ir.JIunc J^l •.RS IBA])ILTin)OI£R. '^' MOTHER'S MEDICAL INSTRUCTOR: BEISG A COMPLETE COURSE OF DIRECTIONS FOR THE MEDICAL MANAGEMENT OF MOTHERS AXD CHILDREN. ALEXANDER STOOKES, L.S.A., F.L.C.M. LONDON : HOULSTON AND STONEMAN, I'ATERNOSTER ROW. LONDON : GEORGE WOODFALL AXD SON, ASGEL COURT, SKIirXEP. STREET. PREFACE. Tins little book owes its orio'in to the suggestion of my friend Mr. Arthur Freeling, who has lately published a work, entitled " Tlie Young Bride's Booli,'' which, containing advice to young married women on many most important subjects, yet left his object incomplete without a medical accom- paniment. Often as I have found the want of an epitome of this nature, it is probable that, but for his sugp^estion, I might not have prepared this little Brochure. My o])ject has been to give the young wife the experience of the matron, not to make her a Quack Doc- tor ; to give her such directions as may enable her to ascertain when ])rcgnancy has taken place, and such information and advice as will remove many anxie- ties and much inconvenience during 2000449 ' 4 PREFACE. the months of gestation * ; T\-liich will enable her so to prepare for the hour of nature's sorrow, as to avoid much of the pain which too often attends it, and which is frequently occasioned by self- nep^lect during an earlier period ; which will enable her to know that the requi- sites for the lying-in room are ready before the moment of their being- wanted arrives; that she has proper support and attendance for that time of anxiety ; that her baby has the proper necessaries prepared for its reception ; and that when removed from the se- clusion of her chamber, she may be able to watch its progress to maturity with precocious experience. I have advised her when medical attendance will be necessary, that she may not delay it until the presence of a medical man will be futile ; and I have directed her to such simple reme- dies as will prevent her uselessly sum- moning him, when his attendance is not required. * The months of pregnancy. PREFACE. O Knowing that delicacy will fre- quently prevent the young wife from asking questions, even on points upon which she feels considerable and natu- ral anxiety, I have gone at some length into the symptoms, and also the diseases of pregnancy ; and I trust this little tome will be the means of allay- ing much anxiety, and of alleviating much pain, in this, the most interesting portion of the creation. ALEXANDER STOOKES. PREFACE TO THE TENTH EDITION. The great favour shown by the public to his little book has induced the author to make some additions, which he flatters himself will make it more generally useful. CHAPTER I. ON PREGNANCY. ITS SIGNS, WITH A FEVT CAUTIONS KESPECTING THEII. Signs of Pregnancy. — The Deity has implanted in the breast of every woman a desire for ofFsprino; ; hence soon after marria2;e arises the anxiety to ascertain the pi'obability of this hope being realized. To enable the young wife to do so, without recourse to per- sonal inquiry, I shall give at some length the signs of pregnancy. These are liable to much variation, inasmuch as some pass through the whole period of gestation with comparatively little inconvenience, and first become aware of their situation by the quickening of the embryo, and the enlargement of 8 GEIs^ERAL SYMPTOMS. the abdomen. Most persons, however, are not so fortunate, and have some of the following symptoms : none of which can, however, be depended upon un- supported ; but when several have been experienced, and they have fol- lowed with a descree of regularity, the fact mav be considered as almost esta- blished.' General Symptoms. — When preg- nancy has taken place, the face usually becomes pale, the under part of the lower eye-lid is of a leaden hue, the features become sharper, and not un- frequently the person becomes thinner ; the temper is often more than usually irritable ; sickness in the morning and after meals, feverishness, indio-estion, heartburn, languor during the day, disturbed sleep and disagreeable dreams at night, are often the accompaniments of pregnancy ; — a sense of bearing down ; an irritation about the bladder and the seat ; an unaccustomed flow of urine, are also not uncommon sj^mp- toms in the early stage of pregnancy. State of the Umbilicus or Na- GENERAL SYMPTOMS. 9 VEL. — This, many have considered, presents one of the most decisive evi- dences of pregnancy. When it has taken place, the navel is drawn inwards and downwards during the two first months ; in the third, it is natural ; in the fourth, it is not so hollow as before conception ; in the fifth and sixth, it is almost level with the surrounding sur- face ; in the latter part of the sixth and the seventh month, it is quite so ; while, towards the latter month of gestation, it projects considerably. If these symp- toms follow in regular succession, they may be considered decisive signs of pregnancy. Ceasing to be Unwell is one of the most common, and generally an early symptom of pregnancy ; but it is by no means a certain sign, as it may arise from many other causes ; if men- struation has been regular up to the time of marriage, it is good presump- tive evidence. Such, however, are the caprices of nature, that in some persons this evidence is never decidedly mani- fested ; in such cases, it will usually be 10 GENERAL SYMPTOMS. found that the discharge is smaller in quantity, returns at irregular intervals, and does not last the usual time. EXLARGEMEXT OF THE BrEASTS. — This is an appearance, which, if un- accompanied bv other signs, is of little value ; but if it has been preceded by somewhat of a diminution of their size, and this enlargement then takes place about the third month after the pre- ceding sign, and is accompanied by a slightly painful and prickling sensa- tion ; with a sort of knobular external feeling when the hand is applied to the surface, and particularly if there is occasionally a milky discharge from the nipple, it may be considered a pre- sumptive evidence of pregnancy. It frequently occurs that the breast be- comes enlaro-ed shortly after marriage, from the person becoming stouter ; but in this case the whole pei*son experi- ences the same change, and the breasts are soft and have not that knobular feeling to the touch. TURGESCEXCE, OR SWELLING OF THE Nipple, and the appearance of GENERAL SYMPTOMS. 11 the areola, (or circle surrounding; the nipple,) are by many writers considered as among the most decisive of those signs of pregnancy which are exhibited previous to quickening. In fair wo- men, and particularly with their first child, the change in the ai-eola is very manifest : from its beautiful roseate hue it turns to a dusky brown shade ; it becomes more extensive and con- tinues darkening until the term of ges- tation is completed. As pregnancy advances, a number of slight excres- cences, resembling small pimples, will also frequently appear tliereon, and when the individual has had children, or is of a dark complexion, this ap- pearance is one of the best criterions for determining the true areola of preg- nancy. Morning Sickness frequently oc- curs soon after conception : it is occa- sioned by the weight of the womb pressing; downwards, and thereby caus- ing irritation and sympathetic action. It is neither a necessary nor an infalli- ble sign of pregnancy, as sickness may 12 GENERAL SYMPTOMS. arise from other causes, and by some individuals it is never experienced. It may be observed, however, that it has this pecuharity, viz. that it does not affect the general health, nor does it usually impair the appetite. ExlarctEmext of the Abdomen. — At an early period of gestation, the abdomen usually becomes flatter, but it is not until about the third month that the enlargement is perceptible. Quickening is perhaps the first sensation which proves to the mother the vitality of her child (the imagina- tion might picture it as the moment when the soul first takes possession of its earthly tenement). The feeling is so peculiar and so sudden, that it often occasions fainting and hysteria. The sensation, which has been likened to the fluttering of a bird, is occasioned by the womb suddenly rising from the pelvis*, where the motion of the child could not be felt, to a part that is more * The peh-is is that part of the body which is defined by the right aad left hip, and the bone at the lower part of the front of the body and the back bone. GENERAL SYMPTOMS. 13 sensible. It is not uncommon for a few drops of blood to escape from the y.teriis'^, at the moment of the first sensation. Qiiickeninp^ usually takes place about the fourth month or eighteenth week; but in sonip cases it occurs as early as the third month, and as late as the fifth. At first the move- ments of the child are feeble ; but in a short time they become strong, and its motions are felt not only internally but very distinctly by applying the hand to the abdomen. Instances are of fre- quent occurrence, when the motions of the child are so lively as to occasion much distress to the parent : but a sen- sation resembling this cannot be de- pended on as a proof of pregnancy, if it be unsupported. Other Symptoms there are which may be denominated Sensible, which prove the fact of pregnancy much more satisfactorily than any here related : such are ascertained by Auscultation and Balottement, and can only be de- cided on by an accoucheur. * Uterus, the vomh. 14 CHAPTER II. ON PEEGNANCY. CIECUiISTA>-CES WHICH MAY INDUCE SYMPTOMS EE- SEMBLIXG PREGXAKCT ON THE DURATION OP PKEGXAKC {, AND THE MODE OF P.ECKONING ON DIET, DEESS, EXERCISE, LATE HOUES, BLOOD-LET- TING ON LONGINGS, AND THE I:;FLUENCE 0? THE IMAGINATION UPON THE CHILD. Obstruction of the Mexses, or Periodical Discharge. — So many diseases may produce this effect, that there is not space here to go into par- ticulars ; suffice it to warn those of my readers, especially who are married late in life, that this obstruction, though continued for months, is no proof of ])regnancy, although, as before said, if the individual be young, and has been regular up to the time of marriage, it may be considei'ed as presumptive evi- dence. quickening. 15 Enlargement of the Breasts may arise from increased obesity or from the stoppage of the menses. Sickness, Heartburn, Languor, Distension of the Abdomen, may each arise' from indigestion. Quickening. — Persons who marry late in liie, are most liable to be de- ceived by an appearance of quickening when pregnancy has not taken place ; and, even medical men have been de- ceived by this appearance when they have relied on it unsupported by other evidence ; this sensation is occasioned by the collection of wind in the bowels, which, even to the touch, resembles the movements of a chikl. Enlargement of the Abdomen may arise from dropsy, disease of the ovum, excessive obesit}', and many other causes, which brings us to the conclusion with which we set out, viz., that, althoufrh each of the s'mns of pregnancy enumerated may be valuable as accessories, yet, isolated, neither is an infalHble one of pregnancy. Duration of Pregnancy, and ]6 RECKONING. Mode of Reckoning. — The duration of pregnancy seldom exceeds forty weeks, or nine calendar months, al- though it sometimes continues as long as forty-five weeks, and sometimes not more than thirty-seven weeks ; without, in either case diminishing or adding to the size of the child or the perfection of its formation. Births which occur within the last mentioned period will be treated of under the head of prema- ture labours. Reckoning. — The usual mode is to calculate from the last time of being unwell, as impregnation generally takes place within fifteen days, or perhaps more often within a week after : this, therefore, is considered the best datum by which to reckon ; although some calculate with great correctness from the period of quickening, allowing four months for the past time. Neither of these data can usually be depended upon so as to foretel the event to a day, although I have known ladies predict the event within a week of its occurrence ; and a celebrated accoucheur relates a case of ON DIET. 17 a lady who informed him, shortly after quickenino;, that she would be confined on Lord Mayor's Day, the 9th of No- vember, and actually verified her pre- diction. Ox\ Diet, Exercise, Blood-let- ting, AND the state OF THE BoWELS, DURING Pregnancy. — Diet. It is a popular error that an individual in a state of pregnancy requires more nou- rishment than at any other time. I would indeed rather advise a decrease than an increase of the usual quantity of food. It is very probable that the appetite will become more craving, but this should not be indulged ; as, if so, it will become voracious and cause much pain and inconvenience, and frequently produce severe attacks of indigestion, flatulence, vomiting, spasm, diarrhoea, (see article " Costiveness.") The young mother in particular will foci a still more imperative call upon her self-denial, when she is informed that the indulg- ence of this capricious appetite must injure her own health, and consequently impair that of her child. If, liowever^ B 18 ox DIET. the general health was not good before pregnancy — if the appetite was very- small — and if after pregnancy the health is improved and consequently the appetite proportionably and ration- ally increased, there can then be no ob- jection to its moderate gratification; always, however, keeping in view the fact, that most people eat much more than is necessary ; make too much rather than too little blood, and that this latter event is now particularly ob- jectionable. The simplest food, and that which contains most nourishment in the smallest compass, is the most ap- propriate for pregnant women ; muci- laginous aliments, such as turnips, pars- nips, cabbage, carrots, and asparagus, should be avoided or partaken of spar- ingly, and always with as much black or red pepper as convenient. Fried, baked, salted and spiced meats ought to be wholly avoided; and whatever may be the food taken, let it be well masticated. Stimulants, such as wines, spirits, or cordials, must be avoided, or taken with great moderation. Tea, cof- DRESS EXERCISE. 19 fee, chocolate, and indeed liquids of any kind taken in excess, are, particularly in a state of pren;nancy, highly injurious. Dress. — The dress of a pregnant woman should be always loose, tight lacing must on no account be allowed ; it prevents the development of the breasts and abdomen ; impedes the growth of the infant, causes inflamed breasts, sore nipples, and all the disas- trous consequences which result there- from ; occasioning acute suffering to the mother, and frequently depriving her of the comfort of suckling her child. In the advanced stage of pregnancy it will frequently produce palpitation of the heart, swelUng of the legs and veins, costiveness, and scalding urinary eva- cuations. Obstinate coughs, and spit- ting of blood, also not unfrequently ac- crue from the same cause. Exercise. — Popular errorsupon this subject of a directly opposite character exist, both of which must be avoided. The first is, that the individual cannot take too much exercise ; hence the honev-moon (as it is termed) is spent b2 20 EXERCISE. in running all over the country — seeing every thing that is to be seen ; and thus going through fatigue which in the ordinary routine of existence would be shrunk from. Other persons, whose station will not admit of this sort of dis- sipation, make this period a season of revelling, parties, and late hours, and confine their excursions to the Sunday; this is frequently employed in long rides or walks. Thus passes the first month or two of pregnancy. Illness and debility naturally ensue ; the par- ties become alarmed — rest is recom- mended — is probably of service, and thus leads to an opposite evil in the later months, i. e. total seclusion and abstinence from exercise. The second error is the reverse of this ; some sup- pose that, in the early months of gesta- tion, exercise should be wholly avoided, and in the latter months that it may be resorted to without restraint: this is even a more fatal error. I would wish mothers to pay particular attention to the following remarks :■ — Be it then observed, that, after con- EXERCISE. 21 ception has taken place, the individual should for days take but little exercise ; her mind should be kept perfectly quiet, and all exciting causes should be avoid- ed. Moderate exercise is, however, pro- per at every period of gestation, unless symptoms of miscarriage present them- selves. Walking is the best exercise, but it should not be continued until fatigue is produced. Sailing is a very beneficial mode of exercise, if the season be favourable. Long journeys — long walks — running or dancing, should be particularly avoided : one -would ima- gine it superfluous to caution a preg- nant woman against the latter, particu- larly if she be in an advanced stage, as delicacy might naturally be supposed a sufficient barrier .to such a gratification; unfortunately, however, we too fre- quently are called upon to counteract the consequence of this indelicate im- prudence, to believe that all can be con- fined by such a restraint. We are in- deed sometimes tempted to believe that the intellect of such people is deposited in their heels instead of their heads, 22 EXERCISE. sucli is the recklessness with which it is prosecuted. Violent exercise is the ordinary cause of floodings from the womb : abortion, rupture, or premature labour may follow ; and be it recol- lected that miscari'iage is far more in- jurious than parturition at the proper period. Lamentable instances of its effects are continually brought under the observation of every medical prac- titioner: few, indeed, whose practice has been extensive, but have seen the young and lovely thus hurrying onwards to a premature grave, from the momentary indulo;ence of a whim — a vanity — and in spite of his advice, and in defiance of his warnings. As the period of parturition ap- proaches more rest is required than in the earlier months; still, however, recollect that air and exercise, if they can be taken without fatigue, will be highly beneficial. Many cases will arise in which exercise must be avoid- ed ; I mean when there is a tendency to miscarriage ; I have known indi- viduals who have been thus necessarily LATE HOURS. 23 confined to their apartment, in a re- clininrr position, or even to their bed, for days, weeks, and even months. I would strongly advise any who have miscarried to take but little exercise, to lie much upon a couch during the day, and most scrupulously to avoid dancing; such, however, has been the infatuation of some ladies, that, after repeated miscarriages, this trifling gra- tification could not be refrained from. Late Hours are highly injurious to the pregnant woman ; she should re- tire to bed early, and take from seven to nine hours' repose ; common sense and ordinary experience must force this on her attention ; the lethargy and fati^^ue which affects her towards night ■ — the desire to be disburdened of her clothes — the refreshment which she ex- periences by their being loosened from their ordinary iastenings, all point out to her the requirements of nature: how Meak, indeed, how wicked then is it to permit these importuniiks of nature to be unattended to : my fair readers may 24 BLOOD-LETTINO, ETC. rely upon the fact that they must suffer eventually if they neglect her require- ments, and not they only, but their off- spring ; for this desire after rest is one of those demands which arise out of an organic law, which cannot be dis- regarded without subsequent punish- ment. Blood-lettixg is supposed by ig- norant persons to be a necessary opera- tion, which must occasionally be per- formed during pregnancy. This is an error as absurd as it is popular: in a few cases it may l)e required — in the majority it assuredly would be produc- tive of much mischief. Let it never be done except under the advice of YOUR MEDICAL ATTENDANT. State of the Bowels. — No per- son can be in health who has not an alvine evacuation perhaps daily. How very necessary, therefore, is at- tention to the state of the bowels dur- ing pregnancy. Indigestion, hysteria, flatulency, spasms, and many other ills, are the consequence of inatten- mother's lilAGINATION, ETC. 25 tion to this important particular. For directions upon this subject, see " Costiveness." On the Influence of the Mother's Imagination upon the Child. — The supposition that the mother's imagination, her longin2;Sj or her disgusts, can aft'ect the form, or mark the chikl in her womb, is opposed to science and the experience of Obstetricians*, as Avell as to i-eason and common sense. The best writers aii^ree, that the circulation even of the blood between the mother and the child is interrupted, and that there is no nervous connection whateverf; in fact, that the only means of communi- cation between them, viz., the jAacenta^ has no nerves, consequently, that there can bo no nervous influence in opera- * Obstetricians — Midwifery practitioners. + The simplest proof that I can refer to of the non-existence of nervous connection between mother and child is the fact, that no pain is ex- piricnced by either when the umbilical cord (or navel string) is dissevered. If there were nerves, acute pain would be experienced by both. 26 INFLUENCE OF THE MOTHER's tion. If \ve appeal to common sense, how decided is reason in opposition to the absurd belief. Tlie embryo* has in itself the elements of all the parts of the future child, how then can ima- gination destroy those elements? The foetus beino; perfect in all its parts, how can the imagination dissever a limb, or confer an additional one ? Can this mental power add an inch to the mother's own stature, a finger to her ov>m hand, a mark upon her own per- son ? in herself she is of course subject to the whole influence of the nervous system, the seat of the imagination ; yet did we never hear of any one hav- ing had the hardihood to assert the ex- istence of this power. If then this be impossible, as regards herself, how can the imagination thus act upon a being with whom she has no nervous connec- tion whatever ? Again : can the will * The tema emhryo is applied to the living being, during the three first months of pregnancy, or until its different parts are distinct from each other. The term jcetns, during the remainder of its sojourn in the womb. IMAGINATION ON THE CHILD. 27 of the mother determine tlie sex of her child? Can her imagination make it larp:e or small, dark or fair ? Can she impart to it her own features, or those of its father? Some authorities have asserted, that the latter might be de- termined by the comparative vigour of the parents at the moment of con- ception, but none have pretended that it could be the result of imagination. Thus then is anatomical science and common sense opposed to the belief. Let us examine the experience of me- dical men. Dr. Hunter particularly directed his attention to the subject, and states that, in every one of 2000 cases the woman was asked if she had been alarmed by any appearance, in- jured by any accident, or longed after any food ; that, in the major part of the cases, the woman asserted that she had longed, or had been frightened or disgusted ; but that in no one of the 2000 cases did he meet with a coincidence. He met with various ec- centricities of nature Avhere no cause was assigned, and found none where 28 INFLUENCE OF THE MOTHEK's the mother had been fearfully appre- hensive of the appearance of such. Modern writers, with very few excep- tions, are opposed to the imagina- tive theory. The celebrated naturalist, Buffon, says, we might as well expect that if a hen on her nest were to see the neck of a cock twisted that her chicks would be hatched with crooked necks, as believe that a child would be born with dislocated limbs through the mother having seen a man broken on the wheel ; and certainly no slight would be likely to create so horrible an eftect upon the imao-ination as the witnessing of this awful punishment. Obstetricians assert that, in almost ever}'" case women will inform them they have had either frights, disgusts, or longings ; yet there is not one child in 5000 vrhich is born with a blemish. We have now proved that anatomical science, common sense, the experience of Obstetricians, and the experience of ever}^ one who has inquired, are all against this absurd belief; and, there- fore, that the mother may divest her IMAGINATION ON THE CHILD. 29 mind of any fear of the consequences to her child. Let her be frightened by rats, cats, bears, or baboons ; let her long for mulberries or goosehen'ics, she may be certainly assured that the effects neither of her longings nor her disgusts will be entailed upon her in- fant; and that, in fact, from the time of conception, the child hns, as it were, an existence independent of the mother, except so far as the circulation is con- cerned, which nourishes and brings the embryo to perfection. — " As the tree falleth, so it lieth;" as the child is conceived, so will it be brought forth, if not destroyed. I would, however, advise w^omen to avoid all objects of disgust, not for fear of the consequences to tlieir child, but for fear of their exciting that nervous irritability, of which pregnant women are often so susceptible, and which fre- quently occasions so much mental pain. If the imagination be excited, the mo- ther will anticipate all manner of evils, w^hich evils do not and cannot exist; but the imagination may cause aa 30 INFLUENCE OF THE IMAGINATION. mucli temporary anxiety as though the evil was inevitable and irremediable. I shall close these memoranda by re- markinn;, that the marks and deformi- ties of infants can be philosophically accounted for ; but as it would involve much delicate discussion fully to ex- plain these causes, and it could be of use only to the professional man, who is of course expected not to require the explanation, I have thought it best to omit it. 31 CHAPTER III. ON THE DISEASES OF PREGNANCY. THE MANAGKMENT OP THE NIPPLES BEFOP.E CON- FINEMENT — OF ABOPvTION, MISCARRIAGE, AND PRE- MATURE LABOUR — SYMPTOMS PRECEDING LABOUR OF THE CHAMBER OP ACCOUCHEMENT AND ITS REQUISITES. By the diseases of pregnancy we un- derstand those which arise from preg- nancy as their cause, or which, from their accidental connection with it, re- quire a modified treatment. Of the more common forms I shall now give a brief description. Did I enter into all, I should fill a volume, and cause needless alarm to my readers, who are to recollect that pregnancy does not ne- cessarily entail any diseases ; the in- habitants of many regions, who live in a natural state, have little inconve- nience even from paturition ; and they 32 VOMITING. will be free from pain and sickness, in the proportion that they abandon ex- citing causes, and attend to the dictates of nature : even in our artificial state of society there is no reason for anx- iety ; ^vomen in general do well — I had almost said invariably do Avell — when they attend to the rules laid down for the preservation of their general health. YoMiTixG generally commences shortly after conception, and leaves on quickening. It is usually most troublesome on rising, and hence has obtained the name of Morning Sick- ness, though its attacks are not unfre- quent after meals. Sometimes it is veiy violent and continues all day, and every thino; taken into the stomach is rejected. This form of the disease requires great attention, and the pre- sence of a medical man. The former will generally be relieved by a mixture composed of a scruple of carbonate of potash, dissolved in a wine glass of water, and taken with a tablespoonful of lemon-juice. These draughts may HEARTBURN — SPASMS. 33 be repeated thrice a dny if the sickness be troublesome ; or half a teaspoonful of citrate of potash in water every hour, until the sickness is removed. A little cold camomile tea during the day is of service. If there be, in addition, pain or pressure at the pit of the stomacli, half-a-dozen leeches may afford ease; but in such case I uould rather you should apply for advice, particularly if a rag dipped in laudanum and applied to the part does not give relief 5 you may, however, try this first. The bowels should be kept well open by some of the medicines recommended imdcr the head of " Constipation." Heartburx and acrid Eructa- tions denote acid in the stomach, and are relieved by opening the bowels with magnesia, or taking half a tea- spoonful of carbonate of soda, or a wine-glassful of lime-water in milk, three times a day, or when required. Spasms, or Cramp of Stomach AND BowEis. If slight, fomentations of poppy heads and camomile iiot^ers c 34 CONSTIPATION. should be applied, and ten drops of laudanum and a teaspoonfiil of tincture of rhubarb be taken in an ounce of ani- seed water every fouith hour. If yio- lent, advice must be taken. Constipation is very usual in preg- nancy, and should be carefully guarded against, as it is the groundAvork of most of the diseases that arise at that period. A lavement or clyster, administered every morning, (composed of a hand- ful of salt and a pint of water or thin gruel,) will frequently afford relief: it should be given in a recumbent posi- tion, to prevent the pressure of tiie womb upon the lower part of the bowels, and I would advise the uri- nary bladder to be emptied before the application ; if the above is not sufficiently active, add a tablespoonful of castor oil. Either of the following dcmiestic medicines taken in the usual quantities will also generally effect the same object — Castor oil, rliubarb and magnesia, senna tea and nianna ; or the ibllowinfr draughts or pills nuiv be t^'kcn : — Dr:!V(jiiiis — Take of sulphate DIARRHCEA, OR PURGING. 35 of magnesia half an ounce, of tincture of senna and of syrup of buckthorn two drachms, of infusion of senna one ounce. Mix — to be taken in the morn- ing. Pills — Take of compound pill of rhubarb one drachm ; divide it into twelve pills ; one, two, or three to be taken at bed-time. These are mild. Take compound extract of colocynth, and of compound aloes pills, each half a drachm. Divide into twelve pills; one, two, or three to be taken at bed- time. These are stronger ^-^ DiARRHCEA, OR PURGINO. Tllis often arises from the bowels having been constipated. Take half an ounce of castor oil and ten drops of lauda- num ; or a dose of magnesia and rhu- barb; and if after the opei-ation the purging continues, take two or three tablcspoonfuls of the following every fourth hour: — Of chalk mixture four ounces, aromatic confection half a drachm, tincture of Oj)ium twenty drops. This will generally check it. * Tliesc medicines may be got from nuy druggist. c '2 do PILES — JAUNDICE. Should it not, immediately apply for medical advice. Piles are small tumours at the verge of the seat, which sometimes bleed. They generally arise from constipa- tion ; and the bowels should be kept open as directed in " Constipation," or by small doses of sulphur and cream of tartar in treacle. The following ointment will afford great relief: Take of powder of nut-galls one drachm, of powdered camphor half a drachm, of powdered opium one scruple, of oint- ment of raarshmallows one ounce. Mix — and let the size of a small nut be rubbed on thrice a day. If the piles are very painful six leeches should be applied, and the part frequently fo- mented. JaUxXDICE arises sometimes about the fourth month, and disappears at the eighth or ninth. If the tinge is slight, taking three grains of the blue pill at night, and the following mixture in the day, will be sufficient to remove it ; but if very great, advice should be taken. Take* of carbonate of soda two IRRITATION OF THE BLADDER, ETC. 37 drachms, powder of rhubarb one drachm, extract of taraxacum one drachm, water eight ounces ; mix — Two tablespoonfuls to be taken three times a diiy. Itching of the Genitals is often troublesome. The bowels should be kept open with seidlitz powders, Epsom or Cheltenham salts, and a spunge wet with lead water often applied to the parts. Irritation of the Bladder, Re- tention OF THE Urine, or diffi- culty OF passing it, require the; bowels to be kept open. Drinks of linseed tea, barley water, &c., should be taken freely; and the })atient should recline on a sofa. Great care should likewise be taken not to retain the urine long. Half a drachm of tincture of henbane at bed-time is often of ser- vice. Involuntary Passing the Urine WHEN coughing OR LAUGHING is troublesome, but not to be cured. It is considered a favourable sign : rest is the only palliative. SS HYSTERIC AFFECTIONS. Palpitation of the Heaiit and Difficulty of Breathing are best relieved by rest, and takino^ during tiie paroxysm a few drops of ether, eau de luce, spirit of hartshorn, spirit of red lav(Mider or volatile tincture of valerian, in Mater. If either be very distressing, medical advice should be taken. Fainting is most usual during the first three or four months. It gene- rally comes on after exertion, agitation, purging, or exposure to heat. The pa- tient should be laid down with the head low ; air should be freely admitted ; the dress loosened; the face sprinkled ■with water ; the forehead and temples rubbed with ether, eau de luce, Hun- gary water, or eau de cologne; and, if possible, a few drops of any of the things mentioned in the article upon " Palpitation" may be given. Hysteric Affections usually arise from the same causes as fainting. The face becomes pale and distorted, ac- companied by faintness and convulsive movements ; sometimes by screams and sobs, Avhich generally end by a copious COUGH SPITTING OF BLOOD, ETC. 39 flow of tears. Let the forehead and temples be riil)bed with eaii de co- lon;ne, and the other means adopted which are advised under the head " Fainting." Cough. — It is generally dry and frequently difficult of cure, and may depend on so many causes, that advice from the medical attendant had better be sought. Spitting, or Vomiting of Blood, call for immediate professional assist- ance. Headache. — If severe and constant and there is fulness of blood indicated by a flushed face, dull or bloodshot eyes, sense of giddiness, heaviness over the eyes or in the skull, and the person is far advanced in pregnancy, advice should be taken n-ithout loss of time. All headaches are, however, not dangerous; they may arise from costiveness, indigestion, or nervousness. There is then a bad taste in the mouth, acidity, slight sickness, and the pain is confined to one part. This description of headache is relieved by opening the 40 TOOTHACHE. bowels and keeping the forehead wet with vinegar and water, or dihited Hungary water. Toothache often attacks sound teeth. In such cases extraction can be of no service. It has been said that extraction in any case will pro- duce miscarriage. It may have done so ; but if a tooth were decayed and very painful, I should not hesitate to ex- tract, and have often done so without any ill consequences. It must not hovr- ever be done without medical advice ; when not extracted the cavity may be filled up with cotton wet with tincture of benzoine, or a drop or two of creo- sote. The mouth should also be washed with equal parts of tincture of myrrh and tinctui-e of rhatany, in double the quantity of warm water. If the teeth are sound, and many ache, the bowels should be kept open, and two drachms of carbonate of iron taken three times a day, in treacle or honey, for a week or two. Salivation, or increased flow OF Saliva, is sometimes very trouble- ENLARGEMENT OF THE BREASTS. 41 some. Wasliinp; the month with ahim water and keeping the bowels gently open frequently affords relief; if it does not, have advice. Pain and great Enlargement OF THE Breasts. — When very dis- tressing a few leeches should be ap- plied, or the breasts be well fomented, and afterwards gently rubbed with soap liniment and laudanum. Tlie bowels should be well opened. Nature often gives relief by a discharge of a milk-like fluid from the nipple. Swelling of the Feet and Legs. — The bowels should be kept open, and a bandage applied every morning. The swelling usually goes down in the night ; during the day the recum- bent position should be maintained as much as possible. Enlargement of the Veins of THE Leg require the careful applica- tion of a bandage, and rest in the re- cumbent posture. This should be at- tended to by a medical man, as severe consequences often follow neglect. Over Distention and Pendu- 42 CRAMPS OF THE LEGS AND THIGHS. LOUSNESS OF THE AbDOMEX. The first is best relieved by laxatives, fo- mentations, and frictions*; the latter by a bandage, so made as to cross the shoulders and throw the weight upon them. Cramps of the Legs and Thighs are often relieved by mere change of position. Gentle friction, with soap liniment six drachms, and laudanum two drachms. Prominence of the Navel. — A pad and bandage should be applied. Falling down of the Womb. — When this is the case there is a sen- sation of something coming from the person. It beijins early in pregnancy, and disappears about the fourth month. Rest is the best remedy. Turbulency of the Child. — The movements of the child are sometimes so violent that it seems as if it would force its way through the side. A bandage should be worn, and a few drops of laudanum taken every six * See '' Fonnula/' page 53. DESPONDENCY, MELANCHOLY, ETC. 43 hours. Bleeding is frequently of ser- vice ; but let it be performed under the sanction of your medical attendant, and not otherwise. Despondency, Melancholy, An- tipathies, &c. — These are not uncom- mon. The two first are best remedied by chan<^e of scene, air, gentle exercise, cheerful company, and due attention to the diet, which should be nourishing ; the bowels should be kept gently open. The last is of little moment: the patient, perhaps, takes a dislike to teu, coffee, wine, fruit, or meat, &c. She requires no ti'eatment. Let her have any food she may like that is not unnatural; but on no account permit crude uncooked vegetables. Abortion (Miscarriage) and Premature Labour. — AVhen the child is expelled at any period before the sixth month of gestation it is called miscarriage ; if after that time, but be- fore the completion of the full period of utero-gestation *, premature labour. * Utbro-Gestation, pregnancy. 44 PREDISPOSIXa CAUSES. Miscarriage is one of the most se- rious accidents that can befal a woman; for should it become habitual, which it frequently does, the system will be debilitated, the constitution broken up prematurely, and the foundation laid for obstinate disease of the womb. The hnmediate danger of mucarricige depends pj-incipalli/ on the extent of Jfooding, which is usually more for- midable in tlie latter than the earlier months of pregnancy. It will be my endeavour to divert the evil (liabitual miscarriage) by pointing out the causes of miscarriage, and the means which are in the patient's own power to pre- vent it. Preuisposixg Causes. — An irrita- ble and feeble condition of the womb not admitting of distention beyond a certain extent, premature development of the mouth of the womb, excessive sensibility, debility, habitual delicacy of health, disposition to flooding, overful- ness of blood, extreme costiveness, and the habit of miscarriage, which, as 1 before said, is justly considered by the EXCITING CAUSES. 45 profession as one of tlie most serious diseases to which the pregnant woman is subjected ; for should a woman once or twice miscarry, there is always more or less danger that she will do so in her succeeding pregnancies. Schulzius relates the case of a woman who mis- carried twenty-three times at the third month. Exciting Causes. — Fatigue, falls, or blows, piles, purging, vomiting; ex- cessive exercise, as dancing, running, or jumping; the motion of a rough carriage; passions of the mind, as grief, joy, fear, &c. ; tight clothing, immode- rate laughter, sometimes the extraction of a tooth, or other surgical operation ; the inordinate use of spirits or wine, or any acute disease, as fever, inflamma- tion, &c., &c. The immediate caus6 of abortion is the sei)aration of the con- nection between the mother and infant, together with contraction of the womb. Symptoms of Miscarriage. — The patient feels languid and hot at night, or has a fit of sickness or hysterical symptoms; there is pain in the back 46 EXCITING CAUSES. and loins, spasms of the bowels, a little fever, and then a discharge of blood. There is frequently before the com- mencement of miscarriage pain and irregular action in the parts near the womb, which give warning of its ap- proach before either discharge or con- traction takes place. This is the pei-iod when it may best be prevented. When it takes place at a very early period, before the end of the second month, it is difficult to distinguish it from being excessively unwell, except by observing that the blood coagulates or forms into clots, for the menstrual fluid never clots or coagulates; it often continues a length of time — is foetid, and mixed with particles like snuff or pieces of skin. When at any period of pregnancy there are regular pains in the back and region of the womb, more especially if attended by a feeling of weight, grip- ing, diificuhy of passing the water and it coniing away in drops, and descent of the womb, we may fear that abor- tion will Uilie place. EXCITING CAUSES. 47 When the child in the womh is dead there is cessation of the morniiio- sick- ness, and any otlier symptom of preg- nancy which may have been present. The breasts become flaccid and lose their firmness; if the pregnancy has ad- vanced beyond the period of quicken- ing, the motion of the child ceases, and a feeling of coldness and weight is felt low in the abdomen. When these signs are observed, and are followed by discharge and regular pains, mis- carriage must take place, and it would be improper to endeavour to prevent it. When miscarriage takes place nt tlie third, fourth, or fifth month, &c. (more take place at the end of third and beginning of fourth than any other period), there is considcrai)le discharge, pain in the back and loins, the stoinacii is deranged, there are regular bearing- down pains, and expulsion of the em- bryo follows. In some the |)ains are severe and protracted, in others short and trilling ; in some the process is coni;)!< t: d in a few hours, in most before ihe expiration of three days; 48 TREATMENT. but in some it is long threatened, and does not take place for weeks. Treatment. — When miscarriage is threatened by pain in the back, &c., &:c., and discharge, the practitioner should be immediately sent for, because it might be in his power to prevent it; and it is impossible to say to vrhat extent the haemorrhaore mio;ht extend. But in the mean time the patient should be confined to the horizontal posture on a bed, (a mattress is better than a feather bed,) the room should be airy, very few bed clothes, no fire in the room, and the most perfect rest of body and mind. She should take nothing but a little barley water or lemonade, and the parts may be kept cool with a spunge wet with cold water and vine- gar, until the arrival of her medical friend. On the Prevention of Habitual Abortion. — The causes that gave rise to the preceding miscarriage should be, if possible, removed : thus, if there be debility and irritability, delicate and feeble health, recourse should be had HABITUAL ABORTION. 49 to soa air and cold bathini^. If cold sea batliinii; cannot be had, much ad- vantaiT^e will be derived from the use of the cold or tepid shower-bath, and sprinkling the whole body, but espe- cially the loins, with vineo:ar and wa- ter, and the daily use of the bidet ; cold water injections and some light bitter medicine should be taken two or three times a day. The diet should be mild and moderately nutritious, the bowels should be kept gently open ; perhaps an ounce or an ounce and a half of the compound decoction of aloes will answer the purpose well, and may be taken every other morn- ing or night if required. This medi- cine is cordial as well as aperient, and will keep the bowels well regulated without purging; it may be disconti- nued from time to time, and an enema of cold water and salt given in the morning instead. There should also be separation from nuj}tial intei'course, and a recumbent position enforced some weeks before and after the term of abortion, and strict abstinence from D •50 HABITUAL ABORTION. •wine, spirits, ale, &e., without tliey be ordered by the medical attendant. Ladies disposed to abortion should never be in a Ivino^-in-room, or they may miscarry from sympathy. On the other hand those of a ple- thoric habit, who have miscarried, should reduce the quantity of animal food and live chiefly on vegetables, take little sleep, and that on a mattress ; eji;ercise in the open air, but not so as to induce fatigue ; the bowels should be kept open by a saline purgative ; they should bathe oil have the use of a shower-bath, and much advanta2:e is gained by pouring water from a water- ing-pot on the loins, and the use of cold water injections two or three times a day. After pregnancy has taken place, they must live absque murito *, at least until it is far advanced. It will also be prudent to have a little blood taken, but not so much as to induce * A'lca-ij from the hii.sband. "VTe ■n'iil, however, give a free translation by adopting the phrase, "ip separate beds." MANAGEMENT OF NIPPLES. 51 fainting ; of course, when the period arrives at -which miscarriage has pre- viously occurred, repose on a sofa must be enjoined. On the Management of the Nip- ples BEFORE Confinement. — For a month or six weeks before confine- ment, especially in a first pregnancy, attention should be paid to the state of the nipple. If it appear healthy, not tender to the touch, and the skin of moderate thickness, nothing more is required than that it should be rubbed two or three times a day with a little sweet oil, and all pressure from corsets and the clothes most carefully avoided ; for this pressure is very frequently the cause of soreness and flatness of the nipple. If the nipples are painful and the skin is thin, they should be washed three or four times a day with soft warm water, and then the following lotion should be applied on lint : — Take of sulphate of zinc six grains, of tinc- ture of rhatany two drachms, of tinc- ture of opium one (Jrachm, of camphor mixture two ounces and five drachms. D 2 52 MANAGEMENT OF NIPPLES. This will generally prevent the trou- blesome chops and fissures which after deliveiy prove so painful, and cause suckling to be a curse instead of a plea- sure. Various other applications have been recommended, and may be tried if the above fails, Avhicli it seldom does. They are, a pretty strong solution of alum, strong spirits and water. Hamil- ton says, the pickle of salted meat boiled has been recommended as an infallible specific ; but of this remedy I have no personal experience. FORMULA. 53 FORMULA, &c., &c. LAXATIVE MIXTURE. Take, Tartrate of Potash, half an ounce. Manna, two drachms. Tincture of Senna, half an ounce. Infusion of Rhubarb, seven ounces and a half. Two tablespoonfuls to be taken three times a day. FOMENTATION. Take, six Poppy heads ; bruise them. A haiidtul of Camomile Flowers. Boiling water, two quarts. Boil this down to one quart, and strain. To be applied with flannel. EMBROCATION, FOR FRICTION. Take, of Laudanum, half an ounce. Camphorated Oil, one ounce. Mix — To be well rubbed on the part three or four times a da v. CHAPTER IV. ON THE TIME OF PARTURITION, AND THE HYGEIANIC AND OTHER GARES AFTERWARDS. SYMPTOMS PRECEDING LABOUR — ON THE LYING- IN CHAMBER AND ITS REQUISITES ATTEND- ANTS SYMPTOMS OF LABOUR LABOUR — DIET NURSE ADMISSION OF FRIENDS SUCKLING, AND MANAGEMENT OF THE BREASTS. Symptoms preceding Laboue. — Generally for some days (it may be two, four, six, eight, ten, or twenty days, or only a few hours) previous to the accession of those phenomena which characterize the existence of labour, there are often present certain premoni- tory sirrns which proclaim its approach, and which, by women who have borne children, ai'e viewed as precursors of that eventful hour. Restlessness, particularly at night. MOVEMENT OF THE CHILD, ETC. 55 is frequent for days and weeks, and is not to be considered unfavourable. Subsidence of the Womb and Abdomen is a usual monitor, and may be viewed in a favourable ligbt, as it indicates room in the pelvis, or basin of the body. The female feels as if she carried the child lower than for- merly, and thinks herself slacker and less than she was before ; and in many cases, though before inactive and indo- lent, she now feels lighter and more alert. Glairy Mucous Secretion, some- times STREAKED WITH Blood, occa- sionally occurs days before the active symptoms of labour, and renders the parts moister than usual ; which are also tumid, relaxed, and soft, and some- times painful. The discharge spoken of is commonly known by the term, a show. Irritability of the Bladder, AND Irritation AND Griping of the Bowels, are often present as symp- toms of approaching labour. The Move3ients of the Child 66 THE BED. become stronger and more active, and are felt lower dov/n ; and there is also pain and weight in the loins. When the above symptoms occur it will be well to send for the nurse, and apprize those who are to be present at the ap- proaching event. Chamber of Accouchement. — The bed should be so placed that the room may be well ventilated without its being in a draught. The bed-cur- tains should be thin, and never com- pletely drawn round the bed, so that pure air may be freely admitted and the impure air easily escape. The bed should not be against the wall, but placed so that assistance could be af- forded on either side if required. The patient is liable, if placed on 2i feather bed, to sink into a hole and thus pre- vent her medical attendant from being of so much service to her as he might be ; it will, therefoi-e, be advisable to remove the feather bed, or place the mattress above it, and over that should be put one or more di-essed sheep skins, or a piece of oil cloth or oiled silk, and THE DRESS. 57 above this the ordinary binding blanket and a clean sheet in the common man- ner ; another in the form of a roller should be applied across the bed, hav- ing the ends folded in at the sides ; a coarse blanket, folded within a sheet in the form of a table napkm, should be laid immediately underneath the pa- tient, so as to be easily removed after dehvery ; the upper sheet, blanket, &c., are put on as usual. The pillows should be placed in such a manner that the face of the patient, when she is on her left side, should be turned from her medical attendant. The nurse is of course supposed to know how to make the heel ; but I have thought it right to throw out a few hints as to the best manner of so doing. The Dress should be as slight as possible. A loose dressing-gown does very well in the earlier stage of labour ; but in the more advanced a bed-gown and chemise should he worn — the latter is to bo folded round the waist, so that it may be kej)tdry and be drawn down after labour is over ; the lower part of 58 HEAT OF THE ROOM. the body should be covered by a petti- coat, so made that it can be taken off without raising the person when de- livery has taken place. The stays should never be worn, but in their place a broad double calico bandage, or binder, made with three rows of tapes on each side, so that it can be made tighter as labour pro- gresses, and be used for the ordinaiy binder afterwards. If it is made with straps to come under the thigh from the back, to fasten in the front with a button, it will be kept down better. These straps need not be used until labour is over. Such a bandage may be had of the Surgeons' Instrument Makers, and is known as " Gaitskill's Bandage." It often is of great use in supporting the abdomen in the latter months of pregnancy. Heat of the Room. — This should be regulated by the patient's feelings. If too hot, it will produce fever, add to the fatigue, often render the pains irre- gular and ineffective, and thus protract the labour. ATTENDANTS — SLEEP — FOOD. 59 Attendants. — The only attendants required are the nurse and medical man, but a female friend may be al- lowed, for it inspires confidence. A word of advice to the friend : " Let your conversation be lively, without being too gay (or you may be accused of want of feeling), and on subjects unconnected with the matter in hand. Remember, the mind of your friend who is suffering is distressed, and easily alarmed. Avoid whispering, or any appearance of concealment, as it may make her distrustful of her own powers, and perhaps doubtful of those of her necessary attendants. Sleep. — If she be disposed to sleep between her pains, she should not be disturbed. Food. — There is seldom much in- clination for food, and, if the labour is not protracted, no occasion for it ; but if there is an inclination to eat she may have a little tea with dry toast, milk, or boiled milk and bread, soup, sago, or light pudding ; but every thing 60 THE URINE. lieavy must be avoided ; it is, however, always desirable that a fair quantity of food should have been taken shortly before. Wine and cordials were once fre- quently given under the mistaken and mischievous idea of keeping up the strength; but now they are most justly relinquished, as they produce heat, disorder the stomach, retard the la- bour, and not infrequently dispose to inflammation or fever, and should never, on the coming on or during the progress of labour, be given but under the direction of the medical attendant. The Urine should be regularly and frequently evacuated. The borreh, if not open, should be acted upon by taking before or early in the labour a glyster composed of a pint of thin gruel and an ounce of castor oil. Much comfort is derived from this, and the unpleasant consequences avoided which sometimes take place at the end of labour wliere this has not been at- tended to. On the other hand, if the POSITION WHEN IX BED. 61 bowels are too much relaxed, take ten drops of laudanum in a wineglass of water. Position tvhen in Bed. — Medical writers have laid down rules as to the best position ; but the nurse, or other matron in attendance, will be fully capable of giving every necessary information on the subject. It is ab- solutely necessary that the medical at- tendant should inform himself of the position of the child. The manner in which this is done will be best ex- plained by the female attendant. It is only requisite for me to say that it is a simple and painless proceeding, but so essential to the well-doing of mother and infant, that I beseech my reader to comply with it as early as her pro- fessional attendant may deem neces- sary, or the life of her unborn infant (should it be in an unnatural position) may be sacrificed ; or she may wreck the happiness of a fond, anxious, and affectionate husband, by thus bein^ accessory to her own death. 62 SHIVERIXG, CRAMP, ETC. Shiyerixg is very common, from a gentle tremor to a complete and vio- lent agitation of tlie body. When this is the case some warm tea or gruel, without wine or spirits, should be taken. Vomiting is not uncommon, and tends sometimes to facilitate the la- bour. Cramp, during labour, is frequent, and may arise from having been in one position too long, for change of posture relieves it ; but, if in the hip and thigh, it generally proceeds from the head of the child pressing on a particular nerve in the pelvis, and is not removed until it has passed that part. Duration of Labour. — A first labour is generally the most pro- tracted ; but under proper manage- ment, and due submission on the part of the patient, is not more dangerous than subsequent ones. Napkins, &c. — The nurse will, of course, be careful to have a sufficient supply of well-aired napkins, a pair of HOT WATER — LABOUR, ETC. 63 scissors, a skein of strong grey thread, and a proper receiver of flannel for the infant. Hot Water. — It will also be well to have an abundant supply of hot water in the house, which might be re- quired if the infant should happen to be born in a state of asphyxia, or sus- pended animation. Of Labour. — The time of actual labour has b'een compared to the fa- tigues of a person on a journey ; and this idea has led medical men to divide the parts of labour into three stages. The beginning only of the first stage shall I describe, because after that my reader will be in the hands of her me- dical friend, who will render her all the assistance required. . Symptoms of Labour. — There is pain in the back and loins, occurring at irrefjular intervals, and producing most disagreeable sensations ; there is generally, also, a show; these sensa- tions continue ; the patient becomes uneasy ; has frequent warm and cold fits, with urgent desire to pass urinO> 64 THE PERIOD AFTER DELIVERY. &2., and is exceedingly restless ; every situation and position appears insnp- ))or:;ibIe and uncomfortable to her. By degrees the pains increase in fre- quency and I'orce ; they occur now at regular intervals of ten or twelve mi- nutes, and do not occasion that con- tinued uneasiness as at first, for when the pain is passed she is pretty easy. The practitioner should now be sent for ; the first stage of labour has com- menced (though sometimes what are called false pains will simulate this stage of labour so completely that none but an experienced medical man can detect the difference between the true and the false, and he only by the touch). In the hands of her medical friend I nowjeave my reader, bidding her be of good cheer and fear not. Of the Period after Delivery. — It is not my intention here to take notice of the many diseases that may arise subsequent to travail — those I leave to the medical practitioner in attendance — but merely to give that description of advice which a very FAINTNESS AND LANGUOR, ETC. Go good nurse should be able to give, but which few of them are capable of doing. Faintness and Languor fre- quently occur immediately after the child is born, even in short and easy labours. The medical attendant will, possibly, in this case, order his patient wine, ale, or spirits, in the proportion that may be required. The Bandage. — If this is not al- ready passed round the body, the medi- cal man or nurse will do this, and make it as tight as may be needful. The Dress and the Bed-clothes, &c. The petticoat worn during the la- bour may be removed soon after de- livery, and the chemise, previously rolled around the waist, brought down. The wet clothes may also be cautiously removed (without it has been ordered otherwise) ; but in doing this great care must be taken not to move the patient, or permit her to make any effort. She must he perfectly jmssive, and her attendants mIU on ?io account raise her from the recumbent position e 66 THE DIET. in the least, but one person taking the feet and another the head, gently re- move her Hmbs as much as may be re- quired to enable them to get away those things that are soiled. Fatal flood- IXG HAS BEEN PRODUCED BY RAISING THE BODY TO A SITTING POSITION. It may be almost unnecessary to remark, that during the whole time of lying-in the person should be kept as dry and clean as possible. The Diet. — This should be light and of easy digestion, but a diet ap- pi-oaching to starvation is not necessary, although it has been recommended by some authors. Tea or cocoa, with dry toast, may be taken in the morning and evening ; or a cup of sago, panada, &c. with dry toast, if preferred. Beef-tea, veal, or chicken broth, may be taken for dinner for the first few days ; or, if soups disagree, a little boiled chicken or fowl, or some light pudding, such as arrow-root, sago, ground rice, mac- caroni, &c. &c., may be substituted. Too great an indulgence in eating is worse than too great abstinence; but THE DIET. 67 both extremes should be avoided. What I wish to inculcate by the above is, that it IS not necessary to deluge the stomach of a lying-in woman with gruel and slops. The use of wine, ale, or spirits, either in gruel or otherwise, is inadmissible for the first three or four days, for they tend to increase fever, and often cause an overflow of milk, and render the breasts tui-gid and painful ; generally, at this period, more milk is secreted than tlie infant can consume. After the fourth or fifth day, if the sirength requires it, tlie patient may have a little good ale, or a glass or two of old white wine, if she has been accustomed to its use. Port wine is generally less advisable, from its disposing to acidity. If, however, the strength is good, all .stimulants had better be avoided for ten or twelve days ; after that time, if nursing her infant, a glass of sound ale after dinner, and another in the even- ing, may be of service. There is generally in the first days after delivery considerable thirst. This K 2 G8 THE MIND BOWELS — BLADDER. is best relieved by drinking sparingly of toast and water, or barley-water j neither of these should be very cold. The Mind after delivery is often in a state of excitement, and highly sus- ceptible of impressions. It is there- fore obvious that any thing which could excite emotion //* health should be scuarded ao-ainst durins: confinement. For this reason the bed-room should be either at the back of the house, or means should be taken to lessen the noise of the street. It is not well for this purpose to stop the ears with cotton, for the mind then becomes anxious, from a natural Avisli to hear what is said by the attendants. Of the Bowels. — They should be opened about forty-eight hours after delivery, by two tablespoonfuls of cold drawn castor oil or a teaspoonful or two of magnesia, or by a laxative lave- ment; but the medical attendant will dii-ect in this case. The Bladder. — If, after a tedious labour, the water passes with difficulty, or in very small quantities, and fomen- VENTILATION OF THE ROOM, ETC. 69 tations of poppies and camomiles, or the application of a spimge icimng out of HOT water, does not speedily afford relief, the medical attendant should be immediately" informed of the circum- stance. Ventilation of the Room. — It is necessary that the room should be kept well ventilated, and pure air often ad- mitted. For this purpose the windows should be opened from time to time, and the curtains round the bed should not be closed. Every thing that can give rise to an unpleasant smell should be directly removed. The Lochia, or Discharge. — This varies much as to quality, appearance, and duration in different women, and in the same woman in different confine- ments. It is sometimes scanty, and sometimes so profuse, especially in those who do not nurse, as to require medi- cal treatment ; but, without it runs into one extreme or the other, it need create no alarm. For two or three days it has the appearance of pure blood; it gradually changes to nearly white ; then 70 THE LOCHIA. to a greenish or broAvnisli cast; and at last entirely ceases. It does not always follow this course, but the red colour may disappear and reappear two or three times. Sudden obstructions of the discharp^e may be occasioned by exposure to cold, or indicate some disease, and are al- ways alarming ; if attended by pain in the abdomen, fever, sickness, &;c. the medical attendant must be sent for; but in the meantime let the lower part of the belly be well fomented, and let a drink of some warm diluent, as whey, barley-water, or thin gruel, be given. Extreme cleanliness during the con- tinuance of the discharge is imperative. The nurse should foment the parts with warm milk and water, or decoction of poppy heads, &c., twice a day ; and if the smell is offensive a proper syrinound Camphor Liniment one ounce. The breasts to be gently rubbed with this three times a day. Drawing the breasts should be avoided, if possible. H 2 CHAPTER VI. OK THE DISEASES OF IKFANCr, AKD SOME DISEASES OF CHILDHOOD. By Infancy is to be understood the pe- riod of time extending from birth to the cutting the last tooth of the first set of teeth, or about two years and a half. It was only intended here to have p;iyeu a sketch of the principal diseases of that period ; but it was found that many diseases appertained to both infancy and childhood, as measles, fever, croup, &c., and it became necessary to take notice of them also. In treating of Concrenital Deformities and Malformations, the author does not profess to enumerate all that may oc- cur, because they are generally so ob- vious to the eye, that they would im- mediately suggest the necessity of sur- gical assistance. DISEASES OF INFANCY, ETC. 117 The diseases of the skin and various eruptions are numberless, and could not be understood, even by a medical reader, without the aid of plates. It, therefore, will be found, that only those of the greatest moment, or most com- monlv met with, are here taken notice of. ' In the slighter indispositions the au- thor has pointed out the simple modes of treatment, which are found gene- rally of service. In the severer class of diseases he has contented himself with drawing a faithful picture of the appear- ance they present, and pointing out in some what should be done whilst me- dical assistance is being summoned. To have laid down a plan of treatment for all the diseases mentioned would have been hurtful and dangerous ; because the treatment in many must be altered from day to day, or even from hour to hour, and must also be varied from considerations of age, sex, temperament, strength, &c. On Congenital and Surgical Diseases of Infants. — Imperfora- 118 IM PERFORATION OF THE ANUS. tions of various natural passages may- take place, as imperforated anus (the lower bowel), nostril, eyelid, urethra, sexual or2:ans of the female, &c.; or they may be malformed, or the exit of the natural evacuations may take place from unnatural openings. These all call for the immediate aid of the surgeon. Imperforation of the Anus (the natural external opening of the gut). — The want of this natural outlet is some- times occasioned by a thin membrane stretched across, and is apparent to the eye when the infant makes efforts to ex- pel the mecomum, in the form of a dusky soft tumor. This extent of ob- struction is easily removed by the sur- geon. In some cases the outlet is very well formed ; but there is obstruction higher up in the bowel, called the rec- tum. This obstruction is generally from about two lines to an inch within the bowel, and is known to be present by the child's not passing the meconium, and the nurse being unable to throw up an injection ; or by introducing the little linger, or a piece of oiled paper. N^Vl MATERNI, ETC. 119 This disease may sometimes be relieved. — There are other and more serious mal- formations of these parts that the art of the surgeon uill sometimes fail to cure. When the meconium does not pass with- in twelve or twenty-four hours after the birth, the medical man should be re- quested to institute a careful exami- nation. The same may be said when the child fails to pass its urine. NiEVi Materni {3Iot]ier''s Marks) may be on any part of the body. When merely discolourations of the skin, and not elevated, they are not dangerous, but seldom admit of cure. But when they are elevated, and of a purple colour, and grow raj^idly, an operation becomes needful for their removal ; as they might burst, and cause so great a loss of blood as to prove fatal. Distortions of various Parts of THE Body, as Club-Foot, &c., are not uncommon. They are to be treated by careful bandaging, &cc., under the direc- tion of a surgeon. Tongue-tied may be known by the child not being able to suck. It is oc- 120 HARE-LIP, ETC. casioned hj the fremim or bridle of the tongue being attached too near the lips, and requires a simple operation for its removal. Hare-Lip is well known. If the child cannot suck in consequence of the cleft, an operation must soon be performed, though always attended with danger to very young infants. If it can take the breast freely, the opera- tion had better be deferred for a year or more. Hydrocele is a collection of water in the purse of the male infant. It is generally to be cured by a lotion of mu- riate of ammonia and water; but if the fluid is not dispersed by these means, it (the purse) will require puncturing in after-life, to let out the fluid. Prolapsus Axi (coming down of tlie seat). When the child has a motion, a portion of the gut protrudes. When this takes pjiJice, it should be carefully returned by very gentle pressure. The bowels should be kept rather lax, and the child not allowed to strain or re- main long at stool, if it comes down BLUE DISEASE, ETC. 121 even when not at stool, after being returned it should be kept up by a compress and bandage. Blue Disease, or Cynopathy, arises from imperfection or malforma- tion of the heart. If the malformation is great, it comes on immediately after birth ; but generally it does not show itself until after the child begins to walk, or is teethijig. The skin of the child is dark, and looks dirty and leaden ; the nails and lips are blue and livid ; the breathing is difficult ; there is a kind of asthmatic, suffocating cough, and sometimes convulsions. When cough and convulsions arise, there is danger; but persons so aifected have lived to adult age, and then died suddenly. There is no remedy in medicine for this disease : but all excitement of body and mind should be avoided ; the child should have rest ; its bowels are to be kept open, and care taken that the sto- mach is never overloaded with food. Discharges of Mucus. — Discharges of matter or blood sometimes takes place from the privates oi female infants, but 1*22 DYSURY, ETC. more generaWy from female childi'eny and has sometimes given rise to unpleasant and uncalled for suspicions. If the dis- charge is white, it generally goes off in a few days, by attention to cleanliness and keeping the bowels open ; but if bloody or greenish, it is obstinate, and requires a more complicated treatment, and professional attention is required. The cold bath is always of service, to- gether Avith purging, and keeping the parts very clean by means of a siDunge and warm water. Dysury (difficulty of passing water) is to be relieved by warm fomentations, and a drop or two of sweet spirits of nitre. IxcoxTixEXCE OF Urine, (inability to retain the water,) especially in bed, is generally incurable until towards puberty. The best remedies are those that strengthen the habit of body, as country air, exercise, and sea bathing. A Burgundy pitch plaster may be ap- plied as low as possible on the back. Ear-Ache is a frequent and painful disease, both of infants and children. OPHTHALMIA. 123 If too young to tell what ails it, it may- be suspected by its being seized with a sudden and severe fit of crying as if it had colic, and like it the pain seems to be easier at times, but it does not, as in colic, spur with its feet, nor is its belly hard ; but the head is restless, and it complains if the ear is touched. In time the child sobs itself to sleep, and in the morning perhaps its cap is found stained by matter. Heat is the best remedy : a warm poultice or warm oil should be applied to the ear, and the back of the ear should be rubbed with warm lauda- num. If there is a foetid discharge, the ear should be syringed carefully and gently every day with warm milk and water, and the bowels -well opened. Some children, whenever they take cold, have a discharge from the ear, and are deaf. In this case the ear should be kept warm and frequently syringed, and the back of it rubbed with a little harts- horn and oil. Ophthalmia, Inflammation of THE Ey'es. — This disease may arise from exposure to a fire soon after birth ; 124 OPHTHALMIA. it then generally disappears in two or three days by washing with milk and water. But it may be what is called Purulent Ophthalmia, which is a very severe disease, and may cause loss of sight. It begin^ with a redness of the eyelids, which soon swell so that they cannot be opened, and discharge a large quantity of yellow, greenish mat- ter, which excoriates the cheek. If allowed to continue, the globe of the eye becomes affected, and the humours of the eye come away. It requires a very complicated treatment, which should be conducted by a skilful sur- geon. The only advice I shall here offer, is absolute obedience to his ordei*s and great attention to cleanliness. This disease generally arises in the infants of mothers who have had, during preg- nancy, a discharge. When this has been the case, great care should be taken, in washing the infant at first, not to expose it to light, and to remove every particle of matter from the eyes. The author prevented the fourth child of a lady being thus affected (the three SCROFULA. 125 previous children having had the dis- ease in a very dangerous form) by attending to the foregoing and keeping it pretty constantly in bed, the room being darkened, having the eyes washed often with milk and water, and by the use of the following lotion four times a day : — Take of acetate of zinc eight grains ; of rose water eight ounces. Mix. This was applied on lint to the eyelids, and a little allowed to fall into the eyes at each time of application. By persevering in this plan during the month, the child entirely escaped, though the mother had been more affected with levcorrlicpci (whites) in this than any former pregnancy. Scrofula is dependent on a pecu- liarity of constitution which is some- times born with the infant. Children who are scrofulous have often a fine skin, light hair, large bine melancholy eyes, and a dehcate complexion ; the veins of the head and other parts are very apparent. Others liave the skin darker, and of a rougli, dirty appear- ance J the hair is dark, the upper lip 126 SCROFULA. full, and face sallow, and sometimes swelled. — When these peculiarities are not strongly marked, a person may pass through life without inconvenience. But when the scrofulous constitution prevails in a great degree, different parts of the body, without evident cause, become deranged and altered in structure, and a slow inflammation in those parts takes place. The glands of the neck are generally the first at- tacked ; but the ravages of scrofula spare no part of the body. These ra- vages soon attract attention, and are too well known to require description. It is not intended to enter more fully on the subject, as a full description of this disease would fill a volume, but merely to point out what is the best means of preventing its havoc in persons with the above characters. They are those that improve the general health ; as good and nutritious food, warm cloth- ing, country air, sea bathing, or the use of the tepid or cold bath daily ; gentle friction of the whole body ^vitll a flesh brush every evening, and great atten- tion to the bowels. RICKETS. 127 Rickets. — This disease generally shows itself between the sixth month and the second year, but sometimes it is found even at birth. The causes of this disease, and of scrofula, of the nature of which it ])artakes, are foreign to our purpose. The face of a rickety child is sallow and bloated ; the skin is relaxed and flabby ; the child is weak and listless ; the bones are softened and can be bent, so that the long bones, as the leg, thigh, arm, &c., become much curved, and their extremities en- larged. The ankles swell first, and then the back changes its shape, and the breast protrudes ; the bones of the hips approach each other ; the head increases much in size, and the belly is hard and large ; the appetite is bad or depraved ; the bowels are bound, and the evacuations are very oflensive ; the teeth are late in appearing, are bad, and are soon lost. Amidst all this bodily deformity we frequently find the mind prematurely developed. This disease sometimes proves fatal, by pro- ducing water in the brain or convul- Bions 5 but it is often stopped in its pro- 128 BURNS AND SCALDS. gress by nature or art, and the person lives, more or less deformed. Bad food, bad air, dirt, insufficient clothing, and all causes of debiHty, call this disease into action, although with every care it is not always to be avoided. The person thus affected should have veiy nutritious diet, country air, sea bathing, and friction over the whole body for some hours a day. The se- cretions of the bowels must be enforced by proper and judicious medicines, long continued ; and the debility prevailing in the system, if possible, obviated. This can only be done by following the prescription of a professional adviser. BuRxs AND Scalds. — If they are slight, a lotion of equal parts of lime water and linseed oil gives much relief, so does the application of flour to the part. If it be the finger or hand, put- ting it into very cold water is the best application at first ; afterwards it may be dressed with brown cerate. If, how- ever, the burn or scald is severe, a medical man must be sent for, as they are attended with much danger^ and STROPHULUS, ETC. 129 especially if on the trunk of the body. Be careful not to break the blisters, and in taking off the clothes do not pull, but cut them off, as it is desirable to preserve as much of the skin as possible ; the loss of this exposes the nerves to the air, increases the pain, and very much enhances the danger. The applications recommended in these cases are very numerous ; but in severe burns, &c., m.ore depends upon the internal, or conditiitio7ial management, than on the local aiiplication. ON CUTANEOUS AND ERUPTIVE DISEASES. Strophulus Intertrinctus, or Red Gum, is a papular eruption of a vivid red colour, on the face and neck of young infants, and somewhat resem- bles measles ; but there is no cough or fever. It is of little consequence, and arises from irritation of the bowels, and calls for a dose or two of magnesia. The child, during its continuance, should not be exposed to cold. Strophulus Albidus, or White I 130 STROPHULUS CANDIDUS. Gum. — This attacks older children than the former. It generally comes on after exposure to the sun, and has been mistaken for itch. It is a number of minute white specks on the neck, face, and breast. It requires no par- ticular treatment. Strophulus Coxfertus, and Strophulus Yolaticus. — These are teething rashes. They consist of pa- pulae (or pimples), so closely together as to form one patch. These patches Tary in size, from a sixpence to a crown-piece, and are generally on the face and arms ; if on the body, the papulae are larger and flatter, and sur- rounded by inflammation, and at a dis- tance look like measles, and as they are sometimes preceded by sickness have been mistaken for that disease. But there is no cough, sneezing, &c., nor much fever. Gentle laxatives of magnesia and rhubarb, or senna and manna, are all that is required. Strophulus Caxdidus. — The pa- pulae are paler than the surrounding skin, and of a smooth and shining ap- CHAFINGS — ERUPTIONS. 131 pearance. It has been taken for itcli, but it is not itchy. It comes out all over the body when teething;, or occurs after some acute disease, and is then a favourable sign. Itertrigo, or Chafixgs. — Is a small rash on the folds of the groin, arm-pits, k,c,, which soon forms a sore. The parts should be frequently washed with warm milk and water, and then well dusted \\ ith violet powder ; or the following ointment may be used : take of sulphate of zinc ten grains ; of simple cerate one ounce — mix. To be applied three times a day ; or when wetted by urine, &:c. Eruptions, almost endless, attend teething, but are of little consequence if unattended by fever. Infants who have artificial nourish- ment, or bad milk, are subject to trou- blesome successive crops of inflamed pimples, which slowly gather and burst, and form brown scabs which fall off. They may be on any part of the body, and sometimes are large enough to be called boils. The colour of these I 2 132 POMPHOLYX — PEMPHIGUS. boils differs according to the streng^th of the infant : in weaklv infants they are purple ; in stronger ones they are red. This eruption, called Ecthyma Infantile, requires better diet or a new nurse, and great attention to the bowels, and removal to the country. This eruption may arise on the other hand from gross feeding. In this case lower and plainer diet, and purging, will effect a cure. PoMPHOLYX appears during teething. It consists of a number of vesicles, or pimples, of different sizes, on the belly, ribs, and thighs, which contain an acrid water. These vesications are most common in summer. Lory considers them to be produced by the heat of the sun ; they require no medicine, except some gentle aperient, but the water should be let out with a small needle. Pemphigus is a disease somewhat similar in appearance to the above, but is much more serious, and it attacks weakly infants soon after birth. The vesicles are at first small, but become large and oval, and the contents tinged. SCABIES — PITYRIASIS. 133 They are surrounded by a livid halo, and when broken the part ulcerates, and the ulcer spreads. This disease is attended by fever, sometimes with Apthce (thrush), and is always very dangerous, and under the best plans of treatment frequently fatal. In all the foreo:oino; cases the advice of a medi- cal man should be taken; in this it is imperative. Scabies, or true Ttch. — Psoria- sis, or Scalytetter, sometimes called dry Itch ; Porri(jo or Tinea, called Scald- head, or Ringworm of the Scalp, are well known by their appearance to most nurses. The treatment of any of these diseases is complicated, and should be entrusted only to a medical man. Pityriasis, or Dandriff, is a dry, scurfy, and scaly eruption amongst the hair near the foreliead. The skin is covered with a thick white scurf, which can be removed like powder; further back large scabs are formed. The hair should be cut very close or shaved, and the head washed with a brush 134 LEPRA — SCABS FROM VERMIN. and soap and water daily. The bead at night should be smeared with the following ointment: — Take ointment of the nitrate of mercury one drachm ; simple cerate seven drachms — mix. The bowels should be kept freely open. Lepra, Lepra Alphoides, Herpes Farinosus (scurvy spots, or ringworm). The appearance of this disease is well known ; it is very contagious and ob- stinate. The ointment ordered in the preceding is a good application, along with frequent ablution of the part, and the use of a lotion, as sulphate of zinc twelve grains, rose water one ounce — • to be applied three or four times a day. The creosote ointment applied three times a day often effects a cure. Scabs from Vermin are best cured by freeing the head of the vermin, by cutting the hair, washing the head, and the use of a brush tw^o or three times a day. The powder of stavesacre dusted into the hair at night, or a drachm of calomel to an ounce of hair powder used in the same way, will destroy the vermin. ERYSIPELAS, ETC. 135 Erysipelas (St. Antony's fire) sometimes affects infants, and when it attacks the head, face, navel, or genitals, is hit station, they are not the less appro- priate to females of a less elevated sphere." — Guardian. "The author appears to have studied the object he had in view with much attention, and has produced a very complete code of matrimonial conduct."— Sw/fW/c Paper. " This is a well-written little manual on the duties of young women on first entering the estate matrimonial." — Devnnport Independent. THE YOUNG HUSBAND; being Hints to Regulate the Conduct of Voung Men who have entered or are about to enter the matrimonial state. By Ar- thur Freeling. 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