WOMAN AND HER DISEASES, 
FROM THE CRADLE TO THE GRAVE. 
BY EDWARD H. DIXON, ffl. D. PUBLISHED BY CHARLES H. RING, 
CORNER OF BROADWAY AND JOHN ST., N. Y. 
OPINIONS OF THE PRESS. 
" The Work is not written for professional persons, but for women, and with a single view to their benefit. Its author—an intelligent and skilful physician and surgeon, a man of earnest benevolence and common sense—aims to acquaint them in a {(lain, untechnical, and, as we think, most judicious and success* ul manner, with the peculiar facts of the female constitution and the diseases that belong to it. Of course it is not his purpose to make every woman her own doctor, and to set her to dosing herself whenever she may imagine medical treatment to be necessary. Far from it. He expressly endeavors to prevent that too common procedure of folly. Nor does he propose to communicate that minute knowledge which is possible only by long study and constant investigation, but simply to inform women of those general laws of the human system which they ought to be aware of. We welcome the attempt and hope that the book will be as widely read as it deserves, and will produce all the good effects that its author can desire. More we know not how to wish for it. 
" We are of the number of those who have no faith in ignorance. We would, if possible, have a blaze of true knowledge shed on every subject, without fear as to the result. But if any class of persons should be well informed, or any kind of information should be disseminated, ought not women—mothers—to be taught the structure of the human body and the laws of physical health 1 One would say that for them this was the first and most necessary kind of information, but yet the fact is that they are woefully deficient in it, as witness all the habits of infant education, of diet, and of domestic life generally. It is to remedy this deficiency that the book now in our hands was written, and we urge it upon every woman as a solemn doty not to suffer herself to remain in ignorance of thjs kind any longer. " Here we will say that mothers do a great wrong, who allow 


2 
OPINIONS OF THK PRESS. 
their daughters to grow up and enter upon the most responsible duties of life in ignorance—without being fully aware of the nature of the most important and delicate functions of the human economy. We speak plainly on this subject—perhaps it may be too plainly—but it is a subject too nearly connected with human welfare for us to speak otherwise. Again we say, here ignorance is a crime—a Crime, too, whose consequences extend far beyond the lives of its immediate victims. " We said that Dr. Dixon had discharged his task in a successful manner. To do so was perhaps not easy. In communicating the necessary information to avoid ministering to impure feelings, to use no expression that could raise a blush on the most delicate cheek, to write no word that could cause the most careful mother to withhold the book from her daughter of suitable age, certainly required a nice judgment and great caution. We believe that this work combines all these requisites." Boston Ckronotype. 
"The careful and prudent mother may consult this work with great advantage to herself and her offspring. Dr. Bartlett, Editor New York Albion 
" Dr. Dixon has lent a deep interest to his work, and is doing good service by its publication. Boston Medical and Surgical Journal. 
" Dr. Dixon has treated his subject in a sincere, earnest, and thorough manner; we think it will have a wide circulation. Tribune. 
" The Author is a practical surgeon of long standing, and a pnpilof Dr. Mott; he has handled the various subjects with delicacy, yet with an apparent detennination to communicate truth with the utmost force and earnestness. 
Evening Post. 
u The author of this book, has executed his purpose very ably indeed, as far as we understand it; and what is more, in these days of ultra-fastidiousness, has done it delicately and as becomes a well educated man. Every woman should be well acquainted with this book, and every mother should assist her daughter wilh the proper perusal of it. The thanks of the public are due to Dr. Dixon, both for the matter of it and the manner." 
Anglo-American. 


WOMAN, AND HER DISEASES, 
FROM THE CRADLE TO THE GRAVE ADAPTED EXCLUSIVELY TO HER INSTRUCTION IN TUB PHYSIOLOGY OF HER SYSTEM. AND ALL THE DISEASES OF HER CRITICAL PERIODS. 
EDWARD M. D., Author of " OiMuei of the Sexual System," tundrjr Surgical Ewaye, and lecturer oo Um Operative Surgery of the Eye. 
"TO THE PURE ALL THINGS ARE rUKE. 
NEW jf'il \ "$/ } t .j A)* PUBLISHED FOR THE AUTHOR, ANTi' l;'£)R 'SALE, BY CHARLES H.^RING, CORNKR OF BROADWAY AND JOHN STREET. 1847. 


Entered, according to Act of Congress, in the year 1846, By EDWARD H. DIXON, M. D., In the Clerk's Office of the District Court for the Southern District ot New Yokk. 
STEREOTYPED BY BURNS * HAN Ml, NO. 11 SPRUCE STREET. 


TO ©Ijc Mot I) era AMONG MT COUNTRYWOMEN, THIS WORK IS RESPECTFULLY DEDICATED, BY THE AU1 HOR, 
5 Mercer Street, Sept lvi. 




INTRODUCTORY. 
It is difficult to perceive either the force or propriety of the arguments used by those who allege, that the diseases of woman form an improper subject for popular instruction. From her position in the social scale, she is subjected to so many causes of physical degeneration from the evident design of nature —as proved by the rare examples of perfection in her sex now and then seen—that it seems but an act of humanity to make an effort for her instruction in some of the more common evils that so constantly beset her; but more especially from the time when her organism asserts the distinctive peculiarity of her sex, to its often eventful close, when she drops prematurely into the grave, the victim of some of those numerous ills incident to that period in which she is fulfilling the great end and object of her existence. 
Who that has a heart to feel, or a judgment to weigh the consequences of those great and acknowledged errors of her physical training, can forbear to wish her enlightened on those immutable laws upon which her happiness so entirely depends? Who can suppress the sigh that involuntarily arises, on beholding a family of attenuated offspring, too feeble to resist the encroachments of infantile disease, bending and withering beneath the slightest vicissitudes of atmospheric change, and constantly exciting the fears of an inva- 


INTRODUCTORY. 
VI 
lid mother for their very existence, whilst she herself, the unconscious cause of most of their ills, is scarce able, from exhaustion, to assert her position as their natural protector. 
I envy not the heart of that man who can witness without emotions deep-felt and sincere, and an instant conviction of his duty to the sufferer, the slow and insidious approach of disease that is to deprive the helpless objects of a mother's love. I claim no sympathy from him who can day after day approach the bed-side of the invalid, and console himself that she who has failed to receive at his hands the anticipated benefit, is beyond the reach of his skill from vices inherent in her organism. Is it his sole duty tc dole out the piti ful pill or potion, that is absurdly expected to restore her lost health ?—to make the rose revisit that sad cheek, blanched into premature decay, from a total want of knowledge of the everlasting and immutable laws of her nature ? Shall she fondly rely upon he; chosen medical counsellor to lead through the perilous paths of gestation and childbirth, when, from deficient education, she is often utterly ignorant of its natural progress ? Will he whose heart and head are better adapted to his high and responsible calling, from an absurd subjection to blind conventionalism, oppose a sincere and honest effort for her instruction ? Look, for one moment, at those horrid and revolting outrages that have been committed in our midst, by those female fiends, the abortionists J Could such things be, if women were properly instructed in the laws of their physical existence ? Would those registers of vice, that may emphatically be called the dial- 


INTRODUCTORY. 
VII 
plates of infamy and corruption, dare to announce the occupations of these wretches, if the community themselves were not in a state of moral apathy and heartlessness? Shall a humane and enlightened profession continue to submit to the assertion, often made in triumphant ignorance, that the most uneducated of her sex is a suitable adviser for her suffering and helpless sister? Which of our number, who values his character for truthfulness, dare to say, that he makes even the most ordinary prescription with more than a faint hope that it is understood, or will be carried out according to his wishes ? 
It is well known to the physician, that very little reliance can be placed upon the best domestic aid our country affords; and that the prescription of the nurse or the patient, (often of no mean degree of power,) frequently accompanies, or precedes his own. Would this be so, if the patient possessed a guide for her conduct, in the perilous situations in which she is often placed ? Can it be improper to tell a rational mother, how to break to her child the end and object of those mysterious powers, which are to place her in a situation to fulfil the duties which her very instinct tells her she will be called upon to perform ? Who shall tell the yearnings of a young mother's heart, when alone with her own thoughts, she murmurs a prayer to Heaven, for the preservation of that dear object she is cherishing with her very blood; whilst, day after day, she prepares for her unconscious babe those little garments to enwrap its tender limbs, and with fear and trembling awaits the first cry, that is to thrill her heart with a joy as yet unknown. 


INTRODUCTORV. 
VIII 
"Will it be believed, that in more than one instance, in a class of life where fortune conferred its choicest blessings, a young mother has learned, for the first time, from her physician,* even when the pains of labour were upon her, that she was not to be subjected to a surgeon's knife, before she could be blessed with the darling object of her love ? What does the feeling heart say to this ? It can say but one thing:—Truths which so nearly concern the welfare of those we love, can nevor be withheld without culpability. If told in the language of sincerity, and that innate feeling of propriety that must ever belong to the true physician, they must be acceptable to every mother. 
If it be conceded, then, that woman should be instructed in the laws of her own existence, a moment's reference to the prejudices i>f society, may well make us falter on the very threshold of our undertaking. Taught from her earliest existence to look upon man as her sole protector, and to fear the slightest frown of society as the greatest misfortune; she is obliged to forego a thousand methods of strengthening both her mind and body, because they come under the interdictions of a conventionalism as absurd as it is mischievous. 
The wide estrangement existing between the various classes of society, prevents an approximation that might, from a natural similarity of youthful impulse, be productive of the utmost benefit to all. Were it possible for the refining influences of the middle and 
* An anecdote related to the author by Dr. Valentine Mott, whilst a pupil of his, in 1828; since which a similar instance has occurred in his own practice. 


INTRODUCTORY. 
IX 
superior classes to be balanced by the more active physical exertion of the lower, as an incentive to a natural and healthful training of the body, the happiest results would follow. The constitution would be strengthened j and, as a consequence, the mind would become more susceptible to a healthful impression, from an exposition of its natural laws. 
The inevitable and almost universal result of our city system of physical education, is the morbid development of the nervous system; which, added to a plan of mental training equally absurd, leaves the mind in a state infinitely removed from that in which it can be supposed capable of a healthful reception of natural truth. 
In another treatise we have traced the effect of these great errors, in the development of a precocious animal temperament; and we should have transferred the two concluding chapters of that work to this volume, were we not obliged to conform so far to a state of things we deplore, as to withhold an announcement adapted only to a purer and more philosophical state of education than exists amongst us. 
In such an emergency, we shall endeavour to avoid shocking the prejudices of the reader, whilst we will indulge the hope, that a plain and truthful exposition of the laws of her being, will exert a happy and ennobling influence upon her and her children. We shall avoid technicalities, as far as possible, and also all the more abstruse explanations of disease; because it is not to be supposed that they could be communicated with any advantage to any other than a medical mind. 


X 
INTRODUCTORY. 
The domestic administration of physic we abhor; and it is doubtful if a much greater evil exists in society, if we except the constant errors of youthful training, than the dosing of affectionate mothers and aunties; —next to which comes that of a mere physicgiving doctor; one who sees no evil in a complete disregard of every law of nature —bad food, want of exercise, ill made and insufficient clothing, want of personal cleanliness, ill ventilated chambers, etc., etc. —but is ever ready with some paltry drug, that is to restore his patient in a day, and efface the consequences of years of error, and total prostration of bodily power. 
We shall also avoid plates. Although they would serve a useful purpose in illustrating derangements of natural position in some important organs, their effect might be injurious to the youthful mind ; and we would fondly hope our book will never communicate evil, should it fail in imparting wholesome instruction. We know and feel the responsibility of our undertaking, and could experience no greater pain, than the consciousness that it had caused a single mother to regret its appearance, or a blush to suffuse the cheek of a daughter, should that mother find it in her hands. 


CONTENTS. 
CHAPTER FIRST. 
CHAPTER FOURTH. 
CHAPTER FIFTH. 
of the mother and physician—Folly of administering medicine to those who do not present evidences of womanhood. 
Effect of Medicine on Menstruation. Superior powers of nature —Exhaustion of the powers of life in early years—Duty 
CHAPTER FIFTH. 
—Appearance in infants—Causes of its early, or late appearance —Moral causes most powerful—Early appearance connected with spinal curvature—Amount —Physiological reflections on animals—Beautiful forms dependant upon free respiration 
Time of Occurrence, and Quantity. Table of the periods of its first appearance in English, French, and American women 
CHAPTER FOURTH. 
est origin of the child—Ovaria, or egg-beds—Bad effects of tight bandaging at birth. 
What is Menstruation 1 It is the origin of the connexion between the child and mother—Modern discovery of the earli- 
CHAPTER THIRD. 
children—Symptoms of its approach. 
Approach of Menstruation. Meaning of the term—Moral affections at that time—Sacred duty of mothers to inform their 
CHAPTER SECOND. 
brain—Lady Morgan's remarks on dress—Dr. Stewart on the brain—Errors of the nursery and schoolroom. 
Childhood. Difference of action in the sexes—Proper training of—Errors of. early management producing dropsy of the 


XII 
CONTENTS. 
CHAPTER SIXTH. 
CHAPTER EIGHTH. 
CHAPTER ELEVENTH. 
Change of Life, or Cessation of Menstruation Serious apprehensions of disease of the blood at that time—Absurdity of 
CHAPTER ELEVENTH. 
of the manner in which it occurs—Its causes—Two distinct temperaments in which it occurs—Evil effects of physic—Proper mode of life to avoid it. 
Excessive Menstruation. What amount is excessive—Difference of menstruation from discharges of blood—Explanation 
CHAPTER TENTH. 
One produced by partial closure of the uterus —Remedies for. 
Difficult and Painful Menstruation. Two forms of— 
CHAPTER NINTH. 
wees's opinion—Attempts of patients to deceive, with regard to the cause of suppression. 
Suppression from Diseases of the Womb. Congestion of— Cold feet—Means to be used to restore menstruation—Dr. De- 
CHAPTER EIGHTH. 
persons in which suppression may occur—Means to be used to restore it—Sad results of factory and monotonous labour—Clothing—Exercise—Ventilation of chambers—Food—Affections of the liver and lungs—Absurdity of the idea of the two sexes being combined in one individual. 
Suppression of Menstruation at Puberty. Circumstances under which it may or may not appear —Two distinct classes of 
CHAPTER SEVENTH. 
food most healthful—Mode of feeding the children of English nobility—Wretched system of our country —Produces weak eyes and enlarged tonsils—Scrofula—Necessity of mothers knowing the most secret habits of their children—Sad results of inattention to this requirement of the Creator—Duty of the Physician to aid her. 
Effect of Regimen on Menstruation. Of parental severit early unhappiness—Beneficial effect of dancing—Simple 


CONTENTS. 
XIII 
CHAPTER TWELFTH. 
of—Not an uncommon cause of the obstruction of the bladder and lower bowel —Means of replacing it—Liability to the accident in pregnancy—Ante-version, or turning over forwards— Rarely occurs—Retro-version of the bladder—Symptoms—Causes—Means of cure—Interesting case of—Abdominal const. 
Other Displacements of the Uterus and Bladder. Retro-version, or turning over backwards of the uterus—Symptoms 
CHAPTER FIFTEENTH. 
Causes of prolapsus—Dissipation—Corsets—Symptoms of different stages—Means of cure—Utero-abdominal supporter, invented by the author. 
Prolapsus, or Falling of the Womb. Structure of the pelvis and position of the womb—Importance of this knowledge— 
CHAPTER FOURTEENTH. 
of the light literature of the day —Domestic precautions. 
some degree independent of her husband—Religious fanaticism —Curious instance of sympathetic attack in five girls—Clairvoyants and mountebanks—Singular whims of females—A female who fancied herself dead—Ludicrous method of cure—Designing females—Danger of burying alive—Wretched consequences 
Hysteria. Meaning of the word—Causes, mental and otherwise—Symptoms—Domestic thraldom—A wife should be in 
CHAPTER THIRTEENTH. 
used—Cold feet and other causes—Mental causes—Novels—Mother's duty to her child—Must herself have knowledge—Symptoms of its long continuance—Only to be cured by retracing life, and amending errors—Chlorosis—Causes of—Symptoms—Depressing influence of an unhappy household—Poverty—Wretched results of servitude—Habit of eating chalk, etc. —Case of a young lady. 
Le ucorrhea, or Whites ; Chlorosis. Their nature —symp- —Causes —Diet—Tea and coffee—Warm bath —How to be 
CHAPTER TWELFTH. 
that idea—Symptoms—Remedies—Proper mode of life to pass through it in a natural manner. 


XIV 
CONTENTS. 
CHAPTER SIXTEENTH. 
CHAPTER NINETEENTH. 
symptoms —Causes—Slow inflammation—Does it exist in the blood—Absurdity of that idea—Natural functions of the breast —Internal structure—Glands and milk tubes—Nipple and its diseases—Tight dress often causes them—Milk abcesses, from 
Cancer and other Diseases of the Breast. Attacks most frequently married women—Most frequent period of- First 
CHAPTER NINETEENTH. 
of—Instances of enormous size—Can they be cured—Impropriety of surgical operation for—Cancer of the ovaria—Symptoms —Dropsy of the ovaria—Causes—Symptoms—Treatment—Remarkable case of, during which two children were born—Often mistaken for pregnancy—When both are affected there can be neither menstruation nor pregnancy —Treatment. 
Diseases of the Ovaria or Egg-beds. Situation—Causes —Often originate in menstrual derangements—Fleshy tumors 
CHAPTER EIGHTEENTH. 
mechanical means, etc.—Slow or chronic inflammation—Wonderful sympathies of the uterus —Displacements and enlargements of—The frequent and unsuspected cause of costiveness— Also of nervous affections—Symptoms of—Cases of polypi—Proper method of investigating uterine diseases—Cancer of the uterus—Does it run in families—Its origin—Table of the respective ages at which it attacked four hundred women—Symptoms— Average time of its continuance—Can it be cured. 
Inflammation and Hardening of the Uterus, and Cancer. Acute Inflammation—Causes—Attempts to procure abortion by 
CHAPTER SEVENTEENTH. 
Description of the structure and functions of the intestines—Pernicious effects of pill taking—Ingenuity of quacks—Description of prolapsus of the lower bowel—Cure of—Piles—Fistula—Cure of—Diet—Adulteration of bread—Tea and coffee injurious—Fruits —Milk. 
Costiveness; Prolapsus of the Rectum or Bowel*, Pilwj; Fistula. Costiveness a frequent cause of all these complaints— 


CONTENTS. 
XV 
CHAPTER TWENTY-FIRST. 
Derangement of the Circulation and Nervous System during Pregnancy. Plethora, or too much blood—Causes— 
CHAPTER TWENTY-SECOND. 
in the stomach and bowels —Remedies—Costiveness not a natural state during pregnancy—Remedies—Diarrhoea and dysentery—Remedies. 
—Excessive appetite —Dyspepsia, and excessive thirst—Capricious appetite should often be indulged—Water brash—Remedies—Difficulty of swallowing—Heartburn—Remedies—Fondness for chalk—Interesting and fatal case of—Irregular pains 
dies—Salivation, or excessive spitting—Derangement of appetite 
Other Diseases of Pregnancy. Is it necessarily a state of disease —Answer—Nausea, vomiting, and costiveness—Reme- 
CHAPTER TWENTY-FIRST. 
others—Symptoms of—Means of preventing it—Serious effects upon the constitution and future offspring. 
herself—Suppression of the menses—Morning sickness—Enlargement of the breasts—Brown circles around the nipples— Appearance of milk—Enlargement of the abdomen—Of the Uterus—Quickening—Formation of the afterbirth—Meaning of the term miscarriage—Premature labour—Precise manner in which miscarriage occurs—Time at which it most frequently occurs— Causes—Will medicine produce it—Answer to that question— Will bleeding produce it—Answer—Reason why a woman will lose quantities of blood from the uterus and not miscarry—Liability in some women to constant miscarriage—Improbable in 
Signs of Pregnancy: Miscarriage, or Abortion. Moral emotion on quickening—Duty of the young mother to God and 
CHAPTER TWENTIETH. 
caking of the milk—Mode of preventing them—Injurious appli cations of nurses—Constitutional treatment—Diet, drinks, etc.— Mental emotions, etc.—Diminution and excess of milk—Women should nurse their own children if possible—Cancer must be extirpated in its earliest stage; no other cure—Dangers of quackery cancer plasters, etc.—Instance of death from their use 


XVI 
CONTENTS. 
Symptoms—Convulsions—Remedies—Difficult breathing, and cough—Causes—Remedies—Inflammation of the lungs may produce abortion—Spitting of blood, and bleeding at the nose— Remedies—Palpitation of the heart, or nervousness —Causes — Explanation of the manner in which it occurs—Remedies— Fainting—Explanation of causes—Remedies—Headache—Causes —Remedies—Toothache—Causes—Remedies—Piles —Causes— Remedies—Distension of the veins of the legs—Description of the manner in which they occur—Measures to be taken to relieve this state—Dropsy of the legs—Manner in which it occurs— Remedy. 


CHAPTER FIRST. 
CHILDHOOD. 
However slight the difference between the male and female infant may appear at the moment of birth, but a short time elapses before the observer may detect the distinctive peculiarities of action in the two sexes. In the male, all the motions are performed with more energy, and their care is usually more fatiguing to the attendant ; both, however, are characterized by such marked activity of the nervous system as predisposes them to a high degree of susceptibility to disease ; and this must be distinctly recognized, and acted upon by those who have the care of infants. 
We allude to it thus early, because we are satisfied that mothers must have these peculiarities constantly in view, if they would give nature an opportunity to establish the functions of the female child, without interruption or obstructions that will form the groundwork of disease through life, and often consign her to the grave ere nature has asserted her ability to continue the species. 
Throughout this work it will be observed, that no other order will be followed in our enumeration of the 


12 
CHILDHOOD. 
establishment, as well as the derangement of the functions, than that in which they usually appear in the state of society in which we live. We write for popular instruction, and must therefore suppose that we shall be most successful in adopting that method of arrangement which is so constantly before the eyes of a mother in her own offspring and those of her friends. She requires also to have her attention directed to the natural difference existing in children, before she can understand the necessity of distinctions in their training and general regimen, as calculated to develope or check disorders in their most important functions. 
There are few mothers so incapable of observation, as not to have noticed very great differences in the deportment and character of children in different families. As all this is the result of moral example in their supervisors, so they may be assured that equal differences in their constitutions will undoubtedly be produced by their physical training. We need only notice the hardy constitutions of those who escape the far more frequent accidents of childhood among the poor, provided always they have sufficient nourishment and clothing, to be convinced that some great error exists in rearing the children of the opulent. The ten thousand aches and pains to which they are subject, from pampering their appetites, counterbalance the carelessness of the poor. The children of the latter are rarely 


CHILDHOOD. 
13 
so precocious in their temperaments. They become men and women at the age intended by nature—their nervous systems are never forced to develope themselves so early as to entail lasting misery upon their whole subsequent lives. What matter is it if they be not able to elicit the admiration of foolish drawingroom spectators by their infantile efforts ? Far oftener do they develope their powers in the hall of science, or in the senate. What though a puny race of offspring attest not the folly of their early marriage ? a well-developed and healthful maturity shall be rewarded with children who will do honour to their parents, and aid them in their declining years. 
It behooves our countrywomen to mark these facts— for facts they are—and until they are attended to, our daughters, though they may glory in their early beauty and accomplishments, will have to lament their premature old age—ay, and their mental feebleness besides; for there can assuredly be no great intellectual energy in a body whose failing powers are constantly taxed to their full extent with the mere effort of living. 
In another work we have endeavoured to point out the more remote causes which precede the birth of the child, and cause the formation of a precocious sexual temperament, and the consequent early exhaustion of vital power. It is inexpedient to adopt an investigation of similar character in a work designed exclusively 
2 


14 
CIIILMIOOD. 
for the general reader; it is our purpose here merely to notice some of the more prominent errors of infantile management, as influencing the future welfare of the young female. The manner in which these act, in producing derangement of her more important functions, will be set forth in subsequent chapters, when we come to speak of them in detail. 
Until the period of its birth, however uncongenial with nature's views as influencing its own development, the management of its parent's appetite may have been, they have not been able to exercise any direct influence for evil upon its body; but no sooner does it make its appearance in this world of independent life, than the distressing results of ignorance of nature's laws appear in its universal management. Firstly, an ignorant nurse is permitted to squeeze its lungs into the narrowest compass with a bandage, enveloping again and again its fragile form; then its intestines are irritated with castor-oil, and various nostrums, such as paragoric, Godfreys's Cordial, Dalby's Carminative, etc., etc., are given to allay the pain produced by the medicine ; then it is fed with pap, composed of crackers, boiled flour, and various other improvements upon its natural diet. It is jolted on the knee, or rocked in a cradle immersed in a feather bed, till exhausted nature comes to its relief and it sleeps. This process is continued from day to day; its head is sweltered with a cap—it is half suf- 


15 
CHILDHOOD. 
focated with the heat of the nursery, or beneath heavy bedclothes—and so it struggles through its earliest infancy, if it does not die with dropsy of the brain during its teething, the most frequent result of the exhaustion of the nervous system consequent on this shocking ignorance. 
The remarks of Lady Morgan in her " Italy" are so applicable to our own country, that we can do no better than insert them: " The noble Florentine of the old caste of either sex begins this troublesome life like an Egyptian mummy; the little form distorted by tight swathing, up to the throat, and the little face purpled with the pressure of bandages, which drives all the blood into the head, and lays the foundation for future malady. If it survives these probationary bonds, and escapes from the knocking and tumbling of its flaunting, gaudy, over-dressed nurse, whose carelessness has little to dread from the mother's quick ear or watchful eye, it is forwarded from one bondage to another. If a female, it is sent in early childhood to a convent," etc., etc. As soon as its infantile education is complete, she remarks, " the victim pursues no occupation but that of conning the rubrics taught at the convent, or working the eternal Adam and Eve under the tree of knowledge, with a serpent in its branches to show the danger of seeking it," etc., etc. 
How very like our beautiful system of conning the 


16 
CHILDHOOD. 
grammar and working samplars is all this • and what a wretched commentary upon our profession does it furnish ? Could such things be, if physicians performed their duty as public instructors ? Would foolish mothers dare to adopt a course so fatal to their offspring, if their advisers had the dignity and independence to speak the truth, regardless of the fear or favour of the mother or the schoolmistress? Far better would it be for our children to grow up without accomplishments, if they are to be attained at the expense of health. But this is not necessary • the highest degree of accomplishment is compatible with perfect health; and when society shall be conducted upon a correct knowledge of natural laws, in their widest sense, it will be found that nature and simplicity inhabit one temple, and both minister with untiring zeal at the altar of humanity and truth. 
Dr. James Stewart, of this city, in his beautiful and classical work on diseases of children, a work in which he has rendered the greatest service to the profession, remarks: " The development of the brain also gives another instance of deranged vital action, at a time when this action is in the greatest excess, causing disease. It is well known that this organ, although large in size, is very imperfect at the time of birth, constituting merely a mass of fluid. It is not complete in its parts until a year or more has elapsed, during which period the vital energy of the part is in great activity, 


CHILDHOOD. 
17 
carrying on the process of development. Is it, therefore, a matter of surprise that infants are so often attacked with convulsions, on the application of any cause which will in any way disorder the all-important action of building up the great source of supply of the muscles ?" Dr. Stewart here alludes to the brain as the great centre of nervous power and growth, and Lady Morgan is equally correct, when she speaks of the bandages " driving all the blood to the head." The truth is, the system is monstrous, and deserves the reprobation of all good and enlightened men. 
We cannot here extend the subject of exhaustion of nervous power, and its sad catalogue of infantile diseases, by the thousand errors of the nursery and the school-room; but most heartily assure the reader, that wherever she departs from the utmost simplicity in rearing her child, she infringes that great law, to a religious observance of which she can only be indebted for its healthful maturity. 
It is the absurd opinionativeness of the parent that prevents an honest exposition of her errors in the management of her child. She almost always precedes the advice of her physician by offering her own views, and he well knows they will take precedence of his own. This says little for his independence; but alas! too many of a profession that should scorn such motives, are governed solely by a desire to please their employ- 
2* 


18 
CHILDHOOD. 
ers, and would far rather yield the welfare of a human life, than their own interest. 
This is an honest expression of opinion. We give it with pain; but cannot withhold it, because we design our productions for expositions of the truth on both sides of the question—the employer and the employed. We know of no immunity enjoyed, by either parent or physician, that should shield them from an honest exposition of the truth, and are willing ourselves to abide the same test, viz. the universal written sentiments of the profession. 


CHAPTER SECOND. 
APPROACH OF MENSTRUATION. 
During the period of life between the fourteenth or fifteenth to the fortieth or fiftieth years, in this climate, woman, when neither pregnant nor suckling, is subject to a periodical discharge from the uterus and its appendages, that is the evidence of her ability to bear children. The term by which this is designated by physicians is menstruation, from a Latin word signifying month; because when healthfully performed, it returns monthly. There are, however, many causes that de< range its appearance at the proper time, and many besides pregnancy and suckling that interfere with its periodic return, as well as diminish or increase the natural amount, and often suppress it altogether; nor is suckling with our countrywomen an invariable cause for its disappearance. We shall treat of all these subjects in subsequent chapters, as they constitute distinct questions, of the greatest importance to many who will read this work. Our object at present is to show what is understood by medical men to constitute the most frequent condition of the monthly period, in the far greater number of females, so that they may 


20 
APPROACH OF MENSTRUATION. 
be able to form a proper idea of the circumstances i'. should present, to constitute a standard of health. 
Yet we would have the reader most distinctlyunderstand, that there can be no such thing as a definite time during which she is to expect the continuance of each period, or a specific amount to be discharged, for these vary greatly. Constitutional differences often exist in the saupWamily, that produce a great variation"; and in different classes of society, owing to dietetic and educational causes, still greater differences are observed. It #ill be a prominent object with us, to set forth in detail, and in their utmost simplicity, the reasons that may induce a departure from the original plan of nature, so that our readers may feel that they possess a degree of intelligence on this most important function, that may assist them in favouring the laws of their being, and avoiding the many useless and often hurtful medicines that are so often prescribed by the ignorant, " to bring nature right," as though she had abandoned her creature to the influence of every designing or ignorant mediciner, when such ample proof is given of the uniform and unerring certainty with which she effects her object by the silent agency of her own forces, when evident obstructing causes are removed, and she is allowed to exercise her powers, unimpeded by the carelessness iof the patient, or the ignorance or design of such as would assist her. 


21 
APPROACH OF MENSTRUATION. 
It would answer no practical purpose to detail those interesting personal changes that occur when the young female is about to pass into the state of womanhood; they are sufficiently evident to the observer to make this period of life most interesting, and to elicit our warmest sympathy, and all the kindlier feelings of our nature. How sensitive—how tremulous is now her nervous system! how susceptible to every gentle emotion of the soul, and how delicately alive to friendship! Happy is she who shares the counsel and sympathy of a fond and intelligent mother—of a mother, whose intellect and whose instincts both combine to convince her of her duties to her child. In such language as a mother alone can use, and with a purpose as pure and holy as she alone can feel in the discharge of that duty, let her communicate, as far as she shall judge expedient, the end and object of nature in this novel and extraordinary change. Much useful counsel, and cautions that may save both many a heart-felt grief, may be communicated by a mother to an intelligent child, without raising a blush upon the cheek of either; and very dear in after life will be the reflection of both, if this duty be faithfully performed. We will endeavour to aid her, by giving an outline of the various phenomena that precede the approach of the menses ; although it is doubtful, if in any two cases, their appearance is accompanied by the same order of symptoms. 


22 
APPROACH OF MENSTRUATION. 
When, at the fourteenth or fifteenth year, a young female, whose person has become suddenly developed, is observed to present irregular nervous symptoms, such as exhaustion from slight exertion, irascibility, and sudden causeless emotions, accompanied with tears, often frequently followed by disturbed sleep, and capricious appetite, with full pulse, headache, and flushed cheeks, suffocative feelings, palpitation of the heart, and pain in the back and loins, we may be pretty sure the menses are about to appear. A colourless mucous discharge usually accompanies and follows its appearance. The first period almost invariably disappears in two or three days, and there is no regular recurrence till the third or fourth one, after which it gradually becomes more regular. Should the female either be very delicate, or uncommonly robust, it is liable to still further interruption, and several additional periods may elapse, before she assumes the proper time and quantity that is to be in future her standard of health. 
In most persons, after the menses are properly established, few of these troublesome symptoms accompany them; indeed, nothing is more common than for them to appear with so little premonition, as to surprise the female very awkwardly. They proceed, for the most part, with more or less regularity for five or six days, and then gradually disappear, leaving a state of lassitude that is dissipated in a day or two. 


APPROACH OF MENSTRUATION. 
23 
There are cases, however, which we shall consider in the chapter on difficult menstruation, wherein many troublesome and annoying symptoms appear at each period, and nothing can be more heartless than a want of sympathy for those who are thus situated. Violent spasms, accompanied with hysterical symptoms, severe headaches and internal pains, with sickness of stomach and vomiting, often accompany " the period," and some women are so unfortunate as to be more or less affected in this way during their whole lives. Let all such carefully study the exciting causes that precede one of their worst periods ; they will soon perceive whether it be fatigue, indigestible food, stimulating drinks—such as strong tea, coffee, etc. —and learn to avoid the cause, over which, when in action, medicine has very little control. 
The intervening period, for the most part, is from twenty-six to twenty-eight days • though this is liable, as will subsequently be seen, to great variation, in cases where there are constitutional derangements. It is said by authors, and I can bear witness to their assertions, from communications made by my own patients, that some persons are subject to these discharges but two or three times in a year; yet these cases are only exceptions to the general rule—a rule so general as to confer, as we have seen, a name upon the function, designating the natural time of its recurrence. 


CHAPTER THIRD. 
WHAT IS MENSTRUATION? 
Before we proceed to a consideration of those constitutional evils and errors of early education, which may interrupt the natural and healthful performance of this function, the question naturally occurs, how far our efforts to instruct will be satisfactory to the reader, without an explanation of the more immediate object of menstruation. Seeing that it is of such invariable occurrence as to constitute the evidence of her fitness to fulfil the dearest and most sacred duty she owes to her Creator, it is reasonable to conclude, that it must be connected with some indispensable change occurring in the uterus, that fits it for its duty. 
It is doubtful how far a knowledge of anatomical structure can be profitably communicated to the non-professional reader, more especially without the aid of numerous plates ; yet the necessity of a correct idea of the use of menstruation will soon appear, when we come to speak of one of the greatest and most distressing evils of married life, viz. abortion ; an accident that is too often supposed by the female to constitute a trivial and unavoidable evil, but which often brings with it ills 


WHAT IS MENSTRUATION ? 
25 
that embitter her whole subsequent existence, and deprive her of healthy offspring, at that period of life when the relation between mother and child is most endearing. Nay, more than this: full often does it entail a habit, that nothing but the greatest subsequent care can prevent; and far oftener still does it lay the foundation of constitutional feebleness, that ends in incurable disease and an early death. That such is the fact, every physician of experience full well knows; the wonder is, that the most thoughtless person should not anticipate from it the most serious evils, instead of believing the accident a trifling one. Can it be supposed, that all this curious adaptation of means should have been prepared by the Creator without the intention of conducting gestation to a favourable issue ? that the infinitely varied sympathies of the system should all be aroused, and then repeatedly and suddenly checked, without producing serious derangements in nature's plan ? It were unphilosophical to suppose so. We shall enumerate in a succeeding chapter the evils consequent on this calamity. 
It will doubtless surprise the reader to learn, that by far the most important fact concerning menstruation, and one that is undoubtedly most intimately connected with its cause, is of very recent discovery. This, however, is true. Late investigations, made by distin- 
guished foreign anatomists, prove conclusively, that 
3 


WHAT IS MENSTRUATION i 
26 
nearly all that has hitherto been attempted, and often supposed to be effected, by the agency of medicine, was either utterly impossible, or, if productive of seeming benefit, that the amendment could only be properly imputed to internal and constitutional changes, occurring at the period when the medicine was given. 
This is a mortifying reflection to us all ; but, be it remembered, that the world of science and wonder in which we live, was not the discovery of a day, nor a year. If it was reserved for the good fortune of those distinguished persons, to whom undoubtedly the credit is due, to make this discovery in the present age, we can point to the past, in which almost the entire structure of anatomical science has been erected ; nay, the discovery of the true causes of menstruation is but the consequence of those important truths that have long preceded it. 
There is, then, no just cause for the condemnation of our predecessors, but of thankfulness, that distinguished men of our own age have added their mite to the number of important facts. We should, indeed, were we to persevere in our hitherto blind treatment of deranged menstruation, deserve the severest censure, more especially when the discovery of the great truth, to which we allude, proves that the proper establishment of the function depends upon a healthy infancy, and the necessity of using every means to carry out the evident 


WHAT IS MENSTRUATION ? 
27 
design of the Creator, and avoid all the retarding influences alluded to in the chapter on Childhood. 
Dr. Meigs, of Philadelphia, speaking on this subject, remarks: " It appears to me, that under the ancient theories, or rather hypotheses, on menstruation, no sound practical views could ever be acquired; although it is true to say, that the lapse of ages had left in the hands of the profession a variety of remedies and indications, the use of which was rather empirical than philosophical, rather customary than useful; and which, though the best that could be recommended, were for the most part found to be incompetent, uncertain, and baffling, as confessed by the celebrated Cullen, at the conclusion of his essay on Emmenagogues, (medicines to cause menstruation,) in his work on the Nature and Uses of Medicines. 
" Happily, at the present day we are better informed upon the nature of the menses, both in health and disease ; and in so far, at least, better prepared to fulfil our duty to the patient." 
We make no apology for this exposure—truth requires none. Something must be done to check the flood of ignorance and empiricism, and we would rather incur the censure of the timid of our own profession, than gain the approbation of the designing, whether in or out of it. 
The researches of anatomists have fully revealed 


WHAT IS MENSTRUATION ? 
28 
to us the nature of the union existing between the new being, and the uterus ; and this is now known to originate directly from the function of menstruation; indeed, each appearance of this discharge is but the evidence that nature is prepared to carry out her whole design, and to produce an independent creature. At each monthly period, whether in married or single life, a small vesicle, or ovum, as it is called by anatomists— meaning literally an egg—passes from one or other of two oval bodies, called ovaria or egg-beds, situated on either side of the uterus, through one of the tubes communicating with its cavity, and into that cavity. This is the rudiment of the new being. In single life, this ovum passes off through the mouth of the uterus, with the menstrual blood, and is lost; nature not then designing it to remain: this vesicle is less in size than a pin's head, and consists of a yolk and two envelopes, as proved by the microscope. 
In married life, when all the conditions of nature have been fulfilled, and the new being is to be developed within the uterus, the function of menstruation is known to be . but the commencement of another and far more important duty, viz. the formation of $n enveloping membrane, composed of myriads of mhv'te blood-vessels, lining, during the first two months of gestation, the whole cavity of the uterus, and passing over the mouths of the two tubes through which the 


WHAT IS MENSTRUATION ? 
29 
ovum arrives there; therefore this ovum can no longer, as in single life, fall through the mouth of the uterus, and pass off with the menses, but is received between the membrane and the sides of the uterus, where it continues to grow by means of the blood derived, through the agency of this membrane, from the mother's system, the uterus itself receiving its blood-vessels directly from the mother, and those of the membrane interlacing with them. 
The reader will observe, however, that as there are vast numbers of these blood-vessels passing between the uterus and this membrane, they could not all go separately into the body of the new being; because, if they did so, when both came to be thrown off at birth, there could then be no such thing as a separation effected, and the destruction of the living child would follow, from the decay of the dead membrane, then called the after-birth, which, having fulfilled its office, and being of no further use as a connecting medium between the child and the mother, dies, if we may so say, at its birth. 
All these numerous vessels unite into one, viz. a large vein, which enters into the umbilicus or navel of the child, and then passes directly into its liver, and so into the circulation; while two large arteries proceed from the child through the navel, and into the after-birth, joining with its blood-vessels, and thus 
3* 


WHAT IS MENSTRUATION 1 
30 
establishing a current directly and constantly between both, the vein conveying the blood from the mother to the child, the arteries returning it to the mother after nature has abstracted what is required for its growth. The object of the after-birth is doubtless to form a reservoir of blood for the development of the child. Its immense number of tortuous blood-vessels may be aptly compared to the roots of a tree, the cord, composed of the three vessels, being the trunk, the child itself the fruit, and the uterus the soil. 
The vessels are all bound compactly together in a cord, as it is always called, that becomes by the time of birth from two to three feet in length, and is covered with a smooth membrane, similar to one that is filled with water, and envelopes the child. It enters, as we have said, the child's abdomen at the navel. At the moment of birth, its arteries pulsate just as our own pulse does • they are evidently under the action of the heart; indeed, they proceed directly from a large artery issuing immediately therefrom. But the moment the child utters a cry, indicative of the first expansion of its lungs, this pulsation ceases; the after-birth is then thrown off, and is of no further use. The cord is tied about two inches from the navel, and divided. This piece of the cord in a few days shrivels up, and falls off, and thus ends the connexion between the child and mother. In applying ths bandage to a new-born in- 


WHAT IS MENSTRUATION? 
31 
fant, we see the first evidence of the utter and lamentable ignorance of its functions; and we cannot forbear noticing it here, although it may be supposed to belong to the chapter on Childhood, and to form a proper appendage to Lady Morgan's remarks; indeed, had that lady been present at the time of a birth, she would doubtless have been still more severe. 
A well adjusted compress and bandage should be applied by the hands of the physician; the nurse being carefully instructed how to repeat it, and what is the precise object of its application, viz. in all cases to support the navel only, which is to be considered for at least a year, a weak spot, and liable to admit the protrusion of the intestines, especially if the child cries much, when all the contents of the abdomen are thrown down by violent inspirations. Instead of this, its proper and legitimate use, a stupid nurse often carries it up to the chest, checking the action of the lungs, and consequent growth of the child, and producing dropsy of the brain, and other diseases so fatal to infant life. 
We have chosen, in accordance with our purpose of imparting actual and progressive knowledge of herself, to give the reader a correct idea of the use of menstruation, although it is only a function of the uterus, before giving a more minute description of the structure of that organ, or its appendages. This we 


32 
WHAT IS MENSTRUATION ? 
shall do when we come to speak of its more important diseases. Moreover, menstruation is the first great era in the life of a female, and that on which the attention of a mother is fixed with a degree of interest known only to one who stands in that endearing relation. Should it not be established, all the charms of her person vanish; her gracefulness and vivacity are replaced with awkwardness and languor, and she falls into despondence, and a train of evils no one can look upon without a sigh for her unhappy condition. Before we enter upon an exposition of the derangements of this function in their proper order, we owe the reader a further history of the effect of climate, diet, education and natural and acquired temperament, upon the time and frequency of its occurrence, its quantity, and effect upon the constitution. 


CHAPTER FOURTH. 
TIME OF OCCURRENCE, .AND QUANTITY. 
Menstruation divides the life of the female into three periods. The first is that of infancy and youth, and exists, in most cases, from birth till the fourteenth or fifteenth year. The second comprises the most important period of her life—that in which she is capable of becoming a mother. This usually ceases at her fortieth or forty-fifth year. This period is commonly called the change of life. The third is the remaining portion of her life. But occasional instances are constantly occurring, in which the menses make their appearance at twelve or thirteen, or even ten years of age ; and its appearance now and then is delayed till the seventeenth, and even twentieth year. 
The excellent and accomplished Dr. Meigs, of Philadelphia, has given a table of his own in his translation of Columbat, upon the authority of Dr. Lee, of London, and others, in which the time of its appearance is noted in seventeen hundred and eighty-one women of England and France. As this coincides with our own observation, and as the French and English women are of similar temperaments, and live 


34 
TIME OP OCCURRENCE, AND QUANTITY. 
within the latitude of our own country, we quote it as the best authority for our readers. 
{at 11 years in 110 ; 'at 16 years in 284. ii 12 " " 144; " 18 " " 144. "13 " " 356; " 19 " " 72. " 14 '• 366; " 20 " " 40. 
Although some rare and extraordinary cases have been witnessed, of discharges much resembling menstruation occurring in extreme infancy, there is no propriety in considering such as identical with proper menstruation. They depend upon ordinary congestion of the blood-vessels of the uterus, in the same manner, and from similar causes, that may produce congestion of the lungs, and consequent bloody expectoration in infants and adults. We have repeatedly heard of these cases, and occasionally had it in our power to relieve the anxieties of mothers On this subject. This discharge is usually the consequence of exposure to cold and wet, and disappears with suitable treatment and regimen. 
Dr. Denman, in his Diseases of Females, remarks: "The early or late appearance of the menses may depend upon the climate, the constitution, the delicacy or hardness of living, and upon the manners of those with whom young women converse. In Greece, and other hot countries, girls begin to menstruate at eight, nine, and ten years of age ; but advancing to the northern climates, there is a gradual protraction of the 


35 
TIME OP OCCURRENCE, AND QUANTITY. 
time, till we come to Lapland, where women do not menstruate till they arrive at mature age, and then in small quantities at long intervals, and sometimes only in summer. But if they do not menstruate according to the genius of the country, it is said they suffer equal inconvenience as in warmer climates, where the quantity discharged is much greater, and the periods shorter. 
" In this country (England) girls begin to menstruate from the fourteenth to the eighteenth years of their age, and sometimes at a later period, without any signs of disease; but if they are of delicate constitution, and luxuriously educated, sleeping upon down beds, and sitting in hot rooms, menstruation usually commences at a more early period." To the latter part of this quotation, especial attention is due by every mother who values the happiness of her child. In another treatise, " Diseases of the Sexual System," we have entered at length upon the causes of the formation of precocious temperaments in youth of both sexes; and we only regret the inexpediency of detailing those causes which precede its birth, with equal precision, in a work designed exclusively for the female reader. 
Columbat, a distinguished French writer, remarks: " Various causes calculated to render the play of the vital forces more active, have the effect either of re- 


36 
TIME OF OCCURRENCE, AND QUANTITY. 
tarding or precipitating the age of puberty; thus, abundant and stimulating food and drinks, manners, habits, and climate, exercise a marked influence upon this vital phenomenon. 
" Certain moral circumstances may likewise accelerate its arrival; but the artificial maturity thus resulting always acts injuriously upon the organization. Among these circumstances may be enumerated premature passions and pleasures, the arts of imitation, music, painting, the perusal of obscene romances, the inspection of lascivious pictures, the theatre, and the ball-room; the bad examples of premature libertinism, of which too many examples are unfortunately furnished in great cities. These specimens of premature puberty, the miserable consequences of too great vivacity of the imagination, are sometimes met with as early as the eighth or tenth year." 
In this city I have known several instances of menstruation at the eleventh and twelfth years, and in all the instances that have passed under my observation, the children were either born of parents who had exhausted the powers of life by too severely taxing their nervous system in the pursuit of pleasure, or come fairly under the description of Dr. Columbat. 
One instance in particular—and this peculiarity has also been noticed by our countryman, Dr. Dewees—was that of a scrofulous child, with curvature of the spine. 


37 
TIME OF OCCURRENCE, AND QUANTITY. 
In this case, a tender but unwise mother, contrary to our often-urged entreaties, persisted in feeding the child highly-spiced food, tea, and coffee, bathing it excessively in warm water, and putting it to rest upon a down bed. The consequence was, the appearance of the menses at the eleventh year, and death at the sixteenth. Tonics, sea-air, and every aid that wealth could offer, availed nothing, and the poor girl died from consumption. 
If it came within the scope of our intention in this volume, we might give ample reason for the conclusion that this sad disease—curvature and ulceration of the bones of the spinal column—was not only greatly influenced by predominance of the nervous temperament of the parent, but that its full development in young girls, and all its train of melancholy results, are often caused directly by the same injudicious regimen that produces premature menstruation. 
I have often been requested to examine the spines of young females, and I remember scarce an instance in which the greatest errors in their infantile management had not existed. When this disease has proceeded to the extent of disorganization of the bones of the spinal column, the menses are always more or less deranged, and it often happens in the latter stages of the disease, that they disappear entirely. 
The treatment of these affections is extremely varied, 
4 


38 
TIME OF OCCURRENCE, AND QUANTITY. 
and calls in all the appliances of great mechanical ingenuity; but there is no dispensing with a rational system of physical and mental training, calculated to counteract the errors of early management. 
With regard to the amount discharged at each menstrual period, we will only say here, there is no forming an accurate estimate. From five or six ounces, to eight or ten, will doubtless compass the truth in the far greater portion of females who do not require medical treatment for excess or diminution of their periods. See chapters on difficult and excessive menstruation. 
It will, however, save much anxiety in many to know, that there cannot possibly be assigned any specific amount for each monthly period; because that must depend entirely upon natural causes. For the same reason that the period is sometimes established, even in those who are perfectly healthy, much earlier or later than in others equally so, it is often greater or less in amount. We have ourselves met with several cases in which it is the constant habit to experience the return only four or six times in a year, and yet the individuals thus affected enjoy very good health. There is no doubt whatever that all these functions differ as much as some others—such as the required amount of sleep, food, clothing, etc. What is demanded by nature is, that the woman shall menstruate 


TIME OF OCCURRENCE, AND QUANTITY. 
39 
according to the requirements of her own peculiar system; and this would unquestionably be far more uniform in its times of appearance, quantity, and effect upon the constitution, were it possible for females to come up to the period of puberty without the innumerable obstacles presented by our miserable system of education. 
Animals, when not domesticated, have a far more uniform standard of health; and we take occasion here to enlarge the sphere of contemplation on this, the greatest and most important event in her life, by directing the reader's attention to the unerring certainty with which, in the inferior tribes, quadrupeds, birds, and insects, nature attains the fulfilment of her entire plans. Although we have not in most of them any visible discharge, there is no doubt an internal change that is analogous to menstruation in woman; for we know that in quadrupeds, the connexion between the young and the mother is similar in most respects to that of our own species, and the periodic returns of the season in which they are capable of becoming mothers, is known to the least observant. In a lecture delivered some sixteen years since, upon the pernicious influence of corsets and tight dress upon the lungs, in deranging menstruation, we used the following language : 
"The lungs are the very citadel of life, and on 


40 
TIME OF OCCURRENCE, AND QUANTITY. 
Iheir integrity and the full development of their func tions, in a vast proportion of cases, depends the establishment of menstruation. How absurd, then, to begin in the very dawn of existence to incapacitate them for the fulfilment of their functions—to prevent their expansion—to shut out the very breath of life, that gives development and symmetry to the whole system. 
" Look at nature as spread out before your view over the whole universe ; look at her thousand tribes of ever-moving, changing life, her i'.isects, birds, and beasts; behold them in their varied states of action and repose; the birds of the air, the lambs that skip over the verdant meadow; has she ever been known to interpose an obstacle to the fulfilment of her ends ? Could the eagle soar to the clouds, or the lark sing his matin lay, if the great process of life's renovation were checked within them ? We know that their muscular activity, their power of rising in the air, depend on the perfect freedom of their respiration. The means of escaping pursuit, of obtaining food, is never denied them. We alone, with our high powers of reason, reserve to ourselves the skill of improving the forms of nature. 
" More by far than personal consequences follow this mighty evil: posterity has suffered; the mind of the rising generation, depending as you have seen on its physical structure, must continually suffer; the chil- 


TIME OF OCCURRENCE, AND QUANTITY. 
41 
dren of weak and unhealthy parents have the seeds of disease within them ; if their early years should be spent under a very questionable subjection to medical regimen, should they chance to survive adolescence, where is their experience of life, their knowledge of facts ? The aching head, the prostrated body, are not capable of acquiring judgment or expansion. 
" Do we talk of beauty ? I appeal to sculpture. The forms of classic art are the reverse of modern deformity. Not a modern shape is to be seen amongst all the classic sculpture of Italy. Graceful carriage ? it is a union of delicacy in its use, combined with evident strength; the limbs are planted with firmness in the successive steps; the chest expands freely; the head is erect; the eyes on a level with the horizon, and frequently elevated to the heavens—is this a description of every day life ? The tottering step, the panting or suppressed respiration, the immovable chest, the downcast lids—are they not visible wherever we turn our eyes ? 
" Not a movement of the human frame but is dependent for its energy and gracefulness on the property of organic and voluntary contractility. The former, you know, means nothing more than the power of contraction possessed by the muscular system —that power which holds it together, and developes its increase, by causing the secretion of new particles from the 
4* 


42 
TIME OP OCCURRENCE, AND QUANTITY. 
blood. It moves the heart, lungs, stomach, and bowels. Voluntary contractility is the power of walking, extending the hands, and every movement performed by the will. Now, let me ask, when do we enjoy them in the highest degree ? Is it not when we possess health ? Soon, in a momentary attack of fainting, we are completely deprived of voluntary, and partially of organic contractility; and can we possess health when the very source of life and motion is crippled by the barbarous corset ?" 
We cannot apologize for this long extract from our more youthful impressions. Every day has added to their force; and, alas! how often have we followed to the grave the remains of our young friends, when we knew full well that a proper understanding of this very subject would have saved them to gladden the hearts of their bereaved parents. With a correct idea of the natural powers, the reader will now be better able to estimate the effect of medical treatment. 


CHAPTER FIFTH. 
EFFECT OF MEDICINE ON MENSTRUATION. 
From her earliest infancy, it is now evident to the reader, that nature has a specific object in view in the attainment of some great end. All her powers are put in action, and everything seems to advance the growth of the body. Not a motion, however destitute of apparent object, is lost. The child dances, laughs, and skips away its early years, and we are astonished at its growth, without being able to perceive in what feature it has altered. No marked distinction occurs to render one year more memorable in its existence than another, until the approach of puberty—when suddenly, the forces of life seem to acquire new strength; and before we are aware of the change, often within a few weeks, we no longer address a child, but a woman. 
What has occurred to mark so important an era in her existence ? But yesterday she was pleased with the veriest trifle —a doll, a dancing puppet, was to her 
a treasure. Now she is a creature prepared to sympathize and to love. All this has been produced by the attainment of nature's grand object, viz. the 


44 
EFFECT OF MEDICINE ON MENSTRUATION. 
gradual production, by her own silent forces, of the ovaria. 
No one suspects that medicine exerts any influence in producing menstruation in those countless thousands of cases, that occur in classes of society where no solicitude is awakened—where the female each day arises, and after a hasty, and perhaps insufficient meal, commences her labours, often continued into the proper hours of sleep. Here every circumstance that can exercise a tendency to hinder the attainment of the great end, is brought into action; and amidst all sorts of depressing influences, the young female at length becomes regular. It is thus evident that nature is all-powerful: she means to compass her purpose, and no slight circumstance will prevent it. 
We have already enumerated causes that act most powerfully in the too early development of the period ; and these, because of their silent and insensible action, and of her total want of knowledge of the subject, the female believes, if her attention should perchance be drawn to them at all, are comparatively of no consequence. She importunes her physician for medicine; this she imagines will restore her child to health. We are now speaking of the state of the young girl who is supposed to be under maternal care, and not of the derangements of later life. We want the reader to have a correct estimate of what is called the physi- 


EFFECT OF MEDICINE ON MENSTRUATION. 
45 
ology of the organs concerned in menstruation, or of those natural living laws which regulate their growth and functions in health. Then she can form a correct conclusion on the propriety of attending to the proper development of the body in early youth*, as the best means of regulating this most important function, apd the utter absurdity of expecting medicine alone to effect so great a result. 
Let us noW trace the effect of too early an occurrence of menstruation. Nature has been compared, most appositely in this function, to a plant under the influence of too much heat and water, and too little light. All know the result of such treatment; it reaches too early maturity, and dies ere it produces seed. It was her intention, in all its earlier changes, to complete the seed-vessels for the future propagation of the species when the plant should have attained maturity: the very fact of its having had power enough to nourish its stem and leaves up to the period of producing seed, implies a gradual increase of that power. The plan is fixed by the Creator. 
Now suppose any of the exhausting causes we have enumerated, are brought to bear upon a young girl; suppose her nervous system to be constantly taxed by too much excitement of stimulating food, spices, wine, etc.; her body debilitated by excessive quantities of clothing, perhaps ill-made and impeding the healthful 


46 
EFFECT OF MEDICINE ON MFNSTRUATION. 
expansion of the lungs; whilst she is severely taxed by the absurd requisitions of a school-mistress, depriving her of healthful exercise, at a period of life when she most requires it—'the inevitable result will be, that the blood, instead of an equal distribution over the surface of the body, will be thrown upon the internal organs, and it will most certainly go, in increased quantity, to those most immediately intended to be brought forward by nature. A premature establishment of the menses is the consequence; and the pale and sickly plant is but an emblem of the young female. In neither have the requisitions of nature been fulfilled; and both present the same consequences, viz. great exhaustion and debility, that can only be overcome by a careful attention to nature's demands. 
The class of medicines called tonics, in judicious hands, may aid her restoration; but they never can effect it without carefully retracing and remedying, as far as possible, the errors of early life. Nutritious and unstimulating food, free exercise in the open air, with a hearty enjoyment of all innocent recreation, should be the means chiefly relied upon. How far medicines of the tonic class shall be used, can only depend upon the intelligent and thoughtful physician, whose aid it is supposed will always be required by the mother. 
When a physician is called in under these circum- 


EFFECT OF MEDICINE ON MENSTRUATION. 
47 
stances, there can be no greater misfortune than the selection of a mercenary being, who uses his profession solely as the means of acquiring wealth. Should this unfortunately be combined with deficient education, and a time-serving spirit, alas! for the poor patient. He will experience no difficulty in carrying out his own selfish views; for the mother, if ignorant enough to suffer her child to pass into a state so unhappy without competent advice, is usually importunate for medicine. This is plied with the greatest assiduity, and relied upon as the only needful requisition. The greatest formality is observed in its administration, and the* physician continues his visits day after day, and week after week. 
To such an individual, and such a mother, the last subject of inquiry would be the operation of those great and unchangeable laws of nature, that are so beneficently waiting to interpose their powerful influence, and are only hindered from triumphant action by the unfortunate position of the patient. Most probably, the poor child is under the daily influence of a doting and fashionable mother, who has called to her aid all the appliances of our modern system of education. 
With the eloquent example of all animated nature before her—the feathered and brute tribes, aided by unrestrained freedom of motion, natural food, fresh 


48 
EFFECT OF MEDICINE ON MENSTRUATION. 
air, and healthful sleep, carrying out the plan of their whole being, and exciting the envy of the poor invalid— she, alas! is subjected to the irksome discipline of the school-room, with its repulsive and dry details, and too often its daily jargon of sound without sense; her body clothed with fashionable garments, the preservation of which seems the most important object of her life; whilst every free and healthful movement is restrained, and every natural impulse checked, because it oversteps some absurd idea of gentility. 
It is impossible, if we are to convey any correct idea of the healthful establishment of menstruation, to avoid constant reference to tight dress, and deficient exercise. Our conviction that these, with ill-chosen food, and some other evils of temperament entailed upon their offspring by the unmanageable passions of parents, impressing their own systems with disease, and thus conveying it to their children, is so strong, and our belief that we should resort to natural means of cure, and not to medicine, so conclusive, that if we recur again to this subject, when speaking of the different forms of derangement in the following chapters, the reader must impute it entirely to a sincere desire to aid her in her endeavours to benefit her child, and not to carry out any hypothesis of our own. We are not here delivering our own sentiments alone; the study of natural agents in alleviating disease, is now attract- 


EFFECT OF MEDICINE ON MENSTRUATION. 
49 
ing the attention of the profession throughout the world. We no longer hear of depriving a patient, burning with fever, of a piece of ice or a draught of cold water; on the contrary, they are given in abundance; and instead of the breath of heaven being studiously shut out by masses of curtains and closed doors, both air and ice are employed as the chief agents of amendment; and calomel and the lancet are replaced with nutritious food and tonics. Let us be distinctly understood in thus expressing ourselves. We know and feel the value of those great and powerful agents; but it is because of their value and power, in suitable cases of disease, that we fear their indiscriminate use; and when we see constantly before our eyes, the sad results of the depressing system of treatment so freely employed by the thoughtless and ignorant, or perhaps the too-learned physician, and entertain the sentiments we have endeavoured to impress on our readers, of nature's great power to cure disease, we are obliged to warn the reader of the danger attending the indiscriminate use of depletion. 
The administration of some of the more gentle medicines may become necessary, from the impossibility of immediately regulating the regimen of the patient ; and we do not object to their use with the view of putting the body as soon as possible in a condition 
to dispense with them. It is the use of stimulating 
5 


50 
EFFECT OF MEDICINE ON MENSTRUATION. 
and specific drugs that we deplore; such as are intended to force nature. This they can never do, without inflicting great injury upon the delicate lining membrane of the stomach and bowels, for on that is their action first expended, before they can possibly affect the ovaria. Moreover, they are often given before nature presents any evidence of personal development, and whilst the evolution of these ovaria is going on with all the certainty and speed intended for the peculiar' individual. 
We have seen cases, in which mothers demanded importunately medical treatment for children, possessing not a single sign of womanhood; and upon one occasion, in which we very unwisely refused to prescribe for a young girl, death was the consequence of the use of a powerful medicine administered by a wellmeaning, though ignorant parent. In this instance we might, by apparently yielding to the parent's desire, or by prescribing some harmless drug, have gained time, as recommended by some humane physicians, until menstruation was produced by the effort of nature. The case made at the time a strong impression upon our sympathies, and we determined to use our humble powers of popular instruction, when time and experience had given us more knowledge of the subject. 
It is equally improper to administer medicines to bring on the courses, in those cases in which the super- 


EFFECT OF MEDICINE ON MENSTRUATION. 
51 
verltion of disease in some part of the body other than the uterus —as of the lungs or liver, for instance— should cause the disappearance of menstruation; for this often happens, as will be seen when treating on " suppression of the menses." In such cases, the disease itself, whatever it be, must first be treated with appropriate remedies; and when that is subdued, the most gentle efforts must be made to favour nature in her attempts to re-establish the function. As we progress, we shall give a general idea of the medication most in use for the various derangements. What we have here said, will convince the reader that the judicious physician prescribes from a knowledge of the laws of the system, and that the mother should never attempt to influence his treatment. 


CHAPTER SIXTH. 
EFFECT OF REGIMEN ON MENSTRUATION. 
Thus far we have spoken generally of the more material agents in their effect upon the development of the body, and its functions; of the regulation of food, clothing, exercise, etc. It is now proper to notice some of the more abstract causes that tend to depress the powers of the youthful system, and to particularize a few of the most prominent errors of early management. And, first of all, of the depressing influence of parental severity. Whatever estimate the reader may form of that most abused of all earthly apothegms, "Spare the rod," etc., for ourselves we can only deplore the sad results to which it so often leads, in the vast proportion (may we not say all ?) of the cases in which it is applied. 
To see a thoughtless and uneducated—perhaps a brutal parent, under the influence of anger, and impelled by a high estimate of his own discrimination and powers of self-government, (for such people are always vain,) constantly and sternly reproving, and often striking a child, either for indulgence in some perfectly natural and innocent recreation, or, what is 


EFFECT OF REGIMEN ON MENSTRUATION. 
53 
as often the case, for some petty roguery, absolutely learned from the example of that very parent, gives us a clear insight into some of the most efficient causes of menstrual derangement. 
Such is the depressing influence of terror in deranging the nervous system, and so certain is it that in early youth, when nature intended life to be a scene of joy and hope, punishment, or even stern language, and the frequent deprivation of unrestrained motion, song, laughter, and sport, will be followed by hypocrisy and falsehood, in order to attain these absolute requirements of the child's system; that the most melancholy results may be anticipated from that wretched system of thraldom, so aptly termed "the iron rule." 
How closely connected are the little ascetic and stern faces, and bodies nicely and vulgarly decked out with gaudy finery, that we often see in the streets, moving with rigid accuracy in the exact line prescribed by the severe and anxious parent, with certain unhappiness, and early disease! What an index to the emotions of the soul, is the face of a little child' Well may philanthropists sigh for a change in society, in which it will be possible for us to bring up our children according to their natural attractions. Often have we witnessed the approach of disease, and full often heard from the lips of the sufferer in recounting 
5" 


54 
EFFECT OF REGIMEN ON MENSTRUATION. 
its symptoms, her convictions that a happy infancy would have insured a more healthful maturity. 
Does the reader require an explanation of all this ? Let her recur for a moment to her own feelings. Suppose, in the midst of happiness, she is overtaken with the intelligence of the death of a near friend or relation, or any domestic misfortune—perhaps the sight of the very child whose failing health she is daily lamenting. Why does she sigh ? Why does the hue of health desert her cheeks ? Physiology tells us that in grief the blood deserts the skin, and seeks the deeperseated organs, and observation confirms the assertion. Surely it cannot be supposed, that the blood in a single day leaves the body; and yet the individual who is florid with health to-day, to-morrow is pallid and deathlike. The lungs, because of their distensibility, receive the first influx of the blood when it is driven inward ; and the sigh is but an effort of nature to force it outward again to the surface. It is a fuller inspiration demanded by the necessity of giving more oxygen or vital air to the extra quantity of blood in the lungs, and other deep-seated parts. Motion, which is consequent upon free respiration, is checked, and the body is languid till this is established. 
Dancing, because it is impelled by the more •cheerful emotions, is peculiarly serviceable in imparting a healthful circulation of the blood ; and all childish 


55 
EFFECT OF REGIMEN ON MENSTRUATION. 
games are to be freely permitted. In short, homo must be made a place of happiness to its occupants. 
What shall we say of food ? Where all is wrong from the very beginning, how shall we bring back the reader's ideas to the simple intentions of nature ? If it be wrong to constrict the lungs, and to swelter the infant with a down bed and a cap, and to deprive the child of exercise and cheerfulness—if this excites prematurely the nervous system, in what language shall we indicate the enormity of the free use of tea, coffee, confectionary, etc., by a young girl, who is vibrating perhaps beBveen the effort of nature to establish menstruation, and a predisposition to disease derived from her parents ? 
Nothing but the pure elements of nutrition are demanded by nature to develope the ovaria, and they are accompanied with the most direct and powerful stimuli ; and what is worse, such as are known to have, of all others, the most prejudical action upon the nerves Milk, coarse wheaten bread, and, as they advance in age, moderate quantities of meat once a day, constitute the food of all children in the higher orders of society in England, and well does it speak for the intelligence of their parents. Look at the indulgence of our own children, more especially in city life. What is the reason of their almost universal lack of rosy cheeks, and appetite for simple food ? We believe it to be too 


56 
EFFECT OF REGIMEN ON MENSTRUATION. 
great variety and too stimulating quality of their food and drink. 
So large a portion of life is spent in sleep, that it becomes a matter of great consequence to secure a renewal of the exhausted atmosphere of the chamber. The culpable system of erecting dormitories immediately under the roof in our trying climate, only to be paralleled by the ill-judged and wretched economy of sitting apartments below the surface of the pavements, is productive of the worst results. The small size of such apartments, with the position of the door and window, renders proper ventilation impossible ; and our climate, during the greater part of the year, compels the occupants, often several in number, to shut themselves up entirely, with no possibility of ventilation during the whole night. Enter an apartment of this kind in the morning, and ask yourself the effect of respiring such an atmosphere for eight or nine hours! Lassitude, headache, and often nausea, with loss of appetite, are its common results. 
During the supervision of the medical department of two of our public charities, the extensive prevalence of an inflammatory-affection of the eyelids was traced to this as a cause; and it is so pronounced by the highest American and European authorities. The writer is still constantly proving this in his daily practice. Spots on the eyeball, or films as they are 


57 
EFFECT OF REGIMEN ON MENSTRUATION. 
called, in children predisposed to scrofula, demanding the utmost care to preserve vision, are constantly presented to his notice; and there is much reason to impute the frequent combination of this malady with enlarged tonsils in the throat to the same cause. 
These two diseases have more than kept pace the increase of our population; and we can assert without fear of contradiction, that there is scarce a family of six children without one or other of these distressing affections. The constant starting and convulsive inspiration, so often noticed by mothers, is, if it persist, almost always imputable to a narrowing of the throat by the enlarged tonsils; and the necessity of their removal is apparent, if the lungs are to receive a supply of air. 
Both of these maladies are often called scrofulous in character, and parents distress themselves very foolishly in their vain attempts to discover the cause. There is no accurate definition of scrofula to be given. We are accustomed to designate general weakness of the solids, evinced by fullness of the lips, eyelids, and nostrils, with either a very transparent state of the skin or one much the reverse, by this term. Such systems require a great deal of nourishing food and fresh air; if these are denied them, and they take much medicine, they are very apt to have the annoyance of diseased throats or eyelids, these evils being 


58 
EFFECT OF REGIMEN ON MENSTRUATION. 
both consequent on debility of the parts, or want of power in the blood-vessels constituting their substance. Precisely in the same way debility, or congestion of the uterus, as it is called by physicians, will produce suppression of the menses after they are fairly established; and it therefore becomes all important to keep up the powers of the system in all such delicate individuals. 
We have said in another place, and on another occasion, that if the powers of life are to be preserved in certain delicate females of a nervous temperament, parents must be perfectly acquainted with their most secret thoughts and actions. There is no such thing as escaping this duty, if the mother designs to fulfil her duty as the natural protector of her child. Nor can the matter be met half way: however she may have estranged herself from her child by neglect of its morals and associates in its earlier years, we assure her, with great earnestness, and the strongest conviction of its necessity, in alas! too many cases, that young females are the victims of precocious passions as well as our own sex. 
She must make her physician her friend, and with his aid and friendly suggestion, inform her child of the legitimate functions of her uterine system, and the great danger of subverting it by improper practices in early life. It would not be proper to enter into further detail 


59 
EFFECT OF REGIMEN ON MENSTRUATION. 
on this subject, in a volume like this; but when it has been said by others as well as ourselves, that this vice is of such frequency as to constitute one of the greatest drawbacks to the preservation of youthful life, we feel that a less decisive mention of it, on our own part, would have been inexcusable. 


CHAPTER SEVENTH. 
SUPPRESSION OF MENSTRUATION AT PUBERTY. 
When at the period of puberty, and under the circumstances detailed at page twenty-second, menstruation should not occur, or appear only occasionally, and that appearance be scarcely visible, the individual is said to labour under suppression of the menses. The reader's attention is directed particularly to that page, as it comprises all the circumstances essential to its appearance. 
There are several important divisions of the subject of suppression, each of which is most intimately connected with its proper understanding and treatment; and although we are not writing on the domestic administration of medicine—which, after what has been said, it will hardly be suspected we approve—it is important that the circumstances attending the different forms of the non-appearance of the menses, or its almost immediate suppression, and the causes that produce that state, should be distinctly understood. Under no other circumstances can this volume either aid the mother in her duftes to her child, or secure her obedience to 


SUPPRESSION OF MENSTRUATION AT PUBERTY. 
61 
her physician ; for it is not likely she will yield blind obedience to that which she does not comprehend. 
The'first form of suppression is that in which it does not appear at all, when from age, personal development, and comparison with other members of the family—if there be any, who have already become regular—it is judged by the physician that the proper period of puberty has arrived. This originates from constitutional causes. 
The second form is that in which it has appeared, perhaps very slightly, once or twice, and then suddenly ceases. This form may originate from the occurrence of congestion, or too great fullness of blood in some other part of the body, as the lungs or liver, for instance, diverting the blood from the uterus to nourish the disease. This may be either a very slight affection, admitting of speedy relief, or a serious change in some internal organ, requiring long continued effort to remove. 
The third form originates in several affections of the uterus itself, and will form the subject of the next chapter. What we now offer comprises the opinions of all the standard authors, both European and American, with such views of our own as experience and observation in every class of our countrywomen have induced us to entertain. 
In speaking of the first form, we take it for granted 
0 


62 
SUPPRESSION OF MENSTRUATION AT PUBERTY. 
that the fact of the appearances of womanhood existing, makes it plain to the reader that we do not mean such cases as the one alluded to at page fifty, where the female, although at the ordinary age of puberty, presents none of its concomitants ; but those in which, from appearances and symptoms, as detailed at page twenty-two, it is evident to the physician that nature is attempting to establish the function. 
There are two very opposite styles of personal appearance, in which the menses do not appear, under circumstances apparently right to the eye of the mother. The first is, that in which the general character of the constitution is remarkable for its robustness ; the strength and appetite are good; and although the complexion has not the clearness, nor the eye its proper lustre or expressiveness, still the bloodvessels seem turgid with their contents, and the mother wonders why nature does not relieve her child. 
This condition is called the sanguine temperament. If there be any propriety in the expression, "the blood is too rich," it is in this state. There is no doubt that what is called the " fibrine," or peculiarly animal part of the blood, is redundant; and clogging, as it were, the delicate secreting surface of the uterus, its extrusion is prevented, or, going to some other internal organ, it is diverted from the uterus. In such cases, bleeding, although a sadly-abused remedy 


SUPPRESSION OF MENSTRUATION AT PUBERTY. 
63 
in many female complaints, is undoubtedly serviceable j and when the parent feels inclined to oppose it as an unnatural resort, let her remember, that in a large proportion of cases her child is in an unnatural condition, the system being in a state of excessive health, if we may so speak. 
The moderate abstraction of blood, particularly at the period when the symptoms indicate an effort on the part of nature, often equallizes the circulation, and establishes the courses in a natural manner. Indeed, they frequently appear a few hours after the blood is abstracted. Foot, or hip baths, in such cases, have a good effect after the lancet. The application of leeches is often resorted to with benefit, especially in cases where the delicacy of the patient, or the prejudices of the parent, forbid the lancet. 
Whatever use may be made of purgative or stimulating medicines, must depend upon the judgment of the attending physician. So far as their mildness or certainty of operation is concerned, they are by no means to be compared to either leeches or the lancet, nor do they always leave the system in as quiet a state, or produce as good an effect. We seek to abstract an amount of blood that we think redundant; and there can of course be no method as direct as that of withdrawing it immediately from the system, either by the lancet, or by leeches. The latter are applied when 


64 
SUPPRESSION OF MENSTRUATION AT PUBERTY. 
used in place of the lancet, in considerable num. bers. 
These remedies are rarely required more than once or twice, and if timed judiciously, they almost always produce beneficial results. A second application is frequently demanded by the patient herself, if sufficiently intelligent to judge of their efficacy, and the relief afforded by the first. 
The diet of a young girl under these circumstances should be of the mildest character—almost exclusively vegetable; and if animal at all, fish or fowl should be the strongest food that is given. 
Exercise in this state may be left exclusively to the natural inclination, requiring only supervision when it is likely to exceed (from too youthful impulse) the bounds of discretion. It may often happen that the system is oppressed with lassitude, and rather shuns active exercise than seeks it. 
The second style of personal appearance in which menstruation does not occur at the expected time, is characterized, it is true, by a sufficient development of the person, yet the great contrast to the state just described, is at once evident to the beholder. The face is pallid, and only flushed on occasion of violent mental excitement, or unusual exercise, which is not endured as it is by her of the sangujne and robust temperament, but soon oppresses and exhausts the 


SUPPRESSION OF MENSTRUATION AT PUBERTY. 
65 
system we now describe. The appetite and affections are more irregular, the former seeking the most opposite and incongruous articles of diet, and the latter requiring much excitement to induce the ordinary demonstrations of affection. In short, the temperament is what is aptly called the lymphatic ; or that in which the vessels are filled with lymph or thiri blood, in contradistinction to the sanguine, or that in which they are filled with thick and rich blood. 
Dr. Columbat, a distinguished French writer, remarks : " The general debility which is so often the cause and the attendant of suppression, does not always derive its origin in the primitive constitution of the female; it is often the unfortunate consequence of a number of debilitating causes, such as living in a low, humid situation, deprived of the light of the sun; aliment of a bad quality; warm watery drinks; insufficient nourishment; want of exercise, or the fatigue produced by labour beyond the strength; tedious diseases and convalescence; leucorrhea, (see that chapter;) the abuse of sanguine evacuations; disappointment, and all the depressing passions; and finally, all the causes which impoverish the blood, and render it incapable of imparting to the organs the energy indispensable for the full exercise of the functions. If the contrary excess, that is to say, the state of plethora 
(sanguine temperament) produces an analogous effect, 
6* 


66 
SUPPRESSION OF MENSTRUATION AT PUBERTY. 
it is because the blood, too rich in fibrine, forms an obstacle to itself, and opposes the periodical exhalation which constitutes menstruation." 
These causes are well calculated, from their frequency and unavoidable nature, to make us sigh for the unhappy state of great numbers of the human family. v Who can consider the condition of those employed in factories—even those of our own favoured country—and not be satisfied that the unavoidable evils attendant on repulsive and monotonous labour, are shockingly prejudicial to human life? Consider their constant deprivation of fresh air, and their constrained position the livelong day, and compare it with the natural desires ! We are satisfied that in the vast proportion of persons thus employed, lasting evil is done to the constitution. It will at once appear from these causes of suppression in this form, that the system of treatment is in many respects the opposite of that recommended for the sanguine temperament. Bleeding, however, in some cases, but in very small quantity, seems to quicken the circulation, and iron, in several of its forms, evidently imparts to the blood a healthful impetus. It would seem from the investigations of chemical philosophers, that in this state of paleness, or in lymphatic persons, the blood lacks this substance, which most of our readers know enters into its composition; and judging from the hue of health 


SUPPRESSION OF MENSTRUATION AT PUBERTV. 
67 
that has often followed its use in our own hands, we have supposed, with them, that it imparted the necessary colouring matter, or a principle essential thereto, to the blood. 
Free exercise in the open air, riding on horseback, or in a wagon, and short and frequent walks, will be productive of all the benefit inseparable from a healthful impetus to the mind and circulation. For the same reason, all the depressing emotions, whether originating in domestic unhappiness, or careless indifference to the welfare of her children, must be dissipated by the mother and her associates. Under the influence of her presence, all unhappiness should flee like clouds before the sun; home must be a 'happy place, or the health of the female inmates will ¦ suffer. Often have we felt the impossibility of conferring any benefit upon those who demanded our care, from the constant gloom that pervaded the household; and knew full well that the gnawing cares incident to poverty, or the discontent originating in an ill-regulated mind or family, opposed our best efforts for ©ur patient's welfare. 
In all these cases, whether connected with'the guine or lymphatic constitution, the utmost eare must be used to avoid currents of air, and cold or wet'feet. Congestions of the lungs and liver are the 'frequent consequences, under the most favourable circum- 


68 
SUPPRESSION OF MENSTRUATION AT PUBERTY. 
stances; and a violent catarrh, or some of its analogous affections, under the popular name of a cold, may turn the balance against her, and entail lasting weakness of the lungs. Neither must the body be neg. lected; clothing enough must be worn at all times to insure a constant state of comfort: a chill must be unknown. Flannel next the skin in the fall, winter, and spring months, is indispensable in most persons. In our climate it may be necessary to change the clothing three or four times a day. 
All exercise must be taken before sundown, as it is impossible to preserve an even temperature after that time. The practice of riding out by invalids before breakfast, or after the evening meal, is absurd. A light meal should always precede exposure to morning or evening air, or the skin will be constricted, and the body chilled, rendering internal congestion of greater or less extent almost certain. It may be only a slight catarrh, but that is too much; the invalid cannot afford it. We seek to equallize the circulation of the blood, not to drive it inward, and that can only be done by exercise never carried to the point of fatigue, and a constantly-equable state of warmth of the skin. 
The invalid should retire to rest immediately on the approach of drowsiness, never suffering a visiter to detain her. Let it be distinctly understood that she is an invalid, and no well-bred oerson will be annoyed at 


SUPPRESSION OF MENSTRUATION AT PUBERTY. 
69 
her departure. The chamber door should never be closed, because it is impossible, owing to the position of the windows in most chambers of moderate dimensions, to sleep with the window open, even in our warmest weather, without danger from a current of air. On the door and an open fireplace and chimney, we must rely for ventilation. \t is highly improper to bathe in cold water, and a warm bath may be too debilitating; indeed, that luxury is always used to excess in regard to the time of its duration. Few persons are strong enough to endure a bath of eighty or ninety degrees, (and they generally use it a hundred,) over five minutes—it is far oftener continued a quarter of an hour. Warm water and a moderately rough towel should be used for ablution, and only part of the skin exposed at a time, taking care to dry thoroughly, and rub it into a glow, before resuming the garments. Daily exercise of this kind will be found a most admirable means of equalizing the circulation; and is not to be dispensed with, where out-door exercise is impracticable. Dancing is an exercise well suited to this condition of the system. The food should be of the most nutritious character, and, in the lymphatic temperament, of a stimulating quality. This, however, is by no means suited to the sanguine. The true physician will always recognise the distinction, and direct the diet accordingly. 


70 
SUPPRESSION OP MENSTRUATION AT PUBERTY. 
So much of what has been said applies to the second form of suppression, or that in which the blood is diverted from the uterus by congestions, or too great fullness of blood in other parts of the body, that the general directions of the patient's regimen need not be repeated. Any such complication is, if not speedily removed by judicious medical treatment, so likely to terminate in serious and persisting disease, that it should come under medical care without delay. 
The utmost attention, and most careful medical supervision is often required in such cases, and we have seen so many victims to neglect, particularly where the liver and lungs were affected, that we hope no parent will be so unwise as to misapply what we have said against indiscriminate dosing. 
There is, in general, no difficulty in recognising these cases. Pain and a slight dry cough show congestion of the lungs, and yellow and dusky complexion, with occasional pain and heaviness under the lower border of the ribs of the right side, indicate the same state of the liver. 
But it is evident to the intelligent reader, that it would be entirely out of place in a popular volume 
to enter upon these complicated cases. Not only their existence, but their treatment, must be determined upon by the physician j but we assure the reader that the administration of medicine, though occasion- 


SUPPRESSION OF MENSTRUATION AT PUBERTY. 
71 
ally indispensable in such cases, is only to be used as an adjuvant and subordinate remedy to the great natural medicines, air, exercise, diet, and cheerfulness. Congestion, or the opposite state of the uterus, may be, and often is, connected with the two forms of temperament. Nearly all that is said in describing these conditions and their treatment, in the next chapter, is closely connected with this. They have been separated because, though intimately associated with constitutional causes, they are, properly considered, affections of the uterus itself. 
The saying of a distinguished writer, " On account of the uterus, woman is what she is," becomes most forcibly apposite in the extraordinary moral and physical peculiarities of those females in whom there exists a complete absence of the ovaria, whether such a condition be combined with an entire want of the uterus also, or whether there be, as is most likely in such cases, a very imperfect development of that organ. There is of course no appearance of the menses, and the mind and body present an extraordinary assimilation with those of the male. Much of the delicacy of expression and caprice which constitute a marked peculiarity in females, is exchanged for the more direct utterance of sentiment and steadiness of purpose, peculiar to males; whilst the personal appearance, and fancy for ruder exercise and sports, are equally appa- 


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SUPPRESSION OF MENSTRUATION AT PUBERTY. 
rent. The passion of love is unknown to them, and they present an aspect altogether at variance with the harmony of nature. From their remarkable physical peculiarities, connected with certain structural derangements sometimes occurring in females, these unhappy persons give rise to the impression that both sexes may be combined in one individual. We need not say that no such anomaly has ever been known to exist. 


CHAPTER EIGHTH. 
SUPPRESSION FROM AFFECTIONS OF THE UTERUS ITSELF. 
Although we cannot, with any degree of profit to the general reader, detail the different affections of the structure of the uterus—as they are so varied in character as to require a minute and comprehensive knowledge of disease, even for physicians themselves to understand them—still we must notice the simple congestion of this organ, because it is a frequent cause of suppression, and one which the patient requires in some degree to understand, in order to favour the efforts of her physician for her relief. 
In the last chapter, when speaking of congestion of the internal organs, viz. the liver and the lungs, we gave the reader to understand that any of the internal parts of the body were liable to have the blood lodge in them in too great quantity; and when speaking of early exhaustion, at page forty-six, we said it would often go by preference to those organs intended to be brought forward at puberty. 
In the human body, any organ is liable to congestion very much in proportion to the number of blood-vessels contained in it; and as the uterus at the period of 
7 


74 
SUPPRESSION FROM AFFECTIONS OF THE UTERUS. 
puberty is pretty well supplied, and is moreover, particularly in an artificial state of society, the point on which a great number of moral emotions concentrate their action, there is no reason why it should not be the seat of frequent derangement in its circulation. All experience confirms this liability, for it is not only often affected with congestion at this early period of life, but, as will be seen when speaking of " difficult menstruation," at a more advanoed period. Indeed, it is known to be the centre of so many sympathies and affections, that it has been said, by a learned Latin author, " On account of the uterus, woman is all disease." 
In the same manner, and from similar causes that the whole system may be either redundant in health, or below the proper standard, the uterus itself may be in this state; viz. either containing in its blood-vessels too much, or too little blood. 
The most frequent cause of suppression from congestion of the uterus is cold, applied either to the feet, from standing in thin shoes upon cold or damp ground, or to the surface of the body when too lightly clothed. The reader will observe we are still speaking of suppression in early life; and although at a later period, when the cares of a family demand more exertion and frequent exposure, this cause may be more common, there is nothing to prevent its action just at the period when nature is about to establish menstruation. 


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SUPPRESSION FROM AFFECTIONS OF THE UTERUS. 
Strange to say, we have known not only very young girls, but even those in whom it might fairly be supposed an act of insanity—because they had been regular for some years, and knew the consequences—actually stop the flow designedly, by putting their feet into cold water, when about to attend a ball or party. On one occasion we were summoned to visit a young lady at a fashionable boarding school, (a kind of institution towards which we have never been very affectionately impressed,) who was with difficulty saved from a violent inflammation of the lungs, consequent on this hazardous experiment. All that has been said in the last chapter, on the precautions of clothing and general regimen, as affecting the constitutional infirmities, applies with equal force to this local affection; for it speedily reacts upon the constitution, and becomes a most powerful cause of general derangement of health. 
In this state of the uterus, it is quite idle to expect from the immersion of the feet in warm water and the administration of herb teas, etc., an immediate reappearance of the menses, should they chance to be suppressed in a female who has previously been regular. That desirable event-may happen in a very recent case, or one of a few hours' duration; but when the impression of cold has been so serious as to cause suppression for even a day or two, no such treatment will suffice. 


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SUPPRESSION FROM AFFECTIONS OF THE UTERUS. 
The violent pain succeeding a chill of greater < less severity, is an evidence of pressure upon th,, nerves of the uterus, from the quantity of blood lodged in its proper tissue or substance. When this reaches the head and abdomen, and produces headache and colic pains, and sometimes powerful hysteric parox. ysms, that mother is acting a very thoughtless part who will trust to any domestic remedies. We sincerely hope she will apply nothing that we have said on the impropriety of constant dosing in early life, to prevent her seeking competent advice. Should she not do so, she may regret it when too late, and perhaps date her child's declining health from an act of folly and presumption of her own. 
In such a state of things, however we deplore the necessity, there is no substitute for the lancet. Whatever may be said by those designing individuals, who are ever ready to appeal to the passions and prejudices of the ignorant, it is the proper remedy; and although the physician will doubtless call in the aid of anti-spasmodic remedies and the warm bath, either general or local, he will not rely upon them as remedies of themselves. They are important aids to the abstraction of blood, which is the nearest approach to nature, inasmuch as she has been prevented discharging the intended amount of blood in her own manner. 
The application of leeches will not answer in such 


77 
Suppression from affections of the uterus. 
cases; they are adapted to those only in which it is designed to draw the blood towards the uterus, as we shall show when we speak of menstrual suppression from too little blood in that organ. But we do not intend to burden the reader's memory with details of treatment, for she could make no use of them; and it would be insulting her common sense to give directions for medical treatment in a popular work designed to give a rational idea of its effect and general meaning, when applied by physicians. 
For the same reason we make no allusion by name to specific remedies, either in this place, or when speaking on the subject of abortion. That physician who is worthy to be trusted at all, well knows the precise amount of reliance to be placed on them, and their respective powers. As we have already said at page fifty, and shall have occasion again to repeat in another chapter, they are decidedly wrong, and very dangerous when the menses are delayed in early life; and although admissible in those cases of suppressions we are now considering, they are only to be used by persons of much practical experience. Indeed, they are so often misapplied by wicked and designing individuals, that we consider any mention of their names or powers would be highly culpable. 
There are many cases in which slight causes will produce the disappearance of the menses in very deli- 


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cate persons, wherein it would not be proper either to apply the lancet or adopt any other very decisive treatment; in such as those in which nature has scarcely been able to effect their establishment, no very severe symptoms will appear, should they pass over two or three periods. All such cases should be carefully watched by the physician, and when symptoms indicate congestion of any internal organ, suitable treatment should be immediately instituted. Every careful mother will avail herself of her family adviser's opinion. 
That excellent practitioner, the late Dr. Dewees, of Philadelphia, remarks: "The general health rarely suffers before three or four successive periods have passed, unless the obstruction be accompanied with leucorrhea, (see that chapter.) If this attend, the health may be earlier affected; and when it happens, it should be immediately noticed. The remedies will vary according to the state of the system; and I cannot too earnestly recommend attention to this point, as success in the treatment of these complaints almost exclusively depends upon this discrimination. Perhaps there is not in the whole range of medical practice, such a departure from principles, as in the treatment of certain female complaints. They seem to be prescribed for with determined empiricism;—as if the laws which governed diseases in general, were not ap- 


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SUPPRESSION FROM AFFECTIONS OF THE UTERUS. 
plicable to them. The want of success in many of the complaints of females, is owing almost altogether to the determination to discover specifics for them; for the existing condition of the system is never taken into the calculation, when the prescription is made ; hence the almost uniform failure in the hands of some practitioners, which are as uniformly successful in those of others. A practitioner acquires by long habit and correct observation, a control over certain diseases, that will not yield to the same remedies when indiscriminately used by others. This tact in the use of certain medicines, is but the result of accurate observations on the various conditions of the circulating system; and when this study is neglected, it is a moot point whether the remedy succeed or not." 
We have given this long extract from a distinguished physician, because it coincides with our own ideas and experience, in the use of remedies intended to stimulate the uterine system. Although we have deprecated their use for the purpose of forcing nature—-in those cases where menstruation has not appeared at the precise time when it was supposed to be due—by persons unacquainted with the laws which govern its appearance, we are well satisfied of the efficacy of several active medicines, in producing a return of the menses, after the powers of the system have been properly equalized. 


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SUPPRESSION PROM AFFECTIONS OF THE UTERUS. 
In many instances we have known patients attempt to deceive their physicians, in regard to one of the causes of their menstrual suppression. It is not necessary to allude more distinctly to a very frequent attempt, than to say, that it is often made by unmarried females with the view of avoiding exposure of character. The well-instructed physician needs no caution on this point. To such as would attempt to deceive, we can only advise a careful attention to the chapter on abortion. 
That there are some individuals who arrive at the age of puberty without a corresponding development of the uterine system, is undoubtedly true; and that these persons are generally of the lymphatic temperament, observation seems also to assure us. It is in such females that we are accustomed to say, the menses do not appear from the existence of too little blood in the uterine system. The distinction between them and those of the sanguine temperament, in personal appearance and the affections, has already been so far described that the reader will doubtless easily recognise them. 
If no development of the general person appear in these cases, and the constitution gives no evidence of suffering, we should classify them with those in whom, none of the evidences of womanhood existing, we ought to make no effort to assist menstruation. But matters 


SUPPRESSION FROM AFFECTIONS OF THE UTERUS. 
81 
are often otherwise. A young girl advances to evident maturity, and is sometimes two or three years in age beyond a sister of the sanguine or nervous temperament, who is perhaps perfectly regular. The one is listless, pale, and inactive, without appetite, and fond of solitude ; the other brilliant and healthful, and the delight of the social circle. Perhaps the invalid presents a tendency to dropsical affections, as evinced by pitting of the flesh on slight pressure ; and her hollow eyes, with discoloration of the skin beneath the lower lids, and bloodless cheeks and lips, evince too plainly that health is suffering. There is, in such cases, a great tendency to leucorrhea (see that chapter;) and although that is a complaint far more frequent in married life, we have often known it proceed even in young girls to so great an extent, as to be accompanied with complete displacement of the uterus. (See chapter on prolapsus uteri.) It is very evident from the description that this affection, although existing more immediately in the uterus, is closely, connected with constitutional feebleness. Hence there is no propriety in the popular idea of specific remedies; and the observations of Dr. Dewees embody the sentiments of all educated and practical physicians. The constitution should receive such attention as we have advised in the last chapter, whilst more immediate treatment is due in this affection directly to the uterine system than 


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SUPPRESSION FROM AFFECTIONS OF THE UTERUS. 
in any other. Whether the secreting surface of the uterus, or the ovaria, or both, are implicated, there can be no doubt of the propriety of using such remedies as are calculated to invite the blood to the parts. It is here that the greatest care and circumspection are necessary by the physician; for in such cases the use of medicines having a more direet action upon the uterus may occasionally be tried with success. They are not to be given to " force nature " to the secretion, for that we have already deprecated. We have said that their use should be shunned in all cases where it is not plain that nature is, from some internal cause, inadequate to the task; and it is here that the skill of the physician is most evident. A careful estimate of the powers of the system, and a judicious use of remedies, are often crowned with success, when the indiscriminate use of stimulating and specific remedies (absurdly so called) is often attended with inflammatory affections of the stomach and bowels, and a train of evils too melancholy to contemplate, without a hearty desire that females should be disabused of their sad prejudices in favour of this heartless system of quackery. The good effects of stimulating food, hip and foot baths, and a careful attention to the happy influences of cheerful and varied society and scenes, music, dancing, etc., already alluded to, are particularly evident in a female thus situated. 


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SUPPRESSION FROM AFFECTIONS OT THE UTERUS. 
The local application of leeches may be tried, under medical supervision; and we have found great benefit from the use of an instrument designed by ourselves to effect a similar purpose, by exhausting the air, and thus inviting the blood to the uterus. This instrument, so invaluable where leeches are not to be procured, we hope soon to see universally adopted by the profession. A great advantage attending it is, that it may be applied, after suitable instruction, by the patient herself. We have had the gratification of receiving letters from physicians in far distant parts of our country, attesting its efficacy in obstinate cases of suppression. These means, together with the occasional use of stimulating injections, comprise the plans most in use by physicians for the relief of this variety of suppression. 
A much better idea of suppression from alteration of position will be gained, when we come to speak of displacement of the uterus; suffice it to say here, that from its mobility, particularly in those who have borne children, it is not only liable to prolapsus, or slipping downwards, but to retroversion, and more rarely to anteversion; that is, to doubling partially upon itself, or turning backwards or forwards, so as to close the passage through its neck, and thus to cause the retention of the menstrual discharge within the uterus; producing enlargements that we have known to subject 


84 
SUPPRESSION FROM AFFECTIONS OF THE UTERUS. 
virtuous females to injurious suspicions. In these cases manual interference by the physician becomes necessary, in order to place the uterus in its proper position. When this is done, the menstrual blood is immediately discharged. It will be seen in the chapter on prolapsus, that this interference is also much more frequently necessary for uterine displacements, where there is no retention, than has hitherto been imagined. 
It will also appear in the chapter on inflammation of the uterus, and some of its other affections, that suppression of the menses may occur from such causes ; indeed, it is a symptom of so many uterine affections, that there seems to be no propriety in including here any other causes of this derangement, than those marked and distinctive ones already explained in this and the preceding chapter. 


CHAPTER NINTH. 
DIFFICULT AND PAINFUL MENSTRUATION. 
This is recognised by authors as a distinct form of menstrual derangement, though it is so often combined with different uterine affections, that it is impossible to separate it from them. That which we are now to describe, is characterized on each return of the monthly period by successive pains similar to those of labour. It is also frequently accompanied with hysterical symptoms, such as a tendency to suffocation, irregular pains in the limbs, cramps, loss of sleep, and greatly increased irritability of temper. There is a distinct variety of this form of disease, in which the menstrual discharge is accompanied with pieces of a membraneous-looking substance of no uniform size, sometimes as large as an ordinary wafer, at others appearing in shreds, and again large enough to line the whole uterine cavity. 
No cause whatever can be assigned for this variety of difficult menstruation. It is not combined with any visible derangement of the uterine structure, as ascertained by examining the bodies of those afflicted with 
8 


86 
DIFFICULT AND PAINFUL MENSTRUATION. 
it, who have died of other diseases—for it is itself never fatal. Dr. Dewees considers it a derangement in the blood-vessels which secrete the menses. This idea is greatly strengthened from the observation made by him, that those afflicted with it are never fruitful; nor have we ever observed an instance in which barrenness was not its attendant. Fortunate medical treatment has occasionally proved effectual in removing this membraneous secretion. On two occasions we have succeeded in relieving it, as directed by Dr. Dewees, by an article of some power, viz. the volatile tincture of guaiac; and some of our friends have proved equally successful in its use. 
The discharge is not always deficient in quantity, though it mostly appears drop by drop. That form, unattended with the membraneous complication, generally admits of alleviation, and often of cure. Dr. Dewees speaks of the successful administration of camphor, and we have ourselves used it with success. Females cannot be too cautious in taking this remedy, for we have witnessed such painful results after its careless use, as to induce surprise that it is not often actually fatal, from the manner in which we have seen it plied by nurses and others. We know individuals of both sexes, who have never entirely recovered from headache, following the most violent frenzy produced by an over-dose; and such is its peculiarity, that a 


DIFFICULT AND PAINFUL MENSTRUATION. 
87 
very small quantity will affect some persons, which in others will produce no sensible effect. 
By far the most frequent cause of painful menstruation, may be found in alterations in the neck and opening of the uterus. Congestion, producing a temporary contraction, may cause a female to have very painful periods, who has previously been perfectly free from all such symptoms. This, if unrelieved, may pass into a state of permanent hardening. (See chapter on alterations of the neck of the uterus.) Such a state will require far more active and continued efforts for its removal ; indeed, this symptom of pain during menstruation in one previously unaccustomed to it, should furnish a hint to the female to seek competent advice; for a permanent hardening of the uterine neck is an ailment of a very serious character. Among the many cases of cancer of this organ, which it has been our misfortune to have seen, we know of no single instance in which painful menstruation had not existed for a greater or less period of time. Should it even pass off entirely, and menstruation be unattended with further pain, it is quite probable the difficulty has been removed by the natural dilatation of a part only of the small opening, the rest retaining a state of hardness that may in time lead to open cancer. 
We offer no apology for thus exciting the anxiety of some one of our readers; we are writing for their in- 


88 
DIFFICULT AND PAINFUL MFNSTRUATION. 
struction and caution, and it is our duty in completing our design, to give all the information that may be of service. If cancer of the uterus is ever to be cured, it must be in its earliest beginning; for when fully developed, it is utterly impossible. 
Difficult menstruation sometimes occurs from con. traction of the uterine opening, and is often the cause of barrenness; in adopting a very simple and successful means for its relief, suggested by a distinguished European physician, it gives us great pleasure to have realized another result, mentioned by its suggester, viz. the birth of children. Several instances in which this practice has been pursued by ourselves and our friends, have proved the truth of his assertion. 
The practice consists in dilating the opening of the uterus until the morbid tendency to contraction should be overcome. It is a measure unattended with either pain or exposure, and one to which the mcst delicate female may submit without the least annoyance. During this process, which should occupy but a few minutes at first, gradually increasing the period for the instrument to remain, the patient is kept under the operation of sedative medicines. Any further mention of the means to be used would be out of place in this volume; the professional attendant is supposed to be fully acquainted with its method of application. 
It is not improbable that this painful performance of 


DIFFICULT AND PAINFUL MENSTRUATION. 
89 
a function so intimately concerned in nature's greatest intention, is connected with an erroneous movement of the forces, brought about in early life by the constraint of dress, and the effect of unnatural diet. Among the aboriginal races of our country, we have been told, by professional friends connected with the army, and having opportunities of investigating the subject among the Indian women, it is quite unknown : and other derangements of the uterine functions are of equally rare occurrence. 


CHAPTER TENTH. 
EXCESSIVE MENSTRUATION. 
By referring to page thirty-eighth, it will be seen that the amount of discharge at each menstrual period varies in different persons. There is, in truth, so much difference, that the term excessive can only be used with propriety when the flow produces debility in the individual, who has not previously been thus affected. The same person may have the quantity greatly increased, without suffering in the least degree, from natural causes, altering the constitution and creating the necessity for a greater discharge. It is therefore to be understood, that it is not excessive unless it produces actual debility, and not that state of languor so frequently the result, when the ordinary amount is evacuated. 
The fact that discharges of blood from the uterus occasionally happen in infancy, and also far beyond the menstB|ating period, with the knowledge the reader now has of the liability of some of the internal organs to become the seat of visible discharges of blood—as proved by its occasional appearance from the lungs, and its passing off with the stools when the kidneys, 


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EXCESSIVE MENSTRUATION. 
bladder, or bowels are affected—will make it perfectlyclear to her comprehension, that all the discharges from the uterus are not to be considered menstrual in character, even when appearing at the actual period of menstruation. 
That function may take place with perfect regularity and good intent on the part of nature, and before it has ceased, or even at its very commencement, from some moral or physical cause—as a violent emotion, great debility, a fall, or excessive exercise—it may merge into a discharge of pure blood. 
It has been said by authors, and it is, we know, quite true, that the discharge occurring at the proper menstrual period, has certain properties not common to blood; such as not coagulating or forming clots, and a slight difference in colour. With these peculiarities we have not burdened the reader's memory, as we conceived them unimportant in a popular work, the more especially as the menses are produced from the blood, are of similar appearance, and so far subject to all its laws and regulations, as to be called by the same name. It is in consequence of this similarity, and its close connection with discharges of proper blood, or " flowing," as it is often called by females, that we combine them in the same chapter. 
After menstruation has performed its peculiar office in the married state, and the new being is contained 


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EXCESSIVE MENSTRUATION. 
within the uterus, it becomes the centre, as we have shown, of a very great afflux of blood; and in abortion, the period of menstrual cessation, and under many other circumstances, as we shall see, very dangerous discharges of the vital fluid occur. What we now wish to impress upon the reader's memory is, that from the very nature of its functions, and its entire subjection to all the causes of mental and bodily excitement, it is constantly liable to an excessive afflux of pure blood ; and that there is no necessity, so far as instruction and precautions on her part are concerned, to separate the two subjects here. We shall, therefore, throughout this chapter, use the terms excessive menstruation and discharges of blood, in close connection. 
It is needless to repeat what has been said on the errors of physical education, the bad results of ill-regulated diet, ventilation, and the depressing influences of grief, terror, etc., in reducing the powers of life and causing suppression; they act with equal force, though in a different way, when menstruation is established, and become prominent causes of this derangement. 
As it is unnecessary to particularize the symptoms of this complaint—its very appearance constituting its distinctive peculiarity—we will endeavour to make it clear to the reader, why, and in what manner, these 


EXCESSIVE MENSTRUATION. 
93 
causes act so differently upon the blood-vessels when menstruation is established, so as to admit of this excessive discharge. 
The whole human body may be said, with strict anatomical truth, to consist of two immense bloodvessel —the one going from, and the other returning to the heart, like two great trees; their roots proceeding thence, and their branches interlacing throughout the body, and constituting its entire substance. Supposing every branch to be hollow, they represent bloodvessels carrying out the blood, by the contraction of the heart giving it at every beat an impulse. This impulse is continued by the alternate contraction and expansion of the blood-vessels themselves. The one tree takes the blood from the heart, the other returns it in a reversed current, after it has performed its function of producing every thing required, and repairing the waste all over the body. It then passes through the lungs for purification, so as to be used again in the same manner. 
This property of the heart and blood-vessels to contract upon their contents, and propel the blood, is as near as we probably ever shall get to the conception of life. As the blood is the source of every thing in the body, so it is the origin of this very contractility of the vessels that contain it. It imparts it to them in a manner as yet unknown to us. In the language of 


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EXCESSIVE MENSTRUATION. 
scripture, "the blood is the life thereof." In an equally mysterious manner, the depressing emotions and inattention to the requirements of nature, produce weakness or loss of contractility all over the body, as well as in the thousand little blood-vessels that open their mouths within the uterus for the purpose of secreting the menses. The proper action of secretion is prevented by their weakness; and as we have said, " permits the blood to pass through them like a sieve." This bleeding, as it progresses, of course produces greater weakness and discharge, until in some cases the blood ceases to flow from diminution of quantity in the vessels, leaving the female in a pitiable state of debility. 
So much for the manner. Let us now endeavour to explain why the same causes may produce suppression in the young girl, and excessive menstruation but a few years later. In the first place it is to be remembered, that in suppression the vessels have not yet assumed their duty of secreting the menses at all; the function is only known to be due, from the age and personal development of the female. They may, therefore, be supposed " unused to it." Moreover, the accidental and constitutional causes already enumerated in the three last chapters, may be operating in a degree that we cannot readily perceive, yet sufficient to prevent the occurrence of the menses. After they have ap- 


EXCESSIVE MENSTRUATION. 
95 
peared, we are obliged to suppose most of these causes cease to operate. 
But it is the moral affections that make the great difference between the individuals. To the young girl all is joy, and the slightest pleasures produce a diversion from the blood-vessels to the general system, and an immediate effort towards equalizing the circulation of the blood. Not so with her whose mind and body are constantly excited in the giddy dance of fashion—or in brooding over poverty, or disappointed hope. It is here that the great difference exists. The mind, like the mimosa, instantly shrinks from causes that affect not its more youthful or hardy associates; and its prostrate leaves are but an emblem of the delicacy of the nervous system of many menstruating females. Let the reader now recur to our explanation of the contractility of the blood-vessels, and we feel assured she will comprehend this seeming contradiction. 
All that can be said on the subject of the treatment of excessive menstruation, will be most profitable to the reader, if combined with further explanations of the temperaments, and causes producing it. It is hoped she will not confound the appearance of the person in this state, with that paleness we have spoken of in menstrual suppressions—where experience demonstrates, that small quantities of blood may sometimes be drawn, with a very happy effect in quickening the 


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EXCESSIVE MENSTRUATION. 
sluggish circulation—for they differ most widely. What will probably prove still more remarkable, is the fact, well known to such as are familiar with medical practice, that profuse discharges of blood, either from the uterus or any of the internal organs in either sex, may often be arrested by a small revulsive bleeding from the arm, until local remedies can be applied to check it, and the general strength be improved by fresh air and tonic medicines. This very remedy, although we use it with the greatest caution, and very rarely under such circumstances, we know from experience to be occasionally successful. In such cases it becomes necessary to determine whether we shall lose a teacupful by the arm, or quarts by the uterus—and we must act from experience in many preceding cases. 
Observation obliges us to recognise a variety of temperament and personal appearance in which excessive menstruation sometimes exists, very much the opposite to that indicating weakness of the system. Indeed it occurs, as in suppression, both in the sanguine and lymphatic temperaments, though much oftener in the latter. A person of the former constitution of body—who, were it not for some occasional and unfortunate combination of circumstances, would be far more likely to be afflicted with congestion of the uterus and consequent suppression of the menses—may, from such circumstances, be the subject of a very profuse 


97 
EXCESSIVE MENSTRUATION. 
discharge, requiring its appropriate treatment, modified by the evidently sanguine temperament of the patient, as indicated by general plethoric habit and red cheeks, appearing even under a combination of depressing causes. 
These modifications of our systems and their necessary treatment, so inseparable from the unnatural state in which we live, render the thoughtful and observing practitioner constantly liable to be misunderstood, for the exercise of that very discrimination which constitutes his peculiar claim to the character of a scientific man ; viz. the adaptation of his treatment to the temperament he is called upon to prescribe for. The public have little or no idea of this; we verily believe, they look to the specific efficacy of the drug they swallow, to add what they conceive to be needful, or to subtract what is redundant in their bodies, forgetting that those bodies are liable to the thousand impressions of an ever-changing series of circumstances. 
In addition to the general causes already enumerated, there is one that operates with some power in this physic-taking community, that is very often productive of excessive menstruation, as well as many other ailments in both sexes, and that is, the enormous consumption of quack pills and potions of every variety of nauseating quality, and set forth with most ingenious and captivating rascality. 


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EXCESSIVE MENSTRUATION. 
Of late, sundry cordials of wonderful restorative power have been added to the catalogue; and were we not too well convinced of their pernicious effects, we could smile at the cunning with which the advertisers of these nostrums seek out " every nook and cranny of the head that is not sound," and avail themselves of every popular prejudice to foist their trumpery upon the unsuspecting public. Both sexes are their victims, and results of a grievous character are consequent upon the use of their nostrums, differing only with the anatomical and physiological peculiarities of the sexes. 
The pills, for the most part, contain ingredients that operate violently upon the lower tract of intestines, near the uterus, and thus determine blood to that organ in excessive quantity, besides producing an exhausting effect upon the bowels. They likewise produce piles. 
The cordials are ephemeral in their action, and injure the lining membrane of the stomach and bowels; they are followed, moreover, by exhaustion, and irritation of the uterus and bladder. Most distressing affections we have been called to prescribe for, in consequence of one of their ingredients, that is well known to every physician who sees this allusion. In one instance, life was preserved with difficulty, from total stoppage of the urine and inflammation of the 


EXCESSIVE MENSTRUATION. 
99 
bladder. (See a further exposition of this subject, in the chapters on leucorrhea and abortion.) 
Tea and coffee, with every kind of warm drink, sleeping on feather beds, foot stoves, and stimulating food or drinks, are prejudicial to those labouring under excessive menstruation. Every kind of local excitement of the uterine system should be studiously avoided. The invalid should live in an upper chamber, in a dry atmosphere, and very little exercise should be taken during the interval. The body should repose constantly upon a hair mattress during the flow, with the hips elevated ; the drinks consist of cold water or lemonade, mucilages, or any of the vegetable jellies dissolved in water. The food, in the sanguine temperament, should be entirely vegetable in character, while in the lymphatic it may consist of flesh and fowl; even wine and porter may often be given with advantage. No melancholy companions must be allowed to approach the patient, and all mental emotion be avoided. The use of medicines must be left exclusively to the physician. Fortunately, they prove, when judiciously adapted to the case, of very decisive efficacy. 
It is in the highest degree important for the bowels lo be kept in order, and medicine cannot be taken without danger of increasing the discharge. Stewed fruits or bran bread will, if perseveringly used, always effect this desirable end. 


100 
EXCESSIVE MENSTRUATION. 
As it sometimes happens, that the discharge is so violent as to subject the female to imminent danger of the loss of life, we deem it proper to mention here, that the application of cold water, either by cloths wrung out therefrom, or by being poured from a pitcher the height of the elevated hand, is sometimes resorted to by physicians. Should this measure ever be attempted in the absence of competent advice, there should be a positive assurance that the patient is in actual danger from the excessive discharge. We give this caution because it is a remedy of very great power, and should only be used in extreme cases. 
We shall have occasion to speak again and again of unnatural discharges of blood, from various causes, and especially from those connected with the final cessation of the function of menstruation. In the chapter on hysteria, many of the consequences will be enumerated. Indeed, as we have said before, it is so intimately connected with most uterine derangements, that this chapter is but the commencement of the knowledge which the reader will acquire, by perusing those that follow. 


CHAPTER ELEVENTH. 
CHANGE OF LIFE, OR CESSATION OF MENSTRUATION. 
If, at her introduction to the menstruating period, woman is calculated to enlist our sympathy, the circumstances attending its final departure are still more adapted to excite our earnest desire for her welfare. In youth she is surrounded with scenes that please the fancy and excite the imagination, and has neither judgment nor precedent to guide her anticipations of good or evil. During the period in which she is fulfilling the great object of her being, she is occupied with the cares and joys of domestic life, and has neither leisure nor desire to reflect upon the approach of that important change, in which she is to undergo the anxieties of a transition to the closing phase of her existence. But when that period approaches, her apprehensions are often painfully excited: it is, indeed, her " critical period." Whether she is to enjoy the remainder of her life, free from some of the severer diseases incident to her sex, or to sink under their accumulated force, when nature has been too severely taxed in youth to retain power enough to repel them, depends much upon 


102 
CHANGE OF LIFE. 
the manner in which she has passed through the childbearing period. 
This extends, as we have said, for the most part, from the fourteenth or fifteenth to the fortieth or forty, fifth year, depending much upon constitutional predisposition, and the educational and other causes men. tioned in chapter fourth. So much of what has been said on the subject of those great laws of nature that preside over the healthful establishment of menstruation, applies to its natural disappearance, that we hope the reader is fully prepared to take a philosophical view of " change of life," and to allow us to disabuse her of the thousand prejudices that interfere so greatly with her happiness, at this important period. 
Nothing is more common, than the most gloomy apprehensions of danger arising from noxious matters supposed to be retained in the blood for want of the customary discharge. A great deal of this prejudice arises from a knowledge of the Jewish regulations and laws, detailed in the book of Leviticus. The necessity for the extreme severity of these requisitions, has never been made sufficiently clear to our comprehension. In modern times, we certainly have no reason to suppose our knowledge of medical subjects of this nature has decreased; and although we feel disposed to concede to the great Jewish lawgiver the possession of much astuteness and great physiological knowledge, 


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CHANGE OF LIFE. 
we see no occasion to imitate his severe regulations. So far as ablutions, and other health-preserving rules are enjoined, such as a common sense of delicacy will always teach, they are practised by all well-bred people. The necessity of an entire seclusion from society during the menstruating periods, we believe to be useless and injurious. 
The idea of disease originating from any deleterious property in the blood retained at this period, is quite absurd. The menstruating blood is of course derived from the general mass; and if one be injurious, the other must be so likewise, for it can gain no new properties in circulating through the uterine vessels. But the truth is, those who entertain this notion reason from the knowledge of the fact, that serious derangement of health is produced by the retention of the menses. Our readers are now aware, that this is produced solely for the want of a customary discharge, and that relief is often afforded by drawing a small quantity of blood from the arm, which could not be the case, if the whole mass were contaminated. 
Another reason for apprehension at this time, exists in the fact, that diseases of the uterus, such as cancer, and other serious changes in its structure, are occasionally developed at the close of menstruation; the discharge from that organ having previously operated as a drain, and prevented their appearance, although they 


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may have been maturing for years. This, although it is generally true so far as it regards their appearance at that particular time, in preference to an earlier period, should not furnish ground for such sad forebodings ; for it appears from the investigations of physicians all over the world, that this time of life is by no means more fatal to females than men; and when they pass over it, for some years their lives are more certain by far than our own. It is true, that cancer is more likely to attack them, because of their sex, inasmuch as it oftener affects the breasts and uterus in females, than other organs in males; but the difference is more than made up against our sex, by other diseases equally serious and fatal. As this is one of the diseases of the uterus, about which we think it will be expected we shall say something, we merely premise in this place, (leaving its proper consideration for another chapter,) that we believe it to be in no way connected with any bad quality in the blood; and have reason to think it would not be so frequent, if sufficient care were taken to ward off some of the severer symptoms of uterine disease appearing at this particular time of life. 
Most females require a great deal of medical supervision, which they rarely receive; partly because they are occupied with domestic duties, and partly from the fact of there being no pressing necessity for actual treatment. We shall therefore give, as fully as our 


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limited space will permit, the necessary rules for the preservation of health, and the symptoms indicating the nebessity for medical interference, with such explanations of the formation of disease, as we conceive to be suitable to the non-professional reader. An intimate knowledge of the subject, it would be useless to attempt to impart; yet we have lived long enough to know, that the best way to cause people of ordinary intelligence to take care of their health, is to convince their judgments that it will suffer from neglect, and that timely notice is necessary to prevent disorganization that no treatment can benefit. 
The first caution we would urge upon the female relates to her diet, clothing, exercise, and the management of her temper. She is already aware of all the necessary rules on these subjects, and that these control the appearance and proper continuance of menstruation ; and it must be evident to her intelligence, that after her system has been for so many years habituated to the discharge, even though nature intends it shall cease, that its cessation must probably be the cause of considerable derangement in the circulation. This indeed is the fact: in some persons it first shows itself by flushing of the face, and occasional confusion of ideas; difficult breathing, and violent headaches occur after sudden suppression, as in that of earlier life ; then the discharge may re-appear with alarming pro- 


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fusion. This is most apt to occur in persons of a deli, cate temperament: we have repeatedly known it to demand instant interference to save life. In such cases, cold water may be applied, poured from a pitcher, as directed in profuse menstruation. This may and ought to be done, if necessary, without the presence of a physician ; and it should be continued till it produces the "desired effect, the female lying motionless on a straw bed or mattress, with the hips elevated. Ice may then be applied over the lower part of the abdomen only, by enclosing it, in a pounded state, in a large towel, or, what is better, a bladder. Every other part of the body should be kept warm with blankets and bottles of warm water, particularly the legs. Air should be freely admitted, and the physician summoned without delay. It is gratifying to know that he is armed with satisfactory resources in these cases. 
One other direction we will give, which must be applied only by a person of clear judgment and a cool head, if used without the presence of a physician. It is this: should the female, from the violence of the discharge, be in a sinking state, as evinced by coldness, and an inability to articulate, a tablespoonful of brandy and water, half and half, should be given every ten or fifteen minutes, till the patient revives. We restrict its use to persons of clear judgment, because, 


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CHANGE OF LIFE. 
as will be seen in the chapter on hysteria, a patient often seems perfectly exhausted from loss of blood, when very little has flowed, owing to the co-existence of nervous symptoms, which are more or less present in these cases. The brandy, however, if too little blood has been lost to render it necessary, will do no harm that the physician cannot rectify on his arrival. Should it not be used, from ill-grounded fears of its propriety, in a case imperatively demanding immediate stimulation in consequence of extreme exhaustion, the physician may find his patient almost beyond the reach of his skill, from the want of a very simple yet efficient remedy. 
This profuse and alarming discharge has been preceded by symptoms that evidently showed the propriety of anticipating it by profound rest of mind and body, and the necessity of abstracting a small quantity of blood from the arm. The flushings of the face, and headache, even though slight, will direct the observation of the prudent physician to the evident design of nature to get clear of the blood in some way or other; and we may suppose, without any extra latitude of idea, that the uterus, feeling distrustful of its powers to permit the required amount only to pass, drives it upon the internal organs, or the brain, as indicated by headache, and the lungs, by difficult breathing. 
If it be desirable to diminish the amount of blood, 


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and nature evidently shows it to be her intention— though we see and are bound to believe she overdoes the matter—how proper it must be to avoid stimulating articles of food and drink. All that has been said on that subject in chapter ninth, applies with great force to this derangement; but above other things, we feel inclined to interdict the peculiarly hurtful stimulants of tea and coffee. These articles, pernicious at all times, are especially so at this, when the blood-vessels of the uterine system are in a state of great excite, ment. Farinaceous articles, such as bread, rice, and the more agreeable made dishes, particularly if combined with fruit, which is desirable for its natural aperient effect, are very proper. All the white meats, fish, eggs, and oysters, are also proper. 
Let the reader, then, refer to what has been written on excessive menstruation; and we are satisfied she will comprehend the subject, as far as may be necessary so to regulate her life, as to meet this change in a manner congenial with the intentions of nature. It will then often steal upon her as gently as it approaches in some individuals, gradually diminishing in quantity, appearing and disappearing in a manner so quiet, that she will scarcely know when it has finally left her. It can scarcely be necessary to repeat, that the mind and the uterine system should remain in profound repose. Any excitement that will agitate the 


CHANGE OF LIFE. 
109 
mind, will instantly re-act upon the blood-vessels of the uterus; and we pity most sincerely that female, whose domestic relations are such that she cannot pass through this stormy period of her life with that calmness that must ever be consequent upon due attention, in those who surround her, to all the requisitions of a quiet and well-regulated household. 
10 


CHAPTER TWELFTH. 
LEUCORRHEA AND CHLOROSIS. 
The different menstrual derangements, (as well as various other uterine diseases and constitutional affections of a general nature, foreign to the subject of this volume,) may be accompanied with a very distressing affection, originating in the minute blood-vessels that line the internal cavity of the uterus, and the passage that leads to it. These blood-vessels are of extreme minuteness, and countless in number. They form a complete membrane, similar in structure and appearance to the delicate one that lines the mouth and throat, which is, like it, called a mucous membrane, from the fact that it constantly produces, in the healthy state, a kind of mucus, similar in consistence and appearance to the white of an egg. It is this mucus, when greatly increased in quantity, and altered in quality, that is called leucorrhea, from two Greek words signifying a white flow. 
The term chlorosis is derived also from a Greek word signifying green, from the greenish complexion of those afflicted with it. It is occasionally the consequence of long-continued leucorrhea, though oftener 


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of retention of the menses, and other depressing and exhausting diseases, as will be seen in the latter part of this chapter. 
Leucorrhea presents, by its very appearance, its most distinctive peculiarity; it will, therefore, be improper to present here an array of symptoms that only appear after it has continued for some time, and effected changes in the constitution, which they indicate. We shall leave them to develope themselves in their proper order; and as we speak of the symptoms that attend its first appearance, give the necessary explanations of their connexion with the constitutional affections, and proper mode of life to be pursued in removing them. 
We do not design to give any of those minute distinctions made by physicians with regard to the various forms, real or imaginary, of this disease; still it is necessary, from its great frequency and annoying character, and in accordance with our avowed purpose to cause females to think and reason correctly on their diseases, to be as minute in our explanations as may be consistent with a popular view of so difficult a subject. 
The same general explanation of the causes and manner of the first appearance of leucorrhea, from congestion of the blood-vessels producing that discharge, already given when speaking of menstrual 


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suppression, may with great propriety be offered to the reader in this place;—but we here take occasion distinctly to avow a sentiment, in which we differ from many distinguished physicians: that it is far oftener owing to the debilitating causes than to those producing excessive action in the circulation; or, in other words, it is far oftener observed in the lymphatic than in the sanguine temperament. 
The fact that it very often appears, after causes evidently productive of general exhaustion of the system, such as long watching, debilitating regimen, and violent emotions of anger, grief, fear, etc., together with its frequent and immediate appearance on menstrual suppression, is to our own minds conclusive on this point. We have had occasion to express these sentiments in an essay on this subject, published in the United States Medical and Surgical Journal, some years since, from which we shall give an extract when speaking on prolapsus uteri—an affection, the acknowledged consequence of debility, and one that in married persons almost invariably follows a severe attack of leucorrhea. 
With the knowledge she now has of the manner in which the menstrual secretion is produced from the blood-vessels lining the uterus, the inquiring reader may wish to know whether the same vessels produce the leucorrheal discharge. Of this we may say, with- 


LEUCORRHEA AND CHLOROSIS. 
113 
out actual certainty, there is very little doubt, as a slight appearance of it very often precedes the menses, and replaces it when the latter is suddenly checked. Moreover, we know from analogy, that the secretions of mucous membranes in other parts of the body, as the nose, for instance, when we have a violent catarrh or cold, vary as much in consistence as those of the uterine and other lining membranes of this part of the body are known to do, in all their other discharges, save blood alone; and the secretion of blood being the acknowledged and peculiar function of the uterine membrane, it will of course effect that, to the general exclusion of its other probable and occasional productions. This it is important should be known, to give equal force to the reasoning on menstrual derangements, as produced by constitutional causes, when applied also to the production of the leucorrheal discharge. 
There is nothing to prevent even an infant from experiencing an attack of leucorrhea, as the mucous membrane at any age must yield this peculiar discharge when affected with congestion, to which it is liable from general dietetic and atmospheric causes, as well as those which originate from menstrual derangements. Leucorrhea is, as we have already said, of much the same nature as an obstinate discharge from the nose. We have ourselves seen it at every period 
10* 


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LEUCORRHEA AND CHLOROSIS*. 
of life, from extreme infancy to old age. In the latter, however, it is generally a symptom of serious organic disease of the uterus, as cancer, etc. 
Its first appearance is indicated by a discharge of a fluid, of greater or less consistence, from the white of an egg to that of thick starch. The colour may at first be white, from which it varies to light or deeper yellow, and at a later period even a green and brownish hue. It is sometimes quite acrimonious in its action upon the skin, and produces erosion and severe smarting. It does not often affect the urethra, (which is a separate passage for the urine,) but when it does so, there is scalding more or less severe on passing that fluid. 
Paleness, pain in the back and loins, general exhaustion, chilliness, and loss of appetite, are apt to accompany ft. If long continued, these symptoms will be greatly aggravated, as we shall see in the latter part of this chapter. Very delicate women, with fair hair and complexions, are its most frequent subjects, though it may and often does attack those of an opposite appearance. It is not apt to annoy these latter individuals, without a decided constitutional or local cause. 
In this city, we may observe every variety of cause, from the most unnatural species of local irritation, up to the most obscure constitutional affection. Very few 


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115 
females reach the age of thirty without frequent attacks. There is a peculiarity in the appearance of per-sons afflicted with leucorrhea, that is very distinctive, to those accustomed to investigate the disease. A half circle, of a bluish or yellow colour, surrounds the lower part of the eyelids; the lips are bloodless, and the action and general expression languid and unhealthful. 
Doctor Columbat remarks: " The mode of life to which the social condition condemns women in large cities, delivers them over, so to speak, defenceless, against the numerous causes of the chronic inflammations of the utero-vaginal mucous membrane. Thus in populous cities, idleness, effeminacy, or sedentary life, the constant contact of the two sexes, and the frequenting of places where every thing inspires pleasure; prolonged watching, excessive dancing, frivolous occupations, and the study of the arts that give too great activity to the imagination; erotic reading; the pernicious establishment of an artificial puberty; the premature shock of the genital system; the concentration of the sentiments and thoughts on objects which keep the genital system in a state of permanent excitation : finally, a number of vicious habits and excesses of all kinds, which, by introducing modifications more or less profound into the general constitution, re-act more particularly upon the sensibility of the womb, which, in 


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the female, is not only the organ most apt to lend itself to fluxionary movements, but likewise the centre towards which all the morbific actions seem principally to tend." 
Most of those dietetic causes that we have had occasion so constantly to refer to in our remarks on menstrual derangement, act with equal force here. Indeed, the reader may almost apply every thing that has been said, but particularly on the subject of those causes which control the lymphatic temperament, directly to this disease, which is most frequent in that constitution of body. The constant drugging of unprincipled pretenders, many of whom, we grieve to say, are provided with their legal warrants under our degrading system of medical education, is equally productive of the disease. The tone of the body is impaired, by the incessant irritation of the bowels with every variety of quack pills and potions, until the whole vascular systern becomes exhausted, and the blood-vessels of the uterus open their mouths, as it were, like dead creatures, and suffer the blood first to escape in large quantities, constituting excessive menstruation ; then, as we know by observation, they take on that peculiar action productive of the leucorrheal secretion. 
All physicians bear witness to the pernicious influence of those drenches of which our countrywomen are so fond, viz. tea and coffee; and we are satisfied 


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that nothing can be more hurtful. They debilitate the stomach and ruin the digestion. We wish to be distinctly understood, when speaking of another cause of a very exhausting character, to allude only to its excessive use, in the higher classes of society; for we grieve to say, in the lower it is not abused, since, alas! it can seldom be used: we mean the warm bath. In this city of fountains, where landlords look to a miserable shell as the means of extorting full half the earnings of its poor occupant, it need scarcely require a caution to the poor; yet the introduction of an abundant supply of water into the dwellings of the middle and wealthier classes, will afford facility for perverting a powerful means of preventing disease, into an equally efficacious agent for its production. 
At page sixty-ninth, we cautioned the reader against the exhausting effect of prolonging a warm bath ; and we here repeat, that over five minutes' indulgence in a warm bath of the temperature of ninety-five degrees, is like to be followed by great exhaustion and increase of the discharge: an equal duration of the shower bath, the water having attained the temperature common to it when exposed for a few hours to our summer's sun, is far more likely to prove beneficial. The purposes of cleanliness may be fully secured, by previous friction with a rough cloth, and soap and water. The shower bath immediately following, produces a 


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delightful reaction, and establishes a healthful circulation in the skin. This is one of the great natural means of cure, and is never to be neglected. 
The local application of cold, as is proved by the frequent attacks following damp feet, or sitting on the damp ground, is a very different thing from its general fleeting application, as made by the shower bath. Cold should never be applied to that part of the system, without express direction by the physician; he, indeed, often uses it, with a proper combination of tonics and general treatment, with very happy effect. The cold bath is, of course, out of the question in this affection. It would conduce to no good result for us to attempt to make those distinctions respecting other medical agents, which are only, to be understood by a long and careful observation of nature. 
Cold and damp residences are both fertile causes of leucorrhea, and excessively warm ones, by causing exhaustion, will produce the same result. The remarks already made, in chapter sixth, on the subject of our domestic arrangements in large cities, are here peculiarly apposite. It may be that we view this subject with a morbid eye, but we cannot forbear tracing these evils to their frequent result, viz. constitutional exhaustion and confirmed leucorrhea. 
There are certain moral emotions which also require regulation, if the female would escape this affection; 


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119 
the mind must be kept pure, and free from improper associations. Suoh is the wonderful influence upon the uterine system, that, as we have shown, any of the more intense emotions will immediately produce it, if the patient be predisposed from debility to the disease. 
Far more certain in its influence, because, alas! much more common, is that state of prurient excitement of the imagination, so often produced by the wretched and demoralizing flood of " cheap literature," as it is called by its unprincipled publishers. Were the statute against obscene publications and prints properly enforced, our families would be rid of these loathsome and filthy productions, and society freed from a curse that is sapping it in the most vital part, viz. the moral purity of its daughters and mothers. 
Nature, for the wisest purposes, has implanted in the sexes the passion of love; it presides like a guardian angel over every sentiment that is pure and holy in our natures; it warms the heart and kindles the affections with a flame of vestal purity; but let the reader beware of the insinuating advances of the siren, disguised by these cunning contrivers with language of the most seductive character, leading to the premature excitement of a passion that was only designed by the Creator to ensure the great end of our existence, viz. the perpetuation of the species. 
What a proof of the entire purity of purpose on the 


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LEUCORRHEA AND CHLOROSIS. 
part of nature, when unsullied by art, is the affection of a mother for her child! Think of the strength and duration of that passion—compare it with an impure emotion—and then ask if we should not blush to lose sight of an impulse so lovely, for the indulgence of a base and selfish gratification. 
A mother has a sacred duty to perform to her child 5 she must win its entire confidence and respect. This can only be done by a happy union of dignity and simplicity of character, that will elicit the affection and reverence of the child. 
There can be no such power possessed by any mother who is destitute of a knowledge of those physiological and moral laws which govern her own nature, as well as her child's. She must know the reciprocal action of the mind and body; and she must not forget that her child, like herself, is a woman, and .surrounded with the same temptations that assailed her, in her own youth. Let her then, with such tact as a woman and mother only possesses, wind herself into the affections of her child, and take care to preserve in all its charming loveliness the innocence of her moral nature. Then will the body present a fit emblem of the mind's purity; and when we look upon it, we shall see the evidence of the mother's intellect and love, portrayed in the face of her child. 
We are sure that we cannot present the reader with 


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a truer picture of the consequences of long-continued leucorrhea, than that given by Dr. Columbat. We have verified its entire truthfulness in a great number of cases, occurring in every class of society, in this city. Dr. C. remarks: "The patient complains of weight in the loins and lower part of the abdomen; great lassitude, and often pain in the stomach, with colic. They suffer from depraved appetite, from acidity, nauseous eructation, headache, frequent gnawing and hiccough; the skin is cold, and sensitive to the least atmospheric variation; they perspire but little; they complain of unusual heat in the head, dizziness, faintness, palpitation of the heart, excessive coldness of the feet, occasional pains under the left breast; the face becomes pale, the eyes hollow, and they weep without cause; they become careless, impatient, and feel a sort of languor and dejection, a sensation of strangling or choking, and an involuntary sadness; they are apathetic, melancholy, hypochondriacal: in fine, they never exhibit the happy physiognomy characteristic of the sex. When the discharge is constant, profuse, and of long standing, exhaustion and degradation of the constitution are soon found to be the unfortunate and necessary result of this flux, which never ceases, and which seems to attract to itself all the sources of all the other excretions, and thus to cause a drain upon the whole economy. The skin now be- 
ll 


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LEUCORRHEA AND CHLOROSIS. 
comes discolored ; the emaciation increases; the flesh becomes loose; the breasts are soft; the pulse small and frequent, and the breath foetid; the eyelids become bloated, the legs are cold, and the whole body dropsical. The patient complains of almost continual colic, and of pains in the spine and loins, the hips and stomach. She is tormented with constant thirst; the appetite is lost; she suffers from habitual pain in the stomach, and obstinate constipation of the bowels, nausea, eructations, and acid vomiting; the urine is dark coloured and turbid, and small in quantity. When it reaches this degree of severity, the patient acquires a disgust and indifference for every thing; her faculties become enfeebled; finally, moral debility and settled despair, together with hectic fever, exhaust the remains of strength, after having destroyed all that lends a charm to life." No description can be more accurate than this; it will at once be recognized by the reader, as applicable to her own or some other case that has been presented to her notice. 
We have thus far confined our observations, in speaking of the curative and preventive means, to such general ones as were likely, with the explanations given, to be understood by every one who reads this book. In making any further remarks, more especially upon agents directly medicinal in their action, we are governed by the desire to save great loss of time, and dis- 


LEUCORRHEA AND CHLOROSIS. 
123 
appointment, to those who need further cautions on the subject of quackery. 
The miserable and absurd compositions, so industriously heralded by their unprincipled inventors as specifics for this infirmity, we have already alluded to in terms richly merited. But we do not think it right, after what we have been obliged to say, here and elsewhere, on the extraordinary manner in which ignorant and incompetent persons are constantly permitted by our colleges to enter the medical profession, to pass over the futile efforts so often made by such individuals, to cure this disease by drugging the system with physic. 
We have endeavoured to show that it originates in deep-seated causes, and abuses of nature's laws; and if we have been at all successful, it is evident, these must be reformed before there can be any hope of a restoration to health. That person who presents the half of those symptoms enumerated by Mons. Columbat, (and they are all true in many cases,) will most eagerly seize upon the promise of a cure, by any medicine, if only enforced with sufficient confidence; —but she will assuredly be disappointed. 
She must painfully and perseveringly retrace her errors, as pointed out by her faithful and intelligent physician, who will never condescend to deceive her with false hopes. He well knows the absurdity of 


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LEUCORRHEA AND CHLOROSIS. 
attempting to alter the long-continued and unhealthfui action of a part that has not for years, perhaps, performed its proper function, by medicines administered by the mouth alone. 
The disease is, in all respects, like some affections of the mucous membrane of the eye, and must, like it, be treated in a great proportion of obstinate cases, byagents that will alter the action of the diseased membrane itself. These may and ought to be combined with such as are known to have a powerful and certain effect in restoring the constitution—such as some of the modern preparations of iron, iodine, etc.; but combined with local measures they must be, or they never can completely restore these advanced cases. 
It is true, indeed, that some fortunate coincidences of cures, often performed by an effort of nature alone, occurring at a happy conjunction of favourable circumstances, are imputed to medicines internally administered ; but cases like these are rare, to whatever cause they may be referred. 
There is a very absurd idea occasionally entertained by females, that leucorrhea is a healthful evacuation, and ought not to be interfered with. It is quite true, that in some severe cases, when the discharge has been stopped by medical or natural means, without proper precautions being taken, other serious constitutional evils have appeared. But what then? should we 


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125 
leave the patient a certain prey to a long catalogue of sad derangements, sure themselves to induce the most fatal constitutional degeneration, because thoughtless persons have abused a powerful remedy? By no means; such timidity can only exist where the subject is not understood. For averting constitutional consequences, we are not without resources, originating in the same acute minds that have directed the proper means of cure. 
The means of applying these local remedies, and their general and particular nature, are treated of by various medical authors of authority on such subjects, and are supposed to be known by every intelligent surgeon. No false idea of delicacy should prevent a mother from the most particular inquiry on this subject; and the surgeon who does not avail himself of the best and least repulsive mechanical means for their application, does not do his duty to his patient. 
It affords us sincere gratification to say that our own efforts, for the attainment of this important end, have been approved by the profession. These mechanical contrivances have been described by several of our medical journals; suffice it here to say, they are such as the most delicate person can use without the slightest pain, or repulsive moral feeling. The intimate connection of leucorrhea as a cause, with displacements 
11* 


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LEUCORRHEA AND CHLOROSIS. 
of the uterus, will be seen when we come to treat of that subject. 
A very advanced state of leucorrhea, and in some peculiarly delicate young persons, suppression of the menses, is followed by a combination of circumstances spoken of in medical books as a distinct disease, and called chlorosis, as we have already said, from a Greek word signifying green, because of the greenish and bloodless hue of the countenance of those afflicted with it. It is certainly not always connected with either of the diseases last named, because it appears in those who have excessive menstruation, in married persons at the change of life, and even in our own sex; yet it is so often connected with leucorrhea, and its symptoms and general means of cure are so very similar, that we have combined them in one chapter. 
The fact of its existence without leucorrhea, even in a single individual, as well as in males, proves that it is essentially different in its nature, however closely it may resemble that disease. This difference is supposed, by very distinguished physicians, to consist in this; viz. that ohlorosis is a disease that exists from the beginning in the blood, producing nearly all the symptoms of leucorrhea, and finally that disease itself. On the contrary, leucorrhea, although originating in constitutional causes, usually begins in the affected membrane itself. 


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LEUCORRHEA AND CHLOROSIS. 
This opinion derives additional force from the fact, that the blood has been found, in this affection, to be very much changed in its constituents from its nealthful state; and the preparations of iron, which are supposed to act more immediately upon that fluid, have a very salutary effect in chlorosis. (See Dr. Meigs' note to the article chlorosis in Columbat.) 
It may be supposed, by those unacquainted with the depressing influence of an unfortunate moral and dietetic condition, that we attach undue importance to those causes. It is hard for one, in the enjoyment of all the comforts and pleasures of a cheerful and delightful home, to conceive that in this favoured land there are many persons, whose daily sustenance is scant and unsuited to the wants of the body; but it is nevertheless true. It may be that there is no deficiency of means to procure wholesome food, but let the reader remember, that money is not all that is necessary for the proper regulation of a household; there must be habits of industry and cleanliness, and a cheerful will in her who presides over it, to insure comforts to its inmates. 
Under the many exciting and depressing influences of society as constituted in our country, and the unexampled rapidity with which children become men and women, constant derangements of health are occurring; and although years are advancing, the constitution 


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suffers great drawbacks; the body does not advance to its full and proper evolution at the time nature intended it to attain that condition. During these intervals of sickness, the powers of digestion are feeble; and very delicate and careful preparation of the food is neces. sary, if we would not oppress them, and greatly hinder recovery. 
If this be true where comparative facilities exist, what shall we say of the condition of those who constitute the working classes of our population j whose every day brings with it its stern demands of nature for attention to all her laws, and the entire time is occupied with toilsome labour ? The damp cellar, or the heated and stifling attic chamber, in the foul atmosphere of some by-lane or street, are not adapted to produce appetite, and the wretched occupant, even if for the time possessing the means, has no leisure to pay attention to the wants of the body. 
Thus it is from day to day, that inattention to the unalterable laws of nature, is followed by a condition of listless and wretched indifference, and the final appearance of this melancholy disease. We know that hundreds of chlorotic persons of both sexes are to be found in this city and its suburbs; and so it will ever be, until successful efforts are made by Christian philanthropists to rescue this degraded class from the miserable thraldom of the system of wages. 


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Once let them be independent of the will of others, and they will learn self-respect; they will purify their bodies, and the atmosphere of their dwellings; where each returning day now impresses its mark on their faces, as upon the dial-plate of misery. They will labour, it is true, but that labour not exceeding their natural powers, will lend the hue of health to their cheeks; and a cheerful and contented mind will be followed by appetite, and inclination to provide food suited to the wants of the body. 
It is unnecessary to enumerate any other symptoms than those already described as belonging to leucorrhea, in its advanced stage. There is one, however, which causes a very disagreeable impression upon the mind of the beholder, and leaves us quite at a loss to account for its origin: we allude to the curious desire to eat chalk, magnesia, slate dust, etc.; even earth, and very repulsive and disgusting objects, as insects, are sometimes swallowed with as little repugnance as bread. This symptom is followed by total failure of the digestion, and unless relief is soon afforded, the patient dies of exhaustion, from absolute inability to retain anything on the stomach. 
It has been several times our misfortune to be called to see cases of this unfortunate character, in this and the adjoining state of New Jersey. One presented a melancholy aspect. It occurred in the practice of 


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LEUCORRHEA AND CHLOROSIS. 
Dr. Stephen Hedges, of Newton, in Sussex county, New Jersey. The patient—a young woman of twenty-two years of age—though living in all the comforts of domestic life, had become the victim of a disappointed attachment, and, without any other cause, gradually sank into a confirmed state of chlorosis. We found, under the care of her truly kind and enlightened physician, every moral and dietetic means had been used, that was dictated by the most enlarged view of her condition, but all to no purpose. Nor were we more fortunate. Our prescriptions were inefficacious, and she fell a victim to disease that left no sign, save the extreme attenuation and unearthly paleness of a body that had only maintained its vitality, under the use of a few teaspoonfuls of barley or milk, administered daily, for months preceding our visit. 
The means to be used in the cure of this disease are exclusively those adapted to the advanced stage of leucorrhea. The moral circumstances are to receive profound attention; and no physician can prescribe with success, unless his patient extends to him he/ entire confidence. 


CHAPTER THIRTEENTH. 
HYSTERIA. 
The term hysteria is derived from a Greek word signifying womb—the disease being formerly supposed to originate in that organ. Hysterics is the common term by which it is known to females. It consists of such an infinite variety of symptoms, and appears under so many circumstances and forms, that it is almost impossible to convey an accurate idea of its peculiarities to any one who has not witnessed it in a great number of individuals, of different shades of character and temperament. Unlike some of the other diseases of which we have treated, there is no regularity in its attacks, nor does it produce any permanent or perceptible change in any part of the body upon which we can put our finger, and say, this is the diseased part. It attacks females at all ages, from the first appearance of menstruation to the change of life; but it has been known to appear as late as seventy or even eighty years of age. These are only exceptions to the general rule, which confines it to the childbearing period. 
We have said it "was supposed to originate in the 


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HYSTERIA. 
uterus." This may be true, so far as the uterine systern impresses its peculiar susceptibility upon the patient, for we may say, with a distinguished physician of old, " on account of the uterus, woman is what she is." There cannot be a question, that it is one of the chief agents in developing that extraordinary and often truly awful combination of symptoms, that attends an attack of hysterics. But the brain and nervous system are the agents of its most powerful manifestations; it is through their influence that it assumes such rapid changes, as often to defy every effort of art for its relief, and all our ability to anticipate its movements. 
No physician who regards veracity as of any value, has any desire to conceal this truism, nor cares to dissemble his annoyance when sent for to prescribe for a hysterical attack. Let it not be supposed that a person possessing humanity, will not make a sincere effort for the relief of the sufferer; it is the ever-changing character of the symptoms that disheartens him; and it is our desire to have this distinctly understood, because we believe that the adult female can, by mental discipline and observation of her own bodily peculiarities, do far more to prevent an attack, than a physician can possibly do for its relief. 
With the knowledge possessed by every thinking person, of the powerful influence of mind over our bodies, and the well-known manner of its accession in 


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HYSTERIA. 
most cases, we need not trouble ourselves about the precise order of symptoms in the attack, for this we shall never ascertain. Sometimes it approaches in a fit of laughing, or crying, without any premonitory symptoms; at others it may be preceded by oppression at the stomach, with cold chills and cold hands or feet, or violent headache ; convulsive inspirations, accompanied with heaving of the chest, and an application of the hand to the throat, with a constant throwing back of the head and body. Should the patient be able to articulate at all at such times, which is rarely the case, she will speak of a " ball rising in the throat and choking her." From the frequent passage of large quantities of wind by the mouth, upon the relaxation of this spasmodic feeling in the throat, we believe it to be often connected with wind as a cause; this opinion is also entertained by others. 
This comprises the symptoms most commonly attendant upon an ordinary attack, and most persons of adult age have witnessed them. Should the cause, whatever it be, continue to operate, the scene may be changed to one of the most appalling character. We have been so unfortunate as to witness repeated attacks in different individuals, that put our powers of description at defiance. Let the reader imagine the patient writhing like a serpent upon the floor, rending her garments to tatters, plucking out handsful of her hair, 
12 


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HYSTERIA 
and striking her person with violence—with contorted and swollen countenance, and fixed eyes, resisting every effort of the bystanders to control her—and she will realize the scene often presented to the practitioner. Those violent attacks are not always accompanied with unconsciousness; on the contrary, females will often express, at their conclusion, a complete knowledge of the circumstances and events that transpired during the attack, and deplore their inability to control themselves, or to give any assurance, even by a motion of the hand, that they were conscious. 
A combination of depressing and melancholy associations often precede these attacks, and should serve to protect the patient from the unkind observations so often made by her associates, who frequently suggest, as its exciting cause, the most repulsive acts. We are painfully aware that among females, even in society where physical and intellectual culture would seem to present the strongest barrier against its incursions, hysteria does occur, and is sometimes excited by 0 causes that are not calculated to move our sympathy. We have, in another publication, endeavoured to point out the influence of those unfortunate departures from moral purity; and here take occasion to refer the reader to all we have said on that subject, in the former part of this work, as equally applicable. 
Violent excitement of the imagination and temper, 


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HYSTERIA. 
is sure to be followed by a corresponding reaction, and great depression of the nervous system. This cannot fail to produce some irregularity, that may be attended by a degree of hysteric excitement, and in those predisposed to it, a full paroxysm, with all its horrid and often disgusting details. Even in such cases, our sympathy, as fellow-creatures, is due to the sufferer. But when we see it attack a delicate female, from causes originating in domestic unhappiness—perhaps a drunken and unkind husband, a thankless child, or disappointed or unrequited affection—we feel most keenly for the affliction that it passes our art to relieve. 
Nothing can be more painful than such cases, and their frequency is calculated to make us acknowledge the necessity of some change in our social relations, which shall elevate the position of a wife, and give her some means of escape from the tyranny of a brutal husband, besides that wretched resort that holds her up as an object of pity to the populace. This, in our view, can only be realized by a thorough revision of society, upon the basis of pure Christianity. Woman must have secured to her the means of an independent support, at least by her own labour, uncontrolled by a husband; such a regulation should form a preliminary to every legal marriage. This would test the strength and purity of attachment, even in the 


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HYSTERIA. 
lowest condition of life; and were the wholesome addition of a compulsory and separate support required for her and her family, when the fortune of the husband would admit, and his conduct could be proved destructive to domestic happiness, it would exert no small influence in alleviating the condition of woman, and preventing the incursions of this and other diseases. We would have this rule reversed, should the conduct 
of the wife require, and her circumstances admit of it. But we are not writing an essay on political economy; our feelings unconsciously betrayed us into the expression of an opinion, suggested by the nature of our daily pursuits. 
The influence of an hysterical attack resulting from terror, upon females who may chance to witness it, is quite remarkable. This was most forcibly illustrated during our attendance upon one of the public institutions, in the year 1832, the season of cholera. A female was attacked with a paroxysm, upon learning the existence of the latter disease in another inmate of the house. Within ten minutes, five others who were present were all lying on the floor in hysterics. The strongest ammonia applied to the nostrils would not arouse them; and effusions of cold water had to be resorted to, ere they could be calmed. This is the secret cause of the many fanatical exhibitions so common in our country, and is closely connected with the 


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HYSTERIA. 
operations of clairvoyants, and other jugglers and mountebanks. 
Nothing is more likely to propagate the influence of an hysterical individual, than expressions of sympathy with the object of her terror. A few words of assurance, spoken in a determined manner by a bystander, or a little wholesome ridicule, will often dispel what generally proves to be a remote and contingent danger, or a complete illusion; for if the object be one calculated to excite real terror, or fear for immediate safety, it will either produce complete fainting, or nerve her for flight. 
An immense number of fanciful diseases are attendant on hysteria in certain nervous females, and we cannot deny that they are productive of nearly as much distress as though the affections were real. Physicians call them sympathetic; which may be thus explained to the reader. The brain being the part of our system which takes note of our connexion with the surrounding world, as well as all the movements of the body, and being in hysterical persons in a state to magnify any impressions from movements within, or made upon the body from without, the slightest irregularity or pain is at once supposed to be a symptom of some grievous disease. 
The patient will imagine her brain, chest, or abdomen to be suffering, in such a countless variety of 
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HYSTERIA. 
ways, that we are obliged to tax our invention to the utmost to explain them to her diseased imagination. This is productive of the most ludicrous consequences, and may, if the impression be very frequently made upon the- mind, become a perfect " monomania," or insanity upon that one subject. We have known an individual constantly agitated, for months together, at the approach of any person, for fear the handle should be broken—the patient imagining herself to be a teapot. 
At this moment we are in occasional attendance upon another, who considers "the muscles of her nerves to be affected," and groans in spirit, because our skill is not sufficient to dispel the " wind from her shoulders." 
During a temporary menstrual suppression, we have known the jaws to be locked for five consecutive days; the patient being sustained by sucking milk through the closed teeth. We succeeded in instantly opening them, by passing a few shocks of electricity from one side of the jaw to the other. 
A very accomplished, and somewhat intellectual woman, after apparent recovery from a severe attack, summoned us to her bedside to restore her to life, if possible—the vagary in her case being a desire to simulate death. She had arrayed herself in her winding sheet, and invited her brother and sisters to the 


139 
HYSTERIA. 
funeral. They sat near her with melancholy faces, at this unwonted exhibition of mental hallucination. Approaching the bedside, with tender interest for the survivors, and dissembled grief for the lady's early death, we commenced reciting John Gilpin, with appropriate emphasis and action. Keenly alive to the ludicrous, when the villagers threw up the sashes, to look at John and his bald pate and red cloak, as he passed through the village, she burst into an uncontrollable fit of laughter, and could only be quieted by the dashing of cold water upon the chest and face. 
Fancies like these, have been variously classified by different writers; but they all belong to a deranged action of the nervous system, and are usually observed in hysterical subjects. Well-directed and good-natured ridicule, from a person from whom she cannot escape, as a relative inhabiting the same house, is decidedly the best means of overcoming the morbid state; but this requires great tact and delicacy, and should never be attempted in a stubborn case, unless by a person thoroughly good-natured, and attached to the patient, or one of irresistible drollery. 
Notwithstanding the frequent occurrence of these fancies, physicians acknowledge many immediate causes that are calculated to excite the attack, and will always be attended to by a prudent practitioner. The most frequent of these, are suppression of the 


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HYSTERIA. 
menstrual discharge, indigestible substances in the stomach, excessive production of wind in the bowels and stomach, worms, and incurable obstructions in the bowels. Bleeding may be necessary for the first of these affections, and should always be adopted, especially if the patient be of a plethoric habit; emetics when crude matter is contained in the stomach, and various remedies for worms. These are positive causes, and can only be judged of, and properly treated by the physician. The various anti-spasmodic remedies—such as opium, assafcetida, camphor, valerian, etc.—will do no good in such cases, but in plethora and suppression much harm. Camphor may be fatal; and, as we have said before, should never be carelessly administered. 
It is certainly a mortifying discovery, (but there is no doubt of its truth,) that certain females will pretend hysteric attacks, in order to excite sympathy and obtain some desired luxury, avoid disagreeable visitors, or compel a guardian's or parent's consent to an undesirable union. These cases are often presented to the physician, and are easily detected. They usually decline treatment, particularly if of a disagreeable character. The unexpected presence and remarks of an extremely disagreeable relative, we have known sufficient to overcome the persistence of the fit. The relatives, if not of a very unamiable character, are 


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HYSTERIA. 
usually good aids to the physician who may be newly summoned to such a patient, in detecting imposition; their history of preceding attacks, with a little skilful questioning, will soon elicit the truth. 
Hysteria may be combined with, or pass into, other serious diseases; such as epilepsy, mania, and syncope. The most unfortunate results have originated from the latter cause, and persons have remained so long in this state as to be thought dead, and actually buried, when life was not extinct. This has been afterwards ascertained, upon exhuming the corpse for removal, or legal investigations. It has been found turned upon its face, or presenting other indubitable appearances of resuscitation —such as rending of the grave-clothes, etc. We were called to examine the body of a young lady, who had been subject to hysteria, but died of another disease; on the sixth day the cheeks were full of colour, which did not leave them even when decomposition took place; the limbs were pliant, and the body quite warm. There is no accounting for these cases, and the greatest care should be used to avoid so terrible an accident. We excite the surprise and just indignation of foreigners, for the rapidity with which we hurry our dead to the grave. It looks like, and too often is, evidence of a want of affection. 
After we have exercised all our sympathy and good 


142 
HYSTERIA. 
feeling towards the far greater number of hysterical persons, it is impossible to avoid the conclusion—from a comparison with them and certain other females of equal, if not greater original delicacy of nervous ternperament, who have been subjected to wholesome exercise of mind and body—that the condition of the for. mer is mainly owing to defective physical and moral education in their early years. Hysteria is undoubtedly mostly due to an indolent, luxurious, and enervating mode of life; and we may thank for this those (well-meaning though short-sighted) persons, who so studiously oppose every effort for enlightening females Upon the laws which govern their being, while they fill their hands and heads with mawkish and sentimental trash, yclept " the light literature" of the day. This absorbs their sleeping and waking moments, to the frequent exclusion of even a proper attention to the duties of exercise and cleanliness. What, then, can be expected, in our enervating climate, but a predisposition to nervous disease ? It must and does follow, and may be traced directly to such causes. 
Columbat remarks: "Whatever be the causes of hysteria, women affected, or predisposed to the disease, generally exhibit all the signs of a very excitable temperament ; their characters are commonly marked with a shade of levity, frivolity, or remarkable obstinacy ; they are commonly capricious and irascible; 


HYSTERIA. 
143 
their temper is uncertain and wavering, and the most trivial circumstances make them pass from immoderate joy—from the most noisy laughter, the most affectionate caresses—to melancholy, mingled with sighs, tears, sobs, and the bitterest reproaches: finally, they experience, in the highest degree, that state of anxiety, of indefinable melancholy and suffering, of which eminently nervous persons complain." 
With these sentiments, it cannot be supposed that we are prepared to recommend any very extensive medication for hysterical patients; neither will it be expected that we should promise'a very speedy restoration to health, should the wisest and most efficacious regimen be adopted. That which has been so long in coming, and so studiously nursed to its full development, will not depart in a day. A physician can easily become a slave to an hysterical patient, should he esteem himself lightly enough to do so ; and he can lose a great deal of professional character, by giving too much encouragement to such persons. Every thing mentioned in the former part of this volume, as conducive to a healthful development of mind and body, is precisely as preventive and applicable to this disease, and should be faithfully carried out in its minutest detail. 
Country exercise and riding on horseback, shower bath, etc., are particularly serviceable; and in cases 


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HYSTERIA. 
proper for their use, such tonics as modern science has proved to be useful, particularly iron in its more elegant forms, will doubtless be advised by the physician. The medical treatment must be left exclusively to him. 
The precautions to be taken by the relatives during an attack, consist in securing the body from violence, removing all causes of mental excitement, and affording a plentiful supply of fresh air. The first is only to be attained, by the constant personal attendance of a sufficient number of persons to control the movements of the patient, without too much violence; every thing must be done quietly, and she had better repose upon a mattress. No aggravating remarks should be made, for they greatly irritate the affected person. The windows of the chamber should be freely raised, and no idle company permitted to consume the air. 
Whether assafcetida, ether, ammonia, or any other antispasmodics shall be administered, must depend upon the experience those who are present have had in the same case. Assafcetida, in watery infusion, is the safest remedy for domestic use, and may be given in teaspoon doses, if a physician be not at hand; sulphuric ether and ammonia are more powerful, and had better be directed by the physician only. The face and chest may be freely moistened with vinegar, or cologne, and, as soon as possible, it will be safe to ad- 


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HYSTERIA. 
minister an ounce of castor oil; this cannot do harm, and may remove existing obstructions in the bowels, from which the disease often originates. The feet and legs may be immersed in a mustard bath, and frictions of brandy may be used to the stomach and limbs. Injections of a half teaspoonful of laudanum and a whole one of tincture of assafcetida, in half a pint of warm water, are often beneficial. These comprise the means that can safely be applied by the household. Every candid physician will freely communicate to some intelligent member of the family, the proper means to be adopted in case of emergency. 
13 


CHAPTER FOURTEENTH. 
PROLAPSUS OF THE UTERUS. 
Closely connected with leucorrhea, because it de. pends in a great degree upon the same causes, is prolapsus, or falling of the womb. This disease, although it often happens in single persons, when they have for a long time been subject to leucorrhea, is more frequently the consequence of exhaustion, and mismanagement after childbirth. In order to make the natural and diseased positions of the uterus intelligible, without a plate, (which we avoid for reasons stated in the preface,) we must claim the reader's close attention to the following explanation of the size and position of the uterus, and its connection with the bladder and rectum, as it is called, or the end of the great tract of the intestines j for upon all these points do the various displacements of these organs mutually depend. 
If it were possible to compress a small egg to about one-half its thickness, or diameter, with an oblong opening of one-eighth of an inch in length across its smaller end, connected with its cavity, it would give a sufficiently accurate idea of the size and shape of the uterus when not impregnated, or enlarged, as it al- 


PROLAPSUS OF THE UTERUS. 
147 
ways is, until some weeks after the birth of the child. Let the reader imagine the uterus situated nearly vertically, with its smaller end downwards, in the middle of a deep pint bowl, four inches across at its rim, and the uterus suspended about four and a half inches from its bottom; let this latter distance be occupied by the natural passage that leads from its appropriate opening, to the uterus, encircling its neck, (or the small part of the egg,) which projects half an inch into the passage. 
Now continue the comparison, by supposing the bladder directly in front of, and occupying the space between the rim of the bowl and the uterus, connected with both by a very loose and moveable tissue; directly behind the uterus, and also between it and the rim of the bowl, runs down to its appropriate opening, the rectum; being also connected with the uterus and rim, by this same loose tissue. 
This familiar comparison of a bowl, will represent the bony cavity or pelvis, (meaning literally a basin,) which constitutes the lowest part of the skeleton of the body proper. Through one large opening in the lowest part of the pelvis, must pass the contents of the bowels, and those of the bladder and the uterus. The bladder and uterus are situated, when not distended with their contents, completely within and below the rim of this cavity, and being connected with the pelvis and each other by a very loose and distensible 


148 
PROLAPSUS OF THE UTERUS. 
tissue, may rise, when distended, entirely out of the pelvis, into the abdomen. The necessity of this pro. vision of nature will be apparent, on recollecting the constant and daily distension of the bladder, and the very great enlargement of the uterus during gestation. The reader, it is hoped, fully comprehends all this, for on its correct conception by her, must depend our successful explanation of the displacements of the uterus, the bladder, and rectum; for they all act upon each other when distended by their contents. 
The intestines and other viscera of the abdomen, lie directly upon the bladder and uterus; and although they are suspended, in some degree, by appropriate ligaments and the muscles of the abdomen, still they become, in connection with these very muscles, a powerful means of pressing downward the uterus, particulaly when its own supports are weakened by disease. We shall soon see what those supports are. The abdomen is composed of skin, various membranes, and muscles. These muscles possess what we call contractile power; we can contract them whenever we choose; but they have also a constant and inherent contractility, without our will, and thus aid the skin and membranes in keeping the bowels in their proper place, and sustaining them against the contractions of the diaphragm. This is a powerful muscular and ligamentous partition, which crosses the body and 


149 
PROLAPSUS of the uterus. 
divides it completely into two parts—the chest, or upper part, containing the lungs and heart, and the lower part, or abdomen, the intestines and other viscera. 
This diaphragm, every time we breathe or sneeze, is forced downward, and presses the intestines upon the uterus and bladder; and if it were not for the resistance of the muscular walls of the abdomen, the intestines themselves would be displaced. But the uterus and bladder have to sustain the contractions of the abdominal muscles, and, through the medium of the intestines, those of the diaphragm also! therefore the reader will again ask, what supports them under this pressure ? The whole of the large opening, in the lower part of the bones forming the pelvis, is completely closed with a powerful and complicated muscle, lying directly below the bladder, the passage leading to the uterus, and the rectum. We may all form an idea of the power of this muscle, by its resistance to our efforts when at stool. It has openings in it for the various passages, which are surrounded by circular muscles, proceeding from itself; thus it serves to close these passages individually, as well as to sustain them, and the contents of the pelvis generally, against the action of the diaphragm and abdominal muscles upon the intestines. 
Now let the reader remember, (and it is according 
13 


150 
PROLAPSUS OF THE UTERUS. 
to the clearest and most logical reasoning,) that it is to the relaxation of this great muscle, that prolapsus uteri is mainly due. (See Dr. Meigs' note to Colum. bat.) The uterus is held in its position between the bladder and rectum, by the loose tissue of which we have spoken; but this could avail nothing against the action of the abdominal muscles, were it not for the powerful contraction of this lower muscle, when in a state of health. 
For the present, we shall confine our attention to simple prolapsus, or slipping down of the uterus; leaving its other displacements, as well as those of the bladder and rectum, till the next chapter. The causes of prolapsus are more or less connected with every chapter in this book; for every disease leaves debility, and long-continued debility is sure to end in leucorrhea. This, as it is the most exhausting disease, is the most effectual in relaxing the great supporting muscle of the pelvis, and thus permitting the descent of the intestines and uterus. We must therefore ask the reader to refer to the chapter on leucorrhea, and to remember, that she will find there all the principal causes of the disease in single persons. In the exhaustion following an ill-managed labour, and too early getting up, as we have before said, a powerful cause is added for prolapsus in married life. 


151 
PROLAPSUS OF THE UTERUS. 
In a professional essay on the causes of the extensive prevalence of leucorrhea and prolapsus, we drew the following picture of the causes of prolapsus, as it is commonly presented to our notice in this city. A prominent place in the list of predisposing causes, is due to the defective physical education of females throughout our country, but more especially in New York. The mania that exists for precocious education and marriage, causes the years that nature designed for corporeal development, and corresponding intellectual vigour, to be wasted in the restraints of dress, the school, and the ball-room. With a body not half clothed, and a mind intent on pleasure, the hours designed for sleep are perverted by the midnight revel. Unequal effort is required from the delicate votary to retain her situation in school, and thus the evil is perpetuated. 
When one is finished, another in perspective keeps the mind morbidly sensitive to impression, whilst the constant restraint of fashionable dress absolutely forbids the exercise indispensable to the attainment of organic strength. Exposure to midnight air, with a body reeking from the effect of dancing in an overheated room, produces its inevitable effect; and at last, an early marriage and premature confinement, cap the climax of her misery; and the unfortunate female, hitherto regardless of the plain dictates of 


152 
PROLAPSUS OF THE UTERUS. 
unerring nature, becomes an unwilling subject for medical treatment. 
The patient is commonly found in a morbidly sensitive state; physical derangement producing mental depression, that with leaden weight reacts upon the organism, and prevents the fulfilment of the first and plainest indication of nature, free exercise in the open air. This is not likely to be used, even if pointed out by the physician; but he indeed is rarely summoned. The ordinary period of professional attendance having elapsed, on her convalescence from confinement he is dismissed, precisely at the period when his advice is of the most consequence to her welfare. He is rarely summoned till domestic care, nursing, and want of exercise have induced leucorrhea, if not prolapsus itself. 
The first period of prolapsus does not always cause symptoms sufficiently marked to warrant manual examination. The pain in the back and sides, and dragging sensation at the abdomen, are not all so uniformly present as to induce this proposition, disagreeable both to the patient and physician. Nay, it often happens that in her morbid state of feeling, the first mention of so disagreeable a suggestion is the signal for discouraging further attendance. The disease gathers strength; and, at his next visit, is fully formed—prolapsus uteri. 


153 
PROLAPSUS OF THE UTERUS. 
an equal number of the cases of prolapsus that occur, originate under circumstances directly the reverse of this. All those who pursue sedentary occupations, and use a watery and unwholesome diet, or much purgative medicine, whether given by the physician or bought from the quack, are liable to its incursions. Nothing is more common amongst those who work in mills and manufacturing establishments, where the fresh air is shut out, and the body over worked in constrained and awkward positions. 
In most of these pursuits, the abdominal muscles are brought into constant use to steady the body, and make it a firm point of action for the hands and arms; thus pressing the intestines down upon the uterus, and causing prolapsus. Even the most severe labour in the open air, is rarely followed by the same results; for there the appetite and general powers of the constitution are improved, and the pelvic muscles strengthened to resist the pressure. Moreover, such persons are, for the same reasons, not likely to surfer from leucorrhea. 
Both these diseases are almost unheard of among the German women of Pennsylvania, who work in the open field. It is not uncommon to find them there for days together, a fortnight after confinement; or precisely at that period when our city females are most liable to be attacked with prolapsus. Let it be remem- 


154 
PROLAPSUS OF THE UTERUS. 
bered, however, in such cases, that the powers of re. sistance in the supporting muscles, have been gradu. ally brought up to this state by a life of industry and temperance; and the woman is able to resist exertions that would kill a delicate person. Those who are of feeble constitution, may require to keep the horizontal position for a full month after confinement. 
The barbarous corset is a powerful cause of producing the disease. It presses the bowels directly upon the uterus, and prevents a proper and healthful circulation of blood in the lungs; thus reducing the general health, and causing congestion and leucorrhea. Frequent abortion is likewise a fertile cause, (see that chapter;) excessive dancing, and various moral improprieties heretofore alluded to. The ques. tion is often asked, if prolapsus is ever fatal to life? The answer is, never of itself alone; but how long oan a person live in so wretched a condition, without inducing other complaints? And what is such a life worth, even if it were not to induce them? Every woman of sense will immediately take all the precautions to avoid the progress of this "scourge of her sexj" and we shall feel as though we have not lived for nothing, if our humble efforts should aid her in so good a resolution. 
In our comparison of the pelvis with a bowl, we said the lowest part of the uterus was four and a half 


PROLAPSUS OP THE UTERUS. 
155 
inches frorr the orifice of the passage leading thereto. The uterus then has that distance to descend, before it can enter the third stage, and become a complete prolapsus, or appear entirely outside of the body. This, fortunately, is a very rare occurrence, and when it does happen, it is not to be supposed that the patient will remain long without surgical advice. We shall, therefore, confine our attention to the two first stages of departure from its natural position. 
The first stage is productive of symptoms indicating its descent about half the distance of the passage ; it is almost always slightly enlarged, or congested with blood. A dull, heavy pain in the loins; a sense of pressure and weight in the pelvis; and a dragging sensation in the groins and abdomen, much increased on standing, sneezing, lifting, reaching, ascending stairs, or walking. All these disagreeable feelings are much alleviated on lying down, because the uterus then returns partially to its proper situation, and relieves the nerves of the pelvis from the pressure caused by its descent. The patient is always better in the mornings, and becomes worse as the day advances. Menstruation, through all its stages, is either too profuse or to sparing in quantity. 
In the second stage, or that in which it has passed so low as to rest directly upon the inner surface of the nelvis, the symptoms are all greatly aggravated, and 


156 
PROLAPSUS OF THE UTERUS. 
there are, in addition, such as arise from pressure upon the bladder and rectum. The reader will see, upon recurring to the description of their position, that they must come in contact; as the uterus enlarges and descends, it presses upon the bladder and rectum; and as the pelvis is of limited size, there may be suppression of urine, and constipation of the bowels. 
In all cases of uterine congestion, which state is apt to be much increased in this second stage, sympathetic affections of the stomach, similar to those in the first period of pregnancy, usually occur. Thus there may be loss of appetite, frequent nausea, and occasional vomiting. The breasts, also, often swell and become painful. After this extreme state of prolapsus has continued for some time, inflammation of the uterus and other parts may occur, from its congestion and weight, with the unavoidable pressure and attrition of the organ against the lower muscular part of the pelvis, which it was not designed by nature to touch. At this period of the disease there will be increased pain and burning, and probably discharges of mucus and matter. 
There are several very important diseases, such as preternatural elongation of the neck of the uterus, morbid growths attached to it, and polypous tumors, growing from the inside of the organ, and projecting through its opening into the lower passage, pressing upon the parts, and producing all the symptoms of 


157 
PBOLAPSUS OP THE UTERUS. 
prolapsus. We have witnessed such cases again and again, and merely mention them to put the patient upon her guard. A competent surgeon can always determine the precise nature of the affection. 
It is doubtful how far any thing likely to prove beneficial to the reader can be said, in this place, on the medical treatment of this disease. Indeed, there is no necessity for any constant medication, or attendance; a certain course of general regimen is to be pursued, and that is like the laws of the Medes and Persians: it can as well be told in a single visit, as a hundred. If the patient be earnestly bent on amendment, and place confidence in her adviser, she will follow his counsel, and improve; if otherwise, she will desire his constant attendance; and he will be continually mortified at her complaints, besides suffering in his professional character, from her reproaches, When he is not present. 
All the necessary dietetic regulations are precisely similar to those given in the chapter on excessive menstruation, and will undoubtedly be represented and enforced by the physician. In mild cases, if perseveringly followed, they will effect a cure. If the disease has become complicated and stubborn, more decisive means should be adopted. It is gratifying to know, that the treatment of this complaint has been greatly improved, by the industry and talent of many distin- 
li 


158 
PROLAPSUS OF THE UTERUS. 
guished men; and that cases are now cured in a comparatively short time, that used to be the opprobium of our science. 
The means resorted to are almost exclusively surgical and local in character, though they do not subject the patient to the pain of a cutting operation; on the contrary, there is no occasion for any other exercise of fortitude, than a womanly resolution to extend perfect confidence to her chosen adviser. This (should she be so fortunate as to select a man of science, and a gentleman) will always be reciprocated by a sincere desire to alleviate her sufferings, and the exercise of all that sympathy and forbearance which her delicate situation demands. 
It was the good fortune of the writer, to suggest to the profession, some fourteen years since, in the United States Medical and Surgical Journal, (then edited by Professor Webster,) an instrument for aiding the powers of the great pelvic muscle in supporting the uterus, in those cases where occupation or inclination would not permit the patient to carry out a proper plan for a radical cure. The instrument then invented, has since been variously modified by a great number of persons; and as neither our professional character nor our inclination would allow us to patent an invention that belonged to humanity at large, it is now sold, of various degrees of excellence and price, in almost every 


159 
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village and hamlet in the country, under the name of the " utero-abdominal supporter." In still preferring the one invented by ourselves, more especially as it has since been much improved, and tested in a vast number of cases; we take it for granted that we present no uncommon exhibition of professional vanity, as we are all apt to esteem our own productions preferable to those of our neighbours. 
Whatever be the opinion of the profession on this point, we are happy to say, that most of them prove of great benefit to the wearer. There are at this moment thousands of persons, engaged with comparative comfort in their daily, and sometimes laborious pursuits, who, but for the support derived from this instrument, would be a burden to themselves, and to all who witnessed their sufferings. 


CHAPTER FIFTEENTH. 
OTHER DISPLACEMENTS OF THE UTERUS AND BLADDER. 
The reader who has attentively considered the subject of prolapsus of the uterus, its close dependance upon pressure from the intestines, and its very moveable and slight connexion with the bladder and rectum, has already mentally inquired, why it may not be displaced in some other direction ? 
To this very natural inquiry we answer, that it may, and often is completely turned over, so as to bring the top against the rectum, and its lower part, or neck, as it is called by anatomists, against the lowest part or neck of the bladder; thus assuming a position directly crosswise in the pelvis, and hindering the discharge of urine, and the contents of the bowels. It is likewise liable to anterior displacement, or that in which this accident of position is reversed; the top being towards the bladder and the neck towards the rectum. 
There are also lateral displacements, as well as complete inversion of the organ, occurring during gestation, and after labour. But these latter accidents we shall not notice; it would be productive of no benefit to the female, as we could give no precautions 


OTHER DISPLACEMENTS. 
161 
whereby she could avoid them; and when they do occur, they must, of course, become the subject of skilful medical interference. 
Not so with the retro-version and ante-version, or turning backwards or forwards; both of these annoying accidents are very much under the control of the female; the retro-version is especially so, and that is by far the most frequent and dangerous. To these two accidents we shall then confine our remarks, commencing with the retro-version; premising, that it may happen both in the single and married state ; the latter, when combined with pregnancy, being the most serious. 
There are two slight ligaments, like small cords, which we have not yet had occasion to mention, proceeding from the sides of the uterus, and inserted in the muscles and membranes forming the walls of the, abdomen, at the lower part of the groin. These, from their position, have a slight tendency to keep it from tilting backwards, and are probably sufficient for this purpose, when not weakened by too frequent distension of the bladder, or when no extraordinary causes are applied to overcome their action. 
By recurring to the relative position of the bladder, uterus, and rectum; the former in front, the uterus in the middle, and the rectum behind; and all inclosed within a bony and resisting cavity of four inches or so 
14 


162 
OTHER DISPLACEMENTS. 
in diameter, the peculiar liability of the uterus to this accident will at once appear. In the first place, the bladder, which is liable to constant, and sometimes extreme distension, rises far above the uterus; but being tied down closely to the pelvis at its neck, or orifice, its distended and uppermost part not only stretches its ligaments and forces the uterus backwards, but downwards j for in such a condition it actually overhangs, as it were, that organ. 
The uterus is, of course, much more liable to retroversion in those who have the pelvis of unusual diameter ; but fortunately for such persons, the same condition affords facilities for its natural reduction, or the elevation of its top to its proper position. This we have no doubt often happens, when it has been retroverted, by the gradual enlargement of the rectum with its contents, below and behind the uterus, thus, as it were, wedging it upwards at a time when the bladder is most empty, and cannot therefore oppose its reposition. Indeed, were this not the case, we should find ourselves puzzled to say, why manual interference by the surgeon is not oftener required. The accident is not very rare, as we know from frequent instances of difficulty in passing urine, where there were no other symptoms to account for it; besides the number of those cases, where, from its persistence, surgical aid has been absolutely unavoidable. 


163 
OTHER DISPLACEMENTS. 
This may become necessary, from a partial, and sometimes total obstruction of the bladder and rectum, in consequence of complete retro-version, jamming the uterus crosswise between the two. It cannot remain long in such a state, without becoming much enlarged from congestion, and therefore more difficult to reduce; as the circulation is greatly obstructed by the compression of its blood-vessels, in so awkward a situation. 
When a female finds both these important passages obstructed, particularly after having retained the urine much longer than usual, she may very confidently impute it to such a cause. As the same imprudence is very apt to recur, unfortunately for those who are subject to this accident, they are not likely to escape long without fresh experience of its symptoms. This disease may steal upon the patient almost imperceptibly. We have known it to occupy months in maturing. It is very often mistaken for prolapsus, and can only be detected by careful investigation. 
The symptoms that mark the commencement of retro-version may, therefore, be more or less serious in character. If the pelvis be unusually large, and the uterus of its natural size, there may at first be very little, or even no perceptible obstruction to the natural evacuations. The first observation of any departure from her natural condition made by the patient, is a sense of fullness and pressure, particularly when on 


164 
OTHER DISPLACEMENTS. 
her feet, or using prolonged exertion; this shortly becomes impossible; then all the symptoms that exist in the second stage of prolapsus are added; viz. a drag, ging sensation at the abdomen, pain of an obtuse and distressing kind, accompanied with a sense of numbness in the thighs, and pain in the back and groins. 
This state does not continue long, before inflammation of the uterus occurs. The pain now increases, and the uterus rapidly enlarging, both the bladder and rectum become obstructed. The urine, however, from its nature, will often continue to pass with comparative freedom; so that this symptom is not to be relied upon, unless in an extreme case, when it is always present. 
The menstrual discharges will of course be much deranged. In the early stages they may be profuse: as the disease advances, and the inflammation increases, they are replaced with leucorrhea, often blended with matter. In this stage, there is much constitutional derangement and exhausting fever. 
We have now sufficiently characterized the disease, to show its insidious nature and great danger;—the close similarity between retro-version and prolapsus, will very often cause it to be confounded, even by physicians of decided ability. The symptoms of a case that advances gradually, are, moreover, absolutely identical with those cases in which the uterus 


165 
OTHER DISPLACEMENTS. 
slowly enlarges from chronic inflammation; the distinction is only to be made by careful manual investigation. Every woman will therefore act most wisely, who submits her case to a practitioner of undoubted ability in female complaints. The most distressing consequences are of daily occurrence, where a little tact and ability would have sufficed to restore every thing to its natural and healthful state. 
If the mechanism of the pelvis is now understood, and the manner in which retro-version occurs, the reader who is interested in what we write, will easily perceive the importance of attending to the evacuation of the bladder. The greatest precaution should always be used, but particularly when obliged to travel j or at any time when there is likely to be occasion for several hours of personal restraint. 
What we have said respecting the occasional reposition of retro-version, by enlargement of the rectum with its contents, was only designed to make the position of the parts still plainer to the reader. She should not suppose that it is either desirable or proper to retain the contents of the bowels, for constipation is greatly under the control of habit, as will be seen in the chapter on that subject. We have said enough in the former part of this work, to show its pernicious effect in all uterine derangements. Moreover, she is not to forget, as we have amply explained in the last chapter, 


166 
OTHER DISPLACEMENTS. 
that the pressure of the abdominal muscles upon the intestines, (as it occurs in using violent efforts at stool,) is a most efficient cause for uterine displacement; retroversion itself often occurring from that very cause. 
As this is a most important precaution, we anticipate what we shall have occasion to state more at length hereafter, by directing attention to the daily state of the bowels. Very few persons dream of the constant effect a large portion of our daily food produces in constipating the system. Nearly every article that passes our lips, undergoes some deleterious change, by the carelessness or ignorance of those who prepare it for the table; —we mean the manufactured articles, as well as those that are prepared at home. A small piece of the root of rhubarb, will produce the most gentle effect in removing constipation and leaving the bowels in a comparatively natural state, till some further error demands its repetition. It should be carried about the person, so as to be always at hand, and used as occasion requires. The object is to produce a single natural movement, and every one will soon learn the quantity sufficient to effect that end in her own person. 
All the consequences of retro-version are more rapid in the earlier months of pregnancy, and that for a very obvious reason ; the uterus is larger, and must continue to increase in size. During the second and third 


167 
OTHER DISPLACEMENTS. 
months, there is nothing to hinder its assuming a completely retro-verted position; at, and after the fourth month, it has become so large, that, in all ordinary cases, retro-version within the pelvis is impossible. The length of the uterus at that time is greater than the diameter of the pelvis; and it is, moreover, increasing so much in its upper part, by the growth of the new being, as to occupy more of the abdomen and less of the pelvis. 
Up to the third month, particularly in those who have a large pelvis, there is increased liability to the accident. Women should always exercise great caution at this time, for this, and other important reasons. (See chapter on abortion.) Should the retro-version not be discovered and replaced, the process of gestation may continue, and very alarming results may follow. The uterus, as we have said, constantly increases in size ; and as the obstruction to the blood is very great, and there is unusual necessity for its perfect freedom of circulation, abortion may occur, and the contractions of the uterus necessary to throw off the ovum, be the first credible warning given the female of the very serious nature of the affection. 
We are far from wishing to excite the alarm of the reader, yet we are writing a book of cautions; and as this accident has occurred again and again under our own notice, we wish to convey to others that infbrma- 


168 
OTHER DISPLACEMENTS. 
tion that may save them a similar misfortune. Let every female, then, who knows from past experience that she is liable to retro-version, exercise peculiar caution during the first three months of gestation. Besides the causes already mentioned, violent and sudden exertion, such as jumping, reaching, sneezing, etc., may, by compressing the intestines, force the uterus below the brim of the pelvis. 
The position of the bladder in front of the uterus, and its constant distension, renders ante-version without prolapsus almost impossible in the unimpregnated state; indeed, we have never seen a case that was not accompanied in so great a degree with prolapsus, as to place the uterus entirely below the influence of the distended bladder, and entitle it to that term also, as well as ante-version. The symptoms differ in no respect when it does occur, thus combined, from retroversion. The pressure upon the bladder and rectum is the same, for the position of the uterus is only reversed ; its top being against the bladder, and its neck against the rectum. We suppose that it will be readily understood, that when the uterus, in the latter months of gestation, is placed above the influence of the bladder by rising high in the abdomen, that anteversion may often occur; indeed, it is the ordinary meaning of the expression, " carrying the child very forward." It is only a temporary inconvenience, and 


169 
OTHER DISPLACEMENTS. 
cannot possibly produce any of the effects of retro or ante-version, when low down in the pelvis, as it is not within that cavity. It may indeed, and usually does, by pressure upon the top of the bladder, cause a more frequent desire to expel its contents; and in actual labour requires precautions perfectly familiar to the well-instructed accoucheur. 
The bladder is liable to displacement from the same causes thai produce the various uterine displacements. Retro-version of that organ may happen in unmarried persons, but it is more likely to occur in those who have been subjected to the debilitating consequences of frequent child-birth; particularly extreme cases of leucorrhea, retro-version, or prolapsus. All these derangements have a tendency permanently to impair the strength of the attachment by which the bladder is sustained in its position, and to allow its own weight when distended, aided by the pressure of the intestines, to force it downward*- and backwards. 
It falls, in the first stage of its retro-version, directly against the uterus, because that organ is immediately behind it. When it settles a little lower, and comes in contact with the passage leading to the uterus, it carries before it on its way downwards the front part of that passage, and may get so far retro-verted as to show itself at the natural opening, or even to pass through it. This is, however, an extreme case; nor 
15 


170 
OTHER DISPLACEMENTS. 
is the disease at all as common as retro-version of the uterus, for the attachments of the bladder are not so liable to distension; neither is it as moveable, its functions not requiring it to be so. It is only to carry out our design of presenting all those derangements, for the avoidance of which we can convey useful cautions, that we include the accident in this chapter. It is, however, closely connected with uterine displacement, from the contiguity and intimate relations of all the pelvic viscera, and the identity of the causes which produce the two diseases. 
Slight degrees of retro-version are constantly occurring, which are relieved by improvement of the general health, imparting fresh vigour to the supports of the bladder. Those surgical and local means, to which we alluded when speaking of leucorrhea, and prolapsus of the uterus, are equally efficacious here; because the main support of the bladder is the very membrane that is most weakened by those diseases. Although complete retro-version of the bladder is comparatively rare, still it is occasionally presented to the notice of a practical surgeon, and requires much care and mechanical ingenuity on his part, coupled with great obedience, and the most favourable surrounding circumstances on that of the patient, to effect a cure. 
The means are partly medical, and partly mechanical, and are of such a nature that no benefit could be 


171 
OTHER DISPLACEMENTS. 
derived from mentioning them in this place. Everything that can improve the general health, as directed in uterine prolapsus and retro-version, should be carefully adopted by the patient. The same care in avoiding distension, should be used for preventing displacement of the bladder, as we urged upon the reader, to avoid its evil consequences in causing retro-version of the uterus. Complete retro-version, by obstructing the passage of urine, always requires speedy surgical interference. Should this be delayed, the most violent spasmodic pains, similar to those of labour, will occur, and if the patient is not relieved, death will soon follow, from inflammation and ulceration of the bladder; or it may burst, and thus she may find immediate relief, at the cost of her life. 
This result has happened, even in this city, in the practice of one of our friends; —though we are happy to say, from no medical incompetency, but the extraordinary folly and absurd false modesty of the patient, who did not send for the surgeon till the bladder gave way. Upon several occasions, we have been so fortunate as to receive notice in time to give immediate relief. One case in particular, occurring in the person of the mother of one of our most able physicians, was followed by such a hearty and common-sense co-operation, on the part of the patient, with the mechanical means we invented for the express purpose, 


172 
OTHER DISPLACEMENTS. 
as to be followed by a complete cure. The lady now enjoys perfect health, and -is completely relieved from the necessity of using any mechanical support, or indeed any precautions whatever. This case we re. ported, together with the means used, in the fourth number of the United States Medical and Surgical Journal, for the year 1832. 
From its position, directly behind and against the walls of the abdomen, the bladder cannot, in single life, like the uterus, be ante-verted; there is no space in front of it, and it therefore cannot be displaced in that direction. But, as we said when speaking of uterine displacements, the uterus may, either in prolapsus, or either of its other displacements or enlargements, sink below the bladder, and there enlarging still more, raise it so far upwards, as to lift it entirely out of the pelvis into the abdomen ; —this, by stretching the passage for the urine, and pressing upon it, may so far obstruct its progress as to render mechanical means necessary, by which to draw off the water, till the uterus shall be restored to its proper state. Several examples have passed under our notice of this state of things. 
Pregnancy may likewise cause this obstruction, at two periods of its existence. The reader may remember that we said in a previous chapter, that the uterus usually rose out of the pelvis at the fourth month of 


OTHER DISPLACEMENTS. 
173 
gestation; but there are some cases in which the pelvis is so much larger than others, that it does not rise at that period ; and thus, by enlarging within the pelvis, the impregnated uterus may produce a similar effect. This will cease as soon as the uterus rises. Again, in a very small pelvis, before the third month, the rectum may, from distension with its contents, force the impregnated uterus against the passage for the urine, and thus cause a similar result; this cause, however, would be only temporary in its effect, the difficulty ceasing when the rectum was relieved. 
Finally, the impregnated uterus, in those persons who, from having borne many children, have greatly relaxed the walls of the abdomen, may, when it does rise, fall so far forward, carrying the bladder with it, and doubling its passage upon itself, as to produce an ante-version ; though that is only possible in the married state. The proper remedy for this displacement is mechanical support, in the form of an abdominal corset. This, by the way, is the only proper application of that ingeniously devised instrument of torture —most certainly properly so called, when applied to the chest. Its application to the abdomen, when that section of the body is relaxed by debility, we conceive to be its only proper use. 
There are other causes of difficulty in passing urine, as well as its complete suppression; such as 
15* 


174 
OTHER DISPLACEMENTS. 
cold applied to the body or feet, producing partial inflammation of the lining membrane of the bladder. The same result may happen from the irritation of piles, and inflammation of the rectum. The formei requires the usual precaution in avoiding its cause: when it does appear, it must become the subject of medical treatment. Of the latter, we shall speak hereafter. 


CHAPTER SIXTEENTH. 
COSTIVENESS PROLAPSUS OF THE RECTUM PILES FISTULA. 
Although the subject of costiveness is sufficientlyextensive in its application to the general health, and the proper performance of all the functions of the mind and body, to warrant the devotion of a chapter, at least, to that subject, yet the purposed extent of our book, and the intimate relation of all the subjects we are about to speak of, induces us to present them thus closely connected, to the reader. 
If we view constipation of the bowels merely in a mechanical light, we hope it is now sufficiently evident to the reader, that, where there is any feebleness of the proper supports and connexions of the uterus and bladder, the violent straining and compression of the whole tract of the intestines, and forcing them all downwards for a considerable time each day of our lives, must exert a very pernicious effect upon the contents of the pelvis. 
But when we reflect that, in an ordinary state of health, we consume each day an amount of food that we know, from occasional intervals in which the bow- 


176 
COSTIVENESS. 
els perform their proper functions, should yield, without effort, five or six times the quantity of the customary discharge; the immense consequence of a sufficient daily evacuation of the bowels is too plain, for us to view its constant deficiency without alarm. 
It is true, we observe many persons who seem to enjoy a pretty fair state of health, who never have more than two or three evacuations a week; yet a critical investigation would show a very different state than that of health, in such individuals. A fevered tongue, an aching head, and inability for active bodily or intellectual effort, is an almost invariable attendant on this state; and its next result will almost to a certainty be, either piles, a permanent weakness or falling of the rectum, or an abcess, and fistulous opening at its side. 
Either of these complaints will be found a powerful drain upon the constitution ; and however skilfully they may be treated, it will be a long while (if at all) before the system regains that equilibrium of health that might have been preserved, by proper attention to the great natural law, of a daily and sufficient movement of the bowels. 
Anatomy informs us that the length of the intestinal tube is nearly six times that of the entire body; and that four-fifths of it is appropriated to the reception, from the stomach, of the nutritious parts of the food 


COSTIVENESS. 
177 
and the bile; while the lower fifth, ending in the rectum, is designed to contain the waste parts, or that which is to be thrown out of the body. 
The whole of this immense tube, formed of three coats —viz. an outer membranous, a middle muscular, and an inner mucous one—is completely lined on its inner surface with myriads of nerves and blood-vessels, as well as a set of vessels having mouths, like small worms, opening in the cavity of the intestine, and taking up the bland and milky fluid produced by the stomach from the food. All these latter gather finally into a great trunk that communicates with the veins, and thus submit it, through the circulation, to the purposes of the economy. 
Comparatively few of these small vessels that absorb the nutrimental part of the food, are to be found in this lower portion of the intestine; they decrease as the grand tract passes downwards to end in the rectum. Still there are some; as though nature designed to economize her food, and not to give it up as useless, till all the useful material was extracted from it. 
The general character of our diet and experience is such as to assure us, that at least one-quarter of the food we swallow is excrementitious; or intended by nature to be evacuated from the system. The experience of persons who are habitually consti- 


178 
COSTIVENESS. 
pated, proves that 00 such amount, or indeed any approach to it, is ordinarily discharged. What then becomes of it ? There can be no question, that it is re-absorbed into the system; for there are a sufficient number of absorbents opening into the lower intestine to effect this mischief, if the bowels remain long unmoved. It is unnecessary for us to point out the injurious effect of this poisoning of the blood, with a substance so different from that pure fluid found in the upper tract of the intestines. We cannot forbear the expression of our astonishment, that any enlightened person can be so absurd as to expect health under such circumstances. 
Nor is it wonderful, that designing and knavish individuals should avail themselves of the indolence of that half-enlightened and physic-consuming class of society—those who, having a mere suspicion of the truths they occasionally hear from physicians, and from partial observation of their own systems, dare not entirely neglect this most important function, but console themselves by taking enormous quantities of quack pills. 
These are all made of stimulating substances, which act by forcing the intestines to throw out from their surfaces so large a quantity of the serum, or watery part of the blood, as to liquefy the hard contents of the bowels. By the excessive irritation they 


179 
COSTIVENESS. 
cause the whole nervous system of the bowels, tney force them to contract, and throw off their contents, leaving the whole tract in a partial, and eventually in a state of permanent inactivity. 
This may be understood, by a moment's reflection on the consequences that follow the operation of one of these doses. When nature has received a violent injury in her organism, she is invariably observed to require rest, that the part may recover its tone. The bowels, if not too severely irritated, so as to be obliged to continue their action from an actual dysenteric effect produced by the pills, are quiet, and do not move at all for several days; thus leaving them worse than they were before. 
Some of these cunning empyrics manage the matter most adroitly. Knowing the result we have just mentioned, and that the repetition of their doses would, by such consequences, either warn the victim of danger, or destroy their harvest by killing her too soon; they only put a small portion of the actual agent in each pill, and form the bulk of some perfectly innocent material, as flour, liquorice powder, etc. Then they may safely direct several at a time; and thus the box is soon consumed, and twenty-five cents pocketed for another, and so till the patient is either killed or convinced. 
Some years since, having the misfortune to be 


180 
COSTIVENESS 
obliged to place a patient at the Insane Asylum, Dr. James McDonald, then the enlightened superintendent of the medical department, informed us, that he found a number of boxes of a popular nostrum in the pa. tient's trunk. She then laboured under excessive irritation of the bowels, that had been found utterly unconquerable; having, doubtless, been kept up by the stealthy use of these pills. The necessity of submitting to the rules of the house, in the examination of all personal effects, furnished Dr. McDonald with the cue to the difficulty. The two preceding cases received at the asylum were in a like condition, from the same habit of pill-taking; and the doctor informed us, that irritation of the bowels was a frequent cause of difficulty in calming the insane, when first brought to the asylum. 
How, in the name of reason, can good results be anticipated by the use of such remedies, given either by the physician or the quack ? Both the irritability of the nerves lining the bowels, and the serum and mucus they cause to be so rapidly exhausted, were designed by nature for economical use. Both depend upon the healthy and natural condition of the mucous membrane, and are only expended in a state of health as they are required. The irritability of the bowels is first naturally excited by the presence of their contents, and the necessity of getting rid of it; the mucus 


181 
PROLAPSUS OF THE RECTUM. 
and serum are then secreted in sufficient quantity to lubricate the intestine, and liquefy the contents, that they may pass gently, and without pain. Such are the simple intentions of nature, though both are aided by proper quality of the food, and a judicious mode of life. 
Compare this with the constant use of pills. First the nerves become obtuse, from excessive and frequent irritation, teaching them, as it were, to expect it; while the partial inflammation of the lining surface of the bowels, prevents the secretion of mucus in a healthful state and natural quantity, causing the contents to remain in hard and unnatural masses. More or less of this is constantly absorbed into the system, thus poisoning the fluids, and producing diseases of the skin, headache, and general depression of vital power. Costiveness is very common in the more advanced stages of pregnancy, from the pressure of the enlarged uterus upon the bowels. It is to be overcome by diet, rhubarb, and drinking cream-of-tartar water, injections of soap and water, etc. 
Prolapsus, or Falling of the Rectum, is also a consequence of constipation, and the constant use of pills; and this is its explanation. Prolapsus consists in the slipping down through the natural passage, of the mucous lining, and sometimes of the whole thickness of the intestine. It slips through that open- 
16 


PROLAPSUS OF THE RECTUM. 
182 
ing in the great muscle we spoke of in the chapter on prolapsus of the uterus, as closing the bottom of the pelvis, and also the different passages, or outlets, of the bladder and rectum. This muscle, like every other part of the body, is relaxed by the exhaustion of physicking—loses its tone, or power of contraction —and aided by the constant pressure of the bowels and abdominal muscles, the rectum "prolapses," or slips down, precisely in the same way the uterus does. 
It often becomes very much inflamed, discharges matter, and renders the patient's life perfectly miserable ; obliging her to replace it by pressure after every evacuation of the bowels. This is a common affection of children who are exhausted with debility from bad diet, suffering, diarrhoea, etc. Various washes and ointments of an astringent character, are applied with benefit, to restore the tone of the bowels and muscle. They are usually only of temporary effect. A cure oan best be effected by leaving off physic, using proper diet, and raising the standard of health. 
Then, if the intestine will not return, but remains permanently prolapsed, it may be removed by the surgeon without danger, or much pain, by a proper application of the ligature. The mode of doing this is somewhat peculiar. We have long used a very simple and efficient plan, and have found it so valuable and safe a method, that we were induced to describe 


183 
BLEEDING PILES. 
it in a late number of the Boston Medical and Surgical Journal; and have since had the pleasure to find it frequently adopted by our professional friends. 
Bleeding Piles are likewise often produced by costiveness. These are hollow tumors, from the size of a pea to that of a walnut, and from one to six or seven in number, surrounding the verge of the opening of the bowel, or its natural passage. They are caused by the hardened contents of the bowels, constantly pressing upon the veins, and obstructing the circulation and return of the blood into the larger vessels. Sometimes they are quite within the opening, and do not appear, or only occasionally, as when the person strains at stool. Their existence may be known, when within the bowel, by the discharge of blood, always appearing at stool. When they slip down and appear outside, they are constricted by those fibres of the great muscle that close the rectum, and thus the blood being completely prevented from returning, they swell, and become exquisitely painful; sometimes they burst, and bleed till the patient is quite exhausted. 
From their universal prevalence, particularly with literary or sedentary persons, who are apt to neglect the bowels, they are one of the greatest evils of our race. There is no method of relief equal to regulating the system, by diet, if possible ; if not, by a little rhubarb; because it is the most simple and natural in 


184 
FISTULA. 
its effects. If the patient desires immediate relief from pain, she must lie down, with the hips elevated, and apply cold water to the tumors. A little opium ointment, or Belladonna, smeared over them, will also aid in giving relief. As in prolapsus of the rectum, astringent ointments of various kinds are used to cure the complaint, but they are not to be relied upon without attention to diet. 
We have never known a case of piles, that could not be radically cured, by the very careful and judicious application of the nitrate of silver. We mention it here, not that the patient may herself apply it, because, from its peculiar nature, she would probably do herself much mischief. Any prudent surgeon knows the proper method of using it, and we sincerely believe that the painful method of tying them, and the still more dangerous operation of cutting, may be always dispensed with, if this remedy be perseveringly applied. 
Fistuljs, or abcesses, are also formed near the rectum. They are frequently, though not always, connected with costiveness. The rectum, from its necessary mobility in depression, and subsequent elevation in passing its contents, is surrounded, on its outside, with a great deal of that substance we spoke of when describing retro-version of the uterus, which is also connected, as we said, by the same loose and move- 


FISTULA. 
185 
able tissue, to the rectum. The abcess, which when it opens is called a fistula, forms just outside of the rectum, amongst this tissue. There is no doubt it occurs in a similar manner, and from a similar cause, with piles; that is, from obstruction of the blood-vessels by the hardened contents of the bowels. 
This fistula does not heal of itself, like many other abcesses, but continues to discharge for years—and even the patient's lifetime, if not stopped by surgical means—an unhealthy kind of matter. It often works its way through the sides of the bowel, when the matter becomes mingled with the fasces, causing a very disagreeable state of things for the poor patient, who is glad to submit to almost any means of relief. 
The most rapid, and by far the least painful method of cure, consists in laying open the fistula with a single stroke of the knife; it will then heal from the bottom, and become sound. Many patients will not submit to this, and we are then obliged to endeavour to cure them with various kinds of injections, or a seaton. Both of these methods are often successful— the seaton generally so. But the patient had better trust the surgeon, and allow him to think for her; she will always save herself much trouble and pain by so doing. 
Fistula? are sometimes produced during tedious child-birth, from the pressure of the child's head 
16* 


186 
DIET 
causing communications between the passage leading to the uterus, and that of the bladder, or the rectum, thus producing most distressing results. It is not our purpose to attempt their description hVe, as they are very complicated, and we are happy to say, very rare; besides, the female cannot, by any precaution of her own, avoid them. When they do occur, they require all the assiduity of the most skilful surgeon. 
Such, then, are a few, and only a few, of the most prominent evils of costiveness. We have said that it was the intention of nature, that we should enjoy a daily movement of the system; and having condemned medicine as unnatural, and spoken of proper diet, and exercise, as the only certain and natural means of effectually carrying out nature's plan, it remains but for us to say, briefly, what the general diet should be. 
So bountiful a supply of every thing that can gratify the palate is produced in our climate, that it is impossible to particularize. We must speak of articles of food collectively, and each person must observe what is suited to their own habit. Nothing can more forcibly illustrate the proverb, " what is one man's meat," etc., than our dietetic regulations. The stomach, in the wealthy classes, is a very capricious organ; but the tongue itself is more so; it punishes the poor stomach most severely, having by far the bet- 


187 
UNWHOLESOME FOOD. 
ter chance, as it has the first vote in the matter, and unfortunately the most to say in the selection of food, whether the stomach suffers or not. But the middle and poorer classes, alas! they do not suffer from any folly in the selection of their food. Notwithstanding the great abundance with which our markets are supplied, there are almost insuperable evils attending its proper application to our necessities. 
The first we shall mention, is that outrageous system by which every thing we eat, even from bread and meat to the meanest vegetable, is made the subject of a vile system of huckstering, adulteration, and universal swindling, that would, in times past, have subjected those engaged in it to the imminent danger of having their ears cropped, as a punishment for their roguery. The actual quality of a large portion of the bread and beef, sold to the poorer classes in the shops of this city, at a price that would purchase a good and wholesome article, is such as greatly to injure the health of those who eat it. 
Why, in the name of humanity, do not our miserable Corporation appoint and carry out a system of rigid inspection of these articles, upon which the very existence of our fellow creatures depend? Why are they permitted to purchase, at double their proper value, meat that is often actually diseased; bread of the worst quality, and stale, fermented, and thrice-sold 


188 
IMPROPER COOKING. 
vegetables, utterly unfit for the human stomach ? Water of sufficient purity we have, but that is only the purifier and menstruum of that food, which is to become the very material of our bodies, and therefore should not surely be a secondary object of solicitude. 
The bad quality of our food—particularly the bread, adulterated by mixing stale and sour flour, partially rectified, with vile astringent drugs—and the toughness of the fibre of our meat and vegetables, have much to do with constipation. Not only the astringent effect of the drugs in the bread, but the actual difficulty and disinclination to masticate such unpalatable food, increases very much the labour of digestion. There can be no doubt, that such food passes through the stomach into the intestines in a half-digested state, and cannot, therefore, be expected to pass the bowels so kindly as it would do, if nature's intentions were properly fulfilled. 
But the food, bad as it often is, is subjected to such extraordinary and incomprehensible operations in the way of cookery, that the few good qualities that remain are usually destroyed by the domestic who prepares it for the table. The use of ovens and fryingpans are highly prejudicial to the quality of meat. Owing to the excess of heat, and exclusion of the article from a free admission of air, there is a condensation of empyreumatic, or burnt oil, upon its undor 


189 
TEA AND COFFEE PERNICIOUS. 
surface, that is decidedly astringent; and such is the predilection of most females for over-done meat, that they would prefer that which has the most of this substance upon it, because it is the best done. 
Meat should be roasted, broiled, or boiled, always exposed to the free admission of air. It is well known that the finest flour is constipating; and Dr. Dewees, whose excellent writings we have so often sion to quote, has used, with the greatest success, in his practice, coarse, or bran bread, long before the present mania for it existed. Bread should be made of the natural grain, without any process of refining the flour, and consist of one-third of Indian corn. All who regard their health will make it at home, and never purchase it of an unprincipled class of men, who are governed neither by feeling nor law. 
It seems almost superfluous to repeat, that tea and coffee are pernicious. That they exhaust the nervous system, we think most persons believe; if they do not do so, why are they so constantly recurring to their stimulus, to wind up their failing energies ? For ourselves, we can safely assert, that after the ordinary use of both for thirty years, we have, for the past two, discontinued them entirely, with surprising improvement of bodily energy, and capacity for mental effort. 
Coffee is said to be aperient. It doubtless is so to some persons; but there are other and more natural 


190 
FRUITS, MILK, ETC. 
means to regulate the bowels; and its stimulating and exhausting effect upon the nerves and digestion none will doubt, sooner or later, if they are capable of correct observation, and continue to use it till they are thirty. Tea is most decidedly constipating, whether green or black. 
Most uncooked fruits are more or less aperient, yet some%re very astringent, whether cooked or raw. A portion of a particular species of fruit may be aperi. ent, and the rest of it astringent, as all medical writers well know. This is of almost universal application to all our fruits. It is therefore impossible to particularize those which are most suited to the economy. As a general rule, we may say, with great propriety, they are more wholesome when uncooked. Indeed, most of the domestic processes to which they are subjected, except plain stewing, very much deteriorate them. 
Almost every kind of vegetable, except the potatoe, is aperient; but that, although not absolutely astringent, is quite as bad, when much used, as fine bread. Milk, and water, are the natural drink of man. In city life the former is often constipating; but we take it for granted, from its elementary nature and extraordinary adaptation to the nutrition of the body, that nature never designed it to be so; it should, therefore, be a special object with every one to discover the cause, if there be any besides want of exercise, that prevents 


EXERCISE. 
191 
the easy digestion of this choice and pure gift of the Creator. We have not an additional word to say on the subject of exercise. Whoever is not already convinced, by what we have already said, will yield no further credence to any thing we might reiterate in this place. 


CHAPTER SEVENTEENTH. 
INFLAMMATION AND HARDENING OF THE UTERUS, AND CANCER. 
The diseases of the uterus we have hitherto enumerated, are not attended with any alteration, in the structure of the organ, of so serious a nature as to preclude the hope of entire restoration to health ; they are merely functional in character, and require, for the most part, close attention to all the laws of nature, to effect a cure. Those we are now about to consider are far more serious; and though mostly curable in their earlier stages, they often resist, for a long time, the best directed efforts of art. Indeed, we may say, without a doubt, that the most intractable of all its diseases—viz. cancer of the uterus—is closely connected with, if it does not actually originate from, inflammation in some of its forms. 
In the earlier years of her existence, woman is scarcely liable to inflammation of the uterus, although it has been known to occur. Until that organ becomes the central point of attraction for so many departures of the nervous and vascular actions of the general system, it does not assume those grave and serious 


ACUTE INFLAMMATION OF THE UTERUS* 
193 
derangements that characterize its affections during the child-bearing period. 
It will at once be perceived, from the avowed object of this work, that we could not, with any propriety, enter into a minute explanation of the symptoms or treatment of the particular kinds of inflammation of the uterus; this the reader could not apply to any profitable use. She could neither detect the disease, nor cure it, by possessing all we could possibly impart of such knowledge. But when assured, in a manner satisfactory to her intelligence, that she is susceptible to serious disease, from certain causes that she has it in her power to avoid, it would be insulting her good sense to suppose she would disregard them, and a failure on our part to fulfil our promise, should we omit to impart them. 
The causes of acute inflammation of the uterus, are in a great degree similar to those which effect the suppression of menstruation; and a youthful subject i3 most likely to be affected by it. Blows on the abdomen, a fall, or any other mechanical irritation of the uterus, or departure from a strict observance of moral propriety, may be followed by the complaint. Dr. Columbat enumerates the following: " Irritating in- 
jections ; suppression of the discharge of piles; leucorrhea ; the use of violent medicines to force the 
menses, or to procure abortion ; sudden cooling of the 
17 


194 
CHRONIC INFLAMMATION OF THE UTERUS. 
extremities; cold bathing of the lower parts of the body; cold general baths and iced drinks, especially during menstruation; fatiguing walks; violent exercise on horseback, or in carriages without springs; excessive dancing; loss of sleep; wounds; heating and stimulating food; spirituous drinks; coffee; wine; and strong moral disturbances, which may suspend the flow of the menses, etc." 
There are other causes, particularly those monstrous attempts that are made to produce abortion by medianical means; violent and ill-conducted labour; the retention of portions of the after-birth; cold injections after confinement, and injudicious and stimulating drinks, given by conceited and ignorant nurses, to increase the discharge, which they conceive to be too small in amount. 
This serious disease is also contagious at certain times, and under certain circumstances, connected with atmospheric causes, that we do not understand. It is often called child-bed fever. Its symptoms, even in the earliest stage, are so decisive, that no female in any rank of life will fail to summon immediate aid; and upon the skill and vigour with which that is rendered, will most assuredly depend the preservation of her life. She can do nothing for herself, but must rely exclusively upon the efforts of her physician. 
Chronic, or slow inflammation of the uterus, 


195 
CHRONIC INFLAMMATION OF THE UTERUS. 
may either follow the acute affection just mentioned, or it may originate from other causes, connected with the patient's mode of life. All those enumerated in chapters seventh and twelfth, as connected with suppression of menstruation at puberty, and chlorosis, are equally active in producing this disease. The reader is requested to refer to them, as it is unnecessary to to repeat them here. 
There are a great variety of distinctions made by medical authors, in the affections of different parts of the uterus; these are all useful in a medical point of view, but of no interest to the patient. Although there is no difficulty in recognizing this affection, when we are permitted to make the necessary investigations, we are often obliged to infer its existence, from the evident alterations in the moral nature of the patient. It would seem, from the universal testimony of physicians, as well as our own observation, that we may often justly suspect the existence of this slow inflammation of the uterus, from the fretful and capricious disposition of females who have previously been of an equable and happy temperament. 
It was said by the ancient physicians, that "the uterus was an animal within an animal," so well were they convinced of its surprising power over the affections and sentiments. Nor does it seem at all inconsistent with the perfect harmony of nature's laws that 


196 
CHRONIC INFLAMMATION OF THE UTERUS. 
it should be so. When we reflect on the inconceivable wonders of its functions—that within its cavity nature, with her plastic hand, gives the first evidence of her power to attach an immortal spirit to those very elements of which the meanest insect, or even a blade of grass, is also formed—we may with great propriety demand, why the whole organism should not respond to its slightest affection. In the chapter on " marks, etc.," we shall present the strongest evidence of the possession of such reciprocal powers, by the uterus, and the system of which it forms so wonderful a part. 
All these enlargements, it will be remembered, are accompanied, from the increased weight of the organ, with more or less prolapsus; and must therefore demand, on the part of the patient, the use of the same precautionary measures, and present to the physician the same requisitions for cure, as that disease. As the functions of the bladder and rectum may also be obstructed, the female is to yield implicit obedience to her physician, in assuming the horizontal position. To this rule there can be no exception, as all attempts to cure the disease without enforcing it, would be quite absurd. The prolapsus of the enlarged uterus would, moreover, if the patient remained on her feet, by its contact with the bladder and rectum, greatly increase its own inflammatory state, as well as the derangement of their functions. 


197 
CHRONIC INFLAMMATION OF THE UTERUS. 
There are additional reasons, from its increased weight, why the uterus, when enlarged, should also become retro-verted. We have again and again found this to be the fact, in cases that had been very judiciously treated in all other respects—as prolapsus and enlargement alone—the retro-version having occurred after the original affections had been properly ascertained, and the patient being impatient, and unwilling to submit to any further investigation at the time. In a case of this kind, to which we were recently summoned, very considerable effort was necessary to effect a re-position of the retro-verted organ, which had for months hindered, in a great degree, the discharges, and prevented the administration of injections. 
There cannot be a question, that this serious evil is the unsuspected cause of hundreds of cases nate derangement of the bowels. So very insidious in their approaches are most of these slow and inflammatory affections of the uterus, that they are doubtless also often the cause of numbers of cases of, so called, "nervous affections;" a state of things characterized by great irregularity of feeling, loss of appetite, sleeplessness, sudden startings, etc., etc. This, of course, has a cause, and it may almost invariably be found in some uterine derangement, more or less serious in character. 
We well remember the particular case of a young 
17" 


198 
CHRONIC INFLAMMATION OF THE UTERUS. 
lady, who had long borne the reputation of an exceedingly "nervous" and troublesome person, and la boured under great enlargement of the uterus. This was only cured by the assiduous application of means, submitted to with the most amiable endurance, when she was satisfied her distressing situation was properly understood. What rendered this case still more interesting was the fact, that the disease was induced by suppression of the menses, from grief at the loss of a sister, to whom she was tenderly attached. 
Several conditions of the uterus, in which it is more or less enlarged and condensed in its tissue, have received different appellations from medical men. We shall not attempt their definition here; but wish the reader to understand, notwithstanding their occasional termination in cancer, that the vast majority of them, particularly if occurring before the change of life, when subjected to proper treatment, admit of permanent cure. 
We cannot, with equal propriety, omit the description of the symptoms of chronic, or slow inflammation of the uterus; because, unlike the acute, the female may for months be labouring under the disease, without a suspicion of its existence ; and it is, of course, constantly.becoming more difficult to cure. 
In addition to all the symptoms of prolapsus and enlargement, this state is characterized by deep-seated 


CHRONIC INFLAMMATION OF THE UTERUS. 
199 
pain in the lowest region of the abdomen, much increased by standing, or unusual exertion. There may be a tolerably regular appearance of the menses, for some time, and then an almost complete disappearance. After a few weeks, and probably at an unexpected period, there will be a violent flow, of many days' duration ; producing great exhaustion, leaden colour of the complexion, and extreme emaciation. Between the intervals of menstruation, there may occur various other discharges, of an unhealthy appearance. Hysterical symptoms always accompany this state, and sympathetic enlargement of the breast often occurs. There is great loss of appetite, and often vomiting. 
It is to be remembered, however, that these symptoms may also indicate other serious affections, of an obscure character, and comparatively rare occurrence; so that we are not to take them as positive evidence of the existence of slow inflammation, without the necessary manual investigation. No female, who has the good sense to distinguish delicacy of deportment, and sympathy for her affliction, will fail to submit at once to a step so necessary for her proper treatment:—we need not say, that the utmost propriety is observed by every gentleman who is obliged to resort to such a measure. 
The necessity of the physician's comprehension, by every possible means, of the patient's actual state, is 


200 
CHRONIC INFLAMMATION OF THE UTERUS. 
illustrated by the great errors often committed by those who do not, in extreme cases, insist upon a proper investigation. An instance occurred in the practice of Dr. Cyrus Weeks, of this city, in which a person nearly lost her life, by* the erroneous prescriptions of another physician, for excessive menstruation. That state, (as it always is in such cases,) proved only a symptom of an enormous polypus, or tumor, growing by a narrow neck to the inside of the uterus. Dr. Weeks discovered the polypus, and requested us to remove it; this was done without difficulty, by means of an instrument invented and described by ourselves, in a late number of the Boston Medical and Surgical Journal. A similar case was discovered by Dr. J. P. Stryker, of Newtown, L. I. This also we effectually removed, by instrument. Both patients en. tirely recovered. 
No doubt whatever exists on our mind, that these very cases of polypi are often mistaken for uterine enlargements; and the patients are worn out, and die with loss of blood, when their cases are perfectly remediable, were their true nature known. 
A considerable variety of ulcerations may attack the neck of the uterus; some originating in the misfortunes, and some in the vices of those who are afflicted with them. They are almost all curable by correct treatment, and require only to have their actual 


CANCER OF THE UTERUS. 
201 
character understood by the surgeon, to admit of relief. Many of them, particularly those of a scrofulous order, present alarming symptoms, and are often pronounced cancerous in their nature, from too superficial an investigation of their character. 
In such cases, mechanical ingenuity has suggested other means of examination, which are calculated to remove all doubt of their true nature. It gratifies us much to state, that our own efforts to modify and improve the valuable means of investigating diseases of the uterus, proposed by the French surgeons, has met with the approbation of the profession. (See an extract from the Boston Medical and Surgical Journal, descriptive of our uterine speculum, with a plate, in our work on Diseases of the Sexual System.) 
This method should always be adopted, when the ordinary and simpler one of manual investigation fails to resolve the doubts of the surgeon, respecting the actual nature of the affection; for it is impossible he can treat with any confidence a disease whose nature he does not fully understand. 
Cancer of the Uterus. We have insisted with the more earnestness upon a thorough investigation of these obstinate forms of disease, because they are evidently closely connected with a state of the uterus which, when once completely developed, is absolutely incurable. Whatever may be said, either by inexpe- 


202 
CANCER OF THE UTERUS. 
rienced or designing persons, to the contrary, we are satisfied, from the melancholy observation of a great number of cases, that this terrible disease, when it has arrived to such an extent as to merit the term cancer, will end in the death of the patient. 
Those who flatter themselves they have succeeded in curing it, have either been deceived by the amend, ment of some ulcer, having a cancerous appearance, (and there are a number of such,) or they have dissi. pated a state of inflammation and hardening, that may have been advancing to the formation of cancer. 
This brings us to the theory of its origin; and here, like many other subjects of professional interest, it would be gratifying if we could give a positive opinion. Some suppose the disease to be hereditary; and they are not without facts to support their opinion. We have ourselves known several instances in the same family, the relationship being more or less distant. Yet there are, in the majority of cases, no such circumstances to induce the belief in its hereditary nature. 
The disease often occurs in families where no other cases can be recollected; and although it appears occasionally at an earlier period of life, it is very apt to show itself shortly after the natural disappearance of the menses, or in cases of difficult and scanty appearance of that evacuation, and likewise after the 


203 
CANCER OF THE UTERUS. 
existence of the slow inflammation of the uterus. All this is well calculated to support an idea, which, if we may so speak, is the safest that can be entertained— viz. that it is one of the consequences of long-continued inflammation. 
This opinion is held by many distinguished members of the profession; and as our opportunities have unfortunately been frequent, of tracing this sad affection through all its stages, both in the female breast and the uterus; and as we sincerely think their opinions correct, we also shall speak of it in that light. 
Our observations will be brief; because it affords us no satisfaction, nor can it be of any service to the reader, to enter into minute details of a malady for which we believe there is no cure. The precautionary hints we have given in the preceding part of this chapter, and our avowed conviction that its incurable state is preceded, in very many instances, by the process of chronic or slow inflammation, which is curable ; will, it is hoped, direct attention to the adoption of treatment calculated to prevent its development. 
There are several forms of cancer, equally destructive and incurable; but as one is far more frequent than all the others together, and observes in its progress the most uniform symptoms, we shall confine our observations to that. ' 
Cancer of the uterus may attack any part of the 


204 
CANCER OF THE UTERUS. 
organ, but it usually selects the neck, or lower part; we believe, from the fact of that being the most liable to inflammation. The period of life at which it is most likely to occur, is at the cessation of the menses, or between the fortieth and fiftieth years. The follow, ing table is taken from the works of two distinguished French writers. Out of 409 cases of cancer, * 
12 occurred under 20 years of age, 83 " from 20 to 30 102 " from 30 to 40 201 " from 40 to 50 7 " from 50 to 60 4 " from 60 to 70 409 
By this table, which agrees with our own observations on the disease, as it appears in our countrywomen, it appears that the liability to uterine cancer increases, as the female reaches the time the uterus is most likely to suffer from congestion and slow inflammation. 
Married women are infinitely more liable to the disease than those who are single j indeed, not more than fifteen cases in a hundred of cancer, occur in those who are unmarried. It has been supposed that it is communicable by innoculation, or by the discharge being applied from one person to another:—but this is not correct; if it were so, there could not, from obvious reasons, remain a doubt upon the subject. 
It is a singular fact, that a person may bear children, when cancer is only waiting for the birth of the 


205 
CANCER OP THE UTERUS. 
child to declare itself. We have had this occur in our own practice, as well as under our observation in that of our friends. It may be progressing for years to its development, and then appear very suddenly, without any other premonition than the increased discharge of what appears to be ordinary leucorrhea. Usually, there is slight pain in the lower part of the abdomen, accompanied with a peculiar sense of uneasiness, and a " tingling" sensation in the front of the thighs. Lever remarks: " Generally there is some slight irritability of the bladder, and frequently the irritation about the rectum is of such a nature, as to cause the patient to suspect she has the piles. 
"The menses are generally regular in their appearance, although, occasionally, their order may be disturbed. Leucorrhea is by no means constant in the intervals. The appetite remains good; digestion is well performed; and the patient makes no complaint of want of sleep, until the disease has lasted for some time. The pulse is generally regular, and of full volume; and it is not until the disease has existed for a considerable period, that the appetite becomes impaired, and the sleep disturbed; the flesh becomes flabby, and wastes; and the countenance becomes pallid, and indicative of serious organic mischief." 
Such is the melancholy progress of this disease. 
18 


206 
CANCER OT THE UTERUS. 
We do not intend to give the final symptoms, but merely to state, on the authority of Lever and our own observation, that it may last from three to twenty months, with pain of more or less violence, and increasing and offensive discharges, till death closes the scene, and rids the patient of a life she rarely wishes prolonged. We offer no apology for thus abruptly terminating a subject, that would be, by its continuance, equally useless to the patient, and disagreeable to ourselves. 
We can say with sincerity, we have never cured a case of cancer that could, with any propriety, be so called; and although we believe that judicious treatment has for a long time kept the patient alive, we again urge our reader to prevent the necessity of her conscientious physician assuring her there is no hope, by attending to the earliest indications of the " slow inflammation of the uterus." But more especially let her regard with suspicion, increased pain and difficulty in menstruation; and, after the change of life, any return of the menses, or leucorrheal discharge; for these are often symptoms of cancer. 


CHAPTER EIGHTEENTH. 
DISEASES OF THE OVARIA. 
As the reader is supposed to be sufficiently acquaint, ed, through chapter third, of the nature and functions of the ovaria, and that their office is not less important than that of the uterus itself, the question will doubtless occur, are not their more serious diseases equally so ? To this we answer, that they are. Next to cancer of the uterus and breast, the ovaria are most frequently affected with that disease. It is likewise often the seat of dropsy, and other enlargements, which render it an object of interest only secondary to the uterus itself. 
It is, alas! too true, that their diseases are very intractable; but that is no reason why we should not endeavour to impart a general idea of their nature. We are painfully aware, that our book will be sought by many who will derive little consolation from its disclosures; yet we have no right to pass over, unnoticed, so prominent an object of interest. 
It is with these important organs, however, very much as with the uterus; —that diseases most hopeless 


208 
DISEASES OF THE OVARIA. 
when fully developed, often admit of essential aid, and often of cure, in their forming stage. 
Indeed, when the reader again turns tp those chap, ters which treat on menstruation, she will find abundant reason to conclude, that the active functions of these organs at each menstrual period, and their necessary congestion with blood, in order that they may separate from its bed and pass an ovum into the uterus, is likely to render them as liable in later life to more serious diseases, as they are in her earlier years to temporary derangements. 
It is, therefore, with the view of giving such precautionary directions as may avail her in avoiding an incurable disease, or for prolonging her existence should it have reached that state, that we design to explain three of the most prominent affections of the ovaria ; viz. the fleshy tumor, cancer, and dropsy. 
The situation of these bodies on each side of the uterus, and their connexion with it by means of the two tubes through which the ovum passes into it, will serve to explain the difficulty in distinguishing, in every instance, whether the disease is in the ovarium, (for they rarely affect more than one of these bodies at once,) or the uterus. It will likewise give a proper idea of their position. In a healthy state, they are situated very low down in each groin, or even below the groin, within the pelvis. Their communicating 


209 
DISEASES OP THE OVARIA. 
tubes pass through two fan-like membranes, which serve to steady the uterus, like the two wings of a bird; and when the diseased ovarium enlarges, it rises considerably above the groins, and causes quite a prominence on that side of the abdomen where the one affected is situated. 
Through the tubes, in like manner with the ovum, matter, when it forms within the ovarium, may pass into the uterus, and thus escape from the body; but it oftener happens, that the same inflammation that produces the matter, closes the tube, and allowing it to accumulate, it enlarges the ovarium, produces fever, and brings the patient under surgical supervision. 
For the same reason we took no notice of acute inflammation of the uterus, we pass over the same affection of the ovaria; both are so decisive in their attacks, as to induce the patient immediately to apply to the physician. It is not our design to instruct him, although we can assure the patient, that upon the decision and judgment with which she is treated, may depend her immunity from severe subsequent evils. Most of the cases of incurable ovarian disease, doubtless have their origin from the same cause as in the uterus—viz. from neglected inflammation. This may pass, by neglect, into the slow, or " chronic" stage, or it may assume that form from the beginning. 
This state of disease originates in too great an 
18" 


210 
DISEASES OF THE OVARIA. 
afflux of blood to the ovaria and uterus during the menstrual period. It is the congestive state, consequent upon its too slow circulation through the bloodvessels of the ovaria and uterus. Both these organs act in concert, in the production of the menstrual discharge; and it is therefore a reasonable conclusion, that their derangements are most probably also connected, and act reciprocally in the production of chronic inflammation. 
The same precautionary measures as it relates to diet, and the general management of exercise, clothing, and the passions, that we have urged upon the reader in excessive menstruation, equally apply to this disease. The intelligent physician, when his advice is desired, will always draw the proper line of distinction between those cases which require reduction of the diet, and those in which the nutrition should be increased. It is impossible for the patient to make a correct estimate of this important point, and almost equally so for her to understand its great necessity. It is to be hoped that the functions of the ovaria, and the surprising rapidity with which their circulation is influenced by dietetic and mental causes of excitement and depression, are correctly appreciated by her, from the knowledge she now has of this subject, and their great importance in producing healthful menstruation. Very certain it is, that nature has 


FLESHY TUMORS OF THE OVARIA. 
211 
chosen to make the ovaria the seat of the first evidence we have of the new being; and to secure its independent existence, by connecting these organs with desires which so absolutely control its future fate. Every thing that we have said on the proper government of the passions, so as to ensure their utmost quiet, should be strictly attended to by the reader. The period of childhood is now supposed to be passed, and we are addressing the adult woman. We are unwilling to believe, that she who wishes to profit by our effort, cannot understand, from what has already been written, our full meaning, and determine to live like a being worthy to become the mother of happy and healthy children. 
Fleshy tumors of the ovaria are far from infrequent amongst our countrywomen. They doubtless originate from inflammation, but are comparatively of very slow progress. We mention them, because we should be sorry if any of our readers, who are so unfortunate as to be thus afflicted, should confound them with cancer, or dropsy; for they are by no means as certainly fatal as the former, nor do they generally attain the bulk of the latter. Both married and single persons are liable to them. 
They are of a fleshy character, or fibrous, and for the most part solid. The uterus is occasionally affected with similar tumors, and we have known them to 


212 
FLESHY TUMORS OF THE OVARIA. 
grow from both these organs at the same time. Very rarely they attain a great size, and have even been known of the enormous weight of one hundred pounds. One of this size was removed from the dead body of a patient of our preceptor's, Dr. Valentine Mott. She enjoyed good health till the day of her death, and died suddenly, from interruption of the respiration, caused by the pressure of the tumor upon the lungs. We ourselves have removed one from the body of a female who died of another complaint, under the care of Dr. John W. Francis, of this city, also our valued friend and preceptor, that was supposed to weigh over forty pounds. They resist every method of treatment, are productive of no pain, and may be known by this symptom from cancer, which is also hard. Both, by their hardness, may be distinguished from dropsy, which is soft and fluctuating. 
We have another motive for introducing a description of this disease, which it is our duty to explain, as we can offer no encouragement of cure, and no certain precautionary measures for the prevention of it. From time to time their removal, as well as that of dropsical ovaria, has been attempted by surgeons of talent and character; and it has been done with sue cess. Still, when we consider the great extent of the necessary incision, and the number of cases that have died under the operation, we cannot forbear urging 


CANCER Of THE OVARIA. 
213 
every one thus afflicted, who shall peruse this, to submit to no such treatment. Her chance for life will be far better, to bear it patiently, under proper medical advice. This, although it will not diminish its size, may prevent its increase, and often allow the patient to attain the allotted period of life, under comfortable circumstances. 
There are a number of other varieties of tumors and ulcers of this organ, more or less serious in character; yet we shall confine our further observations to cancer and dropsy, for they are by far the most frequent. 
Cancer of the Ovarium. Whatever may be the cause, it is very certain that this disease is of much slower development, and attains a far greater size, than that of the uterus. It has often been known to occupy years in maturing, and it may be associated, particularly in its latter stages, with uterine cancer j indeed, if it last long enough, it is scarcely possible it should not affect the uterus, in consequence of its connexion with it by the ovarian tube. It sometimes attacks single persons, though it is much more common in those who are married. 
It is quite as frequent as cancer of the breast, and only less so than that of the uterus. As this disease usually attacks but one of the ovaria, the function of menstruation is rarely affected at its commencement. 


214 
CANCER OF THE OVARIA. 
The tumor is of an irregular surface, and quite hard. Acute pain, of a stinging or lancinating character, attends its latter stages; but this, as an earlier symp. torn, is very obscure. 
It is evident, not only from the irregularity of this symptom, but the great difference of time which different cases require to attain their full development in similar constitutions, that there are in this disease essential variations in the characters even of the same general affection. 
The other symptoms, and general progress of the disease in its eonstitutional effects, are so similar to cancer of the uterus, that we need not pursue the subject any further. It probably originates, as in the uterus, from the slow inflammation. There is a proper course of treatment for palliating its symptoms and checking its advancement, of which, as it is exclusively medical in character, a description could in no way benefit the patient. Though the disease cannot be cured, there is no doubt life may be greatly prolonged by judicious treatment. Our cautions, respecting cutting operations, apply equally in this place: they can do no possible good. 
It is proper to mention here, that cancer may attack other parts of the pelvic viscera, as the rectum, the outlet of the bladder or urethra, and the passage leading to the uterus. Wherever it is so situated 


215 
DROPSY OF THE OVARIA* 
that it can be seen, we have of course better evidence of its early existence, and greater facilities for applying palliating remedies; but it is a source of deep regret, that we can do so little for its cure in those parts of the body, where we cannot freely apply the knife for its speedy and complete removal. 
When we oome to the subject of cancer of the breast, we shall endeavour to expose the cruelty and roguery of those ignorant pretenders, who attempt to cure such diseases by the application of violent caustics and internal nostrums. 
Dropsy of the Ovaria is of still more common occurrence than cancer. It occurs both in the single and married state, but is more frequent in the latter. Although it has been known to attack young females who have not menstruated, and women past the change of life, it is far more frequently found when the ovaria are in the full performance of their functions, or from the twentieth to the fortieth year. 
It consists of one or more sacks filled with fluid, from the consistence of water to that of tar. These are developed within the ovarium. Almost invariably in the commencement of the disease, they exist on one side only; but in its advanced state, are often found to affect both. They gradually enlarge, from the very smallest imaginable beginning, until, in the course of years, they fill the whole abdomen, pre- 


216 
DROPSY OF THE OVARIA. 
senting the uniformly-diffused appearance of common dropsy. This, instead of commencing in small sacks of its own, and on one side only, as the ovarian dropsy does, always consists of water, as it is called by nonprofessional persons, thrown out from the myriads of minute blood-vessels, that supply the great membrane which lines the whole abdomen and contains the intestines. 
This great sack, is already prepared by nature, — those which contain the fluid of ovarian dropsy, have to be produced as they are distended by their contents. These, of whatever colour or consistence they may be, are produced also from the blood-vessels lining the sack. Strange, indeed, that nature should create disease with as much care and assiduity as she forms the most useful parts of our bodies:—but so it is. 
These sacks, as they increase in size, by pressure upon each other, (for they lie in contact,) often unite into one principal one, having openings between its smaller original divisions. This combination of sacks sometimes becomes enormously large. They contain no definite quantity,—from a few pints of fluid, to fifty, or even one hundred, have been known. We have seen them containing forty, at least. In cases of very large collections of water, both ovaria are apt to be affected. 
Dropsy is frequently oombined with a cancerous 


217 
DROPSY OF THE OVARIA. 
state of the sack, and has, from this cause, been considered by some to be always a consequence of cancer; that is to say, the sack is supposed to be produced first, and the fluid to form within it. But there have been cases of ovarian dropsy, which have either burst and disappeared naturally, or been tapped with a similar result, and thus been entirely cured; so that it is impossible that such a complication is in. variable, because cancer never disappears. Our own impression is the same here, as in regard to most organic uterine diseases; viz. that cancer, as well as dropsy, is the consequence of slow inflammation. In this we are sustained by many distinguished physicians. 
The symptoms of this disease, at its commencement, are very obscure. It is frequently supposed, in the married state, to be pregnancy; from the fact, that it is often accompanied with those caprices, and the sickness, with the enlargement of the breasts and abdomen, that attend that state. This illusion is dispelled by its continuance beyond the natural time of gestation, and the attendant deep-seated pain on the side where it commenced. Should one only of the ovaria be affected, and the disease progress very slowly, the woman may even bear children in such a state, so little does it affect the constitution. 
A very extraordinary case of that kind occurred in 
19 


218 
DROPSY OF THE OVARIA. 
our own practice, in the person of a French lady, of this city. She was visited, in connexion with us. by Dr. John. W. Francis and Dr. Berger; and her case is detailed in one of the numbers of the Boston Medi. cal and Surgical Journal. We are thus particular in giving the requisite proof, because it would otherwise be esteemed incredible. It is mentioned, in order that no one may despair, in so apparently hopeless a situation. The circumstances are briefly these: 
Nine years previous to the date of our attendance, the lady was confined at Paris, of a healthy child; though at that time she was the subject of ovarian dropsy. We were called to attend her for prolapsus of the uterus; but observed that this was the consequence (as it often is) of a considerable collection of fluid, in three different sacks, on the left side of the abdomen, commencing, as she assured us, in the region of the ovarium of that side. 
These sacks evidently were in a state of slow inflammation, for they had effected a communication with the passage leading to the uterus, and discharged a great deal of matter. The treatment was, of course, only palliative, as a cure was out of the question. Nevertheless, so great amendment followed, that one year afterwards, we were called to attend her in confinement ; and both mother and child are now living, though it is seven years since the birth of the last 


219 
DROPSY OF THE OVARIA. 
child. We state this case, solely to prove the great extent of the natural powers; for we are quite conscious our efforts were of very little consequence, as the sacks are still distended with their contents, after a period of at least sixteen years' continuance. 
It is evident from this case, that when one ovarium only is affected, there may, as in cancer, be no interruption of menstruation. When both are affected, this, of course, cannot be the case. The uterus is liable to every variety of displacement; and there may also be great constipation, from pressure on the bowels, and inability to retain the water, from pressure of the dropsical sack on the bladder. We leave these, and all its other complications, for medical sagacity to distinguish, as they are subjects unsuited to these pages. After increasing for many years, the sack has been known to burst, and the water, being effused into the abdomen, has been absorbed by its healthy surface, and the patient completely recovered. Such a case occurred in the practice of our friend, Dr. J. Young, of Kingston, in Ulster Co., N. Y. The woman fell down stairs, and burst the sack. It has also been tapped and drawn off, with similar fortunate results. Various other means have been resorted to by surgeons, that have occasionally proved successful; but we regret to say, that this disease is also exceedingly intractable, and often resists every effort of the 


220 
DROPSY OF THE OVARIA. 
surgeon. The same remarks, with regard to a surgi. cal operation for removing the sack, apply here, as in the other diseases of the ovarium—they should never be attempted. Tapping, though only a palliative remedy, may, and ought to be resorted to in extreme cases, threatening suffocation, to preserve life. We have been compelled to resort to this remedy in several cases, and once only, succeeded in effecting a cure by this means. 


CHAPTER NINETEENTH. 
CANCER, AND OTHER DISEASES OF THE BREAST 
It is indeed a sad reflection, that woman, from the performance of duties most endearing to hex offspring, should become the frequent victim of the most intractable diseases that afflict her sex. Cancer of the breast, although it occasionally originates in males, and unmarried females, is far more frequent amongst those who are nursing, or have nursed, one or more children. 
That it is connected, in some manner, with the great afflux of blood to the breasts, necessary for the secretion of milk, there cannot be a reasonable doubt; from the fact, that a vast proportion of the cases occur in nursing mothers. It is most likely to show itself between the thirtieth and forty-fifth years; the cases increasing in frequency as the female approaches the cessation of the menstruating period. This also adds strength to the impressions of many surgeons, that this terrible disease, like cancer of the uterus and ovaria, is developed through the slow or chronic inflammation, occurring in the breast, as in those organs. The fact of all three of them being centres, towards which the 
19* 


222 
CANCER OF THE BREAST. 
blood flows more freely than to other parts of the body —because they exercise functions requiring an un. common supply of that fluid, and are liable to have their circulation excited by a great variety of causes, mechanical, moral, and chemical—seems to be con. nected with the operation of similar causes, in all of them. 
However this may be, inasmuch as we cannot ascertain what cancer is, either by analyzing it by the art of the chemist, or examining it by the microscope; and are obliged most painfully to confess its incurable nature, by any other than the most decisive surgical means, it will be more useful to the reader, after describing its character, to investigate the circumstances under which it most frequently appears. Then, if her judgment be convinced of its necessity, she will be most willing to avoid the disease, by shunning its causes. First, however, let us remark, that cancer is supposed by some to be a hereditary disease, or one existing in the blood of certain families, and liable to show itself without any cause that can be avoided, or determined, with any certainty, as the actual exciting one. To this there are so many exceptions, (cases often occurring in families where no recollection exists of any such disease ever having been known,) that there are more reasons against, than in favour of such an impression. 


223 
CANCER OF THE BREAST. 
The first appearance of cancer is generally that of a small tumor, the size of a cranberry, situated deep in the substance of the breast. This, if taken hold of, and handled freely between the thumb and two fingers, will be found perfectly moveable with the substance or mass of the breast, and more or less hard. If not removed, and it really be a cancer, it gradually becomes immoveable, from attachment to the parts beneath it, larger, harder, and more or less painful. All these characteristics increase, with greater or less rapidity, until the skin becomes congested, and attached to the tumor, and alters in its hue, growing redder and more tense; the tumor then attaches itself to the body, and becomes immoveable; increases in size, either on one side, elevating that part of the breast into an irregular surface, or it surrounds the nipple, and gradually raising the skin all around that point, swallows it up, as it were, in itself. The pain becomes of a cutting, or lancinating kind, and it gradually opens, and discharges a thin and unhealthy sort of bloody matter. When the disease has proceeded to this extent, its further progress, with affection of the general health, is rapid. 
There are several varieties of cancer recognized by surgeons;—amongst others, one in which the whole breast suddenly enlarges, and in all other respects, except in its mobility, proceeds in the manner just 


224 
CANCER OF THE BREAST. 
stated. All of these are far less frequent in number. The manner above described is that of the most common occurrence of tumors that are really cancerous. We shall therefore pursue the symptoms no further, but proceed with a review of the natural functions of the breast; —its structure, the formation of milk ab. cesses, and the circumstances under which cancer is most frequently observed. This is the more neces. sary, as we entertain the same views with regard to the manner in which it originates, that we have ex. pressed .of cancer of the uterus, and other parts of the body; that is, that it proceeds from the slow inflammatory process, originating from interruption of the proper functions, and gradually altering and hardening the natural tissues, until they cease to be (if we may so express ourselves) a living part of the body. 
The popular idea, that cancer exists in the blood, is exceptionable; for if it were so, why should it not always originate in various parts of the body, of similar structure, at the same time ? This is certainly a conclusive argument against that hypothesis. If it be not in the blood, and not, like some diseases—such as itch, vaccination, and some other affections—communicable from another person, or by actual inoculation, it must be produced by some alteration in the natural action of the part where it appears. This is most reconcileable to reason; and thus, for all practical 


225 
CANCER OF THE BREAST. 
purposes, it may with great propriety be viewed. As we said of uterine cancer, it is the safest opinion; for it will cause females to pay more attention to the instructions of their physicians, and the light they may acquire from other sources, in allowing these important and delicate organs to expand in the direction nature designed them to do; without crippling their growth, or compressing their structure, by the modern barbarisms of fashionable dress, and the application of an infinite variety of stimulating substances after confinement, for all sorts of purposes, from the hands of an ignorant and superstitious nurse, or any foolish person, having more presumption and credulity than knowledge. 
We have had occasion to direct the attention of our readers, when speaking of congestion of the uterus, and menstrual delays and obstructions, to the remarkable sympathy or concert between the uterus and breasts, —that quality, we mean, by which one is affected, when the other is either labouring under disease, or performing its natural offices. *The uterus is usually the first to originate these sympathies ; for it is the first whose functions require to be exercised. Nevertheless it will be remembered, that both these organs are fully developed at the same period of life, or at the age of puberty, when menstruation is established, and both cease to exert their 


226 
CANCER OF THE BREAST. 
powers when it ceases. The connexion between the cessation of the secretion of the menstrual blood by the uterus, and the production of milk by the breasts, with the development of congestion and cancer, is thus explained. These discharges, to which the system has become accustomed, having ceased, the excess of blood must vent itself somewhere; and it will be found, as we have said before, to attack those organs which have been most frequently subject to the slow inflammation. We believe that very important practical hints, in avoiding diseases of the breast, may be drawn from the possession of this knowledge, as we have shown in the chapter on the cessation of menstruation. 
The capacity to perform its intended duties may be known, by the expansion of the breast to its full size, with the attendant sensation of fullness and the projection of the nipple, and occasional slight pains. All this is produced, in a certain degree, when menstruation is established; increases very much as gestatio# advances, and ends in the secretion of milk when the child is born. It is all caused, as the reader has doubtless anticipated, by the increased flow of blood to the part, precisely as in the utorus, when that organ is called upon to fulfil its own duties. 
This blood is brought to the part for the purpose of supplying a number of glands, deeply situated in the 


CANCER OF THE BREAST. 
227 
substance of the breast, that surround the roots of the nipple, and send their conducting tubes from these glands to that outlet. The office of a gland is to produce from the blood whatever is required of it by nature; whether saliva, bile, hairs, nails, or milk. These glands of the breast are all closely connected, forming indeed one large gland, composed of several smaller parts. In all serious affections, most of them are almost certain to be involved. They are all connected by means of that loose tissue we spoke of as uniting the various organs in the pelvis. It pervades indeed the whole of the body, and allows the various parts to expand, when enlarged with inflammation, and to perform the necessary movements when in health. This tissue also is liable, as the reader knows, to the formation of abcesses, or collections of matter within its own substance, as we showed when treating of fistula, near the rectum, where it abounds. 
When the nipple is not fully developed, (as is often the case in delicate females, or those where its growth has been checked by tight dress,) the ducts which convey the milk from the glands, where it is produced, may become obstructed, because there is not room enough in the nipple for the passage to its point or outlet; or the gland itself may become, as it were, clogged with the milk, and thus in either case inflam- 


228 
CANCER OP THE BREAST. 
mation may occur. When once fully established, it will almost invariably go on, till matter is formed either in one or more of the glands, and often in the connecting tissue; when it will either force an outlet for itself, with great pain to the patient, or, what is far less painful, one may be made by opening the abcess. This at once relieves by permitting the matter to escape, and the attending distension to cease. 
It will surely be acknowledged, that prevention is better than cure; and if we can make out with suffi. cient clearness, with this slight explanation of* the sympathies and structure of the breast, that most of its diseases, including cancer, are consequent upon obstructions to the performance of its natural and proper functions, we shall succeed in conveying an impression we have always entertained, and acted upon in our instructions, whenever our intimacy and friendship was sufficient to gain the entire confidence of our patient. 
That there are grievous errors in the adaptation of the female dress to the actual requirements of the body, we take it for granted no thoughtful person will deny. We have had occasion to speak of obstruction to the circulation of the blood, produced by the various displacements of the uterus, and to point out the agency of tight dress in effecting these serious annoyances. 


229 
CANCER OF THE BREAST. 
Nature has endeavoured to secure the utmost freedom for the expansion of every organ in the human body, by forming all those that admit of much distensio —such as the stomach, uterus, intestines, etc. —not only of a yielding tissue, but even enclosing them within a moveable envelope, composed of skin, broad flat muscles, and membranes, that, in a state of health, not only gives a comfortable support, but admits of considerable expansion, to accommodate their different degrees of distension by their contents. Were this not the case, we need not reflect long, to perceive the utter impossibility of these organs fulfilling their natural duties. They would not only be incapable of yielding to each other, but if contained within a cavity admitting of no enlargement, (the uterus, for instance, when distended with its contents,) would allow little or no room for the reception of food into the stomach, and thus that organ would be prevented from nourishing the body, and become diseased. 
Before the uterus is called upon to perform its office, we have shown how much tight dress can do to cripple its energies, and congest its blood-vessels, producing menstrual obstructions and congestion, and disease of that organ. We have even thrown out the idea, that cancer may thus originate in it; —that is to say, from interruption of its discharges in early life, it may become more susceptible of inflammation and cancer, 
20 


230 
CANCER OF THE BREAST. 
after its principal function has ceased, and it no long© is the seat of the menstrual discharge. It is thought by many persons, that consumption itself is much indebted, for its extensive prevalence, to tight dress, and more especially to the corset. There cannot be a doubt, that it greatly aids in lowering that healthful tone of the system, so dependant upon a free passage of air through the lungs; and thus may assist in the development of the disease, whatever may be its original cause. 
But in its action on the female breast, this pressure is absolutely an immediate and certain cause of disease. We have repeatedly known cases in which there was, to our comprehension, no cause for the development of swellings and tumors, as probable as the pressure of an ill-made corset ; and we are certain that it is impossible, when corsets are worn at all, for the blood to pass through the breast with its proper and healthful impetus, so as to admit of the development of all its parts in an equal manner. First, the nipple is prevented acquiring its natural protrusion, and consequently its ducts or tubes cannot become pervious for the milk; then the glands are pressed together and condensed; thus, being prevented attaining their proper size, they cannot perform the duties of secreting the milk in all their parts. We sincerely think it more than probable, that in some portion of 


CANCER OF THE BREAST. 
231 
this condensed glandular substance, cancer itself originates, occasionally, from this negligence. 
It is certainly, to say the least, a singular fact, that cancer is almost unheard of in the male breast, although its internal structure is precisely similar to that of the female; and the latter, though rarely the subject of cancer when she has never nursed, is now and then found to be afflicted with it. On the male breast, because of its want of prominence, there is no pressure from the dress. It will easily be understood, that when the breast is called upon every eighteen months or two years to nourish a child, there must be increased liability to disease. If it does not develope itself before, it will be likely to do so when the body shall acquire general plethora, or fullness of blood, from the final cessation of the menstrual discharge. 
We have spoken in what we deem terms of wellmerited reproach, of those compounds so freely applied to the breast, by nurses and others, to cure inflammatory affections, and, as they express it, "to dry up the milk." Whenever it is desirable to effect this object, should it be judged proper to do it, it certainly would be far more likely to be attained in a safe manner, by the advice of an intelligent physician. We have witnessed much mischief and severe pain, from various nostrums, composed of essential oils, and other powerful and astringent applications, made at 


232 
CANCER OF THE BREAST. 
the suggestion of nurses and others, who seemed actuated solely by the desire of doing something—how reconcileable to reason, or the state of the breast, being with them an entirely unsuspected subject, or one to which no attention was due; their vaunted " experience" covering the whole ground, and intrenching them safely behind an impregnable breastwork of ignorance. No such applications will ever be permitted by the patient or surgeon, if they have either intelligence or self-respect. Not only their ingredients, but the violence with which they are applied, greatly increase the inflammation. The surgeon will prescribe from his general knowledge of the system, and the particular state of the disease. 
Either cold air or water, applied to the breast in the state of excitement following the recent secretion of milk, or when inflammation exists, from its " caking," as it is called by females, is very likely to cause serious difficulty, that may lay the foundation for a cancer. This state is what is often called, in the foolish and inexpressive nomenclature of nurses, "the weed." It usually originates on the fourth or fifth day after confinement, and may also appear at the weaning of the child, or at any other period of nursing, from causes calculated to light up inflammation. It is, of course, accompanied with more or less fever, which may advance, if the disease is not checked, to deliri- 


233 
DISEASES OF THE BREAST. 
um. It may attack both breasts, though it oftener exists in one. 
Nothing can be more important, in preventing or checking this disease, than an early application of the child to the breast; this should be done as soon as the fatigue of the labour is over. The breast and body must be kept warm, and if there is any difficulty in getting the child to draw, some person should immediately be sent for, who can perform that office, with gentleness and efficiency. There must not be a moment's delay; as soon as the breasts become distended, they must be drawn, or evil effects will follow. No application whatever can avail, in decreasing the distension or pain. It is produced by the milk; and if there be any difficulty, or much delay in its discharge, inflammation will follow. 
We protest, most earnestly, against the wilful stupidity of those who persist in stimulating the bloodvessels of the mother thus situated, with animal food, soups, and even liquors, and depriving her of a free supply of fresh air, by curtains, and other appliances. Very little drink of any kind should be given, for it greatly increases the distension of the breasts. AH domestic prescriptions will receive the positive interdiction of the physician who means to save his patient from a most distressing attack of suppuration, that will be sure to harden and disfigure the breasts, and ren- 
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234 
DISEASES OF THE BREAST. 
der them liable to future attacks, and possibly to can. cer. Many a woman has, by these means, had one, or even both of her breasts rendered useless, by the ravages of inflammation. 
When any injury, such as a blow, or violent pressure, has been received, it may prove an exciting cause of milk abcess. Malformation of the nipple may also, from obstruction of its ducts, ensure this state. This it may be impossible to overcome, by any means; and thus the physician may be blamed, for what is quite unavoidable. Every prudent mother will, by personal examination, prevent the pressure of her child's dress, and advise her, after marriage, to pay attention to the "drawing out" of the nipple. For this purpose, we have been accustomed to direct well, made grasses, so constructed as to distribute their pressure equally over the whole breast, while suitable holes are left for the nipples. These are to be retained over them, by a properly constructed bandage. The warmth of the body, by causing a vacuum in the glass, draws the nipple into the hole, and will, in a few months, make one, where before their application it was scarcely visible. 
Some women are greatly afflicted with tenderness of the nipple. This often produces extreme suffering, every time the child is put to the breast. Occasionally ulcers are produced from this cause, and nursing 


235 
DISEASES OF THE BREAST. 
becomes so painful, that it is avoided for so long an interval, that there is great danger of inflammation. There are various excellent applications for this. It is well to harden the nipple with a little brandy, with borax or alum dissolved in it, some time before confinement. There are other efficient remedies, which can jnly be used by the physician, from their peculiar nature. But a properly constructed nipple-shell, with a suitable mouth-piece, is the only immediate relief. Physicians in this city are now in the habit of using them, constructed upon a novel method, that ensures their effectual action. 
It is well known to all practical physicians, that violent mental emotions—grief, anger, etc.—have a surprising effect in deranging the secretion of milk. The nursing female should therefore use much caution in maintaining serenity of mind, and endeavour to avoid the company of those who are likely to disturb her equanimity. 
A variety of stimulating articles of food and drink —such as wine, porter, beer, highly spiced dishes, etc., etc.—are prescribed by many ignorant persons, indiscriminately, to all nursing mothers, who either have, or suppose they have, too little milk. This is likely to produce general excitement, that may end in inflammation of the breasts. We have witnessed great mischief from such abuses. 


236 
DISEASES OF THE BREAST. 
Women give milk in various quantities, and o* much difference in its powers of nutrition. It is cei tainly in this secretion, " quality, and not quantity,' that determines its value as nourishment. The use o\ wine and all other stimulating substances, demand) the nicest discrimination. They are used frequentlj by every practical physician, under appropriate circumstances, with great benefit; but a remedy of sucb decisive power, requires medical judgment in its application. Nutritious food—such as mutton and beef, or soup—-is the most powerful and natural means of sustaining the strength. The miserable drenches of tea and coffee, so freely used by our countrywomen, have much to do with their suffering and ill-temper while nursing, and cannot possibly afford nourishment for the child. 
Physicians recognize two other distinct diseases of the breast, having appropriate names in medical nomenclature —the one in which there is, from some cause connected with the constitution or the breast, too little milk, and the other, from like causes, too much. We cannot consider these peculiarities here, nor would it at all benefit the reader if we did, as we could not properly convey to her mind so complicated a subject. We allude to it, to show the necessity of pursuing some settled plan of treatment, to be adopted after proper medical advice. It often happens that 


237 
DANGER OP WEANING. 
women, after a first confinement, give an insufficient quantity, and even a poor quality of milk. This requires that the child should be fed, but not that the milk be, dried up. If injurious to the child, it may be drawn by a puppy. In subsequent births, this will probably be unnecessary,—the breast, if we may so say, will have become used to the secretion, and the constitution may be amended. 
Many women, either from indolence or pride, when they are perfectly able to nurse their offspring, with great benefit to themselves, are in the habit of placing them in the hands of a foster-mother. Without a word of reproach to those who commit a crime that brings with it its own condemnation, we would simply remark, that it is believed by most physicians of eminence, that drying up the milk when the female is in good health, is likely to lay the foundation of the most serious diseases. Cancer, consumption, apoplexy, and other severe afflictions, have all, it is supposed, with more than probability, been produced by this unnatural sin. 
But there are reasons, of a most painful nature, why the young and delicate mother should wean her child at an early period; when her affections will be severely tried by so necessary a measure. She may have a very uncommon supply of milk, and it may be attended with such debilitating results, as to produce 


238 
NECESSITY OF WEANING. 
symptoms of what is termed the "milk pthisis," or consumption. This disease is characterized by a short dry cough, and burning sensation in the throat, with deep-seated pain in the lungs, and an unnatural desire for food and drink. This state of things demands immediate weaning; or speedy consumption, and death, will follow. This should never be done without appropriate treatment, which can only be directed by the physician. 
We have thus endeavoured to trace, in connexion with the performance of the natural functions, and the interruption of them by various abuses, the origin of cancer. Whatever may be thought of the justness of our conclusions, it will, we think, be generally conceded that it is wise to avoid, as far as possible, the evils we have enumerated. That there are other diseases, such as mechanical injuries, scrofulous ulcerations, and some others originating in the misfortunes, as well as the vices of those afflicted, we are well aware; besides many tumors that may be confounded with true cancer. These our limits will not permit us to notice; nor could we consistently do so in a popular work. If we were not fortified with the highest professional opinions, as well as our own experience, with regard to the absolute incurability of cancer, and the propriety of removal, by a surgical operation, of most obstinate and doubtful tumors of the breast, we 


EARLY OPERATION PROPER. 
239 
would have deemed it cruel and improper to make the free disclosures we have done. Every humane and conscientious surgeon will deprecate this sad necessity, yet will necessarily coincide with the following opinion of our most distinguished surgical authority. It is extracted from the Surgical Dictionary of Samuel Cooper, of London. 
" When the breast is affected with schirrus, or ulcerated cancer, the imprudence of tampering with the disease cannot be too severely censured. Were the disorder unattended with a continual tendency to increase, some time might be properly dedicated to the trial of the internal remedies and external applications which have acquired any character for doing good in these unpromising cases. But, unfortunately, by endeavouring to cure the disease by medicine, we only afford time for it to increase in magnitude, and at length attain a condition in which even the knife cannot be employed to take away the whole of the diseased parts. When the case is marked by the characteristic features of schirrus, (the state of hardening that precedes the disease,) noticed in the article cancer, the sooner the tumor is cut out the better. 
"There are also some malignant kinds of sarcoma, (fleshy tumors,) to which the female breast is subject, which cannot be removed at too early a period after their nature is suspected, or known. Indeed, though 


240 
EARLY OPERATION PROPER. 
there is not equal urgency for the operation in many other tumors, yet, as the most of them are continually growing larger, and little success attends the attempt to disperse them, the practitioner should never devote much time to the trial of unavailing medicines and applications, and let the swelling attain a size which would require a formidable operation for its excision. It is also to be remembered, that many simple, fleshy, indolent tumors, are accompanied with a certain degree of hazard of changing into very malignant forms of disease." 
It will be observed, that the distinguished surgeon we have so freely quoted, attaches the greatest importance to the " early removal" of the suspected tumor. There is no doubt, that inattention to this important caution has been the cause of the fatality attending many of those cases in which the operation has finally been determined on. Such is the dread attached to a surgical operation, though frequently less painful than the agony endured from a single hour's continuance of the tumor, that the patient rarely submits to it, till it has progressed to such an extent as to render its removal quite useless. Often, when it is removed thus late, it has extended so far as to cause other tumors under the arm. There is a connexion between the breast and that part, and when it does attack it, after the tumor of the breast has been removed, it gives 


241 
CANCER PLASTERS. 
rise to the conclusion, that the disease must have been in the blood. If so, we again ask, why does it not attack other parts of the body at the same time ? 
The experience of most surgeons, as well as our own, goes to show, that when removed in its earliest stages, it is very often successful in preserving the patient from a lingering and terrible death. There are patients now living, upon whom we have operated fifteen years since; and they have since suckled children, even from the same breast, without the least sign of its re-appearance. 
It is a deplorable reflection, that human cupidity can be found of so base a character, as not to scruple to speculate upon the infirmities and lives of the unfortunate :—but so it is. We are constantly reminded of the weakness of our moral nature, by the facility with which the unfortunate are induced to use remedies boldly announced as capable of curing cancer, aided by the attestations of others, who corroborate their assertions, from ignorance of the disease. 
If the mind under suffering only retained its calmness, there could not be so much error on this subject. None of these empirics pretend that their remedies do not produce pain; they are all employed to " eat out the cancer." Several weeks' application is often necessary, according to their own account; and then, jhould the sore heal up, it is certainly evidence that 
21 


242 
CANCER PLASTERS. 
it could not have been a cancer; for, in the name of reason, how could the plaster evince such discerning powers, as to select the diseased parts, and leave the sound flesh. The surgeon uses the greatest care to include, in his rapid incision, every particle of the " hardness," well knowing if he does not, the disease must return. Arsenic, lead, and mercury, in some of their forms, are the bases of these plasters; and the inexpressible agony, as we have been told by those who have undergone their application, and, after all, been obliged, when too late, to submit to the operation, is far greater, each moment of their action, than the knife ; and this continues for days, and often weeks together. It is but a short time since the coroner was called to inspect the body of the unfortunate mother of a family in this city, who had been poisoned by the absorption of arsenic from a plaster, applied by one of these wretched traffickers in human life. We were called to see another, who had lost an eyelid by the corrosive action of a similar application ; and this, too, as she assured us, for a trifling enlargement of a little blood-vessel—" a mere speck, of a pin's head size," as she expressed it—that had remained from infancy to her twenty-fifth year! What more conclusive evidence that it was not a cancer, could there be? Cancer never attacks an infant, as almost every one knows. These cases are innumerable: and it is a 


243 
CANCER PLASTERS. 
melancholy reflection, that our government allows them. But our space warns us to close this chapter. If we shall succeed in prolonging the life of a single individual, by our cautions, we shall be amply repaid for the fulfilment of our disagreeable task. 


CHAPTER TWENTIETH. 
SIGNS OF PREGNANCY. MISCARRIAGE, OR ABORTION. 
And now, having conducted the reader through the preparatory period of her existence, we are about to enter upon the explanation of a more eventful crisis; a crisis that concentrates a greater variety of emotions, whether good or evil, than the whole of life that has preceded it. We shall speak of things for which the thoughtless, both of the world and our profession, will condemn us; but we believe the time has come, when it is necessary to give information which is constantly demanded, and which, if not attainable from humane and reliable authority, will be sought from sources whose evil influences may be apparent, not only in the subsequent life of the mother, but in that of her offspring. We are about to trace the emotions of a young woman, who has entered upon matrimonial life, without the advantage of a mother's instruction in those momentous truths she is destined to experience. Perhaps the grave has separated the endearing relation. Perhaps—alas! that it should so frequently be so—that a mother, though living and surrounded by wealth, with all that would seem congenial for the 


245 
SIGNS OF PREGNANCY. 
acquisition of knowledge, should herself be destitute of attainments so necessary to win the confidence and respeot of her child. 
The altered condition of that child's life has thrown her more in communion with herself, and she begins to discover changes in her feeling3, and caprices, which induce the belief that the greatest, most anxiously hoped for, and yet most dreaded change, has occurred, —she is about to become a mother. We will suppose her, under these varied and conflicting emotions, surrounded perhaps by her young companions, drawn near her by a sympathy unknown to themselves, to discover, for the first time, the movements of her child. Ah! why that paleness—why that intense emotion ? She leaves her companions, and retires to the solitude of her chamber. What is this new relation that ties thee, young trembler, to this world of joy and sorrow, in which thine own existence has so recently been registered? What is that mysterious sympathy between thee and nature, which has impelled every step of thy onward course, to seek the fulfilment of the great object of thy life ? The moment has arrived; and thy very existence has become doubly sacred to thyself, and thy Creator. 
Thou hast no right to trifle with thy life: from this moment it is sacred to nature, and to God. Who can sympathize with human feeling, and not recognise, 
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246 
SIGNS OF PREGNANCY. 
from the unspoken language of his own heart, his duty to impart a knowledge of those great truths, which the nearest interests of thy life demand, free as the breath of heaven ? It shall no longer be a stain upon our profession, that this knowledge is withheld. Would that a better heart, and a more eloquent pen, had imparted it; yet, according to our humble ability, we present this offering to the young mother. It is not our intention, for various reasons, to enter very minutely into the symptoms of pregnancy; yet it would not be proper to omit them entirely. We shall therefore give such a review of them as our space, and estimate of their value, will warrant. 
The first symptom noticed by the female is the suppression of the menses. The production of that discharge is due to the internal surface of the uterus; and as the object of menstruation is to produce, when it is required, the membrane that is subsequently to become the after-birth, (see chapter third,) it must, of course, cease when this membrane occupies the surface which formerly produced the menses. 
There are some very rare cases in which menstruation continues, for a month or so, during early pregnancy, the discharge being produced by the lower part of the uterine cavity, which is not yet occupied by the membrane; but these are rare. This is the first symotom, and women generally attach to it the 


247 
SIGNS OP PREGNANCY. 
most value. Yet our readers now know, (see chapter on menstrual suppression,) that a great variety of cause —such as wet feet, serious diseases in other parts of the body, depressing emotions, a low state of the general health, and affections of the ovaria—will all cause the disappearance of menstruation. It is therefore to be most relied upon, when it exists in connexion with those symptoms that follow; and more especially, if the general health does not suffer during the suppression. Even this, however, might not occur till the second or third month. 
Morning sickness, and perhaps vomiting. This symptom is usually the second; yet it is also consequent upon congestion, and other diseases of the uterus, when the menses have been suppressed from other causes than pregnancy. 
Enlargement of the breasts. This also occurs from other causes; yet it is a good symptom, particularly if existing with one or both of the preceding ones. 
Brown circles around the nipples. In a first pregnancy, these are much to be relied upon; but lose their value in a second one, as they remain, in a greater or less degree, after the first. 
Appearance of milk in the breasts. This, in connexion with thf- others, is a symptom of some value; yet it is not to be relied upon alone, as it occurs from 


248 
SIGNS OF PREGNANCY. 
uterine disease, and is occasionally known in con. sumption. (See Dr. Dewees.) 
Enlargement of the abdomen. It might be supposed that this was one of the best symptoms; but it is in reality one of the worst; and, taken by itself, is not at all to be relied upon, as it originates from so many other causes. (See chapters on retention and suppression of the menses-.) Very painful and unjust suspicions sometimes attach to unmarried females, from this doubtful symptom. 
Enlargement of the uterus. This is to be viewed in a similar light with enlargement of the abdomen. It is not to be relied upon when estimated by an ordinary investigation; yet the judicious practitioner always considers it one of the very best symptoms, particularly if combined with suppression and morning sickness, if he is permitted to make the necessary manual investigations. 
Quickening, or motion of the child. This symp. torn may occur from the end of the third to the sixth month, though the fourth is the most common. Were it not for the peculiarly nervous state of some women, and their great desire to have children, particularly if they have been long without them, this would be one of the best symptoms; but it is truly strange how often they are deceived. When judged of by the physician, it is always the best. This symptom is apt 


249 
MISCARRIAGE, OR ABORTION. 
(o be followed by cessation or abatement of the nausea, and that helps the conclusion. These are the jrdinary symptoms of pregnancy. They are all liable io be mistaken by the female; but taken collectively, and estimated by the physician, they rarely mislead. We shall now attempt to explain miscarriage, or abortion. 
The investigations of anatomists have fully revealed to us the nature of the union, even from the earliest stage of its formation, existing between the embryo and the uterus. It consists of a delicate, yet rough membrane, the product of menstruation. This is formed of myriads of minute blood-vessels, and lines the entire cavity of the uterus. A similar membrane passes from the ovaria into the uterus, enclosing the new being. The blood-vessels of the membrane lining the uterus, like the roots of a young plant, strike into its walls, and unite with the arteries coming from the mother's system, on that side of it next the uterus, whilst on the other, they unite with those forming the membrane that encloses the new being. Thus these membranes are supplied with blood from the uterus. A.11 their vessels unite, like the roots of a plant to its stem, in one large vein, which enters the child's abdomen at the navel. 
The whole of this subject, embracing the circulation, from the child back to the uterus, is minutely 


250 
MISCARRIAGE, OR ABORTION. 
explained in chapter third, pages twenty-eighth and ninth. We condense it in this place, that the reader may have fresh in her recollection the delicate structure most intimately concerned in miscarriage. 
The reader must here remember that the uterus, like the heart, is a very powerful " hollow muscle," having immense powers of contraction; as is proved by the force it exerts in throwing off the ovum, in miscarriage, and the child, when gestation is complete. The term miscarriage, is used by physicians to signify the throwing off of the embryo, at a period so early that it cannot live; whilst the term premature labour, is confined to the expression of a similar accident, at a period when the child is sufficiently matured to survive its separation from the mother, and maintain an independent existence. The child rarely lives when it is much under seven months from the commence ment of gestation. 
A woman may, therefore, be said to miscarry, at any period of gestation much under seven months. As the connexion between the two membranes is more delicate in the commencement, it is, of course, more liable to occur at an early period. When any cause sufficient to tear asunder a portion of these delicate membranes is applied, blood must be thrown out from the ruptured vessels, between the ovum (as we shall henceforth term the child and its membranes) and the 


251 
MISCARRIAGE, OR ABORTION. 
uterus. This, if it be small in quantity, (the reader will believe in the first month it must be very small,) and the cause that has produced the rupture cease, the female remaining profoundly quiet, may effect no mischief, but gradually disappear by the process of absorption. But if it be too great in quantity, or if small, and the woman continue to take her usual exercise, which will increase it, it will soon cause the uterus to contract spasmodically, and throw it off, together with the ovum, and be followed by a greater discharge of blood from the arteries of the uterus, which have been opened by the tearing asunder of the two membranes. This, then, is the meaning of miscarriage:—it is a spasmodic contraction of the uterus, whereby its contents are thrown off. 
It is supposed by many physicians, that the customary time for the re-appearance of the menses, (which the reader of course knows are not produced during pregnancy,) is that in which miscarriage is most likely to occur. It is not improbable that nature, from habit, may, in some instances, make an effort to re-establish them at her wonted period, notwithstanding the presence of the ovum. Exciting causes, we think, are more effective in producing miscarriage at these periods, in the early months particularly. 
There are a number of causes usually considered sufficient to produce miscarriage; but as several of 


252 
CAUSES OP MISCARRIAGE. 
them are connected with abstruse anatomical peculi. arities of the ovum or mother, we shall only notic< those which are most frequent, and will be most intelligible to the reader. All of them are much more likely to act upon those who have a delicate, nervous, or irritable constitution. Like all the operations of nature, gestation is most sure of reaching its natural result, viz. the full development and birth of the new creature, under a quiet and healthful state of the body. 
Hence it is that passions, or emotions of the mind —such as fright, grief, anger, and any other violent shocks of the nervous system—may produce miscarriage. That all these causes act immediately upon the blood-vessels, every one may know, from the great exhaustion and slowness of the pulse produced by the two former, and its violent excitement, and the tremulous throbbing of the heart, produced by the latter. 
A meager and watery diet, will produce great nervousness and irregularity of circulation, and thus predispose to miscarriage; whilst the excessive use of stimulating food, may cause too great fulness and excitement of the blood-vessels, and eventually the same result. 
Corsets, or tight clothes, are a very frequent cause. We have known a great number of cases, where this occurred from the obstruction of the blood in the lungs, 


CAUSES OF MISCARRIAGE. 
253 
and consequent congestion of the uterus; —this organ being also forced downwards, by the violent compression of the intestines, as we explained in the chapter on prolapsus. 
All the pre-existing diseases of the uterus, and derangements of menstruation, render miscarriage probable:—likewise existing diseases; as cancer, and hardening of the neck, etc. 
Mechanical causes—such as falls, blows upon the abdomen, dancing, a sudden and false step, long-continued vomiting, fevers, costiveness, etc. 
There is likewise a disease, originating either in misfortune or vice, that is a very frequent cause of miscarriage. It is almost certain to produce this result; and unless the person is properly treated, she can never expect to be the mother of a living child. 
All these causes may fail, however, to produce miscarriage at one period, and be more than sufficient at another; so much does this misfortune depend upon the susceptibility of the system when the cause is applied. There are some women who constantly miscarry, from the slightest causes; and others who resist the most violent shocks, without being affected in the least. 
A great number of medicines are supposed to produce a tendency to miscarriage; but there is no certainty in their action, however powerful they may be. 
22 


254 
DIFFICULTY OF PRODUCING IT. 
Of one thing we can assure every one; viz. that she who is tempted, tampers with her life by using them. A moment's thought on the only explanation of their action, will convince all of the truth of the assertion. 
No medicines can possibly act upon the uterus, without first passing through the stomach and bowels. Upon these delicate organs, then, they must expend their first and greatest force, before they can affect the uterus, or its contents. Now let any one ask her common sense, how can any medicine be powerful enough to affect the uterus, after being, as we may say, first digested by the stomach, (that delicate organ, sometimes so violently affected even by ill-chosen food,) and afterwards passing through all the blood-vessels, before it can possibly reach the uterus —we ask, how can this be, without imminent hazard of its producing, from its necessarily powerful nature, certain inflammation of the stomach and bowels? That .this is the case, every physician well knows:—the hazard of life is, indeed, very great. When we hear of married persons adopting such means of effecting so culpable an end, we think them doubly guilty; and consider, (at least with those who think at all,) the attempt at self-murder to be added to the crime actually intended. 
Bleeding is supposed by some to be peculiarly powerful in producing miscarriage, particularly if 


DIFFICULTY OF PRODUCING IT. 
255 
performed in fte feet; but there is no greater error. We have known it tried by an empiric in this city, under the ostensible purpose of curing pain in the head, to an absolutely fearful extent, without the least effect. Nor has it been at all productive of such a result, when used to a great extent by physicians of character, for other diseases occurring during gestation. 
We do not believe bleeding to be a remedy, without positive jeopardy to life by the, quantity taken. Authors cite great numbers of instances, and indeed we have witnessed them, and so have our friends, where large quantities of blood have been lost, for weeks together, from the uterus itself, during gestation; and yet the female has gone on to her full period, and been safely confined, with a living and healthy child. The reader will inquire, after what we have said above, How this can be? Simply thus:—when blood is thrown out between the membranes and the uterus, so high up from the mouth of the latter that it cannot escape, it forms a clot, or coagulum, and irritates the uterus to contraction, by the presence of a dead substance. This, when once produced, is easily continued. It goes on increasing, till it cannot be stopped, and so the ovum is thrown off. This state of things is always accompanied with alternate pains, which are almost certain to be followed by miscar- 


256 
DIFFICULTY OP PRODUCING IT. 
riage; remedies having little or no expulsive pains are present. In the cases alluded to as losing so much blood without miscarriage, the blood came from the lower part of the uterus, near its mouth, and so made its way constantly out. Of course it could not then act as an irritating cause. 
Neither are the most violent accidents and falls always productive of miscarriage. Persons have purposely thrown themselves down stairs; limbs are often broken and set; dislocations reduced, and unavoidable operations performed, without producing it. We have been obliged to perform the severe operation for rupture, (a protrusion of the intestine through a natural opening in the abdomen,) when the patient was in the third month of gestation, and she has not miscarried. We have also applied the trephine for a fracture of the skull, and it has not occurred, though at the second month only. We cite these instances to show, that the most daring attempts on the part of the female to produce miscarriage, may only jeopard her life, and not be followed by the desired result. 
All this is strictly true, as every practical and truthful physician will assure his patient. Yet there are persons whose uterine and constitutional peculiarities are such, that they constantly miscarry, from the slightest causes—nay, no cause that the keenest scru- 


257 
SYMPTOMS OF MISCARRIAGE. 
tiny can discover. From the fact, that these cases are almost sure to happen at one of the periods (usually the same one) when menstruation should have occurred had pregnancy not been present, they have been supposed to depend upon the attempt, on the part of nature, to re-produce the menses. We have already expressed our belief that this may be so. 
The oftener a female has miscarried, the more liable does she become to its recurrence. Most, if not all of these persons, are of a nervous or hysterical temperament, and have been subjected to menstrual derangements, leucorrhea, or prolapsus of the uterus, etc. A great difference is observed in the liability of the same individual to miscarry, when she is diverted from dwelling upon her infirmities, by the cheerful and quiet companionship of some intimate friend. The nervous system is thus equalized, in 
a manner that no medical treatment could possibly effect. 
The symptoms of miscarriage depend upon the period of gestation, and its exciting cause. They are so well stated by Columbat, that we avail ourselves of his beautiful work. " When the result of some disease, during the first two months of gestation, i< often happens that the ovum, then of small size, ia suddenly expelled, almost without pain, or loss of blood. This kind of miscarriage scarcely differs 
22* 


258 
SYMPTOMS OF MISCARRIAGE. 
from a slight attack of bleeding, or from a somewhat difficult menstruation. At a later period, the expulsion of the ovum may produce most of the phenomena of an ordinary labour; sadness, fainting, sensation of cold about the pelvis, paleness of the face, palpitations, bad breath, swelling and dark colour of the eyelids, loss of appetite, nausea, thirst, pains in the loins, and sensation of weight in the pelvis. To these symptoms may be added, elevation of the pulse; falling of the breasts, which now secrete (instead of milk) a thin liquid; the discharge from the uterus of a thin humour, gradually becoming bloody; diminution, or absence of the movements of the child ; and, lastly, falling of the abdomen. At this time the uterine (expulsive) pains become gradually stronger and more frequent." This increases the opening, or dilatation of the mouth of the uterus, and in a little time the ovum is expelled, which generally puts a stop to the bleeding. 
After the fourth month, and so on in proportion to the advancement of gestation, miscarriage is attended with more pain; often quite as severe as the pains of labour at the full period. As the female approaches the seventh month, she ceases to be liable to miscarriage, (which the reader will remember is the term indicating the probability of the life of the child continuing,) and becomes liable to what is called prema- 


PERIODS OF LIABILITY. 
259 
ture labour. Of course, the longer gestation has continued, the more likely the child is to live. Nothing can be more absurd than the popular belief, that a child of seven months will live, whilst One of eight months will not. Such idle notions could never have obtained currency, had females been accustomed to read works on the natural history of their own bodies. There are well authenticated cases of the survival of children of six months; but this can only be expected where gestation has advanced very favourably to the development of the child, and in very healthy persons. In city life they are unknown. 
The liability to miscarriage, as well as premature labour, decreases as the uterus by its enlargement, as gestation advances, rises out of the pelvis into the abdomen. This usually happens at the fourth month. It then receives more adequate support from the muscles of the abdomen, and the bones of the front . part of the pelvis, upon which it rests; consequently many causes that would produce it at an earlier period, cease to be effective at a later one. There are various questions of great interest constantly occurring to females, respecting doubts they entertain with regard to their actual condition, the seeming non-advancement of pregnancy, etc., etc.; but these cannot possibly be explained in a popular work. 
The means proper to be adopted to avoid the lia 


260 
MEANS OF PREVENTING IT. 
bility of miscarriage, are in all respects so similar to those pointed out for invigorating the constitution, wherever treated of in this book, that we refer the reader to them generally. Chapters tenth and twelfth are peculiarly proper to be read, and contain every useful idea:—we think it unnecessary to repeat them in this place. The directions necessary for preventing the accident when it threatens to occur, or to moderate the loss of blood when it has proceeded so far as to be unavoidable, require more careful notice. We shall, of course, only give those that can and ought to be adopted before the physician is summoned. This should be done without delay; and it is gratifying to know, that his remedies in this complaint are neither few nor ineffective. 
There is a popular belief, though it certainly does not exist amongst the most thoughtful persons, that a slight discharge of blood during gestation is not to be viewed as alarming, or indicating a tendency to miscarriage ; and some are so thoughtless as to suppose it beneficial. Nothing is more dangerous than such notions. The reader now knows, that the least appearance of blood must come from a rupture of bloodvessels between the uterus and the ovum; and no one can tell how far it will go, or what effects it may not produce. It is therefore to be viewed and treated as 
a positive threat, on the part of nature, to throw off 


261 
MEANS OF PREVENTING IT. 
the ovum; and every precautionary measure should be at at once applied. The physician who regards either his own reputation or the welfare (perhaps the life) of his patient, will take the absolute control of her management ; at once silencing all cavil and objections, by mildly, yet firmly excluding from the room all who are not absolutely necessary as attendants. These steps are, of course, unnecessary in the higher walks of life. 
Dr. Dewee's admirable suggestions are so perfect, and we have so often been sustained by recurring to them, that we offer no apology for a liberal quotation from so excellent a practitioner. "One of the first steps to be taken, is to command the most perfect possible rest of mind and body. The patient should be placed upon a mattress, sacking-bottom, or even the floor, in preference to a* feaiiier bed. The room should be well ventilated; the patient very thinly covered; her drinks, toast-water, cold balm tea, lemonade, ice-water, etc. No stimulating substance of any kind should be permitted. Care should be taken in the administration of food and drinks, that the patient does not exert herself to receive them; she should be strictly confined to the horizontal position. Her food should be of the same general character as her drinks—such as thin sago, tapioca, gruel, or panada. In neither of these should wine, or any other 


262 
MEANS OF PREVENTING IT. 
liquor, find admission. They can be rendered agreeable by lemon-juice, sugar, or nutmeg. All animal food, or the juices of them, in the commencement of a flooding, should be forbidden. Let whatever is given, be given cool. Absolute rest of every member of the body should be enjoined. 
" The ofliciousness of nurses and friends very often thwarts the best-directed measure of the physician, by an overweening desire to make the patient ' comfortable.' This consists in changing the clothes, putting the bed to rights,' or altering her position : all this should be strictly forbidden. Conversation should be prohibited the patient. This kind of gossiping should be peremptorily forbidden, even at the risk of giving offence, rather than be permitted to the certain injury of the sick." 
Dr. Dewees next speaks of blood-letting; a measure that is often not to be dispensed with. Nothing is more common than for the patient's friends to object to this, urging as a reason, that " she has already lost blood enough." Of this they are in no respect suitable judges. Tne measure is sometimes one of the greatest efficacy, and is used to divert the action of the blood-vessels in another direction, and not because the patient has too much blood. 
There are many other means that are exclusively medical in character, not only to prevent the liability 


INJURIOUS EFFECTS OF MISCARRIAGE. 
263 
to miscarriage, but to check the loss of blood, and even the contractions of the uterus when they exist ; but these we shall not, of course, enumerate. Those who are near the patient, and feel competent to the task, should put in force all the measures suggested by Dr. Dewees. Nothing is more gratifying to the physician than to find, on his arrival, that such directions have been anticipated, by some calm and intelligent woman. 
There cannot be a question that miscarriage is an accident productive of very injurious effects upon the constitution. Let those who entertain contrary views, from having frequently experienced it, and escaped, as they suppose, any permanent injury, be thankful that the evil day has not yet come. A long catalogue of exhausting affections, including most of those we have treated in the preceding part of this work, are its legitimate consequences. Dropsy and consumption may in time supervene; they generally appear, if the patient does not fall & victim to some of the others, before the system breaks up from utter exhaustion. 
Of the motives that may impel the thoughtless and ignorant, either to avoid the necessary precautions to prevent miscarriage, or to seek to produce it, we have nothing to say here. We have spoken of its effects on the mother's constitution; but what shall we say of the condition of her offspring, should she chance to 


264 
INJURIOUS EFFECTS OF MISCARRIAGE. 
become a mother, after years of feebleness, and frequent prostration of her natural powers ? Alas! how many examples of early death from consumption— how many cases of epileptic fits—of dropsy of the brain—of idiocy, may be traced to this cause. With what sensations must that mother be visited, who becomes conscious of such truths, if she has been the voluntary author of results so melancholy. Her feelings, surely, must be dreadful. Very few who are capable of observation, will doubt the transmission of their own physical peculiarities to their offspring; the personal resemblance so common, should not fail to remove the doubts of the most thoughtless. But we shall have occasion to show, in the last chapter, that the resemblance goes far beyond this; and that those who wish to enjoy in their latter years the society of intellectual and amiable children, must exercise, during gestation, the most watchful care over their most secret thoughts and actions. 


CHAPTER TWENTY-FIRST. 
OTHER DISEASES OF PREGNANCY. 
The condition of pregnancy certainly could never have been designed by nature to be a state of disease ; and yet it would seem, from the great variety of ailments to which it subjects them, that women have a right to consider themselves legitimate subjects for oonstant medical supervision. We have had occasion to speak repeatedly, upon the sympathetic affections produced by the uterus during the state of gestation; and we design, in the present chapter, to enumerate very briefly, because of their comparative simplicity, the various diseases to which so remarkable a power in that organ gives rise. 
It has been held by numerous authors of high professional endowments, that most of these diseases are far from injurious, and that several of them, but more especially the nausea and vomiting, are absolutely beneficial in all cases. We cannot ourselves advocate this view, and shall endeavour to give satisfactory reasons for our dissent from it. 
In the first place, it seems rational to infer, that the healthful development of the new being, should 
23 


266 
NAUSEA, VOMITING, AND COSTIVENESS. 
require all the surplus energies of the maternal system. The mother is not, it has been observed, if obliged to sustain herself by her own exertions, half as liable to the annoyances we are about to consider ; nay, it is quite common to find women who, when compelled by poverty to resort to the severest and most constant labour, entirely escape them all. 
On the contrary, those who are surrounded with luxury and invited to indolence, are generally most afflicted with them. This is so often the case, that it is evident there must be some uniform reason for it. We believe it may be found in irregular action of the nervous and arterial systems, brought about by those errors of early life we have been considering. Their effect, and application to the various afflictions which form the subject of this chapter, we hope the reader is now sufficiently prepared to understand. 
Nausea, Vomiting, and Costiveness. The two first in order of these affections are so frequently present, that they are considered the first symptom of the existence of pregnancy. They have been supposed by many authors, to be designed by nature to subdue the fulness of the blood-vessels, but we can hardly view them in that light; for if they were so, why do they not uniformly continue in the latter stages, when there is undoubtedly a far greater tendency to plethora than in the earlier periods ? Dr. Dewees remarks, " that 


NAUSEA, VOMITING, AND COSTIVENESS. 
267 
when they continue after quickening, or are renewed with severity towards the latter periods of gestation, their usefulness is equivocal, if not decidedly mischievous." 
The reasons for these affections, we confess, have never been made clear to our comprehension, by all that we have read on the subject, and we have been obliged to form conclusions of our own. The simple *act, that persons who pursue laborious occupations often escape them, goes very far to show that they are produced by a congestive state of the blood-vessels of the stomach. This answers to the popular idea of dyspepsia; and it seems a fair conclusion, that the blood-vessels of the stomach become clogged with blood, because that blood is not required by the muscles that move the limbs, as we all know it to be during severe exercise. 
The nausea is greatest when the patient arises in the morning, and goes on increasing until it either subsides, or produces vomiting. Usually nothing is thrown up but a frothy mucus, of a sour taste. When the stomach is violently affected, the patient will vomit more or less of bile. The appetite is extremely variable and capricious; the patient sometimes fancying the articles most disagreeable to her at all ordinary times. It usually ceases at the third or fourth month, but occasionally continues through the whole period of 


268 
NAUSEA, VOMITING, AND COSTIVENESS. 
gestation. Very often the patient is unable to retain any thing but a teaspoonful at a time, of gruel, or some equally simple food. Sometimes by swallowing small lumps of ice, she can retain a mouthful of solid food, but of this there is no certainty. 
This state of things, strange to say, does not in most cases seem, even when extreme, to interfere with the proper development of the child. It is usually found of good size, even in very bad cases of the affection. Nor does its development seem to be produced at the expense of the mother's health. Yet there are some cases in which vomiting is so excessive as to threaten, and occasionally to produce abortion. This is denied by some physicians; but most who have had extensive practice, have witnessed such cases. 
It is mostly found, on inquiry, that the bowels are constipated; and much amendment usually follows their regulation with draughts of magnesia, cream-oftartar water, etc., when these can be borne. The administration of medicine of any disagreeable character, is worse than useless; for it will only add to the nausea, and probably cause its own ejection by vomiting. A little magnesia will often be found of great service, because it neutralizes the acid, which is apt to be present in excess in such cases. Dr. Dewees has recommended the acid of lemons, as the 


269 
SALIVATION. 
best agent to overcome the acidity of the stomach; and we have found it, however strange it may sound, of admirable service. The mineral acids should not be used, because of their injurious effect on the teeth. 
Injections of warm water, given by means of the stomach-pump; will often be found very serviceable in evacuating the bowels. And here we cannot forbear remarking upon the miserable structure of the best of the tubes sold in the shops, and their awkward adaptation to this purpose. They are made of bone or ivory, and from their unyielding nature, inflict great pain upon the patient. The tube used by surgeons for pumping poisons from the stomach, is most proper for injections also; and will be found far more comfortable and effective, as it can be introduced with safety much further into the bowel. Two quarts of luke-warm water may be used at once with this instrument, without withdrawing it from the passage; and this may be followed by a free evacuation from the bowels. A number of other medical agents are often used by physicians, to check vomiting and procure movements from the system; but as they are far more powerful than those enumerated, though by no means more effectual, we forbear to mention them, for fear the patient, by their injudicious use, might injure herself. 
Salivation. There is a secretion of saliva usually 
23* 


270 
DERANGEMENT OF APPETITE. 
attendant upon gestation, that is often the cause of great inconvenience to the patient. We mention it, simply to communicate the knowledge of its frequency, and that it may not be viewed in the light of a serious disease. Sometimes it is excessive, and of course, troublesome; as it interferes with sleep, and produces much weakness from this annoyance, and the quantity discharged. It usually abates by the fifth or sixth month, without any treatment whatever; nevertheless, there are some cases of this afFection which, from the delicacy of the patient's constitution, may require medical treatment. Either the debility caused by the profuse discharge, or the disagreeable effect following the quantity that finds its way into the stomach, may add considerably to the nausea and vomiting, and thereby prevent food from being retained long enough for digestion. 
Derangement of Appetite is always a consequence of the two preceding complaints, and is intimately connected with those that immediately follow. The first and most annoying manner in which it appears, is that of complete disgust for almost every kind of food. It occurs under so many different conditions of the system, and in such a variety of temperaments, that nothing can be more unsatisfactory than to endeavour to account for, or remedy it. It is fortunate that these derangements very rarely affect 


271 
DERANGEMENT OF APPETITE. 
the infant; for if they did, either miscarriage, or a feeble infancy, would be still more common than they are. 
It may be judicious to adopt medical measures in some cases of extreme derangement of the digestive organs, and occasionally to use tonics, under medical supervision, for the debility of the stomach. These, when they are necessary, are so decisively so, that it requires a medical judgment to select and apply them. We allude more especially to the use of stimuli—such as wine, brandy, etc.; they are capable of producing the most positive effect, whether for good or evil, and it is much to be regretted, that their domestic application should be deemed a matter requiring so little judgment. 
Whatever articles of food the patient can bear, should be given her. There is no other guide but her own feelings; and if she fancies very unusual articles of diet, they should be tried. We actually know nothing of these caprices of the stomach, and can therefore direct nothing. In every instance the sensible physician will ask the patient what she fancies ; and if the article is not absolutely and palpably improper, he will suffer a trial to be made. Amongst those articles of acknowledged propriety, ice-cream holds a prominent place. It will suffice to sustain life when nothing else can be borne. We have known 


272 
EXCESSIVE APPETITE. DYSPEPSIA AND 
persons to live upon this article, and egg, sugar, ice, and wine, beaten together in a bowl, for the whole four months, until the period of quickening; when the sickness ceased, as it usually does. A little calf's, foot jelly, or beef tea, which is much better, will occasionally be borne; —sometimes a mouthful of steak, or an oyster. 
Excessive Appetite is sometimes observed during gestation, and is occasionally indulged in to such ex. tent as to give rise to various symptoms of repletion; such as headache, vomiting, and dyspepsia; or raising of the food in an undigested state; bleeding at the lungs, nose, etc., etc. This state may be overcome by the artifice of using food of a comparatively innutritious quality—such as rice, crackers, arrow-root, etc., etc.—keeping the stomach constantly occupied with them, and thus diverting it from food of a more nutritious character, which, if taken in excessive quantities, might, by filling the blood-vessels, produce convulsions and apoplexy at the latter part of gestation, or during labour. 
Dyspepsia and Excessive Thirst. The first of these affections may exist, as every one knows, without pregnancy; and most persons who have suffered under it well know, that it is often produced, and always increased, by taking into the stomach too much liquid, particularly warm drinks, as tea, coffee, etc. 


273 
EXCESSIVE THIRST.—CAPRICIOUS APPETITE. 
But it is very apt to increase during pregnancy, particularly in the latter months; when the uterus, by its great distension, presses upon the stomach, and thus interferes with digestion. Various medical means are resorted to for these affections:—the food should be taken in small quantities, and thus the contracted and irritated state of the stomach will be accommodated, and its distension relieved. Chamomile tea, or some of the bitter infusions—such as Quassia, Columbo, etc. —may be tried. Medicines should always be used with caution, as they are, on the whole, more likely to increase than to remedy the difficulty. 
Capricious Appetite. The strangest and most extraordinary fancies sometimes exist in pregnant women, for articles of the most singular character. They certainly depend upon some state of the imagination of which we know nothing; as we cannot anticipate its action, or connect it, when in existence, with any state of the constitution having any supposable relation to the articles of food desired. It is well, under such circumstances, not to disregard them entirely, as we might, by so doing, be overlooking some wise indication of nature. 
Let us then, in this dilemma, select her food from such a department of the animal, or vegetable kingdom, of acknowledged excellence as food, that approximates the most nearly in its elementary constituents, 


274 
WATER BRASH. 
to the articles desired by the patient. We are not in favour of the indiscriminate gratification of every desire of the female in the state of pregnancy, but can. not, with the views we have always entertained, consent entirely to disregard her fancies, particularly when the propriety of their indulgence admits of a reasonable doubt. 
There are such infinite varieties of tastes, and such abundant supplies of every article of food, that we think it but reasonable to attend to these fancies during so interesting a state as that of pregnancy. It is far better to yield to desires that admit of even temporary gratification, than to insure, by accumulated disappointments even in trifles, a state of feeling in the mother unfavourable to the proper development of the child. 
Water Brash is the ordinary term for a very disagreeable affection, common also to those who are not pregnant, but more so when in that state. It is characterized by a copious eructation of a watery, insipid fluid, accompanied with heat in the stomach, which often extends to the lining membrane of the throat and mouth. It occurs in the earlier months of pregnancy, under the most diverse states of the system, and the greatest variety of diet. Lime-water, or magnesia, may be tried, and are often found of service. There are many other remedies of more ques- 


DIFFICULTY OF SWALLOWING. 
275 
tionable utility j but it often resists every thing that is tried, and disappears as pregnancy advances. Like many other diseases we have occasion to enumerate in this chapter, we mention it to remove unnecessary apprehension in the female, and a desire to tamper with quack remedies. 
Difficulty of Swallowing may, with great propriety, be disregarded by the female, as it will disappear like the last mentioned complaint; but if resolved to try the effect of remedies, we recommend an infusion of valerian, in doses of a wine-glass full, when troublesome. We have used this remedy with success, under the impression that the symptom was hysterical in character. (See the chapter on hysterics.) It has certainly been followed with benefit; and we perceive by modern authors, that anti-spasmodic remedies are used, by applying them to the throat in the form of ointments. 
Heartburn. This is certainly, next to nausea, the most frequent and annoying symptom of pregnancy. It occurs generally at the earliest period of pregnancy, but sometimes delays its appearance till quite a late period. Dr. Dewees, whose excellent article on this subject has always been our guide, speaks highly in favour of acids, after the trial of alkalies—such as lime-water, magnesia, etc. It seems very strange, that an acid should correct an acid better than an 


276 
HEARTBURN. 
alkali; but experience proves it, however contrary to theory it is. Heartburn originates in an excess of acid; it may therefore be first attacked with alkalies, upon reasonable theoretic principles; for it is well known to all, that an alkali neutralizes or destroys the property of an acid. Dr. Dewees's remarks are so excellent and intelligible, that we transcribe them, as infinitely more valuable than any thing we could say: 
"Magnesia and chalk are in familiar use, and in moderate cases are every way competent to the exigency—especially the former. Magnesia should always be .preferred to chalk, except a looseness of the bowels accompanies the complaint. The chalk is never as pure as the magnesia, and is always sure to constipate the bowels. Sometimes it is used in immoderate quantities; and then it is with decided injury. I formerly attended a lady with several children, who was in the habit of eating chalk during the whole term of her pregnancy. She used it in such excessive quantities, as to render the bowels almost useless. I have known her without an evacuation for ten or twelve days together, and then it was only procured by injections. The evacuations were literally chalk. Her calculation, I well remember, was three half pecks for each pregnancy. She became nearly as white as the substance itself; and it eventually de. 


277 
HEARTBURN. 
stroyed her, by so deranging the stomach that it would retain nothing on it. 
" When heartburn is moderate, it may be relieved by soda-water, lime-water and milk, and the occasional use of magnesia. The operation of these substances in the cure of an acid stomach is easily understood ; but the action of a few blanched almonds, or a few roasted ground-nuts, is not so easily explained; yet both of these substances I have known most successfully employed, where the complaint was mild. They should be taken from time to time, as the acidity may prevail. Confining the patient to any one article of diet, of either the vegetable or animal kind, is sometimes productive of great advantage: as simple boiled rice ; oysters; milk or cream; or very sweet butter and stale bread, etc." 
This extract we deem it every way proper to give, as it may prevent the singular infatuation of using chalk. No doubt nature impels females to its occasional use; but it is often most signally abused, in this and other complaints, as we have noticed in the chapter on chlorosis. The medical directions of Dr. Dewees are not likely to be misapplied, and as we have tested their great value in numerous cases, we would not willingly deprive the reader of a guide so likely to benefit her in this very annoying affection. 
24 


278 
PAINS IN THE STOMACH AMD BOWELS. 
Irregular Pains in the Stomach and Bowels. These are often called nervous colic. They are characterized by much irregularity of occurrence, and a disagreeable dragging sensation, very similar to that existing in prolapsus of the uterus. Many persons fear the invasion of inflammatory affections; but they do not lead to such results. It is quite possible that they depend upon the settling down of the uterus in the earlier months, and the consequent dragging upon its ligaments. This idea derives additional force from the fact, that the pains decrease when the uterus rises into the abdomen, and disappear in the latter months. They are often relieved by taking food, or by some anti-spasmodic mixture; such as a table-spoonful of the compound tincture of valerian, in a wine-glass full of sweetened water, taken when the pains are most urgent. 
These pains are sometimes associated with others of a more permanent character, that are not relieved either by food or medical restoratives. Should such occur, the patient will act wisely to seek medical advice. We are only describing, in this chapter, the most frequent and least serious annoyances of pregnancy. There is, of course, nothing in her state tc prevent the attack of the most dangerous affections to which she is subject at all other times, during this interesting period of woman's existence. 


279 
COSTIVENESS. 
Costiveness. The observations made in the chapter on costiveness were of a general nature, and applied to the ordinary condition of the system, and the production of local diseases more especially. During gestation, a feverish state of the system, sleeplessness, a tendency to abortion, and violent headache, often depend upon this state of the bowels. Costiveness is generally imputed by physicians, to the pressure of the enlarged uterus upon the lower part of the tract of the intestines, whereby they are obstructed in such a manner that the contents pass with difficulty. 
For ourselves, we attach less importance to these views, as they indicate very little confidence in nature's arrangements. If it were so, the result would seem to be unavoidable. And yet, we often find instances, particularly in labouring people, who take much exercise, and eat and retain much vegetable food during pregnancy, of a perfectly regular state of the bowels, throughout the entire period. Even to the last day, when the uterus is most enlarged, and has subsided very low in the abdomen, (as it always does just before confinement,) and consequently would, according to those views, produce most pressure and obstruction, the bowels continue regular. 
We wish the reader here to refer particularly to chapter sixteenth, because she will there see not only the causes of this unnatural state during pregnancy, 


280 
COSTIVENESS. 
and the means of avoiding them, as far as possible, but other serious consequences to which it gives rise. That and the preceding chapter, moreover, will direct her attention to the " retro-version," or turning over and backwards of the uterus. This, indeed, produces pressure upon the rectum, abundantly sufficient to obstruct the bowels, and that in a very dangerous manner. As we believe that state to be far from uncommon, and know, by frequent observation, the difficulty and distress to which females are often subjected by it, we urge our readers again to consider those chapters : after having carefully read chapter fourteenth, on the structure of the pelvis and the relative situation of the uterus and bowels, they will then understand the subject, and comprehend more fully the directions we are about to give. 
Strangely enough, many medical men are accustomed to say, that costiveness is a state perfectly natural during pregnancy; but how such views can be reconciled with a correct knowledge of the laws of the system, it passes our ability to conceive. Circumstances, it is true, may oblige the female to submit to it; and she may get through " the period" with a tolerable degree of comfort; but that is no argument in support of such an unnatural opinion. 
Women whose bowels are habitually loose, have a great disposition to miscarry; but that looseness itself 


281 
COSTIVENESS. 
is a state of disease, and the same tendency exists in the uterus to throw off its contents that is evinced by the bowels: the viscera and their owner are all weak together. The natural state is the proper one, without doubt, in pregnancy as well as at all other times ; and that is, in nine cases out of ten, to have a daily movement of the bowels. One case in ten may, from natural causes for which we can discover no reason, go over to the second day without inconvenience. No active purgative medicine should ever be taken during pregnancy, without highly competent medical advice; because it has often been known to produce the most serious accidents. The patient should take as much exercise on foot, in the open air, as she can bear without fatigue. 
Columbat remarks: " We may with advantage prescribe the white meats; dressed vegetables, particularly lettuce and spinach; cooked or ripe fruits, such as cherries, melons, grapes, prunes, strawberries, and oranges. It is well to add to these dietetic means, the warm bath, the use of vegetable or veal soup, lemonade, cream-of-tartar, milk weakened with water, decoction of tamarinds, cassia, (a vegetable medicine,) or of prunes and barley-water sweetened with honey, according to the taste of the patient and the effect produced." To these excellent directions we can add nothing of value. We have already said that raw 
24* 


282 
DIARRHOEA AND DYSENTERY. 
are preferable to cooked fruits, and that those of our country are, some of them, actually constipating. (See chapter on costiveness.) 
Should injections become necessary, from the obsti. nate state of the constipation, they are to be made of molasses and water, with a decoction of senna leaves— a handful to a pint of hot water—or an ounce of castor-oil, mingled with molasses and water; either to be used of blood-warm temperature. The stomach-tube, as we said in the first part of this chapter, is the only proper instrument. Those who do not feel inclined to incur the expense of the pump that comes on sale with it, can adapt the tube to a common pint syringe. One of less capacity than this is useless. 
Diarrhoea and Dysentery. Females are also liable, during gestation, to an opposite state of the bowels, depending upon a great variety of causes. There is nothing in these states differing from similar conditions in those who are not pregnant; and as they are supposed to be aware of the danger of their continuance, and the importance of medical aid in such complicated affections, we shall be brief in our explanations of their peculiarities, leaving their treatment to the physician. Diarrhoea means literally, thin and frequent discharges of the natural contents of the bowels, unaccompanied with fever, or any other perceptible derangements, at its commencement. It 


DIARRHOEA AND DYSENTERY. 
283 
usually depends upon some irritating substance in the intestines, or upon cold feet. Its appearance is sufficiently indicative of its existence. Should the patient have several rapid and easy discharges in succession, she has diarrhoea, and should summon her physician. 
Dysentery may be known by a frequent desire to pass the contents of the bowels, and an inability to do so. The small amount of discharge that does appear, is mixed with mucus and blood. This disease may be the consequence of indigestible substances in the bowels; cold applied to the body or feet, either from too slight clothing, or the injudicious use of the cold bath; or it may follow diarrhoea. It has been said, by many writers, that a diarrhoea occurring at the commencement of pregnancy is not to be regarded; but we think such counsel imprudent, and would always advise the female thus affected, to seek medical direction. 
During these affections, the diet should consist of arrow-root, and broths containing no vegetable matter. The patient had better remain in bed until she summons her physician, as it is highly important to keep the skin perfectly warm, in all these complaints. In cases where there is difficulty of procuring medical aid, a dose of castor oil, followed by a drink of the decoction of the roots of the common blackberry, has been found very serviceable,—or a jelly, made 


284 
DIARRHOEA AND DYSENTERY. 
of the fruit, and mixed with water, may be substituted. 
There can be no impropriety, but much benefit, in applying to the abdomen a mustard plaster, made of one-quarter of flour of mustard and three-quarters of common flour, moistened with brandy or vinegar, and spread between thin muslin. It diverts the action from the bowels to the surface. In violent cases, twenty or thirty drops of laudanum may be given to an adult; but there are better and more certain remedies, which can only be properly applied by the physician. 


CHAPTER TWENTY-SECOND. 
DERANGEMENTS OF THE CIRCULATION AND NERVOUS SYSTEM DURING PREGNANCY. 
Plethora, or too much Blood. It may sound strange to some readers, that the human system should ever be said to contain " too much blood;" more especially, when it is engaged in developing and supplying with that fluid a new and independent creature. Let those who think the expression of doubtful propriety, recollect that we are speaking of a combination of diseases, the acknowledged consequence of a great number of errors of life; and that we can only judge of the departure of each person from health, by the palpable effects produced by what we call disease. We have spoken of u excessive appetite" as a disease, and enumerated sundry other causes productive of too much blood, or " plethora," as it is called by physicians. It is unnecessary to repeat these, nor should we again allude to them here, were it not to connect them with their natural result in plethora, and its proper remedies; viz. diet and the lancet. 
It is not to be wondered at that the latter is often objected to, not only because of its disagreeable asso- 


286 
CONVULSIONS. 
ciations, but from the prejudices derived from that passage of Scripture, " the blood is the life thereof." Of the truth of this expressive phrase, all are satisfied. Yet people could not well have too much life; and therefore the thoughtless might ask, Why bleed them ? Recollect that we might say with the same propriety, the food is the life thereof; and who will assert that we do not occasionally eat too much—particularly of animal food ? This is but the blood in another form, and when eaten to excess—or in some persons of peculiarly powerful digestion, even in moderate quantities—it will undoubtedly produce plethora. 
This state of the system may be known (in some persons, though not in all) by redness of the face; but in all by most of the following symptoms, viz. headache, sleepiness and confusion of ideas, giddiness, ringing of the ears, feverish sleep, etc. In short, the person actually feels, and often looks, as though she were " too full of blood." There is a terrible disease that may ensue from this state, during the latter months of gestation, and during and after the birth of the infant. We allude to convulsions. 
Convulsions are preceded by the very symptoms we have just enumerated, and are the direct consequence of plethora. The patient should not, when these symptoms are present, fail, at any period of her pregnancy, to call in the aid of her physician. He 


287 
DIFFICULT BREATHING AND COUGH. 
will be able to judge of the propriety of exercising that much-abused, yet invaluable and indispensable remedy, the abstraction of blood. Should that measure be judged proper, diet will do much to render its repetition needless. What we have said on that subject in various parts of this work, and in the remarks on excessive appetite in the preceding chapter, apply equally to plethora; which may, with great propriety, be viewed as the principal source of several of the diseases that follow. 
Difficult Breathing and Cough are so common, and depend upon such a variety of causes connected with gestation, that it is almost impossible to condense a proper description of them within suitable limits for this chapter. The rapid, and necessarily imperfect sketch of the circulation of the blood through the lungs, given at page ninety-three, explains to the reader, that all the blood in the body should go through the lungs, at short intervals, in order to receive air, and to throw off its impurities. 
The remarks we have made in various places, on the effect of the obstruction of breathing by the constriction of corsets and tight dress, will serve to show that the volume of the lungs, and their ability to expand, ought to be most studiously preserved by every effort of the patient. But the increased size of the uterus, particularly in the latter months of gestation, 


288 
DIFFICULT BREATHING AND COUGH. 
forces the lungs, as it were, into a smaller space, and renders them very liable to congestions of blood, and consequent increased difficulty of breathing; because the blood, when lodged in them, still further prevents the entrance of the air. Cough is the consequence of this state. 
There is a variety of difficult breathing, produced by nervous derangements, that occurs in the early months, and is of very short duration at each attack. This we shall not notice, as it usually passes off without treatment. The first mentioned variety is apt to be accompanied with too great fulness of the bloodvessels, as evinced by an unusual amount of colour in the face, headache, and the other symptoms of plethora. 
However averse we may be to bleeding as a general resort in pregnancy, (and we are conscious of its great abuse,) there is no substitute for it in such a case, and it will always be resorted to by the prudent physician. Blood should be drawn in moderate quantity, and the bowels be opened by a gentle laxative. All pressure should be removed from the chest, and the patient kept upon a light, though nutritious diet. 
Sometimes these symptoms may originate in serious and permanent affections of the lungs, to which the female has unfortunately been predisposed, for some time previous: these are more unmanageable. There 


289 
SPITTING OF BLOOD. 
is nothing to hinder ordinary and acute inflammation attacking the lungs, from draughts of cold air, or cold or wet applied to the feet; and that female who acts with prudence, will take the utmost care to avoid such causes. An attack of inflammation of the lungs during pregnancy, is truly a serious affair, and may easily result in death, under the best of treatment. We mention some of the proper steps to be taken, because there are often absurd objections made to the use of the lancet, under such circumstances. It is very important that constant cough should be relieved, as it may produce abortion, by the repeated shocks it gives to the uterus, and its delicate lining membrane. 
Spitting of Blood, and Bleeding at the Nose. What has just been said on the structure of the lungs, and the obstruction of the blood in them, by all the causes we have enumerated, applies to both the annoyances which form the subject of this paragraph. Spitting of blood is the consequence of congestion of the lungs; and bleeding at the nose may be a consequence of that, or of " a rush of blood" to the head. The bleeding at the nose is, unless excessive, a salutary discharge; and is designed by nature to relieve the head or lungs from too much blood. 
The principal symptoms that usually precede the spitting of blood, are difficult breathing, and a chill, accompanied with cold feet and hands, and more or 
25 


290 
BLEEDING AT THE NOSE. 
less pain in the chest. Should the patient be known to have a pre-disposition to consumption, it is much more serious than when it occurs in a person previously healthy. In the latter, it may be merely the consequence of the sudden rupture of some minute arteries, precisely as in the nose when it bleeds. The consequences are best averted by a moderate use of the lancet, and some other medical remedies, that can only be properly applied by the physician. 
Bleeding at the Nose, it has been observed, when it resists the ordinary domestic remedies, (such as cold water, or ice, applied to the nostrils and back of the neck,) may sometimes be stopped by elevating the hands, and retaining them in that position for some time, by taking hold of a stationary object. This is difficult to account for, but we know it to be true. 
Bleeding at the nose may proceed to an alarming extent, and demand the surgical remedy of plugging up the nostril in its posterior part with sponge, which will always control it. This generally requires to be done by the surgeon; but an intelligent person may be taught to do it, and should always act without the surgeon in such an emergency. Stopping up the nostril alone, as far as a non-professional person might feel inclined to do it without instruction, with a piece of cotton or sponge, will often check it. This acts by retaining the blood, and causing it to form a plug of 


291 
PALPITATION OF THE HEART. 
itself, or coagulum, which presses upon the ruptured artery; and if the person remains sitting, and profoundly quiet, it will often stop the bleeding. She should never lie down, as the blood would then flow too easily to the head. It cannot, of course, mount upwards so readily, notwithstanding the action of the heart; for that is opposed, when sitting, by the weight of the column in the veins above it. 
Palpitation of the Heart. There are so many causes for palpitation of the heart, or " nervousness," during pregnancy, and they are all so connected and dependent upon each other, that it is next to impossi ble to separate them. Thus the pressure of the en. larged uterus upon the great blood-vessels that supply the lower limbs, and its sudden cessation by some unexpected movement of the body, causing it to turn a little from its position, allowing the blood to rush onwards, and depriving the heart, for a moment, of its ordinary distension, may cause it to palpitate. It is also often found, in persons who are not pregnant, to depend upon costiveness; and as that state is usually combined with pregnancy, there are at once two causes, either acting independently or reciprocally to produce it. It is known by every one, that sudden disclosures, of a joyful or sorrowful nature, may produce a tumultuous action of the heart. Excessive stimulation with liquor, tea, coffee, opium, or any other 


292 
PALPITATION OF THE HEART. 
violent means of excitement—too much or too little food, etc.—will be followed by this symptom. All intense moral emotions, anxiety, or a constant state of tension of the nervous system, caused by an unwise desire to command universal admiration from society, is a very fruitful cause in young women. A secret indulgence in certain improper habits may produce it: an immense number of young persons die from this desolating, vice. They may be known from a gradual decline and failure of all the powers of the system, both of mind and body, without any positive disease being apparent, until death is approaching, when they generally go off with consumption. (See page 58.) All the derangements of the menses, as well as a plethoric, or over-distended state of the blood-vessels, will produce it. In short, any unnatural movement in the vascular or nervous system, may be followed by palpitation. It is often called "nervous disease" by females, and is, by all odds, the greatest difficulty the physician has to contend with, in treating diseases of females. (See chapter on hysteria.) 
The means to be used in overcoming this disagreeable symptom, are as various as the causes which produce it. Those that relate to diet and constipation of the bowels, may be gathered from the chapter on those subjects. The necessity of avoiding the other causes enumerated will be apparent to the reader. An in- 


293 
FAINTING. 
finite variety of remedies are usually recommended by the friends of the patient, for this symptom, in number proportionate to their ignorance of its causes. The sensible physician, when obliged to prescribe, usually confines himself to assafcetida, valerian, and other anti-spasmodics, because they will do no harm, if they do no good. The symptom is apt to disappear as gestation advances. It will, in almost every instance, do so before the period of confinement. Every woman of sense will be certain, should she perceive it to persist and increase, to send for her physician, and be guided exclusively by his counsels. Should there be reason, from plethora, to apply the lancet, we hope that what we have said will remove any unreasonable objections the reader may have to its use. If necessary, however, it must be decidedly so; for it is a remedy not to be trifled with, in such cases. 
Fainting, or a temporary suspension of motion in the muscles, and an apparent loss of respiration and action in the heart and arteries, sometimes follows palpitation, but frequently occurs without it. It is often preceded by a sensation of weight at the stomach, confusion of ideas, and dimness of sight, with coldness of the extremities. The causes are the same as in palpitation; to which may be added, the motions of the child. This often produces an entire loss of consciousness for a few seconds. The patient may 
25 


294 
FAINTING. 
remain insensible for four or five minutes, and revive with an inclination to vomit. Hence it is inferred, and often justly so, that it originates from indigestible food. The vomiting, in such cases, effects a cure for the time. The danger from fainting usually affects the child, and not the mother. The circulation from the mother to the child is suspended during fainting, and its death will follow, in most cases, should it be prolonged for an unusual time. When speaking of bleeding at the nose, we advised the patient to remain sitting, so that the blood could not so easily reach the head. In fainting, we desire it to flow towards the heart and head, as freely as possible. The reader should never forget this, and in all cases cause the patient very gently to slide from her seat upon the floor, if there is no bed at hand. This is the first, and most important remedy. Immediately the dress should be loosened, and smelling salts or ammonia, or strong vinegar, be applied to the nose. Water may be smartly sprinkled in the face, and a little wine or brandy may then be given with benefit. The patient should arise very gradually, for fear of a new attack; as the blood slowly regains its passage to the brain when she arises at once. Under medical advice, the shower bath is of great service for this and the preceding complaint. As they have a great number of causes, they will, of course, be closely criticised by the pru 


HEADACHE. 
295 
dent physician. The patient should therefore use the most entire honesty in her answers, and the physician put his questions in a plain and unaffected manner, so that she may distinctly comprehend him. 
Headache. This very troublesome affection is intimately connected with two or three states of the system, and nothing can be more absurd than the indiscriminate use of any single class of remedies, particularly if that selection be made, as it generally is, from the stimulating ones. The first variety of headache may be found in those of a full habit of body, and depends altogether upon too much blood. The remedy consists, therefore, in drawing enough to make a slight impression upon the heart and arteries, and then lowering the quality of the food, as directed in the paragraph at the commencement of this chapter. 
The second variety is observed in women of a habit of body directly the reverse of plethoric. They are thin, and labour under palpitation and nervousness, starting readily upon the slightest shocks, and being much affected with sleeplessness. It is not desirable to adopt any very decisive remedies in this variety of the affection, because the disease depends upon a state of the constitution that has been very suddenly induced, and depending upon pregnancy alone, it is not to be expected that any single remedy, or even any plan of treatment of a formal character, can be car- 


296 
HEADACHE. 
ried out in time to be of much service. It is the con. sequence of the general play of sympathies throughout the system, and may bring in its train temporary affections of the stomach, bowels, liver, etc. 
Those who are most susceptible to such affections during gestation, belong to that variable class of beings denominated " nervous;" and the physician who can duly estimate the ever-changing character of their attacks, and prescribe soothing remedies, and comfort them by his assurance of the harmlessness of the affection, will be most likely to succeed in preventing a resort to quackery. There are, however, some women who are bent on adopting an irregular plan of treatment, and we cannot always with self-respect prevent it j yet the physician should represent to them, in the plainest manner, the possible consequences of tampering with their health in so delicate a situation, and endeavour to divert their attention with composing remedies. In this way he will often succeed in preventing mischief, till time, the great physician, removes the difficulty by ridding them of its cause. 
The head may be wet with cologne, or bay rum, and a pillow of hops will often procure rest, and a remission of pain. Cold applications to the forehead may also be tried, and will often relieve. Camphor is decidedly a precarious remedy for domestic ••^ 


SLEEPLESSNESS. 
297 
internal use; —we have seen it productive of much mischief: so also is ether. Valerian root in the form of tea, made of moderate strength, and a wine-glass full taken occasionally, will often benefit. Laudanum is a very dangerous and improper medicine ever to be used during pregnancy, without medical advice; we have seen it, from its use in a case of headache depending on plethora, produce convulsions and death. 
The third variety depends upon the state of the stomach, and is accompanied by a disagreeable taste, with much dizziness, and want of appetite. It is irregular in its attacks, and can only be properly prescribed for by the physician. A mild emetic 01 cathartic is indispensable, and on its proper choice may depend its efficacy, and the avoidance of abortion. 
What we have said respecting plethora and convulsions, is of the greatest possible consequence to every woman who is the subject of much headache, particularly in the latter months of gestation. She should not by any means be governed by her own judgment in so dangerous a symptom, but invariably consult her physician. Many a woman has died from convulsions or apoplexy, when advice, had it been called in time, might have prevented it. 
Sleeplessness is a frequent result of an overwrought state of the nervous system, consequent on 


298 
SLEEPLESSNESS. 
too great excitement of gay company, or some do* mestic cause of a depressing character. It may, however, depend upon constipation of the bowels, or plethora; and again, it may be the result of actual debility of the nervous system. A late supper is a fruitful cause of sleeplessness. There are many persons, both during pregnancy, and at other times, who are always sleepless if they take much food after dinner, particularly if they use little exercise. Both tea and coffee are almost universally productive of sleeplessness, and are much used by students who wish to prolong their hours of wakefulness. The popular prejudice in favour of black tea is quite erroneous ; if taken of ordinary strength, it is nearly as bad as green. Actual hunger should never exist on retiring: a piece of bread or a cracker will relieve it, and prevent sleeplessness from that cause. 
Washing the brow and face with cool water, and the body with warm, will often procure sleep, and should always be done if wakeful. Constipation must be relieved, or there may be no sleep, even if all other things are attended to. (See that chapter.) The hop pillow, and smelling laudanum by rubbing it on the upper lip, or putting a piece of cotton moistened with it in one nostril, will often procure sleep. The patient must carefully abstain from much mental effort for several hours before retiring, and always 


TOOTHACHE. 
299 
avoid close rooms: for this reason curtains are of all things most pernicious—no sensible woman will ever tolerate them. The internal use of laudanum, or morphine, will never be adopted by any prudent per son ; it not only constipates the bowels, but will produce headache and a tendency to convulsions. A hair mattress, and moderate bed clothing during our summer months, are indispensable aids to sleep. A feather bed in summer is pernicious. 
Toothache. It is often difficult to say whether this frequent and distressing affection of pregnancy originates in a state of nervous excitation of the whole jaw, or in an actual inflammatory affection of one or more of the teeth. When it is very sudden in its attack, and extends rapidly over various parts of the face and jaw, selecting no particular tooth, it is probably not connected with inflammation, as that process would render some distinct spot the necessary seat of the pain. 
In this variety the remedies may be of a general and soothing kind. The head and body must be kept warm. A small quantity of the extract of Belladonna, about the size of a pea in bulk, may be rubbed up with a teaspoonful of water, and applied freely on the skin over the affected part. It should never be taken inwardly, or applied to the gum itself, as it is very poisonous. Laudanum will answer occasionally 


300 
TOOTHACHE. 
the same purpose, though sometimes one will relieve when the other will not. The compound tincture of valerian, in doses of a tablespoonful in a wine-glass of water, every hour or so, will often sustain the nervous system, and mitigate the affection; or a glass of wine may be taken as a substitute. The patient will soon discover if it agrees with her, and can be governed accordingly. A small blister behind the ear will often relieve when every thing else fails. Low diet, which is often adopted, is not always a wise measure; —the patient should eat what she desires. If she can bear a generous diet, it will do much towards mitigating her symptoms; for there is no doubt that a few days' continuance of " nervous toothache" will soon render the supporting treatment indispensable. 
But it is often the case that a decayed tooth gives rise to the pain. In such instances, it is always combined with more or less of inflammation, and will not yield to general remedies. Should there be what is called a gum-boil at the root, it must be opened with the lancet; because it often contains matter which ought to be evacuated. If no matter appears, the slight incision will do no harm, but produce relief, by the evacuation of blood it will occasion. The means directed for the first, or nervous variety, may be applied to this; indeed, they usually precede the call of 


301 
PILES 
the physician. A variety of more decisive remedies may be applied by him, particularly if the stomach requires attention, which it frequently does; but it often happens that nothing but the extraction of the tooth will produce relief. This may generally be done with far less danger of causing miscarriage, than is sure to follow that exhaustion and irritability of the nervous system always the result of a protracted toothache. A skilful dentist is therefore often the best prescription. 
Piles. Our remarks on piles at page 183, will give a general idea of their peculiar nature. The reader is requested to turn to that page, and she will perceive that they were there imputed to costiveness, which is no doubt their most frequent cause. But the pressure produced by the enlarged uterus, will itself aid in producing the affection ; although the retention of the blood in the veins, which may be said to be their commencement, is more effectually caused by constipation of the bowels. It is evident that piles are aggravated by the pressure of the enlarged uterus, from the fact, that they do not usually appear as a consequence of pregnancy, till the middle and latter stages. Many females endure these troublesome little tumors, rather than call in the aid of a physician. But they sometimes proceed to such a painful state, becoming constricted by the great circular muscle 
26 


302 
DISTENSION OF THE VEINS. 
that closes the lowest part of the rectum, that they demand immediate aid to prevent miscarriage, or actual prolapsus of the rectum, and allow the patient to pass the contents of the bowels, which she at first avoids from the exquisite pain it occasions. (See pages 182 and 183.) 
Violent and constant pain, accompanied with a fre quent desire to evacuate the bowels, and an inability to do so, with fever and headache, attend their most aggravated state. Should they open and bleed moderately, it is always attended with mitigation of the severer symptoms; but this may proceed to such extent as to endanger life from loss of blood, and likewise miscarriage. The remedies directed at page 183, are always to be adopted. Injections of a teaspoonful of laudanum and a wine-glass full of starchwater, may be given for immediate relief in a severe case, and a large dose of magnesia taken immediately ; this, on its operation, will insure relief. An ointment, composed of opium, nut-galls, and hog's lard, in equal proportions, will often relieve; but as we said at page 184, the nitrate of silver, in proper hands, is worth all other local applications together. 
Distension of the Veins of the Legs, is produced by the pressure of the enlarged uterus upon the great veins that return the blood from the legs to the body. These veins are as large as the little 


DISTENSION OF THE VEINS. 
303 
finger, and go upwards through the bony cavity of the pelvis to the great vein on the right side of the back-bone, or spinal column, which courses its way singly onwards to the heart. Now the uterus, in its most enlarged state, or generally after the sixth month, rests upon these veins, pressing them between itself and the bony rim of the pelvis. (See page 147 for a description of this part of the body.) It will be observed, however, that nothing is there said of the veins in that place, as they were unconnected with the subject. They pass directly behind the rectum, as it is there described. The enlarged uterus presses the intestine, as well as the veins, against the pelvis, and by preventing the return of the blood, causes the veins to enlarge, particularly when the patient is standing; for then the blood, even without the pressure, mounts upwards with more difficulty. 
These veins lie in tortuous masses, like so many earth-worms, under the skin, causing a very disagreeable colour and irregular surface. They are most apparent on the legs and feet, and less so on the thighs; because the higher the column of blood is above, the more pressure and distension must exist in those below. Although the pressure of the uterus is the principal cause of this state, there must be some peculiar weakness in the coats of the veins of most persons thus afflicted; because the complaint 


304 
DISTENSION OF THE VEINS. 
is by no means of universal occurrence, though cornmon. 
If it were the sole cause, every woman when pregnant would be thus afflicted ; besides, there are very rare cases in which it has been noticed in the upper part of the body, and in the arms. This proves that it must sometimes be connected with the structure of the veins themselves. 
Inasmuch as the principal cause of this disease, as it ordinarily presents itself, must continue till the distension of the uterus is removed by the birth of the child, it may be supposed that little can be done for its cure. This is too true; yet when the reader is informed that this disease is a prominent cause of the severe affliction entitled " milk leg," she will see the propriety of attending to every suggestion likely to benefit her, till confinement. When the upper part of the veins is muoh distended, additional precautions may be required; for it is then probable that the disease extends to the branches within the body; and as there is a possibility of their rupturing and producing sad results, the female should be religiously attentive to directions. 
The first measure to be adopted is to keep the bowels open. This the physician will do in the manner best suited to his own views. The simpler the method chosen, the better for the patient, in all cases. The 


DISTENSION OP THE VEINS. 
305 
next consists in keeping the horizontal position, for the greater part of the time; only arising when compelled to do so. The reason for this measure the reader of course understands to be, the more easy passage of the blood into the great vein within the body. As the veins of each leg unite in the middle of the body, in front of the most prominent part of the spinal column, it is better for the patient not to lie on the back, but on one side, and then the uterus cannot compress them against the back-bone, but allows them to remain unobstructed. 
The third measure is most necessary in those cases where the female cannot lie in bed; a well-adjusted bandage is applied from the great toe upwards, and thus supports the veins against the distension by the volume of blood. As this can only be properly applied by the surgeon, and is therefore attended with inconvenience, a closely-fitting stocking, open on one side from the toe upwards, with a double row of eyelet holes and a lace, has been substituted for it. 
Both the bandage and lace require to be adjusted in the morning before the patient arises, because the veins then contain only their natural amount of blood. As soon as she arises, they become of course distended. One or other of these measures should always be used, if the patient cannot keep her bed; and even if she does, they are very useful to prevent 


306 
DROPSICAL STATE OF THE LEGS. 
distension when she is obliged to arise. Unless the veins permanently lose their power of contraction by repeated pregnancies, they usually assume nearly their proper and natural appearance after confinement. Should they not do so, we do not think that the sentiment of prudent surgeons is in favour of any surgioal operation. The patient had better rely upon the regulation of the bowels, and the laced stocking or bandage. 
Dropsical State of the Legs. In women of a delicate habit of body, or such as have narrow pelves, this disease is apt to occur in the latter months of pregnancy, from causes precisely similar to those that produce distension of the veins of the legs—viz. pressure of the enlarged uterus, and an original weakness in the blood-vessels and absorbents. 
The absorbents, as we have already partially explained, are an immense number of vessels that pervade the entire body. They are quite as numerous as the arteries or veins, and are appointed by nature to take up every part of the body itself, and all the surplus secretions, atom by atom, and drop by drop, and carry alt back again into the veins, (with one of which their grand trunk communicates, on the left side of the neck,) and thus subject the whole, by the action of the heart, to the vitalizing process of receiving air in the lungs, turning all a second time into blood. 


DROPSICAL STATE OF THE LEGS. 
307 
The greater portion of our. blood consists of what is called " serum," a watery fluid that forms the dropsy. It is thrown out of the blood-vessels, in consequence of their distension from the pressure of the enlarged uterus, into the loose connecting tissue of the muscles of the legs, and causes the swelling. It may be known to be outside the blood-vessels, from the flesh pitting, when pressed upon by the finger, which it could not do if the fluid was within them. 
The absorbents, although they constantly take up a portion of this fluid, cannot remove it as fast as the vessels throw it out. Sometimes the skin becomes so much distended as to threaten to burst, and indeed often does so. Besides this, it may become the seat of troublesome inflammation. This can be avoided, which it always should be, by lying down; when the water will run up into the connecting tissue of the thighs and body generally; and then, if the patient continues lying on her side, the water will cease to be troublesome. 
The physician often adopts various remedies, such as bandaging, astringent lotions, mild purgatives, etc., etc., with some benefit; but the recumbent position is the most important means of alleviating the severer symptoms, which cease on the birth of the child. Some persons are apt to suppose a very low diet indicated by this affection; but that is of very doubtful 


308 
DROPSICAL STATE OF THE LEGS. 
propriety, as the disease almost always attacks women of a weakly habit of body. In first cases of pregnancy, there are important reasons, connected with the safety of both mother and child, why this disease should be under constant medical supervision. These are of a nature that could not with propriety, or profit to the reader, be detailed here. 
This comprises what we have to say on the various afflictions of the most important period of woman's life. There are of course a great number of serious ailments, the consequence of confinement; but we could not with any propriety introduce them into a popular work. The intelligent female, at that interesting epoch, is supposed of course to call in the aid of a medical man. If she is fortunate in her choice, she will ever after be provided with a friend and counsellor on whom she can rely with confidence. 
It is far from our purpose to attempt the instruction of the experienced physician. Such an one will find no fault with our effort to inform his patient, and cause her to estimate the value of her own life, and his services correctly. It may be that some of those who will condemn our book with the most force, would act more wisely by studying its contents. Let not this expression be thought a proof of our own want of modesty; we ourselves are entirely conscious of the great value of the labours of those accom- 


309 
DROPSICAL STATE OF THE LEGS. 
plished and studious men, to whom we are indebted for all we know on the important subjects we have endeavoured to adapt to popular instruction. The frequent acknowledgments we have had occasion to make throughout this volume will, we hope, free us from so ungracious an accusation. 
At a future period, it is our intention to continue this subject, with more especial and definite allusion to the influence of the imagination of the mother, during gestation, upon the development of the infant. This subject is one of the most intense interest that can be presented to every mother who desires the intellectual and physical elevation of her offspring. In connexion with some of the diseases of more advanced life, it will form the subject of a continuation of this treatise, and will be published as soon as we can judge of the estimation of our present effort. 
THE END.