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


                        BY DR. A. M. MAURICEAU,
                    Professor of Diseases of Women.

                      Office, 129 Liberty street.

                               NEW YORK.

                                 1847.




        Entered according to Act of Congress, in the year 1847, by
                               JOSEPH TROW,
 In the Clerk’s Office of the District Court of the Southern District New
                                  York.




                                PREFACE.


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

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

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

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

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

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

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

                                                             THE AUTHOR.




                                 INDEX


                                                                   PAGE.
 ABORTION—
      „       Symptoms of, 169
      „       Causes of, 171
      „       Treatment of, 171
      „       Prevention of, 175
      „       When dangerous, 168
      „       When necessary to effect, 177
      „       When attended with no danger, 169
 AFTER-PAINS—
      „       Causes of, 203
      „       Treatment of, 204
 AFTER-BIRTH—
      „       Caution respecting, 199
      „       Mode of extracting, 199
 ARTIFICIAL DELIVERY, 180
 BARRENNESS, OR STERILITY—, 223
      „       Causes of, 225
      „       Treatment of, 230
      „       Remedy for, 232
 CONCEPTION—(See Pregnancy), 36
      „       Signs of, 37
      „       Prevention of (See Pregnancy), 104
 CHILDREN—Management of, 210
 CONCLUDING REMARKS, 237
 DELIVERY—Artificial, 180
 DISEASES OF PREGNANCY, 61
              Desomeaux’s Prevention to Pregnancy, 142
 FALSE PAINS IN PREGNANCY, 187
 FALSE Conception, 30
 FAINTING, during Pregnancy, 87
      „       Treatment of, 87
 FLOODING, 174
      „       Causes of, 23
      „       Treatment of, 174
 FRENCH SECRET, 144
      „       For what purpose used, 144
      „       Its use in France, 144
 INTRODUCTORY REMARKS, ix
 INFANTS, still-born, 202
      „       Treatment of, 203
 INFLAMMATION OF THE BREASTS, 205
      „       To prevent inflamed or broken Breasts, 208
              Index, v
 LABOUR—Signs of, 182
      „       Management of, 185
      „       Ordinary or natural, 186
      „       Preternatural or Cross-Births, 201
      „       Laborious, or difficult, 202
      „       Directions during, 198
      „       Directions after, 99, 203
 MALFORMATION of the Pelvis, 180
 MENSTRUATION, or Monthly Turns, 1
      „       RETENTION OF, 8
      „       Description, 8
      „       Causes, 8
      „       Symptoms, 9
      „       Treatment, 10
      „       SUPPRESSION OF, 11
      „       Description of, 11
      „       Causes, 12
      „       Symptoms, 12
      „       Treatment of, 13
      „       Specific certain to effect a cure, 16
      „       PAINFUL AND IMPERFECT, 18
      „       Symptoms, 19
      „       Causes, 19
      „       Treatment, 20
 MENSES—
      „       IMMODERATE FLOW OF, 22
      „       Symptoms, 22
      „       Causes, 23
      „       Treatment, 23
      „       Prevention, 27
      „       DECLINE OF THE, 28
      „       Symptoms, 30
      „       Causes, 30
      „       Treatment, 33
 MISCARRIAGE—_See Abortion._
 MORAND’S “ELIXIR,” 232
      „       Its success in effecting Cures, 233
 NAVEL CORD—
      „       Manner of tying, 198
 NURSING, 204
 PORTUGUESE FEMALE PILLS, 16
 PREFACE, iii
 PREGNANCY, Signs of, 36
      „       How it may be determined, 37
      „       Ceasing to be unwell, 38
      „       Morning Sickness, 49, 62
      „       Shooting Pains through, Enlargement of and other Changes
                of the Breasts, 50
      „       Changes of the Nipple, 51
      „       Presence of Milk, 54
      „       Quickening, 57
 PREGNANCY,—DISEASES OF, 61
      „       Being unwell during, 96
      „       Costiveness, 72
      „       Diarrhœa, 76
      „       Enlargement of the Veins of the Legs, 82
      „       Fainting Fits, 87
      „       Heart-Burn, 70
      „       Headache, 98
      „       Inconvenience from size, 95
      „       Painful and distended condition of th Breasts, 90
      „       Pains in the Legs, &c., 92
      „       Palpitation of the Heart, 85
      „       Piles, 78
      „       Salivation, or Discharge of Saliva, 89
      „       Swelling of the Feet and Legs, 84
      „       Soreness and Cracking of the Skin of the Abdomen, 94
      „       Toothache, 88
      „       Violent movement of the Child, 93
 PREGNANCY—PREVENTION OF, 104
      „       When unnecessary, 110
      „       When indispensable, 107
      „       Practicability of, 141
      „       Morality of, 146
      „       Social importance of, 114
      „       Mode of prevention, 142, 143, 144
      „       Healthiness of, 145
      „       Reasons for prevention, 144
      „       Objections answered, 146
      „       Proofs of success, 150, 152, 154
      „       Use of in France and other parts of Europe, 149
 SEXUAL WEAKNESS,
      „       Symptoms, 157
      „       Causes, 158
      „       Treatment, 158
      „       Regimen, 163
 WOMB, falling down of the, 163




                         INTRODUCTORY REMARKS.


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

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

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

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

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

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

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

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

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

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




                               MANAGEMENT

                                   OF

                           FEMALE COMPLAINTS.




                             MENSTRUATION.


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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




                        RETENTION OF THE MENSES.


                             _Description._

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


                               _Causes._

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


                              _Symptoms._

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


                              _Treatment._

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

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

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




                       SUPPRESSION OF THE MENSES.


                             _Description._

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


                              _Treatment._

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

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




                  PAINFUL AND IMPERFECT MENSTRUATION.


                             _Description._

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


                              _Treatment._

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

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




                     IMMODERATE FLOW OF THE MENSES.


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


                              _Symptoms._

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


                               _Causes._

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


                              _Treatment._

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

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

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

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

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

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

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

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

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


                               _Regimen._

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


                             _Prevention._

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

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

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

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




                         DECLINE OF THE MENSES.


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

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

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

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

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

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

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

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

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

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

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




                              CONCEPTION;
                                  OR,
                               PREGNANCY.


                              CONCEPTION.

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

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

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




           OF THE MODE BY WHICH PREGNANCY MAY BE DETERMINED.


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

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


                        _Ceasing to be unwell._

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


                          _Morning Sickness._

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

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

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

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

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


_Shooting pains through—enlargement of—and other changes of the breast._

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


                             _Quickening._

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

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

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

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

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

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

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

                      9 Quickened at the 3d month.
                     11 Quickened at     3½ months.
                     21 Quickened at the 4th month.
                     16 Quickened at     4½ months
                      8 Quickened at the 5th month.
                      1 Quickened at     5½ months.
                      4 Quickened at the 6th month.
                     ——
                     70
                     ——

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

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

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

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

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

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

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

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

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




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


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

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

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


                          _Morning Sickness._

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

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

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

If there is merely nausea or vomiting _without the presence of bile_, it
is evident that it arises solely from irritability of the stomach, and
is not connected with a disordered condition of the digestive organs,
which latter circumstance is not unfrequently the case. The best means
that can be employed to relieve this irritable state will be found in a
draught taken twice a day for several days, composed of fifteen grains
of magnesia, one drachm of tincture of columba, and an ounce and a half
of distilled peppermint water.[17]

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

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

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

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

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

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

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

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

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

_Secondly_, of sickness coming on at the _conclusion_ of pregnancy.

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

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

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

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

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


                              _Heartburn._

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

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

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

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


                             _Costiveness._

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

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

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

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

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

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

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

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

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

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

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


                              _Diarrhœa._

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

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

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

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

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

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

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


                                _Piles._

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

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

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

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

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

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

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

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

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

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

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


                _Enlargement of the Veins of the Legs._

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

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

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

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


                    _Swelling of the Feet and Legs._

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

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


                      _Palpitation of the Heart._

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

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

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

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


                            _Fainting Fits._

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

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

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

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


                              _Toothache._

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

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

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


                             _Salivation._

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

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


          _A Painful and Distended Condition of the Breasts._

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

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

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

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

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


                  _Cramp, and Pains in the Legs, &c._

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

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

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


                   _Violent movements of the Child._

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

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


          _Soreness and Cracking of the Skin of the Abdomen._

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

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


                       _Inconvenience from Size._

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

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

Those who suffer much from this cause, ought also to lie down upon a
couch or bed, for two or three hours every day; this will give great
relief to the muscles.


                    _Being Unwell during Pregnancy._

A female may be pregnant, and yet be unwell for one period or more while
in that condition. Indeed, it may take place every month to the time of
quickening, and has even continued in some rare cases up to the time of
delivery.

Now, although this can scarcely be called one of the diseases of
pregnancy—for it, ordinarily, in no way, interferes with the
health—still, as while the discharge is actually present it predisposes
to miscarriage, it is necessary to give one or two hints of caution.

Any female, then, thus circumstanced should manage herself with great
care immediately before the appearance, during the existence—and
directly after the cessation of the discharge. She should observe the
most perfect quiet of body and mind—keeping upon the sofa while it
lasts, and carefully abstaining from any stimulating or indigestible
article of food, and if any symptoms of pain, uneasiness, or threatening
miscarriage come on, immediately seek medical advice.

A case, showing the necessity of carefulness under such circumstances,
occurred to me some time since, and its relation is all that I need add
upon this point.

A lady, resident in Gloucestershire, missing one period, suspected
herself of being pregnant, but being unwell on the following month,
supposed herself mistaken. She had occasion, however, to come to London
on the second day of her being unwell—Monday. On the Wednesday following
she suffered considerable uneasiness from the exertion attendant upon
the journey, and on Friday while from her hotel was obliged to return
home in haste, and before night, miscarried.

Here then is a case in point—first proving, what some persons deny, that
a female may be unwell and yet be pregnant, for she could not perceive
the slightest difference in the appearance of the discharge from what
ordinarily took place, and it was exact as to the time of its return—and
next, showing how necessary is great caution, and the most perfect
quiet, since undoubtedly this lady would not have miscarried, if her
journey had only been delayed another week.

Jaundice sometimes occurs in the early or latter parts of the
pregnancy—certain affections also of disordered functions of the heart,
producing palpitation—a troublesome cough, accompanied with considerable
pain in the head, sudden attacks of difficulty of breathing, and
distressing inconvenience from irritable bladder.

These, and many other slight affections, may manifest themselves during
gestation, but of those I say nothing. It would be advancing beyond the
bounds by which I thought it right to limit myself, and departing from
the object proposed.[27]

I have finished what was purposed, and presented the married female with
that information for direction and relief, in those little ailments and
discomforts which frequently arise during pregnancy, for which she does
not think it necessary to consult her medical adviser, and yet from
which she will not unfrequently go on suffering for weeks, rather than
speak of them.




                       PREVENTION TO CONCEPTION.


We have seen from the preceding pages, that in addition to what may be
termed diseases ordinarily attendant upon a state of pregnancy, there
are others in which to become pregnant is to hazard the health, and
often the life of the woman, involving a peremptory necessity either for
instrumental or Cæsarean operation, premature delivery or miscarriage.
Apart from its agonizing torture, the danger of the Cæsarean operation
is imminent to a frightful extent. Premature delivery is often attended
with success, but the offspring being prematurely born, if they survive,
rarely attain maturity, and even then mostly during their short
existence very sickly. Miscarriage, although attended with but little
danger when skilfully effected and properly conducted, can only be
considered as an alternative; only a choice of evils. But thanks to the
indefatigable researches of the learned and humane M.M. Desomeaux for
his great discovery by which _pregnancy can be prevented_. By this
discovery every woman can have in her own power the means of prevention.

The imperative, and self-evident necessity that, in some cases,
pregnancy should not take place, cannot, for a moment, be doubted, in
view that it is within the knowledge of every medical man, who makes his
profession subserve the amelioration of the suffering to which the
female is subject—knowledge, too, acquired within the sphere of his
daily practice—that there are women who should not become pregnant, for
with them pregnancy is peril to life. And even when life is spared, the
birth of every child snatches many years from the life of the mother,
hurrying her, with a constitution shattered, and health destroyed, to a
premature grave.

Some women are so constituted that they cannot give birth, not to say to
_healthy_, but not to _living_ children. Others again cannot give birth
at all, except through the instrumental mangling and cutting of the
Cæsarean operation—of a piece-meal extraction of the infant from the
mother’s womb—happy, indeed, if the woman’s life fall not a sacrifice to
the butchery. Truly, such spectacles are too horrid to contemplate. And
yet such women are permitted to become pregnant, in total ignorance that
pregnancy ought and can be _prevented_, by safe, simple, invariably
healthy, and infallibly certain means.

Some women, again, although not in immediate danger from becoming too
frequently pregnant, yet during seven or eight of the nine months of
pregnancy, experience the utmost agony of mind and body, making
existence a continuous state of misery and suffering, destructive alike
of their health, beauty, vigor, and spirits; who, after confinement and
recovery, live in constant and perpetual fear and dread of again
becoming pregnant, again to undergo the series of intense sufferings
from which they have but just emerged. Life, under such circumstances,
to the fond and affectionate wife, is but a constant suffering. Can it
be otherwise to the kind husband? Can he behold the partner of his joys
and sorrows—his bosom companion—the mother of his children—his solace in
sickness or difficulty, thus dragging out her days of wretchedness and
anguish, emaciated, disheartened, broken in body and spirits; and that,
too, in the meridian of her life, in the hey-day of her existence,
perceptibly sinking into an early grave, to leave her offspring
motherless, or entrust them to the cold and sordid care of the world!
Can a husband, possessing the feelings of a man, behold this with
indifference; nay, will he not shudder at the possibility of such
consequences arising from too frequent pregnancy! Will he not pause and
reflect ere he becomes the cause from which such dreadful effects would
flow? Surely, if he is a thinking, reflecting, rational, humane man, he
must reflect—he must pause, and permit the adoption of the mode pointed
out in these pages, by which pregnancy can be prevented, and that, too,
without the least sacrifice of those pleasurable sensations experienced
in the connubial embrace.

The happiness as well of husband, of wife, and children, will be
enhanced by the preservation of her health, by lengthening the intervals
between the periods of pregnancy, making the interval between the births
three, four, or more years (as in France), depending upon the health of
the wife. Thereby it will, under ordinary circumstances, be preserved to
rear, guard, and educate her children,—to soothe and comfort the
declining years of the father when age and decrepitude are upon him.
When, perchance, his own sufferings can be assuaged by only her hand,
who alone knows and anticipates his every wish—whose affectionate
attention, having accompanied him through the rugged path of life, alone
knows how to impart content and happiness.

Surely, then, circumstances do arise where it is folly, madness,
wickedness, to permit pregnancy to take place.

Where, for example, the health of the wife evidently sinks under a too
frequent state of pregnancy or a too rapid increase of family; or the
births taking place in too close succession.

Where the female cannot be in a state of pregnancy without the most
intense and excruciating suffering during such period, endangering her
own future health, and perhaps that of her offspring.

Where an incapacity exists to give birth to _living_ children, either in
consequence of malformation of the pelvis, or other deformity; and
where, from the same, or other causes, recourse is necessarily had to
the Cæsarean operation. All which causes have either the health or the
life of the female in view.

But there are still other reasons scarcely less urgent why pregnancy
should be sometimes prevented, which have the welfare of the offspring
in view.

It is but too lamentable a fact that the sins or misfortunes of the
parent are visited upon their offspring. It is indisputable that
diseases which carry off their thousands, are, many of them,
hereditary,—transmissible from parent to child. Such as confirmed
consumption, King’s Evil, or Scrofula, Gout, Venereal Disease,
Hypochondria, Insanity, and other diseases, and even drunkenness.

In view, then, of the transmission of disease and suffering to our
offspring, should they even survive a brief existence, every reflecting
being should hesitate whether it were not better to prevent pregnancy
than to thrust human beings into the world, and blighting their brief
existence with entailed disease and wretchedness—for such offspring are
seldom reared to maturity. This fact accounts for the great mortality of
children, especially in cities. Those, however, that do pass through a
sickly childhood, becoming necessarily endeared to their parents, are
cut off in their early years—sometimes in the bloom of youth—blasting
the fond hopes just springing into existence in the breasts of their
parents. Thus, in some families, five or six, one after another, are
apparently prematurely cut off.

The causes, doubtless, to a superficial observer, looking only upon
effects, appear inexplicable: not so to those who look beyond mere
effects. To such the _present_ is but the child of the _past_, and the
_parent_ of the _future_.

In discussing, therefore, the propriety, the morality, nay, the
inevitable necessity, in some cases, of preventing pregnancy, it has an
important bearing.

In presenting these considerations, however, we must bear in mind that
they are not applicable where the female is capable of enduring the
ordinary inconveniences arising from a state of pregnancy, or where her
health is not thereby injuriously affected, because the reasons for
prevention do not, in such case, exist. Indeed, it is not unusual, that
the health of the female, so far from being injured, is often improved,
in consequence of the existence of pregnancy, and others, again, who
enjoy perfect health without reference to their condition in this
respect.

And, again, it is unquestionable that children are often a source of
domestic happiness—the binding link—the pledge of affection and love—the
delight and joy of parents, upon whose growth and development they look
with pride mingled with fond anticipations of the future. The paths of
life are made less rugged, the charms of home more pleasant, toil itself
becomes less irksome by their influence.

When, therefore, neither the life nor health of the mother is
jeopardized, and the offspring free from hereditary or constitutional
taint, it is, of course, unnecessary that preventive measures should be
used. Neither is it, under such circumstances, recommended.

In regard, however, to the prevention of pregnancy, there are still
other views, taking still other grounds, treating the subject in a moral
and social point of view, which, although not strictly belonging to its
consideration in a medical and physiological character, are yet of
sufficient interest to be embraced in this work.

The following remarks are from a celebrated physiological writer, and
are certainly worthy of consideration, whether we coincide with the
author or not. He thus eloquently introduces the subject:

“Libertines and debauchees! these pages are not for you. You have
nothing to do with the subject of which they treat. Bringing to its
discussion, as you do, a distrust or contempt of the human
race—accustomed as you are to confound liberty with license, and
pleasure with debauchery, it is not for your palled feelings and
brutalized senses to distinguish moral truth in its purity and
simplicity. I never discuss this subject with such as you.

“It has been remarked, that nothing is so suspicious in a woman, as
vehement pretensions to especial chastity; it is no less true, that the
most obtrusive and sensitive stickler for the etiquette of orthodox
morality is the heartless rake. The little intercourse I have had with
men of your stamp, warns me to avoid the serious discussion of any
species of moral heresy with you. You approach the subject in a tone and
spirit revolting alike to good taste and good feeling. You seem to
pre-suppose—from your own experience, perhaps—that the hearts of all men
and more especially of all women, are deceitful above all things and
desperately wicked; that violence and vice are inherent in human nature,
and that nothing but laws and ceremonies prevent the world from becoming
a vast slaughter-house, or an universal brothel. You judge your own sex
and the other by the specimens you have met with in wretched haunts of
mercenary profligacy; and, with such a standard in your minds, I marvel
not that you remain incorrigible unbelievers in any virtue, but that
which is forced on the prudish hot-bed of ceremonious orthodoxy. I
wonder not that you will not trust the natural soil, watered from the
free skies and warmed by the life-bringing sun. How should you? you have
never seen it produce but weeds and poisons. Libertines and debauchees!
cast these pages aside! You will find in them nothing to gratify a
licentious curiosity; and, if you read them, you will probably only give
me credit for motives and impulses like your own.

“And you, prudes and hypocrites! you who strain at a gnat and swallow a
camel; you whom Jesus likened to whited sepulchres, which without indeed
are beautiful, but within are full of all uncleanness; you who affect to
blush if the ankle is incidentally mentioned in conversation, or
displayed in crossing a stile, but will read indecencies enough, without
scruple, in your closets; you who, at dinner, ask to be helped to the
bosom of a duck, lest by mention of the word breast, you call up
improper associations; you who have nothing but a head and feet and
fingers; you who look demure by daylight, and make appointments only in
the dark—you, prudes and hypocrites! I do not address. Even if honest in
your prudery, your ideas of right and wrong are too artificial and
confused to profit by the present discussion; if dishonest, I desire to
have no communication with you.

“Reader! if you belong to the class of prudes or of libertines, I pray
you, follow my argument no further. Stop here, and believe that my
heresies will not suit you. As a prude, you would find them too honest;
as a libertine, too temperate. In the former case, you might call me a
very shocking person; in the latter, a quiz or a bore.

“But if you be honest, upright, pure-minded—if you be unconscious of
unworthy motive or selfish passion—if truth be your ambition, and the
welfare of our race your object—then approach with me a subject the most
important to man’s well-being; and approach it as I do, in a spirit of
dispassionate, disinterested free inquiry. Approach it, resolving to
prove all things, and hold fast that which is good. The discussion is
one to which it is every man’s and every woman’s _duty_ (and ought to be
every one’s _business_) to attend. The welfare of the present
generation, and—yet far more—of the next, requires it. Common sense
sanctions it. And the national motto of my former country, ‘Honi soit
qui mal y pense,’[28] may explain the spirit in which it is undertaken,
and in which it ought to be received.”




                       PREVENTION TO CONCEPTION;
                               CONSIDERED
                        IN ITS SOCIAL BEARINGS.


“What would be the probable effect, in social life, if mankind obtained
and exercised a control over the instinct of reproduction?

“My settled conviction is—and I am prepared to defend it—that the effect
would be salutary, moral, civilizing; that it would prevent many crimes
and more unhappiness; that it would lessen intemperance and profligacy;
that it would polish the manners and improve the moral feelings; that it
would relieve the burden of the poor, and the cares of the rich; that it
would most essentially benefit the rising generation, by enabling
parents generally more carefully to educate, and more comfortably to
provide for, their offspring. I proceed to substantiate as I may these
positions.

“And first, let us look solely to the situation of married persons. Is
it not notorious, that the families of the married often increase beyond
what a regard for the young beings coming into the world, or the
happiness of those who give them birth, would dictate? In how many
instances does the hard-working father, and more especially the mother,
of a poor family, remain slaves throughout their lives, tugging at the
oar of incessant labor, toiling to live, and living but to toil; when if
their offspring had been limited to two or three only, they might have
enjoyed comfort and comparative affluence! How often is the health of
the mother, giving birth every year to an infant—happy if it be not
twins!—and compelled to toil on, even at those times when nature
imperiously calls for some relief from daily drudgery—how often is the
mother’s comfort, health, nay, her life, thus sacrificed! Or, if care
and toil have weighed down the spirit, and at last broken the health of
the father, how often is the widow left, unable, with the most virtuous
intentions, to save her fatherless offspring from becoming degraded
objects of charity, or profligate votaries of vice!

“Fathers and mothers! not you who have your nursery and your
nursery-maids, and who leave your children at home, to frequent the
crowded rout, or to glitter in the hot ball-room; but you by the labor
of whose hands your children are to live, and who, as you count their
rising numbers, sigh to think how soon sickness or misfortune may lessen
those wages which are now but just sufficient to afford them
bread—fathers and mothers in humble life! to you my argument comes home,
with the force of reality. Others may impugn—may ridicule it. By bitter
experience you know and feel its truth.

“Yet this is not all. Every physician knows, that there are many women
so constituted that they cannot give birth to healthy—sometimes not to
_living_ children. Is it desirable—is it _moral_, that such women should
become pregnant? Yet this is continually the case, the warnings of
physicians to the contrary notwithstanding. Others there are, who ought
never to become parents; because, if they do, it is only to transmit to
their offspring grievous hereditary diseases; perhaps that worst of
diseases, insanity. Yet they will not lead a life of celibacy. They
marry. They become parents, and the world suffers by it. That a human
being should give birth to a child, knowing that he transmits to it
hereditary disease, is in my opinion an immorality. But it is a folly to
expect that we can ever induce all such persons to live the lives of
Shakers. Nor is it necessary; all that duty requires of them is, to
refrain from becoming parents. Who can estimate the beneficial effect
which rational moral restraint may thus have, on the health, beauty, and
physical improvement of our race, throughout future generations?

“But, apart from these latter considerations, is it not most plainly,
clearly, incontrovertibly _desirable_, that parents _should have the
power_[29] to limit their offspring, whether they choose to exercise it
or not? Who _can_ lose by their having this power? and how many _may_
gain! may gain competency for themselves, and the opportunity carefully
to educate and provide for their children! How many may escape the
jarrings, the quarrels, the disorder, the anxiety, which an overgrown
family too often causes in the domestic circle?

“It sometimes happens, that individual instances come home to the
feelings with greater force than any general reasoning. I shall, in this
place, adduce one which came immediately under my cognizance.

“In June, 1829, I received from an elderly gentleman of the first
respectability, occupying a public situation in one of the western
states, a letter requesting to know whether I could afford any
information or advice in a case which greatly interested him and which
regarded a young woman for whom he had ever experienced the sentiments
of a father. In explanation of the circumstances to which he alluded, he
enclosed me a copy of a letter which she had just written to him, and
which I here transcribe verbatim. A letter more touching from its
simplicity, or more strikingly illustrative of the unfortunate situation
in which not one, but thousands, in married life, find themselves
placed, I have never read.

                                         “‘_L——, Kentucky, May 3, 1829._

  “‘Dear Sir,

  “‘The friendship which has existed between you and my father, ever
  since I can remember; the unaffected kindness you used to express
  towards me, when you resided in our neighborhood, during my childhood;
  the lively solicitude you have always seemed to feel for my welfare,
  and your benevolence and liberal character, induce me to lay before
  you in a few words, my critical situation, and ask you for your kind
  advice.

  “‘It is my lot to be united in wedlock to a young mechanic of
  industrious habits, good dispositions, pleasing manners, and agreeable
  features, excessively fond of our children and of me; in short,
  eminently well qualified to render himself and family and all around
  him happy, were it not for the besetting sin of drunkenness. About
  once in every three or four weeks, if he meet, either accidentally or
  purposely, with some of his friends, of whom, either real or
  pretended, his good nature and liberality procure him many, he is sure
  to get intoxicated, so as to lose his reason; and, when thus beside
  himself, he trades and makes foolish bargains, so much to his
  disadvantage, that he has almost reduced himself and family to
  beggary, being no longer able to keep a shop of his own, but obliged
  to work journey work.

  “‘We have not been married quite four years, and have already given
  being to three dear little ones. Under present circumstances, what can
  I expect will be their fate and mine? I shudder at the prospect before
  me. With my excellent constitution and industry, and the labor of my
  husband, I feel able to bring up these three little cherubs in
  decency, were I to have no more: but when I seriously consider my
  situation, I can see no other alternative left for me, than to tear
  myself away from the man who, though addicted to occasional
  intoxication, would sacrifice his life for my sake; and for whom,
  contrary to my father’s will, I successively refused the hand and
  wealth of a lawyer and of a preacher; or continue to witness his
  degradation, and bring into existence, in all probability, a numerous
  family of helpless and destitute children, who, on account of poverty,
  must inevitably be doomed to a life of ignorance, and consequent vice
  and misery.

                                                               “‘M. W.’”

“Need I add one word of comment on such a case as this? Every feeling
mind must be touched by the amiable feeling and good sense that pervade
the letter. Every rational being, surely, must admit, that the power of
preventing, without injury or sacrifice, the increase of a family, under
such circumstances, is a public benefit and a private blessing.

“Will it be asserted—and I know no other even plausible reply to these
facts and arguments—will it be asserted, that the thing is, in itself,
immoral or unseemly? I deny it; and I point to the population of France,
in justification of my denial. Where will you find, on the face of the
globe, a more polished or more civilized nation than the French, or one
more punctiliously alive to any rudeness, coarseness or indecorum? You
will find none. The French are scrupulous on these points, to a proverb.
Yet, as every intelligent traveller in France must have remarked, there
is scarcely to be found, among the middle or upper classes (and seldom
even among the working classes), such a thing as a large family; very
seldom more than three or four children. A French lady of the utmost
delicacy and respectability will, in common conversation, say as
simply—(ay, and as _innocently_, whatever the self-righteous prude may
aver to the contrary)—as she would proffer any common remark about the
weather: ‘I have three children; my husband and I think that is as many
as we can do justice to, and I do not intend to have any more.’[30]

“I have stated notorious facts, facts which no traveller who has visited
Paris, and seen anything of the domestic life of its inhabitants, will
attempt to deny. However heterodox, then, my view of the subject may be
in this country, I am supported in it by the opinion and the practice of
the most refined and most socially cultivated nation in the world.

“Will it still be argued, that the practice, if not coarse, is immoral?
Again, I appeal to France. I appeal to the details of the late glorious
revolution—to the innumerable instances of moderation, of courage, of
honesty, of disinterestedness, of generosity, of magnanimity, displayed
on the memorable ‘three days,’ and ever since; and I challenge
comparison between the national character of France for virtue, as well
as politeness, and that of any other nation under heaven.

“It is evident, then, that to married persons, the power of limiting
their offspring to their circumstances is most desirable. It may often
promote the harmony, peace, and comfort of families; sometimes it may
save from bankruptcy and ruin, and sometimes it may rescue the mother
from premature death. In _no_ case can it, by possibility, be worse than
superfluous. In _no case can it be mischievous_.

“If the moral feelings were carefully cultivated, if we were taught to
consult, in everything, rather the welfare of those we love than our
own, how strongly would these arguments be felt? No man ought even to
_desire_ that a woman should become the mother of his children, unless
it was her express wish, and unless he knew it to be for her welfare,
that she should. Her feelings, her interests, should be for him in this
matter _an imperative law_. She it is who bears the burden, and
therefore with her also should the decision rest. Surely it may well be
a question whether it be desirable, or whether any man ought to ask,
that the whole life of an intellectual, cultivated woman, should be
spent in bearing a family of twelve or fifteen children; to the ruin,
perhaps, of her constitution, if not to the overstocking of the world.
No man ought to require or expect it.

“Shall I be told, that this is the very romance of morality? Alas! that
what ought to be a matter of every day practice—a commonplace exercise
of the duties and charities of life—a bounden duty—an instance of
domestic courtesy too universal either to excite remark or to merit
commendation—alas! that a virtue so humble that its absence ought to be
reproached as a crime, should, to our selfish perceptions, seem but a
fastidious refinement, or a fanciful supererogation!

“But I pass from the case of married persons to that of young men and
women who have yet formed no matrimonial connexion.

“In the present state of the world, when public opinion stamps with
opprobrium every sexual connection which has not received the orthodox
sanction of an oath, almost all young persons, on reaching the age of
maturity, desire to marry. The heart must be very cold, or very
isolated, that does not find some object on which to bestow its
affections. Thus, early marriages would be almost universal, did not
prudential considerations interfere. The young man thinks, ‘I must not
marry yet. I cannot support a family. I must make money first, and think
of a matrimonial settlement afterwards.’

“And so he goes to making money, fully and sincerely resolved, in a few
years to share it with her whom he now loves. But passions are strong,
and temptations great. Curiosity, perhaps, introduces him into the
company of those poor creatures whom society first reduces to a
dependence on the most miserable of mercenary trades, and then curses
for being what she has made them. There his health and his moral
feelings alike are made shipwreck. The affections he had thought to
treasure up for their first object, are chilled by dissipation and
blunted by excess. He scarcely retains a passion but avarice. Years pass
on—years of profligacy and speculation—and his first wish is
accomplished; his fortune is made. Where now are the feelings and
resolves of his youth?

                    “‘Like the dew on the mountain,
                      Like the foam on the river,
                    Like the bubble on the fountain,
                      They are gone—and for ever?’

“He is a man of pleasure—a man of the world. He laughs at the romance of
his youth, and marries a fortune. If gaudy equipages and gay parties
confer happiness, he is happy. But if these be only the sunshine on the
stormy ocean below, he is a victim to that system of morality which
forbids a reputable connexion until the period when provision has been
made for a large, expected family. Had he married the first object of
his choice, and simply delayed becoming a father until his prospects
seemed to warrant it, how different might have been his lot! Until men
and women are absolved from the fear of becoming parents, except when
they themselves desire it, they ever will form mercenary and
demoralizing connexions, and seek in dissipation the happiness they
might have found in domestic life.

“I know that this, however common, is not an universal case. Sometimes
the heavy responsibilities of a family are incurred at all risks; and
who shall say how often a life of unremitting toil and poverty is the
consequence? Sometimes—if even rarely—the young mind _does_ hold to its
first resolves. The youth plods through years of cold celibacy and
solitary anxiety; happy, if before the best hours of life are gone, and
its warmest feelings withered, he may return to claim the reward of his
forbearance and of his industry. But even in this comparatively happy
case, shall we count for nothing the years of ascetical sacrifice at
which after-happiness is purchased? The days of youth are not too many,
nor its affections too lasting. We may, indeed, if a great object
require it, sacrifice the one and mortify the other. But is this, in
itself, desirable? Does not wisdom tell that such sacrifice is a dead
loss—to the warm-hearted often a grievous one? Does not wisdom bid us
temperately enjoy the spring-time of life, ‘while the evil days come
not, nor the years draw nigh’ when we shall say, ‘we have no pleasure in
them?’

“Let us say, then, if we will, that the youth who thus sacrifices the
present for the future, chooses wisely between two evils, profligacy and
asceticism. This is true. But let us not imagine the lesser evil to be a
good. It is _not_ good for man to be alone. It is for no man’s or
woman’s happiness or benefit that they should be condemned to Shakerism.
It is a violence done to the feelings, and an injury to the character. A
life of rigid celibacy, though infinitely preferable to a life of
dissipation, is yet fraught with many evils. Peevishness, restlessness,
vague longings, and instability of character, are among the least of
these. The mind is unsettled, and the judgment warped. Even the very
instinct which is thus mortified assumes an undue importance, and
occupies a portion of the thoughts which does not of right or nature
belong to it; and which, during a life of satisfied affection, it would
not obtain.

“I speak not now of extreme cases, where solitary vice[31] or disease,
or even insanity, has been the result of ascetical mortification. I
speak of every day cases; and I am well convinced that (however wise it
often is, in the present state of the world, to select and adhere to
this alternative), yet no man or woman can live the life of a
conscientious Shaker, without suffering, more or less, both physically,
mentally, and morally. This is the more to be regretted, because the
very noblest portion of our species—the good, the pure, the high-minded,
and the kind-hearted—are the chief victims.

“Thus, inasmuch as the scruple of incurring heavy responsibilities
deters from forming moral connexions, and encourages intemperance and
prostitution, the knowledge which enables man to limit his offspring,
would, in the present state of things, save much unhappiness and prevent
many crimes. Young persons sincerely attached to each other, and who
might wish to marry, would marry early; merely resolving not to become
parents until prudence permitted it. The young man, instead of solitary
toil or vulgar dissipation, would enjoy the society and the assistance
of her he had chosen as his companion; and the best years of life, whose
pleasures never return, would not be squandered in riot, or lost through
mortification.

“My readers will remark, that all the arguments I have hitherto
employed, apply strictly to the present order of things, and the present
laws and system of marriage. No one, therefore, need be a moral heretic
on this subject to admit and approve them. The marriage laws might all
remain for ever as they are; and yet a moral check to population would
be beneficent and important.

“But there are other cases, it will be said, where the knowledge of a
preventive would be mischievous. If young women, it will be argued, were
absolved from the fear of consequences, they would rarely preserve their
chastity. Unlegalized connexions would be common and seldom detected.
Seduction would be facilitated. Let us dispassionately examine this
argument.

“I fully agree with that most amiable of moral heretics, Shelley, that
‘Seduction, which term could have no meaning in a rational society, has
now a most tremendous one.’[32] It matters not how artificial the
penalty which society has chosen to affix to a breach of her capricious
decrees. Society has the power in her own hands; and that moral Shylock,
Public Opinion, enforces the penalty, even though it cost the life of
the victim. The consequences, then, to the poor sufferer, whose offence
is, at most, but an error of judgment or a weakness of the heart, are
the same as if her imprudence were indeed a crime of the blackest dye.
And his conduct who, for a momentary, selfish gratification, will
deliberately entail a life of wretchedness on one whose chief fault,
perhaps, was her misplaced confidence in a villain, is not one whit
excused by the folly and injustice of the sentence.[33] Some poet says,

             ‘The man who lays his hands upon a woman,
             Save in the way of kindness, is a wretch
             Whom ’twere gross flattery to call a coward.’

What epithet then belongs to him who makes it a trade to win a woman’s
gentle affections, betray her generous confidence, and then, when the
consequences become apparent, abandon her to dependence, and the scorn
of a cold, a self-righteous, and a wicked world; a world which will
forgive anything but rebellion against its tyranny, and in whose eyes it
seems the greatest of crimes to be unsuspecting and warm-hearted! I will
give my hand freely to a galley-slave, and speak to the highway-robber
as to an honest man; but there is one character with whom I desire to
exchange neither word nor greeting—the cold-hearted, deliberate,
practised, and calculating seducer!

“And, let me ask, what is it gives to the arts of seduction their sting,
and stamps to the world its victim? Why is it, that the man goes free
and enters society again, almost courted and applauded for his
treachery, while the woman is a mark for the finger of reproach, and a
butt for the tongue of scandal? Because she bears about her the mark of
what is called her disgrace. She becomes a mother; and society has
something tangible against which to direct its anathemas. Nine-tenths,
at least, of the misery and ruin which are caused by seduction, even in
the present state of public opinion on the subject, result from cases of
pregnancy.

“If the little being lives, the dove in the falcon’s claws is not more
certain of death, than we may be, that society will visit, with its
bitterest scoffs and reproaches, the bruised spirit of the mother and
the unconscious innocence of the child.

“If, then, we cannot do all, shall we neglect a part? If we cannot
prevent every misery which man’s selfishness and the world’s cruelty
entail on a sex which it ought to be our pride and honor to cherish and
defend; let us prevent as many as we can. If we cannot persuade society
to revoke its unmanly and _unchristian_[34] persecution of those who are
often the best and gentlest of its members—let us, at the least, give to
woman what defence we may, against its violence.

“I appeal to any father, trembling for the reputation of his child,
whether, if she were induced to form an unlegalized connexion, her
pregnancy would not be a frightful aggravation? I appeal to him, whether
a preventive which shall save her from a situation which must soon
disclose all to the world, would not be an act of mercy, of charity, of
philanthropy—whether it might not save him from despair, and her from
ruin? The fastidious conformist may frown upon the question, but to the
father it comes home; and, whatever his lips may say, his heart will
acknowledge the soundness and the force of the argument it conveys.

“It may be, that sticklers for morality will still demur to the
positions I defend. They will perhaps tell me, as the committee of a
certain society in this city lately did—that the power of preventing
conception ‘holds out inducements and facilities for the prostitution of
their daughters, their sisters, and their wives.’

“Truly, but they pay their wives, their sisters, and their daughters, a
poor compliment! Is, then, this vaunted chastity a mere thing of
circumstance and occasion? Is there but the difference of opportunity
between it and prostitution? Would their wives, and their sisters, and
their daughters, if once absolved from the fear of offspring, all become
prostitutes—and sell their embrace for gold, and descend to a level with
the most degraded? In truth, but they slander their own kindred: they
libel their own wives, sisters, and daughters. If they spoke truth—if
fear were indeed the only safeguard of their relatives’ chastity, little
value should I place on virtue like that! and small would I esteem his
offence, who should attempt to seduce it.[35]

“That chastity which is worth preserving is not the chastity that owes
its birth to fear and to ignorance. If to enlighten a woman regarding a
simple physiological fact will make her a prostitute, she must be
especially predisposed to profligacy. But it is a libel on the sex. Few,
indeed, there are, who would continue so miserable and degrading a
calling, could they but escape from it. For one prostitute that is made
by inclination, ten are made by necessity. Reform the laws—equalize the
comforts of society, and you need withhold no knowledge from your wives
and daughters. It is want, not knowledge, that leads to prostitution.

“For myself, I would withhold from no sister, or daughter, or wife of
mine, any ascertained fact whatever. It should be to me a duty and a
pleasure to communicate to them all I knew myself; and I should hold it
an insult to their understandings and their hearts to imagine, that
their virtue would diminish as their knowledge increased. Vice is never
the offspring of just knowledge, and they who say it is, slander their
own nature. Would we but trust human nature, instead of continually
suspecting it, and guarding it by bolts and bars, and thinking to make
it very chaste by keeping it very ignorant, what a different world we
should have of it! The virtue of ignorance is a sickly plant, ever
exposed to the caterpillar of corruption, liable to be scorched and
blasted even by the free light of heaven; of precarious growth; and even
if at last artificially matured, of little or no real value.

“I know that parents often think it right and proper to withhold from
their children—especially from their daughters—facts the most
influential on their future lives, and the knowledge of which is
essential to every man and woman’s well-being.[36] Such a course has
ever appeared to me ill-judged and productive of very injurious effects.
A girl is surely no whit the better for believing, until her marriage
night, that children are found among the cabbage leaves in the garden.
The imagination is excited, the curiosity kept continually on the
stretch; and that which, if simply explained, would have been
recollected only as any other physiological phenomenon, assumes all the
rank and importance and engrossing interest of a mystery. Nay, I am well
convinced, that mere curiosity has often led ignorant young people into
situations, from which a little more confidence and openness on the part
of their parents and guardians, would have effectually secured them.

“But if we _could_ prevent the circulation of truth, why _should_ we? We
are not afraid of it ourselves. No man thinks _his_ morality will suffer
by it. Each feels certain that his virtue can stand any degree of
knowledge. And is it not the height of egregious presumption in each to
imagine that his neighbor is so much weaker than himself, and requires a
bandage which he can do without? Most of all is it presumptuous to
suppose, that that knowledge which the man of the world can bear with
impunity, will corrupt the young and the pure-hearted. It is the sullied
conscience only that suggests such fears. Trust youth and innocence.
Speak to them openly. Show them that you respect them, by treating them
with confidence; and they will quickly learn to respect and to govern
themselves. You enlist even their pride in your behalf; and you will
soon see them make it their boast and their highest pleasure to _merit_
your confidence. But watch them, and show your suspicions of them but
once,—and you are the jailor, who will keep his prisoners just as long
as bars and bolts shall prevent their escape. The world was never made
for a prison-house; it is too large and ill-guarded: nor were parents
ever intended for jail-keepers; their very affections unfit them for the
task.

“There is no more beautiful sight on earth, than a family among whom
there are no secrets and no reserves; where the young people confide
everything to their elder friends—for such to them are their parents—and
where the parents trust everything to their children; where each thought
is communicated as freely as it arises; and all knowledge given, as
simply as it is received. If the world contain a prototype of that
Paradise, where nature is said to have known no sin or impropriety, it
is such a family; and if there be a serpent that can poison the
innocence of its inmates, that serpent is SUSPICION.

“I ask no greater pleasure than thus to be the guardian and companion of
young beings whose innocence shall speak to me as unreservedly as it
thinks to itself; of young beings who shall never imagine that there is
guilt in their thoughts, or sin in their confidence; and to whom, in
return, I may impart every important and useful fact that is known to
myself. Their virtue shall be of that hardy growth, which _all_ facts
tend to nourish and strengthen.

“I put it to my readers, whether such a view of human nature, and such a
mode of treating it, be not in accordance with the noblest feelings of
their hearts. I put it to them, whether they have not felt themselves
encouraged, improved, strengthened in every virtuous resolution, when
they were generously trusted; and whether they have not felt abased and
degraded, when they were suspiciously watched, and spied after, and kept
in ignorance. If they find such feelings in their own hearts, let them
not self-righteously imagine, that they can only be won by generosity,
or that the nature of their fellow-creatures is different from their
own.

“There are other considerations connected with this subject, which
farther attest the social advantages of the control I advocate. Human
affections are mutable, and the sincerest of moral resolutions may
change.[37] Every day furnishes instances of alienations, and of
separations; sometimes almost before the honey-moon is well expired. In
such cases of unsuitability, it cannot be considered desirable that
there should be offspring; and the power of refraining from becoming
parents until intimacy had, in a measure, established the likelihood of
permanent harmony of views and feelings, must be confessed to be
advantageous.

“It would be impossible to meet every argument in detail, which
ingenuity or prejudice might put forward. If the world were not actually
afraid to think freely or to listen to the suggestions of common sense,
three-fourths of what has already been said would be superfluous; for
most of the arguments employed would occur spontaneously to any
rational, reasoning being. But the mass of mankind have still, in a
measure, everything to learn on this subject. The world seems to me much
to resemble a company of gourmands, who sit down to a plentiful repast,
first very punctiliously saying grace over it; and then, under the
sanction of the priest’s blessing, think to gorge themselves with
impunity; as conceiving, that gluttony after grace is no sin. So it is
with popular customs and popular morality. Everything is permitted, if
external forms be but respected. Legal roguery is no crime, and
ceremony-sanctioned excess no profligacy. The substance is sacrificed to
the form, the virtue to the outward observance. The world troubles its
head little about whether a man be honest or dishonest, so he knows how
to avoid the penitentiary and escape the hangman. In like manner, the
world seldom thinks it worth while to inquire whether a man be temperate
or intemperate, prudent or thoughtless. It takes especial care to inform
itself whether in all things he conforms to orthodox requirements; and
if he does, all is right. Thus men too often learn to consider an oath
an absolution from all subsequent decencies and duties, and a full
release from all responsibilities. If a husband maltreat his wife, the
offence is venal; for he premised it by making her at the altar, an
‘honest woman.’ If a married father neglects his children, it is a
trifle; for grace was regularly said before they were born.

“With such a world as this, it is a difficult matter to reason. After
listening to all I have said, it may perhaps cut me short by reminding
me, that nature herself declares it to be right and proper, that we
should reproduce our species without calculation or restraint. I will
ask, in reply, whether nature also declares it to be right and proper,
that when the thermometer is at 96°, we should drink greedily of cold
water, and drop down dead in the streets? Let the world be told, that if
nature gave us our passions and propensities, she gave us also the power
wisely to control them; and that, when we hesitate to exercise that
power we descend to a level with the brute creation, and become the
sport of fortune—the mere slaves of circumstance.[38]

“To one other argument it were not, perhaps, worth while to advert, but
that it has been already speciously used to excite popular prejudice. It
has been said, that to recommend to mankind prudential restraint in
cases where children cannot be provided for, is an insult to the poor
man; since all ought to be so circumstanced that they might provide
amply for the largest family. Most assuredly all _ought_ to be so
circumstanced; but all _are_ not. And there would be just as much
propriety in bidding a poor man to go and take by force a piece of
Saxony broadcloth from his neighbor’s store, because he _ought_ to be
able to purchase it, as to encourage him to go on producing children,
because he _ought_ to have the wherewithal to support them. Let us exert
every nerve to correct the injustice and arrest the misery that results
from a vicious order of things; but, until we have done so, let us not,
for humanity’s sake, madly recommend that which grievously aggravates
the evil; which increases the burden on the present generation, and
threatens with neglect and ignorance the next.

“It now remains, after having spoken of the _desirability_ of obtaining
control over the instinct of reproduction, to speak of its
_practicability_.

“I have taken great pains to ascertain the opinions of the most
enlightened physicians of Great Britain and France on this subject;
(opinions which popular prejudice will not permit them to offer publicly
in their works;) and they all concur in admitting, what the experience
of the French nation _positively proves_, that man may have a perfect
control over this instinct: and that men and women may, without any
injury to health, or the slightest violence done to the moral feelings,
and with but small diminution to the pleasure which accompanies the
gratification of the instinct, refrain at will from becoming parents. It
has chanced to me, also, to win the confidence of several individuals,
who have communicated to me, without reserve, their own experience: and
all this has been corroborative of the same opinion.

“However various and contradictory the different theories of generation,
almost all physiologists are agreed, that the entrance of the sperm
itself (or of some volatile particles proceeding from it) into the
uterus, must precede conception. This it was that probably first
suggested the possibility of preventing conception at all.”


The eloquent writer, who was at that time unaware of the existence of
Desomeaux’s mode of prevention to conception,[39] states the same result
was attained by a complete withdrawal on the part of the male previous
to emission. But this mode, it will be readily perceived, is attended
with, to some, insurmountable difficulties.

In the first place, few men can invariably control themselves in this
respect, and to be an effectual preventive, he must ever, and invariably
control his passions. Now it cannot be denied, that even those who
habitually can, and do control themselves, will inevitably, now and
then, in so exciting a passion, lose their self-control. It is
impossible to do otherwise. And one moment’s forgetfulness defeats the
end. In the second place, even if always and invariably practicable, it
makes the act of coition incomplete and unsatisfactory. In the third
place it would be almost, nay quite impossible, to prevent an
imperceptible and unconscious escape of semen, sufficient however to
produce conception, often giving rise to unjust and unfounded
suspicions, when, in fact, the cause for the existence of pregnancy is
the same as though no withdrawal was practised. And lastly, its effects
upon the constitution are frequently not unlike those produced by
onanism. In addition to which, it is unsafe, because uncertain;
consequently, when indispensable to prevent pregnancy, is of no avail,
if not actually dangerous.[40]

To sum up, in brief, why pregnancy should be prevented, the reasons
adduced seem to be conclusive to the able and talented writer, in its
moral, social, and physiological aspect.

_Morally._ Firstly. It induces early marriages by removing the principal
obstacle thereto, viz.: the fear of having offspring before the parents
are in a pecuniary condition to support, rear, and educate them. And,

Secondly, By inducing early marriages, seductions would become less
frequent, and consequently prostitution, comparatively, become extinct.

_Socially._ Firstly. Young men, instead of seeking excitement and
amusement in the intoxicating cup, gaming, night carousals, brothels,
&c., acquiring habits of dissipation deadening alike to the keen, fresh
susceptibilities belonging to youth—habits too, which often cling to
them in after life, habits which, perhaps for ever destroy their
health,—as tainting their constitution with some foul and incurable
disease,—would, with a view to early marriage, cultivate the social and
domestic ties, while yet pure and uncontaminated by contact with the
dissolute and vicious. And

Secondly, Young persons, even though with very limited means, would
nevertheless marry, and by not becoming parents, be enabled, unitedly,
to husband their resources, with the view to the bettering their
condition pecuniarily; in the meantime, and in the days of their youth,
enjoying all those social endearments which each sex finds in the
society of the other, where reciprocity of views, interests, and
feelings exists. So too, those in middling circumstances would marry
early, merely deferring an increase of family until they will have
established themselves in some business, ere the constant accumulating
expenses of an increasing family encroach upon, or eat up their small
capital, the immediate incurrence of which thus early would, perhaps,
for ever destroy the means for the comfortable provision of themselves,
as also the future welfare of their children.

_Physiologically._ By inducing early marriages, the dire evils arising
from promiscuous sexual intercourse with the tainted or diseased, will
gradually disappear, and in a generation or two we would find springing
up, in the place of the present sickly, puny race, a healthy, robust,
and pure generation.

In regard to the morality of preventing conception it is contended that
everything which tends to the amelioration of mankind, to improve their
condition physically, morally, and socially, or equalize their condition
pecuniarily, cannot be immoral. That the instinct of reproduction should
be, like our other appetites and passions, subject to the control of
reason,—that when the gratification of this instinct results in evil
effects either to ourselves or to our offspring, or even to society—if
such evil can be prevented, it is the obligation of morality that it
should be.

It is contended, then, that the use of a preventive to conception will
make men and women rational, reflecting, thinking beings, regardful
alike of their own welfare and the welfare of their offspring. That it
will banish poverty, vice and profligacy, by enabling the poor to
improve their pecuniary condition and thus engendering habits of
frugality, reflection and economy, which the prospect of future
competency is so calculated to inspire. Vice so often springing from
despair and hopeless poverty will disappear, because the children, by
reason of the competence and moral structure of the parents, will not in
infancy be thrust upon the world to mingle with the depraved and the
licentious. Sexual profligacy and licentiousness will be checked, as
early marriages become more prevalent and universal, as there then will
exist no reasons as now, why two persons, attached to each other, should
not marry, refraining merely from becoming parents. Dishonorable
advances therefore would be spurned, seductions thus have no existence,
and prostitution, the offspring of seduction, would be unknown, and even
the ravages of that disease, engendered by promiscuous sexual
intercourse, now carrying off its tens of thousands, transmitting its
pestiferous poison to thousands yet unborn, would entirely disappear.

The able author thus concludes his views:


“And now let my readers pause. Let them review the various arguments I
have placed before them. Let them reflect how intimately the instinct of
which I treat is connected with the social welfare of society. Let them
bear in mind, that just in proportion to its social influence, is it
important that we should know how to control and govern it; that when we
obtain such control, we may save ourselves—and, what we ought to prize
much more highly, may save our companions and our offspring, from
suffering or misery; that, by such knowledge, the young may form
virtuous connexions, instead of becoming profligates or ascetics; that,
by it, early marriage is deprived of its heaviest consequences, and
seduction of its sharpest sting; that, by it, man may be saved from
moral ruin, and woman from desolating dishonor; that by it the first
pure affections may be soothed and satisfied, instead of being thwarted
or destroyed—let them call to mind all this, and let them say, whether
the possession of such control be not a blessing to man.

“As to the cry which prejudice may raise against it as being unnatural,
it is just as unnatural (and no more so) as to refrain, in a sultry
summer’s day, from drinking, perhaps, more than a pint of water at a
draught, which prudence tells us is enough, while inclination would bid
us drink a quart. _All_ thwarting of any human wish or impulse may, in
one sense, be called unnatural; it is not, however, ofttimes the less
prudent and proper on that account.”

As to the practical efficacy of this preventive, the experience of
France, where it is universally practised, might suffice in proof. We
know, at this moment, several married persons who have told us, that,
after having had as many children as they thought prudent, _they had for
years employed it with perfect success_. For the satisfaction of our
readers, we will select some instances.

A few weeks since, a respectable and very intelligent father of a
family, about thirty-five years of age, who resides west of the
mountains, called at our office. Conversation turned on the present
subject, and we expressed to him our conviction that this preventive was
effectual. He told us he could speak from personal experience. He had
married young, and soon had three children. These he could support in
comfort, without running into debt or difficulty; but, the price of
produce sinking in his neighborhood, there did not appear a fair
prospect of supporting a large family. In consequence, he and his wife
determined to limit their offspring to three. They have accordingly used
it for seven or eight years; have had no more children; and have been
rewarded for their prudence by finding their situation and prospects
improving every year.

The next communication from which we shall copy is from a young man of
excellent character, living in a neighboring state, and now one of the
conductors of a popular periodical. After suggesting to us the propriety
of re-publishing some English works now out of print, he proceeds as
follows:


“Had I not been addressing you upon another subject, I should not have
ventured to obtrude on you my small need of approbation; but I cannot
let slip this opportunity of endeavoring to express how much I feel
indebted to you for its publication.

“To know how I am so indebted, it is necessary you should also know
something of my situation in life; and when it is described, it is
perhaps a description of the situation of two-thirds of the journeymen
mechanics of this country.

“I have been married nearly three years, and am the father of two
children. Having nothing to depend upon but my own industry, you will
readily acknowledge that I had reason to look forward with at least some
degree of disquietude to the prospect of an increasing family and
reduced wages: apparently the inevitable lot of the generality of
working men.

“I had apparently nothing left but to let matters take their own course,
when your valuable work made its appearance.

“I read it; and a new scene of existence seemed to open before me. I
found myself, in this all-important matter, a free agent, and, in a
degree, the arbiter of my own destiny. I could have said to you as Selim
said to Hassan,—‘

         ‘Thou’st hew’d a mountain’s weight from off my heart.’

My visions of poverty and future distress vanished; the present seemed
gilded with new charms, and the future appeared no longer to be dreaded.
But you can better imagine, than I describe, the revolution of my
feelings.

“I have since endeavored to circulate this book as widely as my limited
opportunities permit, and shall continue to do so, believing it to be
the most useful work that has made its appearance.”

The next extract, from an inhabitant of Pennsylvania, we have selected
chiefly as it furnishes a beautiful, and, alas! a rare, example, of that
parental conscientiousness which scruples to impart existence where it
cannot also impart the conditions necessary to render that existence
happy. In this view, the control in question is indeed all-important.
Were such virtue as this cultivated in mankind generally, how soon might
the very seeds of disease die out among us, instead of bearing, as now,
their poison-fruit from generation to generation! and how far might
human beings, in succeeding ages, surpass their forefathers in strength,
in health, and in beauty!

This view of the subject is to the physiologist, to the philosopher, to
every friend of human improvement, a most interesting one. ‘So long,’ to
use the words of an eloquent lecturer, ‘as the tainted stream is
unhesitatingly transmitted through the channel of nature, from parent to
offspring, so long will the text be verified which “visits the sins of
the fathers on the children, even to the third and fourth generation.”’
And so long, we would add, will mankind—wise and successful whenever
there is question of improving the animal races—be blind in perceiving,
and listless in securing, that far nobler object, the physical, and
thereby—in a measure—the mental and moral improvement of our own.

Here is the extract which led to these remarks:—


“I was born of poor parents, and early left an orphan. When of age,
though my circumstances promised poorly for the support of a family, I
desired to marry, knowing that a good wife would greatly add to my
happiness. The preventive spoken of in your book presented itself to my
mind, and for seven years that I have now been married, it has been
used. I was successful in business, and acquired the means of
maintaining a family; but still I have been unwilling, because my
constitution is such a one as I think a parent ought not to transmit to
his offspring. I prefer not to give birth to sentient beings, unless I
can give them those advantages, physical as well as moral and
intellectual, which are essential to human happiness.”

From the letter of an aged French gentleman, who holds a public office
in the western country, I translate the following; and I would to heaven
that every young man and woman in these United States could read it:


“I have read your work with much interest; and desire that it may have a
wide circulation and that its recommendations may be adopted in
practice. If you publish another edition, I could wish that you would
add a piece of advice of the greatest importance, especially to young
married persons. Many women are ignorant, that, in the gratification of
the re-productive instinct, the exhaustion to the man is much greater
than to the woman; a fact most important to be known, the ignorance of
which has caused more than one husband to forfeit his health, nay, his
life. Tissot tells us, that the loss by an ounce of semen is equal to
that by forty ounces of blood;[41] and that, in the case of the
healthiest man, nature does not demand connexion oftener than once a
month.[42]

“How many young spouses, loving their husbands tenderly and
disinterestedly, if they were but informed of these facts, would watch
over and preserve their partners’ healths, instead of exciting them to
over-indulgence.”—Another extract.

“A member of the Society of Friends, from the country, called at our
office; he informed me that he had been married twenty years, had six
children, and would probably have had twice as many, but for the
preventive, which he found in every instance efficacious. By this means
he made an interval of two or three years between the births of each of
his children. Having at last a family of six, his wife earnestly desired
to have no more; and on one occasion, when the preventive was neglected
to be used, she shed tears at the prospect of again becoming pregnant.
He said he knew, in his own neighborhood, several married women who were
rendered miserable on account of their continued pregnancy, and would
have given anything in the world to escape, but knew not how.”

Our readers may implicitly depend on the accuracy of the facts we have
stated. Though in the present state of public opinion we may not, for
obvious reasons, give _names_ in proof.

That most practical of philosophers, Franklin, interprets chastity to
mean, _the regulated and strictly temperate satisfaction, without injury
to others, of those desires which are natural to all healthy adult
beings_. In this sense, chastity is the first of virtues, and one most
rarely practised, either by young men or by married persons, even when
the latter most scrupulously conform to the letter of the law.

It is all important for the welfare of our race, that the re-productive
instinct should never be selfishly indulged; never gratified at the
expense of the well-being of our companions. A man who, in this matter,
will not consult, with scrupulous deference, the slightest wishes of the
other sex; a man who will ever put his desires in competition with
theirs, and who will prize more highly the pleasure he receives than
that he may be capable of bestowing—such a man appears to me, in the
essentials of character, a brute. The brutes commonly seek the
satisfaction of their propensities with straight-forward selfishness,
and never calculate whether their companions are gratified or teased by
their importunities. Man cannot assimilate his nature more closely to
theirs, than by imitating them in this.

Again. There is no instinct in regard to which strict temperance is more
essential. All our animal desires have hitherto occupied an undue share
of human thoughts; but none more generally than this. The imaginations
of the young and the passions of the adult are inflamed by mystery or
excited by restraint, and a full half of all the thoughts and intrigues
of the world has a direct reference to this single instinct. Even those,
who like the Shakers, ‘crucify the flesh,’ are not the less occupied by
it in their secret thoughts; as the Shaker writings themselves may
afford proof. Neither human institutions nor human prejudices can
destroy the instinct. Strange it is, that men should not be content
rationally to control, and wisely to regulate it.




                            SEXUAL WEAKNESS


This complaint, commonly called _fluor albus_, or _whites_, to which
women are peculiarly subject, must form an important object of
attention, since it is always attended with disagreeable symptoms; and,
when aggravated, soon spoils the beauty of a fine face, weakens the
digestive powers, produces a general bad habit, and occasions sterility.


                              _Symptoms._

An irregular discharge from the passage leading to the womb, of a fluid,
which, in different women, varies much in colour, being of a white,
green, yellow, or brown hue. In the beginning it is, however, most
usually white and pellucid, and, in progress of the complaint, acquires
the various discolourations and different degrees of acrimony, whence
proceed a slight smarting on making water. Besides the discharge, the
patient is frequently afflicted with severe and constant pains in the
back and loins, indigestion, paleness of the face, chilliness, and
languor. In process of time, every symptom becomes highly aggravated,
the feet and ankles swell, palpitations, and a difficulty of respiration
are experienced, the menstrual discharge is rendered irregular, the
urine is turbid, the mind is dejected, and either consumption or dropsy
supervenes, and terminates a miserable existence.

In some languid habits, the fluor albus returns periodically, instead of
the proper menstrual evacuation, until the patient’s constitution is
duly invigorated.


                               _Causes._

It may be produced by any cause which either weakens or irritates the
womb and its appendages. It may arise from general debility of the
constitution, but it is especially caused by circumstances impairing the
power of the womb itself, as, for instance, a severe labour, a
miscarriage, or profuse menstruation.

In some instances it appears to depend on a full and irritable habit of
body, and, in other cases, of local irritation, such as disorders of the
womb, or of the urinary organs, or a collection in the gut, of the small
thready worms called ascarides.

Upon the high authority of Dr. Hamilton, this disease is most frequently
first brought on by some imprudence in respect to diet and clothing, or
exposure to cold or fatigue, or neglect of the bowels about the time
when menstruation begins.


                              _Treatment._

In the treatment of this complaint regard must be had to the apparent
cause, and to the state of the patient. The discharge is too often
considered by the sex as the effects of general weakness in their habit,
and, therefore, they are led to the indiscriminate use of heating
medicines, as port wine, balsam copaibæ, &c., without paying attention
to the habit of the body, or cause of the disease.

A milk diet, change of air, and the partial cold bath, as sponging the
loins and thighs with cold water every morning, with attention to
cleanliness and proper exercise, are often sufficient to arrest the
disease, if early adopted.

In addition to this plan of treatment, if the patient be of a full
habit, a disposition to fever from slight causes, attended with a sense
of heat about the passage to the womb, it will be necessary to have
recourse to the lancet, cooling cathartics, and febrifuge medicines, and
to inject, several times a day, flax-seed tea or milk and water, into
the passage of the womb. In the great majority of cases, the complaint
arises from general debility or laxity of the vessels of the parts, and
in such cases the indications of cure are to increase the vital heat,
promote the digestion, and restrain the preternatural discharge. In
order to which, recourse must be had to such of the tonic medicines as
will be found to agree best with the patient. Of these, the bark and
elixir vitriol, the tonic powders or pills, the rust or tincture of
steel, and lime-water have usually been employed, and often with good
effects. In some instances, however, I have known these medicines to
fail, when the nitric acid, diluted, in doses of a wineglassful, three
or four times a day, wonderfully succeeded.

Previously to the exhibition of tonic medicines, it is advisable to give
a dose of ipecacuanha or antimonial wine. Gentle emetics are supposed to
be of singular utility in this complaint, not only by cleansing the
stomach and bowels, and making a revulsion of the humors from the
inferior part of the body, but likewise by their exciting all the powers
of the constitution to a more vigorous action.

The bowels must be kept in a regular state by conjoining a few grains of
rhubarb with some of the tonic medicines, or by taking occasionally, at
bedtime, one of the aloetic, or aperient or diaphoretic pills; or, in
the morning, a teaspoonful of Epsom salts dissolved in a tumbler of
water.

If there be a fulness of the stomach after eating, the tincture of
rhubarb in small doses will excite digestion. In obstinate cases, it is
often expedient to produce a change in the system, by giving a grain or
two of calomel, or one of the mercurial pills at bedtime, until the gums
become slightly affected, and then the cure may be completed by
strengthening medicines, together with the shower bath.

Besides tonics, stimulating medicines, such as commonly determine to the
urinary passages, have very frequently been employed with great benefit.
Of these, rosin in doses of ten grains in the yolk of an egg, or a
spoonful of molasses, or balsam copaibæ in doses of a teaspoonful, or
tincture of cantharides in doses of twenty or thirty drops in some
mucilaginous drink, and taken three or four times a day, will be found
most salutary.

These means strike at the cause of the complaint; but if it do not
remove the effect very soon, we are not to trust to them alone. For once
a morbid secretion being excited, it is very apt to continue, although
the exciting cause cease to operate.

On this account, we ought, without delay, to have recourse to astringent
injections, such as a strong decoction of red oak bark, with the
addition of a little alum or a solution of alum in water. Half an ounce
of the former to be dissolved in a bottle of water; which should be
thrown into the vagina by means of a female syringe, two or three times
a day. The celebrated Dr. Burns says, after many trials, he satisfied
himself, that although assistance may be derived from internal medicines
and the cold bath, yet the chief dependence is to be placed on
astringent applications to the seat of the discharge; and these, where
there is no fulness of the general system, nor any affection of the womb
itself, are perfectly safe, and seldom fail in producing a cure.

It will be prudent, when this disease occurs as an early symptom of
pregnancy, not to check the discharge suddenly, lest miscarriage be the
consequence; but it may be moderated by injections of water, with the
addition of a little vinegar, or an infusion of green tea. Neither
should the discharge be suddenly suppressed when it has been of long
standing, and acquired a considerable degree of acrimony, with an
offensive smell. For if it be unseasonably checked, the belly swells,
and a train of the most disagreeable symptoms occurs. In such cases,
soap suds, or an infusion of chamomile flowers or hops, should be
frequently thrown up the vagina; and, as soon as the blood is freed of
its impurities, by suitable medicines, and has recovered, in some
measure, its soft and balmy quality of which it has been deprived, the
astringent injections may be employed with perfect safety.

The application of a blister to the sacrum, has, in some obstinate
cases, been attended with advantage.

When the fluor albus proceeds from worms, purgatives and bitter clysters
are the proper remedies.

Pain in the back and loins is often mitigated by the application of a
large adhesive or strengthening plaster, and by avoiding a standing
posture of long continuance, much walking, dancing, or any other violent
exertion.

Women should carefully avoid all the remote causes of the disease: they
should pay diligent attention to cleanliness, by washing the parts
frequently with cold water; and when there are excoriations, milk and
water, or lead water, may be employed as a wash.


                               _Regimen._

The diet should be light, cordial, and nourishing, consisting of
isinglass dissolved in milk by boiling it, jellies, custards, rice,
milk, soft-boiled eggs, gelatinous broths, and light meats, together
with a prudent use of genuine wine, particularly claret or port.

Women, affected with this disease, should by no means indulge in the use
of tea and other warm slops of a relaxing nature; but should lie on a
mattress in preference to a feather bed; and they should rise early, and
take such daily exercise as their strength will admit, particularly on
horseback. When there is much languor, with chilliness, friction with
the flesh-brush, and wearing flannel next the skin, must not be omitted.




                       FALLING DOWN OF THE WOMB.


This is a much more common complaint than the former, and takes place in
women of every age, and every rank. As its name implies, it consists of
change in the situation of the womb, by which that organ lies much lower
than it ought to do. In some cases it absolutely protrudes entirely
without the parts. The slightest degrees are styled bearing down; and
the more violent ones descent or falling down of the womb.

In general, the first symptom of this complaint is an uneasy sensation
in the lower part of the back while standing or walking, with now and
then a kind of pressure and bearing down.

If these feelings be disregarded, the complaint increases, and the
patient becomes incapable of making water without first lying down, or
pushing up a swelling which seems to stop the discharge of urine; and if
the disease continues to increase, the womb is actually forced out of
the parts, and takes on the form of a bulky substance hanging down
between the thighs. This extreme degree of the complaint can seldom
happen, excepting in women who have had a great many children, but the
less degrees of it occur occasionally in very young unmarried women.

The causes of descent of the womb ought to be known to every woman, as
many of them may be avoided. Every disease which induces weakness of the
habit in general, or of the passage leading to the womb, in particular,
must lay the foundation for the complaint. Frequent miscarriages,
improper treatment during labour, too early or violent exercise after
delivery, are in married women, the most frequent circumstances by which
falling down of the womb is produced. In the unmarried, it is apt to
take place in consequence of violent exercise, as in dancing, riding,
&c., while out of order, a fact that ought to be impressed on the mind
of every young woman.

In the treatment of this complaint, the means must be adapted to the
degree of its violence. When the descent is inconsiderable, and the case
is of recent date, the daily use of the cold bath, invigorating diet,
very moderate exercise, and the injection of any mild astringent liquor
into the passage, evening and morning, will probably prove successful.
But should the disease be in a great degree or of long standing, a
course of tonics, with the frequent use of astringent injections, as a
strong solution of alum in water, or decoction of red oak bark, must be
added to the above means.

Dr. Leak advises, that after the parts are reduced, the intention of
contracting the relaxed vagina so as to prevent its future descent, may
be effected by the frequent use of the following astringent injection.
Take of alum, and white vitriol, each, one drachm, boiling water, one
pound, mix and filter through paper. Inject it into the vagina, milk
warm, with a womb syringe. At the same time endeavour to strengthen the
whole bodily system by nourishing diet, and tonic medicines.

When the complaint resists such remedies, or when, from its degree, it
may appear unnecessary to employ them, the only relief which can be
afforded, unless the womb become pregnant, is to be obtained by wearing
an instrument called a pessary. It is made of wood or ivory, and if
properly adapted to the passage, and of a proper construction, it can be
worn without much inconvenience, and it never occasions pain. Certain
attentions are however necessary, whenever such an instrument is used.
Thus, the pessary should never be allowed to remain in the passage above
a few days at a time, otherwise it becomes the source of great
irritation. It should, therefore, be occasionally withdrawn on going to
bed, well cleaned and reintroduced in the morning, before the patient
rises. In some instances, after a pessary of a certain size has been
worn for several months, one of a smaller size becomes better adapted to
the passages, and in other cases one of a larger size is required.

Sponges of such a size as, when expanded, fill up the cavity of the
vagina, are very good _pessaries_. They support the uterus, and, by
putting a string through them, the end of which is to be left hanging
out of the os externum, the woman can take them away and apply them
herself very conveniently.

To answer this purpose, a fine sponge, wrung out in alum water, may be
dried in a compressed state, and cut into any convenient form, so as to
be introduced as high as possible: this will act by its astringency, and
by its pressure, in a gentle and uniform manner. During the use of this
application, an astringent injection may be used twice a day; and the
sponge tent should be made gradually smaller as the vagina contracts.

The application of the bandage round the whole belly, with a moderate
degree of firmness, often gives great relief to the uneasy feelings. The
T bandage has also been worn in this case with considerable advantage.

If a woman liable to falling down of the womb, become pregnant, there is
no occasion for the pessary after the third month, and by proper
treatment after delivery, the return of the complaint may be prevented.




                        MISCARRIAGE OR ABORTION.


We now come to the consideration of a subject, in respect to which there
exists much misapprehension and ignorance, causing useless and
unnecessary alarm and anxiety to those who may be so unfortunate as to
be subject, at particular periods of gestation, to abortion or
miscarriage.

The dangers of abortion or miscarriage are often magnified and
exaggerated. It is dangerous if produced by a fall, a blow, a kick from
a horse, or any other external bodily violence or injury, causing
internal contusion, or rupture of some blood-vessels; and, also, but not
to the same extent, if produced by sudden fright, violent fits of
passion, &c., or from general debility or disease of the uterus; but the
danger arises more from the cause which produces the miscarriage, than
from the miscarriage itself; as it is well known by those versed in
obstetrics that, where it is deemed indispensable to effect a
miscarriage, either because of the existence of a deformed pelvis,
diseased uterus, or other causes, if skilfully effected, it is attended
with no danger, especially in the earlier stages of pregnancy.[43]


                              _Symptoms._

When miscarriage is about to take place, its first symptoms are
generally occasional stinging pains at the bottom of the belly,
extending across and around the loins and hips; a feeling of fatigue of
the legs, pain in the forehead, burning sensation of the eyes. The
breasts, which before were distended, become soft and flabby, hot and
cold flashes, attended with thirst, fever, and shiverings. In a day or
two after the appearance of these symptoms, a discharge from the womb
takes place of yellow matter, tinctured with red. If not arrested at
this stage, the pains across the loins become more severe and frequent,
attended with a sense of dead weight, and bearing down about the womb,
the water is discharged, and the expulsion of the contents of the womb
takes place. The symptoms of miscarriage, however, vary with the causes
which produce them, or the state of habit, age, or health of the
patient; some recovering immediately, and rapidly, and with but little
inconvenience. Where miscarriage arises from a serious accident, such as
violent falls, bruises, &.c., the symptoms are somewhat aggravated, and
more severe, and are often preceded and accompanied with violent and
profuse floodings and discharges of coagula, in addition to the other
symptoms; although moderate flowing is not an unfrequent symptom in
miscarriages.

It is always accompanied with two circumstances, separation of the
membranous bag, and expulsive efforts or contraction of the womb itself.
The first is productive of discharge, the second of pains like those of
labor. Sometimes the separation or detachment of part of the conception
takes place before any pain is felt; on other occasions, the pain, or
contraction of the womb, takes place first, and produces a separation.
In the first of these cases, the symptoms of abortion take place
suddenly, and are usually occasioned by fatigue, sudden exertion, or
fright. In the second, the pains come on, and there are particular
feelings, and changes, which indicate that a miscarriage is likely to
take place; as, for instance, the cessation of the morning sickness, the
subsidence of the breasts, &c.

Miscarriage is preceded by floodings, pains in the back, loins, and
lower part of the abdomen, evacuation of the water, shiverings,
palpitation of the heart, nausea, anxiety, fainting, subsiding of the
breasts and belly, pain in the inside of the thighs, opening and
moisture of the womb.


                               _Causes._

The principal causes of miscarriage are blows or falls; great exertion
or fatigue; sudden frights and other violent emotions of the mind; a
diet too sparing or too nutritious; the abuse of spirituous liquors;
other diseases, particularly fevers and hæmorrhages; likewise excessive
bleeding, profuse diarrhœa or colic, particularly from accumulated
fæces; immoderate venery, &c.


                              _Treatment._

When a woman is threatened with a miscarriage, there are two objects to
attend to; the first is, to prevent it if we can; the second is to
manage it so that as little blood as possible be lost; and both these
are obtained by the same means. With this view, the patient should
immediately, on the first alarm, undress and go to bed, lightly covered,
with a firm determination not to rise till the process be either checked
or completely over. There should be little fire in the room, though it
be winter; and in summer, the windows must be opened. Cloths wet with
cold water, should instantly be applied to the lower part of the belly,
and back: the drink must be cold, and everything stimulating should
carefully be avoided.

In robust habits, or when the symptoms have been brought on suddenly by
some such cause as a fall or exertion, it is proper to bleed; and, in
cases of sickness or great feebleness, to give a dose of laudanum; or,
what is better, to administer the anodyne clysters.[44]

Opiates are useful in every case where we hope to prevent abortion, and
must be repeated more often or seldom, according to the effect they
produce. They are, however, improper in those cases where miscarriages
must decidedly take place. Their tendency to occasion costiveness, when
employed, must be obviated by clysters, or some gentle laxative
medicine, such as calcined magnesia, Epsom salts, or a little castor
oil. If there be a continued but trifling discharge, great advantage may
be derived from injecting, three or four times a day, up the vagina, a
solution of alum. Indeed, in all protracted cases, this is of much
benefit. The solution ought to be thrown up pretty high, that it may
reach the womb.

When these means produce not the desired effect, and along with the
discharge of blood large clots come off attended with bearing down or
pains in the back and loins, especially if the symptoms which precede
abortion have appeared, there must be every probability that the
threatening event cannot be avoided; then we must conduct the patient
through the process.

In all cases during the last stage of pregnancy, where our endeavors to
stop or repress the hemorrhage prove abortive, it will be advisable to
deliver her as soon as possible.

When the whole conception come away at once, the pain and discharge
usually go off; but, if only the fœtus come away, all the symptoms
either continue and increase till the placenta come away, or, if they be
for a time suspended, they are sure to return, except in early
miscarriages of ten or twelve weeks pregnancy, when sometimes the fœtus
is expelled separately, and the placenta comes immediately after, but
the latter frequently remains several days. The most prudent mode in
such cases is to leave it to nature, which sooner or later expels this
foreign body.

After the process is over, if the discharge be profuse, and do not stop
on the application of cold water to the lower part of the belly, it will
be proper to plug up the vagina, and this is best done by taking a piece
of soft sponge, dipping it in sweet oil, and then wringing it gently.
This is to be introduced with the finger, portion after portion, until
the lower part of the vagina be well filled. The remainder is then to be
firmly pressed on the orifice; and held there some time for the effused
blood to coagulate. In obstinate cases, previously to the introduction
of the plug, we may insert a little pounded ice, or snow tied up in a
rag, if to be procured,[45] but neither of these should be continued so
long as to produce pain or much shivering. In addition to this mode of
treatment, it will be advisable to have recourse to the astringent
medicines, as advised under the head of _Immoderate Flow of Menses_.


                               _Regimen._

Arrow-root, tapioca, sago, panada, or rice milk, constitute a proper
regimen. If the process be protracted, and the strength much impaired,
the diet may be more liberal. In every case, ripe fruit is safe and
useful. The bowels are to be kept regular, and sleep, if necessary, is
to be procured by an anodyne.


                             _Prevention._

It requires great attention to prevent abortion in subsequent
pregnancies, whenever it has happened.

In all such cases, it will be highly necessary to attend to the usual
habitudes and constitution of the woman, and to remove that condition
which is found to dispose to abortion.

A woman that is subject to miscarriage, and who is of a full plethoric
habit, ought to take the tincture of foxglove, twice or thrice a day,
for two or three weeks.

She should likewise keep her body perfectly open with gentle aperient
medicines, use a spare diet, and avoid all agitations of the mind. The
sleep should be abridged in quantity, and taken on a mattress, instead
of a feather bed. Regular and moderate exercise should be taken daily,
being cautious, at the same time, not to carry it to the length of
exciting fatigue.

In women of a weak, lax habit, a nutritive and generous diet, moderate
exercise, and tonic medicines, will be required. And, along with
nourishing diet, a moderate use of wine should be allowed, if it do not
heat the patient, or otherwise disagree. The cold bath is of signal
service in every instance where it is not followed by chilliness.

Until gestation be far advanced, it would be advisable for the woman to
sleep alone, and strictly avoid every cause which is ascertained to be
capable of producing abortion.

Women more frequently miscarry in the second or third month than at any
other time; but some have a certain period at which they usually go
wrong, and do not vary a week from it. In such cases, the woman should
confine herself to the house, avoid the least exercise, and frequently
recline on the sofa or bed, till that period be past.

When a female has suffered several abortions, it becomes almost
impossible to prevent a repetition at the same period of gestation in a
subsequent pregnancy. Nothing, however, will be so successful in
preventing a recurrence of a similar misfortune, as in allowing the
uterine vessels to recover their tone; for which purpose tonics must be
given. Attend to particular symptoms as they occur; with proper diet and
exercise. _Sea Bathing_ and the _shower bath_ are both excellent.[46]


     _When necessary to effect Miscarriage or Artificial Delivery._

During pregnancy, deformities of the pelvis become objects of solicitude
to the accoucheur, when they are of such a character as to render
delivery at full term impossible without the interference of cutting
operations. At this period only can he guard against the deplorable
consequences of these deformities.


                         _Pelvic Deformities._

The accoucheur may be consulted by a mother anxious to know whether the
pelvis of her daughter is such as to justify marriage. His opinion may
also be desired by a female pregnant for the first time, in whose mind
there may exist fears as to the formation of her pelvis. In this case,
he will have to reply to the following questions:

Is delivery at full term compatible with the safety of the child? What
influence will the deformity have on pregnancy? What precautions are
necessary to guard against accident until the completion of gestation,
and to facilitate delivery?

When the accoucheur states that delivery will not be possible without
the interference of art, he will then be asked whether this interference
will compromise the life of the mother or child; and whether this
operation cannot be avoided by some process during pregnancy, either
saving the life of mother and child, or sacrificing the child for the
benefit of the mother?

In order to answer these questions satisfactorily, and to furnish
himself with a rule of conduct in advance, it will be necessary for the
accoucheur to know precisely the condition of the pelvis, and the
dimensions of the diameters, &c.

However, it must not be supposed that this mensuration can be made with
mathematical accuracy; our means will not enable us to obtain this
precision; but even if we could, the object we have in view would not be
completely accomplished, for, in order to arrive at a rigorous
appreciation of the consequences of the deformity and the operations it
might require, it would be necessary also to know the exact size of the
fœtus, which is not possible.

Happily, in practice, an approximation as to the absolute condition of
the pelvis will suffice, and it is easy to arrive at this result. With
this view, the accoucheur should, in the first place, learn the previous
history of the patient in infancy and youth, and afterward proceed to an
external and internal examination.

When the accoucheur is called upon to pass an opinion as to the natural
or unnatural conformation of a female, he should, says M. P. Dubois,
inquire minutely into the antecedent condition of this woman during her
infancy and youth. The history of early life will often, of itself,
cause him to suspect the state of the pelvis. He should address the
following questions to the parent:

_What diseases was the infant affected with? At what age did they
manifest themselves? At what age did the child walk? After walking, did
it appear weak in the inferior extremities? Was the erect position
possible? Was it easy? Were the articulations large?_

If all these phenomena appeared in infancy, it is highly probable that
the pelvis is deformed; and, moreover, it may be affirmed that the
symptoms arose from rickets, a disease peculiar to infancy. It commences
rarely before eighteen or twenty months, and very seldom after thirteen
of fourteen years of age. If there should be curvatures of the spinal
column and extremities, it will be almost certain that the pelvis is
deformed; and if the curvature commenced in the inferior extremities, we
may conclude that it is owing to rachitis, for this disease exerts its
influence first on the tibias, then on the bones of the thighs, pelvis,
and vertebral column. On the contrary, if the first ten years have been
passed without disturbance of the general health, then curvatures must
be attributed to malacosteon, especially if the curvature of the spine
has preceded that of the lower limbs. Deformity of the spine may exist
alone; then we may legitimately hope that the pelvis is not contracted.
Experience, indeed, proves that the vertebral column may be considerably
curved without the pelvis participating in the deformity, when the
inferior extremities are straight; and that, in general, curvatures of
the extremities alone accompany pelvic malformations.

Indeed, it is not on simple probabilities that the accoucheur is to
interdict the marriage[47] of a young girl, or determine, during
pregnancy, to perform an operation, with the view of protecting the
mother against the dangers of delivery at full term.


                    _Premature Artificial Delivery._

Thanks to the efforts of MM. Stoltz, Dezeimeris, P. Dubois, and Velpeau,
delivery brought on before the full term is an operation hereafter
recognised in French midwifery. For a long time it proved useful to our
neighbors in England and Germany, while a foolish prejudice caused it to
be rejected by French practitioners, who did not hesitate even to have
recourse to the Cæsarean section and symphyscotomy.

We have not within the walls of Paris one solitary example of a woman
who had survived the Cæsarean section. She who lived the longest was one
of those on whom I assisted M. P. Dubois to operate. She died on the
seventeenth day of a tetanic affection, when everything promised a most
successful result.—(_Bull. of the Acad. of Med._, t. iii., p. 694; t.
v., p. 25.)

When the contraction is such that a living fœtus cannot be brought
forth, the accoucheur has then to choose between the Cæsarean section or
miscarriage.

During pregnancy, abortion will present an extreme and last resource.
And it would seem more humane to sacrifice, before the period of
viability, an embryo whose existence is so uncertain, in order to
protect the mother from the perilous chances of symphyscotomy and the
Cæsarean section.

I must confess that, if such an alternative were presented to me, the
diameter of the pelvis being only two inches, I should not hesitate to
propose this means.

The abuse and criminal extension of such a resource is reprehensible,
but not its proper and authorized employment. This operation should
always be undertaken with great care, and all necessary precaution used
to satisfy the public mind of its necessity.




                         LABOR, DELIVERY, ETC.


After seven months of pregnancy the fœtus has all the conditions for
breathing and exercising its digestion. It may then be separated from
its mother, and change its mode of existence. Child-birth rarely,
however, happens at this period: most frequently the fœtus remains two
months longer in the uterus, and it does not pass out of this organ till
after the revolution of nine months.

Examples are related of children being born after ten full months of
gestation; but these cases are very doubtful, for it is extremely
difficult to know the exact period of conception. The legislation in
France, however, has fixed the principle, that child-birth may take
place up to the two hundred and ninety-ninth day of pregnancy.

Nothing is more curious than the mechanism by which the fœtus is
expelled; everything happens with wonderful precision; all seems to have
been foreseen, and calculated to favor its passage through the pelvis
and the genital parts.

The physical causes that determine the exit of the fœtus are the
contraction of the uterus and that of the abdominal muscles; by their
force the liquor amnii flows out, the head of the fœtus is engaged in
the pelvis, it goes through it, and soon passes out by the valve, the
folds of which disappear; these different phenomena take place in
succession, and continue a certain time; they are accompanied with pains
more or less severe; with swelling and softening of the soft parts of
the pelvis and external genital parts, and with an abundant mucous
secretion in the cavity of the vagina. All these circumstances, each in
its own way, favor the passage of the fœtus. To facilitate the study of
this action, it may be divided into several periods.

_The first period of child-birth._—It is constituted by the precursory
signs. Two or three days before child-birth a flow of mucus takes place
from the vagina, the external genital parts swell and become softer; it
is the same with the ligaments that unite the bones of the pelvis; the
mouth of the womb flattens, its opening is enlarged, its edges become
thinner; slight pains, known under the name of _flying pains_, are felt
in the loins and abdomen.

_Second period._—Pains of a peculiar kind come on; they begin in the
lumbar region, and seem to be propagated towards the womb or the
_rectum_; and are renewed only after intervals of a quarter or half an
hour each. Each of them is accompanied with an evident contraction of
the body of the uterus, with tension of its neck and dilatation of the
opening; the finger directed into the vagina discovers that the
envelopes of the fœtus are pushed outward, and that there is a
considerable tumor, which is called _the waters_; the pains very soon
become stronger, and the contraction of the uterus more powerful; the
membranes break, and a part of the liquid escapes; the uterus contracts
on itself, and is applied to the surface of the fœtus.

_Third period._—The pains and contractions of the uterus increase
considerably; they are instinctively accompanied by the contraction of
the abdominal muscles. The woman who is aware of their effect is
inclined to favour them, by making all the muscular efforts of which she
is capable: her pulse then becomes stronger and more frequent; her face
is animated, her eyes shine, her whole body is in extreme agitation, and
perspiration flows in abundance. The head descends into the lower strait
of the pelvis.

_Fourth period._—After some moments of repose the pains and expulsive
contractions resume all their activity; the head presents itself at the
vulva, makes an effort to pass, and succeeds when there happens to be a
contraction sufficiently strong to produce this effect. The head being
once disengaged, the remaining parts of the body easily follow, on
account of their smaller volume. The section of the umbilical cord is
then made, and a ligature is put around it at a short distance from the
umbilicus or navel.

_Fifth period._—If the midwife has not proceeded immediately to the
extraction of the placenta after the birth of the child, slight pains
are felt in a short time, the uterus contracts freely, but with force
enough to throw off the placenta and the membranes of the ovum; this
expulsion bears the name of _delivery_. During the twelve or fifteen
days that follow child-birth the uterus contracts by degrees upon
itself, the woman suffers abundant perspirations, her breasts are
extended by the milk that they secrete; a flow of matter, which takes
place from the vagina, called _lochia_, first sanguiferous, then
whitish, indicates that the organs of the woman resume, by degrees, the
disposition they had before conception.




                          MANAGEMENT OF LABOR.


Women in general are ignorant of parturition or delivery. Almost all of
them are under the impression that labor is completed more by art than
nature; hence the most noted accoucheurs are employed to attend during
this interesting period; and professional men, in general, have no wish
to undeceive them on this subject, as their interest is too much
concerned. It is often astonishing to see the credulity and ignorance
manifested on these occasions. Thanks and blessings have been poured
forth, under the idea that he had saved their lives in labor, when the
accoucheur had merely looked on and admired the perfectly adequate
powers of nature, and superintended the efforts of her work; and it is
nature that accomplishes all, while the accoucheur gets the credit of
it. There is not one case in a thousand in which he can do more than
remain a silent spectator, except to calm the fears of the ignorant and
timid attendants. The mischief and injury that are done by the untimely
interference of art are incalculable.

In pregnancy women are bled till they have not strength enough to
accomplish delivery; and, when it takes place, the forceps or other
instruments are used, which often prove fatal to the mother or child, or
both.

There are various particulars to be avoided, and several things to be
done, in the management of women during labor. We have room here to
state only a few, and shall begin by pointing out the course to be
pursued in

_Natural Labor._

When called to a woman supposed to be in labor, ascertain if her pains
are _true_ or _false_, which may be easily known by a little inquiry. If
the female complains of flying or unsettled pains about the system,
occurring mostly toward evening or during the night, and being slight or
irregular, it may be taken for granted that they are spurious or false.
If these symptoms prove troublesome, an infusion or tea of _hops_ may be
taken; or, if this is not sufficient to relieve them, or procure sleep,
an anodyne may be taken; and it may be necessary also to give laxative
medicines or an injection, with a little laudanum.

_True pains_ may be known by the pain being more concentrated in the
lower part of the belly, through the loins and hips.

The pains now increase in regularity and force, returning every ten or
fifteen minutes, and leaving the woman comparatively easy in the
intervals.

When the pains become regular and severe, there is a discharge of slimy
matter, tinged with blood, known by the name of _shows_. At this period
of labor it will be proper for the person who attends the labor to
examine, in order to ascertain what part of the child presents, which
may be done by requesting the female to sit in the chair or on the side
of the bed, and to extend the legs, when the longest finger, dipped in
sweet oil, may be passed up the vagina to the part which presents, and
the sense communicated will determine the nature of the presentation. In
nineteen cases out of twenty, or in almost every case, the head will be
felt. Frequent examinations should be avoided.

Dr. Bard, speaking of examinations, remarks: “What terms shall I use to
condemn, as it deserves, the abominable practice of boring, scooping,
and stretching the soft parts of the mother, under the preposterous idea
of making room for the child to pass. It is impossible to censure this
dangerous practice too severely; it is always wrong; nor can there be
any one period in labor, the most easy and natural, the most tedious and
difficult, the most regular or preternatural in which it can be of the
least use; in which it will not unavoidably do great mischief: it will
render an easy labor painful; one which would be short, tedious; and one
which, if left to nature, would terminate happily, highly dangerous.”

“All that is proper to be done in a case of natural labor, from its
commencement to its termination,” says Dr. McNair, “will suggest itself
to any person of common understanding; and I have long labored under the
conviction, that the office of attending women in their confinement
should be intrusted to prudent females. There is not, according to my
experience, and the reports of the most eminent surgeons, more than one
case in three thousand that requires the least assistance. I am aware,
however, that there are crafty physicians who attempt, and often
succeed, in causing the distressed and alarmed female to believe that it
would be altogether impossible for her to get over her troubles without
their assistance; and, for the purpose of making it appear that their
services are absolutely necessary, they will be continually interfering,
sometimes with their instruments, when there is not the least occasion
for it. There is no doubt in my mind but that one-half of the women
attended by these men are delivered before their proper period; and this
is the reason why we see so many deformed children, and meet with so
many females who have incurable complaints.”

It is a very common circumstance for an inexperienced (or he may be an
experienced, but ignorant) practitioner to attempt a rupture of the
membranes, and in doing so, rupture the bladder, which would render the
woman miserable during life. We are acquainted with twenty-five or
thirty females who have met with this sad misfortune, and many of them
have been attended by those who are termed our most successful, or old
experienced physicians.

Dr. Rush, speaking of child-bearing among the Indians, says, “that
nature is their only _midwife_; their labors are short and accompanied
with little pain; 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 in a few days to her usual employment; so that she
knows nothing of those accidents which proceed from the carelessness or
ill management of _midwives_ or doctors, or the weakness which arises
from a month’s confinement in a warm room.”

Dr. Whitney remarks; “I have had many cases where I found the attendants
alarmed, and some in tears, from supposing that they should have had
help sooner, fearing the worst consequence from delay; but, admitting
that the ‘doctor knew best,’ they would wait calmly for hours, when in
nature’s time all ended well. I pledge myself as a physician, that all
honest doctors will tell you that _labor_ is the work of _nature_, and
she generally does it _best_ when left to herself.”[48]

“Among the Araucanian Indians,” says Stevenson in his Twenty Years’
Residence in South America, “a mother, immediately on her delivery,
takes her child, and going down to the nearest stream, washes herself
and it, and returns to the usual labor of her station.”

“The wonderful facility with which the Indian women bring forth their
children,” say Lewis and Clark in their well known journal, “seems
rather some benevolent gift of nature, in exempting them from pains
which their savage state would render doubly grievous, than any result
of habit. One of the women who had been leading two of our pack horses,
halted at a rivulet about a mile behind, and sent on the two horses by a
female friend. On enquiring of one of the Indian men the cause of her
detention, he answered, with great appearance of unconcern, that she had
just stopped to lie in, and would soon overtake us. In fact, we were
astonished to see her in about an hour’s time come on with her new-born
infant, and pass us on her way to the camp, apparently in perfect
health.”

Washington Irving, in his work entitled Astoria, relates a similar
incident in the following language: “The squaw of Pierre Dorion (who,
with her husband, was attached to a party travelling over the Rocky
Mountains in winter-time, the ground being covered with several feet of
snow) was suddenly taken in labor, and enriched her husband with another
child. As the fortitude and good conduct of the woman had gained for her
the good will of the party, her situation caused concern and perplexity.
Pierre, however, treated the matter as an occurrence that could soon be
arranged, and need cause no delay. He remained by his wife in the camp,
with his other children and his horse, and promised soon to rejoin the
main body on their march. In the course of the following morning the
Dorion family made its appearance. Pierre came trudging in advance,
followed by his valued, though skeleton steed, on which was mounted his
squaw with the new-born infant in her arms, and her boy of two years old
wrapped in a blanket, and slung on her side. The mother looked as
unconcerned as if nothing had happened to her; so easy is nature in her
operations in the wilderness, when free from the enfeebling refinements
of luxury and the tampering appliances of art.”

When it has been ascertained that the labor is natural, or that there
are no impediments or obstacles, there will be very little more to do
than superintend the process. It will be necessary to give instructions
to the attendants to make suitable preparation, or have everything
required in readiness.

The woman may be delivered upon a bed or a cot, as is most convenient;
if a bed be used, all but the mattress should be turned back toward the
head, and it should be so prepared that the moisture from the uterus and
other discharges may not add to the discomfort of the woman. A dressed
skin, oilcloth, or folded blanket may be placed on that part of the
mattress on which the body of the woman is to rest; a coarse blanket
folded within a sheet, ought to be laid immediately beneath the patient,
to absorb the moisture, which must be removed after delivery; the rest
of the bed-clothes are to be put on in the ordinary way. The woman, when
she is no longer able to remain up may lie down, with her head elevated
in any position which is most desirable; and in nearly every case that I
have ever attended the back has been preferred, although most all
writers recommend that the woman be placed upon her side: the latter
practice is unnatural and wrong, for obvious reasons; it retards the
labor pains, and prevents the midwife from superintending the progress
of the labor; the pillow that is directed to be placed between the
knees, to keep them widely separated, soon gets displaced by the motion
or change of the female; and the legs, instead of being kept apart,
again come in contact, and thus the passage of the child is obstructed:
but when the female is placed upon her back this difficulty is obviated,
a free passage is permitted, the pains are more effectual, the spine is
better supported, and better access can be had to the parts during labor
and after the delivery of the child; in short, there is a decided
advantage in this position in every respect.

The dress of women in labor should be light and simple, both to keep
themselves from being overheated, and to prevent anything from being in
the way of what assistance is necessary. In addition to the means
recommended, I direct a sheet to be placed around the waist of the
woman, to prevent the blood, excrements or waters from coming in contact
with the linen or clothes, and, as much as possible, the bed; her linen
may be tucked or pushed up so far that there will be no necessity of a
removal after delivery.

Every thing being thus adjusted, very little more will be necessary but
to wait patiently the efforts and operations of nature. There should be
but few attendants in the room, and these are not to whisper to each
other, or to express any fears or doubts.

A humane midwife will use every ingenious effort in her power to quiet
the useless fears, and support and comfort the patient. A crowd of
frightened, hysterical women, assailing the ears of the woman with tales
of woe and sad disasters that have happened should be admonished. Half a
dozen midwives, each making pretensions to great skill, ambition, and
competition for obstetric fame, assembled around a feeble woman when
labor is of a lingering character, is always an unfortunate
circumstance, and it would be much better if nearly every one were afar
off.

When the pains become very severe, quickly succeeding each other, the
midwife, or the person who officiates, may sit by the side of the woman,
and, upon every severe pain, may keep her hand upon the parts, even
though no manner of assistance can be afforded, and occasionally, when
the head of the child presses hard, it may be gently touched or pressed
with the longest finger, in order to ascertain the parts that prevent
the progress of labor, as well as to be able to give from time to time
suitable encouragement: not only so; in the last stage of labor the hand
may be kept near the parts, to know the moment when the head of the
child presents, as some little assistance at this time is called for;
but not by supporting the perinæum, as some advise, but,

_First._ To remove any obstruction which often arises from the clothes.

_Second._ To support the child in its passage, and in the interval of
pains; and to keep the head from pitching downward, and thus obstructing
the labor.

_Third._ To detach the umbilical cord or navel-string from the neck when
it encircles it, as is often the case, and which endangers the life of
the child.

_Fourth._ To deliver the woman in case of hemorrhage or great flooding;
but at the same time there must be no further interference of art;
little or nothing can be done toward facilitating the delivery of the
child, except when a large bag or collection of water presents and
opposes, when it may be ruptured with the longest finger, which often
affords much aid, although such is the ignorance and credulity of some
women, that they suppose almost everything to be accomplished by art.
Physicians or midwives who watch only the process of labor, and do
little or nothing, are pronounced inhuman and cruel, and perhaps
ignorant, because they are honest in not interfering with the simple and
beautiful process of labor, or in other words, for relying upon the
great resources of nature: but such is the fashion and credulity of
mankind, or rather womankind, that physicians are obliged to take the
advantage of such ignorance and credulity, and regulate their
proceedings accordingly. We have often been obliged to stand for hours
over a woman, under pretence of aiding delivery, when, in _reality_, we
did nothing at all. The labor would have progressed just as well had we
been out of the room; but this deception we have been obliged to
practise, in order to satisfy ignorant, gossiping, or crying attendants.
When the woman is disposed to make much noise, she should be directed to
hold her breath during the pains, and aid or assist them by pressing
downward as much as possible. The feet may press against the bed-post,
and the woman take hold of a handkerchief and pull when a pain occurs;
or she may grasp the hand of an assistant for that purpose. Sometimes,
from various causes, labor is very much retarded, from rigidity of the
parts, the situation of the child, debility, &c.; when this occurs, and
labor is tedious and protracted, our reliance must still be upon the
powers of nature. We may, however, aid her efforts, by warm fomentations
of _bitter herbs_, often applied to the lower part of the belly, which
will prove relaxing, and will facilitate the labor; warm diluent drinks
may also be given, such as _tansy_, _pennyroyal_, _&c._

If the labor still continues stationary, we have nothing to fear,
provided there is a right presentation; but should the pains become
feeble or lessened from flooding, debility, or any cause, or should they
prove unavailable, after a reasonable length of time, a drachm of
_spurred rye_ or _ergot_ may be put into a tea-cup, and a gill of
boiling water poured upon it, and, when cool, a tablespoonful given
every fifteen minutes. This will increase the pains, and speedily
accomplish a delivery; but it should be very seldom, or never, used,
except when there is a right presentation, and under the most urgent
circumstances.

It is prudent, by judicious precaution and care, to remove obstructions,
prevent accidents by holding or supporting the child in a proper
position, and giving such aid as reason and judgment will dictate.
Receiving the child, preventing its fall, securing the navel cord,
assisting in the removal and disposal of the after-birth, are objects
which are to be accomplished, and all in the most calm and simple
manner; no hurry or excitement is necessary, but, on the contrary, they
embarrass. Yet how common is it that females in general, married and
unmarried, are so uninformed and ignorant, that, instead of attending to
those duties, if necessary, or in cases of emergency, they are thrown
into the greatest consternation, and perhaps run out of the room and let
the child suffocate by the bed-clothes, or by the navel cord twisted
about the neck, and die merely for the want of a little common sense and
knowledge, which might be acquired in an hour. Is it not highly
disgraceful, if not criminal, that farmers can, and do, attend to those
duties toward their stock, and yet remain entirely ignorant of them
toward their nearest relations? Young women and men are taught music,
dancing, drawing, needle-work, and many ornamental branches considered
so essential to a polite education; yet they are suffered to remain
entirely ignorant on a subject of so much vital importance. Is there any
hope or prospect of enlightening this generation, or must it be delayed
till the next, and have them look back with amazement at our ignorance?
We hope there is something yet redeeming in a large proportion of the
community; that the people will yet awake to their own interests.

When the head is delivered, all that is necessary to do is, to support
it, and wait for the pains to expel the child; except it seems livid and
in danger of injury, or when the cord is twisted around the neck, when
assistance must be rendered, to accomplish the delivery. The face of the
child must now be turned upward, and the cord freed from the neck or
body; the person who assists will pass a narrow piece of tape around the
cord or navel-string, about an inch from the body, and tie as tight as
it can be drawn, otherwise hemorrhage or bleeding will take place; and
another must be tied at a little distance from it, above, and be
separated between them with a pair of scissors. The child is then to be
given to the nurse, to be washed, dried, and dressed. The woman must now
be covered, and directed to lie quiet.

_The After-birth._—The after-birth or placenta must be detached or
removed, if nature does not accomplish it in a short time. Generally,
after about twenty or thirty minutes, a pain is felt, which may be
sufficient to expel it; if it should not, and should there be no pain,
gentle manual attempts may be made to remove it.

The head and breast may be elevated, and the cord taken hold of by the
left hand: the two first fingers may be carefully introduced into the
vagina, and the anterior or forepart of the placenta or after-birth held
in this situation for some minutes, in order to excite a contraction of
the uterus. The woman may now be directed to hold her breath and press
down, which forces it forward; and at the same time a little extension
may be made upon the cord with the left hand, while extension is made
upon the after-birth with the right; this will almost invariably extract
it in a few minutes. If from any cause it should not, no farther
attempts must be made for the present, but left for a few hours, when,
if the natural contractions of the uterus do not remove it, it must be
done in the manner recommended, with this difference, that a little more
force be used. In the interval, however, everything wet must be taken
away.

_Subsequent Treatment._—After the labour has been thus completed, if the
woman is not too weak, assistants may raise her up, and seat her upon
the side of the bed or cot, while another removes all the wet clothing
from the patient and her bed, and with a little warm spirits washes off
the blood, water, &c., that remain on her person. This is particularly
necessary, as the omission of it may give rise to puerperal fever. We
know not that others have practised this method; but we have found it
conducive to the comfort as well as the health of the patient. Some
practitioners will not suffer the woman to be removed from the situation
in which she has been delivered under twelve or twenty-four hours, for
fear of hemorrhage or flooding; but this is a great and dangerous error.
It is impossible to tell what mischief may arise in consequence of
suffering her to remain drenched in water and blood for this length of
time.

After these precautions have been observed, and the bed properly
prepared, on which has been placed folded blankets, skin, or oilcloth,
covered with a warm sheet, she may be laid down, and a diaper or
suitable piece of muslin laid to the parts to absorb the lochial
discharges. A bandage may be also placed around the abdomen or belly,
and made moderately tight, but not so as to render her uncomfortable. A
large tub, previously well dried, may be placed by the side of the bed,
and the woman directed to place her feet in it, and, when she is lifted
up, everything that is around her wet to be passed into it. It prevents
the necessity of afterward washing the floor and carpet, which might
prove injurious by causing a check to perspiration.

_Preternatural labor, or cross-births_, are those in which some other
part than the head presents. We cannot in general assign any reason for
such occurrences, nor can the woman, by any sensation of her own, be
assured that the presentation is unusual. Apprehensions of this kind
should not be indulged in. If the feet or breech present, the delivery
is to be accomplished by properly accommodating the position of the
child to the capacity of the pelvis, but no force should be employed;
and though there is always some risk to the life of the infant, yet
there is none to the mother. If the arm, shoulder, or sides of the child
present, the delivery is not impossible, but difficult, until the infant
be turned and the feet, brought down into the passage. This is an
operation which may be done with comparative ease and safety, if the
wrong position of the infant be discovered before the waters are
discharged; but other wise both mother and child are in considerable
danger, though there is often a spontaneous evolution, and delivery is
effected. The womb closely contracting round the body of the infant when
the water is drained away, and being soft and spongy in its texture, it
is liable to be torn if much force be employed, and then either the
child may escape into the cavity of the belly, or, if it be extracted by
the feet, blood may be effused from the womb into that cavity, and such
injury be done as to prove fatal. Women too frequently add to the danger
of the operation of turning, by their restlessness and impatience; they
should remember how much is at stake, and exert all their fortitude, so
as not to embarrass the practitioner.

The labor having been thus accomplished, it will be necessary to guard
against any subsequent symptoms which may occur or take place.

In _tedious_ and very _difficult_ labors, and where common physicians
use the lancet, the hot bath will be found of extraordinary benefit in
facilitating labor, by its relaxing the system without debility;
altogether better than bleeding. First apply spirits, water, and salt to
the head; then let the woman continue in the bath about fifteen minutes.

                  *       *       *       *       *

_Still-born Infants._—This occurs from difficult labors, or the cord
encircling the neck; or a membrane may cover the head or body. When
anything of the kind occurs, the membrane should be immediately removed.
If no signs of life appear, the infant may be put into the warm bath,
and the mouth and body wiped dry. A little cold water may be dashed into
the face, the lungs inflated by some person, and a slight motion made
upon the chest in imitation of breathing. The navel-string may be
permitted to bleed a little.




                       TREATMENT AFTER DELIVERY.


_After-pains._—Soon after delivery these usually come on, and with some
women prove remarkably severe. The quicker the labor has been, the
slighter will they prove in general. Women with their first child are
seldom much troubled with after-pains; but as the uterus is thought to
contract less readily after each future labor, so they are more liable
to suffer from them in any succeeding delivery than in the first.

When after-pains prove so troublesome as to deprive the patient of her
rest, it will be necessary to have recourse to _fomentations_ or
_anodynes_; red pepper and spirits, simmered together a few minutes, and
flannels dipped in it and applied to the belly, will generally relieve
them; if it fails, apply a fomentation of _bitter herbs_, and give two
teaspoonfuls of the tincture of _hops_ in milk or tea. If these fail,
which I never knew, give half a teaspoonful of _capsicum_ in milk. These
remedies are to be assisted by keeping up a sufficient pressure on the
belly at the same time by means of a broad bandage.




                                NURSING.


A child must not be put to the breast, if the mother’s health is very
poor, or if she has any venereal, scrofulous, consumptive taint, or
herpetic disease, St. Anthony’s fire, &c. We have conversed with females
who are subject to the last complaint, and who have communicated it to
their children, which destroyed them all. The poison is transmitted from
the mother to the child. In any of these cases, the infant must be
reared on the nursing bottle. It is best to use cream instead of milk;
the child thrives well upon it, less quantity answers, and it does not
curdle, like milk, upon the stomach.

_Atrophy from Suckling._—Some women of a delicate constitution cannot
suckle long without an evident appearance of declining health; and, if
persisted in, it might terminate in a general wasting of the body and
loss of strength, or some morbid affection of the lungs. When,
therefore, a woman finds her health declining, and that she gets weaker
every day with loss of appetite and languor, she ought immediately to
leave off suckling; she should use a generous diet, with a moderate
quantity of wine bitters daily, and, if convenient, change the air,
particularly if an inhabitant of a large and populous city or town. If
the change is not found sufficiently efficacious of itself, when
conjoined with a restorative diet, a course of _tonics_ should be given.
Gentle exercise on horseback or in a carriage will greatly assist the
effect of these remedies.




                      INFLAMMATION OF THE BREASTS.


This disease is easily known by the pain, hardness, and swelling which
accompany it. In some cases the whole breast appears to be affected; in
others, only on one side; and, in some, the effect is small and
superficial.

When the breast inflames, it is evident that the retention of the milk
must, for a time at least, increase the pain.

The first object then should be to have the breasts drawn, either by the
child or some other means; but, should the milk not come away readily,
and the pain be increased thereby, farther attempts must not be made;
otherwise both the disease and sufferings of the woman may be
aggravated. A cooling diet and an open state of the bowels are necessary
while the swelling continues. And it is better for the patient to remain
in bed, as the weight of the breast, while in the erect posture, often
increases the inflammation. The breast should be gently rubbed with a
small quantity of sweet oil or unsalted butter, and poultices of crumb
of bread and lead water applied. If the pain and hardness do not very
soon go off by this application, warm emollient poultices, as milk and
bread, with a little oil, or united with the leaves of the thorn apple,
must be had recourse to. These poultices will not promote suppuration
unless the inflammation has proceeded so far, that the process has
already begun, and in this case the sooner it is produced the better.

If the abscess do not point and break soon, no good can be gained by
delay: an opening should therefore be made, so as to evacuate the matter
freely. This not only gives immediate relief, but prevents a farther
extension of the mischief. The milk and bread or flax-seed poultices
must be continued for a few days, in order to remove the hardness, and
then the part must be dressed, as in ordinary cases.

Indurations remaining after an abscess, may be frequently remedied by
the application of a mercurial plaster, or cloths wet with the
camphorated spirit, or rubbing the part, night and morning, with
mercurial ointment, united with a little camphor.

Sometimes after the abscess heals, and the breast seems to be cured, it
swells a little, especially towards night. This is from weakness, and is
cured by strengthening the constitution.

Many women suffer more from this complaint than from all the various
stages of pregnancy, labor, and delivery combined, and with whom broken
breasts are an invariable attendant of confinement; they overlook all
the other sufferings they have to undergo, and fix their dread and
apprehension upon this. It is, therefore, all-important _that
inflammation of the breasts should not be permitted to take place_, by
proper precautionary measures, _and this can, in all cases, be
accomplished_, by the mode of treatment pointed out in this work, which,
as yet, has not been mentioned in any other, but of its invariable
success there is not a shadow of doubt, as it has been tested under
circumstances the most unfavorable, in cases where every confinement was
attended with broken breasts, till this mode of treatment was had
recourse to, and the patients, to their great surprise and joy, for the
first time entirely escaped their uniform affliction. It is hoped the
medical faculty will avail themselves of this invaluable mode of
treatment, that hereafter inflammation of the breasts may be unknown,
since prevention is so easy and practicable.


                _To prevent Inflamed or Broken Breasts._

This most desirable and important object is accomplished by covering the
entire breasts with diachylon plaster (which can be obtained of every
druggist, the machine-spread is preferable) rather tightly or closely
put on, merely making a round hole (about the circumference of a dollar)
for the nipple, sufficiently large not to interfere with the suckling of
the infant, should it be put to the breast; and if not, it is not only
unnecessary to draw the milk, but it would be advisable to refrain from
it, even if a little pain or distension should supervene, as the milk is
sure to find an outlet in the nipple. The plaster must be cut round and
embrace and cover the entire of each breast, and should be put on within
eight or ten hours after delivery, and before the milk threatens. The
effect is to superinduce the flow of milk to the nipple, from which it
freely and profusely flows, in no case requiring the application of
stimulants to induce its discharge, and, by keeping the breasts in
constant moisture, effectually prevents hardness by coagulation of milk.
In ten days or thereabout the plasters can be taken off without
inconvenience.

It is not too much to say that broken or inflamed breasts are impossible
when this precautionary mode of treatment is adopted, as it has, in
every instance, where it has been tested upon those who before were
invariably afflicted with broken breasts, been attended with most
triumphant success; and it has thus been put to the test in more than
fifty instances to the writer’s personal knowledge. In communicating
this important fact, therefore, he does so with the most thorough
confidence that he is conducing to the amelioration of much suffering,
and without assuming that this may not be known to others, he can only
say that he has not met with any mention of it in any works to which he
has had access. Should those, therefore, into whose hands this work may
fall have a wife, or a relation, or a neighbor, who, heretofore, have
been afflicted with inflamed or broken breasts, they would have it in
their power to ameliorate, nay, prevent much suffering, which to the
author of these lines will be a source of heartfelt satisfaction.




                        MANAGEMENT OF CHILDREN.


It is during infancy that the foundation of a good constitution is
generally laid, and it is, therefore, important that parents be taught
the best method of managing their offspring, in order to preserve their
health. Great ignorance is manifested on this subject; it is owing to
this that so many children sicken and die; and, furthermore, it is in
consequence of this ignorance in our forefathers that the present
generation have become so weak, sickly, and effeminate; and most of
these evils may be imputed to errors in diet, regimen, _mineral_ and
_depletive_ agents, &c. We have departed from the simplicity of nature,
and we must, of course, suffer the penalty.

_1st. On Diet._—If the mother or nurse has enough of milk, the child
will need little or no food for the third or fourth month. It will then
be proper to give it a little of some food that is easy of digestion
once or twice a day; this will ease the mother, will accustom the child
by degrees to take food, and will render the weaning both less difficult
and less dangerous. All great and sudden transitions are to be avoided
in nursing; for this purpose the food of children ought not only to be
simple, but to resemble as nearly as possible the properties of milk:
indeed, milk itself should make a principal part of their food, not only
before they are weaned, but for some time after.

Next to milk we would recommend good bread, which may be given to a
child as soon as it shows an inclination to chew; and it may at all
times be allowed as much as it will eat. The very chewing of bread will
promote the cutting of the teeth and the discharge of saliva, while, by
mixing with the nurse’s milk in the stomach, it will afford an excellent
nourishment.

Many are in the habit of pouring down various liquids and mixtures made
of rich substances, and so much sweetened that the tender organs of
digestion are impaired, and acidity and bowel diseases follow; articles
of this nature should be avoided: no food, except the milk of the
mother, should be given, unless absolutely necessary; nature has
designated this liquid exclusively for the nourishment of the infant,
and, indeed, we may say, for children.

There is another precaution to be observed, which is, “never to put an
infant to a wet-nurse if it can possibly be avoided;” such persons are
generally strangers, and they often communicate the most loathsome and
fatal diseases; besides, their milk is often rendered unwholesome by age
or other causes: this is a very unnatural practice.

The milk of the mother, then, should constitute the only food of the
infant, except in cases of disease, when it becomes necessary to obtain
a wet-nurse, or bring up the children on the bottle, which can be done
very easily.

We attended a lady who was almost covered with a _herpetic complaint_,
or the _salt rheum_, and that, too, when her child was born. She was
treated and cured her of the complaint. The infant was fed on milk, by
introducing a silver tube into a bottle containing it.

We never knew a child so quiet and free from pain; as much so as any
offspring of the brute creation, which are free from it merely by
following nature or instinct, which never errs. The milk should be of
the best quality, and, if possible, of the same cow.

Now, it appears to us, that if females imitated these animals, were to
live on vegetable instead of animal food, and drink nothing but water,
they would not only bring forth as easy as the Indians or these animals,
but their offspring would be free from pain, and perhaps be as exempt
from sickness. Would not this course produce a revolution in our habits,
health, and in the practice of medicine? In the present diseased state
of society it might require a long time to bring about a change in the
system; but an immediate benefit would follow by adopting these
physiological principles. Do not these facts open a new field of
investigation and improvement?

Is it not notorious that some infants are crying a great portion of
their time in consequence of pain? and is it natural, or can there be
any other cause, except the poison communicated to it, through the
medium of the blood, before and after it is born; or the disease may
proceed from the impurity of the mother’s milk, occasioned by errors in
diet? It is self-evident that it is so, from the fact that animals are
free from these symptoms.

Can there be any other cause why so many children are in distress from
birth, and generally die young, or continue weak and sickly all their
lives? There must be a reformation in the habits, taste, and education
of modern females. Many mothers are as ignorant, when they have brought
a child into the world, of what is to be done for it as the infant
itself.

Says Combe: “The leading error in the rearing of the young, I must again
repeat, is _over-feeding_, an error serious in itself, but which may
easily be avoided by the parent yielding only to the indications of
appetite, and administering food slowly and in small quantities at a
time. By no other means can the colics, and bowel-complaints, and
irritability of the nervous system, so common in infancy, be effectually
prevented, and strength and healthy nutrition be secured. Nature never
meant the infant stomach to be converted into a receptacle for
laxatives, carminatives, antacids, spicy stimulants and astringents; and
when these become necessary, we may rest assured that there is something
faulty in our management, however perfect it may seem to ourselves. The
only exception is where the child is defectively constituted, and then,
of course, it may fail to thrive under the best measures which can be
advised for its relief.

“Another cause of infantile indigestion, and which is too much
overlooked through ignorance of its importance, is _vitiation of the
quality of the milk_, caused by imprudence, neglect, or anxiety on the
part of the mother. The extent to which this cause operates in inducing
irritation and suffering in the child, is not generally understood; and,
accordingly, it is not unusual for mothers to display as much
indifference to health, regimen, and tranquillity of mind during
nursing, as if the milky secretion, and all other bodily functions, were
independent of every external and corporeal influence. Healthy,
nourishing, and digestible milk can proceed only from a healthy and
well-constituted parent; and it is against nature to expect that, if the
mother impairs her health and digestion by improper diet, neglect of
exercise, impure air, or unruly passions, she can, nevertheless, provide
a wholesome and uncontaminated fluid, as if she were exemplary in her
observance of all the laws of health.

“It is no new or uncertain doctrine, that the quality of the mother’s
milk is affected by her own health and conduct, and that in its turn it
directly affects the health of the nursling. Even medicines given to the
parent act upon the child through the medium of the milk; and a sudden
fit of anger, or other violent mental emotion, has not unfrequently been
observed to change the quality of the fluid so much as to produce
purging and gripes in the child. Care and anxiety, in like manner, exert
a most pernicious influence, and not only diminish the quantity, but
vitiate the quality of the milk.

“It is a common mistake to suppose that, because a woman is nursing, she
ought, therefore, to live very fully, and to add an allowance of wine,
porter, or other fermented liquor, to her usual diet. The only result of
this plan is to cause an unnatural degree of fullness in the system,
which places the nurse on the brink of disease, and which of itself
frequently puts a stop to, instead of increasing, the secretion of the
milk. The health and usefulness of country nurses are often utterly
ruined by their transplantation into the families of rich and luxurious
employers. Accustomed at home to constant bodily exertion, exposure to
the air, and a moderate supply of the plainest food, they live in the
enjoyment of the best health, and constitute excellent nurses. But the
moment they are transplanted from their proper sphere, their habits and
mode of life undergo an unfavourable change. Having no longer any
laborious duties to perform or any daily exposure to encounter, they
become plethoric and indolent; and as they are at the same time too well
fed, the digestive functions become impaired, the system speedily
participates in the disorder, and the milk, which was at first bland,
nourishing, and plentiful, now becomes heating and insufficient, and
sometimes even stops altogether.”

_Cocoa shells_, made precisely like coffee, make a very pleasant and
nutritious drink for nursing females.

_Weaning._—“Diet for infants after weaning may be pure milk, two parts,
water, one part; slightly sweetened. This,” says Combe, “makes the
nearest approach to the nature of the mother’s milk, and, therefore, is
more suitable than any preparation of milk and flour, or any other that
can be given.” A child, as a general rule, one year old, ought to be
gradually weaned, and the appearance of the teeth shows the propriety of
giving food a little more substantial than milk. Bread a day old, mixed
with milk and sweetened, may be given in connexion with nursing. Gruel,
arrowroot, plain bread, Indian and rice puddings as they grow older, and
subsequently bread and butter, thickened milk, hasty pudding or Indian,
potatoes, and vegetables. Not a particle of flesh should ever be given.
By the use of meat the system becomes excited, and diseases of
irritation are apt to be produced, which impede nutrition, and lead
ultimately to the production of scrofula and other organic changes in
the glands and bowels, and not unfrequently also in the brain and lungs.
In these instances the child generally eats heartily, but, nevertheless,
continues thin, and is subject to frequent flushing and irregularity of
the bowels, headache, and restlessness. His mind partakes of the general
irritability of the system, and peevish impatience takes the place of
the placid good humour natural to healthy childhood. In this state the
ordinary diseases of infancy—measles, scarlet fever, and
hooping-cough—are often attended with an unusual and dangerous degree of
constitutional disturbance; and when inflammation takes place it is
borne with difficulty, and the system does not easily rally; or the
digestive organs become irritated, and the various secretions
immediately connected with digestion are diminished, especially the
biliary secretion. Constipation of the bowels soon follows; congestion
of the hepatic and abdominal veins succeeds, and is followed by the
train of consequences which have already been detailed. In reality the
wonder comes to be, not that so many children die, but that so many
survive their early mismanagement. A morbid condition of the system
arises, extremely favourable to the production of scrofulous,
consumptive, dyspeptic, and other diseases, under which, perhaps, the
infant sinks; and yet, strange to state, parents will stuff their
children with flesh and grease two or three times a day.

Says Combe, “One of the most pernicious habits in which children can be
indulged is that of almost incessant eating. Many mothers encourage it
from the facility with which, for a time, the offer of ‘something nice’
procures peace. Even from infancy the child ought to be gradually
accustomed to eat only when hungry, and when food is really required.
After two years of age an interval of four hours between meals, will
rarely be more than enough; and to give biscuit, fruit, or bread, in the
meantime, is just subtracting from the digestive power of the stomach.
Like almost every organ of the body, the stomach requires a period of
repose after the labour of digestion; and accordingly, in the healthy
state, the sensation of appetite never returns till it has been for some
time empty. To give food sooner, therefore, is analogous to making a
weary traveller walk on without the refreshment of a halt.”

“When we reflect that the object of digestion is, to furnish materials
for the growth of the body, and to supply the waste which the system is
constantly undergoing, it must appear self-evident that, if the
digestive powers be impaired by disease, by improper quantity or quality
of food, or by any other cause, the result must necessarily be the
formation of an imperfect chyle, and, consequently, of imperfect blood.
The elements of the blood are derived from the chyle, and, if _it_ be
vitiated, the blood also must suffer: if the blood be diseased, so must
necessarily be all the organs which it supplies; and if the body be thus
debilitated, can any wonder be felt that it should no longer be able to
resist the action of offending causes which full health alone can
withstand?”

_Clothing._—Infants and children are often injured by improper clothing.
It is customary for some nurses to wrap them in such a quantity as to
injure their health; moderation in this respect should be observed, due
regard being paid to that which is sufficient to render them
comfortable. Infants, when first born, have clothing enough almost to
smother them.

_Medicine._—Another very reprehensible custom is, to pour down some
nauseous drug, such as paregoric, Godfrey’s cordial, or some other
articles, every time the child begins to cry or is fretful, by which it
becomes habituated to the use of opium, and makes it necessary to
increase the dose in order to produce the same effect.

Another injurious practice is to give frequently worm lozenges (the
basis of which is calomel or mercury) upon any attack of illness, under
the impression that the disorder is occasioned by worms. By this
imprudent course both the health and life of the child are endangered.
Therefore those who wish to bring up their children in a healthy
condition must avoid these evils, and be content to follow the simple
path of nature and common sense.

Few things tend more to the destruction of children than drenching them
with drugs. Medicine may be _sometimes_ necessary for children; but that
it injures them ten times for once it does them good, I will venture to
assert. A nurse or mother, the moment her child seems to ail anything,
runs immediately to the doctor or the apothecary, who throws in his
powders, pills and potions, till the poor infant is poisoned; when the
child might have been restored to perfect health by a change of diet,
air, exercise, clothing, or some very easy and simple means.

Care must be taken to keep the bowels regular, which may be effected in
most cases by the milk of the mother alone. Most of the complaints in
children arise from flatulence or wind; to remove which give common
catnip or fennel seed tea, let them drink it freely, and let the mother
regulate her diet.

When children complain of pain in the stomach and bowels, it may be
necessary sometimes to give a moderate dose of vegetable physic; _senna_
and _manna_ is very good; after the operation of physic let the diet be
attended to. Green fruit must be avoided, and whatever is hard of
digestion. The feet should be often bathed in warm water, the bowels
must be fomented with bitter herbs, and it is also necessary to give the
child sufficient exercise in the open air.

_Bathing_ should never be neglected, as it contributes much to health.
Many complaints of the skin and the system are caused by the neglect of
this practice. Filth collects on the surface, obstructs perspiration,
which retains morbid humors, and which are thrown upon some of the
internal organs and create irritation. Is it not owing to this that
infants fret and cry so much? Daily bathe with tepid water; this is also
good for galling, chafing, excoriations, &c.

_Pure Air and Exercise._—This is very necessary; impure and confined air
with the want of exercise, causes disease; and hence children in cities
are more pale, feeble, and sickly than those who live in the country and
breathe pure air and play in the dirt. Confining children at home, in
low, confined, dirty houses, cellars, and in school-rooms, is
pernicious; also crowding too many in sleeping-rooms. When children are
confined in small apartments, the air not only becomes unwholesome, but
the heat relaxes their solids, renders them delicate, and disposes them
to colds and many other disorders. Nor is the custom of wrapping them
too close in cradles less pernicious. One would think that nurses were
afraid lest children should suffer by breathing free air, as many of
them actually cover the child’s face while asleep, and others wrap a
covering over the whole cradle, by which means the child is forced to
breathe the same air over and over all the time it sleeps. Children,
therefore, must have as much _exercise_ and _air_ as possible, and
should be employed in something useful and interesting.

Again; “The premature exertion of intellect to which the mind is
stimulated at our schools, by the constant emulation and vanity, far
from strengthening, tends to impair the health and tone of the brain,
and of all the organs depending on it; and hence we rarely perceive the
genius of the school manifesting in future years any of the superiority
which attracted attention in early life.”




                              BARRENNESS.


Sterility proceeds from either a temporary or permanent incapability of
conceiving or retaining the embryo, till it acquires a form. The causes
producing this incapability, may consist in some malformation or
deficiency of the womb, or its appendages, which cannot always be
discovered during life, or in merely a weakness in the action of the
womb. This last is by far the most frequent cause, and it is occasioned
by local weakness of the womb, or general affections of the whole
system; and is marked usually by an obstruction, deficiency, or
redundancy of the menstrual evacuation, or by the complaint termed
female weakness.

It may be considered as highly probable, that the absence of the
capacity to be impregnated, will sometimes depend upon the imperfect
condition of either the uterus itself or of the ovaries. If the former,
it may consist in some derangement of the secreting surface of this
organ; for, though there may be a regular discharge of a colored fluid,
and this so nearly resembling the perfect secretion as to deceive the
senses, it may yet want an essential condition or quality, and thus
entail barrenness—hence, all women are not fruitful who may have a
regular catamenial discharge; though, as far as can be determined by
appearances, this discharge is every way healthy, and at the same time,
the ovaries free from fault.

If it depend upon an imperfection of the ovaria, it may not, perhaps,
admit of relief. The diseases of the ovaria may consist, 1st, in their
imperfect development; 2dly, in derangement of structure; 3dly, in a
want of a healthy organization of the ova themselves. Now, either of
these conditions of the ovaria may be so complete as to altogether
destroy their influence upon the secreting surface of the uterus; the
catamenial discharge may, therefore, continue, with all due regularity,
and yet the woman may be barren; and, hence, this discharge cannot be
considered, rigidly, as a constant sign of fertility.

Yet it may be safely admitted, as a general rule, that women who
menstruate regularly without pain, or the expulsion of coagula, or false
membrane, are fecund; and that the reverse of these conditions is almost
sure to be attended with sterility. It may also be observed, that we
cannot attach much consequence to the quantity evacuated; for the woman
who may evacuate double the quantity of another, is not for this reason
more certainly prolific. I have known a number of instances of repeated
impregnations, where, as far as could be ascertained, not more than two
ounces were habitually evacuated; and this not occupying more than a day
and a half, or two days, for its elimination: while, on the contrary, I
have known women who were barren, discharge three or four times this
quantity; and the fluid bear all the sensible marks of a healthy
secretion. From this it would appear, that mere regularity in returns,
the elimination of a proper quantity of fluid, and this fluid apparently
of a healthy character, do not always declare the woman to be fecund.
Yet, when the woman has never menstruated, or when this discharge has
altogether ceased, agreeably to the ordinary arrangement of nature, or
from disease, she either never becomes impregnated, or ceases to become
so, if she ever have been.

We proceed on the principle of rectifying the constitution, where it is
injured or weak, and of restoring the menstrual evacuation, to its due
and healthy state. The means for effecting these purposes, must depend
on the situation of the individual.


                               _Causes._

There are chiefly two states of the constitution productive of those
deviations in the action of the womb, which cause barrenness. The first
is a state of fulness, and a disposition to obesity.

The person gradually becomes fat and inactive, the menstrual evacuation
continues regular for some time; but at last diminishes, and becomes
obstructed, or goes to the opposite extreme, and becomes frequent or
profuse. The patient is either barren or subject to false conceptions.
This state is to be rectified by spare or vegetable diet, total
abstinence from malt liquor, regular and constant exercise, especially
early in the mornings and on horseback, the prudent use of laxatives,
and after some time the cold bath. These means will, if persisted in
prudently, effect the desired changes; but if pushed to an undue degree,
and especially if repeated purgatives, and much vinegar, or great
abstinence be resorted to, the health may be completely ruined.

The second state is that of relaxation; the habit is spare, instead of
corpulent; the mind lively, and, perhaps, even irritable; the menstrual
evacuation either profuse, or it recurs too frequently, and at times
clots and shreds are discharged.

This requires a different treatment: the diet, if not unusually
nutritive, is at least not to be sparing, the exercise must not be
carried the length of fatigue, the cold bath is useful, and
strengthening medicines are required.

Such remedies as have been pointed out for the removal of irregularities
of the menstrual evacuations, or of the fluor albus, must be employed
when necessary.

There are also certain diseases of the female genital organs, which,
when they exist, are found to cause sterility. Polypus in utero is very
generally considered to belong to this class; but although the opinion
is generally correct, it is not universally true, for it has happened
that conception took place notwithstanding the presence of a very large
tumor in the uterus. Of this the late Dr. Beatty (Trans. of the
Association of Coll. of Phys. in Ireland, vol. 4) has described a very
remarkable instance, which occurred in Dublin in the year 1820. The
patient was a lady twenty-five years old, who, in consequence of the
indisposition of her husband, had left his bed in May, 1819, to which
she did not return until August, 1820. In the previous May she first
perceived what she termed a “lump in her womb,” attended with external
swelling and soreness on pressure at the lower part of the abdomen. This
swelling was not permanent, but was observed to disappear during the
menstrual period. Finding an increase in her unpleasant symptoms, she
applied to Dr. Beatty in September, and on the 28th of that month he
made an examination per vaginam. The os uteri was found dilated to the
size of a dollar, and in its opening was a large dense substance with a
regular smooth surface. On the 10th of November, while out in her
carriage, she had a moderate discharge of blood from the vagina, and
upon examination the parts were found as they were a month before. At
two o’clock the following morning she miscarried, the embryo was entire,
the membranes not being ruptured: the contained fœtus was about three
months old—a period corresponding with the time at which the connubial
intercourse had been resumed, and at which she had last menstruated; and
just three months after she first experienced uterine uneasiness. The
tumor was expelled in six days afterwards by pains resembling labor, the
uterus was inverted by its descent, but on separation of the slight
attachment between it and the tumor it was easily reduced. The weight of
the tumor was found to be nearly four pounds. This lady was delivered of
a healthy boy on the 10th of February, 1822. This was an instance of
pregnancy during the existence of a tumor of considerable magnitude in
the uterus; but we believe it to be an exception to what usually takes
place.

Inflammation, suppuration, calculous depositions, cancer, cauliflower
excrescence, corroding ulcer, the irritable uterus of Dr. Gooch, and any
disease in which the texture of the uterus is much engaged, or with
which the constitution sympathizes strongly, are so many obstacles to
impregnation, as are diseases of the ovaria, in which the natural
structure of these organs is obliterated, and both of them engaged.
Leucorrhœa, when profuse, is very often also attended by barrenness; but
this is by no means a constant effect, as we have known instances in
which this disease existed to a great extent without preventing
impregnation.

A question has arisen whether menstruation is necessary in order that a
woman shall be prolific; and it is generally stated that women who do
not menstruate cannot conceive. (_Paris and Fonblanque_, Med. Jur. vol.
i., p. 214.) This is true when applied to those who have never
menstruated, but is not in cases that have had even a single monthly
discharge. Foderé (Méd. Légale, vol. i., p. 397, ed. 2me) states that,
in the first edition of his work, he had maintained that females who do
not menstruate are sterile: but he afterwards was obliged to change his
opinion, from having observed some patients under his own care enjoying
good health without this evacuation, and bearing many children. One of
them was a woman thirty-five years old, the mother of five children, the
last of which she was suckling. She was in good robust health, and had
never menstruated but once at the age of seventeen years. It would
appear that a single occurrence of this periodical evacuation is a
sufficient indication of generative power; and although irregularity in
subsequent years is frequently attended by sterility, it is not to be
taken as an absolute cause of it. There is a form of dysmenorrhœa
described by Dr. Denman (Denman’s Midwifery, 6th edit., p. 90), and Dr.
Dewees (Dewees’ Midwifery, p. 154) of Philadelphia, which both these
authors state to be productive of barrenness. The striking peculiarity
in this disease is the formation of an adventitious membrane in the
uterus, which is expelled after severe and protracted suffering at each
menstrual period. This membrane is sometimes thrown off in pieces, and
at others entire, at which time it bears the strongest resemblance to
the decidua, so much so that, when it occurs in unmarried females, it
may and sometimes does give rise to most painful suspicions. There is a
preparation in the museum of the College of Surgeons, Dublin, of an
entire membrane of this kind, which might deceive the most experienced
eye. Morgagni relates a very remarkable instance in which pregnancy
occurred during the existence of the habit just described, but it is
probable that there was a suspension of the disease for a time in that
case, when the capability of conceiving might exist.

It is well known that instances have happened in which persons have
lived for years in unfruitful matrimony, and being after divorce
remarried, have both had children. This is a fact which in the present
state of our knowledge we are not able satisfactorily to explain, and we
will not delay the reader by offering any speculative opinion upon it.


                              _Treatment._

The treatment of impotence and sterility must be influenced by the
causes from which they spring, some of which are incurable, whilst
others may be removed by appropriate remedies. Those cases which depend
upon congenital deficiency of the penis, testicles, vagina, uterus,
Fallopian tubes, or ovaria, belong to the former; but we have seen that
some of those arising from malformation and disease of these parts are
susceptible of cure. Such are phimosis, adhesion of the prepuce to the
glands with diminution of the orifice of the urethra, priapism, partial
paralysis, strictures in the urethra, diseases of the neighbouring
parts, contracted vagina, occlusion of the mouth of this canal by
adhesion of the labia, or by a dense hymen, prolapsus and procidentia
uteri, polypus in utero, leucorrhœa, dysmenorrhœa: all these are more or
less capable of removal either by operation or general treatment.

By persisting carefully in a proper plan, sterility may at length be
frequently removed. There are many instances of women bearing children,
after having been several years barren.

Various remedies have been recommended for the cure of barrenness, among
which tincture of cantharides is the most prominent, but its effects
being evanescent, are invariably succeeded by lassitude and debility,
and therefore can be attended with no good results. The various
preparations of sassafras and sarsaparilla are useless and not in the
least calculated to reach the nature of the case. The specific known as
the most successful in curing sterility or barrenness—and it has
certainly performed wonderful cures—is the celebrated Morand’s
preparation, called “Morand’s Elixir,” which appears to be specially
adapted to give tone and healthiness to the generative functions, for
the discovery of which, he received a handsome donation from the French
government, as also frequently rewarded by the liberality of private
individuals, who have realized their fond wishes by his discovery.

Its effects, it is said, are so wonderful upon the general health, and
particularly upon the generative functions, that a medical writer of
some note says that he has recommended its use in several instances,
and, with one single exception (a case of malformation), with invariable
success. He says:

“I was acquainted with a very worthy married couple whose life was, if
not embittered, at least unhappy, because of their having no offspring.
They were of respectable and influential standing, possessed of
property, surrounded by friends and relatives, were then married nearly
ten years, and desirous only of having children to make them happy.
Physicians were consulted without success, because physicians mostly
look upon sterility as incurable.

“About this time I visited a patient who had been married about seven
years without having children, who was affected with fluor albus
(whites), and was using ‘Morand’s Elixir,’ by my recommendation, to
eradicate this weakening complaint from the system. This lady having
been married seven years, as I before observed, without offspring, had
nearly resigned herself to a conviction that she was destined to have
none. In recommending ‘Morand’s Elixir,’ I had the fullest confidence
that it would accomplish a thorough cure of her complaint, because I had
often used it in my practice, and with invariable success, but I had
neither hope nor expectation of its ability to remove what I then
considered confirmed sterility, or barrenness, as I then gave no
credence to the various marvellous properties it was alleged to possess,
classing it merely among the impositions of the day. The lady continued
its use, and I found her health evidently and perceptibly improve. The
fluor albus entirely disappeared and her health was restored. Under
pretence that she derived great benefit from it she still continued its
use, however, and to my utter surprise, as well as the great joy of her
husband, four months after she commenced its use, she became pregnant,
and in due time was delivered of a fine, fat, healthy daughter, and had
two more children in close succession after.[49]

“The lady being of the most pure and irreproachable character, it may
well be supposed that it gave me the greatest confidence in recommending
this truly wonderful ‘Elixir,’ in like cases. When, therefore, I was
consulted by the husband of the lady first mentioned, I did not hesitate
to recommend ‘Morand’s Elixir,’ and informing him of its effect in the
case described. My advice was followed. In due course of time this
worthy couple had their fondest wishes realized. Since which time they
also have had several children. Their gratitude to me for recommending
its use, was unbounded. My confidence in the virtues of ‘Morand’s
Elixir,’ was confirmed, and I have heard of its success in other
instances. Indeed, I am convinced, that if the case is curable,
‘Morand’s Elixir’ is infallible.”

It has attained a pre-eminent celebrity in France, Germany, on the
continent of Europe generally, as well as in England, for its unexampled
success in removing general debility, weakness, physical imbecility and
_supposed_ barrenness (for judging from the astonishing results of
‘Morand’s Elixir,’ it is denied that it really exists). The truly
wonderful effect of the “Morand’s Elixir,” has now established the fact
that most, if not all, _supposed natural_ incurable defects, are _only
artificial_ ones, within the powers of the skill and scientific
combination of the virtues and essences of the most nourishing,
strengthening and invigorating fruits and plants of Italy to remove. Its
action is not sudden and ephemeral, leaving the system but the more
debilitated by reason of the previous unnatural excitement, but is
gentle and gradual, by degrees displacing the latent causes affecting
the body, strengthening and invigorating the generative functions,
cheering the mind, enlivening the spirits, engendering a free, full and
healthy circulation, and thus arousing the sexual feelings.

Great and surprising as are the results of the skilful and scientific
combination in the composition of “Morand’s Elixir,” it is not idly
pretended that without any reference to the circumstances of each
individual case of supposed barrenness, it will, unaided and unassisted,
in a few weeks, remove deep seated and obstinate cases of
unfruitfulness—causes which had been growing, strengthening and
fastening for years. Far from it. The absurdity of such pretence is
manifest on the face of it. Assistants, in many instances, must be
resorted to for successful treatment, in respect to diet, clothing,
occupation, &c. Instant and immediate relief is neither to be expected
nor practicable; and even if practicable would lead to the most
injurious results, aggravating instead of relieving. A remedy,
therefore, to be permanent, must be gradual to an almost imperceptible
degree, slowly but surely removing the stagnant humors and impure
secretions, by the searching and penetrating virtues of the “Elixir,”
systematically purging the system of those dormant and inactive
particles, which frustrate the action of the generative functions, and
thus dislodging the cause of unfruitfulness. It may take some time ere
this is accomplished; but, by a proper perseverance in the course marked
out, success, sooner or later, is inevitable. Thousands who had imagined
themselves irretrievably doomed to descend to the grave unpitied and
unmourned by interesting and affectionate children have, by the use of
“Morand’s Elixir,” been blessed with offspring to love and adore in
infancy and youth, and to look to for comfort and solace in old age.

In all cases of incontinence of urine, fluor albus, gleet, painful and
difficult menstruation, incipient stages of consumption, languor,
debility, night sweats and wakefulness, it is surprisingly efficient and
certain. Its chief and great celebrity, however, in eradicating every
symptom of that state of the functions superinducing barrenness or
sterility, is too well established to require comment. Indeed, such has
been its success, as to make it doubtful that what is usually termed
barrenness in fact exists, since by the use of this wonderful remedy,
properly persevered in, a cure has in all cases been effected, and what
had been supposed incurable natural defects proved to be only some
deranged state of the functions.

As there are many who pine and grieve for children—who feel desolate and
lonely without the enlivening and cheering influence of children around
the domestic hearth, the author does not deem it inappropriate or out of
place to present this celebrated specific for the consideration of those
to whom it might prove a great blessing. He has taken its Agency for the
United States, at his Office, 129 Liberty street. Letters must be
postpaid and addressed to Box “1224,” New York City.




                          CONCLUDING REMARKS.


In conclusion, the author of this work trusts that it may prove an
invaluable blessing as well to the unmarried as married, to those in
affluence as well as to those in penury. To the matured woman in the
full enjoyment of the elasticity and vigor of health, its pages direct
how to retain that precious boon. To the weak, sickly, debilitated one,
it lays bare the causes of her malady, and points out the remedy. To the
young female about blooming into maturity—that critical juncture,
involving her future health and welfare, its pages reveal the shoals and
quicksands, surrounding her on all sides, and the necessary steps to
avoid them. To the female already suffering from various complaints,
arising either from retention or stoppage of the menses, their
irregularity, or too profuse flow, the means of a thorough and effectual
cure are pointed out. To the woman suffering in health from a too rapid
increase of family, the perusal of these pages shows that pregnancy can
and should, under some circumstances, be prevented. To those unblessed
with children, from a supposed existence of barrenness, the indubitable
facts herein contained, demonstrate that by following certain
suggestions the result may not be _fruitless_.

In short, in all the relations of life in which a female can be placed,
whether as a daughter, a wife, or a mother—whether in the enjoyment of
good, or suffering under ill health—whether physically formed capable of
enduring the various trials imposed upon her by nature, or whether
mal-formed or physically incapable to endure them, this little book is
one that no female having a regard for her own welfare, or that of her
husband or children, will be without.

-----

Footnote 1:

  The following table exhibits the ages of three hundred and twenty-six
  females, at which they began to menstruate. It is furnished me by Mr.
  Robertson, in the _North of England Medical and Surgical Journal_.

                         In their 11th year,  6
                                  12th   „   12
                                  13th   „   31
                                  14th   „   60
                                  15th   „   72
                                  16th   „   54
                                  17th   „   50
                                  18th   „   19
                                  19th   „   18
                                  20th   „    4

  To this list may be added the case related by Madame Boivin, in her
  account of a new case of abortion. The subject of this case commenced
  to menstruate at seven years of age, and did so regularly after her
  tenth year.

Footnote 2:

  We could record a number of instances where the menses were continued
  much beyond their ordinary period, and where, after ceasing some time,
  they were resumed with their accustomed regularity; but we shall limit
  our observations to one case, and that because it is recent and well
  authenticated. This case is recorded in the _Ann. Univ. de Med._ A
  female aged ninety-four continued to menstruate from the fifty-third
  to the ninety-fourth year. Her relatives were remarkable for their
  longevity; she is at present in perfect health.—_American Journal of
  the Medical Sciences for Feb. 1831._

Footnote 3:

  _Diaphoretic Powder._

   Take of Gum Opium,                                   half a drachm
           Camphor,                                     two drachms
           Pulverized Ipecacuanha,                      one drachm
           Cream of Tartar, or super-carbonate of soda, one ounce

  Pulverize all separately, then mix. It is best to use pulverized
  opium.

  _Dose_—Ten grains, or half a teaspoonful, as often as may be
  necessary.

  _Use_—This forms a valuable anodyne, diaphoretic and sudorific. It is
  beneficially administered in fever, St. Anthony’s fire, diarrhœa,
  dysentery, and cholera morbus, and in all cases where an anodyne,
  combined with a sudorific, is required. In these diseases it should be
  administered in small doses. It is also applicable to many other
  diseases, such as rheumatism, gout, &c. It promotes perspiration
  without increasing the heat of the body. It produces a constant
  moisture of the skin for a great length of time, while it allays
  irritation.

Footnote 4:

  The most successful specific, and one almost invariably certain in
  removing a stoppage, irregularity, or suppression of the menses
  (monthly turn), is a compound invented by M. M. Desomeaux, of Lisbon,
  Portugal, called the Portuguese Female Pills. It would appear that
  they are infallible, and would, undoubtedly, even produce miscarriage,
  if exhibited during pregnancy. And what is equally important, they are
  always mild, healthy, and safe in their effects.

  In the female hospitals in Vienna and Paris, their exhibition has
  entirely superseded the use of the ordinary remedies; because, where a
  cure is attainable by medicinal remedies, they are certain of success.
  Their astonishing efficacy would be almost incredible, if not vouched
  for by indubitable testimony, in numerous instances producing returns
  of the monthly periods after all hope had been abandoned. A remarkable
  case is related by Dr. A. M. Mauriceau, during his residence in Paris.

  “While residing in Paris, I had frequent opportunities of witnessing
  the astonishing efficacy of the Portuguese Female Pills in obstinate
  cases of the suppression of the menses. Their effect, in one instance
  in particular, seemed almost miraculous. A young lady, about twenty
  years of age, of wealthy and respectable parentage, had not
  menstruated for nearly two years before her application to me. On
  inquiry, I ascertained that her health was not seriously affected
  (except at intervals of about four weeks, occasioned, doubtless, by
  the efforts of nature to perform her functions), until within the
  preceding four months, when her symptoms began to assume an alarming
  appearance. Her medical attendants here prescribed the usual remedies
  without success.

  “I must confess, I thought her case desperate, and had but little hope
  that Desomeaux’s celebrated Portuguese Pills, which I determined to
  put to the test, would here avail, as I had never known them to be
  administered under circumstances quite so apparently hopeless for a
  cure. But I resolved upon a trial. Accordingly I recommended their
  use, watching their effects upon the patient. At first their virtue,
  so to speak, seemed to be only negative—that is, the young woman got
  no worse. This, however, under the circumstances, I considered a point
  gained. In the course of three weeks favorable indications began to
  present themselves. The appetite was better; the deathly-sallow
  complexion giving place to a healthy hue; the eyes, also, becoming
  clearer, but still no menstrual discharge. The improvement, however,
  meanwhile, became more and more apparent, till, at the end of the
  ninth week after commencing their use, a slight, somewhat reddish
  discharge took place. Here was a beginning; the patient still
  improving, taking moderate exercise, with light but nourishing diet.
  Their exhibition was then dispensed with until within five or six days
  just previous to the expected return of the menses, when they were
  again used, and their use continued during the seven days; on the
  eighth the menses again appeared—on this occasion somewhat freer, but
  still not in sufficient quantity. Their exhibition ceased with the
  cessation of the menses, which lasted irregularly about four days.
  This treatment continued to the end of the fourth month, when the
  monthly returns were perfectly established. At each successive
  appearance they assumed a healthier color, freer in quantity, and less
  obstructed by coagula. The patient entirely recovered, and became
  possessed of sound health.”

  He then relates another instance still more surprising.

  “A woman applied to be treated for suppression. It appeared that she
  had been subject to irregularity, or stoppage of the monthly turns,
  and as she appeared to be free from the usual symptoms attending
  pregnancy, it was not supposed that the stoppage arose from that
  cause. She commenced using Desomeaux’s Pills. After using them about
  five days—from certain indications attending miscarriage—apprehensions
  began to be entertained that the suppression might have arisen from
  pregnancy, which, upon examination, proved to be the case—too late,
  however, to prevent the miscarriage. In a short time the expulsion
  took place, and on about the third day after she entirely recovered,
  with but little comparative inconvenience to her general health.”

  He further states that their efficacy and certainty are such, that
  they are sometimes administered in cases of malformation of pelvis,
  when the female is incompetent to give birth at maturity. But when
  such is the case, M M Desomeaux’s “Preventive to Conception,” treated
  of in another part of this work, under the head of “Conception, when
  it should be Prevented,” is the proper remedy.

  These proofs of their wonderful powers have induced Dr. Mauriceau,
  since his return from France, to take the sole agency for the United
  States. They are to be obtained of him only, as they can be
  transmitted by mail to any part of the Union. For whole boxes the
  price is five dollars; half-boxes, three dollars. Address to “Box
  1224, New York City.” Dr. Mauriceau attends to all diseases of women,
  especially those arising from suppression of the menses, in the
  successful treatment of which M. M. Desomeaux’s Pills have been of
  such eminent service to him. Office 129 Liberty street.

Footnote 5:

  _Antimonial Powders._—Take of tartar emetic, three grains, nitre, two
  drachms. Mix, and divide into two doses. One dose to be taken every
  two or three hours by adults. In obstinate cases, the addition of ten
  or twelve grains of calomel to the above recipe, will render the
  medicine more salutary.

  _Febrifuge Powders._—Take of ipecacuanha, two scruples; nitre, two
  drachms.—Mix, and divide into twelve doses. One dose to be taken every
  two or three hours by adults.

  _Febrifuge Mixture._—Take of nitre, two drachms; lemon juice or
  vinegar, one ounce; water, half a pint; sugar, a sufficient quantity
  to sweeten.—Mix. A wineglassful to be taken by adults every two hours.
  It will be rendered more active by the addition of two drachms of
  antimonial wine.

Footnote 6:

  _Pills of Sugar of Lead._—Take of sugar of lead and ipecacuanha, each
  six grains; opium, one grain; syrup sufficient to form a mass.—Divide
  in four parts; one part to be taken every three hours, until the
  hemorrhage ceases; or pulv. opii, four gr.; pulv. sugar of lead,
  twelve grs. Mix, and divide in four parts; give one in a little water,
  in an hour give half of another.

Footnote 7:

  I have had, very lately, a lady under my care, who menstruates with
  the most perfect regularity; though she had labored under a prolapsus
  of the uterus to a great extent for several years. She is now in her
  sixty-fifth year. Her uterus is now effectually supported by a
  pessary, which has much improved her general health.—_Dewees._

Footnote 8:

  Indeed, it would seem that this period of female life is freer from
  diseases causing death, than almost any other. By some late
  observations made on the bills of mortality in France, by M. Boiniston
  of Chateauneuf, 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 if this change is effected
  without much disturbance, that they live not only longer than men, but
  are free from morbid inconveniences.

Footnote 9:

  A remarkable case is mentioned by Morgagni:—“I was acquainted,” he
  says, “with a maiden of a noble family, who married before
  menstruation took place, though the menses had been expected for some
  years; nevertheless she became exceedingly fruitful. We were the less
  surprised at this circumstance because the same thing had happened to
  her mother.

  Frank attended a patient who gave birth to three children without ever
  having been unwell. Capuron, also refers to several cases of this
  description, and Foderé assures us of the fact. A case of the kind
  occurred too in the practice of Mr. Montgomery. Low likewise mentions
  a similar instance. Sir E. Moore relates the case of a young woman who
  married before she was seventeen, and never having menstruated, became
  pregnant, and four months after delivery was pregnant a second time;
  the same thing occurred again, and after the third pregnancy she
  menstruated for the first time, continued to do so for several
  periods, and became pregnant again.

  It should be remembered, however, that some women are very irregular
  in the return of their menstrual periods—having them prolonged much
  beyond the usual interval. Mr. Montgomery once attended an unmarried
  woman of forty, who assured him that returns of the menses had
  frequently been delayed more than six months without causing ill
  health. Instances of menstrual suppression for shorter periods are
  frequent. Zacchias mentions that he attended a patient who used to
  menstruate regularly, but who never conceived until the discharge had
  been suppressed for three or four months previously. Mauriceau relates
  a somewhat similar case, and remarks that cases of this character give
  rise to the supposition of protracted pregnancy.

Footnote 10:

  The following cases, as well as others, are extracted from my Note
  Book.

Footnote 11:

  Mr. Robertson of Manchester inquired minutely into the result of one
  hundred and sixty cases, in which he found that eighty-one women had
  become pregnant once or oftener during suckling.

Footnote 12:

  Dr. Heberden was acquainted with a lady who never ceased to have
  regular returns of the menses during four pregnancies, quite to the
  time of her delivery.—_Heberden Commentaries._

  This opinion is confirmed by Gardien, Dewees, Hamilton, Desormeaux,
  Puzos, Francis, &c.

Footnote 13:

  “A woman came to me one morning,” says Dr. Gooch, “with a note from a
  medical man, containing the following statement: The patient’s age was
  forty-two; she had been married twenty-two years without ever being
  pregnant. About seven months ago she had ceased to menstruate; a few
  months afterwards the abdomen began to enlarge, and was now nearly
  equal to that of full pregnancy. For several months the practitioner
  had been using various means for reducing the tumour, but in vain. I
  examined the case, pronounced her pregnant, and seven weeks afterward
  she brought forth a child at the full time.”

  Dr. Montgomery says: “A lady in her forty-third year, who was married
  to her present husband twenty years ago, remained without any promise
  of offspring until within the last few months; but having missed her
  menstruation in September last, and finding her size increasing, I was
  requested to see her in January, when she exhibited evident symptoms
  of pregnancy. She was subsequently delivered of a healthy boy, after a
  natural labor of about four hours.”

  Mosse, one of the medical officers of the Dublin Lying-in-Hospital in
  1775, states, that eighty-four of the women delivered in the
  Institution under his superintendence were between the ages of
  forty-one and fifty-four; four of these were in the fifty-first year,
  and one in her fifty-fourth.

  In May, 1816, Mrs. Ashley, wife of John Ashley, grazier, of Frisby, at
  the age of fifty-four years was delivered of two female children.

  The succession to an estate was disputed in France because the mother
  was fifty-eight years old when the child was born. The decision was in
  favour of the fact.

Footnote 14:

  It may, however, be considered almost a settled fact, that when a
  female has menstruated regularly up to the time of cohabitation, and
  immediately after ceases to menstruate at the time of their usual
  return, especially if attended with morning sickness—that pregnancy
  has taken place.

Footnote 15:

  Cours de Méd. Légale, p. 52.

Footnote 16:

  North of Eng. Med. and Surg. Journ., vol. i., p. 230.

  That the presence of milk in the female breast shall take place
  independent of pregnancy, from the above and other recorded facts,
  there can be no doubt; but the following beautiful exemplification of
  its formation in that of the _male_, places the question in a still
  stronger light. This interesting fact is cited from Captain Franklin’s
  narrative of his journey to the shores of the Polar Sea.

  “A young Chipewyan had separated from the rest of his band, for the
  purpose of entrapping beaver, when his wife, who was his sole
  companion, and in her first pregnancy, was seized with her pains of
  labor. She died on the third day, after giving birth to a boy. The
  husband was inconsolable, and vowed in his anguish, never to take
  another woman to wife; but his grief was soon in some degree absorbed
  in anxiety for the fate of his infant son. To preserve its life he
  descended to the office of a nurse, so degrading in the eyes of a
  Chipewyan, as partaking of the duties of a woman. He swaddled it in
  soft moss, fed it with broth made from the flesh of the deer; and to
  still its cries, applied it to his breast, praying earnestly to the
  Great Master of Life to assist his endeavors. The force of the
  powerful passion by which he was actuated produced the same effect in
  his case as it has done in some others which are recorded: a flow of
  milk actually took place from his breast. He succeeded in rearing his
  child, taught him to be a hunter, and when he attained the age of
  manhood, chose him a wife from the tribe. The old man kept his vow in
  never taking a wife for himself, but he delighted in tending his son’s
  children; and when his daughter-in-law used to interfere, saying, that
  it was not the occupation of a man, he was wont to reply, that he had
  promised the Great Master of Life, if his child was spared, never to
  be proud like other Indians. Our informant, Mr. Wenkel (one of the
  Association) added, that he had often seen this Indian in his old age,
  and that his left breast, even then, retained the unusual size it had
  acquired in his occupation of nurse.” P. 157.

  Man possesses the same organization as woman for secreting and
  conveying milk, which enables us readily both to understand and
  believe in the truth of the foregoing singular statement.

Footnote 17:

  I have found a Burgundy pitch plaster, the surface of which has been
  well sprinkled with powdered opium, an admirable application to the
  pit of the stomach. In many cases the nausea has been soon relieved,
  and the irritability of the stomach subdued.

Footnote 18:

  A teaspoonful of pulverized prepared charcoal in a tablespoonful of
  lime-water, is oftentimes very useful in these cases.

Footnote 19:

  Seidlitz powders with a little syrup of ginger are frequently
  efficient, particularly if followed by a large draught of pure water.
  Many who have taken the Seidlitz powders with little or no effect,
  would be surprised at their efficacy, if one or two tumblers of water
  be taken immediately afterwards.

Footnote 20:

  In these cases, the oil of kreosote will be found a most valuable
  remedy. It is given in doses of from half a drop to one drop. This
  medicine, however, ought not to be used without the sanction of a
  medical man.

Footnote 21:

  Besides the morning sickness, the period of pregnancy is often
  attended with another distressing symptom, described as a sinking at
  the pit of the stomach: the patient complains, to use a common
  expression, that she feels _all gone_. This feeling I have often
  relieved by the free use of soda water. Another remedy which I have
  often used, and which is by no means disagreeable, is a fresh egg,
  beaten up with a tumbler of milk, and sweetened.

Footnote 22:

  The _Red_ mixture, prepared by suspending equal parts of pulverized
  rhubarb and magnesia in mint water, is a favorite prescription with
  many.

Footnote 23:

  In these cases medicine is not always necessary. Much benefit may be
  derived from the use of a laxative diet. Brown bread, mush, or hasty
  pudding made from rye or Indian meal, and eaten with molasses, the
  free use of the dried laxative fruits, as figs, dates, stewed prunes,
  and our native fruits when ripe, will often enable the patient to
  dispense with medicine.

Footnote 24:

  Mild lavements or enemata are here highly serviceable. Where the
  excrementitious matter is hardened or compacted, the distension of the
  bowels by from a quart to three pints of starch water, followed by
  weak soap suds, is a very efficient remedy.

Footnote 25:

  In many parts of New England, the moccasin root is much used to allay
  the motions of the child. One tumblerful of the infusion of this root
  is the usual quantity.

Footnote 26:

  This decoction is made by taking four ounces of poppy-heads, breaking
  them up, putting them into a vessel, pouring upon them four pints of
  boiling water, boiling the whole for fifteen minutes, and then
  straining off the liquor.

Footnote 27:

  There are one or two complaints to which the pregnant female is
  subject, upon which a few remarks seem advisable. Speaking of
  headache, Mr. Fox remarks:—

  “Headache, independent of accidents, may be a sympathetic affection
  arising from disorders of the digestive, or other organs. It may be
  the consequence of a feeble, or disturbed state of the nervous system:
  or it may be the effect of the vessels of the head being distended
  with too much blood; or even of a deficiency of blood in the head.

  “Where headache arises from a disordered condition of the digestive
  organs there will generally be an inactive, or irritable, state of the
  stomach or bowels, which will frequently be accompanied by giddiness,
  imperfect vision, or by specks floating a short distance from the
  eyes, by loss of appetite, sickness, acidity of the contents of the
  stomach, and by flatulence.

  “If the stomach be loaded with undigested, or irritating food, it is
  to be relieved by a gentle emetic. Having drunk a pint of warm
  chamomile tea, or common tea from one ounce to one ounce and a half of
  ipecacuanha wine should be taken, after which vomiting will ensue
  almost immediately, and without any straining, or painful effort. If
  ipecacuanha wine is not at hand, two or three teaspoonfuls of powdered
  mustard, mixed in a little water, may be used in its stead.

  “In almost every case, it will be found necessary to administer mild
  aperients every four or five hours, till the bowels are emptied. The
  aperients may be, rhubarb and Castile soap, of each one drachm, oil of
  cloves six drops, mixed with a simple syrup, and divided into thirty
  pills, of which from three to six are to be taken every four or five
  hours, till the bowels act. Where no disposition to pills exists, from
  one to two table spoonfuls of compound decoction of aloes may be taken
  every four or five hours, till the bowels are relieved freely. Where
  much acidity in the stomach is present, from fifteen to twenty grains
  of magnesia, combined with six grains of powdered rhubarb, and the
  same quantity of ginger, may be substituted for the above aperients,
  and repeated in a similar manner.

  “If the pain in the head continues to be severe, after an emetic has
  operated, or before the aperients begin to act, it will be often
  greatly mitigated by taking a moderate dose of some opiate; this,
  however, should not be employed where attacks are frequent, as a habit
  of taking opiates is productive of much injury.

  “There are persons who do not experience relief from opiates, but on
  the contrary, have the pain aggravated by their use. Strong green tea,
  or hop tea, will occasionally give relief in mild attacks, or where
  decided opiates are not productive of benefit.

  “Where a feeble, or disturbed state of the nervous system gives rise
  to headache, aperients are to be taken as recommended above; and
  stimulants are to be employed, as camphor, ammonia, compound tincture
  of valerian, æther, &c.

  “Four grains of carbonate of ammonia, or fifteen or twenty drops of
  spirit of hartshorn, are to be mixed in a wineglassful of camphor
  julep.

  “One or two teaspoonfuls of compound tincture of valerian are to be
  added to a wineglassful of water, or camphor julep.

  “From twenty to forty drops of æther are to be mixed in a wineglassful
  of water or camphor julep.

  “Any of the foregoing forms may be taken several times during every
  twenty-four hours, if necessary.

  “If the head is hot, linen wet with vinegar and water, or eau de
  Cologne and water, is to be repeatedly applied to the temples and
  forehead; or those parts may be occasionally moistened with æther, the
  evaporation of which will cause the head to become cool.

  “Where reducing the temperature of the head does not diminish the
  pain, it will be well to try the effect of heat, which may be
  accomplished in the following manner: pour a little æther into the
  palm of the hand, and apply it to the forehead, or temples. The heat
  will be kept up so long as the hand is pressed to the part, and any of
  the æther remains.

  “In severe cases of headache, the patient is to lie perfectly quiet,
  with the head moderately raised by pillows, and the room is to be
  darkened.

  “If the feet are cold, they should be put into warm water; and if they
  have a disposition to become chilled again soon, they are to be kept
  warm by heated flannels, or bottles filled with hot water.

  “During an attack of headache, arising from disordered digestive
  organs, it is essential that the food be very simple, and small in
  quantity.

  “In headache, from nervous disorders, requiring stimulants, the food
  may be of a nutritious quality; the quantity, however, should be
  moderate.

  “The foregoing remarks apply to sudden, or severe attacks of headache.
  When slighter affections of the same nature often occur, strict
  attention to diet, exercise, and the use of aperients, as recommended
  in a previous chapter, will greatly tend to mitigate the suffering,
  and to keep off the complaint altogether.

  “Where headache comes on in consequence of fulness of the
  blood-vessels of the head, it will be indicated by a sense of weight
  within the skull, drowsiness, giddiness, particularly on stooping,
  sickness, ringing or other sounds in the ears, and bright flashes, or
  sparks in the eyes. In these cases, it will generally be necessary to
  bleed the temples with eight or ten leeches; and if their application
  to those parts is known to produce swelling of the eyes and face, the
  leeches may be placed behind the ears. The head is then to be kept
  cool by applying cold vinegar and water to it; and purgatives are to
  be administered.

  “The diet is to be very simple, animal food is to be avoided, and no
  stimulants are to be taken.

  “Headache may arise from whatever induces debility. It is generally
  experienced where great loss of blood has taken place, and it may seem
  singular that the symptoms and sensations of this kind of headache,
  appear to be the consequence of the vessels of the head having too
  much blood in them. For instance, there are usually noises resembling
  the violent beating of a hammer, the rushing of water, the blowing of
  wind, ringing, &c. It is therefore necessary to notice the condition
  of the system, to be enabled to decide whether the pain arises from a
  deficiency, or from an over supply of blood to the head.

  “A correct decision should be formed upon this point, by ascertaining
  whether there is a disposition to fulness of the system, or a state of
  emptiness of the vessels from great loss of blood, with general
  debility.

  “In the latter case, quietness is most essential: wine and other
  stimulants, will be necessary; together with a light nutritious diet.

  “Opiates also will generally be found requisite, such as have been
  previously enumerated in this chapter.

  “In all cases of headache, mental tranquillity is of much importance;
  and the patient should not persevere in the pursuit of any occupation
  which materially increases the pain.

  “In this disorder, as well as in many others, accompanied by much
  irritability, the sleep is often seriously interrupted by slight
  noises; in most cases, this may be prevented by stopping the ears with
  small plugs, three quarters of an inch in length, and about one
  quarter of an inch in diameter. If the plugs be made of white wax,
  they will generally answer the best, as they admit of being accurately
  moulded to the form of the openings of the ears. Plugs made of turned
  wood will sometimes be sufficient.

  “If such plans as the foregoing do not soon give relief, medical
  advice should be had, especially where it is supposed that there is
  too much blood in the vessels of the head.

  “Tenderness and irritability of the external parts sometimes come on
  to an almost intolerable extent, in consequence of inflammatory
  action. They are most effectually relieved by bathing the parts
  occasionally with cold or hot water, or decoction of poppy-heads, or
  of laurel leaves, and by using a soothing lotion. The soothing lotion
  may be made of two drachms of acetate of lead, commonly called sugar
  of lead, and an ounce of laudanum, in seven ounces of water. It may be
  applied three or four times during every twenty-four hours.

  “In these troublesome affections the bowels must be kept rather more
  active than usual by gentle aperients. The aperients to be, from two
  to four drachms of Epsom salts. From one to two teaspoonfuls of
  electuary of senna. From one to two spoonfuls of castor oil. Or from
  fifteen to thirty grains of magnesia. Any of which may be taken every
  second night, or every night, as circumstances may require. The diet
  should be mild, and there must be a total abstinence from spirit,
  wine, and malt liquor. If these means fail to give the desired relief,
  it will be advisable to bleed the parts occasionally with six or eight
  leeches, and to apply poultices of the same kind, and in the same
  manner, as recommended in another chapter.

  “A discharge frequently appears from the passage, which is either
  white, or slightly tinged with green, or blood; in such cases, the
  parts are to be washed, or the passage injected with a syringe, twice
  daily, with tepid milk and water, or a weak solution of alum in water.
  For the wash or injection, twelve grains of alum may be dissolved in
  six ounces of water, and about two tablespoonfuls injected at each
  time.

  “Means should be used to secure the regular action of the bowels, by
  employing mild aperients and injections, as previously recommended.

  “More vigorous measures than the above might be productive of much
  mischief.”

Footnote 28:

  One of the English kings, Edward III., in the year 1344, picked up
  from the floor of a ball-room, an embroidered garter, belonging to a
  lady of rank. In returning it to her, he checked the rising smile of
  his courtiers with the words, “Honi soit qui mal y pense!” or,
  paraphrased in English, “Shame on him who invidiously interprets it!”
  The sentiment was so greatly approved, that it has become the motto of
  the English national arms. It is one which might be not inaptly nor
  unfrequently applied in rebuking the mawkish, skin-deep, and
  intolerant morality of this hypocritical and profligate age.

Footnote 29:

  It may perhaps be argued, that all married persons have this power
  already, seeing that they are no more obliged to become parents than
  the unmarried; they may live as the brethren and sisters among the
  Shakers do. But this Shaker remedy is, in the first place, utterly
  impracticable, as a general rule; and, secondly, it would chill and
  embitter domestic life, even if it were practicable.

Footnote 30:

  Will our sensitive fine ladies blush at the plain good sense and
  simplicity of such an observation? Let me tell them, the indelicacy is
  in their own minds, not in the words of the French mother.

Footnote 31:

  For a vice so unnatural as onanism there could be no possible
  temptation, and therefore no existence, were not men unnaturally and
  mischievously situated. It first appeared, probably in monasteries;
  and has been perpetuated by the more or less anti-social and
  demoralizing relation in which the sexes stand to each other, in
  almost all countries. In estimating the consequences of the present
  false situation of society, we must set down to the black account the
  wretched consequences (terminating not unfrequently in incurable
  insanity) of this vice, the preposterous offspring of modern
  civilization. Physicians say that onanism at present prevails, to a
  lamentable extent, both in this country and in England. If the
  recommendations contained in these pages were generally followed, it
  would probably totally disappear in a single generation.

Footnote 32:

  See letter of Percy Bysshe Shelley, published in the “Lion,” of
  December 5, 1828.

Footnote 33:

  Every reflecting mind will distinguish between the
  unreasoning—sometimes even generous, imprudence of youthful passion,
  and the calculating selfishness of the matured and heartless
  libertine. It is a melancholy truth, that pseudo-civilization produces
  thousands of seducers by profession, who, while daily calling the
  heavens to witness their eternal affections, have no affection for
  anything on earth but their own precious and profligate selves. It is
  to characters so utterly worthless as these that my observations
  apply.

Footnote 34:

  Jesus said unto her, “Neither do I condemn thee.” _John_ viii., 11.

Footnote 35:

  I should like to hear these gentlemen explain, according to what
  principle they imagine the chastity of their _wives_ to grow out of a
  fear of offspring; so that, if released from such fear, prostitution
  would follow. I can readily comprehend that the unmarried may be
  supposed carefully to avoid that situation to which no legal cause can
  be assigned; but a wife must be especially dull, if she cannot assign,
  in all cases, a legal cause; and a husband must be especially
  sagacious, if he can tell whether the true cause be assigned or not.
  This safeguard to married chastity, therefore, to which the gentlemen
  of the Committee alluded to seem to look with so implicit a
  confidence, is a mere broken reed; and has been so ever since the days
  of Bethsheba.

  Yet _conjugal_ chastity is that which is especially valued. The
  inconstancy of a wife commonly cuts much deeper than the dishonour of
  a sister. In that case, then, which the world usually considers of the
  highest importance, the fear of offspring _imposes no check whatever_.
  It cannot make one iota of difference whether a married woman be
  knowing in physiology or not; except perhaps, indeed, to the husband’s
  advantage; in cases where the wife’s conscience induces her at least
  to guard against the possibility of burthening her legal lord with the
  care and support of children that are not his. Constancy, where it
  actually exists, is the offspring of something more efficacious than
  ignorance. And if in the wife’s case, men must and do trust to
  something else, why not in all other cases, where restraint may be
  considered desirable? Shall men trust in the greater, and fear to
  trust in the less? Whatever any one may choose to assert regarding his
  relatives’ secret inclinations to profligacy, these arguments may
  convince him that if he has any safeguard at present, a perusal of
  these pages will not destroy it.

  ’Tis strange that men, by way of suborning an argument, should be
  willing thus to vilify their relatives’ character and motives, without
  first carefully examining whether anything was gained to their cause,
  after all, by the vilification.

Footnote 36:

  Instances innumerable might be adduced. Not one young person, for
  example, in twenty, is ever told, that sexual intercourse during the
  period of a woman’s courses is not unfrequently productive to the
  woman of a species of fluor albus, and sometimes (as a consequent) to
  the man of symptoms very similar to those of urethritis or gonorrhœa,
  but more easily removed. Yet what fact more important to be
  communicated? And how ridiculous the mischievously prudish refinement
  that conceals from human beings what it most deeply concerns them to
  know? The following case is related by Dr. Dewees in his work on
  Diseases of Females: “We have known a complaint communicated to the
  male by intercourse with a woman labouring under _Pruritis_. It was
  very similar to that which affected the female in its general
  character. When this occurs with the married man, much disturbance is
  sometimes created from a supposition that the wife has been
  unfaithful, and the contrary. Indeed, it has occurred in more
  instances than one, within our own knowledge, where the woman has
  thought herself the injured party; and in one case the recrimination
  was mutual. In this instance, the friends of the parties assembled to
  determine on the terms of separation, when it was suggested, by one of
  those who happened to be more rational than the rest, that before they
  proceeded to such an extremity, their family physician should be
  consulted. We were accordingly sent for. After an attentive hearing of
  both parties, and an examination of the parts, we were satisfied that
  there was not the slightest ground for either to be charged with want
  of fidelity, and we assured the parties that this was the case, and
  were fortunate enough to cause all further proceedings to be
  suspended.”

Footnote 37:

  Le premier serment que se firent deux êtres de chair, ce fut au pied
  d’un rocher, qui tombait en poussiere; ils attestèrent de leur
  constance un ciel qui n’est pas un instant le même: tout passait en
  eux, et autour d’eux; et ils croyaient leurs cœurs affranchis de
  vicissitudes. O enfans! toujours enfans.

                                       DIDEROT; _Jacques et son Maitre_.

Footnote 38:

  Some German poet, whose name has escaped me, says,

                   “Tapfer ist de Lowensieger,
                   Tapfer is der Weltbezwinger,
                   Tapferer, wer sich selbst bezwang!”

                   “Brave is the lion-victor,
                   Brave the conqueror of a world,
                   Braver he who controls himself!”

  It is a noble sentiment, and very appropriate to the present
  discussion.

Footnote 39:

  The author of these pages having resided many years in France, where
  this preventive has been used with infallible and invariable success,
  can vouch for its efficacy, healthiness and certainty. While there, he
  was importuned to take the agency for its disposal in the United
  States. But aware of the extreme sensitiveness, verging upon
  mawkishness, with which the agitation of a question of this nature
  would be viewed; the misapprehension to which it might give rise, and
  the difficulty of presenting it to the consideration of the public, it
  was not without some reluctance that he was induced to take the
  exclusive agency for its sale in this country. The numerous
  testimonials, however, of its efficacy, and the warm expressions of
  gratitude and thankfulness he has received since taking the agency,
  have convinced him that this invaluable preventive has been
  appreciated.

  Its efficacy is beyond question, as in Europe, among the higher
  classes especially, it is universally used, and of late among all
  classes. Thousands of married persons have for years used it with
  invariable success. Instances are related by the author from whom we
  have liberally quoted, exactly similar to hundreds which have come to
  the knowledge of the writer of these pages. The principle upon which
  it prevents conception, is to neutralize the fecundating properties in
  semen, and it preserves and conduces to the health of the female, by
  eradicating all predisposition to sexual weakness, fluor albus, or
  whites, the falling of the womb, &c., and restores and maintains that
  elasticity and firmness of the generative functions (appertaining only
  to a young female) for many years. The French, who are scrupulously
  observant of themselves in these particulars, and who retain their
  health, vivacity, and capacity to receive and impart enjoyment, to a
  remarkable age, would not for worlds abstain from the use of M.
  Desomeaux’s Preventive to Conception, merely from its effects in
  preserving their youth to an old age, and would not permit a sexual
  act to transpire without its use. When used under these circumstances,
  the directions are somewhat varied. It is well known that the French
  always have intervals of three, four, or more years, between the birth
  of children, depending upon either the health of the wife, or
  inclination or judgment of parents. In cases of malformation,
  deformity of pelvis, low state of health, its use is indispensable. In
  obtaining this celebrated preventive, it is advisable in all cases to
  communicate directly with him, the sole agent of the United States,
  for the disposal of “_M. Desomeaux’s Preventive to Conception_.” The
  packages can be forwarded to all parts of the United States. Letters
  must be postpaid, and addressed to Dr. A. M. Mauriceau, Box “1224,” N.
  Y. Office 129 Liberty street, N. Y. Price of packages Ten Dollars.

Footnote 40:

  In France, and on the Continent of Europe generally, a covering (used
  by the male), called a _baudruche_ (known as the French Secret), is
  used with success, with the view of preventing pregnancy. Its
  intention, however, and for which, perhaps, it is specially adapted,
  is to obviate the penalty incurred by prostitution, and thereby guard
  against the contraction of syphilis. But as the object of the author
  is not to facilitate, but, on the contrary, effectually to prevent the
  degrading intercourse the consequences of which are sought to be
  avoided, in adverting to it therefore, he has only in view its
  adaptation to prevent conception. If made of proper material and
  texture, it can, to a certain extent, be relied upon. Deeming this
  latter consideration of essential importance, and having been applied
  to in regard to it, he has imported them made of the only material of
  which they should be composed. Address Dr. A. M. Mauriceau, Box
  “1224,” N. Y. City, who will send them by mail to any part of the
  United States. Price $5 a dozen.

Footnote 41:

  “This, of course, must be rather a matter of conjecture and
  approximation, than of accurate calculation.”

Footnote 42:

  “Any young man who will carefully note and compare his sensations,
  will become convinced, that temperance positively forbids such
  indulgence, at any rate, more than twice a week; and that he trifles
  with his constitution who neglects the prohibition. How immeasurably
  important that parents should communicate to their sons, but
  especially to their daughters, facts like these! It is true that much
  depends upon habit, as some individuals can indulge even daily without
  apparently sustaining any physical injury; but such a frequency may
  not be compatible with the well-being of both parties, and should
  therefore not be encouraged.”

Footnote 43:

  The writer, under the circumstances just mentioned, in the course of
  his practice as Professor of the Diseases of Women, has been called
  upon to effect miscarriages, and in all cases, it has proved perfectly
  safe, recovery following in about three days. When necessary to be
  attended to, the earlier the better, but in no case, if properly
  effected, with ordinary care on the part of the patient, is it
  attended with any danger. A skilful and practised obstetrician will
  impart no pain.

Footnote 44:

  _Anodyne Clyster._—A gill of new milk, or thin starch, or the same
  quantity of any of the mucilaginous substances composing Simple and
  Emollient Clysters, which consist of milk and water in equal parts:
  flax-seed tea; infusion of quince-seed; barley water; mucilage of gum
  Arabic, or slippery elm; thin starch. From half a pint to a pint of
  either of these should be administered a little more than milk warm,
  with the addition of one or two teaspoonfuls of laudanum, for adults.
  In general, a patient will bear three times the quantity of laudanum
  administered in this way, than would be a proper dose when taken into
  the stomach: so that, when to procure rest, twenty-five drops would be
  given in a draught, seventy-five may be administered in a clyster, and
  the sickness, and other ill consequences, which some persons complain
  of after laudanum has been taken into the stomach, seldom follow when
  administered by clyster.

Footnote 45:

  If faintness occurs from the loss of blood by flooding, a little
  brandy, with two-thirds cold water, should be given in frequent and
  small quantities at a time. Nothing so speedily restores the strength
  in such cases.

Footnote 46:

  As in most cases the predisposition to miscarry arises from a very
  weakened or diseased state of the uterus, or general debility of the
  system, which is mostly caused by one period of pregnancy followed by
  miscarriage, too closely succeeding another with the same results, it
  is obvious that the prevention of pregnancy by the use of M.
  Desomeaux’s “_Preventive of Pregnancy_,” (treated of in the preceding
  pages,) for about two years or so, or until health and strength are
  restored, is the proper remedy; thereby enabling the system to correct
  the predisposition, by improving the tone and vigour of the uterus.
  The writer can vouch that by the use of this “Preventive,” many women
  who had before constantly miscarried, at particular periods, entirely
  recovered, and gave birth to full grown and healthy children, after
  trying all other means without avail.

Footnote 47:

  Interdiction of marriage is not necessary, all that is required is
  that _pregnancy should be prevented_; this, thanks to M. Desomeaux’s
  discovery can be attained by the use of his “Preventive to Pregnancy.”

Footnote 48:

  This is true when it is a right presentation (the head), or when the
  duration and severity of labor may not induce convulsions.

Footnote 49:

  That barrenness, in most cases, arises from some defect or
  obstruction, susceptible of cure, the fact, that those who for a
  number of years have had no children, when once becoming pregnant—the
  defect or obstruction being eradicated—have children in close
  succession, may be adduced as almost conclusive proof.

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                          TRANSCRIBER’S NOTES


 1. Silently corrected obvious typographical errors and variations in
      spelling.
 2. Retained archaic, non-standard, and uncertain spellings as printed.
 3. Enclosed italics font in _underscores_.