H849cLI
puppl.

 1813
ii 
WBA H849d Suppl. 1879




63580340R
NLN  Q51bMM7fi  S
NATIONAL LIBRARY OF MEDICINE
NLM051644782 
I 
 
              SUPPLEMENT






flRD'SlOMESTIC  MEDICINE,


               Being a Practical Treatise on




          MIDWIFEEY

                      AND THE


     DISEASES  PECULIAR  TO  WOMEN.



 Giving Elaborate  Instructions in all that pertains to the structure,
   functions and health of the organs of generation; and treating
     fully of Conception, Development,  Labor, Nursing,
       Diseases  of the Womb, the best remedies, how
          to prepare and administer them, etc.;
             the whole rendered more plain
                        BY
    Many Exceedingly Important Illustrations.

                   TO WHICH IS ADDED

 Illustrations and  Descriptions of  Medicinal Plants recommended
                   in this work.


            SOLD ONLY BY SUBSCRIPTION.
                    PUBLlSHtj> BY

             HUBBARD BROTHERS,

Philadelphia, Pa. ; Speingfield, Mass. ; Chicago, III. ; Cikcinkati, 0.

            Thomas Peothero, Empoeia, Kan.
 
A-nn-eX
VV&A


 1219
  Entered according to Act of Congress, in the year 1879, by
              HUBBARD BROTHERS,
In the Office of the Librarian of Congress, at "Washington, D. C. 
OF  FEMALE  COMPLAINTS
                      INTRODUCTION.
   In the following pages, we expect to do as most modern
 writers who have written upon this subject before us have done,
 borrow from  others either their  ideas or  language, or both,
 whenever it  suits our convenience.   There  is one importani
 point of difference,  however, between the short  tieatise here
 offered to the public, and all others of the same kind; which is,
 that our mode  of treatment  is entirely of* another character.
 This difference  of character  extends to all diseases peculiar to
 the female system, under all circumstances, whether pregnant or
 not, or even in the trying hour of labor.
   Those who have  perused   the  preceding  volume  of this
 work, are aware of the vast difference between our practice and
 that of the fashionable doctors; they must also be equally well
 aware of the grand fundamental principle upon which we con-
 ceive the curative art to be based, and that medicine must act in
 unison  and harmony with the laws  of life, or be  inadmissible in
 practice.  These propositions being admitted, there can be no
 difficulty then in seeing that the same general course of treat-
 ment which will cure in one  case, will also be applicable in
 another.   The  same food, drink, and air, which support  and
 preserve one  sex, do the same  for the other—the same power
 which operates a whole machine, also operates  each particular
 part—and that medicine which acts in harmony with the laws
 of life, is universally applicable in all cases of disease, whether
 of male or female,  The  same general mode of  treatment is,
 therefore, proper for all  the  diseases peculiar to  females that,
 under like circumstances of severity, would be proper for those
 diseases to which males  and  females  are alike liable.   This,
 indeed, is one of the distinguishing characteristics of the new
 Botanical and Physiological school of medicine, and is charac-
 teristic of no other.
  The  foregoing remarks  are no less applicable  to the ofte
alarming circumstances attending pregnancy  and child  birth,
than to  all other cases and conditions.  If the living power flags
or fails, during  the painful time of labor, the  same principle
which stimulates the animal  machine at other times, will do it
 aow : and the same kind of medicines are, therefore, proper to 
A
INTRODUCTION.
  be used.  We know of no situation of females, when  >ut ol
  health, that renders it improper to give the best medicines or tc
  use the best means, according to the urgency of the symptoms*
  An-1 why should any be staggered at these ideas ?  Do not, as
  we observed before,  the same food,  the same drink, and the
  same air, that sustains the  man, also sustain the woman, and
  keep all their various and diversified  organs in the regular and
  proper performance of their different, and, we might also say,
  contradictory functions ? and why may not the same medicines,
  when the functions of the organs concerned in pregnancy and
  child birth fail or become deranged, act upon the same principle,
  and produce the same happy effect ?
    We  deem it important that these general principles should
  he known and well understood, especially by females themselves.
  They are the victims of many peculiar painful maladies, hereto-
  fore considered by medical writers, and hence by  females  them
  selves, as of a most  dangerous if not incurable character. Hence,
  in almost all  those complaints peculiar to women,  and especially
  at the time of labor, they feel a solicitude and anxiety of which
  but few, perhaps, of the other sex, aie sensible ;  and this anxiety
  has been  rendered  more painful  and  intense by the mysteries
  which professional  ambiguity has thrown around  the causes by
  which  it is produced.   All know,  however, that death, from
  some cause or other, will take place, sooner or later; it is a
  consequence  dependent upon our peculiar organization, as well
  as upon that law which proclaims an eternal mutation of matter.
  But we must confess that we have found the diseases of women
  quite as much under the control of medicine as those which are
  common to both sexes.
   How grateful, then, must be this knowledge to  females ; and
  how  necessary for their confirmation in, and assurance of it, as
  well  as  their properly understanding  the important directions
  contained in this work, that they comprehend the general prin-
  ciples just laid  down.   This volume  is calculated  peculiarly for
  their use ; and to them, and to their service, it is dedicated
    We wish  them to  study and understand  it.    By so doing-
  they  will qualify themselves to minister to their own as well as
  each  other s wants and thereby avoid the necessity of consulting
  he o her sex, with all its attendant indelicacy and  mortification!
   After this exposition of our  views, we  trust no apology wiU
 be necessary for the plain manner in  which we shall treat some
.subjects.   Nothing  ess than « affectation of feeling can  fan™
 there 1S indelicacy  m understanding what may save from  ex
 posure, disease, and death."-" Strange perversion ! thoseYpe

 r^^£s07^d?^ tonformX
 ■ede  actual exposure."   Such ^\*^t^Z 
                      INTRODUCTION.                    k
                                                         <j
and our own sentiments fully correspond with his, on  this :m
portant subject.   We are fully satisfied  that  the more knowl-
edge  females  possess of themselves and of  their complaints,
And particularly of  the  principles of true medical science, the
less will they be under the influence of that painful solicitude
and anxiety to which their peculiar situation,  and  the  u.seases
consequent thereon, subject them.
  The plan which we have adopted in this work may be some-
what new;   but it  is one which  suggested itself to us as the
most  natural;  and,  as  every one has a right to select any ar-
rangement  wL;ch he may think will best answer his purpose,
we have no  apology to offer for our own. 
CONTENTS  OF  SUPPLEMENT.
                         PAGE
Introduction....................   3

        CHAPTER  I.
Female peculiarities.............   8
Of the liability of women to
  peculiar diseases...............   8
Peculiarities  of  the  female
  system............................   9

        CHAPTER  II.
Of disease peculiar to the un-
  impregnated state...............  14
Imperforation and too  great
  density of the hymen.........   14
Of the adhesion of the  labia
  pudendi of children...........   17
Of menstruation...................  18
Of the retention of the mense3;
  treatment........................   20
Of  painful menstruation;
  treatment..........................   23
Of  profuse menstruation;
  treatment.'.......................   25
Of suppressed menstruation;
  treatment........................   26
Of  cessation, or dejline of
  menstruation....................   28
Of barrenness; treatment......   30

        CHAPTER III.

Of diseases of pregnancy.......   32
Of  nausea  and vomiting;
  treatment........................  33
Of the cramp; treatment........  34
Of  salivation, or  spitting;
  treatment........................  35
Of palpitation of the heart;
  treatment........................  35
Heartburn ; treatment..........  36
Headache ; treatment...........  36
         6
                          PAGE
Costiveness;  treatment.........  37
Piles; treatment..................  38
Pains in the os pubis ; treat-
  ment ..............................  39
Retention of the urine; treat-
  ment ...........................••  39
Pains in the right side; treat-
  ment..............................  44
Inability to sleep; treatment..  44
Of pruritis, itching; treatment  45
Of swelling of the legs..........  46
Of abortion........................  46

        CHAPTER  IV.
Of diseases consequent on de-
  livery .............................  49
Flooding and fainting; treat-
  ment..............................  49
After-pains; treatment..........  52
Irregularities of the lochial
  discharge; treatment.........  52
Costiveness; treatment..........  54
Child-bed, or puerperal fever;
  treatment.........................  54
Milk fever;  treatment...........  58
Swelled leg (phlegmasia  do-
  lens); treatment................  58
Swelled breasts and sore nip-
  ples; treatment................  59

        CHAPTER V.
Of diseases which are common
  to the pregnant and unpreg-
  nant state........................  62
Of  inflammation of the exter-
  nal  parts  of  generation;
  treatment........................  62
 Hysterics; treatment.............  62
 O t*  fluor albus, or whites........  64
 Of bearing down of the womb  65 
CONSENTS OF SUPPLEMENT.
      OF MIDWIFERY.

        CHAPTER I.
Of conception and pregnancy.  79
Of conception......................  79
Of pregnancy.....................  93
Of the signs of pregnancy......  96
Retroversion of the womb.....  97

        CHAPTER H.
Of the parts principally con-
  cerned in child-birth.......... 102
Of the pelvis....................... 102
Of the womb...................... 103
Of the child's head.............. 104

       CHAPTER III.
Of labor............................. 117
                        PAGE
Of the symptoms of labor...... 117
Natural labor..................... 119
Of the conduct of the midwife
  during labor.................... 125
Preternatural labor.............. 145
Of twins........................... 148
Medical treatment of the child 149
Medical treatment of the mo-
  ther during labor.............. 151

     RECAPITULATION.

Giving a condensed view  of
  the process of labor, and of
,  the  office  to be  performed
  by the midwife................. 154
Description of medicine used
  in this midwifery.............. 159
LIST  OF ILLUSTEATIONS
      TO  SUPPLEMENT.
                        PAGE
Plate    1..........................  67
       II..........................  91
  «   III.......................... 107
  «   IV.......................... 108
  "    V.......................... 109
  «   VI.......................... 135
  "  VII.......................... 110
  " VIII..........................  11
  "   IX.......................... Ill
  "    X..........................  99
  "   XI.......................... 112
  "  XII.......................... 113
  " XIII.......................... 114
  " XIV.......................... 115
  "  XV.......................... 138
                        PAGE
Plate XVI.......................... 150
  " XVII.......................... 116
Lobelia.............................. 159
Queen of the meadow........... 160
Pond lily............................ 161
Bay berry............................. 162
Rhubarb............................. 162
Black cohosh...................... 163
May apple.......................... 164
Quaking aspen.................... 164
Lady's slipper..................... 165
Golden peal......................... 166
Beth-root............................ 167
Blue cohosh........................ 168
Clevera................................ 169 
CHAPTER  I.
                  FEMALE PECULIARITIES.

  In several particulars females have  important peculiarities,
Physologically they have peculiar functions, and, necessarily, pe-
culiar organs.   Hence from both of those causes  they are liable
to peculiar maladies.   These circumstances have induced us to
devote  a short chapter to their general consideration.
                       SECTION 1.

    OF  THE LIABILITY OF WOMEN  TO PECULIAR  DISEASES.

  Women are not only liable to all  the ordinary diseases to
ivhich men  are  exposed,  but  they  are  also subject,  in  conse-
quence  of their sexual  organization,  to diseases peculiar to
themselves.   Many of these  are either of  a  dangerous or an
inveterate character, or both combined.   They are also liable to
still more severe diseases  from derangements  in the functions
performed by their peculiar organs, than from the mere circum-
stance of a different structure.   Upon them devolve conception,
gestation, delivery, suckling, and all the contingent painful dif-
ficulties arising from these functions.
  And to what evils do these processes subject them !  Yet, be-
fore they arrive  at maturity and can experience these, they are
liable to all such as arise from their sexual organization;  and
before they can  perform one of the  ultimate  objects of their ere
ation, they are exposed from  the same  cause, to paiaful,  and
sometimes fatal diseases.
  To woman, the  period of puberty is oftentimes replete  with
serious ills ; she is constantly liable to painful  irregularities of
her menstrual  or monthly purgations, and menaced severely by
their present as  well as more remote consequences. These pur-
gations may come upon her prematurely, and debilitate by their
quantity or frequency; or they may fail so long as to involve
her health in ruin    Or she may be either  defective or exube-
rant in some of her organs, and be obliged to submit, if not to s.
dangerous, yet to an indelicate operation to free her from them.
She is likewise  liable to most of the diseases  of  the male,  anc
thus are entailed upon her almost all the ills to which both  sex-
as are subject.  How much then is she entitled to the sympathy
          8 
        PECULIARITIES OF THE FEMALE SYSTEM.       9

of the other sex   and how much does it become their duty, by
every necessary attention and kind office, to lighten herburthena
and smooth her path through life.
                       SECTION 2.

           PECULIARITIES OF THE FEMALE SYSTEM.

  However extensive the influence of education and mode of
life may be upon the human frame, they are not capable of effecl
ing so great a change upon the female constitution, as to deprive
it of its distinctive peculiarities.  For,  however much may have
been effected by the influence of these  great agents, in producing
a physical and moral similarity in the  sexes, yet no changes in
the  general character  of the female have  ever  been produced
by them, so as to leave the slightest doubt to which of the sexes
the individual  belonged, even  independently of the peculiarity
of sexual organization.
  The anatomical and physiological peculiarities of the female,
are both  numerous and curious; but we shall in this place only
notice, in a very brief manner, those  which principally distin-
guish her from the male.
  One of the most obvious differences between  the female and
male, is the general inferiority of her stature.  Her whole frame,
or bony fabric, is more delicate and less extended.  The gene-
ral features, and expression of the countenance, are more sofi
and  delicate;  and the face is without  that almost universal  ap-
pendage  of the male, the beard.
  In the organs of generation, the peculiarities of the female
system are still  more striking; and the  influence which they
exercise  over the health of the body seems to be commensurate
with the  important offices which  they are destined  to perform.
No organ of the  female system is perhaps so  liable to  become
diseased, or fail  to perform its healthy functions, as the uterus;
and hence arise some of the most obstinate and painful maladie*
to which the sex is liable.
  The female  organs of generation consist, in general terms, of
the uterus or womb, the ovaries and their appendages,  and  tin?
vagina, with the  structure which surrounds its  external orifice
or opening.  As we shall occasionally have to advert to those
paits of the system, we will here, for the  purpose of enabling
the reader fully to understand  all  that we say, give a concise
description of "them : and as these parts must necessarily be dis-
tinguished by  names which are not common,  the reader should
jndeavor to impress them upon the memory. 
10      PECULIARITIES OF THE FEMALE SYSTEM.

  In what is denominated the external parts  of generation., ar«
included  the  Mom Veneris, the Labia Pudendi, the  Clitoris,
the Nymphse, and the Hymen.   Intimately connected with the
female organs of generation, is also  included  the Pelvis, by
which is  meant the cavity formed by the circle of bones which
surrounds the  body at  the  hips;  the front of which bones is
termed Os Pubis.—[_See plates III. and 1V.~]
  The mons veneris or pubes, is the fatty  elevation immedi
ately in front of the os pubis, which, at mature age, as in males,
is covered with hair.
  The external orifice of the generative organs, commences im-
mediately below the pubes;  on either side of which are the labia
pudendi.  The place of their junction below, is denominated the
fourchette ; and the space between their junction and the anus,
is called the perineum.—\_See plates  VIII. and IX. Letter I.~\
  The clitoris is situated within the labia, and immediately be-
low or back of the  upper angle of the external orifice, upon the
os pubis.   This organ  is a small elevation,  bearing some re
semblance,  in appearance and more so in structure, to the male
penis, and is the principal seat of sensual pleasure in the sexual
intercourse.
  The nymphae are two semi-circular, oblong, thin bodies, situ-
ated within the labia, and running parallel with them, from the
clitoris, nearly half their length backward. In some individuals
these  are so broad  as to project beyond or without the labia.
  The hymen is a membrane, placed at  a short distance within
the labia, and in general partly closing the entrance into the va-
gina.   In some instances it is in the shape of a half  moon; in
others it fills the whole cavity, having a  hole  in its centre;  and
cases  sometimes occur in which it is  completely closed, produ-
cing, at mature age, the most disagreeable consequences.   This
membrane is always ruptured or torn during the first sexual in-
tercourse, and hence has been regarded as the test of virginity.
Instances, however, are not wanting in which the hymen never
had an existence, or has been destroyed by disease or accident;
indeed, some authors declare that they have never met with one
in a single instance.  The absence of the hymen cannot, there-
fore, be regarded as an infallible evidence of chastity.
  Immediately below, or rather back of the clitoris, is the mouth
of the urethra or  pipe of the  bladder, termed  meatus urina-
rius,  which forms somewhat of an  elevation   This  position
of the urethra ought to be  well understood, as it often happens
.hat a catheter has  to be introduced through it into the  bladder,
to draw off the urine.
  The vagina next presents itself to our notice, which is the
passage from  the external  organs to  the womb.   This passage
has the rectum adjoining it behind, and the urethra and bladde 
PLATE  VIII.
view  of the natural position of the bladder and womb—
              see pages 10, 11, 90, 97, 98, 104.
  A—The last vertebra of the loins
  B—The sacrum, or rump bone.
  C—The os pubis, or front bone.
  D—The vagina, or canal leading to the womb.
  5—The external orifice of the vagina.
  f—The bladder
  G—The womb, not impregnated.
  HH—The large or straight intestine lying behind and under the womb.
  I__The perineum, or space between the external orifice of the vagina  ani
anus
  K—The anus.
  L—The neck and mouth of the womb.
  M—The urethra, or urinary canal.
  N—The stump of the left thigh cut off.
  O—The buttock.
11 
 12      PECULIARITIES OF THE FEMALE SYSTEM.

before and above it.  It passes backwards and upwards, termi-
nating at the mouth of the womb.  The vagina is narrower a'
its beginning than it is further inwards; and is much larger in
women who have had children than in those who have not.—
[See plates VIII. and IX. Letters D and E.~]
  At the posterior or upper extremity of the vagina, is the moutk
of the  womb,  which  is technically called the Os Tincx,  and
projects or rather falls down, more or  less, into  the vagina.—
[See plate VIII. Letter L.~]
  The uterus or womb in shape and size, is compared to a large
pear, with the  small end or neck downward, and its  large part
or body upward. It is, however, not perfectly round, but some
what flattened.  The  womb, like  the vagina, in women  who
have lately had children, is larger than in those who have nevei
borne them.   It  is situated in the  pelvis, between the bladdei
and the rectum.  The reader must recollect, however,  that we
are  speaking of the womb in its unimpregnated  state.—[See
plates VIII. and IX.  Letters G and Z.]
  Connected with the womb are the Ovaries and Fallopian
tubes, parts essential to generation.  The ovaries produce  the
seed of the woman, as the testicles do that of the man, and are
hence often called the  female testicles.   These are situated  one
on  each side opposite the neck of the womb, and are small
roundish shaped bodies, about tha size of small nutmegs.—[See
plate II.  Letters B and D.~]
  The fallopian tubes  have their  origin at the upper or large
part of the  womb, from whence they extend to the right and
left, nearly in  a  horizontal direction, for two or three inches,
when they suddenly drop down with their ends nearly in con-
tact with the ovaries.   The ends of these tubes are terminated
by a kind of fringe, which is called the fimbriae of the fallopian
lubes.  They are hollow throughout;  opening into  the uterus
or womb at one end, and into the abdomen at the other.
  We will close this section by a few. brief remarks upon the
changes which take place in the womb in the progress of preg-
nancy.   The most striking alteration that occurs in this organ
is the very great enlargement of its size.  We  have already
remarked, that, when not impregnated, the womb  in shape  and
size is compared to a large pear, with so small a cavity, that its
internal surfaces are almost in contact with  each other.   But
towards the conclusion of pregnancy, instead of the small  and
almost  solid body which  we have endeavored to describe,  it
forms an immense sac, which extends  from the termination of
the  vagina in the pelvis, nearly up to the breast bone, and from
one side of the abdomen to the other.  This enlargement, how
ever, is so slow at first,  that before the third month, the womb
does not extend above the cavity  of the pelvis. 
        PECULIARITIES 01  THE FEMALE SYSTEM.      13

  During the first six months the body of the uterus is the part
orincipally  enlarged;  but  after this the neck begins to expand,
and gradually loses its distinctive shape, so as to form a portion
af the uterine sac.
  Considerable changes also take place in the appendages of the
uterus.   The ovaries appear rather larger and more  spongy;
i.he  fallopian tubes are also enlarged; and instead of Dassing off
horizontally, and  making an  angle,  as  the womb expands  and
mounts  upwards,  they assume  a straight  direction downward
along its sides. 
CHAPTER  II.
OF  DISEASES PECULIAR TO  THE  UNIMPREGNATED STATE.

  Almost every state and stage of female existence is liable to
some disease  peculiar to itself, as  well as to others common to
them all.   These remarks, however, are more exclusively ap-
plicable to females after having arrived at mature age.   Previous
to this  period, they are scarcely subject to any complaint not com-
mon to both sexes.
                        SECTION I.

     IMPERFORATION  AND TOO GREAT DENSITY OF THE HYMEN

  We commence with remarks upon these states of this  organ
because if they exist,  they must  have  existed  at birth;  a:
least the imperforation must have then existed.   By imperfora-
tion is to be understood, that there is no passage or communi-
cation through it into the vagina.  By its too great density is tc
be understood, that  although there may be a passage through it,
yet the hymen is so dense and strong as not to be ruptured by
the sexual intercourse.  Instances are also recorded in  which,
although this state of the hymen existed, yet it did not so inter-
fere with sexual intercourse as to prevent pregnancy from  taking
place ; but at labor obstructed  the birth of the child, until the
hymen was divided  with a knife.  Instances of either of those
;ases, however, are  extremely rare.
  No inconvenience is experienced from an imperforated state
of the hymen until mature age when menstruation or the monthly
purgations have taken place.  The menstrual fluid now bein«
regularly secreted by the womb, but not finding an outlet through
the hymen,  its quantity accumulates until not only the vagina
but also the womb itself becomes distended, sometimes to a great
M/e, before the real  cause of the difficulty is discovered  Where
           14 
IMPERFORATION OF THE HYMEN.
15
the accumulation becomes so great as to distend the abdomen, the
poor unfortunate female, in addition to her bodily sufferings, musi
be harassed by the uncharitable suspicions of her friends and
those around her.
  When the hymen is  imperforate, the patient suffers consider-
able pain at each return of the menstrual period.   The pain re-
sembles that of labor, and, in cases attended with an enlargemem
of the abdomen, has often  been, as it very  naturally would be
mistaken for it.  After  continuing for a while, the pam ceases,
and does not recur until another menstrual period arrives.
  It  is  highly probable that an imperforate state of the hymen
exists in more instances than may be generally supposed.  Ir.
those  cases which have been relieved by an  operation,  the hy-
men has been  found to be of  different degrees of thickness and
density ; and it is fairly presumable that in many cases  it may
be so thin and weak, as to be ruptured by the accumulated weight
of the menstrual fluid, or, if not by this, finally by the pressure
occasioned by the pains which take place at each monthly peri-
od.  In once instance  recorded by Dr. M'Cauly, he actually
mistook the protrusion  of the hymen for the  membranes forced
down,  as he supposed, by the pains of labor.   In this case  it
appears from the account, that the hymen was very dense ; had
it been of a thin and weak  texture, the presumption is that the
contractions of the womb were sufficient to have ruptured it.
   The only remedy for the imperforation of the hymen, is that
of making an  artificial  perforation or opening through it.  And
considering the indelicacy of the operation, and the great,  though
oy no means reprehensible  aversion of females to the exposure
consequent upon such operations, we cannot but strongly re-
commend its  performance by some intimate confiding,  but dis-
creet, female friend.   We have no doubt that the finger of the
female sufferer herself would,  in many instances, be sufficient to
rupture the hymen ; or if possessed of sufficient courage and dis-
cretion, she might even perforate it with some  sharp instrument."1
   Although these hints  might be reprobated by  the illiberal ol
the medical faculty, who wish to engross every thing by which
they can make a gain,  no matter at what expense of female del-
icacy, yet we are not conscious that by these remarks we shall
in the least degree encourage a course calculated  in any manner
to aggravate  the  sufferings of the  female sex.   It does  not ap
pear from the operations of this kind which-have been perform-
ed, that any  particular danger is to be apprehended from their
performance either immediately or remotely ;  and should inflam-
mation  even  arise, it requires no more than  the common treat-
ment which is adapted to other cases  of like character.   The
operation is  one of the most simple kind;  nothing more than
passing a knife, lancet, or other sharp instrument, through a thin 
1G          IMPERFORATION OF THE HYMEN.
membrane possessing but little sensibility or sense of feeling, and
consequently producing but little pain.
  In order to perform this operation to  the best advantage, the
external orifice or labia should be well opened  and  distended,
when the knife may be carefully passed through the upper pari
of the hymen and an incision made down to the lower or back
part  of the  same; being  careful not  to  injure or wound  ny
other part excepting the hymen.   This is certainly a most fcim-
pie process,  and might be  performed by any discreet female pos-
sessing a little resolution,  and thus save a modest girl from the
rude unblushing interference of some  professional hand of the
other sex.
  When the menstrual fluid has been retained in consequence of
the imperforate state  of the hymen,  it assumes a dark tarry ap-
pearance, but is  immediately  evacuated  on  opening a passage
through the hymen.   The quantity will vary, of course,  with
the length of time which  has  elapsed since  menstruation  com-
menced,  as  well as with the  quantity of fluid secreted at each
menstrual period.
  The suggestion we believe has by no writer been made, yet
we deem it proper to make it here, that infants be examined soon
after birth,  and if the hymen be found imperforate let an open-
ing through  it be immediately made  when the child is young.
A little lint or a small rag  moistened with oil or salve should be
introduced to prevent the parts from again uniting.   By this tri-
fling attention and simple  process might  always be saved, the
painful exposure and indelicate operation, attendant upon an im-
perforate state of the  hymen,  when the person is grown up to
mature age.
  The too great density of the hymen, although it may be per-
forate, is also productive of serious ills ; but is a difficulty,  as
appears from Dewees, easily removed.   The evils arising from
this state of the hymen, notwithstanding it may be  an impedi
ment to sexual intercourse, and even in most instances entirely
prevent it, yet this is not always the case; for conception has
been known to take  place when the woman labored  under this
disadvantage.   The great difficulty then occurs at child birth, a*
the strong hymen prevents  the expansion or dilatation of the vagi-
na, and of consequence, interrupts the passage of the child's head.
  The method adopted by Dewees for overcoming a difficulty
of this kind,  is very simple, and was as follows:—He made a
slight incision or cut in the hymen, by passing a probe-pointed
bistoury between it and the child's head,  and then introducing
his finger and giving it a  slight rotary motion,  he ruptured ot
rather tire the hjTmen so  as to allow the parts to expand, and
freely permit the passage of the  child.   We  will just remark,
that the probe-pointed bistoury is nothing more than a crooked 
ADHESION OF THE LABIA PUDENDI.         17
knife with a blunt or dull point somewhat similar  to  a  probe,
which prevents the knife from injuring parts it is not intended to
cut or wound.   The same thing may be  done with any other
knife, by taking suitable care
                       SECTION 2.

        ADHESION OF THE LABIA PUDENDI OF CHILDREN.

   The labia of young children are often found adherent; tha*
is,  grown together.  This situation of the labia seldom occurs,
says Dewees,  in children under  six months old.   It is caused
by  an inflammation and  suppuration of the internal surfaces ol
these parts, which,  in  healing,  adhere or grow together.   The
cause of this inflammation is believed to be the want of a pro-
per regard to cleanliness.  Mothers and  nurses ought to be care-
ful  often to examine the labia, paying  strict attention to theii
cleanliness, and if inflammation, canker, or any kind of soreness
appear  between them, take  immediate measures to cleanse and
heal them.   They may be washed with warm milk and water,
carefully and tenderly dried with  a soft cloth, and  dusted with
finely powdered hemlock bark, witch hazle leaves, slippery elm,
or the fine powder of  any old woolen cloth burnt to  a cinder.
One or the other of these we never knew to fail of effecting a
speedy cure in  cases of this kind.  The same application ma;
be made to chafes in the groins, behind the ears, or any where
else, and will always be found useful.
  The  adhesion of the labia is very  readily discoverable from
their being inseparable.  If an attempt be made to part or oper
them, they  can  only be separated  a short distance,  when a con-
tinuous  line of adhesion will be observable from near the mea-
tus urinarius or mouth of the urethra, down to the lower or back
part of the  passage.
  There appears to be but one remedy for this complaint; and
s,o soon  as the difficulty is discovered, it should be attended to,
and on no consideration allow the child  to grow up in  this situ-
j. ion to  womannood.   The remedy is, to divide the parts ; about
the method of doing which there is some disagreement.  Some
direct the operation to be performed with a bistoury or knife;
whilst Denman thinks  such  an operation  neither requisite nor
proper.  His method of separating the  adhering parts, is to make
a firm pressure  upon each side, and at the same time inclining
them from each other, by which means they are torn asunder,
and yet, as he says, scarcely making the child complain.  Bu'
in whatever m?nr.°r it  is performed,  the operation is verv sim
   46 
18
OF  MENSTRUATION.
pie, and requires but little skill.  After the separation is made.
h small quantity of lint with  oil or salve,  should be introduced
between the separated portions ; and the wounds will heal with
out the smallest difficulty, in two or three  days.
                       SECTION 3.

                    OF MENSTRUATION.

  Menstruation is a periodical  discharge from  the womb of
females of the human species alone.  The term is derived from
Mensis, a month;  as, in temperate climates  the  discharge oc-
curs, with healthy women who are not pregnant nor giving suck,
at intervals of a lunar month, that is 28 days.
  We have deemed this notice of a healthy function proper, not
only from the important influence which its regular and suitable
performance holds over  the  system, but also from the certain
destruction of health which follows its deviations.
  The menstrual discharge,  though formerly supposed to  be
Llood, is now  admitted  to be a regular secretion from it in the
internal surface of  the womb; and instead of  being blood, it is
divested of a peculiar characteristic of this important fluid, that
is, the power of coagulation  or clotting.  The cause of this eva
cuation has not been satisfactorily accounted for by physiologists.
  Menstruation commences in hot climates, at the age of eighl
or ten years ; in temperate  ones,  at fourteen  or fifteen,  though
sometimes  protracted to  eighteen or twenty; whilst in very high
or cold latitudes, it does not commence until the  eighteenth or
twentieth  year  of  the female's  age; and then oftentimes takes
place only in the summer.    But at  whatever time  of life this
discharge commences, the woman is said to be at  puberty, thai
is maturity; though it  is the effect and  not the cause of this
state of the system.  Before  menstruation takes place, as well as
after the period at which it ceases, the generative organs i re  in-
capable of  performing their peculiar functions.
  The period at which menstruation commences,  is influence "
by the constitution and mode of life, as well as by climate.  Those
who have a rapid development or growth of body,  have an earl>
appearance of the  menses;  and where this  process is slower,
the  menses appear later.  And those who live in cities menslru-
ate  earlier than those who dwell in the country in  the same por-
tion of the globe.   The  period during which women  are liable
to menstruate,  varies in  duration according to the time that has
elapsed previous to its  commencement; being generally about
iouble this time.   Thus, if a female commence menstruating »> 
OF MENSTRUATION.
19
lot rteen or fifteen, she will leave ofl at about forty-five; those
who commence at eighteen, will continue  till upwards of fifty;
'vhiht those who commence  at  the age of eight or nine, as in
int climates, leave off at twenty-five or six.
   Although,  as has been stated,  menstruation announces the pe-
riod of puberity, it is not the cause but the effect of the complete
development of  the organs of generation, and  seems no other-
wise connected with the generative  process, than as being a pe
-iodieal secretion from one of the instruments concerned in gen
eration during the period which  the organ is capable of perform-
ing its peculiar function, excepting, as before stated, the time ol
pregnancy and giving suck.   It may, however, even  take place,
and  still the  woman be incapable of conceiving, probably from
some imperfection in some other organ : But instances must be
very rare, if any have ever occurred, in which conception took
place either before or after the menstrual period of life.
   Menstruation rarely fails to be preceded by a variety of symp-
toms of greater or less  severity; especially in  girls  who have
been delicately brought up, and  thus have their nervous systems
debilitated and made morbidly sensitive to  those causes which
produce symptoms of nervous irritation.  Hence there is often
ringing in the ears ; a sense of suffocation, or hysterics ; palpita-
tions of the heart; variable appetite, with loathings and cravings ;
a disposition to be easily frightened;  convulsions, &c. &c.; all
oi which are immediately relieved  by only a trifling discharge
ol the menstrual fluid.
   It also often  happens,  that other inconveniences  than those
enumerated occur; such as a sense of weight at the lower pari
of  the abdomen; pains in  the back, or  the womb;  scalding
of the urine ; bearing down;  with listlessness, &c. &c.;  any
or all of which may be regarded as symptoms of the approaching
discharge.
   Very important changes, both physical and moral, take place
at this period, a period which,  above all others, perhaps, is re-
plete with consequences of the first magnitude to the inexperi-
enced female.   The voice at this time assumes gradually a differ-
ent tone*, the neck and throat increase in size ; the breasts swell,
and the nipples  protrude; the chest expands; the eyes oecome
more brilliant  and expressive  of intelligence; in a word,  the
girl  becomes a woman, and almost another being.  A correspon-
ding change also  takes place in the mind.   Childish pursuits
ai \ amusements now afford less diversion, whilst the general de-
portment becomes more  graceful,  and altogether confer upon.
tne female a perfection of those attractive charms of which  she
is so eminently susceptible.
   The quantity of fluid  evacuated at each  period of menstrua-
lion, is much varied in different individuals, and in different cli 
20
RETENTION OF THE MENSES.
mates.  In s.mie, the quantity is very small;  whilst in other* :\
is  much larger, though this seems  to have no connection with
the health of the individual.   It is only the large quantity eonr
pared with what the same person usually discharges, that  ap-
pears to have any influence upon health.  In  regard to climate,
the quantity is greater in temperate than in either cold  or hot re-
gions.
   The menstrual purgation  usually requires  from three  to  six
days for its completion ; and commonly returns with  great reg
ularity in  women  who enjoy good  health ; rarely overgoing
twenty-eight days;  though it sometimes, in  consequence of ill
health, appears once a  fortnight, and at other times, disappears
lor five or six weeks
   As the  time approaches at which this evacuation is to  cease,
it becomes more irregular, both as regards the quantity discharged
and  the periods  of its return.  The latter may be from two to
six weeks ; and finally, the discharges cease altogether.
   The period of the cessation of the menses, is also one of deep
interest to the female constitution.  It may be fraught with the
elements of health and future exemption from previous ills ;  or
it  may be the harbinger of some acute disease, or of a painful
slow  decay.
                       SECTION 4.

             OF THE RETENTION OF THE MENSES.

  In the preceding section, we have shown that  the  period ai
which menstruation may be expected, is regulated  more by the
condition of the system as produced  by climate and  habits of
life, than by the age of the female.   Nevertheless, this being the
case, each  climate  or  portion of the globe has its established
general rules as to the age at which this discharge ought to make
its appearance ; and if long delayed beyond this  period, the
health is apt to  suffer;  and to this  condition of the system has
been given the name of  retention of the menses.
  The period at which  menstruation usually takes place in this
climate, as has heretofore  been observed, is at the age of frur-
teen  or fifteen.   If, however, the menses delay their appearance
considerably beyond this period, and  the general health  is nol
impaired, we are by no  means to regard it as a state of disease.
It is only when the common symptoms of  the menses make
ihcir appearance, without any discharge,  and  the health  evi-
ient.y is s iffering  in  consequence  thereof, that we are to con-
sider it and treat it as  a disease.   In consequence of the fear9
and  anxieties of those  who have  the  charge of females  at thif 
RETENTION OF THE  MENSES.
21
important period of life, they are often  subjectea unnecessarily
to a most rigorous system of doctoring, and frequently with nc
better effect than serious and lasting injury to the health.
   Girls also very often suffer  incalculable  mischief at this pe-j
riod of life, from  the reprehensible, nay, criminal neglect ol
mothers, or others in whose care they may be placed.  The)
are often suffered to grow up in  ignorance  of  the  discharge
which all  females, sooner or later, are to expect, and  of the
rules which ought to govern their conduct at this critical period.
[n consequence of this ignorance, for which the unfortunate girl
is not to blame, menstruation comes upon her unawares, and in
the confusion and alarm  naturally  arising from  this  unlooked
for event, she commits some rash act that perhaps entails upon
her a miserable existence for  life.   Many, under such circum-
stances, have gone into ponds, rivers, or brooks, or sought other
modes of using cold water, for the purpose of washing out the
stain, by which  means they have taken colds that have  often
been productive of irreparable injury to the constitution.   Con-
vulsion fits, and incurable chronic complaints of  various kinds,
are the common and  frequent results of this species of impru-
dence, which might,  in all probability, have been avoided had
the unhappy victim only been apprised of what she  should ex-
pect, and the rules by which she  ought to have been governed.
We are at a loss to  perceive any rational  excuse for a mother
allowing  her daughter to  grow up  in ignorance  of what is so
Intimately connected  with her earthly happiness; and we can-
not but  advise, most seriously  and strenuously, that  where
mothers have any reason to believe their daughters ignorant, in
any degree, of whatever is important for them to know relative
to menstruation, that they take seasonable measures to commu-
nicate  this necessary information to them.  If their  own deli-
cacy or diffidence, or the delicacy or diffidence of the daughter,
be an obstacle to the free and frank communication of suitable
instruction, procure some  one in the confidence of the daughter,
to instruct her.  She may also be permitted to read such books
ys will  enlighten her mind on this  subject, the rules of which
should be occasionally explained or  enforced by any discreet
indiv:dual.  There is no palliating  excuse for that squeamish-
ness ind  false delicacy which many feel  and approve,  about
their daughters being informed, or their reading books contain-
ing suitable  instruction.    They  must unavoidably obtain this
knowledge by some  means or other, and many, by the criminal
neglect of mothers or others, have acquired it at the expense of
health, and even life.
   But we cannot omit observing to those who have the charge
of females, that the lapse  of the ordinary term of years is no1
il]  that  is requisite  fo produce  menstruation: the womb an 
22
RETENTION OF THE MENSES.
ovaries must have arrived at maturity and be in a healthy condi-
tion, before the  menses  can  show  themselves.   The  maturity
of the organs  is always indicated by corresponding changes  in
other parts  of the system—there must  be evidences of woman-
hood before these discharges will make their appearance.
  After girls have arrived at that n<re at which the menses com-
monly appear, and their  breasts  have  become  enlarged, with
other signs of puberty; and have  also the ordinary symptoms
which commonly precede this  discharge, such as pains in the
back, hips, and loins ;  sensation of weight, fullness, and heat in
the pelvis  or lower part of the abdomen, attended sometimes
with a bearing down, measures should then be taken to facilitate
the discharge.  There will also often  be head-ache, loss of appe-
tite, weakness of  the limbs, and a paleness which  seems of a
peculiar kind, with a sinking of the  spirits, loss  of vigor, hys-
terical affections, and other derangements of the  general health,
These  symptoms  usually occur  periodically  for a time; but
sooner or later end in protracted ill health.

  Treatment.—If the patient be not accustomed to  laborious
exercise, she ought to employ herself in some way best calcu-
lated to give all the  organs of the system  that  activity which
they require.  She ought by no means to keep her bed, or  re-
main shut up  in a close room during fair weather;  but go  into
the open air and take exercise by walking, or  riding on horse-
back or  in a carriage, or in any other  manner she may prefer
But  she  must by all means  avoid being out in  the  night air,
walking in the dew, going barefoot int.  cold places, as well  a?
all other means of taking cold.
  At those times in which nature seems disi osed  to favor the dis
charge, she may take rattle-root tea, madder tea, pennyroyal tea,
diaphoretic powders, or cayenne pepper, and use the vapor or steam
bath, at discretion.   The madder tea, which has obtained much
notoriety for this  complaint, is  made by steeping an ounce of
madder, with a few cloves, in a pint  of boiling water for fifteen
minutes; then sweeten, and when cool strain  off, and give a
wine-glassful every three hours.
  If the foregoing means fail to produce  the  discharge, either
the vegetable cathartic, or Bunnell's  pills may be given, two  or
ihree of the.n at night, and if they do not operate, one or two
more in the  morning;  after which  a  dose of the bitters may be
taken three  or four times a day.   Injections, applied either  to
the rectum or  vagina, will also be  found very beneficial.  Tha
injections for the vagina should be  composed of  a strong tea 01
witch-hazel, or red  raspberry leaves, or of the  anodyne  pow
ders, with a very small portion of cayenne, tincture of myrrn
 r anodyne drops, added, and repeated two or three times a dav 
PAINFUL MENSTRUATTON.
23
and the pills  once or twice a week.   But if after  using the
means which have been recommended for a reasonable time, the
desired  evacuation  is not produced, we must  then resort to  a
course of medicine, as described in the  second volume; which
must be repeated  according to the urgency of the symptoms,
\wo or three times a week, taking, during  the intervals between
the courses, the  bitters  and diaphoretic powders,  six or eight
times a day, in doses of half or a whole tea-spoonful; or, in ad-
dition, the madder, or rattle  root tea may also be taken twice  a
day; and thus continue until a cure is effected.
                       SECTION 5.

                OF  PAINFUL MENSTRUATION.

  This disease, says Dewees, is very common in our  climate
and is one not only of great suffering, but  also very often  o.
great obstinacy.   Single and married women are alike liable U
its attacks, and continue so from the commencement to the ter
mination of the menstruating period of life.
  The causes of this painful  malady have not been satisfaeu
rily accounted for ; but those  usually assigned are—taking cok
particularly during the flow of the menses, or after an abortion
or miscarriage.
  The suffering of women who are subject to this complaint, is
often of the severest character; resembling, in  point of inten-
sity, that of labor.  It usually commences with a  slight  men-
strual discharge, which being pretty suddenly stopped, a pain
almost instantly ensues, which is described by women as a forc-
ing or  bearing down pain, returning  at longer or shorter inter-
nals \intil either a membranous substance, or small clots  of
blood,  are  discharged.  After the expulsion of either of those
substances, the woman  generally enjoys a period of ease. Some-
times,  however,  there is a  fresh production of  one or the
other  of those substances, and then there is a return of  pain.
These pains generally continue, with different degrees of vio-
lence, during the whole continuance of the discharge.
  In some cases of painful menstruation, the breasts appear to
sympathize with the womb, and  become swelled and very  pain-
ful ; and besides the labor-like pains, of which we havf spoken.
there is often, if not always,  a permanent pain in the  hips, and
back  or loins.  There is also very frequently  head-ache, sick-
ness at  the stomach, vomiting, ?ad many other unpleasant and
distressing symptoms.
  We  have elsewhere  remarked, that the menstrual dischaiye, 
24
PAINFUL MENSTRUATION.
although it has the appearance of blood, is still a very ilifferen'
fluid, inasmuch as it never  coagulates, that is, never clots likn
blood issuing from a wound.  But, as we have just observed, a
part of the discharge in painful menstruation, is actually clotted
or coagulated blood.   And  it will be found, that whenever this
kind of discharge attends  menstruation, it will also be attended
with severe pain.  Moreover, women who have discharges  of
clotted blood, will never become pregnant and bear children.

  Treatment.—We may commence  the cure of this painful
malady by giving two or three vegetable cathartic pills, at bed
time, and if necessary one or two in the morning,  so  as to pro-
duce brisk purging.  This may be  repeated once or twice in the
course of the month, preceding the  return of the menses, taking
care so to manage  as to  administer  a dose either at the time,  or
a day or two before the  discharge makes its appearance.
  After the operation of the first dose of the pills, the patient
should take  regularly, three  or four times a day, a dose of the
laxative bitters, and at bed time a dose of the diaphoretic  pow-
ders.   When  menstruation  actually commences, she shoulc
drink, in addition to  the  bitters, very frequently of  strong tansy
tea, which appears often to  exert a  powerful influence in allay-
ing painful menstruation.   Injections, as recommended for re-
tention of the menses, should also be occasionally administered
  The unicorn root,  which  has  been highly recommended  to
prevent abortion, it is very probable might be  advantageously
employed in painful  menstruation,  both preceding the  return
and  during  the  flow of the menses.  The partridge berry
[Mitchella repens)  is also recommended for this disease.
  After a trial of  those means,  if they do not afford relief,  or
effect a cure, in addition thereto, a  course of medicine should
be  occasionally  administered, and  particularly at  each  return
of the menstrual period.   During the time the menses are flow-
ing, if  notwithstanding the use of what  we have recommended
the  pains should be  severe, the patient  ought  to take freely of
cayenne, retire to  bed, and  have hot bricks placed at her feet
and back or bowels.   The cayenne may be given either in tan-
sy tea  or  a decoction of Dr.  Wells' anodyne  powders.   His
anodyne drops may also be used; and the tincture of myrrh has
likewise been found  serviceable in some cases of this  kind. 
PROFUSE MENSTRUATION.              25
                       SECTION 6.

                 OF PROFUSE MENSTRUATION.

   Profuse menstruation can only be ascertained by comparison
 with the same discharge from the  same woman at other times,
 or by its debilitating effects.  No two women, necessarily, dis
 charge th^same quantity; and therefore the amount evacuated
 by one may be far greater than that discharged  by another, and
 yet be productive of no bad consequences.   The menses should
 not be considered profuse, or rather their large  quantity ought
 not to be regarded as a disease, unless they produce debility or
 other inconvenience.
   This complaint may arise from general debility of the body,
 or a particular weakness of the uterus or womb.  It .is also sup-
 posed to be caused by an attenuate or thin state of the blood; by
 repeated miscarriages'; poor weak diet; and excessive indulgence
 in sexual pleasures.
   Menstruation may be profuse either from the circumstance of
 of its too frequent recurrence, or from its too great quantity when
 recurring at the proper periods.  There is also often attendant
 upon this disease, a discharge of real blood, which proves very
 debilitating.   These circumstances, however, require no change
 in the treatment which,  in all cases, may be the same.
   Treatment.—In the treatment of this complaint, we should
 make use of such means as have a tendency to strengthen the
 whole system, and  particularly the womb.  For this  purpose,
 birth root, tansy tea, spice bitters, or any of the astringent tonics,
 particularly  the  anodyne  powders, may  be used.   Cayenne
 pepper must also be freely administered if profuse flooding occur,
 taking it in half or whole tea-spoonful doses, several times a day,
 according to the urgency of the symptoms.  Injections and the
 vapor bath are also highly serviceable, and shomd be resorted to
 h the other means advisee, fail.  Or, if the disease prove obstinate,
 in addition to those means,  a course of medicine must be resorted
to, and repeated as the circumstances of the case may appear to
require. A tea of the queen of the meadow has often been found
useful in weakness of the uterine vessels, and is therefore propel
in this case.   A decoction of the amaranth or prince's feather, is
also a very popular  remedy for flooding, and  may be employed
with much confidence 
26            SUPPRESSED MENSTRUATION.


                       SECTION 7.

               OF SUPPRESSED MENSTRUATION

  Suppressed or  obstructed menstruation is usually caused by
exposure to cold ;  and hence, amongst females, is usually styled,
somewhat significantly, taking cold.
  This is a  complaint to which women are exceedingly liable,
and is often productive of the worst of consequences.   The bad
effects, however, of taking cold do not always show themselves
immediately;  but generally  become  manifest  after  repeated
obstructions have occurred ;  sometimes  producing dyspepsy,
dropsy,  consumption, &c.  The  menses are suppressed during
pregnancy and suckling; and  also occasionally by disease; but
under such circumstances it is not to be considered as a disease
itself.  Suppressions from cold are often attended  by hysterical
affections.
  When a cold has been taken during the  interval between the
periods, the first  notice perhaps, which the woman may have
will be the want of a return of the menses at the proper time.
With women who are otherwise in good health, there may be
little or  no pain or other inconvenience experienced,  until the
menses  fail  to return for two or three periods:   But  in  those
whose .health is otherwise deranged, and especially such as have
bad frequent obstructions of their monthly  purgations, there  is
often much pain in the back and bowels, together with head-ache
and  fever.  The  countenance now becomes pale ; the flesh di-
minishes, and the strengtn fails. There may also be palpitations
of the heart; a sense of suffocation, and difficulty of breathing,
together with fluor albus or whites, and various other symptoms.
  When the menses are obstructed by cold taken  near the time
they are about to appear, or after  they have actually commenced,
the painful symptoms are often much aggravated. In such cases,
the patient may be attacked with pain in  the head, back, and
bowels ;  and sometimes with such violence as to create  much
alarm.  Violent hysterics,  painful colics,  and even  temporary
derangements, have sometimes been known to result from thia
cause.
   Women  should be  careful about  exposing  themselves  to
cold at all  times, but  particularly near the time they  expect
their monthly evacuations, and especially  after these ha\e
commenced.  Many a good constitution has been ruined, and
the happiness of  many a female  destroyed for life, by careless
ness at those periods.   Indeed, a very considerable number of
the diseases of women arises from this one cause. 
SUPPRESSED MENSTRUATION.           27
  Treatment.—In all  recent cases,  very simple mean3 wil'
generally  restore the  discharge.  If  the  difficulty be  caused
by a cold  taken during the flow of the menses, or iinmediatel ■
preceding their expected return,  it will almost always be r<
moved by drinking freely of pennyroyal, tansy, rattle root, or
madder tea.   The rattle root especially may be regarded as one
jf the most certain remedies in all cases of this kind.   It seems
to be so prompt in its operations,  that we have sometimes  been
fearful that its indiscriminate or frequent use might be attended
with danger.  But we know of no  bad consequences resulting
from its  administration.  Cayenne  pepper is also a valuable
remedy in this complaint, and may be  given freely, especially
if there be much pain or fever.   Sitting before a hot fire, with
the  feet in warm water, and  at the same time drinking any of
the  forementioned teas  as warm  as can be borne, to promote
sweating,  is very serviceable; or if the case be severe, steaming
will be still better, or  even a full course of medicine may be re-
sorted  to  and  repeated if necessary.  And in short, any thing
warming  or heating taken  into the stomach, and at the same
time applying heat externally, as it relaxes the  system, has a
tendency  to restore the monthly courses, when  stopped  by a
cold;  and women, when they find this to be their situation,
ought immediately  to use some of the means which are  here
recommended, and  persevere in  them until the obstruction is
removed.  By neglecting this, they may lay the  foundation of
painful and sometimes incurable maladies.
  In cases where colds of this kind have been disregarded unti-,
the foundations of health have become fairly sapped; when the
peculiar paleness and debility consequent thereon, give evidence
of the existing  evil;  when a train of nervous disorders, and
hysterical affections are preying upon the unfortunate sufferer,
it will then be necessary to adopt more active measures.  She
should then commence with taking the diaphoretic powders and
laxative bitters alternately,  five  or six times a day,  for a few
days, and then have a full course of medicine, and occasionally
throw an  injection  into the  vagina, made as directed in  section
4, of this chapter.   The course of medicine should be repeated
two or three times a week, together with the diaphoretic pow-
ders  and  especially the bitter tonic, until the usual symptoms
indicating the return  of the  monthly evacuations take  place;
when a dose of the vegetable cathartic, or Bunnell's pills ought
to be administered.
  If there should be  much pain, or  other apparent  disorder,
after the  pills operate, whether  the menses appear or not, the
anodyne  powders, anodyne  drops, or both, may be employed.
[f the female have an  idea of the  time when she  should expect
l-er courses, she may  commence drinking the rattle  root  tea 
28      CESSATION OR DECLINE OF THE MENSES.

day or two before this time, and  continue  it moderately untu
the  discharge  takes  place;  when she ought  to  leave  it off.
If the  discharge be  profuse, she  may drink  freely of a  tea
of the  astringent tonics; or  of the  birth root or witch hazle
leaves, adiing to each dose, from half  to a whole  tea-spoonful
of cayenne.
  Should  the  menses  not  be  restored by the means  recom-
mended, at the first period the organs  seem disposed to favor
it, the courses of  medicine  ought to be  continued once  ^r
twice a week, according as the health of  the individual may
require, until  another  period  arrives.   The use  of the bitter
tonic  must also be persevered in, and if the health appear to
demand it, the  diaphoretic  powders  should  be taken once  or
twice a day, particularly at night on going to bed, together with
the occasional use of injections as before recommended.
  About the  time  that the courses are expected, or whenever
the symptoms thereof  occur, the rattle root or madder tea must
be employed  as heretofore pointed out.  And  in  the  manner
which we have  directed, or as nearly so as the circumstances
of  the  case may require  and the judgment dictate, all cases
of  this kind  may  be treated,  not only until the menses  are
restored, but until they become  regular in every other way, and
the general health is fully established.  There may be many
deviations from the circumstances and symptoms herein detailed,
and so there may be variations in the treatment laid down;  yet
but few, if any, can mistake the disease, and perhaps none mis
apply the medicines.
                      SECTION  8.

       OF THE CESSATION  OR DECLINE OF  THE MENSES.

  We introduce  this  subject here not because the cessation
of the menstrual  discharge is a disease, but because this  pe-
riod is one of peculiar interest to women, all of whom view the
near approach of  the forty-fifth  year with great anxiety.   This
is the most common age at which menstruation  ceases;  and it
often happens that those women who have enjoyed good health
up to this time now become the subjects of some  severe dis-
ease ;  whilst others whose health has been bad, may acquire an
energy and vigor which,  perhaps, they had never before  ex
perienced.
  It does not, however, necessarily follow as an effect of the
suppression of  this function,  that such  changes should  take
place  in  the constitution.   The  cessation is perfectly in  ac
rordance with the laws of nature; the organs have become worn 
        CESSATION OR DECLINE OF THE MENSES.     29

out, that is, their procreative powers  are exhausted, and  their
functions of course must cease.   These changes, when they do
take place, are produced by  accidental causes which cannot a<-
ways be distinguished or for which we cannot account.
  Delicate women, and  especially those who have lived in
idleness, cease to menstruate at an earlier period than those who
are  robust and  have  been  accustomed to  labor.   In some
■cw instances,  however,  the menses cease very  early in life
without any  apparent  cause, and  without  producing any  bad
effect upon the constitution; and on the  other  hand, instan-
ces  are  recorded in which this discharge continued to an ad-
vanced age.
  In some cases, the cessation of the monthly courses produces
so little  alteration as scarcely to be noticed by the woman  her-
self; in others  their  decline  is  so  gradual as  not to attract
attention until the diminished quantity gives notice that  they
are about to leave her forever; but sometimes they become so
irregular, both in the  periods of return and  in quantity,  as to
excite just alarm, as well  as produce the  most serious conse-
quences.  And it is on account of  this latter circumstance, that
the decline of the menses has here been noticed.
  No judgment as to the consequences which may succeed the
cessation of the menses, can be drawn  from their irregularity
either of time or quantity.   So long, however, as health con
tinues good,  no apprehensions need  be entertained as to the
result.
  At this period of life, nothing will so effectually secure fc
males against injuries which may arise from deviations of the
menstrual discharge, as regularity in eating  and drinking; in ex-
ercise and rest; and in the proper government of all the passions
Extremes of every kind should be avoided, and the utmost care
must be taken to preserve the general  health unimpaired.
  But in case the health should become affected,  the same  gen
eral  plan which we have  recommended for other  complaints
ought to be pursued; such  as using  the diaphoretic powders,
bitters,  tincture of myrrh,  &c,  and if the health suffer much
diminution, a course of medicine  must be  resorted to occasion-
ally   If the impaired health appear to arise either from the in-
creased or diminished quantity  of  the  menstrual fluid,  the
course  of  treatment  advised under the  heads of  profuse and
suppressed menstruation must be  adopted, according as eithei
of those conditions may prevail. 
30
BAKRENNESS.
                       SECTION 9.

                   OF  BARRENNE SS

  An unfailing source of unhappiness in  the  married state, a
barren.less or inability to conceive offspring.   It may arise from
various causes, such as imbecility or want of tone in  the organs
of generation, which may be produced by injuries either from
violence, or from disease of the parts ; abortions; violent flood-
ings, or suppressed menstruation; or from excessive  indulgence
in sexual pleasures.
  Barrenness may also be caused by some natural or accidental
defect in the organs.   The ovaries, fallopian tubes, or even  tne
w omb itself, may be defective ; or the vagina may be too narrow,
the hymen imperforate,  or if  perforate, it may be too dense and
not yield to the force of the sexual embrace ; or the fault may be
in the male.   It is only, however, with the inabilities of the fe-
male that we have  any thing  to  do  here.   Another  source of
barrenness, which  we have before noticed, is to be found in  the
same cause that produces painful menstruation, when  coagulated
or clotted blood is  discharged at the menstrual period.

   Treatment.—The best method of treating this misfortune
is to make use of  such means as will  promote the general
health, and establish  a proper tone of action in each particular
part.  Injections both to the vagina and rectum will have a strong
tendency to promote an action in the womb and organs connected
with it—the ovaries and fallopian tubes.
   When irregularities of the menses appear to be the cause of
barrenness,  the treatment will be  found under the heads of
those complaints.  If it is produced by any natural defect of
the organs, a cure  cannot then be expected.
   Dr. Ewell recommends very highly, the exciting  a secretion
or flow of milk in  the breasts, as a cure for barrenness; and we
have no doubt of its being well worth a trial.   There  is certainly
an intimate connection between the womb and the breasts,  as we
sea in the fact that  the breasts of a healthy woman always furnish
milk after the birth of the child.
   "The most natural action," says Ewell, "for the breasts
is the secretion of milk.   They have often been  excited  to
die  discharge without pregnancy.  A child losing   its mother
and sleeping with  a   female  friend, has been known  in  the
night to get the  nipple in  its mouth, and to excite  milk by
morning; the  discovery led to the resort, and the child  was
abundantly nourished at the breast of the maid.  Would it be
'ndelicate or disgraceful—nay, would it not be very  commenda 
BARRENNESS.
31
Mr  as it would be serviceable, for many single women to under
lake this office for motherless infants ?  There are circumstances
in which it is surely loudly called for."
  " There can be no question," continues he, " that any female
breast may be excited  to the  secretion of  milk.   The  means
are  simple.  The woman should drink freely  of any kind of
liquid,  and live  freely.  The breasts should  be handled fre-
quently, rubbed  with the softest hand, bathed in sweet-oil,
and a  warm poultice  applied over the whole  of  them for an
hour.   Then it  should be  removed, and  the  breasts  still be
handled and sucked gently, at  repeated intervals  throughout
the  day,  for  several  minutes.   Particularly  every morning,
noon  and  night, the  operation should be  renewed until the
milk conies.   A young dog has often been used  for drawing
the  breasts.   When  the action is excited, it  should be kept
up  for  months,  by daily sucking them.   About the time of
discontinuance,  or  sometime  after,  impregnation may most
probably be  effected.  There can be no doubt of the womb
being  more  acted  upon, more roused  to  natural action, by
these means, than any other we know;  and they  ought long
since  to  have  been  tried.  I repeat the  declaration, that 1
have  had  it actually  done with complete  success; the good
effects  of  which, in one instance, exceeded  expectation." 
CHAPTER  III
              OF THE DISEASES OF PREGNANCY.

   Pregnancy,  although  a  perfectly natural state, renders the
 woman liable to the inconveniences  of certain  diseases which,
 under other circumstances, she might more frequently  escape
 The most common complaints attendant upon this state of the
 system are such as  are not dangerous  in  their  character,  but
 which are still very often exceedingly troublesome and annoying
 And we  can scarcely  conceive  of any ordinary  situation  in
 which a  female  can be  placed,  that more urgently calls upon
 the  husband  for sympathy and soothing consolation, than that
 of suffering  under the complicated ills so  often attendant upuii
 pregnancy;  nor one  in  which  he  ought  more earnestly  to
 exert himself to lighten her burthens and by the soft blandish-
 ments of connubial kindness,  assuage those irritable feelings  to
 which her situation often  gives rise.
   The other sex may, and we have reason to fear that many
 of them do, look upon  the pregnant female with  the unpitying
 eye of cool indifference,  whilst to herself it is a  period full of
 painful importance, and  not  unfrequently of fearful apprehen
 sion.  She is often harassed  by a train of the  most disagree-
 able symptoms, with the certain puospect that their termination,
 however  anxious  she may be for  the accomplishment thereof,
 must be a scene of still more exquisite and indescribable anguish
 to her mind.  But we do not  wish  to heighten the picture of
 female wo:  such as have  borne children  can respond to the
 truth of what we have said;  whilst those who have not,  need
 not  allow their minds to be depressed.   The process of gesta-
 tion or pregnancy has been  passed  through  by  thousands and
 tens of thousands,  without any  remarkable difficulty, though
 not  without pain — whilst the consolation of being mothers, the
 pleasures associated with lovely, endeared offspring,  afford  a
 rick reward for all.
   Our object in thus enlarging upon this subject is to excite that
 tender sympathy in  the minds of the other sex which the preg-
nant female so justly deserves, and  so much and so imperiously
 needs.   Every husband has it in his power to add immensely
 to the happiness of his wife;  and during thp often  oppressive
 and tedious months of gestation she is- certainly  entitled to ail
 .hat he can bestow.  We very well know,  however, that some
 A-omen  pass the  period  of pregmncy, without experiencing
          32 
NAUSEA AND  VOMITING.
33
much more  inconvenience  than at other times ; yet this can be
said of but very few.
  The increased susceptibility to disease which most females
experience on becoming pregnant, is supposed to be owing to a
 nore  acute  sensibility of the nervous system ; but whilst they
 re more liable to be affected b)  slight impressions, they are less
exposed to man\  fatal maladies.
                       SECTION  1.

                   NAUSEA  and VOIIIITINO.

  Sickness at the stomach and vomiting are regardad as among
Lie rational signs of pregnancy, and, next to a suppression of
the monthly courses, are often the  first to give  notice  of  this
situation.   When  vomiting  is moderate, it is regarded as fulfil-
ling some wholesome intention upon the system.  But, be  this
as it may, it is very unpleasant and  distressing to the woman,
and sometimes reduces her to a state of great debility. In general,
these symptoms cease with the first few months of pregnancy;
though  in  some  instances  they continue during  the  whole
period.  With some women, nausea and vomiting occur only in
the morning on getting out of bed ; whilst with others, they con-
tinue through the day, and take place whenever they eat or drink.

  Treatment. — As these disagreeable  symptoms  arise  in
consequence of the changes  produced in the state or condition
of the womb, but little  benefit, in  general, could seem  to be
expected from  medicine.  Where the sickness is very harass
ing, however, something should be attempted.   We may  just
remark, that the sickness  is often aggravated by the peculiar
longing  for  some  particular  food ;  which, if possible,  ought
always to be gratified.
  If the bowels are  costive,  they should be relieved by some
mild cathartic, or the  daily use of injections.  As a cathartic,
charcoal may be tried, and  if found ineffectual,  the butternut
syrup or pills may be used in  its stead.
  Repealed small doses of the diaphoretic powders,  or  of the
spice bitters, have also been  found very serviceable  as  a stim-
ulus to  the stomach ; and when these  fail,  the  cayenne wil
often answer the purpose.  The nervine tincture  is  likewise
medicine well adapted to allay the irritation of the stomach in
the vomiting of pregnancy, or any of the articles found under
the head of anti-emetics may be used, particularly the antispas-
modic aromatic drops.
   47 
34
CRAMP.
  When sourness  appears  to  aggravate  the  complaint, the
white lye, salaeratus, pearlash water, or soda should be employed:
and if these fail to check it, vinegar, or lemon jutce and water
has been found of vast advantage.   The use of  the  vapor bath
or steaming ought also to be resorted to, and  will rarely, if ever,
fail to produce a good effect.
  But  if these means fail,  and the puking is  severe, a ^omit
of the tincture of lobelia  should be taken,  together  with the
whole  process or course of medicine.   This mav be repeated.
and  any or  all of the other means employed, at switable inter-
vals, whilst the vomiting continues.  No fears need  be  appre-
hended  with regard to the effects of a  vomit of the lobeJ;r»
Instead of its producing abortion or miscarriage, it is found to"
be the best means of preventing it.
                      SECTION 2.

                     OF  THE CRAMP.

  This distressing complaint, is one of the early symptoms ol
pregnancy with some women, and often  continues  with unre
mining if not increasing  severity, during the whole  period
whilst with others, it makes  its attacks at much later  periods
With some too, it is  confined to  the legs and thighs, whils
others suffer most severely by its attacking the  womb.

  Treatment.—Strict attention should be paid to the  state of
the bowels, to keep them  loose and  regular, and at the same
time avoid exposure to cold and  all  other  circumstances and
situations which are found to  induce an attack.   Rubbing the
parts with  opodeldoc, or camphor dissolved  in  oil;  or°with
any kind of bathing drops, will often be found  useful.   Taking
internally a  dose  of cayenne pepper, or anodyne drops, will
sometimes be advantageous. But where it becomes very  tedious,
either from its severity or  frequent  occurrence, a course of
medicine should be resorted to, as occasion may require.   The
steam or vapor bath ought often to  be employed  during preg-
nancy, by those who are subject to cramp.   Or, instead of the
trouble of steaming, have some hot water prepared at bed time,
and sit before a warm fire, with the feet in the  water as hot  as
can be borne, drinking occasionally of a tea  of the diaphoretic
powders, or cayenne,  and be covered with a blanket.   In this
way perspiration may, in  general, readily be produced  ; which
will  usually relieve not only  cramp, but many other  painful
or otherwise disagreeable symptoms attending pregnancy. 
              PALPITATION  OF THE HEART            35

  Another simple though somewhat antiquated remedy, highly
tecommended  by many, is either rubbing the part affected with
a roll of brimstone;  or burn the brimstone on  coals or a  hot
snovel, and let the  patient inhale the smoke or vapor
                      SECTION 3.

                 OF SALIVATION OR SPITTING.

  A frequent and sometimes almost  constant spitting,  is a
tommon, if not general, occurrence in pregnancy.   The cause
assigned for it, like that for many other  phenomena, is unsatis-
factory, being attributed to sympathy between the salivary glands
and the womb.   This frequent spitting is commonly attended
by sourness of the stomach  and a costive state of the bowels.
The quantity of saliva discharged  is sometimes very great, pro
ducing, in a few  instances,  much debility, though  more  com-
monly, perhaps, it  principally annoys the woman by its very
unpleasant and sometimes nauseous taste.

  Treatment.—" As a general plan of treatment in this com-
plaint," says Dewees,  " either when  moderate  or severe, I
endeavor to destroy the acidity of the stomach by the various
antacids ;* to keep the bowels free, by the frequent use of mag-
nesia ;  rinsing the mouth frequently  with lime water, and  the
use of solid  animal food;  together with a strict  injunction to
the  patient to  resist the desire  to discharge the saliva from
the  mouth,  as much as possible."   There  is  no doubt that Dr.
Dewees' plan is  judicious; but the principal thing which we
have employed that proved of much value, was the spice bitters,
infused in  boiling  water, a  swallow of  which is frequently
taken  through the day
                       SECTION 4.

                 PALPITATION OF THE HEART.

  This is not an  unfrequent attendant on pregnancy, especially
drrmg the early  stages; after which  it often ceases, to return
again in the latter period of gestation.

  Treatment.—The powdered  roots  of lady's slipper, m doses
of a tea-spoonful,  repeated as often as  the urgency of the symp-

  •  White lyp. pearlash  water, lime water,  "halk, or soda watci, mav be
toed for t.hiii purpose. 
36
HE ARTB URN.—HE ADACKE.
toms may require, are  very good for this complaint.   Or  the
tincture of those roots, the nervine tincture, or the anodyne drops
mav be used,  and will be found very  serviceable.  Asafetida,
either in pills or tincture, has been found a useful remedy.   If
these medicines, however, fail, or only  produce a partial effect,
the patient should be steamed, or sit  before  the fire with  her
feet in warm  water, to promote profuse  perspiration, which
will rarely fail to give perfect relief.  But if it does not remove
the malady, a course of medicine must be resorted to, and if
necessary, should be repeated.
                      SECTION 5.

                    OF  HEARTBURN.

  This verv distressing symptom is sometimes one of the fir-1
the woman experiences after she has become pregnant; but .it
other times it does not arise until the latter period of gestation.
Occasionally it is absent altogether.   Whenever it is present, it
is difficult to cure.

  Treatment.—A very common remedy is chalk, and in many
instances it answers the purpose very well.  White lye, pearl-
ash water, soda water, &c, are also useful.  Lime  water is
highly recommended, on  the  authority of  Dr. Young.   Mag-
nesia is  also very valuable, and possesses the  advantage of
relaxing  the  bowels, which are so  apt to be costive during
pregnancy.  An emetic should be resorted to if the case proves
obstinate ; after which the bitters may be used to strengthen the
powers of the stomach.
  Any of the articles mentioned under the head of anti-emetics,
may also be employed.
                      SECTION 6

                     OF  HEADACHE.

  Headache,  attended with drowsiness, and sense of fulness
of the  vessels,  with pains in  other parts, are very common
symptoms during pregnancy, and frequently become distressing,
unless timely relieved by proper means.  The common remedy
when any of these symptoms occur, is bleeding.  This practice
we have, in the first volume of this work, shown to be unna-
tural, and therefore wc  need ndt go into any argument to prove
its inconsistency here  Bleeding should no more be resorted to 
COSTIVENESS.
37
lor removing the diseases of pregnancy, than those of any ether
6tate or stage of life.

  Treatment.—Any of the common means recommended  to
promote perspiration may be used, and will be much preferable l
to letting  blood, which, although it may relieve, deprives the
body of a portion of its  most  important flu d.   Sitting befoie
(he  fire with the feet in hot  water,  or over a .steam, taking
at the same time  warm teas, diaphoretic powders, or cayenne
pepper, in general will relieve  any of those symptoms arising
from what  is termed plethora, or fulness of the vessels.  The
bowels ought also to be kept loose; and if these means do not
remove the difficulty, a course of medicine must be resorted to
and repeated as often as necessary.
                       SECTION  7.

                    OF  COSTIVENESS .

   This difficulty during pregnancy, as at all other times, is one
from which many others  flow, and, therefore, ought to be speci-
ally guarded against. It is sure, when allowed to continue long.
to aggravate, if not produce, many of the annoying diseases in-
cident to gestation.   Costiveness is almost sure to accompany
the first, as  well as last, stages of pregnancy;  and frequently
continues unabated during the whole period.  This state of the
bowels  is produced principally, if not wholly,  by ihe pressure
of the womb, with its contents, on the rectum.

   Treatment.—Purgative medicines  should by no means be
the principal, nor even the common remedies employed, for the
 emoval of costiveness.  They may, however, be used occasion
ally;  and for this purpose, the butternut syrup,  black root, cas-
tor oil,  or magnesia, may be taken  in doses just sufficient to
loosen,  but not to purge,  the  bowels.   The laxative bitters will
also be  found very serviceable, and in  addition to their laxat;
effects,  will strengthen  and invigorate the  stomach, and reliei
several other unpleasant symptoms.
   Eating bran, as recommended in the second volume, or livi
upon bread made of unbolted flour, or drinking  strong or rich
bran tea, or  eating parched corn, will be  found to relieve cos-
tiveness in a very natural and agreeable manner, and ought al-
ways  to be  resorted to  in preference to  purgative  medicines.
But in obstinate cases,  injections ought to be employed, at least
ko often as it is necessary to procure a passage from the bowels 
38
OF THE PILES
If one injection does not answer the purpose, it mast be repeat
ed until  a sufficient discharge is procured ;  and where the cos-
tiveness is very obstinate, a little of the butternut syrup,  or oil,
may be  added to each injection.  The injections should be com-
Dosed, in general, of warm water, or warm  pennyroyal tea,
sometimes adding a little cayenne, or the tincture of myrrh, and
administered in large quantity.   But if they do not answer th«
uesired purpose, when prepared in this simple manner, they may
be made more stimulating by adding more of the cavenne
                      SECTION 8.

                     OF THE PILES.

  This complaint is caused principally by costiveness,  and is
sometimes very troublesome and painful.   Many women, who
at other times are not  afflicted with this disease, are very liable
to it during pregnancy.  The first symptom is a fulness and ach-
ing about the anus, which is followed by a slight throbbing^  These
symptoms are  momentarily relieved by pressure on  the part;
but swelling soon succeeds, to a greater or less  extent, attended
by various degrees of  pain.  In general, the  pain is in propor
tion to the size of the swelling and degree ol" inflammation.

  Treatment.—The  means for removing co«tiveness, recom-
mended in the preceding section, should be faithfully employed,
especially  t*ie bran bread, and above  all the injections, as a pre-
ventive, and if the bowels  continue in a  costive state after  the
piles have become troublesome, the same  means must be  perse-
vered in.  It is usual,  however, for the bowels to become relax
ed just before,  or at  the  same time that the  piles come  on
Then the woman should  drink freely of the tea of the diapho-
retic powders, astringent tonics,  or  anodyne powders, and use
injections of any of the astringent preparations, which ouo-ht to
be often repeated whether the bowels are loose or c«stive.°
  She must also  keep  mostly  in bed,  and have a hot brick oi
any other hot substance applied near the part affected, which may
also be anointed with  an ointment made by mixing the powder
of the common puff ball with hogs'  lard, fresh butter, or cream,
or any other of the usual remedies  for this  complaint may be
employed.
  Steaming should also be freely  and frequently employed in
all cases of piles, and  may be regarded, in conjunction  with  the
injections, as the best  means of removing the disease as wt 11 as
of preventing its  occurrence. 
RETENTION OF THE URINE.
39
                      SECTION 9.

                OF PAINS IN THE OS PUBIS.

  In the advanced  stages of pregnancy, some women exjeri-
cuce a severe pain in or about the  front bones of the pelvis,
which is often very distressing.   It appears to be caused by the
continual pressure of the womb  upon those bones, which be-
comes the greater as gestation advances.

  Treatment.—The  pain  may often be relieved by the vapor
bath or steaming, or by profuse sweating before the fire.—
Rut the most effectual relief is obtained by supporting  the belly
with a bandage, over the  shoulders and around the lower part
of the  abdomen.  That  part of the  bandage which  supports
the bowels, should be broad, so as to give an equal  support to
every part.   To  apply the bandage,  the  woman should lie
down, and place it so as to be just of  a suitable length in that
position ; and then when on her feet,  it will  support  the  abdo-
men, and prevent the pressure upon the os pubis or front bones of
the pelvis.
                     SECTION 10.

             OF THE  RETENTION OF THE URINE.

  A difficulty of discharging the urine sometimes takes place
luring pregnancy, in consequence of the pressure of the womb
upon the urethra or  pipe  of the bladder.   The consequences
of a retention or stoppage of the urine are—a swelling of the
bladder, attended with great pain; and  if permitted to continue,
will produce inflammation  of the bladder and urethra, and some-
times  terminate in death.

  Treatment.—If the  stoppage has been suffered to continue
until much pain and inflammation  have arLen, warm fomen-
tations, by means of cloths wrung out of hot water,  or fomenta-
tions of bitter herbs, should be applied to the  abdomen, or the
steam bath may be employed ; taking  at the  same time some
warming teas, or cayenne, to promote  sweating.  This course
not onlv relaxes the parts,  but also prevents or removes  inflam-
mation.   Injections made  of either  flax seed or slippery elm
lea, or even warm water, may also be thrown  into  the  vagina,
from time to time.
  Hut the difficultv  and danger attending  a  stoppage of tht- 
40
RETENTION OF THE  TRINE
urine may be avoided, or if  allowed to occur must be removed,
by a catheter.   This is a very simple instrument, and  the  me-
thod of using  it is equally simple.   The catheter in common
use,  is nothing more than a flexible tube  made  of gum  elastic,
and may be procured at a trifling  expense at most apothecary ~
shops.  Or instead of a catheter, which may not readily be  pro-
cured in all places, a goose quill will answer the same purpose.
  We  have just said that  the method of using the catheter is
very simple, and so we know it will be  found by all  who at-
tempt it; but  what say medical  writers ?   Why,  with but a
very few honorable exceptions, they represent it as an operation
requiring " professional aid," "chirurgical assistance," Sic.  &c.
  The  illiberality of these " professional"  attempts  to blind
the  eyes of those upon whom physicians  are palming these
impositions, will be generally better understood at some  future
period than they possibly can be at the present time.   It  wi 1
then be seen how little the physicians  of this age value  the
feelings of female modesty and  delicacy,  by the gross outrages
which  they so  deliberately press upon them ! We  can look  up-
on their efforts to keep up some peculiar  prejudices, in no other
light than as " professional" aberrations of a most  indelicate and
highly censurable character.  We hope to be pardoned, if pardon
be necessary, for the warmth of our feelings ; it is produced by
the  high value  which we  place  upon female delicacy and the
sympathy which we feel for females, in the necessity that they
often find imposed upon them of submitting to the unnecessary
 nterference of " professional hands," to  perform  operations of
 he  most simple kind, which they ought to manage themselves.
  When we meet with a  writer, insisting  that " professional
aid" is  indispensable  in the performance of so simple an ope-
ration  as drawing off the  urine  with  a  catheter, our feelings
will  not permit us to view him in any other light than  as an
intruder upon  common sense  and decency.   If he knows  any
thing, he knows that the  woman, if in health, can  do it her-
self; and with this knowledge,  if he insists upon  the necessity
jf professional  interference, self  interest  must  predominate
over moral duty and  that refinement of feeling  which  ought
to distinguish every physician.  Even Dr. Dewees, whom  we
understand to be in other respects a gentleman, and who is  cer-
tainly a good author, gives currency to the same gross prejudices
In an account of a case of prolapsus  uteri, producing a  reten-
tion  of urine,  he says  " so permanent  was it.  and so often
repeated, that the husband learned the mode of introducing  ||1P
catheter;" as if it required  long and repeated practice to learn
to do an act which, if any husband, after  a simple  description
-)f the operation, could not perform, he  ought certainly never to
losses* a wife.   And this description,  physicians are m.doulu. 
RETENTION OF THE  URINE.
41
cdly capable of giving, and  ought certainly, when necessary,
always to give;  and which, if they placed  any kind of value
upon female modesty, would give, rather than shock her feelings
by performing so indelicate an operation themselves.
  Yet,  above  every consideration  of delicacy  and  modesty,
there should be a stronger inpulse—a higher motive, to stimu-
late physicians to impart to females this necessary—but simple
knowledge   If, as has been admitted by medical writers them-
selves, females, for the want of this " little  knowledge" which
the faculty have it in their power to give,  are  liable  to " very
great injury;" and  that " many of  them have actually expired,
for want of some one to draw off their urine ;"—we say, if these
are facts, of which none need doubt, how can physicians stand
acquitted in the eyes of the community, or at the day of final
account ?   Who  that knows  the simplicity of the process of
using the catheter, and reflects upon the sufferings that wome.i
have endured, and even death  itself, but will  feel the keenest
indignation towards those whose duty it was and  is, to commu-
nicate the  "little  knowledge," which every woman can, "and
ought to understand"  and exercise, when  necessary, for her
own preservation.   Do not  the serious consequences which
arise from the withholding of the knowledge in question, fully
justify the  warmth of feeling which we have expressed, and the
severity of language which we have used in relation to this subject 1
  What!  can any  one be found who  will  not,  with us, deal
out the severest  rebukes  to those who, by  neglecting to  com-
municate the knowledge of which  we  are speaking,  not only
endanger but actually  destroy the  lives of  " many" women
We  know  that we have  used strong language,  but  we  trus
that  before leaving the  subject we shall  satisfy the candid
reader  there is good reason for  it.   We are also well aware
of the  respectability of, and the great deference which is paid
to, the  medical profession; and we are equally  sensible how
mi ch, as well as  how little, the world is indebted to them.  As
a learned body, they are certainly not  excelled by any other
class in community : and this, joined to their  high respectability,
renders  the difficulty  of  correcting the popular  prejudice in
question, the greater.
  The servility with which the  faculty of  medicine, in some
res oects, is adhered to, is certainly far behind the intelligence of
the age.  We wish women, and likewise men, to think and un-
derstand and act for themselves;  and be dependent no  furthei
than necessary upon others,  especially in matters of so  much
simplicity as the one under consideration, and which at the same
time is so intimately connected with their delicacy, health  and
happiness.
  But we would not dwell upon this one breach of refined feel
        21 
42
RETENTION  OF THE URINE.
ing, and professional trespass upon female chastity, if it stooft
alone, an isolated monument of the unblushing turpitude of the
medical profession.  It is only a part, and a small one too, of a
most stupendous scheme by which  they are imposing upon the
ignorance and credulity of the multitude, for the purpose of their
own pecuniary gain or personal aggrandizement;  of which  inoie
will be said hereafter.
   And what is the operation of introducing  the  catheter ? saye
Dr.  Ewell, whose name we cannot mention but with sentiments
of respect.   His writings evince  that  his whole heart and his
whole mind, are animated by the finest feelings  of human na-
ture ; that he inherits the rare and uncommon qualification so
desirable in physicians, though  seldom met with in the present
age,—a sense of the proper estimate of female delicacy, modesty,
and  morality.  Dr. Ewell says, speaking of the necessity of
using the catheter, " There  is no  complaint to  which females
are  subject,  more manageable  among themselves, and conse-
quently which they ought to attend to with  more  earnestness  ;
and  the  knowledge of which is of such easy acquisition, and
the  performance  so simple, that  much attention is  scarcel}
necessary.   Nevertheless," continues he, " this little knowledge
this  little ability to perform, has been so neglected, that notonlv
 niiumerable females have had to exhibit themselves to men, bu
 nany of them have actually expired, from want of some one to
-raw off their urine, by means of a little tube called a catheter,
 orresponding nearly in shape to a goose quill,  and which has
actually sometimes proved a convenient substitute."
   " And what is  the  operation of  introducing the catheter to
2vacuate the urine ?   The  bladder containing  the  urine,  is
immediately  behind the front  bone called  the  pubes;  the
sanal to it direct—not three  inches long.  The instrument,
the  catheter, is adapted  to the size of the  canal, and the wo-
man lying on her back,  finding the entrance, into which the
end  of the catheter is introduced and pushing it backwards and
"upwards, pushing  it gently in the direction where least resist-
ance is  made, can readily introduce it herself to  draw off the
urine.  If  the woman  be too sick to perform  the operation o~i
herself,  her associate, her nurse, her servant, can do it."
   " From  motives of  delicacy  alone," says Dr. Bard,  " this
e.isy operation ought to  be  in the hands of women ;  but  what
i>  of much  more consequence, if a man is to be sent  for everv
time it  may be  necessary to perform  it, it will  generally  be
neglected too  long, particularly  in  the country;  to  the  verv
great injury,  and  in some instances danger, of  the  patient.—
The o iliee of the urethra, or urinary canal, is  situated  under 
RETENTION OF THE  URINE.
43
the arch of the  pubes or share  bones, and the canal, making
a slight curve, ascends very little, and enters the bladder" almos/
immediately behind it: it is not above an inch and a half lowg,
so large as to admit a catheter of the size of a goose quill, and so
little curved,  [crooked]  that a straight  instrument  is by some
preferred."    It was formerly customary  to  have none  but
crooked, metal catheters ;  though  now, gum elastic ones are
mostly used, and are preferable.
   We have made the preceding quotations in order to show how
simple the  process was of using the catheter, as well as to give
respectable authority for the propriety of confiding it to the hands
of females themselves. The opinions of Bard, no medical man
will lightly contradict; whilst that of Ewell requires  nothing
but time to make it equally respectable.  What then  becomes of
all the mystery which most modern writers have endeavored to
throw around the  " easy operation" of drawing off the urine with
a catheter? the performance of which is  "so simple that much
attention is scarcely necessary," " and from motives of delicacy
alone ought to be in the hands of  women." Oh! professional
shame,  where is  thy blush ?
   In  introducing the catheter,  " if  some  little difficulty should
occur, patience, and  gently moving the hand from side to side,
or upwards and downwards, will overcome it with very little or
no force, and with little pain to the patient.   At any rate, force
is never to be used ;  it is better to desist,  and make  a second or
a third attempt; for whenever any difficulty presents, it  is owing
to circumstances not to be overcome by violence, which can ne-
ver do good, but  may do infinite mischief."   Dr. Bard also di-
rects in "ases where  there may be difficulty in introducing the
catheter, that it be put " into the hand of the patient, who,  di-
r ected by her own feelings, will sometimes succeed more easily
<han  any other person."
   We will  close these observations, by remarking,  that if,  for
want  of a catheter, a goose quill is used, one of the smallest size,
with a long barrel, should be preferred.   To prepare it for use,
cut a  hole in the side of the quill  near the end,  minding not to
cut the end off; by doing so we make sharp edges to the quill,
which may do an injury in passing through the urethra to the
bladder.  Next cut anotber hole at the most extreme part of the
hollow where  the barrel  is attached to the feather part, which
must not be cut off.   This precaution is  necessary, as by cut-
ting the feather from the barrel of the quill it has, in using, slip-
ped from the fingers and passed into the bladder, which has sub-
jected the patient to a dreadful operation to extract it.   By leav-
ing the feather part on the quill, this danger is entirely  avoided 
44                INABILITY  TO SLEEP.
Before introducing either the catheter or the quill these instru-
ments Should be rubbed all over with oil or lard.
  " This is the whole secret of using the female  catheter, for a
want of the knowledge of which thousands of females have been
:ompelled to submit to an exposure of their persons, and thou-
sands more have lost their lives, where assistance could not be
obtained.   By a little attention to this subject, female friends, or
even female servants,  could easily give the required assistance ;"
as well  as " always be enabled to relieve themselves, without an
indecent and mortifying exposure of their persons to males who
act as physicians."
                      SECTION 11.

                OF PAINS IN THE RIGHT SIDE.

  A little after, and seldom before,  the fifth month,  women
are frequently attacked with a deep seated dull pain immediately
in the region of the liver.  Its commencement is with a very tri
fling pain in  the part,  which gradually increases as pregnancy
advances.  The  pain  is very seldom severe, but is almost con
stant both day and night;  and especially during the latter.
  Women are more  liable to this  complaint during their first
pregnancies than afterwards.   The cause is  supposed,  by De
wees,  to be the pressure of the uterus  upon the  liver  as it en
larges in the progress of gestation.

  Treatment.—From the cause which produces this complaint,
little can  rationally be expected  from  medicine; yet  if it be
severe, something should be attempted.  Lying on the  left side
commonly affords some relief.  The side should also be bathed
with cayenne pepper and vinegar,  or any of the bathing drops.
A strengthening plaster may also be applied to the part.  Placing
a hot brick or stone near the part, on going to bed, may likewise
afford relief;  or promoting perspiration  by any other means will
oe found very useful.


                      SECTION  12.

                 OF INABILITY TO SLEEP.

  Towards the latter  period of pregnancy, many women  ex-
perience much inquietude, with an inability to sleep.  This dis-
turbance is sometimes so great as to prevent the  possibility ol 
PRURITIS,  OR ITCHING.
43
sleeping.   The  difficulty seems  principally to  be caused bj
spasmodic  or involuntary contractions  of the  muscles of the
limbs; which take place,  sometimes with  considerable  foice,
just as the patient appears to  be  falling into a sweet slumber
The disturbance thus produced immediately, forces the woman
from her sleep very much against her inclination.
  These disagreeable startings of the limbs, continue longer 01
shorter, but at  length yield  to the impulse of nature, and the
woman falls asleep, though sometimes not  till towards morning.
Sleep, however, when it does come, appears very refreshing, and
she rises in the morning apparently as well as after an undis
turbed night's rest.

  Treatment.—Nervine medicines  appear in general to  have
10  great influence  over this  condition of the  system; though
they ought to be tried.  For this purpose, the tincture of lady's
slipper root, or the  nervine tincture, is perhaps  the  best;  and
Dr. Wells' anodyne drops might also be  tried.  Washing the
face, hands and feet, at going to  bed, is a very good  remedy ;
but nothing probably is equal  to a good sweat at evening,  either
by steaming, or sitting before  the fire, and drinking a tea of the
diaphoretic powders.   The  partridge berry tea  might also be
tried, as  it is the principal ingredient  in a compound highly
recommended for this difficulty by Dr. Smith.  It is also highly
probable that the blue cohush might be advantageously employed
in this complaint.
                       SECTION 13.

                  OF PRURITIS, OR ITCHING.

   Pregnant women are liable to a most troublesome and  dis-
tressing  itching about the private parts.  It is, however, not
exclusively peculiar  to pregnancy, but is much  more common
to this state  than to  any other.  The disposition to scratch is
sometimes so extremely pressing as to set decency at defiance,
or oblige the unfortunate woman to abandon company.
   This extremely disagreeable complaint, sometimes makes its
attack during the early part of pregnancy; but more commonly
not until  the sixth or seventh month. If cleanliness be neglected.
says Dewees, it is sure to be aggravated ; though no attentions of
this kind are capable of overcoming the disease.  No satisfactory
cause has, as yet, been assigned for this troublesome disorder.

  Treatment.—The application of cold water to the part, will
often afford  relief, but does  not effect a cure; the  relief btini! 
46
ABORTION.
only momentary.   A  solution  of borax  in water, as  much as
the water will dissolve, applied as a wash and by injection, has
proved highly advantageous, in some instances;  whilst in oth-
ers, the balsam of capaiva has  succeeded better.  We  think,
probably, in those cases where the capaiva would  answer, the
balsam of fir might be equally as good.
  We believe, however, that injections  prepared as heretofore
directed in Section 4, chapter II, applied to the vagina, ana espe
cially if made moderately stimulating with  tincture of lobelia
tincture of mvrrh, or cayenne pepper, would be far more likel;
to give permanent relief, than  perhaps any thing else.   Afte
trying this, or any other means which might be thought advisa
ble, a course or two of medicine should  be resorted  to,  and L'
found beneficial, continued until a cure is effected.
                      SECTION  14.

                OF SWELLING OF THE LEGS.

  This complaint is a very common attendant on pregnancy
towards the close of which, it sometimes produces much incon
venience and pain.   There is also, very frequently, a swelling
or enlargement of the veins, which is troublesome in pregnancy
Both difficulties appear to arise from one cause, which is a
pressure of the  womb upon the vwssels by which the fluids are
returned to the  body, from the feet and legs.   Neither of those
swellings are dangerous, but disappear at delivery.

  Treatment.—It may often answer a good purpose to draw
on a pair of small tight stockings to reach to the body : and some
swathe the legs  with a bandage,  to prevent the swelling.   The
vapor bath or steaming, alwavs  affords relief; in addition to
which, the bowels ought to be  kept loose.   It frequently an-
swers an excellent purpose to bathe the  legs with tincture of
myrrh, cayenne and vinegar, bathing drops, or any other stimu
lating wash.  Nothing, however, will effect a  permanent o ire
but delivery
                     SECTION  15.

                      OF ABORTION.

  L Dttixo every period of pregnancy, after the first month, the
froman is liable to abortion or  miscarriage; but the time at 
ABOR'I ION.
47
which it most frequently happens, is  about the third or  fourth
month, or from the tenth to the eighteenth week.  Some women
are very liable to miscarry; and when the habit is once formed,
there is difficufty in preventing it.   Abortion may be caused by
a  variety of circumstances;  some  of which can be  guarded
against, whilst  others are  entirely beyond  control.   It may be
produced by violent exertions of strength;  by severe exercise;
by frights, violent fits  of passion, great uneasiness of mind,
strong purges, excessive venery, external injuries, as blows and
bruises, &c. &c.
   The symptoms which  usually  precede an  abortion  are  a
softness or flaccidity of the  breasts;  pains in  the back, loins,
and lower part  of the belly ;  shiverings and palpitations  of the
heart; a falling or subsiding  of the belly ; pain in the inside of
the thighs, &c. &c.   When  any or all  these  symptoms take
place in a pregnant female, and are attended  by a flooding or flow
of blood from  the womb, a  miscarriage may with  much  cer-
tainty be calculated upon.   Miscarriage may be attended  by va-
rious degrees of suffering and danger, from  trifling pains  and
discharges of blood, to  the most exquisite torture and alarming
hemorrhages; and not  unfrequently  death.  All these  symp-
toms, however,  may be mitigated and divested  in some  meas-
ure  of their alarming character, as well  as abortion  itself pre-
vented, by a timely use of suitable medicines.

   Treatment.t—When symptoms of abortion  make their ap-
pearance, the woman should  take freely of the diaphoretic pow
ders, or a tea of the anodyne  powders, with the anodyne  drops,
and keep herself as  quiet as possible in bed.   She may also
take of the  nervine tincture,  and have a hot brick applied near
her bowels or back ;  and if there be much  pain or flooding, she
should take  repeated large doses of cayenne in a strong tea of
equal  parts  of birth root and witch hazel  leaves, or either of
them alone; or, if neither can be had, make use of almost  any
other astringent article  in their stead.   However startling may
be the idea of administering large doses of  eayenne in cases of
flooding, we are satisfied, by repeated experience in the most
alarming cases, that  it  is  of great value.  The vessels  of the
womb, from which  the  flooding takes place, when they act un-
der a  healthy influence, always close and prevent a discharge
of blood ; but in a case of hemorrhage  they have lost this power
Hence thev require the  application of  a stimulus to enable them
to assume a  healthy action, and  thus  prevent the discharge  of
blood.
   We are very  sensible that physicians will generalh  oppose
us in  these opinions, by referring to the doctrine of active and
vasnivc hemor-hage, the fallacy of which we could easily prove 
43
ABORTION.
but as we think the statement which we  have made,  of the
mode or principle by, or upon, which the cayenne acts, is suf-
ficient, we will take no further notice of it here.
   If the  symptoms are more violent, the medicines  should be
given the more frequent;  in addition  to  which, the woman
should be  steamed.   If these means do not moderate  the symp-
toms, a course of medicine must be resorted  to, and, if necea*
sary, repeated at proper intervals until the danger is removed.
   We can assure our female readers, that, however contrary our
treatment  may be from what they have previously been accus
tomed to,  it is nevertheless  not only perfectly  innocent, but ab-
solutely better than  the too common  custom  of bleeding and
using cold substances;  which, instead of strengthening nature
to do her own work in her own proper way, weaken the living
power, and make the woman a more easy prey to disease.  We,
therefore,  intreat you, if symptoms of abortion make their ap-
pearance, not to allow your fears to overpower your judgments
and pursue a course so hostile to life.  But keep yourselves quie
and warm: take freely of cayenne and the astringent medicines,
particulany the  birth root, or witch hazel  leaves; make  free
and frequent use of  the steam bath, at all  times during preg-
nancy, but especially when threatened with abortion.  Perse-
vere in  this course,  nothing deterred by the violence of the
symptoms ; but the more violent they are, the  more freely you
should use the medicine.  If this course does not check the dis-
ease, and especially if there be flooding, take a thorough course
of medicine, which may be repeated at discretion.   This  plan
of treatment, seasonably adopted and persevered  in, would save
many from premature death.  If costiveness prevail, make use
of injections  to relieve the  bowels.  Astringent injections  may
also be thrown into  the vagina, in cases of flooding;  or if sud-
den and profuse flooding takes place, threatening quickly to des-
troy life, it has been  recommended and  practiced,  to make use
of what is termed  the tampon.   This  is nothing more than  a
piece  of sponge of suitable size, moistened with vinegar, and
crowded into the vagina.  " It almost instantly puts   a stop to
the hemorrhage; and,  in some instances," says Dr. Dewf.i.s,
" I believe I was entirely indebted to it for  the preservation of
my patients'  lives."   When sponge  cannot be  procured, he
recommends rags, tow, or flax, well moistened with oil or lard
to be introduced  or confined there, until the  difficulty  can be re-
moved.   We are inclined to think, however, that astringent in-
jections composed of a strong decoction of binh  root, witch
hazel, or any other astringent article,  applied to the  'ngina, is
more to  be relied upon than the tampon. 
CHAPTER  IV
       OF THE DISEASES CONSEQUENT ON DELIVERY

  Parturition or delivery, although  it is a natural process
yet it lays the woman under additional liabilities  to disease,
and  even sudden death.  Several circumstances conspire in
the production of these  increased liabilities ;  such as the ex-
haustion  produced by labor; the  removal of the pressure upon
the abdomen, from the expulsion of the child; the opening  of
the mouths of the blood vessels in the extraction of the placenta
or afterbirth,  which  sometimes causes profuse  flooding; the
injury which the  womb is liable to sustain during  the progress
of a painful and tedious labor; the liability to  take cold, which
interrupts the lochial discharge, as well as  to produce other
painful affections, &c. &c.
                       SECTION  1.

                OF  FLOODING AND FAINTING.

   Where either of those  circumstances  occur  at  child birth,
ihey may be regarded as somewhat dangerous.  Fainting some-
times takes place apparently from mere exhaustion,  whilst at
other times it  is consequent on  flooding.   The  flooding may
either discover itself by a  discharge  of blood externally from
the vagina, or it may be retained  in the womb ;  and  in  either
case it may prove suddenly fatal if not quickly stopped.
   Instances indeed have occurred, in  which sudden death fol-
lowed fainting without any flow of blood, either externally or
internally,  or  any other  discoverable cause; but  occurrences
of this kind are very rare.

   Treatment.—Whenever fainting or flooding takes place afte*
delivery, we have just cause to be alarmed ;  and the most active
measures should be taken to give relief.
   A  dose  of cayenne, anodyne drops, diaphoretic  powders,
tincture of  myrrh, or almost any warming drink, should,  in all
cases of flooding  or fainting, be  administered as soon as possi-
ble,  and repeated  until the  urgent symptoms  are  removed
Measures ought also  to be  instantlv taken to promote perspi
                                            49 
50
FLOODING AND  FAINTING.
ration, by the application of hot bricks or stones, or of botties
or jugs filled with hot water, to the feet and legs.   In  addition
to these means,  the  bowels must  be bathed with  the bathing
drops, tincture of myrrh  or of lobelia, cayenne and  vinegar,
French brandy,  or any other  kind of spirits which may be at
hand.  Strong astringent injections may also be freely and fre-
quently thrown into  the vagina; and if these measures fail, re-
course must be  had  to the  tampon, as recommended in Section
15,  Chapter III.  ;  still  continuing  the  other remedies  both  in-
ternally and externally,  until the uterus is contracted, the flood-
ing  ceased, and the patient  out of danger.
  One of the best means, however, and one of universal  access
and application, is friction applied to the abdomen, either with or
without the external  remedies, which rarely or never fails, when
properly employed, of producing  a  contraction of the womb
This organ, by the growth  of the  child, having  become  vastly
expanded, now,  after delivery, must contract, which will  close
the  mouths of the bleeding vessels.  The most usual cause  of
flooding, is the want of proper tone or action  in the womb  to
enable it readily  to contract after the expulsion  of its contents
A.nd hence  the  necessity  of  giving  stimulating medicines  tc
restore that living healthy action  to the womb, by which it is
pnabled to contract, and thus prevent hemorrhage or flooding.
  In  addition  to  administering stimulating medicines, the  as
tringent tonics must also be employed.   Birth  root and  witch
hazle leaves are amongst  the best of this  class of medicines
for  checking hemorrhage; a strong tea of which should be free
ly used in all dangerous cases. For the want of  either  of those
articles, any of the astringent tonics may be employed  in their
stead.   Injections of the same should also  be  thrown  into the
vagina, at proper intervals,  until the difficulty is  removed.
  The erigeron  canadense, particularly its oil, is recommended
is  a most powerful medicine in flooding.   Two or three drops
of this oil, it is  said, will  suddenly arrest  this dangerous  dis-
charge.  We  would, however, advise these who employ this
powerful  article, to  be  cautious in its administration, although
we  know  of  no instance in which it has produced any bad ef-
fect.   Yet we deem this  caution  necessary, on account  of the
activity and power which the erigeron appears to possess.
  But before leaving the subject of this section, we will  add  a
few remarks upon the method of checking hemorrhage  or flood-
ing, by friction   and pressure upon  the abdomen. We thus
enlarge upon  this important method, not only because  we have
but slightly mentioned or noticed it, but because the practice  is
supported by the best authority. It  is, however, to Dr. Dewees
alone, that we are indebted for the  extracts  which follow; and
lie  not only expects friction  to Dromote the contraction  of  d>< 
FLOODING AND FAINTING.               51
tvomb, but also, in some instances, the expulsion of the  after
birth.
  In Dewees' System of Midwifery, page 459, he describes his
method of employing friction;  which is " by  pretty briskly
passing the hand over the region of the uterus, and from time to
time attempting, as it were, to grasp the uterus by  closing the
ringers  upon it."  This is certainly a very simple process, and
may be used with all safety ; and " I have never,"  says  Dew-
ees, " had the misfortune to meet with a uterus that was insen-
sible to this mechanical stimulus, or  to lose a patient from im-
mediate loss of blood."  And in another place he says, " its in-
fluence is as prompt as it is efficacious : Indeed,  I consider this
as indispensable, let whatever other means be employed."
  Another very successful practitioner  assures us, tbat after the
expulsion or extraction of the afterbirth, he employs nothing but
simple pressure ; applying both hands,  and  pressing  in such
manner as  most to favor the  contraction  of the womb, and its
descent into the  cavity of the pelvis.  A late writer recommends
simply a tight bandage to be tied around the bowels immediately
after the expulsion of the child, without waiting for the extraction
of the after-birth as is usual.  We believe this to be a good practice,
as it at once affords support to the relaxed abdomen, and prevents
faintness and other disagreeable or dangerous  symptoms.
  The contractions of the womb may, with certainty, be known
by the feeling of a hard tumor on pressing upon the bowels, or
by rubbing the ends of the fingers back and  forward from  the
pubes towards the stomach, and vice versa.   But if the womb
is not contracted, on thus examining the abdomen, it  will appear
uniformly soft and yielding, without  any hardness or tumor.
  "But in adopting this method," says  Dewees, "we  are to
take care we do  not abandon it too soon ; for it is not sufficient
that we procure the contraction of the uterus ;  but that we  main-
tain it in this condition for some time, by  the continuance of the
friction.   And I would  here caution the inexperienced practi
tioner,"  continues he, " against alarm, when almost at the in-
stant he  feels the uterus hardening and diminishing under his
hand, he hears very plainly a considerable discharge of coagula
and fluid blood from the vagina ; and at the  same  moment he
finds the uterus retiring, as it were, from  under its pressure.
  " This discharge  is but the effect of the contraction  induced
by  the friction upon the external surface of the  abdomen, and
must  be regarded as a favorable omen,  as  it assures  us that the
uterus  is about to regain its powers.   Perseverance is now all
important; the frictions are  to be  continued  until there is suf-
ficient  evidence of the permanency of  the contraction,  by noti-
on? that the uterus no  longer relaxes  itself,  as it did probabh
it the commer cement of the operation." 
52         AFTER-PAINS.—LOCHIAL DISCHARGE.


                       SECTION  2.

                    OF AFTER-PAINS.

  Soon after delivery, every woman is liable to be severely ton
mented with what are termed  after-pains.  With a first child,
however, these pains are either very slight, or altogether absent.
After tedious labors, they are also lighter than when the  labol
has been short.
  After-pains  are  caused by  the  contractions  of the  womb  to
expel clots of  blood which form in it, and are sometimes almost
as severe as those of labor.  They are also sure to be produced
or aggravated, for several days,  whenever the child is applied to
the breast.

  Treatment.—If the  pains are very mild  and produce but
little inconvenience, it will scarcely be necessary to attempt to
mitigate them ; but if they are violent and distressing, a dose of
the diaphoretic powders, cayenne pepper,  or anodyne drops, may
be frequently given,  in a tea of the' anodyne powders ox the red
raspberry  leaves.  A hot brick,  or bottle filled with hot water,
should  also be applied to the bowels,  and replaced when cool.
By these  means the  skin will be kept moist, the blood vessels
of the womb stimulated to contract, and thus prevent the forma-
tion of clots, and at  the same time the blood be diverted away
from the womb  and  internal  parts, to the surface.   But if the
pains  should continue severe, notwithstanding the use of  these
means, an injection  must be given,  composed  of catnip tea  ot
warm  water, adding a little tincture of lobelia and tincture of
myrrh, or cayenne pepper.
                       SECTION 3.

         OF  IRREGULARITIES OF THE LOCHIAL DISCHARGE.

  The discharge which takes  place  after delivery, is  termed
lochia.  It proceeds from the mouths  of the vessels which have
become  exposed  by the removal  of  the after-birth; and the
quantity must, therefore, depend upon the size of the after-birth
and the well or ill contraction of the womb.  Should the womb
not contract  at all, or but imperfectly,  after the expulsion of the
child, a dangerous flooding is the consequence; but if the con-
traction is more  perfect, the discharge is not a flooding, but  is
termed the lochia.
» 
LOCHIAL DISCHARGE.
53
   The  lochial discharge  may be  either too profuse or entirely
suppressed;  or it may become of a bad quality,  and, from it<s
offensive smell, extremely loathsome.  Its  profusion is caused
ny the  imperfect contraction of the womb and mouths of the
blood-vessels, so  that too much blood is suffered to escape from
them into the womb.  A suppression  is caused only by taking
cold, which produces much pain and fever,  and if not soon re-
lieved is attended with danger.   The vitiated quality of the lo-
chia may be ascribed to a peculiar morbid condition of the womb
by which the discharge is changed from its usual appearance to
a profuse watery  fluid, of a greenish color, exhaling a very fetid
odor, and  frequently so acrid  as  to excoriate the parts  upon
which it may fall.

   Treatment.—If the discharge be profuse and debilitating, the
birth-root,  diaphoretic powders and bitter tonic should be liber-
ally employed; taking a dose of one or the other five or six
times a  day;  and  occasionally the fourth of a tea-cupful of a tea
of the anodyne powders, or raspberry and witch hazle leaves, with
half a tea-spoonful of cayenne in it.   Strong astringent injections
are also to  be thrown into both the vagina and rectum.  Proper
care must be  observed to keep the  skin moist, by the application
of hot bricks or stones;  and if these means  do not check  the
discharge,  a  thorough course of medicine must be added to the
treatment, and repeated as the circumstances of the case may re-
quire, until the complaint is removed.
   When the  lochia becomes suddenly suppressed from cold, ac-
tive measures must be immediately taken to restore  it; for which
purpose a liberal  use must be made of the diaphoretic powders
and cayenne, with the application of hot bricks or stones, to pro-
mote perspiration.   If the pa\n be severe, stimulating injections
should be administered, and the abdomen bathed with any stim-
ulating wash, such as the tinctures of myrrh or lobelia, bathing
drops, &c, and then apply a hot  brick to the part which will
increase the stimulant effect of the wash and promote perspira-
tion.  If these means, faithfully employed,  do not produce the
desired  effect, a course of medicine must be resorted to in addi-
tion to the  other treatment,  and repeated  at  discretion  until the
discharge is restored.
   In case the lochia becomes vitiated in its quality, the  same
course,  in general, must be pursued  as that just pointed out for
the other deviations, particularly resorting to the bitter tonic, in-
jections  both  to the rectum and vagina,  and bathing the bowels.
In fact there is no mode of relieving complaints of the abdomen
better than applying  medicinal washe*  externallv,  and it ought,
therefore, never to be neglected. 
54         CHILD-BED, OR PUERPERAL  FEVER

                       SECTION 4.

                   OF  COSTIVENESS.

  This is almost sure to take place after confinement, and then,
r.s at all other times, is productive of disagreeable consequences.
The consideration of it in this chapter does not seem perfect y
consistent with our arrangement, but its importance we think
fully justifies  its introduction here.

  Treatment.—Dependence should be  almost exclusively pla-
ced upon injections.  These may be made of warm water, cat
nip or pennyroyal tea, adding a little tincture of myrrh, or cay-
enne ;  and be repeated until the bowels are relieved.  If no bad
symptoms arise, the injections need not be used until the second
or third day after delivery ; and in case the costiveness should  be
obstinate,  either a tea or the syrup  of  the twigs or bark of the
butternut should be added to the injections;  or castor oil, or a
decoction of the black root, may be employed for the same pur
pose.
                      SECTION 5.

            OF CHILD-BED  OR PUERPERAL FEVER.

  This is by far the most fatal disease to which lying-in women
are subject;  it having been asserted by some, among whom is
Dr. Wm. Hunter, that three-fourths of those who take it die;
and also that one-half who die in child-bed, are cut off by this
one complaint.  This fever is peculiar to lying-in women, none
Dthers having ever been known to have it.   It is apt to be much
more prevalent in some seasons than others.
  It would seem from a number  of facts and  circumstances on
record  that child-bed fever was contagious ; though further proofs
are yet wanting to place it beyond doubt.
  In the Royal Infirmary at Edinburgh, this fever was unknown
for several years ; but when a case did occur,  " almost every
woman, in a short  time  after  delivery, was attacked with  t;
though prior to delivery, she  may have  lain  for even  weeks
together, not only in the same ward with the infected, but even
in the very next bed."  The disease, it is said, "was only erad-
icated from the hospital in consequence of the wards  being en-
tirely emptied, thoroughly ventilated,  and new painted ;" after
which " the hospital remained as free from disease as formerlv." 
CHILD-BED. OR PUERPERAL  FEVER.
55
   Many instances are related by which it would seem as if the
 contagious matter was carried about the persons, or in the clothes,
 of  mid wives and nurses.  In a late  work on females, by Dr.
 Gooch, of London, he says : " It is not uncommon for the grea-
 ter number of cases to occur in the practice of one man, whilst
 the other practitioners of the neighborhood, who are not move skil
 ful 01 more busy, meet with few  or none."*  " A woman in the
 country, who was employed as washerwoman and nurse, wash-
 ed the linen of one who had died of puerperal fever ; the next ly-
 ing-in patient she nursed, died of the  same disease : a third nur-
 sed by her met with  the same fate ; till the neighborhood, get-
 ting afraid of her, ceased to give  her  employment."!
   Dr. Gordon,  in  an account of an epidemic child-bed  fever
 which prevailed between 1789 and  1792, in  Aberdeen, says:
 ' This disease seized such women only as were visited or deli-
 vered by a practitioner,  or taken care  of by a nurse who had pre-
 viously attended patients  affected with the disease."J
   Dr. Gooch also  relates another singular case:—" A practi-
 tioner opened the body of a woman who had  died of puerperal
 fever,  and continued  to  wear the same clothes.  A lady whom
 he delivered a few days afterwards, was attacked with, and died
 of,  a similar disease ; two more  of his lying-in patients, in ra-
 pid succession, met with the same fate.  Struck by the thought
 that he might have carried the contagion  in his  clothes, he in-
 stantly changed them, and met with no more cases of this kind."§
  Another still  more remarkable case is  related by  the  same
 author:—" Agenerd  practitioner in extensive midwifery practice
 lost so many patients from puerperal fever, that he determined
 to deliver no  more for  some  time, but that his partner should
 attend in his  place.    This plan was pursued for a month, during
 which not a case of the disease occurred in  their practice.  The
 elder  physician being then sufficiently recovered, returned to his
 practice ; but  the first patient he attended was attacked by the
 disease, and died.  A physician who met  him in consultation
 «oon afterwards, about a case of a different kind, and who knew
 nothing of his misfortune, asked him whether puerperal  fever
 was at all prevalent in his neighborhood ; on which he burst into
tears,  and related the  above circumstances."||
  These statements   are selected  from among many  others ot
like cnaracter, but are not adduced as proof positive that child-
bed fevers are contagious ; though if they are not, the coinciden
ces  are certainly very striking  and extraordinary—sufficiently
so.  to put  rnidwives, nurses and  women, on their  guard, in
Bu°h cases.
* Gooch on Females, page 19   f Ibid, page 20.  * Ibid ^ vres 27, 28
§ Ibid, page 19.              fl Ibid, page 77. 
56          CHILD-BED, OR PUERPERAL FEVER.

   Child-bed fevers generally  begin a few days after delivery,
with  a  pain extending over the be wels, with such tendernesi
of the  abdomen  as  to make  the least pressure  upon it ex-
tremely  painful.  The  patient is often unable  to bear  the
weight of the  lightest  bed clothes, or even to turn  herself,  or
De turned in bed.
   The  abdomen also  becomes swelled, and  as the disease ad-
vances, the swelling  sometimes  increases,  though the  pains
grow less severe.   Shivering  is also a common symptom, and
is followed by a very  quick,  and generally  full  pulse, vibra-
ting  under  the finger; he*,  skin; short anxious  breath ng,
severe pain  over the  forehead; peculiar wildness of the eyes ;
sharpness of  the  features  ; prcstration  of  the living  power.
suppression of the lochia and milN, and softness of the breasts,
foetid stools,  and  diarrhoea.  When  this disease proves fatal
it does so about the fifth day.

   Treatment.—This disease, which, from its fatality, carnei
terror and dismay  wherever it makes its appearance, is as much
under the control of medicine,  and may, in general, be as readily
cured, as other fevers.
   Various modes  of  treatment  have  been proposed and tried,
with  different  degrees of  success.  Some have  recommended
tonics; others  sudorifics ;  and others  again  have advocate"
depletion,  by  large bleedings,  and purges.   The  success  o
failure of either plan, has depended partly upon the  state of the
  ystem,  and partly upon the  indolence or activity with which
each  plan was pursued.
   Dr. Gooch, who is  the  latest author on this complaint,  pur
sued  sometimes a depleting, and  at others a  stimulating,  plan
of treatment,  according to the apparent nature  of the °symp
toms.  When they were obviously inflammatory, he let blood
copiously;  but when of a  contrary type, ne made use of stim-
ulants.   It would  seem, however, to those who are  acquaints '
with  the  general  principles advanced in the  first  volume ol
this work, as unnecessary  that we should examine the contra-
dictory theories and  doctrines of the more fashionable  prac-
titioners, as we make  one  rule and  one principle  of practice
apply to all.   We  nevertheless, cannot omit, whilst writing upon
this most fatal complaint, to offer a little of the evidence collected
from  other sources, in support of our own practice.
   Dr. Denman  appears to  have depended principally upon  the
use of antimonial preparations, which acted sometimes by vom-
iting, purging, or sweating  ; the two latter, and especially sweat
ing, appearing to be essentially necessary to the cure.   Clysters
or injections, he also considers of much advantage, as tontribu-
linjj to the immediate relief of the patient. 
            CHILD-BED, OR PUERPERAL FEvER.         57

  The antimonial remedy of Dr.  Boer, of Vienna, seems  to
have  produced its  good effects by a " profuse  sweat" and the
free passage of urine;  as it appears to  have  " always effected
a cure in one and the same way."  " After the adoption of this
remedy," says Boer, " the puerperal fever was never fatal."
  One part of Dr. Gooch's treatment, upon which he teys much
stress, was the application of hot substances to the bowels, "re
newed so often as to keep up heat and moisture."
  The foregoing circumstances and facts, drawn from the writings
of eminent  medical men, are not introduced, by any means,  as
proof positive of the correctness of  the principles of our own
practice, but as collateral evidence of the importance of promoting
perspiration.  Many more authorities to the same effect, might
liave been adduced ; but these must suffice.
  Previously, however, to describing our own mode of treatment,
we will  observe, that we believe  child-bed  fever might almost
always be prevented, by being careful to avoid taking cold, and
by keeping the skin moist by the frequent use, if necessary,  of
the diaphoretic powders, and by strict attention to the bowels to
prevent  costiveness.
  If,  notwithstanding  proper  care,  or  by carelessness,  or by
any  other means, the  woman  takes cold, or gets  a fever of
any kind, a course of medicine should  be  the  first and imme-
diate  resort.  Steaming should be thoroughly performed, and
the  stomach well cleansed  by an emetic  of  lobelia, and the
 ntestines well emptied by laxative  injections.  But if the intes-
tines  do not seem relieved by these, a dose of castor oil, butter-
nut physic, cathartic pills, or black-root, should be taken, enough
to operate freely.  The operation should be encouraged by the
administration of warm  injections, and the strength of the patient
sustained by broth, soup, or gruel.  Hot applications externally
to the bowels, will also be very beneficial to  relieve the pain
and soreness.  For this purpose, a hot brick or stone, bottles of
hot water, bags of scalded bran, or cloths wrung out of hot water.
may be  used.  Much advantage will  also arise from the frequent
application  to the  abdomen of the tincture of myrrh,  or any
preparation  of bathing  drops.   The  steaming and emetic  must
also be repeated, if necessary, at discretion.
  Before leaving this  subject, we cannot too strongly urge the
necessity if immediate  attention to  any of the symptoms  of
child-bed fever.   Promptly pursuing  the plan  which we have
laid down, at the first onset of this fever, we believe would, in
almost every instance,  at once remove the disease ; but neglect-
ing it only for a few hours, always renders the cure more diffi
cult,  and longer delay may make it fatal 
58
MILK FEVER.—SWELLED  LEG
                      SECTION 6.

                    OF  MILK FEVER.

  Two or time days after delivery, the breasts become distended
with milk, whilst the discharge  from the womb, at the sam«
time, is diminished.  This  is apt to be attended by  feveris-h
symptoms, such as  headache,  thirst, heat,  and quickness  of
pulse;  and is known by the name of milk fever.

  Treatment.—By keeping the skin moist, and especially  by
bathing the breast with some relaxing oils, or with  any of the
bathing drops, and  keeping them covered with a flannel, to pro-
mote perspiration in the part, the unpleasant  symptoms  may
always be prevented, or much mitigated.   But if  they arise,
proper means should be employed to promote perspiration;  such
as placing warm bricks,  stones, or bottles of hot water, at the
feet, bowels, or sides, and  particularly one  near the  breasts.
The breasts should  also  be bathed,  as aforesaid, and made to
perspire freely; and the child  be often  applied to  them.   By
pursuing this course, nothing need be apprehended from  a simple
milk fever.
                      SECTION 7.

                     OF SWELLED LEG.

  We have heretofore, in the preceding chapter, when  treating
of the diseases of pregnancy, spoken of swelling of the leg; but
the  complaint now under consideration is an entirely different
disease.  It only occurs after delivery, as that does before,  and
is denominated, in technical language, phlegmasia dolens ; being
also often called white leg.  Its attacks may commence at  any
time between  the  firtt or second  day and  the  third ir fourth
week after delivery.
  The swelled or white leg, is commonly preceded by genera"
uneasiness, low spirit?, slight pains about the womb,' attended
with discharges from  it of  a  peculiarly  offensive  character.
These  symptoms seldom  exci.e much attention, until  the pa-
tient is seized  with a pain  on the inside of the limb, commonly
about the calf of the leg, which soon extends  itself from the heel
to the groin.
  The limb very soon begins to swell, and  a soreness  extends
all over it, so  that it  cannot bear the slightest touch, nor be
moved  withou' creating exquisite pain.  The skin on the leu 
         SWELLED BREASTS AND SORE NIPPLES.       59

becomes pale and glossy ; the countenance is expressive of great
anguish and dejection; the pulse is quick; the skin  hot;  the
tongue white, and  the urine muddy.  And if proper measures
be not taken,  the  complaint is  commonly  tedious, and often
limes shifts from one leg to the other.

  Trlatment.—Whenever  symptoms )f this complaint make
their  appearance,  the woman should  be immediately  carried
through a course of medicine ; previous to which, however, the
leg  should be bathed,  using much friction, with cayenne  and
vinegar, or any of the bathing drops.  And as some authors sun-
pose the disease is  caused by some irritating matter in the womb,
they have recommended the free use of injections, forcibly thrown
into the vagina, with a view  of cleansing  those parts.
  Whether the theory, of the irritating cause being in the womb
be true or false, there  is no  doubt that  strict attention to  the
cleanliness of those parts, after child-birth, as well  as during
and after the monthly purgations of women, would be very con-
ducive to health.   The injections are directed  to be  made of
warm water, or warm milk and water; and during the intervals
between  their application, to make use of sweet oil, applied to
the same part.
  If one course of medicine does not remove the complaint,  it
should be repeated, at intervals of two or three days, occasionally
during the day, bathing the leg as before  directed, and  keeping
it wrapped in flannel, and a hot brick or stone at the  feet, to
promote perspiration.
  The woman ought  also to take, two or three times a day, a
dose of the diaphoretic powders, and about the same number of
times  of the laxative bitters.   A dose of the black root, or of
some other kind of physic, may also be taken occasionally ;  and
if costiveness  prevail, make  frequent use  of  injections.
                       SECTION 8

          OF SWELLED  BREASTS AND SORE NIPPLES.

  Swelled, sore, or inflamed breasts,  is a source of frequent
and excessive misery to mothers, and of inconvenience and
deprivation to children.
  This difficulty is  caused by taking cold, or as some think, by
fever produced by want of proper care, after delivery.—But be
the cause what it may, it is a most distressing and painful  mal
ady ,  and cannot be too carefully guarde i against, nor too pei
Keveringly opposed  if it take place. 
60       SWELLED BREASTS AND SORE TOPPLES.
   Sore nipples are also exceedingly painful, and  from their
 tenderness and irritability, torture and distress the woman very
 much.  This is especially tho case when the child is applied to
 the breast.  Sore nipples, like swelling of the breasts, may and
 ought to be guarded against.

   Treatment.—In  order  to  prevent the difficulties of which
 we  have  been speaking, the  breasts  should be  occasionally
 bathed ' ith relaxing ointments or c'.Ls ; such as sweet oil, bear's
 oil, horse  oil, or goose oil.   Care must also be taken to  prevent
 exposure  to  cold, and its bad conseouences guarded against by
 the use of the diaphoretic powders  or cayenne pepper.  Washing
 the breasts in cold water  i^as also been highly recommended as a
 preventive of colds and obstructions.
   But should the breast  actually become  inflamed, swelled,
 and  painful, perspiration  must  the.i  be freely promoted,  by
 using the  cayenne pepper or diaphoreuc  powders  in  suitable
 quantity, and by the application of hot stones to the feet,  and
 particularly to the  breast; which should in  this manner,  and by
 bathing with pepper and vinegar, or with  bathing drops, be
 made to sweat freely.   If this be attended to early and perse-
 veringly, the complaint may almost always be removed without
 further bad consequences.
   If thes.: means, however, fail, a full course of medicine must
 be resorted to, by wf.ich  a more  powerful  impression is made
 upon the  system ; the vessels are relieved  of their morbid con-
 tents ;  the fluids  are  made  to circulate  more freely, and the
 complaint will thus be with greater ease and certainty removed.
 The local  applications to  the breast should  also be  continued;
 and, to keep it soft and moist, a flannel cloth ought to be worn
 over it, moistened with rum or the tincture of myrrh.
   But if, notwithstanding all this, the  swelling should be dis-
 posed  to  go  on to suppuration, that is, gather, as is commonly
 said, we may then apply  a poultice, renewing it  when  neces-
,sary, and  continue it until  the  breast  is   ripe for  opening
 when, if the breast be not inflamed, it  may be left  off:   After
 the  matter is  discharged, a tent moistened with salve must be
 kept in the oper u.g, over which, for a while, a cloth moistened
 with rum, or  tincture  of myrrh, should be placed; or if there
 should be  pain or inflammation, the poultice may be continued
 The abscess may  also, every day, be syringed out with a weak
 soap suds, followed by  a strong tea of red raspberry or witch
 hazle leaves,  to  whir.i  should be added a  little of the tincture
 if lobelia, or compound tincture  of myrrh.
   For  sore  nipples, the  best method of preventing, is to was!
 them often with tincture of myrrh, and then with  a strong tea
 of anv of  the  astringent  articles;  such as  hemlock bark pond 
SWELLED BREASTS AND SORE NIPPLES.      61
lily root, witch hazle or red raspberry leaves, or with a tea ol
golden seal.
  Should the nipples,  however, become sore, they must be
protected  from the irritation of the clothing, by weaiing over
them nipple glasses, or nipple shields which are made of wood
or wax.   The wash just recommended, may be continued, and
be more often applied, together with the common  salve spread
on a tine piece of muslin, and laid over the whole nipple.
  In all  cases of swelled or sore breasts, the child must be
permitted to suck, or some one draw them frequently, as by
doing  so  the breasts may not only be prevented from swelling
and suppurating, but if they do swell and suppurate, the soreness
and pain will thus be much relieved.  These directions should
be rigidly complied with, not only for the purpose of prevent-
ing pain, but also to  prevent the  milk from drying up. 
•
                   CHAPTER V.

m DISEASES which are COMMON BOTH TO THE PRLGNAN'I
                AND UN PREGNANT STATE.

  Having heretofore considered the diseases either peculiar 01
common to particular states of the female system, we now devote
a chapter to a few which are common to every state excepting that
of childhood, or the time of life previous to puberty or maturity.
We do not claim to be exactly systematical in every part ofoui
arrangement; but  we are enough so,  perhaps, for all practical
purposes.
                     SECTION 1.

  OF INFLAMMATION OF THE EXTERNAL PARTS OF GENERATION.

  Inflammation of the external parts of generation, may occui
at all times, and is sure to take place, more or less, at child-birth,
  It lias been observed, that these affections of the private parts,
when  not caused by child-birth, are apt to  run hastily into sup-
puration; which, indeed, is no uncommon occurrence after labor

  Treatment.—Inflammations of these parts, are to be treated
the  same as all others.  Warm stimulants, such as diaphoretic
powders, or cayenne pepper, must be taken internally ; and cool
ing  applications, such as cold water, or cold poultices external-
ly.  If ulcers form,  they must be treated the same as ulcers of
other  parts; for which the reader is  referred to the second vo-
lume,  under the head of " Ulcers."
                      SECTION 2.

                 OF THE  HYSTERICS.

  Tins is a very common form of disease with many women ,
and is more particularly apt to occur, when any important chan-
ges are taking place in  the organs  of generation.   Hence  it is
very frequent at the  period of puberty, when menstruation is
about to commence;  and  also at each menstrual period, especi 
HYSTERICS.
63
ally if this function be in any way disturbed ; and is likewise com-
mon during pregnancy.
  Hysterics appear under a great variety of forms, imitating va-
rious other complaints, from some of which it is often difficult
to be distinguished.
  This disease is attended by dejection of spirits,  anxiety  ot
mind, difficulty of breathing, weeping, sickness of the stomach
palpitations of the heart, &c. &c.   When it amounts to what '
termed a hysterical fit, it commonly commences with a pain anu
sense of  fulness in  the abdomen, near the navel,  towards the
left side : but gradually increasing and spreading, a  sensation is
felt as of a ball  passing upward, which appears to stick in the
throat, and occasions  a sense of suffocation.
  The patient now becomes  faint, and  is sometimes affected
with stupor and insensibility ; the limbs and  body are agitated,
and she falls down.   Laughing, crying, screaming,  and incohe-
rent expressions, often take place alternately, and a temporary
delirium  frequently arises.  But these symptoms at length abate,
and  a quantity of wind is belched from the stomach, with fre-
quent sighing  and sobbing, and sometimes a severe pain in the
head, and soreness over the whole body.
  In some instances,  however, there is little or no agitation of
the body and limbs, and the patient lies apparently in a profound
sleep,  without either sense or motion.  Indeed the symptoms are
so extremely  various, that any ordinary description could no
apply to  all cases of the disease.

  Treatment.—In cases where this complaint originates from
an affection of the womb, the proper  measures must be taken to
remove this difficulty.  And for this purpose, strong tansy tea,
or almost any strong bitter,  with a free use of cayenne pepper,
may be relied on as a general  remedy.  At the same time, the
patient should sit by the fire, with her feet in hot water, covered
with a blanket,  quilt, or cloak, to promote perspiration and  the
operation of the medicine.
  Any of the nervine medicines may be given at the same time,
proportioning  the quantity to  the violence of the symptoms.
The asafetida is a valuable remedy in. this complaint;  and will
be found perhaps more beneficial in bad cases, to give it after the
other means  here recommended have been employed, and  the
perspiration has become free.
  In very bad cases,  however, or in such as are of long stand-
ing, and the health much impaired, witli frequent returns of the
fits,  a course of medicine must be resorted to, and repeated ac-
cording to the urgency of the  symptoms.   During the interval*
between  the courses of medicine, the patient should take of the
laxative  bitters,  and diaphoref'c powders, or cayenne,  together 
64              FLUOR ALB US OR WHITES.
with occasional doses of the nervine tincture, or of the asafetida.
Particular attention ought also to be paid to the bowels,  which
should be kept loose, or daily evacuations procured by the use
of injections.
  In hysterical cases amounting to fits, the antispasmodic tinc-
ture must be given;  which will  soon remove them, especially
if enough is administered to produce vomiting.  For  the want
of this, give the tincture of lobelia with cayenne ; or either may
be given  alone, if both cannot be readily procured.
                       SECTION  3.

                OF FLUOR ALBUS OR  WHITES.

  This is a very common complaint with women, especially
such as are of a delicate habit, or have suffered much in child-
bearing,  or  in menstruation,  or have  these  discharges  often
interrupted by cold, and the like.
  The degrees of its violence  are extremely various, from  that
of a most trifling discharge of white mucus from the vagina or
the womb, and producing  no other indisposition, to much great-
er discharges,  of different  colors  and offensive smell, with great
pain and weakness in the  back or loins, attended by great pros
tration and general debility.
  Sometimes the discharges are irritating to the parts, as well as
being offensive; and occasionally a feeling of heat and  itching
about the labia, with a sense of weight and relaxation about the
lower part of the bowels and top of the thighs.

  Treatment.—Cleansing  the  part from which the discharge
issues, by means of  injections, is of much advantage  in  this
complaint; though authors disagree as to  whether these should
be  applied warm or cold.   Dr. Dewees strongly recommends
lukewarm injections, whilst many others  prefer  them cold.—
But the facts are, that both are useful.
  In  the  first  place, the vagina may be washed out  t vo ■ t
three times  a  day, by injecting, in quick succession,  two or
three syringes full of warm water,  in which a little mild soap
has  been  rubbed.   After  the  passage  has  thus  been wcl.
cleansed, a cold injection  should be thrown in, composed of  a'
strong tea of some of the astringent tonics, of which the birth
root is  the  best, adding a very minute portion of cayenne, and
then be carefully strained;  or  a little of the compound tincture
of myrrh may  be added,  instead of the cayenne.   This mode of
treatment will  be  sufficient to cure all mild cases of whites, i/
nroperly attended to. 
BEARING DOWN OF THE WOMB.
63
  in worse cases, or such  as  do not yield to these  means, in
addition thereto, a free use should be made of the bitters, and
occasionally steaming or sweating before the fire; and, if ne-
cessary, taking a full  course of medicine, which'must be re-
peated as  the  circumstances of the case may require.   A  tea
of the birth root is also a most valuable internal  remedy, in all
cases of the whites.   It may be taken in doses of a fourth of a
tea-cupful  three or four times a day, with the addition of two or
three tea-spoonfuls of the  compound tincture  of  myrrh in  each
dose.  Bathing the abdomen  frequently with the tincture of
myrrh or lobelia,  will be  found highly  beneficial, and  shouM
not be omitted.
                       SECTION 4.

              OF BEARING DOWN OF THE WOMB.

  There is a most distressing complaint, to which many women
are  exceedingly liable, known by the above name.  Its  more
common name, however, in the works of medicine, is prolapsus
uteri, or prolapsus of the womb.
  This  disease first discovers itself by an uneasy sensation about
tht  loins and the lower part of the abdomen, whilst standing or
walking, attended occasionally with bearing down pains.   After
a while these symptoms become worse, and the woman is obliged
to confine  herself to her bed;  and  if the complaint goe: on in-
creasing, she will suffer the most excruciating pains, with a
stoppage of the urine, in consequence of the womb descending
into the vagina, and pressing upon the neck of the bladder.  Ii
the  disease proceed  on, without interruption, to its wors* stage,
the  womb will be protruded out through the vagina, and bang as
a bag between the thighs.  This, however, is a rare occurrence,
and is very difficult  to cure.

  Treatment.—The best remedy for this disease, is the appli-
cation of injections  immediately to tne part affected ; and at the
same  time  using  proper r^eans to promote  perspiration.  Dr.
Thomson, in his account of the witch hazel, says that an injec-
tion made of a strong tea of the leaves of this article, with a little
cayenne, "is  good  for piles and many complaints common to
females; and in bearing-down pains it will afford immediate re-
lief, if properly administered."  The  ambiguity of the latter pari
of this quotation, has caused much anxiety in the minds of those
who have  purchased his books.  By  the  terms " properly  ad-
ministered," he means nothing more than throwing the injection
into the vagina  wl  ch  usually affords  the most speedy relief
      49 
63           BEARING DOWN OF THE WOMB.
For want of the witch hazel leaves, take the birth root, or any
jther astringent article.
  We  were once called, in a case of this kind, to a lady whc
was the mother of several children.  She was suffering much
pain and anxiety, with some degree of fever.  A few doses  of
the diaphoretic powders were prescribed, and hot bricks placet
it her feet, to promote perspiration;  after which a witch hazel
injection was directed, when we left her.  In the course of three
or four hours we paid her another visit, and  found her easy and
composed.   Che appeared very grateful for  the relief obtained
by the injection ; and remarked that it was the greatest and most
sudden  she had  ever  experienced.   And to  convey an idea  of
her  sufferings, she said she had borne eight children; and would
prefer the  pain of bearing eight more, to  enduring the  distress
which  she had  experienced  in this  instance.  She  continued
taking  the diaphoretic  powders for a few days, by which her
health was completely restored.
  But  in cases wher^ the womb is protruded without the  vagi-
na,  the cu:e will be much more  difficult.  In such  instances,
the part which is protruded should be washed with warm witch
hazle tea made strong, after which, with the fingers well smeared
with oil or lard, the womb must be gently and gradually  pushed
back to its proper place  in  the pelvis, when an injection  of
strong witch hazle tea  should  be thrown  up after it, cold, and
repeated severs.! times a day, so long as necessary.   The  cold-
ness of  the injections increases their tonic effect, by which the
relaxation  of the parts is the  more readily overcome, and the
womb thus enabled to keep its proper place.  They must no'
be so cold, however, as to render  them too unpleasant,  or  they
may be productive of injury from that cause.
  But in those cases in which  the womb falls quite out of tho
vagina, the parts concerned in retaining it to its place, will seldom
recover their tone immediately so as  to be safe to trust to them
alone ; recourse should, therefore, be had to an instrument called
a pessary, for  a representation of which, of two  kinds, see
plate I.  This indeed may also be found to  be advantageous in
some cases of permanent relaxation of those parts, when the
womb has  not descended so low, especially when the case is of
long standing.
  The  pessary  is a  very simple  ir.strument, made of  various
Bubstances, such as wax, ivory, metal, and latterly of gum elas-
tic.  Excepting those made of gum elastic, they are of  a circu-
lar  form, as will be seen by reference to the plate, but flat and
a little oval on one side and  hollow on the other, with a small
hole through the center.   This instrument can be obtained for a
 fmall sum, at  most apothecary stores.
   Most writers on the diseases of women, appear to possess  the 
PLATE  1.
PESSARIES.— SEE  PAGES   66.   68.
   Fig. 1 represents a round Pessary, of a middle size.
   A A—The circumference of the  pessary, two inches and four-tenths in di-
•.meter.
   B—A hole through the center, to permit any discharges to pass, three-ten:hi
of an inch in diameter.
   C C—A depression ;  the dark spot within the light ring being sunk, not
altogether dissimilar to a shallow basin, for the mouth of  the womb to rest in;
the ring representing the sides or edges of the  basin or pessary, are thick an
rounded.

   Fig. 2 represents an oval pessary, which,  on some accounts, is preferred  to
the round one.  The round, however, is most commonly used.   The letters  in
thib refer to tff» aame parts of the instu.iasnt as in fig. 1, and  therefore, need
to farther explanation. 
68
BEARING DOWN OF THE W^MB
same  taste and  anxiety for  introducing the pessary into  the
vagina, that they have for drawing off the urine, which certain-
ly if  they possessed the  feelings of common  delicacy, they
would instruct women  to do for themselves  or  for each other
or entrust it to the hands of the husband, if the woman had on&:
This would certainly be far more decent, far more consistent with
delicacy and sound morality, than for a physician to be permitted
to do  it.  The operation is equally simple with drawing off the
urine, if not more so; and we cannot contemplate the idea of  a
physician doing it, without  sensations of sickening disgust.  In
reflecting upon  the  impositions  practised in  this respect, upon
women of the  nicest  delicacy  of feeling, and  endeavoring to
comprehend the shock which such an operation must give them,
we feel no abatement in the warmth of feeling which we  ex-
pressed when treating of the use of the catheter.
   We believe every physician who, by his conduct or writings,
endeavors to mistify any of the operations which  are so sim^
pie that women may perform  them for themselves or for each
other, is obnoxious to, and worthy of  the most severe reproach.
How many women have suffered the most exquisite torment, and
ea'en death itself, rather than submit to an operation  by a pro-
fessional hand, which  could have been as well  performed  b}
herself, her husband, or some confiding female associate ! The
physician who can calmly contemplate female sufferings, under
circumstances such/as these, as  many undoubtedly have,  cannot
certainly be  accused of possessing any excess of sympainy or
decency, however much he may profess of either or both !
   The method of introducing the pessary, which  any woman
possessing common  sense,  and  having  one  in  her hand,
would at once understand without  any description, is  as  fol-
lows :—The pessary is first lubricated or smeared with hog'
lard or  oil, then separating the  labia with  the  fingers  of one
hand, with the other the pessary is introduced into the vagina.
When it is fairly within  this  passage, it  must be turned with
the hollow side upward, so that the  mouth  of the womb may
rest in  it.   Previous to its introduction, the urine should be
passed, and the bowels emptied by an injection, in order to
make all the room possible in the pelvis.   If the pessary is  too
large, it will create  pain;  and if too small, it will escape when
at stool: and  therefore  the woman should make use  of a pot.
and not go to the necessary or privy for two or three days, or
it might be lost.  If it be too large and give pain, it must be re
moved, and a smaller one put in its place.
   The pessary should be taken out once in a while, and cleansed
r>y washing in  soap suds  and  rubbing with a woolen  rag, the
 woman lying in bed, for fear that the womb  fall down and  cre-
 ate difficulty ;  or if she prefer it, she may take it out  ever 
               BEARING DOWN  OF THE WOMB.             69

night after retiring to rest, and  return it again in the morning
before  getting out of bed.  The  pressary should be continued to
be worn until the  parts have sufiiciently recovered their tone to
keep the womb to its  place, when it may be cautiously omitted.
In  young  women, this  may  be  but a few weeks  or  months,
whilst with older ones, and especially those who have had many
children, it may require  years,   or  perhaps  must  be continued
for life. 
CHAPTER  VI.
OF MIDWIFERY.
   We approach  this  part  of our work with seriousness and
 with  diffidence;  not because  of  its anticipated magnitude,  or
 its difficulty of detail, though we look upon these, and especially
 the latter, as involving much responsibility.   But it  is the cir-
 cumstances by which this reputed mysterious art is surrounded.
 that impress us with a seriousness and diffidence with which, in
 our other medical labors,  we had not  to  contend.   To  oppose
 pjpular prejudices, or  attempt innovations  in  matters ever  so
 plain, and capable of the  clearest demonstration, is certainly nc
 enviable task; it  is one from which the  mind involuntarily
 shrinks, in contemplation  of its responsibilities, and its inter-
 minable discussions and  animosities.   But when we attack a
 custom, the subject of  which, both from its delicacy  and by de-
 sign, is kept hidden from  the broad gaze of the world, and  it;
 attacking  which we must have recourse to reason to a great
 extent, in the first instance, to supply the place of demonstration,
 the weight of  responsibility, and other concomitant  consequen-
 ces, recoil upon the mind  with redoubled force, and far more
 repulsive energy.
   From the very nature and peculiarity of midwifery, it seems.,
 by common consent, generally to be little inquired  into, espe-
 cially by men; and hence  the too  great ignorance respecting a
 matter of the highest importance to the whole  community.    It
 seems to be one of the consequent evils of civilized life, that we
 are disposed to devote our time and attention to things of lesser
 importance; such as acquiring some unmeaning accomplishment
 or personal embellishment; whilst the more important concerns
 connected with health and happiness are  disregarded as if they
 were  matters  of small account.  Hence we  find  in civilized
 nations, little is generally known respecting hea.th and disease,
 and still less about the  momentous concerns of pregnancy and
child-birth ; the very important knowledge of these things being,
 by common consent, yielded to a select few.
  This highly interesting  and necessary part of all female edu-
cation, a correct knowledge of the phenomenon of child-birth, has
 for many years been passing into the hands of  physicians, who
 appear to hold it with a most tenacious grasp.
          70 
MIDWIFERY.
71
  We  hope, while writing upon this subject, to be excused foi
any plain language wh ch  we may use.  The subject is one of
much importance to the  world, and particularly to females; and
it is to them we wish to  address ourselves.  Upon them devolves
die office  of mothers—the often tedious  process of gestation'
—the  more painful  one of delivery, and the still more careful
and responsible one of watching over and rearing their  tender
offspring from infancy  to mature age.   What claims, Indeed,
has a mother upon the sympathy, the compassion, and the grat-
itude of the world!
  We feel most  sensibly the responsibility of  the task  which
we have imposed upon ourselves—that of  endeavouring to con-
vince women of their capacity to render to  each  other all  the
needful assistance which  is  generally necessary  at child-birth,
instead of continuing  the present indelicate,  unnatural, and im-
moral habit of calling  upon the other sex.  The prejudices which
sanction  this  custom of employing  men instead of women, to
officiate as  midwives, are of comparatively modern origin; anJ
are no where to be met with but in civilized life: and no
where are  the difficulties of labor so severe, and the mortality
in child-bed so great, as  amongst those nations which  claim
to be the most refined.
  " I  have seldom," says Dr.  Ewell,  in  treating  upon this
same  subject, "felt  a  more ardent desire  to succeed in any
undertaking, because I  viaw the present increasing practice of
calling upon men in ordinary births,  as a source  of serious evils
to child-bearing—as  an imposition   upon  the credulity of wo
men, and upon the fears of their husbands—as a means of sacri
ficing delicacy, and consequently virtue—as  a robbery of  many
of the good common women [midwives] of their employment
and support.  Tiuly, it shows as extraordinary  a revolution in
practice, as any afforded by a survey of  all the arts."  " Should
the strangers to the practice, inquire  if our men have large  un
wieldy hands—great curiosity about  women; should they ask
if our women have the requisites for useful services—small hands,
good  sense of touch, and patience  in  attendance—they will
absolutely  deny this  monstrous perversion  of   the course of
nature."
  But so it is; tne practice of midwifery,  in all our towns and
villages, and to a great  extent in the country,  is now  almost
exclusively confined  to  the  hands of the  physicians, who by
their  marvelous tales of the hair-breadth  escapes of numerous
women to whom  they have been called just in time to save life
strike  a terror in the  mind of the suffering woman, which con-
firms her in the determination, no matter how repulsive  to  hei
delicacy, to employ none but doctors.  These tales are told, ol
course, in presence of the attendants of the woman  in labor 
72
MIDWIFERY.
and most commonly perhaps the individual whom the doctor has
so fortunately rescued from such great  peril, was at  the same
time in the hands of  a female midwife,  who, however  skillful,
was unable to render the needful assistance. The frequent repe-
tition of these stories in the presence of the same women,  with
the affected mystery in which the transaction is enveloped, make
a serious impression  on their minds, and fill them with the  most
awful apprehensions ; and  they, in turn, employ the same indiv-
idual, feeling themselves safe in the hands  of no one else, unless
it be some other physician who can tell equally marvelous tales.
   We are truly sorry for poor human  nature, that professional
men are obliged to resort to such miserable shifts and criminal
subterfuges, to  secure to  themselves a lucrative business, for
which by nature they were never designed.  And we are equally
sorry to  find ourselves under the  necessity of  thus exposing
them and their artifices, in proper colors; in  doing  which we
beg leave to say, that we are not actuated by malicious motives,
but by a  sense of the impropriety, impolicy, and immorality of
the practice, and  by a sense of duty to the female community
and to the world.  We will take this occasion  also to observe,
that we wish not by this  honest expression of our sentiments,
to wound the feelings of any who  are  not justly obnoxious to
reproach. Some physicians who practice midwifery, do it more
in compliance with common custom  and the prejudices of those
amongst whom  they reside, than from the desire of retaining the
business, or from a belief in the propriety of its being wrested
from the hands of women.  A few authors, too, have nobly
stept forth as advocates of the insulted rights of female midwives,
amongst  whom  Dr. Bard  and Dr. Ewell  stand pre-eminently
above the rest.   But how has their devotion been appreciated,
and their toil repaid ?  We are informed that professional oppo-
sition has so retarded  the  sale of Ewell's Family Physician,
that the author remains unremunerated for his labor and expense;
and Bard's excellent  Midwifery,  probably from the same cause,
has passed through only a singie edition.   By a perusal of these
authors Ave have been largely profited ourselves, end have made
copious extracts from their works for the benefit  of the  readers
of our own.
   We have  heretofore alluded to the marvelous tales of physi-
c..ms to frighten women to a belief in the necessity of employing
them at child-birth.   The  following, from  Dr. Ewell, seems to
hai e reference  to this circumstance; " A thousand times you
are told of one  irregularity of nature; but seldom hear  of her
almost undeviating correctness in operating."  Of the truth of
this you may all satisfy yourselves, with only a little reflection
Even if you hear a long list of unfortunate cases related,  with
rhich all books more or less abound, remember that these ar 
MIDWIFERY
73
gatheied from all quarters of the world, and do not constitute
perhaps, one in a thousand.   " P-ovident nature," says Dr
Bard, " is wonderfully kind to pregnant women ; and when she
is properly consulted, attended to, and obeyed, from the begin-
ning—not weakened by excess, nor thwarted by preposterous
management—will, nine hundred and ninety-nine times out of a
thousand,  carry her votary safely through  all the wonderi'ii,
changes of this  eventful period."
  " A thousand times," says Dr. Ewell, " you dwell upon the
miseries of one  sufferer, without thinking upon the millions who
happily and  healthily  pass the period of  parturition.   Away
with your forebodings ! Believe the truth, when pregnant, that,
in  all human  probability, you  will do  perfectly well;  that the
most ordinary women can render you every needful assistance,
without the interference ofii-.cn midwives.   Their hurry, their
spirit for acting, have done the sex  more harm than all tne
injudicious management of midwivec, of which they are  so
fond of talking.   This, Dr. Denman, Dr. Buchan, and many
other really great  physicians, have long since remarked."
  Why then, let us seriously ask, will you continue the practice
of employing physicians, since it is asserted, even by themselves.
that they do more injury than midwives of your own sex ?  You
ought certainly to know that  "the simple process of child-
bearing is performed by yourselves, and not by attendants' hands—
by the resources of nature, and not by the powers  of art."  But
of these facts, physicians, as well as too many midwives,  have
criminally kept you ignorant.   They have clothed the operation
of child-birth with so much oystery, which is the very ground
work of deception, as to make you suppose that midwives always
render essential assistance ; when, in fact, in almost all cases, it is
completely out of their power  t3 do it, or if they are so ignorant
or impatient as  to attempt it, they are sure to do an injury.  Fig-
ure to  yourselves,  for a moment, the condition of child-birth.
The head of  ihv child  presenting, is driven forward by the con-
tractile force of the woiiib, in the same  manner that the urine is
expelled by tl.2 bla.der, oi.ly that the pains of labor are not un-
der the control  of the will. The head fills completely the whole
passage, and  very greatly distends it beyond its natural size.
  We  would now a. k, what can the  midwife  do to assist the
mother in  the expulsic n of the child ?   Can she lay hold of the
head and  drag it  forcibly away!   By no  means:  it is  im-
possible ;  and should she be so ignorant or presumptuous as to
attempt  it, would certainly repent her folly and rashness. Well
what then can the midwife do ?  Why, at the most, in cases of
wrong presentations, she may, by careful and discreet manage'
Bient, assist nature in  rectifying those errors; but beyond this
 he can do nothing more than to receive the child  when  it 
74
MIDWIFERY.
somes into the world.  And what woman could not, what woman
would not, nay, ought not, when necessary, to perform  this
simple office?
  In confirmation of these views, we will introduce some  sen
sible remarks from an anoymous publication by a female writei
and midwife:—
  " What arguments  shall I use to convince  you that it is out
of the  power of either  midwife or  physician, with  safety to
mother  or child, to offer  any assistance, even in the last stage
of labor.   Every woman who  has  borne children, knows, or
might know, that in  this  stage, nature  is so pressing that it
would  require  a  great  resistance  to restrain the  child  from
coming forth, that is if there had been no mismanagement.  1
have seen this acted out by many, whilst they were waiting with
fearful  expectation, lest the birth should take place before the
physician arrived.
  " I am aware  that  many women  may object to this proposi-
tion, thinking it was never so with them ; but this is for the want
of proper information.  I recollect very well, that soon after I
entered  into  this practice, a certain woman whom I had visited a
second time, exclaimed immediately after the birth of her child,
' I know that I could not have a child born without  assistance.'
The fact is,  she was not assisted ; but because of the custom of
the times, I thought  best  to pacify her by deception,  as  Dr.
Denman justifies.   I practiced in this way for a number of years,
till a reproachful conscience bade me advance this light; though
not without fears that some inexperienced female may consider
this doctrine disheartening."
  Here  is the  frank  and candid confession of one whose  con-
scientiousness and moral honesty impelled her to  disclose the
light of  truth, which  has  been too  long kept hidden from the
view of the  world.   And  what a melancholy picture  does  it
exhibit of the depravity of those practitioners who are insisting
upon the propriety of employing men-midwives, and who have
themselves disclosed  nearly as much as the lady to whom we
are indebted for the  foregoing extracts.   But we will omit our
own remarks, and hasten to another  quotation from the same au*
thoi, which at the same time  that it exhibits her very correct
knowledge of human nature, also displays her exalted views of
Deity, and a rational confidence in his wisdom.
  " Therefore," says she,  " when your labor commences, be no!
afraid with any amazement, though a mother or any kind friend
should insist on sending immediately for help; which we know
is frequently done, but generally not without a bad effect,  as it
produces affright  or  embarrassment,  which  only  retards the
operation of nature:  But  let such know, (at least  if you are a
child o*' God,1)  that vour  trust is in vour Creator, and that h 
MIDWIFERY.
75
 who appointed to the female tfiis destiny, has also formed hei
 equal to the task."
   How much the embarrassment alluded to in the foregoing ex-
 tract is  increased by calling in male assistance, we must leave
 for females themselves to judge; as, indeed, too many of those
 who have become mothers know its extent from mortifying and
 painful  experience.  We beg the privilege here of introducing i
 remark  of Dr. Ewell upon this subject.  After speaking of th<
 distress and disgust which husbands feel at the exposure of theii
 wives to doctors, at child-birth, he says :—"But the opposition
 the detestation of this practice,  cannot be so great in any hus-
 band, as amongst some women.   The idea has driven some to
 convulsions and  derangement; and every one of the least deli-
 cacy, feels deeply humiliated at the exposure.  Many while in
 labor, have  been so shocked at the entrance of a man in  their
 apartment, as to  have all their pains banished.  Others, to the
 very last of their senses, suffering the severest  torment,  have
 rejected the assistance of men.   There have been many of this
 description in all ages !   Virtuous sainted souls—they preferred
 dying  in  all  the agonies,  the  throes, and the convulsions of
 fatal labors !  They did err on the side of delicate feeling, but
 their errors shall be blotted  out forever! To be instrumental in
 relieving one of  this truly interesting  cast, will be a heavenly
 consolation to all who  can be alive to the pleasures of  serving
 the virtuous."
   Can it be possible that it is a  part of the wise plan of Deity,
 to  subject the delicate,   the modest,  the virtuous feelings  of
 women, to such agonizing emotions as these ?  No! never!  It
 may possibly be said that the cause  of all this distress,  is the
 improper indulgence of  a false  delicacy—that child-birth  is an
 extraordinary occasion, and it is the duty of women, at such a
 time, to conquer those feelings.   But we  must confess that we
 have no ear for  philosophy like  this.   This sense of delicacy
 was given them by the all-wise Creator, for a noble and valuable
 purpose;  and as well may we be told that hunger is a false de-
 cepth e  feeling which  should be overcome,  as that the delicacy
 of women should be so far conquered as to admit, without  erao»
 tion, the interference of physicians at child-birth.
   The  case  then  is  clear, that none but women,  excepting
 the husband, should  in ordinary cases,  be permitted to  be
 present  or officiate  as a midwife at child-birth.   But if noth-
 ing will satisfy  but male assistance,  let the  husband  be the
accoucheur—the  midwife;  there is surely more propriety in
this than in  employing  another, and  it is certainly more  nat-
ural, • and.  to the wife at least,  must  be far more agreeable;
whilst it wants nothing but custom  to make it consistent  witl
»>opulai  sentiment.  Let  the  feelings of none be shocked at the 
*" r-n
  /o
MIDWIFERY.
idea of husbands waiting  upo.i their wives  in tho capacity of
accoucheurs; many have done it with the best success, and no
one, that we know or have heard of, with any misfortune.  Some
have even declared their own husbands to be superior to any
others.   And who, indeed, can have more tenderness of feeling
for both mother and child  than an affectjonate husband?   And
truly, if physicians and midwifes would but generally acknowl
edge the simplicity of most labors, it  would be manifest that it*
ninety-nine cases out of a hundred the husband would do in
every respect as well as the most experienced doctor.
  Did physicians really possess that sympathy for female suffer
ing which many  of them profess, together with that  nice sense
of delicacy of which they are certainly not devoid, they would
assuredly pursue a  very different course from the one that has
marked their conduct during the last  thirty years.   Instead of
intruding themselves upon the sex as  accoucheurs, whereby the
feelings of all women are  more or less  shocked,  and many of
them most keenly  distressed, they would  endeavor  to instruct
and encourage prudent, sensible females, in the art  of midwifery,
and withdraw themselves  from such an indelicate and, in some
sense, immoral practice.
  But the prevailing idea  that none but men can be relied on in
bad  cases, has become so fixed in the  minds of  most women,
that if  a woman even consents to trust herself in the hands of a
female  midwife, and the labor prove tedious or severe ; the assist
ants  become alarmed, to which the prejudices of the day render
them exceedingly prone, and nothing will satisfy them but calling
in a  physician.  It is no matter whether the case be  really difficult
or not; the statements of the midwife avail nothing where prejudi-
ce is so strong in favor cf  :.r idwives of the other sex.   We have
known many cases  of '.his nature, and we  can conceive of no
sun r means  by which the t est midwives are  liable to lose both
their reputation and business.
  The doctor comes; makes a great display  of affected knowl-
 dge; discovers something wrong, which however, by his supe-
rior  skill and experience is soon set right; the patient and at-
tendants acquire confidence, rmd, no matter whether difficulties,
real or imaginary, exist or afterwards occur,  the  woman is de-
livered, for which the doctor is applauded, whilst the unfortunate
midwife is silently condemned; when at the same time too, she
would in all probability, have delivered the woman sooner, easier,
and  better than the doctor who is thus supplanting her in repu-
tation and business on which perhaps she may be dependent for
a  precarious subsistence.  It  too often happens in cases like
those of which we have been speaking,  that the judgment of the
midwife  is not  ptrmitted  to  have any  weight.   Although she
pay give assurance that all things are right, ard protest agains 
MIDWIFERY.
77
the necessity as well as propriety of calling in a physician, it is
frequently piesumed by surrounding and  sympathizing friends
that she does not, or may not, know the true condition  of ^-he
patient.  The patient,  too, is probably suffering much pain, and
being flattered with the idea that the doctor can relieve her, she
consents that  he shall be called.   The husband, also, ignorant
of the real state of  the case, being moved by the solicitude he
feels for a tender companion, is compelled to post off for a phy
sician to violate his  own  delicacy in the  person of  his wife''
   Scenes similar to what  we have endeavored to describe, have
been acted  again and again, whereby  the practice of midwifery
has become almost exclusively  engrossed  by the physicians,  in
which condition it seems likely to remain until women assert
and exercise those prerogatives and powers with which they are
endowed by Deity, and  which they  owe to their  dignity and
duty to claim.
   And what, let us inquire,  will be the effect upon  society of
employing men instead of women to perforin the offices of mid-
wives? Who is there that cannot, by a little reflection, perceive
the immoral tendencies of such a custom ?   What is the natural
consequence of those familiarities that are and must be taken by
men, in the discharge of the duties of a midwife ?   Is it not  to
obliterate that delicacy  of  sentiment, and remove those salutary
restraints, by  which chastity of feeling is preserved,  and im-
moral  familiarities, and undue liberties prevented ?   Most as-
suredly such are the natural consequences ; and we are not alone
in these sentiments.
   " Ceveral observing moralists," says Ewell, " have remarked
that the practice of employing men midwives has increased the
coiniption  among married women.   Even  among the French,
so prone to set aside the  ceremonies among the sexes—the im
morality  of  such exposures  has been noticed.  In an anecdote
of Voltaire, it is related, that when a gentleman boasted to him
of the  birth of  a son, he asked  who assisted at the delivery ;  to
the answer, a man midwife, he replied—then you are traveling
the road to cuckoldom."
  " The  acute observing Count Buffon, (on puberty,) observes,
• Virginity is a  moral being,  existing solely in purity of heart.
In the submission of women, to the unnecessary examinations
of physicians, exposing the secrets o" natu'e, it is forgotten that
every indecency of this kind is a violent attack against chastity ;
that every situation which produces an internal blush,  is a real
prostitution.'  It is  very  certain,  where these exposures have
been most common, as  in  large citiss,  th jre adultery has been
most frequent.
  "Be it folly cr prejudice, or not, there is a value in the belief
that the husband's hands  alone are to have access to his sacred 
78
MIDWIFERY.
wife.   Break through this prejudice, if you please to call it so,
but for once, unless powerful reasons command  it,  the rubicon
is passed ; and rely upon it,  the barriers, on future emergencies,
will not be so insuperable.   Time and opportunity to press on a
grateful heart, for a favor in  regions where magnified favors have
been conferred, have been used and more frequently desired. To
convince you of this, you will not require me to enter into the se-
cret history of adultery.   Many of these modest looking doctors,
inflamed with the  thoughts of the  well-shaped bodies  of the
women they have delivered, handled, hung over for hours, secret-
ly glorying in the privilege, have to their patients,  as priests to
their penitents,  pressed  for accommodation,  and driven to adul-
tery and madness, where they  were thought  more innocently
occupied."
  Such, reader,  is  the picture drawn by an individual whose
experience and powers  of mind enabled him to portray, in its
true colors, the temptations and vices consequent on the unwar-
rantable custom  of employing men  instead of women in the
practice of midwifery ; and dare any physician deny its correct
ness?   We think not.   It  may possibly be thought to exhibit
female chastity in a disparaging light;  but whilst all admit  that
women, in common with the  other sex, are the  subjects  of
temptation, it is to be hoped that both our  quotations and re-
marks  will not  be regarded as an indignity, but rather  as an
attempt to  guard females as well against seduction as unjust
suspicion.  We can also most cheerfully admit, what truth will
not allow us to deny, that in point of virtue, 'he female sex is
superior to our own; and, moreover, that in the  particular case
under consideration, the latter are, in every sense,  the original
transgressors.   They were, in the first  place, the active  and
principal agents in producing those unnatural and unjust  preju-
dices which have obliged females to submit to the interference
of male midwives;  and they stand in the same connection with
regard  to the crimes which  grow out of this practice.   And
however few may be the deviations on the part of females from
the  path of strict rectitude, they nevertheless owe it to their moral
character, as they would  be  above both temptation and  suspi-
cion—to their delicacy,  as  they  would be  released  from  the
scrutiny of males—to their independency, as they ought not, in
this particular, to be under any obligation to the other sex__to
their own powers which Deity has endowed them with, as they
are  capable of rendering to each other all the assistance usually
necessary at child-birth—to each and all these circumstances, we
repeat, females owe it to encourage the employment of women
instead of men as midwives at child-birth.
  And we ought  not to be satisfied by believing that our own
«vives are above the temptations, or beyond the dangers of which 
MIDWIFERY.
79
 we speak.   The prevalence and increase of tne custom of em-
 ploying men  midwives, as it adds to the number of those im-
 moral familiarities, very naturally has an extensive and powerful
 influence  over  the  prevailing  character of  the age.  " The
 interest, the affection, the duty, of all, require that every effort
 should be made  to preserve women delicate and  virtuous; to
 keep  them out of the way of temptation, as well for the presenl
 as for succeeding societies.  Nothing," continues Dr. Ewell,
 ' can be more certain, than that in defiance of our wishes and
 expectations, our own daughters will partake more  or less of the
 prevailing manners of  the times—will be pure  and  refined, or
 indelicate and unprincipled, according to their associates.  It is
 therefore  obvious, that by assisting in  the establishment and
 preservation of good practices in the community, we assist in
 perpetuating them among those dearest to our  hearts."
  Some, no doubt, may conclude that our remarks on the im-
 morality of employing  men midwives, are unsupported by facts.
 To such we can only say, that if you are  indifferent as to the
 importance of a high-toned  moral  standard in  the community,
 you  will not  give yourselves the trouble  of  investigating the
 causes by which this  standard is depreciated; for all who feel
 an interest in this matter, we think, will find sufficient evidence
 in the arguments we  have adduced to satisfy them of the correct-
 ness of the position which we have taken.   We well know
 that the subject upon which we are writing, has hitherto excited
 but very little attention; but does it follow from this fact, that
 he custom of employing men midwives has not had a  demoral-
 zing  influence ?  We  think not.   Many things, although little
 seen and perhaps still less known, are, nevertheless, exercising
 a sway over the moral constitution of society, the effects of which
 it is much to be feared will, sooner or later, disclose themselves
 in the mutual and extensive  corruption and degradation of both
 sexes and all classes  in the community.  It is not at all impro-
 bable  that we  may be censured as holding  and inculcating un-
charitable sentiments respecting the present and prospective state
of social morality; but if the practice of employing physicians
as midwives continues  and becomes universal, as it seems likely
to, we shall feel perfectly willing to abide the decision of dis-
cerning moralists who live fifty, nay, but thirty years hence
  But however  important may be the consideration of the de-
moralizing influence upon the  community, of employing men
midwives,  this is not  alone the  serious object of our present
solicitude.   " It is," in the language of Dr. Ewell, " to wrest
 the practice of midwifery from the hands of men, and transfer it
 to women, as  it was in the beginning, and ever  should  be;"
 ind to this object we most earnestly request the  attention of
 vprv female in the community.   Your good  sense, your deli 
80                     MIDWIFERY.
i
^acy, your virtuous feelings, all must approve what we are en-
deavoring to accomplish.  And permit not, we entreat you, any
childish affectation of feeling to induce you  to  say or  to think
the knowledge of this subject is too indelicate for you to acquire.
How inconsistent  is such an  idea with the exposures which
your ignorance and your prejudice make  necessary, by the em-
ployment  of men to perform a simple office which properly be
longs to yourselves.
  " Indeed," says Dr. Ewell, " it is on account of your deli-
cacy, that I entreat you to acquire valuable information respect-
ing your  own  structure.  Nature  has  given you  functions  to
■erform, and every body knows that you perform them; and
can you seriously think there  is as much indelicacy in endea-
voring privately to acquire accurate information, as thjere is in
your  neglecting to do it rendering it almost  indispensable  to
expose yourselves  to the hands and eyes  of strangers ?"
  We do  not expect all to become midwives;  but we  wish all
to acquire a correct knowledge of  the simple process of  child-
birth.  This  knowledge will have the most  powerful tendency
to dispel those anxious fears and gloomy forebodings So common
to pregnant females, and which is a source of more misery, and
of more disasters,  than  labor  itself.  But do not suppose that
the idea rests upon  our assertion alone. It is the opinion of
observing writers,  deliberately formed and candidly expressed,
not for selfish  purposes, but for the benefit of the world.   By
acquiring  a correct knowledge of the simple process of child-
bearing, what  consoling influence might  you possess and exer
cise over  the  minds of many a tender timid woman,  in those
painful scenes through  which  the greater part of you  have  to
pass—a consoling influence which perhaps  you  all  need,  at
times, the benefit of yourselves.
  " Many times,"  says  the anonymous female author whom we
have  before quoted—" many  times has a house been  set in an
uproar, without any ground for alarm, and the unhappy patient
driven to despair and thrown into fits, when  all might have re-
mained in peace, if those  present had properly understood the
case,  and  been properly enlightened."  How important it is, on
such occasions of alarm, that the husband should be competent
to direct the proper measures, and thus prevent premature trouble
and unnecessary panic.
   We cannot dismiss this part of the subject without introducing
a quotation from Dr. Ewell, which is directly in point.  " ft
requires," says he, "but little  understanding of this subject, to
enable you frequently to prove of great service in removing the
fears and forebodings of many ignorant sufferers, who  imagine
that only professional skill  can  afford relief.  Many such objects
of commiseration have languished day after day, solely for the 
MIDWIFERY.
81
 want of a little information in one of the attendants ; all unneces-
 sarily lamenting that physicians  cannot be procured."
   Indeed, in whatever light we view the subject of midwifery—.
 a branch of knowledge, simple as it is, of the highest importance
 to the whole community—decency, delicacy, reason, morality,
 all conspire to sanction  the propriety of restoring k back to
 women,  as it was in the beginning.  Every woman knows with
 how much more confidence she can unbosom  herself to a female
 than to a male, and how much more freedom  she  feels in  the
 presence of a  midwife of her own sex, than of the other; and
 that nothing short of the most exquisite suffering can make  the
 presence of a physician even tolerable.
   Most women also know, not only from the general habits and
 temper of men, but also by experience, the impatience of doctors
 in those protracted, tedious cases which sometimes  occur  in
 child-birth ;  and hence the disposition too often indulged in, by
 physicians, of hurrying on the birth, to the great and frequently
 irreparable injury of both mother and child. On the other hand,
 how well do the retired occupations of women fit them for that
 patience  of  attendance which it is  well  known  they  possess;
 and how well does their own experience in similar circumstances
 qualify them to sympathize with the sufferer, and extend to her
 that encouragement and consolation which she so often  needs.
 And are not women qualified—have they not the capacity to per-
 form the  common office of midwives ? Most assuredly they have
   "Every day," says Ewell, " shows that the practice of mid-
 wifery requires no  particular skill,  no superior knowledge, no
 slight of hand, nothing beyond the most common sense and ob-
 servation, to do all that is required with perfect success.  Nature
 has so wisely provided for the birth of the young, that  even the
 extensive practice so highly rated among ladies is not necessary
 for the discharge of all the duties required from attendants. The
 male practitioners who in general from  accidents have got into
 great repute, received their first impressions from  books, from
 directions which any one in the  country can comprehend."
   "At Athens,"obseives Ewell, "a law was passed forbidding
 women to practice; but from perseverance among  the  delicate,
 preferring death to exposure,  the  law was speedily repealed.
Since then no government, it is believed, has  been so ridiculous
as to compel*sueh unnatural interference.  In consequence, the
practice has been confined to women, until within a few years,
in some European countries and  their colonies."
   A i a contrast to the indelicate  and ungallant spirit  of the
 Athenians, however, we cannot well omit noticing the liberal,
elevated,  and  more refined views of a  few  nations  of more
 modern  date.   "  The  Danish  government," says  Ewell,
 " viewing1 the employment of men  midwives. in  natural »abor,
        50 
82
MIDWIFERi'.
 as highly improper, established schools  for the instruction  ol
 women in the principles of midwifery.  Several of the German
 states have imitated the example."
   But with all the advantages of light and knowledge which it
 may be supposed the people of the United States possess, there
 arc few countries in which  the  anxiety, nay the folly, of em-
 ploying men  as midwives exceeds ours.  And yet it is an un-
 deniable fact, admitted  by  Buchan, Denman, Ewell, &c, that
 men midwives have done women more harm  by their hurry,
 their  spirit for acting, and we will  add, curiosity, than all the
 ignorant and injudicious management of female midwives "aboul
 which the doctors are so fond of talking."
   Many cases of the  most wretched, inhuman management  of
 midwifery might be detailed in proof of these assertions.  Two
 cases of this character came under-our own observation, in which
 the physician  inhumanly introduced his hand, which was of un-
 usual  size, to extract the after-birth, without waiting a moment
 for the powers of nature to do it in the only proper manner.
  In one of these cases the woman lingered out a wretched ex-
 istence for a few months, and died.  The other  suffered  much,
 and did not long survive.  Our recollection is still often haunted
 by the sensations which the  bare  recital of one  of those  cases
 produced in our  mind—the tears, the groans, the shrieks, and
 the earnest entreaties to be spared the torture, were such as one
 might think  would ring in the imagination  of  the guilty practi-
 tioner to the end of time !   The coloring of  this picture is not
 heightened above the reality; and it would no doubt apply with
 equal  force and propriety to thousands of cases.
  A variety of the most shocking circumstances  might be given
 from various sources; some, of doctors forcing deliveries when
 in a hurry, and from no other earthly cause ;  some, of their ex-
 hausting all their skill to produce  such a result,  and  after being
 obliged to desist, nature has done her work in her own way and
 in her own time; some, of the  mutilation or entire destructior
of children, to say nothing of sudden  or lingering deaths, ana
 many other painful occurrences of minor importance.  But time
 would  fail us  in  collecting and rehearsing the  sickening cata-
 logue ; and moreover, we wish rather to convince the judgment
 than to excite the fears of our female readers.  Truly there has
been enough to create alarm; but the greater part of  the really
bad cases have been made  so by art and not by nature—by im-
 proper interference, instead  of patient acquiescence; and  in-
 stances of this kind have  been full as frequent in the practice
 of physicians  as  of the most  ignorant women.   Nature  is,  in
 general, competent to perform her  own work,  and  cannot  be
 meddled with only at immense hazard.
  Dr. Denman.  in  enumerating  the causes of  difficult lab.» 
MIDWIFERY.
83
observes: " There is one  much more  frequent than  the  rest
which is the derangement of the order of labor by an officioui
interposition, or by improper management.  Upon this  subject,'
continues he, " it would be unpardonable to make an assertion,
which is not supported by experience; but I am now fully con
vinced, that the far greater number  of  really difficult  labors to
which I have been called,  (and I must not conceal the  truth on
this  occasion,  that  many  of  those  which have been originally
under my care,) were not  difficult from unavoidable  necessity,
but were rendered such by improper management, in the com-
mencement or course of labor." There is certainly a great deal
of candor in this acknowledgment of Denman's ; more, we fear,
than often falls  to the bt of professional  men.  Indeed  candor
and honesty seem to be diffused through, the whole work of this
eminent individual; evincing that he wrote for the benefit of the
world, rather than the selfishness of the profession.
  It is agreed, we believe,  by the best authors,  that  natura,
labors  do  not  come within the scope  or purview of the art of
midwifery, which can only be properly applied to  those cases
which need assistance.  The great object, therefore, of the works
upon this subject, is to instruct  how to manage difficult  labors;
and hence, the  bare contemplation of what these works contain,
strikes the mind  of the inexperienced with alarm and  terror.
Indeed, but few persons, we presume,  excepting those who are
accustomed to the practice, could cast their eyes over a ponder-
ous volume, and find it contained little else than details of cases
the most desperate, or operations the most painful and horrible,
without concluding that child-birth  is  a scene of hazard from
which scarcely one could escape with life.
  But should  these same  books contain general registers of all
yases indiscriminately as they actually occur in midwifery prac-
tice, the  unnatural interspersed amongst the natural, those
desperate and alarming ones,  so much the objects of dread and
terror, would   be so " few  and far between," that child-birth
would be stripped of  almost  all its terrors.  And  when from
this  number we deduct those cases which are rendered difficult
by malformation, or by improper management of either  mother
or midwife, the simple though   painful process of parturition,
would  be found  to present  much  less cause of alarm  than is
commonly attached to it.  And  why  is it,  we will  ask, thai
popular opinion has become  impressed with such sentiments of
teiror  at the consequences of  labor.  We  answer — in part
because of the mystery which has designedly been thrown about
the process of delivery; and partly  because of the high colored
tales of difficulties and dangers which practitioners of midwifery
too often represent themselves as having been the means  of dex
lerouslv or miraculously removing. 
84
MIDWIFERY.
  But to correct the false impression which the affected know-
ledge and dexterity of those trumpeters of their own fame hav?
bo injuriously made upon the  public  mind, we are happy in
having it in our power, from registers or  tables,  to  set the
thing in its true light before the reader.  These registers are
derived  from different practitioners, both male and  female, and
from different countries.  The following is a  condensed result
of them, obtained from a late work on Midwifery, by a French
author:*
  Merriman gives, as  the result of  1800 cases of midwifery
1746  natural or spontaneous labors, to  which may be added 23
more  that  were regarded as unnatural only because there was
more  than  one child, making in all 1769 natural,  and leaving
»nly 31 unnatural labors in the whole 1800 cases.
  At the Maternite, at Paris, out of 20,357 labors, 20,153 were
natural, and 204 only unnatural.
  Under the superintendence of Dr.  Bland, out of 1897 cases
1860 were  brought to a conclusion by the hand of nature.
  " Madame Lachapelle, in her new tables, divides the labors
that have fallen under her notice into two periods ; the first, ex-
tending from the 1st Germinal, year IX, to the 31st December,
1811, comprises 15,662  cases;  of which 15,380 were sponta-
neous, and 272 were difficult: the second, which extends  from
the 1st January, 1812, to the 31st December, 1820, comprises
22,243  labors ; of which 21,974 terminated without any  artifi-
cial assistance, and 269 by the assistance of art."
  In Dr. Boer's statement of cases at the Obstetrical School of Vi
enna, out of a total of 9,590, only 102  were difficult or unnatural.
  It would also seem probable, from a comparison  of different
presentations, by Velpeau, that another French  lady, Madame
Boivin, had been equally fortunate with Lachapelle. He cites,
in one 20,357 cases, and in another, 20,517 under  the practice
of Madame Boivin ; almost all of which, from the mode of pre-
sentation, must have terminated without aid.
  The  cases which we have selected are, we freely acknowl-
edge, from amongst the most favored practitioners.   But as
these often very justly accuse those who are less fortunate than
themselves, with injudicious management, may we not also sup-
pose that even  those  most favored might also  have the  same
charge applied in a less  extended sense to themselves ?   There
is certainly too much reason to concur in the idea  of Denman,
" that the abuse of art  produces evils more  numerous  and seri-
ous than the imperfections of nature."
   We can very cheerfully admit, however, that the art of midwif-
ery has, when rationally and judiciously practised even by men.
• See Vilpeau's Midwifery, p. 283. 
MIDWIFERY.
85
been the means of saving some lives; but  w hen we compare
the small amount of good done in this way, with the vast amount
of evil which has resulted from the haste, the impatience,  the
inquisitiveness, and the want of caution, too frequently predomi
nant in men midwives, we shall very probably arrive at the con
elusion, that it would have been  better for the world, had mer
never interfered with the practice.  We wish, in making this
suggestion, to be correctly understood.  We believe that ninety
nine cases  in a hundred  will terminate without  any aid from
art whatever;  leaving  but  one  case in a  hundred requiring
assistance.   Of this number, probably nine-tenths could be  de-
livered by the ordinary female midwives;  the other tenth—sup-
pose they die,  the mortality would be far less than  it  now is.
Hence we infer that the custom of employing men midwives is
productive of more harm than good.
  We  do not wish to be understood as attempting to give  the
exact proportions of difficult cases occurring  in practice, though
perhaps it might not be far from the truth.  But we are morally
certain that with judicious female midwives, and the use of such
botanic medicines as act in harmony with the laws of life, many of
the most alarming difficulties attending the practice of  midwifery
may be removed and the  number of deaths very much lessened.
  The dangers  attending, and evil consequences  following,  the
incorrect or improper treatment either of diseases arising during
pregnancy or of difficulties occurring at the time  of child-birth,
are acknowledged as well as justly deplored by all humane phy-
sicians.  And these consequences are not only  more liable to
take place  at the  times  alluded to, but they are also liable to
be far more sepious than at other times and under other circum-
stances.  And why is this so ?  We ask this question  in allusion
to the mineral practice.   The answer, to us, is obvious :  It is
because the remedies employed act contrary to the laws of  na-
ture, perverting the very order they are designed to restore!
  In the progress of pregnancy, and during the process of child-
birth, a greater  number of organs are  brought into play than at
other times, which  are acting a new part in the grand machine.
Hence the machinery being more complicated, is more  easily
affected and more extensively influenced  by the same causes,
than at other times   Therefore, if any mode  of treatment adopt-
ed be wrong, the evil consequences will be more immediate, ar d
more extensive, and the effects more sensible.  These we con-
ceive to be the true reasons why more difficulty and more danger
attends  the  administration of improper medicines at or during
those periods of which  we  have been speaking, than at other
times.
  But in the employment of innocent botanic remedies, which
»ct  as medicine should a ways have acted, in unison and har 
86
MIDWIFERY.
mony with the laws of nature, these difficulties are all avoided.
The machinery, however complicated,  or however deranged in
its action, may, with such medicines, be restored,  if its structure
be not too much  injured, or its powers exhausted, without the
uncertainty and hazard of doing it an injury instead of a benefit.
This is the plain and distinguishing difference between the bo-
tanic system and the too common practice  of  bleeding, physic-
ing, refrigerating,  and starving, so much relied upon by  the
medical faculty.
  In every point of view then, it is most proper,  most rational,
most correct, and most agreeable  to both  husband  and wife, to
have the practice  of  midwifery restored back again into  the
hands of women and of nature.   Although we  do not expect
all women to become midwives, yet we wish them generally to
become acquainted with the simplicity of natural births, which,
as we have heretofore  said, constitute at least ninety-nine hund-
redths ;  and no doubt, with proper management, might far ex-
ceed that proportion.  This knowledge would enable any woman
to act on any ordinary  occasion, when no professed midwife was
at hand, as very frequently happens in remote situations.   And
if women possessed this information, and would teach it to their
daughters who are about to become mothers, how much painful
anxiety would it  save ? how much distress and anticipated trouble
and pain of  mind would it remove ?
   We  beg leave once more, in these introductory  remarks, to
employ the language of Dr.  Ewell.   " If the difficulty," says
he, " of obtaining doctors at the proper time—if  the indelicacy
and tendency to immorality of having them in any  but the critical
and unnatural cases-—if the propriety of giving to helpless wo-
men proper employment and support—if the salvation of many
women, who, shocked at male interference, have theii  pains van-
ished and their minds deranged, and who sometimes prefer death
to exposure—if  the salvation  of  many children,  born almost
 vithout warning—if the prevention of the destructive interference
of ignorant attendants, cannot,  united,  induce you to attend to
this subject, the mechanical advantage between  a man's and a
delicate woman's hand, ought to command your decision in favor
of employing and  encouraging female assistants.    Such is  the
confined organization  of the parts for our birth, and such  the
large size of men's hands,  that I verily believe  as much mis-
chief as good  has been done  by them, as has been stated by-
more extensive observers than myself."
   " The rule,"  continues  he, " that I would  prescribe for  the
females for whom I felt the most affection and solicitude, would
be that w.iich I now urge—on no  account submit  to the inter-
ference of men in  common labor;  but do it most readily in the
uncommon cases, when a nurse, under the direction of a phvst 
MIDWIFERY
87
cian, cannot  afford relief.   I will venture to add, that there is
not a physician, disinterested, of sound sense  who  would not
approve  the  rule.  The best authors  on midwifery decidcej'y
recommend it."
   We  have already extended this introduction to a great length
hurried on by tne high importance of the subject  under  consi-
deration ; but we cannot yet dismiss it  without  an appeal to
every feeling of the female breast which repels the idea of em-
ploying male midwives.   And you all know that these feelings
are strong: they are  modesty, delicacy, and a sense of moral
and conjugal propriety, over which nothing can, or ever has
predominated, but the pains of child-birth, joined to the mystery
under which  this  process is designedly cloaked; together with
the thousand  changes which have been rung upon the few cases
of difficulty and danger which have occasionally occurred in the
practice of midwifery.  No ! nothing  else than what we have
enumerated has driven women to the unpleasant—the unnatural
dilemma, of calling upon men instead of women to act as mid-
wives.   Away, then, with all these false ideas;  satisfy your
selves of their absurdity;  inform yourselves that nature is sini'
pie—her  operations  simple, and that in almost all cases she is
adequate to their complete performance, whilst  interference caq
only be offered at the certain hazard of doing an injury.
   And to husbands  we beg leave to tender the same  advice
Make yourselves acquainted with these things ;  they are matters
of h'gh moment to you,  as well as  to  your wives  ; they are
susceptible of your complete comprehension ; and your love for
a tender  wife, and your duty to her and to your children, alike
impel  you to  the task.   Let  no  false delicacy  nor " mock
modesty," we anxiously* intreat,  deter you from  it.  Your wives,
oy your  means, bear children;  they contribute alike  to youi
happiness as  well as hers ; and  you ought to neglect no oppor-
tunity of acquiring every information by which you might be
of service to her during the tedious months of pregnancy, or in
the painful hour of labor.
   Satisfy yourselves, we beseech you, that the difficulties and
dangers of child-birth are very much,  and no doubt designedly,
magnified—that they are scarcely to be  dreaded, when compared
with the happiness and high duty on the part of wives, of beiny
mothers.   Teach them the simplicity of the process so fearfulh'
anticipated, and that  whilst  one is destroyed  by  it, hundreds
pass safely and without difficulty through it.  Nor let that kind
of delicacy which  forbids men to inquire into or understand the
art, or the situation of their wives when in labor, deter you from
this important  duty.   If, by this knowledge, you are, as  yoi.
.•night on some occasions be, able, by preventing officious inte.r-
"«rence. to save the  life  of wife or child, or perhaps both. •' 
88
MIDWIFERY.
would be an ample, a more than equivalent compensation, for
any sacrifice of  delicacy which  you  might feel  compelled  to
make.   Indeed what has delicacy—false  delicacy—to do with
a matter of such deep interest to the husband ?
  Nay, with but little qualification, you  might be enabled, in
cases of emergency, to act as midwives yourselves, or if you
chose,  you might, as many do, perform  at all  times this office
for your wives.   There is  no immorality, immodesty, nor  in
decency in it.   And how infinitely more natural, more proper,
and more consistent with morality, than to employ a physician
at the sacrifice of so much delicacy of feeling on  the  part both
of yourselves and wives ?   These feelings were not given  to be
violated—to be thus wantonly trifled with.   They are a part of
that law which the Creator has ordained for the regulation of
the creature, and cannot be violated with  impunity.   There is
a punishment  annexed to  the  transgression ; and in  this case
seems doubly severe—it is a tax upon the  delicacy of your own
and your wives' feelings, with  the fceqvent loss  of  them and
your children, 
CHAPTER I.
              OF CONCEPTION AND PREGNANCY.

   We deviate no less widely from other writers, in the arrange-
 ment of this part of our work, thr.n we do in the general method
 of treating disease.   For this deviation we have no  apology to
 make, nor concessions  to  ask.   We have  adopted the piai.
 which we here present to the reader, because we think it mosl
 natural, and the most readily understood  by the uninformed  ;
 which is the only advantage of a systematic arrangement in any
 science whatever.
  It may not be amiss, however, to offer a few remarks  in ex-
 planation of the reasons  which have induced us to deviate fiom
 other writers on midwifery.  Almost all authors, especially late
 ones, commence their works with a description of the pelvis;
 whereas  we have deemed it better to begin with whatever it is
 proper to notice with regard to conception and pregnancy.  By
 doing thus we place the description of the pelvis, the  know-
 ledge of  which is so necessary to the correct understanding of
 the mechanism of child-birth, in  immediate contact with the
 chapter on labor.   This arrangement seems to us to connect the
 different  parts  of the  science of midwifery, in the manner in
 which those  who  are unacquainted  with it would naturally
 expect to find it.   We first treat of conception  and pregnancy;
 then of those parts, both of mother and child, which are principal-
 ly concerned in child-birth;  and close with an account of labor.
  We may further observe that we embrace the  common  pri-
 vilege of all writers, to borrow  the language of others  when-
ever we find it convenient. Indeed, in treating upon midwifery,
like  all other sciences,  there is a difficulty at  this day, in ma-
king a purely original work.  We should not, however, have
deemed these remarks  necessary,  only that ve are disposed no'
to trouble ourselves with too many quotations and references to
authors, which can be of little use  to readers in  general.
                       SECTION 1.

                    OF CONCEPTION.

  Conception is  the  process by which, after tne sexual inter-
course or coition,  the  womb  acquires the means or capacity
t«f fulfilling  its ultimate destiny,  the production  of anothei
                                            89 
90
CONCEPTION.
being.  Various theories have been suggested by the most pen
etrating minds, to explain this amazing phenomenon ; bat noth
ing has been  hitherto elicited that appears every way satisfac
lory.   The  theories which have been offered, appear too com
plicated, as we think, to be entitled to full  credit.   We do  not
make this suggestion, however,  because we have any thing bet-
ter to offer; but we ground it upon the well known simplicity
«f all the operations of nature.
   But as all, perhaps, feel  a  lavdable curiosity in knowir.^
something about the peculiar  method by which the species is
propagated,  we are disposed to offer a few remarks upon this
interesting subject.  The  reader will recollect that we have
heretofore described, with some degree  of accuracy, the female
organs of generation ; but in order that  our remarks on concep-
tion may be more fully understood, we will subjoin a more gen-
eral description of them  here.  The vagina and womb may be
compared to a small sack or bag with a  string tied around it,
nearer the bottom than the  top; the  mouth of which would  an
swer  to the external opening of the vagina, and the bottom of
the sack below the string, would answer to the womb.   It musl
be  remembered, however, thai the bottom  or closed end  of  the
Ba^k,  comparable to the womb, is upward,  and the open end or
mouth,  comparable to the  vagina, is downward.  Now,  if  we
suppose that part of the sack between the string and the mouth to
be enclosed within something else, as  the vagina is in the cavity of
the pelvis, and adhering to all its sides by which it is  confined,
whilst the bottom or closed end of the  sack lies loose above it,
we shall have a tolerably correct idea of the situation and  shape
of the vagina and womb.
   The  string  around the bag, closing  its  sides together,  forms
the mouth of the womb,  and as the womb  lies  loose in the pel-
vis above the open par' of the sack or vagina, and is somewhat
heavy compared with its bulk, we may easily imagine that it
will settle a little into the sack or vagina, as  the  mouth  of  the
"womb actually does.  (See plates 8 and 9.)
   We  will next observe, that just above the mouth  of  the
womb, on either side of its  neck, upon the external surface,
are situated the ovaries or female testicles  ; and from the  i  r *?
part  of the  womb, on  each side,  issue the fallopian  tuoes,
which are hollow throughout; one end opening into the womb.
and the other into the abdomen, the abdominal ends terminating
in a number of elongated fringe-like portions somewhat similar
to fingers.   These tubes  extend in a horizontal direction a short
distance, and  then  form an  elbow,  the ends dropping  down
nearly in contact with the ovaries.   (See plate 2.)
   Although there have been  a great many hypotheses invent
ed by which conception  is said to  take place, yet thev maw 
                   PLATE II.

female organs of generation—see  pages 14, 90.
  A—The uten»s, or womb.
  BB—The fallopian tubes.                         .
  CC—The ligaments which connect the womb to the pelvis.
  DD—The ovaries.
  E—The mouth of the womb.
  FF—The round  ligaments which pass out of the abdomen, and are fixed
to the labia.                 ....
  G—The inside of the vagina, which is cut open.
  HH—The labia.                                    91 
92
CONCEPTION
all be arranged, says Dewees, under a  few  general  heads
1. Those which suppose the male semen or seed to be conveyed
directly to the ovaries, through the womb  and fallopian tubes
2. Those which represent that the semen,  after being deposited
in the vagina, is absorbed aid carried to the ovaries by or in the
blood.   3.  Those which conclude that the semen  makes an im-
pression upon  the  vagina or uterus, and the  ovaries sympathi-
zing with this impression, produces conception. 4. Those which
suspect the existence of a set of vessels,  whose  whole duty  it
is to take  up the  semen from  the  vagina, and carry it to the
ovaries.
  We  cannot pretend to point out the relative merits or absur-
dities of those different hypotheses; it would  be foreign to  our
object  so  to do ; but the reader will  perceive that all refer the
ultimate effect of the lodgment of the male  seed or seminal fluid
in the vagina to the ovaries of the female ;  without which effect
conception  cannot take place.  But how the  seed of the male,
or even its  influence, can be conveyed to these organs, is a diffi-
culty sufficiently evident from the  contradictory theories which
have been offered to account for it.
  We   have  before remarked that the ovaries contain the seed
of the  woman; which consists in  minute ovules or eggs arran-
ged  on the surface  of the  ovaries, being merely covered by a
thin membrane or skin.   One of these eggs,  after a successful
intercourse of the sexes, begins to enlarge ; but why one should
enlarge instead  of another,  or all the others, has not been  ex-
plained. We would suppose, however, that the sexual embrace
stimulated  the  fallopian  tubes, and  induced them to draw their
ends in contract with  the  ovaries, to which  it is  admitted they
are sooner or later attached by means  of the  fringes acting
as fingers.   This attachment, if the end of the tube happen to
fix  itself upon  one of those eggs,  it seems  probable, so  acts
upon it as  to produce the enlargement; and finally, when it be-
comes  so large as to burst the skin by which  it is covered,  it  is
received into the fallopian tube through which  it is conveyed  into
the womb,  where it lays, as it were,  the foundation of a new
being.   If  each tube happen to  fix" itself in contact with an
egg  in  the ovaries, the consequence is the conception of twins.
But  if the  tubes  attach  themselves to  parts of  the  ovaries
where  no  ovules are located, no conception will take place.
  How the ovum  or egg is propelled  along the tube to the
womb,  is  to  be  ranked among the  many other inexplicable
phenomena of the animal machine; but that such is the fact,
experiments and dissections have  pretty clearly proved.
  When conception takes  place, the  organs  concerned in the
generative  process  experience important  changes.   We have
»lread\ alluded to the f.cundating of  the  ovum or  egg in the 
PREGNANCY.
93
ovary, its separation therefrom and passage to the womb.  How
long a time this process requires is not precisely known.  Dew-
ees says, in summing up all the evidence the subject affords, it
would seem  to be about twenty days.  Others, however, have
made the time much shorter.
  The  changes  which take place in the womb,  are  also as
extensive as  those in the ovaries and tubes.   It has been ascer
tained, that so soon as  the egg in the ovary becomes impregna-
ted by the male semen, the womb forms a thin membrane extend-
ing  over nearly the  whole of the internal surface,  which  ap-
pears to be intended  as the  connecting organ between the appen-
dages of the child and  the mother.
                       SECTION 2.

                     OF  PREGNANCY.

   Hitherto we have been speaking of what takes place pre-
vious to the arrival of the ovum, or egg, in the womb, which
we have  considered as belonging to the process of conception.
B it the ovum having arrived within the womb, pregnancy has
n<»w  commenced.  Borrowing  the  ideas  of Buchan,  nature
h«s now entered upon her grandest work.
   Still  greater changes now take place, not only in the womb,
I A also in other parts of the system   The generative organs
\ ave to provide the means of sustenance and growth for a new
being.  Menstruation ceases, and a new order of things arises ;
whilst almost every part of  the system experiences more or
less the effects of  these important changes.
  In  order to supply the  embryo, as it is now called,* new or-
gans are formed either for its nourishment or protection, respect-
ing which  it will be necessary for us to speak somewhat partit •
ularly.  These  are the placenta or after-birth, the membranes,
and navel-string or umbilical cord.
  The  placenta or after-birth is attached to some part of the
womb, generally' the upper  part which  we have  compared to
the bottom of a sack, though it may be to any other,  even over
its mouth; in  whic'i case dangerous floodings may take place
  • " At present," says Velpeatj, " it is generally agreed to give to the
g?rm, when without i.. membranes,  the name of embryo, until  the third
•nonth of pregnancy ; or according to some, until its several parts can be dis-
tinguished from each other: it is afterwards called foetus as long as it remains
m the womb ; and the term child is not applied to it until after its birth.  Al-
though this division is entirely arbitrary and difficult to justify, I feel bound
partially to conform to it in this work."—Velpeau's Midwifery, page 188. 
94
PREGNANCY.
at the very commencement of labor;  though attachments ol this
kind are extremely rare.   The  navel string  adherei it one end
to the placenta, commonly in its  center, and the other end to
the  belly of the child.  The membranes are a thin delicate sub-
stance, continued from the edges of th°- placenta, and forming a
sack in which is contained the foetus or child, and a peculiar fluid
callea the liquor amnii;  and from this circumstance is usually
called, at child-birth, the bag of waters.
  The placenta is of a spongy appearance on that side which ii
connected with or attached  to the womb; is about six or  eight
inches in diameter, flat and round ; generally thinner at its edges
than in  the center, resembling a cake;  whence its name, pla-
centa ; often also vulgarly called the cake.
  The umbilical cord or navel-string, is of various lengths, but
almost always sufficiently long to admit of the birth of the  child
without pulling upon the placenta.   It is composed of two arte-
ries and a vein, which are generally so twisted as to resemble a
rope.  The blood from the mcthc;', passing through the womb,
enters the  placenta,  whence it  passes  through the umbilical
veins, as they are called, to  the child, and after having fulfilled
its purposes there, passing the rounds of the circulation,  it re-
turns through  the umbilical artery to the placenta, and thence
again to the mother.
  The membranes, as before observed, with the placenta,  form
a sack within which is included the foetus or child, the umbilical *
cord or navel-string, and  the liquor amnii or waters.   Hence it
may be understood, that the young being is enclosed not only
in the womb, but in another sack or bag, one side of which, the
placenta, is attached to the womb,  by which the fcetus is  nour-
ished and its  growth supported, until it has acquired sufficient
perfection of organs and firmness of structure to bear the  vicis-
situdes of another mode of existence.
  As a matter of curiosity to the  reader, rather than as being
intrinsically valuable, we give a condensed history of the gradual
development or growth of the foetus, from Velpeau's Midwifery.
  Previously to the  end  of the first week, it is a curved body,
forming nearly a complete circle, of not more than one-sixth or
one-fourth of an  inch  in  diameter.  One extremity is bulbous
and rounded,  whilst the  other terminates in a  point.   This
curved body  being hollow  and semi-transparent,  seems  to be
filled with a limpid fluid, in the center of which  may  be  seen.
even with  the  naked eye, a white  or yellowish line, which
represents the back-bone.
  Numerous  observations made on very young embryos,  seem
to prove that  the spine or  back-bone  is the first production in
the  formation of the body, existing for a considerable time alone
For twenty days, or a little longer, it remains curved or crooked 
PREGNANCY.
93
the heaa  anil neck constituting at least one half of the whole
length : as it continues to grow or increase  in size, it  becomes
more straight, the external part  of the  ring or curve beingrthe
back, and the internal part  containing or producing the boweia
and other vital organs.
   The  different portions of the  body successively make theii
appearance upon  the inside of this ring—first the face,  then the
limbs and abdominal and thoracic viscera, that is, the intestines   *
and  liver, lungs  and heart, &c    It might, indeed, be called a
real  vegetation;  the lower jaw, the limbs, the mass which is to
occupy  the abdomen and breast, increase and come forward like
huds springing from the branch of a tree.
   The circle thus fills up progressively, and as. it fills, gradually
forces  the  spine  or back-bone more and more  straight.  The
head, however, still  remains inclined  upon the breast, and is
much larger in proportion  than the other parts  of the system.
Ii  even  retains this over-large proportion long after birth.  As
neither  the face  nor chest exist at first, there is  in fact no neck
at  the commencement of embryo life.   At five weeks, the face
is  very  Jistinct from  the  cranium or top  part of the  head, in
which most  commonly may be  seen the  general arrangement
of the brain.
   The mouth is  amongst the first organs  of  sense that can be
perceived.  " I have found it," says Velpeau,  " in the youngest
embryos that have fallen under my notice;  consequently, it
exists at the twentieth day."  At thirty days, the  nose is often
perceptible by its round openings situated immediately above the
mouth,  look directly forward, and resemble two dark spots.
   The eyes appear about the same time with the mouth.  They
have been seen in embryos not exceeding  one-third of an inch
in  length, and may  always be found in those which have mis
carried during the fourth week.   But  instead of being directly
in  front, at this period, they are, as in most  animals, turned very
much to the sides of the  head.
   The ears will make their appearance in  the form of simple
openings, without any trace of  the auricula or external ear.
The limbs also make their appearance, and between the thirtieth
and fortieth  day, the fingers begin to show themselves ;  an  ai
forty-five or fifty days, the heels  ard knees ; and at six  or seven
weeks,  the whole mass is rapidly approaching a completion of
its form and organization.  It, however, requires the  term of
forty weeks for  the •foetus to acquire such  a state of perfection
as  to be capable  of existing without  this  intimate connection
with  the  mother.   At the conclusion of  this period, by the
action of a law which seems peculiar to itself, the womb com'
menees  its contractions for  the  expulsion  of the  child, which
 onstitutes what is termed labor.   The description of  this pro 
96
SIGNS OF PREGNANCY.
cess  vvould seem  naturally to follow this section;  but as there
are other important circumstances requiring attention, this must
be deferred until after  the  description  of the parts principally
;oncerned in child-birth.
                        SECTION 3.

                 OP THE SIGNS  OP PREGNANCY.

   The certainty of the existence or non-existence of pregnancy
 s a matter in which females usually feel much interested ; and
 »vomen in general  have little or no difficulty in making a deci-
 sion, especially after a first pregnancy.  The signs are commonly
 so certain and conclusive, that in ninety-nine cases out of a hun-
 Ired no one will be  mistaken.   But still, as many diseases to
 which women are liable, produce the same symptoms that occur
 in pregnancy, there is often cause to doubt the certainty of many
 of the early signs of this state of the system.
   In common, the first symptom of pregnancy is a failure 1.1 the
 return of the menses  or courses at the proper time,  or sickness
 at the stomach, or perhaps  both may occur about the same pe-
 riod, attended sometimes by cramp in the womb.   The eyes
 lose their vivacity, assume an expression of langour, and seem
 to sink in the sockets; the eyelids turn dark, and are surrounded
 with a leaden colored circle;   the face  becomes pale, and  the
 features sharp;  though sometimes the  countenance grows more
 bright and expressive of health ; but occasionally it appears
 darker, or  assumes a dead whitish-yellow, and  often spotted
 with freckles of a reddish brown color.
   The waist frequently grows slim and lank, continuing so for
 «ome  time;  whilst the neck swells and becomes softer.  The
 woman  is often faint, languid,  and  feeble, and unable  to go
 through with her accustomed avocations, and is frequently under
 the necessity, though  much against her inclination, to lie down
 for rest.  Sometimes  she  has strange and  indescribable sensa-
tions.  With most women, spitting is  a very common and dis-
agreeable attendant  on pregnancy; and when it occurs, is a
 pretty certain symptom.
  The breasts also enlarge;  and the  rose colored ring around
 he i-;pple becomes dark; this symptom, however,  is most ob-
servable in a first pregnancy, as  after this the ring never returns
to its former color.   The appetite is  often very capricious;
somclmes being entirely lost and at other  times voracious, and
then again  desiring for food the  most singular and disgusting
objects.   Animal food, however, seems in general less Jesirable
 to pregnant women than a vegetable diet. 
DISPLACEMENT OF THE  WOMB.
97
   Some women become dull,  gloomy,  peevish,  or fretful;
whilst others  are more lively, witty, good-natured, and  agree-
able.   Tooth-ache,  head-ache, palpitations of the heart, colic,
heartburn,  dianhea, dizziness of the head, vomiting, sourness
of the stomach, frequent disposition to make water, protruding
of the navel, and swelling of the abdomen, are all symptoms of
pregnancy; and without some, or  all  of them, it never doei
exist.   Yet they may any,  and even all  of them, occur, and
still the woman  be not pregnant.  Hence these symptoms are
called equivocal symptoms or signs of pregnancy, because they
do  not indicate to a certainty that this condition actually exists.
   One of the  most certain, but not positive signs of pregnancy
is,  the failure of the monthly courses to appear at the proper
ltime, when the woman has been enjoying good health.   Under
such  circumstances, and  especially if there be sickness  of the
stomach and vomiting, capricious  appetite, and  other common
symptoms, there need, in general, to be but little doubt  of the
existence of pregnancy.  But the  only certain sign of this con-
dition of the female system is, the  motion of the child, which is
usually perceived about the  fourth month, or between the six-
teenth and twentieth week, and  is  termed quickening.
   The  first movement is commonly only a weak kind of flut-
tering, though sometimes it  is  a sensation of a strong motion,
as of a hand or  a foot.   These motions become stronger as the
foetus or child acquires strength, so much so sometimes as to be
unpleasant to  the mother.  Previous to the time of quickening,
the foetus lies  in the pelvis ; but at this period it has become too
large to remain  there,  and rises into the  abdomen, which now
begins  to swell or enlarge,  which it continues doing until the
birth of the child.
                        SECTION 4.

DISPLACEMENT  op the  womb,  commonly  called  retroversion
                        OF  THE WOMB.

  This  difficulty, perhaps, should  have been treated of in the
first part  of this volume; but its intimate connection with mid-
wifery induced us to omit it in its proper place there, and give
it an introduction here.  It is not exclusively a complaint of
pregnancy, as it has sometimes happened in the unpregnant state.
  By reference to plate 8, the reader will perceive the situation
of the  womb in contact with the bladder in the pelvis, which
will  give  a  more correct idea  of it than can be conveyed by
writing.   A  retroversion of the womb  consists  in its  falling
backwards, with  its  upper part resting against the rectum, and
        51 
98
DISPLACEMENT OF THE WOMB.
its mouth pressing against  the  neck of the bladder, as repre-
sented in plate 10.
  If retroversion of the uterus or womb takes  place, it  occurs
between  the  second and  fourth months of  pregnancy, aftei
which the bulk of the womb prevents the possibility of its turn-
ing down from the want of room in the pelvis. This complain!
is  caused by whatever has a  tendency to overset the womb;
such  as blows, pressure,  sudden exertions, violent efforts  in
vomiting or coughing, but most commonly, perhaps, a'distended
bladder.  By a reference to the aforesaid plates  8 and 10, it will
be readily perceived that  a very full bladder has a  strong ten-
dency to overset the womb by pushing it backwards, and when
in this condition, if one of  the circumstances  just enumerated
should occur, a  retroversion might more readily happen.
  The symptoms  produced by this  unnatural situation of the
womb, may be more or less violent, according to the size which
the womb has acquired, or as the displacement may have been
suddenly or  more  slowly produced.  When suddenly induced,
the symptoms are violent  and alarming—such  as an immediate
suppression of the urine, or  of the passage of the stools; alter-
nate pains, accompanied with  a  great  forcing  and  bearing
down; a disposition to fainting; and it is sometimes followed
by extensive inflammation  of the neighboring  parts.
  Retroversion  of the uterus  appears to have awakened but
little  attention  until  about the  middle of the  eighteenth cen-
tury,  when a fatal case  occurred in London, which excited the
special notice of Dr. William Hunter. Since then,  it has
been much written upon, and was for many years, and is even
yet by many practitioners, considered as a  very fatal disease.
But by Dr. Gooch, who is the latest writer  on this  subject,  it
appears  to be viewed in a different  light.  He  says: "This
disease when first known,  was fatal: but now if you are called
in early to a case of this description, the  death of your patient
will perhaps be the death of your reputation."
  In  all cases of retention of the urine, occurring about the third
or fourth month of pregnancy, we will have reason to suspect
a retroversion of the  womb; though a retention is not  always
produced by this cause.  This  may  be   determined, however,
by an examination.  If the course of the vagina  be  found up-
ward and forward, with a tumor or swelling behind it, instead
of its being upward and backward, the evidence  will be con-
clusive that the  womb is retroverted, having its upper  part  oi
fundus turned down between the vagina and rectum.
  We cannot better describe the method  of attempting  the  re-
duction of the womb to its proper place,  than  by copying the
following from Dr. Gooch's  Lectures on midwifery :—
  " In the treatment of this complaint there are three principal 
               PLATE X.


VIEW OP A RETROVERTED WOMB—SEB PAGE 98.
F—The distended bladder.
It—The neck of the womb.
99 
100
DISPLACEMENT OF THE WOMB
objects : The first is, to restore the displaced uterus, if possible,
to its proper position; if  this should not be practicable, the sec
ond is, to keep the bladder free from  distention, by the use  of
the catheter, as often, and for so long a period, as may be requi-
site ; the third is, to guard a^- !nst inflammation of the bladdei
or contiguous parts, by"  the proper use of means  to promote
perspiration, and keep up a healthy action in the circulation, by
administering  the diaphoretic powders, cayenne, the black rool
as a cathartic,  anodyne drops, and the application of hot bricks,
the use of the  vapor  bath, and  if necessary a  full course  of
medicine.
  " Before any attempt is made to restore the womb to its place,
the bladder should be emptied by the catheter, and  the rectum
by an injection; then place the patient on her hands and knees.
introduce the finger into the rectum, and make a pressure against
the womb."   The object in placing the woman on  her hands
and knees must be obvious.   It raises the hips,  and the higher
they are raised the better, so that by a little pressure against the
womb  it may the more easily and readily fall back to its natural
position.
  " The womb is sometimes so low that the finger passes be-
yond  it, and an ill-directed pressure from the rectum may force
it down still lower; therefore first push it upwards by introdu-
cing a finger into the vagina, and then endeavor  to complete the
reduction by pressure on  the womb from the rectum, not direct-
ly upwards, as the curve  in the back bone  will be  an obstacle,
but rather to one side or the other of the center where there is
the greatest space, and then upwards.   The degree  of pressure
employed may be pretty  considerable, and it may be continued
for ten minutes ; if the womb is once felt to move from its  pre-
ternatural position, it rises easily into its proper place.
  " We will,  however, suppose that an  adequate pressure  has
been made for a sufficient length of time, but without success ;
it will  then be necessary, in  order to  prevent distention of the
bladder, to draw off the  urine with  a catheter three times in
every twenty-four hours   Thus will be obviated the principal
danger; and as pregnancy advances, the womb  will  rise  spon-
taneously out of the pelvis, in this way accomplishing a natu-
ral cure.   In addition to  the regular employment of the cathe-
ler  during  the state of  retroversion of  the womb, the  bow-
els  which, frcm the pressure of the  womb, would otherwise
suffer  from  the accumulation of faeces, must be kept constantly
relieved by gentle  laxatives."   We  would, however, recom-
mend a close attention to diet, endeavoring by this to keep  the
bowels loose, which should also be aided by the daily use of
injections.   The woman  should also confine herself mostly t*
her bed. until  the womb  has regained its natural position 
              DISPLACEMENT OF THE WOMB.            101

   "The  womb  when reduced by  pressure, fiequentiy again
 becomes retroverted.   It must be again replaced, and  a spoiio*
 pessary  must be introduced,  which  will effectually prevent a
 similar occurrence.     The uterus, in the  unimpregnated state
 may be come retroverted, perhaps two or three days after deliverv
 01 even in a  woman who has never bee^ pregnant.  When th>?
 uterus is enlarged  by disease, it  is atso liable to this displace
 ment, attended by its usual consequences.  I was lately request
 ed, by a young practitioner, to see a woman who had been de-
 livered  three days; he s?id she had retroversion of the uterus.
 I thought he meant inversion, but on examination I  found his
 designation  correct.  My finger passed upwards and forwards :
 there was a tumor at the back of the vagina, between  it and the
 rectum ; she had retention cf urine, and a difficulty of passing
 the faeces, together with pain m the pelvis.   This, I  said,  will
 have a  natural cure:  the  uterus  will  be daily getting smaller;
 therefore  take care of the bladder, and let the uterus take care
of itself.  The urine was regularly evacuated by the introduc
 tion of the catheter twice or three times a day; in about a week
all the symptoms vanished, and on introducing the  finger  into
the vagina no symptoms of the complaint could be discovered."
  " The treatment of this complaint is the  same in all cases,
and may be  thus summed up:—Reduce the retroverted uterus
if practicable ; if you  fail in  this  attempt,  draw off  the urine
twice or three  times  in every twenty-four  hours;" evacuate
the bowels every day ; and  if any  degree of inflammation is
indicated by  tenderness on pressure, employ the proper means
to  remove it, as heretofore  directed.  It may, however, be re-
membered, that this complaint very rarely  occuis.
I 
                   CHAPTER VIII.

  OF THE PARTS PRINCIPALLY CONCERNED IN CHILD-BIRTH.

  It  becomes  necessary  to have  some  correct notion of the
parts  immediately concerned in child-birth, in order to under-
stand  its mechanism.   Under  this head, are  included parts of
both mother  and child.  The parts  of the mother are  the pel-
vis  and  womb;  of the  child, the head and shoulders.  We
shall,  however, devote  distinct sections only to  the  pelvis
womb, and head of the child.
                       SECTION  1.

                     OF THE  PELVIS.

  The  term pelvis, properly speaking, means the cavity con-
tained within the bones  of the pelvis, which form, as it were, a
bony girdle or frame around the lower part of the body.
  The bones  of the pelvis consist, in the adult, of four pieces,
all connected together; which are, the  os sacrum  behind, the
ossa innominata on each side and joined in front, and the os
coccygis below   As an anatomical description  of  these  bones
can be of little  use  to  the reader, we  will content ourselves
with  merely giving them  their awkward and  inconvenient
names, with  whatever may be  necessary to convey a correct
'dea of the cavity of the pelvis.
  The shape of the pelvis is very irregular and difficult to de-
scribe, though it has been compared to a bason, without a bot-
tom ;  one side of which, however, the front, is very shallow,
and the back part deep, forming a kind of circle of which the
front bone, called the os pubis, is the  center.  This will be the
better understood by reference to plates 3, 4, and 5.
  The pelvis is  divided into two regions,  called the superior
and inferior straits.  This division, however, is only imaginary,
but seems necessary in order to describe the cavity with the most
ease and  accuracy.   The  superior or upper region is of an
oval shape, being longest from hip to hip, and narrowest from
pubes to sacrum, that is  from front to back.   It is in this region
that the womb lies when not impregnated, and also  during the
first months of pregnancy.
           102 
THE WOMB.
103
  1 he inferior or lower  region of the pelvis  Dn the contrary,
affords more  room from front to rear, that is, from the pubes tc
the sacrum.  This peculiar form of the pelvis is very important
to recollect, in order to understand the mechanism of child-birth
  There is also  another  circumstance connected with the de-
scuption of  the  pelvis, which it  maybe necessary to notice;
that  is, what is termed the axis of the pelvis, which in the two
regions do  not correspond.   By the axis of the pelvis is meant
an imaginary line drawn through its center,  in  the  direction
which the child passes at birth.  Hence the axis of the superior
portion of  the pelvis is  in a direction, in descending from the
abdomen, backward; whilst the axis of the inferior portion of
the pelvis,  is forward.  This description may be more conve-
niently understood by an  examination of the plates,  by which it
will  be seen  that the direction  of the child's head, at birth, is
first backward, and then forward,  following the axis of the pel-
vis.   [See plates XIII. and XIV.~\
   The pelvis is  sometimes  distorted, as  it is called; that is,
grown out of its  natural or  proper shape, which gives rise  to
difficult labors.   The pelvis is said to be deformed when it is
either above  or below the common size, though  the difficulties
which arise from its deformity are principally caused by its  too
small size, in which case it does not  admit of a free passage of
the  child's head.  In most  instances, however, this  inconve-
nience is overcome by time and patience.  Indeed it is wonder-
fully surprising how nature  is adapted to accommodate herself
to every difficulty.*
   The upper strait or region of the pelvis is the part most ust
ally distorted, which is  caused by a projection of  some of  the
surrounding  bones  into its  cavity, and almost always from  the
back.  [See plate VII.']  This mostly arises from the rickets
softening the bones in  infancy, by which they are  rendered in
capable of sustaining the  weight of the body, which continually-
resting upon the pelvis, presses it out of shape, and  thus pro-
duces a distortion.
                       SECTION 2.

                      OF  THE WOMB.

  It seems scarcely necessary to submit any further description
of the womb, although  it appears proper to give it a  separate

  •  Dewees and James bom declare, that they have not met with a single
instance in American women of deformity of the pelvis  to such an extent a.
to render labor  « impracticable by the natural powers," though they had in
European women. 
104                THE CHILD'S HEAD.
consideration,  on account of the important function or offic«
which it performs during labor.
  We  have before  observed, that the  unpregnant womb  was
comparable in shape  and size to a large  pear, the cavity ot
which  will scarcely contain a quail's egg.   [See plate VIII.']
When  it becomes  impregnated, the cavity enlarges, and  con-
tinues to increase m size until  the completion of the term of
gestation or pregnancy, [see plates IX. and XL] which has been
variously stated by different authors, at from thirty-nine to forty-
two weeks; but  by a majority of authors, we believe, it is com-
puted at forty weeks.   The foetus or child has now become ca-
pable of existing in the external world,  and the body of the
womb, from some unknown impulse, begins to contract, whilst
the mouth expands to make room for the passage of the child.
These contractions of one part and expansions of another almost
always produce pains, and these are termed labor or travail pains.
These contractions are  not from the circumference to the center
of the womb, but from  the fundus or upper part downwards, in
the proper direction for forcing the child through the mouth of
the womb  and vagina.
  As these contractions continue,  or as  it is  said, as  the labor
advances, the child is forced onward, until it is finally expelled
from the womb through the vagina and  external orifice into the
world.   The womb still continuing its contractions, the placenta
and membranes,  commonly called the after-birth, are expelled,
and the womb gradually in a short time returns to  its forme i
state, size, and situation in the  pelvis.
                      SECTION  3.

                   OF THE CHILD'S HEAD.

  The shape  and structure  of the  child's head is a matter of
more  importance, if possible, to  understand, than that  of  the
pelvis.  It is composed of several bones loosely connected  to-
gether by seams, or as they are termed, sutures.   One of these
seams passes over the head  from front  to  back, and another
crosswise between the forehead and crown, as may be seen in
pfcite VI.;  the  dark spots in the same being the openings in tke
skull, called the fontanelles,  one  of which  has four and  the
ither  three sides.  The four-sided one, it must be borne in mind,
is towards the  forehead, and the three-sided one at the crown or
back part of the head.
  The seams or sutures are so loosely connected  in the skull of
a child as to admit of easy separation,  which is  < provision »>/ 
THE CHILD'S HEAD.
105
much consequence, as it admits, in case the head is large or the
pelvis small, of these bones overshooting each other, byr which
the size of the head is much lessened and enabled  to pass more
easily through the pelvis.  This overshooting of the bones seems
to be attended with no  serious difficulty or danger to the child,
as they soon recover their proper  position.   The  fontanellei
also appear to be calculated to facilitate this beneficial movemen
of the bones, as  without these openings they could  scarcely
slide over each other to such an extent as is often necessary for
the passage of the  head.
   A correct knowledge of the fontanelles is a matter of impor-
tance to the midwife, as by these and the course of the sutures,
she can determine the situation and mode of presentation of the
head.  We will, therefore, give a more minute description of
them.   The front opening or  fontanelle, though it varies as to
size in different foetuses, always possesses the same shape, hav-
ing four angles or  corners, and of course four sides, the edges
of which are tipped with a yielding and smooth cartilage, and
may be  easily distinguished  by the  point  of the  finger, but
should by no means be pressed hard against.
   The back opening or fontanelle has but three corners or sides,
and is less in size  than  the front opening.  Its edges, instead of
being cartilaginous, are bony, and often present to the point of
the finger a rough  edge, resembling bony teeth ;  a circumstance
which is never met with in  the front fontanelle, and by which
they may with great certainty be distinguished.
   The shape of the head is  also a matter of  importance, as i
appears very nicely adapted to the form of the pelvis through
which it must pass.   In considering this circumstance, we shall
regard the  head  as  presenting three principal diameters:—
1st.  From the chin to the crown.   2d. From the forehead to
the crown.   3d. From one side of the head to the other.   Of
these diameters, that from the chin to the crown is the longest,
and that from side to side the  shortest.   Hence it will be seer,
that in order for the head to accommodate itself to the shape of
the pelvis whereby it will meet with the least resistance in its
passage, the crown must present at the mouth of the womb, the
forehead to one side, and the back of the head to the other side
of the pelvis, as in fact it actually does in almost all cases, [See
plates XII. and XIII.]  This presentation of the head is called
the natural one, not only because it is the most  frequent, but
because it is the best mode in which it can present, in order that
its shape may correspond in the best manner with the form of
the pelvis.  The longest way of the head is  from the crown to
the chin; now in order that the crown  should present, the chin
must rest upon the breast; hence we may see that the longest
wav of the head is in a line with the axis of the upper strait of 
106
THE CHILD'S HEAD.
the pelvis.   The next longest way of the head is from the fore-
head to the crown or back part of the head ; hence to correspond
with the shape of the upper portion of the pelvis, which is long-
est from hip to hip, the forehead must present at one side, eithei
right or left of the mother, whilst the back  of the head will bo
at the other side.  This  brings one side of the head or the eai
to the pubes or front, and the other to  the  sacrum or back of
the mother, which is both the narrowest way of the  pelvis and
the child's  head.
   But this  description of a most astonishing adaptation of the
parts only applies to the superior strait of the pelvis ; for in the
lower  strait the dimensions  are directly reversed;  the largest
way of the  pelvis being from front to rear.  And how admirable!
how necessary is this!  The head, in  order  to  accommodate
itself to this reversion of shape in the  passage, must turn half
round, which fetches the shoulders  in  the proper position foi
passing through the upper strait.  But in order to have the child
in every respect to correspond with the  formation of  the pelvis,
so that all parts may, in the best possible manner, accommodate
each other, and make the birth the  most easy to both mother and
child, the face  must turn to the sacrum or  back of the mother,
which fetches the crown to  the external orifice of the vagin?,
which, astonishing as  it may be,  almost  always takes  place.
[See plate XIV.]  Does not all this go to substantiate our re
marks in the observations introductory to midwifery ?  Such is
the wonderful provision of a kind Providence for the birth of the
human species ! and who can view it and  believe it the  work
of chance ?  Does it not afford the clearest evidence of the wise
design of a Being possessing superior intelligence ? 
PLATE III.
SBNEBAL  VIEW  OF THE BONES OF  THE PELVIS—SEE PAGES 10, 102.
A—The last vertebra or bone of the loins.
B__The os coccygis, or extreme termiaation of the back bone.
0 C—The cavity of the pelvis; obscured by the ccccygis.
yj d__The  ossa innominata, or two bones which compose the sides of the
pelvis, projecting up toward the ribs.
  E E—The thigh bones, with their round heads.
  p__The symphises pubes, or anion of the front bones.
107 
                          PLATE IV.


VIEW OF THE SUPEEIOR  OPENING OP  THE  PELVIS--SEE PAGE 102.
A B—Shortest diameter of the pelvis.
C D—Longest diameter, from hip to hip.
E YQ H—Diagonal diameters.
108 
PLATE  V.
SIDE VIEW OF THE PELVIS, DIVIDED THROUGH THE CENTRE  FROM

                 FRONT TO BACK—SEE  PAGE 102.
d—The last vertebra, or bone of the loins.
B—The coccygis.
C—Hollow of the sacrum.
D—The os pubis.
E—The os innominatnm, or side bone of the pelvis.
109 
PLATE VII.
  This plate represents the child's head as passing the upper strait of the
pelvis; the passage contracted about one-fifth of its diameter, by the jutting
inward of the back bone.  The natural pains of  labor are sufficient to over
eome a difficulty of this kind, if suitable time be giren.—Se-a pages 103,137
110 
PLATE  IX.
VIEW  OF TnE  NATURAL  CONDITION  OF  THE  CONTENTS  OP  THE

  PELVIS AT  THIRD   OR  FOURTH  MONTH  OF  PREGNANCY--SEE

  PAGES 10, 11, 104.
  A—The last vertebra of the loins.
  B—The sacrum, or rump bone.
  C—The os pubis, or front bone.
  D—The vagina, or canal leading to the womb.
  E—The external orifice of the vagina.
  F—The bladder.
  n__Thp womb  not impregnated.                               .
  HH-The large or straight intestine lying behind and under the womb.
  I-The perineum, or space between the external orifice of the vagina and
anus.
  K—The anus.
  L—The neck and mouth of the womb.
  M—The urethra, or urinary canal.
  N—The stump of the left thigh cut off.
  O—The buttock.
Ill 
PLATE  XL
FRONT VIEW OP A  CHILD  IN  THE WOMB  AT THE PULL  PERIOD  O*
                   PREGNANCY—SEE  PAGE 104.
A A—The os innominata, or side bones of the pelvis.
112 
                      PLATE XII.

VIEW OP A NATURAL PRESENTATION OP THE CHILD'S  HEAD AT THE
          COMMENCEMENT OF LABOR—SEE PAGE 105.
52
113 
PLATE XIII-
  Representation of the child's head entering the upper straight of the pel?is;
.he mouth of the womb considerably enlarged.—See pages 103,105.
114 
PLATE XIV.
  This plate represents the head much further advanced than in Plate XIII,
passing the lower strait  of the pelvis, with  the crown presenting at the  ex
ternal or fice of the vagina, and the face in the hollow cf the stcrum.—See  pp
103,106,137.
115 
PLATE XVII.
INTRODUCTION OF THE  CATHETER—SEE PAGE 106.
  This plate is intended to represent the introduction of the catheter to draw
off the urine when labor is far advanced, which, however, is very rarely neces
sary.
  A__The child's head seen low in tne peivis.
  E—The distended bladder.
  D—The front bone.
  C__The neck of the bladder pressed (and consequently much lengthened),
between the head of the child and the front bone.

  In a case of this kind, the catheter cannot be introduced In the  usual man
ner •  but the end must first be introduced into the  urethra  or  neck of the
alad'der, as represented at F ; then gradually turn it back, as at 6, and it will
readily pass into the bladder between the child's head and the front bone.
116 
CHAPTER  IX.
                        OF  LABOR.

  Labor is the last process of the womb in  performing  tie
I unction of reproducing the species;  and consists in expelling
the foetus or child from the organ of generation.  This is purely
■». natural operation, though it rarely takes place so suddenly or
silently as not to present a very marked train of symptoms, some
of which, at least, appear to be essential to its well performance.
Some of these are local, being confined to the organs immediately
concerned ;  and some are general, affecting the whole body.
  Labor has been divided, by different writers, into a variety of
classes, from three to seven; but we propose no more than two,
which we  shall denominate  natural and preternatural labors.
We design, however, first to  devote a section to the symptoms
of labor.
                       SECTION  1.

                 OF THE SYMPTOMS OF LABOR.

  Various  symptoms precede  as well as accompany  labor.
They are, however, not uniform in different women, nor indeed
with the same woman at different times.   There is, neverthe-
less, so much similarity that they are not very often mistaken,
though this  sometimes happens.
  Shiverings or tremblings are often a first symptom of the ap-
proach, or they may arise in the progress  of labor.  In some
instances this symptom  is violent, so much so  as  to  produce
alarm, though no bad result has ever  been traced to a connection
with it.   Shiverings also sometimes occur immediately after
delivery ;  but they seem to be as innocent when they take place
at this time  as  before labor commences.   They appear to  be
wholly a nervous sensation, as there is  no feeling of coldness
sttending them.
  A disposition frequently to void the urine is another circum-
stance  attending  labor, and  should  always be  gratified, thus
keeping the bladder  as empty as possible.  If there be a diffi-
culty in voiding the urine, amounting  to a suppression of  it, the
catheter should be used, especially in tedious labors.   [See plate
XVIL]  A disposition also  to  go to stool is another attendant 
118
SYMPTOMS OF LABOR.
symptom,  which,  like the last, ought  always  to  be indulged,
and if necessary, should be promoted by an injection, which as
a general  rule ought always to be administered several times,
especially in tedious labors.
  A few hours, and sometimes days, before labor actually com-
mences, the abdomen sinks, and consequently the waist becomes
smaller; the woman feels light and active, and hence many &■
males prognosticate their labor a  day or two  beforehand, from
their feeling unusually well.   This sinking of the bowels id
caused by the womb or  its contents settling down into the pelvis,
and is considered  as indicating a healthy state of both the womb
and the  pelvis.
  A secretion and discharge of mucus from the vagina is another
common symptom of approaching labor, though sometimes there
is little or nothing of it until  labor commences, and may even
then be in small  quantity.  This discharge seems to depend
upon the relaxation  of  the soft  parts* through which the child
has to pass, and is hence always in proportion to the relaxation
Therefore, the more of this mucus there is secreted and dis-
charged, the more the  parts are relaxed,  and  the  easier in all
probability will be  the birth.  From this  circumstance may be
inferred the injury  of frequent  examinations (called touching)
of those parts at the time of labor,  which produce inflammation
and check the secretion of mucus.   And hence too  may be esti-
mated the value of the  vapor bath  in tedious labors, or in cases
of unusual dryness  of  those parts.  The  mucus also acts as  a
lubricant to moisten the passages, whereby the  head of the child
moves with greater ease through them.  When this fluid is tinged
with blood, it is called  the show,  and is regarded as an almost
infallible evidence that  the woman is in labor.
  The symptoms  which we have thus far enumerated may take
place without any pain  being perceptible, though it is not com-
mon ; we  will now  notice this circumstance.
  The pains of labor, or rather those which are generally con-
sidered  as preceding active labor, commence in various ways,
but most usually  they  are in the  back, or bowels, sometimes
extending from the  back  forward  round the abdomen,  and  then
down the  thighs.   At  other times  they extend upward to  the
stomach, and even to the  head.  Sometimes the pain is confined
to the bowels, and resembles  colic;  at other times the back is
the  only part  complained of;  and some women  even affiim
that the  first sensations  of pain  are  in the head, the teeth, the
stomach, the thighs, or  the feet.
  The pain, in whatever  part or manner it  may occur, continues
»nly a short time, when it is succeeded by an  interval of ease.
• The muscles or flesh are thus called, in contradistii :tion to the bones. 
NATURAL LABOR.                 119
This interval of ease is extremely various in its duration; but
usually, as labor advances, it becomes shorter and shorter; whilst
the pains, thus rendered more frequent, also become more severe.
The  pains are the effects of  the contraction of the body and re-
laxation  of the mouth of the womb for the expulsion of the
child ;  and are mild or severe according to the size of the child's
head or of the pelvis, or the lesser or greater difficulty in the
dilatation of  the soft  parts.  They, therefore, seem  almost  a
necessary consequence of child-birth though not strictly so, as
cnildren, in a very few instances, have been  born without pain
                       SECTION  2.

                    OF NATURAL LABOR.

  By natural labor, we mean a labor in which nature does all
that is necessary, without any interference which  is dignified
with the name of assistance; and what we say of this will be,
therefore, nothing more, than simply describing a healthy pro-
cess of the  organs of the female system, and will  apply to at
least ninety-nine cases  in a  hundred where  nature is left  free
to act for herself.
  By almost all writers, labor  is divided into  three differeni
stages :—1st. The period during which the mouth of the womb
is becoming dilated sufficient for the passage  of  the  child's
head.  2d.  The period  in which the complete expulsion of the
child is accomplished.   3d.  The period required for the  expul
sion of the after-birth.   We  are,-however, not capable  of per-
ceiving  any advantage  in this  arbitrary  division of labor into
distinct periods.  The whole process is conducted by the natu-
ral powers of the system, without any obviously marked stages,
excepting the period between the expulsion of the child and that
of the after-birth; and we, therefore, deem it  improper to retain
those unnecessary distinctions.
  The commencement  of labor is  announced by pains in the
back, and short and  slight colicky sensations in the bowels, re-
turning at short intervals.   The  external  parts of generation be-
come moist, and when the pains are present,  the womb  will br
found on applying the hand to the abdomen, to harden, becomo
more round, and sink lower in the pelvis.
  If an  examination be now made, the mouth of the  woml1-
will be found to be opening, and its lips or edges growing softer
and thinner.  By introducing the finger into this opening, the
membranes may be felt, endeavoring at the return of each pain
\o find a  pasuige through it.  But  it should be remembered, 
120
NATURAL LABOR
that these examinatiDns ought seldom  to be made at this stage
of labor.  The softest hand, when compared with the delicate
texture of those parts, is  rough, and hence liable to produce in-
flammation,  which, as we have before stated, dries up the juices
and prevents the parts from relaxing.   Moreover, there is dangei
of rupturing the membranes, without great caution, and thus let-
ting the  waters discharge—a circumstance always to be de
plored at this early stage  of labor.
  Sometimes, however, on making an  examination of this kind,
the opening  alluded to will not, at first, be  discovered ;  instead
of the orifice of the womb, or its hardened lips, there will be
nothing perceptible but a large,  roundish,  uniform mass, the
mouth of the womb being turned backward and upward.  An
occurrence of this kind might be  a little embarrassing to  an in-
experienced  midwife; but she need not  be  disheartened noi
alarmed; the orifice may  always  be reached by  a further intro-
duction of the finger.  The pains,  in this case,  will be mostly
at the back, and the  woman  may be  afflicted with them and
with unpleasant sensations in consequence of this unnatural po-
sition of the womb, for  many days before labor commences.
This difficulty can at any time be removed, by gently  dcaving
the mouth forward  to its natural position; though it is some
times very troublesome, in consequence of its disposition to re
assume its unnatural posture.  To reduce it to its proper place,
nothing more is necessary than to introduce the end of the finger
over the edge of the  mouth of the womb, and gently draw  it
down towards the  external orifice. If it be out of reach, two
fingers of the  same hand must be used, by which it may be
gradually drawn, first  by one and then  by the  other, by almost
imperceptible degrees, until the finger may hook itself into the
orifice of the womb.
  At  this stage of labor the woman is perhaps distressed with
gloomy  forebodings, becomes  low  spirited, loses  her courage,
is overwhelmed with  sadness, and indulges in  great  despair.
She is often  afflicted with hysterical affections—weeps, is much
agitated, or perhaps remains silent and  motionless.  This  is a
time when women need comforting—need  encouraging, if ajjy
comfort or encouragement could be  given—but this is rarely the
case.  Those feelings  arise from a peculiar sensitiveness of tha
nervous system, and human consolation is  often of little avail.
Nevertheless, she must not  be  allowed  to despair:  rational
lueans should be employed to rouse and keep  up her  drooping
mind.                                                 r  s
  The pains gradually increase in strength and severity, and ai
the same time become longer ana more frequent.  The mouth
of the womb gradually becomes more and more open with each
•eturning pain,  at which  time also the membranes, commonlv 
NATURAL  LABOR.
121
called the bag of waters, are forced through it  into the vagina.
A.s the pain  goes  off, however, the bag of waters recede;  but
when the pain returns, the waters are again, by the contraction
of the womb, forced through, and fill the membranes in a man-
ner re.-: ambling a bladder.
  As the pains grow more severe, the  woman sometimes  be
comes cross,  touchy, and impatient of control,  and is often rest-
less and dissatisfied with every body about her.  With very ir-
ritable women these symptoms are vastly increased, whilst with
many others  they fall short perhaps of our description, or may
not even  be  apparent.   Sickness  of the stomach  and vomiting
also  often take place, but are  regarded as favorable symptoms.
 *Vhen the pain goes off, every thing returns, as it were, to its
natural pc =itT.o;i or state;  the restlessness ceases;  the  mem-
branes retire vithin the womb, the mouth of which, during a
 lain, is thin, hard, and sharp, now is thick, soft, and round.
  Each pain produces  the same series of  symptoms, and is
succeeded by remissions which become more  and more com
plete or free  from  all pain, and at the same  time  grow shorter
and  shorter,  as labrr advances.   The  mouth of  the womb is
more and more dilated or opened by each succeeding pain, until
finally it can no longer be distinguished from  the vagina,  and
this passage and the womb become one continuous sack.  This
terminates, agreeably to most writers  on midwifery, the  first
stage of labor.
  But there is no intermission here—no abatement of the pains
—they go on still increasing in severity and duration, with  in
tervals becoming shorter and  shorter, but of more perfect ease
and quietness.  The courage has  now returned, the sadness  dis
sipated, and the woman only thinks of the accomplishment of
Tier labor.  Some women, oppressed with fatigue  and want of
 rest,  will often sleep soundly during the intervals  of  ease, from
which they are only aroused by the recurrence of their pains.
  As the labor progresses,  and the head of the child  settles in
the pelvis, a sensation is experienced which inouces the woman
to assist  her pains  by  pressing down, and almost in spite of
herself she is compelled to do it.   Some writers  strongly urge
the necessity of the midwife's advising the  patient ta refrain
from this ;  but in our opinion she might almost as well be urged
not to got hungry or thirsty.  She is impelled to  these efforts
by instinct  and  not by reason :—She  is  influenced by a sensa-
tion  over which she has no control, originating  in  the parts
concerned in parturition, and which is no doubt designed for a
useful purpose.  It is seen in animals, and experienced by  the
savages of the forest, alike as by those who are  found in  the
walks, and  enjoy th'3 blessings, of civilized life.   We think it,
 therefore, not only idle, but  we think it useless   arid even  in- 
122
NATURAL LABOR.
jurious, to advise women in the last stages of labor, when there
are no difficulties in the way, to  refrain  from thus instinctively
assisting or bearing down with their pai\;<
   The membranes, or bag of waters as they are usually termed,
still  continuing  to  advance,  at length,  during a violent pain,
burst, and the waters  gush out.   There  are cases, however,
sometimes occurring, in which the wa*ers are discharged before
the labor has progressed thus far, and  occasionally ttiey begin
to discharge two or three days before labor commences.  Under
circumstances such as these,  the labor is apt to be tedious, al-
though it may in other respects be perfe V-ly natural.
   The waters being discharged, there  is a longer intermission
previous to the succeeding pain ; and if  an examination be nov
made, instead of finding the bag  of waters, a hard  substance
may  be  felt,  which  is the  child's head.   The pnins. however,
soon return with increased energy, and succeed each other with
greater rapidity than before the breaking of the waters. During
the intervals between them, however, the woman enjoys perfect
ease, and in the hope of speedy relief, she feels a satisfaction in
every succeeding pain.  Each one is ushered in by a general
kind of shiver, and often seems in some  sort  to be double; first
a mild one, and then, with only a momentary kind of intermis-
sion, a severer  one following immediately after  it.  At other
limes the pains will alternate  with each other, first a strong and
then  a weak one, at regular  intervals.   Now, when  the pains
come on, the woman seizes  any thing  within her reach; the
 ides of the  bed  or bedstead, chairs, or persons around her, and
placing her feet in a suitable position, presses  down upon them;
then  she draws a long breath, and  all the fibers of her system
being thus  prepared,  she  contracts,  with  all her  powers, thii
muscles of the belly ; whilst  the diaphragm,  with every muscl 3
of the body, act  with the same energy :  the neck and face swell,
are engorged with blood, and sometimes become purple or livid ;
the veins of the  neck are enlarged, and the arteries beat violent-
ly ; the eyes sparkle;  and  at length, when  the contraction or
pain  is  about to cease, the  woman  involuntarily  utters rap:d
sobs,  which  are soon followed by a most perfect calm.
   Very soon, however, another,  pain returns, attended by the
 ame round  of symptoms.  As the head of the child continues
 o descend towards the external orifice  of the vagina, and pres-
sing  upon the rectum,  the exertions of the mother become re-
doubled, and she  bears down with her pains with all her power
The  head continuing to ascend, approaches the external orifice
the coccyx  or lower end of  the back-bone is forced backward,
and the  perineum and all the  soft  parts  around  the orifice  are
projected outward, and appear thin; at length a  painful efl'o: ,
vhich i? more severe than any former one, and which is often 
NATURAL LABOR.
123
composed of two pains of unequal violence, for which the womb
^ems to have rallied all its powers, brings the head almost to
the point of passing through  the  external orifice;  but at  this
moment of anxiety, when but a  small degree  more  of force
would seem necessary to finish  the labor—when nature  has
overcome all  but  the  last difficulty—and just as she appears
about to attain the object of so many exertions—and in  her very
last effort, she seems likely to fail—to yield to the obstacles by
°^rhich she is opposed ;—but  she onfie more rallies—she  only
seems to have paused to collect her energies, and with an extra-
ordinary effort, in which every muscle of the body performs its
part,  the head of the child is forced into the world ! The great
and sudden relief that is now experienced, produces in the minds
of many women an overwhelming sense of gratitude, which is
poured forth in an ejaculatory expression of thankfulness to Him
who has sustained them thus far through the trying scene. After
a few moments or a few minutes, another short, but moderately
strong pain generally completes the birth of the child.
  In  the  language of  Velpeau, the labor is finished.   One of
the most melting scenes—a scene adapted most vividly to affect
the human heart, is now presented to the contemplation of the
sympathetic mind.  To  those painful conflicts and mental agit-
ations,  succeeds a delicious  calm, full of charms, says Desor-
meaux, interrupted only by the happy idea of being  a  mother.
The  new born child cries, and all the sufferings, for its sake so
courageously endured,  are forgotten; passionate expressions of
thankfulness and satisfaction are substituted for those of pain
and sobs  of happiness succeed the  groans  of  distress.  And
this sudden transition from the most extreme dread and frightful
anxiety, to the height of joy  and most tender affection, in the
person of a beloved wife, is  a circumstance which, above  all
others, most  endears her to  the husband's mind, and entwines
an additional coil of his affection around her heart!  What sen-
sible  husband, we  are constrained to  ask, can contemplate, un-
moved, a scene like this ?  We think  none.
  But do  not oe mistaken: we have  not drawn  this picture of
child-birth  to  create unnecessary alarm in the minds of such
women as have not experienced its faithful realities.  Many of
those  who  ha^e borne children know that it is correct; whilst
thousands of others have not seen one half its shades.   No
consideration  could induce us, in treating upon this subject, in-
tentionally to add to woman's sufferings  a single  unpleasant re-
flection.   No; we know  that  she will  have pains  enough to
bear, and our most anxious desire is to do all in our power for
their prevention and alleviation. This is our object; and whether
we  succeed well or ill, we shall ~etain the grateful recollection
\hat we write under feelings of moving sympathy for ner in he 
124
NATURAL LABOR.
sufferings, as well as of good will for all mankind. 0, wo*r»in
woman ! tender, delicate, lovely woman—how reluctantly wouiJ
we add to thy woes a single pang; and how ardently we desire
to assuage thy many pains.   But, remember, we  entreat thee,
that child-birth, although a painful process,  is not near so peri-
lous  as  many imagine, or as thy gloomy forebodings may lead
thee to suppose.   Thousands are continually passing through it
without any essential or permanent injury ;  whilst the  numbei
that dies or materially suffers is exceedingly small.   Remember
that thou art in the care of thy Creator, whose superintending
care  is over  all  His works, of which man is chief, and is said
to be of " more value than many sparrows," not one of which,
it is declared, " is forgotten before God," or " falls to the ground"
without his knowledge.   Here is certainly encouragement for
thee and for us all; and why wilt thou despair and unnecessarily
bemoan and lament thy condition ?
  But, hurried on by the warmth and anxiety of our feelings,
we  had nearly forgotten to describe the expulsion of the after-
birth ;  but we  hope to be pardoned for the digression, as well
as to be believed when we declare,  that  our great anxiety ta
serve the cause of  humanity led us into it.
  After the expulsion of the child, there is  a remission  of pain
for a longer or shorter time, perhaps from five to fifteen minutes
in common, but sometimes for several  hours,  when the  pains
return  again but are far less  severe, and the after-birth is expel-
led, which completes the process.
  It  may be proper for us  to observe, that the general history
which we have given of labor is  far from being  applicable to all
women, or to all the labors of the same woman.  For most wo-
men, perhaps, our account is too highly colored, but still it will
be found faithful to the experience of many; whilst others more
favored, give birth to their children almost without effort and
without pain.  The habits and customs of  civilized life have a
decided influence in this particular.  The most refined, that is,
those who depart farthest  from the simplicity of nature, have
the most painful labors,  whilst women amongst savages suffer
least,  and have  the shortest labors.   So true indeed is it, that
this kind of refinement perverts the course  of nature, that even
in nations which are civilized, but in which the women are ac-
customed  to labor or exercise themselves much  in the open air,
they suffer but little at child-birth, compared with  those  who
are  more  confined.  We must now point out the  offices which
it is expected the midwife will perform at child-birth; in doing
which, we shall of course descend more minutely into the iletaili
».' labor. 
CONDUCT OF THE MIDWIFE DURING LABOR.     125
                        SECTION 3.

         OF THE CONDUCT OF THE MIDWIFE DURING  LABOR.

   TnE attention of the midwife will be principally directed to
 the following particulars:—
    1st. to guard against all officious interference with the natural
      process of labor.
   2nd.  To the opening of the mouth of the womb.
   3rd. To the formation of  the bag of waters.
v  4th. To the proper presentation of the child's head.
   5th. To the final expulsion and separation of  the child  from
      the mother.
   6th. To the removal of the afterbirth.

    1.  With regard to improper interference, it would have been
 cnnecessary, in all probability, for any cautions of this kind to
 be given, had  the conduct of midwives and physicians  always
 been open and undisguised.   But the  false ideas  which  have
 been  so extensively inculcated  into the minds of  women, that
 midwives render essential assistance at child-birth, induces them
 always to expect that something will be done.  Hence the mid-
 wife, whether male or female, to satisfy the woman, must do
 something, or pretend to  do  it; and in pretending  to  do some
 good, it will  be well if she do  no harm.  The power  and
 instinct of nature is far better to trust to than officious meddling•
 and in general, those women do best who  give birth  to  then
 children without the assistance, falsely so called, of a midwife.
   The deleterious consequences of interfering with the process
 of child-birth, are  deplored by most authors; and yet, it would
 seem, if their instructions had any  good effect, that this fruitful
 theme upon which they so much dwell, would have become ex
 I austed, and there would  be no necessity for the constant  repe-
 tition of their  precepts upon this subject.    But they have failed
 to bestow  their lessons  upon the  proper  students, and  have
 moreover neglected to enforce their precepts by their own ex-
 amples.  Had they taught all women verbally, instead of confi-
 ning  their instructions to books, that child-birth was a simple
 unassisted process of nature; in short, that it was performed ex-
 clusively by the mother instead of the midwife, and that, in the
 language of Denman, " the  abuse  of art  produces evils  more
 numerous and serious than the imperfections of nature," the
 necessity of so often and so strongly inveighing  against  offi«
 nious meddling, would long since have ceased.
    Bui the sentiment has  been inculcated,  that the  assistance o<
  a  midwife is absolutely  necessary at child-birth, because sh 
126    CONDUCT OF THE MIDWIFE DURING LABOR.

nelps to bring forth the child! And the better to conceal the de«
ception, all the mystery of Heathen mythology has been drawn
around it, in order, if possible, that every clew  to the knowledge
\>f its simplicity might be cut off.
  From all these circumstances combined, such prejudices have
been created even in the minds of common midwives, that they
appear to think something must always be done; and as t:.is it
almost always unnecessary,  they are sure to do harm.   And
women midwives are  not alone to blame in this respect.  Men
midwives have also been guilty of the same officious and injuri-
ous interference; though all have not been so candid as like Dr
Denman, to acknowledge it.
  Moreover, women in labor are not satisfied without some
thing being done ; as they have been taught to believe  that the
midwife can assist them,  by either  moderating their pains  01
shortening  their  labor.  But  for the benefit of the female corn-
munity, we  could wish these false impressions done away.   In
the progress of labor, and when suffering its pains, you are anx-
ious to obtain relief;  but  remember that nature performs the
work,  and  not the midwife: therefore recollect, that although
in accordance with custom,  when your pains become severe,
you may anxiously desire the midwife to offer assistance,  yet,
bear it in mind we entreat you, that she  can do  no good, bul
may on the  contrary, do harm by attempting  to  do something
unnecessary, and thus increase the very difficulties which she
is expected to prevent.
  " Tliere is no circumstance,"  says Dewees, " that so largely
and certainly  contributes   to divert  nature  from  her  propei
course, as the persuasion that art can always benefit her—hence
the constant employment of ill-directed measures by an igno-
rant accoucheur, or midwife.  And unfortunately for the interesl
of humanity, it requires  more  knowledge  not to be officious,
than falls to the share  of many of those who pretend to practice
midwifery.   It  is  a  vulgar prejudice,  that great and constar.'
benefit can be derived  from  the agency of the  accoucheur, espe-
cially during the active state of pain;  and this feeling is but too
often encouraged  by the ignorant  and the designing,  to the
injury  of the patient and the disgrace  of  the profession."
  We  might make extracts from  many other authors  on thii
subject, until we should prove, what we are almost ready to be-
lieve a  fact,  that  meddling with women in  labor  always doe«
more hurt than good, but we will let  this one suffice.    Indeed
it is granted by some of the best authors, that the  abuse  of the
art of  midwifery has been productive of more  evil  than  its
proper exercise has done good.  This is truly a melancholy co:i
sideration, and ought to be an inducement to all women to maxe
themselves  acquainted with every  principle  appertaining to it 
        CONDUCT OF THE MIDWIFE DURING LABOR.    127

whereby each individual will be  able  to  know  for herself,  a3
well as for others, what  constitutes  the  midwife's duty; and
thus have  it in her power  to  prevent  those disastrous conse-
quences, which  are acknowledged on all hands to have  resulted
from ignorance, impatience, or  unnecessary  interference.  And
you can never become fully sensible of the dangers arising from
these sources until you become well  acquainted with  the real
simplicity of nature, her capacity to perform, in almost all cases,
her own operations, and the difficulty there is in distinguishing
when assistance can properly be afforded.   Nature can never be
meddled with, but at immense hazard, as reason nas taught, and
experience ever confirmed, to be a fact.
  It is from all these considerations,  that we  have entered  so
minutely into many subjects deemed too indelicate or offensive
to converse about; and which,  it is not improbable, may be  of-
fensive to  some even  to read about.   But,  although we could
not by any means wish to make these things the subject of too
common conversation, or that this book should be placed in the
hands of children, yet we most earnestly and seriously desire
that, at least married women, as well  as their husbands, should
make  themselves acquainted with its contents.   Do not, we en-
treat you,  allow your feelings to be disgusted  with a transient
glance over its  pages;  it contains principles and instructions ol
the highest importance to  your health and  happiness.   Recol-
lect that a.x you may deem most offensive, and a great deal more,
 s contained in most works on medicine and midwifery, which
 re in the  hands of every student and physician;  and how much
greater indelicacy is there in  your being inspected  and  handled
by  them, than in your  understanding these things yourselves,
and being thereby enabled to avoid such unnatural exposure ?
  But we know, that with all we are capable  of saying, your
prejudices  may, at least for a time, keep the ascendancy over a
better judgment, and some of you, under the influence of a false
delicacy, may be liable to reject the advantages herein offered to
your acceptance ; but do only for once reflect, that so long as
this disposition prevails in the female community, hapless wo-
man will be under the necessity of submitting to those  mortify-
ing exposures which we know you all  so much detest and abhor.
Why  not  renounce then, at once,  those  unhappy  prejudices
which prevent you from understanding  your own selves, when
you must  be satisfied, by a little reflection, that this very  igno-
rance  may, and often perhaps has, subjected you to sensations
a thousand times more mortifying and indelicate than can possi-
bly arise from the perusal of this book.  "It is certain," says
Ewell, "that  the mind, in  private, with perfect  purity,  turns
to everv pcint,'v and contemplates, we may add, every subject
upon which we  treat;  how little reason, then, for the indulgenc 
 128   CONDUCT OF THE MIDWIFE  DURING LABOR.

of that false delicacy which would prevent women from obtain
ing a correct knowledge of their organization, as well as of thaii
maladies, and thus be prepared to become each other's midwivei
or physicians, on every necessary occasion.
  But we have wandered from the subject  of  the present sec-
tion ; a digression which we think both the importance of the
Bubject as well as the reader's judgment will fully justify —
We will now return.
  We were exposing the impropriety of the frequent examina-
tions or handlings of women  in  labor;  which, under rretence
of affording assistance or of  guarding  against difficulties, h?ve
become so  fashionable, and are believed, though  falsely, to  be
so necessary, that we shall be inexcusable, perhaps,  if we omit
taking some notice of it. By touching, the midwife is enabled
to ascertain whether labor is  actually commenced, and in gen-
eral, whether the head or some other part presents; though in
this there is a liability to great mistakes, even  with  those who
have had much experience.   In the language of Velpeau, "in
order to practice  it  with success, to  avoid  the gross  mistakes
that it may cause us to commit, to derive from  it every possible
advantage, it is necessary to practice it for a long time, inasmuch
as practice  alone can make us skillful in such 'Sn operation."
  We recollect  of seeing somewhere,  an anecdote of a cele-
brated. French Professor, who was examining a woman in labor,
at one of the hospitals, in the presence  of his students, and on
withdrawing his hand, said it was a head presentation, "there
could be no mistake about it," when  at  the  same time the stu-
dents were  laughing in their sleeves at the evidence which the
meconium on his fingers presented to them,  though unobserved
by  himself, that it was the breech.  We mention this fact for no
other purpose than  to show how easily even experienced phy-
sicians, with all  their  boasted superiority  of  knowledge, may
be mistaken.  There is, however, little liability to fall into  so
great and mortifying an error as the one just  related, but still
this may sometimes occur; and the only positive evidence to be
derived from the touch is, whether the woman is actually in  la-
bor or not, of which we will presently  speak more explicitly.
   When an examination is decided  upon, the  woman  may  ba
placed upon the bed, either on her side or back—if on her back,
something should be placed under her hips  to raise her  lowei
parts a little from the bed: or she may  sit on a cushioned chair,
with hei  bottom slipped a little off; or  she  may stand  upon her
feet having her knees somewhat separated, and a little bent,
leaning upon a chair or an assistant.  After  being placed in one
of those ways, or any  other  that may  suit  the patient better,
the midwife may proceed, at the time of a pain, in the most
gentle  manner, to introduce  either one or two fingers into the 
       CONDUCT OF THE MIDWIFE DURING LABOR.    129

vagina, and search for the mouth of the womb.  In doing this,
the fingers will be introduced along the front bone, called the
os pubis, and then gradually pushed backward until  the  moutl.
of the womb is reached ; and if labor have not commenced, it
will be found closed or nearly so, with its lips feeling hard, not
altogether dissimilar to cartilage or gristle: and there can be nc
mistake as to the part, for there is no other that resembles it, in
the vagina.
   The end  of  the finger is to  be  kept  near the mouth of the
womb until the return of a pain, when if labor be actually com-
menced, it will be felt to open a little ; and if the  finger be in-
troduced into the opening, the membranes will  be  found dis-
tended and  endeavoring to force themselves through the orifice.
It must be borne in mind, however, that this description applies
only to  the  early stage of labor.  If the  labor be further ad-
vanced, the mouth of the womb will be  found more  open and
the bag of waters protruded, in  proportion to the progress of
the labor.   During the time of  a pain, the edges of the orifice
will become thin, as  if stretched, and the membranes  and water
be forced out into the vagina, forming a kind of bladder or bag
in size proportioned to the dilatation of the mouth of the womb;
and when the pain goes off, the waters and membranes return,
and the edges  of the womb become  thick,  rounded and  soft,
having somewhat of  a spongy feel.
   When the mouth of the womb has thus become a little dilated,
if the finger is introduced into  it, the hard  head of the child
may be sometimes  felt, when  that presents, or perhaps some
other part;  but this is not always the case.  We are constrained,
however, once more  to advise that these  examinations be made
with the utmost tenderness and  caution,  to avoid injuring  both
mother and child.  They should also be but rarely made, as in-
flammation of  the parts will be the consequence, from  wliich
will be sure to arise  tedious and painful labor.   After  one ex-
amination has been made, it will not be necessary to  make an-
other until the waters break.  Indeed, unless it be an object to
ascertain for a certainty that labor has commenced, the first ex
amination may be deferred until this time.   But since examina
tions have become so fashionable, it is a very rare thing that the
suffering woman can be satisfied or persuaded to  wait so long,
from the too common error of supposing that the midwife can
render essential assistance.  We hope,  however, that all  who
read this volume will, with  a little  reflection, become satisfied
that no good can be  done  in this way, whilst much evil  may
arise from the practice, and will, therefore, have the good sense
to set a better example.
   Previous to the bursting of the membranes, and after the pains
have become pretty  severe, is  the time at which women ai»
       53 
 130     CONDUCT OF THE MIDWIFE DURING LABOR

anxious for, and  midwives liable, in  accordance  with  popuhn
customs, to offer, assistance.  "But," says Denman, "it is the
ease,  that all artificial interposition contributes  to  retard  the
event so impatiently expected, by changing the nature of the ir-
ritation  thereon depending; or does mischief by inflaming the
parts, and rendering them  less disposed to dilate ;  and occasion
ing either present or future ill.  For these reasons we  must be
firm, and resolved to withstand the entreaties which the distrese
of the patient may urge her to make, as we must  also  the dic-
tates of vehemence and ignorance in  the  bystanders.   Others
may be  impatient, but we  must possess ourselves and act upon
principle.   The event will justify our conduct; and   though
there  may be  temporary  dislike  and  blame, if we do  what is
right, there will be permanent favor and reputation."   These
remarks of the  great Denman ought to be treasured up  and re-
membered, not  only by every midwife, but by every pregnant
woman.
  The pains, during the stage of labor of which we are speak
ing, are often very distressing, and are denominated by  women
as  grinding, rending, or  cutting  pains, frequently producing
great  anxiety,  depression  of spirits,  and impatience  to obtain
relief.   It is now, in the language of  Dr. Gooch, that  it "be-
comes a matter  of importance to keep  up her spirits, and main
tain her confidence.  This is easily done if the labor  is a shori
one;  but if it proceeds slowly, through one night—if  the  fol
lowing day advances and still no prospect of a speedy termina
tion, the patient begins to doubt whether she has received propei
assistance, and  those about her look suspiciously at you:  they
calculate the number of hours the labor has already lasted ;  they
wonder  it is not further advanced; and you are made  to  feel,
both by looks and hints which are sufficiently intelligible, that
your competency is thought to be rather questionable.   When
you find yourselves in this situation, you will not think it a re-
markably  agreeable one."
  From the great danger,  whilst the woman  is suffering from
those cutting, grinding pains, of something being done to  hex
injury, we hope to be pardoned, if we dwell  somewhat longer
upon it.   Had women  always been taught  that nature  or their
own organs expel the child, instead of the midwife, there would
then have been  no  necessity for  the many cautions which have
been given ; but we have prejudices so deep rooted and strong
u> contend with, that it becomes  necessary to oppose  them at
every step.  Nor are these sentiments exclusively our own ; we
also have  the authority of  the best writers to sustain our views.
'* The first observation I shall make,"  says Dr. Bard, " on this
stage of labor is, that no skill or art of the midwife, no exertion
ol the woman,  can in the  least contribute to lessen the  severiu 
       CONDUCT OF THE MIDWIFE DURING LABOR.   131

<;i the pains, or shorten their  duration.   They are  intended by
nature to  accomplish the necessary and important object, tho
complete dilatation of the mouth of the womb." " But although
the  midwife, during this stage, can  neither lessen  the patient's
pain nor shorten its duration; and although  she  is absolutely
forbid interfering in any manner with the progress  of labor, her
presence is now far from being  useless ; it is very necessary.
She should inquire into the state of her  patient's bowels, and
unless they are perfectly free, give an injection; indeed, when
ever there is time for it, it is  a good rule always to do this," as
well as also by all means to see that the patient evacuates her urine.
  After some  remarks respecting examinations, Dr. Bard con-
tinues :—" But if it be necessary  to be  thus cautious in respect
of a careful and occasional examination, what terms shall 1 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  [[wicked] conduct, and dangerous
practice, too  severely;  it is always wrong:  nor can there be
any one period in any 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.
  " I know," continues Bard, "  that I  have to combat the pre-
judices of many of my countrywomen on this subject;  and tha
although I may convince the judgment of a  sensible midwife,
she may not always be permitted to exercise it, unless she has
firmness and self-possession to resist the solicitations and impor-
tunities of her patient, and mistaken friends.  She will not only
be importuned  on some occasions of a little delay,  but  she will
be reproached with permitting  her  patient to suffer without as-
sistance, and will even be threatened with application to others,
and the loss of  her reputation.  I speak from experience ;  still,
however, if she values her patients safety, and the approbation
of her own mind, she must  be firm, and the event will justify
her conduct and establish her character."
  We hope to  be excused, if we make further extracts from the
excellent work of Dr. Bard.  The  period of labor  of which we
are  treating,  demands,  that  not  only  the midwife should be
armed with all  the reasoning and  all the authority which can be
brought to  her aid ;  but also  that  the woman  herself should be
fortified by every consideration which  a correct knowledge of
what is proper can bestow.  And  we  write not for a sect—for
i profession—not for the midwife alone; we write for the whola
female community—for the world ! 
 132   CONDUCT OF THE MIDWIFE DURING LaBOR.

  " Leaving  nature, therefore,"  continues  Dr.  Bard, " to  her
own unassisted, undisturbed efforts, the midwife is to encourage
her patient by appearing perfectly calm  and easy herself, with-
out hurry or assumed importance; by assuring her, that as far
as can now be discovered, all matters are perfectly natural; by
entering into easy conversation with her herself, and encouraging
her to do so  with her friends.  She is to direct her to walk
about the chamber, or from room to room ;  to sit or to lie down
as she finds most agreeable to herself;  and if she can, to sleep
between her pains, which some  women are much disposed to
do.  At the  proper  season, the apparatus of a  meal, or of the
tea-table, may serve to while away an hour, and every occasion
of this nature should be embraced to lessen impatience, and to
protr^t expectation.
  *• Indeed to gain time during this painful and irritable period, is
an acquisition of no inconsiderable moment; for the time which
uninterrupted nature requires to bring about the great changes
which are  now accomplishing, is  always  necessary: and  un-
questionably women in general recover better after a labor rather
slow, than after such as are quick and sudden.   Hence too we
learn the great impropriety of directing the patient at this period
to assist her  pains, as  it is called, by holding her breath, and
exerting strength by forcing, straining, or bearing down ;  which
inevitably will exhaust her strength now in the beginning of la-
bor, which may be very necessary for her  support at the con-
clusion of it.   Young women  in  their first labor, are most apt
 o be guilty of this error; by which they overheat  themselves,
and may bring on fever ; it may likewise occasion the premature
bursting of the membranes, an accident too  apt to happen with*
out any such  effort, when labor begins with very strong pains,
and which will inevitably protract it."
  Having extended our remarks upon the conduct of midwives
during labor, to a length far beyond what  we  anticipated, we
now turn our attention to the remaining particulars noted at the
beginning of this section.
  2. Of the opening or dilatation of the mouth of the womb.__
This is a most important part of labor, but it is one, as has been
already sufficiently indicated, over which human  interference
can exercise no beneficial control.  It is during the period  oc-
cupied in  the opening of the mouth of the womb,  that those
cutting or grinding pains, of which we have spoken, take place.
They appear  to depend upon, or  are  in  some way inseparably
connected with, this circumstance; which  not  only every mid
wife, but every woman  should know; and as they must be born*
by all women in  labor, they ought to make up their  minds to
bear them with all the fortitude, composure, and  resignation of
i/hich they are capable. 
       CONDUCT  OF THE MIDWIFE DURING LABOR.   133

  It is  during  this period,  that most  women are assailed by
those gloomy forebodings  and presentiments of approaching
danger, and need all  the comfort and consolation that the mid-
wife can bestow, and all the encouragement that a well grounded
assurance of a happy  deliverance can inspire.  Here, too, is an
ample field for the exercise of the endearing blandishments of a
husband's love: and whose  presence, we ask, can be more ac-
ceptable, or conversation more agreeable, or kind offices more
consoling, than his, to the desponding wife?  To whom can she
with so  much  freedom, and with so much  confidence, disclose
her thoughts and unbosom her very soul, as  she can to an affec-
tionate companion who  gives ample evidence of his anxiety to
alleviate  all her cares ? A responsibility, in  this particular, rests
upon husbands, which cannot be too faithfully  discharged.
  But we cannot conceal the fact, which should long  ago have
been known, that the  many fears and forebodings to which hap-
less woman is  liable, at these periods, are  vastly magnified  in
consequence of the ignorance in which she has been unfortu-
nately kept, with  regard to the great simplicity of the process
of child-birth, or of the little assistance  which ever has been,  or
ever can be, given to  her at those  times.  Correct information
upon this subject, we believe, would relieve women of an im-
mense amount of bitter anxiety and wo, by inspiring them with
that  confidence which they cannot  possibly derive  from any
other source, or by any other means.   It  is partly to convey
those ideas of the simplicity of nature,  and  of her almost unde-
viating correctness in  operating, and  thus to inspire  that  confi-
dence which women so much need, that we have ventured upon
the  publication  of this work; and if we only succeed in this, to
the  extent of our desires, we shall feel amply compensated for
our toil.
  We are very sensible of frequent digressions from the subjects
upon which we ostensibly profess to treat;  but in this we must
be indulged.  Our object is not to  present a work purely scien-
tific, but  one that will  instruct and benefit the mass of mankind;
and, therefore, we not only make  digressions,  but repetitions,
whenever we find it  necessary either to instruct, or to make a
more forcible impression upon the reader's mind.  The peculiar
circumstances under which we come before  the  public renders
this  doubly necessary.   No  work  of this kind, ever before
published, was  calculated or expected, so  extensively and so
generally, to circulate through all ranks of the community, nor
of course, to be assailed  by so many and so strong prejudices,
as this.   We must, therefore, appear before the  world, armed
with every weapon which the limits of our  work will  admit us
to use, and which  not only our own necessity but the reader's
benefit, most imperiously requires. 
134    CONDUCT OF THE MIDWIFE DURING LABOR.

  But to return to the dilatation of the mouth of the womb.—-
This is sometimes a tedious process; it is indeed the chief im-
pediment to natural labors, as when once this important object
is effected, the labor, in general, is  soon accomplished.   The
time occupied in this process varies in different women, and in
the same woman in different labors.  It may be one, two, or ten
or twenty hours, or even two or three days.  Some women  al-
ways have short or expeditious, whilst others as constantly have
tedious or difficult, labors.   Most authors define a labor natural,
if it  terminate within  twenty-four hours; and tedious, if it  re-
quire a longer time.
  The opening of the mouth of the womb is always slow, and
often almost imperceptible, at the commencement of labor; but
is  effected  with greater rapidity  as  it advance.?.   When the
mouth of the womb is so much dilated as no longer to be felt, or
in other words, when  it is so opened as to give the  womb and the
vagina  the character of one continuous sack, the labor generally
progresses with far more rapidity, and the child is soon expelled.
But tedious delays may even now, or at any succeeding period,
take place, and the labor be protracted far beyond the midwife's
expectation;  at which, however, no  alarm need  be  taken.
The mouth  of the womb may, even at this stage, for a time
seem to contract to such a degree as to produce a belief that the
labor is going backward instead  of advancing.   This  is most
usually met with in first labors.
  3. The formation  of the bag of waters.—This is one of the
almost constant or essential phenomena attending  births, though
it sometimes fails ; as, for instance,  when the waters  are dis-
charged before labor commences ;  and occasionally the quantity
of water is so small as to be incapable of forming a bag of any
considerable size.  It is a commonly received opinion  that the
bag of  waters tends very much  to open the womb  by its passage
in advance of the child's head; but it does not seem probable
that  it  has much agency in this operation, as the mouth of  the
womb  opens, though not  equally as well, when  the waters do
not gather.  But whether  the bag of waters exercises any influ-
ence mechanically, that is, by stretching the parts, or not, it is
 rery certain that its  too early rupture always makes the labor
more tedious.  Hence all examinations should be  made with  the
utmost care not to break the membranes and thus  produce a pre
mature discharge of the waters.
   The reader will recollect that the pains of labor are at first
slight;  hence the contractions  of the womb are also moderate:
but as  the mouth of the womb opens, the pains and  contractions
become more severe,  and the membranes and waters are forced
further and further into the vagina, or in other words the bag of
 vaters grows larger and larger with every pain, until the mouth 
PLATE VI.
BOXES  OF A  CHILD'S HEAD--SEE PAGE  102.
Pig. 1.
Fig. 2.
A.—The forehead.
3—The hindhead.
0 D—The diame'er from ear to
135 
1C6   CONDUCT OF THE  MIDWIFE DURING LABOR.

of the womb becomes completely  open;  about which time
either a little before or a little after, the membranes are generally
ruptured and the waters are instantly discharged.  Though some-
times, as has before been observed, the waters are discharged long
before this period of labor;  and instances occasionally occur in
which the membranes do  not break until  the  labor is nearly
completed.
  4. The proper presentation of the child's head.  When th3
waters break and discharge, as the parts are now dilated or open-
ed, it is the  most proper time to make an examination, in order
to ascertain  the presentation of the child, whether it be right or
wrong.   And to do  this,  the reader must call to mind the de-
scription of  the child's head, and particularly  the operings styled
the fontanelles, and the seams or sutures, for a more correct un-
derstanding  of which the reader should refer to plate 6.   It will
be recollected that the proper  presentation  of the head, is the
crown ; consequently the three-sided fontanelle or opening will
be felt; and instead of the four seams or sutures which lead to
the front or four-sided opening,  there will be only three seams
felt leading to it;  or instead of the opening being readily found,
there may be a soft tumor in place of it, but  still the three seams
may be  felt  running to it.   If the four-sided opening, or any
other part of the head, except the three-sided  fontanelle,  is felt
at the mouth of the womb, the  presentation  may be regarded as
not being natural.  The only thing  to be done in such cases is,
to place the  woman in such posture as will most favor the  reduc-
tion of the child's head to its  proper presentation.   Thus, if the
fontanelle present  too high up on the front bones or pubes, the
woman must lie on her back : and then during the absence of a
pain, the midwife, with one or two fingers,  should most  gently
endeavor to  push the head a little back, and fetch it down  by ap-
plying the other hand externally on the abdomen, until the fon-
tanelle presents at  the center of the orifice of  the womb.   And
so, if the fontanelle presents either at the  right or left side of the
orifice, the woman should be placed  on the  opposite side,  that
the weight of the  child's head may assist in  bringing it to its
proper place.
  But it  does not follow, however, that because  the head may
not present exactly right, that it is necessary to offer assistance
in the manner we have directed :  indeed we  are  not sure that it
is not better in all cases  of trifling deviations,  not to meddle
with them at all.   Nature is surprisingly  provident in regulating
these things; and it is far better not to offer  any  interference at
all,  than to do it at the  hazard of doing  an  injury.   Cases of
the  very worst presentation, have been,  according to Denman,
rectified  by  the unassisted efforts of nature, even where it was
regarded as  impossible to  offer any assistance, with a rational 
       CONDUCT OF THE M.DWD7E DURING LABOR.   137

prospect of doing good.  Indeed, if women could  only knovi
the  wonderful  resources of nature in all  cases  of difficulty,
and  how much safer and better it almost always is to  trust  to
her  than to officious meddlings or human interpositions, they
would certainly dismiss the most of their fears about child-birth,
as well  as discard the too often proffered assistance of midwives.
   5.  The final expulsion  and separation of the child from the
mother,  This  is the last act  of  child-birth, though agreeably
to authors, not of labor.   The mouth of the womb being dila-
ted or open, so that the womb and  the vagina become one con-
tinuous  sack, [see plates 7,  14, and 15,) the child, propelled by
the contractions of the womb, passes slowly down through the
pelvis.  The pains now,  instead of bearing the  character of
grinding or rending, are forcing, pressing, or bearing down pains.
The  mournful depression,  and gloomy foreboding,  so often at-
tendant  upon the first stage of  labor, now give place to very dif-
ferent feelings.   The woman acquires new courage and energy ;
and instead of wishing to avoid the returning pains, as she does
during  the early stages of  labor,  she is ready to meet  and co-
operate  with them.   A  disposition is now felt to  press  down
with the pains, by which the expulsion  of the child is facilitated,
Some writers strongly oppose the propriety of these exertions
by the mother, and urge midwives to advise their patients against
it.   But these efforts  are instinctive;  they  are produced by  a
sensation  peculiar to this stage of labor, arid if nature is to be
consulted,  ought not to be discouraged.   We  have elsewhere
said, that we think it not only idle, but useless  and even injuri-
ous,  to  object to the gratification of this instinctive feeling, over
which the woman has no control.
   The  midwife should carefully  remember that nothing can be
aone by herself  to assist the woman or forward the labor; and,
therefore, she must attempt nothing.  She may, however, as is
customary, keep her hand,  or rather her  finger, to  the child's
head, in order  to ascertain its progress through the pelvis, but
nothino- more.  It sometimes happens that the head of the child
appears  to stick in the  pelvis or bones,  as it is familiarly termed,
and  the woman  will  have many apparently unavailing pains,
during which the child does not seem  to  come forward at all.
If the women is in bed, it may sometimes have a good effect to
take  another position, or if she desires it, as many women do,
she may get up and walk the floor. No danger need be appre
bended" from doing this, as, under the existing circumstances,
no fears need be entertained of any injury that might arise from
the sudden birth of the child.  When any such obstruction,  as
that  of  which wc are speaking, occurs, nothing should be at-
tempted, because nothing can be done, by the midwife, by which
it can be removed or overcome.   Nature herself is always com 
PLATE XV.
  A representation of the head in a position reversed from that of Plate XIV
By comparing this plate with the last, it will readily be seen that this position
of the head must be far more inconvenient for child-birth than that:  N<ster-
tl-eless, children are often bom in this manner, though labor is much more te-
dious and painful.—See p. 137.
  A—The anus.
  B—The external orifice of the vagina.
  C—The nymphse.
  D—The labia pudenda of the left side.
138 
       CONDUCT OF THE MIDWIFE DURING LABOR.  *139

 petont to the removal of difficulties of this kind, by giving her
 time, and to her we should always trust.
   Sometimes the pains may also die away, and the woman be-
 come easy for some time.   This, however discouraging to her
 or her friends, is by  no means a cause of alarm : neither mo-
 ther nor child will suffer by it, as the powers of the system will
 be aroused in proper time, and the labor completed.  Nature
 knows her own laws and will execute them, if let alone, in her
 own  way and in her own time; and, therefore, we need not—
 we ought not to  be impatient with her delays.
   The crown of the head at length presents at the external ori-
 fice of the vagina.   The soft parts of the mother are protruded,
 and  consequently, as the  head is pushed forward by  the pains,
 are more and more  stretched, which, of course, somewhat in-
 creases the pain; and  the  resistance  which is now offered  is
 sometimes very great, especially with a first child, but  less so
 afterwards.   The  labor may  even  be retarded for some time,
 which is very necessary,  in order that the parts may gradually
 dilate  or  become  relaxed, so that they need not be torn.   The
 perineum, which is the part between the orifice of the vagina
 and  fundament,  is much  stretched or carried forward, is  very
 thin, and is sometimes torn.  Authors on midwifery almost uni-
 versally recommend the application of the hand over or around
 the elongated or protruded perineum at this stage of labor, as a
 support to prevent its being injured.  There are some  writers
 who do not even hesitate to advise, where the labor is rapid,  to
 hold the  child back for two or three pains, by the midwife pla-
 cing her  hand against its head. We must  confess, however, foi
 ourselves, that we are not prepared fully to believe the  first  to
 be useful, or the last proper.   There are some who, with  our-
 selves, doubt the utility and propriety of both.
   We cannot satisfactorily understand how this support, given
 by the hand to the perineum,  can oppose  its  being torn.  It
 may, and certainly does, crowd the head more forcibly against
 the front  bones or pubes, and possibly takes off some pressure
 against the perineum in this way.   But then,  a few individuals
 nave advised  to push the head backward, that it may pass under
 ihe pubes with greater ease.—Again, it has not been proved but
that quite as great a proportion of women who have been deliv-
ered of their children without any assistance, have escaped acci-
dents of  this  kind, as of those who have had the aid of the best
 midwives.  Even Dr. Denman, who has labored the subject of giv-
 ing assistance, and insists  on the propriety of  offering it, says:
 " when women were delivered without assistance, I have not  in
 any case observed any considerable laceration" of the perineum.
 fcnd he concludes 't " reasonable to presume that  the frequent 
140   CONDUCT OF THE MIDWIFE DURING L.ABOR.

occurrence of it in the human species," " ought to be  imputed
to some accidental cause, or to error in conduct."
  The anonymous female writer whom we have heretofore quo-
ted,  in  her remarks  upon Denman's recommendation to apply
the  hand to prevent the  difficulty of which we are speaking,
says : " I would just observe, that in the  course of my practice
I have  not found  any occasion for such kind of interference,
although I have had a large portion of very rapid labors ;  and in
every instance, the patient has been left sound.  Nor have I ever
known amongst a very large number of children, who have been
born within the circle of my acquaintance, before a doctor could
arrive, any inconvenience to follow.  But I do not," continues
she, "justify my practice on this foundation alone; I  consider
if nature  forces a  child forward, and I put my hand in opposi-
tion, I shall insult her order as much as if I should by violence
undertake to hurry its birth."*
  We now consider the subject of the propriety  or impropriety
of the midwife's interposition to prevent a laceration of the per-
ineum, as fairly before  the reader.   In favor  of its  propriety,
are  arrayed nearly every author who has written on midwifery;
and against it, are the arguments, and  the evidence which  we
have here adduced.  The midwife, therefore, so far as our opin-
ions are concerned, is left free to act as she pleases, though  we
must confess that we incline against any interference.
  When  at length, however, the child's head is expelled from
the  vagina, the woman enjoys a short respite  from her pains ;
 ut they soon return and the body and lower extremities quickly
follow the head.   In  fact, with  the birth of the head, the wo-
man's sufferings may be considered as being over.  A few mod
erate pains at  most, often times one, will be sufficient to com
plete the birth.
  So soon as  the head has come into the world, the midwife
should*  search  with her fingers about the neck of the child, to
know whether the navel string is not wound around it.  If  she
finds it is, she must gently fetch it over from the back  of  the
head to  the face, and then wait for the pains to finish  the  expul-
sion of  the child.   And we wish this particularly to be attended

  * Since writing the above, in turning over the pages of the pamphlet from
which we have made these and former quotations, we have become apprehen-
sive that we possibly may be doing injustice to the compiler, who has, with
her judicious extracts from other authors, intermixed many sensible remark*
of her own.  The pamphlet of which we are speaking, appears, on closer in-
spection, to be composed of two, stitched together, instead of one, with the title
page of the second one torn out; and upon this page, for ought we know, may
have been  the compiler's name, which we doubt not was Ruth Stebbins.
We are thus positive, because of a certificate  of character and qualification
published in one of those pamphlets, which appears to have been given by
Mason F. Cogswell. M.  D.. to the above luned individual. 
       CONDUCT  OF THE MIDWIFE DURING LABOR.   141

lo, as some authors recommend the midwife, as soon as tho head
is born, to finish the extraction herself.  But  this is a bad  prac-
tice, and ought never to be followed nor encouraged, unless the
woman is sinking by profuse flooding.   Nature  is adequate to
the performance, and in her own time will finish her work  with-
out hazard to child or mother.
  The first important  thing, after the child  is expelled, is the
establishment  of its breathing.  For the most  part  this  takes
place immediately  after its  expulsion from the mother; some-
times, indeed, it cries very forcibly the moment the head is in the
world.   But should it fail to do so very soon after it is  com-
pletely expelled, immediate attention must  be given to  it.  Ir.
the  first  place, the child  should be received upon a w*.rm
cloth,  and be  kept sufficiently  defended from  the  air,  if the
weather  be  cold.   The finger of the  midwife should  also be
introduced into its mouth to  clear out whatever may be in it to
interrupt  the  breathing.  Its body may also be wet with cold
spirits or cold water, by suddenly dashing on  it a small quantity
of either; or the midwife may take a mouthful and spurt it from
her mouth.  In most cases, this will be all that is necessary, as
the child will generally cry immediately on applying the cold
fluid.
  But should  these means fail, the mouth must be more care-
fully cleansed,  and the  navel-string be stripped repeatedly be-
tween the thumb and finger, from the mother to the child; and
if this docs  not produce signs of breathing,  the  extraction  of
the after-birth  ought to be attempted, by very gently pulling a
the navel-string, the mother aiding at the  same time  by gentl)
bearing down.  If it can be obtained, it should be taken to the
hearth and placed upon hot embers or coals, and the navel-string
stripped, as  before  directed,  from  the afterbirth  to  the  child.
This perhaps, is the most successful manner of treating children
when still-born, as  it is termed, but not dead.
  Dr. Thomson, in what he styles a " Supplement to his  New
Guide to Health," relates his having had an agency in restoring
to life, a still-born  child, in the way last pointed out; and leaves
it to  be inferred that  the discovery was  one  of his own.  We
wish  by no means to deprive him of any portion of his  well-
earned fame ;   but, in  justice, we  must say, that the plan was
suggested by the  mother of  the woman just delivered;  who,
being an  aged  and experienced midwife, had often employed it
with success, in her own practice, in similar  cases.   The  truth
is, the same method agreeably to Denman, was known to and
adopted by the ancients; but,  excellent as it is, has been nearly
lost to the world.
  But  if the after-birth cannot be procured,  other means  must
be resorted  to.  Some  recommend  blowing into the  lungs, and 
142    CONDUCT OF THE MIDWIFE DURING LABOIt

then  press out the air and blow again.  Others, however, hav«
condemned this practice as useless.   Upon the whole, it seems
hardly worthy of much confidence.  The mouth of the child
should, however, be kept freely exposed to the air, and if the
pulsation in  the navel-string cannot be felt, it may after a while
be cut off and tied, or tied before it is cut, no matter which, and
then  the child taken to the fire.  It should now be gently rubbed
with the warm  hand, both body and limbs.   The smoke  of
burnt linen or paper, when allowed to come in contact with the
nostrils, is also valued by  some and might be tried.   A warm
bath  has likewise been used with advantage, and should be made
about blood heat, into which the child may be plunged up to its
shoulders. The means adopted, whatever they may be, whether
any or all that we have recommended, or any other, should be
continued for a long time,  as children have been known to come
to after being some time laid away as dead.
   When the child  cries  either immediately or soon after it is
born, it will in all probability need but little attention more thar
to cut the navel-cord.  By some  this  is directed to  be dona
without further ceremony, but we think it safest, at least it can
do no harm, to wait until  the pulsation in the cord ceases;
which it may do very soon, though sometimes it continues  for
fifteen or  twenty minutes.  After the pulsation in the navel-
string ceases, there will be no danger in cutting before  tying it,
as no blood could  discharge  from it, though it is universally
customary to tie it before  it  is  cut.   Different authors  recom-
mend different distances from the belly at which the cord should
be tied: but this is a matter of but little consequence.   An inch
and a half, or two fingers' breadth, is sufficient, and a  common
course sewing thread will answer to tie with; and  after it is tied,
the  cord  should be cut off about three fourths of an inch from
the string.   It was formerly customary to tie the cord in two
places, and  cut it  between the ties ; but this can be of no use
unless possibly in some cases of twins; as, if blood is dischar
ged from it, the  end may be held in the fingers.
   6.  Removal of the after-birth.  A variety of rules have been
given by practitioners with regard to the  extraction or removal
of the placenta  or  after-birth.   Almost any of  thtm  may b«
adopted, excepting those  which recommend the hasty removal
of it by force.   Unless there is flooding, there is no  need of
anxiety about it.  It may  remain in the womb for  one, two, or
three hours, or as many days,  and  has been known to remain
even  for months, without  producing any bad effect.  But in mosi
cases, the placenta will be expelled in from ten to thirty minutes.
   The placenta, during pregnancy,  is attached to some part of
the inside of  the womb, through  which a communication is
established between  the mfther and the foetus.  Now, in oider to 
       CONDUCT OF THE MIDWIFE DURING LABOK   143

 ts expulsion from the womb, this attachment must be destroyed,
which  is almost always accomplished by the contractions of the
womb to expel the child.  How do the contractions of the womb
loosen  the after-birth from its attachment ?   The womb, by con-
tracting, lessens the surface of the part to which the placenta is
attached; but as this  body does not contract, the  womb tears
itself loose, as it were, from it; and in most births, it is proba-
bly detached from the womb during the  last  pains of labor.
The number of instances must be very few, in which  this is not
the case.
  The navel-cord being cut, and the child given to the nurse or
other person to wash and dress, the midwife must  apply hei
hand to the bowels of the mother, and ascertain if the womb is
contracted or contracting.   If the womb be not  contracted, the
abdomen will fee* soft uniformly all over; but  if contracted to
the size which the placenta will admit of, a hard ball will be felt
just above the pubes, and it will often happen that the placenta
can be  immediately extracted, or perhaps may even now be ex-
pelled and lying in the vagina, without the mouth of the womb.
The navel-cord must now be very gently  and  steadily pulled,
and the placenta will most probably be soon obtained.  But if
it do not come with moderate force, there is danger of breaking
the cord, and, therefore, the midwife must desist.
  After  delaying for a reasonable  time,  occasionally pulling
moderately at the  navel-cord, without extracting it, we may pro-
ceed to offer assistance.   How is this to be done ?   Wind  the
cord around one or two fingers of  the left hand, and introduce
into the vagina two or three fingers of the right, the ends of
which are to be placed oh the cord,  when by gently pulling the
cord with the left hand and pressing on it with the fingers of the
right, the placenta may almost always  be extracted, with  but
little trouble to  the midwife and no hazard  to the woman.   But
the midwife must understand  the mechanism  of the  operation,
cr she may not by this means succeed immediately in  its extrac-
tion.   This we will  endeavor to explain in  the most familiar
manner possible.
  We  will  > uppose  a bulky  substance lies at the bottom of a
/essel  whose  sides are  perpendicular,  or  suppose it  may be
smallest at the top.   To  this  substance we  will suppose a rope
to be attached, by which it is to be drawn from the vessel.  Now
in  what manner can  this object be accomplished  with  least
possible force? by  raising it directly  perpendicular, with tie
rope in the center of the  mouth of  the vessel; or  by drawing
the rope over its edge, and at right angles with its side I Doubt-
less by raising  it perpendicularly, with the  rope in the center
Raised in this manner, the force  would  be said to be applied
alono  the axis of the vessel ; or, in  other  words,  along an 
144    CONDUCT OF THE MIDWIFE DURING LABOR.

imaginary  line through the center of the  vessel.  Now apply
these remarks  to the placenta  in  the  womb, and  the  midwife
will understand the mechanism, and the reason why the placenta
cannot always, though completely  detached from the  womb, be
extracted by simply pulling at the  cord.
  The axis of the upper strait is, from above, backward ;  and
hence it may often happen, that in  order  to  extract the after*
birth the force must be so applied  as  to carry  it backward, in-
stead of forward  as will be  the case in pulling the cord without
introducing the fingers into  the vagina.  If, on introducing the
fingers, the direction  of  the cord appears to be from  either the
right or left side, or from the back, it should be drawn in a line
as directly  as possible from  the point where it  appears to  be at-
tached or located.  It is the want of understanding this method
of extracting the after-birth, that has in most instances produced
the frightful stories about its  adhesion or growing  fast.   It al
ways adheres or  is grown fast to the womb during pregnancy,
and is almost as constantly  separated from it during labor.
  But the midwife must be cautioned against using any means
for the extraction of the  placenta, unless the womb is  contracted
into a hard ball, as before observed, just above the front  bones
or pubes ;  and even then it  is not necessary only to put an  end
the sooner  to the woman's  anxieties.  If the  bowels feel  uni-
formly soft all over, the midwife, instead of making any attempt
to extract  the placenta, should  rub the  abdomen  briskly, oc-
casionally placing one hand on each side and pressing the bow-
els together, and  sometimes grasping the belly with  the  hand.
By pursuing this course, a short time, the womb will contract,
which may be known by its hardening, under the hand, and the
hard space  gradually  lessening in  size until it becomes like a
ball at the  top of the  pelvis.  After this has taken  place, some
time should be allowed to elapse in order to be satisfied that the
womb will not again  relax; when  the placenta may  be extrac-
ted as before directed.*
  In case of flooding, the directions just given must be closely
attended to. as this difficulty is  always caused by  the  womb's
not contracting and closing  the mouths of the  vessels which are

  * The artificial extraction of the after-birth seems  so much at variance with
the fundamental principle of trusting to nature, which we have so strongly
and so often enforced, that we feel almost disposed now,  in offering the second
edition, to erase the directions for its performance from our pages. After much
reflection, however, we have concluded to let them remain, and subjoin the fol-
lowing :—Rarely, or never, attempt the artificial extraction of the after-birth
until a return of pains indicates that the womb is making an effort to expel it,
unless these should not occur for  an unusual length of time after the child is
born.  We think this the safest mode of procedure because it can do no harm,
ind is likewise sanctioned by some of the best authors, as well as being more
consistent with nature, which should always be consulted. 
PRETERNATURAL LABORS.
145
left open by the separation  of  the  placenta fiom  the  womb
Floodings of «*n alarming and even fatal character have once i.i
a while occurred without any discharge of blood from the vagi-
na.  In this case the placenta closes the mouth of the womb so
as to prevent the escape of the blood ;  and the flooding  is only
known by the woman's becoming deathly pale and faint.   When
symptoms of this  character take  place, or if the blood is dis
charged, the bowels must be instantly  examined, and the  rub-
bing,  &c. immediately resorted  to, and  continued  until the
womb contracts ;  when the flooding will cease.   The midwife
must be cautioned  against any alarm if  pains and a discharge of
blood should immediately follow the  rubbing of the bowels;
they are to be regarded as favorable symptoms of the good ef-
fects of the means employed.  For more extensive observations
respecting the treatment of flooding,  see chapter 4, section 1.
  The practice of introducing the hand to extract the placenta
is, at best, cruel, barbarous, and  dangerous to  the woman, and
we think should rarely or never be attempted.   If any circum-
stance can justify it, it must be a case  of  flooding which con-
tinues after the womb has contracted to the smallest size  that
the placenta will permit;  but cases  of this kind, if ever they
occrr, must be exceeding rare.
                       SECTION 4.

                 CF PRETERNATURAL LABORS.

   Preternatural or difficult labors are caused by almost any
circumstance out of  the usual order of  things.  Hence they
may be produced  by flooding, convulsions, fainting, weak con-
tractions of the womb, or by deformity  of the  pelvis, or unu-
sual or unnatural presentations.  The reader who is acquainted,
as every one ought to be,  with  the general principles  of the
healing art, as we have laid  them down, and with the medicine
and mode  of practice contained  in  the second  volume of this
work, scarcely need be told what course to pursue as to the medi-
cal treatment of  all the causes of difficult labor, excepting de-
formed pelvis and wrong presentations.*  We  shall,  therefore,
oiny notice, at present, the difficulties arising from wrong or un-
natural presentations ;  and these so  seldom occur, that we deem
a brief account of them all that is necessary.   The  difficulties
^rising from a deformed pelvis are so rare, that several eminenl
  • Thn medical treatment of women in labor will be found in Section 7 of
ttiif chapter
       54 
146
PRETERNATURAL  LABORS.
and extensive practitioners, in the United  States, have asserted
that they have never met with an instance in American women
in which nature was not entirely sufficient to accomplish the hv
bor without any assistance from art.
  "Preternatural  presentations," says Dr. Gooch, "are those
of the feet, breech,  and arm: writers  on midwifery describe
others, as of the shoulder and knees; but these  are only  mod-
ifications of the arm and feet presentations."   Presentations of
the back and belly have also been spoken  of, but it would seem
impossible for this to be the case ;  though the navel-string does
sometimes present.  But if we know, says Dr. Gooch, how to
manage the three  first deviations from the natural position of the
child, we know how to manage all.
  Although the midwife may suspect a wrong presentation, ye*
she cannot with certainty know it until the membranes are rup-
tured and the waters discharged.  When this takes place, by a
careful examination,  there will be but little difficulty in ascer-
taining what part  presents;  and  every part which can  present
has something to  distinguish it from every other part;  thus  th«*
hand  has a thumb, and the foot a heel.  If the feet present,  en-
deavor to get both of them, though  some  think  it a matter of
little consequence whether one or both are  brought down, as  the
shild  will be born either way.  In this case, the  labor may be
suffered  to progress in the natural  way  until the navel is  ex
pelled, when, if the  birth be not gently  hurried, the  child maj
die from the navel-cord being so compressed as to stop  the cir
culation between  it and the mother.
   Before proceeding to describe the method of assisting the ex
pulsion of  the shoulders and head, when the labor is thus far ad
vanced, we will remark, that in order to have the head in  th<
right  position to pass the upper strait of the pelvis, the toes ol
the child must be towards  either the right or left side of  the
mother.   If,  therefore, they are turned to the front  or back of
the mother, wrap a cloth around the legs and as much of  the
body as  possible, and during  the intervals between  the pains,
very  gently turn the body so that the toes  are in the right direc-
tion ; that is, either  to the right or left side.   This being done,
and the expulsion of the child to the navel completed,  pull the
navel-cord down a little way, and then commence the extraction ;
and  no time is to be lost,  for if the child be  not born in a few
minutes  it will certainly be dead;  but  the midwife should  be
cool arid deliberate, and not be frightened, or she may be in too
much haste, and  injure both mother and child.
   The extraction is to be performed by wrapping a cloth around
the breech, and  then  carefully but  quickly working the body
from  hip to hip, and minding also, as the child advances, to turn
rt with t'le belly  to the back of the mother, as this is necessar* 
PRETERNATURAL LABORS.
147
10 accommodate the head to the lower  strait of the pelvis.  As
soon  as the sho llders are born, pass the fore finger from  the
shoulder,  which is at the back of the mother,  along the arm to
the elbow, and fetch the arm and hand down;  then proceed to
extract the other as  soon as possible.   When this is done, pass
up one finger along the breast of the child, introduce it into the
mouth, and press  the chin down towards  the breast, with th6
other hand raise the child towards the pubes of the mother, ex-
tracting at the same time downwards and forwards,  and the de-
livery will be readily accomplished.
   If the breech presents, it will be ascertained after the discharge
of the waters, by the peculiarities of its  shape, and by the organs,
of generation, especially if it be a male.   The  efforts of nature
are almost always sufficient to  accomplish delivery in cases of
breech presentations; though in many  cases it  may be tedious
When the breech has  advanced  low  down, some assistance may
be given by passing one or two fingers  of each  hand into eithej
groin, by which the midwife will be  enabled, with perfect safety
to render  any assistance which may  be necessary.  Or whei
still lower a  handkerchief may be  passed over the groins, bj
which the necessary aid may be more easily afforded.  The legs
are not to be  brought  down in this case as  the arms are ; but it
must  bs borne in mind, that if the belly is not towards the back
of the mother, the child must be turned in proper season to fetch
the face to the back,  to favor the passage  of the head  through
the lower strait of the pelvis.
   When the feet and body as far as the navel are delivered, it
then become---: necessary to use  the same caution and expedition
in completing the delivery that is used in the presentation of the
feet.
   Wh?n the shoulder or the arm presents, the child lies across
the pelvis ; and sa long as it continues in this position,  delivery
is impracticable.   The arm may readily  be distinguished by
feeling the hand and fingers ; but the shoulder is not as readily
known,  being liable,  from its  softness, to  be mistaken for  the
breech.   By  a careful examination,  however, the midwife may
be fully satisfied.  In extending her finger around, she will be
able to distinguish the shoulder-blade, the neck, the arm-pit, or
the arm.   When either the shoulder or arm present, it is almost
always considered  a sufficient reason for turning the child, and
fetching it by the feet.
  The time for turning is immediately after the waters are dis-
charged and the mouth of the womb well opened.   Though it
sometimes  happens,  that by pushing back  the presenting part.
and keeping it so,  the pains will force the  head into  the pelvis
and make it unnecessary to turn.   But should this fail, an at-
tempt must be made to nach the feet, and bring  them down 
148
TWINS.
ind the first thing is to decide upon which hand the midwife
shall employ.   If the palm of the child's hand is towards the
abdomen of  the mother, then use the right hand, which must be
passed up the front part of the womb; but if the back of the
child's hand  occupies this position, then use the left hand, which
must be passed up the back part of the womb.   These precau-
tions are necessary that the midwife may the more readily arrive
at  the feet, and be enabled to bring them down in the proper
manner.   But if it be found on introducing one hand,  that the
other  will do better,  that must be withdrawn and  the other in
troduced.
  When the operation of turning is determined upon, the hand
is to be smeared with lard,  then compressed or contracted into
its smallest  possible  size,  and in the most  gentle and  gradual
manner introduced into the womb ; and the greater the resistance,
the more gentle and  slow should be the introduction.  During
the time of a pain the operation  must be stopped, and only be
performed during the intervals between the pains.  Whenever
the womb contracts,  the fingers and hand must be made as flat
as possible lest the womb should be injured by contracting upon
an uneven surface.   Having reached the feet, endeavor to bring
both down at once; but if this cannot be done, fetch one  at a
time,  but be sure and get  both.   Remember also  to fetch them
down by the face instead of the back, or  there will be much
danger to  both  child and  mother.  When the feet are  thus
brought down, some authors recommend the immediate extrac-
tion by force,  whilst others leave it to nature; but in  this the
midwife must be governed by circumstances.   If the woman is
not exhausted, and the pains indicate a prospect of delivery, the
labor may be suffered to go on, and must  be conducted in th \
same manner as when the feet present; but if the woman has be
come  much exhausted and  feeble, the delivery should be hasten
ed by the midwife.
                      SECTION 5.

                        OF TWINS.

  Cases of twins sometimes occur, though they are  not ve: y
frequent.   And although much anxiety is sometimes felt by wo-
men from suspecting themselves pregnant with twins, yet there
can be no positive evidence of this fact, when it even exists, pre-
vious to the birth of the first child.  If the abdomen of the wo-
man be very large and the child small, with only a trifling dis-
charge at the rupturing of the membranes, there is then reason 
          MEDICAL TREATMENT OF THE CHILD.       149

to svt»pect there may be another child.  And if, on applying the
hand to the abdomen of the mother, after the b:rth of one child,
it still  feels large  and hard,  there can be but little doubt that
there is another.   In this case, the navel-cord should be tied in
two places and  cut between the ties, as the  two after-births
may be so connected that a flooding might take place from the
cord of the first child.
  Sometimes, after the birth of the  first child, the pains cease ;
whilst at others,  they are very soon renewed, and labor goes on,
and is to be conducted in every respect as if it were an original
labor.   There should be no attempt made to extract the placenta
after the birth of the first child,  but always wait until the second
child is born, when both placentas,  if there  be two, will be ex-
pelled, at the  same time.  The same general principles and mode
of conducting the labor and removing the  after-birth will be
proper when there are twins, that have been recommended when
there is but one child.
  After the first child is born if the pains do not soon return for
the expulsion of  the second, rubbing the abdomen as recommend-
ed for the expulsion of the  placenta, should be resorted to in or-
der to stimulate the womb to contract;  and in every other respect
the labor may be conducted for  each child separately as directed
for single births.   It may,  however, be recollected, that in case
of twins, one presents the  head, and the other the feet.   (See
vlate 16)
                       SECTION  6.

            medical treatment of the  child.

  This is a subject upon which much has been written, and the
necessity  of  administering something much insisted upon by va-
rious authors.  Gooch recommends giving a tea-spoonful of cas-
tor oil " nearly as soon as the child is born,"  for the purpose of
purging the meconium; Ewell directs this on the second day,
if other means fail; and Dewees advises a little melasses and
warm water, and on failure of this, to give the castor oil.   Oth-
ers  again  recommend more drastic and irritating medicines, by
which no  doubt much evil has been created, and many children
destroyed.
  We would bv no  means positively reject the castor oil or some
other mild physic, such as the melasses and water, or butterfly
root, if absolutely necessary ; but if laxative  injections are oc-
casionally administered when the bowels df> not move naturally,
«at'nrtic medicines given by  the mouth, will very rarely be 
PLATE XVI.
twins—see page  414.
  This plate exhibits a front view of twins as they appear in tha womb at th«
beginning of labor; the front part of the  abdomen, womb, and membranes
being removed.
  A A—The upper part of the innominata, or side bones of the pelvis.
  fi—The acetabulum, or socket which receives the head of the thigh bone
  C C—The lower part of the os innominata.
  D—The extreme point of the coccygis.
  E—The lower part of the rectum.
  F F—The sides of the vagina.
  G—The mouth of the womb, a little opened.
  H—The lower part of the womb, filled with the waters which descend be-
low the head of the child that presents.
  11—The two placentas attached to the back  part  of the womb, the two fe-
tuses lying before them ; one with its head presenting in a natural position at
the upper strait of the pelvis: the other with its head at the  fundus  or upper
part of the womb.   The body of  each child is represented as entangled in its
proper navel-cord, which is often the case with either twins or single children
  K—A part of  the membranes of one of the children.
           150 
       TREATMENT OF THE MOTHER DURING LABOR.   151

necessary.—Introducing the stem of a tobacco leaf smeared with
lard, into the rectum, for a short time, will often answer  every
purpose of giving physic or administering injections ; or instead
of a tobacco stem,  a piece of paper nicely rolled up and smeared
with oil  or lard, may be substituted for the tobacco  stem, and
will do very well.
  If the   child,  however, is applied to the mother's  breast,
whether  there is any milk or not, there will generally be no ne-
cessity for physic of any kind.   There is. even before the milk
is secreted, a  fluid found in  the breasts, which, as well as the
first milk, is of a purgative quality ; and as it is a more natural
so it is a more' suitable material to act upon the intestines than
the mildest medicines we can employ.   Moreover, the frequent
application of the  child to the breast, has a tendency to excite
the flow  of the milk much earlier than would otherwise be the
case.
  But if  a new-born child appears to be indisposed, evincing by
its appearance and actions that it is suffering much inconvenience
or loss of health, we should proceed  to treat it as we  would a
grown  person; give it a tea of the diaphoretic powder,  with
cream and sugar;  an emetic of the tincture of lobelia; keep  it
warm and make it sweat; there can be no better way than this ;
to manage in every respect  upon the same principle  that we
would  in case of an  older  person.   We pursue this plan uniform-
ly,  having frequently vomited children of but a few days old,
with the  happiest effects. The quantity of medicine to be given
must, to  be sure, be very small,  proportioned to the age of the
infant; but enough should be administered to produce the desired
effect.
  A stoppage of the urine is an affection that sometimes take-j
place with infants just born.   The common remedy for thii
difficulty is a tea made of the seeds of water melons or pump-
kins, and it almost always  answers the purpose.
                       SECTION  7.

     MEDICAL TREATMENT OF THE MOTHER DURING LABOR.

  The introduction of this important subject at the close of the
work may seem, and perhaps is, out of place; but as we have
not any where  else given directions respecting it, we must dc
it here.
  In the first place we will remark, that every necessary atten
lion ought to be paid to the woman's health  previous to the en 
152   TREATMENT OF THE MOTHER DURING LABOR

pected time of her confinement, so that she may be  in the best
possible condition for sustaining herself during labor.
  When she begins to experience pains resembling those of
 abor, she should drink occasionally of a tea of the  diaphoretic
powders, or anodyne powders, in sufficient quantity  to keep the
skin very moderately moist.  This has a tendency to relax the
parts concerned in  the passage of the child's head, as well as to
give strength  and energy to the mother.  If the  pains be  un-
timely, it will aid  powerfully in allaying them ; or  if they are
timely and not sufficiently strong, it will increase them, and for-
ward the labor.
  Dr. Thomson recommends the leaves of the red  raspberry, as
being the best thing he  ever used as a medicine for women in
labor.  He directs them to  be steeped and made into a strong
tea, adding to it a little cayenne to make it stimulating, of which
the  woman must drink freely and  frequently.   If  the pains are
premature, it will remove them ;  or if  timely and feeble, it will
stimulate the womb to more vigorous contractions, and facilitate
the  labor.  We  have  had some experience in the  use of this
medicine, and find it very good; but it does not.appear to merit
all the praise  that Dr. Thomson has bestowed upon it.
  In most cases of labor, what has already been recommended
will  be sufficient; but  when  any untoward  symptoms arise,
more active measures must be pursued.  If the pains are severe
but  unavailing, the quantity of cayenne must be increased, and,
if necessary, the steam bath and injections should be employed.
After  pursuing  this course  for a reasonable time, without miti
gating or removing the  symptoms, a fvll course of medicine
should be resorted to.   Most women unaccustomed to our prac-
tice, perhaps, may be  startled at the idea of a woman in  labor
taking an emetic, but it may be done with perfect safety. Emetic?
of lobelia have frequently at such times been given, not only
without any injury, but with the very  best effect.
  If the parts concerned are slow in dilating, or if they oecome
dry, swelled, or inflamed, the woman should sit over a hot steam,
long enough  to  produce a free perspiration, taking  cayenne 01
some  other stimulant  article to assist  in producing it.  If con-
vulsions or fits occur at any time during or after labor, or at any
other period, a tea-spoonful, or more, of the anti-spasmodic tinc-
ture should be administered, and repeated, if necessary, unt;J the
removal of the spasms, which we believe will always* take place
<vhen enough of it is given.  This tincture may also be admin-
istefed in case of any unnatural, uncommon, or alarming symp-
tom  suddenly taking  place  during labor; and will often, when
the  pains seem dying away, or the woman is faint or exhausted,
arouse the drooping energies and restore the powers of nature.
when nothing else  will. 
        TREATMENT OF THE MOTHER DURING  LABOR.   153

  When floodingg take place, a great deal will depend upon the
free use of cayenne, and keeping the skin moist.   The cayenne
may be given in  large doses with strong birth-root or witch-
hazel leaf tea, and repeated according to the violence or urgency
of the symptoms.   The other means heretofore  recommended
in cases of flooding  should also be employed.
   Dr. Smith recommends the partridge-berry, above every thing
else, as the means of regulating the process of labor; relieving
pains when untimely, or increasing them when too feeble.  He
also advises the use of this  article for a week or  two previous
to the expected time of confinement, as a means of rend* ring
labor safe and easy.  He says he learned the use of this valuible
medicine from  the  Indian women, who employ it in this way
He, however, recommends it in combination with another article
with which we are unacquainted;  but says it answers almost as
well alone.  It may be used in tea, at discretion.
   The blue cohush  is an article highly recommended by Peter
Smith, for pregnant women at the time of labor, as well as  pre-
paratory to this event.  If the pains are untimely, a tea of  this
root will relieve them; but if timely, and the pains insufficient
or labor lingering, it will stimulate the womb,  and hasten,  in a
safe manner, the delivery.   In like manner, if the pains are se-
vere, but ineffectual, it will  moderate their severity and make
them  more efficient.  Or if cramps or spasms in any part  take
place, it will remove them, being, as Smith says, "the best anti-
spasmodic in the compass of medicine."
   " But the great benefit," says he, " is the state of safety and
of speedy  recovery that the mother experiences afterwards."
   The  root is  to be made into a tea, a small handful to half a
pint of boiling water, pour off and give the half of it, and then
add more hot water, until the strength of the root is exhausted,
repeating the dose every ten or twenty minutes 
RECAPITULATION;
 GIVING A CONDENSED  VIEW OF THE  PROCESS OF LABOR, AND  Ol1
        THE OFFICES TO BE PERFORMED BY  THE  MIDWIFE.

   1.  If a pregnant woman, about the time she expects to be
 confined, feels slight pains in her back, shooting forward to the
 pubes or front bone, and down the thighs, with intervals of ease
 between them, and the pains gradually increasing in severity,
 she will  have good reason to suspect that her labor is approach-
 ing.  And if, in addition to these symptoms,  there has been a
 unking down of the belly, or womb, and a discharge of mucus
 from  the vagina  for several days, she may with still more  cer-
 tainty be assured that her travail is commenced.
   2.  If  she feels  any doubts whether her labor is really ap-
 proaching, she may take, occasionally, a  dose of the anodyne
 powders, cayenne, or  any other article recommended to regulate
 the pains of labor, sitting by the fire, to  promote perspiration.
 The  partridge-berry or winter  clover, and blue cohosh, have
 been  highly extolled  in these cases, and are probably very use-
 ful.   But we  have generally depended  upon  the cayenne  in a
 tea of the  raspberry leaves, bayberry, or  diaphoretic  powders.
 If, by the use of any  of these articles, the  pains gradually sub-
 side,  nothing more is  necessary ; but if they are increased, and
 become pretty regular and sharp, such help as may be desirable
 or convenient should  be called in.
   3.  When the  midwife arrives, it is customary to make an im-
 mediate examination ; though this is by no means always neces-
 sary.  Common usage, however, sanctions the custom;  and if
 the pains are urgent,  the woman, as well as her friends, may be
"anxious  to have  it attended to ;  therefore, if insisted on, and the
 midwife think proper, she may proceed carefully to  its perform-
 ance.   For this  purpose, the woman may stand up, lie in bed,
 or sit in a  chair.  If  she stands on her feet, she  should have
 them somewhat separated, leaning a little forward, supported by
 the back of a chair or an assistant,  and  her knees a little bent;
 if she sits on a  chair, she must  lean back considerably and slip
 so far over the edge of the seat  that this shall  offer no impedi-
 ment to the examination ; or if in bed, she may lie either on her
 back or side; and if  on her side, her knees must  be drawn u^
 towards the abdomen with a pillow placed  between th< c  to
 keep them  separated; and  if she lies on  her  back, she  should
 have a cover1**., auilt, or sheet,  folded narrow so that it mav hn
             151 
RECAPITULATION.                 155
placed under tla.3 hips to elevate the breech a litLe from the bed,
having her  knees also flexed or drawn up.   When the woman
is  properly  adjusted in some  one of these ways, the midwife
may proceed to irtroduce, in the most gentle  manner, the fore-
finger of the right  or, if she prefer it, of the left hand, into the
vagina, and  there search for the mouth  of the womb.  On the
retuir. of a pain, if labor has actually commenced, the mouth of
the womb will be felt to dilate or open a little ; or if it does not
sensibly dilate,  the lips or edges of the opening, when the pain
is on, will be felt very sensibl) to  grow thin, and as soon as the
pain ceases, the edges will become thick and rounded, and have
a kind of puffy or spongy feel.    But  if labor is  not  actually
commenced, none of these changes will take place in  the mouth
of the womb, which, in that case, will be hard and unyielding
to  the touch, and  no way affected by the  pain.   Sometimes,
however, the mouth of the womb will  not readily be found at
the first introduction of the finger; and then it is to be suspected
that it is turned backward.   In this case the finger must be  fur-
ther introduced, and  if the open mouth  can be found, introduce
the end of the finger a little into  it, and  bring it forward to its
proper place. If, however, it cannot be reached without so much
violence as  to make the woman complain, two fingers may be
introduced, and, by using  a little dexterity, first with  one fingei
and then with the other, it may be gradually brought  forward.
  4. The midwife being  satisfied that labor has actually com-
menced,  and every thing, so far  as  the examination  enables
her to know, is  right, the woman may take such moderate ex-
ercise as she chooses, or  she may sit, lie, or pass  away the
time in any  manner most easy and agreeable.   If the labor pro-
gresses slowly, she may take some article of medicine, such as
tansy, pennyroyal, red raspberry, 6r bayberry tea, with, from
one-eighth to one half a tea-spoonful of cayenne pepper in each
dose, or she may take the tea without the pepper; or she may take
any other article  hereinbefore recommended  in cases  of tedi
ous labor.   It should, however, be borne in mind by both  wo-
man and midwife as well as by all concerned, that slow labors in
general end  better than those which are quick, and are less liable
to  be attended by any bad consequences.  The cause of this is
very obvious:—In tedious labors the parts which must necessarily
be dilated are more gradually subjected to this process, than they
are in speedy labors, and hence far less liable to be injured.
  5. When  the mouth of  the womb has become fully dilated or
opened, or about this  time, either before  or after, the membranes
are generally ruptured, which is called  breaking  of the waters,
which are then  discharged.   This is the proper time to make
an  examination  for  the  purpose  of ascertaining  whether  the
child presents naturally or  properly.   There  is new a longer 
156
RECAPITULATION
intermission  of pain;  the parts  are fully dilated,  the  watm
out of the way, and the best possible opportunity presents for
ascertaining the exact position of the child; and if wrong, now
is the proper time to attempt righting it.
  6. The position in which the woman is placed for the com-
pletion of labor may be left to her own choice, as she will,  in
general, know best what position is most agreeable.  " Indeed,"
says Velpeatj, " a strong and well formed woman may be  de-
livered in any posture, on a chair, on the floor, a bundle of straw,
on  foot,  and  on all kinds of beds," to which we will add that
some prefer resting upon their knees and elbows on a quill or
carpet.   If she becomes restless in, or  dissatisfied  with, one
position, she  may  take any other that she may choose.  But
the most common situation is lying on a bed; and  most women,
if left to their  own choice, will, especially during  a  pain, place
themselves on the back, with the knees drawn up.
  We cannot suspect so much ignorance, either in the midwife
or others who  may be called upon as assistants, as  to deem it
necessary to describe, in detail, each or any particular method
of  arranging  the bed or other contrivance for the  accommo-
dation of women  in labor.  We  will, therefore,  only remark,
in  general terms, that if she  prefers  lying  on her back,  a
cushion, folded sheet or blanket,  or somethirg of  that kind,
should be placed under her hips so that her  bottom may be
clear from the bed that it may not interfere with the passage
of the  child.   The back should also be supported  by passing
around it along towel or sheet folded narrow, an assistant hold-
ing and pulling each end during the pain.   If the woman prefer
lying on her  side, an assistant may either sit on  the bed in
contact  with her back, or she may press against it,  during  the
continuance of the pain, with her hands.   A folded  blanket, or
something of that kind, ought  also  to  be placed immediately
under the woman's bottom, to receive the discharges, to prevent
wetting and soiling the bed; and the better to protect the woman
from the disagreeableness  arising from  her own clothes get-
ting wet and  soiled,  she  may have  a sheet, folded  to a proper
size, either  fastened around  her waist or spread  under her,
and after delivery removed.  As a further protection, her linen
may also be carefully tucked up, minding to observe the utmost
decency, to avoid any exposure of  the woman.
   7. The proper time for the  woman to place herself on the
bed of labor, or in such posture as she may prefer, to be deliv-
ered, must be left to her own choice.  Most women, however,
will desire this situation previous to the breaking of the waters.
But they must be allowed to rise when they please, or to roll
from side to side, which almost all women are  inclined to do,
tnd man\  especially in tedious labors, will even desire it when 
RECAPITULATION.
157
the child  is very far advanced; in which cases they are to b«
allowed to follow the dictates of their own feelings, as by doing
so the labor is frequently accelerated, and brought to a mor« spee-
dy termination than would have been the case by confining her to
a situation which has become irksome and unpleasant.  But we
must  again observe,  for the benefit of those who may become
impatient  or alarmed in  consequence of the tediousness of labor,
that there  is less real danger to apprehend in such cases than it
those  which are remarkably speedy.
   8. The woman having taken to her bed and the waters being
discharged, or even sooner  if much insisted upon, the midwife
may introduce a finger into the vagina, and if the head  presei.t
properly,  nothing more  is necessary than to note the progress
of the child so  as to be ready to give proper care  to it when
the head comes into the world. So soon as  this takes place, the
midwife should search with her fingers around the  neck of the
child  for  the navel-string,  and if she finds  it she should gently
fetch  it over  the head from  the back to the face.  Then wait
until the pains expel the body of the child, having a warm cloth
to receive it upon, and by no means attempt to take it away by
force.   When this is accomplished, the next thing is to attend
to its  breathing.  In most cases, however, the child will give
ample evidence by its cries, that no attention to this matter is
necessary. But if it does not, it must immediately be examined.
If there  is  a  pulsation or beating in the navel-string, but little
danger need be apprehended so long as it continues ; but if there
 s no  pulsation and the child's body flaccid or soft and yielding,
 he event  will then be doubtful.   In all .cases  the  mouth must
be carefully wiped out as far as can be reached, with a piece of
rag, or some such thing, on the little finger, and then dash upon
its body a little cold spirits or water.   If this does  not  induce
breathing turn the face downward and hold the feet, legs, &c,
upward, and at the same time gently  shaking it, which may
possibly loosen the mucus that interrupts its breathing, and allow
it to  flow from the mouth ; after this  again wipe the mouth as
before directed.   The navel string may also be stripped between
the thumb and finger from the mother towards the child, or th«
after-birth may be taken and placed on coals, and the same pro-
cess repeated, for some time, or until breathing is produced.
   Breathing being established, and pulsation in the navel-cord
having ceased,  a string must be firmly tied around it, abou\
an inch and a half or  two inches from the belly of the child;
and if twins are suspected, another tie, about  two inches from
the first, must be made, and the  cord  cut  with a  pair  of scis-
sors between them.  Some writers recommend  two ties in all
cases, though this  is seldom  necessary; but to  ensure the
greiter safety  it might always be done. 
158
RECAPITULATION.
  6. The  child  being separated from the motrn'r it mus be re-
moved from the bed, and  attention  next  given to the txtrac-
tion  of the after-birth.   This  should almost always  be  per-
mUted to  take  place  spontaneously,  as  nature, in  her  own
operations, is the best guide and should, therefore,  always be
consulted.  At least, there  is,  in general, most safety in allow-
ing the  after-birth  to remain until the contractile powers of the
womb expel  it into the vagina, whence it must be removed by
the midwife into a chamber pot, and deposited behind the fire,
or buried in the earth.
  If, however, flooding takes place, which may be  known by
the discharge  of blood from  the  vagina, or by the woman's
becoming deathly pale and faint, the bowels should then be rub-
bed briskly with the hands, occasionally grasping the abdomen
by closing the fingers, and also by pressing  upon the bowels.
If the woman complains of pain, it is an evidence that the fric-
tion or rubbing, &c. is producing the desired effect, as the pain
is caused by the  contraction of the womb ;  which as it contracts
closes the mouths of the bleeding vessels,  and also  expels the
after-birth.   An  assistant should also at the  same time prepare
and administer to the woman a dose, consisting of from half to
a whole tea-spoonful of cayenne in a tea of some of the astrin-
gent articles, if  there be any at hand,  if not, in water either
warm or cold.  This will stimulate the womb  to  contract and
thus arrest the flooding.   Tying a bandage around the bowels
immediately after the birth  of the child,  and before the placenta
is extracted, is highly recommended by a  late author, as a means
of preventing fainting and flooding by the  support which it affords
the relaxed abdomen; and there is no doubt it is worthy of con-
sideration.
   10. The woman being  delivered, a cloth well aired should
be applied  to absorb the discharges, and  then, if she is not too
weak, she may be  assisted to rise upon her feet and every thing
which is wet or  soiled must be removed, the bed prepared, anC
she placed  in it.
   We have now completed a regularly connected account of
the common management of child-birth,  such as will most usu
idly  be necessary on ordinary occasions.  We  are well awart
that our directions are only general, having left  many minute
parts unnoticed; but as  they are  mostly such as will readily
suggest themselves, or are every  where known, we thought it
better to omit going into detail for fear of burthening   the mind
by too much prolixity.   We will therefore close this  subject by
observing that a little  experience  in midwifery, as  in every
thing else, is of more value than much  reading, however gi mi
 may be tht advantages of books. 
PREVENTION OF CONCEPTION.
159
INFALLIBLE RULES FOB PREVENTION OF CONCEPTION AND CONTBOH
                         OF OFFSPRING.

  How mat conception be prevented ?  There are many reasona
why it may become very important to prevent the frequent or even
entire recurrence of child-bearing; can this be done with due regard
to health and safety ?  It can.
  For  the  better understanding of the rules we now give for this
purpose, we refer the reader to ChapterVII,Seel, for  explanation
of the philosophy of conception; and it at once occurs to the mind
that the same precautions for securing a desired pregnancy are to be
observed for avoiding it.  It follows, then, that it is simply necessary
to abstain from the sexual act during that period in which tlie egg is re-
tained within the womb.   The result  of a large  number  of observa-
tions demonstrates  that the egg is  discharged  from  the first day
after the cessation of the menses to  the  thirteenth, but in the great
majority of  cases  it passes away from the  fourth  to  the ninth.  If
connection, therefore, be  deferred until the fourteenth  day, it can
not be productive of offspring;  and for  all practical purposes, absti-
nence from eight  to twelve days would be  entirely sufficient  in the
great majority of  instances.   And even  this period may be abridged
by ascertaining the period of  the discharge of the egg, which each
female may do for herself, without  great trouble.  When it passes
away there are usually slight pains through the region of the womb,
with an increase of mucous discharge from the vagina, and the egg
comes away as a small clot, to all appearance such a mucous clot as is
thrown  off from  the  lungs by expectoration during  a  slight cold.
The egg is in the center of this clot,  and may discerned by the
microscope.   Now the period of this discharge is quite uniform with
each female ; the period at which it passes away  at one  time is tht
period at which it almost always passes  away with that  female, and
when once discovered,  the rule given above may be changed  to ab
stinence until the clot has passed away.  The observance of these rule*
is infallible and philosophical, and infallible because philosophical.
             OTHER MEANS, WITH THEIR OBJECTIONS.

  Other means have been used to prevent conception, and in many cases
they are successful, but all are liable to serious objections.
  Thus we have the cundrum  or sheath worn by the male to retain
the semen ;  this is inconvenient and unhealthy, because it is desir-
able that the sexual act should be complete,  and even for the health
of the female  there appears to be a necessity that the seminal dis
charge be  received into the vagina.  Rome wear a  soft sponge, \yith
a string attached, to receive the semen ; this  is manifestly not always
certain.  A great variety of injectijL^ have been directed to  be used
immediately  after the sexual act; thus,  cold water, solutions of
alum, zinc, and various other arjcles.   In many instances these will
lecure the end desired, but they are objectionable frorx. iheir freque v 
160                   FOOD FOR THE  SICK.
 uncertainty and  inconvenience, while many of the articles advised
 are  absolutely hurtful.    Dancing, and other forms  of violent exer-
 cise, immediately after the sexual act, are pursued by some to pre-
 vent conception; these  are  uncertain.   If the  conjugal act be  not
 carried to eDtire completion,  but by a strong mental effort be  termi-
 nated  before, of course impregnation  is  avoided.   This  requires,
 however, great  presence of mind, and if repeated frequently exerts
 a deleterious effect on the male in the same manner as does onanism.
 We return, then, to the  two rules already given, as  sure,  healthy,
 and in accordance with strict physiological laws.
   1st, abstain from intercourse for fourteen days  from cessation of
 menses ;  or, 2d, ascertain the period of the discharge of the  egg clot,
 and observe abstinence  from appearance of menses until after  the
 discharge of clot.


                    FOOD  FOR THE  SICK.

  Water Gruel.—Mix a table spoonful of  corn meal with  half  as  much
 wheat  flour, and a sufficient quantity of cold water to make a thick  batter j
 stir it into a pint of boiling water; season it  with salt, and let it boil ten or
 fifteen minutes. An excellent diet for a weak stomach and after an emetic.
  Rice  Gruel.—Take  a table spoonful of soft boiled rice;  add to it half a
 pint of new milk and boil five minutes.  The above may be made without milk,
 by taking a tablespoonful  of rice flour and stirring it up with five  times as
 much cold water, then add the whole to a quart of boiling water, letting it  boil
 ten minutes.  Loaf sugar and nutmeg may be added if agreeable to the taste.
  Milk Porridge.—Mix a  table spoonful  of  wheat flour with a little  cold
 water, carefully making all the lumps fine; then stir it into a pint of boiling
 milk, and let it boil five minutes, constantly stirring to  prevent its burning on
 the bottom or sides of the pan.
  Toast Water.—Take a thin slice of bread, toast it brown on both sides;
 put it into a small pitcher or bowl, and pour on boiling water.  Sweeten with
 white sugar.   An excellent nourishing drink in fevers.
  Barley Water.—Take two ounces of well washed barley; put  it into  a
 sauce pan with a quart of water and a few raisins or  some lemon peel; let it
 boil  slowly until the water is half evaporated; then pour off and drink while
 hot.  The boiled barley may be eaten with sugar instead of rice.
  Wine Whey.—Stir into a pint of boiling milk two  glasses of wine; let it
 boil a minute, then take it from the  fire; and after the  curd has settled, pour
 off the whey, and  sweeten to suit  the taste.  Good in the  low stages of  Ty-
 phoid and other fevers.
  Cocoa.—Boil two ounces of cocoa shells in a quart of water an hour, a lit-
 tle milk may be added when the patient can bear it.  This is not as rich as the
 ground cocoa, and is less likely to disagree with the stomach.
  Beef Tea.—Take half a pound of lean, fresh beef in thin slices; put it into
 a pot, cover it with water and boil an hour.  It may be seasoned with salt and
 pepper.  Chicken tea may be made in the same manner.
  Another Method.—Broil a slice of beef steak thoroughly; then cut it into
 Bmall pieces, and boil it half an hour in a little water;  seasoning, same  as  for
 the above.
  Mutton Broth.—To a pound of mutton allow a quart of water; let it boil
 an hour and a half, adding a cupful of rice in time to be cooked.  Sometimes,
 potatoes and turnips cut fine are  boiled with the meat. Broth from  chicken,
 veal, or beef may be made in the same manner.
  To prepare tea from aromatic herbs.—Put the dried or green herb into
a bowl or pitcher and pour on boiling water, let it stand on the stove  or by the
fire half an hour, the vessel remaining closely covered.  Infusions  of baim,
 mint and other herbs, made in this manner, furnish pleasant  drinks for  the
Bick, and also a convenient medi un for the administration of stronger reme-
dies, such as tinctures, etc. 
CHAPTER 10.
DESCRIPTION
MEDICINES  RECOMMENDED IN THE  WORK.
                                    LOBELIA  INFLATA —
                                 Lobelia.  The Lobelia is ona
                                 of the most valuable of medi-
                                 cal plants, and is now gener-
                                 ally known by the  people aa
                                 well as the profession through-
                                 out the  country.   It is the
                                 most prompt, certain, and safe
                                 emetic now known, and is re-
                                 markable for its antispasmodic
                                 and relaxant properties.  In-
                                 deed,  its chief value in mid-
                                 wifery is on account of these
                                 last  named  virtues.   Every
                                 part of the plant is employed
                                 for the same purposes, but the
                                 seed is the most powerful.  It
                                 may be employed in powder,
                                 tincture, or concentrated ex-
                                 tract.  The dose of the latter,
                                 as an  emetic, is 5 to 10 drops;
                                 that of the powdered seed, a
                                 tea-spoonful;  and that of the
                                 powdered  herb  or  tincture,
                                 from  one  to  four times aa
                                 much, taken alone or in com-
                                 bination with other emetic sub-
                                 stances,  or some  stimulating
                                 and astringent tea, as that of
                                 Bayberry or Boneset.  As an
                                 expectorant, relaxant, or anti-
                                 spasmodic, it is taken in nau-
seating doses of say quarter of a teaspoonful, often repeated.

  POLYGONUM;  HYDROPIPER — Smartweed; Water-pepper.
Smartweed is a good emmenagogue if it is employed without being
heated as by decoction, &c.  It should be used by infusion or in the
form of powder.   The leaves are the part employed, and may be
prepared in any form desired if not heated.  The dose is a teaspoon-
ful of the powdered leaves, or a table  spoonful of the tincture, or
wine fflass full of the cold infusion of the herb.
                                         161
Lobelia Tnflata 
162
MEDICINES.
 EUPATORIUM PER.
FOLIATUM — Boneset,
Thoroughwort.   Bone
set  is  a very common
plant, growing in  mead-
ows  and  wet   placei
throughout  the States.
It  is  emetic, laxative
diaphoretic, relaxant, and
somewhat  tonic.   It  is
employed to promote the
operation of Lobelia, as
an  emetic  and relaxant,
and is  given  as a nau-
seant  in febrile  affec-
tions and in tedious la-
bors, to relax the system.
It is also  useful  as an
emmenagogue, in  cases
of painful  and irregular
menstruation.   It is usu-
ally taken in the form of
an infusion, or pills made
of the extract, in  doses
as large as is agreeable
with the stomach.

 GERANEUM MACTJ-
LATUM —  Cranesbill.
The root of this species
of geraneum is one of our
best and purest  astrin-
gents, useful in all cases
where astringents are in-
dicated.  It is commonly
employed in the form of
infusion.
Queen of the Meadow.
  EUPATORIUM  PURPUREUM— Quern of the Meadow.  The
root of this plant, which is also called Gravel Root, is one of our
best diuretics.   It is used in strong infusion, taken freely.

  APOCYNUM ANDROSiEMIFOLIUM —Bitter-root. This arti-
r,le, which is also called Dogsbane, and  Wandering Milkweed, is a
plant  of great value as a medicine.   The bark of  the  root  ia
employed in the form of powder, tincture or extract.  The medicine
is a laxative tonic very useful  in obstetrical practice as a means of
keeping the bowels  open during confinement.  It is tonic and will
promote the appetite and the general strength of the patient.  The
dose  of the powder is ten grains or about two-thirds of a tea-
jpoonful. 
MEDICINES.
163
  NYMPH45  ODORATA— White  Pond Liq.   This species of
                                                  the water lily
                                                  furnishes an
                                                  article of
                                                  medicine of
                                                  considerable
                                                  value.   The
                                                  root,which ia
                                                  large  and
                                                  fleshy,  is  a
                                                  very pure
                                                  astringent
                                                    An infu-
                                                  sion  made aa
                                                  strong as
                                                  possible, of
                                                  the powdered
                                                  root, is an ex-
                                                  cellent appli-
                                                  cation in
                                                  cankered
                                                  sore eyes and
                                                  sore   mouth
                                                  o f  children.
                                                  The  powder
                                                  when  very
                                                  fine may also
                                                  be sprinkled
                                                  into  the fis-
sures on the thighs, groin, and axilla of children, when they become
inflamed by neglect.  The infusion also makes a good injection for
the vagina in cases of leuchorrhoea or prolapsus.

                                           MYRRH A— Myrrh.
                                         This is a valuable ar-
                                         ticle in obstetric prac-
                                         tice.  It acts as a gen-
                                         tle yet permanent ton-
                                         ic, antiseptic, and stim-
                                         ulant.  It is often ser«
                                         viceable in parturition,
                                         as an incirant to effec-
                                         tive labor pains.  But
                                         its chief use  is in the
                                         puerperal state, and as
                                         an emmenagogue.  It
                                         may be  employed in
                                         fine  powder,  pills, or
                                         in the form  of  tinc-
                                         ture.  The Compound
Tincture of Myrrh (No. 6) s a popular remedy for both internal and
external use.  The dose of Myrrh  is about five to ten grains, or
about half a tea-spoonful;  but  is  often taken in  much larger
quantities.
 
164
MEDICINES.
MYRICA CERIFERA — Bayberry.
Barberry
Rhubarb.
The bayberry is a shrub
          growing   on
          the Atlantic
          coasts on the
          Eastern part
          of our  conti-
          nent.
            Its virtues
          were brought
          into  notice
          chiefly byDr.
          Thomson.
          The bark of
          the root is a
          powerful
          stimulant
          and  astrin-
          gent,  useful
          in  many
          forms of dis-
          ease.   It is
          one  o f  the
          chief  ingre-
          dients  of Dr.
          Th omson'a
           Composition
          Powders.
  RHEUM— Rhubarb. Rhu
barb is one of the best of the
mild cathartics, very useful in
dysentery  among  children as
well as grown  persons.  The
dose of the  best Rhubarb is
ten grains.


  LEONURUS CARDIACA
—Motherwort.  This is a com-
mon domestic remedy long in
use.  The leaves are nervine,
tonic, and emmenagogue. Its
chief use  is in obstructed men-
struation.  A strong infusion
may be taken freely for a week
or two before and during tho
menstrual period.
  CAPSICUM — Cayenne Pepper   th
ful and permanent stimulants that we
This is one of the mi>st power-
 — oossess.  It is emL Joyed, is 
MEDICINES.                     165
enfeebled states of the body, to excite the rital powers, or to incne
the organs to more vigorous action.  Thus, in feeble and ineffectual
.abors, Capsicum will often seemingly renew the powers of nature,
and produce the most happy effects in  a very short time.  It is also
emmenagogue, by virtue of its general incitant power.   The dose
is from three to ten grains, or about a quarter to half a tea-spoonful.
It is usually taken  in hot water, sweetened, but is disagreeable in
this form on account of its pungency, and is much more  agreeable
in tbe form of pills or emulsion.
                                           BOTROPHIS RA-
                                         CEMOSA;  MACRO-
                                         TRYS  RACEMOSA
                                         — Black Cohosh; Rat-
                                         tlewred.  This is a plant
                                         of  luxuriant  ^growth
                                         common in the western
                                         and the middle States
                                         growing in woods  ana
                                         new grounds.   As  a
                                         medicine, the rcot of
                                         this  plant is of great
                                         value in midwifery and
                                         diseases  of females.
                                         It is a powerful  em-
                                         menagogue,  antispas-
                                         modic, or relaxant, and
                                         somewhat nervine. Its
                                         greatest use is in diffi-
                                         cult or obstructed men-
                                         struation, and as  a par-
                                         turient.   Indeed,   its
                                         power in this way is so
                                         great,  that  it has  fre-
                                         quently been  success-
                                         fully employed for the
                                         (generally   unjustifia-
                                         ble)  act of procuring
                                         abortion.    For  this
                                         purpose, however, it is
                                         unsafe.  As an emmen-
                                         agogue it may be taken
                                         in doses  sufficient to
                                         produce a slight sense
                                         of heaviness, or  a feel-
                                         ing of dizziness  in the
                                         head.   The decoction
is the most common form of its use.  But the precipitated alcoholic
extract, commonly called Macrotin, but more properly Botrophin. is
the most convenient form of its use.  The dose of this is from one
to  three grains. 
166
MEDICINES.
  PODOPHYLLUM  PELTATUM— May-apple.    This article,
which is also called Mandrake, is an important article of the cathar.
tic class of remedies.   The root is a hydragogue and  antibilioua
cathartic, useful in fevers and dropsical diseases.  The  powder of
the root, the alcoholic extract,  and  the resinoid principle commonly
called Podophyllin, are the preparations most commonly employed.
The dose of the two last is about three grains ;  that of the powder
is about ten grains.
                       POPULUS  TREMULOIDES— Quaking
                     Aspen.   The  Aspen Poplar bark furnishe?
                     one of  our purest and finest tonics, useful in
                     all cases of debility.

                       ANTHEMIS — Chammomile.  There are
                     two  species  of this plant—the  common
                     garden Chammomile, and the  Anthemis Co-
                     tula  or wild Chammomile, or  Dog Fennel,
                     commonly  called  Mayweed.  The flowers
                     and  leaves of both these are  nervine tonio
                     and  emmenagogue, useful in  painful men-
                     struation and parturition.  They are em-
                     ployed in the  form  of an infusion.

                        TANACETUM VULGARE —  Tansy,
                     The double tansy is an aromatic bitter tonic,
                     nervine and  emmenagogue.   The infusion
                     of the  leaves is employed in  painful men-
                     struat'on and parturition.
       Quaking Aspen.
 
MEDICINES.
167
Lady's Slipper.
    CYPRIPEDIUM -
Lady's Slipper.   Thera
are various species of this
plant, all of which are
medirinal, and employed,
for the   same purposes.
The  root i-s  nervine and
tonic, useful in various
nervous affections.
   NEPETA CATARIA
—Catnip.    This,  like
Motherwort, is a common
domestic  remedy, and is
used for  the same pur-
poses and in like manner
with that.

   ASTRINGENT TONIC.
   Take equal parts of
    Bayberry,
    Hemlock Bark,
    Witch Hazel,
    Cranesbill,
    White Pond-lily.
Pulverize and mix.  This
is  a  good compound  for
making  astringent  infu-
sions for  internal use in
diarrhea,  and for regulat-
ing labor  pains as directed
in the book, as well as  for
injections in cases of pro-
lapsus, &'C.
                COMPOUND TINC. MTRRK — NO.
               Take Myrrh (best) 1 pound,
                    Brandy (best) 1 gallon,
                    Capsicum, 2 ounces,
Pulverize the Myrrh and Capsicum, and  digest them in the brandy,
in sun heat, for six  days, stirring it occasionally, then pour off the
tincture.  Dose, one tea-spoonful.   The  Compound Tincture  of
Myrrh is an excellent stimulant aud tonic, and constitutes a very
popular remedy for colds, and for  all violent  attacks of disease,
particularly those   affecting the alimentary  canal.  Pain  in  the
stomach, bowels, &c, arising from flatulency, is readily relieved by
the use of this medicine.  It is a powerful antiseptic, and  is thui
successfully employed, both externally and internally, in cases  of
incipient mortification.

  HAMAMELIS  VIRGINICA — Witch Hazel.  The leaves  of
this shrub are a pure and  mild  astringent, useful in the same way
wnd for the same purposes as other astringent articles. 
168
MEDICINES.
  HYDRASTUS  CANA
DEN SIS— Golden Seal.
This  article, which is also
called Yellow Puccoon, is an
acrid  and permanent tonic,
employed in  tonic  com-
pounds for debility.  A wash
made   of  this  article  and
Bayberry is  very good  for
sore or  cankered  nipples;
also, when employed by in-
jection, the infusion of these
articles is very serviceable
in cases of chronic diarrhea.

      SPICED  BITTERS.
Take  Golden Seal, 1 pound;
      Poplar  Bark, 2   "
      Balmony,    1   "
      Bayberry,    1   "
      White Sugar, 5   "
      Cloves,      8 oz.
Pulverize finely and  mix.
Dose, a tea-spoonful, in hot
water.  More sugar may be
added if desired.  This is an
excellent tonic for common
                                    EMMENAGOGUE POWDER.
                                  Take equal parts of
                                    Black Cohosh;
                                    Smartweed (Polygonum),
                                    Myrrh.
                                  Pulverize and mix.   Dose, a
                                  tea-spoonful three  times a
                                  day.
Thia is an excellent remedy for obstructed menstruation.
Golden Seal.
   Thomson's  composition powdees—diaphoretic powders.
                  Take Bayberry, 2 pounds;
                       Ginger,  1    "
                       Cloves,   2 ounces;
                       Capsicum, 2    "
Pulverize finely and mix.  These powders are generally employed
in the form of  hot  infusion or tea, as a diaphoretic and stimulant,
and form a very popular remedy.  The compound is improved, for the
common purposes for which it is  employed, and especially in obstet-
rical practice,  by substituting one pound of White root (Asclepias
Tuberosa) for one of the Bayberry, and by adding a pound  of Colia
root (Liatris Spicata). 
MEDICINES.                     169
 TRILLIUM—Bethroot.  There
are many species and still more
varieties of the Trillium, all of
which are medicinal.  The root
is stimulant, slightly astringent,
tonic,  pectoral, and  emmena-
gogue.   It has been supposed to
facilitate labor, and is still much
employed in  obstetrical  prac«
tice.  The dose is a tea-spoon*
ful of the powdered root, taken
in boiling water, sweetened, and
repeated as  occasion may re-
quire.

   antispasmodic tincture.
Take
  Lobelia herb, 1 ounce;
  Lady's Slipper, 2 ounces;
  Myrrh, 1 ounce;
  Alcohol, 2 pints.
Pulverize the dry  articles, and
digest them  in  the alcohol for
five days.  This is  an excellent
remedy  in  convulsions  among
children as well  as grown per-
sons.  Dose, from  a tea-spoon-
ful to a table-spoonful, repeated
if necessary.
             Bethroot

                NERVINE  AND ANODYNE TINCTURE.
          Take English Valerian, 2 ounces;
               Extract garden Lettuce, 1 ounce;
               Oil Anise, £ ounce;
               Camphor, £ ounce;
               Alcohol, 2 pints.
  Pulverize the Valerian, and digest with  the other articles (made
fine) in the alcohol for three days, stirring it occasionally.   Dose, a
te&.spoonful.  Good for after-pains and painful  menstruation.

                       CATHARTIC POWDER.
               Take Mandrake,}
                     Senna,    > Equal parts.
                     Blackroot,)
  Pulverize and mix.  Dose, a tea-spoonftn.
                    CARBONATE OF AMMONIA.
  This article is used for the purpose of a smelling sajt, in cases of
fainting.   It  is commonly, but improperly, called Hartshorn,
»bould°be kept cbsely from the air
It 
1  170
MEDICINES.
                         Blue Cohosh.

  CAULOPHYLLUM THALICTROIDES — Blue Cohosh.   The
Blue Cohosh is antispasmodic, emmenagogue,  and nervine, and it
employed for  the purpose of regulating labor pains, especially to
prevent those premature pains experienced by some women, and
which  are frequently more harrassing than the  true labor pains
The  medicine is equally beneficial  as a remedy  in cases of pain-
fill menstruation.  The dose is five grains, or one large pill of the
extract, three or four times a day.  The infusion of the root is takei
freely, in doses as large as is  agreeable to the stomach.

                       BATHING DROPS.
  Take Antispasmodic Tincture, and shake with  it in ounce of the
Spirits  Turpentine to the half pint  tincture.  Good application for
 emoving pain and swellings. 
MEDICINES.                      171
                                             GALIUM— Clevers,
                                         There are several spe«
                                         cies of Galium, all  of
                                         which are good diuretics,
                                         useful in dropsical affec-
                                         tions and stranguary.

                                                VERMIFU'JE
                                           Take
                                         Castor Oil (best), 1 pint;
                                         Wormreed Oil,  1 oz.;
                                         Spts Turpentine, I "
                                            Mix.   Dose,  a tea«
                                         spoonful three  times  a
                                         day for two days, and if
                                         it does not operate give
                                         a cathartic.   This is one
                                         of  the most  convenient
                                         and  best  preparations
                                         against worms that we
                                         possess.

                                             CATHARTIC PILL3. ^
                                           Take
                                         Podophyllin (active prin.
                                             of May Apple, 1 oz.;
                                         Extract Boneset,  1 oz.;
                                         Oil of Anise,     1 dr.;
                                            Mix and  form  into
                  Clevers.                  pills.   Dose, one to two
                                         pills.   This is an excel-
lent pill for ordinary use, and is considerably anti-bilious in its ef-
fects.  It may be given in all cases in which Bunnell's  pills or the
Anti-bilious pills are recommended.

                        TONIC  CORDIAL.
              Take Poplar Bark,  "
                    Yellow Parilla,
                    Golden Seal,   f one pound each;
                    Lady's Slipper,
                    Sculcap,
                    White Sugar, six pounds.
  Bruise and boil in one and a half gallons of water for  two hours;
■train and boil down to half a gallon, and, while hot, add the sugar;
when dissolved, bottle for use.   Dose, a wine glass full three timei
SECRETION OF  MILK.
  Spirits of Camphor (Camphire) applied to the breasts will have a
tendency to arrest the secretion of milk.  The bruised leaves of
the Castor Oil plant (Ricinus Communis), applied for several days
will  excite the secretion of milk, and will sometimes enlarge tho
breasts spontaneously. 
INDEX TO  SUPPLEMENT.
                                                             PAGE
 Abortion............................................................................  46
    "    articles used to prevent...............................................  47
 Adhesion of the labia pudendi.................................................  17
    "       "       "       operation for, how performed.........  17
 After-birth, expulsion of the................................................... 142
     "      removal of the..................................................... 142
 After-pains..........................................................................  52
 Appeal to wives and husbands................................................  87
 Bag of waters, formation of the................................................ 134
 Barrenness..........................................................................  30
     "     causes of...............................................................  30
     "     treatment..............................................................  30
 Bearing down of the womb.....................................................  65
 Breathing, how to promote in still-born children........................ 141
 Causes, why there is more danger in administering improper medi-
   cines during pregnancy and child-birth than at other times......  85
 Cessation of the menses.........................................................  28
     "     "      w    effects of the, upon health......................  29
 Chafes, how treated.  (Also, see Sore ears and chafes).................  17
 Changes produced by conception.............................................  92
 Child,  its expulsion from the mother....................................... 137
 Child-bed fever....................................................................  54
     "      "   appears to be contagious....................................  54
     "      "  remarkable cases of........................................54, 55
 Child-birth, consoling influence of the knowledge of [its simplicity  80
 Child's head........................................................................ 104
    "     "  proper presentation of the...................................... 136
-Clitoris...............................................................................  10
    "    description of.............................................................  10
 Colds, obstruction from..........................................................  27
 Comparative view of natural and  difficult labors........................  83
 Conception..........................................................................  89
     "     theories of............................................................  90
     "     changes produced by.............................................  92
 Conception and pregnancy.......................................................  89
 Conduct of midwife during labor............................................. 125
 Costiveness........................................................................37, 54
 Cramp................................................................................  34
 Difficult labor (See Preternatural labor).................................... 145
 Diseases of females, to be treated on the same general principles as
           of males...............................................................   5
    "    peculiar to the unimpregnated state..............................  14
                                                     172 
INDEX TO SUPPLEMENT.
173
                                                             PAGE
Diseases consequent on delivery...............................................  49
   "    common both to the pregnant and unpregnant state.........  62
Displacement of the womb......................................................  97
Expulsion of the after-birth.................................................... 142
Fallopian tubes....................................................................  12
Female peculiarities..............................................................   8
   "   organs of generation...................................................9, 10
   "   system, peculiarities of the...........................................   9
Fever, child bed..................................................................  54
   "   milk.........................................................................  58
Flooding and fainting...........................................................  49
Fluor albus, or whites............................................................  64
Formation of the bag of waters................................................ 134
Generation, organs of............................................................   9
Headache...........................................................................  36
Head, child's....................................................................... 104
Heartburn..........................................................................  36
Hymen...............................................................................  10
   "   description of............................................................  10
   "   imperforation and too great density of the.......................  14
Hysterics............................................................................  62
Imperforation and too great density of the hymen.......................  14
       "       operation for the, how performed..........................  16
Improper interference at child-birth, cautions against.................. 1.5
Inability to sleep..................................................................  44
Inflammation  of the external organs of generation.....................  62
Midwifery...........................................................................  70
Irregularities of the lochial discharge.........................................  52
Labia pudendi.....................................................................  10
   "      "     adhesion of the................................................  1'
Labor.................................,............................................... }}7
   "    symptoms of................................................................ H'
   "    natural....................................................................... 119
   "    conduct of midwife during............................................. 1*5
   "    preternatural...........................................................'••• 145
   "    registers of..........................................•.......................  °-*
Liability of women to peculiar diseases.....................................    8
Lochial  discharge, irregularities of the......................................  52
Meatus urinarius.........,.........................................................  10
Medical treatment of child..................................................... 149
    «<       «      "  mother.................................................. 1&1
Menses,  retention of the.........................................•...............  20
   "     cessation of the.........................................................  ^
Menstruation.......................................................................  :J°
      "       symptoms attending  its first appearance.............—  I*
      "       painful............................................................  23
      ''       profuse..........................•..................................  ~
      "       suppressed........................................................  ^
Midwifery...........................................................................  7n
     "    but little inquired into...............................•.......••••.•■   iyj
     "    artifice of the physicians to retain  the practice or, in
            their own hands...................................................  Iq
Swelled breast and sore nipples...............................................   £*
Symptoms of labor............ ................................................ 
174
INDEX TO SUPPLEMENT.
                                                             PAGE
Midwifery requires no particular skill......................•••••...........   °|
    "     ridiculous and indelicate law respecting, at Athens.......   81
    "     liberal law respecting, among the Danes and Germans..   81
Midwives, men do more harm than women................................   78
    "     can render no assistance at child-birth.......................    ^3
    "     means by which they lose their reputation..................   76
    "     immorality of employing men as...............................   '*
    "     comparative difference in the qualifications of men and
            women..............................................................   °1
Milk fever...........................................................................   58
Mons veneris............................... .......................................   10
Mouth of the womb...............................................................   1-
Natural labor.......................................................................  H;
Nausea and vomiting...........................................................   3&
Nymphae.............................................................................   10
Obstructed menstruation........................................................   26
Opening or dilatation at the mouth of the womb........................  132
Organs of generation.............................................................    9
Os pubis.............................................................................   10
Os tincse..............................................................................   12
Ovaries.................................................................................   12
Painful menstruation............................................................   23
Pains in the os pubis.............................................................   39
Pains in the right side..........................................................   44
Palpitation of the heart.........................................................   35
Parts principally concerned in child-birth.................................  102
Peculiarities of the female system............................................    9
Pelvis.............................................................................10,102
Perineum............................................................................   10
Piles..................................................................................   38
Pregnancy...........................................................................   93
    "      signs'of...............................................................   96
    "      history of.............................................................   94
Preternatural labor................................................................  143
       "       "   feet presentation.........................................  146
       "       "   breech     "    ........................................  147
       "       "   shoulder or arm...........................................  147
       "       "   time for turning..........................................  147
Profuse menstruation............................................................   25
Proper presentation of child's head..........................................  136
Pruritis, or itching...............................................................   45
Pubes...................................................................................   10
Recapitulation......................................................................  154
Removal of the after-birth.......................................................  142
    "     "        "    how performed..................................  143
Retention of the  menses................................................'..........   20
    "      "    urine...........................................................   39
Retroversion of the womb.......................................................  97
Salivation, or spitting.............................................................  35
Signs of pregnancy.................................................................   95
Suppressed menstruation.......................................................   26
Swelling of the legs...............................................................  45
Swelled leg..........................................................................   53
Diseases of pregnancy............................................................  32 
INDEX TO SUPPLEMENT.
175
                                                             PAGE
Turning child, proper time for................................................ 147
   '«     "   how performed...............................'................. 143
Twins................................................................................. 148
Urethra................................................................................  10
Urine, retention of the, in women............................................  39
  "   to be drawn off with  a catheter, or with a quill......................  40
  Simplicity of  this operation................................................................  40
  Strictures on physicians respecting this ope ration....................  40
Vagina...............................................................................  10
   "   and womb, description  of.............................................  90
  Ihites (See Fluor albus, or whites)........................................  61
  Dmb................................................................................12,97
   "  bearing down  of  the...................................................................... 132
  ;"  opening or dilatation of  the mouth of......................................  12
 
 
 
WBA H849d Suppl. 1879




63580340R
Mips
NLM051644782