w i m SDIGAL ^ HomE an : ON NLM D0555fifi4 5 SURGEON GENERAL'S OFFICE LIBRARY Section Form 113c W.D..S.G.0 *o. Jl.411: VFRNJtENT PRINTING OFFICE NLM005558845 EXERCISE OF CHILDREN najjie—s^mothei's ever on his tongue, ;cruitfl for him ihe bieeze.fcrr him sKe speeds ^t rid of their uneasy feelings. They become suspicious of every one, and their usual energy of mind and firmness of purpose are exchanged for capricious- ness, timidity and irresolution. The hands are alternately hot and cold ; in the former state they are dry, in the latter more usually damp. Parox- ysms of intense pain are occasionally experienc- ed in the stomach, which terminate by the throw- ing up, often without effort, of a quantity of glairy, limpid fluid, some times insipid or sweet, at others peculiarly acid. The limbs ache as though they had been bruised, and the flesh on the suW'»i'e of the body is even sore to the touch. ^4A ANTERIOR VIEW OF THE DIAPHRAGM IN A STATE OF REPOSE. Health of the Unmarried. T* and any change of position is attended with incon- venience. Every alteration of the weather is felt as a serious evil ; if it becomes a degree or twc colder, the patient creeps near the fire—if its temperature is only slightly raised, oppressive heat is complained of. The bowels become more and more bound—if purgatives are resorted to, they must be gradually increased in strength, and, when they do operate, their action is too powerful, and its effects are not easily checked —when they are, however, obstinate costiveness succeeds. The depression of spirits increases as the disease advances; the patient falls into frequent paroxysms of ill humour, or sheds tears profusely from the slightest causes, and often without any apparent cause. Dyspeptics inva- riably magnify all the symptoms under which they labour—and fancy a thousand which are not present. They consider a speedy death inevitable, gradually lose flesh, and are troubled with wandering pains in their bowels and side; a tenderness at the pit of the stomach is expe- rienced on pressure; the abdomen is often per- manently distended and tense ; a discharge of the food in the same condition in which it w;is swallowed, often takes place by the mouth. The breathing is occasionally hurried or oppressed; a short, dry and distressing cough, and a seamy and difficult, or profuse, expectoration ensue. In dyspeptic patients the urinary secretion i.s always more or less affected. The urine is sometimes discharged in immoderate quantities 78 Woman's Medical Companion. and perfectly limpid, at other times it is defi- cient in quantity, thick, and of a white, red or yellow colour, and its passage is preceded by pains shooting downwards from the loins, and accompanied and succeeded by a distressing sense of burning. With this brief sketch of the more ordinary features of Dyspepsia, our readers must be satisfied—they will learn sufficient from it to detect the disease during its earlier stages, as well as to form a tolerable conception of the symptoms which mark its protracted and more aggravated forms. We come now to an all important question; namely, how is Dyspepsia, with all its attendant evils, to be removed ? It is certainly unneces- sary to say any thing in regard to the proper preventive means; a reference to the list of cau- ses productive of Dyspepsia, will at once point out a well regulated diet and regimen as the means which are alone to be depended on, and these we have considered at sufficient length in the Chapters of this work, which treat of Diet, Exercise, Clothing, Cleanliness, Sleep and the Passions. The treatment we propose to lay down on the present occasion will not consist in the administration of a variety of medicines internally, which, so far from restoring the sto- mach to its accustomed health and vigour, very generally add to the mischief which already exists, and extend it over a larger portion of the body. A vigilant attention to diet, air, exercise and clothing, regulated in reference to Health of the Unmarried. 79 the particular condition of the stomach and other organs ; together with all those means calculated to insure mental tranquillity—in other words a rational system of framing for health, will be found more decidedly beneficial in restoring to the digestive organs their healthful functions, than all the drugs of the apothecary or the various specifics which have from time to time been extolled as the only certain stomachics. In our next Chapter will be detailed the system of training proper to be adopted for the cure of dyspeptics. Before closing this, however, we must warn such of our readers as are unfortu- nately the victims of stomachic disease, against the abuse of purgatives, to the use of which they are so frequently prompted by the state of their bowels, and by the temporary ease experi- enced after a full evacuation from them. Though purgatives may sometimes relieve unpleasant sensations, they do not in general produce even this effect: while all active purgatives, or even the mildest laxative, frequently repeated, will increase the disorder ; the bowels are kept by their action constantly in a state of irritation, while at the same time, when their use is once commenced, to obtain the desired effect they must be repeated daily in continually increasing dosps. Constipation is capable of being much more safely and effectually remedied by diet than by medicine. 80 Woman's Medical Companion. CHAPTER VIII. TRAINING FOR HEALTH In what it consists—Of food—Of drinks—Of exer- cises passive and active—Of repose—Proper period for sleep—Means for promoting the healthy functions of the skin— Warm bath—Frictions—Sponging—Pro- per clothing—Means of remedying cold feet—Exposure to pure and free air—Necessity of avoiding cold and damp—Injury from nightly assemblies—Proper regu- lation of the passions—To remove acidity of stomach— Remedies for constipation—To arrest diarrhoea— Shampooing—Mr Halsted's method—Recapitulation. The plan of Training for the restoration of Health consists in a proper choice of food cooked and prepared in such a manner as to deprive it of any irritating property, and to facilitate its digestion; in the observance of the strictest rules Health of the Unmarried. 81 in regird to the quantity of aliment taken into the stomach, and the period at which it is par- taken; in the entire relinquishment of all fer- mented and distilled liquors, and of all fluids possessed of a stimulating or narcotic principle ; in a proper regulation of exercise in relation to its quantity, nature, and the periods at which it is resorted to ; in a proper regulation of the season for repose, whether for a cessation from active exertion or for sleep ; in a proper atten- tion to the condition and functions of the skin, including clothing, bathing and frictions; in sufficient exposure to a free and pure atmos- phere ; in the proper regulation of the passions ; and in the use of such other means as tend to promote the health and vigour of the stomach, skin, and other organs. First. In regard to food. The chief object to be kept in view in regulating the diet in dys- pepsia is, that it should consist of such articles, as shall tend as little as possible to produce either undue distension or irritation of the coats of the stomach. The stomach may be morbidly distended independent of the qualities of the food itself:—First, by partaking of too much food at a time, or eating too frequently. Second, by eating with too great rapidity, the food being swallowed without proper mastica- tion and a due admixture of the saliva, both of which are essential to its quick and perfect diges- tion. To eat moderateh and slowly of whole- some food, therefore, is a highly important rule F 82 Woman's Medical Companion. at all times, but especially when the stomach is suffering from dyspepsia. The dyspeptic should always attend to the first feelings of satiety. It is a strange circumstance that food of any kind eaten without an appetite, or taken after the appetite has been satisfied, is rarely well di- gested, but oppresses and irritates the stomach. We warn the patient, however, against the error of partaking of food in small quantities and at short intervals: the stomach is always more or less injured by this mode of feeding— Let the dyspeptic eat as much food as may be prudent at a single meal, and allow sufficient time to elapse for the digestion of what has been taken before she partakes of more. Thirdly, morbid distension and irritation of the stomach may be produced by the food being of such a nature, that the stomach is unable to produce in it the proper changes, in consequence of which it is retained for a long period within that organ, becomes rancid, or runs quickly into fermenta- tion. The dyspeptic, therefore, should feed upon aliment which is at once nutritive and easy of digestion. Tough, acescent, oily, and fibrous food, eaten with a large proportion of fluid, uomposes the diet most difficult of digestion. In the first stages of dyspepsia, a diet, com- posed principally of animal food and stale bread, is the best. The flesh of full grown animals should be preferred to that of young animals. Mutton and beef, and most kinds of game are easy of digestion, and therefore most proper for Health of the Unmarried. 83 delicate stomachs. Very fat meat of all kinds, fish, pork, geese and ducks, are to be avoided. Eggs, when soft-boiled, and eaten in moderation with bread, are easily digested, and may form part of the diet of a dyspeptic. Oysters, also, taken raw or simply warmed through, are at once a wholesome and nutritive food easily managed by the stomach. Few things are more indigestible and oppress- ive to the stomach than fresh bread, cakes of all kinds, pastry, the crust of apple dumplings, boiled puddings and the like. These should form no part of the diet of the dyspeptic. Even stale bread, if eaten alone, is somewhat oppressive. Biscuits and toast will sometimes agree better with dyspeptics than bread. Bran bread is an admirable article when the bowels are constipated, from its laxative proper ties; it is also much less liable to turn sour upon the stomach than that composed entirely of flour. Rye bread should never be eaten by those affected with this disease.. The bread may be taken with a moderate quantity of fresh butter, when this is found to agree perfectly well with the individual, but if the least uneasiness is experienced from its use, it should be at once abandoned. Stale butter, or that which has been melted, is decidedly in- jurious. The dyspeptic should carefully avoid all strong jellies, food carefully mashed into a pulp, made gravies, and rich soups of every kind, all of which are indigestible and irritating to the 84 Woman's Medical Companion. stomach. The best mode of cooking the food of the dyspeptic is unquestionably simple roast- ing, broiling or boiling—it should not be either under or over done. All attempts to increase the flavour of the food by mixture, spices, or other condiments, or to concentrate its nutritive pro- perties—all essences, extracts, and complicated stews, are injurious to the stomach. All tough and hard animal food, particularly if salted, dried or smoked, is difficult of diges- tion, and unwholesome. The fat of all meat is extremely oppressive to the stomach, and should as a general rule be abstained from by those labouring under dyspepsia. Fat is rendered still more pernicious and indigestible when acted upon by heat, particularly in the processe-s of frying and baking. Cheese is another article, the use of which must be prohibited in dyspep- sia under every circumstance. Milk will be found in general, particularly when fresh, to agree with the stomach, and to be readily di- gested:—occasionally persons will be found v.ho cannot tolerate it however, even in health; to such its use would of course be improper. It will be found very frequently that fresh cream will sit more easily upon the stomach of the dys- peptic than milk. All fresh vegetables, on account of their ten- dency to fermentation, are, generally speaking, improper in dyspepsia. Peas, beans, cabbage and waxy potatoes are the most unwholesome ; mealy potatoes, turnips, broccoli and spinage Health of the Unmarried. 85 the least so. Fruits are also very generally improper and injurious, particularly when of a very firm texture, watery, mucilaginous or acid. The only species of fruit of which the dyspeptic can make use, with any degree of propriety, are peaches and strawberries when they are in season, and even these will often be found to disagree with the stomach. Pickles and preserves of every kind must be given up by those affected with dyspepsia. To some dyspeptics, the least quantity of sugar is highly oppressive; by others it may be eaten in mode- ration with perfect impunity. Much seasoning is pernicious, both on account of the irritation of the stomach to which it gives rise, and by inducing an artificial appetite by which the patient is induced to eat more than the stomach can properly digest. The very defect and caprice of appetite which attend upon a disordered state of the digestive organs, will induce the dyspeptic to commit excess in regard to spices; on this account it would be better to abandon them all with the exception of salt. Not only should the food be well chosen and pro- perly prepared, but it should likewise be simple —variety of food at the same meal always endan- gers over-distension of the stomach, and causes imperfect digestion. The dyspeptic should al- ways confine herself to a single dish at dinner, and rise from the table before the desert is served, nearly every article of which this latter is gene- rally composed, being to her forbidden fruit. 86 Woman's Medical Companion. Second. In regard to drinks. Water is evi- dently the fluid destined by nature to be the diluent of our food, and to it should the dys- peptic be strictly confined. Even water, how- ever, should be taken in moderation, especially at meal time. An excess of fluid in the stomach over-distends it for a time, and impedes the proper digestion of the food. In dyspepsia the irritation which exists in the stomach and the altered state of the fluids secreted in the mouth often cause considerable thirst, which, if in- dulged incautiously, will cause too great a quantity of water to te taken in the stomach. The dyspeptic should not, therefore, yield to every slight sensation of thirst; and, when drink is necessary, should take it in moderate quan- tities at a lime, swallowing it slowly. It is unnecessary for us to say that all fermented and distilled liquors are injurious to the stomach of the dyspeptic. Those which contain a large amount of alcohol produce injurious effects by directly irritating the coats of the stomach, and when taken to the extent of intoxication indi- rectly exhaust the vital energy. Fermented liquors of a less stimulating character quickly turn sour upon the stomach, and thus become a source of irritation ; and, when they contain a large amount of free carbonic acid gas, they un- duly distend it. On this latter account the arti- ficial mineral waters of the shops, spruce beer, bottled cider, mead and beverage, are improper in dyspepsia—All acid drinks, as lemonade, Health of the Unmarried. 87 punch, orgeat, and the like, increase the suffer- ings of the dyspeptic, and should therefore be strictly refrained from. Unfortunately the sense of sinking and of faintness experienced by the dyspeptic about the region of the stomuch—together with the languor, depression of spirits, and other uneasy feelings which accompany this disease, are so many causes prompting to the use of stimulating drinks: hence it requires some degree of resolu- tion to abstain entirely from them—particularly on the part of those who have heretofore been accustomed to their use ; but it may be safely asserted that so long as they are indulged in a cure cannot be effected : they, on the contrary, invariably increase all the most unpleasant 6f the symptoms, and hurry on the disease to a rapid crisis. Tea and coffee, also, when taken very strong, and in immoderate quantities, are injurious to the dyspeptic. In moderation, however, and when weak, they seldom disagree with those accustomed to their use. A warm dish of coffee in particular without sugar or cream, taken a few hours after dinner, is often found to facilitate digestion. Good chocolate, deprived by cooling of its fatty portion, and then reheated, will agree with many dyspeptics—others, however, it heats and oppresses. The period and repetition of meals must be directed by the calls of appetite, and in Borne measure by previous habits. The stomach, particularly when weak, should never be allowe J 88 Woman's Medical Companion. to experience for any time the sensation ol hunger. In general three meals each day will be found sufficient ; but some dyspeptics are troubled with a sense of sinking at the stomach when a considerable interval elapses between their meals, and will require four. The last meal, which should never consist of animal food, ought always to be taken an hour or two before bed time. In the intervals of the meals the dyspeptic should abstain entirely from food of every kind. Third. Of Exercise. The exercise of both body and mind demands particular attention in the treatment of dyspepsia. Whatever attention may be paid to diet, unless the body is exercised daily and to a sufficient extent, and the mind receives a proper and pleasurable excitement, but little progress will be made towards a cure. The patient may often be so much reduced in strength or so disinclined to active exertion, that riding in a carriage, or some other species of passive exercise, is all that she can at first be induced to make use of, or can bear without fatigue. The best and gentlest kind of passive exercise is sailing; next to sailing, riding in a gig or carriage, particularly the former, when the patient is capable herself of driving. As substitutes for riding in a carriage, but far in- ferior to it in their effects, spring chairs, swings and the like are sometimes resorted to. None of the above species of exercise is equal, how- ever, to riding on horseback for several hour! Health of the Unmarried. • 89 daily, when the patient is sufficiently strong to undertake it. Walking, as soon as it can be borne without too much fatigue, is of all exercises the most natural; and the best in reference to its effects in dyspepsia. It frees nil the organs from any degree of compression or restraint, and exer- cises all the muscles equally. A walk of a few miles'in the morning, and repeated when the patient is sufficiently strong for a shorter dis- tance in the evening, should be urged upon the dyspeptic daily, whenever the weather permits, as essential to the complete removal of the malady under which she labours. Those exer- cises in the open air, in which bodily exercise is combined with a moderate and pleasurable ex- citement of the mind, particularly various games and gardening, are well adapted to the dyspeptic. But, in all the exercises which are resorted to, care must be taken, that while they are regularly persevered in, they be not carried to the extent of producing exhaustion or undue fatigue. Neither should they be undertaken immediately after a meal, otherwise, in place of benefiting, they will disturb digestion and increase ulti- mately the irritation of the stomach. Proper exercise of the mind is equally impor- tant to the dyspeptic as that of the body. The languid, listless, and desponding state of the mind, induced by a disordered condition of the digestive organs, is more or less counteracted, by a due degree of bodily exercise ; but the occu- 90 Woman's Medical Companion. pation of the mind on agreeable and cheerful subjects is all-important. The greatest care must, however, be taken that the mind be not fatigued or too closely occupied. All deep, intense study, or close thought is injurious, by robbing the stomach of nervous energy, and concentrating it upon the brain. When the debility of the 'dyspeptic is considerable, her mind should be exercised by amusement alone— Even those amusements which greatly interest the feelings, or require any considerable effort of the mind, are hurtful. When, however, the patient has somewhat recovered her strength, a moderate attention to business or to domestic occupations is often serviceable. If the occupa- tions whether for exercise or amusement, tend only to present gratification, or are undertaken merely as a task, they soon become insipid and irksome. Some plan for increasing its enjoy- ments, and interesting it agreeably, must be pre- sented to the mind. Hence the importance of short journeys, visits to new and interesting parts of the country, and the like. The early part of the day is that bes adapted for mental and bodily exercise. Towards evening active exer- tion of every kind becomes irksome, and of course hurtful. Fourth. The repose of the dyspeptic must be regulated according to the extent of her debility. After exercise and for a short time succeeding each meal, rest will be proper. But the habi- tual inclination to inactivity is so great, that Health of the Unmarried. 91 care must be taken that it be not too much in- dulged. Never should the patients be per- mitted to sink for hours into that gloomy, listless, and dreamy state in which they so much delight; hence their hours of rest should be spent in light and cheerful converse with their friends, or in reading such works as occupy and amuse the mind without fatiguing it or exciting too much the feelings. In regard to sleep, the dyspeptic should retire early to bed and rise with the sun. By so doing, she will avoid the pernicious effects of late hours and evening parties. She will gain the period of the night for sleep, and rise in the morning with renewed strength and inclination for the occupations or exercises of the day. No species of excitement is more prejudicial in its effects on the digestive organs, than that attendant on late hours ; no kind of inactivity more baneful, than lying in bed for the greater part of the morning. Fifth. So intimately connected is the health of the stomach with that of the skin, that every attention should be paid by the dyspeptic to restore and maintain the proper functions of the latter. Cleanliness is of the first importance; to maintain which the regular use of the warm bath should be resorted to. Not only, however, does the warm bath clear the skin from all acci- dental impurities, but it also acts upon it as a gentle and agreeable stimulant. Promoting in this manner the circulation of the blood through 92 Woman's Medical Companion. the minute vessels spread over the surface of the body, producing a healthful development of heat upon the skin, >ind causing the whole of the functions of this latter to be performed with due regularity and activity; it indirectly restores health and vigour to the stomach and other digestive organs. Frictions of the surface, with the hand, a coarse cloth, or a pro- per flesh brush, are also of great importance, as a means of promoting the functions of the skin, and in this manner of acting beneficially upon the stomach. They should be renewed daily over every part of the body, but particu- larly over the stomach and abdomen. The warm bath and frietions tend in a very great degree to remove that peculiar irritability of the nervous system from which many dyspeptics suffer so much ; they render the body also less susceptible to changes in the atmospheric tem- perature, and promote sound and refreshing sleep. When the patient has not the conveni- ences for using the bath, advantage will be derived from sponging the whole surface with tepid water and then immediately drying it by means of brisk friction. The proper time for using the warm bath and frictions is when the stomach is empty—After active exercise they will often be found productive of a pleasurable feeling of refreshment. It is all important that the surface of the body be protected from ex- ternal cold and dampness, by a sufficiency of clothing, adapted in its texture to the season of Health of the Unmarried. 93 the year and the state of the weather. Flannel in winter and during changeable weather, and coarse muslin for the rest of the year, ought always to be worn. The feet especially, which are generally disagreeably cold, even when the other parts of the body are of a comfortable temperature, should be kept warm and dry. It has been recommended, with the view of reme- dying this coldness of the feet, to produce in them an artificial excitement, by dusting the soles of the stockings, with mustard, cayenne pepper, or some other stimulant: the effects of such applications are, however, merely tempo- rary. Bathing the feet in warm water pre- viously to retiring to rest, and applying after- wards smart friction to them, and wearing con- stantly warm dry stockings, will be productive of more permanent good. Sixth. Exposure to a free pure atmosphere is another means for the cure of dyspepsia which must not be lost sight of. The daily exercise of the patient should always be taken in the open air, and in as healthy a place as can con- veniently be commanded. Short excursions into the country, or even removal for a season to some dry and elevated district is often productive in a very short time of the best effects. The dyspeptic should always avoid small, confined or overcrowded apartments during the day, as well as at night. She should be cautious also against exposing herself to the night air, to damp and wet, and to the extremes 94 Woman's Medical Companion. of cold or heat. The midnight ball and even- ing party must be abandoned ; for, independent of the improper excitement to which their vota- ries are subjected, at a period when they should be seeking that repose which the fatigued con- dition of so many important organs imperiously demands, they are forced to breathe for hours an overheated and impure atmosphere : and in a state when its injurious effects are most liable to be experienced, they are obliged to expose them- selves to the damp and chilly air of night. Seventh. The proper regulation of the pass- ions is by every persuasive means to be urged upon the dyspeptic. While every cause capable of unnecessarily exciting or depressing the feel- ings is to be carefully withdrawn ; a cheerful, even tenor of the mind is to be solicited by constant and varied occupation, both of mind and body. In regulating the passions exists certainly one of the great difficulties we have to eontend against in the treatment of a dyspeptic: but much may nevertheless be done by a strict attention to diet, by a judicious selection of amusements and exercises, and by a proper re- gulation of the hours of rest; these will aid the moral means resorted to in giving cheerfulness and composure to the mind—without them the latter will have little or no effect. Eighth. There are certain other means from which much benefit may be anticipated in the treatment of dyspepsia, which cannot be ranged under any of the foregoing heads, but which Health of the Unmarried. 95 here demand some notice. When the stomach is troubled constantly with acidity, and heartburn is experienced, an occasional dose of calcined magnesia, or a table spoonful of lime water com- bined with the same quantity of new milk, will often be found an excellent palliative. The pa- tient should at the same time be confined pretty much to biscuit or crackers with milk or cream for diet, and to toast or rice water for drink. Vegetables and fruits, generally speaking, will be found to disagree with the stomach in these cases, by increasing the acidity. The patient often suffers greatly from cos- tiveness—days sometimes will elapse without an evacuation taking place from the bowels, and flatulence and griping pains to a greater or less extent will be .experienced. Of the impropriety, in such cases, of a resort to purgatives we have already spoken. A pro- per regulation of the diet will very generally give the desired relief without their use. Bran bread, and a decoction of bran in water taken occasionally during the day, will often succeed, when at the same time proper exercise, the warm bath, and frictions, are also had recourse to regularly. Ripe grapes, strawberries, mul- berries or peaches, when in season and eaten in moderation, will likewise tend to produce a lax state of the bowels. An occasional meal of rye mush and molasses or sugar, when it does not too much oppress the stomach, is also of service in this manner. Although soups are 96 Woman's Medical Companion. improper as a diet for dyspeptics, yet we have frequently found a bowl of plain domestic soup, made of veal or mutton, one of the most effec- tual means of procuring a free discharge by stool, without the least inconvenience resulting to the patient. When all these fail, injections of tepid water may be resorted to—they are far less injurious than purgatives by the mouth. The patient should recollect, however, that few things have a more powerful effect in es- tablishing regularity of the bowels than the habit of soliciting a passage every morning. The bowels are occasionally affected with diarrhoea; this seldom, however, lasts long, un- less when excited by the abuse of purgatives, or occasioned by some indigestible or irritating article of food lodged in the intestines. When the bowels are too lax, fruit and vegetables should he avoided; and the patient should make use of rice water sweetened with the best loaf sugar, and crackers or stale bread and milk, or rice and milk, for her diet. Shampooing, applied particularly over the region of the stomach, and to the external sur- face of the abdomen, is often productive of good effects, by restoring activity to the functions of the stomach, and regularity of action to the bowels. Shampooing consists in kneading, and rubbing with the hands, the whole surface of the abdomen, so as to move about and agitate, as it were, the stomach and bowels in every direction. This practice, in cases of dyspepsia, has received Health of the Unmarried. 97 a very considerable degree of notoriety partly, in consequence of its practice by Mahmoud at Brighton, England, and the announcements and publications oc Mr Halsted in this country. The plan pursued by the latter, which he claims as being original with himself, is precisely that which was recommended and pursued by admi- ral Henry in 1787. The latter, it is true, kneaded the stomach and bowels with instruments of a particular shape; the former gives to them gentle shocks with the hands only—the principle how- ever upon which the manoeuvre acts is in both cases precisely the same, as well as the effects. Mr Halsted commences by applying to the whole anterior surface of the abdomen warm fomentations, emollient poultices, the steam of hot water, &c. These applications are, no doubt, when properly applied and sufficiently long persevered in, of decided advantage; but at the same time the warm bath and frictions will be even more beneficial and far more agreeable to the patient. Mr Halsted next directs a gentle tap or slight push to be given with the fingers on the pit of the stomach until this part becomes acutely sensible; against this manoeuvre we most solemnly protest, as in many cases it will have a tendency to excite a serious amount of distress or of inflammation in the stomach. After this he directs a series of gentle shocks to be given to the stomach, by which a motion is communicated to the latter very nearly resembling, he supposes, that communicated to it by the natural exer- e 98 Woman's Medical Companion. cises of the body. The manner in which this '19 to be done, is by placing the patient in such a position, as will favour most the relaxation of the abdominal muscles. He may sit for in- stance with his body inclining forwards. The practitioner, seated before him, places his right hand upon the lower part of the abdomen, press- ing it as it were beneath the bowels, so that these shall rest upon the edge of the extended palm ; then, by a quick but gentle motion of the hand, the bowels are thrown upwards towards the stomach, by which a kind of pulsatory ac- tion is communicated to the latter, and a sensa- tion excited in it similar to what would be occasioned by a slight blow over that organ. The manner of effecting this manoeuvre may he varied, and the patient placed in different posi- tions according to circumstances. Thus, the practitioner may stand at his back, and, passing his arms around him, clasp the abdomen in front with both his hands; or the patient may perform it himself, either in a sitting or lying position. The whole object is to communicate a suc- cession of gentle shocks or impulses to the stomach ; recollecting, however, that no force or violence of any kind is ever to be employed. In obstinate cases this manoeuvre must be re- peated frequently during the day, and at short intervals, continuing it for a minute or two each time—never however entering upon it until at least an hour has elapsed after each meal. As the stomach recovers its healthy functions, the Health of the Unmarried. 99 intervals at which it is repeated may be longer until at length twice or thrice in the course of the twenty-four hours will suffice, and then by degrees less and less frequently until finally it is entirely discontinued. We have not thought it worthwhile to enter into the explanations given by Mr Halsted of the manner in which the process here detailed prodi ^es a beneficial effect upon the functions of the digestive organs, as we believe them to be altogether incorrect. The kneading and shaking communicated by the hands or by instruments to the skin, abdominal muscles and the organs contained within the latter, act evidently like friction, by exciting the action of the skin; and, as a kind of passive ex- ercise, they increase, no doubt, the tone of the muscles of the abdomen and indirectly the healthy action of the stomach and bowels. We have no idea, however, that this plan has any thing to recommend it over a proper course of frictions on the surface of the abdomen, and of daily exercise in the open air, with the occasional use of the warm bath. As a general rule, liable to some few excep. tion? from the circumstances attending individual cases, the following is the manner in which the day should he occupied by the dyspeptic. 1. If the patient be much debilitated immedi- ately after rising, which should be soon after day- break, she may take her first meal; at which a slice of cold chicken, a soft boiled egg, or a very mode- rate portion of heaf steak or a mutton chop, may 100 Woman's Medical Companion. with propriety be taken, provided the stomach is not labouring under that degree of irritation which would forbid solid food of every kind. When, however, the debility of the patient is less, she will find a short walk or ride in the open air before breakfast of very great advantage. 2. Some light and agreeable occupation of the mind, with rest of the body, is best for an hour and a half after breakfast. 3. From this period until that of the second meal, which should be midway between breakfast and bed-time, is the proper portion of the day for all the more active exercises both of mind and body. An hour or two previous to dinner will be an excellent time for a warm bath and frictions. 4. After the second meal the same rest should be taken as after breakfast. 5. Between the period of the second and third meals, the occupations, both mental and bodily, should be of the gentler kind. A ride in an open carriage or gig, or a short excursion on horseback, will be proper, and towards the latter period of the afternoon a walk should be taken in the open air. 6. The third and last meal should be taken early in the evening, and the period between it and bed time spent in cheerful conversation or light instructive reading. 7. At an early hour the patient should retire to rest—immediately before doing which, how- ever, she will find great advantage from repeat- ing the frictions over the surface of her body. Health of the Unmarried. 101 CHAPTER IX. THE PASSIONS. Their influence upon health and beauty—Connection between body and mind—Irritability and despond- ency—Love—Grief—Effects of temperance and exer- cise, in regulating the passions. Health cannot be long maintained without a proper regulation of the passions. They are implanted in the human constitution by the Great Creator for wise and useful purposes. Without them we could, in fact, have no motive for aotion, the mind would become torpid; and there being no foundation for morality or reli- gion, virtue and vice would be nothing more than indiscriminate and unintelligible terms. Although the passions are thus essential to the happiness and dignity of man, >t is only when 102 Woman's Medical Companion. they are kept within their just bounds and directed into their proper channels. When allowed, however, to exceed their proper limits and to master reason or to be directed to unworthy ends, they degrade their unhappy slave, destroy his peace of mind, and undermine his health. While evenness and amiability of disposition, contentment and cheerfulness, beside shedding a roseate hue over every event of life, exert over the body the happiest influence, giving a salu- tary impulse to the circulation of the blood, preserving all the organs in easy and agreeable play, adding a new charm to the outward deportment and an increased and fascinating loveliness to the countenance : their opposites, discontent, peevishness, envy, jealousy and ill nature, embitter life, impair the appetite, render the digestion of the food imperfect, destroy the strength of the body, and tarnish the fairest complexion. They are more fatal tr beauty than the small pox was formerly; becaust their ravages are more certain, more disgusting and more permanent. One great source of injury to health, tr which females are too frequently liable, is ar> irritable or a desponding disposition; particu larly when excited by trifles and matters of little or no moment. Over-exertion, or anxiety of mind, disturbs digestion and impairs the func tions of the other organs, more than almost an) fatigue of body. How many female* give waj Health of the Unmarried. 103 to every impulse of passion on the most frivo- lous occasions, or allow their minds to sink into gloom and despondency from every slight disap- pointment—even the anticipation of improbable evils; without seeming at all aware of the conse- quences. There is doubtless, great difficulty in so arming ourselves against the trials to which our feelings are frequently subjected, or against those vicissitudes and reverses of fortune we may be destined to undergo, as to experience no material disturbance from them; yet still we may exert a degree of fortitude, and call to our aid all those considerations whieh reason and revelation present, to heal our wounded feelings and mitigate the severity of our disappointment and our grief. We may thus maintain a suffi- cient tranquillity to prevent injury to our health; for nothing can be more absurd than, by giving way to our passions, to add the loss of health to our other pains and misfortunes. The cultivation of a kind and virtuous dispo- sition, and of that buoyancy of mind and heart beneath the reverses and sorrows, the trials and afflictions of this world which arises from a good conscience—a full confidence in the over- ruling wisdom and goodness of our Creator, and a well grounded hope of a blessed immortality, is, in fact, of as much importance in promoting health and longevity, as it «s in insuring happi- ness. Love is one of the strongest and most frequent passions to which the female mind is subject. 104 Woman's Medical Companion. In its commencement it has a favourable influ- ence on the functions of the body ; but being often in its progress attended by other perni- cious passions, such as fear and jealousy, it is liable to become the source of infinite disquie- tude. No passion undermines the constitution so insidiously, or so effectually destroys the health, as love, when unreturned, or enkindled by an improper object, or when repaid by scorn and contumely. How many a fair form has been consumed by its smothered fires, and how many a noble mind has been driven by it to insanity! Grief is another destructive passion more liable to take deep hold upon the mind of wo- man than of man. When violent and long con- tinued, it depresses the energy of the whole nervous system, retards the circulation' of the blood, disorders the functions of the stomach, and prevents the proper nutrition of the body. When nourished by indulgence, the energies of the mind, as well as of the body, often become its prey. Even after its first violence has been alleviated by time or by the cheering influence of friendly conversation, exercise and amuse- ment; it will often be found that a shock has been given to the constitution from which it can never again completely recover. To the moralist we leave the inculcation of those divine precepts and laws by which our passions are to be controlled, and those virtues cultivated, which 'give to the flower of fleeting Health of the Unmarried. 105 life its lustre and perfume.' It is our duty, however, to point out to our fair readers how greatly these moral means may be aided by a regular, active and temperate mode of life. This, by fortifying the health of the body,tends in no slight degree to tranquillize and render cheer- ful the mind—and to keep the passions within bounds. The soundness of the body, and the ease with which its several functions are per- formed, contribute essentially to the soundness of the mind, increase its energy, and insure its calmness. This intimate connexion between our physical and moral well-being, ought to be, kept constantly in mind. Females in particular should recollect that if they suffer their bodies to be enervated by sensuality, by indolence or by excess, their minds will likewise become enfeebled, and incapable of regulating their actions and of directing them aright amid the many temptations and difficulties with which they are constantly beset. 106 Woman's- Medical Companion. CHAPTER X. MARRIAGE. Proper age—Effects of premature marriages on offspring—Health and vigour of the female—Predis- position to disease—Other physical defects—Deformity Not only the happiness of both husband and wife, but the health, comfort and welfare of their offspring, require that marriage should be enter- ed upon with a much greater degree of caution, and that the fitness of the parties for fulfilling the important objects of the solemn contract, should undergo a much closer investigation, than is ordinarily the case. Our remarks on the [•resent occasion will be confined exclusively to the conditions necessary on the part of the Female. The health of the latter, as well as thai of Health of the Unmarried. 107 the children to whom she may give birth, re- quires that her marriage should not take place until she has attained a fitting age—In other words, not until her body has acquired its full development and vigour. Thisperiod it would be difficult, if not'impossible to designate by a certain period of years. The constitution, phy- sical and moral education, state of health of the female, as well as the climate and other circum- stances, may cause the development of the body to take place prematurely, or to be unusually retarded. We may nevertheless, as a general and very safe rule, fix it, in this climate, between the nineteenth and twenty-first years. That in many instances marriage may take place with propriety at a somewhat earlier age, or be de- layed a few years later, we pretend not to say : the safest period however, we are persuaded, is that designated. It is an undoubted fact that the females of our own country fade much earlier than those of Europe. Although climate may have its share in thus early robbing them of the freshness, vigour and charms of youth ; yet it must be confessed, that one great cause of their speedy decay is to be sought for, in the very early age at which the American females enter into the mar- riage state: very often, before the body has re- ceived its proper growth, and has become fitted for the proper fulfilment of the new and impor- tant functions, which are thus prematurely called into play But, the faded beauty, impaired 108 Woman's Medical Companion. health, and premature old age of the mother — the augmented pangs and danger of child birth, to which she is subjected, are not the only evils attendant on a too early marriage. Its baneful effects extend also to her offspring; who are too often curtailed in stature, debilitated in body,and of enfeebled intellect; or, they are born with a strong predisposition to scrofula, rickets, con- sumption and other diseases, by which their lives are embittered or early destroyed. A too late, as well as a too early marriage is likewise attended on the part of the female with numerous inconveniences. The effects upon the offspring are by no means, however, so pernicious, when marriage has been delayed too late, as when it is entered upon too early in 'ife : but the difficulties and pains of labour ndd greatly to the suffering and the danger of the mother. Not only is it requisite for the body of the female, previously to marriage, to have acquired its full development in order to insure the health, physical comfort and longevity of her offspring; but it is necessary that she be also healthful and vigorous, and free from any pre- disposition to disease. Not unfrequently, it is true, children with all the appearance of robust health, are born of mothers of enfeebled consti- tutions, or who are even actually labouring under disease; but such appearances are in the majority of instances deceptive, and the little beings soon droop and perish. "We have many times," Health of the Unmarried. 109 remarks Dr Dewees, "seen children of robust appearance from parents of feeble health; but we do not recollect a single instance, where such children attained an age much beyond man- hood—old age was out of the question. Indeed it would seem, in many instances, that the children of such parents most frequently give an early promise of future health ; but it is illuso- ry—for it is never, or but very rarely realized." There are certain diseases, or rather a predis- position to them,transmitted from parent to child, and which do not manifest themselves, some- times for many years afterbirth, or until they are called into action by some exciting cause. They who inherit such a predisposition, enjoying for many years a comfortable state of health, seldom suspect the disease which is lurking in their systems and waiting for some exciting cause to hurry them rapidly to their graves; and their ignorance often hastens the development of the disease by lulling them into fancied security. Every female, therefore, of an enfeebled consti- tution, or who is evidently predisposed to scrofula, to consumption, to cancer, to insanity, to epilepsy, to convulsions and the like affections; or who is actually labouring under either »f them; should consider it a conscientious duty to refrain from marriage, lest she be the means of bringing into the world a miserable offspring, to languish for a few years in misery and pain. Certain other physical disabilities may exist on the part of the female, which would render 110 Woman's Medical Companion. her ineligible for the married state—these should neither be concealed nor passed over lightly ; since, with a knowledge of them, it would be dishonest towards the man she marries, as well as fatal to herself, to become a wife. The existence of any disease or malformation of the womb and of its appendages should be considered, by every female, as an insuperable barrier to her marriage. We would also re- commend a woman who is deformed in body, to remain for ever single; as she may purchase the title of wife at too high a price—the most excruciating tortures and even life itself; to say nothing of the effects which such deformity may have upon the children to whom she might give existence. To sum up therefore the physical requisites in the female, to adapt her for the marriage state :—her body must have attained its full development and vigour, and be free from deformity; she must possess a sound constitu- tion, and be neither predisposed to nor labour- ing under disease. PART SECOND. DIRECTIONS FOR THE CONDUCT OF PREGNANT AND LYING-IN WOMEN. CHAPTER I. PREGNANCY. Its safety promoted by prudence—Its symptoms— Premonitory signs—Quickening. We come now to consider the conduct proper to be pursued duringone of the most interesting conditions of the female sex. Pregnancy is a pleasingly anxious state. Most married women feel a pleasure in the prospect of becoming mothers; and hence always experience more or less anxiety respecting the issue, from the com- mencement until the termination of their preg- nancy. It is a happy circumstance that, under prudent management, to very few women is this state one of any great suffering or danger. The apparent infliction which child-bearing imposes on females is, in a very great measure, due to their own imprudence. By a proper physical education, and an adherence to that course of u 113 114 Woman's Medical Companion. life by which the health and vigour of the body and the firmness of the mind are best secured, all danger may very generally be avoided, and the whole period of pregnancy be entirely divested of suffering. During this state the imprudences of youth often meet their punish- ment ; while a previous life of temperance, of activity and of virtue exhibits its beneficial effects. With judicious management, the fe- male who has pursued the latter need have nothing to fear in the prospect of becoming a mother. Pregnancy is so equivocal in its symptoms. that it is frequently no easy matter to determine its existence, for several weeks after a casual suppression of the periodical evacuation. The sympathetic connection between the womb and the other parts of the body is such, that in the earlier stages of pregnancy a variety of morbid symptoms, more easily felt than described, are produced in different remote organs, which are very apt to mislead the female who has never borne a child. During the first three months of pregnancy, there is no alteration in the external appearance^ except a peculiar variation of- countenance, readily recognized by an observant eye. The eheeks are rather flattened, leaving the eyes prominent, the skin is often freckled or of a leaden hue, and the whole expression of the face is somewhat changed. The first circum- stance calculated upon is a suppression of th« Health of the Married. 115 monthly discharge, which, together with a sense of fulness in the breasts, headach, flushing of the face, a sense of burning in the palms of \\\<: hands, and more or less disorder of the stomach constitute the premonitory signs of pregnancy. Toothach, and an increased discharge of saliva with a frequent disposition to spit, are also very commonly present. The disposition of the mind is early affected. A placid temper be- comes easily ruffled, and propensities for singular and indigestible articles of diet often take place. If the female disposition ever deserves the de- nomination of whimsical, it is at this period ; but as this caprice is produced by the condi- tion of the uterus, and the sympathy between that organ, the stomach and the brain, over which the will has no direct control, the ut- most charity should be exercised towards it. A capriciousness of mind, changeable appetite, with frequent nausea, disrelish of ordinary food and a craving for uncommon diet, form the list of breeding symptoms, as they are usually called. The presence of these alter- nately excites the hopes and the fears of young women: but patience must be exercised; nothing positively certain as to her actual condition can be determined until the fourth or perhaps near the fifth month. About this period, the womb is so far enlarged as gradually to ascend towards the stomach : the motions of the child are now first felt by the mother. The sensation caused by the rise of the womb from out the bony basin 116 Woman's Medical Companion. in which it had previously been confined, or tne motions of the child felt soon after, constitute what in popular language is termed quickening. These, with the progressive and visible increase of the womb, and the appearance of milk in the breasts, are the most unequivocal signs of preg- nancy. Though even these may be delusive. Having premised thus much in regard to the ordinary phenomena of pregnancy, we proceed now to lay down the course of conduct to be pursued by females in whom they occur, in order M insure their own comfort and their offspring's lafety. Health of the Married. 117 CHAPTER II. CONDUCT DURING PREGNANCY. Dress of pregnant women—Injury from tight lacing —Exercise—All violent exertions injurious, especially about the period of quickening—Repose—Early rising —Company—Food—Drinks—Regulation of the mind —State of the bowels—Bleeding. If good sense were more generally to preside, than it does, over a lady's toilet, there would be little necessity of any change being made in her ordinary dress, during at least the first four or five months of pregnancy. But, in the present state of fashionable attire, a change is absolutely demanded, from the moment pregnancy is ascertained to have commenced. If a female have previously no regard for her own health and comfort, and think but little, if at all, 118 Woman's Medical Companion. of the being to whom she may be destined to give birth, now, at least, when not only her own freedom from suffering and danger, but the very existence of her anticipated offspring, may be jeopardized by an impioper dress a:.d tight lacing, it is to be hoped, she will cheerfully re- linquish both—let the dictates of fashion be what they may. The dress of a pregnant woman should be of such a form and size as will most effectually leave every part of her body, but especially her chest, waist and abdomen, free from the least restraint. The wearing of tight dresses, and particularly the corset, during a state of pregnancy, is attended with the utmost danger. The undue pressure which they exert upon the body of the mother, besides impeding her digestion, breathing, and the free circulation of her blood ; the healthful performance of all which functions is all-important to the well-be- ing of the infant she carries; may either induce 9 miscarriage, or, by preventing the proper de- velopment of the womb and of the little being within it, occasion the death of the latter, or cause it to be sent into the world a dwarf in size or a monster in shape. Besides all this, the serious immediate evils to which tight lacing often gives rise, ought to be a sufficient warning to all females of the impropriety of persisting in it during pregnancy. It has been known ac- tually to displace the womb, and to produce difficult and dangerous inflammation of that organ or of the breasts. The close sympathj Health of the Married. 119 which exists between the latter and the womb i.« such, that injury done to the one is very gene- rally followed by disorder in the other ; a fact which should teach mothers the impropriety of wearing, during pregnancy, any thing tight over the breasts; for this of itself may endanger the healthy and symmetrical growth of the infant by deranging the functions of the womb, while it never fails either to prevent the mother from suckling her own infant, or to cause tedious and painful inflammation of one or both breasts. Let the pregnant female, therefore, as she values her own health and happiness, the free- dom from deformity—nay the very existence of her infant, assume, the moment pregnancy has commenced, if she has not before, a loose and commodious dress. During the latter months, it should merely hang from the shoulders, so as not to compress in the slightest degree any part of the body. Of the propriety of a dress sufficiently warm to guard against the effects of cold, as well as of any sudden changes in the weather, nothing need be said, as common sense will point this out to every female. Exercise, so important always for the support of health, is still to be regularly pursued. But, during pregnancy, it must be of a less violent and active character, than such as would be proper, and might with perfect safety be in- dulged in, at any other time. Especially, should all unnecessary fatigue, violent and long conti- 120 Woman's Medical Companion. nued exertion, as walking too fast or too far, jumping, running, dancing, &c. be avoided. Dancing in particular, as well as going hastily up and down stairs, lifting or carrying heavy weights, are exercises peculiarly hazardous during a state of pregnancy. Abortion, op displacement of the womb, has repeatedly been occasioned by them. Some women are blessed with a vigour of constitution which enables them to exert themselves to almost any extent and under almost any circumstances; and an unhappy spirit of emulation too frequently in- duces the young and unthinking, whose bodies are less vigorously constituted, very injudi- ciously to imitate the feats of the former. Every kind of exercise which can be indulged in without fatigue, and which produces no jolting of the body, nor any very sudden, violent or long continued action of the muscles, is proper for the pregnant female; but the example of others should not induce her to venture upon any other —an over degree of prudence is here better than the least degree of risk. There is no period of pregnancy, at which incautious exercises are so hazardous, as about the time of quickening. More than ordinary care should be taken, for some weeks before and after this has occurred, in ascending and descending stairs, going in and out of carriages, stepping off a curb stone, and in rising out of bed. Towards the latter period of pregnancy the same caution is requisite: in- deed at this period it will be prudent to avoid Health of the Married. 121 even any powerful exertion of the voice, as in loud talking or singing. In her ordinary periods of repose, provided they have been well chosen, the pregnant fe- male need make no change. Let her, however, be even more punctual than previously, in retir- ing to bed at an early hour of the night, and in rising betimes in the morning. When a woman has the pleasing prospect of becoming a mother, it is no longer a time for her to revel in midnight assemblies. Such a course not only deprives her of her natural rest; but in other respects destroys her health, endangers the safety of her infant, and often causes its premature birth. While, on the other hand, too long an indulgence in repose, and especially in warm feather beds, increases the irritability of her system, lowers its energies, and causes the same danger to the fruit of her womb, as spending the night in wakefulness, amid company, or in a round of dissipation. We may here remark that the pregnant female should at all times avoid crowded and overheated rooms; and, as her pregnancy advances, it will be prudent to relin- quish entirely the excitement invariably attend- ant upon parties of pleasure, and mixed companies for whatever purpose assembled. On the contrary, the company of cheerful and sensible friends, enjoyed amid the domestic circle, is of the utmost advantage. The tedious, portentous hours may be thus beguiled, by plea- surable conversation and innocent amusements— 122 Woman's Medical Companion. letting the final term steal on without apprehen- sion or reluctance. In regard to diet, during pregnancy a woman should live within the bounds of strict modera- tion, and on plain and wholesome food. She skould avoid the indulgence of every inordinate appetite, and reject carefully all such substances as have a tendency to produce a costive state of the bowels, to cause flatulence, or which may give rise to indigestion ; as made dishes, high- seasoned and rich food, pastry, flatulent vege- tables, unripe fruit, and the like. The suppo- sition, so frequently entertained, that, during pregnancy, a greater amount of or more nour- ishing food than ordinary is required, is alto- gether unfounded. So far from this being the case, in the majority of instances the irritability of the stomach and the tendency to fever during pregnancy point out the necessity of a reduction and greater simplicity in diet, rather than an increase. This tendency to excessive irrita- bility in the system during child-bearing should cause the female to avoid every species of food by which it may be increased, and especially strong tea and coffee, as well as preparations ot opium, and the like. She ought never to give way to the depraved appetites, or those long- ings for certain articles of food, or even sub- stances absolutely of an indigestible nature, not unfrequent during pregnancy. This indul- gence is liable to disorder the stomach, and is in other respects attended with injurious effects. Health of the Married. 123 Nor need she fear, if such absurd longings be not gratified, that her child will incur the risk of blemish or deformity. Such an apprehen- sion is neither warranted by reason, nor con- firmed by experience. For drink, during the period of pregnancy, nothing can be taken with prudence, excepting pure water, toast and water, or similar bland and simple fluids. An indulgence in liquors or cordials, in wine, distilled spirits or even malt liquors, should be cautiously shunned, whether as an ordinary drink, or only occasion- ally under the pretext of sustaining the strength of the body, calming sickness, relieving pain, or expelling wind. Females must not persuade themselves, that it is only the excessive indul- gence in such articles that is mischievous; they should clearly understand, that, by irritating the stomach, interfering with the proper digestion of the food, and unduly stimulating the system, they are highly injurious at all times, and in all quantities to the pregnant woman. The ridi- culous notion, that a moderate quantity of intoxi- cating drinks is necessary during pregnancy and lying-in, has not unfrequently created an inclination for their habitual use, destructive alike to happiness and health. Nothing contributes more certainly to the safety and future good health of the child, than cheerfulness or at least equanimity of mind on the part of the mother during the period of her pregnancy. She should, therefore, guard most 124 Woman's Medical Companion. sedulously against any violent gusts of passion— against sudden alarms of every kind; as well as against anxiety of mind, fear, or undue depress- ion. Tranquillity, cheerfulness, confidence and hope, should by every rational means be ex- cited and cherished. While indulgence in the first class of emotions we have enumerated will prove highly injurious if not fatal to the mother and child, the latter will do much in insuring the safety and well-being of both. A pregnant female will do well to avoid, as much as possible, placing herself in a situation which may subject her to unpleasant sights, or to seeming or possible dangers. She should turn a deaf ear to every tale of disaster or of horror, purporting to have happened to pregnant and lying-in women, and to all the gossip of the credulous and malignant, by which the confi- dence and cheerfulness of her mind may be impaired, and her thoughts turned too anxiously upon the nature and result of her own condition. When she has been so unfortunate as to have suffered any great alarm, been surprised by any unexpected event, or appalled by some frightful object or occurrence; she should dismiss as quickly as possible its influence from her mind, never dwelling upon it with gloomy forebodings, nor in unreasonable fears for the future conse- quences it may produce upon her child or upon her own safety. If no immediate consequences ensue, all dread of future evil may in general be dismissed: the continued effects of depiesser5 Health of the Married. 125 spirits and an anxious mind are in such cases far more injurious than any sudden shock to which the feelings may have been subject. An important precaution, which should never be lost sight of during the whole term of preg- nancy, is to preserve the bowels in a perfectly regular condition. To do this, all that is in general required, is for the female to confine herself to a simple diet, both in regard to food and drinks—to make use of gentle exercise daily, if possible in the open air, and not to spend too large a portion of her time in absolute inaction, or in sleep. Some gentle laxative, or an occasional injection, may in some cases be required, particularly when the state of the bowels has been for a long time neglected. Their use should, however, as much as possible be avoided, as they are liable to produce some- times, especially if frequently resorted to, dis- agreeable effects, and they rather confirm a costive habit than remove it. The use of such purgatives, let it be recollected, which produce a too active or violent effect upon the bowels, is highly pernicious during pregnancy ; the loss of the child may be occasioned by them. To avoid costiveness, all substances which tend to confine the bowels ought to be shunned, such as high seasoned and stimulating food—astrin- gent wines—chalk—anodynes and the like; the female should, also, be careful not to disregard the calls of nature, when they intimate the ne- cessity of an evacuation. 126 Woman's Medical Companion. A very common opinion, entertained by fe- males, is, that bleeding during pregnancy is not only necessary but proper, and that to omit it would be attended with bad effects. This, however, is a mistaken notion. The mere cir- cumstance of pregnancy is no proper indication for blood-letting—on the contrary, if during that period blood be unnecessarily or repeatedly drawn, more or less injury is always produced Doth to mother and child. The loss of blood is demanded only when symptoms of disease are present; or for the removal of pain, incessant vomiting, headach, a sense of over fulness, gid- diness, the loss of or imperfect sight, &c. In all such cases, however, it is better, when practicable, to have the advice of an experienced physician. The woman, in particular, who is in the habit of miscarrying, should never venture on blood-letting, without such advice, as it some- times produces the evil it was intended to prevent. Health of the Married. 127 CHAPTER ix.. CONDUCT AFTER DELIVERY. Necessity of rest and quiet—Impropriety of stimula- ting food and drinks—Putting the child to the l>reast— Ventilation, temperature and cleanliness of the chamber —Change of bedding and body clotliing— Visitors— Calmness of mind—After pains—Free state of the botvels— Milk fever—Inflamed and gathered breasts- Sore nipples—Silling up—Leaving the chamber. Presuming that the female has passed hap- pily through the anxious period of pregnancy, and has been safely delivered of her burthen, the great object is now to restore, as quickly as possible, her strength, to avoid by a prudent course ot conduct the various accidents to which she is liable, and to qualify her for the pleasur- able exercise of her maternal duties. 128 Woman's Medical Companion. There is, perhaps, no condition of life, in which women are more frequently injured by mistaken kindness and a system of injudicious interference, than during lying-in. Jleating cordials and stimulating food are too often given to remove the fatigue and debility which succeed labour; the chamber is closed, and the curtains of the bed are drawn together, to prevent chills and fevers: thus, in addition to partial suffocation, the languid patient is not permitted to enjoy the cordial effects of rest and sleep, but is sweated and harassed out of her remaining strength, under the pretence of avoiding evils which this very course tends most effectually to produce and aggravate. More enlightened views have, it ii true, penetrated of late into the parturient chamber; and many of the absurdities formerly committed there have, in consequence, been re- formed: but much still remains to be learned by females and their nurses, before they will consent that the entire management during lying-in shall be confined, strictly, to keeping the mother perfectly quiet, and at rest in an hori- zontal position, furnishing her with light but nourishing food, allowing a free circulation of fresh air through the bed chamber uninterrupted by bed curtains, keeping her person clean and comfortable, and her mind composed. And yet, experience and reason teach us that this is all that is required, to insure her safety, and a speedy restoration to her ordinary health and condition. Health of the Married. 129 Immediately after delivery, the lying-in fe- male should impose upon herself the most perfect tranquillity, and endeavour to obtain that repose, for which her more or less ex- hausted condition so loudly calls. She should be left entirely undisturbed, the room should be darkened, and all conversation on her part or in her hearing rigidly abstained from. The moment the gloomy apprehensions, which pre- cede or attend delivery, are dispelled by the gratification of having become a mother, and of being relieved from pain and uncertainty; vio lent transports of joy too often succeed, the noisy congratulations of friends and relatives are im- mediately proffered, and excessive talking is indulged in :—the exertions thus excited, added to the previous fatigue, contribute still further to exhaust the patient. All this should be avoided. Pleasure and joy should be for a mo- ment forgotten, and the necessity for present repose alone kept in mind. The horizontal position should be constantly preserved by the mother for one or two days after delivery. On no consideration should she attempt to rise, or even assume a sitting posture. In effecting whatever change of clothing she may require, this caution should not be forgotten. Its neglect will endanger fainting, profuse dis- charges of blood, or a falling down of the womb; which are always disagreeable, sometimes very dangerous occurrences. The Diet of the lying-in female, as we have i 130 Woman's Medical Companion. already stated, should be light, but nourishing, and taken in moderation : for the first day or two, plain gruel, panada, tapioca, sago and the like—succeeded by simple meat broths, a soft boiled egg, &c. should constitute her food. Af- ter the first day, if no fever be present, nor any other circumstance which would forbid its use, animal food plainly cooked may be eaten; in such moderate quantities, however, as never to allow the stomach to be overloaded. But little change should be made in the diet; better keep the system up to the normal standard. It ia true that some women eat and drink with impu- nity, as at other times—still it would be better, and it is always safer to restrict the diet, than to run the risk of any bad effects being produced by overfeeding, or by partaking of improper ar- ticles. For drink, toast and water, apple-water or weak tea is all that is required. The use of stimulating liquors during confinement cannot be too severely reprobated. Even had they the negative character of doing no immediate harm, it is better to avoid them, lest an habitual craving for them be acquired; but we denounce them as directly injurious, by overstimulating the system, disordering the stomach, and retarding the re-establishment of every female who makes use of them. As soon as the mother has obtained a few hours' rest, the infant should be applied to the breast. This is an important rule, from an ad- herence to which she ought not to permit herself Health of the Married. 13J lightly to be persuaded. The advantages of allowing the infant to suck the breast of its mo- ther, as soon as possible after its birth, are many and important, as well to the child as to the mother. The first milk which the child draws has the effect of cleansing out its bowels, pre- vents the necessity of giving medicine to it to produce that effect, and removes all pretext for an officious nurse cramming it with food, to prevent its starving during the many hours she denies its natural aliment to it. The early appli- cation of the child to the breasts, is the best means also of preventing the latter from becom- ing over-distended, inflamed or gathered, and secures the mother from the pain and often permanent inconvenience which thence result. Should the secretion of milk not have occurred previously to delivery, the act of suckling will encourage and hasten it. If the infant be not put to the nipple until the breasts have become over-distended with milk, the nipples are often bo much retracted, that it cannot lay hold of them, without the greatest difficulty; its ineffec- tual efforts produce exquisite suffering to the mother, and are often the cause of sore nipples. In all cases, unless circumstances be present which preclude altogether the possibility of suckling, or render it imprudent, the mother should make every effort to induce her infant to take the breast; her own comfort and the health of the child being materially promoted by the act of suckling. When circumstances forbid 132 Woman's Medical Companion. this, the breasts should be carefully drawn seve« ral times a-day, and, with the view of preventing a copious flow of milk, she should use a very spare diet, keep the bowels freely open by mild laxatives, and abstain as much as possible from liquid aliments. The Lying-in Chamber should be as large and airy as possible, and it should be regularly ven- tilated by the admission of fresh air; the female who occupies it being at the same time so guarded by clothing, or a screen, as to prevent her from experiencing the direct influence of the draft of air thus admitted. In winter the temperature of the room should be kept of a comfortable warmth, by means of an open fire__ taking care that at one period it be not oppress- ively hot, and at another chilly or cold—but of an equal temperature throughout the day and night. The bed should be entirely without cur- tains: all the advantages apparently derived from bed-curtains are more than counterbalanced by their confining the air within the bed, and in mild weather increasing too much the heat of the patient. No cooking should be allowed within the chamber; and as a further means of preserv- ing the air within it perfectly pure, the utmost attention should be paid to cleanliness. The Bedding and Body Clothing of a lying-in woman should be fiequently changed, taking care, however, that, for the first two or three days, in effecting this change, she be not raised from the horizontal position, nor subjected to Health of the Married. 133 too much fatigue. All unnecessary attendants and visitors should be excluded without cere- mony: they vitiate the air, improperly excite the patient, and interfere with that repose which her condition requires. She should be preserved even from the labour of replying to the useless interrogatories and congratulations of friendship itself. The influence of the passions has a powerful effect upon the welfare of a lying-in woman. Every care should, therefore, be taken to keep her mind calm, cheerful and contented. All ebullitions of passion, fear, fright, grief and anxiety, even immoderate joy, and excessive ex- citements of every kind, are in the highest degree injurious. Quietude both of mind and body is indispensable to her speedy and perfect restoration; nor should it, if possible, be inter- rupted by the officiousness of friends, the indis- creet conduct of relatives, or the cruel and impertinent gossip of idle neighbours. When the process of child birth has been happily completed, the female naturally expects exemption from any further pain; but in the greater number of cases this hope is fallacious. After-pains, as they are termed, more or less violent, usually take place, excepting perhaps at the birth of the first child. These pains fre- quently harass the mother, and prevent her from obtaining the requisite amount of repose. But irksome as is this continuance of pain, after she had hoped the measure of her sufferings was 134 Woman's Medical Companion. already completed; yet, as it is generally occa- sioned by the womb contracting in size, and ex- pelling from its cavity any clots of blood which may accidentally form there, it is in some mea- sure a necessary evil, and should be borne with patience, if not very violent or too long continu- ed. Frictions over the region of the womb with a warm hand dipped in olive oil, by exciting the prompt contraction of that organ, will very gene- r illy relieve the after-pains: if, notwithstanding, they continue with great severity or continue for many hours, anodynes may then with propriety be administered to moderate or remove them. The physician in attendance will, however, in all such cases give the necessary directions. It is important to preserve a free state of the bowels subsequently to delivery. Costiveness is particularly to be guarded against. During the first forty-eight hours, it is better, however, not to disturb the female, unless the necessity be urgent, by the administration of injections or medicine ny the mouth. Very generally, if her diet has been properly chosen, free evac- uations occur spontaneously; if not, about the third day, under the direction of the medical attendant, some mild but effectual laxative should be given. Occasionally, and particularly with a first child, milk appears in the breasts before confinement, but generally it is not secreted, in any quantity at least, until after the birth of the infant. Ordinarily, it is between the second and third Health of the Married. 135 day, that the breasts become turgid with milk. When the secretion is moderate, and the child has been early applied to the nipple, it causes no inconvenience: but when copious, and the breasts are permitted to become distended by it; when the mother is of an irritable habit—has been allowed too stimulating and nourishing a diet—has been much excited or exposed to cold or damp; it gives rise, very commonly, to a pretty smart attack of fever—generally denomi- nated the milk fever. This is preceded by a sense of chilliness, and accompanied by a hot skin, sickness, restlessness, pains in the head, back and breasts, and considerable thirst. Sometimes the fever subsides entirely in twenty- four hours, but in other cases it is more severe and of longer continuance. Medical advice in such cases is indispensable. Sudorifics will often be demanded, with warm emolient fomentations to the breast—cooling laxatives, and other re- medies. The patient must be restricted to a very spare diet, of light unirritating food, have cool drinks, be clothed as lightly as the tempe- rature of the season will permit, and kept perfectly quiet. By prudent management the occurrence of this fever may in almost every instance be prevented. Inflamed and gathered breasts constitute another of the inconveniences to which lying-in women are occasionally subject. They may in general be avoided, when the management of the female after delivery has been such as we 136 Woman's Medical Companion. have pointed out, by the early application of the child. Whenever the breasts are notieed to become tense, hot, swollen, and painful ; without delay, leeches should be applied to them, in number and frequency proportionate to the extent of the swelling, and the degree of inflammation present. Cooling laxatives are then to be administered, and the breasts covered with cloths wet with a solution of sugar of lead in water; or if this be objected to, from the apprehension of the lead being absorbed by the delicate surface of the nipple and its areola, the cloths may be soaked in a solution of alum, or muriate of ammonia. The patient should retain a recumbent posture, or if she sit up, the weight of the breasts should be supported by a handker- chief, passed beneath them and around the neck. By this treatment, the swelling and inflammation may frequently be reduced, and the formation of an abscess prevented, which is always to be desired. If, however, the breasts gather, they should be enveloped in a soft emollient poultice frequently changed; and as soon as the matter approaches near to the surface, the tumour should be opened with a lancet, which- causes very little pain, prevents an unsightly scar, and allows the matter more fully to discharge itself than when the abscess is allowed to burst. In cases of simple hardness of one or other of the breasts, without fever or pain, anointing it with olive oil, and then covering it with a piece of soft silk, will frequently answer every purpose. Health of the Married. 13? The countless number of washes, poultices, salves and plasters recommended by the know- ing visitors of a lying-in chamber, as infallible preventives for gatherings in the breasts, are not only useless, uut many of them are posi- tively injurious—hurrying on the very evil they are intended to prevent. Many women suffer very much during their confinement from sore nipples. This painful affection often arises from the irritation of the child's mouth, in its attempts to seize the nipple when it has been depressed by tight lacing, or by the over-distension of the breast with milk; or by inattention on the part of the mother to keeping the nipples, and the clothing in contact with them, perfectly dry. When excoriation does occur, the nipples should be washed two or three times a day with a solution of one drachm of alum to about eight ounces of rose or hydrant water, and afterwards smeared with sweet-oil or a little simple cerate. Great care should be taken to prevent the tender nipple being irritated by the clothes—this is most effectually done by covering it with a little cup of wax. If only one nipple is affected, the child should be con- fined to the other. A slight soreness of the nipples need not prevent the continuance of suckling: the mother should lake care, however, the moment the child leaves the breast, to wipe the nipple perfectly dry with a soft cloth, anoint it with sweet oil and cover it with the wax cup. But when both nipples are severely affected 138 Woman's Medical Companion. nursing must be given over for a few days—and the breasts should be carefully drawn by means of a nipple glass twice or thrice a day. In case of sore nipples, it has been proposed, with the view of protecting them, to make use of an arti- ficial teat, by which the child will be able to suck tolerably well; and the nipple itself, being undisturbed, will soon heal. For the first eight days after confinement it is better for the female to retain, uninterruptedly, the horizontal position ; after this she may be allowed to rise while her bed is made, and in a day or two later she may sit up for an hour at a time, until her strength and other cir- cumstances will allow her to remain out of bed for the greater part of the day. By rising too soon, remaining up too long at a time, or making any considerable bodily exertion, a falling down of the womb, or a flooding, will be endangered. For several weeks indeed after getting up, women should recline frequently during the day upon a sofa. Even when every thing has gone on well, and her health and strength are rapidly re-established, it will not be prudent for her to leave her chamber under a week—nor until a still later period when the weather is very cold, damp or inclement, and her constitution is delicate. No female should subject herself to partial exposures, under the hope of ' hard- ening herself.' As soon as her strength is fully recruited, and the state of the weather will permit, she should take frequent gentle exercise _______Health of the Married. 139 in the open air. Of course many circumstances may occur requiring a much longer confinement to bed or to the chamber, than what is here specified: our observations have reference espe- cially to confinements after a natural labour, and where no unfavourable occurrences super- vene. A long and unnecessary confinement is attended with as had effects, as a too hasty getting up. 140 Woman's Medical Companion. CHAPTER IV. NURSING. Propriety of the mother suckling her infant—Ad- vantages resuking from it to both—Circumstances which may prevent it—Diet during nursing—Excess- ive eating and stimulating food injurious—Drink of a nurse—Water the best—Wine and fermented liquors to be abstained from—Exercise—Cleanliness—Influ- ence of the passions of the nurse upon the infant- Precautions in giving suck—Improper practices- Feeding infants at the breast—Weaning—Proper nursing prevents the necessity for medicine. Unless very particular and urgent reasons prohibit, the mother should always support her infant at her own breast. It is the dictate of nature, and the requirement of reason and com- mon sense. No children exhibit such unequi- Health of the Married. 141 vocal signs of health, or bear up so well under disease as those who live exclusively on their mothers' milk. Whenever the voice of instinct and nature is implicitly obeyed, such is the course which it points out; and happy would it be for mankind, if parents would so far return to a state of nature, as to regulate their own diet and that of their children by her simple and salutary dictates. In various parts of the world, where children attain to the greatest beauty and vigour, they are not permitted any other nourish- ment than the mother's milk, until they are twelve months old ; and some of the finest and most robust children to be seen in this country are such as have been reared in a similar manner. The idea that suckling is injurious to the mother's constitution is altogether unfounded; on the contrary in most cases her health is ma- terially benefited by her performing the duties of a nurse. Delicate females often derive strength from nursing; and many of the infirmi- ties to which they are liable are removed by it. If the period of pregnancy he excepted, fewer women die whilst giving suck, than at any other time; and it is a very common observation, that their spirits are more lively and uniform, their tempers more placid and even, and their general feelings more comfortable and pleasant than under almost any other circumstances. When, however, the mother is of so de/licate a constitution that it is impossihle for her to 142 Woman's Medical Companion. undergo-without danger the task of nursing her babe; when the breasts do not secrete a sufficient supply of milk, or when, from the presence of disease of these or any other parts of the system, the milk furnished is thin, poor and vitiated— affording not a sufficiency of nourishment to the child, or such as it would be imprudent to allow it to partake of, then must she resign her child to the charge of another;, taking care, however, that she to whom the maternal office is delegated is perfectly adapted, from her age, her constitu- tion, the state of her health, her habits and her manner of living, to perform properly its impor- tant duties. The Diet during nursing should be simple, nutritious, and suoh as is readily digested. Provided it be plain and nourishing, a mother may, with impunity to her infant, partake of almost any artiele of simple food, to which her stomach has been accustomed: whatever agrees well with herself will'rarely be found to disagree with the child at her breast. A nurse should live on a diet composed of a due proportion of animal and vegetable aliment. It is a mistaken notion, that it is necessary for her to refrain from any wholesome vegetable if it be well boiled and eaten in moderation, or from perfectly ripe and slightly acid fruits. Her food should not be highly seasoned* nor fat. Rich gravies, pastry, and every other indigestible article, she will avoid, as well for her owr, sake as for the wel- fare of her child; If a woman who is nursing Health of the Married. 143 eat heartily, but not immoderately, of plain food, avoiding every thing that is stimulating, she will insure a full supply of milk, and the maintenance of her own and her infant's health. One hearty meal of animal food during the day is quite sufficient. It is a common hut very pernicious error, to suppose that it is ne- cessary for a nurse to indulge freely in rich and stimulating food to insure a plentiful sup- ply of milk; this has often, on the contrary, an opposite effect, by inducing a disordered state of the stomach and a degree of feverishness. The drink of a nurse should be water—simply water. No objection, it is true, can be urged against the use of milk and water, toast and water, weak halm tea, thin gruel, and similar bland diluents: we must, at the same time, insist upon- the fact that plain water is the most natural and wholesome beverage for habitual use. Fermented and distilled liquors, as well as strong tea and coffee, should be strictly ab- stained from, as alike prejudicial to mother and infant. Never was there a more absurd or per- nicious notion, than that the use of wine, porter, ale, or of milk punch, is necessary to a female whilst giving suck, in order to keep up her strength, or to increase the amount and nutritive properties of her milk. So far from displaying Buch effects, when taken in any quantity they produce others directly the reverse. Moderate daily exercise in the open air, suffi- ciently active to counteract the effects of her 144 Woman's Medical Companion. sedentary habits, but not carried to the extent of producing fatigue, should never be neglected by a female during the period she suckles her infant: keeping up the healthy action of the system assists in insuring an abundant supply of milk, while it improves its qualities. Cleanliness, both as it regards the mother and tike child she suckles, is always an object of im- portance, but never more so than during the period of nursing. Few objects are so disgust- ing as a slovenly nurse—few infants so apt to be fretful and sickly as those whose persons and clothing are kept unclean. Whilst giving suck a female should endea- vour to preserve as cheerful and quiet a state of mind as possible. All powerful emotions and sudden or long continued agitations of the mind invariably do injury to an infant while at the breast. The milk becomes vitiated, its secre- tion is very often diminished or altogether suspended; and the little sufferer has not unfre- quently fallen a victim to the indulgence of violent passion, grief or jealousy in the mother. We too seldom take into consideration the pernicious and long continued, if not permanent influence which the mental affections of the mother, during the period of suckling, may have upon the temper, the inclinations and happiness of her offspring, by producing permanent de- rangements of digestion, and consequent imper- fect nutrition, and disturbance of die nervous »ystem. Health of the Married. 145 No fixed rules can be laid down as to the frequency with which the child should be applied to the breast during the day and night. All that is necessary to be kept in mind <-( any attention : even, however, when to the extent above described, all that is demanded is to confine the child to the breast, or when the thirst is considerable and it has been accustomed to other food, to give it, occasionally, a little toast, barley or rice water, sweetened with loaf sugar—to be careful not to keep it too warm, either by too much clothing or too hot a room. Its head in particular should be kept cool, as well during the night as in the day. As chil- dren appear to derive relief from the application of a slight degree of pressure to the gums dur- ing teething, something should be allowed them to bite. A substance that will yield to the pressure of the gums is to be preferred: An oblong piece of Indian rubber, two or three in- ches in length, will probably be the best; it should be suspended round the neck by a ribbon or tape. All hard and unyielding substances are positively injurious. Little attention need be paid to the bowel complaint which commonly attends teething; it is seldom very profuse. When, however, it is attended with much griping, an injection of thin starch or flaxseed tea, with the addition of a little sweet oil, will be beneficial. The same injection, with the addi- tion of ten or twelve drops of laudanum, may 202 Woman's Medical Companion. also be given when it becomes necessary to ren- der the discharges from the bowels less frequent. During teething a child should be strictly with- held from animal and solid food, all stimulating drinks, and spices of every kind: its diet should consist, as we have already stated, solely of the breast milk or with the addition only of rennet whey, or of rice or toast water sweetened with loaf sugar: the use of the warm bath daily should not be neglected. If, in place of being more free than usual, the bowels are costive, an evacua- tion should be procured by some gentle laxative: in most cases a little molasses and water will suffice ; this proving ineffectual, a dose of mag- nesia or of castor oil may be given. It is not always, however, that the process of teething is attended with so little inconvenience, or that the symptoms which it produces can be managed with so much ease. In children of very irritable habits, in those who are gross and plethoric, or who previously to the commence- ment of dentition labour under some affection of the stomach and bowels, dentition is generally productive of very violent and serious disturb- ance, which, if not judiciously treated and promptly controlled, may terminate in the death of the little sufferer. Violent pain and ulceration of the gums, long continued and ex- tensive disease of the bowels accompanied with frequent and vitiated discharges, convulsions and inflammation of the brain terminating in dropsy of that organ, are some of the unfortunate results Management of Infants. 203 of difficult teething in children predisposed to disease. Their prevention, as we have already remarked, is to be sought for in a judicious system of nursing, carried on without interrup- tion from the moment of birth; and by watching the advance of each tooth and endeavouring to reduce the irritation which it produces before it has had time to extend itself to other organs. The same regimen as was recommended above should be adopted—there is even still greater necessity for confining the child to a plain unirri- tating diet—avoiding every thing that has a tendency to increase too much the heat of the body, and keeping the head cool. The gums should be daily and carefully ex- amined, and if hard and swelled, and the tooth is evidently pressing upwards upon them,a free incision should be made with a lancet, so as to separate the tough membrane by which the tooth is enveloped; the tension of which by the latter as it rises upwards to penetrate the gum, causes all the pain and irritation which the infant suffers. The lancet should be carried down until it reaches the tooth, and, if it is one of the large teeth which is about to protrude, a cross incision will be necessary, as well as one in the direction of the jaw. This operation gives but little pain, and is never, when judici- ously performed, attended with danger, while in many cases it is followed by immediate relief, and prevents fever, convulsions, and sometimes even death. It is important, how- 204 Woman's Medical Companion. ever, that it be performed before the irritation has extended itself from the gums to the brain, stomach or other organ, that is as soon as the swelled and distended state of the gum indicates that the tooth is pressing firmly upon it. If the bowels are costive, it will be necessary to administer some mild purgative. The best perhaps will be a few grains of calomel followed by a dessert spoonful of castor oil. If there is considerable heat about the head with flushing of the cheeks, much benefit will be derived from frequently washing the head with cold water, and if the child wears a cap leaving this off. In many cases the increased determination to the head is such as to demand the application of a sufficient number of leeches to the temples or behind the ears. When the glands in the throat become swollen and tender, great relief will be obtained from leeches to the part where the swell- ing is the greatest. Considerable fever, pain in the stomach and bowels, frequent slimy stools often streaked with blood attended with considerable griping, are best treated by leeches to the re- gion of the stomach or abdomen, plentiful dilu- tion with cold toast or rice water, and mild mucilaginous injections. The diseases to which teething may give rise, when they have once made their appearance, demand the same treat- ment as when produced by other causes: care should always be taken, however, by freely scari- fying the gums, to remove or lessen the irrita- tion produced by the advancing teeth. Management of Infants 205 CHAPTER VIII. VACCINATION. Improper to consider it a disease—Its importance as a means of preserving life and preventing deformity— Objections to vaccination considered—It is a certain preventive against small pox—Its effects are not im- paired by time—Does not entail a tendency to eruptive diseases on the child—Age and condition of the child during which it is proper to vaccinate—Proper season of the year for vaccinating—General precautions— Plienomena and progress of vaccination. It is usual to treat of vaccination among the diseases of infants: we prefer, however, to con- sider it as an item, and a very important one, in the proper rearing of children. It cannot surely be viewed as a disease. During the whole time the infant is subjected to the infec- 206 Woman's Medical Companion. tion of the vaccine virus, notwithstanding the important modification which certain portions of its system undergo, it scarcely suffers a mo- mentary pain or inconvenience, nor is there ordinarily a single symptom developed which calls for the administration of even the simplest medicine, or which requires the most trifling change in its diet or in any thing connected with its nursing, provided this hasbeen«onducted on correct principles. Vaccination is, however, an all important means not only of preserving the lives of infants, but of preventing their being subjected to the loss of sight and other deformity, and of insuring their future health and comfort. Previously to the discovery by Jenner in 1798, of the protective powers of vaccination, and the subse- quent general introduction of the practice among all civilized people, more than one tenth of all the children born, perished either immediately of small-pox, or ultimately of affections which it had been the means of calling into existence. This statement has not reference merely to the disease as it prevailed epidemically, and previ- ously to inoculation for small-pox being practised: even after the latter period the mortality from the disease was immense—the inoculated form- ing so many points from which infection was con- tinually diffusing itself among the unprotected. But, independent of this appalling destruction of life caused by small-pox, it was productive, in those who survived its attack, of effects scarcely less to be dreaded than death itself. After suf- Management of Infants. 207 fering for many weeks under its loathsome symptoms, thousands have recovered with the entire loss of their sight, or to drag out a miserable existence, deformed and debilitated by diseases of the joints, a burthen to themselves and all about (.hem; or with their faces disfigured by seams and pits and wrinkles ; objects of pity and commiseration to one portion of their fellow creatures, and not. unfrequently of ill concealed disgust to another. From all these evils vaccination is an effectual and easy se- curity. Those parents who neglect to place their offspring at an early period under its influence, cannot he said to have performed honestly all their duty towards them, and should the latter, in consequence of this neglect, become the victims of a hideous and loathsome disease, compunction and regret of the keenest kind will not fail to be the portion of the unhappy delin- quents. A few unfounded objections against vaccination are still urged by some persons, who however are ignorant of the facts connected with its history. The principal of these are the following: 1st. Vaccination, it is said, does not afford an absolute protection against an attack of small- pox, as is evinced by the prevalence of what are termed varioloid epidemics. We reply that the great majority of those who have been success- fully vaccinated, have, under every possible ex- posure to the contagion of small-pox, entirely escaned an attack of that disease even in the 208 Woman's Medical Companion. mildest form. But when a modified form of small-pox does occur in the vaccinated, there is no well authenticated instance of its being ac- companied in its progress by violent symptoms of any duration; of its proving fatal, destroying Bight, disfiguring the countenance; or, like gen- uine small-pox, leaving after it tedious and dis- gusting diseases. Even were this not the case, the fact of a second and even third attack of small- pox is well established; the succeeding attack being often more violent and destructive than the first. So that nothing would be gained, ad- milting this first objection to be valid, were inoculation for the small-pox to be resorted to in preference to vaccination. 2dly. Another objection frequently made to vaccination is, that although it affords a security against the small-pox, during the first years of infancy, until perhaps the seventh year, yet, after that period, the individual is liable again to the latter disease, and numbers then do con- tract it. The great body of facts which have been accumulated in reference to the protective powers of vaccination, and repeated and numer- ous experiments, prove the entire futility of this objection. It is not true that the modifica- tion produced in the system by vaccination, upon which its subsequent insusceptibility to small- pox depends, is ever obliterated. The adult, vaccinated in his infancy, has been found as effectually to withstand the contagion of small- pox, under an equal degree of exposure, as the Management of Infants. 209 infant that had been placed under the influence of the vaccine virus but one year previously. 3dly. It is objected to vaccination, that it entails a variety of eruptive diseases on the child, and, in the language of the objectors, bad humours. This same objection, and with a greater degree of propriety, was urged against inoculation for small-pox in 1746. In the Royal Metropolitan Infirmary for children, in London, no case of cutaneous disease has been observed after vaccination, where other evident causes could not be ascertained. The period commonly chosen for vaccination is from six weeks to three months after birth, when the infant is in general confined entirely to the breast, and is accordingly protected in a great measure against the evils of overfeeding and improper food, and when the irritation from teething is yet distant. To one or other of these causes the majority of the eruptive disea- ses of children are undoubtedly referable ; and as these do not generally come into operation until after vaccination has been performed, it is not a matter of surprise, that credulous mother* should be often led improperly to connect them together as cause and effect. The most ample experience has shown however that no cutaneous affection, or bad humour, ever springs from vac- cination, beyond a trifling rash, which now and then shows itself during the progress of the vesicle on the arm to maturity, and always dis- appears spontaneously. o 210 Woman's Medical Companion. There is no particular age at which vaccina- tion cannot be performed without the least danger: in general, however, it is better to wait until the infant is six weeks or two months old, after which the sooner vaccination is performed the better. During the prevalence of small-pox as an epidemic, whatever may be the state of the child's strength or health, provided there is a reasonable prospect of its surviving, and it is labouring under no severe disease, we should not hesitate to afford to it the protection of early vaccination; but under ordinary circum- stances, when the child is weakly or indisposed, it is better to wait until it has regained its vigour or it is restored to health. The season of the year or the state of the weather has little or no influence upon vaccination. It is never- theless proper, when it can be prudently done, to defer its performance until a mild and dry season, avoiding the intense heat of summer as well as the severe cold of winter. The prin- cipal precautions in vaccinating are to make choice of genuine matter taken from a healthy child; to insert it in the arm in such a manner that a sufficient quantity fully to impregnate the system shall be absorbed; to debar the child during the progress of the infection from all solid and heating food; and to be careful that ••he arm in which the matter is inserted be pre- served from irritation, and the vesicle, when it forms, from rupture. We shall now proceed to describe the appearance and progress of the Management of Infants. 211 arm, when vaccination has been effectually per- formed—any irregularity, or considerable devia- tion from the phenomena here laid down, will, in our opinion, indicate a spurious disease affording no certain protection against the small-pox. Between the second and fourth days after the insertion of the matter into the arm, a small red speck will be observable at the place of insertion which gradually becomes larger and more distinct until about the fifth or at furthest the sixth day, when in its centre is perceived a distinct vesicle filled with a per- fectly limpid fluid; on the seventh day this vesicle is larger and more turgid; on the eighth it is surrounded with a bright areola or ring, perfectly circular, and varying from one to two or even more inches in diameter; the part oc- cupied by this redness is evidently inflamed, hard and swollen. About this period it is not uncommon for the child to be affected with some slight symptoms of fever, which may con- tinue for a day or two; these however are by no means an invariable concomitant, nor in any manner necessary to perfect vaccination. Until this period the vesicle has been depressed in the centre with an even surface; but on the ninth or perhaps the tenth day it will become more even, and sometimes the centre will be the most pro- minent part. The vesicle assumes a circular form and is of an opaque pearly colour. The inflamed ring or areola is now at its height, and from this period will begin to fade. About the 212 Woman's Medical Companion. eleventh or twelfth day, the centre of the vesicle becomes of a brownish colour, the areola is much less distinct and in a short time entirely disappears. A hard, round, brownish scab now forms, becoming finally almost black, and if not accidentally detached, it will not fall off for a week or ten days. After the removal of the scab the surface it occupied presents a round scar of a shining silvery appearance, ar d having an uneven surface as though it had been formed by the nib- bling of some small animal. PART FOURTH, DISEASES OF FEMALES 213 CHAPTER I. DISEASES OF MENSTRUATION. What is meant by menstruation—The age at which it occurs in different climates—Its duration—Cautions to be observed on its first appearance, and during its presence—Period at which it ceases—Retention of the menses, symptoms, causes and treatment—Suppress- ion of the menses, causes, symptoms and treatment— Immoderate flow of the menses, treatment—Difficult menstruation, causes and treatment—Cessation of the menses—Proper treatment to prevent unpleasant symp- toms at this period. Br menstruation is meant that discharge of a bloody fluid, which takes place every month from the womb of a healthy adult female. The age at which the menstrual discharge commences varies from many circumstances, chiefly, how- ever, from those of climate, and peculiarity of 215 216 Woman's Medical Companion. constitution. In warm climates, menstruation appears often as early as at eight or nine years of age; for there the general growth of the body advances more rapidly than in colder climates, and the atmosphere is more stimulating. In temperate climes, it is usually postponed until the thirteenth or fourteenth year; and in the colder regions, until the nineteenth or twentieth. In all climates, however, when the constitution has acquired the age in which the discharge should take place, various causes may accele- rate or retard its appearance. The chief ol these are preternatural degrees of heat, certain diseases, fever, or any stimulus that quickens the circulation ; anger, or other violent emo- tion of the mind; inordinate exercise; fear, and severe grief; improper diet; a luxurious mode of life; neglect of exercise, &c. The flow continues from two to eight or ten days; and the quantity discharged varies from four to ten ounces in different individuals. Women of a delicate habit and lax fibre have a more copious and longer continued discharge than those of a robust constitution. For the two or three first times of its appear- ing, the discharge is apt to be somewhat irregu- lar, both as to the quantity of fluid which is dis- charged, and the period of its return; but after these,it usually observes stated times, and nearly the same quantity is lost at each visitation, un- less some irregularity should take place. About the first appearance of this discharge, Diseases of Females. 217 the constitution undergoes a very considerable change, generally, indeed, for the better, though sometimes for the worse. The greatest care is then necessary, as the future health and happi- ness of the female Jepend in a great measure upon her conduct at that period. She should be careful to take exercise daily in the open air, to partake of a wholesome, nu- tritious, easily digested diet, and not to indulge in tight dressing. The exercise should be tree and active, which will be found to promote digestion, to enliven the spirits, and to insure a proper discharge. It is worthy of the especial attention of young women, that we seldom meet, at this period, with complaints from obstruction amongst the more active and indus- trious portion of the sex; whereas the indolent, inactive and luxurious are seldom free from them. After the menses or courses have begun to flow, great care should be taken to avoid every thing that may tend to obstruct them. Females ought to be exceedingly cautious of what they eat and drink at the time they are out of order. Every thing that is cold, or apt to sour on the Btomach, all stimulating food and drinks, and whatever is found by experience to disagree with them, ought to be avoided. Exposure to cold is extremely hurtful at this period. More females date their disease from cold caught while they are in this situation, than from any other cause. A degree of cold that 218 Woman's Medical Companion. would not in the least hurt them at another time, will, at this period, often be sufficient to ruin entirely their health and constitution. It is not meant that they should then confine themselves wholly to the house or to warm rooms, but that imprudent exposures should be guarded against, and the clothing, especially of the feet, be some- what warmer'han usual. The final cessation of the menses generally occurs at about the fortieth or forty-fifth year. In some rare instances they continue, however, until a much later period, and they sometimes cease more early. When the courses do not make their appear- ance about the fourteenth or fifteenth year, it need excite no uneasiness, so long as 116 symp- toms of disease present themselves, and the functions of the stomach, lungs and heart are performed with regularity. In some instances, however, the non-appearance of the menstrual discharge at the usual period, is connected with a diseased condition of the stomach and other organs, to remove which a proper course of treatment is all important. The menses are then said to be retained, and the female most commonly presents a pale, blanched complexion. She is affected with great languor, and listless- ness, her appetite is impaired, and digestion is imperfectly performed. The disease is gene- rally termed, from the pale, livid, and greenish cast of the skin so commonly present, the Green Sickness. The symptoms consist chiefly in a general Diseases of Females. 219 sense of oppression, languor, and indigestion. The languor extends over the whole system, and affects the mind as well as the body; hence, while the appetite is feeble and capricious, and shows a desire for the most unaccount- able and unnutritious substances, as lime, chalk, See, the mind is capricious and variable, often pleased with trifles and incapable of fixing on any serious pursuit, or it is depressed with melan- choly forebodings. The heat of the surface is dif- fused irregularly, and is almost always below the point of health; there is, consequently, great general inactivity, and particularly in the small vessels and extreme parts of the body. The pulse is quick but feeble, the breathing attended with labour, the sleep disturbed, the face pale, the feet cold, the nostrils dry, the bowels irregular or confined, and the urine colourless. There is also, sometimes, an irritable and dis- tressing cough; and the patient is thought to be on the verge of a decline, or perhaps to be run- ning rapidly through its stages. A decline, however, does not usually follow, nor is the disease often fatal, although it should continue, as it has done not unfrequently, for some years. The principal causes which give rise to these ■ymptoms are indigestion occurring at the age of puberty, combined with a want of energy in the blood vessels of the womb that prevents them from fulfilling their office. Constitutional weakness and relaxation frequently predispose to green sickness ; and whatever enervates the 220 Woman's Medical Companion. general habit, or the stomach in particular, such as an indolent mode of life, indulgence in heated rooms and late hours, long residence in crowded cities, insufficient, unnutritious, or stimulating and indigestible diet, and constipation, may be ranked among its causes. The great object in the treatment of this dis- ease is, to restore the impaired functions of the digestive organs, the skin, heart and lungs; and the uterus will be quickly roused from its inac- tion, and perform its office with regularity and vigour. The patient should take daily exercise in the open air, particularly on horseback, re- sorting to change of air and scene as often as circumstances will permit. Dancing likewise will be found an excellent exercise, provided it be in the day time and not indulged in to the extent of producing fatigue. She should make use of light nutritive food of easy digestion, and abandon the use of tea, coffee, and all stimulat- ing drinks. To rise from bed and to retire to rest at an early hour morning and evening is all important in this disease. In fact, the rules to be observed with respect to diet and regimen, are precisely the same as those which are laid down in our chapter on training for health. A warm bath twice or thrice a week, and active friction twice a day with the flesh-brush over the region of the stomach and bowels, are on no account to be neglected. The friction should be performed by the patient herself, at least Diseases of Females. 221 every night and morning, for fifteen minutes at each time. A regular state of the bowels should be solicited by occasional doses of the compound rhubarb pill or common aloetic pill, or when obstinate costiveness prevails a dose of the com- pound colocynth pill will be proper. When the acidity of the stomach is very dis- tressing to the patient, a tea-spoonful of calcined magnesia, or a mixture of equal parts of magne- sia and rhubarb may be taken. Electricity, in the form of sparks drawn from the lower belly, or of slight shocks passed through it, may be resorted to in obstinate cases, and will frequently be attended with considerable advantage. It now and then happens, that retention of the menses occurs in florid, full-bosomed girls, who have no mean share of general vigour, in which case the pulse is full and tense, the face flushed, and the pains in the head and loins very severe. The ordinary cause of the retention in these cases, is exposure to cold at the period of the menstrual discharge; and the full habit of the patient and symptoms of fever by which it is attended will bear and require at the commence- ment the use of the lancet and saline purgatives. The warm bath also should be steadily used, with a plain light diet, and regular exercise. After the menses have made their appearance and have continued to recur regularly for months or even years, it sometimes happens that they 222 Woman's Medical Companion. are accidentally suppressed after catching cold, and from various other causes. In full robust habits the suppression of the menses is attended with pain in the head or side, cough, heat of the skin, thirst and other symptoms of fever. In such cases blood-letting, moderate doses of Epsom salts, the warm or hip-bath used twice a day, with a very low vegetable diet, and cool slightly sour drinks, will be the remedies demanded. But in no case should forcing or heating medicines be given. A cessation of the courses takes place also during many diseases. In these cases the female is apt to think that the absence of the monthly discharge is the cause of the disease under which she may labour; this, however, is rarely, perhaps never the casej all endeavours, therefore, to restore the discharge under such circumstances, especially by active purgatives, heating teas and forcing medicines of any kind, are positively- injurious. When the primary disease is removed, and the body has re- covered its strength, the womb will resume its healthy functions, and the monthly discharge will be restored. Luxurious living, with indolence or inactivity, often gives rise to an obstruction of the menses; hence, abstinence, and an increase of exertion and daily exercise in the open air, are the natural remedies—the effects of which may be aided in many cases by a moderate bleeding and mild laxa- tives. They who are subject to suppression of the menses should be careful to avoid cold and Diseases of Females. 222 wet by proper clothing; they should especially keep the feet warm and dry. Excessive flow of the menses. Whenever the discharge from the womb is in such immoderate quantities as to weaken the female, great caution is demanded. Perfect rest in a recumbent pos- ture, with the hips considerably elevated, expo- sure to a cool air, cold applications to the lower parts of the abdomen, such as linen or cotton cloths wrung out of cold water or cold vinegar, and a very abstemious cool diet, will be advisable. From thirty to forty drops of the elixir of vitriol in a glass of water, or from ten to fifteen drops of the tincture of steel, may also be taken two or three times a day. In some instances, however, a profuse flow of blood from the womb is a very serious disease requiring a much bolder and more energetic treatment than that here described. Such cases can be managed only by a skilful and experienced physician, and in procuring the advice of such a one no time should be lost— a trifling neglect may endanger the life of the female, or at least entail upon her for life a dis- agreeable and enfeebling infirmity. Painful or difficult menstruation. Few com- plaints are more distressing than painful men- struation. Some nervous females suffer so acutely from spasms in the region of the womb, and sometimes in the stomach, and from violent pains in the loins, that the whole nervous system, particularly the brain and spinal marrow, be- comes greatly disordered, so as to produce violent 224 Woman's Medical Companion. hysterical fits, and even convulsions. A conside- rable degree of pain in the loins, and some nervous symptoms generally accompany the first appear- ance of the menses, and until their regularity is fully established. When painful menstruation occurs at a later period, it may arise from cold, irritability of constitution, costiveness, or inflam- mation of the womb or of a neighbouring part; but a very common cause is a morbid sensibility of the nerves distributed to the womb, inconse- quence of some affection of the spinal marrow. Women who have had what is commonly called the childbed fever, those who have not married till late in life, those of a nervous temperament, and particularly those of a scrofulous habit, are very subject to it. They who are liable to painful menstruation, or to spasms in the stomach, or any other part of the abdomen, immediately before or during the period of the courses, should be very parti- cular in keeping the feet warm, and should wear flannel next the skin, and avoid green vegetables, raw fruit, and stimulating food and drinks of every kind. When the pains are very violent in the back, loins and lower part of the belly, bleeding will often be demanded, followed by the warm bath and a pill of opium and camphor. Cupping the lower part of the back between the hips, or a blister to this part, is often of service. Whenever the system is full of blood, and particularly when pain of the head is complained »f, or if blood escapes from the nose, or is Diseases of Females. 225 brought up from the stomach or lungs, or dis- charged from piles, and the discharge from the womb does not take place, or if it be deficient in quantity, abstraction of blood from the loins or thighs, by cupping, will be proper, and, if the lungs be oppressed, or the head much affected, it may prevent very serious mischief. One of the best palliatives in this affection is the application of warmth to the region of the womb, and over the whole surface of the abdo- men, by means of bottles filled with hot water. Warmth may also be applied, at the same time, to the feet. In many cases of painful menstruation the most efficacious plan of treatment is said to be the administration of from thirty to forty or even fifty drops of the volatile tincture of guaiacum, in sugar, or in milk and water, three times a day; with a gentle laxative every other night, so that the bowels may be kept regular without being purged. At the same time, the patient ought to take much exercise daily in the open air, either on horseback or on foot; to be atten- tive to the rules of diet laid down in the chapter on Training; and to mingle with cheerful so- ciety. A warm bath at about ninety degrees, every other morning, will likewise be advisable; and change of air and scene will much conduce to recovery. This plan ought to be persevered in for a considerable time, until the patient is sensibly restored to the full enjoyment of health and strength; for this is the great object p 226 Woman's Medical Companion. aimed at, the accomplishment of which will very rarely fail to prevent the recurrence of pain at the future returns of this discharge. Tight lacing must be avoided, particularly for a few days previously to the time the dis- charge should take place. Final cessation of the menses. This discharge seldom ceases all at once, but for some time before its stoppage becomes somewhat irregular, both as to the periods and the quantity. The time of its final cessation is always a critical one; because the constitution then undergoes a considerable change, and there is often a strong tendency to the formation of obstinate and pain- ful complaints. When the discharge happens to disappear suddenly in women of a full, plethoric habit, the diet should be more spare than usual, regular exercise should be taken, and some gentle lax- ative to keep the bowels free, occasionally ad- ministered. When the patient is sensible of a seeming fulness of the vessels of the head, with giddiness and pain, bleeding will be advisable. If ulcers break out on the legs, or any othet part of the body, at this period, great care should be observed not to heal them up incau- tiously, lest disease of some internal organ be thus induced. Diseases of Females. 227 CHAPTER II. DISEASES OF THE EXTERNAL PARTS, AND 0> THE WOMB. Of the whites, symptoms, causes and treatment- Itching of the external parts, remedies—Falling of the womb, causes, remedies—Inversion of the womb symptoms to which it gives rise, by what caused, treatment—Fleshy tumours of the womb, description, symptoms indicating their presence, treatment— Polypus of the womb, description, symptoms, manage- ment—Cancer of the womb, symptoms, treatment Whites. This complaint consists in a dis- charge of a yellowish-white or greenish fluid from the womb and its passage. In the mildest cases, the discharge is mostly of a whitish colour, sometimes almost colourless, small in 228 Woman's Medical Companion. quantity, and unaccompanied with any soreness or uneasiness in the parts; but in the severer examples, it is yellow, greenish or dark coloured, thin, sometimes very acrid and highly offensive, and occasioning itching, smarting and othef local symptoms of a very distressing nature. In most cases, there is pain and weakness in the back, and a sense of general languor; and when the disease is severe and of long standing, it is generally associated with an unhealthy counte- nance, disordered stomach, general debility, and a dry, hot skin. It occurs most frequently in women of delicate constitutions, or in those whose health has been greatly impaired by profuse evacuations, impro- per diet, sedentary living, grief, intemperance, or other causes of exhaustion. It sometimes, however, arises chiefly from injuries inflicted upon the parts themselves, in consequence of difficult labours, frequent miscarriages, a disso- lute life, or other causes. Those persons who live in a moist atmos- phere, who keep late hours, and spend much of their time in bed, or who are much confined in hot rooms, are particularly apt to be affected by this complaint. It sometimes arises from suckling too long. Women of all ages are subject to it. In the treatment of the whites, our reme- dies must be directed as well towards the gene- ral constitution, as to remedy the local disorder. Any attempt, unadvisedly, to remove the dis- charge by astringent applications, might in many Diseases of Females. 229 cases prove highly prejudicial. In many in- stances, particularly when the patient is young, tolerably robust or full of blood, and the disease has not been of long duration, it will be advisa- ble to take blood from the arm, and restrict the female to a very spare unirritating diet of easy digestion. If there should be symptoms of local fulness, or much pain, tenderness or heat about the womb, leeches may be applied to the lower part of the abdomen with advantage. Soda water, made with the lemonated soda powders, may be used as common drink, and will be found of great service. If the discharge still continues after these remedies have been properly and fully tried, then injections of lead water, a solu- tion of white vitriol or of lime water are to be had recourse to. Injections of alum water, of a decoction of oak bark, of a solution of nitrate of silver and other substances have been directed in obstinate cases; their use, however, demands considerable circumspection and sound judgment. It is an important indication in the treatment of the whites to correct any improper habits of life, and remedy the state of the general system. The country air will in most cases be beneficial Exercise in a carriage, when it can be obtained, should be regularly used. Sea-bathing will be found very useful, when no symptoms are present forbidding it, and the strength has been a little improved. The warm bath may be substituted for this, in most cases, with decided advantage. 230 Woman's Medical Companion. It is all important to keep the parts perfectly free from the vitiated discharge which takes place from within them. To do this, frequent washing with warm water will be demanded, as well as injections of the same internally. Iced water injected will also be of service in many cases. The whites almost always attends the dis- eases of the womb; these cases should be care- fully distinguished from those which arise merely from disordered action, as the use of astringent injections in the former might prove injurious. Those cases in which it occurs after the entire cessation of the menses, may be sus- pected to arise from some other disease; it will therefore be necessary, in these instances, to re- sort to the best medical advice. Itching of the external parts. This is a very distressing complaint, sometimes amounting to a degree of intolerable suffering. It fiequently accompanies diseases of the womb, on the re- moval of which its cure will depend: some- times it occurs independently of any other complaint, and in these cases frequently bathing the parts with warm water, and anointing aflei- wards with fresh lard, will be found of advantage. A small quantity, applied night and morning to the parts affected, of an ointment composed of equal parts of blue and citron ointments, has been recommended as very generally effectual in removing the itching. Leeches to the parts will be sometimes re- Diseases of Females. 231 quired—in other cases relief will be obtained from washing them with a watery solution of opium, or lead water, or a weak solution of nitrate of silver. In the intermediate time, they may be frequently fomented with warm milk and water. Thirty drops of balsam copaiba taken inwardly three times a day, has succeeded in curing the affection when all else has failed. Falling of the -womb. This is a complaint, in which the womb descends from its natural situ- ation into the passage, and sometimes entirely passes through the external parts, forming a tumour there of about the size of an ordinary melon. The immediate causes of it are i relaxation of those ligaments by which the womb is supported in its natural position, and a want of due tone or strength in the walls of the pass- age, which should assist in sustaining it; the first permitting it to fall, the second allowing it to be received into its cavity. Therefore, what- ever is capable of producing a lengthened state of the ligaments, or a relaxed state of the pass- age, may become the occasional cause of the com- plaint. This sometimes occurs after long continu- ed diseases, and profuse discharges particularly of blood, which have diminished the patient's strength. But the most common cause is a long continued erect posture of the body at an early period after delivery, and, in some cases, after miscarriage; at this time the patient is not only weakened, but the womb weighs eight or ten 232 Woman's Medical Companion. times more than it does in the usual state, and is carried, down by its own weight. Patients are often inclined to think, that their medical attendants oppos-e their leaving bed for an unnecessary length of time; and it is very common for them to disobey their directions in this, as well as many other respects. But thi» advice is given from having frequent occasion to observe the evils that ensue from a contrary prac- tice. When females are inclined to leave their bed, they should not remain long on their feet, nor sit in a chair, but lie down frequently on a sofa or outside of the bed, until the third or fourth week after delivery; at which time the womb will have regained its usual size, and all the parts their former strength. Those females who are liable to violent coughs during their confinement, are especially the subjects of this complaint, from the pressure made upon the womb when the passage can afford no assistance in supporting it. The symptoms in this complaint arise partly from the effects produced on the surrounding parts by the change in the situation of the womb, and partly from sympathy. At the commence- ment there is pain in the back, with a sensation of dragging and bearing down; pain is also felt about the groins; there is a sense of fulness in these parts, and a discharge of mucus from the passage. The pain and bearing down generally cease as soon as the patient assumes a lying posture. A frequent painful and straining in- Diseases of Females. 233 clinalion to pass the urine, is sometimespresent; and considerable uneasiness is also felt on going to stool. The symptoms arising from the sym- pathy between the stomach and the womb are distressing. The appetite becomes irregular, or is totally lost ; the stomach and bowels lose their tone, and are much distended with air; the spirits sink, every employment becomes irk- some, and life itself is scarcely desirable. The womb, in some cases, merely falls into the cavity of the passage, but, in others, it pro- trudes beyond the external parts: in the latter case, from exposure to the air, and the friction it suffers, sores usually take place upon its sur- face, surrounded by a good deal of inflammation. Slight degrees of this complaint can only be as- certained by great attention to the state of the parts, together with a knowledge of the common size and length of that part of the womb which hangs down into the passage. It maybe distin- guished from other tumours, by the existence of the orifice of the womb at the lower part of it. In every case of falling of the womb, the latter should be restored as quickly as possible to its proper place, by an experienced practitioner. After replacing the womb as nearly as possible in its natural situation, it is to be retained there by an instrument called a pessary. Pessaries are made of various shapes and substances; but the best is that of box wood, of an oval shape, flat, and with a hole in the middle, large enough for the insertion of the finger. One of these, of a 234 Woman's Medical Companion. proper size, previously oiled, is to be intro- duced, as far as possible, up the passage, and constantly worn there. Some care is necessary in the introduction of it; the patient should lie on her back, and place the instrument between the external parts, so that one edge will be turned towards the anterior, the other towards the posterior part; it is then to be moved in a circular direction on its own axis, pressing it backwards, and carrying it gently upwards to the part at which it is to be placed; it is then to be turned, and applied with its longest diame- ter crossways, so that the womb may rest on one of its broad surfaces. As the parts recover their tone, and become more contracted, the in- strument may be changed for a smaller one. For some time after the replacement of the womb, the patient should remain in a lying posi- tion, and be careful, always, of using any violent exertion, remaining too long on her feet, or walking too far. The bowels should be carefully attended to, in order to prevent costiveness or straining at stool. When opening medicine is required, castor oil will, generally, he found to answer best. If griping be troublesome, from five to ten drops of laudanum may be taken two or three times a day, in any simple aromatic wa- ter. Sea-bathing, when it can be obtained, will sometimes be particularly beneficial. The diet should be nutritious but plain, and of easily digested food. The patient should sleep upon Diseases of Females. 235 a sofa or a mattrass at night, in preference-to a bed of feathers. Astringent injections, thrown up the passage by means of a proper syringe, will often be ser- viceable: as a solution of alum or white vitriol, or a decoction of oak bark or nut galls. A bandage properly applied round the lower part of the abdomen from the hips upwards will be found of eminent service in contributing to retain the womb in its proper situation and to give strength to the weakened parts. When pregnancy takes place, this complaint always disappears after the fourth month, as the womb then rises above the basin, and is pre- vented by it from falling. In this case, great care should be taken not to assume the erect posture too early after delivery. The patient should keep her bed for several weeks, until the parts have recovered their strength; by which means, the recurrence of the disease will, in general, be prevented. Inversion of the ivomb. This complaint con- sists in an inversion of the cavity of the womb, so that the upper part comes through its orifice; consequently that part which was formerly the inside of its cavity, is converted into tlie outside of a tumour, either contained in the passage, or projecting from it. The disease is not so fre- quently met with as it was formerly, from the improved state of the art of midwifery; as it most usually proceeds from mismanagement of the after-birth In case* of retention of that 236 Woman's Medical Companion. substance, it was formerly the custom to pull at the navel string, instead of introducing the hand to separate it, by which the womb, being in a relaxed state, has sometimes come along with it, being in a manner turned inside outward. It is, consequently, a complaint almost peculiar to those who have borne children. But it some- times, though very rarely, affects unmarried women, from a peculiar tumour being formed in the womb, called a polypus, which, passing through the orifice of the womb, drags down that organ with it. The immediate consequences of an inverted womb, when it takes place after delivery, are flooding, faintness, and a sense of fulness in the external passage. When this disease is discov- ered early, it may generally be removed without difficulty. By gradually pressing on the lower part of the tumour, it will be restored to its natural situation. If the after-birth be still ad- herent, it should be allowed to remain until this is effected; as if it be removed while the womb is inverted, excessive flooding may ensue, from its not being able to contract and close the vess- els in that situation. But if the accident he not discovered until after some time, there may be difficulty, and indeed an impossibility of re- ducing it, from the orifice contracting so firml) around the neck of the womb, as to prevent the body passing through: and the difficulty and danger of the case may also be increased, by in- flammation having attacked the part. But as it Diseases of Females. 237 is a case in which the assistance of a medica. practitioner will be absolutely necessary, we shall not enter further into the consideration of it in this work. We have made these observa- tions, that patients may be aware of the nature of the accident, when it occurs, as by timely information much future ill may be prevented. Fleshy tumours of the -womb. These are tumours, various in shape and consistence, growing from the inner surface of the womb. In some cases there is only one tumour; in others there are several. Their form differs very much; they are most commonly of an ob- long spherical form. These tumours are some- times not larger than a nut; sometimes they weigh several pounds. This disease is some- times mistaken for a dropsy of the ovaries, and for pregnancy. It may, however, be generally- distinguished from dropsy by the firmness of the tumour, and the want of fluctuation. It is only in the early stages of the fleshy tubercle, or polypus of the womb, that this can be mistaken for pregnancy; because, when the womb in pregnancy rises above the brim of the pelvis, the motion of the child may be felt. The tumour of pregnancy after this time increases quickly; that of polypus slowly. In pregnancy the stomach becomes affected, and the 'breasts enlarge and are painful—changes which do not in general occur in polypus of the womb. No dependence is to be placed upon the stale of menstruation; because in pregnancy, coloured 238 Woman'» Medical Companion. discharges occasionally take place, and in the disease of which we are treating, the menses are sometimes wholly obstructed. This is not a very uncommon disease, and it affects women at all periods of life. Married and unmarried are alike liable to it. These tumours have no disposition to ulcerate, neither do they form abscesses or gatherings. They are generally accompanied by a slimy discharge, sometimes mixed with blood. The other symp- toms are, for the most part, such as arise from the mechanical effect of the tumour. There is a frequent disposition to go to stool, and also to make water. The legs are sometimes affected with cramp, from its pressing on the nerves going to them: and there is a puffy swelling of the feet and ancles from its pressing on the vessels which conduct the fluids from the lower extremities. When the tumour becomes so large, as nearly to fill the cavity of the basin, there may be great difficulty in evacuating the bowels, and a total inability of emptying the bladder. The weight of it, and its pressure upon the parts below, will occasion a sense of bearing down. The constitution is seldom much affected. This disease does not appear to be influenced by medicines internally exhi- bited, nor by external applications. Cramp will generally be relieved by lying for a sho^t lime in a horizontal posture: and if there should be much difficulty in evacuating the bowels, an in- jection may be given every morning. Frictiou Diseases of Females. 239 with liniments containing opium, may be use- fully employed in cases where much uneasiness is excited in the parts surrounding the tumour. The circumstance that requires most particular attention, is the state of the bladder. Retention uf urine, from the pressure against the neck of it, is one of the earliest and most distressing symptoms. In some cases the patient will be capable of voiding small quantities, if she lie upon her back with the hips raised by pillows a little from the bed. But, in other cases, it will be necessary to draw it off by an instrument called a catheter. It may be necessary, occasionally, to have re- course to anodynes to diminish the painful sen- sations that arise from irritation. Polypus of the womb. The foregoing are the symptoms arising from those tumours which have a broad and short basis; but that which has a long and slender stalk, and to which the name of polypus has been given, is productive of symptoms which vary in some degree from those just described. The tumour does not in general attain so large a size; consequently the symp- toms arising from pressure on the parts within the basin are not so urgent; and when the polypus attains a certain bulk, it reaches the orifice of the womb, dilates it, and escapes through it into the external passage. Polypii generally grow from the upper part of the womb, and the weight of the tumour then brings on many disagreeable symptoms; as bear- 240 Woman's Medical Companion. ing down, pain, and irritation; and sickness, and disorder of the stomach from sympathy. This species of tumour may, in general, be re- moved by a ligature; and when it has arrived at this state, it should be done without delay, as the symptoms it induces exhaust the strength of the patient. But, as the removal must of course be done by a surgeon, it will be useless to treat of it in this place. We must however observe, that a natural separation sometimes takes p+ace: this may occur either from the weight becoming too great for the slender stalk to bear, or from inflammation attacking it, or the neck of the womb acting upon it as a ligature. Cancer of the -womb. This disease most fre- quently occurs soon after the cessation of the menses. The notion that cancer arises from a peculiar poison in the system, or that it is a dis- ease of the whole body, is certainly erroneous; it has its origin from the same causes with other tumours. The symptoms of cancer in the early stage, are but trifling, and it frequently continues for several years before they excite much attention, particularly in those who lead a temperate life. A sense of weight in the womb, and a slimy discharge, are usually those first perceived. This discharge is sometimes tinged with blood, and particularly when the patient indulges too much in eating or drinking, or when the food has been of a stimulating quality. Violent ex- sreise will sometimes cause a discharge of blood. Diseases of Females. 241 in such quantity as to produce great weakness, and occasionally fainting. Generally, whilst there are discharges of blood in moderate quantity, the tumour remains stationary. If menstruation has not ceased, it becomes irre gular, and is more profuse than it ought to be. The symptoms produced by the mechanical effect of the tumour within the womb are sel- dom of much consequence, as the size is not often considerable. When pain comes on, the stomach and bowels usually become disordered. Even in the early stages of this disease the sto- mach is liable to be, in some degree, affected; though the more severe affections of this organ do not generally attack the patient until ulcera- tion has commenced. Upon an examination, the neck of the womb will be found thickened, and with a resisting feel, resembling that of gristle ; or a distinct tumour will be perceived arising from some part of the neck of the womb, the other parts remaining healthy. In either case, pressure upon the diseased parts will be produc- tive of pain, and of a sensation like that of mov- ing a hard body. The neck of the womb will also be found to have undergone a change. It becomes larger than natural, and feels as if sur- rounded by a thick, firm, irregular ring. As soon as the existence of the disease is ascertained, the most vigorous measures should be adopted to check its progress. The treat- ment that we would strongly recommend, from s conviction of its beneficial effects, is that of a. 242 Woman's Medical Companion. touching the womb frequently with carbolic acid, or injecting in the tissue thereof strong acetic acid. The diet should not be stimulating, but light and nourishing. The state of the general health should be carefully attended to, as much will depend on a due regulation of that. The bowels should be kept freely open by clysters; and the complaints of the stomach palliated by a proper diet with light bitter medicines, and the use of carbonated soda water as a common drink. When ulceration has taken place, the use of opium must be had recourse to, for the purpose of alleviating the pain and sense of bearing down, and moderating the effusion of blood, which usually accompany it. Violent exercise must be avoided; and the patient should lie in a recumbent posture the greater part of the day. When the disease has made a certain progress, medicine, we regret to say, is of little service excepting to abate the more distressing symptoms; but much allevia- tion will be experienced from the moderate use of opium, quietness, and a light, cooling diet. Diseases of Females. 243 CHAPTER III. HYSTERICS. What is meant by hysterics—Symptoms—Persons most liable to them—Causes—Treatment, during the fit, in the intervals. Hysterics consist in a convulsive struggling, alternately remitting and increasing, with a sense of a suffocating ball in the throat; drowsiness, copious discharge of pale urine, rumbling in the bowels, and fickleness of temper. The hysteric fit often takes place without any previous warning, though generally there are some precursive signs, as yawning, stretching, dejection of spirits, anxiety of mind, sickness at the stomach, palpitation of the heart, and sudden bursts of tears, without any assignable cause. The paroxysm soon succeeds, with a coldness 244 Woman's Medical Companion. and shivering over the whole body, and fre- quently with an acute pain of the left side, and a sense of distension, giving the idea of a hall or globe rolling about in the abdomen, and gradu- ally advancing upwards until it gets into the stomach: thence removing to the throat, it occasions the sensation of an extraneous body lodged there. The disease having arrived at its height, the patient appears threatened with suffocation, she becomes faint, and is affected with stupor and insensibility; whilst, at the same time, the trunk of the body is twisted backward and forward, the limbs are variously agitated, and the fists are closed so firmly, that it is diffi- cult, if not impossible, to open the fingers: wild and irregular actions follow, in alternate fits of laughter, crying, and screaming; incoherent ex- pressions are uttered, and sometimes a most obstinate and distressing fit of hiccough takes place. The spasms at length abating, a quan- tity of wind is evacuated upwards, with frequent sighing and sobbing; and the patient, after appearing for some time quite spent, recovers the exercise of sense and motion, without any other feeling than a general soreness, and a pain in the head. It is rarely that an hysteric fit becomes dangerous; it has, however, in a few instances, terminated in epilepsy or insanity. Hysteric affections occur much more fre- quently in the unmarried than in the married, and most commonly between the age of fourteen and that of thir'y-five years; and they make Diseases of Females. 245 their attack oftener about the period of men- struation than at any other time. Women of a delicate habit, and whose nervous system is extremely sensible, are those most subject to hysterics; and the habit which predisposes to » their attacks is acquired by inactivity and a se- dentary life, grief, anxiety of mind, late hours, dissipation, a suppression or obstruction of the menstrual flux, excessive evacuations, intemper- ance, an unchaste life, and the constant use of a too stimulating or an unnutritious diet. They are readily excited in those who are subject to them by passions of the mind, and by every considerable emotion, especially when the effect of surprise; hence sudden joy, grief, or fear, are very apt to occasion them. They have also been known to arise from an accidental irritation of the stomach, bowels or other internal organs affecting the nervous system sympathetically. In regard to the treatment of hysterics: this may be divided into that which is proper during the fit; and that demanded in the intervals, to prevent its return. During the fit, it will be the safest practice to rouse the patient by applying burnt feathers, assafcetida or smelling salts to the nose; by rubbing the temples with ether, and by putting the feet into warm water. In obstinate cases, cold water maybe dashed over the limbs, and a purgative injection administered: a clyster of cold water alone has been effectual in putting an end to the fit. If the patient be young, robust and full of 246 Woman's Medical Companion. blood, and the attack of a recent nature, from ten to sixteen ounces of blood may be taken from the arm; but in very weak and delicate constitutions, or where the disease has been of long standing, taking blood from the arm would be often improper. In these cases, however, cups to the temples and back of the neck and along the backbone, will be found advantageous. Whenever the hysteric fit is very violent, the application of cups to the head, followed by cloths wrung out of cold water, and mustard poultices to the extremities are not to be neg- lected. In the intervals of the paroxysms, the object is to restore the healthy action of the stomach and bowels, and to strengthen the whole consti- tution. Every remote or exciting cause is to be sedulously avoided. Active exercise is to be taken daily in the open air. The diet should consist of light nourishing food. These, with early rising and cheerful company, are the principal means of invigorating the body and mind, and thus effecting a radical cure of hys- terics. The warm bath, with frictions over the whole surface of the body, will in all cases be useful; a visit to the mineral springs and the cautious use of the waters are often advantageous. When hysteric affections are connected with a suppression or obstruction of the menses, the means recommended when speaking of these affections should be adopted. Diseases of Females. 247 Anodynes and antispasmodics, as opium, musk, castor and valerian, together with a long list of tonics, are often had recourse to in this complaint, but they are all of very doubtful ad- vantage, and often injurious. The tincture of meadow-saffron has occasion- ally succeeded in curing obstinate attacks of hysterics; and from its acknowledged power of allaying pain and nervous irritation, it may be considered a valuable remedy in many cases. Used as a palliative to put an end to the actual fit, a tea-spoonful may be given, in water, and repeated to the second or third time, if neces- sary: and when employed, in the intervals, with the view of obtaining a radical cure, thirty drops may be given twice a day. In its power of affording present relief, it seems to be superior to assafcetida, or any of the antispasmodics in common use, and much safer than opium. It should not be continued for any length of time; in general, not longer than three or four weeks at one time. Cups along the spine, and rubbing this part with an ointment composed of simple cerate and tartar emetic, are often attended with the very best effects. Regular exercise on horseback, variety of scene, and early rising are particularly desi- rable. The diet should be nourishing, such ai is recommended in dyspepsia. PART FIFTH. DISEASES OF INFANTS. 249 DISEASES OF INFANTS. When children are properly nursed; supplied with food of a proper quality and in quantity adapted to the wants of the system; when they are kept in a pure and fresh atmosphere; and are neither allowed to suffer from cold, nor oppressed with heat; when their bodies are preserved strictly clean by frequent bathing in warm water, and their clothing is light and loose; and they are allowed their natural amount of repose: they will be found to suffer from few diseases; provided always they are born of healthy parents, and with bodies not suffering from congenital disease or debility. Never should medicine be given to an infant unless it is labouring under some decided malady. Slight deviations from health can always be readily removed by a proper attention to the diet, exercise and cleanliness of the infant and 251 252 Woman's Medical Companion. nurse, by the use of the warm bath, and by ex- posure to fresh and wholesome air. The too common practice of overlooking the evident ca-ises to which the diseases of infants are to be attributed; the indolence, perhaps prejudice, which prevents the necessary reformation in the plan of nursing; and an inconsiderate resort to active and pernicious remedies for the most trifling ailments; have produced almost as great a destruction of life during infancy, as the disea- ses peculiar to that period of life. RETENTION OF THE MECONIUM. The dark-coloured viscid matter accumulated, sometimes in great quantities, in the bowels of new born infants, is called meconium. It is usually discharged soon after birth, or is brought away in the course of a few hours by the purgative property of the first milk which the child sucks from its mother's breast. Occa- sionally, however, it is retained for several days, giving rise, by irritating the lining mem- brane of the bowels, to various unpleasant symp- toms. A little molasses and water, or a tea spoonful of melted butter will very generally he sufficient to procure its evacuation. Should these simple means fail, a spoonful of castor oil Dr an injection of warm water should be resorted to. The warm bath and gentle frictions over the belly of the infant will likewise be of service. Diseases of Infants. 253 EXCORIATIONS OF THE SKIN, OR CHAFING These are in almost every instance the effect of carelessness and bad nursing. Let every part of an infant's skin be properly washed with warm water, and then completely dried with a soft cloth, especially in the folds of the groins, neck and arm pits, and let due attention be paid to keep its clothes clean and dry, and chafing or excoriation of the skin will rarely occur. When it has taken place, dusting the parts after washing with a little powdered starch or pre- pared chalk, is all that is necessary to be done to prevent further mischief and cause the fretted skin to heal. COSTIVENESS. The bowels of some infants are slower than others, without, however, implying the presence of disease, or giving rise to any inconvenience. In such cases all interference on the part of the nurse is improper. In general it is desirable that an infant's bowels should be freely opened once in the twenty-four hours. If a longer period than this elapses without an evacuation taking place, and the infant appears to be in pain or is affected with vomiting, a tea-spoonful of castor oil or melted butter, a suppository of yellow 254 Woman's Medical Companion. soap or an injection of warm water should be administered, and repeated according to circum- stances. Costiveness will often be induced by improper food, or, if the child is exclusively confined to the breast, by some peculiarity of the mother's milk, arising perhaps from the na- ture of her diet; the removal of such causes should always be attended to, and the repeated administration of purgatives as much as possi- ble avoided. The use of composing drops to induce sleep or quiet restlessness in an infant is often the real but unsuspected cause of a costive state of the bowels ; which is another powerful proof of the injurious effects of such remedies. COLIC--GRIPING. Colicky and griping pains of the bowels con- stitute a troublesome and distressing complaint to which infants who are improperly nursed and fed on unsuitable food, or who are allowed to eat too much, are peculiarly liable. Besides the errors in diet already referred to, colic is often caused in infants by exposure to cold or to an unwholesome atmosphere, by neglect of cleanliness in their persons and clothing, and not unfrequently by improper food eaten by the mothers or nurses, or by other imprudences committed in the regimen of the latter. When the irritation of the bowels produced by these causes is very considerable, or frequently re- Diseases oj Infants. 255 peated, it may give rise to convulsions or terminate in inflammation. Ordinary attacks of colic demand for their removal a dose of oil or magnesia, the warm bath and frictions to the abdomen with warm sweet oil, in which a few grains of opium have been intimately rubbed; oleaginous and mucilaginous injections will also often be found advantageous. In full blooded robust children, the pains being violent and long continued, the skin warm and dry, and the belly painful upon pressure, indicated by the child springing and screaming when the hand is ap- plied to it, the judicious application of leeches to the abdomen will be demanded. The treat- ment of a severe attack of colic, let it be re- collected, always requires very considerable medical skill, and should not be attempted without the advice of a regular practitioner. A careful avoidance of the exciting causes of the dis- ease is all important; and as it most fiequently originates in errors of diet on the part of the infant or nurse, or the bad quality of the breast milk of the latter, these circumstances should demand particular attention. The common nursery prescription for infantile colic, of lau- danum, paregoric, or carminative and various other empirical compounds of which opium, in uncertain proportions, constitutes the active in- gredient, cannot be too severely reprobated these remedies often do more harm than the dis- ease itself, and not unfrequently convert a trifling affection into a severe and even fatal dis- 256 Woman's Medical Companion. ease. Gin, also, and other spirituous liquors are sometimes given to infants labouring under colic. Humanity shudders at such reprehensi- ble conduct: it might justly be termed, a breach of moral rectitude on the part of the parent or nurse. FLATULENCY. Flatulency in infants may be attributed to the same causes as those which produce colic. Its removal can only be effected by restoring the stomach and bowels to their healthy condition, by a proper diet, cleanliness, and pure air; and, if costiveness be present, by gentle laxatives, the warm bath and frictions to the abdomen. Spice te?.s, stimulating drinks, and other heating pre- scriptions should never be resorted to; they are always productive of injury. HICCOUGHS. Nearly the same statement as above may be made in relation to this disagreeable though seldom dangerous disease, to which infants are sometimes subject. Hiccoughs are generally produced by an overdistended stomach, by acidity of the bowels, or by wind. Their treat- ment is similar to that for flatulency. Diseases of Infants. 257 RUPTURES. A protrusion of the bowels, beneath the sk/n at the navel, in the groins, or into the scrotum of males, forming an external tumour at these situations, sometimes exists at birth, or occurs soon after: it should never be neglected. By proper management, which can be directed only' by a physician, commenced at an early age, the child may be relieved from an inconvenience and imminent danger, which he would otherwise be subject to all his life. JAUNDICE. The skin of some children soon after birth has a yellowish tinge, which generally disap- pears in a week or ten days ; the whites of the eyes do not partake of the yellow colour, nor is the urine tinged by it. The stools are often of a yellowish or dark green colour. This yellow- ness of the skin cannot be considered a disease, nor does it demand any particular treatment. • It would seem to be occasioned by the gradual change of the ordinary red hue of the infant's skin at birth to the natural tint. Genuine jaundice, characterized by yellowness of the skin and eyes, bilious urine, and light or clay coloured Btools, is of very rare occurrence in infants. R 258 Woman's Medical Companion. When it does occur it is sometimes a very seri- ous and unmanageable disease. The child is affected with frequent vomiting, flatulence, ex- treme languor, and a great tendency to sleep. The removal of the disease is to he attempted by the administration of from a quarter or a half to two grains of calomel, according to the age of the child, rubbed up with a few grains of magnesia and sugar, and followed in a few hours by a tea-spoonful of castor oil; by the frequent use of the warm bath; and confinement to the breast milk, or a simple, light and un- irritating diet if the child is weaned: fresh air and exercise are also demanded. The repeti- tion of the calomel and oil must be governed by the effects of the previous dose and the circum- stances of each case. The advice of a physician cannot in this affection, be dispensed with. SORE EYES.* Infants are very subject to a soreness or a slight inflammation of the eyes, a short time after birth. It is generally occasioned, by ex- posing the eyes too much to the light, by smoke, or by exposure to cold. When the complaint is slight, avoiding the exciting cause, and wash- ing the eyes frequently with cool water, an infusion of common tea, rose water or weak lead water, is often sufficient for its removal. But when the inflammation continues or is of * In all affections of the eyes consult an oculist at once, if there be one near at hand, as loss of time is often very dangerous to sight. diseases of Infants. 2«M any extent, the application of leeches to the affected eye is indispensable. When the edges merely of the eyelids are affected with soreness, anointing them with a very little weak citron ointment at bed-time, will generally remove the complaint in a few days. PURULENT OPHTHALMY. Puhuient inflammation of the eyes of infants, bo called from the copious discharge of matter by which the inflammation is attended, is a most violent and serious disease. If not treated in a judicious manner so as promptly to arrest the violence of the inflammation, it will very com- monly produce an entire and irremediable des- truction of sight. Infants are sometimes seized with this disease of the eyes almost immedi- ately after birth, and commonly within the first week or ten days. It commences with a swell- ing of the eyelids, the inner surface of which is intensely red, thickened, and of a velvety appearance; the child becomes very irritable from the pain and itching by which the inflam- mation is accompanied, and the eyes cannot bear the stimulus of light; the redness soon extends over the white of the eye, and a fresh discharg of matter takes place. The eyelids are perma nently closed, and their edges adhering causes the matter to accumulate to a considerable ev- *enr within them. When they are forciUv 260 Woman's Medical Companion. opened, a gush of light straw or grecu coloured matter takes place, their red and thickened lin- ing membrane protrudes, and the ball of the eye is with difficulty brought into view. This dis- ease demands the most vigorous and judicious treatment in order that the destruction of the eye may be prevented. Leeches in sufficient number must be applied and repeated according to the violence of the existing inflammation. The eye must be washed out frequently by inject- ing between the lids an infusion of sassafras pith or a stream of warm water. Blisters should be applied behind the ears, and the bowels should be acted upon by some brisk purgative: as the inflammation subsides, the eye can be washed as above with some mild astringent fluid. As the swelling of the eyelids diminishes, and they assume a more natural and healthy appear- ance, the washing is to be gradually diminished, taking care for some time not to expose the eyes to a strong light. Such is the outline of the treatment required by this formidable disease: its details must be left to the physician, whose services should be early obtained. eruptions. The eruptions or breakings out on the skin, to which children at the breast, espeoially during the first months, are so very liable, would ap- pear in the greater number of instances to be Diseases of Infants. 261 occasioned by some irritation of the stomach from improper feeding; an intimate connexion and sympathy existing between the stomach and skin in infancy, by which a diseased condition of the latter is readily produced by whatever offends the former. Eruptions and blotches on the surface are also liable to be caused by im- pure air, and neglect of cleanliness. The means of avoiding their occurrence is therefore very evident. The principal of these eruptions are:— The red gum, consisting in an efflorescence of small red spots on the skin, usually about the face or neck, but sometimes extending to the hands, thighs, and other parts of the body. Now and then there are small pustules filled with a limpid or yellowish fluid. The yellow gum differs in nothing from the former ex- cepting in the colour of the pimples. The milk blotch consists in large patches of thick scales, commencing with little white blisters which gradually increase in size, and rupture. They are mostly confined to the forehead and face, but sometimes extend over the greater part of the body. The hives are large, slightly- raised blotches of a pale red, which appear often over the entire surface suddenly, and as suddenly disappear; they are often attended with heat of the skin, and a sense of smarting or itching. Infants are, also, liable to other eruptions resembling moasles, nettle rash, &c. which it *8 not necessary here to describe. All th*ise 262 Woman's Medical Companion. eruptions are attended with very little danger. Their cure is to be effected by keeping the child on a light unirritating diet—regulating his bowels, if these be costive or irregular, by a dose of magnesia or castor oil preceded or not, according as circumstances may demand, by a grain or two of calomel; keeping the infant's body cool, but at the same time avoiding expo- sure to cold or damp; causing it to breathe a wholesome atmosphere, and immersing it daily in the warm bath. Ointments, salves and medi- cated washes never do good, but often harm. Even the favourite prescription among nurses of hot saffron tea should be forbidden—cool toast water or weak balm tea is far preferable. SORE EARS. Ulceration of the skin behind the ears is very common in children of gross and irritable habits about the period of teething; it may occur earlier, however, from overfeeding and neglect of cleanliness. A common prejudice prevails, that these sores are salutary, and that to heal them up is attended with danger. Neither, however, is true. No harm will arise from checking them by judicious treatment; and on the contrary, when allowed to increase, they form disagreeable and irritable sores, often at- tended with danger to the child, besides estab- lishing a constant issue, which long continuance Diseases of Infants. 263 may render at last necessary. The best treat- ment for these sores is to confine the child to a plain unirritating diet, to wash the ulcers daily with a little soap and water, and afterwards to dress them twice a day with the simple cerate or mild citron ointment spread on a soft rag. When very irritable and giving discharge to a thin bloody matter, the sores will quickly im- prove in appearance* f washed with a weak solu- tion of the nitrate of silver. The bowels of the child should be kept open by small doses of a mild purgative, as magnesia, Epsom salts, or castor oil. SCALD HEAD. This is at once a very disgusting, troublesome and obstinate complaint provided it be neglected on its first appearance, but it is one readily cur- ed if attended to in time. It makes its appear- ance on the scalp, forehead and neck, in form of irregular patches, on which arise a number of yellowish pustules. On bursting, these discharge the matter they contain and form scabs, upon removing which the parts underneath appear red and shining. The hair at the part affected be- comes lighter and drops off. The itching pro- duced by this complaint is generally very great; the child, by scratching, breaks the pustules, and in consequence communicates the disease to the parts not before affected. The scald head may 264 Woman's Medical Companion. arise spontaneously in children of a gross habit of body, who are fed on rich unwholesome food, who are deprived of sufficient exercise and pure air, and whose heads are kept too warm and not sufficiently clean; it is also often communicated by contagion from using the same towels, combs, caps, &c. As soon as the disease makes its appearance, the hair should be cut off as near to its roots as possible, and the head washed twice or thrice each day with warm water and castile soap. If the scalp is very tender and covered with thick hard scabs, a soft bread and milk poultice may be applied over the parts on which the disease is seated, and a small quantity of citron ointment should be rubbed in night and morning. An occasional dose of one or two grains of calomel, and three or four of magnesia followed by castor oil should be given: the washing of the head being still continued and the child put upon a light farinaceous diet with milk ; all animal food, crude vegetables, spices and stimulating liquors being forbid. The warm bath, pure air, and daily exercise must not be neglected. In this manner a cure is generally effected in a short time. An ointment composed of the tar ointment one ounce, and corrosive sublimate two grains, well mixed together has been found very successful in some cases; and by many practitioners an ointment is strongly re- commended mude by reducing common salt to a white powder by holding it in a shovel ovei Diseases of Infants. 265 the fire and then intimately combining it with fresh butter. THRUSH—APHTHA, OR THE INFANT'S SORE MOUTH. The thrush is so common an affection of in- fants, that mothers and nurses are apt to imagine every child must necessarily experience it at some period or other—it has even been viewed as a disease beneficial to the child; neither opinion, however, is true. It may be traced, in the great majority of cases, to a bad condition of the mother's milk, to impure air, to feeding the child too much or on improper food, to a defect of cleanliness, or to exposure to cold and dampness. The ulcerations commence about the angles of the mouth in the form of minute white specks, which finally spread over the tongue, inside of the cheeks, and throat, becoming gradually larger; as the crusts fall off the parts beneath bleed freely and form often large ulcers which occasionally assume a dark or livid hue. The ulcerations sometimes extend through the whole of the bowels. In light cases there is no fever, and only a slight disturbance of the bowels witVi green stools; but in severe cases, there is considerable fever, vomiting, frequent griping and acrid discharges from the bowels, hiccup, stupor and other bad symptoms. In the treat- ment or aphtha, the first important step is to 266 Woman's Medical Companion. place the child upon a proper diet. It should, if not already weaned, be confined to the breast milk of its mother, or in case her milk is sus- pected to be of a bad quality, to that of a healthy nurse. If it has been weaned, let it be confined to fresh rennet whey, or to toast, gum or rice water sweetened with loaf sugar. Exposure to a fresh, dry and pure atmosphere, of a comfor- table degree of warmth, is all important, as is also strict personal cleanliness and the daily use of the warm bath. In the generality of cases these means with the local application of borax to the mouth, will be all that is required. The ordinary plan of dissolving the borax in sage lea and rubbing it into the mouth with a rag, ii highly injudicious: the best plan is to powder together equal parts of borax and loaf sugar; a small quantity of which in its dry form is then to be thrown into the mouth every two or three hours. The powder dissolving in the saliva is by the natural motions of the tongue and lips applied to every part of the mouth. If the bowels are much disturbed and the evacua- tions green and frothy, a dose of magnesia in milk may be administered. In more violent cases of sore mouth with deep ulcerations of an unhealthy aspect; the best local application will be a weak solution of nitrate of silver in water. Repeated doses of purgatives are highly impro- per. When the bowels are very open, the 6tools being thin and attended with severe grip- ing, an injection of thin starch and olive oil with Diseases of Infants. 26V the addition of a few drops of laudanum will be advantageous. In all severe cases the advice of k physician should be considered indispensable. SNUFFLES. This disease consists in an inflammation of the nostrils, and though generally viewed as a very trifling affection, is nevertheless always pro- ductive of much uneasiness to the infant, and in some instances produces troublesome ulcerations inside the nostrils, or the inflammation extend- ing to the throat, gives rise to extensive swell- ings and suppuration of the glands in that part, and destroys the life of the little sufferer. The lining membrane of the nose in early infancy is so susceptible of irritation, that it becomes in- flamed upon the slightest exposure to cold or dampness. It is not uncommon to hear an infant sneeze soon afterbirth, in consequence no doubt of the sudden transition from a warm medium to the cold atmosphere. Snuffles are most preva- lent in cold, damp and changeable weather. The first apparent symptom is sneezing; on exami- nation the nostrils will be found to be more or less dry and swollen—sometimes the swelling is so great as to prevent the free passage of the air through them; respiration being carried on solely by the mouth, the voice becomes hoarse in consequence and otherwise altered in sound. A copious discharge of a thin watery fluid now 268 Woman's Medical Companion. takes place from the nostrils, which,in the course of a few days, changes to a thick whitish mucus, which gradually becomes more consistent and of a yellowish hue. The child appears heavy and dull: when put to the breast, in consequence of the closure of the nostrils, and the breathing through the mouth being suspended by the act of sucking, a sense of suffocation is occasioned, and the child is prevented in this manner from receiv- ing sufficient nourishment; hence, unless fed by the spoon, it in consequence may suffer from in- anition. Sometimes the infant sleeps constantly; irritation of the brain to a considerable extent and convulsions occasionally occur. As the dis- ease begins to decline, the secretion from the nose will gradually lessen in quantity and con- sistence; the child breathes more readily through its nose, and in a few days the healthy condition of the parts is perfectly established. In slight cases little is required in the way of medicine: the bowels should be gently moved by a dose of oil; the body of the little patient should be pre- served of a mild and equal temperature; it should be immersed in the warm bath, morning and evening, and may take occasionally a few spoonfuls of rennet whey or toast water of tepid warmth. In more violent cases, the application of a leech or two between the nostrils will be requisite ; or, if the throat becomes affected, under the jaw on each side. A small blister to the nape of the neck may be found useful, and internal small doses of calomel, ipecacuanha Diseases of Infants. 269 mid magnesia, or of calomel, nitre, and powdered digitalis, will be of advantage in scrofulous chil- dren. VOMITING Vomiting in infants, when not the symptom of a diseased state of the stomach, is almost always occasioned by overloading the stomach with food, or by the irritation of some improper ar- ticle that the child has eaten. Care in avoiding the exciting cause is all that is required in such cases. When vomiting does not cease after the removal of the offending cause, three grains of carbonate of magnesia, with a grain of pepsin and some powdered anise-seed, may be given 2 or 3 times a day; the child may also be immersed in a warm bath, and the region of the stomach rubbed with an anodyne liniment, or covered with a spice plaster BOWEL COMPLAINT, OR DIARRHOEA. Few children are so fortunate as to pass through the period of infancy without experien- cing more or less of a bowel complaint. So susceptible is the digestive canal in early life; bo readily is it affected by impressions made directly upon it, or upon the surface of the body: that the least error in diet; the smallest r.hange occasioned in the mother's milk, from 270 Woman's Medical Companion. v\ improper regimen on her pari, or any violent affection of the mind; a few moments' exposure to cold and dampness; an imperfect attention to preserving the skin from the accu- mulation of filth; or any neglect to maintain the proper ventilation and purity of the air which the infant breathes, very generally give rise to an irritation of the intestinal canal resulting in diarrhoea.' About the period of teething, as we have already remarked, a looseness of the bowels very commonly occurs, in consequence of the ir- ritation being transmitted from the gums to the lining membrane of the intestines. The numer- ous varieties into which the bowel complaints of infants have been divided by writers, founded mostly upon the different appearances assumed by the discharges, deserve very little attention. All that is necessary to be attended to is the de" gree of irritation existing in the mucous or inner membrane of the intestines; the extent to which this irritation has caused the latter to deviate from its healthy condition; and the facility with which this irritation is propagated from it to the brain and other organs. Diarrhoea then always depends upon an irritation of the intestines. The irritation may be either transient, ceasing the moment its exciting cause is removed; or per- manent, in consequence of a morbid change having taken place ji the lining membrane of the bowels. The first gives rise-to a very trifling disturbance, which is ordinarily quickly removed by the efforts of nature; the second Diseases of Infants. 271 constitutes a disease involving often the life of the child. In the treatment of diarrhoea, the first object is to remove and guard against the exciting cause whatever this may have been, and secondly to moderate the irritation of the intestines and cause it to cease. The child, if at the breast, should be confined to it solely, or if the milk of the mother has undergone any morbid change, provided this cannot be at once removed by confining her to a proper diet, and regimen, a healthy nurse should be procur- ed. When weaned, the child's diet should be precisely that directed in treating of Aphthae (ante p. 265). Its body should be kept of a mode- rate and equable warmth, and in damp, cold and changeable weather it should be clothed in a loose light dress of soft flannel. If the dis- charges from the bowels are green and frothy, or have a sour smell and curdled appearance, a few grains of calomel and magnesia may be given; but when they are thin and slimy with occasional streaks of blood, a dose of oil "ill perhaps be preferable. The propriety of re- peating either prescription, must be determined by the circumstances of each case. We would remark, however, that teasing the bowels by repeated doses of even the mildest purgative is always productive of serious mischief. The warm bath night and morning, followed by a spice plaster over the abdomen, are all-impor- tant remedies. If the skin of the child be dry, harsh, and hot: if the diarrhoea be attended 272 Woman's Medical Companion. with frequent severe griping pains, or if the inclination to stool be constant, and occasion the discharge, after considerable straining, of only a little mucus, and more especially if the abdomen be hot, tense, swollen, and tender to the touch, then ice to the surface of the abdomen, or warm narcotic fomentations, will be demand- ed. When the discbarges from the bowels are profuse, and the inclination to stool almost in- cessant, the utmost advantage will be derived from bland, mucilaginous, or oily injections, with or without the addition of a small portion of opium: thin made starch, flaxseed-tea, olive oil, or oil of sweet almonds, form in these cases the best injection*. In many cases of the bowel complaint of children, during particular stages, very minute doses of calomel and ipecacuanha frequently repeated, or of saccharum saturni, opium and calomel will be found advantageous; but as the judicious administration of these de- mands a very great deal of skill, and as they may injure or even destroy the child when im- properly resorted to or too long continued, they should never be given excepting under the direction of a regular physician. 8UMMER COMPLAINT, OR CHOLERA OF INFANTS. Summer complaint is the name generally given to the severe and almost incessant vomit- Diseases of Infants. 273 ing and purging of a thin watery fluid, with which children undertwo years of age are liable to be affected, in the middle and southern states, during the heat of summer; and by which a large number of them are annually destroyed. A description of this affection is unnecessary in the present work, so well is it known to the generality of parents in this country, by all of whom it is justly dreaded. The predisposing causes of infantile cholera are evidently the very irritable state of the bowels in early infancy, particularly towards the period of teething, and the influence of the heated, impure and confined air of our larger cities and of certain localities in the country, by which the irritability of the bowels is still further increased. Its exciting causes are improper nursing, errors in diet and clothing, difficult dentition, imprudent exposure to a damp and cool atmosphere, personal filth, the abuse of purgatives and other remedies. The disease prevails most extensively among the children of the poor who live in unwhole- some dwellings or locations. It may almost invariably be avoided by proper nursing; by removing the child to a cool and pure atmos- phere before the heats of summer commence, and by a careful avoidance of the exciting causes already enumerated. In connection with this Bubject the reader is referred to our chapter on the Exercise of Infants for an account of the different means by which a child maybe enabled to enjoy the advantages of eool, fresh and s 274 Woman's Medical Companion. wholesome air (see page 187). The treatment adapted to an ordinary case of infantile cholera is the same as that recommended in our last chapter for diarrhoea. Removal from the heated and impure air of the city, let it be remembered, is indispensable; without it a permanent cure can scarcely be anticipated. PROLAPSUS ANI. Prolapsus- ani, or a falling down of the fun- dament, is often met with in children of a relaxed habit, tnd in those who have been much afflicted with severe purging. It is also a frequent con- sequence of irritation of the rectum, arising from the presence of thread-worms within the gut. In this affection much advantage has been often experienced from astringent injections, partic- ularly an infusion of galls or oak bark; a small proportion of opium added to the injection tends greatly to lessen the irritation in the extremity of the gut and prevent the falling down of the lat- ter. The projecting parts should always be replaced the moment they are protruded, or an inflammation and thickening which will prevent their replacement is very apt to occur. To effect the reduction, the protruded gut should be well fomented with a decoction of poppy heads or flaxseed tea, and anointed with fresh olive oil; after which a gradual and gentle compression is to be used to reduce and place it within the anus. Diseases of Infants. During the operation the child is to be laid on its back, with its thighs widelv distended and its hips raised. In children it is often difficult toredure the last folds of the intestine if the finger is push- ed through the orifice, for when this is withdrawn the gut slips down. A piece of paper in the shape of an extinguisher or funnel moistened and oiled, placed on the point of the fore finger, to push up the last portion within the anus, will slip out easily without bringing down the gut with it. A piece of sheep's gut distended with air, is sometimes used to press up the protruded parts. when the air is let out of the distended gut, it may readily be brought away without the pro- lapsus recurring. The child should not be permitted to strain, nor to take the usual position at stool. It should be kept in an erect posture, and the hips held together by an assistant, so as to compress and support the gut during the evacuation. With a view to strengthen the parts, cold water dashed over the back and buttocks has been •bund useful. INWARD FITS. YorNG infants are often affected with slight spasmodic twitching? of the muscles particularly of the face, to which the name of inward fits has been popularly applied. The infant's sleep is imperfect and disturbed, am' it frequently 276 Woman's Medical Companion. awakes crying, and apparently much agitated; at other times it lies in a slate of imperfect sleep, with its eye-lids half open and eye-balls rolled upwards. Its breathing is soft and almost inaudible; the muscles of the nose and mouth are slightly convulsed, giving the appear- ance of a smile or an approaching laugh. The face sometimes changes repeatedly from a pale to a livid hue, particularly under the eyes and about the mouth. These inward fits, as they are termed, may almost always be referred to the presence of wind in the stomach and bowels, the expulsion of which gives almost immediate relief; or they may be produced by some slight irritation of those organs. For the removal of this iffection,all that is necessary isto takeup the child if it does not immediately awake, to tap it gently on the back, and rub its stomach and abdomen well with the hand before the fire. This will gene- rally cause an expulsion of wind, and the child will then fall quietly to sleep again. To prevent a recurrence of the symptoms, a dose of magnesia in a little cinnamon or aniseed water may be given, and strict attention should be paid to the infant's diet and regimen. CONVULSIONS. The immediate cause of convulsions in child- ren is an irritation or inflammation seated in the brain or spinal marrow. When convulsions Diseases of Infants. 271 depend upon a simple irritation of these parts, this is very often the result of an irritation ex- isting in the stomach and bowels, or in some other portion of the system, and transmitted sympathetically to the organs first mentioned. Thus improper food, an overloaded stomach, the irritation of retained feces or worms in the intestines, the irritation of the gums in difficult dentition, are frequent causes of convulsions. They may also be induced by the infant being subjected to the influence of a confined and un- wholesome atmosphere. In nearly all these cases an early removal of the exciting causes is sufficient very speedily to put a stop to the con- vulsions. When, however, those causes have been of long continuance, and the irritation has been repeatedly transmitted to the brain or spinal marrow, an inflammation of these organs may be produced, in which case the convulsions will be much more difficult to control, and often under the best devised treatment will terminate fatally. Convulsions may likewise be induced by causes directly affecting the brain and spinal marrow, as exposure to intense heat or to cold, blows and falls upon the head, violent parox- ysms of crying, fright, the abuse of anodynes and other active remedies, &c. Some children are more predisposed than others to convulsions from slight causes, and this predisposition may very generally be traced to improper nursing. During the presence of a fit, the remedies are, cupping, leeching, and cold applications or ice 278 Woman's Medical Companion. to the head, immersion of the feet in hot water, followed by mustard plasters to the ankles, and give injections of asa foetida one drachm, fluid extract of valerian one drachm in five or six oz. of water, one-third at a time, and repeating every half hour. Blisters to the nape of the neck will often be advantageous. In some cases, the warm bath is likewise productive of good effects. If the gums are red and swollen, they should always be freely lanced. While the fit lasts the infant should be supported in an upright posture, i 11 ligatures being removed from about its neck, body and limbs. To prevent a recurrence of the fits attention must be paid to restore the stomach and bowels to their healthy condition; to allay completely all irritation in the brain and spinal marrow, and to avoid carefully every ex- citing cause. CROUP. This fearful and destructive disease is pro- duced by exposure to a cold and damp atmos- phere, or by an imprudent style of clothing which leaves exposed the arms, shoulders and breast of the infant. The little patient is first seized with shivering, restlessness and a diffi- culty of breathing, which rapidly increases, and is accompanied with great heat of the skin, flushing of the face and other symptoms of fever; and a cough of a peculiar barking Diseases of Infants. 279 hollow sound, as if air were transmitted in a broken and violent manner through a brazen tube. The child throws back its head in the height of the disease, to favour respiration and escape impending suffocation. Respiration is not only interrupted by frequent convulsive fits of coughing, but has often a hissing sound as if the windpipe were in part obstructed by some soft substance. A degree of swelling and soreness of the throat generally takes place by which swallowing is rendered painful and diffi- cult. As the disease advances, the face becomes swollen and livid; the eyes protuberant and wild in their expression; the respiration becomes more shrill and difficult, and is performed at longer intervals. The cough is commonly dry; but sometimes thick purulent-looking matter is spit up, or shreds of a membranous appearance. The moment a child is seized with a hoarse croupy cough and difficulty of breathing, without the least delay a pretty active emetic either of tartarized antimony, ipecacuanha or any safe emetic substance that can be the most readily obtained should be given ; ice water compresses should be constantly laid on the neck. If the emetic does not take effect, then give chlorate of potash and tr. of chloride of iron in solution every 15 minutes. Cold water, poured slowly down the spinal column from a sufficient height, is often very beneficial when the emetic will not take effect. The emetic and ice are often sufficient, if early resort- ed to, completely to arrest all the symptoms of a 280 Wo man's Medical Companion. slight attack. If, however, the relief is only partial, a physician should be sent for without delay, who will direct the application of a suffi- cient number of leeches to the throat, and the swabbing out the throat every 15 or 30 minutes with a solution of nitrate of silver or chlorate of potash, of the strength of 2 drachms to 3 ounces of water. He will perhaps find it necessary to continue the use of tartar emetic in small nause- ating doses, or to resort to the mercurial remedies. If the symptoms persist, and he finds it unadvia- able to draw more blood by leeches, he will in many cases order the throat to be covered with a blister. Such are the outlines of the treatment demanded by a case of croup, and which, if promptly and judiciously carried into effect, will in a large number of cases save the child from a painful and speedy death. Delay in resorting to proper remedies, and timidity in their application, will be equally fatal; and if nothing helps, the operation of opening the wind-pipe may be ne- cessary. WORMS. Worms are less often the source of disease in children than is popularly imagined. In the generality of cases, the symptoms ordinarily referred to their presence are produced by an affection of the stomach and bowels and perhaps of the Drain, entirely independent of the exist- ence of worms, and which the remedies so commonly resorted to by parents and nurses, Diseases of Infants. 2R1 including the long list of vermifuges supplied b) the quacks, to cause their expulsion, cannot fail seriously to aggravate. We pretend not to say, that worms are never the cause of inconve- nience or of disease in children; but we do maintain that children will seldom if ever he troubled with them who are fed upon a whole- some and properly regulated diet; who are at the same time well nursed; exposed constantly to a fresh and wholesome atmosphere; defended from the effects of cold and moisture; and kept strictly clean. It is when the bowels have be- come weakened by disease, that worms are generated, and the mischief they occasion, when they do exist, is from the irritation they excite upon the lining membrane of the intestines, already brought to a state of morbid irritability, by the action of certain morbific causes to which the child has been subjected. The safest and indeed the only effectual means for destroying worms is evidently, therefore, such a diet and regimen as are calculated to restore the stomach and bowels to their healthy state, in conjunction with remedies that act by reducing the morbid irritability of these organs; as for instance, leeches to the abdomen, the warm bath, emollient fomentations, &c. When, however, alarming symptoms, as convulsions, a state of coma or insensibility, spasmodic twitchings of certain muscles, a convulsive cough, or slight delirium, are fairly attributable to the irritation caused by worms upon a morbidly excitable intestine: the 282 Woman's Medical Companion. immediate removal of the worms is then all important. Probably, the most certain means to effect this will be a doseof santoninefollowed by a spoonful of castor oil alone or combined with a few drops of spirits of turpentine. Rut against the free and continued use of these arti- cles when no violent or urgent symptoms are present, as well as against the use generally of any of the irritating and drastic purgatives, or substances supposed to operate as poisons to the worms, so commonly resorted to, we most loudly protest. They always prevent a suffi- ciently early resort being had to the course of treatment demanded by the actual complaint under which the child labours, and, of them- selves, not unfrequently produce serious and permanent injury. We have seen their use pertenaciously persisted in dav after day, and although the child evidently grew worse, the infatuated parents would not believe that any thing serious was the matter with the little suffer- er, until effusion of water had taken place in the brain and medical aid was no longer of any avail. APPENDIX. ASIATIC. OR EPIDEMIC CHOLERA. 283 ASIATIC, OR EPIDEMIC CHOLERA. As an epidemic, Cholera first made its appearance in Bengal during the month of August 1817. Since that period it has continued to prevail, with scarcely » any intermission, up to the present time, spreading itself over nearly the whole of India and the rest of Asia, over a part of Africa, and over a considerable portion of Europe. In 1832 it broke out in the Canadas, and visited successively nearly all the larger cities of the United States. By this terrible epidemic, provinces have been ravaged, and districts depopulated; entire garrisons have been destroyed, and victorious armies arrested in their triumphant progress. Under every point of view Epidemic Cholera claims the attention of every individual, and of every community. Though attended with the most violent symptoms, extremely rapid in its progress, and in relation to the real cause by which it is pro- duced, shrouded in the most impenetrable mystery; yet there are few diseases an attack of which can be so readily and certainly guarded against—while no one is so completely under the control of medicine during ite first stages 285 286 Woman's Medical Companion. CAUSES. Cholera, like all other epidemics, is evidently dependent upon a morbid change in the condition of the atmosphere. What is the actual nature of this change it is impossible to ascertain. By some it is referred to irregularities in the electrical slate of the air; others have presumed that the air be- comes loaded with poisonous effluvia emitted from the earth; while others restrict its cause to a change in the sensible properties of the atmosphere, in other words, to unusual coldness, heat, moisture or dryness —or to rapid and sudden transitions in these particu- lars. It is certain, that in most places where the cholera has appeared, it has been preceded or accom- panied by violent storms or earthquakes, or by sea- sons unusually disturbed. That the disease is in no degree contagious, that it is not capable of being communicated from the sick to the well, is now established by so many posi- tive facts, that it appears unnecessary to enter here into an examination of this point. Its non-contagious- ness is proved by the disease appearing, at the same time, at points far distant from each olher; while in situations intermediate between these not a single case will occur. Physicians, nurses, and attendants upon the sick, are not more affected by thertlisease than other classes of persons, nor even in as great a proportion; and individuals who were in hos- pitals with other diseases, and were seized with cholera, did not communicate the disease to the other patients in their immediate vicinity. Predisposing and Exciting Causes. 1st. A vitiated and damp state of the atmosphere. Cholera has always prevailed most extensively and produced the greatest ravages, in those situations ordi- narily the most unhealthy, particularly in the vicinity Asiatic, or Epidemic Cholera. 287 of low, wet, and marshy districts—along the low, muddy banks of rivers; in crowded towns and villa- ges, and in the hovels of the poor, where a proper ventilation is neglected, and in which all kinds oJ filth are allowed to accumulate. 2d. A constitution broken down by misery, vice, intemperance or fatigue. In every place where Cholera has made its appearance, the great majority of those attacked have been individuals of the lowest classes of the community; those living in the depths of vice and misery; the habitually intemperate ; those who were constantly exposed to fatigue, and to the inclemencies of the weather; and ihose who, from extreme poverty, are obliged to subsist on unwhole- some food, or such as is deficient in nutriment. But few persons in easy circumstances and of temperale lives have been attacked ; and in those few, the oc- currence of the disease could very generally be traced either to fatigue, to exposure to wet or damp or to the night air, to fear and anxiety, to improper food, as that which is too stimulating, difficult of digestion or flatulent, to fasting too long, to a consti- tution broken down by disease or a slate of conva- leseeney particularly from stomachic and bowel complaints, to the use of impure water, of cold and iced fluidsorof iced creams when the body is in a stale of fatigue, or overheated.to indulgence in acid drinks, or those which readily become sour in the stomach, as the weaker wines, table beer, cider, &c, to the imprudent use of medicine, especially emetics and purgatives, or to prolonged watchfulness PREVENTION. To avoid Cholera, therefore, an individual must live temperately on plain, nutritive food, simply cooked. He must avoid rich, high-seasoned soups and sauces, all made dishes and pastry; of salted provisions he must partake in great moderation, 288 Woman's Medical Companion. salted, dried, and smoked fish he must abstain from, as also pork, geese, ducks, crabs, lobsters, and the like. He must avoid all flatulent vegetables, as cabbages, radishes, green corn, dried peas and beans or those difficult of digestion, as mashed potatoes, cucumbers melons, mushrooms, pickles, &c. and likewise all unripe, decayed, or very acid fruit. H( must give up entirely the use of ardent spirits, bran- died wines, &c. as ordinary drinks: indeed, as a general rule, pure water should be his sole beverage. Active regular exercise in a free pure air, not carried bo far as to induce fatigue; regular and sufficient sleep; the avoidance of crowded assemblies, of the night air, of wet or damp, or extreme heat, or of ex- posure to cold, without due precaution, are other means essential to be observed, in order to escape an attack of Cholera. Personal cleanliness, and all the other means cal- culated to insure the due performance of the functions of the skin, are likewise all important preventives; hence the use of the warm bath daily, or sponging the entire surface with tepid water, followed by brisk frictions, morning and evening, and a flannel or thick cotton garment next the skin, should never be neg- lected. The possession of that species of moral courage which is intimately connected with a well informed mind; a reliance upon the goodness and superin- tending providence of the Supreme Being; and a consciousness of having fulfilled, to the utmost of our abilities, our religious as well as social duties (which, while they prompt us to avoid danger by the use of all practicable and rational means, pre- vent all unnecessary terror and alarm when the evil is present), have a powerful influence in guard- ing the system against disease during the prevalence of every epidemic. The necessity of comfortable, clean and well ven- tilated dwellings, situated in a dry, elevated and otherwise healthy situation, must be sufficiently Asiatic, or Epidemic Cholera. 289 evident to all. When, however, an individual is under the necessity of residing in a low, damp, unhealthy situation, much may still be done to pre- vent disease, by a proper attention to ventilation, during fine weather; by strict cleanliness; by closing th? doors and shutters before night fall; by occupy ing the upper rooms of the house, and, in very damp weather, by fires in the apartments where the family pass the day, and in the bed-chamber. SYMPTOMS. Epidemic Cholera, in regard to its symptoms, may be divided into four stages or periods. 1. The Stage of Diarrhoea. This stage is usually accompanied with griping pains in the stomach and bowels; by a sense of lassi- tude; rumbling of wind in the bowels; frequently, pain and giddiness of the head, and dull pains in the knees and loins. The pulse is various; the tongue is coated with a thin white or yellowish mucus, or thickly furred in the centre and red at the edges. The appe- tite is diminished; and the thirst increased. There are often shooting pains or stitches through the calves ox the legs. The foregoing symptoms are most usually attended with nausea, with frequent watery dis- charges from the bowels, or with a constant inclina- tion to go to stool without any evacuation taking place, or with only a thin mucous discharge some- times streaked with blood. This stage may last for several days before the symptoms of the ensuing stage are developed; in many cases the symptoms of the latter appear in a few hours. The occurrence of the second and subsequent stages depends greatly upon the constitution and habits of the patient, aa well as upon the circumstance of his having, or not, resorted to proper medical aid. In the debilitated and especially the intemperate, the discharges from T 290 Woman's Medical Companion. the bowels are not unfrequently from the first very copious, of the appearance of whey, and giving rise to a sense 6f extreme exhaustion, of faintness or even fainting In such cases, in a very few hours, cramps, vomiting and collapse are apt to come on; any im- prudence in eating or drinking, improper exposure, &c. will also accelerate the occurrence of the second and subsequent stages of the disease 2. The Stage of Spasm. This stago is characterized by violent pains of the stomach and bowels occurring at intervals; by pain of the head and back; by almost incessant vomiting and purging of a rice-water fluid ; by inordinate thirst and violent spasms, particularly of the muscles of the ex- tremities. The skin still remains warm, but is bathed with perspiration, and has a peculiar doughy feel; the tongue presents nearly the same appearance as in the first stage; the temperature of the hands and feet is reduced ; the pulse is often full and of some firmness ; in other cases it is very compressible; or-again, it is small and contracted. The mental faculties are un- impaired ; the countenance is expressive of great suffering or distress. In this stage the secretion of urine is often diminished in quantity or entirely sus- pended. 3. The Stage of Commencing Collapse. In this stage the skin is cold,livid and covered with a profuse clammy perspiration ; the tongue is also cold and livid; and the extremities corrugated as if they had been soaked in water; there are frequent cramps of the extremities; the eyes are sunk, the features contracted; there is constant purging, occasionally accompanied with vomiting; there is pain of the stomach, a small. feeble and depressed pulse, and a complete suppress- ion of the urinary secretion. The mental faculties ire stih unimpaired. Often considerable heat is fell over the stomach. Great thirst and a constant desire for cool air are almost invariably present. Asiatic, or Epidemic Cholera. 291 4. The Stage of Confirmed Collapse. This stage is marked by icy coldness, and a deep blue or purple hue of the skin, tongue and inside of the mouth; the extremities are corrugated ; the whole sur- face is covered with a profuse cold perspiration, which seems to exude in large drops from the pores of the skin. No pulsation can be detected in any of the su- perficial arteries, and the action of the heart is slow and feeble. Involuntary watery discharges flow from the bowels. The voice is low, husky, and almost extinct. The body exhales a peculiar and very dis- agreeable odour. There is a short quick respiration, with heaving of the chest. The patient complains of a burning heat in the region of the stomach, and craves without intermission cold water and fresh air; he is extremely restless, or doses with half open eyelids, the pupils of the eyes being rolled very much up wards. Until the very end, the mental faculties continue unimpaired. TREATMENT. The treatment of Cholera diners according to the stage of the disease. 1. In the first stage, when the patient is young and robust, the skin dry, the pulse frequent and hard, and the griping pains in the bowels constant or severe; a large mustard plaster over the abdomen, and another on the back, will be found of great service. Bathing the feet in warm water, also the applica- tion of frictions to the whole of the lower extrem- ities, or mustard poultices to the ankles, will also be decidedly beneficial. When the diarrhoea is but trifling, a dose of cam- phor with a few drops of laudanum should be given, and repeated if necessary. If the discharges from the bowels are very co- pious, and of a thin, watery and unnatural appear- aace, a pill of camphor, rhei and opium, repeated at 292 Woman's Medical Companion. proper intervals, will often be found very speedily to arrest these discharges, and after a time to pro- cure the evacuation of a very dark, viscid and offensive matter, followed by natural stools. When the griping and constant inclination to stool are peculiarly troublesome, place lumps of ice continually on the tongue, and an injection of thin starch, olive oil and opium will often remove very speedily the disease. The warm bath is a remedy well adapted to this stage when properly managed. Attention to diet and clothing is all-important. The patient should be confined exclusively to gum or rice water taken cold and in small quantities at a time; even after the symptoms of the disease have disappeared, the diet should consist for sev- eral days of well boiled oat meal gruel, thickened milk, or crackers boiled in milk. A very slight impropriety in diet will often bring back the very worst symptoms of the complaint, and render a cure impossible. 2. When Cholera has reached its second stage, there is not a moment to be lost—the least delay on the part of the patient, or timidity in the prac- titioner will be followed by the most fatal conse- quences. Give the patient every five minutes a dose of the following anodyne and cordial tinc- ture: Take of aromatic spirits of ammonia, lau- danum, chloroform and spirits of camphor li fluid drachms, creosote 8 drops, oil of cinnamon 2 drops, alcohol enough to make 1 oz. of the tinc- ture. Put a tea-spoonful of this in a wine-glass of ice water, and give one tea spoonful of the so- lution every five minutes until the patient decid- edly improves, then lengthen the intervals of doses till the symptoms all abate. This treat- ment, the result of much experience during the Asiatic, or Epidemic Cholera. 293 visitation of the cholera in 1849, 1850, and 1854, has been found very successful. The limbs of the patient should then be rubbed well with some stimulating liniment: these fric- tions are to be followed by mustard poultices to the ankles, wrists, thighs and arms. In this stage, particularly at its very commencement, bathing the feet in hot water will frequently be followed by a very good effect. Internally the patient should take iced water in small portions at a time; or when this is immediately rejected by the stomach, a tea-spoonful of powdered ice may be given every fifteen minutes. After the stomach has become calm and is capable of re- taining medicine, the pill of camphor and opium, as directed in the first stage, should be given, and repeated every two, three or four hours according to circumstances. By this treatment, in a very short period, the vomit- ing and spasms will be suspended, and the inordi- nate discharges from the bowels arrested. In many cases a dose of'castor oil will now bring away copious stools of a very dark and extremely offensive nature, after which the bowels will return to their natural condition. It is all important in this stage to prevent the patient from drinking too much; which, in conse- quence of his inordinate thirst, he will be very apt to do unless carefully watched. The warm and vapour baths do no good, but rather harm in the se- cond stage of Cholera; and the most pernicious effects will in general result, if recourse be had to stimu- lants, or to inordinate doses of opium or lauda- num. Occasionally it will be found that there is a ten- dency in this stage to an overloaded state of the vessels of the brain, indicated by drowsiness, dilated pupil, and a dark flushed appearance of the coun- tenance; here, cups to the temples or back of the 294 Woman's Medical Companion. neck, with cold applications to the scalp, should never be neglected. 3. When Cholera has reached its third stage, to save the life of the patient will demand great cir- cumspection, judgment, and decision on the part of the physician and attendants. The entire sur- face of the patient should, be diligently rubbed either with the hand, or a flannel cloth, wet with a liniment composed of equal parts of spirits of turpentine and a solution of pure ammonia; after the frictions, large mustard poultices should be applied to the arms, wrists, thighs and ankles; and the feet should be enveloped in bags filled with warm bran or sand, and the whole body covered with a blanket. By the treatment just detailed, the reduction of the symptoms is produced gradually : first there is a cessation of the profuse perspiration ; the fea- tures then become more natural, the corrugation of the extremities disappears, and finally the livid colour of the skin is removed and the natural tem- perature of this part is restored. Throughout the third stage of Cholera the pa- tient should be supplied, at short intervals, with small quantities of powdered ice or of iced"water. Even greater caution than in the second stage, will be required to prevent him from indulging his inordinate thirst; to guard him against the use of stimulants, and the too free administration of opiates. In the early period of this stage all kinds of food are to be abstained from: when conva lescence has been established, the same remarks in regard to diet will apply as were made in refer- ence to the first stage. Asiatic, or Epidemic Cholera. 295 4. When the period of confirmed collapse has arrived, little hopes of recovery need be enter- tained. The patient should be carefully rubbed over the whole body with ice, then dried and wrapped in dry blankets outside of which bags filled with warm bran or bottles of hot water may be applied, and internally give champagne and ice, or rum and Selters water, or oue gr. camphor every £ hour, or spirits of hartshorn one draohm in 6 oz. sugar water, a table-spoonful every i to $ hour. Also rub the body with spirits of mustard, and for the cramps in the calves of the legs rub them with chloroform and camphor spirits. As soon as reaction takes place and has been fully established, the treatment should be con- ducted as in the other stages. In the period of reaction let the patient sleep and perspire freely, and continue giving him Selters water and ice. To arrest the discharges from the bowels, give £ gr. calomel every 3 hours with or without opium; if vomiting should take place, give small doses of morphium 1-15 gr.,—and a mustard plaster over the stomach; if there is a tendency of con- gestion to the head, apply cold iced cloths or leeches. After recovery, the patient must natu- rally be very careful for a long time with his diet. » INDEX. After-pains, 133 Age of Menstruation, 216 Air and Exercises, 25 Anodynes, 196 Aphthae, 265 Asiatic Cholera, 285 Astringent Injections, 235 Baths, Warm, 44 Bedding for Infants, 167 Belly Band, The, 158 Breakfast, 63 Bowel Complaint, 269 Cancer of the Womb, 240 Calisthenics, 41 Carrying Infants, 188 Causes of Cholera, 286 Chafing, 253 Cholera, 285 Cradle, The, 167 Cessation of the Menses, 218 Cheerfulness, 102 Cholera Infantum, 272 Cleanliness, 42 of Infants, 172 Clothing for Girls, 29 Coffee, 62 Colic, 254 Conduct in Pregnancy, 117 after Delivery, 127 Convulsions, 276 Corsets, 50 Costiveness, 253 Covering the Feet, 56 Croup, 278 Dancing, 40 Dentition, 198 Despondency, 102 Diarrhoea, 269 Diet of Children, 182 Females, 63 Difficult Menstruation, 223 Dinner, 63 Diseases of the External Parts, 227 of the Womb, 227 of Infants, 251 of Menstruation, 215 Drink, 58 for Children, 183 Dress, 47 of Infants, 177 Pregnant Women, 117 Dyspepsia, 67 Early Rising, 30 Eruptions, 260 Errors in Dress, 24 Excessive Flow of Menses, 223 Excess in Eating, 60 Excoriations of Skin, 253 Exercise, 35 of Infants, 187 of Girls, 27 Falling of the Womb, 231 Fasting, 61 Final Cessation of the Menses, 226 Flannel, 57 Flatulency, 256 Fleshy Tumours of theWomb, 237 Flimsy Clothing, 48 Food, 58 Gathered Breasts, 135 Gluttony, 58 Grief, 104 Griping, 254 Green Sickness, 218 Halstead's Method of Sham- pooing, 97 297 INDEX. Health, Early Attention to, 23 Heating and Stimulating Food, 182 Hiccoughs, 256 Hives, 201 Horseback Biding, 38 Hysterics, 243 Improper Dress, 24 Indigestible Food, 62 Infant's Sore Mouth, 265 Inflamed Breasts, 135 Introduction, 15 Inversion of the Womb, 235 Inward Fits, 275 Itching of the External Parts, 230 Jaundice, 257 Lancing the Gums, 203 Late Marriages, 108 Rising, 30 Love, 103 Lying in, 128 Food, 130 Suckling, 131 Bedding, 132 After-pains, 133 Management of Infants, 155 of Temperature, 156 of Washing, 157 of Belly Band, 158 of Clothing, 160 of Food, 161 Marriage, 106 Premature, 107 Late, 108 Meconium, Eetention of, 252 Milk Blotch, 261 Necessity of Early Attention to Health, 23 Neglect of Physical Educa- tion, 24 Early Rising, 30 Nursing, 140 Diet, 142 Drinks, 143 Nursery, The, 171 Objections to Vaccination, 207 Obstructions toMenstruation, 217 Over-exertion, 102 I Painful Menstruation, 223 | Passions, The, 101 Despondency, 102 Amiability, 102 Love, 103 Grief, 104 of Infancy, 193 Pessaries, 233 Polypus of the Womb, 239 Predisposing Causes of Chol- era, 286 Pregnancy, 113 Symptoms, 114 Premonitory Signs, 115 Quickening, 115 Tight Lacing, 118 Exercise, 119 Repose, 121 Early Rising, 121 Company, 121 Food, 122 Drinks, 123 Bleeding, 126 Prevention of Cholera, 287 Progress of Vaccination, 211 Prolapsus Ani, 274 Purulent Ophthalmy, 259 Physical Education, 24 Quickening, 115 Quieting Infants, 195 Reading Aloud, 41 Red Gum, 261 Regular HabitsinRetiring,32 Remedies for Painful Men- struation, 225 The Whites, 229 Retention of the Menses, 218 Urine, 239 the Meconium, 252 Riding on Horseback, 38 Rocking Infants, 168, 187 Ruptures, 257 Scald Head, 263 Shampooing, 97 Shoes, 56 Singing, 41 Skin, Excoriations of, 253 Sleep of Infants, 165 Soothing Cordials, 196 INDI Sore Eyes, 258 Sore Ears, 262 Sore Nipples, 137 Sponging, 44 Swelling of Glands of Throat, 204 Snuffles, 267 Summer Complaint, 272 Supper, 64 Suppression of the Menses, Symptoms of Cancer of the Womb, 240 Cholera, 289 Falling Womb, 232 Hysterics, 244 Pregnancy, 114 Tea, 62 Teaching an Infant to Walk, 189 Temperance, 59 Thrush, 265 Tight Lacing, 51 Training for Health, 80 Cleanliness, 91 Costiveness, 95 299 Diarrhoea, 96 Drinks, 86 Exercise, 88 Exposure, 93 Food, 81 Repose, 90 Shampooing, 96 The Passions, 94 Treatment of Cancer of the Womb, 241 Cholera, 291 Hysterics, 245 Vaccination, 205 Vomiting, 269 Wakefulness of Infants, 165 Walking, 36 Warm Bath, 44 for Infants, 174 Washing Infants, 157,174 Weaning, 149 Whites, The, 227 Wine, 65 Worms, 280 Yellow Gum, 261 THE END. NLM005558845