Midwifery and the diseases of women

by Joel Shew

CONTENTS.

Introduction	Page [v]
LETTER I.
HISTORY OF MIDWIFERY.
The Art of Midwifery in Ancient and Modern Times—To what extent may the Perils of Childbirth be Lessened?	[19]
LETTER II.
OF MENSTRUATION.
Puberty—The Menstrual Discharge—The Marriageable Age	[34]
LETTER III.
OF MENSTRUATION.
The Menses—Names—Source—Commencement—Periodicity—Nature—Quantity of the Menstrual Discharge	[40]
LETTER IV.
OF MENSTRUATION.
Cessation of the Menses—Turn of Life—Management at this Period	[49]
LETTER V.
OF MENSTRUATION.
Tardy and Suppressed Menstruation—Chlorosis—Sudden Check of the Menses	[61]
LETTER VI.
OF MENSTRUATION.
Menorrhagia and Dysmenorrhea—Their Nature and Treatment	[81]
LETTER VII.
SIGNS OF PREGNANCY.
Importance of the Subject—Difficulties of ascertaining Pregnancy in some Cases—Means by which it is to be Known	[92]
LETTER VIII.
DURATION OF PREGNANCY.
Difficulties of Ascertaining it—Rules by which it is to be Known—At what Age can a Fetus Live?	[99]
LETTER IX.
MANAGEMENT IN PREGNANCY.
Importance of Attention to the Health at this Period—Clothing, and its Effects—How to Regulate it	[108]
LETTER X.
MANAGEMENT IN PREGNANCY.
Of Solar Light—Its Effects on Life and Health—Air and Exercise—Rules of Management	[118]
LETTER XI.
MANAGEMENT IN PREGNANCY.
Of the Diet Proper in this Period—Animal and Vegetable Food—Superiority of the latter—The Drink	[123]
LETTER XII.
DISORDERS OF PREGNANCY.
Nausea and Vomiting—Means of Prevention, and Cure Page	[132]
LETTER XIII.
DISORDERS OF PREGNANCY.
Fainting—Its Causes—Symptoms—Results—Treatment	[139]
LETTER XIV.
DISORDERS OF PREGNANCY.
Abortion—Its Nature and Ill Effects—Its Causes—Means of Prevention	[143]
LETTER XV.
DISORDERS OF PREGNANCY.
The Evils of Abortion—The great Danger of bringing it on purposely—Cases—Illustrations of the Methods of Cure—Uterine Hemorrhage—Cases of Cure	[152]
LETTER XVI.
DISORDERS OF PREGNANCY.
Its Febrile Condition—Acute Disease—Sleeplessness—Heart-burn—Constipation—Diarrhea—Piles and Hemorrhoids—Their Treatment	[165]
LETTER XVII.
DISORDERS OF PREGNANCY.
Headache: the Nervous and the Plethoric kinds—Stye in the Eye—Salivation—Hemorrhage from the Stomach—Cramp of the Stomach—Toothache—Jaundice	[179]
LETTER XVIII.
DISORDERS OF PREGNANCY.
Difficulty of Breathing—Pain in the Right Side—Itching of the Genitals—Swellings of the Limbs—Cramps of the lower Extremities—Pain of the Breasts—Hysteria—Physical Hindrances—Exposure to Disease	[190]
LETTER XIX.
DISORDERS OF PREGNANCY.
Nervousness—Mental Despondency—Longing—The Imagination—Effects of Fright Page	[200]
LETTER XX.
DRUG-TREATMENT IN PREGNANCY.
Effects of Blisters—Emetics—Purgative Medicines—Bleeding	[218]
LETTER XXI.
STERILITY OR BARRENNESS.
Their Causes—The Catamenial Discharge as affecting it—Fluor Albus—Corpulency—The Treatment appropriate in these Cases	[224]
LETTER XXII.
THE PELVIS AND ITS ORGANS
General Description—Differences between the Male and Female Pelvis—The Bladder and Urethra—The Vagina—The Uterus and its Appendages	[229]
LETTER XXIII.
ANATOMY OF THE FETUS.
Its Length and Weight—Its Osseous, Muscular, and Vascular Systems—The Fetal Circulation—Nervous System—Organs of Sense—Its Lungs, Heart, and other Internal Organs	[243]
LETTER XXIV.
PHENOMENA OF LABOR.
Meaning of the Term—Its Divisions—Duration—Is Pain a Natural Condition of Labor?—Ether and Chloroform	[253]
LETTER XXV.
MANAGEMENT OF LABOR.
Its Premonitory Signs—Progress of Labor—Its Different Stages—Age as Affecting it	[260]
LETTER XXVI.
MANAGEMENT OF LABOR.
The Placenta, or After-Birth—The Membranes—Management of the After-birth—Rules for Extracting it—Of Flooding after Delivery Page	[272]
LETTER XXVII.
ADVICE CONCERNING LABOR.
The Medical Attendant—State of Mind—The Room—State of the Bowels—The Dress—The Bed—The Position, Exercise, Food, and Drink	[280]
LETTER XXVIII.
MANAGEMENT AFTER DELIVERY.
Importance of Attention to this Period—Evils of too much Company—Bathing—The Bandages, Compresses, etc.—Sleep—Sitting up soon after the Birth—Walking about—The Food and Drink	[285]
LETTER XXIX.
MANAGEMENT OF THE CHILD.
Of Separating the Umbilical Cord—Practices of different Nations—Of Still-Birth, and Resuscitation of the Child—Washing and Dressing it	[292]
LETTER XXX.
HYGIENE OF NURSING.
Lactation a Natural and Healthful Process—Rules for Nursing—At what time should Lactation cease?—Food and Drink proper during the Period	[308]
LETTER XXXI.
OF TWINS, TRIPLETS, ETC.
Twins, Triplets, and Quadrigemini of comparatively rare Occurrence—Of the Signs of two or more Children in the Womb—Management of Twin and Triplet Cases—The Nursing of Twins	[316]
LETTER XXXII.
TREATMENT OF AFTER-PAINS.
The Nature of After-Pains—The different Kinds—Their Causes—Treatment—The great Value of Water-Cure Page	[328]
LETTER XXXIII.
THE LOCHIAL DISCHARGE.
The Mosaic Law concerning Purification of Women—Nature of the Lochia—Excessive and Offensive Discharge—Treatment of Suppression of the Lochia	[336]
LETTER XXXIV.
OF CHILDBED FEVER.
Milk Fever as distinguished from Puerperal Fever—The great Danger of Childbed Fever—Its Symptoms and Nature—Modes of Treatment—Is it a Contagious Disease?	[342]
LETTER XXXV.
OF SORE NIPPLES.
This Complaint is a very common one—Its Causes—Methods of Prevention and Cure	[362]
LETTER XXXVI.
INFLAMMATION OF THE BREAST.
Structure of the Mammary Gland—Nature and Causes of Inflamed Breast—Means of Prevention and Cure	[370]
LETTER XXXVII.
CASES IN MIDWIFERY.
A Collection of Facts Illustrative of the Effects of Water-Treatment before, during, and after Childbirth	[383]
LETTER XXXVIII.
CONCLUDING REMARKS.
Hysteria—Its Prevention and Cure—Leucorrhea, or Whites—Falling of the Womb	[428]

LETTERS TO WOMEN

LETTER I.
HISTORY OF MIDWIFERY.

The Art of Midwifery in Ancient and Modern Times—To what extent may the Perils of Childbirth be Lessened?

Midwifery is the art of aiding women in childbirth. In some mode—rude, simple, or complex—it has been practiced in all ages of the world. According to the records of medicine, however, the great mass of the human family has been born and brought up without the aid of the so-called obstetrical science of modern times. The ruder nations anciently, as well as the savage nations in later times, appear to have exhibited, practically at least, a much greater confidence in the prophylactic and healing powers of nature than we see among the more civilized and enlightened portions of our race.

But let us, for a little, glance at midwifery as it has existed at different periods of the world.

We read in the Book of Genesis, chapter thirty-fifth, that as Jacob and Rachel were journeying from Bethel, Rachel travailed, and had a hard labor.

“And it came to pass, when she was in hard labor, that the midwife said to her, Fear not, thou shalt bear this son also.

“And it came to pass, as her soul was departing (for she died), that she called his name Ben-oni: but his father called him Benjamin.

“And Rachel died, and was buried in the way to Ephrath, which is Bethlehem.”

In the twenty-fifth chapter of Genesis, Moses informs us that Rebekah, who had been barren, conceived, being the wife of Isaac.

“And when her days to be delivered were fulfilled, behold, there were twins in her womb.

“And the first was born red, all over like a hairy garment: and they called his name Esau.

“And after that his brother was born, and his hand took hold on Esau’s heel: and his name was called Jacob.”

The birth in this case appears to have been a natural one, in which the children followed each other in quick succession.

We read also in the thirty-eighth chapter of Genesis, the case of Tamar, who bore twins, being attended by a midwife.

“And it came to pass, in the time of her travail, that, behold, twins were in her womb.

“And it came to pass, when she travailed, that the one put out his hand; and the midwife took and bound upon his hand a scarlet thread, saying, This came out first.

“And it came to pass, as he drew back his hand, that, behold, his brother came out; and she said, How hast thou broken forth? this breach be upon thee: therefore his name was called Pharez.

“And afterward came out his brother that had the scarlet thread upon his hand; and his name was called Zarah.”

Some have supposed that this was a case of spontaneous evolution of the fetus, a thing which has been known to occur in modern practice, proving that nature sometimes works in a very wonderful manner in these circumstances. It is certainly a very singular fact for the hand of one child to recede after coming into the world, and the other child to be born first.

The Hebrew women, when in captivity, had, as we read, two midwifes, Shiphrah and Puah. These were commanded by Pharaoh, that when they did the office of a midwife to the Hebrew women, if a son should be born, they should kill him. But the midwives feared God, and did not as the king of Egypt had commanded them, but saved the male children alive.

The period of suckling appears to have been prolonged, in Bible times, to a much greater length than it is in modern times. In the Apocrypha, the woman says to the son, “I, who gave thee suck three years.”

Profane writers, prior to the time of Hippocrates, give little account of the art of midwifery; and from the time in which the Father of Medicine lived, down to a comparatively recent date, little was said or known concerning it as an art.

Dr. Francis informs us, that toward the latter part of the sixteenth century, a Dr. Raynald published in England a work, the first of the kind that had appeared in that country, which he called the “Garden of Lying-in Women and Midwives.” It was afterward translated into the Latin, and most of the modern languages, and became the manual of instruction for females. “The popular prejudice was so great at that time in favor of female practitioners,” observes Dr. Francis, “that an unfortunate physician of Hamburgh was publicly branded, whom curiosity had induced to be present at a delivery, in female attire.”

Still quoting from Dr. Francis, we learn, concerning this old work, the following particulars: “In his prologue to women readers, he states that the byrth of mankynd doth mostly concern and touch only women, and that he hath declined nothing at all from the steps of his Latin author, but that many things are newly added to this boke. In his first part of the work he gives the anatomy of the inward parts of women; in the second, he declares the divers sorts and manners of the deliverance or birth of mankind. In the third, he treats of the election and choice, by signs and tokens, of a good nurse, which may foster and bring up the child, being born. In the fourth and last, he communes of conception, with the causes hindering or furthering the same, showing the councils and remedies whereby the unfruitful may be made fruitful, and the impediments of conception, by virtue of medicines, removed. He solicits the favor of the reader to good acceptance of his labor and pains spent in compiling these aforesaid matters. He invocates all the nine muses of Helicon, with their poetical spirit, to breathe over this his boke, against the strange, perverse, and wayward wits who would desire this performance to be suppressed and kept in darkness, rather than that it be sent forth into the light. There is nothing, he says, that may not be abused and turned to evil, even meat and drink; but that to the good every thing turneth to good. He is fearful that the medicines he recommends may be abused; that light persons ought not to read his boke, and some would that neither honest nor dishonest should have it. He adds, every one may read it; because no one shall become by it either lewd, unhappy, or knavish. The consideration which prompted the publication he declares to be on account of the manifold, daily, and imminent dangers, which all manner of women, of what estate or degree soever they be, in their labors, do sustain and abide, even with peril of their lives. He considers it to be a charitable and laudable deed, and thankfully to be accepted of all honorable and other honest matrons, if this little treatise were made to speak English, as it hath been long taught to speak Dutch, French, Spanish, and divers other languages.

“He enjoins that ladies and gentlemen have this boke in their hands, and cause such parts of it to be read before the midwife and the rest of the women present in labor, whereby the laboring woman may be greatly comforted and alleviated in her travail. And though some midwives would have this boke forbidden, yet, he adds, the good need not be offended, though the evil-hearted endeavored to make it that it was nothing worth, and that he hath exposed the secrets and privities of women, so as that even boys read his boke openly, as the tales of Robin Hood. Notwithstanding all these accusations, he trusts that all good midwives would be glad of his work, because of their familiar knowledge, and that others of them such as could read, would read it themselves, and laud it as its merits deserve.”

In regard to the employment of men as midwives in France, it appears that in 1663, the Duchess de Villiers was delivered by the assistance of Julien Clement, a professor of surgery in Paris. He was soon after appointed to the office of midwife to the Princess of France.

The princess, it is said, had some scruples in regard to employing Clement. As she desired it might be kept a profound secret, she sent for him, he being a surgeon of great reputation; and he was conducted with the greatest secrecy into a house where the lady was, with her head covered with a hood. The same surgeon was employed in subsequent labors of the same lady, and the princesses made use of surgeons on similar occasions; and as soon as it became fashionable, the name of accoucheur was invented to signify that class of surgeons. Foreign countries soon adopted the custom, and likewise the name of accoucheurs, for they had no such term in their own language; but in Great Britain they have more generally been termed midwives.

Dr. William Shippen, of Philadelphia, a very worthy citizen and exemplary man, had the honor of being the first teacher of midwifery in the United States. In London he enjoyed the advantages of the instructions of the celebrated Dr. William Hunter, and on his return to his native country he was chosen professor of anatomy in the earliest of its medical schools, the University of Pennsylvania. His lectures on obstetrics, like those upon anatomy and surgery, are said to have evinced great ability and command over his auditory. His first course on midwifery was delivered in 1762, and was attended by only ten pupils. He, however, lived to give instructions to a class of two hundred and fifty. This leads me to the reflection, will those who now advocate the employment of females principally in midwifery, even when the country has grown many times larger in numbers than it then was, meet with one half the success that Dr. Shippen did? If so, may it be, and Heaven speed the right.

In the year 1767 the first medical school of New York was founded, under the auspices of Kings, now Columbia College. Among the appointments to that institution was Dr. John V. B. Tennant as professor of obstetrics. It is said that he was a very worthy man and of good reputation. He died at an early age, of the yellow fever, in the West Indies, where he had gone for his health. Since the time of Drs. Shippen and Tennant, midwifery has been taught as an important part of medical education in all of the medical colleges in the United States.

In China the practice of midwifery is regulated in a very good way certainly; and on the whole, the Chinese custom is to be regarded as a safe one. It, however, recognizes the superiority of man’s intellect, nerve, mechanical skill, to that of woman’s, in scenes of trial and danger. The custom is this: Female midwives attend in all ordinary cases; but there is a class of obstetric surgeons which is devoted exclusively to this department, is perfectly skilled in the use of instruments, and the management of every possible difficulty. One of these is located in each particular district, having a given number of inhabitants, and after a woman has been a certain number of hours in labor, the child not being yet born, the midwife is required by law to call in the obstetric surgeon. Thus it is, I repeat, that man’s superiority over woman’s, in ability to perform great and difficult operations, is recognized even in China. Nor is it to be supposed that it is in the most difficult cases only that the male practitioner is called in that country, because many a woman has, on the whole, a safe labor which is yet a good deal protracted.

It is said that in Russia the obstetric branch of the medical art is practiced for the most part by females. They are educated at the government’s expense, and are said to be very skillful in their art. We are not, however, in the habit of looking to Russia as a country eminent in civilization and the arts.

It is admitted that a great majority of the human family, from the beginning of the world down, have been born by the aid of female midwives only, or without there being any assistant whatever at the birth, as is still the case with some of the savage tribes. At the present day even, of all births that take place in the world at large, probably not one out of twenty is superintended by a male practitioner. But all of this proves nothing in regard to the question, as to whether it is better for men or women to be employed in such practice. It proves to us the competency of nature to do, as a general thing, her own work. But to say that it proves that males should never practice midwifery, would be as absurd as to affirm that railroads, steamships, and magnetic telegraphs ought never to be brought into use. But I have already spoken on this subject in my introductory letter, and need not here enlarge upon it.

The question regarding the extent to which the pains and perils of childbirth may be modified by the voluntary habits of individuals and nations, and by the appliances of art, is one of the greatest importance to society, a subject which has been probably more neglected than any other in both medical and scholastic lore.

To prove that the evils and dangers attending child birth, even among the most civilized and enlightened portions of the human family, may be brought to a great extent within the range of man’s control, is the object of the following remarks.

Let us look first at the habits and condition of the aborigines of our own country.

The state of society among the Indians necessarily excludes the influence of many of those passions which are known to cause bodily derangement. If an Indian becomes angry, the turbulent effects of his passion are hushed in deep and lasting resentment. Envy and ambition also are, for the most part, excluded by the equality of savage life. “The weakness of love,” says Dr. Adam Smith, “which is so much indulged in ages of humanity and politeness, is regarded among savages as the most unpardonable effeminacy. A young man would think himself disgraced forever if he showed the least preference of one woman above another, or did not express the most complete indifference, both about the time when, and the person to whom he was to be married.” Thus the savage state, although being in many respects far from a truly natural one, exempts the individuals of both sexes from those violent and lasting diseases which are well known to arise from excesses in matters pertaining to the sexual and marital relations.

It is to be observed, also, that marriages do not, as a general fact, take place among the aborigines before the period at which the body has attained its full vigor. The men seldom marry before thirty, and the women before twenty years of age. Abortion, one of the most frequent mishaps with women of civilized life, is almost entirely unknown among the Indians. They nurse their children for two years, and often longer, and during this whole period they utterly refuse the embraces of the opposite sex. The manual labor to which they are constantly subjected, and their hardy habits generally, tend powerfully to invigorate their bodies, and although they are, during pregnancy, exempted from the more laborious parts of duty, they are always habitually active. Nature is their only midwife; and according to Dr. Rush, “each woman is delivered in a private cabin, without so much as one of her own sex to attend her. After washing herself in cold water, she returns soon to the usual employments of her station;” so that, according to the authority just quoted, “she knows nothing of those accidents which proceed from the carelessness or ill-management of midwives, or those weaknesses which arise from a month’s confinement in a warm room.”

It is, indeed, said on good authority, that if, during journeys, the Indian woman is taken in labor, she merely falls back for a little on her way in the forest, delivers herself, and then shortly makes up to her companions with her new-born child on her back.

The most natural state of the female constitution, and one which is connected with the best and firmest health, is that of pregnancy and nursing; and it is a remarkable fact, that there is seldom a period during the interval between marriage and the cessation of the menstrual function in which the Indian women are not either pregnant or giving suck.

Among other nations than the aborigines of our own country, we find also striking examples of the freedom from suffering with which childbirth is endured. Thus, according to Stephenson’s “Twenty Years’ Residence in South America,” “among the Araucanian Indians of South America, a mother, immediately on her delivery, takes her child, and going down to the nearest stream of water, washes herself and it, and returns to the usual labors of her station.”

The women of Otaheite, according to “A Description of Pitcairn’s Island and its Inhabitants,” have all learned the art of midwifery. Childbirth generally takes place in the night time, labor lasting seldom more than five hours. It is always safe, and no cases of twins occur. Miscarriages, too, are unknown among them, except from accident. Infants are generally bathed in cold water (which in that latitude must be only moderately cool) three times a day, and are sometimes not weaned for three or four years; and when they are taken from the breast they are fed upon ripe plantains and boiled taroroot rubbed into a paste. Nothing is more extraordinary in the history of the island than the uniform good health of the children; the teething is easily got over; they have no bowel complaints, and are exempt from those contagious diseases which affect children in more civilized countries. Neither the young nor the old are ever vaccinated. “The natives of Otaheite,” says Captain Cook, “both men and women, constantly wash their whole bodies in running water three times every day; once as soon as they rise in the morning, once at noon, and again before they sleep at night, whether the sea or river be near them or at a distance. They wash not only the mouth, but the hands, at their meals, almost between every morsel; and their clothes, as well as their persons, are kept without spot or stain.” “The women,” according to a missionary writing of this people in 1797, “have black and sparkling eyes, teeth white and even, skin thin, soft, and delicate, limbs finely turned; their faces are never darkened with a scowl, or covered with a cloud of sullenness or suspicion; their manners are affable and engaging, they step easy, firm, and graceful, their behavior free and unguarded; always boundless in generosity to each other and to strangers; their tempers mild, gentle, and unaffected; slow to take offense, easily pacified, and seldom retaining resentment or revenge, whatever provocation they may have received. Their arms and hands are very delicately formed, and though they go barefooted, their feet are not coarse and spreading. In private life they are affectionate, tender, and obedient to their husbands, and uncommonly fond of their children; they nurse them with the utmost care, and are particularly attentive to keep their infants’ limbs supple and straight; a cripple is hardly ever seen among them in early life; a sickly child is never known; any thing resembling it would reflect the highest disgrace on the mother.”

A very worthy medical friend who spent some time at New Zealand in 1839, gave the writer lately the following particulars concerning midwifery, as practiced among the inhabitants of that island.

Women (who generally followed out-door active employments a considerable portion of the day), as soon as they experience the first symptoms of labor, retire some little distance from the settlements, among the fern (a native growth resembling bushes in the United States), by the side of a stream of pure water. Within about one hour not unfrequently the mother returns with her new-born infant, both herself and it having been previously washed in the pure stream. The child is never bound with clothes or swathed, but for a few days at first it is dressed in one light flaxen garment. This is placed loosely about the trunk of the body, the extremities being left wholly free and exposed to the action of air and light, and after a few days, they are left entirely naked, being allowed freely to roll about and exercise their limbs upon a mat of smooth texture. It is left much of the time in the open air, but not exposed to the sun’s rays. At other times, when the mothers are at work, planting or hoeing in the ground, they are allowed, even when not more than one week old, to roll among the potatoes and corn. They are often taken to the streams of pure water with which the island abounds, for the purpose of being bathed. The mothers, in consequence of their almost constant labor and exercise in the open air, and their simple habits generally, are remarkably strong and muscular, and free from deformity and disease. Their food, particularly of the inland parts (where the finest specimens of physical development are to be found), consists almost wholly of the vegetable productions of the earth, such as corn, pumpkins, potatoes, common and sweet, peaches, and various other fruits, all of which articles grow to great perfection on the island. The New Zealanders wear but a single garment of flax, sometimes thrown loosely over the shoulders, and sometimes only about the loins. They have a great dislike to head-dresses, and never wear them.

In civilized countries, also, we find among the laboring classes, some remarkable examples of the general safety with which childbirth is endured; and it has often been remarked among the legal profession, that in cases of concealment and child-murder, a most wonderful degree of strength and capability of exertion is often exhibited. There is, it is true, in cases of this kind, a powerful stimulant for extra exertion; but even admitting this consideration in its full force, these examples afford a striking proof of what the human constitution is able to endure, even under many untoward circumstances.

Mr. Alison mentions the case of one Catharine Butler, or Anderson, of Aberdeen, Scotland, who in the spring of 1829, walked in two or three days after delivery, in a single day, with her child on her back, from Inverury to Huntly, a distance of twenty-eight miles; and the same author also remarks, “that it is not unusual to find women engaged in reaping, retire to a little distance, effect their delivery by themselves, return to their fellow-laborers, and go on with their work during the remainder of the day, without any change of appearance but looking a little paler and thinner. Such a fact,” Mr. Alison observes, “occurred in the case of Jean Smith, of Ayr, in the spring of 1824.”

Among the peasant women of the mountains in Austrian Silesia, childbirth is regarded in a very different light from that among the women of our own country. They are exceedingly hardy and robust, and seem to care as little about giving birth to a child as if it were an everyday occurrence. Physicians are very rarely employed on such occasions in that country, as I learned when there by frequent inquiries. In the winter of 1848, when I was last at Graefenberg, the wife of the proprietor of the Hotel de Graefenberg, a very good and worthy woman, of the middling class, gave birth to her first child, without the aid of any one save her husband and a female attendant; and, although the labor was a severe and protracted one, lasting a day and a half, she preferred to have no physician, although one of skill and experience lived next door to them, and who was, moreover, a particular friend of the parties. These German peasants appear to regard labor as it should be, a natural process, and the degree of patience for which the German character is noted, is nowhere more strikingly exemplified than in the matter of childbirth.

Witnessing, then, the great numbers of facts that may be gleaned from the history of savage and civilized nations, concerning the safety with which childbirth and its attending circumstances may be endured by persons in the lower walks of life, it becomes a very important practical question as to what may be accomplished in the higher grades of society. To prove that there is need of a great and thorough reform, both in the habits of society generally, and in the practice of the healing art, I will bring forward some facts, which have occurred in my own experience as a healer of the sick during the past seven years. It has fallen to my lot to study the subject of midwifery with more earnestness and satisfaction to myself, than any other with which my mind has been engaged. It was, moreover, necessary for me to strike out a course of my own, a course which has been attended by a degree of success which has far exceeded the most sanguine expectations of my younger years.

LETTER II.
OF MENSTRUATION.

Puberty—The Menstrual Discharge—The Marriageable Age.

I am now to write you on a most important subject; I mean that which refers to puberty—the menstrual function, and what we call the marriageable age. I think you will agree with me in thinking that there is no period of the whole life of the female which should give a parent more anxiety and solicitude than the one of which I am now to speak. I trust, therefore, that you will give good attention to all I may say on so important a matter, and learn all that you can about it, from whatever source.

Puberty, or the marriageable age of woman, occurs at a somewhat different age in different parts of the world. In temperate climates, the period of puberty may be reckoned as being at from the twelfth to the sixteenth year. In tropical climates it appears to be considerably earlier, as from eight to twelve; and in the frozen regions later than all, from fifteen to twenty years. It has been said that the Turkish women are capable of becoming mothers at the age of seven or eight years; but of this there is at least room for doubt.

There are other circumstances than those of climate that influence the coming on of the period of puberty. Those that lead habitually an inactive life, a life of leisure and luxury, so called; those who, without sufficiently attending to physical and out-door exercise, practice much the imitative arts, such as painting and music; those who frequent theaters, balls, and parties, late at night; read novels and other works that powerfully excite the imagination and feelings; and especially such as are so unfortunate as to have access to obscene pictures and books, arrive at the season of puberty earlier than others.

So also the use of rich, concentrated, and highly stimulating food and drinks, render the young, of whichever sex, far more precocious, in regard to puberty, than a plain and unstimulating diet. Temperance and frugality, with simplicity of manners, especially if the individual lead a rural, or country life, are always more favorable in reference to the coming on of this important period.

Previously to the period of puberty, the general organization of the male and female progresses very much alike. The tastes and habits, however, vary. The little girl is fond of her doll-babies and play-houses, while the boy exhibits a liking for more manly sports. There is, however, no great difference, up to this time, in the physical frame of the two sexes; but as the period of puberty approaches, there is manifested a great difference in the two beings. In the language of an eloquent writer, Velpeau, “the young girl becomes more timid and reserved, her form becomes rounded, her voice alters but to take on a softer and more harmonious tone, and her bosom is developed; the cellular tissue extends from the front of the breast and the hypogastrium, as from two centers, toward the neck, while at the same time it proceeds to form a soft cushion for the upper part of the limbs. Her eyes, which are at once brilliant and languishing, express commingled desires, fears, and tenderness; the sensations she experiences, and the sense of her own weakness, are the reasons why she no longer dares to approach the companions of her childhood but with a downcast look. On the other hand, the gentle modesty that animates her countenance, and the engaging graces of her demeanor, soon disclose a power, the existence of which she never suspected, and which renders it true to say that the marriageable age in the softer sex is the spring-tide of nature, and the season of the pleasures. But a new function—the catamenial—the absolute compass of good or bad health in woman—is established, with more or less difficulty, in the midst of this great revolution; and by the disorders and accidents which it involves, sometimes dashes with bitterness those happy seasons to which it should naturally serve as a prelude. Such are the changes that go on in the female constitution at one of the most important and critical seasons that can occur in the female’s life.”

The period at which woman may be said truly to arrive at her womanhood, is certainly, in the present state of artificial life, fraught with many dangers to the future health. But, on the other hand, we have proof the most positive and indubitable—the proof of facts—that if young girls are brought up in a simple, judicious manner, and if all their habits—social, moral, physiological, and hygienic—be correct, there can be, as a general law, no danger at the coming on of puberty. With judicious management throughout, the girl will pass through this change with as little difficulty, as little danger and derangement of the general health, as occurs at any other season of her whole life. Although the change is a great one, it is yet within the order of nature, a fact which we should always bear in mind.

The foregoing remarks on puberty lead me necessarily to speak of the menstrual function.