P^;';& stvf* ^•^JShh iii Bk''3oo5RKI v<(y00l)Qi^y^QTyQ^0Q'0£)'CQ0QrCOCD'Ul Surgeon General's Office fc !&» ei£ Hi HOMEOPATHIC BOOKS, for salt by Wm. Radde, 322 Broadway, New-York. Jahr's New Manual: originally published under the name of Symp- tomen-Codex. (Digest of Symptoms.) This work is intended to facili- tate a comparison of the parallel symptoms of the various Homoeopathic agents, thereby enabling the practitioner to discover the characteristic symptoms of each drug, and to determine with ease and correctness what remedy is most Homoeopathic to the existing group of symptoms. Trans- lated, with important and extensive additions from various sources, by Charles Julius Hempel, M. D., assisted by James M. Quin, M. D., with revisions and clinical notes by John F. Gray, H. D. ; contributions by Drs. A. Gerald Hull, George W. Cook, and Dr. B. F. Joslin, of New- York; and Drs. C. Hering, J. Jeanes, C. Neidhard, W. Williamson, and J. Kitchen, of Philadelphia; with a Preface by Constantine Hering, M. D., 2 vols., bound $11. 00. The third volume is issued as a separate work, under the title of Com- plete Repertory of the Homoeopathic Materia Medica. By Charles J. Hempel, M. D. 1224 pages. Price $6, or all 3 volumes at $17. Jilhr'S New Manual of Homoeopathic Practice; edited, with Anno- tations, by A. Gerald Hull, M. D. From the last Paris edition. This is the fourth American edition of a very celebrated work, written in French by the eminent Homoeopathic Professor Jahr, and it is considered the the best practical compendium of this extraordinary science that has yet been composed. After a very judicious and instructive introduction, the work presents a Table of the Homoeopathic Medicines, with their names in Latin, English and German; the order in which they are to be studied, with their most important distinctions and clinical illustrations of their symptoms and effects upon the various organs and functions of the human system. The second volume embraces an elaborate Analysis of the in- dications in disease, of the medicines adapted to cure, and a Glossary of the technics used in the work, arranged so luminously as to form an ad- mirable guide to every vmedical student. The whole system is here dis- played with a modesty of pretensions, and a scrupulosity in statement, well calculated to bespeak candid investigation. This laborious work is indispensable to the students and practitioners of Homoeopathy, and highly interesting to medical and scientific men of all classes. Complete Symptomatology and Repertory, 2 vols., bound, $6. 00. Jahr, Dr. G. H. G., Clinical Guide, or Pocket-Repertory for the Treatment of Acute and Chronic Diseases. Translated from the Ger- man, by C. J. Hempel, M. D. 1850. Bound, $1. 50. Jahr, Dr. G. U. G., Diseases of the Skin; or Alphabetical Repertory of the Skin-symptoms and external alterations of substance, together with the morbid phenomena observed in the glandular, osseous, mucous, and circulatory systems, arranged with pathological remarks on the dis- eases of the skin. Edited by C. J. Hempel, M. D. 1850. Bound, $1. Jahr, Dr. G. H. G., and Grnner's New Homoeopathic Pharmacopoeia and Posology, or the Mode of Preparing Homoeopathic Medicine, and the Administration of Doses, compiled and translated from the German works of Buchner, Gruner, and the French work of Jahr, by C. J. Hempel, M. D. 1850. Bound, $2. 00. Jahr'S, Dr. G- H G., and Possart'S New Manual of the Homceopa- pathic Materia Medica, arranged with reference to well authenticated ob- servations at the sick bed, and accompanied by an alphabetical Repertory, to facilitate and secure the selection of a suitable remedy in any given case. 4th edition, enlarged by the Author. Symptomatology and Re- pertory. Translated and edited by C. J. Hempel, M D. 1853. Bound, $3. 50. William Radde, Publisher, [322 Broadway, Kew-York. BOOKS BY THE SAME AUTHOR. ROKYTANSKYS PATHOLOGICAL ANATOMY ; Translated from the Ger- man with additions on Diagnosis, from Schonlein, Skoda, and others, by Dr. John C. Peters. 75 cts. Opinions of the Press.—'1 Dr. Rokytansky's book is no more than it professes to be : it is morbid Anatomy in its densest and most compact form, scarcely ever alleviated by histories, cases, or hypotheses. It is just such a work as might be expected from its au- thor, who is said to have written in it the result of his experience gained in the careful examination of over 12,000 bodies, and who is possessed of a truly marvellous power of observing and amassing facts. In the course of our analysis we have said comparatively little of its merits, the best evidence of which is found in the length to which our abstracts have been carried without passing beyond the bounds of what is novel or important. Nor would this fault have been committed though much more had been borrowed, for no mo- dern volume on morbid Anatomy contains half so many genuine facts as this; it is alone sufficient to place its author in the highest rank of European medical observers."—British and Foreign Medical Review. Just published: RUECKERT, TH. J., A TREATISE ON HEADACHES; with Introduction, Appendix, Synopsis, Notes, Directions for Doses, and eighty additional cases, by John C. Peters, M.D. 1853. Bound. 75 cts. " Dr. Peters' book owes its existence to the work of Dr. Ruckert just alluded to, but it is no mere translation, indeed it may almost be considered as an original and independent treatise on Headaches. To a certain extent the author has followed Riickert's arrange- ment, and given all his cases and clinical remarks, but Dr. Peters' volume is enriched by more than eighty additional cases taken from sources not accessible to Ruckert, to wit, the French, English and American homoeopathic publications. Scattered throughout the work are many useful practical remarks in the form of notes, and at the end is a good synopsis, of the indications for the employment of the different remedies for headache. There is also an excellent introductory chapter on the nature and causes of headaches, which con- tains much curious and interesting information. We may give the reader some notion of the immense amount of original matter in Dr. Peters' volume, when we state that the number of pages in Riickert's work occupied by headaches is but 68, whereas Dr. Peter's book contains 173 pages of nearly equal size. " Dr. Peters promises a second volume, on Apoplexy, encephalitis, and hydrocephalus, still founded, wo presume, on the work of Ruckert; and if he shall follow Ruckert through all his diseases in the manner in which this volume is executed, we shall be forced to admit that the German original has, like a bishop, gained by translation."—British Journal of Homceopathy. RUECKERT ON APOPLEXY AND PALSY. Successful Homoeopathic Cures, collected from the best homoeopathic periodicals. Translated and edited by J. C. Peters, M.D. With full descriptions of the dose to each single case. 1853. Bound, 75 cts. This is another of the series of able monographs, for which the medical profession is in- debted to the learning and zeal of Dr. Peters. It is founded on Rveckert's Clinical Ex- perience, but contains such large and important additions as to make it essentially a new contribution to medical literature. The number of pages in Riickert's work occupied by Apoplexy is but 18, while Dr. Peters' book contains 164 pages of equal size. The editor or rather author has availed himself freely of the labors of Rokytansky, Hasse, Simow, Lehmann and other foreign medical writers of distinction, as well as his own experience in fifteen years study of Homoeopathy. He is not, however, to be regarded as a professional sectarian. In the treatment of such terrible diseases as Apoplexy, Palsy and Softening of the Brain, he strenuously urges the importance of discarding all considerations of preju- dice, theory or system, and of aiming only at the welfare of the afflicted patient. The Appendix on Softening of the Brain is peculiarly- valuable. William Radde, Publisher, 322 Broadway, New-Fork. A TREATISE ON THE DISEASES OF FEMALES—Disordvks or Men- struation—by John C. Peters, Ml)., with full description of the dose to each single case. 1853. Bound, 75 cts. This work is compiled in part from the highest medical authorities upon the subject of which it treats, and in part from the memoranda made by the author during a professional experience of fifteen,4>r more years. We may add that the volume before us is written in a style perfectly intelligible to the non-professional reader, and contains information of which no mother should be ignorant. Just published : A TREATISE ON THE DISEASES OF MARRIED FEMALES, including the Disorders of Pregnancy, Parturition, and Lactation, by J. C Peters, M.D Preparing for Press : A TREATISE ON THE DISEASES OF THE WOMB, OVARIES, AND UTERINE APFENDAGES—by John C. Peters, M.D. In Press, and will soon be published: A COMPLETE TREATISE O.N DISEASES OF THE EYE. Ready for Press : A COMPLETE TREATISE ON NERVOUS AFFECTIONS, AND MEN TAL DERANGEMENTS. HOMEOPATHIC MEDICINES. Wm. Raddk, 322 Broadway, New-York, respectfully informs the Homoeopathic Physicians and the friends of the System, that he is the sole Agent for the Leipzig Central Homoeopathic Paarmacy, and that he has always on hand a good assortment of the best Homoeopathic Me- dicines, in complete sets or by single vials, in Tinctures, Dilutions, and Triturations; also, Picket Cases of Medicines; Physicians' and Family Medicine, Chests to Laurie's Domestic (60 to 82 Remedies).—EPP'S (60 Remedies, —HERlNG'S (60 to 102 Remedies).—Small Pocket- cites at $3, with Family Guide and 27 Remedies.—Cases containing 415 Vials, with Tinctures and Triturations far Physicians.—Cases with 260 vials of Tinctures and Triturations to Jahr's New Manual or Symptomen-Codex.—Physicians' Pocket Cases with 60 Vials of Tinctures and Triturations—Cases from 200 to 300 Vials with low and high dilutions of medicated pellets.— Oases from 50 to 80 Vials of low and high dilutions &c. dec. Homoeopathic Chocolate. Re- fined Sugar of Milk, pure Globules, Those who suffer Avith severe pain for one or several hours after each move- ment of the bowels, should either lie down for some time after stool, or else change their habit of evacuation to the night, just before bed time, so that they may have entire rest in the recum- bent posture. In many cases there is a slimy discharge and an evidently unhealthy state of the mucous surface of the piles; Pulsatilla may be given when there are discharges of blood and mucus, with pains in the back, tendency to diarrhoea and difficulty of urina- tion. Capsicum, when there is great irritability of the gastric and intestinal mucous membrane, Avith burning heat and itching at the anus, Avith pain and heat during urination. Copaiba and Cubebs, when there is a profuse discharge of pus, or muco-pus from the boAvel. Although Capsicum, or red-pepper is most relied upon by homoeopathists, yet in the old school the confec- tion of black pepper, better known as Ward's paste, has long been in great repute as a remedy for piles, and Curling says, there can be no doubt, that it exerts a beneficial influence upon the complaint; this preparation is supposed to pass through the alimentary canal but little altered, and on reaching the rectum haemorrhoids, or piles. 73 to act directly upon the piles as a stimulating application ; the Cubebs pepper taken internally seems to relieve piles much in the same way as the 'confection of black pepper.—(Curling). In cases Avhere there is much irritation about the mucous mem- brane of the rectum, great relief may be obtained from the Bal- sam of Copaiba. When there is much inflammatory irritation Avith or without discharge of blood, Aconite is the most appropriate remedy. Belladonna and Stramonium are regarded as peculiarly suited for females, when there is haemorrhoidal constipation from con- gestion, swelling, or inflammatory irritation of the piles, attended with violent pains in the small of the back, discharge of blood for several days, urgent tenesmus and spasmodic contraction of the anus, with constant pressure and bearing down of the boAvel. Nux and Ignatia are most homoeopathic when there is much spasmodic irritation of the lower bowel; they are admirable pal- liatives, when there is a lax state of the sphincters, alloAving the piles to protrude when the patient stands or walks. Ignatia is most indicated, when the stools are soft; Nux, Avhen they are hard and constipated; while Sulphur is the most important re- medy where there is alternate constipation and diarrhoea. When there is profuse bleeding from the piles, Sabina, Mille- folium and Aloes are the most important remedies. Where there is ulceration of the rectum, Arsenicum, Acid- nitric and Acid-muriat. are the most useful remedies. In the majority of cases, the alternation of Nux and Sulphur, one dose every evening, will soon produce a most marked alle- viation of all haemorrhoidal sufferings; if the constipation be very obstinate, Ignatia and Opium should be given in alterna- tion every two or three hours until relief is obtained. But I regard Aloes as by far the most homoeopathic and useful re- medy ; it may be given in alternation with Ferrum, if the loss of blood has already been very great, and a certain amount of Anaemia has been produced. Tilt says, that he has never seen piles produced by the frequent use of Aloes, but he has often seen them relieved by it, and his experience is corroborated by that of Giacomini, Avicenna, Stahl and Cullen. Sulphur and Aloes in alternation are almost specific against 74 DISORDERS OF PREGNANCY. piles, when attended with marked bilious derangement, or torpor of the liver. Calcarea and Sulphur have been given successfully against the consequences of suppression of piles, such as continual ver- tigo, even Avhen so severe, that the patient is apt to fall down unconscious ; congestion of blood to the head, constant aching in the back of the head, palpitation of the heart, great excitability of the whole vascular system, pulsations throughout the whole body, violent, oppressive, stupefying headache, and weakness of memory, with anguish and oppression of the chest from slight physical exertions or moral emotions. DOSCS.—Nux has been used successfully in repeated doses of the tincture ; also in the 3d and 30th dilutions. Sulphur has been most useful when given in the tincture, or 1st trituration, or in doses of ^-0 of a grain. Muriatic acid, in the 1st dilution; Nitric acid, in the 5th t potency ; Arsenicum, in the 30th dilution ; Aconite and Belladonna in the tincture, or 1st, or 3d dilution. INCONTINENCE OF URINE. This inconvenience has already been alluded to, (see page 10). During the early months of pregnancy it generally arises from irritability of the neck of the bladder, or of the entire or- gan, in consequence of its sympathy with the womb. The pa- tient is tormented with a constant and painful desire to make water; and often, if this desire be not instantly gratified, it is discharged involuntarily. The irritation is sometimes extended to the vulva, and is greatly aggravated by the passage of the urine ; the patient may suffer intensely, especially in the night, from scalding, itching and pain of the external genital parts. It may also arise from pressure of the womb upon the neck of the bladder, giving rise to a partial and temporary paralysis of it. At a later period of gestation, the incontinence is owing to the pressure of the enlarged womb upon the base and body of the bladder, diminishing its capacity, and hence rendering the calls to urinate frequent, be they voluntary or involuntary. This pressure may cause a tedious paralysis of the bladder, so that it may be some time after delivery before its functions are perfectly restored. The incontinence will be much increased, if the pa- retention of urine. 75 tient has a cough, as each paroxysm will be apt to let the urine escape. In some cases the condition of the patient is very distressing ; the constant discharge of urine excoriates the vulva more or less, and the upper part of the thighs, so that the patient can- not move without pain, and the urinous odor may be extremely offensive. RETENTION OF URINE. This seems to be an opposite condition from incontinence, or inability to retain the urine, yet both are apt to arice from very similar causes. Irritation of the neck of the bladder may give rise to frequent evacuations of urine, or if it proceed to a greater degree, may cause spasmodic constriction, and consequent reten- tion. Pressure upon the neck of the bladder may irritate, or completely compress and obliterate it; pressure upon the body of the bladder may cause paralysis of this, and leave the neck either naturally, or spasmodically contracted. An attack of piles, or swelling of the urethra, may also cause retention of urine. It is scarcely necessary to describe the symptoms of retention of urine, although a few words may be said about its conse- quences ; these are : difficulty, or inability to evacuate the blad- der ; great distention of the bladder, so that it presses back upon the womb, and may retrovert, or tilt it backAvards ; if re- lief be not afforded, the pain and tension of the bladder may in- crease to agony, the abdomen become tender, and ultimately the bladder may burst, and the urine be effused into the Cavity of the abdomen. Should retention occur at the commencement of labor, the consequences may be very serious ; for the bladder may be forced down into the cavity of the hips by the descent of the child's head, and if it be not ruptured, which is very likely, the bladder will receive such a serious compression and contusion as will doubtless excite inflammation, sloughing and perforation subse- quently, and all the horrible consequences of vesico-vaginal fis- tula. Treatment.—Nux vomica is recommended both against re- 76 DISORDERS OF PREGNANCY. tention of urine from paralysis of the bladder, and against in- continence of urine from morbid irritation of the neck of the bladder, with frequent calls to urinate, with pain or urging, without any particular change in the character of the urine. The South Pole of the Magnet has also removed a kind of paralysis ' of the bladder. Cicuta, 3d dilution has cured paralysis of the bladder, with involuntary urination. Conium 30, has relieved a painful retention of urine. Cannabis has relieved obstinate retention of urine, when accompanied by obstinate constipation. Cannabis has also relieved the most violent irritation of the bladder, with violent desire to urinate and discharge of a few drops only of bloody and acrid urine. Cantharides is homoeo- pathic to a very similar state to the above; also Capsicum. Staphisagria also relieves painful micturition, when the urine is only passed drop by drop. Rhus has cured incontinence of urine, the urine being passed in\Toluntarily unless the desire to pass it is satisfied immediately. Pulsatilla, Bellad., Cina, Magnes.-carb. and Antimon.-crud. also deserve attention in obsti- nate cases. Dulcamara is efficient against tenesmus of the bladder brought on, or aggravated by taking cold. Sulphur is said to have cured urinary fistula. SPASM OF THE URETERS. Pregnant females are occasionally subject to accessions of severe pain in the course of the ureters, leading up to the kid- neys, and this Churchill says, Dr. Burns attributes to spasm oT the ureters, probably OAving to pressure upon these ca- nals as they pass into the cavity of the hips ; the attack con- sists of severe and sometimes intermitting pain, with distress- ing strangury, Avhich may cause abortion if not relieved. Change of position will sometimes relieve the pain by removing the pressure; if Cannabis, Pulsat. or Cantharides do not afford re- lief, Opium should be resorted to, as it is not only anodyne, but also homoeopathic to irritation of the bladder and ureters, and to difficulty or retention of urine. Camphor is a useful pallia- tive. These attacks may be mistaken for colic, and for conges- tion or irritation of the ovaries. (See page 10). WHITE-WEAKNESS. 77 ITCHING OF THE VULVA, is not an uncommon accompaniment of pregnancy, owing pro- bably to the increase of fluids in this part during gestation; at times it is owing to an aphthous or cankered condition of the mucus membrane of the vagina. Treatment.—Sulphur, Sepia, Opium and Borax are the most important remedies. CEDEMA OF THE LABIA, / is rather rare during the early months of pregnancy; it is most common during the seventh, eighth and ninth months. In many cases it is the result of pressure on the veins byjthe en- larged womb, and is most common in those females who have such large hips that the womb can settle down into the pelvis. In another class of cases it appears as part of a general dispo- sition to dropsy. It is attended with a sensation of fulness, with more or less stiffness of the parts, and difficulty or pain in moving. (See Dropsical affections). Mauriceau has described a variety in which there is always considerable itching. Aphthous inflammation may set in, and erysipelas may even occur. Still the whole affection generally disappears soon after delivery. Treatment.—Arsenicum, Digitalis and Apis-mell. are the most important remedies. WHITE-WEAKNESS, or VAGINAL LEUCORRHCEA, is an extremely frequent accompaniment of pregnancy, so much so, that few females entirely escape, although it is rare for it to produce serious effects. It is worse before the womb rises from the pelvis than subsequently, as it is frequently caused by the gravid womb producing irritation, and by the slow return of the bloed from the vagina, OAving to the pressure of the womb, coupled with the increased Aoav of blood to all the sexual parts, which takes place during pregnancy. The state of the patient's 78 DISORDERS OF PREGNANCY. constitution has also much to do with the frequency and severity of leucorrhcea during gestation. When excessive it causes much debility and aggravates the aching in the back., of which pregnant Avomen so often complain ; but at the end of gestation it is said to render the labor more easy, by lubricating and relaxing the passages. Frequently, the discharge is merely an excess of natural mu- cus, transparent, colorless and bland; occasionally it is thicker and yellowish and greenish, but rarely acrid; sometimes it is attended Avith acute inflammation. Treatment.^Bovista is one of the most important remedies ; Sulphur is said to cure many chronic cases ; Pulsatilla, when the discharge is thick like cream, and causes itching and irrita- tion ; ^epia, if the discharge is yelloAvish, greenish, fetid or corrosive, and attended with bearing-down-pains. Cocculus, if it is reddish and attended Avith much colic and flatulency ; Cal- carea, when it is white and corrosive. DISCHARGE OF WATERY FLUID FROM THE VAGINA. HYDRORRHEA, OR FALSE WATERS. Pregnant females are occasionally attacked with a fluid dis- charge from the \Tagina, quite distinct from the leucorrhcea, which has been described. It may occur, once or several times during pregnancy, and continue for a week or two, or it may persist for several months. These discharges are neither preceded or followed by any pains or contractions of the Avomb; their nature is such as to interfere but slightly with the pregnancy, the latter advancing as usual to its natural term, and at the time of delivery the true bag of waters is regularly formed. Most generally the female enjoys her usual health before the discharge comes on, when she unexpectedly finds herself wet, the fluid escaping drop by drop, or else she hears the peculiar sound caused by the sudden discharge of a considerable quantity of waters. In most cases she suffers no pain either during or after the discharge, though slight uterine contractions may set in; but if the patient keeps perfectly quiet, the pains soon cease \ EXCESS OF WATERS, WITHOUT DISCHARGE. 79 and everything resumes its natural order again. The diseharged waters are usually a little yellowish, very limpid, and at times tinged with blood, leaving stains upon the linen, and having a well marked spermatic odor. The discharge is much influenced and increased by mental emotions and bodily excitement; on the other hand it augments in quantity during the most perfect quietude, as for instance, at night during sleep. In one case, observed and treated by myself, the discharges only took place at night, during rest or sleep, and then often amounted to one or several pints. Cazeaux supposes, that the fluid is formed outside of the membranes, between the internal surface of the Avomb and some portion of the external surface of the membranes, Avhich becomes detached; that is to say, the fluid is secreted from the internal surface of the womb, gradually detaches the membranes, thereby forming a pouch for itself, until its constantly increasing quan- tity succeeds in separating them as far as the neck of the womb ; when a discharge of the fluid takes place. He thinks, that this is the only supposition, which Avill account for the frequency and abundancy of the discharges, without rendering the true Waters less abundant than usual at the time of confinement, and Avithout there being any marks of laceration of the membranes from careful examination after delivery. Treatment.—Although this is generally not a serious affec- tion, still it is a very annoying one. Churchill thinks, that nothing can be done except to keep the patient dry, quiet and clean. Arsenicum and Digitalis deserve attention. I once re- lieved a case with Arsenicum in which there were sudden, fre- quent and profuse discharges of waters from the vagina. EXCESS OF WATERS, WITHOUT DISCHARGE. DROPSY OF THE AMNION. In this affection the principal suffering is mechanical, from the pressure of the excessive quantity of Liquor amnii upon the neighboring parts. The womb is much larger than usual, and proportionably more weighty, rendering the patient very un- comfortable in the upright position and in Avalking; if the walls 80 DISORDERS OF PREGNANCY. of the abdomen be flaccid and weak, the womb may fall forwards, causing what has been called pendulous belly, and adding greatly to the distress. In most cases considerable inconvenience is felt from the increased pressure on the bladder, and upon the stomach and bowels. It would naturally be supposed, that the greater size of the womb and belly would more decidedly ob- struct the various veins and blood-vessels of the legs, and cause them and the feet to swell more than usual; but this does not appear to be the case. The patient's urine is generally scanty; and the infant is very apt to be enfeebled or diseased, or even to die before de- livery. The great distention of the womb sometimes occasions delay in labor, from the too great stretching of the muscular structure of the uterus, and flooding aftenvards, from a kind of paralysis from previous over-distention, which interferes with the due con- traction of the womb. Treatment.—The scanty secretion from the kidneys may be increased by the use of Arsenicum, Digitalis, Scillae, Apis, or Apocfynum. (See Dropsical affections). MENSTRUATION DURING PREGNANCY. Bloody discharges are not very uncommon during pregnancy —some females menstruate once or twice after conception; in others the discharge returns for four, five or six months, or even during the whole period of gestation. In a few very rare cases the menses appear for the first time during pregnancy, or only during gestation. Churchill thinks that there is not any risk of abortion or premature labor, but these cases should be care- fully and anxiously distinguished from those of placental pre- sentation. Churchill thinks, that they are cases of vicarious men- struation, and that it is neither more or less difficult to account for a monthly discharge of apparently menstrual fluid from the vaginal mucous membrane, than from the mucous membrane of the gums, eyes, ears, or from the surface of an ulcer. (See my Book on Disorders of Menstruation, p. 116). The discharge or secretion may also take place from the internal surface of a MENSTRUATION rfURING PREGNANCY. 81 portion of the womb, in the same way as suggested, when treat- ing of False waters, or Watery discharges from the Vagina during Pregnancy, see page 78). Whitehead, however, gives a different and probably very satisfactory explanation; he says, all his patients had leucor- rhcea in greater or less degree, accompanied by the train of sym- pathetic disturbances usually attendant upon these affections. This product communicated yellowish stains to the linen upon which it was deposited, and exhibited alkaline properties; evi- dences of a conclusive character as to its purulent character. ^ On examination with the speculum, inflammation or ulcera- tion of one or both labia, or of the neck of the womb, compli- cated in some instances with warty excrescences growing from the neck, or from some part of the vaginal membrane, or inflam- mation of the vagina, &c, was met with in every case, without an exception. Fifteen cases Avere submitted to vaginal exami- nation while the blood was flowing. In not one of these did any fluid whatever escape from the interior of the womb; the orifice being completely occupied at the time by a plug of transparent mucus. On removing the accumulated secretion by means of a piece of lint, the parts were immediately afterwards covered by a coating of blood, which was distinctly seen issuing from in- numerable pores on every part of the diseased surfaces, and soon collected in sufficient quantities to trickle down into the speculum. Whitehead thinks, that his experience is suffi- ciently ample to establish as a general rule, that the blood dis- charged in cases of alleged menstruation during pregnancy is not furnished by the lining membrane of the AA'omb, or by any healthy secreting surface, but by the lower extremity of the womb, external to its cavity, or by the neighboring portions of the vagina, one or the other being in a state of ulceration or suppurative inflammation. Treatment.—Arsenicum, Cantharides, Argentum-nitricum and Sabina, or Crocus, are the most important remedies, although Cocculus, Kali, Phosphor and Rhus have been used successfully. Where there is decided ulceration of the neck of the womb, Aveak injections of Nitrate of Silver, Bichromate of Potash, Nitrate of Mercury, or of Aurum-, or Stannum-muriaticum may be care- fully used. ^ F DISORDERS OF PREGNANCY. Mercurius, Nitric-acid, Thuja and Sepia deserve attention, also Kreosote and Sulph.-acid. UTERINE HEMORRHAGE. BLEEDING FROM THE AVOMB. This is an entirely different and much more serious affection than menstruation during pregnancy. It is almost always either a precursor of abortion, or else is a sign of placental presen- tation. This can only be decided by carefully watching the case, or by a vaginal examination. In the mean time, the patient should be put to bed immediately, and preserve the horizontal position not only until the complete cessation of the discharge, but until all danger of its return is past. Cold drinks and spare diet should be given ; the body kept cool; the bed covering light, and the room moderate in temperature. Treatment.—According to Croserio and Leadam, if the bleeding should occur in consequence of a muscular effort to raise or carry anything, a violent exertion of the body, of a mis- step, or fall, or bloAv upon the stomach or back, Arnica should be given, either in the tincture or 3d dilution, and repeated every five, ten or fifteen minutes, according to the urgency of the case. Ipecac, should be used if the flow of blood is copious, and comes in a continued stream, attended with pains at the navel, bearing doAvn efforts, arid pressure upon the Avomb, and lower boAvel, with chills, or general coldness, but heat of the head and face, general lassitude and inclination to lie down. Dose.— Either sufficient of the tincture or powder should be given produce slight nausea, or elsev the 3d or 6th dilution may be used every ten or fifteen minutes until relief ensues. Chamomilla may be used, Avhen nearly the same symptoms are present as those mentioned as indicating the use of Ipecac.; especially if the pains are like labor-pain3. Platina, when the blood is black and thick, but not coagulated or grumous ; Avhen there is a dragging sensation from the back to the groins, and the internal genitals are exceedingly sore and tender to the touch. RHEUMATISM OF THE WOMB. 83 China and Ferrum may be given, when the profoseness of the discharge has caused great debility. Crocus, when the blood is very black, clotted and viscid. Sabina, when the discharge is bright and red, occurring in jets, followed by the expulsion of clots. Secale, when the blood is black, tar-like and liquid, and the patient is feeble, and has trembling or cramps of the limbs. Belladonna, Hyosciamus, or Stramonium, Avhen there is great agitation, excessive vicacity, dimness of vision, some delirium, twitching of the tendons, headache, &c. N.B. For further information see my book on Disorders of Menstruation, p. 36 to 72, and the Chapter on Abortion in the present work. RHEUMATISM OF THE WOMB. This may arise from the general causes of rheumatism, such as exposure to cold and wet, inadequate clothing, constitutional tendency, &c.; but besides these, there is a peculiar suscepti- bility of the womb to the impression of cold under the attenuated integuments of the abdomen during the latter months of gesta- tion ; for the abdomen is only covered at that particular point by very light clothing, and the back, or sacro-lumbar region is often but imperfectly protected by the short jacket, worn by the pa- tient. Symptoms.—According to Cazeaux this disease exhibits some well marked peculiarities, by Avhich it can be easily re- cognized. The principal symptom is pain, or a distressing sen- sation, which involves the whole, or a part of the Avomb; its in- tensity varies from a simple feeling of heaviness to the most painful dragging sensation. When the rheumatism is seated at the top or base of the womb, the pain is particularly apt to be felt about the navel; it is increased by pressure, by the contrac- tion of the Avails of the belly, and sometimes e^en by the weight of the bed clothes; and in many cases the patient is unable to bear any movement whatever. If seated someAvhat loAver, she suffers from acute dragging sensations that run from the loins towards the lower part of the belly, thighs, external genital or- gans, and the back along the ligaments of the womb. Finally, 84 DISORDERS OF PREGNANCY. where the lower portion, or neck of the womb, participates in the affection, the seat of it can be detected by vaginal exploration, which, however, gives rise to the most acute sufferings. But, of all the causes which'may aggravate these pains, there are none more distressing than the incessant movements of the child. Like all rheumatic pains, those of the Avomb are wandering, and they occasionally pass rapidly from one part of the organ to another; often, indeed, they disappear at once, and pass off to some other part of the body. They offer frequent and variable exacerbations in their dura- tion and intensity, followed by remissions during which the pa- tient only experiences a vague sensation of heaviness. The womb-pains are usually accompanied by pains in the loAver bowel and bladder (recto-vaginal tenesmus), Avhich are the more dis- tressing, the more the rheumatism is located in the lower part of the womb. The patient is then tormented by a continual de- sire to empty her bladder; the discharge of urine is attended by a smarting sensation, and sometimes by acute suffering, while at others it is even wholly impossible; and in many cases the attempts to move the bowels are equally painful and ineffectual. The attacks may be attended with chills, fever, extreme agi- tation and restlessness ; towards the end of the paroxysms, a profuse perspiration generally breaks out, Avhich seems to be the prelude of a decided improvement. Then the general and fever- ish symptoms become moderated together with the pain in the womb ; but they reappear with the latter, after a A'ariable period ranging from a few hours to several days. Influence of Rheumatism of the womb over the progress of Pregnancy.—The paroxysms are apt to be followed by pains and contractions of the womb, and may bring on premature de- livery. The patient feels some acute and tensive pains, but this feeling of tension is not uniform; for it increases to an extreme degree, and then becomes Aveaker. At first the womb becomes hard and contracted, the mouth of the womb may dilate, though its dilatation is at first sIoav and difficult; abortion is then im- minent, but it is far from being so frequent as might be sup- posed ; and when it does occur, it is most common Avhen there is decided fever present. The mouth of the womb has been known to dilate to the extent of an inch in diameter, and then the bag INFLAMMATION OF THE WOMB. 85 of waters, gradually retreated, the womb closed up again, and the abortion did not take place. Consequently, as long as the dilatation [of the mouth of the womb does not amount to two inches, we may reasonably hope to prevent labor from setting in. These uterine rheumatic pains may simulate those of par- turition, and thus lead the practitioner to suspect, that labor has regularly commenced, Avhen in fact such is not the case. The character of the rheumatic pains will aid in preventing such an error. It is probably to some mistakes of this kind, that we must refer those pretended instances of prolonged gestation, as well as those cases, Avhere the genuine travail of parturition Avas developed, and afterwards suspended during several weeks or months. The influence of this disease over the Labor, and the Puerperal functions will be treated of in a subsequent chapter. Treatment.—The local application of the tincture of the Root of Aconite over the region of the womb is the most impor- tant part of the medical treatment. Aconite may also be used internally, or Bryonia, Pulsatilla, Colchicum, or Mercurius, ac- cording to the several and well known indications for the use of these remedies in rheumatic affections. INFLAMMATION OF THE WOMB. Tins is much more frequent during pregnancy than in the unimpregnated state, though less so than after confinement. It very seldom attacks the whole of the womb, except in the early months ; the more advanced the pregnancy, the more limited is the affection. It is generally seated in some portion of the body or fundus of the womb, often in that part to which the after- birth is attached; the muscular tissue is most frequently in- volved. Symptoms.—The patient complains of a severe and constant pain or stitch in some part of the enlarged womb, limited gene- rally to a small space; there is tenderness on pressure, in- creased by walking and by the movements of the- child; the pain, unlike that of rheumatism of the womb, does not come on in paroxysms. The bladder and rectum may be sympathetically affected. There is a quick pulse, hot skin, thirst and vomiting. 86 DISORDERS OF PREGNANCY. It may terminate in resolution and the woman go to the full time and be safely delivered ; it may terminate in effusion of lymph, firmly uniting the after-birth to the Avomb, requiring manual assistance to remove it after delivery; it may cause softening of a portion of the womb, followed by rupture during the period of labor: or an abscess may form.—Churchill. Treatment.—The frequent and free application of the tinc- ture of the Root of Aconite over the region of the inflamed part, is all important. Nux-vomica has proved a most efficient remedy in IIart- mann's hands, Avhen the fundus, neck, anterior or posterior sur- face of the womb Avas the seat of inflammation ;—when there Avas much fever, he gave Aconite previous to the use of Nux. Belladonna and Mercurius are also suitable in severe and obstinate cases ; while Bryonia and Rhus may be useful, Avhen the serous surfaces are also involved. Chamomilla and China are useful after the acute symptoms have been subdued, and great nervousness and debility remain. IRRITABILITY OF THE WOMB, Depends upon an excited and irritable state of the nerves of the womb, and is nearly allied to hysteria. The symptoms consist of pain in the region of the womb, constant, but occa- sionally increased in severity, especially after exercise. There is some tenderness to pressure over the pubes, and the womb itself is tender on being touched per vaginam.—Anderson. Treatment.—Agaricus and Stramonium are the most impor- tant remedies. Cicuta-virosa, Cocculus, Conium, Ignatia, Magnesia-muria- tica, Nux and Pulsat. are reliable remedies; also Argent.-nit., Bryon., Caust., Cham., Ilyosc, Natrum-m., Platina, Sepia and Stannum. SPASM AND INFLAMMATION OF THE WOMB. The womb in some cases is affected with pain of a spasmodic character, attended with inflammation ; the symptoms are simi- lar to those of irritation of the womb, but far more severe. The CRAMPS and pains IN the abdomen, &c. 87 pain is evidently spasmodic, and is felt in the back, hips and groins, as well as in the region of the womb; there is great tenderness on pressure, and some fever, and occasionally vo- miting. The result to be feared is abortion, after which in some cases the patient may sink. Treatment.—Aconite, Belladonna, Stramonium and Secale are the'best remedies. Ignatia, Kreosote, Nux-vom. and Thuja. also deserve attention. CRAMPS AND PAINS IN THE ABDOMEN, BACK, AND LOINS. Pregnant women are very subject to pains in the loins— the bearing of the trunk backwards—the efforts made to support the Aveight of the abdomen, and to maintain the equilibrium of the body, &c. are sufficient to account for these sufferings. Cramps, spasms, or irregular pains in different parts of the lower half of the body, are a source of frequent and great an- noyance to pregnant females. There are various situations in which the cramp or pain is felt, and the effects vary accordingly. 1. In the abdomen.—The patient may complain of pain or stitches in one side or the other, generally the left, between the false ribs and the crest of the ilium, or along the line of the su- perior insertion of the abdominal muscles. Again, the inferior insertions may be similarily affected; in both cases it appears to be owing to over-distension, which throws some of the mus- cular fibres into spasmodic action. The pain may be very severe, effectually preventing the patient's taking exercise. It is in- fluenced by the state of the stomach, more than cramp in any other situation, and is often combined with heart-burn or water- brash; but it is easily distinguished from pain in an internal organ, by its spasmodic character. Churchill has seen this kind of cramp fix itself about the symphysis pubis, and extend down into the labia pudendi, pro- bably depending upon pressure, congestion, or dragging upon the round ligament. 2. In the back.—The lumbar muscles are sometimes the seat 88 DISORDERS of pregnancy. of cramp ; and when it is severe, it greatly impedes the move- ments of the patient, especially the assumption of the upright position. Occasionally, the distress is extended from the crest of the ilium to the sacrum, affecting the origin of the muscles. It may be the result of distension, or of pressure upon the nerves. Treatment.—Nux-vomica is thought to be generally the best medicine, especially if the severest pains occur just when the patient is going, to bed. Rhus is best suited, when lumbago has been caused by some muscular effort, or by fatigue. Arnica, when the pains are principally felt when coughing, or walking about. FALSE PAINS. Some women are affected at the latter part of pregnancy with pains someAvhat resembling those of parturition, but in reality quite unconnected with it. The causes of these pain3 are va- rious ; they may depend upon flatulence or irritation of the boAvels, accompanied either with constipation or diarrhoea, spasm of the bowels, ureters, or biliary ducts, or possibly of the Avomb itself, and they may be the result of inflammation with accom- panying fever. They may be distinguished from true labor pains by their situation and character, the irregularity of their recur- rence, and in some instances by their being permanent. On placing the hand over the Avomb it is not felt growing hard and contracting, as during a true labor pain, and a vaginal exami- nation finds the mouth of the womb closed; or should it by chance be a little open, it does not dilate any more.—Anderson. Treatment.—Pulsatilla, Secale, Belladonna and Stramonium are the most important remedies. RIGIDITY AND LAXITY OF THE ABDOMEN. In first pregnancies we occasionally meet with great rigidity of the abdomen; the womb increases in size, but the abdominal walls do not give way in equal ratio, and a considerable amount of distress is the result. The greatest danger is, that such a FALLING OF THE WOMB. 89' degree of pressure Avill be exerted upon the kidneys as to cause an interference with their functions, followed by dropsy and al- buminaria. Laxity of the abdomen generally occurs in women who have borne many children; in these the abdominal walls are so loose, that they are incapable of affording proper support to the en- larged womb, which consequently may fall in any direction. Treatment.—In rigidity of the abdomen frictions with Sweet Oil, or Glycerine, or the application of a Ccfiium- or Belladonna- plaster, coupled Avith the internal use of Conium, Bellad., or Stramonium will generally suffice. For laxity of the abdomen, Colocynth and Sepia internally, or dry frictions, or frictions with tincture Nux-vomica, Angus- tura or Ignatia, together Avith the internal use of one or the other of these remedies, or of Cuprum and Zincum, Cuprum and Argentum in alternation may prove beneficial. FALLING OF THE WOMB. In the early months of pregnancy, Avhen the womb begins to increase in size and weight, falling, or prolapsus is apt to occur; this is attended with a sense of bearing doAvn pain and uneasi- ness in the lower part of the back, and very frequently in the loAver part of the abdomen. This symptom can almost invariably be alleviated and eventually cured by keeping the patient in a recumbent posture. Finally the womb increases so much in size, that it must rise above the brim of the pelvis, there rests, and is of course unable to sink or fall down again during this pregnancy. Sometimes, hoAvever, in a more advanced stage of pregnancy, wrhere the hips are unusually large, and the pelvis consequently extremely capacious, a sudden prolapse may occur during some act of unusual exertion. Both these cases require attention; for in the first, the womb having descended, and the patient continuing to go about, it en- larges within the pelvis and gradually becomes impacted therein; —in the 2d instance, the womb becomes at once impacted on ac- count of its larger size. Treatment.—The bladder must first be emptied by means of 90 DISORDERS OF PREGNANCY. the catheter, and the fallen womb then carefully replaced in its proper situation above the brim of the pelvis ; the recumbent position must be perseA-ered in, until the Avomb is sufficiently en- larged to maintain its location. Aurum, Bellad., Calc, Kreosot, Merc, Nux-mosch., Nux- vomica, Sepia and Stannum are the principal remedies. FALLING BACK OF THE WOMB. RETROVERSION. The fundus or top of the womb becomes tilted backwards, dropping beloAV the promontory of the sacrum, Avhile the neck of the womb is pushed forwards and upwards, frequently rising above the symphysis pubis, and dragging the vagina up with it. It is most common during the third or fourth month of pregnancy. The rectum or lower boAvel is pressed upon by the base of the womb, and the neck of the bladder by the mouth and neck of the uterus; the discharge of urine and faeces being thus inter- fered with. Symptoms.—These consist in retention of urine, which fre- quently sets in somewhat suddenly, and may be either partial or complete. Defecation is performed with difficulty, the fasces being flattened, and coming away in small quantities. When the retention of urine is not complete, only a small quantity is passed at once; there is frequent desire to pass water, but the bladder is never completely emptied ; the urine eventually dribbles away involuntarily, and the bladder becomes enormously distended, to a sufficient extent to cause rupture if left to itself; or chronic inflammation of the bladder may set in, even if relieved after the retention has existed for any considerable length of time. There is pain in the small of the back, thighs and pubis, with a sensation of bearing doAvn ; and these symptoms coupled Avith the fact of the patient being in the third or fourth month of pregnancy, should lead one to suspect the nature of the case. If there be much obstruction of the bladder, fluctuation may be felt above the symphysis pubis. After the bladder has been emptied by the catheter, the womb will not be felt in its natural position in front of the abdomen, above the symphysis pubis. FALLING BACK OF THE AVOMB. 91 On examination per vaginam, the base of the Avomb will be felt as a large tumor, lying between the vagina and rectum, and be- low the promontory of the sacrum; the mouth of the Avomb can scarcely be reached with the finger, but is found directed upwards and forwards above the symphysis pubis. This, however, is not invariably the case, for the neck of the womb is occasion- ally very flexible, may be doubled upon itself, and thus leave the mouth in its natural situation Avhile the fundus and superior part of the neck are alone retroverted. A large pelvis, and wide hips may undoubtedly act as pre- disposing causes to this accident, but they are not by any means essentially necessary ; for the womb not having attained a suffi- cient size in the early months of pregnancy to prevent the pos- sibility of its falling below the promontory of the sacrum, is ca- pable of doing so in a pelvis of ordinary dimensions. A dis- tended bladder may be the immediate cause ; this is particularly apt to be the case, when there is torpor of the bladder, the urine being retained for a longer period than natural, and finally voided in large quantities. This torpor is of course a more serious disorder than irritability of this organ, as it is apt to give rise to retroversion. A loaded rectum may also cause tilting back of the womb; sudden contraction of the abdominal muscles, other circumstances being favorable ; in fact any thing which can tend to tilt the heavy body and base of the womb backAvards, * where there is sufficient room for the force of gravity to carry it beloAV the brim of the pelvis.—Anderson. Treatment.—Restoration of the womb to its natural location and direction should be attempted as soon as the nature of the case is made out; the bladder should be emptied at once, and occasionally as soon as this is done, the displaced organ will re- turn spontaneously to its natural position. The rectum should also be thoroughly emptied, and then, if necessary, one or two finders should be introduced into the rectum and pressed against the retroverted fundus of the womb ; at the same time, two fin- gers of the other hand should be introduced into the vagina, and the neck of the womb should be carefully and steadily depressed, while the fundus is elevated. This manipulation may generally be done in the usual obstetric position on the left side; in some rare cases the patient must be placed on her hands and knees, 92 DISORDERS OF PREGNANCY. in order to get the influence of the force of gravity; in others, the uterine-sound must be used. Nux, Ignatia, Bellad., and Aurum are all serviceable reme- dies. The patient should learn to lie upon her face, always at night and frequently during the day time. ANTIVERSION. In this, the body of the womb is thrown fonvards ; it is ex- ceedingly uncommon during pregnancy. The symptoms are similar to those of retroversion, but the signs on examination are entirely different. The enlarged womb may be felt above the pubis, and the neck of the Avomb is found directed backwards towards the promontory of the sacrum. Treatment.—The patient should practice lying upon the back, with the knees drawn up. The bladder and lower bowel should be regularly and methodically emptied. A bandage and compress over the pubes may be serviceable ; the fundus of the womb may be pressed back, and the neck pushed fonvards by the physician. FCETAL TURBULENCE. The motions of the unborn child are generally felt at four months, or four and a half months ; * frequently these move- ments are exceedingly feeble, at first only producing a kind of tickling, or rather a sensation analogous to that which a spider's claws excite in craAvling; at other times they are veritable shocks, which may be violent enough to elicit cries from the mother ; occasionally they become 'So violent as to be truly dis- tressing, causing a sense of nausea, often attended with local pain, and much general nenous agitation. Anderson thinks that this affection may depend upon some preternatural sensi- bility of the womb itself, but more frequently it arises from a * Of seventy cases the motions of the child were felt at the end of the third month in nine cases; at three and a half months in eleven cases ; at the fourth month in twenty-one cases ; at four and a half months in sixteen cases; not until the fifth month in eight cases ; at five and a half months in one case ; in the sixth month in four cases. PALPITATION OF THE HEART. 93 state of general nenous irritation, which is from time to time determined to the womb. Treatment.—Mechanical compression by means of an abdo- minal bandage will frequently prove of much service. Agari- cus or Stramonium may remove the morbid sensibility of the womb; while a general nervous condition may be alleviated by Chamomilla, Sumbul, Cannabis-Indica, Coffea, &c PALPITATION OF THE HEART. Churchill says, that almost all females suffer from attacks of palpitation at some period or other of their pregnancy, espe- cially those of a Aveakly, delicate body, or nervous temperament. By some it is felt immediately after conception, and some even have attacks after ordinary intercourse ; by others it is only felt at the period of quickening; and by a third class towards the end of pregnancy. Among the exciting causes may be" enumerated mental emo- tions, disordered stomach and bowels, especially errors of diet and flatulency ; the motions of the child often give rise to it. Symptoms.—The attack may come on suddenly, or be pre- ceded by some nervous or gastric disorder ; the patient feels the heart strike violently against the ribs, so as to shake the whole body ; in general the heart's action is regular, although exces- sive ; but in some cases a marked and frequent intermission may be observed. If asleep when the attack occurs, she starts up suddenly ; and if walking is obliged to stand still; the breath- ing becomes hurried or impeded, the nervous system may be dis- turbed by headache, giddiness, dimness of vision, noises in the ears, and sensation of approaching apoplexy.—Churchill. It is not dangerous, although often distressing; for the hard and increased action the heart may be either very sudden, and violent, or persist night and day, for many days. Treatment.—As it may be produced by excitement of the mind and derangement of the digestive organs, the diet should be carefully regulated, and the mind kept at rest; some severe attacks only subside after full, free and spontaneous vomiting; if it arises from indigestion accompanied Avith much flatulence and acidity, almost immediate temporary relief may be obtained 94 disorders of pregnancy. by the administration of an alkali. Sarsaparilla is useful when there is painful palpitation ; Zincum, Avhen there is a painful palpitation, with sharp stitches at every beat of the heart; also Agaricus and Hepar-sulph. Veratrum and Nitric-acid, Avhen there is diarrhoea, anxiety, and hurried breathing. Au- rum and Asparagus, when there is anxiety and oppression of the chest, with loAvness of spirits. Nitrate of Silver, when there is palpitation Avith faintness and nausea. Ammonia-carb., when there is a weak and sinking feeling at the pit of the stomach. Gratiola, when there is such violent palpitation, that the whole body is shaken; also Crocus and Secale. Spigelia and Sabadilla, Avhen there is palpitation, Avith throbbing in the abdomen, and over the Avhole body. Mercurialis, Avhen there is an undulating and throbbing motion in the stomach and abdo- men, with pulsation of the abdominal aorta, and dizziness. FAINTING, Is not a frequent occurrence during gestation, except perhaps at the time of quickening, and in the Aveakly, and delicate. It is ordinarily of no great importance ; when organic disease of the heart is present, it is very serious. ToAvards the end of pregnancy, fainting is regarded with great suspicion, not so much for the immediate consequences, as for its effect upon the con- Aralescence after parturition. It is also a very unpleasant occur- rence at the time of labor; it sometimes folloAvs each pain, caus- ing great alarm, but Avithout apparently retarding the progress of delivery; but after delivery, from slight over-exertion, or from too active aperient medicine, fatal fainting may set in. Ordinary fainting after confinement may easily be distin- guished from fainting in consequence of internal haemorrhage ; the latter is more prolonged, accompanied with fulness and ten- sion of the abdomen, dull Aveight and pain in the pelvic region, permanent blanching of the surface, and after a short time by escape of blood from the vagina. Treatment.—When there are repeated fainting fits, Cuprum and Hyosciamus.—Arsenicum, Camphor, Ammonia, Cocculus, SPITTING OF BLOOD. 95 Moschus, Veratrum, Stramonium, Laurocerasus, Ferrum- acet., Nux, Petroleum and Opium all deserve attention. DIFFICULTY OF BREATHING, May occur during the early months from a nervous affection and sympathy with the Avomb; it is also often connected with the nervous palpitations already treated of; the attacks are ge- nerally, short, sudden, and not attended with plethora, congestion or fever. In the middle of pregnancy it is more frequently OAving to plethora, and the face is apt to be flushed, the pulse quick, head heavy, &c In the latter months it generally arises from the pressure of the enlarging womb ; it is then apt to be most severe in first pregnancies, OAving to the resistance afforded by the abdomen in expanding for the first time to so great an extent. The attacks are not serious unless complicated with conges- tion, inflammation, or organic disease of the lungs. Treatment.—Moschus, Ipecac, and Aconite are the most im- portant remedies. COUGH. The cough, which is peculiar to pregnancy only, occurs in the earlier and latter months; it is either constant, short and teasing, or recurs in violent paroxysms, causing great distress and inconvenience. In the earlier months it is generally nervous, spasmodic and sympathetic ; there is rarely any expectoration, and no evidence of catarrh, or disease of the lungs. . In the latter months it is owing to a mechanical cause; the aorta is compressed, the cir- culation through the lungs somewhat arrested, and the lungs irritated and rendered uneasy. Treatment.—Conium is the principal remedy. Ipecac, Drosera, Ferrum-acet., Pulsatilla, Petroleum, Plumbum-acet., Rata, Mezereum, Cina and Sepia all deserve attention. 96 DISORDERS OF PREGNANCY. SPITTING OF BLOOD. This formidable disorder is fortunately very rare ; in the earlier months the attack may be simple, consisting of a secre- tion of blood from the mucous membrane of the air tubes, owing probably to the sudden suppression of menstruation. In the middle or latter months it may arise from congestion of the lungs ; or more frequently from consumption, which often runs its course quietly, and unnoticed during pregnancy. Treatment.—Aconite, Stibium and Ipecac, are the principal remedies; although Phosphor, Kreosote, Hamamelis and Millefolium deserve attention. Mercurius-solubilis, Arnica, Arsenicum, Zincum, Digitalis, Ferrum-aceticum and Hepar- sulph. have been used successfully. HEADACHE. Churchill says, that next to disturbance of the stomach, headache is probably the most common complaint of pregnant women. In the early months it is generally of a nervous cha- racter ; at a later period it most frequently arises from plethora. In nervous headache there is seldom any quickness of pulse, suffusion of the eye, or flushing of the face ; in headache from plethora the pulse is full, quick and strong, the face flushed, the eyes bright or suffused, the eyelids heavy and closed, and there may be intolerance of light and sound. In some congestive headaches, however, the face is pale. Either variety may arise from constipation; or from scantiness of the urine. Treatment.—See Treatise on Headaches. Pulsatilla, Stra- monium, Sepia, Aconitum, fyc. deserve attention. SLEEPLESSNESS. Churchill says, there is scarcely a more distressing com- plaint to Avhich pregnant Avomen are subject, than sleeplessness. It is not uncommon, and appears chiefly to attack females of a delicate constitution, or of a nervous temperament. It may oc- " sleeplessness. 97 cur at an early period of pregnancy, though it is more common during the latter months, and may persist for a considerable time. It generally seems to be a purely nervous affection, excited by want of exercise, excessive motion of the child, or uneasy sensations in the womb; sometimes, however, it arises from a plethoric and feverish state of the system. If it persist long, the patient will suffer severely ; become restless, feverish, agitated, peevish and fanciful; her appetite will diminish, the bowels and secretions generally become de- ranged ; the skin get' hot and dry, and the pulse quick ; she will complain of great weakness and misery, and ultimately her judgment and mental faculties Avill become impaired. Sometimes the patient will sleep well in the day; but not at night. At other times the rest is disturbed by frightful dreams. Treatment.—Air and exercise are very important; a draught of cold Avater just as the patient steps into bed, or wrapping a wet towel around one hand, or bathing the feet at bedtime, will often calm the nervous irritation. Rhus is the best remedy, when the patient cannot sleep before midnight. Ranunculus-seel., when she always wakes after mid- night. Plumbum, for obstinate sleeplessness for weeks to- gether. Moschus, when there is no sleep all night, or only mo- mentary losses of consciousness. Mercurius, when she sleeps much in the daytime, but cannot sleep at night. Ledum and Hyosciamus, Avhen sleep is constantly interrupted by starting. Causticum, when she wakes every morning at four o'clock, Aconite, when there is sleeplessness from pain. Veratrum. when there is an intolerable feeling of heat, and restless tossing about. Ambra and Agaricus, when there is sleeplessness from great activity of mind and nervousness; also Chamomilla. Graphite, when she cannot sleep before tAvo o'clock at night. Fluoric-acid, when there is no sleep until towards morning, and then a very little slumber is sufficient to refresh the patient. Bryonia and Causticum, when there is sleeplessness from vas- cular excitement, and dry heat. Digitalis, when there is un- easy sleep, from constant desire to urinate. Cuprum, when there is much vomiting. Laurocerasus, when there is loss of sleep from excitement and attacks of heat. Nitric-acid, when a 98 DISORDERS OF PREGNANCY. icy coldness of the feet prevent sleep. Borax, when sleep is disturbed by thirst and coldness of the body. Anacardium, when there are severe pains in the abdomen. HYPOCHONDRIASIS. Has been sufficiently treated of at p. 22 & 23. PLETHORA, Has been alluded to on p. 18. Acute serous plethora is not uncommon during pregnancy, and is apt to be attended with bloating not only of the legs and feet, but also of the face, arms and hands ; it then is a most serious disorder, being often com- plicated with albuminuria and retention of urea in the system, to be followed by severe headache, violent vomiting, and pain at the pit of the stomach, and is too often succeeded by convulsions. Treatment.—Aconite, Sulphur, Aurum, Digitalis and Kali- carbonicum. DROPSICAL AFFECTIONS. DROPSY OF THE LEGS. According to Churchill during the latter months of preg- nancy we frequently find patients complaining of a swelling of the feet or legs, increasing towards evening, and occasion- ing a certain amount of inconvenience. This dropsical swell- ing may be confined to the feet and legs, or it may involve the thighs, vulva, and hips. In the majority of these cases the swelling is caused by the pressure of the gravid uterus simply. When the effusion is the result of pressure, there are none but mechanical symptoms ; the limb is swollen, and of a semi-trans- parent, pearly appearance ; it feels heavy, and the patient can- not walk as well as usual. These inconveniences are much ag- gravated if the swelling extends to the thighs ; the patient may not be able to approximate them, and may find it as distressing to sit, as to stand, or walk. But little additional distress is oc- casioned during pregnancy by the swelling of the labia ; but \X DROPSICAL AFFECTIONS. 99 very large they may prove a very serious impediment to the exit of the child during labor. Change of posture has a great effect upon the swelling of the legs ; in the morning it is but slightly perceptible, but during the day it increases, and towards night it arrives at its maximum. After delivery the effusion disappears quickly ; but previously it may be unpleasantly va- ried by an attack of erysipelas, or by phlegmonous inflammation of the cellular tissue. General Dropsy of the Skin. (Anasaraca).—In a few cases the dropsy is more general and extends to the upper part of the body, and to the hands and face. If the urine be scanty or albuminous the case should be narrowly watched. Albu- minuria, or Bright's disease, according to Devilliers and Regnault is not a frequent complication of pregnancy, but when it is present, oedema and eclampsia are the most frequent indications of its presence. Albuminuria and its effects are more common in first than in later labors, and then generally • disappear after delivery. Dropsy of the face and hands, going on occasionally to general anasarca, is one the most frequent accompaniments of albuminuria in the pregnant female. Albu- minuria, when present during the last months of pregnancy, denotes a marked tendency to puerperal convulsions. Every case of puerperal convulsions seen by M. Blot was accompanied by albuminuria. The Albuminuria of pregnancy is generally attended with dropsy of the face and hands, and lumbar pains : it is almost always unattended by fever; is in most cases the result of a simple functional hyperalmia of the kidneys, and dis- appears a few hours after delivery; this condition of pregnancy is free from danger as long as it is uncomplicated with conges- tion of the brain; but if severe headache and a peculiarly se- vere pain in the pit of the stomach be attended with profuse bilious vomiting in a pregnant female, in the latter months of gestation, albuminous urine also being present, then we may almost certainly expect an attack of puerpual convulsions. Treatment.—Arsenicum is useful against elastic swellings ; also when there is swelling of the face and feet, with dryness of the mouth and lips, distension of the abdomen, diarrhoea, colic and vomiting ; or swelling of the right sight of the body 100 DISORDERS OF PREGNANCY. down to the hip, with swelling of the left foot and leg; or swelling of the face and body. China, when there is swelling of the limbs. Ledum-palustre, when there is ©edematous swelling of the whole body. Lactuca- virosa, when there is a dropsical sAvelling of the whole body, with asthmatic complaints, heaviness of the head, difficulty in lying down, chills, shortness of breath, hacking cough and small slow pulse. Sepia, in chronic cases, when there is a swelling of the wrist, elboAV and ankle joints in the evening; or swelling of the whole body, face, belly, legs and arms, extending down to the wrist-joints, with shortness of breath, fever, and alterations of chills and heat; also Avhen there is swelling of the labia, folloAved by a moist and itching eruption upon the inner surface. Digitalis, when there is an elastic and painful swelling of the legs, followed by a similar state of the arms and forearms, slowly passing off, after some months, Avithout increased secre- tion of urine ; or when there is an elastic, white swelling of the whole body, Avith painfulness to the touch, followed after many- weeks by anasarca, with great softness of the swelling. Rhus- toxicodendron, is most homoeopathic against acute inflammatory oedema, especially of the face and eyelids ; but it has also been used successfully in large doses, against torpid and chronic ana- sarca. Apis-mell., is indicated under almost similar circum- stances to those which call for Rhus, Mezereum or Cantharides. Hellebore is also useful in chronic dropsy, ^eca/e-cornut., is homoeopathic to watery, soft and painful swellings. Crotalus in swellings of the whole body. Hartmann regards Digitalis and Scilla as mere palliatives in dropsy; he thinks, that Cantharides may prove useful, when there is much irritation of the bladder; Kali-carb. is pro- nounced indispensable, when Anasarca and Ascites are conse- quent upon suppression of the menses. Zincum-metallicum, when there is great distress in the region of the kidneys. Col- chicum, when dropsy has been caused by suppressed perspira- tion, from exposure to cold, damp and foggy weather, or from getting wet through to the skin; Dulcamara deserves attention under the same circumstances; and Colchicum is peculiarly homoeopathic to the severe pain in the stomach and violent bilious vomiting, which is apt to precede an attack of convulsions, DROPSICAL AFFECTIONS. 101 during the progress of dropsy during pregnancy; also Bryonia and Hellebore. The indications for the use of Arsenicum, China and Hellebore are too Avell knoAvn to require repetition here. Aurum-muriaticum cured a case of dropsy of one year's standing, first causing a copious secretion of fine clear urine; while Ononis-spinosa caused a secretion of turbid urine, of an ammoniacal odor. Dose.—According to Rueckert, Arsenicum has been used success- fully in six cases of dropsy, generally in the 30th dilution. Bryonia in two cases, in the 5lh dilution. Cainxa, in two cases, in the 4th dilution. Camphor, in two cases, in the tincture. China, in eight cases, in the 4th dilution. Convolvulus-arolus, in the 30th potency, is said to have been found very useful in cedematous swellings of all kinds, in dropsy with abdominal obstructions, derangements and de- bility; it causes liquid stools and profuse flow of urine. Digitalis, has been given successfully in the tincture, 4th and 10th dilutions. Dulcamara, in two cases, in ihe tincture, and 7th dilution. Hellebore, in twelve cases, in the tincture, 3d, 4th and 30th dilutions. Kali- carb., Lactuca-virosa, Ledum and Lycopodium, each in one case. Mercurius, in two cases, in the 1st and 3d dilutions. Phosphor, in two cases. Rhus, 30th dilution in several cases. Sambncus-cort.-int., in one case. And Stannum-muriat., in drop doses of the tincture. A few words must be added on the treatment of Bright's dis- ease of the kidneys in pregnant females. I claim the credit of being the first to point out a truly homoeopathic and specifically curative remedy, viz: Mercurius-corrosivus, against at least one variety of Bright's disease of the kidneys, (see Homoeopa- thic Examiner, New Series, Vol. 1, p. 285), as long ago as the year 1846; (also, see my Treatise on Apoplexy, p. 42). I am sorry to be obliged to admit that Mercurius-corros. will not cure all cases of Albuminuria in pregnant females; perhaps because the disease, in them, often arises from a mechanical cause, viz: from the pressure of the gravid uterus upon the kidneys, aided somewhat by the unyielding and rigid state of the Avails of the abdomen in primaparee. Emollients applied to the walls of the abdomen, viz : SAveet-oil, Glycerine, aided by the frequent use of warm baths, Avarm clothing, light diet, the soiled sheets and bed clothes have been forcibly removed, the patient's dress changed, and after this and sundry other things havp hw-n rlm^*, tLo nurse consoles herself Avith the belief that her charge will now sleep comfortably But delicate women are very susceptible of ner- v^xxo irritation at this time; if their rest be once disturbed, or their sleep be put astray, they remain wakeful arid unrefreshed ; presently the senses become more than usually excited; the noise of their infant, although from another apartment disturbs them ; light becomes exceedingly unpleasant to them, and finally, although the nurse carefully darkens the room and closes the bed-curtains, the patient does not sleep; and even if she does fall into a slight dose, it is but momentary, for the slightest noise or whispering aAvakes her. After some hours, headaohe will set in, and just as the secretion of milk is fairly commencing, it may be arrested by the presence of an irregular nervous fever, chills occur at irregular intervals ; the headache becomes more severe ; the pulse becomes frequent and perhaps irregular, and sometimes delirium may set in. A feverish and nervous distur- bance of this kind may not be subdued for weeks, and often has its origin in no other cause, than in a little want of knoAvledge in the management of the patient immediately after her delivery. Murphy has known a patient to be lifted up, drawn down to the bottom of the bed, then dragged up again, now to one side, and then to the other in this process of changing the bed clothes, who afterwards presented a most alarming train of nervous symp- CONVALESCENCE after parturition. 125 toms, and all this because the nurse insisted upon making her " comfortable." Too much excitement is not the only risk to which the woman is exposed during this interval. Errors in diet may very easily be committed. After the patient has had a refreshing sleep, she is apt to feel, and thinks that she is perfectly well, and may eat and enjoy whatever she can get hold of. There is therefore sometimes the greatest possible temptation to partake of too hearty food, the mischief of which may not become apparent for some time, viz, until reaction sets in ; but when the pulse na- turally begins to rise, and the milk to form, the natural febrile paroxysm may be superseded by one of a more decided and se- rious character. Treatment.—The chilliness should be met with warm clothing, by some warm tea, or gruel, or milk and water; if it persists, or returns frequently, China or Arsenicum may be given. If the patient be feverish, restless and nervous, Aconite and Chamomilla may be administered. If there be much headache with a tendency to delirium, Aco- nite and Belladonna. Errors in diet, may be contracted by the use of some gentle laxative medicine, or by Ipecac, or Pulsatilla. For the treatment of obstinate sleeplessness, see page 96. Other and frequent consequences of these cleanly and orderly intermeddlings, are the occurrence of severe after pains, or of more or less dangerous floodings. The patient cannot be moved about in this way without disturbing the bandage that was to secure and support the womb. If the patient leave the horizon- tal posture, and she is often allowed to set bolt upright, the blood will again accumulate in the uterine veins, blood is consequently poured into the cavity of the womb, where if it go no farther, and coagulates, will expose the patient to a severe attack of after- pains ; but it may not coagulate, but flow away, and produce a most violent and dangerous flooding. The patient is thus ex-/i posed to the risk of her life, at a time when every moment of repose is of the highest value to her, and her physician is pro- bably far away from her. Treatment.—Severe after-pains require the use of Arnica, Belladonna, Strammonium, Secale, or Opium. For the treatment of flooding, see page 82. 126 DISEASES of parturition. LACTATION MILK-FEVER, &c. The second period of time after parturition is marked by an increase in the force and frequency of the pulse; a slight chill, some thirst and perhaps headache: the breasts are becoming dis- tended. If the previous management of the patient has been judicious, or no other causes of disease be present, the patient will pass safely over this period. The distention of the breasts and the natural fever that accompanies it, are relieved chiefly by the child; Avhen the milk flows freely, the fever subsides, and the function of lactation is established; but very slight causes will derange this natural process, such as improper food, agitation of mind, exposure to cold. In some cases the patient has a se- vere chill, followed by profuse perspiration, forming the so-called milk-fever. In other instances the formation of milk is too ra- pid, although there is not much fever; still the breasts become tensely distended and painful, presenting a firm unyielding sur- face to the infant, who cannot grasp the nipple sufficiently to nurse ; hence the breasts are not relieved, and inflammation is apt to set in. In another set of cases the secretion of milk may be suspended or suppressed, and the absence of milk is the pre- cursor of some deeper-seated and more distant inflammation, or of puerperal fever itself. Hence the practitioner should be very s olicitous that the function of lactation be safely established; if he child is strong enough and healthy, and if the mother be properly managed previously, this object is generally success- fully accomplished. But, both local and constitutional causes may throw impediments in the way; the nipple may be badly formed, either too small or too large, or perhaps flattened by the fashionable corset, so as to form a depression in place of a pro- minence, so that the child cannot properly grasp it. Or it may happen that the extremely delicate skin that covers the nipple is very irritable and easily inflamed, consequently it will not yield to the traction of the child; it gives way at the base of the nipple ; fissures are the result; they bleed easily, and in place of a comfort and enjoyment, the nursing of the child becomes the greatest source of anguish and distress to the mother. Again, we may meet with cases in which the breasts and nipples are well formed, nevertheless the milk will not flow, because the minute LACTATION, MILK-FEVER, &C. 127 milk-ducts are not free to transmit it; they may be plugged up with a thick tenacious secretion which the child has not sufficient suction-power to remove. In another class of cases the milk is secreted scantily, and what is extracted contains but little nourishment; the infant. therefore, is never satisfied, and after having obtained Avhat it can it may sleep, exhausted by its efforts to draw the breasts; but it is only a momentary dose, for it soon wakes up, becomes feverish, cries constantly, and is ravenously hungry ; the mother has no farther supply, her anxiety contributing still more to ar- rest the secretion; and thus difficulties of no ordinary character arise. There are also certain constitutions where there is no defi- ciency of milk in the breasts, but it is of poor or bad quality; the milk may be abundant, but it does not satisfy the child, or possibly it may produce a considerable amount of irritation in the stomach and bowels of the infant; the child may scarcely have obtained a sufficient quantity before it is ejected from the stomach, or if it pass down into the bowels there Avill soon be evidences of irritation in its passage along the intestines and an exhausting diarrhoea may place the infant in extreme danger of its life ; or it may be exposed to all the torments of colic, and its wild screams that cannot be appeased, soon give evidence of the agony it is enduring.—(Murphy.) Treatment.—If the flow of milk be excessive, we must reduce the force of the general circulation, and prevent the effects of over-distention of the breasts. Aconite and Antimony are the most important remedies. But Bryonia may be given if the afflux of milk is very considerable and the breasts greatly dis- tended, so as to produce pain and oppression of the chest; it will generally relieve the tumid breasts and check the fever. Still, Belladonna may be required if there be violent pains in the head, tendency to delirium, glistening of the eyes, and fever. Warm fomentations skilfully managed so as to maintain an equal temperature around the distended breasts are often most grateful to the patient; and gentle frictions with warm oil over the surface are useful in promoting the absorption of the excess of milk; when the distention and consequent irritation are re- lieved, the milk whicht has been arrested will frequently flow 128 DISEASES OF PARTURITION. quite freely; if it be slow, the breast-pump may be used, or what is still better, another child, older and stronger, may be applied, and will soon reduce the distention. If it should hap- pen that the milk-ducts are much obstructed, even these methods may fail, and some female friend or nurse must be called upon ; their stronger poAvers of suction will soon remove these plugs, and the milk then flows without difficulty. As soon as this ex- cessive distention is once overcome, it does not generally return, provided caution be used in the diet of the patient, and some gentle laxative medicines are given. When the flow of milk is deficient we have a far more difficult case to manage ; in the first place the babe must be fed artifi- cially, so as to prevent its restlessness. It may then be applied to the mother at longer intervals than usual, twice perhaps in the day, and once at night, so as to allow the milk which is but sloAvly secreted, time to accumulate. The mother will generally require a more nutritious diet than can usually be given after parturition; and if the deficiency of milk depends upon the ex- haustion and diminished sustenance which have been caused by a protracted labor, even stimulants are sometimes necessary; broth or soup may be given, and, Avith caution, warm negus. It is there that the virtues of caudle shine so conspicuously. It is also essential that sufficient rest and sleep be secured the mother; these patients are apt to be particularly restless, because the desire of the mother to nurse her infant is too frequently strong in proportion to her inability to do so; she is unwilling to resign her little charge to the care of another, and becomes anxious, irritable and sleepless. But the more general causes of defi- ciency of milk Avould seem to be a lymphatic constitution, a feebleness of arterial action, or of the vital energies; or a gene- ral constitutional debility produced by moral causes, depressing mental emotions, or by an unhealthy pregnancy. In these cases, Lea dam says that J^-nws-castus is the most useful remedy ; if the mother is desirious of nursing, and the signs of milk are not apparent in thirty- six hours after delivery, the Agnus should be given at once; it is also equally useful, when the milk dimi- nishes or disappears without any appreciable cause, or becomes impoverished; Conium and Iodine also deserve attention. Dr. Kallenbach having noticed that when Assafcetida LACTATION, MILK-FEVER, &C , 129 plasters had been applied to the pit of the stomach in hysterical females for a long time, they were sometimes folloAved by swelling of the breasts, from which a milky fluid oozed, gave it internally with success in four cases. Leadam has found it to materially increase the flow of milk, improve its quality, and cause the child, which before was pining and constantly disturbed by flatulent colics, to thrive and cease crying. THE USE OF THE B0FAREIA, ("bicjnus communis" of botanists) as A MEANS ADOPTED B£ the natives of THE CAPE DE VERD ISLANDS TO EXCITE LACTATION. By Dr. J O M'William, F.R.S., R.N., &c. While engaged in an official investigation into the nature and history of a yellow fever epidemy, prevailing in the Island of Boa Vista, in the Cape de Verds, during the year 1846, my at- tention was called to a remedy commonly had recourse to there, and in the other islands of the group, to accelerate and increase the flow of milk from the breasts of childbearing women, in cases where that secretion was tardy in appearing, or deficient in quantity when it did appear. I also learnt that, on occasions of emergency, this remedy could be successfully applied to a still more important use, namely, to produce milk in the breasts of women who are not childbearing, or who even have not given birth to, or suckled a child for many years. The leaves of a plant, called, in the language of the country, Bofareira, but which, in reality is the " Ricinus Communis" of botanists, and, occasionally, the leaves of the " Jatropha curcas," both belonging to the natural family euphorbiacice, are the means by which these interesting if not extraordinary results are produced. The Bofareira groAvs in most if not all, the Cape the Verd Islands. That used by the natives for the purposes I have men- tioned, is called by them the white bofareira, to distinguish it from what appears to be nothing more than a variety of the same species, the red bofareira. The white, or that which possesses galactagogue qualities, is recognized by the natives by the light green color of the stem of the leaf, whilst the leaf stem of the red is of a purplish red hue. The latter plant is carefully i 130 DISEASES OF PARTURITION. avoided, as it is said to be a'powerful irritant, and, if applied as it occasionally has been, by mistake, for the white, it produces an immediate and often immoderate flow of the menses. In cases of childbirth, when the appearance of the milk is de- layed (a circumstance of not unfrequent occurrence in those islands) a decoction is made by boiling well a handful of the white Bofareira in six or eight pints of spring water. The breasts are bathed with this decoction for fifteen or twenty minutes. Part of the boiled leaves are then thinly spread over the breasts, and allowed to remain until all moisture has been removed from them by evaporation, and probably, in some mea- sure, by absorption. This operation of fomenting with the de- coction and applying the leaves, is repeated at short intervals until the milk flows upon suction by the child, which it usually does in the course of few hours. On occasions where milk- is required to be produced in the breasts of women who have not given birth to or suckled a child for years, the mode of treatment adopted is as follows :— Two or three handfuls of the leaves of the Ricinus are taken and treated as before. The decoction is poured, while yet boil- ing, into a large vessel, over which the woman sits so as to re- ceive the vapor over her thighs and generative organs, cloths being carefully tucked around her so as to prevent the escape of the steam. In this position she remains for ten or twelve min- utes, or until the decoction cooling a little, she is enabled to bathe the parts with it, which she does for fifteen or twenty minutes more. The breasts are then similarly bathed, and gently rubbed with the hands; and the leaves are afterwards applied to them in the manner already described. These several opera- tions are repeated three times during the first day. On the second day, the woman has her breasts bathed, the leaves ap- plied, and the rubbing repeated three or four times. On the third day, the sitting over the steam, the rubbing, and the ap- plication of the leaves to, Avith the fomentation ofj the breasts, are again had recourse to. A child is now put to the nipple, and, in a majority of instances, it finds an abundant supply of milk. In the event of milk not being secreted on the third day, the same treatment is continued for another day, and if then there LACTATION, MILK-FEVER, &C 131 still be want of success, the case is abandoned, as the person is supposed not to be susceptible to the influence of the Bofareira. Women with well-developed breasts are most easily affected by the Bofareira. When the breasts are small and shrivelled, the plant then is said to act upon the uterine system, bringing on the menses, if their period be distant, or causing their immo- derate flow if their advent be near. Exposure to cold is carefully avoided by persons who are being brought under the influence of the Bofareira. They scrupu- lously abstain from wetting with cold water either the hands or the feet, Maria, a dark mulatto woman, with woolly hair, thirty years of age, tall, stout, and well-formed; menstruating regularly; the mother of three children, the youngest of Avhom was three years old, and had been weaned when under the age of one year, was brought before me by Dr. Almeida, of Boa Vista, on the morning of the 30th of June, 1846, for the purpose of being submitted to the action of the Bofareira. She stated that when her child was weaned, every trace of milk disappeared from her breasts in the course of a few days. I could not detect any sign of pregnancy. The breasts were like those of negro women in gsneral who have borne children, pendulous and flabby. No sign of milk was given out from them upon careful expression of the nipple. The baths, fomentations, the application of the leaves, friction, suction, &c, were adopted in the manner and order I have al- ready described. On the second day there was a slight oozing of serous-looking milk from the nipples, with slight increase of size in the areolar portion of the breast. On the third day the milk was increased in quantity, and less watery. On the morning of the fourth day there Avas evident enlargement of the lower part of the mamma, and milk flowed abundantly upon the application of a child to the nipple. The use of the Bofareira in cases of childbirth, to accelerate the flow of milk, is common, but comparatively rare as a means « of procuring a wet-nurse. Some instances of the latter kind occurred, in consequence of the death of mothers Avith children at the breast during the progress of the Boa Vista epidemy of 1845—46, which decimated a population consisting almost wholly 132 DISEASES OF PARTURITION. of blacks, with a few Europeans—Portuguese and English—and a small proportion of mixed negro and European blood. Generally, however, this use of the Bofareira is seldom called for. Death in childbirth, or prolonged illness after parturition, sometimes requires a kind relative or charitable neighbor, who for the safety of the offspring, places herself under the influence of the Bofareira. The son of a wealthy landed proprietor of San Nicolao (well known to my friend, Mr. George Miller, of that island,) a re- markably hale and robust-looking man, was wet-nursed by a woman who gave him milk produced by the bofareira. The nurse in this instance had borne two children in early life. Her hus- band had died shortly after the birth of her second child; she lived in a state of virtuous widowhood, and it was many years after th e death of her husband that she so generously submitted herself to the bofareira, and nursed the infant in question. Consul-General Rendall, of the Cape de Verds, informs me that a lady, a native of Boa Vista, now residing at San Antonio, and the wife of one of the foreign consuls, had a daughter in 1843. "Having very little milk," says Mr. Consul Rendall, "she caused an old female servant to be prepared with the bofa- reira, and to act as wet-nurse, which she did in the most satis- factory manner, having plenty of good milk, although she had not had a child for ten years previously. The child is now (March, 1847) a healthy one, and well-groAvn. " In short," con- tinues M. Rendall, "women who use the bofareira are in two or three days in order sufficient to nurse the child of a queen. I have not been able to ascertain, from personal observation, or from any very accurate information, what effect the bofareira has upon virgins, or upon those who, although they have noi borne children, are nevertheless not virgins. As regards the latter class, however, an intelligent native midwife assured my most able and observant friend, Mr. George Miller, of San Nicolao, that the effect of the administration of the bofareira is much • the same upon them as upon them as upon childbearing women. In some cases, but rarely, the decoction of the bofareira is taken internally, with a view of assisting the action of its ex- ternal application. I regret not having been informed of the alleged difference in LACTATION, MILK-FEVER, &C 133 the action of the white and red bofareiras, while I was at the Cape de Verds, that I might have examined the latter plant upon the spot. The seeds of each plant were, however, kindly forwarded to me by Mr. George Miller, and Sir William Hooker most readily and obligingly examined them. Sir William, in a note to me, says, "What you remark as red bofareira and as white bofareira, are both, not only of the genus 'ricinus,' but also of one and the same species—viz., ricinis communis, the common palma Christi, or castor-oil plant. In our gardens, as well as abroad, the plants vary, and your two plants vary a little in the form and size of the seed, and especially in the color, but they are one and the same species." It is thus evident that the whit© and red bofareiras, if they differ at all, can only be varieties of the same species. It is kn'own, however, that certain varieties of other plants, as thyme, mint, &c, do yield different properties, and such may be the case with the bofareiras. I have thus stated all the facts that have come to my know- ledge regarding this galactagogue of the Cape de Verds, which I consider to be well Avorthy of a fair trial in this country. Should its action in our more temperate regions be similar to that which it exerts within the tropics, an interesting field of inquiry will be opened, as regards its hygienic, medical, medico- legal, and other relations. These, however, are points, the consideration of Avhich had better be reserved until it has been determined, by experiment, how far the bofareira can be successfully introduced into the practice of this country. Note.—Dr. Tyler Smith, to whom I showed my paper before my visit to Edinburgh, has written to inform me that he has in several cases tried the bofareira in the manner described by me ; and he assures me that the effects of the plant grown in this country fully bear out the facts I have detailed respecting the use of this plant in the Cape de Verd Islands.—Lancet, September 1th, 1850, p. 294. 134 DISEASES OF PARTURITION. GALACTAGOGUE AND EMAIEXAGOGUE EFFECTS OF THE LEAVES OF THE BOFAREIRA, (RICINUS COMMUNIS, OR PALMA CHRISTI.) By Dr. Tyler Smith. [Dr. Smith states, that being struck by the facts related in Dr. Mc William's paper, and learning for the first time that the plant is no other than the ricinus communis, which grows as an annual plant in this country, he determined to ascertain by Dr. Mc Williams' wish, whether the plant when growing in our latitudes, preserves its remarkable properties of stimulating the mammary glands. Dr. Smith says :] In directing the use of the Bofareira leaves, which I have procured from the Botanical Gardens at Chelsea, Kew, and the Regent's Park, I have followed as nearly as possible the de- scription of Dr. Mc William, with the exception of the applica- tion of the steam of the decoction to the generative organs. The following are the cases in which the agent has been used under my directions. The following case was conducted by Mr. C. Stillman, one of the house-surgeons of Queen Adelaide's Lying-in-Hospital. Case I.—Mrs. O, twenty-four years of age, rather tall and thin, mother of two children, had weaned the last about six weeks, and had still a little milk, of a very thin, serous charac- ter, left in the breasts. She commenced the use of the Bofareira, on the morning of Wednesday, August 21st, by bathing the left breast only, Avith a strong decoction of the leaves. The leaves themselves were afterwards applied to this breast. In the evening, she repeated the bathing; after which she perceived, on squeezing the nipple, that her milk, which was at first thin and watery, had now become quite thick. After repeating the application on Thursday the 22d, she felt throbbing pains in the breast, accompanied by sickness and pains in the back, which she described as being like after-pains, and the areola surround- ing the left nipple had become much darker than the right; the glandular follicles Avere also larger than in the nipple which had not been under the influence of the Bofareira. The difference betAveen the two breasts Avas very marked. Having at this time no more leaves, she was unable to continue the application. On the following day, a fresh supply of the leaves was obtained, LACTATION, MILK-FEVER, &C. 135 • and she again bathed her left breast as before. After tAvo applications, the catamenia appeared before the regular time, and the fomentations were not afterwards continued. Case II.—Mrs. H., mother of four children, her youngest child aged one year and five months, had been Aveaned more* than six months. During the latter months of lactation, she had little milk; the breasts Avere small, and the nipples con- tracted. Before applying the Bofareira, the breasts were care- fully examined, to learn if they still contained any traces of milk. After much trial, she could squeeze from her left breast the smallest points of serum from the mouths of two or three of the galactophorous ducts, as is the the case with most Avomen who have suckled; but from the right breast not a trace of moisture could be expressed. The Bofareira was used night and morning for four days, by bathing with the decoction, and the application of the hot leaves to both breasts, in the manner described by Dr. Mc William. After the second application, thick milk, like the colostrum, could be squeezed from both nipples, the breasts were considerably swollen, the glands in the axillae were also painful, and pains extended down the arms. There were, in fact, in this case, all the symptoms present, in a minor degree, which are usually observed in the establishment of the milk after parturition. Mrs. II. had also distinct periodical pains in the back and abdomen, Avhich she compared to after-pains. A leucorrhoeal discharge was also produced. At the end of the fourth day, milk flowed so freely into a breast-pump, that there Avas no doubt she could have suckled a child; but at this point the application of the Bofareia was omitted, and the milk has since gradually disap- peared. Case III.—Mrs. D., a married lady, Avithout family, hearing of the use of the Bofareira in the last case, wished it tried upon herself As there was no possibility of injury she was supplied with some of the leaves, and proceeded to use it. The applica- tion, and the use of the decoction, produced SAArelling of the breasts, pain in the back, and an increase of a leucorrhoeal discharge, to which she is subject; but there was no appear- ance of milk in the breasts. At the time of using the Bofareira, the catamenial discharge had ceased about a week. 136 DISEASES OF PARTURITION. Case IV.—M. L, a young woman, who had been delivered three weeks, but whose milk, though profuse, was so poor as to be little more than serum, used the Bofareira three times. under its use the secretion from the breasts became markedly thicker; but the child was unfortunately attacked with diar- rhoea, and it was not thought advisable to continue the use of this agent longer. Case V.—L. M., a young woman, mother of one child, but who had weaned her infant about a year and a half, applied the Bofareira in the form of decoction and poultices two or three times; but the pain and swelling were so considerable, that she refused to go on with it. She had a little serum in the breasts, at the time when the use of the Bofareira was com- menced. The secretion speedily became milky. This patient had a leucorrhcea, which had been present, ever since the weaning; and the uterine and vaginal irritation, upon which the leucorrhcea depended, had kept up, in all probability, the serous secretion from the breasts, which is common enough in leu- corrhoeal cases. Since the foregoing cases occurred, I have used the remedy in a case of scanty menstruation of a remarkable kind. OAving to exposure to marsh malaria, some years ago, the patient had scarcely a sign of colored discharge at the usual catamenial periods. She used the infusion of the leaves of the red Bo- fareira at the date of her period, applying the infusion and leaves to the breasts, and the vapor to the genitals, with the effect of producing, in tAvo days, a considerable flow of the cata- menia. From the effects in this case, and in one of the cases already related, the Bofareira promises to be of considerable value as a direct emmenagogue; at all events the cases in which I have tried it, show that the plant does not lose its effi- cacy in this climate. I hope that, in America and other parts in which the plant is common, perennial instead of annual, extensive trials of its efficacy both as an emmenagogue and a galactagogue, will be made.'—London Journal of Medicine, Oct. 1850, p. 951. SORE NIPPLES. 137 SORE-NIPPLES. According to Murphy, the local cause that chiefly inter- feres with nursing, is the extreme tenderness of the nipples, or the fissures, or so called " sore-nipples." If attention be paid to the breasts before delivery, if the nipples be prepared or hardened by astringents, weak brandy, Arnica- or Alum-water, there will be less risk of accidents afterwards. Still, this pro- cess of hardening may fail, or it may not have been tried; and then, as soon as the child is applied to the breast it causes great pain; inflammation follows, and a crack, or fissure in the nipple is the consequence. From the moment this happens the pa- tient's miseries begin; every time the child is applied, the wound is opened and bleeds; the inflammation increases, the nipple swells and becomes painful, even when the child is not drawing upon it; but the pain becomes intolerable when the child nurses; and thus a very slight inflammation in the be- ginning may soon become so severe and obstinate as to require weeks before it is subdued. The treatment of sore nipples is the treatment of inflamma- tion ; and the first and most important point is the prevention of the fissure. It is here that the watchfulness and intelligence of the nurse is of the utmost importance. It is not usual for physicians to examine the breasts and nipples of his child-bed patients every day, although there are many good reasons why he should do so, especially if he has the least reason to suspect any deficiency or tenderness of the nipples, or inflammation. The nurse has daily and hourly opportunities for observation ; if there be any great pain, unusual swelling, or redness of the nipple, she must necessarily soon observe it, and always should give timely notice to the physician. But many women have an unreasonable and foolish disinclination to expose their breasts to the eye of the accoucheur, until several or many domestic reme- dies have been tried and failed. In the first stage a mild astrin- gent will arrest farther trouble; Murphy has found Alum- whey a useful lotion; while Alum-curds may be applied as a poultice to the nipple ; the infant should be applied to the breast as seldom as possible, and before doing so it is always well to cover the nipple with a circular piece of gold beater's skin, or 138 DISEASES OF PARTURITION. adhesive plaster, having a hole in the centre just sufficient to leave the orifices of the milk-ducts uncovered. This will lessen the pressure and irritation of the infant's gums and render the process of nursing more tolerable. Nipple shields are generally next to useless, if not injurious. The breasts should be gently rubbed from time to time with warm oil, in order to help the milk to flow more freely and easily. Arnica, five drops of the tincture in a wine-glass full of water, applied to the nipples several times a day, is said to be very effectual in removing the tenderness and excoriation consequent upon the first few applications of the child to the breast. Chamomilla, may be used internally and externally in the same way as Arnica, when there is inflammation, swelling and ulceration of the nipples. Graphite, when there is burning, aching, cracking and ten- derness of the nipples. A dose may be given every night and morning. Sulphur, when the nipples are sore and deeply fissured; when the cracks bleed and burn. In some severe cases Sweet-oil and Lime-water may be ap- plied frequently; or Magnesia-ointment; or Glycerine, or Col- lodion ; or a solution of Nitrate of Silver, in the proportion of ten grains to the ounce of water, which will form a slight eschar leaving a sound cuticle after it falls off. In some of the severest and most painful cases, Morphine is the only useful external ap- plication, but it must be washed off very carefully before the child is allowed to nurse. In order to prevent any trouble about the nipples they should be washed off gently Avith Avarm water, immediately after the child has nursed, dried carefully, and then dusted with superfine Avheat-flour. In difficult and obstinate cases Calcarea, Lycopodium, Mer- curius, or Silex may be required; besides the internal use of these remedies, a fine poAvder of Calcarea, Lycopodium, or Silex may be applied externally ; or a weak ointment of Mercurius, or a fine powder of one drachm of white oxide of Zinc to one ounce of fine powdered, or sifted arrow-root. A wash of Borax is fre- quently useful. DEPRESSED NIPPLES. 139 DEPRESSED NIPPLES. According to Murphy these are extremely troublesome and render the chance of nursing almost hopeless. They may be drawn out by the breast-pump so as to enable a strong infant to seize and maintain its grasp ; but more frequently it fails to do so, and the nipple gradually shrinks back to its former size and place, while the infant is moving about its mouth to seize it. Such cases as these, as well as those in which the nipples are badly. formed and shaped, often oblige the practitioner to dis- courage the reluctant mother from making any further attempts to nurse her child. But the simple plan of Tracy (see page 21) will often jsrove successful; it consists in winding a bit of woollen thread or yarn two or three times around the base of the nipples (after this has been previously draAvn out sufficiently), and tying it moderately tight, but not so tight as to interfere with the free circulation of the blood. *Thus, the nipple may be kept permanently and sufficiently prominent; and the woollen threads may be worn constantly for many days Avithout the least inconvenience, and with permanent good results. If the mother still be unable to nurse her child, the secretion of milk must be lessened or prevented; the remedies for exces- sive secretion of milk, must be used, viz : Aconite, if the breasts be hard and knotted, the skin hot and dry, the face red, and the patient restless and discouraged. Bryonia «may be given, if the Aconite does not relieve suffi- ciently; or Belladonna under nearly the same circumstances. Calcarea is especially suitable if there be great fullness or enlargement of the breasts, Avith tardiness in the formation of milk. Rhus-toxicodendron, if there i3 a painful distention of the breasts, with rheumatic pains throughout the body ; swelling, heat and redness of the breasts, headache, stiffness of the joints and face. Rhus is very serviceable at the time of weaning. If the patient' be of a full habit of body, small doses of Sti- bium may be given ; some milk should be drawn from the breasts at long intervals only, and a bandage or strips of adhesive plas- ter may be applied over them, so as to maintain a firm and equable pressure, and thus promote the absorption of the re- 140 DISEASES OF PARTURITION. mainder. If there be much distention of the breasts, warm fo- mentations and warm frictions will be found very serviceable. Drinks of Citrate of Magnesia, or Cream of Tartar are said to be almost uniformly successful, when aided by low diet. Many other affections of the breast may arise after confine- ment ; for it must be recollected that each breast is composed of an association of small glandular masses, or in other words that each lobe is a perfect and independent gland, enjoying exclusively its own vascular and nervous system, and having its own proper duct, the separate orifice of which is at the nipple. A large quantity of interlobular cellular tissue unites these lobes to- gether, and the whole is at last surrounded by the investing fibrous membrane, or mammary fascia. Both around the mar- gins and in front of the gland is a large quantity of fat; and there also exists much fibre-tissue in the nipple between the ducts and under the areola. Hence inflammation and its results may affect, and be limited to the nipple or areola, the cutaneous or sub-cutaneous tissue, the lobes individually or collectively, and the uniting fibro-cellular tissue ; it may be either intfm-lobular or tWer-lobular, or both combined.—Birkett. Inflammation of the minute follicular glands scattered over the nipple, forms a peculiar variety of inflammation and fissures of the nipple. The first difficulty which the mother experiences is a sensation of heat, then of tingling or smarting with a very slight redness; the skin of the nipple becomes harsh and dry, and upon careful examination one or more small vesicles will be detected. These in time become rubbed, the skin breaks, and then a little oozing is noticed, with perhaps a minute ulcer or crack at the most painful spot. These appearances may be ob- served in any part of the nipple, from the apex to its base, or even upon the areola; as the mischief advances the cracks ex- tend, taking either a circular or longitudinal course : but the former is most common. The pain now becomes very severe when the infant nurses ; the fissures divide and increase in ex- tent and depth ; the skin becomes entirely destroyed, or a cir- cular fissure surrounding the base of the nipple threatens its total destruction by sloughing. The fissures and ulcers bleed frequently so that the infant often vomits blood after nursing. One of the most important and troublesome consequences of DEPRESSED NIPPLES. 141 this form of disease is secondary inflammation of the deep fibre- tissue uniting together the tubes or 'ducts in the nipple ; the in- flammatory exudation and induration may cause obliteration of one or more of the milk-ducts. The inflammation may also ex- tend to the glandular tissue, and give rise to deep and numerous abscesses. Treatment.—The preventive treatment consists in hardening the nipples as soon as quickening begins ; the nipple then should be exposed to the air occasionally, washed with bland-soap and water, and wetted night and morning with a little diluted Co- logne-water, or with alcohol and water, or with Arnica-Avater. After the birth of the child, too much care cannot be taken to see that the nipple is carefully and properly washed and cleaned after each application of the infant to the breast; the secretions from the child's mouth, combined with the milk should never be suffered to become dry upon the part. The nipple should also be protected from the pressure and friction of the dress and bed- clothes by some resisting body, such as a nipple-shield. When the inflammation, fissures and abrasions are not very severe they will often yield to protection, frequent ablution, aided by some mild powder, such as Lycopodium, starch-powder, or Carbonate of Magnesia, or one drachm of White Oxide of Zinc mixed AYith one ounce of finely powdered and sifted arrow-root, applied after the nipple has been carefully washed and dried. When the soreness of the nipples is produced by an aphthous inflammation of the child's mouth, a solution of Borax, or Chlo- rate of Potash, or the 1st dilution of Nitric-acid may be applied three or four times a day, or more. The internal and external use of Nitrate of Silver may be tried ; but the external application as ordinarily used is attended with great pain, although the second or third application is not as severe as the first. Collodion is said to be a very useful application and prefer- able to most others. Among the internal remedies, Graphite, Sepia, Zincum-ms- tallicum deserve attention ; also Petroleum, and Sanguinaria. 142 DISEASES OF PARTURITION. MICK FEVER. This according to Colombat is not so much a disease as a febrile movement requisite to form the secretion of milk in a woman recently delivered. It commences with shooting pains and aching in the breasts, which become swollen; the glands under the arm pit are also apt to become tender and enlarged. These symptoms generally commence on the third day after the birth of the child ; in certain cases as early as the first or second and sometimes even as late as the sixth. The pulse becomes full and frequent, the skin hot and dry, face flushed, there is thirst, Avhitish fur on the tongue, scantiness of the urine, more or less general agitation and headache. This fever gene- rally subsides in twenty-four hours; sometimes in the course of six, eight or tAvelve. While the milk-fever lasts, the lochial discharge diminishes, or is temporarily suspended ; but soon an abundant perspiration sets in, and the lochia then again become as free as before the attack. If the child is applied early and sufficiently frequently to the breast there is generally little or no milk-fever; the same holds true of those Avomen who perspire very copiously. Treatment.—If the fever runs too high and the breasts are very much swollen and painful, small doses of Aconite and An- timony should be relied upon ; the breasts should also be drawn regularly, at least every four hours, and sometimes every two or three hours. The Sulphate of Potash enjoys a very long- standing reputation as an anti-lactic remedy. ENGORGEMENT AND INFLAMMATION OF THE BREASTS. Engorgement of the breasts generally appears on the fourth or fifth day after delivery, and principally affects persons who do not wish to nurse, or who do not apply the child to the breast at least every four hours, both by night and day, or those who have too great a flow of milk and nurse a feeble child, or have ENGORGEMENT OF THE BREASTS. 143 their nipples too small or large, or who have taken cold. The patient has chills and pain in the back followed by fever ; the breasts become hard and unequal, but preserve their natural color ; but the breasts may become caked or indurated, and the secretion of milk will then be diminished or completely sus- pended, while the patient has pains in the whole of the breast, which may even extend to the arm pits. When inflammation has set in, the breasts gradually increase hrsize, and become very painful and hard ; they are excessively hot and tense, and assume a reddish color ; the pains lancinating and pricking ; fever sets in, with headache, which increases more and more ; the face is flushed, urine scanty with a whitish sedi- ment ; the faeces exhale an acid odor; and lastly the inflamed breast acquires considerable size and hardness, Avhich may ex- tend to the arm-pits and neck. The pains may become so acute that delirium sets in. Simple engorgement generally terminates by resolution ; while suppuration is the most common termination of the really in- flammatory variety. We ascertain that suppuration is taking place by the persistence and progressive increase of the inflam- matory symptoms, and by the presence of hard lumps or cakes in the breasts, together with throbbing pains and intolerable shootings. Finally fluctuation is discovered. Treatment.—The preventive treatment consists in applying the infant early to the breasts in order to empty them as soon as they are filled; in keeping the breasts and person of the patient warm; and by moderate diet. When engorgement has once set in, a flaxseed poultice con- taining a little milk, castile-soap, or ten or twelve grains of Soda, or Potash, may be applied ; or Hydridate of Potash-oint- ment, one drachm to the ounce of simple cerate; or bits of Canton-flannel, or Spongio-piline dipped in hot Pearlash-water, not too strong. Aconite and Antimony may be used internally; or Aconite and Bryonia; or Belladonna, or Mercurius may be given in al- ternation with Bellad., especially if transient chills and throb- bings set in. Phosphorus is another very useful remedy when the inflam- mation is active and rapid suppuration threatens ; it will often 144 DISEASES OF PARTURITION. be found to quickly relieve the excessive pain, redness and swell- ing. It is also useful against a fistulous, or indurated condition of the breast. Ilepar-sulphur is indicated after the inflammatory symptoms have someAvhat abated, yet signs of suppuration are still present. It may help to produce resolution, but is also said to expedite the bursting of the abscess Avhen it has already formed. Nitric-acid is said to be useful, when there are hard nodosities in the breasts. Sulphur, Avhen there is inflammation and induration of the breasts; or erysipelatous inflammation with heat, hardness, and redness radiating from the nipple. Lycopodium, AYhen there are hard, burning nodosities in the breasts; with discharge of blood and sticky water from the nipples. Conium, when there is hardness of the breasts with pains at night. Bromine and Sabina, when there is swelling of the breasts. Mercurius-solubilis, when there is swelling of the breasts, especially of the nipples, which are somewhat harder than na- tural. Calcarea, when there is swelling and heat of the breasts, with inflammation of the nipples. Belladonna, when there is hardness, with excessive secretion of milk, and some inflammation. Rhus-toxicodendron, when there is painful distention of the breasts, when the milk first begins to flow, with pain and itching of the nipples. Zincum, when there is distention of the breasts, with soreness of the nipples. If the abscess be small, it may be allowed to open of itself; but if the engorgement and induration is extensive an open- ing should be made as soon as fluctuation is discovered; the incision should be made in the' direction of one of the radia of a circle, of which the nipple is the centre; a bit of lint or linen may be introduced into the opening to prevent its closing too soon ; the fears of some homoeopathic physicians about lancing abscesses are founded upon the grossest ignorance and prejudice. ALTERATIONS OF THE MILK. 145 ALTERATIONS OF THE MILK. According to Colombat, after nervous diseases the milk is apt to become thin like water, or of a greenish color; it may assume a yellowish color in inflammations of the breast; a saltish and disagreeable taste in inflammatory diseases, and lastly, a sour smell after labor generally ; while it contracts an odor like that of garlic in persons who eat that substance. To discover whether the consistence of the milk is too thin, or too thick, it is merely necessary to put a drop on one of the nails; if it adheres to it at first, and then spreads without running, it is in. a natural condition; if it runs, it is too thin; and if it adheres to the nail without spreading, it is too thick. In nervous women the milk is apt to be thin and not very nu- tritious, whilst it is also subject to important changes from the slightest vexation, or other powerful mental emotions. Men- struation renders it thin and serous ; Pregnancy makes it thick and unfit for the nourishment of infants; salt-meats, highly seasoned dishes, mealy vegetables, salads and fruits make it more abundant and thinner; spirituous liquors, late hours, ex- cessive sleep and all abundant secretions diminish it in quantity. From the chemical examination of eighty-nine females Ver- nois and Becquerel have established the healthy standard of human milk, as follows : Density..................... Water...................... Solid constituents............. Sugar................... Casein and extractive matters. Butter...................... Salt........................ MEDIUM. MAXIMUM. 1032.67 1046.48 889.08 999.98 110.92 147.70 43.64 59.55 39.24 70.92 26.66 56.42 1.38 3.38 MINIMUM. 1025.61 832.30 83.33 25.22 19.32 6.66 0.55 In twenty-six cases the influence of the presence of Colostrum from the first to the fifteenth day after delivery, was as follows'; K 146 disorders of lactation. MAXIMUM. 1032.86 882.97 147.70 48.46 48.66 56.42 3.38 MINIMUM. 1025.61 870.34 117.03 35.54 32.92 28.89 1.23 MEDIUM. 1031.34 872.45 127.55 41.23 44.05 40.35 1.92 MEDIUM. NORMAL STATE. 1032.67 Water.............. 889.08 Solid constituents..... Sugar ............... 110.92 43.64 Casein and extractive 39.24 Butter.............. 26.66 1.38 Hence the presence of colostrum causes a partial diminution of the density of milk, constant diminution of the quantity of the water of milk, constant increase of solid constituents, constant but slight diminution of sugar, notable increase of casein, very marked increase of butter, increase of the salts. As regards the influence of the age of the nurse: Density.... Water..... Solids..... Sugar..... Casein, &c Butter..... Salts...... 15 to 20 20 to 25 25 to 30 30 to 35 35 to 40 YEARS. YEARS. YEARS. YEARS. YEARS. 1032.24 1033.08 1032.20 1032.42 1032.74 869.85 886.91 892.96 888.06 894.94 130.15 113.09 107.04 111.94 105.06 35.23 44.72 45.77 39.53 39.60 55.74 38.73 36.53 42.33 42.07 37.38 28.21 33.48 28.61 22.33 1.80 1.43 1.26 1.44 1.06 MEDIUM. NORMAL STATE. 1032.67 889.08 110.92 34.61 39.24 26.66 1.38 Hence although the difference is not very great, it will be most desirable to have a wet-nurse from 20 to 30 years of age. As regards the age of the milk, the above authors have fur- nished the following table: alterations of the milk. 147 3 £ 2 HO)OClff)(D-( CO 00 r-> ■"* CO IN IN 2 c 2 I rtiommiNNm CO t- —i in (N rn £ 5' n t~ in in co to m to t, ^ aimto-HoomiN o S -q< ^-i CD tj< 00 ■* i-i *• a CO OS © tr CO CO IN o to tji t- e* cm co — r oo co .-h tj< co co « s - 2 c c - s -h as .-< co to m as i-h CTS O -h IN o in COi(N! t-^ COI 00 rji i-i CO t— IN Tji t)i CO OOOi-h Po os t to o oo in co to co «-h tji co in go -h in r-^ o ui as —' CO t— IN ij< T* CO O 00-h »?>S^ » d 3 a Q ? r/) CO O ffl IO 1. The only conclusions which can be drawn from this table are: That the milk of a nurse whose breast of milk is from 1 to 3 months old will contain too much butter for an in- fant over three months of age; and conversely; while breast-milk over 3 months old, will contain too little butter for a child under 3 months of age. 2. That breast-milk under 2 months old, will contain too much casein for infants over 2 months of age ; and a breast of milk over 2 months of age will contain too little casein for in- fants under 2 months. The quantity of sugar in breast- milk of all ages does not vary ma- terially. As regards the influence of the constitution of the nurse, it is err roneously supposed that a strong powerful wet-nurse has the best and most nourishing milk. But this is far from being the case ; all her food goes to supply her own body, and hence she has but little to spare in the shape of milk. 148 DISORDERS OF LACTATION. Density............... Water................. STRONG CONSTITUTION. 1032.97 911.19 88.81 32.55 28.98 25.96 1.32 DELICATE CONSTITUTION. 1031.90 887.59 112.41 42.88 39.21 ■ 28.78 1.54 MEDIUM NORMAL STATE. 1032.67 889.08 Solids................. 110.92 43.64 39.24 Butter................. 26.66 Salts................• . 1.38 INFLUENCE OF PREGNANCY. PREGNANCY TOR 3 MEDIUM NORMAL MONTHS. STATE. 1030.67 1032.67 860.97 889.08 139.01 110.92 46.47 43.64 34.52 39.24 55.97 26.66 2.05 1.38 Density ... Water..... Solids..... Sugar..... Casein, &c Butter..... Salts..... "The principal influence of pregnancy on milk is to produce a great increase in the quantity of butter; and it is remarkable that the same effect is produced in the cow, the proportion of butter increasing from 36.12 to 47.52. THE INFLUENCE OF MENSTRUATION, is variable; as a rule the density, quantity of water, and sugar are somewhat diminished; and that of the solids and casein decidedly increased,. the butter and salt decidedly or slightly augmented. Still in two instances the solids increased from 111 and 113 to 142 and 144, and in another case, fell from 113 to 96. The quantity of Sugar in one case fell from 54 to 35; in- creased in another from 39 to 47; and remained stationary at 44 in a third. The quantity of Casein increased in one case from 35 to 40; in another from 41 to 42; and fell in a third from 41 to 39. The quantity of Butter increased in one case from 21 to 67; in a second, from 29 to 52; and fell in a fourth, from 24 to 10. Hence it is to be supposed that equally great changes will take place in the state of the stomach and bowels of the infant. ALTERATIONS OF MILK. 149 INFLUENCE OF COMPLEXION AND COLOR OF THE HAIR. It is supposed that the milk of females with brown fiair is preferable to that of blondes. • The milk of persons with blond hair is less dense; contains more water; less of solids, sugar, casein, and salt; and a little more of butter. INFLUENCE OF FOOD. In nurses who are poorly fed the quantity of water in their milk is apt to increase from 876 to 893 ; the solids to diminish from 123 to 104; the sugar to increase from 41 to 45; the casein to remain unaltered; and the butter to lessen from 43 to 18. INFLUENCE OF THE QUANTITY OF THE MILK. When the breasts furnish but little milk, the density, and water and butter are apt to increase; the solids, sugar and casein to diminish. INFLUENCE OF ACUTE FEVERS. Density ... Water..... Solids..... Sugar..... Casein, &c. Butter .... Salts...... MEAN IN FEVERS. NORMAL MEAN 1031.20 1032.67 884.91 889.08 115.09 11092 33.10 43.64 50.40 39.24 29.86 26.66 ■1.73 1.38 Hence in fevers, there is a slight diminution of the density of the milk, and a notable lessening of the water and sugar; while there is an proportionate increase of solids, a marked augmentation of casein and butter, and a slight increase of salt. INFLUENCE OF SEVERE MORAL EMOTION. Density.. . . Water..... Solids..... Sugar..... Casein, &c. Butter..... Salts...... MORAL EMOTION. NORMAL MEAN 1032.99 1032.67 908.93 889.08 91.07 110.92 34.92 43.64 50.00 39.24 5.14 26.66 1.01 1.38 150 DISORDERS OF LACTATION. In this case there was a sudden increase of water and casein; and a very great diminution of the solids, sugar and butter. INFLUENCE OF CHRONIC DISEASE. Density ... Water..... Solids.... Sugar..... Casein, &c Butter..... Salts..... MAXIMUM. 1037.52 923.58 167.04 51.98 47.49 73.05 3.38 MINIMUM. 1027.07 832.96 89.51 30.38 1270 6.90 0.61 MEDIUM. 1034.47 885.50 114.50 43.37 37.06 32.57 1.50 NORMAL MEAN. 1032.67 889.08 110.92 43.64 39.24 26.66 1.38 In acute diseases the quantity of sugar is apt to be greatly diminished; while it generally remains unaltered in chronic affections. On the other hand, the quantity of casein is fre- quently very much increased in acute diseases, and lessened in chronic. The density and quantity of water is lessened in both acute and chronic disorders; the solids, butter, and salt some- what increased. The inference would be, that when infants must be partly fed while their mothers are suffering from acute dis- ease, less milk and more sugar and water should be added to their food; and more milk and less sugar in chronic affections. INFLUENCE OF CONSUMPTION. Density ... Water..... Solids..... Sugar..... Casein, &c Butter..... Salts...... The milk of decidedly consumptive females is markedly de- ficient in butter. Without diarrhcea, With diarrhcea, abscesses and ema- Elogius 26 Jeremias 27 Seven Sleepers 28 Leo 29 Peter and Paul 30 Paul APPENDIX. JUNE. MIDDLE. OCTOBER. 18 Luke 19 Ptolemy 20 Wendelia 21 Ursula 22 Corduca 23 Severus 24 Solomon 25 Crispin 26 Amandus 27 Sabina 28 Simon and Ju 29 Engelard 30 Hartman 31 Wolfgang november. 1 All Saints 2 All Souls 3 Gottlieb 4 Charlotte 5 Eric 6 Leonard 7 Erdman 8 Claude 9 Theodore 10 Jonas 11 Martin 12 Cunibert 13 Britius 14 Lewin 15 Machutus 16 Ottoman END. MARCH. ' 8 Philemon 9 Prudentius 10 Henrietta 11 Rosina 12 Gregory, M. 13 Ernest 14 Zacchary 15 Isabella 16 Syriac 17 Patrick 18 Edward 19 Joseph 20 Rupert 21 Benedict 22 Casimer 23 Everard 24 Gabriel 25 Annunciation 26 Emanuel 27 Hubert 28 Gideon 29 Eustace 30 Guido 31 Philip APRIL. 1 Theodore 2 Theodosia 3 Christian 4 Ambrose 5 Maximus 6 Sixtus 180 APPENDIX. JULY. BEGINNING. MIDDLE. END. JULY. NOVEMBER. APRIL. 1 Theobald 17 Hugh 7 Celestine 2 Visita. of Mary 18 Gotschalk 8 Heilman 3 Cornelius 19 Elizabeth 9 Bogislaus ' 4 Martin 20 Edmund 10 Ezekiel 5 Anselm 21 Presentation 11 Herman 6 Isaiah 22 Cecilia 12 Julius 7 Thorn, a Bechet 23 Clement 13 Justin 8 Kilian 24 Lebrecht 14 Tiburtius 9 Cyril 25 Catharine 15 Obadiah 10 Felicity 26 Conrade 16 Carisius 11 Pius ; 27 Lot 17 Rodolph 12 Henry 28 Gunter 18 Florence 13 Margaret 29 Noah 19 Werner 41 Bonaventure 30 Andrew 20 Sulpitius DECEMBER. 15 Swithin 1 Arnold 21 Adolphus 16 Enstace 2 Candida 22 Lothario 17 Alexis 3 Cassian 23 George 18 Caroline 4 Barbara 24 Albert 19 Ruth 5 Abigail 25 Mark 20 Elias 6 Nicholas 26 Raymar 21 Daniel 7 Antonia 27 Anastasius 22 Magdalen 8 Conception 28 Theresa 23 Albertine 9 Joachim 29 Sibylla 24 Christine 10 Judith 30 Joshua i MAY. 25 James 11 Waldemar 1 Philip & James 26 Anne 12 Epimaehus 2 Sigismund ' 27 Berthold 13 Lucy 3 Holy Cross 28 Innocent 14 Israel 4 Florian 29 Martha 15 Johanna 5 Gothard 30 Beatrice 16 Ananias 6 John Evangelist 31 Germain 17 Lazarus 7 Godfrey APPENDIX. 181 AUGUST. BEGINNING. MIDDLE. END. AUGUST. DECEMBER. MAY. 1 Peter 18 Christopher 8 Stanislaus 2 Gustavus 19 Manasses 9 Job 3 Augustus 20 Abraham 10 Gordian 4 Perpetua 21 Thomas 11 Mamertus 5 Dominick 22 Beata 12 Pancratius 6 Transfiguration 23 Ignatius 13 Servatius 7 Donatus 24 Adam and Eve 14 Christiania 8 Ladislaus 25 Christ born 15 Sophia 9 Romanus 26 Stephen 16 Honoratus 10 Lawrence 27 John 17 Pascal 11 Titus 28 Innocents 18 Livorius 12 Clara 29 Jonathan 19 Dunstan 13 Hildebrand 30 David 20 Frances 14 Eusebius 31 Sylvester JANUARY. 21 Prudens 15 Assumption 1 Circumcision 22 Helena 16 Isaac 2 Abel 23 Desiderius 17 Bertram 3 Enoch 24 Esther 18 Emilia 4 Titus 25 Urban 19 Sebald 5 Simeon 26 Augustine 20 Bernard 6 Epiphany 27 Bede 21 Athanasius 7 Melchior 28 William 22 Oswald 8 Lucian 29 Mazimilian 23 Zaccheus 9 Caspar 30 Wigan 24 Bartholomew 10 Paul Hermit 31 Petronella JUNE. 25 Lewis 11 Erhard 1 Nicomede 26 Irenaeus 12 Reynold 2 Macarius 27 Gebard 13 Hilarius 3 Erasmus 28 Augustine 14 Felix 4 Ulrica 29 John 15 Habakkuk 5 Bonifacius 30 Benjamin 16 Marcellus 6 Benignus 31 Rebecca 17 Anthony 7 Lucretia 182 APPENDIX. . SEPTEMBER. BEGINNING. MIDDLE. END. SEPTEMBER. JANUARV. JUNE. 1 Giles 18 Prisca 8 Medard 2 Rachel 19 Ferdinand 9 Bamimus 3 Man'suetus 20 Fabian 10 Onuphrius 4 Moses 21 Agnes 11 Barnabas 5 Nathaniel 22 Vincent 12 Blandina 6 Magnus 23 Emerantia 13 Tobias 7 Enurchus 24 Timothy 14 Modestus 8 Mary 25 Paul 15 Vitus 9 Bruno 26 Poly carp 16 Justina 1 10 Sosthenes 11 Gerard 12 Otilia 27 Chrysostom 17 Alban 28 Charles 18 Paulina 29 Samuel 19 Gervase v 13 Christlieb 30 Adelgunda * 20 Edward 14 Exaltation 31 Valerius FEBRUARY. 21 Jacobina 15 Constantia 1 Bridget 22 Acharius 16 Euphemia 2 Purific. of Mary 23 Basilius 17 Lambert 3 Blaise 24 John Baptist 18 Sigfred 4 Veronica 25 Elogius 19 Januarius 5 Agatha 26 Jeremias 20 Frederica 6 Dorothea 27 Seven Sleepers 21 Matthew 7 Richard 28 Leo 22 Maurice 8 Solomon 29 Peter and Paul 23 Joel 9 Apollonia 30 Paul JULY. 24 John 10 Renata 1 Theobald 25 Cleophas 11 Euphrosyne 2 Visita. of Mary 26 Cyprian 12 Severinus 3 Cornelius 27 Cosmo • 13 Benigna 4 Martin 28 Wenzel 14 Valentine 5 Anselm 29 Michael 15 Formosus 6 Isaiah 30 Jerome 16 Juliana 7 Thorn, a Becket APPENDIX. 183 OCTOBER. BEGINNING. MIDDLE. END. OCTOBER. FEBRUARY. JULY. 1 Remigius 17 Constantia 8 Kilian 2 Voirade 18 Concordia 9 Cyril 3 Ewald 19 Susanna 10 Felicity 4 Francis 20 Eucharius 11 Pius 5 Charity 21 Eleanor 12 Henry 6 Faith 22 Peter 13 Margaret 7 Hope 23 Reynard 14 Bonaventura 8 Ephraim 24 Matthias 15 Swithin 9 Denys 25 Victor 16 Eustace 10 Amelia 26 Nestor 17 Alexis 11 Burkard 27 Hector 18 Caroline 12 Erenfried 28 Justus MARCH. 19 Ruth 13 Edward Conf. 1 Albin 20 Elias 14 William 2 Louisa 21 Daniel 15 Hedwig 3 Cunigund 22 Magdalen 16 Gallus 4 Adrian 23 Albertine 17 Etheldreda 5 Frederick 24 Christine 18 Luke 6 Everhard 25 James 19 Ptolemy 7 Perpetua 26 Anne 20 Wendelia 8 Philemon 27 Berthold 21 Ursula 9 Prudentius 28 Innocent 22 Corduca 10 Henrietta 29 Martha 23 Severus 11 Rosina 30 Beatrice 24 Solomon 12 Gregory, M. 31 Germain AUGUST. 25 Crispin 13 Ernest 1 Peter 26 Amandus 14 Zachary 2 Gustavus 27 Sabina 15 Isabella 3 Augustus 28 Sim.on and Jude 16 Syriac 4 Perpetua 29 Engelard 17 Patrick 5 Dominick 30 Hartman 18 Edward 6 Transfiguration 31 Wolfgang « 19 Joseph 7 Donatus « 184 APPENDIX. NOVEMBER. BEGINNING. MIDDLE. END. NOVEMBER. MARCH. AUGUST. 1 All Saints 20 Rupert 8 Ladislaus 2 All Souls 21 Benedict 9 Romanus 3 Gottlieb 22 Casimer 10 Lawrence 4 Charlotte 23 Everard 11 Titus 5 Eric 24 Gabriel 12 Clara 6 Leonard 25 Annunciation 13 Hildebrand 7 Erdmann 26 Emanuel 14 Eusebius 8 Claude 27 Hubert 15 Assumption 9 Theodore 28 Gideon 16 Isaac 10 Jonas 29 Eustace 17 Bertram 11 Martin 30 Guido 18 Emilia 12 Cunibert 31 Philip APRIL. 19 Sebald 13 Britius 1 Theodore 20 Bernard 14 Lewin 2 Theodosia 21 Athanasius 15 Machutus 3 Christian 22 Oswald 16 Ottoman 4 Ambrose 23 Zaccheus 17 Hugh 5 Maximus 24 Bartholomew 18 Gotschalk 6 Sixtus 25 Lewis 19 Elizabeth 7 Celestine 26 Irenseus 20 Edmund 8 Heilman 27 Gebard 21 Presentation 9 Bogislaus 28 Augustine 22 Cecilia 10 Ezekiel 29 John 23 Clement 11 Herman 30 Benjamin 24 Lebrecht 12 Julius 31 Rebecca SEPTEMBER. 25 Catharine 13 Justin 1 Giles 26 Conrad 14 Tiburtius 2 Rachel 27 Lot 15 Obadiah 3 Mansuetus 28 Gunter 16 Carisius 4 Moses 29 Noah 17 Rodolph 5 Nathaniel 30 Andrew 18 Florence 6 Magnus APPENDIX. 185 DECEMBER. BEGINNING. MIDDLE. END. DECEMBER. APRIL. SEPTEMBER. 1 Arnold 19 Werner 7 Enurchus 2 Candida 20 S.ulpitius 8 Mary 3 Cassian 21 Adolphus 9 Bruno 4 Barbara 22 Lothario 10 Sosthenes 5 Abigail 23 George 11 Gerard 6 Nicholas 24 Albert 12 Otilia 7 Antonia 25 Mark 13 Christlieb 8 Conception 26 Raymar 14 Exaltation 9 Joachim 27 Anastasius 15 Constantia 10 Judith 28 Theresa 16 Euphemia 11 Waldemar 29 Sibylla 17 Lambert 12 Epimachus 30 Joshua MAY. 18 Sigfried . 13 Lucy 1 Philip & James 19 Januarius 14 Israel 2 Sigismund 20 Frederica 15 Johanna 3 Holy Cross 21 Matthew 16 Ananias 4 Florian 22 Maurice 17 Lazarus 5 Gothard 23 Joel 18 Christopher 6 John Evangelist 24 John 19 Manasses 7 Godfrey 25 Cleophas 20 Abraham 8 Stanislaus 26 Cyprian 21 Thomas 9 Job . 27 Cosmo 22 Beata 10 Gordian 28 Wenzel 23 Ignatius 11 Mamertus 29 Michael 24 Adam and Eve 12 Pancratius 30 Jerome OCTOBER. 25 Christ Born 13 Servatius 1 Remigius 26 Stephen 14 Christiana 2 Voirade 27 John 15 Sophia 3 Ewald 28 Innocents 16 Honoratus 4 Francis 29 Jonathan 17 Pascal 5 Charity 30 David 18 Livorius 6 Faith 31 Sylvester 19 Dunstan 7 Hope /"* INDEX. A. PAGE. Abortion,...................... 107 Acidity of Stomach,............ 51 Acids, in Heartburn,............ 54 Acid, Nitric,................... 73 " Muriat.,................. 73 Aconite, in Morning Sickness,... 37 " " Toothache,......... 42 " " Jaundice,........... 70 " Piles,.............. 73 " " Rheumatism of Womb,___ 85 " " Inflammation"...... 86 Aethusa Cynapium,............ 13 Aethusa Cynapium in morning sickness,.................... 37 After-birth, delivery of,......... 119 After-birth, hemorrhage before, du- ring, and after,.............. 120 After pains,................... 154 Age, for marriage,.............. 4 Alterations of milk,............. 145 " " taste, during preg- nancy, .... 30 Alkaline Dyspepsia,:............ 52 Aloes in Jaundice,.............. 70 Piles,................. 73 Alumina in Constipation,........ 60 Ammon. mur. in toothache,.......' 44 Anacardium,.................... 13 Anger, inclination to,........... 13 Anteversion of the Womb,....... 92 Antipathies,................... 13 Antimony in Toothache,......... 43 Anxiety, about the future,....... 12 Apis mell.,.................... 77 " in Dropsy of Amnion,.. 80 Apocynum in Dropsy of Amnion, 80 Appendix,.....................173 Argentum nitricum in Menstrua- tion during Pregnancy,........ 81 Arnica in Toothache,........... 43 Arsenicum " 44 " in Diarrhoea,......... 68 Piles,............. 73 " (Edema of Labia,... 77 " False waters,...... 79 " Dropsy of Amnion, 80 " Menstruation during Pregnancy,.... 81 Aurum in Menstruation during Pregnancy, ................. 81 Aversion to Meat,.............. 30 Fish,.............. 32 Water,............ 32 Milk and Butter,..... 32 Sweet things,....... 32 Vegetables.......... 32 B. Baryta,....................... 12 " in Toothache,........... 44 Belladonna.in Morning Sickness, . 37 " in Toothache,..... 45 " Jaundice,...... 70 Piles,......... 73 " Inflammation of Womb,___ 86 Bleeding during Pregnancy,...... 82 Bofareira,..................... 129 Borax in itching of Vulva,....... 77 Bovista in Leucorrhcea,......... 78 Breasts, Pain and Tension of,.... 107 " Engorgement of,....... 142 188 INDEX. PAGE. Breasts, Inflammation of,........ 143 Bright's Disease,............... 101 Bryonia in Toothache,.......... 45 Constipation,........ 59 M Diarrhcea,........... 68 C. Calendar, Ladies perpetual,...... 174 Calcarea in Toothache,.......... 45 Calcarea against Piles,.......... 74 Calcarea in Leucorrhcea,......... 78 Camphor in Morning Sickness,... 36 '' Against Spasm of Ure- ters,___■ 76 Causticum in Toothache,........ 46 Cannabis in Incontinence of Urine, 76 Cantharides " " 76 " Against Spasm of Ure- ters, ___ 76 Cannabis against Spasm of Ureters 76 Cantharides in Menstruation dur- ing Pregnancy,.............. 81 Capsicum in Constipation,....... 61 Piles,............. 72 '* Incontinence of Urine, 76 Copaiba in Piles,.............. 72 Carb-veg. in Toothache,......... 46 Castor Oil Plant in Lactation..... 129 Chamomilla in Uterine Hemor- rhage, ...................... 82 Chamomilla in Toothache,....... 46 " Jaundice,........ 69 Chills and Trembling,.......... 109 China m Toothache,.... ; ....... 47 China in Diarrhcea,............. 68 " Uterine Hemorrhage,... 83 Cicuta in Incontinence of Urine,.. 76 Cicuta,....................... 13 Cocculus in Leucorrhcea,........ 78 Cocculus during Pregnancy,..... 81 Colomba in Morning Sickness,... 35 PAGE. Colchicum in Toothache,........ 47 Colchicum in Jaundice,......... 70 Conception,................... 6 Constipation,.................. 56 Convulsions,................... 104 Contraction of Vulva,........... 114 Convalescence after Parturition,.. 123 Conium,...................... 13 " In Morning Sickness,.... 36 " In Incontinence of Urine, 76 Cough,........................ 95 Cramps and Pains in Abdomen, Back and Loins,.............. 87 Crocus in Menstruation during Pregnancy,.................. 81 Crocus in Uterine Hemorrhage,.. 83 Cuprum,...................... 13 " In Morning Sickness,... 36 Cubebs in Piles,................ 72 Cyclamen in Toothache,......... 47 D. Delivery, too rapid,............. 114 " of After-birth,......... 119 Depressed Nipples,........ 11 & 139 Digitalis in Salivation,.........-39 Derangement of the Stomach,.__ 110 Desires during Pregnancy, .. 32 & 28 Diarrhoea,..................... 66 Diet during Pregnancy,......... 27 Difficulty of Breathing,......... 95 Digitalis,..................... 13 " in (Edema of Labia..... 77 " False waters,........ 79 " Dropsy of Amnion,.. 80 Dropsy of the Amnion,......... 79 Dropsical Affections,........... 98 Dropsy of the Legs,............ 98 Dulcamara in Diarrhcea,......... 68 Dying, fear of,................. 13 INDEX. 189 PAGE. E. Engorgement of Breasts,........ 142 Euphorbium in Toothache,...... 47 Excess of Waters,............. 79 Excessive Lactation,............ 169 Exercise during Pregnancy,...... 26 Extra Uterine Pregnancy,....... 118 F. Fainting,...................... 94 Falling of the Womb,.......... 89 " back of the Womb,...... 90 " forwards " 92 False Waters,................. 78 " Labor..................... 109 " Pains,................... 88 Fault-finding,.................. 13 Feebleness and Slowness of Con- traction, ..................... Ill Ferrum in Morning Sickness..... 37 Ferrum-aceticum in Constipation, 61 Foetal Turbulence,.............. 92 Fluoric-acid in Toothache,....... 47 Full Bloodedness............... 98 G. Graphite,...................... 13 ' H. Haemorrhoids,................. 70 Headache...................... 96 Hydrocyanic-acid in Morning Sick- ness, .....___.............. 38 Hydrorrhcea,................... 78 Hypochondriasis,............... 98 I. Ignatia in Constipation,......... 60 Piles,............... 73 Incontinence of Urine,.......... 74 Inflammation of Womb.......... 85 " Vagina,......... 159 PAGE. Inflammation of Mucous Membrane of Vagina and Womb,....... 159 " Asthenic, of Vagina 160 '; Cavity of neck of Womb,....... 161 " Fibrous Structure of Womb,..... 161 " Peritoneum,..... 162 Sub-Peritoneal tis- sue, .......... 165 Post-Partem, 158tol69 " Veins of Womb,.. 167 Crural and Pelvic Veins,........ 168 Iodine in Salivation,............ 39 Inversion of the Womb,......... 122 Ipecac in Morning Sickness,..... 37 " Uterine Hemorrhage,... 82 Irritability of Womb............ 85 Irregularity of Pains,........... 113 Itching of the Vulva,........... 77 Jaundice,...................... 69 K. Kali-bichrom. in Constipation, .. 61 Kiesteine,..................... 14 Kreosote in Morning Sickness, ... 35 " Toothache,.......... 48 L. Lactatiqn,..................... 126 " Excessive,............ 169 Ladies Perpetual Calendar,...... 174 Laurocerasus,................. 13 Ledum,....................... 13 Leucorrhcea,................... 77 Liver Spots,................... 69 Lochial Discharge,.............. 156 Lochia, suppression of,..........158 Lobelia,...................... 13 Lycopodium in Constipation, .... 60 190 INDEX. PAGE. M. Magnesia in Toothache,......... 48 Marriage,...................... 1 Menstruation during Pregnancy, 80 Mercurius in Salivation.......... 39 Toothache,........ 48 " Jaundice,.......... 69 Mezereum in Toothache,......... 48 Milk-Fever,................... 126 " " 142 " Altet^ions of,............ 145 '' Healtny standard of,....... 145 " Colustrum of,............ 146 " Age of Nurse,............ 146 " Age of.................. 147 " Constitution of Nurse,..... 148 " Influence of Pregnancy..... 148 " " Menstruation, 148 " " Complexion,... 149 " " Food,..........149 " " Quantity,...... 149 " " Acute Fevers, 149 " " Moral Emotions 149 " " Chronic disease 150 " " Consumption, 150 " Quantity of Sugar in,...... 151 " " Casein,....... 151 " " Butter......... 151 " Comparison with Cow*s,... 151 " Incontinence of,........... 153 Milk Leg,..................... 168 Millefolium against Bleeding Piles, 73 Moles,........................ 117 Morning Sickness,.............. 33 Moschus in Constipation,........ 61 N. Nervousness,.................. Ill Nipples, Soreness of,............ 137 " Depressed,............. 139 Nitric-acid,.................... 13 " in Salivation.......... 39 Nux,......'................... 13 PAGE. Nux in Toothache,............ 49 " Dyspepsia,............ 53 " Heartburn,............ 53 " Constipation,...... 59 to 60 " Jaundice,.............. 69 Piles,................. 73 " Retention of Urine,..... 75 " Inflammation of Womb,. 86 " In Morning Sickness, ... 35 O. Obliquity of the Orifice,......... 116 ffidema of the Labia............ 77 115 Opium in Constipation,.......... 60 " Itching of Vulva....... 77 Ox-gall in Constipation,........ 62 P. Pains and Cramps of the Stomach, 55 Pain and Tension of Breasts,.... 107 Pains, Relaxation of,........... 113 " Suspension of,........... 113 " Irregularity of,........... 113 Palpitation of the Heart,........ 93 Parturition, Convalescence after,.. 123 Perpetual Calendar, Ladies,...... 174 Piles,........................ 70 Phosphorus in Diarrhoea,........ 68 Phosphor in Acidity,............ 53 Platina in Constipation,......... 60 " Uterine Hemorrhage,.. 82 Plethora, ..................... 98 Plumbum in Constipation,....... 61 Post-1'artem Inflammations,..... 158 Pregnancy,.................... 7 " extra-uterine,........ 118 " duration of,......... 8 " state of Breasts in,... 11 " state of Urine,....... 13 " management of,..... 19 " treatment of,......... 22 " superstitions about, ... 24 INDEX. 191 PAGE. Pregnancy, exercise in,......... 26 diet during,......... 27 perverted tastes during 30 menstruation during,.. 80 Puerperal Mania............... 169 Pulsatilla in Salivation,......... 39 Leucorrhcea,....... 78 " Toothache,......... 49 " Diarrhcea,.......... 67 " Piles,............. 72 " Acidity,............ 53 R. Relaxation of Pains,............ 113 Retention of Urine,. •........... 75 Retroversion of the Womb,..... 90 Rheumatism of Womb,.......... 83 Rhododendron in Toothache, .... 49 r Rhus in Toothache,............. 49 " Diarrhcea,.............. 68 " Incontinence of Urine,.. 76 Rigidity and Laxity of Abdomen, 88 " of the Neck of Womb,.. 116 " of Vulva,............. 114 S. Sabina in Toothache,........... 50 " Jaundice,............ 70 Piles,............... 73 " Uterine Hemorrhage, .. 83 Salivation,.................... 38 Scilla in Dropsy of Amnion,..... 80 Secale in Mdrning Sickness,..... 36 " Toothache,........... 50 " Diarrhoea,............. 67 " Uterine Hemorrhage,... 83 Sepia in Morning Sickness,...... 36 " Toothache,............ 50 " Itching of Vulva,....... 77 " Leucorrhcea,........... 78 Silex in Toothache,.....,...... 50 Sleeplessness,.................. 96 Slowness and Feebleness of Con- tions,....................... Ill PAGE. Sore Nipples.................. 137 Spasm of the Ureters,.......... 76 Spasm and Inflammation of Womb 86 Spitting of Blood,.............. 9(5 Spigelia,............. ........ 13 '' in Toothache,.......... 50 Staphysagria in Toothache,...... 50 Stramonium in Piles,........... 73 Sulphur in Morning Sickness,.... 38 " Salivation,........... 39 Toothache, .. .Wi..... 51 Sulphuric-acid in Acidity,....... 53 Sulphur in Acidity,............. 53 Constipation,........ 59 " Diarrhoea,........... 68 " Jaundice,........... 69 " Piles,............... 73 " Leucorrhcea,......... 78 " Itching of Vulva,..... 77 Suspension of Pains,........... 113 Swelling of Anterior Lip,....... 117 T. Tabacum in Morning Sickness,... 36 Thrombus,.................... 115 Toothache,.................... 40 Trembling and Chills........... 109 V. Varicose Veins,................ 106 Veratrum in Morning Sickness,... 36 " Salivation,......... 39 " Constipation,....... 62 W. Waters, excess of,............. 79 " False................. 7H Weaning,..................... 170 White Weakness,.............. 77 Womb, Changes of, after Parturi- tion, ....................... 153 Z. Zincum in Morning Sickness,.... 36 " Constipation,......., 62