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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?

P.—Well, I can’t tell; we go sometimes in one direction and sometimes in another. We even walk to neighboring villages; we go some days, I should think, in all ten miles on foot; and I think, indeed, sometimes twice that distance.

D.—Does this give you fatigue?

P.—It does at first, sometimes; but somehow my mind becomes so interested with the country, I forget all my aches and pains; you know I have always lived in the city, and the country seems to me a new life; I seem to feel as happy as the birds.

D.—How do you sleep at night?

P.—It’s a rude place you know, and it is fashionable in the summer there to sleep on straw beds. But it is no matter; we get so tired as to be very glad to sleep any where. We could sleep on the floor, or sitting up in a chair if necessary; when we get so tired sleep we must.

D.—How long do you stay in the country?

P.—Six weeks, and sometimes more.

D.—What kind of food do you eat?

P.—Plain food, such as the country people have. I generally take bread, vegetables, berries, and milk. They have hams, pork, all sorts of meat, and things of that kind; but you know father does not wish me to eat meat; nor have I any particular relish for it. I sometimes eat a little fresh butter along with my brown bread; I suppose I would be just as well off without even that; I enjoy the bread, berries, and milk very much.

D.—Does food agree with you in the country?

P.—Generally very well.

D.—How do you feel after you get back to the city?

P.—Very well for a time.

M.—I guess you would think so, doctor. She acts like a perfect romp; there is no keeping her any where.

D.—It is natural for healthy girls to romp, as you call it. What would a boy be worth, if he were not allowed plenty of exercise? Girls must have their plays and sports, otherwise they will suffer in health. Thus you perceive when your daughter goes to the country, takes plenty of exercise, eats plain food, avoids excess in study, and lives mostly in the open air, she very soon becomes well. Some, perhaps, might tell you that all this is merely the result of a change; but, I ask, if it is merely a change that makes her so much better in the country, why does she not grow still better even when she changes back to the city? The truth is, it is not so much a change, as it is the healthful influence of air, exercise, diet, and freedom from excessive study, which work so great a benefit to her health. You perceive, also, it is not medicine your daughter needs. What has your family physician said about this?

M.—Well, be sure, Dr. K—— used to give a great deal of medicine, but lately he has changed; he says, in such cases it is not of much use. All he ordered was some iron pills, as he called them; and he did not seem to make much reckoning of these, either.

D.—I suppose not. He is an intelligent man—a man of great experience; and he knows well that all well-informed physicians have given up the idea of emmenogogues, or medicines, which have a specific effect to bring on the monthly periods. The pills of iron are supposed to be tonic; that is, they invigorate the system somewhat for the time being; but these, even, soon wear out. You have to take more and more of them, until at last they lose their effect altogether; and worse than that, they in the end become debilitating. That is the way with all medicines, not excepting even tonics. Physicians are in the habit of thinking that they must order something from the apothecary’s, even if it is nothing more than bread pills, colored a little, to make them look like medicine. They think they must do something, or else it would not be fair to charge for their visit. Medical men, you know, must live by their profession; and people have not been in the habit of thinking they must pay, unless the doctor does something. For my part, I think that physician deserves the most pay who does the least; that is, who will teach people to cure themselves, and to keep well without medicine.

Thus, you perceive, I advise your daughter to take no medicine. If there were any medicine in the wide world which I thought would do her the least permanent good, I would advise it; but I do not believe there is any such in her case. Correct her habits of life throughout, and then, in due time, nature will of herself make all right. I advise, then, a course something like the following: take your daughter at once from school, no matter if she loses a year from her books. She can practice music somewhat, the best of all her studies, except, perhaps, reading and writing her mother tongue; but I would not have her practice music too much; a half hour or an hour at a time, perseveringly employed, and this two or three times a day, would be sufficient. And if you choose to take up with my plain advice, let her try her hand at the bread-trough and wash-tub. She is getting to be quite along in her teens. Now let her imagine that she were to become the wife of some honest, intelligent countryman—a physician, merchant, or perhaps, best of all, a farmer—no matter what, so that he be a good, honest, industrious, and worthy young man. Suppose, now, that she really loved him, as I am sure she would, although he is not rich, but in moderate circumstances; now, I say, let her imagine that she is going to be a housewife, as well as wife; let her suppose that she is to make his bread, cook his food, clean his house, and do his washing, at least so far as her health would permit, never further; at least we will suppose that she is to understand all of these matters, and that she will habitually oversee them, and take some part therein—we cannot suppose that a house-servant, however good and faithful, will feel so deep an interest in so important a matter as making the family bread, as the wife would. As the wife loves the husband better than all the world besides, so she is the one who is naturally expected to take a deeper interest in all that pertains to his happiness and comfort, and general good. Now, I say, let your daughter practice all these things; for every good and intelligent young lady looks forward—and that with solicitude—to the day when she shall become a wife.

Let her imagine, then, if you please, that she is to be married, and that the husband of her choice is actually poor; and you know every wise and good parent will not ask their daughters, in forming connections of this kind, “Is he rich?” No; but rather, “Is he honest?”—“Is he respectable?”—“Do you love him?” That is all. Leave other matters all to herself. And then, another thing, riches, as we are told, often take wings, and fly away; so that it is better for every one to be independent, and know how to do for themselves. Let my daughter know how to make a living by teaching music, or painting, or drawing, or any thing that is useful and proper; but, first of all, let her know how to make her own clothes, her own bread, and do her own work. Teach these things first to your daughter, and then as much more of science and the fine arts as you can—the more the better, only do not let it interfere with health.

And now, if, in connection with what I have said, I were to advise your daughter a course of water-treatment, physiological treatment, or hygienic treatment, or whatever you please to call it; or what I consider actually best for her case, it would be something like the following: Let her take a packing-sheet, for twenty minutes, early on rising; then a good bath; then a walk, but not too much at first. Let her repeat the same process in the afternoon. Let her walk a great deal in the open air, that she may have the influence of air, the exercise, the light, and the mental impressions caused by a change of objects combined. Thus may she gradually regain her health. And let her, in connection with this, observe all good rules of which I have spoken.

There can be no doubt that retention and suppression of the menses often occur from precociousness—from precocious education and precocious habits. Parents are, I fear, too often in the habit of wishing that their daughters should become young women early. The daughters are often, no doubt, put forward a great deal too much. I have known numbers of instances where little girls, five, six, or seven years of age, have been sent to dancing schools; and are we to suppose that these early imitations of older persons have no injurious effects? True, children are fond of jumping, skipping, and dancing, in their own way; but this being sent regularly to a dancing master, and being allowed to dance with persons much older than themselves, and of the opposite sex, too, will no doubt have an effect in rendering them precocious. I have known such young girls often become very feeble in general health; and when severe disease attacks them they are found much less able to resist it than those who have not been reared in this doll-baby, fashionable style.

I do not deny that young girls should be allowed to indulge freely in their natural and healthful sports. The restraints of womanhood should not be put too soon or too strongly upon them; nor should their minds be overtaxed during the tender age. This is far too common a practice nowadays everywhere. If people but have the means, they seem to vie with each other in endeavoring to make their children precocious, so far as learning is concerned, while the physical training, which, before ten years of age, is far the most important, is almost wholly neglected. Chlorosis and other forms of amenorrhea are, beyond doubt, caused by these unnatural habits in which children are too often reared at the present day.

A sudden suppression of the menses is often caused by taking cold, as we say. A young woman is in the habit of being much confined within doors, and perhaps in poorly-ventilated and overheated rooms; she dresses too tightly, sleeps perhaps on a feather bed and feather pillow; she drinks freely of tea and coffee, as people generally do; eats superfine bread, gravies, flesh-meat, and other forms of stimulating food, and thus she becomes nervous, irritable, variable in her feelings, and highly susceptible to changes of temperature. Now, a young lady living in this manner is invited to an evening party. We will suppose it is in the fall or winter time. In dressing herself for the entertainment, she puts on her thinnest clothing, and in place of her firmer stockings and thick shoes, she puts on very thin and light ones. The party is continued late in the night, for hours beyond the usual bedtime; the room becomes overheated, and in consequence of the numbers present, the air is rendered very foul. At length refreshments are handed around, such as cakes, tea and coffee, nuts, and the like articles, and of these she partakes freely; and among the other excitements, she perhaps, before going home, engages in the dance; she becomes overheated, overexcited, and perhaps starts for home in a perspiration. She is certainly very liable, under such circumstances, to take a cold, which, in many instances, if it does not result in any thing worse, causes a sudden suppression of the menses.

EFFECTS OF DRUG-TREATMENT.

And now, to follow out our imaginary case, how is this young lady to be treated? Do not people generally set at work in such cases with hot drinks, hot baths, and, in short, the heating means generally? And what is the result of such treatment? If it be at all persevered in, the individual is rendered more weak. Such treatment may occasionally succeed; but any and every means of debilitating the system must necessarily render it more liable to a similar attack. But it is also to be observed that such treatment generally fails of its object, and thus, in the end, the patient is certain of being made worse for it.

How came this delusion? How does it happen that people are so much afraid of the cooling and tonic means? It is from a wrong understanding of the nature of the case. In the first place, a cold was taken. This is literally true; cold made a more powerful impression upon the system than it could bear at the time without harm. As a secondary effect, inflammation is the result. In all cases of acute, but sudden suppression of the menses, I conceive that there is more or less inflammation of the womb; and wherever there is inflammation, which always consists in increased heat, the natural discharge cannot go on. Now here, where there is a cold, as we say, which means heat and inflammation, should we apply hot things? Certainly not; but rather cold. And yet I would not use cold too much; never more than the individual can safely bear.

This, then, is the plain treatment for acute suppression of the menses: do all that may be in fortifying the general health of the individual.

If at any time there is shivering, or rigors, apply the rubbing wet-sheet, rubbing briskly over it, and then let the patient go and exercise in the open air. Let her bathe, at least daily, in water tepid, cool, or cold, accordingly as she can bear. A tepid-bath, that is, water from 70 to 80° Fah., is always cooling in effect, it being much cooler than the blood, which, in its natural state, is 98° Fah. She should also wear the wet girdle constantly, changing it at least four times in the twenty-four hours. She should walk out daily and often, but not too far at a time. She should, in short, pursue just such a course as we would in any similar case of debility; and, if necessary, take a full course of water-treatment, such as is suited to the particular case.

I am sorry that some of my younger friends of your sex are in the habit of checking the menstrual discharge for some particular object; but if they could know the great hazard they run in doing so, they would not, I hope, do it. Let me say a few words to them on this subject.

Frank mentions the case of a young lady who put her feet several times in cold water during the flow of her menses, because she expected her lover, which quickly arrested them. An inflammation of the womb followed, and she was brought dying into the hospital, at Vienna.

One of his relatives, of fine health and rare beauty, who, after dancing all night with her menses on her, left the ball-room in full perspiration; she would not wait for a carriage, but proceeded home, which was not far off. She was attacked with inflammation of the womb, and died on the fourth day.

Mr. Brown, a writer in the Edinburgh Medical and Surgical Journal, gives the case of a lady of about forty years of age. She had become very much heated by a long walk in hot weather. At the end of her walk, the menses appeared, but which were entirely suppressed by a drink of cold water. This was followed by headache, oppression, and amaurosis of the left eye. In about six months, Mr. Brown succeeded in restoring the menstrual discharge, at which time, also, her sight fortunately returned to her. The eyes are particularly liable to affections of this kind, arising from a sudden stoppage of the catamenial function; and some have been made blind for life in this way. I hope, therefore, that those for whom I write, both young and old of your sex, will hereby learn to be very cautious in regard to checking the monthly discharge. You see how dangerous it is, and how easy, by carelessness or design, it is to cause it. But, beware!

Shall I again speak of the water-treatment? If you bathe habitually every day; if you are careful to avoid overheated rooms, and becoming too fatigued; if you exercise daily in the open air, and keep yourselves actively engaged in some useful employment, you will have little to fear from the evils of which I have been speaking. But, after reading what I have said, if any of you will persist in taking such a course as will tend to the suppression of the catamenia, or, what is worse, if any of you should dare to put a check to this discharge, when it interferes with your pleasure or convenience, the evil must be upon yourselves, and not upon me. But I hope for better things of you, and that no one will be guilty of designedly or wantonly doing that which can only end in harm.

LETTER VI.
OF MENSTRUATION.

Menorrhagia and Dysmenorrhea—Their Nature and Treatment.

In the present letter I propose giving you some thoughts concerning two other forms of disordered menstruation—I refer to menorrhagia—an immoderate flow of the menses, and dysmenorrhea, by which we understand painful or difficult menstruation. There are few subjects connected with health, which deserve more particular attention, or which are of greater interest to you, than these of which I am now to speak.

Menorrhagia, from two Greek words signifying the menses and to break out, implies, according to common acceptation, either an immoderate flow of the menses, or uterine hemorrhage, which is often a very different thing. It is generally characterized by pains in the loins, small of the back, and abdomen, similar to those of labor. There is always a preternatural flux of either blood or menstrual fluid from the vagina in what is termed menorrhagia.

Dr. Cullen reckoned six varieties of this disease.

1. Menorrhagia rubra, or bloody menorrhagia, from women neither with child nor in childbirth.

2. Menorrhagia alba, or white menorrhagia, which is, in other words, leucorrhea, fluor albus, or the whites.

3. Menorrhagia vitorium, arising from some local disease.

4. Menorrhagia lochialis, or lochial menorrhagia, from women after childbirth.

5. Menorrhagia abortus, or menorrhagia with abortion.

6. Menorrhagia nabothi, when there is a serous or watery discharge from the vagina in pregnant women.

I think it a better mode to treat of menorrhagia according to the original signification of the term, namely, an immoderate flow of the menses. I admit it must, from the nature of the case, be often difficult—indeed impossible—to determine whether a case belongs really to menorrhagia proper, or to hemorrhage from the womb. But the true indications of treatment would be the same in either case, so that a mistake in diagnosis would be of no manner of account in practice. I shall, then, speak of menorrhagia as a separate and distinct disease. I shall use the term simply as meaning an immoderate flow of the menses. Leucorrhea, hemorrhages, abortions, and the lochial discharge, will be spoken of separately. But I admit it must, after all, be a question, whether in all cases of immoderate flow of the menses, there is not actually hemorrhage. It is held by some, that the fluid, or discharge, in menstruation, is never capable of forming clots; in short, that it is in no sense common blood. But we know that in a great number of cases clots are formed. If it is, therefore, true, as some assert, that the menstrual fluid proper never coagulates, then, in all these cases to which I have referred, there must be hemorrhage. I am of the opinion, that the menstrual fluid is capable, in some cases at least, of coagulating like common blood. For all practical purposes then, it will be sufficient to understand by the term menorrhagia, all immoderate menstruation that does not actually amount to a plain and palpable hemorrhage.

Who are the persons that are most subject to menorrhagia? “Women who live indolently and indulge in stimulating articles; who use little or no exercise; who keep late hours; who dance inordinately; who are intemperate; who have borne many children; who have been subject to febrile affections; who have much leucorrhea; who are too prodigal of the joys of wedlock; who are advancing toward the non-menstrual period; who yield too readily to passions or emotions of the mind, are those,” says a distinguished author, “most subject to menorrhagia; to which may also be added, those women whose physical labors are too great, as well as those who have too little labor, are also subject to this disease.”

Menorrhagia, like amenorrhea, indicates a deteriorated state of the general health. A really healthy person can never have the disease, except, possibly, under some peculiar circumstance, for a single time. Real healthy persons, who have no natural impediments, always menstruate regularly.

Treatment.—The general indications of treatment will be inferred from the character of the disease. Do every thing that may be to fortify and invigorate the general health. Every thing that tends to this important object, acts indirectly to effect a cure. This is the only rational mode.

Daily and habitual bathing in water, tepid, cool, or cold, according to the patient’s strength, is a means of wonderful advantage in this disease. The fibers of the system are too lax, so to say; the vessels open too readily, and thus an unnatural discharge takes place. Imagine that you have walked a long way in a hot day: you find the veins of the hands and feet swollen, heated, and enlarged. The tonicity of their coats has become lessened. If a vein were opened under such circumstances, the flowing of blood would be much more free than ordinarily. Now if we wash these parts in which the veins are too much enlarged, we find that the water immediately strengthens them. The unnatural amount of blood is driven back, the vessels again assume their normal condition. Here we find an evidence of the tonic effects of cold water. Tepid water is also tonic, to a greater or less degree, because always cooling. It is on this tonic principle that water acts so favorably in excessive menstruation.

It is to be observed that in menorrhagia there is much less pain than in the opposite state, namely, deficient menstruation.

DYSMENORRHEA.

I next speak of dysmenorrhea, or painful, difficult, or laborious menstruation. This is not only a very common affection, but one of the most painful to which females are subject. Many a woman has spent almost her whole menstrual life with as much pain occurring at each menstrual period, as though labor itself had been passed through. What untold sufferings, alas! are women brought to endure in this disease. Can we for a moment suppose that it is in accordance with the designs of a benevolent Creator, that woman should thus suffer? I answer unhesitatingly, it cannot be. Neither can reason, analogy, or the facts of experience be brought to prove the contrary of my position.

The most prominent and distinctive feature of this disease is the pain. This is experienced mostly in the loins. There may also be pains in the uterus; pains, in short that resemble, both in character and severity, those of actual labor. These become so severe and agonizing, in some cases, as to cause the patient to faint. This affection is one in which not only great suffering is experienced, but is also often one of great obstinacy.

Dysmenorrhea may, for the sake of convenience, be divided into three species:

1. The inflammatory; which occurs in persons of a full, plethoric, and sanguine temperament.

2. The neuralgic; which occurs in persons of a highly excitable temperament, and of a delicate habit of body; and,

3. Where there is a mechanical difficulty to the passage of the menstrual fluid, as, for instance, a closed, or nearly-closed vagina, and a too small opening of the womb.

Those suffering from the first species of the disease are such as are generally too indolent in their habits, and partake too freely of rich and gross articles of food.

The second variety of the disease is often caused by the too free use of narcotics and stimulants, such as tea, coffee, opium, and, in some cases, tobacco; though, to woman’s credit, it is to be said this last article is not much used by them.

The third species may arise from some congenital impediment, or such as existed from birth. In the treatment of this last, mechanical or surgical means may, therefore, not unfrequently be resorted to with benefit.

Females, whether married or single, appear to be equally subject to this disease. In some cases, marriage appears to cure it; in other cases, it would seem that it caused it.

A change of air, such as leaving a city to reside in the country; or perhaps on the contrary, in some cases where persons remove from the country to the city, the affection ceases.

Effects of Pregnancy.—Pregnancy appears sometimes to break in upon the disease, and cure it; but it is far oftener true, that females who suffer from dysmenorrhea, are incapable of conceiving. Oftener, in this disease, there is a too scanty flow of the menstrual discharge. Sometimes, however, it commences with little or no discharge, but ends in a very copious gushing forth of the menses, which brings entire relief from the pain. “A membranous substance, or small coagulum, is discharged; if it be a membranous substance it will be found of unequal size, sometimes small, at other times large; and sometimes it resembles the cavity from which it has been expelled; at other times it will be broken into many fragments. After the expulsion of this substance, the woman enjoys ease, unless there be a fresh production, in which case it requires for its expulsion fresh contractile exertions of the uterus.” Dr. Denman regarded the secretion of this membranous substance as a mark of barrenness, and says that he never knew a female conceive, in whom it was formed. This rule, doubtless, often holds true, but not always, as observation proves.

Causes.—The causes of this disease are plainly the same, or very similar, to those which operate greatly to deteriorate the general health. “It would perhaps be very difficult,” says Dr. Dewees, “to assign all of its remote causes. The most common are the application of cold during the flow of the menses; taking cold after abortion; and in some instances it follows the beginning of marriage; but in other instances the causes are so hidden as not to be cognizable; the married and single are alike subject to it.”

Treatment.—Immense mischief has been done in this disease by the administration of powerful medicines. A disease so obstinate in its nature as often to call forth the greatest endeavors on the part of the physician to cure it, has been combated, in instances innumerable, by the most potent drugs. Nor are these poor suffering patients backward themselves to swallow any opiate, anodyne, or antispasmodic, however powerful and however harmful it might prove to the general system, if there is any prospect of obtaining present relief.

As this is one of the most painful affections to which human nature is subject, I will enter particularly into a consideration of the means to be employed to cure it. We may divide the treatment into two heads:

1. That which relates to the general health; and,

2. That which relates to the time in which pain is experienced.

As to the first of these considerations, all that I have said or can say in these letters respecting the means and modes of improving the general health and stamina of the system, should here be brought to mind. The second of these indications, however—that of relieving pain—I will endeavor to explain fully.

I must tell you that I have studied and practiced the healing art now a considerable number of years. I have endeavored to learn the truth in this important mission of healing the sick. I now, therefore, solemnly declare to you, that in the whole range of the medical art, so far as I have been able to learn it, I know of nothing that excites in my mind a more lively interest, or a more thankful feeling toward the Author of our being, than the adaptation of cold water as a means of relieving the pain and agony which often attend the menstrual period. There is, if I am a judge in this matter, nothing in the whole range of the materia medica, no, nor in all drug substances combined, that can at all compare with the power of this blessed element to assuage pain. But of this I shall speak more, presently.

As a remedy in painful menstruation, Dr. Good recommends “the advantages of traveling, change of air, and new stimulus given to both the mind and body by novelty of scene, novelty of company, amusing and animating conversation, and exercise of various kinds.” “With these,” continues this author, “may also be combined, in the intervals of the menstrual season, and particularly before the discharge has appeared, the use of cold, and especially of sea-bathing.”

Thus it appears that Dr. Good himself entertained the erroneous notion that cold bathing is a dangerous measure at the menstrual period. He observes, however, that “an unnecessary apprehension of catching cold by the employment of this powerful tonic has been entertained by many practitioners;” that with proper care he had never known it occasion this effect; and that it should only be relinquished when no reactive glow succeeds to the chill produced by immersion, and the system is hereby proved to be too debilitated for its use. But in the water-treatment, as you all know, we are not obliged to resort to cold immersion alone; the rubbing wet-sheet is a most excellent application in those cases where the reactive or calorific force is at a low ebb. We can also use tepid ablutions of various kinds with great advantage, under such circumstances—great, not only as regards the patient’s feelings of comfort and strength, but as to cleanliness, which is also an important consideration.

As to the second indication of treatment in these cases, suppose the pain is already upon you. You ask, “What are we to do?” I answer, there are many things, among which are the following:

The rubbing wet-sheet, with a good deal of rubbing and faithfully applied—many times in the whole day if you find need—is one of the best applications.

The wet girdle, likewise, should be kept constantly about the body, and changed as often as the pain requires. Wet compresses about the thighs and below the knees, or about the calves of the legs, are also useful.

The sitting-bath, cold, and sometimes alternating with warm, is also to be employed. If, at the same time, some one rubs the back well with the wet hand, the relief will be more speedy. In very bad cases, when the pain amounts really to a great agony, sitting in a wash-tub, with a couple of pails of cold water in it, at the same time having two or more persons to aid in rubbing the whole surface, if properly persevered in, must sooner or later quell the pain. Possibly, in some cases, it might require an hour or more to effect the desired object. If the patient becomes too much fatigued to continue the half-bath a long time, she can recline in a folded wet-sheet to rest herself, and then afterward proceed again to the bath. Frictions with the wet hand upon the surface, generally have great effect in assuaging pain in these cases.

The folded wet-sheet, that is, a common double sheet of linen, although cotton answers tolerably well, folded once each way, half of it being wet, and applied about the trunk of the body from the arms downward, is a very soothing application in these cases. Applied in this way, two thicknesses of the sheet next to the surface are wet, and the two outer thicknesses are dry. This is a very convenient application, and one great advantage in using a sheet in this way is, that we can open it in front of the body and rewet it, by sprinkling water upon it, without the patient being obliged to rise. If she is able to get up at the time of rewetting the sheet, it is better to do so; but if she is not, it can be done without. A patient may remain many hours in this folded sheet if there is need, a whole night, for example; but she should not allow herself to become too warm in it, as that would weaken the body. According to the season of the year, it should be rewet more or less often, and the patient should have more or less covering as she may feel a need.

The clyster is also a great help in subduing pain in the womb and back. The tepid, or lukewarm, as a general thing, answers best. We use, sometimes, gallons in succession, until the object is brought about.

The foot-bath is likewise a useful remedy. If the feet are cold, they should be put in warm water, the old-fashioned way; but if otherwise, cold answers the purpose best.

Now, it may occur to you, that this kind of treatment, which is so opposed to the old notions, is to be considered as a dangerous one. You know how afraid women are of cold under such circumstances, and how dangerous it is, in fact, to chill the body at certain times. But remember I am speaking of extreme cases of pain. Cold does not injure the body at such times; but, on the contrary, does a great amount of good. You know that if the discharge gets well started in these cases, the pain ceases. Now the cold, instead of checking the discharge, does actually help it to come. The pain, the undue heat in the uterus, the inflammation, as it might almost be styled, is the cause of the discharge not appearing. The application of cold puts a stop to this pain and undue heat, and thus the discharge is helped to come forward.

You will, then, perceive that cold, under circumstances of fatigue and exhaustion, must have a very different effect from what it does when the body is in great pain. In the former case it is highly dangerous; in the latter, highly useful.

But good as cold water is to relieve pain, do not, I beseech you, neglect the means of restoring the general health under these circumstances. It is very foolish, as well as inconsistent, to allow yourselves to go on in habits which your own better judgment must tell you, can only tend to make you worse at the menstrual period. Do not think, that because you have so good a remedy as cold water always at hand, that you can do as you like in regard to self-indulgence.

LETTER VII.
SIGNS OF PREGNANCY.

Importance of the Subject—Difficulties of ascertaining Pregnancy in some Cases—Means by which it is to be Known.

There are some circumstances in which a knowledge of the signs of pregnancy is of very great importance. Dr. Rigby informs us that “there are numerous cases on record where a false diagnosis in women convicted of capital offenses, has led to the most lamentable results, and where dissection of the body after death has shown that she was pregnant.”

Baudelocque, a French writer on the subject, relates the case of a French countess, who was imprisoned during the Revolution, in consequence of being accused of carrying on a treasonable correspondence with her husband, an emigrant. She was ordered to be examined by two of the best midwives in Paris, and they declared her not pregnant. She was accordingly beheaded upon the guillotine, and her body taken to the School of Anatomy, where it was opened by Baudelocque, who found twins in the fifth month of pregnancy.

A great many mistakes of this kind have been made, first and last, in the medical world. Not many months ago, in this city, two eminent practitioners—one of them in particular being one of the most celebrated in the world—had a patient whom it was declared had an internal tumor, from which it would not be possible for her to recover. The physician who attended principally in the case, went often to visit the lady, to crowd up the tumor, as it was called. After a time the physician was sent for early in the morning, to visit the case, as the lady was suffering a good deal of pain. He said he would make it his first visit to see her. On arriving, what must have been his surprise to find his patient already delivered of a fine boy!

The signs of pregnancy, that are very difficult to understand; or, in other words, to ascertain whether a woman is really pregnant in a given case, may be a very difficult matter, if not absolutely an impossible one.

You will agree with me, I am confident, that the old custom of impanneling a jury of twelve matrons, where a court of justice wished to ascertain whether a woman was quick with child or not, was not a good one. If the most experienced physicians and midwives are liable to great mistakes in these matters, how much more so those who have paid little attention to the subject.

But it is my purpose in the present letter to speak of the ordinary signs, changes, and appearances which will usually be found to be accompaniments of this state; and that you will feel a deep interest in the subject, I am already fully aware.

Suppression of the menses, as you well know, is not necessarily a sign of pregnancy. As a rule to which there can be but few exceptions, menstruation and pregnancy do not go on together. Indeed, many writers contend that there can never be menstruation in connection with fecundity. Others assert the contrary. But the rule is, pregnancy and menstruation cannot be present at the same time. But, as we have seen elsewhere, there is often suppression of the menses from various other causes than the one we are now considering.

Nausea, and vomiting in the morning, constitute one of the most common signs of pregnancy; but it is to be remembered also, that, in a considerable proportion of cases, no stomach-sickness, whatever, is experienced. On the other hand, likewise, many persons have nausea and vomiting arising from other causes than pregnancy.

If the child dies in the mother’s womb, it is believed that nausea and vomiting, for the most part, cease immediately.

An irritable state of the stomach is one of the most common symptoms in the early part of this period. The breasts often, at first, grow smaller; after two or three months, they enlarge, and sometimes become painful. A fluid, somewhat resembling milk, only more watery, is not unfrequently observed to ooze from these parts during the early months of gestation. The nipple is seen to be surrounded by a brownish circle; this is at least true in many cases. In the beginning of pregnancy, the abdomen does not necessarily grow larger, as might at first be supposed. Indeed, good authorities assert, that in the commencement of the period, it becomes rather flatter than formerly; and that when it does first increase in size, it is rather from inflation of the bowels, particularly the colon, than from expansion of the uterus. An enlargement of the abdomen may arise from such a variety of causes as the obstruction of the menses, dropsy, diseases of the ovaries, or of the womb. This sign must necessarily always be looked upon with caution, especially in those cases where there is a strong desire for progeny.

I remarked that a fluid resembling milk, is sometimes one of the signs of pregnancy. When this secretion takes place, it is looked upon by many of those who are not well-informed on the subject, as being a certain sign of this state. But it should be remembered, that not unfrequently when the menses cease from some other cause than that of pregnancy, a milky fluid is secreted in the breast. This has been known, likewise, to take place in women who had passed the child-bearing period, in young girls and infants, and even in men. Dr. Dewees gives us a case which is well calculated to impress upon us how careful we should be in forming our judgment in cases of this kind. It is as follows:

“I once knew a considerable quantity of milk form in the breasts of a lady, who, though she had been married a number of years, had never been pregnant, but who, at this time, had been two years separated from her husband. She mentioned the fact of having milk to a female friend, who, from an impression that it augured pregnancy, told it to another friend, as a great secret, who, in her turn, mentioned it to another friend; and thus, after having enlisted fifteen or twenty to help them keep the secret, it got to the ears of the lady’s brother. His surprise was only equalled by his rage; and in a paroxysm he accused his sister, in the most violent and indelicate terms, of incontinency, and menaced her with the most direful vengeance.

“The lady, conscious of her innocence, desired that I should be sent for forthwith, and insisted her brother should not leave the room until I arrived. Some time elapsed before this could be accomplished, as we were several miles from each other, during the yellow fever of 1798. During the whole of this time she bore his threats and revilings with almost exemplary patience and silence. I at length arrived; and, in the presence of the brother and a female friend, she informed me of what I have just stated, and said, her object in sending for me was, to submit to such an examination as I might judge proper to determine whether she were pregnant or not. She would not permit her brother to leave the chamber, and I conducted the examination without his withdrawing. This thing turned out as I had anticipated, from the history given at the moment, of her previous health. I pronounced her not pregnant; and she died in about eight months after of pulmonary consumption, in which disease obstruction of the catamenia is not an unfrequent occurrence.”

Quickening is one of the most unequivocal of the signs of pregnancy. This usually happens about the middle of the period. It may occur, however, as early as three months; not unfrequently, probably, at the end of four months; and sometimes considerably later than the middle of the period, or four and a half months. In quickening, “the motion is first felt in the hypogastrium, and is languid and indistinct, but by degrees it becomes stronger. It is possible for women to mistake the effects of wind for the motions of a child, especially if they have never borne children, and are anxious for a family.” But the sensation produced by wind in the bowels is not confined to one spot, and is very often referred to a part of the abdomen where the motion of a child could not possibly be felt. It must, however, be acknowledged that sometimes a sensation seems to be produced, distant from the uterus, and higher than the child can actually lie. This may be from motion communicated through the folds of the intestines, and the result shows that the woman was not mistaken in her sensation. It is not to be supposed that the child is not alive previous to the period of quickening, though the code of criminal law is absurdly founded on that idea. The child is alive from the first moment that it becomes visible, but the phenomena of life must vary much at different periods. It is seldom felt to move until after the ascent of the uterus out of the pelvis. Does the motion of the child arise from any change of the phenomena of life at that time in the child itself, or from the muscular power becoming stronger, or from the uterus now being in a situation where, there being more sensibility, the motion is better felt? All of these circumstances probably contribute to the sensation, which becomes stronger as the child acquires more vigor, and as the relative proportion of liquor amnii decreases. This fetal motion, however, is not to be confounded with the sensation sometimes felt by the mother, from the uterus rising out of the pelvis, and which precedes the feeling of fluttering.

If this elevation of the fetus takes place suddenly, the sensation accompanying it is pretty strong, and the woman, at the time, often feels sick or faint; and in irritable habits, even an hysterical fit may attend it. From the time when this is felt, women are said to have quickened, and they afterward expect to be conscious of the motion of the child.

The motion of the child, in many, soon increases, and becomes very vigorous; in others, it is languid during the whole of pregnancy; and in a few cases scarcely any motion has been felt, although the child at birth be large and lively. The morning-sickness, and many of the sympathetic effects of pregnancy generally abate after this, and the health improves during the last two quarters.

There is also liability to mistake in regard to quickening, as well as in the other signs of pregnancy. Thus, hysterical persons in particular may feel motions in the bowels, or imagine that they feel them, which they suppose to be the motions of a living child. This is much more apt to occur with those who are very desirous to be pregnant. Other persons also, doubtless, who are not hysterical, may, from flatulency in the bowels, be led into errors in this matter.

In some cases it is probably impossible for the female actually to determine whether pregnancy exists. These cases, however, are exceptions to the rule. As a general thing, there is no difficulty in determining by, or after, the middle of the period, whether a woman is with child.

A manual examination, by a competent physician or midwife, is the most certain test. In ascertaining pregnancy after the middle of the period, there is some liability to error. Practitioners of great experience, as I have before remarked, have made errors in regard to this matter.

Seeing, then, how difficult it is to determine positively beforehand in any case whether pregnancy really exists, you will, I am confident, look charitably upon those who are suspected of this state, without a full and sufficient cause. “It is better that ninety-nine wicked persons should escape, than that one righteous one should be punished.”

LETTER VIII.
DURATION OF PREGNANCY.

Difficulties of Ascertaining it—Rules by which it is to be Known—At what Age can a Fetus Live?

The question relating to the duration of pregnancy is a difficult one. The general belief is, that the term lasts about nine calendar months. We hear spoken of “nine calendar months,” “ten lunar months,” “forty weeks,” or “two hundred and eighty days,” as indicating the length of this period.

It should be recollected, that there may be a material difference between nine calendar months and ten lunar months, as also between nine calendar months and forty weeks. Nine calendar months may fall short of forty weeks by from four to seven days. Thus, it may be two hundred and seventy-three days, two hundred and seventy-four, two hundred and seventy-five, or two hundred and seventy-six days, instead of two hundred and eighty days, or forty weeks.

What are the means by which the true duration of pregnancy, or an approximation thereto, may be established?

1. Cessation of the menses. This is by no means an infallible sign, as every one knows. The menstrual function, as we have already seen, often becomes obstructed from other causes than pregnancy. Conception may take place without the woman being regular. Thus, it may occur some months, even, after the menses have ceased from other causes. If, then, the reckoning should be made to commence at the time when cessation occurred, it would be found very fallacious in many cases. On the other hand, menstruation may occur one or more times after conception has taken place. So, also, it appears to be well established, that pregnancy may occur before menstruation ever appeared with the individual.

2. The period of quickening. This, too, is not a reliable source of reckoning the period of gestation. Quickening sometimes takes place, doubtless, before it is perceived. It takes place, also, at very variable periods, as I have elsewhere remarked; sometimes as early as the third month, sometimes not until the fifth, or, perhaps, the sixth. The range of quickening may be said to extend over a period of at least sixteen weeks. Thus it will appear that this mode of reckoning is by no means to be depended upon, although it often has been.

3. Peculiar sensations soon after conception. Some persons experience peculiar sensations within a day or two after conception. This is not true of every case, nor does the same individual experience these symptoms at each time of pregnancy. At one time she may have them, and at another time not.

4. Nausea and vomiting. These symptoms are too indefinite to enable us to form any just idea of the time when conception takes place. Some individuals do not experience them at all; some experience them very soon, almost immediately after conception; others not until the lapse of weeks, in some cases, probably months.

5. Coition. In the generality of cases it is impossible to know at what precise period pregnancy has commenced, because it is not known when the effectual coition took place. Now and then, however, such cases do occur; and in such instances, which are, on the whole, very rare, we find that the period of pregnancy varies somewhat as to its length.

Another method of reckoning has been to count from the time of the last menstrual discharge. Dr. Merriman, of London, has published a table of the births of 144 mature children, calculated from the day after the last menstruation was perceivable. According to this table

Dr. Guy, of London, gives the following cases:

The results of these cases are as follows:

Thus it is plain that the period of gestation is more variable than some have supposed.

The same thing is also observed in animals, where, in general, a much more true record can be kept, than is possible in regard to the human species. M. Tessier, in France, caused a set of observations to be made on the duration of pregnancy in 160 cows, which commonly go nine months with young. His table is as follows:

There is, as will be seen in this table, a variation of sixty-seven days in the time a cow may carry her young.

A similar variation has been found in mares as cows, respecting the time of gestation. The same author—M. Tessier—made observations which were extended to 102 mares. The shortest period at which they brought forth was two hundred and forty-one days, the longest at three hundred and eight days.

Where there is no knowledge as to the precise time when an impregnation took place—and such is the fact in almost all cases with the human subject—a very good mode of reckoning is this: first ascertain the precise time when the menses last appeared, then reckon two weeks; at which time consider pregnancy as beginning. Nine calendar months, or forty weeks, which may vary somewhat from that period, will be about the time at which labor will ordinarily come on.

Another method is as follows: Quickening takes place at about the twentieth week; add twenty weeks more to the previous time, and we have an approximation to the truth. But, as I have elsewhere shown, the time of quickening is subject to a good deal of variation, namely, from the twelfth to perhaps the thirtieth week.

I think it will seldom be found to happen that labor occurs short of forty weeks, or 280 days, after the last appearance of the menses. But it is not out of place for me to inform you that medical men have varied considerably in regard to the duration of pregnancy. Thus, Dr. Guy has quoted five authorities, of greater or less eminence, to wit:

Sir Charles Clarke; 40 weeks—280 days.

Dr. Blegborough; 39, usually 40 weeks—273–280 days.

Mr. Pennington; 37 weeks; some, 40 weeks—259–280 days.

Dr. Gooch; a day or two before or after nine calendar months—271, 274, 275, or 278 days.

Dr. D. Davis; a day or two under nine calendar months.

The question as to the length of time it is necessary for a child to remain in the mother’s womb, in order to enable it to live, or to render it viable, as the term is, has been a very puzzling one to writers on medical jurisprudence. On this subject, I do not know that I can interest you in any better way than to give you some of the remarkable examples on record which go to establish the point.

“I have seen,” says Belloc, “a girl who, at birth, was only twelve and three quarters inches in length, whose skin was of a marbled redness, whose head was covered with down, whose nails were imperfectly formed, and who altogether bore a close resemblance to a young flayed rabbit. She was fed with the spoon for eight days, because she was unable to suck. Nevertheless, she is not only at the present moment alive, in her seventeenth year, but is likewise an extremely clever, amiable girl, above the middle stature, graceful in figure, and gay in her disposition. The mother could not fix with precision the date of her conception, but was convinced she was not at the term even of seven months. I considered her at six months, at the utmost.”

Dr. Guy, of London, mentions a case given by Dr. Rodman, in which he describes the mother as “more cautious in her decisions, accurate in her observations, and steady in her deportment than what is usually met with in society.” She had borne five children previously, and in this instance “was confident that the period of her gestation was less than nineteen weeks.” Premature labor came on in consequence of fatiguing exertions, and she was delivered of a living male infant.

“Not daring to allow the washing of the infant’s body, he was speedily wiped, and wrapped in flannel, with only an opening in the dress around his mouth for the admission of air; and by the time the dressing was over, the mother was ready to take him into the warm bed with herself. It is common, if there be much apparent weakness, to feed a child the first twelve hours after birth very frequently, yet, in this instance, although the child was weak, no feeding was attempted until beyond that time; the nourishing heat with the mother in bed was relied on. On the following day, the head, body, and extremities of the child were surrounded with fine cotton wool, pressed to appear like cloth, to the thickness of two or three folds, and over that the flannel, as before; and again the child was given to the mother in bed. His vital energy was so deficient, that even with this dress, of himself, he was unable to support the degree of warmth which was necessary to his existence. The heat of a fire was evidently injurious, as he soon became weaker when exposed to it; while the warmth of the mother in bed enlivened and strengthened him. Too much heat induced a sickly paleness of his face, with an obvious expression of uneasiness in his countenance; and the abstraction of heat, even by tardily undressing his head, brought on a nervous affection, or starting of the muscles all over his body. From seeing how these morbid affections were induced, the child was kept regularly and comfortably warm, by the mother and two other females alternately lying in bed with him, for more than two months. After this, he could be left alone from time to time, but was still undressed very cautiously, and only partially at any one time. It was not till the child was three weeks old that the length or weight of the body could be ascertained. The length was found to be thirteen inches, and the weight 1 lb. 13 oz. avoirdupois. It was extremely difficult to get the child to swallow nourishment the first week; the yellow gum soon came on, and the thrush seized him severely on the eighth day, and was not cured till the end of the third week. During the first week, he was fed with toasted loaf bread, boiled with water, sweetened, and strained through fine linen; in the second week, twenty drops of beef tea were added to the two or three tea-spoonsful of his mother’s milk, and in two days afterward he made exertions to suck. His mother’s milk was gradually substituted, at least in part, for the panada, though this was still continued occasionally, with a few drops of port wine. Under this careful management he attained the age of four months, at which time his health and excretory functions were peculiarly regular.”

Dr. Guy has arranged a table showing the lengths and weights of children reported to be born during the fifth and sixth months of gestation, with the assumed age and the probable age, according to estimates and observations which he had made and collected from various authors on the subject. It is as follows:

Thus, it would appear, that it is possible for a child to live when born at about the end of the sixth month of fetal life, and, perhaps, somewhat earlier. But these cases must, I think, be rare, and not according to the general rule.

When a child is born, some idea may be formed respecting its age by the appearance it presents. A description of the signs of maturity and immaturity, founded upon that of two French authors, Foderé and Capuron, will serve to contrast the one with the other.

The signs of maturity are the following:

The ability to cry as soon as the child reaches the atmospheric air, or shortly thereafter, and also to move its limbs with facility, and more or less strength; the body being of a clear red color; the mouth, nostrils, eyelids, and ears perfectly open; the bones of the cranium possessing some solidity, and the fontanelles not far apart; the hair, eyebrows, and nails perfectly developed; the free discharge of the urine and meconium in a few hours after birth; and finally, the power of swallowing and digesting, indicated by its seizing the nipple, or a finger placed in its mouth.

The signs of immaturity, on the other hand, are the following:

The length and volume of the infant—much less than those of an infant in full term; it does not move its members, and makes only feeble motions; it seems unable to suck, and has to be fed artificially; its skin is of an intense red color, and traversed by numerous bluish vessels; the head is covered with a down, and the nails are not formed; the bones of the head are soft, and the fontanelles are widely separated; the eyelids, mouth, and nostrils closed; it sleeps continually, and must be preserved by artificial heat; and, lastly, it discharges its urine and meconium imperfectly, and often after a long interval.

You will, of course, readily comprehend that the appearances of children at birth, even of the same age of fetal life, must be subject to a good deal of variation. Some are much stronger than others, and the size and weight also varies a good deal. At one time a mother may have a very large, strong, and well-formed child, and at another a small and weak one. The size, however, does not determine the healthfulness of a child.

LETTER IX.
MANAGEMENT IN PREGNANCY.

Importance of Attention to the Health at this Period—Clothing, and its Effects—How to Regulate it.

There is, perhaps, no period of life in which the management of the health becomes a matter of more importance than in pregnancy. A little mismanagement here is not unfrequently sufficient to cause the individual life-long suffering and disease. I have known a woman, in the fifth or sixth month of pregnancy, to go to an evening party, become excited and mirthful, remain late at night, eating and drinking, as is customary on such occasions, and perhaps, worst of all for a person in such a condition, engage freely in the dance. Immediately, thereupon, that woman has been taken with uterine hemorrhage, that ended necessarily in abortion, a circumstance always more unfavorable to the constitution than labor itself. I have known such a woman to be not only in a very precarious and dangerous situation at the time, but to experience for many months afterward an extreme prostration of the general health, and an amount of suffering from depression of spirits and nervousness, with all its multitudinous train of ills, which cannot be conceived of only by those who have suffered them. I have known a woman commit imprudences, such as doing a great deal of work at one time, when she was generally indolent in her habits; and thus, by the indolence and overworking alternately, abortion, hemorrhage, attended with fainting—and which has brought her to the very verge of death—has been caused. I have known, too, imprudent women, who, dissatisfied with themselves and their condition, have taken powerful medicines, with the idea of removing their unwelcome obstructions, and thus to bring upon themselves a train of evils and sufferings which have ended only in the sleep of death. I have known, too, women to be exceedingly injured by the gross habits of their prurient husbands during this period. The abominable and disgusting practice to which I here allude is, I fear, exceedingly common. It cannot be too much reprobated or spoken against. He that uses his wife like a brute during this time, is, to say the least, little better than those who go away from home in quest of illicit intercourse.

Women, too, are liable to accidents during this period. I lately had a case in this city (New York), of a strong, healthy woman, who had borne a number of children, and, at about the end of the seventh month, an unfortunate circumstance occurred, in which no person was to blame, and by which she became so much and so suddenly frightened as to be prostrated on her bed for nearly a week. She did not recover the general tone of the system during the remainder of the period; and the day after the birth of the child, it was seized with fits resembling those arising from fright. The child, as well as the mother, was very feeble. By very prudent management, however, both finally recovered.

All great and powerful excitements, whether of mind or body—every thing, in short, that is not consistent with a uniform, even tenor of both mental, moral, or physical life, should, as far as possible, be avoided. If ever woman’s life is to run like the smooth and placid stream, let it be at this time, on which so much, not only of her own health, but that of her offspring, depends.

CLOTHING.

The great advantages to be derived from a proper regard to the wearing apparel in pregnancy, leads me to make in this place some general remarks on the subject, which I shall follow with more special advice in regard to this particular period.

It is an old maxim, that those who accustom themselves to go habitually clad in thin garments are the most hardy, vigorous, and free from disease.

The question then arises, how far is it safe, in each individual case, to diminish the amount of clothing worn?

It is very evident that no great change should be made suddenly.

By practicing the various natural means of hardening the system and invigorating the general health, such as daily bathing, going often into the open air, and avoiding overheated and illy-ventilated rooms, and, in short, pursuing such a course of daily regimen as sound physiology dictates, almost all individuals may very soon bring themselves to need a much less amount of clothing than is usually worn.

At the far-famed hamlet Graefenberg, in Germany, many persons wear very thin clothing, even when the weather is frosty, and the snow deep upon the ground. According to the rules of fashion there, no cravat of any kind need be worn upon the neck. Even the breast may be left exposed, to receive the invigorating effect of the cool, fresh air. It is amusing even, to see there, as I have often done, old men who have become so hardy and vigorous that they could brace themselves up against the snow-storm with bare and uncovered breasts, with a thin coat, and perhaps no vest; and all this with apparent luxury and comfort. It is indeed surprising to witness what habit is sufficient, in a short time, to accomplish in these matters.

LACING.

Some persons seem to suppose, that if they dispense with the words fashion, corsets, stays, and the like, they have nothing more to do in the matter of tight clothing; but it should be remembered, there may be lacing, that is, compression of the body, by other means than mere corsets, corset-strings, and stays. A dress may be so tight—and such there often are—as to lace the body as effectually as if the strings were actually used.

It is to be hoped that the times will, ere long, change; that it will become as fashionable for females to vie with each other as much in possessing a full, plump waist, as it has hitherto been to possess a small one. Why may it not be, and may we not imagine that cotton wadding, etc., may be yet brought into requisition to remedy the forms of nature about the waist, as now in other parts of the body? At any rate, fashion can do any thing; and since it is the order of fashion to change, we may, in time, expect a different state of things.

It is well remarked by Dr. Andrew Combe, that “already sounder views of the nature of the human frame, added to the lamentable lesson of experience, have convinced many mothers that the surest way to deform the figure, and to prevent gracefulness of carriage, is to abolish exercise, and enforce the use of stiff and tight stays; and that the most effectual way to improve both, is to obey the dictates of nature in preference to the inspiration of ignorance. It was not by the use of tight bands and stays that the classic forms of Greece and Rome were fashioned; and if we wish to see these reproduced, we must secure freedom of action for both body and mind, as an indispensable preliminary. If the bodily organization be allowed fair play, the spine will grow up straight and firm, but at the same time graceful and pliant to the will, and the rest of the figure will develop itself with a freedom and elegance unattainable by any artificial means; while the additional advantage will be gained, of the highest degree of health and figure compatible with the nature of the original constitution.”

Let us look at this matter a little more in detail.

1. It is a law of the living body, that in order for easy, healthful, and natural motion to be put forth, no unnatural or artificial pressure must exist.

If we wear a shoe that is too tight, we know how much walking is impeded, that, perhaps, best of all exercises; and that if this pressure be continued for a considerable time, nature revolts at our waywardness, and produces for us a corn. The parts are made to grow out of proportion; the toes crooked, bent, and ugly in appearance.

So, too, if a person wears a tight cravat, we see how soon circulation is impeded, and headache follows.

Compare, too, the breathing of an individual with a full, healthy, and well-expanded chest, that has not been exposed to artificial pressure, with that of a man or a woman which has been for years contracted to the smallest span; the one can scarce mount a flight of stairs for want of breath, while the other can climb the mountain-side, and be but the more invigorated thereby.

2. Pressure upon any part of the system impoverishes that part.

It is said of the Chinese women, that many of them wear shoes so tight that their feet remain as small as in childhood. If a person is in the habit of stooping forward too much, or of leaning against a desk a considerable length of time in the counting-house or at school, we see the chest becomes enfeebled and sunken. The general law is, artificial pressure impoverishes any part of the system to which it is applied.

3. Look at the skin. It is naturally a breathing organ.

If you keep the air from the skin, your system feels smothered. Does not every one know how refreshing it is, on a hot, sultry day, to allow the atmosphere to circulate freely about the surface?

Every lady, however genteel, however pinched up in her fashionableness she may choose to be when she goes out before the world, takes off her clothing from instinct as soon as she is alone by herself again.

Even in cold weather, smothering the skin is productive of uncomfortable sensations; and all persons may observe, that in lying down to sleep by day, with the usual amount of clothing on, they become feverished, unrefreshed, and awake with at least a general lassitude, and very likely with a severe headache, or other uncomfortable feelings of the head. On the other hand, if there is necessity for deep during the day, and the individual lies down with suitable clothing, and yet sufficiently covered to remain comfortable, a refreshing sleep is obtained.

Ladies especially who, from pregnancy or other reasons, have need of their forenoon “naps,” will do well to remember this advice. So also infants should always be undressed when they are allowed to go to sleep. Thus much for the skin as a breathing organ.

4. But perhaps the worst of all physical injuries produced by clothing, is that exerted upon the chest. We read that in the blood of the animal is the life thereof. In the stomach the digestible portions of the crude materials of food are formed into chyme. The chymous mass passes then onward through the pylorus into the duodenum, or second stomach. Here the chyle is formed, which is a step nearer blood than chyme. The lacteals suck up this milk-like fluid called chyle, and carry it into the portal circulation, to commingle with the blood. The blood, in this crude state, is sent to the liver, where a still further purifying process goes on. After this the venous blood passes to the heart, from whence it is sent to the lungs, there to become arterialized, or rendered in its purest state. Thence it passes back again to the left side of the heart, from which it is sent to all parts of the system, to afford life, growth, energy, and strength.

You will now perceive that this blood-restoring process, which, by the wonderful mechanism of nature, goes on in the lungs, is a very important one to the health. Here, in myriads of air-cells contained in the lungs, the surface of which amounts to at least as many superficial inches as the entire external skin, it is purified, and rendered fit for the purposes of life.

We see, too, that when the system is left free to perform its own normal functions, the chest expands freely at every inspiration of air we breathe; and in proportion as this expansion of the chest is full and free, will be the amount of air inspired, and, as a consequence, the amount of oxygen, or the blood-purifying principle, will be proportionately augmented. On the other hand, if, by compression of the chest, the full, free inspiration of air is hindered, less oxygen will be received into the system, and, consequently, the blood will become less pure.

A woman who laces herself tightly about the waist cannot be supposed to breathe hardly more than one half the amount of air she should do. How, then, in the name of common sense, can she expect to enjoy health? Every organ of the human system must be allowed its free exercise, or a deterioration of the general health must be the inevitable result. We might as well expect to have good health with only half the amount of food we should have, as with half the amount of the air we should breathe.

Thus, you perceive, if any unnatural pressure is made upon a part of the system, motion is impeded, and without free motion, health cannot exist; that with such pressure, parts upon which it is made are impoverished; that if clothing is worn too tightly about the body, the breathing function of the skin is hindered, and that debility is the result; that in particular, if the chest is compressed, as is often done by the use of stays and corsets, tight dresses, and the like, that important function of respiration is impeded, and that thus the health must inevitably sink. These principles cannot be too much studied, or too much carried out in practice, in order to secure the firmest and most enduring health.

There are also other ill effects than those we have glanced at that are caused by tight clothing. Thus, in compressing the chest, the abdominal organs are also made to suffer. The functions of the stomach cannot go on properly; the food is not digested as it should be; the liver cannot act freely; the bowels become torpid and constipated; the uterus is pressed out of its place, causing prolapsus uteri, or falling of the womb, as it is called; neither the blood-making, the blood-purifying, nor the blood-distributing processes can go on healthfully. Thus the entire system is made to suffer merely from the pressure made upon the external parts of the body.

Do you ask me, how does all this bear upon the subject of pregnancy? I answer, that if in ordinary states of health, clothing should be of such a character as at all times to allow of the most free and unrestrained movement of every part of the system, how much more important and imperative is this consideration with those in pregnancy. And, accordingly, as is well remarked by Dr. Eberle, “The custom of wearing tightly-laced corsets during gestation, cannot be too severely censured. It must be evident to the plainest understanding, that serious injury to the health of both mother and child must often result from a continued and forcible compression of the abdomen, while nature is at work in gradually enlarging it for the accommodation and development of the fetus. By this unnatural practice, the circulation of the blood throughout the abdomen is impeded: a circumstance which, together with the mechanical compression of the abdominal organs, is peculiarly calculated to give rise to functional disorder of the stomach and liver, as well as the hemorrhoids, uterine hemorrhage, and abortion. The regular nourishment of the fetus, also, is generally impeded in this way: a fact which is frequently verified in the remarkably delicate and emaciated condition of infants born of mothers who have practiced this fashionable folly during gestation. It may be observed, that since the custom of wearing tight-laced corsets has become general among females, certain forms of uterine disease are much more frequent than they were sixteen or eighteen years ago.” Hence, as has been judiciously remarked, “it ought to be the first duty of the young wife, who has reason to believe pregnancy to have commenced, to take special care so to arrange her dress as to admit of the utmost freedom of respiration, and to prevent even the slightest compression of the chest or abdomen.”

If I could write as impressively as I feel earnestly on this subject, how would I warn you, my friends, against the evils of too tight and illy-adapted clothing in pregnancy. How often have I pitied the newly-married woman, who seems really to be under an unavoidable necessity of conforming to fashion—so much are we all of us under the world’s influence—that her health and bodily comfort have been deteriorated and greatly interfered with. How often, too, have I wished that the day might hasten in which there would be a wide and general dissemination of light on this subject, so that people might not only know the truth, but be able to practice it. That such a day is not far distant, I do most confidently hope.

LETTER X.
MANAGEMENT IN PREGNANCY.

Of Solar light—Its Effects on Life and Health—Air and Exercise—Rules of Management.

Among the life agents, solar light is one of the most important.

Anciently the sun was considered as a deity. In most countries it was called the “Supreme Being,” the “Father of Light,” “Jupiter,” “Jehovah,” the “Creator of all living matter,” the “residence of the Most High.”

All nations, in all periods of time, have been impressed with the magnificence and power of the great center of the solar system.

That the sun’s light has a powerful influence on the living body, every one will readily admit. Knowing the reviving influence of a moderate degree of solar heat, the ancients had terraces on their house-tops, called solaria, in which, to use their own expression, they took a solar air-bath.

According to physiological experiments, it has been shown, that if tadpoles be nourished with proper food, and at the same time exposed to the constantly renewed contact of air, so that their respiration may be fully carried on while they remain in their fish-like condition, and, at the same time, be entirely deprived of light, their growth continues, but their metamorphosis into the condition of air-breathing animals is arrested, and they remain in the condition of a large tadpole.

The rapidity with which water-flies, insects, etc., of pools, undergo their transformation, is found to be much influenced by the amount of light to which they are exposed.

If equal numbers of the eggs of the silk-worm be preserved in a dark room, and exposed to common daylight, a much larger portion of the larva are hatched from the latter than the former.

A great variety of facts might be given in proof, that light exercises an important influence over the processes of development in animal life.

“Those who live in mines, or dark caves,” says Dr. Andrew Combe, “and who are rarely exposed to the light of day, present a pale, relaxed, sallowness of skin, which contrasts with the ruddy freshness of country people and others living much in the open air.”

Every one knows how much paler and more delicate those are who remain mostly, or entirely, within doors. The inhabitants of villages, towns, and cities, may often be known by the lighter color and delicacy of skin, which arises from their occupation being more in the shade than that of the country people.

The extreme paleness and depression of the poor population resident in the dark lanes of crowded cities, medical observers have often noticed, as a striking exemplification of the effects of a want of light.

Light is also well known to have a great influence in preventing deformity.

Those who are confined much within doors, or that are brought up in cellars, mines, and the dark places of cities, where the sun can never come, have much oftener deformity of body than such as have free access to the light.

Among those nations that wear but little or no clothing, thus leaving the system more to the influence of light, it is well known that there is a remarkable freedom from this form of disease.

Rickets is much more common in the dark, dirty parts of cities, than elsewhere.

There is, however, of course, in all these instances, other agencies concerned, than mere light. The effects are more or less modified by a variety of causes, as, for instance, the want of a due circulation of pure air in dark and confined places produces debility of the body, which always tends to deformity and disease. But it is demonstrably true, that the want of light is one of the most prominent among the many causes of bodily deformity.

In curing diseases, and the general management of the sick, light, too, is an important agency.

It is said by Sir A. Wilie, who was long at the head of the medical staff in the Russian army, that the cures of disease on the dark side of an extensive barrack at St. Petersburg, have been uniformly, for many years, in the proportion of three to one, to those on the side exposed to strong light.

In one of the London hospitals, with long range of frontage, looking nearly due north and south, it has been said by observers, that a residence in the south wards is much more conducive to the welfare of the patients, than in those on the north side of the building.

Light is a very important matter as regards the health of the eyes.

We find nowhere so much disease of these important organs, as among the poor people who inhabit the dark, filthy, and illy-ventilated portions of large cities.

This is true of infants, who are, more than others, kept within doors. It is, indeed, said, that in a certain dark alley of the city of Boston, infants are not unfrequently born blind.

Fish that live in the pools of the Mammoth Cave, in Kentucky, we are told, have no sight.

Thus, my friends, I have spoken at length on the subject of light; almost more than was necessary, perhaps, you will say. But it is a matter which has not been much spoken of; and this, if there is need, is my excuse.

What practical lessons are we to gather from facts like these?

Shall ladies darken their parlors and sitting-rooms, thus making them more like dungeons than pleasant apartments for use?

Shall they practice reading, sewing, and the like exercises in rooms so poorly lighted that a person coming from the open air can scarcely discern one object from another?

Shall they remain in-doors as much of the time as is possible, lest the light should render their skin of a somewhat less delicate hue?

Shall they, when they must needs come out for a walk, wear a thick, heavy, and perhaps three-double vail, in order to preserve that delicacy, of which women too often appear to be so fond?

Shall they go on thus keeping up this so-called beauty and delicateness, even if it be at the expense of ennui, debility, nervousness, and general ill health?

Or, on the other hand, shall they go often and freely into the open air, walking miles every day; or what is perhaps better, engage in active, and, if possible, out-door pursuits, a part of each day?

In the one case, health is, as a general thing, easy to obtain; in the other, impossible.

As children know by instinct, and physiologists by scientific facts, human beings must go often into the open light of day, in order to insure firm and enduring bodily health.

Nor are the good effects of light less important on the feelings, habits, and mental manifestations of the individual.

AIR AND EXERCISE.

Would that I could now impress upon your minds, in some good degree, the importance of AIR and EXERCISE in pregnancy.

See how well the Indian women get along with child-bearing; and you know they are active in their habits, and go a great deal in the open air.

How well, too, the poor, laboring people, the Irish and the Germans, get along in having children; and are not they obliged to work? Labor! verily thou art a blessing which we poor mortals do but poorly prize!

I must say to you, then, in my humble way, to all of you who are pregnant, DO NOT FAIL TO WORK. Work regularly—not too much at a time, but little and often, avoiding all extremes. Go out, too, EVERY DAY, and get the fresh air and light of heaven. So will you be rewarded for every thing you do.

LETTER XI.
MANAGEMENT IN PREGNANCY.

Of the Diet Proper in this Period—Animal and Vegetable Food—Superiority of the latter—The Drink.

I have in different places, in these letters, made some remarks on the subject of food and drink. I thought it necessary, however, to be a little more explicit on so important a matter.

I have in another letter said some things on the subject of those strange and peculiar longings which women sometimes experience in pregnancy, and have given you some advice on that point, which I wish you also to bear in mind in this place.

Have you not often heard women remark, that when they are pregnant they ought to eat more food than at other times, because they have two to support!

It is my duty to tell you in all frankness, as also earnestness, that if any one makes such a plea an excuse for dietetic indulgence; or if any one, from ignorance on the subject, sets to eating more freely in pregnancy than she would do at ordinary times, she will be very liable to harm herself seriously; and more than that, she may thus actually destroy her child, and have an abortion. If she should be so fortunate as to run clear of this sad evil, she would yet be liable to indigestion, costiveness, diarrhea, and all the long list of troubles that grow out of a disordered state of the stomach and alimentary canal at this period of her life.

Let us make a little calculation in regard to this matter of “having two to support” in pregnancy.

The growth of the fetus, as depending upon the mother, is in proportion to the length of time it is destined to remain in the womb.

In the first place, let us endeavor to ascertain the average weight of infants at birth. I do not know that we have any tables in this country that throw light upon the subject. We can, however, go to France, where the industry of physicians has reduced almost every thing connected with the medical art to figures and rules.

At the L’Hospice de la Maternité, in the city of Paris, the following results were ascertained in regard to 7077 cases of births:

The average weight of children, then, at birth, would appear to be only between six and seven pounds. To make our calculation a safe one, we will suppose the average to be seven pounds.

There is also to be taken into the account the placenta, the membranes, and the liquor amnii, with which the child is surrounded. We may, then, make the following calculation:

The number of days in a normal pregnancy is about two hundred and eighty. Reckoning three meals to a day—and some average more than this number—we have eight hundred and forty meals in the period. Now, according to the rule of three, if eight hundred and forty meals are to produce one hundred and forty-four ounces, how much must one meal produce? The answer, in decimals, is one hundred and seventy-one thousandths of an ounce, and a fraction over, or only a little more than one and one half tenths of an ounce at each meal.

You will then at once perceive how absurd it is for a woman to think that she must cram herself with food when she is pregnant, because of the notion that she has two to eat for instead of but one as at other times.

An intelligent and well-meaning lady of this city, Mrs. Pendleton, once put forth a work entitled, “Childbirth Made Easy.” The theory of the book was given on the authority of some English writers; and the purport of it was, that in order to bear and bring forth a child as easily as possible, the mother should live principally on fruit, more particularly toward the close of the period of gestation. The more substantial forms of food, it was contended, went to make too much bone in the fetus, and hence, that if these were avoided, the bones would be smaller and softer, in which case the birth would be the more easy. The work also recommended the water-treatment, and all other good rules of health.

I have no doubt that such a course of dieting in pregnancy would do a good deal toward mitigating not only the pains, but the dangers of the puerperal state.

The greatest of all dietetic enemies the world over is excess in quantity. You see, then, how admirably this theory would work in practice, although it might be false in real fact.

At any rate, you cannot be too careful of your diet when you are pregnant. There is no period of your lives in which it is more necessary to guard against all error than in this; and excessive alimentation, as I before remarked, is the greatest of all dietetic mistakes. It was one of Jefferson’s great canons of life, that we never repent of having eaten too little. So I will say after him, that I never knew a pregnant woman to suffer from taking too small an amount of nutriment, but I have known many to suffer from eating too much.

I have elsewhere remarked, that the period of pregnancy is necessarily attended by a greater liability to febrile and inflammatory disease than is ordinarily the case. Every one knows—that is, every one who knows any thing at all about the subject—that flesh-meat is more heating and feverish in its tendency than the farinacea and fruits. Mark, then, the evidence of the wisdom and benevolence of the Creator, in taking away, for the most part, your appetite for animal food when you are pregnant. You are more liable to disease at this time than you are at others; and when disease does lay hold, it is more apt to go hard with you. God in His mercy then says, “I will take away the woman’s appetite for flesh when she is pregnant; yea, I will give her nausea, and loathing, and vomiting, for her heart is prone to lead her to excess.”

Do not then, I warn you, eat animal food at this time, even if you should have some appetite for it, as is sometimes the case.

Observe, also, how very sumptuously you may live in the vegetarian way. Indian mush; rye mush; rye and Indian bread; rye bread; corn bread, or Johnny-cake, as it is called in many parts; hominy; cracked wheat; wheaten mush; peas; beans; pumpkins; squashes; melons; apples, green, dried, or otherwise, with a little of milk and eggs, if need be, a little sweet; and a great many other things, which I need not now mention, which you can have according to the season. How well we could live, all of us, if we but would, without causing the farmers to wring the chickens’ necks off, to beat out the brains of the faithful ox and the affectionate cow with an axe, or to cut off the head of the innocent lamb. Do you ever think of these things when you eat meat?

What would you think of a woman who would eat pork meat and pork grease in pregnancy? You have heard a great deal of scrofula—that dreadful disease. In the long catalogue of maladies to which the human body is subject, there is not one more fearful, more dreadful than this. Scrofula is the swine’s disease; and the word is from the Latin scrofa, which means a sow. The swine is, probably, of all living creatures, the most subject to it. Think, then, of a woman’s eating such food when she is performing so important an office in God’s government as that of nourishing within her own body a living child. How much pain, disease, and suffering may she cause by her improper conduct at this time; or, on the other hand, how much happiness and physiological well-being, if she pursues a proper course. “Wisdom’s ways are ways of pleasantness” to her also as to her child.

If it were not wandering to much from the tenor of my subject, I might speak of the cheapness of living on vegetable food.

In this country of abundance we do not often see much misery arising from want of sustenance. Still such things do happen, and now and then in almost every part. True, our charities are munificent, our country fertile, our people industrious, and on the whole, benevolent; yet, there is always room for charity to work in. If we cannot find an object at home, assuredly we can somewhere; and we ought never to be satisfied with our course of self-denial, so long as there is one hungry mouth more in the wide world to fill. I have often thought of these things, I admit, when I have been eating things which I ought not to have eaten. I presume you have done the same thing all of you, for the human heart is as prone to evil as the sparks are to fly upward, or a stone to fall to the ground.

If I could speak a word to a husband through you, on this important matter of diet in pregnancy, I would say to him, “Do not, as you love your wife, tempt her to any excess while she is pregnant. Remember how you loved her when she consented to give you that which was of incomparably more importance to you than the whole world besides, her own faithful, loving heart. Remember, too, how much she is made to suffer on your account. You can aid her by your example, and by your sympathy you can uphold her; but the pains, the agonies, and the perils of childbirth, these all are inevitably hers. I say, therefore, set your wife a good example yourself. If you do not thus aid her, surely as God liveth will you be made to suffer for your evil deeds.”

If you should think that I have, in the course of these letters, harped too much upon the subject of diet, I must ask your indulgence. The importance of the topic, I am sure you will admit; but as to my method of treating it, that is another thing. If you consider that I have made a mistake, that I have taken up too much of your time with that which you, perhaps, already understand, I hope you will set it down against me only as a mistake of the head, and not one of the heart, as the theologians say.

THE DRINK.

It has been a serious question with some, whether man is at all naturally a drinking animal.

Whatever may be the truth in regard to this question, we all know that man does drink, and that a good deal, and too often of things which he ought never to take.

It is admitted, however, that if a person subsists wholly or principally on farinaceous food and fruits, and avoids stimulants of every kind, and all other excesses, leading throughout a regular, sober, and temperate life, he will seldom experience the sensation of thirst, and would then, consequently, not naturally drink. True, water is one of the most important of all life agents—one which will keep an animal alive more than twice as long as he could exist without it; and notwithstanding the fact that the living body is composed of nearly nine tenths of this element, still, under the circumstances which I have supposed, we do not wish to drink because our natural thirst is answered by the pure water that is contained in the food and the fruits we use.

This, then, I consider the better plan: live in a manner so healthful, so temperate that you will need little drink of any kind.

But if you do at any time need fluid internally, why not act in accordance with all experience, all good judgment, all reason, and adhere to the one best of all drinks?

See how the fever patient takes to water; how the animal, and the vermin that have been poisoned with arsenic. See, too, the faithful cow, the horse, and the ox, how they satisfy themselves with this best and most abundant of all beverages when the hot sun comes down them.

I wish that you could all have pure, soft water, both to drink and to cook with; but you cannot, and then you must do the best you can. However, if you will leave off all useless, and worse than useless expenses in your living, you can soon make a cistern and a filter which will give you an abundance of the best of water—that from the clouds. A very little expense and trouble will also serve to construct an ice-house, so that you can have luxury and health combined, although I wish you to remember that ice should be used sparingly, especially if you should become very much heated and fatigued.

When I sat down to write this evening, I thought I should say something on the properties and effects of those almost universally-used articles, tea and coffee. This much I do say, however, you who are pregnant—you who are nursing, and, indeed, all and every one, do as I for these twelve years have done, ESCHEW THEM ALTOGETHER. They are pernicious in a great many respects. Besides this, I advise you to get my worthy friend Dr. Alcott’s excellent work on TEA and COFFEE. If you will but read that, I think you will conclude that it is a great deal better to do as I have done.

Thanks to Father Mathew, and the noble cause of temperance, there is little need of saying much now concerning the evils of tippling, which women were some years ago in the habit of when Dr. Dewees wrote, and against which he said so much. I need not say to you at this late day, that it is a great deal better for you to leave off alcohol in all its forms, and particularly during the period of which we have been speaking.

LETTER XII.
DISORDERS OF PREGNANCY.

Nausea and Vomiting—Means of Prevention, and Cure.

There are a variety of physiological troubles that are connected with pregnancy. True, women do not all experience these, any or all of them; but inasmuch as you are liable to these affections, it is my duty to speak of them. In doing so, I shall class all of these abnormal symptoms under the general head of “disorders,” because I believe that in a truly natural, or, in other words, healthful state of the system, none of these ailments would be experienced.

Nausea and vomiting, as most of you know, and not a few of you by experience—are, in the present state of society, frequent attendants of pregnancy.

These symptoms occur, for the most part, during the earlier months of gestation. They may, however, continue through the whole period, and in some cases they cease and then return again toward the latter part of it.

Most frequently morning-sickness commences from two to three weeks after the beginning of pregnancy. It may, however, come on the very day of, or next after conception, and some women have been able to discover this circumstance by the occurrence of the vomiting which follows it.

This sickness of the stomach is most apt to occur in the morning. Hence it has been called “morning-sickness,” from the fact that it is most apt to take place at this period of the day. This is in part, doubtless, owing to the circumstance of the woman’s getting up at this time, and not to any thing necessarily connected with that part of the twenty-four hours. If she reclines, the sickness leaves her for the most part, but again appears if she attempts to rise.

The matter thrown up from the stomach varies in character in different cases. Much here depends upon the dietetic habits of the individual and the state of the health. It is more commonly a sort of tough, sour mucus; but sometimes there is vomited an extremely acid, thin water, which in some cases is strong enough to excoriate the mouth and set the teeth on edge. Sometimes, too, bile is thrown up with the other matters.

The appetite is apt to become very variable in these cases; often, indeed, there appears to be none at all; at other times the most singular and even disgusting articles are craved for, and not unfrequently that kind of food which we would suppose the worst for the patient proves to be the best, that is, so far as retaining it on the stomach is concerned.

It may appear a strange doctrine to you, that in general those who suffer from nausea, vomiting, and the other more common accompaniments of pregnancy, get along better than those who experience none of these symptoms. “If vomiting should not be violent, and occur only in the early part of the day, though very troublesome,” observes Dr. Denman, “it is so far from being detrimental, that it is generally found to be serviceable, by exciting a more vigorous action of the uterus, and by bringing the stomach into a better state.”

Some have been afraid that vomiting would cause abortion; and such an occurrence might happen, if this symptom were brought on in a violent manner, as by the administration of powerful drugs. But the vomiting which comes on in consequence of the stomach-sickness, instead of causing premature delivery, appears to be a safeguard against such an occurrence. In other words, those who experience nausea and vomiting, are not so liable to miscarry as those who have none of these symptoms.

If we could but take into our minds the whole scope of nature, and if we were able to trace, like the Infinite Mind, causes and effects, we should, doubtless, much oftener than we now are, be struck with the evident goodness of the Creator, even in the physical sufferings which He has made it our lot to endure. What is the office of nausea and vomiting in these cases? It is possible, under bad management, for these symptoms to become actually alarming in their extent. But what, it is well for us to inquire, is the design of these occurrences, so common during the period of gestation? Plainly, to restrain the woman from the gratification of a voracious and wayward appetite, the indulgence of which could but be of material detriment to both mother and child.

How is it in sea-sickness? Do we not find that people who go to sea are generally benefited in health thereby, and that none are so much benefited as those who are made sick? And how are they thus benefited? I answer, by the abstinence and fasting which they are compelled to practice. Almost all persons—all, I will say—have more or less of impurity in their bodies, so badly have we treated ourselves, and so badly do we live. Hence it is that in sea-sickness, and in the vomiting that occurs in pregnancy, benefit is received; the body is made to purify itself by its own inherent power.

If every pregnant woman could have nausea enough, no doctor would ever think of bleeding her; it would prevent all that plethora and fullness of the system which, under such circumstances, have led good and honest men, as well as women, to believe it is often best to abstract blood.

But you ask me, are these symptoms really natural, and intrinsically best for the system in pregnancy? I answer, they are not. I believe it possible so to live that a woman pregnant need not have them any more than any one else. In sea-sickness how is it? The sailors—they who are kept up regularly in the open air every four hours at farthest—never have it to any extent worth speaking of. The first time they go to sea they are apt to be sick, like other people; but in a day or two it is all gone—they work it off.

So, too, in the sickness of pregnancy. We never hear of the Indian women having it. They, likewise, are active in their habits, live plainly, and go often into the open air.

One of the most important things to observe in these cases is, not to eat too much, or at wrong times. A great many patients of this kind make sad work with themselves by eating all sorts of things for which they have a relish, and at all hours of the day, just as the fit happens to take them. We know full well how important it is to eat regularly when we are in health. How much more so, then, must it be when we are ill! If you have nausea, or if you have not, but no appetite, drink some pure cold water, and wait; the appetite will come.

It is really surprising to see on how small a portion of food a patient can subsist for many days.

The laboring classes—those who are compelled to work hard, whether they would or not, and who are obliged, in consequence of the iron hand of poverty being upon them, to live on plain, homely fare—they are not troubled with nausea and vomiting, as the idlers and the luxurious are.

You will naturally expect me to speak of the professional treatment for these troubles; and in regard to this, I remark, there are a great many things to be taken into the account. You cannot well know too much in regard to all the means of improving the general health.

The nausea is the most distressing part of morning-sickness, as it also is of sea-sickness. In the former, as in the latter, it is one of the most comforting things that can be done—the most comforting, rather—to take a good draught of pure, soft water, at about the blood temperature. If enough is taken it causes vomiting, which at once brings relief; but if the stomach should not thus be excited to an inverted action, the water will yet do good, as it tends to “settle the stomach,” and this of itself brings a good deal of relief, although not so much as actual vomiting would do.

Some may tell you that vomiting is dangerous in pregnancy—that it is liable to cause abortion. So it is, as I have before said, if it is rendered very violent by the giving of powerful drugs. But any thing like a reasonable emetic, even of the drug kind, is comparatively safe in this respect; so much so, that the most experienced and most honest physicians are not now afraid to vomit a pregnant patient, if they consider it important to resort to that measure. Emetics of the drug kind have even been used, and apparently with good success, as a cure of the nausea of which I have been speaking.

But do not understand me as recommending vomiting, even by water, the best and mildest of all emetics, except in cases of urgency, and when it can be made to take place without great straining or effort. As a general thing it is far better to fast.

I do not know of any thing in which physicians have been more puzzled than in the treatment of these symptoms. They have left nothing in the materia medica untried. The result is, however, that no plan has yet been fixed upon as being a legitimate one, or one that can be depended upon with any tolerable chance of success. Patients have sometimes died of the exhaustion caused by the vomiting, as has been supposed; but I am more inclined to think they have far oftener been drugged to death. It is mostly in the hospitals that these deaths have occurred, and there, as you know, there is great temptation for experimenting. Young physicians are there allowed to make experiments; and there the older ones are also too much tempted to do as they would not wish to be done by.

Physicians have been so much thwarted in these cases, that they have often recommended bringing on premature delivery, fearing that the patient would be destroyed if they did not resort to this dreadful expedient. Most of them, I have no doubt, have acted honestly in these dreadful emergencies. It is to their credit that they seldom, if ever, have resorted to premature delivery without first having counsel on the subject.

I have already hinted that exercise and activity are great helps in keeping off those troubles that so often occur with the pregnant. I would repeat, BE ACTIVE. Do not let a day, a half day, nor even an hour pass over without your doing something. Be active, regularly, habitually active. Let this be your motto, and your practice, too.

I must tell you also that water-treatment is a most useful help. Take the rubbing wet-sheet when you feel so badly, and see how great a change it will work. Wear the wet girdle, and take the cold hip-bath, not too long at a time, if necessary. I do not know that I can recommend eating ice, as some have done; yet it has sometimes appeared to act very favorably, and great quantities have been used by some in this way, without any apparent harm.

The cold water injections are much to be recommended in cases of costiveness, which often occurs in connection with the vomiting.

LETTER XIII.
DISORDERS OF PREGNANCY.

Fainting—Its Causes—Symptoms—Results—Treatment.

Fainting sometimes happens in pregnancy, even with those who are not subject to it at other times. It is more apt to occur at or about the time of quickening. Some persons are very subject to it, from very slight causes, during the whole period of pregnancy; others experience it only occasionally; and some have it repeatedly, and some periodically. It is more commonly the weakly and delicate who are thus attacked; but some healthy females are subject to it. It happens with some every month periodically, with others every week, and in some cases every two or three days, or even oftener.

Causes.—Fainting in pregnancy is often excited by the first movements of the child, even while they are weak, and by subsequent ones when strong. It is sometimes a consequence of palpitation, or derangement of the heart’s action and of the circulation. Too great exercise of either mind or body, want of exercise and employment, violent mental emotions, running too quickly up stairs, want of sleep, offensive sights and odors, overeating, and too great heat in the apartment—each of these may bring on fainting in pregnancy. Dr. Campbell observes, “As in the gravid (pregnant) state, fainting seizes individuals so suddenly, and that, too, while they are in perfect health, it is difficult, more especially in the early months, to account for it, since the uterus at this period cannot, from its bulk, produce any interruption or irregularity in the circulation of the heart or larger vessels. The womb, however, may influence the heart in another, viz., through the medium of the nerves, whereby irregularity of its action, as often happens from a similar cause on other occasions, is produced; this inordinate action may lead to some irregular distribution of the blood in the cerebral vessels, and hence fainting.”

Symptoms.—The patient experiences a feeling of langour, weariness, and weakness, and there is a frequent inclination to yawn or sigh; the sight becomes dim; surrounding objects appear to turn round; specks float before the eyes; there is a ringing or buzzing in the ears; the face becomes pale, and thus the patient becomes faint and insensible. The premonitory symptoms, if any appear, are sometimes so rapid in their course, that the patient is unable to call attention to them.

During the fit there is no pulsation at the wrists; the heart beats but faintly; breathing is nearly suspended; the muscles lose their power, and a cold sweat breaks out over the surface. But there is no convulsive motions of the limbs, nor any frothing at the mouth, in a case of simple fainting.

This condition of things may last only a few minutes, or for several hours. When the fit begins to pass off, respiration becomes more distinct, the patient utters a few long-drawn sighs, the heart begins to act with more energy, the pulse at the wrist becomes more perceptible, some color appears in the face, and the consciousness is again restored. In some cases consciousness is not entirely lost, and in some it is long before it is fully regained.

“There is a species of syncope,” says Dr. Burns, “that I have oftener than once found to prove fatal in the early stage of pregnancy, dependent, I apprehend, on organic affections of the uterus; that viscus being enlarged, or otherwise diseased, though, perhaps, so slightly, as not previously to give rise to any troublesome, far less, pathognomonic symptoms. Although I have met with this fatal termination most frequently in the early stage, yet I have also seen it take place so late as the sixth month of pregnancy.”

Cases of organic disease of the heart, however, are rare, so that you ought not to think, at every little fainting spell you may experience, that you have a disease of this organ. If in the syncope there is convulsive motion of the limbs, distortion of the features, and frothing at the mouth, it is only a hysterical spasm.

If fainting happens most toward the close of pregnancy, it is to be regarded with more suspicion, according to the opinions of some authors; not so much, however, for the immediate consequences, as for its effect upon the convalescence after parturition.

This symptom sometimes occurs in consequence of an internal hemorrhage, in which case it is generally never prolonged, accompanied with fullness and tension of the abdomen, dull pain and weight in the pelvic region, permanent blanching of the surface, and after a short time a discharge of blood from the vagina.

Results.—In fainting, the circulation becomes for the time almost suspended. When, therefore, we consider the dependence of the fetus upon the maternal circulation, we cannot suppose that its frequent recurrence is wholly innocuous to the child. Occasional fits of syncope, however, appear to do no harm to the fetus; and yet it is always best to avoid the occurrence as much as possible. It has been known to cause abortion when it has been often repeated.

Treatment.—The patient should, during the fit, be placed in the most comfortable posture, the recumbent being the best, the head at the same time being laid rather low, and, if possible, where a current of cool or cold air can be made to blow over it, particularly upon the face; sprinkling cold water in the face, and washing and rubbing the face and hands in cold water are useful measures. In some cases it would be also advisable, or rather necessary, to wash and rub the whole surface.

A full injection of tepid water will aid materially in bringing about consciousness and circulation in these cases.

This water-treatment is incomparably better than that which is usually adopted, such as giving the patient wine, brandy, spirits, carbonate of ammonia, etc.

It generally happens that people themselves, without the aid of the physician, have to manage cases of syncope. This they can readily enough do as a general thing; but if it should prove at all persistent or troublesome, they should lose no time in getting the best medical advice they can obtain.

Prevention.—Every thing should be done that may be to restore the general health. Oftener by far than otherwise, fainting is purely a symptom of debility. This fact of itself suggests the measures that should be adopted in order to ward off the attacks.

LETTER XIV.
DISORDERS OF PREGNANCY.

Abortion—Its Nature and Ill Effects—Its Causes—Means of Prevention.

Abortions are evidently not in the order of nature. We see in the animal kingdom that, as a general fact, gestation everywhere goes on to its full and normal period; that abortions are very rarely indeed seen; but when we come to consider the animal man, we find a different state of things. With man, and man only, abortions are frequent.

Certain classes of females are more subject to abortion than others. Fleshy or excessively fat women, and those who experience excessive menstruation; those who are hysterical, nervous, irritable, or excessively sensitive; those who have a very fair complexion, and are rickety, scrofulous, or have any other taint of the general system; those who have dropsy, or are affected with cancers; those who drink tea and coffee freely, and eat habitually highly concentrated and stimulating food; those who live a life of excitement, frequenting balls, parties, and theaters late at night; those who are in the habit of much novel reading, and perhaps, above all, those who, in connection with their sensual and worse than brutish husbands, abuse the marital privileges, are most apt to abortion. If husbands have any regard for the physical welfare of either their wives or offspring, or even their own health, let them refrain from all sexual indulgences during the period of the wife’s pregnancy. Dr. Edward Baynard, a quaint but able English writer, one hundred and fifty years ago, in speaking of the evil effects of swathing and dressing infants too tightly, indulged in the following reflections: “’Tis a great shame that greater care is not taken in so weighty an affair, as is the birth and breeding of that noble creature, man; and, considering this stupid and supine negligence, I have often wondered that there are so many men as there are in the world; for what by abortions, too often caused by the unseasonable, too frequent, and boisterous drunken addresses of the husband to the wife, when young with child, and her high feeding, spiced meats, soups, and sauces, which, with strait lacings, dancings, and the like, one full half of the men begotten are destroyed in the shell, squabbed in the nest, murdered in embryo, and never see light; and half of the other half are overlaid, poisoned by ill food, and killed at nurse,” etc.

Terror, fright, and excessive fatigue, also, not unfrequently cause abortion. All unpleasant sights, and all undue mental excitements, should be, as far as possible, avoided by those who are pregnant.

There are vile books in circulation, sold too, sometimes, by highly respectable booksellers, in which the writers affirm that abortion can be produced without any harm to the constitution. There is one physician in this city, whose book we saw a few days since in a bookstore in the city of Boston, in which he proposes to effect abortion with perfect safety; but, for the package of medicine, a fee of ten dollars must be sent, of course, in advance. It may be of service to some who may peruse these pages, for me to inform them, that there is always great danger in causing the expulsion of the fetus. The most powerful medicines for this purpose are often known to fail. Gastritis, enteritis, peritonitis, and death itself, has been caused by medication, without causing the intended abortion. And in those cases where the desired object is by chance brought about, sad is it to think, what for years must be the health. Even life-long misery and suffering have often been caused by drugging the system to produce abortion.

You have read those lines of Ovid, which Dryden gives us:

“But righteous vengeance of their crimes pursues,

And they are lost themselves who would their children lose,

The poisonous drugs, with mortal juices fill

Their veins, and undesigned themselves they kill.

Themselves upon the bier are breathless borne

With hair tied up, which was in ringlets worn.”

Women cannot be too careful of their bodily health during the period of pregnancy. If they would avoid, among a multitude of evils, the great misfortune of abortion, they cannot be too vigilant, and watchful, and careful in all matters pertaining to health at this time. Any imprudence here, such as would scarcely be noticed at other times, may lay the foundation for much future suffering.

I am here led to remark, that too much labor and exercise, as well as idleness and habits of effeminacy generally, in this hard-working country of ours, not unfrequently cause this evil. Lazy people do habitually too little; industrious people often too much.

It appears that abortions are becoming more and more frequent in this country at the present day. It is notorious that the habits of Americans are not now as simple as they formerly were. More tea and coffee are drank, more rich and stimulating food is used, and there is a vast deal more idleness withal. Formerly labor was more dignified, more respected; but labor now is degrading. It is not fashionable to spin, weave, knit, sew, wash, and to make bread, as in the good days of our grandmothers. People are everywhere growing more indolent. “The sluggard will not plow by reason of the cold; he shall, therefore, beg in harvest, and have nothing.” So, also, those who will not employ the limbs and muscles which God has given them for use, cannot have permanent and enduring health at any price.

But it is asked, Would you pay all attention to physical culture, and neglect the mental? I answer, no. I would have my daughters taught music, painting, drawing, as well as science generally, but on no account would I do this at the expense of bodily health. Nor is there any need of this; the highest possible cultivation of the mental manifestations can only be accomplished when the physical powers are suitably and proportionably developed to their fullest extent. “A sound mind in a sound body, is nature’s inevitable law.” There is yet one evil pertaining to the subject of abortion, an increasing one too, in some parts of our country at least, of which I should speak.

Abortion, it will thus be seen, is a serious evil. Its consequences may, in general terms, be condensed as follows:

1. A stronger tendency to a recurrence of the evil. Those who miscarry once are much more apt to do so again.

2. Menorrhagia, or an immoderate flow of the menses.

3. Irregularity of the monthly periods; these occurring either too often or too seldom, and attended with much prostration of the general health.

4. Dysmenorrhea, or painful, laborious menstruation, accompanied often with more pain and suffering than attend labor itself.

5. Hysteria, or hysterics, depression of spirits, disquietude, dissatisfaction with life, its pursuits, pleasures, and enjoyments, and an habitual melancholic state of mind.

6. Dyspepsia, with all its train of pains and penalties. This picture, terrible as it may appear, is no imaginary one. Every well-informed physician will at once recognize the truth of all that has been affirmed. It is a bad state of the system which allows of abortion. One abortion ordinarily is far more trying and worse upon the constitution, than two labors at full term.

Means of Prevention.—In speaking of the evils of abortion, the means of preventing such an occurrence have necessarily been hinted at. There are yet other things, however, which should be referred to on this subject.

It will naturally suggest itself to every reflecting mind, that the great object to be attained in regard to the prevention of abortion, is a thorough, habitual, and permanent cultivation of the physical powers. Invigorate the general system to its fullest extent; accomplish this, not only for a single time, but, as it were, perpetually, by daily and never-ceasing effort. Is not health the greatest of all earthly blessings? How, then, in order to secure it, can we do or sacrifice too much?

In reference to the prevention of abortion, let the following particulars be observed:

1. The use of cold water. In all cases of abortion there is too great laxity of the system; there is a want of tonicity, so to say; the fibers are, as it were, unstrung. Cold bathing, for its tonic, constringing, and invigorating effect, has for centuries been recommended as a most valuable means of preventing this evil. In pregnancy, the same general principles should be observed in fortifying and invigorating the general health as at other times. No violence should be done to the system. A general bath in the morning, cool or cold, according to the individual’s strength; a hip or sitz-bath of five or ten minutes’ duration, two or three times during the day, and an ablution with water, not too cold, on going to rest, will ordinarily be sufficient for the daily routine of treatment in those cases where there is tendency to abortion; such a course is, in fact, good at all times. The wet girdle, elsewhere explained, will often be of advantage; but to make it a tonic or strengthening application, as it should always be under these circumstances, great care must be taken that it does not become too warm. This is very apt to be the case in hot weather. It must then be changed often and rewet. If it becomes too hot, it weakens the system instead of strengthening it, thus tending to cause the very difficulty it is intended to prevent. “Injecting cold water into the vagina twice or thrice a day,” says Dr. Burns, in his work on midwifery, “has often a good effect, at the same time that we continue the shower-bath.” And this writer also observes, “that when there is much aching pain in the back, it is of service to apply cloths to it, dipped in cold water, or gently to dash cold water on it, or employ a partial shower-bath, by means of a small watering can.” Water, let it be remembered, is the greatest of all tonics to the living system.

2. Feather beds and overheated rooms. These have much to do in causing abortions. People ought never to sleep on a feather bed, unless, possibly, very old and feeble persons, who have long been accustomed to them. In such cases it might not always be safe to make a change in cold weather suddenly. But for a pregnant woman to sleep on a feather bed is one of the worst of practices. And here also I must mention that feather pillows, as well as feather beds, do a great amount of harm. Even those who have emancipated themselves from the evils of feather beds usually retain the feather pillow. It is a wise old maxim, “to keep the head cool.” The head has blood enough, more than any other part of the system, to keep it warm. No person, not even the youngest infant, should ever sleep on a bed or pillow made of feathers. The animal effluvia coming from them is bad, and the too great amount of heat retained about the surface debilitates the system in every respect.

3. Undue mental excitements. Let those who are pregnant avoid theaters, balls, and parties late at night, all highly excitable public meetings, whether literary, political, or religious, and all undue mental and moral excitements of whatever kind. In no situation is it more necessary for a human being to maintain a pleasant, consistent, and equable frame of mind, and good and permanent health of body, than in pregnancy.

4. Sexual indulgences. The more strictly chaste and free from sexual indulgences, the better for the woman during pregnancy.

5. Recurrence of abortion. Every succeeding miscarriage is more apt to be followed by a recurrence of the evil; the body, as it were, like the mind, is capable of getting into bad habits. Those who have abortion oftenest are most liable to their recurrence; and every attack is more apt to be worse than the preceding one.

6. General health. Abortion always indicates a bad state of the system generally. A person of really good health could scarcely have abortion. Possibly fright, unpleasant occurrences, or accidents, might cause such a result. Abortion always injures the general health. Labor at full term is natural, and is therefore attended with less danger. Abortions are unnatural.

7. Vegetable diet. This was observed by the celebrated Dr. Cheyne, of England, to have a great influence in preventing abortion; milk, however, which is in some sense a form of animal food, was generally used. A total milk and seed diet, as Dr. Cheyne terms it, was a most excellent means of preventing unfertility and abortion.

8. Tea, coffee, and spices. All stimulants, that is, articles which do not go to nourish the system, such as tea, coffee, tobacco, wine, porter, spirits, and the like, should be strictly avoided. All stimulation of the system is followed, necessarily, by commensurate depression. A person takes a stimulant, and feels better for the time. In the same proportion as the stimulation will be the consequent depression. The more a stimulant is used, the more necessity will there be to keep up the habit; and the more the habit is followed, the weaker does the system become. Thus in pregnancy, by the use of stimulation, the system becomes more liable to abortion.

9. Exercise. More than one hundred years ago, the celebrated Dr. Cheyne remarked, concerning abortion and its causes, as follows: “It is a vulgar error to confine tender-breeding women to their chambers, couches, or beds, during all the time of their pregnancy. This is one of the readiest ways to make them miscarry. It is like the common advice of some unskillful persons to such as have anasarcous or dropsical legs; namely, to keep them up in chairs, on a level with their seats, which is the ready way to throw up the humors into their bowels, and fix them there. The only solid and certain way to prevent miscarriage, is to pursue all those means and methods that are the likeliest to procure or promote good health, of which air and gentle exercise are one of the principal. All violence or excesses of every kind are to be carefully avoided by the parturient; but fresh air, gentle exercise, walking, being carried in a sedan or chaise on even ground, is as necessary as food or rest, and therefore is never to be omitted, when the season will permit, by tender breeders.”

In my next letter I shall speak in detail concerning the special treatment that should be adopted in these cases.

LETTER XV.
DISORDERS OF PREGNANCY.

The Evils of Abortion—The great Danger of bringing it on purposely—Cases—Illustrations of the Methods of Cure—Uterine Hemorrhage—Cases of Cure.

In the summer of 1849, walking down the Bowery, in the city of New York, I fell in company with a lady whom I had attended in childbirth, some three years previously. She was of middling stature, and I should judge twenty-five or six years of age. She said she had been for some time desiring to speak to me concerning her health. Since the birth of her last child she had a number of times experienced abortion, at three or four months from the commencement of pregnancy. She could not understand why it should be so; she was tolerably careful in diet, and bathed, to some extent, daily. She was, perhaps, in her husband’s store too much of the time, standing upon her feet, waiting upon customers, etc. Formerly she was a great walker, and could endure a good deal of fatigue, but latterly she was becoming less and less able to take long walks. She soon became fatigued, whereas, formerly, she could go to almost any extent in pedestrian exercise. The question was, how to avoid these abortions and their ill consequences. I gave her advice concerning diet, bathing, exercise, etc., and the next day wrote her husband substantially as follows:

“Dear Sir—Your very worthy wife inquired of me yesterday what she should do in reference to preventing abortions, to which she is of late growing subject. I advised her the following treatment:

“1. Perform thorough ablution on rising in the morning. Drink some water, and walk in the open air, but not so much as to induce great fatigue. Housework is very good, but going into the open air, an hour or thereabout before dinner, will be better.

“2. Take the rubbing wet-sheet, and after it the sitting-bath ten minutes. Take also some kind of exercise before and after this bath.

“3. In the afternoon practice the same thing as in the forenoon.

“4. The rubbing wet-sheet on going to rest.

“5. It is very important that due attention be paid to diet. She should eat no meat, butter, and as little sweet as possible. Rice, brown bread, Indian mush, hominy or samp, potatoes, good fruits, and milk—these are the best articles for her.

“6. In addition to the above advice which I gave to your wife, there is a very important matter to be observed. Do you not practice too frequent cohabitation with her? This is, perhaps, of all, the most prominent among the causes of abortion. Taking a survey of the animal kingdom, we observe it to be a law, that animals do not cohabit during the period of pregnancy.

“Knowing that you are a kind and good-hearted husband and desire the best good of your wife, I take the liberty of submitting to you the following rules, which, I am confident, you will agree with me will be safe:

“1. Always sleep separately for six months at least, and twelve would be better. By that time we have every reason to believe your wife will enjoy her natural health.

“2. Suppose that after these six or twelve months, pregnancy again occurs, sleep then again separately during the entire period, and at the same time let your wife follow a similar course in water, diet, exercise, etc., to that I have above recommended.

“Then will she be able to prevent those disastrous consequences of frequent abortion.”

Case II.—In the spring of 1845, I was called upon by a gentleman and his lady for advice in regard to herself, she being then at about the middle of the term of pregnancy. She was threatened, as she believed, frequently with abortion. The year previously she had had a bad miscarriage, which was occasioned by a fall. She was of scrofulous habit of body, and had borne already seven or eight children, a number of whom had died.

I directed the patient to practice general ablution two or three times daily, with hip-baths of short duration, to exercise in the open air, and ride frequently, according as she could bear; but to be careful never to do too much at a time. A little overdoing would be liable to cause the difficulty with which she was threatened. The strictest care in diet I strongly advised her to observe.

She went on faithfully in the fulfillment of these directions, and about the end of the month of August, in exceedingly hot weather, she gave birth to her child. She followed the water-treatment resolutely, according to my directions, and in ten days was able to enjoy very long walks in the city. Twice she has been pregnant since that time; and at the time of writing this, has gone to the eighth month without experiencing any symptoms of abortion.

I should remark, this lady had frequently had miscarriages before the one above referred to.

Case III.—A very small, delicate, young woman, of this city, being about seven months advanced in pregnancy, went to an evening party, at which she danced. Being very fond of that exercise, she, no doubt, overdid the matter. Indeed, dancing at all in that condition is rather a hazardous experiment. Abortion came on, attended with a great deal of prostration. Water-treatment was practiced in this case, and she recovered as well as could be expected. She felt very sad at thus having lost her child, and resolved for the future to do better. Since that she has succeeded in bringing forth a tolerably healthy offspring.

Case IV.—I knew, some years since, a young married lady, in the city of Boston, who was much addicted to novel reading, and going to balls, theaters, parties, etc., at night. She walked a long way one very hot, sultry night in midsummer, and became overheated and fatigued. On arriving home she commenced bleeding, which became so severe that before a physician could be obtained she fainted many times, and apparently came very near losing her life.

Case V.—I recollect a case which occurred some years ago—one, indeed, which I shall not soon forget, because of the fatigue and anxiety it caused me. A gentleman came after me in the night time, telling me that his wife was bleeding, and had already bled to such an extent that he believed she would be dead before I could get to her. On arriving at the house, I found she had fainted many times, and that she had bled enormously, and even then there was no amendment of the symptoms. I do not know that I ever saw a person apparently so near death from hemorrhage as this lady, and yet recover. I had to remain with her almost constantly for two days and nights, before she appeared to be at all safe.

Years afterward, this lady gave me the following information respecting the cause of that frightful abortion:

Suspecting that she had become pregnant, and much against her inclination at the time, she resolved upon procuring an abortion. Pregnancy, she said, at that time would interfere very much with her comfort, arrangements, etc. She consulted a lady-clairvoyant in reference to the matter. The clairvoyant could not even tell her whether pregnancy existed or not; but to make safe in the matter, she ordered some vegetable teas to be drank in large quantities, which she said would expel the fetus, if one existed. She thus went on for some time. Her general health became deranged by the dosing, and yet no abortion was procured. Afterward, more powerful medicines were directed by the clairvoyant. These she found were at length making great mischief with her health; her stomach became very much deranged, and a regular tertian intermittent set in, yet no abortion came on.

At length, one day her children fell down stairs. Hearing them, she ran down two flights with the greatest precipitation, and as if she were in no sense delicate in health. This, together with the fright she experienced, prostrated her system very much, caused a great trembling to come over her, which soon resulted in the miscarriage I have referred to.

It was a long time—many months—before this patient recovered any thing like her former health. She was low-spirited, dull, inactive, and could take no comfort of life.

Case VI.—Two years after this the same lady was again pregnant. One day she did a very large washing, together with other kinds of work, and became much exhausted. This, again, brought on miscarriage, attended with fearful bleeding as before. A resolute course of treatment was practiced, and thus she was again rescued from danger; but such attacks are always worse than labor at full time.

Case VII.—While I have been writing and arranging these letters, I have been called to visit a lady who has been pregnant a few weeks the second time. Her first child has been somewhat ill from teething—in fact, a good deal sick for some days and nights, and taking care of him, bathing, dressing, applying the bandages, etc., to him, has made her quite weak. Two or three days ago, her husband was gone from home of an evening, and being a very punctual man in such matters, as all good husbands are, his wife expected him home early. He was, however, hindered beyond his time. This caused her a good deal of anxiety, although he had a friend with him. Soon after his return, bearing-down pains came on, and some discharge. Afterward she got better, and then in a day or two much worse. The mother-in-law gave her gin, the old-fashioned way to help on the courses, not believing, I suppose, that she was pregnant. But nature did better than the dosing; it would not let her abort. About this time I was sent for, whereupon I told her to keep pretty quiet, put on a heavy wet girdle, and change it as often as she felt bearing-down pain—every hour or two, at farthest. The cloth worn upon the genitals, under such circumstances, was also to be kept wet in cold water. But first of all, she was to take a good washing by sitting before a fire in a wash-tub, with tepid water, but not quite warm. This gave her a good deal of relief. In the morning I found her quite well, and free from pain and discharge.

It is far from being my wish, by any of these letters, to fill your minds with unpleasant thoughts or ideas of horror. But it occurred to me that you were, perhaps, many of you not aware that there are vile persons in our great cities who make it a regular business to procure abortions. Now I need not repeat to you, that a practice so wicked and unnatural as this must necessarily be fraught with great danger.

I thought I would present you with the account of a case of this kind, given us by a celebrated professor of this city, Dr. G. S. Bedford. It is as follows:

“Mrs. M—— was the mother of two children, and had been suffering extremely, for the last fourteen hours, from strong expulsive pains, which, however, had not caused the slightest progress in the delivery. I was likewise informed, that about four hours before I saw the case, Dr. Miner, an experienced physician, had been sent for, and, after instituting a vaginal examination, remarked to the attending physicians, that, in all his practice, he had never met with a similar case. Dr. Miner suggested the administration of an anodyne, and having other professional engagements, left the house. Mrs. M—— was taken in labor Monday, December 18th, at 7 o’clock, P. M., and on Sunday, at 7 o’clock, P. M., I first saw her. Her pains were then almost constant, and such had been the severity of her suffering, that her cries for relief, as her medical attendants informed me, had attracted crowds of people about the door. As soon as I entered her room, she exclaimed, ‘For God’s sake, doctor, cut me open, or I shall die; I never can be delivered without you cut me open!’ I was struck with her language, especially as I had already been informed that she had previously borne two children.

“On assuring her that she was in a most perilous situation, and at the same time promising that we would do all in our power to rescue her, she voluntarily made the following confession:

“About six weeks after becoming pregnant, she called on one of these infamous female physicians, who, hearing her situation, gave her some powders, with directions for use. These powders, it appears, did not produce the desired effect. She returned again to this woman, and asked her if there were no other way to make her miscarry. ‘Yes,’ says this physician, ‘I can probe you; but I must have my price for this operation!’ ‘What do you probe with?’ ‘A piece of whalebone.’ ‘Well,’ observed the patient, ‘I cannot afford to pay your price, and I will probe myself.’ She returned home, and used the whalebone several times; it produced considerable pain, followed by a discharge of blood. The whole secret was now disclosed. Injuries inflicted on the mouth of the womb, by other violent attempts, had resulted in the circumstance as detailed above. It was evident, from the nature of this poor woman’s sufferings, and the expulsive character of her pains, that prompt, artificial delivery was indicated. As the result of the case was doubtful, and it was important to have the concurrent testimony of other medical gentlemen, and as it embodied great professional interest, I requested my friends, Drs. Detmold, Washington, and Doane, to see it. They reached the house without delay, and, after examining minutely into all the facts, it was agreed that a bi-lateral section of the mouth of the womb should be made.

“Accordingly, without loss of time, I performed the operation in the following manner: The patient was brought to the edge of the bed and placed upon her back. The index finger of my left hand was introduced into the vagina as far as the roughness, which I supposed to be the seat of the os tincae. Then a probe-pointed bistoury, the blade of which had been previously covered with a band of linen to within about four lines of its extremity, was carried along my finger, until the point reached the rough surface. I succeeded in introducing the point of the instrument into a very slight opening which I found in the center of this surface, and then made an incision on the right side. I then withdrew the instrument, and in about five minutes it was evident that the head of the child made progress. The mouth of the womb dilated almost immediately, and the contractions were of the most expulsive character. There seemed, however, to be some ground for apprehension, that the mouth of the uterus would not yield with sufficient readiness, and I made an incision of the posterior lip, through its center, extending the incision to within a line of the peritoneal cavity. In ten minutes from this time, Mrs. M—— was delivered of a strong, full-grown child, whose boisterous cries were heard with astonishment by the mother, and with sincere gratification by her medical friends. The expression of that woman’s gratitude, in thus being preserved from what she and her friends supposed to be inevitable death, was an ample compensation for the anxiety experienced by those who were the humble instruments of affording her relief. This patient recovered rapidly, and did not, during the whole of her convalescence, present one unpleasant symptom. It is now ten weeks since the operation, and she and her infant are in the enjoyment of excellent health.

“At my last visit to this patient, with Dr. Forry, she made some additional revelations, which I think should be given, not only to the profession but to the public, in order that it may be known, that in our very midst there is a monster who speculates with human life, with as much coolness as if she were engaged in a game of chance.

“This patient, with unaffected sincerity, and apparently ignorant of the moral turpitude of the act, stated most unequivocally to both Dr. Forry and myself, that this physician, on previous occasions, had caused her to miscarry five times, and that these miscarriages had, in every instance, been brought about by drugs administered by this trafficker in human life. The only case in which the medicines failed was the last pregnancy, when, at the suggestion of this physician, she probed herself, and induced the condition of things described, and which most seriously involved her own safety, as well as that of her child. In the course of conversation, this woman mentioned that she knew a great number of persons who were in the habit of applying to this physician for the purpose of miscarrying, and that she scarcely ever failed in affording the desired relief; and among others, she cited the case of a female residing in Houston Street, who was five months pregnant; this physician probed her, and she was delivered of a child, to use her own expression, ‘THAT KICKED SEVERAL TIMES AFTER IT WAS PUT INTO THE BOWL.’”

Thus you have an exemplification of the danger of the wicked and fearful practice which I have spoken against. If any of you are ever tempted under such circumstanes, beware!

UTERINE HEMORRHAGE.

As intimately connected with the subject of abortion, it is fit that I should here make a few remarks on that form of uterine hemorrhage which is not connected with childbirth.

Case I.—I recollect a case of this kind that occurred with a lady who was, I should think, at least sixty years of age. It was in the month of October, 1846, on a passage from New York to London, in the packet ship Switzerland, Captain E. Knight. The old lady and husband had taken a steerage passage from New York. They were English people, returning after many years’ absence, again to visit their native country.

One day the old gentleman came on deck and told me his wife was very sick of uterine hemorrhage, and that he wished my advice. I told him I would prescribe what I considered to be the best course in such cases, but that I feared his wife would not be willing to follow it. Indeed, I had no idea that she would do so.

However, I gave the advice, which was substantially as follows: First, take old sail-cloth, which was clean, make some pieces into the shape of towels, and one larger, to be used in the form of a child’s diaper; place these cloths, wet, about the abdomen and thighs, and let the patient wear a large one, wet, in the form of a child’s diaper; let her take but little and very light nourishment for two or three days, and be careful and not move about too much; help her out upon deck, when the weather is fine, so that she may enjoy the invigorating effects of the pure air and light. You need not chill her much with the wet cloths, but be exceedingly particular that they do not become too warm; let her wear them the larger portion of the time, until she becomes quite well.

Contrary to my expectations, the old lady followed the course resolutely, and in a very short time was again entirely well. She spoke in great praise of the invigorating effects of the cold cloths; she also drank cold water. We were at sea about three weeks after this, and the old lady’s health continued good until we left the ship.

Case II.—A lady of about the same age, in the winter of 1848–49, living in Jersey City, experienced uterine hemorrhage. She had been overdoing in the way of work. A similar course to that in the above case was followed, and in a few days she also recovered. Rest, alone, in such cases—that is, abstaining from severe labor, and taking but very little exercise, such as can be easily borne, and without fatigue—is alone sufficient for the curing of many of these cases.

Cold hip-baths, of short duration, and often repeated, are always good in attacks of this kind. Indeed, the more coolness generally to the body, the better; but we should not chill the extremities too much—not that it is dangerous to do so, but it is better to avoid it.

In the treatment of hemorrhages, the Indians pursue a very rational mode of treatment. If a severe hemorrhage follow a wound, which is not unfrequently the case, they plunge themselves into cold water, thereby producing a constriction upon the bleeding vessels. We all know by experience the efficacy of cold to arrest bleeding at the nose. We put a piece of ice on the neck, pour cold water down the spine, or even put a cold door-key on the back of the neck, and in most cases epistaxis ceases. All physicians and surgeons—all who at all deserve the name of such—know well the power of cold to arrest hemorrhages—often, too, such as are of the most alarming character. We should make very poor work indeed, in stopping hemorrhages, if we were deprived of cold water. Cold water is worth more—incomparably more for this purpose—than all other remedies under the firmament of heaven combined.

LETTER XVI.
DISORDERS OF PREGNANCY.

Its Febrile Condition—Acute Disease—Sleeplessness—Heart-burn—Constipation—Diarrhea—Piles and Hemorrhoids—Their Treatment.

It is said to have been an aphorism of Hippocrates, the father of medicine, who lived more than two thousand years ago, that pregnant women attacked with acute disease always die. This strong assertion cannot be said to hold good, certainly, at the present day; but yet pregnancy, it must be admitted, exercises, as a general fact, a very unfavorable influence on the system in acute disease. The danger here may be said to be three-fold. First, the system is already in a febrile condition, or one very nearly bordering thereto; second, there is the new disease; and third, this often causes the death of the unborn child, and then the dangers of abortion are superadded to the others. “The life of the child, too,” say authors, “is endangered by the treatment necessary for the cure; especially in the use of harsh purgatives, violent emetics, salivation, and profuse bleedings.” But thanks to a better day, we of the water practice are under no necessity of running such fearful risks. We have not only a more effectual way, but one, when managed by judicious hands, harmless and safe. “It is by the prompt use of mild means, and a persevering attention to small matters,” judiciously observes Dr. Maunsel, “that the patient is to be conducted through the dangers that encompass her.” And he justly adds, “Above all, avoid the dreadful blunder of treating a woman for acute disease without discovering that she is pregnant.”

Pregnancy, as I have remarked, is always attended with more or less excitement of the system, an excitement which bears some resemblance to a state of fever. There is also a greater proneness to fevers, even from slight causes, now than at other times. Hence the necessity of avoiding, as far as possible, all such causes; and hence also, the necessity of exercising the greatest care in regard to diet and drinks. Too much food, and that which is too exciting, will cause more harm in pregnancy than at other times, from the greater tendency to fever. The common belief among women is, that more food is needed during pregnancy than at other times, because the food goes to furnish nourishment for two instead of one, that is, for the mother and the child within her. “It is therefore,” says Dr. Dewees, “constantly recommended to eat and drink heartily; and this she too often does, until the system is goaded to fever; and sometimes to more sudden and greater evils, as convulsions or apoplexy.”

If, instead of full diet, women in pregnancy will but try the plan of eating less food, even of becoming very abstemious, they will most assuredly find that they get along better, suffer less from plethora or fullness, and enjoy greater comfort of body in every respect.

SLEEPLESSNESS.

This, in a greater or less degree, not unfrequently occurs during pregnancy. It is most apt to occur during the later months of the period. Within a few days of the birth, however, better rest is experienced, and a greater degree of comfort in every respect. This tendency to sleeplessness during pregnancy is sometimes so troublesome as almost wholly to prevent sleep. “The limbs are agitated by involuntary contractions of the muscles, which, by the frequency and suddenness of their motion, instantly interrupt the sleep to which the woman was at the moment strongly inclined.”

“Sleeplessness,” says Dr. Maunsel, “most frequently affects the weak, nervous, and irritable, occurring sometimes early in pregnancy, oftener toward the end of the term. If the want of sleep continue for many days, it is commonly followed by very grave symptoms, as restlessness, fever, mental disturbance, convulsions, etc.; abortion has resulted from it, and some cases have terminated in insanity; others have destroyed life.” But those who follow a judicious course of water-treatment do not become thus afflicted. If such occurrences should be at all possible in the new modes, the cases would be exceedingly rare. I have known many persons to follow bathing during pregnancy, but none who have had any thing like serious difficulty in obtaining a proper amount of rest.

In many cases this want of sleep in pregnancy does not sensibly impair the general health. Some persons have been under the necessity of walking their room much of the night; and yet, after a short repose at the dawn of day, have been astonished to find themselves as much refreshed, apparently, as after a good night’s rest.

Treatment.—To prevent sleeplessness in pregnancy, a variety of means have been recommended. If there is plethora, or too great fullness of the system, small bleedings and cooling purgatives of mild kind are recommended by almost every author who has written on the subject. It is well known that in many parts of the country, women believe that they cannot get through pregnancy at all without being bled. The doctors have been at the root of this matter in the beginning. This old-fashioned practice, fortunately, is now fast going out of date. It is not for me here to enter into a discussion of the question whether such means ever do any good in pregnancy; but I will say, on the authority of physiological and pathological science, and my own experience, that bathing, water-drinking, and the proper regulation of the general habits, are incomparably the best modes; the best, not only for the time of pregnancy, but also for that of childbirth and the period of nursing.

Dr. Dewees recommended for this affection, low diet, cool air, and cold water, as being among the best remedies. And Dr. Denman says, that “a glass of cold water drank at bedtime is not a contemptible remedy;” and he might have said one of the best, especially if the dose be soon repeated. And Dr. Dewees, in quoting this advice of Dr. Denman, adds, “We know that bathing the hands and face in cold water is an excellent practice, and should always be resorted to.”

Dr. Maunsel says, “Pediluvia (foot-baths), or, what is better, hip-baths, very often do good.” But the important matter of temperature, the doctor does not speak of. A warm hip-bath and a cold one are very different things. He remarks, also, well, “that the diet should be cooling, and exercise in the open air as freely as circumstances will permit.”

I may, however, dismiss this whole matter of sleeplessness in pregnancy, by saying, that those who bathe daily, exercise judiciously, and, when possible, in the open air, drink only pure soft water (and all can have this from the clouds), partake only of plain and unstimulating food, and sleep upon hard beds and pillows, in cool, fresh air, will rarely, if ever, be troubled with want of sleep.

One other thing, however; it sometimes seems necessary for persons in pregnancy to get a “nap” during the day. Those who have great cares, and many in our country have, often find it extremely difficult to get through the long, hot days of summer without sleep. Now, in such cases, if the woman can go by herself, and be wholly undisturbed, and feel entirely free from every care, and thus get a good half hour or an hour’s sleep, she will be much refreshed thereby. It is necessary to observe that the clothing should be removed as at night. Persons often wonder how it is that they feel worse after sleeping than before. When one lies down, if the clothing be left on, too much heat is retained about the surface, and thus debility, instead of refreshment, is experienced. This day-sleeping should be done with the stomach empty, as at three or more hours after a meal, and not in the afternoon, as that would be liable to cause wakefulness at night. It is truly surprising how much, under favorable circumstances, a short sleep even will refresh the powers of life.

HEART-BURN.

This is not unfrequently one of the first unpleasant symptoms that women experience after becoming pregnant. It sometimes becomes very distressing, and difficult to manage according to the ordinary modes. “It is generally,” says Dr. Dewees, “very distressing and very difficult to subdue.” He had known large and repeated doses of the alkalies given with scarcely any temporary alleviation, and much less, permanent benefit.

The great cause of heart-burn in pregnancy, as well as in other cases, is acidity of the stomach; and acidity of the stomach comes from improper food. Very seldom, indeed, can a pregnant woman be troubled with heart-burn, acidity of the stomach, or vomiting, if the dietetic and other habits be regulated according to principle. Pregnant women, in this country of abundance, generally eat a great deal too much food. They have also too little exercise in the open air. Some, indeed, have too much exercise, as in doing household work; but more are injured by doing too little than too much. But in this country ninety-nine of the one hundred eat too much food while in the pregnant state.

Treatment.—To cure the heart-burn, let the woman, when she first experiences it, at once desist in the quantity of food. If she rises in the morning and finds the symptom upon her, she may be certain that digestion has gone on badly the day previous, and that the stomach contains portions of the undigested aliment which has passed into the acetous fermentation, and thus causing the difficulty she experiences. What is to be done in such a case? Will the introduction of another portion of food into the already disordered stomach make matters any the better? Certainly not, except for a short time. When the stomach is goaded on by a new meal, the individual may feel the better for half an hour; but, other things being equal, it in the end only makes the matter worse. Fasting a meal or two, with water-drinking for its tonic effect, is the best possible means. The stomach, thus, has time to regain its vigor, and food taken in moderation, subsequently, will then be found to agree perfectly well. It will here also surprise any one to learn how small an amount of food is really necessary, with water-drinking, to sustain the strength.

If the heart-burn is very troublesome, it will be found of great relief for the patient to vomit by means of water. This, in most cases, will take place very easily by drinking, in quick succession, a number of tumblers of soft water, about blood-warm temperature. This, with a little help, as by putting the finger in the throat, will be found sufficient; and if, in any case, the vomiting does not take place, the water yet does much good by means of diluting the offending matters in the stomach. Thus, suppose there is one ounce of acid matters in the gastric cavity, and that ten ounces of pure water are introduced therein, the offending mass is weakened tenfold; so that even if vomiting does not take place, great relief is experienced. I would not have any one make too great an effort to produce vomiting, especially in pregnancy, for hard vomiting might cause abortion. There is, however, no danger except the vomiting caused by drug substances. Water-vomiting is easier than can be imagined by those who have tried only the old modes.

Soda and other alkalies, taken so often to ease heart-burn, do more harm than good in the end. The wet girdle, worn occasionally about the abdomen, and managed so as to produce a cooling effect, will be found of great service in invigorating the stomach, thus tending to prevent heart-burn, acidity, and the like. So, also, the general ablutions, which ought never, for a single day, to be omitted during pregnancy, as we may say, too, of other times.

In heart-burn, arising from whatever cause, it is a very common custom, both with the profession and the people, to give alkalies, as magnesia and chalk. Dr. Dewees, I remarked, had known large and repeated doses given, with scarcely any temporary alleviation, much less permanent benefit. It is of little effect, certainly, to continue giving these articles, when at the same time the dietetic habits are such as are certain of keeping up the difficulty. This would hold true even if the articles administered were perfectly neutral in their effects as to harm, which can never be the case. All drug substances, however much good they do, at the same time cause a certain amount of harm. The articles, magnesia and chalk, the ones generally resorted to in this difficulty, are moreover often impure. This is particularly true of the latter article.

Dr. Dewees mentions a case in which the lady’s health was utterly destroyed by her enormous use of chalk. “I formerly attended a lady, with several children,” says he, “who was in the habit of eating chalk during the whole term of pregnancy; she used it in such excessive quantities as to render the bowels almost useless. I have often known her without an evacuation for ten or twelve days together, and then it was only procured by enemata (injections); and the dejections were literally chalk. Her calculation, I well remember, was three half-pecks for each pregnancy; she became as white nearly as the substance itself; and it eventually destroyed her, by so deranging her stomach that it would retain nothing upon it.” I repeat, that these alkaline substances always and inevitably do more harm than good; and the part of wisdom is to do without them.

CONSTIPATION.

During the early months of pregnancy, there appears to be a greater tendency to constipation than in the latter months, a fact which is the direct reverse of what we should expect from a priori reasoning. But during the whole period, constipation is more apt to occur than at other times.

Constipation is exceedingly common among all classes of females in this country at the present day. The American people have such a predilection for fine food, it is a hard matter to make any great change in this respect. It is in the dietetic habits, more than in any other, that we are to look for the causes of this evil.

Superfine flour is, I hold, the greatest of all causes of constipation. I know tea and coffee, which are astringent articles, have a tendency to cause this condition of the bowels; and the same may be said of idleness and physical inactivity; but too great richness of food—and superfine flour is the article most concerned in this—is the great cause of constipation. Our country abounds with it everywhere. By our numerous railroads and canals, superfine flour is transported from one end of the country to the other, so that in large districts, where formerly the people were in the habit of eating coarse bread, as of rye and Indian, and were consequently more healthy, they now use the superfine. Even a beggar would sneer at one for offering him brown bread.

Constipation, common as it is everywhere among females, is still more common in pregnancy. This arises, first, from the pressure of the enlarged womb upon the lower bowel; and second, there being a new action set up in the uterus, there is, as a natural consequence, a greater tendency to torpor in the bowels; but the principal cause is that of the pressure.

This condition of the bowels induces of itself numerous other difficulties. Headache is often brought on solely by constipation; that is, in many cases we remove the constipation, and the headache is sure to leave with it. Sickness of the stomach and vomiting are always aggravated, and often caused by it. The same also may be said of heart-burn, palpitation, and fainting. Sleeplessness, and, in fact, almost every one of the disorders of pregnancy, may be said to be either caused directly, or greatly aggravated, by constipation of the bowels. Even miscarriage has been known to be induced by it.

Some persons have gone an almost incredible length of time without any movement of the bowels. A whole week is not uncommon. Dr. Dewees mentions a case of fourteen days, and no doubt there have been those who have gone one to three whole weeks.

Treatment.—What have we to do in order to cure constipation of the bowels? Does not every person of common sense understand at this day, that the more we dose the system for constipation, the more we may? Let those answer who have tried these things. Always, other things being equal, the more we take drugs for constipation, the worse it grows. We must therefore look to some other means of cure.

Constipation of the bowels may always be cured, and this by the most simple means. Dr. Dewees mentions a case where a lady had suffered three successive miscarriages from this cause, and by the constant use of brown bread, drinking only water, and taking no animal food or broths—taking now and then a little castor-oil, or the like, which, however, he did not reckon upon as having done any material good—enabled her to pass safely through the whole time. We need here only mention, in general terms, that constipation in pregnancy is to be cured just the same as constipation in any other case. Brown bread, fruits, and vegetables, with a very moderate use of milk, if the patient desires it; regular exercise, the hip-bath, wet girdle, injections of cold water, or tepid, if that is preferred—these are the means to be used. The brown wheat or rye mush will be found most excellent. No woman, if she can have brown bread, and occasionally an injection, need ever suffer from constipation of the bowels.

DIARRHEA.

Sometimes the reverse of constipation occurs during pregnancy; namely, diarrhea. This also not unfrequently alternates with constipation. Constipation, however, is the most frequent symptom.

Treatment.—Singular as it may appear, diarrhea should be treated on the same general principles as constipation. Fortify and invigorate the general health, observing at the same time a correct general regimen, and either symptom disappears. In diarrhea, the hip-bath, often repeated, the wet girdle, and cold injections, taken as often as there is any disposition for the bowels to act, are effectual means. The diet should be regulated on the strictest principles. If a diarrhea is very severe, entire abstinence from all nourishment, except water, for a day or two, is a very salutary remedy. Food should then be taken with the same precautions as in nausea and vomiting.

PILES AND HEMORRHOIDS.

Piles and hemorrhoids are more apt to occur in pregnancy than at other times; and when these already exist, they are apt to become worse at this period. Constipation being more apt to occur in pregnancy, and that condition of the system being the one in which these symptoms are most liable to occur when the woman is not pregnant, so also they occur more frequently now than at other times. The constant pressure of the fetus upon the blood-vessels within the pelvis has also an agency in the matter, because every thing that causes sluggishness of circulation tends to bring on piles. So also the more sedentary habits of many females, during the period of pregnancy, are often a cause of this difficulty; but in other cases the opposite extreme is practiced—too much exercise or standing on the feet. Both these extremes may cause piles in pregnancy, or aggravation when they previously existed. Cathartic medicines not unfrequently bring on a “fit of the piles.”

This affection always denotes a wrong state of things in the general health. A really healthy person can never have the piles. Some, however, who are what would be termed tolerably well and strong in general health, experience such symptoms, but such is not the rule. Old cases, particularly, denote derangement of the general system.

When piles come on suddenly, they are often attended with very great pain and suffering to the patient. Not only is the pain great at the part affected, but there is also feverishness, pain, and a very unpleasant feeling in the head, with deep and severe pain in the back.

Treatment.—As to the treatment and general management in this affection, we should of course do the best that may be for the general health. As a general fact, no surgical operation should be allowed upon piles during pregnancy. These operations are often attended with so great pain, that abortion might be the result.

There is nothing in the world that will produce so great relief in piles as fasting. If the fit is severe, live a whole day (or even two, if necessary) upon pure, soft, cold water alone. Give then very lightly of vegetable food. Those who have suffered the agony of this affection, if they will but have patience to try this means, will find the truth of my remarks.

Water applications are also very useful in this disease. Dr. Dewees observes: “The pregnant woman may derive both comfort and advantage from sitting in a demi-bath of cold water, for five or ten minutes at a time, two or three times a day, when the complaint is advancing, or when about to retire; that is, after the severer symptoms have abated, or before they are high.” This advice is partly right and partly not. There is a notion with many that cold water-applications in high inflammation are not good; that they increase the difficulty instead of making it less. Thus in a burn, it is said that after the application of cold water the pain becomes worse. This is not true, although it appears to be so; for so great is the relief afforded by the application, that the pain appears worse, when in fact it is not; but only keep on continuously with the cold water-treatment, and the pain does not return at all. Such at least is the fact in all burns, however severe, when the surface is not destroyed; and the same principle holds good in all high inflammations from whatever cause. Very frequent sitz-baths, or merely washing the part often in cold water, will be found excellent in these severe cases of piles. Cold compresses worn upon the part also afford great relief. Cold injections are also useful. But, as before mentioned, fasting and the regulation of the diet are the great means.

LETTER XVII.
DISORDERS OF PREGNANCY.

Headache: the Nervous and the Plethoric kinds—Stye in the Eye—Salivation—Hemorrhage from the Stomach—Cramp of the Stomach—Toothache—Jaundice.

Headache is one of the most common of all the disorders of pregnancy. It may occur at any part of the period; in the early months, it is supposed that nervous headache is most apt to occur; in the latter, headache arises more frequently from plethora. In such cases there may be throbbing of the temples, suffusion of the eyes, ringing in the ears, indistinct vision, and flashes of light passing before the eyes. If the headache gets to be very severe—splitting, as we may say—there is danger of either apoplexy or puerperal convulsions. But these things, be it remembered, do not come upon those who live moderately and temperately, lead an active, industrious, and regular life, go often into the open air, and practice daily ablutions.

That form of headache in pregnancy which occurs often, and is not a sick or nervous headache, so-called, is regarded by authors generally as being a very serious affair.

Treatment.—Dr. Maunsel says of the nervous form of this disease: “This, especially if it take the form of hemicrania (that in which the pain is confined to one half of the head), is one of the most unmanageable of all the diseases of pregnancy.”

According to the old practice, prompt and decided measures must be taken in these cases, especially if the affection is of that form arising from a general fullness of the system.

“If the state of the system indicates bleeding,” says Dr. Maunsel, “it will commonly do good; local should be preferred to general bleeding. If bleeding is not indicated, we should at first attend to the secretions; when these are corrected, antispasmodics and anodynes come in well. Hyosciamus and camphor, a grain of each, is a good remedy; also the volatile tincture of valerian. The external application of some anodyne extract, as stramonium, belladonna, or cicuta, may be tried, but with caution, lest they produce the poisonous effects of the drug.”

Dr. Churchill remarks: “These nervous headaches may usually be relieved by antispasmodic medicines, or diffusible stimuli, such as valerian, hartshorn, etc.

“Eau de Cologne applied to the forehead, or a blister behind the ears, is often useful.

“A brisk purgative should also be given occasionally.

“A much more active treatment will be necessary when there are any symptoms of plethora, or vascular excitement about the head, both for the relief of the pain and for the purpose of anticipating evil consequences. Blood should be taken from the arm, in quantity according to the strength of the patient and the relief afforded; and this should be repeated, or leeches applied to the temples, if necessary. We are not to rest satisfied that enough has been done until the pain is relieved, and the arterial system reduced to the ordinary standard.

“After a certain amount of good effect has been produced, great benefit will often result from the application of a blister to the nape of the neck.”

Now compare with the above practice of bleeding and dosing, secundum artem, the true and rational one.

In nineteen cases out of twenty, the nervous headache comes from either tea or coffee drinking, or the use of improper food. Only remove the causes, then, and the difficulty vanishes. Strange to say, however, there are many women who have either so little confidence in what any one can say to them, or so little control over themselves, they will not even make the experiment. Should one who has been cured tell them the fact, they will not yet believe; nor would they if one should rise from the dead. Such persons—those who have the truth set before them, and yet will not act—are welcome to all their tea and coffee, their fine food, their bleeding and dosing, and their sick headache.

STYE IN THE EYE.

This form of boil, occurring on the eyelid, sometimes appears as one of the disorders connected with pregnancy, more particularly in its earlier part.

Stye is much more apt to happen with those who have a disordered stomach than with the healthy. As a general rule, however, it may be regarded that boils are healthy; that is, it denotes a very good state of the vitality, when it has the power thus to throw morbid matter out of the system. Still, it is yet more healthy to have the body so pure that it has no need whatever of symptoms of the kind of which I am speaking.

A stye is much more painful than might be expected, considering its small size. This is owing both to the vehemence of the inflammation and to the excessive sensibility of the part upon which it is situated. The disturbance caused by it may become so great as to amount to a good deal of feverishness and restlessness, attended not unfrequently with a severe pain in the head.

Treatment.—We cannot do a great deal in such cases, except to let matters take their own course. It is productive of a good deal of relief to hold the eye in tepid water, and if the patient will consent to live two or three days almost wholly without food, the suffering will be rendered much less, and the stye will come the sooner to a head.

SALIVATION.

There is often a greater or less degree of this symptom during the period of pregnancy. Probably all women experience, at this time, a more than ordinary flow of the salivary fluid. This sometimes becomes very excessive and troublesome to the patient, especially at night, when the sleep is disturbed by the frequent necessity of emptying the mouth. Dr. Dewees observes: “It is almost always accompanied with acidity of the stomach and constipation of the bowels; the fluid discharged from the mouth, for the most part, is perfectly colorless and transparent; at other times it is more tenacious and frothy, and the quantity poured out is sometimes incredibly profuse. It almost always has an unpleasant taste, though not attended with an offensive smell; it keeps the stomach in a constant state of irritation, and not unfrequently provokes vomiting, especially if the saliva be tenacious, and requires an effort to discharge it.” This author relates a case where salivation commenced at the second month of pregnancy, in which the patient discharged daily from one to three quarts of salivary fluid, and became so weakened thereby, that she was unable to sit up without immediately fainting.

The above description of salivation in pregnancy may be said to apply to patients who live according to the ordinary modes of society. I have, during nine years past, known many women who have passed through pregnancy, practicing at the same time daily bathing, water-drinking, exercising regularly in the open air, with plain diet, and in no instance have I known salivation to prove at all inconvenient or troublesome. I judge that this affection, if such we may call it, can only come on when the general health is at fault, or the dietetic and other hygienic habits bad. True, there is probably always more or less increase of the salivary secretions in pregnancy, but if good habits are daily persevered in, I think no one will be troubled at all in this matter.

I find in a late work on Females—Professor Meigs’s—the following remarks on this subject, which go to show, on good authority, the uselessness of drug-treatment in this affection:

“I am sorry to tell you (the Professor addressing himself to his class), that I know of no remedy at all to be depended upon for the management of these great salivations. They are the troublesome concomitants of the gestation, and they cease with the cessation of the gestation. They cannot be cured by alkalies or acids, by venesection or purgation, or by any therapeutical treatment with which I am acquainted. If it were just, always to attribute the salivation to a state of the stomach, then it would be reasonable to apply remedies with a view to correct a faulty state of that organ, in hopes of curing the salivation.”

All this goes to prove, that you who are troubled with this affection are to depend upon the rational means, air, exercise, diet, and water-treatment, and not upon drugs, to remedy it. Mark too, how, year by year, the superiority of these hygienic and curative influences is being recognized by medical men, and how the old methods of dosing the system are going into disrepute.

HEMORRHAGE FROM THE STOMACH.

In consequence, probably, of a general fullness of the system, or perhaps from the cessation of the menstrual function, a discharge of blood sometimes takes place from the stomach, in the earlier periods of pregnancy. It is generally small in quantity, and continues but a short time. The occurrence, generally, causes a good deal of alarm to the patient, but it is seldom to be looked upon as a dangerous affection.

Treatment.—If the hemorrhage arises from too great fullness of the system, a reducing process should at once be commenced—not by drugging the system, or by blood-letting, but by abstinence and fasting.

If the discharge should be at all alarming, we should place cold wet compresses upon the abdomen; we should, in short, proceed upon the same general principles as we would in any other case of hemorrhage.

If the bleeding occurs in consequence of hard vomiting, as it sometimes may, we should take measures to arrest that symptom.

I remark, in conclusion, that this affection is a very unfrequent one, and such, in most cases, as should cause no alarm.

URINARY DIFFICULTIES.

Incontinence of urine is quite apt to occur toward the end of pregnancy.

It arises often from the pressure of the womb upon the neck of the bladder.

There is a notion with some of the “old women,” that incontinence of urine is an indication of good labor.

Treatment.—This difficulty cannot, of course, be altogether remedied; the cause cannot be removed. It may be lessened, however, by short and frequent hip-baths, wet bandages, and cold bathing. Drinking soft water instead of hard, will also be found to have a good effect in all difficulties of the bladder whatever.

Blisters are always liable to bring trouble upon the urinary organs, but more particularly so in pregnancy. The system is then in a more excitable or impressible state. Strangury in pregnancy is a very distressing and untoward symptom when it follows the use of blisters. Dr. Dewees had known cases where entire retention of urine followed the use of blisters, so obstinate that it could only be relieved by the catheter, causing a distressing inclination and violence of effort, only to be surpassed by labor itself. Retention may also come on from other causes.

Treatment.—It can be very seldom indeed necessary to resort to the use of the catheter for draining off the urine, if cold hip-baths, cold foot-baths, and even the cold general bath, if necessary, be sufficiently persevered in. Cold has a truly wonderful effect in causing the flow of urine.

CRAMP OF THE STOMACH.

This affection, as it occurs in pregnancy, is most common with those whose stomachs have become much enfeebled by dietetic improprieties, excess in the use of warm drinks, and by the abuse of medicines.

Treatment.—By way of comparison, let me present you with the remarks of a celebrated European author, Doctor Churchill, concerning the medical treatment of this affection, that you may see what you think of the reasonableness of it. He says:

“Our first object is to quiet the pain by a full dose of laudanum.

“When this is attained, we may proceed to remove the cause, and to arrest any intestinal irregularity. Dr. Burns recommends aloetic purgatives, but these may not in many cases be suitable. If there be piles, as is very often the case with pregnant females, they will rather prove injurious than beneficial. I have found Gregory’s powder, electuary of sulphur and senna, or castor-oil, to answer the purpose better.

“During the intervals of the attack, tonics (of which oxide of bismuth or preparations of iron are recommended) or stomachics may be exhibited. A belladonna or opium plaster, or a blister over the stomach, is often very useful.

“Should the attack be very severe, bleeding, or leeches to the epigastrium, may be advisable; this will be especially the case should there be any symptoms of congestion about the head, and more for the purpose of preventing an attack of convulsions, than even for the relief of the gastric affection.”

Assuredly you will say that drug-treatment affords a variety of resources, notwithstanding it is so little to be depended upon.

I need hardly hint to you how much better, safer, and more effectual the water processes are than all the drugs of the materia medica to cure a case of cramp in the stomach.

If it is a bad case—acute, as we say—at once drink warm water enough to cause speedy vomiting.

The tepid clysters, used to the extent of gallons, that is, by repetition, if need be, is also a serviceable remedy.

We also use wet compresses, frictions, and the hip-bath, if necessary; but as a general fact, as soon as we cleanse the stomach and bowels thoroughly, the cramping ceases.

Afterward, as in all cases of stomach ailment, and all other ailments, great care should be observed in regard to the food.

TOOTHACHE.

Breeding with a toothache is an old proverb. Toothache is certainly more apt to occur during pregnancy than at other times, and not unfrequently it is a very early symptom of this state. And what may appear singular, the teeth ache without being diseased. Especially those who drink strong tea and coffee are more subject to this nervous toothache, as we may term it; toothache where there is no decay. Ceasing with the cause, then, is the surest means of relief.

Treatment.—It is dangerous to extract teeth in the early months of pregnancy. The operation has been often known to cause immediate abortion. There is the greater danger of this in the early months.

Bleeding has often been practiced for this affection in pregnancy; but that is a worse than useless resort, and moreover, generally fails of the object. After a few days of full diet, the affection is quite certain to return, and appears to be even the more obstinate for the bleeding. Fasting, with water-drinking, is a much better mode. Very seldom will toothache withstand twenty-four hours’ entire abstinence from all food. If the face has become much swelled, of course so great relief could not be experienced in so short a time. But even then the fasting is of incalculable good. General bathing, and going into the open air, are also excellent means. The rubbing wet-sheet is particularly applicable. And Dr. Burns, in his work on midwifery, years ago said, “Sometimes a little cold water held in the mouth abates the pain.” This will be the case whenever the toothache is one of inflammation; but if it be of the more nervous kind, warm water will give more relief. If the nerve is much exposed, it is perhaps always best to hold warm, or at least lukewarm water in the mouth, and at the same time to practice very brisk and continued rubbing of the face, temples, neck, etc., with the hand wet often in cold water. Wet bandages upon the face are also good. If the aching be of the nervous kind, that is, without inflammation, warm bandages, often repeated, afford the most relief.

I must repeat, that I hope none of you will ever consent to have your teeth extracted, or in any way operated on, while pregnancy exists.

JAUNDICE.

This, as a disease of pregnancy, is one that most frequently makes its appearance in the latter months of the period.

This state of the system should not be confounded with that in which the woman acquires a dark, almost yellow color, which, however, is not jaundice, and readily passes off after the delivery has taken place.

Causes.—In pregnancy, as at other times, this affection is often preceded by a disordered state of the stomach and alimentary canal generally. There is also, generally, a sense of weight and tightness in the abdomen, especially at the pit of the stomach, and in the right side. But in some cases none of these symptoms are observed.

Sometimes abortion has happened in connection with this state of the system; such, however, is not often the case.

Treatment.—If it is attended with violent symptoms, as is sometimes the case, it will be necessary to use active measures to cure it. In a majority of cases, however, a few days of abstemious living, alternating now and then with a day of entire fasting, together with plentiful drinking of pure, soft water, and a moderate share of bathing, will suffice to effect a cure. The wet-sheet pack is especially useful in these cases.

LETTER XVIII.
DISORDERS OF PREGNANCY.

Difficulty of Breathing—Pain in the Right Side—Itching of the Genitals—Swellings of the Limbs—Cramps of the lower Extremities—Pain of the Breasts—Hysteria—Physical Hindrances—Exposure to Disease.

Toward the latter months of pregnancy, there is always, necessarily, more or less difficulty. The uterus becomes so large, and fills so much of the abdomen, that the upward and downward motion of the diaphragm, or partition between this and the chest, is greatly impeded. Hence the dyspnœa, or difficulty of breathing. A cough, likewise, not unfrequently attends this symptom, and becomes so severe in some cases as to cause abortion.

Prevention.—Great and protracted exertion, severe fatigue of whatever kind, bodily or mental, ought to be avoided during pregnancy. Running up stairs too quickly, walking too rapidly, and any undue mental excitement, increases this difficulty of breathing. Some mothers are in the habit of taking up heavy children needlessly, and carrying them, which is one of the most certain means of doing harm to themselves. So also, inaction is bad for the breathing. If the individual do not have exercise enough to answer the purposes of health, the system becomes more plethoric or full, and thus also the difficulty is increased. The medium of neither too little nor too much should always be observed. The same also may be said of the diet. And here I remark, that if any pregnant woman will carefully make the experiment, she will find that in the latter months of pregnancy, an exceedingly small allowance of food only, with free water-drinking, bathing, and moderate exercise in the open air, will be sufficient to keep up her strength, and that in a most remarkable manner. Let her not be deluded by the old maxim, that because there are two to support she must take a greater amount of food.

PAIN IN THE RIGHT SIDE.

After gestation has passed the middle of its term, there is experienced often more or less pain in the right side. This does not usually happen until after the beginning of the fifth month of pregnancy. It comes on as a deep-seated pain in the immediate region of the liver; often it is merely a trifling sensation at first, increasing as pregnancy advances. It is not increased by ordinary inspirations, as many internal pains are, although a very full and deep inspiration may augment it in a slight degree. The pain is seldom, almost never, very great; it is constant both day and night, but worse in the latter. The patient can lie on either side, but better on the left. A severe sensation of heat is sometimes experienced at the part where the pain exists. This is sometimes almost constant, at others only occasional, and in still a greater number of instances, nothing of the kind occurs.

Women are more subject to this affection during the first pregnancy than at subsequent times. It may, however, be experienced after a number of children have been borne; this is true more especially in those cases when the child is carried “high up,” as it is called. This comes from the fact, that the pain is caused by the pressure of the upper part of the womb upon the liver, which lies mostly upon the right side.

Treatment.—No material harm can be said to come from this pain, and for this reason no harsh and severe medical treatment should be adopted with a view of removing it. Bleeding is well known to be a common remedy for ordinary pains in the side. But Dr. Dewees, of Philadelphia, whose experience was so great in all matters pertaining to midwifery, remarks of this practice, that so far as he had seen it, not the slightest advantage had arisen from it. “Nor,” observes this candid writer, “has any other treatment which we have advised been any more successful. Leeching, cupping, and blistering, have in turn been employed without benefit. Indeed, we have now ceased to prescribe for this complaint, unless it be attended with some alteration in the circulating system; if this be disturbed, and the pulse tense and frequent, advantage is sometimes experienced from the loss of blood and gentle purging, as this pain may be aggravated by this condition of the system. But in this instance, we prescribe for the general condition of the system, and not for the local affection—as we should have to do most probably as much, were this pain in the side not present.” These are the candid remarks of one whose experience in treating diseases of women was as great, probably, as that of any other man, showing conclusively that ordinary means are of no avail in this difficulty.

Now I can speak confidently in this matter. The water processes are effectual in mitigating this pain much, to say the least. I conclude it is rather a symptom of debility than otherwise. I do not believe it natural. Bathing to support the general strength, and particularly the wet girdle, often rewet, especially in hot weather, so as to keep it at all times cool, and hip-baths, with a good share of friction by the wet hand over the part affected, will be found excellent means. The immediate relief caused by the application of the wet girdle will be often astonishing. Keeping the bowels freely open, as by the habitual use of brown bread, mush, and the like, and injections of cold water, are also of service here.

But if, in any case, the pain resists all remedial means, and as we have before said, those of a severe nature should never be resorted to, the individual should not allow her mind to become depressed by thinking that harm must inevitably be caused in consequence of it.

Too much, as well as too little exercise, may cause this difficulty. A proper medium should therefore at all times be observed.

ITCHING OF THE GENITAL ORGANS.

Pruritus pudendi, or itching of the genital parts, becomes sometimes a most troublesome and distressing complaint in pregnancy—so troublesome, indeed, as utterly to set decency at defiance. Cases under the ordinary modes of treatment, have been known to be so severe as to compel the lady to remain in her chamber for months.

The causes of this affection cannot always be ascertained. A want of proper cleanliness is no doubt often one of the principal sources of it.

A great variety of remedial means have been used in this disease. Astringents, such as alum, borax, acids, etc. are the agents indicated. But cold is the greatest astringent of all; no matter how troublesome the affection, it is completely within our control by the use of cold hip-baths, cold cloths, ice, and the like. In a late number of Braithwait’s “Retrospect,” one of the leading English periodicals of medicine and surgery, it is stated by Dr. James Arnott, “that a most distressing attack of this affection was completely subdued by two congelations, each of about thirty seconds’ duration, after a prussic acid lotion and other routine applications had been tried in vain.” By “congelation,” Dr. Arnott means the application of intense cold, by the use of ice between cloths, or some freezing mixture, but not an actual freezing of the parts, as some might suppose. But shallow hip-baths of cold water from a well, persevered in, will be found sufficient in every case.

It should be remembered that uncleanliness is a most fruitful source of this troublesome affection.

SWELLINGS OF THE LIMBS AND VARICOSE VEINS.

Swellings of the lower limbs, and varicose or knotty and swelled veins, may occur in pregnancy from the same causes as piles and hemorrhoids, namely, an obstructed circulation.

Washing the parts affected with cold water, and attention to the general health, are the means to be used here. Do no violence to the system. The exercise should be moderate. Nor should the woman be too inactive; the medium course in all cases is the better rule.

If the patient can find time to lie down a number of times during the day, removing her clothing at each time, she will find the practice a good one.

CRAMPS IN THE LOWER LIMBS.

Toward the close of pregnancy, cramps may occur in the lower extremities, because of the pressure of the child upon the large nerves that pass down them. This is seldom very troublesome, and cannot, of course, be altogether prevented. Too great fatigue, and any thing that tends to depress the general health, will at least make the matter worse than it otherwise would be.

PAIN IN THE BREASTS.

Mastodynia, or pain in the breasts, is more common in the first pregnancy. Compression by clothing may cause the difficulty. Washing the parts with cold water, and wet bandages or cloths worn upon the parts, are the means to be used. If the pain is of a spasmodic kind, it may be best in some cases to use warm fomentations.

HYSTERIA.

There appears to be with many a greater tendency to hysterical symptoms during pregnancy, than at other times.

Hysterical females are, for the most part, those who live a life of excitement, attending frequently balls, theaters, and public exhibitions late at night, and especially such as are much addicted to tea and coffee drinking, the use of concentrated and stimulating food, and have little exercise in the open air.

Treatment.—Medicines, especially the preparations of opium, also have a tendency to cause hysterical symptoms. Pregnant women should, then, as far as possible, avoid these causes of so pitiable a disease. Whether in pregnancy, or at other times, hysteria cannot come upon those who live correctly, and maintain at all times good and permanent health. I will here further remark, that all novel reading should be avoided during pregnancy; and the less the better, I may say, at all times, of such novels as ninety-nine hundredths of all that are put forth at the present day.

PHYSICAL HINDRANCES.

There are various mechanical inconveniences connected with this state. In the earlier months more particularly, there is pressure upon the rectum, causing a tendency to constipation. This should be guarded against, not by “the due administration of mild laxative medicines,” for that only tends to make matters worse in the end, but by the use of proper food, such as cracked wheat or rye, brown or unbolted bread, Indian mush, well boiled, and good fruits and vegetables, in their season. Exercise, employment, daily bathing, and clysters, tepid or cold, according to the season, and the patient’s strength, should all be brought to bear in the case.

Pressure upon the urethra, or neck of the bladder, is also one of the mechanical evils of pregnancy, rendering the evacuation of urine difficult, and sometimes painful. To prevent this, the patient should be exceedingly careful to evacuate the bladder frequently, and never to allow the calls of nature to go unanswered; nor should she stand or walk too much at a time, as this is calculated, in a powerful manner, to increase the difficulty. The same may be said in regard to the feeling of weight which is experienced in the loins during the early part of the period; and in reference to all these mechanical evils of pregnancy, I remark that it is of great service for the patient to recline, for a short period, a number of times a day. If she is of active disposition and habits she may not feel inclined to do so; yet she will find the practice a good one, and productive of much comparative comfort.

If the abdomen becomes too pendulous, as it sometimes does, owing to the flaccidity of the abdominal parietes, a considerable degree of relief may be obtained from stays of a proper construction. These, however, should be so fashioned and arranged as not to overheat the parts, otherwise they will be made weaker, and thus more harm than good will be the result. The wet girdle, suitably applied, is an excellent appliance. Nor should any of these helps be used too much of the time.

EXPOSURE TO DISEASE.

Pregnant females should not expose themselves to infectious diseases; although it appears to be established that they are not, under such circumstances, as liable to contract such disease as at other times. Still, if they do contract them, the result is likely to be a more serious one; and in case the mother escapes, the child may suffer, and abortion, even, may be the result.

VACCINATION.

I am opposed to vaccination at all times. It is better, I believe, to live carefully and consistently in all respects, and trust nature for the result. There are many objections to vaccination, which I need not here mention. Pregnant women especially, who are necessarily, in the present state of things, more than others, subject to inflammatory diseases, and less liable, when attacked by acute disease, to recover therefrom, should not be vaccinated. Here are Professor Meigs’s earnest injunctions on the subject. Writing to his class, he observes:

“Pregnant women ought not to be vaccinated. This is a rule which I would advise you to depart from only on the most urgent occasions. If a woman have been ever vaccinated, and appeal to you to re-vaccinate her, because there is a prevalent variolous epidemic, I hope you will refuse to accede to her request. Small-pox is exceedingly and peculiarly pernicious to pregnant women. She who has it, and miscarries, or who is brought to bed at term, generally dies. It is, in my opinion, inexcusable to expose her to so great a risk—a risk far greater than that from accidental contagion, or that of the epidemy. But the vaccine is identical with the variolous animal poison, saving some lessened intensity of its malignant form, derived from its having been modified by the nature of another mammal. To inoculate a cow with small-pox virus, is to give her the vaccine disease, with the lymph of which you can vaccinate, but not reproduce unmodified small-pox. Keep your pregnant patients clear of small-pox, in all its forms, whether modified or unmodified. Do not vaccinate them. I have been the witness of dreadful distress from the operation. Eschew it, I entreat you.”

By way of digression, we may inquire, if pregnancy is an objection to vaccination, why should any person be vaccinated? If those who are in a condition which renders them most susceptible of disease should not be exposed to the variolous poison, why should others who are less susceptible? If any are to take the risk of small-pox without vaccination, I think the strong can afford to do it, rather than the weak. If vaccination is good for any thing, it should be, I think, the most worth for those who are the most liable to harm from the variolous disease.

LETTER XIX.
DISORDERS OF PREGNANCY.

Nervousness—Mental Despondency—Longing—The Imagination—Effects of Fright.

During that portion of the woman’s life in which she is capable of bringing forth children, a period usually of about thirty years, the uterus may be justly considered as the great center of her system. The truth of no observation in medicine has been more generally acknowledged than that of the extreme irritability of this organ, and of the propensity or aptitude which the whole body has to become affected or disturbed by its influence. In the progress of the development of the procreative function, great changes take place; and in pregnancy these effects are not the less remarkable.

The changes which are wrought in the system by pregnancy are not less remarkable in the nervous system than in the other parts of the body. The womb itself is highly endowed with nervous connections and sympathies, and in many respects the uterus, during the child-bearing period, may be considered the great nervous center of the female.

When it is remembered how extremely impressible the nervous system becomes during pregnancy, we are taught the importance of preventing women, under these circumstances, from witnessing things that are calculated powerfully to excite the mind. This caution is especially to be observed in regard to exposing her to scenes of suffering, distress, danger, or the agonies of a death-bed. It is a sad thing for a pregnant woman to lose a husband, child, or other near and dear friend.

Pregnant women should be very careful to avoid the sight of convulsive and nervous affections. They should not, on any account, be present when another is in labor; for it has been observed that some become greatly terrified under such circumstances, while of themselves they are able to pass through its agonies with all commendable courage.

MENTAL DESPONDENCY.

When we consider how important an epoch the period of pregnancy is in a woman’s life, we cannot be surprised that her mind should sometimes fall into a state of depression, out of which it is not in her own power, or that of any who are about her, to recall it. In the first pregnancy especially, the mind is apt to become thus affected. Shall I be able to survive the period? Shall I bring forth a well-formed, or a diseased, misshapen, deformed child? Will it not present badly at birth? Shall I not have twins, or triplets, perhaps? What new and untold agonies must I be brought to endure? These, and the like questions, must suggest themselves to the mind of every sensible and reflecting woman, and more particularly so when she is carrying her first child. And so it should be; for, say what we will about the safety of labor, about its being a natural process, etc., there are yet the pains and perils which belong necessarily to it, and which all of your sex who bear children must inevitably, to a greater or less extent, be subject to. I have not, I trust, heretofore, in my medical lifetime, been wholly unmindful of my duty as a physician, in endeavoring to instruct and to encourage your sex in these matters. But I have never wished to conceal my conviction that I regard pregnancy and childbirth as things of very serious moment in a woman’s life; and he who can trifle with them is almost worse than a very fiend. Bear witness, then, I respectfully ask of all of you, that I, for one, have no sympathy with that nonsensical foolishness which would lead some people to tell you that pregnancy and childbirth are matters which need cause you no trouble, no agony, and no pain. I repeat, then, considering the truth in these things, it is not at all surprising that the pregnant woman should feel a good deal of concern in consequence of what she is to pass through.

But I must tell you also, that this mental solicitude is often increased to an unnecessary extent by the inadvertent remarks which are sometimes made respecting some unfavorable case. One tells of one sad accident, and one of another. Now all this is both unkind and unjust. Only place yourselves in the case of the pregnant woman. Would you like to have those strange and horrible stories told you, some of which may be true, and some not? Would you not rather that your sisters would speak to you, generally, at least, of pleasant occurrences, and of pleasant things? If they could not speak to you in a hopeful manner, certainly you would rather they would not speak to you at all.

Did you ever think of one of your sisters who is pregnant with an illegitimate child? If you who have kind husbands and kind friends to take care of you, become low-spirited in pregnancy, what must be the feelings of her who knows that she must constantly be looked upon as an object of shame? What think you of her who has been led astray by the profligate from virtue’s paths of pleasantness and peace? of her who is compelled to consider her pregnancy as a curse instead of a blessing, and who has, in addition to the troubles of this state, to bear up against the agony of her disappointed hopes, her sorrows, and her grief. She must live in anticipation of a shame from which she can find no antidote, no retreat. How often, alas! has such a state of mind ended in a state of disease which has, in a short period, terminated life. Believe we that Jesus of Nazareth would treat such a one as we too often have done, when we know that He said, kindly and affectionately, to a woman who had been caught in the very act of adultery, “Go, and sin no more!” Many a one has been thus disowned who might have been a loving mother and an affectionate companion through a long and happy life, and whose death-agonies were only the more embittered by the reflections of her fallen and deserted state.

In ordinary cases depression of the spirits is most apt to come on during the earlier months of gestation. Dr. Montgomery speaks of a curious fact connected with the state of mind in pregnant women, when their bodily health is at the same time good, namely, that however depressed or dispirited with gloomy forebodings they may have felt in the early part of their pregnancy, they in general gradually resume their natural cheerfulness as gestation advances; and a short time before labor actually commences, often feel their spirits rise, and their bodily activity increase to a degree they had not enjoyed for months before. This, however, does not always take place, for in some cases the despondency continues to the very end of the period, at which time it generally disappears, but not until the pains of labor have actually commenced. With some, likewise, the despondency continues even after the labor has been passed through, and amounts almost to a fit of mental derangement.

Treatment.—It should always be remembered, that in most cases of the kind I have been considering, the state of health is not good. In some cases the deranged state of the body operates, doubtless, to depress the spirits and to derange the mental manifestations. In other cases the mind appears to become first affected, and afterward the body suffers in consequence thereof. In some cases, also, it is to be supposed that the action is reciprocal, and probably pretty fairly balanced between the two.

This explanation will enable us to form an opinion as to what the course of treatment should consist in, which is, as far as possible, to remove the causes of the difficulty.

In the slighter cases of mental depression a little improvement of the general health is often sufficient to work a radical change in the patient’s feelings. In the more persistent cases we should do all in our power to tranquilize the mind and restore the bodily health.

LONGINGS.

Some women, when pregnant, experience the most strange and wayward desires in regard to particular articles of food. This sensation is what is commonly called longing; and it is believed that if the preternatural craving is not gratified, a likeness or representation of the article longed for is very apt to be impressed upon the child.

It is true that some writers of eminence—as Professor Meigs, of Philadelphia, for example—have doubted the existence of any such sensation as the one in question; but the majority of writers are of the opposite opinion. Women also themselves—and they ought to be the best judges in a matter of this kind—do tell us that they know positively the truth of such a sensation as longing.

There are some remarkable facts on record concerning the symptoms which I am considering, and which would go to prove that it is not always the good things of this world that are longed for. If women were always in the habit of craving good and savory dishes under these circumstances, we should have some reason to suspect them of dishonesty in regard to the reality of longing; but when the fickle and morbid appetite is found often to crave the most unrelishable articles, we must admit the truth of the doctrine of which we are speaking.

A lady has been known, who, when not pregnant, having a great horror of eating eels, and yet when in this situation she has demanded them with an importunity not to be resisted. She would not only eat them with avidity, but in large and repeated quantities, for the first few months; she would then become indifferent to them, but not averse, until after her delivery.

A woman pregnant, riding over a common, has scented spoiled shad that had been thrown out, and became instantly so fascinated by their odor, that she obliged her husband to take some of them into his gig; and as soon as she arrived at home, began to eat of them, raw as they were, and continued to do so daily until they were consumed, though they were extremely offensive to every body else in the house.

A woman pregnant, while passing through her kitchen, has taken a disgusting piece of bacon boiling in a soap-kettle, out of the vessel, eating it afterward, with the greatest relish.

These are, it is true, extreme cases; but there are many which are far from being of a character so trifling as to warrant the conclusion that no such thing as longing for strange and disgusting articles during pregnancy exists. Indeed, the truth of the doctrine is so well understood among all classes as not to need any further proof.

Should these longings in pregnancy be gratified, and if so, to what extent? This is a question of great practical importance, and one which should be deeply pondered upon.

It is notorious, in the first place, that longing seldom, if ever, occurs in a woman of good health and a well-constituted mind. If we observe correctly, we shall find that it occurs seldom, if ever, in any other than delicate and nervously irritable women.

It occurs, in the second place, particularly among those who are indolent in their habits, having little or nothing to do, and without any wholesome object of thought or occupation with which to “kill time.”

It occurs, in the third place, to those who have been in the habit of being pampered and indulged on every occasion. A woman who is continually in the habit of saying to her indulgent husband that she wants this, that, and the other thing, and if the good husband sees fit to gratify his interesting spouse in every thing which a morbid fancy can imagine, he will have business enough to kill his time, and a feeble, sickly wife in the bargain.

If this longing occurs only to the feeble and delicate, to the nervous, the indolent, and those who have been habitually pampered, what, I ask, are we to do in the premises? Shall we gratify every whim of a nervous, unhealthy person, or shall we rather advise her to live on plain and wholesome food, at the same time directing her to occupy herself, body and mind, as a reasonable being should? It does not certainly require much common sense to enable one to settle this question as it should be.

But there are those among women who honestly believe that if their cravings are not satisfied in pregnancy, the child is very liable to become marked with an appearance like that of the article longed for.

The fallacy of this belief will at once be apparent, when it is considered how many cases of longing there are—cases, too, which are never gratified, while, at the same time, but very few children are ever found marked. The imagination can have no more effect here than in the cases of malformation, the absence or addition of a part, or in determining the color of a child. Hence a woman need not fear, as I have known them to do, that if their morbid appetite is not gratified in every particular, they are in danger of bringing forth a marked child. But more of this in another place.

Some physicians are of the opinion, it is true, that it is best to gratify longings to a certain extent. But suppose they are not gratified: the worst that can come is sickness at the stomach, nausea, and possibly vomiting—symptoms which, all of them, vanish soon enough, ordinarily, if the diet is made what it should be, in connection with good habits generally.

The truth is, that the mind itself is more disordered than the stomach in these cases. Hence an important consideration in the cure of it is, to provide the individual with some useful and wholesome employment, which at the same time engages both the mind and body healthfully. At the same time the food should be of such a character as is best suited to a delicate state of the system, remembering always, that there is no period of life in which more care is necessary, in this respect, than in pregnancy.

But if, on the other hand, the preternatural craving is indulged, and the mind is left to prey upon itself, as it will without any suitable employment, the sensation will grow more and more persistent, and the fancy will be continually excited to produce new whims for its gratification, which, if answered, must necessarily be attended with detriment to both mother and child.

THE IMAGINATION.

Women are sometimes troubled about certain matters in pregnancy, which, if they had a proper knowledge on the subject, would cause them no mental disquietude whatever. Thus it is believed that the marks which sometimes appear on children, and continue through life, are to be attributed entirely to the workings of the mother’s imagination during this period, and that even the color of the offspring may be determined by this circumstance alone.

The origin of this belief is, indeed, coeval with the history of the race. But antiquity alone is not a sufficient argument for any doctrine, no matter how old or how venerable a theory, if we know it to be disproved by the actual facts. If we were to take the antiquity of a doctrine or belief as the rule, and not have regard to reason and experience there would be no end to error, and no improvement.

In the earliest period of medicine this delusion prevailed; and Hippocrates, honest and learned as he was, yet believed it, and aided in its propagation. Through his influence kings and nobles acted upon the principle, which, in some cases, at least, was made the cloak of wickedness and deception. Thus Hippocrates saved a noblewoman—and honestly, without doubt, though ignorantly—from the severity of the law, when she had given birth to a colored child, herself and husband both being white. He alleged that the darkness of its color was the effect of a picture of an Ethiopian that hung upon the wall in her chamber, and which was often the object of her contemplation. Galen was also of the opinion that a picture was sufficient, if contemplated with interest, to give a corresponding appearance to the fetus in utero; and Soranus declares that the tyrant Dionysius, who was deformed and ill-favored himself, employed the aid of beautiful pictures, with the hope that his wife might have comely issue. Cælius Rhodius also mentions that Fabius Quintillian saved a woman from suspicion, after she had brought forth a negro child, by asserting that the circumstance arose from the fact of her taking great pleasure in viewing the picture of a black man in her apartment. From the prevalence of this belief it was, likewise, that Heliodorus formed the first, and, as is said, one of the most beautiful novels in the world, called the “Loves of Theagenes and Carachlea,” the latter having been born white from black parents, but the queen, her mother, had often viewed, during her pregnancy, the picture of Andromeda, who was painted with a white face; and the sages attributed the white color of the child to the force of the mother’s imagination.

This superstition—for it does not deserve a better name—has probably always been believed in the world, and for a long time will continue to be by many, but not to that extent which it anciently was. We cannot believe, if cases like these, occurring in the time of Hippocrates and Quintillian, were to occur in our own day, and were now to be presented for judicial decision, that any judge or jury could be found so ignorant as to decide that the color of a child can be changed by force of the mother’s imagination alone; but things scarcely less ridiculous and absurd are believed by almost every member of society who has any belief whatever on the subject. Thus it is now a matter of common belief, that the imagination of the mother may impose upon the skin certain resemblances to things upon which the fancy has been much employed, such as fruit, articles of food and drink, animals, insects, etc., or by the destruction of certain parts of the body, such as the head, arms or legs, lips, etc., or by the production of an additional part, as the fingers, toes, head, etc.

In order to settle this question satisfactorily, and beyond the possibility of mistake or doubt, it is well for us to look at the facts of nature as they exist everywhere about us, or, in other words, to the anatomy and physiology of the human body as it really is.

In regard to the anatomical connection between the mother and fetus, it is to be observed that it is altogether indirect, and is carried on only through the medium of the circulation. There is no nervous connection between mother and child; that is, no nervous filament, however small, has ever been detected passing from one to the other. “From this wise and all-important arrangement,” observes Dr. Dewees, “it follows that the fetus is not subject to the various and fluctuating condition of the sanguiferous, or to the never-ending changes of the nervous system of the mother; since no direct communication exists between her blood-vessels or nerves and those of the fetus, to impose upon it any alteration that may take place in her system, or to render the child liable, through the medium of nervous connection, to her affections.” If the indirect connection that exists between the mother and child were better understood, and more justly appreciated, we should, doubtless, hear much less of the influence of the imagination of the mother upon the body of her infant, and thus one of the greatest of the attendant evils of pregnancy would be removed.

It is not to be denied that cases do occur in which there seems to be a hereditary predisposition to the perpetuation of supernumerary parts, marks, etc., in certain families; such as an additional thumb, finger, toe, or double teeth, in place of single; but such cases are not the result of any mental emotion, but are merely the effect of hereditary predisposition, the truth of which is admitted on all hands, and is a very different thing from that which we are now considering.

It has not been attempted, on the part of any, to determine at what precise period during pregnancy the imagination begins or ceases to have an influence upon the body of the child, but, according to the accounts given, every period is liable to the accidents or anomalies in question. The imagination, it is supposed, has the power, not only of causing the creation of a new part, but also of destroying one or more of the members of the body. Now, suppose a leg, an arm, or a toe, to be cast off, must it not be expelled from the womb? And who has ever detected such an occurrence? Besides, too, is it to be supposed that nature would arrest the flow of blood after the part has been separated from the body of the fetus? There can be no doubt as to what is the truth in this matter.

Dr. Dewees mentions the case of a child that was born with but the stump of an arm, which, at the time of birth, was perfectly healed, or, rather, presented no evidence of ever having had a wound upon it at all. The mother declared that she had been frightened at the sixth month of pregnancy by a beggar. But what became of the lopped-off arm? and what arrested the bleeding? The child was born healthy and vigorous, and neither scar, wound, or blood could be discovered. In this case, as in all others of this kind, the “freak of nature” commenced at the first of gestation, the imagination of the mother having nothing to do with it.

The most learned and experienced medical men are all agreed on this subject. Dr. William Hunter, it is said, used to declare in his lectures, that he experimented in a lying-in-hospital upon two thousand cases of labor, to ascertain this point. His method was as follows: As soon as a woman was delivered, he inquired of her whether she had been disappointed in any object of her longing, and what that object was? If her answer were Yes, whether she had been surprised by any circumstance that had given her an unusual shock, and of what that consisted? Whether she had been alarmed by any object of an unsightly kind, and what was that object? Then, after making a note of each of the declarations of the woman, either in the affirmative or negative, he carefully examined the child; and he assured his class that he never, in a single instance of the two thousand, met with a coincidence. He met with blemishes when no cause was acknowledged, and found none when it had been insisted on.

Dr. Hunter, however, confessed that he met with one case in his private practice that puzzled him; and he told his pupils he would merely relate the facts, and leave them to draw their own conclusions. A lady had been married several years without proving pregnant, but at last she had the satisfaction to announce to her husband that she was in that situation. The joy of the husband was excessive, nay, unbounded, and he immediately set about to qualify himself for the all-important duty of educating his long wished-for offspring. He read much, and had studied Martimus Scribelerus with great patience and supposed advantage, and had become a complete convert to the supposed influence of the imagination upon the fetus in utero. He accordingly acted upon this principle. He guarded his wife, as far as in him lay, against any contingency that might affect the child she carried. He therefore gratified all her longings most scrupulously; he never permitted her to exercise but in a close carriage, and carefully removed from her view all unsightly objects.

The term of gestation was at length completed, and the lady was safely delivered, by the skill of Dr. Hunter, of a living and healthy child; it had, however, one imperfection—it was a confirmed mulatto. On this discovery being made, the father was at first inexorable, and was only appeased by his dutiful and sympathizing wife calling to his recollection the huge, ugly negro that stood near the carriage door the last time she took an airing, and at whom she was severely frightened!

Dr. Dewees, whose experience in matters connected with the birth of children was probably as great as that of any other individual, tells us that he commenced practice with the popular belief concerning the effect of the mother’s imagination upon the physical condition of the child. But he had watched these things attentively for many years, and for the want of facts to substantiate the truth of the common belief, he was obliged to abandon it. He came to the conclusion that the imagination of the mother has no influence whatever upon the form or complexion of the fetus.

Fortunately, these absurd notions have long since been rejected by all sensible, observant, and intelligent physicians; and the fact that multitudes of those who are, or are to become mothers, do yet believe them, is the only reason for attempting a refutation of them. If we can but convince mothers of the fallacy of the belief we have been combating, we shall save them a great amount of anxiety and alarm. With many, who are not by any means to be classed among the “weak, ignorant, and superstitious” of females, every sudden or unexpected occurrence that happens to strike them with fear, or produces any strong mental emotion or excitement, is apt to impress them with alarming apprehensions as to the effects it may have on the development and conformation of the child in the womb. These ridiculous illusions, moreover, are often much increased by the strange stories respecting marks and malformations, occasioned, as is asserted, by the imagination of the mother; and these narratives always find their way among the credulous in society; for ignorant nurses, and gossiping idlers among the old women, are everywhere to be found, and all of them are well stocked with extraordinary examples of the pretended influence of which we are speaking. If a child is born with any spot or blemish upon its body, or with any malformation whatever, forthwith the mother is questioned as to the whole circumstances of the matter. If, at any time during pregnancy, any thing has attracted her attention, or strongly impressed the mind, which bears any resemblance or similitude to the mark, spot, blemish, or malformation of the child, it is at once put down as the certain cause of the defect. In this way these absurd apprehensions are often made to take so deep a hold upon the mind of pregnant females, that no expostulation or ridicule of the physician, or other friend, can entirely subdue them; and in some instances these apprehensions become so fixed as to cause a great degree of anxiety and distress of mind, and not unfrequently cause a great amount of physical suffering and ill health.

EFFECTS OF FRIGHT.

I have already remarked that the mind of the pregnant woman should be kept as calm, composed, and contented as possible during the pregnant state. In no respect is this advice more appropriate than in regard to the strong impressions of fear and every sudden emotion of an unpleasant kind.

Some of the most remarkable cases illustrative of the effects of fright in pregnancy, are given by Baron Percy, an eminent French surgeon, as having occurred at the siege of Landau, in 1793. It is stated that, in addition to a violent cannonading, which kept the women for some time in a constant state of alarm, the arsenal blew up with a terrific explosion, which few could listen to with unshaken nerves. Out of ninety-two children born in that district within a few months afterward, sixteen died at the instant of birth; thirty-three languished for from eight to ten months, and then died; eight became idiotic and died before the age of five years; and two came into the world with numerous fractures of the bones of the limbs, caused by the cannonading and explosion! “Here, then,” as Dr. Combe observes, “is a total of fifty-nine children out of ninety-two, or within a trifle of two out of every three, actually killed through the medium of the mother’s alarm, and its natural consequences upon her own organization.” Cases are recorded, in which the mother, being abruptly informed of the death of her husband, has suffered an immediate miscarriage in consequence. In some cases the child has survived, but has afterward, throughout life, been subject to great nervousness and liability to fear. James I., King of England, is said always to have had a constitutional aversion to a drawn sword and to any kind of danger, which was attributed to the constant anxiety and apprehension which his mother suffered during the period of gestation.

It will appear very plain to any one who is at all acquainted with this subject, that an impression which is powerful enough to cause such effects upon the child as the cases given by Baron Percy would indicate, must also act with detriment upon the mother. Indeed, it is only through the mother’s organization that it is possible for the impression to be communicated to the child; and although the mother’s life is not often actually destroyed under such circumstances, her nervous system may yet receive a shock which is sufficient to cause her life-long misery and ill health.

The practical lessons to be drawn from such facts are many, and, for the most part, easy to comprehend. They teach us how important it is that a woman who is pregnant should, by all that is in her power, shun scenes of fear and danger. Husbands, and all who are in any way connected with her, should spare no pains in rendering this important and trying period of her life as happy and tranquil as the circumstances will allow. True, she should not make a baby of herself, or be babied by others; but, considering the liability to danger while in this condition, she should be careful of herself, in all respects, while passing through the period, and those about her should use all due caution in regard to it.

LETTER XX.
DRUG-TREATMENT IN PREGNANCY.

Effects of Blisters—Emetics—Purgative Medicines—Bleeding.

I could hope that not one of the large number of persons whom I address, would ever be subjected to any of the processes of drug-treatment in so critical a period as pregnancy. The water-treatment I regard as being so much safer, as well as more effectual, for the eradication of any and all the diseases to which you may be subject at this time, as well as others, that I should be very glad if I could say something to inspire you with a greater degree of confidence in the new method. But perhaps I am wrong; some of you, at least, have the fullest confidence in the sanative powers of water, and have no need of any thing more being said on that point. It is proper, however, that I say something here respecting the effects of certain drugs and drug-appliances, in this period.

BLISTERS.

It is the testimony of honest and capable practitioners, that these are far more liable to do harm in pregnancy than at other times.

Dr. Dewees asserts that he had known two cases of abortion caused by the use of blisters, although he acknowledged they had, in some cases, been advantageously resorted to as a means of preventing that evil. But how, it may be asked, are physicians to know when to use them, and when not? This no man can tell. Nor have we any need of blistering at this or any time, because there are better means, which are entirely safe.

The same able author whom I just quoted, tells us that blisters are much more likely to produce strangury during pregnancy than in other cases; and that when this occurs, it is almost sure to be followed by the most distressing and untoward symptoms. Entire retention of urine sometimes follows the use of cantharides in these circumstances, which can only be relieved by the use of the catheter. There is also, at such times, not unfrequently so distressing an inclination and violence of effort to void urine, as to be surpassed only by the agony of labor itself. Bloody urine has sometimes followed the use of a blister; and a discharge of mucous from the internal surface of the bladder has continued, as a consequence, for a long time after. “It is true,” observes a distinguished author, “these are extreme cases; but they nevertheless occur, and should, therefore, suggest a great deal of caution in their employment, especially in the more advanced periods of gestation.”

EMETICS.

These are no more necessary in pregnancy than blisters. Severe vomiting is sometimes productive of abortion; and who is wise enough to foretell what may be the effect of a dose of tartar emetic given to a woman when in this highly impressible state? A single emetic has caused severe and permanent pain, which has been removed only after parturition has taken place.

PURGATIVE MEDICINES.

That pregnant women do not bear purging so well as at other times, is a matter of common observation among medical men. There is in such practice a great liability of causing abortion, especially if it be carried too far. It is not difficult to account for the fact, when we remember how great is the sympathy which exists between the womb and the bowels.

If you should be obliged, any of you, under such circumstances, to be purged, I advise you to see to it that you know what medicines you take. Those particularly which have a powerful effect upon the bowels should be avoided; aloes, colocynth, scammony, and gamboge, should on no account be tolerated. These have a particular effect in exciting the lower part of the alimentary canal, causing tenesmus or a bearing-down pain in the rectum, which, by sympathy, is very liable to be communicated to the womb. This is shown by the fact that dysentery often causes miscarriage.

BLOOD-LETTING.

Not many years since, it was generally supposed that a woman could not pass through the period of pregnancy safely without being bled; and although a change has been wrought in the public mind in regard to this practice, there are yet many who labor under erroneous impressions in regard to this subject. There are those who regard it as indispensable to resort to this measure, notwithstanding there may be no particular symptom that, under other circumstances, would be considered necessary to warrant a resort to the measure.

It must be admitted, however, that pregnancy is attended with a degree of fullness, and a tendency to plethora, which does not obtain in other states of the system. There is, indeed, always, during pregnancy, a greater liability to febrile and inflammatory diseases than is ordinarily experienced. But all this does not prove that blood-letting should be practiced in all, or in any considerable number of cases. Besides, also, it is doubted by many honest and able practitioners of the medical art, as to whether bleeding is ever, under any circumstances, necessary. There are others, too, who believe in the comparative necessity of blood-letting under certain conditions of the system, but who, at the same time, hold that there are better, safer, and more efficacious means of bringing about the required object. At all events, physicians very seldom, at the present day, resort to blood-letting during pregnancy, either in this country or the old; and in those rare cases in which this measure is resorted to, it is in answer only to indications of an imperative and decided nature.

Nor is the practice of blood-letting a comparatively harmless one, as many suppose it to be. “Why,” it is said, “if it is not absolutely necessary, it can yet do me no harm.” This is a poor recommendation of a remedy. If a remedy is not capable of doing harm under some circumstances, it would hardly be possible for it to do good at any time. The testimony of the strongest advocates for the practice is, that blood-letting has frequently been known to do serious, and sometimes irreparable mischief, when practiced during the period of which we are speaking.

Dr. Eberle gives the following good advice on this subject: “A very severe and troublesome pain is often experienced in the right hypochondrium during the latter period of pregnancy; and this suffering is, almost always, sought to be mitigated or removed by blood-letting. When decided evidences of plethora accompany this painful affection, bleeding will occasionally procure considerable relief; but in the majority of instances, no mitigation whatever is obtained from this measure. The relief which is sometimes procured by bleeding is always of short duration, the pain usually returning in the course of two or three days; and if the bleeding is thus frequently repeated, as is sometimes done, much mischief is apt to be produced by the general debility and languor which it tends to occasion. When the symptoms of vascular turgescence throughout the system are conspicuous in connection with this pain in the side, it will certainly be proper to diminish the mass of the circulating fluid by venesection; but when no indications of this kind are present, blood ought not to be abstracted, merely on account of this affection, for it will most assuredly fail of procuring the desired relief, and may, when not particularly called for, operate unfavorably on the general health of the patient. Moderation in diet, together with a proper attention to the state of the bowels, and the use of gentle exercise by walking, will, in general, do much more toward the removal of this source of uneasiness and suffering, than will result from blood-letting, when this evacuation is not specially indicated by the fullness and firmness of the pulse, or by other manifestations of general vascular plethora.”

But in these cases, when so careful a practitioner as Dr. Eberle even, would think it best to resort to the lancet, it is a well-attested fact, that fasting and prudent abstemiousness are far better, more effectual, and more permanent in their action upon the system than blood-letting. The hunger-cure, which I have so often for years past recommended, is a most valuable remedy in all plethora or over-fullness of the system, and in all kinds and degrees of pain arising from such fullness. See, too, how reasonable it looks; for the body, as you know, is always wasting itself, so that if we stop off the supply, the over-fullness must by a natural process very soon become cured; hence I say, do not be bled in pregnancy; and when you have need FAST.

LETTER XXI.
STERILITY OR BARRENNESS.

Their Causes—The Catamenial Discharge as affecting it—Fluor Albus—Corpulency—The Treatment appropriate in these Cases.

When a woman is not able to conceive, the defect must depend upon a malformation, a diseased state, or a diseased action of the generative organs.

Causes.—Organic barrenness happens in those cases where there is some structural hindrance or defect, either natural or accidental. The vagina may be imperforate, so as wholly to preclude the intermission of the seminal fluid; the ovaria may be either wholly wanting or too small; or the Fallopian tubes imperforate; or the uterus so small as not to be capable of its proper functions. The hymen may also be so hard and resisting as to prevent the natural measures for conception.

In most cases of barrenness, however, the organs of generation appear to be properly formed, but their action is imperfect or disordered.

If the menses have not appeared, or if the discharge is scanty, and occurs at irregular periods, the woman rarely conceives.

So also when the menstrual flux is more frequently repeated than it is in its natural course, or when it occurs even after the proper time, in too great profusion, and, as is generally the case, intermixed with genuine blood, there is little prospect of conception taking place. In such cases there often appears to be as little desire for cohabitation as there is power of fecundity.

Pregnancy seldom happens when the catamenial discharge is attended with great and spasmodic pain, particularly if the discharge is small in amount, and of deteriorated quality. If, under such circumstances, conception does take place, the next periodical flow is very apt to cause the uterus to discharge the germ, thus bringing on an early miscarriage.

The state of weakness and debility of the uterine system occasioned by too frequent sexual intercourse, is a common cause of sterility. Those unfortunate creatures who follow a life of prostitution seldom bear children.

Bad cases of fluor albus often indicate a state of the uterus and ovaries which does not admit of conception.

There is also to be mentioned, among the causes of barrenness, what has been called by medical writers copulative incongruity. “Every one,” observes Dr. Good, “must have noticed occasional instances in which a husband and wife, apparently in sound health and vigor of life, have no increase while together, either of whom, nevertheless, upon the death of the other, has become the parent of a numerous family; and both of whom, in one or two curious instances of divorce, upon a second marriage. In various instances, indeed, the latent cause of sterility, whatever it consists in, seems gradually to diminish, and the pair that was years childless is at length endowed with a progeny.”

Corpulency is also to be mentioned among the causes of barrenness. Women who are very fat are often sterile, from the fact that obesity is in reality a state of disease.

It is supposed by many that barrenness is almost always the fault of the female. But this is not necessarily so; the husband, as well as the wife, may be feeble in the procreative function; and men who have lived a debauched or dissipated life are very apt to be so. Hence it is that women are often blamed when they ought not to be.

Treatment.—In regard to the therapeutic management suitable to be adopted in such cases, it is to be remarked, that if organic disease is the cause of the difficulty, we cannot, as a general thing, expect by any means to effect a cure. But in a large majority of cases the difficulty is only a functional one; in many of these, therefore, a cure may be brought about.

The sum total of the therapeutic management proper to be adopted in such cases is, invigorating the general health. That which will best tend to fortify and strengthen the system generally is also best for the local weakness. Nor is a cure to be effected in a short period of time in most cases of sterility. It may require many months, and even years, to accomplish the object.

“Abstinence by consent for many months,” observes Dr. Good, “has proved a more frequent remedy than any other, and especially when the intercourse has been so incessantly repeated as to break down the staminal strength; and hence the separation produced by a voyage to India has often proved successful.”

Some years ago I wrote in my note-book the following paragraphs on this subject:

“A few months since, one of my patients, a gentleman of this city, informed me that a lady relative of his, with whom also I am acquainted, had been married about eight years, remaining, much to her sorrow, childless. She experienced frequent miscarriages, accompanied with much general debility. About two years since the subject of water-treatment came under her observation. She at once commenced a course of bathing, with due attention to regimen, etc. She became much improved, and, in due time, bore a healthy, well-formed child. She attributed this most desirable result to the effects of water in restoring her general health.

“Another lady remained without offspring for fifteen years after marriage. Her husband, in building a new house since the introduction of Croton water into this city, erected also convenient bathing fixtures. The lady practiced perseveringly a course of bathing, and became much improved in her bodily health. She, too, was at length blessed with an offspring, and, as she believed, in consequence of the course she had pursued in restoring her general health.

“I have known and heard of numbers of cases in which, by a prudent course of bathing, exercise, etc., the use of a plain and unstimulating diet, and the observing of proper temperance in the marital privileges, persons have borne children when most earnestly, and by a great variety of means, that object had been sought in vain. Yet be it ever remembered, that little is to be expected from either water or diet without strict temperance in all things.”

The vegetable diet, so called, is very favorable to reproduction in the human species. See how Ireland, a small island comparatively, sends its inhabitants all over Great Britain and the wide extent of the United States. Yet the mass of Irish people, as every one knows, subsist, while in their own country, mainly on potatoes and sour milk, or a diet equally simple. The celebrated Dr. Cheyne remarked, from much experience, that the total milk and seed diet (meaning by seed, farinaceous substances generally), persevered in for two years, was in almost all cases sufficient to enable the barren to become pregnant by the appropriate means.

Fortify and invigorate the general health, observing at the same time the strictest “temperance in all things.” These are the means by which to overcome that, to many, unfortunate state, barrenness.

You, then, who may be in the condition we have been considering, if you wish to be cured of it, leave none of the tonic means, none of the good rules of health untried. If you are faithful in every thing, so may you expect to succeed. But if it should be found that it is not possible for you to conceive, you will yet have the satisfaction of knowing that your toils have not been in vain; your health will become so much improved as to reward you a thousand-fold for every good thing you do.

I ought to remark also, before closing, that when a woman who has been for a time barren becomes again pregnant, she must be very careful of herself during this period, as with a little imprudence abortion is very likely to occur.

LETTER XXII.
THE PELVIS AND ITS ORGANS.

General Description—Differences between the Male and Female Pelvis—The Bladder and Urethra—The Vagina—The Uterus and its Appendages.

Before entering upon the subject of labor and its phenomena, it is proper that I should give you some idea of the parts more immediately concerned in parturition. In doing this, I propose for the most part to adopt the plain and concise description of these structures given by Mr. Erasmus Wilson, of London, whose work on anatomy stands as high as any other that has ever been written.

THE PELVIS.

The pelvis, considered as a whole, is divisible into a false and true pelvis; the former is the expanded portion, bounded on each side by the ossa ilii, and separated from the true pelvis by the linea iliopectinea. The true pelvis is all that portion which is situated beneath the iliopectinea. This line forms the margin or brim of the true pelvis, while the included area is called the inlet. The form of the inlet is heart-shaped, obtusely pointed in front at the symphysis pubis, expanded on each side, and encroached upon behind by a projection of the upper part of the sacrum, which is named the promontory. The cavity is somewhat encroached upon at each side by a smooth quadrangular plane of bone, corresponding with the internal surface of the acetabulum, and leading to the spine of the ischium. In front are two fossæ around the obturator foramina, for lodging the obturator internus muscle, at each side. The inferior termination of the pelvis is very irregular, and is termed the outlet. It is bounded in front by the convergence of the rami of the ischium and pubes, which constitute the arch of the pubes; on each side by the tuberosity of the ischium, and by two irregular fissures formed by the greater and lesser sacro-ischiatic notches; and behind by the lateral borders of the sacrum, and by the coccyx.

A FEMALE PELVIS.
1. The last lumbar vertebra. 2, 2. The intervertebral substance connecting the last lumbar vertebra with the fourth and sacrum. 3. The promontory of the sacrum. 4. The anterior surface of the sacrum, on which its transverse lines and foramina are seen. 5. The tip of the coccyx. 6, 6. The iliac fossæ, forming the lateral boundaries of the false pelvis. 7. The anterior superior spinous process of the ilium; left side. 8. The anterior inferior spinous process. 9. The acetabulum. a. The notch of the acetabulum. b. The body of the ischium. c. Its tuberosity. d. The spine of the ischium seen through the obturator foramen. e. The os pubis. f. The symphysis pubis. g. The arch of the pubes. h. The angle of the os pubis. i. The spine of the pubes; the prominent ridge between h and i is the crest of the pubes. k, k. The pectineal line of the pubes. l, l. The ilio-pectineal line; m, m. The prolongation of this line to the promontory of the sacrum. The line represented by h, i, k, k, l, l, and m, m, is the brim of the true pelvis. n. The ilio-pectineal eminence. o. The smooth surface which supports the femoral vessels. p, p. The great sacro-ischiatic notch.

The pelvis is placed obliquely with regard to the trunk of the body, so that the inner surface of the ossa pubis is directed upward, and would support the superincumbent weight of the viscera. The base of the sacrum rises nearly four inches above the level of the upper border of the symphysis pubis and the apex of the coccyx, somewhat more than half an inch above its lower border. If a line were carried through the central axis of the inlet, it would impinge by one extremity against the umbilicus, and by the other against the middle of the coccyx. The axis of the inlet is therefore directed downward and backward, while that of the outlet points downward and forward, and corresponds with a line drawn from the upper part of the sacrum, through the center of the outlet. The axis of the cavity represents a curve, which corresponds very nearly with the curve of the sacrum, the extremities being indicated by the central points of the inlet and outlet. A knowledge of the direction of these axes is most important to the surgeon, as indicating the line in which instruments should be used in operations upon the viscera of the pelvis, and the direction of force in the removal of calculi from the bladder; and to the accoucher, as explaining the course taken by the fetus during parturition.

There are certain striking differences between the male and female pelvis. In the male the bones are thicker, stronger, and more solid, and the cavity deeper and narrower. In the female the bones are lighter and more delicate, the iliac fossæ are large, and the ilia expanded; the inlet, the outlet, and the cavity, are large, and the acetabula farther removed from each other; the cavity is shallow, the tuberosities widely separated, the obturator foramina triangular, and the span of the pubic arch greater. The precise diameter of the inlet and outlet, and the depth of the cavity, are important considerations to the accoucher.

The contents of the pelvis are, the bladder, vagina, uterus with its appendages, and the rectum. Some portion of the small intestines also occupies the upper part of its cavity.

THE BLADDER.

This is in relation with the os pubis in front, with the uterus behind, from which it is usually separated by a convolution of small intestine, and with the neck of the uterus and vagina beneath. The form of the female bladder corresponds with that of the pelvis, being broad from side to side, and often bulging more on one side than on the other. This is particularly evident after frequent parturition. The coats of the bladder are the same as those of the male.

THE URETHRA.

This is about an inch and a half in length, and is lodged in the upper wall of the vagina in its course downward and forward, beneath the arch of the os pubis, to the meatus urinarius. It is lined by mucous membrane, which is disposed in longitudinal folds, and is continuous internally with that of the bladder, and externally with the vulva; the mucous membrane is surrounded by a proper coat of elastic tissue, to which the muscular fibres of the detrusor urinæ are attached. It is to the elastic tissue that is due the remarkable dilatability of the female urethra, and its speedy return to its original diameter. The meatus is encircled by a ring of fibrous tissue, which prevents it from distending with the same facility as the rest of the canal; hence it is sometimes advantageous in performing this operation, to divide the margin of the meatus slightly with the knife.

THE VAGINA.

This is a membranous canal, leading from the vulva to the uterus, and corresponding in direction with the axis of the outlet of the pelvis. It is constricted at its commencement, but near the uterus becomes dilated, and is closed by the contact of the anterior with the posterior wall. Its length is variable; but it is always longer upon the posterior than upon the anterior wall, the former being usually about five or six inches in length, and the latter four or five. It is attached to the cervix of the uterus, which latter projects into the upper extremity of the canal.

In structure, the vagina is composed of a mucous lining, a layer of erectile tissue, and an external tunic of contractile fibrous tissue, resembling the dartos of the scrotum. The upper fourth of the posterior wall is covered, on its pelvic surface, by the peritoneum, while in front the peritoneum is reflected from the upper part of the cervix of the uterus to the posterior surface of the bladder. On each side it gives attachment, superiorly to the broad ligaments of the uterus, and inferiorly to the pelvic fascia and levatores ani.

The mucous membrane presents a number of transverse papillæ or rugæ, upon its upper and lower surfaces, which extend outward on each side from a middle raphé. The transverse papillæ and raphé are more apparent upon the upper than upon the lower surface, and the two raphé are called the columns of the vagina. The mucous membrane is covered by a thin cuticular epithelium, which is continued from the labia, and terminates by a fringed border at about the middle of the cervix uteri.

The middle, or erectile layer, consists of erectile tissue enclosed between two layers of fibrous membrane; this layer is thickest near the commencement of the vagina, and becomes gradually thinner as it approaches the uterus.

The external, or dartoid layer of the vagina, serves to connect it to the surrounding viscera. Thus it is very closely adherent to the under surface of the bladder, and drags that organ down with it in prolapsus uteri. To the rectum it is less closely connected, and that intestine is therefore less frequently affected in prolapsus.

The uterus is a flattened organ, of a pyriform shape, having the base directed upward and forward, and the apex downward and backward in the line of the axis of the inlet of the pelvis, and forming a considerable angle with the course of the vagina. It is convex on its posterior surface, and somewhat flattened upon its anterior aspect. In the unimpregnated state it is about three inches in length, two in breadth across its broadest part, and one in thickness, and is divided into fundus, body, cervix, and os uteri. At the period of puberty, the uterus weighs about one ounce and a half: after parturition, from two to three ounces; and at the ninth month of utero-gestation, from two to four pounds.

The fundus and body are inclosed in a duplicature of peritoneum, which is connected with the two sides of the pelvis, and forms a transverse septum between the bladder and rectum. The folds formed by this duplicature of peritoneum on either side of the organ are the broad ligaments of the uterus. The cervix is the lower portion of the organ; it is distinguished from the body by a well-marked constriction; to its upper part is attached the upper extremity of the vagina, and at its extremity is an opening, which is nearly round in the virgin, and transverse after parturition; the os uteri, bounded before and behind by two labia, the anterior labium being the most thick, and the posterior somewhat the longest. The opening of the os uteri is of considerable size, and is named the orificium uteri externum; the canal then becomes narrowed, and at the upper end of the cervix is constricted into a smaller opening, the orificium internum. At this point the canal of the cervix expands into the shallow triangular cavity of the uterus, the inferior angle corresponding with the orificium internum, and the two superior angles, which are funnel-shaped, and represent the original bicornute condition of the organ, with the commencement of the Fallopian tubes. In the canal of the cervix uteri are two or three longitudinal folds, to which numerous oblique folds converge, so as to give the idea of branches from the stem of a tree; hence this appearance has been denominated the arbor vitæ uterina. Between these folds, and around the os uteri, are numerous mucous follicles. It is the closure of the mouth of one of these follicles, and the subsequent distention of the follicle, with its proper secretion, that occasion those vesicular appearances so often noticed within the mouth and cervix of the uterus, called the ovula of Naboth.

Structure.—The uterus is composed of three tunices: of an external, or serous coat, derived from the peritoneum, which constitutes the duplicatures on each side of the organ, called the broad ligaments; of a middle, or muscular coat, which gives thickness and bulk to the uterus; and of an internal, or mucous membrane, which lines its interior, and is continuous, on the other hand, with the mucous lining of the Fallopian tubes, and on the other with that of the vagina. In the unimpregnated state, the muscular coat is exceedingly condensed in texture, offers considerable resistance to section with the scalpel, and appears to be composed of whitish fibers, inextricably interlaced and intermingled with blood-vessels. In the impregnated uterus the fibers are of large size, and distinct, and are disposed in two layers, superficial and deep. The superficial layer consists of fibers, which pursue a vertical direction, some being longitudinal and others oblique. The longitudinal fibers are found principally upon the middle line, forming a thin plane upon the anterior and posterior face of the organ, and upon its fundus. The oblique fibers occupy chiefly the sides and fundus. At the angles of the uterus, the fibers of the superficial layer are continued outward upon the Fallopian tubes, and into the round ligaments and ligaments of the ovaries. The deep layer consists of two hollow cones of circular fibers, having their apex at the openings of the Fallopian tubes, and by their bases intermingling with each other on the body of the organ. These fibers are continuous with the deep muscular layer of the Fallopian tubes, and indicate the primitive formation of the uterus by the blending of these two canals. Around the cervix uteri the muscular fibers assume a circular form, interlacing with and crossing each other at acute angles. The mucous membrane is provided with a columnar ciliated epithelium, which extends from the middle of the cervix uteri to the extremities of the Fallopian tubes.

Vessels and Nerves.—The arteries of the uterus are the uterine, from the internal iliac, and the spermatic, from the aorta. The veins are very large and remarkable; in the impregnated uterus they are called sinuses, and consist of canals, channeled through the substance of the organ, being merely lined by the internal membrane of the veins. They terminate on each side of the uterus in the uterine plexuses. The lymphatics terminate in the lumbar glands.

The nerves of the uterus are derived from the hypogastric and spermatic plexuses, and from the sacral plexus. They have been made the subject of special investigation by Dr. Robert Lee, who has successfully repaired the omission made by Dr. William Hunter, in this part of the anatomy of the organ. In his numerous dissections of the uterus, both in the unimpregnated and gravid state, Dr. Lee has made the discovery of several large nervous ganglia and plexuses. The principal of these, situated on each side of the cervix uteri, immediately behind the ureter, he terms the hypogastric ganglion; it receives the greater number of the nerves of the hypogastric and sacral plexus, and distributes branches to the uterus, vagina, bladder, and rectum. Of the branches to the uterus, a large fasciculus proceeds upward by the side of the organ, toward its angle, where they communicate with branches of the spermatic plexus, and form another large ganglion, which he designates the spermatic ganglion, and which supplies the fundus uteri. Besides these, Dr. Lee describes vesical and vagina ganglia, and interior and posterior subperitoneal ganglia, and plexuses, which communicate with the preceding, and constitute an extensive nervous rete over the entire uterus. Dr. Lee concludes his observations by remarking: “These dissections prove that the human uterus possesses a great system of nerves, which enlarges the coats, blood-vessels, and absorbents during pregnancy, which returns, after parturition, to its original condition before conception takes place. It is chiefly by the influence of these nerves that the uterus performs the varied functions of menstruation, conception, and parturition, and it is solely by their means that the whole fabric of the nervous system sympathizes with the different morbid affections of the uterus. If these nerves of the uterus could not be demonstrated, its physiology and pathology would be completely inexplicable.”

APPENDAGES OF THE UTERUS.

The appendages of the uterus are inclosed by the lateral duplicatures of peritoneum, called the broad ligaments. They are the Fallopian tubes and ovaries.

VISCERA OF THE FEMALE PELVIS.
1. The symphysis pubis; to the upper part of which the tendon of the rectus muscle is attached. 2. The abdominal parietes. 3. The collection of fat, forming the projection of the mons Veneris. 4. The urinary bladder. 5. The entrance of the left ureter. 6. The canal of the urethra, converted into a mere fissure by the contraction of its walls. 7. The meatus urinarius. 8. The clitoris, with its præputiam, divided through the middle. 9. The left nympha. 10. The left labium majus. 11. The meatus of the vagina, narrowed by the contraction of its sphincter. 12. The canal of the vagina, upon which the transverse rugæ are apparent. 13. The thick wall of separation between the base of the bladder and the vagina. 14. The wall of separation between the vagina and rectum. 15. The perineum. 16. The os uteri. 17. Its cervix. 18. The fundus uteri. The cavitas uteri is seen along the center of the organ. 19. The rectum, showing the disposition of its mucous membrane. 20. The anus. 21. The upper part of the rectum, invested by the peritoneum. 22. The recto-uterine fold of the peritoneum. 23. The utero-vesical fold. 24. The reflexion of the peritoneum, from the apex of the bladder upon the urachus to the internal surface of the abdominal parietes. 25. The last lumbar vertebra. 26. The sacrum. 27. The coccyx.

The Fallopian tubes or oviducts—the uterine trumpets of the French writers—are situated in the upper border of the broad ligaments, and are connected with the superior angles of the uterus. They are somewhat trumpet-shaped, being much smaller at the uterine than at the free extremity, and narrower in the middle than at either end. Each tube is about four or five inches in length, and more or less flexuous in its course. The canal of the Fallopian tube is exceedingly minute; its inner extremity opens by means of the ostium uterinum into the upper angle of the cavity of the uterus, and the opposite end into the cavity of the peritoneum. The free or expanded extremity of the Fallopian tube presents a double, and sometimes a triple series of small processes or fringes, which surround the margin of the trumpet or funnel-shaped opening, the ostium abdominale. This fringe-like appendage to the end of the tube has gained for it the appellation of the fimbriated extremity; and the remarkable manner in which this circular fringe applies itself to the surface of the ovary during sexual excitement, the additional title of morsus diaboli. One of the processes, longer than the rest, or, according to Cruveilhier, a distinct ligamentous cord, is attached to the distal end of the ovary, and serves to guide the tube in its seizure of that organ.

The Fallopian tube is composed of three tunices: an external and loose investment derived from the peritoneum; a middle or muscular coat, consisting of circular (internal) and longitudinal (external) fibers, continuous with those of the uterus; and an external or lining mucous membrane, which is continuous, on the one hand, with the mucous membrane of the uterus, and at the opposite extremity with the peritoneum. In the minute canal of the tube, the mucous membrane is thrown into longitudinal folds or rugæ, which indicate the adaptation of the tube to dilatation.

The ovaries are two oblong, flattened, and oval bodies of a whitish color, situated in the posterior layer of peritoneum of the broad ligaments. They are connected to the upper angles of the uterus at each side by means of a rounded cord, consisting chiefly of muscular fibers derived from the uterus, the ligament of the ovary.

In structure, the ovary is composed of a cellulo-fibrous parenchyma or stroma, traversed by blood-vessels, and inclosed in a capsule consisting of three layers: a vascular layer, which is situated most internally, and sends processes inward to the interior of the organ; a middle or fibrous layer of considerable density; and an external investment of peritoneum. In the cells of the stroma of the ovary, the small vesicles or ovisacs of the future ova, the Graafian vesicles, as they have been termed, are developed. There are usually about fifteen fully-formed Graafian vesicles in each ovary; and Dr. Martin Barry has shown that countless numbers of microscopic ovisacs exist in the parenchyma of the organ, and that very few out of these are perfected so as to produce ova.

After conception, a yellow spot, the corpus luteum, is found in one or both ovaries. The corpus luteum is a globular mass of yellow, spongy tissue, traversed by white areolar bands, and containing in its center a small cavity, more or less obliterated, which was originally occupied by the ovum. The interior of the cavity is lined by a puckered membrane, the remains of the ovisac. In recent corpora lutea, the opening by which the ovum escaped from the ovisac through the capsule of the ovary, is distinctly visible; when closed, a small cicatrix may be seen upon the surface of the ovary in the situation of the opening. A similar appearance to the preceding, but of smaller size, and without a central cavity, is sometimes met with in the ovaries of the virgin; this is false corpus luteum.

Vessels and Nerves.—The arteries of the ovaries are the spermatic; their nerves are derived from the spermatic plexus.

The round ligaments are two muscular and fibrous cords situated between the layers of the broad ligaments, and extending from the upper angles of the uterus, and along the spermatic canals to the labia majora, in which they are lost. They are accompanied by a small artery, by several filaments of the spermatic plexus of nerves, and by a plexus of veins. The latter occasionally become varicose, and form a small tumor at the external abdominal ring, which has been mistaken for inguinal hernia. The round ligaments serve to retain the uterus in its proper position in the pelvis, and during utero-gestation to draw the anterior surface of the organ against the abdominal parietes.

LETTER XXIII.
ANATOMY OF THE FETUS.

Its Length and Weight—It Osseous, Muscular, and Vascular Systems—The Fetal Circulation—Nervous System—Organs of Sense—Its Lungs, Heart, and other Internal Organs.

As a matter of natural science, rather than one of real practical utility, to you for whom I write these letters, I present you with a description of some of the more important characteristics of the fetus. In doing this I acknowledge myself indebted to Mr. Wilson, the distinguished anatomist before referred to.

The medium weight of a child of the full period, at birth, is seven pounds, and its length seventeen inches; the extremes of weight are four pounds and three quarters, and ten pounds; and the extremes of measurement fifteen and twenty inches. The head is of large size, and lengthened from before backward; the face small. The upper extremities are greatly developed, and the thorax expanded and full. The upper part of the abdomen is large, from the great size of the liver; the lower part is small and conical; and the lower extremities are very small in proportion to the rest of the body. The external genital organs are very large, and fully developed, and the attachment of the umbilicus is one inch farther from the vertex of the head than from the soles of the feet; and one inch farther from the ensiform cartilage than from the symphysis pubis.

OSSEOUS SYSTEM.

The development of the osseous system is treated of in the various works on anatomy. The ligamentous system presents no peculiarity deserving of remark.

MUSCULAR SYSTEM.

The muscles of the fetus at birth are large and fully formed; they are of a lighter color than those of the adult, and of softer texture. The transverse striæ on the fibers of animal life are not distinguishable until the sixth month of fetal life.

VASCULAR SYSTEM.

The circulating system presents several peculiarities: 1st. In the heart; there is a communication between the two auricles by means of the foramen ovale. 2d. In the arterial system; there is a communication between the pulmonary artery and descending aorta, by means of a large trunk, the ductus arteriosus. 3d. Also in the arterial system; the internal iliac arteries, under the name of hypogastric and umbilical, are continued from the fetus to the placenta, to which they return the blood which has circulated in the system of the fetus. 4th. In the venous system; there is a communication between the umbilical vein and the inferior vena cava, called the ductus venosus.

FETAL CIRCULATION.

The pure blood is brought from the placenta by the umbilical vein. The umbilical vein passes through the umbilicus, and enters the liver, where it divides into several branches, which may be arranged under three heads: 1st. Two or three, which are distributed to the left lobe. 2d. A single branch, which communicates with the portal vein in the transverse fissure, and supplies the right lobe. 3d. A large branch, the ductus venosus, which passes directly backward, and joins the inferior cava. In the inferior cava the pure blood becomes mixed with that which is returning from the lower extremities and abdominal viscera, and is carried through the right auricle (guided by the Eustachian valve), and through the foramen ovale, into the left auricle. From the left auricle it passes into the left ventricle, and from the left ventricle into the aorta, whence it is distributed, by means of the carotid and subclavian arteries, principally to the head and upper extremities. From the head and upper extremities, the impure blood is returned by the superior vena cava to the right auricle; from the right auricle, it is propelled into the right ventricle; and from the right ventricle into the pulmonary artery. In the adult, the blood would now be circulated through the lungs, and oxygenated; but in the fetus the lungs are solid, and almost impervious. Only a small quantity of the blood passes therefore into the lungs; the greater part rushes through the ductus arteriosus, into the commencement of the descending aorta, where it becomes mingled with that portion of the pure blood which is not sent through the carotid and subclavian arteries.

Passing along the aorta, a small quantity of this mixed blood is distributed by the external iliac arteries to the lower extremities; the greater portion is conveyed by the internal iliac, hypogastric, and umbilical arteries to the placenta; the hypogastric arteries proceeding from the internal iliacs, and passing by the side of the fundus of the bladder, and upward along the anterior wall of the abdomen to the umbilicus, where they become the umbilical arteries.

FETAL CIRCULATION.
1. The umbilical cord, consisting of the umbilical vein and two umbilical arteries; proceeding from the placenta (2). 3. The umbilical vein dividing into three branches; two (4, 4), to be distributed to the liver; and one (5), the ductus venosus, which enters the inferior vena cava (6). 7. The portal vein, returning the blood from the intestines, and uniting with the right hepatic branch. 8. The right auricle; the course of the blood is denoted by the arrow, proceeding from 8 to 9, the left auricle. 10. The left ventricle; the blood following the arrow to the arch of the aorta (11), to be distributed through the branches given off by the arch to the head and upper extremities. The arrows 12 and 13, represent the return of the blood from the head and upper extremities through the jugular and subclavian veins, to the superior vena cava (14), to the right auricle (8), and in the course of the arrow through the right ventricle (15), to the pulmonary artery (16). 17. The ductus arteriosus, which appears to be a proper continuation of the pulmonary artery, the offsets at each side are the right and left pulmonary artery cut off; these are of extremely small size as compared with the ductus arteriosus. The ductus arteriosus joins the descending aorta (18, 18), which divides into the common iliacs, and these into the internal iliacs, which become the hypogastric arteries (19), and return the blood along the umbilical cord to the placenta; while the other divisions, the external iliacs (20), are continued into the lower extremities. The arrows at the terminations of these vessels mark the return of the venous blood by the veins to the inferior cava.

NERVOUS SYSTEM.

The brain is very soft, almost pulpy, and has a reddish tint throughout; its weight at birth, relatively to the entire body, is as 1 to 6, and the difference between the white and gray substance is not well marked. The nerves are firm and well developed.

ORGANS OF SENSE.

Eye.—The eyeballs are of large size, and well developed at birth. The pupil is closed by a vascular membrane called the membrana pupillaris, which disappears at about the seventh month. Sometimes it remains permanently, and produces blindness. It consists of two thin membranous layers, between which the ciliary arteries are prolonged from the edge of the iris, and form arches and loops by returning to it again, without anastomosing with those of the opposite side.

The removal of the membrane takes place by the contraction of these arches and loops toward the edge of the pupil. The capsule of the lens is extremely vascular.

Ear.—The ear is remarkable for its early development; the labyrinth and ossicula auditus are ossified at an early period, and the latter are completely formed before birth. The only parts remaining incomplete are the mastoid cells, and the meatus auditorius. The membrana tympani in the fetal head is very oblique, occupying almost the basilar surface of the skull; hence, probably, arises a deficient acuteness in the perception of sound. It is also extremely vascular.

Nose.—The sense of smell is imperfect in the infant, as may be inferred from the small capacity of the nasal fossæ, and the non-development of the ethmoid, sphenoid, frontal, and maxillary sinuses.

FETAL LUNGS.

The lungs, previously to the act of inspiration, are dense and solid in structure, and of a deep-red color. Their specific gravity is greater than water, in which they sink to the bottom; whereas lung which has respired will float upon that fluid. The specific gravity is, however, no test of the real weight of the lung, the respired lung being actually heavier than the fetal. Thus the weight of the fetal lung, at about the middle period of uterine life, is to the weight of the body as 1 to 60. But, after respiration, the relative weight of the lung to the entire body is as 1 to 30.

FETAL HEART.

The heart of the fetus is large in proportion to the size of the body; it is also developed very early, representing at first a simple vessel, and undergoing various degrees of complication until it arrives at the compound character which it presents after birth. The two ventricles form, at one period, a single cavity, which is afterward divided into two by the septum ventriculorum. The two auricles communicate up to the moment of birth, the septum being incomplete, and leaving a large opening between them, the foramen ovale (foramen of Botal).

The ductus arteriosus is another peculiarity of the fetus connected with the heart; it is a communication between the pulmonary artery and the aorta. It degenerates into a fibrous cord after birth, from the double cause of a diversion in the current of the blood toward the lungs, and from the pressure of the left bronchus, caused by its distention with air.

VISCERA OF THE ABDOMEN.

At an early period of uterine life, and sometimes at the period of birth, as Dr. Wilson observed in the imperfectly-developed fetus, two minute fibrous threads may be seen passing from the umbilicus to the mesentery. These are the remains of the omphalo-mesenteric vessels.

The omphalo-mesenteric are the first-developed vessels of the germ; they ramify upon the vesicula umbilicalis, or yolk-bag, and supply the newly-formed alimentary canal of the embryo. From them, as from a center, the general circulating system is produced. After the establishment of the placental circulation they cease to carry blood, and dwindle to the size of mere threads, which may be easily demonstrated in the early periods of uterine life; but are completely removed, excepting under peculiar circumstances, at a later period.

The stomach is of small size, and the great extremity but little developed. It is also more vertical in direction the earlier it is examined, a position that would seem due to the enormous magnitude of the liver, and particularly of its left lobe.

The appendix vermiformis cæci is long and of large size, and is continued directly from the central part of the cul-de-sac of the cæcum, of which it appears to be a constricted continuation. This is the character of the appendix cæci in the higher quadrumana.

The large intestines are filled with a dark-green, viscous secretion, called meconium, from its resemblance to the inspissated juice of the poppy.

The pancreas is comparatively larger in the fetus than in the adult.

The spleen is comparatively smaller in the fetus than in the adult.

FETAL LIVER.

The liver is the first-formed organ in the embryo. It is developed from the alimentary canal, and at about the third week fills the whole abdomen, and is one half the weight of the entire embryo. At the fourth month the liver is of immense size in proportion to the bulk of the fetus. At birth it is of very large size, and occupies the whole upper part of the abdomen. The left lobe is as large as the right, and the falciform ligament corresponds with the middle line of the body. The liver diminishes rapidly after birth, probably from obliteration of the umbilical vein.

KIDNEYS AND SUPRA-RENAL CAPSULES.

The kidneys present a lobulated appearance in the fetus, which is their permanent type among some animals, as the bear, the otter, and cetacea.

The supra-renal capsules are organs which appear, from their early and considerable development, to belong especially to the economy of the fetus. They are distinctly formed at the second month of embryonic life, and are greater in size and weight than the kidneys. At the third or fourth month, they are equaled in bulk by the kidneys; and at birth, they are about one third less than those organs.

VISCERA OF THE PELVIS.