarities of the individual concerned may be con- sidered, or submitted to those who delight in such metaphysical (?) inquiries. The question of temperaments, however, is one that should receive attention from marriageable people even aside from its influence on fertility and the fruitfulness of the union. It is easy enough to follow the subject in the divisions laid down by those who have made the study a specialty, and to say who are best adapted to each other, but to carry the question to a consid- eration of sterility is extremely difficult, because there may be circumstances connected with the sexual life of a husband and wife, before or after marriage, that no inquiry except made in individual consultation would reveal, and I must confess that the subject in the present state of society seems a very unproductive one. 292 PAINLESS CHILDBIRTH We have already considered the most frequent causes of barrenness and pointed out the indications for their removal, many of which we are sorry to acknowledge cannot be carried out wholly by the woman herself. In the treatment it may sometimes be found that after the removal of some cause the sterility will con- tinue. When this is the case some other cause must be sought, for it so happens that occasionally a combi- nation of causes may exist. The researches of Dr. Sims have shown that for the most part the causes of ster- ility are mechanical, and that the removal of the mechanical cause is followed by pregnancy in a large proportion of cases. It has been my endeavor to show the barren woman the operation of those causes and to point out others which may offer an opposition to her happiness. There are, however, still others which do not admit of any general classification, but they are not very frequent, and it is presumed that they operate remotely rather than by being causes within themselves. Of these we may mention season, climate, social position, sexual relations, etc. It is claimed that spring is the most favorable season for fecundity. Climate no doubt has much to do with fecundity and barrenness, but it is no doubt due to the influence it exerts upon the general health, though it is said that the southern climate is more favorable than the northern. Perhaps this may be accounted for by the difference of the sexual dispositions of those who live in the different climates. Sterile women travel- ing with their husbands, sometimes find that an ocean voyage, or a trip to some other climate, so modifies and improves their general health that it ultimates in their STERILITY 293 becoming mothers. Social position no doubt has some- thing to do with fecundity, and without making any inquiry into the sexual relations of the rich and poor, I will state that women who live in luxury and fashion are not so prolific as their poorer sisters. Those who are in the best circumstances to care for large families rarely have as many children as those who find it difficult to provide for them. It is said that in Belgium the higher the price of bread the greater the number of children, and the greater the infant mortality. In another chapter allusion has been made to the greater prevalence of uterine disease among wealthy ladies in proportion to their numbers, which may partially account for the difference in the size of families. On the other hand, many weak and feeble women have a numerous progeny. Sexual relations no doubt exert a greater influence upon fecundity, fertility and sterility than is generally supposed, and this is not only in relation to the rela- tive conditions of health, but also to the other rela- tions married people sustain to each other. The sub- ject, however, is one which, while the reader might be specially desirous of understanding, my regard for propriety forbids its consideration in this place. Should those thus affected choose to consult me personally or by letter I will endeavor to enlighten them as far as possible. There is an inadaptability often existing between the parties to a marriage contract that renders their lives unhappy and prevents them from having children. These troubles require skillful treatment and are gener- ally of such a character that they yield readily when the requisite skill is obtained, and no one should be 294 PAINLESS CHILDBIRTH discouraged if they should be unfortunate enough tc at first fall into the hands of quacks, for those unprin- cipled rascals are plenty and are ready to palm them- selves off for scientific physicians. The sterile will do well to consider the subject and ask themselves the question, what is wrong? When people live unhappy lives, who is to blame? Are both, or is only one? Such queries may lead them to be more forgiving to each other and thus relieve the mental causes of sterility. This may seem far-fetched and will perhaps be criticised by those who can see only causes of ster- ility in the tangible conditions already considered; yet if the mind can influence ante-natal conditions so as to cause " birth marks," may not lack of mental, moral, social, sexual and domestic harmony be equally as unfavorable to the occurrence of conception as to the perfect development of the child that has been conceived? In closing, the author hopes that a consideration of this chapter will be the means of directing unhappy and sterile wives to the realization of their maternal desires as well as by previous chapters to relieve the fertile ones of the difficulties and dangers, the pains and the perils of childbirth. . CHAPTER XVIII DISEASES OF CHILDREN Children are subject to various disorders, the lia- bility to at least some of which diminishes as they advance in age. It is estimated that fully one fourth of all the children born, die before reaching their seventh year. To know what to do before the arrival of the family physician or in his absence is often of very great advan- tage, and the writer hopes his suggestions may be of practical value to the anxious parent and an aid to the physician in the performance of his many duties. As the unprofessional reader will derive little or no benefit from pathological considerations I shall omit them almost entirely and, instead of pursuing the usual arrangement of diseases by groups and classify- ing them according to their pathology, I shall consider them in a manner that seems to me to be of the greatest convenience to the reader, endeavoring to render the subject as intelligible and practical as brevity will permit. Unless otherwise specified, the doses advised in this chapter will be for children from one to four or five years of age and should be increased for those older, adding about half as much more for children between 296 PAINLESS CHILDBIRTH five and ten, double from ten to fifteen and treble for adults. This plan will be rather more convenient than the old one of graduating the dose by years from one to twenty-one, particularly as I do not intend to pre- scribe remedies in such a manner as to endanger life by the difference of a fraction of a dose. It requires not a little tact and discrimination to properly investigate the disorders of childhood, partic- ularly among very young children. We are compelled to depend upon signs almost entirely. These should be well understood by the mother or nurse, for the attending physician must derive his information largely from those who are constantly present, and as many of these signs appear only at intervals a habit of obser- vation should be acquired that every sign may be noted at its occurrence. GENERAL SIGNS Among the sources from which information may be obtained in children who cannot convey a knowledge of their condition by speech, are the countenance, gestures, attitude, breathing, circulation, sleep, cry, discharges, skin, temperature, odors, the tongue, ag- gravations, etc. We are to make use of our senses, see, hear, feel and even smell ! Some diseases generally appear at certain seasons of the year. The prevalence of epidemics should put us on our guard. The expression of the countenance varies with the stages of the disease as well as in different diseases. In affections of the brain and nervous system, the forehead is contracted and heavy, the brows knit, the eyes vacant, expressionless or wild, staring, fixed, some- times squinting, bloodshot, half open, dropping of the lids, the pupils contracted in the early stages of the DISEASES OF CHILDREN 297 disease and dilated later on; the face is generally hot and flushed, spasmodic drawing of the features in twinges of pain. Sometimes the upper lip will be drawn tightly over the teeth and perhaps be almost livid. In diseases of the liver, the skin and eyes become yellow and sodden. In worms, and intestinal irritation from other causes, the nose and upper lip are apt to be swollen, the white of the eyes of a pearly cast, a sharp white circle around the mouth, and if fever is present the rest of the face flushed. In bowel diseases, the cheeks are sallow, sunken, mouth compressed and the lips drawn, dry, dark, parched and, as the disease progresses, anxiety, ema- ciation, the chin prominent, the eyes sunken and hol- low; if not stupid, the whole features sharp; as exhaus- tion comes on, the face is alternately flushed and pale, hot and cold; and in the latter stages the face is glisten- ing, pale, cold, eyes sunken, half closed, lips parched and the features pinched. In diseases of the respiratory organs, as pneumonia, bronchitis, etc., the face is flushed dusky red, nostrils working, dilating with each inspiration and contract- ing with each expiration, the brows knit, lips livid, sharp, dark circle around the mouth, and in advanced cases, emaciation, etc. In measles, the whites of the eyes are red, the eyes watery, overflowing, squinting, avoidance of light, the lids swollen and the general appearance as if crying. In scarlet fever, the eyes are often red and watery, but never overflow, and give the appearance of crying, as in measles, and the intolerance of light is not so marked. 298 PAINLESS CHILDBIRTH In chronic diseases, the face pales and flushes at intervals, the eyes sunken and pupils dilated, with circles beneath, the whites muddy, the cheeks hollow (particularly in diseases of the nutritive organs), sunken, complexion sallow. In diseases of the lungs, the cheeks are sunken, emaciated, pale, with a circum- scribed redness, the eyes often unusually bright. The attitude and gestures aid in indicating the loca- tion and character of the disease. Early, there will be inattention to surrounding objects, languor or rest- lessness. In inflammatory diseases of the chest and abdomen, motion will be avoided as much as possible, the position, on the back with the knees bent and drawn up, sharp cries as there is sudden twinges of pain. As a rule the pain of inflammation causes the child to lie very still. Spasmodic pain causes the child to start in terror and writhe and twist about as the muscles are caused to suddenly contract. In convulsions, the head is thrown backward, the eyes roll upward, the hands clenched, an arm becomes rigid, a leg drawn upward, the toes are drawn downward, the thumbs drawn into the palms of the hands, the child starts or screams or perhaps becomes unconscious, the breath- ing is spasmodic, perhaps frothing at the mouth, gnashing or grinding the teeth. In inflammation of the brain or its membranes, the head is rolled from side to side as the child lies on its pillow, the hands make sundry motions in different directions and are frequently raised to the head, clutching at the hair or cap as if endeavoring to tear them away. DISEASES OF CHILDREN 299 In diseases of the mouth, teething, etc., it works at the mouth, bites, throws itself, rubs the gums, etc., and may have convulsions. In croup and other suffocating diseases, the hands clutch at the throat, press it from side to side, the child struggles to maintain the upright position with the head thrown back to favor the entrance of air into the lungs. The cry is indicative of displeasure, uneasiness or pain. In affections of the lungs, it is a sort of a groan. In croup, it is a hoarse, peculiar, metallic or crowing sound. In acute diseases of the brain, it is one single sharp, powerful cry at distinct intervals. In diseases of the bowels, it is a low moaning sound. Shedding tears during a sickness is regarded as a favorable sign. The discharges should always be noted. They may be scanty, excessive or perverted. When there is vomit- ing, it should be noted to see if it is sour, thick, watery, clear, opaque, yellow or green, or if it contains food. Improper food is often got rid of by vomiting, or pass- ing onward into the bowels it creates colic or diarrhoea. Diseases of the stomach are often characterized by vomiting, when it may contain the undigested food mixed with other matters. Yellow or greenish dis- charges indicate the presence of bile. Vomiting is nature's provision for the removal of an excessive amount of food in infancy. In cholera infantum the vomiting is persistent, watery and mixed with the food. It is one of the first symptoms of some eruptive fevers and often terminates a paroxysm of whooping cough. Diseases of the brain and injuries to the head may cause vomiting. 300 PAINLESS CHILDBIRTH The stools, if frothy, sour or green, indicate de- rangements of digestion and are generally attended with griping. Slimy stools are usually present during teeth- ing and when worms are causing trouble. Blood and mucus indicate dysentery. Thin, offensive stools, vary- ing in color frpm light to dark, are the principal charac- teristics of diarrhoea, and clay-colored discharges indi- cate deficient action of the liver. The frequency of the stools should be observed, for even though they present no unnatural appearance, if too frequent they indicate defective appropriation of nourishment and are apt to contain undigested food. The urine is scanty, highly colored, has a strong odor and is generally loaded with a branlike sediment in fevers, inflammations and rheumatism. The quan- tity, color and smell may be ascertained by observing the diapers of children too small to use a urinal. In diabetes, it is clear and profuse. In nervous disorders, it is apt to be profuse, and on standing deposits a dirty whitish sediment and soon becomes offensive. In diseases of the bladder, it will be passed often and but little at a time. In affections of the liver, it will have a yellowish or saffron color. The circulation in infancy is more variable than in adults, the pulse more rapid and easily influenced, and is not as reliable as a diagnostic means in infants as in grown persons. The skin and its temperature are influenced by disease. It is hot and dry in fevers and inflammations, cool and moist in constitutional weakness. Profuse sweating with cold, clammy skin indicates debility. A doughy, inelastic skin is apt to be present in tubercular or scrofulous affections. It is yellow in jaundice, sallow DISEASES OF CHILDREN 301 and sodden in diseases of nutrition. A bluish tint points to structural disease of the heart. It is red in fevers and eruptions, purplish or livid when the blood is imperfectly oxygenated, and dry and harsh in dia- betes and Bright's disease. The temperature has of late years become an impor- tant aid to diagnosis, and furnishes moderately relia- ble indications of the probable result. In health it is about 983^2° Fahr., and any persistent or considerable deviation from this standard denotes disease, and the greater the rise the greater the danger. The tempera- ture can be determined only by a thermometer designed for the purpose. As it sinks below the natural standard during the progress of a disease it indicates danger of collapse, though in diabetes it is usually one or two degrees lower than in health. It rises in fevers and inflammatory diseases, and if the rise is persistent shows there is severe illness and danger. When it rises to or above 106°, recovery is rare, unless the rise is only temporary. Odors are not easily described, but a knowledge of them serves a very useful purpose. In measles or small pox, there is a peculiar smell that once observed will seldom be forgotten. In lung diseases, a yeastlike odor ,is often present. In stomach and liver diseases, the breath is sometimes very offensive. A peculiar smell accompanies fevers. In rheumatism, the perspiration is usually sour. When the stools have a sickening, cadav- erous odor during any disease it indicates danger. Urine during protracted fevers, inflammations, etc., may have an ammoniacal odor, and indicates danger. The tongue furnishes the intelligent practitioner with a vast amount of information. In health, the 302 PAINLESS CHILDBIRTH mouth is moist and pale, the tongue moist, pale and partially covered with whitish mucus. When loaded with whitish curdy matter there is generally disturb- ance of digestion. A dry tongue is common in most febrile diseases. If it becomes moist after having been dry and furred, it is favorable. It is fissured in typhoid fever. Redness and dryness is present in inflammatory diseases of the alimentary canal; in the eruptive fevers, it is very red; it also indicates acute indigestion. A heavy fur shows disease of mucus membranes and, if yellow, disease of the liver; and a brown or black fur, a low state of the vital forces and, if dry, danger. A large, pale, flabby tongue indicates debility and tardy retrograde metamorphosis. A heavily coated, moist tongue indicates derangement of the secretions with- out inflammation. Redness of the tip and edges of the tongue indicates irritation of the stomach or upper part of the intestines. Gradual clearing of the tongue during disease indicates a tendency to recovery. If the tongue becomes browner, drier, dirtier each day, and the nerv- ous system more feeble, the hope of recovery fades. When the fur comes off suddenly or separates in patches, leaving a glossy surface beneath, it is unfavorable. Although the foregoing indications are not as com- plete as if this work were intended mainly for the guidance of physicians, and admit of many exceptions, they furnish many valuable guides tp the recognition and location of diseases — an outline to diagnosis — as will be observed in the consideration of the following diseases. EXCORIATIONS AND ULCERATIONS Without the greatest attention to cleanliness, children are apt to get chafed behind the ears, in the DISEASES OF CHILDREN 303 wrinkles of the neck and groin, and about the arms. This causes the child untold suffering, and unless it receives proper attention is apt to degenerate into more or less extensive ulcerations. Treatment. — The prompt removal of discharges and carefully washing and drying the child will go far towards obviating this trouble, yet in fleshy children this alone may not be sufficient and additional means will be required. Bathe the irritated parts with warm milk and water, rejecting the common coarse soaps of commerce and, after drying carefully with a soft cloth, sprinkle with powdered starch and lay into the folds of the skin a bit of scorched linen rag. Dusting the parts with powdered lycopodium, which can be got at any drug store, is also an excellent means of preventing serious ulcerations, giving almost instant relief in chafes. When the trouble is persistent, bathing the raw surfaces with an infusion of golden seal is a very reliable remedy. The strength of the infusion should be a teaspoonful of the powdered root in half a pint of water; after standing a few hours, strain. To this we may add a little borax or in some cases ten grains of sulphate of zinc will do better. In children of a scrofulous habit there is a disposi- tion in such cases to form extensive sores, and atten- tion to the child's general health becomes necessary. We must see that it receives proper nourishment and then give some alterative as : Compound Syrup of Stillingia, . 4 ounces Fluid Extract of Bayberry, . 3^ ounce Dose. — One fourth to one half teaspoonful three times a day. At the same time continuing the lotion of golden seal and zinc. 304 PAINLESS CHILDBIRTH If this does not cure in a reasonable time, it might be well to substitute Peruvian bark for the golden seal and prepare and use it in the same manner. VOMITING Vomiting is often caused by overfeeding, and is one of nature's methods of disposing of surplus food. When it results from this cause, careful regulation of the diet will generally be all that is required. For the most part vomiting is symptomatic of other diseases, though it may exist as a disease itself. When it occurs in dyspepsia the food is usually un- digested, in a state of fermentation, and the bowels deranged. In such cases the bowels require some laxa- tive, such as castor oil, rhubarb or calomel^ or we may put five drops of the fluid extract of nux vomica in a glass of water and give a teaspoonful every three or four hours. It exerts an excellent influence in many cases of chronic constipation in children and adults. In connection with this, give two grains of pepsin and a half a grain of subnitrate of bismuth either just before or after the meal. Ordinarily, five drops of the tincture of ipecac in a glass of water given in teaspoonful doses every hour or two will control vomiting, particularly if associated with a looseness of the bowels. If the tongue has a yellow coating or there is a yellowness around the mouth, alternate the ipecac with the nux vomica, prepared as for dyspeptic vomiting. If the vomited matter is sour, dissolve a teaspoonful of bicarbonate of soda in a glass of water and give in sips every half hour till the acidity is corrected, con- tinuing the nux vomicae DISEASES OF CHILDREN 305 A plaster composed of allspice, cloves and cinna- mon, or ginger and Peruvian bark, applied over the stomach is an excellent auxiliary means, but is not to be left on too long, on account of the irritation of the skin it may cause. When vomiting occurs as a symptom of some other disease, the treatment recommended for that will be most appropriate, though the temporary use of the means just considered may become necessary. CONVULSIONS Spasms or fits, as convulsions are .often called, may arise from a variety of causes. They may be symptom- atic of disease of the brain or nervous system, such as meningitis, tumors, hydrocephalus, etc., but as generally met with in children they are caused by irri- tation reflected to the brain from different parts of the body. In this way they are caused by the presence of worms in the intestinal tract, by indigestible food, acidity of the stomach, flatulence, teething, retention of urine, foreign body in the ear, surface irritation, as from burns or wounds, the striking in of some erup- tion, etc. Convulsions frequently occur at onset of certain diseases, especially pneumonia, scarlet fever, acute indigestion, typhoid fever, measles and diphtheria. Convulsions are common in whooping cough. The younger and more irritable the child, particularly if of a highly nervous temperament or scrofulous consti- tution, the greater its liability to fits from intestinal irritation. Convulsions are always to be regarded with apprehension. Four fifths of the cases of convulsions occur during the first two years of life. The symptoms vary in duration and severity, lasting from a few minutes to several hours, and the attack 306 PAINLESS CHILDBIRTH may be repeated at indefinite intervals. There is a sudden and involuntary jerking of the extremities, twitching of the muscles of the face, grating the teeth, rolling the eyes, perhaps frothing at the mouth, the thumbs drawn into the palms of the hands, and the hands clenched and the toes drawn downward. The pulse may be accelerated and irregular, small or hard, and the face pale, flushed, or slightly blue, especially about the lips. Beads of cold sweat often cover the forehead. The contents of the bowels or bladder may be ex- pelled and consciousness may be wholly or partially lost. Toward the end of the convulsion the jerking becomes less frequent and less severe — there is a long- drawn breath and the child passes into a sleep or coma. The premonitory symptoms, twitching of the face, grinding of the teeth, without actual convulsions, are often denominated inward fits. In the treatment, we must be governed by the cause as far as possible. If the premonitory symptoms are noticed or if the child can swallow give a few spoonfuls of salt and water. It is always at hand and is an excel- lent remedy. It may be given freely, for it will only cause vomiting if more than is necessary be taken, and this is often desirable. Put the feet in hot mustard water, and if the head is hot and the face flushed apply cloths wet in cold water to the head. It is better, how- ever, to put the child at once in a hot bath (about 100 F.). Keep the head raised and apply to it cloths wet in cold water. Do not wait to undress the child before placing it in the water — that can easily be done whilst giving the bath and rubbing the body. The bath should DISEASES OF CHILDREN 307 last about five minutes and then the baby should be taken out. and wrapped in a warm blanket. The inhalation of a few drops of chloroform or ether from a napkin held near the nose almost always affords relief. Prevent biting of the tongue by placing a knife handle, spoon, etc., between the teeth. Give a copious warm rectal injection of soap and water to clear out the lower bowel. When the convulsions are caused by the irritation from teething, and the gums are hot and swollen, give a teaspoonful of the following, every hour: Bromide of Potassium, . . 1 dram Water, 2 ounces Five drops of tincture of aconite can be added to the above if there is much fever. Discontinue it when the fit is broken, or continue it in smaller doses every three or four hours. When due to worms, give the salt and water already mentioned, pumpkin seed tea or ten drops of turpen- tine in a teaspoonful of castor oil, increasing the dose for a child over three years old. Follow this with the treatment laid down under the head of worms, which see. If the fit is caused by irritation of the stomach or bowels from indigestible food, give an emetic of ipecac or lobelia, 10 or 15 drops in warm water, and repeated every 15 minutes till free vomiting ensues. One half a teaspoonful of ground mustard in a cup of warm water given part at a time is a very prompt emetic and almost invariably at hand. Follow the emetic with a dose of castor oil to move the bowels, or the neutralizing mixture mentioned in the latter part of this book. (Page 411.) 308 PAINLESS CHILDBIRTH If the stomach is sour, give the neutralizing mixture or, if not at hand, put a teaspoonful of bicarbonate of soda or saleratus in a gill of water and give it in table- spoonful doses every 10 or 15 minutes. Attention to the bowels is necessary, and as the neutralizing mix- ture accomplishes both purposes it is preferable. A highly sensitive condition of the nervous system predisposes to fits, and the gelseminum and bromide of potash already mentioned will be found an excellent remedy to modify this condition and thus prevent the fits, but attention to the removal of the causes is nec- essary and must not be forgotten. When the convulsions are due to the sudden strik- ing in of some eruption, use the warm bath at once, and be careful in removing the child from it that a chill is not experienced. At the same time give: Tincture of Aconite, ... 5 drops Tincture of Belladonna, . . 5 drops Water, ..... 6 ounces Dose — A teaspoonful every half hour to one hour. Call the family doctor in the meantime, as the troubles are sometimes complicated and need combined treatment. COLDS Although most people regard a common cold with indifference, a writer has well said that " Colds destroy more lives than any other cause. " They result from exposure in some way or other and are too well known to require any description. All are liable. They may affect any or all parts of the body. Colds vary greatly in severity, and their frequent repetition lays the found- ation for severe and often fatal diseases. Indeed, colds DISEASES OF CHILDREN 309 are the immediate cause of a large percentage of our diseases. Treatment. — Colds should always receive prompt attention, for neglect is often fatal. Give a hot foot bath on going to bed and drink a cup of warm catnip, boneset or composition tea, cover warm and encourage perspiration, but be careful the next day not to renew the attack. A mild cathartic after the sweat will aid in breaking up the cold. Hot lemonade at night has enjoyed a good reputation. Five to ten drops of aconite in a goblet half full of water, given in teaspoonful doses every half hour or hour until perspiration is established, is good treatment for either child or adult. An alcoholic or spirit vapor bath is always beneficial. INFLUENZA— LA GRIPPE This is an acute contagious disease, often appearing as an epidemic. Most writers consider influenza and colds together, but as the former is usually so much more severe I have separated them with the view to impress the importance of prompt and efficient treat- ment, for while the disease may not be fatal itself it often lays the foundation for chronic nasal catarrh, bronchitis and even consumption. Symptoms. — An attack of influenza is generally ushered in with chilliness or rigors, lassitude, stiffness and soreness of the muscles, sneezing, a dryness or increased discharge from the nasal cavity, oppressed breathing, soreness of the throat, redness and watering of the eyes, the nose sore and swollen, thirst, etc. With these symptoms there is a fever of varying severity which is apt to remit in the morning. The tongue is coated, the bowels deranged and the urine scanty and 310 PAINLESS CHILDBIRTH highly colored. A troublesome cough comes on, at first dry and irritable, which in time is followed by expectoration, the child snuffles, and in adults the se- cretion sometimes becomes so profuse as to keep the person " hawking" or spitting all the time. There is more or less dullness of the intellect, headache, darting pain, and in some cases there may develop croup, bronchitis or pneumonia. Treatment. — In mild cases of influenza the symp- toms will so nearly resemble a common cold that unless an epidemic of the disease is prevailing it will be im- possible to distinguish between them. The treatment advised for colds is appropriate in mild cases, but in severer ones a more thorough course may be necessary. Keep the little patient in bed, give liquid foods and apply hot applications to chest or other painful parts. An old-fashioned domestic remedy of considerable efficacy, I well remember, in " childhood's happy hours," consisted of vinegar, molasses and butter stewed together and taken hot on going to bed; for an adult a large cupful was a dose. In the early stages of the disease a thorough sweat is decidedly appropriate. A spirit vapor bath (de- scribed elsewhere) aided by a hot mustard foot bath and the warm teas advised for a cold, followed by the use of aconite as for a cold, and pushed till the pulse is regulated and the fever controlled will in nearly every case cut short the attack. Allay thirst with drinks of lemonade, flaxseed tea or water. If the bowels are constipated give some mild laxative, but always bear in mind to so time it that it will not be operating on the bowels when the patient is bathed in perspiration. DISEASES OF CHILDREN 311 If the* symptoms of nasal catarrh predominate, snuff up the nose some warm salt and water (one teaspoonful of salt in one pint of water) or spray nose with DobeH's Solution. Inhaling the vapor of ammonia often acts equally well, and is almost always to be found in every house. The vapor of camphor is also excellent. Put a teaspoonful of the spirits of camphor into a teacup of hot water and inhale the vapor as it arises, snuffing it well up the head. Another. — Into a wide mouthed bottle, capable of holding an ounce, mix two drams each of carbolic acid and spirits of hartshorn; then put in cotton batting enough to absorb the mixture, and inhale the vapor, keeping it corked when not in use. The evolution of the vapor may be increased by setting the bottle in a cup of hot water during inhalation. When the severity of the disease is spent on the chest, the following will relieve the inflammation and soreness, promote expectoration and overcome the cough : Tincture of Aconite, ... 10 drops Tincture of Bloodroot, . . 1 dram Paregoric, .... 3 drams Compound Syrup Squills, . . 12 drams Mix. Dose — For a child two to five years old, 10 to 15 drops three or four times a day. For an adult a teaspoonful. If there is a sense of dryness in the throat and bron- chial tubes, a whistling noise in breathing, a poultice of flaxseed applied to the chest as warm as can be borne will aid in its relief. Great care must be taken not to catch a fresh cold during the course of the disease, which is apt to con- tinue a week or two^ unless the treatment cuts it short, 312 PAINLESS CHILDBIRTH as it would be very apt to bring on a renewal of the attack more severe than at first and perhaps cause a serious disease of the lungs. After the severity of -the attack is passed, tonics may be required, as iron, quinine, syrup of hypophos- phites, etc. SPASMODIC CROUP This is the ordinary croup of childhood, due to a spasm of the vocal cords, and is also known as false or pseudo croup. When the attack appears suddenly and without warning, in her child, the mother is often alarmed and terror-stricken. The common causes of this distressing affection are exposure to cold and damp weather, indigestion, constipation, rickets and ade- noids. It is most common in children between the ages of six months and five years, and a child that has had one attack will be very liable to have more, especially when the weather is cold, damp and changeable. Symptoms. — The attack usually comes on suddenly during the night, although there may have been symp- toms of a cold for a day or two previously, with some cough and hoarseness, but not sufficiently severe to occasion any anxiety. The child is wakened suddenly from a sound sleep with difficulty of breathing and a peculiar brassy cough, which once heard can never be forgotten; the head is thrown backward, the skin is hot, the pulse rapid, the eyes protrude, the countenance expresses anxiety, the lips and finger tips slightly blue, the breathing attended with a whistling sound, the sides of the chest and the notch above the breast bone are depressed, the voice is rough and hoarse, croaking, and is finally reduced to a whisper. Sometimes the child is disposed DISEASES OF CHILDREN 313 to be drowsy, waking as the paroxysms occur. The attack lasts from half an hour to three hours, and then the cough lessens in force, the breathing becomes easier, the little one breaks into a free perspiration and soon falls asleep, tired or worn out with its suffering. The next day the child seems apparently well, with the exception of a croupy cough or slight soreness of the throat. On the second night there may be another attack just as severe as the first, and on the third a lighter and milder one. Treatment. — During the attack apply to the throat cloths wrung out of hot water or wrap a cold cloth around the neck and place the child in a hot bath. A splendid method of treatment is to place the child in a croup tent that can be easily improvised over the crib by fastening a broomstick to each corner and covering with a blanket. An umbrella placed on the bed and covered with a blanket makes a good substi- tute. The tent is filled with steam from a croup kettle or ordinary tea kettle, and a teaspoonful of compound tincture of benzoine (Friar's Balsam) poured into the water adds to the value of the steam. When the ca- tarrhal secretion is profuse and the throat so full of mucus that it embarrasses respiration seriously, an emetic becomes necessary. Vomiting should be induced by tickling the throat or by running the finger down the throat or by giving lukewarm water and salt. From one half to one teaspoonful of the wine or 20 drops of the syrup of ipecac may be given every two hours until vomiting occurs, or a little alum mixed with honey or molasses and given in teaspoonful doses. A simple enema of soap and water to clean the bowel is always advisable. Goose oil or lard applied to the chest and 314 PAINLESS CHILDBIRTH given internally in teaspoonful doses are popular in some parts of the country, but I have no confidence in them. Woolen cloths wrung out of an infusion of hops or hops and vinegar and applied to the chest as hot as can be borne are beneficial, and the inhalation of the hot steam from the same infusion is valuable. In the application of such means care should be exercised to prevent the cloths becoming cold and doing more harm than good. Physicians of the eclectic school rely on bloodroot and lobelia as an emetic in this disease and, though nauseous, I regard them as less dangerous than those already described. The acetic syrup of bloodroot and* lobelia when it can be obtained is a remedy on which I place great reliance in croup. The following prescrip- tion can generally be obtained at any drug store, and answers the purpose well, if the real acetic syrup cannot be had : Tincture of Lobelia, . 3 drams Tincture of Bloodroot, 3 drams Simple Syrup, . 1 ounce Vinegar, .... . 2 l /i ounces Dose — Fifteen drops to a teaspoonful repeated once in fifteen minutes till vomiting occurs. The dose must be varied accord- ing to the age of the child, the smaller dose generally being sufficient for those two or three years old. After vomiting, give it in smaller doses an hour or two apart, continuing the aconite at the same time, and increase the intervals between the doses as the symptoms become less severe. If necessary, it may be again pushed to cause vomiting in the same manner as before. Unpleasant as this medicine is, it is a very certain one, relaxing the spasm of the larynx, reliev- ing the suffocation, removing the accumulations of DISEASES OF CHILDREN 315 mucus and materially aiding in overcoming the inflam- matory symptoms. The avoidance of colds, regular bowels, plain, easily digested food, especially for supper, and a properly ventilated bedroom will do much to prevent further attacks of croup. If the child is a " mouth breather" the tonsils and adenoids if enlarged should be removed. Membraneous or true croup is diphtheria of the larynx, and under that heading its symptoms and treat- ment will be given. ADENOIDS These are masses of enlarged lymphoid tissue in the upper part of the throat (vault of the pharynx, naso- pharynx) directly back of the posterior openings of Figure 30 the nose. They are very common in children between the ages of six and ten, especially in damp, changeable climates. 316 PAINLESS CHILDBIRTH Causes. — Heredity has an important influence in the production of adenoids. Frequent colds, measles, diphtheria, scarlet fever, are frequently followed by a catarrhal inflammation of the throat that results in the formation of adenoids. Symptoms. — Constant discharge from the nose, fre- quent colds in the head, restlessness at night, noisy sleep or snoring, night terrors, thick speech, are almost always present. Owing to the obstruction to free respi- ration, the child is compelled to breathe day and night through the mouth (mouth breather). In some cases the bridge of the nose becomes depressed, the lips thick, the edge of the nostrils sore. Ear-ache, deafness and cough are common symptoms. Many children suffering from adenoids become anaemic, listless, apathetic, back- ward in school studies and do not want to play. Treatment. — The nose and throat should be kept clean by sprays, douches or gargles. For this purpose Serler's tablets that can be bought at any drug store may be used. Crush one tablet, dissolve in four table- spoonfuls of clean warm water and use as spray to nose and throat with atomizer. One part of listerine and seven parts of water will aiso act as an excellent cleansing agent. Such remedies, however, are only nose-cleaners and never cure either catarrh or ade- noids. The adenoids should be removed by a surgical operation, and when this is done carefully and thor- oughly by a physician who knows just how to do it the results are most pleasing. ACUTE BRONCHITIS This is an inflammation of the lining mucous mem- branes of the bronchi or tubes of the lung and is a very common ailment in children, especially in the early DISEASES OF CHILDREN Figure SI Treachea (windpipe), heart, and lungs Figure 82 317 The Left Ear A, vestibule; B. auditory canal; C, middle ear; D, semicircu- lar canals; E, cochlea; G, eustachian tube 318 PAINLESS CHILDBIRTH spring months when high winds and sudden changes in temperature are so frequent. Taking cold, insuffi- cient clothing or getting the feet wet are the usual Figure 33 The Heart and Blood Vessels 1, right auricle; 2, left auricle; 3, right ventricle; 4, /eft ventri- cle; 5, aorta; 6, the arch of the aorta; 7, descending aorta; 8, rigid subclavian vein; 9, left subclavian vein; 10, descending vena cava; 11, ascending vena cava; 13, innominate artery; 14, right carotid artery; 15, right subclavian artery; 16, left carotid; 17, left subclavian; 18, pulmonary artery dividing into two branches, of which one, 19, goes to right lung and the other, 20, to the left; 21 and 22, pulmonary veins. DISEASES OF CHILDREN 319 causes, but the disease may also occur as a complica- tion of whooping cough, measles, diphtheria and many contagious diseases. Symptoms. — The disease is often preceded by snuffles, running at the nose, sore throat or hoarseness. Fever, cough, rapid breathing and soreness and tight feeling in the chest show that the inflammation has extended to the tubes of the lung (pulmonary bronchi) . The fever is not high, but the child's respiration may be 40 to 50 per minute. The cough at first is dry and tight, but later becomes loose; the sputum is swallowed and often causes vomiting. A child under four does not expectorate. Rattling or wheezing sounds in the chest are frequently heard. Loss of appetite and restlessness often exist. In the very severe types, the breathing becomes more rapid, the pulse weaker, the skin clammy, there is great prostration and the child falls into a deep stupor or convulsions end the struggle. Treatment. — Keep the child in bed in a well venti- lated room free from draughts. Give a laxative dose of castor oil at once or, if the taste of the oil be objec- tionable, a tablet containing one tenth of a grain of calomel every half hour for five or ten doses. The food should be liquid, soft or semi-solid, given in small quantities regularly every three hours, and hot drinks and hot mustard foot baths may be given, hot fomen- tations or poultices applied to the chest, but an oiled silk jacket worn during the whole attack of illness is preferable. The jacket is made like a vest and con- sists of three layers — an inner one of cheesecloth or light flannel, a middle one of half an inch of cotton batting, an outer one of oiled silk. When the cough is very tight a mustard paste made by mixing one part 320 PAINLESS CHILDBIRTH of mustard with from four to six parts of flour or corn meal in some lukewarm water and spread between two layers of muslin or soft linen and large enough to en- velop the child's whole chest may be applied two or three times daily for a few minutes (usually about five), until the skin is slightly reddened. After removing the plaster, the skin is powdered and the jacket again put on. Rubbing the chest with camphorated oil will often give relief. Inhaling the steam from one pint of boiling water to which one teaspoonful of compound tincture of benzoin is added will often soothe the inflamed air passages. In young children the air may be moistened by allowing steam to pass from the tube of an Arnold sterilizer or tea kettle through one side of a canopy placed over the bed. In the first stage give: Tincture of Aconite, ... 20 drops Wine of Ipecac, ... 1 dram Sweet Spirits of Nitre, . . 2 drams Simple Syrup, to make . . 2 ounces Directions — One teaspoonful in a little water every two or three hours. In the second stage when the secretion becomes thick and viscid, ropy or lumpy, and is coughed up only after considerable effort, especially in the morning, give : Chloride of Ammonium, . . 1 scruple Compound Licorice Mixture, . 2 ounces Dose for a child five years old — One half teaspoonful in water every four hours. PLEURISY An inflammation of the serous membrane covering the lungs is called pleurisy. It is by no means common DISEASES OF CHILDREN 321 in children, and when it does occur is usually as a complication of some other disease, such as pneumonia, scarlet fever, measles, typhoid fever, tuberculosis of the lungs, influenza, rheumatism. There are two kinds : (a) Dry pleurisy, (b) Pleurisy with effusion of serous fluid into the pleural cavity. When this fluid changes into pus the disease is called empyema. Symptoms. — Sharp localized pain or " stitch " in the side, short, dry, teasing cough, shortness of breath; child usually lies on the affected side, spaces between ribs are bulging, fever about 101°-103° F. Unless the case becomes an empyema, the disease rarely lasts longer than ten days. Treatment. — Put the child to bed, open bowels freely, apply poultices, fomentations or mustard plas- ters to painful part of chest. A flannel band around the chest sometimes relieves the pain. If the urine is diminished give from 1 to 5 grains of citrate of potash every 4 hours according to age. When the fluid in the pleural cavity is excessive, the physician will remove it by aspiration or other operation. PNEUMONIA This affection, also known as inflammation of the lungs, lung fever, winter fever, etc., is an acute inflamma- tion of the substance of the lungs, of frequent occur- rence and serious in its results. Its fatality, however, has been materially diminished by the improved methods of practice of late years. When the disease is confined to a circumscribed por- tion of the lung, it is termed lobular pneumonia; when only one lung is affected, single pneumonia; when both 322 PAINLESS CHILDBIRTH lungs are involved, double pnuemonia; if pleurisy ex- ists in connection, pleuro-pneumonia; and when a typhoid condition is developed during its course, typhoid-pneumonia. In the majority of cases it is caused by cold, but those who have been debilitated by previous diseases, intem- perance, faulty nutrition, etc., from any cause, are specially liable. Symptoms. — For a day or two there is languor, dullness, a feeling of oppression in the chest, short cough, chilliness, etc., similar to a common cold. These symptoms may not attract any attention for a day or two when the advent of the disease will be marked by a pretty distinct chill, often resembling that of malarial fever. In children the chill is often replaced by convul- sions. This is.succeeded by fever, pressure in the chest, which often increases to a constant pain that is aggra- vated by an annoying, short, dry and distressing cough. The pulse becomes frequent, the skin is hot and dry, the face flushed, the eyes red; there is severe pain in the head and back, the appetite is lost, the tongue is covered with a whitish coat, the bowels constipated and the urine scanty and highly colored, usually de- positing a branlike sediment on cooling. As the disease advances, respiration becomes shorter and more diffi- cult, the nostrils are dilated and the chest and shoul- ders elevated with every effort at inspiration. Delirium is often present. At first the cough brings up a little frothy mucus, but later on the sputum becomes opaque, very sticky and tenacious and assumes a peculiar rusty color, which is the characteristic expectoration of pneumonia. DISEASES OF CHILDREN 323 In mild or favorable cases, and those in which the disease yields to the treatment properly, the expectora- tion now becomes more free, the cough looser and less painful, the fever diminishes and the symptoms sub- side, so that in from seven to nine days from the attack convalescence is established. In the severer cases all these symptoms are increased. The delirium is constant, there is great prostration, picking at the bed clothes, and dirty accumulations are seen on the teeth. Expectoration may be profuse, purple, yellow or bloody, and the breathing greatly embarrassed. ' In fatal cases, the delirium passes into stupor, and death may occur from the second to the fourth week. Recovery, however, may take place by the gradual subsidence of the symptoms, but a cough is apt to remain, or other diseases of the lungs, as hepati- zation, hemorrhage or consumption develop. The diagnosis of inflammation of the lungs in chil- dren is not always easy until the disease is well ad- vanced, although physicians by the aid of auscultation and percussion are able to distinguish it when the other symptoms are unreliable. To the unprofessional these aids are not available. Bronchitis and pleurisy so much resemble pneumonia that it is often difficult to dis- tinguish between them, but this is not so important to the general reader, for the treatment, particularly in the early stages, is almost the same. Treatment — The disease usually subsides about the seventh or ninth day, and during the whole course of the disease the little patient should be kept perfectly quiet in bed in a large, airy, well ventilated room. If we recognize the disease early and are successful in our efforts, we may cut it short or greatly modify its 324 PAINLESS CHILDBIRTH severity and thus materially promote recovery. Give a hot mustard foot bath at once, with warm teas internally to promote perspiration, and then commence with the following: Tincture of Aconite, . . .40 drops Water, ..... 4 ounces Mix and give a teaspoonful every hour till the skin shows a disposition to moisten and the pulse becomes less frequent, then lengthen the interval to two or three hours, and thus continue it till the inflammation is subdued. If the difficulty of breathing is marked and the pain in the side severe, as in pleurisy, I would give in alter- nation to the foregoing: Tincture of Bryonia, . . 5 drops Water, ..... 4 ounces Dose — A teaspoonful every hour till relieved, and then it may be omitted. Open the bowels freely and apply hot poultices, hot fomentations or the oiled silk jacket described on page 319. The scantiness of the urine may necessitate a reme- dy, when three to five grains of acetate of potash in a tablespoonful of water repeated three times a day will act nicely. This dose may be increased, if necessary, and for older children. Throughout the case give plenty to drink. Lemonade, acid fruits, jellies, water, milk, etc., are most agreeable. The diet should never be solid, but liquid or very soft. Milk, koumyss, beef tea, mutton broth, oyster soup, soft toast and, if there is much prostration, milk punch, eggnog, wine, etc., but care should be taken never to overstimulate. As improvement occurs, puddings, custard, scraped beef may be given, and still later a full, solid diet. DISEASES OF CHILDREN 325 A warm alkaline sponge bath once or twice a day will materially promote comfort and recovery. Warm water containing a little common soda or saleratus is all that is necessary, care being taken, however, to pre- vent exposing the body when bathing lest a chill occur. During convalescence, tonics are called for — iron, quinine, hypophosphites, etc. The following is a good combination : Quinine, . . . . .10 grains Compound Syrup Hypophosphites, 2 ounces Dose — For a child one to two years old, one fourth to one half a teaspoonful three times a day. Sleep is encouraged by bathing at bed time, but if necessary, small doses of Dover's powders at night may be given. One or two grain doses are sufficient. The cough is sometimes very troublesome and may call for a special remedy, though in the milder cases the treatment already advised will be sufficient. When something of the kind is needed and in those cases where the cough continues after the inflammation has subsided give : Tincture of Bloodroot, . . 1 dram Tincture of Ipecac, ... 1 dram Compound Syrup Squills, . . 1 ounce Syrup of Wild Cherry, . . 2 ounces Dose — One half to one teaspoonful three or four times a day. When the cough is unusually severe and annoying, I add half an ounce of paregoric to the above; some, however, might prefer half a grain of morphine in place of the paregoric. This use of the opiate would of course overcome the necessity of the Dover's powder already mentioned. TUBERCULOSIS— CONSUMPTION Consumption is a serious constitutional malady characterized by a wasting of the body and attended 326 PAINLESS CHILDBIRTH by an affection of the lungs, in which sooner or later tubercular deposits occur. No other disease is so wide- spread or fatal as consumption. It preys upon all classes of society and is the cause of about one seventh of all the deaths that occur in Europe and North America. It is much more prevalent among children than is usually supposed and is closely allied to scrofula. Some writers regard them as essentially the same, one being only a modified form of the other. The disease is characterized by feeble vitality, ema- ciation and loss of strength, sooner or later followed by a cough, expectoration, difficulty of breathing, fever, night sweats, hemorrhage and death. Consumption or tuberculosis is an infectious disease, and it has been definitely and positively proved that the actual cause is a germ called the Bacillus Tuberculosis, first described by Dr. Koch in 1881. The germs or bacilli are found in enormous numbers in the sputum or expectoration coughed up by those suffering from pulmonary tuberculosis or consumption of the lungs, and when this infected sputum is allowed to dry it enters the air as a fine dust, in this way spreading the disease in every direction and infecting houses, bed- rooms, furniture, carpets and clothing. The disease is most frequently contracted from breath- ing or inhaling air or dust containing the consumptive germs. It may, however, result from slight wounds or abrasions of the skin becoming inoculated with the germs, and tuberculosis of the intestines sometimes results from eating meat or milk from tubercular cows. Certain conditions of the system render it more favorable to infection. In from ten to fifty per cent of cases there is a family history of tuberculosis. It DISEASES OF CHILDREN 327 very commonly occurs in weak, delicate, sickly people who have low vitality or deficient chest expansion. No age is exempt, but tuberculosis of the bones, in- testines and covering of the brain is more frequent in children than in adults. Depressing influences and any- thing that lowers the standard of vitality and lessens the resistance of the tissues favors infection. Thus, we find tuberculosis frequently following bronchitis, colds, pneumonia, pleurisy, measles, intestinal catarrh, fast life, exhaustive discharges, whooping cough, etc. Local injuries may so weaken the tissues that they are readily infected. Thus, for example, a simple inflamma- tion of a joint may become tubercular. While some of these causes do not apply to child- hood, I have introduced them here as a warning to the older ones into whose hands this book may chance to fall. Impairing the constitutions of the parents, they are, through hereditary transmission, indirect causes of consumption. In spite of the fearful mortality of this disease and the general belief that it is incurable, researches during the past twenty-five years prove conclusively that it can be cured. All modern writers are agreed upon this point. Numerous cases are on record where com- plete recoveries have been made, and many years after- ward the person has died from other diseases. Post mortem examinations have revealed many cases of the kind. The symptoms of consumption vary with the stage and progress of the disease. In most cases a general breaking down of the general health occurs for a longer or shorter time before the lung symptoms are developed. Whenever we find a growing weakness, paleness, loss 328 PAINLESS CHILDBIRTH of flesh, quickened pulse, a little fever and shortness of breath coming on without any apparent cause we have just reason for anxiety. These are premonitory symptoms, and remedies will now be found most effi- cient. Soon a cough, generally hacking and worse at night, occurs. The patient says "I have taken cold and will soon be all right." Food does him no good; the cough becomes worse, expectoration more profuse. There may be a remission of all these symptoms and the victim think he is getting well, but another cold sets him back and develops the disease more severe than before, and fever and night sweats occur. Thus the disease goes on, alternating better and worse. Each time more severe and the recovery not quite so perfect. This may last for years, or it may complete its course in a few months. It is needless to trace the disease further; it is easily recognizable now, and its onward progress is marked with symptoms so plain that none need be longer deceived. In children, however, the symptoms of the lung disease are not always as well marked as in the adult, the deposition of that peculiar substance termed tubercle is apt to be more generally distributed through- out the abdominal and thoracic viscera. Consumptive children may waste away and die without the develop- ment of the lung symptoms when it receives the more technical name of tuberculosis. Treatment. — The most important consideration is the successful treatment, and the more thoroughly and persistently it is carried out the greater the chances of success. Any who have the slightest reason to believe that they are developing a consumption, or are in the least danger of doing so, should not rest until they have DISEASES OF CHILDREN 329 marked out a course of hygienic and medical treat- ment. Do not wait a single day, time is precious. Your life depends on what you do now. Do not be put off by evasive answers. If you have not implicit confidence in your family physician's skill, consult some one else. Do not permit deference to old fogyism to rob you of life. Errors committed now will be over- come only with the greatest difficulty. We may indicate the general plan of treatment, but each individual is apt to present characteristics or modifications that will demand attention and perhaps require changes of remedies. It is too serious a disease to admit of unprofessional control, and yet there is time to select competent professional advice. I shall therefore beg the reader's pardon if I confine my remarks, mainly to the outlines of treatment, or to that part of it which the patients themselves or their friends must conduct for them. Take advantage if possible of climate, hygiene and medicine. As to climate, seek that which will enable you to live a greater portion of the time in the open air. No one climate is suitable for all tubercular patients. A dry, clear, pure air with an even tem- perature is best. Young people in the early stages of the disease usually do best in a cold, bracing climate like the Adirondacks, but those who are old or have the disease in an advanced form are, as a rule, better off in a warm, dry air like that of Southern California or Carolina. The very young, the very old and those in whom the disease is well advanced are better treated at home. Study the rules of hygiene and do everything that can contribute to health. Take plenty of good air, 330 PAINLESS CHILDBIRTH gentle exercise, but not enough to cause fatigue, nutri- tious food, and keep every organ in as nearly a healthy condition as possible. We must avoid every debili- tating influence. The disease breaks down. We must build up. It is folly to depend upon cough medicines for, as a rule, they only relieve one symptom at the expense of another; many of them ease the cough and destroy digestion. When employed they must be expected to benefit only the one symptom — cough. It must be understood that the cough in consumption is only a symptom of the disease, it is one of its branches as it were, and unless it is very troublesome is best left alone. Pain in the chest is often relieved by mustard paste, poultices or painting with tincture of iodine. Details of this character should be presided over by a competent physician who will provide for such indications as they arise. Figure 34 The sputum must be coughed or spat into a paper sputum cup (Fig. 34), that should be destroyed every DISEASES OF CHILDREN 331 day by burning. If a porcelain or other cup is used, it should be half filled with a 2% solution of formal- dehyde or carbolic acid, constantly kept covered, emptied and boiled every day. Paper napkins or pieces of gauze or old linen are preferable to handker- chiefs. Kissing must not be allowed. The bedclothes and dishes used for eating and drinking by a person with tuberculosis should be frequently boiled and disin- fected. A person with tuberculosis should when possible remain out of doors all day, and at night sleep alone in a room with all the windows wide open and the bed so placed that he will get the full benefit of the incom- ing air, but at the same time be protected from draughts. Sleeping in a tent or on a partly enclosed veranda is excellent. A window bed for tubercular patients is sold by many dealers The diet should be simple, wholesome and abundant. Milk, cream and eggs should be taken freely, but fresh meats, fresh fish, vegetables, cereals and fruits may also be used. Fats will do good if the patient can eat and digest them, but sweets, dainties, highly seasoned and rich foods should be avoided. Scraped beef, raw or slightly browned in the oven, is tasty and beneficial. Ale, porter or light wanes may be used in moderation. When milk and cream are not well borne by the stom- ach, cod liver oil in as large doses as the patient will tolerate should be taken. Flannels should be worn at all times and the clothing must be warm and adapted to furnish protection against atmospheric vicissitudes. Avoid crowded schools, excessive study and sedentary habits. Adenoids 332 PAINLESS CHILDBIRTH and enlarged tonsils should be removed to allow full and easy breathing. Bedrooms and living rooms occupied by persons with tuberculosis must be thoroughly fumigated and disin- fected before they are used by others. ASTHMA This disease is a spasmodic affection of the lungs which comes on in paroxysms, generally at night, and is attended by difficult respiration, short, dry cough, tightness across the chest, a wheezing noise, inability to lie down, etc. These symptoms may continue for several hours at a time and the attacks may occur very frequently or be separated by intervals of weeks or months. Repeated attacks often develop pulmonary disease. Although asthma is not usually seen before puberty, I have met with several cases among small children. When once developed it is apt to reappear at irregular intervals during the lifetime of the patient. The symptoms are too familiar to require any de- scription. The causes are obscure and varied. That which brings on an attack in one subject may have no influ- ence whatever on another. Atmospheric vicissitudes, overloaded stomach, inhalation of dust, certain odors, etc., may bring on an attack, and nasal catarrh, ade- noids and enlarged tonsils are frequent exciting causes. Some persons will be entirely free from it while in cer- tain localities, and be attacked again as soon as they depart. I know one man who would be entirely free from the disease while he remained at home in Saratoga Springs, but if he went even ten miles from home, he would be sure to have an attack, and if during the DISEASES OF CHILDREN 333 attack he returned home, when within a mile or two of home would experience perfect relief. The treatment is empirical. Remedies without number have been advocated to be tried and discarded. Change of climate is often serviceable, but no climate will furnish immunity for all, or even a majority. The climate which one asthmatic finds beneficial will be of no advantage to another. During the late war I knew several soldiers who were entirely free from it while in Virginia, but the disease returned on coming home. If I had an asthmatic child I would seriously con- sider a change of climate for its benefit, and would expect to have to go a long distance to get the greatest benefit by the removal. Chronic bronchitis and nasal catarrh, co-existing with asthma will be likely to defeat any plan of treat- ment that does not consider their cure. I have seen the asthma yield readily after these complications had been overcome. Any plan of treatment should include the correction of all co-existing diseases. Adenoids and enlarged tonsils should be removed. When the attack is caused by an overloaded stomach or indigestion, an emetic should be given. Temporary relief may almost always be afforded by inhaling the fumes from burning niter, and stram- monium, or belladonna leaves. Mix one fourth pound of coarse powdered strammonium leaves and one pound of nitre, burn a tablespoonful of the mixture and in- •hale the smoke; repeat if necessary. This may be varied by using half strammonium and half belladonna leaves to the same proportion of nitre. Blotting paper soaked in a strong solution of nitre, dried and burned, is also 334 PAINLESS CHILDBIRTH effective. These substances furnish the basis for all the cigarettes, smokes, pastiles, etc., now in use. The California plant grindelia, combined with other remedies to suit the peculiarities or complications of the different cases, has proved beneficial in many in- stances. The following will usually afford temporary relief: Tincture of Bloodroot, . . 34 ounce Tincture of Lobelia, J^ ounce Bromide of Potash, . . . J^ ounce Simple Elixir, . . to make 4 ounces Mix. Dose — For an adult a teaspoonful every half hour or hour till relieved or nausea is produced. Smaller doses for chil- dren. This is an excellent though nauseous remedy. Some find pretty large doses of quinine capable of cutting short an attack^ Attention to the bowels is necessary. A cathartic dose of podophyllin or a compound podophyllin pill taken at the commencement will often modify an attack. Measures for a permanent cure, if undertaken, must be persevered with for a considerable length of time, and are to be continued during the intervals as well as during an attack. WHOOPING COUGH This is a disease peculiar to childhood, but is some- times witnessed in adults. It is contagious and prevails as an epidemic, uninfluenced in its occurrence by season; rarely attacking an individual more than once, which is generally the first time they are exposed to its causa- tive influence, though cases are known where it has reappeared a second and even a third time. It is due to a specific poison which appears to be - communicated directly from one child to another, yet it is presumed that some peculiar atmospheric condi- tion is favorable to its propagation and is the principal DISEASES OF CHILDREN 335 means by which it is spread. Be this as it may, there is plenty of evidence for and against this theory, but, as no good can well result to the nonprofessional reader from its discussion, it will be omitted. It generally runs a regular course, lasting from six to ten weeks, and were it not for the complications liable to develop during its course would seldom or never prove fatal. Spasmodic cough, bronchitis, etc., often continue for a long time after the specific disease has run its course. Whooping cough is essentially a nervous disease, usually milder in warm than iu cold climates and is less severe when it occurs during warm weather. Symptoms. — The disease may be divided into three stages: the catarrhal, the spasmodic or paroxysmal, and the stage of decline. The first or catarrhal stage is very similar to an ordi- nary cold, accompanied by slight fever, languor, loss of appetite and restlessness with more or less cough. Sometimes these symptoms are severe and in other cases pass unnoticed. After a week or two, the second or spasmodic stage appears. The fever abates, and the cough which has gradually developed becomes peculiar, persistent, spas- modic and characterized by a loud, shrill inspiration or whoop which gives the disease its name. The cough comes on in paroxysms, varying in frequency from once or twice a day to as many times an hour. When a fit of coughing comes on, the child instinctively grasps something for support or runs to its mother for protec- tion, but returns to its play when the paroxysm is 336 PAINLESS CHILDBIRTH ended. During the paroxysm, which may last from a few seconds to several minutes, there is a rapid succession of short, spasmodic coughs, succeeded by the prolonged inspiration or whoop, during which the face becomes red, turgid and bloated, the blood vessels distended and the eyes prominent. The paroxysm often terminates in vomiting or the expulsion of a thick tenacious mucus. This vomiting may be so serious as to materially interfere with nutrition, by causing the child to vomit so soon after eating as to prevent the digestion and assimilation of its food. This stage — the spasmodic — lasts from three to eight weeks, when it gradually subsides, passes into the third stage — decline — and terminates in recovery, unless some serious complication, such as pneumonia, hemorrhage, convulsions or diarrhoea has been devel- oped. In the first stage the expectoration is a frothy mucus. In the second it is transparent, yellowish, possibly purulent, ropy and tenacious. In the third it becomes less tenacious, slightly opaque, diminishes in quantity and disappears. Sometimes this expectoration is so ropy it cannot be drawn out of the child's mouth with the fingers. When it is so very tenacious and in feeble children they may be aided by grasping it with the corner of a napkin and drawing it from the mouth and air pas- sages. Treatment. — It is questionable if treatment ever does more in whooping cough than to palliate and DISEASES OF CHILDREN 337 modify the symptoms and prevent or control compli- cations. T kdess it is prevailing in the neighborhood as an epidemic, it will be impossible to distinguish the first stage from other catarrhal affections. When sus- pected give : Tincture of Aconite, ... 5 drops Tincture of Belladonna, . . 5 drops Water, ..... 4 ounces Dose — A teaspoonful every hour or two. If the cough is har- rassing, add to the foregoing prescription half a dram of the tincture of drosera and give in the same way as before. Keep the child with whooping cough away from school, and from other children and in a room where the air is pure and the temperature even. Give light, nourishing food and keep bowels regular. Keep chest anointed with camphorated oil. A strong tea or infu- sion of chestnut leaves sweetened to the taste and given in doses of one or two tablespoonfuls five or six times a day sometimes exerts a wonderful control over the disease in the first and second stages. The earlier it is given the better. If the leaves cannot be obtained, the fluid extract which can be got at nearly all drug stores may be given in five or ten-drop doses in water and repeated as often as the infusion. A tea of red clover blossoms has long been favorably known in rural districts and may be given freely, sweetened or not. Sometimes it will cause looseness of the bowels. I have seen it control other forms of spasmodic cough very promptly. If the child vomits soon after eating, it should be given another meal. In infants the milk should be well diluted. 338 PAINLESS CHILDBIRTH The wearing of an abdominal binder seems to check the vomiting in many cases 6 The following remedy often proves helpful: Fluid Extract of Belladonna, . 5 drops Fluid Extract of Lobelia, . . 30 drops Water, ..... 4 ounces Given in teaspoonful doses every hour or two to children under five years will often afford decided relief from the spasmodic efforts. If taken too freely it causes vomiting, and is therefore objectionable to some. Antipyrin and codeine prescribed by the physician in doses suitable to the age of the child are excellent remedies. The following is an old fashioned remedy that often answers well when others fail: Cochineal, .... 10 grains Bicarbonate of Potass, *. . 1 dram Fluid Extract of Belladonna, 10 drops Syrup, ..... 4 ounces Dose — A teaspoonful three or four times a day. It has been my experience that remedies that relieve very effectually, some years, have very little influence in others. I do not pretend to explain this observation. I have found the following very efficient during two epidemics occurring in the fall and winter: Bromide of Potash, ... 2 drams Fluid Extract of Veratrum, . 10 drops Fluid Extract of Black Cohosh, . 1 dram Syrup, ..... 4 ounces Mix and give a teaspoonful four times a day. It speedily modifies the spasms, controls the bronchitis and relieves all the symptoms. Belladonna in equal proportions may be substituted for the veratrum if relief is not obtained in two or three days. This may be given at the same time the infusion of chestnut leaves is employed, giving the doses an hour or two apart. DISEASES OF CHILDREN 339 Length of Quarantine C3 on BO d 3 oT CO ~Z 02 CO 3 to 4 weeks, or until bacteriological ex- amination of cultures from throat are negative, i. e., no longer show bacilli of diphtheria 02 3" 42 c3 o 32 >> 3 > CD 3 DO 03 T^«*-i co 00 X > 3 o fS si £ a 00 & ^73 "3 02 "c3 CJ "3 pi s- — . O CD .-a •gjs i 8 r+< 02 CO a o +a a a >» 02 b— >_- §! Eh » o-c - a X X 44 e9 g s CO 03 < •2-S a c3 ■+3 s- 3 73 c; -^ 2 3 a 1- 2 R . X x o9 x x c c X =3 CJ X 73 CD +3 'o Pi >» X >. 5 X 09 g s x — o9 cd"" Duration of Eruption fcO s 73 _3 "3 rt o^ 3| >>3 oE '"" ' 55 ° +j73 m >> -z o »0 02 >> 09 73 02 _CD o 02 >> 09 73 !> X >> c3 73 CM O m >> o3 73 O CM +3 3 O 42 < X x — r3 4s -^ S II? !2 CD CD ^ X w Day on which Eruption or Rash Appears >> o9 -a 73 CM O 02 09 >> c3 73 73 CM O ~ -' G73 o3 be > CJ >> 73 CO >> c3 H O -u >» c3 73 73 CM X Period of Incubation c3 +j ^CO o"3 -** 3 DO o3 -*■' O a && 73 o *-< CD b- O 02 >> a 73 o 1— 1 o •43 CM 02 & 73 CO o X >» c3 73 O +3 o 02 >> 73 CM O +a 1> ^ c3 = X r3 73 O X >, 03 O CO o CD X g3 O 02 * 8 -u> CD a > — o C3^H o X _^ X c3 CO 02 05 09 go a .5 Q A •*» a 6 o a. CD 44 o 'Si 02 a S 3 73 h "n a -a > em .5 — X JBJ g, X 340 PAINLESS CHILDBIRTH Two or three days is usually long enough to deter- mine whether a remedy is going to do good or not and, if no improvement is apparent in that time, something else may be tried. If there is decided determination of blood to the head, the head hot, with dizziness, extreme suffocation, the expectoration stringy and profuse, I would use the last named prescription with a good deal of confidence MUMPS This is an inflammation of the parotid glands, situated just under the ear, hence the name parotitis. The salivary glands under the jaw are also at times affected. It is a contagious disease and usually occurs in childhood, and when both sides have been affected it rarely returns. We often see cases where only one side has been affected. In these cases, perhaps years afterwards, the individual may have another attack which will be confined to the opposite side. It usually occurs as an epidemic and appears in from five to twenty days after the exposure. Children under three years of age are rarely affected. Symptoms. — There is more or less febrile disturb- ance, chilliness and sometimes vomiting, followed in from twelve to thirty-six hours by a pain under the corner of the jaw, sometimes extending into the ears. Soon after the advent of the paili a swelling begins that sometimes attains an enormous size. This swelling gen- erally reaches its greatest size on the fourth or fith day, when it remains stationary for a day or two and gradu- ally declines, so that by the twelfth day it has entirely disappeared. It may involve both sides simultaneous- ly, or may disappear on one side first and, about the time of its disappearance on this side, attack the other. DISEASES OF CHILDREN 341 An old fashioned domestic diagnostic symptom that appears to be ignored by the profession was to have the suspected individual eat a pickle or some acid substance when, if it caused severe twinges of pain running into the swollen gland, it was pronounced mumps without any further ado. A peculiarity of this disease is that the inflammation is liable to suddenly disappear from the neck and ap- pear in the testicles of the male or the breasts or ovaries of the female, more especially if the afflicted person " catches cold " duringthe progress of themalady. Seri- ous consequences, amounting to impotence or sterility, sometimes occur by this metastasis, as it is termed. Treatment. — We have no remedies that do more than modify the severity of the disease, and many persons, particularly when the attack is mild, do nothing at all further than to remain indoors and, perhaps, take a few extra precautions against taking cold. The food should be liquid and the mouth frequently cleansed with an antiseptic mouth wash (one teaspoon- ful of listerine in half a glass of water) . A mild laxative may be given if the bowels are sluggish. Apply hot fomentations or poultices to the neck. A poultice of common beans cooked till nearly done, bruised and applied is excellent, or the swollen gland may be smeared with camphor liniment and covered with flannel. If the febrile symptoms are severe, give: Tincture of Aconite, ... 10 drops Water, ..... 4 ounces Dose — A teaspoonful every hour or two. If the swelling is severe, add to the aconite and water half a dram of the saturated tincture or fluid extract of poke root (phytolacca decandra) and take it as before. 342 PAINLESS CHILDBIRTH Aconite is the remedy, and if properly pushed and proper care exercised to guard against cold it is rare that suppuration or metastasis to other glands will occur. Should it disappear from the neck suddenly, and attack those other parts mentioned, keep on with the aconite and Phytolacca and also give in alternation: Tincture Pulsatilla, . . .15 drops Water, . . . . 4 ounces Dose — A teaspoonful every two to four hours between the doses of the other. Apply to the swollen parts, as warm as it can be borne, a solution of muriate of ammonia in water, an ounce in a pint of water. Rest in the recumbent position under such circum- stances should always be enjoined, and the swollen parts carefully supported instead of being permitted to hang down. To secure rest and if the pain is severe a dose of Dover's powder proportioned to the age of the patient should be given. When the gland suppurates it should be opened by the physician. This will be better than to endure the pain and suffering for many days, waiting for the forming abscess to break itself. Every case of mumps should be isolated or quaran- tined for at least three weeks. SORE THROAT This is a very common complaint and we meet with numerous cases that do not admit of the customary classifications; as they are neither diphtheria nor quinsy they are too often ignored. DISEASES OF CHILDREN 343 We might perhaps satisfy sticklers for names if we include all these cases under the one general classi- fication — pharyngitis, but, after all, it is "sore throat." Sore throat is often an accompaniment of other diseases. There are several varieties of the affection depend- ing for the most part upon atmospheric conditions resulting in colds as the exciting cause. The predis- posing causes are catarrh of the head and throat, im- paired constitutional vigor, venereal taint, and many persons acquire a habit of having a sore throat on ex- posure to cold, damp, changeable weather, etc. Diphthe- ria, quinsy, laryngitis, etc., often leave behind them a tendency to sore throat. When a person has once suffered from a severe sore throat, future attacks are to be feared. Chronic sore throat is very prevalent. Symptoms. — The symptoms vary according to the cause and peculiarities of the patient. The throat is tender, inflamed and sometimes ulcerates. During an inflammatory attack there is chills and fevers, hoarseness, a desire to swallow often or clear the throat, the mucus membrane may be bathed in a profuse glairy mucus or it may be dry, irritable and husky. The natural color may be changed to an intense red, vary- ing to a dusky or livid. The whole pharynx may be swollen, and if there is a tendency to ulceration the breath becomes exceedingly offensive, and examina- tion reveals small ulcers or cankers which may run together and produce extensive sores. Usually these sore throats are very annoying, and when neglected are apt to become chronic, and by ex- tension downward along the mucus membrane into 344 PAINLESS CHILDBIRTH the lungs or stomach are apt to give rise to serious consequences. The treatment must be varied to suit the conditions that present. If of the inflammatory variety, the throat red and swollen, pulse accelerated and there are general Figure 86 febrile symptoms, aconite is pre-eminently the remedy, whether the patient is a child or an adult. It may be given in combination with belladonna. Put five drops of each in half a goblet of water and take a teaspoonful every hour. Then give chlorate of potash as a gargle and permit a little of it to be swallowed every three hours. A teaspoon- ful of the crystals in half a goblet of water is about the DISEASES OF CHILDREN 345 proper strength. The compressed tablets of chlorate of potash which can be got at any drug store are more convenient, as they can be carried in the vest pocket and dissolved in the mouth and swallowed slowly as they dissolve. The dose for children may be one fourth to one half a tablet, or two or three grains every two or three hours. If the breath is offensive, give a grain or two of the second trituration of the red iodide of mercury, or pink powder as it is often called. It comes the nearest to being a specific in the majority of cases of " sore throat " yet discovered and is specially valuable when the breath is offensive, though, if there is inflammation, never omit the aconite. Those subject to an attack of sore throat with every change of weather should carry a vial of aconite pellets and a box of tablets with them for use at once. These remedies are always appropriate even in those cases where the predisposing cause is catarrh or syphi- lis, but a complete course of treatment to completely overcome these constitutional affections must be insti- tuted in the interval, depending only on the remedies above named for the relief of acute symptoms. Sprays are better than gargles and the following will be found excellent when the throat is cankered or ulcerated: Peroxide of Hydrogen, . . 2 ounces Aqueous Extract of Witch Hazel, 2 ounces Cinnamon Water, ... 2 ounces Directions — Use as spray to throat every two hours by means of an atomizer. Wet packs about the neck, gargling the throat with very hot water or equal parts of hot milk and water 346 PAINLESS CHILDBIRTH facilitate the cure, but of course are to be used only when the patient remains indoors. Frequent bathing the neck with cold water or whisky and water on the outside is beneficial in overcoming the sore throat habit. In chronic sore throat there is generally an impaired condition of the general health that demands aid for the reparative powers of nature by appropriate reme- dies as well as the employment of medicines for the local symptoms. QUINSY Quinsy or tonsilitis is, as the name indicates, an acute inflammation of the tonsils, implicating the uvula, soft palate and throat generally. One or both tonsils may be affected at the same time. It sometimes terminates in suppuration, requiring to be opened with the knife, or perhaps breaks and discharges the matter itself. The causes are cold, change of temperature, damp, wet feet and all the usual causes of colds. Rheumatic persons are most liable to it. Symptoms. — At first there is a soreness or stiffness of the throat, with heat and often pain. There may be chills which will be succeeded by fever. The throat is dry, hot and swollen and swallowing becomes difficult and every attempt is attended by excruciating pain. The uvula is enlarged and elongated; the end drop- ping down into the throat occasions a sensation as if some foreign substance was lodged in the throat, caus- ing frequent attempts at swallowing and giving rise to much irritation. On examination, one or both tonsils are seen to be swollen, the uvula elongated and the whole throat un- naturally red and shiny. The pulse is rapid, the tongue DISEASES OF CHILDREN 347 furred and the bowels usually constipated. The pain from the inflamed tonsils often extends into the ears. As the disease advances, the difficulty in swallowing increases to such an extent sometimes that on attempt- ing to swallow fluids they are expelled through the nose. The speech becomes indistinct and the thirst is great. These symptoms all vary in severity. The s3 r mptoms described may continue from five to twenty days, and may gradually subside, or they may terminate in suppuration of the affected tonsil. The 'ormation of matter is indicated by a throbbing pain, sometimes accompanied by a chill. This throbbing continues until the swollen gland is opened or breaks itself and a free discharge of matter takes place, when the swelling is suddenly reduced and all the symptoms subside and rapid recovery takes place. Sometimes during the disease the tonsils are covered with little ulcerated patches and may be mistaken for diphtheria. Sloughing may take place, particularly in those w^hose constitutions are previously much impaired. Both children and adults are subject to the disease. Treatment. — One of the first remedies to be thought of is aconite, five drops in half a goblet of water and a teaspoonful given every hour. It may be combined with Phytolacca with benefit, thus: Tincture Aconite, ... 5 drops Fluid Extract Phytolacca, . . 15 drops Water, ..... 4 ounces Dose — A teaspoonful every hour or two. 348 PAINLESS CHILDBIRTH If this prescription is given at the outset, it will be likely to cut short the disease. Alternate it with: Tincture of Hyoscyamus, . 30 drops Water, . . . . .4 ounces Dose — A teaspoonful every two to four hours, between the doses of aconite. Larger doses for adults. I do not remember ever having seen hyoscyamus recommended in quinsy, but I have used it in a number of cases with most gratifying results. A cathartic is always demanded. A seidlitz powder or a dose of salts may be given or, what is better, podo- phyllin and leptandrin, one tenth of a grain each for a child, one half grain each for an adult and repeat in twelve hours if needed; let it be taken at night, as a rule, the saline in the morning. If the pain is so severe as to prevent sleep, a small dose of Dover's powder may be taken at bedtime. An ice bag or hot poultices applied to the neck are bene- ficial and inhaling the vapor from an infusion of hops and vinegar sometimes affords marked relief. The peroxide of hydrogen spray mentioned on page 345 will be found very helpful. Small pieces of ice to suck may be given. The food should be liquid and not too hot. Anti- rheumatic remedies, salicylate of sodium or aspirin should be given to those who are rheumatic. Frequent attacks are liable to result in a permanent enlargement of the tonsils and give so much annoyance that an operation for their removal becomes necessary. DIPHTHERIA Diphtheria is an exceedingly grave malady in which we have a profound constitutional disturbance accom- panied by a severe affection of the throat, characterized DISEASES OF CHILDREN 349 by the development of patches of false membrane de- veloped more or less extensively on the mucous mem- branes of the throat and air passages. The cause of diphtheria is a germ — the Bacillus Diptherise. It is a contagious and infectious disease, and often prevails as an epidemic, though isolated cases are occasionally seen. As a result of over- crowding, it is more common among the poor. Diphtheria is no respecter of person, age, condition, rank or temperament. Whole families are sometimes destroyed, although children under ten years furnish the greater percentage of its victims. The symptoms vary in different cases from a mild sore throat to the most serious and malignant blood poisoning. Between these extremes we meet with every grade of intensity. The exudation of " false membrane " is the most certain diagnostic sign. There may be premonitory symptoms, as languor, dullness, fretfulness, thirst and impaired appetite, but they are apt to pass unnoticed. These may last two or three days, when there will be chilliness sometimes amounting to a severe chill, succeeded with feverish- ness, headache, backache and, in some cases, rheu- matic pains, with derangement of the skin, kidneys and bowels. There may be a stiffness of the neck, heat and irri- tation in the throat at the outset, but usually the throat is not complained of until the fever is developed. On examining the throat it will be found somewhat swollen, of a red or livid hue, at first covered with a glairy mucus, soon to be followed by ashen gray spots on the membrane, which are usually grouped together in 350 PAINLESS CHILDBIRTH clusters, becoming more numerous as the disease ad- vances and, coalescing, extend over large surfaces, pre- senting the peculiar ashen gray wash-leather appear- ance characteristic of the disease. This peculiar exu- dation may take place upon the surface of any mucous membrane in the body. It frequently extends upward and lines the nasal cavity (nasal diphtheria) and down- ward into the larynx (laryngeal diphtheria or true croup) and trachea, seriously endangering life by suffocation, or it may extend downward along the esophagus into the stomach and bowels and has extended the whole length of the alimentary canal. There is more or less fever, usually typhoid in char- acter. The pulse varies from rapid and full at first to feeble; or it may be slow and feeble at the outset. The temperature is frequently very high. The saliva is thick and tenacious and difficult of removal, the breath offensive, the teeth become cov- ered with sordes and the lips black and parched. After two or three days the exudation is liable to become detached, leaving the surfaces beneath raw and ex- tremely sensitive, so that the attempts at swallowing or even breathing are exceedingly painful. The more extensive the patches of membrane are the greater the difficulty of detaching them will be, and as one edge becomes loosened before the rest it may be heard to flap back and forth with each respiration with a noise well calculated to occasion anxiety. The denuded surfaces may ulcerate, and foul, unhealthy sores re- place the " false membrane." In mild cases when the membrane has not yet been formed it may be mistaken for catarrhal sore throat, but in all such cases, particularly if diphtheria be DISEASES OF CHILDREN 351 prevailing in the neighborhood, the great depression of the system is sufficient cause for alarm and suggest- ive of immediate action. In some cases an eruption has appeared upon the skin so nearly resembling scarlet fever that many have been led to regard the two diseases as identical. Sometimes in the beginning of the severer forms of the disease the patient will be attacked with vomit- ing of a yellowish watery fluid; this may be followed by a purging of a matter similar in character. After a painful restlessness the patient may sink into a stupor or unconsciousness, which may be again replaced with delirium and all the powers of life rapidly fail. In fatal cases death may occur from blood poison- ing, the patient gradually sinking, but more often it is occasioned by the sudden formation of heart clots. Suffocation is also a frequent form of death, when there will usually be a gradual decline, the patient becoming unconscious and comatose before the end, owing to the accumulation of carbonic acid in the blood. When the disease terminates favorably a marked improvement in all the symptoms generally takes place from the fifth to the tenth day. The swelling of the throat subsides and the patches of false membrane cease to re-form, as the different portions become loos- ened and are thrown off. The local discomfort grad- ually disappears and the general sjmiptoms rapidly improve. The temperature permanently becomes natural, the appetite returns, the skin and kidneys resume their natural functions and, with the exception of the muscular weakness, the invalid feels quite well. The danger, however, is not yet entirely over, for relapses frequently occur, with a new formation of 352 PAINLESS CHILDBIRTH false membrane and a return of the most serious symp- toms; or there may be a clot formed in the heart with a sudden failure of its action and death by fainting result; and even when there is an escape from these contingencies at a later period there may occur diphthe- retic paralysis. It is well, therefore, that the convales- cence be well guarded and care taken against all ordinary exertion and exposure for some little time after the symptoms have disappeared. LARYNGEAL DIPHTHERIA This variety of diphtheria is also known as mem- braneous or true croup and, as it is by far the most dangerous form of the disease, it is very important that it be recognized as early as possible and prompt measures taken to avert its consequences. As a rule, it comes on gradually and results from an extension or spreading of the diphtheretic process from the throat to the vocal cords. It is recognized* by a persistent harsh, croupy cough, often occurring in paroxysms at any time of day or night; dry, stridulous whistling breathing, hoarseness or loss of voice. During the fits of coughing, tough gray pieces of membrane are often expelled. The face is pale and anxious, the breathing labored and there is retraction of the soft parts at the sides of the chest and above the' breastbone. As the obstruction to breathing increases, the child becomes restless and tosses and struggles for air, the wings of the nose expand, the veins become distended, the lips and fingertips blue, the skin covered with cold sweat, the pulse weak and rapid, the extremities get cold and the child falls into a state of semi-stupor that steadily increases until death occurs. DISEASES OF CHILDREN 353 Treatment. — It is folly to advise that the manage- ment of so grave a disease be undertaken without the attendance of a physician and, though such be the case, in view of the conflicting opinions, I will venture to describe such treatment as has served me best. If possible, the patient should be put into a clean, dry, well aired bed in a good-sized, well ventilated room, stripped of all unnecessary furniture and dra- peries and a sheet put over the door. The room should be one that can be kept at a moderate temperature. Exclude everyone from the room not necessary for the care of the sick person and thus prevent as much as possible the spread of the malady. Disinfectants should be employed about the room and are not only benefi- cial to the patient, but afford a certain degree of pro- tection to the attendants. Chloride of lime may be used for the purpose, exposed in dishes and occasion- ally a little vinegar poured upon it. Under the direction of the physician a little sulphur may be burned in the room, care being taken that the sulphurous acid gas disengaged does not become so dense as to cause suffocation of the patient. We must maintain the vital powers by all the means at our command. Nutritious and stimulating food is necessary from the commencement — beef tea, mutton tea, milk, eggs, wine whey, milk punch, etc. If milk disagrees, the addition of a little lime water will usually overcome the objection. Repeat or alternate these articles so that every two or three hours some nourish- ment is given. As soon as diphtheria has been diagnosed, or even strongly suspected, the physician should administer a dose of antitoxin. . The value of this agent has been 354 PAINLESS CHILDBIRTH demonstrated and proved in so many thousands of cases that it should be given without delay, and re- peated if necessary. Every child that has been exposed to the disease should receive an immunizing or pro- tecting dose of antitoxin. The peroxide of hydrogen spray mentioned on page 345 may be used every two hours with an atomizer. Small pieces of ice to suck will often prove grateful to the little patient. Infants with diphtheria should not nurse from the breast, but the milk should be pumped out and fed from a bottle. Fumigations of calomel may be ordered by the physi- cian. Stimulants are often needed. Infants under one year will need from one quarter to one half teaspoonful of whiskey in water every three hours; children over two years a teaspoonful at the same intervals. The child should be kept quiet on its back and not allowed to toss or struggle, as the extra exertion may prove too great for the heart. In laryngeal diphtheria, antitoxin should be adminis- tered, but should the obstruction to breathing increase, intubation or tracheotomy will be necessary. In nasal diphtheria the nasal cavities should be irri- gated with warm solution of salt (one teaspoonful of salt dissolved in one pint of water). CEREBROSPINAL MENINGITIS This exceedingly fatal disease is also called spotted fever and consists of an inflammation of the cerebro spinal meninges (the membranes covering the brain and spinal cord). It is infectious and usually occurs as an epidemic, prevailing as a rule in circumscribed DISEASES OF CHILDREN 355 localities and does not seem to be retarded by the best sanitary regulations. The young and vigorous as well as the debilitated and infirm are among its victims. But little is known regarding its cause. Symptoms. — The symptoms vary according to the severity of the disease to such an extent that Stille has termed it the " chameleon-like disorder." The attack commences abruptly with lassitude and muscu- lar pains, soon followed with a chill, intense headache, vomiting, dizziness and great prostration. There may be mental excitement amounting to delirium, but this gives way sooner or later to depression and a disposi- tion to sleep, or unconsciousness. At first, there is intolerance of light and sound to be replaced later on by insensibility to both. The greatest suffering is from the pain in the head and spine. A curious symptom is that when the patient is insensible a slight pinch or even the attempt to open the eyelids will call out an expression of pain. The muscles of the neck, back and extremities be- come painful and rigid, the head drawn backward and the back curved so that the body describes the arc of a circle. The face is pale and shrunken, the features pinched, indicative of great suffering. Muscular twitch- ings occur and, in some cases, general convulsions. The surface of the body is very sensitive to the touch, and a slight motion sometimes will be sufficient to excite a spasm. When the finger is drawn over the skin a red line remains — the tache cerebrale. Some little time may be consumed with these symp- toms, so that the disease may not reach its height for three or four days, but in the severer forms of the mala- dy the patient is suddenly stricken down with a chill 356 PAINLESS CHILDBIRTH and dies in a few hours without showing any signs of a reaction. In such cases the chill is speedily followed by a rapid sinking of all the vital powers, the skin becomes blue and cold, the blood settles in blotches under the skin in various parts of the body, perhaps oozes from the nose, gums, mouth and skin, and there is a short period of delirium followed by a stupor from which the patient never revives. So rapidly may the disease do its work that the char- acteristic bending backward may not occur, and I have seen cases in which the blood spots did not appear till after death. In mild cases, the muscular pains, headache, stiffness of the muscles, fever, etc., may be present two or three days and then gradually disappear without the develop- ment of the other symptoms. When recovery does take place, there may be a long period of great nervous irritability, feebleness, together with more or less perversion of all the faculties. Fatal relapses sometimes take place after several weeks of apparently satisfactory convalescence. Treatment. — Great diversity of opinion prevails in regard to the proper treatment of cerebro-spinal meningitis, and no suggestions I may offer should be permitted to take the place of professional attendance. The variable character of the attack necessitates the best judgment in the selection of remedies. In the severer cases, all our efforts seem powerless. Flexner's serum has robbed this disease of all its former terror and is to cerebro-spinal fever what anti- toxin is to diphtheria. The physician should inject the serum into the spinal canal as soon as the disease has been diagnosed. DISEASES OF CHILDREN 357 The application of heat to the back of the neck and spine is a measure recommended by good authorities, and may be managed by cloths wrung out of hot water, or hot bottles of water. This should be frequently repeated and often gives decided relief. Ice bags applied to the spine usually feel more grateful and give better results. Attention to the bladder should not be forgotten. This organ is often paralyzed and will need measures for its relief. Heat placed over the lower abdomen will sometimes succeed, but, if it fails, a catheter must be used. Prostration must be combatted by stimulants, among which ammonia, capsicum and alcohol are at the head. But little can be said as to the dose. It must be governed by the effect and, while they do good or improve symptoms, they may be pushed, but many times they will produce but a transitory effect or no result at all. From the commencement, a good nutritious diet must be given. Beef essence, animal broths, eggs, milk, milk punch, etc., should be given, alternating so that some nourishment is administered as often as once in three hours. Stimulants, as already remarked, are to be given cautiously. During convalescence, tonics are necessary and may be given for a considerable length of time. SMALL POX Small pox or variola is an eruptive fever, propagated by a specific contagion, running a definite course, rarely attacking a person more than once, though cases are on record where it has attacked individuals twice and even three times. It is caused by exposure to a 358 PAINLESS CHILDBIRTH small pox patient during the pustular period, or from excrementitious matter thrown off during the disease. How long this matter retains its infectious character is unknown, but it is certain that it may be conveyed in the clothing or otherwise a long time after these media have been exposed to the contagious material. Symptoms. — After exposure to the contagion, a period of incubation, varying from seven to eighteen or even twenty days — usually about twelve — elapses before any special indications of the disease appear. Then there is headache, lassitude, mental depression and a severe chill, or perhaps several chills in succes- sion. Fever develops with nausea and vomiting, in- tense pain in the back and legs, the headache becomes more severe, the mind confused, which may amount to delirium. The pulse is rapid, the tongue coated and the breath offensive, the throat sore and eyes bloodshot. In young children, convulsions are apt to occur before the eruption comes out. The fever continues high until the eruption appears, which will be from the end of the second to the fifth day. The eruption, which is the diagnostic mark of the disease, first appears on the forehead and scalp, about the eyes and mouth and then extends to the body and extremities. When the eruption is delayed till the fourth day and the pustules well separated from each other, the attack is likely to be mild and is called discrete small pox; but when it appears early and the eruption so close that the pustules run into each other, it is apt to be severe and is then termed confluent small pox. The eruption first appears as small red pimples, which gradually become more prominent. These DISEASES OF CHILDREN 359 pimples are at first hard, but disappear for a moment under pressure. About the third day, and sometimes as early as the second, there appears upon the top of these pimples a small vesicle containing a transparent fluid, in the center of which there will soon appear a small depression or pit. They attain their size about the eighth day after the attack, and the fluid in them then becomes opaque and in two or three days they begin to dry down and form scabs. When the eruption has first appeared, there is a diminution of the fever, the headache and pain in the back and limbs are relieved, but return again about the seventh or eighth day and continue for a longer or shorter period, dependent largely upon the severity of the case and the amount of matter reabsorbed into the system; the chills and fever being due to the blood poisoning going on. About the tenth or eleventh day the swelling of the face subsides and the hands and feet swell. There is now great itching, and the vesicles break and pour out a liquid matter that forms crusts that are the cause of the disfiguring pits. In the severer forms the return of the fever is accom- panied with intense pain in the head and back, with delirium, which may be so acute as to necessitate con- stant watching. Diarrhoea and intestinal hemorrhage sometimes occur during this stage. In some cases the disease is so mild as to require little or no attention, while in others it is of the most malignant character, and the sufferer is reduced to a mass of putrescency. Between these extremes may be seen all grades of intensity. 360 PAINLESS CHILDBIRTH Treatment. — Small pox has a regular course to run, and the object of treatment, therefore, is to mitigate its severity and guide it to a successful termination. It is highly important to isolate the patient at once and maintain a rigid quarantine to prevent the spread of the disease. Every person who has been exposed to the disease should be vaccinated at once. Secure a commodious, well ventilated apartment, where the atmosphere need not become loaded with the emanations from the patient, not too cold nor yet too hot, and maintain as nearly an even temperature as possible, and let the room be well disinfected by carbolic acid or other disinfectants freely sprinkled about. Give the patient a warm sponge bath two or three times a day, in which a small quantity of carbolic acid is dissolved. For two or three days before the characteristic eruption appears it will be difficult to determine the disease, unless it is prevailing in the vicinity or the patient is aware of having been exposed to it. As soon, however, as it is known that the disease is small pox, give: Fluid Extract Veratrum, . . 10 drops Fluid Hydrastis, ... 30 drops Water, ..... 4 ounces Mix, and to a child five years old give a teaspoonful every hour, lengthening the intervals as the fever subsides and increas- ing when the fever increases, and continue till the fever disappears. This will also control the stomach. The internal use of carbolic acid is believed by some to be of value in diminishing the severity of the blood poisoning, and a drop in half a wineglassful of water may be given three times a day. DISEASES OF CHILDREN 361 The saracenia or pitcher plant has acquired some- thing of a reputation in this disease and is believed to materially lessen its severity. The infusion of the plant, an ounce steeped in a pint of water, and the whole taken in twenty-four hours, is regarded as the best mode of administration. Should the condition of the bowels require a laxa- tive, a seidlitz powder, calcined magnesia or some of the laxative mineral waters in appropriate doses may be given. Pain, irritation and wakefulness may be so severe at times as to demand the use of opiates, when pare- goric or tincture of opium or Dover's powder may be given in suitable doses to afford ease and sleep. To prevent pitting, a great variety of plans have been tried, but the principle of them all is to exclude the air. The following is a good formula: Carbolic Acid, .... 1 dram Fluid Hydrastis, ... 1 ounce Glycerine, .... 5 ounces Mix, and apply with a soft brush or earners hair pencil, care- fully avoiding breaking the pustules. Repeat the application several times a day as often as it partially dries. It will allay the troublesome itching and disposition to scratch. Another method is to smear oil over the exposed skin and over it dust a powder composed of equal parts of bismuth subnitrate and prepared chalk. From the first, a supporting diet must be given — beef tea, mutton broth, eggs, milk, oysters, etc.; and particularly is nourishment demanded at the time of the maturation of the pustules; at this period the use of milk punch, brandy or whisky sling should be used to support the vital powers and favor the process of pustulation. If the eruption strikes in suddenly, warm 362 PAINLESS CHILDBIRTH drinks should be given, and milk punch or camphor sling made by putting three or four drops of the spirits of camphor into a cup of warm sweetened water should be repeated every three or four hours. In the severer cases, the eyes should be protected by darkening the room or covering them with a mask. Diarrhoea may occur and should be treated with small doses of the neutralizing mixture and perhaps two to ten drops of the fluid extract of cranesbill, small doses of the tincture of cinchona, say five to ten drops for children every two or three hours, is well adapted to the necessity. During convalescence, nourishment is usually of more consequence than medicine, except the hydrastis in two or three-drop doses, or the cinchona in five or ten-drop doses, three times a day, increasing the dose in adult patients proportionately. VACCINATION Every baby should be vaccinated when it is five or six months old, because successful vaccination is almost certain protection against small pox. The vaccination should be repeated in the tenth year and after that every five to seven years. The outer side of the left arm is the place usually selected, but girls may, if preferred, be vaccinated on the thigh or leg. A shield should be worn as a protec- tion until the sore has thoroughly healed. CHICKEN POX Chicken pox or varicella is a mild, contagious erup- tive disease having some resemblance to small pox, but very much milder. An eruption appears — generally much scattered, principally on the body — as small red pimples, which in a few hours develop into vesicles, DISEASES OF CHILDREN 363 and in rare instances become pustules. The rash first appears on the face and forehead and then spreads over other parts of the body. The pimples come in crops — new ones coming for three or four days. The rash may often be seen in the throat or mouth. In a day or two the vesicles dry up and scabs or crusts form that fall off in from five to twenty days; neither scar mark nor pitting is left, except occasionally after a very severe attack. There is seldom any fever till the eruption appears, then the temperature raises somewhat and there may be headache, thirst, constipation, irritation of the eyes, severe itching, etc. School children should be quarantined for three weeks, or until all scabs have fallen off. But little or no treatment is necessary. If there is much fever, a mild laxative of citrate of magnesia and a few drops of aconite in a glass of water, given in teaspoonful doses every hour or two, is all that is neces- sary in the way of medicine. Itching of the skin can be allayed with carbolized vaseline. Infants should wear mittens to prevent scratching. A warm bath and pre- caution against taking cold should be employed. MEASLES Measles or rubeola is an acute contagious eruptive fever, due to a specific poison, propagated by contact with the sick or some article of clothing in which it may be carried long distances. Measles prevail epidemically at any and all seasons, but most generally during cold weather, and is then most severe, attacking all ages, but principally the young. It seldom attacks a person more than once and 364 PAINLESS CHILDBIRTH is apt to be more severe among adults than children.. It is attended with a more or less serious inflammation, of the mucous membrane of the respiratory organs,, varying from a slight catarrh to a severe bronchitis or pneumonia. Symptoms. — After a period of incubation varying; from seven to fourteen days — generally about ten- days — after the exposure, febrile symptoms accom- panied by catarrh make their appearance. The early- symptoms may not differ materially from a common cold; there are chills and fever, coughing and sneezing, discharge from the nose; the eyes become inflamed,, sensitive to the light and watery; there is headache, the throat feels raw and there is hoarseness with thirst, disturbance of the appetite, etc. These symptoms vary greatly in intensity. Usually on the fourth day from the beginning of these symptoms the characteristic eruption appears upon the face, in the edges of the hair and forehead, whence it extends to the neck, breast, body and ex- tremities, reaching its maximum in thirty-six to forty- eight hours. The eruption then remains stationary two or three days, when it gradually disappears in about the order of its appearance, and by the eighth or ninth day is all gone. This characteristic eruption appears as small dull or dingy red, slightly elevated circular spots resem- bling flea bites; at first separate with intervals of natur- ally colored skin between them, but soon run together in such a manner as to form crescent-shaped patches, slightly elevated above the surface of the skin. Koplik's sign — a day or two before the rash appears,, small, bluish white specks surrounded by a red areola* DISEASES OF CHILDREN 365 may be seen on the mucous membrane of the cheeks and lips. The symptoms described are sometimes varied and the eruption may appear out of its regular order. A person may wake in the morning after a restless night covered with the eruption without having noticed the early symptoms; or the " breaking out" may be de- layed beyond the fourth day. The only disease measles is likely to be confounded with is scarlet fever, but there are distinguishing features. The eruption of measles is darker than that of scarlet fever and gives the skin greater roughness; it being at first separate, then forming the crescent- shaped blotches, while the eruption of scarlet fever is usually in patches of a bright red color. In measles the eruption appears later then in scarlet fever. In measles it is first seen on the face and fore- head, in scarlet fever on the neck and chest. In measles the catarrhal symptoms are characteristic, except in very mild cases, but are rarely present in scarlet fever, though the throat is sore. These characteristics, though varying somewhat in different cases, will generally enable the reader to make a correct diagnosis. During the development of the eruption, the fever is generally pretty high, and there may be delirium, but when the measles are well out it subsides, unless the bronchial irritation is so severe as to cause its renewal. When the eruption declines naturally, yellowish dis- colorations remain and the skin is thrown off in fine scales. Sometimes the eruption is slow in coming out, or suddenly recedes after it has made its appearance, when the fever is likely to be greatly aggravated and the 366 PAINLESS CHILDBIRTH bronchial irritation becomes a serious and troublesome complication. This often develops into pneumonia, which is liable to leave behind a pulmonary disease that may terminate in consumption. Ordinarily, measles are not a severe disease. Some years they are extremely mild, while in others the mortality is great. When the eruption is very dark and the powers of life greatly depressed, malignancy being the type of the disease, it is often termed black measles. Treatment. — -As in all contagious diseases, the child should be isolated. The room must be slightly darkened on account of the condition of the eyes and the intoler- ance to light. Carbolized vaseline or washed lard will do much to allay the irritation or itching of the skin, and after the rash has disappeared warm baths should be given once or twice a day to assist the fine peeling of the skin. The eyes should be bathed night and morn- ing with a weak solution (10 grains to the ounce) of boracic acid and the throat sprayed three times daily with one part listerine and six parts water. In mild cases very little medicine is required, a hot foot bath, a warm sponge bath and warm drinks, with extra precautions against taking cold from exposure to draughts may be all that will be needed. Care must be taken to prevent taking cold for some time after the disappearance of the eruption. If the fever is exces- sive, aconite is the remedy and may be given alone or in connection with the pleurisy root or asclepias, thus: Tincture Aconite Root, . . 10 drops Fluid Extract Asclepias, . . . 2 drams Water, . . . . . * 4 ounces Dose — A teaspoonful every hour or two. This will not only modify the fever and induce moderate perspiration, but wil] materially aid in bringing out the eruption. DISEASES OF CHILDREN 367 When the eruption is tardy in making its appear- ance I would add five drops of tincture of belladonna to the above prescription and give in the same way. Should the cough require a remedy, give: Tincture Ipecac, ... 15 drops Tincture Drosera, ... 30 drops Water, ..... 4 ounces Mix and give a teaspoonful every two hours, continuing the aconite. Compound licorice mixture in doses of five to thirty drops (according to age) will relieve the cough. The bowels should be opened with a soapsuds injec- tion or a dose of castor oil or calcined magnesia. Secure rest at night by a warm bath and, if necessary, a dose of Dover's powder adapted to the patient's age. When the irritation of the lungs is great and does not yield to the foregoing, as will sometimes be the case, and a true bronchitis or pneumonia developing, the chest should be enveloped in warm fomentations or poultices or the oiled silk jacket. Then give: Fluid Extract Lobelia, . . 3^ dram Fluid Extract Asclepias, . 2 drams Syrup of Squills, ... 4 ounces Dose — One fourth to one teaspoonful every two to four hours, sufficient to afford relief, the dose to be varied according to age. Throughout the disease the diet should be nutri- tious. Give broths, soups, milk, milk punch, tea, toast, cereals, soft-boiled eggs, crackers, zweiback, jelly will make a good diet. Orangeade and lemonade may be given in moderate quantities. If the child complains of earache, notify the physician at once. 368 PAINLESS CHILDBIRTH When all the symptoms are* disappearing and the condition of the lungs does not require any special remedies I give tincture of Pulsatilla, ten drops in half a glass of water in teaspoonful doses every two or three hours. When there is great malignancy, supporting treat- ment is demanded, and milk punch, whisky toddy, beef tea, eggnog, etc., are called for. GERMAN MEASLES This is an acute contagious disease also known as Rubella, or Rotheln, that frequently occurs as an epi- demic. The constitutional symptoms are mild; the rash or eruption usually well marked, sometimes re- sembling that of ordinary measles, at other times that of scarlet fever. It may attack the same child a number of times as well as those who have previously had measles or scarlet fever. Symptoms. — For half a day the child may feel drowsy, be slightly feverish and complain of a little sore throat and watery eyes, but frequently the first symptom noticed is that the child when it awakes in the morning is covered with a, rash. The eruption appears first on the face on the temple and cheeks and then spreads rapidly over the rest of the body. It consists of small reddish pimples, usually scattered, but on the face often forming blotches like that of measles. In other cases the eruption takes the form of a uniform reddish blush that closely resembles that of scarlet fever. The erup- tion lasts for two or three days, fades and disappears, sometimes with slight peeling or desquamation. The glands of the neck are usually enlarged and there may be some itching of the skin. DISEASES OF CHILDREN 369 Treatment. — The disease is so mild that hardly any treatment is needed. The disease is contagious and the child should be kept away from other children for two weeks. Keep the bowels regular, sponge the body with tepid water two or three times a day. When the itching is severe, apply cacao butter or a bland oil to the skin. SCARLET FEVER Scarlet fever, scarlatina, or " canker rash," as it is variously called, is essentially a disease of childhood and rarely attacks a person but once. It is an acute infectious and contagious eruptive fever, characterized by a scarlet-colored eruption on the skin, associated with an inflammation of the throat. It is contagious from the outset of the disease to the end of desquama- tion or peeling and is communicated by contact or in- haling the exhalations of a person affected with it and may be conveyed in the clothing for long distances. Physicians recognize three varieties of the disease, distinguished by its severity: the simple, the anginose and the malignant. Scarlet fever in any form is to be dreaded, for it is a treacherous malady; an attack slight at first may become severe as it progresses and terminate fatally, and mild cases are often followed after convalescence is established by a fatal disease of the kidneys; on the other hand, cases that are severe at the outset become milder as they progress and ter- minate in complete recovery. Symptoms. — After exposure to the contagion, four to eleven days intervene, when the attack begins suddenly with chills, more or less severe, languor, headache, h : gh fever, rapid pulse, nausea and vomiting. Convul- sions frequently replace the chills in young children. 370 PAINLESS CHILDBIRTH The throat is sore, the tonsils swollen and inflamed. In twenty-four to forty-eight hours from the beginning, the characteristic eruption of the disease makes its appearance upon the neck and upper part of the chest, whence it extends over the rest of the body. There is rarely any rash around the mouth and chin and the pallor is in marked contrast to the rest of the face. In severe cases the eruption is delayed. The eruption consists of numerous little points or spots of a bright scarlet color which diffuse themselves uniformly over the skin or appear in large, irregular patches. This vivid color of the skin disappears under pressure, but quickly returns when the pressure is removed. At first the tongue is covered by a light yellowish coating through which numerous elevated points may be seen; about the fourth day this coating falls off, leaving the surface of the tongue raw and the elevated points swollen, giving it something the appearance of a large strawberry, from which we have "the straw- berry tongue" of scarlet fever. About the fifth day from the beginning of the attack the eruption begins to fade, and in a day or two — remaining longer in severe than in mild cases — it has entirely disappeared. The eruption is often attended by a troublesome itching; as it recedes, desquamation or peeling of the skin commences, first falling off in a minute scurf and later in large scales. This peeling lasts for two or three weeks, or even longer. In the mild or simple variety the symptoms are mild, and the trouble of the throat is not severe, the erup- tion comes out early and is of a pale rose color and soon fades. DISEASES OF CHILDREN 371 In the anginose form, all the symptoms are aggra- vated, the swelling of the throat is severe and swallow- ing very difficult. On examination of the throat, the tonsils are seen swollen, dark red and the mucous mem- brane presents more or less ulceration; the breath is offensive and there is an acrid discharge from the nose, and the glands of the neck are inflamed, often forming abscesses. The eruption is more general, and the whole body presents the appearance of a " boiled lobster." The occurrence of the eruption gives no relief, but all the symptoms are apt to be aggravated. In this form the eruption does not follow the regular course, it does not come out so early and may soon recede; it often shows a tendency to recede and reappear, and the throat is likely to remain sore for some time. In the malignant form we have all the severity of the anginose variety from the first, and a state of pros- tration soon develops that rapidly assumes all the characteristics of typhoid. The pulse is small, irregu- lar, indistinct, soft and so rapid as scarcely to be counted. The eyes are a dull red, with intolerance of the light, the cheeks flushed and dusky and there is deafness and delirium or stupor. The eruption is very dark colored, comes out late and disappears again in a few hours. The tongue, teeth and lips are covered with dark incrustations, the breath is exceedingly fetid, the breathing is rattling and laborious; swallowing exceed- ingly painful and -difficult, sometimes the whole neck becomes a dark livid color, the throat sloughs and an offensive diarrhoea occurs. These symptoms are very likely to terminate in death on the second, third or 372 PAINLESS CHILDBIRTH fourth day. This form of the disease, even under its most favorable circumstances, is extremely fatal. Severe kidney complications may occur in any form of the disease, and attention to the secretion of the urine should never be overlooked, as entire suppression sometimes takes place. Other possible complications are swelling and suppuration of the glands of the neck, purulent inflammation of the middle ear, inflamed joints. Treatment. — In the milder forms of the disease the objects of treatment are to modify the fever and pro- mote the appearance of the eruption. The patient should be isolated in a large easily ventilated room, as far away as possible from the rest of the family; all unnec- essary furniture and draperies should be removed; the air should be pure and the temperature about 68° F. A sheet wet with some disinfectant should be hung over the door and nothing must be allowed to leave the room unless it has been thoroughly boiled or disinfected. A tepid sponge bath repeated two or three times a day will materially aid in promoting the comfort of the patient by reducing the fever, and by assisting the peeling and preventing the scales from the skin from flying about will act as a preventive against spreading the disease. This bath may be ren- dered more efficacious by making it alkaline by adding a tablespoonful of saleratus or baking soda to each quart of water. Then give internally: Tincture of Aconite Root, . . 10 drops Tincture of Belladonna, . .5 drops Water, ..... 4 ounces Dose — A teaspoonful every hour or two as the fever is severe or mild. DISEASES OF CHILDREN 373 Warm drinks, mint teas, warm lemonade or hot whisky sling in moderation are useful in bringing out the eruption. In the anginose form, make use of the bath and warm drinks and give internally: Fluid Extract of Veratrum, . 10 drops Fluid Extract of Baptisia, . . 30 drops Water, ..... 4 ounces Dose — A teaspoonful every hour. Give two-grain doses of the second trituration of the red iodide of mercury every three or four hours and between the doses gargle the throat with the chlorate potash solution or, in its stead, gargle with the. following : Powdered Cayenne Pepper, . 1 teaspoonful Salt, . . . . . 2 tablespoonfuls: Cider Vinegar, .... 4 ounces Boiling Water . . to make 1 pint, Infuse and strain and use freely. The pungency of this mixture will make it objection-, able to small children, but its use is apt to be followed by speedy relief. Children too small to use a gargle may have the throat mopped out with a soft brush or sponge, but rough usage is not to be permitted. As a spray to the throat use the peroxide of hydro- gen formula mentioned in the treatment of sore throat, page 345. If the bowels require unloading, an injection of soap and water or a dose of castor oil should fc& given. 374 PAINLESS CHILDBIRTH A stimulating liniment applied to the neck on a layer of flannel is serviceable and the following answers well : Hemlock Oil, J^ ounce Olive Oil, y 2 ounce Spirits of Hartshorn, . . 3^ ounce Spirits of Camphor, . . . }^ ounce Mix. Anointing the entire body three or four times a day with vaseline or cacao butter does much good, allaying the troublesome itching and promoting the comfort of the patient. A ham or bacon rind is equally good if not better, though not quite so nice or fashionable. If there be great prostration, stimulants may be required, when milk punch, eggnog, wine whey, etc., are the most desirable forms. If they quiet and strength- en, they do good, but if they cause delirium they do harm and should be suspended. If there is great nervousness, give a few doses of: Tincture of Chamomilla, . r 60 drops Water, ..... 4 ounces Dose — A teaspoonful every two or three hours, timing its administration so as not to interfere with other remedies that are being given at stated intervals. If the functions of the kidneys fail and the urine becomes scanty and thickens on being heated, give: Acetate of Potash, ... 2 drams Tincture of Apis, . . . 15 drops Water, . . . . . 4 ounces Dose — A teaspoonful every four hours in plenty of water. Care must be taken to determine that instead of there being no urine secreted, the bladder be not over- full, having lost its power of evacuation. When this is the case, the bladder can generally be felt distending DISEASES OF CHILDREN 375 the lower abdomen. A hot sitz bath may afford relief or a hot fomentation of hops on which a little spirits of camphor is sprinkled may be applied over the bladder. If these fail, instrumental measures will be necessary. The bedding of children too young to tell may be found wet and yet the bladder be distended with urine, that which dribbles away being in excess of the capacity of the bladder. Distinction must be made between suppression y or failure of the . kidneys, and retention, or failure of the bladder to expel its contents. In the malignant form of the disease, treatment is very uncertain and unsatisfactory, yet every effort must be made. * Stimulants are to be given persever- ingly, brandy, milk, beef tea, eggs, etc., and this medi- cine internally: Tincture Rhus Tox, ... 5 drops Tincture Belladonna, . . 8 drops Fluid Extract Baptisia, . . 1 dram Water, ..... 4 ounces Mix. Dose — A teaspoonful every two hours. Throughout the disease a nutritious diet should be given and alternated so that every few hours some easily digested nourishment is given, as beef tea, mutton broth, eggs, milk punch, junket, wine, soft toast, etc., etc. Disinfectants should be exposed in the room, as chloride of lime, sulphurous acid gas, carbonic acid gas, carbolic acid, etc., as has been advised in diphtheria, small pox, etc. Dropsical complications may occur after the sub- sidence of the other symptoms, usually about the twenty-first day, and seems most liable to follow those cases that have been mild. When it occurs, put ten 376 PAINLESS CHILDBIRTH drops of apis and thirty drops of apocynum canabinum in a goblet half full of water and give a teaspoonful every four hours and alternate with ten drops of Fowler's solution in a like quantity of water, given in teaspoonful doses between the doses of the other. The alcoholic vapor bath may also be used at the same time with a view to remove the dropsical effusion through the skin by perspiration. During convalescence in the severer cases, tonics are needed, and the elixir of calisaya and iron in appro- priate doses suits the requirements well. It is perhaps needless to add that a physician be called at the outset who can watch the developments of the case and take advantage of conditions as they arise. I have detailed the treatment more particularly for the benefit of those who cannot have medical aid without delay, and as a guide in his absence and not by any means to supersede him. ERYSIPELAS This affection is a peculiar form of inflammation of the skin and tissues immediately beneath it, with a disposition to extend itself over large surfaces and accompanied by more or less severe febrile disturbance. It sometimes occurs as an epidemic, though isolated cases of the simple form are often met. It is an acute contagious disease due to a germ — the Erysipelas Streptococcus — that enters the body through a wound or abrasion of the skin. Facial erysipelas usually starts from a small wound at the edge of the eye, nose or mouth. In new-born babies it may start from the navel. Symptoms. — In the simplest or superficial variety there may not be very general disturbance, the disease being localized on the skin. The skin inflames and is DISEASES OF CHILDREN 377 attended by an intense itching or burning sensation, with redness, which so gradually merges into the sur- rounding tissues that it is almost or quite impossible to tell where it begins or ends. This simple form scarcely merits a description except to illustrate an extreme of the disease. In the severer forms, in addition to the symptoms mentioned, there is a chill at the outset, though it may be slight, soon followed with fever, loss of appetite, headache, nausea and perhaps vomiting, and there may be stupor or delirium when it attacks the face or head. A sensation of intense heat is felt in the skin where the disease shows itself, stinging and itching and attended with a swelling or puffiness, with a vivid red- ness which in a little while assumes a purple hue. The swollen skin presents a glistening appearance and is very sensitive. Erysipelas frequently attacks the face and head, though no part of the body is exempt. When it occurs in loose tissues like the eyelids the swelling is much greater than in tightly drawn tissues, but the latter are most painful. The swelling of the face is often extreme; the eyes may be closed and great deformity exist. Sometimes small blisters or vesicles appear on the affected surface. When the deeper structures are affected, abscesses form and typhoid symptoms are developed. The inflammation generally reaches its height in two or three days, and in a day or two longer gradually declines and the skin assumes a yellowish hue and peels off. It often happens that when the inflammation has arrived at its greatest height at the point of its com- mencement it will spread to adjacent tissues before 378 PAINLESS CHILDBIRTH it declines and in other instances advances in one direction as it declines in another, while at other times it leaves one point to attack another entirely remote. This form is known as migratory erysipelas. When situated on the head and face there is always danger of inflammation of the brain. Its ordinary duration is from seven to fourteen days, but it may assume an erratic form and wander about, receding in one direction and spreading in another, keeping up its maximum severity. Treatment. — Wash the inflamed part with Castile soap and water, then bathe with a 1 in 1000 solution of corrosive sublimate; dry with soft towel and apply white lead or the following salve: Ichthyol, . . ' . . . 2 drams Vaseline, .... 1 ounce Directions — Spread on inflamed part, cover with gauze, cotton or linen and hold with bandage. It is well to give children five drops of the tincture of chloride of iron in a wineglass of water three or four times a day, however mild the case may be. The use of iron as already described, alone or asso- ciated with quinine, is a very popular remedy with many physicians, particularly when the disease attacks persons previously debilitated. When constipation is present, a laxative may be necessary, and a seidlitz powder, Rochelle salts, cal- cined magnesia, or even castor oil may be given. The diet must be nutritious and sustaining — animal broths, toast, tea, milk, etc., and, if the prostration is great, stimulants may be necessary. Cool or tepid sponging of the body will always allay fever and add to the patient's comfort. Let the hygiene be as thorough as DISEASES OF CHILDREN 379 possible. During recovery, iron and calisaya makes an agreeable tonic. NOSE BLEED— EPISTAXIS Blows on the nose, picking at the nose, plethora, growths and ulcers, catarrh, are the most frequent causes of bleeding from the nose. Treatment. — Pinching the nose between the fingers will sometimes stop the bleeding. Powdered alum, pure or mixed with an equal quantity of starch, blown into the nose, or a small piece of absorbent cotton or bacon fat inserted just inside the nostril will often check the hemorrhage. Peroxide of hydrogen, lemon juice or weak vinegar may be sprayed into the nose with an atomizer. Raising one or both hands above the head, a small piece of ice to the outside of the nose, a hard substance, like a marble or thimble, placed be- tween the front teeth and upper lip are simple means that have often proved successful. Solutions of adrenalin and antipyrin are excellent remedies often used by physicians. DIARRHOEA Diarrhoea is an affection characterized by an in- creased frequency of the discharges from the bowels, of variable quantity and consistence, associated with derangement of the digestive function. It prevails largely among children at all seasons, but principally in the summer months. It often occurs as a symptom of other diseases and is one of the consequences of general blood poisoning. It is due largely to irritation of the intestinal tract from overloading the stomach, eating unripe, indigestible or irritating food, the pres- ence of worms, imperfect digestion, biliary disturb- ances, want of tone in the bowels, teething, etc. ; and 380 PAINLESS CHILDBIRTH in young children it is often caused by improper arti- cles of food when the child first commences to eat, impure milk, etc. Symptoms. — The symptoms of diarrhoea vary con- siderably. There are frequent evacuations of the bowels of a more fluid character than is natural. The dis- charges are generally preceded by a rumbling noise, uneasiness in the lower part of the abdomen, with a sense of weight or pressing down, which is relieved as soon as the evacuation is completed, but returns before the succeeding one occurs. In some cases the griping is severe, while in others it may be wholly absent. The tongue is usually coated, there is a bad taste in the mouth and often nausea and vomiting. If the disease continues long, the strength is reduced, emaciation occurs, all the various functions are disturbed and the skin becomes dry and sallow. The appearance of the stools varies greatly. In diarrhoea arising from irritation of the bowels, due to acrid, indigestible food, green vegetables, over- feeding, the presence of worms or from cold, etc., there are frequent copious, offensive discharges, preceded by griping, flatulence, nausea with coated tongue, loss of appetite, headache and, if it continues any length of time, prostration. When indigestible food is the cause, particles of the food may be seen in the evacuation. If due to worms, these parasites whole or in pieces may be seen, but the reader is referred to that subject for a more complete description. When from teething, there will in addition to the other symptoms be irri- tation of the nervous system, swelling of the gums and the symptoms generally accompanying teething. DISEASES OF CHILDREN 381 Figure 37 large intestine Lorye Intestine Vfrm,form i rippendix ' / Small JntJsti The Stomach and Intestines 382 PAINLESS CHILDBIRTH When the disease is due to lack of tone in the intes- tines, the relaxed vessels pour the watery portion of the blood into the intestinal canal where it is mixed with the other matters, thus causing copious watery stools in addition to the other symptoms. The pros- tration in this form is rapid. When diarrhoea is caused by an excessive secretion of bile, the passages will at first be mixed with greenish yellow matter, semi-solid and offensive, which as the disease advances becomes more watery. The mixture of the vitiated bile with the acids of the stomach when present in much quan- tity in the intestines occasions severe griping and offen- sive green discharges mixed with mucus. The griping does not wholly cease after the evacuation, and there is tenderness in the right side and pit of the stomach. The mouth tastes bitter, the tongue has a dirty yellowish white coat, the appetite is lost, the skin is dry and the urine scanty and highly colored. The presence of bile in the stools can generally be recognized by its appear- ance and smell. These symptoms may be so combined and varied that a given case will not admit of classifi- cation under any of the recognized forms of the dis- ease, and the discharges may amount to merely a looseness and may consist of mucus or be watery and present every shade of color and odor. Treatment. — When the diarrhoea is due to the presence of irritating materials in the intestinal canal, as unripe fruit, indigestible food, -etc., or the excessive secretion of bile, it is a good plan to preface all treat- ment with a mild purgative, which aids the efforts of nature by the expulsion of the offending matter and often puts an end to the whole trouble. For this 2 drams 2 drams Y2 dram 4 drams 4 drams 4 ounces DISEASES OF CHILDREN 383 purpose a good dose of castor oil should be given or, if preferred, the following prescription that very nearly resembles the old fashioned neutralizing mixture. Take: Fluid Extract of Rhubarb, Bicarbonate of Soda, Essence of Peppermint, Brandy, .... Simple Syrup, . Water, sufficient to make The dose of this for children from two to five years old is a teaspoonful or a little less repeated every two hours, until it appears in the stools, or a bright yellow color is seen in them, when it is to be stopped. If either of the foregoing does not put a stop to the diarrhoea, make use of the following mixture: Tincture of Camphor, . . 1 dram Tincture of Catechu, . . 1 dram Tincture of Capsicum, . . Y dram Essence of Peppermint, . . Y2 dram Elixir of Lactopeptin, to make . 2 ounces Dose — Ten to thirty drops, according to the age of the child, repeated every two to four hours, or oftener in violent cases. It should be given in warm sweetened water. Apply hot fomentations or a hot water bag to the abdomen. With these two prescriptions the majority of diar- rhoeas may be controlled, varying the doses to suit the age of the patient and violence of the attacks. Diarrhoea in which the tongue is heavily coated, but which is not due to overeating, etc., but in which there is griping, flatulence, rumbling noise in the bowels, 384 PAINLESS CHILDBIRTH with offensive semi-fluid stools, is generally controlled very readily by : Fluid Extract of Mandrake, . 5 drops Fluid Extract of Veratrum, . 3 drops Water, ..... 4 ounces Dose — A teaspoonful every hour or two. Painless watery diarrhoea will usually yield to five drops of the compound tincture of cinchona in a tea- spoonful of water, repeated every hour or two. It is also beneficial in those cases in which there is a want of tone in the intestines. Great care should be excercised in administering opiates and astringents to children in intestinal dis- orders for, though potent for good when properly em- ployed, they are equally productive of harm when mismanaged. During the disease, attention must be paid to the diet, and only light and easily digested food should be allowed. Toast, rice, boiled milk are among the best articles. The patient should at the same time be kept in bed. DYSENTERY This disease, also known as flux, bloody flux, colitis, etc., is an acute inflammatory affection of the lower bowel, attended with looseness. It is usually confined to the lower portion of the large intestine and is at- tended with severe straining, bearing down, fever and bloody stools — symptoms that distinguish it from diarrhoea. Dysentery frequently occurs as an epidemic and is then more severe and fatal than when it occurs in iso- lated cases. It is met with oftenest during the autum- nal months. When dysentery occurs as an epidemic, DISEASES OF CHILDREN 385 it is supposed to be due to some poisonous germs floating in the atmosphere. It is also caused by malaria and, when occurring in the fall, may be due to cold and moisture following intense heat, cold, improper diet, etc.; a cause of considerable importance is the chilling of the surface of the body during the autumn, when cool nights follow hot days. A person retires with a covering sufficiently comfortable at the time, but wakes in the night with a sense of chilliness. This causes the blood to recede from the surface and, being driven upon the intestines by repetition, predisposes to the development of dysentery on the operation of some additional cause, however slight. Symptoms. — It will frequently be observed that con- stipation has preceded the attack, but for a couple of days before the disease develops there is loss of appe- tite, languor, uneasiness or tenderness in the lower part of the abdomen, chilliness, nausea, etc.; soon there is an increased frequency of the evacuations, with griping, etc.; as inflammation develops in the lower bowel there is burning and pain in the rectum, the discharges become more frequent and less abundant; there is a constant desire to go to stool, and great efforts are made to expel something, which only results in the ejection of small quantities of mucus which are apt to be streaked with blood. As the discharges pass through the inflamed parts they occasion intense pain. These symptoms continue to increase and the quan- tity of blood becomes greater. The evacuations vary in appearance, sometimes frothy, containing portions of fecal matter, mucus and blood. Again they appear like the washings of meat; sometimes they are wholly mucus or perhaps pure blood. More or less fever 386 PAINLESS CHILDBIRTH attends these symptoms, with dry, coated tongue, thirst, great prostration and in malarious sections there will be evidence of congestion of the liver and obstructed circulation. Dysentery has no regular duration and may yield in a few days or it may be protracted into weeks. As the disease progresses, ulceration of the parts affected is liable to occur when pus will appear in the discharges. The appearance of brown, chocolate-colored discharges, great prostration, typhoid symptoms, etc., indicate great danger; but the reappearance of the fecal matter, except when it is passed in hard lumps, is generally a favorable omen, as a decline in the inflammation is likely to follow, even though the suffering and all the other symptoms may continue for two or three days longer before much improvement is noticed. Treatment. — To empty the bowels by the use of the rhubarb mixture advised for diarrhoea before the development of severe inflammatory symptoms is a judicious measure. Then put the patient upon: Tincture of Aconite Root, . . 10 drops Tincture of Gelseminum. . . 5 drops Water, . . . . .4 ounces Dose — A teaspoonful repeated every two hours, unless the characteristics of gelsemium appear, as double or indistinct vision, drooping lids, etc., when the dose must be lessened or given at longer intervals. This will not be likely to occur from this dose, except in very young children. For adults the dose must be materially increased. Alternate the foregoing with: Corrosive Sublimate, . . J/£ grain Fluid Extract of Ipecac, . . 1 dram Water, ..... 8 ounces Dose — A teaspoonful every two to four hours, according to the severity of the symptoms. DISEASES OF CHILDREN 387 These remedies have proved themselves so near specifics in my hands that I place great reliance upon them. If the pain and tenesmus are severe, a few doses of paregoric or laudanum may be prescribed by the physician until some degree of comfort is obtained. Washing out the bowel slowly and gently with mild antiseptic solutions will often prove beneficial. Diet is of the greatest importance in this disease, and no solid food is to be permitted. During the acute attack give pasteurized or peptonized milk, or lime water and milk in about the proportion of one part of the former to eight of the latter. As patient improves, give arrowroot, custard and other easily digested foods. To allay the thirst permit small pieces of ice to slowly dissolve in the mouth; this is far better than copious draughts of any liquid. The whole body should be frequently sponged with warm water made alkaline with a little soda. Warm fomentations of hops or hot water bag over the abdo- men will often afford material relief. They must be light and never be wet enough to drip. The sick cham- ber should be kept well ventilated and disinfected with carbolic acid, daily, and the discharges from the bowels must be removed at once and thoroughly disinfected. ACUTE INTESTINAL CATARRH This disease, also called muco enteritis, is an inflam- mation of the mucous membrane of the small intestine. It may result from cold or the irritation of particles of undigested food, or from other causes of intestinal troubles. It may extend upward and involve the stom- ach or downward to the large intestine. 388 PAINLESS CHILDBIRTH Symptoms. — Muco-enteritis generally begins with pain and tenderness about the navel, griping and a frequent desire to evacuate the bowels. There is diar- rhoea, but whether the evacuations be large or small they do not relieve the desire to go to stool. The evacu- ations vary, sometimes yellowish, thin, acrid and mixed with mucus and sometimes tinged with blood. If the stomach is involved there will be vomiting. If it ex- tends to the large intestine there will be the straining characteristic of dysentery. There is languor and chilli- ness or perhaps a severe chill, fever and pain about the navel, the appetite is lost, the tongue coated with a yellowish fur and, in the severer cases, it is dry with redness of the tip and edges. In some cases the pros- tration is great and typhoid symptoms develop, pres- sure on the bowels reveals tenderness and pain, the stools are variable, the desire irresistible, yet perhaps very little or nothing passes. Treatment. — The use of the popular " diarrhoea medicines' J in these cases is often worse than nothing, frequently aggravating the disease. The function of the skin should be re-established as soon as possible, and for this purpose a vapor bath or even a warm bath should be employed at the commencement. The patient should then be put into a warm bed and moder- ate perspiration promoted, care being taken when getting up to evacuate the bowels to be well wrapped to prevent taking cold. I then give: Tincture of Aconite Root, . . 10 drops Fluid Extract of Ipecac, • . 10 drops Water, ..... 4 ounces Dose — A teaspoonful every hour or two. Alternate this with: DISEASES OF CHILDREN 389 Fluid Extract of Mandrake, . 10 drops Water, ..... 4 ounces Dose — A teaspoonful every two to four hours between the other doses, and continue it until the discharge becomes more natural in appearance and consistence. If there is much blood in the stools with mucus and severe straining, in place of the mandrake I would give : Corrosive Sublimate, . . J^ grain Water, . . . . 8 ounces Dose — A t-easpoonful every four hours. Counter-irritation over the bowels with mustard or with turpentine applied a few moments at a time on a cloth answers a good purpose in many cases. The thirst, which is sometimes extreme, may be allayed by allowing small pieces of ice to melt in the mouth and will not aggravate the diarrhoea as large quantities of fluids are apt to do. The diet must be light and no solid food allowed. Pasteurized or pep- tonized milk or milk and lime water should be given in small quantities at regular intervals. The warm sponge bath should be repeated two or three times a day, As a rule, opiates do not act kindly in these cases. Usually this treatment will produce a very favorable impression in two or three days, but care must be ob- served, for the disease is extremely liable to relapse, even after the discharges have had a natural appear- ance for several days. When a relapse occurs, it neces- sitates a repetition of the treatment, in which case it is to be supplemented with a few doses of qui- nine, proportioned to age, given after the active symp- toms have declined. This is more particularly demanded when malarial influences exist. A looseness of the bowels 390 PAINLESS CHILDBIRTH sometimes remains that will demand the administra- tion of astringents. For this purpose two to five-drop doses of fluid extract of cranesbill is one of our best remedies and may be repeated two to four times a day. A pure article of Hungarian wine answers an excellent purpose, combining as it does an excellent astringent with a mild stimulant; it must, however, be used cautiously or it will induce constipation that may be followed by a relapse. An infusion of red raspberry leaves answers well. Blackberry cordial or an infusion of the blackberry root are agreeable astringents and some of them are always within reach. CHOLERA MORBUS This is an acute disease, characterized by vomiting and purging, associated with derangement of the func- tions of the liver. It may occur at any period of the year, but is most frequently met with in the latter part of summer and autumn and prevails more extensively some years than others. The influence of extreme heat upon the functions of the liver is a powerful predis- posing cause. Sudden changes in the weather, eating improper food, unripe vegetables and fruits, of which cucumbers, green apples and plums are most deserv- ing of mention, drinking freely of icewater when over- heated, ice cream, impure milk, etc., etc., are the most frequent exciting causes. Symptoms. — In a large per cent of cases it will be ascertained on careful inquiry that there has been present for a few hours or days some derangement of the stomach, nausea, coated tongue, flatulence, with a sense of weight and oppression, as if some of the food eaten remained in the stomach undergoing fermenta- tion instead of being digested, sometimes accompanied DISEASES OF CHILDREN 391 by diarrhoea. These premonitory symptoms are not always present or are so mild as to attract little or no attention. The real attack generally comes on suddenly and violently; sometimes a severe chill awakens the patient from a sound sleep, soon to be followed by a pain in the bowels, nausea, vomiting and purging. At first the matter vomited will consist of partly digested food mixed with mucus and a dirty yellowish or greenish fluid, and the discharge from the bowels will consist of ordinary feces mixed with a similar matter as that ejected from the stomach. The discharges become more fluid as the disease goes on, containing for a time more or less vitiated bile. In severe cases the discharges soon take on the characteristic "rice water" appearance of Asiatic cholera. The discharges are profuse, frequent and sudden and rapidly exhaust the patient, so that he becomes so weak as to scarcely be able to move in bed. The weight of the body is rapidly reduced. There is a terrible thirst present, but drinks are rejected almost as soon as swallowed. Spasmodic contractions of the muscles of the lower extremities frequently occur and sometimes the abdominal muscles are involved. These cramps are exceedingly painful. The pulse is small and frequent, the surface cold and bathed with a cold perspiration, the face appears blue and pinched. If relief is not obtained the prostration is increased, the mind wanders, insensibility and collapse occur to end in death. The disease lasts from a few hours to two or three days, but sometimes it is followed by a secondary fever lasting a week or more. Usually the disease is easily recognized and in the majority of cases, particu- larly with proper management, recovery takes place. 392 PAINLESS CHILDBIRTH Treatment. — The irritable condition of the stomach demands attention. The time was when emetics were regarded as about the only thing capable of accom- plishing this object, but alas! how mankind changes. Emetics are no longer the fashion and we seek to accom- plish the same end by entirely different means, and we suggest : Fluid Extract of Ipecac, . .5 drops Fluid Extract of Veratrum, . 5 drops Water, ..... 4 ounces Dose — A teaspoonful every ten minutes. Apply over the stomach a mustard paste or plaster and keep it on until the skin is considerably reddened. Apply dry warmth to the extremities; brisk rubbing, with or without dry mustard, will aid in stimulating the circulation and relieving the cramps. Endeavor to restore warmth to the surface. Do not permit large draughts of any fluid, but allay the thirst by allowing small bits of ice to melt in the mouth. Give internally: Tincture of Camphor, . . 1 dram Essence of Peppermint, . . Yi dram Essence of Jamaica Ginger, . 1 dram Chloroform, .... 1 dram Brandy, to make ... 2 ounces Dose — Five to fifteen drops according to the age of the child, with larger doses for adults, given in hot water sweetened and repeated every fifteen to thirty minutes, oftener if rejected. At the same time continue the ipecac and veratrum. This prescription alone is a powerful stimulant to the nervous system, aids in controlling the vomiting and diarrhoea, relieves the cramps in the extremities and fulfills most of the indications that call for medi- cine in the disease. DISEASES OF CHILDREN 393 When the stomach has been brought under control, we may use the following for the liver: Tincture of Leptandra, . . 1 dram Aromatic Syrup Rhubarb, . 1 ounce Dose — A teaspoonful every two or three hours until bile is seen in the stools and they begin to appear natural again. This dose is for a child from five to ten years old. Friction and dry warmth to the extremities must not be overlooked, for this and cholera are the diseases above all others in which "heat is life. ,J Sometimes the vomiting is very obstinate. If it does not yield to the measures already advised in a short time, other means should be employed. Iced champagne will sometimes succeed. An infusion of peach leaves is efficient in some cases or, if it can be procured, the compound tincture of cajeput in fifteen to twenty-drop doses every quarter or half hour is one of the best remedies. It is best taken on a little sugar. If collapse threatens, artificial warmth and stimulants and two drops each of the tincture of cam- phor and cayenne in water every ten or fifteen minutes. Inhalation of ammonia is also beneficial. If necessary, persevere with these means and many apparently hope- less cases will be restored to health. After the acute symptoms are over there will remain a debility and prostration which may be met with the following: Tincture of Cinchona Compound, % ounce Tincture of Nux Vomica, . . 20 drops Simple Elixir, to make . . 4 ounces Dose — One half to one teaspoonful three times a day, larger doses for grown persons. Convalescence is usually rapid. 394 PAINLESS CHILDBIRTH SUMMER DIARRHCEA— CHOLERA INFANTUM This disease, popularly termed the " summer com- plaint of children/ ' is one of the greatest foes of in- fancy and is one of the most difficult diseases we are called upon to treat. It prevails more extensively in cities and towns than in the country and is usually met with in the first and second years of a child's existence. In large cities almost one half the deaths in infants under one year old are caused by summer diarrhoea. It is most frequent in bottle-fed babies. There are several varieties of the disease, a fact that has occasioned much diversity of opinion; and as any attempt to distinguish the different types of the disease could only result in confusing the readers, I will omit it. There is a serious perversion of the nutritive func- tions with vomiting and diarrhoea, sometimes acute, at others chronic, sometimes accompanied by fever and sometimes without. Causes. — Impure food, the heat of summer, bad water, bad air, unhygienic surroundings, irritation of the nervous system from teething, etc., all contribute to the production of the disease. Frequently several of these causes are combined. The country districts present decided advantages for children; there the heat is not usually so intense or continuous; the ventila- tion is better; the water pure and not poisoned by the conductors it traverses; the milk is better, unmixed and unadulterated and not subjected to the natural changes that occur in it on account of time after leaving the cow and the agitation of transportation; vegetable food is obtained before it undergoes retrograde meta- morphosis. The opportunities for out-door exercises are greater, etc. The disease frequently occurs about DISEASES OF CHILDREN 395 the time of weaning or when young children are sub- jected to a change of food which, combined with other causes, are sufficient to develop it. Even when fed upon its mother's or the nurse's milk, unhygienic surround- ings, dietetic or sexual imprudence may cause such a change in the milk as to be exceedingly deleterious to the child and thus, aided by other causes, induce an attack of this disease, The mother's or nurse's milk even while plentiful, may be so impure or impoverished as to be a source of the disease. •Nursing bottles, unless cleansed at regular intervals with the greatest care, develop disease germs with great rapidity and are a great abomination. The more complicated they are the more difficult they will be to cleanse and consequently the worse for the child. Inpure air, often the result of decaying matters preg- nant with disease germs, is not backward in its contri- butions to the development of the scourge. Symptoms. — Necessarily, the symptoms of this dis- ease vary. Vomiting and diarrhoea, however, being present in all cases, but in variable severity. These, with the intense thirst, the great prostration and rapid emaciation furnish us with means of diagnosis, however much the other symptoms may vary. There may be an increased irritability of the child with diarrhoea for several days, but attracting little attention. This may increase slowly, the nausea, vomiting and thirst grad- ually developing. In other cases the attack comes on suddenly and is severe at the outset. The passage from the bowels at first contains fecal matter, little odor or perhaps a sour smell, but, as a rule, they are very offensive, the odor sometimes pene- trating every part of the house. The stools frequently 396 PAINLESS CHILDBIRTH contain partially digested food mixed with stringy mucus, yellowish, greenish or clayey in color, or are perhaps almost white with curds of undigested milk and sometimes streaked with blood. In other cases the stools are watery, and it is not unusual to see them change rapidly, presenting all these peculiarities in turn. The thirst is intolerable, incessant, and the fluids taken are almost immediately rejected or discharged by the bowels. The child is uneasy, restless, never satis- fied, desiring constant change, or it may lie semi- stupefied, roused at intervals by paroxysms of pain that seem to resemble the pains of cholera morbus, the child suddenly screaming and then lapsing into the stupor again. The nervous system is very irritable and often disease of the brain complicates the case. As the disease progresses, the eyes become sunken and partially closed, the lips are dry, parched, bleeding, the countenance pale, the skin dry and pinched and rapid emaciation takes place. The bowels are tender. An eruption often appears upon the buttocks or, ex- coriated by the discharges, contact with the stools or urine occasions great smarting, and pain is materially added to the child's suffering. The pulse is small, quick, tense; the tongue at first coated with a whitish fur, becomes dry and glossy. All the symptoms are generally worse at night and a remission towards morning apt to occur, but rapid changes are likely to take place at any time. When the brain is affected, the head becomes hot and is rolled from side to side, or the child sinks into a stupor, the eyes rolled upwards, the lids but DISEASES OF CHILDREN 397 partially closed, the pupils dilate and do not contract on exposure to the light. There may be as many as fifty stools in twenty-four hours, but, as a consequence when so frequent, the quantity at each passage will necessarily be small. Sometimes the disease assumes a more chronic form and the symptoms are not so severe, and some of them may be absent, but the vomiting and diarrhoea reduce the child to a skeleton, the skin becomes dark and harsh, with livid spots, the mouth filled with apthous ulcera- tions, the tongue swollen or perhaps shrunken and the stools acrid and offensive. In such cases, acute symp- toms or disease of the brain are sometimes developed and destroy the child. The disease may last from three days to two weeks, leaving the child in a broken-down condition from which it will require months to recover. In others the alternate periods of getting better and worse will protract the case for weeks and even months. Absolute safety from a relapse is never certain until the warm season is passed and the cool weather is accompanied with a complete convalescence; and even then there is no immunity against a recurrence the next season, except the child be over two years old, when there is comparative safety. Treatment. — Reference to medical writings will convince the reader that the profession is at sea in this complaint, and it is no wonder with this experience many prefer to rely on the nursing and care of "grand- ma" or "aunty" instead of resorting to "doctor's stuff." Pure air is essential and a removal to the country, particularly an elevated situation, is desirable. This cannot always be done and in cities every effort should 398 PAINLESS CHILDBIRTH be made to render the air as pure as possible by the removal of everything offensive; avoid dark, damp rooms and secure plenty of sunshine, even though the heat has to be modified by shades, but with the sun- shine secure constantly changing air. Allay the inor- dinate thirst by a spoonful of cold water; it is very grateful and, though too much will be rejected, small quantities repeated often are generally acceptable. Small bits of ice dissolved in the mouth are beneficial. The ice must be clear and pure; repeat the bits often; break them so fine that if swallowed they will not do any harm. No time should be lost in calling a physician to treat an infant or child suffering from an attack of diarrhoea. If for any reason his visit is delayed all breast nursing or bottle feeding should be stopped for from twelve to twenty-four hours and some egg or barley water given instead. A dose of castor oil and a warm rectal injection of soapsuds will help nature to get rid of the irritating and poisonous substances in the bowel. The following powder given every three hours will often check the diarrhcea: Salol, ..... H grain Subcarbonate of Bismuth, . . 2 grains Lime water may be added to milk advantageously in the proportion of an ounce to a pint. See that the nursing bottle is thoroughly cleansed and scalded after each feeding. Diminish the quantity of food from that taken before the sickness began and give it only at intervals of two to four hours. Sometimes the milk will be rejected by the stomach because it is too rich in fatty matter; in such cases skim it, but do not go DISEASES OF CHILDREN 399 to the other extreme and starve the child on the shadow of milk. In older children the juice of raw meat is sometimes very acceptable and better than milk; add a little salt to it to make it palatable and give half to one tea- spoonful every two hours. Carefully watch all food and if it disagrees set it aside. I have seen weak mutton broth agree nicely sometimes when other food was rejected. I have seen skimmed milk accepted and agree well when unskimmed was loathed and rejected. This is not apt to happen in cities. There are many artificial foods in the market, but of their relative value I am not prepared to speak. When tried, it should be cau- tiously and under advisement of a physician. The digestive process being almost wholly if not quite suspended, there is usually more danger of overfeeding than starving the child. Small quantities digested do good, but large amounts are apt to undergo fermen- tation and add to the existing trouble. Bathing is not to be omitted. If the child is feverish, restless, thirsty, tepid bathing is decidedly beneficial and should be repeated several times in twenty-four hours. A sponge bath is most proper and care should be observed that the clothing is not left wet. The removal of the discharges from the bowels should be effected immediately and disposed of so that no smell is left behind. As the buttocks are very apt to get sore, they should be dusted with powdered stearate of zinc or smeared with oxide of zinc ointment. Powdered starch or lycopodium is also good, and may be freely dusted on. The neutralizing cordial of the eclectic school is in great favor with many. I esteem it highly if the tongue 400 PAINLESS CHILDBIRTH is moist with a whitish fur, the matter vomited sour or the stools clay colored, sour or curdy. For these cases I prepare it thus and consider it better than the usual preparation on account of the omission of the sugar, which is always in the preparation as usually obtained : Pulverized Peppermint Leaves, J^ dram Pulverized Rhubarb Root, . 1 dram Bicarbonate of Soda, . . 1 dram Boiling Water, ... 4 ounces Cover, let it stand until cool, strain and add half an ounce best brandy and give in teaspoonful doses every hour until its pecu- liar color is seen in the stools; then give it three times a day. The addition of one half grain of subnitrate of bismuth in each dose often materially enhances its value. When we have the vomiting under control, we have gained an important point. If the stools are copious, watery, offensive and apparently painless I would give two to five drops of the compound tincture of cinchona every three hours in a teaspoonful of water. When the discharges begin to yield, lengthen the intervals between the doses. If the trouble depends on irritation from teething, and the gums are hot and swollen, lance them and give in alternation with the neutralizing cordial above: Tincture of Aconite, . . .10 drops Water (one half goblet), . . 4 ounces Dose — A teaspoonful every hour or two until the irritation of the nervous system is relieved. The use of pepsin in grain doses just before or after the feeding will aid the digestion of the food taken at that time and is a valuable auxiliary to other means. After the urgent symptoms are passed, a looseness of the bowels or a feebleness of the digestion often DISEASES OF CHILDREN 401 remains. In such cases continue the pepsin at the time of feeding and also give three to five drops of compound tincture of cinchona in a spoonful of water about four times a day. This, however, may be replaced by hy- drastis in some form or other, of which the fluid with- out alcohol, five drops in two ounces of water given in teaspoonful doses three or four times a day, answers a good purpose. I might add fifty or more other remedies, but as they would be more apt to mislead than aid I omit them. Many cases will occur which in the judgment of the attending physician require that other remedies should be given. WORMS Several varieties of worms infest the intestinal canal, but children are specially liable to the round or stomach worm (Ascaris Lumbricoides) and the small white or pin worm (Oxyuris Vermicularis). The round worm (Fig. 39) is smooth, light brown or reddish in color, about as thick as a slate pencil, tapering at each end and from five to ten inches long. Pin worms are very common in children between three and ten, and while usually there are from two to ten present there maybe hundreds. Round worms infest the small bowel. The pin worm (Fig 38) is about one third of an inch long and looks like a little piece of white thread. It in- habits the rectum and lower bowel. ■ Figure 88 402 PAINLESS CHILDBIRTH Figure 89 The symptoms they occasion are variable; usually there is a malnutrition and a catarrhal con- dition of the bowels, plenty* of mucus being favorable to their development. The appetite is capricious, sometimes absent and sometimes voracious, the breath offensive, acrid eructations, colicky pains about the navel, sometimes vomiting and diarrhoea, slimy stools, profuse urine, grinding the teeth, sudden starting in the sleep, picking the nose, fever, emacia- tion, hacking cough, irregular pulse and sometimes convulsions. In addition to these symptoms, when pin worms infest the lower bowel there will be an intolera- ble itching of the anus with slimy stools, etc. All these symptoms may be present and yet we can- not be absolutely certain that they are due to worms, unless we see them or pieces of them in the stools. Occasionally, however, they will be vomited up or crawl from the mouth. In little girls ■ pin worms will sometimes find their way from the rectum into the va- gina and give rise to troublesome itching and leucorrhcea and some- times irritation of the bladder. DISEASES OF CHILDREN 403 Treatment. — The indications are to destroy the parasites and improve the condition of the intestinal tract so as to prevent their reproduction. Worms are exceedingly prolific, and children of a scrofulous dispo- sition and those indulged in an excess of sweets or fed on unwholesome food will be very apt to suffer from frequent repetition of the symptom unless the treat- ment to destroy them is repeated at intervals and an improvement in the intestinal condition effected. For the first indication we have several remedies, even the common pumpkin seed is a good one. It may be eaten by the children or steeped and the tea drank. The old fashioned infusion of pink root and senna is an effec- tual remedy in doses of one half to one teaspoonful for a child of two years. Turpentine fulfills the indication well, fifteen to twenty drops of spirits of turpentine in a dose of castor oil repeated every third day does well. Salt water gives temporary relief. I like the following : Take Santonine, . . . .10 grains Podophyllin, Bicarbonate of Soda, Sugar, 2 grains 30 grains 1 dram Another good method is this: Give the child (six years old) a glass of milk only for supper and at bed- time a powder containing one half grain each of calomel and santonin for three nights. I have seen this plan do wonders for children some- times. When convulsions occur, in addition to the use of the "worm medicine," give such treatment as is advised under the head of convulsions. The pin worms infest the lower bowel and remedies administered by the mouth are of little consequence. 404 PAINLESS CHILDBIRTH To effectually destroy them it is necessary to apply the remedies directly. Injections are required and a strong solution of salt and water is very effectual. An infusion of ground quassia chips (one ounce of quassia in one pint of hot water) is good, or fifteen drops of carbolic acid in a goblet of warm water may be used. Whichever injection is selected should be used after the turpentine and oil or santonin and podophyllin have acted on the bowels and it should be repeated every two or three days until they are entirely de- stroyed. In using injections, let the quantity be suffi- cient to distend the folds of mucous membrane of the rectum and reach all the hiding places of the parasites, or they will speedily be reproduced. At least half a pint should be used at a time, but not sufficient to distend the bowels so much as to cause the child severe pain. The injection is to be retained a few minutes if possible. This plan of treatment, simple as it may seem to some, will be found efficacious and has the advantage of being available under nearly all circumstances. The itching caused by pin worms may usually be overcome by applying cold cloths or mercurial oint- ment to the anus. Cleanliness of the parts is all impor- tant. Although we have already exceeded the intended scope of the present edition, the author realizes that there are many other subjects deserving consideration that must be left to the future. Still, if the directions already given shall enable woman to find even partial relief from sickness and pain and render her assistance in the preservation of her darlings and the promotion of their welfare, his object will have been accomplished. CHAPTER XIX CARE OF THE SICK FOODS AND MEDICAL FORMULAE Sponge Bath Plain water or equal parts of water and alcohol, or water and vinegar may be used. The temperature of the water should be 85° F. to 90° F. Remove all cloth- ing (in infants except the diaper) and sponge one part of the body at a time, the rest of the body being kept covered. The sponging should last for five to fifteen minutes, and the child then wrapped in a blanket without any clothing. Mustard Bath Stir four or five tablespoonfuls of mustard in one gallon of tepid water and then add four or five gallons of water the temperature of which is 100° F., as ascer- tained by the bath thermometer. By adding more hot water the temperature can, if desired, be raised to 105° F. or 110° F. This bath is very useful in heart failure, shock, collapse, congestion of lungs or brain. The mustard bath should not usually last longer than ten minutes, when the child is quickly removed and wrapped in a blanket, without drying. 406 PAINLESS CHILDBIRTH Mustard Foot Bath for a Child Protect the bed with rubber sheet covered with towels. Cloths are wrung out of mustard water, made by adding one teaspoonful of mustard to a quart of water heated to 110 F. Wrap these cloths about the child's feet (keeping the rest of the body covered) and apply until the skin becomes red. Mustard Plaster or Paste t For adults this is made of pure mustard, or of equal parts of mustard and flour freed from lumps, mixed into a paste with tepid water and spread between two layers of muslin or soft linen. The object of the flour is to prevent blistering, and in its place corn meal, vaseline or the white of egg may be used. For children the proportion should be one part mustard to from four to eight parts flour. The mustard plaster is ap- plied to the part, covered with a towel and allowed to remain in place until the skin is well reddened — usually ten to twenty minutes. A corner of the plaster should be raised from time to time to see that it is not blister- ing. After the plaster has been removed the skin should be well cleansed, smeared with vaseline, oil or lard and covered with a soft cloth. Hot Water Fomentations Place a piece of flannel or blanket (preferably white) of the size required in the middle of a large towel and dip it in a basin of boiling water until thoroughly soaked. Twist the ends of the towel to thoroughly wring out the water, unfold the towel, shake out the flannel, apply it to the affected part, cover it with dry flannel or towels and rubber sheeting and apply a bandage to retain it in place. CARE OF THE SICK 407 Spice Plaster Thoroughly mix equal parts of allspice, cloves, cin- namon, and nutmeg and add one half part of black pepper. Place in a muslin bag, quilted to prevent sag- ging. Moisten one side of the poultice with warm brandy or whisky and apply to part desired. When the skin is tender, the amount of cloves and black pepper should be decreased. A spice plaster may be allowed to remain in position for hours, and is by many consid- ered a very useful application in some forms of stomach and bowel troubles in children. Turpentine Stupe Sprinkle about thirty drops (for children ten or fifteen) of turpentine over a piece of flannel wrung out of boiling water. A better way is to soak the piece of flannel in a pint of boiling water to which two or three teaspoonfuls of turpentine have been added. Take out the flannel, wring thoroughly and apply. Another method is the following: Place a tin cup containing the turpentine in a vessel or dish of hot water so that the turpentine may be warmed without coming near the fire. Dip a piece of flannel into very hot water, wring it so dry that no water drips from it, dip it into the hot turpentine and wring it again to free it from any excess of turpentine. The flannel while hot is then applied, but should not be left on too long, as it might blister. Flaxseed or Linseed Poultice Two and a half cups of meal and three cups of water will be required for a poultice for the chest or back. Add the meal to the boiling water, stirring all the time with a knife or spoon. When the mixture is just thick 408 PAINLESS CHILDBIRTH enough to drop from the spoon, remove from the fire, beat it well and spread it evenly, about a quarter of an inch thick, on muslin or soft linen, leaving a two-inch margin to turn back. Before applying the poultice hold it to the face to see that it is not too hot. Put it on slowly — a patient can stand a hotter poultice when it is let down a little at a time. The poultice should not be left on longer than one hour. After removing it dry the skin, and if no more are to be used apply a little oil, vaseline or lard to the skin, if irritated, and cover with flannel. Beef Essence Mince finely one pound of lean, juicy beef, put it into a fruit jar and cork tightly. Set the jar in a kettle of cold water over a slow fire and let it boil for three hours. Strain and season with salt and red pepper. Scraped Raw Meat Scrape the pulp from a good steak, season with salt and pepper to taste and serve as a sandwich between two thin lightly toasted slices of bread. Beef Broth Cut up one pound of beef, put it into one pint of water and allow to stand for four or five hours. Then cook over a slow fire for one hour and skim off the fat. Beef Tea (l). Chop fine or mince one pound of lean beef, put it with its juice into an earthen vessel containing one pint of tepid water and let it stand for one hour. Strain thoroughly and squeeze all the juice from the meat. Place on a fire and slowly raise just to the boiling point, stirring briskly all the time. Season CARE OF THE SICK 409 with salt and pepper, and when giving the tea always stir up the sediment. (2). Chop up fine one pound of lean beef and put it into one pint of cold water, to digest, two hours. Simmer on stove for two hours, but do not boil. Make up for water lost in the evaporation by adding cold water so that one pint of beef tea represents one pound of beef. Squeeze the beef thoroughly, strain and flavor to taste. Flaxseed Tea Add three teaspoonfuls of flaxseed, not ground, and one half teaspoonful of extract of licorice to ten ounces of boiling water and allow the mixture to stand in a warm place for from one to four hours. Lemon juice and sugar may be added to improve the taste. Albumen or Egg Water Add the white of one fresh egg to one half pint of cold water previously boiled. Shake thoroughly for half a minute and it is ready to serve. Sugar, salt, cinnamon or brandy according to taste may be added if desired. Barley Water Put two good sized teaspoonfuls of well washed pearl barley into one pint of cold water in a saucepan and boil slowly down to two thirds. Strain. Rice Water Cover two tablespoonfuls of rice with boiling water. Boil five minutes, drain and throw water away. Cover with two quarts of boiling water and simmer gently until reduced to about one quart. Strain through gauze. If used alone add a little salt. 410 PAINLESS CHILDBIRTH Rice Milk Add one tablespoonful of well washed rice to one pint of fresh milk and boil for an hour and a half. Rub it through a sieve, add two tablespoonfuls of granu- lated sugar, heat and serve. Oatmeal Water Put one tablespoonful of oatmeal flour in one pint of water and boil down to two thirds of a pint. Strain. Beaten white of egg may be added if desired. Oatmeal Gruel Mix two tablespoonfuls of oatmeal in a little cold water and add a quarter of a teaspoonful of salt. Pour over it one pint of boiling water and stir over the fire until it boils. Place it to one side where it will bubble slowly for half an hour; add a lump of sugar and a tablespoonful of whipped cream and serve. Arrowroot Juice Moisten a tablespoonful and a half of arrowroot in a little cold water. Pour over it a pint of boiling milk. Stir over the fire until it thickens and let it boil slowly for ten minutes. Remove it from the fire and add a teaspoonful of sugar and a quarter of a teaspoonful of salt. Junket Put a half pint of cold, fresh milk into a clean sauce- pan and heat it lukewarm (not over 100 F.) ; add one teaspoonful of essence of pepsin or liquid rennet and stir just enough to mix. Divide quickly into small cups or glasses and let stand until firmly jellied, when the junket is ready for use, just as it is, or with sugar, grated nutmeg, etc.; or it may be placed on ice and taken cold. CARE OF THE SICK 411 Whey Put one pint of cold, fresh milk into a clean saucepan and heat it lukewarm (not over 100° F.) ; add two tea- spoonfuls of essence of pepsin and stir just enough to mix; let it stand until firmly jellied, then beat with fork until it is finely divided; now strain, and the whey (liquid part) is ready for use. Keep in a bottle or glass jar near ice. How to Fumigate a Sick Room After Contagious Disease Books, playthings, toys and articles of trifling value should be burned. Close all cracks and openings in the room by stuffing them with cotton or pasting paper over them. On a clothesline in the room hang all bed- clothing, rugs and draperies, and open all closets and drawers. Pillows and mattresses should be ripped open so that the sulphur fumes may have access to every part. In the center of the room place a washtub partly filled with water and in it put two or three bricks on which to put a small dish containing the broken roll sulphur saturated with alcohol. Now light the sulphur, close the door, keyhole and all cracks. At the end of twenty-four hours open the door and all windows, so as to thoroughly air the room for at least another twenty-four hours. All furniture, floors and walls should then be washed with a one-in-one-thousand solution of corrosive sublimate. Neutralizing Mixture This valuable preparation, so much in use by the eclectic school, for dysentery, cholera morbus, diar- rhoea, vomiting, etc., is variously prepared by differ- ent physicians. The following formula will be found 412 PAINLESS CHILDBIRTH convenient and efficacious. The pulverized peppermint leaves, from the plant gathered fresn each year, will be found preferable to the oil or essence. Take: Indian or Turkey Rhubarb, . 1 ounce Bicarbonate of Potassa, . . 1 ounce Peppermint Leaves, Pulverized, . 3^ ounce Mix. Put it in a covered stone or porcelain jar, and add a pint of boiling water. When cold add one half pint of best brandy and one half pound of loaf sugar. Let it stand a day or two and then strain through cloth, and bottle. Dose — For an adult a tablespoonful every half hour. For a child two to four years old a teaspoonful every two hours. Some add cinnamon and cloves to the above formula, but I do not know that they increase its efficacy. The bicarbonate of soda may be substituted for the potassa if necessary. Mothers will find this an excellent preparation to have at hand for the stomach and intestinal disorders to which every one, large and small, are liable. It will keep indefinitely. Acute Laryngitis, Hoarseness, Etc. Compound Tincture of Benzoin, 2 ounces (Friar's Balsam) Directions — Put two teaspoonfuls in a pitcher containing one pint of boiling water, throw a towel over the head, hold face over pitcher and inhale the fumes. Dobell's Solution Borax, .... 1 dram Bicarbonate of Soda, 1 dram Carbolic Acid, . 3^ dram Glycerine, 1 ounce Water, .... 1 quart A useful wash for nose and throat in catarrhal affec- tions; should be used with an atomizer. CARE OF THE SICK 413 A Calomel Purge Calomel, . . . . J^ to 1 grain Sugar of Milk, .... 10 grains Divide into ten powders. Directions — One powder every half hour or hour until all are taken. A Useful Mixture for Fever in Children Citrate of Potash, . . . J^ dram Sweet Spirit of Nitre, . . 1 ]4, drams Orange Syrup, to make . . 2 ounces Dose for Child One Year Old — One teaspoonful in one teaspoonful of water every three hours. Sore Throat — Tonsilitis Chlorate of Potash, ... 2 drams Bromide of Potash, . ... 2 drams Tincture of Chloride of Iron, . 2 drams Extract of Licorice, ... 1 dram Water, to make ... 6 ounces Dose for an Adult — One teaspoonful in water every two hours; gargle and swallow. 414 PAINLESS CHILDBIRTH When to Use Dr. Dye's Mitchella Compound WHEN young girls are just reaching maturity and merging into womanhood, and nature unaided is unable to perform its new functions, Mitchella Compound, by giving tone and strength to the distinctly female organs, allows the menstrual periods to recur regularly and without pain. WHEN menstruation is disordered and is either painful, scanty, profuse, premature, delayed, suppressed or irregular, Mitchella Compound will quickly remove the cause, correct the difficulty and allow the functions to be performed naturally, regularly and painlessly. WHEN, owing to neglect or to insufficient or improper treat- ment, you are suffering from female weakness in any of its varied forms, Mitchella Compound will make you well. Under its won- derful influence the female organs are made healthy, normal and strong, and those annoying symptoms — backache, sideache, bearing-down, prolapse, dragging and wearing pains, irregular or painful menstruation, leucorrhcea (whites) — quickly disap- pear; the nervous system is toned and strengthened, and the prostration, nervousness and exhaustion vanish as if by magic; the stomach, kidneys and bladder are freed from all traces of disease and, as a result, the symptoms of dyspepsia (such as pain in stomach, wind, bloating, vomiting, etc.), the symptoms of diseased kidneys or bladder (such as painful and irregular urination, getting up at night, swelling of the feet, etc.), rapidly disappear. WHEN you wish to prevent pain during pregnancy and at the time of confinement, take Mitchella Compound. The many annoying symptoms which occur during pregnancy and at con- finement are due to abnormal or diseased conditions of the female organs. Mitchella Compound, by removing all traces of disease in these parts and restoring all the parts to a normal, healthy state, prevents pain and makes childbirth easy and natural. WHEN you wish to prevent miscarriage, which is almost always due to disease of the womb or ovaries, the use of Mitchella Compound will always be found satisfactory. WHEN you wish to hasten recovery after confinement, take Mitchella Compound. Do not forget that almost all cases of female weakness result from carelessness after confinement. Prevent all future suffering and aid the female organs to return to their normal condition by using two or three packages of Mitchella Compound. TESTIMONIALS 415 WHEN you wish to have healthy, robust and strong children, tone and strengthen the womb by using Mitchella Compound, so that the unborn babe may be nourished with healthy, life- giving blood. WHEN you are passing through the " change of life, " Mitchella Compound by its tonic influence will prevent or remove all those nervous symptoms which are so prone to occur at this time, and by its tonic and disease-removing effect on the female organs remove tendency to malignant diseases (cancer, etc.), which are so frequent at this stage of life. WHEN you consider yourself sterile or barren and are anxious to become a mother, let Mitchella Compound show its virtue. Sterility is always due to abnormal or diseased female organs. Mitchella Compound makes these parts healthy and free from disease, and childbearing then becomes a possibility. WHEN you are harrassed by kidney or bladder disease, do not forget that the trouble is almost always due to the pressure of diseased female organs. Mitchella Compound cures these diseases, and the symptoms of bladder and kidney disease quickly disappear. A WARNING. — For many years Dr. Dye's Mitchella Com- pound was the only preparation sold which was claimed to allay the pains of pregnancy and confinement. The praise and en- comiums which have been showered upon it by many thousands of women who have tested its virtues and merits have caused many imitations to spring up. These imitations are poor and worthless, and in no way resemble Dr. Dye's Mitchella Compound, either in composition or in results. Therefore, when ordering, see to it that you get the original Dr. Dye's Mitchella Compound. If you are still in doubt as to the worth of Dr. Dye's Mitchella Compound, write to one or more of the women whose testimo- nials we publish; always enclosing a stamped and self-addressed envelope. We are always willing and anxious to allow those women who have used it to speak the plain truth as to its worth. Price, $1.00 per package, or six for $5.00. Sent prepaid. DR. J. H. DYE MEDICAL INSTITUTE, P. O. Box 137. Lewis Block, Buffalo, N. Y. Unsolicited Testimonials Enclosed please find $5.00 for six boxes of your Mitchella Compound Tabules. Your Compound is a God-send to all expectant mothers. I took a three months' treatment before my baby girl was born. I can truly say I had no pain and she was born before my husband could go one mile and a half for my sister-in-law. She is a bright baby girl, one year, seven months old, and has never been sick an hour in her life. I always speak a good word for your Compound and wish all mothers knew about it. If my few lines of testimony will be of any use to you, you are welcome to publish it. Alma Center, Wis. MRS. JAMES A. ADAMS. 416 PAINLESS CHILDBIRTH Kindly send me a box of Mitchella Compound Tabules for the enclosed $1.00. I got three boxes two years ago and had a fine ten-pound baby girl. Never had no pain or ailments while taking the Tabules ; could do all my own work and never felt sick. I would never be without the Mitchella Compound Tab- ules any more, for they certainly helped me along fine and I am recommending them where they are needed. 812 Willow St., Scranton, Pa. MRS. JNO. F. EGEN, JR. I thought I would write and tell you how well I got along since I took your medicine. Just four weeks before I was confined, my four children and myself had the measles. When I took the measles, I never expected to get over them, and I baffled two good doctors how well I went through them. When confinement came, I was only in labor one hour and had only about four hard pains. The baby was a girl and weighed about seven pounds. I shall certainly always speak a good word for your medicine and tell all my lady friends that are in need of such a medicine about it. If you wish to use my name as a testimonial for it in Iowa, you are at liberty to do so. Baby Evans Udell, Iowa. MRS. BLANCHE EVANS. Please send me six boxes of Mitchella Compound Tabules for the $5.00 en- closed. This is not the first time I have used this great medicine. I took six boxes of the Compound about three years ago, with excellent results, and with very little trouble or suffering gave birth to a fine baby boy, weighing 1434 pounds. I have highly recommended your medicine to others of my sex, and you may publish my testimonial in reference to your great medicine, Mitchella Compound, if you so desire, as I would not be using this remedy again if I did not know it to be good and do just as it is claimed. Mulberry, Ark. MRS. NORA DUVALL. I began the use of Mitchella Compound in July and my baby was born October 3rd, a nine pound boy, very healthy. I was in labor only a little more than an hour — my doctor and nurse both considered it a very easy confinement; recovery rapid; and I give Mitchella Compound and you the praise of making me a healthy woman. I suffered for nearly twenty-four hours when my first baby was born, and then I was put under the influence of chloroform and instruments resorted to. If you have no agent in this vicinity I would be glad for the chance to handle your remedies. I will answer all letters from women who wish to know more about my case. R. No. 1, Kingsley, Mich. MRS. JULIUS MIHULKA. I have been using your Tabules for my daughter and I use them for myself, and we thank you for your medicine. It did wonderful for us. I had five children before this one and always had such a hard time. This time I used your Tabules and got through in less than no time. I had no doctor. My husband had to assist, and my baby is big and fat. I send you his photograph. Pitman, Pa. MRS. CHAS. MORGAN. Baby Morgan to be an agent for your fine medicine Box 22, Pearland, Texas. I write you to let you know that I passed safely through my confinement and had a much easier time of it than I ever had before. The other time I was sick half a day and this time I was sick only half an hour and did not suffer as much as I did before. Our baby is a big, fine boy. I would like Please send particulars. MRS. I. M. ARMSTRONG. TESTIMONIALS 417 Baby Sorensen Will you kindly inform me if you still sell the Mitchella Compound, also give me the price of same. Twenty-three (23) years ago I used this Compound which was a great help to me, and as my daughter is now a prospective mother I would like to secure the same help for her. No. 7 So. loth St., Colorado Springs, Col. MRS. L. C. NISBETT. Enclosed please find money order for which send one box of Mitchella Compound Tabules. This is for a friend. I took your Tabules about two months before confinement. The baby was born before the doctor got here, after less than two hours' pain. She is a fine, healthy baby, as you can see by picture I enclose. She is now three and one half months old. MRS. C. SORENSEN. 3441 Calumet Ave., Chicago, III, Enclosed find $1.00 for one box of Mitchella Compound Tabules, Have taken four boxes and am in perfect health. They have helped me so much. MRS. LAURA WITHROW. 218 Wheatland Ave., Logansport, Ind. You will find enclosed $1.00 for which send me one box of your Mitchella Compound in Tablet form, as I am nearly out. I used only two pack- ages and gave birth to an eight pound girl on November 17th and was not sick but ab^ut three and a half hours. I had the easiest time I ever had. I was always sick about a day and a night before. I have been sitting up ever since baby was three days old. I cannot praise your medicine enough. I suf- fered with cramps and varicose veins and could hardly walk, but they have all disappeared and I feel better than I ever did before. I will praise your medicine to anyone, and have recommended it to all my friends. R. No. 2, Nashville, N. C. MRS. J. M. TURNER. As I promised to let you know how I came through my confinement, I thought I had better write and let you know. Our baby weighed between seven and eight pounds when born. From the time I took sick until the baby was born it was only two hours and a half. I had an easy confinement. I was really surprised, because I never thought that a confinement could be so easy. I have good faith in your Mitchella Compound and shall tell other women about it. I am getting along well and so is my little boy. He is a healthy baby. If I ever get pregnant again I shall use some more of Mitchella Compound. Kevin, Mont. MRS, E, J. ENGLE. Through the kindness of my sister, Mrs. James Tharp, I was induced to take your treatment, con- sisting of four boxes, and to express my thanks and appreciation of your medicine, I am enclosing a picture of my baby girl, Waunetta, IS 1 2 months old the time the photo was taken. I must say she is the healthiest, smartest baby I ever saw and I give your medicine the credit, I have never been up a night with my baby and never had a doctor but once, and that was for a cold. She is one of the best babies I ever saw. There is no comparison with other babies whose mothers never used your medicine. Whenever I have a chance I will al- ways recommend your medicine. My sister has a little girl, four years old, who is considered a very beautiful child. She took your treatment, and my medicine was ordered through her. your medicine to my sister-in-law, and she has a fine healthy baby, sider vour medicine a great help in childbirth. Fulton, Mo. MRS. JNO. L. DUNN. Baby Dunn I also recommendec 418 PAINLESS CHILDBIRTH I used five boxes of Tabules and got along nicely. I think your Mitchella Compound is worth its weight in gold. I have a healthy baby boy. His weight is twenty-four pounds. Cannelville, Ohio. MRS. WARREN PLETCHER. Enclosed please find photograph of my baby. Before baby's birth I took your great remedy, Mit- chella Compound. She is now over two years old. When she was born she weighed sixteen pounds. I am again using your Compound to help and aid me through my present pregnancy and coming con- finement. MRS. E. E. CARTER. Grafton, W. Va. I used three packages of Mitchella Compound and can say I was well pleased with it. I only wished I had used more. I have a baby girl, four months old, weighed eleven pounds at birth. I shall recommend your medicine to all expectant mothers, as I am sure it is good. Oelwein, Iowa. MRS. A. D. O'NEEL. Baby Carter I thought I would write and tell you how I got along when I was confined. I just used one box of your Mitchella Compound, and when I received it I was unable to do my housework, was weak and all run down and had morning sickness very bad. I got relief from the first two or three doses of the Com- pound, went to work and did my household duties and washing for the family up to the very last. With my twins I was in labor about 48 hours, but with the last child I was in labor about 25 minutes and gave birth to a nine-pound girl. I had five labor pains. The baby is very healthy. Has had only one spell of sickness which was hives. She will soon be three months old. Your medicine is worth its weight in gold, and if ever I am in need of it again, you will receive my order. You may use my testimonial if you wish. R. No. 1, Box 148, Earleyville, Tenn. MRS. DELIA FOSTER. I suffered three days before the birth of my first baby. I had not then heard of your wonderful medicine, but before the birth of my second baby I took three packages of Mitchella Compound and was only sick a very short time. Baby is now two months old and very fat and healthy. I will always speak a good word for your wonderful medicine, as I know it saved me lots of suffering. You may print this if you wish and I will answer any letter of inquiry, enclosing a stamped envelope for the reply. Hawkeye, Mo. MRS. ZYLPHA STRUTTON. Inclosed you will find a picture of my baby. She was eight months old when it was taken. I took two boxes of Dr. Dye's Mitchella Compound Tabules and same helped me greatly. You may publish this picture if you wish. My baby is well and hardy. MRS. ALLEN HEAGY. Mount Joy, Penna. Your Mitchella Compound is certainly a wonder- ful medicine. With my last baby I was only sick three hours, and not so sick as with my two first children. The baby was a boy and he weighed seven pounds at birth, ten pounds at one month, sixteen pounds at three months. He will soon be four months old, and so far I have not lost one Baby Heagy hour of rest. He is a dandy. Success to you. Box "B," Robinson, Utah. MRS. LEONARD W. PECK. TESTIMONIALS 419 Enclosed you will find money order for $1.00 for which please send me one package of Mitchella Compound in the tablet form. I have, and am at the present time, deriving much benefit from your medicine. I cannot praise it too much, as it certainly makes childbirth easier. 239 11th St., Renova, Pa. MRS. GEORGE VAN RIPER. We have two little twin girls, six months old, and weighing twenty pounds each. I only took two boxes of your Mitchella Com- pound and did not have one pain. I thank you again for your great help. I send herewith the picture of my twin babies. MRS. MATILDA BELLOCK. Vilas, S. D. Mrs. Bellock's Twins I will write you a few words in praise of your Mitchella Compound. I have used it twice and cannot praise it high enough. Each time I was only sick for a few hours and suffered very little, and at other times I almost suffered death for two or three days and nights. I think your medicine makes healthy babies. I have a fine baby boy, five months old, weighs eighteen pounds. I never had a doctor either time and got along so fine. Never had any trouble. I know God will bless you for the help you have been to women. I have advised all preg- nant women of this community to use your medicine, and several have tried it and it has proved all you claim for it. I shall always praise Mitchella Com- pound. Pine Level, Fla. MRS. SARAH FORD. I will drop you a few lines to let you know how nicely I got through my dreaded confinement, and was up and around on the tenth day and felt real strong. I gave birth to a nice baby boy which weighed ten pounds. My attend- ing doctor was so surprised to think that I would get along so nicely on account of my age. I shall be pleased to recommend your Mitchella Compound and thank you for such a God-send to women in my case. Bonner Springs, Kan. MRS. J. C. VAN ZANT. I took your Mitchella Compound before my baby was born and got along very well. _ My baby weighed fifty-seven (57) pounds at eighteen (IS) months old. Everybody says she is the finest baby they ever saw. A great many people come to town to see my baby. She is a show for every- body and the joy of our home, as you will readily see by the photograph I enclose of her. If you wish to use this letter, you are at liberty to dp so. I am now on the road to motherhood again and, as I derived so much benefit from your Compound before, I wish to use it again. MRS. MAGGIE BAKER. Greenville, N. C. T ,, , «~ ™ r , • , , , , Baby Baker I will enclose S3. 00 for which send me three boxes of Mitchella Compound Tabules, for I cannot recommend them high enough for the good they have done for me. Cyclone, W. Va. MOLLIE BAILEY 420 PAINLESS CHILDBIRTH I will write to thank you for the good your Mitchella Compound did me. My baby was born March 18th, and everyone said I certainly had a fine time. Was only in pain two hours, and everyone predicted a hard time, and one good thing — I never suffered with anything before — nob even morning sickness. I certainly have a fine baby boy — one who has never been sick a day. I am very glad I took the Compound. I am ordering one box now for a friend, which I hope you will send at once. 424 Main St., Camden, N. J. MRS. J. C. SCHWENKER. I have used your Mitchella Compound and I think it has no equal for what it is recommended. Gorman, Tex. MATTIE B. SELLERS. Enclosed please find $2.00 for which send me two packages of your Mitchella Compound. Have used your medicine and think it is worth its weight in gold. Seneca Falls, N. Y. MRS. H. B. EDKIN. After so long a delay I will write and let you know how your medicine has benefited me. It did me, I must say, a world of good. Baby weighed 10^ pounds and the brightest babe we ever had. I had an easy and short labor — was only sick 23^ hours, when I was always before from six to nine hours. My baby weighed 193^ pounds at 6>£ months old. I have recommended the Compound to several women who are now taking it. I feel very grateful for what your medicine has done for me. Box 136, Cameron, W. Va. MRS. BERTHA HIBBS. I will try and write you this evening and tell you what your wonderful medicine did for me. I took three boxes of your Mitchella Compound and had an easy time at confinement. I was not sick but four hours and I was not in labor fifty minutes. My baby is a fine healthy girl. I can gladly recommend your medicine to all suffering women. I had a box of the Tabules to take after the baby was born, but I feel so well I do not think I need the medicine. I had no faith in your medicine when I saw your advertisement in the paper, but it is just what you claim it to be. I was always sick and feeling bad through pregnancy until this time — I felt fine. I can never praise your medicine enough. Tokio. Ark. MRS. ZADIE ASKEW. Too much cannot be said in favor of Mitchella Compound. It will do all it is claimed for. I took five packages before confinement and one after. I did not suffer any to speak of — I was on my feet until the last minute. I rushed them to fix my bed, laid down, had three pains and I gave birth to an eight- pound boy. I surprised them all. This is my fourth baby and I always suffered before. I got up the seventh day feeling strong. I never got up before before the eleventh day, then had to be held so I wouldn't faint. I am stronger than ever before, doing all my own work since baby is fourteen days old. You can print this and, if anyone doubts it, they can just write me, enclosing postage, and I will answer all inquiries. I also have a copy of your book Painless Childbirth and think it grand. I left two others read it and they say the same. R. No. 1. Knierin, Iowa. MRS. GEO. I. WILHELMS. I want to tell you what a great help your Tabules have been to me. I only used one and one half boxes and gave birth to twin babies, a boy and a girl. The boy weighed ten pounds and the girl eight pounds. They have never been sick a day, I did not have a half hour's pain and did not have a doctor. Every- thing was over with so quick. I would have been all alone but for the aid of the telephone and automobile, and every time before I was so slow and helpless that the neighbors were afraid to be near me, and even then I would have a doctor, and after all my sufferings at confinement, and months of suffering before, I would lose my babies. I wish every suffering sister could only have seen what a miracle your Tabules worked for me. It is the wonder of every- one who hears about it, I was able to do all my work and was just fine after my babies were born. I could have gotten up and took care of them so far as TESTIMONIALS 421 strength was concerned. I am trying to get more suffering sisters to try your Tabules. Oh, how welcome the word "confinement" would sound to all sisters' ears if they would try your miracle-working medicine. They will have to try it to find out how good it is, as its goodness cannot be spoken in words good enough. If you wish to use my name in regard to the benefit your medicine does, you are welcome to do so. R. No. 1, Oak Hill, Kans. MRS. CHRISTINA A. NOLAND. Enclosed find SI. 00 for which please send me one box of your Mitchella Compound Tabules. I have taken four boxes of your Mitchella Compound and find it a great benefit. I have a fine boy five days old. I only remained in bed two days, and when baby was born I only had two pains worth speaking of. He is the largest and healthiest one out of my four, and has been no trouble so far. I am feeling fine. Many thanks to you. R. No. 5, Marshall, N. C. MRS. SARAH FRISBEE. Enclosed find money order for SI. 00, for which please send me one package of Mitchella Compound. I took the last of the Compound one month ago and cannot do without it. I have a fine boy two months old — he weighed nine pounds at birth. I think your Compound a wonderful medicine. R. No. 8, Box 7, Columbia, Tenn. MRS. FRANK HAMMON. Although my baby is seven months old I feel that I ought to write you what Mitchella Compound has done for me. After undergoing terrible suffering at two previous confinements where instruments were used, losing both babies, at this birth I was sick just one hour and twenty-five minutes and gave birth to a five-pound baby girl. I was up on the sixth day and felt fine. My baby is well and strong, weighing sixteen pounds now. I have persuaded several to use your medicine, with good results, and am now sending for three one dollar boxes of the Mitchella Compound Tabules for a sister of mine. You are at liberty to use my letter if you wish. Blencoe, Iowa. MRS. W. C. ISOM. I have used your Mitchella Compound before the birth of each of my three children and have been able to work and do everything just the same as usual. N,ever have any kind of sickness and scarcely any pain at confinement. Chil- dren are fat and healthy. Shellsburg, Iowa. MRS. ANNA KING. I feel it my duty to give you my testimonial. You may publish it if you wish. In April, 1903, I became pregnant and my condition was such that I had to take to my bed. After three months of severe suffering and after all other medi- cines had failed, Mitchella Compound almost raised me from the dead. I would not be without it at that time for five times its cost. R. No. 2, Fyffe, Ala. MRS. CORA GRAVES. 422 PAINLESS CHILDBIRTH Are You Afflicted with Any Kind of Chronic Disease? For nearly a quarter of a century I have been in- vestigating and treating all forms of obscure, delicate, chronic diseases. During this time I have developed a system of treatment and discovered remedies with which I am able to cure, even after other remedies have been used in vain, all such obstinate, lingering maladies of both sexes as kidney and bladder diseases, chronic nasal catarrh, asthma, bronchitis and incipient consumption, diseases of the heart, liver and nervous system. All blood poisons, rheumatism, gout, neural- gia, epilepsy, Saint Vitus' dance, spinal irritation, paralysis, all forms of diseases peculiar to women, as well as the ailments incident to men — spermatorrhoea, impotency, strictures, etc., etc., etc. By the method now pursued by me, all cases not requiring surgical treatment can be cured at their own homes with small expense. I cordially invite all afflicted persons, no matter what the nature of their ailments may be or of how long standing or what treatment they may have tried in vain, to write me. I make no charge for such con- sultation and they may write me fully and freely in perfect confidence. No one sees their letters but myself, consequently any secret they confide in me will be perfectly safe. TESTIMONIALS 423 The first step towards a cure is a correct diagnosis; this I can make without difficulty if the patient will answer my questions carefully. To enable them to do this I will send examination blanks to those desiring them. If on their return I find additional questions necessary, I wA\ ask them, until I obtain the necessary information. Analysis of the urine will be made when- ever it can be of advantage or benefit to the patient or necessary to complete my diagnosis. Diagnosis is both a science and an art — qualifications all do not possess, by any means, or there would be fewer mistakes and more cures. My methods are based upon scientific principles and are successful. I begin right, and then spare no pains for my patrons' benefit. Occasionally there is a physician who will advise patients against being treated at a distance, but it is either because they are ignorant of the method pursued, bigoted or jealous. Sometimes they will appeal to the patients' incredulity, but there is usually a selfish motive in it, which a few have even carried so far as to prefer their patients should never get well than that somebody else should cure them. My experience extends over many thousands of cases in which every conceivable manner of complications existed. My opportunities have been practically un- limited and certainly far better than one whose practice has been confined to a certain locality, and in this regard the aphorism that " practice makes perfect" is true if it ever is. I can furnish the very best kind of references as to my qualifications and integrity, but I want all to in- vestigate for themselves. If, on investigating any 424 PAINLESS CHILDBIRTH case submitted to me, I find it incurable, I will tell the patient candidly his or her condition. Afflicted Reader, I offer you health. I can cure you if it is in the range of human possibility; but, remember, chronic diseases are progressive, they thrive by neglect; therefore, do not procrastinate. Write me freely; it will not cost you anything and may save your life. If the experience of a quarter of a century counts for anything it is in your favor. In writing me be explicit. Describe all the symptoms you experience. It is my province to unravel the tangled skein of pathological derangement. Describe your ailments in your own language and I will under- stand it and use it to your benefit Address all communications plainly and they will receive prompt attention. Respectfully and sincerely yours, JOHN H. DYE, M. D., Buffalo, N. Y. A Few Testimonials From Grateful Patients Sterility. I want to let you know what your special treatment did for me. You can use this for a testimonial if you so desire. I am now pregnant just sixteen weeks. I have no more indigestion or pain and am gaining in flesh. I have told several of my friends and they can hardly believe it, as I have been married seven years this January and never had a child. I am glad, however, to say that I am now on the road to motherhood. Box 102, Hewlett, N. Y. MRS. L. GANGLOFF. I have taken your medicine about nineteen (19) years ago in the Change of Life. I am now fifty-six (56) years old and never see a sick day and never have an ache or pain. Before I took your treatment I was never well and was always troubled with constipation, and since I have taken your treatment I have never been troubled with this ailment. Would advise both young and old to try Dr. J. H. Dye's cures for all ailments, of the body. Chester, W. Va. MRS. M. E. RUSSELL. TESTIMONIALS 425 Sterility. After taking your special treatment I find that I am now about five months along on the road to motherhood. I have not had one sick morning. Milford, Cal. MRS. G. R. WALES. Rheumatism, Constipation, Catarrhal Congestion of the Stomach. I enclose money for another month's special treatment, the same as you last sent me. I am very much improved and have not been as well in twenty years as I am now. R. No. 5, Dover, Del. MRS. MARY M. FAULKNER. Weak Nerves, Leucorrhoea, Backache, Displacement of the Womb. I was very glad to hear from you and still gladder to get the treatment. Doctor, I am still improving in every way and I am so thankful to you and to your fine treatment. All praises to you and I praise you from the depths of my heart. T have told all of my friends who are suffering from womanly ail- ments what you have done for me, and I will do my best to get them to try your treatment. Box 127, Dardanelle, Ark. MRS. WM. HELM. Painful Periods, Leucorrhoea, Headache, Female Weakness. I will write you to let you know how I am getting along. I just feel fine. I feel like a new person altogether. Before taking your medicine I suffered ter- ribly at the time of my monthlies, but this time I hardly knew I was that way. I am able to do my own work without feeling a bit tired, while before I could hardly sweep the floor. You are at libertv to use my testimonial if you like. R. No. 2, North Liberty, Ind. MRS. NANCY BARTON. Rheumatism, Congestion of the Kidneys. I had rheumatism in the ankles so bad that I could not sleep at night because I was in so much pain. I used your special remedies for one month and they helped me wonderfully. My ankles are not nearly so painful now. Many thanks for your medicines. I will recommend your medicines to all. Box 14, Riverton, N. H. , MRS. JNO. E. DEERING. This is to certify that one year ago I was suffering untold misery and had been for seven months. I had rheumatism, nervous neuralgia and sudden cold. They had three different doctors with me, but they and all other medicines failed to do me any good until your agent, Mrs. Maggie Gary, came along with your medicine, which began to help me at once. Gentlemen, I cannot describe how I suffered those terrible months. I had given up all hope, my people and friends also had lost all hope. When I began using your medicine I was so near gone it did not look as if I could live from one minute until the next. I was so nerv- ous I could not hold still on the bed. I thank you a thousand times for the wonderful good your medicine did me. I cannot praise it as much as I want to, for I believe if it had not been for your medicine I would have been in my grave. May God bless you and may you succeed in the good work you are in is my earnest prayer. If you like, you may print this, as I would like every suffering girl and woman in the country to know how I have suffered and how I was benefited by your medicine. Smith, W. Va. MISS SARAH F. ALBRIGHT. I am only glad, too glad, to write a testimonial and let others know my case. I owe my health and happiness to Dr. Dye's Mitchella Compound and Female Cones. I have been married going on seven years, and by using his two medi- cines and following his advice I soon began to feel better and found myself pregnant, and words cannot express the happiness I felt. I am sorry, however, to say that I quit using them for a while and then by moving upstairs in a brick house, I had steps to climb, and greatly to my sorrow, had a miscarriage. I, however, again began taking Mitchella Compound and I am now delighted to say I am going on three months pregnant. I am enjoying the best of health and have all hopes of carrying this baby the full nine months. I bless the day I started to take Dr. Dye's remedies and strongly advise all women to give Mitchella Compound and Female Cones a fair trial. I recommend Dr. Dye's medicines to young and old — they save doctor's bills and are a help and saving to all. I cannot fully express my appreciation to Dr. Dye. My sincere wish is that he may live long to help suffering women. I write this hoping it maybe Dublished. Box 282, Enid, Okla. MRS. GRACE WEISSINGER. 426 PAINLESS CHILDBIRTH INDEX Abdomen, enlargement of 59 pendulous - - 70 Adenoids - - - 315 Afterbirth - - - - 145 Afterpains - - 168-170 Age of wife - - - 18 Albumen water - - 409 Amenorrhoea - - 210-213 Anaesthesia in labor 157-162 Anteflexion of uterus - 243 Anteversion of uterus - 242 Appetite, depraved - - 98 loss of - - - 99 Arnold sterilizer - - 207 Arrowroot juice - - - 410 Artificial feeding - - 203 Asthma - - - - - 332 Attributes, sexual - - 1 Babv, feeding of - - 201 " full tub bath for - 180 " how to bathe the - 180 " rectal syringe - 129 " rocking the - - 192 " washing the new - 154 " water for - - 193 Baby's basket - - - 129 " bathtub - - 129 " bed - - - 130 " binder - - - 156 " wardrobe - - 130 Barley water - - - 409 Barrenness, frequency of 270 Bathing - - - - 65 Bath, mustard - - 405 " sitz - - - - 67 " sponge - - - 405 " temperature of differ- ent kinds - 67 " thermometer - 129 Bed, how to prepare for labor - - - - 126 Beef broth - - - - 408 " essence - - 408 " tea - - - - 408 Binder, abdominal 127-182 breast - - - 127 Bladder - - - 24-56-184 " irritability of - - 108 " loss of control of 170 Black Cohosh - - - 90 Blue Cohosh - - - - 87 Bones, composition of - 75-76 Bowels, evacuation of baby's 184 " gas in - 171 " opening up after labor 171 Breast, abscess of - 174-175 " cancer of -_ - 267-268 " care of, during preg- nancy - - 115-116 " changes in, during preg- nancy - - 49-50 " how to dry up milk in 176 " inflammation of 174-175 " nursing - - - 202 " small and shrunken - - - - 266-267 Breath, shortness of, in preg- nancy - - - 52 Bronchitis, acute - - 316 Cachexia, cancerous - - 258 Caesarean section - 55 Calomel^ prescription for - 413 Cancer of breast - - 267-268 of uterus - 256-258 Canker rash - - - 369 Cartilages, pelvic - - 51 Cascara sagrada for constipa- tion ----- 93 Catarrh, acute intestinal - 387 Cerebro spinal meningitis - 354 Change of life - - 258-261 Chicken pox - - - 362 Child attitude of, in womb 48 " average weight of new- born - - - 39 " bony development of 39 Child-bearing, excessive - 7 Child-bed fever - - 175-176 INDEX 427 Chloasma - - - - 52 Cholera Infantum - - 394 Morbus - - - 390 Cleanliness at confinement _ - - - - 166-167 Clothing worn during la- bor - - - 125 " during pregnancy - 69 Code Napoleon - - - 133 Cohosh, black - - - 90 « blue - - - - 87 Colds - - - - 308 Colic - - - - - 188 Compound licorice powder 93 Conception - - - 5-44 Confinement bed - - 126 " how to foretell date of - - - - 54-55 " preparations for - 124 " room - - - - 125 Constipation - - - 92-94 Consumption - - - 325 Contagious diseases, table of 339 Convulsions - - - 110-305 Cord, how and when to tie 144 " how to dress - - 156 " umbilical - - 154 Cough during pregnancy - 104 Cramps, treatment of - 114 Cravings during pregnancy 98 Crawling ----- 180 Croup, membraneous - - 352 " spasmodic - - 312 Deformities of pelvis - - 35 Delivery, dangers of too rapid - - - - 30 Dentition - - - 194-196 Depraved appetite during pregnancy - - - 98 Determination of sex - - 74 Diapers - - - - 184 Diarrhoea, - 379 " in pregnancy - 102 " summer - 394 Diet after confinement - 166 " for pregnancy - - 79 Dietetic measures - - 75 Diphtheria - - - - 348 " laryngeal - - 352 Displacements of uterus - 241 Dobell's Solution - - 412 Douche, vaginal, how to take - - - - 227-229 Dysentery - - - 384 Dysmenorrhoea - - 215 " inflammatory - - 217 " mechanical - - 220 " membranous - - 218 11 neuralgic - - 216 Egg water - - - - 409 Embryotomy - - - 35 Eruptive diseases, table of 339 Erysipelas - - - 378 Excessive childbearmg - 7 " nursing - - - 7 Excoriations - - - 302 Exercise - - - - 63 Eyes, care of baby's - - 183 " inflammation of - 183 Fainting, treatment of - 106 False pains - - - 136 " pregnancy - - - 53 Feet, swelling of - 110-111 Fever mixture, prescription for - - - - - 413 Fits ----- 305 Flatulency - - 99 Flaxseed poultice - - 407 tea - - - 409 Foetal movements - 59-60 " heartsounds - - 60 Foetus, symptoms of death of 60 Fomentations - - - 406 Fontanelles, closure of - 179 Fresh air and sunshine - 194 Fumigate, how to - - 411 Gas in stomach and bowels 99 " in bowels after labor 172 German measles - - 368 Hands, swelling of - 110-111 Head, bones of, in child - 41 Headache in pregnancy 103-104 Hearing in infant - - 179 Heart, the - - - 24-51 Heartburn - - - 101 Hemorrhage after de- livery - - - 163-164 Hip ache - - - 114 Hoarseness, remedy for - 412 Holding up of head - 180 428 PAINLESS CHILDBIRTH Hygienic management . - 62 Hymen, imperforate, test of virginity - - - - 276 Indigestion in infancy - 187 Infant, average weight at birth - - - - 178 Infant, average length at birth - - - - 179 Infant, average size of head 179 " care of - - 178-200 Infection, puerperal - 175 Infectious diseases, table of 339 Influenza - - - 309 Insomnia - - - - 113 Interests of man and woman 8 Intestine, acute catarrh of 387 Involution of womb - - 165 Inward fits - - - 306 Itching of genitals - 105-106 Jaundice in infancy - 192 Junket - - - - 410 Kidneys, care of during preg- nancy - - - 94-95 Labor, cause of - - - 134 " duration of - - 29 " false pains of - - 136 " first stage of - 139 " management of - 132 " position of patient dur- ing - - - 138 " premature - - 132 " premonitory- signs of 134 ". second stage of - 140 " symptoms at com- mencement of - 135 " third stage of - 143 " true pains of - - 136 Lacing, results of tight - 34 La Grippe - - - 309 Laryngeal diphtheria - 352 Laryngitis, acute, remedy for - - - - - 412 Laws of being - - 8 " of life - - - 3 Leucorrhoea - - -224-227 Lightening - - - 135 Liver spots - - - 52 <[ " treatment of - 107 Living rooms - - - 65 Lochia - - - - 166 Longings - - - - 98 Love - - - 1 Lying-in-fever - - - 176 " " room - 125 Marriage - - - 3 " early and late - 19-20 Mask of pregnancy - - 52 Maternal impressions - - 71-74 Maternity - - - 10-12 Measles - - 363 " German - - - 368 Meconium - - 157 Medicine dropper - - 129 Membranous croup - 352 Meningitis, cerebro spinal 354 Menorrhagia - - 221-223 Menses, retention of - 210 Menstruation, cessation of, sign of pregnancy - 56 " irregular - - 214 " vicarious - - 223-224 Milk, failure of breast - 176 Miscarriage - - 117-122 Mitchella repens - - 86 Morning sickness - - 57 Morning sickness, treatment of- - - - - 95-98 Mother,care of, after delivery 163 " influence of - 17 Mothers' marks - - 71-74 Moth patches 52 " " treatment of 107-108 Mouth, sore, of nursing mothers - - - - 175 Movements, foetal - 59-60 Mumps - - - - 340 Muscular system - - 37 Mustard bath - 405 " footbath - - 406 " plaster - - - 406 Naevi - - - - 72 Napoleon Code - - - 133 Navel at end of pregnancy 51 Neck of womb, softening of 59 Nervous system in pregnancy 53 Nervousness, treatment of - - - - 109-110 Neuralgia during preg- nancy - - - 103-104 Neutralizing mixture - 411 INDEX 429 Nipples, care of - 115-116 " changes in preg- nancy - - 49-51 Nose bleed - - - 379 Nurse, wet - 193 Nursery discipline - 198 Nursing, breast - - 202 " bottle, how to clean 207 " excessive ,—'—■— 7 " first - - - - 156 " sore mouth - - 174 Nymphomania - - - 4 Oatmeal gruel - - 410 " water - - - 410 Offspring, avoidance of 15 Ophthalmia neonatorum 183 Ovaries, jdiseases of 263-265 Ovum, changes in - 44-48 Pain, causes of - - - 31 Pains, false - - - 136 " true labor - - 136 Palpitation, treatment of 107 Passion, sexual - - - 2-4 Pasteurizer, Freeman's 207 Pelvic cartilages - - 51 Perineum, rigidity of - 38 Phenophthalein in constipa- tion ----- 93 Philoprogenitiveness - 10 Piles - - - - 101-102 Placenta - - - 145 Pleurisy - - - - 320 Plural births - - - 61 Pneumonia- - - - 321 Pregnancy, false or spurious 53 " mask of - - - 52 " protraction of - 132 " Signs and symptoms of 56 Premature birth - - 117 Preparation for confinement 124 Profuse menstruation 221-223 Prolapse of uterus - - 241 Pruritus vulvae - - 105 Puerperal fever - - 175-176 " infection - 175 Quickening- - - 54-59 Quinsy - - - - 346 Raw meat, scraped - - 408 Reasoning powers - - 2 Retention of menses - - 210 Retroflexion of uterus - 243 Retroversion of uterus 242 Rice milk - - - - 410 11 water - - - 409 Rocking the baby - - 192 Rooms, the living - - 65 Rotheln - 368 Salivation - - - 58-115 Scarlet fever - - - 369 Sciatic pains in pregnancy 114 Scraped raw meat - - 408 Sepsis puerperal - - 176 Septicaemia - - - 176 Sex, determination of - - 74 Sexes, attraction of - 3 Sexual attributes - - 12 " excesses - - - 67 " passion - - - 2-4 " questions - - 2 " relations during preg- nancy - - - 71 Shortness of breath - 52 Show, the - - - - 135 Sight in infant - - 179 Signs of disease in children 296 Sitting alone - - - 180 Sitz bath - - - 67-68 Skeleton, human - 40 Slave women - - - - 26 Sleep - - - - 68-69 " for infants 181 Sleeplessness, treatment of 113 Smallpox - - - 357 Softening of neck of womb 59 Sore mouth of nursing mothers - - - - 175 Sore throat - - - 342 " " prescription for 314 Spasms - - - - 305 Speech in infants - - 180 Spice plaster - - - 407 Sponge bath - 405 Spurious pregnancy - 53 Squaw vine - - - - 85 Standing alone - - 180 Sterilitv - - - - 269 " causes of - 272-279 " treatment of - 276-292 Stomach, the - 24 Striae gravidarum - - 51 430 PAINLESS CHILDBIRTH Stricture of uterus - 261-262 Subinvolution of uterus 250-252 Suppression of menses - 213 Teething- - - - 194 Thrush - - - 189-191 Tight lacing, results of - 34 Tonsillitis, prescription for 413 Too rapid delivery - - 30 Toothache during pregnancy 108 Transmission, vital - - 7 Triplets - - - - 61 Tuberculosis - - - 325 Tumors, fibroid - - 253 " of uterus - - 252-256 " pelvic - - - 35 Turpentine stupe - - 407 Twins - - - - 61 Tympany - - - - 171 Ulceration of womb 238-241 Umbilical cord - - - 154 Urine - - - - Uterus cancer of - 256-258 " changes in during preg- nancy - - - 49 " compared with other organs - - - 24 " displacement of - 241 " stricture of - 261-262 " subinvolution of 250-252 " tumors of- - 252-256 Vaccination -■—■-■- 362 Vaginal douche, how to take 227 Vaginismus - - 262-263 Varicella - - - - 362 Varicose veins - - 100 Vicarious menstruation 223-224 Virginity, test of - - 276 Vital transmission - 7 Vomiting - - - - 304 " in infants - - 186 *' of pregnancy - - 57 Walking, first attempt at 180 Wardrobe, baby's - - 130 Weaning- - 197 Weight, average of new born 39 " gain in, during preg- 52 193 411 334 18 256 229-238 241 164 261 250 252 238 401 nancy - - - Wet nurse - - - Whey - - - - Whooping cough - - Wife, age of - - Womb, cancer of - " chronic inflamma- tion of - " displacements of " involution of - " stricture of - " subinvolution of - " tumors of - - " ulceration of - Worms - - - -