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MIDWIFERY
AND THE
DISEASES OF WOMEN
A Descriptive and Practical Work
SHOWING THE SUPERIORITY OF WATER-TREATMENT IN MENSTRUATION AND ITS DISORDERS, CHLOROSIS, LEUCORRHEA, FLUOR ALBUS, PROLAPSUS UTERI, HYSTERIA, SPINAL DISEASES, AND OTHER WEAKNESSES OF FEMALES; IN PREGNANCY AND ITS DISEASES, ABORTION, UTERINE HEMORRHAGE, AND THE GENERAL MANAGEMENT OF CHILDBIRTH, NURSING, ETC., ETC.
Illustrated with numerous Cases of Treatment.

BY JOEL SHEW, M. D.,

AUTHOR OF VARIOUS WORKS ON HYDROPATHY.

NEW YORK:

FOWLERS AND WELLS, PUBLISHERS,

No. 308 Broadway.

London: 142 Strand.

Entered, according to Act of Congress, in the year 1852, by Joel Shew, in the Clerk’s Office of the District Court of the United States for the Southern District of New York.

INTRODUCTION.

Concerning matters pertaining to midwifery, friends of Water-Cure sometimes ask questions like the following:

1. What methods of treatment shall we adopt to enable us the better to pass through the period of pregnancy?

2. What methods to aid in mitigating the pains and perils of childbirth?

3. Shall we employ a physician on such occasions?

4. If so, shall it be a male or female practitioner?

As regards the first and second of these queries collectively, I remark, that in 1843 I commenced the practice of midwifery according to the hydropathic plan, and have, from time to time since that period, published articles on the subject of pregnancy and childbirth, and have put forth, also, a small work which has had a wide circulation, and been the means of doing some good. There is, doubtless, no branch or department of the medical art in which a judicious regulation of water, air, exercise, and diet, are more strikingly beneficial than in that now under consideration. I would speak earnestly on this point, and as to the truthfulness of what I affirm, I may confidently refer to the experience of those who have a knowledge of the subject—to those who have themselves experienced the effects of hydropathy. We do not hear persons say, “We have resorted to the water-treatment in childbirth and have found it to be an injury to us;” but on the contrary, we do hear it said, “We had borne a number of children under the old methods, suffering at each time more than mortal tongue can describe; but now, since we have become informed on the subject of Water-Cure, we find childbirth—hard as it necessarily is—a much more easy thing to bear.” I repeat, the uniformity of the testimony in favor of water-treatment among those who have in their own persons tested it, is remarkable and without parallel in the healing art.

But I must here allude to the fact, that different practitioners in the new system must, some of them at least, entertain honest differences of opinion in regard to the hydropathic uses of water in pregnancy and childbirth. One tells us that too much bathing is usually practiced on such occasions; another that too little is done. One tells us that water patients are everywhere allowed to get up too soon after childbirth; another that they are kept in bed too long. One says that the vagina syringe is almost the all in all for woman kind, and would almost make us believe that women were made for syringes, and not syringes for women. Another says that the vagina syringe, so far as labor and the getting up are concerned, is at best comparatively only a poor affair; that it is not in accordance with the principles of sound physiology or pathology to throw cold water upon any bleeding surface—external or internal of the body; that the use of the vagina syringe is revolting to the feelings of nine tenths of all midwifery patients who have had it used; that so far as the limited experience of hydropathic practitioners extends in this department, it would appear that those who have not in their practice thus used cold water internally, have had, at least, as good success as those who have.

In regard to preventing the “pains and perils” of childbirth, there seems likewise to be some differences of opinion among the water doctors, so called. Some who are, as it were, just commencing the practice, and have more zeal than knowledge in the matter, would have us believe that water almost wholly prevents the pains of parturition and the perils thereof. But there are others who maintain, that do what we will, labor must, as a general fact, be attended with severe suffering; that as a mere palliative of pain at the time of labor, little can be claimed for water; that labors are not, probably, on the whole, shortened by the use of water either before or at the time; that very short labors are not probably, more frequent in the new than in the old way; that very quick labors are not desirable, since experience teaches that they are not so safe as those which are more protracted. It is maintained, too, that say what we may, childbirth is, and must necessarily be, in all civilized societies, a serious thing to enter upon. What woman who has ever passed through this ordeal does not regard it so? and what physician, no matter how old, or experienced, or skillful he may be, does not, every time he enters the lying-in chamber, feel this responsibility to be a great and trying one? Admitting all that can be done by the water-treatment in matters of midwifery, and much, very much, certainly may be—childbirth is yet an agony, and must ever continue so to be.

Various other points might be mentioned in which there is honest disagreement of opinion among hydropathists. This must, in the nature of the case, be so. Nor should such disagreements make us enemies toward each other. One thing is remarkable, and speaks volumes for the new method, namely, the good success that everywhere attends it.

Respecting our third question—Shall we employ a physician on occasions of childbirth? I remark that people should, themselves, be the judges. If you possess the courage that I have seen exhibited among the peasantry of the Silesian mountains of Germany, you may get along almost without an assistant of any kind. There childbirth is looked upon in a light very different from what we see in our own country. If, moreover, you can, by great and continuous effort, arrive at the degree of physical hardihood and strength which is possessed by those vigorous, out-of-door working females to whom I have referred, then you may, as a general thing, get along safely without the aid of a physician. But things are different with us here; we are not to expect that our females will, for generations to come, be as hardy and enduring as the peasant women of many parts of the old world.

In this country we find that the younger married people are more apt than the older to resort to water-treatment in childbirth. I imagine I am addressing myself to a young couple, who hope soon to become parents. They have talked the matter over, and resolve that they will try to get along without a doctor of any kind. I say to them, Young friends, you are about to pass through a matter which you can know but very little about beforehand. Would it not be safer to get a physician into your house, at least? Pay him for his time accordingly as you are able, and, mark my word, he will be very willing to stay in the parlor, kitchen, anywhere, if you do not need him. If it be in the night, get him off to bed, and tell him you will call him when needed. Thus you will both feel safer than if he were away. You might need him very much before morning, and possibly when it would be too late to get him from a distance. Once the birth is over, and the mother rested a little, he will allow at least a tepid sponging; and the word tepid allows a good deal of latitude, so that the water may be taken quite cool. Besides, too, once you have got the liberty to do it, you can repeat it often. By so doing the doctor will be astonished to find how well you get along.

Should male or female physicians be employed in midwifery? This is a bone of contention with many. The facts are these: the world got along anciently very well without physicians, or, at most, with those only who were rude and untaught in schools. I do not know that we have statistics enough to prove much in regard to the question, as to whether the world is more thriving with or without physicians; and as to whether male or female midwives are more successful, the great Dr. Rush—who was certainly a most candid and liberal-minded man, and in all particulars not only in favor of human right, but of “woman’s rights,” of which we nowadays hear so much—tells us “that it appears from the bills of mortality in London and Dublin, that about one in seventy of those women die in childbirth who are in the hands of female midwives; but from the accounts of the lying-in-hospitals in those cities which are under the care of man-midwives, only one in a hundred and forty perishes in childbirth.” But admit that the female doctors in those cities are not properly educated, or so well educated in their calling as the men are—a thing, however, which does not appear—it is not yet proved to us that males should not practice in this department.

The broad ground I take on this subject is this: educate THE PEOPLE in all matters pertaining to health; let physiology and hygiene be taught at the fireside and in the schools as much as any other science. At a proper age let both sexes throughout be taught all that may be concerning pregnancy and childbirth; and, all this accomplished, let those of both sexes practice whom skill, talent, and experience dictate. Educate the PEOPLE, and they will find out soon enough who are the most competent, and who are not, to practice the healing art.

As to the talk we hear so much of at this day about the indecency of man-midwifery, it is idle twattle, that scarce needs a remark. Indecent for a man to get up of a cold, wet night, and attend a poor, suffering woman in labor, and night after night, as not unfrequently happens! Indecent for us to resort to the use of instruments with which to destroy the life of the unborn child, in order to save that of the mother, as must sometimes, with the best possible management, be done! Away with all such foolishness, and the worse than false modesty which dictates it! They ought to take shame on themselves who utter it.

Yes, friends, I will tell you in a word how I feel in this matter. When I was born, my most worthy mother was very young. I was her first child. And since I have come to years of understanding, and often when I have attended women in childbirth, I have thought it was not possible for me to be thankful enough to that good old man—and who is yet living—for attending my mother at my birth, young and inexperienced as she was; and although I know that I could now teach him some things, which in his hoary age he does not at all understand, I have yet often felt in my heart that I would go leagues long to take him by the hand, that I might thank him for the good he had done.

Depend upon it, friends, there are only two things that can induce men to practice midwifery; and these are, first, that it may be necessary for a man so to do, in order to get his living; and, secondly, if he be a benevolent man, he will most gladly relieve suffering, if he can be the means of doing so. And do not physicians, almost to a man, the world over, attend the poor in childbirth, gladly and willingly, when they know they are to receive from them no pay whatever, except such as God gives them?

Is it said that man-midwifery leads to licentiousness? I answer, go to the veterans of the “godlike art”—those who have toiled long and hard in their calling, and who will not consent to relinquish it so long as their powers of body will allow them to pursue it, and ask them to tell you candidly, if the practice of midwifery has made them bad and unprincipled men? Mark, they will tell you, “No; but rather our knowledge of woman’s sufferings, and the pains and perils which we have but too well and sadly often learned that it is her lot to endure, have chastened us, and made us more what we ought to be.”

Suppose that now and then it may happen—as a rare exception to the rule, it is true—that a physician conducts himself in a lascivious way before a patient, are we for this reason to call all physicians bad men? Do we not also hear of bad men among clergymen? And because there is now and then a bad one in the clerical profession, are we to scout them altogether, and say they shall never preach to or converse with women?

I wish, therefore, to be understood, that I speak in strong terms against the foolishness of the cry we so often hear against man-midwifery. On the other hand, too, let it be understood, that I never have and never shall object to female midwives; the more of them the better, if they become properly qualified, and women choose. I know something of the benevolence, sympathy, kindness, and assiduity of woman in her care of the sick. We attend a man at a New York boarding house, lonely in the world, without wife or children, or brother or sister to console him in the day of his disease. Death lays hold of him in the morning, and takes away his senses, and all the long day, as he still breathes on, with the cold sweat upon him, the women of the house gather about him, watching anxiously, tearfully, for the last death agony to come. All this have I witnessed, here in this city of New York; and far be it from me to withhold from WOMAN any share which it may be her duty or privilege to perform in that noblest of earth’s callings, the attendance of the sick.

I do not, however, wish to conceal the fact, that I do not believe woman will ever, as a general thing, in any well-regulated society, practice the healing art. I give her all credit for her purer and more devoted sympathy with the sick, for her kindness and benevolence, as well as for her capability of acquiring science. But I do not believe that it is her mission to pursue that toilsome and life-wearing calling, which requires, oftentimes, the exercise of all the sterner faculties and powers, mental and physical, of the stronger sex. In the city of Paris, women, so far as I am acquainted, have had equal medical privileges to those of men; and yet the great proportion of medical practice is done by the latter.

In referring to the following letters it will be seen that I have presented some very striking facts illustrative of the effects of water in childbirth. But it may be asked—Do you have no unfavorable cases in water-treatment? I answer, yes. A few months ago it was my lot to advise a most worthy lady, of active and industrious habits, in this city, in her third pregnancy, and to attend her in childbirth. Owing to mal-position of the child, the face presenting forward instead of backward, as it should, to answer to the wider part of the pelvis, the labor was a very severe and protracted one. She suffered incomparably more than she had in both her former confinements. Expecting to have to resort to the use of instruments, I went for them late in the night; but before returning nature had done her own work. The child’s head, however, was dreadfully misshapen in consequence of the wrong presentation, and the result was, it soon had a sort of convulsions, which, after some weeks of suffering, carried it off.

Another sad case, too, has happened while I am preparing these letters for the press. A most estimable lady of this city, in whom I had for years felt a deep interest, and who was one of the most devoted friends the Water-Cure has ever had, was for the third time pregnant. She had probably always been scrofulous, and a good deal subject to disease. She had, moreover, an old rupture, which at this time was so bad she could not sit up. Such, at least, was her state, for the most part, during the last three or four months she lived. She became very weak, and at about the end of the sixth month of her period she sank. I had not the whole charge of her case, it is true, toward the last, for she was willing, at the most urgent solicitation of her friends, to resort to means which I could not approve of. My candid opinion is, that she would have died, whatever treatment might have been pursued.

If my words are to be believed, it will be seen that I have very great confidence in the Water-Cure. But if I know my own heart, I would in nowise overstate the truth; nor would I knowingly, for my right hand and my left, say that which would mislead either myself or my readers, or make us presumptuous toward that Being who alone can sustain us, and whose paternal care is ever over us, giving us every thing we have—mercy, blessing, and health.

I have not in the following letters spoken particularly of the treatment of spinal disorders. The subject is a most fruitful one, upon which a volume might be written. You are already, many of you, aware of the fact, that almost all of the young ladies who attend boarding-schools nowadays are more or less crooked in the spinal column. The ill hygienic management they receive from birth onward at home, and their too great confinement in schoolrooms, too often badly ventilated, renders the young and growing body of the girl too feeble to maintain itself in its proper position. The brain is likewise too much drawn upon in the mental exercises, which also causes debility of the bodily structures.

In after-life, as well, we see among females a great deal of complaining nowadays in regard to the spine. How few of the sex, indeed, do not, sooner or later, suffer with some form of spinal infirmity! True, in many cases the difficulty at the vertebral column is only sympathetic with some other disorder, as of the womb, stomach, bowels, etc. Yet spinal disease, in some of its protean forms, is a very common complaint.

In all cases of this kind, the water-treatment will be found an invaluable remedy; not that all can be cured—for that is not possible by any earthly means—but as a remedy for either cure, prevention, or palliation, water is the greatest of all remedies for spinal disease. In multitudes of instances, when the patient cannot walk, the new method proves an effectual one. In other cases, palliation is all that can be hoped for.

In multitudes of instances of so-called spinal disease, all that is needed is to establish the general health. Patients have often wondered how it is that by simply pursuing a course of general treatment the local part becomes so much benefited. The reason why a weak spine is often cured without any special applications to the part, appears evident when we consider that the local weakness is merely symptomatic of the general health.

J. S.

No. 98 Fourth Avenue, New York, 1852.

CONTENTS.

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.

AGE AT WHICH THE MENSES COMMENCE.

In Greece and other hot countries, it is said that the menses appear usually at nine or ten years of age. In the more temperate climates generally, as in Great Britain and our own country, the average age at which menstruation commences is from fourteen to fifteen years.

Habits of life, also, have something to do with the evolution of this function. “The early or late appearance of the menses,” says Dr. Denman, “may depend upon the climate, the constitution, the delicacy and hardness of life, and upon the manners of those with whom young women converse.” High living, the use of stimulating food and drinks, living in populous cities, the habit of frequenting balls and theaters, and of being taught early in the habits of civic life, have all, doubtless, a considerable effect in rendering girls precocious as to menstruation. In Paris, girls are occasionally observed to become regular at ten, eleven, and twelve years. Velpeau knew one that menstruated at nine and a half years; another at ten and a half; and one young woman who at fourteen was as tall and robust as the majority of women at twenty, and had been entirely in a state of puberty since she was eight and a half years old.

On the other hand, a country life and occupation, simplicity of manners, and frugal regimen, appear to be circumstances which procrastinate, to a greater or less extent, the coming on of the menstrual function. It is said that with the North American Indians this epoch does not commence until from the eighteenth to the twentieth year.

A table showing the ages at which the menses appeared in 450 cases, as quoted by Dr. Maunsel, of Dublin, as having been given by Mr. Robertson in the Edinburgh Medical and Surgical Journal, is as follows:

According to this table, it will be seen that with the largest number, namely, 97, menstruation commenced at the age of fifteen; and nearly as many at sixteen as fourteen; so that we are to regard the average age in such a climate as Great Britain, Germany, France, and the United States, as being from fourteen to fifteen years.

Dr. Meigs, of Philadelphia, gives a table on the authority of Drs. Boismont, of Paris, and Lee, of London, showing the ages at which 1,781 women began to menstruate, in France and England, as follows:

At what age the remaining five first menstruated, the table does not show. On the whole, its results may be regarded as very similar to those of Mr. Robertson’s table, before given.

Dr. Guy, of London, gives a table of the ages at which menstruation commenced of 5,062 cases, 2,905 being of England, 1,825 of France, 332 of Germany; the total numbers being as follow:

There is one topic connected with this subject which I cannot here enlarge upon, but which I will simply refer to by quoting the remarks of a certain author who has given much attention to the subject.

Dr. Ray, author of a work on the “Medical Jurisprudence of Insanity,” observes, “that the evolution of the sexual functions is very often attended by more or less constitutional disturbance, especially in the female sex, is now a well-established physiological truth. The shock seems to be felt chiefly by the nervous system, which experiences almost every form of irritation, varying in severity from the slightest hysteric symptoms to tetanus, St. Vitus’ dance, and epilepsy.” “And when we bear in mind, also, that general mania is sometimes produced by this great physiological change,” continues this author, “it cannot be deemed an extraordinary fact that partial mania, that partial acts, inciting to acts of incendiarism or murder, should be one of its effects.”

LETTER III.
OF MENSTRUATION.

The Menses—Names—Source—Commencement—Periodicity—Nature—Quantity of the Menstrual Discharge.

In my last letter, speaking of the menstrual discharge in females, I omitted to mention the several names and expressions by which the function is known. Those by which it is more commonly designated are “menses” (meaning a month), monthlies, monthly discharge, show, being regular, regular discharge, flowers, turns, monthly turns, regular periods, monthly periods, courses, monthly courses, catamenia, catamenial discharge, etc. We read in the Bible that Rachel said to her father, “Let it not displease my lord that I cannot rise up before thee, for the custom of women is upon me.” And we also read of Sarah, that a son was promised to her when “she was old and well stricken in age, and when it had ceased to be with her after the manner of women.”

Menstruation, then, commences at puberty and ceases with fecundity, and generally during the period of giving suck. As a general fact, women who experience no menstruation can never bear children.

COMMENCEMENT OF THE MENSTRUAL DISCHARGE.

This is usually preceded by more or less disturbance of the general system. There may be a general excitement or a depression, or the two in alternation. There is often experienced a sense of weight in the loins, accompanied sometimes by a feeling of tension in the epigastrium, or pit of the stomach, with pain in different parts of the body. There is also general uneasiness, lassitude of the body, and irritableness of the temper and feelings. With these symptoms, a mucous discharge, more or less yellow, takes place. This, after a time, becomes streaked with blood; yet many experience no particular symptoms at this time, and such, doubtless, would generally be the case were the laws of life and health habitually obeyed. In general, menstruation does not become regular until after some months have elapsed from its commencement.

The health should be carefully guarded at the coming on of menstruation. Perhaps at no one period of woman’s life is attention to the laws of health more requisite than here. A little mismanagement may now lay the foundation for life-long suffering and disease.

Bathing, a full share of exercise in the open air, particular attention to diet, and, in short, all the hygienic means that can be brought to bear in keeping up a good condition of the general health, is the course to be pursued. Cheerfulness, contentment, and a pleasing frame of mind, are very desirable at this time. Severe study and unpleasant discourse, of whatever kind, should not now be undertaken.

Neither should parents be too tender of their daughters at this period. Especially should the reading of novels and books of an exciting nature, the attendance of balls, parties, theaters, etc., be avoided; and persons of whatever sex should be particularly careful to treat those of this age with the utmost kindness in every respect. One unkind look, one harsh expression, or one angry word from a parent or near friend, may be the means of affecting severely the individual’s health.

It has been a question with some, as to whether menstruation is strictly a natural function to the human system. So far as we know, it has occurred in all climates and in all periods of time. We read in the Levitical law, “If a woman have an issue of blood in her flesh, that she be put away seven days, and that whoever toucheth her shall be unclean.” The cases of Rachel and of Sarah every one may recollect. Naturalists tell us, too, that some of the monkey tribes, or species of animals nearest resembling man, have symptoms of this kind. Still there have been those who believed that this function has come upon the human race in consequence of great and long-continued physical transgressions, continued, perhaps, through ages and ages, until at length it took on the form of an apparently natural function.

SOURCE OF THE MENSES.

From whence comes the menstrual discharge? This has been a question which has caused a good deal of dispute on the part of some.

The majority of writers, of all ages, agree in regarding the menstrual flow as coming from the womb; yet some have held that it issues only from the vagina and more external parts. This latter supposition cannot hold good except, possibly, now and then, as an exception to the general rule. Blood may exude from any part of the body, from the vagina and external organs of generation, as well as from the womb. But this organ, beyond doubt, is the great and principal source of the menstrual discharge.

PERIODICITY.

The periodicity of this function is remarkable. With those who are regular, menstruation occurs every twenty-eight or twenty-nine days, or once a lunar month. There is, however, considerable variation from this rule. Some having menstruation twice a year appear to enjoy very good health. Some have asserted that the frequency of menstruation varies considerably according to climate. Linnæus, it seems, saw women in Lapland who menstruated about once a year. Dr. Denman speaks of the inhabitants of Lapland, where women do not menstruate till they arrive at mature age, and then only in small quantities and at long intervals, and sometimes only in summer. But if they do not menstruate according to the genius of their country, it is said they suffer equal inconvenience, as in warmer climates, where the quantity discharged is much greater and the period shorter.

NATURE OF THE MENSTRUAL DISCHARGE.

The question as to the nature of the menstrual discharge, has attracted a good deal of attention among physiologists and others. Savage nations, and perhaps some others in the world who would claim a higher place in the range of human civilization and improvement, have entertained singular notions concerning it.

Superstition has been carried so far in this matter, that if a man should meet with the great misfortune of dropping his pipe, and breaking it, the accident would be imputed to its having been lighted at the hut of a female who was at the time menstruating.

So, also, it has been regarded that if a woman, during this period, should walk three times around a garden, all the flowers would be destroyed, and the caterpillars killed in it.

A North American Indian, according to Dr. Gooch, said that if the saliva of a menstruating virgin were applied to the bronchocele of a male, it would cure it.

Every one has read the strict regulations recorded in the Old Testament concerning this function. Thus in the Levitical law we read:

“And if a woman shall have an issue, and her issue in her flesh be blood, she shall be put apart seven days; and whoever toucheth her, shall be unclean until the evening.

“And every thing that she lieth upon in her separation shall be unclean: every thing also that she sitteth upon shall be unclean.

“And whoever toucheth her bed shall wash his clothes, and bathe himself in water, and be unclean until the evening.

“And whoever toucheth any thing that she sat upon, shall wash his clothes, and bathe himself in water, and be unclean until the evening.

“And if it be on her bed, or on any thing on which she sitteth, when he toucheth it, he shall be unclean until the evening.

“And if any man shall lie with her at all, and her flowers be upon him, he shall be unclean seven days; and all the bed on which he lieth shall be unclean.

“And if the woman shall have an issue of her blood many days out of the time of her separation, or if it shall run beyond the time of her separation, all the days of the issue of her uncleanness shall be as the days of her separation: she shall be unclean.

“Every bed on which she lieth all the days of her issue shall be to her as the bed of her separation; and whatever she sitteth upon shall be unclean as the uncleanness of her separation.

“And whoever touches those things shall be unclean, and shall wash his clothes, and bathe himself in water, and be unclean until the evening.

“But if she shall be cleansed of her issue, then she shall number to herself seven days, and after that she shall be clean.”

Thus we see how particular, in regard to the menstrual function, were those good old people of the Mosaic time. No doubt many at this enlightened age would say that they carried things to an extreme.

I cannot but think, however, that it would be a great improvement if our modern ladies, some of them, at least, would be one half as careful in regard to cleanliness as the Jewish people were.

The Romans believed the menstrual fluid to be endowed with the most noxious qualities. It was, in short, regarded as a dangerous poison, the exhalations of which alone are sufficient to turn all the sauces of a whole kitchen, the cheeses of a whole dairy, and make a whole family sick, and wilt all the flowers of a parterre.

If the ancients went to an extreme on one side in this matter, there is, perhaps, equal danger with the moderns of going quite as far in the opposite way. Certain it is, that too great pains cannot be taken in reference to this period. It is generally true that old proverbs have at least some truth on which they were originally founded. There was wisdom in the Levitical law, so strict in regard to the purification of women at this period.

Does the menstrual discharge consist of blood? This is a question concerning which physiologists, both ancient and modern, have put forth many speculations, and many experiments have been instituted to settle the matter.

Hippocrates regarded the menstrual fluid like the blood of a slaughtered animal, or, in other words, blood.

Aristotle was of the same notion, comparing it to the blood which flows from a simple wound. It may be a question whether pure blood is discharged; but that the fluid contains the most important properties of blood, is a fact settled beyond dispute.

QUANTITY.

The quantity of menstrual discharge has been a matter of inquiry on the part of medical men.

It would be a very difficult task, if indeed, not impossible, to determine in any given case the precise amount of menstrual fluid discharged at a single period. An approximation to the general rule is all that can be reasonably looked for in investigations of this kind.

In cold regions, the discharge is more scanty; in hot, more profuse; and in temperate climates, a medium quantity is observed.

Dr. Gooch, in his “Treatise on Midwifery,” quotes De Haen as having made inquiries among poor women, who told him that they used only one cloth at the period, which, when wet, was dried, and then applied again. He then took a similar napkin, dipped it in blood, dried it, and applied the same. This experiment he tried repeatedly, and from it he deduced that from four to eight ounces, rarely ten, and most commonly about six, of the menstrual fluid, are lost at each period.

When we consider the great difficulty in ascertaining accurately the amount of menstrual fluid at a given period, and the great show which a comparatively small quantity of blood or menstrual fluid makes upon white, or light-colored clothing, it is not at all surprising that observers should have varied so much in regard to the true amount.

Hippocrates believed that the Greek women lost twenty pounds of blood at each menstrual period.

Galen estimated the quantity at eighteen ounces.

Haller computed it at six, eight, or twelve ounces for the German women.

According to Smellie it amounts to four ounces.

Astruc says that in England it varies from eight to ten ounces.

Magendie thinks it is often very great among the French women, and may amount to several pounds.

It need hardly be said that the quantity of menstrual discharge often varies greatly in the same individual according to the condition of health, general habits, and a variety of circumstances too numerous to mention. It may be so slight as to be scarcely perceivable, or, on the other hand, it may be so very profuse as to amount to several pounds.

I have no doubt but that the amount of this discharge varies a good deal with the same person at different times, and that, even, when the health is good. At all events, I advise you to take no trouble in reference to it, provided you can manage to keep clear of pain and other derangement of the general health. Keep up a good degree of strength, observing, at the same time, all good hygienic rules, and you have nothing to fear in regard to the quantity of blood you may lose. In other words, take good care of the system, and the system will take good care of itself.

In the next, I shall speak of an important matter connected with this subject. I refer to what is termed the change of life, or the period at which the menstrual function ceases. I need not add that this is a matter of importance to each and all of you, for I am persuaded that you already regard it as such.

LETTER IV.
OF MENSTRUATION.

Cessation of the Menses—Turn of Life—Management at this Period.

In every department of nature we see the most unquestionable evidences of design.

Who but an Almighty Hand could have created a being so complex, and a body so admirably adapted in every respect to his wants, as that of man? Every part of this great piece of God’s handiwork is most accurately fitted to its place, and every function is performed for some important end.

Menstruation and child-bearing are, as we have seen, intimately connected with each other. Suppose a woman could bear children at any period of her life she might choose, what a premature offspring would that be which she would bring forth in childhood, and what a feeble, decrepid one in old age.

But it is not so. Nature has set up bounds which all the art and ingenuity of the whole combined world cannot pass.

It was the benevolence of the Creator that formed her body in this way; for if it had been left to the choice of us poor erring mortals, women would bear children at those times when it would be very improper to do so. And this benevolence extends equally to both mother and child.

Menstruation commences, as we have seen, usually at the age of from fourteen to fifteen years.

AGE AT WHICH THE MENSES CEASE.

The age at which the menstrual function ceases is somewhat various. The average has been regarded in this country as being at about forty-four or forty-five years of age. It is, at least, so with the community at large. In seventy-seven cases quoted by Dr. Maunsel, of Dublin, the period was as follows:

Dr. Guy gives a table showing the ages at which 443 persons ceased menstruating, 337 having been collected and communicated to him by Dr. James Reed, and 106 by himself. The table is as follows:

M. Brierre de Boismont, a French author, remarks: “It has been said, in a general way, that the cessation of the menstrua takes place about the forty-fifth year in this country—a little sooner or a little later. The fact is true; but we believe that a better appreciation would be made by presenting a table indicating the different periods of the critical age.” This author collected 181 cases of women, indicating the age at which they had ceased to menstruate, and here are the results:

The time at which menstruation ceases in Great Britain, must be doubtless very nearly or quite the same as in this country. In the above table it will be perceived that twenty-six females had menstruation until fifty, and only three to forty-four, and four to forty-five years of age. According to this, the average is considerably above forty-five years in Great Britain; and it is probably about the same thing with us in the United States.

EXTENT OF THE FRUITFUL PERIOD.

The cessation of the menses, as I have remarked, is generally the limit of the period of child-bearing; but this rule, like all others, has its exceptions.

Bartholomew Mosse, according to Dr. Guy, mentions four cases of women pregnant in their fifty-first year, and Dr. Labatt, of Dublin, one; Knebel and Lamatte each one in the fifty-second year; Bartholomew Mosse and Knebel each one in the fifty-fourth year; a case of pregnancy at the same age (that of Mrs. Ashley) is also related in the Edinburgh Annual Register for 1816, in the French accusation, in which the succession to an estate was disputed on the ground of the mother being fifty-eight years old when the child was born, and the decision was given in favor of the fact.

Pliny, Valescus de Tarenta, and Marra, of Venice, record cases of pregnancy at sixty.

Capuron, a French author, states that a woman of sixty-three was generally believed in Paris to have given birth to a daughter.

Dr. Beck, of Albany, quotes a case from the Boston Medical and Surgical Journal, of a woman at White Hall, New York, becoming a mother at sixty-four.

A writer in the Edinburgh Medical and Surgical Journal, Mr. Robertson, states that out of 10,000 pregnant females registered at the Manchester Lying-in Hospital, 436 were upward of forty-six years of age. Of these there were—

In some rare instances, also, conception has been known to take place prior to menstruation. Cases of premature fruitfulness are related by high authorities. Montgomery delivered a female of twins before the completion of her fifteenth year; La Motte and Sir E. Horne give instances of pregnancy in the thirteenth year; the last-named author another in the twelfth; and Bruce, in Abyssinia, and Demboss, in Bengal, met with mothers of eleven years. These facts I take from Dr. Guy.

I am next to speak of the cessation of the menstrual function, the turn, or change of life, as it is called. And I will here observe, that this period is as natural to the system of the female as puberty, or any other. But notwithstanding it is so, it is important to be remembered that all great changes or evolutions of the body render it probably, on the whole, more liable to take on diseased action than it is at ordinary times.

IS THIS PERIOD A DANGEROUS ONE?

From a long-prevailing idea that the cessation of the menstrual function is attended necessarily with a greater or less degree of danger to the general health, it has been called the critical period.

Doubtless, the health of some persons does at this time become worse; but, on the other hand, there are those who improve, and become in every respect stronger at the cessation of the menstrual function.

The learned Dr. Dewees, of Philadelphia, whose experience in the treatment of the diseases of women was perhaps as great as that of any other man, went so far even as to say, “The vulgar error that women at this period of life are always in danger, is replete with danger to the suffering sex;” and he continues: “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.”

According to observations made on the bills of mortality in France, by M. Benoiston de Chateaunauf, as quoted by Dr. Dewees, it appears that fewer women die between the ages of forty and fifty than men, or, indeed, at any other period of their lives after puberty; and further, that this change is effected without much disturbance; that they live not only longer than men, but are more free from morbid inconveniences. These facts are well worthy of notice.

In some cases, the menstrual function becomes more copious about the time at which it is to cease, and amounts almost, or quite, to an hemorrhage.

Sometimes it ceases, and then returns again; and thus an irregularity is caused. At length a final cessation occurs. In the place of menstrual fluid, a sort of mucous discharge takes place at times; the individual experiences lassitude and depression of spirits, nervous complaints set in, and, in some cases, serious diseases come on. But, poorly as the rules of health are by the many observed, the picture is often reversed—the woman’s health becomes re-established, and firmer and better than before. She appears often more plump and ruddy after the change of life has taken place, and does, in fact, seem to grow younger for a time.

THE CHANGE OF LIFE.

Fanciful writers have sometimes indulged in poetic strains, depicting the changes of this season, as being very unfavorable to the personal attraction of woman. It is said, “that the bosom and cheeks become flaccid, the skin is wrinkled and appears to be too large, and loses its delicateness; the eyes sink in their orbits; the carnation of the cheeks is supplanted by a yellow tint; that empurpled flush which once, amid smiles, sat on her rosy lips, is chased away by a bluish or leaden hue. Every circumstance proclaims that the season of the pleasures is past, and that she can no longer rely on the attractions peculiar to her sex.”

This delineation is by far more fanciful than true; and it oftener happens that, in consequence of the pernicious habits of civic and civilized life, changes as great, and often greater than these, occur at a much earlier date than this critical period, so called. Were the laws of life and health reasonably observed, there could no sudden or considerable change take place at any one time in life. As middle age merges into the more advanced, so, gradually and imperceptibly, comes on the riper and more mature state, before which woman does not arrive at the full time of her dignity, and the full period of the magnitude of her moral power.

But it must be admitted that there are in some cases reasons why the time of cessation of the menstrual function should be called the “critical period,” or the “turn of life.” Thus, with the beginning of suppression, or cessation, there may occur swelling of the abdomen, nausea, sickness, and loathing of food, as in pregnancy.

The imagination, too, may have something to do with this matter, for it is doubtless true, that some women “have such a dislike to age, that they would rather persuade themselves that they are with child, than suppose they are feeling any of the consequences of growing old.”

I ought here to mention, that in those cases where pregnancy does not exist, the abdomen is softer and more equally enlarged, and swells more speedily after the obstruction than it does from real pregnancy.

Some persons are, at this period, so imaginative, as even to believe that they actually experience motions of the child, whereas there is only wind or flatulency in the bowels, which, by rumbling, or shifting from place to place, causes a sensation analogous to that of the motions of a real child. Some persons have even gone so far in this matter as to believe that they had passed through the entire period of pregnancy, and have called physicians and attendants, believing that labor had actually began. And some physicians, even, have remained many hours with these patients, when at last it has been discovered, to the great mortification of all concerned, that one important feature was yet wanting, in order for labor to take place, namely, the presence in the mother’s womb of an actual child.

This change of life, I remarked, is a natural occurrence to every woman. It is as natural for menstruation to cease as it is for it to begin. Were the habits of society such as they should be, health, and health only, would be the natural result in all these changes; but such is not always the case. Some are barren and unhealthy, and have not vital stamina enough for them ever to gain truly firm and enduring health. Others, too, and probably a far greater number, have their health destroyed, either by the ignorance of their parents or themselves, or of both combined. In such cases, some of the following symptoms may be noticed. If any organic disease is already present, with many it appears to be aggravated or increased. This is especially true in diseases of the womb and the breasts. It seems, indeed, that cancer of these organs is more apt to become developed about this time. Symptoms of dyspepsia are apt to be aggravated. Some become more corpulent, and as corpulency is a state of disease, more or less general debility, and inaptitude for walking and physical exertion of whatever kind, is experienced. There appears also, at this time, to be with many a greater tendency to inflammatory disease, diarrhea, dysentery, cholera morbus, or, on the other hand, a constipated state of the bowels; or the constipation may alternate, with one or more of the former complaints.

But, as I have already remarked, there are other cases in which the health becomes, in every respect, more firmly established and better after menstruation has ceased, than it was before.

MANAGEMENT AT THE CHANGE OF LIFE.

The explanation I have already given will indicate to you the nature of the general management which should be employed at the period of the cessation of the menstrual function.

I have said it should be regarded as a natural change in the system. The best local and general treatment that can be adopted, therefore, will be that which is calculated to fortify and invigorate the general health. Every thing in diet, exercise, bathing, the daily occupation, and the moral and mental habits of the individual, should be, as far as possible, regulated according to physiological principles, and the laws of health.

Especially let not fear excite in you any unnecessary alarm respecting this period. Trust nature, and do by her properly, and she will do safely, faithfully, and efficiently her own work.

Those methods of dosing and drugging the system which have by many been practiced on such occasions, are, as a general fact, pernicious, doing a great deal of harm. Those especially who take powerful, and so-called expulsive medicines, with the view of forcing nature to continue the menstrual discharge, render themselves liable to serious injury. It is easy thus, by, as it were, a single misstep, to seal the inevitable doom of life-long ill health.

Doctor Dewees, in speaking of the great advantages of a well-regulated regimen in securing the woman against injuries which may arise from the irregularities of the menstrual discharge at this period of life, judiciously observes, “that 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, 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 insure 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 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.

The advantages of a suitable degree of care in regard to exercise, diet, and all those habits that tend to the promotion of the general health, will likewise appear evident when we take into consideration the manner in which the system is sometimes found to suffer at this period.

During that part of the woman’s life in which menstruation occurs, the constitution is under the necessity, so to say, of forming not only a sufficiency of blood for its own support, but a superfluous quantity for the purposes of menstruation. Now it must be the order of nature, that in a healthy and well-balanced constitution, enough blood only will be elaborated for the normal purposes of the economy; but if too great an amount is formed after the menses cease, there will be no outlet for it, and as a consequence, there will be, perhaps, fullness and congestion of the head, and other symptoms of plethora.

For this reason, physicians have often thought it necessary to abstract blood, and to use other depletive means. But I am led here to remark, how very much better, under such circumstances, it would be to employ fasting, or, at least, a proper degree of abstinence, and the other measures calculated to keep off too great fullness of the body. Nothing in the world is easier—provided a woman has sufficient control over herself, and perseverance—than to vary to any desirable extent, the quantity of blood in the system; and all physicians agree that it is far better to regulate these matters by diet, and other hygienic measures, than to have to resort to bleeding and cathartics, provided that it can be done.

The practical deductions to be drawn from these remarks then, is, that if, at the change of life, the woman feels any of the symptoms of plethora and too great fullness in her system, she should adopt all good rules in regard to the improvement of the general health, and she should be especially guarded in reference to the amount and quality of food taken. In so far as she attends to all these matters, will she be more than doubly rewarded for her patience, her perseverance, and her self denial.

In conclusion, I remark, that if any one of you who is about arriving at the turn of life, feels that you are growing old, that you will be less attractive to those about you, and that you will enjoy less of the social pleasures of life after this change has taken place, there is yet a comfort for you, even in this world. You will now no longer be subject to those monthly troubles which, for these thirty years, have been your lot. All the annoyance, the irregularity, the tardiness, the suppression, and the pain—these all are now gone from you, no more to return. No doubt you may feel sad as the sighing wind reminds you in the autumn that we can be young but once. We all feel sad at times when we think how age is creeping upon us. But may I not say to you, there is yet that which can make us triumph over all of these things, yea, over death and the grave.

LETTER V.
OF MENSTRUATION.

Tardy and Suppressed Menstruation—Chlorosis—Sudden Check of the Menses.

One of the most important of all subjects connected with the health of females, is that of disordered menstruation.

You will find, as you read medical works on Females, the word amenorrhœa, which signifies a partial or total obstruction of the menses in women, from other causes than pregnancy and old age. You will find, also, the words menorrhagia, signifying an immoderate flow of this discharge, and dysmenorrhea, meaning difficult or painful menstruation.

Before proceeding to speak of obstructed menstruation, I ought to make some remarks upon the too tardy appearance of this discharge.

As I have before observed, the catamenia usually appear at from the fourteenth to the fifteenth years of age. Now, when there is a failure on the part of nature to bring about this state of things, there is not unfrequently a great deal of anxiety experienced on the part of mothers and those most intimately concerned. If, likewise, the girl at this time is attacked with any particular ailment, it is almost sure to be attributed to this cause. Too often, under these circumstances, she is also subjected to various modes of medical treatment, with the view of forcing nature into that sort of work which it is believed she ought to do, but will not. Now, the effect of such a course can be only harmful, as a general fact. To aid nature, it should be remembered that we must increase her powers, and not diminish them, as is almost necessarily the case if a course of drug-medication is practiced.

Please notice, then, that I wish to persuade you that this plan of drugging the system for tardy menstruation is a most unwise and unnatural one. Attend well to nature, and nature will take care of herself. Let me give you a few words from an honest, good man, Dr. Dewees, who years ago went to his long home. He says:

“Our exertions in favor of such patients, should tend to the invigoration of the system in general, and the development of the uterine system in particular. The first should be attempted—First: By the establishment of a regular course of exercise; such as riding on horseback, when practicable; walking in proper weather; skipping the rope within doors, when the weather will not permit exercise abroad; dancing moderately, and with strict regard not to become overheated, and cooling too suddenly. Secondly: By proper attention to dress; wearing flannel next the skin in cold weather, and properly protecting the feet and legs against cold; carefully avoiding damp and wet places, and partial streams of cold air, especially when warm. Thirdly: By a diet of easily-digested substances, both of the vegetable and animal kind; avoiding all stimulating drinks, such as wine, spirits, or beer, etc., under the specious pretext of their being strengthening.”

I give you these words, not that I would altogether agree with every idea advanced, but because of the general worth and correctness of the remarks, and the high authority from which they come. I do not believe it best for any one to wear flannel next to the skin, but I do believe in guarding the body sufficiently against cold, a thing which young ladies too often neglect. Dancing, too, as a general rule, cannot be regulated in the way it should be; and as for animal food, it is not necessary, to say the least.

I do not wish to appear to be fault-finding with your sex; but I must say, in all frankness, that some have taken an unreasonable course in regard to bringing on the courses, when they are tardy. The following case happened to a physician of eminence: The girl was a most amiable and interesting creature, for whom he was requested to prescribe for the expected menses, but who had not one mark which would justify an interference, and especially as she was in perfectly good health. She was fifteen, it is true; and this was all that could be urged by the mother in favor of an attempt to “bring down her courses.” He relied too much upon the good sense of her anxious parent, and freely explained himself to her. She left him apparently satisfied with his reasoning, and he heard nothing of the poor child for six months; but at the end of this time he was suddenly summoned to attend her, as she was said to be alarmingly ill.

When he saw her, she was throwing up blood in considerable quantities from the lungs; she died a few days after from the excess of this discharge. The distracted mother told him, that though she appeared satisfied with what he had said when she left him, she was convinced he was wrong, and that her daughter’s health required the immediate establishment of the menstrual evacuation. With this view, she determined upon the trial of a medicine of much celebrity in similar cases, vended by a quack. She procured it, and gave it according to direction; in a few days her daughter became feverish, lost her appetite, and frequently vomited; her strength failed, and after a short time she was confined to her bed. She called upon the “doctor,” and made known to him the condition of her daughter; he encouraged her to persevere, and told her that the fever, etc., was an effort nature was making for the end proposed. She persevered, fatally persevered, for in a few days she lost her lovely and only daughter. The medicine given in this case proved, on examination, to be the oil of savin (juniperas sabina), a most active poison, and one which, in the smallest doses, has been known to produce disastrous results.

EFFECTS OF WATER-TREATMENT.

There is one remarkable fact concerning the effects of water-treatment, as affecting menstruation, which should here be spoken of. Where a vigorous course of hydropathy is practiced for chronic disease, the menstrual function, in some cases, ceases for months, and even a whole year or more. I had first to learn this fact for myself, no other practitioner ever having promulgated the doctrine, so far as I know. And it is a remarkable fact, that in such cases no injury arises from the circumstance; but the individual’s health grows, month by month, in all respects better. No inconvenience is experienced from the suppression, nor need the slightest alarm be felt. The probable reason why menstruation thus ceases is, that a vigorous action of the skin is caused by the water process; elimination, or the throwing off of the waste, morbid, and impure matters, is made to go on so rapidly and vigorously, that there is no need of the purification of menstruation at the time. This doctrine, however, is conjecture and mere speculation, and one that does not appear to be susceptible of positive proof. That the occurrence does takes place, and that women have, at the same time, been remarkably benefited in health; cured, as we may say, of long-standing and most obstinate chronic diseases, we know to be a fact.

But whenever retention of the menses occurs, and is not caused by pregnancy, or by the age of the individual, at which the function ceases naturally, or by a course of water-treatment, we are to suspect some derangement of the general health. This is a natural function, and if we find it ceasing when it ought to go on, we may safely conclude, that the efforts of nature are by some means thwarted; otherwise she would do her work.

CHLOROSIS.

Retention of the menses is very often attended with what is technically termed chlorosis.

The word chlorosis signifies a greenish, or greenish-yellow hue of the skin, and might, therefore, be applied to certain affections belonging to both sexes; but the term is “generally confined to that modification of amenorrhea, which is attended by a dingy-pale, or greenish color of the skin.” Chlorosis also goes often under the name of green sickness.

In this disease there is “heaviness, listlessness of motion, on the least exercise palpitations of the heart, pains in the loins, back, and hips, flatulency and acidity in the stomach and bowels, a preternatural appetite for chalk, lime, and various other absorbents, together with many dyspeptic symptoms.” In the progress of the disease the face and lips become pale, and after a time assume a more yellow hue; there is great general debility, flaccidity of the muscles, and not unfrequently, swelling of the feet and lower limbs; there is, in short, a great variety of symptoms, varying more or less, endlessly, as we may say, in different cases, and such as denote a very depraved state of the constitution generally.

This disease is sometimes cured spontaneously. The simple force of nature, acting also, perhaps, in consequence of favorable circumstances as to air, exercise, diet, clothing, occupation, etc., is often sufficient to effect a cure. Menstruation is brought on, and thus the individual becomes well; but in other cases the affection is of a very obstinate nature, and leads to disease of some important organ, as the womb, bowels, lungs, etc., and ends at last in death.

Chlorosis has been sometimes mistaken for tubercular consumption. When the patient has been cured, it has been said she was cured of that disease. Thus it is that more persons are said to be cured of this dreadful malady than actually have been. Chlorosis, as a general fact, is by far oftener curable than consumption is. It is, in fact, generally curable if taken in season, which, alas! cannot be said of that most formidable disease, consumption of the pulmonary organs.

Causes.—The causes of chlorosis are as numerous as the causes of depraved health generally. Any thing which tends to lower the tone of the system generally, during the period at which chlorosis ordinarily comes on, may act as a cause, either directly or indirectly, of the disease.

I will here give you a case which may serve to throw some light on the subject.

A physician was called to visit a young lady of the city of New York, of a wealthy family, in which, the mother being present, something like the following conversation occurred:

Doctor.—Well, Miss, how are you to-day?

Patient.—Not very well, I am sorry to say.

D.—Do you attend school at present?

P.—Yes; I am at Mrs. ——’s seminary, in —— street.

D.—How long have you been there?

P.—Four years, including now and then a vacation of a few weeks.

D.—What have been your studies?

P.—Composition, Rhetoric, Mathematics, Philosophy, Chemistry, Botany, French, Spanish, Music, and Drawing.

D.—Do you like your studies?

P.—Yes; some of them very much.

D.—How do you like the study of English composition?

P.—I can hardly say; we have to do every thing in French; address our teacher in French when we go to school in the morning; speak French in our exercises; in short, it is nothing but French all day.

D.—On the whole, you say you like your studies?

P.—Yes, when I am well; but latterly I have been so ill and low-spirited I could not enjoy any thing. I like study when I am able to perform it—like it very much. I used to succeed well; but latterly I am discouraged, and do not accomplish any thing at all.

D.—Well, now let us know all about your health, and see if we can find out what the matter is, and what it is proper to do. Here you have a fine, airy residence, an abundance of the best things to eat and drink, and to wear; good baths, good walks, and every thing about you to make you happy and comfortable.

Mother.—She has never been regular, doctor, in her whole life.

D.—Does she take her regular baths?

M.—No; she won’t bathe hardly ever, and as for taking an injection, she would die first.

P.—No, mother; I do bathe two or three times a week; but then it chills me and makes me tremble so, I don’t get over it all day.

D.—But don’t chill yourself, use the water milder; but take your bath every morning, or at least some time during the day. You cannot be as clean as you should be in a dusty city like this, unless you wash the body every day.

M.—The rest of us take a cold bath every morning, and it does us a great deal of good; we would not do without it on any account.

D.—How much does your daughter walk every day?

P.—Walk! why! mother won’t let me walk. I only go to school and come back, that’s all.

D.—You only go to school and back. Let’s see how far that is; about a quarter of a mile there, and a quarter of a mile back. Then you walk a half mile each day.

M.—She sometimes goes up and down stairs dusting off the furniture in the house.

D.—That is all very good, so far as it goes. Does she ever make bread?

M.—No; we get the bread at the baker’s.

D.—And rather poor stuff at that. Does she ever wash?

M.—Well, no; the servants attend to that. She has too many studies you know, doctor, for that, and then—

D.—How is the patient’s appetite?

P.—Not very good; sometimes I eat a great deal too much, but the most of the time I relish nothing. I am often wanting what I cannot get; and food always distresses me, gives me acid stomach and heart-burn, and so on.

M.—Yes; she likes chalk, charcoal, slate pencils, vinegar, and all such things. She has always an appetite for these.

D.—This is a morbid, diseased appetite. Do not blame her, she cannot help that; if you or I had just such an appetite, and felt in all respects as she does, we would very likely gratify it to as great an extent. How does the patient sleep?

M.—Not very well; the bed is never right; sometimes we put on a feather bed, and then she gets fidgety and says she cannot sleep; then again we put the hair mattress over the feather bed; but this is either hard, rough, or uneven—there is always some kink in her head about the bed; it’s never right.

D.—Does she have her window open?

M.—No; she’s afraid of taking cold.

D.—What kind of pillow does she sleep on?

M.—Feather pillow, of course.

D.—Of course—a great many people are getting to sleep on hair pillows—and some on harder ones even, such as palm leaf, corn husks, straw, etc.; and some young ladies won’t have any pillow at all; it makes them crooked not to lie straight. For my own part, I like to have one pillow, stuffed with hair, moss, corn husks, or straw—something that is clean, without smell, and cool. One pillow, and one only, that is just thick enough, so that when I lie upon the side, as I think persons who can ought, it is just comfortable. There is a great deal of truth in the old maxim, “keep the feet warm and the head cool!”

M.—I had not thought of that; I suppose the head does keep warm enough of itself.

P.—O yes; you know, mother, my head is always burning hot, and aches most dreadfully too.

D.—At what time of day does it ache most?

P.—It aches all the time; it’s never right.

D.—How do you feel in the morning when you get up?

P.—Very badly; I never sleep well; I feel heavy and weak, and my head aches.

D.—How do you feel when you walk out in the open air?

P.—Well, I can hardly say; in fact I don’t feel as if I could walk. It is as much as I can do to get up and eat breakfast and fix off for school.

D.—Did you ever go to the country in the summer?

P.—O yes, to Massachusetts.

D.—How did you feel there? Could you walk?

P.—O yes; we had walking parties, rides, visitings, and a great many things to take the attention; and I, in fact, either forgot all my ailments, or else had none, I don’t know which. I have been to the country a number of times, and whenever I go all my headache leaves me, my appetite becomes good, and I am soon able to bear as much exercise as any one need.

D.—Do you have any headache?

P.—Strange as it may seem, not the least.

D.—Do you study your books much in the country?

P.—No, very little; we go for relaxation and amusement; we read, perhaps, a little, but do not undertake hard study.

D.—How much do you walk or ride in the day?