<:d gc m c«d CC d ect ccec d - 187 Defects in the action of the womb - 190 Delivery by forceps - - - 192 Difficulties from after-birth at the mouth of the womb - 196 Labour with convulsions - - - ib. Cases of common occurrence - - 197 Rare cases, from Dr. Bard, of the turning inside out of the womb, called inversion - - 202 Letter Ninth - 209 General remarks on the treatment of women after delivery - - - - ib. Directions to be observed for preventing diseases, and producing a flow of milk - - 211. Diet - - . _ 214 Of giving milk - 218 Diseases of lying-in women - - 221 Fainting after delivery - - ib. Chills - 222 After-pains - . ib. CONTENTS. Pag*. Local inflammation ... 223 Inflammation of the breast - - 224 Sore nipples - - * •• - 227 Milk fever - 229 Child-bed or puerperal fever - - 230 Miliary fever - 232 Common fever - 235 Swelled leg - ib. Madness or mania - 237 Letter Tenth - - 239 General remarks on the treatment of children after birth - ib. Means to prevent their taking cold - 240 First washing and dressing navel - - 241 First application to mother’s breast - ib. Rules for giving nourishment - - 242 Raising children without the breast - 244 Moving children ... 245 Diet of mother on account of the child - 246 Daily washing in warm water - - ib. Rocking children - 248 Proper place for them to sleep—new plan - 249 Daily causing them to open their bowels - 250 Of abundance of air for them - 251 Of their clothing—to be neither excessive or defec- tive - 252 Exposure to sun and rains - - 253 Simplicity of diet recommended - ib. Bad effects of cake - 254 Of excess and changes in their diet - 255 The time for Weaning children - - ib. Teething of children - - 256 Cutting gums universally recommended - 257 CONTENTS. XIX Pare. Teaching children to govern themselves - 259 Tetter Eleventh - 2G1 Diseases of children - - il>. Of early colds - 262 Eruptions of the skin - - ib. Sore eyes - 263 Swellings—excoriations - - 264 Hooping cough - 265 Of the croup - ib. Wind in the stomach and bowels - - 266 A sickness with or without throwing up - 269 The thrush frog, or sore mouth - - 274 Sore and scald head - - 278 The measles - 280 Of cholic ... 285 Of convulsions ... 287 Of fever ... 291 Of worms - 299 Of mumps ... 30i ,Of cow pock .... 3Q3 Of chilblains ... 304 Of scalds and burns ... 305 Itch ... . ib. Bowel, or summer complaint - - 307 03* The reader is requested to correct, in page 103, line 22, as fol- lows : erase in and insert i-tlro in the word inversion. LETTERS TO LADIES. LETTER I. Containing reasons why Ladies should attend to tin: subjects of the work. THE influence of pure, delicate, and cleanly women in society has long been the subject of remark. With the appearance of but little power, they have borne a sway more irresistible than that of males. When mothers have been noble or debased, it has often been the consequence that men have been refined or depraved. In no age has violence imposed on the placable spirits of the sex, without severe suffering; not so much from present loss of pleasure, as from reaction on the rising generation. The interest, the affection, the duty of all require that every effort should be made to preserve women delicate and virtuous ; to keep them out of the way of tempta- tion, as well for the present as succeeding societies. No- thing can be more certain, than that in defiance of our wishes and expectations, our own daughters will partake more or less of the prevailing manners of the times ; will be pure and refined, or indelicate or unprincipled, accord- ing to their associates. It is therefore obvious, that by assisting in the establishment and preservation of good practices in the community, we assist in perpetuating them among those dearest to our hearts. It was, ladies, from very sincere feelings to promote your welfare that I designed this publication ; feelings, 22 increased by the hope of its tendency to prevent practices I deem improper, from extending to my own female de- scendants and dearest friends, whose shield and whose powder, in common with their sex, should rest on their vir- tue, their delicacy, and their usefulness. My'first object was, to arrest the useless, the indelicate, the injurious, yet growing practice, of calling on men midwives, in common cases of births; the second object, to ensure better treatment of yourselves and children. In soliciting your attention to this subject, it is not my desire to make you midwives or physicians. I only ask you to learn the principles of the facts you have already learnt, while gratifying the universal curiosity on the sub- ject of the birth of man. Accurately understand, at least the outlines, leave nothing to fancy, and you will be able to command, to render important services in scenes where you have appeared as idle, useless spectators. You will be able to direct ignorant attendants, as physicians direct nurses at the bed-sides of those delicate patients refusing to exhibit their persons. You will not only save the ex- pense of male attendants, the wives from disgust, and hus- bands from mortification, but what is of vast importance, indeed, you will always be able to detect, and forbid the officious meddling of the ignorant midwives, sometimes terribly destructive to mother and infant. The great im- portance alone, of giving these common women proper directions, enabling them ever afterwards to act with pro- priety, ought to be a sufficient inducement for all of you to attend to this subject. Many of you pay great attention to the preparation of compositions for eating, you do not consider it improper to learn that this food is ground under the teeth, blended with saliva, swallowed, digested, and then passing through the bowels, is discharged by the organ and at the orifice assigned for the purpose. Truly then you ought not to think it strange, that I should request you to acquire a knowledge of the preparation and passage of the human body. None of your mixtures for eating, nothing in truth, that you have learnt, can be of greater importance. You can acquire all the necessary information in less time than you require for a novel. The famous Cleopatra of Egypt is said to have studied, and written for the public on the subject. Should affectation of feeling induce you to say that it is too indelicate—how inconsistent will be such an assertion with an unnecessary exposure of your persons at births, to the hands and eyes of physicians. Indeed, it is on account of your delicacy, that I intreat you to acquire valuable information respecting your own structure. Nature has given you functions to perform, every body knows you perform them ; and can you se- riously think there is as much indelicacy in endeavouring privately to acquire accurate information, as there is in your neglect to do it, rendering it almost indispensable to expose yourselves to the hands and eyes of strangers ? There is not the least reason in the common aversion of mothers for their daughters to be acquainted with the his- tory of generation before their marriage. Ignorance of any subject appearing mysterious, naturally tends to the excitement of curiosity ; and it is very likely this ungrati- fiecl curiosity to learn the nature of generation, has in- clined females to dishonourable connection. According to reason and common sense, assuredly it must appear, that for inquisitive girls to act with prudence, it is best they should be instructed plainly, that they should be told, as Milton represents an angel sent to Adam in Paradise, declaring, that sexual connection is not the heaven or hap- 24 piness of a rational mind ; that it is an operation common to brutes. Learning that there is nothing so greatly de- sirable about it, so wonderfully mysterious, they must be less inclined to yield to a dishonourable prostitution. They will the more readily believe, that to be rational and proper, there must be a refined regard for the object of their love, and their union with him, consummated accord- ing to the usages of the virtuous. Indeed, it clearly ap- pears to my mind, that a young lady, understanding the whole subject, not having had her fancy inflamed by a mysterious silence, could not be prevailed upon to tarnish by her conduct, the honour of her sex, and dignity of her family. But this is not the serious object of my present solici- tude. It is to wrest the practice of midwifery from the hands of men, and to transfer it to women, as it was in the beginning, and ever should be. I have seldom felt a more ardent desire to succeed in any undertaking, because I view the present increasing practice of calling on men in ordinary births, as a source of serious evils to child-bear- ing : as an imposition upon the credulity of women—and upon the fears of their husbands : as a means of sacrificing delicacy, and consequently virtue: as a robbery of many of the good common women of their proper employment and support. Truly it shows as extraordinary a revolution in practice, as any afforded from a survey of all the arts. That all females do bring forth their young without assist- ance, excepting the human in a state of civilization ; and that women should call for the assistance of men, the only animals tormented by jealousy, is a fact that will scarcely be credited in a Turkish Harem, or by the Christians of some future and purer age. Should the strangers to the practice, inquire if our men have large unwieldy hands— great curiosity about women ; should they ask if our wo- men had the requisites for useful services—small hands— good sense of touch, and patience in Attendance—they will absolutely deny this monstrous perversion of the course of nature. From the peaceful and retired occupations of women, they are generally more numerous in the community than men. Nevertheless, the men have assumed several of- fices, properly belonging to the weaker sex. The natu- ral consequence is, that many women, as men in similar circumstances, wanting profitable occupation, seek the em- ployments of the vicious. In as much, therefore, as these men midwives have meddled with this proper business of women, they have been instrumental in the depravity of many. Indeed, it is owing to their acting where they are not required, that the female practitioners are so often ig- norant—not having the opportunity or means to qualify themselves for attendance on ladies. Several observing moralists have remarked, that the practice of employing men midwives, has increased the corruption among married women. Even among the French, so prone to set aside the ceremonies among the sexes—the immorality of such exposures has been noticed. In an anecdote of Voltaire, it is related that when a gentle- man boasted to him of the birth of his son, he asked who assisted at the delivery: to the answer a man midwife, he replied, then you are travelling the road to cuckoldom. The acutely observing historian of nature, Count Buffon, (on puberty) observes, “ virginity is amoral being, existing solely in purity of heart. In the submission of women, to the unnecessary examinations of physicians, exposing the secrets of nature, it is forgotten that every indecency of this kind is a violent attack against chastity—that every situa- tion which produces an internal blush, is a real prostitu- tion.” It is very certain, where these exposures have been most common, as in large cities, there adultery has been xftost frequent. Be it folly, or prejudice, or not, there is a value in the belief, that the husband’s hands alone are to have access to his sacred wife. Break through the preju- dice, if you please to call it so, but for once, unless pow- erful reasons command it, the rubicon is passed; and rely upon it, the barriers, on future emergencies, will not be>o insuperable. Time and opportunity to press on a grateful heart, for a favour in regions where magnified favours have been conferred, have been used, and more frequently de- sired. To convince you of this, you will not require me to enter into the secret history of adultery. Many of these modest looking doctors, inflamed with thoughts of the well-shaped bodies of the women they have delivered, handled, hung over for hours, secretly glorying in the privilege, have to their patients, as priests to their pe- nitents, pressed for accommodation, and driven to adultery and madness, where they were thought most innocently occupied. In one case, I was well assured, that a physi- cian in Charleston, infuriated with the sight of the woman he had just delivered, leaped into her bed before she was restored to a state of nature. The melancholy tale of the seduction of the wife of a member of congress from Caro- lina, by her accoucheur, is a warning that ought not to be disregarded. The beautiful organization of the lady prey- ed on his mind for years : he sought her from one to the other extremity of the country, regardless of all dangers ; and on acquiring his game, received a premature and vio- lent death—leaving horror and ruin in the family he had been hired to serve. Whatever you may think on this subject, there are many 27 husbands to whom the idea of their wives’ exposure of per- son, is horribly distressing. I have heard of cases, afford- ing singular mixtures of the ludicrous and distressing. In one case in my neighbourhood, the husband sent for his physician to his wife in labour, yet was so strongly excited at the idea of her exposure, that very solemnly he declared to the doctor, he would demolish him if he touched or looked at his wife. No man possessed of a correct and d( licate regard for his wife, would subject her to any exposure to a doctor, that could be avoided without danger. But the opposition, the detestation of this practice, can- not he so great in any husband, as among some women. The idea of it has driven some to convulsions and de- rangement ; and every one of the least delicacy, feels deep- ly humiliated at the exposure. Many of them while in la- bour, have been so shocked at the entrance of a man in their apartment, as to have all their pains banished. Others, to the very last of their senses, suffering the severest tor- ments, have rejected the assistance of men. There have been many of this description in all ages ! virtuous and sainted souls—-they preferred dying in all the agonies, the throes, and the convulsions of fatal labours ! They did err on the side of delicate feeling ! but their errors will be blotted out for ever ! To be instrumental in relieving one of this truly interesting cast, will be a heavenly conso- lation to all who can be alive to the pleasure of serving the virtuous. It requires but a little understanding of this subject, to enable you frequently to prove of great service in remov- ing the fears and forebodings of many ignorant sufferers, who imagine that only professional skill can afford relief. Many such objects of commiseration have languished day 28 after day, solely from the want of a little information in one of the attendants ; all unnecessarily lamenting that physicians cannot be procured. By a little information, you can at all times prevent the miserable mutilation of mo- ther and child, which has frequently been committed in a shocking manner, solely from the grossest ignorance. In- deed, to be able to say to ignorant widwives, fancying they must be doing something continually, “ Thou shalt not in- terfere—thou shalt not meddle with nature,” will alone be sufficient to effect essential service. On other occasions, and in all parts of the country, sudden labours coming on, before proper attendance can be had, you will be able to do important good to mother and child. One case of suffer- ing of this kind, from want of assistance, in my opinion, is a great reflection on the ladies who are convenient for at- tendance. Indeed I think it disgraceful, that any female should be allowed to grow up in ignorance—in pursuit of pleasure, too fancifully nice—so falsely delicate, as not de- liberately to get so much knowledge in one hour, as will enable her to do, or to direct the unlearned servant, how to perform the little offices required on the emergency, to which all of them are subject. It is not to be disguised, that all classes in the communi- ty have to deplore the loss of some friend in child-bed. Many are mourning at the loss of amiable wives—victims to what ought to have been the subject of their joy. Pa- rents are still lamenting the premature death of their daughters—buoyed up with the hopes of feeling as mo- thers, when the pains of labour were forgotton. Innume- rable babes have been sacrificed in the most afflicting man- ner ; many of whom may have become ornaments to their country. All such calamities may have been prevented, if but one lady in: the neighbourhood of each case, had 29 have devoted but a part of the time spent in guessing about the operation, to an accurate knowledge of the subject, so that she might have directed the ignorant and meddling attendants. It is said the Lord declared he would save the city of Sodom if but ten men were found good in it; and surely it is equally certain, that the whole of you should attend to this subject, with the prospect, even that pnlv ten might be called on to render the needful assist- ance. Every day shows that the practice of midwifery .re- quires no particular skill, no superior knowledge, no slight of hand, nothing beyond the most common sense and observation, to do all that is required with perfect success. Nature has so wisely provided for the birth of the young, that even the extensive practice so highly rated among ladies is not necessary for the discharge of all the duties required from attendants. The male practitioners, who in general, from accidents, have got into great repute, received their first impressions from books, from direc- tions which any one in the country can comprehend. The increasing applications to these women doctors, remaining satisfied with such business, are really made in vain ; for most commonly, in qualifications they are not far removed from the sisters of the profession. Physicians of the best abilities, discovering, that it is by the fingers instead of the talents, that many get the most profitable business, attend to this subject only in the beginning. An introduction into better occupation, excepting in the cases of their fa- vourites, is almost invariably followed by an abandonment of midwifery ; so that the ladies have often to look out for different attendants. In some parts of our country, the negro women, feel- ing their ignorance, and fearful of hurting their mistresses, 30 hesitate in acting, until they accidentally discover the pow- ers of nature; then they obtain great reputation in the practice of widwifery, rivalling the most renowned doc- tors of the trade. They soon discover the secret, that nature does all the business, and that they have only to keep themselves quiet, and pocket the credit of the ope- ration. During the simplicity of the early ages, women alone officiated at births. In Egypt, the cradle of so much sci- ence, they were the sole actors. At Athens a law was passed forbidding them to practise ; but from persever- ance among the delicate, preferring death to exposure, the law was speedily repealed. Since then no government, it is believed, has been so ridiculous as to compel such un- natural interference. In consequence, the practice has been confined to women, until within a few years, in some European countries and their colonies. The excessive spirit for meddling with women is no where so great as in France. They are so fond of indulging their curiosity at births, that they even attend on the domestic animals in labour. Mr. S. told me, that he witnessed the operation by a professional character for cows. The cow, dis- pleased with his intrusion, made all possible resistance ; and when it was over, for hours endeavoured to attack the meddler. There is a stronger sense of propriety among the northern neighbours of the French. The Danish go- vernment, viewing the employment of men midwives in natural labour, as highly improper, established schools for the instruction of women in the principles of midwifery. Several of the German states have imitated the example. The American government should establish such institu- tions. The legislators in congress would thereby render the nation more essential service than they have done for years. 31 If the difficulty of obtaining doctors at the proper time ; if the indelicacy and tendency to immorality of having them in any but the critical and unnatural cases ; if the propriety of giving to helpless women proper encourage- ment and support; if the salvation of many women, who, shocked at male interference, have their pains vanished, and minds deranged, and who sometimes prefer death to exposure ; if the salvation of many children born al- most without warning ; if the prevention of the destruc- tive interference of ignorant attendants cannot, united, induce you to attend to this subject, the mechanical ad- vantage between a man’s and a delicate woman’s hand, ought to command your decision, in favour of employing and encouraging female assistants. Such is the confined organization of the parts for our birth, and such the large size of men’s hands, that I verily believe as much mischief as good has been done by them, as has been stated by more extensive observers than myself. I con- clude with the remarks, that when professional assistance becomes necessary, from unnatural occurrences, the case is altogether altered. The exposure is not of parts in a natural state, but deranged ; the woman becomes a pa- tient for his operation; is a subject of commiseration ; and the solicitude to remove her danger and agonies is the only thought a man can have. In such cases, there ought not to be the least hesitation in the female to submit to examination ; there is no indelicacy in it. Religion, future usefulness, command that life should be preserved at the expense of an hundred such sacrifices. The rule that I would prescribe to the females for whom I felt most affection and solicitude would be that which I now urge, on no account submit to the interference of men in com- mon labour ; do it most readily in the uncommon cases, when a nurse under the direction of a physician cannot af- ford relief. I will venture to add, that there is not a phy- sician, disinterested, of sound sense, who would not ap- prove of the rule. The best authors on midwifery decid- edly recommend it. An acquaintance with the subject of these letters will enable you to be of service to more than those in child- bearing. The rational treatment of your own peculiar disorders, often so injudiciously conducted, the prevention and cure of children’s complaints, so interesting to every woman of extended feeling, are taken into consideration ; subjects well worthy of your serious attention. If no other benefit can be derived, but that of preventing the administration of improper doses, it will not be inconsider- able. Many disorders are rivetted in you, and especially in children’s constitutions, by taking articles contrary to the indication for cure. So many of you are inclined to quackery, to believe in stories of cures from the prescrip- tions of common people, that it is an important point to impress on your minds, that our bodies are subject to laws, our diseases to be cured according to principles. If you will seriously believe this, will believe that medicine is a rational science, you will increase the respectability of the profession, and your own safety, by always selecting for your physician the man of sound mind, who reads the books of his profession, instead of the pliant, fin cal, “ lady’s doctor.” You will discover that your diseases are to be prevented and cured ; not by the compounded trash of apothecary shops, but chiefly by the rational use of what may be termed the family materia medica. Cold and heat, in water and in air, bleeding, rest, exercise, me- chanical irritation of the skin, an oiled feather to excite vomiting, and glysters to excite purging. 33 LETTER II. Contents. Cleanliness—warm bath—advantages from its daily use—care for rheumatism—air bath—cold and sea bath—local washing—puri fication of feet—certain prevention of colds—purification of arms—great ad- vantages of sitting daily in cold water—regular evacu- ations—certain cure of costiveness—prevention and cure of piles—warts—boils—fistulas—excoriations—mouth —preservation and extraction of teeth—tooth powder— of the skin—preservation of its beauty—means of pre- serving general health—softening the hands. An attentive observer of mankind has said that all per- sons are pleased with the odours escaping from their own bodies, while no one likes those from another, of the very same nature. Although Dr. Swift defines a cleanly per- son, one with nasty ideas, yet we are all most pleased with the cleanly ; I mention this, as introductory to some most disagreeable, though useful reflections, necessarily contain- ed in this letter. In order to find out that “ heavenly Chloe,” may be dis- covered by the nose, the smelling powers of a dog, which can trace, through fin immense crowd, the footsteps of his mas- ter, are not necessary. One with very moderate smelling powers can perceive the odour of several parts of the body, and however agreeable when from one’s self, is very disgusting when, as is too often shamefully the case, strik- ingly perceptible in others. It is a fact, that daily some of the finest, most tender excitements of love, are shocked away from men and women by the discovery, on a near approach, of some of these offensive odours. You are spoken of, in the most disgusting manner, particularly by the lower classes of society, on discovering that you may be smelt as themselves. Moreover, men of sense really consider your virtue as intimately connected with the cleanliness of your person and habits. Count Rumford remarks, “ with what care and attention do the feathered race wash themselves, and put their plumage in order ; and how perfectly neat, clean, and elegant, do they always appear \ Among the beasts of the fields, those which are the most cleanly, are generally the most gay and cheerful ; or are distinguished by a certain air of tranquility and con- tentment. So great is the effect of cleanliness upon man, that it extends even to his moral character. Virtue never dwelt long with filth ; nor do I believe there ever was a person scrupulously attentive to cleanliness, who was a consummate villain.” Indeed, it would be difficult to imagine the reason why females were so constituted as to become offensive to the nose, unless for the purpose of suppressing too ardent devotion in males. One might sup- pose, that nature designed this quality as a defensive wea- pon ; agreeably to which, I would suggest, to those ap- prehending a rape, to insure protection, by rendering themselves as disgusting as possible. In every practica- ble manner, on the attack of the assailing villain, the body may be rendered so offensive, as to subdue the brutal pas- sion of the ravisher. Although the liberty of indulging in the worst filth be excusable in such cases, yet, in no kind, in the slightest degree, is it to be tolerated in decent so- ciety. I have always thought it a reflection upon every lady in a company, an insult to each member, for one of 35 them to be discoverable by means of the nose. It would be a moderate punishment, if establishing the rule you would invariably strip and scrub, from head to foot, in spite of all resistance, every unclean person. Indeed you ought to consider the purification of your bodies as the more im- portant, since it is an unquestionable truth, that the best means of doing it, most wonderfully promote health, pre- vent and cure several diseases to which you are liable. You may be the more disposed to believe this truth, by knowing that the diseases of the body are much more un- der the controul of those articles nature has abundantly supplied around us, than the various mixtures administer- ed a physic. Physicians of greatest intelligence will tell you, that a correct knowledge of the proper use of the most common articles, will avail you more than a knowledge of every medicine. You ought, therefore, to correct your partiality for dependence upon nauseating doses, from dis- tant countries, in preference to the remedies at hand for every family. One of the greatest mistakes most frequently committed by young ladies, is the anointment with perfumes, to sup- press the natural exudations. It is seldom that this does more than partially suppress the effluvia, and but for a short time : it often does injury, by stimulating the skin to diseased action ; and it never fails to suggest to others, that the contrivance is resorted to for the suppression of stronger fumes. As I positively assure you, that I am ac- quainted with superior means of correcting such smells ; means which c\o no possible injury, never fail of success, and essentially promote health, you ought certainly to abandon the use of all such perfumed compounds, and give the prescription a full and fair trial. You ought to be apprized, that it is extremely preju- dicial for the secretions of the various parts of the body, to remain on them. The matter adhering, acts on them somewhat as infectious matter to the body, causing the secretion of more of the kind. The secretion adhering to the surface excludes the air, and stimulates the parts un- derneath, which the more rapidly secrete ; in some cases, particularly with fat women, to such a degree, as to render the atmosphere around them excessively disgusting. The remedy for such a state is the same as that for prevention. It is not to apply any thing to the part, but to remove, in the best possible manner, the matter on the surface, so as to allow the contact of cool air, and the insensible evapora- tion to go on. The best means of removing the filth from the surface of the body, consist in the use of an article excessively cheap—one of God’s greatest blessings to the human fami- ly. It does far more than dissolve, cleanse, and purify every part ; it prevents and cures several of your serious complaints. Considering the vast importance of this in- valuable article—how often it has escaped your notice— passing it by as beneath attention, I am at a loss how to introduce its name. In order to make a deeper impression, I wish I could rouse all your faculties at the development —that I could extort from you a solemn resolve, that it shall be treasured in your remembrance, and daily used in unabating ardour. You need not smile at this pomposi- ty, in introducing the name of this universal cleanser ; for if you had never known of it, and could henceforth be pre- vailed on to give it the fullest trial, you would do homage to its powers more extravagantly than I could speak of them. Hear, then ! and remember, it is hot and cold wa- ter freely applied to every part. Doctor Sangrado never 37 extolled it half so much as it ought to have been, when sup- ported by “ soaking and elbow exertion.” The most effectual means of washing the whole body, is to immerse it for a few minutes daily, in warm water, at the same time rubbing it with a coarse hair brush, to take off the scales and filth of the skin. This entrance in the bath will have a most powerful effect indeed, in prolonging your lives, and exempting you from disease. I cannot say too much in favour of the cleanly, healthy, invigorating practice. An idea of the vast importance of washing the whole skin of the body in a bath, may be formed by adverting to the effects of it among the Romans. Physicians were of a respectable order in the community, until bathing became general. The free use of the bath prevented so many dis- orders, ending in such inconsiderable demand for doctors, that barbers performed their ordinary duties. In like manner, the standing of the medical faculty was reduced in France, after the general introduction of the bath. The French women are particularly partial to free washing ; and in consequence, seldom think of a doctor, excepting for the fashionable occasion of an accouchment. An American physician who visited Paris for the purpose of improvement in his profession, assured me that he had often endeavoured in vain, to smell the odours with which we are so frequently assailed in this country—sometimes among persons in elevated stations. The experience of those in our own country, who make a daily use of the bath, is just as impressive. They are not subject, in general, to half of the disorders afflicting those who suffer their skins to remain besmeared and co- vered with the exudation from the pores. The females of the southern states, who frequently bathe during the sum mer, derive great benefit from the operation. The advan- tages derived from visiting the water places, unquestion- ably depend more on the washing of the skin, than on any medical qualities in the water. Indeed I think after viewing this subject in the fairest light, on account of humanity and pleasure, every person ought to be compelled to bathe daily in warm water. The means of warming water are in the hands of every one, without incurring the expense of additional fire. If a small excavation be made in the funnel of chimneys, a pot may be fixed, around which the smoke passing, will give a sufficiency of its heat to make a large quantity of water of the requisite warmth. But the plan giving least trouble, is that of heating water to scald hogs in the country. It is to put stones and old irons into the fire, and when heat- ed, to throw them to the bottom of an open mouthed barrel of water. Two or three of such bodies can always be kept without inconvenience, in every fire-place, and will suffice in a few minutes, to make the water of the proper heat. As soon as this is done, they can be removed, and the per- son sitting in the barrel, will have a most pleasant mode of purifying every part. I consider the suggestion of apply- ing this mode of warming water for your daily baths, as worthy of your remembrance and observance. Rheumatism, I ought not to pass over the subject of the warm baths, without alluding to its efficacy in preventing and curing rheumatism. I do not mean to say it is a cer- tain cure, but it is assuredly one of the greatest ever dis- covered. In an extensive ward of a large hospital, I have seen it the only prescription; and only a few were not relieved by it—these few essentially benefited. The wa- ter should be very warm, and the patient remain in it from 30 minutes to 2 hours, having his skin well rubbed during 39 the time. On coming out, the part affected should be co- vered with finely carded cotton, which has been found re- markably efficacious in relieving the pains of long standing rheumatism. Flannel bandages passed around the affect- ed limb, have been also found efficacious in this disease. Air Bath. Dr. Franklin discovered that our health was considerably promoted by exposing our persons naked every morning to cold air for a few minutes, and then re- turning to bed a little while before dressing. This ex- posure to air favours evaporation from our skin, and has considerable effect, therefore, in cleansing the body, in- creased by the glow, or sense of heat felt on the surface, which promotes the evaporation, while it tends to prevent internal disorders. Much good would result from its universal observance. Cold and Salt Bath. The use of the cold bath every morning could not fail to answer the purpose of promot- ing health, more effectually than the air bath. Persons generally suppose a great deal of water is necessary to be poured on the body, but it is a mistake. The object is to shock the system, so as to rouse action on the surface ; and a quart of water splashed on the back suddenly, and running around the body and down the legs, will answer all the purpose. Instead of the ordinary preparations, to stand on the hearth, and some one, (or one’s self can do it) to turn over on the back the water in a basin or cup, is all that is necessary. When it is desired to use the sea bath, you can always have it by adding half a pint of salt to half a gallon of water. The salt assists in stimulating the skin ; and is such a powerful remedy, that it will much more certainly cure periodical diseases, as intermittent fever, than Peruvian bark. It gives such vigour, is so cheap, that it should be used daily in every family. As I shall frequently prescribe this mixture, I wish it to be re- membered under the name of the salt bath. The substi- tute for general bathing is local washing ; and I com- mence with the feet. In some persons they are so disgusting, as to be into- lerable ; and persons taking up the idea that it is natural, give themselves no trouble about purification, unless it be now and then to make them worse, by putting some per- fume on them. But there is nothing more certain, than that the smell may always be prevented, by constant daily washing in soap and water. They should be rubbed and scraped hard. It is proper to guard against wearing old shoes, as old leather increases the odour. Before I pass over the subject of the feet, I wish to communicate to you a real discovery by an old woman, for preventing the colds or catarrhs, which annoy so many of us. It is, every morning before dressing, to dip the feet in a basin of fresh cold water, to wipe them immediately, and return them to bed for a little while. A glow will be felt, which is a proof of the determination of blood to the part ; a determination, which will prevent your receiving colds one tenth as often as you have had, or otherwise might have. The practice can do you no possible harm ; and I entreat you to ob- serve it, because I am positive, that in addition to the cleanliness of the practice, it will shield you from many attacks, probably even from those that might end in con- sumptions. The best remedy for colds is to toast, to scorch the feet every night for an hour or two before go- ing to bed. The smell of the arms is another point to which more attention should be paid than generally is. Per- fumes do here no good. It is water and soap, hard scrubbing, that purifies this region. An idea has been entertained among many, that this is naturally in some 41 cases too strong to be relieved by washing. But it is a mistake. I declare, that there is no case in which the arm pit cannot be made perfectly mild in its smell, by daily rubbing with soap and a wet cloth. Lime water is a species of lye, and has been preferred by many. When the hair under the arm has been allowed to remain as it were matted in the secretion of the part, the more persever- ance will be necessary. Among those who smell so very rank, I would advise the cutting off the hair in the be- ginning, so that the daily washing may be more effectual in cleansing the skin. I conclude this subject with the re- mark, that, considering the certainty with which ladies can relieve themselves from this smell in the way pointed out, there is some excuse for the frequency with which they are laughed at by their male attendants, for the puffs in- haled from the arms. The next subject for which I have to request your at- tention, is the most disagreeable, but it is best to state it plainly at once ; it is the smell peculiar to the posteriors and the adjacent parts. The large quantities of fat in this region with the numerous glands, tend to keep up a constant profuse secretion of strong smelling matter, es- pecially after walking, the most disgusting that comes from our bodies. I have heard some ladies more condemned for neglecting to free themselves from this effluvise, than for any other negligence. Some of them really have in- dulged in it so long, as not only to appear partial to it, but to fancy that others must have the same relish. I once knew a physician refuse continuing his visits to a fat lady of wealth, because of the excessive disgust this smell, arising solely from her laziness, gave him. I hope you will pay the more; attention to what I have to urge for keeping these parts clean and inodorous, as truly the means will have a powerful tendency to establish and pre- serve your health, since the parts are intimately connected with the general system. The great secret for cleansing, and exempting these parts from disease, is, ladies, do pray remember it, to sit night and morning in a tub or piggin of cold water, with or without soap ; and for four or five minutes splash and rub the water around. I feel my want of powers to im- press the importance of the observance of this practice. The prescription should be observed from the oldest to the youngest, male and female. The posteriors of most animals are naked ; so that, what is secreted is speedily evaporated, with the consequence of their total exemption from dis- order. Children frequently throwing up their clothes, so as to ventilate themselves fully, have but few complaints of these parts, and it is certain with us, they would be more healthy, if more exposed to cold air. The substi- tute for this exposure is cold washing. The matter se- creted around is dissolved, and goes oft' with the water, leaving the air to take off what is afterwards formed in imperceptible evaporation ; while the tone of the parts becomes so improved, the action of the vessels so lessen- ed by the cold, that the quantity and quality of the secre- tion cease to be subjects of attention. If I can but prevail on those of you who can get pig- gins and all who cannot procure them, to go daily at the edge of a brook, and to sit in cold water for a few minutes, I shall render you more real service than I could by en- abling you to double your fortunes. Indeed, this fre- quent washing in cold water will prevent your having that distressing complaint, called the piles, as also any kind of boils, fistulas, or inflammations of these parts. Another great and important advantage of the practice, is the tak- 43 ing away from the birth place, the secretion of the ad- joining glands, which is apt to become acrid and offensive; and then irritate and excite the external sources of sexual feeling. There is no doubt, but that such irritation is the cause of premature desires, prostitution, hysterical affec- tions, and diminished growth of the body. As all ani- mals have their growth diminished by such excitements ; mothers ought to guard their daughters not only against this, but too early hugging, toying and amorous conversa- tion, which produce the like action. The practice of this cold washing, at least at night, will prove so highly advan- tageous, that I cannot avoid feeling anxious to induce you, universally to do it. As soon as you get in the habit of it you will find it no trouble, a source of far more agreea- ble feeling at the time, than washing the face and hands. I beseech you to entreat all your acquaintances, to direct all your servants to follow the advice. While on this subject, as of equal importance, I would earnestly recommend the visiting daily the necessary at the same hour ; never going before or after the fixed hour, unless disease exists. You have heard of great effects pro- ceeding from inconsiderable causes, and this case affords an instance. The diseases brought on by the supposed trifling cause of retaining the contents of the bowels, are great indeed. The retention by the bulk of the matter, produces irritation in the surrounding parts, marked by piles and boils: next, the matter which should be discharg- ed ferments, generates large quantities of foul air, which passing through the bowels, stimulates to diseased action, as any other fumes introduced would certainly do. You will readily admit this, if you will advert to the difference in quality and quantity of the wind escaping from the bow- els, when the contents are long retained, or speedily dis- charged, as often exemplified in children. Most of the cases of colic and indigestion, arise from this cause : also frequently dysentery, and all the diseases arising from parts sympathizing with those affected. The habit of evacuating the bowels, may be acquired by every one who will take the pains to attend to the means ; and this will insure a total exemption from the distressing costiveness of which so many complain. Our systems have been called a bundle ot habits : they are perpetually inclined to do one day, what they did the day before. You must have observed the remarkable regularity in the re- turns of appetite, thirst, sleep, agues, bleedings, and the like periodical excitements. My object is to prevail on you to avail yourselves of this tendency of the system, to establish this habit, to let nothing prevent you from attending to it afterwards. In the beginning, efforts will be necessary ; you must be accurate in observing the hour, never going before or after it, unless you are diseased. In obstinate cases, you should use what is called the “ sailor’s remedy;” which is, to push up the fundament a piece of hard soap, shaped as the little finger, and hold it there until the eva- cuation comes on. A similar cut piece of wood, with a soaped or greased rag around it, will answer, as also the oiled finger. By persevering in such attempts, the habit will soon be fixed, and it will remind you of the approach of the hour without fail. Again I beseech you to perse- vere in the attempt, although disappointed in the beginning. The advantages resulting, would compensate far greater labour. If you fully knew the enormous quantities of physic swallowed for correcting costiveness, the variety of diseases brought on by retaining the decomposing contents of the bowels, you would not require again to be told of this certain remedy. I will add, the efforts had better be 45 made in a necessary open at bottom, for the cool air, on tha principle of Dr. Franklin's air-bath, before described, will evaporate the moisture of the parts, and rouse to a new ac- tion and determination. This will be infinitely more saluta- ry, as it is more cleanly, than the lazy, disgusting habit of some women who use pots in their rooms. Piles. This presents itself as a proper place to state what should be generally understood on the subject of the piles. It is a disease which almost every one has at times, varying in degree : from moderate inflammation of the fundament, to the formation of tumours. In the beginning, the anus and its edges, have their sensibility greatly increased : there is a sense of soreness, a feel as if innumerable sharp points were perforating the parts. There is generally an increase of the secretion of the mucus of the part, erroneously sup- posed the cause of the complaint, as its seat is in the hard parts, the fibres and vessels. Sometimes the inflammation increases considerably, as does the swelling ; which often terminates in tumours of a dark colour, which bursting, discharge a dark blood, that affords present relief. At other times, the pain extends up the gut, constituting what is called the blind piles. The disease is apt to be attend- ed with fever, and to return at intervals. The prevention of this loathsome disease is ensured, as certainly as that you exist, by daily washing the fundament in cold water, especially after every evacuation from the bowels. When, from riding or walking, there appears to be an increased feeling in the part, there should be an im- mediate resort to the use of water. I never knew or heard of one person who ever had the piles, who took the trouble of using this cleanly ablution. The cure of piles may generally be effected by the hour- ly application of cold water, made more so by ice, particu- 46 larly if aided by abstinence in eating and drinking, and rest. When the disease is considerable, it is best to apply a solution of sugar of lead, a tea spoonful to the pint of water, and to keep a rag wet with it constantly on the in- flamed parts. I have seen the most distressing cases of it cured by cold water alone, much sooner than by the old modes, with nut galls, alum and supposed astringents. In cases attended with fever, you should bleed, and purge with salts, oil, or calomel, to be repeated until the fever and inflammation subside. When the pain is violent, in addition to the iced and lead water, sweet oil should be applied : mild mercurial ointment is also proper. When the pain is up in the bow- els, more evacuations are proper than in the other cases ; but above all, inject freely, every hour or two, cold water. If the pain be great, add two grains of sugar of lead to each injection. Proper attention to this may save you from the most miserable condition that disease can b‘ ing you to. Warts. The parts about the fundament are very subject to warts or tumours, particularly among those who do not sit daily in cold water. When they grow to any consider- able size, it is best to tie a small string tightly round each at its origin, or to cut them off with a sharp pair of scissors. As there is no danger in the operation, (though painful,) any one may perform it. The parts should be bathed in lead water, as above, after the operation, and mild mercuri- al ointment applied to the sores until cured. Free wash- ing will prevent the recurrence of these tumours. Boils and Fistulas. No part of the system is so subject to inflammation as the fundament; and when inflamed, to degenerate into fistulas, which are running sores through long inflamed passages or canals, formed for the passage of matter. The number of men and women who daily die in the United States, from neglecting these affections at their commencement, is in reality almost incredible, and should be a warning to you to avoid the like evil. I would have every female affected with the slightest inflammation in this part, to have before her view, until the cure be completed, the most distressing termination, in order that in good earnest she may attend to the subject. These inflammations are certainly to be prevented by frequent washing in cold water, and daily evacuating the bowels. The cure is to be effected by cold applications. An hourly application of the coldest water of ice, with abste- mious diet, and perfect rest, will be sufficient to relieve lesser degrees of these affections. But when these reme- dies have been neglected, or when the inflammation still increases, the patient should be blooded freely, should be cupped near the part, to which leeches should be applied; immediately after, rags wet with lead water should be ap- plied, and removed every hour or two. If this do not prevent the boil from forming matter, (called corning to a head, or suppuration) then a poultice may be kept on it, of any oily moist article. The moment the matter appears to be formed, and coming to a point, it should be lanced, cut straight in the direction to the anus, the orifice just large enough to allow the passage of the matter. The lancet may safely go half an inch deep : needles have been used for these boils by women, when the matter appears to be near the surface. The best instrument, giving least pain, is the common spring lancet, for opening all boils. After the opening, and the passage of the matter, a poul- tice of milk and bread should be applied ; I have used these made wet with lead water, with advantage. It is by subduing the inflammation of these boils, by evacuations and cold applications, remedies which the most ignorant can resort to with safety, that the formation of fistulas is prevented. The cold applications are to be continued some time after the cure, to prevent returns, to which the parts are generally much disposed. When the fistula is but slight, it will be practicable for a woman to cut it open, particularly if instructed by a physician. The dressings should be simply oiled lint, to keep the external parts open till the bottom heals up. In other cases, surgeons must inspect and operate ; but the necessity will seldom exist, if attention be paid to the pre- vention. Excoriations. Those taking much exercise, by walking or riding, are very apt to have their skin rubbed off, par- ticularly about the thighs. The best remedy I have ever seen tried is cold water. It is proper after washing to ap- ply some oily substance j tallow or hogs’ lard answers very well. The moment one feels any part increasing in sensi- bility, the cold water should be applied as a preventive. Teeth. The last point which I shall with solicitude press upon you, is the purification of the teeth and mouth. If possible, this is more all important for your general health, than cleansing any other part. To the scripture, that “ out of the mouth cometh forth evils,” might have been added with equal truth, w in it are engendered many.” It is inconceivable how greatly the whole system is affect- ed, sometimes inflamed, by the mouth. You must have witnessed, that a small quantity of spirit held in the mouth of a sick person invigorates the tvhole body. A disgust- ing mouthful frequently excites vomiting in persons not very delicate ; and diseases of the mouth almost univer- sally produce serious effects in other parts of the body. This being the case, as it assuredly is, dses it not appear 49 strange that so many ladies escape sickness and death* who, neglecting their mouths, have the most disgusting matter perpetually generating between their teeth, and car- ried down to the stomach, there acting as a slow poison in the excitement of innumerable disorders ? It is with the utmost pleasure that I am enabled to say to you, the evils from this source may be prevented entirely ; that you may all have what all want, a pure sweet breath, as it is called, however defective your teeth, by the means contributing to feelings of pleasure. After all the researches of doctors, quacks, and ladies, for the best dentrifice; after the use for centuries of sim- ples and compounds, hazarding the destruction of all, and ruining many teeth ; after all the inventions of tooth- brushes, stiff, soft, then with sponge, the great discovery has at last been made, that the best possible application to the teeth and gums, is an article very cheap, endangering nothing, purifying the mouth, by bringing out the offen- sive matter formed in it; which important article is com- monly called warm water ! The preservation of the teeth depends most on the pu- rification of the mouth. In order to purify the mouth and teeth effectually, they must be washed in warm water morning and night, besides regularly after eating. The water should be taken into the mouth, the lips held tight, and then freely and strongly agitated by working the jaws and tongue, so that the effects shall be felt on the gums, and the glands of the mouth, as well as on the teeth. No tooth-brush is necessary, the finger answers sufficiently for rubbing ; but if you will have a tooth-brush, let it be ol the softest kind you can procure; a piece of sponge tied at the end of a stick, answers very well ; as does a clean linen rag. Nothing can be more destructive to gums and teeth than a stiff hair brush. There is but one tooth-powder I would ever consent to be used. This is vegetable matter, as crust of bread, or common coal, burnt well, and reduced to fine powder. Objections have been made to it, from the fear of darken- ing the teeth, which are entirely groundless ; as the teeth are only darkened when their covering, called enamel, is rubbed away in consequence of the folly of using cor- rosives and hard brushes. Charcoal has a powerful effect in resisting the putrefaction of all the matter between the teeth. Those W'ho fancy there are better powders, may be allowed to try powdered chalk, soap and water, also, Armenian bole and Peruvian bark ; but they should be absolutely prohibited from the use of acids, salts, or any active article. Remember, that the enamel of the teeth once destroyed, can never be restored. When the teeth, from long neglect, become incrusted with a dark yellowish looking matter called tartar, this ought to be scraped off with a pen-knife, very slowly. There are little scrapers made for the purpose, answering with more convenience. Only the parts of the teeth that have on them the tartar, or foreign substance, ought to be scraped ; so that the sound parts will not be injured, as they always are, when hard brushes and active ar- ticles are used to wear off, and to dissolve the incrusta- tion. In cases where the teeth are “ rottening,” in order to prevent the disagreeable taint they give to the breath, it is best to push in them a small particle of charcoal. Where the hollow of the tooth is considerable, after putting in a little charcoal, there ought to be a small piece of bees’ wax pressed over it, to remain as a plug. The facility with 51 which this plug may be removed is a great convenience, as it enables you to take out at pleasure any matter which may be formed underneath. There are cases where the enamel of the teeth being broken off by some violent operation (nut cracking) a plug more permanent than wax is necessary. In such cases, a dentist should be employed to insert a plug of gold to exclude permanently from the root of the tooth, the air, saliva, and whatever else may be put in the mouth. But where the teeth are actually decaying ; and in cases where defective roots of teeth, called stumps, re- main in the sockets, excepting with pregnant women, they should in every case be extracted ; more especially in those cases where the health is delicate. The neglect to do it, has been the cause of the disease and death of mil- lions. I before hinted at the connection between the mouth and the general system. You perceive that chil- dren, teething, have a great variety of disorders in conse- quence of the irritation in their mouths. This connec- tion or sympathy between the mouth and other parts, will appear the more striking, from the facts respecting the transplanting of teeth, which was formerly done frequent- ly. Those who underwent the operation of transplanting were very often subject to diseases almost precisely like those of the venereal nature. They had enlargements of the bones, deep ulcerations, and were cured, for a short while, by mercury, which induced the belief that they were of the venereal kind. This led to the greatest cau- tion in the selection of the person to supply the teeth ; nevertheless, the same consequences ensued. At last it was discovered, that the cause of the complaints was the irritation kept up in the pockets of the teeth, by the foreign tooth inserted ; which, of course, led to the abandonment of the practice, and substitution of artificial teeth resting on the gums. Now, what I wish you to remember con- stantly is, that decayed teeth in the gums produce pre- cisely the same effects ; enlargement of bones, ulcera- tions, bowel complaints, and many other disorders, de- pending on the particular sympathies of each person. But few physicians ever think of this subject. It was very early and very forcibly impressed on my mind by two or three cases clearly establishing its importance. In one instance an elderly gentleman, repeatedly salivated for a supposed venereal taint, sent for me, and on my prescrip- tion, “ take out every defective tooth,” he laughed hear- tily ; at length I prevailed on him to follow the advice, and a perfect recovery made him a warm convert to extracting rotten teeth. Deafness has been often produced by decay- ed teeth in the sockets, and often relieved by their ex- traction. Whether you comprehend the reasoning or not, on the subject, you will save yourselves from many tormenting affections by following the advice. Indeed, I am so po- sitive of the great advantages which will result from it, that you will be fully paid for the trouble of a year’s study, if you will but remember to compel your doctors to ex- tract your decayed teeth, at least whenever you have any serious complaint. It will at all events be of essential service in lessening the irritation in your systems, inclin- ing them to fever. It will have a great tendency to pre- vent the adjoining teeth from decaying ; especially if, in addition, you will keep the mouth well cleansed with warm water, particularly after eating, and sleeping, without in- juring the gums. Tooth-ache. Before dismissing the subject of teeth, i2 will be proper to make some remarks on the tooth-ache, to which so many females are liable. The general impres- sion, that this disease is confined to the part affected, is erroneous, in almost every case ; the system is in an in- flammatory state, and requires bleeding and purging. In- all cases, except pregnancy, where the tooth is hollow, it is best to extract it. If this be declined, relief may often be obtained, by putting into the hollow of the tooth a small piece of opium, or camphor, or particles of sugar of lead, or a drop or two of oil of cloves ; the gums should always be cut. When the mouth is inflamed, or the cheeks swelled, I would advise a warm solution of sugar of lead (a tea spoonful of lead to half a pint of water) to be held in the mouth for some time, care being taken not to swallow it, and afterwards to wash the mouth with warm water; to be repeated every two or three hours* A mustard plaster, and also cupping behind the ear, or on the neck, have afforded relief; as also cloths dipped in hot water, or in vinegar and water, or in brandy and water, applied round the cheek and neck. A blister plaster on the cheek for an hour or two, to irritate the surface, and divert the action from within, is very good ; in cases of long standing, the blisters may be allowed to rise, and discharge for a few days. Those who have sound teeth, ought not to have them extracted for the tooth-ache ; be- cause, generally, the next or an opposite tooth becomes equally pained ; so that some have, without any good ef- fect, had all their teeth extracted. In these cases, it is pro- per to pay great attention to lessening the inflammation of the system ; and to diverting action from the part, by cup- ping and blisters externally, with a solution of lead wa- ter within the'mouth. Sometimes, a solution of alum, also ol white vitriol, held in the mouth in like manner, have lessened the inflammation causing the pain. Of the Skin. Having said so much on very disagreea- ble subjects, I proceed to make a few remarks on the mode of beautifying your skin. This is a subject which has attracted so much attention, that I believe, if all the money could be collected which has been expended for the object as well as in payment of physicians, for curing diseases brought on by improper applications, from buttermilk fill- ed with maggots to mineral poisons, it would be sufficient to support all the poor people in every country. All the ex- pense and trouble too have been encountered to no purpose; both women and apothecaries having lost sight of the fact, that the state of the skin depends on the state of the body; that to make it look well, you must make the body healthy. The great receipt for making the skin look well, is, ob- serve a regular diet of very mild articles, refraining from strong tea, spices, pickles, and all that is pungent, as from intoxicating liquors. Regularly evacuate the bowels, and sit in cold water ; pour a quart of water over your bodies every morning, go into the warm bath every night ; take more exercise out of doors than you are in the habit of taking in the house ; adapt your clothing to the changes of the weather ; guard against exposure to a hot sun, with Us much regularity as you observe among the horses and cows, that appear to know its poisonous effects upon ani- mal bodies. Especially sleep in rooms admitting fresh air through doors, chimneys, and cracks, but never have the windows opened at night. I wish to press the observ- ance of this the more, as I know the obstinacy with which gome insist on having them open. Occasional escapes from violent pains in these show no more the propriety of the practice, than of a man’s living thirty years, daily get- 55 ting drunk, shows that it is healthy to get drunk. I am positive, that, on the average, one half of the fevers of our climate arise from exposure to night air. Our systems can do well in any extreme, but not in any changes. The air of the day is dry, that of the night is humid ; at night, too, our bodies, having less action, are less capable of resisting disease. You have observed that a current of wind on the neck at night produces the wry-neck ; how much great- er must be the effects on the constitution ? The habit of sleeping with your windows down will soon be found as agreeable as the reverse ; for the air entering at an open door, and through chimneys and cracks, will be fully sufficient for perfect respiration. By adhering to these rules, rely upon it, you will be rewarded, not only with a beautiful healthy skin, but long life, and exemption from many diseases. 1 warn you never to endeavour to im- prove your skin, by using, in any shape or manner, the poisonous metallic preparations of lead, mercury, and arsenic. It is indispensably necessary to shield the face and arms from the sun and a current of air to prevent them from being discoloured by light. But in screening from this, it is improper to cover so as to oppress, and, conse- quently, excite disease by the great heat retained. The best covering is that which is thinnest, and least pervious to light. If covers could be had of any metallic body, as silver or steel, they would answer best. The only means of softening the skin consist in oiling it well with sweet oil, at least, on going to bed. Gloves and leather for the neck, oiled and worn at night, are proper for this object. In those countries where large quantities of sweet oil are made, the women apply it freely, and have remarkably soft skins. To prevent and cure the pimples on the forehead and face, it is proper to wash frequently in cold rvater. A weak solution of sugar of lead, applied every night to them, would be of service, if aided by exciting action in the lower extremities. Married women have them not ; and those who are single would escape them, if they would excite a determination to the lowTer extremities by walk- ing, riding on horseback, jumping the rope, rubbing the skin of the extremities, and about the same time washing the face in cold water, or a weak solution of lead. Sweet oil, rubbed over the pimples, has also a powerful effect in preventing their return, if aided by the other means men- tioned. I suppose it will be useless to make any remarks upon the old fashioned, ridiculous notion, that the face and hands of ladies ought not to be washed in cold water. I conclude this letter with the remark, that if I have said enough to induce you to do three things ; first, to sit daily in a tub of cold water, if not, bathe in the eco- nomical manner suggested ; secondly, at the same time daily evacuate your bowels ; and thirdly, to wash your mouth in warm water, and have your decayed and stumps of teeth speedily removed, I shall have rendered you most essential good. I pray God, that you may not be satisfied until you have a full and fair trial of what so earnestly I entreat you to do. Make the experiment, and the moment you perceive the advantages which I know will follow, then I beseech you to impress it on all the tminformed coming under your notice. LETTER III. Contents. Principles of lift—of disease—of cures—cir- culation of blood—secretion—use of fat—starvation— sympathies. An essential part of the education of every male and fe- male, in my opinion, should be a general knowledge of the outlines of the nature of their bodies, and the principles of the cure of their disorders. Not for the purpose of prac- tising physic, but to enlarge the mind ; to habituate it to think rationally on the subject, and to guard against the innumerable impositions of the quacks, as well those who advertise as such, as those of vast boasting experience—de- ception only to the ignorant. Had but the slightest know- ledge been cultivated on these points, the world would never have been pestered with the innumerable and pre- posterous accounts of doses “ for thinning the blood, for cor- recting the bile, for purifying the urine, for dispersing tu- mours,” and for the like ridiculous objects. It is well known how greatly the science of chemistry has improved since the introduction of proper names ; and the same would take place in medicine, if the same accuracy were observed. Most of the improvements in medicine were discovered by the common people ; and how much greater these must have been, had they understood the principles of the science. The persons feeling the disorders must more accurately describe their varying stages, and the ef- fect of medicines, than their attendants can possibly do. 58 Although I cannot pretend to give such a full view of the subject as might be best for you, I will proceed to sketch some of the outlines which ought to be remem- bered. On viewing the body, nothing is so obvious as that all the animated parts are composed of innumerable fibres, or small particles, which, being endowed with the power of contraction, cause all the actions, voluntary and involunta- ry, in our systems. Our bodies grow, and are supported by the food taken into the stomach. The food excites in the stomach the se- cretion of a solvent called gastric juice ; which is adapted to the solutions of the article taken into the stomach, when the stomach is habituated to it. But not so when it is not: thus stomachs accustomed to meat alone, will not dissolve vegetables, and the reverse, unless the changes are very gradually made, from one kind of diet to another. Hence the propriety of our changing diet by degrees. When the food is dissolved in the liquid of the stomach, it is carried along the bowels, and there absorbed, forming chyle, which is carried into a large duct, which empties it into a vein ; when, mixing with the blood, it circulates over the system, and soon becomes blood, the article which our bodies re- quire for every purpose. The blood into which our food is so converted circu- lates or passes through every part of the body, and supplies to each part matter for its formation and existence. The circulation of the blood is as follows :—there are vessels, called veins, in all parts of the body, which, uniting, carry the blood to the right side of the heart, when the heart contracts, with wonderful power, and throws it into four large arteries, which convey it to the lungs ; and then di- viding into innumerable small branches, spread all over the interstices or cells. In the lungs, the blood receives some vital substance from the air, and gives out its useless parts —the whole process is called respiration. After it under- goes this respiration in the lungs, which gives it a very florid appearance, it is collected in small veins, gradually uniting, till they form four large veins, which go directly to the left side of the heart; here the heart contracts, and throws the blood into a large artery, which, dividing, and going all over the body, supplies every part with what is wanted ; and then it passes of a dark colour to the veins ; and thence as at first stated, repeating the course. The stroke of the heart for propelling the blood over the bo- dy, as you will find by feeling the pulse, is in an infant about 120 the minute, of 5 years is 100, of 20 years 80, of 50 years 60, of 90 years 55. This action is subject to great irregularity. Thus, you perceive, the pulsation of the ar- teries is derived from the heart—that the blood is purified in the lungs by our breathing, and constantly thrown over the body for its various purposes. This, termed the circula- tion of the blood, you will find explained in detail in the books of anatomy ; it wonderfully displays the wisdom and care with which nature has made our bodies. It is the union of the little fibres that constitute what is called flesh, or muscles. These fibres possess the capabili- ty of contraction, and this is called irritability, or suscepti- bility, or excitability; by which words you are simply to understand, capability of action. It is on this susceptibili- ty of action that animal life depends. The causes or things which operate on it, are called stimulants ; and the action throughout the system is called excitement. Thus you have an abstract of the beautiful, sublime, and simple theory of animal life, as explained by the great Dr. Brown of Edinburgh. Our bodies have capability of action, call- ed excitability; and stimulants operate on it, producing the various excitements of life. For health to exist, excitement and excitability must be equal ; in proportion to the difference between the twro is disease. Diseases, general or local, of high excitement, are what we call inflammatory, marked by all the symptoms of in- flammation, or high action. For their cure, of course, they require reduction of the excitement,by perfect rest, by cold, blood letting, and by other evacuations, as purges, eme- tics, and the like. All things, in these cases, which sti- mulate without producing evacuations, must of course be injurious. Diseases, general or local, of low excitement, are called nervous, or typhus, and are marked by low, weak pulse, &c. For their cure, stimulants are proper, as brandy, wine, bark, &c. All things which reduce or weaken must of course be injurious. This is the outline of the theory of diseases of our body, from which you will perceive, that the practice of physic is reduced to the simple points of ascertaining what kind of action exists in a person, and what remedies of the nature called for, are best for each particular case. Now as every disease may, at different times, take on these two opposite actions, high or low, it follows, that the treatment of the same disorder which wTill cure in one stage will destroy in another 1 Thus fall, ladies, all the stories of “ a certain cure,” in any one article, for there can be no one cure for any one disease. If you be- lieve I have not deliberately deceived you in stating the great principles of life and disease, you must cease with your credulity, almost universally believing in the state- ments of special cures by special mixtures. No more cor- meeting, blood sweetening doses l You will perceive, that such secretions are the result of the diseased actions of the fibres; that cures are to be effected through the solids, the fibres, the active parts, not the fluids without capacity or power of action. For example, in what is called bilious fever, you give an emetic, not to throw off the bile, but to raise the fibres to a new healthy action. The principle on which cures of disordered parts are effected, has been a subject of great inquiry, though not yet explained as we could desire. There are, however, several doctrines which ought to be understood. When a diseased action exists, and we suspend it by any means, the tendency of the body is, not to go back to that action, but to its healthy action. Thus bleeding and cold, or any thing raising the system to a new action, so as to suspend the diseased action, the body, from its own nature, returns to its healthy state. When a diseased action exists in some central part, the excitement of disease on the surface relieves that within. Thus, blisters on the side, for inflammations within ; is- sues, whipping, irritations of the skin, &c. operate in re- lieving disorders. In other cases where disordered action exists, it is oc- casionally cured by that which excites and keeps up for some time a stronger action in the body. Thus mercu- ry, laudanum, and any thing highly stimulating, produces so much action in cases of the venereal disease, as to over- come the diseased action. The modes of curing according to these rules, can only be understood by those devoting great attention to the practice of physic. The consideration inducing me to state them here is, that you may the more readily admit, that a strong, sound mind is indispensably necessary fov the successful application of principles to practice. Hence you must infer, that no doctors you employ can be good who have not extensive, observing minds. A little ex- perience, with a thorough knowledge of theory, are the indispensable requisites for successful practice. The formation of the various parts of the body pre- sents to the rational mind one of the most curious sub- jects of inquiry. There have been various theories on the subject. At one time it was supposed to be by filtration, the solids only acting as strainers to let out such parts as were not wanted. The theory that succeeded to this was, that the vessels of each part took on a peculiar action, by which action the substance, whether for one of the secre- tions, or for the growth of the body, was formed. Seeing that these explanations were not satisfactory, I accounted for the secretions in my inaugural essay in a different man- ner, which, the more I consider, appears the more cor- rect. This theory is, that the compound fluids of the body entering in different parts, variously formed under various circumstances of minute division, action, heat, and electricity, assume, according to their inherent nature, termed affinities, the respective shape and qualities pecu- liar to such part. Thus the blood in one part becomes bile, in another saliva, in another urine ; and so on, by the exercise of its peculiar attractions or affinities in the parts in which it is passing ; precisely on the same principles that in certain states of heat, water appears in vapour, then in the fluid state, then in very hard ice ; and so on of every body in nature, assuming the different condition or quali- ties peculiar to them in each different state in which they are placed. According to this theory, we have only to change the state of any part diseased, in order to change its secretion ; this is done in many ways, but most remark- ably by exciting contractions in the fibres, as by blood-let- ting, cold, fox-glove, lead, and the like articles. It is upon this principle of natural attractions, that when a part of the body is cut open, as in any wound, the parts living brought in contact, attract and unite together, the intervening blood, when in smali quantities, forming a me- dium favouring the operation. I mention this, as it af- fords an opportunity for representing to you the folly of the many articles applying to wounds to make them heal. Every body has something to recommend for this purpose; with such poor advantage, however, that the escape of wounds from ulceration is a great affair. The great se- cret, ladies, in curing wounds, is to put nothing on them ; not even sugar, salt, brandy, British oil, nor any of the other articles so generally daubed on. When a wound is made, nature supplies the balsam ; it is the blood of the part. Bring the sides as closely in contact as possible, immediately, and keep them so by sticking plaster ; keep the air excluded by a greased or waxed rag over the edges, and the parts at perfect rest. Nothing is so important as to keep wounded parts perfectly quiet, that the attractions and union may be undisturbed ; nothing so important as to keep away all the old women’s prescriptions for healing. The next subject to which I shall request your atten- tion, with the hope of your receiving some practical be- nefit, is the formation of fat in our bodies. In certain states of the system, the blood, passing through the parts formed for the transformation, is converted into fat, and deposited in places made for its reception. In another state of the system, this said fat is turned into blood. You have no doubt heard that bears go into their dens for the winter very fat, live months without food, and turn out in the spring very healthy, though miserably reduced bulk. During the winter their abundant fat has been con- verted into blood, the article necessary for the various parts of their bodies. Just so with ourselves in fevers. We have fevers, we take no nourishment, we are daily evacuated, we may daily lose blood, in the last stage we shall have more blood than in the beginning of the attack ! Our systems have been busy in the transformation of fat in the innumerable cells of our body into blood. Having then an abundance of blood, you should never more in- dulge in fears from repeated bleedings, when directed by physicians ; you should never again so incessantly counteract the directions of physicians, by tempting and almost stuffing the patients with articles adding to the dis- ease ! Abstinence, when prescribed by the doctors you confide in, who judge from the state of the patient, should never be counteracted by the mistaken kindness of females. You must believe this, if you view the power of nature in transforming the deposits of the body into the commodity, blood, which is wanted for her purposes. She procures it in her mode without any extraordinary exertion of pow- er or action that we perceive, while, on the other hand, when we attempt the supply by nutritious, stimulating food, the irritation produced does more harm than good. Although I represent this subject for the purpose of preventing an improper interference in cases where low diet is prescribed, and to prevent an unnecessary uneasi- ness in those whose sympathies are excited for the sick, from impressions of defect of food ; I would not prevent your kindness in supplies of the food proper for the patient. Indeed, without the offices females generally perform, I should look upon recovery from a long attack as a kind of miracle. Our bodies have a strong propensity to return to their old habits ; and often the excitement of an action that 65 has been suspended, will restore the habit of action to eve-1 ry part of the system. The eating of an article, which, by its bulk, restores the stomach to its accustomed state and action, has often, especially when given at the accustomed hour, been very instrumental in restoring health. It is right then to show your kindness, but not in giving articles, and at improper times, in opposition to medical prescrip- tion. I could not state to you any thing more, showing the importance of keeping up these habitual actions, than the experience on the subject of fasting. A man who eats nothing for a few days, will become feverish, and expire in a very little time. But if he will preserve the habitual ac- tion, or operation of his stomach, although there shall be nothing added to his body, yet he will live in tolerable health for a considerable time. If he will observe the pre- caution of opening one of his veins, and daily suck in half a pint of blood, his stomach will be kept in action, and his system will supply the deficiency, by forming blood from his inactive fat, for all the purposes of his body, so that he may certainly live, and in tolerable health, forty days and forty nights, without encountering any serious disadvan- tage. This fact ought to be impressed on every person who may possibly, for short periods, be exposed to total deprivations of food, frpm shipwrecks, besieges, or any other sources of starvation. If they would have this blood drawn and boiled with water, they would fare with better comfort. The last subject on which I shall make general observa- tions, is the various connections between different parts, called sympathy. This is one of the most important parts of the study of those desiring to treat the sick with pro- priety ; and affords an additional reason why there should not be a meddling with physic among those not qualified. In consequence of this sympathy, when one part is dis- eased, another part will take on the diseased action. Thus, when the womb is inflamed, there shall be great sickness at stomach in one person, in another affection of the breasts; the remedy of course to be directed to the part primarily affected. Thus, when the stomach is affected, there shall be excessive pain in the head. When the liver is affected any length of time, the skin, particularly of the face, takes on diseased action. When the stomach is af- fected, by putrid meat, for example, the skin will become spotted. When a wound is made in one of the extremi- ties, often the parts near the junction of the limb with the body will become affected. It is often by means of this sympathy that we cure parts affected. We excite the kidnies, for example, to an in- creased secretion of urine, by water and salts in the stomach. We cause the dispersion of large collections of matter, by the administration of an emetic, and so on. This short view I have given of a few general princi- ples, I hope will be sufficient to make such a forcible im- pression on your minds, as will forever root out all further belief in great cures, by quackish prescriptions, as before observed. Each case of disease occurring, requires the exercise of a sound sense for its treatment. The adminis- tering of an article to cure one patient, because it cured some others, must of course be. improper, unless there be reason for believing that the state of the different persons is the same. Admitting what I have advanced to be true, can you put further faith in stories of great cures by treat- ment contrary to principles, to common sense, although many should tell you, although you might fancy you saw the effect yourself? Such instances of recoveries only show the power of nature in restoration ; the supposed re- 67 medy was not the instrument. Could you believe that any stimulating article, as brandy or opium, or the like, could cure an inflammatory fever ? or that heat, restlessness, food, or stimulating drinks, could fail making it worse ? Could you believe that in diseases of low action, called nervous or typhus, that great evacuations would fail to de- stroy ? Would you believe that moving a child during high fever, would not make it worse, although an hundred told you to the contrary ? Indeed, you may believe me, although sometimes it may appear very hard to dose one to death, there is not one disease which is not to be treated according to principles, and not one to be treated according to “ guessing/’ LETTER IV. G ont ents. Menses—his to ry—treatmen t—excessive—ob- structed and suppressed—period of cessation—fluor albu's er whites—hysterics—indigestion—healthy food. I commence this letter with the remark, that you gene» rally err in attaching so much importance to the periodical discharge, called courses or menses ; and in thinking so much of it on the approach of diseases. The apprehen- sions on this subject, amounting to excessive anguish, which annoy so many women, are entirely groundless. It is not material whether it be great or inconsiderable, regu- lar or irregular, early or late in its appearance. The following history of this evacuation is from Dr. Denman. “ At whatever time of life this discharge comes «n, a woman is said to be at puberty, though of this it is a consequence, not a cause. The early or late appearance of the menses maj depend upon the climate, the constiuition, the delicacy or hardships of living, and upon the manners, as hinted by Rousseau, of those with whom young women associate. Heat appears to operate on women as on fruit, producing earlier ripeness ; as the warmer the climate, the sooner the menses appear. In Greece, and other hot coun- tries, girls begin to menstruate at eight, nine, and ten years of age ; but advancing north, there is a gradual protraction of the time, till we come to Lapland, where menstruation does notpccur till a maturer age, then in small quantities, at long intervals, and sometimes only in the summer. 70 “ In hot climates, women are in the prime of their beauty when they are children in understanding ; and when their understandings grow to maturity, they cease to be objects of love. In temperate climates, their persons and minds arrive at maturity at the same time ; and by the united power of their beauty and intellect, they become irresistible. “ Some girls begin to menstruate without any preceding indisposition ; but generally there are appearances or symp- toms, indicating that it is about to take place. These are usually more severe at the first, than in the succeeding pe- riods ; pains in the back and inferior extremities, affections of the abdomen, with hysteric and nervous affections. These commence with the first disposition to menstruate, and continue till the discharge comes on, when they abate or disappear. “ The quantity of bloody secretion discharged at each evacuation depends on climate, constitution, and manner of living ; but it varies in different women in the same state, and in the same women at different times. In hot countries it is near twenty ounces, in the coldest about two ounces. There is also a difference in the time required for the completion of the discharge. In some it returns precisely at stated periods, in others there is a variation of several days. In some it continues but for a few hours, , in others for ten days ; but from three to six days is the most usual period. “ At the approach of old age menstruation ceases, the time depending on the time of its appearance ; that is, ear- ly or late, as it occurred in each case. When it took place at the age of ten or twelve, it ends about the fortieth year; when about the twentieth, it continues till about the fifti- eth, sometimes till the sixtieth year ; but in middle tempe- rate countries, the period of its cessation is the forty-fifth 71 year. By this constitution of women the propagation of our species is happily confined to the most vigorous part of life. “ The discharge is a secretion coming from the vessels of the womb, and ceases when impregnation takes place. Sometimes it is confounded with periodical evacuations from these parts of blood, often from the vagina, and er- roneously has been supposed to occur occasionally during pregnancy. Of the cause of the discharge it can only be said, it appears to be a provision of nature to accustom the womb to great discharges, preparing it for the supply of the substance constituting the body of the child.” During this evacuation, women ought to be as quiet as practicable. They should be, particularly at this time, ex- tremely cleanly. The statement by Moses of what he sup- posed the Lord said, “ women should not touch any thing after this issue for six or seven days,’’was designed to ensure greater attention to cleanliness. Morning and night they should sit in a tub of warm water a few minutes, for effec- tual washing. The common prejudice against die use of warm water in this state should be disregarded, as it is not only of no injury to the general health, but is of real service in lessening the irritability of the part. The diet ought to be rather less than common in quantity and qua- lity. Sudden exposure to cold, rain and alarms, should be avoided, though frequently encountered without injury. The womb from whence the menses come is subject to great varieties of diseased action ; and it is a subject of re- mark and astonishment, how much the stomach, head and pulse sympathise on such occasions. There are almost always symptoms of hysterics, despondence, sickness at stomach, and low pulse. The chief varieties of its eased action are classed under the heads of excessive, ob~ 72 structed, and suppressed menstruation. Most women oc- casionally are affected with different degrees of these varie- ties. Considering their habits of living, so contrary to the activity for which they were formed, it is astonishing they do not more severely suffer. The remedy for these affections is generally sought for in physic, but most erroneously. There are no diseases you are subject to, not more under the controul of medi- cine, yet none more easily prevented and relieved by the exercise of common sense, in attention to habits. Like all animals breathing much air and eating freely, women were made for exertion, their fluids for constant circulation. Each part must expend by exertion so much of its irritability; or disease will appear. Among the In- dians and labouring class of women, there are but few if any cases of this disease. This alone should be sufficient to induce all subject to these complaints to seek relief in imitating the diet, exercise, and habits, of those who live agreeably to nature. EXCESSIVE MENSTRUATION. The first variety mentioned of the diseases of menstrua- tion, was excessive discharge. This is usually greatest in most robust women, of indolent habits. In some it is pro- fuse at once, in others it continues for several days reduc- ing the system greatly, to extreme weakness. In this dis- ease there is too great determination of blood to the womb, too much action in its vessels. The remedy is the dictate of common sense, equalise the action. This is to be done in persons very full of blood, to be determined by the pulse, or the feverish state of the system, by blood letting, by purging with salts, oil, or magnesia ; and by exciting action in other parts of the body. During the discharge, the patient should keep cool in bed, the hips a little elevated ; abundance of cool fresh air to be admitted in her apartment. A vomit of ten or twelve grains of ipecacuanha, or a grain of tartar emetic, may be given eve- ry half hour, until the stomach is fully excited. When the discharge of blood is profuse, there should not be the least hesitation in introducing up the the birth place, cold water; by injecting it with a syringe or any common squirt, or by pushing up wet cloths. Sitting in a tub of cold water will often answer; an injection of sugar of lead water (a tea spoonful of lead to a pint of water) is a more certain remedy, but it should not be tried till the other prescrip- tions fail. In moderate cases wet cloths from cold tvater, or ice in a bag, applied to the abdomen, will afford relief. When the blood flows in an alarming quantity, it is by all means necessary to prevent its passage, by stuffing cloths up the birth place. Bleeding from the arm, the patient sit- ting up to favour fainting, should always be done, if the pa- tient be not already too much reduced. Two grains of sugar of lead, with a quarter of a grain, or not, of opium, may be administered every two hours, until the discharge of blood is reduced. After this a purge should be given to carry off any remains of the medicine in the bowels. In com- mon cases simply purging, keeping cool on a sofa, avoiding all stimulating diet or drinks, is all that is requisite during the discharge. But the great object is to prevent returns of this exces- sive discharge. The only effectual means for prevention will be found in attention to the general health, as pointed out on the subject of the skin. In addition I would urge every woman subject to it, to revolutionize her habits, to spend her time between the discharges very different from formerly, taking different exercise, diet and drink ; parti- cularly exciting a powerful action on her skin by frictions, by coarse applications, by cold and salt bath, and by blis- ters. About the time for the return, she should lose blood, particularly if of a full habit of body. She should devote unusual attention to her daily evacuations from the bowels, sitting daily in cold water, and to relieving her mouth from the irritation of rotten teeth. It has been suggested by a respectable physician, to cup the breasts, with a view to excite such a determination to them as would divert from the womb. But I have no hesitation in recommending, as of far su- perior importance, the excitement of the breasts to the se- cretion of milk. The means of doing this will be particu- larly explained when on the subject of barrenness, to which I refer. The discharge being excited, I would advise it to be continued daily for two or three months, and in all probability it will relieve the determination to the womb, causing its excessive bleedings at least the more certainly, if aided by attention to the first advice. OBSTRUCTED MENSTRUATION. Unmarried women are most subject to this disease. The variations of it are from total to partial suppression ; attended with little or great pain, and often marked by af- fections in the other parts of the system, from sympathy, analagous to those characterizing the pregnant state. When menstruation first takes place, it is usually at- tended with pain, head-ache, and feverish symptoms. These generally go off without requiring any particular treatment. But when they are considerable, or the per- son delicate, it is best to favour the evacuation, by sitting in a tub of warm water; this may be continued for hours when the pain or irritation is great. Dipping the feet in as hot wate r as can be endured, or in strong lye, or lime water, as is done for curing whitlow, or inflammation of the finger, will prove of service. It is not designed for the purpose of exciting perspiration, but to produce a scorch- ing, or sense of burning, which will increase the determi- nation to the lower parts. When the pains of the patient are considerable, blood should be taken from the arm, and sweet oil be applied all around the belly and small of the back. More serious attention is necessary in cases where the discharge is suppressed after it has taken place. Strong passions of the mind, and exposure to cold during the menstrual period, frequently check the evacuation, which is followed by fever, by inflammation of the womb, and its attendant symptoms, pains in the neighbourhood, sick stomach, head-ache, and general appearances of fever. In every such case, it is proper that the patient should imme- diately sit in a tub of hot water, go to bed, take a purga- tive, and lose a little blood. When the evacuation is obstructed for a length of time, more serious disorders ensue ; u indigestion, sickness, va- riable appetite, heart-burn, distension of bowels, head- ache, palpitations, and many hysterical symptoms. Some- times the face becomes pale, the eyes sunk, the bowels cos- tive, pulse contracted and irregular, tongue foul, feet swelled, belly tumid, appetite diminished, craving of chalk, or indigestible food, the sleep interrupted.” In order to bring on a return of the menses, it is of the greatest importance to attend to the time when they should take place, as then the greatest efforts are to be made. The patient should have a small blister applied about a day or two before the time, between the fundament and birth-place, called perineu m. A purgative should at the same time be given, of four or five grains of aloes ; to be repeated twice or three times. The next advice to be ob- served is, to sit in a tub of as hot water as can be endur- ed, suddenly getting in and out of it. In a greater degree the feet should be scalded. Sometimes blisters applied to the ankles for three or four hours to redden the skin, have afforded relief; as also to the lower part of the belly, or to the small of the back. If these remedies do not succeed, it is proper, in addi- tion to their use, to inject in the vagina a mixture of strong brandy and water, as hot as can be borne, or of any thing else diat will slightly irritate and inflame the parts, such as vinegar, w ine, strong brine, and the like. The more the patient at the expected time moves about, by walking, riding, or jumping, the better. Electricity, used by drawl- ing sparks from the thighs and neighbourhood, has been stated to be serviceable in many cases. Ligatures or ban- dages tied around the thighs, so as to compress the veins and not the arteries, a day or two previous, is also a reme- dy well worthy of trial ; they are only to be continued an hour or two at a time, till the blood collecting in the legs, they are to be removed. The momentary distension pro- duced, tends to excite a new and increased action in the lower parts, and thereby relieves the disease of the womb. It is often of sendee to lose a little blood, if the general health be good ; also when there is reason to believe the least fever exists. The change produced in the constitu- tion by this evacuation, tends to favour the return of the womb to its natural action. In guarding against this complaint, the health of the constitution is to be kept in view. I refer you to what 77 Was recommended for the health of the skin. And I will only add, that you should be more cautious in avoiding ir- regularities, in taking exercise in open air, on foot, or on horseback, in having your skin well rubbed with a coarse brush every night, in evacuating your bowels every day, in having your decayed teeth extracted, lastly, in using the salt bath every morning, until within a few days of the ex- pected return. PERIOD OF CESSATION OF MENSES. This is with most women a very critical time, and de» serving of more attention than is generally paid to it. During all changes in the constitution, diseases are most apt to creep in ; and never more so than at the revolution taking place in the womb at this period of life. As stat- ed in the history of this evacuation, it disappears from the forty-fourth to the fiftieth year, preceded by varying irre- gularities in its appearance and symptoms. Medicine can afford no relief ; yet there is no affection so perfectly under the controul of management. It is the dictates of common sense, not the effect of doses, that are to be regarded. You know that this discharge for thirty years has been attended with considerable action and irri- tation in the womb, and great determination of blood to the part affording the secretion. The important object, then, on the cessation, must be to accustom the system gradually to the loss of irritation, and discontinuance of secretion. This is to be done by exciting temporary ir- ritations in other parts, and by exhausting in exercise the superfluous quantity of blood, and by abstinence. The means for the prevention and the cure of the affec- tions arising at this period are the same. There should be an unusual action kept up on the skin, by the roughest rub- bing of it daily. During half of every day, very coarse flannel, or coarse oznaburgs, should be worn next the skin; by wearing it longer, the skin becomes so fa- miliarized to it, that no effect is produced. A pair of drawers, and waistcoat for the body, is the best mode of applying this irritating dress. Of the utmost impor- tance is exercise in open air, riding, walking, and throw- ing the arms around the body, as is sometimes done to warm the hands, or cutting a little wood, or any exercise like it. The diet at this time should be lessened for seve- ral months. Purges of salts or oils, not aloes or jalap, or any gum, should be taken to evacuate the system ; and it is proper occasionally to lose a little blood, especially among the robust. It is of the utmost importance to keep the birth-place perfectly clean, as the retained secretions ir* ritate and excite diseased action in the womb. Above all, keep the bowels daily open, and whenever irritation or pain is felt, try the general warm bath, or at least sit in a tub of warm water, and until the pain goes off’ remain quiet. When there appears to be considerable disease in the womb, to be judged by pains in it, and around the back, and by the sympathy of other parts with it, as pains in the stomach, head and breast, it is proper to apply a blister plaster between the shoulders. In milder cases, the ap- plication of this plaster two or three hours, to redden the skin without blistering it, will do much good. The injec- tion of warm water up the birth-place, will also be of con- siderable service, as also injecting it up the bowels. If the inflammation of the womb be considerable, it will be proper to vary the injection, to substitute cold water and a solution of lead (a tea spoonful to the pint) for the vagina. A large blister over the belly, to be dressed with mild sweet oil, will 79 greatly assist in diverting the action from the internal parts. I wish to impress you strongly, that you are not to seek relief from opiates, so generally and improperly taken. They add to the disorder, by stimulating the system, al- ready too inflammatory—sometimes most inflammatory when the pulse is low. The warm bath continued, blood- letting, keeping the body quiet and cool, afford the only safe anodynes in these cases. By attending to these general directions, I can safely promise you, as the result, relief from present pain, and from a distressing succession of future complaints. No lady need apprehend cancerous womb or breasts, who will give a reasonable compliance to what I haVe urged; nor indeed will they have any of the affections occurring at this revolution in the system. FLUOR ALBUS OR WHITES. This is an increased secretion from the glands lining the vagina and womb, and it is an affection so local, that the constitution is seldom affected by it. The qualities of the discharge vary considerably. “ In the mildest form it is slimy, resembling the white of an egg, having very little colour or smell. In the next degree, it is of a yellowish colour, but the colour not very deep, and the discharge not offensive. In a greater degree of disease, the colour is in- dined to green, and the discharge is slightly offensive, and somewhat irritating. In the worst form, it resembles purulent matter, is ill smelled, and frequently mixed with blood. “ The simplest and slightest kind is not attended with pain in the back ; the general health not much affected; 80 the strength scarcely diminished, though the back is rather weaker. The menstrual discharge is not interrupted, or irregular. In the next degree, the back is constantly weak, and after any exertion aches considerably ; the power of digestion is diminished, and the bowels are generally cos- tive, the menses continuing pretty regular. Sometimes there is a feeling of heat and itching about the lips of the vagina. In a greater degree of this complaint, the back is constantly painful, and very weak, and there is a feeling of much weight or relaxation about the lower part of the belly and top of the thighs. The menstrual discharge is either obstructed, or rendered irregular or profuse. The stomach is much impaired in its vigour, the bowels costive and flatulent; there is want of appetite, heart-burn, the face pale and unhealthy, palpitation, hysterical appearances; and the constitution seems altogether to be very much de- bilitated. This state is always productive of barrenness, u The quantity of this discharge is as variable as the quality ; in some cases very little, in others very profuse ; in some continuing uniform, in others it increases or di- minishes, or may altogether disappear for a day or two, or for a longer period. While the menses continue, the dis- charge of this disease often increases before and after the monthly period : sometimes when the menses are obstruct- ed, it is greatly increased, attended with additional pain in the back : when the discharge comes from the womb alone, and not from the birth-place, it is sometimes interrupt- ed for a day previous to menstruation; and if the patient conceive, it immediately stops. On the other hand, the discharge from the passage alone is often increased during pregnancy ; and in some instances, takes place only at that time. This disease may arise from many causes, but par- ticularly from those impairing the power of the womb it- self ; as a severe labour, or miscarriage—particularly if the patient get up too soon, and mismanage herself, or from pro- fuse menstruation, or much fatigue, or exposure to cold at the menstrual time, or at any time, in the same way as dis- charges are produced from the glands of the nose, or wind pipe, which we observe in colds.’’—Dr. Burns. The treatment of this complaint depends on its degree ; in slight degrees of it, washing two or three times a day in cold water is sufficient. It is best to inject the water into the passage to the womb. In all cases, great cleanli- ness should be observed, as the excretion remaining in the passage changes to an acrid, irritating state, and increases the secretion. If the use of cold water do not suffice, it will be proper to use other articles that abate inflammation. The best is sugar of lead, about a tea spoonful to the pint of water, injected at least three times a day. The same quantity of white vitriol, in equal solution, is also esteemed of great ef- ficacy. Lastly, four or five times the quantity of alum in the same quantity of water may be used. If the discharge be very offensive, a small spoonful of very finely powdered charcoal, may be introduced up the birth-place every night and morning, until it is corrected. Sometimes a small quantity of laudanum may be added to the solutions injected. Such treatment never fails to give present relief. But it is of the greatest consequence to prevent returns of the discharge, by diverting the action of the blood ves- sels to some other part of the body. All the means point- ed out for relieving profuse menstruation, must be pur- sued ; they are to be applied in the one case as rigorously as in the other. The only additional direction I have to give, is, to apply a small blister, either between the birth- 82 place and fundament, (called perineum,) or a large one on the small of the back, or in front of the lower part of the belly ; at the same time, more freely using the injections, to restrain the action of the vessels in the birth-place. I conclude, urging you to preserve the general health by the means pointed out before, especially by exciting action on the surface of your body ; and take great care never to let any old acrid matter remain on the part, or in the bowels. HYSTERIC FITS. The following description of this disease by Dr. Den- man, is as good as can be given. “ In a well marked hys- terical fit, a sense of pain or fulness is felt in the belly near the navel, or towards the left side. This gradually spreads, and a sensation is felt as if a ball passed upwards and stuck in the throat. The patient now usually falls down insensible, or convulsed, and seems to suffer much in breathing, sobbing violently, or uttering a kind of shriek. She is generally pale, and frequently apparently insensible during a great part of the fit; or seems to be in a faint : but when she recovers, she is not only conscious of having been ill, but also of many circumstances which occurred during the fit. After remaining for a considerable time in a state of muscular agitation, alternating Avith an appear- ance of fainting, the affection abates. She utters deep sighs, opens her eyes, and looks around her, as if surpris- ed, and at length recovers both composure and sensibility, but remains for some time languid, and complains of head ache. This restoration is accompanied with eructation, and the discharge of a quantity of limpid urine. The dura- tion of the fit, as well as the circumstances attending it, va- ry much. In some instances it lasts only a few minutes, 83 in others, for more than an hour. Sometimes there is great muscular agitation, or pretty strong convulsions; at other times, the fit resembles more a faint. In some in- stances, violent fits of laughing and crying alternate with each other, whilst in many cases these symptoms are en- tirely absent.” Most women are subject to some of the irregularities of this disease, as manifested by too acute sensibility. The time is about the period of menstruation, when their systems appear to have great irritability. The acrid se- cretion coming from the womb, tends to irritate the exter- nal parts and produce the disease: and it is also probable that it is always attended with some particular state of the womb itself. They are most subject to it who lead a sedentary life, breathe foul air, and retain their excrement too long in the bowels. The acrid contents of the lower guts readily ex- cite action in the adjoining womb, and produce disease. Next the adherence of the ordinary secretion of the glands about the birth-place, which, irritating the sensible parts, cannot fail to produce similar effects. Lastly, irregulari- ties in eating and drinking. The disease once excited is very apt to become periodical, and appear without any ex- citing cause. The prevention consists in guarding against the causes mentioned with the most earnest diligence. To sleep with the bed room door open, and to take moderate exer- cise out of doors daily, is indispensably necessary; or by all means, they should sit daily in a tub of cold water. The excitement of any sudden or strong passions should be carefully avoided, as also indulging any length of time in particular habits or whims. Travelling and salt bathing are of great service. When it is necessary to open the bowels with medicine, it should be done with aloes, m pre- ference to all other purges. Glysters are extremely ad- vantageous. About the time the fit is expected, it is best always to take about five or six grains of aloes, as well as a glyster. Purging is extremely proper, as the contents of the bowels are always offensive in this disease. A des- sert spoonful of prepared chalk, or as much charcoal in yeast, will tend to correct this offensiveness. The system of the person should be as much revolutionized, or chang- ed, in order to destroy the habit of such returns of action, as possible. Bleeding in addition to the purging is pro- per. An emetic may be given with greatest advantage, before the expected time. The skin should be irritated by the roughest friction ; the mind should be kept as mildly occupied as possible. This disease is most assur- edly under the controul of such treatment, earnestly at- tended to, and its recurrence among those aware of the pre- vention, affords some grounds for reflection on their lazi- ness and inattention. The treatment when the fit comes on is very simple. Let the patient be placed in cool air, on the bed or floor, and turn and writhe, so long as they do not hurt them- selves. This is to be prevented by holding them. Vola- tile salts, or any thing pungent, or offensive to smell> should be held to the nose. It is said, a Yankee Doctor, not having any thing at hand, once successfully applied his toes to the nose of his hysteric patient. The limbs should be rubbed with a stiff brush. The moment it can be done, pour down the throat, either twenty grains of ipe- cacuanha, or a solution of three grains of tartar emetic, or a table spoonful of antimonial wine. As soon as the vomit- ing commences, the fit generally ceases. After the opera- tion of the vomit, you should give of aloes and asafoetida. of each four grains, to be repeated on any symptoms of the return of the disorder. If none be at hand, give thir- ty or forty drops of laudanum and any purgative. If lauda- num be not at hand, use a glass of brandy ; but beware of its leading to dram drinking, as has often been the unhap- py case. It has been supposed that this disease arises from a pe- culiar state of the womb. Our means of operating on the womb are but few ; we have none more powerful than through the breasts. I would therefore press on those subject to periodical returns of hysteriad, which do not yield to the treatment before suggested, to excite the breasts to their healthy action, the secretion of milk so as to influence the womb. The means of doing this will he stated on the subject of barrenness, to which I refer. INDIGESTION. The last complaint of which I shall make a few obser- vations, is one of which every one has occasional attacks in lesser degrees. The difficulties of digestion are com- plained of as universally as the subject of digestible food is discussed. Indigestion of greatest degrees, is sometimes marked by “ sickness of stomach, vomiting, and excessive flatu- lence: also, heart-burn, hiccup, water brash, acidity, head- ache, lassitude, unhealthy complexion, bad sleep, high co- loured urine, &c. Some modifications of this disease are attended with vomiting of blood or of bile ; severe paia in the stomach, or are connected with uneasiness in the right side j bloody coloured urine, pain in the top of the shoul- der, yellow complexion, repeated fits of vomiting, &c.in short, by all the symptoms of diseased liver, of which it is sometimes a symptom. When the liver is affected, the best medical men should be consulted, and should super- intend the salivation of the patient, which affords the only chance of cure. Lesser degrees of indigestion arise from sedentary life, occur to those of costive habits, too lazy to take the trou- ble to evacuate the bowels every day. Persons who eat irregularly large quantities of articles they are unaccustom- ed to, drink immoderate stimulants, or eat them as in spices, are subject to serious degrees of this disease; as also those who have rotten teeth. The cure will, in most cases, be perfected by avoiding the causes. When it is not, it will be best to consult a physician. Costiveness and a sedentary life are easily to be avoided. The general health is particularly to be pro- moted by rubbing the skin with the brush, and wearing- coarse flannels in contact, and by the salt bath. Lastly, but not of least consequence, is the diet. To determine what is the best article of diet, what the most healthy food, although talked of by every body, is a most difficult task. Indeed, the most extensive obser- vation leads to the conclusion, that there is no diet, healthy or unhealthy, but that all depends on our habit of using the particular kind. It is habit that familiarizes the sto- mach to the digestion of each article ; and it is inattention to this habit, indulging in sudden changes from one to another diet, that has induced so many persons to pro- nounce so many articles unhealthy. As soon as there is the least reason for believing the stomach to be disordered in its digestion, it becomes the patient to observe the greatest regularity in eating, as to time and kind. The most simple food, and that of which most has been eaten during life, should be selected. Wheij it is necessary to change, be sure to change most gradually, taking at first but a mouthful daily for several days pre- vious to changing altogether. The propriety of this is confirmed by the sickness so generally produced in spring seasons, when the food is changed. Nothing more shows this than the nausea so generally felt after eating fish the first time ; and similar are the effects produced by eating large quantities of any new fruit. Although we may not be sensible of it, in our common changes, ne- vertheless, very considerable effects are produced in the stomach by all variations in diet. Instead, therefore, of deceiving you, as some physicians often do, by advising you to confine yourselves to veal, fish, pork, or fowl, that they may gain reputation by the fancied skill displayed in the selections, I state the truth, that the good effects arise from the confinement; and that, in all human probability, one kind of meat, one article, is precisely as good as ano- ther. To this I will add, that rest after eating greatly facilitates digestion. This is unquestionably proved by an experiment often repeated. To two similar healthy animals equal quantities of food have been given ; the one kept moving, the other perfectly quiet, for a few hours. On killing and opening their stomachs, the food in the one at rest is always found digested, the other not at all. To eat but few articles regularly, to change the kind very gra- dually, to keep quiet for three or four hours after eating, is the sum of all that can properly be said on the subject of healthy or unhealthy diet. When the eructations from the stomach are very acid, chalk and magnesia, or a quarter of a tea spoonful of pot- ash, or of soda mixed in milk or water, may be taken two or three times a day. When the stomach has been destroy- ed by the operation of strong stimulants, as spices, drams, opium, or strong tea, it is necessary to substitute, in lesser degrees, other stimulants to promote digestion, different from those which have been freely used. The quantities or proportion must be regulated by previous habits, and should, with those who desire to be restored to health, be gradually discontinued altogether. 89 LETTER V. Contents. Description of organs of generation—their diseases—child’s head—suppression of urine, and draxv- ing off ivith catheter—falling backwards—doxvnxvards —turning inside out of the xvomb—dropsy of the fe- male testicle—venereal disease. I have now to give you a description of the parts con- cerned in generation. It is not my design to attempt mak- ing more than such a general statement as will enable you to think and speak with tolerable accuracy of, the parts. I have witnessed so many groundless fears, so many dread- ful forebodings on the slightest appearance of disease in this region, that I feel confident you will be greatly benefit- ed by a more correct knowledge of them. To make you certain that they are like all other parts of the body ; have nothing of a wonderful nature about them, and require for the treatment of their diseases simply the exertion of sound sense, will be of advantage. In describing them, it is customary to do it under the divisions of hard parts, meaning the bones, and soft parts, including the external and internal. The bones immediately concerned in generation are those forming the circle around our bodies, about the hips, collectively called the pelvis, a name you may readily re- member. This pelvis is formed by the union of separate bones, of which you should remember particularly the end of the back-bone, called sacrum. This bone turning 90 round as it were our rumps, forms a considerable curve and hollow, as you will perceive by reference to figure the second, representing it split down and a side view. The end of this sacred bone, or sacrum, is called os coccygis ; which is so joined as to move a little backwards and out- wards at births; particularly among those who marry late it sometimes makes a noise in moving. The sacrum is connected to the hip bone on each side (called os ilium,) and these hip bones unite to a bone on each side towards our front, called os pubis. Each os pubis unites in the centre to each other, and forms what is called the sym- phisis, or union of the pubes. This union has at- tracted more attention than any other of the pelvis, be- cause it is sometimes defective after child-bearing; and sometimes it has been divided to facilitate the passage of the child’s head; a practice which experience has proved to be improper. In women of small pelvis, where these parts have been strained at birth, there is great weakness ; in some cases impossibility of walking. There is no re- medy for this misfortune but rest, and a tight bandage around the hips, so as to compress them together. All the hard names you have to remember on the sub- ject of these bones are, the pelvis, meaning the bones around our hips collectively ; then the sacrum, or end of the back-bone, with its end called os coccygis ; then the pubes in front. With the os ilium, or hip-bone ; and the os is- chium, or haunch-bone, connected to it, on which we rest while sitting, you need not trouble your memories. The female pelvis is larger than that of males. It has been compared to a basin, without bottom, one side much narrower than the other. In front it is much more shal- low than at the back, which, as before observed, is formed by the back-bone, called at this end os sacrum. 91 The pelvis is considerably wider from hip to hip, above, that is, at its upper edge towards our head, than below. This upper part is called its upper brim, and measures from side to side, or hip to hip, from four to near six inch- es, in those of the largest size ; from front to back it measures from about three inches to near five. But at the bottom of the pelvis, when the child’s head passes out from the bones called the lower brim, these dimensions change, and are reversed; so that the widest part of the lower brim is from front to back, instead of from side to side, as at the upper brim. Understanding this, and knowing the dimensions of a child’s head, narrowest from ear to ear, and knowing that nature always performs her bu- siness in the wisest manner, you could at once tell how a child’s head passes through this opening at natural births. After reading the above, you may impress all on your mind that is necessary to be known on the subject; par- ticularly if you will refer to the first figure, showing a well formed pelvis. This does not give you an accurate idea of the back bone or sacrum, and os coccygis, which is properly represented in figure the second. The nar- rowness of the front of the pelvis, where the pubes unite, may be observed in each of these figures. These are fi- gures of a well formed pelvis. But the pelvis is subject to deformities as well as irregularities in its dimensions. These deformities are common in manufacturing coun- tries, as in England and France ; but very rare in those countries where the people are not cramped up, as in the United States. The chief deformity is the projection for- wards of the back-bone, so as to come nearer the pubes in front, and obstruct the passage of the child. Parents ought always to avoid giving their daughters blows on the lower part of the back, as they might produce the injury of causing the spine to bend forwards. The extent of the obstruction produced by the sacrum on a living subject is difficult to be ascertained ; but an idea of sufficient accu- racy for practical purposes may be formed, by pushing the fore finger up the birth-place, in front close to the pubes, then moving it backwards to the projecting part of the sacrum. The distance the finger goes before it reach- es the back part or sacrum, will give you the capacity of the pelvis. The actual distance the finger moves must be conjectured. In order to end the dry subject of bones, I will mention those of the child’s head proper to be attended to. From figures the third and fourth you may form ideas of the skull of an infant. You should observe and remembef, that it is longest from the front to the back part, which part is called the crown of the head ! so that, when the chin rests on the neck, as at birth, it a kind of cone. From ear to ear the head is generally not more than three inches ; and the head of course adapting itself to the fa- vourable shape of the pelvis, would pass out its ears to the front and back bones of the mother, at the beginning or upper brim, and in descending would twist one quarter round, and come out with the ears towards the hips of the mother, as from side to side of the lower brim of the pelvis, it is narrowest. It is necessary to observe and re- member the seams marked on the figure of the scull, which correspond to divisions of the tfones called sutures. You should remark that the sutures run from front back- wards, and from the sides upwards, and that at their meet- ing towards the forehead an opening is formed, called the front fontanelle, which is of nearly square shape, distin- guishable by its four corners, or angles ; at the meeting towards the back or crown of the head, another open- ing exists, called the back fontanelle, of nearly three sides, or triangular shape. It is most necessary in tedious labours, when the head presents, to be able to distinguish which of these openings is at the mouth of the womb. The bones forming the child’s head, which you ought to re- member, are, the bone of the forehead, called frontal bone, and the bone opposite, backwards, called the occiput. The temple bones, at each side of the ears, and the bones forming the remaining sides of the head, called parietal bones, are not necessary for you to commit to memory. It is the crown bone, or occiput, that presents in the best cases of births, and consequently the lesser, or back fon- tanelle, is always felt, with its triangular or three sided edges. This formation of the head of the infant, is one of the master works of nature. The edges of the bones are very soft, of a somewhat gristly nature, readily yielding to com' pression; the edge of one side passing over that of the other, so as to favour the variation of the shape of the skull, to suit the opening it has to pass. It is worthy of remem- brance, that so singularly pliable is the infantile head, so strong are the expelling powers of the womb, that in cases of deformity of pelvis, the head has passed through an ori- fice not exceeding two inches from front to back. After taking into view the formation of the child’s head, and the formation of the pelvis, it must readily appear, as nature always operates wisely, that the one ought to pass in the manner best suited to the form of the other. According- ly, in natural cases, it is precisely so. The head enters the upper part of the pelvis, called the upper brim, with the ears to the front and back bone of the mother, then passing along, it twists one quarter around, so that in making its escape, at the lower brim, or edge of the pelvis, the ears are from hip to hip ; the face, of course, towards the back, 94 No female of reasonable mind, seeing such display of pro- vision for the birth of the young, ought to indulge in fears of her delivery ; probably more destructive in their ten- dency than the greatest irregularities of nature. The parts next to be described, are the soft parts, as ex- hibited externally. The front view exhibits to the eye the fatty elevation on the pubes, called the mons veneris, with its crown of hair. This mass divides, one half running down each side, forming something like lips, and called the labice; at the bottom these lips unite again, and exhibit a kind of sheet, called perineum, about an inch long, and then disappears about the fundament, or anus. Upon opening these labise or lips, the first conspicuous part above is a small elevation, or rising, called clitoris, the seat of pleasure in the sexual intercourse, called copulation, In some it is of very small size, scarcely perceptible, in other cases very conspicuous. There are numerous glands around this, secreting a cheesy, odorous substance, which, unless washed off, irritates the clitoris, and excites venereal desires, as before stated. Directly under this clitoris, is a small orifice, leading to the bladder, through which the. urine passes. The canal leading to the bladder is called the urethra. Beneath the urethra, in some virgins, is seen a thin mem- brane, called hymen. In the first sexual connexion, it is rent asunder, and appears in ragged edges each side. Some virgins have had this membrane so compactly formed, as to prevent the passage of the menses, so that they have col- lected in the womb, and produced a distension like that of pregnancy. The remedy is to make a small puncture with a lancet, and allow the confined matter to pass. In many, this membrane does not exist. Where it has been destroy- ed by copulation, and the desire existed to impose the sub- ject on some man for a virgin, the opposite sides have been slightly scarified, and being kept in close contact by the forceps, or any other means of compression, they have united, so that the parts have quite the virgin appearance and difficulty in entrance. The hymen being destroyed, and the parts opened, there is the entrance to the womb, called vagina, or birth-place, which in virgins is narrower than in those who are not so. The exterior parts, particularly the labise, or lips, are very subject to inflammations and swellings ; to great itch- ing, and to ulceration or sores. The regular application of cold water, as before remarked, prevents such disease. When itching or inflammation exists, the application of iced or cold water, as also a solution of sugar of lead, will af- ford relief. Fresh sweet oil is also of service. In cases of ulcerations or sores, the most simple applications are best. Mild mercurial ointment, mild fat, and oil and bees* wax melted together, are proper. The parts should be treated just as other parts, when similarly affected. Having thus given you a brief sketch of the exterior parts of generation, sufficient, if remembered, for all prac- tical purposes, I proceed to the explanation of the interior parts. As before remarked, the first orifice is that of the ure- thra, for the exit of the urine. Around its edge it has a small or slight elevation, which it is proper to remember as a guide for an operation which will presently be mention- ed. This orifice of course conducts to the bladder ; and it is this channel which is called the urethra. It is wider than the largest goose quill, and from two to three inches in length. This urethra, or canal to the bladder, is subject to con- siderable disease ; sometimes to obstruction, preventing 96 tne discharge of the urine. There is no complaint to which females are subject more manageable among themselves, and consequently which they ought to attend to with more earnestness ; yet the knowledge necessary is of such easy acquisition, the performances so simple, that an earnest at- tention is not necessary. Nevertheless, this little know- ledge, this little ability to perform, has been so neglected, that not only innumerable females have had to exhibit themselves to doctors, but many of them have actually expired, from want of some one to draw off their urine, by means of a little tube called u a catheter,” corresponding nearly in shape to a goose quill, which has often proved a convenient substitute. In my undisguised opinion, it is a disgrace to the sex, that a man should have been called upon to perform an operation so indelicate, and so simple in its nature—that while a child in its senses, of six years of age, blushed in submitting to the operation, it would declare its ability to perform it on another. And what is the operation of introducing the catheter, to evacuate the urine ? The bladder containing the urine, is immediately under the bones in front, called the pubes ; the canal to it is direct, not three inches long. The instru- ment, the catheter, as a quill, is adapted to the size, and the woman laying on her back, finding the entrance, and pushing it backwards and upwards, pushing it gently, in the direction where least resistance is made, can readily introduce it in herself for the flow of the urine. If there be too much sickness for a woman to perform the opera- tion on herself, her associate, her nurse, her servant can do it. The catheter is to be greased with the mildest oil; the patient laying on her back, it is pushed most slowly and gently into the bladder : it is to be held between two fingers, and may occasionally be rolled around. The ure- thra makes some resistance, particularly at its entrance in the bladder, which is to be overcome with patience ancl gentleness, not violence. In figure the eighth, you see the introduction of the catheter. When pregnancy exists, and the biadder is thrown up in the belly, as soon as the cathe- ter is introduced, it should be held downwards, as in ca- theter j\o. 1. In catheter No. 2, it is supposed that the bladder is not so elevated, and it is pushed backwards in- stead of upwards. In cases of pregnancy, the urethra is compressed by the head of the child, and the best catheter is an elastic or compressible one, which will yield, or adapt itself to the part it has to enter. You should remember, if it be impos- sible for you to procure a catheter, and consecjuently have to use a goose quill for a catheter, it should be so tied or connected, as to prevent its entire intrance in the bladder, where it has sometimes passed, and exposed the patient to the necessity of a dreadful operation for its extraction. Tile common catheters have a handle, to prevent this ac- cident. I suppose it is scarcely necessary to mention, that, on introducing the catheter, you should have a pot or ba- sin, to let the urine flow into. Where it is to be intro- duced, and the patient cannot discharge«the water after- wards without aid, it should be introduced twice or three times every day. Dr. Bard thus writes on this subject. “ Introducing the catheter, in the female, when the midwife is properly ac- quainted with the situation of the orifice, and the direction of the urinary canal, is an operation of little more difficulty than administering a clyster ; except where certain obsta- cles occur, which are to be overcome, more by patience and gently repeated attempts, than by any remarkable skill. From motives of delicacy alone, this easy operation ought to be in the hands of women ; but what is of much more consequence is, that if a man is to be sent for every time it may be necessary to perform it, it will generally be ne- glected too long, particularly in the country ; to the very great injury, and in some instances, danger of the patient. The orifice of the urethra or urinary canal, is situated un- der the arch of the pubes or share bones, and the canal, making a slight curve, ascends very little, and enters the bladder almost immediately behind it ; it is not above one inch and a half long, so large as to admit a catheter of the size of a goose-quill, and so little curved that a straight instrument is by some preferred. Having discovered the orifice, the operator, standing or sitting on the right side of the patient, and holding the instrument in the right hand, with the hollow of the curve towards the patient, is to in- troduce it; directing the point at first a little downwards and backwards, when gently depressing the hand, raise the point a little upwards and forwards : it will almost imme- diately enter the bladder, and the urine will flow from its extremity. If, however, some little difficulty should oc- cur, patience, and gently moving the hand from side to side, or upwards and downwards, will overcome it with very little or no force ; and with little pain to the patient. At any rate, force is never to be used ; it is better to de- sist, and make a second or a third attempt: for whenever any difficulty presents, it is owing to circumstances not to be overcome by violence, which can never do good, but may do infinite mischief. In some cases it is best to put the instrument, when introduced into the orifice, into the hand of the patient; who, directed by her own feelings, will sometimes succeed more easily than any other person : a caution, however, necessary to be observed respecting the use of the catheter, is not to introduce it unnecessarily; 99 or before such remedies as warm bathing, fomentations, a clyster, soft mucilaginous drink, have been tried : because, when it has once been introduced, it is frequently found necessary to repeat the operation, from the increased sen- bility it induces on the urethra and neck of the bladder.” It is proper in this place to remind you, that there are many temporary suppressions of urine, not requiring the introduction of the catheter. A purge of salts or cream of tartar, will generally relieve effectually, as also sitting in the warm bath. Such is the habit of urinating at the time of evacuating the bowels, that it is seldom the bowels are opened in these temporary suppressions, without relief to the bladder. Your rule for introducing the catheter, should be generally when the bladder is painful, or when it may be felt just over the pubes or front bones ; and when, by introducing the finger up the birth-place, you feel the bladder enlarged. In many cases of fever, there is no secretion of urine for a day or two, sometimes longer : it is useless in these cases to indulge in the least fear or un- easiness. From the application of blisters, there is sometimes great pain and difficulty in voiding the urine : the parts being considerably irritated. This generally wears off in a day or two ; particularly if aided by a free use of flax-seed tea, or any mucilaginous drink, as gum arabic and water, or elm bark tea. < The certain remedy for this complaint, is a clyster of half a pint of.warm water, with fifty drops ol' laudanum. Generally a little starch may be blended with it. You ought not to use this injection in cases of high lever, unless the pain of the stranguary be very great. Before using it, I would always try sitting in a tub of warm water, and keeping a rag wet with a solution of sugar of lead over the parts inflamed. 100 The second internal part below the urinary canal, is called the vagina, or birth-place. At the age of puberty, and before copulation, it is from two and a half to three inches long, and rather more than an inch in width. Its internal surface is lined with glands which secrete consi- derable quantities ol mucus, particularly during connec- tion with the male, and when excited to action, as in the disease called xvhites. The vagina, or birth-place, is subject, from its commence- ment at the edge of the labia or lips, to its termination at the mouth of the womb, to inflammation. Sometimes matter very much like that of sores is formed. The re- medy is a free injection of cold water ; in more violent cases, of lead water, or of white vitriol and water. Low living and purging always expedite the cure of such in- flammations. There have been some'cases where the vagina has con- tracted, forming a stricture, impeding entrance. I knew a case of this kind, where the poor pregnant woman was left by her injudicious physician to have it enlarged by the connection with her husband. The consequence was, that the stricture increased till her delivery, when the re- sistance was such that she died. The remedy for this complaint is gradual distension ; the gradual distension may be made by introducing any large body which will stretch the passage. The best article for this purpose, is a stick made tapering to a blunt point, as large as can enter; this is to be covered with waxed linen, made tight around it, and three or four times a day should be gently pushed up, so as to stretch the parts more and more every day. A piece of dry spunge dipped in melted wax, then press- ed and pushed in the stricture, and allowed to enlarge by the moisture of the part, will be of great service. In cases 101 where the constriction increases, the stick for dilating it may be worn ; a bandage around the parts will support and preserve it in place. The birth-place, or vagina, receives into it the mouth of the womb, the edges or lips of which project forwards ; so that they may be felt, before its connection with the va- gina. It has been compared to the inverted finger of a glove. This projection of the womb into the birth-place should be understood by midwives, as it is from its feel that the existence of labour is certainly ascertained. This mouth of the womb is called, ridiculously enough, os in- ternum, and os tincae; but you will better understand it, by calling it the mouth of the womb. The womb is called the uterus ; it is of the size of a common large pear ; the largest part upwards towards the stomach. It is divided into neck, sides, and fundus. The small part, commencing at its mouth, is the neck, this disappears in its round sides ; and lastly, the largest upper part, called the fundus ; to which the after-birth is often attached. The womb is a very fibrous mass of considerable thick- ness. It is the receiver of what forms the child. It is of such a nature, that it enlarges, and grows to the enormous size for containing the child and its appendages j never- theless, always retaining the same thickness of its sides. It is by the contraction of these fibres that the contents are expelled. It receives large quantities of blood, and secretes the discharge called the menses. The Avomb is suspended, from each side of the pelvis, by a membrane, which allows it to float about considerably. Attached to the two opposite sides of it is a small fleshy tube, extending near three inches, called the fallopian tubes. These tubes terminate in a ragged kind of edge. To each side of the pelvis' is a small mass of the size of a large bean, called the ovarife, or female testicles, as they supply the seed the woman yields at impregnation. They have little reservoirs, like small blisters, and at every conception one of these bursts, and gives up its contents, leaving some- thing of a scar in its place. By cutting these out, as in the spaying of hogs, the animal is deprived of the power of conception. From these circumstances, it has been set. tied, that in successful copulation, these floating, moving fallopian tubes, all stimulated by the seed of the male, have their ragged edges attached to the ovaria, take up the contents of one of the little bladders, and carry it to the womb for its growth or development. Behind the womb and vagina, and attached to the curve or hollow of the sacrum, or end of the back bone, is the receptacle of the excrement, called the rectum or strait gut. By reference to figure the sixth, you will perceive the relative situation of these parts better than can be ex- plained by writing. Having fully familiarized your mind to the relative situ- ation of these parts, by the inspection of the figures, you will be better qualified to understand the nature of the affections of the womb. You observe that it is connected to your sides by a membrane at each side of the womb. Now this membrane is liable to extension, particularly 103 when an ignorant midwife is allowed by ignorant by- standers, to pull the after-birth away. This is called the falling down of the womb. Its mouth continues to sink through the birth-place, till it protrudes out, a most la- mentable affliction, since the remedies are but partial. They consist in bathing the parts well in cold water, gen- tly pushing back the womb, and putting up the birth- place a little, oval, oblong ball, called a pessary. This may be made of bees’ wax, of sponge, silver, bone, or ivory, which you may get from the apothecaries, if you do not choose to make it yourselves. You push it up the vagina while lying on your back, and retain it there by a bandage around, as in wearing diapers. It may be taken out at night after laying down ; but must be pushed up in the morning before rising. Cold water poured around the hips every morning* will tend to expedite the retrac- tion or cure, which in some cases has been perfectly effect- ed by perseverance in the use of the pessary, or long, round body, worn in the birth-place, to support the falling womb. The next affection of the womb I wish you to under- stand, is what has been termed its inversion, or falling back- wards, as represented in figure the seventh. This takes place in the early stages of pregnancy, when, after the en- largement of the womb, particularly on retaining the urine, sometimes from a blow, kick of a child’s foot, and the like, above the pelvis, the bottom of the womb is thrown backwards over the strait gut, so that its mouth is turned upwards. This presses on the neck of the bladder, and, preventing the evacuation of urine, increases the de- rangement by consequent distension. The treatment for this accident is very simple ; be sure first to draw off the urine with a catheter; give a clyster to open the lower bowels ; then let the woman rest on her feet and head, or elbows. In this situation, push the finger, well greased, up the fundament, and you will feel the ball formed by the womb, which you are to push upwards. Yqu may also have a finger up the vagina, and it is scarcely possible, by gently raising the womb with each finger towards its natu- ral place, that you can fail of success. On its restoration, the woman should be quiet for a week or two, and be cau- tious of exposure to the causes, particularly to void her urine very often. In some cases of this inversion, there is only a difficulty in discharging the urine; which, as the womb enlarges, increases. In every such case you must evacuate the urine, and resort immediately to the pushing back the womb, as directed. Dr. Denman remarks, that it is the middle class in society who are most subject to this complaint ; the highest and lowest are not ashamed to walk out and evacuate their urine the moment they desire it. The middle class are so modest, so ashamed, at the suspicion they wish to urinate, that they sit, the bladder distending till it inverts or turns over the bottom of the womb. There is no caution which a married woman ought to bear in mind more constantly, than that it is very injurious to retain her urine. The last derangement of the womb I shall mention is one that very seldom occurs. It is when the inside of the womb is turned directly outwards, and protrudes out of the birth-place as a bag or bladder,, immediately after a delivery. The cause of this is over straining at delivery, but mostly violence in pulling away the after-birth, for 105 which any midwife ought to be punished. The remedy is, to reduce the patient by blood-letting, if not previously enough reduced ; to foment and bathe the womb, so as to reduce the inflammation, that it may be replaced. To do this, hold the mass grasped in one hand, with the fore-fin- ger of the other push back the bottom, as if you wanted to push in a bladder, so as to be inside out; continue gently pushing till the inversion is effected, and then the whole with a finger may be pushed up the vagina, to its natural situation. A medical man ought to attend to the patient’s health, while she carefully avoids sneezing, bearing down, and the like causes of relapse. The next disease I shall mention of the internal parts of generation, is a dropsy of the ovaria, commencing with a small swelling in either side, gradually enlarging till the belly becomes immensely distended. The best treatment is to let it alone ; as the melancholy truth has been discov- ered, that no cure can be effected by medicine. Sometimes it has been known to burst in the womb, discharging all its contents through it, so as to relieve the patient. Opening the side to evacuate the contents has seldom done ser- vice. All the useful that can be urged on this subject is, that as there are strong reasons for believing the complaint arises from blows or bruises about and above the groin and pubes ; females should be careful to avoid them. The womb, like every part of the body, is subject to in- flammations. The treatment of these inflammations is pretty much the same as that of other parts. It is very re- markable how much the breasts, stomach, and brain, sym- pathize with the womb, when inflamed. The only pre- scription, in addition to the general evacuating remedies for inflammation, is to apply a lump of ice, or a cloth wet in cold water, for a few minutes, several times during the day, on the belly, just above the pubes. VENEREAL DISEASE. I shall conclude this letter, by giving some account of that loathsome disease called the venereal; which I think every mistress of a family ought to understand. There is scarcely a day in which some poor female servant does not suffer greatly from it; constantly labouring to conceal it, from the shame of exposure to physicians. Were they to know that they could readily be cured by one of their own sex, they would speedily apply for relief. There are two kinds of venereal disease ; one called the clap—the other the pox ; very different in their natures, and requiring as different treatment. CLAP. The clap is called the gonorrhoea. It is simply an in- flammation from infectious, irritating matter, of the glands, lining the vagina or birth-place. It is a disease supposed to have been brought on solely by filthy habits. When the disease exists, there is an increased discharge from the birth-place, of purulent looking matter; sometimes of va- rious shades in colour. There is pain in making water and often great sensibility of the parts. The cure for this disease, is the cure for common inflammation. Confine the patient to a low diet, give purges of salts, and use those washes which lessen inflammation. I have known this complaint to be perfectly cured, by washing every hour in the coldest iced water. But the best wash is, twenty grains of sugar of lead, or of white vitriol in a pint of water, squirted up the birth-place every two hours. The best squirt for the injection is a common one, with a large blunt point; the wash to be thrown up with considerable force. The common squirts, or female syringes, will answer the purpose. By perseverance in the use of these for ten or fifteen days, at farthest twenty days, taking extreme care to keep the parts perfectly clean, a cure may be certainly effected. The rule for discontinuing the wash, is the ces- sation of the inflammation and discharge. I have to add, that physicians of great respectability have very warmly recommended, for every patient affected with this disease, to take, in addition to the above prescriptions, thirty or forty drops of the balsam of copaiva, on a lump of sugar, three or four times a day. Its efficacy is so well established, that I would recommend its universal use. POX. The second venereal disease, which has slain its thousands and tens of thousands, is very different from the clap; and is called the pox, or siphilis. In these cases the constitution is affected ; and to it the remedies are to be applied. About the edges of the lips of the birth-place, there appear small sores, called chancres. Their characteristic is, that they are always hollow, and appear as if eating inwards. Sometime after the appearance of these chancres, from five, to forty or fifty days, there comes a tumour in the groin, like what is commonly called a waxen-kernel. The professional name for these tumours is bubo. 408 For the cure of this disease, physicians rely upon mer- cury, from beginning to end. The sooner it is commenced with the better. On the chancres or sores, about the lips of the part, calomel should be sprinkled twice a day, after washing them with soap and water. Half a grain of calo- mel should be swallowed three times a day, until the mouth becomes sore ; when the quantity should be reduced one third. The great secret in salivating, to cure this com- plaint, is to keep up the action of the mercury, without producing great discharges from the mouth. This is done by the patients never lying down when it can be avoided: also by guarding against exposures to wet and cold. The mercurial action should be kept up from six to twelve weeks ; or about one week after the sores heal up. When the salivation is excessive, it should be remembered, that the cure is not to be effected by sulphur, or by any medi- cine : not by the innumerable washes for the mouth. The certain means for curing, are keeping the patient up ; never having the head down when it can be avoided ; and keeping the body in constant exercise. This disease is cured by many in preference, especially when the calomel affects the bowels, by rubbing mercu- rial ointment every night over the arms and thighs, until the mercurial action is produced as by the calomel. Some- times it is necessary to apply this ointment to the sores. A little red precipitate sprinkled on them for a few days, often expedites the cure. It is also proper to apply lunar caustic to the edges of the sores, whenever they appear hard. They should be touched with it in the manner used for warts. For the bubo, before it has bursted, a power- ful vomit, also a large blister plaster put over it and the groin, has frequently dispersed It. When they burst they are very apt to become dangerous, and in that case a phy- sician ought always to direct the treatment. It is not to be denied, that there are some cases of this disease extremely difficult; nay, impossible to be cured. The matter acts upon the body as a poison, baffling the prescriptions of the ablest physicians, I would enjoin, whenever the case becomes obstinate, to call in a physi- cian, for the treatment of the first symptoms as well as the secondary. The secondary symptoms never fail to make their appearance, when the salivation has not been continu- ed sufficiently long to cure the constitution. These are pains on going to bed, in the muscles and in the bones, enlargement of the bones, sore throat, destruction of nose, &c. LETTER Vi. Contents. The xvomb in pregnancy*—history of its en• largement—symptoms, and sign of conception—conduct during pregnancy—diseases attendant—inf animation of boxvels—sickness and vomiting—heart-burn—colic- fainting—swelled legs—-flooding—abortion—cure of barrenness. From the description of the organs of generation, f proceed to explain their functions. Every woman in child-bearing becomes of more interest ; another is de- pending upon her, and none but the most indifferent ob- servers fail to feel a deep solicitude for their prosperous delivery. At the sexual intercourse between man and woman, when the circumstances have been favourable for concep- tion, the seed of the male is supposed to enter the womb of the female, and uniting with the seed of the woman, comes down through the tubes called the fallopian, and forms the commencement of our bodies. At the same time is form- ed what is necessary for the growth ; that is, a coat or cov- ering to include the whole, and lining the womb, called the membranes ; also, a fleshy substance, almost like the liver, called after-birth, or placenta. This after-birth receives and prepares the blood supplied by the womb for the child j there is a tube passing from the after-birth to the navel of the child, called the umbilical or navel cord ; the tube is for the purpose of the circulation of blood between the mother and child ; lastly, is also formed a liquid, call- ed among women, “ the waters,” resembling in its na- ture the white of eggs, a fluid in which the child moves. Thus the contents of a pregnant womb, formed in minia- ture at conception, are the child, the waters, the mem- branes holding them, the navel cord, and the after-birth. The natural history of their growth is thus stated bv count Buffon. “ Immediately after the mixture of the seminal fluids, it is probable the whole materials of gene- ration exist in the womb, under the form of a small globe. This globe is formed by a delicate membrane, which con- tains a limpid liquor, very like the white of an egg. In this fluid may be seen some small fibres, which are the first rudiments of the young. Upon the surface of this globe there is a net work of delicate fibres, which extend from one end to the middle, forming the beginning of what is termed the placenta, after-birth, or secundines, which is the part connecting the child Jo the mother. “ Seven days after conception, parts of the child are distinguishable to the naked eye ; very imperfect, ap- pearing as of a clear jelly, though of some degree of so- lidity. The head and trunk may be easily distinguished, it being of an oblong figure, the trunk being longest and most delicate. Some small fibres, resembling a plume of feathers, issue from the middle of the child, (the navel,) and terminate in the membrane by which the whole is enclosed. These fibres are the rudiments of the tube con- necting the young to the after-birth, called the umbilical cord, or navel string, which connects to the after-birth, or placenta. 113 44 Fifteen days after conception, the head and most pro- minent features of the face are apparent. The nose re- sembles a small elevated thread, direct over a line which marks the division of the lips ; two black points repre- sent the eyes ; and we see two holes in place of ears. The body has also acquired some growth ; on each side pro- jections appear, which are the rudiments of the arms and legs. In three weeks, the body is a little enlarged ; both the arms and legs are visible. The growth of the arms is quicker than that of the legs ; and the fingers separate sooner than the toes. The internal parts now appear ; the bones seem as threads. The ribs are disposed on each side as fine threads ; the arms, the legs, the fingers, and toes, are also represented by similar threads. “ At one month, the young, called the foetus, is an inch in length. It takes a curved posture in the middle of the liquor that surrounds it; and the covering or membranes, in which the whole is included, are increased and thicken- ed. The whole mass is about an inch and a half in length, of an oval or egg shape. All the parts of the face may be seen ; the body is visible ; the haunches and belly are prominent ; the hands and legs are formed ; the fingers and toes are divided ; the skin is thin and transparent ; the parts in the belly resemble a knot of fibres ; the ves- sels are as fine threads ; the bones are still soft, only a few places beginning to assume some degree of solidity. The vessels forming the navel cord extend in a straight line. The after-birth now occupies less space than in the begin- ning, though its solidity has increased, and it has become thicker than the covering or membranes covering the whole. 114 “ At the end of six weeks, the foetus is about two inches long ; the form is more perfect, only the head is longer in proportion to the other parts of the body. About this time the motion of the heart is visible ; in fifty days it was perceived to beat for a considerable time after the foetus was extracted from the womb. In two months it is more than two inches in length ; the formation of the bones being much more visible. In three months it is near three inches in length, and weighs about three ounces. Some women affirm they have felt its motions about this time ; but it is difficult to be certain; motions in the neighbourhood are mistaken for those of the child. Yet the sensations excited by its first motions, depend more on the sensibility of the mother, than on the strength of the child. Before the end of the third month, the head is bent forward, the chin rests on the breast ; the knees are elevated, and the legs folded back upon the thighs. One of the hands, of- ten both, touch the face. Afterwards, as it acquires more strength, it perpetually changes its position ; though, in general, the head inclines downwards.” It is at the fourth month, that generally the mother feels the motion of the child within, which is called quickening ; and which in some produces very considerable alarm ; sometimes sickness, hysterical symptoms, vomiting in the night and in the day, either repeated or not, for days. This motion is the only infallible symptom of pregnancy ; and generally terminates the unpleasant sickness and diseases preceding. 4 After this the development or growth of the child be- comes much more rapid than in the beginning. At first 115 the waters, membranes, and after-birth, were much larger in proportion to its size, than at this time, and every day this difference is increased, till the birth, when, in bulk, they appear very inconsiderable in comparison with the child. About the time of quickening, the womb may be felt floating, as it were, in the lower part of the belly ; particu- larly if the woman relax the surrounding parts by not ex- erting them. Before this, while the womb is retained in the pelvis, upon putting a finger up the birth-place, while the woman is standing, the mouth of the womb may be felt, lower than in a natural state, as its additional weight causes it to descend. This is very perceptible for some weeks after conception. After this it enlarges, and ap- pears ascending up in the belly, till it grows so large as to be unable to descend through the pelvis. After conception, the breasts become rather smaller ; but in the third month they enlarge ; the nipple is sur- rounded with a brown circle, and frequently a milky fluid can be pressed out. The belly at first becomes somewhat flat, but very soon increases in size in the lower part. In the fifth month, the womb begins to render the belly hard, and may be felt as a ball l'ising to the middle point between the pubes and navel. In the seventh month it reaches to the navel; in the eighth, half between that and the breast bone ; in the ninth it nearly touches that bone, particularly in first pregnancies, when the resistance of the belly pre- vents the hanging down, as in following pregnancies. With some persons, generally in the best cases, after the expiration of nine calendar months, or forty-two weeks after menstruation ceased, the child is so well made, that it is able to live without connection with the mother ; making allowances for a few days variation. The delivery, effected by the contraction of the fibres of the womb, which are not designed longer to bear the irritation of such distension, takes place, sometimes not till the hour of de- livery, sometimes a few days, at others twonor three weeks; the woman feels an increase of anxiety, busies herself for the reception of the infant, moves with difficulty, and fre- quently complains of restlessness, and pains in the back and loins. As the period approaches, her belly subsides most, in the most favourable cases : her discharge of urine is affected, sometimes suppressed, at others not to be re- tained ; occasionally a lax ; generally she is rather costive; and she perceives a discharge of mucus from the vagina tinged with blood. But the history of this expulsion will be reserved till the next letter. As was remarked, the liquid called “ the waters,” in a healthy state, resembles the whites of eggs. Among ma- ny, however, this appearance docs not exist, and the wa- ters become of various qualities ; sometimes extremely of- fensive. The quantity of the waters is also subject to great variations at birth; in some cases there is scarcely half a pint, in others half a gallon has been found. The means nature provides for the growth of the child are very remarkable. As stated in the commencement, the growth is entirely effected through the after-birth or placenta, which prepares the blood in the proper condition, as our lungs do for respiration ; and then it is transmitted 117 by the umbilical or navel cord to the child. The after- birth is a fleshy substance, its edges thin, differing in weight from one to two pounds ; it adheres to the sides of the womb, often to its upper part, called fundus, and receives the blood from the womb. The navel, or umbilical cord, is composed of two veins,' which come from the placenta, and an artery coming from the child, twisted round so well, as to resemble one cord. The blood carried through the veins enters at the navel of the child ; thence, in proper vessels, is conveyed to the heart, and by it diffused over all the body for its growth. It returns from thence, and, by the power of the heart, is sent back through the artery of the cord to the placenta, or after-birth, where it again undergoes the change neces- sary for fitting it for the use of the child. The length of the cord through which it passes varies considerably. It has been known not to exceed six inches, and in other cases to be thirty inches. About eighteen inches is its or- dinary length. Some women, on conceiving, feel such an alteration in the state of the stomach, or in their sensations in general, as apprises them of their situation. “ But, usually, the earliest notice is afforded by the obstruction of the month- ly discharge. This is an invariable effect cf conception j but it must be recollected, that it may take place from other causes. Early after conception the stomach is affected, heart-burn, sourness on the stomach, want of appetite, dis- gust at the usual food, and sometimes a craving for things formerly not desired. Frequently the woman is sick in the morning, vomiting after getting up, though some are only 118 sick in the afternoon, sometimes troubled through the day with qualms, faintiness, and inclination to vomit. Some have a constant desire to spit, have the tooth-ache, cough, and other affections of variety of kind and duration, dif- fering in every case. In some cases, the complexion greatly suffers in preg- nancy, the features being affected, as in cases of children with worms ; in other cases, the looks are much improved. Sometimes the pulse is as common, though generally it is quicker. Perhaps there is no woman who does not under- go such an alteration in parts or the whole of her system, after conception, as would enable an attentive observer to ascertain the fact. But it is enough for you to know, that there is no one certain sign of pregnancy, excepting the visi- ble motions of the child. In all those cases where doubt exists, and the object is to ascertain the fact, for purposes of punishment, both men and women should unhesitatingly decide on the safe side, suspending all judgment, till proof be unquestionable. As this is enough of the natural history of the contents of the womb, I proceed to remark on the rules women should observe during pregnancy ; and the treatment of some of the most common complaints to which many are subject. In order for you to discover the very best modes of con- ducting yourselves during pregnancy, you have only to make a few common observations, and exert a little com- mon sense. The course pointed out by nature, pursued by all the pregnant animals, from inclination ; by the wo- men in the lower classes of society, and in the savage state, from necessity, is the course you must discover, is the proper one for you to pursue, in order to ensure suc- cessful child-bearing. It is known that all our domestic animals ; mares, cows, sheep, and the like, produce the best young in the largest pastures ; and that women mov- ing about in the country have much finer children than those leading sedentary lives in town. Is it necessary that I should press on you the truth, that moderate exercise in the open air, not by starts, but long continued, with sim- ple diet, regularly taken, so necessary for the health of your bodies at all times, is more especially so, during the critical period of child-bearing ? It is to be regretted that so many pregnant women lead such inactive lives, not only on their own account, but on account of their children ; for doubtless, it is owing to the sluggishness of the ac- tions of the mothers that so many in society are mere stupid masses of flesh and blood. Among the Indians, such want of genius could not be found. Pray believe the de- claration, that it is necessary to take the trouble, to make efforts to secure what we want. If you desire health, you must take the trouble to walk or to ride about every day : to breathe a fresh, pure air by night and day, as well for your own as your infant’s sake. You must con- fine yourself to a plain, simple diet, abstaining from every thing stimulating; keep your bowels regularly open, and sit daily in cold water. Your sleep should be regulated with great attention ; night companies abandoned, and all ex- posures, particularly to such as may suddenly alarm you. Your dress should be loose, without tight bandages binding any part of you. I will not speak of your lacing yourselves, confining your waists, compressing your breasts and the contents of the womb ; because the laws arc defective in their operation, for not giving prompt pu- nishment to the mother ; who, from feelings of vanity, be- comes accessary to deforming and destroying the unfor- tunate contents of her womb. I again give you the caution of voiding your urine fre- quently, and particularly, on having the least desire; which was pressed while treating of the womb. You should re- fer to it, and remember that the mischiefs of inattention may be incalculable. As of next importance to the evacuation of the blad- der, is the daily evacuation of the bowels. What I have urged on this subject, in the second letter, I would press with increased zeal on pregnant woman. It is of ten times the importance during pregnancy. The womb rest- ing on the lower gut, lessens the ability to evacuate ; but persevere, and do not remit, till daily at the same hour your bowels are opened. Some have neglected this to such a degree, that they have had a confined column of excrement in their bowels of great length, requiring that they should be turned up, and have it scooped out with the handle of a spoon. If you cannot have a natural evacu- ation daily, from your own efforts, take an injection ; there will be in the end a real saving of trouble by the ope- ration. The system of women during pregnancy, is always more or less inflammatory ; even among the emaciated. Their bodies convert the flit of every part into the circulating blood ; which, when drawn, has the buffy coat, character- istic of the high action of their bodies. There is generally 121 increased irritability of temper, marked by great fretful- ness : requiring soothing, not provoking returns. Those who are well should commiserate them ; and those preg- nant should labour to restrain their petulance and violent temper ; constantly bearing in mind, that their acuteness of feeling arises not from any hard circumstances in which they live, but rather from a morbid action in their bodies. This irritability of the system and mind may be lessen- ed, by a moderate use of the mild tepid bath. The hot bath has produced abortion ; but sitting in a long vessel of milk warm water, covering thighs and legs, having it gently poured around the belly, the skin slightly rubbed with a soft hand, will have a strong tendency to preserve and equalize the healthy action of the womb and adjacent parts. Some women complain greatly of pain in the pubes or front bones, particularly in advanced pregnancies. The womb hangs over the pubes, presses on them, and pro- duces this uneasy feeling. This complaint may be lessen- ed by the above bath ; but most by wearing a bandage around the shoulders, extending down each side and around the under part of the belly, so as to support it. This at the same time prevents the belly from hanging over, and becoming so pendulous after delivery. The ap- plication of the bandage should be when the person is ly- ing down : it should be very wide ; several inches where the belly rests on it; and drawn so as merely to be felt in that position. When the woman rises, the abdomen will rest on it, and great support will be derived from it through- out the day. Some women have the lower bowels inflamed hv the 122 pressure of the womb, and also a constant desire to void the excrement. The relief for this is moderate blood- letting, sitting in a tub of warm water, and a slight purge of salts or oil; rest, and laying on the belly will be of ser- vice. Sometimes the piles are particularly distressing in pregnancy, to be relieved by the means pointed out, while treating of their cure in the second letter. SICKNESS OF STOMACH. The next complaint I shall mention, is sickness of sto- mach and vomiting. Generally this does no harm ; but when excessive, it is to be relieved by moderate bleeding, by keeping the bowels open, by cupping, or applying leech- es to the stomach, and rubbing laudanum over it; also, with the application of hot cloths to it. The saline draught, made of lime juice, and salt of tartar in effer- vescence, is very good. Soda water has been drank with success ; lemonade, and the like common articles. The internal use of laudanum should be avoided. HEART BURN. For heart-burn, the general prescription is prepared chalk, a tea spoonful mixed in water or milk at a dose, every two or three hours. A little soda, potash, or magnesia, may occasionally be taken; sometimes gum arabic and liquo- rice have done service. The best remedy is a few drops of spirit of hartshorn. I have known large quantities of warm water quickly drank, to relieve the symptoms; gen- tle vomiting in distressing cases might be tried, excited by putting the finger down the throat. A little bleeding has sometimes done good ; and regular exercise never fails t© produce the like effect. 123 COLIC. ' ♦ In cases of colic, or pains in the bowels from flatulence, when violent, blood-letting should be resorted to, if not at once relieved by injections of warm water : a moderate purge of oil, salts, manna, or cream of tartar, should al- ways be taken. The bowels, during colic, should con- stantly be kept open, by keeping a piece of soap in the fundament, as recommended in the second letter. Sitting in a tub of wrarm water, or applying hot cloths wrung out of hot water, will alleviate the pain. FAINTING. In fainting fits, the patient should be kept laying down, exposed to cool air. Moderate bleeding is proper, with slight purging. When the sickness is very great, a mouth- ful of wine or spirit affords a temporary relief. SWELLED LEGS. Swelled legs are very common in the pregnant state. Towards the last, they are often a source of pain and great uneasiness. They are produced by the pressure of the distended womb on the vessels returning the fluids from the lower extremities. Generally they disappear at night, and return daily, particularly in the evening. For- tunately they are not dangerous. A recumbent posture lessens the swelling considerably. Moderate bleedings occasionally are requisite. No local remedies afford half as much relief as wearing laced stockings ; sometimes the common stockings, lengthened so as to reach to the body, and fitting very tight, answer sufficiently ■, these resist the distension, and support the parts ; delivery always termi- nates this disease. During pregnancy women are always subject to the same complaints as in the unimpregnated state. For their treatment professional characters should always be con- sulted. They should bear in mind that their systems in this situation are very inflammatory ; and that the reme- dies ought not to be so very strong as in other situations, particularly when applied to the bowels. Powerful pur- gatives should never be taken. All that shocks the system should be carefully avoided. CRAMP. Doctor W. Moss, a most excellent and judicious writer,, of Liverpool, states, on this subject, that “ the cramp is not an uncommon attendant on pregnancy, and will attack those at this time, who seldom or never have it at any other. It seldom comes on before the fourth month, and is most common at the latter parts. It most frequently attacks in the night, in bed, in the legs, sometimes in the thighs, hips, and belly. “ Getting up, and standing barefoot on the cold hearth, is a common remedy, and, so far as I have observed, is a safe one. In cases of costiveness, keeping the body open will frequently mitigate it ; as also, bleeding, when it is severe and frequent. It will oftentimes be rendered more severe by unusual exercise or fatigue. If instead of the usual way of rubbing the cramped part with the hand, the. part is strongly pressed or grasped with the fingers and hands, more present and temporary relief will be had.” Pouring cold water on the part, rubbing with a woollen cloth briskly, and sleeping under fewer bed clothes, will be found of service. FLOODING. The most important and fatal of all complaints to which pregnant women are exposed, is what is called flooding, or loss of blood from the womb. This is brought on by alarms, falls, jolting, over-action, and sometimes from no visible cause. The membranes lining the womb, particu- larly the after-birth, separate from their adhesion to the womb, and the large blood-vessels entering into it, dis- charge the blood, which then passes through the mouth of the womb in large quantities. The complaint is the more alarming, as the danger is of the most imminent kind when least apparent. Death frequently ensues with very incon- siderable warning. The treatment of flooding requires much attention and skill. In all cases, medical aid should be had the moment the disease appears. If it cannot be had, you must make the patient continue in bed, as cool, and with as much fresh air as will be tolerably comfortable. In the beginning she should always be blooded freely, rapidly, so as to pro- duce fainting, which should never be checked, as it is at this moment that those clots of blood are formed, which put a stop to the flooding. If no one can be had to bleed directly, bandages around the arms and thighs, so as not to hinder the pulsation, may be applied until the arrival of » bleeder. Cool air being admitted, the bowels should be opened with a clyster of cold water : every thing heat- ing, as warm clothing, stimulating drinks and diet should be avoided. If the blood continue to flow considerably, stuff up the birth-place a cloth to stop the passage. A cold wet cloth on the belly will tend to stop the discharge : this should be renewed every two or three hours ; a bag of ice is the best application. These cold applications (sitting in cold water has been found good) should not be continued so long as to produce chills. If the bleeding still continue, two grains of sugar of lead should be given every hour, un- til it ceases, or until five or six doses are taken: about twenty grains in a quart of water, one fourth injected in. the bowels, and the remainder used in washing the birth- place, will expedite the cure : it may be repeated two or three times. Almost always, these remedies relieve the discharge for the present. The great danger is in its re- turn. In order to prevent the return, no matter how well the patient feels, she must continue in bed two or three weeks, cool and quiet, and ready at all times to ap- ply the cold wet rags up the birth-place, in case of return. I warn you not to disregard this cautious conduct; if you do, ten chances to one, you are dead without an hour’s warning. When the flooding returns, in great degree, in spite of all efforts to prevent, the woman becoming extremely pallid, showing excessive loss of blood, but one remedy is left, and that is to produce an immediate abortion. Unless the danger be very pressing, the advice or direction of a phy- sician should be taken before the destruction of the child. Tt should, however, be always remembered, that the life of the child is not to be compared with that of the mother. A forced delivery being determined on, a woman with small hands should be the operator. The patient should lay on her side, her thighs drawn up near her belly, with a pillow between them. The wo- man operating should grease her right hand well with the mildest lard or oil, and folding her fingers together as round as possible, should very gradually introduce or push them up the birth-place, gently dilating or extending the parts as she carries her hand forwards. When her hand arrives at the mouth of the womb, she will perceive its edges or lips, and between these she must gently insinuate her finger, so as to pass through the membranes holding the waters : this being done, the waters immediately flow out, and the womb begins to contract. If the flooding cease in this stage, it is well to stop ; but if the womb ap- pear relaxed, not contracting, it is necessary to go on, gra- dually insinuating the fingers in the mouth of the womb, then opening them gently so as to enlarge it; then still gradually introducing the hand and arm, and passing the head of the child, feel for a foot, which you will distin- guish by the heel, the toes, and the difference in its feel from the hand, if you hold it as if to shake hands. After taking hold of the foot, it is to be brought down to the birth-place. But the following from Dr. Bard, is a better description of the operation than I can give. “ Introduc- ing the hand into the womb, turning the child, and deliver- ing by the feet, is an operation seldom attended with much difficulty or danger, provided it be performed early, be- fore the waters of the womb are fully discharged, and with due deliberation and caution. Whenever it is determined on, let the woman be brought down to the edge of the bed, still lying on her side, or, as I have generally found most convenient, on her back ; her hips a little raised, and her feet supported on the lap of an assistant on each side ; whilst a double sheet spread under her, over the laps ot the assistants, and that of the accoucheur, (sitting on a low seat before her) protects her from cold, and another thrown over her, forms a decent covering. The hand then lubri- cated with good oil, or fresh hog’s lard, and the fingers collected into a cone, is to be gently and slowly introduced, through the vagina to the womb ; which, in some wo- men a little advanced in life, especially in case of a first child, may make so much resistance as to require an hout* or more ; employed in gradual and cautious efforts to overcome ; when the circumstances of the case will admit of such delay. The internal orifice is next to be dilated, by introducing first one finger and then another, until by slow and gentle attempts it will admit the hand *, remem- bering always, that by the natural contractions of the womb, the orifice will be more safely and easily dilated, than by the finger. Whenever, therefore, the pains occur, our efforts to dilate are to be suspended, and the pains are to be permitted to produce their effect on the hand. When the pain ceases, a gentle distension is again to be made, which will probably soon occasion another pain ; which is again to be permitted to produce its effect. And on some occasions, just as the hand is passing info the womb, it is to be opened and laid flat, lest a violent contraction on the knuckWs, should injure, perhaps rupture the neck, which is the part most liable to such an accident. The orifice of the womb being sufficiently dilated, if the hand can then be easily passed over that part of the placenta which has 129 been already separated, until it reach the membranes, that is to be done; and breaking the membranes, it is to be immediately passed into the womb. But if we cannot readily pass the separated portion of the placenta, and the flooding be profuse, it may be necessary to pass through the placenta ; which is less dangerous either to the mother or child, than to separate a larger portion, by passing the hand between it and the uterus. The hand being intro- duced into the womb, the neck will generally cling so close round the wrist as to prevent the escape of much water, and we shall find room to act with freedom ; and as the same pressure generally suspends the haemorrhage, we may take time for deliberation. It is therefore generally pro- per at this period to rest a few minutes, to recover any fa- tigue we may have sustained ; and to refresh the woman by some proper drink, whilst we deliberate on the circum- stances of the case, consider the position of the child, and the readiest way to get at the feet. It will be recollected, that the most natural presentation is the most common; and that in that case, the child’s head is at the brim of the pel- vis, with the face and belly to the back of the mother, the knees bent to its breast, and the feet towards the fundus uteri. As therefore, the child must ultimately be turned, this may be the best time to push the head and shoulders up towards the fundus, and to turn the face of the child to the back of the mother ; which is most easily done within the membranes, and by which the feet will be brought within reach of the hand ; and having secured them, they may be easily brought by a waving motion into the vagina. It is always best, when it can easily be done, to bring down both feet; one however will answer, and generally the child can he turned and delivered by one, with nearly as much ease as by both. In bringing down the feet, bend them a little to either side where you find most room, and remember always to desist during the action of a pain, and proceed again during the interval. After this we may take the assistance of the pains in delivering the hips and body of the child ; cautiously extracting during the pains from side to side, and from pubes to sacrum. As the hips are brought down, carefully consider again how the child lies in the womb ; with its belly to the belly or back of the mother; and take care, if it shall be necessary, to turn it gradually, so that by the time it shall be delivered as far as the arm pits, the belly of the child shall certainly be to the back of the mother, which is the position in which the arms and head can be most easily delivered. And now, or rather somewhat before this, examine the navel string, and occasionally pull it down a little, so as to prevent its being put on the stretch. If the pulse in the navel string be strong, and the haemorrhage suspended, we may still proceed with deliberation, and take the assistance of the pains in accomplishing the delivery. But if the pulsation has ceased in the cord, or if the woman floods freely, either the child or the mother may be lost by delay ; and it becomes necessary to finish the delivery as soon as we prudently can. If therefore, the child’s arms make any resistance, introduce one finger under the pubes, and car- rying it along the child’s arm to the elbow, pull that down a little, then go on to the wrist, it will easily turn down in- to the hollow of the sacrum, and be delivered ; the other arm will be still more easily delivered in the same way. But let it always be remembered, that caution and dexte- rity are more necessary than force; by which, unskilfully applied, there will be great danger of breaking the child’s 131 arms. Having delivered the arms, lay the body of the child on your left arm, and passing two fingers of that hand into the vagina, introduce them into the child’s mouth, and draw the lower jaw down a little, so that, if possible, you may extend the fingers above the mouth along the child’s nose; then placing the fingers of the right hand across the child’s neck, again cautiously ex- tract during the pains, sometimes pulling down towards the sacrum, again up towards the pubes, and from side to side ; and again pushing down and backwards towards the hollow of the sacrum, so as to free the occiput from the pubes. The chin being brought down as low as the fo- shette, stand up, and raising the back of the child towards the belly of the mother, the face will turn out from the perineum, and the delivery be finished. “ In giving this description, I have purposely supposed the most favourable circumstances that occur in a case of so much importance : the haemorrhage to be restrained by the introduction of the hand : and the greater part of the wa- ters to be retained by the wrist plugging up the orifice of the womb ; that I might describe the successive steps of the operation minutely and distinctly : but we must not flatter ourselves, that this will generally, or even frequent- ly, be the case. There are few situations of greater terror or alarm, than a woman flooding at the latter end of preg- nancy ; and we are frequently called on to decide instant- ly, and to act promptly ; yet we must never suffer our- selves to be confused or hurried ; for, even during the operation, many occurrences may happen, which call as much for cool reflection, as for prompt and ready execu- tion. Of these I shall take notice in describing those pre- ternatural cases in which they are most likely to occur. In many of these cases, women are so much exhausted by loss of blood, that even after a safe delivery, they require great attention to recruit their strength and save their lives. Rest, promoted by small anodynes, in some cordial julap, such as spirituous cinnamon water, or what can al- ways be had, good toddy with nutmeg, are the remedies first called for : these must be succeeded by small portions of nourishing diet, frequently repeated? and by tonics, in which an infusion of the Peruvian bark and cinnamon in claret agreeably sweetened, makes a pleasant and efficacious mixture. The after-birth is neverto be hurried.” The opera- tion, altogether, may appear difficult to perform, but it is not. The exertion of a good sound sense will ensure success. Many women have performed the operation on themselves, to get rid of a disgraceful pregnancy: they have succeed- ed by simply introducing the finger between the lips of the womb ; so as to burst the bag of waters, and immedi- ately an abortion comes on. When the murder is deter- mined on, it is certainly better to do it, so as to save the mother's life for repentance, than that she should be de- stroyed, as is often the case, by taking drastic purgatives to effect this object. However, of late there has been discovered an article called ergot, which is the musty, dark looking heads of rye, found in most fields of rye when nearly ripe. These heads reduced to powder, are used, it is said, on good authority, for producing abortion, without injuring the mother. The dose is twenty grains, mixed in a little molasses and water ; and it is stated, that the operation is such, that immediate- ly after being taken, the contraction of the womb com- mences. Whether this medicine will supersede the man- 133 ner of producing the delivery above pointed out, remains to be determined by experience. Even if this medicine succeeds, agreeably to expectation, I would prefer the mode of suppressing the flooding by perforating the mem- branes with the finger, since without introducing the hand in the womb to turn the child, as above described, this perforation or bursting of the bag of waters has been suc- cessful ; more perfectly so than I supposed, on writing the first part of the operation for turning. I would therefore always recommend for flooding in excess, the perforation of the membranes with the finger, before attempting to turn the child. Abortion. Connected with floodings, during pregnancy, is abortion, or premature discharge of the contents of the womb, ending in its destruction. Not having had any par- ticular experience on this subject, I give the best brief view of it from Dr. Bard; a few words of which are changed. “ Abortion happens frequently, and deprives women of their health and happiness. Very strong and very weak women are most prone to it; but the numbers of the strong bear no proportion to those who are of delicate constitu- tions ; the numbers of active country women, to the more indolent and inactive inhabitants of cities ; the number of women of good sense, of calm and steady minds, to the weak, irritable and passionate : hence a most important lesson may be learnt, that good health, and a good educa- tion, are the best preventives. It then, in a great de- gree, depends upon mothers, upon the care they take in rearing their girls, restraining the indulgence in all pas- sions, to lessen this great and common evil. “ Another observation is, that women who have once miscarried, are apt to miscarry again at the same period, from the same causes, and with the same symptoms. So that if the habit be once acquired, it becomes difficult to remove. Hence the importance of great care in young women, not to miscarry in their first pregnancy ; and the propriety of particularly guarding against the causes that produced it at first, in all following pregnancies. “ Miscarriages are most apt to occur between the eighth and the twelfth week, and from the fifth to the seventh month, periods which will require particular attention ; though a prudent care be at all times necessary, as the cause of the miscarriage may, and commonly does exist at a much earlier period than that at which the abortion oc- curs. M The causes of abortion may be reduced to the death of the child ; to the separation of the bag or membranes enclosing it, from the womb, and to the disordered con- traction or action of the womb. “ That the child may die, independently of any disease in the mother, has been proved by many cases in which a healthy mother has discharged it, with marks of consider- able disease. “ A frequent cause of abortion is the separation of the membranes lining the womb, and surrounding the child. The extreme delicacy and tender structure of the vessels connecting this membrane to the womb, especially in the early months of pregnancy, renders the separation not very difficult', by slight causes : hence miscarriages happen most frequently between the eighth and sixteenth week. Yet the cause operates much earlier ; for sometimes, before a small rupture occurs between the after-birth, or any part of the membranes and the womb, the blood is gradually ef- fused ; thereby increasing the separation, till the womb, be- ing excited to action, expels its contents. This cause of miscarriage cannot be detected before labour, and is proved only by the expulsion of a quantity of coagulated blood, immediately before or after the delivery. The causes of the separation of the membranes from the womb, are, gene- rally, too much fulness of blood in the system, arising from free living and little exertion, indulgence in excessive joy, sudden or violent exercise, awkward postures, stimulating food or drink, costive habit, and excessive passions. These operating most directly after marriages, require that great- er attention should then be paid by women to guard against them. The remedy for this state is moderate bleeding, keeping the bowels open, and temperance and regularity in every action. “ The disordered action of the womb itself, is a great cause of abortions. Disorders or affections of any part in the neighbourhood are apt to produce it. This points out the propriety of promptly treating any affections about the pelvis in the most judicious, mild manner. The warm bath and bleeding are the great remedies, and should be administered by the ablest physicians for all the complaints of these regions, in pregnancy. From the recurrences of abortions the womb is very apt to get in such a state, that it will not enlarge beyond a certain size, and as soon as it arrives at this size, it contracts, and expels its contents, as if from habit. This affords a powerful reason for do- ing all that can be done to prevent the formation of the habit, by preventing the first abortions. “ The signs of approaching miscarriage are, absence of the morning sickness, subsidence of the breasts, a dis- charge of blood, or of water from the birth-place, and re- gular labour pains. A coldness of the belly, or sense of weight, and cessation of motion after quickening, are said to denote the death of the child ; but this is very equivo- cal, as many women have produced healthy children, when, from these symptoms, they were supposed dead for some time. In all cases the woman is not to act carelessly, as she may be mistaken, and as the delivery will be always easier and safer when left to nature, than when hurried. “ A discharge of blood from the womb, although a very frequent, and generally the most important symptom, is not always followed by miscarriage as you will find, by reference to what was said on floodings. Doctor Burns observes, “ when abortion is going to take place, the patient feels pain in the back and lower part of the belly, with uneasiness like colic, and a sensa- tion of slackness. This state, if not preceded, is soon followed by a discharge of blood, and presently regular bearing down pains are excited. The discharge is some- times from the commencement red and profuse ; but in other cases it is at first rather watery, or sparing in quan- tity ; presently it flows more copiously, and considerable clots come away, often pieces of skinny or fleshy looking substance may be discovered. In some cases there is much pain and little discharge, or the reverse may hap- pen, or both may.be considerable and protracted. If the miscarriage takes place at a very early period, little can be detected except clotted blood, but if every thing be put 137 in a basin of water, sometimes a more solid substance may be observed, like a chesnut, which, when examined, con- tains a small bag of water with a child in it, no larger than a bee. If the third month be completed, we find that the whole conception comes away at once, like a bag covered with fringed vessels ; or, if the bag burst before it comes away, a gush of water takes place ; by and by the child is expelled, and some time after the after-birth comes away. Abortion is sometimes preceded by shivering, attended with great pains and a feeling of sickness or sinking about the stomach, or a tendency to faint ; occasionally the pa- tient is greatly troubled with wind in the stomach or bow- els. But the symptoms vary in each case, as does the du- ration. In some the whole process is over in six hours, in others it is protracted for many days.” The treatment of females during a miscarriage is clear and simple. On the least attack, or symptoms of its ap- proach, they should go to bed, with a resolve not to rise until the event is decided. If of a full habit, they should be blooded. They must be kept cool and quiet, avoiding every thing heating, drinking only cold water, or some weak tea. The bowels may be opened by injecting warm water. Sitting in a tub of warm water will always lessen the irritation of the womb. The application of large quantities of sweet oil around the back, belly, and breasts, will also have a considerable effect in allaying the action. When the expulsion has actually commenced, it is im- possible to prevent the completion. The woman should keep quiet, as in common labour. A cold, wet rag to the belly will promote the contraction of the womb. Some- times the contents ot the womb (called ovum) lodge either at its neck or in the birth-place, when it is proper to intro- duce the finger, and move it from side to side, for hurrying its expulsion. The after-treatment, particularly in full habits of body, is, to evacuate freely by bleeding and purging, with salts, cream of tartar, and oil. From neglect to do this, inflam- mations have come on, ending in lamentable derangement of these parts; as cancers, dropsies, and barrenness. The treatment which cures the tendency of the system to abor- tions, is not so very certain of success. Before pregnancy, bleed, live low, to take regular, gentle exercise, to avoid violence and excesses, to salivate, and to change the gene- ral habits of the body, as well as residence, are the general prescriptions which have done good. The course I would prescribe is, to revolutionize every habit, to eat a different diet, particularly using sweet oil, to take a new exercise ; to arouse the system every morn- ing by the shower bath of salt water, to apply the flesh- brush to the skin every night. When conception has tak- en place, the most gentle exercise, regularity in eating- simple food, and evacuating the bowels, daily applying sweet oil round the back and belly ; to keep the birth- place free from all irritating matters, by nightly washing in warm water ; to bleed on the slightest feel of fever or fulness ; and to preserve the breasts in a state free from irritation, by applying sweet oil to them, and keeping them unconfmed. Above all, I would the most earnestly re- 139 commend, as the most certain cure, to have the breasts drawn, particularly alter an abortion. When the abortion has taken place, a child or grown person may suck the breasts, and milk will be secreted. This secretion of milk should be kept up for six or eight months. In one in- stance, in my neighbourhood, a child was taken by a lady who was subject to, and then had an abortion, and she raised it in good health. After a few months, the lady became pregnant, and, to her great joy, passed, for the first time, to her full time for delivery. This is, unquestionably, the most certain mode of enabling a woman to pass to her full time, which has yet been discovered. BARRENNESS. Inability to conceive, is a misfortune distressing many women, as much as habitual abortion, ft is often fol- lowed by constitutional affections, of fatal tendencies. The cure has been sought alter with great earnestness. In some instances barrenness proceeds from defective organization. These cases are, however, very rare, and cannot be cured by art. The next general cause is a toi'- por, and irregular action in the womb and its appendages, which often yields to judicious management. The general means of relieving this misfortune which have been prescribed are, to revolutionize the system, to travel, to excite action on the surface by the salt bath, to vary the exercise and habits as much as possible ; and in some instances, salivation has been resorted to with good success. 14U Viewing the subject of the propagation of our species in an important light, I early gave it considerable attention. The theories published on this subject, appeared too defec- tive to be satisfactory. The result of my investigation, as will appear from reference to the medical repository, was, that the presence of a pure vital air was necessary for suc- cessful copulation, or the first excitement of animal life ; that in a foul impure air, impregnation could not take place. These inferences appeared the more correct, as those who cohabit like the negroes, in open fields, at the sides of hills, seldom fail in impregnation. All the animals of creation require a similar pure air. It follows of course, that the connection in the foul air of beds, which will often extin- guish a candle, is improper : that persons solicitous of suc- cess in the business, ought always to get into fresh pure air : that, for a like reason, when the birth-place secretes freely, it should be Well wiped, as the secretion might ab- sorb the pure air. But the great, the important means of rousing the womb to action, will be found by exciting the breasts to their na- tural action. The connection between the womb and breasts, has been before remarked ; it is scarcely possible to excite an action in the one, without affecting the other. The most natural action for the breasts is the secretion of milk. They have often been excited to the discharge, without pregnancy. A child losing its mother, and sleep- ing with a female friend, has been known in the night, to get the nipple in the mouth, and to excite milk by the morning: the discovery led to the resort, and the child was abundantly nourished at the breast of the maid. I I1 1 S1 ~ ''vl' 't I I 5?1 | l f Fig. H. Sl/rwitui MstendsdL BltJddfr and wp'oduclwv if dtrihtfg w f rt’thi'/i. Fig. 1. Shewing Films .from side to side about finches Jronl to inch, 4 do. Catheter . iftcr entrance Scull three sided or hack Janirmdlc. ofunitufe esaituip a1~ iiatuml birth N?2 \\ Fuj. 4. fumed tiomi Shewing the Womb fedlen hack- and its month against the Ifethra of the bladder distended. cur fed ho erneuating the with with a Catheter. then /lotting the ginger a// the /inidamrad and //a.dano the 1ibmh an towards Hgjider. iig. d. Shewing /unfa if generation Fin. 7. Fig. 2. Shewing Fthvis divided, curve of Back tone. / jPei'ineuni. or /tad /Jar the /land to Jn'efs again at at hut// , Head /ia/kt/t/] bnfk 1 'jdace, Birth /dace ,Tubes or \ Front hour ' of Feins ffig. ‘d 141 There can be no question that any female breast may be excited to the secretion of milk. The means are simple. The woman should drink freely of any liquid, and live freely. The breasts should be handled frequently, rubbed with the softest hand, bathed in sweet oil, and a warm poultice applied over the whole of them for an hour. Then it should be removed, and the breasts still be handled and sucked gently, at repeated intervals throughout the day, for several minutes. Particularly every moming, noon, and night, the operation should be renewred until the se- cretion comes. A young dog has often been used for draw- ing the breasts. When the action is excited, it should be kept up for months, by daily sucking them : about the time of discontinuance, and sometime after, impregnation may most probably be effected. There can be no doubt of the womb’s being more acted upon, more roused to natural action by these means, than by any other we know. I have recommended the excitement of this secretion, as will appear from reference, to those labouring under suppressed or profuse menstruation ; also to relieve the womb from habitual miscarriages. I will now only add, that as milk is the most delicious food taken by children, that the ladies declining marriage, might render an essential and honourable service in raising the human family. Let them excite their breasts to the secretion of milk, and they will have the joy of gratifying many poor infants pining away for natural food, and many poor mothers, too reduced to afford sufficient nourishment. The consequent exemption from spleen, and the pleasure of contributing to the growth of some friend’s, some sister’s child, will 143S cause a revolution in public sentiment, a general declara- tion, that the old maids are as valuable, as estimable as the young ; which I sincerely pray God may be the fortunate issue. 143 LETTER VII. History of natural labour—offices of the attendant, or mid wife, in such cases—recapitulation—Q'uestions, and an- swers in illustration. The subject to which I have now to request your at- tention is extremely interesting ; one of the most natural operations to which your systems are liable. I mean the delivery of the contents of the womb, by what is com- monly called labour. Should the person have been pro- perly occupied, the process will give but inconsiderable pain. In the hot countries, among the negroes, and among the savages, bringing forth takes but very little time, and is attended with most inconsiderable suffering. It does not there seem to be verified, that “ in sorrow shalt thou bring forth,” but only where the rules or laws of nature are disregarded. Indeed, considering the extraordinary facilities nature has provided for the birth of the human kind ; consider- ing the numbers who f ing forth daily without suffering, it seems wonderful how so many ladies, on such occasions, can make such a to do about the business, can so idly in- jure themselves with unhappy conceits, can apprehend any thing but the most fortunate termination of their case. But the cause of all such groundless fears may be traced to the arts and ignorance of designing persons. A thou- sand times more notice is taken of one little irregularity of the attendants, than of the many cases nature conducts, without aid. This operates on the fears of the women ; each considers the worst may be her case ; assistants at extravagant rates are sent for ; and they pocket, commonly very handsomely, for the folly of the pa- tient. I beseech you, for the sake of decency, of justice to your attendants, of charity to poor women, abandon such improper infatuation ; believe the truth, when you are in labour, that five thousand chances to one, you will do per- fectly well without any assistance ; that in ten thousand instances, to one to the contrary, the most common wo- men can render you all proper assistance, without the meddling of men operators. Their huge fists, zeal for hurry, and spirit for acting, have certainly done more harm than the improper conduct of women, of which they are so fond of talking. This, Dr. Denman, Dr. Buchan, and every really great physician, have observed. But you are to thank neither man or woman for your labours ; nature does the whole business for you, and would probably for ever do it perfectly, if you would merely preserve sense enough to let her operate without your fears, or the meddling of others. What is the operation ? By the contraction of your low- er bowels, and the pressure produced by the exertions of the muscles connected with the parts, their contents are expelled ; which, when hardened and done rapidly, has often torn the parts. So, by the contraction of the womb, and the muscles connected, its contents are squeezed down- wards ; and by over acting, improper exertion, come out so fast as to tear the surrounding parts. The great secret to be pressed on your minds in the very beginning of this subject, is, do nothing, leave nature to herself, allow only the involuntary powers to operate ; and the discharge will be productive of as little injury in the case of the womb, as in the case of the bowels. Merely to receive what na- ture gives up, is nearly as much the duty of attendants in the one case, as in the other. Iri manufacturing countries, where men are enfeebled, and female children are confined till disease deforms their bones, surgical assistance becomes necessary in about one case in a thousand. It is only the services of physicians, (not midwives) which are more frequently wanted. But in other countries, where such evils do not exist, it is most preposterous to follow the custom emanating from such misfortunes. If I can impress it on your minds, that the operation of child-bearing is most simple ; that it is performed by your own systems, not by attendants’ hands ; that the pains of it are to be lessened by leading a proper life of industry, in pure air, and cleanliness and temperance ; that you will seldom require the least assistance from any but your own sex, cautioned not to interfere with you ; that when you do want other assistance, in almost every instance a good physician’s prescriptions will afford you relief, with a wo- man’s hands to operate, I shall have effected a great deal. For by this, there will be an abatement of your fears, which will greatly abate the pains and dangers of your body, so greatly increased by your incessant fears and forebodings, before and at labour. The natural history of labour, and the offices to be per- formed by attendants, are as follows : There are slight and flying pains over the belly, the womb appears to contract, or, as the widwives say, it falls down, or descends lower in the belly, sometimes even for some days previous. Gradually these pains increase, and the intermission between them becomes less. The pains are produced unquestionably by the contraction of the fibres of the womb, and differ in severity according to the peculiarity of the person ; in some being so slight, the child has been evacuated in the necessary, without a knowledge of the birth. Many other parts of the body become pain- ed, in consequence of their sympathy with the womb. Ge- nerally in a few hours, sometimes in less than an hour, the business is completed ; of the rapidity of which, some idea may be formed by the rapidity of the pains or contrac- tions. The following excellent account is from Dr. Denman. “ About the commencement of the opening of the mouth of the womb, by the pushing forward of its contents, the anxiety of the woman appears to be greatest; her manner excites great sympathy, and it is necessary the attendants should console her, and do nothing, whatever may be the entreaty of herself or friends. In the beginning of labour, there is frequently one or more chills, called rigors, with 147 or without a sense of cold in parts of the body, which being void of danger, and showing that the whole system is occu- pied in the business, ought not to be alarming. There is frequently an inclination to avoid urine, sometimes an in- ability to retain it, sometimes an inability to retain the ex- crement, and a constant discharge of it, which is to be in- dulged in the beginning, aided by a clyster of warm water, if convenient; care being taken not to sit down low for the evacuation, lest the child should be thrust out. If the evacuation can be had lying down, it is always best. There is a colourless mucus discharged from the birth-place, which is sometimes tinged with blood, and is called a shew. “ The pains of labour return periodically ; the intervals between them being of different continuance. In the be- ginning, they are slight in degree, and have long intervals ; but, as the labour advances, they become more violent, and the intervals shorter. Sometimes the pains are alter- nately strong and weak, or two weak, then one strong ; and there is reason to think, that every variety has its ad- vantage, by being suited to each patient. In every circum- stance,” continues the doctor, “ which relates to natural labour, it is impossible not to see, and not to admire the wisdom and goodness of Providence, in making the pow- er, and fitting the exercise, with a marked regard to the safety of both mother and child. This should afford a les- son of patience to those females who become intractable, losing their self-possession, add to the evils of their situa- tion, as well as to those practitioners, who, being led away by popular errors, attempt to add to the strength of the pains, or to quicken their returns ; acting as if they thought there was no other evil to be dreaded but a slow labour; WHICH HAS DONE MORE MISCHIEF THAN THE MOST SKILFUL PRACTICE HAS DONE GOOD. Although there be some repetition, I give the following from Dr. Burns, to impress the more on your minds the general history of labour. “ The first stage of labour is preceded or accompanied by a subsidence of the belty ; and the child is often felt, even for some days, to be carried lower than formerly. The pains at first are short, and come seldom. They go entirely off during regular intervals ; but they often leave a considerable degree of general uneasiness, so that the woman feels restless and uncomfortable, or is hot and cold by times ; and in some cases has a sensation of sickness, or gripes, or a troublesome desire to make water. The pains are usually felt chiefly in the back ; but in some cases they often skip to the fore part of the belly, or are from the first felt there. They are at first very slight, and but only for a short time, perhaps not half a minute, and return at the interval of fully half an hour ; but they come on with more frequency as the labour continues, and are felt lower down in the back, short around to the top of the thighs, and cramps are also occasionally felt in the legs. They are also attended with an inclination to catch at, or take hold of the chair, or of any thing which is near. “ The pains, after a short time, gradually increase in sharpness and frequency; they often seem to decline for a time, after which they again become brisker. There is a great diversity in the situation and degree of the pain, for in some cases it is felt chiefly in the belly, in others in the 149 back ; sometimes it is attended with shivering and trem- bling, in other cases with sickness and vomiting. These circumstances, though unpleasant to the patient, are by no means unfavourable, but, on the contrary, often called a quick labour. “ This stage is attended with a discharge of slimy fluid, which, when the orifice of the womb is considerably open- ed, becomes of a red colour. These pains are often sharp, and seem to be doing no good, and the woman is apt to become restless and fretful; and as thev are sometimes at- tended with sickness, heart-burn, and vomiting, she be- comes impatient and depressed in her spirits. “ These pains proceed from the attempt made by na- ture to dilate the mouth of the womb, and they must con- tinue till this be accomplished. The complete dilatation is assisted and rendered both easier, and frequently more speedy, by the protrusion, through the mouth of the womb into the vagina, of part of the bag which contains the child, and the water which envelops it. The degree to which it is pushed out of the womb, during a pain, varies much in different cures. Sometimes, it forms a very slight projection ; at others it is very bulky, as large as a child’s head ; when these membranes begin to be pushed down, the water is said to “ gather.” “ The mouth of the womb being considerably opened by these operations, efforts are next made by the system to press down the child, to empty the womb. These pro- duce a change in the pains, which are attended with the inclination to press down. This gradually increases, and at last the sensation of bearing down becomes very strong, almost irresistible ; and it is observed, that though the pains be strong and forcing, they produce less complaint, than those which in the beginning of labour appeared to be less severe. There is a great variety in the duration oi this part of the process. It is sometimes gradual and slow ; in other cases sudden and rapid. The pains may be strong and forcing, have very little interruption, may come on at regular periods, with complete intervals of ease.” During this period, the bag, or membranes holding the waters, in which the child lies, usually bursts, and the li- quor contained is discharged, at least the greater part. This event is soon followed by an increase of the pains, which become more forcing, and the spirits of the woman rise in proportion. At length the head of the child ad- vances to the birth-place ; (refer to figure the ninth;) some- times it seems to draw back ; again it advances and dis- tends the external parts gradually and repeatedly ; this being designed for their dilatation. The parts dilating, the. head at length passing, gives a momentary relief to the woman. In a few minutes the pains return, the body of the child is expelled, it begins to cry as the air penetrates its lungs ; the woman appears, from the release of pain, and the pleasure of being a mother, to have the happiest feelings. In a few minutes after, differing in each case, the womb continuing to contract, the pains are felt, and the fleshy substance, called the after-birth, or placenta, or secundines, with the membranous bag which contained the whole, and 151 clots of coagulated blood, are all expelled by a similar operation ; the pains being half as severe as those attend- ing the expulsion of the head. “ The duration of this process is various, but it is ge- nerally longer in the first child than afterwards. This is particularly the case in the second stage of labour, when the external parts being rigid, not having been dilated, most remarkable in those marrying late, the passage of the head is delayed. Some women are always expeditious, others tedious in the operation. Some have the waters discharged early, others not till the child is born. Some have much sickness, as retching, shaking, others none at all. In short, there is a great variety in these respects with different women, or with the same woman in differ- ent labours. In a natural labour, the whole process is con- cluded within twenty-four hours ; oftentimes in a much shorter period.” With this description of natural births, I proceed to speak of the duties the attendant has to perform. In ge- neral, one assistant is enough, two are a great abundance, and more than three persons should never be allowed to enter the room. I shall suppose that no midwife can be had at the time, or if an ignorant one, that some lady of sense enough to understand the most simple things, will stand by and direct. But admitting a midwife of great conceit, or of great reputation, attend, the directions are to be attended to ; and the friend of the woman in labour should stand by, and not suffer the dictates of experience and common sense to be sacrificed to notions of dexterity and successful performance, which have slain their thou- sands and tens of thousands. The first business is to sooth the woman, to compose her mind as much as possible. All other animals, and women in a state of nature, retire to some sequestered spot to bring forth. There should be but little talking, that little for consolation, and recommending patience, never for the en- tertainment of the by-standers, as is generally the case. The largest room should be taken for the operation ; the bed neither exposed to a current of air, or the heat of a fire. Free airing is very important from the beginning to the end ; nothing being more prejudicial than a con- fined atmosphere, for mother and child. The moment a woman conceives herself in labour, she ought to be dressed in the loosest clothes, of the kind that may be most easily removed ; then to have every thing that may be wanted for herself or infant ready in the room. Instead of the parade that is made about getting the bed ready, all that is necessary, is a bed made up as others, with, on the part her middle is to rest, several separate cloths, that the top one may be pulled away from under her, as it becomes dirty, leaving the next one for the up- per piece ; and so on till all are taken away. The articles required in the room, after baby cloths, are cold water for drinking, and for a bath if accident occur ; any weak tea, or gruel, in case of its being desired; then a clyster pipe ; warm water and soap to be in constant,readi- ness ; a pair of scissors and a little cord of tape, or any string, to tie the navel with; old cloths for wiping up what- ever may be offensive to cleanliness, or to the sight. 153 The first thing required of an attendant to a woman sup- posed to be in labour, is to ascertain if the labour has ac- tually commenced, an operation called TOUCHING. This is done by introducing the fore-finger up the birth- place, to feel if the mouth of the womb be opening. The fore-finger is introduced near the pubes, and then pushed backwards as a pain is coming on. If the orifice of the womb appears to dilate during the pain, the woman is cer- tainly in labour ; and this is the only certain proof of its existence. The best position for touching is when the woman is standing, leaning on the shoulder of the one feeling. It may be well done while she is lying on her side. It should always be done with the greatest gentleness, as from vio- lence the bag of waters have often been bursted, to the great injury of the case. In general, no oil or grease is necessary for the operation, (as formerly used,) since the natural secretions are unquestionably the best for lubrica- tion. The finger being introduced, it should be held still until a pain is commencing, when the mouth of the womb will be felt opening. This dilatation of the mouth of the womb being ascertained, no more inspection should be made for some time, as frequent examinations do no good, and much irritate and inflame the parts. When the pains have frequently recurred, always, if there has been an evacuation of the waters from the womb, the woman should be touched again; sometimes the hard head of the child may be felt, resting against the front bones : if the waters have been evacuated, the hairy scalp of the child, sometimes in parts, folded as a cord, the openings called the sutures, and the back fontanelle, sometimes the pulsation of an artery, may be felt. In every inspection, again and again, the attendant should feel most gently. In addition to the dilatation of the mouth of the womb, the existence of true labour may generally be predicted, from the “ recurrence of the pains at regular intervals, by affecting the back, and shooting around to the thighs, and by protruding the bag, as a bladder of water, through the mouth of the womb.” The actual existence of the labour being established, the woman should evacuate her urine and excrement, the last by the aid of a clyster of warm water and soap. If the urine have not been evacuated for twelve hours, a catheter ought to be used for the purpose, unless sitting in a tub of warm water, or an evacuation from the bowels, produce the discharge. I repeat, have the bowels well opened with an injection, because the confined excrement obstructs the passage of the child’s head, and causes the parts of the mo- ther to be destroyed by the compression ; because, unless this be done, there is an evacuation at birth, so offensive as often to interrupt the operations of the attendants ; and because it proves of great service to the woman after la- bour. Indeed, ladies, you will save yourselves a world of suffering, if you will attend to the injunction of emptying your bladder and bowels on the approach of a delivery. The directions for a woman to observe when labour has commenced, are various ; but those most consistent with common sense are the best. Dr. Burns says, that “ in the first stage of labour the patient may stand, walk, or sit, or 155 remain in bed, as she is inclined ; but by no means stand as long, or walk so much, by way of forwarding the la- bour, as is productive of fatigue. Women should always be impressed, that a slow labour is much less injurious than those which are quick. When the pains become frequent and pressing, she should keep to her bed. “ Before the child is delivered, there is often a strong desire to rise to go to stool, but is not to be indulged, as the child might, with great danger, be born when the wo- man rises up. Sometimes it has been born in the pot! “ Fretting should be avoided as much as possible. All voluntary attempts to press down, called bearing down, must—must be avoided, as by expediting the passage of the head before the dilatation is effected, the parts might be miserably torn.” After the head of the child descends in the birth-place, the external parts begin to obtrude, and great attention is necessary, not to do, but to guard against doing too much. An account of all ills brought on by interfering in this stage, would appear incredible. All parties seem, in this stage, to unite in doing thje wrong of hurrying the birth. The woman should be confined to her bed. The best po- sition for all parties, is lying on her side, legs drawn near the belly, and a pillow between the thighs. Talk to her, to prevent her bearing down. Keep the hand applied be- tween the fundament and birth-place, (part called perine- um.) The pains in this stage of labour, are called bearing or forcing pains ; as the woman, by her exertion, bearing down, forces, most improperly, the delivery. As the head advances, push your hand with a force equal to about pushing forwards a ten pound weight. If the head be coming too rapidly, extend your hand, so as to delay its passage, for a pain or two pains more ; tell the woman not to bear down ; and still as the child’s head passes, keep the hand pressing against this perineum, so as to incline the child’s head forwards, towards the pubes. The head hav- ing passed, the perineum retracts, a respite is felt. The body of the child is not then to be touched, the pains of the mother will soon expel it; they alone are to do it. The hand is to be kept on the perineum, as the shoulders and hips pass, pressing as before, though with less force. The child being thus born by the powers of the mother, it is to be left, its head free for fresh air, during its crying ; it is not to be touched for some time. When the navel cord begins to lessen its pulsation, always remain from eight to twenty minutes, the cord is to be tied within two or three inches of the child’s navel, by any kind of string, moderately tight; then tie it again, two or four inches from the last knot, towards the mother, in like manner; the cord between the knots to be cut in two with a knife or scissors ; always look while doing this, lest some parts may be cut, which should not be, as has been done. The child being handed over to be washed in warm wa- ter, and to be dressed in the most free, loose, easy, possible manner, the woman is to remain quiet. The after-birth, placenta, and membranes, are to come away, and soon the womb contracts, the pains return, and the whole is expel- led. If it be detained longer than thirty minutes, the belly is to be rubbed, the woman may roll over in bed to the other side, the cord may be pulled a little during a pain, with a force equal to one pound. Some robust persons have been advised with success to stand up a minute or two ; these means not succeeding, a cold wet rag applied to the belly will excite the action ; lastly, the finger may be pushed up the birth-place, and being turned around the sides of the womb, excites it to contraction. Remember, the object is not to drag away the after-birth, but it is to cause the womb to contract, to expel it. If there be much loss of blood, cold water to the belly, by means of wet rags, and pushed a little way up the birth-place, will stop it ; fainting is to be encouraged, not hindered, as during fainting the bleeding is checked. The after-birth being discharged by the contracting power of the womb, the woman is still to be kept reclin- ing ; and being wiped dry, is to be rolled over to the dry and other side of the bed ; turning over is best; she may be lifted as she lies, but should not elevate herself. Any succession of cloths may be pushed under her; and between her thighs, at the birth- place, a rag is to be applied, to absorb the discharge that follows. Thus, you must be struck with what inconsiderable of- fices are to be performed by midwives. A great duty is, to know when not to act, which very few have learnt properly. In 999 cases out of the thousand, in this country, excepting when a physician is wanted to prescribe for the constitution, they may be summed as follows, and ought to be committed to memory by every female. “To have the woman’s urine and excrement well eva- cuated in the beginning; to keep her composed and quiet; charging not to exert her voluntary powers, as the work is best done by the involuntary; to be careful not to burst the bag containing the waters, by fingering j nor to be too constantly fingering the parts. When nearly ready for delivery, to keep her lying on her side : knees drawn up- wards, and opened by a pillow between them. As the child’s head advances, and distends the parts about the fundament, to keep the palm of the hand ready to press as the head protrudes, pressing equally and gently on the perineum, so as to incline the head forwards, towards the front or pubes ; and when, as the child appears to be ad- vancing very rapidly, threatening to pass before the parts are opened, to incline the hand more forwards, so as to de- lay its passage for a pain or two ; in this stage particularly, entreating the woman to be quiet ; to let the child’s body be expelled by the powers of the mother ; of the cord, be sure that it is not compressed or tightened, and in ten or twenty minutes, when its pulse ceases, tie it in two places, two or three inches from the navel, then towards the mo- ther, and cut it between the knots ; to wait for the af- ter-birth ; if it do not come away in thirty or fifty minutes, to roll the woman on her belly and back again ; to rub the belly with the hand, and to pull the cord with a force not exceeding one pound weight, to excite the womb to con- traction ; lastly, in an hour, applying for a minute, a cold wet rag to the belly, another to the birth-place, and always doing this when there appears to be a great loss of blood. The woman to be rolled over, wiped dry, and put in her place for repose.” Duties which can be done by the low- est servants, and not disgraceful, if performed bv the high- est, to a suffering mother. If these offices be compared with those generally per- formed by common attendants, a great difference will be found. True, persons frequently do very well, under the different and great varieties of treatment. But it only shows that women have wonderful constitutions, and can stand against incredible exposures, and ill treatment. I will now make a few questions and give their answers, the more effectually to impress on ladies’ minds the offices to be performed at labour. What is the first thing a woman in labour should attend to ? A. The evacuation of the bladder and bowels, in order to prevent the compression and injury of these parts. What ought the attendant first to do ? A. Introduce the finger up the birth-place, and gently, during a pain, feel the opening of the mouth of the womb, in order to pro- nounce certainly whether the labour exists. What will she feel on introducing her finger ? A. Probably the bag of waters, like a bladder, which she is to touch so gently as not to endanger bursting ; if the labour has not advanced, she only feels the mouth of the womb gradually dilating at each pain. When the waters are discharged, what should the attendant do ? A. Examine or touch the woman again, so as to feel what part of the child presents at the mouth of the womb. Finding the hard bones of the head, probably the hairy scalp, folds of the scalp, and observing, probably, the pulsation, of some artery of the head ; what should be done ? A. Nothing, but keep the woman in bed, her legs drawn up, a pillow between her thighs, so as to give room for the passage of the child, and to allow its head to rest on delivery. What is the difference between the pains when the mouth of the womb and external parts are dilating ? A. When the mouth of the womb dilates, the woman feels more excruciating pains, called grinding, rending, and cutting pains. When the external parts dilate, she feels bearing, forcing pains, as if the external parts were bursting. What are you to do, when the last pains come on ? A. Keep the woman in bed, the right hand against the part called perineum, between the fundament and birth-place ; earnestly entreat the woman not to bear down ; to amuse herself with talking ; lastly, as the head advances, press firmly against the perineum, so as a little to incline the child’s head towards the front or pubes, in order to sup- port this perineum. What is the difference between the perineum in this stage, and when not distended ? A. In a common state, it is about an inch wide ; at the passage of the child, it expands greatly, and becomes very thin, so thin, that by hurrying the passage of the child’s head, it has been torn, leaving the lower gut and birth-place as one opening. How is this to be avoided ? A. By not hurrying the labour ; by holding the hand against it, so as to support it; by resisting, with the same hand, the passage of the child’s head, for one or two pains, if it appear to be com- ing very fast. When the child’s head is expelled, what are you to do ? A. Let the head lay supported at the side, and do nothing until the pains of the mother expel the body ; during the expulsion of which, the hand is to be still kept supporting the perineum. * After the expulsion of the child, what is to be done ? A. Remain quiet, after allowing fresh air for it to breathe, until the pulsation of the navel cord has lessened, and the child freely breathes. This is generally sufficient in ten minutes, and then, with any string, the cord is to be tied near the navel, within a short distance, and cut between the knots. After the separation of the child, what is next to be done ? A. Let the woman remain quiet for a few minutes, then feel her womb through her belly, to see if it is con- tracting, to expel the after-birth. If it do not contract, the belly is to be gently rubbed, and the navel cord a very lit- tle moved, to excite the womb to contraction. Are you in any case to pull the after-birth away by the navel cord ? A. By no means ; as the object is not to take it away ; but to make the womb discharge it by its contractions. j|>. What other means are there for exciting the womb to expel the placenta ? A. Turning the woman over on her belly ; then introducing the finger to the mouth of the womb, and turning it around its edge, to excite its ac- tion ; at the same time gently extending the cord, so as to aid in producing the contraction. In strong women, who have not lost blood, they may stand up, leaning the head and body over the operator: lastly, if the after-birth do not come away in one hour, the hand may be introduced in the birth-place, and the fingers extended all around the edge of the womb, to make it contract; and then insinuated between the edges of the after-birth and womb, slowly se- parating them, if they adhere, as the contraction goes on. If there should be an alarming discharge of blood, how would you stop it ? A. By applying a cold, wet rag on the bell)’, and pushing another a little up the birth-place. What are the evils of pulling away the after-birth ? A. The separation being made before the contraction of the blood-vessels, profuse bleeding ensues ; and if the ad- herence be great, the womb may be torn from its connec- tions. The after-birth being removed, what next ? A. The woman is to be wiped dry, turned or rolled over to the other side of the bed, with a dry at the birth-place ; and with fresh air, without a current, is to be left to slum- ber quietly for a few hours. Recapitulation of natural labour from Dr. Meriman. Labour is divided into four stages. First stage, the head of the child passes through the upper brim of the pelvis, and the mouth of the womb di- lates the size of a crown. Second stage produces that change in theqiosition of the head, which turns the forehead into the hollow of the back bone, (os sacrum,) and brings the crown of the head to emerge under the pubes in front. Third stage produces the expulsion of the child from the external parts. Fourth stage, the after-birth is delivered. (Note.) The mouth of the womb opens fully, sometimes in the first stage, at others not till the second stage is over. The time at which the membranes rupture is various. The longer they remain entire, the safer in general is the labour : the most natural being when the waters are not evacuated, till the head of the child is just ready to pass into the world. Beginning symptoms of labour. First: general and equal subsidence of the womb and belly ; a very favourable symptom. Second: a discharge of a mucus fluid from the birth- place, called a shew, when tinged with blood. Third: frequent gripes, and desire to evacuate the bowels. Fourth: a frequent urgency to make water. Occurrences during labour. Pains, restlessness, despondency, rigors, vomitings, pro - fuse perspiration. Pains are true or spurious. The spurious are known by irregular occurrence, by affecting the belly more than the back or sides, and by not opening the mouth of the womb. True pains are known by recurring at regular intervals ; by affecting the back, and shooting round to the thighs; by producing a perceptible opening of the mouth of the womb during each pain ; and by protruding the bag of waters as a bladder, through the mouth of the womb. True pains are of two kinds : 1st. grinding, rending, cutting, as the mouth of the womb dilates. 2. Bearing, or forcing pains, after the womb has opened, and the bag of waters, or the head of the child, is forced through the mouth of the womb, and the external parts of the mother. The restlessness and despondency of women in labour, occur in the early stages, during the grinding pains, gene- rally relieved when the bearing pains come on. Rigors, or thrillings, often occur during the opening of the mouth of the womb, and when it is completed ; some- times preceding the passage of the head through the ex- ternal parts ; and terminate by producing violent cramp in the lower extremities. These are favourable indications of labour, different from those distinct shivering fits, the forerunners of fever, occurring in long, difficult labours. 165 Vomiting is also a favourable symptom in labour, at the beginning ; but should create alarm, when it occurs after a long continuance of labour, the mouth of the womb open- ed, and pains suspended. Perspiration is a natural consequence of labour; but artificial perspiration, brought on by heated air, and bed- clothes, or heated liquors, is injurious. Rules for Management of Natural Labour. 1. Natural labour requires but little assistance. The dilatation of the soft parts is effected by the pains, assisted by the bag of waters ; of course, no attempts to dilate must be made by the attendant. 2. During the first and second stages, the patient may sit, stand, kneel, or walk about, as she pleases ; repose oc- casionally on a bed or couch, but not too long at a time. 3. She should be supplied with mild bland nourish- ment, if desired, in moderate quantities. Tea, coffee, gruel, barley-water, milk and water, lemonade, broths not salted, may be allowed ; but beer, wine, spirits in any form should be forbidden, as injurious in the early stages of la- bour ; and only used in small quantities in the last stage, in cases of great exhaustion. 4. Bladder and bowels, by all means, to be emptied af- ter introducing the finger into the birth-place. 5. Touching must be resorted to in order to judge of the progress of labour ; not too often repeated, and with great care not to break the membranes. 6. The spirits of the patient to be kept up by cheerful conversation ; not noisy or unpleasant remarks. 7. About the end of the second stage, the patient is to lay down ; legs drawn to the body ; knees opened with a pillow ; the attendant to be behind, ready to support the part between the fundament and birth-place, as the head and body pass, to retard it one or two pains, if too rapidly coming. 8. After the head passes, allow the pains to expel the body. 9. After the child breathes freely, in ten or fifteen mi- nutes, tie the navel cord, one or two inches from the belly, another within four or five inches, and divide the middle, examining as it is done, to prevent cutting improper parts. 10. The child being born, secondary pains come on to expel the after-birth: these, generally in less than twenty minutes, expel it in the birth-place, from whence it is ex- tracted easily. With all these accounts, recapitulations, questions and answers, I do not see how it is possible you can fail under- standing the subject of natural labour, so as to direct all needful assistance. 167 LETTER VIII. Contents. General remarks—particular charges to at- tendants on women in labour, to prevent flooding and la- ceration—the treatment—delivery of after-birth when retained—twins—breech presentment, feet and knees, forehead, face, head and arms—delivered by powers of mother—cases where art is necessary—presentments of arms, shoulder, back, belly, sides, navel cord, &c.—ope- ration—recapitulation*—tedious labours on account of the mother—destruction of child—delivery by the lever and forceps—after-birth before the mouth of the womb— convulsions—means of lessening the pains of all labour. On entering into the subject of the more particular treat- ment of women at births, I cannot avoid feeling distressed at a survey of the afflictions which so many good mothers have had to encounter; probably as justly attributable to themselves, as to their ignorant attendants. For what ex- cuse can be found for neglecting to procure accurate infor- mation of the outlines of the great work of child-bearing, the most interesting operation to which they are subject ? Had but small portions of those hours lost on cookery, novel reading, and pretty exhibitions, been devoted to the exer- cise of common sense, about parturition, there would have been scarcely an evil to encounter. To think that rational beings would consent to expose their lives to the mercy or ignorance of attendants, when they could have felt the sc 168 curity of certainty, of what treatment was proper, is truly most extraordinary. The more does it deserve to be re- probated, since the moment the woman is in the situation requiring assistance, the ignorance contributes to the alarm; the most indifferent prescriptions are seized, more fatal than catching at straws ; they embrace the means which increase their danger. Of the evils which women have had to encounter at births, those from ignorance about what is necessary to be done, are not an hundredth part so numerous as those from acting in such a way, that a child, understanding how a child was born, would detect and condemn. The serious misfortunes of bursting the external parts, pulling down the womb, alarming floodings, and innumerable mutilations of children, ought not to be so much ascribed to the igno- rant attendant, as the negligent woman and her friends. Should a physician offer to relieve a tooth-ache, by cutting off a member of your body, the prescription would be in- stantly rejected ; and yet such a remedy for such a com- plaint is not more ridiculous, more at war with common sense, than the exercise of those arts, tricks, and follies at births, which bring on the above misfortunes. From the history of labour, we learn that the object of the slow returning pains was the gradual opening of the parts, for the passage of the contents of the womb. To say nothing of experience, can you fail perceiving that the hurry of the operation must tend to burst the parts ? In- deed, for a woman to suffer a midwife, without any cause, to be thrusting her hand up her womb, tugging at the parts, exciting irregular action and irritation; for her to be pre- 169 vailed on to bear down, forcing, striving, to discharge the child, all show, that she no more exercises her common sense than such officious, meddling midwifes. A contra- ry treatment, patiently waiting for the involuntary contrac- tions to do the business, and when appearing too rapid, to press with the hand on the distended parts, then so thin, that is, the perineum, so as to support it, (and not to tear it open with her fingers, or slip it off, as some have been known to do,) is the course pointed out by common sense. To guard against this accident, in addition to the above means, the mucus should never be removed from the parts ; and when dry, they are to be well oiled. When the perineum has unfortunately bursted, the parts should be well washed, and freed from any thing that can keep their edges apart. A clyster should immediately be given, if the bowels have not been cleansed before delivery. The thighs should be drawn up, the knees kept close toge- ther, the parts at perfect rest; any mild ointment may be applied externally. Sometimes these lacerations have thus healed up, though often otherwise ; leaving the excrement perpetually entering in the birth-place. Slight lacerations of the lips of the birth-place some- times take place ; and large quantities of blood are effused in the part. This is painful, but requires no other treat- ment than a soft poultice, and cold washing. Pulling clown the womb, and floodings in labour, are produced by as unnatural treatment, as much in violation of common sense, as the bursting of the perineum. Every woman would instantly bleed to death, if, on the separa- tion of the placenta from the womb, the womb did not contract, so as to stop up the mouths of the large vessels which carried the blood to the after-birth. I repeat, then, the great business is, not to extract the placenta, not to pull at it, (sometimes even the cord has been pulled off, in the abominable exertion,) not to force it away, as has been so generally done, but to excite the womb to contract and ex- pel it. The common sense, therefore, of every woman should tell her, that this pulling away must either pull down the womb, or separate the placenta before the womb contracts, and must produce floodings, and therefore ought not to be submitted to. The means of exciting the womb to action in common cases have been mentioned. They should be continued after a pain, the cord gently pulled (again remember, not to pull it away, but to excite the ac- tion of the womb;) lastly, the hand may be introduced up the womb, the fingers rubbed against the sides, around the edges of the placenta ; lastly, the careful midwife is to in- sinuate her finger all around its edge, slowly separating it; and with a cold wet rag on the belly ; rubbing the belly, pressing gently, and moving about the great ball or mass of the womb, its contraction will be certain. A general rule is never to remain more than two hours without forcing the delivery by the above means. The hand going into the womb, is guided by the navel cord ; when the whole is brought away, it should be so turned, or wiped around, as to take up the membranes and clots of blood, which may adhere to the sides, and produce af- ter-pains. Whenever there is an alarming loss of hlood after delive- ry, cold water is to be applied ; a bag of fine ice or snow 171 has been stuffed up the birth-place, and applied to the belly, with success. You are unhesitatingly to pour on a pitcher of cold water, and inject the coldest iced-water up the birth-place with a common syringe. It is needless to add, that the patient should have fresh air, no heating drinks or cloths ; and is to be wiped dry, and moved as little as possible. If the womb has been detached from its connections above, so as to come out of the birth-place, called inver- sion ; ascertained by its descent, and the vacancy in the lower belly, the treatment should be immediately pur- sued, as recommended in the description of the external parts of generation, to which I refer you. Next to the charge, that the attendants are not to be allowed to do those things which are found to produce la- cerations, floodings, falling down and inversion of the womb, and that they are to do all that common sense points out for prevention ; they should be warned not to feel, or finger roughly, the child in the womb. The gentle appli- cation of the finger will enable each part to be more easily distinguished. Some midwives have been so rough as to push out the eyes, and destroy the organs of generation of the child, when such parts presented. The directions you have now had, relate to about ninety- eight cases in the hundred of births, according to accurate records kept of deliveries, at various lying-in hospitals. If you attend only to this proportion of cases, you will do much good indeed. But I would wish you to do more ; I would have you to attend to the remaining cases ; to form at least, such a knowledge of each varying case, as will enable you to understand the treatment, to direct an attend- ant, in case of inability to procure a physician to consult with. But truly, in most of these two cases in the hundred, a physician is not necessary ; the powers of the mother, with but little art, are often adequate to disburden the womb of its contents. You have had accounts only of cases where one child is in the womb, and the head presents, with its occiput or crown, the back fontanelle, with its three edges and three sutures, or seams leading to it. On the belief that you will comply with my entreaty, not to be so ridiculously fanciful as to suppose every varying case will be your own, I proceed to state to you, that there are other cases : cases of twins ; and of different parts of the body presenting at the mouth of the womb, particularly of the breech. I com- mence with twins. And first, be not alarmed on the discovery of the exist- ence of twins. With proper treatment, the mothers do very well. The directions to be observed, are the same as those given for single births. Dr. Meriman has summed up all the useful information, in the following laconic manner. “ It is seldom possible to ascertain that there are twins, till after the birth of the first child ; yet, very rarely, it is known during the first labour, by the membranes of each child being felt at the same time in the birth-place; and 173 sometimes different parts of the two children come down together. u Each of the twins is commonly smaller than a single child, which occasions often the birth to be rapid; and gives the first idea of the twins. At other times, though it is evident the child be small, and there is room for it to pass ; yet the pains, though frequent, do not propel it, as the action is impeded by the child, at the upper part of the womb.” After the delivery of the first child, by feeling the belly, the existence of another child may be ascertained. II the womb feel very large, rather than leave the woman in uncertainty, it is advised to introduce the hand in it, and feel for the child. Generally in twin cases, the second child is delivered in an hour after the first, and in a position contrary to that of the first; so that if the first present head foremost, the second is a breech or feet presentment. “ The first child being delivered under the management prescribed for single cases, the question to be resolved is, whether the birth of the second child shall be left to na- ture, or terminated by art. “ It will hardly be denied, that some time ought to be allowed to recruit the woman’s strength, and to give an op- portunity for the second labour to come on spontaneously. There are many cases, in which it would be unadvisable to wait so long as four hours, without interference. 1st. When artificial aid was requisite for the first delivery. 2d. When the child presents unnaturally. 3d. When fits or flooding come on. In either of these cases, the labour is to be finished before four hours.” “ The following is an outline of the practice which I have been in the habit of adopting. 1st. When both children presented naturally, and the labour of the first terminated without aid, and without much fatigue to the patient, I wait for the secondary pains ; but should these not come on in a reasonable time, (four hours,) I introduce my hand, and rupture the membranes ; when, commonly, the second child passes readily through the pelvis. 2dly. If the first labour has been natural, and the second child presents in a wrong direction, 1 have generally deemed it expedient, with very little delay, to extract it by the feet. Sdly. If the first labour has been unnatural, with but very little de- lay, the membranes are to be ruptured ; and whether the child should be brought down immediately, and delivered by the feet, or not, the attendants must decide. The rules applicable to cases of twins, will equally apply to cases where there are three or more children.” After the delivery of twins, greater care is necessary to prevent the mother’s fainting, than in single births : she should not have her head elevated ; and in moving, should be rolled over in the bed. It will be more proper to apply a bandage, in these cases, to support the belly. The rules respecting the delivery of the after-birth in these cases, are the same as in other cases. BREECH PRESENTMENTS. Cases of the child’s presenting with its breech foremost, are not very uncommon ; occurring, perhaps, rather more frequently than twins. The signs of breech presentment are not very certain at the commencement. In general, it may be ascertained by the soft flesh, and globular shape of the presenting part, by the cleft between the buttocks, by the parts of generation, and by the evacuation of the con- tents of the child’s bowels, called meconium ; which last, however, takes place at other presentments. The progress of this labour is generally, particularly in the beginning, more slow than presentments of the head. The thighs and feet of the child are drawn up close to its body ; and in its passage through the pelvis, the navel cord being compressed, the death of the child is very apt to oc- cur. Delivery in these cases is generally effected by the powers of the mother. At first, while the breech remains above, nothing but patience is necessary ; when it passes out of the external parts, the perineum is to be supported with great attention, as it is more apt to burst in these cases, particularly as the heels pass, they are very apt to produce the laceration. As soon as the navel cord ap- pears at the navel, it should be pulled down a little, to les- sen the stretching. In this situation, every thing should be done to hurry the delivery, which is consistent with her safety. The compression on the cord soon causes the death of the child, which may be remarked by its convul- sive, tremulous motion. The belly should be rubbed, gently pressed, to excite pains. As soon as the arms appear at their shoulder joint, the finger should be in- troduced over the shoulders of the child, as far as to the bend of the elbow, and then gently depressed, when the fore arm passes readily into the birth-place ; the second arm will be more easily extricated. The body of the child is then to be gently extended, in the direction it appears ad- vancing : not powerfully, as death will be produced by the destruction of the back-bone. When the neck appears, the finger may be pushed up around the mouth of the womb, and moved or rubbed a little against the edge or sides of the cavity, in order to hurry a return of pains. As soon as the mouth can be reached, a finger should be introduced in it, and the chin pulled down, to expedite the birth, at the same time that air may enter its mouth. Strong wo- men may stand up, or kneel, in these cases, to hurry the delivery. In some cases, the child presents with its breech situat- ed differently from the above ; so that the face is towards the pubes, and as the chin may lodge against them, and retard the labour, the attendant should turn the belly of the child to the best direction. When the breech is delivered, and the toes are towards either hip of the mother, the child is in a right direction. But if the toes point to the pubes, or belly of the mother, the head will come in an unfavour- able position ; and therefore, it will be proper, as soon as the breech is delivered sufficiently, to take hold of the thighs with the two hands, and when the next pain comes on, so to turn the body, or give it such a slight inclination, by guiding it with the hands, as will direct the face to- wards the mother’s spine. “ There is no difficulty in effecting this turn, if it be done prudently and cautiously. Much force is not re- quired ; nor is it necessary that the child’s belly be turned quite round to the mother’s back ; an inclination towards the mother’s back is all that is wanted. In cases where the mother has a large, well-formed pel- vis, the child may certainly be delivered living ; but the chance is very indifferent, when the pelvis is narrow, or any thing occurs to retard delivery. I should recommend, when ever a breech presentment can be ascertained to ex- ist, to send for some experienced hand ; or, at all events, the united sound sense ot the bystanders must be exerted in defending the perineum of the mother from laceration, and the child from death, by delay in the pelvis. To this I will add, that the efforts to reanimate the child, by blow- ing down its nostrils, rubbing its skin, bathing in hot wa- ter, should be continued two hours at least, as life has been restored in several cases of longer duration. The next presentments of children at birth, are the knees, and the feet. Sometimes either one foot, or one knee. The knee may be ascertained by its bluntness ; the foot by its thickness, the heel, the great toe, shortness of the toes, and their forming nearly an even line. The treatment in these cases is precisely the same as that of breech presentment. If the child do not present so that its face shall be towards the back of the mother, its body is to be a little inclined towards it, as soon as the breech is delivered. The navel cord is to be guarded from extension, and the birth, after the navel passes, to be hurried as much as possible ; though all these cases are to be left to nature, until the navel passes. In these cases, the greatest possible care is to be taken not to burst the bag of waters, which will hinder the dilatation, so particularly re* quisite in such presentments. You have now the history of the births upon a fair ave- rage of four thousand nine hundred and ninety cases in the 5000. You perceive the offices to be performed by attend- ants, in all these cases, amount to almost nothing ; chiefly to not breaking the membranes ; applying the hand to the peri- neum, to support it ; and, in possibly one case in a thou- sand, inclining the body a little round, so as to turn the face towards the back of the mother, when, as so rarely happens, the toes are towards the belly of the mother ; and lastly, in hurrying the labour, when the navel is de- livered, by telling the mother to bear down ; by rubbing the belly, and by a gentle pulling of the body in the di- rection it advances. Although I consider any further detail to you on the subject of midwifery, as unnecessary for any useful pur- poses ; yet as it may tend to gratify curiosity, and possi- bly be a subject of reference by some practising midwife, I proceed to state the remainder of the cases occurring. It is probable that there is not one part of the infant’s body which has not, at some time or other, presented at the mouth of the womb for delivery. The rules to be observed, in such cases, I shall continue to extract from Dr. Merriman. “ The irregular presentations of the head are, when the forehead is towards the pubes, or belly of the mother ; when the face presents ; when a hand or arm enters the pelvis with the head. 1. “ The most common of the wrong head presentations is, that of the forehead to the pubes. It is seldom discov- 179 ered at the first examination ; the labour continuing longer than usual, the attendant makes a more accurate ex- amination, and discovers the presenting part is not so conical at the union of the pubes in front; the bones do not ride one over the other ; the scalp does not form into a cushion ; the hollow of the sacrum is not so filled up by the head ; the front fontanelle, with its square shape, and four seams or sutures, at each corner, may be felt. Na- ture, in general, particularly in those of large pelvis, will deliver in this presentment ; but there will be danger of laceration of the perineum, and the labour will be tedious ; all will be prevented, if the attendant will apply the fingers to the side of the forehead of the child, and care- fully press the fontanelle from the thigh bone, it approach- es, a little around, to the side or edge of the sacrum, whereby the crown of the child’s head (occiput) is brought under the pubes in front, and the delivery is safely effected by nature. 2. “ The presentation of the face is distinguished, by the general inequality of the presenting part, by the eyes, nose, mouth, and chin ; the chin, in these cases, is towards the front of the pubes. These cases are generally to be left to nature ; the bones not yielding, the labour will be tedious ; the children generally born alive, but the fea- tures of the face are amazingly distorted, and require se- veral days of rest for recovery. 3. “ When, with the head, one arm presents, nature ge- nerally performs the work but slowly. This irregularity occurs chiefly in those of wide pelvis. If it be only the fingers or hand, coming down in a flattened shape, by the 180 side of the head, the difficulty will not be very great ; if the elbow be the part, its fore arm bent on the upper arm, the difficulty will be increased ; and still more, if the hand and arm have descended before the head, the head resting upon the arm at the elbow. “ Occasionally the operator may with the fingers pre- vent the hand or arm from descending below the brim of the pelvis, till the head progresses so low, as to be clear of the impediment ; but in attempting this, if the operator bring the arm down lower, or force the head back, no good, but great danger will be done. It will be very prac- ticable to push back the hand with a finger, without push- ing back the head, or pulling out the arm. The arm, in these cases, in general is much tumefied, but in a few days recovers itself. “ In these cases unusual care must be taken to keep the patient calm, free from fever, cool, not sweating under hot clothes, and guarding against fatigue in vain attempts to force the child, before the parts are properly prepared to let it pass ; opening occasionally her bowels with laxatives; and never allowing the urine to remain in the bladder ; to which, in these cases, it is particularly inclined. “ The next presentations are, first, those of the superior extremities ; second, the back, belly, or sides ; and third, the navel cord. These cases are only to be ascertained by feeling up the birth-place. “ If, on an examination, the mouth of the womb be di- lated, and the child cannot be felt ; if the waters be eva- 181 cuated, and the child out of reach of the finger, the pro- bability is increased of an unnatural case. 1. “ The most difficult cases are those of the superior extremities ; for, whether the part be the hand, elbow, shoulders, or both hands, it is impossible for the child to be delivered without being turned ; and delivered as a footling case. The established practice is for the opera- tor to pass the hand in the womb, to take hold of a foot, both if practicable, and bring them down to the external parts, and conduct the delivery as if it had occurred na- turally. “ The rules, in these cases, are, first to let the bag of waters dilate the parts. As soon as the mouth of the womb is sufficiently opened, or the waters evacuated, the attendant is gradually to dilate the external parts, till they make no further resistance to the passage of the hand. Then slowly carrying his hand through the birth-place and mouth of the womb, in the absence of a pain, he must (if they have not been opened) rupture the membranes, by- pressing a finger firmly against them, when the hand will come in contact with the limbs of the child ; the hand is then to pass forwards till it reaches the feet, which are to be drawn along the belly, not over the back of the child ; proceeding slowly, still in the absence of a pain, it will be found, as the feet are brought lower, the arm will be re- tracted ; and lastly, when brought down, that the case is become as a foot or breech presentment; of which it must be particularly remembered, to turn the feet towards the sides of the mother, in order that the face may pass at her back. These are the safest cases ; generally the waters are evecuated before the hand is introduc- ed to prevent their passage; and the womb contracts around the child, so as to make great resistance to the in- troduction of the hand. In such cases, and when the mouth of the womb is not dilated, the patient ought to be blooded freely, if she can bear it, to lessen the contraction; and immediately after, (the better if fainting exists,) the mouth of the womb is to be dilated, and the hand insinu- ated as above. Lastly, when the action of the womb is so violent, as to make great resistance to the hand, it has been advised to wait, till the pain exhausts its powers. Dr. Hamilton prefers doing this, by administering eighty drops of laudanum. I would always advise free bleeding and bathing the parts, in large quantities of sweet oil, or melted hog’s lard, and to keep warm wet cloths around the parts, to be often wrung out of warm water ; if not, to bathe the whole person in warm water, sufficiently long to produce a general relaxation. 2. “ The next presentation is that of the back, belly, and sides. In these rare cases, the child often spon- taneously turns into a breech presentment. When it does not, the introduction of the hand is necessary, to bringdown the feet. 3. “ The presentment of the navel cord. In these cases the cord falls down, before the child, and is com- pressed, so that the death of the child is generally the consequence. When the pulsation of the cord ceases, the child is generally dead. Sometimes the cord has been slipped back out of the way of compression. If this can- not be done, and the child be living, after the part of the 183 child is engaged in the brim of the pelvis, the labour is to be hurried, by letting the woman stand up, by rubbing the belly, and by bearing down. In order to impress on your minds the more what has been said respecting the mechanical knowledge, and operations of labour, I recapitulate. First, If the after-birth be not delivered in about an hour and a half, after the use of the gentle means first sug- gested, the hand is to be introduced into the womb ; the fingers to touch and move against the sides ; then the pla- centa to be separated slowly? and brought away during the contraction of the womb. 2. “ In cases of twins, nothing extraordinary is re- quired in common ; if the second child be detained four hours, delivery to be forced as directed. 3. “ In breech presentments, the beginning to be left to nature : the presentment to be ascertained by the feel, the cleft between the buttocks, and the parts of generation, ,and discharge of contents of the bowels. When the heels pass, great care is to be taken to support the perineum ; the slower the labour so far, the better; then as the body passes, pull a little the cord ; moderately extend the child, not so as to destroy its back and neck,; rub the belly occasionally ; let the woman bear down ;*let her stand up, leaning forward, that an attendant may properly support the child; when the arms appear at their origin, to pull them down gently ; rub the finger around the edge or the mouth of the womb, to excite it to contraction ; lastly, when the child’s mouth ap- proaches, introduce the finger, and pull down a little ; as soon as delivery, the woman to lie down, the child so supported as not to be injured ; air to be blown in its nos- trils, if not breathing ; the cord to be cut; the skin to be rubbed, and every attempt made, and long continued, to reanimate the body. The standing up of the woman, as above, will proba- bly hurry the birth with sufficient rapidity ; and I would particularly charge, that the child be so supported in its passage, as not to be endangered by the position; its weighs, properly directed, must have a considerable effect in ex- pediting the birth. 4. When the feet present, to be ascertained by the heel, the shortness of the toes, their straight edge, &c.; and when the knees present, to be ascertained by the blunt- ness of the angle they form ; or when one foot, or one knee presents, the delivery to be effected as in breech cases, toes turned towards the thighs, on the passage of the breech. 5. When the forehead presents, ascertained by feeling the front, or square opening, or fontanelle, with its four seains or sutures, and the cavity in the back or hollow of the sacrum, to apply the fingers to the side of the forehead, and turn or incline it around from the thigh bone of the mother, towards the edge or side of her back bone, or sacrum, where it unites to the hip bones, so that the presentation be- comes natural, which it often does, even without assistance. 6. When the face presents, to leave to nature, pre- serving the powers of the mother, without excitement .ctr molestation, as cool and comfortable as possible, 7. When the hand or arm presents with the head, to endeavour, without pushing up the head, to push hack the arm, (never to pull it forwards,) and, if not successful, still leave to nature. 8. When one or two arms, the hack, shoulder, belly, or breast, present, as soon as ascertained, and the mem- branes have opened the mouth of the womb, slowly intro- duce the hand, search for the feet, bring them down over the child’s belly, thereby making a feet or breech present- ment. When the womb contracts so violently as to make- great resistance to the entrance of the hand, the woman to be blooded freely, bathed around the body with sweet oil, fomentations of warm cloths to the belly, or general warm bath, to produce relaxation. Lastly, a large dose of lau- danum, not exceeding eighty drops. 9. When thenavelcord presents, if early discovered, some- times it may be so pushed back, as to lessen its compression. The delivery to be hurried, to save the child, but not so as to lacerate the mother. The shortness of the navel cord is also sometimes an impediment to delivery : art does not here promise much : the cord has been cut, and the child dj,gd : the after-birth generally comes with the child. You must believe that there is nothing in these uncom- mon cases, which a woman of good sound sense, cool, composed, not in a hurry, could not perform. I would, in full confidence, trust to any such, especially if directed by a by-stander, in what manner to proceed, and directing from established, written rules. Nevertheless, where no such confidence exists, I would advise an application to a physician, whenever there are rational grounds for believ- ing the labour will be tedious or difficult. I have now stated the difficulties at births, arising from the bad presentation of the child. These are, probably, not more than one half of the difficulties attendant upon child delivery. The powers of the mother are as liable to irregularity as the presentation of the child. Probably in confined manufacturing countries, the bad presentation of the child is not so frequent an occurrence as the mal-forma- tion and disease of the mother. The first impediment I shall mention to births, on the part of the mother, is the bad formation of the pelvis, a most rare (Recurrence indeed, in all countries like the United States, where children are brought up without that confinement, which destroys their vigour and make. The chief defect in the formation of the pelvis, is the projection of the back-bone too far forward, that is, near the front or pubes. The extent is ascertained by introducing the finger near the pubes, and moving it back to the most projecting part of the back-bone ; care being taken not to move it downwards, in the hollow of the sacrum. By this mode, it may be ascertained if the opening be three inches wide ; such are the powers of the mother, that often through a les- ser opening, of two and a half inches, children are born. When the presentment of the child is natural in cases where the pelvis is found small, the rule is to let the labour pro- gress, as long as the powers of the mother exist in good state ; but if no progress be made in the labour, that is, it the child do not descend at all in the pelvis, if the labour have continued, so that the mother’s strength is greatly im- paired : lastly, if after consultation with the best profes- sional advisers, it be determined impossible to deliver the child living, the only object isthe safety of the mother : the child is to be brought away by pieces. The instrument for doing this is called the crotchet ox- perforating scissors. Dr. Bard’s account of using them is annexed, as a subject of reference. “ After a solemn and serious consultation, the operation being determined on, the woman is to be placed on hen back ; the fingers of the left hand being introduced into the birth-place, and fixed on the presenting part of the child’s head, (be sure the mouth of the womb is sufficiently open- ed,) the scissors made for the purpose, are then pushed through the palm of the hand, and between the fingers, and piercing the scalp to the skull, the bones are perforated by a boring motion, until the fingers reach the stops on their edge(a much better plan is, when the sutures, or a fon- tanelle can be felt, to introduce the scissors through them, and destroy the organization of the brain;) “ the scissors are, when introduced, to be opened in one direc- tion, turning them half round, (the joints guarded by the fingers of the left hand,) they are to be closed, and opened again in the opposite direction ; and again turned round, so as to destroy the texture of the brain : then being closed with the same care not to entangle any of the soft parts of the mother, they may be withdrawn. Some time is now to be allowed for the woman to rest; and for the pains, if they still continue, to produce their effect, in discharging the brain, and lessening the diameter of the head. “ This being effected, we next endeavour to remove any nigged edges of bone which might injure the mother ; and then passing one or two fingers within the skull, and taking hold at the edges of the perforation, we may endeavour, in that way, to assist the pains in forwarding the birth. But in a necessary and justifiable case, we shall be able to make but little progress in this way; and we shall find it necessary again to fix the fingers of the left hand over the opening in the skull, and between them to introduce the crotchet within ; then fixing the point on some of the bones ; with the left hand so placed within the vagina, and the fingers so spread on the child’s head, as that the point of the instrument, should it slip, will rather strike the palm or fingers, than the parts of the mother ; we exert as much force, gradually increasing it in extracting, as the part*s will bear : and should they give way, the instrument is to be fixed again on another part, or on the outside of the head, in the eye, under the jaw, or behind the ear ; and varying the direction of the extracting force, as far back as possible, from side to side, or directly forward, endeavour to bring the head through the contracted pelvis. If we again fail, both hooks may be fixed, one on each side of the head, by which as much force may be exerted, as can be necessary, or as the parts will bear : nor is it easy to conceive how much force, or how tedious and fatiguing an exertion is sometimes required. All, however, is to be done deliberately, slowly, and cautiously; resting our- selves, and allowing the patient to rest, and, from time to time, to receive some mild cordial nourishment: haste is seldom necessary, and although we may wish the delivery accomplished as soon as possible, we must never be hur- ried.” “ Having delivered the head, a cloth is to be Avrapped round it, or a handkerchief round the neck ; by Avhich Ave may make use of as much force as Ave dare, Avithout risk- ing the separation of the neck from the trunk. And if even Avith this we do not succeed to bring doAvn the shoul- ders and breast, Avhich in a very narroAV pelvis Avill some- times be the case, Ave are again compelled to have recourse to the perforator, to fix it in the arm pits, or to tear open the chest, or the abdomen, Avhen sAvelled in consequence of putrefaction ; Avhich, in a child long dead, is frequently the case. ' “ This, as well as that in which the child’s head may be enlarged by disease, particularly the hydrocephalus, are cases in which the perforator may be required, even in a woman with a well-formed pelvis. The hydrocephalus may be suspected, when in the beginning of labour the child’s head readily recedes from the touch, floating as it were back in the waters of the womb ; or where, in a Well-formed pelvis, the head remains a long time above the brim without engaging in it, notwithstanding active pains ; and at the same time, we can discover the sutures and fontanelles very largely open, and the bones very easi- ly moved on each other. Yet so much uncertainty always attends this conjecture, even in a person of considerable experience, that it becomes our duty to wait as long as the pains continue regular, and the woman’s strength be not greatly impaired. “ It will generally happen, that the expediency of intro- ducing the hand, and delivering the feet, with the hope of saving the child, will occur before we have recourse to the last remedy : tiiis will put it in our power to examine carefully the nature of the case, and to ascertain what it is which obstructs the labour. If the head be not found very large, nor the pelvis very narrow, it may be proper to proceed, and deliver by the feet ; but if the head be found swelled very large, the chance of saving the child will be so little, and perforating the head, in this case, so easy and safe, that that may be most justifiable. The perforation in this case is generally all that is necessary; as soon as the waters shall be discharged, the head will collapse, and the labour may then be left to nature. “ The death of the child, when that can be ascertained, removes every objection to the use of the crotchet, when otherwise necessary. But of this there is but one real evidence ; that is the separation of the skin from those parts of the child, which can be felt. Neither coldness of the abdomen, disappearance of the milk, cessation of mo- tion for any length of time, nor even putrid and offensive discharges from the womb, are to be depended on. But the peeling off of the scarf-skin is unequivocal, and is sometimes attended with such a distension of the cavi- ties from extricated air, as to render it necessary to open them before the child can be born ; and for this purpose the scissors and crotchet are the most convenient instru- ments.” But a great cause of difficult and tedious labours with mothers, is found, not in the bones, but in the womb ; it sometimes does not act; it acts irregularly ; its mouth will not dilate ; its mouth is also subject to displacement. The remote cause of these irregularities is most gene rally an inflammatory state of the system ; marked by too violent action in the beginning of labour, some* rrjs by a prostration of the animal powers. Relief is had by free bleeding, even when the pulse is weak, if the person be of a strong, healthy make. In these cases a physician should attend, to judge of the power of the patient, and direct when delivery is to be forced. Constant attention must be paid to emptying the bowels and bladder in all tedious cases. The first cause I shall mention of tedious labours is, the refusal of the mouth of the womb to dilate ; it re« mains rigid, as will appear from feeling it. The remedy most universally successful, is free bleeding, sometimes as much as forty ounces. A vomit has been often given with success. Filling up the birth-place with a large quantity of sweet oil, keeping the oil in by a plug of cork surround- ed by a rag, will be of great service. Sitting over the steam of hot water is also beneficial. There is probably no case, in which these remedies, properly applied, would not relieve ; nevertheless, in ca. of failm , would sug- gest maki g a weak decoction of what is called stramonium, ">r James’ town weed, and injecting it up the birth-place, «.o auth of the womb. T* ;s weed has su„-ia powe - f’.i erfe ... relaxing muscular contraction, that I \vo'uld try it in such cases, with great expectations of success. These labours last sometimes many hours ; diet to be very low, and exercise taken freely, though not to fatigue. The next cause of tedious labour, is, the refusal of the body of the womb to contract regularly ; the pains are jrrcgular, but there is no contraction of the mouth of the womb ; bleeding in these cases is proper. Professor Jame°- of Philadelphia, says “ from the repeated trials oi the effects of spurred rye, (called ergot) that, when the soft parts concerned in labour are dilated, to render the interior action more perfect, a dose of one scruple of this medicine, finely powdered, should be given, suspended in a little molasses and water ; that the dose may be re- peated in half an hour, if the interior contractions are not energetic ; that he. never found occasion to give a third dose.” This is a most important discovery ; the medi- cine ought to be in every midwife’s hands. I suppose it will nearly supersede the use of the forceps, for hurrying the birth. Nevertheless, as cases may occur in which it may not be safe to trust to this medicine, I extract the following account of the manner of using them. The forceps are made of two blades, corresponding to two levers, of shape and make as may be seen by re- ference to them in physicians’ hands. The one part sepa- rates from the other ; and this one part, called a lever, in most cases, answers as well for hurrying the delivery, as the two united, called the forceps. The manner of using each is as follow's : after giving a clyster, and being cer- tain that there is no urine in the bladder, by introducing the catheter. The best position' tor the woman to lie, is on her left side, the posteriors near the edge of the bed. The opera- tor is to introduce the fore finger of the right hand to the child’s ear; then holding the blade or lever in his left hand, he is, under his finger, which is his guide, to push it 193 slowly over the ear, till the claw of the blade is at the edge of the birth-place. The introduction of the blade will probably renew the pains, of which advantage is to be taken, by using the blade during the pains, and desisting during their intermission. The manner of acting is to hold the left hand on the blade, close to the birth-place, and with the right hand to raise the handle of the instru- ment slowly, but firmly ; so that while the part held down with the left hand, keeps it fixed, the other end presses the child’s head downwards, in the hollow of the sacrum, and thereby ends in the expulsion ; when there are no pains, we are to imitate them, by acting and resting alternately. The head soon begins to descend, and distend the perineum, which is to be supported by an assistant* When, instead of this blade or lever, the forceps are to be used, after the introduction of the first blade above, the second is to be introduced with equal care below, precise- ly opposite to the first. Should the opposite ear not be felt, the direction of the blade must be by the position of the first. Both blades being most slowly introduced, the claws are to be brought together and locked, care being taken not to entangle any of the hair, or soft parts, in the lock. If, on endeavouring to lock the forceps, the handles do not come near together, or are very far apart, or are close together, the points of the blades are not properly fixed ; the last one should be extracted, and more carefully fixed. The forceps being so fixed as to enclose the head of the child, the handles being held in both hands, they are to be moved from handle to handle, or upwards and downwards, or from ear to ear ; because, if moved from side to side, or face to crown, they will slip off. The most gentle force only is to be used. Dr. Meriman observes, “ when acting with the forceps, the force at first used should be very mo- derate, but is to be increased as occasion may require yet if the head advances at all, however slowly, with the force first applied, it need not be increased ; for as Dr. Denman truly remarked, u a small degree of force, con- tinued for a long time, will be equal to a greater force hastily exerted ; and with infinite less detriment either to mother or child.” In concluding this short sketch of the use of instruments, so terrible to so many ladies in imagination, I would remind you of the folly of such fears. What are these mighty in- struments ? a pair of scissors, to cut as they open, digni- fied with the name of perforator, as harmless to the mother in this operation, as proper to be used, when the child can- not be born living, or is dead. And what are the forceps ? a pair of large pincers ! one blade, when used alone, dig- nified with the name of lever. And as to their use, a source of no pain to mother or child, requiring not more sense for fixing them over the ears of the child, so as to compress its head equally, and not injure the mother, than the application of a pair of pincers to pull out some body from a mass which a little surrounds or envelops it. 'Fak- ing this fair view of the subject, I think that although not one in half a million may have to submit to the operation, all ought to view it as a simple affair, without any terror ; really not so dangerous or painful as the extraction of a tooth. I now come to the third cause of tedious labours. It is when the mouth of the womb is turned towards one side of the woman; or thrown backwards to the back of the pelvis, so as nearly to reach the sacrum; or thrown for- wards over the pubes. Laying on the opposite side will change the leaning of the mouth of the womb. When the mouth is turned backwards, (which occurs sometimes with those of very pendulous bellies,) it is re- commended to lay on the back, the hips elevated; and it may prove of service to support or push towards the back bone or spine, the top of the womb, it being the part nearest the stomach. The fact of this inclining backwards of the mouth of the womb, will be ascertained by intro- ducing the finger up the birth-place, and finding the mouth of the womb not in its proper place, but pushed away back- wards, scarcely in reach of the finger. In these cases, the head enters the pelvis, the part nearest the pubes being co- vered with the front of the womb, which has been mistaken for the child’s head, without hair. The delivery requires patience, and no interference. The bending of the mouth of the womb forwards to the pubes, has been questioned; if it ever so incline, the treat- ment is to leave to nature. Before concluding the subject of delivery, I will remark two cases of most rare occurrence, and attended with gfeafc danger. The first is, when the after-birth adheres to the mouth of the womb ; and at its dilatation, bleeds freely. By the introduction of the finger, the orifice of the womb will be felt dilating during a pain. The practice recommended in these cases, is to introduce the hand, gradually dilating the parts, to push it through the body of the after-birth, feel for the feet of the child, and deliver with as much rapidity as in footling cases ; as is practicable without bursting the parts of the mother. Although I never had such a case, I would strongly recommend in preference, two doses of the ergot, the one half an hour after the other; at the same time introducing up the birth-place a strong solution of sugar of lead, the buttocks elevated, a tight plug in the birth-place, then to cover the external parts with the hand, firmly pressing to prevent the escape of blood, until the head of the child advances. So long as the womb con- tracts, no blood can flow, if you will prevent its passage externally, which I am sure, by hands to relieve each other, may be done till the ergot operates. When there are no pains, then turning, and delivery by the feet, is the only re- source. The second case is attended with convulsions. These often arise from irritating matter in the bowels. The re- medy is bleeding most freely ; at the same time, pour down the throat either ten or fifteen grains of calomel, or any other purgative medicine. In addition, a solution of a spoonful of salts ought to be given ; also a clyster every two hours, until the purging is free. When the stools are of* fensive, their irritating nature will be greatly lessened by giving the patient a tea-spoonful of chalk, or half as much salt of tartar, or what is nearly the same, a table spoonful of common strong ley, everv two hours, either mixed in milk or water. When the head of the child is low in the pelvis, it is advised to hurry the delivery with the forceps. My solicitude to make one and all of you acquainted with the history of child-bearing, induces me to add an ac- count of some cases which may occur in every family, as well as the offices performed by attendants. The perusal must make you more familiar with the subject, and the better enable you to assist some suffering woman, or even to direct the performance of services to yourselves. Case 1. Mrs. A. was taken in labour with her first child. She had indulged in excessive fears, increased by the accounts her attendants and companions gave of dread- ful accidents they heard of at other births. She was con- vinced that her situation was deplorable, that the birth would end in her death. Her pains, extending around her back and belly, were at regular intervals. The midwife Was sent for, and in obedience to her fears also, a man at- tendant, to be ready in case of accident. When the mid - wife arrived, she requested the patient to lay on her left side ; and having her nails closely cut, without any oint- ment, introduced up the birth-place the fore-finger of her right hand ; at first near the pubes or front bones, then ex- tended it backwards towards the back bone, called sa- crum, from which she perceived at once, there was a con- siderable space, abundant for the passage of any common child. She kep’ ,ier hand in the birth-place or vagina, un- til a pain came on, and then, with perfect gentleness, ex- tended her ger towards the middle, to the mouth of the womb. She found that the orifice had opened a little, that it was on the stretch during the pains or contractions of the womb ; she felt a small presenting part of the membranous bag containing the waters ; and desisting from pushing, lest her finger might burst the bag, she withdrew it a short distance, preserving it at ease in the birth-place, until the pain had subsided. When this was ended, she moved her finger around, and felt the hard head of the child, but could not of course perceive the hair of its head. Though it were possible for her to be mistaken, yet she affirmed that it was the head, and told her patient that all was right; that her case was very favourable. The midwife next charged her to evacuate her urine whenever she felt the least inclination; and had an injection of warm w'ater given to open her bowels; which speedily had the effect. The pajns returned at regular intervals, increasing in fre- quency as the labour came to a close. As the mouth of the womb was opening, the woman said she felt as if cut open with a knife, so excruciating were the pains. The bag of waters protruding through and dilating the part, at every point, the head soon descended. In this state, dur- ing every pain, the bag or membranous covering was much distended, feeling as a bladder ready to burst. When the pain was over, the waters receded, the bag became flaccid, and it was very practicable to feel the round crown of the head of the child, the soft part in its skull called fontanelle, and the pulsation of an artery in its head ; which proved that it was living. Presently the pains became more fre- quent, the head of the child perceptibly descending, when the patient was improperly alarmed at a gush of water 199 escaping from the birth-place, which arose from the timely bursting of the membranes : now the external parts began to distend, the head being in the birth-place, the pains be- ing more frequent, the head would descend almost to the external parts, and when the pain ceased, would go back considerably. The midwife saw that this was the critical time, and kept the patient on the bed, on her left side, her knees drawn half way up to the belly, and a pillow between them ; also large cloths underneath her, to preserve the bed. In this situation she sat at her side, her right hand applied so as to cover the part called the perineum, (being between the fundament and birth-place, now very thin, and spread so as to appear four or five times as wide as com- mon.) On this equally, she kept her hand, to prevent the too rapid expulsion of the child; and when the head was advancing, held her hand pressed against it, so as to push or incline the head towards the pubes, or front of the wo- man. Being the first birth, she thought the child might tear the perineum in its passage, therefore held her hand so as to resist altogether the exit of the head during two pains, so that the parts had better time to dilate. In this stage, she took unusual pains to direct the attention of the wo- man from bearing down, or holding in her breath, inducing her to talk all the time. At last the head passed into the world, the face towards the mother’s back or fundament: the midwife all the time keeping her hand on the part until the pains of the woman expelled the buttocks of the child. After the head passed, an additional quantity of water escaped, it being squeezed out by a pain, which in a few seconds returned. The head of the child was supported by her left hand, until the expulsion of the body, which was completed in two minutes: care was taken from the first 200 appearance of the mouth, that air should freely be admit' ted, as also that the navel cord was not compressed. About six minutes after the delivery, the child crying loudly, and the pulsation of the cord lessening, she tied a string once around it, about two inches from the navel, then another string towards the mother, within two inches of the first, then cut the navel cord between the two knots, with a pair of scissors. In about ten minutes after the delivery, the happy feelings of the mother began to cease : she felt the pains returning. The womb still contracted: it wras felt as a large ball over the pubes; the after-birth made its ap- pearance at the birth-place ; and with considerable clots of blood, was taken away, and put in a pot for the purpose of burial or burning. The patient was kept unmoved during this operation ; and about ten minutes after, her bottom was raised a few inches, the wettest cloths pulled away, and dry ones put under; and then she was wiped as dry and clean as practicable, without any exposure to the cold air; here she continued about an hour. After this, without raising her head, she was rolled over to the other side of the bed, a small bundle of rags put at the edge of the birth- place, and a sheet folded up and pushed under her bottom, where she was left to repose. The only drink taken from the beginning to the end was cold water, and weak cold tea. The midwife had only to introduce her fingers from time to time, and always most gently. She had not her hand thirty minutes on the perineum to prevent its tearing ; and excepting the tying the navel cord, and guarding against pressure on it, keep- ing the child’s mouth exposed to pure air, she did nothing, except prevail on the patient to be quiet, and not disturb the operations of nature, by using her powers in bearing down. As soon as the navel cord was cut, the child was handed to a nurse, who kept it in her lap, covered, excepting its mouth, in a warm cloth. As soon as warm water could be got ready, it was put in a tub and washed, then dress- ed in light clothes, so that its limbs could move. In six hours it was applied to the breast. This case, conducted by a sensible midwife, is pretty much the history of ninety-nine cases out of the hundred, of common deliveries. The offices, required in such cases, surely no woman can hesitate in admitting, may well be performed by the most ignorant servant in the family. The only office is keeping the hand against the perineum, which might safely be dispensed with, if the mother would be sure not to bear down to hurry the birth. Case 2. Mrs. B. was in labour with her third child. The midwife not being properly instructed, with too much violence pushed her fingers, during a pain, so that it burst the membranes, and the waters were discharged, before they had assisted in dilating the parts. The birth was, in consequence, attended with more pain, but in other re- spects terminated favourably ; excepting that the bowels not being evacuated, at the birth of the head of the child, considerable quantity of excrement was expelled. Case 3. Mrs. C. in labour with the second child, took an injection, as all ought to do in that situation. The membranes burst in proper time, and the child was born without any accident. But there was considerable delay 'n the delivery of the after-birth, which excited some un- easiness. The ball of the womb was felt in the belly ; the midwife moved it about; at last she introduced the finger, and turned it around the edge of the womb, which produced a return of pains ; as the pain came on, she gently extended the cord, and the whole came down into the birth-place ; she then received it, turning it round, so as to wipe up, and bring along the membranes. The following cases from Dr. Bard, I annex, as they more fully explain the treatment for the inversion of the womb, than I have done in the account of it. They will, at least, serve to remind you of the folly of pulling away the after-birth frith violence ; and the impropriety of wo- men standing up at delivery, excepting where indispensa- bly necessary to save the child. Case 4. “ A lady, very tall, after a labour rather te- dious and severe, was at last, by one long and severe pain, delivered of her second child. On tying the navel string, I observed it to be remakably thick, and very short, and on taking hold of it between my thumb and finger, (for I could not twist it round my finger,) I perceived, as I thought, the placenta to be descending ; not however by successive pains, but by one interrupted descent, until it was thrown out of the vagina; and to my very great astonishment, with it came the whole volume of the womb. It is not easy to express my feelings at this moment; still, however, I commanded so much presence of mind as nei- ther to lose runtime nor alarm my patient. The placenta, which was already in part separated, was immediately de- tached ; and my fingers being applied to the fundus of the womb, it was immediately and completely reverted ; the hand and arm being introduced as high as the elbow, then slowly withdrawn. No flooding or other ill consequence ensued, and the patient speedily recovered. It was seven years before this lady became again pregnant; her labour was then natural and happy ; she has since had a fourth child, and now enjoys good health.” Case 5. “ The gentleman who communicates this case to me, found the patient in the very last stage of labour ; standing, supported by her friends, in a very awkward pos- ture, between upright and recumbent. The child was born in this posture, immediately after he entered the room ; the navel string was wound round the neck, and the greater part of the placenta protruded the external orifice, slightly adhering to the fundus of the womb, which was found very low down in the vagina : no flooding en- sued. The case being perfectly new to the physician, he contented himself with gently pushing up the fundus as high as he could with his fingers ; and ordering himself to be sent for in case of flooding or any unusual occurrence, he went home to reflect upon it. In about eight or ten hours, the husband called on him in great agitation, and informed him, that a substance as large as an ox’s bladder blown up, had come out of the vagina. In this situation he found his patient, with very little haemorrhage, but very faint, and a pulse not to be felt at the wrists. He imme- diately grasped the womb with both hands, and compressed it until he could grasp it with one, then, with the fingers of the other, he pushed the fundus through the external and internal orifices, pursuing it until he had restored it to its natural situation ; and letting his hand remain until the womb contracted about it, then gently withdrew it. The faintness immediately went off, the pulse returned, and the patient had a quick and good getting up. It is now nine years since this happened, the woman has enjoyed good health, her menstruation has been regular and moderate, but she has never since been pregnant. Case 6. “ A lady, after a labour rather severe, was de- livered of her first child ; the placenta did not follow in less than two hours, and was then delivered with so much pain, that, from that circumstance, as well as from what followed, there is reason to believe much mismanagement occurred. For some time before the delivery, a suppres- sion of urine took place, which continued unrelieved above three days; during all which time, in addition to much pain, she complained of a continual nisus, as if something was to come away. On the fourth day, while sitting on the pan, and endeavouring to pass her urine, the whole womb was suddenly thrown out of the vagina. It was eight or ten hours before medical assistance could be pro- cured ; but in the mean time, the nurse, a prudent and ex- perienced woman, grasped the womb, and endeavoured to replace it ; and actually saved the patient’s life, by pre- venting the midwife from rudely attempting to bring it away; which she insisted on doing, asserting it to be a part of the placenta left behind. By the time the physi- cian arrived, the nurse had so far succeeded as to replace the womb within the vagina ; the urine was immediately drawn off by the catheter, but it was then found to be im- possible to revert the womb. For upwards of thirty years, this lady remained subject to profuse haemorrhages, and consequently endured a very feeble state of health, but has survived until the menses have ceased, and now enjoys a perfect state of health.” Case 7. “ A lady, after a labour in all respects per- fectly natural, was delivered of her fourth child on Sun- day. The gentleman who attended, assured me, that no force was applied to the navel string, but that the placenta was delivered by the natural pains ; on examining after the deliverance, he discovered a tumour in the vagina, the nature of which did not immediately occur to him ; a slight convulsion and a considerable bleeding ensued, but soon ceased. Apprehensive of renewing the bleed- ing, no further examination was made, and the lady was put to bed, apparenttly as well as she usually had been. The usual after-pains followed ; in addition to which, on Tuesday night she complained of much uneasiness, and a feeling, as she expressed, as if something wanted to come away: and on Wednesday morning, after a throe a little more severe, the womb was protruded from the vagina, as large as a pint decanter ; and resisted every attempt that was made to replace it. I saw the patient at noon of the same day, after which, such attempts as were thought jus- tifiable, were again made to revert the womb, and persisted in above an hour, in all the variety that could be devised, but without any sensible effect. An emollient fomenta- tion was then directed, and the protruded womb was or- dered to be covered with a piece of fine linen, spread with simple ointment, (sweet oil is best,) and to be suspended by a bandage ; the bowels to be kept open, the bladder empty, and every means to avoid inflammation to be strictly pur- sued. After this, two women, who both professed to have seen and relieved similar cases, were successively applied 206 to ; and both appeared to have treated the complaint very properly, with soft emollient applications ; and the last particularly, to have persevered with great attention and tenderness. Under this management, the protruded womb gradually diminished in size, and after seven or eight days, that is, on the Tuesday or Wednesday following, with very little assistance, was suddenly retracted from the hand in to the vagina. OF LESSENING THE PAINS OF LABOUR. I come now to the means of lessening the pains of la- bour. The first point I wish to impress on your minds, is, that labour being an operation in which the whole sys- tem is greatly concerned, the main object is to preserve the general health. I have already told you, that washing and rubbing the skin, especially in parts where there is great secretion ; that a plain, simple diet, regularly taken, with exercise in open air, are indispensable requisites for health. You are already apprised, that the confined con- tents of the bowels generate such stimulating, offensive air, as to distend, and excite to diseased action the womb and neighbouring parts, all effectually prevented by daily eva- cuating the bowels at the same hour. I state it as an in- controvertible truth, that almost universally the woman who preserves her health by diet, exercise and cleanliness, instead of by physic, will have infinitely the best time in child-bed. It has been urged, that a free use of sweet oil in diet, tends to lessen the pains of labour. I have seen cases where many believed it to have this effect. Its free use in 207 bathing the belly, and around the thighs, in injecting it, and retaining it up the birth-place, as labour advances, certainly tends to lessen considerably the painful irritation and distension. Bat of greater efficacy, of greater certainty, I recom- mend the loss of blood, when labour commences. It has been recommended by the ablest physicians in this coun- try. I have never seen a person who resorted to it, who failed having an obvious mitigation of suffering. Abun- dant diet, the high action of the system, converting the fat into blood, give sufficient reason for its universal use, ex- cepting in those enfeebled by disease. In addition to less- ening the pains of labour, it lessens the diseases apt to fol- low. It is impossible to give you directions applicable to each case, but I would recommend to all who are four hours in labour, to lose from ten to twenty-five ounces of blood, according to their vigour, unless reduced by dis- ease, as before remarked. There is nothing which will so lessen the painful contractions of the womb, and dis- tension of the exterior parts ; so effectually prevent their inflammation, and the subsequent diseases of the constitu- tion, which destroy so many. 209 LETTER IX. Contents. Treatment of lying-in women to prevent their diseases—of their milk—diseases of the parts concerned at birth—of paintings—chills—local pains and inflamma- tions of the parts—after-pains—inflammation of breast —sore nipples—milk fever—puerperal fever—miliary and common fevers—studied leg and mania. The proper management of women after child-birth, is a most important subject. The great irregularities and errors in the common treatment of lying-in women, have caused physicians of the best abilities, to take the subject into consideration. The result has been the unquestion- able establishment of a course in direct opposition to the old. Most of your sex indulge in great apprehensions of the dangers of bringing forth ; they seldom fear the hazards of the succeeding month : but I will venture to assert, that two women have died from mismanagement after delive- ry, for one at delivery. It is an established fact, that our systems very well endure even the excesses of any one state continued: in any wet, dry, cold, or hot climate, our bodies will be in perfection ; but the moment changes are made, the animal powers are affected and diseased. The delivery of the great mass contained in the womb, which for nine months it had so highly stimulated, is a change producing as great a revolution in your systems, as any to which your bodies are exposed. It is at this revolution that diseases enter, over power, orundermine your consti- tution ; and that the exertion of the greatest wisdom is demanded for your escape. You have been told that your systems, during pregnancy, were in an inflammatory state, marked by quickened pulse, and the buff coat appearing in your blood when drawn. The evacuations at delivery lessen, but do not relieve it. A fever of considerable action follows ; an over secretion of milk marks the excitement, necessarily increased by stimulants and confined air. With such facts, would you believe, if you had not heard, and probably often seen, that it is most customary to dose women after delivery with spirits, wine, and spices ; their heat and exhalations retained, still more stimulating their bodies ; and the contamination of the air they breathe, in- creased by bed curtains and closed doors ? I have already suggested to you the selection of the largest room in your houses for delivery. I would press that from the beginning to the end, the door should be kept a little open. The current of air should be kept off with a screen, not by bed curtains. Every thing filthy should instantly be removed from the room: old carpets among the number, unless effectually washed. The clean- est room about a house, should be that used for lying-in. Frequent cleansing, and a free admission of fresh air, are to be had, without exposure to cold. True that nothing is more destructive to womeu than receiving colds after child-delivery; but those are ten times more subject to them, who are confined to a close air, than those who are not. I am sure, by the exercise of your own sense, you will always find means to keep your bodies comfortable, neither oppressed with clothing, or so exposed as to re- ceive colds. The treatment every woman requires after child-bear- ing, is almost precisely that directed for the small pox. By following that course, you will find benefit equal to that which was found on substituting a cooling diet and air, for the heating, stimulating practice pursued formerly, with those who had the small pox. After a woman is wiped dry, and rolled over, or lifted up, to the other side of her bed, she should, if not disa- greeable, lie on her back, with a pillow on her belly, which will produce a moderate compression on the parts. The more perfect her rest, the better; there should be as little moving as possible. The child should always be applied to the breast before six hours elapse, after washing the nipple in warm water, to take off the bitter matter adher- ing. Those who have had much loss of blood at the de- livery, will probably be long in having the milky action in their breasts. To such, as to all doubtful of having milk in time, I would strongly recommend the application for an hour or two, of a large, soft, warm poultice of bread and milk, around and over the nipple, which will foment the parts, and promote the secretion of milk, with less fe- brile exertion of the system. At the beginning of the second day after delivery, and never later, every woman should have a flannel roller, or some kind ol compression applied around her belly. This is not designed to make her sides grow together ! there- fore it is to be moderately close, rather loose. It should be continued during her month’s confinement, so that the sides of the belly being kept from distension, her belly will not be so apt to protrude or distend, after the recove- ry. A tight, instead of a simple supporting bandage, is in- jurious. On the second day, a dose of castor oil, or mag- nesia, or salts, ought always to be taken, if the bowels have not been opened since delivery. An injection of warm soap and water will answer, if the medicine be ob- jected to. You have no idea of the degrees of disease brought on by neglecting to do this. The bowels have been in an unusual state, and their diseased action is rea- dily excited, by the confined contents. One third of the women who have died, while lying in, I am convinced, have perished from neglecting to evacuate their bowels. Indeed, I know the importance of it so well, and feel such anxiety for your escape from disease, that I most earnest- ly entreat you, for your own and your child’s sake, never to let more than twenty-four hours elapse from the hour of delivery, until your perfect recovery, without having an evacuation from your bowels, naturally if you can, but if not, by the artificial means of introducing a piece of soap in the fundament, or of an injection, or a laxative medicine. The proper place to have this evacuation is in bed, lying over a bed pan, which ought to be in every house. When they are not to be had, a piggin with an additional hoop at bottom, sawed off, two inches from the bottom, then covered with plank ; this top to have a round hole made in it, then to be screwed or tied to the piggin, will answer as well as the best bed pan* The cost will not ex- ceed a dollar ; and take my advice, always to have one in readiness in your families ; it will often be of service, it may even be instrumental in preventing an exhaustion, which might end in death. The next thing I wish most earnestly to recommend, is, to wash the birth-place every day in warm soap and water after delivery, for at least one week. It may be done un- der the bed clothes, a little elevated at bottom. A basin pushed under the breech is all the preparation necessary* Women in confinement ought to have a syringe for injec- ting in the bowels, and the same will answer to squirt warm water up the birth-place. The utility of taking away the irritating secretions from the parts after deli- very, (called lochite,) is indeed truly great. The retention, inflaming the womb and bowels, has been a great cause of the fevers of lying-in women. This discharge generally lessens on the third day, when the breasts distend with milk ; it varies considerably in smell, colour, and quanti- ty. These changes in smell and colour, arise chiefly from the varying putrefactions or fermentations it undergoes af- ter it is secreted by the vessels of the womb. I mention this, to induce you to be the more particular in its remov- al. The quantity of the discharge differs in almost every woman. It indicates the degree of increased action in the womb. When it is suddenly suppressed, as it is by improper exposure to cold, the remedy is to bleed a little, to foment the belly by cloths, taken from hot water; to give a purge and clyster immediately. Whenever it is of a very offensive nature, by all means inject, with considerable force, warm soap and water up the womb ; it will assist in the expulsion of the clots of blood that may be detained and in other respects will be of great service to the sys- tem. A common squirt, made of elder, will answer the purpose ; and I beseech you to inject soap and water freely, if not daily, at least on the slightest appearance of disease. The linen should be changed every day during confine- ment ; and dry cloths pushed underneath the breech, which can be done by a good nurse, without disturbing the patient. DIET. The next subject I have to press on your attention, is the proper diet of a lying-in woman. And the first remark I have to make, is, that the intend- ed kindness of women to each other in this state, has de- stroyed more than it has saved. The diet of our peni- tentiaries, bread and water, would have proved a blessing, from the highest to the lowest of your sex, if it had been, strictly adhered to for the first two weeks after delivery. I could scarcely name a disease which has not been brought on, either directly or indirectly, by the cramming of strong stimulating food during their confinement. It is not my intention to recommend almost starvation, as has been done so extravagantly by some writers : but moderate diet. I would advise every woman to eat small quantities of food ; bread, potatoes, rice, barley, or any vegetable body, nothing heating, no spices, from the 215 beginning precisely at the same hours the meals are taken in health. The keeping up the habitual action of the sto- mach, has a powerful effect in keeping off diseased action. The quantity the first day should not be much ; but after the second day, the bulk taken may be as much as the per- son was in the habit of eating. Not till the first week passes, w'ould I consent that meats, butter, and very nourishing articles, as cream custards, &c. should be taken. Nor would I agree to a return to a free use of meat for several days. The drink during this whole time, should be good strong xvater ; weak tea, or gruel; towards the last, if any, very mild soup. A gruel made of oat-meal is greatly esteemed by many ladies. Unless prevented by good reasons, every woman should sit up a little in her bed, the day after delivery, for half an hour or an hour ; she may be supported with a chair and pillow at her back. This sitting up promotes the natural evacuations from the birth-place, and should be prolonged every day, not enough, however, to fatigue. Sometimes this is attended with fainting-feeling; which, when there is no flooding, it will, notwithstanding, be proper to perse- vere, as it speedily goes off. The woman should not stand up before the fifth or sixth day ; and not leave her room before the seventh or eighth ; and then but at short inter- vals. In making these changes, a middle course is to be observed, neither to be exposed to a current of air, or op- pressed with warm clothing. Dr. Moss, the judicious writer before quoted, says, il The treatment of lying-in women, has been, till very lately, universally founded upon the supposition that, from tlx* moment of delivery, and for a certain time after, they could not have too frequent and plentiful supplies of warm liquids, cordials, and nourishing food, in the form of gruel, of dif- ferent sorts, made with spices, with the addition of wine or spirits ; and that an unusual degree of warmth and sweating was to be kept up by these means, further sup- ported by the warmth and closeness of the room, confine- ment to bed, and additional quantity of bed clothes. All this was done with a view to support and recruit the strength and spirits, and to keep oil cold and its effects. However, these opinions and practices are proved by ex- perience, not only erroneous, but to produce the very evils they xvere intended to lessen and obviate. t( There is, from the time of delivery, a constant, par- ticular, and natural propensity and disposition to fever, which gradually increases the first three or four days, and is a source of great danger. Whatever will add to the heat of the body, or action of the system, will increase and prolong this fever ; than which, nothing is more calculated than wine, spices, cordials, and liquids of all kinds taken hot, with unusual warmth in the room and bed. A person in the highest health, so treated, would most likely have a lever : and it is easy to conceive how much the milk fever of women, and all its consequences, are to be aggravated by such treatment. u A coldness and shiverings very commonly accompany all feverish complaints, and of course very common at this time ; which may have led to tlie notion of the warmth, and warm, things being proper, by way of preventing them, and 217 removing them when present: but this is a false and mis- taken opinion ; for whatever brings on the fever, may be said to bring on the shiverings also, as the shiverings will not come on if the fever is kept off; and when the shiver- ings are actually present, the most heating things will not lessen or abate them, so as to do good : therefore no more than a moderate warmth should ever be employed for that purpose. “The sweating which is brought on by this warm treat- ment, has also been supposed necessary to prevent or carry off any degree of the fever, and to prevent the shiverings ; but which is a notion as fallacious as the other, as it not only serves, when in excess, or long continued, to support and increase the fever, but exhausts the strength and spirits. “ Those who lie in, are sensible how liable they are to he over-heated, by the most trifling additional heat of the room or bed, or by taking any thing warm, which makes them feel very uncomfortable and uneasy to themselves ; often have the head-ache, perceive a faintness, weariness, and depression of spirits ; all which continue, and are in- creased, according as the heat and heating things are re- peated ; and are the symptoms of the feverish complaint mentioned. On the contrary, they w ho are never exposed to be over-heated by the warmth of the bed, the room, or what they take, seldom or never experience these disagree- able sensations, but feel comfortable and easy to them- selves, and find their strength and spirits increase apace ; all which desirable circumstances, with many others, are entirely effected by subduing and keeping off this feverish- ness, by cool treatment-” 218 You will, ladies, be well paid for imposing on yourselves these restraints after delivery. Give no attention to the stories of perfect recovery under a different treatment. I beseech you to bear in mind, that it is not so much on ac- count of present exemption from disease, as to save your constitutions, which at some future day will suffer for your transgressions. After this operation of delivery, your sys- tems are in their most delicate state ; from the most in- considerable causes, sensibly or insensibly, they become, or will become, most seriously affected. To conduct you with safety through these changes, far more skill is requi- site than for the delivery of your offspring. Indeed, for the latter, wise nature is the actor ; for the other, manage- ment ; the directions of our confined minds are to come in- to operation ! Do not understand me as saying that you must consider yourselves as patients, requiring doses from doctors : you only require the hourly exercise of common sense. Be quiet in mind, and body: most gradually let your systems be restored to their common state and action, by returning to your habitual diet and exercise in slow de- grees : subdue all inflammation on its first approach, by abstinence, and by evacuations. These are the suggestions, not so much of medical knowledge, as of common sense. Observe them; and if in other respects you do not act in opposition to the dictates of this common sense, you will pass through child-birth with a safety greatly superior to that of the generality of your sex. OF GIVING MILK. I have now to urge the necessity of nil mothers suck- ling their own children, if they desire to preserve their 219 health. It is to me a subject of astonishment, how an} woman could be so lost to the feelings of nature, as to give up the pleasure of this undertaking. As they are not alive to the joy of furnishing the food from their own bo- dies for their babes, they ought to be solemnly warned, of the effects on their own constitutions, by such neglect. Such is the wonderful nature of the system, that no one func- tion can be suspended, without its having some influence on other parts of the body. Unless every part goes through its natural action, or irritation, some other part of the bo- dy will, even at most distant days, take on an action of dis- ease, equal in extent, and more fatal in consequences. The womb, I believe, never properly performed its office, when not relieved by the determinations to the breasts. Nor is this the only evil ; for a little while you may escape dis- ease, but at last you will suffer greatly for not conforming to nature in suckling your children. Cancerous womb and breasts, diseases of the bones, rheumatic and other pains, will come on, as symptomatic of the action which would have attended the milky secretion. For ever bear it on your minds, that nature will not be trifled with ; her laws are not to be violated with impunity ; atonement she will have for all your irregularities. Your physicians may postpone, but your bodies must make the payment at last. lt is a subject of considerable anxiety among mothers, what is the best food for them to take while giving suck. I am happy in being able to settle this question with perfect certainty ; and I beseech you to remember it. I have already told you, that the stomach secretes a li- quid to dissolve what we eat, which becomes adapted to the nature of the food we take ; a change in diet then neces- sarily changes this liquid, and the stomach can never be changed, without its affecting other parts of the system. The diet then for a woman, is the diet to which she has been most accustomed. If she has not been habituated to any one, she should commence while giving milk, for at least the first three months, until the powers of the babe become equal to the change. The diet should not be so thin as is generally taken ; it causes the milk to be too wa- tery j requiring such large quantities for the child, as to de- range its stomach, and incline to gluttony. This effect i3 pretty much as the secretion of urine on drinking freely of liquids ; it contains not an eighth of the salts and other matter, which it has when secreted without such drink. The liquid does not go to the glands, but the glands sym- pathise with the watery excitement of the stomach, and secrete the watery fluid. The proper diet then for mothers is one of solids, only a moderate quantity of liquids ; never changed for the first three months ; always, when to be changed, slowly done. It is improper for women to take large quantities of sti- mulating drink while giving suck. There will be an abun- dant secretion from the stimulus of exercise ; and this is the best stimulus. It is because women giving milk are so sedentary while suckling, that there are such determi- nations to the breasts, which end in so many disorders of the parts. They should take more exercise, by walking at this time, than at any other, in order to equalize the action of the blood vessels. Among the delicate I would recommend the stimulus of any white pure wine, with moderate dilution. Some women give but small quantities of milk ; in ge- neral the difference in quantity is made up in quality. The means ol increasing this secretion, are, free living, great exercise, much handling, and drawing the breats af- ter the child has sucked. They should be drawn with a strong mouth, fully exerted, particularly when the action of the pulse is increased by excessive diet or drink. And there can be no doubt of success, especially if a large hot poultice be immediately applied for two or three hours. When it is designed to suppress the secretion of milk, a directly different course should be pursued. Abstemi- ous diet, avoiding salt, taking but few drinks, and a daily purge, are called for. The whole breasts should be cover- ed with a rag wet with a weak, cool solution of sugar of lead, to be applied every two or three hours. Sweet oil may be substituted at night. When they become painfully distended with milk, they should always be slightly drawn, merely enough to relieve the distention. DISEASES OF LYING-IN WOMEN. PAINTINGS. The first complaint after confinement, is generally a sense of faintiness. As soon as observed, an examination should be made, to ascertain if there be flooding. In this case, cold applications, and cool air, are indispensable, and should be fully used; the head kept low, and the womb com- pressed with the hand, to make it contract. When there is no loss of blood, a glass of wine or toddy should be given with gruel. A wide bandage around the belly, drawn tolerably tight for an hour or two only, will support and compress the parts, and thereby relieve the complaint. Sometimes this arises from the falling down of the womb; which points out the propriety of feeling for the womb, in the belly. When there is great coldness of the extremi- ties, hot applications should be made to them. CHILLS. When the chills and coldness which women generally have after delivery, are excessive, they are to be relieved by hot bricks to the feet, wrapping the legs up in hot flan- nels, and hot applications to the belly, opposite the stomach. Their legs may be rubbed under the bed clothes, with a coarse brush. But it is absolutely improper to take stimu- lating drinks, as they actually increase the fever which en- sues. Hot tea or gruel is the only drink that ought to be taken. When the shivering is very violent, it is expedient to hold the patient fixed, until they subside. AFTER PAINS. These pains are generally least distressing at the deliv- ery of the first child, and after long tedious labours. They arise from the contractions of the womb, to expel clots of blood, and the secretion contained in it. Sometimes the pains are almost as severe as those of labour. They are felt in the lower part of the belly, and sometimes in the back, like those of labour. They are usually accompanied with the discharge of clots of blood, and frequently are re- newed for a day or two, especially when the child is an plied to the breast. When these pains are moderate, they should not be in- terfered with. When they are severe, they will be reliev- ed by a bladder of hot water on the belly, or hot wet cloths. An injection of forty or fifty drops of laudanum in the bowels, will generally afford relief: as also half the quan- tity swallowed. But this had better be dispensed with, as all itimulants are improper; especially the spices, drams, and wines usually given by old women to relieve this com- plaint. LOCAL INFLAMMATIONS OF THE PARTS. When there is great soreness about the belly, acute sen- sibility to the touch, it is incumbent on every woman to evacuate herself freely immediately, and to foment the bel- ly by flannels from hot water and sweet oil, until she can get a physician. It is the miserable habit of neglecting this course, which causes so many women to have the pu- erperal fever. Inflammations and suppuration of the external parts of generation, are extremely apt to occur after tedious labours. The application of sweet oil, or hog’s lard, with or without suet, also poultices, cold and lead water will speedily relieve the parts ; or rather, if they are kept clean and greased, they will relieve themselves. Whenever the sides of the birth- place ulcerate, greased lint or rags should be daily applied, and stuffed between them, so as to keep their edges apart. Women are also very subject to a bearing down of the womb, termed its falling down, when describing the dis- eases of the womb. To remain lying quietly, repeatedly in the day washing the parts, squirting water up the birth- place, fomenting with wet cloths when painful; taking no- thing to stimulate the system ; are the prescriptions to be attended to. Affections of the stomach, head, and bowels, often attend this complaint, and are mistaken for original affections, instead of those from sympathy. Dr. Burns says, “although rash management on the part of the midwife may occasion this complaint, vet it is much oftener the fault of the patient herself; getting up too early after de- livery or miscarriage. There is another affection which may be mistaken for this ; it is a relaxation and protrusion of the passage to the womb ; forming a soft swelling at the side ; sometimes entirely encircling the opening, at others, greatest at one side ; it gives no particular uneasi- ness, and disappears on going to bed. The cure is effected by washing it with weak solutions of sugar of lead, of white vitriol, or of alum. The frequent application of cold water alone, often cures. The parts about the fundament are very apt to become irritated, constituting lesser degrees of the piles. The mo- ment pain is felt in these parts, rags, wet with a weak so- lution of sugar of lead, should be applied ; a rag wet with cold water, will often relieve. When the irritation is con- siderable, sweet oil, or fresh hog’s lard, on going to sleep, will be of service ; you should refer to what was said on the subject of the piles. Sometimes the irritation about the fundament arises from small worms in the lower gut. Injections of brine, of sugar and water, or of any irritat- ing liquid, will destroy them. INFLAMMATION OF TIIE BREAST. The inflammation of the breasts is a source of incalcu- lable misery to mothers, and deprivation to children. All mothers should have such affections in their view at every confinement, in order effectually to guard against them. No complaint can be more certainly prevented by proper care. You must bear in mind, that your systems are in an in- flammatory state after delivery, for two or three weeks. It is the general fever which produces these local obstruc- tions in the breast. The means of prevention, are ; never fail, three hours after delivery, to apply a soft, warm poul- tice of milk to the nipple and breasts, to favour the dis- charge of the first milk. Let the poultice remain from two to four hours ; and, if the child do not suck, let some person suck a little milk from the breast. Let the breast be bathed with sweet oil, if possible to be had, if not goose grease, or hog’s lard. Never let the diet be free, until the secretion of milk be well established ; and never let the breasts remain painfully distended with milk ; for, in every stage of giving milk, when the breast is full, from the slightest cold and fever, inflammation is apt to ensue. The most important means of lessening the liability of the breasts to inflammation, is ; never to have them too thickly covered, never fail to wash them every morning in cold water as regularly as the face. I dwelt sufficiently on the influence of cold water on important parts, while ad- vising the daily sitting in a tub of cold water. The whole is applicable to the breasts ; most animals have their teats exposed to cool air, and they, as the negroes, have but few afflictions of them. At first you can wipe them with a wet cloth, then lean over a basin filled with water, and let one at a time be dipped. Indeed you will find this one of the most effectual means of "preventing the inflammation of the nipple as well as the breast. It will give a tone, a hardening to the parts, which, exclusive of the cleanliness of the habit, will be extremely advantageous. You find your hands and face improved by this cold washing, and why will you withhold it from your breasts ? Lastly, the moment there is the least appearance of in- flammation, apply a solution of sugar of lead (a tea-spoon- ful of lead to a pint of water.) Keep a rag wet with this constantly on and around it, until the inflammation disap- pears. If the inflammation increases, by all means apply leeches to the part, take a strong purge, and refrain from taking more than half of your ordinary diet, until the cure be complete. I have seen such excess of agony from neglecting these precautions, that I feel a strong soli- citude to enforce the observance by every woman with an infant at her breast. I am positive, that no woman will have an abcess, (called boil,) on her breast, who will duly attend from the beginning. If the inflammation be not dispersed, its extent will be greatly reduced; and this is an important point. The old practice of hot poulticing the lump should never be done; nor is rubbing the breast with the hand proper. Nothing that gives pain should be applied. When it is ascertained that the boil will suppurate, it is best to discontinue the lead, and to apply bread and milk poultice. When the matter is fully formed, it ought, at its lowrer depending part, to have a small puncture, very small, for the gradual escape of the matter without admitting air. As soon as opened, a little lard may be applied to the edges, then the solution of lead is to be continued, by covering with a Wet rag as at first, in order to prevent a return. The question of drawing the nipples, when the breasts are in a state of inflammation, has been differently decided by physicians, one in favour, the other opposed. The pro- priety, however, of the prescription, depends on the treat- ment of the patient. If it be determined, that the wo- man shall eat and do every thing she can to increase the inflammation of the system, drawing the breast is impro- per, for it only brings on an additional determination to the part, tending to increase the disease. But if she refrain from inflaming her system, by exercise, diet, and drinks ; if the breast be kept particularly cool, a rag wet with su- gar of lead to the outside, (not on the nipple, where it may get on the child’s mouth,) then moderately drawing the breasts repeatedly in the day, is a most powerful re- medy in relieving the inflammation. SORE NIPPLES. This is a complaint to which most women are subject; and as it is extremely distressing, is worthy of serious at- tention, as well for the prevention as cure. The frequency of the diseases of the nipple, unquestion- ably arise from the improper manner in which they are universally treated. Mothers expecting their daughters to become mothers, should pay particular attention to their manner of binding their breasts. Compression continued, will cause the absorption even of our limbs to be almost completely reduced : no wonder then, that the tight ban- dages around the breast, reduce its size, and destroy the nipple. No females but women have their teats com- pressed. In order to guard against sore nipples, they are not to be compressed, and are to be washed daily in cold water, as regularly as the breast. In those cases where the nip- ple has sunk, or been pressed in, wearing rings of wrax over it, so that the nipple may protrude or pass through, or wearing the glasses called nipple glasses, during preg- nancy, to promote the lengthening of the nipple is proper. Washing them in brandy and water, has also been recom- mended for hardening them. When the nipple becomes sore, it is first necessary to guard it against the rubbing of the clothes, by wearing, during the day, a wax cup over it, made so as to receive the nipple. Those made of lead are better than of wax. Washing them with a weak solution of sugar of lead in the beginning, is of great efficacy. Washing with a solution of alum in brandy, with spirits, borax in water, a solution of nut galls, laudanum and water, opium in water, port wine, and such articles, are to be tried occasionally, for a few days at a time. Dr. Bard says, w simply keeping a linen cloth constantly wet with rum, over the nipple, will frequently do more than either; but then it must be kept constantly wet. Sometimes precipitate ointment, on slips of rags, and applied, has done good.” It has been found of service to procure the teat of a heifer, (let her be dead before it is cut off,) and fastening it to the nipple of the mother, and a metallic or wooden pipe to the other end for the child to suck. The best application to the sensible parts or sores around the nipple, is lunar caustic. The caustic is to be applied to each little ulceration, as is done for warts. Let the parts be tolerably dry, the end of the caustic merely moist, (not a drop pending to z7,) and there will be but little pain j the cure is certain. The milk can be drawn on covering the nipple with a rag, as used for straining milk, and given to the child : as soon as the scabs come off, which will be in a day or two, the child may be applied to the breast. To preserve the parts clean and cool, and to be as little moved as possible, are important points. MILK FEVER. Between the second and third days after delivery, the breasts become distended, from the milk secreted in them, and the discharges from the womb diminish. This is attended with some heat, thirst, head-ache and fever. This fever is partly owing to the disturbance, which, to a certain degree, constantly takes place in the system, when- ever a new process is established ; and partly to the swell- ing and irritation of the breasts themselves. The degree of the action will be greatly lessened by following the ad- vice of early applying a soft poultice to the breast, to favour the escape of the first secretion ; then never failing to ap- ply the child to the breast, within from six to twelve hours. Rubbing the breast with sweet oil, goose grease, or fresh hog’s lard, will tend to prevent, as also taking some laxa- tive, and confining to a low diet. When tiie fever takes place, the treatment is very sim- ple. Give any warm drink, as lemonade, gruel, or weak tea; allow the lice entrance of pure air: if the feet be cold in the beginning, apply hot flannels. During the whole fever, the above drinks may be taken. In general, no other pre- scriptions are requisite; but if the fever be high, the breasts painful, a purgative of salts should be given, a slight bleed- ing, then two grains of tartar emetic in half a pint of water, to be taken one eighth every hour, till perspiration is ex- cited. No heating articles are to be used; when the fever is over, the recovery is rapid, to be promoted by sitting up, and taking the food before prescribed. PUERPERAL FEVER. The puerperal is commonly called the child-bed fever. When it comeson, it is generally in the first week after delivery, about the third or fourth day. It begins with a shivering like the cold fit of an ague, and like it, is suc- ceeded by great and burning heat of the jwhole body, thirst, flushing in the face, pains in the head and back, sickness at stomach, especially with great sensibility of the belly, so much sometimes, that the weight of the bed- clothes is oppressive ; the belly feels full, sometimes there is great pain and a looseness. Sometimes the disease comes on without a shivering fit, beginning impercepti- bly with languor, faintness, sickness, frequent vomiting, sweating, and looseness. It is distinguished from the milk fever, by the shivering, and by the breasts, which do not swell and become hard and painful as in the milk fever, j This disease may be defined a general fever, partaking of the character of the prevailing fevers of the place where it appears, attended by inflammation of the womb, and the adjoining parts concerned during delivery. Hence in wards of hospitals, in confined rooms, in unhealthy spots, it often appears of a low, nervous character ; and in the neighbourhood it may be inflammatory. It is prevented by adhering to the directions given for ,the conduct of wo- men while lying-in ; most of all, by keeping the bowels open, the birth-place clean, and pure air. During the cold stage of the fever, hot applications are to be made to the feet. When the hot stage comes on, cool drinks are proper. The patient must be blooded and freely purged with calomel, followed by a dose of salts ; a solution of tartar emetic, ten grains to a pint of water, and one or two spoonfuls taken every hour or two, so as to keep up a constant sickness of stomach, will afford the best means of relieving the fever. Antimonial wine may be substituted, or any preparation of antimony ; but you may rely upon it, that keeping up the sickness just so long as the fever lasts, is the only certain method of cure ; you should inject in larger quantities in the bowels, if the stomach do not retain it. The belly is to be well covered with sweet oil; occa- sionally warm cloths, wrung out from hot water, are pro- per in allaying the irritation. As I never knew good sweet oil to be applied to or near an inflamed part, with- out lessening the irritation, I would not only have it ap- plied on the belly, but injected up the bowels and birth- place, and detained there as possible. When the action of the system is reduced, or when the disease assumes the low nervous character, then an oppo- site course is proper ; wine bark, toddy, nourishing diet, are requisite, in such portions as will keep up the action pf the system. But I suppose you will be sure to have a physician to prescribe in these cases. MILIARY FEVER. 1 extract the following from Doctor Moss, as his testi- mony may have the more weight in securing your atten- tion. “ A miliary fever is what lying-in women are known to be sometimes liable to ; and is known and distinguished by an irruption resembling a rash, coming out commonly first upon the neck and breast, afterward upon the other parts of the body, and seldom or never upon the face : it gene- rally appears the thickest upon those parts which are kept the warmest and closest covered. a The eruption, upon its first coming out, is red; but to- wards the second or third day it becomes white ; and soon after goes off with a dry scurf. The complaint does not however terminate here, as it is immediately succeeded by another rash or eruption, which proceeds, and goes off, in the same manner ; and that, sometimes, successively and repeatedly, “ The time of its first appearing is uncertain : it seldom comes before the end of the first week ; and may happen afterward at any other period of the confinement to the bed particularly. It is attended with a sense of weakness, and a dejection and depression of spirits. 233 u This fever, and these appearances, are entirely occa- sioned by much warmth, warm and heating things, and more especially, by much and long continued sweating in bed, as there is every reason to suppose it never happens without, and except in consequence of much sweating. The means for preventing it therefore are very clear and obvious ; and if the method and directions at, and from the time of delivery, and during lying-in, are properly attended to, it may always be with great .certainty pre- vented, and never be feared or apprehended. u With respect to the treatment and cure of the miliary fever, when it does happen, it may be observed, in general terms, that the same means which will prevent it, are also the likeliest and best suited to remove and cure it. The medicines, and other medical treatment of it, cannot, with any prospect of advantage be here given ; however, the following directions may, so far, be safely observed and attended to. Every means that can heat the patient must be cautiously avoided. The room must be made cool, by removing the fire, or setting open the door, and even a window if needful. The bed-curtains must be un- drawn, and the additional quantity of bed-clothes, if any there be, be removed ; all ivhich must be done gradually. Whatever she takes as food or drink, must be cool, and without spices, wine, or spirits of any kind. If she is cos- tive, a stool or two, and not more, must be procured by a clyster, some laxative, infusion of senna, or castor oil much of a looseness will be injurious. “ As soon as, by these means, the heat and sweating are checked and abated, she must be raised up and supported in bed, and, with the assistance of a bed-chair, she will be able to sit up in bed ; and which she may do once, twice, or oftener in the day; observing that she be not too much covered up, and muffled in the bed-clothes, &c. and that she has her hands and arms out of bed, which will be a means of putting an entire stop to the sweating, and, of course, of removing the disease. She ought, as soon as she is thought able of bearing the fatigue of it, to be got out of bed once a day, which will be an effectual means of removing any remains of the complaint, and also of pre- venting a return of it. The notion that is commonly en- tertained of the propriety of keeping up a heat and sweat- ing, by way of forcing out the rash or eruption, is very er- roneous, as the heat and sweating are the sole causes of the rash, and consequently the removal of them must be the most sure means of removing the complaint: and except the sweating is checked, and even entirely stopped (which may be done with safety, by degrees,) all other at- tempts to remove the disorder will be vain and fruitless. It is well known that long continued sweating will alone produce a rash at any other time, and upon any other oc- casion. “ This complaint is justly dreaded, as it has proved fatal, in this situation, when in the extreme ; although a slight attack of it may be got over without danger. It was very common, when sweating, and long confinement in bed, and heating things were in vogue ; and is much less so since the cool treatment has been introduced. Those of weak and delicate habits seem more liable to this com- plaint than the strong and healthy,” COMMON FEVERS. There is a fever common to many women in child-bed, called a xueed. But there is no foundation for particu- lar names for any of the fevers to which such are sub- ject, excepting the milk fever. As before remarked, in this state their systems are very susceptible of febrile ac- tion. The directions for treating any kind of chill and fevers, are the same as those offered for the puerperal or child-bed fever. In the cold stage, apply hot articles, slightly burn- ing, to the extremities; in the warm or hot stage of the fever, evacuate and keep cool. A good purge in the be- ginning ; and any preparation of antimony, taken in small doses, to keep up for hours, and sometimes a few days con- stant sickness at the stomach, is the sum of all the improve- ments made in treating persons under fever. I would strongly urge to all females labouring under any feverish symptoms, to resort to these antimonials in preference to all the trash which has been offered, as sudorifics, cooling powders, and the like nonsense. SWELLED LEG. Child-bed women are liable to a very peculiar disease, of which a swelling of the lower extremities, preceded and accompanied by great pain, difficulty in moving, are the most remarkable symptoms ; not appearing connected with any peculiarity of constitution or preceding complaint, nor the kind of preceding labour, or on the treatment before or after child-birth. It occurs at any period from the first or second day, to two or three weeks after delivery ; it is preceded by general uneasiness, lowness of spirits, slight pains about the womb, with a discharge from it peculiarly offensive. These symptoms seldom command much atten- tion, until the patient is seized with pain on the inside ot the limb, commonly about the calf of the leg, which soon extends from the heel to the groin, along the course of the vessels called absorbents. The limb soon after begins to swell; the soreness extends all over it, so that it cannot bear the slightest touch, and every attempt to move gives exquisite pain; the skin becomes glossy and pale, the countenance is expressive of great anguish and dejection, the pulse is quick, the heat of the skin increased, the tongue white, and the urine muddy. These symptoms strongly mark the absorption of some acrid, irritating matter ; and no doubt it is taken from the womb. The prevention must depend on cleansing the birth-place, injecting water with such force as to enter and cleanse the womb. The cure of this complaint is often tedious ; sometimes the other leg takes on the disease, as the first subsides. Gentle evacuations, keeping the bowels open, bathing the limb in sweet oil, and in oil and laudanum in equal parts, is always proper. Laudanum may be taken to procure rest, when the pain is violent. Dr. Hosack of New-York, and other physicians of eminence, recommend strongly, taking about two grains of calomel mixed up with the like quantity of squills, made into a pill, to be taken every night, and morning also, if there be no excessive purging. The. moment this disease begins, I would recommend the immediate cleansing of the birth-place, and using the strongest syringe to inject up water: a table spoonful of the finest powdered charcoal mixed up with sweet oil, should, after the washing, be also injected up, and retained for some time by a plug or the hand. This will prevent the discharge from becoming so offensive, and lessen the irritability of the part, inclining it to the absorption. MANIA OR MADNESS. The peculiar connection between the womb and the head, was before stated; in consequence of this connection, women after delivery are very subject to head-aches and to madness. The derangement of women after labour, does not re- quire the evacuations used for this disease on other occa- sions. Moderate bleeding is proper, if the pulse be active, with slight purging. It is advisable to lose the blood by frequent cupping: issues in the back of the neck are of more use than blisters in this disease. Frequent vomits are very proper. Great attention should be paid to re- storing the womb to its natural action, menstruation. For this object, the purges should be of aloes; sitting in hot water, injecting a little brandy and water up the birth- place ; blisters on the thighs, or one on the perineum, will be found of powerful efficacy in restoring the menses. Women in this state should be treated with perfect gen- tleness ; thwarted in nothing not injurious. Travelling, change of air, and the salt bath, will all tend to restore the intellect, as well as the body. LETTER X. Treatment of children after birth—navel—washing— dress—applying- to the breast—their first diet—that of the mother—rocking—sleeping—to have the mother's 'warmth, without danger of suffocation—evacuation of their bowels—air for respiration—clothing—exercise— simplicity of diet—objections to compounds as cake— weaning—teething of children—lancing gums recom- mended universally. The next subject that presents itself, as of great import- ance for all women to understand and attend to, is the proper treatment of their children, to be directed by them- selves, not by ignorant nurses. The variety of plans which have been adopted and recommended, would fill a volume. Even the stupid would be astonished to observe some kind of treatment, different from that which they follow, probably of not worse tendency than their own usages. Every midwife and every family appear to have some peculiarity in the treatment of children. Surely the whole of them will have to account for the injuries they have done to babes, if we have ever to account for fol- lies which might have been avoided by the exercise of our natural sense. As an example of such follies, in one of the most intelligent families I have ever seen, the mid- wife was allowed, at every birth, on first dressing the child, to hold it up by the heels, and give it a shake ! then a mo- derate dose of brandy and water : this stimulus, aided with nutmeg, was poured down the throat 1 Indeed, al- most in every house, I have been struck with the infatua- tion that prevails on such occasions ; something must be given! every thing appearing, but good common sense. Because the business of generation seems so mysterious, something extraordinary is supposed to exist in every de- partment ! To break the spell, to put down the prepos- terous boast of experience among old nurses, and some mothers j to teach the bystanders, that the bodies of the little babes are subject to the same laws as their own, pre- sents as an important point, from the singular infatuation prevailing on the subject. If the little innocents could speak, they would tell you, they knew no difference be- tween being disordered and destroyed by intended kind- ness, or by intended neglect. In the hope, that you will yield to reason ; with the earnest entreaty, that, for the sake of humanity, you will conform to the course pointed out and confirmed by the most successful practice of the greatest physicians, I pro- ceed to state the directions for the treatment of children which should govern every woman. After the child is separated from the mother, the utmost care is to be taken to prevent its receiving colds. These colds affect it most seriously, producing inflammations of a destructive kind, in the lungs and bowels. In order to guard against them, the child should be received in a warm flannel, having an opening to breathe, and kept in a warm place, where no cool air can have access, until warm water is procured for washing it. Never use cold water for the purpose, and nothing but warm water. By gently washing it in warm water, the matter adhering to the skin will come off, if not the first, the succeeding day. After it is kept in the water a few minutes, undergoing this gentle washing, it is to have a linen rag put on its navel, a burnt rag, or any charcoal might be first applied to les- sen the offensive smell of the part that comes off. Gene- rally there is a sore, made by the nutmeg and other trash foolishly applied ; there will be none, if the parts are dressed with simple sweet oil, or hog’s lard, after the se- paration of the cord, which takes place about the sixth day no irritating matter, nothing but something mild is wanted to exclude the air from the surface. After a linen rag is applied to the navel, a band is to be applied around the belly, not tight by any means, as compression of the belly will be injurious. The next object is, to dress the child : no clout is necessary to be put on ; the child can’t turn, and simply putting a cloth under is sufficient for a month ; its clothes should be of linen ; no pins to secure them, but strings ; never allow its limbs to be confined: the more it can use every part, the sooner will it strengthen. The child being dressed, it requires nothing more than to be laid down, level, to repose quietly. From the fifth to the tenth hour after birth it should always be applied to the breast of the mother. It wants nothing else; the milk is its physic and its best nourishment. You will observe the redness of the skin, sometimes blisters, and extreme irritability in every part. These are symptoms of its inflam- matory state ; and these, exclusive of experience,-* pro- claim the folly of giving it other stimulants, drinks, or mixtures, to add to the too much excited actions of its bo- dy. It wants nothing but its mother’s milk, for which it should be applied to the breast in the time above directed. The first discharge from the breast will, in all probability, open its bowels in sufficient time. If the bowels are not opened the second day, pushing gently half an inch up the fundament, a small quill covered with an oiled rag, will produce the evacuation ; in case of failure, a tea-spoonful of sweet oil poured down its throat, fo be repeated in three hours, if the first be not successful; lastly, for continued failure, a tea-spoonful of castor-oil, or a little manna, might be given on the third day, I never knew the introduc- tion of the pipe, as above advised, to fail in producing an evacuation. It is always to be preferred to giving medi- cine. It will not be necessary to refer to the medical part, the treatment of the small blisters, swellings, and inflam- mations, which are so apt to appear on the skin, and parts compressed at birth. The cure is to be effected, by not touching them ; some prefer puncturing the blister with a sharp needle, so as to let out the water, without letting in air; a cold, wet rag, applied for a few minutes, will expedite the dispersion of the For other com- plaints I refer to the next letter. The rules for nourishing children are, never for sixty or seventy days, give any thing but the mother’s milk ; in the beginning give the breast every three or four hours. Some have urged to begin with establishing hours for this supply; but they mistake. The habit is best acquired weeks after. In the womb its body was slowly and con- 243 stantly nourished ; and we should imitate, by having in its stomach, always a little, never much at a time. I suppose the means I have recommended for exciting the breasts, will have been used to insure the supply of milk. But if accidental causes should render it impossible for the mo- ther to give milk, then, as the lesser evil, some woman should be procured who can yield the supply. Giving in- fants other food, has done incredible mischief. No other animal requires aught but the mother’s milk ; yet there is scarcely a midwife or nurse in the country, who is not for pouring down the child’s throat, soon after its birth, some of their mixtures. There is not one of these compounds that does good. They pretend they give very little; then the very little can be of no service; never yield a fiftieth part of the nourishment taken away by its acting as irri- tating substances in the bowels. Instead of giving up the early treatment of children to such attendants, there is stronger reason then than in subsequent advanced stages, for the mothers and friends to exert all their senses on the subject. Follow nature; I cannot impress on you too much. Nature never intended, that for your child’s ac- commodation at birth, a ship should have to sail to the East Indies for nutmegs, and another to the West Indies for sugar, to make the almost universal doses given to children. Nature could hardly have provided against such abominable outrage on its laws : to add to this, sugar and water, and nutmeg, the intoxicating liquors, is shame- ful in the extreme. If there be not enough milk in the mother’s breast, and another nurse cannot be had, then give the like—cow’s milk newly drawn, mixed one third with warm water, with very little if any sugar. After sixty or seventy days at least, the child may then properly have its diet changed; first, it is best for some other wo- man occasionally to suckle it, then the mixture above mentioned, and then milk alone, until all the common arti- cles of our diet may be administered. The periods of feeding the child should be regulated about this time ; beginning to let it suck very late at night and early* in the morning. After a week or two, the breasts may very well be withheld during the night, and by de- grees reducing the times of feeding to four or five times a day. It is so important that I would impress it an hundred times—most gradually make every change in the child’s diet. Begin with the mildest articles, and but in small quantities ; the article you begin with, persevere in its use, unless powerful reasons prevent, until the child is habitu- ated to it. I repeat the remark, one good healthy article is nearly as good as another. Boiled milk diluted and bread, or arrow root, or sago, are excellent articles to commence with : weeks after soups and boiled meats may be substituted. On the subject of raising children without the breast, Dr. Bums says, “ a mixture of cow’s milk, water and sugar, has been used as a substitute for breast milk. But more advantage will be derived, by adding to cow’s milk, a third part of new made whey, (not made by wine,) with a sixth part of sweet cream and a little sugar. Whey, with the addition of cream, and very little sugar, without milk, may also be employed.” Children have been reared tolerably well on these mixtures, without the breast, though never as well without as with it; which is a strong reason why wet nurses should be got if possible. Dr. Moss says, that an excellent substitute for breast milk, is the milk of a cow, (the cow should never be changed,) drawn when- ever wanted, and mixed with one third warm water, not to be boiled. The addition of sugar is not needed, better without any, but if any, let it be but little, as the stimulus of the sugar is too strong for the bowels, and often pro- duces disease. It is more incumbent not to change the diet of children brought up at the spoon, than those at the breast, as their bowels are very irritable. Whenever their stools become very offensive, you may rely upon it that they are diseased; in nine times out of ten, from some- thing defective in their diet, often from quantity as quality. Whenever any diet disagrees with them, it should be dis- continued, and a physician consulted for directions. In feeding with the spoon, care should be taken not to feed until the child ceases to eat, a little often is better than much at once; the jaws tire while sucking, but not so much in taking from the spoon. With respect to the time of moving the child, Dr. Moss remarks, that warmth and rest are indispensably necessary for infants at an early age. “ In the first week, it should not be carried out of the room ; not till the end of the second week should it be carried out; and then only to adjoining apartments. About this time the child, if it do not appear disagreeable to it, may have its skin rubbed gently with the hand, its legs and arms stretched; it may be handled once or twice a day, for a little time, on the nurse’s knee, near the fire. During the third week, the time of the child’s being up and out of bed may be lengthened; and after this its other exercises are to be conducted by degree®- In the beginning, great caution should be observed in car- rying the child into strong light, and a damp air.” Many women feel considerable anxiety on the subject of the influence of their diet, on their children’s health, especially in early infancy. They fancy that the physic they take enters in their milk, and operates on the child as on themselves ; but this is a mistake ; and it is lolly in a mo- ther to swallow medicines for the purpose of affecting the child. Now it is a truth, that whatever affects the stomach of the mother, affects her milk ; and whenever changes in the milk are made, they affect the child, not by any means, however, always in the manner they operate on the mother. If the mother change her diet, or drink, or take any medi- cine, or get in a violent rage, or have a fever, unless the child be unusually healthy, it will be affected by the altera- tion wrought in the milk: generally purging will be ex- cited, just as it will be, if any foreign, irritating substance is given to the child. From this an important inference should be drawn by mothers : they should learn to adhere to one diet, to be regular in their habits, to preserve their tempers while their children are at the breast; at least un- til their constitutions are well improved. Those who have delicate children, should of course pay the more attention to this subject. I will only add, the best milk is given bv those females who preserve their health by simple diet, taking only the stimulus of exercise and pure air. There is no treatment of children found so certainly beneficial, as washing them all over every morning in a tub of warm water, from the day of their birth, till they have passed two years of age. It is a luxury every wo- man can afford for her child, indeed they will find econo- my in its use. The free motion of its limbs in water, contributes to its health. The circulation of its system is greater than ours, and therefore in proportion it has more excretions. These excretions are more apt to become acrid and irritate, than those of grown persons. It is there- fore most important to immerse them daily in warm water, that the surface of their bodies may be kept clean. More-1 over, the warm water tends to equalize the action o£ all parts of their systems, on which equalization depends their health. L never knew children subject to irruptions, nor one tenth so sickly, when daily made to sit, immersed from neck to toe, in warm water, as others under the same cir- cumstance excepting the washing, if you be a fond mo- ther, half of either reason I have given, will induce you to attend to the prescription. You will he delighted at witnessing the pleasure the child shows in the bath, and much more at the consequent exemption from disease. If you be a friend to humanity, most earnestly entreat every mother, the poor and the ignorant, to adopt the practice ; remind them of the facility of warming water with hot stones or irons, and many will be the lives saved. No- thing but severe illness, should eve‘r postpone the daily operation. Some persons have recommended bathing the children in cold water, but the shock is too severe; it has been the death of many. Nevertheless many have improved under its operation. 1 know that the warm bath is best, and I cannot see the least reason for using the cold, ex- cepting the incorrigible laziness of those who may ne- glect to warm the water. The advantages of a momentary shock to the skin, are abundantly derived from exposure to cool air, during the wiping. The astonishing improve- ment I have seen so many interesting little children de- rive from its introduction, for which important practice, much is due to the zeal and benevolence of Doctor Bu- chan, that I do most earnestly beseech every mother to let hereafter a tub of warm water be the first article, brought to her children every morning. The question of the propriety of rocking children in cradles, has been considerably discussed ; many doctors urging that the rolling motion stupefies ; all nurses urging the great convenience of the practice. I am certain, that the gentle rocking of a cradle, at a proper time, will not be injurious. It should always be most gentle, never al- lowed by its violence to drown the cries of the child ; ne- ver to be done when the child is diseased. It is indispens- able for the cure of children’s complaints, as well as for our own, that they should have rest. When they cry from the pains of disorders, rocking them is excessively injurious ; and unless the nurse is cautioned and bound not to rock a child crying from pain, there had better be no cradles. But these cradles probably never did as much harm as shaking the child on the knee, in the way that is so universal, even in the earliest days of infancy. The agitation, most certainly in the state in which the brain then is, must have aided in impairing the facul- ties of so many. An invariable rule should be with mo- thers, never to let a child cry wuthout examining and turn- ing it over to rest on another part. The next subject is, the proper place for children te 249 sleep in cold seasons. There is a strong feeling to take the child in the bed, although many have been destroyed by the intended kindness. Yet I will assert, that notone has lost its life by the practice, for five that have died by the diseases brought on by the coldness and dampness of the cradle. There can be no doubt, that a great cause of the fatality among children, is their suffering while in the cradle alone. We, in our beds, frequently are unable to preserve our warmth ; and no wonder the extremities of children are so often found cold. All mothers in a natu- ral state sleep with their young ; the heat of their bodies appears essential for keeping up that of their offspring. Excepting among hogs, I never heard of their being suf- focated by the bodies of their parents ; and why should not women be able to guard against such a misfortune ? A variety of expedients could be adopted to have the warmth of the mother, without endangering the life of the child. The most simple, practicable plan, which presents itself to my mind, is, to have a small plank, but little larger than the child, its edges surrounded with a few pegs, eight or ten inches high, and the little bed to be put in it„. Any contrivance may be made to prevent the turning over to the mother ; the pegs will prevent her turning over on it. Those who can afford it, can have the contrivance made of as fine materials as they please. The expedient will answrer for the rich and poor, the mistress and the slave ; the necessary expense not being ten cents, I would earnestly entreat every mother desirous of giving comfort to her child, to adopt the plan. It will save children from many diseases, as well as pains ; and it will be a conveni- ence to mothers to have them so near, for the purpose of giving the breast, and applying clean clothes. Next I have to request )'our attention to the daily eva- cuation of your children’s bowels. If there be no impro- per cramming of the child, no sickness, once or twice every day, at stated hours, will be sufficient. The advantages derived from the cleanliness of the habit, should induce every nurse to attend to it. It will supersede the use of the clout in almost every case : a great relief to mother and child. The simplicity of the modes of bringing on the habit, is such, that I feel almost tempted to advise giving a grain or two of some powder along with it, that you might think the dose did the business. But I shall rely on your better sense. The means of effecting this regularity of habit in the child, are precisely the same as in our own case. Turn up its posteriors to cold air every day at the same hour, let nothing prevent, if necessary twice a day, morning and night, at first introduce an oiled rag around a small quill; some months after a piece of soap may be substituted ; keep it there till the evacuation is made. Af- ter a little perseverance, (if you will not forget once or twice, and let the habit be lost) the child will daily dis- charge its excrement at the same hour. You may rely upon the success of this treatment in every case, and at all times, except when disease is existing. It will greatly con- tribute to the health of the child, by preventing the reten- tion of offensive matter in its bowels, which it sometimes forgets to evacuate. Moreover, the children are often afraid to evacuate, because, being great observers of the countenance, they see the displeasure and uneasy feelings excited frequently at the ill-timed deposit. They retain till they can retain no longer, and often show sorrow, not at the bad habit disordering their delicate bodies, but that at 251 fast they are obliged to evacuate. It is the nurse, not the child, that in all cases should be condemned. I have now to urge for your consideration, the proper use of air for children. They, in proportion to their bodies, require more and purer air than older persons. A confined air is more pestiferous to them than the most fatal epidemics. The difference in the deaths and diseases of town and country children, establish this beyond doubt. Probably an occasional breathing of a pure atmosphere, is more injurious than habitual confinement to one that is de- fective. Children in very tight houses are never so healthy as those in open buildings ; their diseases are more violent; they feel every change of weather. It is equally remarka- ble, that although they be more healthy in houses of loose joints, in which the air can penetrate, than in those that more effectually exclude the air, they never do well, ex- posed to cold and currents of wind. They require an abundance of pure air, with their bodies to be kept warm. Indeed it seems incomprehensible, how so many children could have survived the confinement to the air of close rooms, corrupted by their parents, companions, and ser- vants, a crowd which may frequently be found in the rooms of some very wealthy persons, ridiculously afraid to trust their children out of their bed-rooms. All parents should bear in mind, that their children cannot enjoy perfect health, without having good, wholesome air for their lungs, and warm clothing for their bodies. As a child requires almost as much air as an adult, there should be never more than three to sleep in a room of less than twelve feet square with a door, chimney, and loose jointed window. Warm clothing in cold weather, is nearly as essential tor the health of children as fresh air : comfortable, not oppressive clothing. Let their clothes be changed to suit, not only the varying seasons, but the changes in the day, in spring and fall. It is at these times they are most subject to disease, therefore clothing to suit the day is almost more essential than in the coldest seasons. The fantastic manner in which many mothers dress their children— arms and breasts exposed, in cold seasons, betrays as much want of sense, as ridiculous vanity. This excessive folly is sometimes defended, with the pretence of harden- ing their children. Just as the old generals prepared their soldiers for fatigues they might never require, killed about the half in hardening. There can be but little doubt, that a greater number of children have been sacrificed to such schemes of hardening. Better commanders now reserve their men until the time comes for exposure, and so should our better mothers do. You will misunderstand me, if you infer that I wish parents to bring up their children with oppressive care snd kindness ; destroying them with daily confinement to close rooms, only taking exercise by rules, and with covering enough to weigh them down. There is a medium in all things, to be settled by exercising com- mon sense, without a bias to any particular system. It is by this that we may all ascertain the best method for rear- ing children, neither with excessive care or neglect. Free exercise in open air, with comfortable clothing for all parts of the body ; a frequent, but not a long indulgence in the plays of childhood, while the weather is bad, are outlines of management, which all of sound mind must approve. We must not deny the propriety of the course, if, in a few cases, we see exceptions to its success. Ten' dencies to disease are sometimes produced by causes very likely to escape our observation. A too confined or crowd- ed room to sleep in, eating too much of an unusual food, for example, have frequently produced the com- plaint, that the over careful have ascribed to their children’s exposure. Exposure to rains, and more especially ex- posure to a hot sun, have had great influence in making so many excessively particular about their offspring. They restrain the proper playful pursuits of children, because other children have suffered ; and often from what the beasts of the field take excessive care to guard against, that is, exposure to rains, and most to a summer’s sun, That a child in our country, in the months of June, July, August, and September, could survive two hours exposure to the rays of the sun, which so frequently kill the most vigorous men in a few hours, is to me unaccountable ; and I would not believe that they do it frequently without perceptible injury, but that I see they do escape. Rely not, affectionate mothers, on such escapes ! Keep youd* children from exposure to rains, and particularly a hot sun, as you would from a raging fire, or pestilential atmo- sphere ; often warn them of the dangers in the beginning, and they will habitually shun them : Let all of them play as much as they desire in shades, uncontrolled, with clothe ing suitable for the day, and with pure air for their respi- ration ; and by such means you will save millions of your offspring from premature disease and death. Another important point I would press parents to ob- serve, is, a never varying simplicity of diet for their children, at least in the early stages of life, aided by great regularity in eating, and indeed in all other habits. The numerous specimens we daily see of distempered, distort- ed people, owe their existence to parents disregarding such important rules. Strange as it may appear, ’lis selfishness, his extreme of weakness, that has led to these pernicious practices to the contrary. Children are perpetually in- clined to be doing something ; when not at play, they refer to eating ; the father and mother find more pleasure in giving than in restraining. They but seldom encounter the labour of thinking of consequences ; and the child is not only allowed to eat until distension becomes painful, but it takes sometimes the most stimulating food ; fre- quently is excited by the offer of compounds ; most gene- rally with that favourite article, found in so many houses, commonly called CAKE. This abominable compound, first used only for the purpose of stimulating the worn-out stomachs of the intemperate, has disordered and destroy- ed millions of children. Either of its component parts, separately taken, is healthy ; it is when compounded, that it is pernicious. The appetite for it is artificial; and as children have the strongest relish for the most simple food, when confined to it, (as for the mother’s milk,) it is infi- nitely better that they should never have such excitements. It ought not to be allowed, if for no other reason, than the uneasy feeling many other children have, in not partaking of an article deemed so good. I have no hesitation in de- claring that its use is as pernicious as dram drinking; that no child under five years ever eat it without injury visible or secret to his constitution. You may perceive how pow- erfully the compound operates, by having two children under the same circumstances, both accustomed to simple diet ; give the one at night cake to eat, none to the other; watch the sleeping; and the starts, the restlessness, if not 255 the screams, will proclaim, which took the disordering compound. Sweetened light bread is the substitute, but no substitute is wanted ; the more simple, the more agree- able will be the diet. Children ought never to be allowed to eat too much: the means of preventing such gluttony, is to give them some light article to eat, before their regular meals, which prevents that eagerness to eat, which naturally leads to ex- cess. They should always, the moment they awake, take, something to eat. In giving them new articles of diet, the commencement should be with small quantities, to habituate the stomach to its digestion. It is excesses, compounds? and irregularities in diet, which have produced so many small persons. A return to the old simple diet of the an- cients, would be followed by a restoration of the size of our species. The time for weaning children, generally the critical time of teething, is next to be noticed. This varies in every country ; indeed in each family so considerably, that it is impossible to give any thing satisfactory on the sub- ject. The general rules are, by all means to habituate the child for weeks before to a different diet; by no means suddenly to withhold the breast. Next, the time for wean- ing should always be taken when the child is in a healthy state. The substitute for its diet, ought at first to be that which was recommended for children in early infancy, the mildest articles. Children have done well when wean- ed at the fourth montV ; but unless some state in the mo- ther renders it improper, it is best not to deprive them of the breast before the ninth month. "When the parents are of small stature, it is best to keep the child longest at the breast, as in all other animals it appears to have the effect of increasing their size. Judging from comparison, and from a few observations, I have no doubt such a course, liot destroyed by stimulating diets, or drinks, or premature venery, would have the effect of greatly enlarging our puny breed of men and women. The next subject for consideration is the teething of children ; an operation which has probably caused the death of more children than any one to which they are lia- ble ; and all from the ignorance and fears of the attend- ants, often supported by the conceits of their physicians. The important connection between the mouth and all parts of our body, has already been dwelt upon. It is not, there- fore, surprising, that such great variety of diseases should follow the irritation in the mouth during teething. The time of cutting the first teeth is irregular; from the third to the fifteenth month ; generally between the seventh and ninth. There arc two stages in this operation ; the first is about the third or fourth month, marked by slaver- ing, when the child'delights in having its gums rubbed; sometimes they have fevers, fretfulness, and diseases of the bowels. The second stage is about the seventh month, when the teeth are penetrating the gums. The gum is swelled, and too painful to allow the slightest touch; as the tooth is about to appear, a white blister appears over it. Children have often most difficulty in cutting the first teeth ; which, if they come in proper order, are, the two lower front teeth, then the two above them; but when the usual time of their coming has past, the two upper teeth will sometimes appear first, then the two eye teeth ; but the appearance is very irregular, and not material. About the seventh year, these teeth, give place to new tevth. In order to prevent the diseases so often attendant upon teething, it is necessary to watch the first symptoms of disease, and invariably to scarify or cut the gum, at the same time giving some laxative medicine, and lessening the diet. In the first stage, it may be difficult to discover which gum ought to be cut, but,when disease is violent, it is best to cut all over the gums in front. Whenever the gums are swelled, it is then of the utmost importance to cut them freely; a common penknife, or thumb lancet, will answer, and any mother’s or father’s hands, just as well as a sur- geon’s. The first object is to draw blood from the part; then, if the symptoms continue bad, to cut down to the top of the tooth. There is no danger of hurting the child ; in- deed they derive such relief, that often they open their mouths for it, when once relieved. Their gums are very insensible, excepting when, from neglect to scarify them, they are inflamed. Nor need you be afraid of hurting the teeth, as they ascend, covered with their enamel. A ridiculous idea prevailed among physicians for some time, that cutting the gum gave present relief, at the ex- pense of future pain; that the scar formed when the wound healed, was more difficult of penetration by the teeth. To this day, some are ignorant enough to believe in the doctrine, and refrain from relieving the suffering children, as if their gums could not be cut every day, if ne- cessary, even if their notions were true. But the fact is the reverse. All new formed parts are more easily de- stroyed than old ; they more readily dissolve, or disappear, as instanced in the cicatrix, or new formed flesh of old sores. To cut a gum over a tooth which has not appeared to rise, is therefore rather of service than injury to its future passage. The_ greatest surgeon who ever lived, Mr. John Hunter, of London, writes, M it often hap- pens, particularly when the operation of cutting the gums is performed early in the disease, that the gum will re- unite over the teeth; in which case, the same symptoms will be produced, and they must be removed by the same method. I have performed the operation above, ten times upon the same teeth, when the disease had recurred so often, and every time with the removal of the symptoms.” I do sincerely wish I could prevail on all mothers or fathers to undertake this gum lancing. Nothing is more simple, or more easily performed ; it never does harm, and it would so much lessen the sufferings of the little children, that I should be happy in the recollection. It is best for the child to cry when lancing the gum, as the mouth is then most opened, and the cut may be directly on the top of the tooth. In some cases, where there is reason to be- lieve the teeth to be advancing, yet no visible sign, great relief has been obtained by cutting down to where the tooth should be, thereby letting out blood, with probably some little irritating matter, producing violent action in the sys- tem. If you will not do it yourselves, I beseech you to insist on your physicians frequently performing the opera- tion. I have not dwelt upon the diseases incident to teething, because they are so numerous, and vary almost in every child. The most common are, affections of the bowels and convulsions. When these or other violent complaints 259 appear, or are apprehended, the child should be blooded, by cupping about the lower extremities, and purges be given, with the warm bath, (not hot) to take off the irri- tation. The gums, of course, to be freely lanced. The rule I have adopted, and would prescribe to all, is, what- ever may be the inflammatory affection of the child, if it have slavered freely, before, or if it be the time for the teeth to appear, by all means to cut the gums, so that they shall bleed freely. All parents should be apprised of the importance of teaching their children how to command their own minds in early life. The numerous ungovernable spirits we see daily in society, originate from the folly of neglecting this important object. I make the assertion in the fullest con- fidence of its truth—that there is no child which cannot be trained, and with but little trouble, to any habits of self- command. It only requires a good beginning. The first correct practice is to prevent them from getting in the habit of crying; to make them suppress their cries, at least loud crying; which is not only horribly annoy- ing to others, but calculated to produce convulsions in the child. Whenever they are heard to cry, enquiry should be made into the cause, and their attention di- rected to some other point. A little perseverance in the beginning, will soon be crowned with success ; and it is indeed worth a long attention. The ability to suppress cries, will be followed by ability to command other feel- ings. The example of submission in the eldest child, will have great influence over the younger ; so much, that half the discipline, will suffice with them. Children so brought up, do not require or receive a tenth part of the correction of those punished irregularly, or, as it is termed, by fits and starts. The practice I have pursued with my chil- 260 dren has been, to begin early with punishment, uever to suffer disobedience in the slightest degree ; never to with- hold one proper gratification they desired; never to allow one that was improper; and the consequence has been, that no children less frequently require punishment. In concluding this letter, I feel some pain at the appre- hension that I have not said enough to induce a strict ad- herence to the practices recommended. I knew them to he so judicious, that I felt as if argument were useless. The subject is those, of whom our Christ declared, “ of stich is the kingdom of heaven !” Ladies, if you feel as mothers, if you have souls to partake of the heaven of doing good to innocence in pain, you will not require long arguments to adopt practices promoting the health of children. I ask—I pray you—if I have not urged suffi- ciently to induce you to do it, then, as a favour, as a kind compliance, in return for the wish I have to serve, imme- diately prescribe— 1. That all little babes shall sleep with their mothers or nurses, in the safe manner pointed out. 2. That until their constitutions are formed, their diet shall be simple, and of the same kind. 3. That they shall be kept warmly clothed; never exposed to sleep, breathing a foul, close air ; nor with windows open. 4. That every morning, from birth, for at least two or three years, they shall be put in a tub of warm water and washed. 5. That they shall be, as far as practicable, got in the habit of evacuating their bowels at the same hour. 6. Lastly, though not least, that whenever their gums appear in the least inflamed, you will, or will have them, freely and often cut. LETTER XI, Contents. Diseases of children—-first month—colds— eruptions on the skin—sore eijes—sxvellings and excoria- tions—hooping cough—croup—of wind in the stomach and bowels—of sickness, £s?c.—sore head—measles—of colic—convulsions—offevers—of worms—of chicken pox —of cow pox—of chilblains—-of scalds and burns—of the itch—of scald head—summer complaint. The treatment of the disorders of children ought to be understood by every mother; as well for the purpose of giving occasional relief, when a physician cannot be had, as to prevent injudicious meddling with their complaints. Improper doses, at improper times, have probably caused the death of more children than have been relieved by me- dicine. The first thing to be impressed on the parent’s mind, is, that the bodies of their children are governed by the same laws as their own ; and the cure of their disorders is to be effected, not by doses operating as charms, but by the ap- plication of the principles of medicine to their particular ease. The great variety of prescriptions for the diseases of children, in almost every old woman’s head, should be abandoned ; but few medicines, and those of the most sim- ple kind, are wanted for them. From the moment a child is born, its system assumes more or less an inflammatory state ; its diseases are almost invariably those of high action, requiring evacuations and medicines, to determine to parts not affected. The prac- tice is so simple in most cases, the. treatment so well laid down by other writers, that I shall confine myself merely to making extracts from them. From the works of doc- tors Moss and Burns, the following is taken. OF COLDS. “ In the first month, most children are affected with colds* commonly in the nose, and called snuffles. Warming the feet at the fire, will often be sufficient to cure them. But when the disease is attended with fever, it is best to administer a vomit. This may be of three grains of ipecacuanha, or of one grain of tartar emetic, in four table spoonfuls of warm water, and one tea spoonful to be given every thirty minutes, until vomiting is produced. The bowels should be kept open with magnesia, rhubarb, manna, or castor oil. in small doses. I would recommend a repetition of the vomit, if the first do not relieve. ERUTTIONS OF THE SKIN. ' “ Children, particularly those not daily put in a tub of warm water, are very subject to a great variety of eruptions on their skin, commencing sometimes in the first week of their birth. Different names, as red gum and white gum, are given to each kind ; but it is useless, as they vary much, and require nearly the same treatment. In the red gum, there is a number of small, elevated red spots, scat- tered over the trunk of the body, and sometimes on the cheek or forehead; on the feet the spots are still larger, and contain occasionally a clear fluid. In some stages it resembles the measles. Generally no medicine is requisite,: 263 but if it suddenly disappears, and the child shows symp- toms of internal disease, an emetic or purgative ought to be given, and repeated, if not at first relieved. The white gum appears after the red gum, resembling the itch, with white, shining little blisters, containing a little clear fluid. There are other varieties of these eruptions of the skin, but few of them require medical treatment. A vomit or purge to clear the bowels, generally relieves. The preven- tion is in great cleanliness, free washing daily in soap and water, with regularity in nursing. When these affections of the skin are attended with fever, they require treat1- ment, such as for common fevers, with applications to the parts inflamed, to lessen the action; cold lead water and sweet oil, are the best for this purpose. “ Sore Eyes. Children are very subject, sometimes during the first month, to inflammations of their eye- lids and eyes, particularly those whose parents neglect the great preventive of their complaints, setting them every morning in a tub of warm water. At whatever time the inflammation comes on, in slight cases, cold wa- ter alone ; after a few days, a very weak solution of sugar of lead, fifteen grains to the pint of water, should be ap- plied every two hours to the part. If it do not speedily subside, a purge of oil should be given, to relieve the in- flammatory state of their bodies. . The inflamed eye should never be turned towards the fire, and the hand of the infant so confined, as to prevent rubbing the part. In cases where the inflammation of the ball of the eye is great, a leech should be applied to the eye-lid, also cup- ping about the temples ; and if the child be a few months old, bleeding four or five ounces may be necessary to save the sight of the eye. “This cold and lead water alone is the proper application to the eye, and nothing should be added excepting where the eye-lids adhere together. In this case, the mildest sweet; oil, mild hog’s lard, or any bland grease, should fee applied to the edges. A want of the knowledge to cool, and evacuate at once, and effectually, the children, and avoid every stimulating application, in inflammations of their eyes, has been the cause of the frequent loss of their vision. I trust, that no parent, hereafter, will suffer any other application to their children’s eyes, unless from the recommendation of same eminent physician. •