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THE MARRIED WOMAN’S
PRIVATE MEDICAL COMPANION,
EMBRACING THE TREATMENT OF
MENSTRUATION, OR MONTHLY TURNS,
DURING THEIR
STOPPAGE, IRREGULARITY, OR ENTIRE SUPPRESSION.
PREGNANCY,
AND
HOW IT MAY BE DETERMINED;
WITH THE TREATMENT OF ITS VARIOUS DISEASES.
DISCOVERY TO
PREVENT PREGNANCY;
ITS GREAT AND IMPORTANT NECESSITY WHERE
MALFORMATION OR INABILITY EXISTS TO GIVE BIRTH.
TO PREVENT MISCARRIAGE OR ABORTION.
WHEN PROPER AND NECESSARY
TO EFFECT MISCARRIAGE.
WHEN ATTENDED WITH ENTIRE SAFETY.
CAUSES AND MODE OF CURE OF BARRENNESS, OR STERILITY.

BY DR. A. M. MAURICEAU,

Professor of Diseases of Women.

Office, 129 Liberty street.

NEW YORK.

1847.

Entered according to Act of Congress, in the year 1847, by

JOSEPH TROW,

In the Clerk’s Office of the District Court of the Southern District New York.

PREFACE.

The “Introduction” in the succeeding pages, being amply explanatory, but few prefatory words will suffice. The object and intention of the work is manifest and self-evident.

It is to extend to every female, whether wife, mother or daughter, such information as will best qualify her to judge of her own maladies, and, having ascertained their existence, apply the proper remedies.

From these pages she will learn the causes, the symptoms and the remedies, for such complaints to which she may be liable, the nature of which she may not desire to impart to another.

Whether married or unmarried, she can, from these pages, compare her own symptoms with those described, and act in accordance with the mode of treatment prescribed. She will thereby be exempt from those doubts, perplexities and anxieties, which arise from ignorance of her situation, or the causes which produce it.

In short, the author sincerely believes that to the female budding into womanhood,—to one about to become a wife, or to the wife about becoming a mother, as well as to every one already a wife and a mother, as also to the female in the decline of years, in whom nature contemplates an important change, the “Married Woman’s Private Medical Companion” contains instructions of such paramount importance, as to embrace the present happiness and future welfare of each.

One word in conclusion. It is not pretended that the concentration of the results of medical research emanates from one author, for be he ever so versed in medical science, he would come far, far short of so herculean a task. It is, therefore, necessarily derived from authors on medical and physiological sciences, of great acquirements and distinguished celebrity.

It hardly need be added that great labour has been encountered in the preparation of a work of this nature, as the most reliable and correct sources have been availed of.

THE AUTHOR.

INDEX

INTRODUCTORY REMARKS.

In introducing a subject of the nature treated of in this volume we are perhaps treading upon interdicted if not dangerous ground, for the world is not free from those pseudo-moralists, who would check, and, if possible, arrest the onward progress of medical and physiological science, and compel all to trudge on in the old beaten path, neither turning to the left nor the right, much less to look forward, but cast their glance backward. And although they behold every other science marching with rapid strides to comparative perfection:—what through the agency of steam and iron rails, space as it were, annihilated; what but yesterday, comparatively speaking, required weeks to perform, a few hours now suffice; nay the lightning fluid itself is made subservient to man’s powers of discovery and ingenuity, transmitting intelligence from distant points with the speed of thought:—yet, in physiological and medical science, we are required to be as an immovable rock, upon which the overwhelming billows of physiological science and discovery are to wash fruitlessly and in vain, to recede back into the dark sea of ignorance.

Truly, is it that in all that concerns man’s welfare and woman’s happiness, we are to stand still, while improvements and discoveries, in arts and sciences connected with agricultural and mechanical pursuits, are rushing by with the impetus of a torrent? Is it that physiological and medical science has long since reached that state of perfection that improvement and discovery are impossible? Is it that preceding generations had engrossed, in physiology, all the knowledge that could be attained, and left nothing for succeeding generations to attain? Is it that disease, decrepitude, bodily suffering and stinted and imperfect physical development among mankind has no longer an existence? Is it that every woman enjoys the full bloom, virgin freshness and beauty belonging to the enjoyment of a perfect condition of health? Is it that we no longer behold the deathly pale, sallow, sickly female of sixteen or eighteen, in the last stage of some chronic disease, prepared for the cold embrace of death? Is it that for the married woman six of the nine months of pregnancy is often a state of suffering and anguish destructive to her health and cutting off her days? Is it too, that it never happens that she often has children only at the hazard of her own life, and that of her offspring? Is it that children are invariably born healthy and rugged, capable of enduring the ordinary maladies to which infancy may be subject, to be reared into robust and virtuous sons and daughters? Is it that by far the greatest proportion of those born, survive, instead of, at the least, two-thirds being cut off in infancy? No, indeed, it is not because of all this. It is because prejudice or ignorance thinks that if men and women acquired the knowledge whereby to improve their condition as social moral beings, guard against disease, and preserve their health, that perhaps, it might lead to immorality and vice. This is ever the pretext to arrest the progress of physiological discovery.

Discoveries, then, so directly and intimately connected with the personal individual happiness of every man, woman, and child, are alone to see no progress; without being met at the threshold with the senseless and idle cry of “vice and immorality.” Thus then, the sufferings, the pains, the anguish, which have existed five hundred years ago, are to be irremediable and endured in despite of any discoveries by which they can be prevented. We must do nothing to alleviate, or better still, to prevent, the sufferings of the wife, daughter, or mother, because it was not done five hundred years ago! Monstrously absurd as is this reasoning, yet it is of this kind which the discoveries introduced before the public in this work will be met.

But the subject is one which embraces our social joys and comforts, the endearments of home and the family fire-side, the health and well-being of wives, mothers, and daughters, and cannot be retarded by the cobwebs in its way, to stem its onward course. No female, either married, or about to be married—no wife about becoming a mother—no mother having a daughter—no father who desires to prolong the health, beauty, and vigor of his offspring—no husband who has his own happiness, or the happiness of the companion of his bosom at heart—no young man, even, having a regard to his future welfare, should be without this important little work. Here the wife, mother or daughter, can detect her own complaints, trace them to their causes, and apply the remedy. This is all important. For, how often does the young female (because of a supposed delicacy), suffer in health rather than impart her malady to another, and especially to a medical man; and thus, many diseases, which though trifling in their origin, and at first easily removed, become seated and confirmed in her constitution. How deplorable are the consequences arising either from neglect or ignorance in the treatment of females who are afflicted with a stoppage, irregularity, or entire suppression of the menses or monthly turns, from which spring a train of diseases, which it would, in this place, be useless to enumerate, but which make our wives and daughters sickly, and our offspring short-lived.

It is also important that the female should understand the cause which might occasion a stoppage of the menses to possess the information contained in this work, by which it can be ascertained whether it may not arise from pregnancy and thereby avoid that anxiety of mind arising from an uncertainty as to her real situation, alternately imagining the one or the other, as her inclinations or fears may tend.

During pregnancy, many a wife lives in almost perpetual bodily ailment and suffering, which ought and should be prevented, and would not in most cases exist if this work is perused. Here important truths and discoveries are revealed, which may be the means of saving many an affectionate wife and fond mother from a premature grave. How many females marry, who, in becoming pregnant, jeopardize their life, would learn, if they perused these pages, of the discovery by which pregnancy can be prevented, by means at once safe, simple, certain, and healthy, and thus many a victim would not fall a sacrifice to the Cæsarean operation.

In respect, too, when a woman is threatened with miscarriage or abortion it is important that the treatment, either to prevent it, or, when that is impracticable, to assist and expedite it, should be thoroughly understood, and its treatment made clear and simple, that no unnecessary alarm need be occasioned when it occurs.

So, too, in regard to the various diseases accompanying and belonging to pregnancy, every woman should know how to prevent the one and ameliorate the other.

And finally, the subject of unfruitfulness, sterility, or barrenness, is here presented in a manner, which, to some extent, demonstrates that in most cases it can be cured, yet how many are pining in childless loneliness, in utter despair of cure.

Such are some of the important topics treated of in these pages, so intimately connected with every woman’s peace and happiness, with which every woman should be conversant, and yet how little informed are most females with what concerns themselves, their children, and their husbands so much.

MANAGEMENT

OF

FEMALE COMPLAINTS.

MENSTRUATION.

One of the principal constitutional characteristics of the female, is menstruation, or the monthly evacuations peculiar to the sex.

This important operation generally takes place about the age of twelve or thirteen; but varies through the world, either in degree or frequency, both from constitution and climate.

Women in the higher ranks of life, and those of a delicate, nervous constitution, are subject to sickness, headache, and pains in the back and loins, during periodical evacuation. Those of the lower rank, inured to exercise and labor, and strangers to those refinements which debilitate the system, and interrupt the functions essential to the preservation of health, are seldom observed to suffer at these times, unless from general indisposition, or a diseased state of the womb.

After the discharge has become established it recurs periodically while in health; and its recurrence is so regular, that it can be calculated with great exactness. The usual period of its visitations is from twenty-seven to thirty days. As to the time of its continuance, this is various in different women; but it seldom continues longer than six days, or less than three, and does not cease suddenly, but in a gradual manner.

Its approach is generally preceded by certain feelings of oppression or deviation from the ordinary state of health, which warn the individual of what is to happen. There is, in particular, a sensation of fulness about the lower part of the belly, and a relaxation about the uterine system which can scarcely be overlooked by the most heedless. The appetite becomes delicate, the limbs tremble and feel weak, the face becomes pale, and there is a peculiar dark streak or shade under the eyes; sometimes great restlessness, slight fever, headache, heavy and dull pain in the small of the back and bottom of the belly, swelled and hardened breasts, &c. All of which are sometimes instantly relieved by a trifling discharge from the vagina, and this not necessarily colored. It must at the same time be admitted, that in some few constitutions these feelings are so inconsiderable as to be little attended to; so that the woman mixes in society as usual without any apparent inconvenience.

The period at which the menses make their appearance, is various; it is much influenced by constitution, climate and mode of life. As a general rule, it takes place at puberty, or at that period at which the female is capable of propagating her species; and this period varies as climate may differ. They constantly, however, keep pace with the development of the body; where this is rapid, they will appear proportionably earlier; where this process is slower, they will appear later: but whenever the menses appear as regular evacuations, they mark the period of puberty: thus, in hot countries, women commence to menstruate at eight or nine years of age, and are not unfrequently mothers at ten.[^[1]]

In the more northern regions, as in Lapland, &c., this evacuation is generally delayed until the female has attained her eighteenth or nineteenth year: in the temperate latitudes the average period will be found from the fourteenth to the sixteenth year. A difference, will, nevertheless, be found in the women who may reside in cities, and in those who dwell in the country of each respective portion of the globe. It may also be observed, that in cold countries, women continue to menstruate for a longer period than in warm; and as a general rule, it will be found they are obnoxious to this discharge double the period that elapses before it commences. Thus, women who have not this discharge until eighteen, will be found to have it until beyond fifty; those who commence at fourteen or fifteen, will leave off at forty-five; those who begin so early as eight or nine, will have it cease at twenty-five or six.[^[2]]

On the appearance of the menses, or monthly turns, nature seems to perfect her work, both as regards development and proportion: it is the period of the most perfect beauty of which the female is susceptible; it is the one at which the moral changes are not less remarkable than the physical; it is a moment, of all others, the most replete with consequences to the inexperienced and confiding female.

At this period a great variety of interesting and curious phenomena present themselves: the voice is found to change; the neck and throat to increase in size, and to become more symmetrical; the mammæ to swell; the nipple to protrude; the chest to expand; the eyes to acquire intelligence, and increase of brilliancy; in a word, a new being, almost, is created.

The quantity of fluid expended at a menstruous period differs in different individuals; with girls who precociously menstruate, the quantity is in general smaller, and the returns less regular. Climate exerts an influence upon the quantity discharged, as well as upon the periods at which this evacuation shall commence. Thus, in the equatorial and more northern regions, it is less than in the more temperate climates.

It is of importance for women to know that occasional irregularities are not always the consequences of disease. Constitutions vary as much in respect to the regular returns of this discharge, as they do with regard to their first appearance or final cessation. Those in whom the change occurs very early from vigor of constitution, require little to be done for them; but in weak and delicate habits, the non-appearance of this evacuation is too often considered as the cause, whereas it ought to be viewed as the effect, of the state of the habit unpropitious to its taking place. And, according to family practice, under this false impression, warm teas and forcing medicines are employed at the approach of this disease, which have often done much harm.

Nature is not so defective in her own judgment as to require auxiliaries. Care should be taken to improve the general state of the health, by attention to diet, moderate exercise, change of air, &c.

In some instances the menstrual discharge does not make its appearance before the age of seventeen or eighteen, and, nevertheless, health is not in the least affected. The mere want of evacuation at the ordinary time, therefore, is not to be considered as morbid, unless the system be evidently deranged thereby. In many cases, however, symptoms of disease appear which are evidently connected with the defect of the menses, and go off upon its discharge. The treatment, in such cases, must be regulated by the particular circumstances and constitution of the individual. There is no remedy adapted to every case of this kind; but an open state of the bowels, and a due regulation of the diet, together with moderate exercise, are useful in every instance of this complaint. Warm clothing, too, particularly about the lower extremities, is of most essential benefit. The occasional use of the warm bath is pleasant and beneficial, especially if the skin be dry and warm. As the health improves, the cold bath will prove an auxiliary, if, after using it, the patient feels a glow of heat and a greater degree of liveliness. When the means ordinarily employed have failed, marriage, or a change of climate, has produced the wished-for effect.

In some instances the evacuation is impeded by a mechanical cause, that is an obstruction of the passage to the womb. This occasionally is met with, and the chief obstacle to its speedy removal is the difficulty of ascertaining its existence. The operation by which it is completely remedied, is not more painful nor formidable than blood-letting.

Fortunately, in most cases, the evacuation takes place in due time, and the constitution sustains no material or permanent injury. It is, however, in every instance, proper to pay particular attention to the system during the continuance of the evacuation.

The stomach and bowels, at this period, are very easily disordered, and therefore, everything which is heavy or indigestible, ought to be avoided. Some are hurt by eating fruits or vegetables; others by taking fermented liquor. In this respect experience must enable each individual to judge for herself. Exposure to cold, particularly getting the feet wet, is hurtful, as it tends suddenly to obstruct the discharge. The same effect is likewise produced by violent passions of the mind, which are also, at this time, peculiarly apt to excite spasmodic affections, or hysterical fits.

It is, in general, a very proper rule not to administer any very active medicines, at this time, unless some violent symptom absolutely requires them. Opiates, for instance, are, in many cases, necessary to allay spasmodic affections, or abate pain; and they are, in such circumstances, uniformly safe. They give speedy relief to hysterical feeling or suffocation, or to spasm of the stomach or bowels.

Dancing, exposure to much heat, or making any great or fatiguing exertion, are improper. These causes may increase, to an improper degree, the quantity of the evacuation, and in certain circumstances may give a disposition to a falling down of the womb.

RETENTION OF THE MENSES.

Description.

The menstrual discharge is liable, from many causes, to become obstructed at the period when it ought to appear; when this takes place it is attended with very painful or serious effects; and, if nature is not assisted, the health is impaired or the constitution undermined, inducing consumption or some other complaint.

Causes.

The remote cause of this complaint is most frequently suppressed perspiration; and it may arise, in part, from an inactive sedentary life, and such habits as are peculiar to the higher classes of society, particularly in cities and towns. The proximate cause of it seems to be a want of power in the system, arising from inability to propel the blood into the uterine vessels with sufficient force to open their extremities and to allow a discharge of blood from them.

Symptoms.

Heaviness, listlessness to motion, fatigue on the least exercise, palpitation of the heart, pains in the back, loins, and hips, flatulence, acidities in the stomach and bowels, costiveness, a preternatural appetite for chalk, lime, and various other absorbents, together with many other dyspeptic symptoms. As it advances in its progress the face becomes pale, and afterward assumes a yellowish hue, even verging upon green, whence it has been called green sickness; the lips lose their rosy color; the eyes are encircled with a livid areola; the whole body has an unhealthy appearance, with every indication of a want of power and energy in the constitution; the feet are affected with swellings; the breathing is much hurried by any great exertion of the body; the pulse is quick, but small; and the person is liable to a cough, and to many of the symptoms of hysteria. Sometimes a great quantity of pale urine is discharged in the morning, and not unfrequently hectic fever attends. In cases of a more chronic character there is a continued, though variable, state of sallowness, yellowness, darkness, or a wan, squalid, or sordid paleness of complexion, or ring of darkness surrounding the eyes, and extending perhaps a little toward the temples and cheeks.

Treatment.

As this disease proceeds from debility, it is evident that the great object to be fulfilled will be to give tone and energy to the system; and if this debility has arisen from a sedentary life, the patient must begin immediately to exercise in the open air, and, if practicable, to change her residence. The tepid or warm bath should be used in preference to the cold. The first medicine given may be the pulverized mandrake root, combined with a little cream of tartar. This, as well as other medicines, should be taken upon an empty stomach: after it has been given, motherwort, pennyroyal, and other herb teas may be freely drunk. After the exhibition of the purgative, which may be occasionally repeated, gum aloes may be taken, combined in such a manner as to prevent the piles. This medicine, from its action upon the uterus through the medium of the rectum, is very useful in retention of the menses. Emmenagogues, or “forcing medicines,” should not be used to bring on the menses, except there be a struggle or effort of nature to effect it, which may be known by the periodical pains and pressing down about the hips and loins. When this occurs let the feet be bathed, and perspiration promoted, by drinking freely of diluent teas, such as pennyroyal, motherwort, and garden thyme. Should considerable pains attend the complaint, eight or ten grains of the diaphoretic powders may be given, and fomentations of bitter herbs applied over the region of the womb. Desomeaux’s Portuguese Pills are now recommended as the best specific, especially if the disease proves obstinate.

The female should be very careful not to expose herself to the vicissitudes of the weather, and not suffer the feet or clothes to become wet: warm clothing must be worn, and particularly flannel. For pain apply a heated brick, covered, to the bowels.

The diet should be light, nutritious, and easy of digestion.

SUPPRESSION OF THE MENSES.

Description.

In this disease there is a partial or total obstruction of the menses in women from other causes than pregnancy and old age. The menses should be regular as to the quantity and quality; that this discharge should observe the monthly period, is essential to health. When it is obstructed, nature makes her efforts to obtain for it some other outlet; if these efforts of nature fail, the consequence may be, fever, pulmonic diseases, spasmodic affections, hysteria, epilepsy, mania, apoplexy, green sickness, according to the general habit and disposition of the patient. Any interruption occurring after the menses have once been established in their regular course, except when occasioned by conception, is always to be considered as a case of suppression. A constriction of the extreme vessels, arising from accidental events, such as cold, anxiety of mind, fear, inactivity of body, irregularities of diet, putting on damp clothes, the frequent use of acids and other sedatives, &c., is the cause which evidently produces a suppression of the menses. This shows the necessity for certain cautions and attentions during the discharge. In some few cases it appears as a symptom of other diseases, and particularly of general debility in the system, showing a want of due action of the vessels. When the menses have been suppressed for any considerable length of time, it not unfrequently happens that the blood which should have passed off by the uterus, being determined more copiously and forcibly to other parts, gives rise to hemorrhages; hence it is frequently poured out from the nose, stomach, lungs, and other parts, in such cases. At first, however, febrile or inflammatory symptoms appear, the pulse is hard and frequent, the skin hot, and there is a severe pain in the head, back, and loins. Besides, the patient is likewise much troubled with costiveness, colic pains, and dyspeptic and hysteric symptoms.

Treatment.

It will be necessary, in the treatment of this disease, to remove urgent symptoms if they are present. If the patient is in severe pain, give the diaphoretic powders,[^[3]] and at the same time let a strong infusion of garden thyme and pennyroyal be freely given. Immerse the feet in warm lye water, and rub well with coarse flannel. If relief is not obtained in the course of an hour, or in a very short time, a strong decoction of bitter herbs should be thrown into a proper vessel, and the patient steamed fifteen or twenty times, as long as she is able to bear, or until perspiration is produced; immediately after which let her be put in bed, covered warm, and the herbs be enclosed in flannel or muslin, and applied to the lower part of the abdomen or belly. This process will almost immediately relieve the urgent symptoms. After this our next object will be, to regulate the menstrual discharge, by a proper course of strengthening medicine; that recommended under the head of chlorosis, or a retention of the menses, may be taken with advantage. Inasmuch as both proceed from debility, it is evident that it must be removed in order to effect a cure; and, therefore, that medicine and treatment which strengthen and invigorate the system, will invariably benefit the patient. The skin, stomach, and intestines, all seem concerned in the production of this disease, and hence our attention should be directed to a restoration of their proper offices: the stomach and bowels should be cleansed and stimulated to a healthy action; perspiration must be promoted, and, in short, every secretion and excretion of the system. If the stomach is in a morbid condition, let an emetic be occasionally given, and afterwards a dose of mandrake; both of which may be repeated as occasion requires. The patient may then take the following tonic bitters: Take prickly ash bark, two ounces; wild cherry tree bark, two ounces; Seneca snake-root, one ounce; tansy, one ounce; gum socotrine aloes, half an ounce; devil’s bit, two ounces: pulverize; to every two ounces of the powder add half a pint of boiling water and one quart of Holland gin, and half a wineglassful taken three or four times a day. This may be continued while it agrees with the patient, or as long as benefit is derived. About once a month there will generally be felt more or less symptoms preceding a catamenial discharge; considerable pain will be felt through the lower part of the abdomen, hips, and loins, showing that there is a strong effort or struggle of nature to return the menses. Our principal object, when this occurs, should be, to aid her salutary efforts, as directed in the Retention of the Menses. The patient should sit over the steam of bitter herbs for ten or fifteen minutes, retaining the steam by means of a blanket, to concentrate it upon the lower part of the body; at the same time the feet may be bathed, and tansy tea freely drunk. The abdomen should also be fomented, as before directed. It will not be necessary, however, to use these means, except there is an obvious indication to return the menses.[^[4]]

It must be recollected that when the patient labors under some other disease, there is such debility that there is not superfluous blood sufficient to keep up the menstrual discharge; and in this case our attention must be directed to the primary affection, without any regard to such symptoms; it is also very necessary to bear in mind the fact, that the menses are often suppressed from pregnancy. By a proper attention, we can always discriminate between a suppression of the menses and pregnancy; and the principal diagnostic symptom is, that in the former complaint there is a pain or affection of the head, attended with dizziness.

PAINFUL AND IMPERFECT MENSTRUATION.

Description.

Besides the two deviations from the usual course of nature already mentioned, there sometimes occurs a third, viz. where menstruation, although not wholly suppressed, is nevertheless somewhat difficult, and accompanied with severe pains in the back, loins, and bottom of the belly. This disease is owing to a weak action of the vessels of the uterus, or spasm of its extreme vessels, and is to be obviated by tonics, warm bathing, both local and general, together with the use of anodynes, which should be employed as soon as the symptoms which denote its approach are apparent. This complaint is a common, and generally an extremely harassing, affection. It may occur at every period during the menstruation stage of life; but it appears to be most common between the twentieth and thirtieth years of age, and in subjects of an irritable and sanguineous temperament. In many instances severe pains are experienced in the back, loins, and lower part of the abdomen for five or six hours previous to the appearance of the menses. This, however, soon ceases, and an immediate aggravation of the torturing pain follows. Sometimes the catamenia begin to flow moderately, with little or no previous pains; but in an hour or two, they become suddenly arrested, at the same time that violent pains come on in the hips, side, loins, back, and thighs, with a distressing sensation of forcing or bearing down. Occasionally a very slight menstrual discharge continues uninterruptedly for three or four days, accompanied throughout with extremely severe pains in the abdomen; and in some rare instances the catamenial evacuation, although attended with great suffering, is sufficiently copious and prolonged in its course, and may even exceed the regular duration and quantity of an ordinary healthy menstruation.

Treatment.

Since it is well known that a derangement in the uterine functions must generally proceed from a check of perspiration, astringing the minute ends of the uterine vessels, or in some manner deranging their functions, causing debility, &c., it will appear clear that our first attention must be directed to the skin. Cold appears to be the cause of the disease, and heat seems to remove it; therefore, when these periods of distress occur, let the patient sit over a strong decoction of bitter herbs, such as tansy, hoarhound, wormwood, catnip and hops, while a blanket is thrown round the waist of the patient to confine the steam to the lower parts. After the diseased person has been thus steamed and the feet bathed, let her be put into a bed, warmly covered, and diluent drinks given, such as tansy, thyme, pennyroyal, &c. At the same time let fomentations of the same herbs, enclosed in a flannel bag, be applied to the abdomen, as before directed. This will produce perspiration and afford immediate relief; and when these distressing symptoms are removed, and the patient becomes comfortable, a course of treatment must be adopted to prevent a recurrence of these symptoms, or to produce a natural flow of the catamenial discharge; and similar to that recommended under the preceding complaints. Herbs may be freely drunk.

A writer on this subject thus remarks, “This case of painful menstruation deserves particular attention, because it impairs the health of patients by its present effects, and seems to render them less prolific in future. Dr. Fothergill has afforded relief to several by the following process: Let the patient have near her a few pills, consisting of opium, gr. i. each, made soft with a little of any kind of conserve. She is to take one of these pills the moment the pain attending this discharge comes on. A pill may be taken every hour till the pain ceases: more than two will seldom be required; yet they must be taken in quantities sufficient to mitigate the pain. Let the patient keep either in or upon the bed, or at least in a recumbent posture, drink moderately of any diluting liquor, as herb teas, weak whey, or thin broth. When the time is past, a course of chalybeate bitters, in small doses, may be continued, till within a few days of the return; and the bowels should be kept open with some proper laxative. This excruciating pain seems to be spasmodic, and to proceed from the extreme irritability of the uterine system.” The diaphoretic powders will be found very useful. Diet and exercise are important. A hot brick or salt, enclosed in flannel wet with vinegar, and applied to the bowels, soon relieves the pain.

IMMODERATE FLOW OF THE MENSES.

This alarming complaint may occur under two different states of the constitution. In the one, the woman is of full habit, and often of a ruddy countenance. In the other, she is pale, delicate, and easily fatigued.

Symptoms.

In plethoric habits it is often preceded by headache, giddiness, or difficult breathing, and is afterwards attended with pain in the back and loins, universal heat, and a frequent, strong, and hard pulse. But when it arises from general debility, or in consequence of a laxity of the organ, paleness of the face, chilliness, lassitude of the body, oppressed breathing on the slightest effort, pains in the back on remaining any length of time in an erect posture, and coldness of the extremities, together with a long train of nervous complaints.

Causes.

A variety of causes may produce this troublesome disease. Some of these are general, such as a state of great weakness, or of too much blood; others are local, such as debility of the uterus, occasioned by tedious labor or frequent miscarriages. It may also be produced by accidental circumstances determining the blood more copiously and forcibly into the uterine vessels, as violent exercise in dancing, much straining at stool from great costiveness, contusion on the belly, excess in venery, or strong passions of the mind, particularly at the menstrual period.

Treatment.

In the management of this disease we have two objects: first, to moderate the discharge and procure present security; and, secondly, to prevent a return.

The first thing to be done when the hemorrhage is sudden or profuse, is instantly to remove the clothing which may occasion the least interruption to the free circulation of the blood, and to put the patient to bed, lightly covered with clothes. So long as this discharge continues, it is of importance to keep her in a recumbent posture, as cool as possible, and perfectly at rest, both in body and mind. Cloths, dipped in cold vinegar and water, and renewed as often as they become warm. These cold applications have a powerful effect in restraining uterine hemorrhage, and ought never to be omitted where the discharge of blood is profuse.

If the patient be of a full habit, attended with severe pain in the head or back, and febrile symptoms, it will be proper to give the antimonial, or febrifuge powders, or mixture.[^[5]]

The state of the belly must be attended to. It can be kept gently open by the cathartic mixture, sulphur, or any mild laxative medicine. Stimulating purgatives or clysters, under such circumstances, are improper, from their tendency to increase the discharge.

When no symptoms indicating an increased action in the vessels of the womb are present, astringent medicines should be employed. And, in cases where the discharges have not continued long, and the strength not much impaired, it is often sufficient to arrest the disease by giving fifteen or twenty drops of elixir vitriol, or six or eight grains of alum dissolved in a glass of cold water every hour; or, what is preferable, alum whey, sweetened to the taste, in doses of a small cupful, as often as the stomach will receive it. But, if the discharge be obstinate, we should have recourse to pills of sugar of lead and opium.[^[6]]

In no instance which has come under my knowledge, where the hemorrhage was in consequence of a laxity of the uterine vessels, have these pills failed in producing the desired effect.

In those cases where the hemorrhage is profuse, or of long continuance, and resists the means already pointed out, it will be proper to inject into the uterus from a gill to half a pint of a strong decoction of oak bark, in which one or two drachms of alum have been dissolved, or as much of the saturated solution of alum in water, in order to constringe and strengthen the vessels of the womb. This may be repeated twice or thrice a day, according to circumstances.

When symptoms of an increased action in the vessels of the womb are observable, the tincture of foxglove, in doses of twenty drops every four hours, constitutes the best remedy.

When there is reason to suppose the hemorrhage proceeds from a scirrhous or ulcerated state of the womb, all that can be done, is to afford temporary relief by giving opium in large doses. Indeed, opiates may be given with advantage in every case where there is considerable pain or anxiety, and the patient much exhausted. Under these circumstances, from one to two teaspoonfuls of laudanum, or from two to four grains of opium, according to the urgency of the case, will be useful not only in giving a check to the discharge, but also in preserving the strength, and abating nervous irritation. In most cases it is preferable to give opium in the form of injections to allay the spasmodic pains of the womb; and, when administered in this way, clysters of thin starch or gruel, in each of which two teaspoonfuls of laudanum are added, should be given every two hours until relief be obtained. (See Abortion and Flooding.)

Regimen.

The diet, at the time of excessive discharge, must be light and cool. The drink must always be cold, as ice-water, lemonade, or tamarind beverage. Port wine, in such cases, is too frequently resorted to, which uniformly does harm by increasing the circulation.

Prevention.

To prevent a recurrence of the attack in those who are subject to it, the patient must necessarily avoid the causes by which it has been produced.

When it is evident that the discharge is in consequence of a full habit, it will be proper to reduce the system by living sparingly, by keeping the bowels rather in a laxative state, and by rising early, and taking through the day regular but frequent exercise; and, after the plethora is removed, by strengthening the vessels which have been over-distended, by the use of the cold bath.

In a greater number of cases, however, we meet with a delicate constitution and spare habit, with pale countenance: this state requires the use of sea bathing or the shower bath, and the vessels of the womb are particularly strengthened by pouring cold water daily on the back and loins.

It will be advisable to use a generous nutritive diet, with wine, and to have recourse to some of the tonic medicines, as advised under the head of obstructed menses, to strengthen the system generally. At the same time the bowels must be attended to, and invigorating exercise taken daily; whilst on the other hand, fatigue, and especially exposure to relaxing heat, must be carefully avoided.

DECLINE OF THE MENSES.

The nearer a woman approaches her forty-fifth year (cæteris paribus), will be the risk of some irregularity in the menses; and as this period is more frequently the one at which any latent disease of the uterus shows itself, it is always looked forward to with much anxiety by women. Indeed, so replete is this time with horrors to many, that we may very justly suspect apprehension to be the cause of some of the distressing symptoms, which sometimes accompany this interesting process of the human uterus.

Delicate women, and especially those who have lived idly, have this period of life arrive earlier than those of a contrary constitution, and opposite habits. We have already noticed, in our section on Suppression, that this change sometimes takes place at a very early period of life, and this without leaving any injurious consequences behind it; and, on the other hand, we find many cases on record, where this discharge had continued with regularity to a much longer period than the ordinary one. Gardien mentions a case which fell under his own notice, where this evacuation continued with great exactness, until beyond the seventy-fifth year; others, still more uncommon, are mentioned by various writers.[^[7]]

This change is sometimes effected so silently, that the woman scarcely notices her altered condition; at others, its approach is so gradual, as not to attract observation, until the diminished quantity gives warning that it is about to take its leave for ever; while, again, the irregularity, both in period and quantity, may be such, as justly to give alarm, as well as to produce the most serious danger.

But, as a general rule, it may be observed, that when the woman arrives at about her forty-fifth year, she finds her menses to become irregular, both in the quantity of fluid evacuated, and in the periods they observe; being sometimes in advance, and at others, not appearing until long after the accustomed time. The woman also finds some alteration has taken place in her general health; she becomes pale, debilitated, and nervous; arising, however, for the most part, from the too frequent returns of this discharge, or its too great abundance.

At this time, also, the woman sometimes becomes the victim of a strange illusion, should the menses not have returned for several periods; for she now supposes herself to be pregnant, as her abdomen enlarges, as do the mammæ; her appetite becomes capricious, or she has strange longings, &c., the whole of the rational signs of this condition being present, in her imagination, even to the motion of the child. This delusion is most common to women who marry late in life, and who are very desirous of offspring. Now the breasts lose their intumescency; the morning sickness vanishes; the swelling of the abdomen subsides; the imagined stirrings of the fœtus cease, or the sensation becomes so unequivocal as to satisfy that it arises from the movement of wind; and, to put everything beyond hope, the menses return in overwhelming quantity. It is highly proper, that practitioners, and especially the younger part of them, should be put upon their guard in respect to this condition of the patient, and not too easily yield credence to all her wishes may dictate, or absolutely to treat as an impossibility, a circumstance of which there is occasionally an example.

It seems that the apprehensions of this period of life have arisen mainly from the notions entertained of the final cause of the menses; namely, that it gives vent to peccant humours. But females should be made to know, that all this is purely the theory of the vulgar; as the menstrual blood is formed from the general mass; and, consequently, if that be pure, the other will be; therefore, the idea is altogether ill-founded. But unfortunately, whenever this discharge is less abundant than usual, the most serious fears are entertained, that there will be a retention of a portion, which will cause disease, either in the uterus itself, or in some other part of the body; hence, a diminished menstruous secretion is always more alarming to the female, than an unusual flow. But it may be well to remark, that there is a great difference between the cessation of this discharge, and the suppression of it. In the one instance, it is an event which nature has designed should take place, and is effected altogether by arrangements of the system itself; and, of course, one of its natural processes: in a word, as much so as its commencement; but the suppression, from some morbid agency, is in direct opposition to the intentions of nature, and will, of course, be followed by some baleful consequence, if it continue beyond a certain period.

The vulgar error, that “women at this period of life are always in danger,” is replete with mischief to the suffering sex; and I feel it a duty to declare, that they are not necessarily more obnoxious to disease at this, than at any other period of their existence.[^[8]] That they are sometimes liable to a disease at this time; and that disease one of the most terrible in the long list of human infirmities, I admit; but must, nevertheless, insist that Cancer (the disease to which I allude, and the one so much dreaded) is more rare in the uterus than in certain other portions of the body; for instance, the mammæ; and, perhaps, I am within the truth, when I say, that there are three instances of the latter for one of the former. If latent dispositions to disease, either in the uterus or other parts, become active about this period of life, it is not because the declining menses excite them; but because the disease is slow in developing itself, and is, perhaps, kept in check for a long time, by the menstrual discharge serving as an important evacuation; especially when the uterus may be the seat of the complaint. In such instances, the foundation of the disease was laid, perhaps, at the time when the menses were the most perfect, as regards period and quantity; consequently, they could have had no agency in its production; but, on the contrary, from its frequently relieving the engorgement of the vessels, served to keep it in subjection for a long time; not as a specific discharge, but as a mere depletion; or, in other words, that if an equal quantity of blood could have been by any other means as certainly abstracted from the uterus, the same favorable result would have followed. Coincidences in the human system are so common, that they are frequently mistaken for cause and effect; hence the cessation of the menstrual discharge, and the appearance of scirrhi and cancers, are considered as cause and effect.

At this period of life, nothing will so effectually secure the woman against injuries which may arise from the irregularities of the menstrual discharge, as a well-regulated regimen. By regimen, in this place, we would wish to be understood, not only eating and drinking, but exercise of both body and mind, including the proper government of the passions; in a word, everything which relates to both moral and physical existence.

A well-ordered course of exercise in the open air in well-selected weather, and great simplicity of diet, is of the utmost importance to the female at this period of life, and should never be neglected, if it be possible to indulge in them. By these means, the nervous, muscular, vascular, and lymphatic systems are all preserved more certainly in equilibrium with each other, since they are the best calculated to ensure a reciprocation of their respective offices; and, consequently, to maintain that condition of the system, termed health. Hence, the justness of the remark, that the women who live in the country, and who exercise freely in the open air; who have fulfilled their duties scrupulously as mothers, by suckling their children, agreeably to the views of nature; who do not goad their systems by over-stimulating food and drinks; who do not relax their bodies by too long indulgence in bed, have but little suffering at this period.

From this it will follow, that a milk and vegetable diet, together with pure water as a drink; regular exercise, not carried to fatigue; keeping the bowels well open, by well-selected food, as the fruits of the season in proper quantities: the bran bread if necessary; but not by medicine, unless absolutely required; governing the temper; restraining the passions, as well mental as animal, will largely contribute to the safety and comfort of this period. All that we have just recommended, is calculated to place the system in a condition by which it shall preserve its various forces; have its irritability diminished; its sensibility moderated; and pretty certainly prevent that condition of the blood-vessels, most decidedly unfriendly to the general health at this time, called plethora. And, though last, not least in fair estimation, is an attention to cleanliness. The external organs should be washed with lukewarm water at least twice a day, and the whole body once a week, by going into a lukewarm bath. In using the bath, care should be taken to come out of it as soon as the purposes of cleanliness are answered.

Our next concern is with the derangement of the discharge at or about the period of cessation: this will consist, 1st, in a diminution of the proper quantity; and, 2dly, in an excess of it. As regards the first, we have already said enough when treating of the suppression of the menses; and, with respect to the second, it must be treated according to the rules prescribed for the management of hemorrhage from the uterus from any other cause, that is, first, to diminish the quantity discharging; secondly, to prevent an excessive return.

CONCEPTION;
OR,
PREGNANCY.

CONCEPTION.

In order to procreate the human species, there is a periodical discharge of blood from the vagina of every female, termed the catamenia, or menses. The secretion of this fluid commences at that period of life termed puberty, which occurs at different ages, according to the climate. In some latitudes it commences as early as eight or ten, and in others not until fifteen. As soon as conception or pregnancy commences, this discharge ceases, and goes to support the fœtus, or the child.

The manner in which conception takes place has ever been a fruitful subject of inquiry, but we are unable to account for this change precisely. It is, however, pretty evident that the semen of the male is introduced into the uterus, while the semen of the female is discharged from the ovaria by means of the Fallopian tubes, the fimbricated extremity of which closely embraces that organ.

These tubes, by a kind of peristaltic motion similar to the intestines, convey the semen of the female into the uterus, where it unites with the semen of the male; and it is these united fluids which constitute the rudiment of the fœtus, and which often give to the child the appearance and dispositions of their parents. Sometimes one trait is inherited, sometimes another; at other times a new compound or character is formed (like a chemical union), which does not partake of the nature of either of the former.

OF THE MODE BY WHICH PREGNANCY MAY BE DETERMINED.

There are certain signs which a female is taught to regard as essential evidences of pregnancy and it is supposed by most, if not by all women, that their presence is absolutely necessary to the existence of this state. In reference to one or two of these signs, this is far from the fact; for they are not unfrequently absent, although pregnancy exist, and the remainder may be present, although pregnancy be absent. Many a female, I am confident, has, from this very circumstance, experienced much difficulty in attaining certainty as to her state, and suffered months of anxiety and doubt. This has arisen from a want of those clear notions, and that precise information, which a question so important demands.

The object of this chapter is to remove this difficulty, by presenting a short account of those symptoms of conception which the female may herself observe, and to point out to what extent they may be relied on. It will be necessary to notice only four of the signs or symptoms of pregnancy, and they may be considered in the order in which they usually arise; that is, ceasing to be unwell; morning sickness; shooting pains through, enlargement of, and other changes of the breast; and, lastly, quickening.

Ceasing to be unwell.

The first symptom of pregnancy is the omission of that monthly return, which, in female phraseology, would be described as “ceasing to be unwell;” and it may be adopted as a general rule, that, in a healthy woman, whose menstruation has been established, and continued regular, and who is not nursing, “Conception is followed by a suppression of the menstrual discharge at the next return of its period.” Thus, a female may have been pregnant a week or two already; but she is not aware of it till that period of the month arrives when she is accustomed to menstruate, and then, when she expects to be unwell, she finds that she is not so.

Now this symptom, as a general rule, admits of four exceptions:—

First. A young female shall never have menstruated, and yet conceive.

Secondly. A mother shall conceive while she is nursing, and not menstruating.

Thirdly. A female shall conceive, and yet be unwell during the first three, four, or more months of pregnancy.

Fourthly, and lastly. Occasional conception takes place late in life, after menstruation has apparently ceased for ever.

First Exception.—Many cases are on record proving this point. I have met with only two cases; one quite a girl, not having arrived at her seventeenth year, and yet was in her sixth month of pregnancy when she applied for a letter for the Finsbury Midwifery Institution; the other was in her nineteenth year. Menstruation was, subsequent to confinement, established in the first; with the result of the latter, I am not acquainted.[^[9]]

Although pregnancy under such circumstances is not of frequent occurrence, still it does now and then take place. A knowledge of the fact may therefore prove useful.

Second Exception.—It is scarcely necessary to advert to the well known fact that a woman may conceive while she is nursing, without any previous return of the monthly discharge, except to expose the popular error, “that a female will not become pregnant during lactation.” This is very far from being the case. Poor women are much in the habit of nursing their infants eighteen months, two years, and even two years and a half, in order to protect themselves, as they imagine, from becoming pregnant; and many a poor creature have I seen with exhausted frame and disordered general health, arising from protracted nursing, pursued alone from this mistaken notion.

I have large opportunities of investigating this, as well as the several points touched upon in this chapter. On an average, between forty and fifty poor women call upon me every month, with midwifery letters for attendance in their confinement: and the result of my inquiries upon the present question has led me to believe, that more than one third of these women have conceived at least once while nursing, and very many of them oftener.[^[10]]

Mrs. M——, ætat. 30, married six years. Became pregnant three months after her marriage. Having suckled this child for more than two years, became pregnant a second time. This last died in three weeks, and immediately after she proved pregnant for a third time. The third child she brought this morning (being out of health), and assured me that she had not seen anything since she first conceived, that is, three months after her marriage, and six years from the present time.

Mrs. W——, ætat. 25, married five years. Has not been unwell since she first fell in the family way; is now pregnant with a third child, having hitherto fallen pregnant while nursing.

Many other cases illustrative of this fact I might assert, but these suffice to prove the exception.[^[11]]

Third Exception.—That a female should become pregnant, and yet be unwell during the first three, four, or more months of pregnancy, may appear an extraordinary statement; but it is a fact, that the menstrual discharge sometimes continues in its usual regularity for two, three, or more months after conception, and without any dangerous consequences.

It has been asserted, as an objection, that this discharge is not truly menstruation; but the discussion of that question does not concern us here. We have only to consider, whether there does not frequently, during pregnancy, take place a discharge, so closely resembling menstruation in its periods, quantity, duration, and appearance, that neither the female herself nor her medical adviser shall be able to detect any difference between them; and of this I have no doubt.

It may occur once only after conception, either in diminished quantity or more profuse than usual. It may thus give rise to miscalculation as to the expected time of confinement.

It may continue in its usual regularity for two or three months. The following instance of a patient I attended illustrates the fact of its going on to the period of quickening:—

Mrs. R——, ætat. 27, married eight years. Was first unwell when eighteen years of age, and continued to be so regularly until she became pregnant, two years from the time of her marriage. She suckled her first child for eleven months; soon after she became unwell, and continued so until she quickened with her second child; a circumstance which she had not the slightest suspicion of, for there was no perceptible difference either in the quantity or appearance of the monthly discharge. During the remaining months of gestation she did not see anything; she afterwards suckled her little one for ten months; and then was obliged to wean the child, having an attack of the cholera. She continued from this time regular for two years; but meeting with a fall, much to her surprise, two or three days after, miscarried of a four months’ child. She is now pregnant again, having been regular every month till she quickened, and expects to be confined, Feb. 1836.

In this case then, the female was unwell in two pregnancies till the period of quickening; and in the other for four months, when miscarriage took place from accident.

And lastly, it may occur through the whole period of pregnancy.

Mrs. F—— is now pregnant for the third time. In her first pregnancy the monthly returns appeared for three periods, regular as to time, and in quantity and appearance as heretofore. During the second child-bearing, at every month till confinement. During the third—her present pregnancy—for three months only. This patient is always unwell while nursing.

Mrs. J——, now in her eighth pregnancy. Was unwell every month throughout the first six pregnancies; but the quantity always slightly diminished. In the seventh, the same circumstances occurred; but premature labour was this time induced, between the sixth and seventh months, by a fall. During the present pregnancy she has not seen anything. Is always unwell while suckling.

Mrs. P—— is in her fourth pregnancy. In the first three was unwell, at her regular periods, to the time of confinement. The discharge the same in quantity, but rather lighter appearance. Has been unwell in her pregnancy every month up to the present time.[^[12]]

The following case proves how important it is that this fact should be generally known; for up to a very late period, some medical men have even denied the possibility of this occurrence.

The case I refer to was that of a young lady, privately married, the gradual enlargement of whose abdomen was decided by her medical attendant to arise from dropsy; for, although she had most of the symptoms of pregnancy, and the medical man was aware she had been married eight months, still, as she continued to menstruate, he declared it impossible that she could be pregnant. Tapping was proposed; and, except that her general health suffered much at this time, the operation would have been performed. The delay saved the patient such unfortunate and mistaken treatment—it might have proved fatal in its results—and she shortly gave birth to a living and healthy male child.

Fourth exception.—That women late in life have conceived after menstruation had apparently ceased for ever, the following cases prove:—

In September, 1834, I was called to the assistance of a female in labour in her forty-ninth year. She had not been pregnant for twelve years, and supposed she had ceased to menstruate two years previous to that time. She did well, and never afterward saw anything.

Mrs. B——, ætat. 39. Has been married eighteen years, commenced to be unwell very early in life. Has had three children; the last pregnancy seven years since. Is now again pregnant, her menses having left her sixteen weeks prior to conception; before which, she had been very irregular, and supposed she had ceased to be unwell for ever.

Other cases of a similar nature are on record. There can be no doubt they are authentic; but at the same time it must be acknowledged that a female is not unlikely to be deceived, by the irregularity which attends the returns of this discharge, late in life. It so happens, too, that just before the change of life takes place, there appears in the constitution of some females a great disposition to pregnancy; so that many who have ceased to bear children for years, or have been hitherto barren through the whole of their married existence, at this time, to the surprise of their friends and themselves, become pregnant.[^[13]]

A knowledge of these facts must be useful, as they will tend to allay apprehension at what might be supposed disease, both by the mother and by the hitherto childless woman.

A female must not forget, however, that she may mistake her condition, and that such mistakes are not at all unlikely to arise from the circumstance that the symptoms which naturally accompany the cessation of menstruation, much resemble those of pregnancy. She passes over the menstrual period;—she is struck with this. Other symptoms are soon manifested; the size increases—the breasts even become swollen and painful—the stomach disordered, and the appetite capricious;—flatulence collects in the intestines; and while on this account the size still increases, the air moving about the bowels gives an inward sensation which is mistaken by the female for the plunging of the child. Time alone, or the investigation of the medical attendant, detects the mistake; and the symptoms are then to be easily removed by the exhibition of carminative and purgative medicines, the use of active exercise, and bandaging the distended abdomen.

It must be remembered, also, that suppression of the monthly return may arise from a variety of causes, altogether independent of conception. Every female is aware, that exposure to cold, just before the expected period, is a frequent cause. Different forms of disease, hardship, or mental emotions, may produce the same result. It does not follow, therefore, because a woman ceases to menstruate, she must be pregnant; which naturally presents this inquiry: what dependence, then, is to be placed upon the omission of menstruation as a symptom or sign of pregnancy?

When a female ceases to be unwell, and experiences other symptoms of pregnancy, she must consider her situation as yet uncertain, because these signs are common to disease as well as pregnancy. But if toward the third month, while the suppression continues, she recovers her health, and if her appetite and colour return, she needs no better proof of pregnancy; for under other circumstances her health would remain impaired, and even become worse.[^[14]]

Morning Sickness.

Soon after conception, the stomach often becomes affected with what is called “morning sickness.” On first awaking, the female feels as well as usual, but on rising from her bed qualmishness begins, and perhaps while in the act of dressing, retching takes place.

This symptom may occur almost immediately after conception; but it most frequently commences for the first time between two or three weeks after. Now and then it is experienced only the last six weeks or two months of pregnancy, when it is attended, generally, with much distress and discomfort. And lastly, it is not unfrequently absent altogether.

It continues, more or less, during the first half of pregnancy, and subsides about the time when the movements of the child begin to be felt.

Irritability of the stomach, however, may arise from a variety of causes totally independent of pregnancy, and connected with disease or disordered function. Of what avail, then, it will be asked, is this symptom as a sign of pregnancy? It is so far available:—

The nausea and vomiting of pregnancy are not accompanied by any other symptom of ill health; but, on the contrary, the patient feels as well as ever in other respects, and perchance takes her meals with as much relish as formerly; but while doing so, or immediately after, she feels suddenly sick, and has hardly time to retire, when she rejects the whole contents of her stomach, and very shortly after is quite well again. Not so with sickness arising from disease, or disordered condition of the stomach.

Shooting pains through—enlargement of—and other changes of the breast.

When two months of pregnancy have been completed, an uneasy sensation of throbbing and stretching fulness is experienced, accompanied with tingling about the middle of the breasts, centring in the nipple. A sensible alteration in their appearance soon follows: they grow larger and more firm. The nipple becomes more prominent, and the circle around its base altered in color and structure, constituting what is called “the areola.” And, as pregnancy advances, milk is secreted.

The period of gestation at which these changes may occur, as well as the degree in which they become manifested, varies very much. Sometimes, with the exception of the secretion of the milk, they are recognised very soon after conception;—in other instances, particularly in females of a weakly and delicate constitution, they are hardly perceptible until pregnancy is far advanced, or even drawing towards its termination.

Enlargement of the Breast.—The changes in the form and size of the breast may be the result of causes unconnected with pregnancy. They may enlarge in consequence of marriage, from the individual becoming stout and fat, or from accidental suppression of the monthly return. There are, however, these differences: enlargement from pregnancy may in general be distinguished from that produced merely from fat, by the greater firmness of the breast, and its knotty uneven feeling—it is heavier; and the tension and enlargement from suppressed menstruation, by its subsiding in two or three days, whereas that caused by pregnancy continues to increase. Nevertheless, the dependence which may be placed upon the enlargement of the breast only, as an evidence of pregnancy, is not very great, and considered alone, but a doubtful sign.

The Nipple.—Not so the changes which take place in the nipple, and around its base. These alterations, if present, are of the utmost value, as an evidence of pregnancy. The changes referred to are these:—

About the sixth or seventh week after conception has taken place, if the nipple be examined, it will be found becoming turgid and prominent, and a circle forming around its base, of a colour deeper in its shade than rose or flesh-colour, slightly tinged with a yellowish or brownish hue, and here and there upon its surface will be seen little prominent points, from about ten to twenty in number. In the progress of the next six or seven weeks, these changes are fully developed; the nipple becoming more prominent and turgid than ever: the circle around it of larger dimensions, of an extent of about an inch or an inch and a half; the skin being soft, bedewed with a slight degree of moisture, frequently staining the linen in contact with it; the little prominences of larger size, from the sixteenth to the twelfth of an inch perhaps; and the colour of the whole very much deepened, but always modified by the complexion of the individual, being darker in persons with dark hair, dark eyes, and sallow skins, than in those of fair hair, light-coloured eyes, and delicate complexions.

Such are the essential characteristics of the true areola, the result of pregnancy, and, I believe, of that condition only.

This, then, is a most valuable sign; but, unfortunately, it is frequently absent; and how often it is present, although I have examined many hundred cases for it, I cannot determine, as unfortunately no note was made upon this point. It should also be observed, that both in dark and fair women, the change of colour, without the other appearances, may be present, and yet pregnancy exist; and I have also seen frequently the dark circle alone, where pregnancy did not exist; but I never saw an instance where these prominences were truly developed, without the presence of pregnancy.

This fact has been more particularly noticed of late years by an eminent physician-accoucheur, and the attention of the author has, in consequence, been much directed to it; and, as a striking illustration of its truth, he may mention, that, called upon very recently to visit one of the Institution patients, the third day after her delivery, and having occasion to examine the breast, I pointed out to the gentleman in attendance the presence of these little prominences around the base of the nipple; upon which the patient, to my great surprise, immediately observed, “Ah, sir, I always know when I am pregnant by them, for they appear about ten days or a fortnight after its occurrence, and subsequent to delivery diminish gradually, as my milk leaves me.”

It has occurred to me during the past year to be consulted in five cases of doubtful pregnancy. In two of them, circumstances forbade the probability of its occurrence; but in both the true areola was distinctly and fully developed. It decided my opinion; and the result proved its correctness: both became mothers. Two others had made themselves patients of the Lying-in-Institution, having obtained letters for attendance from governors of the charity, and upon which was marked, by their own calculation, the month of their expected confinement. But I was led to believe, from observing two or three symptoms, that pregnancy did not exist.

Their cases were examined, and at last the breast; in both the true areola was wanting: the review of symptoms decided all doubts. Had, however, the true areola been present in either, it would at once have reversed, instead of confirming my first suspicions.

The fifth was pregnant, but the true areola was wanting; and I was obliged to refer to those signs which can alone be recognised by a medical man.

The absence, then, of this sign, except in combination with other circumstances, proves nothing, but, if present, I believe it conclusive.

The Presence of Milk.—With regard to the presence of milk in the breasts, as this is a symptom which may arise, and does very generally, in the latter months of gestation alone, when the existence of pregnancy has been long determined, it is only mentioned here to refute the popular error, that “the presence of milk in the breasts is an infallible proof of pregnancy.” It is no such thing; and many well-recorded instances could be brought forward to prove the possibility of its formation under circumstances totally independent of pregnancy.

Belloc speaks of a servant girl, who being obliged to have sleeping with her an infant who was being weaned, and which by its crying disturbed her rest, bethought her of giving it her breast to appease its clamour; and the result was, that in a short time she had milk enough to satisfy the child.[^[15]]

The following case is related by Mr. George Semple: Mrs. B——, wife of John Breward, Simpson Green, near Idle, aged forty-nine, the mother of nine children, the youngest of whom is twelve years old, lost a daughter-in-law about a year ago, who died in about a fortnight after giving birth to her first child. On her death, Mrs. B. took charge of the infant, a little puny sickly baby. The child was so fretful and uneasy, that Mrs. B. after many sleepless nights, was induced to permit the child to take her nipple into its mouth. In the course of from thirty to thirty-six hours she felt very unwell; her breasts became extremely painful, considerably increased in size, and soon after, to her utter astonishment, milk was secreted, and poured forth in the same abundance as on former occasions, after the birth of her own children. The child, now a year old, is a fine, thriving, healthy girl, and only a few days ago I saw her eagerly engaged in obtaining an apparently abundant supply of healthy nourishment, from the same fountain which, nearly twenty years ago, poured forth its resources for the support of her father.”[^[16]]

Quickening.

There is only one other symptom which I think it useful to notice, that is quickening; by which is meant, the first sensation experienced by the mother of the life of the child within her womb.

The first time this motion of the child occurs, the sensation is like that of the fluttering of a bird within her, and so sudden that she frequently faints, or falls into an hysterical paroxysm. A day or two passes by when it recurs. It afterwards increases both in frequency and degree, until the movements of the child are fully recognised.

It is proper that a female should be informed that the period when quickening takes place is very uncertain; for an impression is popularly prevalent that it always occurs exactly at the end of four calendar months and a half. This is not the case; it varies in different women, and in the same women during different pregnancies, as the following one or two instances will prove:—

Mrs. F——. Quickened with her first child at four months: quickened with the second at fourteen weeks: and is now in her third pregnancy, and reckons from the fourteenth week again.

Mrs. B——. Has had seven children, and with all felt the motion of the child for the first time at the third month.

Mrs. Mc M——. Has been several times pregnant; seldom feels movements of the child at all until the sixth month, and not strongly till the eighth.

The annexed table of the periods of quickening of seventy cases taken in the order in which they have been entered in the author’s note-book, will forcibly stamp the truth of these opinions:

In a few of these cases, for the sake of convenience I have used round numbers, when two or three days before or after was the exact time; and for the sake of correctness, have omitted several cases, in which there was the slightest doubt in the patient’s mind of the exact time.

It appears from this table, that this symptom takes place more frequently between the twelfth and sixteenth week, than before or after these periods; and that subsequent to the 4½ and the expiration of the sixth month, it may occur in the proportion of more than one case out of every five.—Before the third month, quickening seldom arises.

This symptom may not be felt by the mother at all, and yet pregnancy exist. This is rare, but the fact is confirmed by many writers; and I have met during the last seven years with two instances, and in both the mothers gave birth to living and healthy children.

Now comes the question, how far this symptom is of value, as a sign of the pregnant state?

If it has been experienced in former pregnancies, it is invaluable, for I believe it is not to be mistaken. If it is a first pregnancy and doubtful, it removes all obscurity, provided the sensation grows stronger and stronger, until the movements of the child are distinctly felt.

Four only of the symptoms of pregnancy have been noticed, because the remainder are not recognisable, except by the accoucheur, although to him of the greatest value when pregnancy is complicated and doubtful from the presence of disease.

The nature of these symptoms has been described as plainly, and yet as briefly, as possible, because of the importance of their being clearly understood by married women.

I have also endeavored to point out their real value as evidence of pregnancy—how they are sometimes absent in patients who are pregnant, and some of them present in those who are not so—because of the doubt and obscurity which arise from these variations.

And lastly, in bringing these observations to a conclusion, I venture to say, that if the married female will only take the trouble to make herself familiar with this little detail, she will not regret the time as lost or misspent, because it will generally guide her aright, and I trust save her many moments of anxiety and discomfort.

ON THE
DISEASES OF PREGNANCY,
AND HINTS FOR THEIR
PREVENTION AND RELIEF.

In describing the diseases which are incident to the whole period of pregnancy, my design is to take a general popular survey of the subject. I wish simply to communicate that kind of information, which every married and well-educated woman should certainly possess, and can usefully employ. To advance further than this, to those points upon which the assistance of the medical adviser ought to be sought, would be on every account improper, and productive rather of evil than of good.

There is no organ in the body, with the exception of the stomach, that exercises a more extensive control over the female system than the womb. Hence, when in the condition of pregnancy, it affects, directly or indirectly, various parts of that system. The effects of pregnancy, however, vary much according to the constitution of the female.

Sometimes a very salutary change is produced, so that the individual enjoys better health during gestation than before. The delicate and frequent-ailing girl, for instance,—the propriety of whose marrying was a matter of doubt among her friends—becoming pregnant, instead of realizing the apprehensions and fears of those most dear to her, will sometimes acquire new life and vigor from the altered circumstances of her condition. On the other hand, speaking generally, it is sometimes the case that harassing and painful symptoms will arise. These are designated the “diseases of pregnancy.”

Morning Sickness.

Nausea or vomiting, is one of the most common and distressing affections of pregnancy. It is chiefly troublesome in the earlier months of gestation, continuing until the period of quickening, when it decreases or ceases spontaneously;—or it does not occur until the latter months of pregnancy, when it subsides only upon delivery. I shall consider these states separately; and—

First, of sickness during the earlier months. This arises solely from sympathy with the newly commenced action, and irritable condition of the womb. This is evident from the fact, that, as the novelty of the pregnant state ceases, and the stomach becomes accustomed to it, the sickness subsides gradually, and is rarely troublesome afterwards.

It occasionally commences immediately after conception; and it is a remarkable fact, that a pregnant woman scarcely ever feels sick, until she first gets upon her feet in the morning. Hence it is called the “morning sickness.” She awakes refreshed and well, arises from her bed, and while dressing begins to feel qualmish. At the breakfast table she has no appetite, or if she takes anything, is shortly obliged to leave for her dressing-room, where she returns what she has taken; or, if she has been unable to take anything, ejects a fluid, limpid, thin and watery; and if the vomiting increases in severity, bile is thrown up at the same time. After the lapse of three or four hours, she feels quite well again, and by dinner time sits down with an appetite to her meal.

If there is merely nausea or vomiting without the presence of bile, it is evident that it arises solely from irritability of the stomach, and is not connected with a disordered condition of the digestive organs, which latter circumstance is not unfrequently the case. The best means that can be employed to relieve this irritable state will be found in a draught taken twice a day for several days, composed of fifteen grains of magnesia, one drachm of tincture of columba, and an ounce and a half of distilled peppermint water.[^[17]]

Medicine sometimes is hardly called for; and I have known a tumbler of warm chamomile tea, or even warm water only, taken immediately after nausea was felt, by inducing immediate vomiting, tranquillize the disturbed stomach, and thus abridge the morning attack. It is sometimes attended with advantage to take the chamomile tea before the female rises from her bed. I advised this with the most marked success very lately in the case of a lady who was very much reduced by the morning sickness. It had continued for several weeks, and with so much violence and straining, as to cause blood to be ejected with the fluid. In less than one week, when all other means had previously failed, the above suggestion was successful.

It frequently happens that the acidity is very great, in which case fifteen or twenty grains of magnesia should be taken in a wine-glass of milk[^[18]]—or, if it is preferred, a small tumbler of soda water; but the latter must not be persevered in for any great length of time, as it will then become injurious. The presence of acidity, however, is sometimes so difficult to overcome by alkalies, that these medicines must be given up, and acid remedies employed. Lemonade may first be taken, but lemon juice and water is still better.

The state of the bowels must not be forgotten, and if any of the latter remedies are resorted to, the most marked benefit will be derived from a gentle dose of Epsom or Cheltenham salts every second morning, if so often necessary.[^[19]]

The diet in such a case must also be carefully attended to; but as this point will be referred to more particularly presently, it is only necessary now to say that the quantity of food taken must bear some proportion to the slightly diminished powers of the digestive functions, and that it will be well, when the sickness is very obstinate and distressing, to take no food at all for several hours after rising. If, after a few hours, the mouth is much parched, it may be moistened with a little broth, or weak beef-tea; but let nothing more be taken for five or six hours, and it is most probable that the sickness which has resisted all other means, will thus be relieved.

If this irritable state of the stomach is connected with a disordered condition of the digestive organs, the sickness will be accompanied with the presence of bile in the matter vomited, a furred tongue, confined or irregular action of the bowels, and occasionally with what is termed “a sick headache.” These symptoms are to be relieved by medicines which thoroughly clear out the bowels, allay the irritability of the stomach, and afterwards by those which restore tone to both. But it is to be observed that the following directions are only intended to apply to those simple cases, in which, whether necessary or not, no one ever thinks of consulting their medical adviser, and for which it is certainly desirable that they should have some judicious directions, rather than be left entirely without them. If these symptoms become at all aggravated, it is requisite that they should make immediate application for professional advice.

The bowels will need in the first instance a draught composed of infusion of senna and Epsom salts—the common “black draught,”—with half a drachm of the tincture of henbane in addition. This, with five grains of blue pill, most probably effects the object desired; the bowels will be well purged, and the tongue become clean.

The next thing is to allay the irritability of the stomach, which is to be accomplished by the means already pointed out—the effervescing draught of soda, magnesia, chamomile tea, &c.; but in connexion with this, two or three grains of the purified extract of aloes, with an equal quantity of the extract of henbane, must be taken two or three times a week, at bedtime. This will keep the tongue still clean, and the bowels in order.

After a little time, the sickness having subsided, tonic medicines may be used: and a fourth part of the following mixture, taken three times a day, will, under the present circumstances, be the best means of restoring the tone of the stomach and bowels: sulphate of quinine, six grains; diluted sulphuric acid, half a drachm; infusion of columba, five ounces and a half; simple syrup, half an ounce.

Having pointed out the means for mitigating sickness in the early months, there only remains one additional suggestion to make, and it is, that all the remedies for relief detailed may, in some cases, fail. The sickness continues most obstinate; every time the female takes food, or even sometimes when abstaining from it, she vomits; and at last, from this excessive irritability and long-continued violent action of the stomach, symptoms threatening miscarriage will manifest themselves.[^[20]] There is generally in such a case, pain and a sensation of tension about the pit of the stomach, increased after every attack of sickness. If symptoms of miscarriage are not present, the application of nine or twelve leeches to the stomach, and pieces of soft linen rag well soaked with laudanum, constantly applied and renewed, will give the most decided relief. If, however, there is pain in the loins and hips, increasing in frequency and power, becoming at last slightly bearing down, I strongly advise the patient to consult her medical adviser, as the loss of a little blood from the arm, perfect rest in the recumbent position, and other directions which he alone can give, will, in such a case, be absolutely necessary, and I may add, if perseveringly acted up to by the patient herself, be certainly followed by success.

Secondly, of sickness coming on at the conclusion of pregnancy.

This arises from the distended state of the womb affecting mechanically, by its pressure, the coats of the stomach, and certain parts of its neighborhood.

This form of vomiting but rarely occurs; for do not let me be supposed to refer to the sickness which sometimes immediately precedes, and generally accompanies, the early part of labour. I am speaking of that irritability of the stomach which may arise about the sixth, seventh, or eighth month, and from which the female has been entirely free during the previous months of gestation, and now producing vomiting of an exceedingly troublesome form.

A lady suffering from sickness thus late in pregnancy, ought to seek medical advice at once. From this cause, if severe, premature labour might be brought on, and judicious medical treatment is always decidedly necessary to mitigate this form of sickness. The patient must lose a little blood, she must keep strictly to her sofa, and the bowels ought to be gently acted upon by small doses of Cheltenham or Epsom salts. A grain of the extract of opium may be given to allay the irritability at night, and cloths dipped in laudanum frequently applied to the pit of the stomach.

In all forms of sickness arising from pregnancy as its cause, the diet must be light, mild, and nutritious, taken in moderate quantities of three or four meals a day. It should consist of mild animal food, boiled or roasted. Chicken, white game boiled, mutton or beef roasted, are the viands most nutritious and easily digested. Stale pure bread untoasted, or pilot bread, mealy potatoes, or well-boiled rice, in moderate quantities, may be taken with animal food for dinner. A glass of port wine with warm water at the conclusion of the meal, is the best kind of beverage.

Advantage has often been derived from always taking brown bread, and Jamaica sugar in the morning’s coffee. The healthy operation of the bowels has thus been promoted; although a system of regular exercise by walking, apportioned to the strength, and not continued so long as to fatigue, will generally effect this purpose, while at the same time it gives tone to the general health. Fatigue of body is sedulously to be avoided. Slow and moderate walks, exercise in an open carriage (if the patient has sufficient strength), should be taken daily between breakfast and dinner; always avoiding to sit down to the latter meal tired, and, therefore, probably, with a blunted appetite.[^[21]]

Heartburn.

This is a very distressing symptom, and occurs early after conception; sometimes, however, not till after the fourth month; and occasionally is absent altogether. It is produced by an acid forming on the stomach, which rises into the throat, and, from the sensation it occasions, is called heartburn.

It is a very common complaint of pregnancy, and every female knows that she finds relief by taking a little magnesia or chalk, or lime-water and milk, with the occasional use of magnesia; but, although these means generally mitigate this symptom, occasionally it is very severe and almost intractable, and they fail. Under such circumstances, a draught composed of 15 grains of magnesia, 10 drops of the solution of the subcarbonate of ammonia, and 1½ ounce of mint or peppermint water, taken three times a day, and continued for three or four days, will remove the complaint.

If the bowels are confined, as is frequently the case, mild doses of Epsom or Cheltenham salts will be the best aperients. The use of these must be regulated by circumstances,—taken every second, third, or fourth day; that is, resorted to with sufficient frequency and perseverance to guard against costiveness.[^[22]]

The diet must also, in every case, be strictly attended to, and regulated upon the plan already stated.

Costiveness.

A costive state of bowels is one of the most common and, at the same time, troublesome of the diseases of pregnancy. It arises partly from the increased activity which is going on in the womb, and which induces a sluggish condition of the bowels, and partly from the pressure of the now enlarged and expanded womb on the bowels themselves.

A confined state of bowels is the frequent source of many serious evils; it therefore behoves the female to be vigilant and guard against it.

First,—Because, as before stated, pregnancy itself predisposes to constipation.

Secondly,—Because it is much more easily prevented than removed, when, after several days’ confinement, an accumulation of hardened fæces has collected in the lower bowel.

Thirdly,—Because such an accumulation may give rise to inflammation of the bowel itself, and, in the earlier months of pregnancy, to miscarriage; and,

Lastly,—Because, if a female falls into labor with her intestinal canal so loaded, it will of itself be sufficient to render, what would otherwise have been a quick, easy, and safe labor, a long, painful, and difficult one; and may be the cause also of very serious and alarming symptoms some forty or eight-and-forty hours after her labor is over.

The first and leading symptom of this affection is a costive or more consistent state than usual of the fæcal excretions, with a less frequent call for evacuation than is customary with the individual when in health. If this is not attended to, and several days, perhaps a week, pass by without the bowels being relieved at all, pain in the head, a foul tongue, and an increased degree of fulness and tension of the abdomen, are experienced. These symptoms are followed, in all probability, by thin watery evacuations, attended with pain, weight, and pressure about the lower bowel; they become frequent; and the female at last, finding that the bowels are not only open again, but even loose, takes chalk mixture. She is not aware that this very looseness is nothing more than increased secretion of the lining membrane of the bowel, caused by the pressure of the accumulated mass of hardened fæces, which it passes and leaves unmoved. The chalk mixture relieves the irritation upon which the looseness depends, but the disease is not removed, and, instead of its being a case simply of costiveness, it has now become one of constipation; an accumulation of hardened stool is distending and irritating, by its pressure, the lower bowel and the womb, and the serious consequences before enumerated may follow.

Very often have I been consulted by a female far advanced in pregnancy for what she supposed mere looseness of bowels, which has already been found to originate under circumstances like these. It is of the highest importance that the patient should endeavor to guard against such a result; and without doubt she may avoid it, and regulate her bowels with great comfort to herself, throughout the whole period of pregnancy, if she will only use the means.

In pointing out a plan to accomplish this desirable object, the first prescription I have to offer is by far the most valuable,—“prevention is more easy than cure.”[^[23]] If the bowels are sluggish to-day,—that is to say, if they are not as freely relieved as usual,—and you do not assist them by medicine, depend upon it, to-morrow they will be confined, and there will be no relief at all. If, then, the bowels, are disposed to be costive, I would recommend one large tablespoonful of castor oil—if it does not nauseate the stomach,—and advise that the dose be repeated in four hours, if the desired effect has not been produced, or a wine-glass of beaume de vie at night; and early the next morning, before leaving the dressing-room, let the lavement be used, the injection consisting merely of a pint of blood-warm water;—or the following pills will be found useful to be kept in the patient’s bedroom:—Two scruples of the compound extract of colocynth and one of the extract of henbane divided into twelve pills. Two or three of these may be taken at bedtime, when the bowels have not been, during the day, satisfactorily relieved. These are always ready in the bedroom, and, as they generally answer the object efficiently, and with comfort to the patient, are the most convenient form of aperient.

It will now and then happen, however, that the female has let the day slip. When this is the case, in combination with medicine, the use of the lavement is desirable. Medicine alone will not answer the purpose, unless it be taken in doses so strong as will not only move the bowels but irritate them too. With the exhibition of the warm water, mild aperients never fail. Females, generally, are averse to the use of the lavement, and it is a prejudice which is most deeply to be regretted. I have known purgative medicines so often resorted to, and, in time, so increased in power and quantity, because they began to lose their effect, that, by their continual irritation, disease of the lower bowel has been produced, and death has, at last, been the consequence. If, then, the bowels have been one or two days confined, the lavement in the morning will render much less medicine necessary, and frequently have an effect when medicine alone would not. Many ladies use the warm water every second or third morning, during the latter weeks of pregnancy; and by this means they regulate their bowels—which would otherwise be confined—with great comfort to themselves, and need no medicine at all.

I will only add one word, in conclusion, upon this subject. Let it be remembered, that if the bowels have been confined several days, and diarrhœa comes on, that this is not a natural relief, but the effect of irritation, caused by the presence of a loaded state of the lower bowel, which must be quickly removed by the medical attendant, or it may give rise to some one of those serious evils already enumerated.

Diarrhœa.

An affection very opposite to that which has just been discussed, may occur during pregnancy. We have seen how diarrhœa may arise as a symptom of costiveness. It will manifest itself, however, independently of such a cause. The intestines may participate in the irregularity of the womb, and, their vermicular action becoming morbidly increased, diarrhœa is the consequence. It is a disease which varies very much in different individuals, and may clearly be divided into two kinds.

One, in which the motions are more loose and frequent than in health, but not otherwise much altered in their appearance. The tongue is clean, or only slightly white, and the appetite is pretty good. No medicine is required here; a careful diet will correct the evil.

In the other case, the stools are liquid, dark-coloured, and very offensive, accompanied with a coated tongue, bad taste, offensive breath, loss of appetite, and more or less disorder of the digestive organs. In these latter circumstances, your medical adviser should be consulted; in case you do not see him, I have found at first the following draught, given every three or four hours, very useful—rhubarb, eight grains; ipecacuanha, one grain; dill water, one ounce.

As the tongue cleans, the stool becomes more natural, a wine-glass, three times a day, of some bitter infusion, such as cascarilla, orange peel, or gentian, may be taken with advantage. If the diarrhœa continues for any length of time, it is always wise to have the surface of the body kept warm with flannel; and this is best accomplished by a flannel roller bound gently round the abdomen.

But in either form of this disease, whatever remedies are proposed, there is one mode of treatment applicable to both, and which is the most important of all; a proper system of diet. The food must be sparing in quantity, of the mildest quality, and such as to leave, after the process of digestion, as little excrementitious matter as possible.

In a recent attack, the first day, the patient should only take mild drinks, containing a small quantity of unirritating nutriment; such as barley water, or arrowroot made with water. Irish moss will be found palatable. During the next day or two the same diet must be continued, but may be given in larger quantity, and of greater strength. Tapioca, sago, and rice-gruel might be added to the list. When the irritation is somewhat allayed, on the third or fourth day, perhaps, broth may be taken; but no solid food of any kind, least of all solid animal food, until the disease is removed or greatly allayed. As soon as this is the case, a small quantity of the lightest animal food may be taken; such as the animal jellies, made from calves’ head or feet, chicken with well-boiled rice, white game boiled, roast mutton and beef may follow; but lamb and veal for the future should be avoided.

It may be observed, that in some cases, where the diarrhœa has been of long standing, a drier diet is best, the liquid food appearing to keep up the disease. Rice well boiled, and merely moistened with a little broth, is the best and one of the most desirable articles of diet in such cases.

Piles.

Pregnant women are very subject to piles. Both with costiveness and diarrhœa they are a frequent attendant, but particularly with the former. They will usually disappear, if they are slight, as soon as the bowels are restored to a healthy action; but they may not, and then will give rise to great suffering.

The pregnant woman recognises piles under two forms: 1, where they exist as little tumours within or without the bowel, becoming, very soon after their exclusion, more solid and firm, unless they early break and bleed; and 2, where they present, without the bowel, a tumour, large in circumference, separable in lobes, altogether like a piece of sponge coloured, and bleeding occasionally from the surface.

Of all the causes which operate in the production of piles, habitual constipation is the most frequent. The excrementitious matter is delayed in the bowel, becomes hard and knotty, and a source of great irritation: this irritation induces a determination of blood to the part, and the gradual dilatation of its vessels takes place as a consequence, which eventually forms the tumours known under the appellation of piles. Now, as in pregnancy there is a greater disposition to costiveness than at any other time, and as piles are a consequence of this disordered function, so this disease is much more prevalent during the pregnant state than at any other period; another argument, and a very powerful one, why costiveness should be diligently guarded against.

The symptoms of this complaint are well known. There will be weight, heat, and a sense of fulness about the lower bowel, a frequent desire both to relieve the bowels and bladder; all of which symptoms are removed for a time if a discharge of blood takes place.

If the piles be without the bowel, they are constantly irritated by the friction of the parts in the ordinary motion and erect position of the body, and that to a painful degree during the period of the evacuation of the bowels. If exercise be taken in a carriage, the pain is much aggravated; and if the irritation produce inflammation, the piles will become swollen, red or purple, and excessively painful.

The treatment of this disease, when it occurs during pregnancy, is two-fold—general and local. We must remove the cause by such means as excite a brisker action of the bowels; and our choice of aperients must be directed to those which act efficiently but mildly, and without irritating the lower bowel itself.[^[24]] Next to small and repeated doses of castor oil—say a tablespoonful,—the most desirable form of aperient that can be employed is the confection of senna, that is, lenitive electuary, combined with sulphur and magnesia. Of the following form, a dessert-spoonful or more should be taken, at first, twice daily:—Confection of senna, two ounces; flowers of sulphur, one ounce; carbonate of magnesia, two drachms and a half. In conjunction with this medicine, much benefit may be derived by the injection of half a pint of warm or cold water—whichever soothes most—as a lavement; but it must be administered very cautiously, to avoid irritating the parts with the pipe of the instrument.

It is important that medicine, in frequent use, should be so taken as to act upon the bowels in the evening only; for if the bowels are acted upon in the morning, the patient being obliged to move about all day, will suffer considerable distress and local irritation; whereas, if the bowels are not evacuated till the evening, the horizontal position, and the perfect rest of a long night, will obviate all inconvenience.

Great assistance may be afforded in the cure, and also in alleviating pain, by external applications to the tumours themselves. If, however, the piles are swollen and inflamed, and the pain experienced great, half a dozen leeches, or from half a dozen to a dozen, should be first applied in their immediate neighbourhood, the parts fomented, and then warm bread and water poultices renewed every three hours.

These remedies will afford very considerable relief; and, when the inflamed state is subdued, an ointment must be applied to the tumours and around them night and morning, composed of two drachms of powdered galls, half a drachm of camphor, and two ounces of lard; or composed of one drachm of powdered black hellebore root, rubbed down in one ounce of lard. The latter preparation will, for some time after its application, give much pain, but proportionate relief will follow.

The diet must be sparing in quantity, mild in quality, and such as to leave after its digestion, as little to pass through the bowels as possible.

I would beg attention to one more observation on this subject. The removal of piles by operation, during the pregnant state, is perhaps never justifiable. Let the patient, therefore, consult her medical attendant in time, and not by a false delicacy expose herself to an evil which it is her duty to endeavour to prevent.

Enlargement of the Veins of the Legs.

This is a frequent, but not very troublesome, accompaniment of the latter months of pregnancy. It arises in some degree from the pressure of the womb upon the large venous trunks, impeding to a certain extent the free flow of blood through them. It is frequently remarked in pregnant women who have passed a certain age; but it is particularly unusual for it to happen, in the case of young women, even during a series of repeated pregnancies.

When first observed, if the veins have not become knotty,—that is, having little lumps or swellings in their course up the leg,—the only means which it is necessary to employ, is the application of a muslin or cotton bandage,—six yards in length, and as wide as three fingers—from the sole of the foot up to the knee, and sufficiently firm to give support to the venous trunks. This bandage well and equally applied to the limb, with a little aperient medicine twice a week, and the recumbent position for two or three hours in the middle of the day, will cure this form of the affection.

When after a time the veins, more and more distended, have become lengthened, tortuous, coiled up or knotty, the female begins to experience a sense of heaviness, numbness, and sometimes very acute wandering pain, through the whole of the affected limb. In a more advanced stage, in proportion as the knotty tumours increase, the limb becomes generally swollen.

This form of the disease calls for much care and patience on the part of the sufferer. The legs should be strapped, from ankle to knee, with strips of adhesive plaster, and over this a muslin or cotton bandage must be applied with a moderate degree of tightness, and kept wet with goulard water. In conjunction with these local appliances, it is sometimes wise to lose a few ounces of blood from the arm, and always necessary to take every other night a gentle aperient, to live upon a spare diet, and for some days to keep the horizontal posture. An elastic laced stocking made for the purpose may be afterward worn, and will be found at once a sufficient support to the limb, and a source of great comfort to the wearer.

Swelling of the Feet and Legs.

In the course of pregnancy, during the latter months particularly, the feet and legs frequently become much enlarged. It is partly owing to the pressure of the womb, but sometimes apparently independent of it. It is first observed towards night, about the ankles; by degrees the swelling rises higher, and the legs may become of a very large size. The female suffering from this complaint, always goes to bed with legs much swollen, but towards morning her face swells, and the enlargement of the legs disappears to a greater or less extent, returning, however, as the day advances.

Sometimes this disease is very trifling in its character, and in ordinary cases, except aperients, no medicine is necessary, and support may be given by a well-applied flannel roller; but when the swelling is extensive and permanent, remaining in the same degree after the patient has been for several hours in bed, and connected with uncomfortable sensations in the head, an accelerated pulse, &c., a medical man ought to be consulted, for the consequences might otherwise be dangerous.

Palpitation of the Heart.

If this affection occur for the first time during pregnancy, it is rarely connected with disease of the heart itself; it is therefore without danger, although very distressing. Occasionally there is connected with it throbbing of the vessels in the temples, as also in the abdomen; the latter not unfrequently mistaken by the patient for the beatings of the heart itself.

It will make its attack repeatedly in the course of a day, particularly after a meal; and very frequently at night, on first lying down in bed; and it may be brought on at any time by the slightest agitation of mind.

Treatment for an attack.—When it comes on it is to be relieved by putting the hands and arms up to the elbows in water, as warm as can be borne—friction with the warm hand applied to the feet—absolute rest—and taking the following draught: Compound spirits of ammonia, half a teaspoonful; Camphor mixture, a wine-glass. It may be repeated again in an hour or so, if necessary. It will be well to keep a bottle of this mixture in the bedroom; a resource will always be then at hand, and the dread which attends anticipation in a great measure removed. This is the more necessary, as an attack, if it comes on in the night, is always very distressing. The patient awakes, perhaps, out of a frightful dream, with a sense of fluttering in the region of the heart—calls out for breath—begs to have the curtains of the bed withdrawn, the door of the room opened—and will tell you she feels as if she was dying;—wine, brandy, any stimulant that is at hand is resorted to, for the husband or friend of the patient is naturally much excited, and in his alarm scarcely knows how to act. Now there is no occasion for alarm; the sufferer must be assured of this; her mind must be soothed and quieted; the means just pointed out for the relief of a paroxysm must be used; the palpitation will after a little time cease, and the patient will drop off into a quiet and tranquil sleep.

These attacks may be prevented by taking for ten days or a fortnight a teaspoonful of the following electuary three times a day:—Carbonate of iron, one ounce and a half; syrup of ginger, one ounce and a half. The bowels must be carefully regulated; a tablespoonful of Elixir Prop. is the best aperient, provided there are no piles. Fatigue and all exertion must be avoided, and the mind kept perfectly tranquil.

Fainting Fits.

Fainting may occur at any period of pregnancy; but is most frequent during the first three months, and especially about the time of quickening. It may come on when the person is at perfect rest; but is ordinarily produced by unusual exertion,—exposure to heat,—or any sudden excitement of the mind. The paroxysm or fit is sometimes of short duration; and the female does not lose her recollection; she has a knowledge of what is going on about her, and soon recovers; but in other instances the fainting fit is complete and of long duration, continuing for an hour, or upwards.

The treatment during a fit.—This consists in immediately placing the patient in a recumbent posture—the use of pungent volatiles—sprinkling the face with cold water—free exposure to air, and the cautious administration of cordials. And if the fit continue long, the extremities must be kept warm, and the friction of a warm hand be applied to the feet.

It is scarcely necessary to add, that those who are subject to these attacks ought to avoid fatigue—crowded or hot rooms—fasting too long, quick motion, and agitation of mind. The bowels must be attended to; and a wine-glass of the infusion of columbo or cascarilla, taken every morning, will be useful in giving tone to the system.

After a few weeks the disposition to fainting will altogether subside, and although a very alarming state to those who are inexperienced, yet the subject of it should never allow her mind to be depressed, or to anticipate an unfavorable result. Pure air, simple diet, and regular exercise, as we said above, will do much to prevent it.

Toothache.

This may appear a trifling disease, to notice in connexion with the subject before us: but, in the course of pregnancy, females will sometimes suffer severely from erratic pains in the face and teeth. As these pains are generally induced by the increased irritability of the nervous system, the result of the new action which is going on in the womb, and not from the decay of any particular tooth, extraction of any tooth for its cure is out of the question. Indeed, did the suffering arise from a carious tooth, its removal is unadvisable, inasmuch as this operation has been immediately followed by a miscarriage. The fact is, that the patients who have consulted me while suffering from this affection, have had, apparently, in most cases, very sound teeth; and, feeling confident that its cause has been what has been before pointed out, the treatment has been purely constitutional. The following pill may be taken, night and morning:—Socotrine aloes, one grain and a half; blue pill, two grains; together with one drachm of the rust, or carbonate of iron, mixed with treacle or milk. The latter must be repeated twice a day for four days, and then a third dose may be added in the middle of the day; and the remedy continued, even after all uneasiness in the face has subsided for some time, with great advantage to the general health.

The only local application I would advise, is that of washing out the mouth and teeth, night and morning, with salt and cold, or lukewarm water. This plan of treatment not only relieves the painful affection of the face and teeth, but allays also that local irritability of the nerves, upon which it depended.

If a carious tooth seems alone affected, it has been proposed carefully to apply a drop or two of nitric acid, which is said to be infallible; a drop or two of oil of kreosote or cajeput is frequently useful.

Salivation.

A pregnant female must not be surprised, if, some little time after conception, or during any of the months of gestation, the ordinary quantity of saliva, which lubricates and keeps the mouth constantly moist, should increase to such an extent as to be exceedingly troublesome; and, indeed, sometimes become so excessive, as seriously to affect her health. It is a symptom of pregnancy, but a very unusual one; although the quantity of saliva discharged has now and then exceeded three, and even four pints daily.

It differs essentially from the salivation produced by the exhibition of mercury, inasmuch as in this case, there is no tenderness of the gums, or disagreeable fœtor in the breath. The fluid itself is either perfectly colorless and transparent, or more tenacious and frothy. It has an unpleasant taste, and, when tenacious, induces vomiting. It is generally accompanied with acidity; and the plan of treatment most advisable, when the disease is moderate in its character, is the frequent use of from twenty to thirty grains of magnesia, say every morning, rinsing the mouth out very often with lime-water, and to resist the desire to discharge the saliva from the mouth as much as possible, for, if it is not very great in quantity, it may be swallowed to advantage. Should this symptom, however, be very excessive, the health will suffer considerably in consequence, and the assistance of the medical man is imperatively called for.

A Painful and Distended Condition of the Breasts.

Pain and tension of the breasts frequently attend, as also they are natural consequences of, conception.

In a first pregnancy, a large and rapid development of this organ may take place, the breast becoming two or three times as large as before marriage; but if tight lacing be only avoided, and the breasts be permitted to expand, no material inconvenience will arise from this circumstance.

As, however, these symptoms are sometimes attended with considerable distress, I would advise, under such circumstances, the application of half a dozen leeches, or more, tepid fomentations, and a gentle aperient—two drachms of Epsom salts in a little peppermint water—night and morning. These means, by relieving the over distension and fulness of the vessels of the part, remove the cause and complaint at once.

If these symptoms occur to a female who may have been several times pregnant, and formerly has had an abscess in one or other breast, that bosom is generally most painful which was before affected, and there will be an increased hardness about it, which may give rise, perhaps, to the apprehension of an abscess again forming, or, what is much worse, to the disease terminating in cancer. Both these fears are groundless: and, if she will only use fomentations, gentle friction frequently during the day, with almond oil and laudanum—about a drachm of the latter, to an ounce of the oil, warm,—and exercise patience, everything will do very well.

Nature often seeks her own cure, and a colourless, thin fluid runs from the nipple, which relieves the symptoms.

Cramp, and Pains in the Legs, &c.

Some females, during the latter months of pregnancy, suffer dreadfully from cramp and pain in the legs, and about the sides and lower part of the stomach. This symptom arises from the pressure of the womb upon certain nerves in its neighbourhood, which proceed to the extremities.

If the cramp be seated in the muscles of the legs, a hard, knotty induration is perceivable to the touch, accompanied with great soreness, the latter continuing for a long time after the lump has disappeared. An uneasy position of the muscles is a sufficient cause of irritation, to produce it, and it is frequently removed, by simply rising from the bed or sofa, and walking the room, so as to put the muscles of the leg into action. If this does not succeed, warm friction with the naked hand, or with camphorated oil, generally will.

If spasm affect the sides, or lower part of the stomach, the speediest relief will be obtained from twenty, to five-and-twenty, or thirty drops of laudanum, with a little ether, in distilled peppermint water, or, even at the moment, a little brandy and water; but I generally order, for patients who are at all subject to this affection, the following mixture:—Batley’s sedative solution of opium, one drachm; compound tincture of lavender, half an ounce; distilled peppermint water, six ounces. Two tablespoonfuls to be taken before retiring to rest, if there is the slightest intimation of an approaching attack, and also direct that the feet be put into a mustard foot-bath. During the attack, great benefit will be derived from the external application of hot flannels, moistened with the compound camphor liniment.

Violent movements of the Child.

Before the third month of pregnancy, the child is not sufficiently developed to enable it to move. When a little further advanced in growth, it moves, but so feebly and imperfectly, that the mother is not yet sensible of it. A period, however, soon arrives, when its movements, although at first like the mere fluttering of a bird, acquire a power and force, that enable it to give decided proof of life. It is instantly recognised, the female knows she has quickened, and perhaps the sensation experienced is so sudden, that she faints. After this time the motions of the child increase both in frequency and degree, and are readily perceived by the mother, but after a time the womb accustomed to this action within itself, is less sensible of its effects, and except as a satisfactory evidence of the life of the child, is little regarded.

Sometimes, however, the child is disagreeably active, so violent as not merely to alarm the mother, but occasion much sickness and uneasiness;—sleepless nights; feverish symptoms, &c., and all this to such an extent, as to require medical interference. If this is not thought necessary, relief will be obtained from losing blood, when not otherwise objectionable, to the amount of a few ounces; gentle aperients, and a night draught containing from twenty-five to thirty drops of Batley’s sedative solution of opium. These remedies will afford the greatest relief, and if the symptoms are not altogether removed by them, the female must then endure patiently, recollecting they are a proof that the child is alive and vigorous.[^[25]]

Soreness and Cracking of the Skin of the Abdomen.

It will sometimes happen during the latter months of pregnancy, that the skin covering the abdomen will not yield readily. This produces much uneasiness; the skin becomes tender and fretted, and if there is very great distension, cracks. It forms a source of great discomfort, and renders the female miserable whenever she moves.

It is to be relieved by fomenting the parts with a decoction of poppy-heads;[^[26]] and the frequent use of warm almond oil, applying in the intervals spermaceti ointment, spread very thinly on a piece of soft linen.

Inconvenience from Size.

Many women in the latter months of gestation experience considerable annoyance, and sometimes severe suffering from the great size of the abdomen, and from want of support, when even not so very large. This is a rare occurrence in a first pregnancy, owing to the firmness of the abdominal muscles, but very frequent in subsequent ones. Little women especially suffer from this unpleasant cause, and, in fact, it is so universally the case with all, who have borne children rapidly, that it is highly important for a female to be provided with the means of relieving it.

There is but one remedy with which I am acquainted, but have usually found it answer every purpose. It is wearing during the day-time a well-applied belt, next the skin. It must be sufficiently broad for its upper edge to surround the abdomen above the point of its greatest diameter, and its lower edge to come down to, and be supported by, the hips. It must be drawn tight by a lace-string behind, as circumstances may require, and it must likewise be supported by broad straps passing over the shoulders. This will give the required support to the womb, and when the patient is in an upright position, as much as possible of the weight, of what she externally carries, will be thrown upon, or hang from, her shoulders.