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* .-6 ^. ^^";^^> .V^ ^'^ /^f^\ .0-' -o, * '^^ ^ .'?-• \ . ^'^^^ ^^'::;r' A^^" ^^ "oo^ .H -71, V- '^.. <*» 'V*o ^^ 1 1 > . ': '^- .uhes; the haunch-hones at the sides, and the seat- hones hQ\ov^\ \hQ cross-hone ; and 1\\q terminal-hone. The Arm is attached b}^ the shoulder-joint to the blade- bone or scapula. The upper aim consists of one bone, the humerus, jointed at the elhow to the forearm, which con- sists of two bones, the ulna on the inner side, the radius on the outer. The Wrist comprises eight bones, the Hand fiA^e, the Fingers three each, the Thtdib two. The Leg" is attached to the basin or pelvis b}' the hip- joint. The thigh has one bone,, called the femur. The lower leg, connected b}^ the knee-joint, and covered b}' the knee-pan {jnUella), has two bones, the shin or tihia on the inner side, the small hone or Jlhula on the outer. The ankle- joint connects the leg and foot. The under sm-face of the latter is called the sole, the upper is called the hack or dorsum; behind is the heel, and in front are the toeso General Description of the Human Body, 15 The body may be dmded into the Head, the Trunk, and the Limbs. The Head, consists of the face, the skull, and the lower jaw. Within the skull lies the hrain^ a mass of nervous matter continuous with the spinal cord. From the brain or spinal cord delicate threads called nerves pass to everj^ part of the bod}'. Motion and sensation are dependent on the healthy condition of these organs, and injury or distui'bance of their action may be followed by ^Dain, convulsions, or parah'sis. The Trunk consists of the neck, the chest, and the abdomen ; an accurate idea of the respective organs con- tained therein and their location being most readil}" conceived b}' reference to the engTa\angs on pp. 16 and 17. The front or anterior part of the neck is called the throat; the back or posterior part of the neck is called the najpe. Close up underneath the jaw the bone of the tongue {os liyoides) can be felt ; a little lower is a projection, com- monly called " Adam's apple," more prominent in men than women (the th3Toid cartilage) , the interior of which forms part of the larynx, or instrmnent by which the voice is pro- duced ; below this the windpipe (trachea) can be readify traced. The Chest, or thorax, is formed by the twelve dorsal vertebrse, the collar-bones, blade-bones, ribs, and breast- bone with the flesh ; all these bones are so jointed to each other as to allow of considerable alternate contraction and expansion of the chest during the act of breathing. The Breasts {mammoi) . On either side of the breast- bone (stermtm) are the Breasts. These are made up of fat, connective tissue, vessels, nerves, and milk -glands. These glands have some resemblance to bunches of currants, and terminate by fine tubes or ducts in the Nipple or Teat {rnamlUa) . The surface of the nipple is dark, and it is seated 16 Woman's Medical Companion. Fig. I.— Front View of the Thorax. The Ribs and Sternum are represented in Relation to the Lungs, Heart, ^d other Internal Organs. General Description of the Human Body, 17 Fig. 2. — ^The Regions of the Abdomen and their Contents. Edge of Costal Cartilages in dotted outline. 18 Woman's Medical Coinpanioji. on a colored circle or areola^ which in the virgin is usually of a rose-color, but becomes dark when pregnancy occurs, and never afterwards regains its former pink hue. The hollow beneath the shoulder-joint is called the arm- pit (axilla). The space below the left breast where the heart is felt beating is called the cardiac region. The interior of the chest is called the thoracic cavity. Its chief contents are the heart with its vessels, and the lungs with their bronchial tubes, in which terminates the wind-pipe. The ofRce of the lungs is to expose the blood to the action upon it of fresh air admitted to them through the larynx, trachea, and bronchial tubes, during the act of inspiration^ or drawing in the breath. If, then, the ex- pansion of the chest is hindered by the clothing, as by tight-laced staj'^s, or if the air is polluted, as by the breath of persons in close, unventilated rooms, or by the gases from drains, etc., the office of the lungs is interfered with, the blood becomes impure and poisoned, and the result is ill-health or disease. The blood flows to the heart by the veins from every part of the body ; is by it pumped into the lungs to be purified ; returns to the heart, and is thence transmitted by the arteries throughout the system. The Xndse is commonly felt at the wrist, because at that part an artery lies near the surface of the body, and is therefore easily felt. The number of beats for an adult is ordinarily about sevent}^ a minute, though it varies much, even in health, in different persons ; but it usually maintains its own rate in any individual. The part of the chest containing the lungs and heart is separated internally from the belly by a fleshy partition called the diaphragm^ or mid-rib^ which thus forms the floor of the thoracic cavity. Geiteral Description of the Human Body. 19 THE BEIil^Y CABI>OME]¥) Is divided into two parts, an upper and larger part, the abdomen^ or belh', properly- so-called, and a lower part, named the ' ' basin," or thaiielvic cavity. For convenience of description, the belly or abdomen is marked ont into nine regions. A line is drawn across the body at the level of the pit of the stomach, and a second line at the level of the hips ; these two horizontal hnes are crossed by two vertical lines drawn each from the breast to the middle of the groin. The upper third is thus marked off into the epigastric region, or pit of the stomach, with on either side the h^^DO- chondriac regions (hj-^DO, under ^ chondria, the cartilages of the ribs) . The middle part of the belly, or abdomen, is divided into the umbihcal or navel region, and right and left lumbar or loin regions, the flanks. The lower third is divided into the M-pogastric (hypo, under, gaster, the stomach) or pubic region in the centre, and the right and left iliac or inguinal regions on either side. These three, the pubic and two iliac regions, are often together called the loiver belly. The chief contents of the belly, or abdomen, called the viscera, are as follows : in the upper thu'd going from left to right are the liver, with its gall-bladder, portions of the intestines, the pancreas or sweet-bread, the stomach, and the spleen. In the middle and lower third are the small intestines or bowels, and the large intestine called the colon, which ascends from the right iliac region to a httle above the level of the navel, then crosses and descends on the left side into the basin or pehic cavitj^, where it is called the rectum or straight gut, and terminates at the fundament or anus. It is into this portion of the intestine that injec- tions, clysters, or enemata are thrown. 20 Woman^s Medical Companion. Ill the lumbar or loin regions lie the kidneys^ whose secre- tion, the urine, passes into the bladder. This vessel empties itself b}" a small canal called the urethra. The bladder, when distended with mine, can be felt like a ball rising out of the " basin" or peMc cavity into the pubic region. The " basin" or pelvic canity contains the bladder when empty, the womb with its appendages, and the rectum. All these viscera — stomach, intestines, liver, pancreas, spleen, kidnej^s, bladder, womb, etc. — are covered, more or less, with a thin lining membrane, called 1^q peritoneum. This membrane in certain j^arts is gathered into folds, which serve to tie or support certain of the viscera in their places, and these folds are called " ligaments." THE IVERVOrS SYSTEM. "Within the skull lies the brain, a mass of nerv^ous matter similar to and continuous with the spinal cord. From this brain-matter or spinal cord, delicate threads called nerves pass to every part of the body. Some idea of the nature and beauty of their arrangement ma}" be seen in Fig. 3, p. 21. THE SPIIVAIL. NERVES, Connecting with the cord, are in pairs, of which there are thirty-one. Each pair has two roots, — a 77iotor root, aris- ing from the anterior columns of the cord, and a sensitive root, springing from the posterior columns. A section of the cord is suiToundcd by its sheath. The spinal nerve is formed by the union of the motor and sensitive roots. After the union, the nerve, with its motor and its sensitive filaments, divides and subdivides as it passes on, and is distributed to the tissues of the several organs. General Description of the Human Body. 21 The Nervous System. 22 Woman s Medical Compaiiion. The thirty-one pau's of spinal nerves are divided into eight pairs of cervical, twelve paii'S of dorsal, five pah's of lunibar, and six pairs of sacral nerves. THE SX3IPATHETIC XERVE Consists of a series of these gangha, or knots, which extend down each side of the spinal column, forming a kind of chain throughout its whole length, communicating to both the cranial and spinal nerves, and distributing branches to all the internal organs. These nerves, then, are undoubtedly the organs of feehng and sensation of every kind ; through them the mind operates upon the body. The intelligent mind, whatever that may be, whose seat is in the brain, wills that a certain action shall be performed, and instantly through the main channel of communication, the spinal cord, the message flies, branching off here or there according to the du-ection in which the work is to be done, and setting in motion the muscles which form it. The Female Organs of Generation. CHAPTEE II. THE FEMALE ORGANS OF GENERATION. These arc the ovaries, or egg receptacles, in which the ovum or egg is secreted, whence it passes along the Fallopian tubes to the uterus or ivomb, whose office it is to contain the fecundated ovum diu'ing its gi'owth, and then to expel it along the front passage or vagina into the world. These organs are all contained within a canity, the walls of which are composed of bones and of soft parts, known as the basin, or cavity of the pelvis. The external organs of generation are usually included under one name — the pudenda, or the " Privates." Passing backwards from the " privates " (vulva) , we find the perineum. This bridge-like structure extends to the anus. It measures an inch and a quarter in its normal condition, but when, during birth, the child's head is press- ing upon it, it is capable of extension to three or even five inches. The anus is the circular opening into the bowel, and is a muscular structui'e capable of considable dilatation and contraction. Behind this, 3'ou can feel the terminal bone of the spinal column, or the coccyx. THE IXTERIVAIi ORGANS. (See cut 4, page 25.) 1st. The Vagina, or front passage. This is a canal or tube measm'ing four or five inches in its natural condition, and is extremely elastic. In its healthy state, the walls are close together, thus forming a substantial means of sup- 24 Woman! s Medical Companion. port to the womb. In certain cases the walls become very relaxed, when, as a natural consequence, the womb loses a large proportion of its support, and it is apt to fall — an affection known as Prolapsus Uteris Procidentia Uteris etc. To the fore-part of its upper wall or roof the urethra and bladder are attached ; farther back, about two-thirds of its length, the neck of the womb projects into it. The surface of the vagina, when healthy, is only just moist, except dur- ing labor, when an abundant secretion or mucus is poured forth, to aid the passage of the child into the world. A similar secretion is ver}^ frequently found in unimpregnated females, and in very large quantities, but this does not arise from the same cause or the same source. This un- natural and unpleasant discharge comes from the womb, and is known by the name of Leucorrhcea, or the Whites. In these and all the other affections we shall have to mention^ medical advice should he at once obtained. Behind the vagina, in the hollow of the cross-bone, or sacrum, lies the rectum. THE TFOMB C^^TERUS) In the virgin resembles a small flattened pear in size and shape. It is about two and a half inches in length, one inch in thicknes, two inches in width, and weighs about one ounce. After child-bearing, these dimensions are per- manentl}^ increased, so that the whole organ is larger and heavier than in the adult virgin. The bottom of the womb is called ihQ fundus^ the middle third is called the hody^ and the remainder is called the neck or cervix. In the centre of the body is a cavity that will contain an almond, lined by a mucus membrane, which, during pregnancy, becomes greatly thickened. From this cavity a small canal leads through the neck or cervix to the external month of the womb. There are also two minute openings near the fundus, which are continued through the Fallopian tubes. The Female Organs of Generation. 25 t 3 2. O S I 3 ^ n> 3 3 & 3 3 ^ J? 26 Woman's Medical Compa7tion. The neck of the womb, or cervix^ in a healthy woman, who- has never been a mother, projects abont three-quarters of an inch, or for two-thu'ds of its total length, into the ' ' front passage," or vagina, presenting a smooth, conical surface, having a transverse or circular depression in its centre, the mouth of the womb {os uteri or os cervicis) , with an an- terior and a posterior lip. The opening mil admit a large knitting-needle or a quill. In women who have borne children, the length and size of the neck or cervix var}^ greatly ; usuall}' it becomes thickened, and the orifice {os cervicis) is often notched, and will sometimes admit the top of the forefinger. THE FAIiLiOPIAN TTJBES Are two pipe-like flesh}' canals which pass off from opposite sides of the bottom of the womb {fundus uteri) ; they are about four inches in length, and as thick as a crow-quill, the passage through them hardl}' admitting a bristle. They end in a sort of trumpet-shaped mouth (the paviYiOTi or fim- hriated., that is, fringed extremity)^ which, at certain times, seizes the ovar}' in its gi*asp, and receives the ovum, or ^g^^ which then passes along the Fallopian tube to the cavity of the womb. THE OVARIES. CEGG RECEPTACI.ES OR OVARIA) Are two fleshy bodies, about the size and shape of a large almond, which lie half encircled b}' their respective Fallopian tubes, a little behind and about half an inch away from the bottom of the womb {fundus uteri) , one on each side of the ovary to which the}" are connected b}'' a ligament. Each womb, contains a number of vesicles, in which the " ova" or eggs, are formed, and which, as they become ripe, fall into the mouth or "pavilion" of the Fallopian tube to pass to TJie Female Organs of Goieration. 27 Fig. 1. — Pelvic Organs in position. Bladder distended. Womb virgin. 28 Woman^s Medical Companion, the womb. The Fallopian tubes and ovaries are sometimes called tlie appendages to the womb. The womb, Fallopian tubes, and ovaries are supported in their mid-centre position in the basin or pelvic cavity chiefly by a membrane, the peritoneum, in which they are enveloped, and which is attached by its outer border to the soft parts lining the side of the ' ' basin " (^pelvis) , and to the other viscera, like a diaphragm. This membrane forms a broad fold on the right and left sides of the womb, and these folds are called the broad ligaments; it forms two narrower and more cord-like folds behind the womb, which pass one on each side round the uterine {rectum) to the cross- bone, and these are called the utero sacral-ligaments; two other less distinct and slighter folds pass in front between the womb and the bladder, and are called utero-vesical (or womb-bladder) ligaments. The bladder, womb, and bowel are thus all tied together, and consequently ii'ritation or dis- ease affecting one of these organs frequently involves one or both of the others. The womb is further upheld by the va- gina. Two fleshy bands, called the round ligaments, arise from each side of the womb, a little below and in front of the Fallopian tubes, and pass downwards to the groins. The entire aspect of the UTEBIIVE ORGANISM (Exhibited on page 27, and again referred to in our chapter on Uterine Displacements, for the purpose of showing their normal position) will illustrate the intimate connection of the several functions with each other, and demonstrate the important fact that the healthy or diseased condition of one organ necessarily and inevitably involves the integrity of the whole. Puberty and Meiistr nation. 29 CHAPTER III. PUBERTY AND MENSTRUATION. During infancy and childhood the breasts and organs of generation, both internal and external, remain undeveloped ; but when the girl reaches the age of puberty — fourteen j^ears or thereabouts — these organs take on growth, enlarge, and graduall}' become mature, and fit to perform the functions of reproduction ; the girl, in the course of the next five years, becomes an adult woman. MEIVSTRUATION. There is no function of the female economy of which even females themselves are more ignorant than menstrua- tion. That a process so vital to their general health, as well as to the fulfilment of their natural functions, as the source from which future generations are to derive their existence, should be so imperfectly understood by women generalh', is a disgrace and a crime, for the existence of which there is not even the shadow of an excuse. Igno- rance of this first and fundamental law of woman's nature is the cause of two-thirds of the demoralization, wicked- ness, and loss of virtue with which this world has been cursed since the creation. Fully three-fourths of those insidious and life-destrojing maladies to which women are liable may be directly traced to their misapprehension on this matter. What wonder, then, that the medical fraternit}^ should be so divided in opinion, and originate so many contradictory and speculative theories, within the last 30 Woman's Medical Companion. two centuries, on menstruation and the disorders arising out of the derangement of this function? The fault, without doubt, lies primarily at the doors of the maternal parents themselves. From a spurious idea of modesty, from indifference, or pm-e carelessness, thej^ have permitted their daughters to arrive at the age of puberty without the slightest intimation as to what they might expect to experience ; no word of counsel or caution has escaped their lips — the i)Oor girls, affrighted at the appearance of the unexpected discharge, have endeavored to arrest it, and thus laid the foundation for an interminable train of painful and fatal diseases, making their life a prolonged and never- ending miser}' to themselves and those with whom they are connected. The Ancients had many superstitious notions regarding menstruation. The wonderful periodicity^ and regularity of the flow once in every twenty-eight days led to the conviction that this flow was caused and governed by the moon, the same as the ocean tides. Were such the case, the whole of the race would be ' ' unwell " at the same moment ; but the contrary is the fact, for there is not an hour, or, indeed, a moment, in the whole 3'ear in which thousands are not under- going that periodic \dsitation. POPUXiAR ERKORS COIVCERKIIVG MEIVSTBTJATIOIV. Many of our most eminent medical practitioners confi- dently assert that menstruation is inseparabl}^ connected with and dependent on the process of ovulation, or conception. But this also has been proved to be an error in fact. The truth, as estabUshed and corroborated b}' the general experience of women is, that ovulation can and does exist without menstruation^ and that menstruation frequently oc- curs without ovulation. Conception or ovulation doubtless has an exciting or stimulating influence on the menstrual Puberty and Menstruation. 31 function, but that the one is necessarily and inevitably the cause of the other is manifestly erroneous. The ph^'siological function and sole duty of the ovary is to mature and deposit its ova, or eggs, once ever}" twenty- eight daA's, which it regular!}' does, in the majority of healthy females. The same principle regulates the occurrence of the menstrual function, but the simultaneous occurrence of the ovulating with the menstrual epoch is a pure coincidence. Many a female has become pregnant, not once only, but sev- eral times in succession, without even the sUghtest sign of menstruation. In this country the sexual function is not assumed until the fourteenth year, as a rule ; in warm climates it appears somewhat earlier, and in colder regions, at a later period. Perhaps local causes and conditions have quite as much to do with the early or late appearance of the catamenia as the climate. It has been observed that those who are brought up luxuriously, and whose moral and physical training has been such as to exaggerate the susceptibilities of their ner- vous system, menstruate at an earlier period than those who are brought up roughly and are accustomed to coarse food and laborious emplo}^nent. The appearance of the menses prior to the fourteenth year is much to be regretted, because it demonstrates a premature development of the generative organs ; and, on the other hand, a late or retarded first ap- pearance is always to be regarded as an evidence of weak- ness or disorder. An undeveloped state of the uterine organs, indicated by a procrastination or non-eruption of the menstrua, always, in the mind of the skilled physician, excites apprehension for the welfare and security of the per- son in whom it is observed. In such cases we often find the body bhghted, the mind dull and weak, with the chest and lungs insufficiently developed, all of which render the patient an easy prey to disease. 32 Woman's Medical Companion, SYMPTOMS AiVI> l>lTRATIOIV. The first accession of the menses is usually preceded by headache, heaviness, languor, pains in the back, loins, and down the thighs, and an indisposition to exertion. There is a peculiar dark tint of the countenance, particularly under the eyes, and occasional^ uneasiness or a sense of constriction in the throat. The perspiration from the skin has a faint or sickly odor,* and the smell of the breath is peculiar. The breasts are enlarged and tender. The appetite is fastidious and capricious, and digestion impaired. These sjTuptoms continue for one, two, or three, or more days, according to ckcumstances, and subside gradually as the menses appear. The period lasts for three, five, or seven days, according to the peculiarities of the constitution. These monthly periods return with great regularity from the age of fourteen to about forty-five, when they usually cease. This period is ordinarily one of great anxiety to females, the s3Tiiptoms which present themselves at the time, such as sickness at the stomach, capricious appetite, swell- ing and pain in the breast, etc., being frequently mistaken for pregnancy. Menstruation very^ rarely ceases suddenly, but the intervals become irregular, eventuating in utter disappearance. Dur- ing the menstrual period, especially in young persons, great care should be taken to ward off all influences, whether mental or ph^'sical, which may have the least possible ten- dency either to interrupt or increase the discharge ; be- cause upon the health}' and regular action of the discharge depends so much of the beauty, perfection, and security of the female. During this period there is an increased sus- ceptibiiity and excitability of the s^'stem, and consequently a greater liabihty to derangements and to diseases of vari- ous kinds. Puberty and Me7tstr nation. 33 Serious and even dangerous results often follow a sud- den suppression of the menses. Among the causes which produce trouble at this period, we may mention sudden frights, fits of anger, great anxiety, and all powerful men- tal emotions. Excessive exertions of every kind, long wallvs or long rides, especially over rough roads, dancing, frequent running up and down stairs, have a tendency not onl}' to increase the discharge, but to produce falling of the womb. The discharge is not unfrequently morbidly increased, or entirety arrested, by taking purgatives, emet- ics, stimulants, and the various patent medicines recom- mended for female weaknesses. Cold and warm bathing, hip and foot baths, should be discontinued during the period. Care should also be taken not to expose the feet to cold or wet. Females subject to leucorrhoea, and who are taking vaginal injections, should discontinue them shortly before and during this period. During the menstrual period in a health}^ person there is little required besides carefully avoiding the injurious mental and physical influences above- mentioned. 7/", liowever^ the female he delicate and suffering from any of the mimerous derangements of menstruation^ or any other of the thousand and one sexual irregidarities to tvhich the sex are at all times subject, they shoidd not attempt to medicate or p)'r^scrihe for themselves, but without delay SEEK THE ADVICE AND AID OF A SKILFUL PHYSICIAN. 34 Woman's Medical Companion. CHAPTEE lY. HYGIENE, OR THE LAWS OF LIFE AND HEALTH. We have traced the cleyelopment of the 3'oung female to the point where the first great constitutional change takes place, transforming her from a child to a woman — from a dependent and comparatively helpless being to an independent and responsible individual — responsible to herself and others for ever}^ act affecting her physical and mental condition, entailing either happiness or misery upon herself and those with whom she is connected socially or by family ties. She consequently needs the closest attention, and the most judicious and careful management, not only to counteract the tendencies of her semi-childish constitution, but also to control her in the enjoyment of her new privileges, and in- fluence her in the selection of companions and pursuits. She has reached the spring-time of her life ; all her charms are budding forth like the opening rose ; she is now the delight and attraction, the life and soul, of the social circle, and henceforth is an indispensable integer of the species she is designed to perpetuate. The first and most essential provision for the young as- pirant to the privileges of society is, that her surroundings should be genial, health-inspiring, and calculated to expand her faculties, mental and physical, in order that she may Tcnow^ and be thoroughly fitted to fulfil, her mission as a citizen of the world, and as the chief agent in moulding the character of the community in the immediate future. The first law inculcated by nature and by our Divine Cre- ator, is that of Cleanliness. Hygiene, or the Laws of Life and Health, 35 BATHI]\G. From the time of Adam until now, the importance of keeping the skin clean has been universally acknowledged and more or less acted upon by the members of every com- munit}^, civilized, semi-civilized, or savage. Sanitary regu- lations formed a part of the civil and religious laws of the Jewish, Mohammedan, and Christian sects ; and even amongst the so-called heathen, cleanliness was deemed a primary essential to admission even to the lowest grades of societ3^ A clirtyin2iii, woman, or child, might be found, doubtless, in ever}^ community, but seldom in company with intelligence or morality. It is not merely the hands and face which have to be kept clean, — every part of the bod}^, seen or unseen, must be subjected to the daily operation of cleansing, for the reason that our skin is not merel}^ a covering and protection from atmospheric and other influences ; it is a huge collec- tion of more than seven million spiral canals (or 2,800 to every square inch of the body) , through which we receive a great portion of the supply of air by which we live, and from which the refuse of what we have partaken in our dail}^ food, and the perspiration or vapor contained within our s^'stem, passes off. Any obstruction, therefore, to the free passage of the perspiration through these pores, by the accumulation of particles of dust, coagulated perspiration, etc., not only interferes very seriously with the health of the body at every point, but occasions the majority of those annojing and unsightly cutaneous eruptions which ever}^- body looks upon with horror and apprehension. The pores of the skin are equal in importance to the lungs themselves. Now these pores cannot be kept open and perfectly free from impediment by the ordinary ablution from a small basin and a little soap. A sitz bath, or if that is not avail- 36 Woman's Medical Companion. able, a large washing-tub, with a sponge, a good rough j}] towel, and carbolized, Castile, or even ordinar}^ toilet soap if (so long as it is not scented) , will answer the purpose. You : will speedily see and experience the benefits arising from it the use of the bath, if you only examine the condition of ^ the person when it has been neglected for a few daj's, and j- the under-garments hare not been changed sufficiently \ often. The insensible perspiration accumulates and dries upon the surface of the skin, mingling with the oily matter secreted b}^ the oil-glands, and, with the shreds of the scarf- skin, foiTHS a tenacious, gluey matter, which completel}^ closes the pores. These pores being so closed, the i)er- spiration, and other matter which is seeking an exit from the bod}^, is retained to poison and embarrass the liAing current of the blood, or else to seek an outlet through the kidney's or lungs, which are akeady burdened with their own legiti- mate work. You will acknowledge then, dear reader, that a clear, purified, and healthy skin is one of the first and most imperative essentials to a health}' body. COI.I>, ^VARM, AIVI> SPOIVGE BATHS. A great variety of opinions exists as to the advisability or propriety of cold baths. An}" bath below the tempera- tm-e of 75° is called a cold bath ; and, if the body is in a condition to bear it, it acts as a decided and powerful tonic. Our own experience, as well as the experience of many thousands of our brother practitioners, has proved the effi- cacy' and undoubted advantages of its use, promoting the compactness, solidity, and strength of the bod}^, — a tangi- ble proof of which is given in the almost instantaneous reaction which follows its application. The vessels imme- diately contract, and the blood retreats towards the internal organs, causing the bather to feel a genial glow all over the bod}', from the l^lood being forced back through the Hygiene, or the Lazus of Life and Health. 37 invigorated vessels from the crown of the head to the toes. As we have said, some persons are so conditioned that the shock of cold water cannot be borne. In such cases, when a sensation of chilliness is felt, it is an evidence either that the bath has been too profuse, or that the S3'stem is too much enervated to produce the reaction we have spoken of; under these circumstances the bod}^ must \>q gradually educated to its use, by using tepid ivater, and reducing the temperature slowly until it becomes accustomed to the use of water in its natural state. A wet sponge, with or with- out soap, applied in turn to every part of the bod}", and immediately followed up by a brisk rubbing with a flesh- brush or rough towel, will soon accomplish the desired result. With persons in a feeble condition of health it will be necessary to expose a part of the bod}' at a time, quickly sponging and rubbing each part dry before proceeding with the other, — so subjecting the whole of the person, however feeble and delicate the}'^ may be, to the bracing influence of water and friction, without the slightest risk of shock, or cold arising from exposure. There is no form of bathing so universally applicable or so generally" conducive to health as the sponge bath. THE ^var:?i bath Is usuall}" of the same temperatm-e with the body (blood heat), from 98° to 105°. It produces no shock, and is of special service to those who have passed life's meridian, or who are suffering from nervous and muscular debility, or whose sj'stems have been prostrated by sickness or inactive life. In the last-named cases, great care should be exercised in regulating the temperature, so that sensations of heat or fulness, or increase of pulsation. 38 Woman's Medical Companion, should not be induced. As a rule, the Tvarni, vapor, or shower bath should be used under the advice of the phj'si- cian, as serious consequences might ensue from their inju- dicious or excessive use. There has been, and is even now, a large amount of eiTor and fanaticism about the exclusive use of water as a cura- tive remed}'. The ' ' water-cure " as a remedy for all dis- eases, known and unknown, is simply an exaggeration and a ridiculous caricature, calculated to bring into derision one of the most valuable remedial agencies with which nature has provided us. But even this will effect its own cure in time. People will learn that water, judiciously iised, in the foim of baths, is a potent moral and physical renovator of the race ; and that a community with clean hands, clean bodies, clean faces, and clean, health}' habits, will naturall}' appreciate and insist upon clean streets and clean cities — and eventually clean consciences. Cleanliness in 23h3'sical matters naturall}" causes an iiTesistible affection for purity in ever}^ other form, until it pervades the moral as well as the physical nature. CI.EA]VI.i:VESS OF PERSOX; Is not all that is required. The same principle must be rigidl}' carried out in all the domestic arrangements, ^o soiled clothing, no animal or vegetable refuse, no stagnant waters or decapng organic matter, no defective drainage or close rooms, no miasmatic or malarial poison, should be tolerated about the homestead or adjacent buildings under any pretext. "With well- ventilated, well-aired, well-lighted, well-scoured apartments ; culinary utensils thoroughly cleansed ; free ingress for the balm}' breezes of heaven in every room ; plain, wholesome food ; systematic and regular manual exercise, — walking, running, jumping, dancing, in moderation^ — and an avoidance of all excess, dissipation, Hygiene^ or the Laws of Life and Health, 39 late hours, and bad habits generally, — acthig out such rules, the person who has but just passed the threshold of adult life cannot fail to rejoice in the possession of a " sound mind in a sound bod}^," and can safely look forward to a long, happy, healthful, and useful life, ending in a hale and honored old age. A CAREFULiliT REGUl.ATEI> DIET Is of all means the most appropriate for moderating the excitement and derangement resulting from the momentary plenitude of the circulatory s^'stem. The food of a young girl should consist mainly of vegetable substances, preparations of milk, of the tender, juicy meats, and of hght and easily digestible substances, some few of the more succulent fruits, and puddings made of farina and other cereal products. Water, milk, broma, and cooling liquids should form the chief part of her drink, and on no account whatever should she indulge in candies, ice cream, and other confections, pickles, solid and highly seasoned meats, and made dishes, sour and unripe fruits, stimulating articles, alcoholic liquors, or the dail}^ use of coffee and tea ; they should all be studiously and resolutely avoided. Tepid, or nearly cold baths, sponge baths, as we have abeady described, taken occasionally, say twice or thrice a week, will contribute, together with regimen, to produce a general purif}ing, cleansing effect, and will have the advantage, moreover, of softening the skin, and dispersing the cutaneous eruptions to which girls are particularly subject at the period of pubert}'. In order to maintain the generative organs in a normall}^ healthy condition, and in a suitable state of preparation for the periodic exercise of the menstrual functions, moderate exercise in calisthenics or gymnastics, wall^ing, riding, and running easily, the skipping-rope, jumping, horseback, etc., 40 Woman^s Medical Companion, should be indulged in. Special precaution should be taken in regard to the underclothing ; judicious friction should be kept up in the genito-urinary region by wearing Canton- flannel drawers, etc. ; the wearing of corsets with busks or whalebones, or an}i:hing which obstructs the motion and free development of the pehis, thorax, and neck, should be absolutely and rigidly forbidden. The subject of clothing will, however, be detailed in another section. "\Ye will now, however, pass from the consideration of phj^sical regulations, for a moment, to consider the mental and moral influences which should be brought to bear on the new candidate for the honors and pri^dleges of woman- hood. The most important media for determining the physical and social futm*e of the young aspirant is THE SEIVSATIOjVS. A sensation is an efl'ect produced on the mind through a nerve. Hunger is a sensation. It is an efl'ect produced on the mind through the stomach. Nausea is a sensation produced b}^ some injurious substance acting upon the coats of the stomach. In this way the various conditions of the body, whatever their origin or exciting cause, have a pro- portionate efl'ect upon the mind ; and every mental emotion, no matter how remote or apparently trifling, has a depress- ing or exhilarating efl'ect upon the constitution. It is a demonstrated fact, that the mental faculties and the ph^^sical functions are so intimately associated and absolutely identi- cal, the one with the other, that the hj^gienic laws refer 'wdth equal force to both ; and any neglect or infraction of those laws would have an equall}" injurious influence on the mental and ph3'sical development of the individual subjected thereto. Sensations are either pleasurable or painful. Pleasurable sensations arise from the healthy and legitimate exercise of some mental or physical function, or the coming in contact Hygiene, or the Laws of Life and HcaltJi. 41 ■with some genial and harmonious influence, and are a suit- able and adequate reward for the control or self-denial exercised in keeping the desires and faculties within proper limits. For example, the sensations of freedom and satis- faction felt after a moderate amount of exercise, or the partaking of a wholesome, moderate meal, is a present and tangible reward which the gormandizer or the unmanageable romp never feels or knows. The muscles find a sort of en- jo}nnent in action. Those who lead a sedentary life, either from choice or necessit}', lose much mental and pln'sical enjo}Tnent. Hence there is pleasure in labor ; and the working-women (the women who pass their time in house- hold emplopnent or in light and healthful labor of any kind) , though frequentl}' an object of pity with the wealth}^ and the laz}-, are usually the happiest members of the hmnan race. The ej'e and ear, when directed to agreeable sights and sounds, drink in their inherent beauty, and gradu- ally become so thoroughly imbued with their spirit, that their possessor reproduces and transmits their beneficent influence on all with whom she may be associated. The mind is nourished and expanded, and b}" the irresistible tendenc}' of s^Tupath}', and the desire to communicate to others the advantages or blessings it has itself experienced, the blessings received b}' one intelligent and appreciative mind are distributed and dispensed throughout the com- munity. The female organism is speciall}^ adapted for this mission. From her ver}' birth, woman's nature is eminentl}' susceptible of pleasant, joyous, agreeable impressions ; her mind is, beyond all dispute, the most pm'e and truthful media for the transmission of Nature's eternal truths ; her sympathies, her intelhgence, and her imaginative powers, ever enlisted on the side of the true and beautiful ; and it is only when that natm'e and those S3TQpathies have been directly or indirectly warped, restrained, and aiTested by 42 Woman's Medical Companion. ■_ n impure or antagonistic associations, that we find lier suffer- ing from physical or mental disqualifications, which unfit her for the high and useful position in the social econom}' for which God and Nature destined her. HOME HVFIiUEIVCES AIV© ASSOCIATIOjVS. In view of the facts we haA^e narrated, the influences and i associations hy which the young girl is surrounded should ' be of the purest and least exciting character. Kindness, ? sympath}', gentleness, cheerfulness, and broad benevolence t and generosity of sentiment should be brought to bear upon | her mind in ever}' phase of her existence. Harshness, I coercion, insincerity, unreasoning prejudice, sensational and inflated ideas of mankind and the world generally, are essentiall}^ repugnant to her nature, and should, therefore, be studiously and resolutely kept from her path. She is in the sunshine of her j^outh : let her see or hear nothing of the dark side of nature. To ensure this, Jiome influence is undoubtedl}' the best. Many o^ our countr}" boarding- schools and city work-rooms are nothing better than moral pest-houses. Another inexhaustible source of mischief is the cheap periodical literature of the day, sensa- tional romances, highl3--wrought novels and love tales, exciting a morbid taste for the marvellous, inspiring a desire to experience those imaginary scenes and sentiments which are never known or realized — except on paj^er; the already exalted and excited imagination having been raised to fever-heat by questionable books and unsuit- able companions. Endowed with a beautiful, delicate, and impressionable nervous organism, she contracts baneful habits and thoughts, is tormented b}' an absorbing amorous melancholy, becomes sad, dreamy, sentimental, and languish- ing, and, like a delicate plant withered by the raj's of a Hygiene, or the Laws of Life and Health, 43 burning sun, she fades and dies under the influence of a poisoned breath. As a matter of coiurse, the remarks we have just made refer to those young persons whose buo3'ant, jo3"ous nature, cheerful, open disposition, sanguine temperament, and genial, courteous, and agreeable manners, and attractive figm-e, render them the favorites of the circles in which they move. But there are many interesting and intelligent young women to whom these observations would be scarcely appli- cable. The}" are of a l}Tnphatic, cold, retiring temperament, indifferent to the allurements of company, the fascinations of romantic scenery, the pleasures of perusing an interesting volume or witnessing a legitimate, well- wrought drama. Individuals evincing such a tendenc}" should be encouraged to seek such som'ces of recreation, in order to dissipate their morbid conditions, infuse vigor into their mental and physical sj'stems, and develop those latent powers which they possess in full}^ the same measiu-e as their more vivacious sisters. We have hitherto spoken mainly of the outside influences — those independent of the DOMESTIC REIiATIOWS. It is here, within the magic home-circle, that the true^ the life character of the woman is formed. If the mother be morose, fretful, hast}', careless, slovenly, haughty, despotic, unreliable, loving, orderly, or thrifty, the daughters will, to a gTeat extent, reflect, either exaggeratively or in miniature, the virtues or vices which they have more or less inherited from their parents, especially the mother. The parental peculiarities, mental and moral, as well as physical, are, as it were, photographed on the children, never to be entirely eflTaced. As with hereditary defects of the constitution, af- fections of the skin, and other congenital diseases, so it is with mental idiosyncracies, they are transmitted from gen- 44 Woman^s Medical Compaction. eration to generation ; and, unless arrested and eradicated b}' some superior curative power, increase in intensity until the pli3'sical and mental faculties are utterly absorbed and transformed by the ruling power or agency. Before we leave this department of our subject we would give a few general directions as to the h^'gienic regulations of a well-ordered household, in order to preserve the body and mind in a healthy and 'sigorous condition, sustain and develop their vitality, and enable them to avoid disease or derangement. REST AjVD SI^EEP. The human frame resembles a clock ; it runs down and is wound up once in ever}" twent3"-four hom's (or, rather, it should he) . Were a female required to work on uninterrupt- edly, no matter what might be the nature of that employ- i ment, she would undoubtedly wear out in the course of a very few claj^s ; her physical and mental powers would be prostrated beyond all possibility of recuperation. It is a merciful interposition that periods of repose are allotted to us. Ever3i:hing has its proper place. Rest is not less a luxury after exercise than exercise is after rest. They both confer happiness at the same time that they pro- mote our well-being. But it must be remembered that, as natm*e has ordained night for rest, the turning of night into da}^ either for pleasure or for labor must necessarily^ be at- tended with evil, phj'sical as well as mental. The abridg- ment or the alteration of the hours of rest carries with it its own inevitable penalt3\ Two hours* sleep before midnight is more productive of benefit to both hody and mind than six hours after that period. There is no more truthful axiom extant than — " Early to bed and early to rise Makes a man healthy, wealthy, and Avise." Hygiene, or the Laws of Life and Health, 45 Of the health and wisdom derivable from the adoption of such a S3'stem every reasoning being ma}^ receive daily' demonstration ; the icealth is of course a relative question, and may truly consist in the accession and maintenance of a sound mind in a sound body. In regard to the period allotted to rest and sleep, nature is the most efficient arbiter. It depends solely on the ph3^si- cal condition of the bod}^, the nature of the occupation, and the age and sex of the individual. Dr. Abernethy, an eccentric, shrewd, but cj'^nical " Old School Physician," had some " hard and fast" rules, which, nevertheless, had a cer- tain amount of common sense in them. He divided the day of twenty-four hours into three sections, — eight hours for recreation and rest, eight hours for sleep, and eight hours for work ; but he accompanied this suggestion by a rather invidious allusion in reference to sleep ^ saving that six hours' sleep were sufficient for a man, seven hours for a woman or child, and eight horu-s for a fooL You may rest assured that none of his patients voluntarily included themselves in the last-named category. Practical experience demonstrates that more than eight hours' emplojTnent for a child or female is necessarily and absolutely injurious to their mental and ph^'sical organisms. Nor should this eight houishe continuous, — it should be re- lieved by intervals of rest and recreation — not sleejD. Sleep should be reserved for night, w^hen darkness covers the earth and all nature slumbers ; when the feathered song- sters have ceased their song, and the flowers have closed their petals. Ten o'clock should, as a rule, find every one within the precincts of the bed-chamber, not burning the mid- night oil in reading sensational andx>rurient novels and tales, but courting the embraces of the drowsy god, and gather- ing mental and phj^sical strength by enjoying that sweet repose which a conscience devoid of reproach, a healthy, 46 Woman's Medical Companion. well-nom'islied body, and a well-balanced mind will alwaj's invoke and secure. OUR SliEEPEVG-ROOMS. Sleep and rest, however, will afford us but little benefit, if the room in which we sleep is small, unsuitably situated, or surrounded with conditions prejudicial to health, as the hom-s spent within the bed-chamber 'permanently affect our physical and mental well-being, for good or for e\dl. We necessarily breathe a large amount of air during the night, and oiu" health becomes seriousl}^ injured if we breathe this air over and over again. The room should be tolerably large (not one of the smallest, as is usual in famihes), dry., well-ventilated^ ivell-aired^ ivell-lighted, and, when practicable, on the top floor. Just as much, and even more, attention should be paid to the size, situation, temperature, and cleanliness of the room as to the parlors or di'awing- room. It should be especially i)ro^T.ded that two persons (except in certain cases) should never occupy one bed in a small room, nor should there be more than two beds, each occupied by one person, in a large room ; and again the young and the aged should never occupy the same bed. Any accumulation of refuse, decaying organic matter, or even the location of a large number of trees, near the sleep- ing-rooms is highly objectionable. The temperature of the bedroom should not be lower than 70 or 75 degrees ; there should be ample means for the ingress of UgJit as well as air, for in health, as well as in sickness, light and air are the chief and most efi'ective restorative and preservative agen- cies. Fires in sleeping-rooms depend simply on local consider- ations. If the occupant be an invaUd, with feeble circulation, and ailing, a small fire, kept up for one or two hours prior to retiring to rest, may be necessary in cold weather ; but a Hygiene^ or the Laws of Life and Health. 47 person in a normall}' health}^ condition should never indulge in a luxury so perfectly unnecessary and prejudicial to robust health. The Windows should, during the night, be let down about an inch from the top, but in such a manner as not to create a cross-current from the opposite sides of the room. Immediately on rising, every window (the lower sash) should be opened wide. The oxygen which the partially opened window admits is of the greatest benefit to the occu- pant of the chamber, and if the practice is prudently per- severed in, will prove an invaluable preservative to health. The open fire-place is one of the best ventilators we can have for the passing off of the vitiated air, and no sensible person would, for a moment, think of hermetically closing this useful aperture. B£:i>S AN© B£I>I>I]VG. While we most emphaticall}- disapprove the use of feather- beds and feather-pillows, we do not sanction the oppo- site extreme, the un}i.elding hardness of a closely-packed straw-mattress : there is in this, as in all other matters pertaining to our every-day life, a happy medium to be ob- served. The hair mattress^ or what is termed the Excelsior^ is the best, the most comfortable, and the most healthy that can be used. No one, after a fair trial of it, would ever return to the use of feathers. In hot weather linen sheets are decidedly preferable to cot- ton, where persons are able to prowle them, but in winter cotton is much more deskable to use, especially by persons peculiarl}^ susceptible to rheumatic affections. Bed-spreads^ or "comforters," as they are called, are objectionable, because they concentrate the insensible perspiration, and envelop the individual in a sort of vapor-bath. Blankets serve the pm'pose as an outer covering much better, as they 48 Woman^s Medical Companion. are light, porous, and are excellent radiators of heat. There should be just as few clothes as possible on the bed, — only sufficient to prevent chill and to keep up the same tempera- ture as that experienced in the da3'time. NIGHT-DRESS. The under as well as the outer clothing worn during the day should be taken off on retiring at night, care being taken to have the night-dress of the same qualit}' and thick- ness of material as the day -clothes. The underclothing should be subject to the same regulations. THE AMOUafT OF AND PROPER POSITION FOR SliEEP Can only be regulated b}' individual circumstances. The average time for sleep in the case of a healthy person (female) is from seven to eight hours, according to their occupation and constitutional peculiarities. There is no absolute standard for this, any more than for the amount and description of food. Kature is the best indicator in this matter. If the sleeper be in health, he should get up when he fii*st wakes, whether it be five, six, or seven in the morning. The object of sleep is to restore the wasted energies ; the extent of that waste and the recuperative power possessed b}' the individual will measure the amount required. The temperament, constitution, amount of exer- cise, and the exhausting nature of the mental application, are the elements to be considered in the calculation. The most natural position for rest is to recHne on the right side, — as it gives perfect freedom to the internal or- gans, — of course, occasionally changing to the left side; but by no means on the hack^ as in that position the stom- ach, bowels, etc., are pressed upon the larger blood- vessels in the neighborhood of the vertebral column, thus Hygiene, or the Laws of Life and LLealth. 49 obstructing the circulation of the vital fluid. The hands should never be raised above the head during sleep, but should be placed in an easy and natural position on a level with the bod3\ IMCEIVTIVES TO SXiKEP. The best incentives to sleep with a person in possession of a health}^ mind and a healthy body are judicious exer- cise, a proper admixture of mental and physical labor, rec- reation and amusement, the partaking of food in moderate quantities and at regular hours, the avoidance of all ex- cesses, and the possession of a good conscience. No person can expect to enjoy a good state of health who in- dulges in late and heavy suppers^ or who spends the best part of the night in carousals, entertainments, and exciting asso- ciations. Fully tJiree Jiours should be allowed to elapse be- tween the evening meal and the hour of retirement. The best preparation for rest is a quiet hour spent within the happy and exhilarating influences of the home-circle. As we shall have to consider the important subjects of food and clothing in a separate chapter, we will hasten to the consid- eration of that essential item in our domestic life. EXERCISE IIV THE OPEN AIR Is another invaluable adjunct in the preservation of health. Persons who take but little exercise leave the lower x^art of their lungs comparatively unemployed. As a conse- quence, the breathing is labored and unnatural. In the case of 3^oung persons, females especially, from fifteen to twent3"-flve minutes' exercise should be taken in the open air every morning before breakfast, when they should inflate the chest by long-drawn inspirations and respira- tions, and, after a few such exercises, in addition to the 50 Woman's Medical Companion. morning bath, they would eat their breakfast with a rehsh and satisfaction thej" never knew before. But this is not all the exercise that is required. It is quite true that many persons who have dwelt in one spot all their hves, and never enjo3^ed a trip to other scenes or chmes, have yet lived to a good old age. But one thing is certain, — that, as a rule, both mdnd and body tire of con- templating one set of objects for any length of time ; the ideas get contracted, the routine of life becomes monotonous ; and graduall}^, but surely, both bod}' and mind sink into a- lethargic, apathetic condition, incapable of enjopnent it- self, or of imparting enjoyment to others. The phj^sical frame droops, loses all energ}', and becomes predisposed to sickn-ess of various kinds ; and, when the indiAidual is actually suffering from illness, frequently sinlvs below all possibihty of restoration, from want of change of scene and occupation. Travelhng, if onl}^ for a da}" or two, tends to draw the thoughts of the sick and feeble from themselves, and awaken interest in surrounding objects. In the young and healthy it expands the ideas, enhvens the imagina- tion, and furnishes them with sources of occupation which relieve the monotony of daily life and afford fresh incen- tives to exertion. It opens up new sources of gratification within them, and gives an abiding and constantly renewing interest in the world and its surroundings, which perma- nently disengages their thoughts from subjects of a personal or painful natm^e, until their very existence seems to bear a new aspect, and shadows forth a loftier and more expansive world in which they can exercise then- faculties and pro- gress toward the final fruition of their ambition. The ner- vous system has a miraculous power over the bodily health, and the pleasurable sensations evoked by minghng with new people, effecting new associations and visiting new scenes, often awaken in the constitution latent energies Hygiene^ or the Laws of Life and Health. 51 essential to recover}'. The facilities which extended rail- way communication, and general reduction in cost of living, have given to every one, however humble in station, to make short or long trips to the coast or inland districts (ac- cording to circumstances), prompt us to recommend this means of health preserv^ation and restoration, as one within the grasp of all, and as infinitely preferable to the most effective medicament the drug-store ever yet furnished. It is a true, but common saying, that " All work and no pla}', makes Jack a dull boy." The great problem of the da}' is to make a judicious selection, age and sex con- sidered, of — I-EGITIMATE AND HEAIiTHFUXi AMUSEMEIVTS. These must be adapted, not only to the sex and age of the individual, but to the time and season of the 3^ear, lo- calit}', etc. There is a time for everything. There are many amusements in which a young or elderly lady may participate with advantage and benefit, without derogation from her dignity or position. Of course the same amuse- ments are not adapted to all persons. THEATRICAI, ENTERTAINMENTS are specially gi-atif^dng and attractive to those who have a taste for art, and a love for works of genius and poetry; it appeals to a higher order of feelings, expands the S}Tn- pathies, and gives a more accurate idea of our relations to the outer world, and in this respect is a prolific source of health and gratification. Many people, we know, think theatrical exhibitions are immoral and hurtful ; but in this, as in other matters, the evil exists only in the person seek- ing it, not in the thing sought. Immoral persons will find evil in a church or in a grove, just as they would in a 52 Woman's Medical Companion. theatre, if their motive be e^dl. To the pure all things are pure ; they Tvill find sermons in stones, seiTQons in run- ning brooks, sermons in eYer}i;hing. Why, even the roar- ing farces and the laughable comedies have points of ex- cellence ; the absui'dity of the situations and the jokes produce laughter, and the laughter drives away the gloom and care which might otherwise fill our mind and make om* lives a continuous misery. The onh' precaution to be taken in going to the theatre is to choose good companions, not to stay to a late hour, and not to go too often ; excess in awijtMng^ even in bathing or eating, is injiu"ious. DOMESTIC A31i:SE3IE]VTS (such as Fox and Geese, Hunt the Shpper, Bhud Man's Buif, etc.) have unhappil}' gone out of fashion, not only in town but in the countr}' districts. These and an occa- sional dancing-party {en famiUe) are exceedingl}" healthful and enjoyable, in the fall and winter evenings, as a variation in the dehghtful atmosphere of the home-ckcle. These are recreations which would bear the morning's reflection ; and if these domestic games, interspersed with singing, dancing, and social intercom-se, were generally revived in America (both in town and country) , we honestly believe that one- half of the sickness, invahdism, nervous debihty, and posi- tive insanity^ by which our worth}' citizens (male and female) are affiicted, would disappear forever. Amuse- ments are necessary to give a completeness to life. It is only when all the numerous mental and ph^'sical faculties with which we are endowed are exercised in due and proper proportion, that there is a harmonious beauty in them. The customs of society put us all out of shape, and rob us of every womanl}' and healthy qualit}'. Adhere to Na- ture's simple dictates, and you will not onl}' preserve 3'our Hygiene, or the Lazus of Life and Health, 53 beauty of form and character, l)iit develop it to an extent far beyond 3'our present comprehension. GYMIVASTICS AIVI> CAI.ISTMEIVIC EXEKCISES, as a means of healthful exercise for young women, cannot be too highly extolled. We are glad to find that it is now becoming a part of the curriculum of education in the public and private educational institutions throughout this and other States, and that it is so admirably combined with intellectual instruction, that the mental and physical devel- opment of the scholars take place simultaneous^, tlie one helping the other, and rendering them capable of meeting and surmounting any difficulty with which they may be brought into contact. Our attention must now be dkected to the AKTICIiES OF F001> specially suited to the requirements of the female organism. It would be absurd to suppose for a single moment that all articles were equally suited at all times for the support of all, and every individual, man, woman, and child. There are many points to be considered in dietary, — age, sex, condition of bod}', the occupation, time of year, the climate, etc. Food, however, ma}" be first divided into two principal sections, — that which produces blood and flesh, and that which produces heat. Those producing blood and flesh comprise the vegetable and animal products which are or- dinarily to be found in an American larder ; the heat-produc- ing articles include oils, sugar, starch, farina, arrow-root, tapioca, gums, etc. The main feature to which we have to look is not so much the properties it contains, as its relative digestibility, and its suitability to the occupation and condition of health of the person concerned. The young woman just entering 54 WomarCs Medical Companion* upon her life of usefulness and often thankless toil needs some counsel as to her diet at the most critical period of her life, and we shall commence b}^ advising her not to adopt any hard and fast ride either as to the quality, quantit}', or kind of food for her consumption. If she be of a liveh', sanguine, nervous temperament, full-blooded, and excitable, no highly-seasoned or luscious dishes should form her diet. On rising in the morning a glass of milk with an egg beaten-up in it, prior to her morning's " constitutional," would impart additional \\gov to her frame, and prepare her for the thorough enjo^inent of her morning meal. This might consist of bread and milk, a little fish or oatmeal, a cup of broma, and home-made bread and butter. Her domestic or other duties might then be undertaken T'rithout any feeling of fatigue, tu-edness, or ennui, and, the digestive powers not ha\'ing been overtaxed, she would be ready to do justice to the mid-day refection, which should be con- fined to plain, juicy meats, well-cooked vegetables, and some light, farinaceous pudding. If liquid beverage of any kind were desired, it should supplement the meal, and not be taken during the time of eating, lest it should interfere with the gastric secretions, and should consist of pure ivater, with an occasional addition of lemon-juice. She would then resume her special occupation until the evening hour, when her physical wants might be supphed by a little wholesome fruit, bread and butter, hght biscuits, and broma or milk. The habitual use of tea, cofi'ee, pickles, condiments, candies, or any heav}', solid material, should be studiously avoided. Between that period and bedtime any recreation of mind and body suited to her taste and not in- volving any undue strain on her mental or ph3'sical faculties would close the day happil}', and leave her with intellect un- clouded, and her system in a condition to enjoy and derive positive benefit from the period of rest assigned her by Dame Nature. Hygiene, or the Laws of Life and Health. 55 For the purpose of general guidance, but by no ineans as an infallible or authoritative statement (for the digestive powers of each individual, even when normally healthy, exhibit considerable variation) , we append a TABXiE OF THE COMPARATIVE IHOESTIBIIilTT OF STAPI.E AI1TICI.es OF FOOD. Boiled Dishes. Time A. m. .1 00 .1 00 1 00 1 30 .1 45 Rice Pig's feet, soused Tripe, soused Salmon Trout, fresh .... Sago Codfish, cured dry 2 00 Milk 2 00 Tapioca 2 00 Wild Turkey 2 25 Parsnips 2 30 Beans, pod 2 30 Apple Dumphngs 3 00 Fresh Eggs, boiled soft 3 00 Fresh Mutton 3 00 Chicken Soup 3 00 Orange Carrot 3 15 Fresh Eggs, boiled hard 3 30 Irish Potatoes 3 30 Mutton Soup 3 30 Oyster Soup 3 SO Flat Turnip 3 30 Beets 3 45 Green Corn and Beans 3 45 Domestic Fowls 4 00 Soup, Beef, Vegetables and Bread .4 00 Salted Salmon 4 00 Old Hard Beef, salted 4 15 Cabbage, with Vinegar 4 30 Pork, recently salted 4 30 Boii/ED Dishes. Time. A. m. INIutton Suet , 4 30 Fresh Beef Suet 5 30 Tendon 5 30 Fried. Salmon Trout, fresh. 1 30 Fresh Eggs 3 30 Fresh Flounders 3 30 Fresh lean Beef 4 00 Animal Heart 4 00 Pork, recently salted 4 15 Fresh Veal 4 30 Raw Aeticles. Sweet Mellow Apples 1 30 Sour MelloAr Apples 2 00 Cabbage, with Vinegar 2 00 Milk ...2 15 Cabbage-head 2 30 Sour Hard Apples 2 50 Fresh Oysters 2 55 Pork, recently salted ,3 00 Old, strong Cheese 3 00 Broiled. Venison Steak 1 35 Beef Liver, fresh 2 00 Fresh Lamb 2 SO Striped Bass, fresh 3 00 Beef Steak 3 00 56 Woman's Medical Companio7t> Broiled. Time. h. in. Fresh Mutton 3 00 Pork, recently salted 3 15 Pork Steak 3 15 Sausage, fresh .' , 3 30 Veal, fresh 4 00 Roasted. Turkey, wild 2 18 Turkey, domesticated 2 30 Sucking Pig 2 30 Goose 2 30 Beef, fresh, lean, under-done 3 00 Oysters, fresh 3 15 Mutton, fresh 3 15 Beef, fresh, lean, dry 2 30 Domestic Fowls 4 00 Wild Ducks 4 30 Pork, fat and lean 5 15 Warmed. Time. 7i. m. Meat hashed with vegetables 2 30 Fricaseed. Chicken, full grown 2 45 Baked. Potatoes, Irish 2 30 Cake, sponge 2 30 Custard 2 45 Corn cake 3 00 Corn bread 3 15 Bread, wheaten, fresh 3 30 Melted. Butter 3 30 Stewed. Fresh Oysters 3 30 The vitally-important and much-disputed question of CliOTHIlVG AMD ©MESS REFORM now remains to be considered. It has been truly said, that " What is everybody's business is nobody's business ; " and, consequently, every one has a different idea on the subject, and it is let alone. FasJiions have been ^et from time to time, but without any regard to suitability or com- fort, or even the satisfaction of the wearer. The laws of physiology are entirely set aside and ignored ; and though every woman on the face of the earth readily acknowledges the evils, inconveniences, and injuries attendant upon the wearing of their garments as at present constructed, it would appear that they prefer to suffer the most indescrib- able torture, both now and in after-life, rather than disobey the slightest decree of their imperious mistress — Fashion. Hygiene, or the Laws of Life and Health. 57 Bony Fsauework of tuk Body. 58 Woman! s Medical Coinpanion. "We are indebted for many of the valuable suggestions on this all-important subject of dress-reform to that indefati- gable, disinterested, and talented advocate of, and ornament to, her sex, — Professor Maky J. S afford Blake, M.D., Professor of Gynaecology at the Boston University School of Medicine, — whose untiring efforts and personal sacrifices on the behalf of suffering womanhood entitle her to and will secure for her and her earnest coadjutors the lasting gratitude of women throughout the world, and be an endur- ing monument to her in the hearts of future generations. Fig. 7. The Results of Tight Lacing. The freaks of Fashion are so numerous and erratic that they would scarce be worth noticing, were it not that the results were so dangerous and even fatal. From time im- memorial, she seems to have run directly counter to Nature and Nature's laws. Dress should be made to suit the form, not the form distorted to suit the arbitrary rules of the Hygiene, or the Lazus of Life and Health. 59 costume. The Venus de Medici (the heau ideal of grace and sjTQHictiy in the female form) was never encased in a framework of whalebone " and steel, with some twenty pounds' weight of dr3'-goods hanging upon the abdomen and hips. If you will just glance at the anatomical diagram on page 57, you will be able to judge of the normar shape of the ribs and ' ' waist " of a S3^mmetrical, well-formed woman. Now, compare it with the distorted '^ framework of a fashionable miss" of seventeen (Fig. 7), just eman- cipated from boarding-school, and yovi will be enabled to form some faint idea of the miser}-, suffering, and hourlj- martjTdom which the reckless votary of' Fashion's follies has entailed upon herself. i>ress-refobm:. Prof. Mary J. Safford Blake, in her admirable lecture on dress-reform, remarks, in reference to the absurdities of woman's dress, that, as a rule, from six to ten thidvuesses of woollen or other material encase the region of the waist, while the lower extremities are covered with but one thick- ness, and that only of cotton. Under such circumstances, an eifort to obtain proper warmth is usuall}' made by adding an extra supply of skirts, although these garments contribute much more to pressure about the waist, weight upon the hips, and undue heat in the kidnej'S and abdominal OJgans, than to warmth in the lower extremities. Still it is in these lower parts of the body that heat is most needed, because there the circulation of the blood is less active, and an undercm-rent of air around them is apt to produce chills. ' ' Let a woman step from a temperature of 70 degrees within doors to zero without, and stand on the street-corner five minutes for a car, while the breeze inflates her flowing skirts till they become converted into a balloon ; the air whizzes through them and beneath them, and a wave of 60 Woman's Medical Companion. cold envelops the entire lower portions of her body. Then let her ride for an hour in the horse-car, with ankles wet from drabbled skirts, and exposed to a continual draught of aii' ; of course her whole S3^stem is chilled through, and it cannot be otherwise than that a severe cold will follow as the penalty for such exposure. A woman, accompanied by her husband, came to consult me, on one of the dreariest days of last winter. Her teeth chattered with the cold ; and you will not wonder at it any more than I did, when I tell you that she had on cloth gaiter-boots, tliin stockings, loose, light cotton di'awers, two short skirts of flannel, a long one of water-proof, another of white cotton, -an alpaca dress-skirt, and an over-skirt. This made seven thicknesses, multiphed by plaits and folds innumerable about the abdomen. Each of these skkts was attached by a double band, and thus the torrid zone of the waist was encircled by fom^teen layers. All this weight and pressure rested upon the hips and abdomen, and the result was — what it alwa3^s will be if this pressure has been long continued — a displacement of all the internal organs; for you cannot displace one without in some way interfering with all the others. Here was this woman, with nerves as sensitive as an aspen-leaf to external influences, clad in such a manner that every breath of cold chilled her to the very marrow, the neck and shoulders protected by furs, the hands and arms pinioned in a muff, the head weighted down by la3'ers of false hair, and the legs almost bare ; while her husband, the personification of all that was vigorous in health, was enveloped, as he told me, from head to foot in flannel. His every garment was so adjusted that it not onlj^ added to the heat generated by the body, but helped to re- tain it. I question whether that hale, hearty man would not have suff'ered twinges of neuralgia or of rheumatism, had he been exposed, as his wife was, to the severity of our atmospheric changes. Even in summer these changes are Hygiene, or the Laws of Life and Health. 61 sudden and severe ; and then men are usually clothed in woollen garments only a trifle thinner and lighter than those worn in winter, while women are often decked in nothing but mushn, and are chilled by every sudden nor'-easter." Through the courtesy of other physicians I have had the opportunity to be present at the autopsy of several unmar- ried women, of the class not compelled to labor unduly, so that most of the abnormal conditions of the generative organs could be rationally accounted for only by improper dress. In one girl aged twentj^-two, whose waist after death was so slender that 3^ou might almost have spanned it with united fingers, there was an atrophied state of all the glandular organs. The death of women occurring under the influence of anaesthetics has in many instances been traced to impeded ckculation, resulting from tight clothes. However loosely corsets are worn, the steels and bones must adjust themselves to the various curves and depres- sions of the body, and must be felt, or else the sure death that women so often declare would follow their abandon- ment would not be anticipated. As soon as the muscles give warning, by their weakness, that they are no longer adequate to the support of the bod}"", it is high time they were given a chance to recuperate. It does not requii-e the foresight of a clairvoyant or for- tune-teller to diagnose a chronic case of tight-lacing and heavy skirts. You know that when the abdominal muscular walls become inert, and almost wasted, one of the most important daily functions of the body is rarely, if ever, normally carried on. We might enumerate the ill-results that follow ; But these are only links in the Ion g chain of disorders that have won the disgraceful distinguishing ap- pellation of "Women's Diseases," when they should truth- fiill}' be termed "Women's Follies." There has been no blunder in the formation of women ; there would be harmony 62 Woman^s Medical Companion. of action in each organ, and in the function assigned it, if Katnre were not defrauded of her rights from the cradle to the grave. FASUIOIV'S PE3fAr,TIES. ' ' A few days ago I stepped into a large corset-factory caiTied on by a woman. I told her I was interested to know what women and children wear in this line, and asked to see her wares from the least unto the gi-eatest. She began by showing me the tiniest article I ever saw in the shape of a corset, saying that was for babies. Then she brought forward another grade, and still another, and so on, till I think she must have shown me fifteen or twenty dif- ferent sized corset-moulds, in which she runs the female forms that get into her hands. She informed me that all the genteel waists that I should meet on the streets in the fashionable part of the city she had made ; and that the mothers brought their daughters in infancy to her, and that she passed them thi'ough the whole course of moulds till they were read}^ for the real French corset, when she considered them finished and perfect. *' Yesterda}' I visited the first class in one of our City Girls' Grammar Schools, consisting of fortj^-two pupils. I had five questions on a shp of paper, that I asked permis- sion of the teacher to put to the giiis. '''•First. 'How many of 3'au wear corsets?' Ansvoer. Twenty-one. ' ' I asked them to stretch their arms as high as they could over their heads. In every instance it was hard work, and in most cases impossible to get them above a right angle at the shoulders. " Second. ' How many of you wear your skirts resting entirely upon yom- hips, with no shoulder-straps or waist to support them ? ' Answer. Thirty. Hygiene, or the Laws of Life and Health. 63 " Third. ' How niaii}^ wear false hair?' Ansiver. Four. ^''Fourth. 'How many wear tight boots?' Answer. None (which I doubted) . ^^ Fifth. 'How maii}^ do not wear flannels?' Ansiver. Eighteen. " I went across the hall to a boys' class corresponding in grade, consisting of fort3"-four pupils. I asked for the num- ber of bo3's without flannels, and found only six. " Of course one hundred per cent, were without corsets, or weight upon hips, tight boots, or false hau\ Every boy could raise his arms in a straight hne with his body as far as he could reach, with perfect ease." — Fi^om " Corsets vs. Bixcins" by Louise S, HotchMss. [Since writing the above, we have been informed by Professor Blake, that the young women of Boston have at last paid some httle attention to the reform we have sug- gested, and that the average measurement round the waist now reaches twenty-seven inches. — Ed.] The Dress-Reform Committee, of 2^ Hamilton place, Boston, have done noble work in the breaking down of this absurd sj^stem of nature-distorting costume, to which the women of America have for so many years been voluntary martjTS. Desirous of inaugm-ating a permanent reform, they have not ventured upon revolutionizing the dress- making art suddenly, but -have initiated and brought into practical use the suspenders and underclothing dehneated in the following pages for the purpose of relieving the hips and abdominal region of the fearful burden they have hith- erto had to bear. A glance at the simple but eff'ective ap- paratus there portrayed and described will convey, in the most absolute and convincing manner, the strong common- sense, and practical utility which they evince, and the physio- logical advantages derivable from their use. They speak for 64 Woman^s Medical Companion. themselves in language too eloquent to need any further com- ment from us. We cordiall}^ and sincerely commend those garments and apparatus to the attention and patronage of all our readers who desire to maintain their physical sj^stem in its pristine symmetry and health. Fig. Fig. 2. Fig. 1 . Union Under-Flankel. This is a garment worn next to the skin, and is made to cover the bod}'', and impart uniform warmth, without hgature. Fig. 2. CriEMELETTE. — A garment combining chemise and drawers in one, or it is made separate, with drawers to button on, called basque waist and drawers. These can be arranged to support skhi;s and stockings from the shoul- der, leaving the lungs and other vital organs free and un- trammelled in their action. This may be made of cotton, hnen, flannel, or au}^ fabric adapted to the habit of the wearer. Fig. 3. Emancipation Waist. — This waist is made sep- arate from the drawers, and may be made double, to take Hygiene, or the Laws of Life and Health. 65 the place of the corset. It is made single for a corset-cover and skirt-sui^porter. Fig. 4. Fig. 3. Fig. 4. Dress Drawers. — The ^' Dress Drawers" maj" be worn in place of the underskirt, for extra warmth in riding or walking, and during extreme cold in and out of doors. This article is made of colored flannel, water-proof, or of the dress material, as may be preferred, made to fit the ankle closely inside the boot, or with gaiters to go over the boot, and to fasten by buttons arranged for the pm^pose upon the " Emancipation Suit," or " Chemelette." 66 Woman^s Medical Compmiion. Fig. 5. Skirt Supporters and Shoulder Brace. Fig. G. Shoulder Brace, Stocking and Skirt Supporter. Fig. 7. Stocking Supporter and Shoulder Brace. Stocking-supporters separate are highl}^ recommended. Fig. 6. Fig. 7- The principles on which these garments and suspenders are made is — 1. That the vital organs in central regions of the body should be allowed unimpeded action. 2. That a uniform temperature of the body should be preserved. Hygiene y or the Laws of Life and Health. 67 3 . That Treight should be reduced to a mmimum. 4. That the shoulders, and not the hips, should form the base of support. ATe Tvould only remark, in conclusion, that there is a con- siderable amount of error in the popular idea as to the anal- ogy between the color of clothing and its suitability to the season or climate. TThite or light-colored fabrics make the coolest garments in summer and the waiTQest in winter, for the reason that in summer the}' prevent the sun's raj'S from passing inward, and in the winter they interrupt or arrest the heat of the bod}^ in its passage out. The contrary being the case with dark-colored fabrics, thej^ are rendered less suitable for winter clothing than is generally supposed. Another great evil prevalent among women is the fashion of wearing tliin sJioes^ thus lading a sm-e foundation for con- sumption and a thousand other ills of similar character. If our ladies would in this matter only follow the example of English women, and wear the Jiard double sole (half the thickness of that of a gentleman's boot) , they would live much longer, and leave a more hardy posterity behind them. We rejoice that the native common-sense of New England women has latterl}^ much improved the fashion in this respect ; and there is every probabihty that, in the com^se of two or three 3'ears, our " ladies" will, as a rule, protect their feet from damp by the Enghsh " double-sole shoe." 68 Womcin's Medical Companioji. CHAPTEE Y. |t II THE MARRIAGEABLE YOUNG WOMAN. Ij The young ladies of America should be eternall}^ grate- j ful to that Divine Providence which has cast their lot in a j land where, as a rule, woman is respected, independent, j and the queen of the sphere in which she lives, moves, and ! has her being. The United States of America is, without dispute, the Utopia, the El Dorado, for womanhood. Mor- ally, socially, and intellectually, she is the peer of, and in some respects superior to, masculinity generally, sharing their educational privileges and fully participating in all the amenities of " societ3\" But here, alas, our eulogies and congratulations must, for a time, be suspended ! Though they possess such manifest and solid advantages over their European sisters in educational advancement and social status, they are far behind them in the vitally im- portant matter of health, physical strength, and endurance. The 3'oung graduate from the High School in Boston or New York may, meteor-like, far outshine her transatlantic sister in intellectual brilliancy, refinement of taste, social attraction, and mental development generallj' ; but in symmetry of form, ruddy, robust health, freedom from con- stitutional ailment, and general power of endurance, she will not bear a moment's comparison. Like the comet in the solar system, she shines brilliantly, it is true, and be- comes the c^'nosure of every eye ; but, alas, for a period as brief as it is brilliant ! The fragile, feeble, sparsel}'- nourished body is signally unequal to the strain brought TJie Marriageable Voting Woman. 69 to bear upon it by the prematureh'-developecl, clelicatel}- organized mind wliich inhabits it. In place of the roseate, dimpled cheek and plnmp figure of the English girl be- side her, 3'ou note the highl3^-wrought nervous organization, the pale countenance, fitfully illumined by the hectic flush, the anxious, enervated expression, the languid and ex- hausted air, the fretful, fitful restlessness of disposition so unmistakabl}^ indicative of physical inability to bear the mental pressure. The spirit is alive and equal to any and ever}' emergency ; but the flesh, the framework which con- tains that spirit, is unequal to its slightest effort. Why should these things be? Nature is not to blame. God made of the same flesh and blood all nations of the earth. The same immortal, expansive soul inhabits European and American alike. Why, then, this great dis- crepanc}', when the germ (material and spiritual) exists equallj' in every member- of the human race ? Where the effect is, there must the cause be found. Nature does not change or vary her laws, nor does the Almighty Creator permit an}' of his works to fall short of absolute perfection. The fault rests entirely with ourselves, a fact which we will now endeavor to demonstrate. Five-sixths of the American women who arrive at tlie age of pubert}^ are more or less afflicted with some con- genital or hereditary defect or tendency of a mental or physical character, — an abnormality which, as a rule, will distill guish and materially influence the whole of their after- life. FREMATURE DEVEIiOPMElVT. The influences which lead to this unhappy result are legion ; but, fortunatel}', are all wdthin our own control, if we will onl}' exercise that discretion, care, and caution with which every human being is endowed. There is a time for 70 Woman's Medical Companion. everytliing. If a flower is forced into Ijlooin two or thi'ee months before its time, it is proportionate!}- deficient, either in fragi-ance, beaut}', or length of life. The hardy peren- nial, Trhich resists the snows and frosts of winter, knows not' the atmosphere of the hot-house. So it is with the child brought up in accordance with Xatm-e's laws. The smihng infant, nesthng in its mothei*'s loving arms, and fed from Katui-e's fountain a?o?ie, imtil dentition enables it to i^artake of stronger food ; whose hthe and sinuous form is untram- melled by iron hoops and mummy-like bandages ; whose ros}" cheeks are fanned and braced by the j)ure breath of heaven, and illumined by the glorious sunhght ; whose round and chubby hmbs are daily bathed in waters fi'om the lim- pid brook and crystal spring ; whose beaming eyes are greeted with losing looks and cheering words from its ten- der nm'ses ; whose little feet are cautiously trained to step fi-om chau' to chau* until they gain sufficient strength to walli alone, — an infant the subject of such losing care will sm'ely develop into a child able to combat successful!}- with all the ailments to which cliildhood is specially liable ; its mental capacity will expand simultaneously with its physi- cal gi'owth, and, in all hiunan probabihty, it will reach the close of the first epoch of its hfe in the full possession of its powers, and with the abihty to press onward, happily and yictoriously, to a youth of promise and practical useful- ness. CITY CHI1L1>REX. TMiat a contrast, however, is presented in a wallv down cm' crowded city thoroughfares ! Fully fifty per cent, of the babies you meet you would not recognize as babies, — they seem more lilvc old men and women in miniatm*e ; all the in- fantine lovehncss has departed, if. indeed, it ever existed, and a really healthy, symetrically-formed, well-proportioned TJie Marriageable Young Woman. 71 bain' is the exception ; and wh}' ? The reason is apparent : the smTonndings of these hapless little beings are tlie exact reverse of the j^^n-j^ictiire we have just drawn ; the}^ are brought into the world, but onl}' to drag out a miserable existence for a few 3'ears, and die an early death. Take the census of Massachusetts for 1875 as an example, and a comparison of the births and deaths in that State will reveal some facts worthy our most serious attention. The births to American mothers during the previous year were exactly one-half those to foreign mothers ; that is, there was one birth to nine native-born mothers, while the foreign-born return one birth to four and thi'ee-fourths individuals. The percentage of births to American parents, furthermore, shows a constant diminution, while the foreign-born evince a corresponding increase. Nor is this the worst phase in the matter. Of these fully half die before the}' reach the age of thirty ; three-fourths of the mortality occurring within the first fi\ e 3'ears (or the period of infancy) . I>A]VGEI6S OF GIRIiHOOD. ^^e will suppose, for argument's sake, that the 3'oung gu'l has surmounted all the dangers of infancy, and that the gaj'cties of girUioodlife, the school-room, the play-ground, and 3'oung companions, loom out before her. Here are fresh dangers for Zier, fresh responsibilities for her guardians. Man}' an evil habit which has imprinted its sign-manual on the featm-es, character, and futm-e life of its victim, can be traced to her school-girl da^'s, when the mind was fresh, fertile, and impressionable, and the physical functions in that peculiar condition of receptivit}" and susceptibility that made or marred their prospects and principles for the whole of her natural life. Fresh from the nm'ser}' and the domestic hearth, the child's eyes open on new scenes and new surroundings ; 72 Woman's Medical Companion. its heart is opened to new impressions ; its affections seek and welcome new companionships, -^ how Adtall}^ essen- tial, then, that these scenes, impressions, and companion- ships should be pure, elevating, innocent, and congenial ! The most prominent characteristic of child-nature is imita- tion. If vice, profanit}", looseness, deceit, formahty, fash- ionable folh', excess of any kind, characterize the surround- ings of the 3'oung girl ; if the senior members and visitors of the family display such tendencies, will not she follow but too readil}^ the example set her ? Will not she imagine that their example would fully justif}^ her imitation thereof? But these liome injluences form but one moiety of her life. Her hooks and her school associations have quite as impor- tant an influence on her future. On the other hand, undue restriction — debarring the child from health}-^ and seasonable recreation ; excessive taxation of the intellect b}' protracted study ; exclusion from all associations of a gen- ial, health-inspiring, vigorous nature, and the adoptfon of a rigorous, monotonous routine — will produce an effect quite as calamitous and unnatural as the course we have just depicted. THE TVOMEM OF THE FUTURE. The only true and proper course of mental and phj^sical culture is Nature's own wa^^, — the via media., — in which the latent womanhood is controlled., not subdued ; in which truthfulness, honesty, natural, unaffected demeanor are in- culcated and encouraged ; where the sanitar}^ and hygienic laws of both mind and bod}" are faithfully adhered to ; where the hours of study are restricted to six hours as the out- side limit, recreation another six hours, and the remaining twelve hours are devoted to food and rest. Combined with this, the moral and social elements must be of the i:)urest, and the influence of sensational scenes and sentiments stu- TJie Marriageable Young Woman. 73 dioiish' avoidecl. The 3'oung girl who is just entering the confines of that m3^sterioiis ph^'sical change which is to trans- form her into an ehgible candidate for the sacred duties of womanhood requu'es all the care and tenderness which love and s3Tapathy can suggest. THE AGE OF PUBERTY, OR T^ OMAIVHOOD IIV ITS EARLY BliOOM, has now fairl}^ commenced. The chr3'salitic period has passed. She appears for the first time on life's stage as ''' a thing of beaut}^ ; " it rests with herself, her counsellors, and advisers, as to whether she is or is not to be " a joy for- ever." If the design of her Di\dne Creator be carried out to its full fruition, she will not only be a Jo?/, but an unmiti- gated blessing to all future generations. How wonderful the change which has taken place, both outwardly and in- wardh^, phj'sically and mentall}^, in the being now before us ; whether we take the sturdy, health}^, x^leasant-looking dair3'woman of the subm'ban farm, or the languid, pale, but gi'aceful maiden of the cit3^ drawing-room. The awkward gestures, angularities, and innocent freedom of manner which characterized the school-girl have given place to a roundness and S3'mmetr3^ of form, a gliding gracefulness of gesture, a maidenl3^, gentle reserve, and a mellow, rich, melodiousness of voice, which, of itself, would indicate the fundamental revolution her constitution and her functions have undergone. Her childish playfulness and love of mis- chief is now superseded b3^ a gentle dignit3^, and, in the full enjo3mient of mental and bodil3^ health, a kind of self- consciousness of power to please. A sense of the jDossession of new thoughts, new deskes, and new relations to the world, vague though it be, pervades her whole being and imparts to her new fascinations and feelings which she scarcel3' understands. But if she has not been dul}^ pre- 74 Woman's Medical Companiojt. pared and educated for this change, she seeks retii'ement, shuns society, has tearful parox3'sms, is inattentive to her ji studies, her memory becomes treacherous, she exhibits a., disinchnation to mental exercises, loses all her pla3'fulness \ of disposition, and listlessness and inertia pervade all her I actions. This is the culminating point of her life, moral, J physical, and mental. She is now destined to be the crown- \ ing glory of the human race, or a pitiful, miserable wi'eck ofhmnanity, an aborted, distorted, and heterogeneous col- | lection of noble elements run to waste, and rendered worse ' than useless. Every man possessing common sense and i honesty holds in the highest and most sincere admiration I the transcendental and glorious qualities of woman in her ' pristine condition of mental and bodily perfection — and, on the other hand, beholds, with most profound and un- si^eakable s^^mpath}' and sadness, the numberless depar- tures from that normal state of beaut}^ and completeness enjo^'ed b}" our fii'st parents. The only obstacles to this normal condition of health of body and mind are to be found in that one dread word — Disease — congenital or acquii'ed. THE DISEASES IZVCIDEIVTAE TO THE PERIOD OF PUBERTT. At this critical period the seeds of hereditary and con- stitutional diseases manifest themselves. They draw fresh mahgnanc}' from the new activity of the S3'stem. The first spiiptoms of tubercular consumption, of scrofula, of obstinate and disfiguring skin diseases, of hereditary insanit}', of con- genital epilepsy, of a hundred terrible maladies, which from birth have lurked in the child, biding the opportunity of attack, suddenly spring from their lairs, and hurry her to the grave or the mad-house. We propose, however, to take the several affections to TJic Marriageable Young Woman. 75 which 3'ouiig women are liable, in the order of their prev- alence. THE SYMPATHETIC ACTIOIV OF THE UTERUS, OR WOMB, with the other functions of the bod}' is so marked, and is so little understood b}' women generall}-, that a word or two on that subject is necessar3^ In the earlier ages of medi- cal science this s^'mpathetic influence was much exag- gerated ; but the recent researches of modern science have demonstrated beyond all doubt that in man}' cases where the breasts, stomach, bowels, brain, heart, vocal organs, or facial nerves have been supposed to be the seat of the affec- tion, ultimate experience has proved that the real location of the disease Avas in the uterus — the action on the other organs being only of a secondary or sympathetic character ; as, for instance, in neuralgia, hysteria, etc. The diseases of the uterine system may be divided into three sections — functional, organic, and malignant, — the fanctional consisting of those deviations from the natural menstrual secretion known as amenorrhoea, or suppression of the menses ; dysmenorrhoea, or difficult and painful men- struation ; and menorrhagia, or excessive menstruation. Nearly alhed thereto is that anno}'ing, depleting affection known as leucorrhoea, the whites, or vicarious menstruation. All these disorders, when uncomplicated with other affec- tions, may continue for many years without evincing any tendency to degenerate into organic disease of the womb. ORGANIC DISEASES OF THE UTERUS. The organic diseases of the uterus and its appendages are frequently the result of inflammation, either of the mucous membrane or of the muscular and vascular tissues, pro- ducing induration, softening, ulceration, and abscesses. ( 76 Wo7nan's Medical Coinpaiiio7i. The secreting surface of that organ may also originate puralent discharges, or its caTity be distended with air, fluid, or masses of degenerated tissue called moles and hydatids. Certain organic changes not unfrequently ^yq- €iu(iQ f.hrokl tumors, of various degrees of consistence, which maiulj aiise from a change of nutrition. The most insidious, dangerous, and fatal class of uterine troubles are those denominated malignant diseases, com- prising fungous growths, mahgnant ulcerations, and mor- bid deposits. The fungous gTowths are called cauliflower excrescences, being nothing more than a mass of enlarged and diseased vessels , smTounded by cellular substances. Jfalignant ulcerations usually commence their attack at the neck of the uterus, rapidly spreading to the body of that organ, and even including the vagina in their operation. Cancerous deposits, on the other hand, may originate either in the neck or body of the uterus, or in the cellular tissue connectuig the uterus with the adjacent organs, and may occiu' simultaneously in two or more x^laces. Besides these recognized diseases, the uterus is suliject to various, accidents^ such as ruptm^e, displacement, etc., of which we shall have to treat in then" proper order. The Fallopian Tubes and Ovaries are also hable to cer- tain morbid changes of a similar character to those afi'ect- ing the uterine system, the most common of which are obhteration of their canals, distention by serous efi'usion, tubercular or encephaloid matter, adhesion, and cancerous deposit. But up to the period of commencement of the menstrual flow, diseases of the internal organs are of venj rare occur- rence. As we have aheady remarked, the assumption of the menstrual function opens the flood-gates of inherited, latent disease ; it awakens the susceptibilities of the generative organs to the dominating influence, whether that influence The Marriageable Voting Woman, 11 be normal or abnormal in its tendenc}^ — whether the several functions be healthy and vigorous, or feeble and inert. We will now consider the AFFECTIOIVS OF THE EXTERlVAIi ORGAIVS OF GEiVERATIOW, which ma}^ have had their origin prior to the establishment of the menstrual function. These are so constructed as to render them liable to a variet}^ of complaints calculated to alarm the patient unnecessarily, from the prominence or urgency of the sjTuptoms, though they are seldom attended with absolute danger. The [Labia Majora (or outer lips of the vagina), on account of their looseness of texture, sometimes become enlarged and inflamed from slight irritation, and necessarily a source of considerable annoj^ance. The}" are hard, red, and very sensitive to the touch ; ■ and more or less fever, accompanied b}" burning or shooting pains, is invariably present. It may arise from cold, excoriation or chafing, or from mechanical injuries, though in veiy many cases it is produced by neglecting to keep the parts properly cleansed every day during and after the periodic menstrual pm-gation. In the latter case, the accumulation of the acrid secretions causes an intolerable itching ; friction or rubbing is consequentl}" indulged in, and the result is exco- riation. The same symptoms also occur in the N^^mphse, and from similar causes. TREATMEIVT. Frequent ablution of the parts with warm water, especially during the flow, is absolutel}" necessar}^ in any case ; which should be followed, if caused through cold, by administer- ing belladonna, mercurius, or rhus ; if by inflammation, rhus and belladonna in alternation ; and if by mechanical 78 Woman's Medical Conip 'anion. injury, arnica, both internallj^ and as a lotion, will prove effectual. {^See ^'' Hommopatliic Remedies.'^) ABSCESSES, TUMORS, ETC. Abscesses not unfrequentlj form in the labia, and are extremely painful, and are usually caused by blows, falls, forcible intercourse, or other external injuries, though oc- casionall}^ the}^ may be traced to a general disposition to in- flammatory action, without any other exciting cause. Where an abscess is present, a hard, throbbing pain is added to the previously described sjTaptoms of heat, swelling, and red- ness, which involves the groin and a large portion of the thigh. The location of the abscess ma}^ be easily discovered b}" its hardness. Of course, rest and quiet are indispens- able ; a gentle purgative treatment must be adopted, and, if possible, suppuration be induced by means of warm poultices. If it will not then j'ield, incision will be nec- essary. {See ^^ Laxatives'' in Remedies, and ^'Poultices" in Sick-Room -Management.) Encysted Tumors, generally circumscribed and of varied circumference, are occasionally met with, the onh^ remed}' being incision or entire eradication. Warty Tumors occur in this organ, both singl}" and in clusters, and are generall}^ suspended by a pedicle from some part of the external surface. They vary in size from a i^ea to a turke3''s egg, and have a tendency to spread to the internal surface, but are neither painful nor tender, and are onl}' inconvenient on account of their bulk. In most cases these tumors are venerecd in their origin ; and if per- mitted to suppurate, form unhealth}^ sores. They must be taken awaj^by knife, caustic, or ligature ; the patient be kept quiet and have a moderately nutritious diet ; and if s3T^)hins be the origin, mercury, in one of its many forms, should The Marriageable Young Woman. 79 be administered, with the occasional alternation of a gentle purgative to purify the system. (/S'ee ^^ Laxatives'' and '• Treatment of Leuco7Thoea.") Tlie Kyiiipliae, or Labia Minora, are subject, as we remarked, to the same contingencies as the labia majora. The same treatment is requisite, with perhaps additional attention to the local application of bread-and-milli poul- tices. It was the practice of the Arabs and Moors, in the earlier ages, to apply the rite of circmncision to then* young women, by the excision of the part. Tlie Clitoris, adjacent to the labia, is subject to en- largement from inflammation and to cancerous growths. In the former case, cooling and astringent lotions outwardly, and belladonna, mercurius, or rhus inwardl}', would give relief ; but in the case of cancerous growths there is no alter- native but extirpation, which should be performed at as early a i^eriod as possible. A curious popular error has arisen from the malformation and enlargement of the chtoris, which has deceived even the medical practitioner, and has been the cause of much scientific and legal con- trovers}' ; viz., the possibility of the sexual organization of male and female being coexistent in one individual. "We o\\\j mention the fact for the purpose of showing the source of error and dispelling an idea so absurd and erroneous from the minds of our readers. Iiiiperforatioii of tlie Hymen. — It is by no means infrequent that the hymen is found to be imper- forate, or of such intense densit}' that great difficulty is experienced in the performance of the menstrual function. In the case of imperforation, no inconvenience is felt until after the age of puberty, when the menstruous fluid is dul}^ secreted, but, finding no outlet, is accumulated within the uterus, causing pains at those periods ver3' nearly resembhng those of labor, for which the}'^ have fre- 80 Woman's Medical Conipa^iion. quently been mistaken. The same symptoms, somewhat modified, attend cases of partial occlusion, though it does not entirely preclude conception, several instances having occurred in which safe deliverj^ was ultimately effected. The remedy is necessaril}' the same in both cases ; ^iz., the division of the confining membrane. Inflaimnatioil of tiie Vulva. — The inflammation of the mucous membrane of the vulva is one of the most common, the most unpleasant, and the most obstinate of all the affections to which the female generative organs are subject. It occurs at all periods of hfe, though it differs in its outward manifestations. In children it is called Infantile Leucorrhoea, invoMng the whole of the mucous membrane, and extending to the vagina, and producing a profuse milky discharge. It is more general!}' found among the children of the poor, and is the immediate result of neglect, want of cleanliness, cold, mechanical injuries, etc. In the 3'oung woman or adult the discharge is thicker, more copious, and of a 3'ellowish color, acrid, and excoriating the skin at the margin of the external organs. In the milder form, the treatment is simple and ordinarily successful. TREATME^TT. The parts should be well fomented with camomile flowers or poppy-heads three or four times per day ; and a weak dilution of mere, corr., hj'oscyamus or hamamelis virginica applied. Internall}', rhus, belladonna, or aconite might be administered. If the disease has become obstinate and chronic, and assumes the form of Leucorrhcea, of which it is the t3*i)e and origin, astringents and tonics of a more pro- nounced' character should be given. {See No. 6 et seq.) If complicated by dian-hoea, pulsatilla or coloc3'nth would remove the s3'mptoms. In all cases extreme cleanliness should be observed, with a spare diet. H The Marriageable Young Woman. 81 PRrRITtJS, OR ITCHIXG OF THE VUI.VA. This distressing and troublesome complaint ,is the most dreaded and obstinate disease to which women are subject, and is generally S3^mptomatic of some other disease in the uterus, bladder, or rectum. It takes awaj^ all rest or sleep during the parox3'sm, and consequently causes extreme debility. It is b}" no means confined to the period of pregnane}^, for 3'oung unmarried women are frequently troubled by the visitation. The ' irritating sensations are so OTerwhehmng, and the desire to scratch so indomitable as sometimes to put decencj^ to defiance ; they make her mel- anchoh^, unfit for societ}', desirous of solitude, and subject to the most intense ph^^sical and mental excitement. It ahnost exclusivelj' affects the abdomen, the private parts, and the fundament. The predisposing causes of pruritus are : uterine, vaginal, or urethral disease ; pregnane}" ; depreciated general health ; habits of indolence, luxmy, or yice ; uterine or abdominal tumors ; want of cleanliness ; constitutional syphilis, and scA^ere exercise in one of seden- tar}" habits. The immediate exciting causes are the contact of an ii'ritating discharge and local inflammation or u-rita- tion, — leucorrhoea being by far the most prolific som-ce. In every case the A^agina should be carefully inA'estigated for CA^dence of leucorrhceal discharge, unless some other sufficient cause is apparent. TREATMEIVT. The treatment should be mainh' directed to the disease of which this is a leading SA'mptora, — the internal remedies being accordingl}' chosen from conium, kreosote, bryonia, arsenicum, rhus, Pulsatilla, silica, sulphur, l^'copodium, and graphites, in accordance with the originating aff'ection. A A'er}' efficacious and simple external application is made by dissoMng one ounce of borax (biborate of soda) in a 82 Woman's Medical Compaction, pint of rose-water or soft rain-water, and washing the affected part therewith several times a da}'. We have found a sokition of mercurius corrosivus extremely effective as an outward apphcation, in combination with m}T0- petroleum soap. (/S'ee Ho. 252.) We are now brought, in the logical sequence of events, to consider those diseases to which the j'oung woman is especiall}' liable prior to or independent of the menstrual function, the most prevalent being CHI^OKOSIS, OR THE " GREE^V SICKIVESS," which derives its designation from the peculiar pale gTeen- ish hue it gives to the complexion. As a rule it manifests itself about the age of puberty, and is characterized b}' the hue of the countenance just described, deficient warmth, perverted, depraved appetite, with occasional nausea or sickness, great pli3'sical and mental weakness, impaired digestion, palpitation of the heart, and general derangement of the sexual function. Among the middle and higher classes a predisposing condition of the system (the very opposite of the robust, full-blooded condition which should exist) to chlorosis or general debihty is unhappilj" far too general, so much so that more than three-fom'ths of the 3'oung women in the large cities of Em'ope and the Western Continent are the subjects of uterine trouble from the ver}' commencement of their womanly career. Chlorosis usually accompanies re- tarded or suppressed menstruation ; but though this is, and rightfully so, a subject of great anxiet3'to parents, yet there is no justification, under any circumstances, of adopting means for the pm-pose of hastening menstruation, nor for attempting to remove local sexual aihnents by the adminis- tration of astringent, detergent, and other remedies to The Marriageable Yottng Woman. 83 produce the menstrual flux. It is on!}' when all other in- dications demonstrate be3'ond doubt that some abnormal obstruction alone retards this natural process, that it be- comes absolutel}' necessar}' to im^oke artificial auxiliaries ; and even then the most skilful medical advice should be sought, and not the numberless patent and quack nostrums which beset the innocent and ignorant on every side, and only serve to still further derange and frequentl}^ destroy the health}" action of the sexual functions altogether. SYMPTOMS. Chlorosis is always a chronic disorder, and commences slowly. The patient is at first languid and listless, dis- inclined to amuse herself, and is easil}" fatigued ^^J ordinary- mental or bodil}' occupation ; her face graduall}- becomes pale, and the skin assumes a sallow appearance ; the bowels are constipated ; she loses her appetite, and has an unnat- ural craving for certain articles of food ; the tongue is white, the breath fetid ; and if menstruation has already been es- tablished, the discharge loses its red color, and gradually diminishes in quantit}" until it is entirely suppressed. In the confirmed or chronic condition there is often con- siderable emaciation ; the flesh loses its firmness ; the lips, tongue, gums, and inside of the mouth are unnaturall}- pale or whitish ; sliglit swelling in the e3'elids and face is ob- served in the morning, which wears off during the day, and at night the feet and ankles are swollen ; the mine is pale and limpid, the abdomen is frequentl}' enlarged from flatu- lency, particularl}" after eating ; there is sometimes nausea or vomiting in the morning, heart-burn, and other sjTuptoms of indigestion. The appetite is in man}^ cases morbidly capricious ; sometimes there is an insatiable deske to eat pickles, chalk, lime, pipe-clay, cinders, etc. The shortness of breathing, which, in the first stage, was only sHght, is 84 Woman's Medical Companioji. noT7 exceedingly oppressive, and accompanied Tvith palpi- tation of tlie heart on ascending the stahs, attempting to walk quickly, etc. The pulse is feeble and small ; there is great difficulty in keeping the feet warm ; sometunes there is cough, periodical headache, and a yariety of nervous or hj^sterical s^Tiiptoms. Females of the hTuphatic temperament and of weak con- stitution are most frequently attacked with chlorosis. It is developed under various debihtatiug causes, as frequent exposui'e to a cold, moist atmosphere, water}' or poor diet, more especially when conjoined with fatigue and long watching, the various depressing passions, as giief, un- requited love, etc. This disease seldom proves fatal ; but, when left to itself, or badly treated, it may be prolonged during many months or even years, and leave traces of its injmious effects on the constitution in after-life. TREATMEA'T. There is no disease in which the administration of ii'on, in some one of its many forms, is attended with such uni- formly favorable results. The tinctm^e or chloride of iron should be taken in doses of fifteen drops thi^ee times a daj^, about half an horn* before each meal ; the diet must be nomishing, as fresh meat and bread, and easj^ of digestion. The patient should walk out in the air and sunlight, take plenty' of sleep, and frequent^ sponge the body and rub thoroughly dry with a coarse towel. Care is necessar}', however, to avoid attempting too much at fii'st. The bowels have to be regulated before taking a tonic course, and the stomach thus become accustomed to the medicine. The use of tight corsets and the prevalent method of dress among women, viz., overloading the abdominal region and hips with a superfluity' of clothing, while the lower ex- TJie Marriageable Young Woman. 85 tremities are exposed to the inclemenc}^ of the weather, should be entirely abjured ; the bed should neither be too warm nor too soft ; sleep should not be protracted bej^ond eight or nine hours, — and all food, drinks, or amusements calculated to cause undue mental and ph3^sical excitement, such as wine, highh'-spiced condiments, and made dishes, yivid emotions, frequenting balls and other entertainments of an exhausting character, the reading of highlj^-wrought romances, etc., should be absolutely forbidden. {See Nos. 7, 156, 157, 158, and 159.) HTSTERIA, OR HYSTERICS. Hj^steria has in many respects a close resemblance to epileps}', and is supposed by mau}^ phj^sicians to be a species of that disease. Several well-marked symptoms, however, distinguish these disorders from each other. In hysteria the face is not nearly so much distorted, nor does it ever acquire* a livid color, as in epilepsy ; and in the former affection the patient generally hears what is said to her and seldom becomes entii*ely insensible ; froth does not appear at the mouth, there is nO grinding of the teeth, nor is the tongue ever injured ; the breathing is not stertorous or snoring ; and the hands remain open. SYMPTOMS. A parox3'sm or fit of hysteria is generall}^ announced by headache, restlessness, cramps, coldness of the feet, j^awn- ing, and sometimes b}" immoderate fits of laughter, or cr3'ing and laughing alternately ; the patient experiences a peculiar sensation, as if a ball were moving about with a rumbling- noise in the abdomen. This, after some time, rises to the stomach, and thence to the throat, where it fixes itself, causing a most intolerable feeling of choking or strangu- lation. The breathing now becomes hm-ried, the heart 86 Woman's Medical Companion. palpitates ; giddiness, sickness at stomach, and dimness of sight follow. The patient then falls down, seized with con- vulsions ; she screams, perhaps tears her hair and beats her breast ; her body is writhed to and fro, and her limbs assume a variety of postures. The convulsive movements are not constant ; a succession of fits take place, with longer or shorter intervals between them. Sometimes the urine is discharged involuntarily ; and during the absence of the convulsions the patient laughs wildly, cries, or screams, and sometimes a distressing hiccup comes on. The abdominal muscles may be irregularly contracted, the abdomen drawn inwards towards the spine, or tense and distended with air ; the veins of the neck are greatly dis- tended, and the carotid arteries beat with unusual violence. In delicate females the face is pale and flushed alternately ; in the more robust, it is flushed, and appears fuller than usual. The patient having remained in this state during a longer or shorter period, often for twent^^-four hours, and sometimes considerably longer, at length begins to recover gradually. The spasms abate ; wind is freely discharged from the stomach ; there is frequent sighing or sobbing ; she complains of severe headache, with a feeling of soreness over the whole bod}^ and limbs, and lies in a languid and listless state for some time before she is able to rise. The recovery in some cases is sudden, and accompanied with a loud fit of laughter or immoderate crying ; and there is often a copious discharge of pale urine. SIMIIiARITY TO OTHER DISEASES. This disease simulates so man}^ others, and assumes such a variety of s;yTiiptoms, that a concise description fails in conveying an adequate idea of it ; but we do not see any necessity for giving a minute account of all its various The Marriageable Young Woman. 87 forms and relations, because, however formidable in appear- ance, it is never attended with positive danger. A point, however, of considerable importance with regard to h3'steria is the difficulty of distinguishing it from other diseases ; indeed, it has such a close resemblance to h3^po- chondria in males that medical men are often embarrassed b}^ the variet}" of s3^mptoms which occur in h3"sterical females ; and in man}" cases considerable experience and judgment are required in order to be able to discriminate between functional or even organic disorders and the end- less variet}" of forms which this affection presents. An M'sterical female sometimes complains of great pain and tenderness in the abdomen, and even screams if it be touched ; she may have headache at the same time, and remain in bed during several da^^s ; but the pulse continues tranquil, and the skin is not hotter than natural. Many girls, however, have been bled repeatedly while in this state, under the idea that some inflammatory action was going on. Pains about the region of the heart, accompanied with palpitations and occasional fainting fits, constitute another form assumed b}^ h^^steria, and may at first lead any one ignorant of the use of the stethoscope to suppose that organic disease of the heart exists. Females from fifteen to thirty years of age are most liable to h3'steria, and it is generally observed in those of a highly nervous temperament, with spare habit of bod}^ ; or in plethoric and fat persons with soft and relaxed muscles, who are subject to irregularities of the menstrual discharge. EXCITING CAUSES. The most common exciting causes are disappointed love, jealousy, undue excitement, ungratified desires, and all 88 Woman's Medicat Companion. powerful mental emotions wMcli act strongly on the nervous S3-stem and tend to induce derangements of mensti'uation. H3'steria, in fact, depends almost entii'ely on the education, social position in life, mode of living, and moral training of females ; many, from having been over-indulged Tvhen childi'en, become iiTitable, wa}"ward, capricious ; and, in a word, are so self-willed that the slightest disappointment or opposition brings on a paroxysm. The eminent physician Sj'denham remarked, some years since, that "upon the least occasion they indulge terror, anger, jealousy, distrust. and other hateful passions ; and abhor joy, hope, and cheer- fulness, which, if thej" accidentally arise, as they seldom do, quickly fly away, and yet distm'b the mind as much as the depressing passions do ; so that the^' obseixe no mean in anything, and are constant onlv to inconstancy. They love the same persons extravaganth' at one time, and soon after hate them without a cause ; this instant they x^ropose doing one thing, and the next change their mind and enter upon something contrary' to it, but without finishing it. So unsettled are then minds that thej^ are never at rest." People in general are not much inclined to sympathize with h3'sterical females, however formidable or alarming the fits may apx^ear, because it is well known that this affection is, in a great measure, under then own control ; and, in fact, in nine cases out of ten the paroxj'sm is the result of a fit of bad temper, or of some excitement which could not have arisen in a weU-regulated mind. TREATMENT. Two indications are to be attended to in the treatment of hj'steria : the first is to shorten or moderate the A'iolence of the paroxysm ; the other, to prevent the return of the fit. The apphcation of cold water to the head and neck, and of pungent salts to the nostrils, is sometimes practised with The Marriageable Young Woman. 89 advantag'e, thoiigli in mild cases the fit ma}' be allowed to run its course with safet}'. When the parox^'sm is severe, the first thing to be done is to prevent the patient from receiving injury b}' the violence of her struggles. She should be placed in bed in a w^ell-aired apartment, her shoulders raised and her dress loosened. If she be capable of swallowing, a teacupful of cold water or the following draught may be given ; Camphor mixture, two ounces ; sal volatile (aromatic spirit of ammonia) , a teaspoonful ; mix. Or a teaspoonful of ether may be given in a little cold water. Should the face be flushed and the head hot, cloths moistened with ether are to be placed on the forehead, or wet towels or pieces of linen ma}^ be applied to the same part. In order to effect a radical cure of this affection, attention must be paid to the general health of the patient, and to the state of the digestive organs and womb. If the habit of body be full and plethoric, low diet and exercise are proper ; but if the patient be dehcate, and her stomach debilitated, tonic remedies, such as small and repeated doses of quinine and preparations of iron, are the most suitable remedies. Medicine, in order to have any decided effect in this dis- order, must be clkected towards improving the condition of the digestive and uterine functions. {^See also JSfos. 13, 102, 231, 232, 233, 234, 235.) Hysteria may attack any part or organ of the body^ and resemble organic disease. Lilie hypochondria, it is reall}' a disease, and is to be treated accordingly. Moral influence can do much, but it cannot do ever}i:hing. It is a nervous disease, and is to be managed on the same general principles as other nervous diseases. It should always be remembered that hysteria is to woman what h}"pochondria is to man. Both are reall}' diseases ; are probably symptoms of some disturbance of the central nervous S3'stem ; gradually in- crease in frequency ; are often premonitions of actual 90 Woman's Medical Compaiiion. insanity ; may occur at an}" time of life after pubertj^ ; and both diseases may often be relieved and cured by appropriate treatment. IXilAC PASSIO]V, OK HiSUS. This disease consists of excessive vomiting, with obstinate constipation of the bowels. It is so dangerous and erratic that it may commence sudd.enly and terminate fatally within fom' or five da^'s, though cases of this description are for- tunately very rare. It usually commences with acute griping pain, obstinate constipation of the bowels, retrac- tion of the navel, and the usual s^^mptoms of severe colic, which, not being reheved by any mode of treatment, a still more distressing state supervenes. The patient is racked with severe pain ; the abdomen becomes swollen and tender to the touch ; the pulse is weak, small, and quick ; thkst is urgent ; face anxious and shrunk ; fecal matter is vomited ; cold sweats, hiccup, and frequent fainting-fits follow, and death generally puts an end to the patient's misery. In some cases acute pain is felt at a particular part of the abdomen, accompanied with heat of skin, quick pulse, thirst, and the ordinary s}Tiiptoms of inflammation ; in others there are no sjTiiptoms of fever ; in the latter case, life ma}^ be i^rolonged a considerable length of time. CAUSES. Hens may arise from various causes, the principal of which are : ruptures, one portion of the bowels i^assing within another and becoming entangled ; contraction or stricture of the bowels ; obstruction from cancerous or other morbid growths ; bands, formed by false membranes, stran- gulating or compressing a portion of intestine ; paralj^sis or torpor of the bowels, arising from hardened faeces, impacted The Marriageable Young Woman. 91 in some part of the intestinal canal ; or it ma^' be a S3Tnptom of inflammation of the bowels. TREAT3IEIVT. In ever}^ case, the first thing to be done is to ascertain whether or not the disease is the result of hernia or rupture. A hernial tumor is sometimes so small that the patient is ignorant of its existence, or ma}^ not consider it wo^th}^ of notice ; and women are often ashamed or unwilling to admit that the}" have an}^ complaint of this nature. The bare statement of the patient is not b^^ an}-^ means sufficient in these cases : the most skilful and careful medical examina- tion for rupture should be made. The necessity for pro- curing the best professional assistance at an early stage of the disease, in order to avoid intense sufi'ering and death, cannot be too absolutel}" insisted on. Another essential point to be attended to before ha^dng recom'se to anj- remedial means, is to ascertain whether or not the disease is accompanied by inflammation, the signs of which are a constant, acute, and burning pain in the abdomen, which is distended, tense, hot, and acutely sensi- tive to the slightest pressure, urgent thbst, and high- colored urine. In this case, instead of administering opiates and strong purgatives, which would soon destroy the patient, recom^se must be had to judicious blood-letting, and the means usually adopted to subdue inflammation of the bowels, of which the ileus may be onl}" a symptom, which will, of com'se, be removed along with the inflamma- tion. If the disease does not depend on hernia, and if no inflammatory s3'mptoms be present, the careful adminis- tration of x)m'gatives and opiates wiU be necessary. WY3IPII03IAJVIA, OR FUROR ITTERIiVUS, is a disease frequently confounded with prmitus vulvae, Woman's Medical Companion. from tlie similarit}^ of some of the sjTiiptoms, and also from the fact that they are sometunes found to coexist in the same patient. The diseases are, however, -^TLdel}' different in character, and require special treatment. The source or seat of this affection, m^mphomania, has been a much- disputed point for man}^ years, some placing it in the brain and others in the genital organs. We beheve, however, with M. Columbat and other modern authors, that it is a simultaneous initation of the brain and sexual organs. As its name tmphes, it is an exaggerated voluptuous sensa- tion, accompanied by irresistible and insatiable venereal desii'e. It is less a disease than a symptom, for the con- cmTence of the brain and the sexual organs is essential to the erratic manifestations. In the former case, the disease is developed under the influence of mental causes, which secondarih' mitate the genital organs ; and in the latter, it is a primary- irritation of the organs of generation, reacting s^mapatheticallj' upon the brain, and especially on the cere- bellum. SYMPTOMS. This affection, which maj^ appear at all ages, generally attacks women of an original uterine temperament (that is, of sanguine temperament, and suffering extreme irrita- biht}^ of the abdominal \dscera) . Women of this constitu- 1 tion have certain characteristics : their statm^e is small, their skin dark, and their complexion highly colored ; and the breasts, and all the other attributes of womanhood, arc full}' develoi^ed and extraordinaril}^ sensitive. Young widows, women of ardent nature, fond of pleasure and excitement, and, finalh', those attacked with some chronic cerebral or uterine affection, especially those inhabiting warm climates, are especially hable to this form of disease, from the vivid character of then- passions and the super- exaltation of thek imagination. I TJie Marriageable Yoimg Woman. 93 We will not pm^sue the frightful train of symptoms attached, to this disease, but only remark in general that the patient gradually loses all self-control, completely for- getting her native modest}^, at last falling into a furious dehiium. The generative organs are red, excoriated, much swollen, and the seat of a purulent, fetid discharge ; there is ardent thu'st, grinding of the teeth, spasm of the oesoph- agus, and, in some cases, what are called hydrophobic S3'mptoms, or rabies. The attacks are frequent, periodic, and often fatal, especially where organic disease of the uterus or its appendages is present. TREATMENT. In general, much gTeater benefit is derived from hygiene than from drugs, which are not so successful in opposing a disease the origin of which lies more in the mental and moral than in the ph^^sical region. Some means of diver- sion should therefore be devised to turn her imagination from seductive or unproper thoughts, such as constant mental and bodily occupation of some kind, travelling, new scenes and companions, etc. Ever3i;hing capable of pro- ducing erratic excitement should be studiously avoided. Frequent and prolonged warm baths, with cold affusions to the head, cold and sedative drinks, and light diet of cereals, poultry, milk, vegetables, and total abstinence from all stimulating drinks and food, from soft feather- beds, and all the enervating luxuries of modern civihzation, must be rigidly enjoined. HTSTERAI.GIA, OR IRRITABILE UTERUS. This disease is also known as neuralgia of the uterus, from the fact that those afflicted with irritability of the uterine reoion are more or less affected with neuraloia of 94 Woman's Medical Companion. that organ. Dr. Goocli defines it as " a tender and painful state of the uterus, neither attended by nor tending to produce change in its structure." This disease occurs in females of every temperament, and maj' appear at au}^ time T\ithin the menstrual age ; the 3^oung and middle-aged, how- ever, are most subject to it, the aged being rarely attacked. This afiection, at times, is one of extreme suffering. SYMPTOMS. There is pain in the lower part of the abdomen and loins, which usually comes on a few daj^s before or after menstru- ation, and from which the jDatient is never quite free. It is subject to aggravations from mental excitement and bodily exertion ; hence the patient is induced to give way to the rehef afforded by repose. The result is, that, in conse- quence of the pain, want of exercise, and fresh air, the general health is broken, and a languid cii^culation, consti- pation, and dyspepsia are superinduced. Upon examination, the uterus is found tender from shght pressm^e. Sometimes the neck and bod}^ are slightlj' swollen, but not hard ; the mouth of the uterus and vagina are usuall}^ healthy. The disease may continue for months or 3^ears ; it may be subdued b}^ medical treatment, or it maj^ subside spontaneousl3^ It is a sm-e cause of barren- ness while it exists, but it does not terminate in organic disease of the uterus or endanger life. Leucorrhoea sometimes, though not alwa3's, accompanies this disease. It ma}" be distinguished from acute and chronic inflammation of the uterus by the absence of heat and throb- bing, and b}^ the long continuance and non-progressive character of the S3'mptoms, without apparent invasion or degeneration of the organ itself. It is distingiiishable from ' ' painful and difficult menstruation " b}- the non-cessation of the pain, in greater or less degree, throughout the inter- TJie Marriageable Yoiuig Woman. 95 veiling periods. It differs from displacements of the uterus and vagina b}^ the maintenance of those organs in their nat- ural position during this affection. From a comparison of this malad}^ with long-continued and painful affections of other parts of the frame, it must be inferred to be nervous. Thus, the breasts, the spine, and the various joints ma}^ be the seat of acute pain, which may endure for many j^ears without being accompanied b}^ organic change. The CAUSES of this disease are often obscure. The most prominent are : bodil}" exertion during menstruation or at too early a period after dehvery or abortion ; excessive coition, and an improper use of astringent injections. It niay also supervene on extreme fatigue, such as long jour- ne3's, dancing, dissipation, late hom's, etc. TREATMENT. There are few diseases so tedious of cure and liable to relapse as this. The indications are : first, to relieve the pain ; second, to restore the constitution to its nonnal con- dition. The violence of the pain must be alla^^ed b}' abso- lute rest during the parox3'sm, and narcotics, such as opium, h^^osc^'amus, etc. {Nos. 231, 256, 257), either alone or in combination with assafoetida. If the stomach be too irrita- ble, they will be found equall}^ as efficacious by injection into the vagina or rectum. Opium or belladonna plasters, or anodyne fomentations to the sacrum and abdomen are also useful. Counter-irritation should be practised by means of small blisters to the loins. Much relief will be afforded by vaginal injections of warm water alone, or aconite and belladonna if the pain be severe. The warm hip-bath will often give relief. The bowels should be kept open b}" the mildest possible means, as all active purgation in this dis- ease is invariably injmious. Although, during a severe i^aroxj^sm of pain, close con- 96 Woman's Medical Companion. finement is indispensable in the horizontal posture, this should not prevent the patient from often being carried into the open air, and taking moderate carriage exercise, particularl}^ as soon as there is an abatement of the most violent S3'mptoms. A generous diet, — but not so as to burthen the stomach, — fresh air, and a gradual coui'se of tonic medicines (preparations of iron are preferable) are the best means of treating the constitutional condition accom- panjdng this obstinate disorder. (/See J^os. 317, 318, 319.) There is another affection of the uterus, much resembling this, which might be, perhaps, more properly named rheuma- tism of the tcomb. The plan of treatment is the same as above reconunended. There is a painful condition of the vagina frequently met with b}' the physician, analogous to the atfection of the uterus we have just described, and which may be termed Irritable Vagina. It is characterized bj" extreme tenderness when the lining membrane is touched by the finger, and a h3'steric attack not unfi^equentl}^ follows coitus. In some marriage develops this weakness ; in others, child-bearing, or both, become agents of development. The treatment is mainly the same as directed for hysteralgia. liEUCORRHCEA. Perhaps there is no single term in the whole catalogue of "woman's diseases" more undefined, more extensively misunderstood, or about which a greater amount of prac- tical ignorance exists than this. It is derived from two Greek words, signifj'ing " white discharge ;" and fully Jioe- sixths of the female population of all our large cities, 3'outli and adult, are afflicted with it. By the people generally the term is vaguely and indifferently applied to all non- sanguineous vaginal discharges, no matter what their char- The Marriageable Young Woman. 97 acter or the diseased conditions of the organism from which they spring ; the natural consequence being much confusion and loose treatment on the part of the ph3-sician, and an untold amount of suffering, annoyance, and anxiety on the part of the patient. It will, therefore, be apparent to our readers that, in the treatment of this insidious and mys- terious affection, it is primarily essential that all conclu- sions should be based an an accurate knowledge, not only of its p^'mptoms, but of its seat. In popular phraseology, " leucorrhoea," " fluor albus," and "female weakness" mean the same disease, which is described as a light, colorless discharge from the genital organs, varjing in hue (according to its virulence or origin) from the n:iMte or colorless, mucilaginous, mucous discharge to the yellowish, light green, or slightly red and brownish exudation, differing in consistencj" from a thin and watery fluid to a thick, tenacious, ropy kind of substance, and fluctuating in quantity from an almost imperceptible increase of the healthy vaginal secretion to from one to six ounces during the twenty-four hours. Leucorrhoea may occur at any time of life, from earl}^ in- fancy to old age, but it is most frequently prevalent between the ages of fifteen and forty-five, or the change of life, seldom continuing after that period, except when it has its oriojin in some organic disease of the womb. In children afflicted with hereditar}" scrofula, it is often present prior to puberty, and even in infancy, materially inter- fering with, and in all probability causing retardation or suppression of, the menstrual function. As a rule, the leuchorrhoeal discharge is much more profuse at the men- strual period than at other times. Whether taken as a disease or as a symptom, it maj^, like all other diseases connected with the reproductive or- gans, be divided into two principal forms, — the acute and 98 Woman^s Medical Co^npanion. the chronic ; the acute being nothing more nor less than an attack of inflammation of the mucous membrane lining the parts, whatever ma}' have been its cause. In a large ma- jority of cases it will be found to be nothing more than a catarrhal inflammation, occasioned by taking cold, which, if promptly- and resolutely treated, will speedily disappear. If neglected, unnoticed, or improperly treated, it neces- sarily passes into the chronic form, which is simply a continuation and aggravation of the acute form, and is fre- quently complicated with severe and obstinate inflammation of the adjacent tissues and ulceration of the neck of the womb. CAUSES. Many individuals en^oneously look upon leucorrhoea as the direct and immediate result of " general debihty," and most persons sufi'ering from the disease vainly imagine that if they could only get something to strengthen them they would be cured. Under this delusion manj^ a woman has dallied awaj^ valuable time and mone}' in taking successivelj", but b}' no means successfulh', the man}' strengthening bit- ters, universal panaceas, and nice-tasted, pretty-named nos- trums, advertised to regenerate and rejuvenate sufi'ering humanit}' generall3^ But this is a great, a sad, and a fearful mistake, by which human hfe has been risked, and the period of restoration to health indefinitely postponed. The debility is not the cause of the disease ; neither is the discharge. Both the discharge and debiht}' are simply the outward manifestation or result of some morbid action going on in some portion of the uterine organism. A\Tiat that disease is, or has been, which has given rise to these s^Tuptoms, can generally be ascertained b}' the nature of the discharge and the peculiarities which each particular case presents. For instance, there are three distinct varieties of discharge from the vagina alone : mucous^ purulent^ or matter}', and water}' ; The Marriageable Young Womajt. 99 and there are morbid conditions capable of producing each of these evacuations. Inflammatory action is not absokitely necessary for the secretion of mucus, though it must exist where pus or matter is present. As both pus and mucous secretion is frequent!}^ found in the leucorrhoeal deposit, it is therefore essentially necessary that the true source of the various forms of the malady should be accurately ascer- tained, in order that it may be treated intelhgentl}^, and not bUndly. In far too many instances leucorrhoea has been treated and looked upon as a vaginal disease, pure and simple. With the ver}^ limited knowledge of its pathology which many physicians possess, it is no wonder that the}^ have fallen into the habit of treating it upon routine principles, and that the success of that treatment has been an3'tliing but flatter- ing. Nine out of every ten cases of leucoiTlioea have their origin in congestion^ inflammation^ or ulceration of the necJc of the uterus; and when the cause is removed — when this condition of the organ is terminated — the discharge entirely ceases, and the nervous and muscular derangements of the uterine apparatus soon give way to generous diet and tonic treatment, the organs being restored to their normal health and vigor. That leucorrhoea is hereditary is a fact too well substan- tiated to need comment ; man}" women, more especiall}' those possessing a lymphatic, nervous constitution, with soft flesh and pale in color, being hereditarily predisposed to uterine affections generally. With such persons, a cold, unsuitable diet, nightl}" dissipation of any kind^ tight lacing, and the various other indiscretions and reckless indulgences preva- lent among women of all classes and stations in life, would inevitabl}" result in a more or less aggravated attack of leu- corrhoea, as a sjTtiptom and sequela of some other affection ; while those differently constituted might commit the same 100 Woman's Medical Companion. imprudences, but would be affected in a totally different manner. The immediate exciting causes of the disease include severe colds, sudden changes of atmosphere, sitting upon cold, damp seats, such as stone, gi'ass, earth, etc., exposure of the upper and lower extremities to cold air, A^iolence, excessive indulgence, tight lacing, encumbrance of the abdominal region and hips with weight}^ and tightened clothing, iiTitation from stimulating injections, inflammation of the rectum, hemorrhoids, miscarriages, abortions, uterine displacements, ulceration of the womb, tumors of various kinds, purgatives and emmenagogue medicines given for the purpose of hastening the menstrual discharge, warm injec- tions, the abuse of warm baths, late hours, excessive indul- gence in fish, flesh, or acid and watery fruits, the intemperate use of tea, coffee, and other so-called harmless, non-intoxi- cating beverages, and the uncontrolled indulgence in the depressing passions, — fear, grief, bad temper, etc. It is quite common in cold, damp climates, and especiallj' in the two extremes of society, the high and loiv, — those who are comj)elled to hve in narrow lanes and alle^^s and in basements, where the atmosphere is damp and fetid and loaded with noxious gases exhaled from decomposing masses of refuse, — and those who, living in the highest strata, revel in every luxurious indulgence : beds of down, soft cushions, highty-spiced food, deprived of all its nutri- tion, and social habits and amusements calculated to exhaust all their vitality and energy, have ruined their constitu- tions and secured to themselves quite as luxuriant a crop of uterine diseases as theu' less fortunate sisters who drag out a miserable existence at the opposite extreme of the social circle. A leucorrhoeal discharge is not unfrequently produced in young female children by the presence of pin-worms, which The Marriageable Young Woman, 101 find their wa}' from the rectum to the vagina. In such cases, a removal of the worms is speedily followed by an abatement or disappearance of the discharge. It is alwa3's advisable, when httle girls are troubled with a discharge from or itching of the vagina and neighboring parts, to make a vigilant examination. I have frequently known children to be kept awake night after night from the irritation caused b}" the presence of two or three little worms just within the lips of the vagina. They can be easily removed with a httle piece of cloth. SYMPTOMS. In ver}' rare instances the vaginal discharge is the only s^^nptom noticed. As a rule, however, there is a miserable catalogue of aches and pains extending over the entire sj'stem. In fact, the constitutional sjonptoms, in many cases, are so distinctive that they are mistaken for the cause of the disease. The color of the skin, the bloated appearance of the face, the shortness of breath, constipation, moral and intellectual obtuseness, general debilit}^, etc., will all be mentioned by the patients in the enumeration of their aihnents, as separate ailments^ but not one word ars to their origin — the leiicorrJioeal discharges — will escape their lips. The duty of the physician as to vaginal examination under such circumstances is self-evident. As we have before said the color, quantity, and consis- tency of the discharge A'aries proportionately with the other constitutional indications, and also with the intensity of the affection which originates it. It is sometimes so copious as to require the same provisional protection as during the menstrual flow, and in some cases amounts to an actual flooding of the peculiar secretion, and is accompanied by the uneasiness, pain, and prostration felt at severe menstrual periods. In shght cases of catarrhal leucorrhoea, there is no irrita- 102 Woma7i's Medical Companion. tion or excoriation of the parts ; the discharge is extremely mild, and bnt httle inconvenience is felt. In acute cases. those arising from colds, the usual indications of catarrhal inflaunnation — a sense of heat and soreness in the parts, a feehng of weight or heaviness, or a bearing-down pain, with languor and general feehng of weaiiness — are present. These s^-mptoms are sometimes accompanied with shght chills, pain in the back, quick pulse, thirst, high-colored lu'ine, and other febrile indications. Under these circmn- stances, if proper treatment is at once instituted, there will be but httle difficulty in subduing the s}"mptoms. and the organ speedil}' assumes its normal health and strength. If improperly ti'eated. and especially if astringent injec- tions and cathartic medicines have been used, the disease will most certainly become obstinate and chi'onic. the languor an(J debihty increase, the discharge become still more pro- fuse, pain and a general sense of heaviness in the abdomen be continuously felt, the digestion become impau-ed, and nausea, loss of appetite, headache, veitigo. palj)itation of the heart, weariness upon the shghtest exertion, and a host of *dyspepric symptoms, will soon manifest themselves. Ultimately, the disease will extend to and i^enetrate the womb ; congestion, inflammation, or iilceration take place ; the tissues become relaxed ; prolapsus uteri, or some similar affection of the uterus, follow, and a general increase of constitutional derangement supervene, which will declare itself by a loss of flesh and color, a quick, small pulse, the di'\Tiess or partial coatuig of the tongue, a constant aching jDain in the small of the back and about the hips, gi-eat ex- haustion and general debility, eruptions of small black- headed punples on the face and forehead, and the sinking of the eyes with a dark circle around them. The intel- lectual and moral faculties are always more or less weak- ened. The Marriageable Yoimg Woman. 103 ^ATien the discharge is purulent, fetid, and stained with streaks of blood, the affection causing it is evidentl}" of a serious character. As we have previously observed, simple leucorrhoea is, in itself, seldom, if ever, serious ; but there are so many uterine affections producing a discharge similar to that of leucorrhoea, that the person suffering therefrom should, for her own safet}^, comfort, and ease of mind, with- out delay place herself under the care of some intelligent, experienced medical practitioner. It is a disease, which, at the best, is difficult of cure, and the longer it is permitted to continue, the more obstinate it becomes, though a well- •directed and persistent course of treatment seldom fails to afford permanent relief. tbeatm:e:vt. We have endeavored to show that this disease has its origin in deep-seated causes, — nothing less than a positive abuse of the fundamental laws of nature. The intelligent physician well understands the absurdit}' of attempting by the administration of medicine alone to change the long- continued and unhealthy action of organs that have for 3^ears failed to j)erform their natural functions, while the original cause of theu* derangement remains still in action. It is evident, therefore, that there is no alternative but that the woman must first perseveringlj^ retrace her steps and reform her errors of habit, etc., before there can be a gleam of hope of her ultimate restoration to health. She must first place herself, phj'sically and mentallj^, in a recep- tive condition for the remedial influences which are to be brought to bear upon her debilitated and disorganized S3's- tem. All the surrounding circumstances which may in any way tend to excite or aggravate the disease must be promptl}^ removed. All indulgences and luxuries., or exces- sfi'c use of necessaries, must be absolutely forbidden. Bod- 104 Woman's Medical Co7itpanion. ily and mental excitement of all kinds must be avoided ; tiie diet must be regulated and strictly adhered to. The laios of nature as to hj'gienic and sanitaiy matters must be strictly observed and implicith^ obej-ed ; the food must be simple, nomishing, and as little stimulating as possible, and be taken at regular intervals; and tea or coffee, acid and watery fruits, absolutely abandoned. Moderate exercise in the open aii' will be most effectual in promoting the cm^e, though great care must be exercised in the avoidance of fatigue ; the clothing must be adjusted so as to admit of i^erfect freedom of motion, — the waist, especially, being free from all hgature. All exciting and depressing emotions should be avoided as far as possible. If the patient resides in a damp, low, or unheaMw district, she should be removed, at an}' rate for a time, to a drj', open, and healthy region, when such an arrangement is possible. These requisitions being comphed with, the medical rem- edies take theii' iDroper places, as alteratives, in arresting the disorder — being, of course, chosen in accordance with the indications given of the origin of the discharge. The most effective at present known are pulsatilla, sepia, alum- ina, calcarea carb., kreosotum, nitric acid, mercurius, coc- culus indicus, couium, sulphur, aud sihcea. {See Xos. 6, 256, 257,258.) Most ph3'sicians speak highh* of water as a remedial agent in this disease, and experience has taught me that too high encomiums can hardl}' be awarded to it when judiciously em- plo3'ed. Under the head of " Causes of Leucorrhoea,". it will be remembered, I asserted that the disease was not unfrequentl}' occasioned b}' the use of water. This is true Some over-fastidious females are not content with cleansing their persons in the ordinar}' ^'^Ji but think it necessary {while in the most iierfect health) to s^Tinge themselves out The Marriageable Young Woman. 105 once or twice per day with tepid or cold water. Vaginal injections during health are not onl}^ uncalled for, but, in some instances, positivel}^ injurious ; for, in its natural, healthy condition, the lining membrane of the vagina is kept constantl}" moistened by a mucous secretion. Now, an injection', even of simple water, washes away this secretion, and leaves the surface chy, in a condition easily irritated and prone to disease. Water is, unfortunately, not the onl}^ injection made use of, and cleanliness not the only pretext for its use, prevention of conception and abortion being frequently attempted by this means. With this mat- ter, however, we do not propose to deal at present, but simply to protest against the use 'of any injections in the healthy uterus. In any form of leucorrhoea, vaginal injections are of the gi^eatest importance ; and they are especiall}^ beneficial in cases where the discharge is acrid and causes excoriation of the parts. The water dilutes the secretion, and thus renders it less irritating, besides having a decided tendency to reestablish a health}?- functional action, as has been abundant!}^ proved b}" prompt recover}^ following its use in many cases. Cold hip-baths are also beneficial. Some extremely severe and obstinate cases have been entirety cured by the injection of a decoction of hamamelis virgin- ica into the vagina, the cavit}' having previously been thor- oughly cleansed with injections of warm water and castile soap, repeating the operation some three or fom' times per da}^. The imperative necessit}^ of immediate attention to leu- corhoeal or au}^ vaginal discharge, no matter how slight, is self-evident. Nine-tenths of our bed-ridden and chronic invalids of the female sex may directly trace their ailments to neglected leucorrhoea. It saps their very life-blood, de- stro3^s their ambition, prostrates them mentally as well as 106 Woman's Medical Companion. pliysically^ and renders their existence a i^ositive calamity to themselves and to those b}' whom the}' are smTounded. Tlie Effects of Iie^icoiTlioea, if neglected or peiToitted to become clu-onic, are so disas- trous and fatal to the comfort, health, and happiness of the sufferer, that we take this opportunit}' to again impress upon the minds of our readers the imperative necessit}- for immediate attention to its first symptoms. As we have remarked, it saps the ver^' hfe-blood of the S3'stem, im- l)Overishes the tissues, reduces the once hale, healthy. hvely girl to a walking shadow, pale, emaciated, without vitaht}', weak, fi-agile, hj'sterical, and iDecuharh' susceptible to consmnption, fever, contagious diseases, etc. It deprives her of ever}' i^article of phj'sical or intellectual enjo^inent in this life ; it extinguishes all hope or ambition, and makes her wish for death as the onl}' avenue of escape from her j)ain and trouble. Anaemia means ^oi'e?% of the blood. There are a variet}' of causes which produce this condition, such as haemor- rhage, exhausting diseases, blood-poisoning, and confine- ment within doors, from sedentar}' employment, etc. The s3Tnptoms are paleness of countenance, debilit}', nervous- ness, and nervous palpitation of the heart. This disease is ver}' apt to be confounded with purely nervous diseases, such as chlorosis or neurasthenia. Anaemia is essentialh' a disease of the blood; chlorosis is an affection of the nervous S3'stem. One may cause the other, and the}' are frequently associated. Both are especialh' liable to occui' to 3'oung giiis and bo3's at the age of pubertj'. TREATMENT. The treatment of anaemia is important, for the reasons we TJie Marriageable Yoiuig Woman. 107 have given. Electrization, a course of tonics, and a gener- ous dietaiy, calculated to build up the constitution, are all needed, and produce the most satisfactory results. But above and beside all these restorative and recuperative rem- edies, a?'r, sunlight^ and exercise are absolutely essential to the restoration of the patient to a vigorous and healthy con- dition. Abundant and nourishing food, such as meat, beef- tea, fresh eggs, bread, etc., and plenty of sleep ^ are the most effective auxiharies to nature's efforts. {^See Nos. 156,157, 158, 159.) ^AJVGIiVA PECTORIS, OR IVETTRAI^GIA OF THE HEART, is an affection to which 3'oung women (especially those brought up in our large cities) are peculiarl}^ liable. It is a strictl}' nervous disease, and begins with a sense of pain and constriction in the region of the heart. This is ac- companied with more or less pain and numbness in the left arm. In women it is not uncommon for it to be attended with great sensitiveness and pain of the breasts. When the attack is violent, the pain in the heart is excruciating and even terrific. There is attending this a feeling of great oppression in the chest, amounting, in the severest cases, to a sense of suffocation. The heart palpitates violent^, the brain is oppressed, and fainting sometimes occurs. The disease is brought on, in nervous persons, b}^ over- excitement. Walldng up-hill against a strong wind, ma}' bring it on. If wallving at the time of the attack, the pa- tient is compelled to stop and stand still till the pain sub- sides. The disease is often connected with organic changes in the heart's structm-e, such as ossification and othei Alter- ations. TREATMEI^T. ^\Tien the affection is connected with organic disease of the heart, remedial measures must, of com-se, be directed 108 • Woman's Medical Companion. to the cure of that disease. To reheve a severe attack, the patient must be placed in a recumbent, quiet position ; wind in the stomach, if present, must be expelled by ginger, peppermint, ether, or some aromatic. If there is acidity or sourness of the stomach, it must be corrected by a tea- spoonful of soda in a half-tumbler of water ; and if the stomach is full of undigested food, let the patient take a tablespoonful of ground mustard, stirred up with a teacup- ful of warm water. This will cause almost instant vomit- ing. These things having been done, give some quieting or antispasmodic medicines. Great relief is sometimes afforded by sending a magnetic cmTcnt through the regio?i of the heart, by applying one pole of the machine in front and the other on the vertebral column. During the inter- vals the general health is to be improved b}^ a wholesome, nourishing diet, gentle out-door exercise, and a careful con- trol of the passions. (/S'ee Nos, 302, 303, 304, 305.) Derangements of the Menstrual Function, 109 CHAPTEE YI. DERANGEMENTS OF THE MENSTRUAL FUNCTION. AMENORRHCEA, OR SUPPRESSIOIV OF THE MEWSES. There is natiirall}^ a considerable amount of confusion and error engendered in the minds of our women by the CommingUng of the two affections or conditions; viz., the retardation and the suppression of tlie menstrual flow. The menstrual function ma}^ be retarded in its operation by imperfect development, by local obstructions of a tempor- ary character, by a chronic affection of some adjacent or- ganism, or by congenital malformation, in either of which cases the exertions of the patient herself, her guardians, and her medical adviser must be directed to the invigoration of the s^^stem in general, and to the development of the uterine S3'stem in particular. Where the obstruction arises from malformation, surgical interference will obviously be necessary" ; but on no account should the artificial hastening of the flow be attempted by the administration of emmena- gogues, such as ergot, savin, etc. But we will now pro- ceed to the consideration of amenorrhoea. Amenorrhoea is that condition wherein the menstrual function, after having being established for a longer or shorter period, has been arrested, without being interrupted by pregnane}", nursing, or old age. This may happen at any period of menstrual life, and it may take place sud- denly or very gradually ; in other words, it may be acute or chronic. 110 Woman's Medical Companion, CAUSES. Acute AmenorrhcBa is caused by sudden exposure to the cold and damp air, immersion of the feet or hands in cold water ; cold ablutions of the genital organs ; sitting upon the ground, etc., during the menstrual term; the eating and drinking of ices and very cold drinks, especially while the body is in a state of violent perspiration ; violent bleeding ; the application of a large bUster ; the employment of purgatives or emetics, and strong perfumes or odors ; the act of coition during the flow, or the setting-up of any fever or severe disease at that period. Also, a severe bodily or mental shock received just previous to or during the^ period of the discharge, or the exercise of vivid emotions, such as anger, love, jealousy, immoderate joy, sudden fright, disappointment or grief ; all circumstances tending to sud- den determination of the blood in a contrary direction to the uterus, ma}^ give rise to this condition. The most com- mon cause, however, is the application, in some way or other, of cold to the feet. The majority of women pay so little regard to this period that the}^ are continual^, even hourly, exposed to derangements from this cause alone by standing in thin shoes, sitting upon damp, cold ground, going too lightly clothed, and dabbling in water, etc. Some indeed are so utterly reckless as to deliberately bathe their feet in cold water during their menstrual flow, in order that, b}" so arresting it, they ma}^ be enabled to keep a prior engagement to a ball or part3\ Such criminal acts as these, however, bring speedy and severe punishment with them. SYMPTOMS. These are extremely variable, but most commonly there is fever, with a sensation of heat, weight, and pain in the pelvis, uterine colic, disagreeable tension of the loins and upper part of the thighs, enlargement of the breasts and Derangements of the Menstrual Function. Ill abdomen, lassitude, nausea, vomiting, dizziness, headache, ringing in tlie ears, frequent palpitations, scalding urine, etc. Or there ma}" be s3"mptoms of local inflamma- tions either of the lungs, brain, intestinal canal, or of the uterus itself. Occasionall}^, instead of inflammation there are severe neuralgic pains of tlie womb, or a species of h3'steria simulating inflammation, and changing from one organ to another as soon as remedies are brought to bear upon it. Attacks of apoplexy and paralj^sis have also been known to result from sudden suppression, as also aphonia, or loss of voice, curious derangements of vision, and cuta- neous disorders. These secondar}" attacks ma}^ be mitigated 'in severit}' by the occurrence of vicarious menstruation^ or discharge of blood from some other part of the uterine region, by which the temporary plethora is removed without an}" return of the uterus to a normall}^ healthy condition ; or b}" uterine leucorrJioea, which appears to afford relief; and more naturall}", since there is a sort of action of the uterus which, though faulty, seems preferable to a condition of perfect indiff'erence and lethargy. On account of the sec- ondar}" attacks to which it gives rise, sudden suppression is a much more serious disorder than any other form of men- strual derangement. TREATMEIVT. There can generally be no difficult}^ in ascertaining the fact of suppression : if in an}" cases there should be any doubt as to their nature, they should at first be treated as simply inflammatory. Attempts are sometimes made by unmarried females, with the view of avoiding exposure of character, to deceive physicians in reference to one of the causes of menstrual suppression. The experienced physi- cian needs no caution on this point, but we will, for the in- formation of oiu' readers, give a more detailed account of 112 Woina7i's Medical Companion. its dangerous and malefic influence, in our chapter on Abor- tion and Miscarriage. The acute form is more easily cured than the chronic. Our first endeavor should be to efi'ect a resumption of the menstrual discharge ; and for this purpose the patient should take a warm bath, or put the feet into warm water, and take a bowl of warm gruel. Rest in bed is absolutel}^ necessary, and warmth should be applied to the legs and thighs hj means of hot flannels or bottles filled with warm water, or cloths saturated with tm-pentine and warm water. Gentle pm^ging will also be found useful ; but if it be induced to any extent, it will necessarHj^ defeat its own object, as copious discharges of any kind, b}-- relieving the constitu-' tion, to a certain extent supersede menstruation, and pre- vent effort on the part of the uterus. Should this course fail after reasonable perseverance, and a state of congestion prevail, relief will be obtained b}' loss of blood. If adopted in the earher stages of the malad}', it will, in all probability, prevent the local disorders to which we have refeiTed ; but when they do arise, the}^ must, of course, receive the treatment usual for the specific diseases. The hysterical afi'ection of the different organs should be com- bated with what are called antispasmodic medicines, such as assafoetida, musk, camphor, etc. {See Nos. 213 or 214.) If colic be present, the most certain relief will be found in aloes and m^Trh, in their several combinations, till the bowels are opened. {See Nos. 118, 119, 120, 121.) Upon the approach of the next period, gi-eat attention should be given to the patient, and ever}^ means used to facihtate the natural secretion. The bowels should be kept open, the surface comfortably warm, and the hip or foot bath used alternate nights. The strength, if necessar}^, must be supported by a generous, but not stimulating diet. If, at the proper time, the menses should be reestabhshed. Derangements of the Menstrual Ftcnctioji. 113 onr object will be accomplished ; but if merely a white dis- charge appear in its stead, we must again, during the inter- val, put into action all those means mentioned in the treatment of the tard}^ appearance of the menses. If the white dis- charge persist during the interval, it must be treated simply as Icucorrhoea. But if no discharge appear, neither red nor white, recourse must be had to those means and remedies which we shall prescribe in our next section for chronic suppression of menses, according to the condition of the patient. CHKOXIC SIJPPR3ESSI01V OF THE MEIVSES may be the consequence of an acute attack, arising from neglect or improper treatment, or it may be caused by gradual depression of the bodily powers, giving rise to deh- cate health. It may also arise from diseases of the ovaria, uterus, and other parts of the body, as inflammation, indura- tion, ulceration, hydatids, etc., of the uterus and its ap- pendages ; anteversion, retroversion, and complete prolapsus of the womb. It ma}' also be the sequela of pulmonary con- sumption, disease of the heart, scrofula, particularly of the bones, inflammation of the brain or spinal marrow, the stomach, spleen, liver, lungs, pleura or peritoneum, or any irritation in the sj^stem which retains the blood and prevents it from being dkected upon the uterus. The quantit}' of the secretion ma}' gTaduall}' diminish, and the time become irregular and uncertain, till at length the uterus altogether ceases to act ; or, which is perhaps more frequent, the menses diminish in quantity and become of a paler color, with shorter intervals, until leucorrhoea becomes permanentl}' estabhshed in its stead. SYMPTOMS. The Symptoms which arise from chronic suppression are 114 Woman's Medical Companion. various, being often the same (though less marked) as those mentioned under acute suppression. The features of the 3^oungTroman, heretofore briUiant with freshness and health, are observed to assume the impress of feebleness, depression, and languor ; the roses upon the countenance fade, the fire of her ej^es is extinguished, and a dark cu'cle surrounds them ; finally, the most frequent sjnnptoms are habitual headache, dyspnoea, dizziness, pains in the back, sides, limbs, and joints; deficient appetite, and a general failure of the Adtal powers, ending in a confirmed state of ill-health. The moral alteration is equall}^ great ; sometimes there is an excessive sensibilit}^, which renders the sufferer impatient and ii-ascible ; at others, her ideas are sad, her imagination sombre ; sometimes the patient seeks for sohtude and sheds causeless tears ; again, on the contrary-, she becomes pas- sionately fond oflnusic and amusements of all kinds. The general health rarely suffers before three or four successive periods have passed, unless it be accompanied by consider- able leucorrhoea. If the menses do not occur after suckling, and the health of the individual appears to suffer, an examination into the parts should be instituted to ascertain their condition. There may be an obstruction or obliteration of some por- tion of the canal in the neck or mouth of the uterus or of the vagina, in consequence of inflammation following dehv- er}^ The introduction of the finger will satisfy as regards the vagina, but the permeability through the neck of the uterus can only be determined b}^ passing up a moderate- sized bougie (a slender gum elastic instrument). Some care is necessary to distinguish between chronic suppression and pregnancy^ as the patient, if she be in a position to have children creditably, may mistake the sup- pression for the first symptoms of pregnancy. The arrest of the menses, when occasioned b^^ conception, is shortly Derangements of the Menstrtcal Function. 115 breasts, etc. The remedies for this form of suppression will vaiy ac- cording to the cause which has given rise to it, and the state of the sj'stem generall3\ When it is consequent upon disease of the genital organs, or some other part of the bod}", we shall find that, upon the patient's recovery from such disease, the menstrual flow will generall}^ return. When the menses have been superseded by leucorrhoea the proper treatment of it will generally restore the uterine functions. The reader will readil}" perceive, from our previous re- marks, that ever}" deviation from menstrual regularity does not necessarily demand medical interference, for in many cases of earl}^ menstruation, and indeed with young girls generall}", there will, at first, be considerable irregularity, which must not be mistaken for disease. This may also be the case with hearty, robust 3"0ung women, in whom a tem- porary suspension may be caused by cold, excessive passion, or mental emotion, — the flow voluntarily resuming its proper course, after a time, without artificial aid. The rule with the medical practitioner on this point should be, never to interfere^ unless there he some tangible evidence that the health is suffering from the absence of this discharge. TREATMEIVT. In chronic suppression the general health is rarely invaded for the first three or four months of the aff*ection ; up to that period the treatment should be purely hygienic; that is, strict obedience to the phj^siological laws, in the proper reg- ulation of diet, exercise, proper clothing, well-ventilated apartments, avoidance of all excess in passions, amuse- ments, and food and beverages ; strict cleanliness, the avoidance of all those modern luxuries and indulgences 116 Woman^s Medical Companion. which predispose the sj^stem to disease, and, more than all, a careful selection of associates and pursuits, and a strict adherence to the higher law of moralit}', without which the most careful physical and intellectual development is worse than useless. If we find that the i^ulse manifests a tend- ency to excess of action, the treatment should be com- menced with such remedies and regimen as will reduce it to a proper standard, before we proceed to the use of medicines which have a direct tendency to produce the menstruous dis- charge, such as slight bleeding, the application of leeches to the Tulva, etc., pm-ging, and a strict vegetable diet. Under such circumstances, coloc^mth will answer admirably in doses of two teaspoonfuls twice per da3^ After these remedies ' have been persevered in for a time, tincture of cantharides or guaiacum, with a small quantity of opium, ma}^ be ad- ministered, not more than ten drops, in a tablespoonful of water, at a time, and applications of the electro-magnetic batter}' may prove serviceable in cases where aU. other means have failed. This last is, however, a powerful rem- ed}^, which should be emplo^^ed verj^ cautiously, lest it may depress the nervous sj'stem, and thus protract the disease ; when moderatel}' applied, it often rouses into activit}' the energ}^ of torpid organs and functions, but when used to excess, it may altogether destro}' their excitability. It should not be emploj'ed in cases of local congestion or gen- eral plethora, nor during pregnane}^, and should seldom, if ever, be used alone. In man}' cases of suppression, the flow ma}- be reestab- lished b}' the application of simple counter-irritants, stimu- lating poultices, liniments, etc., to the groins, over the ovaries ; with scrofulous constitutions the sirups and tinc- tures of iodine and the various preparations of iron have proved effective, and aloes, mjTrh, turpentine, sa^in, and the sulphates, carbonates, and citrates of iron (as given Derangements of the Mejistrual Fimction. 117 in Prescriptions 6, 8, 118, 119, 120, 306, 307, 308) are ex- tremeh' useful when judiciously applied. Ver3'feTr of the remedies wc have just enumerated, except the u'on and iodine, are applicable to patients of feeble, nervous, or Ij'mphatic temperaments, or who are constitu- tionalh' scrofulous, until their general health has become rees- tablished. Change of scene and occupation, the enhvening influences of the social circle, music, and a judicious varia- tion of the scenes and surroundings, so as not to create ab- normal excitement, will prove the most efficient auxilia- ries in the restoration of the patient to health. As a last resom'ce for the gM or 3'oung woman laboring under obstinate suppression of the menstrual flow, marriage has been recommended b}" man}" eminent ph3^sicians from the tune of Hippocrates to the present da}" ; but we should have considerable hesitation in indorsing the recommend- ation or advising such a course ; as, apart from the moral aspect of the question, i\iQ physical uncertaint}" of the result would not compensate for the risk. We should advise that, whenever practicable, the sufferer from chronic sup- pression should remove to a fresh and dry atmosphere (pre- ferring mountainous localities) ; we should also recommend the use of nourishing food, such as rich soups, hght meats, etc., bitter infusions and gentl}' excitant beverages, mineral waters, dr}' friction, flannel underclothing, cold bathing and swimming, pedestrian and equestrian exercise, healthful games, calisthenics, gymnastics, etc. In conclusion, we would remark, that the moral condition of the patient merits as close an attention as the medical treatment. If we neglect to attend to the state of the mind, menstrual disorders, depending upon certain mental conditions, such as profound dejection, resist all the resources of the healing art ; the}" are generally powerless in remedying the malady in a young woman who is tormented b}" a disappointed or 118 Woman's Medical Companion. unfortunate love. It is to the persuasive eloquence and counsels of friendship, the consolations of a prudent, en- hghtened mother, and especially the gratification of the affections by marriage, ii:lien there is not extreme prostra- tion^ that we are to look, in these cases, for the arrest of the disease at its soui'ce. VICARIOUS ME]VSTRirATIO:V. In cases of suppressed menstruation, where the monthly menstrual effort occurs without secretion on the part of the uterus, and where the sj^stem generalises suffering from the consequent plethora or hregular distribution of blood, an attempt is made b}^ the natm-al powers to afford relief by a discharge of blood from some other part, generally one which is alread}^ diseased or enfeebled. This is called vicarious menstruation, and has been known to take place from the nostrils, eyes, ears, gums, lungs, stomach, arm- pits, bladder, nipples, toes, fingers, from the stumps of amputated limbs, from ulcers, and from the sm^face of the skin generall}^ The mucous membranes, however, of the the lungs, stomach, and intestines, are the most common seats of the discharge. This discharge generall}' comes on suddenly, and continues at intervals for several daj^s. In most cases, it seems to reheve the constitutional distress consequent upon suppression, but does not promote the natural establishment of the function during the interval. In general, it is not followed b}^ more serious consequences than those resulting from the loss of blood. The most dangerous form is when it proceeds from the lungs. TREATMEIVT. The same may be said of vicarious menstruation as of sup- pression, — that medication for the symptom is often worse than useless ; the real object being to rid the system of the Derangements of the Menstrual Function. 119 cause, and not merel3'the effect. Our desire is not so much to compel the return of the menstrual flow, as to cure the pa- tient of that disordered condition of her sj^stem which led up to the suppression. In the words of the eminent Dr. Wm. Hunter : " "With regard to the management of the menses, mj opinion is that you should pay no regard to them, but endeavor to put her to rights in other respects. If jon cure the other disorders, jou. can cure the irregularity of the menses, which is the consequence and not the cause of her complaints." Taken as a whole, the remedies pre- scribed, and the hj^gienic and other regulations given for amenorrhoea, are equall}^ applicable and efficacious in this form of menstrual derangement. {Nos. 118,119,120). MENORRHAGIA, OR EXCESSIVE MENSTRUATIOIV. Menstruation may continue too long, or occur too often, or be too profuse while it lasts ; or all these irregularities ma}' be experienced by the same person. Any one of them will prove a serious irritation and a drain upon the consti- tution : the whole together, if not arrested, will undermine and destroy it. The cause of this, as of all other female diseases, is in a gi'eat majority of cases overlooked. It is not to be attri- buted, as so man}' suppose, to a congested state of the womb, but is usually the result of the inflammatory or ulcerated condition of the uterine neck. In a still larger number of cases it arises from a succession of ovarian abortions. When the blood has run low, and nutrition is defective, as in persons of a consumptive habit, the ovarian vesicles fail to reach maturity. Like other products of the uterine economy, the}" become blighted and abort. And, as these blights occur often, nature is busy every two or three weeks in casting them off. Hence, the excessive and fre- 120 Woman's Medical Companion. — ■ =« ^ quentl}' repeated flow. The}' come and go irregiilarty, and without order, because they spring from processes dkectly in contravention of nature's laws. It is not easy to explain how inflammation and ulceration of the uterine neck should in one case produce suppression and in another profuse menstruation. Yet it is a self- evident truth that such opposite results do come from one and the same apparent cause. Probably the explanation is to be found in the difl'erent degrees of inflammatory action, in the varieties of constitution, and in the various degrees of tenacit}^ with which the vessels hold the blood. Bleeding from the genital organs may be produced by a variet}'' of causes which have nothing to do with menstruation. Suctf hemorrhages are properl}" uterine or vaginal hemorrhages^ and not jDrofuse menstruation. The}' are the result of yi- flammations or tumors within the uterine neck, or of consti- tutional weakness. The womb ma}^ bleed for da^^s, or even for months, from pure debilit}'. As the normal quautit}' of fluid discharged at the monthly evacuation varies in different women, menorrhagia only exists where there is a disproportion between the loss and the power of replacing it. It is the relative^ and not the absolute quantity lost which constitutes the disease, so that seeming derangement should ovXj be considered excessive menstruation when it has an injurious efi'ect upon the gen- eral health. We shall include ever}-^ variet}' of menorrhagia under two gi'eat divisions, principalh' in reference to their severit3\ In the first division are those characterized b}' a sudden gush from the vagina, suddenly ceasing for a few hours, and then again recurring, pursuing this intermittent course throughout the entire period of menstruation. On the other hand, sometimes the discharge goes on regularly, but, instead of being over in three or four da^'s, lasts for ten Derangements of the Menstrual Function. 121 da3's, a fortnight, or even three weeks ; or it may return, in its usual quantit}^, ever}^ two or three weeks ; this last va- riety, more frequently than the other, being connected with that condition of the lining membrane of the uterus which gives rise to leucorrhoea. In this condition, there may be more or less discharge of dots of blood along with the proper secretion, though it rarely occurs in young or unmarried women. The subjects of it are generally women of a torpid or sluggish temperament, whose constitutions have been impaired by disease or frequent childbearing. One or two small clots appear at first, at short intervals, return- ing each time in increased quantity. It is not known, in these cases, whether the discharge is altered in quantity or quaht}^ SYMPTOMS. These are : languor, exhaustion, weakness across the loins and hips, paleness of the countenance, headache, ringing in the ears, and giddiness ; these occur, to a greater or less extent, in the slighter cases. If the disease continues, and especiall}^ if leucorrhoea be present, all these s^onptoms be- come ver}^ much aggTavated — the languor increases, the face becomes sallow, there is an aching pain across the loins, extending around the abdomen, repeated and severe head- aches, and derangement of the stomach and bowels ; and, fiuall}^, there is extreme exhaustion, with a feeble pulse, melancholy, nervous sjnnptoms, ending in dropsy and even epilepsy. A prominent cause, in this ph3^sic-taking com- munity, of this as well as many other ills to which woman is heir, is the enormous amount of quack pills and patent medicines of every variety of form and name. These so-called medicines contain, for the most part, ingredients that operate violently upon the lower part of the intestines adjacent to the uterus, thus determining an excessive 122 Woman^s Medical Companion. quantity of blood to that organ, besides debilitating the bowels and frequently producing piles. At a more advanced i^eriod of life, the most frequent exciting causes of menorrhagia are childbearing and pro- tracted nursing of children, a practice which is extensively carried on among the poorer classes for the avowed purpose of preventing a too rapid increase of the family. This result it achieves very effectually, when it gives rise to this dis- order, but at the untold expense of great loss of health and extreme suffering on the part of the unhappy woman. Tlx- cessive coition is another very prolific source of menorrhagia, and always aggravates the disease. In the severer cases, . conception does not take place, though it not unfrequently does in the milder forms. Menorrhagia ma}" or may not return after parturition, but it necessaril}" predisposes the woman to abortion and miscarriage in subsequent preg- nancies, and, from the excessive relaxation of the i3arts, is largety productive of falling of the womb and vagina. TBEATMEIVT. The primary object is, of course, to remove the cause of the affection if possible. If it arise from excessive nursing, the child should at once be weaned, and marital intercourse should, for a time, be suspended. In any case, she should - be kept perfectly quiet upon her back ; cloths, wrung out in cold water, should be laid over the uterus, vulva, and thighs ; cold, acidulated drinks, such as iced lemonade, solution of elixir of vitriol in ice-water, etc., should be given freel}-, and the introduction of all warm fluids into the sj'stem strict!}' forbidden. The bed-chamber should be kept cool, and the foot of the bed raised about ten inches or one foot above the level ; opium, or some similar soporific adminis- tered, and all conversation prohibited ; and gallic acid, ergot, or (especiall}') cannabis indica (in 5 to 10 drop doses), be Derangements of the Mensti'ttal Fimction. 123 given internall}". If local pains of a continnous or sharp, energetic character exist, belladonna or opium plasters may be placed over the seat of distress with great advantage. Salt-water sponge-baths, daily, specially apphed to the lower extremities, will do much towards relieving the weak- ness in the loins and spinal column. Tonics, especially preparations of iron, should be freely given. If the patient be of sanguine temperament, the diet should be almost ex- clusively vegetable. Tea and coffee, feather-beds, foot- stoves, and stimulating food or drinks must be entirely avoided. If of a lymphatic temperament, the diet should » be generous ; but everji^hing tending to excitement of the uterine sj^stem should be carefully prohibited. The invalid should live in a cby atmosphere, and very moderate exercise should be taken throughout the interval. No melancholy companions should be allowed to visit her, and all mental emotion should be strictl}" avoided. {See also No. 272.) METRORRHAGIA. In the second division of menorrhagia, or Metrorrhagia., as it is usually called, the discharge is more profuse, and its effects more severe than in the first ; and it is accompanied by alterations in the condition and size of the mouth of the uterus, occurs at a later period of life, and is much more difficult of cm-e. SYMPTOMS. The attack commences much in the same way as in the milder form, but not so suddenly, and is not confined to any particular temperament, though it is more frequently found in the sanguine than in the debihtated or melancholic. It rarely appears before the fortieth 3'ear, or after the cessation of the menstrual flow or change of life.. There is, for some time previous to the attack, 124 Woman's Medical Companion. irregularity in the time, quantity, and dui'ation of the menstrual periods, with occasional attacks of leucorrhoea duiing the intervals. TVTien the menses have flowed natu- rally for about twenty-four hoiu's, the bloody discharge appears ; large clots are expelled, and there is a considera- ble increase in the fluid discharged. At the inception of the affection, the dm^ation of the attack is not more than eight or ten days ; but in long-standing cases, it not unfre- quently extends throughout the entke intra-menstrual period. The quantity lost is sometimes very large, producing exces- sive exhaustion and weakness of the loins, a sense of weight or pain in the pelvis, difficulty in discharging mine, great depreciation of general health, excessive constipation, blanching of the countenance, and nervous and muscular prostration or anaemia. The exact change in the uterus and its appendages re- sulting from this condition is not known in detail, but ex- amination reveals the mouth low down in the peMs, the neck more or less swollen, and tilted forward so as to press ui)on the bladder, thus producing the affection we have described. There is sometimes tenderness upon pressure in the neck and body of the uterus, the vessels of which are e^identl}- verj' much congested or engorged with blood, so that the discharge is not the result of secretion, but of the rupture of some of the vascular twigs which ramif}^ the hning membrane of the uterus. The disease, unless the organic changes are very considerable, is not usuall}' obsti- nate ; it ma}' subside by sldlful treatment, or possibly' spon- taneoush' in three or four months, or ma}' continue as man}' vears. CAUSES. These are much the same as in the milder afi'ection akeady noticed, those most subject to the disease being women who live indolent lives, yield too readily to the passions and Derangements of the Menstrual Function. 125 emotions of the mind, dance inordinately, and keep late hours, who are in the habit of tight lacing, and adopting other fashionable absurdities of costume, who take httle or no exercise, are intemperate in the use of stimulants and hot drinks, as tea, coffee, etc., and who are too i^rodigal of marital privileges. This description of excessive menstruation is easily dis- tinguished from the flow of blood arising from organic diseases of the uterus, as corroding ulcers, cancers, x)ol}7:»i, etc., b}^ the irregularit}^ of its occurrence in these diseases, and its persistence after the usual period of this excretion » has expu'ed. TREATMENT. At first, the remedial measures we have alread}^ mentioned should be perseveringly employed ; and if the}^ are found ineffective, as is frequently the case, the use of ergot and other similar remedies must be resorted to ; it may be given in doses of five to ten grains, three times per day. During an attack the patient should be kept in a state of perfect rest, on a hard mattress, covered rather lightly with bed- clothes. All her drinks should be cool and unstimulating, unless she become faint, when a small quantity of wine or brandy may be permitted. At the same time that the ergot is given, cold must be persistently applied to the lower extremities by means of the douche or wet cloths. The precaution of keeping the feet warm should alwa3'S be ob- served. If the discharge is not arrested, it is a matter of serious consideration how far the use of injections of cold water and astringent solutions may be permitted prior to its entu'e cessation, considerable danger attending their use during the period of attack. As soon as the discharge has ceased, curative measures should at once be taken to eradi- cate the disease of which this exudation is so formidable a S}Tnptom. We have found the repeated application of 126 Woman's Medical Companion. blisters to be veiy efficient in diminishing or suppressing the discharge ; and, in our later experience, belladonna plasters have proved specially effective in the removal of pain from the affected region, the swelhng of the uterus rapidly diminishing, the leucorrhosa disappearing, and the parties being able to walk about with comparative ease. (^See No. 272.) The patient is alwaj's hable to a relapse, consequently she should permit two or three menstrual periods to elapse, tak- ing the same precautions and adopting the same medicinal and h3'gienic regulations, so that her health shall be thoroughly reestabhshed, before she resumes her ordinary routine of duties. Should a relapse unfortunately occur, the s3'mptoms must be met again by the same treatment and regimen as before. Dming the intervals, the treatment di- rected under the primar}^ or milder form of the affection, must be strictly observed. The bowels must be kept free, witJiout purging^ and tonics, mineral waters, liberal, nutri- tious diet, moderate exercise in the open air, and freedom from undue mental and bodily excitement must be rigidly adhered to as the rule of hfe. I>YSME]¥ORRH CRIME. But there is a sad, a heart-rending reverse to this picture. The principle of heredity of taste, of habit, and of intellect, necessarily involves an heredity' of vice, of disease, of crime, of sensuality, of dissipation, — of all those abnormahties of moral and mental force which have, in the present as well as the past, transformed this world from a Paradise to a Pande- monium. The 'passions^ in all the fearful intensit}' of then* original parox3'sm, are permanently and indelibl}^ photo- graphed on the foetus. The poor mother, whose period of pregnancy has been marked by a succession of domestic vicissitudes and griefs, cannot wonder that her dear new- born infant is ushered into existence with a prostrated nervous organism, and bears the impress of premature old age on its infantile countenance. What wonder that the offspring of a mother who, during the nine months she has borne her child, has indulged pcrsistcnll}' in the use of the clram-bottle, should, before it is able to wallt, exhibit an unnatural cra^dng for intoxicating beverages, and positively Woinc?i as Wives and Mothers. 137 refuse to take its natural nutriment ! Two-thirds of the drunkards of this present generation have been m(.(de so, and horn with that hereditar}' tendenc}^ to dissipation ; the}' are onh' following out the behests of their nature^ by the development of the germ implanted in them b}' their pro- genitors. In their case, it is a disease, and not a crime. Their parents are the only criminals, — and the parents' crime has culminated in an hereditarj^ curse on the children and children's children. If we desire a proof of the law of heredity in reference to vice., a visit to our State prisons will show that fully 75 per cent, of our 3'outhful criminals owe their iiTcsistible passion for the commission of crime to the moral depravity and physical and mental degradation of their parents. In fact, so firmly established is this truth, that most of our juvenile offenders feel a sort of family 2')ride in tracing their pedigree to the most notorious law-breakers om* criminal records can furnish. Suicidal tendencies are frequently inherited, and sudden deaths at a certain age have been known to run thi'ough successive generations of families. Education may do and doubtless does much to transform and modify, but it never creates. It may make a good musician, but it cannot make a musical genius. It ma}' and does modify hereditary mental and physical defects, but it cannot eradicate them. TRANSMISSI03r OF TRAITS OF CHARACTER. When considered in all then- varied relations, the scales of influence are evenly balanced between the parents and their children ; neither can evade their responsibilities and be found guiltless. A large share of the influence coming from the father is communicated through the mother to the child b}' the impressions she receives from him during the period of gestation. If there is unison of spirit, a harmo- 138 Woman's Medical Companion. nioiis blending of their natiu-es, there is more likely to be an equal mingling of the traits of both parents ; while, on' the other hand, if the husband is brutal, if she loathes his presence, then will the child, in all probabilitj^, be stamped for life with his most undesirable characteristics. Likes and dislikes, of persons, places, and even articles of diet (frequenth^of the most erratic nature), possess the mother's mind dm^ing this period ; she tries to overcome the feeling, but in Tain, and the consequence is that these nnpleasant pecuharities are reproduced in the child. These indisputable facts show us the imperative necessit}^ of making the sur- roundings of the mother as genial and pleasant as j)ossible, if we would have the child all it might be, — -bright, happ}-, and beautiful. HOW PABEIVTS SHOUI.I> I^IVE AFTER COIVCEPTIOIV. The life and surroundings of both parents, before, at the time of, and after, conception, are conditions that du'ectly affect the child. The importance of physical perfection, both in the individual and in the race, cannot be overstated, for upon a sound ph^'sical basis rests strength of mind and soul, and all its multiple mental and moral outgrowths. The sickly in bod}', the depressed in mind, by becoming fathers and mothers, run the fearful risk of multiplying and intensifying the maladies and defects from which the}' suf- fer, and which they have, most probably, received from the neglect or ignorance of their parents. It is incumbent upon the x^arents, therefore, to make constant effort after purity of bodj' and culture and strength of mind, that these desirable qualities ma}' become the birthright of their oflfspring. This can only be attained by a simple but nutritious dietar}-, partaken at regular hoiu's, and selected with due regard to its digestibility and suitability to constitutional peculiarities ; healthful and congenial em- Women as Wives and Mothers, 139 plojTnent, both mental and phj^sical ; judicious and frequent exercise in the open air ; the cultivation of music as a recreation ; and, above and before all, the inculcation and development of a spirit of purity and cleanliness in thought, act, and deed. Human beings must learn, and adopt as an inviolable principle, the fact that sexual appetite was only given as a means of perpetuation of the race, not as a vehicle for lust, reckless passion, and indiscriminate indul- gence in the lowest and most degrading species of sensual gratification. Until both man and woman have been enabled to bring their passions thoroughly under the control of the moral and intellectual faculties, they will never secure a progen}" worthy of their high and holy mission, as the pro- pagators of the highest race of beings known in God's creation. DUTIES OF THE HUSBANI> DURING THE PERIOD OF GESTATIOar. During the last twenty-five years the attention and in- terest of the public has been constantly drawn to the important subject of improvement in stock ; and farmers, stock-breeders, and those who devote their time and atten- tion to the raising of cattle, take especial care in the selection of the finest and most healthy animals, and those possessing the highest qualifications for the purposes re- quired. This having been done, the efi'orts of the owners are concentrated on the preservation of the health of the animals so selected ; their food, their general surroundings, their exercise, and their periods of rest, so that their constitutions shall not be deteriorated or undermined b}^ overwork, neglect, irregularit}^, etc. ; for the experienced stock-breeder is fully cognizant of the fact that, just in proportion as the animal is cared for, and its welfare vigilantly watched, so will he be rewarded by the superior 140 Woinan^s Medical Companion, pli3'sical properties, health, and consequent market-value of the stock so raised. Now, if this be true in regard to the lower order of animals, how much more emphatically so in relation to the human race, in which the maintenance and improvement of the intellectual as well as the ph^^sical faculties are of the most vital importance in the exercise of the reproductive function ! The instances we have cited in the first part of this chapter demonstrate the fact most in- disputably, that these physical and mental qualifications or peculiarities which distinguish either or both of the parents are reproduced and often intensified in the children. It must be presumed, as a matter of com'se, that the husband and wife have been attracted to each other \)j an affinity of taste, intellect, and mental and ph^^sical cultm-e, far above the mere ph^'sical j^erfection sought for by the cattle-breeder or stock-raiser ; but j^et, the same principles must be acted upon, and the same care observed in the one case as in the other. Some of our first physiologists have remarked, and ever3^-day experience has tested its truth, that if 3'ou want to make 3^om' child great and gifted in an intellectual point of A'iew, 3'ou must first make it a " power- ful animal ; " that is, it must be amply endowed with ph^^sical Aigor and health. This deskable object can only be efi'ected by the adoption of a strict and inflexible course of conduct. YOUIt CHII.I> BEGIIVS ITS r.IFE AT THE MOMENT OF co3rcEPTio3ir. The instant that 3'ou have reason to suspect that a new organism has been brought into existence, the united efibrts of yourself and 3'our husband should be du'ected to the maintenance of 3'our health, comfort, and happiness. Your husband should bear in mind that tlie future of your imhorn infant^ morally, intellectually, and physically, entirely de- Women as Wives and Mothers. 141 pcnds upon the course of life pursued b}^ himself and j^ou during the nine months of gestation. You are to live a natural, healthful life ; not one of seclusion, melancholy, or abstemiousness, or, on the other hand, of wild excite- ment, indulgence, and neglect of those wholesome, health- producing home-duties which ordinarity devolve upon the wife in the daily routine of the homestead. But, as the condition of gestation, though perfectly natural, renders the woman susceptible of a constant succession of influences, alike unknown and incomprehensible to her or those with whom she is surrounded, it is the husband's paramount duty to evince towards his wife that self-denial, affectionate solicitude, and vigilant watchfulness and anxiety to an- ticipate her ever}" wish, which an earnest, ardent love would prompt. He must treat her as an intelligent, reasoning being, not as a mere vehicle for the gratification of his passions. He must keep her mind free from all trouble, anxiety, or disturbing influences. Her diet and exercise must be regulated with the utmost care and discretion ; all indigestible or highl3^-seasoned dishes, stimulating bever- ages, late hours, exciting amusements, or arduous labors being especially avoided ; in a word, he must, as a rule, allow her to have her oivn ivay in these matters ; for her own common-sense and inclination will usually prompt her in the right direction. And, lastly, though b}^ no means least, he should seize every opportunity of evincing his affection- ate sohcitude for her welfare, b}^ those little unobtrusive kindnesses and attentions which are so grateful to, and heartily appreciated b}^, ever}' true woman. A strict ob- servance of this course of conduct cannot fail to produce the result so ardently' desired by both parents, — an offspring in the full possession of all the mental and pli3'sical faculties which go to make up the perfect man or woman. 142 Woman^s Medical Companion. SIGXS OF PR.EGXAXCY. The diagnosis of early pregnancy is no easy task : it fre quently baffles the most experienced i^h^^sicians ; therefore i great care and discrimination should be exercised before yenturing upon a i^ositiye assertion. The general condition , of a pregnant woman is a plethoric habit of the bod}^, a | quick, full pulse, and an apparent increase in the circula- \ tion of the blood. The sympathetic action of the seyeral organisms (the brain, stomach, etc.) with the uterus is ! markedly evinced ; yariations in temper and disposition are ■ of frequent occurrence ; the aj^petite is curiously capricious ; \ and the skin occasionall}' becomes sallow, or shows dis- i colored patches in yarious parts of the body. The special i de\dations from the normal ph3'sical condition, or unyar}'- , ing signs by which pregnane}- maj- be determined, are : — . ' 1. Cessation of Menstruation. — The non- appearance of the catamenia at the proper time is one of the first circumstances which leads a woman to suspect her pregnane}' ; and if a second term passes by without their appearance, it is usually looked upon as conclusive. But, strictty speaking, it is not so, for menstruation may be ar- rested by yarious diseases which we haye already described ; or, on the contrar}', it is by no means infrequent that men- struation will continue its course uninterruptedly for seyeral months after conception or during the whole period of ges- tation. Neyertheless, although exceptions of this kind do occur, when menstruation ceases without au}- perceptible cause, the woman otherwise remaining perfect!}- healthy, we take it as pretty good e\'idence that conception has taken 'place. 2. Morning-Sickness, combined with other symp- toms, is of considerable yalue, though, of itself, it is extremely unreliable, because pregnancy frequently occm's Women as Wives and MotJiers. 143 without the shghtest indication of sickness in the morning ; while, in other cases, morning-sickness may present itself, from various causes, and yet the patient not be pregnant. This iiTitability of the stomach, arising from s^mipathy with- the uterus, commences soon after conception, and ceases shortly after the third month. 3. Salivation. — This is sometimes, though far from invariably, present. T^^hen it exists, however, it differs materiall}' from mercurial salivation, inasmuch as there is a total absence of the peculiar odor of mercmialization, and the sponginess and soreness of the gums produced b}' that metal. 4. Enlargeinent of the Breasts. — About two mouths after conception, the woman's attention is called to the state of the breasts. She feels an uneasy sensation of fulness, with a ^thi'obbing and tingling pain in then- sub-, stance, and at the nipples. They increase in size and fii'mness, and have a pecuhar, knottj^, glandular feel ; the areola (the colored ckcle about the nipple) darkens, and after some time milk is secreted. But it must be recollected that the breasts may enlarge from other causes ; this happens with some women at each menstrual period when the cata- menia are suspended, or after the}' cease ; and at such times a milky fluid may be secreted. 5. Enlargement of the Abdomen. — The gradual enlargement of the abdomen, taken in connection with the sjTinptoms already mentioned, enables us to esti- mate with considerable certainty the period of pregnancy at the time the examination is made. Distention of the ab- domen, however, sometimes takes place from other causes than pregnane}' ; therefore, this sign alone is not sufficient to warrant us in pronouncing upon a case. 6. Qnickening. — This term is applied to the first movement of the child within the womb, or rather to the 144 Woman's Medical Companion. first perception of such movement on the part of the mother. Some women labor under the erroneous idea that the child does not commence its life until the fourth month, — the time about which the quickening is usually felt. The fact is, however, we have just as much reason to believe that the child is quite as much alive at \hQ fourth loeek^ and, indeed, from the very moment of concejytion. Quickening sometimes takes place at an earher period than the fourth month, while occasionally it is delayed until the sixth or seventh month. The sensation is, at first, like a feeble pulsation, and, \ though so slight, is often accompanied by sickness at the , stomach, a feeling of faintiiess, and, sometimes, complete H syncope or swooning. By degrees it becomes stronger and | more frequent, until the movements of the extremities are j plainly distinguishable. i PRESERVATION OF HEALTH 1>URIjVG PREGNANCT. 1 I To the vitall}' important question, " How shall perfect i health be secured?" we reply, "By vigilant attention to j dress, diet, and exejxise." These items are of the highest I importance under ordinary circumstances, but in pregnancy j this importance is increased a hundred-fold. 1. Dress. — Lycurgus, the great Spartan lawgiver,, decreed that all pregnant women should wear wide, loose clothing. A similar law also prevailed among the Romans. , The dress should be warm, loose, and light during the | whole period ; and, at this da}^, were there such a law, i and the proper power to enforce it, 3'ou would hear ; fewer complaints of "bad gettings up," " faUings," "pro- j lapsuses," "broken breasts," "weaknesses," and other} complaints which do so much to undermine the constitutions j of married women. Let out 3'our dresses early ; no part of | the dress should be tight ; even garters should be aban- ,' doned ; everything should be loose, so as to allow a free 1 Women as Wives and Mothers. 145 circulation of the blood. Tight lacing is highly injurious : how can it be otherwise ? While nature is gradually in- creasing the capacity of the abdomen to accommodate the steady development of the child, the absurdity of compress- ing the chest with staj's, or girding the abdomen with skirts, would seem patent to an}^ one possessed of common intelli- gence, for they must know that it cannot fail to have an extremely injurious effect on both mother and child. CARE OF THE BREASTS. Special care must be taken that the dress is loose about the breasts. This is highly important, for not un- frequently the breasts and nipples are so flattened out by direct pressure that after confinement there is nothing that can be properly called a nipple left. Sometimes they are almost entkely obhterated, from compression during girlhood, and a continuance of that pressure during married life. But this pressure does not affect the nipple only : the secretor}^ structure of the breast itself is permanently in- jured, and the important function of lactation never attains that state of perfection which it otherwise would. The suf- fering resulting from this state of things to both mother and child is b}^ no means trifling. The breasts should be effect- uall}^ protected from compression of any kind, and should be subjected to careful but gradual development, especially the nipple, their most sensitive part, by the medium of which alone the infant can obtain its natural nourishment. Dr. Trac}', one of the most eminent obstetricians in the United States, suggests the following method for keeping the nipples permanently prominent after they have been once drawn out : " Wind a bit of woollen thread or yarn two or three times around the base of the nipple, t^dng it mod- eratel}^ tight, but not so tight as to interfere with the free cu'culation of the blood." 146 Woman's Medical Companion. Retraction., or deficient development., is not the only difficulty to which the nipples are subject. The most common affections to which they are liable are excoriations, cracks, inflamma- tion, scaly eruptions, and small abscesses. These usually arise from the extreme sensitiveness of the skin, occasioned b}^ the nipple being kept folded down upon the breast by the clothing ; in this waj^, the skin around the base of the , nipple, being folded upon itself, becomes very delicate and thin, and unfitted for the purpose for which it was designed. The natural result is, as soon as the child begins to nurse, the skin becomes irritated and inflamed ; cracks, fissures, or abscesses form, and the mother is subjected to untold misery ever}'' time the child is put to the breast. Now, the main object to be attained in preparing the "breasts during early pregnancy for their future important function, is to thicken and toughen the skin upon and at the base of the nipple. For several weeks prior to delivery, the entire breast and chest should be bathed in cold water daily, and afterwards well dried and rubbed with coarse towels. Some recommend bathing the breast and nipple with brand}'', or various decoctions of herbs ; but I should infinitel}^ pre- fer the cold-water treatment, or simply rubbing the parts upon all sides, and in every direction, wdth the palm of the dry hand. This rubbing should be commenced soon after the establishment of pregnancy, and continued until con- finement. Should there be tenderness, excoriation, or sore- ness, the parts may be bathed in a weak solution of arnica. DEBAIVGEMENTS BURIKG PREGIVAXCT. The undermentioned derangements during the period of pregnancy^ are not considered in detail, for the reason that they cannot fairly be classed under the head of diseases; but remedies for each of these ailments will be found at the following numbers in the Appendix : — • Women as Wives and Mothers, ' 147 Continued menstruation, 8, 272. Headache and vertigo, etc., 9, 216, 217, 218. Morning-sickness, 10, 214, 331, 332. Constipation, 11, 179, 180, 181, 182, 183. Diarrhoea, 12, 190, 191, 192. Hysteria, or fainting-fits, 13, 231, 232, 233, 234, 235. Palpitation of the heart, 14, 275,. 276. Toothache, 15, 321, 322, 323, 324. Neuralgia, 16, 281, 282, 283. Pains in back and side, 17. Cramps in limbs, back, or abdomen, 18. Varicose or swollen veins, 19. Hemorrhoids, or piles, 20, 225, 226, 227, 228. Jaundice, or icterus, 21, 236, 237, 238, 253, 254. Incontinence of urine, 22, 280. Difficult or scanty urination, 23, 280. Flooding, 24, 219, 220, 221, Miscarriage, or abortion, 25, 259. False pains, 26. FAIiSE PAUVS. Some time previous to delivery (varj'ing from two weeks to a few days) women are frequently much annoyed with what are termed spurious or false 2)ciins. These pains some- times so closely resemble true labor-pains, that it is exceed- ingly difficult to discriminate the one from the other. From this close resemblance arise what are called " false alarms." Now, in view of all this, it becomes quite essential that both patient and nm'se should fully understand the differ- ence between true and false pains. False pains usually differ from labor-pains in the irregularity of their occurrence ; in being entirely unconnected with uterine contraction, and being chiefly confined to the abdomen, which is peculiarly sensitive to touch and movement ; and in their not increasing 148 Woman's Medical Companion. in intensity as they return. True labor-pains commence low down, and are first felt in the hack^ extending gradually to the front, recui'ring with regularity and increasing in in- tensity with each retui'n. Spurious pains arise from Tarious causes, such as over- fatigue, indigestion, cold, mental emotions, constipation, en'ors in diet, and frequently by the active motions of the cMld. TREATMESTT. As these spurious pains, when they come on early in pregnancy, are liable to bring on premature labor, or, when at full term, occasion great distress and loss of rest, it is always desirable to relieve them as speedily as possible. This may generally be effected by one of the following rem- edies, each of which is appropriate to the before-mentioned causes, in the order named : Br3^onia, Pulsatilla, nux vomica, dulcamara, and aconitum. Twelve globules of either of these remedies, dissolved in twelve teaspoonfuls of water, taking one teaspoonful of the solution every half- hour until the symptoms are reheved, will be found effectual. {See Xo. 26.) METHOD OF CAI^CUIiATEVG THE TIME OF CO]VFr3fEME]VT. The time when confinement may be expected, particularly if it be a.Jirst pregnancy, is natm-alty a matter of consider- able importance and interest to the J^oung married woman ; and it is certainlj^ verj^ desu'able on all accounts that it should be as accurately determined as possible. It is impossible, however, b}^ what is called reckoning, or by any other means, to ascertain the exact day upon which labor will take place. There are many circumstances which prevent this ; among others, the uncertainty connected with the duration of pregnancy itself. The nearest approach to the actual time. Women as Wives and Mothers. 149 and the most effective way of meeting the difficulty is to allow 280 da3^s as the full period of gestation — a fact which is proved b}^ the gi'eat weight of experience all the world over. For the purpose of facihtating reckoning, the following tables have been prepared. The mode of using them needs but little explanation : Suppose the lady to be taken unwell on the 28th of December, and continue so until the 31st, the reckoning must then commence on the da}^ following, — the 1st of January. Look for this date on the first column of the January table, and the corresponding dates of quick- ening and labor will be found in the same line ; that is to say, she will quicken about the 20tli of May, and be con- fined about the 8th of October. 150 Woman's Medical Companion, JANUARY. Date of becoming D? iteof Date of expected Pregnant. Quic liening. Confinement. Januakt 1 Ma^ r 20 October 8 2 21 9 3 22 10 4 23 11 6 24 12 6 25 13 7 2^ 14 8 27 15 9 28 16 10 29 17 11 30 18 12 31 19 13 JuN] z 1 .... 20 14 2 .... 21 15 3 22 16 4 23 17 5 24 18 6 25 19 7 26 20 8 .... 27 21 9 28 22 10 29 23 11 30 2^ 12 31 25 13 November 1 26 14 2 27 15 3 28 16 4 29 17 5 30 18 6 31 19 7 Women as Wives and Mothers. 151 FEBRUARY. Date ofbecoming Pregnant. Date of Quickening. Date of expected Confinement, Eebruart 1 June 20 November 8 2 21 9 3 .... 22 .... 10 4 .... 23 .... 11 5 24 .... 12 6 25 .... 13 7 .... 26 .... 14 8 .... 27 .... 15 9 .... 28 .... 16 10 .... 29 .... 17 11 .... 30 .... 18 12 July 1 .... 19 13 2 .... 20 U 3 .... 21 15 4 .... 22 16 5 .... 23 17 6 .... 24 18 7 .... 25 19 8 .... 26 20 9 .... 27 21 .... 10 .... 28 22 11 .... 29 23 .... 12 .... 30 . 2-t .... 13 December 1 . 25 .... 14 2 . 26 .... 15 3 27 .... 16 4 . 28 .... 17 5 152 Woman's Medical Companion. MARCH. Date of Ijecoming Pregnant. Date of Quickening. Date of expected Confinement. March 1 JULT 18 December 6 ... 2 .... 19 7 ... 3 20 8 ... 4 .... 21 9 ... 5 22 .... 10 ... 6 .... 23 .... 11 ... 7 .... 24 .... 12 ... 8 25 .... 13 ... 9 .... 26 .... 14 ... . 10 .... 27 15 ... . 11 .... 28 .... 16 ... 12 .... 29 .... 17 ... . 13 30 .... 18 ... . 14 .... 31 .... 19 ... . 15 August 1 .... 20 ... . 16 2 .... 21 ... 17 3 .... 22 ... . 18 4 .... 23 ... . 19 5 .... 24 ... . 20 6 .... 25 ... 21 7 2^ ... . 22 8 27 ... . 23 9 .... 28 ... . 24 .... 10 .... 29 ... . 25 11 .... 30 ... . 26 12 .... 31 ... . 27 .... 13 January 1 ... 28 .... 14 2 ... . 29 15 3 ... . 30 16 4 ... . 31 17 5 Women as Wives and Mothers, 153 APRIL. Date of becoming Date of Date of expected Pregnant. Quickening. Confinement. Apkil 1 August 18 January 6 .... 2 .... 19 .... 7 .... 3 .... 20 .... 8 .... 4 .... 21 .... 9 .... 5 .... 22 .... 10 .... 6 .... 23 .... 11 .... 7 .... 24 .... 12 .... 8 25 .... 13 .... 9 .... 26 .... 14 .... 10 27 .... 15 .... 11 .... 28 .... 16 .... 12 .... 29 .... 17 .... 13 30 .... 18 .... 14 31 .... 19 .... 15 Septembeb 1 .... 20 .... 16 .... 2 .... 21 .... 17 .... 3 22 .... 18 4 23 .... 19 .... 5 24 .... 20 .... 6 .... 25 .... 21 .... 7 26 .... 22 .... 8 27 .... 23 .... 9 .... 28 .... 24 .... 10 .... 29 .... 25 .... 11 30 .... 1^ .... 12 .... 31 .... 27 .... 13 February 1 .... 28 .... 14 .... 2 .... 29 .... 15 .... 3 .... 30 .... 16 .... 4 154 Woman's Medical Companiofi. MAY. Date of becoming Pregnant. Date of Quickening. Date of expected Confinement. Mat 1 September 17 February 5 2 .... 18 6 3 .... 19 7 4 .... 20 8 5 .... 21 9 6 .... 22 .... 10 7 .... 23 .... 11 8 .... 24 .... 12 9 .... 25 .... 13 . 10 1(^ .... 14 11 .... 27 .... 15 12 .... 28 .... 16 13 .... 29 .... 17 14 .... 30 .... 18 15 October 1 19 16 2 .... 20 17 3 .... 21 18 4 .... 22 19 5 .... 23 20 6 .... 24 21 7 .... 25 22 8 .... 26 23 9 .... 27 24 .... 10 .... 28 25 11 March 1 26 .... 12 2 27 .... 13 3 28 .... 14 4 29 15 5 80 16 6 31 .... 17 7 Women as Wives and Mothers, 155 JUNE, Date of becoming Date of Date of expected Pregnant. Quickening. Confinement. June 1 October 18 March 8 2 .... 19 9 3 .... 20 .... 10 4 21 .... 11 5 22 .... 12 6 .... 23 .... 13 7 .... 24 .... 14 8 .... 25 .... 15 9 .... 26 .... 16 10 27 .... 17 11 .... 28 .... 18 . 12 29 ..... 19 13 .... 30 .... 20 14 .... 31 21 15 November 1 .... 22 16 2 .... 23 . 17 3 .... 24 18 4 .... 25 19 5 .... 26 20 6 .... 27 21 7 .... 28 22 8 .... 29 23 9 .... 30 24 10 .... 31 25 11 April 1 26 .... 12 2 27 .... 13 3 28 .... 14 4 29 15 5 31 .... 16 6 156 WomatCs Medical Companion. JULY. Date of becoming Date of Date of expected Pregnant. Quickening. Confinement. July 1 November 17 April 7 2 18 8 3 .... 19 9 4 20 .... 10 5 21 .... 11 6 .... 22 .... 12 7 23 .... 13 8 24 .... 14 9 .... 25 .... 15 . . . . 10 .... 2^ .... 16 .... 11 .... 27 .... 17 .... 12 28 .... 18 . . . . 13 .... 29 .... 19 .... U 30 .... 20 .... 15 December 1 .... 21 ... 16 2 .... 22 ... 17 3 23 ... 18 4 .... 24 ... 19 5 .... 25 ... 20 6 26 ... 21 7 .... 27 ... 22 8 .... 28 ... 23 9 .... 29 ... 24 .... 10 .... 30 25 11 Mat 1 ... 26 .... 12 2 ... 27 .... 13 3 ... 28 .... 14 4 ... 29 .... 15 5 ... 30 .... 16 G 31 .... 17 7 Women as Wives and Mothers. 157 AUGUST. Date of becoming Date of Date of expected Pregnant. Quickening. Confinement. August 1 December 18 Mat 8 2 19 9 3 20 10 4 21 .... 11 5 22 12 6 23 13 7 24 14 8 25 15 9 26 16 10 27 17 11 28 18 12 29 19 13 30 20 14 31 21 15 January 1 22 16 2 23 17 3 24 18 4 .... 25 19 5 26 20 6 27 21 7 28 22 8 29 23 9 30 24 10 31 25 11 June 1 26 12 2 27 13 3 28 14 4 29 15 5 30 16 6 31 ".... 17 7 158 Woman^s Medical Compajiion. SEPTEMBER. Date of becoming ! Date of Date of expected Pregnant. Quickening. Confinement. September 1 Jaxuabt 18 Jr>-E 8 2 19 9 3 20 10 4 21 11 5 .... 22 12 6 23 13 7 2i 14 8 25 15 9 26 16 10 27 17 11 2^ IS 12 29 19 13 30 20 U 31 21 15 Eebruart 1 .... 22 16 .... 2 23 17 3 24 ]8 4 25 19 5 2^ 20 6 21 21 7 28 22 8 29 23 9 30 24 10 JULT 1 25 11 .... 2 1(^ 12 3 27 13 4 2^ U 5 29 15 6 30 16 7 Women as Wires and Mothers. 159 OCTOBER. Date of becoming Date of Date of expected Pregnant. Quickening. Confinement. October 1 February 17 July 8 2 18 9 3 19 10 4 20 11 5 21 12 6 22 13 7 23 14 8 24 15 9 25 16 10 1^ 17 11 27 18 12 28 19 13 March 1 20 U 2 21 15 3 22 16 4 .... 23 17 5 24 18 6 25 19 7 26 20 8 27 21 9 28 22 10 29 23 11 30 24 12 31 25 13 AUGTTST 1 26 14 2 27 15 3 28 .... 16 4 29 17 5 30 18 6 31 19 7 160 Woman s Medical Companion. NOVEMBER. Date of becoming Date of Date of expected Pregnant, Qnickening. Confinement. NOTZMBEK 1 ^Iakch 20 August S .... 2 21 9 3 22 10 4 23 11 5 24 12 6 25 13 7 26 14 8 27 15 9 28 16 10 29 17 11 30 18 12 31 19 13 Apeil 1 20 14 2 21 15 3 22 16 4 23 .. . 17 .... 5 24 .. 18 6 25 .. 19 .... 7 26 .. 20 8 27 .. 21 9 28 .. 22 10 29 23 11 30 24 12 31 25 13 September 1 ... 2^ 14 2 ... 27 15 3 ... 28 16 4 ... 29 17 .... 5 ... 30 18 6 - Women as Wives and Mothers, 161 DECEMBER. Date of becoming Date of Date of expected Pregnant. Quickening. Confinement. December 1 April 19 September 7 2 20 8 3 21 9 4 22 10 5 23 11 6 24 12 7 25 13 8 26 14 9 .... 27 15 10 28 16 11 29 17 12 30 18 13 Mat 1 19 14 2 20 15 3 21 16 4 22 17 5 23 18 6 24 19 7 25 20 8 26 21 9 27 22 10 28 23 11 29 24 12 30 25 13 October 1 26 14 2 27 15 3 28 16 4 29 17 5 30 18 6 CI 19 7 162 Woman^s Medical Co7np anion, PAHTTmmox, OR coxrrxuMir^T. You hare now arriYed at the tliird great epocli of jour life, on the happy consummation of which all your hopes of future happiness, comfort, and usefulness depend. In a few short hours an entirely new world will have opened to your vision, a new and inexhaustible source of joy, affec- tion, responsibility, and fond anticipation will spring up in your heart, and the httle being whom you are now about to introduce into the world will awaken within you feehngs to which you have hitherto been a stranger, and which language would utterly fail to describe. TTe will, of coiuse, suppose that your physician is in attendance, and that the nurse, — whom you have selected on account of her ex- perience, genial temperament, and skill in the execution of the critical and onerous duties of her position, — has made all the necessary preparations for the comfort and safety of her patient and the •• httle stranger" now about to make its advent. Under these circumstances, it is but natural and proper that you should look forward to a happ}' and suc- cessful tenn illation of your present trouble, for past ex- perience demonstrates that, where both parents are in a normally healthy condition, and ordinary care has been taken, not more than one case in two hundred has a dis- astrous or unfavorable termination, either for the mother or child. CHIIiI>BBRTH. Labor, as we have said, generally takes place at the end of two hundred and eighty days from conception ; but it is not absolutely- certain, for it sometimes occurs pre- maturely, or may be prolonged to the two hundred and ninetieth day, especially in first cases. The commencement of actual labor is usually preceded by some of the following premonitory symptoms : agitation, nervous trembhng. low- Women as Wives and Mothers. 163 ness of spirits, irritability of the bladder, with frequent desire to urinate, nausea and vomiting, flj'ing pains through the abdomen, followed by an increased mucous discharge. The occurrence of true labor-pains may soon be looked for after the premonitory^ symptoms we have described. The pains usually commence in the back, but sometimes the}' are fii'st felt at the lower and front part of the abdo- men, and extend to the loins and lower part of the back. The}' are not constant, but periodical or intermittent, com- ing on at regular intervals of longer or shorter duration. At the commencement they are not actual pains, but rather a feeling of uneasiness. When active pains first begin, they are slight and of short duration, lasting but a few moments, and with intervals of rest lasting from half an hour to an horn- or more. B}- degrees they become more and more frequent, gradually increasing in intensity until labor is completed, which usually takes from four to six hours. Anxiet}^ on account of the length of labor should never be indulged in. If the position of the child is right, protracted labors are no more dangerous than short ones. First labors are generall}- longer than subsequent ones. Your medical attendant and nurse having attended to the requirements of yourself and your new-born babe, your own course of action is self-evident; viz., to render implicit obedience to their instructions, banish all anxiety or thought from 3'our mind, and com't that rest and sleep your exhausted frame so m-gently requires. EVSTRUCTIOIV TO NURSES IIV PARTUBITIOW OR COST- FIIVEMEIVT. It is of primary importance that every woman should be more or less conversant with the necessary cares and duties of a Ijing-in chamber, for the piu-pose, not of making them poor physicians, but of fitting them to become competent. 164 Woman's Medical Companion, efRcient, and trnstworth}' nm^ses, so qualified that in cases of emergency the}' may render intelligent assistance. It not unfrequently happens, especially in quick cases, that the medical attendant may be detained, and delivery take place before he arrives. In such a case how important that the nm'se should be capable of meeting the emergency, and seeming the safety of both mother and child ! Though, as I have before observed, labor is a perfectly natm-al process, and the majority of cases would terminate favorably with none present but an ordinary nurse, yet events may occur which would call for prompt interference, and such interference as none but a well-educated and quali- fied medical man could afibrd. PREPARATIOiVS FOR THE BIRTH. Immediately on 3^om' arrival you should take care that j every necessary preparation is made for the occasion : the i room should be put in perfect order, the clothing for both j mother and child be placed in readiness, arranged in the j order in which they will be required, and x)laced in such a j convenient position that they can be obtained without i trouble. You should also have convenient a pau' of sharp i scissors and a couple of short pieces of strong cotton cord. As soon as possible 3'ou should " make the bed,'* that is, 1 place a square of oiled silli or rubber sheet over the mat- | tress, to protect it and the bedclothes from the "dis- charges." Over this place the under-blanket and sheet, • and upon them two or three sheets folded square. These j will absorb the greater portion of the discharges, lea\ing the dr}' bed-hnen beneath. When you have put the patient to bed, draw up her night-gown above the hips, to escape soihng. Assist her Women as Wives and Mothers. 165 to the best of yoiu' abilit}^ in promoting the expulsive pains and mitigating her sufferings. Place 3^our patient in the most convenient position for the delivery, — on the left side, and near the edge of the bed, the knees drawn up, and a pillow between them. When the last pai-n, which expels the head of the child, comes, receive the child upon 3'om' extended hands, taking care that the mnbilical cord is not wound round the child's neck ; wait patientl}^ until the entire body is expelled, and then convey the bod}' to a sufficient distance to avoid the dis- charges ; place it in such a position that it shall rest easy and breathe freel}'. As soon as respiration is fully established, the lunbihcal cord should be tied at about two inches from the navel, and again a few inches further on, cutting the cord between the two ligatm'es with the scissors. As soon as the cord is tied and cut, the child should be wrapped up closely in a soft flannel blanket which has pre- yiousl}' been well warmed, and then be removed. Immediately after the bu'th the binder should be applied to the mother. This ma}' consist of a folded towel, or other broad bandage, i^laced around the whole abdomen and ex- tending down over the hips. It should be pinned firmly, but not too tight. Be careful to have it smooth, so as to give an even support to the whole abdomen. This is especially serAdceable for the first few weeks, particularly in the case of feeble women, and also when the patient suffers faintness immediately after deliver}'. If j^roperly applied at first, it is very useful in maintaining a certain degi'ee of contraction of the uterus, and giving support to the abdom- inal walls. It also assists in promoting a return to the natirral condition of the abdomen, preventing that loose, flabby state of the abdominal walls which so frequently fol- lows confinement. I recommend that it should be worn 166 Woman's Medical Companion. some time after getting up, as it has a happy effect in pre- serving the natural form and dimensions, especially of women who have many children in the course of a few years. After the placenta or after-birth has been taken awa^', a warm napkin should be applied to the external parts, and the binder tightened, if necessary. The soiled bed-linen should then be removed, the night-dress drawn down, and the patient be induced to sleep. After a few hours' rest, the napkin should be removed, the parts washed with soft warm water, to which a few drops of the tincture of arnica should be added, and another napkin apphed. This opera- tion should be repeated twice or thrice per day for the first few days. The room should be kept neat and clean, well lighted, and well ventilated, and of an equal temperatiu-e, between 67° and 73°. The patient should be kept free from the excitement of company and conversation, for the first few days at least, all visitors or children being excluded but the nurse and attendants. Take care that the patient has appropriate and nourishing, but not exciting food, rigidly following out the phj^sician's orders, who will direct the changes in diet according to the patient's condition. The dii-ections as to the care of the infant will be found in a subsequent chapter. Treatment after Delivery. 167 CHAPTEE YIII. TREATMENT AFTER DELIVERY. Many persons labor under the preposterous impression that it is necessary to keep the chamber constantly darkened, alleging many reasons therefor, the principal of which is, that the infant's e3^es are too delicate and sensitive to bear the ordinary light of day. It would be just as rational to close all the doors, windows, and other apertures to exclude the air, on the supposition that the atmosphere was too strong for the infantile lungs. It is well enough, for the first two or three da3's, that the light should be so modified that its rays should not be too strong for both mother and infant ; but light, equable temperature, and thorough ventilation are as necessary for all in the apartment as food and rest. Let the room be neat and dean, light and airy. Ventilation is far too frequently neglected. Not many years since, the doors of the chamber would be barricaded with sand-bags, and the windows closely encased in weather- strips or some similar material, to preclude all ingress and egress of air, the inmates being thereby obliged to breathe over and over again the same vitiated atmosphere, and thus made painfully susceptible of puerperal and other diseases, which common-sense treatment would have pre- vented. The temperature of the room should always be kept at a given standard, from 67° to 75°. It should not be in- creased, the air "vitiated, or jour own health and life endan- gered, by the excitement of visitors or children, for the first few days at least. All friendly calls should be positively 168 Woman^s Medical Companion, forbidden during the first week, the only persons admitted being your physician and your attendants. AFTER-PAIIVS. These seldom occur as the result of a first confinement^ though they are very frequently met with in second and subsequent labors. They are the direct result of uterine contractions. As a general rule, they commence within half an hour after delivery, and ordinarily cease within thirty or forty hours, though they may continue longer. They vary- much in their frequency, severity, and duration, but are usually unaccompanied by any sense of bearing-down. Within certain limits, their operation is undoubtedly salutary, as they prevent flooding, diminish the size of the uterus, and expel its contents. But when they occur in an aggravated form, and are unduly protracted, — an occurrence not at all uncommon in females of excitable, nervous sensibility,— they should be subdued as speedily as possible. TREATMEjVT. In the event of soreness, local pain, or nervous excite- ment supervening, arnica, coifea, and aconitum may be given in doses of 10 globules every two or three hours. They may also be used in the liquid form externally as a lotion. (For other remedies, see Nos. 16, 17, 25, or 26, according to circiunstances.) FI.OODIIVG AFTER IJELilVERT. Of course in all cases it proceeds from the mouths of the vessels which have failed to contract after the separation of the after-birth. One of the most frequent causes of hemorrhage after de- Treatment after Delivery, 169 livery is mental excitement, caused b}^ too much company, the worry arising from children's noise, depression of spirits from disappointment, and indeed excitement of any kind. It is therefore necessary that all excitement should be rehgiousl}" avoided, and sleep, that great restorer of health and strength, be com'ted. TREATMEIVT. A drop of the tincture of cinnamon in a tumbler half full of water — a teaspoonful every few minutes — has produced happy results in exciting contraction of the womb when all other remedies have failed. Cold water is a valuable auxihary, and in all severe cases should be freely used. Cloths dipped in the coldest water should be applied to the abdomen and genitals and renewed every few minutes ; or pounded ice, if necessary, may be put in bags and applied in the same manner. Cold drinks are also of great service. (Nos. 24, 219, 220, 221.) DTJRATIOIV OF COIVFIIVEMEIVT. It will be advisable for you to lie quietly in bed for six or eight da3'S after delivery. The length of time, however, will, in a great measure, depend upon circumstances ; many women are better able to stand upon their feet within six daj's than others are within three weeks. Should your .general health be poor, your strength exhausted, or the dis- charge profuse, amounting to hemorrhage, and producing gi'eat debUit}', you will be compelled to occupy your bed or couch for as long a period as the s^^mptoms continue. For the first nine daj^s, as a rule, the greater part of your time should be spent in bed, if even your good health should appear to warrant your getting about earlier, as by indis- cretion you might bring on local displacements or other 170 Woinajt's JMedical Companion, serious uterine diseases, whicli would take many 3'ears to recover from, if even they did not become i)ermanent. After this period, you may get up, resting in an easy-chair for a short time every day. When twelve or fifteen days have elapsed, if you feel pretty strong, it would be advisable to take gentle exercise about your room ; but you should not resume your ordinary household duties or go up and down stairs until the close of the third week, nor are you, in reahty, thoroughly recovered until the expiration of the sixth week. i>iET AXD regime:^ dijrevg coxfevemext. By a strict and well-regulated regimen dming confine- ment, you will be able to ward off a gTeat man}' accidents. Great care must be taken that the utmost cleanliness is observed ; in washing the body, warm water should be used, being gTadually reduced in temperatm-e, from time to time, until it is nearly but not quite cold. The linen should be changed at least once in twenty-four hours. The food must be eas}^ of digestion, moderate in quantity, and not stimulating. For the first thi'ee days it should consist of gruel, hght custards, toast, bread, weak black tea, broths, and other similar articles. After the thii'd da}', or when the supply of milk is fully estabhshed, a httle soup, light, nour- ishing meats, such as chicken, lamb, etc., can be partaken of, until, gi-adually, the ordinary diet may be resumed without danger. Ales, wines, coffee, and stimulating diinks generally, which are commonly used to promote the secretion of milk, should be studiously avoided as being peculiarly injurious. Most of these preparations predispose to fcA'ers, and not un- frequently to night-sweats. Coffee especially deranges the nervous s}'stem8of both mother and child, and produces numerous diseases of the digestive organs. For drinks. Treatment after Delivery. 171 weak tea, claret, and cold water, either pure or flavored with sirups, are excellent for women in confinement, as is also broma, which is a specially nutritious preparation of cocoa, and can be procured at any respectable grocery. DISEASES FOI^I^OWIIVG PARTURITIOIV. The IjOCliia. — The discharge of blood which accom- panies dehvery continues for several days afterwards, doubtless from the mouths of the vessels exposed by the separation of the after-birth. After three or four daj^s the character of this discharge changes, and, instead of con- tinuing a mere escape of blood, it takes on the character of a secretion. This discharge is called the " lochia." For the first three or four da3's it continues of a red color, but much thinner and more watery than blood ; it then some- times becomes thick and yellow, but more frequently maintains its watery consistence, and changes its color successivel}^ to greenish, yellowish, and lastly that of soiled water. The duration of the lochial -discharge varies greatly in different women ; in some it is thin and scanty, and ceases in a few da3^s ; while in others it continues for several weeks, and is sometimes so profuse as to almost amount to hemorrhage. As this secretion is necessary to health, its sudden suppression is generally attended with evil results. Frequent washings with soft, warm water should be prac- tised as long as it continues. Suppression of the Lochia. — This may be caused by exposure to cold, errors in diet, or sudden mental emotions. The sjnnptoms are generally chilliness, fever, thirst, headaches, and occasionally delirium, pain in the back, limbs, etc. 172 JJ^o?Hc7/i's Medical Companioii. TREATMEXT. TTaiTQ compresses aroiind tlie abdomen, and warm hip and foot baths will prove excellent remedial agents. For internal remedies, see Xos. 219. 220. Excessive or Protracted LiOcMa. — When the lochial discharge is too profase or continues too long, tepid hip-baths are valuable auxiliaries, and. in all severe or obstinate cases, should be freely used ; complete rest and good nomishment are indispensable to the correction of this derangement. In all affections during or subsecpent to partmition. where the svmptoms do not at once succumb to the temporary treatment. sklLfLil medical aid should at once be obtained. aiTLK-FETER. About the third or fomth day after confinement you may expect your breasts to become distended with milk ; and at the same time you may ex^^erience a cldll, followed, more or less, by fever and headache. This is called milk-fever. It is but seldom, however, that this distm-bance becomes sufficiently serious to call for medical interference, espe- cially if you nurse your own infant, when the milk can, of com-se, be drawn off as soon as it commences to flow. K, however, you do not nurse your child, this fever may become compUcated with other ailments, which it is necessary to prevent. External applications are of little use during milk-fever (excepting the arnica lotion). The milk should be drawn out as soon as possible, either by child or mu'se ; during the continuance of this fever none but the hghtest articles of diet should be partaken of, such as gi'uel, boiled rice, toast, toasted crackers, weak tea, broma, or other equally light food . ( See JVbs. 210.211.212.) Suppressed Secretion of 3Iilk, — The secretion of milk being a natm-al function, its sudden suppression not Treatment after Delivery, 173 unfrequently produces sudden disorders, such as internal or local congestion and inflammation, determination of blood to the head, chest, or abdomen, and the usual train of sjTnptoms constituting childbed fever. The evil effects arising from the suppression of the milk are frequentl}^ of so serious a nature that the slightest diminution in the supply should excite 3'our apprehension and place you upon your guard ; for, in the gTeat majority of cases, at the outset of this difficult}^, the flow of milk may be restored by the administration of Nos. 210, 211, 212. Excessive Secretion of Milk is generally accom- panied by painful distention of the breasts, emaciation, debilit}^, and not unfrequently initiates nervous and inflam- mator}' disorders. In all cases wrap the breasts in cotton batting ; it will reduce the swelling and mitigate the pain. COIVSTIPATIOIV AT^TER COIVFIIVEMEIVT. It is somewhat common to find the bowels inactive for some few da3^s after dehvery, the secretion from the intestinal tube being partially or wholly suspended ; and this is not to be wondered at, when we take into account the great changes going on at this time within the female organism, whereby a gTeat quantity of liquid is discharged from the womb and breasts. This, together with the vicarious action of the skin, demonstrating itself by the increased perspu'ation, amply compensates for the tempo- rary inactivity of the alimentary canal ; and, by this provision of nature, the balance of the s^^stem is kept up. TREATMENT. We cannot too strongi}' condemn the use of aperients in such cases ; as they only tend to promote irritation, which is indeed but the stepping-stone to inflammation. And, besides, the relaxation thus produced always interferes 174 Woma7t's Medical Companion, Tvith the proper secretion of tlie milk. It was, and still is, to a great extent, among " old-school " ph^^sicians, the practice to give a mild cathartic on the second or third day after delivery. What reason or ntility there can possibh^be in such an unwarrantable interference, is totall}' bej'ond our comprehension. Natui'e purposely- pro^ades other means of relieving the system, in order that the patient shall be undisturbed until the uterine organs have been enabled to recuperate their energies and resume their normal form and position. We have frequenth' known the use of- cathartics at this time to produce the most serious results ; but we have never yet seen an instance where any trouble has arisen from this temporary inactivity of the bowels. As a general thing, the bowels will move spontaneously about the fifth or sixth da3\ In very obsti- nate cases, which seldom occur, an injection of lukewarm water, with hnseed oil, will produce the desired result. (Nos. 11, 27, 179, 180, 181, 182, 183.) BIARRIICEA AFTER COjVFI]VEMEi\'T. This should always be looked upon as a highty dangerous condition, and prompt means should at once be taken for its speed}^ removal. It is generally caused by cold, errors in diet, or the abuse of aperient medicines. TREATMEiVT. For appropriate treatment see Nos. 12, 190, 191, 192. RETEXTIOIV OF URIIVE, OR PAIjVFUI. IJRKVATIOX, DUKEVG COJVFIIVEMEiVT. It not unfrequently happens, especially after severe labor, that the neck of the bladder, and the whole tract of the urethi^a becomes extremel}' sensitive, causing painful emis- Treatment after Delivery, 175 sions, and sometimes even entire retention of urine. .This sensitiveness arises from the great amount and long-con- tinued pressure to which the parts have been subjected. Retention of the urine, when it lasts for an}^ considerable length of time, is an extremely dangerous affection, because if relief is not obtained, and the pressure on the inner sur- face of the bladder is not relieved b}^ the removal of the accumulated water, inflammation must necessarily follow. Fortunately, complete retention is seldom met with, and the painful and difficult emissions of urine, which are frequent, as a general thing, ^ield readily to treatment. The appli- cation of warm fomentations to the parts will sometimes be of great benefit, or sitting over a pan containing warm water will often have the desired effect. SORE NIPPIiES. This frequent and exceedingly annoying complaint may, in a large majority of cases, be prevented if proper care of the breasts is taken previous to confinement. Of this we have spoken at large in the article on " Preparation of the Breasts." There appears to be a constitutional tenderness of the skin in some females, which predisposes it, upon the slightest occasion, to the development of cracks and sores of a most distressing nature, which at times prove most obstinate to heal. Wherever a tendency of this kind exists, the utmost care should be taken to avoid the least irritation or abrasion of the skin, either by 3^our clothing, b}^ a shield, if you use one, or by the breast-pump. When a shield. is made use of, it should be frequently and carefully removed, and the parts bathed with a weak solution of tincture of arnica, or brandy and cold water. This will obviate the otherwise certain result of tenderness and con- sequent excoriation. There is no doubt that many cases of broken breasts owe 176 ■■ Woman's Medical Companion. their origin to the reluctance of the mother to encounter the pangs of suckhng her infant while these cracks and fissures remain unhealed. The most frequent form of sore nipples consists of a long, narrow ulcer, about as wide as a horse- hair, and varying in length from the sixteenth of an inch to the whole ckcumference of the nipple. The chief difficulty in healing sores of this nature, jovi will readil}^ observe, arises from their being constant!}' torn open afresh by the efforts of the child in nursing. It is, therefore, ver}' important, especiall}' where the fissures are deep and gape open, that some means should be devised to keep the edges pressed together. This can be accomphshed with a narrow bit of adhesive plaster, or 3'ou can spread some adhesive salve upon a narrow piece of ribbon; the latter, on account of its pliabilit}', I have found to answer the purpose better than the common adhesive plaster. I have also used arnicated collodion in the same manner with great success. This, as well as the other application, will admit of the child's nursing without tearing the fissures oj^en afresh. In all cases, as soon as the child has left the breast, the nipple should be washed with cold water, to which a few drops of tincture of arnica have been added, and should then be thoroughh' dried. Then, taking the nipple between the thumb and the first two fingers, gentty compress it. This is done for the pm-pose of disgorging the small vessels that have become distended by the suction of the child. As soon as 3'ou have rendered the nipple soft and fiexible, cover it over thickl}' with powdered wheaten starch or gum arable. Pulverized white sugar, according to Dr. Hering, makes an excellent application. Should this precautionary treatment prove inefficient, and the fissure in the nipple become sore, and refuse to heal in spite of all 3'our care and attention, you will then have to resort to the use of internal remedies, Treatment after Delivery, 177 to counteract or remove the constitutional taint to wMch the disease generall}^ owes its origin. TREATMEIVT. In the majority of cases, sulphiu* would seem to be spec- iall}' indicated, especially when the nipples are sore and chapped with deep fissures around the base, which bleed and burn hke fire. ^Vhen these fissm-es are large, bleed easih^, and prove obstinate to heal, 3'ou will generally find them to contain little granulations of proud flesh. In all such cases, appl}' burnt alum, or pulverized tobacco ashes and burnt alum in combination. All cases of sore nipples, however, do not present them- selves in the form above described ; sometimes the nipple becomes abraded or excoriated, and even suppuration occasionally takes place. A very important point in the successful treatment of those cases is, to keep the parts p)erfectl3" dry. This, I have already remarked, can best be accomplished by wrapping the nipple in pulverized starch or gum arable. There are numerous domestic remedies, in the form of powders, salves, and lotions, which have been used with various results. Borax, dissolved in mu- cilage of shppery elm, makes a pleasant and serviceable wash ; powdered potter's clay, sprinkled upon the parts, frequently effects a cure. Rehance, however, cannot be placed upon any form of treatment, especially in severe cases, except the internal administration of appropriate remedies. In all cases where external applications of any description have been made use of, the nipple should be carefully cleansed with a little warm milk and water before presenting it to the child. GATHERED OR BROKEIV BREASTS. To make the nature and importance of this disorder per- 178 Woman's Medical Companion. fectly plain and intelligible, we will give a brief anatomical description of the female breast. Beneath the skin on the front of the chest, there lies — one on each side — a large secretory organ, called the mammary gland. It is composed of milk-tubes, nerves, arteries, veins, and lymphatics, the whole being inclosed by a fibrous investment, which also sends out i^rolongations through the glands, dividing it into numerous lobes. Between these frequent membranous divisions, especially near the skin, exist numerous small cells in which fat is deposited, giving to the sui^face its beautiful, soft, smooth, hemispherical form. THE MAMMARY GliAWDS. The nipple is only a bundle of milk-tubes, nerves and blood-vessels, gathered together and covered with a thin derm, or skin. The milk-ducts or tubes, resembling little canals, vary from ten to fifteen in number. When distended they are about the size of a small goose-quill. Starting from the extremity of the nipple they enter the breast, soon become divided and subdivided, becoming finer and finer as they go inward, until each minute tube terminates in a small hollow globule or granule about the size of a mustard-seed, from the inner surface of which the milk is secreted. The number of these little granules it would be impossible to count. If you should take a small s^^ringe and inject each of these ten or fifteen distinct milk-tubes from the nipple with different colored substances, thus filling one canal with yellow, another with green, a third with violet, and so on, until the whole breast was completely distended, you would see no amalgamation of colors, no uniting or coales- cing of tubes, but each injection would follow its own canal, through all its divisions and subdivisions, to its granular termination. Thus, you observe, we can trace the course Treatment after Delivery. 179 of each milk -tube from its exit at the nipple, through all its divisions and divergences, to the actual minute milk-pro- ducing granule, just as we can trace a river on the map from the broad Atlantic, where it empties, to the very springiets among the mountains, where it has its origin. The quantity of milk that a given gland will produce at one time does not so much depend upon the size of the organ as upon its secretor}^ power. With a breast-pump some women can draw out a half-pint from one breast at one sitting ; not that it was actually all present in the breast when she began, but was secreted, as it were, upon demand, the flow of milli only ceasing when the secretor}^ power of the gland becomes exhausted, and then a period of rest is demanded. To carry on this process of milk-secretion, it is necessary that the organ should be supplied with a large amount of blood and nerve-power. Accordingl}", we find numerous branches from large arteries distributed throughout the breast, while by a great number of nerve fibres it is intimately connected with the two great nervous systems. CAUSES OF DISEASE. Dm'ing lactation the breasts are in a high state of activit}^, which, together with their intimate connection with the rest of the S3^stem, renders them exceedingly liable to partake of any disorder, either ph3^sical or mental, which happens to aff'ect a woman while nursing. Thus we shall find ague in the breast, as it is called, arising from a cold, a chill, fright, anger, fear, grief, etc. Gathered breasts not unfrequently arise from a too tardy application of the child to the breasts, or from sudden ces- sation of suckling, occasioned either by the death of the child or an unwillingness on the part of the mother to 180 Woman's Medical Companion. encounter the pangs of nm-sing the infant, consequent upon sore nipples. When the breasts become distended with milk, and all the little milk -tubes are filled and crowded against one i another, you will often find it incomijressible, and its sensi- bility so greatl}^ increased that the least handhng produces great pain. Now, unless this tension is speedil}' reduced, as a natural consequence, inflammation must follow, or fever soon arises, ushered in by rigors or severe chills. A chill acts in the same manner, or at least is productive of the same results ; the breast increases in size from con- gestion of its blood-vessels and consequent obstruction of the milk- tubes ; and the result, if not prevented b}^ prompt interference, as before, will be inflammation and suppura- tion. TREATMENT. The treatment is, of course, to take away the milk, when the breasts soon become cool and flaccid, and the freest handling produces no pain. Do not let the breasts become distended ; appl}^ the child often, — as often as necessary to keep the breasts in proper order. Where hard lumps or cakes are felt deep down in the breast 3^ou must, by some means or other, soften them, and extract the milk. These lumps, or cakes, as the}^ are commonly called, are caused by the milk-tubes becom- ing clogged up ; or rather they become distended, and crowd against each other, until they are so compressed that the flow of milk is obstructed ; and thus one division of the gland becomes caked, while the rest remain open. Nm-ses make use of all sorts of embrocations and hot applications to scatter the cakes, which simpl}^ means to soften and relax these particular tubes so that the milk can Treatment after Delivery. 181 flow. And this inust be done, or inflammation, followed by suppuration , will be the result. AMien the breasts become swollen and very tender, the following receipts may be successfully used: Nos. 29, 136, 137, 138. Should the swelling and tenderness subside, but there still remain limips or cakes in the breast, j^ou will find relief from applying a plaster made of beeswax and sweet oil. The gTcat art in preventing gathered breasts is to keep the breasts well drawn ; -if the child is unable to do it, then3'ou must resort to nipple-glasses, the breast-pump, or, what is better than either, the lips of the nurse or some other adult person. You will seldom find a nurse who will acknowledge that ever such a thing as a broken breast did occur to a patient of whom she had the entire charge ; but all such assertions it is well to take with a few grains of allowance, for in spite of all precautions the breast will sometimes gather and break. In the early stages of this disorder, it is best to abstain from appMng warm poultices, as they have a tendency to in- volve a still larger part of the breast within the suppurative sphere. But as soon as the gathering points, or when it becomes evident that it must soon break, it should be hur- ried along as fast as possible ; and if j^ou employ a ph3^si- cian, he will at this period undoubtedly lance it. Ground flax-seed makes the best poultice : it should be applied wann, and changed once in three hours. When the abscess has opened and the matter has been discharged, the breast should be compressed either by strips of adhesive plaster or a bandage. This you will find will facilitate the process of healing. Should the above remedies fail to produce a cure, you can have recourse to Nos. 29, 236, 137, 138. 182 Woman's Medical Companion. During all the time that the breasts have been gathering, and still after the abscess has broken, the infant should be permitted to nurse ; for you must recollect that milk is se- creted by that portion of the gland which is not involved in the abscess, and it must be withdrawn. If the infant can- not, or refuse to do it, j^ou must resort to artificial means. Diet. — The diet should be plain and nourishing, but not stimulating. CHIIiI>BEI> FEVER, OR PUERPERAIi PERITOIVITIS. I shall not enter into any detailed description of this dis- ease, because I do not deem it safe for any but an experi- enced ph3^sician to attempt its treatment. I shall, therefore, briefly give its nature and characteristic sj^nptoms, together with such remedial measures as will be adapted to the pre- monitor}^ s^^mptoms and first stages of an attack. Definition. — Childbed fever, or puerperal peritonitis, as it is technically called by physicians, is an inflammation of the peritoneum, or serous membrane lining the abdomen and covering the bowels. It is not unfrequently complicated with inflammation of the womb and its appendages. Causes. — Among the exciting causes of this disease, may be enumerated, violence during delivery, taking cold, diarrhoea, irritation of the bowels induced by cathartic medi- cines, severe mental emotions, suppressed secretion of milk, and so on. Symptoms. — Childbed fever is generally preceded or attended by shivering, and sickness or vomiting, and is marked by pain in the abdomen, which is sometimes very much distended, though in other cases it is at first confined to one small spot. The abdomen soon becomes swelled and tense, and the tension rapidly increases. The pulse is fre- quent, small, and sharp ; the skin hot, the tongue either clean or white and dry ; the patient thirsty ; she vomits Treatment after Delivery. 183 freqiienth% and the milk and lochia are usuall}^ obstructed. These symptoms often come on ver}^ acutely, but the}^ may also approach insidiousl}'. But whether the early symptoms come rapidly or slowlj-, they soon increase, the abdomen becoming as large as previous to delivery, and often so tender that the weight of the bed-clothes can scarcely be endured ; the patient also feels much pain when she turns ; the respiration becomes difficult, and sometimes a cough comes on, which aggravates the distress ; or it appears from the first to be attended with pain in the side, as a prominent symptom. Sometimes the patient has a great inclination to belch, which alwa3's gives pain. The bowels are either cos- tive or the patient purges bilious or dark-colored faeces. These symptoms are more or less acute, according to the extent to which the peritoneum is affected. They are, at first, milder and more protracted in those cases where the inflammation begins in the uterus, and in such the pain is not A'ciy great or very extensive for some time. In fatal cases, the swelling and tension increase, the vomiting con- tinues, the pulse becomes very frequent and irregular, the extremities become cold, and the pain ceases rather sud- denh'. The patient has unrefreshing slumber, and some- times deluium, but she may remain sensible to the last. TREATMENT. In all such cases, but little can be done until the arrival of a plwsician ; but temporary alleviation can be secured by administering No. 30, 134, or 135. MtLK-XiEfi, OR CRURA!. PHXEBITIS. Definition, — Milk-leg is the common name given to a peculiar form of disease which sometimes affects women dining confinement. As the name implies, it was once sup- posed that the milk had fallen into the woman's leg. I 184 Woman's Medical Companion, cannot say that ph^^sicians ever took this view of the disor- der, but certainly the people did, and it is no uncommon occurrence to meet with persons who still insist that the milk has gone into the leg, because the limb is swollen and looks vv'hite ; and besides, the milk has partially or entirely left the breast. All the reasoning in the world will not make them beheve differently. But it is the sheerest non- sense to say that the milk has fallen into the woman's leg, for such a thing is impossible. Physicians, now, who know anything about the disease, call it crural phlebitis, which name signifies inflammation of the veins of the leg ; and this is the true seat and nature of i the affection. The swelling of the limb is due to the effusion j of l3'mph and serum from the blood into the cellular tissue. I Causes. — The origin of the affection may generally be I found in exposure to di'aughts, severe cold, or sudden alter- nations of temperature. ! Symptoms. — The ordinary premonitory symptoms i of an attack of this disease often resemble and are not un- j frequently mistaken for after-i^ains. There is uneasiness or I pain in the lower part of the abdomen, extending along the j brim of the pelvis through the hips. The patient is irrita- 1 ble, depressed, and complains of great weakness. Often, I however, there will be no precursory symptoms, the patient I being suddenly seized with pain in the groin or calf of \ the leg, and not unfrequently she will complain of pain in 1 the hip-joint, calling it neuralgia or rheumatism. As soon j as the inflammation is fairly set in, the region about the groin I becomes tumefied; and in a short time, — twenty-four or | forty-eight hours, — the thigh becomes swollen, tense, white, j and shiny. The swelling, which sometimes increases the limb to the size of a man's body or an elephant's leg, may j. be confined to the thigh, or it may extend down to the foot, j When the pain commences ni the calf of the leg, the swelling , Treatment after Delivery, 185 is first observed tliere, and graduall}' extends itself up tlie leg and thigh. The temperature of the limb is generall}' increased, although in some cases it falls below the natural standard. Along the course of the inflamed vein, although there is great tenderness, there is neither redness nor other discoloration. In most cases, the vein may be traced from the groin down the thigh, feeling hard, and rolling under the finger like a cord. Either leg may be affected, although the left appears to be more frequently attacked, and it not imfrequentty happens that the sound leg participates in the disease before the affection is entirely removed, and then it runs a similar course the second time. TREATMEjVT. The treatment of this disease should be undertaken only by an experienced j^hysician. A few remedies, which may be used at the commencement of the attack, wiU be found at No. 31. IVURSIIVG SORE MOUTH. In this disease the soft part, and sometimes the whole interior of the mouth, becomes very red, and so sensitive and tender as to render it almost impossible for the patient to partake of any solid food whatever. This is quite a different disease from what is generally called canker sore mouth. In some females it appears to be constitutional. As I have before remarked, the breasts are intimately connected with the whole nervous system ; 3^ou will not be surprised, therefore, to learn that this form of sore mouth arises from the peculiar irritation which the act of nursing- produces upon the digestive organs . If not properly treated, it sometimes becomes so severe, and is attended with so much suffering and debility, that the weaning of the child becomes absolutely necessary, and has a magical effect upon 186 Woman's Medical Companion. this disease, — the whole of it vanishing as soon as nursing is discontinued. (Nos. 32, 285, will be found serviceable remedies.) Diet and Hegimen. — The diet of a woman suffer- ing from nursing sore mouth should be generous and nourishing, but not flatulent. Whatever articles of food are found to disagree should be strictly avoided. Exercise in the open air would be found beneficial. PEHSPIRATIOW AFTER I>EIiIVERT. The increased perspiration which takes place immediate^ after delivery, and continues for several daj^s, acts, as I have before remarked, as a substitute for the suspended mucous secretion and consequent inactivity of the alimen- tary canal. Therefore, its sudden suppression from expo- sure to cold, or a sudden chill, is unavoidably followed by some injurious result, not unfrequently gathered breasts, diarrhoea, or childbed fever. No. 33 will meet the ordinary emergencies of the case. EXCESSIVE PERSPIRATIOIV AFTER DEIilVERT. Excessive perspiration, besides causing great debility, predisposes to other disorders, by the high susceptibilit}^ of taking cold which it occasions. It is sometimes occasioned by the too high temperature at which your room is kept, in which case the remedy is obvious. When it still remains, after the proper regulation of the temperature of your room, and the removal of all superfluous clothing, • or when the perspiration is profuse while lying still, but diminished by moving about, remedies No. 34 will prove eflScacious. i I The Care of the Infant, 187 CHAPTEE IX. THE CARE OF THE INFANT. Let us now return to the infant, which, you will remem- ber, we left wrapped in a warm flannel blanket, and laid on one side while the bandage was being applied, and the mother otherwise cared for or attended to. If the infant appears feeble, and its respiration not well established, the skin haying a leaden hue instead of the healthy pink or rose color, it should be permitted to remain undisturbed for some little time, until it is better able to undergo the fatigue of being washed and dressed. Bat if it appears strong, and cries lustil}', it may be washed and dressed as soon as convenient. Some people use cold water to wash the child with, even for the first ablution, under the absurd impression that this earl}^ introduction to the vicissitudes of temperature will invigorate and harden the child, and thus make it less liable to the injurious effects of sudden atmos- pheric changes. I hope Providence has endowed you with more sense than to imagine that any such happy results would follow this barbarous practice. WASHIIVG THE IIVFAIVT. For the whole period of its uterine existence the infant has experienced a uniform temperature of 98° ; now to wash it with or put it into a basin of cold water must give it a shock, which cannot fail to be highl}^ injurious. I would about as soon think of putting the child into a kettle of boiling hot water. In my estimation, the temperature of the water in which the child is first washed should be as 188 Woman's Medical Companion. Mgh as 90° at least ; and this, you will observe, is still eight degrees below the temperatm-e to which, till within a short time, it has been accustomed. It is not necessary that you should stand with a thermometer in one hand, and a kettle of hot water in the other, and thus temper j^our bath to the fraction of a degree. All that is necessary is to be certain that the water is n:arm and so/?, instead of hard and cold. The white caseous substance which, to a greater or less extent, covers the bod}^ of every new-born infant, and which sometimes adheres with gi'eat tenacit}^, can best be removed by rubbing those parts to which it adheres freely with hog's lard or sweet oil, until the two substances become thoroughly mixed, and then wash ^"ith soap and water. Owing to the extreme sensibility of the infant's skin, 3'ou should use none but the finest quahty of white soap and a soft flannel wash-cloth. This is important, for a slight abrasion of the cuticle, or even the least irritation, ma^^ cause troublesome sores. After the child has been well washed, it should be wiped perfectly dry with a fine, soft napkin. THE USE OF POTVDERS. It is customary, as soon as the child is washed and dried, to dust it over with some kind of powder, especially about the neck, armpits, and joints, or wherever the skin is folded upon itself. I would ad"^ise you to get along without this, if 3'ou possibl3^ can, because the powders that are usually sold for this purpose are most of them highl}^ injurious ; and if 3-our child is proper!}' washed and dried, 3'ou will have but little, if an}', call for them. If, however, you think you must use something of the kind, pulverized starch is the best. Both the washing and dressing of infants should be done as expeditiously as possible, and with the greatest care, so as neither to hurt or fatigue them. Duiing this TJie Care of the Infant. 189 daily process of washing, whicli sliould not be done lan- guidh', but briskl}' and expeditions!}', the mind of the infant should be amused and excited. In this manner, the time of washing and dressing, instead of being dreaded as a period of dail}^ suffering, instead of being painful and one con- tinued fit of cr3'ing, will become a recreation and an amuse- ment. In this, treat 3'our infant, from the first, as a sensitive and intelligent creature. Let everj-thing which must be done be made a som*ce, not of pain, but of pleasure, and it will then become a source of health, and that both to body and mind, — source of exercise to the one and of early discipUne to the other. Even at this tender age the little creature may be taught to be patient, and even cheerful, under sufi'ering. Let it be remembered, that every act of the nurse toward the little infant is productive of good or evil upon its character as well as its health. Even the acts of washing and clothing may be ijiade to disciphne and im- prove the temper, or to trj^ and improve it, and may, there- fore, be very influential on its happiness in future life. For thus it may be taught to endure affliction with patience and cheerfulness, instead of crj^ng and fretting at every operation necessar}^ to its well-being. The parent and the nm'se should, therefore, endeavor to throw their whole mind into their duties toward the tender being. And in their intention of controlling the infant's temper, let them not forget that the first step is to control their own. How often have I observ^ed that an unhappy mother is the parent of unhapp}'' childi'en. I>RESSIIVG THE WAVEIi. Most nurses and many physicians have fanciful notions in regard to dressing the navel. Some think nothing will do but a piece of scorched linen ; others want a flannel, either scorched or well besmeared with grease. I am acquainted 190 Woman's Medical Companion. with one old nurse who always keeps a box of powdered cob- web, a little of which she sprinkles over the navel before doing it up with a piece of scorched linen. Now this is all useless ; the simplest way is the best, and that is, to take a folded piece of soft, plain cotton or linen cloth, about six inches long and three wide ; cut a hole in the centre, and pass the cord through. The cord should then be laid up toward the child's breast, and the lower end of the linen or muslin folded up over it. Over this place a compress, made of several thicknesses of soft muslin, about the size of a silver dollar, or perhaps a little larger. The whole is to be kept in place by the belly-band, which should alwa3^s be made of a strip of fine flannel of four or six inches in width. This band should be applied smoothly, so as to give equal strength to the whole abdomen ; pin it just tight enough to keep it in place. For the first few days the condition of the navel-cord should be carefully examined, to see that the child's movements have not disturbed it, nor caused it to bleed. In the course of six or seven days it will become separated from the child, when you can remove it. The parts are now to be carefully washed, and the compress reapplied. If the parts around the navel are not properly washed and dried, and perhaps dusted with a little starch- powder once or twice a day, they are apt to become red and sore. In case of soreness, or inflammation of the umbilicus or navel, after the falling off of the ligature, or even before, you had better give an occasional dose of sulphur. In case there is an evident tendency to rupture of the navel, after the ligature has dropped off, great care should be taken to apply a proper bandage, and this bandage should be worn some time after the cure, as a precautionary measure against its return. TJie Care of the Infant. 191 Cr^OTHIlVG OF INFANTS. I presume it will be entirel}' useless for me to say one word in regard to the infant's dress. Fashion dictates here, as well as ahiiost ever^^where else, frequently to the detri- ment of the child, and alwa3^s to the great inconvenience of the mother. But this has ever been the case, and I pre- sume alwa3's will be. However, I would have 3^ou remem- ber that the power of generating heat at this early period is very feeble indeed, and the child up to this time has been confined in a temperature of 98°, and at the same time most perfectly protected from the possibihty of atmospheric changes. You will therefore see the necessity of clothing the infant warml3^ Flannel should always be worn next the skin, for various reasons. First, it is warmer, being a bad conductor of heat ; and, what is very important, it is much lighter than cotton goods ; besides, it is a bad con- ductor of electricity. The flannel should of course be hght, soft, and of the finest textm-e. In my opinion, if your child's clothing were all made of this material, it would be far preferable to any other ; jow. would then have a loarm^ light dress ; whereas, should j^ou use cotton, it will require a much greater weight of it than of flannel to obtain the same amount of warmth. Besides, cotton or linen goods do not produce upon the skin that healthy degTce of friction which flannel does. No doubt you will object to flannel frocks, and sa}^ they do not look as nice and prett^^ as tucked or ruffled muslin ones do. Well, I do not think they do ; but you will acknowledge that health and comfort should alwa3-s be studied in preference to appearance. Another important item in infants' dress is looseness ; the clothes should be so adjusted as to admit of the freest motion of the chest and hmbs. The imperfectly developed organization of the child, you will bear in mind, is liable to 192 Woman's Medical Companion. compressions and distortions from the most trivial causes ; many of the bones are as 3'et but mere hgaments, and as easily bent as the twig of a tree ; the ribs, from, the slightest pressure, may become crowded from theu' natm'al position, making the child x^igeon-breasted, or deformed in, other ways. THE ESSEIVTIALS OF EVFANTS' CI.OTHIIVG. The essentials of the clothing of children are lightness, simplicity^ and luarmth. By its being as light as is con- sistent with warmth, it will neither encumber the child, nor cause any j^aste of its powers ; in consequence of its sim- 'plicity, it will be readily and. easily put on, so as to prevent many cries and tears ; while, by its looseness, it will leave full room for the gi'owth and due and regular expansion of the entke form, a matter of infinite importance for the seeming of health and comfort in after-hfe. Short sleeves and low-necked dresses are never suitable^ under any circum- stances, for children or 3'oung persons, much less a delicate infant. To leave the neck, shoulders, and arms of a child nearly or quite bare, however warml}' the rest of the body ma}^ be clad, is a sure means of endangering its comfort and health ; violent attacks of croup, bronchitis, or even inflamma- tion of the lungs, pneumonia, angina, catarrh, general fevers in cold seasons of the 3'ear, and bowel complaints in sum- mer, and the seeds of pulmonar}^ consumption, are often induced b}' this irrational custom ; and it is not improbable that the foundation of pulmonar}^ consumption is often thus laid during childhood. It is an important precaution, there- fore, to have the dress worn by children so constructed as to protect the neck, breast, and shoulders, and with sleeves long enough to reach the wrist. The fact is, that vanity is, in man}^ persons, a stronger passion than parental love ; but it should never be forgotten, in reference to the di'ess TJie Care of the Infant. 193 of infants, that the power of generating animal heat is lotvest at the time of birth, and gradually increases loith the advanc- ing age of the individual till past the period of childhood. APPARENT I>EATH, OR ASPHTXIA. It sometimes happens, after severe or protracted labor, that the new-born infant presents all the appearance of being dead ; it does not breathe, the blood does not seem to cir- culate, and there is no apparent motion. This may be termed the first danger to which the infant is subject on its entrance into this world of trouble and vexation. Cases of this kind demand the energetic and immediate attention of the ph3^sician and nurse ; for, if means are not sj)eedily taken to revive it, the child will not probably recover from this suspension of vitalit}^ The first thing to be done is to place the child in such a position that there will be no impediment to the circulation through the umbihcal cord ; then wrap the body and limbs in warm flannel cloths, and rub the hands and feet with soft, warm flannel, or with what perhaps is better, the warm, naked hand. Ordinaril}^, this will be suflftcient to reestablish the circulation ; the pulsation in the cord will soon manifest itself, the action of the heart will become apparent, breath- ing will soon follow, and nothing more will be required. "When the infant has fully recovered, the cord may be tied and divided. Now and then, however, cases do occur which do not jield so readil}", but we must not be easily discour- aged in our eflbrts, for infants have been restored after laboring with them three or four hours ; we should, there- fore, persevere, as our eflbrts may ultimately prove suc- cessful. If, after rubbing the infant with warm flannels, the naked hand, or some stimulant, for five or ten minutes, still no pulsation shall be felt in the cord, it should be tied and 194 Woman's Medical Companion. cut, and the infant be immersed in a warm bath. While in the bath, the friction of the skin should be continued, and the chest pressed and rubbed ; also dip 3'our hand in cold water or alcohol, and rub the breast. Some j)h3^sicians have directed a stream of cold water to be poured upon the chest from the spout of a teapot placed some two or three feet above the infant, and have found the action very efficacious. If, in the course often or fifteen minutes, there is no sign of retmiiing animation, or if there is but feeble pulsation of the cord, and limbs relaxed, or if the face is purple and swollen, taHar emetic should be administered ; and if this fail, opium should be tried. All other means having proved unsuccessful, artificial in- flation of the lungs should be attempted. This ma}' be done by placing 3'our mouth over the child's mouth and blowing gentl}', so as to inflate the lungs, at the same time pressing the child's nostrils between the finger and thumb, so as to prevent the air from passing out through the nose. After the lungs are filled, the chest should be compressed gently with the hand. Care must be taken not to force too i much air into the child's lungs, lest 3'ou injure them. An 1 excellent internal remedy will be found in Prescription No. j 35 ; and a mild current of electricity carefully applied to j the spinal column, nerve centres, and chest, will oftentimes ' prove beneficial. 1 ST\EriIiI]VG AND ELONGATION OF THE HEA1>. j It is quite common for the head of the infant to be swollen ■ and elongated immediately after birth, and especially when the labor has been diflScult or protracted ; sometimes the i head is so drawn out or swollen as to be shockingly de- formed ; and to the uninitiated its appearance not unfre- f quently causes gi'eat alami. In most cases this is but a trifling affection, and generally disappears of its own accord. The Care of the Infant. 195 In case the swelling be extensive, or does not disappear in a day or two, repeated washings with cold water or a weak solution of tincture of arnica will prove beneficial. SW^EIil^IXG OF THE IIVFA^VT'S BREASTS. Sometimes at bu'th, or immediately after, the breasts of infants are found inflamed and swollen. It is onl}'^ a simple inflammation of the gland, and should be treated as such. Our first endeavor should be to reduce the swelling ; and to accomplish this, we generall}'- cover the breast with a piece of lint or soft linen, dipped in sweet-oil. This is all the apphcation I have ever found it necessary to make. Some- times, when the inflammation has been excessive, I have deemed it ad\'isable to apply a poultice of chamomile flowers steeped in warm water. Some authors speak of a propensity on the part of nurses to squeeze the breasts, under the absurd impression that there is milk, or some like mattej*, in them which should be pressed out. I never have had the misfortune to meet with such ignoramuses ; but, nevertheless, I can easily con- ceive how they might do a considerable amount of injury by exciting an inflammation which would end in the suppura- tion and disorganization of the whole breast, and thereby, in • females, destro}' its usefulness forever. THE mecoivitj:»i, or first discharge from the BOWEIiS. The first evacuation from the infant's bowels consists of a dark, bottle-green substance, called the meconium. Nm-ses are never content until the infant has had a free evacuation of the bowels ; and, to make sure of an early movement, they, upon its first arrival, give the little stranger a good dose of some laxative trash. I have often wondered if an infant had the use of its reasoning faculties, what 196 Womaji's Medical Companion, would be its first impression of the inhabitants of this world, where the ladies in attendance, without even saying, " By yoiu' leave, sir," just open its mouth and force down a teaspoonful of molasses, or perhaps the same quantity of some nauseous compound. It must think it had come into a strange land. Now, this does seem to me the most absm'd thing in all the world. Suppose the large intestines are full of meco- nium : hare the}' not been in the same condition for a long time ? ^Tiat is the great haste to get rid of it ? "Will it kill the child if it remains there a few hom's longer ? Xatm-e, who is wise in all her dealings, will take just as good care of the bowels as of the brain or lungs. In fact, she has alread}' made provision for the expulsion of this bugbear in the kind and quality of the milk secreted. in the mother's breast. But it is a fact that some people, in theu' self- conceit, imagine themselves wiser than then* Creator, and, at the very threshold of life, commence marring the truh" beautiful frame of God's image. Although it may seem perfectly rational that the earl}' contents of the bowels, called the meconium, should be pm-ged off, you should never forget that natm-e has made wise provisions for this very want. As soon as the mother feels herself sufficiently recovered to permit it, the infant should be placed at the breast, where it will obtain just the quality and quantity of medicine neces- sary for its welfare. THE rSES OF COIiOSTRFM. The generally received opinion is, I am well aware, that at this early period there is no milk secreted, and this is true ; but every physician knows, and it is high time that mothers and nurses were aware of the fact, also, that there is secreted within the mother's breast, long before the bu-th of the The Care of the Infant. 197 infant, a fluid technically called colostrmn, exactly fitted for, and containing the properties to produce just the necessary amount of mechanical action in the alimentary canal to assist in the expulsion of the meconium. If the mother is able to nurse her child, absohitel}^ nothing should be allowed to enter its mouth, for the first few days at least, but what it gets from her, except perhaps a little cool water, which all children should have. The nurse should always be careful to wash the infant's mouth out well with cool water every morning. The colostrum fm-nished by the breast does not act like physic, producing a succession of stools, but more slowly, so that it may take two or three days for all the meconium to pass away ; but when the work is thus once done, it is well done. Mothers need be under no apprehension should a tempo- rary delay occur in the passing of the meconium ; far greater evil results from the violent method taken for its expulsion than could possibly occur from its continuance in the alimentary canal for a longer period than natural. Should, however, an unusually long period elapse, and the child appear costive, uneasy, and restless, a few teaspoonfuls of warm sugar and water may be given to it, which will generally have the desired eflect. ISITRSING. Every healthy and well-organized woman should support her child from the natural secretion of her own bosom, which is the dicta of both nature and reason. The mortality among infants fed wholly on artificial nourishment is far greater than among those which are nourished from the maternal source. It is extremely difficult to estimate the injury sustained by the infant being deprived of its natural food ; as farinaceous and other artificial substitutes, however 198 Woman* s Medical Companion. carefully prepared, cannot possibl}^ supply its place. No animal refuses to nurse its 3'oung ; it is only among the human species that we find mothers cruel enough to deprive a new-born infant of its natural food. If this is done from wilful neglect or indifference, mothers often pay dearl}" for such violations of natui'e's laws. If the bab}- is allowed to nurse as soon as it seems hungry, and the mother has ob- tained rest, there mil be no need of giving any other laxa- tive or cathartic, such as molasses, castor-oil, etc., for nature has made all the provision in this direction which is necessar}'. For the last fifteen or twenty years I have not given, in a single instance, any form of laxative medicine to new-born infants, aside from that nourishment provided in the mother's breast ; and I am satisfied that children do much better without than with such articles as are frequently given to them to move their bowels. The nearer we follow nature the better. If the infant is fed a few times before nursing, it often loses the faculty of nursing, and it is, in such cases, exceedingly diflScult to induce it to nurse. WrRSING NECESSARY TO HEAT.TH. Nor does the child alone suffer from its not being allowed to nurse. It is exceedingly rare for a woman's constitution to suffer from the secretion of milli ; but, on the contrary, their health is, very generally, materially improved by the performance of the duties of nursing. Parental affection, and occasional self-denial, would be abundantly recompensed by blooming and vigorous children. Bj' this practice, too, the patient is generally preserved from fever, inflamed or broken breasts, and other maladies. Where the supply of milk is not sufficientl}^ copious, or the mother is not sufficiently strong and vigorous to main- tain the infant's demand for sustenance, both mother and The Care of the Infant. 199 child ma}^ be materially benefited b}" feeding the infant with nicelj'-made panada, gruel, or farina, in the intervals of nursing, thereby averting the undue drain on the mother's strength, and aiding the infant in its approaching period of dentition. REGIMEIV ©ITRIiVG IVITRSIIVG. It is of the utmost importance that nothing should occm' to the nursing mother that may interfere with or arrest the secretion of milk, or alter and diminish its nutritive qual- ities. Nature alwaj's provides for her new-born, and the fountain of life which she has opened within the mother's bosom would ever give forth a bounteous supply of pure and healthy nom-ishment were it not for our follies, sins, and fashionable dissipations. Mental and moral emotions, improper diet, and irregular habits have a decidedlj^ injurious effect upon both the quan- tity and the quality of the milk. This is a point which it seems almost superfluous to discuss, but, nevertheless, in the face of all the proofs which can be brought in support of this fact, there are still in existence those persons who wholh^ ignore the idea that mental emotions or changes in diet in any wa}^ affect the lacteal secretion, and who very much doubt that errors in diet ever produce an}' very marked changes in the quality of the milk. COIVSEaUElVCES OF IMPROPER I>IET. Now, who has not seen children suffer from indigestion, vomiting, colic, and diarrhoea, in consequence of the mother having indulged in a very rich diet ? Some parents cannot even partake of fruit or vegetables, or make the slightest change in then* food, without its having an immediate effect 200 Woman's Medical Companion. upon the nursling. I would not, for a moment, counsel entire abstinence from fruits, vegetables, or any other ordinary article of food, but only emphatically enjoin the greatest and most vigilant watchfulness and care in selecting the articles and regulating the quantit}^ to be eaten. We are all aware that butter made from the milk of a cow fed upon Swede turnips, or garhc, or strong- smelling oils, herbs, or plants, will contain the flavor and odor of that plant or substance, to a greater or less extent. The same principle obtains, most markedly, in the maternal secretion. The worst case of cohc, I think, that I ever saw in an infant was produced by the nm'se eating unripe fruit. I am acquainted with a lady who cannot eat the least thing that is at all sour or acid but that her nursing infant is sure to have an attack of colic. It therefore fol- lows that a nursing mother should be specially careful in the choice of her nourishment, in order to impart to the milk such properties only as will make it a wholesome and nutritive agent. Plain, wholesome food, as a general thing, will produce wholesome miUv, while a diet of highly-seasoned and fancifully-cooked dishes, served perhaps at iiTcgular hours, and accompanied with tea or coffee, is almost certain to impart something to the milk which will prove injurious to the child. If, after a proper regulation of the diet, the milk still proves unwholesome, you may rest assured that there is some constitutional difficulty resting with the mother, which will have to be removed by internal medication. DIETETIC REGTIIiATIOIVS. The diet should be simple and nourishing ; not too rich nor too stunulating ; bread, fruit, and vegetables may be freely used ; while meats should be partaken of in modera- The Care of the Infant. 201 tion. The mother's own wishes will generally point out what kind of food is most wholesome for herself and child, A little experience will soon teach her what does and what does not agree with her infant ; and if she be a true mother she will be willing to sacrifice some of her choice dishes, her coffee and tea, and any other little luxuries which she finds to disagree with her child. Regularity in eating is of the utmost importance. As I have already observed that a stimulating diet is, under no circumstances, advisable, it may be well here to make a few remarks upon the popular beverages, such as ale, porter, and the like, so extensively made use of for the purpose of increasing the flow of milli. It has been asserted that ' ' no idea can be more erroneous than that women, during the nursing period, stand in need of stimulants to support their strength and increase the flow of milk." A^Tien j^ou come to look into the subject a Kttle, you will find that this is true. ©ETERIORATIOIV OF MIIiK. A great ado was made, not many years ago, by the citi- zens of New York, because the dair^^men from the country and suburbs of the city insisted upon supplying them with swill-milk, or milk secreted by a cow constantly fed upon swill. Now, if people are so opposed to using swill-milk themselves, why will they insist upon manufacturing it for their children, by introducing the alcoholic element into the lacteal secretion ? No one doubts the fact that swill-milk is unwholesome. In the first place, the milk contains more or less of the properties of the substance from which it is manufactured. Now, if you manufactin-e milk by passing swill through a cow, — the udder acting simply as a filter, — you of course get more or less of the properties of the swill, whatever they may be. In the second place, a cow fed upon swill soon becomes diseased, and of course gives dis- 202 Woman's Medical Companion. eased millc. You will now readily observe that the milk which you get, in addition to containing more or less of its original properties, as affected by swiU, is still further con= laminated by being drawn from a sick cow. AriCOHOX^IC lilQUORS IIVJnJRiOUS. Now it is just the same with a nursing woman fed upon ale and porter ; not to so great an extent, it is true, because her diet is not exclusivel}^ confined to one unwholesome article,- but the milk which she produces is unhealth}^, and therefore not a proper nourishment for the infant. Drugs enter largely into the composition of all malt liquors, wines, and brandies, and to a far gTeater extent, too, than is gen- erally supposed. Milk, impregnated with either of these drugged articles, can scarcely fail to engender obstinate and formidable chi^onic diseases both in mother and child. The regular administration of alcohol, with the professed object of supporting the system under the demand occasioned by the flow of milk, is " a mocker}^, a delusion, and a snare," for alcohol affords no single element of the secretion, and is much more likely to impair than to improve the quality of the milk. If a woman cannot afford the necessary sup- ply without these indulgences, she should give over the infant to some one who can, and drop nursing altogether. The only cases in which a moderate portion of malt liquor is justifiable are when the milk is deficient, and the nurse is averse or unable to put another in her place. Here of two evils we choose the least, and rather give the infant milk of an inferior quality than endanger its health by weaning it prematurel}^, or stinting it of its accustomed nourishment. But, as a general rule, a judicious S3'stem of feeding, grad- uall}^ introduced from a very early period in the life of a child, is infinitely preferable to an miperfect supply of poor milk from the mother ; and, if the mother is so foolish as The Care of the Infant, 203 to persist in nursing lier infant after natnre lias repeatedly warned her of her incapacit}' to do so, it is the dnt}^ of the medical man to set before her, as strong!}^ as possible, the risk — the absolute certaint}- — of future prejudice to her- self. The evils which proceed from lactation, protracted be3'ond the abilit}' of the s^'stem to sustain it, may be to a certain degree kept in check b}^ the use of alcoholic stimu- lants ; but we are convinced, from experience and observa- tion, that the arrestation of these evils are only temporary, and that they will, sooner or later, manifest themselves a hundred-fold intensified. Under no circumstances is the habitual or even occasional use of alcoholic liquors during lactation either necessary or beneficial. By the use of alcoholic stimulants the constitution of both mother and infant is stimulated far beyond the limit set b}^ nature. The laws which govern the animal economy are j)ositively in- fringed, and it is impossible that mother or infant should escape the penalt}^ of that infringement. Both will suffer to a certainty in some shape or other, if not immediate^, at some future period. Thousands of infants are annually cut off bj^ convulsions, etc., from the effects of these bev- erages acting on them through the mother. We wish it to be clearl}' understood, then, that when the mother does not furnish a sufficient supply of milk for the wants of the child, a wet-nurse should be obtained, or the child should be weaned immediatel3^ MENTAIi EMOTIONS AFFECTING THE MILK. It is just as important that a nursing mother should pay strict attention to the state of her mind as to her diet and general health. No other secretion so evidently exhibits the influence of the depressing emotions as that of the breast. The infant's stomach is a ver}^ dehcate apparatus for test- ing the quality of the milk, far exceeding anything which 204 Womaii^s Medical Companion. the chemist can devise. How a mental emotion can affect the qnahty of the milk, perhaps it would be difficult to demonstrate, and what that change in the character of the milk consists in, no examination of its physical properties by the chemist can detect ; but, nevertheless, we are well aware that, after severe fits of anger, some change takes place in the milk, which alters it from a healthy, nutritive agent to an irritating substance, producing griping in the infant, and a diarrhoea of green stools. Inasmuch, therefore, as the quality of the milk is vcr}^ liable to be injuriously affected by any sudden or unpleasant excitement of the feelings, or other causes jproducing a constant and continued state of unhappiness, it is desirable that the most assiduous care should be taken to keep the mind in as quiet and happy a state as possible. It may not be practicable for nursing mothers to avoid all occasions of getting angry or sad, but it certainly is possible to avoid all violent and artificial excitement. Grief, of course, is an emotion which we cannot entirely control, and it is not an uncommon occurrence for the loss of a relative or friend to have such a depressing effect upon a nursing mother as to cause an almost total suppression of mill^. EFFECT OF EMOTION UPOW THE IIVFAIVT. It is not unfrequent, either, for a child to suffer from griping pains and green, frothy stools while sick with some other disease, and yet there be no connection between the two complaints. We, as physicians, can readily understand it, but the mother little apprehends that it is all owing to her own anxiet}". Terror which is sudden, and great fear, instantly stop the secretion of milk. Sir Astley Cooper remarks : " The secretion of milk pro- The Care of the Infant. 205 ceeds best in a tranquil state of niind, and with a cheerful temper ; then the milk is regularly abundant, and agrees well with the child. On the contrar}', a fretful temper lessens the quantit3'of milli, makes it thin and serous, and causes it to distm'b the child's bowels, producing intestinal fever and much griping.'* It is absoiutel}' necessar}', therefore, that, if you would have healthy, quiet, and good-natured children, 3'ou should alwa3's 3'ourself be calm, cheerful, and happy. It is not well for a woman to nurse her child soon after having recovered from fright, passion, etc. She should wait until she is perfectl}^ composed, and perhaps it would be as well to draw off a portion of the milk before the child is again applied to the breast. WEAjVING. There is a gi-eat variet}^ of opinion among the members of the medical fraternit}', and a still greater difference in the sentiments and actions of mothers and nurses, as to the period when the infant should be "weaned." There is no doubt that many thousands of infants, from the unskilful- ness, ignorance, and recklessness of their mothers and nurses resfardinoj the withdrawal of natm-e's nutriment and the substitution of unsuitable and badly prepared food, la}' the foundation of many serious chronic, inflammator}', and fatal infantile diseases. I do not hesitate to assert most emphatically that nature herself has plainly and unmistak- ably demonstrated the proper time for the commencement of this process b}' the appearance of the temporary teeth. THE FIKST DEiVTITIOX. The operation of dentition generall}' commences between the fifth and the seventh month of infantile existence, and the first ten teeth have usually cut themselves through by the close of the ninth month, an unmistakable intimation of 206 Woman's Medical Conipajiion. Dame Nature that the digestive apparatus is so far prepared for functional action that it can assimilate and utilize food of a different character to that which it has hitherto obtained from the maternal organism. As the office of the teeth is to masticate and divide the solid portions of om* food, one ma}' very natm'ally suppose that their appearance and gi'owth is a fair index of the development of the infant's digestive organs, and of the capabilities and powers of the stomach, as well as the demands of the general system, in regard to nutriment. If we take the protrusion and gi'owth of the teeth as a guide 'hj which we are to regulate the diet of the infant, we shall undoubtedly come to the common- sense conclusion that some childi'en ma}' be weaned far earlier than others ; so that it is impossible to name a defi- nite age at which all children may be entirely deprived of the breast. As a rule, if the mother be ordinarih' robust and healthy, the child should be fed exclusively from the breast until the first two teeth have made their appearance (say the sixth or seventh month) , when farinaceous food, the juice of light, delicate meats, gTuel, etc., may be alternated with the periods of nursing, so as to accustom the organs to their new aliment. As the other teeth appear successively, the quality of the maternal secretion administered may be less- ened, and the variety and quantity of the artificial food be gradually increased, until the nursing is altogether discon- tinued. There are, as we have said, many exceptions to this rule, which Mill be considered as they occm*. One thing must be specially borne in mind, that the child should never be allowed to swallow solid animal food until the first dentition (that is, all excepting the upper molars and canine teeth) is completed. "We Avill now proceed to notice some of the reasons why it is not always possible to follow the rule we have laid TJie Care of the hi f ant. 207 down. Owing to fever, or some acute or chronic disease, the milk ma}^ spontaneous!}' " dry up," in spite of the utmost care ; or it ma}' be, that, during the wliole life of the mother, there has been a latent tendency toward consump- tion, scrofula, or even cancer, which the excitement during pregnancy, or the nervous shock of confinement, may have brought into activity, and either of which diseases would so contaminate her milk as to render it highly injurious to the child's health if she continue to nourish it at the breast. Again, some mothers are unable to support this constant drain upon their system more than six months without becoming pale, weak, and emaciated, their milk thin and watery, and so deficient in nutriment as to be totally inade- quate to the support of the child. In such a case the child should be Immediately weaned, or recourse had to a healthy wet-nurse. The return of the menses during the period of nursing sometimes, though not always, has a decidedly prejudicial effect upon the mother's milk ; but, as a general rule, it does not render the weaning of the child necessary, especially while the milk continues to agree with it. The same is true if pregnancy should occur while the child is too young to wean, particularly if the mother is strong and healthy ; but it is not advisable to continue that nursing longer than three, or, at the most, four months after the commencement of pregnancy. On the other hand, there are many circumstances w^hich may render it advisable to protract the term of nursing beyond the ordinary period. The child may be delicate and weak, with feeble digestive i^owers ; it may be suffering from some disease incident to teething, or incipient infantile complaint. You would, therefore, naturally wait until the sickness had passed off before you changed its food. Again, it would be hardly prudent to wean a child during 208 Woman^s Medical Companion. the hot months of summer. The months of March, April, May, September, October, and November ma}", all other things being equal, be regarded as the most favorable for weaning children. Some persons are A^erj^ particular that weaning should take place during a certain phase of the moon ; but this is all moonshine. It would be hardly advisable to wean a child during the prevalence of an epidemic among children ; because the morbific influence prevailing produces a strong disposition to disease. Caution upon the points which we have here briefly glanced at ma}^ be the means of preventing a severe fit of sickness, or even of saving the life of 3"0ur infant. STTPPIiEMEKTARY DIET OE EVFAI^TS. It is universally acknowledged as a fact that the mortality among children " brouglit up b}" hand," as it is called, is immeasurably greater than among those who are not de- prived of the maternal source of nourishment. Dr. Merri- man, an eminent London phj^sician, in remarking upon the infantile mortality of that populous cit}", sa^^s : "I am con- vinced that the attempt to bring children up b}^ hand proves fatal in London to at least seven out of eight of these miserable suflferers ; and this happens whether the child has never taken the breast, or, having been suckled for three or fom* weeks onl}', is then weaned. In the country", the mortality among drj'-nursed children is not quite so gTeat as in cities ; but it is abundantly greater than is generally imagined." COT^^'S MIIiK. It is of course primarity necessary that the special food which the child partakes of in addition to or as a substitute for the mother's milk, should approach the quality of that milk as nearly as possible ; and from chemical anal3^sis we The Care of the Infant. 209 find that \^\ adding a portion of loaf-sugar and water to imre and good cow's milk^ we obtain a substitute closely resembling breast-milk. The great requisite, of course, is purity ; and there can be no doubt but that perfectl}' pure, fresh milk from one cow, sweetened with loaf-sugar, and diluted at first with w^ater, and gradually reducing the dilution and giving it pure, is the best diet for young infants ; but the diabolical concoction which is peddled through the streets of all our large cities in wagons, and which is obtained b}^ filtering distillery swill through sick cows, is utterly unfit either for man or beast, and still more for tender infants and feeble children. "VMiat, then, remains to be done? The poor little innocent cannot be fed on such vile stuff, nor can it subsist forever on gruel and the numerous farinaceous mixtures and abominations with which nurseries generally are constantly deluged. The only course that can be taken is to partially avert these disadvantages by taking special care that the child is not overfed. No one will doubt that loading the child's stomach with farinaceous or any other description of food will produce gastric de- rangement. I am thoroughlj^ convinced, from close observa- tion, that it is not so much the article given, as it is the state or quantity in which it is given, that produces the trouble. For instance, 3'ou will find that the gi'uel prepared for chil- dren is made from meal ground ver}' coarse and containing a great deal of feculent matter, as is also the case with pan- ada, crackers, or bread and water, etc. Now, at best, this substance is unfit for the deUcate stomach of a tender infant ; but how much more so is it when you come to feed it after it has been prepared two, three, or more hours ; and, though not actuall}' soiu- to 3'our sense of perception, it has under- gone some change which renders it unwholesome to the infant, occasioning the colic and the gastric derangement which writers attribute to the kind instead of the quality of 210 Woman's Medical Companion. tlie food. Experience also teaches us that we as frequently injure children by overfeeding them as we do by feeding them with unwholesome food. We ourselves are not unfrequently reminded by fits of indigestion that we have indulged our appetites to too great an extent. Some mothers look upon every cry of their offspring as an indication of hunger, and every time the child worries or frets a little it must be fed. By this means the stomach is kept constant^ distended with food, and the inevitable result of such a course — indigestion — will speedily follow. As a general rule, a healthy child from one to three weeks old requires a pint of hreast-milk^ or other food equally nutritious, during the twenty-four hours. At the end of the first month, and in the course of the second, the quantity usually taken by the child increases gradually to about a pint and a half or a quart. FARIIVACEOUS FOOI>. After a thorough investigation of the subject, I am con- vinced that, in cases where the maternal supply is deficient, unwholesome, or entirel}^ absent, the best supplementary diet is that made from finely-gTound rice or barley-flour. This flour is frequentl}^ sold in fancy packages weighing a pound, and in that form, is often impregnated with pepper, cloves, cinnamon, or some other spice, from contact with those articles upon the grocer's shelves ; it is much the best, therefore, to purchase it loose, like ordinary meal. The following is the method b}^ which these articles should be prepared for children's diet : For an infant, take one tablespoonful of the flour — more, of course, for an older child — and moisten it with cold water, being careful to have it well stirred, so that it shall contain no lumps ; then add a little salt and a sufficient quantit}^ of hot ivater, and boil it for ten minutes, during which time it should be constantly The Care of the Infant. 211 stirred to keep it from burning. After it has been removed from the fire, 3'oii should add a sufficient quantity of loaf- sugar to make it about as sweet as breast-milk. The quantity of water which 3'ou should put to a spoonful of flom- will, of course, depend altogether upon the consist- enc}" 3'ou wish to give it. If it is to be fed through a nursing-bottle, it will have to be quite thin (but, from m}^ own personal experience, I have reason to condemn the use of feeding-bottles, as for several reasons they are de- cidedly injurious to the infant, and are the primary cause of many infantile ailments) ; if from a spoon, which is by far the most advisable method, it can be made quite thick, — almost as thick as an ordinary farina pudding. For those children whose bowels are habitually inclined towards constipation, 3'ou will find the barle3"-flour better adapted, as it Jaas a slight loosening tendenc3^ On the contrar3':, for those whose bowels are inclined to be lax, or tend in that direction, 3^ou will find the rice flour preferable. You will observe that I advise that the flour should be cooked with water, not with milk. I do this, not speciall3^ on account of the difficulty of procuring pure milk in the cit3^, but because I have observed that when a child is taking breast-milk, it should not be fed with cow's milk, as it will not assimilate with the breast-milk, and consequentl3^ produces disturbance in the digestive organs. When the mother does not supply any nourishment for the child from her breast, I would recommend you to add a portion of pure milk to the flour and water. These two articles of diet, with the exception of a small quantity of the grav3^ of underdone meat occasionall3^, in addition to the milk furnished b3^ the mother, are all the child will need or ought to have ; and a strict adherence to this simple diet, with as few variations as possible, except in case of sick- ness, until after the temporary teeth have made their 212 Woman's Medical Companion, appearance, 3'oii will find more concluciye to the general health, comfort, and happiness of the child than an}" other 3"ou can adopt. NECESSITY FOR REGIJIiARITT OF I>IET. If it is perfectly true that whatever is taken into the S3"stem and digested is assimilated by the ^ital forces, and goes to make up the tissues of which the body is composed, is it not important that we, who have the selection of the food, should be extremel}' particular regarding the material I from which the thread of life is spun ? Experience has : taught observing mothers, as well as x^hj^sicians and nurses, | after having made a proper selection of food for the infant, | the importance of adhering to one plain, simple course of | diet, and not to be constantly" fl^'ing from one thing to an- | other, giving it cracker and water one day, farina another, j and gruel another. i I have chosen rice-flour and barley because I have found | them to agree with the infant's digestive apparatus better I than an3'thing else ; and I recommend them as a constant | diet, with the exceptions alread}'" mentioned, until after the ! period of first dentition. I After the fifth or sixth month, the food ma3" be of a more ! substantial nature. When the child is taking its food it: should be supported in an eas3", semi-recumbent position' upon the arm or lap of the person feeding it, and should be kept quiet for at least thirt3^ or fort3" minutes after! having received its nourishment. Rest is peculiarl3" favor-, able to digestion, because the digestive organs require ' a concentration of the vital energies upon themselves inj order to enable them to perform this important function ^ with due rapidit3' and ease. Both experience and experi-j ments upon the lower animals have shown that the process ■ of digestion is particularly liable to be impeded by strong ! The Care of the Infant. 213 mental or corporeal exercise or agitation after a full meal. The practice, therefore, of dancIHng or jolting infants soon after they have taken nourishment is decicledl}^ improper. You Tvill notice that all the lower animals, as well as ^-our babe, manifest a disposition to this quietness and repose after eating. We have several times spoken of the impurity of the cow-milk prociured in large cities. For the information and benefit of mothers and nm'ses, we will append a few remarks on the precautions necessary to be taken in its selection and use. METHOD OF TESTIIVG MIIL,K, In the first place, it is of the highest importance that the milk should be taken from a single cow, and not be a mixture of that of several. Then it is essential that, in the case of a verj^j'oung infant, the cow shall have been in full milli for at least three or four weeks, and not more than four months. Cow's milk should be slightly alkaline ; but it sometimes occurs that it is slightly acid, in which case it is ver}^ apt to disagree with children. Hence, in selecting a cow from which to obtain milk for an infant, it is alwaj'S well to test the milk by means of blue litmus-paiDer. Hold the end of a strip of this paper in fresh milk for a short time, and if it changes to a red color, the milk is acid, and not suitable for a 3'oung child ; another cow should therefore be selected. Good milk will change red litmus-paper to blue after some minutes' contact. Litmus-paper can be obtained at the druo-ojists'. If milk which is being used disaorree with a child, or cause disturbance of the stomach and bow- els, it should be rejected, and the milk from another cow tried ; but test the milk as above directed before using it. For an infant, it is important to use the milk which is first di'awn, as it is much weaker than the last which is obtained, 214 Womaji's Medical Companion. and will not require diluting with water, which may impair its quality. The first drawn milk need not be diluted, but should be sweetened with a little white sugar. Milk which has been boiled is not so easily digested as unboiled milk, and it is generally better only to heat it to the right temper- ature for drinking ; and it is best that this should be done by setting the dish containing the milk into a A^essel of boil- ing water. TVET-IVURSES. That the nurse's milk is the best substitute for the mother's milk, we presume will not be questioned. Should any, however, be sceptical enough to doubt it, we have only to refer them to those children who have ' ' been brought up by hand," in comparison with those who have had a nurse. The healthy appearance of the one beside the emaciated condition of the other offers proofs stronger than any argu- ment that we can adduce. Inasmuch as the child will undoubtedly be influenced, to a greater or less extent, both by the moral and ph3'sical condition of the nurse, it is highly important that we should use great discrimination and care in selecting the person to whom we give the entire charge of the infant. It is true we are seldom left much margin for a choice ; often, we con- sider ourselves fortunate indeed if we are able to find a female with a breast of milk who is willing to give her whole time to the care and nursing of another's infant. But, in 3'our eagerness to secure the object of your search, j^ou should not accept the first that offers, irrespective of her general health or moral character ; or else, in after 3'ears, when perchance your child develops a cross and sour dispo- sition, oris afflicted with some ugly eruption, you may have the unpleasant recollection that, in all probability, it took it from its nurse, and then forever blame 3'ourself for what you can never, though 3'ou would gladl3", remove. The Care of the Infant. 215 "We have alread}^ seen that errors in diet, mental and moral emotions, etc., have a decidedly deleterious effect upon tlie milk, changing it from a source of nourishment to a substance which seems to act like poison on the infant. If, then, the delicate organism of the infant is so sensibl}^ affected b}' these changes in the milk, — changes which the most delicate chemical tests are miable to detect, — perhaps we can catch an inkling of the manner in which the whole constitution of the infant might become radically changed ; the whole moral and physical disposition, as inherited from the mother, become supplanted, or at least obscured and superseded by the peculiarities of the moral and physical organization of the nurse in whose hands the infant has been placed. HVFIiUE^rCE OF THE NURSE OIV THE INFAIVT. Humanit}', in the first flush of its tender existence, both in its moral and physical aspect, is not milike the potter's clay ; and, lOve the potters, they who have the handling of it can fashion it into almost any form they please. A child of a kind and loving disposition, confiding, and easily led, is very apt to be led astray by an unprincipled or careless nurse ; while a child who is perverse and shows a preternat- ural disposition to wrong, would, in such hands, be ruined bej^ond all hope of redemption. At no period of life is a child so susceptible of being influenced b}" the unamiable qualities of a companion as during the early months of infancy. The impressions made upon an infant at this early period are not simpl}^ transient, as most persons are apt to think, but they sink deeply into the mind, and do seriously affect, either for good or evil, the whole future character of the subject of them. And, therefore, I would earnestly impress upon the minds of all parents the importance of early atten- 216 WoiJian's Medical Co7ftpanioii. tion to the moral education of children. If there is any- thing in this Tvorld that a child does inherit from its parent or nurse, it is fretfulness, ill-humor, -vicious propensities, and tendencies to physical derangement. ]S"o"vr, if the nurse, in whose society the child is constantly kept, pos- sesses a genial disposition, the prominent points of which are cheerfulness, contentment, gratitude, hope, joy, and love, don't you suppose that, as the child becomes developed, as each mental petal of that mind unfolds to the influence of sun'ounding objects, the impressions it receives are quite different from what the}' would have been had the nm-se | possessed all of those little satanic embellishments which ) we call moroseness, ill-humor, selfishness, env}', jealous}^, || hatred, revenge, and the like ? I am pretty certain you will see in whose hands it is best to place the infant, especially ^ when you come to remember, or, if you do not abeady know, \ to learn, that '' the feelings constitute an ever-acting source i of bodily liealth or disease^ and also a principal som'ce of enjoyment, as well as of suffering ; and that upon their proper regulation most of the happiness and true value of human life .depend." As 3'et I have said scarcely anything in regard to the ; 'physical diseases a child ma}' inherit from its nm'se. These \ are legion^ — acute, chronic, hereditary, and blood-diseases of all kinds. This part of the subject is so palpable to the perceptions of all. that elucidation is unnecessary. QrAt,IFICATI03rS OF A XURSE. I would advise you never to engage a wet-nm'se, however favorably you may be impressed with her appearance, until your family physician, in wliom you put imphcit confidence, has first seen her. In fact, the question should rest upon his decision, especially as to her physical condition. If there is any disease about her, he wiU be able to detect The Care of the Infant. 217 it. The best nurses are those who possess all the evidences of good health : the tongue clean, teeth and gums sound, indicating healthy digestion, breath free from unpleasant odor, the surface of the bod}' free from eruptions, and the insensible perspiration inoffensive, the breast smooth, firm and prominent, the nipples well-developed, rosy-colored, and easil}" swelling when excited. The milk should flow easily, be thin, bland, of a bluish tint, and of a sweet taste, and, when allowed to remain in a cup or other vessel, be covered with a considerable amount of cream. She should be thoroughly healthy, free from an}'' discoverable tendency to chronic diarrhcea, about the same age or even j^ounger than the mother, and delivered at least within a few months of the same time ; let her complexion be clear, skin smooth and healthy, ej'es and ej'elids free from any redness or swell- ing. She should be of an amiable disposition, not irritable, nor prone to anger or passion ; of regular habits, not indulg- ing in any of the forms of dissipation ; naturall}' kind and fond of children. The nurse should make it her dut}' to guard the child as much as possible against diseases. This she will be best able to do by pacing strict attention to her diet and her general mode of li^^ng. A nurse who loves children will cheerfully denj^ herself the pleasure of eating or drinking any articles whatever which injuriousl}' affect her milk. She should, by all means, avoid all heating or spirituous beverages, spices, flatulent food, or food that is very salt. In a word, her diet should be simple and easily digested, consisting of a proper proportion of animal and vegetable food. As little change as possible should be made from her former mode of living, lest the change should affect her health, and thus disturb the child, causing flatulence, colic, diarrhoea, constipation, or some other of children's many ailments. 218 Woman's Medical Companion. CHAPTEE X. INFANTILE AFFECTIONS AND DISEASES OF CHILDHOOD. CRTIIVG, IfVAKEFUIiJVESS, AlVD RESTIiESSlVESS OF IWEAIVTS. f It ma}^ be taken for granted that infants do not cr}' — that is, have frequent and long-continued fits of wying — without there being some occasion for it. What that occasion is can usuall}^ be ascertained upon careful examination. A fit of cr^'ing is not unfrequentl}^ caused by some mechanical j' irritation; the child's dress may be wrinkled, or so adjusted as to be uncomfortable, or a pin may be misplaced or prick- ing into the flesh. Perhaps the most frequent cause of crying in infants is derangement of the stomach and in- testines, such as cramps, colic, griping pains, and so forth. These are indicated by writhing of the body, drawing up of the legs, and diarrhoea. Occasional cr3'ing of infants should cause no uneasiness \ in the mind of the mother, because this is the only method \ b}^ which the child can manifest its wants. It maj^ cry or worr}^ from hunger, or from lying too long in one position ; '' but when attention to these and other particulars, which will suggest themselves to ever}^ thoughtful parent, has been !' given, and the infant still refuses to be pacified, clmmomilla^ v belladonna^ rhubarb^ or some other remedy mentioned in I the Appendix, according to the abdominal and other sj^mp- \ toms, will be found beneficial. I' Ltfantile Affections. 219 Restlessness and wakefulness, like crying, are not dis- eases, but simply symptoms of some derangement of the sj'stem. It is not alwaj's possible to sa}" with exactitude what causes the child to worry and prevents it from sleep- ing. y^Q can often trace it to flatulence, and not unfre- quentl}' to an overloaded stomach, but we are quite as often in the dark as to its cause. Treatment. — Nos. 260, 261. As the difficulty is sometimes occasioned by the condi- tion of the mother's milk, it being in some way unwhole- some, it will be occasionally necessary to prescribe for the mother, as well as to make some restrictions or regulations regarding her diet. DISEASES OF THE AIR-PASSAGES A1VI> LUIYGS. When taking into consideration the alarming prevalence of disease of the air-passages and lungs, especially among young persons and children, half-grown maidens and tiny infants, together with the large percentage of deaths caused thereby, one would naturally suppose that if those who had given this subject its due attention could devise any method whereby these numerous affections could be warded off or prevented, their advice would be eagerly sought for and implicitly followed. But no, it is not till grim disease, in the shape of some appalling epidemic, wrapped in a malari- ous robe, mounts his chariot and comes sweeping over fair sections of our countr}^, spreading dismay and desolation on ever}^ side, snatching from circles here and there a bud, a blossom, or possibly a full-blown rose, that the oft-re- peated advice of the family ph3^sician, though listened to with marked attention, is actually heeded. Ever}' time a ph^'sician is called upon to prescribe for a patient he is reminded of the necessity of administering a short lecture upon the general laws of health, including 220 Woman's Medical Companion. dress, diet, and the like. It is a noticeable fact that sick persons are very penitent, sorry foi* past transgressions, willing observants now of the Decalogue, anxious bej^ond measure to obey implicitly every wish of the physician. But no sooner does the first glimmer of health irradiate their sickly forms than their self-reliance and independence return : — God and the doctor they alike adore, But only when in danger; not before : The danger o'er, both are alike requited; God is forgotten and the doctor slighted. CHIIiWKEIV'S DRESSES. The subject of dress, in connection with this class of dis- eases, is a very important one. Nearly if not quite all the diseases of the air-passages are caused by the sudden chill- ing of the body. Our climate, with its sudden vicissitudes of heat and cold, together with the exquisite method of our American mothers of dressing, or rather I would sa}^, of undressing their children : the low neck, to show the beautiful contour of shoulders and of bust ; the half pants, exposing the knees of small boys — yet what beauty there is in a hoy's knee I never could ascertain, but I presume they must be charming, or certainly they would not be left bare ; all these add their quota to the full development of throat and lung affections. The universal, deplorable ignorance or inattention, or both, in regard to the subject of dress, is astonishing, and cannot be too frequently brought before the minds of those who have the special care of J^oung children. Prevention is in all cases better than cure ; and certain it is that by careful and wise attention to the physical education of young children you can ward off such diseases as croup, bronchitis, laryngitis, pneumonia, and the like, even in those who have shown a predisposition or a liabihty to Infantile Affections. 221 them. Undoubtedly one of the most important means to be made use of is the adoption of a proper dress ; and this, in cold weather, should be one that will cover the whole bodj^ liOTV-lVECKEI* DRESSES. You can see, at an}^ time, ladies wearing warm and com- fortable dresses, with high necks and long sleeves, sitting in the same room with their children, who are almost naked. The dear little creatures, their arms and necks must not be covered up, they look "so cunning" and "so sweet." Their dresses are made so low and loose about the neck that the whole chest, even down to the waist, is virtually exposed. Yet, mark you, as soon as the children grow older, and therefore become stronger, and better able to bear exposure, they are dressed warmer. What inconsist- enc}' ! Is it any wonder that children are more liable to diseases of the air-passages and lungs than adults? O Fashion ! th}^ potent sway fills many an infant grave ! I do not wish to dictate to any i^arent how she should dress her children ; at least au}^ further than is necessary to preserve their health, by protecting them against the evil effects of sudden transitions of temperature. Children should never be dressed with low neck and short sleeves, except in the heat of summer, and in the New England climate not at all. I am well aware that it is the custom so to dress them even in midwinter ; but you 3^ourself would be uncomfortable, to say the least, clothed in this manner ; and how much more so must they be, with their extreme sensibility of skin. WHAT IVURSERIES SHOLTI,l> BE. But, 3'ou ma}^ argue, the child, especially the infant, is never exposed ; the nursery is alwa3^s warm, and it seldom goes out of it: why be so particular to cover the neck 222 Woma7i's Medical Companion. and arms? That is true ; the rooms are always warm, and, in the yast majorit}^ of cases, too w^arm ; but the doors are continually being opened and shut, subjecting the child to a constant fanning. Kow, the nurser}^, or room where the children are kept, should be large, air}-, and well ventilated. Plenty of cool, fresh, and pure air should be constantly admitted, for the purpose of respkation. The temperature, while the chil- dren are well, should never exceed sevent3^-two degrees ; and, genera% speaking, from sixt^^-seven to seventy degrees will be sufficient to be comfortable, provided the children are properly clad. I am aware that j^ou will frequentl}' be told, and that, too, by those who ought to know better, that earl}^ expo- sures harden the children, and make them robust. Would you expect to harden a tender plant b}^ exposing it to chilling winds, or to the cold ^nd biting frosts of a winter's night? Would 3'ou expect j^our flowers to grow, j'our roses to bud and blossom, without the genial warmth of a summer's sun? No, indeed ! Neither can 3'ou harden your children by allowing their little shoulders, arms, legs, or feet to be cold ; and j^ou will often see them so cold that the}^ are fairly blue. It is cruel ; and you may rest assured, that if these chil- dren do not suffer in infanc}^ they will, as they grow up, be more liable to diseases of the air-passages and of the lungs than those who have been properly cared for. Croup is a rare disease among the Germans ; thej' are very particular in regard to children's dresses, taking great care to have the throat and chest well protected. WHAT CHIIiDRElV SHOUIiD WEAR. Delicate children should invariably wear a flannel under^ shirt, or a shirt made of some woollen material, next the Infant lie Affections. 223 skin, made high up about the neck, and with sleeves to come below the elbows. Then put on the accustomed underclothes, and even those had better be made of woollen, not only on account of its warmth, but because it is lighter than other goods ; and over all a stout muslin or a light woollen dress. The stockings should also be of wool, and come high lip, always above the knees. The old way of tying a gar- ter around the leg, to keep the stocking up, is open to many objections. In the first place, it spoils the beauty of the leg, by preventing a full development of the calf, by cutting off, or at least retarding the circulation. This alone would be sufficient reason to condemn it ; but, what is of more con- sequence, it also produces cold feet, and causes congestion of the veins, making them knotty and uneven. An elastic strap, going from a button upon the outside of the top of the stocking to a button upon the waistband of the drawers, will answer every purpose and be quite as convenient. As I have before stated, all children should be accus- tomed to cold (or very slightly tepid) bathing. For puny, weak, and delicate children, subject to croup, catarrh, and cough, in fact, taking cold upon the slighest exposure, I have found bathing, alwa3'S in conjunction with warm cloth- ing, of valuable assistance in strengthening the child, giving a good healthy tone to the S3^stem, and thus protecting it from many diseases to which it would otherwise have fallen a prey. Our city houses are generally warmed — no, heated^ that is the word — with furnaces, another prolific source of disease. The children are virtually parboiled, or rather baked, while indoors, and, consequently, when they are taken out, the first draught of air that strikes the tender little hot-house plant produces a shock, drives the blood from the surface to the dehcate membrane linino; the throat or 224 Woman's Medical Companion, — _ , — _ — ____ lungs, and thus produces some one of the innumerable dis- eases of the air-]3assages so prevalent in our midst. CORTZA, SWUFFr.ES, COI.D IIV THE HEAO. This disorder, which consists of an inflammation and consequent thickening-up of the mucous membrane lining the nasal passages, occurs as a distinct disease ; but it is also frequently connected with inflammation of the lungs, with measles, but more frequent^ with scarlet fever. It attacks all, indiscriminate!}', both old and j'oung. In the older children it is but of httle account, never injuring the general health by its own action ; but in the infant it is quite a different thing, and becomes a serious, even a dan- gerous disease. In these little sufferers, who are unable or unwilling to breathe otherwise than through the nose, it is quite an impediment to respkation, especially after the first few da^'s, when the head and nose become completely filled with a thick, tenacious secretion, which it is impossi- ble to remove. Being prevented from breathing through the nose, the child, when nursing, is obliged to frequently relin- quish the nipple in order to obtain breath, which makes it cross and fretful. When coryza exists in connection with other diseases, it of course adds to their severity. Causes. — As a general thing, cold is the exciting cause. Children, when put to sleep, should never lie with their head toward or near a window, or in any other position where there is the least liabilit}^ of a draught of air, however slight, blowing upon them. A person takes cold much more read- ily while asleep than awake. Nurses are in the habit of covering the child's face with a little blanket after it has been put to sleep. This, by con- fining the breath , invariably produces perspiration. Children covered in this wa}'- alwaj'S waken with their head dripping with sweat, and, when taken up in this condition, are very Infantile Affections, 225 liable to become cliilled, — and snuffles is the result. Do not cover the face. Syniptoms . — All are acquainted with the sjTnptoms of an ordinary cold in the head. It usually commences with shivering, some little fever, sneezing, obstruction, and dr}^- ness of the nose. This drj^ness is soon followed by a dis- charge, more or less profuse, with watering of the ej'es, pain through forehead and temples, as well as about the root of the nose. Of course the little infant does not com- plain of this pain, but the older children do ; therefore we are led to infer that all suffer more or less from it. The secretion from the nose interferes with respiration, and when the passage from the head is completely filled, the patient is compelled. to breathe tlirough the mouth ; and this soon causes drj'uess and stiffness of the tongue and throat. TREAT3IE]VT. For the premonitory' symptoms of corj'za, with shivering and headache, camphor is the best remedy ; and, if admin- istered prompth', a few doses will, in the vast majority of cases, be sufficient to eflfect a cure. In case j^ou have nothing but the ordinarj^ spirits of camphor convenient, 3'ou may put one or two drops upon a lump of sugar, and dis- solve the whole in water. - It is sometimes advisable, when the secretion becomes suppressed, or before it has commenced, when the nose is hot and dry, to appl}^ with a feather or camel-hair pencil a little almond-oil or cold cream to the interior of the nose, or let the vapor of hot water pass up the nostrils. Goose- gTease rubbed upon the bridge of the nose in any quantity is of no earthly use. (Nos. 36, 245.) COUGH, OR TUSSIS. A cough is not a disease in itself, but rather a sjTiiptom denoting an abnormal condition of the limgs or thi'oat. 226 JFomau's ^ledical Cojupanion. Coiigli is a yioleut and sonorous ex|3ulsion of air from the lungs, x^recedecl by, rapidl}' followed by, or alternating with, quick inspii'ations. This, in fact, is but an effort on the part of nature to remove some obstruction or to throw off some accumulation which disease has created. Duiing the course of an inflam- mation of the lungs, there is always more or less mucus secreted ; and, were it not for these forcible and yioleut ex- pirations, the air-passages would become clogged up, and respii'ation materially interfered with. This is but one of natui'e's ways to rid herself of an offending substance : she has many. Tou will see an illusti-ation of this parental care exhibited in the young infant : the child, not knowing how to eject air yiolently through the nose for the purpose of clearing that organ, has been provided with a " sneeze.'* Cough is often combined with a cold in the head, both originating from the same cause, namely, exposurSo In the majority of cases cough is but a shght inflammation or iiiitation of the thi'oat or upper part of the windpipe, ac- companied with more or less fever. Sometimes, where cough originates from a high state of inflammation, the soreness in the throat, the fever, in fact, all the acute inflammatory sjTiiptoms will have passed away, and the cough, though diminished, still remains. Such a cough should not be neglected, or it will become chronic, prove troul)lesome, and not easily be gotten rid of. Causes. — Like ever}- other disease of the air-passages, cough usually originates from exposure. But, then, there are ii great many indirect causes which produce coughs ; that is, it maybe sympathetic, depending, as it not imfi'equentl}' does, upon some derangement of the digestive apparatus. A very troublesome kind frequenth' met with is one occa- sioned b}' an elongated palate ; this keeps up a constant tickling, which is very pro^'oking, and the cause being over- Infantile Affections. 227 looked, it not iinfrequently. proves intractable. It would be impossible to enumerate all the causes, direct and indirect, which give rise to cough ; in selecting a remedy 3^ou must not look upon it as an isolated s^rmptom, you must take into account all the attendant circumstances, the source, and the peculiar condition of the system at the time. If much fever, chilliness, headache, sore throat, pain in the windpipe upon pressure, inflammation, elongation of the palate, enlargement of the tonsils, congestion, irritation, or presence of a foreign body, — all these concurrent and coinci- dent symptoms will require special treatment, and the cough be treated and looked upon as a result or relative effect of that peculiar condition of things. Again, the cough may be entirely sj^npathetic, and originating in a derangement of some other important viscera besides the lungs. TREATMENT. Now, looking upon cough in this light, you will readily see the folly, the utter absurdity, of cough panaceas. I would therefore advise you never to have recourse to them. Their effect, to say the least, is uncertain, and not unfre- quently they do a great deal of mischief. You should study each particular case thoroughly and on its own merits ; ascertain, if possible, from whence comes the difficulty, and endeavor to select a remedy that will give temporary relief. Then, if it does not yield to that palliative treatment, at once seek the aid of a skilful, intelligent physician. In all ordhiar}^ cases jo\i will have no trouble whatever in making prompt and perfect cures ; but occasionally you will meet with chronic, obstinate cases, which can only be successfully treated by the physician. (Nos. 37, 169.) Diet. — Patients suffering from cough, particularly if it is chronic, should live upon a good, plain, substantial diet, avoiding all articles of food which are found to disagree with 228 Woman's Medical Companion. them. Avoid all rich, high-seasoned food, fat meats, new bread, and all articles of a stimulating nature, or having a strong, pungent taste or smell, strong drinks, acids, beer, and so forth ; also spices of ever}" description. Regimen. — Free exercise in the open air is highl}^ beneficial ; a morning walk, exercise with the dumb-bells ; ch'awing large quantities of ak into the lungs, then beating npon the chest with the hand ; all this will not onty expand and strengthen the lungs, but the whole bodil}' frame. Children should be encouraged in lively out-of-door pla}' ; it makes them active ; let them run, skip, and jump ; let them pla}^ at any and all games calculated to develop their ph3'sical and expand their mental faculties. During a por- tion of the day children should be permitted uncontrolled liberty of action. The dail}" batliing with cold or slightly tepid water is the most eifectual method of overcoming a predisposition to coughs and colds. A sponge, sitz, or shower bath should be taken everj^ morning, and the skin should afterwards be rapidly dried and rubbed to a glow, either with the hand or a coarse towel, after which the child should be warmly dressed. BROjVCHITIS. This disease has several appellations ; by some it is called catarrhal fever, or catarrh on the chest, by others, cold on the chest, etc. It is simply an inflammation of the mucous membrane lining the bronchial tubes, those formed b}' the division of the windpipe, and leading directly to the lungs, their office being to convey air into the lungs. In mild cases, ordinary bronchitis, or cold on the chest, the in- flammation, which is slight, is confined onl}- to the larger tubes ; there is little or no difficulty of breathing, moderate cough, and slight fever; while in the severer forms, the inflammation extends down into the most minute bronchial Infaittile Affections. 229 ramifications, and all the symptoms from the outset are of a severe nature. Causes. — The chief causes are transitions from warm to cold temperatures, or vice versa., and inadequate or unsuit- able clothing, especially in children, whose absurd styles of dress originate fully three-fourths of the bronchial troubles. There is many a long row of little white stones in Forest Hills, Mount Auburn, and all our suburban cemeteries, that would never have been erected but for the weekly holo- causts of innocent little victims which are offered at the shi'ine of Fashion. Every physician, as soon as he commences to treat a case of bronchitis, orders the child to be warmly dressed about the chest and arms, and to be kept from the cold au'. He knows that without this precaution, in the large majority of cases, his remedies would be prescribed in vain. Symptoms. — For convenience' sake we divide this disease into three forms : 1st, Simple Acute Bronchitis ; 2d, Acute Suffocative or Ca]pillary Bronchitis ; 3d, Chronic Bronchitis. The first form, simple acute bronchitis^ is a very frequent disease among children of all ages. It seldom sets in suddenly as an inflammatory affection, but gradually de- velops itself from an ordinary catarrh or cold in the head. The breathing becomes somewhat accelerated, there is more or less cough, stuffing of the chest, some fever, and skin a little hotter than natural. On applying your ear to the chest you will hear a wheezing sound, or a rattling of mucus in the air-tubes ; sometimes, after a severe coughing spell, vomit- ing will take place. As a general thing, toward night the patient is more restless and uneasy, fever higher, and cough more troublesome. Remarkable remissions at times take place in the course of this disease, the child appearing quite well for hours at a time, or it may wake up quite bright in the morning, but, as the day wears on, the fever rises, the skin 230 Woman's Medical Co7np anion. again becomes hot and cliy, respiration hurried and anxious, cough frequent, with a sensation or an appearance of tight- ness across the chest, so that during the day and forepart of the night it appears to be quite ill, but, as morning approaches, the fever diminishes, the skin becomes moist, the cough less frequent, and the child gets a quiet nap, which so much refreshes it that during the next forenoon it api^ears quite like itself. These s^Tuptoms ma}^ run along for four or five da^^s, when the difficulty of breathing, with the fever and the restlessness, disappears ; the cough grows less, graduall}^ diminishes, and the child soon regains its accustomed health. In cases rather more severe than this, the cough is a prominent sj^mptom from the beginning ; at fii'st dry and ■vdolent, ver}^ frequent and harassing as weU as painful, the paroxysms of coughing sometimes lasting a quarter of an hour, during which the child cries, throws its arms up or its head back, thus evincing its anxiet}' and pain. The cough is excited b}" crpng and sucking. As the disease progresses, the cough becomes loose ; small children vomit up quantities of plilegm, while larger children expectorate quite freely. The mucous rattle ma}^ now be heard over almost every part of the lung, the fever is high, breathing quick and oppressed, skin hot and dry, pulse frequent, child fretful and restless. Older children com- plain of pain when coughing, and the infant e^dnces it "bj its wincing as well as by its endeavor to suppress the cough. The expectoration, at first scant}' and viscid, later becomes copious and streaked with blood. There is an entire loss of appetite, foul tongue, gi'eat weakness, pale- ness of the lips, countenance anxious or dull, and the child drows}'. Symptoms of improvement, which generally take place in three or four days, are diminution of the fever ; the skin, Infa7itile Affectio7is. 231 instead of continuing hot and diy, becomes moist, and feels more natural to the touch ; respiration becomes less fre- quent, soreness and pain diminished ; the cough becomes loose ; the appetite returns, and the child rests better. Or- dinary' bronchitis Is a very frequent disease among children, and often follows in the wake of whooping-cough, scarlet fever, or measles. This form of disease is rarely fatal. During convalescence, there is profuse secretion of mucus, which can be heard rattling in the chest, from a contractive tightening of the muscles. Capillary BroilcMtis is so named from the fact that the inflammation extends down into the capillaries or small subdivisions of the bronchial tubes. It may appear as an idiopathic or primary affection, but, as a general thing, it succeeds the form just described, particularly- when that form has been neglected or improperl}" treated. Chronic BroncMtis usually follows an acute attack, either on account of improper treatment, or the presence of. some hereditar}^ taint, predisposing the child to scrofula or consumption. The cough from the acute form never entu'el}' ceases ; it becomes loose, and the expectoration ma}- be considerable ; the difficulty of breathing, though diminished, never entkely disappears ; every night, or per- haps only every other night, fever arises, and is followed b}^ more or less perspiration ; the lips crack and become ulcerated, sores break out around the nostrils, the skin looks blanched, e3'es are sunken, appetite lost, strength diminished, thirst is excessive. The neighbors and friends remark that the child is going into a " decline." These S3Tnptoms ma}- last for weeks, months, or even j'^ears ; but at an}' time a colhquative or watery diarrhoea may set in, and this will soon put out the last ray of its glimmering existence, and the little sufferer die of marasmus. 232 Woman s Medical Co7npaition. TREATMEIVT. It needs considerable skill, nicety of discrimination, and practical experience in the selection and administration of remedies for this disease ; and a great many things in regard to the general health and constitution of the patient have to be taken into consideration. For these reasons we have refrained from giving any general treatment, as, in the great majority of instances, the advice and experience of a skilful ph3'sician will alone meet the requirements of the case, and carry it through to a successful issue. (For Temporary Remedies, see Nos. 38, 139, 140, 141, 142.) PXiEURIST, OR PI.EURITIS. The lungs are enclosed and their structure maintained by a serous membrane called the pleura. This membrane forms a shut sac, as in fact do all the serous membranes ; and the lungs fit into it, as a boy's head would into a tippet when it is inverted or i^artially folded within itself. You will observe, therefore, that the lungs, though enclosed by this membrane, are still upon the outside of it. After covering the lungs as far as their roots, the pleura is re- flected over the inner surface of the chest. Plemis}^, or, as ph3^sicians call it, pleuritis, consists of an inflammation of this membrane ; at every act of respiration, every time the lungs expand and contract, the opposing surfaces of this membrane must glide upon each other, and, when in a health}^ state, they do this freelj', for the parts are well lubricated with serum, just as a piece of machinery is with oil, and for the same pui-pose ; but when inflamed, the pleura becomes hot and dry, the supply of serum is diminished or entirely sup- pressed, and the friction thus inevitably produced causes the pain or stitches in the side and chest. Pleurisy may either terminate by an adhesion or a gluing together of the opposed surfaces of the empty sac, or its walls may be widely Ltfantile Affections. 233 separated b}- a pouring forth of serum ; this latter effect constitutes dropsy of the chest. This disease seldom at- tacks infants and young children ; it is not as frequent, neither is it as dangerous a disease, as inflammation of the lungs, Tvith which, however, it is often connected. Causes. — The exciting cause, as a general thing, is exposure to cold or damp. It may also arise from severe injuries to the chest, as from a blow or a fall. Symjjtoins. — Pleurisy, from the onset, is marked by a sharp, stabbing pain, on a level with, or just beneath one or the other of, the breasts, preceded or accompanied by chilliness or shivering ; a dr}', ineffectual cough is usually present with no expectoration, or, if any, very little, and of a froth}^, whitish look ; some difficulty of respiration, high fever, pulse quick and hard, great thirst, hot, dry skin, loss of appetite, headache, and sometimes bilious vomiting. The pain beneath the breast may diffuse itself throughout the chest, but usually it is confined to a small space, and is of a sharp, stabbing nature, seemingi}^ as though a knife were thrust into the side, which prevents the patient from taking a long breath, and produces great suffering ; when coughing or sneezing, the child endeavors to suppress the cough. The pain is alwaj^s aggravated by deep inspira- tions, change of position, or by pressing upon the parts ; it usually lasts three or four daj^s, and then subsides. In some cases — but these are few indeed — there is little or no pain. The patient cannot lie upon the affected side, at least dming the first stages of the disease ; that position increases the pain ; however, as the pain subsides, and effusion takes place, she is unable to lie on either side, on account of the pressure made upon the sound lungs by the effused serum, which produces great difficult}^ of breathing. The patient is, therefore, compelled to he upon her back, pr nearly so. 234 Woman's Medical Compaction. This eflfiision into the pleural sac, sometimes amounting to several pints, causes the affected side to bulge out and become evidently larger than the other. TREATMENT. As in pneumonia, the application of cold bandages is often of great service. The diet is substantially the same. (Palliative remedies may be found in Nos. 39, 290, 291, 292, 293.) PlVEUMO^riA, OR EVTIiAj^IMATIOIV OF THE liUIVGS. Pneumonia is an inflammation of the substance of the lungs ; but the majorit}^ of the cases of pneumonia are at- tended with more or less inflammation of the serous mem- brane lining the interior of the chest, and inverting over the lungs ; that is, there is some pleurisy. Bronchitis is also a frequent accompanunent. Pneumonia ma}' be either single or double ; one lung may be afl'ected or both. It is more common upon the right side than upon the left, and generally commences in the lower lobes. Why it does so is not known, but such is the fact. Causes. — Inflammation of the lungs, or lung-fever, as some persons call it, is a very important, because frequent, - disease of childhood. As a general thing it does not occur as a primary aflection, but supervenes as a complication either in scarlet fever, measles, whooping-cough, inflamma- tion of the bowels, or bilious remittent fever. As cold is an active exciting cause, 3'ou will find pneumonia much more frequent dming the winter than during the summer months. A severe blow or fall upon the chest, the inhala- tion of noxious or irritating gases ma}', and often do, pro- duce it. I have known children to inhale hot steam from the spout of a coffee-pot or tea-kettle, and thereby excite an inflammation of the lungs. Children of all ages are liable to its invasion ; but, from statistical reports, we are Infantile Affectio7ts. 235 forced to believe that it is more frequent from the third to the fourth 3'ear ; nm-sing infants and children under two 3'ears of age being less liable to it than those older. Syini3toniS. — Pneumonia, in the majority of cases, commences, as do all inflammatory or febrile diseases, with a chill or shivering, followed b}' heat and an increased fre- quency of the pulse. Cough is always present, at first dry and deep, or quick and spontaneous. The respu-ation is accelerated, the breathing from 50 to 60, sometimes even 60 to 80, in a minute. Pain, or, more properl}'- speaking, a stitch in the side, usuall}" the right, on taking a long breath or deep inspiration. If 3'ou will now, in this the first stage of the disease, place 3'our ear to the j)atient's chest you will hear a peculiar crackling sound, similar to that produced b}' throwing salt upon hot coals, or like the sound produced by rubbing between 3'our finger and thumb a lock of one's own haii', close to the ear. This is an important S3Tnptom ; it gives an earl3^ and sure intimation that en- gorgement or congestion, the forerunner of inflammation, has taken place. The expectoration, which, however, is seldom present in children under four or five 3'ears of age, is at first tough and stick3', but soon changes to a bloody mucus ; sometimes, especiall3^ in older children, the sputa is of a rusty color. The face is flushed, and wears an anxious look ; it is, in severe cases, blanched, and the feat- ures pinched ; the skin is hot and dr3^, and of a shiny or glazed appearance ; thkst is excesssive ; the pulse ranges from 130 to 140 ; in 3'oung children it ma3^ run as high as IGO, or even 180; the tongue maybe hot and parched; but, as a general thing, 3'ou will find it moist, and covered with a 3'ellowish or whitish fur. The patient does not wish to be disturbed, would much rather be let alone, usualty hes upon his back, and desires nothing but plent3' of cold water. lA 236 VVoman^s Medical Companion, Now, the train of sj'mptoms presented in a young infant — a babe at the breast — differs in some respects. Of course the child cannot tell you that it has a pain in the side ; it cannot express its sufferings in words. How, then, are j^ou going to ascertain what is going on within that little chest? In fact, liow are you to know what is the difQcult}^, and where located ? Children are not deceitful ; and if 3'ou are atten- tive, and at all discriminating, you will have but little trouble in interpreting their look of anguish or thek cry of pain. The child will be peevish, restless, and uneas}^ ; cries and frets all the time ; does not care to nurse ; skin hot and dr}', respiration short and hurried. You will observe that the chest does not rise and fall regularly with each inspiration, but the movements are short, uneven, or jerking. Respiration is carried on chiefly through the action of the abdominal muscles. From the onset, cough is present, at first drj', short, and hacking, but it soon becomes loose ; vomiting is frequently' present ; sometimes a spell of cough- ing will end in vomiting, and, thereb}^, the expulsion of a quantity of glutinous mucus, or mucus tinged with blood. That the child suffers from pain when coughing is evident from the expression of its face ; the grimaces and twistings of the features are alwa^^s marked ; and then, as you will observe, when the cough comes on, the little sufferer attempts to smother it, instead of taking a full inspiration, as it would if its chest were not sore ; it tries to make it short and sudden ; it tries to suppress it. Each spell of coughing is accompanied or instantly followed b}^ a scream of pain, or a fit of cr3'ing. The cr}', also, is peculiar. It is not a healthy | cry, but a kind of a suppressed cry, more of a sobbing nature, but still sharp and shrill, indicative of real suffering. When the inflammation has reached its height, which it does generally by the fifth or sixth day, the sjTuptoms, not ;, Infantile Affections, 237 invariabl}', but usually, remain stationaiy for one or two days, and then begin to subside. The fever diminishes, the skin loses its hot and harsh feel, becomes soft and moist, the cough becomes quite loose, less frequent, and ceases to be painful, the child can take a deep hispkation, or even cr}^ aloud, without suffering pain. The flushing of the cheeks passes away, the expression of the face becomes more natural, the child looks around, and notices all that is going on. At this period of the disease children are apt to be quite cross and fretful, wanting ever^^thing, and throwing all awa}' as soon as gotten. Mothers say that this is a good sjTnptom. TThen pneumonia ends unfavorabl}', the patient lingers along for a great while ; the disease runs the course we have described ; but instead of taking a favorable turn, the fever continues, the breathing becomes less frequent, but more laborious and kregular, the child gradually fails, the strength diminishes, the face looks blanched and sunken, low muttering deluium may be present, but usually intelh- gence is retained to the last. TREATMEIVT. The temporar}^ treatment, which will have a palliative effect until medical aid can be obtained, will be found at Nos. 40, 294, 295, 296. Diet and Hegiineil. — The diet should be plain, consisting of light, easil}' digested substances, panadas, gi'uels, etc. Cocoa makes an excellent drink. Cold water may be allowed, when desired. The breast, of course, is the diet for infants. While suffering under a short attack of pneumonia, or more particularly when recovering from it, gTeat care should be taken that the child is not exposed by taking it from one room to another, through cold halls or passages, or into damp basements. 238 Woman's Medical Companion. HOARSEIVESS, OR RATICITTJS. This affection, like croup, does not, in itself, constitute a disease, but is dependent on some morbid condition of the thi'oat or larynx, such as irritation or a congested con- dition of the parts. The causes are the same as in almost all chest difficulties, and is frequently the sequence of a common cold. It ought never to be neglected, for it is one of the premonitor}^ s3^mptoms of membranous croup. No. 41 is an excellent temporary remedy. CROtJP is one of the most frequent diseases to which childhood is exposed. It is almost peculiar to children, and occurs, as a general thing, during the period of first dentition, that is, about the second year, though children from one to twelve years of age are more or less liable to it. It occm-s in- differently in the weak and strong, in boj^s and girls. Though not contagious^ as some people suppose, there is strong argument in favor of its hereditar}" character, a predisposition to this disease being very frequently trace- able for three or four generations. From whatever cause it originates, it consists in a simple ordinary inflammation of the upper part of the windpipe — the larj^nx — with a violent spasmodic action of that organ. Its attacks are usually abrupt, without any premonitory signs, awakening the child from his slumber with a paroxj'sm of spasmodic coughing. Causes. — Croup is more common in cold, damp cli- mates than in warm, dr^^ ones. Rapid and frequent changes of season, weather, and temperatm^e have considerable influ- ence in producing it. Certain conditions of weather speci- ally predispose children to its attacks, without doubt ; hence the popular idea that it is epidemic in character, and that it is a contagious disease, which we do not believe. Infantile Affections. 239 Symptoms. — The sj^mptoms of croup are well marked, and need never be mistaken for those of any other disease. In the evening, or before midnight, the child will be aroused b}^ a parox3'sm of spasmodic coughing. The cough is rough, barking, and is accompanied b}^ a shrill, sharp sound ; dur- ing the paroxj'sms of cough, the breathing is spasmodically oppressed, at times seemingly almost to suffocation. The face and neck are at first highly flushed, but, as the parox- ysms become more violent, assmne a dark, livid red, which afterward passes into a deadly paleness, if the fit is of long duration. The veins swell, and beads of perspiration stand out upon the forehead ; sometimes the whole head is wet with sweat. The disease seems to threaten immediate suf- focation, the countenance presenting a picture of the utmost anxiety. The patient ma}" remain in this condition for fifteen or twenty minutes, or from half an hour to even an hour. As soon as the violent symptoms abate, the child falls asleep ; and, on awakening, only a slight hoarseness, a loose cough, and slight fever will remain. If the disease be improperly treated, or neglected, these frightful attacks will continue and increase in intensity, successive daj^s and evenings ; and before the third day has passed the inflammation will have extended through the trachea or lower part of the windpipe, toward, and some- times even into, the bronchial tubes ; and then, with all its attendant horrors, you wiU have a case of true membranous croup. TREATMEIVT. An ordinary case of croup no mother need fear, if she only have the proper remedies at hand. A warm bath, about 96° temperature, and kept up to that standing or raised three or four degrees higher, is an invaluable auxiliary, lessening the agitation and subduing the patient's s^nnptoms. 240 ]Vo7naji's Medical Compa7iio7i, Poultices of flaxseed meal should be applied to the thi'oat and chest, and a moderate emetic, such as a teaspoonful of ipecacuanha wine, a spoonful of diy mustard in water, etc., should be immediately administered. ^JUMBRAIVOrS cRorp is an aggravated or exaggerated form of the disease we hare just described, and consists in inflammation of the lar_^Tix (the upper part of the windpipe) of a highly acute character, terminating, in the majority of cases, in the exudation of false membrane, more or less abimdautly, upon the affected sm-face. The inflammarion usually begins high up, near that part which contains the vocal cord, or what physicians call the larynx. Perhaps you would better understand me if I should say that it commences in the region of that projecting caitilage called •* Adam's Apple," and extends down into the bronchial tubes. This fonn differs from ordinar}' croup in the formation of a false membrane upon the inflamed sm'face, which obsti'ucts the air-passages, and, in severe cases, completely closes theia up, so that the patient dies fi'om actual suffocation. This membrane, when coughed up, or when taken from the dead i body, looks like a stick of boiled macaroni, is commonly' of a 3'ellowish color, and from one-sixteenth to one-twelfth of an inch in thickness. Its general symptoms are very similar to those of cataiTh, being attended b}' shght fever, drowsi- ness, watering of the eyes, and running from the nose. In the last stage, and in very severe cases, the child is wholly unable to speak, even in a whisper, or cry ; the onh* noise it is able to make is the pecuhar violent, short, shilll, barking cough. Between the parox^'sms of coughing, the wheezing is heard in the au'-passages at every inspu'ation. As the disease grows worse, the voice becomes more hoarse, the accumulation of false membrane and the mucus increases, Infantile Affections. 241 till at last the tube is entirely filled up or completely lined, so as to preclude the possibility of respiration — and death is the inevitable result. The duration of the disease is from three to twelve or fourteen days, though many cases have occurred in which death has taken place on the first day. TREATMENT. In all cases, the treatment must necessarily be left to some skilful and experienced phj^sician, the life of the pa- tient being in too great danger to permit of its being left to nurses or relatives, however careful, intelhgent, or aff'ection- ate they may be. (Remedies at Nos. 42, 43, 174, 175, 176, 177.) TTHOOPIJVG-COUGH, OB PERTUSSIS. This is one of that peculiar class of diseases that seldom, if ever, attacks the same individual but once in a lifetime. It is essentiall}^ a disease of childhood. Not but that adults would be just as liable to it as children were it not for the fact that they had already had it as children. Let it once enter a family of children, and the whole group is pretty cer- tain to have an attack. It is undoubtedly contagious, and usuall}'' appears in the spring and fall. When it occurs in the fall, it is generally more severe, from its frequent complica- tion with catarrhs, lung diseases, and other ailments. Par- ticular care should be taken that feeble children, as well as youn^ and dehcate infants, are not exposed to whooping- cough dming the fall months. Its duration extends from six weeks to six months. Symptoms. — Whooping-cough may be divided into three stages: 1. The Catarrhal; 2. The Spasmodic; and 3. The stage of Decline. The catarrhal period commences with the ordinary sj'mptoms of a common cold. For ten or twelve days, the child will generally evince all the charac- teristics of catarrh, though occasionally this stage wiU be 242 Woman^s Medical Companioit. entirel}^ absent. The spasmodic stage is marked by violent spasmodic i^aroxysms of coughing, =svhic'h occm- at longer or shorter intervals, lasting from a quarter to three-quarters of a minute. These fits may succeed each other so rapidl}^ as to make one continued parox3^sm of fifteen minutes' dura- tion. They are made up of a succession of expirations with- out any intervening inspirations^ until the little suflTerer gets almost black in the face, and appears upon the point of suffo- cation. This is followed b}^ one long-drawn act of inspira- tion, which produces that peculiar shrill sound, or whoop, from which the disease derives its name. This operation i? repeated time after time, until all the air is expelled from the lungs, the long inspiration again filling them ; and the ]^arox3^sm usually terminates in the expulsion of a quantit}^ of thick, ropy mucus, or else in vomiting. In some A-er}" severe cases, dui'ing a fit of coughing, blood will fl}^ from the nose and mouth, and occasionally from the eyes and ears. The e^'es, bloodshot and sunken, will fairly start from their sockets, presenting a horrid spectacle of suffering. The stage of decline consists in an amehoration of the severe s^Tnptoms ; the paroxysms become less frequent and of shorter duration ; the child's appetite returns, and he again resumes his natural habits and disposition. In this stage of improvement, when all is going on smoothly, a slight cold may reproduce all the distinct characteristics of this peculiar cough. (For remedies, see Nos. 44, 170, 171.) Complications. — Simple whooping-cough, when un- connected with any other disease, is seldom or never at- tended with much danger. But its complications are many, and of various fonns ; therefore it is highl}^ important that all the accidents apt to occur should receive a careful con- sideration. Bronchitis is a frequent complication, and ma}' be recognized b}' a greater amount of fever, increased diffi- culty of breathing, and an incessant congh during the first Infantile Affections. 243 stage. The expectoration will be more difficult, less profuse, and liaA'e a froth}' or 3'ellowish look. A marked expression of pain will cross the child's face in every fit of coughing. Sometimes the whooping-cough will be entirely superseded b}' the bronchial affection. Cg^^vulsions are by no means rare as a complication, and are b}' far the most dangerous ; and consequently require the most vigilant care and watch- fulness. Convulsions and head troubles are usually found in connection with whooping-cough at about the second 3'ear, or during dentition, and may be considered serious and especially liable to a fatal termination. Pneumonia is another complication often met with, the sj'mptoms of which will be found indicated under that head. Diet and Regimen. — This is a matter of the great- est importance. An}i;hing stimulating should be especially avoided. It should be particularly plain and nutritious. Light and easily digested food is the best. Spices and hot stimulating drinks should never be permitted. Cold water, oatmeal gruel, barle}'- water, rice-water, toast-water, etc., are the onl}' suitable beverages. Exposure to cold will veiy much aggravate the cough and even reproduce all the severe sjTiiptoms when the child is in a fair way of recovery. The dress should be so regulated as to guard against sudden atmospheric changes, and the body be kept at an even tem- perature. IXFAIVTIIiE ASTHMA. This disease has frequentl}' been confounded with spas- modic croup, and treated as such. It is piu-el}' a nervous affection, and is chiefly manifested in children of a strumous or scrofulous habit, occurring between the first and third year of hfe, and frequently connected with dentition or a deranged state of the digestive system. Many of the symp- toms are similar to those of croup, but asthma may be dis- tinguished by the absence of premonitory sjTnptoms, its 244 Woman'' s Medical Companion. occiuTence in tlie da}i:irQe as well as at night, the absence of fever, and its leaving no cough or hoarseness behind it. No. 45 will be found an efficient remedy. I^ABYNGITIS, OB IXFIiAMMATIOX OF THE liARTlVX. Laryngitis is simply an inflammation of the mucous membrane lining the lar^Tix, just as bronchitis is an inflam- mation of the mucous membrane lining the bronchial tubes. It occurs at all times of life, but as a general thing is con- fined to children of from three to six years of age. It very much resembles an ordinary case of croup, the only point of difl'erence being the absence of that peculiar spasmodic cough. On looking into the throat, you will observe more or less inflammation about the tonsils and palate, which ma}^ be diffused over the whole surface, or be in patches varying in color from a mere blush, as in mild cases, to a deep-rose or even a violet-red. The first s^'mptom which should ex- cite your alarm and prompt 3'ou to call in a ph3'sician, is the difficulty of swallowing^ for which you can find no acZe- quate cause. To this will be added difficulty of breathing. The respiration is peculiar, being attended with a throttling noise, each inspiration producing a wheezing sound, as if the air were drawn through a narrow reed. The larj^nx is painful upon external pressure, the face flushed, skin hot and dr}^, pulse more frequent than in health, rising to 120° or 130° per minute, and the child is thirsty, restless and uneasy. The disease is, happily, not very frequent, at least the severer form of it. It is easih' distinguished from a common sore throat b}^ the difficult}- of breathing and swal- lowing. It is true, extreme enlargement of the tonsils ob- I structs respiration, but then on inspection this swelling will be visible. In larj'ngitis, there is but slight inflammation and swelling, at least little can be seen of it. {See Remedy \ No. 46.) Infantile Affections. 245 Diet and Reg'imen. — A child suffering from this disease should be confined to a warm room, and not be al- lowed to roam all over the house, through cold rooms and in draughts of air. A slight reduction of diet is advisable, forbidding all condiments or anj'thing of a stimulating nature. A fiirinaceous diet is the best. The application of cold water is alwaj^s advisable, often affording great relief. Rubbing the throat with camphorated oil, goose-grease, or Ready Relief, or, in fact, the application of embrocations or stimulating lotions of any kind, is highly objectionable. COLDS. The term ' ' cold" is a relative one, used to express a certain condition or sensation produced by the abstraction of heat from the S3'stem by any substance of a lower temperature than that of the body. This may not alwaj^s be occasioned b}' the same degree of temperatm^e. For instance, a tem- perature that, to a health}^, vigorous, active man would seem warm or comfortable, would, to one enfeebled by disease, appear quite the reverse. A man or child, though not ph3''sically strong, but full of energy, courage, and excite- ment, would resist a greater amount of cold than one who is faint-hearted, nervousl}" depressed, or despondent. Children are more susceptible to atmospheric depressions than adults, and simpl}^ because the power of generating heat within themselves is weak, undeveloped. Cold does not alwa3's cause disease in the exact part to which it has been applied ; that is to say, because a person sits through a tedious concert with a draft of air continuously playing a disease-tattoo on his back, he must not necessarily have rheumatic pains or some other trouble in the part, although this may be the case. As a general rule, the cold, by diminishing vital actions in the parts on which it acts, so determines and increases the same in distant parts, as to 246 Woman's Medical Companion. give rise to congestions and inflammations, or to a train of diseased action, more or less definite, ^hicli. b}' common consent, is nsuallj' termed a cold, sucli as cliills, general soreness and lameness, j)ains and aches in the head and limbs, followed, as soon as reaction comes on, by accelerated resi^iration and ciiX' illation, as Avell as other symptoms which constitute fever. Cold does not affect all persons alike. Two ladies, ex- posed to the same current of air, may. as the result, suffer from diseases quite dissimilar. This depends upon pecu- liarities in temperament, predisposition, and habits of the individual. As a general rule, however, those organs or I)arts of the system are first affected which are the weakest. If the lungs are predisposed to disease, cold will develop some difficulty in these organs. Should a person be subject to catarrh, cold will act as an exciting cause to bring it into action. Children subject to croup, glandular enlargements, or gatherings in the head, need only a cold to set the dis- ease in motion = The same principle is true with other organs and structures of the system. The extent and severity of the disease thus excited will depend upon the amoimt of exposm-e and the dehcacy of the part affected. The most common results of taking cold are catarrh and croup, some- times fever, cohc, dysenter}', diarrhoea, nem-algia, sore thi'oat, pains in the teeth, ears, or general pain and soreness thi'oughout the whole system. (-See Remedy Xo. 47.) DISEASES OF THE STOMACH A^TD EVTESTEVES. The particular age at which chilch-en are most hable to these affections is from birth to the termination of the first dentition ; tliis, of course, includes the second summer. From this period onward, as the child increases in years, it becomes less Hable to their invasion. Causes. — By far the most frequent exciting cause of Infantile Affections. 247 all gastric diseases during iiifanc}', is an improper or un- ■wholesome diet. Thej are not unfrequenth', in nursing infants, dependent upon an unhealth}^ condition of the mother's milk ; but it appears to me that the chief source of difficulty is the too earl}" resort to an artificial diet, or an artificial diet badly chosen. Of course, the natural aliment of an infant, for the first nine months, is the mother's milli, which, during the first few months, is ver}- thin, and pos- sesses properties pecuhar to itself. Xow contrast this with the various articles of food prepared for children, consisting mainlj' of pap, or thick bread and milli, or crackers moist- ened with milk and water, to which sugar is added ; gruels of all kinds ; coarse preparations of rice, barle}', etc. As before intimated, the stomach of an infant is only intended to receive the milk provided by its parent ; and it is entirely incapable of digesting the thick or coarse, and often too rich, food, which is so frequentlj" substituted for that which natm-e has provided. But it is not only the quality of the food that is at fault, but the quantity. The overfeeding of children is a constant and never-failing source of mis- chief. Childi'en artificially fed scarcely ever escape these intestinal derangements. Diarrhoea frequently sets in im- mediatel}' after weaning a child, and this is the necessary result of irritation of the mucous membrane lining the in- testinal canal, produced by the change of food. Indigestion, or loss of digestive power, and the conse- quent enervation and wasting away of the sj'stem from im- perfect assimilation, is but the direct effect of an improper diet, or the over-taxation of the digestive apparatus from excessive feeding. The heats of summer and sudden atmospheric changes are undoubtedlj' powerful predisposing causes to infantile bowel complaints ; in fact, we seldom have these diseases to an}" great extent, presenting all their characteristic features, 248 Woman's Medical Coinpaiiio?t, except during the hot months of snmmer. To the heats of summer we have usually to add impure air and badh'- yentilated houses. As you pass through some of the streets of our cities, and inhale the effluvia from the dii't}" gutters, you wonder, not that so many are taken sick, but that all do not die ; and then, when 3-ou come to enter the damp basements, and find huddled together whole famiUes of ten or a dozen persons, occupying one room, in which they cook, eat, and sleep, you are actually bewildered and in amazement, wondering how any mortal can di-aw the breath of life from such a vitiated atmosphere. To people living thus, and all those who reside in narrow, crowded streets and alleys, these diseases are as scourges. But these disorders are not confined exclusively to the poor and to those living beneath the ground, and away from the light and air which God has given us. No, the}' are only too common among all classes of the inhabitants of our large cities. Dentition being a natural physiological process, we should not expect it to be productive of any evil results ; nevertheless, it is a well-estabhshed fact that the cutting of teeth is a powerful predisposing cause to intestinal iiTita- tion, and it frequently impaii's or diminishes the tone of the digestive function, so that the infant is often unable, during the period of dentition, to digest food, which at other times agrees with it iDerfec|:ly well. Gastric derangements of children, from the completion of the first dentition to the age of eight or ten years, ma^^, in the majoritj' of cases, be traced directly' to the persistent inattention on the part of mothers and nurses to the general laws of health. It is the strangest thing in all the world to me, that poor human na- ture, plain and sunple in all its requirements, should be so wholly disregarded. It is either from ignorance or thought- lessness, or most likel}" both. It is quite a common thing. Infantile Affections. 249 in fact the general custom, to allow children of from two to three j^ears to sit at the table and partake of the same food that is prepared for the adult members of the famil}^ : hot rolls and butter, hot buckwheat cakes, sausages, salt fish, radishes, cucumbers, candies, meats, and indigestible dishes of all kinds. These are partaken of at all hours, and in ex- cess, from breakfast-time to just before going to bed ; and the wonder is, not that we are a pale, thin, dj^speptic, and anxious looking race of people compared with Europeans, but that we have an}' health at all, especially when our chil- di'en are allowed to make use of the indiscriminate and unwholesome diet we have described. Now, one would think this alone would be sufficient to exterminate the whole race in a short time ; but to all this is 3'et to be added that vile, pernicious habit of drugging children with medicines. Most mothers and nurses have each their little collection of remedies. For ever}' little ail- ment that may overtake a child, brought about by some error in diet, a dose of medicine, usually a cathartic, must be given. And what is the result? Why, a slight indispo- sition, which a little care or judicious restriction in diet would have speedily removed, is transformed into some serious disorder. The medicine given is so repulsive to nature that the whole sj^stem is thrown into commotion in the effort to reject it ; the child is vomited, ph3'sicked, — thoroughly "cleaned out." If the child recovers, it is in sjnte of the treatment ; but usually the digestive apparatus and the entire nervous sj'stem are shattered, the child be- comes irritable, cross, morose, a burden to itself and to all around it. I never pass through our cemeteries, and contemplate the rows of small white stones, without the thought crossing my mind, — Sleep on, sweet child, thy trouble's past ; Physic has freed thy soul at last. 250 Woman's Medical Cornpajiion. THRUSH, OR APHTHA]. The term thrush or aphthcB is applied to an ulcerated sore mouth pecuhar to infants, which makes its appearance during the first 3'ear, as a general thing within the fii'st fortnight. Nurses, and women of experience generall}', anticipate and avert its arrival b}' frequently washing the infant's mouth with a soft linen rag dipped in cold water. The most prolific cause is the trash which is forced down the poor infant's throat during the fii'st few weeks of its existence. It consists of a series of vesicles or pimples, capped with small white spots, which break out into ulcers, occuppng the internal siu-face of the under lip and cheeks, the edges of the tongue and giims, sometimes extending over the entire mouth. There is little or no fever, though the mouth is hot, and the quantit}' of sahva is largely increased. "WTien the ulceration extends far back. into the mouth, the stomach, and the alimentary canal, the act of swallowing is materialh' interfered with and performed with great pain. In such cases diarrhoea often sets in, and the affection assumes a serious aspect. TREATMEIVT. Borax is an excellent remedy, and majy either be given dr3', in the form of pills, or in solution, and is verj' fre- quently' used as a gargle. (Xo. 48.) CAJVKER OF THE MOUTH. This form of sore mouth is usualh' found in children of from five to ten 3'ears of age ; b}' many it is considered con- tagious, but upon this point physicians are divided, though all agree in considering it epidemical. It is an inflammation of the mucous membrane, with an exudation upon the surface of a 3'ellowish, plastic IjTnph, with erosion or ulceration, Infantile Affections. 251 which occasional^, particularly if improperl}' treated, be- comes ver}'' destructive in character, running into dark, deep, sloughing sores. It is also known as cancrum oris, scurvy of the mouth, or canker-sores. Symptoms. — The peculiar characteristics of this disease are : first, pain and uneasy sensations in the gums, which soon become hot, red, and very sensitive ; they also swell, become spong}', and bleed when touched. The gums and internal sm-face of the cheeks are covered, or rather spotted over, with patches of false membrane, which adhere with considerable force to the tissue beneath. Under this laj'er of exudation small ulcers make their appearance on the gums, the inside of the lips and cheeks, the soft palate, and edges of the tongue. Sometimes this false membrane is entirel}^ wanting, when the ulcers are plainly visible, and present a gi-a^'ish or livid appearance, with swollen, softened, or bleeding edges. These ulcerated spots may be but few in number, either upon the inner surface of the lips and cheeks, or edges of the gums, or the}' ma}' be studded over the whole cavity of the cheek. The breath is alwaj'S more or less fetid, and not unfrequentl}' has a putrescent odor ; and sometimes, especiall}' in severe cases, there is a copious discharge of offensive blood}' serum from the mouth. The glands about the throat and neck are swollen and painful, the moA^ements of the under-jaw are stiff; this, together with the looseness of the teeth, makes mastication very difficult, while swallow- ing is interfered with from soreness of the tongue and throat. There is generally more or less of a low grade of fever ; the patient loses his strength, and becomes very much prostrated. The course of this disease is short, if under judicious treatment, but not unfrequently sudden, severe, and destructive salivation is set up by the excessive administration of calomel, which, if not ending in gangrene 252 Woman's Medical Companion. of the mouth, prolongs the difficult}' to an indefinite length of time, (For Temporaiy Remedies, see Nos. 49, 145, 146.) Diet and Hegimen. — The diet should be plain, and of either a farinaceous or vegetable form ; animal food, either solid or in soups or broths, had better be dispensed with. It is desirable that the mouth should be frequently gargled or rinsed out, and especially after eating, that no offensive matter or particles of food maj^ remain to irritate the parts. A weak solution of brandy and water makes the best wash ; lemon-juice and water or a decoction of sage is also frequently used. Decajxd teeth, or stumps of teeth remaining in the mouth, are a frequent source of irritation, and should be speedil}' removed. GAIVGREAE OF THE MOUTH. This term — gangrene — signifies mortification, which is justly the terror of all who have to contend with it. It gen- eralh' commences with ulceration of the mucous membrane lining the cheek and gums . The mucous tissues and substance of the mouth, gums, lips, etc., are destroj'ed, turn black, and slough awa}', the teeth loosened, and the jaw-bone denuded and exposed. The affection is seldom met with in private practice, and is almost exclusively confined to institutions where large numbers of children are gathered promiscuously together. It ahnost alwa3's follows upon some pre^dous acute or chronic disease, such as long-continued fevers, measles, or other acute exanthemata, during which the pa- tient suffered more from the treatment than from the actual disease. Unfavorable hygienic conditions, debihtated con- stitutions, a scrofulous habit, etc., are conceded on all sides to constitute the predisposing cause of this affection, but the exciting cause has been and still is a bone of con- tention among physicians encountering this disease. It is hi f until e Affections. 253 perfectl}^ plain, however, to those who are disposed to see, that gangrene of the mouth is nothing more nor less than poisoning b}' mercury. The duration of the disease extends from six to twenty days ; and the aspect of the poor little patient is as sad as it is hideous. This disease is usually terminated by entire prostration, insensibility, and death. PTYAI^ISM, OR SAIilVATIOIV. This disease consists in an irritation, inflammation, and swelling of the salivary glands of the mouth and throat, with a profuse discharge of saliva or spittle. Most persons are too apt to attribute it to the injudicious use of mercury ; but we often see patients recovering from severe attacks of fever, with all the symptoms of salivation, where there has not been one particle of mercury given. Salivation is pro- duced by administration of copper, antimony, potassium, arsenic, castor-oil, digitalis, and opium, under certain con- ditions of the system, quite as readil}^ as by mercur^^-. Sometimes it occurs spontaneously, as a result of local irritation, decaj^ed teeth, cold, fever, etc. It occasionally occurs as a critical discharge, by the action of nature, and is then beneficial. The salivary glands and mucous membrane of the mouth and throat are red, swollen, and considerably inflamed, the glands beneath the under jaw being enlarged and very ten- der. The saliva, which is discharged in large quantities, is much changed in its character and appearance. Instead of being thin, water}', colorless, inodorous, and tasteless, as in health, it becomes dark, thick, stringy, fetid, and very offensive. All astringent washes or gargles which directly diminish the salivary discharge are injurious. Mild washes or gargles, such as milk and water, may be used with consid- erable benefit. (Also Remedy No. 50.) 254 Wo7nan's Medical Companioji. The diet must be of the mildest kind, — gTuels, milk and water, crackers soaked in water, plain puddings, and the like. For a diink, cold water maybe used, or cocoa, if the patient likes it. RAAIJIiA, OR SWEI.I.I1VG UXDER THE TONGUE. This is a swelling of the subling-ual glands, caused by some obstruction of the salivary duct — which is the little canal that carries the sahya from the gland to the mouth — from cold, inflammation, or some irritating cause. Tumors of this kind are not generally painful ; but when thej^ are of an}^ considerable size, they interfere ^ith the free motion of the tongue, and thus materially impede the power of speech. {See Remedy yo. 51.) GIJM-BOrCS.— ABSCESS 131 THE GUMS. Almost every form of swelling with inflammation aflfect- ing the gums (even abscesses and suppurations) are popularly but erroneously classed under the head of gum- boils. This is a very annoying aflTection, and arises from various causes, such as cold, decaying teeth, or the cutting of new teeth, especially the molars and bicuspids, or from their unskilful abstraction. Sometimes a slight incision by knife or lancet will be found necessar}^ ; but outward apph- cation of anodynes, warm cloths, fomentations, etc., will usually be found efl'ective. {See Remedy Ko. b'2.) MUJIPS, OR PAROTITIS. The salivary glands are six in number, three upon either side of the throat, and are called the parotid^ the sub- maxillary^ and the suhlingual. The j^ct^'otkl are situate below and in front of the ear ; the suhmaxillai-y below the lower jaw, and the sublingual under the tongue. The office of these glands is to fui'nish the saliva or spittle with which htfantile Affections. 255 the food during mastication is softened, so that when carried into the throat it passes with ease through the oesophagus into the stomach. Now, mumps is an inflammation of the largest and most important of these glands, the parotid; hence the name parotitis. It often prevails as an epidemic. When it attacks one child in a family or a school, it is almost cer- tain to affect all the others, simultaneously or in succession. It is undoubtedly contagious, chiefly attacks children and young persons, and seldom, we may say never ^ attacks a person the second time. There are no marked S}Tnptoms at the commencement of the disease, except the tumefaction and swelling under the ear. Sometimes one side only is affected, and sometimes both at once, but most frequently one side is first affected, and the disease afterwards extends to the other. The swelling is hot, dry, and painful, and ver}^ tender to the touch. There is usuall}^ some fever ; the motion of the under jaw is inter- fered with from the sweUing in the vicinity of the joint. The inflammation reaches its height in about four days', and then begins to dechne ; its whole duration may be stated, on an average, at eight or ten daj^s. Mumps is not considered dangerous, unless from im- prudent exposure the patient takes cold, or from any other cause the disease "strikes in," that is, becomes thi'own back upon the s^^stem, so as to involve some of the vital organs. In many cases, under these cn-cumstances, the swelhng about the throat and neck subsides quickly on the fifth or seventh da}^, and shows itself upon the testicles in the male sex, and upon the breast in the female, and these parts become hot, swollen, and painful. Another dangerous transfer of this disease, but particularly rare, is from the testicles to the brain. {See Remedy No. 53.) Diet and Keffimen. — The diet must be liorht. 256 Woman's Medical Companion. Toast and black tea, cocoa, custards without spice, bread- puddings, baked apples, and stewed prunes maybe allowed. If it is dming cold weather, the patient should be kept in a moderately warm room ; if there is much fever, he had better lie in bed. No external application need be made, unless it be simpl}^ a handkerchief tied around the neck. Should the neck get very tense, hot, and dr}^, it will be advisable to apply hot flannel cloths. Great care must be taken to prcA^ent the patient from taking cold. Never apply cold water or any of the many lotions ; follow simply the directions above given. EVFIiAMMATIOW AlVD SWEIiT^IlVG OF THE TOWGXJE.— GliOSSITIS. Glossitis is an inflammation of the substance of the tongue, characterised by pain, redness, hardness, and swell- ing, either with dryness of the mouth or profuse discharge of sahva, and accompanied with the usual sj^mptoms of inflammatory fevers. The inflammation may be confined to one side of the tongue, or the whole organ may be implicated. It usually arises from mechanical injuries, or from con- tact mth chemical agents or acrid substances which excite irritation. This afl'ection is sometimes induced b}" exposure to cold or to cuiTeuts of cold air about the head after the use of mercurials, or by the suppression of the sahvary discharges. In many cases the attack is very sudden, a severe inflaimnatory action setting in without any apparent cause. The first S3Tnptom complained of is usually an acrid, stinging sense of heat or burning pain in the tongue. The inflammation, as a general thing, sets in very suddenty, and proceeds rapidh^ ; the pain and swelling is very gi-eat ; the tongue i^resents a livid or dark red appearance. The inflammation may commence upon one side, or be restricted Infantile Affections, 257 to a very small portion, but gradually it may extend until the whole organ becomes involved. During the progress of the disease the pain becomes more acute, and of a burning and lancinating character, which is aggravated b}" the slightest movement ; the attempt to talk or swallow causes great suf- fering. In severe cases, the tongue becomes enormously swollen, filling the entire mouth, speaking and swallowing being prevented while respiration is obstructed, even to threatened suffocation. In other cases, the swoUen and inflamed organ is protruded from the mouth, presenting a horrid picture of suffering. The tongue is usually furred over with a thick coating, and a profuse secretion of saliva flows from the mouth. Should j^ou meet with a case where the swelhng has become so enormous as to threaten suffo- cation before a physician can arrive, do not hesitate to take 3'our knife, or any sharp instrument, and make a free longitudinal incision in the tongue. This gives egress to the blood, which removes the congestion and relieves the patient. {See Remedy No. 54.) DEiVTITION, OR TEETHIIVG. Dentition being a natural process, we should scarce^ expect it to occasion disease or suffering of any sort, and were all children in a perfectly healthy condition at the time of its commencement, they would suffer but little, if anj^, during this period. But all children are not born health}', and many that are ordinarily healthy at birth, are, by neglect and mismanagement in dress, diet, and ex- ercise, speedily rendered unhealthy. Under these circum- stances, dentition frequently becomes complicated, difficult, and dangerous, the digestive organs and nervous system being the first to feel the baneful influence. The first, millc, or temporary teeth, are twent}^ in number, and begin to make their appearance at about the sixth 258 Woman's Medical Companion. month, continuing until the end of the second ^■'ear, those of the lower jaw preceding the upper. The regular order and time of teething, however, is subject to consider- able variation. Some children get their teeth two or three weeks after birth, or are even born with them, while others do not cut any teeth until the}^ are ten or twelve months old. Teething, in the most favorable cases, is preceded by slight salivation or drooling, as it is called, by heat and swelhng of the giuns, increased thirst, restlessness, or fret- fulness, etc. Sometimes there is a rash upon the skin, called " red gmn" or tooth-rash. Connected with teething, there are often many sjTiipathetic affections, such as deter- mination of blood to the head, convulsions, constipation, swelling and sux)puration of glands, eruptions of various kinds, both upon the head and bod}', gatherings and dis- charges from the ears, cough, and general irritabihty of the nervous sj'stem, so that trifling ailments, which at other times would scarce!}' trouble the child, would, dming this period, excite a train of acute and serious sjTnptoijis which onl}' prompt and judicious treatment could successfully com- bat. In children of deficient vital power, a cold, an error in diet, or some undiscoverable cause, may excite a slight derangement, at first scarcel}' noticeable, but which, by improper treatment or neglect, leads to a permanent state of bad health, ending in tubercular degeneration of the lungs or digestive apparatus. The necessity', therefore, of zealousl}' guarding the children from every source of disease, to which the}^ might be exposed at this time, will be obvi- ous to all. Unfortunatel}', however, for the children, most 3-oung mothers haA'e aunts, gi'andmothers, or some well- meaning but officious female friends who " know all about these httle complaints of teething, and can ti^eat them qiute as well as any doctor." The mantel-piece is accordingly adorned with lotions, pills, and powders, bottles of all kinds Infantile Affections. 259 in waiiilvG arra}^, — ipecac, squills, Godfrey's cordial, pare- goric, soothing sirups, castor-oil, sulphur and molasses, peppermint, goose-grease, catnip-tea, mustard, and onion draughts, — all of which the poor infant is bound to have thrust down its throat in regular and constant succession. This is continued day after daj^, until the child is ' ' doc- tored" into some serious disease. Then the physician is sent for, but, alas ! too late to be of any service : the child dies, either from the disease or the treatment ; most fre- quently from the treatment, for the disease itself seldom kiUs. The Care of tlie Teetll. — The proper culture and preservation of children's teeth is a subject demanding the attention of every thoughtful parent. When taking into consideration the importance of sound and regular teeth, alike in regard to health, comfort, and appearance, the little care and attention requisite to keep them in a proper state seems almost insignificant. The soundness of the teeth depends in a gi'eat measure upon a healthy state of the stomach and bowels, so that whatever tends to the derange- ment of those organs will exert a deleterious influence upon the teeth. Children are often refused candies because they are said to rot the teeth. Now, sugar itself never directly injures the teeth, but the confectioners' preparations, with the mj'steriously-made but pretty-looking fixings of which children are in the habit of partaking, have a direct and extremely injurious effect upon the stomach, deranging the bowels, causing dj^spepsia, flatulence, and gassy eructations, which blacken and corrode the enamel of the teeth, thus lading the foundation for their decay and speedy destruc- tion. As a general thing, health}^ persons have sound teeth, while sickly, feeble persons have decayed teeth. A few brief hints for the preservation of the teeth will here, we doubt not, prove acceptable to our readers. 260 Womaji's Medical Companion. 1st. Tliey must he Jcej^t clean; not b}' the use of denti- frices, tooth-pastes, powders, etc., but b}' the nse of piu'e water and powdered charcoal or white Castile soap, apphed with a soft brush. 2d. By avoiding the introduction of Terr hot or very cold substances into the mouth, as all sudden changes of temperature eventually crack the enamel and produce decay. 8d. By peremptorily forbidding the use of metallic toothpicks of any kind. 4th. By remo^'ing the temporary teeth as fast as they get loose. 5th. By refraining from the practice of cracking nuts, biting threads, or lifting heavy bodies, etc., with the teeth. {See Remedy ^o. 55.) TOOTHACHE. This troublesome and painful affection, for which so little sympathy is felt, either in youth or adult, has its origin in many causes : some are hereditarily predisposed to it ; in others it is induced by exposure ; it may originate from dis- turbances hi other parts of the system, or it may be purely nervous. It is often rheumatic, or may have its origin in carious teeth and the excessive use of coffee or calomel, etc. TREATMEIVT. Do not have the teeth extracted, unless they are decayed or the roots ulcerated. Many of the ordinary remedies for toothache are not onh" useless, but positively injurious to the general health, as well as to the teeth themselves, such ' as creosote, laudanum, tincture of cloves, etc. Better remove the cause of the diseased condition. (Treatment Nos. 5G, 321, 322, 323, 32-4.) Infantile Affections. 261 SORi: THROAT, OR UlIIVSY. This is known by a variety of names, and consists in an inflammation of the back part of the throat, inchiding the palate and tonsils, frequenth^ terminating in the formation of abscesses in the tonsils or adjacent parts. It is not strictl}' limited to an}' particular age, the infant, cliild, 3'oung gui, and adult being alike susceptible to attack. Syiliptoms. — Ordinar}' quins}', of moderate severit}', generall}' begins with restlessness, irritabiht}', fever, some- times a slight cough, and more or less soreness or pricking sensation in the throat, especially when swallowing ; the older children complain of this pain and refuse all diet except di'inks and soft food, while the infant betraj's it by refusing to nurse, and wincing its face whenever swallowing is attempted. The face is flushed, respiration accelerated, voice thick, and speaking difficult or painful. The combined S}Tnptoms are ver}" similar to, and often mistaken for, inflam- mation of the lungs ; but upon placing j^our ear to the chest, 3'ou will readily mark the difference in the two diseases by the entire absence of all physical signs of pneu- monia. To examine the parts well, the head should be thi'own back, the mouth wideh' opened, and the root of the tongue depressed with the handle of a spoon. B}' this means the whole of the interior of the throat will be exposed to 'S'iew. In its severer forms it is quite a serious aff'ection, and if not at once attended to becomes dangerous. Relief cannot reasonably be looked for until the abscess bursts. (/S'ee Remedies JSfos. 57, 312.) Diet and Regimen. — The diet will have to be regulated according to the degree of inflammation. If extensive, the throat much swollen, and swallowing diffi- cult, solid food cannot be taken. Custards, panadas, gruel, 262 Womaji's Medical Companion, light soups, are all that can possibl}^ be given. In no dis- ease, perhaps, is the beneficial effect of cold water more marked than in sore throat. When going to bed at night put a wet bandage around the throat, and cover it with a drj^ cloth. If the ]3atient is confined to the house, repeat the same thi'ough the day. If it does not jdeld to this treat- ment, and the abscess continues its progress, its ripening should be hastened by the external apphcation of warm flaxseed poultices and garghng the throat with warm water. When much pain is present, the inhalation of the vapor from boihng water wiU afford considerable rehef. All medicinal gargles, bhsters, leeches, mustard di^afts, and kindred remedies, are not only useless, but decidedly injurious. MAIilGWAlVT OR PUTRID SORE THROAT. This is usually a sjTuptom of mahgnant scarlet-fever, but is also an independent form of disease, generally occurring in damp, autumnal seasons, attacking childl-en of vitiated, impoverished, or delicate constitutions, weak- ened by some pre^dous diseases. It is also more apt to attack children living in low, damp, cold, mould}", or ill-ventilated dwellings. Under such circumstances, an ordinary sore throat is readily transformed into one of a malignant t3^pe. It is an exceedingly dangerous disease whenever and wherever it appears ; the treatment should therefore be prompt and energetic, and should never be attempted by any one but a medical practitioner. Symptoms. — This disorder commences with a chiU, fever, and languor, oppression at the chest, with or with- out vomiting, more or less inflammation of the throat and tonsils, an acrid discharge from mouth and nostrils, exco- riating all the parts with which it comes in contact, weak Infantile Affections. 263 and rapid, almost imperceptible pulse, swollen throat and glands, face bloated, and general restlessness. Upon ex- amining the throat, numerous small, 3'ellowish ulcers, cov- ered with an ash^'-gTay crust, will be seen, the surrounding tissue being of a hvid or dark -red color. These ulcers are not confined to the throat and tonsils, but extend over the entii'e mucous membrane of the mouth, and even involve the windpipe. In severe cases the}' run together, and present a gangrenous appearance ; there is excessive pros- tration ; the teeth and tongue are covered with a black crust, similar to that of t3'phus-fever ; there' is more or less dehriiun ; the breath is fetid, countenance sunken ; vomit- ing and diarrhoea supervene, the pulse gTows feebler, cold and clammy sweats take the place of the previous harsh, dry skin, stupor sets in, and the patient dies. Should the disease ^ield to treatment, the s^^mptoms we have described gradually subside. (/S'ee Remedies Nos. 58, 309, 310, 311.) Diet and Regimen. — The first thing to be done is to place your patient in a dry, airy room ; plenty of fresh, pui-e aii' is the best adjuvant in the treatment of this or any other disease. The food, as a matter of course, will have to consist of rice, arrow -root, corn-starch, thin flour gruel, broths, and the like. When the mouth is very hot and dr}', it is ad^dsable to moisten it with a little warm milk and water. The mouth should be frequently washed out, and this must be done very gently, so as to produce no mitation. As a wash, warm water is the most desir- able. During convalescence, great care should be taken that the patient does not overload the stomach, as this would tend to produce a relapse, or at least excite some gastric derangements whereby recovery would be retarded. 264 Woman's Medical Companion. TO:\SIIiI.ITIS, OR liVFIiAMMATIOJV OF THE TOiSfSIXiS. As we have already partially considered tonsillitis under the head of " Sore Throat," we will confine our remarks to chronic enlargement of the tonsils. You will frequently hear the ignorant speak of children having tonsils in their throat, as though all children, and adults, too, were not provided with them by nature. The tonsils are two rounded oblong bodies, placed between the arches of the palate. The use of these glands is to secrete a fluid which makes the passage to the stomach smooth and slipper}^, so that the food can be easily swallowed. Tonsillitis constitutes the enlargement of these glands from chronic or congenital inflammation, or an inflammatory condition arising from excessive nutrition. Symptoms. — The first indication is continued snoring, caused hj the pressm-e of the tonsils upon the palate, which partially closes the passage through the nose, the air being forcibly drawn through the narrowed opening. Deafness is another sj'mptom, and originates from the pressm-e of the elongated tonsils on the small canal leading from the throat to the internal ear, called the " Eustachian tube." But the most serious consequence is the effect it produces on the chest, the obstruction preventing the free entrance of air into the lungs. These organs are but imperfectl}^ developed, and produce the prominence of the breast-bone known as " pigeon-breast." Treatment. — The application of nitrate of silver and other caustics, or the cutting-out of the tonsils, is bar- barous and injurious in the extreme, for in the majorit}^ of cases such treatment induces lung-fever, consumption, and a thousand other aff'ections more or less calamitous and fatal. The treatment we have advised in quinsy will also Infantile Affections. 265 be found beneficial in this disease. {See Remedies Nos. 59, 243.) FAr.I.IIVG OF THE PAIiATE. Though so much has been said about this disease, it does not exist ; it is purely imaginaiy. The fact is, that some persons, after a shght cold or attack of indigestion, suffer from a trivial inflammation of the palate, which, from its thickened and elongated state, produces a sensation of looseness or descent. Cold water is very beneficial, used both internally and externally. All stimulating articles of diet, fancy or highly seasoned dishes, should be especially avoided. {See Bemedy No. 60.) DIPHTHERIA, OR DIPHTHERITE. This term is used to designate a specific and peculiar form of inflammation of the throat. Unlike ordinary in- flammations of these parts, it is attended with an exudation of false membrane upon the mucous surface, attended usuallj" with a low grade of fever, and is mainly confined to the thi'oat, tonsils, and nasal cavities. It is a constitu- tional, and by no means a new disease, for we read of its ravages in all parts of the world during more than 2,000 3^ears. Causes. — Diphtheria is propagated by two causes: epi- demic influence, and contagion. Scrofulous children, those subject to glandular enlargements, catarrhal and croupous aflections, are usually first afi'ected when the disease rages as an epidemic. It generally spreads through the entire household where it once enters, affecting both adults and childi'en, those most closel}^ in communication being first attacked while those removed from the locality of the con- tagion at an early period escape. Children are the chief sufferers from this deadful affection. 266 Woman's Medical Companion. There is a great diversit}' of opinion, even in the medical profession, both as to its origin and nature. But in the hght of critical investigation and practical experience it may be safely concluded that diphtheria arises from a specific poison taken into the system, which, acting through the blood, produces a ti'ue constitutional disease, exhibiting its local manifestations in the formation of false membrane upon mucous and abraded cutaneous smfaces, and becomes capable of transmission from one to another, without any recmTcnce to the original som-ce of poison. Such being the case, the instant one child in a famih^ is attacked, all the other children should be removed beyond the range of infection. Symi)toiiiS. — There is a strong resemblance in the S3Taptoms of scarlet-fever and diphtheria, so much so that, in regard to the eruption, it would seem to be a sort of cross between that of measles and scarlet-fever, while the other symptoms have a pecuhar similarit}' to scarlet-fever. But, for all that, it is an entkeh- distinct affection. It generally commences in the same manner as an ordinary' cold or influ- enza : slight chills and fever, general prostration and wear- iness, occasionalh' high fever and severe pain in the head, disordered stomach, and loss of appetite, etc. In the course of twentj^-fom* or forty-eight hom's there is a decided aggra- vation of the throat trouble, the glands about the neck becom- ing sensitive and swollen, with an increased flow of saliva or water into the mouth. In many instances the beginning of the disease is so insidious that its true nature would hardlj' be suspected were the patches of false membrane not seen in the throat. These patches var}' from the size of a split pea to half an inch in diameter. When the membrane becomes detached it leaves the surface beneath in appearance not unlike a piece of raw meat. There is stiffness of the neck, more or less fever, unbearable headache, the inflamed sur- Infantile Affections. 267 face is bright and giass}^, or almost purplish, the breath is offensive, and there is great prostration. Under favorable circumstances, and with judicious treatment, convalescence majnisuall}^ be established in from eight to ten days, though it may be weeks or even months before the debihty and ner- vous depression is removed and the system restored to its natural elasticity and vigor. Hence the great danger of relapse^ which is too generally fatal. It frequently occurs that the patient is suddenly seized with rigors and vomiting of a thin, white, yellowish matter of a A'cry offensive nature, and purging of a similar fluid, followed b}'' prostration, stupor, and more or less violent dehrium. The membranous exudation increases to such an extent as to impede respiration and threaten strangulation, the countenance assumes a leaden hue, and the skin becomes cold and shrivelled. In a few hours, at this crisis, if the disease is not effectually arrested, the patient is beyond all hope of recover}^, and death closes the scene. If allowed to extend to the windpipe and bronchial tubes, it invariably proves fatal. The phj^sical appearance of the membrane is similar to that thrown out in true inflammatory croup, except that it is soft and is saturated with fluids. It is of a yellow- ish-white, gray, or light-brown color in the mouth and tonsils, looking lilve gray velvet or wet chamois, but of rather hghter color in the windpipe and bronchi. TREATMENT. In all cases of diphtheria, no matter how mild it may ap- pear, the patient should at once be placed under the care of a skilful physician. {See Remedies Nos. 61, 193, 194, 195.) Diet and Reg'iinen, — The main feature in diph- theria being debihty, the most watchful care is necessary. 268 Woman^s Medical Companio7i. In the first- or fever stage, stimulants would be Mghly injurious; but so soon as the prostration begins to show itself, a sustaining regimen and good nourishing diet, judi- ciously combined with stimulants, should be adopted. The amount of both stimulants and diet will, of course, depend entirely upon the nervous and general condition of the patient. In the majority of instances, beef-tea will be found most suitable to theii* requii'ements. It should be made palatable by seasoning, and be given by the spoonful every few minutes or half-hour. In cases of extreme prostration, it should be given by enema. Clam-broth, the soft parts of oysters, port wine, champagne, eggs beaten up, brandy in small quantities, are all of great ben- efit. As a beverage, when the patient is thirsty, barley- water, or toast-water, flavored with lemon-juice, or cold water, with raspberry or sti'awberry sirup added, will prove grateful. JJfAirSEA, VOMTTEVG, A]VI> REGTJRGITATIOrV OF MTLK. Owing to the imperfect development of the infant's stomach, this affection is common. It is usually a simple act of nature, ridding the stomach of any excess of food received by it. Older children also have these spells, but they are generally the consequences of visits to the apple- orchard, the candy-store, or some place for the sale of cheap and nasty " indigestibilities." This kind of vomiting always affords rehef and proves beneficial. Sometimes, however, vomiting arises from other causes, and instead of only a -portion^ the v:liole of the food is thrown up, accompanied by mucus and bile. This is, of course, far from salutary, and needs immediate attention. (>See Rem- edies Nos. 63, 331, 332, 333, 334.) Infantile Affections, 269 BrLIOUSlVESS. This ailment is so vagnel}^ comprehended and generally misunderstood that considerably more permanent mischief is done by the remedy^ in a great many instances, than by the disease itself. If a child loses its appetite, has a cough, sickness at the stomach, dizziness, or headache, it is declared to be bilious, and is accordingly drenched with powerful emetics, until the whole digestive apparatus is temporaril}', if not permanently, injured. A more disgust- ing and injmious course of procedm^e cannot possibly be imagined in ordinary cases. There are instances, as in the ejection of any foreign substances from the stomach, in which the}^ are both useful and necessar}^, but these are, or rather ought to be, exce]3tions to the rule. Syiiil)toins . — The patient appears dull and languid ; headache, giddiness, great oppression, fulness at the pit of the stomach, nausea, vomiting, offensive belching, smelling lilve stale meat or rotten eggs ; the tongue is covered with a thick, slimy, j^ellowish coating ; there is a disagreeable, bitter, putrid, slimy taste in the mouth, especially in the morning ; the bowels are either constipated or quite loose ; passages dark, very offensive, and accompanied with much wind ; ej^es dull and heav}^, of a 3'ellowish cast, and the skin, particularly about the mouth and nose, of the same hue. (^See Remedy No. 64.) Diet and Regimen. — Meats and soup strictly for= bidden ; nothing but gruel, oatmeal cakes, dry toast, milk toast, crackers, plain bread, without butter, oranges, and cold water. Even lemon-juice should not be taken if diarrhoea is present. 270 Woman's Medical Companion. OFFENSIVE BKEATH. This unpleasant affection arises from one of several causes : decayed teeth, inflammation or other disorder of the gums, ulcers in the mouth, or from want of careful attention to cleanliness, allowing particles of food to collect and remain between and around the roots of the teeth, or the accumulation of tartar. The correction of such matters belongs naturally to the dentist. The mouth and throat should be rinsed with cold water twice or thrice every day, and the teeth thoroughly brushed with a soft brush after every meal. When offensive breath arises from a deranged stomach or from other diseases, the proper treatment will be found under the head of such disorders. In other cases, where it is the chief symptom, and its origin can be traced to no apparent or perceptible cause, Eemedies Nos. 65, 286, may be employed. WIBTD COI.IC, OR COI.IC OF IIVFAIVTS. All severe pains in the abdomen not dependent upon inflammation are called colic; when its principal s3Tnptoms are sharp and griping pains, it is called spasmodic colic; when accompanied with nausea and vomiting, it is called bilious colic; when the abdomen is distended, and relief is afforded by the passage of wind, it is called wind colic. Causes, — It arises from cold, sudden or violent emo- tion of the mother, improper food, or a confined state of the bowels. Symptoms. — Disturbed sleep, rolling of the eyes, distortion of the features, drawing up of the knees, abdo- men tense and swollen, with rumbling in the bowels. Severe attacks, unless speedily relieved, may end in spasms or convulsions. Infantile Affections, 271 Treatment. — {See Remedies JSFos. 66, 293.) Most cases of colic are attended with constipation ; a free evacuation of the bowels often gives instant relief. It is imperative, therefore, that a movement should be effected as soon as possible. The most efficient way to obtain this is an injection of tepid water with a little salt mixed in it, continuing it until the desired effect is produced. Hot applications to the abdomen should alwa3^s be made use of. CHOIiERA MORBUS. This disease is characterized by great anxiety, painful and violent gripings, copious and frequent vomiting and purging, and coldness and cramps in the extremities. The gTiping pain evidently proceeds from violent spasmodic con- traction of the alimentary canal, causing the repeated and frequent ejection of its contents by vomiting and purging. Causes. — Intense heats of summer, especially when the da3's are hot and the evenings cool, with heavy dews, sudden atmospheric changes, cold drinks when the body is overheated, and the incautious use of ice, sudden suppres- sion of habitual discharges, diarrhoea, cutaneous eruptions, vexation, fits of anger, errors in diet, partaking of un- healthy food, or of an improper quality or quantity, unripe or indigestible fruits, particularly melons, cucumbers, pine- apples, green apples, or poisonous and irritating food of any kind. Large doses of cathartic drugs not unfrequently produce it. Symptoms. — The attacks are generally sudden, and without premonitory s3Tnptoms. The patient has vomiting and purging, severe griping pains inthe bowels and stomach, great anxiet}' and restlessness. The discharges from the bowels, at first fecal, soon become watery, bihous matter, 272 WomarCs Medical Companion, each evacuation preceded and accompanied by violent burn= ing and cutting, colicky pains, especially in the region of the navel, extending in severe cases to the arms and hands, with pinched features, sunken eyes, cold and clammy skin, and general depression. The substance vomited is the con= tents of the stomach, largely mixed with bilious matter ; and afterward a watery fluid ; the gagging and retching is continuous. Treatment. — (Remedies Nos. 67, 162, 163, 164.) CHOIiERA IJVFAIVTUM, CATARRH OF THE IWTESTIlVESj OR SUMMER COMPI.AIWT. The chief seat of this affection is in the large and lower part of the small intestines, seldom extending to the stomach. In ordinary and mild cases, it is simple catarrh or irritation, arising from teething or Improper diet. It is seldom met with at any other time of year than June, July, and August. It is far more prevalent in cities and in northern and eastern climates than in country districts, or in southern and western territory, so that it is evident that heat alone will not produce it unless allied with close, unwholesome air, want of cleanliness, and neglect of sani- tary precautions. The most prolific causes, however, are, as we have said, teething and unsuitable diet. It is astonishing how reckless parents are in reference to the diet of their children ; overfeeding, unripe fruits, rich and luscious dishes, and indigestible, poisonous messes of all kinds are placed within their reach, and, consequently, the children are susceptible to its attacks at all times and sea- sons. In many cases there would seem to be an hereditary predisposition to the affection, especially in those families where the constitutions of the children are feeble and deli- Ltfantile Affections, 273 cate, of a, nervous, irritable tendenc}^, or derive scrofulous or consumptive tendencies from their parents. Sj^ni^toins. — This disease is both sudden and grad- ual in its attacks. A child, apparently in good health, may be suddenl}' attacked with diarrhoea, vomiting, great exhaustion, anxious and contracted countenance, coldness and paleness of the skin, similar to the cholera of adults. Usually, however, the mode of attack is gradual, com- mencing with a diarrhoea, which soon proves obstinate and exhausting, nausea and vomiting, preceded by feverish restlessness. The mother la3^s it to the teeth, and calls the child cross when in reality it is sick. The dejections become more frequent and abundant than natural, spotted and streaked with green, looking like chopped-up greens or spinach, and mixed up with particles of undigested food. Occasionally they contain blood and mucus. Evacuations are accompanied with more or less pain, severe straining and bearing down. The frequency and severity of the vomiting depend upon the violence of the attack. The tongue is coated with a dirty white or yellowish-brown fur, the edges and tip being red. The thirst is intense. There is alwa^'s more or less fever of a remittent t3'pe, the abdo- men hot, distended, and tense, the head hot, and the extrem- ities cold. The emaciation is rapid, and if not speedily checked, the child soon has all the appearance of an aged person. The duration of the disease almost entirely depends upon the treatment, its course varying between six weeks and six months, though frequently the patient's fate is decided in twent3'-four to fortj^-eight hours. Treatment. — (Remedies Nos. G8, IGO, 161.) Diet and Regimen. — If the patient be an infant at the breast, and the mother has enough for it, no change should be made. If the child be older, the diet must depend entkely on circumstances. Overloading the stom- 274 Woman's Medical Companion. acli should be especiall}' avoided, as that would endanger the child's life. The amount should be restricted to the smallest possible quantit3\ The motto should be, "Little and often." Fresh cow's milk should form the chief ingre- dient. It should be diluted with about one-third water, boiled for ten or fifteen minutes, and moderately sweet- ened with loaf-sugar. This may be alternated with rice- flour, arrow-root, sago, tapioca, or wheat-flour. In cases where there is excessive vomiting, a little gum-water or arrow-root or • rice-water ma}" be given until it ceases. Fresh air, in the countr}' or at the sea-side, is as important as good diet ; tepid or sponge baths, and a dress suited to the weather, and changed to suit the alterations in the temperature, care being taken not to clothe the child too warml}^ DYSPEPSIA, OB IIVDIGESTIOIV. The term Dj'spepsia means any condition of the stomach in which the function of digestion is disturbed or suspended, causing want of appetite, distention of the stomach, eruc- tations of various kinds, heartburn, water-brash, pain in the region of the stomach, uneasiness after eating, occa- sional vomiting, constipation or diarrhoea, with an endless string of nervous S3'mptoms. Indigestion may be, and doubtless is, simpl}' debility', a defect of muscular power in the stomach, or a want of vital power and strength. Indigestion, though not confined to any period of life, is most common between the ages of twenty and fort3'-five, and is more frequent in females than in males. The upper and middle classes are most subject to it. The predisposi- tion to it is sometimes hereditar}', particularly in persons of a weak, relaxed S3'stem, with highly nervous suscepti- bility and general debility of constitution. Sedentary oc- Infantile Affections, 275 cnpations, indolence, long and intense stiid}^, insufficient exercise, breathing impure air, essentially" predispose to this complaint. Tiie principal exciting cause of indigestion is im- perfect mastication. The fact is, we, as a nation, have not time to cat ; business or pleasure is too pressing. From child- hood to old age we are in the habit of " bolting" our food, as if our teeth were in our stomach, and we could masticate it at our pleasure, like a cow. Children's stomachs are unable to digest solid lumps or tough masses of food, and whatever passes through them undissolved receives but little digestive aid from the stomach. Another very frequent cause of d3'spepsia in this country is the excessive use of cathartic medicines in the shape of pills. In addition to this, great quantities of bitters are used, which exhaust the powers of the stomach and produce numberless func- tional and structural derangements ; so that, were the truth to be told, the epitaph on tlie tombs of nine-tenths of our pill-takers would be : — I was well ; wished to be better ; took physic, and here I am. Indigestion in infants is frequently caused by the mi- health}' condition of the nurse's milk. In all cases, from the infant to the adult, the tongue is generally pale, flabb}', or slim}', dr}", or loaded with a thick coating, especially on rising in the morning. There is generally headache, lan- guor, and mental depression, nausea and vomiting, the last symptom usually affording relief. One form of pain is usually called heartburn. Another frequent symptom is cramps or spasms in the stomach, accompanied by belching and flatulence, which is occasioned by the generation of gases in the abdominal cavity. It is almost always allied to a sluggish state of the bowels. The evacuations are commonly dr}', scant}', and deficient in healthy color and odor. In 276 Woman's Medical Companion. females, dyspepsia not unfrequentl}^ occasions difficult, too frequent, delayed, or irregular menstruation, leucorrhoea, chlorosis, hysteria, and painful affections of the spinal nerves, with tenderness and soreness of the back. Treatment. — (Remedies Nos. 69, 202, 203, 204.) Diet and Keg'iinen, — Good cooking is a matter of the first importance to the d3'speptic. They should avoid all cured, salt, smoked, or pickled meats, sausages, etc., raw vegetables, salads, cucumbers, pickles, etc. Fresh meats, poultr}', fruit, and well-cooked vegetables may be taken in moderation, if thoroughly masticated and par- taken of at regular hours. Leave off eating as soon as 3'ou are satisfied. At least six hours should elapse between each meal. There should be total abstinence from all astringent or alcoholic drinks. Pure spring water is the best possible drink. Ice-cold water is injuiious. COIVSTIPATION. In infants it usually arises from an improper mode of living on the part of nurse or child. Those fed on artificial diet are especially liable to it. In adults and older children it is the consequence of unsuitable diet, the use of stimu- lating and astringent drinks, too long indulgence in sleep, inattention to desire for evacuation, sedentary' habits, im- paired condition of the digestive function, and excessive use of aperient medicine. Symptoms. — The tongue is coated at the root and sides, tip red, urine high-colored, slow pulse, quicker after meals ; sallowness of countenance and skin ; more or less uneasiness and distention about the lower part of the abdomen, much flatulence, and alwaj's more or less head- ache. Infantile Affections. '^ll Tkeatment. — (>See Remedies Nos. 70, 179, 180, 181, 182, 183.) Diet and Regimen. — The cure of constipation depends more on a proper mode of living than on medicine. Plent}' of out-door and manual exercise ; the avoidance of all food of a binding nature, as salt meats, cheese, wheaten flour in an}' shape, stimulating drinl^s, high-seasoned dishes ; a liberal allowance of all kinds of fruits and vegetables, soups, coarse bread, etc., a free use of cold water, and special attention to mastication. DTSEWTERT. This is sometimes called bloody flux, from the fact that the evacuations are scanty, mixed with blood and mucus, and but little fecal matter. It is essentially an inflamma- tion of the mucous lining of the large intestines, accom- panied by general constitutional disturbance. The mucous membrane is swollen, thickened, red, and softened, and in severe cases ulcerated. It is not, as many suppose, an aggravated form of diarrhoea, but the very reverse, nameh', constipation, with a constant desire to evacuate, caused by the inflammation. The inflamed and congested parts are tender and painful. It most frequently makes its appearance in the autumn, when the da^'s are hot and the evenings cool. It is generally epidemic, and may be excited by cold, exposure to wet, unripe or sour fruit, stale vegetables or meat, drinking cold water when heated, from taking cold, etc. Synii3toms. — In mild cases there is little or no fever ; in severe cases, high fever, hot, drj' skin, excessive thu'st, etc. It often begins with diarrhoea ; blood passes in con- siderable quantities, either black or of a dark reddish color, resembhng the washings of meat. There is severe pain and Im 278 Womaiis Medical Companion. burning in the lower bowels, especially just before and after eacb evacuation, accompanied by a painful constriction of the anus, called tenesmus. Nausea, vomiting, and head- ache are frequently present. The disease is frequentl}' much aggravated by the administration of cathartics. Treatmext. — (^See Remedies JSfos. 72, 200, 201.) Diet and Regimeii. — Care should be specially taken that the patient should not be thinlj'clad, nor be allowed to sit on cold stone or brick seats. He ought to lie in or upon the bed during the attack. For food, water-toast, aiTOw-root, sago, gi'uels, and the like maybe taken, and, in convalescence, mutton-broth. The patient should eat little and often. Cold water, toast-water, or barlej'-water ma}" be drank. All kinds of animal food and wine should be strictly avoided, even during convalescence. The water- closets should be abundantl}" and frequently disinfected, to prevent the spread of the epidemic. PROIiAPSrS AIVI, OR FAI.I.IJVG OF THE BOI>T. This is a protrusion or faUing down of the lower part of the bowels, and though it may at fu'st cause much unnecessary alarm, there is reall}' nothing dangerous or serious about it. It is very co mm on in infanc}", and is frequently" met with at all periods of life. It arises from a laxity of the muscles, habitual costiveness, straining at stool, diarrhoea, hemor° rhoids, drastic purgatives, worms, and other causes. TREATME]VT. The first thing to be done is to replace the protruded mem- brane, which should be accomplished as speedih' as possible. If it does not return of its own accord, then, after protect- ing the protruded parts b}' lading over them a piece of soft. Infantile Affections. 279 smooth cloth, wet with warm water or sweet-oil, embrace it with the ends of the lingers, and gently and steadily press it upward, not using a great deal of force, until it slips in, which it will do in a minute or two if the operation is rightly performed. If it has become red, swollen, or inflamed, do not be in a hum^ to reduce it, but place upon it rags saturated with a weak solution of arnica-water. As soon as the inflammation subsides, the bowel may be retiurned. When once returned, great care should be taken to prevent a repetition of the trouble. The child should be accustomed to use the chamber at . regular intervals ; and should be watched to prevent its overstraining while sitting, or remain- ing on it too long, particularly if the bowels are in any way constipated. Cold hip-baths or sponging with cold water, and sometimes cold-water injections, are of great service. The temperature of the water should be graduated accord- ing to the age and vigor of the child. {^See Remedy No. 73.) Diet. — The diet should be the same as that observed in derangements of the digestive organs in general. If possible the diet should be so governed as to prevent either constipation or diarrhoea. The child may be allowed as much cold water as it wants to diink. RUPTiJBE, OR HERNIA. By this we understand a swelling formed by the protru- sion or escape of a portion of the intestine from the cavity of the abdomen. The places at which these swellings generall}^ make their appearance are the navel and the region of the groin. The point of egress selected by the hernia gives it a peculiar name to express its position : as umbilical, when it appears at the umbilicus or navel ; inguinal, when it appears in the groin. Three descriptions of hernia only are especially met with in childi*en, namely. 280 Woman's Medical Companion. umbilical, inguinal, and oblique inguinal. The latter variety' is where the intestines have intruded into the scrotum. Hernia is termed reducible when it can at any time be returned into the abdomen, and irreducible when it cannot be returned to the ca^it}" of the abdomen without inflamma- tion or obstruction to the passages of faeces, either OT^ingtb adhesions or entanglements of the intestines ; strangidated, when the protrusion is not onl}' incapable of being reduced, from consti'iction of the aperture thi'ough which it passed, but the circulation is arrested, the passages of faeces towards the anus cut off; inflammation sets in, the tumor becomes hard and tender to the touch, pain, nausea and vomiting occm-, accom]Danied by other alarming sjTnptoms. These Yarieties are frequent in children of all ages. Causes. — Children whose muscular development is not compact, but, on the contrar}^, relaxed and flabby, leading the natm-al outlets of the abdomen unusually large, or capable of easy enlargement, are more prone to accidents of this nature than those who are robust and strong. The weakest parts are those at which the accident most fre- quentl}' occurs. Crying, coughing, or straining, or great bodil}' exertion or external injury, ma}' produce hernia. Symptoms. — Umbihcal hernia need not be mistaken for an}' other tumor. Those appearing at the groin, how- ever, so closely resemble other diseases that mistakes may readily be made b}^ any one else but an experienced ph3'sician. It generally shows itself as an indolent tumor upon some part of the abdomen, such as tl^e navel or gi'oin. The tumor appears suddenly, is developed above, and descends gi'adualty. It is subject to changes in size, being smaller upon pressure, or when the patient lies upon his back, and larger when the pressure is removed, or when he Infantile Affections. 281 stands upright. Vomiting, constipation, and colic are fre- quently the result of the unnatural position of the bowel. TREATMENT. In ever}^ case of hernia, no matter how slight or trivial it may appear, send at once for 3'our family physician, or some experienced practitioner, and ascertain from him its precise nature and probable termination. It is of the utmost importance that a cure should be effected during childhood, otherwise the individuals will, in after years, suffer great inconvenience, be unfitted for any kind of man- ual labor, and ma}^ any da}- be in danger of losing their lives. The hernia, or swelling, thus formed varies in size from a hazel-nut to a walnut, always increasing in size under the influence of coughing, straining, or sneezing. It is not often painful, unless it becomes very large. The parts should be bathed with cold water every night and morning, and the child be kept as tranquil as possible. Alarming s^Tuptoms sometimes accompany hernial protrusions, such as violent burning in the abdomen, as from a hot coal, with tenderness of the tumor, the least touch giving pain, sick- ness at the stomach, with bitter bilious vomiting, nervous- ness, and cold perspiration. (Remedies, Nos. 74, 229.) TTORMS. Many errors prevail in the popular mind regarding the natiu"e, origin, and consequences of the existence of these animalculse in the human organism. Worms were never yet the sole or originating cause, of any disease, either in the child or adult. That worms do exist in the alimentary canal of all children is an indisputable fact, but no experi- enced physician will assert that any particular disease is 282 Woman's Medical Companion, caused b}^ worms. Beyond all doubt, they serve some useful and necessary purpose in the human economy. Worms, as such, are not injurious. They exist in many children with- out their presence being suspected. If they were the cause of disease, their mere expulsion would be sufficient to remove the s}Tnptoms attributed to their presence ; but no such beneficial results follow the administration of vermi- fuges, although numbers of worms are killed and expelled by their use. In treating these cases it must alwa^'s be borne in mind that it is not merely the worms you wish to remove, but that habit of body which favors thek accumu- lation in such quantities as we sometimes find them. You cannot possibly get rid of them entii'ely. There are five diff'erent species of worms which infest the alimentary canal, but two of these are pecuhar to childi^en. The first and most troublesome is the common seat-worm, ascaris vermi- cularis, thread-worm, pin-worm, or maw-worm, as it is variously called. This is the smallest of the intestinal worms, measuring only from two to five-twelfths of an inch, and resembling a small piece of white cotton thread. They are usually found in the large intestines and rectum, but sometimes crawl into the urethra and vagina, causing a troublesome itching and a mucous discharge. The next species of worms most frequently found in children is the long, round worm, called the ascaricles lumbricoides, which very much resembles the common earth-worm. The small intestines is their favorite locality, but they traverse all parts of the alimentar}" canal. They are sometimes found in the large intestines, from which they are expelled by stool. They are occasionally found in the stomach, and even in the throat. It is not uncommon for children to eject them by vomiting. The use of much sugar, fat, cheese, butter, fruit, or any other diet which enfeebles or disarranges the digestive s^-stem, strongly predisposes to Infantile Affections. 283 tlieir production. Children of a IjTTaphatic or scrofulous constitution are more liable to them than others, and those living in dark, damp, and unclean dwellings, or in marshy regions, are specially prone to worm affections. Symptoms, — Sudden and frequent changes in the color of the face, red, pale, or lead-colored, bluish semi- cu'cles round the lower eyelid, dilatation of the pupils, itch- ing of the nostrils, bleeding at the nose, headache after meals, excessive flow of saliva in the mouth, dryness of the tongue, pains and enlargement of the abdomen, itching at the anus, abundant fetid stools ; in severe cases, convul- sions, delirium, epileptiform attacks, etc. Treatment. — (Remedies, Nos. 77, 336, 337, 338, 339, 340.) Diet. — Avoid all gross, heavy nourishment, such as too much bread and butter, potatoes, or boiled vegetables of au}^ kind, rich puddings, pies, cakes, and pastry in gen- eral. Give the patient meat soups, roasted or broiled meat, plenty of cold water and mihi. Exercise in the open air is very essential. Cold water, ^dnegar and water, or lemon- juice and water injected, will allay the itching. EPIDEMIC CHOr^ERA. This is to a great extent a nervous disorder, and where dread and panic prevail, it will reap a rich harvest. Fear will at once cause the premonitory sj-mptoms. People should understand that cholera is a disease w^hich can gener- all}' be warded off if the}" but pay proper attention to known h^'gienic laws. It is neither difficult to manage nor is it dangerous, and, ordinarily speaking, is not contagious. The only necessary precaution is to avoid over-taxation, anxiety, long fasting, overeating, damp, ill -ventilated apartments, undue excitement, or exhausting employment, unwholesome 284 Woman^s Medical Companion, food, and irregular or improper diet. It is the necessary accompaniment of filth, negligence, and the collection of noxious, decomposing material of any kind. Symptoms. — During cholera seasons diarrhoea has a special tendency to run on, if not checked, into the more perilous form of the disease, and nothing is more sure and certain to hasten that catastrophe than pm-gative medicines. As it has hitherto appeared in the United States it has always been preceded by a well-marked premonitory stage of from one to thi'ee da3V duration, such as confusion of the head, languor and debility, and derangement of the stomach. It may, however, seize upon the patient suddenly, instantly prostrating and dei3ri\-ing them of almost every element of vitality. A sunken and death-like expression of coun- tenance, feeble pulse, blue, cold, and shiivelled skin, covered with a clammy sweat, cramps thi'oughout the muscular sj'stem, with stupiditj' or extreme angnish, vomiting, and frequent rice-water discharges, may at once set in. TREATMENT. Perfect quiet and maintaining a recumbent position are absolutely necessary. Have immediate recourse to Reme- dies 78, 162, 163, 164. Diet and Kegimen. — As soon as the disease has spent its violence, and the patient beghis to mend, he should have a little gruel, toast-bread, meat-broth, etc., frequently, and in small quantities, gradually increasing the diet, both in qualitj' and quantity, until he finall}' gets back to the accustomed mode of living. HEMORRHOFDS, OR PILES. Women, both single and married, are very often subject to piles, and more especially during the period of preg- Lifantile Affections. 285 nancy. Many have supposed this disorder to originate from obstructed circulation, but the fact seems to be that the most frequent cause which operates in its production is habitual constipation of the bowels, a common affection among females of all classes. If this is avoided in the wa}' we have pointed out in the article on Constipation, much suffering and inconvenience will be prevented ; but if it is permitted to exist, and temporary' relief only sought by an occasional cathartic, the disease will become chronic, and possibly remain throughout the remainder of the patient's hfe. The inexperienced can scarce!}' imagine the amount of suffering some females undergo from- piles ; and the pain is constant, day in and day out. Various external apphcations have been devised for their removal ; even the knife has been resorted to. Against all these we would warn 3'ou, as they are not only exceedingly' painful, but, during pregnancy especiallj', highly dangerous. It is very important that a pregnant woman, and especiall}' if it be her first pregnancy, should pdy strict attention to the state of her bowels, not allowing either constipation or diarrhoea to set in, as early attention to either of these derangements will cause their prompt removal. TREATMEIVT. Remedies Nos. 20, 225, 226, 227, 228. In addition to the internal administration of remedies, much benefit ma}' be obtained from a proper use of cold water. When the piles do not bleed, cold applications, either as sitz-baths, compresses, or injections, are of great benefit. As evil results sometimes follow the sudden sui^pression of the dis- charge, it is not ad^'isable to use cold water where there is much if any bleeding. When, however, the bleeding is profuse to such an extent as to cause alarm, cold applica- 286 Woman's Medical Co77ipanioii. tions are the best st3'ptic. Warm water or steam is prefer- able when the tmnors do bleed, or when, from any cause, the bleeding has ceased, and there is considerable pain. When, after each evacuation, the bowels, or a small tumor, protrude, causing great pain, relief ma^^ be obtained by genth' pressing them up again with the ball of the finger. Injections of cold water, when judiciously administered, are of the greatest value ; but more harm than good is so often done from the carelessness of introducing the syringe, that I seldom recommend them. Diet. — As the use of condiments and stimulants of every description tends to produce gastric and intestinal derangements, it is advisable that, in this disease, they be dispensed with, and the patient confine herself strictly to the hygienic miles of diet. Meat diet should be avoided as much as possible ; some physicians even recommend their patients sufi'ering from this complaint to eat nothing for a few days except bread and water. Diseases of the Skin. 287 CHAPTEE XL DISEASES OF THE SKIN. SCARI.ET-FEVER, OR SCARILATIIVA. Considerable mj^stification exists in the minds of many about this complaint, imagining that scarlatina is a modi- fied form of the disease. But the fact is that they are one and the same ; it is epidemic, contagious, and febrile in character, and distinguished by a peculiar rash, which ap- pears upon the first or second day, and by inflammation of the tonsils and mucous membrane of the mouth. The two most important and striking features are the affection of the throat and the skin ; and yet either may be entirely absent, or so imperfectly marked as to attract but little at- tention. It is almost exclusively a disease of childhood, and seldom attacks the same individual more than once in a lifetime. It is less prevalent than measles, with which it is frequently confounded ; afi'ects both sexes equally, and usuall}' appears between the ages of one and five. In the majority of cases scarlet-fever is contracted from the epidemic constitution of the atmosphere, and not by direct communication with other individuals or their clotliing. Scarlet-fever commences, like all eruptive diseases, with shivering and lassitude, severe headache, and occasionally delirium, nausea, and vomiting. It is generall}^ sudden in its onset, the child going to bed apparently in its usual health, but awaking with these premonitory symptoms, the eruption showing itself in the course of a few hours over 288 Woman's Medical Companion. face, shoulders, neck, and breast, and extending rapidly over the entire surface of the body. It first appears in j dark-red points, speedily becoming so numerous as to pre- | sent a universal red blush. It is not usually diffused i equall}" over every part of the bod}', but is more apparent ' about the groins, the back, and the flexures of the joints ! than elsewhere. On the arms and legs the eruption does \ not present the same appearance as on the trunk ; instead of being a uniform smooth redness, it is more spotty and rough. In most cases the fever is attended with a bm-n- ing iiTitation of the skin. The redness disappears under I slight pressure of the finger, and returns when the pressure is removed. The eruption reaches its height about the "\ fourth da}", remains stationary for about twenty-four hours, j after which it begins to decline and become indistinct, and i usually disappears altogether about the seventh or eighth I day. At this time the skin begins to peel off. In some \ mild cases the whole duration of the eruptive period is 1 not more than two or three days, the skin presenting but a j slight blush, and there being but little heat or fever. Sore j throat is always present ; scarcely perceptible, perhaps, I but, on closer inspection, inflammatory action is plainly visible. The fever does not subside on the disappearance i of the eruption ; the pulse is strong and frequent, running ' up to 120 or even 160. The tonsils are swollen and red, ^ and the glands of the neck are tumefied and tender to the [: touch. The appearance of the tongue is also peculiar. At " the commencement it is covered with a thick, cream-like ) fur, the edges and tip sometimes being of a deep-red color After the first two or three days the tongue clears off and be- li comes preternaturally red and rough, looking hke raw ': flesh. Diseases of the Skin. 289 DIFFEREiVCE BETTVEEIV SCARIiET-FEVEB AlVD MEASIiES. Possibly scarlet-fever and measles may be confounded by those unfamiliar with eruptive diseases. The distinguishing marks between the two diseases, therefore, are : — First. The eruption of measles is always preceded by catarrhal symptoms, such as coughing, sneezing, and run- ning from the nose, while scarlet-fever is not. Second. Scarlet-fever is alwa^'s accompanied by sore throat ; measles is not. Tliird. The rash of scarlet-fever appears on the second day ; that of measles, at least in its regular form, not until the fourth. Generall}-, the eruption of scarlet-fever is smooth and even to the touch, and of a uniform scarlet color ; in measles, on the contrarj^, the eruption consists of minute httle pimples, which are felt to be slightly elevated, and firm to the touch ; besides, the eruption is not continu- ous, but cut up in little clusters by portions of health}^ skin. In measles, the eruption is of a raspberry hue ; in scarlet- fever, it resembles that of a boiled lobster. Scarlet-fever in anj^ form is of too critical a character to be treated by any but a medical ^Dractitioner, for it not unfre- quently happens that for one or two days the case may promise to be mild, but suddenly, and without any ascertainable cause, it may assume the threatening features of the worst form of the disease. The consequences of scarlet-fever are fre- quentl}^ worse than the disease itself. Children who have suffered from it are hable to fall into a state of permanent ill-health, and become a prey to some of the chronic forms of scrofula, boils, ulcers, diseases of the scalp, sores behind the ears, scrofulous swelling of the glands of the neck, chronic inflammation of the eyes and ej^ehds, etc. The 290 Woman's Medical Companion, same results sometimes follow measles and other eiTiptive diseases. One of the most frequent and important sequels of this disease is dropsy. This dropsical effusion attacks the struct- ure or tissue just beneath the skin, or any of the ca^dties of the bod}^ When it affects the head, dropsy or water on the brain is the result. When the chest becomes the seat of the effusion, we have water on the chest. It is generally the result of cold caught during convalescence. At this time the child needs the most watchful care and attendance, and at no stage of the disease is the patient more apt to be neglected. The mother, thinking the child almost well, leaves it to the care of a friend, or older children, while she goes out, and they, not understanding the necessity of great caution, permit it to stand by an open window or door, or allow the fire to go out or the room to become chilled. The patient, from this exposure, takes cold, becomes drooping, languid, irritable, peevish, and restless, after which swelling about the face soon makes its appearance, at first so slight as to be scarcely percepti- ble. From the face it extends to the hands and feet, and finall}' to the whole surface of the body. The patient should never be allowed the free range of the house until at least four weeks have elapsed from the commencement of the disease. MAIilGIVAiVT SCARIiET-FEVER. Scarlet-fever does not always present itself in as mild a form as we have described. In mahgnant and severe cases, the eruption, if it appears at all, is livid, partial, and fades early, is attended with feeble pulse, cold skin, and by t}^- phoid depression ; sometimes the patient sinks at once, and irretrievably, under the virulence of the poison. Or, where the patient survives the first shock, as the disease pro- Diseases of the Skin. 291 gi-esses, a condition of the throat develops itself which frequently baffles the skill of the physician, and soon de strop's the life of the patient. TREATMENT. The great fear in this disease, as in many others, is that the child will be too much " doctored." Simple scarlet-fever is fatal only thi'ough the officious and unnecessary administra- tion of drugs. Hygiene, carefulness in sanitar}" regulation, and unceasing watchfulness are the chief elements necessary to recover3\ Cathartics are totally out of place. When the skin begins to peel off, a few doses of sulphur will place the patient out of reach of danger. The irritation of the skin ma}^ be allayed by bathing the child in a weak solution of saleratus, or the application of an ointment composed of one drachm of gh^cerine and one ounce of ointment of rose-water. The application of cold-water bandages lo the throat will usually be found efficient in preventing dropsical affusion. Great benefit ma}^ be derived from the judicious use of water, either in the shape of baths or ordinary ablutions. (Remedies, Nos. 79, 236, 237, 238.) Diet and Kegimen. — During the height of the fever the patient seldom cares for anything to eat. When the mouth is dry and parched, small quantities of thin rice-gruel, or gruel made of arrow-root, may be administered ; or, if preferred, rice-water, toast and water, or cold water, fl.i- vored b}' raspberry or strawberr}^ syrup. Warm drinks should not be allowed, unless especially craved, and then only sparingly. When the teeth and lips become covered with crusts or scabs, they should be carefully cleansed with tepid milk and water. Great care should be taken to keep the mouth as clean as possible, and this can only be done by constant attention. The return to a nourishing diet 292 Womaji's Medical Companion. should be very gi^adiial, as overtaxing the digestive organs might be productive of the most serious consequences. The room in which a scarlet-fever patient is confined should be as large and any as possible, well ventilated, but never fumigated. The bed should be kept sweet and clean ; clothes, bandages, in fact, ever}i:hing about the patient, should be removed as soon as done with. Of course, great care should be taken to guard the i^atient from cold. A room can be kept thoroughly ventilated without exposing the patient. ! SCARL^ET-RASH. i This, though frequently mistaken for, is quite a different disease from, scarlet-fever. Scarlet-rash consists of small gi'anular elevations, easilj' felt on passing the finger over the skin. The eruption is of a dark-red color, sometimes i almost pm'ple ; the pressm-e of the finger leaves no white i imprint, as in scarlet-fever, and there is seldom much, or j indeed any, sore throat. Scarlet-rash may easily be con- founded with measles, as the eruption in the two diseases is very similar. This malad}' is most common in summer and autumn, though it does occur at all seasons of the 3'ear. It attacks children of all ages. It is not a contagious dis- ease, and is occasioned by gastric derangement, sudden atmospheric changes, violent exercises, the use of cold diinks while heated, and by checked perspii'ation. The eruption is generally preceded by chilhness, alter-" nating with heat, accompanied by loss of strength, heavi- ness and fulness of the head, restlessness, sometimes with vertigo, severe pain in the head, and even mild delirium. I There is for the first few daj's, in connection with the above '' symptoms, more or less fever, heat and diyness of the skin, 1 loss of appetite, and perhaps some gastric derangement. *, After these S3miptoms have continued for an indefinite length ■■- Diseases of the Skiit. 293 of time, the rasli appears, sometimes upon the third or fom'th da}', and in its regularit}' and appearance nearly resembles measles. There is, however, this difference between the two : measles is attended b}' catarrhal s3Tnptoms, has a defi- nite time and special succession of localities for the appear- ance of the eruption ; whereas scarlet-rash is not accompa- nied b}' catarrhal sj'mptoms, and the eruption is irregular in its appearance, or occurs suddenl}^ over the whole body. It cannot be mistaken for scarlet -fever, because it is not con- tagious, is not accompanied b}^ sore throat, and is composed of irregular circular patches of a deep rose -red color. (Remedies, Kos. 80, 236, 237, 238.) MEASLES — RUBEOXiA. This disease is characterized by inflammatory fever, ca- tarrhal symptoms, hoarseness, dry cough, sneezing, drowsi- ness, and an eruption. The eruption generally appears on the fourth da}', in the shape of small red dots, like flea- bites, which, as they multiply, unite together into irregular circles or horseshoe shapes, leaving the intermediate por- tions of skin of their natm'al color. These red points are slightly elevated, and can readily be felt b}^ passing the hand over the sm-face. The causes of measles are epidemic influ- ences and contagion by personal contact. The particular period of the disease in which its infectious power is most potent has not yet been clearly ascertained. The average period of incubation, or time required to develop the disease after exposure, is from seven to twenty days. It occurs but once to the same j)erson. As a general rule, the first s^inptoms complained of are lassitude, uTitabilit}', aching in the back and limbs, and shivering, which is soon followed b}' fever, thu'st, and head- ache, irritation of the mucous membrane of the e^'es, nose, 294 Woman^s Medical Companion. mouth, and laiynx. The premonitory spnptoms are those of a severe cold in the head : the ej'es are bloodshot, the ejehds heav}", turgid, and red, excessive sneezing, watering of the eyes, copious defluxion from the nose, soreness of the throat, and a dr}^, hoarse, peculiar cough, arising from the iiTitation and inflammation of the mucous membrane hning the throat and nasal passage. This first stage lasts generally about three days ; upon the fourth day, seldom earlier, frequenth' later, the eruption makes its appearance ; the rash is two or three days in coming out, beginning upon the chin, cheeks, or some other portion of the face, and extending to the neck, arms, and trunk of the bod}', and finall}' to the lower extremities. This stage lasts from twenty- four to fortj^-eight hours. The fever does not diminish when the eruption makes its appearance. All the sjmaptoms are at their height, but the moment the eruption passes its high- est point of intensity, the whole of the sjTiiptoms gradually subside. After the eruption has passed away, the parts which it recently occupied are left covered with a dry, small scurf, and small bran-lLls:e scales. The skin does not peel off in large flakes, as it sometimes does in scarlet-fever, but it crumbles away like dust or fine powder. This stage of des- quamation, as it is called, is more indefinite in its duration than those which precede it ; but, as a general thing, it lasts six or seven days, and during this period the patient ought to receive as much care as when the disease was at its height. There are, however, frequent exceptions to this com'se, which we will now notice. The severity of the measles does not depend upon the amount of eruption ; the early and plentiful appearance of the rash is, in itself, no sign that the disease will be more severe or dangerous ; on the contrary-, the worst cases are those where the eruption is but partial, does not come out well, appears late, or irregular. In what is called the " black Diseases of the Skin. 295 measles," the eruption comes oiitslowl}^ and imperfectl}^, and is of a livid, purplish, Or even blackish color. This is a very dangerous form of the disease ; the patient may die early from exhaustion or congestion of the brain or lungs. A retrocession of the eruption is very apt to be followed by unpleasant, if not alarming, sj^mptoms. Sometimes measles are complicated with gastric derange- ments ; in such cases the tongue will be found coated ; there is some nausea, and, perhaps, sickness at the stomach ; the eruption does not stand out as prominent as it should, and the healthy portions of the skin between patches of erup- tion have a 3'ellowish tinge. Perhaps the most frequent and important complication of measles is inflammation of the lungs. Inflammation of the bowels is also a frequent compli- cation. Treatment. — In ordinary cases, aconite is the onty remedy caUed for ; the uncomplicated forms of the disease need scarcely any other treatment than a strict attention to hygiene. In all cases, no matter how mild, the patient should be confined in a large, well-ventilated room. In most cases, the patient is quite wilhng to lie on his bed during the first part of the disease ; but as soon as the erup- tion begins to disappear and the fever subside, he will want to be dressed ; and, when once dressed, he will think it strange that he cannot go out, especiall}" if he feels quite well ; however, he should not leave the room, and certainl}^ not the house, until he has regained his accustomed health- ful look. It has alwa3's been the custom to shut a measles patient in a hot room, and allow him nothing but hot drinks. This is a most pernicious habit, and has no doubt led to a great man}^ serious and even fatal results. The patient should never be allowed liot drinks, and especially those which are recommended to throw out the eruption. If he is thu'sty, give him cold icater, as much as he wants. It is 296 Wommt^s Medical Companion. the most palatable, and b}" far the best drink jou can pro- cure. I have seen the happiest results brought about by its free use. In those cases where the eruption is backward in coming out, give the patient a glass of cold water and cover him up warm in bed. This is especially advisable where the fever is violent and the heat of the skin very great. (Remedies Nos. 81, 267, 268, 269, 270.) The diet during the febrile stage should be very light. The patient usually will ask for but little, but that little should consist of thin wheat or rice flour gruel, barley-water, toast-water, milk and water, tapioca, crackers soaked in water, or some similar food. When the fever begins to abate, the allowance may be increased to plain or toast bread, bread-pudding, or some light broth, either animal or vegetable, and even a small quantity of chicken or beefsteak once a day until the strength is regained, when the usual diet can be resumed. By observing these rules strictly all trouble will be avoided. Disorders consequent upon measles are frequentl}' even more dangerous than the primary affection. Running at the ears, inflammation and swelling of the glands, especially about the neck, are apt to occur. This is frequently the case in scrofulous children. WETTXiE-RASH, HIVES, UltTICABIA. This disease, called by each of these names, is a non- contagious eruptive disease, characterized by little, hard elevations upon the skin, of uncertain size and shape, and generally- of a red color with a whitish tinge. Sometimes there is little or no redness, and the elevated parts are even paler than the surface around them ; more frequentl}', how- ever, the elevated spots are partly red and partl}^ white. The eruption, on making its appearance, is attended with Diseases of the Skin, 297 intense heat, tingling and itching, a sensation much like that produced b}' the sting of the nettle, from which it takes its name. Causes. — Some people have a constitutional predispo- sition to this disease, and the slightest error in diet, or the most trivial functional derangement of the digestive appa- ratus, is sufficient to bring on an attack. Children possess^ ing a fine, delicate skin are particularly predisposed to attacks of hives ; in such, slight gastric afiection, a warm da}', excessive clothing, dentition, or almost an}^ little dis- turbance, will 2)roduce it. Syiiil)toins. — As a general thing the disorder in children manifests itself without any premonitory S3^mp- toms. The eruption is attended with heat, burning and itching, the blotches continuall}^ changing from one position to another, or disappearing in a few hours on one part and appearing on another. The most frequent form of the dis- ease which we meet with in small children consists in large inflamed blotches, of an irregular shape, being either round or oblong, appearing suddenly, and preceded by very slight, if an}', constitutional S3'mptoms. The blotches are of a bright red color, excepting the slightly elevated centre, which Is white. The form of the disease is not dangerous, but verj' annoj-ing, and occasions great irritability and cry- ing. The eruption most commonly makes its appearance about the face, the upper part of the arms, thighs, and buttocks. In some cases, especially with older children, the eruption is preceded b}' headache, bitter taste in the mouth, coated tongue, nausea, vomiting, and fever. This is particularly the case in that form of the rash which is induced by' errors in diet and exposure to cold. Another form of the disease which is preceded for a few hours or a few da3's by feverish- ness, headache, nausea, chilliness, and languor, is where the 298 Woman's Medical Co^npanion, blotches become reddish and sohd elevations, either round or oblong, often called wheals. They resemble as much as an^^thing the ridges caused by the stroke of a whiplash. This eruption, like the other forms, is attended with violent itching and burning. During the attack the patient is usually more or less feverish, and suffers from headache, languor, loss of appetite, and other signs of gastric de- rangement. TREATMENT. Aconite, internally, and myro-petroleum alburn^ externally, in the form of a soap, will be found especially valuable and effectual in subduing it and accomplishing a thorough cure of this and all other skin diseases. Every effort should be made to promote perspiration by covering the patient well and giving him plenty of cold water to drink. The same diet and regimen should be adopted as for measles. (Remedies Nos. 82, 236, 237, 238.) ERYSIPEI.AS, OR ST. A]\THO:XY'lS FIRE. Er3'sipelas is a non-contagious disease, characterized by a deep, red rash, or superficial inflammation of the skin, which has the peculiaritj^ of spreading from place to place, the part first attacked recovering while the neighboring parts are becoming affected. Erysipelas is rarely experi- enced during childhood. The few cases that I have seen arose indirectly from vacchiation, the vaccine virus and the local irritation produced b}' it bringing into activit}' a dis- ease the seeds of which already existed in the system. - The causes of er^'sipelas are obscure ; slight points of irritation upon the skin may form a nucleus from which the er3'sipelatous inflammation ma}'- spread, but these certainly cannot be the real cause. There must be a general epidemic Diseases of the Skin. 299 constitution of the air at times, in certain localities or dis- tricts, Avhicli predisposes to the disease, or else there is an hereditar}' taint in the S3'stem. Symptoms. — Generall}^ there are but few, if any, marked premonitory constitutional symptoms, the appear- ance of the eruption being the first indication of the disease, after which we soon have fever, heat, dr3mess of the skin, and thirst. The inflamed surface is at first of a bright red and shining appearance, but it soon assumes a purplish hue ; and as this change takes place, the parts become tense, hard to the touch, and more or less swollen and painful. The color disappears under pressure of the finger, but returns as soon as the pressure is removed. When the inflammation once begins, if not soon arrested there is no knowing where it will end. AATien it starts upon the face, it may extend to the scalp and cover its whole surface ; or when commencing upon the arm, it ma}^ extend down to the fingers or up to the shoulder, and from there over the whole trunk of the bod3^ For this disease, it is always best, when possible, to consult a good, skilful phj^sician. TrvEAT^iiENT.— Eemedies Nos. 83, 206, 207, 208, 209. Diet and Kegimen. — The same as for any other febrile disease, measles, or scarlet fever. To allay the itch- ing, which is sometimes intolerable, dust the parts over with powdered starch, or, which is better, wash with a solu- tion of mjTO-petroleum soap. Wet or greasy applications of ever}" description should be specially avoided, as they alioays aggravate the disease. ITCH, PSORA, OR SCABIES. This is a contagious eruptive disease, characterized by more or less numerous distinct pointed Axsicles, transparent at the summit, and filled with a viscid, serous fluid, while, 300 Woman's Medical Companion. from the base of each vesicle small red lines usually run off. It is comparativel}^ rare in America, though it is prevalent among the i^oorer classes in Europe ; and is contracted onh^ by actual contact. It is generally the result of want of cleanliness. These little vesicles which rise upon the skin are caused by the presence of a small insect called ' ' acarus scabsei." The zigzag track which the mite makes in burrow- ing beneath the scarf-skin to deposit its eggs can readil}' be seen, but not so the mite itself, for it is very small, and only discoverable b}^ a powerful microscope. As a general thing the eruption first appears upon the wrists and between the fingers, and extends more or less rapidly over the whole bod}', except the face. It is fre- quentl}", however, confined to the hands, fingers, and the joints. The number of these vesicles is variable ; in some cases they are very abundant, while in others the}^ are few, and confined to the flexures of the joints. At first they are of a pinkish color, and contain a drop of stick}^ transparent serum ; these soon becomes broken bj'' the clothes or fingers, or burst spontaneously, and form their scabs. The disease is alwa3's attended by severe itching, the most prominent and distressing feature of the affection. It is most troublesome at night, being increased by the warmth of the bedclothes. TBEATMEHTT. Sulphur ointment, or, what is much better, parafllne soap in solution, well rubbed into the skin before a fire, night and morning, for two days, will eradicate the disease. During this treatment, the jDatient should wear a flannel gown and keep his bed. On the third daj^ the skin should be washed off with soap and water. Should the first at- tempt not succeed in removing the trouble, repeat it. The Diseases of the Skin. 301 disease scarce!}' requires any constitutional treatment. (Remedies Nos. 84, 247, 248, 249, 250.) ITCHIIVG OF THE SKIIV. Simple itching of the skin is scarcely a disease of itself, but rather a S3'mptom of some disease ; and, indefinite though it is, it ma}' direct us in the selection of a remedy for the morbid condition which gives rise to the irritation. For itching produced b}' mosquito bites, camphor is a spe= cific, applied externally. (Remedies Nos. 85, 247, 248, 249, 250.) HERPES, OR TETTER; ZOSTER, OR SHIBTGLiES ; CIB= CliVATUS, OB BIIVGWORM. Herpes is a contagious, non-eruptive disease, characterized b}' an assemblage of numerous little vesicles or watery pimples in clusters. These patches are surrounded b}' more or less inflammation, or rather the A^esicles are situated on an inflamed sm-face, and are separated from each other by portions of perfectl}' healthy skin. The fluid in each vesicle, at first transparent and colorless, soon becomes millv}^ and opaque, and in the course of eight or ten daj's is entirely absorbed, or concretes into furfuraceous, bran-like scales. The most common varieties among children are shingles and ringworm. The causes of skin diseases are obscure and uncertain ; but decidedl}' the most frequent and appreciable are want of cleanliness, disturbance of the digestive function, bilious disorders, sudden transitions of temperature, suppressed perspiration, irregularity in diet, and local irritants. The characteristic feature of ringworm is the peculiar arrangement of the vesicles in small circular rings. The first indication of its presence is the more or less vivid red- 302 Woman's Medical Companion. ness of the skin at the point affected » This inflammation is rapidly filled in with vesicles. The circular patches vary considerabl}^ in size, from that of a ten-cent piece to two or three inches in diameter. "WTien small, the whole surface of the patch is inflamed, the centre being of a lighter shade than the circumference. ^Tien larger the circumference alone is red, the centre retaining the natural color of the skin. These eruptive patches or rings may appear upon any part of the bod}', but are most frequent upon the upper extremities and neck. Slling'les is an uncommon variety of the disease, the eruption appearing in the form of a half-zone or belt sur- rounding the body. Old ladies will tell 3'ou that if the two ends of this belt should meet, that is, extend clear round the body, the child will die ; but as this never happens, it need not alarm you. The most frequent seat of shingles is at the waist, the belt seldom extending more than half-way around the body. It is preceded b}' constitutional symp- toms, more or less severe, such as languor, loss of appetite, rigors, headache, sickness, and fever. The local s^Tuptoms are pungent and burning pain at the points where the eruption makes its appearance. It is variable in duration, is an acute disease, and seldom lasts over eight or ten daj's. Sometimes the rings appear, and in a short time fade away, onl}' to reappear in some other part of the body ; and thus, by the formation of successive rings or patches, the disease is continued for three or four weeks. TREAT^IEIVT. Ringworm usually j'ields readily to the action of sepia, and, even in the scA'crest cases, will succmnb to the admin- istration of some of the preparations of refined petroleum. The only external application called for is a solution of the Diseases of the Skin. 303 remedy which j^ou are gi^^ng internally. (Remedies Nos. ^^, 248, 249, 250, 251.) Diet and Regimen. — As the complaint often arises from gastric derangement, particular care should be taken as to the patient's diet. Avoid all highly-seasoned food, all rich dishes, all irritating substances ; in a word, place the child upon a plain, farinaceous diet. The skin should be kept perfectly clean ; avoid all irritating or scented soaps, and be careful to have the clothes so adjusted that they will not rub and irritate the eruptive patches. PRICKI.T HEAT. During the heat of summer, adults, infants and 3'oung children are frequently much annoyed with an eruption con- sisting of small papulae, or pimples, few of them being larger than a pin's head, scattered more or less thickly over the af- fected surface. The pimples are about the size of a pin's head, and are of a red color, more or less bright, according to the intensity of the eruption. As a general thing, the skin between the papulae retains its natural appearance. The eruption is most abundant on those parts covered by the dress ; its development is undoubtedly favored b}^ warm rooms and excess of clothing. It will usuall}' be found more copious about the neck, the upper part of the chest, and on the arms and legs. More or less fever usually accompanies the affection, and the intolerable itching of the parts causes much fretfulness and a desii'e to scratch. In the infant, there is considerable restlessness, worrying, and distm-bance of the sleep. TREATMEIVT. In most cases, scarceh' an}' treatment is called for. The eruption is rather beneficial than otherwise, so far as the 304 Woman^s Medical Companion. health is concerned. It is a veiy bad practice to apply an3^thing having a tendenc}^ to repel it ; it is only when the heat and itching is intolerable, that any attention should be paid to it, and even then nothing beyond a coohng and cleansing wash or lotion should be apphed. Great comfort and benefit will be obtained by frequent bathing. Sponging the child off two or three times a day with bran- water, shppery-elm water, or other mucilaginous water, will often allay the irritation and afford considerable reUef. (Reme- dies Nos. 87, 247, 248, 249, 250.) STROPHrUTiUS— BED GTJM, WHITE GIJM:, TOOTH-RASH. These eruptions are most common during dentition. The}^ are caused b}' disturbances of the digestive apparatus, are never attended with danger ; and as they are about the only pwijoly eruption to which young infants are subject, there is no difficulty in distinguishing them. Bed Gum. — The papulae or pimples in this variety rise sensibly above the level of the skin, are of a vivid red color, and scattered here and there over different parts of the body, but more generally over the cheeks, forearms, and back of the hands. Red gum occurs chiefly within the first two months of lacta- tion. The eruption remains on the skin for one or two weeks, the pimples disappearing and reappearing in suc- cessive crops. It usually terminates in the peehng off of the skin. White Gum runs the same course, only differing in the color of the pimples. Tooth-rash. — In this variety, the pimples are much smaller, more numerous, and set more closel}" together than in the others ; their color is not so vivid, but thej' are generall}^ more prominent, and constitute a more severe disorder. The eruption appearing generally during dentition, has, for this reason, been called "tooth- rash." Diseases of the Skin. 305 TREAT3IEIVT. As a general rule, it is hardl}" worth while to prescribe for either of these complaints. A gentle aperient is all that is needed. -Cleanliness and attention to the di^ess is the chief necessity in all such affections. (Nos. 88, 247, 248.) CHICKEN-POX. Chicken-pox, or Varicella, as it is technically called, is a contagious, eruptive disease, febrile, and characterized b}^ more or less numerous transparent vesicles or little bladders, which appear first as a small red dot, and gradu- all}^ change into a bladder about the size of a small pea, containing a watery or millty fluid. Chicken-pox was at one time considered a modification or variety of small-pox, but experience has proved that it is not in the remotest degree related to varioloid or small-pox. It is propagated b}' contagion, and by epidemic influences. Symptoms. — The constitutional s3^mptoms are only trifling. The preliminary indications are chills followed by heat, hurried pulse, loss of appetite, nausea, and sometimes vomiting ; after which the eruption makes its appearance, but without that regularity which marks variola. It is first observed upon the back or face more frequently than on other parts of the bod}^, though it ma}^ appear on any part. The eruption appears in the form of small red pimples, which, in the course of a few hours, show small transparent vesicles in their centre. About the second day the}^ change into globular bladders, the size of a small pea, filled with a transparent orange-colored or colorless fluid. Generall}' the}' are not numerous, and all scattered over the bod}'. Sometimes we find them crowded together, even running into each other. On the fourth day they begin to 306 Woman's Medical Companion. shrink and tuiui into a thin, brownish, horny scurf, which falls off in two or three days, leading onh' a faint red spot behind, which soon disappears. The eruption is usually accompanied b}^ a sensation of heat and itching, which is the occasion of a great deal of uneasiness. The child rubs and scratches those vesicles that are within reach, thereby breaking and preventing them from running the regular course above described. TREATMEiVT. Unless complicated, this disease requires but little treat- ment beyond attention to diet and the avoidance of cold \ during couA'alescence. Poor people let their children, dur- , ing the whole course of the disease, run about the streets the same as ever, and they recover. The diet and regimen , should be the same as in measles. (Remedies Nos. 89, | 185.) I VARIOIiA AjVI> VARIOtOIB. Small-pox is an epidemic and contagious eruptive febrile disease, characterized by an initial fever, which, upon the | thii'd or fourth da}', is followed by an eruption of red | pimples. In the course of two or three days these pimples i are gradual!}' changed into small vesicles, which contain a di'op of transparent fluid. From the fourth to the sixth daj^ these again change into pustules, for the suppurative process now commences, converting the serum or trans- parent fluid contained in these vesicles into pus or matter, after which the pustules (hy up and are converted into scabs, which fall ofl" between the fifteenth and twentieth day. Owing to the attention now everj^where given to vaccina- tion, small-pox is comparatively a rare disease in children Diseases of the Skin, 307 belonging to the upper and middle classes of societ}^ ; but as, among the careless and the poorer clases, vaccination is sometimes neglected, the disease will occasionall}" break out, and one case is enough to alarm the whole neighbor- hood. It is as well that all should understand its nature and appropriate treatment. The principal cause of the disease is contagion^ the propagation by epidemic influence being a matter of very considerable doubt. At what particular . period of its course the disease acquires its power of infec- tion has not been precisel}' ascertained ; and as it is alwa^'s best to err, if err we must, on the safe side, it is advisable to avoid the patient and his house from the moment the real nature of the disease becomes apparent. The period of incubation, after exposure to the disease, before the first s^'mptoms manifest themselves, varies from nine to twelve or fourteen da^'s. Like scarlet-fever, one attack protects the constitution, in the majority of cases, against subse- quent contagion. Symptoms and Treatment. — The disease has been divided into four stages, which we will proceed to describe, and give the treatment appropriate to each as we go along. The^?'s^ or febrile stage commences, as we have said, from nine to twelve or fourteen daj's after exposure to the contagion. The patient first complains of pains in the bones and loins, similar to, and indeed often mistaken for, those of a common cold, or he may be taken with a more or less severe chill, accompanied with headache and fever, dry, hot skin, and great thu'st. Nausea and vomiting often exist from the beginning of the attack ; there are at the same time loss of appetite, oppression in the stomach, and constipation, more or less obstinate ; tongue red and dr}'. The principal s}TQptom during this stage of the disease is the pain in the loins, which, though varying much in degree, is always severe. In some cases, the head s^TQptoms are 308 WomarCs Medical Companion. especially marked, consisting of restlessness and irritabilitj" ; light hurts the e^'es ; there is swimming in the head ; the mind wanders ; the patient is flight}^, and occasional!}' there are convulsions. These S3anptoms continue up to the time the eruption makes its appearance, which is usually in from fortj'-eight to seventy-two hours. {See Remedies Nos. 90, 302, 303, 304, 305.) Second or eruptive stage, — Some time in the course of the third day, after the patient is first stricken with fever, the eruption begins to make its appearance in the shape of small red pimples, of the size of pin-heads ; as the eruption j comes out, the fever subsides. This pimply eruption first j shows itself upon the face, and then extends to the i neck, trunk, and hmbs. This stage of the disease lasts ) about three daj^s, during which time the papulae or pirn- I pies gradually increase in size, and are changed into i vesicles, or little pouches, filled with a transparent fluid. ' At the same time the eruption appears upon the skin we j have something corresponding to it affecting the mucous j membrane of the mouth, throat, and nose. Sometimes } there is severe inflammation of the throat, with tenderness ii and swelling of the glands about the neck. J Third or suppurative stage. — At this stage, the eruption changes from vesicular to pustular — the fluid changes from serum to pus or matter. This change takes place from the fourth to the sixth day of the eruption, or the eighth or j ninth day of the disease. During this stage the pustule completes its development, the pock becoming distended, and as large as a split bean. During the filling up of the pock the face swells, often to such a degree that the e3^es j are completely closed. As the eruption occupies about three days in coming out, those pustules which appeared first upon the face are quite in advance of those which appeared last upon the extremities. In fact, while those upon Diseases of tJie Skin. 309 the face are in the third stage, those upon the breast are only in the second stage, and those upon the extremities are in the first, or just making their appearance. "Witliout tliis division of the burden, the disease certainly would be unbearable. The treatment adapted to this disease depends gi'eatl}' upon the condition of the patient at the time of its arrival. If there are no alarming symptoms, if the fever which is reproduced during this time is not severe, if the color of the skin between the pustules is not of a livid hue, the remedies which have already been given to the patient ma}' be continued. Fourth^ or stage of desquamation. — This is the stage of decline. At about the eighth day of the eruption, a small dark spot makes its appearance on the top of each distended pustule. At this point the pock bursts, a portion of the matter oozes out, and the pustule dries up into a scab. This, however, is not always the case ; sometimes the dark point formed upon the apex extends itself until the whole pustule is converted into a hard crust. The forma- tion of crusts begins upon the face, and extends thence to the trunk and extremities. When, at length, these crusts fall off, the appearance of the skin beneath is peculiar : there is left a purplish-red stain, which gradually fades awa}-, or else, in severe cases, where there has been true ulceration of the skin beneath, there is a depressed scar, or, as it is said, the patient is " pitted." Desquamation, or the falling off of the crusts, does not reach the limbs until about three or four da3's after it has commenced on the face. The above description refers only to the regular and favorable course of the disease ; where the pustules are not so numerous as to run together, it is called the distinct, in contradistinction to the conjluent, or that severe form where the pustules are numerous, come in contact, and, running together, form one immense scab, covering the 310 Woina7i's Medical Coinpanio7t. Tvhole surface, the latter being necessarily more severe and danojerous than the former. The treatment for this stas^e is very simple, scarcely anything is called for except cleanli- ness. Simple ablution with tepid water will generally be all that is requked. At the beginning of this stage it is as well to give an occasional dose of sulphui'. Diet and Regimen. — The room in which the patient is confined should be as large and any as possible ; it should be kept at a moderate temperature, well ventilated, and almost dark. A straw-bed or mattress is preferable to a feather-bed. The diet should be cooling, such, for instance, as water, ice-cream, lemonade, oranges, roasted apples, stewed prunes, strawberries, gi'uel, toast, etc. Avoid the fruits and acids if diarrhoea should be present. Animal food should not be used until conyalescence is pretty well established. VABIOI^OrD. This is simply a modified form of small-pox. The treat- ment which has been given for that answers equally well for this disease. VACCEVATIOW. As a preventive against small-pox, vaccination is favorably known, and practised by all ci^-ilized nations. Many per- sons object to vaccination, for fear that b}' this means some other disease ma}' be introduced into the s^^stem. To avoid this, seek the aid of a physician whose integiit}^ and ability are above suspicion. Vaccination, and reA^accination from time to time, are considered b}" every physician as an imperative dut}', and the only safeguard against the en- croachment of one of the most loathsome and fearful of all diseases. Diseases of the Skin, 311 INTERTRIGO, EXCORIATIOWrS. B}^ " Intertrigo " is understood those superJScial sores, ex- .coriations, or gallings which sometimes appear behind the ears, between the thighs, in the folds of the neck, or other parts of the bod}" where the skin folds back upon itself. This troublesome disorder, as a general rule, is peculiar to fat children. It is said to be caused by the mother or nurse indulging in highty-seasoned or acrid food, particularly pork. Fat children are particularly predisposed to the disease, but, without doubt, an3'thing which irritates the skin will act as an exciting cause : a want of cleanliness, or the con- trar}^, too frequent washing, especially with coarse soap ; acrid perspiration, especially when combined with some of the various " baby-powders " sold by druggists, materially aid in the development of and even cause the disease, from the fact that l^^copoclium, and other vegetable productions haling chemical properties, form the chief ingredient of these powders. (Remedy No. 91.) PIMPI.ES ON THE FACE, ACIVE, PUIVCTATA, COMEDONES. "We not unfrequently find upon the faces of children and young persons, small, black-headed pimples, from which, b}" pressing upon their sides, we can squeeze out a small, vermiform or worm-like cylinder, about one-tenth of an inch in length. The disease received the name of come- dones from the fact that they were for a long time believed to be small insects ; investigation has proved, however, that the white cylinder which we squeeze out is nothing more nor less than an accumulation of fatty matter in the follicles of the skin, and the black head is caused b}^ the dust which adheres to it. The causes of comedones are anything which obstructs the excretory ducts of the cutaneous follicles, or. 312 Woman's Medical Companion, indeed, the secretion of itself ma}' be of a morbid charac- ter, which is frequentl}' the case in persons with a torpid skin ; the contents of the oil tubes become too thick and &XJ to escape in the usual manner. The obstructed and distended tube sometimes inflames, even suppm^ates, and the pimples become ver}' sore. (Remedies Xos. 92, 289.) ABSCESSES. B}' the term ' ' abscess " is understood what, in popular language, is called a " gathering." A collection of pus, or matter, in an}' part of the bod}', resulting from inflamma- tion, which may be either acute or chi'onic. Abscesses are of various kinds ; we shall confine om' present consideration to those lymphatic tumors and superficial gatherings, such as we so often meet with in children, especially about the head and neck. An abscess is not an original disease, but always the result or termination of inflammatory action. Inflammation and suppuration of the cervical glands of the neck are fre- quently concomitants of other diseases. Scald-head, scarlet fever, measles, and many other diseases are frequently followed by glandular inflammation, which terminates in the formation of pus — true abscesses. There is about some children an hereditary dyscrasia or constitutional taint, — scrofula, or some kindred diseases for instance, — which pre- disposes to the disorder. Syixij)toiilS . — Acute abscesses are preceded and ac- companied by sensible and inflammatory action in the affected part ; it is hot, tumefied, throbbing, and painful. The commencement of the suppurative process, that is, when the formation of matter takes place, is to be known, or at least suspected, by the change in the character of the pain which takes place at this time, and by the appearance Diseases of the Skin. 313 of the skin. The pain, which has previously been acute, loses its intensit}', becomes dull and throbbing, the skin changes from a red to a livid color. The tumor presents a somewhat conical shape ; and the skin over its apex be- comes thin and of a dark livid color. At this point, if left alone, the abscess will burst, and allow its contents to es- cajDe. In abscesses of any magnitude, during the suppura- tive process, we have usually more or less definitely marked rigors and chills, succeeded in turn by increase of fever. After an abscess is fully formed, provided it is not too deeply seated, fluctuation in the tumor is always perceptible. Chronxc Abscesses. — Although all abscesses are the result of inflammation, the inflammatory action in chronic abscesses is sometimes of so low a grade as to be almost imperceptible ; indeed, during the first stage of the disease, it is entirel}^ so, and were it not for the swelling, which always becomes apparent before it reaches any great mag- nitude, we would scarcely know that an}- thing ailed the child. The entire absence of all local and constitutional symptoms renders the disease obscure, until it begins to approach the surface and form an external swelling. An acute abscess readily heals, as soon as the pus is freely evacuated. Not so with a chronic abscess : the latter, instead of contracting and filling up with healthy granula- tions, that is, portions of new flesh, remains open and dis- charges copiousl}^ of thin, acrid matter ; and this state, if continued any great length of time, results in the production of hectic fever ; or, in other words, the patient goes into a decUne. TREATMEIVT. As abscesses do not always end in suppuration, but sometimes in resolution, — that is, the inflammation and sweUing subside without the formation of pus, the tumor 314 Woman's Medical Companion. not gathering, — it is not always advisable to apph' poultices, as this may cause it to gather, when it otherwise would not. Should a swelling appear an3'where upon the surface of the bodj^, which we apprehend may terminate in an abscess, our first endeavor should be to cut short the inflammation before it reaches the point of suppuration. This can best be done \)j the external application of cold-water bandages and the internal administration of Remedy' 93. This treatment is especially recommended when there is considerable consti- tutional distm'bance, with intense pain and extensive in- flammation of the parts. Should this treatment fail to arrest the disease, the next best thing to be done is to hasten suppuration, or bring the abscess " to a head " b}" the exter- nal application of hot fomentations and gi^ound flaxseed poultices. As soon as the abscess points or comes to a head, the skin becoming livid and thin, and there is distiuct fluctuation, it is advisable to make a free incision into the tumor, and evacuate the matter. The sooner it is discharged the sooner will the abscess heal. I see nothing gained by waiting ; it is but prolonging the patient's suffering and retarding the cure. After the abscess has been opened, and the matter freely discharged, the poultices should be dis- continued and simple dressing substituted.- (Remed}^ Xo. 93.) Diet. — In acute abscesses, where there is considerable fever, the diet should be about the same as in fevers. During the long and tedious course of some exhausting chronic abscesses, it will be found necessary to select such a diet as will nourish and strengthen the patient. The food should be nutritious and of easy digestion. Broiled steak, mutton- ' chop, meat broths, rice and barley gruel, etc.,* may be allowed. Diseases of the Skin. 315 BOILS. A boil consists of a round, cone-shaped, inflammatorj^, and very painful swelling immediateh' under the skin. It varies in size from a pin's head to a pigeon's Qgg. It alwaj^s has a central "core," as it is called, and is mostly found in strong and A'igorous children. A boil alwaj'S suppurates, and sooner or later discharges its contents, the matter being at first mixed with blood, and afterwards composed of ]3us. A boil never discharges freel}^ and never heals until the core comes awa}". The causes of these annoying excres- cences are certainly impurit}', fermentation, and impoverish- ment of the blood ; the treatment is similar to that prescribed for abscesses. Appl}" a poultice early, and bring the tumor to a head as soon as possible. After the matter has been discharged, wash the parts clean, and dress with lint and simple salve. The lint should be placed ne.r^ to the sore, and the salve over the lint. To eradicate the predisposition to boils, a dose of sulphur, twice a week, will be found very efficacious. (Remedy' Xo. 94.) SCAI.I>-HEA1>, Ti:VEA CAPITIS, FATTJS. Tinea capitis is a contagious eruptive disease of the scalp. It is characterized at first by small 3'ellow pustules, situated on an inflamed ground. The pustules are of a peculiar shape, depressed in the centre, and scarcely raised above the level of the skin. Each pustule, as a general thing, surrounds a hair. Probabl}^, the whole disease con- sists in an inflammation of the hair follicles. The disease is comparatively rare in America, much more so than ring- worm of the scalp or millv-crust. Among the upper or middle classes of society it is seldom, if ever, met with. I have not seen more than two cases in this cit}-" (Boston) , 316 Woman's Medical Companion. except in dispensaiy practice. There is ver}' little doubt but that this disease is contagious, aud ma}' be propagated b}' dii-ect contact of a diseased with a healthy skin, or by means of combs, brushes, towels, etc. Although chiefly found in children, it is by no means exclusivel}' confined to them. Children living in low, damp, and iU- ventilated dwellings, and those subjected to an unwholesome or an insufficient diet, are most prone to it. The featui'e which distinguishes this disease from other eruptions of the scalp is the pecuhar shape of the scabs or crusts. Commencing as a small yellow pustule, scarcely raised above the level of the skin, it gi-adually increases to perhaps an inch in cu'cumfereuce. As it spreads, the watery portions of the pustule dry up, leading a large j^ellow crust with inverted edges and a depressed centre. This cup-formed yellow crust, pierced hy a hair, is peculiar to this disease, and distinguishes it from aU other erui^tions of the scalp. At first, when the pustules are small, the}' are usually isolated ; but as they increase in diameter, their edges come in contact, and thus a number of pustules, blended together, form UTCgular patches of larger or smaller size, ^hen the crusts have been re- moved, the surface beneath is seen to be red and moist, having the appearance of ulceration. By no other eruptive disease of the scalp with which I am acquainted is there a permanent loss of hair. In this disease the hair falls out, and the scalp is left shining and uneven. The hair seldom, if ever, reappears ; if it does, it is short, wooU}', and un- healthy. TREATMENT. Until 3'ou can secm-e the services of a good phj^sician, fol- low the treatment given for " milk-crust." The first essen- tial step is to remove the hau\ This may be sufficiently well done with a sharp pair of scissors ; shaving the head is Diseases of the Skin, 317 scarcely practicable. No attempt whatever should be made to remove the crusts. Strict attention should be paid to cleanliness. A good and soothing wash for the head is bran-water. (Remedies Nos. 95, 186, 247, 248, 251.) CRTJSTA liACTEA, MIIiK-CKTJST, IMPETIGO. This is almost exclusivel}^ a disease of infancy. It is characterized by an eruption of small, round, yellow, flat- tened pustules, which are crowded together upon a red sur- face. The pustules end by the drying up of their contents into thick, rough, and j'ellow scabs. The eruption may appear upon the forehead, cheeks, or scalp, the latter place being the more frequent seat of the disease. Like most other varieties of infantile eruptive diseases, the real cause is ver}" imperfectl}- understood. Many suppose the cutting of the teeth to be the cause. Others ascribe it to unhealthy h3'g'ienic conditions, as, for instance, improper or unwhole- some food, want of cleanliness, damp or ill- ventilated apart- ments. Not a few think it arises from some constitutional taint existing within the child, as scrofula, or some kindred disease, and that it more frequentty manifests itself in fair, fat chikben. My own opinion is, that children so affected possess a constitutional tendency to the disease, and that the exciting cause, in nine cases out of ten, is some gastric derangement. Symptoms. — In some cases the eruption is confined entirely to the face ; in others, entirely to the scalp ; or, again, it may implicate both, extending up the side of the face, affecting the ear, neck, and portions of the scalp. The disease ma}' be either acute or chronic in its nature. When acute, it is not unfrequentl}' attended with severe inflamma- tion of the skin. It appears in all grades of severity ; in some cases it is very light, extending over a small surface, 318 Woman's Medical Companioii. remaining stationaiy, or quickly drying np and disappear- ing ; or, when severe, the whole scalp ma}' become com- pletely scabbed over, x^resenting an offensive and disgusting appearance. As a general thing it attacks but a small spot at first, and then gi'adually spreads to the surrounding parts. "Wlien the}' first appear the pustules are numerous, small in size, of a light yellowish or straw color, and not unfre- quently attended with severe burning or itching. These soon break or get broken, and discharge a sticky fluid, which glues the hair together, and forms into thick uneven crusts. The successive discharges from the surface beneath, constantl}' add to the thickness of the crust, and as the fluid escapes from under the crusts, it irritates or inoculates the i^arts with which it comes into contact, and thus extends the disease until, in some cases, the whole scalp is covered with a thick, rough, brownish-yellow crust. . In warm weather, or from the warmth of the head and exposure to the ah', these crusts sometimes undergo partial decomposi- tion, and exhale a sickening and most ofl'ensive odor. "When the crusts are removed, the sm^face beneath is found inflamed and wet, the secretion which oozes from them plainh' A'isi ble ; little excoriated points soon form new crusts similar to the one that has been removed. The disease, as it appears about the face, passes through about the same course as when appearing upon the scalp, except that the large crusts are seldom allowed to form. The severe itching attending the disease causes the child constantly to scratch or rub the part, sometimes to such an extent as not onty to prevent the scabs from forming, but to cause the surface to bleed quite freel}'. In most cases the general health of the pa- tient remains good ; sometimes, when the inflammation and itching are severe, it makes the child cross and peevish, dis- turbs its sleep, and makes it feverish. The glands situated upon the neck, and especially behind the ears, not unfre- Diseases of the Skift, 319 quently inflame, become hard and painful, and finally gather and break. The duration of the disease depends upon the severity of the case, and the treatment which is instituted for its removal. Some cases 3ield in a few weeks ; others, more stubborn, ma}- continue for months, and, if improperly treated, even for 3-ears. The whole course of the disease ma}' not be of the same severity ; it not imfrequently sub- sides to such an extent that the mother is already congratu- lating herself upon the speedy return of her child's health, when a fit of indigestion, the cutting of a new tooth, or even some change in the weather, may bring it back with renewed violence. TREATMEJVT. I frequently meet with children who have had the disease for months, their parents refusing to do anything for its re- moval, under the impression that the attempt to cure it would be attended with serious risk to the health, and even the life of the patient. Now, the idea that the disease is useful, and beneficial to the future health of the child, is preposterous. -Perhaps it originated from the fact that a sudden suppression of the disease, by active, external means, has been followed by dangerous and even fatal symptoms. But then it should be remembered that suppressing is not curing a disease. I believe it to be unsafe to procure, by the employment of external means, the suppression of any eruptive diseases. We are all aware that alarming and dan- gerous symptoms frequently follow the " striking in," as it is called, of measles and scarlet-fever. Every physician can call to mind cases of acute disease of, the brain, result- ing from the sudden drying-up of this very disease by the application of some one of the numerous specific ointments. This is a literal " striking-in " of the disease, or a transla- tion from the scalp to the brain. The idea that the disease 320 Womaji^s Medical Companion, is in any Tray beneficial to the health of the child, cannot be entertained by an}" one who has had much acquaintance with the suffering it produces. The dreadful itching induces restlessness, crjing, and sleeplessness ; in fact, it keeps the infant in a constant state of actual suffering, which cannot continue for months or years without seriously injuiing the constitution of the child. I consider it, therefore, an en- thel}' mistaken act of kindness which permits the disease to continue a single da}" without an endeavor to arrest it, under the impression that the child is thereby being permanently benefited. Active treatment should be instituted as soon as the first symptom of the disease is observed. Apply nothing externally but a little glycerine. Keep the head clean by washing with weak soapsuds of Castile soap. (Kemedies Nos. 96, 185, 186.) Diseases of the Brahi aiid Nervous System. 321 CHAPTEE XII. DISEASES OF THE BRAIN AND NERVOUS SYSTEM. liSTFLiAMMATIOIV OF THE BRAIIV. Inflammation of the brain itself is called encephalitis; inflammation of the membranes which invest the brain is called meningitis. Inflammation of the brain and of its investing membranes has no fixed uniform train of s^^mp- toms b}' which it declares itself ; perhaps the most common and striking phenomenon is a sudden and long-continued attack of general convulsions. Still, convulsions, espe- cially in children, frequently arise from various other causes ; for instance, from teething, from overloading the stomach, or from worms. The attack may come on with but slight pain in the head, with vomiting and impatience to light. More commonl}^, however, there are severe pains over the entire head, throbbing of the arteries of the neck and temi^les, fits of shivering, vertigo, sleeplessness or restless sleep, disturbed dreams, unsteady gait, quick pulse. In those cases which are occasioned by blows or falls upon the head, the patient may recover entirely from the shock and external wound, if there be one, and remain for a certain period, to all appearances, perfectly well. But, after some days, or even weeks, he begins to complain ; may come in from his play with headache and chilliness ; the skin soon becomes hot and dr}^ ; he is restless ; cannot sleep ; his countenance becomes flushed ; his eyes red and fiery ; the pulse is hard and frequent ; nausea and vomiting supervenes ; 322 Woman's Medical Companion. the sulDstanee thrown up is generall}^ a greenish or 3'ellow- ish fluid ; and, as the case draws to a close, delirium, con- vulsions, or profound stupor takes place. Inflammation of the substance of the brain, either when it invades the whole organ at once, or begins in one part of cither or of all the membranes and extends rapidl}' to all the rest, is alwa3^s attended with high excitement, much fever, and great delirium. The face is red aild bloated, the e^'es are blood- shot and brilliant, the pupils contracted, great sensitiveness to light and noise. The deeper the interior of the brain is aflfected, the more the senses are stupefied, until the patient becomes entkel}^ unconscious ; he can neither see nor hear ; the pulse is small, frequent, and tremulous. Owing to the fact that the organization of a child's brain is much more delicate, and, therefore, more sensitive, than that of adults, its disease must necessarily be more frequent and dan- gerous. It is well, therefore, i)romptly to heed, and notice criticallv, ever}' sj^mptom, no matter how trivial, which points a finger of suspicion toward the brain. Generally speaking, these diseases are uncommon as a 'primary disorder ; but the}^ are frequently met with as a seco?if7ar?/ affection, and in the following manner: A child suffering from a discharge, either acute or chronic, from the ear, takes cold ; the discharge stops, or from any other cause is suddenl}^ suppressed ; the inflammation, so to speak, travels inward, or, in other words, is transmitted to the membranes covering the brain. The patient becomes dull and drows}' ; sometimes, when there is high fever, he is delirious ; he puts his hands up to his head, or bores it into the pillow, and b}' degrees sinks into a complete stupor, from which he ma}' never recover. There is no doubt that catarrhal diflficulties of the head and throat are frcqucntl}' transmitted to the brain. Or the inflammation creeps along from one membrane to another, Diseases of the Brain and Nervotis System. 323 until it finally reaches the brain, and produces fatal results. This is especially the case when astringent lotions and injections are made use of for the cure of such complaints. In "eruptive" fevers, especiallj' "when the eruption does not come out Tvell upon the surface, or, after being well out, it suddenh' strikes in ; also, during difficult dentition, or even in some forms of severe colds, the child will complain of chilliness, with alternate flushes of heat. There will be pain in the head, manifested b}' the child putting his hands up to it ; he moans, becomes drows}', stupid, or restless ; rolls his head and screams. Any general u'ritation may bring on the disease. It sometimes supervenes upon the drying up of eruptions, such as scald-head or sores behind the ears, especiallj' in scrofulous children. Diseases of the brain dming infancy are much more frequent among those born of parents who are either suffering from some tuber- cular disease themselves, or in whose families such com- plaints have existed to a greater or less extent. Perhaps the most frequent form of brain disease in child- hood is that known as " tubercular meningitis," or acute hy- drocephalus, or more commonh', water on the brain. This is verv insidious in its attack ; it steals upon the patient before he is aware of its approach. He loses his appetite ; becomes capricious ; sometimes he appears to dislilvc his food, and sometimes devours it voraciously ; his tongue is foul, breath offensive, his abdomen enlarges, and is sometimes tender; his bowels are torpid, and the evacuations from them unnat- ural ; the stools are pale, and contain but little bile, or are dark, fetid, som'-smelling, lump}' ; and the child loses his former health}^ aspect. There 'are obscure indications of cerebral derangement, and he shows unsteadiness and tot- tering in his gait. When these s}^nptoms are observed in a child who has any hereditar}' tendenc}' to scrofula, or in a child who is precocious or particularly clever, there will be 324 Woman's Medical Companion. much reason to apprehend that mischief is brewing in his head. The pain is usually located just over the brows, but may extend all over the head ; at the beginning of an attack, there is often pain and stiffness at the back of the neck, extreme tenderness of the scalp, and the child cries and shrieks when taken up. Vomiting is nearly a constant S3'mptom, and is often excited by raising the child to an erect position ; the headache and vomiting are both aggra- vated b}^ motion ; there is a total loss of appetite, the tongue is coated white, the breath is offensive. Constipation is almost always a prominent symptom. Diarrhoea is rare ; the constipation is generally obstinate for the first week or ten days of the disease, and then, toward the termination of the case, gives way to a diarrhoea with involuntary stools. The head is usually hot, the pulse variable, the senses of sight and hearing become painfully acute, the patient is excessively sensitive to light, and the slightest noise or jar, even a person walking across the room, irritates and dis- tresses him. The next stage evidences a marked change in his aspect and S3'mptoms : noises no longer disturb him, he is in a half comatose condition, convulsions frequently' occur, sometimes paralysis. The urine and stools are passed unconsciously ; he is incessantl}^ picking at his lips, nostrils, ears, and bedclothes. This stage may last a week or two, with intermissions of intelligence, api^arently restored health and vivacit}^, and regaining the use of his senses, but only to sink into a deeper stupor than before. He now enters upon the last stage. He rolls his head perpetually from side to side ; palsy frequently occurs ; the circulation is unequal ; intermittent fever supervenes ; he is alternately raving and insensible ; the pulse gets weaker and weaker ; and death, in many instances, takes place in the midst of a convulsion. No treatment of a temporary nature can be prescribed ; the most skilful and patient watchfulness of an experienced Diseases of the Brain and Nervous System. 325 pli3'sician can be alone relied upon. The diet and regimen should be the same as in fevers. (Remedies Nos. 97, 132, 133, 134, 135.) CHROIVIC HTDROCEPHAI.US. Chronic h3Tlrocephalus is an actual drops}" of the brain. The disease is generally congenital, the child being born with a head out of all proportion to the rest of its body. From some cause not well understood, a watery fluid col- lects within the brain, and the skull, being but ' imperfectly developed, 3'ields to the inward pressure, and the head is augmented in some cases to an enormous size. When this accumulation of water takes place, as it frequently does, while the child is yet in the womb, it is sometimes impossi- ble for it to pass through the natural outlets into the world. In such cases the mother's life must be saved and the infant's sacrificed. In a large number of cases, however, the child is brought into the world entire and unhurt, and lives for a longer or shorter period. Sometimes, however, the accumulation of water does not take place until after bkth ; but when it does take place, which may be in a few daj^s, weeks, or even months, it will be per- ceived that the head enlarges with gi'eat rapidity, is quite disproportionate to other parts of the body, and of course gives the child a very strange aspect. The greater part of those afflicted with this form of dropsy either recover or die diu'ing infanc}' ; they seldom grow up in this condition ; there are, however, isolated and rare instances where they have reached adult life and possessed a fair amount of mteUect. (Remedies Nos. 129, 130, 131, 230.) CONVTJIiSIOlVS, SPASMS, OR FITS. These terms are used indifferently and indiscriminately, to indicate a violent and involuntary agitation of a part or 326 Woman'' s Medical Companion. of the whole body. These agitations consist in alternate contractions and relaxations of the muscles of the part affected. Convulsions may be either general or partial, WTien general, the muscles of the face and body, as well as those of the extremities, are involved. When partial, the spasmodic action is confined to one particular part. All con^Tilsive diseases consist in affections of the true spinal S3"stem of nerves. Causes. — Among the predisposmg causes of the dis- ease may be mentioned a highly susceptible, irritable, or nervous temperament. It has been stated that convulsions are more common in girls than in bo3's. Whether there is am" truth in this or not, I am unable to sa3^ It is also said that dehcate children are more subject to them than robust ones. This ma}^ be so. We frequently meet with families in which all the children, daring infancy, are afflicted more or less with spasms. This ma}' be owing to a similarit}" of nervous temperament inherited from the parents. Convul- sions occur most frequentlj' in children under seven 3'ears of age, and particularly duiing first dentition. The most common causes are irritation of the bowels, diflScult teeth- ing, and worms. A dangerous form of convulsions is often produced by overloading the stomach, or by eating heavy or indigestible substances. The most alaiTning variet}", however, — because of frequentl}' terminating unfavorabl}", — is that occasioned by heavy blows or falls upon the head. Spasms in children are frequently occasioned b}" the inor- dinate use of drugs. When we come to consider how deli- cate the organization of an infant's nervous s^^stem must be, it is not to be wondered at that the enormous quantities of patent and domestic remedies which children are compelled to take frequently derange the equilibrium. The onl}' wonder is, that they ever recover from convulsions tluis Diseases of the Bram and Nervous System. 327 produced. Excessive jo}', sorrow, anger, fear, or any other passion, undue exposure to cold or heat, severe pain, and repelled eruptions, frequently cause convulsions. When convulsions usher in eruptive, fevers, they seldom have a. fatal termination, but when they appear during or at the termination of those diseases, the result is usualty fatal. Syiliptoms. — Convulsions are not, as a rule, preceded by any premonitory symptoms. The attack usuall}' com- mences with the e3'es, which are at first fixed and staring ; as the case advances, the}^ become agitated, and are turned up beneath the upper e3'elid, leaving only the whites visible ; the eyelids are sometimes open, and sometimes shut ; the e^es are frequently crossed, the pupils being either excessively contracted or dilated. The muscles of the face next become affected, and the contractions produce at times most horrid contortions. There are sometimes onl}' slight twitchings of the muscles of the face, with alternate con- tractions and relaxations. The mouth is distorted into various shapes : the corners are drawn down and fixed in this position, or the muscles of one side may contract while the others relax, and so keep the parts in a constant state of agitation. The tongue, when it can be seen, will be observed to be in constant motion. It not unfre-. quently gets between the teeth, and is severely bitten. Sometimes the jaws are firmly set, and at other times in violent motion. In rare cases there is foaming at the mouth ; there is alwaj's a blue shade around the ej^es and mouth, and often the whole surface of the head becomes violet-colored. In severe cases, the movements and distor- tions are much more violent. In all cases, mild or severe, though consciousness is entirely destroj^ed, the child is still sensible to external impressions, that is, will open his mouth when a spoon is i)ut against his lips, and swallow anything given to hun. The duration of the fit is extremely uncer- 328 Woman's Medical Companion. tain ; it may be of onl}' a few moments' duration, or it may continue for hours. The average range of the paroxysm is from two minutes to half an hour. When the spasm is protracted, it is usuall}^ broken b}' brief intermissions. The duration and recm-rence of an attack depends entirely upon the cause of the disorder. So long as the disease continues in action, we can expect no permanent improvement. Our first effort is naturall}^ to remove the cause, but it is often so difficult of detection, that the cure is necessarily much retarded. TREATMENT. In this work, we must of course confine ourselves to gen- eral treatment^ the special and particular treatment for the disease which occasions it, and the disordered condition of the nervous S3'stem, being solely the work of the ph3'sician. The first thing to be done in a case of convulsions, is to put the child into a warm bath, about 96° ; it is almost certain to alia}' the spasm. In slight cases, a foot-bath, with a little mustard in it, will be found sufficient. The patient should be kept in the water from ten to twenty minutes, or until the convulsion ceases. "When he is taken out, 3'ou should not stop to wipe or dress him, but just wrap him in a warm fiannel or woollen blanket. Cold icater a]3plied to the head is also an excellent auxiliary. During the application of the foot-bath, cold applications can be made, and should be continued until the head feels quite cool. The best way to apply it is to pom* cold water from the nozzle of a small watering-pot, held two or thi'ee feet above the child's head. This process must be repeated as often as the head begins to get warm again ; it should not be allowed to get hot. If possible, the child should be placed in a large, well-venti- lated room, where the air is pure. "WTien this cannot be done, the next best thing is to expose the patient to fresh Diseases of the Brum and Nervous System. 329 air at an open window. Above all, do not torture the child by the appUcation of mustard plasters, onion -draughts, and the legion of disgusting nostrums advised b}^ well-meaning but indiscreet friends. {^See Remedies Nos. 98, 184.) Indigestion. — If the convulsions be caused by over- loading the child's stomach, or the presence of some indi- gestible substance, evacuate the stomach at once by an emetic. Lukewarm water is as good as an3'thing, or tick- hng the thi'oat with a feather. The feet and legs should be placed up to the knees in hot water, as hot as can be borne. Should this fail, immerse the entire body in hot water, at the same time pouring cold water on the head. If the bowels are constipated, or if 3'ou cannot excite vomiting, give an injection of sweet-oil and warm milk. Teething". — ^^Hien the spasms arise from this cause, as they ver}^ frequently do, take a sharp penknife and make an incision in the gum wherever the seat of the irritation appears to be. A warm bath is, of course, essential. Mechanical Injuries. — TVlien convulsions arise from blows or falls upon the head, a solution of arnica should be at once applied, and a ph3^sician summoned. Fright, Suppressed Eruption, or Catarrh, or Unknown Causes. — In convulsions having such origin, the warm bath or cold douche are indispensable. Diet. — After a convulsive seizm-e it is best that the child should be kept upon a low or rather non-stimulating diet for a few da3's. Especial care should be taken in this respect if the spasm has been caused by indigestion. CHOREA — ST. VITUS'S DAIVCE. Chorea is essentiall}' a disease of the. nervous sj^stem, of a spasmodic nature. It is characterized by tremulous, ir- regular, and, in some cases, most ludicrous motions of all or 330 Woman^s Medical Companion, any of tlie yoluntary muscles. These contractions are partia% involuntar}^, are more marked upon the left side than the right, affect females more than males, occur chieflj" in persons between six and fifteen years of age, and are not accompanied b}^ pain. Causes, — It is said to occur most frequently in chil- dren of a nervous, delicate, excitable temperament, and is frequently hereditary, No doubt but that a disordered con- dition of the digestiA^e sj^stem, as well as uterine affections, predispose to the disease. Among the exciting causes may be mentioned anything which makes a forcible impression upon the nervous system : sti'ong mental emotions, of which fright is the most common ; injmies of the head and back ; the improper emplo3^ment of lead, mercury, and other metallic poisons ; suppressed eruptions or discharges of an}^ kind ; the extension of rheumatism to the membrane of the spinal cord ; cutting of the permanent teeth ; anxiety ; sup- pressed emotion of any kind ; excitement of the passions, and retained or difficult menstruation. Symptoms. — Its approach may be either sudden or gradual, and is indicated by a variable condition of health for two or three weeks, imperfect digestion, constipation of the bowels, loss of appetite, and general derangement of the digestive and menstrual functions. This disease, unlike many other convulsive diseases, does not render the subject unconscious, neither does it affect volition. The patient knows perfect^ well what he is about, and what he wants to do ; but he cannot alwa3's do exactly as he wishes. The ordinary movements of the bod}', to a certain extent, can be performed ; but there is some other power besides the will at work, and this power is constantly interfering with all the movements, misdirecting the hand that is put out to seize something, or jerkhig it back and giving it a new direction, rendering unsteady and imperfect every act, bringing into Diseases of the Brain and Nervous System. 331 play muscles that should be quiet, and arresting those which the will has set at work. The muscles of the face are jerked about with an agility that is truly surprising, drawing the face into all sorts of shapes and grimaces. The hands and arms are twisted and jerked into every con- ceivable position. The inferior extremities are affected in the same way. In fact, it seems sometimes as though the whole muscular S3'stem had gone crazy. If you ask the patient to put out her tongue, she will have to make many attempts before she can accomplish it. She cannot keep her limbs in one position for half a minute. "Walking is alwa3's more or less difficult. There is no sajang in what direction the hand or foot ma}^ be moved when it is once lifted. The patient progi'esses in a zigzag direction, totters from side to side, going by fits and starts, even standing being frequently impossible. Articulation, too, is not un- commonly arrested, and mastication so materially inter- rupted by the irregular contraction of the muscles which move the jaw, as to render feeding by the ordinary method impracticable. Treatment. — Remedies Nos. 99, 165, 166, 167. Diet and Regimen. — The diet should be perfectly plain and nutritious ; all articles of pastry, and rich or highl}^ seasoned dishes should be avoided. Coffee and tea are unmistakably injurious. Out-door exercise — plenty of it — is decidedly beneficial. HXIABACHi:. By this general term is understood a pain of any descrip- tion in the head. It is usually accompanied by an intol- erance of noise and light, and alwaj^s with incapability of mental exertion. As headache appears in many forms, it has, consequently, as many causes, and an accurate 332 Woman's Medical Companion. knowledge of the cause of the pain is essential to the suc- cessful choice of the remedy. It may arise from nervous irritability or excitement, uterine or abdominal derangement, over-exertion, fasting, decayed teeth, excessive menstrua- tion, nursing, impure air, sudden suppression of discharges or eruptions, mental excitement of any kind, severe cold, etc. The sjTnptoms of the various descriptions of pain : neuralgic, rheumatic, nervous, sick, bilious, congestive, catarrhal, etc., are too well known to need enumeration, and the treatment of the various phases of this affection will be found in detail under its appropriate head in Rem- edies Nos. 100, 216, 217, 218. The diet during an attack should be light and low, and all articles of a stimulating nature should be avoided, and especially tea, coffee, or alcohoKc drinks. RHEUMATISM is an inflammation of a peculiar character, being caused by acid or poisonous matter in the blood, and having for its seat the fibrous tissue, or that thready texture which enters largely into the composition of the cords and muscles of the human body. The sj'novial, or lining membrane of joints, is also peculiarly subject to rheumatic inflammation. Hence the terms fibrous rheumatism and synovial rheumatism. There are also acute and chronic rheumatism. Acute rheumatism is a very painful affection. It is most frequently brought on by exposure to wet and cold after fatiguing exercise to the muscles. Women are usually very reckless in this respect, dabbling about in water, both warm and cold, and rushing about from kitchen or sculler}'- to dining-room, parlor, or dr3dng-gT0und, half clad, and encountering a constant alteration or change of temperature. The only wonder is that they manage to Diseases of the Brain and Nervous System, 333 retain their health at all under such opposite conditions of the atmosphere. Symptoms. — Its principal characteristics are high fever, full, bounding pulse, furred tongue, profuse sweat, with a sour smell, the bodil}^ weakness increasing without relieving the pain ; scant}' and high-colored urine, with brick-dust sediment, and swelling of the joints, with slight redness, gTcat tenderness, and severe pain, which is par- ticularly agonizing when the patient attempts to move. This affection often changes suddenly from one part of the bod}' to another, or from one set of joints to another. This sudden shifting, termed metastasis, is peculiarly dangerous, for sometimes the inflammation, seeming to regard the constantly moving heart as a large central point, suddenly seizes upon its lining membrane, and occasionally results in sudden death. Chronic Rheumatism sometimes follows as the sequence or result of a severe attack of acute rheumatism, but it is much more often an independent disease. It differs from the acute form in being seldom attended by fever. It fre- quently lasts for many years, and causes excruciating suffering. The S}Tnptoms are varied, according to the temperament and constitution of the patient, but usually comprise pain, lameness, stiffness, etc., in the joints and other parts. The joints are frequently swollen, but not nearly so much as in the acute disease. It is peculiar to this form of the complaint that when the patient remains at rest for a time he wiU have pain and stiffness in the affected part on beginning to move, but as he grows warm both will disappear. Treatment. — Chronic rheumatism is often palliated, and sometimes cured, by passing a current of electro- magnetism through the affected parts, both internally and externally. Remedies Nos. 297, 298, 299, will be found 334 Woman's Medical Companion. efficacious. It is -well to wear a piece of oiled silk over the affected part. It keeps up a gentle perspiration from the rheumatic surface, and materially hastens a cure. To bathe the affected joint at bedtime with hot sweet-oil, and then envelope it in cotton batting, to be kept on through the night, will often give much relief. The bowels must be kept regular, and all exposm-e to wet feet or clothes, and to currents of cool ail' when sweating, must be carefully shunned. ]VEURAIiGIA. The meaning of this term is pain in the nerve. "Wlien occmTing in particular parts of the S3^stem it is frequently confounded with rheumatism, though it differs materially from that disease. Rheumatism is a specific kind of inflam- mation, affecting particular tissues of the body ; while neuralgia is quite independent of inflammation, and is simply a pain in the nerve, unaccompanied b}' fever or any noticeable change of structure in the affected part. The pain of neuralgia is often severe, sometimes excruciating ; it occurs in paroxysms of irregular duration, and, after either regular or irregTilar intervals, affects various joarts of the body, and attacks males as well as females. Causes. — In not a few cases the causes of neuralgia are very obscure. One very great difficulty in making out the causes and origin of these pains is, that they are so fre- quently occasioned by some som-ce of irritation situated in a part distant from where the pain is felt. For instance, you strike 3'our elbow in a certain way, and 3'ou produce a tingling sensation, not in the part struck, but at a dis- tance, — in 3'our little finger. The same thing is constantly happening in disease. Something taken into the stomach, which arrests digestion, may cause pain in a remote part ; Diseases of the Brain and Nervous System. 335 some affection of the brain or spinal cord may cause it. Damp and cold, in an}^ form, dwellings, clothing, exposure to inclement weather, etc., most frequently cause neuralgia. Facial neuralgia is often occasioned by decayed teeth, while the tooth itself may be perfectly free from pain. The S3'mptoms are so familiar to us all that they need not be enumerated. The attacks are very variable in duration, as they may last a minute, an hour, a day, or a week. Tic douloureux, angina pectoris, and sciatica are purely neu- ralgic affections. Treatment. — As an external application, perhaps nothing is better than cold water, or, when that cannot be borne, warm or tepid water. Frequent bathing and plenty of out-door exercise are very beneficial. Internally, take prescriptions Nos. 101, 280, 281, 282, 283. Angina Pectoris is a neuralgic affection of the heart. It is sometimes called breast-pang, and is a painful, suffoca- tive sensation in the breast, which comes on suddenly dur- ing walking, but ceases as soon as one stands still. During the paroxysm the patient should remain perfectly quiet, in an erect position, with all the clothing loosened. For remedies, see Nos. 280, 281, 282, 283. Tic-Douloiireux, or neuralgia of the face, is an ex- cruciating affection, too well known to need comment. The most effective remedies are Nos. 280, 281, 282, 283. Sciatica, — This is nem-algia of the great sciatic nerve. The pain starts in the region of the hi]3-joint and extends to the knee or even to the foot, accurately following the course of the great sciatic nerve. The pain is sometimes so severe as not only to impede the motion of the foot but to deprive the patient of all rest. It frequently produces stiffness and contraction of the limb. As diseases of the hip and knee joint not unfrequently result in serious de- formit}^, it is alwa^'s best, when these parts are threatened, 336 Woman's Medical Companion. to place the child under the care of an experienced ph3^si- cian. For remedies, see Nos. 101, 280, 281. Diet and Reg'imeii. — The diet should be plain and nutritious. Coffee and.green tea should be speciall}' avoided. As gastric disturbance is frequently the exciting cause, care should be taken to avoid all indigestible and other descrip- tions of food likely to disagree with the constitution. DISEASES OF THE EYES, EARS, AND NOSE IN CHILDREN. Diseases of the Eyes. — The dehcate structure of the e3'e renders it extremely liable to accidents of various kinds and diseases of various forms ; and, what is indeed fortunate for all these diseases and accidents, ever}' one whom the patient meets has a certain cure, — one never known to fail. It is not asserting too much to say that, without a doubt, more permanent injury has been done to the e^'es b}' the use of local applications than has ever been done b}' natural disease. Slight ailments, which would have, been but trifles under rational treatment, have been aggra- vated into serious diseases by irritant washes and lotions. I would advise ever}' one to abjure all eye-waters, lotions, salves, ointments, and the like, and adhere to pure cold, or, in cases of peculiar sensitiveness, warm water. When Erysipelas affects the eyes (which will be known by the surrounding redness), nothing wet should be applied, but, instead, dry and warm applications should be used. SORE EYES OF TOUNG INFAI^TS. This affection is very common among young infants, set- ting in frequently when the child is but a few days old. Generally the eyelids are first affected, but the eye proper Diseases of the Eyes, etc, in Children. 337 soon, becomes implicated if the disease continues long or is neglected. It is occasioned, either by some irritating substance getting into the e3'e — soap, for instance — when the child is being washed, or by cold. The child's eyes should be washed with lukewarm water, giving the child internally Nos. 103, 242. • STY OX THE EYEI.II>, A sty is simply a small boil on the margin of the eyelid. They are quite painful, suppurate slowly, and show no ten- dency to bui'st. Give remedies Nos. 104, 242. When the remedy does not check the advance of the disease, and sup- puration is about to take place, or when there is considerable redness, with throbbing pain, a warm poultice should be apphed to facilitate its breaking. S^UIlVTIIVG-STRABIS^SfTJS. This is an affection of the e3^es, in which they are drawn out of their natural position. It may be spasmodic, caused by some affection of the brain, or it may be occasioned by a permanent shortening of one of the lateral straight mus- cles of the eyeball. In the latter case an operation is necessar3^ Drugs seldom have an}^ beneficial effect on this affection, though sometimes Nos. 105, 242, render material aid in conjunction with the mechanical means. DISEASES OF THE EAR — IlVFIiAMMATIOW OF THE EAR. This is a very painful disease. The inflammation affects the passage or tube of the ear, sometimes causing it to swell to such an extent as to close it entirely, and at times occa- sioning such severe pain as to scarcely allow the affected member to be touched. The s}Tnptoms indicative of this disease are : violent burning, itching, beating pains, deep in the ear ; and, finally, swelling and redness, both internally 338 lVoman*s Medical Companion. and externally, great sensibility to noise, and more or less fever. As a general iTile, this disease can "be conti'oUed \^\ one of the following remedies : Xos. 106, 242. It is neither judicious nor safe to be constantly inti'oducing oil, laudanum, and the like, into the ear. Rehef is often afforded by covering the ear with cotton to protect it fi'oni the air and noise ; and warm water, appUed with a spft hnen rag, will often ease the pain without doing injury. EABACHE. This is a very frequent affection of young children, and, although resembhng inflammation of the ear, is quite a dif- ferent disease, the one being accompanied by fever, and the other not. The pain of e^irache is of a neuralgic or rheumatic character, and generally arises fi'om taking cold. The attacks come on suddenly, and are of short dm-ation. TREAniEXT. — See remedies Xos. 107. 242. In regard to external api)lications. which are so frequently used, and sometimes with advantage. I have no serious ob- jection to offer. Tor my own part I would rather ti-ust to the remedies I have mentioned, because the parts may be so injm-ed that restoration will be almost impossible. The safest way is to use nothing, unless it be a httle ohve-oil, or tepid water. Sometimes a sponge, or soft muslin, dipped in water and apphed to the eai', will migitate the pain. RtJlA'JUVG OF TffE EABS. This troublesome and sometimes exceedingly offensive disorder arises from various causes. It frequently remains after inflammation, gatherings in the head. etc. Perhaps the worst form, and that which is most difficult to cm-e, is that resulting from scarlet-fever. The attempts which are Diseases of the EyeSy etc., in Children. 339 frequenth' made to arrest the discharge b}^ some local appli- cations are greatly to be reprehended, as the most insignifi- cant discharge may, when suddenly suppressed, produce most dangerous consequences. It is best to bear patiently with the affliction until a cure can be effected with the proper remedies. Kever tamper with the eye or ear. The princi- pal remedies are Nos. 108, 242. BI.EEDEVG FROM THE IVOSE. EPISTAXIS. This is quite a common occurrence among j^oung people, and seldom amounts to more than a temporary inconvenience, rarely needing an}^ remedial assistance. A shght blow, a fit of sneezing, or the summer heat, is sufficient, with many, to bring it on. This is owing to an undue fulness of the bloodvessels of the head. In young girls it sometimes comes on periodically, with or at the time the menses should appear, and frequently in fevers and other diseases. It often relieves or cures headache or vertigo. In young children it is almost always salutary, and may be left to work its own cm-e. TREATMENT. The nm'sery remedy is to slip a kej" or piece of cold metal down the back, or to sprinkle the face with cold water, which sometimes restrains the hemorrhage by producing a contraction of the bloodvessels. Very often a severe hem- orrhage can be stopped by causing the patient to hold his hands high above his head. Remedies Nos. 109, 220, 221, wiU be found very efficacious. DISEASES OF THE XTRIIVART ORGAjVS. IVETTIIVG THE BE1>. It is a general, but erroneous, opinion that this affection is simply a " bad habit," when it is in reality a disease. 340 Woman'' s Medical Cofnpanion, . The child is whipped for what is not its fault, — for a thing which is totally beyond its control. In the majority of cases it arises from a weakness of the parts, and, as the bladder fills up, the urine escapes involuntarily. Now, is the child to blame here ? TREATMEIVT. All articles which have a tendency to increase the secre- tion of urine should be avoided. Tea, coffee, and all salt or sour articles of food are objectionable. The child should take a moderate supper, and as little drink as possible (cold water or milk being preferable) and should not be sent im- mediatel}' to bed. Plenty of out-door exercise is always advisable. The child should be taken out every day, and permitted to run, hop, skip, jump, etc. When in bed, it should not be allowed to he on its back. If the difficulty presents itself in young bo3'S of ten or twelve years of age, there is reason to suppose that they are practising a secret vice^ which should at once be arrested. The proper remedies are indicated at No. 110. RETEIVTIOIV OF URINE EV IIVFAIVTS. As a general thing, new-born infants discharge the con- tents of the rectum and bladder shortly after birth ; occa- sionally, however, it happens that the urine is retained for a longer period, not unfrequently producing sj^mptoms which demand our immediate attention. It is uneasy, nervous, and cries, especially when pressure is made on the region of the bladder ; there is more or less fever ; it twists its body and draws up its legs. If relief is not soon afibrded, convulsions and other dangerous symptoms follow. Treatment. — A warm bath, or rubbing with the warm hand over the region of the bladder, is of great service. The Diseases of the Eyes^ etc^ in Children. 341 following remedies will generall}^ afford a satisfactory result : No. 111. IIVFtAMMATIOlV OF THE PRIVATES. A great source of anno3^ance sometimes befalls young girls (and occasionally bo3^s, too) in the shape of an in- flammatory swelling of the private parts. The lips of the vagina become swollen, hard, red, and A'erj^ sensitive to the touch. In boys the prepuce or foreskin becomes swollen or puffed up ; there is always more or less fever, accom- panied by burning or shooting pains. It may arise from cold, excoriations or chafings, or mechanical injuries. In women it is at times caused by rupture of the hymen, or difficult labor. 342 Wo7nau's Medical Companio7t. GHAPTEK XIII. THE DOMESTIC MANAGEMENT OF THE SICK- ROOM. The most important element in the recovery of the sick is the h3'gienic and sanitar}^ surroundings of the patient. If these be neglected, the efforts of the ph3'sician, however skilful or attentive he may be, will avail but little. The sleeping apartment of the sick should be large, airy, loft}^, and well ventilated ; if possible, it should have a northern aspect, so as to avoid the mid-day heat or the afternoon sun ; and the windows should always be let down about an inch from the top, so as to allow the escape of the foul air and the admission of fresh, pure air. No room, however large, should be used as a sick-room, where it is possible, unless it has an open chimney. There should be no un- necessary articles of furniture, — two tables, a chair or two, a chest of drawers, and the bedstead and its necessar}^ ap- purtenances, such as a wash-stand, basins, etc., being all that is requisite. A sofa or reclining-chair is, of course, essential to the patient's comfort. There should be no kettle or other culinar3Mmplement in the sick-room, — the odor, or even the noise and bustle, of culinary preparation being specially injurious and annoying to the patient. The room should be carpeted, in order that the movements of the attendants may not disturb the sick person ; and on no account should there be anno3'ance or excitement by the sight or conversation of visitors. Beds and Bedding. — French, or iron bedsteads, without curtains, are the most suitable. In ever3' case of dis- Domestic Management of the Sick-room. 343 ease, especially when attended by fever, the patient should be kept cool, and the most perfect freedom for respiration afforded. The mattress (not one of straw, however) should be placed over the feather-bed, and the pillows firm and elastic. The bed-spreads usually placed upon the bed during the day, and often retained during the night, are much too heav}', and calculated rather to increase than to subdue fever. When the patient is suffering from fever, it would be much better if she could have two beds at her disposal, either in the same or adjoining room, so that she could be moved from one to another every twelve hours. It would promote sleep, and go far to ensure her personal cleanliness. But when there is only one bed, the linen should be changed every morning and evening, or at least once in twentj^-four hours. In infectious diseases especially, and, relatively so, in diseases of all kinds, thorough ventilation is an absolute necessit}^ It must be remembered that infection rarely ex- tends above a few feet from the patient — even in the most malignant diseases not more than a few yards — if the room be well ventilated. If ventilation be neglected, the power of infection becomes greatly augmented, settling upon the clothes of the attendants, and even impregnating the uphol- ster}' and furniture of the room. Smooth and polished sur- faces do not readily retain or receive the infectious matter ; consequently, the nurses and attendants, in all infectious cases, should wear glazed gowns and aprons of oiled silk. It must also be borne in mind that infectious matter, even in the most virulent diseases, is not poisonous to every one ; there must be a predisposition — a sort of receptive condi- tion — in the person placed within the sphere of its influence. Hence, a thoroughly healthy person, taking the necessary precautions, will be wholly unaffected by the malarious or miasmatic influence of the disease. 344 WomarCs Medical Companion. In ever}^ case of infectious disease the attendants, even in the best-ventilated rooms, should stand on the windward, or that side of the sick-bed from which the current of ak comes ; if they keep on the other side the infectious exhala- tions from the patient are blown upon them in a direct stream. They should never lean over the sick, or inhale their breath. Next to ventilation the temperature of the room is to be considered. The extremes of depression or elevation should be studiously avoided ; but much depends on the nature of the disease as to the exact degi'ee of temperature required. It is especially important in fevers, as it often does more good than any other remedial measures. The best average temperature is 60° Fahrenheit. In convalescence the air of the chamber should be frequentl}" renewed ; the temperature in spring and autumn should be maintained, as near as pos- sible, at 55° or 60° Fahrenheit, gradually lowering it as the patient acquires strength, so that she ma}'' be able to bear with impunity the atmospheric variations of the open air. The absolute cleanliness of the sick-room itself, and every- thing in or about it, is of the first importance. It should be cleansed and arranged the first thing in the morning, with as little noise or bustle as possible. The moment any vessel or implement is used by the invalid, it should be removed from the apartment, thoroughly cleansed, and retui'ned as soon as it is cleaned. Nothing in the form of a slop-basin or a slop- pail is admissible ; they only administer to the laziness of nurses. A glass or cup should never be used for medicine a second time without cleansing. It is a great mistake to suppose that the sick-room should be darkened; a moderate amount of light should always be admitted. The nurses or attendants should always be healthy, cheer- ful, good-tempered, neat, active, orderly, sober, and pos- sessed of a practical knowledge of diseases and remedies, Domestic Management of the Sick-room. 345 and good general education sufficient to understand and intelligently cany out the instructions of the physician. One of the most important auxiliaries to the remedial efforts of the physician is the COOHERT FOR THE SICK-ROOM:. Baelet TTater. — Pearl barley, two ounces ;' boiling water, two quarts. Boil to one-half, and strain. A httle lemon-juice and sugar may be added, if desirable. To be taken freely in Inflammator}^ diseases. Rice Water. — Rice, two ounces; water, two quarts. Boil one horn' and a half, and add sugar and nutmeg. Rice, when boiled for a considerable time, becomes a kind of jelly, and, mixed with milk, is an excellent diet for children. It. has, to a certain extent, a constipating property, which is increased by boiling the milk. Decoction of Bran. — New wheat bran, one pint ; water, three quarts. Boil down one-third ; strain off the hquor, and add sugar, honey, or molasses, according to the patient's taste. Bran tea may be made b}^ using boihng water, and allowing the mixtm'e to stand in a covered vessel for three or four hours. Sage Tea. — Dried sage leaves, half an ounce; boUing water, one quai't. Infuse for half an hour, and strain ; add sugar and lemon-juice to suit the taste. Balm and other teas are made in the same manner. The above infusions form agreeable and useful drinks in fevers, and their diaphoretic powers ma}' be increased by adding a little sweet spu'its of nitre. Barley Coffee. — Roast one pint of common barley in the same way in which coffee is roasted. Add two large spoonfuls to a quart of boihng water ; boil five minutes. Add a little suscar. 346 Wo7nan's Medical Companion, Lemon Water. — Put two slices of lemon, thinly pared, into a tea-pot ; a little bit of peel, and a bit of sugar. Pour in a pint of boiling water, and cover it close two hours. A Refreshing Drink in Fevers. — A little sage, two sprigs of balm, and a little sorrel in a stone jug, — the herbs ha^-ing first been washed and dried. Peel thin a small lemon, shce it, and put in a small piece of the peel ; then pour in three pints of boiling water ; sweeten, and cover close. A Very Pleasant Drink. — Pour a teacupful of cran- berries into a cup of water, and wash them. In the mean- time boil two quarts of water with one large spoonful of corn or oat meal, and a bit of lemon-peel, then add the cranberries. Add as much fine sugar as shall leave a smart flavor of the fruit, and a wineglassful of good sherry. Boil the whole gently for fifteen minutes, and strain. Flaxseed Tea. — Take of flaxseed, one ounce ; boihng water, one pint. Pour the boiling water on the unbruised seed, cover the vessel, and let it stand near the fire for an hour or two. The seeds must not be crushed or boiled, lest the oil in the interior be extracted. HaA^ing strained the infusion, add to it a httle lemon-juice, if no contra-indi- cating circumstances exist. Flaxseed is a imld demulcent, and is much used in diseases of the throat, chest and urinary passages. Oat:meal Grlt:l. — Of oatmeal (coarse is the best) two tablespoonsfuls ; water, one quart. Boil for ten or fifteen minutes, and strain. Add a httle salt, and sweeten to taste. If no reason to the contrary exists, the flavor of the gruel is much improved by adding some nutmeg, with a little wine or brandy. Toast Water. — Cut a shce half an inch thick, from a loaf of stale bread ; remove the crust, and carefulh' toast the shce on both sides. Place the toast and a small piece of orange or lemon-peel in a suitable vessel, add a pint of Domestic Ma?iagement of the Sick-room, 347 boiling water, cover the vessel, and, when cold, strain off the water. This forms an agreeable drink in fevers. GrUM- Arabic Water. — As an article of diet, the proper proportions are one ounce of gum-arabic to a pint of boil- ing water. The solution is allowed to cool before it is used. Gum-arabic is very nutritive, and life can be sustained on it alone for some time. Lemonade. — Take of fresh lemon-juice four ounces ; fresh and very thin lemon peel, one-half ounce ; white sugar fom' ounces ; boihng water, three pints. Let them stand until cold, then strain off for use. When emplo3'ed in fevers, a little sweet spmt of nitre is sometimes added. Wlieu fresh lemon-juice cannot be procured, an excellent lemonade can be prepared from lemon s^Tup, made as fol- lows : dissolve ten drachms of tartaric or citric acid, and eight pounds of loaf sugar, in a gallon of water. Then rub from half a drachm to a drachm of fresh oil of lemon with a portion of the s}Tup, and afterward carefully mix it with the remainder. Lemonade, when freely taken, sometimes produces pain in the bowels. It must, therefore, be used with some re- serve as a daily drink. Arrow-root. — Arrow -root, one tablespoonful ; sweet milk, half a pint ; boiling water, half a pint ; sweeten with loaf sugar. Excellent aliment for children when the bowels are irritable. Vegetable Soup. — Take one turnip, one carrot, two pota- toes, and one onion. Let them be shced, and boiled in one quart of water for an hour. Add as much salt as is agree- able, flavor with a small portion of pot-herbs, and pour the whole upon a piece of dry toast. This is an agreeable preparation, and may be given when animal food is inad- missible. Mutton Broth. — Select two tender mutton chops, put 348 Woman's Medical Companion. them into a saucepan, add one quart of cold water, and a little salt, cover the pan, and cook slowly for two hours ; then skim off the fat, and add a tablespoonful of rice, one white potato, one turnip, and a httle parsley, chopped fine. Simmer for thi'ee quarters of an hour, then pour into a bowl, and remove the chops, with all of the remaining fat. This broth is nutritious and palatable. Beef Tea. — Take of lean beef, cut into shreds, one pound, cold water, one quart. Heat slowly to the boiling point, and then boil twenty minutes, taking off the scum as it rises. Strain the hquor, and add salt according to the taste. This preparation is more nomishing than ordinary broths, and very j^alatable. Liebig's Beef Tea. — One pound of lean beef, free of fat, and separated from the bones, in the finely chopped state in which it is used for mince-meat, is uniformh' mixed with its own weight of cold water, slowly heated to boiling, and the hquid, after boihng briskly for a minute or two, is strained through a towel, from the coagulated albumen and fibrine, now become hard and horny. Thus we obtain an equal weight of the most aromatic soup, of such strength as cannot be obtained, even by boiling for hom's, from a piece of flesh. This is to be seasoned to taste. Essence of Beef. — Put a sufficient quantity of lean beef, sliced, into a porter-bottle to fill up its body ; cork it loosely, or not at aU, and place it in a pot of cold water, attaching the neck to the handle of the vessel by means of a string. Boil for an hour and a half or two hours, then decant the liquid and skim it. To this preparation ma}' be added spices, salt, wine, brandy, etc., according to the taste of the patient and na- ture of the disease. Calves'-Feet Jelly. — Take a set of four feet, break them into small pieces, add to them one gallon of water, and re- Domestic Management of the Sick-room. 349 duce b}" boiling to one quart. Strain, and, when cold, skim the fat entirelj' off. Add to this the whites of six eggs, well beaten, a pint of wine, a pound of loaf-sugar, and the juice of four lemons, and let them be well mixed. Boil the whole for a few minutes, stirring constantl}^, and then pass the jelly through a flannel strainer. This forms a very nutritious article of diet for the sick and convalescent. BLAkc-iViANGE. — Boil One ounce of shred gelatine in a quart of milk, for a few minutes, stirring constantly. Sweeten to the taste, flavor with peach-water or essence of vanilla, and strain into a mould. Chicken Water. — Take one half of a chicken, divested of all fat, and break the bones ; add to this half a gallon of water, and boil for half an hour. Strain, and season with salt. A nutritious drink. Mucilage of Starch. —Take of starch, one ounce, pow- dered cinnamon, one drachm, gum-arabic, one ounce, boil- ing water, three pints. Boil until reduced one-third, and strain. The above may be taken for a common drink in d3'sentery. Mulled Wine. — Take two drachms of bruised cinnamon, half a nutmeg, grated, ten bruised cloves, and half a pint of boiling water. Infuse one hour, strain, and add of hot port or sherry wine (or good domestic wine) , one pint, and white sugar, one ounce. Mix. This is a mild, stimulant diink, used in convalescence from low forms of disease. Wine Whey. — Heat half a pint of milk to the boihng point, and, when boihng, add a gill of sherry or Madeira wine. Let it boil again, and then remove from the fire, and let it stand a few minutes. Then remove the curd, pour the whey into a bowl, and sweeten it. A little sugar aiid nutmeg may be added if desired. This is a mild and very useful stimulant, and may be used in diseases where there is great debihty ; the dose to be regulated by the circum- 350 Woman's Medical Companion. stances of the case ; from a gill to a pint or more may be taken during the da3^ Flaxseed Meal, and other Poultices. — Take of the flax- seed meal, or other material, sufficient to servx the intended purj^ose ; pour boihng water over it, stiiTing briskly until it becomes a thick mass ; spread it upon an old piece of linen or cotton cloth, and place a small piece of netting or lace over it, so that it does not soil the clothing. Apply to the seat of pain. Casualties — External Injuries — Burns ^ etc. 351 CHAPTER XIY. CASUALTIES — EXTERNAL INJURIES —BURNS AND SCALDS. BURNS AND SCAI.I>S. Burns and scalds, unless superficial and of small extent, are always troublesome to manage. When covering a large surface, or deep, they are both dangerous and troublesome. In the treatment of burns there are two essential points : First, careful attention to the constitutional symptoms in severe cases ; and, second, the prevention of adhesions and contractions during the process of healing. When the shock is severe, and there is great constitutional depression, it will be necessary to give stimulants ; these, however, should be given sparingly and with discrimination, for, when reac- tion takes place, it may even proceed to inflammation. The healing surfaces of fingers or other portions of the extremi- ties should be widely separated by splints and bandages to prevent deformity. The Treatment for superficial burns, of slight extent, is extremely simple. The most convenient and effectual is first to evacuate the serum or contents of the blisters, cover the part with raw cotton, and apply a bandage firmly over it. Other excellent remedies are detailed at Nos. 112, 143, 144. CONCUSSION OF THE BRAIN. This may arise from a fall or blow upon the head, or from some violent shock to the bod}^ The symptoms will usually depend upon the severity of the shock. In cases 352 Woman's Medical Companion. where the violence has been comparatively slight the dis- turbance of the intellectual functions will be transient. There will usually be some vertigo, dimness of sight, trem- bling of the limbs, and sickness of the stomach. In severe cases loss of sensation may exist for many hours, and finally be followed by reaction, which, if not controlled by treatment, increases to inflammation. Tbeatment. — Remedies ]^os. 113, 152, 153. SPRAEVS. These are caused by falls, lifting heavy weights, jerks, false steps, etc. Si3rains of joints, when severe, often arise from momentary displacement of the bones, which strains or perhaps partially tears the ligaments surrounding the joint. They are often troublesome, and require rest and bandaging a long time after the occurrence of the acci- dent. The Treatment consists in bandaging the part with cloths wrung out in cold water, to which a little tincture of arnica has been added. Internally, Remedy No. 114. Wounds are classified into incised, contused, lacerated, punctured, poisoned, and gunshot wounds. Incised icounds are clean cuts made in the soft parts with a sharp instru- ment. The troublesome feature of such wounds is hemor- rhage or bleeding. If an artery has been cut, the blood spouts in jets, and is of a bright-red color ; if a vein, the flow of blood is gradual, and of a purple color. The treat- ment consists in cleaning the wound by removing an3'thing that may be left in it, arresting the hemorrhage, bringing the cut surfaces and edges in close contact, and retaining them in such position. Small superficial wounds seldom require Casualties — External Injuries — Burns, etc, 353 an3-tliing more than a bandage, snugly applied after the edges have been nicely adjusted. Wounds of greater depth sometimes require a stitch or two ; but, as a general thing, small strips of adhesive or arnica plaster properly applied will answer every purpose. No more dressing should be applied than is actually necessary to keep the parts to- gether. After a wound is dressed, the injured part should be kept in such a position that the wound will not gap. To accomplish this, it is sometimes necessary to apply a splint. Surgeons nowadays apply nothing to wounds for the pur- pose of healing them, except cold water. Ointments, salves, and a host of other things once used, have long since been abandoned. After a proper dressing has been applied to the wound, if bleeding still continues, apply cold water or pounded ice, nothing more. Should this not arrest it, and the blood be of a bright-red color, spouting out at intervals as the pulse beats, endeavor to compress the artery between the heart and the wound. Feel for the artery on the interior part of the limb ; 3'ou will know it by its beating when found. Place over it a large- sized cork, or a compress made by folding up a piece of cloth about two inches square, and as thick as your finger, and bind it down firmly with a roller. This will arrest the bleeding until you can procure professional assistance. (Xo. 115.) Contused Wounds, Bruises, etc. — These are occasioned by blunt surfaces, falls, or forcibl}^ coming in contact with some object. There is generally no break or division of the external surface, consequently the hemor- rhage is comparatively' slight and internal, forming what is called a "black and blue" spot. If the wound is severe there is little pain, the life of the part being destro3^ed ; if the wound be slight the pain is often intense. There is usually swelling, and discoloration of the skin. Treatment 354 Woman's Medical Companion, consists in the prompt and continued application of cold water. The water can best be applied by saturating linen cloths with it, and keeping them applied to the parts. In severe cases, where suppuration is about to take place, it should be hurried forward by poultices. When all the dead flesh separates and comes away, this application should be changed to simple dressing of water, perhaps it will also be necessary to support the parts by adhesive strips. Lacerated Wounds are those where the soft parts are torn or rent asunder by violence, leaving a ragged, irregular wound. Hemorrhage is usually slight. Treat- ment consists in cleaning out the wound, and adjusting the parts as near to their natural position as possible, and securing them by as little dressing as practicable. As these wounds generally suppurate, spaces should be left between the adhesive strips to allow the matter to escape, and thus prevent abscesses from forming. Cold water, to which a little calendula has been added, should be constantly ap- plied. Lacerated wounds are prone to inflammation. Punctured Wounds. — These are made by some sharp, narrow instrument, as a needle, pin, thorn, splinter, piece of glass, etc. Slight wounds of this kind are seldom troublesome, provided the substance can be removed, unless it extend deep down among the tendons and nerves, where matter may form, causing great pain, and even deformity. When a person runs a nail or splinters of glass into the foot, they should be removed. When this cannot be done, all that need be applied is a little Canada balsam. This should be renewed every day. If there is much inflammation, apply cold water. Poisoned Wounds. — Bites and stings of insects, — bees, spiders, bugs, mosquitos. The bites and stings of insects, though seldom dangerous, are often exceedingly troublesome. The treatment for wounds of this kind con- Casualties — External Injuries — Burns ^ etc. 355 sists in removing the sting of the insect, when it remains in the part, applj-ing a plaster of damp earth, and keep it wet afterward with a mixture of arnica and water. Should inflammation and feA'er ensue give internally aconite. For mosquito-bites apply spirits of camphor or lemon- juice. DISIiOCATION OF JOIIVTS. To "be skilful and successful in the reduction of disloca- tions, a perfect knowledge of the anatomy of the joints is indispensable. A dislocation maj^ be recognized by the fol- lowing S3'mptoms : in addition to the pain there will be loss of motion, swelling, alteration in the shape, length, and clirection of the limb. The treatment consists in reducing the luxation as speedil}^ as possible. This, however, a lay- man can seldom do. Still 3'ou can make a trial. If you do not succeed apply a solution of arnica — a spoonful to half a pint of water to the injured part. Give arnica internall}" (five to ten di'ops in a wineglass of water) , and await the arrival of a competent surgeon. FRACTURES. Fractures of bones may be recognized by the deformity, which, by comparing the sound limb with the injured one, will be readily recognized. The most certain sign, perhaps, is that of crepitation., which is a peculiar grating sound, dis- tinctly heard, when the two broken surfaces of the bone are rubbed together. In all cases of suspected fracture place the limb in the most comfortable position, and keep it con- stantly bathed with a solution of arnica, after which send for a competent surgeon. Do not get so excited as to accept the first doctor you can get, without any knowledge of his abihties. The case wiU take no harm if a whole day 356 Woman's Medical Companion, should elapse before 3^011 obtain assistance. If the patient should be faint and weak give an occasional dose of cam- phorated spu'it, or aconite (about ten drops in a wineglass of water) . FOREIGN SUBSTANCES IN THE EYE, EAR, NOSE, AND THROAT. In the Eye. — No matter what has gotten into the ej^e, washing with cold water will always be beneficial. Rubbing the eye only increases the irritation, and should, therefore, alwa^'s be avoided. When lime or ashes enter it a little cream or sour milk is the best remed3^ If a hard subject or an insect has got into the ej-e draw the e3^elids apart, and turn the upper one over the lower one a couple of times until it is felt that the substance is removed. If particles of iron have entered, and have become fixed, bathe with arnica lotion, ten drops in a teacupful of water, until 3'ou can have it extracted. Should there be much inflammation use a tincture of aconite (a teaspoonful in half a pint of water) as a fomentation. In the Ear. — Insects sometimes find their way into children's ears ; in such cases lea,n the head to one side, and fiU the ear in which the insect is with sweet-oil. This floats it to the surface, when it can easily be removed. If a bean or an}" other substance which will swell bj" heat and moisture gets into the ear, the best way to remove it is to make a hook b}' bending a hair-pin into the right shape. This should be cautiously introduced behind the substance, and an efl'ort made graduall}' to extract it. After the opera- tion wash the ear out with a lotion of arnica. In the Nose. — Foreign substances maybe removed from the nose with a small pair of forceps, or the same instrument recommended for the ear. First, endeavor to eject it b}' sneezing, which may be excited either with snuff, Casualties — External Injuries — Biirns^ etc. 357 or b}' tickling the nose with a feather. Sometimes the ob- struction may be pushed back so as to fall into the mouth. If these means fail apply to a surgeon. In the Throat or Windpipe. — If a foreign sub- stance lodges in the throat, first examine closel}'^, and, if within sight, endeavor to extract it with the fingers. If it is not visible excite vomiting immediately, by tickling the throat with a feather, or by putting mustard or snuff far back upon the tongue. Foreign substances have been re- moved from the windpipe by gently turning the patient upside down. 358 Woman's Medical Companion. CHAPTEE XY. POISONS, AND THEIR ANTIDOTES. Substances which derange the vital functions and produce death by an action not mechanical are denominated poi- sons ; and the most eminent authorities on this subject have divided these substances into three classes, viz. : — Irritant Poisons, or those which produce irritation and inflammation, such as mineral acids, — arsenic, copper, etc. Narcotic Poisons. — Those producing stupor or delirium, and specially affecting the brain and nervous system, as opium, prussic acid, etc. Narcotic-acrid Poisons. — Those producing irritation or narcotism, and sometimes both together, — all of which are derived from the vegetable kingdom, — as strychnia, nux vomica, etc. As most everybody is compulsorily so situated that, through mistake or accident, poison of some kind is de- posited in various accessible places about their dwelling, and may, therefore, at any time, be taken into the sj'stem, it is desirable that every housekeeper or mother of a family should be thoroughly versed in the use of antidotes and the treatment of the supervening irritation or inflammation. If Sulphuric, Nitric, or Hydrochloric Acid is taken into the stomach in poisonous doses, give chalk or magnesia ; or, if this is not at hand, take the wall-plastering, and make it into a thin paste with water, and take it plentifully. Soap- suds is another antidote. Drink freely of milk, or any other mild fluid, both before and after the administration of Poisons and their Antidotes, 359 the antidote. For the supervening inflammation use the same remedies as for gastric disturbances generall3\ In the event of Oxalic Acid being taken by mistake, as it easily ma}- be, from its close resemblance to Epsom salts, you must at once excite vomiting by tickling the throat with a feather, or by an emetic ; afterwards administering the remedies we have given for nitric and sulphuric acids. Take freely of mucilaginous diinks. For poisoning with Arsenic the first thing necessary is to thoroughly evacuate the stomach, and for this purpose give an emetic, and then follow with iron-rust, or the sesqui-oxide of iron largel}- diffused in water ; and let the patient drink freely of mucilaginous, farinaceous, or albu- minous drinks, and milk. For poisoning ivith Mercury, and Corrosive Sublimate. — This is the usual form of mercury employed for committing suicide ; and as it is used for bedbug poison, it is liable to be taken through carelessness or mistake. It is therefore requisite to point out some antidote the nearest at hand. Give whites of eggs in abundance, or gluten, if eggs cannot be had ; or else milk. The most usual form of the super- vening irritation is salivation or mercury fever. For these give nitric acid, and obtain for the patient fresh air and a nourishing diet as soon as possible. For p>oisoning with Copper. — The blue vitriol, or sul- phate of copper, and verdigris, are the forms in which this poison is most common ; and when taken into the system, the most ready antidote is the whites of eggs. Great care should be taken to exclude \Tinegar, for this acid would add ^Ti-ulence to the poison. To allay or cui'e the remaining irritation, give sulphur twice a da}". Poisoning with Antimony, or Tartar emetic, is liable to occm', as this substance is sometimes used in medicine as an emetic. When given to excess it produces vomiting, 360 Woman's Medical Companion. attended with burning pain at the pit of the stomach, fol- lowed by purging and cohc, stricture of the throat, and cramps. As an antidote give large draughts of warm water, and tickle the throat with a feather to induce vomit- ing ; also the decoction of any bark containing tannin, as oak, hemlock, or cherry-tree bark. For poisoning with Zinc^ or white vitriol^ which is denoted by violent vomiting, sunken eyes, and pale face, cold ex- tremities, and fluttering pulse, give the infusion of any of the substances containing tannin, and feed the patient with cream, butter, and chalk quite freely. For poisoning with Lead. — Red lead and white lead, as well as sugar of lead, are liable to be taken by mistake ; and their poisonous effects are denoted b}^ obstinate colic, spasms of the muscles, and sometimes apoplexy. As an antidote give water of ammonia, or hartshorn, or pearlash- water, or any of the earthy sulphates, as lime, etc. For lead paral3'sis give sulphur. For p)oisoning with Cantharides, which is denoted by intense burning in the pit of the stomach, and pain in the lower abdomen, feeble voice, laborious breathing, strangury, and tenesmus of the bladder, headache, and delirium. To remove the cantharides from the stomach excite vomiting in the most speedy way, — by tickling the throat with a feather, or drinking a strong mustard-tea, or by taking snuff upon the tongue. Spirits of camphor is the best antidote. For poisoning with Morphine^ which is denoted by giddi- ness and stupor, and insensibility to external impressions, the first thing necessarj^ is to remove the poison from the stomach by vomiting. Then keep the patient from sleeping, and in vigorous action ; administer strong coffee. For poisoning with Prussic Acid, when not fatal, resort to cold shower-baths, and inhalation of diluted water of Poisons and their Antidotes. 3G1 ammonia vapor ; also a solution of carbonate of potash (of course as a vapor) . For poisoning with Charcoal-gas,, or with any of the poisonous gases, cold affusion should be immediately re- sorted to. Poisoning by Strychnia or Nux Vomica is denoted by strong convulsions, with great agitation and anxiety during the fits, rigidit}' of the entire body and limbs, lividity of the face and hands, etc. If taken in poisonous doses it generally proves fatal, in spite of treatment. If emetics are given, and the stomach is made to disgorge its contents sufficiently early, and the patient is not attacked with con- vulsions in two hours, he will generally be safe. Alcohol. — Large quantities of alcohohc liquors, taken by persons unaccustomed to their use, often produce fatal effects. The treatment in such cases is to evacuate the stomach as soon as p)ossible ; but from the rapidity of absorption this may not alwa^'s be effectual. The patient must be kept roused, and cold affusion plentifully used. Large draughts of tea or coffee ought to be taken until the stomach is thoroughly evacuated. Vinegar is an antidote for alkahne poisons, and obviates the ill effects of aconite, opium, poisonous mushrooms, belladonna, etc. Coffee. — Strong black coffee, made of the berry lightly roasted, and di'ank hot, is an antidote to opium, nux vomica, belladonna, narcotics, mushrooms, poisonous sumach, bitter ahnonds, and all those substances containing prussic acid. It must be borne in mind, however, that the cause must be removed, if possible, first. Camphor antidotes the ill effects of poisonous insects, and especially cantharides, whether administered internally or externally. It also antidotes the toxical effects of phos- 362 Woman's Medical Compajiion. pliorus, spigelia, and santonin. It is very useful for the after-effects of acids, salts, metals, etc., after the poisonous substance itself has been removed from the stomach by means of vomiting, etc. Milk is frequently alluded to as an antidote for poisons ; but it has no real merit. Mucilaginous substances are better, and much to be preferred. Olive-oil ranks with milk, and is much less useful than is beheved. It is useless in metalUc poisons, and even hurtful in poisoning with arsenic. It is of some service, however, in case of poisoning either with nitric^ sulphuric^ or pJios- pJioric add. Olive-oil and vinegar, administered in alter- nation, have proved serviceable in cases of poisoning with alkalies. jSoa2J. — Castile soap, dissolved in fom' times its bulli of hot water, and drank, will antidote many cases of poisoning with corrosive sublimate, and also with arsenic, or with any of the numerous forms of lead. Soapsuds is likewise a valuable antidote for poisoning with sulphuric and niti'ic acid. Soap is hmlful in cases of poisoning with alkalies. Sugar, or sugar-water, is quite as good as any of the antidotes, and much to be preferred in cases of poisoning with paint, verdigris, copper, sulphate of copper, alum, etc. In cases of corrosive sublimate, in solution, being taken into the stomach by mistake, as it has been, sugar-water may be given before the white of an egg. Sugar is also an excellent antidote in cases of poisoning with arsenic. The other antidotes are : — Ammoniacal gas, or the volatile odor of spirits of harts- horn, for poisoning Avith alcohol, bitter almonds, or prussic acid. Iron-rust, or the sesqui-oxide of iron, for poisoning with arsenic. Epsom salt, for the various alkaline poisons. Poisons y and their Antidotes. 363 Charcoal, for poisoning with putrid fish, meat, or mush- rooms, or mussels. Kitchen salt, for poisoning with nitrate of silver, and oisonous wounds. Magnesia, for poisoning with any of the mineral acids. Potash and sweet almond oil are also good antidotes for acids. Starch, in solution, is the best antidote for poisoning with iodine. Strong tea is a good antidote for poisoning with honey ; and so is wine for noxious vapors and poisonous mush- rooms. A general antidote for poisoning, in which the nature of the poison is unknown, consists of equal parts of calcined magnesia, pulverized charcoal, and hydrated peroxide of ii'on, which are to be diffused in water, and given freely. Although these articles are simple and innocent in their operation on the system, they will probably prove efficient, as one or another of them is an antidote to most of the mineral poisons. The albumen of eggs and tannic acid are also general antidotes of great value. But, if we should know the poison to be mineral or metallic, the first resort may be to white of egg, sugar-water, soap-water, or soapsuds, and for the remaining effects give sulphur, wiiich has been ascertained to be a real antidote to the effects of metallic poisons. If it should be known that acids or corrosive substances have been taken give Castile soap mixed with four times its bulk in warm water, or magnesia dissolved in water, or powdered chalk stirred up in water, or a solution of saleratus, pearlash, or super-carbonate of soda, in spoonful doses, after each parox3^sm of vomiting, as long as it continues ; and after- wards give mucilaginous drinks, and, alternately, coffee and opium. In case it should be known that allialine substances 364 WomarHs Medical Compaftion, have been swallowed in poisonous quantities vinegar and water may be liberally given, and also lemon-juice or cran- berry-sauce, or sour milk, without sugar ; and for the second- ar}^ effects of poisoning with potash give coffee or powdered vegetable charcoal. If the poisoning is known to be the effects of spirits of hartshorn give sulphur; if it should be known the patient had been inhaling noxious vapors bathe him freely with vinegar and water, and let him inhale the vapor of a solution of hydrochloric acid ; and, after a return to full consciousness, give a strong decoction of partially-charred coffee. The vapors of coal, when having a poisonous effect, may be antidoted b}'' copious draughts of vinegar and water ; and for poisoning b}^ any substance not mentioned first follow the rule of removing the poison from the stomach by vomit- ing ; if it is known that any of the anhnal poisons have been taken into the stomach give a teaspoonful of powdered charcoal in half a tumbler of water at a dose, and repeat after each vomiting until the stomach becomes quiet ; and if a poison of this kind has come in contact with the eyes give aconite ; and, finally to guard against the infection of poisonous wounds, when touched with the fingers or hand, let thein be held in strong heat, as strong as can be borne, for ten or fifteen minutes, and afterwards wash them with soap. Uterine Displacements y etc, 365 CHAPTEE XYI. UTERINE DISPLACEMENTS, FUNGOID GROWTHS, TUMORS, ETC. "We had thought, at the first inception of this work, that, in deference to the inherent delicac}^ of our fair readers, and their natural reluctance to enter upon the discussion of affections connected with the female reproductive organs, we would omit any special reference to them in this volume ; but, in view of the lamentable fact that, from want of proper acquaintance with the peculiarities of their own sys- tem, from negligence or from constitutional weakness, fully five-sixths of the female sex throughout the world are suf- fering, to a greater or less extent, from vm^ious affections of the luomb; and that to this cause alone is to be attributed the unhealthy, enervated condition and susceptibilit}^ to disease evinced in both parents and children, — for this reason, we, after consultation with several of our most experienced medical brethren, determined that, as a mat- ter of common humanity and sympathy, it was our duty to present, in the most decorous, unobjectionable, and easily understood method that language would permit, a brief explanation of the nature, S3''mptoms, and hj^gienic treatment of these affections, so that they might, to a great extent, prevent, or, at any rate, lessen, the inconvenience and suffering so generally and so uncomplainingly sustained b}" women. We are indebted to the generous courtesy of our eminent and talented brother. Dr. Ephraim Cutter, of New York, for the use of the admirable diagrams with 366 IVopiaus Medical Companion, which this chapter is embellished (with the exception of the fii'st figui'e). Feeling convinced that our lad^^ readers will accept the few following remarks in the respectful, sj^mpa- thetic, and trustful spirit in which they are wi'itten, and credit us with an earnest desii'e to promote their best inter- ests, while avoiding every term or allusion which should offend their sense of propriet}^, we will now venture on the consideration of Fig. I.— Pelvic Organs in position. Bladder distended. Womb virgin. Uterme Displacements y etc, 367 I>ISPi:,ACEMEXTS OF THE UTERUS OR WOMB. The accompanying illustration (Fig. 1) represents the womb in its natural position in the uterine organism, with its adjacent organs and theh' relative action. But, from congenital or constitutional weakness, accidental or other causes, it is subject to various displacements, such as Descent of the womb, or Prolapsus Uteri. Retroversion of the uterus, or falling backwards of the womb. Retroflexion of the uterus, or bending backward of the womb. Reti'oversion and flexion, or bending and falling back- ward. Anteversion of the uterus, or falhng forward of the womb. Anteflexion of the uterus, or bending forward of the womb. Anteversion and anteflexion, or bending and falling forward. Latero-version and latero-flexion or displacement side- ways. 368 Woman's Medical Compajiion. Fig. 2. RZTKOVZBSION. RETROVERSION OF THE TVOIWB. This form of displacement is (excepting prolapse, or fall- ing of the womb) the most frequent in occurrence. It xareh' occurs as a disease, but is usualh' an accompaniment or s}"mptom of the presence of inflammatorj^ action in the uterus, or of an increase in its size and weight ; in other words, it is usually caused by parturition, general muscular debility, or habits of indolence and inacti^it3^ It frequently occurs as a consequence of pregnancy, congestion, the presence of fibroid tumors, a fall or other injury, or the l^ressure of the viscera down upon the fundus b}' tight clothing or muscular efforts. The absurd practice of tight bandaging after parturition, and makin»; the patient lie upon her back continually, instead of on her side, is almost certain to cause this displacement. Retroversion may either hejxirtial or complete. Symx^toins, — The most strongly marked symptom in- Uterine Displacements y etc. 369 dicative of retroversion of the uterus is found in the difR- cultj of emptjing the bladder, accompanied with pain and tenesmus, alwa3'S more or less present. Next to this is the pressure of the rectum, and consequent frequent calls to stool, with difficulty or impossibility of evacuation. These fru'O symptoms, especially the retention of urine, render the displacement dangerous and painfully distressing ; while the accumulation of fecal matter renders the restoration to its natural position a matter of extreme difficulty. A gnawing or other pain in the back, backache, difficult}^ in walking, inabilitj^ to stand for an}?- length of time, nausea and vomiting, even to a violent degree, may set in, and unless the patient is promptly relieved she may sink under the accumulation of her sufferings. Fig. 3. RZTUOFLEXION. 370 Woman's Medical Compa^iion, RETROFIiEXIOlV OF THE TTOMB. ' This form of displacement consists in the bending back- ward of the fundus and bod}^ of the womb toward the hollow of the spinal column, the womb being bent in such a way that the cervix or neck is not removed from its normal position, or is but slight!}^ deviated from it. It is generally the result of a weakness of the uterine tissues, in con- sequence of which the body of the womb, either tln'ough its inherent weight, whether natural or preternatural, or in consequence of some force or pressm'e applied to it, is bent at the junction of the neck or ceiwix. Eetroflexion occurs most frequently in women who have borne children, and seldom in the \T.rgin uterus. Symptoms. — Irritability of the rectum is one of the chief s^-mptoms ; and if the pressm^e upon the intestines be great, retention of stool will be a natm^al consequence. Neu- ralgia of the womb may occur as a result of the congestion and nervous compression, and so-called uterine colic ma}^ occur from a retention of the secretion of the intra-uterine mucous membrane. If the retroflexion exist in a marked degi'ee, so as to close up the uterine canal, dysmenorrhoea and sterility will be the consequence. treatme:^'t of retroversio^t aat> retroflexioiv. There are certain cases of Eetroflexion which are unman- ageable, and entirely be3'ond the control of the ph^'sician or the patient — for instance, those which have become chronic, and are surrounded with aggravated circumstances, causing includable insanit}', a peimanent and agonizing derangement of the nervous sj'stem. In ordinary or cui'able cases of Eetroversion or Eetro- flexion, it is essential to cure that the uterus and vagina should be restored to their normal position and maintained in that position by means mechanically adapted to the parts Uterine Displacements, etc. 371 allowing of the normal contraction of the vaginal fibres, and permitting a natural degree of mobilit}^ Special care should be taken that the Instruments emploj^ed should be manageable by the patient, and that general health should be maintained by ample nutriment. The catheter should be used regularly twice per day, until the uterus rises above the pelvis. The catheter should be small, flat, and curved considerabl}^ more than common, in consequence of the dis- torted course of the urethra. The bowels must be kept open, and absolute rest, in a recumbent posture, be en- joined. Should it be impracticable to draw off the urine, attempts must be made to replace the uterus by the medical practitioner who has the case in charge. Fig. 4. Retroversion and Flexion. RETBOVERSIOIV A]\I> RETROFt.EXIO]V COMBIIVEI>. Here the vagina is so much relaxed that the retroflexed uterus is thi'own down as much as the sacrum and rectum 372 Wommi^s Medical Companion. "svlU allow. This combination is very frequentl}^ found. It interferes with defecation to a greater extent than the two yarieties previousl}^ described. It is more difficult to treat. In all these cases the patient should recline on a bed raised at the foot. The treatment should be similar to that akeady given. Fig. 5. Ajjteversion. AIVTEVERSIOjV of the ITOMB. This displacement, although it does sometunes occur, is comparatively rare in single women or those who have not borne children. The normal position of the womb is slightly forward, so that the natm-al tendency, in the event of preg- nancy or undue exertion, is to fall forward rather than back- ward. But it is sometimes so morbidly increased as to give rise to some verj^ unpleasant and painful s^miptoms. It may be considered in a condition of unnatural anteversion when it lies across the pelvis, with its neck in the hollow of the sacrum, and the fundus encroaching upon the bladder. An- teversion may be combined with flexion at the junction of Uterine Displacements^ etc. 373 the cervix with the bod}^, in which case the fundus is thrown still more forward and downward. Symptoms. — This form of displacement may come on gradualh', and can be distinguished readily from pro- lapse b}^ the yaginal touch, the body of the womb l^ing in a horizontal line across the pelvis. It may occur suddenly ; and in this case the S3^nptoms closely resemble those of prolapsus, or falUng of the womb. It gives rise to very un- pleasant urinar}^ sj^nptoms, and occasions more or less irri- tation of the rectal passage, constipation, and hemorrhoids. In some cases walking is rendered extremely difficult and even impossible. But the urinary disturbance is the most annoying, and prompts the woman to call in the aid of her physician. Pig. 6. Anteixexion. AlVTEFLiEXIOIV OF THE WOMB. This derangement is of common occurrence, and differs from ante version, in that while the fundus and body of the 374 Woman's Medical Companion. uterus are directed downward and forward, the neck or cer\ix retains its proper position, or nearly so, although flexion of the uterus forward may comprise a bending in that direction of both body and neck at the point of junction of the two, the bending being in some cases nearly at an acute angle. Or, in other cases, while the bod}^ of the uterus retains its proper position, or nearly so, the cervix or neck becomes bent and extended forward toward the pubes. Symptoms. — The S3^mptoms produced by anteflexion are similar to those of anteversion, though generally rectal and vesical irritation are not so great. In consequence, however, of the bending of the womb, very serious sj^mp- toms may arise, which are the results of various diseases which this abnormal position may originate. D^^smenorrhoea is almost a constant attendant ; congestion of the womb may occur, and occasion a variety of diseased conditions, corporeal and cervical endometritis may be set up, and from pressure or other cause even peritonitis may result. The same causes which occasion anteversion maj^ operate to produce anteflexion, previously existing weakness of the uterine tissue at the junction of the cervix and body of the uterus being premised. Treatment of Anteversion and Anteflex- ion. — In the treatment of these forms of displacement the patient must remain quiet, in a reclining position as much as possible, and, in severe cases, keep her bed and lie upon her back for a few daj^s. In those cases only in which the fundus is actually thrown beneath the arch of the pubes will there be any necessity for manual interfer- ence. A patient sufl'ering from this aflection should not urinate too often, as by moderatel}^ distending the bladder she will greatly assist nature in the replacement of the womb. The health being once restored, the womb will nat- urally resume its normal position. Uterifie Displacemc7its, etc. 375 Fig. 7. Ain-EViHSiow and FiiExioN. AIVTEVERSIOIV AW© AlVTEFIiEXIOIV COMBrSfED. These constitute a formidable combination against suc- cessful treatment. The uterus forms a portion of the vaginal dome, reaching from the pubes in front, upwards, to be3'ond the middle of the highest point of the vagina. The uterus being so excessively flabby and yielding, every part is so much out of line as to render its normal replacement a matter of great difficulty. If the uterus is hypertrophied remedies should first be applied to reduce the size of the organ. Depletion or blood-letting (by appl3ing two or three leeches) is one of the most prompt and successful agents in restoring contractihtj". The most frequent sequences to this combination are the irritable intra-uterine ulcer, and the doubling of the uterus over the pessary (if that instru- ment be used) , which we disapprove. It frequentl}^ occurs that the uterus shifts its position so readily that the patient ma}^ suffer alternately from all the displacements we have mentioned, the ligaments being so 376 Woma7i's Medical Companioii. much relaxed that the womb cannot remain in one position for any length of time. In such cases it is best to convert it into a reti-oversion at once, allowing the organ to be slightl}' turned back, so as to be less liable to be thi'own forwards duiino- the bodv movements. riATEKO-VERSIOIS. There are two varieties of this displacement, but they are rare. They may be found associated with prolapsus (or falling), or with the backward and forward displacements, and result either in consequence of inflammator}' conditions, unnatural weight, or direct pressm'e. The patient should be dii'ected to he upon the side opposite to that of the ob- liquity, and to keep at rest as much as possible. rig. 8. Prolapsus Utehi. PROILAPSrS rTERI, OR FAXLIXG OF THE TVOMB. This is one of the most common fonns of uterine dis- placement. It occurs in three different degrees, which we Uterme Displacements, etc. Zll Tvill briefl}' describe. Thus, relaxation or simple descent of the icomh is understood to indicate the first and least dis- placement downward, and to consist onl}^ in a simple bear- ing-down of the womb upon the upper portion of the vagina. In 2>^'olapsus uteri the organ comes still lower down, and may even present itself at the lower orifice of the vagina. li\ procidentia uteri there is actual protrusion of the organ, even the entire body of the womb being in some cases ex- tended from the vulva. These are but diff'erent degrees of the descent of the uterus in the line of the vagina. Upon examination of the same displaced uterus at different times of the da}' it will be found more or less prolapsed, accord- ing to the condition of active exercise or quiet in which the parts may have been for some hours previous. Symptoms. — The principal indications are, dragging and aching pains in the small of the back ; pulling and bearing-down pains in the lower part of the abdomen ; a sensation of expulsion from the vagina ; suff'erings much greater after walking or other exercise ; frequent calls to urinate, and incontinence or retention of the urine. The primary cause of prolapse or descent is, of course, the excessive relaxation of the peritoneum and broad liga- ments, bj" which the womb is retained in its proper position. (See Fig. 4, p. 25.) The system generall}^ being much de- bilitated, the slightest strain or extra exertion increases the descent more and more, and renders recover}^ more doubtful. Persons of a scrofulitic temperament are especially liable to the afi'ection ; and, far more than all other causes combined, carelessness or improper treatment at and after confinement, are direct agents in producing this displacement. The want of prompt attention to the primary' s3'mptoms, and omitting to seek medical advice, would speedily transform the afiec- tion into a chronic displacement. 378 Woman's Medical Companion, IWTERSIOIV OF THE UTERUS is the most formidable and dangerous, as it is fortunately the rarest, form of displacement. It occurs principally as an accident in connection with delivery. When the inver- sion is complete the womb is turned entu'ely inside out, and protrudes beyond the orifice of the vulva, the mucous lining membrane consequently becoming the external covering. This naturally occasions a very serious complication of all the uterine organs, dragging the Fallopian tubes, ovaries, and bladder out of their natural position (see Fig. 4, p. 25), causing excruciating distress and derangement in each of the organs involved, and profound depression of the nervous sj'S- 1 tem and vital strength. The presence of polypi, tumors, or' malignant growths considerably increase the danger, not only ft-om the unhealthy nature of the cause itself, and the fact that it may only be a development of still more serious forms of disease, but from the hemorrhage it may occasion. TKEATME]VT. The inverted womb should be carefully reduced, and the whole organ replaced in the pelvis, with as little and as gentle manipulation as possible. The patient should remain in bed in the position most comfortable to her, receiving such medicines as are best calculated to contribute to the functional and structural rehabilitation. [In all affections of the womb the physician should be summoned without delaj', the points of treatment we have mentioned being only of a temporary or provisional char- acter. In an organism so delicate, sensitive, and complicated in structure, the slightest act of ignorance, recklessness, or nervous anxiet}" on the part of the nurse or friend in attend- ance (other than the physician) may be attended with the most serious or fatal consequences.] Uterine Displacements ^ etc. 379 THE IMMEMATE EFFECTS OF THESE DISFXiACEMElVTS are by no means confined to the uterus. They drag or force out of position every other organ within the trunk. A general derangement and disorganization ensue, and Uver, spleen, heart, intestines, and kidneys are all involved, sympathetically and mechanically, in the disturbance. The machiner}^ is entirely put out of order by this one neglected displacement, and, if not instantly attended to, will, in all probabiht}', result in the most serious if not fatal, organic difficulty, and ultimate prostration or death. CANCERS, TUMORS, FUJVGOI© GROWTHS, ABSCESSES, ETC., TN THE ORGANS OF GENERATION. The reproductive organs are so constructed as to render them hable to a variety of complaints, which are apt to excite alarm in the mind of the female, however free from actual danger some of them may in reality be. Women, especially those who are married, when laboring under affections of these parts, are often kept in a state of great anxiet}^, until they are made acquainted with the exact nature of the difficulty, and that it will not be attended with danger. On this account, if for no other reason, every woman should be acquainted with the diseases to which they are incident, and thus, in a measure, be enabled to preserve their peace of mind, avoid the causes which tend to them, and be enabled to obtain a timely application of the necessary remedies. The attention of our readers will naturally first be drawn to 380 Woman's Medical Companion. AFFECTIOIVS OF THE EXTERIVAIi GEIVEKATIVE ORGAiVS. The Labia Majora, or Outer liips, are, on account of their looseness of texture, subject to considerable en- largement or swelling, from comparatively slight irritation. It frequently happens with persons who neglect the daily washing of the parts during and after the menstrual flow, producing acrid secretions and intolerable itching ; and, if scratching or rubbing is used for the purpose of allaying the irritation,- the parts become much swollen and inflamed. The same remarks will apply to the N^yonphse, or inner lips. ABSCESSES OF THE liABIA sometimes occur, which are extremely painful, and are usually caused by blows, falls, forcible intercourse, or casual injuries of au}^ kind, and sometimes from an inflam- matory condition of the body, without any other cause. The sj^mptoms are heat, swelling, redness, and throbbing pain in the part, extending to the groin and down the thigh ; there is a circumscribed hardness, and the part is exquisitely tender. The treatment comprises rest and quiet, the application of leeches or poultices, according to the special sj^mptoms, and brisk purgatives. Another afi'ection to which they are subject is the formation of ENCYSTED AIVD TIARTY TUMORS, both of which var}^ in size from that of a pea to a turkej^'s egg. The warty tumors are distinguished b}^ having a pedicle or stem, and are apt to spread internally ; but they are neither painful nor tender, and are onlj^ inconvenient from their size. In many cases they are of venereal origin, Uterine Displacements ^ etc. 381 and frequentl}^ degenerate into unhealth}^ sores or ulcers. The treatment for their removal is necessarily surgical. THE ClilTORIS is subject to certain diseased or abnormal conditions, and local inflammations. It is sometimes the seat of CABTCEROUS GROWTHS A1VI> GI^AWDTTXiAR EIVIiARGE- MEIVT. If cancers exist there is no alternative but excision by the knife ; if there be malformation or enlargement of the part it is frequently found necessary to resort to amputation of the organ ; but simple and uncomplicated inflammatory conditions will soon succumb to cooling and astringent lotions. TUMORS, ABSCESSES, AlVD THICKEIVING OF THE MEM- BRA]VE also invade the orifice of the urethra, the pelvis, exterior to the vaginal canal, and the space between the vagina and rectum. THE IlVTERlVAIi ORGANS OF GEjVERATIOIV are subject to a much greater and more appalling variety of affections and complications ; and, from their being so intimately connected with every other section of the human system, so entirely disorganize and derange the functions of the body, that they may truly be said to originate three- fourths of the diseases of which the female frame is susceptible. Married women frequently suffer from 382 Woman's Medical Companio7i. EUETATION, OIMOBBLITT, AIVB HERXIA OF THE UTERI'S AJijy OVARIES. Elevation of the uterus is caused by abscess or insuffi- ciency of the ligaments, dropsy of the ovaries, displace- ments of the uterus, and the presence of hydatids and other growths. Immobility is caused by peritoneal adhesions, or inflammation of the neighboring organs. Scrofulous women, girls of a lymphatic temperament, those who practise mas- turbation, and those who suffer from severe constipation, are especially liable to it. Hernia of the womb is fortunately a very rare affection, the tumor being hard, of a roundish form, and scarcely capable of reduction. There are three descriptions ofthis hernial trouble, called the m5fMJ?ia?,whenit makes its appearance in the groin ; the crural, when it appears on the thigh ; and the ventral, when it takes place in the gra^-id uterus, through an accidental separation of the abdominal muscles. It originates from relaxation or weak- ness of the ligaments, a violent blow, or contusion, etc. The ovaries are subject to six different kinds of hernia, viz. : the inguinal, crural, and ventral; the iscliiatic, when it appears near the loins ; the ^nnhilical, when the protrusion takes place at the navel, and the vaginal or rectal, when it takes place in those organs. These tumors are caused by tight-lacing, undue compression, wounds and abscesses, and -violent emotion or crying. The treatment is purely surgical. BISPI.ACE5EEXT OF THE BI.ADDER, or rather its protrusion into the vagina and external labia, is a very frequent and annoying affection. Fig. 1, in our chapter on uterine displacements, will plainly show the con- nection between the vagina and bladder, and the means by which the accident may arise. The predisposing causes Uterme Displacements ^ etc, 383 are : an excess! vel}' large pelvis, nuiiiGrous pregnancies, violent exertion of the muscles, leucorrhoea, retention of urine, an abuse of sexual indulgence, or warm bathing, tight- lacing and the use of busks, general debilit}^ and peculiar conformation. The principal exciting causes are : parturi- tion, violent exertion of an}' kind, coughing, vomiting, excessive dancing, etc. It is more common in women who have borne children. The tumor presents itself usually within the vaginal canal, or just outside the vulva ; it is bluish, with a pohshed surface, when the bladder is distended ; and at other times is wrinkled and soft. It is frequently complicated with various displacements and inflammations of the womb. When it occurs in a pregnant woman it may become so large as to prevent the delivery of the infant. BISPIiACEMENT OF THE IIVTESTHVES KVTO THE TAGIXA, arises from the same causes as prolapse of the bladder ; but is much more amenable to treatment, and is not attended with such disagreeable or disastrous consequences. PROI.APSIJS OF THE VAGINA means a turning inside out of the lining membrane of that organ. It may be either complete or incomplete. In the former the tumor projects more or less beyond the vulva ; in the latter it remains within the vaginal orifice. The predisposing causes are Ij^mphatic temperament, chronic leucorrhoea, frequent childbearing or abortion, abuse of hot bathing and of warm, relaxing drinks, bad nutrition, and general debilit}'. It may be immediately brought on by abuse of marital privileges, injury during labor, external violence, excessive efforts of any kind, etc. It is a very 384 Woman! s Medical Companion. troublesome affection, and may become dangerous during labor. MOLES, HYDATIDS, AND FAXiSE CONCEPTIONS are growths within the cavity of the uterus, originating in the destruction of the foetus a short time after conception. The causes of this destruction may be found in general de- bility, mental and bodily shocks, and iiTegularities of the nervous and circulatory systems. The foetus is seldom retained in the womb more than two or three months, but if not then expelled, it becomes transformed into the fleshy mole. These moles and hydatids are found, sometimes singl}', varying in size from a pea to a grape ; and some- times m clusters, attached by a stem, to the outside of the ovum and placenta. They are necessarily consequent upon sexual intercourse and impregnation, and are simply blighted or imperfect conceptions. The symptoms exactly re- semble those of ]3regnancy, and can only be distinguished therefrom by the absence of foetal movement and pulsation. FIBROUS TUMORS OF UTERUS AlVD OVARIES. This appellation is applied to a species of fleshy tumor attached to the body of the uterus, and consisting of a mass of irregulfir fibres, bound together by cellular tissue, w^hich do not ulcerate or become malignant. They vary in size from that of a pea to a man's head, and have been known to weigh as much as forty pounds. Thc}^ are usually found in persons of a h^mphatic or scrofulous tem- perament, and may be caused by chronic leucorrhoea, celibac}^, barrenness, abortion, and from too close application to sedentary emplo^'ments. They are mostly met with between the ages of thirt}' and fifty. When these are present, conception is possible, but abortion at the third Uterine Displacements, etc. 385 or fourth month will most probably follow ; if pregnancy proceeds to the full term there is great danger of flooding. POIiYPUS OF THE TJTERUS. This description of tumor is similar in structure to the fibrous, but differs in form, situation, and S3'mptoms. They may be attached to any x>art .oi the uterus, vary in size, shape, and color, and are accompanied by a leucorrhoeal or hemorrhagic discharge, according to the stage of growth. The appetite becomes impaired, bowels relaxed, and dropsy of the extremities is frequently induced. They are oval or pjTamidal in shape, and appear both singly and in clusters. CATJIilFIiOWER EXCRESCENCES OF THE UTERUS are usually found at its mouth, and are met with in women of all ages, temperaments and conditions of life, married and unmarried, without regard to habits or residence. They are mostly hereditary or congenital in origin, very vascular, of a bright, fleshy color, with a smooth or slightly granulated sur- face, upon which are numerous small projections. They vaiy in size from a strawberry to a bulk sufficient to fill the entire vaginal orifice, and are alwaj^s attended by more or less hemorrhage and watery discharge. They bleed freely upon being touched, and if extirpated, grow again with great rapidit3^ The stomach and bowels become much dis- ordered, and the patient is liable at any time to die from drops}', or effusion into some of the great cavities of the body. Cancers and corroding ulcers of the uterus and ovaries are diseases of the most serious and excruciating character, which, unfortunately for the sufferers, are seldom detected and treated in their earlier stages ; consequently they have 386 Woman's Medical Companion, been classed among the incurable diseases. They are| malignant and contagious in their character, poisoning the I glands, tissues, and fluids of the body and adjacent organs j as they come in contact with them. They are generally! accompanied by hemorrhage and leucorrhoea, and, from| the severity and critical character of the affection, demand j the most skilful treatment that medical science can afford. They may be found in almost any part of the uterine, ovarian, and abdominal regions, and are so varied in their appearance, form, and character, that even to attempt a description of them would require space far beyond the limits of this volume. Change of Life. 387 CHAPTEE XYII. THE CHANGE OF LIFE. By this phrase, or the " critical period," as it is some- times termed, is understood the final cessation of menstru- ation, and, consequently, the capacity for childbearing. Popular opinion fixes the time for this change at about the forty-fifth year, and all women anticipate its occurrence about that time ; but many are disappointed, for some women have been known to cease to flow at the thirtieth or thirty-second year, while others have continued to men- struate to the fiftieth year, or even later ; but, as a general thing, the average period of its occurrence may fairly be fixed at the age of forty-five. Women of delicate constitutions, and those who have been in the habit of living well, enjoying the good things of life, and whose occupations have been sedentary, who have been confined to the house, and especially to warm rooms, experience the change earlier than those of a more robust organization, or those who have led a temperate, active life, avoiding all dissipation. This period of life, which is rightl}^ considered a critical one for every female, may pass without a single untoward sj^mptom, the monthlj^ evacuation gradually ceasing, with- out being attended by any unpleasant consequence, and leaving the patient enjoying better health than she ever ex- perienced before. On the contrary, it may be fraught with peril, through which she can be safely conducted only by a skilful and experienced physician. It is, therefore, highly 388 WomatCs Medical Companion. important that all the unpleasant sensations which ma}' be experienced during this time should receive a careful con- sideration, and not be hushed up with the unsatisfactory reply that such complaints are owing to the " change of life," and likely to vanish whenever that change shall become complete. If proper attention is not paid to the various affections which may and frequently do manifest themselves during this period, the seeds of endless miseries and even early death will be allowed to germinate and cut short a life that, b}' proper foresight and care, might have been conducted to a ripe old age. As the change approaches, the menses gradually become iiTegular, both in regard to the time of their recurrence, and the quantity discharged. They may return too soon, or be delayed be3'ond the usual time. The quantity discharged is at times much less than common. Sometimes the discharge returns every two weeks, then ceases for several weeks, or even months, and afterward recurs for a few periods as regularly as ever, and then ceases altogether. Perhaps, in the majority of women, while this change, which usuall}^ extends over a j^ear or a 3'ear and a half, is in progress, there is more or less disturbance of the general health. It is often difficult, and even impossible, to say exactl}' what is the matter with the patient, except that she is generall}^ out of health. A host of sjTnptoms present themselves ; the patient complains of headache, vertigo, biliousness, indigestion, flatulenc}', acidity of the stomach, diarrhoea, costiveness, irregularity in the urinar}^ discharge, piles, pruritus, violent itching of the privates, cramps and colics in the abdomen, palpitation of the heart, ner\'Ousness, pains in the back and loins, swelling of the abdomen and the extremities, paleness and general debility. To unravel all these, and to decide what is the best plan of treatment Change of Life, 389 to pursue, requires the skill of an intelligent physician. Remedies Nos. 117 and 157 will be found effective. It is ver}^ important in these cases to pay strict attention to dress, diet, and exercise. The diet should be light and easily digested. Ever3i;hing of a stimulating nature, unless ordered by the attending ph3'sician, should be studiously avoided. Daily exercise in the open air, either by walking or riding, will be found highl}^ beneficial. The clothing should be warm and comfortable, and changed to suit the weather. OIiI> AGE A]VI> ITS DISEASES. Life, like the natural da}', has its morning, its noon, and its evening ; and its decline, unlike the period of j'outh and manhood, is marked by a calm, quiet stillness and peaceful repose. The decline of old age reverses the natural order of growth, the waste of tissue and nerve force gradually but surely outstripping the addition resulting from the food taken into the body daity. Declining age may be said to extend from fifty to sixty. Incipient old age from sixty to seventy. Ripe old age from seventy to eighty, and decrepi- tude or second infancy from eighty to the close of life. During all these periods, particularly the latter, important structural and other changes are occurring in the human sj'stem, and piles, apoplexy, paralysis, diseases of the liver, kidney's, and bladder, with organic changes of the heart, drops}', chronic affections of the respiratory organs, gout, etc., frequently present themselves. There is an hygiene for old age as well as for youth, — a means of preserving health, which may lengthen out their days to the utmost limit without the intervention of any of these affections which we have named. The first essen- tial is regular habits. Any sudden cessation of a practice long indulged in, such as the use of tobacco or an}^ narcotic, 890 Woman'' s Medical Companio7i. ardent spirits, or malt liquors, will often prove fatal to the aged. Even the hours of taking meals should not be changed ; nor should old people transfer their residence to new climates, or form new social relations, their decreased vitality being insufficient to sustain the altered physical and mental conditions. Diet and Reg'imen. — This is by far the most essential item in maintaining the healthy condition of those who have passed life's meridian. We need scarcely say that special attention in the selection of food easy of digestion is a primary requisite. Plain boiled or roasted meats are frequently unsuitable, — they should alwaj^s be finely chopped, and thoroughly cooked. Soups and milk are excellent articles of diet ; and, in moderation^ ripe fruits, and plain puddings and pies are not objectionable. Vege- tables should be sparingly partaken of. Wine, good and pure, if judiciously administered, will be found beneficial in cases of unduly diminished vitality. But, above all things, the aged should be cautious never to eat to excess or repletion ; they should eat slowly, and chew their food very thoroughly. Aged people suffer YQvy much from cold hands and feet, and indeed from languid circulation and low temperature generally. The heart and muscular system usually becomes feeble and relaxed. The clothing of elderly people should therefore be much thicker and warmer than that worn in youth and manhood. We must prevent the escape of what little animal heat there is by flannel worn next the skin, and by woollen clothes generally, they being bad conductors of heat. It is during winter nights that the old are apt to suffer most from cold. If the bed clothing is not sufficient to create the required amount of warmth, artificial heat, in the shape of a heated stone, or bottle of warm water, should be applied. Change of Life. 391 A far greater number of aged people die in winter than in summer or fall. For this reason they should be very careful how they expose themselves to frequent and sudden changes of temperature, or inclement weather. Important as the care of the skin is to the health of persons at all periods of life, it is especially so in old age. In the decline of life, the scarf-skin exhibits a tendency to become drj- and peel off ; this may be prevented by frequent and regular ablution in tepid water, followed by brisk rubbing, or if the skin be too tender for the application of water, friction alone can be emploj'ed, either by the naked hand, a piece of soft flannel, or a flesh-brush. In rubbing the abdomen, the rubbing should be across, from right to left, in order to remove or obviate constipation or flatulence. Exercise of any kind — walking, riding or working — should be used in the greatest moderation, as great fatigue would always prove injurious. Aged people should get as much sleep as they feel to want, from eight to ten hours out of the t wenty-foui' being by no means too much. They should always retii'e earl}'. Many aged people suffer considerably from inability to sleep ; but, for all that, the use of narcotics should be avoided as much as possible. A great deal may be often effected by taking early and light suppers. Earl}' rising and exercise in the open air will generall}' produce refreshing sleep at night. With many persons electricity, moderately indulged in, of course under the ad^-ice of a physician, will be found to have an extremely beneficial effect. APPENDICES APPENDICES. Appendices A and B are intended as an intelligent and infallible guide to the interpretation of symptoms and the temporary remedial agencies for the nmnerous affections — chronic, acute, or incidental — to which women and children are especially liable at all ages, and under all circumstances. For instance, supposing a child to present the premonitory S3'mptoms of measles, scarlet-fever, or colic, the mother or nurse, from inexperience, ignorance of the sjTnptoms, or the natural anxiety of the parents, is uncertain as to the natm-e of the affection b}^ which the child is threatened. By reference to Appendix A, she will be able to form a tolerably correct judgment as to the probable cause of the ph3'sical disturbance, and b}" referring to the disease men- tioned in the table of remedies in Appendix B, will at once have it in her power to intelligently and safely administer the appropriate temporary remedj^, which may mitigate the patient's suffering, and arrest the progi*ess of the disease until skilful professional aid can be obtained. 396 Woman's Medical Companion. APPEXDIX A. DISEASES AND THEIR SYMPTOMS. The following table is designed to enable the mother, wife, nurse, or attendant, to form some idea of the disease or affection under which the patient may be suffering by the symptoms which may present themselTes, and thereby to intelligently administer local or temporary treatment, and mitigate the suffering : — Disease. Symptoms. Dropsy — Inflammation or Ob- struction of Bowels Dyspepsia Disease of the Heart or Lnng-s, in terfering with breathing .^ 'Maintaining Abdomen. — Increased size. Can only lie upon the back, pinched countenance, tongue furred and dry, increased thirst, diminished perspiration, diminished secre- tion of urine, small pidse. Cold hands and feet, red or yellow deposits in urine, Toracious ap- petite (occasionally), black flecks floating before the eyes, tongue white or furry; when acute, coating of tongue peels ofT, fetid breath, clammy mouth, bitter taste, eructations, weight at pit of stomach. Pleurisy the sitting posture only, or lying upon the unaffected side only, forcible and rapid dila- tion of the nostrils, debility, cough harsh and concentrated, dimin- ished appetite. Pain in parts moved in breathing, harsh and concentrated cough, breathing diminished in rapidity, ability to lie upon one side only, depression or retraction of one side of chest; sharp, tearing pain below the nipple, enlargement of one side of chest. Appendix. 397 Diseases and their Symptoms. — Continued. Disease. Convulsions . Consumption Erysipelas or Small-pox. . . Nervous diseases generally Paralysis of one half of tlie body . Fevers Typhus Fever Symptoms. Head bent on one side, temporary spasm. Hands and feet hot, night-sweats, fat in stools, constant pain be- tween shoulders, pain darting from front part of chest to be- tween shoulder-blades, muco- purulent expectoration, or ex- pectoration of pus, harsh and concentrated cough, depression or retraction of one side of chest, breathing slower, paleness of face, faint and sweetish smell of expectoration, hollow, barking cough. Swollen scalp, frequent pulse, diminished secretion of urine, external local heat. Cold hands and feet, white sediment in urine (in severe cases), small, weak pulse, hollow and barking cough, trembling, exaltation of vision. Distorted features, altered position and impaired motion of limbs, head bent to one side, eyelids remain open, limbs immovable and diminished in size, retention of urine in the bladder. General heat of surface, chills, fetid smelling sweats, red or yel- low sand deposits in urine, tongue trembling, dry, and diminished in size (in low fe- vers), morbidly increased sensa- tion, tongue white, afterwards clean, red, and dry, with much thirst ; paleness of face (in cold stage), restlessness andtossings. Bluish tint of head, face, and neck, tongue white and loaded, or dry, parched, and black, difficult of protrusion and trembling, dull hearing, debility, loss of moral sensibility, acrid heat, burning the hand when applied. 398 Woman's Medical Companion. Diseases and their Symptoms. — Continued. - Disease. Typhoid Fever Various kinds of Colics Cerebral, or Brain Diseases Insanity, Mania, Delirium St. Vitus's Dance Catalepsy Apoplexy Acute Diseases generally, and progress of Chronic Complaints. Diabetes . Symptoms. Perspiration, smelling like ammo- nia, retention of urine in the bladder, tongue trembling, dry and diminished in size, dull ex- pression of face. Lying upon the face ; hard, sharp, contracted pulse, vomiting, pain relieved by pressure, hard and lumpy stools, cramps, abdomen diminished in size. Hot scalp, absence of thirst, full pulse, temporary spasm, rigidity of extremities, exaltation of vision, black flecks floating be- fore eyes, morbidly increased sensation, contracted limbs, vio- lent pulsation of carotid arteries, perpetual motion of eyelids, head increased in size, full, red face, blood-vessels of eyes in- jected, restlessness and tossing, ability to lie only on the back, painfully acute hearing, vomit- ing. Sweat having odor of mice, vora- cious appetite, great and un- natural boldness, and many of cerebral symptoms previously noted ; increase of strength and loss of moral sensibility. Irregular and perpetual motion. Entire and absolute loss of power of motion. Ability to lie only upon back; full or slow pulse. Great and unusual languor, contu- sive pains, debility, diminished appetite, abdomen diminished in size. Diminished perspiration, sugar in urine, increase in amount of urine, fat with stools. Appendix, 399 Diseases and their Symptoms. — Continued. Disease. Rheumatism, Gout, etc. . . . Neuralgia Measles, Scarlet-Fever, etc, Hysteria Bilious disorders. Disorders of the Bowels — Diar- rhoea, (1) ; Dysentery, (2) ; Constipation, (3) ; Cholera, (4) ; etc Congestion or Inflammation of Liver <. Bronchitis and Bronchial affec- tions Symptoms. Profuse perspiration, sour-smelling sweats, sand deposits in urine, boring pains, swelling of joints, ability to lie only on the back. Shooting, tearing pains in part affected. Sweat with mouldy odor, forcible closure of eyelids, tongue loaded with white, through which numer- ous elongated red papillae pro- trude their points. Increase in amount of urine, re- tention of urine in bladder, small pulse, voracious appetite, cough in paroxysms, cramps, painfully acute hearing, morbidly increased sensation, enlargement in epigastrium, increased rise in abdomen. Dark-green, yellow or dark-brown stools, surface of tongue covered with white, soft, mucous sub- stance, clammy mouth. Shreds of false membranes in stools (1 and 2) ; stools red and bloody (2) ; hard and lumpy stools (3) ; urgent desire for stool (1 and 2) ; watery stool (I audi) ; increased thirst, small pulse, pain in left shoulder, rice-water stools (4) ; bluish tint of face, etc. (4). Strong pulse, pain in right shoulder, tongue covered with yellow fur. Dull, heavy, aching pain at base of chest, soreness of breastbone and between shoulders, faint, sweetish smell of expectoration, (yellow in color, and mucous) ; hollow, barking cough. 400 Woman's Medical Companion, Diseases and their Symptoms. — Concluded. Disease. Pregnancy Cancerous disease Asthma Inflammations generally; Hemor- rhages Chronic affections Diseases of Bladder Bright's Disease . . . . "Worms Symptoms. Vomiting, voracious appetite, cramp. Citron tint of countenance, enlarge- ment in epigastrium, shooting, tearing pains. Wheezing cough, spasm of mus- cles of chest, jerking respira- tion, breathing increased in rapidity, clammy mouth, bitter taste, fetid breath. Vomiting, external local heat, diminished secretion of urine, frequent pulse, breathing dimin- ished in rapidity, paleness of face, tongue furred and dry. Hectic flush, at first, afterwards changing to paleness, tongue white and furry, hoarse, hollow, or barking cough, weak pulse, constant pain between shoulders, abdomen diminished in size. Mucus in urine, small pulse, pain in region of bladder. Albumen in urine, paleness efface, great debility. Shreds of false membrane in stool, itching of nostrils. Appendix. 401 APPENDIX B. EEMEDIES FOE THE DISEASES. I. HOMGEOPATHIC REMEDIES. These remedies are given in the order of symptoms men- tioned in the description of the disease. Prolapsus Uteri (Falling of the Womb) . 1. Aurum, or Belladonna, in cramping pains through abdomen, pelvis, and spinal column ; great sensibility and irritabilit}^, and when accompanied by leucorrhoea and men- orrhagia. 2. Nux Vomica, for congestion of the womb, with pres- sure downwards ; great heat and weight in vagina and womb ; dragging pains, abdominal spasms, tendency to miscarriage, profuse or irregular menstruation, and fetid leucorrhoeal discharges. 3. Sepia, in suppressed or irregular menstruation, con- tractile and expulsive pains in back and abdomen, frequent urination, and itching, excoriating leucorrhoea. 4. Calcarea-carb., for weakness or laxity of muscular S3'stem, scrofulous habit of body, and exhaustive or pro- fuse menstruation. 5. S scale cornutum, in prolonged bearing-down, forcing pains, profuse menstruation, depression, and deficient con- traction after miscarriage. Of either of these remedies, one dose of Jive pellets should be taken every four hours, and be continued for one week ; during the next week ?io medicine should be taken, and so on, in alternation, until a cure is effecteci. 402 Woman's Medical Companion. lieucorrhoea, or Whites. 6. Ptt?sa^i7Za, when the discharge is thin and acrid ; Sepia^ when the patient is sensitive and dehcate ; Alumina^ when it appears just before and after the menses, is profuse and transparent during the day, and is of a corrosive character ; Calcarea-carb.^ for itching, burning leucorrhoea, and too pro- fuse or too frequent menstruation, especially for persons of light complexion ; Kreosotum, when smarting, itching, of a whitish hue, accompanied by great pain and weakness, falling of womb, etc. ; Nitric Acid, for fetid, brownish, greenish, or flesh-colored discharges ; Mercurius, when the discharge is purulent ; Cocculus, if watery and bloody, during pregnancy, — for scanty menstruation, with leucorrhoea between the periods, or leucorrhoea instead of the menses ; Conium, for ex- cruciating leucorrhoea, with pinching coUc, lameness in small of back, and excessive itching ; Sulphur, in stubborn cases ; and Silicea, when milky, acrid, and accompanied by itching. Of these remedies, six pills every morning and evening, until Jive doses are taken; then suspend for four days, and repeat treatment. Chlorosis, or Green Sickness. 7. Pulsatilla, for females of mild, esisy, melancholy disposi- tion ; Bryonia, in alternation, when congestion, constipation, and fever are present ; Ferrum, in great debility and dropsical tendency ; Sulphur, for obstinate cases, pain in back of head, emaciation, constipation, drowsiness, and sense of pressure, especially for irritable persons ; Calcarea-carh., in alternation, for difficulty of breathing, and excessive emaciation, pal- pitation, etc. ; Belladonna, for pressing or bearing-down pains, scant}^ and painful menses, preceded by colic ; China, when it occurs after a, severe fit of sickness or severe hemorrhages. Appendix. 403 Five or six globules once in six Jiours until improvement takes place; afterwards gradually lengthen the intervals to twelve hours and two or three days. DISEASES OF PREGNANCY AND PARTURITION. Continued Menstruation. 8. Cocculus^ for severe spasmodic pain low down in the abdomen ; Crocus, when the discharge is dark and copious ; Phosphorus, Platina, and Sulphur are also serviceable. Headache and Vertigo during" Pregnancy. 9. Aconitum, Belladonna, Opium, NuxVomica, Coffea, Ignatia, or Pulsatilla, for the respective sjTnptoms of head- ache, vertigo, sparks before the eyes, sleeplessness, and sleepiness. Morning- Sickness . 10. Ipecacuanha, for bilious vomiting and relaxed bowels ; Arsenicum for excessive vomiting, fainting, and emaciation ; Nux Vomica, for constipation, vomiting, and nausea in the morning or after eating, irritability of stomach, etc. ; Pulsa- tilla, for depraved appetite and obstinate sickness. Dissolve ticelve globules of either of these remedies in eight teaspoonfuls of water, and take one teaspoonful every three hours. Constipation during Pregnancy. 11. Nux Vomica, Opium, Lycopodium, or Sulphur, one dose of five pellets ever}^ night and morning, for three or fom' da3's. On no account whatever should cathartics of an}^ kind be given. 404 Woman's Medical Companion. Diarrhoea during" Pregnancy. 12. Chamomilla., Pulsatilla^ or Dulcamara^ for violent colic, water}^, or greenish stools, or severe cold. Six pills at a dose, every two or thi'ee hours. Hysteria, or Fainting Fits. 13. Chamomilla, Belladonna, or Acomtum, when arising from anger, or in cases of congestion in the head. Dose as in No. 12. Palpitation of tlie Heart. 14. ChamomUla, when caused by anger ; Veratrum, when by fear ; Coffea, when by jo}^ ; Opium, when by sudden fright. Ignatia, Coffea, or Chamomilla, for nervous persons ; Aconi- tum and Belladonna, for plethoric persons. Dissolve twelve globules in twelve teaspoonfuls of ivater, and take one every Jiour, or half-hour if the attack be severe. Toothache. 15. Pulsatilla, when pain flies about from one tooth to another ; Antimonium, Mercurius, or Sulphur, for carious teeth ; for violent and sudden paroxj^sms, Coffea or Bella- donna; fornervous toothache, J^jiafia, Hyoscyanius, oy Sepia. Six globules at intervals of one to six hom's, according to severity of pain. Neuralg-ia. 16. Belladonna, Aconite, Coffea, or Bryonia, six globules at intervals of one to four houi's, according to severit}" of pain. Appendix, 405 Pains in Back and Side. 17. Blius^ Belladonna^ or Nux Vomica^ for pain in back ; Aconite^ Pulsatilla^ Ilercitrms, or Sid^hur, for pain in side. Dose same as No. 16. Cramps in Liimbs, Back, or Abdomen. 18. Veratrum^ or Sidpliur^ for the limbs ; Nux Vomica^ Belladonna^ or Pidsatdla, for the abdomen ; Ignatia or Bhus^ for the back. Dose same as No. 16. Varicose Veins, or Swelling of the Veins. 19. Nux Vomica^ when attended with hemorrhoids, constipation, and bearing-down pains ; Pulsatilla, when much pain, inflammation, and swelling ; Arsenicum, when swelling is of livid hue, with bm^ning pain ; Lycopodium for inveterate cases. Dose, twelve globules in twelve teaspoon- fuls of water, a teaspoonful every four hours. Hemorrhoids, or Piles. 20. Pidsatilld, Nux Vomica, and Sidphur, especially the two latter. Take ten globules, dry, upon the tongue, night and mornirig ; unless in severe cases, when the remed}^ should be repeated every hour. Jaundice, or Icterus. 21. Commence with Mercurius, six globules every three hours for thi'ee dajs, followed by Hepar Sidphur, or Lachesis, Two doses of six globules dail}", night and morning. 406 Woman's Medical Companion, Incontinence of Urine. 22. Pulsatilla,, Sejna, Belladonna, or Hyoscyamus. Six pUls, dry, upon the tongue, once in three or four hours. Dysury, or Strangury (Diflacult or Scanty Urination). 23. Pulsatilla or Nux Vomica. Six globules every two hours. Flooding during Pregnancy. 24 . Tincture of Cinnamon . Three drops in half- tumbler of water, a teaspoonful every quarter or half hour, until physician can be summoned. Miscarriage, or Abortion. 25. Arnica, Cinnamon, Secale Cornutiwi, or Belladonna, as temporary remedies. Twelve globules in twelve teaspoon- fuls of water, one teaspoonful every fifteen, thirty, or sixty minutes, according to severity of case. False Pains. 26. Bryonia, Nux Vomica, Pidsatilla, or Aconite. Twelve globules in twelve teaspoonfuls of water, one teaspoonful every half hour or hour. Constipation after Confinement. 27. Bryonia, Nux Vomica, or Sulphur. One or two doses of six pills each. Sore Nipples. 28. Chamomilla, Nux Vomica, Mercurius, Graphites, or Silicea. Same doses as No. 26, every six hours. Appendix. 407 Gathered or Broken Breasts. 29. Bryonia or Belladonna. In same doses as No. 28, every hour. Child-bed Fever, or Puerperal Peritonitis. 30. Aconite^ Belladonna^ Bryonia^ or Pidsatilla. Ten or twelve globules of either two, in alternation, at intervals of one, two, three, or four hours, according to severity. Milk-leg, or Crural Phlebitis, 31. Aconite^ Arnica^ Belladonna^ Bryonia^ or Pulsatilla. Six globules, dry, upon the tongue, once in two hours. Nursing Sore Mouth. 32. Mercurius^ Borax, Nitric Add, or Sulphur, according toseverit3^ Twelve globules in twelve teaspoonfuls of water, one teaspoonful every four or six hours. Perspiration after Delivery. 33. Didcamara, Bryonia, Belladonna, or Sulphuric Acid. In same doses as No. 32, every three or four hours. Excessive Perspiration. 34. China, Sambucus, or Sulphuric Acid. Six globules every three hours. Asphyxia. 35. Tartar Emetic or Opium. One or two globules, dis- solved or dry, upon the tongue, every ten or fifteen minutes. 408 WomatCs Medical Companion, DISEASES OF CHILDEEN. Coryza, Snuflles, or Cold in the Head. 36. Arsenicum, Nux Vomica, Chamomilla, Belladonna, Mercurius, Pulsatilla, or Sulphur, according to symptoms. In same doses as No. 32, every one, two, or three hours. Coug-li or Tussis. 37. Aconite, Belladonna, Bryonia, Chamomilla, Nux Vomica, etc. Same doses as No. 32, at intervals of one to four hours. Bronchitis. 38. Aconite, Pulsatilla, PJiosphorus, Tartar Emetic, Chamomilla, given dry or in solution. If dry, three to six pills for a dose. If in solution, dissolve twelve globules in twelve teaspoonfuls of water, a teaspoonful for a dose. Doses to be repeated every two to four hours. Pleurisy. 39. Aconite and Bryonia are the two principal remedies, and in most cases will be all that is necessary to complete a cure. Mercurius, Arnica, and Arsenicum are sometimes used in severe cases. Doses as in No. 38, every half-hour, hour, or two hours, according to the severity of symptoms. Pneumonia. 40. In the first stages Aconite is the most prominent remedy ; Belladonna and Bryonia are also used in alterna- tion. In severe cases. Phosphorus, Tartar Emetic, Pulsa- Appendix, 409 iilla^ Arnica, Mercurius, and Arsenicum are administered, according as the peculiar symptoms may indicate. Dose as inNos. 38 and 39. Hoarseness or Raucitus. 41. For excessive acrid discharges from nose, Arseni- cum. If combined with influenza, catarrh, or chronic hoarseness, Causticum. For tickhng or crawling at nose, violent cough, and smarting in throat, Capsicum. If fever, accumulation of mucus, and pain in throat, and great irritability, Chamomilla. Carbo-veg., Mercurius, Nux Vomica, PhospJiorus, Pulsatilla, and Sulphur, are also used in severe cases, especially when the affection is the sequel or result of other diseases. Dose as in No. 38. Spasmodic Croup. 42. Aconite, Hepar Sulph., Spomjia, or Tartar Emetic, are effective remedies in all ordinary cases of croup. Dose as in No. 38, repeated every half-hour, hour, or two hours, according to circumstances. Membranous Croup, 43. Aco7iite is the first remedy, in alternation with Spongia; if this has no effect, institute Hepar Sulph. If the case be very violent, Kali Bichrom., Bromine, Lachesis, or Phosphorus, will prove efficacious. Dose as in No. 38. Whooping-Cough, or Pertussis, 44. Corallia, one dose every four hours, as in No. 38 ; Drosera, a dose every six hours, and an occasional dose of Causticum, will generally have the desked effect. In con- valescence, Hepar Sulph. should be administered. 410 Womaii s Medical Companion Asthma of Miller. 45. The principal remedies are Samhucus^ Ipecac.^ and Arsenicum^ tlie first two especiall}'. A dose of five pellets every ten or fifteen minutes. If tliese fail, Plwsphorus or Belladonna may be tried. Xiaryng'itis, or Inflammation of the Larynx. 46. ^coniYe is specially indicated. Spongia^ Belladonna^ Hepar, Tartar Emetic, Phosphorus^ and Lachesis, are also very influential in severe cases, according to the prominent s}Tnptom in each case, in doses of five pellets from one to two hours apart. Colds. 47. When they result in Cough, Aconite; for cold in the head. Belladonna and Nux Vomica; when very severe, Mercurius, Sepia, Arsenicum, and Pulsatilla ; for Headache, Belladonna; for Earache, Rhus, Dulcamara, Mercurius, Bryonia, or Sulphur; for Toothache, Aconite, Bryonia, Rhus, Nux Moschata, or Mercurius; for Sore Throat, Belladonna or Mercurius; for Diarrhoea, Arsenicum, Bry- onia, Dulcamara, or Glonoine. Kepeat the dose as in No. 38 as frequently as the exigency of the case demands. Thrush, or Aphthae. 48 . For ordinary cases , Mercurius and Sulphur internall}^, with a gargle of Borax; Arsenicum and Nitric Acid, in very severe cases. Canker of the Mouth. 49. Mercurius may always be given, followed, if neces- sary, by Hepar Sulphur or Nitric Acid. In very severe Appendix. 411 cases, Natrum Muriaticum, and Nux Vomica. Sulphur has been found extremely beneficial, and is now generally used. The dose of five pellets, dry or in solution, should be re- peated every two, three, or four hours, according to urgency of the case. Ptyalism, or Salivation. 50. If from use of Mercury, Hepar, Lachesis^ Belladonna^ or Sulphur^ will be the appropriate remedies. "When caused by cold, give Mercurius. Dose as in No. 49, both as to time and quantity. Kanula, Swelling" Under Tongue. 51. Mercurius, CalcareaCarb., Thuja, Siud SulpJiur, are the principal remedies, three or four globules being given, dr}^, upon the tongue, night and morning. Gumboils, Abscess in the Gums. 52. Aconite and Belladonna, in alternation, ever}" two hours, when caused by decayed teeth ; Mercurius, when they fail to afford relief. If there be swelling of the jaw with suppuration, Silicea is the appropriate remedy. During the inflammatory stage, the remedies may be given every hour, gradually coming to two or three hours interval. When Silicea or Calcarea, three pills night and morning. Mumps, or Parotitis. 53. Mercurius is the principal remedy, and often the onl}' one required ; two or three doses in most cases will effect a cure. A dose of four pills every night until four doses are taken. When it has an erj'sipelatous appearance, 412 Woman's Medical Companion, or affects the brain. Belladonna or Hyoscyamus^ three globules everj' houi\ Should it suddenly disappear and affect the ovaries, Pulsatilla, same quantity, every two or three hours, will prove beneficial. Injflainiiiatioii and Swelling- of the Tongue, Glossitis. 54:. Aconite should be administered at the commence- ment, followed hy Mercuriiis and Belladonna in alternation, at intervals of from one to four hours, according to ch'cum- stances. Dose, four globules, dr}*, upon the tongue. Dentition, or Teething. 55. Aconite, Belladonna, or Chamomilla, for the ordi- nary nervous derangements ; Cina, when attended TNith cough; Coffea, for fever; Ignatia, for thi'eatened convul- sions ; Sulpliur, Magnesia Calc, ov Mercurius, for diarrhoea ; Ipecacuanha, when nausea and vomiting are combined with diarrhoea ; 2su:c Vomica, in alternation with Bryonia, for obstinate constipation; Calcarea Carh., to hasten the pro- cess of dentition. Three pills, dry, to the dose, every one, two, thi'ee, or foiu' hom's, according to ckcumstances. Toothache, or Odontalgia. 56. For feverishness, violent pain, congestion, and heat, Aconite, followed b}* Belladonna or CliamomiUa . T\'heu the pain arises from mechanical injury, as extraction or plug- ging, Arnica. For hollow or decayed teeth, Antimonium crude. For drawing, jerking pain. Belladonna, Bryonia, or Chamomilla. TThen gums are swollen or congested, Kreosotuni and Mercurius. For toothache in i)regnanc3"', Xux Moschata or Nux Vomica. Pulsatilla is most suitable Appendix. 413 for 3'oiiiig* girls or children, and Sulphur for tearing and pulsa- tive pain in carious teeth. Twelve globules in twelve tea- spoonfuls of water, a teaspoonful at a dose, at intervals of fifteen minutes, one hour, or two hours, according to severity of pain. Sore Throat, or Quinsy. 57. Aconite and Belladonna in the first stages will generally efi'ect a cure. In the sore throat of scarlet-fever, Belladonna or Mercurius, Bryonia or Chamomilla, when resulting from cold. In dryness jind extensive swelling, Lachesis. For women and 3^oung persons, Pulsatilla and Ehus, in ordinary cases, and Sulphur and Silicea in pro- longed and severe cases. The doses, either dry, or in solu- tion (three globules at a time) , may be given at intervals of one, two, or three hours, according to urgency of symptoms. Lengthen the intervals as the severit}^ subsides. Malignant, or Putrid Sore Throat. 58. If there be inflammatory fever, a few doses of Aco- nite should be given, followed by Belladonna and Mercurius in alternation. If the ulcers increase in size, and become painful. Nitric Acid. For gangrenous sore throat, Arseni- cum. Dose, same as in No. 56, every hour at commence- ment, gi'aduaUy increasing the interval as improvement takes place. Tonsillitis. — Inflammation of the Tonsils. 59. Belladonna, Causticum, Graphites, Lachesis, or Sul- phur, in doses of three globules, every other night, for about six weeks, will usually eradicate the affection. 414 Woman^s Medical Companion, Falling- of the Palate. 60. Nux Vomicci (three globules every two hours) -will usually prove efficacious. Should it fail, Mercurius^ Bella- donna^ or Sulphur will doubtless result successfully. Diphtheria. 61. Aconite at the commencement of an attack, in alter- nation with Bryonia^ especiall}^ if there is considerable fever ; Belladonna when the inflammation is of a bright scarlet, and extends uniformly over the entire mucous membrane ; Rhus tax. when it is of a dark -red color ; Arsenicum in aggravated conditions ; and Kali-chlor, in extreme depression and sep- tic tendencies. Dissolve twelve globules in six teaspoonfuls of water ; one teaspoonful every six hours. Pyrosis, Heartburn, Water-Brash, Sour Stomach. 62. For water-brash, Nux Vomica, Pulsatilla, Silicea, Chamomilla. For heartburn, Arsenicum, China, Sepia, Sulphur. For flatulence. Graphites, Phosphorus, Pulsa- tilla, Carbo-veg. For sour stomach, Chamomilla, Pulsa- tilla, Phosphorus, Sulphur. Twelve globules, dissolved in twelve teaspoonfuls of water ; one teaspoonful ever}^ hour, for children. An adult may take six or eight globules every hour. Nausea, Vomiting-, and Regurgitation of Milk. 63. Ipecacuanha is generally the only remedy required. If much flatulence, Pulsatilla and Antimonium crude, in alternation. T\Tien attended with diarrhoea or convulsions, Chamomilla. In cases accompanied by vomiting and con- Appendix. 415 stipation, Nux Vomica and Bryonia, in alternation. Chronic cases of long standing require Calcao-ea or Sulphur. For vomiting caused by "worms, Cina, Mercurius, or Ferrum. Three globules at a dose, or a teaspoonful of solution (as in No. 62) every four hours, for an infant. In severe cases of vomiting repeat the dose every fifteen minutes or half- hour. Biliousness. 64. When accompanied by chilliness, fever, headache, etc., use Bryonia. If caused by eating fat or greasy sub- stances, and accompanied with offensive eructations, Pulsa- tilla. For ordinary cases. Ipecacuanha and Mercwius y^ill effect a cure. Dose, six globules every one or two hours. OflPensive Breath. 65. If only in the morning. Belladonna, Nux Vomica, or Sulphur. If at morning and night, Pulsatilla. If after a meal, Sulphur or Chamomilla. If in young girls at the age of puberty, Aurum, Pulsatilla , Belladonna, Sepia. If caused b}^ worms, Cina or Sulphur. If caused by salivation with calomel, Carbo-veg., Hepar Sulph., Nitric Acid. One dose ma}' be given ever^^ night and morning, either dr^^, or dis- solved (as in No. 62). Dose, if dry, six or eight pills. Colic. 66. Spasmodic Coi^ic, Colo cy nth, Chamomilla, Belladonna, or Nux Vomica, five or six pills every few minutes. Bilious Colic, Nux Vomica, Colocynth, Mercurius, Pulsatilla, Chamomilla, and Plumbum, every five or ten minutes. The Colic of Infants, Chamomilla will answer in ordinary cases. If there is nausea, vomiting, and diarrhoea, Pulsa- 416 Woman's Medical Companion. tilla. If the evacuations are fermented, and have a putiid o^or^ Ipecacuanha, If constipated, iV"'wa;Fo??uca. If caused by excitement on the x^art of the mother, Ignatia. Colic caused by worms, Cina^ Sulphur, or Jle'rcurius. For Cohc in Pregnant ~Women, Chamoinilla, Xux Vomica, Pulsatilla. For Menstrual Cohc, Pulsatilla, Coffea, Belladonna, Coc- culus. Dose for infants, two or three globules, dry, upon the tongue ; for adults and older childi*en, fiA'e or six pills every fifteen or thii'ty minutes, houi', or two hours, accord- ing to the severity of the case. Cholera Morbus. 67. If the attack be Induced by excitement, and there are severe pains and cramps, Chamomilla. When vomiting predominates, with severe pains in the abdomen, Ipecacu- anha and Veratrum, in alternation. For "violent cramps and constrictions, or cutting pains, Colocynth. In cases of rapid prostration, Arsenicum. In most cases, even the most severe, Veratrurn, will prove an almost certain cui'e. Cuprum,, when there are severe spasms of the hmbs ; and Cinchona, for the debility which invariably accompanies the disease. Dose, six pills every few minutes. Cholera Infantum. 68. Ipecacuanha is usually the only remedy required. When mucus or sour vomiting occurs, with gi'een and slimy evacuations and colick}"- pains, use ChcLmornilla, especially during dentition. "VMien the diarrhoea is chronic, Magnesia carb. Should the evacuations be light-colored, offensive, and froth}', the chikl moan and toss in its sleep, and have cramp-like pains in the abdomen, use Podox)hyllum . If accompanied with colic and straining, the stools shmy and 'ix, 417 mixed with blood, Mercurius. For diarrhoea immediately after eating, and loss of appetite, give Cinchona. In ex- treme cases, with great prostration, nausea, and vomiting, Arsenicum. Sulphur is a valuable remed}^ for protracted cases. If head symptoms manifest themselves, give Aco- nite^ Bryonia^ or Hellehorus. Doses, same as in No. 62, repeated every fifteen or thirty minutes, until the severe sj^mptoms have subsided, after which lengthen the intervals. Dyspepsia, or Indigestion. 69. Dyspepsia of Adults. — Arnica., when caused by a fall, blow upon the stomach, or lifting heavy weights ; Aconite^ when considerable fever, thkst, and nausea ; Anti- monium crudum, when from an overloading of the stomach ; Belladonna, in painful distention of the abdomen; Arseni- cum, in curious chronic cases ; Bryonia, Cepa, Carbo veg., Calcarea carb., Chamomilla, China, and Hepar Sulph., are, given in other comphcations of the disorder. For Dis- PEPSiA IN Children, Ipecacuanha is the chief remedy, as it generall}" arises from imperfect mastication, or improper food. Either for Children or Adults, Lachesis, Mercurius, Nux Vomica, Pulsatilla, Phosphorus, Sepia, Sulphur, and Veratrum, are singularly efiectual in severe cases of dis- peptic derangement, according to the predominating symp- toms. For recent attacks, there should be intervals of half an hour, until relief is attained, gradually lengthening until one to three hours apart. In chronic cases, doses three times per day ; adults, ten globules at a dose ; an infant, two globules. Constipation. 70. Nux Vomica or Bryonia, with Opium in alternation, for irritabilit}", distention, loss of appetite, and tendency to 418 Woman's Medical Companion. vomit ; Platinum and Magnesia mur., with occasional dose of Lycopodium, when there is impaction of faeces, shudder- ing after evacuation, severe bearing-down, or inability to pass the fasces. Sulphur and Plumbum, for obstinate con- stipation, accompanied by piles. For constipation of preg- nant women, JSfux Vomica, Opium, and Sepia; for lying-in women, Bryonia and Nux Vomica; for nursing infants, Bryonia, Nux Vomica, Opium, and Sulphur. Dose, for adults, six pills once in four hours ; for infants, two or three pills. Diarrhoea, 71. When arising from cold, and without pain. Dulca- mara; for froth}^, fermented evacuations, offensive, with pain in rectum, Ipecacuanha; also for nursing infants, when caused by overloaded stomach, offensive, tinged with blood, accompanied with nausea and vomiting. For infants, where evacuations are slimj^, green, or yellowish, the child draw- ing up its legs, fretting, worr3'ing, and wanting to be car- ried all the time. For the diarrhoea of teething, Nux Vomica. Dose, three or four pills drj upon the tongue, every half-hour, hour, or two or three hours, according to the severity of the pain. For adults, six pills, at similar intervals. Dysentery. 72. Aconite, for ordinary or inflammator}^ dysenter}^ ; Ar- senicum, in severe cases ; Belladonna, in severe pain and tenderness ; Chamomilla, for thirst, headache, fever, and nausea ; and Colocynth, for extreme pain, slim}^, and bloody discharges ; Podophyllum, for cramp-like pains, moaning, rolling of the eyes, etc. Mercurius, Nux Vomica, and Sulphur are exceedingly valuable and effective remedies. Appendix, 419 Dose, ill solution, twelve globules, in twelve teaspoonfuls of water, every half-hour or hour, until rehef is obtained. Prolapsus Ani, or Falling of the Body. 73. Ignatia and Sulphur are the principal remedies, the latter in alternation with Nux Vomica; Calcarea, and Mercurius are also very efficacious. Thi'ee globules every twelve hours. Rupture, or Hernia. 74. JSfux Vomica or Sulphuric Acid. Three globules every evening for about a week. Jaundice, or Icterus. 75. Mercurius and Cinchona in alternation, six pills once in four hours. Nux Vomica, Sulphur or Lachesis, when accompanied by constipation or diarrhoea, or both. One dose of six pills every night and morning. Jaundice of Infants. 76. Chamomilla, China, or Nux Vomica. One or two pills every four hours. Worms. 77. Aconite, Cina, or JSFux Vomica, are the chief remedies ; when complicated with colic, Spigelia; with scrofulous erup- tions, Silicea; Lycopodium, Sulphur, and Teucrium, are each of them almost specific for the affection. Dose, three or four drops of the tincture in a tumbler half full of water, giving a large teaspoonful three times per da}- for two, thi-ee, or four days. 420 Woman's Medical Companion, Epidemic Cholera. 78. Preventive Treatment : Cuprum and Veratrum alternatel}^ for every six or seven da3^s. Dose, same as No.l 72. Curative TreatjVient : Camphor, Dose, same as No. l 72, after each evacuation ; for violent vomiting and purging,! Veratrum; for intolerable burning in the bowels, Arseniaim,\ Same dose repeated every- five minutes. Cuprum ton: tlcq- ^ water discharges. Carho-veg. for the state of collapse.' Secale Cornutum^ when the patient is aged. Scarlet-Fever. 79. Belladonna and Cuprum are specifics for this dis- I' ease in its various phases. Aconite^ Mercurius^ Arsenicum^ ^ or Opium may be found very useful. In malignant cases, Crotalus^ Phosp>horiG Acid, Lachesis, or Nitric Acid; and in the after aflfections, Sulphur, Rhus, Digitalis, Pulsatilla, or 'f Lycopodium will afford relief. Dose, two drops, or twelve j globules, in twelve teaspoonfuls of water, a teaspoonful j every half-hour, hour, or two houi's, according to severity of the s}Tnptoms. I, \ Scarlet-Rash. f rl 80. Aconite, in alternation with Coffea, is the only remedy necessary in ordinary cases. Exceptionall}', Belladonna, Ipecacuanha, Pulsatilla, or ^ryoma are called for. Dose, as | in No. 79, everj^ two hours. Measles. ' -| 81. Aconite is generally suflicient, but, in the subsequent complications. Belladonna, Pulsatilla, Ipecacuanha, Bryonia, Euphrasia, and Bhus will prove efficacious. Dose, as in No. 79. Appendix. 421 Nettie-Rash, Hives, Urticaria. 82. Aconite, Pulsatilla, Nux Vomica, Dulcamara, and Rhus, but especially Ledum Palustre, which will cure all ordiuaiy cases. Dose, five globules, dry, every three hours. In severe cases, dose same as No. 79. Erysipelas, St. Anthony's Fire. 83. Aconite when there is high inflamniator}' fever; Belladonna is especially valuable for erj^sipelas of the face, with delhium, swollen eyes, great thirst, and dr}' skin ; Lachesis when the entire face and glands are involved ; Arsenicum when the eruption is of a dark color, and there is gi'eat prostration ; Pidsatilla and Graphites when the eruption changes from one locahty to another ; Mercurius and Hepar Sulph. when it terminates in abscesses. Dose, as in No. 79, every two or three hours. Itch, Psora, Scabies. 84. Sulphur ointment is the only specific remedy for this disease. An occasional dose of Mercurius or Causticum, three globules every four hom's, will sometimes prove beneficial. Itching of the Skin. 85. Drosera, Sidphur, or Lycopodium (same dose as No. 84) will efiectually reheve this sjTnptom, for it can scarcely be called a disease. Herpes, or Tetter; Zoster, or Shingles; Circinatus, or Ringworm. 8 6 . Eingworm will generall}' peld to Sepia , three globules every night for three nights, then omit for three da3^s, and 422 Woman's Medical Companion repeat, and so on until cured. Bhus^ Calcarea^ Graphites^ or Sulphur may sometimes be found necessary. For Shingles, give Aconite or Tartar Emetic, Prickly-Heat. 87. Aconite and Chamomilla will usually afford relief, j though Mhus, Arsenicum, and Sulphur are sometimes called' for. Dose, same as No. 79, every two hours. Strophulus, Red-Gum, White-Gum, Tooth-Rash, 88. Coffea, Chamomilla^ Aconite, or Belladonna may be j given, in similar doses to No. 79, when there is great rest-] lessness. Chicken-Pox. j 89. Aconite and Belladonna are generally all that is re- quired ; Pulsatilla will considerably shorten, if not entirely prevent, the disease. Dose, same as in No. 79. Variola and Varioloid, 90. In the first stage, Aconite, Belladonna, Bryonia, Rhus, and Tartar Emetic. In the second, or eruptive stage, Tartar Emetic, Thuja, and Stramonium. The third, ' or suppurative stage, requires Mercurius, Arsenicum, Muri- atic Acid, Opium, or China, according to S3^mptoms. The fourth, or desquamative stage, requires only Sulphur, Dose, three globules every morning. Intertrigo, Excoriations. 91. Chamomilla, Ignatia, Pulsatilla, or Sulphur, accord- ing to the circumstances, will generally prove effective. Appendix. 423 Dose, three globules, night and morning. If fever exists give Aconite. In obstinate cases, Sepia ^ Graphites^ Sul- phuric Acid, or Silicea. Pimples on Face, Acne Punctata, Comedones, 92. The remedies suitable for this disease are Belladonna, Calcorea, Sulphur^ and Nux Vomica. Six globules in twelve teaspoonfuls of water ; one teaspoonful every six hours. Abscesses. 93. Mercurius, Hepar Sulph., Silicea, Calcarea, Lachesis, Phosphorus, and Sulphur are suitable remedies, according to the cause and stage of the disease. Dose, same as No. 92, every four hours. Boils. 94. Arnica to lessen pain ; Belladonna and Mercurius for fever and headache ; Sulphur as a preventive. Twelve globules in twelve teaspoonfuls of water ; a spoonful every three or four hours. Scald Head, Tinea Capitis, Favus. 95. Calcarea carb., Sulphur, Lycopodium, Sepia, Arsenic cum, and Rhus, are the prominent remedies for this disease. Dose as in No. 94. Crustea Lactea, Milk-Crust, or Impetigo. 96. Aconite, either alone or in alternation with Chamo- milla, once in two hours, is the best remed}^, though circum- stances sometimes necessitate the use of Rhus, Viola tri- color, and Sulphur. Nothing should be apphed externally but a little Glycerine. Dose as in No. 94. 424 Woman's Medical Companiort, Inflammation of the Brain. 97. Aconite at the commencement of the attack. Bella- donna is the most important and effective remedy, and in alternation with Aconite, Stramonium, or Hyoscyamus, is often attended with the happiest results. In very severe cases, where the head sjTuptoms are the result of some other disease, Helleborus, Bryonia, Zincum, and Opium will be called for. Dose, twelve globules in twelve tea- spoonfuls of water ; one spoonful every one or two hours. Convulsions. 98. K from indigestion, Nux Vomica, Pulsatilla, Vera- trum, or Aconite, If from teething, Belladonna, Goffea, Chamomilla, or Ignatia. If caused by worms, Cina, Mercurius, or Hyoscyamus. If the result of repelled eruptions, Tartar Emetic, Belladonna, Stramonium, Sul- phur, or Bryonia. If from fright, Hyoscyamus, Coffea, Ignatia^ or Stramonium. If from mechanical injuries, Arnica. Dose, same as in No. 97, every ten, fifteen, or- twenty muiutes, until improvement takes place, when the intervals should be lengthened. Chorea, or St. Vitus's Dance. 99. Belladonna, Cocculus, Colchicum, Pulsatilla, Nux Vomica, and Sulphur. Dose, same as No. 97, three times per da3\ Headache. 100. Nervous or Neuralgic, Aconite, Belladonna, Coffea, Nux Vomica, Ignatia, and Pulsatilla, according to circum- stances. If from suppression of menstruation, Bryonia, I Appendix. 425 NiLX MoscJiata, or Chamomilla. If accompanied by irrita- bility and h3'steria, Mercurius^ Platina^ or Hepar Sulpli. In stubborn, chronic cases, China, ColocyntJi, Arsenicum, Veratrum, Silicea, or Sulphur, according to accompanying symptoms ; Sulphur, especially, in cases of nausea. Sick or bilious headache, Belladonna, Sanguinaria, Ipecac, Pul- satilla, or Spigelia. Dose, same as No. 97, if in solution ; if dry, three or four globules, to be repeated every half-hour, one, two, three, or six hours, according to severity, until rehef is obtained. Congestive headache. Aconite, Bella- donna, Bryonia, Rhus, Glonoine, or Pulsatilla, in same doses. Rheumatic headache, Chamomilla, Ignatia, Ipecac, or Colocynth, especially the latter. Catarrhal headache, Hepar Sulph., Euphrasia, Arsenicum, or Aconite. If from constipation, Bryonia^ Opium, and Lycopodium, Neuralgia. 101. Aconite, Belladonna, Bryonia, China, Platinum, Spigelia, Staphysagria, or Kalmia, according to locality and severity of pain. Dose, same as No. 97, repeated every quarter or half hour, hour or two hours, according to ur- gency of case, lengthening the intervals as the symptoms amehorate. Hysteria. 102. Cocculus, Cuprum, Coffea, Ignatia, Lachesis, Co- nium, Natrum, or Veratrum, according to origin and inten- sity of affection, in same dose as in Neuralgia. Sore Eyes of Young Infants. 103. Aconite, Belladonna, Chamomilla, Euphrasia, Rhus, or Sulphur, according to symptoms. One globule every three hours. 426 Woman's Medical Companion. Sty on the Eyelid. 104. Staphysagria or Silicea, three or four globules every four hours. Squinting" — Strabismus . 105. Hyoscyamus and Belladonna, in same dose as 97, every three hours, for two or three days, then discontinue for some length of time, and proceed as before. Inflammation of Ear. 106. Pulsatilla, Belladonna, or Aconite, in same dose as 97, every half hour or hour, according to severity. Earache. I I 107. Chamomilla, Pulsatilla, Belladonna, Rhus, or Sul- phur, according to the cause of the affection. Dose, as in 97, every fifteen minutes, until better. Running of the Ear. 108. Pulsatilla, Lycopodium, Belladonna, Lachesis, Cal- carea, or Sulphur, in accordance with symptoms. Dose, as in 97, every four hom's, for six days. Bleeding from the Nose — Epistaxis. 109. When from a fall. Arnica; when from determina- tion of blood to the head. Aconite, Belladonna, or Bryonia; when from over-exertion, Rhus; when from worms, Cina and Mercurius. Dose, same as 97, every ten or fifteen minutes, in profuse hemorrhage. "When only periodical, every hour or two hours. Appendix, 427 Wetting the Bed. 110. Pulsatilla, Nilx Vomica, Belladonna, Sulphur, Silicea, or Causticum. Dose, three to six pills, every four houi's, according to age of patient. Retention of Urine in Infants. 111. Aconite, Pulsatilla, or Ipecacuanha, two globules every two hours. If in an older child, same dose as in 97. Burns and Scalds. 112. Linseed and Lime-ivater, or a solution of Oanthari- des, ten drops to a half tumbler of water, applied by dip- ping linen cloths into the solution and placing theni, on the burnt surface. Arnica and Tincture of Urtica Urens are exceedingly eflBicacious remedies. To promote healing, use Creosote-water ; if erysipelatous inflammation is tlireatened, Belladonna or Phus internally. For the accompanying fever. Aconite; for pain and restlessness, Carbo-veg. and Coffea. If there is ulceration, Causticum, in water, exter- nally. Sulphur or Silicea, internally, one dose every six houi's. Concussion of the Brain. 113. Arnica is the usual remedy. Where inflammation is imminent Aconite and Belladonna in alternation. Dose, as in 97, every hour. Sprains. 114. Externally, Tincture of Arnica, Internally, Phus or Bryonia, once in two hours. If there is sickness of the stomach, Pulsatilla. 428 Woman^s Medical Companion. Wounds, 115. Superficial Wounds, Staphysagria^ externally. Contused Wounds, Arnica or Hypericum per. internally. ITepar Sulph. during the suppurative process. Bruises al^out the eye should be kept constantly wet with a solution of Arnica. Lacerated Wounds should be dressed with a solution of Calendula in cold water. If there is inflamma- tion and fever, Belladonna or Hhus, and an occasional dose of Aconite. Punctured Wounds only require an applica- tion of Canada Balsam. Poisoned Wounds, — Externally, a solution of Arnica; internally. Aconite or Apis. For mosquito-bites, Spirits of CampJior or Lemon-juice, II. ALLOPATHIC AND ECLECTIC REMEDIES. 116. For Acidity of Stomach. Liquor Potassa . . . 20 minims. Chalk Mixture 1 oz. Tincture of Colombo 1 drachm. Make a draught. 117. Alterative. Nitric Acid, diluted .... ^ drachm. H3^drochloric Acid, diluted 1 " Spirit. CEther. Nitrici J- oz. Sj^rup of Sarsaparilla 1 " Water, pure . 6^ " Two spoonfuls three times a day. ii Appendix. 429 118. Amenorrhoea, or Suppression of Menses. Powdered Aloes ..... 3 grains. Powdered Tartrate of Antimony Cocoa Butter .... 1 grain. 2 drachms. 119. Compound Aloes, pill, Compound Iron, pill Oil of Savin, | Oil of Rue, j Powdered Capsicum . ,"•} of each of each 1 drachm. 3 drops. 8 grains. Divided into 24 pills. One pill three times per day. 120. Liquor of Ammonia ..... Cow's Milk An Injection — 1 oz. to be injected daily. 3 scruples, 4 oz. Anti-spasmodic. 121. Camphor, "j Sesquicarbonate of Ammonia, J Ipecacuanha Powder Extract H3'osc3'amus of each 3 grams. 1 gTain. 4 srrains. Mucilage sufficient to form three pills. Dose, one or two. 122. Ascites, or Swelling of the Abdomen. Gamboge ....... 2 scruples. Tartrate of Potash . . . . . 1 oz. White Sugar 2 drachms. Water 6 oz. A tablespoonful every two or three hours. 430 Woman's Medical Companioit, 123. Asthma. Socotrine Aloes 16 grains. Mastick Eoot Powder . . . . 8 " Ext. Gentian, Compound Galbanum Pill, Oil of Anise sufficient. Make into twelve pills. Take three every day on going to sleep. >ill, [ of each . 124. Decoction of Aloes . . « . « 6^ oz. Compound Tinct. of Senna . ' . » 1 " Tinct. of Squills 3 drachms. ' Three table-spoonfuls to be taken occasionally. 125. Spasmodic Asthma. Sesquicarbonate of Ammonia Rue Water ..... SjTup of Poppies .... A spoonful every ten minutes. 1 drachm. 9 oz. 1 *' 126. Ext. Hyoscyamus Tinct. Squills . Nitric Acid Water Make a draught, repeated every three hours. 4 grains. 10 minims. 6 " 10 drachms. I Appendix. 431 127. Aatringenta. Decoction of Oak Bark Powdered Nut-galls . Tinct. Catechu .... Tinct. Cardamoms (Compound) SjTup of Orange A di'aught to be taken twice a day 128. Outside Oak Bark, bruised Aquafortis .... Macerate for three, hours and strain Powdered Gall-nuts . Tinct. Cardamoms (Compound) A wineglass full for a dose. IJ oz. 10 grains. ^ drachm. 1 '' 1 " 11 oz. 1 pint. Q ; then add 2 drachms 2 oz. 129. Brain Diseases. — Hydrocephalus. Tinct. Digitalis 1 oz. S}Tup of Squills 1 '' Ten di'ops for a child seven years old every four hours. 130. Infusion of Digitalis . . . . Acetate of Potash Sweet Spiiits of Nitre . . . • Cinnamon Water . . . . . A table-spoonful every four or five hours. 4 oz. 2 drachms. 2 *' IJoz. 131. Iodide of Potassium .... 1 drachm. Water ....... \ oz. Thirty di'ops to a child seven years old, every hour. 432 Woman's Medical Compaction. 132. Pulv. Gamboge Pulv. Scammony Elaterium Croton Oil Ext. Stramonium Make twelve x)iUs. operates. Brain Fever. 12 grains. 12 " 2 " 8 drops. 3 grains. One pill repeated every hour until it 133. Pulv. Scammony Pulv. Gamboge Pulv. Colocynth Castile Soap Oil of Anise Make twelve piUs. till it operates. 12 grains. 12 " 8 " 4 " 5 drops. One pill repeated every three hours 134. Powdered Antimony . , • . . 4 grains. Camphor Scrap'ings 4 '' Extract of Hyoscyamus . . . . 6 " Syrup of Poppies . . . . . sufficient. Three pills, to be taken just before bedtime. Inflammation of Brain. 135. Sulphuric Ether, Liquor of Acetate of Ammonia, Rectified Spirits of Wine, Rose Water An evaporating lotion. of each IJoz. 3i" Appendix, 433 136. Hard and Inflamed Breasts. Liquor of Acetate of Ammouia Rectified Spirit Make a lotion. 6oz. 2 " 137. Painful Affections of Breast. Chlorinated Ether DistUled Water Make a lotion. 8 drachms. 1 pint. 138. For Gathered Breasts. Fresh Tobacco Leaves, sliced ... 10 oz. Diluted Acetic Acid 4 pints. Boil the tobacco in the acid, strain, and evaporate the decoction to six ounces. Add this to thii'teen ounces Ba- sihcon Ointment, heated, and stir till cold. 139. Bronchitis. Tartar Emetic .... Boiling Water .... One teaspoonful every two hours. 1 grain. 10 drachms. 140. Tincture Blood-root . 1 oz. Sulphate of Morphia IJ grains. Tinct. Digitalis I oz. Wine of Antimony . . . h " Oil of Wintergreen . 10 drops. Dose, from twenty to forty drops twice or three times a day. 434 Woma7i's Medical Companion. 141. Syi'up of Tola ..... 1 oz. Sji-up of Squills .... • ^ " Wine of Ipecac .... 2 drachms. Paregoric 3 " Mucilage of Gum Arabic . 11 oz. Take a teaspoonful occasionally. 142. Carbonate of Soda . 1 drachm Wine of Ipecacuanha ^ oz. Tinctui-e of Opium . 1 drachm Sjrup of Tolu .... 2 oz. Water . . U " Half an ounce for a dose. 143. Powdered Tragacanth Lime Water Pure Glycerine Rose Water Make a liniment. Bums. 2 drachms. 3 oz. 1 " 3 '' 144. Extensive Burns. Liquor Diacetate of Lead, \ Olive Oil, Rose Water Make a liniment. each . 1 oz. 4 " Appendix, 435 145. Canker of the Mouth, Ulcerated Throaty etc. Infusion of Cinchona . . . . 3 oz. Chlorinate of Soda in solution . » » 1 " Make a mouth- wash. 146. Sulphate of Copper . Ox3TQel . . » = . Apply with a camel-hair brush. 5 grains. Joz. 147. In Catarrhal Affections. Leaves of the Red Poppy Flower . . 2 oz. Sulphuric Acid, diluted . . . . 15 drops. Sugar ....... 2 oz. Decoction of Barlej^ ..... 1 pint. Infuse and strain. Drink freely, as often as you desire. 148. Muriate of Ammonia Gum Arabic Infusion of Chamomile Antimony Wine Ext. Liquorice 15 grains. \ drachm. 3oz. 1 drachm. 2 drachms. Half a spoonful every two hours, to a child 5 or 6 years old. of each 149. Muriate of Ammonia, Extract Liquorice, Decoction of Marsh Mallow Ox^Tnel of Squills ..... Two table-spoonsfuls three times per day. 1 drachm. 6 oz. 1 '' 436 Woman's Medical Companion. 150. Common Catarrh. of each Acetate of Ammonia, Liquor, ") Camphor Mixture, j Syrup of Poppies Antimony Wine (Tartrate of Potash) . A draught to be taken before going to bed. 6 drachms. 1 drachm. 20 minims. 151. Cathartic. Magnesia, ") Supertartrate of Potash, Flour of Sulphur, \ of each 6 grains. Powdered Rhubarb Root, Powdered Chamomile Flowers, ^ Orange SjTup . . . . 3 drachms, Oil of Pimento . . . . • . 2 minims. Make an electuary for a dose. 152. Cerebral Affections. Boracic Acid 1 drachm. Camphor Mixture . . . 4 oz. Orange Syrup . . . . . 1 " Two teaspoonfuls every two or three hours. 153. Camphor-powder 3 grains. James's powder 4 '' Nitrate of Potash J scruple. Extract of Hyoscyamus .... 7 grains. Conserve of Roses, sufficient to make a bolus. Appendix, 437 154. Laxative in Change of Life. Sulphuric Sublimate 1 oz. Bicarbonate of Soda ..... 1 drachm. Powdered Ipecacuanha .... 5 grains. From 1 to 2 scruples, in milk, at bedtime. 155. A Valuable Liniment for Chilblains. Sulphuric Acid 1 drachm. Spu'its Turpentine . . . . . 1 " Olive Oil 3 *' Mix the Oil and Turpentine first, gradually adding the Sulphm-ic Acid. To be rubbed on two or three times a day. 156. Chlorosis, Aneemia, etc. Decoction of Aloes 2 oz. Syrup of Crocus, Kf^^^^ ... 1 « S3TUP of Rhubarb, j Make a mixtm-e, to be taken in two doses. 157. Iron Filings 1 drachm. Ext. Absinthe, sufficient to make into 4-grain pills. One to four, night and morning. 158. Pulverized Iron, with Sesquioxide of Iron. ^ oz. Nitrate of Bismuth 5 drachms. Extract of Opium, diluted . . . . 3 grains. S}Tup and Gum Acacia, sufficient to mix and di\dde into one hundred and twenty-five pills. From one to ten daily, duiing meals. 438 Woman's Medical Companion, 159. Sesqiiioxicle of Iron Valerian powder ..... S^Tup of Ginger, sufficient to form a bolus. I" scruple. 160. Cholera Infantum. Sub-muriate of Mercur3- .... 2 grains. Acetate of Lead . . . . . 1 grain. Divide into four powders. One every three hours. 161. Sulphate of Iron .... Sulphuric Acid, diluted White Sugar ..... Water ...... One oz. three or four times per day. 2 grains. 10 drops. 1 drachm. 1 oz. 162. Cholera. Assafoetida, "\ Powdered Opium, )- of each . . . 1^ grains. Black Pepper, J Make a pill — to be bruised and taken in a glass of brandy and water everj^ half or three-quarters of an hom\ 163. Potassio-tartrate of Antimony ... 2 grains. Sulphate of Magnesia . . . . ^ oz. Water 10 " For an adult, a table-spoonful ; for a two-year old child, a teaspoonful every half hour. Appendix. 439 164. Puly. Camphor. Pulv. Opium Puly. Cayenne . Make sixteen pills. One eyeiy hour. ^drachm. 16 gi'ains. J drachm. 165. Puly. Senna Bicarbonate of Potassa Puly. Cayenne . Puly. Jalap Diyide into twelye parts, until it operates. Chorea, Epilepsy, etc. . . . . 2 drachms. 2oz. 10 grains. 1 drachm. One part every fom' hours 166. Leptandrin Podophyllin Scutillaria Puly. Ca3'enne . Puly. Loaf Sugar Rub well together, the aboye. 1 drachm. 1 scruple. 2 drachms. 1 scruple. 4oz. Dose for an adult, one-sixteenth of 167. Ext. Skullcap . Ext. Boneset . Ext. Chamomile Quinine Pulv. Caj^enne . Oil of Valerian . Beat well together and make ninet}^ pills two or three hours. 2 drachms. 1 drachm. 2 drachms. 1 drachm. 1 scruple. ^ drachm. One pill everj' 440 Woman's Medical Companion, 168. Cough. Mtrous Ether, Spirit, | ^^ ^^^^ Sp'up of Tolii, 3 A teaspoonful when troublesome. 1 oz. 169. Cougha of Children, -without Inflammation. Liquor of Onions ..... 1 oz. Sugar 1|- " Make into s}Tup — a teas^DOonful occasionally. 170. Alum ...... 24 grains. Sulphuric Acid, diluted 12 minims. Syrup of Red Poppy .... 4 drachms Water ^ oz. Take thi'ee di'achrris every six hours. 171. Bicarbonate of Potassa 15 gi-ains. Cochineal ...... 8 " Distilled Water 6 oz. Rub up together, sti'ain, and add Hydrocyanic Acid, diluted 10 minims A teaspoonful to be taken when the cough is troublesome. 172. Cough of Consumption. Mixture Acacia 1 oz. Distilled Water 6^ '' S^Tup Tolu i oz. Hj'drocyanic Acid, diluted . . .12 drops. A table-spoonful every thi'ee houi's. Appendix, 441 Cough of Measles. of each 2 oz. 1 " 173. Oil of Almonds Syrup of Poppies S^Tup of Tolii, Powdered Sugar • . . . . 2 drachms. Make a thick s}Tup, of which the patient may partake freel}" when the cough is troublesome. 174. Croupy Cough. Hydroc3'anic Acid diluted ; . . . 5 minims. Rose Water . , . . . . 5 oz. Poppy Seed ...... 3 drachms. A teaspoonful every two or or three hours. 4 oz. 2 scruples. 1 oz. 175, Croup. Decoction of Seneka root . o . . Antimony Wine ..... Syrup of Marsh Mallow .... A teaspoonful frequently. 176. Decoction of Seneka root . . . . 5 oz. Carbonate of Ammonia . , , . 8 grains. Tinct. of Squills 16 drops. S}Tup of Tolu 2 drachms. Three drachms in milk, every 4th hour, for children three or four 3^ears old. 177. Dover's Powders . . . . . 15 grains. Calomel 5 " Divide into ten powders. One every three hours for a child. 442 Woman's Medical Companion, 178. Condylomata or Fungous Grovrths. Pulverized Savin . ... Sulphate of Copper ..... To be sprinkled on the growths. 1 scruple, 1 '' 179. Constipation. Leptandrin 1 drachm. Podophj^llin 1 scruple. Apoc^^nin . 1 " Ext. Nux Vomica 6 grains. 'Castile Soap 1 drachm. Make thirty pills. One pill every night. 180. Compound Infusion of Senna . Tartrate' of Potassa . Carrawa}^ Water Manna . . . . . For a child, a table -spoonful. 4 oz. 2 drachms. 2 oz. 1 drachm. 181. For Indigestion, with Costiveness. Extract Aloes 1 scruple. Powdered Ipecacuanha .... 8 grains. Powdered Ginger ^ drachm. Syrup ....... sufficient. Make sixteen pills. One to be taken before dinner. 182. Aloes and MjTrh Pill .... 1 drachm. Compound Galbanum pill .... 2 drachms. Divide into forty pills. Two pills to be taken three times a day. Appendix. 443 183. Obstinate Costivenesa, Barbadoes Aloes ..... 24 grains. Sulphuric Acid ...... 6 drops. Divide into six pills. Two to be taken every four hours. 184. Infantile Convulsions. Oil of Anise ...... 4 drops. Wliite Sugar ...... \ scruple. Mix intimately, and add "Water . ... Powdered Rhubarb Carbonate of Magnesia .... Tinct. Opium ...... Sulphuret of Ammonia . . . . 10 A dessert-spoonful every third hour. 2 ounces. ^ scruiDle. 1 " 4 drops. 185. Crusta Lactea — Milk Crust. Sulphuret of Zinc ..... 2 drachms Decoction of Marsh Mallow 2 oz. Make a lotion. 186. Cutaneous Eruptions of Infancy and Childhood. Green Iodide of Mercur}^ .... 2 'grains. Mercur}^ with Prepared Chalk . . . 12 " Aromatic Powder . . . . . 9 " Divide into six powders. One every morning for a child two 3xars old. 187. Diabetes. Phosphoric Acid diluted . Decoction of Barle}^ .... To be used as an ordinary beverage. 1 drachm. 2 pints. 444 Woman's Medical Companion, 188. Sesquicarbonate of Ammonia ... ^ drachm« Sweet Spirit (Rum) . . . . .5 drachmSo Simple SjTup . . . . . . 5 " Water 3 oz. Half to be taken, morning and night. 189. Liq. Arsenite of Potassium . . .3 dracbms. Liq. Hj'drosulphate of Ammonia . . 20 minims. Tinct. Hyosc3^amu3 . . . » . 2 drachms. Infusion of Buchu . . . . . 8 oz. Take a table-spoonful every fourth hour. • 190. Diarrhoea. Pulverized Catechu 2 drachms. Bruised Cinnamon . . . . . ^drachm. Boiling Water . ' 5 oz. Steep in covered vessel for one hour and strain. A tea- spoonful every two, three, or four hours, according to age, etc.. 191. Tinct. Catechu . J oz. Laudanum 2 drachms. Spirits of Camphor . . . . 2 " Tinct. Myrrh . 2 " Tinct. Cayenne. 2 " From half a teaspoonful to a teaspoonful when required. Appendix. 445 192. S3TUP of Orange Peel . . . . 1 oz. Acetate of Morphia ..... 2 grains. Tinct. of Cinnamon ..... 6 drachms. Tinct. of Cardamoms . . . . 2 '' A teaspoonful ever}' one or two hours. 193. Diphtheria. Hydi'ochloric Acid and Honey in equal paxts. Touch the fauces with the mixture. 194. Powdered Alum ..... 2^ drachms. White Honey 10 " Half a spoonful every hour ; powdered alum or sulphur to be blown into the throat every four hours. 195. Iodide of Potassium ... . . . J drachm. Tincture of Orange . . . . . j- oz. S}Tup of Ginger . . . . . ^ " Pm-e Water 5 " A tablespoonful in equal quantity of water three times per day. 196. Dropsy. Tinct. Black Cohosh . . . . . 1 oz. Tinct. M}Trh 6 drachms. Laudanum ...... 1 drachm. Tinct. Caj^enne , . . . . 1 " Thirty or forty drops four times per day. 446 Woman's Medical Compajtiojt. each 197. Dysmenorrhoea. H^'dro chloric Acid, diluted. Nitric Acid, diluted, Tinct. Camphor (Compound) Tinct. Orange . . ... S3TUP of Sarsaparilla Rose Water ..... Take two teaspoonfuls twice a day. 198. H^'drochloric Acid, diluted, ") ^ , Nitric Acid, diluted, 3 Extract Dandelion Root Compound Infusion of Gentian . Two table-spoonfuls twice a day, before meals. 30 minims .1 4 drachms. I 1 drachm. 1 oz. 7 oz. '•} of each 199 Hydrochloric Acid, diluted. Nitric Acid, diluted, Infusion of Dandelion Root Infusion of Cinchona .... Two teaspoonfuls twice a day, before meals. 200. Dysentery. Infusion Cascarilla ..... Cinnamon Water ..... Compound Powder of Kino SjTup of Poppies • A draught to be taken twice a day. 201. Aromatic Confection .... Lime -Water ...... Carbonate of Magnesia .... Tinct. of Hops A di'aught, three times per day. 1 drachm. 1 oz. 7 oz. 6 drachms. 3 *' J- scruple. 1 drachm. 15 grains. 11 drachmi 6 grains 1 drachm Appendix, 447 202. Dyspepsia. Sweet Tincture of Rhubarb . . . 4 oz. Bicarbonate of Soda . . . . . 2 drachms. From a teaspoonful to a table-spoonful, as occasion may requii'e. 203. Pulv. Charcoal (Willow bark) . . . 1 J- drachms. Pulv. Rhubarb ...... 2 scruples. Pulv. Ipecac ...... 6 grains. Ext. Hj'oscj^amus . . . . . 12 " Divide into twelve portions. Give one every three or four hom's. 204. Pulverized Rhubarb 2 oz. Bicarbonate of Potassa . . . . 1 " Mix. Take sufficient to produce one movement of bowels per day. 205. Epilepsy. Ox-gall, ) Assafoetida, \^^ ^^^"^ .... 1 drachm. Powdered Rhubarb 1 scruple. Syrup, sufficient to make forty pills. Two, twice per day. 206. Erysipelas. Wine of Colchicum 30 minims. Sulphate of Magnesia .... 1|- drachms. Carbonate of Magnesia .... 1 scruple. Peppermint Water . . . . . 10 drachms. Make a draught. 448 Woman's Medical Companion, 207. Senna .... 3 drachms. Salts .... 2^ drachm. Manna I " Fennel Seed 1 Boiling Water . Ti/T „i._ —J ~j.. i— m 1 pint. ^—1 _ Xf 1 J.i Macerate and strain. Teacupful every four hours unti it operates. 208. Calcined Magnesia . Pulv. Rhubarb . Pulv. Ipecac One-fourth of this daily. 1 scruple. 1 " 1 grain. 209. Nitrate of Silver 2 scruples. Nitric Acid . . . . . . 12 drops. Soft Water 1 oz. Apply with a piece of lint tied to the end of a stick. 210. Fevers — Typhus, Typhoid, Malignant, etc. For Children. Hydrochloric Acid 1 drachm. Distilled Water 6 oz. Syrup of Mulberry 1 " A table-spoonful every four or five hours. Appendix. 449 211. For Adults. Muriatic or Hydrochloric Acid ... 1 drachni. Decoction of Barley . . . . . 1 pint. White Sugar . . . . . . ^ oz. Take from two to four ounces, twice or three times a day. 212. Nitric Acid, diluted . . . . . 1^ drachms. Water . . . . . . . 24 oz. Sugar . . . . . . . Ig- " Take three ounces three times per day, through a glass tube. 213. Mixt. Camphor . . . . . 10 drachms. Sulphuric Ether ..... 1 drachm. Aromatic Confection ..... 1 scruple. Compound Tinct. of Lavender . . . i ^z- In Sinking of Fevers. A draught, repeated every four hours, or oftener, if symptoms be urgent. 214. Flatulence ^vith Nausea. Angostura Bark, powdered, ] ^ ^ k^- ^ '^ ' V of each. . 5 grams. Rhubarb in powder, j To be taken an horn* before dinner. 215. Gout and Inveterate Rheumatism. Spirits of Hartshorn .... 4 drachms. Succinic Acid, sufficient to saturate Sulphuric Ether . . . . . 4 " Twent}^ to forty drops in a glass of sugar and water two or three times a day. 450 Woman's Medical Companion. 216. Headache. Sulphate of Iron .... 2 grains. Epsom Salts . . . 2 scruples. Diluted Sulphuric Acid 10 drops. Compound Tincture .... 1 drachm. Syrup of Poppies .... 11- drachms. Pimento Water .... 9 '' To be taken at a draught twice a day. 217. Comp. Infusion Senna Infusion of Rhubarb . Comp. Tinct, Cardamoms . SjTup . . . . To be taken at a draught. of Dyspepsia. 5 drachms. 5 ^ drachm. 1 J- drachms. Excellent for the headache 218. Carbonate of Soda ..... 10 grains. Aromatic Spirits of Ammonia . 1 drachm. Tincture of Orange Peel .... 1 " Syrup of Orange Peel .... 1 Compound Infusion of Gentian . 10 drachms. To be taken at a draught twice a day. 219. Hemorrhages. Acetate of Lead 3 grains. Opium 1 grain. Extract of Hemlock ..... 4 grains. Divide into two pills. To be given twice a day. Drink some acidulated draught afterwards, until it ceases. Appendix. 451 220. Hemorrhages, Spasms, etc. Sulplim-ic Acid, diluted . . . . 15 minims. Compound Infusion of Roses . . . IJ- oz. Sj^rup, simple 1 drachm. Make a draught. 221. Sulphuric Acid, Nitric Acid, \ in equal parts. From five to ten drops in an ounce of water. 222. Hemorrhoids. Sulphate of Magnesia 3 drachms. Carbonate of Magnesia 2 scruples. Wine of Colchicum .... 11 drachms. S^Tup of Red Poppy ^ oz. Peppermint Water .... 4 " Distilled Water .... . H " Two tablespoonfuls twice a day. 223. MorjDhine 2 grains. Olive Oil . . . . . 2 drachms Rub up together and add Zinc Ointment 1 oz. Powdered Nutgalls .... 1 drachm. 224. Confection of Black Pepper ... 1 drachm. Assafoetida ...... 5 grains. Syrup of Ginger, sufficient to make a uniform confection. Twice per day. 452 Woman^s Medical Companion. 225. Alum ■. Fresh Butter . Make an Ointment. 1 drachm. 1 oz. IJ^oz. drachm. 226. Confection of Senna Powdered Jalap Sulphur ..,,.,, i " Syi'up of Senna, sufficient to make an electuary ; taken three times a day, until bowels well opened. 227. Slaked Lime Ointment of Colocynth Wine of Opium Make an ointment. 2 drachms. 2 oz. 2 drachms. 228. Hemorrhoids, with Constipation. !■ of each Bitartrate of Potash, Extract of Horehound Honey Water Half to be taken morning and evening 2 drachms. 3 oz. 229. Hydrocele of Children. Muriate of Ammonia .... 1 drachm. Liquor Acetate Ammonia . . . . 2 oz. Water 4 " Lotion : To be kept constantly applied. Appendix. 453 1 grain. 230. Hydrocephalus. Chloride of Merciiiy ..... Powdered Digitahs . . . . . I " Powdered Tragacanth (compound) . . 6 gTains. Make a powder One every sixth hour, for child of two or three j^ears. 231. Hysteria. Tinct. Hj'oscyamus .... ^ drachm. Aromatic Spii'it of Ammonia i " SjTup of Orange Peel i " Peppermint Water .... 10 drachms. 232. Ai'omatic Spirits of Ammonia . 1^ drachm. Sulphuric Ether .... 1 " S^Tup of Ginger .... 3 drachms Anise Water ..... 31 oz. A thii'd part frequently, as occasion requires. 233. ^theris Acetici . . . . . 30 minims. Camphor Mixtm-e, with Magnesia . . 6 oz. To be taken immediately, and repeated every hour if necessary. 234. Infusion of Quassia .... J- oz. Tinct. of Ammonio-Chloride of Iron . I drachm. Sesquicarbonate of Ammonia . 6 grains. Orange S}Tup ..... 1 drachm. Distilled Water .... 7 drachms. A di'aught to be taken two or three times a day, 454 Woman's Medical Companion. 235. Strychnia . Compound Rhubarb Pill Calomel Pill . Oil of Peppermint Divide into fifteen pills. One twice per day. 1 grain. 1 drachm. 6 grains. 4 drops. 236. Icterus, Nettle Rash, and Scarlet Fever. Pulverized Ipecac Pulverized Cayenne . Water .... To be taken at a draught. 1 scruple. 10 grains. 2 oz. 237. Tartar Emetic 1 grain. Pulverized Ipecac ..... 1 scruple. Mix, To be taken in a wineglassful of sweetened water. 238. Pulverized Lobelia 1 oz. • Pulv. Bloodroot ^ '' Pulv. Seneka 1 scruple. Pulv. Ipecac 6 drachms. Pulv. Cayenne ...... 4 scruples. Half-teaspoonful in warm water, repeat every fifteen minutes, for one hour. 239. Indigestion. Tincture of Musk Seed . . . . 1 oz. Tincture of Hops 3 drachms. Liquor of Potash 2 " Infusion of Buchu 6 oz. Three table-spoonfuls three times a day. Appendix. 455 240. Hydocliloric Acid Infusion of Columbo Eoot . Tine, of Hops . One-sixth part for a dose. 2 dracliins. 5^ oz. 241. H3Tlroc3'anic Acid . . . , Muriate of Morphia, Tinct. Mixt. Tinct. Sweet Ahiionds A table-siDOonful three times a day. 32 drops. 3 drachms. 8 oz. 242. Inflammation of Eye or Ear. Tartrate of Antimony . . . . 1 grain. 2 pints. Decoction of Barley ..... Dissolve and add SjTup 3 oz To be taken by glassfuls in the com:se of the day. 243. Inflammation of the Mucous Membranes. Decoction of Barley (compound) . . 10 oz. SjTup of Indian Sarsaparilla ." . . 2 " Two table-spoonfuls occasionally. 244. Inflammatory Complaints of Children — as an Emetic. Potassia Tartrate of Antimony ... 1 grain. Distilled Water 1^ oz. Simple Syrup . . . . . . J- " One, two, or three teaspoonfuls every quarter of an hour until vomiting is produced. 456 Woman's Medical Companion. 245. Citrate of Iron . Sulphate of Quinine . Ext. Nux Vomica Make thii'ty-two pills. Influenza. . ' . . 1 drachm. 1 scruple. 8 grains. One pill three times per day. 246. Irritable and Acid Stomach. HjTirocyanic Acid, diluted Bicarbonate Potassa .... Syrup of Ginger .... Anise Water . . . . . A draught to be taken twice per day 4 minims. 10 grains. ^ drachm. 247. Itching Eruptions. Hydrocyanic Acid, diluted Bichloride of Mercury Emulsion of Sweet Almonds Mix. Make a lotion. 2 drachms. 2 grains. 6 oz. 248. Cyanide of Potassium Mixture of Sweet Almonds Make a lotion. 12 grains. 6 oz. 249. H3^drocyanic Acid, diluted Decoction of Mallow Leaves Make a lotion. 4 drachms, lib. Appendix, 457 250. Hydrocyanic Acid, diluted DistiUed Water Acetate of Lead Kectified Spirit Make a lotion. 1^ drachms. 7 oz. 16 grains. 2 drachms. each 251. In Tinea Capitis. Muriatic Acid, Marsh Mallow Ointment, Ointment of Juniper To be appHed twice a day. 2 oz. 2 oz. 252. Pruritus Vulvae — Itching of the Privates Biborate of Soda Eose Water 6 " Sulphate of Morphia .... 6 grains. i oz. 253. Jaundice. Calomel Pill . . . . . . 10 grains. Powdered Ipecacuanha (compound) . . 5 " Divide into 3 pills ; one every 4 hours. 254. Indian Hemp Seed .... Light Beer . . . , Boil, strain, and add sugar, sufficient. Take half pint every morning. 4 oz. 2 pints. 458 Woman's Medical Companion. 255. Leucorrhoea, or "Whites. Nitrate of Silver Crj- stals 10 grains. Corrosive Sublimate .... 5 " Sugar of Lead IJ^ drachms. White Vitriol . . . . 11 - Soft Water 6oz. An injection. 256. Powdered Cantharides 12 grains. Ext. Hyoscyamus .... 1 drachm. Nitrate of Silver .... 10 grains. Sulphate of Quinia . . 2 scruples Make 40 piUs ; one every night and morning. 257. Cresote .... Liquor Potassa White Sugar Rub up together, and add Distilled Water Make an injection. 20 minims. 2 di'achms. 2 " 8 oz. 258. Powdered Cubebs Powdered Ergot Compound Powder of Cinnamon White Sugar 1 oz. 2 drachms. 2 scruples. 1 drachm. Divide into 8 powders ; one three or four times per day. Appendix. 459 259. In Labor. Powder of Ergot .... \ drachni. Syrup ...... \ oz. Peppermint ..... 1 '' A thii'd part eyery 20 minutes. 260. Laxatives. Infusion of Cascarilla 11 oz. Sulphate of Magnesia 1 drachm. Sulphuric Acid, diluted 15 minims. Draught to be taken twice or thrice a day. Also a Tonic. 261. Compound Decoction of Aloes 3 oz. Bi-carbonate of Potass. 2 drachms Ammonia-tartrate of Iron . ^ " Ai'omatic Spuits of Anmionia . 3 '' Water 6^ oz. A sixth part twice per da3\ Also a Tonic, 262. Liver Derangement. Compound Mixture of Gentian Sulphate of Magnesia Tinct. Jalap Aromatic Spirits of Ammonia . A di'aught to be taken in the morning. 10 drachms. 3 " 1 '' 263. Chloride of Mercury Compound Ext. Coloc3mth Two pills to be taken at bedtime. 4 grains. 8 " 460 Woman's Medical Companion. 264. Powdered Jalap 12 grains. Submuiiate of Mercury . . . . 3 " Sulphate of Potash 7 " Make into a mass. Dose, 20 to 30 grains. 265. Sulphate of Magnesia . . . . i- oz. Tinct. Jalap 1 drachm. Nitric Acid 2 minims. Green Peppeimint Water . . . . 2 oz. Make a draught. 266. Mania, with Torpid Bowels. Tinct. Black Hellebore .... 1^ drachms. Compound Infusion of Senna . . . 1 oz. S^Tup of Ginger ..... 2 di'achms. A di-aught to be taken early in the morning. 267. Measles. Fluid Extract Senna .... 1 drachm. Compound Fluid Extract Gentian . . i" " Fluid Extract of Ginger . . . . J- " Aromatic Spirits of Ammonia . . . J- " To be taken in wineglass of sweetened water. 268. Tinct. Lobelia J oz. S}Tup of Squills . . . . . ^ " Twenty drops four or five times a day for a child two years old. Appendix. 461 269. Tinct. of American Hellebore . . . 1 drachm. Tiuct. of Black Cohosh . . . . 2 oz. One tea-spoonful three to six times per day. 270. As a Stimulant. Muriate of Ammonia . . . . 1 oz. Soft water 9 " One table-spoonful three or four times per day. 271. Painful Menstruation. Ext. Belladonna ..... ^ drachm. Lard . . . . . . . :^ oz. To be rubbed on the neck of the womb. 272. Profuse Menstruation. Wine of Spurred Rye . . . . 2 oz. One teaspoonful thi'ee times a day. 273. Nausea and Vomiting. Lime Water, \ ^^t. . ^^ New Milk, I eacn^oz. A table-spoonful every half-horn-, horn-, or two hours. 274. Nervous Affections. Assafoetida, ] • i 4. -r, T ' . . ^ m equal parts. Powdered Valerian, j ^ ^ SjTup and Tinct. Valerian in sufficient quantity to make a mass, and divide into 5 -grain pills. Take two twice per day. 462 Wojfian's Medical Companion. 275. In Nervous Palpitations. Tinct. Digitalis . , . . . 12 minims. Mixture of Camphor . . . . 1 oz. Orange SjTup 2 drachms. Hj'drocj'anic Acid, diluted . . . 1 minim. Make a draught. To be taken two or three times per day. 276. Solution of Magnesia (with Carbonic Acid) \\ qz. Tincture Muriate of Iron . . . . 25 minims. A draught to be taken three times a da}', and immediately followed by a wineglass of cold or tepid water. 277. Nervous Debility. Disulphate of Quinia . . . . 12 gi'ains. Powdered Sugar 2 drachms. Divide into six powders. One night and morning. 278. Disulphate of Quinia . . . . 15 grains. Cinnamon Powder ^ drachm. Extract of Cinchona . . . .20 grains. To make thirty pills. Four every second, thkd, or fourth hour. 279. Sulphate of Quinine . . . . 32 gi-ains. Simple S3TUP . . . . . . 8 oz. Make a Quinine SjTup. Two teaspoonfuls two or thi'ee times per day. Appendix. 463 280. Neuralgia of the Bladder, etc. Arsenious Acid PoTvdered Opium StiTchnia . Extract Aconite Divide into sixteen pills ensues, take only half a pill 2 grains. 5 " 1 " One every six houi's ; if nausea 281. Neuralgia. Distilled Water 2 oz. Valerianic Acid . . . . . 1 " Subcarbonate of Ammonia enough to neutralize the acid ; then add Alcoholic Extract of Valerian, 2 scruples. A tea- spoonful thi'ee times per day. 282. Ext. Hyoscyamus Sulphate of Morphia Str3^chnine Pulv. Ca3xnne . Sulphate of Zinc Make thirty pills. ^ drachm. 3 gi-ains. 2 " ^ drachm. 15 grains. Take one four times per day. 283. For Neuralgia of the Face. Ext. of Hyoscyamus .... ^ drachm. Valerianate of Zinc ..... 1 scruple. Make thirty pills. Take one two or three times per day. 284. Sore Nipples. Powdered Gum Arabic .... J- drachm. Powdered Alum. ..... 5 grains. Make a powder. Apply as often as necessary. 464 Woman's Medical Companion, 285. Nurse's Sore Mouth. Nitrate of Silver 8 grains. Distilled water . . . . . . 4 oz. Make a gargle. 286. Offensive Breath. Charcoal of White Wood, powdered . . 1 oz. Orange S;yTup 3 " Make an electuary. One or two teaspoonfiils every two hours. 287. Paralysis, Rheumatism, etc. Flowers of Arnica 1 oz. Water 2^ pints. Boil to a pint and a half, and add SjTup of Ginger . . . . . 2 oz. Take from two to three ounces every second hour. 288. Paralysis. Dried Juice of Spurge . . . . 1 drachm, Olive-oil 10 drachms. Digest for ten daj^s and strain. Used in rubbing. 289. Pimply Eruptions. Nitric Acid, diluted ^ drachm. Decoction of Barley . ' . . . 1 pint. A wine-glassful to be taken three times per day. 290. Pleurisy, Colic. Compound Extract of Colocynth . . ^ drachm. Extract of Jalap . . . . . 15 grains. Mix. Make twelve pills. Two or three pills will pro- duce active operation of the bowels. Appendix. 465 291. Fluid Ext. Sarsaparilla Fluid Ext. Pipsissewa Water ..... Iodide of Potassium . A tablespoonful three times a day 4 oz. 1 " 1 quart. 2 oz. 292. Wine of Ipecac ... 1 oz. Spiiits of Turpentine .... 1 " Castor-oil 1 " Molasses . ^ pint. Warm Water . . . . . . J '' Mix. 293. Thoroughwort . 1 oz. Senna 1 " Lobelia . . . ^ drachm. Caj'enne . 10 grains. Epsom Salts 1 tablespoonful. Molasses . ipiiit- Boiling Water . 1 " Make a strong decoction of the herbs, and then add the salt and the molasses. 294. Pneumonia, Typhoid Fever. Bicarbonate of Soda .... Compound Infusion of Gentian Tincture of Colombo .... S^Tup of Orange Peel .... A tablespoonful three times per day. 4 " 1 " 466 Woman's Medical Companion. 295. Sulphate of Quinine ..... 1 scruple. Alcohol . . . . . . . . 4 oz. Sulphuric Acid 5 drops. Madeira Wine . . . . . . 1 quart. Two wineglassfuls per da}-. 296. Eose Water 6 oz. S^Tup of Orange Peel . . . . 1 '' Muriated Tincture of Iron . . . 1 " For adults, one teaspoonful in a wineglass of water after each meal. 297. Rheumatism. Diluted Acetic Acid . . . . . 1 drachm. Tinct. Jalap . . . . . . 15 minims. Tinct. Orange 1 drachm. Camphor Mixture ..... 10 drachms. A draught to be taken two or three times per da}^ 298. Rheumatism and Cell-Dropsy. Tinct. Black Cohosh • • . 1 oz. Iodide of Potassium . . 2 drachms S}Tup of Ipecac . . 1 oz. Spring Water . . . 2 "■ A teaspoonful three or four times per day. 299. Rheumatism. Peppermint Water . . . lioz. Wine of Colchicum Root . , , . h " Sulphate of Morphia . . 1 grain. Magnesia . . 1 scruple. One teaspoonful three or four times per day. Appendix. 467 300. Ring^T-orm. Pulverized Sulphate of Copper . Ext. Spanish Flies . . . . Lard ...... Rub into the scalp or part affected. 10 grains. 5 " 1 oz. 301. Castor-oil Pure Alcohol . Pulv. Spanish Flies Oil of Bergamot Otto of Roses . A superior preparation for keeping and to prevent dandruff. Let the mixture stand for a few da3-s and then filter. 2^ pounds. 2 J- pints, i oz. 20 drops, the hair from falling, 302. Small-Pox, Angina Pectoris. Spirits of Mindererus . . . . Sweet Spmts of Nitre . . . One teaspoonful every three hours. 2oz. 1 <-' 303. Comp. Tinct. of Cardamoms . . . 2 oz. Comp. Tinct. of Lavender . . . 2 " Comp. Tinct. of Gentian . . . . 2 " One teaspoonful at a time, as occasion may require. 304. Pulv. Gum Arabic . . 1 scruple Soft Water . 2 oz. Sweet Spirits of Mtre . . . ^ " Tinct. Veratrum Viride • 20 drops. Half a teaspoonful every hour. 468 Woman's Medical Companion. 305. Aromatic Spiiits of Ammonia ... 2 drachms. Ether . . . . . . . 1 ckachm. Laudanum . . . . . . 20 di'Oi)s. Spmts of Camphor 1 di'achm. Half a teaspoonful as often as requii'ed. 306. Scrofula and LeucorrhcEa. Sesquioxide of Iron. ) Extract of Hemlock. I "f^^^'^ ■ " 1 di-achm. Make into twentj-foui' pills. Two twice per day. 307. Scrofula. Oxysulphuret of Antimony, ) Chloride of Mercury, 'j of each . ^ drachm. Ammonia 1 " Balsam of Peru ..... sufficient. Make thuty j)ills. Take one or two every night. 308. Scrofulous and Cancerous Affections. Chloride of Bar3i:a 1 oz. Mm-iatic Acid 4 drops. Four di'ops, increasing to ten drops, twice per day. 309. Sore Throat. — Malignant. H3'dro chloric Acid ..... 1^ drachms. Decoction of Cinchona, Compound Infusion of Roses, 2 Honey of Eoses Make a gargle. Appendix. 469 310. Infusion of Sage Hydrochloric Acid S}Tup of Mulberry Make a gargle. 8 oz. 1^ drachms. 2 oz. 311. Putrid Sore Throat. H3^drochloric Acid . Infusion of Cinchona Honey of Roses Make a gargle. 15 minims. 4 oz. 1 <-' 312. In Common Sore Throat. Decoction of Quince Seed . S^Tup of Sage . Hydrochloric Acid . Make a gargle. 7 oz. 1 '' 20 to 30 minims. 313. Tonics. Decoction of Cinchona .... 10 drachms. Aromatic Confection .... 1 scruple. Compound Tincture of Cinchona . . 1 drachm. A draught to be taken every fourth hour. 314. Infusion of Gentian (compound) . . Compound Tinct. Gentian Orange S}Tup ..... A draught to be taken twice per day. 9 drachms. 2 " 1 drachm. 470 Woman's Medical Companion. 315. Infusion of Roses . . . . . 10 drachms. Aromatic Sulphuric Acid . . . . 15 minims. Tincture of Rhatany ... . . 1 drachm. Mix with Diluted Spirits . . . . 2 pints. Syrup of Red Poppy .... 1 drachm. A draught to be taken three times per day. 316. Infusion of Orange . Aromatic Tincture of Rhatany, ] Syrup of Ginger, J Three tablespoonfuls three times a day. of each 6 oz. 1 '' 5 minims. 317. Hydrochloric Acid, diluted, l Nitric Acid, \oi^^\ . Compound Mixture of Gentian . . 10 drachms. Draught three times per day. Also, laxative in its effects. 318. Sulphuric Acid, diluted . ... 12 minims. Infusion Cascarilla ..... 10 drachms Orange Syrup 1 drachm. Draught to be taken three times per day. 319. Sulphuric Acid, diluted .... 40 minims. Compound Spirits Ether . 2 drachms. White Sugar 2" ^2* Green Peppermint Water . A fourth part four times per day. Appendix, 471 320. Tonic in Dyspepsia. Powdered Ehubarb ..... 1 drachm. Magnesia ...... 1 J- drachms. Powdered Ginger ..... 1 scruple. Peppermint Water . . . . . 1 pint. Mix. Dose, one-half ounce. 321. Toothache. Tannic Acid 1 drachm. Mastich 1 '' Sulphuric Ether l^oz. To be introduced, on cotton, into a hollow tooth. 322. Powdered Resin |^ drachm. Chloroform sufficient to dissolve the Resin. Steep a small piece of cotton in the preparation, and place it in the hollow of the tooth. 323. Canada Balsam Slaked Lime Pressed into the cavity. 1 drachm. 1 " 324. Oil of Cloves . Cajeput Oil Powdered Opium, Camphor, Rectified Spirit, sufficient to dissolve. Apply as above, or to the swollen gums. of each 1 drachm. 1 " ^ scruple. 472 Woman's Medical Compaition. 325. Typhus, and Other Fevers. Powdered Scammony, ^ Powdered Aloes, J- of each . . 2 grains. Chloride of Mercury, J Make two pills. To be taken at once. 326. Ulcerated Mucous Membranes, Mouths, etc. ; and In- flammation of Mouth in Infants. Sugar of Lead . . . . . . 3 grains. Soft Water ..... 1 oz. As a wash. 327. Sulphate of Copper . . .. . . ^drachm. Soft Water ...... 1 oz. To be applied twice a day to the ulcers in gangrene of the mouth. 328. Creosote 1 drachm. Alcohol . 1 " To be applied with a camel's-hair pencil to the gangre- nous ulcers of the mouth, after running a lancet through the sloughs. 329. Acid Nitrate of Mercury .... ^ drachm. Soft Water 1 oz. To be injected into the throat with the shower-s^Tinge, or applied to the ulcers with a pencil. Appendix. ,473 330. For Curdy Patches in CMldren's Mouths. H3'drochloric Acid ..... 1 drachm. Honey 1 oz. 331. Vomiting. Ext. Belladonna . . . v . . 6 grains. Piilv. Ipecac ...... 10 grains. Confection of Roses 2 grains. Make thirty pills. One pill twice per day. 332. Compound Infusion of Orange Green Beppermint (Spirit) Liquor of Potass Carbonate of Magnesia Tinct. H^'oscyamus . Extract Hops . Syrup of Ginger Mix. Make a draught. 10 drachms. 1 drachm. 10 drops. 1 scruple. ^ drachm. 8 grains. 1 di-achm. 333. Sesquicarbonate of Ammonia . Gum Tragacanth Distilled Water Mix. A teaspoonful every hour. 2 drachms. 1 scruple. 7 fluid oz. 334. Vomiting. Creosote ...... Pulv. Tragacanth .... Camphor Mixture .... A sixth part to be taken for a dose. ^ drachm. G oz. 474 Woman's Medical Companion, 335. For Wind and Belching. Powdered Chamomile Long Pepper Powder Powdered Aloes .... A powder, to be taken every night. ^ scruple. 3 grains. 1 grain. 336. "Worms. Garlic Bulbs ...... 4 drachms. Milk 8oz. Boil gently and strain, to make an enema. 337. Decoction Aloes . . . . . 1^ oz. Extract Liquorice 2 drachms. Wine of Aloes ..... 2 " One or two teaspoonfuls twice a day. 338. Oil of Almonds, of each 1 oz. Distilled Water, Sesquicarbonate of Ammonia (Liquor) . 20 minims. A draught. To be taken every morning on an empty stomach. 339. To prevent the Breeding of Worms. Hydrochloric Acid, diluted Infusion of Quassia . Syrup of Orange Take one-fourth twice per day. 2 drachms. 71 oz. 2-OZ. Appendix. 475 340. To Expel Tape-"Worms. Gamboge ....... ^ scruple. Sulphate of Iron . . . . . 6 grains. IMiite Sugar . . . . . . 1 scruple. Peppermint Water ..... 3 drops. Make a powder. Prepare six similar doses. One to be taken every four houi's until expelled. 476 Woman's Medical Compajtion. APPENDIX C. DOMESTIC RECEIPTS. "Whooping-cough Syrup. Onions and garlics sliced, of each 1 gill ; sweet oil, 1 gill ; stew them in the oil in a covered dish, to retain the juices ; then strain and add honey, 1 gill ; paregoric and spirits of camphor, of each one-half oz., bottle and cork tight for use. Dose for a child of two or three years, 1 teaspoonful three or four times daily, increasing accord- ing to age. ^ DiarrhcEa Tincture. Compound tincture of myrrh, 6 oz. ; tincture of rhubarb and spirits of lavender, of each 5 oz., tincture of opium, 3 oz. ; oils of cinnamon and anise, with gum camphor and tartaric acid, each \ oz. Dose, 1 teaspoonful in half a teacupful of warm water sweetened with loaf sugar. Repeat after each passage. Cathartic. Jalap and peppermint leaf, each 1 oz., senna, 2 oz., powder finel}^ and sift through gauze. Bottle it, and keep it corked. Mix a good teaspoonful of the powder, and an equal quantity of sugar, into a wineglassful of boiling water ; when cool, stir and drink. Repeat every three hours until operation. Appendix. ^11 Small-poz. To prevent Pitting the Face. — A great discoveiy has recentlj' been made bj^ a surgeon of the English army in China, to prevent pitting or marking the face. The mode of treatment is as follows : — When, in small-pox, the preceding fever is at its height, and just before the eruption appears, the chest is thoroughly rubbed with croton oil and tartar-emetic ointment. This causes the whole of the eruption to appear on that part of the bod}^ to the relief of the rest. It also secures a full and complete eruption, and thus prevents the disease from attacking the internal organs. This is said to be now the established mode of treatment in the English army in China, by general orders, and is regarded as perfectly effectual. Female Laxative Pill. . Aloes, macrotin, and cream of tartar, of each 2 drs. ; podophylUn, 1 dr. ; make into common-sized pills by using oil of peppermint, 15 to 20 drops, and thick solution of gum mucilage. Dose, one pill at bed-time, and sufficiently often to keep the bowels just in a healthy condition. If the aloes should not agree with the patient, the fol- lowing ma}' be used : — Female Laxative and Anodyne Pill. Macrotin and rhubarb, of each 10 grs. ; extract of hyos- cj^amus, 10 grs. ; Castile soap, 40 grs. ; scrape the soap and mix well together, forming into common-sized pills with gum solution. Dose, one pill, as the other, or sufficiently often to keep the bowels in proper condition, but not too free. The h3'Osc3'amus tends to quiet the nerves without constipating the bowels. 478 Woman's Medical Companion, To soothe and quiet the nervous system and pains, if very violent, when the courses commence, or during their progress, make the following : — Pill for Painful Menstruation — Anodyne. Extract of stramonium and sulphate of quinine, of each 16 grs. ; macrotin, 8 grs. ; morphine, 1 gr. ; make into 8 pills. Dose, one pill, repeating once or twice only, 40 to 50 minutes apart, if the pain does not subside before this time. The advantage of this pill is that costiveness is not in- creased, and pain must subside under its use. Tea — Injection for Leucorrhea. When the glairy mucous discharge is present, prepare a tea of hemlock, inner bark, and witch hazel (often called spotted alder) leaves and bark ; have a female syiinge sufficiently large to fill the vagina, and inject the tea, twice daily ; and occasionally, in bad cases, say twice a week^ inject a syringe of the following : — Injection for Chronic Female Complaints. White vitriol and sugar of lead, of each | oz. ; common salt, loaf sugar, and pulverized alum, of each \ dr. ; soft water 1 pt. Simmer all over a slow fire for 10 or 15 min- utes ; when cool, strain and bottle for use, keeping well corked. Inject as mentioned in the paragraph above, hold- ing the s}Tinge in place for a minute or two at least. This injection is valuable in diseases of the generative organs for males and females. Appejidix, 479 STIIVIULANTS. Stimulants are medicines -which increase and sustain the action of the heart. They are often useful in diseases characterized by great prostration, and in convalescence from fevers, etc. Brand}^, whiskey, wine, etc., are stimu- lants, and maybe used in appropriate cases, in proper quan- tities, three to six times a day. The dose of brandy or whiskey should not, as a general rule, exceed one to two table-spoonfuls. If wine be used, about two ounces maybe given. Alcoholic Stimulants should not be continued longer than they are required as medicines; for the daily use of spirituous hquors, by persons in health, is very injurious, and tends to undermine the constitution and bring on serious and even fatal diseases of the brain, liver, and kidneys. Wine "Whey. Take of good milk, one-half pint ; heat to the boiling point ; then add of sherry wine, one gill ; strain, and add of white sugar one ounce, and a little nutmeg. There are few mild stimulants more employed or more useful, than wine whey. The dose must be regulated by the circumstances of the case. From one gill to a pint may be taken during the day. Egg-Nog. Take the White and Yolk of . . . 4 eggs. White Sugar . . . . 1 oz. Beat well together, then add Sherrj' Wine . . . . 2 oz. Water ..... 4 oz. Grated nutmeg to taste. The above is sufficient for about four doses. Stimulant and nutritious. 480 Tl^oi7ta7t's Medical Companion. Milk Punch. Take of good Brand}' .... 1 gill. Fresh Milk J- pint. White Sugar . . . . 1 oz. A little grated nutmeg. Mix. A table- spoonful or more may be taken every hour or two in low fevers, and other diseases characterized by great prostration. Mixture of Carbonate of Ammonia. Take of Carbonate of Ammonia . . 2 drachms. "White Sugar .... 3 " Powdered Gum Ai'abic . . 3 " Spearmint Water ... \ pint. IMix. Give a table-spoonful every two houi's. ANTHELMINTICS. Anthelmintics are medicines which are taken to destroy and bring away worms from the alimentary canal. They are frequently termed vermifuges. Fluid Extract of Pinkroot and Senna with Santonin. Take of Fluid Extract of Pinkroot and Senna 2 oz. Santonin 16 grains. Mix. Give a child, two j^ears old, a teaspoonful night and morning, until purging takes place. This is verj^ effect- ual for removing the common round-worm. Appendix. 481 Mixture of the Extract of Male Fern. Take of Ethereal Fluid Extract of Male Fern ..... \ drachm. S3T11P of Gum Arabic . . . 1 oz. Mix. Shako well before using. Take one-half at bed- time, and the remainder early in the morning, on an empty stomach. Used for tape-worm. If the worm does not come awa}' in six or eight hours after the last dose, take some mild purgative, as castor-oil. For Pin-Worms. — Injections are the most certain of all remedies for ascarides, or " pin-worms." Injection of Salt Water. Take of Common Fine Salt . . . 1 oz. Warm Water .... 1 quart. Mix. One-half or even the whole may be injected into the bowel of an adult, and retained fifteen minutes, if possible. It should be repeated once or twice a day for a week or two. When used for children, let the quantity be in proportion to age. OINTMENTS. Simple Ointment. Take of Fresh Lard . . . . - . 3 oz. White Wax . . . " . 1 or 2 " Oil of Sweet Almonds . .. 1 " Melt together, and stir until cool. If for winter use, one ounce of white wax will be sufficient, but if for warm weather, use two ounces. A few drops of oil of rose added when nearly cool, will give it a fine odor, but this is not essential. Useful in dressing wounds, burns, scalds, blisters, cuts, and sores of almost every description. 482 Woman's Medical Companion, Resin Ointment. (Basilicon Ointment.) Take of Powdered Resin . . . . 1 oz. Yellow Wax . . • • i " Fresh Lard, or Simple Ointment . 2= " Melt with a gentle heat, strain through flannel, and stir constantl}^ until cool. Useful in dressing indolent ulcers, sores, wounds, etc., where something more stimulating and adhesive than simple ointment is required. Compound Sulphur Ointment. This can be bought at the apothecaries. Used for diseases of the skin ; itch, ringworm, etc. Simple Sulphur Ointment. Take of Lac Sulphur .... \ pound. Fresh Lard .... 1 " Oil of Bergamot . . . . 2 drachms. Mix well. Used in itch. In making simple sulphur ohitment, the sublimed sulphur is generally used, but I prefer the precipitated or lac sulphur. Astringents for E2:ternal Use. Tannin, powdered matico leaves, alum, etc., are often useful to check bleeding from superficial wounds. In bleed- ing from the nose they may be used in solution, or the dry powder may be used as snuff. BLISTERS Are those articles which produce a serous or watery dis- charge beneath the cuticle, — the blister of common language. Appendix. 483 Blistering Plaster. This may be made by spreading blistering ointment on leather, cloth, or adhesive j^laster. It maj^ be of any size required, from one to six or eight inches square. It should remain on the part until a good blister has formed ; then re- move it, and dress the blister with simple ointment, or sweet oil. This is sometimes termed a " Fly-blister," the active ingredient being Cantharides, — Spanish flies. Aqua Ammonia, Mustakd, and some other articles, will "blister," but the ordinary /?/-6Zi5^er is preferable in most cases. Mustard Plaster. Take of Powdered Black Mustard . . 1 oz. "Water sufficient to make a paste or poultice. The uses of the mustard plaster are too well known to re- quire description. It is sometimes made by adding an equal quantity of flaxseed or Indian meal ; this should always be done for children, or persons of delicate skin. It should be kept on as long as it can be borne, which will not generally be longer than half an hour. Ground Black Pepper. If mustard is not at hand, this may be taken as a sub- stitute. Onion Poultice. Onions are often used in cases of croup, and in diseases of the chest in children, as re\Tilsives and antispasmodics. Ha^-ing been partiall}^ roasted, mashed, and spread between two folds of thin muslin, they may be applied over the chest, and permitted to remain as long as they retain their warmth and moisture. 484 Woman s Medical Compc EYE WASHES. Sulphate of Zinc Eye Wash. Take of Sulphate of Zinc .... 2 grains. Rose TTater . . . . • 1 oz. ]yiix. Drop a little into the e^-e, two or three times a day, when sore or inflamed. Acetate of Zinc Eye "Wash. Take of Acetate of Zinc .... 2 grains. Rose Water 1 oz. Mix. Use three or four times a day, for sore eyes. Sugar of Lead Eye Wash. Take of Sugar of Lead .... 2 grains. Rose Water . . . . . > 1 oz. Mix. Excellent for inflamed eyes. It should be used two or three times a day. WASH FOR THE EAR. Goulard's Extract and Rose "Water. Take of Goulard's Extract (Liquid Subace- tateof Lead) .... ^ drachm. Glj^cerine . . . . . 1 " Rose Water 2 oz. Mix. This ma}^ be dropped into the ear until the ca\dty is full, and be allowed to remain there for a few minutes. Use morning and night. For running from the ear. Appendix. 485 Solution of Nitrate of Silver. Take of Nitrate of Silver .... 10 grains. Distilled Water . . . . 1 oz. Mix. Used in ulceration, attended by discharges of matter (pus) from the ear. Dip a camel's-hair brush into the solution, and apply every second or third day. Between the applications use the preceding recipe. FOMENTATIONS. Fomentations, used warm, or hot, are good counter-irri- tants. They may be made by dipping a piece of flannel, folded several times, in warm or hot water, allowing it to remain three to five minutes, and then wringing it nearly dr}'. It should be of sufficient size to well cover the part to which it is applied. A piece of oiled silk or a dry cloth maj^ be placed over it, to prevent evaporation. Fomentations should generally be about as hot as the patient can bear, where active counter-irritation is indicated, and must be renewed. every ten or fifteen minutes. In pleurisy, conges- tion of the lungs, lung fever, and inflammation of the bowels, oil of turpentine may be gently ajiplied to the parts, before appl}ing the hot cloths ; or it may be sprinkled upon them. MISCELLANEOUS RECEIPTS. Tooth- Ache Drops. Take of Mastic 1 drachm. Chloroform . . . . . 1 oz. INIix. Moisten with the solution cotton enough to fill the cavity of the tooth, and press it well in. 486 Woman^s Medical Companion, Another. Take of Oil of Cloves , 1 drachm. Chloroform . . 1 " Mix.. Use as directed above. Oil of cloves alone is excellent. Another. Take of Gum Camphor . . . - 2 <^^* Strongest Alcohol . 1 " Mix in a mortar, and rub until the camphor is dissolved. Use as above. Tooth Powder. Take of Prepared Chalk . . 1 oz. Powdered Orris Root . . 1 '' Powdered Castile Soap . . 2 drachms. Mix. Use after breakfast and supper. Another. Take of Powdered Orris Root . 1 oz. Powdered Peruvian Bark 1 drachm. Powdered Gum M3Trh 1 u 2 Powdered Cinnamon Bark . 1 " Bicarbonate of Soda 1^ drachms. Mix. Use as above. PREPARATIONS FOR THE HAIR. Hair Oil. Take of Castor Oil 2 oz. Glycerine Cologne Spirit Oil of Bergamot Oil of Rose . 2 drachms. 2 oz. 1 drachm. 4 drops. Mix. Appendix. 487 Another. Take of Olive or Castor Oil . . . 3^ oz. Glycerine ..... 2 drachms. Oil of Jessamine .... 1 drachm. Oil of Orange .... 1 '' Mix. 4S8 Woma7i's Medical Companio7i. APPEIS'DIX I>. VARIOUS METHODS OF BATHINO. It would be difficult to exaggerate the importance of ablution as a means of preserving and maintaining health. In the earliest ages it was strictly enjoined on all ^Dersons, young and old ; and want of cleanliness was xDunished as a crime. In both the Jewish and Mohammedan religions constant ablutions (four or six times a day) were prescribed as an essential part of religious dut}^ The ancient philoso- phers, too, continually inculcated in their orations and writings the absolute necessity and beneficial influences of cleanhness. Aristotle describes it as one of the half vui:ues. Cicero taught his disciples to ' ' preserve health by atten- tion to the body and temperance in living," and the inhabi- tants of the East have for the last six thousand 3'ears looked upon bathing and washing, not only as an imperative dut}^ but a positive necessity and indescribable luxury, far more important to life than even food itself. And, theoret- ically^ it occupies an equalh^ prominent position in the sani- tary and hygienic laws of the most civilized communities of the present age, England and America; but, unfortunately'' for the health, comfort, and physical and mental development of the masses of the people, there is, in this much-boasted nineteenth century, far too much theory, and comparatively little practical application of these first principles of cleanli- ness, especially among the more educated classes, to whom we would naturally look for a strict adherence to Nature's laws. Dr. Guy, an eminent member of the Medical Faculty Appendix. 489 in England, remarks that " a want of personal cleanliness is more frequenth'^ chargeable against persons of edncation than might at first sight be thought possible." The fact is, it is one thing to know what is right, and another to con- scientiously act upon that knowledge. The practice of dail}' ablution (5f the whole body is observed by a ver}^ small number of the community, despite its acknowledged neces- sity. In thickty populated towns and cities, especial^, many hundreds of thousands of lives might be saved if soap and water were but freely used. Cholera, typhoid fever, small- pox, and skin diseases of all kinds, would be effectually and permanently di'iven from the land if daily ablution were systematically and compulsorily practised. Want of clean- liness has caused more misery, desolated more homes, originated more crime, and peopled many more church-j^ards, than all the wars that have occurred since the creation of the world. There are many Absurd Prejudices against frequent Bathing among all classes of the people ; one would almost think that an h3'drophobic mania had seized civilized communities, — for they seem to be frightened of the sight of or contact with water, so far as the ablution of the entire body is concerned (except in the warmest weather) . A ludicrous illustration of the reluctance to perform this operation, occurs to us at this moment. Dean S"wift's Satire upon Uncle anliness. While this eminent satirist was staying at his episcopal resi- dence near Dublin, one of his servants (who had evidentl}^ not washed his hands and face for some da3's) approached him. 490 Woman^s Medical Companion, "James," said the dean, "when did 3'ou last wash 3'oiir- self?" " Yesterday morning, your reverence," the servant rephed. The dean put on a very solemn countenance, and said : " I should seriousl}^ ad\^se you to discontinue such a useless and unnecessary practice, for two or three reasons. 1st, on the score of econom}^ : soap and water cost money, and washing involves an expenditure of time, money, and trouble. 2d, as a matter of personal comfort : j^ou must bear in mind that the dirt on 3^our skin will keep you warm ; and that if 3'ou wash ^^ourself one morning 3'ou must repeat the operation daih', else 3'ou will get dirt}" again ; so that I would, if I were 3'ou, let it remain." It need scarcel}" be said that the servant, w^ho was constitutionallj" laz3", took the advice literally, and refrained from washing himself afterward. Beneficial Effects of Daily Bathing. In our chapter on Hygiene we have defined the various methods of bathing, and the benefits du'ectl3" derivable from the constant adoption of the practice ; but we desu-e spe- ciall3' to call the attention of our readers to the fact that warm and towel and sponge baths, or even wash-tub baths, persistentl}' adopted, not only keep the bod}^ in a vigorous, healthy condition, but in our variable climate are absolute j^reventives against catching cold, and ensure to the skin the proper and unimpeded performance of its func- tions. Persons in ordinar3" health should use either of the baths we have named, at least twice each week, if they wish to keep perfectl3' clean. The Functions of the Skin. The pores of the skin are the great avenues of egress and ingress for the human body, — the direct means b}" which we Appendix. 491 exhale the noxious mephitic elements, and absorb or in- hale the regenerating influences of pure water, pure air, etc. There are more than two thousand of these re- spiratory tubes to the square inch, and as a person of average size and height has about two thousand five hundred square inches of surface, the number of tubes in the skin of one person is seven millions^ each about a quarter of an inch in length, making an aggregate length of tubing in the human skin of twenty-eight miles. Now, imagine the irreparable injury occasioned by the continued obstruction of those delicate ducts or tubes. If the organs of respira- tion and inspiration are prevented from performing their office, the whole of the complicated machinery of man is necessarily deranged and debilitated, and an interminable series of chronic diseases originated. But the evil does not rest here : the mental faculties are proportionately deterio- rated, dwarfed, and demoralized as bodily cleanliness is neglected. The poet of Nature, Thomson, says : — Even from the body's purity the mind Receives a secret, sympathetic aid. Directions for Bathing. In all descriptions of bathing, great care should be taken to avoid imparting a "shock" to the system by sudden plunging, or other application of warm or cold water to the body. Water below 75° is considered cold, and, if applied to persons in ordinary health, is a powerful and efficient tonic, adding greatly to the strength, vigor, and compact- ness or firmness of the body. With the exceptions elsewhere named, it is alwa^'s advisal)le to keep the temperature of the bath as near 75° as practicable or consistent with the comfort of the patient. 492 Wo7naiis Medical Companion. The Sponge Bath is the simplest, most agreeable, and certainl}' the most efficacious method of bathing, if practised daily in the morn- ing. Those who are feeble should expose onl}^ a ^^art of the body at a time, quickh' sponging and dr3-ing it, and proceeding in this way until the entire surface has been subjected to the bracing influence of water and friction. The onh^ apparatus necessary for this is a good-sized sponge, a basin, and a towel. The Shower Bath requires great care and discrimination in its use. Either warm or cold water ma}' be used, or both successively, but especial caution is necessarj^ to let the shower be more after Nature's pattern — gentle, regular, equal in quantitj^, and not in sudden spasmodic spirts. It will then prove, what it was originall}" intended to be, a means of invigoration and stimulation, which the feeblest invalid might bear with- out injury. The Cold Bath and its application has been treated of in the earlier part of this work, and is onlj- referred to here to intimate to our readers that it is the most easil}^ arranged of any of the modes of bathing (the sponge-bath excepted.) An ordinary wash-tub, with a coarse towel and a flesh-brush or horse- hair glove, is all that is required to render it a pleasurable, healthful, and invigorating preparation for the labors and occupations of the day, and an efficient preservative against infection and the ordinary ailments of humanity. Appendix. 493 The Sitz-Bath. We have referred in various parts of this volume to the use of the Sitz-bath (or Sitting Bath) as a remedial agenc}^, and as an invaluable tonic for the stomach, hver, bowels, spine, uterine organism, in eruptive fevers, etc. An oixli- nar}^ wash-tub is all that is required, sufficiently large to permit of the immersion of the bod}' just above the hips ; soap ma}" or ma}' not be used at the discretion of the opera- tor ; but the bath should never be continued for less than ten or more than thii'ty minutes at a time. The Leg-Bath, especially designed for the cleaning of open wounds, ulcers, and persons afflicted with scrofulitic and other eruptions of the skin, should consist of an ordinary wooden tub, the water wanned to blood-heat, and, when necessary, medicated with the preparations indicated in the treatment for those dis- eases ; but, in every case, pure, clean water is an essential and indispensable element in the cure of all cutaneous trouble. Special Directions for Bathing. In rubbing and drying the body, the muscles and nerves should be thoroughh' manipulated, especiall}' those of the arms, legs, and spinal column. The friction, either by hand or towel, should be upward, not dowmvard, and the mo- tion over the abdominal and thoracic viscera (the abdomen, chest, and trunk) iqnvard and across — a kind of circular motion. By this means the ligaments through which the uterine organism is held in position would be materially strengthened, and displacements and iceaknesses, in most instances, easily corrected or entirely averted. 494 Woman's Medical Companion. Bathing in Advanced Age should be confined to warm water, the temperature ranging between 95° and 105°. A warm bath of this kind, every other day, would, if the person be otherwise healthy, prolong her life from ten to twenty years. Cold- Water Foot-Baths (with or without salt) are invaluable as remedies in rheu- matism, rush of blood to the head, inflammation of the e^'es, hemorrhages, gout, and other inflammatory or poisoned conditions of the blood, and especially in fevers (whether remittent or intermittent, contagious or simple.) Injections. In the treatment of the various diseases, and also in the chapter on Hvgiene, we have recommended the cleansing of the internal organism b}^ injection, or the judicious use of syringes. Now, as the kind of syringe used is of the most vital importance, we deem it our dut}^ to caution our readers to exercise the greatest possible care in their selection of the instrument. There are a great many in the market, each of which possesses some peculiar excellence, but at the same time there are others which are worthless and should never be used. We consider the use of the old st^^le glass syringes., in uterine difficulties, to be attended with consid- erable danger, from their lial^ility to break or chip, and cause laceration of the parts. Many metallic sj^inges are equally objectionable, from the oxidation and other chemical changes to which they are liable, and also from the fact that it is very difficult to regulate the force of the injection, so as to avoid stricture or other injur}' to the adjacent organs. Our Appendix, 495 own preference is for a syringe or injecting apparatus made of vulcanized rubber, which should be entirel}^ under the control of the patient, easil}' cleansed, and simple in construc- tion, such as " Fairbanks'," which are manufactured with glass, metal and hard rubber tubes ; but we should decidedly recommend the hard rubber as being the most cleanl}^ dur- able, and least likely to get out of order. If an}^ of our readers should desire to purchase through us, we have made special arrangements with the manufacturers whereby we can suppl}' them — Small size, No. 1 . • • . . . . $2.00 Medium size, No. 2 2.50 Large size, No. 3 . . « . . . 8.00 A large and varied selection of the best and most approved instruments may always be obtained at Messrs. Codman & ShurtlefF's, and other reputable and eminent surgical mechanicians, whose reputation would be a suffi- cient guarantee for the reliability of any instrument they might recommend. GLOSSARY Abdomen. The lower "belly, containing the stomach, intestines, liver, kidneys, etc. Abnormal. Irregular; unhealthy. Abortion. Miscarriage, or the expulsion of the foetus before the seventh month. Abscess. A collection of pus. Acute. Sharp ; a disease of recent date, or -which terminates in a short time. Adipose. Fatty. Albumeyi, albuminous. A substance re- sembling the -white of an egg. Aliment. Nourishment; food. Alimentary canal. The passages from the mouth to the anus, through -which the food passes. Alvine. Relating to the intestines. AmenorrTum,. Suppression of the menses. Anatomy. The knowledge of the struct- ure of the human bo .ly. Ancemia. Debility. Anthelmintic. Whatever procures the evacuation of -worms. Aorta. The large artery from the left ventricle of the heart. Aperient. Whatever gently opens the bo-wels. Anus. Termination of the recttim ex- ternally. Atrophy. A -wasting awaj'. Auricle. A cavity of the heart; an ear. Belladonna. The deadly night-shade; a narcotic. Bile. The gall; a b.tter fluid secreted by the liver. Bronchia. The smaller branches of the windpipe. Bronchial. Belonging to the -windpipe. Bronchitis. Inflammation of the bron- chii. Cesarean operation. Cutting the child out of the -womb. Cardiac. The heart. Caries. Mortification of the bones. Carotid. An artery of the neck. Cartilage. The gristle attached to bones. Cartilaginous. Ha-ving the appearance of cartilage. Catamenia. The menses. Cataplasm, A poultice. Catarrh t Catarrhal. An increased dis- charge from the nose. Cathartic. Whatever produces an evacu- ation from the bo-wels. Catheter. A hollow instrument to in- troduce into the bladder for the pur- pose of dra-wing oflf the urine. Caustic. Whatever burns or destroys the texture of a part. Cellular. Ha-dng little cells. Cellular membrane. The fatty mem- brane immediately beneath the skin.^ Cerebellum. The lower part of the brain. Cerebral, cerebi'um. The brain. Cervical. Belonging to the neck. Chest. The cavity of the body -which contains the lungs. Chlorosis. The green-sickness. Chlorotic. ^ff'ected by chlorosis. Chronic. Applied to diseases of long standing. Chyle. The milk-like fluid resulting from the digestion of food, and from -which the blood is formed. Cl'ivicle. The collar-bone. Clyster. An enema or injection. Appendix . 497 Coagula. The clot of the blood. Coccyx. A small bone belonging to the pelvis. Colon, The largest intestine. Coma. A propensity to continued sleep. Conception. Impregnation of the ovum of the female. Congenital. Existing at birth. Congestion. Distended with blood. Conjugal. Relating to marriage. Conjunctiva. The membrane that covers the anterior part of the eyeball and the inner surface of the eyelids. Constipation. Costiveness, Counter-irritation. Artificial irritation in a part distant from that diseased. Cranium. The skull or upper part of the head. Craniotomy. The operation of perfo- rating the cranium. Cutaneous. Relating to the skin. Defecate. To purge; to evacuate the bowels. Demulcent. A medicine of a soft, mild and viscid character. Derivatives. Counter-irritants. Diagnosis- The art of distinguishing diseases. Diaphragm,. The midriff, or muscle that divides the chest from the abdomen. Diarrhoea, An increased discharge from the bowels. Diathesis. Peculiarity of constitution. Dietetic. Relating to the food. Digestion. The process by which the food is converted into chyle. Diluents. Those substances which in- crease the fluid portion of the blood. Diuretic. That which increases the flow of urine. Dorsal. Relating to the back. Douche. Water poured from a height ui^on any part of the body. Duodenum. The intestine next to the stomach. Dyxcntery. A discharge of bloody mu- cus from the bowels. Dysmenorrhoea, Painful menstruation. Dyspepsia. Indigestion. Dysuria Suppression of the urine. Edematous. Dropsical swelling. Embryo. A germ ; the foetus before the seventh month. Emetic. That which produces vomiting. EmmenagoQue. That which promotes the discharge of the menses. Emollient. Softening ; relaxing. Emulsion. A soft or oily substance. Enema, pi. enemata. A clyster or injec- tion into the rectum. Engorgement. Distention; fulness. Epidemic. A generally prevalent dis- ease. Epigastric. Over the stomach. Epilepsy. The falling-sickness. Ergot. The spur of rye. Erotic. Passionate; lustful. Erysipelas. St. Anthony's fire. Esophagus. The gullet or passage for food. Exacerbation, An increase in the vio- lence of a disease. Excrement, The faeces. Exhale. To emit. Expectorant. That which increasea the discharge of mucus from the lungs. FcRces. The escrcmenticial portion of the food. Farinaceous. Of flour or meal. Fauces, The cavity behind the tongue. Febrile, Feverish. Femoral. Belonging to the thigh. Femur. The thigh. Fetid. Offensive to the smell. Fibre. A filament or thread. Fibrine, A fibroiis substance obtained from blood and animal matter. Fistula. An ulcerous cavity with a nar- row opening. Flex. To bend. Foetus. The child in the womb. Follicle. A small gland. Fxcnction. The natural action of any organ. Fungus. Proud flesh. 498 Woman's Medical Companiojt. Gangrene. Mortification. Oanglion. A knot; applied to the en- largement of nerves. Gastric. Appertaining to the stomach. Gastritis, gastralgia. Inflammation and pain of the stomach. Gelatin. Known as jelly. Gestation. Pregnancy. Glottis. The opening of the larynx. Emmatemesis. Vomiting of blood. Hoemoptysis. Spitting blood. Hectic. A fever arising from Internal suppuration. Hemiplegia. Palsy of one half of the body. Hemorrhage. A bleeding. Hemorrhoids. Bleeding piles. Hepatic. Belonging to the liver. Hernia. A rupture. Humor. A fluid of the body. Hygiene. Relating to the regimen, diet, etc., of the sick. Hium, Hiac. Relating to the haunch- bone or region of the body near it. Induration. A hardening. Inferior The lower part. Insalivation. Mixing the food with sa- liva. Integument. An external covering. Intercostal. Between the ribs. Issue. An artificial ulcer, kept open for the purpose of producing a discharge. Jugular. Belonging to the throat. Labia. The lips; applied to the exter- nal female genitals. Lactation. Nursing. Larynx. The superior opening of the windpipe. Laxative. A gentle purge. Leucorrhoea. The whites. Ligament. A strong membrane con- necting the bones. Ligature. A thread. liniment. An oily fluid. Liquor amnii. The fluid in which the foetus floats. Lochia. The cleanings, or show, after labor. Lumbar. Relating to the loins. Lymph. A thin white, or rose-colored fluid found in the lymphatic vessels. Lymphatic. Relating to lymph ; a cold, relaxed habit of body. Marasmus. "Wasting away. Ifarita I. Relating to a husband. Masticate. To chew. Meatus urinariua. Opening of the ure- thra. Meconium. The excrement found in the intestines of the child at birth. Membrane. A thin expanding and elas- tic substance. Menorrhagia. Immoderate flow of the menses; flooding. Menses, menstruation. The monthly dis- charge from the vagina of females. Micturition. Voiding of urine. Morbific. Diseased. Mucilage, mucilaginous. Of a gummy or slimy character. Mucus. A viscid fluid secreted by mu- couB membranes. Narcotic. Anodyne; a medicine that produces sleep. Ifasal. Relating to the nose. JVates. The fleshy parts on which we sit. Nerve. A long white cord transmitting sensation. Neuralgia. Pain in a nerve. Nitrogen. A component of the atmoB. phere. Normal. Regular ; healthy. Nucleus. That about which something is formed. Nutrition. Nourishing. Nymphomania. Uncontrollable desire in women for coition. (Edema. A swelling; dropsical. Ophthalmia. Inflammation of the eye. Appendix. 499 Opiate. That which procures sleep. Organic. Belonging to a part of the body; a structural disease. Organism. Organized structure. 08. A bone; the mouth. Osseous. Bony. Ovaria, Ovarium, Ovary. The organs that contain the female ova,. Oxygen. A gas which forms the vital part of the air. Paralysis. The palsy. Parenchymatous. Relathig to the cellu- lar substance. Parturient, parturition. Childbirth. PatJiology, pathological. Diseased. Pectoral. Belonging to the chest. Pelvis. The bony cavity below the ab- domen. Penis. The male organ. Percussio7i. The act of striking against the abdomen. * Peritoneum. The membrane that sur- rounds the whole contents of the abdo- men and pelvis. Peritonitis. Inflammation of the peri- toneum. Perspiration. The vapor thatpasses off from the skin. Pessary. An instrument to support the uterus by being introduced into the vagina. Phthisis. Pulmonary consumption. Physiology. The science of life. Placenta. The afterbirth. Plethora. An excess of blood. Pleurisy. Inflammation of the mem- brane that surrounds the lungs. Postmortem. After death. Pregnancy. Being with child. Prolapsus. A slipping-down. Puberty. Ripe age. Pihes. The part covered with hair above the genitals. Pulmonary. Belonging to the lungs. Purgative. Whatever produces increased discharges from the bowels. Pus. A matter found in abscesses and Rachitic. Rickety. Rectum. The last portion of the large intestines, terminating in the anus. Regimen. The diet, etc., of the sick. Reproduction. Producing anew. Resolution. Termination of inflamma. tion without disorganization. Sacrum. A bone belonging to the pel- vis. Saliva. The fluid that is secreted in the mouth. Salivation. An increased flow of saliva. Sanguine. Bloody. Scirrhus. Cancer. Scrotum. The skin that covers the male testicles. Sedative. Whatever diminishes animal energy. Serum, serous. The watery part of the blood. Simulate. To appear like; counterfeit. Spine, spinal. The backbone. Stethoscope. An instrument for making out internal diseases by the abnormal sounds. Strumous. Scrofulous. Strychnine. A stimulant; poisonous substance. Suppurate. The formation of pus. Sutures. The union of the bones of the Tendon. A white, hard cord by which a muscle is attached to a bone. Tenesmus. A continual inclination to go to stool without a discharge. Therapeutical. Means employed to cure disease. Thorax, thoracic. The chest ; relating to the chest. Tissue. The texture of an organ. Trachea. The windpipe. Trunk. The body apart from the limbs. Tubercle, tuberculous. Scrofula; a hard, indolent tumor in the lungs and other glandular parts. Ulceration. A purulent solution of any part of the body. 500 Woman s Medical Companion. Umbilical cord. The navel string or Veriebrce, vertebral. The spinal col- cord which connects the child with the umn or backbone. placenta. Vertex. The crown of the head. Umbilicus. The navel. Vertigo. Dizziness. Uterus. The womb. Vesicle. An elevation of the scarf-skin, containing a watery fluid. Vascular. Relating to the veins. Vicarious. Instead of. Veins. The vessels which return the Virus. The poison of contagion. blood to the heart. Viscera. Applied to the internal organs Venery, venereal. Intercourse of the of the body. sexes. Viscid. Sticky ; ropy. Venous. Relating to the blood of the Vulva. The passage from the external veins. generative organs to the womb. CODMAISr & SI1UI?>TLEFF, 13 & 15 TREMONT STREET, BOSTON, MANUFACTUKERS AND IMPOKTEE8 OF SURGICAL AND DENTAL INSTRUMENTS, Besides a complete assortment of articles intended for the exclusive use of the Medical and Dental professions, have always in store, at the lowest prices, a great variety of the following articles, suited to the wants of the general public : — Self-Propelling Chair for Invalids. A LARGE ASSORTMENT OF BEST PATTERNS from which to select to meet the requirements of each case. If conven- ient, persons requiring Trusses should call at our establish- ment, where they can have a suitable Truss carefully fitted by a competent and experienced person familiar with the anatomy of hernia. When a call in person is impracticable, a careful description should be sent, stating whether the rupture is on the right or left side ; also the measure around the person two inches below the top of the hip-bone. If the rupture is at the navel, the measure should be around the body at the navel. N.B. — Ladies attended by those of their own sex. ^ EI^J^^STIC HOSE, For Varicose "Veins, Swollen Limbs, and Weak Joints. Of these goods we have several classes of silk and cotton, pos- sessing diflferent degrees of elasticity, the stout silk being usually the most satisfactory. The sizes are full length (of leg), three-quarters, half, or knee hose, knee-caj), and ank- lets. Unusual sizes made to order. ALSO, STEAM AND HAND ATOMIZERS IN GREAT VARIETY. NASAL DOUCHE, Elastic and Spring Abdominal Supporters, Shoulder Braces, Suspensory Bandages, Apparatus for Weak Ankles, Bow-Legs, Club-Feet, etc. Also Crutches of various and most improved kinds; Syringes, Rubber Urinals, to wear on the person day or night, for males end females ; Galvanic Batteries, Hearing Trumpets. Auricles, and Conversation Tubes for the Deaf; together with many other articles for use of the Sick and Invalids. A Gold Mkdat. has lately been awarded us by the Middlesex Mechanics' Association, as will be Been from the following rt-poit, signed by a leading New England Surgeon and Physician : — ** 1503. CODMAN & SnUETLEFF, Boston, Mass. One Case Surgical Instruments and Atomizers. "The Committee have no hesitation in awarding for this superb exhibition the highest premium. . . . The various other instruments for inhalation of Atomized Liquors, and for Local Anaesthesia, were all apparently faultless, both in design and workmanship. The exhibitera are regarded as more especially deserving of the highest token of merit for having produced nothing except of their own manufacture. GOLi> Medal. (Signed), OILMAN Kimball, M.D., Chairman." In ordering Elastic Rose refer to letters of cut, stating length and measicre around at points indicated. THE AUTHOR OF THIS WORK, EREFK J. GARBIT, M.D., OF 124 TREMONT ST., BOSTON, MASS., Is an Alumnus of the University of London, England (Class of 1858), a Graduate of the Medical Department of that University, and a Member of the Royal College of Physicians, England, and has had thirty years' practical experience in the treat, ment of the DISEASES OF WOMEN AND CHILDREN, MENTAL AND NERVOUS DISORDERS, AND CHRONIC DISEASES GENERALLY, Having been for more than twenty years connected professionally •vrith Barthol- omew's and Guy's Hospitals in London ; and subsequently (in consequence of the Financial Crisis in England in 1866) removing to New Tork, where he was engaged for ten years in Medical Practice in the principal Hospitals, Dispensaries, and other Public Institutions. He has made this important and prevalent class of Aflfectiona his special subject of investigation and study, and has met with uniform and signal success in the treatment of the numerous cases which have come under his notice. He can be seen at his office, as above, From 7 to 9 A.M., 2 to 4, and 5 to 9 P.M. Correspondents by mail will receive prompt attention on description of symptoms and transmission of Fee of Two Dollars ; or will be visitedat residence, on payment of Travelling Expenses and Consultation Fee. It is, however, always desirable to have a Personal Interview with the Patient, if practicable. The JiosT UNEXCEPTIONABLE REFERENCES can be given, to patients and others, as to professional skill, eiaJp , Cf (I- X 8 9 5 'ft iJoFFICE, 124 Tremont St., Boston, Mass. A^- ,V;j^}^^^ ^^' /o.. r-'^s^r-. .%. A^ ''^ I.* * o 1 V ^^. s "oo^ ,-^ -^A /^^ '^./^"^ ^~^\nO^ oo^ x> .^^' * LIBRARY OF CONGRESS ll1ll!fl!!ll!'i!ll1iTIL 022 216 009 1