LIBRARY OF CONGRESS. ®jf8jr*.-_. ___'_ diqt^nglt 3fs+ Shelf ..jL^ UNITED STATES OF AMERICA, AN OBSTETRIC MENTOR A HANDBOOK OF HOMOEOPATHIC TREATMENT REQUIRED DURING Pregnancy, Parturition, and the. Puerperal Season, CLARENCE M. CONANT, M. D., Author of "Repertory," Lilienthal's Skin Diseases, Member of the American Institute of Homoeopathy, &c, &c. NEW YORK : A. L. CHATTERTON PUBLISHING CO., 1884. Copyright, 1883. BY A. L. CHATTERTON PUBLISHING CO. W. L. Mershon & Co., Printers, Electrotypers and Binders. Rahway, N. J. PREFACE. The design of this little compilation originated in this wise. Frequently perplexed in prescribing for pregnant and parturient women, we have rushed from the bedside to the office, and after hunting through a dozen or more authorities, gone back to the patient, prescribed and succeeded. The first idea was, a case in which to carry Guernsey's Ob- stetrics and have it always in the conveyance ; but the amended thought was, " suppose the cream of our therapeutics divested of all other matter, and culled from every available source, in so small a compass as to be pocketable ! " The tangible expression of the idea is before you, and while we do not hope but that omissions and errors have been made, we do hope that none will be found which are very vital. Corrections and additions will be thankfully received by the compiler. We must acknowledge assistance and advice from several members of the profession ; and especially we extend thanks to Selden H. Tal-cott, M. D., Superintendent of the State Homoeopathic Asylum for the Insane in this town, for suggestions regard- ing the treatment of puerperal insanity. PREFACE. 13 In compiling this reminder the following authori- ties have been scrutinized : Guernsey's Obstetrics. Leavitt's " Richardson's " Croserio's Marsden's Practical Midwifery. Jahr's Diseases of Females. Hale on Diseases of Women. Ludlam Eaton Eggert's Uterine and Vaginal Discharges. Lilienthal's Homoeopathic Therapeutics. Ostrom on the Breast. Hart on Diseases of the Nervous System. Bell on Diarrhoea. Allen & Norton's Ophthalmic Therapeutics. King on Headache. Johnson's Therapeutic Key. Hale's New Remedies. Jahr's Manual. Dunham's Lectures on Materia Medica. Raue's Record of Homoeopathic Literature. Files of The Homoeopathic Journal of Obstetrics. " The Hahnemannian Monthly. " The Medical Counselor. The American Homoeopath and The Transactions of the American Institute of Homoeopathy, and of the New York State Homoeo- pathic Medical Society. CLARENCE M. CONANT. MlDDLETOWN, N. Y. , 1883. CHAPTER I. Variations of Appetite — Gastroses — Enteric Diseases — Hepatic Troubles. Not infrequently the first intimation of the exis- tence of pregnancy is an extraordinary capricious- ness of appetite. There may be loss of appetite in general, or aversion to particular things; or there may be great increase of appetite, or merely craving for special articles of diet. Along with these con- ditions, or independent of them, the sense of taste may be perverted. As to increase of appetite, we will remark, in passing, that where it exists in preg- nant women otherwise in health, it is usually a good sign, and, within reasonable limits, should be in- dulged, and not checked as is sometimes done. Variations of Appetite and Taste. Anorexia: Chin., Cycl., Nux. v., Rhus tox., Sep. r Sil. Bulimy: Calc. carb., Chin., Cina., Iod., Lye, Nux v., Puis., Sil., Verat. alb. Hunger, without Appetite: Bry., Nat. mur., Op.. Rhus tox. Thirst: Aeon., Ars., Bry., Calc. carb., Cham., Chin., Merc, sol., Sulph., Verat. alb. Adipsia: Apis., Ferr. acet., Gels., Hell., Merc, sol., Nux mos., Puis., Sarsap. 1 6 AN OBSTETRIC MENTOR. Thirst, with Aversion to Drink: Bell., Canth., Hyosc, Nux v., Stram. Aversion to Acid Food: Bell., Coca, Ferr., Sabad., Sulph. Aversion to Beer: Bell., Chin., Coca, Nux v., Stann., Sulph. Aversion to Brandy: Ign., Merc. sol. Aversion to Bread generally: Con., Nat. mur., Puis., Sep., Sulph. Aversion to Rye Bread: Lye, Nat. mur., Nux v., Phos. ac., Sulph. Aversion to Broth (Meat): Arn., Ars., Graph. Aversion to Butter: Carbo veg., Chin., Merc. sol. Aversion to Coffee: Bry., Calc. carb., Cham., Coff., Nux v., Phos., Rhus tox. Aversion to Fat Food: Bry., Carbo an., Carbo veg., Cycl., Nat. mur., Petr., Puis. Aversion to Fish: Graph., Zinc. Aversion to Meats: Calc. carb., Carbo veg., Graph., Lye, Mur. ac., Nitr. ac., Petr., Rhus tox., Sabad., Sep., Sil., Sulph. Aversion to Flour and Meal (Dishes made of): Phos. Aversion to Milk: Bry., Calc. carb., Guaj., Puis., Sep., Sil., Sulph. Aversion to Salt Food: Carbo veg., Selen. Aversion to Solid Food: Ang., Bapt., Bry., Ferr., Staph., Sulph. Aversion to Sweet Food: Caust., Sulph. Aversion to Vegetables: Hell., Magn. carb. Aversion to Water: Bell., Calad., Nux v., Stram. Aversion to Wine: Merc, sol., Sabad. Desire for Acids: Ant. crud., Ars., Bry., Cham., Hep., Lach., Phos., Strain., Sulph., Verat. alb. AN OBSTETRIC MENTOR. 1 7 Desire for Beer: Bry., Merc, sol., Nat. carb., Nux v., Op., Petr., Puis., Sabad., Stront. Desire for Bitter Things: Digit., Nat. raur. Desire for Bread: Ars., Plumb. Desire for Brandy: Ars., Hep., Lach., Nux v., Op., Selen., Sep., Sulph. Desire for Coal, Chalk, Slate, etc.: Cic, Nitr. ac, Nux v. Desire for Cake: Plumb. Desire for Cheese: Ignat. Desire for Coffee: Ang., Aur., Bry., Chin., Con., Selen. Desire for Fat Food: Nux v., Nitr. ac, Thuja. Desire for Fruit: Ign., Sulph. ac, Verat alb. Desire for Juicy Things: Phos. ac. Desire for Soup and Broth: Ang., Ferr., Staph., Sulph. Desire for Meat: Magn. carb., Merc, sol., Sulph. Desire for Meal and Flour (Dishes made of): Sabad. Desire for Milk: Aur., Chel., Merc, sol., Sabad., Sil. Desire for Raw Potatoes and Flour : Calc carb. Desire for Salt Things: Calc. carb., Caust., Con., Nitr. ac, Verat. alb. Desire for Smoked Food: Caust. Desire for Sourkraut: Carbo an. Desire for Sweet Things: Aram, carb., Chin., Kali carb., Lye, Nat. carb., Rhus tox., Sabad. Desire for Vegetables: Alum, Magn. carb. Desire for Warm Food: Ferr., Lye Desire for Wine: Cic, Hep., Sep., Sulph. Taste: i. Bitter. — Aeon., Bry., Calc. carb., Cham., Merc sol., Nux v., Puis., Sep., Sil., Sulph., Verat alb. 1 8 AN OBSTETRIC MENTOR. 2. Lost or Diminished: Nat. mur., Puis., SiL 3. As of Blood: Ipec, Sulph. 4. Empyreumatic: Puis., Sulph. 5. As of Pus: Puis. 6. Like Clay: Chin., Hep., Puis. 7. Flat, Watery, Insipid: Bry., Caps., Chin., Ipec., Puis., Rhus tox., Sulph. 8. Foul, Putrid, Offensive: Aeon., Am., Bell., Bry., Cham., Merc, sol., Nat. mur., Puis., Rhus tox., Sulph., Verat. alb. 9. Oily, Greasy: Caust, Sil., Valer. 10. Metallic: Cupr., Nux v., Rhus tox. 11. Slimy, Viscid: Arn., Bell. 12. Rancid: Asaf., Bry., Mur. ac, Nux v., Petr., Puis., Sulph. 13. Salty: Ars., Carbo veg., Merc, sol., Nat. mur., Nux v., Phos., Puis., Sep., Sulph. 14. Sour: Bell., Calc. carb., Chin., Coca, Cupr., Nux v., Phos. ac, Puis., Sulph., Tarax. 15. Sweetish: Bell., Bry., Chin., Cupr., Ferr., Merc, sol., Phos., Plumb., Puis., Sabad., Squill., Sulph. Food Tastes badly: a. Bitter: Ferr., Hep., Rhus tox., Sulph. b. Salt: Sulph. c. Sour: China. Bread Tastes sweet: Merc. sol. Beer Tastes Sweet: Puis. In Morning Taste Sour: Nux v., Sulph. " Bitter: Arn., Puis. " Foal: Rhus tox., Sulph " Sweet: Sulph. Bry., Coloc, Carbo veg., Calc. carb., a a u u u a AN OBSTETRIC MENTOR. 19 Sour Taste: a. After Eating: Carbo veg., Cocc, Nat. mur., Nux v., Puis., Sil. b. After Drinking: Nux v., Sulph. c. After Drinking Milk: Carbo veg., Sulph. Food and Drink Taste Bitter: Chin., Puis. Bitter Taste after Eating and Drinking: Ars., Bry., Puis. Morning Sickness, Nausea and Vomiting. First, compare: Cocc, Ipec, Kali carb., Kreas., Lact. ac, Lobel. infl., Nux v., Petr., Puis., Tart, em., Tabac, A^erat. alb. Cocculus : Naitsea felt in head. Inclination to vomit in morning on attempting to rise, which at- tempt makes her faint. Worse from riding in a car- riage or sailing. Yellow tongue and aversion to food. Ipecac : Incessant nausea; not a moment's relief. Cutting pain about umbilicus. Great uneasiness in stomach. Vomiting great quantities of mucus, of sour or undigested food, of bilious matter, with colic and diarrhoea. Kali carb.: Nausea, without vomiting, coming on only during a walk; feeling as if she would like to lie down any where and die. Swoon-like failure of strength while vomiting. Very sleepy while eat- ing. Stitching pains in abdomen. Kreas.: Vomiting of sweetish water before breakfast, breakfast and dinner being retained. Vomiting after supper. Lactic ac: Sour, taste and vomiting of sour matter. Faintness in stomach and diarrhoea. Lob. inflat.: Nausea and vomiting, with pro 20 AN OBSTETRIC MENTOR. fuse running of water from the mouth ; worse at night and after sleeping, and relieved by a little food or drink. After vomiting, breaks out in a sweat, followed by sensation as of needles pricking her all over. Asthmatic sufferings. Nux v.: Nausea and vomiting in morning after eating. Thinks she would feel better if she could votnit. Food and drink smell bad to her, and she cannot bear the odor of tobacco. Bitter or sour taste, belching, eructations, hiccoughing, and heart- burn. Vomiting of food, bile, of black or sour mat- ter, and of sticky mucus. Restless sleep, particularly after 3 a.m. Great depression and irritability. She wants to be alone and let alone, and will not talk. Constipation ; large, difficult faeces. Petrol.: Vomiting of bile. Aversion to fat food and meat. Nausea worse while riding in a carriage. Diarrhoea only in daytime. Particularly applicable to all the gastroses of pregnant women. Puls. : Excessively bad taste in mouth in morning, but nausea and vomiting in evening and at night. Vomiting at night, with flatulent colic ; of green slimy, bilious masses ; nausea and colic after vomit- ing, and are followed by diarrhoea of changeable stools, of white, green, or yellow mucus. Percepti- ble pulsations in the pit of the stomach. Loss of thirst and taste : water is repugnant ; things taste bitter, fatty, salt, sour, or sweet. Eructations tast- ing of the food recently eaten. Tart, em.: Vomiting of large quantities of mucus in a most violent manner. Belching and disgust for food. Salivation. Tabac: Nausea, with deadly faintness and pallor of the face, relieved by going into the open air. Nausea on beginning to move. She gets very thin AN OBSTETRIC MENTOR. 21 rapidly, and vomits water or acid liquids or mucus. Verat. alb.: Violent and profuse vomiting of egesta and bile. Cold sweat on forehead. Desire for fruit and juicy things, for acids and salt food, for cold food. Canine hunger. Feels very weak and faint. Second, study also: Alet. far., Anac, Ant. crud., Ars., Bry., Carb. ac, Con., Cycl., Cupr. ars., Ferr. acet., Gossyp., Nat. mur., Nitr. ac, Phos., Sep., Sil., Staph. Alet. far.: Nausea with vomiting, with indi- gestion and debility. The least food causes distress in stomach. Frequent faintings, with vertigo. Sleepy all the time. Emaciation. Constipation. Anacard.: Morning nausea. Empty feeling in stomach. Nausea worse before and after eating ; better while eating, and after vomiting egesta. Weak digestion, with fullness and distention of abdomen. Ant. crud.: Persistent vomiting, with convul- sions. Milky white tongue, and eructations tasting of egesta ; derangements from overloading the stomach. Desire for acids. Arsen.: Vomiting after eating and drinking, and at night, of green or black matter. Cold water seems to lie in the stomach, therefore she cannot drink it, although greatly desired. Great weakness and exhausting diarrhoea. Burning pains in stomach, bowels, and breasts. All symptoms relieved by mov- ing about. Food is relished, but leaves a bitter taste in mouth. Aversion to meats and desire for fruits and vegetables. Coldness and restlessness. Bryon.: Nausea and vomiting worse from mo- tion and after eating. She desires to keep still, and gets marked relief by so doing. Dry lips, mouth and 22 AN OBSTETRIC MENTOR. tongue, with thirst. Splitting headache. Worse from sitting up (even in bed) in warm air and dur- ing warm weather, or from warm food. Carbol. ac: Vomiting with frantic headache. Great irritability of temper, and aching in stomach. Conium : Terrible nausea and vomiting in women having scirrhosities. Vertigo while lying down or when turning over in bed. Swelling and soreness of breasts, especially when it has been habitual during menstruation. Intermittent urination. Eructations and heartburn. Cyclam : Wants no breakfast. After eating the least quantity, nausea and disgust in mouth and throat. Vertigo : dimness of vision, with fiery specks and sparks before her eyes. Intermittent thirst. Greasy taste, and fat food disagrees. Cupr. ars. : Constant nausea: vomits every- thing. Spasmodic uterine pains. Very weak, with a full, quick pulse. Ferr. acet. : Vomiting only after eating, with a fiery red face, of food ; of sour, acid matter ; of blood. Vomiting at midnight. Nervous erethism. Gossypium : Nausea before breakfast. Great distress, weakness, and prostration. Useful in very bad cases where miscarriage is threatened. Nat. mur.: Nausea in morning. Vomiting of food. Profuse, constant waterbrash, like limpid mucus. Obstinate cases, with loss of appetite and taste ; great hunger, as if stomach were empty, but no appetite. Heartburn after eating. Always awakes in morning with headache. Dreams of rob- bers in house, which must be searched to satisfy her. Palpitation of heart. Nitric ac: Nausea and gastric troubles better moving about or riding in carriage. Nausea and AN OBSTETRIC MENTOR. 23 burning in the stomach and throat. Urine very strong and offensive, like that of horses. Phos. : Very sleepy, especially after dinner. Long, narrow, hard stools, difficult to expel. Sour eructa- tions and vomiting. Vomiting of food, sour matter, and of blood. Profuse, watery diarrhoea. Slender, red-haired phthisical women. Sepia :' Great sense of emptiness at pit of stomach. Nausea in morning, as if viscera were turning inside out. Vomiting of milky water or mucus, and of bile. The thought of food sickens her. Taste (and eructations) as of spoiled eggs or manure, and loath- ing of all food, especially meat. Yellowness of face, especially across the nose. Almost specific for con- stipation of pregnant women. Dunham was wont to call Sepia " the washerwoman's remedy," and its complaints are aggravated from doing laundry work. Silicia : Nausea and vomiting in women who have palpitation of heart during menstruation. Aversion to meat. Taste of blood in mouth in the morning. Nausea, with palpitation after every exer- cise that warms her up a little. Constipation : stool seems to recede after partial protrusion. Staph.: Extreme hunger, even when stomach is full of food ; sensation as if stomach hung down relaxed. Constant accumulation of water in mouth. Hygienic Measures : Advise the patient not to rise until she has eaten a little something and taken a cup of coffee (if habituated to it), or tea if pre- ferred ; cocoa or alkethrepta is sometimes better than either. Cold milk is excellent. Many kinds of jellies (calves-foot, beef, or wine), taken in very small qua?itities, are good nourishment. For this and the other gastric troubles of preg- nancy consult further the following 24 AN OBSTETRIC MENTOR. Repertory of Remedies for Gastroses. Belching or Eructations : (Like rotten eggs — Arn. and Brom.) Arn., Bell., Bry., Cocc. Con., Merc, sol., Nux v., Phos., Puis., Rhus tox., Sarsap., Sep., Sulph., Sulph. ac, Tart, e., Verat. alb. Hiccoughing : i. Amm. mur., Cycl., Hyosc, Ign., Kali brom., Nux v. 2. Agar., Bell., Bry., Puis., Ran. bulb., Verat. alb. Heartburn : 1. Calc. carb., Carbo veg., Caust, Con., Croc, Nux v. 2. Amm. carb., Caps., Carbo an., Chin., Iod., Lye, Merc, sol., Nat. mur., Phos., Puis., Sep., Valer., Verat. alb. Ptyalism : Jaborandi, Kali bich., Kali iod., Merc, sol., Nat. mur., Puis., Sulph. Risings into Throat : 1. Asaf., Merc, sol., Lach., Plat. 2. Con., Phos., Puis., Spig., Valer., Verat. alb. Disgust for Food : 1. Ipec, Kali carb., Sep. 2. Ant. crud., Bell., Bry., Puis., Sil., Tart. e. Nausea Felt in Throat : 1. Cycl., Phos. ac, Stann. 2. Cupr. met., Puis., Staph., Valer. Nausea Felt in Chest : Aeon., Croc, Carbo veg., Merc, sol., Phos., Rhus tox. Nausea Felt in Abdomen : Bry., Puis. Empty Retching, Gagging : 1. Bell., Ipec. Verat. alb. 2. Arn., Asar., Bry., Chin., Nux v., Puis., Sulph. Vomiting of Bile, Bitter Vomiting : 1. Ars., Bry., Cham., Ipec, Merc, sol., Nux v., Puis., Sep., Verat. alb. 2. Aeon., Bell., Chin., Con., Cupr., Dulc, Ignat., Lye, Petrol, Plumb., Sec, Stann., Sulph. Vomiting of Black Matter : 1. Ars., Cadmium sulph., Chin., Nux v. 2. Petr., Phos., Plumb., Verat alb. AN OBSTETRIC MENTOR. 25 Vomiting of Blood : (Clotted — Arm, Caust.) i. Am., Ferr., Ipec, Phos. 2. Aeon., Canth., Chin., Ham., Millef., Nux v., Plumb., Puis., Sep., Sulph. Vomiting of Brown Matter : Ars., Bism., Mez., Phos. Vomiting Caused by Passive Motions, (Sailing, Riding in a Carriage, etc.) : 1. Ars., Cocc., Colch., Ferr., Hyosc., Petrol. 2. Bell., Croc., Nux mos., Sec, Sil., Staph., Sulph., Tabac. Vomiting Caused by Overloading Stomach, (or Eating Indigestible Food) : 1. Ipec, Puis. 2. Ant. crud., Ars., Bell., Bry., Ferr., Nux v., Rhus tox., Sulph. Vomiting Caused by moving : Ars., Bry., Nux v., Petrol., Verat. alb. Vomiting,- with Diarrhoea : Ars., Bell., Coloc, Cupr. met., Dulc, Ipec, Phos., Puis., Verat. alb. 2. Apoc. and Iris. Vomiting of what has been Drunk : 1. Ars., Phos., Verat. alb. 2. Bry., Cham., Dulc, Ipec, Nux v., Sil., Tart. e. Vomiting what has been Eaten : 1. Ars., Bry., Ferr., Nux v., Squill. 2. Amm. Carb., Ant. crud., Calc carb., Cina, Cupr. met., Dros., Hyosc, Ign., Ipec, Lye, Nat. mur., Phos., Plumb, met., Puis., Sep., Stann., Sulph., Verat. alb. Vomiting of Foetid Matter : Sep. and Ars., Bry., Cocc, Carbo veg., Cupr. met., Ipec, Krea's., Nux v., Opium, Stann., Sulph. Vomiting of Greenish-Black Matter : Petrol., Phos., Plumb. Vomiting in Morning : 1. Ars., Dros., Nux v., Verat. alb. 2. Hep., Lye, Nat. mur., Sil. Vomiting at Night : Ars., Chin., Ferr-, Nux v., Sil., Sulph. 26 AN OBSTETRIC MENTOR. Vomiting of Salty Matter : (Bitter salt — Sil.) Magn. carb., Puis., Sil., Sulph. Vomiting of Slimy Matter : i. Dros., Puis., Tart. e. 2. Ars., Bell., Cham., Chin., Con., Digit., Hyosc, Ign., Ipec, Merc, sol., Nux v., Sec, Sulph., Verat. alb. Vomiting of Sour Matter : (Bitter sour — Ipec, Puis., and Tart, e.) 1. Calc Carb., Chin., Lye, Nux v., Phbs., Puis., Sulph. 2. Ars., Bell., Cham., Ipec, Verat. alb. Vomiting of Watery Matter : 1. Bell., Bry., Caust., Ipec, Verat. alb. 2. Arn., Cann. sat., Chin., Con., Cupr. met., Nux v., Stann., Sulph. ac Vomiting of Worms : 1. Aeon., Cina, Ferr., Sabad., Sec. 2. Hyosc, Sil., Spig., Verat. alb. Vomiting Worse after Drinking : (When cold fluid gets warm in stomach — Phos.) 1. Ars., Chin., Ferr., Verat. alb. 2. Aeon., Arn., Bry., Cham., Nux v., Puis., Sil. Vomiting Worse after Eating : 1. Ars., Ferr., Ipec, Kreas., Nux v., Puis., Sulph., Verat. alb. 2. Aeon., Arn., Hyosc, Nat. mur. Vomiting of Mucus, then Bile : Verat. alb. Vomiting of Mucus, then Food : Ars., Oleand. Vomiting of Food, then Bile : Nat. mur., Phos., Zinc Vomiting of Food, then Mucus : Dros., Nux v., Selen. Vomiting of Food, then Water : Ferr., Puis. Vomiting of Water, then Food : Ipec, Magn., Carb., Nux v., Sulph. Vomiting of Yellowish Matter : Ars., Colch. Iod. AN OBSTETRIC MENTOR. 27 Hepatic Troubles. It is rare that the liver is sympathetically affected during pregnancy, excepting conditions causing or accompanying diarrhoea and constipation. For these, indications will shortly be given. Richard- son says, ." Icterus is a frequent accompaniment of utero-gestation," and gives indications for twelve remedies ; but Guernsey does not even mention it. Icterus during Pregnancy : i. Aeon., Bell., Cham., Puis., Phos., Sepia. 2. Bry., Digit., Plat., Pod., Sulph. Icterus Caused by Anger and Chagrin : Aeon., Cham., Chin., Ign., Nux v., Nat. mur., Sulph. Icterus caused by Chilling Changes of Tempera- ture : Cham., Dulc, Nux v. Icterus Caused by Overloading Stomach and Bad Food : Ant. crud., Bry., Carbo veg., Cham., Nat. carb., Nux v., Puis. Icterus Caused by Chamomile Tea : Chin., Ign., Nux v., Puis. Icterus Caused by Mercury : Asafcet., Ars., Chin., Hep., Iod., Nitr. ac, Sulph. Icterus Caused by Peruvian Bark*: Ars., Ipec, Merc, sol., Puis. Icterus, with much Flatulence : Carbo veg., Cham., Chin., Ign., Lye, Nux v., Plumb. Constipation. This condition is almost universally present dur- ing gestation, but is no less serious or remediable for that reason. Advise active (but not excessive) exercise in the open air, and frequent bathing of the whole body in cold water if it can be endured. 28 AN OBSTETRIC MENTOR. Encourage the use of plenty of fruit and vegeta- bles (not much bread or cake), and for drinks, chocolate (alkethrepta better), lemonade, and cold- water, and not much tea and coffee. Advise fur- ther, and insist upon, regular times for evacuation and their strict observance ; and if the bowels do not move, let nature be assisted by an enema of tepid water and soapsuds. Compare for Constipation : i. Alumin., Bry., Lye, Nux v., Opium, Sep., and Sulph. 2 ^Escul. hip., Collinso., Hydrast., Kali c, Lach., Nat. mur., Phyt, Plumb, met., Puis. Alumina : Inactivity of rectum : it requires great effort to expel even a soft stool. Stool hard, knotty, and scanty. Bryonia: Stool very large and seems to tear the anus j very d?y, hard, and dark, as if burnt. Splitting headache. Very irritable and prone to fits of anger. Mouth and lips dry, and much thirst. Rheumatic diathesis. After abuse of castor-oil. Lycopodium : Many dyspeptic troubles. Much rumbling and flatulence and pain in abdomen. Urine very hot and smarting, and contains red sand: Pain in back before urination. Nux v. : Women of sedentary habits who eat high seasoned food and use wines and coffee freely. Much backache, and pressing and urging both to stool and urination. Piles, headache, and unref resh- ing sleep. Colicky, flatulent pains in abdomen. After the use of cathartics. Opium : Stool of hard, round, black balls, with paralysis of the rectum. Sleeplessness and acute hearing at night Sepia : Sensation of a lump or heavy weight in the anus. Stool very difficult, covered with mucus AN OBSTETRIC MENTOR. 29 and sometimes cannot be voided, or is ejected with terrible involuntary strainings. Sepia is almost spe- cific for the constipation of pregnant women, but must be given high. Do not give it at night, for it will aggravate night symptoms. Sulphur : Flushes of head all over ; head hot and feet cold. Hunger and faintness between n a. m. and noon. Stool hard, lumpy, and striped or streaked with blood. The first effort at stool is so agonizing that she must desist. Piles, prolapsus, and fissure of the rectum. ^Escul. hip.: Backache in the sacro-iliac sym- physes, with piles and constipation. Collinso.: Stool lumpy and light-colored, with piles and dull pains in the anus. Hydrast.: Headache, piles, and pains in the anus and rectum for hours after stool. Hughes says, " A precious remedy, far superior to Nux v.; " but we have not found it so. Kali carb.: Stitching pains and many bad feelings before stool. Rectum seems too weak to expel the stool. Hatulency. Violent backache. Bowels move every other day. Wakes every morn- ing at 3 a. m., and feels very badly. Lach. History of chronic constipation and ovari- an affections. The anus feels closed, and faeces press against it all the time without passing. Nat. mur. : Stool very dry and hard, Assuring the anus and making it bleed. Headache on wak- ing every morning. Desire for salt and aversion to bread. Dreams very vivid and fearful of robbers in the house, which must be searched for to satisfy her. Phytolacca: Chronic constipation, with rheu- matic pains in hips and thighs when the weather 30 AN OBSTETRIC MENTOR. changes. Soreness of breasts and nipples. Chronic dry sore throat. Plumb, met.: Stool of small balls compacted like sheep-dung. Violent colic and flatulence. Pulsat.: Alternate constipation and diarrhoea caused by gastric derangement from eating rich, greasy food. Borborygmus and emissions of foetid flatus. Very nauseous taste in mouth in morning : she must wash it out. She has many uterine and back pains, and says the child turns over and does not lie right, so that it hurts her. HAEMORRHOIDS. Bleeding Piles : i. Aeon., Aloes, Collinso., Ha- mara., Millef., Nitr. ac, Nux v., and Sulp. 2. iEscul. hip., Bell., Calc. carb., Caps., and Puis. Blind Piles : 1. ^Escul. hip., Collinso., Lach., Mur. ac, Nux v., Podoph., Ratanh., and Sulph. 2. Ars., Graph., and Puis. Aconite: Bleeding piles in plethoric women. Great restlessness and uneasiness. Pain and pres- sure at anus and in back and abdomen, as if bruised. tEsculus hip.: Protruding piles, bleeding very rarely or slightly, with constipation and severe back- ache in the sacrum and hips, which give out when walking. Aloes : Protruding piles in a bunch, like a clus- ter of grapes, relieved by bathing with cold water. Fistula in ano. Bilious diarrhoea (which may have caused piles). Want of confidence in the sphinc- ter : it seems as if the botvels would move inhile she urinates. Hepatic troubles, and history of the same. Arsenic : Blind piles which burn like fire, es- AN OBSTETRIC MENTOR. 31 pecially at night after midnight, with great anguish and restlessness. Fissures of the anus ; backache, as if broken. She cannot stoop. Thirst. Belladonna : Congestive, throbbing headache and nervous restlessness and insomnia, although she is sleepy. Spasmodic contraction of the sphincter, causing strangulation and excessive sensitiveness of the piles : she must lie with the nates separated, as the piles will not tolerate the least contact. Dysu- ria. Calc. carb.: Profusely bleeding, protruding piles. Terrible aching and shooting pains in the anus and rectiu?i for hours after stool. Worse when walking. Feet are cold and damp ; the sweat is ichorous and offensive, and makes the feet sore. Vertigo after suppression of the hsemorrhoidal flux; after Sulph. Capsicum: Bleeding piles, with burning in anus. Drawing pains in the back and cutting pains in the bowels. Very large piles in fat people easily ex- hausted. Suppressed flux, causing melancholy. Collinso. : Blind or bleeding piles, with obsti- nate constipation and stools only in the evening j sensation as if the rectum were filled with gravel or sand. Aggravation from evening to late at night ; better in the morning. Graphites : Blind piles, with constipation, fis- sures and prolapsus of the rectum. Itching blotches, especially on the face, which exude a sticky fluid. Worse at night. Hamamelis : Profusely bleeding piles, with ex- cessive soreness, and prostration out of proportion to the loss of blood. Backache, as if it would break. Haematuria, constipation, frontal headache, and restless nights. 32 AN OBSTETRIC MENTOR. Lachesis : Piles, with chronic obstinate constipa- tion, and history of ovarian affections (especially left side). The anus feels as if filled up by the piles, so that nothing can pass. The piles are strangulated and protruding : a stitch runs through them when she coughs or sneezes. Millefolium: Profuse, bright red haemorrhages from the piles, which are very painful. Mucous piles. Mur. ac: Protruding, bluish, strangulated piles, which are excessively sensitive to contact even of the sheet ; violent itching. Prolapsus ani, and involun- tary stool while urinating. Nitr. ac. Old hemorrhoids bleeding profusely (bright red, not clotted) at every stool* which is fol- lowed by a sharp cutting pain in the rectum which lasts for hours. Worse after a loose stool. Fis- sures of the anus. Hematuria. Nux v.: Sedentary habit, after coffee and spirit- uous liquors. Blind or bleeding piles, with frontal headache and many agonizing back pains. Consti- pation,, with ineffectual urging, or stool in the morn- ing, with great aggravation of all complaints. Ir- ritable disposition and anorexia. Podoph. : Piles, with prolapsus ani (and also es- pecially after confinement) and morning diarrhoea or constipation. For this latter a high potency is in- dispensable. She is subject to " bilious attacks," and has many hepatic symptoms. Pulsatilla: Constipation, with stool mostly in the evening. Blind piles, with many anal pains. Very bad taste i?i the mouth in the morning. Con- stant chilliness and evening aggravation. Fainting spells. Many pains in the back and abdomen ; she cannot lie on her side. Sharp, colicky pain at AN OBSTETRIC MENTOR. $$ night, followed by a bilious, bloody diarrhoeic stool, with much flatus and rumbling in the abdomen. " These varieties of nightly diarrhoea are character- istic of Pulsatilla." Ratanhia: Blind, protruding piles, with consti- pation and great sensitiveness of the rectum. Sulphur : All kinds of piles, especially painless piles, with dark hemorrhages, suppression of the hemorrhoidal flux, with headache, vertigo, and backache. Weak, faint spells, especially when standing or walking, and about ii a. m. Heat on top of head. Where constipation is present, the excessive ten- derness and pains of blind piles may often be re- lieved by cold-water injections, a strong lather of castile soap being used. Bleeding piles should never be treated locally, lest the flow be suppressed. If blind piles are highly inflamed, a simple poultice is sometimes admissible. In cases accompanied by constipation the same rigid regularity of relieving the bowels should be observed as was recommended under Constipation. The surgical treatment of piles during pregnancy is not to be permitted. Fissure of the Anus. Compare first for — Ulceration of Anus and Rectum, Ars., Carbol. ac, Ham., Hydrast., Merc, iod., Nat. mur., Paeon., Phos. Fissure of Anus and Rectum : i. Ign., Nitr. ac, Paeon., Thuja. 2. Caust., Graph., Petrol., Sep., Sulph. Ulceration of the anus and rectum will usually be found associated with piles, and we should con- sult indications for that affection. For fissures, the following are characteristic symptoms : 34 AN OBSTETRIC MENTOR. Ignatia : Fissure, with haemorrhoids and pro- lapsus recti, with pains shooting upward in the rectum after stool, particularly a loose stool. Pains return at the same hour every day, and are worse from walking and standing. Severe proctalgia. Eggert regards Ign. an intercurrent rather than a curative remedy. Nitr. ac. : Sharp, splinter-like pains as if torn in the rectum during stool, with smarting and twitch- ing continuing for hours after stool. Prolapsus recti. Haemorrhages from the rectum. Violent proctalgia. Tendency to diarrhoea. She is very irri- table and despondent and thinks she will never get any better. P^eonia : Painful ulcers in the anus and rectum, with fissures emanating from the ulcers. The parts are swollen and exude foetid moisture. Thuja : Fissures, with edges trimmed with, poly- poid excrescences or true rectal polypus. Piles. Condylomata. Urinary symptoms. Nitr. ac. fol- lows Thuja to advantage often. Also : Causticum : Fissures which tend to dry up and have dark brown or purple edges. Walking causes pain in and bleeding from the anus. Graphites : Fissures in rectum, with many little cracks studding the anus. Constipation. Petroleum : Fissures, with diarrhoea, herpes, and small boils around and at the verge of the amis. Sepia : Fissures, with constipation, prolapsus recti, and many rectal pains extending into the abdomen. Mucous discharge from the rectum. Sulphur : Pain in rectum so severe that she can- not sit down. Swelling, with smarting, stitching pains in the anus which keep her awake all night. AN OBSTETRIC MENTOR. 35 Psoric diathesis. If Sulph. seems indicated and fails, study Psorinum. Fortunately, ulceration and fissure of the rectum is not common during gestation. But where fis- sures are found, diarrhoea often accompanies, and sometimes one drug is required to cure the diar- rhoea, while quite another is necessary to heal the fissure. Diarrhoea. Not infrequently the gastric troubles of preg- nancy are accompanied by diarrhoea ; sometimes, it alternates with constipation, or it may be, as we might say, idiopathic. This last form is by far the most dangerous and is more to be dreaded than constipation. For if it continues long it may cause piles, fissures, and even inflammation of the bowels, making miscarriage almost a certainty. And that accident may occur, too, simply from the exhaus- tion caused by a neglected diarrhoea. When a pregnant woman is seized with diarrhoea, whatever the cause, she should be put to bed and instructed to lie there as quietly as possible. All fruit and vegetables, and especially all indigestible food should be strictly prohibited and the diet made light both in quality and quantity. The abdomen should be covered with a flannel apron next to the skin. A second apron a trifle heavier should be worn at night. If these require washing they should be very carefully sun or oven dried and well aired before using again. The feet too must be kept dry (if they tend to perspire freely, by wiping with a flannel) and warm. Consult first : 36 AN OBSTETRIC MENTOR. Ant. crud., Cham., Gels., Hyosc, Iris, Lye, Petr., Puis., Sulp. Ant. crud. : Watery, lumpy, diarrhoea early in the morning and at night, with white tongue and vomiting and absence of thirst. After acids and overheating. Cham. : Hot, small, frequent, green and white mucous stools of very offensive odor like rotten eggs. Very irritable temper. Diarrhoea at night, with much colic. After taking cold and getting angry or mortified. Gels.: Yellow fsecal diarrhoea from sudden de- pressing emotions, grief, fright, bad news; occipital headache and ache the whole length of the spine. Depressed, discouraged state of mind and body ; thinks she will have a serious illness. Hyosc. : Yellow, watery, painless and involun- tary diarrhoea, involuntary jerkings of the muscles, involuntary urination, delirium and many nervous phenomena. Iris vers. : Watery, green or yellow diarrhoea with burning at the anus, nausea and vomiting, and much gastric disturbance. Diarrhoea comes on every morning about two or three o'clock. Aggra- vation during hot weather. Lycop, : Thin, brown, foetid diarrhoea, with sen- sation as of yeast working in the bowels. Very- much flatulence, not with stool; dyspeptic suffering and fulness in throat and stomach after a meal. Red sand in urine, which is very hot ; cutting pain in back before micturition. Diarrhoea worse in the morning, dyspepsia worse in p. m. and long after supper. Petrol. : Diarrhoea only in the day time, or in the last half of the night and early morning. After AN OBSTETRIC MENTOR. 37 eating cabbage. Puis, is often given unsuccessfully when Petr. is the similimum. Puls. : Green, bilious, or watery diarrhoea com- ing on at night with sharp, colicy pains after eating fruits, ice cream or fat food. Much backache and chilliness with rumbling of flatulence and weeping mood. Sulph. : Yellow, brown, green, undigested (changeable) diarrhoea, which wakes and urges her out of bed early in the morning. No pain, but strong urging, or else cutting colic before stool. After taking milk ; she cannot eat meat, or bear to bathe herself. Compare also Aloes, Ars., Bry., Cinch., Coloc, Ipec, Merc, Nux v., Phos., Podopb., and Verat. alb. Aloes : Yellow, faecal, bloody, jelly-like mucous diarrhoea "in gobs," involuntary when expelling flatus or urine. Very much flatus with the stool, and sharp, cutting colic about the navel. Diarrhoea in hot weather coming on very suddenly. Large ten- der piles relieved by cold water. Pain and fulness in the hepatic region, and sensation of great weight in the pelvis. Long gurgling in the abdomen as of water running out of a bottle. Arsen. : Dark green mucous, or brown, or black- ish, watery diarrhoea, with intense thirst and marked prostration and restlessness. After eating cold food (ice cream, etc.) and drinking ice water. Aggrava- tion after eating and drinking and at night. Bry. : Diarrhoea coming on when the weather suddenly becomes hot. Worse in the morning and from every motion. Diarrhoea alternating with constipation. Fever, thirst and delirium, threaten- ing typhoid. Cinch.: Yellow, watery faecal and undigested 38 AN OBSTETRIC MENTOR. diarrhoea after eating fruit, and at night and during the prevalence of malarial diseases. Worse in the afternoon and every other day. Weakness and pro- fuse sweating, especially at night. Pinching, tor" menting, {but not une?idurable) colic every afternoon. Coloc. : Bright yellow, frothy, watery, or mucous, ox green, sour or musty diarrhoea, after eating fruit and after grief or indignation, with cutting colic, (relieved by bending double), which causes nausea, and is not always better after stool. Ipecac: Bright green mucous, bloody diarrhoea, with incessant nausea, flatulent colic and pale face, with blue-ringed eyes. Merc. v. : Dark green mucous, bloody corrosive diarrhoea in hot weather after getting chilled at night, with excessive urging and tenesmus and con- stant chilliness. Thirst, aphthous condition of the mouth, anus a?id rectum and female genitals, sour night sweats on head. Nux v. : Thin, brown mucous, or watery diar- rhoea of small, frequent stools after use of stimulants, high living and cathartic medicines. Alternate con- stipation and diarrhoea. Backache as if broken. Constant urging and pressure upon the bladder and rectum, which is mostly fruitless. Over-sensitive- ness to light, noise, strong smells, fear, etc. Phos. : White, watery, undigested diarrhoea, con- taining little grains like tallow. Worse in the morn- ing, and from eating warm food (hot bread, biscuit.) Thirst for cold drinks ; vomiting of what has been drunk as soon as it becomes warm in the stomach ; slender red-haired women. Podoph. : Watery, greenish or yellow faecal di- arrhoea, with meal-like sediment, and of excessively offensive odor. The stools are profuse, usually pain- AN OBSTETRIC MENTOR. 39 less, frequent and gushing, and occur in the latter part of the night or early morning, especially in hot weather. Verat. album : Profuse, black or greenish watery stools, with severe pinching colic before and during the evacuation and complete prostration after it. Cold sweat on the forehead especially — sometimes all over. Vomiting during the stool. Bell says : "It is useless to give Verat. in painless cases" Dr. T. F. Allen remarks : " Everything about Verat. is on a large scale. The vomiting is profuse, the stool enormous and the pain and thirst excessive. Hygienic : The diarrhoea of pregnancy is far more to be dreaded than the constipation, which is sometimes so troublesome, as if long continued it may cause an abortion. Guernsey well enjoins three essentials, absolute rest in bed or on a lounge, suitable diet, and (in cold weather especially) warm feet and abdomen. Let a flannel apron be worn day and night, so made as to cover the whole space from the ensiform cartilage to the pubes ; the diet should be scalded milk taken hot, either alone or thickened with wheat or rice flour or arrowroot, mutton broth, toast and light plain crackers. Gum arabic and slippery elm water are good drinks. In cases which tend toward dysentery and thirst is a great annoyance, claret and water (without sugar) may often be safely used. Not unfrequently the fat is not all removed from a meat broth ; let your broth cool after it has its full strength, remove the cake of fat, then salt lightly, and re-heating, serve warm. If the diarrhoea has been long continued and the anal symptoms are prominent, a fissure may be sus- 4-0 AN OBSTETRIC MENTOR. pected, for which condition remedies are given else- where. Intestinal Repertory. Flatulence Incarcerated : i. Carbo. veg., Cham., Coca, Graph., Ign., Kali c, Lye, Nitr. ac, Nux. v., Plumb., Puis., Staph., Tart. em. 2. Ant. crud., Arm, Asar., Canth., Chin., Coloc, Con., Nat. c, Nat. mur., Nux. mos., Phos., Phos. ac, Plat., Rheum., Squill., Verat. alb. Borborgymus : 1. Caust., Chin., Hell., Lye, Nux. v., Phos., Phos. ac, Puis., Sulph. 2. Aloes, Agar., Arm, Bry., Canth., Carbo. veg., Cham., Ignat., Nat. mur., Plumb., Sarsap., Squill., Sepia, Spig., Staph., Tart, em., Verat. alb. Flatulent Colic : 1. Carbo. veg., China, Lye, Nux. v., Puis., Rhodo., Staph., Verat. alb. 2. Anac, Arm, Asaf., Aur., Cham., Con., Graph., Hyosc, Ignat Nux. mos., Phos., Plumb., Rheum., Squill., Tart. em. Constipation : 1. Alumin., Bry., Lye, Nux. v., Op., Sepia, Sulph. 2. y£scul., Collinso., Hydrast., Kali c, Lach., Nat. mur., Phyt., Plumb, met., Puis. 3. Bell., Calc. carb., Canth., Carbo. veg., Coca, Dula, Graph., Kali a, Kreas., Laura, Meng., Merc. s., Nitr. ac, Phos., Plat., Sabad., Sil., Stann., Sulph. ac, Verat. alb., Verbas. Constipation from inactivity of the bowels : 1. Alum., Hep., Kali a, Nat. mur., Nux. v. 2. Anac, Arm, Camph., Carbo. veg., China, Coca. Ignat., Nat. carb., Nux. mos., Op., Phyt., Petr., Puis., Ruta., Staph., Sulph., Thuja, Verat. alb., Zinc. Constipation from induration of the stools : 1. Bry., Magn. mur., Op., Plumb., Verbas. 2. Amm. carb., Aur., Carbo. an., Caust., Chelid., Graph., AN OBSTETRIC MENTOR. 41 Kali carb., Merc, sol., Nux. v., Petr., Ruta, Sep., Sil., Sulph., Sulph. ac, Thuja. Diarrhoea : i. Ant. crud., Cham., Gels., Hyosc, Iris vers., Lye, Petr., Puis., Sulph. 2. Aloes, Ars., Bry., Chin., Coloc., Ipec, Merc, sol., Nux. v., Phos., Podoph., Verat. alb. 3. Aeon., Aram, mur., Asaf., Bor., Calad., Calc. o, Carbo. veg., Digit., Lach., Nat. mur., Nitr. ac., Phos. ao, Rheum., Rhus tox., Sep.,Silicea. Painful Diarrhoea. 1. Cham., Coloc, Merc, corros., Rheum., Rhus tox., Verat. alb. 2. Aloes, Ars., Bry., Caps., Dulc, Merc, sol., Nux. v., Puis., Secale. 3. Aeon., Ant. crud., Ipec, Iris vers., Nitr. ac, Petr., Sulphur. Painless Diarrhoea : 1. China, Ferrum, Hyosc, Phos. ac, Podoph., Strain. 2. Bell., Chelid., Opium, Phos., Plat. 3. Ars., Cham., Gels., Lye Stools knotty, like sheep's dung : 1. Magn. mur., Op., Plumb, and Sulph. 2. Amm. carb., Carb. an., Caust, Chelid., Graph., Merc, sol., Nux. v., Sepia, Sulph. ac, Thuja. Stools Acrid, corrosive : 1. Ars., Chin., Ign., Iris vers., Merc, sol., Puis., Sulph. 2. Ant. crud., Canth., Cham., Coloc, Dulc, Ferr., Graph., Gum. gutt., Kali carb., Lach., Nux. v., Phos., Staph., Verat. alb. Scools alternating Diarrhoea and Constipation : Ant. crud., Bry., Lach., Nux. v. Stools Bilious : 1. Cham., Puis. 2. Aloes, Ars-. K Chelid., Coloc, Dulc, Ipec, Lept, Merc, sol., Podo., Verat. alb., Sulph. Stools Black : Ars., Bry., China, Lept., Sulph. ac, Verat. alb. Stools Bloody : 1. Canth., Caps., Coloc, Ipec, Merc corros., Nux. v., Phos., Sulph. 2. Apis., 42 AN OBSTETRIC MENTOR. Arn., Ars., Bapt., Bry., Calc. carb., Carbo. veg., China, Dros., Ferr., Led., Lye, Merc, sol., Nitr. ac, Puis., Rhus tox., Sabina, Sarsap., Sepia, Sil. 3. Aeon., Aloes, Iris vers., Verat. alb. Stools Changeable : Sulphur. Stools Copious : 1. Podo., Verat. alb. 2. Ant. crud., Gum. gutt., Iris, vers., Lept., Secale. Stools Chalklike : Calc. carb., Digit., Hep., Podo. Expulsion Difficult (of loose Stool) : Alum., Gels., Sil. Expulsion Forcible, Sudden : 1. Croton tig., Gum. gutt., Podo., Sulph., Thuja. 2. Aloes, Phos., Sepia, Verat. alb. Stools Frequent : 1. Ars., Bell., Caps., Carbo. veg., Cham., Merc, corros., Merc, sol., Nux. v., Podo. 2. Aeon., Apis., Bapt, Bry., Canth., China, Coloc, Dulc, Gum. gutt., Hyosc., Ipec, Iris vers., Sec, Sep., Verat. alb. Stools Knotty : 1. China, Coloc, Sulph. 2. Calc. carb., Magn. mur., Merc, sol., Op., Rhus tox. Stools Green : 1. Cham., Phos., Puis., Rheum., Sulph. 2. Aloes, China, Dulc, Iris vers., Merc, sol., Phos. ac, Stann., Verat. alb. Stools Involuntary : 1. Bell., Carbo. veg., Hyosc, Phos., Phos. ac, Secale, Verat. alb. 2. Ars., Calc. carb., Chin., Digit., Ferr., Mur. ac, Nat. mur., Op., Rhus tox., Sulph. Stools Involuntary, during sleep : Arn., Bry., Con., Hyosc, Puis., Rhus tox. Stool Involuntary, while urinating : Aloes, Mur. ac. Stool Involuntary, while passing flatus : Aloes, Kali carb., Oleand., Phos. ac, Verat. alb. Stool Involuntary, with every motion :. Apis. AN OBSTETRIC MENTOR. 43 Stools Mucous : i. Asar., Bor., Caps., Cham., Nux. v., Phos., Puis., Sulph. 2. Arn., Ars., Carbo. veg., Chelid., China, Coloc, Digit, Graph., Hyosc., Ipec, Iris vers., Kali carb., Lept., Magn. mur., Merc, sol., Nat. carb., Nitr. ac, Petr., Rheum., Rhus tox., Sepia, Sil. Stools Purulent : Merc, sol., Sil. 2. Arn,, Ars., Canth., Iod., Lye, Puis., Sulph. Stools shooting, or pouring out suddenly : Croton tig., Gum gutt, Podoph., Thuja. Stool Small, Scanty : 1. Ars., Bell., Merc, corros. and sol., Nux. v. 2. Aeon., Aloes, Arn., Asar., Canth., Caps., Cham., Coloc, Dulc, Oleand. Stool-smell like brown paper burning : Coloc. Stool-smell cadaverous : Carbo. veg., Sil., Strain. Stool-smell like rotten cheese : Bryonia. Stool-smell like rotten eggs : Cham., Psor. Stool-smell foetid : 1. Arg. nit., Sulph. 2. Bell., Calc. carb., Cocc, Iod., Lept., Lye, Nitr. ac, Rhus tox., Sepia. Stool-smell musty : Coloc. Stool-smell offensive : 1. Ars., Graph., Op., Podo., Psor., Squills. 2. Apis., Gum. gutt., Lach., Nux. v., Puis., Sulph. ac. Stool-smell putrid : 1. Ars., Asaf., Carbo. veg., Coloc, Puis., Sil., Stram., Sulph. 2. Arn., Aur., Calc carb., Cham., China, Dulc, Graph., Ipec, Nitr. ac, Nux. mos. and v., Oleand., Plumb., Podo., Sep., Squill. Stool-smell sour : 1. Coloc, Hep., Rheum., Sulph. 2. Amm. carb., Bell., Calc. carb., Cham., Dulc, Graph., Magn. carb., Merc, sol., Nat. carb., Phos., Robina, Sepia. Stool without smell (odorless) : Hyosc, Rhus tox. 44 AN OBSTETRIC MENTOR. Stools Undigested : i. Ars., China, Ferr., Graph., Hep., Oleand., Phos., Phos. ac. 2. Aloes., Ant. crud., Arn., Bry., Coloc, Con., Iris vers., Lach., Meny., Nitr. ac, Nux. mos , Pod., Sulph. ac, Sulph. Stools Tenacious : Asar., Caust., Merc, sol., Plat., Plumb., Sarsap. Stools Insufficient : 1. Arn., Cham., Magn. mur., Nat. carb., Nux. v., Sulph. 2. Alum., Colch,, Hyosc, Sabad., Sepia, Staph. Stools (constipated) too large : 1. Bry., Kali carb. 2, Graph., Ignat., Lach., Plumb., Verat. alb. Stools (constipated) too small : Caust., Merc sol., Phos., Sep., Sulph. Stools with Ascarides : 1. Calc carb,, China, Cina, Ferr., Ign., Sulph. 2. Asar., Merc, sol., Nux. v., Phos., Plat., Squill., Sil., Spig., Spong., Teucri. Stools with Lumbrici : 1. Cina, Sabad., Sil., Spig., Sulph. 2. Aeon., Anac, Calc. carb., Cham., Cic, Graph., Nat. mur., Ruta, Secale. Stools with Taenia:' 1. Calc. carb., Graph., Plat., Puis., Sabad., Sil., Sulph. 2. Carbo. veg., China, Kali carb., Nux. v., Petr., Phos., Sepia. CHAPTER II. Thoracic, Cystic, Renal, Uterine, and Skin Diseases. Severe pulmonary affections rarely complicate pregnancy, and where they do arise the indications for remedies are not especially distinctive or differ- ent from those at other times appropriate. Pulmonary Congestion. Aeon., Bell., Cactus, Cimicif., Gels., Phos., San- guin., Verat. vir. Aconitum: Is the great homoeopathic anti-con- gestive and anti-phlogistic. Palpitation of the heart, with short, dry cough, violent pressure, dyspnoea and great anguish, disturbing sleep, high fever and thirst. Bell. : Hard beating of the heart, which is felt in the head and makes it ache. Short, dry, hack- ing cough. Red face, thirst, fever and oppressed respiration. Cactus: Constriction of the chest and throat. She can hardly speak and her voice is hoarse and low. Dyspnoea and cardiac palpitation She can- not lie down and all symptoms are worse at night and when walking or lying on the left. Cimicif.: Stitching, lancinating and aching pains in the left chest, increased by taking an inspiration. Heart beats too fast and strong and very irregularly. ^6 AN OBSTETRIC MENTOR. Gels.: Constricted sensation in the lower part of chest. Stitches in lungs from above downwards, Dyspnoea, inspiration long, sighing, croupy ; expi- ration sudden and forcible. Dark red face and dull headache, with heavy countenance. She appears as if drunk. Phos. : Oppression, heaviness, tension and fulness in the chest. Dry, hacking cough. Sanguin.: Full, pressing, sore sensation in chest with intense burning ache. Dyspnoea, cardiac pal- pitation, weakness and marked fever of a low grade. Sang, is often the remedy after Aeon, or Verat. v. Verat. vir. : Oppression of the chest as of a load upon it, with constant nausea, chilliness, and constant intense burning ache in the chest. Dry, rack- ing cough with high fever. Nervous twitchings of the muscles (especially of the face). Verat. vir. com- bines handsomely many symptoms of Aeon, and Bell. and is often to be preferred to either. Dyspnoea (in general): Ars., China, Ipec, Kali c, Lach., Lobel. inflat., Mosch., Nux. v., Phos., Puis., Samb. Ars.: Great weakness, fever, thirst and restless- ness. Face swollen and pale, yellow or greenish. Feet and legs dropsical, with dyspnoea. She is worse after midnight. China: Shortness of breath, with flatulent dis- tension of the abdomen and periodical colic. Ipecac. : Wheezing respiration with nausea, vomit- ing and faintness. Face pale or blistered. Kali c. : Dyspnoea in phthisical women who awake at 3 a. m. and are much worse. Stitching pains in the chest and many heart symptoms. Lach. : Extreme dyspnoea, worse after sleeping. (She cannot lie down again.) Cannot bear any AN OBSTETRIC MENTOR. 47 clothing to touch the throat or waist. Left side troubles and history of ovarian or heart affections. Constipation. Lobelia inflat.: Asthmatic subjects with many stomach symptoms and sensation of a lump in throat and chest. Moschas.: Hysterical sleepless women who faint easily and often. Hypochondria. Nux. v.; The prime remedy for the dyspnoea of pregnant women. Red face, headache, backache. She urinates often with great urging. Phos.: Phthisical women. —Tall slender red-haired women with chronic cough. She is worse before midnight. Puls. : Difficult digestion; bitter taste after eat- ing and in . the early morning. Much chilliness even in warm weather or by a fire, and yet she wants all doors and windows open and to be fanned so that she can breathe. Sambuc: Dyspnoea worse before midnight, with restlessness and no thirst, eyes half open and de- lirium. Dropsical swelling of the feet and hands which are bluish as if bruised. Ars. is often used when Samb. would do better. Cough. A cough which arises from disease of the lungs, bronchi or larynx, or some other plainly specific cause during pregnancy will of course be met by the treatment suitable to such affections at other times. But there is a sympathetic cough peculiar to pregnancy which often harasses the patient and annoys her physician by its persistency; and un- less checked by remedies it will prove a torment to the end of gestation. 48 AN OBSTETRIC MENTOR. Compare first Aeon., Bell., Hyosc, Phos. Aconitum: Sore throat, fever, thirst and dry- cough, from tickling in the throat. Belladonna: Dry, hacking cough, coming on every evening or at night with sore throat and throbbing headache. Hyoscyamus: Dry nervous cough coming on when she lies down and keeping her awake all night. The cough is not severe, but incessant. Phosphorus: Hard dry cough with pains, soreness and oppression of the chest and scanty white frothy sputa. Hoarseness and rough soreness of the throat. Study also Caust., Con., Dulc, Ipec, Nat. mur., Puis., Sep., Sticta. Causticum: Dry hollow cough with scanty sputa, great soreness of throat and chest and hoarseness or even aphonia. The urine spirts out when cough- ing. Conium: Dry hacking cough after lying down at night and little or no cough during the day. When . Hyosc. seems indicated for a dry night cough and fails, try Con. in a high potency. Dulcamara : Loose spasmodic catarrhal cough with profuse mucous expectoration caused by ex- posure to cold or damp weather. Ipecacuanha : Loose suffocative cough with much dyspnoea and violent coughing spells, which cause vomiting and strangulation. The chest seems full of mucus and but little is expectorated. Colic and diarrhoea. Natrum mur. : Hard cough with stitches in the liver, spirting out of the urine and violent morning headache. Pulsatilla : Hard cough which shakes her AN OBSTETRIC MENTOR. 49 and makes her feel as if she would vomit, and causes uterine pains. Dry cough at night, going off when sitting up in bed ; loose cough during the day with yellow, greenish, bitter sputa. Diarrhoea at night. Sepia : Dry cough at night in bed before mid- night, or worse morning and evening. Scanty yel- low, green, or gray salty sputa. Derangements of the portal circulation. Constipation, yellow spots (liver matter) on the face. Sepia often follows Aeon, well : and both Phos. and Puis, should be compared with it. Sticta pulmo. : Dry hacking cough (incessant at night) with much dryness and soreness of the respiratory tract, and oppression and fullness in the lungs. I)?y cough after fluent coryza. Sticta resembles Phos. and is sometimes to be preferred. Cardiac Palpitation. This annoying condition is met with during pregnancy, mostly in very nervous women, and principally at three distinct periods : first, shortly after conception, when it is frequently associated with plethora ; second, during the fifth month when sometimes she can't tell whether she feels life or not, and thirdly, during the last month. Compare — Aeon., Actea rac, Cact, Ign., Kalm., Lach., Mosc, Nat. mur., Phos., Puis., Spig., Verat. virid. Aconitum : Palpitation with great anguish, fear of death, fever and thirst. Actea rac: Palpitation of the heart in rheu- matic women, or those subject to congestive dys- menorrhcea, great melancholy and apprehension and sleeplessness. 50 AN OBSTETRIC MENTOR. Cactus : Palpitation of the heart, worse at night, when lying on the left side and when walking. Constricted sensation in various parts. Severe right sided periodical headache. Ignatia : Palpitation or stitches in the heart at night. Many hysterical symptoms. Kalmia lat. : Palpitation of the heart with albuminuria, and violent neuralgic or rheumatic symptoms. Lachesis : Palpitation of the heart with inter- mittent pulse, dyspnoea and stitches in the left side. She can't bear any pressure on the chest or throat, and must sit up or lie on the right side. Always worse after sleeping. Moschas : Palpitation of the heart with many hysterical phenomena, dyspnoea. She talks only of approaching death. Natrum mur.: Violent palpitation of the heart (which shakes the body) from every exertion, worse when lying on the left side. Morning headache. Chlorotic women. Phosphorus : Palpitation of the heart from mental emotions with dyspnoea and tightness across the chest. Tall slender phthisical women who have a revolving morning vertigo, which walking about before breakfast. Pulsatilla : Palpitation of the heart in violent paroxysms with anguish and loss of sight. Con- stant chilliness. Spigelia : Violent visible and audible palpita- tion of the heart. She must lie with her head and shoulders well elevated, but is worse by bending forward. Veratrum viride : Palpitation of the heart with dyspnoea, high fever, and delirium, chilli- AN OBSTETRIC MENTOR. 5 1 ness, nausea and burning ache in the cardiac region. Dysuria. Increased frequency of micturition with some straining and burning sensations, we have observed as early and constant symptoms of pregnancy in primiparae especially, but in multiparas as well. Whether, these urinary disorders appear in early or late stages of gestation, they are alike amenable to the homoeopathic remedy, albeit the causes are so widely divergent. Study. — Aeon., Bell., Cann. sat., Canth., Cupr. ars., Equiset., Hell., Lye, Merc, corr., Nux vom., Puis., Terebinth., Uva ursi. Aconitum : Frequent and violent urging to urinate, with scanty emissions of red turbid urine. Fever, hot dry skin, thirst, restlessness and anxiety, after exposure to cold dry air. Belladonna : Micturition in drops of blood- red or golden yellow urine, with urging and pains m the bladder. Soreness of the bladder, the least touch or jar is intolerable. Backache as if it would break. Cannabis sat. : Urging and pressing to urin- ate with some burning during and very much after micturition. When Canth. seems indicated and fails, Cann. sat. should be tried. Cantharis : Very frequent urination with vio- lent cutting pain and frightful scalding, burning and extreme tenesmus. Bloody or mucous urine passed in drops. Cuprum ars. : Dysuria with rectal tenesmus and the evacuation of mucus. Equisetum : Dysuria with albuminous urine. Severe pain after urination. 52 AN- OBSTETRIC MENTOR. Helleborus : Dysuria with dark urine and cof- fee-colored sediment. Impending dropsy. Lycopodium : Violent pain in the back before micturition, better after. Urine is hot and clear, and contains red gravel. Burning, itching, and sharp shooting cutting pains in the bladder, urethra, and anus during and after micturition. Flatulent dyspepsia and constipation. Lye. resembles Nux vom. with some striking distinctions. Mercurius cor. : Extreme vesical irritation and tenesmus, with bloody albuminous or brown urine, brick dust sediment, severe right sided facial neuralgia. One of our best remedies for retinitis albuminurica. Nux v. : Very painful and ineffectual efforts to urinate and defalcate. Reddish urine with brick dust sediment, sore, burning, and lancinating pains in the neck of the bladder during micturition. Next to Canthar., Nux is the best drug we have for the dysuria of pregnancy, and qur third choice, pro re nata, would be Puis. Pulsatilla : Continued pressure on the blad- der without desire to urinate. Dysuria with drawing in the abdomen. Spasmodic pains in the neck of the bladder extending to the pelvis and thighs after micturition. Scanty brown urine with brick dust, bloody or mucous deposit. Terebinthina : Dragging, cutting, and burn- ing pain in the bladder with dysuria and scanty, red or bloody urine, which has the odor of violets, and a mucous or thick muddy sediment. Uva ursi: Painful micturition with burning pains while urinating and slimy, purulent urine-. AN OBSTETRIC MENTOR. 53 Enuresis. Incontinence of urine, like dysuria, may appear in early or late months of gestation. When at the later time it is caused chiefly by pressure of the gravid uterus upon the bladder and we shall be powerless to give that relief which we may confi- dently assume to extend during the earlier stages. Consult: Arg. nitr., Bell., Camph., Caust., Equi- set., Kreas., Nat. mur., Plantago, Puis., Sepia. Argentum nitr.: Profuse, pale urine passed frequently at night. Belladonna: Enuresis nocturna, with starting up, screaming and restlessness during sleep. Re- laxation of the neck of the bladder, she cannot re- tain the urine, which is copious, yellow and turbid and frequently voided. Camphora: Paralysis of the bladder and invol- untary micturition. After the abuse of diuretic drugs such as Cantharides, Turpentine, Copaiba, etc. Causticum: Enuresis, when coughing, walking, sneezing, and at night. Paralysis of the bladder from prolonged (voluntary) retention of urine. Dark-haired women, with warts on the hands or face, (or both), who are subject to bronchial ca- tarrh, with morning hoarseness and even aphonia. Equisetum: Enuresis day or night in women who had the habit as children. Kreasotum: Enuresis at night; wakes from deep sleep, with great urging and cannot retain the urine, worse when lying down, better while walking or standing, profuse bland leucorrhcea. Natrum mur.: Enuresis, while walking, stand- ing, coughing or laughing, violent desire to urinate day and night, which she cannot control. 54 AN OBSTETRIC MENTOR. Plantago: Profuse nocturnal enuresis, caused by relaxation of the sphincter vesicae; odontalgia. Pulsatilla: The drug to be first thought of for the enuresis of pregnant women, involuntary- urination in dropsy, while sitting or walking, great urgency of the call, she cannot delay at all, worse on taking cold, when there is a tough, slimy sediment in the urine. Sepia: Enuresis nocturna during first sleep, she is very nervous about the matter, has a sensation of urine passing and gets up thinking she has wet the bed, when such is not the case, urine has a strong odor and deposits a reddish-pink sediment, which adheres tenaciously to the vessel, violent itching of the vulva, constipation. Ischuria — Anuria. Fortunately neither suppression nor retention of urine are common during pregnancy. Great care should be exercised in such cases however to make a correct diagnosis, and unless remedies act prompt- ly retention should be speedily met by the use of the catheter. For Retention of Urine : Aeon., Apis, Apoc. cann., Ars., Bell, Camph., Canth., Eupat. purp., Nitr. ac, Nux v., Puis. For Sicppression of Urine: Apoc. cann., Camph., Eupat. purp., Helleb., Stram. Aconitum: Retention, with stitches in the region of the kidneys, fever, thirst, restlessness and anxiety, worse from exposure to cold, dry air. Apis: Retention or suppression of urine, inces- sant desire to urinate but inability to pass more than a few drops of high-colored urine or none at all. Holcombe says: " The dose of Apis must vary with AN OBSTETRIC MENTOR. 55 the state of the renal secretion; if the flow is excessive, the high dilutions are best; if it is very- scanty or suppressed the lowest succeed." Apoc. cann.: Urine retained, scanty or sup- pressed, skin dry and hot, constipation, dropsy, general or local uterine haemorrhage. Arsen.: Retention of urine, from paralysis of the bladder. Burning in the urethra at the commence- ment of micturition, ceasing upon the full estab- lishment of the stream; restlessness, cold sweat and the characteristic thirst. Bellad. : Retention of urine, with congestive headache and backache, urine clear at first; becomes turbid on standing, hypogastrium very sensitive to the lightest touch or jar even, and suffers stitching pains toward the perineum. Camph.: Retention of urine, with constant de- sire to urinate. After the abuse of diuretics. Canth.: Retention of urine, with pain in the back and incessant efforts and agonizing urging to urinate, cutting pains through and in the bladder, the urine dribbles away with cutting and burning in the urethra. Eupat. purp.: Retention or even suppression of urine, vertigo, with tendency to fall to the left, threatened abortion at the third or fourth month, cutting, aching pains in the kidneys and bladder, with urging to urinate. Helleb. niger.: Suppression of urine, which is very dark with a sediment like coffee-grounds, bad cases where the irritation at the neck of the bladder threatens to run into inflammation. Nitr. ac: Painless retention of urine, the urine is cold when emitted, and very foetid (like that of horses), nightly desire to urinate, with burning in the 56 AN OBSTETRIC MENTOR. urethra and cutting in the abdomen, she urinates in hopes to relieve these symptoms, but they are worse after the act. Nux v.: Spasmodic retention of urine, with urging and frequent ineffectual efforts to urinate, burning, lacerating, sore pains in the neck of the bladder during micturition, constipation, head- ache and backache, very irritable disposition. Pulsat.: Retention of urine, with redness, heat and soreness of the vesical region externally, pressure on the bladder without desire to urinate, desire to urinate with drawing pain in the abdomen, frequent ineffectual urging, with cutting pains, spas- modic pains in the neck of the bladder, extending to the thighs, after urinating. Stram. : Retention and suppression of urine ; it dribbles away slowly, and painlessly. Illusions of the senses : she fancies she sees rats and mice, snakes, etc., and is constantly looking under the bed for them. Albuminuria and Uraemia. Although albumen is almost universally found in the urine of pregnant women at some stage or other of gestation, yet its presence in any consider- able quantity, must always be viewed with appre- hension; and prompt and persistent treatment should be employed to meet any untoward symptoms and avert the more alarming complications of uraemia, retinitis albuminurica, and puerperal convulsions. Compare: * Apis, *Apoc. cann., Kalm., * Merc, corros., and * Terebinth. Kalmia : Albuminuria with nausea and eructa- tions of wind, worse about eight or nine o'clock * See Dysuria, Enuresis, and Ischuria. AN OBSTETRIC MENTOR. 57 a. m. Stiff drawing sensation in the eyes on mov- ing them. Shifting rheumatic pains in the arms, especially the right arm. Painful stiffness and aching in the back. Prosopalgia very severe and worse on the right side ; neuralgic pains in the bowels. Retinitis Albuminurica. It seems to us almost a mistake to call nephritic retinitis a disease ; for the condition of the retina is a symptom and sometimes a diagnostic symptom of the grave renal trouble which occasioned the ophthalmic lesions. Whenever a pregnant woman begins to complain of any diminution of seeing power, the urine should at once be tested for albu- men and the eye examined by an expert ophthal- moscopist. Or the presence of albumen in the urine alone should lead us to watch the eyes and be ready to fight the nephritis from the incipiency, feel- ing assured that only so can we have any measure of success. Consult: i. *Apis, *Ars., Gels.,* Kalm.,* Merc. corros., Zinc. 2. *Colch., Kali acet., *Phos. Retinal Hemorrhages : Arm, *Bell., Crot., *Lach., *Phos. Apis. : CEdema of the lids and general dropsy, very drowsy, little thirst and pale and scanty urine. Arn. : Retinal haemorrhage, particularly that of traumatic origin. Ars. : Restless all the time but especially at night before midnight. Great thirst for small quan- tities of cold water frequently. Urine scanty and albuminurious. * Compare also Dropsy and Albuminuria. ■■ 58 AN OBSTETRIC MENTOR. Bell. : Retinal hemorrhage from congestive headache. Retina and optic nerve congested and inflamed. Crotal. : Retinal haemorrhage when Lack, seems indicated and does not benefit. Gels. : Retinitis albuminurica during preg- nancy especially. Extravasations of blood and white patches in the retina. Sudden dimness of vision. Serous infiltration into the vitreous, mak- ing it hazy. Thirstlessness, evening fever and albu- minous urine. Kali acet. : Amauroses coming on suddenly in both eyes during acute nephritis. Lach. : Retinitis with haemorrhage, " very com- monly called for when no characteristic symptoms are present except the pathological changes. The retina and optic nerve are inflamed and congested, while throughout the retina may be observed extra- vasations of blood of various ages and sizes." Allen and Norton. *Zinc : Periodic and temporary amaurosis during severe attacks of headache. Dropsy. CEdema of the lower extremities and vulva is very common during pregnancy. Usually it occurs only during the later months and is not so extreme as to cause very great inconvenience. Should ascites come on, or the local dropsy become very great we should feel more concern. And if albumin- uria and symptoms of amaurosis and uraemia still further complicate the case, we shall be on our guard against the gravest of conditions. Not infrequently a discharge of water from the vagina takes place from time to time with these AN OBSTETRIC MENTOR. 59 dropsies, which is very perplexing to the inexperi- enced. This is a symptom of the general dropsical condition, and other things being equal is not a dangerous symptom. It is styled hydrorrhcea or false waters* An acute dropsy, dropsy of the amnion is of course peculiar to pregnancy, but not of great frequency. This disease causes great suf- fering, runs a rapid course, and is not often recog- nized until so fully developed that abortion is a certainty. Women who have once suffered it should be subjected to prophylactic treatment dur- ing subsequent pregnancies and carefully watched. Dropsy (in general.) : i. Apis., Apoc. cann., Ars., Colch., Digit., Dulc, Hell., Helon., Lye, Merc, corr., Uran. nitr. 2. Aur., Bell., Benz. ac, Bry., Cact., Canth., China, Convolv., Ferr., Kalm., Kali c, Lact., Led., Merc, sol., Phos., Phyt., Rhus tox., Senec, Sep., Sulph., Terebinth. CEdema of the Feet. Ars., Chin , Ferr., Kali c, Lye, Merc, sol., Phos., Puis., Rhus tox., Sulph. Apis : "Absence of thirst is very characte?'istic of Apis in uterine dropsy" says Guernsey. Stinging pains as of bee stings. Abdomen very tender to touch. Urine profuse and pale (high dilution) or scanty and high-colored (low dilution.) (Edema of the face, hands, legs, ankles, feet and labia. Apoc. cann.: Ascites : sinking in and irrita- bility of the stomach, even water is speedily re- jected. Great thirst, muddy urine, diarrhoea. Face bloated while lying down, passing off when sitting up. " Whenever it acts beneficially, the skin becomes * See Guernsey's Obstetrics, p. 357. 60 AN OBSTETRIC MENTOR. moist before the urine becomes more abundant." Lilienthal. (Edema of the feet and ankles. Ars. : GEdemaof the lower extremities. The face appears pale, earthy, waxy or greenish. Great pros- tration and thirst j drinks frequently and very little. Suffocative spells at night while lying on her back. Great anxiety and dyspnoea, must jump out of bed. Aur. : Albuminuria and dropsy with suicidal melancholy. Bell. : Urine dark and scanty or golden yellow. Worse after three p. m. Tenderness of the abdomen aggravated by the least jar of the bed or chair which she occupies. She even steps with great care while walking to avoid any jar. Benz. ac. : Urine high-colored, hot, scalding, and of strong, pungent ammoniacal odor. She wakes every morning at two o'clock with humming in the ears and beating in the temporal arteries which prevents her from going to sleep. Br yon. : The swelling increases during the day and diminishes during the night. Urine dark and scanty, and deposits a pinkish stain. GEdema of the lower eyelids and feet. Constipation. Splitting head- ache. Great thirst for cold water. Cact.: CEdema of the hands (especially left). GEdema of feet and legs to the knees. Skin shining. Pressure with the finger leaves a dent a long time. Copious straw-colored urine, passed by drops with burning. Canth. : Pain in the abdomen, vomiting and fever. Bloody urine and strangury, tenesmus of the cervix vesicce. Albuminous urine containing cylin- drical casts. Pains in the limbs and chronic coryza. China : Dropsy from haemorrhages or loss of other vital fluids. Abdomen distended. She belches AN OBSTETRIC MENTOR. 6 1 wind frequently without relief. Urine dark, scanty and sandy. Colch. : (Edema of the pale face and of the cold hands, feet and legs. Urine dark, scanty, and discharged in drops depositing a whitish sedi- ment. Convolv. : Urine almost entirely suppressed. Constipation with abdominal disturbance. But good appetite. Digit.: Dropsy with difficult urination. Stools light color. The heart sympathizes : pulse quick, fine and intermittent. Cyanosis. Dulc. : Dropsy after suppressed sweat from cold, damp air. Ferr. : Dropsy with cold skin, constant chilli- ness and evening fever. Very weak and nervous but face fiery red. Hell. : Urine almost suppressed, very dark, and deposits a sediment like coffee grounds. Slow com- prehension. Griping pains in the abdomen, and diarrhoea of jelly-like mucus. Debility. Piercing pains in the limbs. Helon. : Dropsy from albuminuria, general debility or haemorrhage. Urine pale yellow. Kali carb. : Weakly women with chronic bronchitis worse at three a. m. Sacculated swelling of the upper eyelid. Kalmia : Dropsy with albuminuria. Retinitis. Rheumatic pains in the arms and back.. Neuralgia facial. Lact. : (Edematous swelling of the abdomen, feet and eyelids. Asthmatic and heart affections. Lach. : Cyanosis. Urine black. Legs ©edema- tous, first left, then right. Ledum. : Pains in the limbs : skin dry. She feels " 62 AN OBSTETRIC MENTOR. very cold and cannot keep warm. Worse from warmth. Lyc. : Red sand in the uri?ie ; terrible backache just before micturition. Borborygmus in left hypo- chondrium. Satiety, even after eating a very little. One foot cold the other hot. (Edema of the feet. Ascites. Restless sleep. Feels worse on getting awake. Upper part of the body emaciated, the lower enor- mously swollen. When Lyc. seems well indicated and fails, consider Rhus tox. Merc. corr. : (Edema of the face and labia. Albuminuria. Right sided prosopalgia. Merc. sol. : Much perspiration affording no re- lief. Constant short racking cough. Not much thirst. Phos. : (Edema of the face, hands and feet. Shaking exhaustive cough with dyspnoea. Gray sand in the urine, which is turbid and whitish like curdled milk ; brick dust sediment. Variegated cuti- cle on urine, and albumen in it. Amaurosis. Phyt. : Dark red albuminous urine leaving a deep stain in the vessel. Aching of the heels. Chronic dry sore throat. Puls. : Constant chilliness. (Edema of the feet. Many uterine symptoms. Rhus tox. : Dropsy with turbid urine. (Ede- ma of the lower limbs. Restless sleep, she ?nust change her position often. Rheumatic stiffness in the back, better after moving about a little, which she is certain comes from her kidneys. Terrible cough, which seems as if it would tear something out of her chest. Lycop. is sometimes prescribed when Rhus is the similimum. Senecio: Abdomen swollen, very tense; lower ex- tremities oedematous. Pain in lumbar region. AN OBSTETRIC MENTOR. 63 Urine alternately scanty and high colored, or co- pious and pale. Sepia: Rises frequently at night to urinate; urine turbid and deposits a red mud which adheres tenaciously to the vessel; or blood red with a white day-like sediment (which it is also difficult to remove) a cuticle on its surface; or it is so foetid and offen- sive that it must be at once removed from the room. CEdema of the labia. Dropsy after miscarriage. Sulph.: Dropsy from suppressed eruptions. Moaning during sleep, quick pulse, cold feet, sweat- ing of the face. Heat in crown of head. Consti- pation or morning diarrhoea with painless urging. Pimply rough skin. Terebinth.: Dropsy with albuminuria. Pressing pain in kidney region while sitting down, better while moving about. Dysuria; urine bloody, de- posits a thick slimy, muddy sediment; urine scanty, turbid, dark and deposits an epithelial sediment: urine has the odor of violets. Uran. nitr. : Albuminuria. Urination increased in frequency and preceded by a pain over left eye. Ill temper and debility. Urinary Repertory. Urine Acid.: i. Hep., Merc, s., 2. Arn., Bor., Cact., Cann. sat., Caust., Clem., Cocc, Graph., Iod., Kali c, Natr. mur., Par., Phos., Rhus tox., Senega, Thuja. Urine bloody: 1. Canth., Puis., 2. Ars., Calc. c, Caps., Cann., Ipec, Lye, Merc, sol., Mez., Nux v., Phos., Sars., Sec, Sep., Sulph., Terebinth., Uva ursi, Zinc. Urine black: 1. Colch., Hell., Nat. mur., Lach. 2. Erigeron (dark urine turning pale.) 64 AN OBSTETRIC MENTOR. Urine cloudy when voided: 1. Cina., Con., Merc, s'., Sabad. 2. Ambra., Ant. crud., Cann. sat., Caust, China, Dulc, Ign., Phos., Puis., Rhus tox., Sep. Urine cloudy, after standing: 1. Bry., Cham., Phos. ac. 2. Acetic ac, Caust., Cina, Graph., Hep., Merc, s., Mez., Rhus tox., Senega, Sulph., Valer. Urine dark: 1. Aeon., Bell., Bry., Colch., Merc, s., Tart. 2. Verat. alb. 3. Ant., crud., Arn., Calc. c, Canth., Carbo v., Dig., Hell., Hep., Ipec, Puis., Selen., Staph., Sulph. Urine Flaky: 1. Canth., Mez. 2. Cann. sat., Cham., Sarsap., Zinc. Urine Frothy: Lach., Lye, Seneg., Spong. Urine greenish: 1. Camph. 2. Ars., Aur. fob, Berb., Bov., Chin., Colch., Iod., Kali carb., Magn. carb., Oleum an., Rheum., Ruta, Verat. alb. Urine greasy and varigaled pellicles on surface: 1. Paris. 2. Colch., Hep., Iod., Lye, Petrol., Phos., Puis. Urine hot and scalding: 1. Ars., Canth., Hep., Lye. 2. Aeon., Caps., Cham., Colch., Dig., Merc. s., Phos. ac, Squill. Urine milky: 1. Aur. mur., Cina, Phos., ac. 2. Carbo v., Coloc, Con., Merc, s., Mur. ac, Nitr. ac, Phos., Sulph. Urine mucous: 1. Nat. mur., Puis. 2. Ant. crud., Canth., Coloc, Dulc, Merc, s., Verat. alb. Urine odor like ammonia: 1. Asaf. 2. Benz. ac, Iod., Mosch., Nitr. ac, Pareira, Petr., Phos. Urine odor foetid. 1. Ars., Carbo. veg., Dulc. 2. Merc, s , Nitr. ac, Nat. mur., Petr., Phos., Phos. ac, Puis., Sep., Stann., Sulph., Viol, trie Urine odor filthy: Oleum an. AN OBSTETRIC MENTOR. 65 Urine odor urinous in excess: Benz. ac. Urine odor sweet: Lactue, Nux mos., Tere- binth. Urine pale, colorless: i. Apis, Con., Nitr. ac, Phos, ac, Plant., Puis. 2. Agar., Alum., Angust., Apoc. cann., Am., Aur. fol., Bell., Colch., Coloc, Dig., Eupat. purp., Erig., Ign., Magn. c, Mur. ac, Phyt., Polygon., Puis., Phos., Phos. ac, Plat., Rhus tox., Rumex, Sang., Senec, Sarsap., Sec, Sep., Staph., Stram., Stront. Urine purulent. 1. Canth., Clem. 2. Cann. sat., Con., Lye, Nitr. ac, Puis., Sabin., Sep., Sil., Sulph. Urine sticky or viscous: 1. Coloc. 2. Arg. nitr., Canth., Cupr. met., Dulc, Kreas., Phos. ac. Sediment bloody: 1. Canth., Hamam., Nux v., Phos. ac, Puis., Sep., Sulph. ac. 2. Aeon., Dulc, Hell., Lye, Phos., Sulph., Tereb., Uva ursi, Zinc Sediment cloudy: Bry., Nitr., Phos., Seneg. Sediment clay-like: Anac, Sars., Sep., Sulph., Zinc. Sediment flaky: Berb., Canth., Merc, Mez., Zinc. Sediment like flour: Calc carb., Graph., Merc, Nat. mur., Phos. ac, Sulph., Tart. em. Sediment mucous: 1. Chimaph., Dulc, Nat. mur., Puis., Valer. 2. Ant. crud., Asclep. tub., Aur., Berb., Bry., Caust. Coloc, Con., Eriger., Eupat. purp., Merc, Nat. carb., Phos. ac, Sarsap., Senec, Seneg., Sulph., Sulph. ac. Sediment of mucous threads in the urine: Cann. sat., Canth., Merc, Mez., Nitr. ac, Seneg., Tart. em. Sediment purulent: 1. Canth., Cham., Lye, Puis. 2. Calc. carb., Cann. sat., Chimaph., Clem., Cann., Kali carb., Nitr. ac Nux v., Sep., Sel. Sediment Reddish : 1. Canth., Nat. mur., Puis., Sep., Valer. 2. Aeon., Ambr., Ant. crud., Arm, 66 AN OBSTETRIC MENTOR. Chin., Dulc, Lach., Lye, Nat. mur., Nitr. ac, Sil., Squill. Sediment Sandy, Gravelly : i. Ant. crud., Calc. carb., Lye, Phos., Ruta, Sarsap., Sil., Zinc. 2. Ambr., Arn., Chin., Menyanth., Nat. mur., Nitr. ac, Nux mos. and vom., Puis., Thuja. Sediment Whitish : 1. Phos., Rhus tox. 2. Co- loc, Colch., Con., Eryng., Eupat., perf. and purp., Hep., Nitr. ac, Oleand., Petr., Plant., Phos., Phos. ac. Phyt., Sep., Spig., Sulph., Valer. Sediment Yellow : 1. Cham., Phos., Sil., Spong., Sulph. ac, Zinc. 2. Aram, carb., Bar. carb. Canth., Cupr., Lach., Lye Desire to Urinate Ineffectual : 1. Aeon., Canth., Dig., Sarsap. 2. Arn., Ars., Camph., Coloc, Hyosc, Kaii carb., Nux v., Phos., Phos. ac, Plumb., Puis., Stram., Sulph. Discharge Too Copious : 1. Arg. nitr., Mur. ac, Rhus tox., Squills, Verbas. 2. Acet. ac, Agn., Apis, Bar. carb., Bism., Canth., Guai., Ign., Merc. s., Nitr. ac, Phos. ac, Sang.,Seneg., Tarax., Viol, trie Discharge Too Scanty: 1. Apis, Apoc. cann., Canth., Colch., Digit., Graph., Hell., Op., Ruta, Sulph. 2. Aeon., Ars., Arum triph., Bell., Bry., Caust., Chin., Dulc, Hep., Hyosc, Kali carb., Lach., Lauro., Nitr. ac, Nux v., Phos., Plumb., Puis., Sulph., Te- reb., Verat. alb. Discharge Too Frequent : 1. Agar., Bar. carb., Canth., Caust., Merc, Nitr. ac, Rhus tox., Squill., Staph. 2. Bry., Coccu. cact., Ferr., Phos., Ign., Kali carb., Kreas., Lach., Mur. ac, Natr. carb., Phos. ac, Plant., Selen., Spig., Thuja. Discharge Too Seldom : 1. Canth. 2. Aeon., Arn., Ars., Aur., Camph., Hep., Hyosc, Lauro., Nux v., Op., Plumb., Puis., Ruta, Stram. AN OBSTETRIC MENTOR. 67 Discharge By Drops (Dribbling) : i. Canth., Sulph. 2. Arn., Canth., Clem., Dulc, Petrol., Sulph., Strain., Thuja. Discharge Intermittent : i. Clem., Con. 2. Agar., Caust., Dulc, Sulph., Zinc. Complaints Before Urinating : 1. Bar., Coloc, Lye, Nux v., Puis. 2. Arn., Bry., Digit., Phos. ac, Rhus tox., Sulph., Tart. em. Complaints When Beginning to Urinate : Canth., Clem., Merc. Complaints While Urinating : 1. Alum., Canth., Cann. sat., Hep., Lye, Merc, Phos. ac, Puis., Thuja. 2. Acet. ac, Aeon., Clem., Colch., Con., Ipec, Nitr. ac, Nux v., Phos. Sarsap., Sep., Sulph. Verat. alb. Complaints on Cessation of Flow : Bry., Canth., Sarsap., Sulph. Complaints After Urinating : 1. Canth., Coloc, Hep., Merc, Nat. mur., Sarsap., Thuja. 2. Anac, Arn., Bell., Calc carb., Cann. sat., Caps., Chin., Con., Digit., Nat. carb., Nux v., Par., Puis., Ruta, Staph., Sulph., Zinc. Specific Gravity Too High : Asclep. syra.,. Eupat. purp., Helon., Myr., Phyt., Puis., Senec. Specific Gravity Too Low :• Eryng., Eupat. purp. Puis. Bladder Remedies : 1. Canth., Hyosc, Lye, Nux v., Puis., Ruta, Uva ursi. 2. Aeon., Ant. crud., Arn., Bell., Calad., Caps , Dulc, Mur. ac, Pe- trol., Sarsap, Squill., Sep., Staph. Urethra Remedies : 1. Cann. sat., Canth., Caps., Clem., Merc, Phos., Thuja. 2. Aeon., Bry., Calc. carb., Caust., Chin., Colch., Con., Mez., Nat. mur., Nitr. ac, Nux v.. Phos. ac, Puis., Sabin., Sep. Sulph., Zinc. 68 AN OBSTETRIC MENTOR. Kidney Remedies : i. Arg. nitr., Apis, Berb., Canth., Chimaph., Kalm., Merc, corr., Nux v., Te- reb., Uva ursi. 2. Lye., Phos., Sarsap., Uran. nitr. Uterine Congestion : The symptoms which were formerly laid down under " Plethora" in textbooks may be caused by congestions of various parts (e.g. the head, lungs, and uterus). A highly congested state of the mucous lining of the cervix uteri is not uncommon in the early stages of pregnancy, and in fact at any stage where there is persistent " morning sickness." The local application of Calendula, either in a warm aqueous solution or in a glycerole has proven very useful in such cases. Compare Actea rac, Bell., Cauloph., Gels., Ign., Puis., Sep., Sec, Trill., Ustil. Uterine Displacements. Uterine deviations are not very common during pregnancy if we except anteversion during the later months. But when found may easily be recognized and demand prompt and intelligent attention. If drugs do not speedily relieve urgent cases, the use of a suitable pessary is advisable, otherwise the most serious consequences may follow. Prolapsus may usually be helped by putting the patient upon her back, keeping her quiet, and ex- hibiting the similimum. The growth of the ovum will assist the cure and ultimately prevent prolapsus. Anteversion may be treated in the same way, un- less it is of so extreme a type that the fundus is caught below the symphysis pubes. It will then be necessary to gently replace the organ and enjoin rest. Retroversion is the worst form of uterine devia- tion observed during pregnancy. It generally comes AN OBSTETRIC MENTOR. 69 on slowly during the third month, and at last reach- ing its climax the patient is seized with those vio- lent and unmistakeable symptoms which show that the fundus is bound down by the sacral promontory. The uterus should be replaced, and the patient in- structed to lie as much as possible on her face. Nor will most accoucheurs be satisfied until a retro- version pessary is put under the organ to retain in situ, where it will rarely remain without this assist- ance after being once extremely retroverted. Prolapsus Uteri : Actea, Alectris, Aur., Bell., Calc. carb., Cauloph., Con., Helon., Kali carb., Lilium, Nat. mur., Nux v., Phos., Podo., Puis., Sep. Anteversion of the Uterus : Aur., Bell., Calc. carb., Ferr., Helon., Lilium, Merc, Nux v., Plat., Sep. Retroversion of the Uterus : Actea, tEscuI. hip., Bell., Calc. carb. and phos., Cauloph., Ferr., Helon., Kali carb., Lilium, Lye, Murex, Nux v., Plat., Sep., Sulph. Actea ras.: Prolapsus and retroversion. Sen- sation of weight and bearing down in the uterine region with heaviness and torpor in the lower ex- tremities. Neuralgia or rheiunatoid diathesis. His- tory of dysmenorrhcea and abortion. JEscul. hip. : Pain about the sacro-iliac symphysis. She cannot walk because her back gives out. Con- stipation and haemorrhoids. Alectris: Prolapsus uteri. Obstinate nausea and vomiting of pregnancy* False pains. Abortive habit. Debility. Aur. fol.: Falling and anteversion of the womb. Heaviness in the abdomen with icy cold hands and * See Morning Sickness. 70 AN OBSTETRIC MENTOR. feet. Suicidal melancholy. Very sensitive to pains and cold air. Bell.: Useful in all uterine displacements. Pres- sure as though everything was coming down through the external genitals, especially in the morning. Heat and dryness of the vagina. Sharp pains come and go suddenly in the pelvis and back, leav- ing the latter so sore she can hardly move. . Calc. carb.: Like Bell., Calc. is often useful in uterine displacements. Feet and legs feel as if she had on wet stockings. Vertigo on going up stairs ; she is out of breath and must sit down to rest be- fore she reaches the top Constant wearing ache in the vagina and rectum. Melancholy as it gets dark at night. Calc. phos. : Especially retroversion. Every cold causes rheumatic pains in the joints and other parts. Cauloph. : Prolapsus and retroversion. Uterine congestion, with fulness, heaviness and tension in the hypogastrium. Drawing pains in the groins. Threatened miscarriage. Con.: Induration and prolapsus. Vertigo when turning over in bed. hiterinittent urination. Breasts sore, enlarged and painful. History of ovarian troubles in the individual and of cancer in the family. Ferr. : Weak ancemic women with fiery red faces. More especially ante- and retroversion. Helon. : A very useful drug in womb diseases. Deep undefined depression and sensation of sore- ness and weight in the uterus ; consciousness of a womb. Flooding and threatened abortion after lifting the least weight or moving about a little. Albuminuria, pruritus pudendi. Helon. much re- sembles Conium. AN OBSTETRIC MENTOR. 7 1 Kali carb.: Heavy aching pain in the small of the back. Stitching pains in and about the uterus. She has a dry bronchial cough and wakes at 3 a. m. feeling very badly every way. Lilium : All uterine displacements. Bearing down as if everything would come through the vagina: she must put her hand on the vulva to prevent this. Severe neuralgic pains in the uterus. She dates all her troubles from a miscarriage. Her pains and bearing down seem to extend and drag from the shoulders and chest downward. Lyc: Especially retroversion. Flatulent dys- pepsia and constipation Terrific pain in the back previous to micturition, with relief as the very hot urine flows j red sand in the urine. Cutting across the hypogastrium from right to left. Merc, sol.:* "A very valuable remedy for all displacements." Cold clammy sweat on the thighs every night. Deep sore pain in the pelvis. Ab- domen feels weak as if it must be held up. Itching of the genitals. Murex.: Retroversion especially. Sore pain in the womb as if cut by some sharp instrument. Nervous temperament, strong will and cheerful dis- position. Pain in the right side from the abdomen into the chest. Nymphomania. Nat. mur. : Prolapsus: Pushing towards the genitals every morning : She has to sit down to prevent prolapsus. She awakens every morning with a violent headache. Itching of external parts and falling off of the hair. Constipation and fissure of the anus. She imagines there are robbers in the house at night, and it must be searched to quiet her. * Guernsey. 72 AN OBSTETRIC MENTOR. Nux v : A royal remedy for uterine deviations, arising from lifting or straining. Aggravation from walking and standing. Dyspepsia, constipation and piles. Urinates frequently and but little at a time. Headache and backache. She wakes at 3 a. m. and can't get to sleep again. A careful choice must often be made between Lye. and Nux. v. Plat.: Great sensitiveness of the genitals and continual pressure and bearing down. The body cold and numb. Constipation : the stool is soft and sticks to the anus like clay. Melancholy, or peculiar proud defiant mood : she feels a little more important than other persons and above them. Phos. : Tall, slender, red haired phthisical women who pass long narrow hard dry stools. Stitches upward from the vagina cut the pelvis. Heat running up the back. Emptiness and weak- ness in the abdomen. Podo. : Prolapsus uteri and ani together, espec- ially after confinement. Sensation as if the genitals would come out during stool. Constipation and liver trouble : or morning (and after part of the night) diarrhoea. Puls.: She cries at everything and is very de- spondent, very bad taste in the morning. Pressure in the abdomen and small of the back as from a stone, with disposition of the lower limbs to go to sleep when sitting, with ineffectual desire for stool. Sepia : Retroversion especially. Pressing in the uterus, oppressive breathing : Sensation as if everything would come out of the vagina : she has to cross her legs to prevent it. Constipation with sensation of weight in the anus not relieved by evacu- ation. Sulph.: Burning in the vagina and of the soles AN OBSTETRIC MENTOR. 73 of the feet. She stoops in walking because so weak ; worse between n and 12 ; she wants her dinner early. Heat in the crown of the head. Leucorrhosa. .This affection is not common during pregnancy, save in women who are predisposed to it. And the indications for the use of remedies will not vary greatly from those depended upon at other times. We may, however, first and particularly con- sult : Cham., Cocc, Collinso., Kreas., Puis., Sep., Sabin* Cham.: Yellowish smarting leucorrhoea, particu- larly after a meal. Nervous irritability and hysteri- cal spasms. Cocc: Leucorrhcea like serum mixed with a purulent ichorous liquid. Vertigo, clouded con- fused feeling in the head. General sense of pros- tration as if it were impossible to make any exertion ; feels too weak to talk aloud. Backache. Colltnso.: Leucorrhcea with pruritus, obstinate constipation and piles. Kreas. : Leucorrhcea with great debility, especially of the lower extremities. The discharge flows in- termittently. Both bland and ichorous discharges, causing excoriation and itching. Puls. : Burning, thin, acrid leucorrhcea. Milky or thick white mucous leucorrhoea. Sepia : Green-red fluid discharged from the vagina. Leucorrhoea like pus, or milk, excoriating thighs and flowing only during the day time. Pro- fuse mucous foetid discharge with drawing pains in the abdomen. Much itching in the vagina. Sabina : Corrosive leucorrhoea making the thighs sore and causing intense itching. Yellow, 74 AN OBSTETRIC MENTOR. ichorous foetid corrosive leucorrhcea with itching of the pudenda. Pruritus Pudendi. This troublesome affection is among the most •obstinate which can befall a pregnant woman. For- tunately it is not very common, but when met it will tax the resource of the doctor and the spirit of his patient to the utmost. Guernsey uses no local treatment : most other authorities advise a great variety. Water, warm or cold (as the patient pre- fers) is useful. Glycerine, medicated with Cantharis tincture for the vesicular forms, or Urtica urens tincture for the erythematous or Hydrastis tinc- ture for the aphthous, is also recommended. For this latter, however, we prefer the first centes- imal or second decimal of Hydrastin, triturated with corn starch instead of sugar of milk, and ap- plied locally as a toilet powder.* Compare Ars., Bor., Calc. carb., Carbol. ac, Col- linso., Con., Graph., Hydrast., Kreas., Lye, Merc. 5., Nat. mur., Sep., Sil., Sulph., Thuja. Arsen.: Chronic eczematoics pruritus : aphthous inflammation of the genital mucous membranes. Borax.: Aphthae of the external genitals. Cor- rosive leucorrhcea, thick and white like starch. Calc. carb.: Itching and stitches in the inter- nal and external genitals, either or both. Consti- tutional symptoms of Calc. Women who bear un- healthy hydrogenoid children. Carbol. ac: Mucous tubercles on the labia and inside of the thighs, with itching relieved by scratching but it soon returns. Feels as if she had taken cold : is cold and aches all over. * This is a most excellent application in infantile intertrigo. AN OBSTETRIC MENTOR. 75 Collinso. : Violent itching of the genitals, parts badly swollen, dark red and protruding. Uterine displacements. All her trouble seems to co??ie from obstinate constipation and piles. Con.: Violent itching of the vulva followed by- pressing down of the uterus. Intermittent urina- tion. Acrid milky leucorrhcea. Graph.: Itching with vesicles or excoriation. Pimples, smartiiig and painful on the labia. Painless pimples inside of the labia. Hydrast.: Excoriation and itching of the vulva from extreme debility. Tenacious viscid leu- corrhcea. Kreas.: Corrosive itching of the vulva with soreness and burning after scratching from foetid corrosive leucorrhoea. Lyc: Great sense of dryness of the parts with much itching. Constipation. Ascarides. Merc, s.: Aphthous or eczematous pruritus. Itching of the vulva aggravated by a single drop of urine : it must be washed off. Pimples or tubercles on the labia, which are particularly troublesome at night. Very often the remedy. Nat. mur. : Itching of the vulva and falling off of the hair upon the genitals and head. Pimples on the mons veneris. Sabin.: Pruritus with leucorrhcea.* Sepia : Swelling and humid itching eruptions on the inner labia. Very much itching of the vulva. Leucorrhcea and bearing down. Constipation with sensation of a weight in the anus. Do not give Sepia at night. Sil. : Itching of the vulva with acrid leucorrhoea. * See Leucorrhoea. 76 AN OBSTETRIC MENTOR. Constipation, stool advances to the verge of the anus and then recedes. Sulph.: Troublesome itching of the vulva with pimples all around* Violent itching of the clitoris. Thuja : Itching of the vulva when walking. Chloasma, or Liver-Moth. The skin of pregnant women is very subject to a dirty brown discoloration, which is supposed to come from the liver. Compare Ant. crud., Cauloph., Con., Lye, Sep., Sulph. Ant. crud.: Hepatic spots. Brown liver-colored spots on each shoulder. Light brown dots on the arms. Cauloph.: Brown-yellow spots on the face. Con.: Chronic, frequently recurring brown-red spots on the body. Yellow spots on the fingers. Lyc: Brown spots on the abdomen. Large dark red spots on the legs and epigastrium. Hepatic spots on the chest. Painful liver spots on the chest and arms. Sep.: Brown spots on the chest and elbows sur- rounded by herpetic skin. Claret-colored spots on the neck and under the chin. Livid spots on preg- nant women. Yellow spots. Yellow streak like a saddle across the ?iose and cheeks. Sulph.: Yellow and brown hepatic spots on the back and chest. Cracktng of the Skin of the Abdomen. During the last months of pregnancy many women (usually primiparse) are annoyed by fissur- * Also Hydrastis. AN OBSTETRIC MENTOR. 77 ing of the skin of the abdomen. These seams are often exquisitely painful and not infrequently a little blood fills them. Moreover they leave un- sightly scars. For these rents or tears (for such they are, the skin being pressed apart by the con- tinued and increasing expansion) Calendula is speci- fic. We give the 30th internally and use either lotion of the tincture or a cerate of Calendula locally. Cosmoline medicated with the same is often successful. By this means very many cases can be speedily relieved and often the scarring pre- vented. CHAPTER III. Pains in Various Parts — Varicose Veins. Headache is one of the most common and tor- menting affections to which pregnant women are subject. This headache may be bilious or gastric, congestive or neuralgic. Neuralgia in the face and teeth is also frequently found during pregnancy. Nor is the latter often benefited by the extraction of teeth ; whereas such procedure has been followed by miscarriage. Headache (in general during pregnancy) : i. Actea, Bell., Bry., Gels., Glon., Ign., Nux v., Puis., Sep., Spig. 2. Aeon., Cact., Calc. c, Cedr., Chin., Collinso., Coloc, Hydrast., Hyosc., Ipec, Iris, Kalm., Lept., Merc, corros., Opium, Phos., Podo., Sang., Sil., Stram., Sulph., Verat. alb., Verat. virid. Headache from and with constipation : Alum., Bry., Coff., Collinso., Hydrast., Lept., Nux v., Opium, Sep., Verat. alb. Headache, bilious or gastric : Bell., Bry., Calc. carb., Ipec, Iris., Nux v., Podo., Puis., Sang., Sep. Headache, congestive : Aeon., Actea, Bell., Cact., Gels., Glon., Hyosc, Phos., Sep., Stram.,, Sulph., Verat. virid. Headache, neuralgic : Actea, Bell., Cedr., China, Coloc, Gels., Ign., Kalm., Merc corros., Nux v., Phos., Sil., Spig. Prosopalgia-, i. Actea, Bell., Cact., Cedr., Chin. AN OBSTETRIC MENTOR. 79 sulph., Coloc, Gels., Kalm., Merc, corros., Nux v., Spig. 2. Cham., Lach., Mez., Phos., Plant., Sep.,. Stram., Verbas. Odontalgia : Aeon., Apis, Bell., Bry., Calc carb., Cham,, Coff., Hyosc., Kalm., Kreas., Merc, sol., Nux mos., Nux v., Puis., Rhus tox., Sep., Staph. Acon.: Congestive headache or neuralgia with vertigo on. rising up in bed. She fears to be in a place of excitement or confusion. Stitching throbbing toothache from taking cold. After coffee. Actea rac: Congestive or neuralgic headache, over, in and behind the eyes (especially one eye) ex- tending to the occiput. Fulness, heat and throbbing in the head. Ache better in the open air. Alumin.: Headache (with constipation) relieved by lying quiet in bed. Throbbing, stitching frontal headache with nausea, worse going up stairs or stooping. Apis : Jumping toothache in left upper molars ; suddenly, involuntarily biting the teeth together. Swelling, redness and bleeding of the gums, with stinging and sore pains. Bell.: Headache and neuralgia. Flushed face and injected eyeballs. Cannot bear noise or light. She seems to be in a stupid or stunned condition. Right sided headache from 4 p. m. to 3 a. m., aggravated by lying down and by the heat of the bed. Pains come suddenly, are horribly excessive, last indefinitely, and go suddenly. Amelioration by sitting up, leaning back with the eyes closed. Toothache after eating and at night. Bry.: Headache with constipation and bilious symptoms. Bursting, splitting headache with dry parched lips and thirst. She must keep perfectly quiet j her eyeballs feel bruised and it is painful to- So AN OBSTETRIC MENTOR. move them or the lids or have them touched. Nausea on rising in bed. Toothache in sound teeth, shoot- ing from tooth to tooth and in the head and cheeks. Worse while eating, especially warm food and from warmth in general. Cactus : Congestive headache or neuralgia, worse on the right side, returning periodically. Heart symptoms. Calc. carb.: Headache with much dandruff on the scalp, with vertigo. Throbbing headache every morning lasting all day ; so severe that she thinks her head will burst or she go crazy. Worse while going up stairs, talking, walking, in sunshine and from taking cold. Better from tight bandaging, and lying down and closing eyes. Toothache in hollow teeth, around loose stumps, with sore, easily bleed- ing, painful gums ; worse from any change of tem- perature of air or food. Offensive odor from the teeth. Cedrum : Headache and neuralgia pains, wan- dering from place to place and returning with clock- like periodicity, but especially in the afternoon. Severe sharp, shooting pains starting from a point over one eye (generally the left) and extending along the supraorbital nerve into the head. Cham.: Unbearable toothache, which makes her very irritable ; pains of all kinds during and after eating or taking any thing warm in the mouth (espec- ially coffee). Hot swelling of the cheek. Red shining swelling of the gum. Pain in a whole row of teeth, but she can't say which one particularly. China : Periodic neuralgia ; pains excessive, from left to right, especially infraorbital and maxil- lary branches, worse from contact, draughts of air, lying down and in the night. AN OBSTETRIC MENTOR. 8 1 Chin. sulp. : Paroxysm sets in daily at the same hour : no pain in the interval and no other derange- ments. Coffea : Congestive, one-sided headache or headache from constipation. Excessive agonizing toothache relieved by holding ice or ice-water in the mouth. Collinso.: Headache with constipation and piles from which all the ailments seem to come. Coloc: Tensive tearing pain, with heat and swelling, especially of the left side. Constric- tion and pressing in left malar bone extending into the eye ; worse from touch and motion ; better from perfect rest and external heat. Gelsem.: Congestive or neuralgic headaches. She gets blind before the headache. Sharp shoot- ing pains through the face, eyes and head like rheu- matic pains. Face heavy dark red. She appears stupid. Headache commencing suddenly in the neck and spreading over the head or vice versa. Vertigo. Neuralgias of the fifth nerve. Glon. : Whirling in the head with vertigo. Sen- sation of expansion in the brain as though the head would burst. Brain feels as if expanding in waves. Headache or neuralgia from exposure to the sun. Hydrast.: Dull frontal headache, with pains in the back and abdomen from constipation. Hyosc: Congestive headache, delirium, red sparkling eyes, bluish countenance. Violent tear- ing, pulsating toothache, causing spasmodic jerkings of the fingers, hands, arms and facial muscles. Spasms in the throat. After Bell. Ign.: One-sided headache, periodically, as if a nail were forced into the temple. Melancholy, hysterical women. 82 AN OBSTETRIC MENTOR. Ipec: Gastric headache with nausea. Iris vers. : Gastric or hepatic headache, always- beginning with a blur before the eyes. Worse in the afternoon. Kalm.: Sun headache (like that of Glon). Ex- cessive right-sided faceache, especially between the eye and nose. Pain over the right eye (which is weak and watery) with vertigo. Neuralgia every afternoon, getting much worse at nigh't. Pressing toothache in the molars in the evening with or with- out prosopalgia. The chief remedy for the face pains of pregnant women. Kreas. : Drawing tensive pains in carious teeth extending towards the temple. Lept. : Dull frontal headache with liver symp- toms and constipation. Merc, corros. : Right-sided face-ache with many mercurial symptoms. Merc. sol. : Teeth are so sore that closing them (as in eating) increases the pain ; her teeth too long and loose. Worse at night in bed. Tooth- ache starting from a decayed tooth and involves the whole side of the face, which is red and swollen. salivation, lachrymation, perspiration, restlessness and sleeplessness. Mez. : Right-sided neuralgia with troublesome twitchings of the muscles of that side. Pains come quickly and leave the parts numb. Worse from warmth. Nux mos.: Toothache in front teeth as if wrenched out, going from right to left. Women with cool dry skin who do not perspire. After tak- ing cold in the night air or cold damp weather. Better from warmth. Very often indicated. Nux v.: Women addicted to high living, like AN OBSTETRIC MENTOR. 8$ wine, spirits and coffee, keep late hours ; or those who lead sedentary life. Habitual constipation and piles, and dyspepsia. Very irritable disposition. Sensation as if the skull would split. Contusive pain in the brain. Headache every morning on wak- ing, after eating and in the open air. Intermittent neuralgia of the face. Violent toothache with all sorts of pains. Opium : Congestive headache with constipation, unsteady look, thirst, dry mouth, sour eructations, nausea, acute hearing at night. Phos. : Headache from mental exhaustion ; chronic congestion of the brain, coldness in the cerebellum. Neuralgia in nervo-sanguineous tem- peraments. Drawing, tearing pains in the jaws, root of nose, temples and eyes. Vertigo. Toothache of a jerking, twitching nature from having hands in water (warm or cold). The dental periosteum is inflamed and tender. Plantago : Shooting, tearing neuralgia in the left jaw extending into the ear. Toothache, sore- ness of sound teeth while eating and rapid decay of the teeth. Podo. : Liver headache, alternating with diarrhoea, every morning with a flushed face. Puls. : Hemicrania in mild, gentle women ; worse at night and while at rest and in a close, warm room ; better in the open air and from bandaging the head. Pale face, no thirst, palpitation of the heart. Toothache, with much swelling of the face, better from cold food and drink and fresh air. Chilliness of the whole body. Rhus, tox.: Rheumatic (?) toothache from get- ting wet, relieved by external warmth. Many kinds of pains. 84 AN OBSTETRIC MENTOR. Sang.: Right-sided bilious headache from the occiput, neck and shoulders to the temple, passing off with frequent profuse discharges of pale urine. Nausea and vomiting. She must be perfectly quiet. Sepia : Headache, with aversion to all food and a distressing "gone," empty feeling in the stomach and constipation. Headache in the morning with nausea, vertigo and epistaxis. Moth patches on the fore- head and bridge of the nose, sallow complexion. Pain in terrific shocks as of powerful jerks in the head. Chronic congestive headaches with photo- phobia and ptosis. Right-sided hemicrania with nausea and vomiting. Intermittent faceache with the congestive headache. Beating, stitching tooth- ache which extends to the ears, and even the arms, leaving a numb, creeping sensation there. Sil. : Headache from nervous exhaustion, re- lieved by heat but not by pressure. Pain in occiput ascending to vertex and supraorbital region. Spig.: Headache commences every morning at sunrise, increases till noon, and decreases till sun- set, even in cloudy weather. Pains darting from behind forward through the eyeball. Headache and neuralgia left-sided. Neuralgia very seVere in- volves eyeball and orbit, the eye being much con- gested. Pains relieved by firm pressure. Staph.: The teeth turn black (also Kreas.), loose, brittle and carious. She is very sensitive to mental or physical impressions. Stram. : Neuralgia; pains maddening; spas- modic starts and shocks through the body, throws arms upward. Deliriiwi with open eyes, fancies she sees reptiles, vermin, etc. Sulphur : Headache with local congestions. Heat in top of head and flushes of face, cold feet AN OBSTETRIC MENTOR. 85 and vertigo when going up stairs. Spells of faint- ness. Psoric. cures when other drugs fail. Verat. alb.: Headache with delirium, dementia and cold sweat on forehead. Indigestion, nausea and vomiting, diarrhoea or constipation. Verat. virid.: Congestive headache from the nape of neck to supraorbital region. High fever ; threatening puerperal convulsions, mania or fever. Verbas. : Periodic right-sided headache and neuralgia, with vertigo and great aggravation from the slightest pressure. Pains in the Breasts. Many women suffer much pain in the breasts, both during early and late stages of pregnancy, owing to the increasing development and activity of these sensitive organs. Bell.: Erysipelatous swelling, hardness and redness of the breasts, which feel heavy and very tender. If one be worse, it is the right one. Bry.: Breasts swollen in hard lumps and feel heavy, but are not red. Thirst, fever and desire to be quiet. Carbo an.: Breasts swollen in red nodosities, with tenderness and induration of the axillary glands. Bitter taste in the mouth. Cimicif.: Puckerings in both mammas, aching waving pains in left breast. Pains paroxysmal. Threatened abortion. Weakness and pain in back. Nux v.: Distensive pains in the breasts. Con- stipation, backache, haemorrhoids. Very irritable and sullen, won't answer any question. Secale : Stinging and distensive pains in the breasts. Passive uterine haemorrhage and threat- ened abortion. 86 AN OBSTETRIC MENTOR. Sepia : Distensive pains in breasts which are in- flamed and troublesome. Many Sepia symptoms (see " Sepia " under other headings.) SORE NIPPLES. This annoyance sometimes distresses pregnant women, and arises like the preceding from a little over activity of the breast and a consequent inflam- mation of the nipple glands. A great variety of applications are advised not only to cure but also to prevent. Brandy and sugar, with some astrin- gent like alum or tannin has been used to harden the nipple. Nut-galls hollowed out to fit the nipple and soaked in brandy are advised by Uhlemeyer. To cure, Hydrastis or Arnica in water or glycerine, sweet oil and lime-water, Magnesia ointment, Green tea and Glycerine, Collodion, an oxide of zinc and arrowroot powder (one to sixteen), and even a solu- tion of nitrate of silver (grs. x. to § i.) have been recommended. Of this long catalogue only two numbers attract the homceopathist ; a bruised or injured nipple he knows needs Arnica, and for an excoriated or aphthous nipple he may use Hydrastis. But in our experience by far the most useful remedy is Calendula applied either in water, glycerine or cerate, as the physician or his patient may prefer. We think, moreover, that many of the above appli- cations are too severe, and instead of curing or pre- venting they lay the foundation for serious evils. Guernsey advises Graph., Lye, Petrol., Puis., Sep. Sil., Sulph. Abdominal Myalgia. Tensive or stitching pains in the abdominal parie- tes, either under the short ribs or in the inguinal AN OBSTETRIC MENTOR. 87 Tegion, on one side or the other, not infrequently torment pregnant women. It will be necessary for us to distinguish carefully between these neuralgic .pains and those painful uterine contractions styled " false pains," as the remedies required in each case are sometimes different. Compare Actea, Alectris, Arm, Bell., Bry., Nux v., Puis., Verat. virid. Actea : Abdominal myalgia. Rheumatic pains in the muscular structures of the abdomen. Neu- ralgia of the abdominal plexuses. Women who suf- fer from rheumatism, neuralgia or dysmenorrhea j or who have had protracted labors from inefficient pains. Alectris: Anomalous myalgic pains in the walls of the abdomen simulating "false pains." Marked debility. Many gastric symptoms* and threatened miscarriage. Arn. : Stitches under the false ribs, arresting the breathing. Fine tearings in the abdominal muscles. Bell. : Long lasting painfulness of the whole abdomen. Itching stinging about the umbilicus. Lancinations in the inguinal glands. Bry. : Colic (?) of pregnant and lying-in women. Thoracic pains. Nux v. : Colic of pregnant women, with ab- dominal spasms. The abdominal muscles feel bruised when coughing, moving, laughing, or touch- ing the parts. Puls. : Abdominal spasms. Swelling and pain- ful sensitiveness of the abdominal walls with tensive pains, worse from yawning, singing, laughing, or -any movement of the abdominal muscles. * See "Alectris" under Morning Sickness, chapt. I. 35 AN OBSTETRIC MENTOR. Verat. virid. : Neuralgic (?) pains at the right side of the umbilicus passing to the groin and also in the left groin. Sudden and violent thoracic and uterine congestions. Convulsions before, during, and after labor. Spurious peritonitis. False Pains. It almost invariably occurs during the last weeks of gestation that those uterine contractions which have been insensibly and periodically transpiring, become exaggerated, sensible, painful, and exces- sively annoying, frequently occasioning the woman to believe that the time of labor is at hand and summoning the accoucheur. We shall, however, readily perceive their false nature by the abdominal and vaginal touch, as we shall find no tension or hardness of the uterine muscles in this case, and no bulging of the membranes through the soft os uteri, and often that orifice undilated, and frequently much of the cervix uteri yet distinct from the body of the womb* If labor be at hand and the pains those of genuine labor all these signs will be re- versed. Consult — i. Cauloph. 2. Actea, Bell., Cham., CorT., Diosc, Gels., Hedeoma, Nux mos. and vom., Puis., Sep., Viburn. prun. Cauloph. : Pains in the hypogastrium appearing at nearly regular intervals ecery night about the same time, recurring every few moments or every hour. The pains may extend in the limbs and up the sides of the abdomen. This drug is almost specific for false pains, and its use is usually followed by easy labors. It seems to behave kindly be the pains false or real (labor pains) : if false it will stop them AN OBSTETRIC MENTOR. 89 if genuine it will develop them and facilitate labor. We prefer the 3 x trituration to all other prepara- tions, whether higher or lower. Actea : * Spasmodic, neuralgic, rheumatic, labor-like pains in the uterus : uterine rheumatism, f Pain under the left breast changing to the ovary or arm of. the same side, or to the cervico-occipital region. Melancholy and threatening puerperal mania. Women subject to neuralgia, rheumatism, and hysteria ; or those who have chronic dysmenor- rhcea and functional dystocia. Bell. : Pains appear and disappear suddenly. The bed feels very hard to her. She cannot bear the least jar or noise. The back feels as if it would break. Cham. : Abdominal pains with frequent emis- sions of large quantities of pale urine. She feels her pain keenly and regards it as unbearable. Very irritable, spiteful, unreasonable, unhappy and lamen- ting. Coff. : Very distressing abdominal and facial neuralgia. She feels as if she would " go dis- tracted." Great mental excitement and sleepless- ness. Do not attempt to use Cojfea low. Dioscor. : False pains with violent continuous flatulent colic : the abdominal pains suddenly shift and appear in distant localities (fingers and toes). Gels. : Cramp-like pains in the abdomen (and legs), running upward and backward like those of commencing labor. Convulsions with complete unconsciousness. She feels muscularly weak, which arises from weak will power which cannot command the muscles as in health. * Macrotin is sometimes to be preferred, f See Meigs's Obstetrics, page 260. go AN OBSTETRIC MENTOR. Hedeoma : Severe periodical pains (like labor- pains) in the uterus, aggravated by movement and with a sensation of weakness or paralysis in the legs. The old midwives use a decoction of penny- royal to check false and after pains very success- fully. Nux mos. : False labor pains. Threatened mis- carriage. Women with cool dry skin who never perspire. Nux vom. : Abdominal spasms. Spasmodic false labor- (like) pains, with ineffectual urging to stool. Threatening miscarriage. Puls. : Labor-like pains which make her walk about (to relieve the pain). She cannot sit long at a time. The close or warm room oppresses her, she must have the window or door open, the fresh air is so grateful to her. She weeps and frets and fidgets, and is very despondent. She complains that the child " lies so queer," and hurts her so that she can only lie on her back. Do not give Puis. low or you will fail with it. Sepia : Frequent bearing down pains in the back and abdomen. She crosses her legs to relieve them. Sense of weight in the anus. Painful tormenting sensation of emptiness ("goneness") at the pit of the stomach. Viburn. prun. : Very painful cramp-like, labor- like pains in the uterus, with terrible cramps in the legs and abdominal muscles (and a gush of bright red blood from the uterus). Excessive nervous hysteri- cal excitement, spasms (hysterical) and threatened miscarriage. Women who have dysmenorrhcea. Viburn. is our best remedy for threatened miscar- riage with great nervous excitement. Palpitation of the heart. AN OBSTETRIC MENTOR. 91 Pains in the Back. Pregnant women are very subject to distressing backaches arising from a great variety of causes. Consult the articles on Constipation, Haemorrhoids, Leucorrhcea, Uterine Displacements and Conges- tions, where such troubles are associated with back- ache. But sometimes this pain will be idiopathic, so to speak, arising from the increasing pressure of the enlarged uterus and the tension of its ligaments, or it may be a pure neuralgia. Compare : 1. Actea, Arm, Bell., Gels., Lye, Nux v., Puis., Rhus tox., 2. Arg. nitr., Kali carb., Kalm., Phyt., Sang., Sep. Actea : Dull heavy aching pain in the small of the back, increased by motion and relieved by rest. Lumbago. Crick in the back. Pain and soreness along the spine in the ligaments and muscles of the vertebral column. Arn. : Pain in the back as if bruised or dislo- cated. Tingling in the back. Her back is so sore that she cannot bear the least motion or jar. Bell. : The bed feels very hard to her, and her back feels as if it would break. Cramp-like pain, or as if strained in the back. Gelsem. : Chilliness, chills and coldness in the back. Backache with occipital headache. Ly.c. : The foetus is unusually active. Red sand in the urine. Flatulent dyspepsia and constipation. Stiffness, aching and drawing pain in the small of the back. Aggravated when rising up from stoop- ing. Nux v. : She can't turn over in bed, her back is so lame and sore. She wakes at 4 a. m. and is 92 AN OBSTETRIC MENTOR. obliged to get out of bed and walk about to relieve her backache. All sorts of pains in the back, especially in the small of the back. Puls. : Severe backache, which causes her to walk and stand very erect with the shoulders well thrown back. She cannot lie or sit still long at a time. Her pains are chiefly in the sacral region. Rhus tox. : Very severe backache and weak- ness from lifting and carrying ; the small of her back seems bruised and feels better by lying on a hard bed ; but she must move freque?itly, especially at night. Her back is very stiff in the morning, but is better after she has moved about awhile. Also : Arg. nitr. : Tensive squeezing pains in the back at night. Time seems to pass very slowly. Belching of wind after each meal until nearly time for the next. Kali carb. : Backache so that she feels as if she could lie down in the street while walking to obtain rest and relief. Kalm. : Aching, paralytic, rheumatic pain, as if the back would break ; the pains extend to the shoulders and arms. Phyt. : Lumbago. The back is stiff every morning. Sang. : Pains in the loins extending into the hypogastric and iliac regions and down the thighs, with threatened miscarriage. Pains in the sacral region caused by lifting. Neuralgic pains in the great muscles of the back. Sepia : Bearing down pains in the back and abdomen. Pains of various kinds and stiffness in the back. AN OBSTETRIC MENTOR. 93 Cramps. Many women suffer severe and sudden attacks of cramps in the thighs, legs, or feet during pregnancy and mostly during its later weeks. Very rarely in extreme cases of nervous irritation these cramps affect other parts of the body. Friction will go a great way to relieve these spasms, and we should always advise rubbing upward from below, since that assists the circulation to its equilibrium, whereas the reverse action tends to stagnate the venous blood. The homoeopathically indicated remedy may be advantageously used locally in sweet oil, glycerine, or cerate, or, best of all, in hot water. Cramps (in general) : 1. Actea, Camph., Cham., Coloc, Cupr., Gels., Rhus tox., Sulph., Verat. alb., Viburn. 2. Calc. carb., Lye, Sec, Sep., Verat. virid. Actea : Cramps and even intermittent spasms in the extremities. Hysterical women. Sleepless- ness from nervous excitement. Profound melan- choly. Camph. : Cramp in the legs with desire to be uncovered. Her skin is as cold as marble and yet she feels hot and must be uncovered. Cham. : Severe cramps in the calves of the legs. She is beside herself with pain and indignation, and declares she " cannot and will not stand it." Coloc. : Severe intermittent cramps in the abdomen with cramps in the calves of the legs, and great restlessness. Cramps in the hands. If Coloc. fails give Diosc, which has similar symptoms with the distinction that the pains are continuous. Cupr. : Violent cramps in the fingers and toes, 94 AN OBSTETRIC MENTOR. or in the stomach. Coppery taste in the mouth Restlessness. Gels. : Cramps in the legs and abdomen. Threatening convulsions. Muscular prostration arising from loss of will power. Rhus tox. : Cramps in the legs causing her to rise and walk. Cramps in the legs every night, she jumps out of bed and walks about. Very rest- less at night and can find ease but for a short time in any position. Sulph. : Cramps in the legs with hot flushes and weak faint spells. Verat. alb. : Cramps in the extremities with cold perspiration. She feels so very weak that she is obliged to lie down. Violent retching with cold sweat breaking out. Viburn. : Cramps in the legs and feet, especially after walking or at night. Palpitation of the heart. Women who have had dysmenorrhea. Threatened miscarriage a?id cramp-like abdominal pains. Viburn. is one of our best remedies for cramps. Also : Calc. carb. : Cramps in the soles of the feet or toes. She has hard work to get to sleep at night. Her feet and legs feel cold and damp. Vertigo and cramps while going up stairs. Lyc. : Cramps in the calves of the legs and cold feet, which sweat profusely. Secale : Weakness, paralysis, or spasms of the legs. Scrawny, ill-conditioned women. Sepia : Violent cramps in the calves of the legs at night in bed. Verat virid : Coldness, blueness, dampness, and cramps of the legs, toes, and fingers. AN OBSTETRIC MENTOR. 95 Relaxation of the Pelvic Articulations. It is probable that a greater or less degree of re- laxation of the pelvic sutures is universal during pregnancy, but it is comparatively rarely that it is the cause of much suffering or complaint. When our attention is called to pains and inconvenience in walking from which we suspect a separation of the pelvic bones it is usually late in the pregnancy in women of scrofulous diathesis. Insist upon absolute rest, as neglect of this precaution may lead to a dangerous inflammation. Use hot water solutions of the indicated drug locally, and con- sult, i. JEs. hip., Arm, Calc. c, Ham., Puis., Rhus tox., Thuja. 2. Aloes, Calc. phos., Hep., Sil. ^Esculus : Pain and soreness of sacro-iliac symphysis ; cannot walk because her back gives out there, she must lie down and doing so feels better. Aloes : A sense of pelvis seems to cause hsemorrhoidal sufferings. Arnica : Spots feel sore like a bruise. She can hardly move from soreness in the pubic and sacro- iliac symphyses. Calc. carb. : Leucophlegmatic constitution ; great fatigue on walking but a short distance, with a general lame feeling in pelvis. She is clumsy and stumbles and falls easily. Can't sleep after 3 a. M. Calc phos. : Worse after taking cold, which she does easily, and has pains all over (in all joints). Hamam. : Excessive soreness and tenderness of weight and pressure into lameness, diarrhoea, and g6 AN OBSTETRIC MENTOR. pelvic articulations, but no pains. Arnica seems in- dicated and fails. Hepar. : Ulcerations with pimples about them. Puls. : Can't walk toward evening and feels worse in bed. Can't find one easy position or sleep all night as the pelvic articulations hurt so. Rhus tox. : Painful stiffness in pelvic articula- tions on attempting to walk, better after getting warm in walking. She must often change position at night in bed, and feels easy for a while after, but is soon restless and must change again. Silicea : Ulcerations with very tender fistulous openings. Thuja : Soreness in left sacro-iliac symphyses and pains also extending into groin. Pain from walking is so insupportable that she must lie down. Varicose Veins. We simply re-voice Guernsey in claiming that varicose veins can be cured by the homoeopathic remedy ; or if first taken in hand when very large and numerous, or when gestation is far advanced, their further development can be checked. And as a woman with the varicose diathesis having once suffered this annoyance will be subject to it in sub- sequent pregnancies, we have a double duty, to relieve the present case and remove the varicose diathesis, which homoeopathic remedies certainly will do. Where it is possible and gives comfort the enlarged veins should be supported by a judiciously applied bandage, snug, but never tight (or by an elastic stocking). Vulvular varices may be often advantageously supported by a compress (or com- presses), and a T bandage. A sitting or recumbent position should be assumed as much as possible. AN OBSTETRIC MENTOR. 97 If the varices suddenly rupture apply a cold water compress strongly medicated with the tincture or fluid extract of Hamamelis and give the same in- ternally. Sometimes Millefolium is useful. If these fail use styptics. Varicoses : i. Arm, Carbo. v., Fluor, ac, Hamam., Lye, Millef., Puis. 2. Aeon., Apis., Ars., Caust., Ferr. met., Graph., Nux v., Sulph., Zinc. met. Acon. : Advised by Richardson in alternation with Hamam. or Puis, for much pain and general febrile condition. Apis, : Burning, stinging pains in varicose veins, either with or without constipation. Profuse urine calls for a high dilution, scanty discharge for a low potency. Arn. : The varices feel very sore and as if bruised. Varices of the vulva and vagina especially. Arsen. : If they burn like fire. Caust. : They become much more painful when the patient is walking. Carbo. v. : Painful discharge or suppression of urine with' vaginal varices. The varices are bluish. This is one of our best remedies be the varices where they may, but must be used in 30th dilution or higher. Ferr. met. : Weakly persons with fiery red faces. Fluor, ac. : Obstinate cases of long standing, and especially in women who have borne many children. Graph. : Varicosities itch very much and have little pimples on the skin over them. Itching blotches on various parts of the body. Hamam. : Hard, knotty, swollen and painful varicose veins. Ruptured varices which bleed terribly. The legs are chiefly affected. 98 AN OBSTETRIC MENTOR. Lyc. : Varicose veins of the lower limbs, extend- ing nearly to the feet ; they feel large and hard under the finger. Red sandy sediment in urine. Borborygmus and constipation. Millef. : Ruptured varices whose bleeding is not checked by Hamam. The bleeding from the bursted veins is attended by uterine haemorrhage. The varices are painless. Nux v. : In women who keep late hours, use wines and highly seasoned food, and suffer from constipation and gastric derangements. Puls. : The chief remedy for varices dwing preg- nancy. Pain in varices (and general symptoms), worse toward evening ; the veins have a blue ap- pearance. Women who cry easily and are of mild disposition. Sulph. : Varicose veins of extremities or vulva, with haemorrhoidal sufferings. Other Sulph. charac- teristics, such as morning diarrhoea, etc. Zinc. met. : Varicose veins which give rise to fidgetiness of feet and limbs. CHAPTER IV. Sensory, Nervous and Mental Affections, Vertigo and Plethora, Insomnia and Neu- roses. Old fashioned allopathy assigned multitudes of physical sins to Plethora, and sought their allevia- tion by bleeding. More recently we diagnose from the same phenomena, vertigo, localized congestions and even uraemia and impending convulsions. Pregnant women often suffer vertigo and faint- riess, for which advise bathing face and head with cold water, cool acid drinks and rest in bed. Vertigo Repertory. * In morning hours : Calc. c, Nat. mur., Nux v., Phos., Rhus tox. In evening hours : i. Bell. 2. Cyclam., Lach., Puis., Sep., Zinc. When lying down : 1. Ars., Aur. met., Cyclam., Pulsat. When rising up : Con., Lach., Nux v., Rhus tox. When walking : Caps., Con., Lye, Phos., Puis. When stooping : Bry., Calc. c, Sep., Spig. With empty stomach : Calc. c, China, Iod., Phos. * Compare also Gastric derangements, headaches, Cardiac palpitation and Albuminuria. IOO AN OBSTETRIC MENTOR. After eating : Calc. c, Lye, Nat. mur., Nux v., Phos., Sep. After Sleeping : Apis, Lach., Nux v., Phos., Sep. In fresh air : Coca, Nux mos., Nux v., Sil. In the room : Agar., Ars., Puis., Sil. Better by motion : Caps., Cyclam., Lye, Puis., Rhus tox. Better by rest : Bell., Colch., Nat. mur., Nux v. Revolving vertigo : Am., Bry., Phos. Nux v. Stupefying vertigo : Bell., Calc. c, Hyosc, Sil. Staggering vertigo : Aeon., Nux v., Plat., Rhus tox. With trembling and uneasiness : Aeon., Ars., Calc. c, Ign., Phos. With fainting : Aeon., Ars., China, Nat. mur., Nux v., Phos. With vomiting : Ars., Ipec, Nux v., Puis.. Verat. alb. With tendency to fall — a (forward) Cicuta, Phos. ac, Spig. b (backward) Bry., China, Nux v., Rhus tox. c (sideways) Con., Ipec, Sil., Sulph, Loss of Hearing. Rarely cases will be seen of sudden or gradual loss of hearing during pregnancy not associated with any recognizable otological lesion. The best course is to consult an ear specialist. Where that is impossible or inadvisable, compare i. Capsic, Carbo an., Caust., Graph. Kali iod., Lach., Merc, s., Nitr. ac, Phos., Puis., Sil., Sulph. 2. Calc. c, Hep., Petrol., Staph. AN OBSTETRIC MENTOR. IOI Guernsey gives : Capsic. : The petrous portion of the ear is much smaller, red and painful. Carbo an. : She is able to hear, although faintly, but cannot tell from whence the sounds proceed. Caust. : Reverberation of all sounds, even of the patient's own voice, in the ears. Graph. : Great dryness in the ears. The deaf- ness is better when riding in a carriage. Lach. : The cerumen is too hard, too pale and insufficient. Merc. : Sensation of coldness in the ears con- tinually. Nitr. ac. : Much swelling of the internal ear ; it is nearly closed and sometimes there is much pain within it. Phos. : Difficulty in distinguishing the human voice. Puls. : Sensation as if the ears were stopped up. Sil. : Partial relief is obtained by blowing the nose. Sulph. : Aggravation for a while after eating or blowing the nose. Hygienic Means : Where there is much " tinnitus aurium," a collection of wax upon the drum may be suspected. If found use a warm suds syringing, and that failing, a drop or two of warm sweet oil, Glycerine or fluid Cosmoline should be put in the ear. Should the ear be foetid (either with or with- out otorrhcea) use a warm weak solution of perman- ganate of potash with the syringe and Kali iod. 3 x internally, being very careful never to suppress the discharge suddenly. 102 AN OBSTETRIC MENTOR. Eye Affections. Blindness (partial or complete) and many pains about the eyes are very common to pregnant women. Where the former occurs ophthalmoscopic examina- tion should be sought at once, and if albuminurious retinitis exist we shall be on our guard (see page 67) against most grave complications. We believe that almost all amauroses occurring during preg- nancy will be found to arise from diseased kidneys. We draw again from Guernsey : Aur. met. : Objects appear as if divided hori- zontally. Bell. : Dim appearance of objects ; they appear inverted or double. ■ Calc. c. : All objects appear as if seen through a mist. Caust. : Sudden and frequent loss of sight, with a sensation of a film before the eyes. The dimness of vision is greater after every headache. Paralysis of the upper eyelids so that they hang down. China : She can only distinguish the outlines of distant objects. When reading the letters appear pale and surrounded with a white border. She sees better after sleeping. Cicuta : The letters seem to move about when she is reading. Cina : She can see more clearly for a while after rubbing the eyes. (Eupbras. also). Hyosc. : Frequent spasms of the eyelids — stra- bismus. All objects appear of a red color or larger than they are. Nat. mos. : Frequent spasmodic closure of the lids. Nux v. : Heaviness and contraction of the lids. AN OBSTETRIC MENTOR. IO3 Phos. : All objects appear to be covered with a gray veil. Puls. : Sensation a? if the eyes were covered with a mist, or as if the dimness could be removed by rubbing something off from the eye. Sulph. : Dimness of vision and the gas or lamp- lights appear to be surrounded by a halo. Also: Cyclam., Dros., Glon., Merc, Ruta., Senega, Sep., Verat. alb. Insomnia. When a pregnant woman is sleepless either she is unhappy, excessively nervous, or else some physical cause may be found. Sometimes too violent mo- tions of the foetus keep her awake, (see page 127). She sleeps in an illy ventilated room, perhaps, or retires too early or too late ; or she has some bad habit of life, or some physical ailment. First then find out why she cannot sleep and remove that "why," and all will be well. If the cause can not be found regulate all living habits very strictly and compare : 1. Aeon., Bell., Coff., Hyosc, Ighat., Mosch., Opium. 2. Ambr., Cact., Cham., Chin., Gels., Lye, Nux v., Puis., Rhus tox., Staph., Strain. Acon. : Sleeplessness after midnight with anx- iety, restlessness and continued tossing about. Eyes closed but no sleep, says, " / shall not live through it" Ambr. : Cannot sleep at night, yet knows not why. Bell. : Drowsy all the evening and after going to bed, but cannot sleep. Starts up from a nap as if frightened (compare Stram.) A colleague of great experience in nervous diseases, says, " Bell. low is the great remedy for sleeplessness." ■■ 104 AN OBSTETRIC MENTOR. Cactus : Sleeplessness without cause or from pulsations in the pit of the stomach or in the ears. Cham. : Scarcely ever sleeps, and on falling asleep is tormented by anxious frightening dreams. China : She lies awake all night thinking, rest- less and uneasy, and is miserable next day. Or if she drops asleep she wakes in a profuse perspira- tion. Coffea : Sleeplessness from over excitement of body or mind ; from joy or surprise or long watch- ing. She is wide awake and has no desire to sleep. We have been very successful with this drug. Gels. ; Languid, drowsy, but cannot compose the mind for sleep. Hyosc. : Drowsiness without sleep. She starts from her sleep and cannot sleep again. She has bad dreams, or sleeps very heavily, or talks in her sleep. She imagines something is in the room and. is afraid (compare Stram.) Irritable, nervous, easily excited woman. She cannot sleep because of a short hacking cough all night which is absent during the day. Ignat. : She is very nervous, and lies thinking about herself and other cares and anxieties. She weeps or laughs alternately, and if she sleeps at all it is a light, restless slumber during which she hears everything, even distant sounds (compare Opium). She complains in the morning that she is not rested ; her mind is weary. Lyc. : Drowsy by day and sleepless by night. Sleep restless, is easy in no position ; cries out, starts and jerks her limbs about. The child moves about so constantly and vigorously that she cannot sleep. If she sleeps and wakes, she is hungry, cross and unreasonable, and in the morning unrefreshed. AN OBSTETRIC MENTOR. 105 Mosch. : Sleeplessness from nervous excitement without any other ailment. Is sure she is about to die. Nux v. : vVakes at 3 a. m. and lies awake for hours with a rush of thoughts ; falls asleep in the bright daylight with troublesome dreams and gets up tired and dispirited. Opium : Stupid sleeplessness (Gels.), with great acuteness of hearing. If she sleeps she has frightful visions, especially before midnight. Puls. : Sleeplessness after a too late or hearty supper. She sleeps late in the morning. Rhus tox. : Sleepless and restless, must often change position, especially before midnight. Staph. : Sleepy all day, awake all night ; body aches all over. Stram. : Restless disturbed sleep : she starts up in a fright and says there are rats or snakes under the bed. At times deep sound sleep. Hysteria. Fortunately pregnancy does not often give rise to hysteria unless the woman has already a tendency towards the disorder. It is, however, very com- monly seen during gestation, since many women are subject to it at all times, and doubly so when preg- nant. In fact, many women have hysterical con- vulsions or spasms, interspersed with what might almost be styled an hysterical mania, during the first seven or eight months of pregnancy ; the true puerperal convulsions occurring almost exclusively either shortly before, during, or soon after the actual labor. Compare especially for Hysteria: t. Asaf., Aur. met, Cocc, Con. 106 AN OBSTETRIC MENTOR. Gels., Ign., Magn. mur., Mosch., Nat. c, Nux v., Plat., Valer. 2. Anac, Ars., Bell., Cal. c, Cauloph., Caust., Camp, monobrom., Cann. indie, Cham., Coff., Hyosc, Nat. mur., Nux mosch., Pall., Puis., Sab., Sep., Sticta., Stram., Sulph. Anac. : Great forgetfulness. Loss of memory. Uses profane language. Ars. : Hysterical asthma developed by every little excitement ; worse at night after midnight. She cannot lie down for fear of suffocation. She wants a little water every few moments. Great fear of death. Asafclt. : Much trouble about the oesophagus ; burning and dryness in it. Sensation as of pressure or as if a lump was ascending in the oesophagus. She has to be constantly swallowing to keep it down. This sensation causes great dyspnoea. Aur. met. Desire to kill herself ; she thinks and. talks of little else. Fine eruption on the face, forehead, or lips. Palpitation of the heart. The Arsenic patient fears but expects death ; the Aurum case longs for death and expects it, even to seeking suicide. Bell. : Cerebral congestion ; face and eyes very red before and during the spasms. Throbbing frontal headache. Sleeplessness (see preceding section). Plethoric women. Calc. carb. : Women of a leucophlegmatic temperament. Feet and legs feel cold and damp, especially at night in bed. She cannot go to sleep at night for thinking. She cannot sleep after three o'clock in the morning. Vertigo on going up stairs. Camp, monobrom. : Hale advises this drug low AN OBSTETRIC MENTOR. IO7 for hysteria, hysterical spasms, and cerebral con- gestions during pregnancy. Cann. Indic. : Extreme nervous prostration or irritability (or both). Short distances (as from one room to another) seem eziormous, and she dreads to attempt to traverse them. Vertigo, faintness, and a nameless distress referred to gastric and cardiac regions. Metrorrhagia, sleeplessness, nightmare. Many dreams, vivid and frightful. Cauloph. : Hysteria and women subject to epilepsy and dysmenorrhea. Severe frontal head- ache in spells. Moth spots on the forehead. Anae- mia. Ca'ust. : Cannot keep upper eyelids up : eyes feel sore and as if they had sand in them : sight dim as if looking through a mist. Piles, enuresis nocturna. She looks on the dark side of every thing. Cham. : Exceeding sensibility to pain and extra- ordinary irritability of temper. She has to restrain herself so as to answer any one with civility. Coccul.: Choking constriction in the upper part of the fauces with dyspnoea and disposition to cough. Roaring in the ears. Coffea : Great sensitiveness and excitability. She is in a state of ecstasy. Sleeplessness. Conium : Vertigo in a recumbent position. Globus hystericus. Intermittent micturition. Gelsem. : Hysterical convulsions with spasms of the glottis. Stupor with muscular prostration. Occipital headache and afternoon fever. Hyosc. : Disposed to uncover herself and go naked. Much silly laughter and many foolish actions. Thinks all food and drink are poisoned and refuses them. Jerking and twitching in the spasms. 108 AN OBSTETRIC MENTOR. Ignat. : Spasms with sighing, anguish, shrieking for help. Suffocating constriction of the throat. Quiet silent grief antS. depression. One of our best remedies. Magnes. mur. : Many spasms day and night with great sleeplessness. Hysterical spasms which stop her labor pains. Fainting fits at table, nausea and trembling, relieved by eructations. Constipa- tion, (Lilienthal says: "one of our best remedies in the 200 dilution") of large difficult stools crum- bling as they pass the verge of the anus. Guernsey recommends as : " one of the most important reme- dies " in hysteria. Mosch. : Scolding, long, loud, and vehement, frequent fainting ; continual prating of her death and its near approach. Great desire for stimulants. Nat. carb. : Worse at night. Full of fancies all night. Sadness. Irritability. Inclination to start. Nat. mur. : She wakes in the morning with a bad headache. Somnambulism. Inclination to weep. She says " something awful will certainly happen." She witnessed a frightful sight which she cannot get out of her mind. She dreamed robbers were in the house and will not be satisfied until it is searched. Nux Mosch. : Sudden changes from grave to gay and vice versa. Excessive tendency to laughter. Abdomen extended excessively after meals. Mouth and tongue dry after sleeping. Frequent fainting and tendency to abortion. Excessive dyspnoea. Nux vom. : She wakes at 3 a. m., and lies awake until daylight, goes to sleep and lies late ; and feels badly when she finally wakes. Dyspepsia and constipation. Obstinate and will not speak to any one. AN OBSTETRIC MENTOR. 109 Pallad. : She imagines herself neglected : wounded pride. Uses much strong language and many violent expressions. Flatulently distended abdomen. Constipation and chalky stools. Platina : Self-exaltation : she looks down with contempt on every body : she feels as if getting big physically, Spasms with wild shrieks. Stools diffi- cult, adhering like clay to the anus. Pulsat. : Feelings and symptoms very variable and change often. Flat slimy taste, very intolera- ble in the morning, so that she must wash out her mouth. Constant chilliness and great disposition to weep. Sabina : Very nervous and hysterical and dis- posed to abort about the third month. Sepia : Involuntary fits of laughter and weeping. " Goneness " at the pit of the stomach. Paroxysms of something twisting about in her stomach and rising toward her throat. Urine putrid and deposits a clay-colored pediment which adheres with great tenacity to the vessel. Sticta. : Hysteria after loss of blood. Hysterical Chorea. Headache, which noise and light aggra- vates. Stram. : Strange and absurd fancies. She thinks rats and reptiles are under the bed and will not be persuaded but looks to see. She is very talkative and desires light and society. Awakes with a scream and a frightened and fixed stare. Sulph. : She co?nes out of her spasms very happy, and everything seems beautiful. Copious micturi- tion announces the termination of the spasms. Head hot and painful on top. Hungry before dinner can be gotten. Verler. : Fearfulness, trembling and palpitation, IIO AN OBSTETRIC MENTOR. sensation as if something warm were rising from her stomach into the throat ; or as of a thread hanging in the throat ; tickling in the throat and coughing. Chorea. Women who have suffered attacks of chorea (or even hysteria) will be likely to suffer from it during gestation. Rarely idiopathic cases (so to speak) will be seen during pregnancy. Consult : i. Agar., Actea rac, Cauloph., Caust, Coca, Croc, Cupr. met., Hyosc, Ign., Lauro, Nux v., Sticta, Stram., Verat. virid. 2. Bell, Calc. c, Cicuta, Secale, Silicea. Actea : Left sided chorea from rheumatism or uterine troubles. Irregular, tumultuous, strange movements of the heart. Spinal irritation. Loss of speech. Agar : True cerebral chorea, with congestion, dilated pupils, flushed face. Twitching of volun- tary muscles when awake but quiet when asleep. Nictitation of eyelids. Bell. : Cerebral chorea from hyperemia ; reflex chorea from pregnancy. Right side especially : diffi- culty in articulation and deglutition. Incontinence of urine. Face and eyes red. Calc. c. : Chorea from fright. Cauloph. : Chorea during pregnancy. Caust. : Right side. Eyes distorted. Tendency to aphonia or other paralyses. See also " Hysteria." Cicuta : Sudden rigidity with jerking of the limbs ; or twisting and distortion of limbs with screaming. Coccul. : Always worse after eating, drinking, sleeping or talking. After Nux v. AN OBSTETRIC MENTOR. I I I Croc. : Worse in evening : alternations of affec- tionate tenderness and excessive rage. Jumping, dancing, laughing, whistling. Wants to kiss every- body. Epistaxis or metrorrhagia : blood dark and stringy. Cupr. met. : Chorea minor : the paroxysm begins in one part and spreads over whole body. Terrible contortions with laughter, grimaces, and exultation. She cannot speak. After fright. Bet- ter when lying. Often on one side only. Hvosc. : Twitching and jerking of muscles all over, aggravated by eating. Disposed to laugh and act and talk foolishly. Ignatia : Chorea from fright, grief, or mental excitement : worse after eating. See Hysteria. Lauro : She tears her clothing and strikes at everything. Spasmodic deglutition. Indistinct ar- ticulation. She is furious because not understood. Incessant motion. She cannot stand, sit or lie. Gasping for breath. After fright. Nux v. : Numbness and crawling in affected parts. After dragging. Worse in the morning. See Constipation. Coccul. follows well. Secale : Choreic motions beginning in face and spreading all over even to jumping and dancing. Silicea : Chorea from ascarides. Pale face, canine hunger, irritated nostrils, constipation. Sleep full of dreams and horrors. Sticta : Hysterical Chorea. She cannot keep her feet to the ground : they jump and dance about in spite of all efforts to control them. When she lies down her limbs feel light as feathers as if floating in the air. See Hysteria. Stram. : Choreic motions of the leg of one side and arm of the other : or of the lower extrem- 112 AN OBSTETRIC MENTOR. ities. Frequent putting hands to genitals. Indina- nation to pray. Loss of speech and memory. Or, furious motions and emotions : laughter, lamentations, efforts to escape, hallucinations. Compare Hys- teria. Verat. v. : Chorea Magna, which is almost con- vulsions in severity. Champing of the teeth. Sex- ual excitement. Full, hard, bounding, rapid pulse. Disorders of the Affections, Emotions and Feelings. The peculiar mental conditions developed by pregnancy are often among those most harassing to the patient and puzzling to her attendant. A little kindly given advice to both husband and wife as to forbearance, good nature, diversion, etc., will often do more than drugs. Nevertheless the mate- ria medica is full of jewels of mental symptoms which will richly reward the diligent seeker. The following repertory is offered, not as covering all possible mental conditions during pregnancy, but, merely as including those commonly observed. Aggravation in the dark : Cann. indie, Stram. Aggravation in the evening : Arn., Bell., Coloc, Hyosc, Lach., Lye, Phos., Plat., Puis., Sep. Aggravation in the morning : Aur., Nat. mur., Nux v., Phos. Aggravation in the night : Aeon., Arn., Ars., Con., Nat. mur. Anger, effects of : Bry., Cham., Coloc, Nux v., Staph. Appearance as if stunned : Bell., Gels. Changeable disposition, from sad to gay, or vice versa : Asaf., Coff., Ign., Nux mos., Phos., Puis , Zinc. AN OBSTETRIC MENTOR. 113 Complaining and reproachful : Lye, Mosch., Nux v., Plat. Confidence, none in herself and thinks others have none : Aur. Contradictory humor : laughs at the sad and is sad at the gay : Anac. Death, foretells the day of her : Aeon., Mosch. Demon, thinks she is a : Anac. Demon, thinks every one is a : Plat. Discontent with her condition, does not want any baby, hopes it will die, and she miscarry, etc. : Ign. Disgust, estrangement, from individuals, or so- ciety, even from husband and family : Actea, Anac, Con., Nat. carb., Nat. mur. Fear of abortion : Nux mos. Fear of an incurable condition : LiL, Sep. Fear of death : Aeon., Actea, Apis, Ars., Coff., Gels., Kali carb., Mosch., Lye, Sec, Stram. Fear of being poisoned : Hyosc. Fear of an undefined or undetermined something terrible which will happen : Aeon., Calc carb., Ign., Hyosc, Nat. mur., Sep. Fear she will become insane : Cann. indie, LiL, Nux v. Fear that she will be thought insane : Calc carb. Fear of being left alone : Ars., Lye, Stram. Fears about her health : Ars., LiL, Sep., Staph. Fright, effects of a : Aeon., Bell., Gels., Hyosc, Ign., Nat. mur., Opium, Plat., Verat. alb Fright from a disgusting or horrible sight, of which she cannot help thinking constantly : Nat. mur. Gaiety and frivolity : Arm, Croc, Stram. 114 AN OBSTETRIC MENTOR. Grief, effects of : Ign., Phos. ac, Staph. Happiness, thinks she has beautiful things ; awake at night singing, she is so happy : has happy dreams : Sulph. Haughty, overbearing, full of contempt : Lye, Plat., Verat. alb. Home, thinks she is away from it : Opium. Ideas, strange and ridiculous : Anac, Stram. Impatient : Ign., Ipec, Merc. sol. Inconstancy : Actea, Ign. Indifference : Nux mos., Phos. ac, Sep. Irresolution : Ign., Lach., Nux mos., Nux v., Puis. Irritability : Bry., Carbo veg.,Cham., Gels., Ign., Ipec, Iod., Kali carb.. Lye, Merc, sol., Mosch., Nat. mur., Nux v., Phos., Sep., Sulph. Joy, effects of : Aeon., Coff., Sulph. Jealousy, suspicion : Actea, Hyosc, Lach. Memory, loss of : Anac, Zinc. Melancholy, grieving : Aeon., Actea, Ars., Aur., Calc carb., Bell., Caust, Ign., Lach., Lye, Nat. mur., Nux .v., Puis., Sep., Verat. alb., Ustil. Mischievous : Arm, Calc carb. Noise, intolerance of : Bell., Ign. Obstinacy : Bry., Calc carb., Nux v. Past events trouble her : Calc. sulph., Plat. Pins, occupied with and hunts for : Sil. Prayerfulness, excessive : Stram. Quarrelsome : Ign. Solitude, desire for : Actea, Anac, Ign., Nux v. Swearing, inclined to : Anac. Suicide, desire to commit : Aur., Ars., Nux v., Rhus tox. Taciturn, silent : Calc. c, Ign., Nitr. ac, Nux v., Phos. ac, Verat. alb., Zinc. AN OBSTETRIC MENTOR. I I 5 Talkative, vivacious : Croc, Gels., Hyosc, Lach., Strain., Sulph. Thinking impossible, mind dull : Anac, Nux v. Visions, frightful : Bell., Stram. Wandering about the house, desire for : Nat. mur., Verat. alb. Weeping, disposed to : Aur., Ign., Kali carb., Phos., Puis., Sep., Staph., Sulph. Violent Fcetal Movements. Not infrequently women suffer during the last three months of gestation from violent and inces- sant movements of the foetus ; and we certainly think that the over-active child may often be ■quieted by a judiciously selected remedy. Study carefully the condition of the woman and taking any abnormalities into full consideration compare the following : Too violent or incessant fcetal movements. 1. Arn., Lye, Puis. 2. Con., Opium, Psor., Sep., Thuja. Diathesis. We believe that the unborn child may be radi- cally influenced by the homceopathically applied drug, so as to prevent or at least modify the disease tendencies which it is likely to inherit from its parents. Therefore we advise : study the constitu- tions and peculiarities of both parents (especially the mother) and give her the drug or drugs in a not low potency which specially antagonize the forms of dyscrasia which it is desired to overcome. Give the remedy sparingly ; once in three days or a week. To Modify Diathesis Study: Il6 AN OBSTETRIC MENTOR. i. Calc. carb., Calc. iod., Calc. phos., Calc. silic, Sil., Sulph. 2. Phos., Phos. ac, Psor., Rhus tox., Syphil. 3. Bar. carb., Bar. mur., Caust, Hepar, Nux v., Sepia. Hygiene. Every physician should inculcate, in the minds of his patrons, a sense of the advantage of profes- sional supervision to every pregnant woman from the moment conception is known to exist. That point gained, attention should be given not alone to physical abnormalities but also to engendering the best hygienic conditions. Bathing is an essential : tepid sponge-baths, and, if the woman can endure it without a shock, cold water applied to the genitals and breast. Cold water is a tonic (Nature's own), and women who use it as advised rarely have rigid perinaeums, agued breasts, or sore nipples. The sitz-bath is warmly advocated by many. We have had but little experience with it and, having found a purely natural bath all sufficient, adhere to the latter. Diet should be widely varied, never heavy and always palatable. An exclusive fruit diet we do not advise : because after a faithful observation of it in a considerable number of cases, we do not find it doing what has been claimed for it. On the other hand, a carefully selected diet certainly does help not only in averting an extremely difficult labor, but also in producing a healthy child. Stim- ulants of all kinds, coffee, spices, pickles, etc., and salt food should be avoided. Whole wheat, brown or graham bread, eggs, fruit, and vegetables of all kinds in profusion, soups and broths should be the AN OBSTETRIC MENTOR. 117 staples. Of meat not much and then the flesh of young animals. Rice and sago, and in a less degree barley, oats and rye may also be used. But be it understood that we do not approve an exclusive diet, although advising the predominance of such as we have indicated. For drinks, none excel soft or distilled water and lemonade ; if tea is used it should be black. " *The key to a comfortable happy pregnancy and the subsequent bringing forth (by a not difficult labor) of a healthy intelligent child, is flenty, but not too much food in variety, exercise of mind and body, literature, art, religion, in just and harmonious proportions." — Those wishing to study this subject further, should consult Verdi's Matern- ity, Holbrook on Painless Parturition, Richard- son's Obstetrics, and Hale's Diseases of Women. Functional Dystocia. When a woman has been subject to dysmenor- rhoea, we expect a difficult labor and endeavor to avert it. Questioning the woman closely we try and find out what were the full symptoms of her men- strual trouble : these fitted by a similimum, other things equal, said similimum will avert a hard labor. We use the drug or drugs during the last six or eight weeks of pregnancy twice or three times a day, and usually find our helper from among the following : 1. Actea, Cauloph., Puis., Viburn. op. 2. Bry., Cham., Collinso., Helon., Nat. mur., Plat., Sep., Verat. virid., Xanthox. *See Author's paper, " Horn. Journ. Obstet." Vol. 2, page -175. CHAPTER V. Miscarriage or Abortion. The worst ill which can afflict a pregnant woman is a threatened loss of the imperfected product of conception, whether it be styled miscarriage or pre- mature labor. When therefore the enciente one complains of uterine pains, with or without down- ward forcing sensations, or when any bloody flux is noticed from the genitals, it is a warning of impend- ing disaster not to be disregarded. Let every woman so affected be put upon her back and kept there until the danger is past or the exfoliation of the foetus completed. Verdi, the woman's friend, advises that where a woman has aborted at any given time she keep quiet upon her back for two weeks before and after said time, and be watched by her physician : good advice. Of course if we are certain the foetus is dead, we shall hasten its dis- charge from the uterus by all means in our power. If, moreover, we find the membranes or foetus par- tially expelled, or even protuberant, from the uterus, we should by tht hand or ovum forceps extract the whole in the shortest possible time, directing our remedial treatment towards the haemorrhage. Treatment Abortion :* i. Actea, Arm, Bell., Cauloph., China, Cinnam., Ipec, Kali carb., Puis., * See Fright, etc., under Disorder of Affections. AN OBSTETRIC MENTOR. II9 Sabin., Sep., Sec, Viburn. op. 2. Aeon., Alect., Apis, Arn., Bry., Calc. c., Cham., Croc., Ferr., Gels., Helon., Hyosc, Lye., Nux mos., Nux v., Rhus tox., Sil., Tril., Ustil. Pains predominating : Actea, Arn., Cauloph., Cham., Gels., Nux v., Puis., Rhus tox., Viburn. op. Haemorrhage predominating : Aeon., Bell., China, Cinnam., Croc., Hamam., Ipec, Millef., Sabin., Sec, Trill., Ustil. Haemorrhage after abortion : China, Hamam., Millif., Nux mos., Trill. Early months of gestation : Apis, Viburn. op. Later months of gestation : Opium. First month : Viburn. op. Second month : Apis, Kali carb. Third month : Croc, Sab., Sec, Thuja. Fifth to seventh month : Sepia. Discharge black : Asar., Croc, Kreas., Plat., Puis., Secale. Discharge black and coagulated : Cham., Chin., Croc, Puis., Sabin., Ustil. Discharge thin, black and with foul smelling clots : Secale. Discharge black and stringy : Crocus. Discharge black, in gushes : Puis. Discharge black and thick : Plat. Discharge black and offensive : Cham., Croc, Kreas., Secale. Discharge coagulated : Arn., Bell., Cham., Chin., Croc, Ferr., Helon., Ipec, Plat., Puis., Sabin., Sec, Ustil. Discharge comes and goes suddenly : Bell. Discharge continuous : Arn., Cinnam., Ham., Hyosc, Ipec, Sabin., Ustil. Discharge continuous but not profuse : Ustil. 120 AN OBSTETRIC MENTOR. Discharge continuous with nausea : Ipec. Discharge dark : Bell., Bry., Cham., Chin., Ferr., Helon., Kreas., Nux mos., Plat., Puis., Sabin., Sec, Trill., Ustil. Discharge dark and coagulated : Bell., Cham., Chin., Croc, Ferr., Puis., Sabin., Sec, Ustil. Discharge dark fluid : Bry., Plat., Secale. Discharge dark and offensive, or foetid : Bell., Cham., Croc, Kreas., Sabin., Sec, Ustil. Discharge dark and thick : Nux mos., Plat. Discharge in gushes, bright red : Cham., Chin., Puis., Sabin., Sec, Ustil. Discharge hot, bright red : Bell. Discharge intermittent : Chin., Kreas., Puis. Discharge passive : Alect., Cauloph, Chin., Croc, Ham., Helon., Sec, Ustil. Discharge profuse : Apis., Am., Bell., Cham., Chin., Cinnam., Croc, Erig., Ferr., Helon., Ipec, Hyosc, Sabin., Sec, Trill. Discharge bright red : Arm, Bell, Cinnam., Erig., Hyosc, Hamam., Ipec, Millef., Sabin., Trill., Ustil. Discharge bright red, continuous : Hyosc, Ipec. Discharge bright red, intermittent : Bell., Rhus tox., Sabin., Ustil. Discharge bright red, not coagulating : Hamam. Discharge bright red, with clots and coagulating : Am., Bell., Ipec, Sab., Ustil. ^Discharge Scanty : Cauloph., Nux v. Discharge coming on suddenly : Bell., Cinnam. Discharge watery : Chin., Ferr., Kreas., Sabin., Sec Discharge watery, with clots : Chin., Ferr., Sabin., Sec. * Compare " Pains predominating," page 157. AN OBSTETRIC MENTOR. 121 Discharge worse from motion : Coff., Croc, Erig., Sabin., Sec. Pain in back as if it would break : Bell., Kali. c. Pain in back drawing : Rhus tox. Pain in back, extending through to pelvis : Sabin. Pain in back, extending into thighs : Actea, Kali. c. Pain in back, paralytic, legs almost useless : Cocc. Pain in back, severe in back and loins : Cauloph. Pain in small of back : Asar., Bell., Calc. carb., Lye. Pain in small of back with great weakness : Kali. c. Pain in back, intolerable before urinating : Lye. Pain in back, worse by motion : Bry. Pain in uterine region, colicky : Bell., Calc. c, Chin., Sep. Pain in uterine region, colicky, with desire to urinate : Cham. Pain in uterine region, cramplike ; Cocc, Nux mos., Viburn. Pain in uterine region, cramplike with cutting stitches : Ign. Pain in uterine region, exciting desire to defecate : Nux v. Pain in uterine region and distention : Chin., Lye Pain in uterine region coming and going sud- denly : Bell. Pain in uterine region with faint sick sensation in abdomen : Sabin. Pain and heaviness in uterine region : Cham. Pain in uterine region, labor-like and alternating with haemorrhage : Cham., Puis., Secale. 122 AN OBSTETRIC MENTOR. Pain in uterine region, labor-like : Actea, Apis, Bell., Calc. c, Cauloph., Cham., Hyosc., Ipec., Kali c, Nitr. ac, Nux v., Opium, Plat., Puis., Sabin., Sec., Sep., Ustil. Pain in uterine region labor-like as if pelvic con- tents would issue through vulva : Bell., Nitr. ac, Sep. Pain in uterine region, labor-like, extending into back and thighs : Kali c. Pain in uterine region, labor-like, extending into ovarian region : Podoph. Pain in uterine region, labor-like, extending into hypochondrion : Cham. Pain in uterine region, labor-like, extending into thighs : Apis, Cham., Kali c, Sang., Viburn. Pain in uterine region, labor-like and periodical : Cham. Pain in uterine region, labor-like, shooting across abdomen from right to left : Lye. Pain in uterine region, labor-like, spasmodic : Cauloph. Pain in uterine region, labor-like, from urging : Arn. Pain and motion in uterine region as of some- thing alive ; Croc. Pain, great restlessness, and agony referred to uterine region : Cham. Pain in uterine region shooting to legs : Viburn. Pain in uterine and stinging in the ovarian region : Apis. Sinking empty sensation in uterine region : Ign., Sep. Tremulous sensation in uterine region : Plat. Great weakness in uterine region : Phos. Weight in uterine region : Alect. AN OBSTETRIC MENTOR. 12^ Pain about umbilicus passing off into the uterus : Ipec. Abortion from anaemia : Alect., Calc. carb., China, Ferr., Helon., Kali carb., Plumb., Puis., Secale. Abortion from uterine congestion : Actea, Alect., Bell., Canth., Cauloph., China, Croc, Hep., Nux vora., Sepia. Abortion from passive uterine congestion : Cau- loph., Secale, Ustil. Abortion from uterine congestion with ulceration : Canth. Abortion from constipation : ^Escul., Apis, Bry., Collinso., Nux vom., Sil. Abortion from Cystitis : Aeon., Cann. sat., Canth. Abortion from cold or damp : Aeon., Dulc, Puis., Rhus tox. Abortion from fright : Aeon., Gels., Opium, Abortion from Hysteria : Cann. indie, Cauloph., Nux mos., Sabin. Abortion from gonorrhoea : Cann. sat. Abortion from indurations of cervix uteri : Aur., Con., Sepia. Abortion from uterine inertia : Actea, Alect., Cauloph., China, Ferr., Helon., Puis , Sabin., Sec, Ustil. Abortion from lead poisoning : Plumb. Abortion from leucorrhcea : Calc. carb., Camp., Lye, Sep., Sulph. Abortion from nervous sensibility : Asar., Camp.- mono-brom., Ferr., Plat. Abortion from plethora : Aeon., Apis, Meet., Calc. carb., Sabin. Abortion from shocks, falls, concussions : Arm, Cinnam., Con., Rhus tox. 124 AN OBSTETRIC MENTOR. Abortion from a strain in the loins, misstep or over exertion : Cinnam., Rhus tox. Abortion from typhoid fever : Bapt. Abortion from stimulants, drugs or narcotics : Bell., Hepar., Nux vom. Abortion from rheumatism : Actea, Cauloph., Rhus tox. Threatened Septicaemia after abortion : Arm, Ars., Bapt. For the most frequently useful remedies we sub- join, Particular Indications. Actea : Habitual abortion, with cold chills and pricking pains in breasts. Women of rheumatic tendencies. Marsden alternates it with Ergot in cases of retained secundines. Pain predominant. Arnica : In case of a fall, shock, bruise or con- cussion a pregnant woman should always take Arnica, not too low. Flowing without pain, pain without flow ; or both pain and flow. She feels bruised and sore ; it hurts her to move and the child hurts her when it moves and feels as if it lay across the ab- domen. Pain predominates. Belladonna : Backache as if it would break with severe pressing down as if the pelvic contents would issue through the vulva. Congestive headache and red face and eyes. Profuse hot hemorrhage. The least jar, or noise or light are insupportable. Haemorrhage predominates. Caulophyllum : One of our best remedies to arrest the abortive process. Severe pain in back and loins with great want of uterine tonicity. Feeble uterine contractions and very slight hemorrhage. Cinnamon : Profuse flow of bright red blood after a strain in the loins or a false step. Hemor- rhage predominates. AN OBSTETRIC MENTOR. 125 Gelsemium : Sharp, distressing pains run up- ward or upward and backward. Abortion from sudden depressing emotions with diarrhoea. Pain predominates. Kali carb. : Abortion at the second month (third?). Pains begin in back and go down thighs like stitches. Backache when walking. She feels that she must sit or lie down. Pain predominates. Nux mos. : Obstinate, long continued flooding after abortion. Hysterical women disposed to fainting attacks who greatly dread and fear an abortion. Dry mouth and throat (especially after sleeping) . Hemorrhage predominates. Opium : Abortion threatened after a fright. Spasmodic labor pains. Latter part of pregnancy. Pain predominates. Pulsatilla : Flowing is intermittent (also Kreas.) Black blood passed with labor pains : the pains and haemorrhage alternate. Pain predomi- nates. Rhus tox. : Abortion from a wrench, strain, a ?nissiep or from lifting (lifting also, Calc. c.) Pains in the last part of the night, she is restless. Cramps in legs. Pain predominates. Sabina : Abortion at the third month, violent forcing or dragging pain extending from the back through to the pubes. Profuse bright red or dark fluid and clotted discharge. Haemorrhage predom- inates. Secale : Abortion at the third month, with co- pious black foetid fluid discharge and convulsive movements. Feeble women who have borne many children. Trillium : Delicate anaemic women subject to uterine displacements. Flow mostly bright red, 126 AN OBSTETRIC MENTOR. more rarely dark and clotted. Haemorrhage pre- dominates. Ustilago : Passive long continued haemorrhage after abortion. Huge clots or lumps of blood. Bearing down pains and profuse flow, either dark or bright, and almost always clotted. A very valuable and too often neglected remedy in which haemor- rhage predominates. * Viburn. op. Spasmodic pains shooting from the uterus into the legs. Frequent and early miscarriages ; the ovum is expelled at the fourth or sixth week, thus causing a seeming sterility : We have repeatedly verified the symptom — Labor like pains of extraor- dinary severity. With Arn. and Cauloph. Viburnum ranks as among the best of remedies for abortion in which pain predominates. In case the similimum is not found above con- sider further : Acon. : Fright and the fear remains. Haemor- hage with fear of death. Great excitement mental and physical. Unconscious and apparently un- reasonable fear controls her. Haemorrhage predom- inates. Alectris far. — Habitual abortion, with sensa- tion of weight in uterine region and prolapsus uteri. Anaemia, haemorrhage predominates. Apis. — Stinging pains in ovarian region, followed by pain and flowing. Urine scanty (low dilution) or profuse (high dilution). No thirst. Prolonged and difficult constipation. Abortion early in gestation, (second month). Pain predominates. Cantharis. — Constant {sometimes ineffectual') de- sire to urinate, only a few drops passed at a time * See page 117 " Viburnum." AN OBSTETRIC MENTOR. 1 27 with cutting burning pain. (Compare Cann. sat., Equiset. and Nux vomica.) Pain predomi- nates. Chamomilla. — Pains and dark clotted haemor- rhage with frequent profuse urination. Spiteful, snappish irritability. Pain predominates. China. — Sensation as if abdomen were " bloat- ed " full : passage of flatus up and down without relief. Profuse bright red haemorrhage (especially after abortion) with most alarming prostration : She is wiconscious , pulseless, breathless, limp and pallid. Such cases cinchona will often rescue. Haemorrhage predominates. Crocus. —Sensation as if something alive mov- ing in the abdomen, with nausea, faintness and haemorrhage, which is caused by the least move- ment. Black strings of blood with little knots, or clots, upon them. Haemorrhage predominates. Ipecacuanha. — Incessant nausea. Pain about the umbilicus passing into the uterus, with profuse bright red haemorrhage predominating. Kreasote. — Intermittent (also Pulsatilla) dark offensive corrosive discharge after abortion. Pro- lapsus uteri after abortion (also Helonias and Podophyllum). Nux vomica. — Every pain produces a desire to defecate and urinate, especially the former (the latter Catharsis). Constipation, dyspepsia and dysuria, soreness in uterine region. Very irritable and dreads to move or be moved. Pain predomin- ates. Podophyllum. — Pain in the ovarian regions every night, disturbing sleep, making her nervous and restless, and finally inducing abortion. Prolap- sus uteri (especially after abortion or confinement) 128 AN OBSTETRIC MENTOR, the womb falls very low, painfully so. Pain pre- dominates. Sepia. — Habitual abortion from the fifth to sev- enth month. Sensation of weight in the anus with constipation. Painful empty " gone " sensation in the stomach. The fcetal movements are very feeble. Yellow spots on face (yellow saddle across nose). Pain predominates. CHAPTER VI. The Pains of Labor. Rigid and Contracted Os Uteri, and Hour-Glass Contractions. The variations of labor pains from a normal standard, are very many, frequently encountered, and easily overcome by the similimum. Dr. E. M. Hale has well pointed out the absurdity of con- founding the rigid and the spasmodically contract- ed os uteri, and his distinction we observe. Hour- glass contractions are usually only found retaining the placenta ; but we have seen one case of such constriction about the waist of the unborn child preventing its delivery ; and instances have been observed of its occurrence after the placental deliv- ery. Pains ceasing : i. Actea, Bell., Cauloph., Kali carb., Opium, Puis., and Sec. 2. Cham., Gels., Nat. mur., Nux v., Ruta, and Sepia. 3. Arm, Bor., Camph., Carb. v., Chin., Cocc, Graph., Ignat., Lye, Magn. mur., Nux v., Plat., Sulph., and Thuja. Pains, distressing : 1. Cham., Gelsem., Kali carb., Sepia. 2. Aeon., Actea, Arm, Aur., Bell., Coff., Con., Lye, Nux v., Secale. Pains, spasmodic : 1. Cham., Gelsem., Hyosc, Puis. 2. Actea, Ambra, Bell., Cocc, Cupr. met., Ipec, Lye, Nux v., Sepia, Viburn. Pains, too weak : 1. Actea, Bell., Cann. s 130 AN OBSTETRIC MENTOR. Cauloph., Gelsem., Kali carb., Opium, Puis., Secale. 2. Cham., Nat. mur., Nux v., Ruta., Sepia. 3. Arm, Bor., Camph., Carbo v., China, Cocc, Graph., Ignat., Lye, Magn. mur., Nux v., Plat., Sulph., Thuja. Pains, too strong : Bell., Cham., Coff., Cact., Nux v., Puis., Sec. Aconitum : Great distress swooning and rest- lessness with each pain (and after ?). She fears that she will not be delivered or that she will die, or that something will certainly go wrong. The vulva, vagina and os are dry, tender and undilatable. Actea : She complains the pains are of a tear- ing distressing character and not located properly to effect expulsion. Rheumatic women. Great nervous excitement with very violent spasmodic pains. Arnica : With each pain flushed face and heat of head while the rest of the body may be cool. The pains are so violent as to drive her almost dis- tracted and yet little is accomplished. She feels very sore and bruised in any position and must often change her position, with very feeble pains. Aurum met : The pains make her desperate and she would like to jump out of the window and dash herself down ; congestion to the heart and chest and palpitation of the heart. Belladonna : Pains come on and go off sud- denly. Spasmodic contraction of the os uteri which is hot dry and tender : the labor is slow and tedious and the os uteri does not dilate in proportion to the pains. Face red and eyeballs injected. Borax : Pains accompanied by violent and fre- quent eructations. She fears a downward motion. Very sensitive to any noise, as rustling of paper, attling of a door latch, etc., etc. AN OBSTETRIC MENTOR. 131 Camphor. : Her pains have ceased and her skin is cold, dry and shrunken ; she does not like to be covered and is restless. Carbo. veg : The pains are too weak or cease from great debility. Varicose vulva. After great loss of animal fluids, or other debilitating effects of previous or existing disease. Caulophyllum : False pains. Extraordinarily rigid os uteri : (spasmodic contraction). Severe spasmodic pains without progress : pains flag from long continuance and exhaustion, thirst and fever. Causticum : Distressing sore pain in her back is her chief complaint. After debility, night watch- ing, grief or some depressing influence. Chamomilla : Spasmodic distressing pains. She can hardly bear them : she wishes to get away from them. She is very fretful, peevish and cross, and can't return a civil answer. Tearing pains down the legs. She is spiteful or cries out sharply. China : When much blood has been lost, or there has been fainting, fits or convulsions. Ces- sation of pain from loss of vital fluids. She can't bear to be touched (even her hands) during a pain. Cocculus : Spasmodic irregular paralytic pains : a hard pain and then after a longer interval several lighter ones. Much headache. Numb paralyzed feeling in the lower limbs. Coffea : Pains insupportable to her feelings : she feels them intensely and weeps and laments fearfully. Although severe the pains are not effica- cious. Conium : Scirrhosis in the breast or uterus. Pains spasmodic : vertigo on turning in bed : spasmodic contraction of the os uteri. Cuprum met : Violent spasmodic pains at ir- 132 AN OBSTETRIC MENTOR. regular intervals, with severe cramps in the lower extremities ; or cramps in fingers and toes only. Great restlessness between the pains. Gelsemium : Cutting pains in the abdomen from in front and below, upward and backward, rendering every labor pain useless. Rigid os uteri. Graphites : Large corpulent women of venous constitution ; tettery eruptions. Pains weak or lost. Hyoscyamus : Delirium : startings and jerkings all over face, eyelids, etc. Pains spasmodic and contracted os uteri. Ignatia : Deep sighs and sadness ; she must take a deep breath to breathe at all. Hysterical symptoms. Pains too weak or ceasing. Rigid os uteri ? Ipecacuanha : Constant nausea. With each labor pain a sharp cutting about the umbilicus darting off to the uterus, which renders the pain useless. Kali carb. : Pains begin in the back and pass off down the buttocks. Sharp cutting pains across the lumbar region, arresting the labor pains. She is greatly disturbed by sharp stitching pains. Lycopodium : During the paroxysms of her pain she is obliged to keep in motion. Spasmodic con- traction of the os uteri. Magnesia mur. : The labor pains are inter- rupted by hysterical spasms. Natrum mur.: Very sad and foreboding. Pains too feeble. Nux mosch. : Very drowsy and sleeping: faint- ing spells : pains slow and feeble or suppressed. Nux vom.: Every pain causes vesical and rectal tenesmus and fainting. Opium : Pain suppressed by fear or fright. AN OBSTETRIC MENTOR. 133 Soporous condition with red face, injected eyes and stertorous breathing : twitching and jerking of the muscles. Platina : Very painful sensitiveness of the vagina, external genitals (and os uteri ?) interrupts the labor pains. Spasmodic, very painful, inefficient pains. Her thoughts horrify her. Pulsatilla : Inertia uteri. (Arnica fatigue of the uterus.) Pains excite palpitation, suffocating and fainting spells.* (She must have the doors and windows wide open.) No thirst, very slow labor. Abnormal presentations may be righted if the drug is exhibited in a potency before the membranes are ruptured or the presenting part firmly engaged. Rut a : Lame and sore all over : very weak feeble contractions. Secale : Weak cachectic women, or those debil- itated from venous haemorrhage or by frequent and repeated child bearing. Weak, suppressed or very distressing pains. Fainting. Do 7iot give in a ma- terial dose until the os uteri is well dilated (if so at all) as it sometimes causes spasmodically contracted os and retained placenta. Sepia : Shuddering attends the pains and she wants to be covered up more as she can bear the pains easier so. Induration felt upon the uterine neck. Shooting pains in the neck extending up- ward. Spasmodic contraction of the os uteri. A Colleague has repeatedly verified every one of these symptoms. Sulphur : Flushes of heat, frequent weak faint spells, wants more air. Cold feet, heat on top of the head. * We have confirmed this symptom with six separate dilu- tions of the drug : 3X, 30, 200, 1000, Cm., and M. 134 AN OBSTETRIC MENTOR. Thuja : Syphilitic troubles which hinder con- tractility. Viburnum : False pains preceding the real pains. Cramps in the abdomen shooting down the legs. Spasmodically contracted os uteri. Rigid os uteri : Gelsem., Ignat., Lobel. inflate Nux v., Passiflora, Tart, em., Verat. virid. Gelsemium : False pains from before back and up, interrupting the labor pain. Cramping pains in various parts of the abdomen. Os uteri round, hard, thick, rigid and undilatable. Face dark flushed. Women stupid and apathetic. Ignatia : Where Nux v. seems indicated and fails ; or the Ignatia mental state is marked (see previous section). Lobelia : Thick leathery unyielding cervix uteri with nausea with each pain. She has such violent dyspnoea that the pain is useless. Nux v.: Pains in the loins causing constant urging to stool with a tendency to tetanic rigidity of the os uteri. Passiflora (curare) : Almost tetanic rigidity of the os uteri in hysterical subjects. Tartar emetic : Rigid os uteri with much nausea and dyspnoea, especially in women with history of sub-acute or chronic pelvic inflamma- tions. Verat. virid : Rigid os uteri with threatening convulsions : plethora, pulse full, hard and quick. Head and chest congested. Spasmodic Contraction of the Os Uteri. Spasmodic contraction of the os uteri : Aeon., Actea, Amyl., Bell., Cact., Cauloph., Con., Hyosc, Lach., Morp. acet., Viburn., Xanthox. AN OBSTETRIC MENTOR. 135 Aconitum : Great heat and dryness of the vag- ina and os uteri, which is contracted and undilat- able. Restless, anxious and discouraged after the drug. Actea : Severe spasmodic ineffectual pains : rheumatic diathesis. Dr. Marsden advises chiefly for rigid os : Dr. Hale gives as a remedy for spas- modic contraction : irregularly constricted os ; at one time dilating and dilatable, then suddenly closed by spasm. Melancholy and nervous, irritat- ing choreic motions all over. Amyl.: Spasmodic pains and constriction of the os uteri : flushing with each pain and severe head- ache. Belladonna : Heat and tenderness of the parts : swooning : flushed face, eyes injected : quick mo- tions : pains come and go suddenly : one of our best remedies. Cactus : Women who suffer heart spasm (of the circular fibres) and dysmenorrhoea. Caulophyllum : Spasmodic inefficient pains in various parts of the abdomen. She is much ex- hausted. Or, severe contractions of the fundus and constriction of the os uteri. Do not give low in these cases. Conium : See Conium, page 136. Hyoscyamus : When Belladonna fails : compare Hyosc, page 136. Lachesis : Contracted os with throat and heart symptoms : women near climacteric. Morphia acet.: Excessive pain and uncontroll- able nervous irritation. Spasmodic constriction of the os uteri. Dr. Hale prefers the valerianic salt. Viburnum : Violent pains and cramps in the 136 AN OBSTETRIC MENTOR. legs, thighs and abdomen. Spasmodic contraction of the os uteri. Xanthoxylum : Sandy haired delicate women who have had dysmenorrhcea, ovarian troubles, headaches, amenorrhcea and chronic coughs Hour-Glass Contractions. Hour-glass contractions : 1. Bell., Cham., Kali . carb., Plat., Secale, Sepia. 2. Coca, Con., Cup. ars., Hyosc, Nux v., Pulsat., Rhus tox., Sulph. Belladonna : Almost constant moaning which seems to afford relief ; injected eyeballs ; flushed face ; can't bear light or noise ; pulse full and bounding ; very hot skin. Chamomilla : Distress which it seems she can hardly endure ; spiteful irritability ; thirst ; desires fresh air ; restlessness ; more or less discharge of dark blood from the vagina. Cocculus : Terrible pain in the small of the back ; lower limbs feel paralyzed ; frequent vomit- ing. Conium : Vertigo when turning the head ; very sensitive across the abdomen. Cuprum ars.: Violent and distressing cramps in the uterine region ; and in the hands and feet. Hyoscyamus : Delirium ; jerking and twitching of the muscles ; bluish color of the face. Kali carb.: Distressing pain in the back run- ning down into the buttocks ; stitching pain in the abdomen ; abdomen bloated with wind ; restless- ness and thirst. Nux vomica : Sore aching pain in the region of the uterus ; very frequent inclination to stool ; great mental depression and nervous irritability. AN OBSTETRIC MENTOR. I37 Platina : Very great sensitiveness of the organs, severe cramping pain in the uterine region ; con- stant oozing of dark grumous blood from the vagina. Pulsatilla : Very mild, tearful women ; desires fresh air ; very restless ; absence of thirst. Rhus tox.: Occasional paroxysms of pains ex- tending down the posterior surface of the limbs ; restlessness with relief after every change of posi- tion ; must change position frequently. Secale : A sensation of constant tonic pressure in the uterine region, causing great distress ; wishes fresh air and don't like to be covered much. Sepia : Numerous little darting pains shooting upward from the neck 'of the uterus ; flushes of heat ; cold feet. Sulphur : Frequent weak fainty spells ; wishes to be fanned : flushes of heat and cold feet. CHAPTER VII. HEMORRHAGE. Haemorrhage : i. Aeon., Apoc. can., Arg. nitr., Bell., Bry., Calc. carb., Cham., China, Cinnab., Cinnain., Croc., Erigeron, Ferr., Hamam., Hyosc., Ipec, Kali carb., Lach., Millef., Nux. v., Sabina, Secale, Sepia, Silic., Sulph ., Sulph. ac, Trill, Ustilago. 2. Actea, Alectris, Ant. crud., Apis, Arn., Ars., Canthar., Carbo veg., Cauloph., Ign., Iod., Kreas., Lye., Nitr. ac., Nux mosch., Phos., Platina, Puis., Rhus tox., Stram. Active Haemorrhage : Aeon., Apis, Arn., Croc, Hamam., Ustilago. Haemorrhage alternating with labor pains : Pul- sat. Continual Haemorrhage : Apoc. can., Ipec, Secale, Ustilago. Bright red continual Haemorrhage : Hyos., Ipec. Dark, suddenly appearing Haemorrhage : Ars. Haemorrhage continual or in paroxysms : Apoc. can. Intermitting Haemorrhage with uterine cramps, colic and painful distention of the abdomen : China. Oozing of Dark Blood with small coagula for days : Ustilago. Painless Haemorrhage : Bov., Calc. carb., Ha- mam., Magn. carb. AN OBSTETRIC MENTOR. ■ 1 39 Passive Haemorrhage : Alectris, Cauloph., Carbo veg., Croc, Hamam., Plumb., Secale, Ustilago. Paroxysmal Haemorrhage, brought on by the slightest motion : Sabina. Periodical Haemorrhage : Arg. nit., Ipec. Profuse Haemorrhage : Apis, Bell., Bry., Calc. card., Cauloph., Cham., Cinnam., Eriger., Hamam., Helon., Kreas., Millef., Nux v., Sabina, Secale. Profuse Haemorrhage, long lasting : Phosph. Profuse Haemorrhage between the after pains : Bell. Profuse Continuous Haemorrhage : Ipec. Profuse Dark Haemorrhage : Sepia. Profuse Dark Clotted Haemorrhage : Trillium. * Profuse Haemorrhage during abortion : Arn., Cham., Ipec., Pals., Sepia, Sabina, Secale, Viburn. Profuse Haemorrhage in gushes : Hamam., L Ipec, Viburn. Profuse Haemorrhage, in gushes at every effort to vomit ; gasping for breath ; faintness : Ipec. Profuse Haemorrhage of bright red blood, at the least motion : Trillium. Profuse sudden Haemorrhage : Cinnam. Profuse Haemorrhage, thin, partly black, coagu- lated : Ferrum. Profuse Haemorrhage of equal parts, clotted^or fluid, dark or bright : Sabina. Profuse Haemorrhage with easy bearing down pain : Cyclam. f Scanty Haemorrhage : Cocc, Nux. v. Haemorrhage Worse from Motion : Arg. nit., Calc. carb., Coff., Croc, Plumb., Sabin., Secale, Trill. * Compare " Abortion," page 119. f Compare " Pain Predominating," under Abortion. 140 AN OBSTETRIC MENTOR. Haemorrhage worse from the least motion, but better from walking : Sabina. Haemorrhage worse from the least jar : Bell. Haemorrhage worse from mental excitement : Calc. carb. Haemorrhage worse when vomiting or trying to do so : Ipec. Black Blood : China, Elaps, Kreas. Black Clotted Blood (See also Clots) : Arundo m., Cham., China, Croc, Ferr., Lye, Puis. Sabina. Black Liquid Blood : Secale. Black Stringy Blood : Crocus. Bright Red Blood : Arn., Bell., Calc. carb., Cinnam., Diadema, Erecthilis, Hamam., Hyosc, Ipec, Lye, Millef., Rhus tox., Sabina. Bright Red Consta nt Flux : Hyosc, Ipec, Mil- lef. Bright Red Hot Flux ; Bell. Bright Red Lumpy Flux : Am., Ustilago. Bright Red Lumpy Flux, in paroxysms with colic : Bell., Nux v., Rhus tox. Bright Red Partly Clotted Flux : Sabina. Brown Fluid Flux : Apoc can., Secale. Clots : Cham., China, Nux v., Puis., Rhus tox., Stram., Thlapsi bursas., Ustilago. Clots, partly bright red and partly bloody serum ; Lye. Clots, Dark : Cham., China, Ustilago. Clots Dark in paroxysms ; Pulsat. Clots Dark, alternating with bloody serum : Plumb. Clots hard and black, mixed with fluid blood passing away in a dark tarry appearance : Plat- ina. Large Clots : Apoc. can., Stram. AN OBSTETRIC MENTOR. 141 Large Black Clots*. Coff., Secale. Large Clots in bright red blood : Arm, Ustilago. Large Offensive Clots : Bell., Kreas. Large Clots with violent pains ; increased by motion : Arg. nitr. Large Clots mixed with pale watery blood : China. Dark Haemorrhage : Ars., Bry., Canth., Coccul., Haraam., Kreas., Nitr. ac, Plumb., Secale. Dark Fluid Haemorrhage : Bry., Plat., Secale. Dark Haemorrhage, with blackish clots in thin watery blood : Sabina. Dark Painless Haemorrhage immediately after delivery : Nuxmosch, Plat. Dark Haemorrhage, profuse at first, then for a few days bloody ichor with pungent odor, and cor- rosive itching and smarting of the parts : Kreas. Dark Thick Haemorrhage : Nux mosch., Plat. Dark Clotted Profuse Haemorrhage for days : Trill. Pale Haemorrhage : Carbo veg., Hyosc, Merc. v., Sabina. Pale Haemorrhage, Clotted or very thin, offens- ive ; aggravated by motion ; after miscarriage : Sabina. Pale Watery Haemorrhage with coagula : China. Pale Watery Haemorrhage with pale lips and face : Ferr. Pale Watery Haemorrhage, more and more watery : Prunus spin. Stringy Viscid Haemorrhage, Dark or Black : Crocus. Thick Black not Coagulated Haemorrhage : Platina. Foetid Haemorrhage : Crocus, Secale,Terebinth., Trill. 142 AN OBSTETRIC MENTOR. Offensive Haemorrhage : Bell., Cham., Croc, Kreas., Sabina, Secale. Pungent Haemorrhage : Kreas. Putrid Haemorrhage : Cham. Haemorrhage after Falls, Shocks, Concussion : Arn. Haemorrhage after Abortion : Bell., Cham., China, Cinnam., Croc, Eriger., Ferr., Hyosc, Ipec, Kali carb., Lye, Nitr. ac, Plat., Sabina, Secale, Silic, Symph., Thlapsi bursae. Haemorrhage after a Dose of Chamomile : China, Ignat. Haemorrhage after Abuse of Drugs and Coffee : Nux v. Haemorrhage after a Dose of Quinine : Ferr., Ipec, Nux v., Puis. Haemorrhage after Anger : Cha?n., Staph., (dur- ing pregnancy Kali carb.). Haemorrhage after Dancing or Walking, with or without pain : Crocus. Haemorrhage after a False Step, Lifting, or strain in loins : Cinnam., Croc, Rhus tox. Haemorrhage after Coition : Arnica. Haemorrhage after Every Stool : Iodine. Haemorrhage after Fright : Aeon., Bell., Nux. v. (during pregnancy Secale). Haemorrhage after Great Exertion : (mental, Plat.) Millef., Nux v. Haemorrhage after Labor (natural especially) : A?-n., Acetic ac, Bell., Bry., Cauloph., Cham., China, Croc, Erigeron, Ferr., Hamam., Hyosc, Ipec., Kali carb., Kreas., Lach., Millef., Nitr. ac, Nux v., Plat., Sabina, Secale, Senec, Trill., Ustilago. Haemorrhage after Labor, Days and Weeks : Kali carb. AN OBSTETRIC MENTOR. 143 Haemorrhage after Labor, Difficult : Phos. Haemorrhage after Hasty Labors : Cauloph. Haemorrhage after Leucorrhcea : Magn. mur., .Sabina. Haemorrhage after Mental Excitement and De- pression : Ignat., Nux v. Haemorrhage after Motion (the least) : Crocus. Haemorrhage from Loss of Fluids : China. Haemorrhage from Overheating : Croc, Nitr. ac. Haemorrhage after Removal of the Placenta : Ipec. Haemorrhage from the Least Cause : Ambr., Sepia. Haemorrhage During Labor : Bell., Cham., China., Cinnam., Ferr., Hyosc, Ipec, Lye, Plat., Sabina, Secale. Haemorrhage During Pregnancy (without abort- ion) : Cocc, Phos., Plat., Rhus tox. Haemorrhage at Fifth and Seventh Month : Sepia. Haemorrhage at Third Month : Kali carb., Kreas., Sabina. Haemorrhage in First Month, from overheating, while cooking, etc.: Crocus. Haemorrhage from Uterine Atony, after Pro- tracted Labor : Secale. Haemorrhage from Uterine Atony and general debility : Cauloph., China. Haemorrhage from Constipation, high living, in- toxicants, etc.: Nux v. Haemorrhage while Nursing the Child : Silic. Haemorrhage from Retained Placenta or Coa- gula : Pulsat. Haemorrhage from Retained Placenta with De- lirium, loquacity, etc. : Secale, Stram. 144 AN OBSTETRIC MENTOR. Haemorrhage from Retained Placenta ; profuse hot haemorrhage, speedily coagulating : Bell. Aconitum : Active haemorrhage with fear of death, moving, turning, or of something to happen. Vertigo. Can't sit up in bed or rise. Excitement. Plethoric, dark-hatred young women. Ac tea : Profuse dark coagulated flux with spasmodic heavy pressing down pains. Nerv- ousness, hysterical spasms, and chorceic motions. Rheumatic diathesis. > Alectris : Feeble women of lax fibre and anae- mia. Antimonium crud.: Uterine haemorrhage with distinct pressure in the womb, as if something would come out. White tongue : nausea and vomiting. Apis : Profuse flowing with heaviness in the ab- domen, faintness, uneasiness, yawning. Red spots like bee stings on the skin and stinging sensation in the ovarian region and elsewhere. Apocynum cann.: Uterine haemorrhage with great irritability of the stomach. Flux with large clots and shreds. Urinary and dropsical complica- tions. Fainting. Argent, nitr.: Confusion and pain in head, ag- gravated by the least movement. A short time seems very long to her : every thing done seems done so slowly. Belching wind relieves her dis- tresses. Arnica : After a full shock, or concussion, or fatigue. Constant bright red or clotted flux, with or without pain. Nausea at pit of stomach. Head hot and extremities cool. She feels sore as if bruised in the uterine region. Arsenicum : Lancinating burning pains : low states of the system when aphthae appear. AN OBSTETRIC MENTOR. I45 Belladonna : profuse discharge of bright red hot blood with downward pressure, as if all would escape from the vulva and pain in the back as if it would break : blood coagulates easily and is sometimes offensive ; flowing between the after- pains. Hot red face and head, congested face and eyes and head. Worse from light, noise, motion, the least jar. Very frequently indicated after labor. Bryonia : Dark red hemorrhage with pain in the back and splitting headache. Dry mouth and lips ; thirst. Nausea and faintness on sitting up in bed, or even raising the head from the pillow. Calcarea carb.: Leucophlegmatic, plethoric women with light hair, who have usually menstruat- ed too often, too much and too long. Cold damp feet. Vertigo on stooping, worse when rising again or going upstairs. Cantharis : Uterine haemorrhage with great irritation of the neck of the bladder : cutting,, burning pains during the frequent efforts at mic- turition which only discharge a few drops. Carbo veg. : Passive haemorrhage : she is al- ready cold and deathly pale : excessive prostration and burning pain across the sacrum : itching of the vulva and anus. Caulophyllum : Uterine debility : profuse haemorrhage from a relaxed or feebly contracting womb after a hasty labor : passive oozing haemor- rhage. Chamomilla : Great irascibility or spiteful irritability. Flow dark, coagulated, black or foetid, lumpy, with frequent discharge of colorless urine,, tearing pains in legs and violent labor pains : flow- ing by fits and starts at irregular intervals. China : Haemorrhage, from uterine atony, and 146 AN OBSTETRIC MENTOR. from abuse of Chamomile. Dark clots. Uterine spasms. Desperate cases after loss of vital fluids : skin cold and blue, twitching of muscles, heaviness in head and ringing in ears, vertigo, sight lost, fainting, pulse gone : China will sometimes save even such. Cinnamonum : Bright red flow after a misstep, strain in the loins, or some other exertion. (Com- pare Arm, Croc, and Rhus tox.) Crocus : Dark, stringy haemorrhage in dark or black strings after walking or dancing, with or with- out pain. Sensation of rolling and bounding in the abdomen. Very often the remedy in post-partum haemorrhage. Erigeron : Profuse bright red haemorrhage, alarmingly increased by every movement, with irri- tation of the bladder and rectum. Ferrum : Haemorrhage with fiery red face and hard full pulse. Flow partly fluid and partly black clotted, with violent labor-like pains, headache, vertigo, constipation, hot urine, and great weak- ness. Hamamelis : Passive haemorrhage with anaemia ; steady, slow, dark, painless flow. Hyoscyamus : Haemorrhage with general spasms of the whole body, interrupted by jerks or twitch- ing of single limbs. Bright red continuous flowing. Delirium, or even mania. Ignatia : Haemorrhage from abuse of Chamo- mile : great despondency, sighing, sobbing, etc. Iodine : Haemorrhage with every stool, cutting in abdomen, and pains in loins and small of back. Ipecacuanha : Constant, profuse bright red flow, or flowing in gushes ; with incessant nausea and vomiting, and cutting pain about the umbilicus. AN OBSTETRIC MENTOR. 147 She is cold and pale, faint, gasping for breath. Haemorrhages after the abuse of Cinchona. One of our best helpers after expulsion of the child or removal of placenta. Kali Carb. : Haemorrhage with stitching pains. •Guernsey says : " One of the best remedies for post- partum haemorrhages." Lachesis : Paroxysms of pain in right ovarian region, relieved by a gush of blood. Lycopodium : Profuse, protracted flowing, partly black, clotted, partly bright red or serum, with labor-like pains until she faints. Millefolium : Profuse, sudden, bright red fluid. Haemorrhage after great exertion, especially in women phthisical or subject to haemoptysis. Lilienthal advises "in alternation with China." A very valuable remedy, to be studied with Bell., Cinnamon., Ipec, Sabina and Trillium. Nitric acid : Haemorrhage with violent pressure, as if everything were coming out at the vulva, with pain in small of back, through the hips and down the thighs. Nux mosch. : Dark, thick, long continued hemor- rhage (especially after abortion), with dry mouth and tongue, fainting, sleeplessness and hysterical symptoms. Nux vomica : Haemorrhage with large, difficult stools, or frequent call to stool with small, painful stools or without result. Phosphorus : Haemorrhage after difficult labor, in tall, slim, phthisical women with black hair. Constipation. Platina : Haemorrhage of dark, thick blood, with pain in back extending into both groins, and ■excessive sensibilities of the genitals. Black clots or 14^ AN OBSTETRIC MENTOR. fluids, or one thick, black, tarry mass. Sensation (with flowing) as if the body were growing larger in every direction. Pulsatilla : Intermittent black haemorrhage with clots, alternating with labor pains. Mild, gentle, weeping women, who want the doors and windows open so as to have plenty of fresh air. Rhus tox. : Haemorrhage after a strain or wrench, in rheumatic subjects. Sabina : Dark red haemorrhage, with dark clots in thin watery blood. Lilienthal says "most fre- quently bright red." Painless dark haemorrhage after delivery. Forcing down pain from sacrum to- pubes. The least movement increases the flow, but walking diminishes it. " Sabina is used next in frequency to Ipecac." (Guernsey). Secale : * Passive haemorrhage of dark, foetid, thin blood, in feeble cachectic women, who have borne many children ; with strong very painful bearing down pains (after pains). Desire for air, does not want to be covered although the body is- cold. Haemorrhage from uterine atony especially after protracted labor. Sepia : Plethora, or congestion with a sensation of weight. Pain in right groin ; fine darting pains in neck of uterus from below upwards ; feels better from drawing up the limbs. Yellow spots on face. Icy cold paroxysms, and flushes of heat ; cold feet. Painful "goneness" at pit of stomach. Urine foetid and has sediment as if clay were burned on bottom of the vessel. Constipation. Stramonium : Threatened puerperal fever ; de- lirium (with haemorrhage), excessive loquacity, * We have repeatedly verified these indications with Secale low. AN OBSTETRIC MENTOR. 149 singing and praying. Full of strange absurd ideas. Thinks she sees rats, mice, vermin, snakes, etc., and looks under the bed for them. Drawing pains in. the limbs. Sulphur : Chronic haemorrhage ; she seems almost well and is then worse ; so on for days and weeks. Weakness, fainting, unseasonable hunger, flushes of heat ; heat on top of the head ; cold feet, etc. Sulphur, acid : Tremulous sensation all over without trembling, with passive haemorrhage. Trillium : Active haemorrhage of thick, dark, dotted blood (or rarely bright red flowing), after confinement or abortion. Great prostration. Women who habitually flow profusely after parturition. A very frequently useful remedy. Ustilago : Chronic passive haemorrhages. Slow persistent oozing of dark blood, with small black clots ; dark semi-fluid but not watery blood. Uter- ine inertia. Haemorrhages, whether before or after delivery, often tax the courage and skill of the attendant to the utmost ; but a calm, common sense treatment of each case, and a resolute dependence upon the similimum, will carry patient and doctor safely through what might be a most alarming experience should the accoucheur allow himself to be stam- peded. We have never lost a case from such a cause after several hundred confinements, although we have been witnesses of terrific and terrifying haemorrhages arrested by the indicated remedy in various potencies. In a desperate and apparently uncontrollable flooding, however, we should use hot water and plenty of it in a continuous stream against the os uteri. Where vital forces have 150 AN OBSTETRIC MENTOR. seemed exhausted we have used stimulants until the remedy (often China or Carbo veg.) could effect reaction. Several women, faint, pale, cold, pulse- less, breathless and all but lifeless, we have seen revive after bathing the face freely with brandy and placing a drop or two upon the tongue. But this ■ is purely temporary : do not depend upon stimu- lants long or you will lose your case. CHAPTER VIII. Fainting and Exhaustion. Puerperal Con- vulsions. Fainting During or After Labor, i. Aeon., Arn. r Ars., Carbo. veg., Cham., China, Coif., Digit., Nux v., Ign., Sep., Stram., Verat. alb. 2. Bry., Camph,, Cocc., Ign., Lach., Rhus tox. Aconite : Violent palpitation of the heart. Con- gestion of the blood to the head ; buzzing in the ears ; pale face on raising up : after a fright. Arnica : From injuries, fatigue or stitches about the heart. Head hot and body cool. Arsenicum : Debility or prostration when the least effort causes fainting : thirst for frequent sips of cold water : wishes to be wrapped up warmly ; pale bloating of face. Bryonia : Fainting fits from the least motion, even when no effort is required : sighing respira- tion : thirst for cold water in large quantities. Camphor : Marble-like coldness in the whole body : very weak pulse. Some prefer the mono- bromide, where nervous symptoms predominate. Carbo veg. : Fainting from weakness, caused by loss of animal fluids ; after sleeping ; after rising in the morning ; much belching of wind or eructation. Flatulent gastric dyspepsia. Chamomilla : Spiteful irritability ; very sensitive to the pains, which cause fainting with vertigo, 152 AN OBSTETRIC MENTOR. dimness of vision, dulness of hearing and nausea ; must have fresh air and water. China : After loss of blood particularly, or other animal fluids : ringing in the ears, cold skin, loss of pulse, and cold sweat. Cocculus : Paralyzed feeling in the limbs with trembling ; paralytic weakness, particularly in the lower extremities ; spasmodic pains in the uterus, with nausea and vomiting. Coffee : Highly sensitive persons, after a fright, if Aconite fails. Digitalis : Pulse very slow, thin and irregular, cold sweat and death-like countenance. Ignatia : From grief ; much trembling, sighing and sobbing. Lachesis : Great and almost unconquerable sad- ness and gloom ; dreads society and company ; great and persistent constipation with sensation as if the anus were closed. Nux vomica : After indulgences at table ; after vomiting, after stool, after every labor pain ; with congestion of the blood to the head or chest, with trembling. Rhus tox.: Retention of urine ; a full bladder but no uneasiness or desire to urinate ; restlessness, especially after midnight ; left sided complaints. Sepia : Feet and hands very cold ; flushes of heat ; a distressed empty feeling in pit of stomach. Stramonium : Fainting spells every day several times a day ; she suddenly falls with pale face and almost imperceptible breathing ; face bloated ; very long continued faints. Veratrum alb.: Fainting from the slightest ex- ertion; turning in bed; straining at stool; retching as if to vomit,*etc.; cold sweat on forehead. AN OBSTETRIC MENTOR. 153 For exhaustion compare : Ars., Cocc, Carb., China, Ferr., Iod., Kali carb., Lye,, Mur. ac, Nux v., Rhus tox., Sepia, Stram., Sulph., Verat. alb. Arsenicum : A sense of great exhaustion after every effort however small ; chilly, wants to be warmly wrapped up ; cold water is craved but dis- agrees ; very pale skin ; may be bloated ; great restlessness after midnight. Calcarea carb.: Leuco-phlegmatic women; much perspiration about the head and upper part of body ; every exertion is fatiguing ; going upstairs causes vertigo ; cold, damp, clammy feet ; the least cold air is unendurable. China : After haemorrhage or other loss of ani- mal fluids ; compare China, preceding section. Ferrum : Frequent attacks of tremor, alternat- ing wjth a sensation of weakness as if very weary ; trembling of the whole body ; feeling very weak, even from talking ; wishes to lie down, face and lips very pale, or cheeks fiery red. Iodine : Pulsation in all the arteries at every muscular effort ; great prostration of strength, so that even talking causes perspiration ; the sensibil- ity of the nervous system is greatly increased. Kali carb.: She feels the pulsation of all the arteries even down to her toes ; feeling of empti- ness in the whole body as if it were hollow ; the whole body feels heavy and broken down, so that it is only by the greatest effort she can make any exertion. Lycopodium : While lying in bed she feels as if she would die from weakness ; the lower jaw drops, not being able to keep the mouth shut ; slow breathing through the mouth ; eyes half open ; when walking she is obliged to let her hands hang 154 AN OBSTETRIC MENTOR. down and the bones of her lower extremities are painful ; sudden weakness even while sitting ; red sand in urine ; intestinal flatulence (Carbo v. gastric flatulence). Muriatic acid : Great debility with haemor- rhoids, so painful that they can hardly be touched and often bleed ; so weak that she cannot keep up on a pillow but constantly slides down in the bed. Nux vomica : Debility from abuse of coffee, wines, spirituous liquors, or narcotics, or highly seasoned food ; night watching ; cannot walk on account of giving out of the lower extremities ; knees knock together ; wants to lie down all the time ; cannot sleep after three o'clock in the morning ; great sensitiveness to external impressions, noise, talking, strong scents and odors, or bright light ; blue margin around the eyes ; nose looks more pointed and sharp than usual ; face shrunken. Rhus tox. : Restlessness relieved for a short time by change of position ; loss of appetite ; cold water disagrees ; compare Rhus, preceding section. Sepia : Urine deposits a very hard crusty sedi- ment ; anorexia ; compare Sepia, preceding section. Stannum : Great weakness in larynx and chest, thence all over the body, from talking or reading aloud ; worse after twelve o'clock, noon. Sulphur : Frequent weak faint spells, especially from eleven to twelve every morning; flushes of heat, cold feet ; heat on top of head. Veratrum alb.: Excessive weakness : is obliged to move very slowly : she can hardly raise her hand and every motion seems to increase the debil- ity ; weak almost imperceptible pulse and thirst for icy cold water ; compare Veratrum, preceding section. an obstetric mentor. 155 Puerperal Convulsions. 1. Aeon., Actea, Bell., Cupr., Gels., Hydroc. ac, Hyosc.^ Stram., Verat. virid. 2. Arg. nitr., Arn., Bry., Canth., Cauloph., Caust., Cham., China, Cicuta, Cocc, Coff., Glon., Hell., Hydroph., Ign., Ipec., Kali brom., Kali carb., Lach., Merc, s., Nux mosch., Nux v., Opium, Phos., Puis., Secale, Tanac., Verat. alb., Zinc. Aconite : Hot dry skin, thirst, restlessness, fear of death, cerebral congestion ; pri?niparoz with fore- going symptoms and spasmodically contracted (or perhaps rigid) os uteri. Actea : The spasms are preceded by great mental excitement, with visions of objects not pres- ent, and are followed by languor, and relaxation of the whole system. The paroxysms are very violent. Convulsions with spasmodically contracted (or rigid) os uteri. Belladonna : She appears as if stunned ; semi- consciousness and loss of speech ; convulsive move- ment of the limbs and muscles of the face ; paralysis of the right side of the tongue ; difficult deglutition, foam at the mouth ; dilated pupils, red or livid countenance : she may have a pale and cold face with shivering ; fixed or convulsive eyes ; involuntary escape of urine or faeces. Renewal of spasms with every pain ; unconsciousness or more or less tossing between the spasms ; or deep sleep with grimaces, starts, cries and fearful visions ; violent pulsations of the carotids ; jerking and twitching of muscles between the spasms. Bell. is the chief remedy and always first to be considered in puerperal convulsions. 156 AN OBSTETRIC MENTOR. Cuprum met. : Spasms with or preceded by vio- lent vomiting j opisthotonos with every paroxysm, with spreading out of the limbs and opening of the mouth. The spasms begin as cramps in the fingers and toes, or in the whole extremities ; or even in the abdomen. Gelsemium : Head feels large, or she has a stupefying occipito-frontal headache, with great muscular prostration. She feels and looks stupid, face dark red, speech thick, pulse slow and full, symptoms premonitory of convulsions ; albumin- uria ; rigid os uteri with convulsions or preceding them. Compare. This drug probably ranks next to Belladonna in frequency of value. Hydrocyanic acid : She is conscious of a shock passing through her whole body before the spasm. (Compare Helleb.) Hyoscyamus : Bluish face and twitching and jactitation of every muscle of the body, face, eyelids and all. Shrieks, anguish, oppression of the chest, continued delirium or unconsciousness. Stramonium : She appears terrified and shrinks back from every object on opening her eyes ; or she looks under the bed for vermin a?id reptiles which she fancies are there. Sardonic grin ; stam- mering or loss of speech. Puffed up red face ; loss of consciousness and sensibility ; cries and frightful visions ; laughter, singing, efforts to escape; copious perspiration with the spasms, which are caused or renewed by the sight of bright objects and sometimes by contact. Veratrum viride : Full, hard, quick pulse is characteristic of this drug ; cold clammy sweat ; convulsions before, during and after labor, es- pecially where mania remains after the con- AN OBSTETRIC MENTOR. 157 vulsions cease. Furious delirium. Emotional causes. Compare also secondly : Argentum nitricum : She has a presentiment of the coming spasm (an aura epileptica ?) She is in constant motion from the time she comes out of one spasm until she goes into another. The spasms are violent and preceded by a sensation of expansion of the whole body, but especially of the face and head. Arnica : Full strong pulse and during every pain the blood rushes to the head and face ; symp- toms of paralysis of left side (Bell, right) ; loss of consciousness ; involuntary stool and urine ; head hot and body cool. Abdominal tympanitis after labor. Bryonia : After the spasms cease there is full hard pulse, thirst, abdominal tenderness, perspira- tion, and dry parched lips ; she cannot bear to move or be moved. Cantharis : Bright light on objects, and the sight, sound or use of water causes violent spasms ; dysuria. Caulophyllum : Spasms during labor, with very moist genitals and spasmodically contracted os uteri. Causticum : Spasms with screams, gnashing of the teeth and violent movements of the limbs. Chamomilla : Spasms excited by. anger ; one red and one pale cheek. Starts and shocks during sleep. Great impatience and disposition to anger. China : Spasms caused by great loss of blood. Cicuta : Strange contortions of the body and limbs during the paroxysms, with blue face and frequent interruptions of breathing for a few mo- ments. 158 AN OBSTETRIC MENTOR. Cocculus : Spasms following difficult labor, and those developed by changing the patient's position. Coffea : Extreme excitability of the nervous sys- tem and sleeplessness. Spasms, with cold extremities and grinding of the teeth. Glonoine : Spasms, unconsciousness ; face bright red, puffed up ; pulse full and hard ; urine copious and albuminurious ; after protracted and difficult labor. Helleborus : A shock passes through the brain as if by electricity, followed by spasms. Hydrophobin : Spasms excited whenever she attempts to drink water, sees it, or hears it in motion (also Canth.), even though she desires it. Ignatia : Deep sighing and sobbing, with a strange compressed sensation in the brain. The spasms commence and terminate with groaning and stretching of the limbs. Fright with grief the ex- citing cause. Ipecacuanha : Incessant nausea with occasional spasms. Kali bromatum : Advised by Hempel, Hart and others in material doses. Kali carbonica : Spasms relieved or passing off by frequent eructations. Lachesis : Convulsions particularly violent in the lower extremities, with cold feet, stretching backward of the body and crying out. Mercurius sol. : Much salivation and driveling ; convulsions, mostly in the extremities. Nux moschata : Convulsive motion of the head from behind forward. Hysterical women who faint easily ; drowsy before and after the spasms. Nux vomica : Great torpor of intestinal canal ; irritable disposition, etc. AN OBSTETRIC MENTOR. 159 Opium : Sopor with stertorous respiration, which continues from one spasm to another. Incoherent wandering and convulsive rigidity of the body, with red, swollen, hot face. Hot perspiration and insensible pupils. Suppressed labor pains : Opium is one of the chief of the lesser remedies. Phosphorus : Previous to the convulsion a sensa- tion of heat rushes up the back into the head. Pulsatilla : Face cold, pale and clammy. Loss of consciousness and motion ; stertorous breathing and full pulse. Labor pains deficient, irregular and sluggish. Mild and tearful and wants doors and windows open to get fresh air. After labor. Sec ale : Scrawny, illy nourished women with too feeble labor pains ; violent forcing after pains ; opisthotonos. Tanacetum vulgare : When taken to produce abortion often causes convulsions. Veratrum album.: Pallor, collapse, anaemic or violent cerebral congestion with bluish bloated face ; delirium, wild shrieks and tearing of the clothing. Zincum met.: Eruptions have recently disap- peared, even old eruptions ; muscular twitchings ; coma, from cerebral exhaustion, loss of sensation. After failure of the indicated Phosphorus. Puerperal convulsions have been divided into various kinds upon various principles ; but as these distinctions are purely theoretical, sometimes con- fusing, and not always based upon scientific facts, we have ignored them. Do not neglect to see that the bladder and rectum are unloaded and if the woman be " at term " the progress of the labor should be assisted by all means at command, even to the use of instruments if the head descends ^m l6o AN OBSTETRIC MENTOR. slowly. But if the time of pregnancy has not ex- pired, avoid all tampering with the uterus until certain that therapeutic means will fail to save the maternal life, as all such interference tends to in- crease the irritation we seek to allay. Above all let peace and calm quiet endeavor prevail ; no confu- sion in the furniture, action and conversation of the attendants ; let these latter be few and their talk little. Many authorities advise anaesthetics, and some chloral and bromides in material doses. Richardson mentions morphia and atropine in combination one-eighth to one-ninety-sixth of a grain. CHAPTER IX. Retained Placenta. Retention of Urine. After Pains. Lochia. Abdominal Soreness. Umbilical Ulceration. Pendulous Abdo- men. Constipation and Diarrhoza. * For retained placenta : First Pulsatilla is more frequently indicated and generally useful than all others. Uterine inertia, or spasmodic reten- tion ; intermittent flow of blood ; restlessness ; she wants the fresh air admitted and weeps because the labor is not completed. Also: i. Bell., Canth., Sabina. 2. Actea, Cauloph., Gels,, Gossip., Sec, Sepia. Belladonna : Red face and eyes, great distress and moaning : great heat and dryness of the vagina ; profuse flow of hot blood, which speedily coagu- lates : the slightest jar of the bed causes great suffering. Canth aris : Burning pain in the pelvis and back; fever, vomiting, great anguish and distress ; swell-, ing of the lips of the os uteri. Sabina : Intense after pains, notwithstanding the retained placenta, with discharge of fluid blood and clots in equal parts with every pain. Pain, or un- easy bad feeling from sacrum and pubes and a slight sensation as of motion in the abdomen. * Compare Hour-glass Contractions, page 182. 162 AN OBSTETRIC MENTOR. Finally compare : Actea : Rheumatic women ; distressing tearing pain in uterine region ; no uterine action. Caulophyllum : Spasmodic retention. Gelsemium : Retained placenta with cutting pains in the lower abdomen running upward and upward and backward. Gossipium : Retained placenta, especially after abortion or premature labor. Sec ale : Constant sensation of bearing down ; it seems (to her) too constant and strong to be effect- ual ; passive haemorrhage ; the parts seem relaxed and there is an absence of uterine action. Sepia : Little sharp shooting pains in the cervix uteri, sometimes with burning. If the uterus is followed down and contracted by a hand, steadily, gently and firmly pressing down and back during the second stage of labor, retained placentae are rare. Nor do we believe that such cases should be left to nature and the indicated remedy indefinitely ; when the placenta is not re- pelled under influence of the indicated remedy within an hour or so remove it by hand. We practice and advise Crede's Method of expressing the placenta. For retention of urine (after delivery) : i. Ars., Caust., Hyosc. 2. Arn., Bell., Canth., Lye, Nux v., Puis., Secale, Sepia, Stram., Sulph. Arsenicum : No sensation as of desire to urinate, or inconvenience from a long retention : we rely upon this drug and rarely have to employ any other. Causticum : Retention of urine with frequent and urgent tenesmus ; occasionally a few drops pass involuntarily. AN OBSTETRIC MENTOR. 163 Hyoscyamus : Retention of urine with constant pressure in the bladder. Also : Arnica : Retention with urging to urinate and a bruised sore feeling. Belladonna : The urine only passed in drops, without pain. * Cantharis : Great desire to urinate, with cut- ting burning pains in the bladder or urethra. Com- plete retention or very painful drippling of urine. The remedy for painful retention next to Caust. Lycopodium : Retention of urine with violent pain in the back, coming on in paroxysms ; when she can urinate the back is better, but when the flow of urine is checked the backache is worse. Nux vomica : Painful and ineffectual desire to urinate : frequent urging to stool: where Canth. seems indicated and fails, Nux is often successful. Pulsatilla : Retention of urine with heat, red- ness and soreness of the hypogastrium externally, which is painful to the touch. Secale : Dr. Marsden recommends this drug in 10 drop doses of the mother tincture for retention of urine after confinement. It is more applicable to suppression than to retention. Stramonium : Retention (or more probably sup- pression) of urine with a sensation as if the urethra were too narrow. Although she strains violently only a few drops are passed (because the bladder is * There has been a tendency of late years to discard Canth., and use Apis in its stead, a very grave error. Apis and Stram. correspond to suppression of urine and their action refers to the kidney more than the bladder ; while Cantharides pi-oduces (and cures) retention of the already secreted urine, and rarely profoundly affects the kidney. i™ 164 AN OBSTETRIC MENTOR. empty). Or, she passes no urine and suffers no painful sensation. Sepia and Sulphur : Chronic retention of urine after confinement. We cannot endorse the advice given by at least two homoeopathic accoucheurs, that the catheter should be used without any drug trial whatever in every case of retention of urine. We never drew water but for two women after labor, and one had been delivered by another physician with inconceiv- able brutality after a long labor, marked by colossal blunders. For After Pains. 1. Am., Cauloph., Cham., Morph. acet., Secale, Viburn. 2. Actea, Bell., Bry., Coff. } Cupr. acet, Cupr. ars. y Ferr., Gels., Hyosc, Ign., Kali carb., Nux ?;., Puis., Rhustox., Sabina, Sepia, Sulph., Sulph. ac, Xanthox. * Arnica : If this drug is given promptly after the close of labor, after pains may often be entirely averted, or at least held in check. Caulophyllum : Spasmodic pains in the lower abdomen, sometimes extending into the groins ; after protracted and exhausting labors particularly. Chamomilla : Very distressing after pains, she feels that she cannot bear them. She wishes to get away from herself and is ill-natured and irrita- ble. Dark lochia. Thirst. Desire for fresh air. One of our best remedies for this condition. Morphia acet. : This drug is highly recom- mended in the 2X trituration by Dr. Marsden. We have used it empirically many times with fewer * We have frequently had women to whom Arnica was given after labor say to us, " Every time I take that medicine it seems to stop the after pains for a while." AN OBSTETRIC MENTOR. 165 failures than with any drugs excepting Chamomilla and Viburnum. Secalk : Thin, scrawny, elderly women who have borne many children. A prolonged, pressing, forcing, labor-like pain, frequently repeated. Thin brown lochia. Although she feels cold she does not want to be covered. Viburnum opulus : Violent cramp-like after pains. Hysterical nervous women. Also : Actea : Low-spirited, sleepless, restless women, very sensitive to impressions and feels her pains very keenly : (Compare Cham.) Belladonna : Pains come on and go off very suddenly and are severely forcing, as if the contents of the pelvis would be forced through the vulva. She cannot endure noise, light, or a jar of the bed. She complains that the lochia is hot. Bryonia : After pains excited by the least mo- tion, even by taking a deep inspiration ; she wants to lie perfectly quiet. Splitting headache. Dry lips and mouth and throat. Coffea : Sleeplessness. Very distressing pains which she feels acutely. Cuprum acet. : Terrible cramping pains which often produce cramps of the extremities, including the fingers and toes. Cuprum ars. : This drug is highly recom- mended by Dr. Marsden ; it seems to resemble Cupr. acet. and Viburnum. Ferrum : Violent labor-like pains in the loins and abdomen, with discharge of partly fluid and partly clotted blood ; full hard pulse ; frequent short shuddering headache and vertigo. Feeble women with fiery red faces. l66 AN OBSTETRIC MENTOR. Gelsemium : Severe pains running upward and backward ; she seems to have lost control of her muscular movements. Hyoscyamus : Much jerking and twitching of various parts of the body ; she is delirious. The pains are spasmodic. Ignatia : Much sighing, sadness and despond- ency with after pains. Kali carb. : Stitching, shooting pains. Pains in the back shooting down into the gluteal region or hips. Nux vomica : Aching pains. Every pain pro- duces desire to go to stool ; or sensation in the rectum as of something there to be evacuated. Sore feeling in the uterine region, so that she dreads to be moved or disturbed in any way. Irritability. Desire to have the room warm and to be well covered. Pulsatilla : Mild, tearful disposition. The pains become worse toward evening. Thirstlessness. Bad taste in the mouth. She feels uncomfortable if the room is moderately warm and wants the doors and windows open and plenty of fresh air. Rest- lessness. Changeable feeling, now better now worse. Rhus tox. : Pains worse at night with great restlessness ; they last sometimes all night and there is not much pain during the day. Frequent change of position gives temporary relief. Likes a warm room and covering. Sabina : Pains from sacrum to pubes. With every pain discharge of fluid and clotted blood. Pains sometimes from back and sacrum to thighs. Sepia : Constant sensation of weight in the anus ; pain shooting upward in the vagina. Pains AN OBSTETRIC MENTOR. 167 felt mostly in her back ; severe forcing or bearing down occurring in paroxysms in the back. Sulphur : Lochia scanty. She feels badly in the abdomen although the pains are in the uterine region exclusively. Bleeding, itching, sore haemor- rhoids. Flashes of heat ; weak faint spells. Soles of feet either cold or burning hot. Sulphuric acid : Great general weakness. Sense of trembling all over without actual trem- bling. Xanthoxylum : This drug is warmly recom- mended for after pains by Prof. O. B. Gause and others. Spare habit, nervous temperament and delicate organization seem more particularly to call for this drug. Variation of the Lochia. Lochia, Acrid : Bapt., Carbol. ac. Lochia, Acrid, Watery : Con. Lochia, Aggravated by the least jar : Bell. Lochia, Aggravated by the least Motion : Bry. Lochia, Reproduced by Motion and Relieved by Rest : Eriger. Lochia, Aggravated by Eating and Drinking : Colocynth. • Lochia, Aggravated by a Warm Room : Puis. Lochia, aggravated when Child nurses : Ferr., Phelland., Silic. Lochia, Aggravated at night with Inflammation of the genitals : Merc. s. Lochia, Black, (Clotted) : Bell., Kreas., Plat., Crocus. Lochia, Brown : Carbo. veg., Secale. Lochia, Cadaverous : Stram. Lochia, Cheesy : China. l68 AN OBSTETRIC MENTOR. Lochia, Corroding : Bell., Carbo. an., Kreas., Lilium, Sepia, Sil. Lochia, Causing Debility : Rhus tox., Sulph. ac, Trill. Lochia, Dark : Cham., Secale. Lochia, Dark and Stringy : Crocus. (Pus-like or mucous strings) Kali b. Lochia, Foetid : Bapt., Carbol. ac, China, Lach., Secale, Sepia. Lochia, Hot : Bell. Lochia, Ichorous : Rhus tox. Lochia, Intermittent : Kreas., Plat. Lochia, Milk-like : Calc. carb., Puis. Lochia, Offensive : Aeon., Bell., Carb. an., Carbo. veg., Kreas., Nux v., Rhus tox., Secale, Sepia. Lochia, Pale at first, then bloody : Calc. carb. Lochia, Profuse : Aeon., Bry., Carbol. ac, China, Corf., Con., Eriger., Hep., Millef., Plat., Rhus' tox. Secale, Trill., Ustil. Lochia, Profuse and Too Long : Asar., Bry. Calc. carb., Croc, Eriger., Hep., Plat., Puis Rhus tox., Secale, Senec, Trill., Ustil. Lochia, Profuse, Too Long and Corrosive : Lilium. Lochia, Profuse, In gushes : Plat. Lochia, Too Long : Aur. met., Carb. an., China, Merc, s., Nux mos., Rhus tox. Lochia, Too long : Thin, offensive, excoriating : Bell. Lochia, Too Long in habitually profuse menstrua- tors : Calc. carb. Lochia, Too Long, oozing passively : Cauloph., Ustil. Lochia, Too Long, Bloody : Cauloph. AN OBSTETRIC MENTOR. 169 Lochia, Purulent : Calc. carb., China, Merc, s., Sepia. Lochia, Red : Calc. carb., Cauloph., (Bry. bright. Aeon. deep). Lochia, Scanty : Aeon., Secale, Strain., Sulph. Lochia, Scanty and Offensive in high livers : Nux v. Lochia, Scanty and Milky : Puis. Lochia, Scanty, Too Long, black and clotted : Plat. Lochia, Suppressed : Aeon., Aetea, Alect., Ars., Bapt, Bell., Cauloph., China, Coloeynth, Hedeoma, Hyosc., Millef., Nux v., Plat., Puis., Secale, Stram., Tereb., Verat. alb., Verat. virid., Zinc. Lochia, Suppressed, followed by diarrhoea, colic, toothache, etc.: Cham. Lochia, Suppressed from anger : Coloeynth. Lochia, Suppressed, from cold (and damp, Dulc): Aeon., Actea, Verat. virid. Lochia, Suppressed, from fright (or grief, Ignat.): Opium. Lochia, Suppressed, with child-bed fever (or threatened): Aeon., Secale, Stram., Verat. virid. Lochia, Suppressed, with spurious peritonitis : Verat. virid. Lochia, Suppressed, with splitting headache : Bry. Lochia, Suppressed, with colic, tympanites and diarrhoea : Coloeynth. Lochia, Ceasing almost, only to return and so alternates : Kreas. Lochia; Thin : Bell., Carbo. an., Lach., Rhus tox., Secale. Lochia, Viscid : Crocus. Lochia, White : Puis., Sepia, Sulph. 170 AN OBSTETRIC MENTOR. Aconitum : Lochia, suppressed (or too scanty) with distress iu abdomen, chest, and head, from local congestion (compare Verat. virid). Fever, thirst, restlessness, fearfulness. Sharp cutting pains in the tender abdomen. Arsenicum : Offensive acrid watery lochia, with fever, prostration, restlessness, thirst and threaten- ing toxaemia. * Baptisia : Very offensive and acrid lochia with debility, prostration and delirium. Belladonna : Offensive hot lochia. Flushed face and injected eyeballs ; delirium and frightful visions. Pain in the uterine region coming and going suddenly. Drowsiness, or she is half awake and half asleep ; or she does not sleep sound and is not refreshed by her sleep. Very sensitive to even a jar of the bed ; great tenderness of the abdomen. Bryonia : Suppression of the lochia with sensa- tion as if the head would burst. The least motion aggravates her suffering. Dry mouth and lips. Profuse lochia with burning pains in uterine region. Thirst for large draughts at a time. Calcarea carb.: Lochia lasts too long in women who habitually menstruate too profusely ; milky lochia. Caulophyllum : Lochia lasts too long and is too long bloody, oozing passively from relaxed uterine vessels ; great exhaustion. f Chamomilla : Suppression of lochia followed * In threatening puerperal toxaemia or fever it may be dif- ficult to differentiate between Ars. and Bapt. As a generality it may be said, Ars. has more restlessness; while Bapt. has more delirium. f Both Chamomilla and Coffea are drugs more useful in and above the 30th dilution than in any lower potency. AN OBSTETRIC MENTOR. 171 by colic, diarrhoea, and headache ; irritable and im- patient ; thirst ; redness of one cheek while the other is pale. Coffea : Profuse lochia with exalted nervous sensibility and great wakefulness. Colocynthus : Suppression of lochia with vio- lent colic, or from anger ; tympanitic abdomen and diarrhoea. Aggravation after eating and drinking ; great restlessness. Carbo animalis : Lochia too long ; thin, offens- ive, excoriating discharge with numbness of the limbs. Crocus : Lochial discharge in dark strings ; sensation of motion in the much distended ab- domen. Dulcamara : Lochia suppressed by cold or damp, and the milk greatly diminished. Erigeron : The least motion excites a return of the bloody lochia, which is relieved by rest. Hyoscyamus : Delirious jerking of the muscles. She says she is being drugged or poisoned, very suspicious. Ignatia : After abuse of Chamomile tea ; if produced by fright or grief with sighing and sob- bing. Kreasote : Very offensive, excoriating lochia. The discharge almost ceases, when it becomes much more profuse and again almost disappears and anon returns, etc. Merc, sol.: Discharge worse at night with some swelling and inflammation of the genitals. Groins sore and swollen. Nux vomica : Scanty and offensive lochia in women accustomed to high living. Frequent calls to stool and to urinate, with scalding urine ; soreness. 172 AN OBSTETRIC MENTOR. in uterine region : she does not wish to move or be disturbed ; wants to be warm. Opium : Lochia suppressed from a fright, with sopor. Platina : A little black clotted discharge re- mains a long time ; genitals very tender ; she can- not endure the usual napkins ; intermittent dis- charge in gushes ; very changeable sensations ; can- not bear a warm room. Pulsatilla : The milk has suddenly dried up ; the lochia scanty and* milky ; feverish but no thirst. Rhus tox.: Lochia lasts too long and is thin and ichorous, and offensive as it becomes occasionally b>loody. She is well nigh exhausted ; shooting pains up the rectum ; restless at night, must change position often and finds relief by it. Secale : Offensive, thin, scanty or profuse very dark lochia in thin scrawny women, or those who have many children ; painless discharge or (more often) ; prolonged bearing dow7i pains, very severe and often recurring. Sepia : Foetid odor ; characteristic excoriating lochia with little sharp pains in the uterine neck ; distressing bearing down in the back. Silicea : Pure blood flows every time the child nurses ; after pains in the hips ; sometimes excori- ating discharge. Stramonium : Mind full of strange absurd but strongly marked ideas ; thinks she sees rats and mice under the bed and looks to find them ; lochia having a cadaverous odor. Sulphur : The discharge causes a sensation of weakness, and she has hot flushes ; perspiration ; heat of the soles of the feet (or her feet are cold all the time) ; sore bleeding itching piles. '; an obstetric mentor. 1 73 Abdominal Soreness. For this distressing and sometimes alarming sequela of labor use Hamamelis internally and locally in hot water. Compare also : Arm, Colocynth., Con., Mur ac, Plumb., Rhus tox., Ruta, Sulph. * For Cracks on the Abdominal Surface : Hep., Sepia, Sil., Sulph. For Umbilical Ulceration : i. Ars. 2. Apis, Lach., Lye, Sep., Sil., Sulph. For Pendulous Abdomen : 1. Bell., Croc, Plat., Podoph., Sepia, Secale. 2. Calc. carb., China, Col- ocynth., Kali carb., Nux v., Viburn. op. Alvine Discharges. For treatment of the usual constipation or the more rare diarrhoea of lying-in women, compare what has been said under these headings in our first chapter, bearing the following in mind. For Constipation {after confinement) : 1. ALs- cul., Podoph., Phyt. 2. Nux v., Opium, Sulph. For Diarrhoea [after confinement) : 1. Hyosc, Rheum., Secale. 2. Ant. crud., Dulc, Phos. ac, Puis. * Compare same rubric, page. CHAPTER X. Puerperal Fever and Spurious Peritonitis. Puerperal Insanity, Milk Leg. Pelvic Cellulitis. For Puerperal Metritis : i. Aeon., Apis., Verat., vir. 2. Arn., Bell., (Calend. when extensive lacera- tions cause a primary inflammation) Iod., Merc, s., Puis., Nux v., Stram., Terebinth. Puerperal Peritonitis : i. Aeon., Apis, Cham., Coloc, Puis., Terebinth., Verat. vir. 2. Bell., Bry., Merc, s., Nux v., Rhus tox. Uterine Putrescence : 1. Bapt., Carbo. veg., Secale. 2. Ars., Carbol. ac, Kreas., Salicylic ac, Sulph., Ustil. Puerperal Typhoid : 1. Ars., Bapt., Bry., Chin, ars., Mur. ac, Phos. ac, Rhus tox., Terebinth. 2. Arn., Bell., China, Stram. Puerperal Ovaritis : 1. Apis, Bell., Lach., Merc sol., Podoph. 2. Con., Plat., Puis., Sabina. Partiadar Indications : Aconitum : General inflammatory action with shiverings, * rigors, chattering teeth, and tenderness of the whole abdomen ; followed by intense and continued heat, thirst, short breathing ; headaches * Dr. Eaton thinks Arsen. should be given during the rigors and Aeon, exhibited only when the reaction is established, as shown by fever, thirst, etc. AN OBSTETRIC MENTOR. 1 75 all over, with swimming sensation, forcing her to turn to the right ; she feels as though the bed were turning around, and inclines to lie on the right side. She speaks and acts horridly, and is peevish, fretful, apprehensive, vigilant and anxious. Loathing of food, and the odor from it often nauseates her. Pulse hard and quick. Flying, stitching, sharp, cut- ting, burning pains here and there all over the bowels with occasional flatulency ; urinates often with shud- derings. Thin watery painful diarrhoea ; lochia suppressed, mammae lax and empty. Says Dr. O. P. Baehr, " Aco?iite cannot be too highly praised for puerperal fever where no appearance exists of mechanical injuries," and the above symptoms su- pervene. Apis : Restlessness from a fine rough, red, sting- ing rash ; breathing hurried and difficult, feeling as though she could not breathe ; excited and anx- ious ; wants to get up every few moments, and then drops back again ; is uneasy and fears death ; seems disposed to scold, but gets confused ; com- plains that she cannot collect her ideas ; head feels stupid ; dull stinging burning pain in the abdomen with rumbling and uneasy distention, accompanied by a feeling as of approaching diarrhoea ; bearing down feeling with heat and dry burning of vagina ; suppression of lochia. Downward pressure from the abdomen upon uterus and ovaries with moaning and muttering ; hysterical laughing and crying. Arnica : Particularly in primiparae who have suffered dystocia, bruises, retained placenta (or placental shreds), and have foul odorous lochia. Mostly cases from the first to fifth day. Severe chill throughout the whole body, hands and feet cold, head and face hot ; no thirst ; yawning and I 76 AN OBSTETRIC MENTOR? sleepless until after midnight, yawning and nausea and bruised feeling, itching and tingling down the back and lower limbs, with shiverings in streaks down the back and thighs, fever after a long chill, lasting until late in the evening, with sour sweats towards morning ; tongue rough and heavily coat- ed ; ropy saliva and sour breath ; frequent flushes of heat to chest and face, with anguish and oppress- ed breathing and abdominal soreness ; sudden starts in sleep as if frightened, sleep restless and full of dreams, waking up tired and tremulous ; dizzy on raising the head, flashes of heat from the uterus through the abdomen to the stomach, creating nausea and even vomiting. Abdomen tympanitic. Arsenicum alb.: Burning, throbbing, lancinat- ing pains in the abdomen. Great restlessness, want of sleep, anguish with fear of death, and sudden ex- treme prostration ; sunken countenance, sallow or livid complexion. Burning heat, and thirst ; dry parched lips ; vesicles on the lips and face ; nausea and vomiting, dizziness, headache, delirium ; small, feeble, intermittent pulse. Dr. Eaton recommends the iodide of arsenic. Baptisia : Puerperal fever or septicaemia from absorption of purulent matters, with typhoid symp- toms : foztid lochia, with much prostration. Abdo- men distended, fullness, flatulence, and rumbling ; feels as if vomiting would relieve ; sharp shooting pains in the bowels, urine scanty and dark red ; op- pressed breathing ; delirium. Belladonna : Fever marked by frequent alter- nations of chill, heat, and perspiration ; or fre- quently the patient will be chilly for some time over the chest, shoulders, back and limbs ; then hot ; then chilly again. Sharp, quick, electric- AN OBSTETRIC MENTOR. I 77 like intermittent pains, bearing down with an invol- untary straining force ; she says, "I can't help it." Sensitive to light, noise, motion, jarring the bed or walking heavily disturbs her very much. Delirious, furious, nervously excited, mind wanders, urine and milk diminished ; urine passed involuntarily and offensive. After fright, mortification, chagrin, cold and hard labor. She draws up her limbs every few- moments to relieve the abdominal tension. Fleshy women, angular in their motions, language and thoughts. Abdomen distended. Headache and red face. Difficult deglutition. Sleeplessness. Lochia (suppressed) or scanty, watery, slimy ana offensive. Breasts swollen and inflamed ; or flaccid and empty. Constipation or slimy diarrhoea. Lili- enthal says, "If Bell, be insufficient try Hyosc." Bryonia : High fever, nearly or quite equal over the whole body, with great thirst ; sensitive to mo- tion, often screaming when moved from side to side ; irritable, irascible and moodish ; stitching, burning pains in the abdomen, particularly on pressure ; cough, splitting headache and red cheeks. Lochia suppressed. Perspiration in short spells on single parts of the body. Constipation. Calendula : After instrmnental labors, when the cervix uteri or perineum are lacerated. Where the vulva has been long distended and the parts are tumefied and lacerated. Chill without thirst, fever with thirst, and aching all over. If Arnica seems indicated and fails try Calendula and compare also carefully Hypericum. Carbo veg. : Threatening uterine putrescence ; foetid lochia. Collapse in the last stages o'f puer- peral disease. In the last extremity a potency of Carbo veg. will often bridge a terrible chasm. 178 AN OBSTETRIC MENTOR. Carbolic acid : High fever alternating with oft recurring chills of short duration, followed by profuse sweat with restlessness ; increased tender- ness over the uterine region and right iliac fossa ; pulse filiform ; involuntary diarrhceac stools of great fcetor : lochia foetid or suppressed ; worse in the afternoon j right-sided pains. Chamomilla : A fit of anger induced the dis- ease ; mammae flaccid and empty ; whitish diar- rhoea ; scanty lochia. Abdomen distended and sensitive. Colic like labor pains. General heat and great thirst. Excessive irritability and impatience. (Compare Bry. and Nux.) Urine pale and abundant. China : Useful in late stages of puerperal ty- phoid, and after cases marked by excessive haemor- rhagic (or other) discharges. China arsen. : Advised by Dr. Baehr for ex- treme prostration, muttering delirium, grasping at flecks, involuntary stools. Colocynthus : Disease caused by violent cha- grin. Severe colicky pains causing her to bend double, with great restlessness : feeling in the whole abdomen as if the parts were squeezed between stones. Delirium alternating with sopor. Hot head, red face, glistening eyes, dry heat, hard, full, quick pulse. ConiUm : Puerperal ovaritis. Aching in the uterine region. Vertigo. Intermittent urination. Irregular pulse. Iodium : Puerperal metritis characterized by a low, persistent grade of fever, and feeble pulse. Acute pain and inflammation of the breasts de- veloped from the uterine trouble. Kali iod. is sometimes preferable upon similar indications, especially if a syphilitic taint be suspected. AN OBSTETRIC MENTOR. 1 79 Kreasote : Stiches in the vagina, proceeding from the abdomen, causing her to start at every pain. Uterine putrescence j lochia putrid, excoriating and intermittent; stools also putrid ; urine foetid, clouded and brown. Abdomen distended and tense like a drum : labor-like pains in the abdomen : drawing in the upper abdomen extending to the small of the back and pressing forward towards the lumbar vertebrae, with flushes of heat in the face and pal- pitation of the heart. Painful cold sensation in the abdomen. Loss of memory ; thinks she is well. Lachesis : Unconsciousness with purple coun- tenance. Lochia foetid, urine suppressed. Abdomen swollen a7id sensitive. She is constantly lifting up the bed-clothes because their pressure causes an uneasy sensation in the uterine region. Pain in the uterus relieved for a time by a flow of blood, but soon returning. Aggravation after sleeping. Constipa- tion and history of ovarian affections. Mercurius vivus : Pueiperal metritis (or peri- tonitis especially). Lancinating, boring or pressing pains in the uterine and genital regions. Abdomen, especially the pit of the stomach, very sensitive. Moist, soft tongue, showing the imprint of the teeth. Intense thirst and profuse sweat day and night without relief. Worse all night, but especially be- fore midnight. Bloody slimy diarrhoea. Muriatic acid : Puerperal typhoid ; where China or China ars. fail. Nux vomica : Bruised sensation referred to the cervix uteri. Heaviness and burning in the genitals and abdomen. Lochia suppressed or too profuse and offensive with violent pains in the small of the back. Frequent desire to urinate, with scald- ing burning pain. Constipation, or rectal irrita- l8o AN OBSTETRIC MENTOR. bility. Nausea and desire to vomit, or actual emesis. Spasmodic pains in the arms and legs which " go to sleep." Dull headache, red face, vertigo, dimness of sight, ringing in the ears, fainting turns. Aggra- vation in the morning. Platina : Painful sensitiveness and continual pressure in the region of the mons veneris and genitals, she cannot bear the touch of the napkin. Voluptuous tingling in the abdomen and vulva. Profuse, thick, black, bloody lochia. Puerperal •ovaritis. Phosphoric acid : Puerperal typhoid. Great debility ; sinking condition with irregular intermit- tent pulse. Profuse sweats. Indifference to every- thing, low delirium, dullness of the head. Coldness of the extremities. Meteoristic distention of the uterus. Dr. J. H. Woodbury says: "With the above symptoms I have seen it of most decided service, in some cases rescuing patients when in an apparently hopeless condition." Pulsatilla : Milk and lochia suppressed, or at all events abnormal. Towards night more pain, more thirst, more despondency, more very severe after- pains, with dull, aching pains in the back. Small pulse even though the fever be high, causing a burning skin, followed by profuse sweat often cool and clammy or sticky, with a soft flabby feel of the flesh. Some cough towards evening with spitting of stringy mucus. Urinates often with some dis- position to diarrhoea. Palpitation of the heart with trembling of the hands and voice. Sight and hear- ing impaired. She starts and twitches in her sleep, often moans and awakes somewhat bewildered. Has a gnawing feeling in her stomach as if hungry, but when she eats her stomach aches and she has AN OBSTETRIC MENTOR. 151 nausea and even vomiting. Abdomen tender to touch ; flatulent colicky pains about the umbilicus ; pains cutting through the pelvis from back to front. Not only foetid flatus from the bowel but also loud reports from the uterus, with a feeling of weight, pressure and fullness. Dry, burning heat in the vagina and uterus with thick offensive discharge causing much itching and general irritability. Feet jerk and tingle and " go to sleep." She wants them rubbed frequently. She lies on her back either awake or asleep. Sleep restless and full of dreams ; she wakes often much disturbed and is soon asleep again. Sweat during sleep. Easily chilled, hands, feet, and forehead often icy cold. Says Dr. O. P. Baehr, " Its attacks are not violent like those of Aeon., Gels., or Verat. virid., but they often creep on slowly, mildly and stealthily but surely. . . . The changes in a Pulsatilla puerperal fever are very numerous : one hour you may fancy your patient better, when in another she is alarmingly prostrated. She may sleep and eat, talk and sit up in bed one day, and need the doctor three times the next. Stick to Puis., and all will be right." Rhus tox : Puerperal peritonitis or typhoid. Cool skin and high pulse, or low pulse and hot skin ; apathetic and stupid ; lochia offensive and intermittent ; milk vanishes ; restlessness ; she changes position often which affords a few moments' relief ; loss of power of the lower extremities. Tongue dry, with red tip. Sabina : Puerperal ovaritis. Salicylic acid : Uterine putrescence ; high fever and excessive sensitiveness to jar or motion. Rheumatic tendencies ; compare with Carb. ac. and Kreas. l82 an obstetric mentor. Sec ale : Uterine putrescence ; broivnish, offen- sive lochia. Burning fever interrupted by shaking chills ; small sometimes intermitting pulse ; ab- domen distended but not very painful ; pain at the pit of the stomach, vomiting of decomposed mat- ter ; offensive diarrhoea ; urine suppressed ; bed- sores which tend to become gangrenous. Quiet delirium, or wild desire to get out of bed. Terrible forcing, bearing down after pain. Stramonium : Mental excitement and delusions very marked ; thinks rats and mice are under the bed and looks to find them ; thinks that she lies doubled or cross-wise in the bed ; the head is jerked up from the pillow and falls back again. Pu- erperal metritis. Sulphur : Vulva excoriated by the discharges ; after improvement (under other remedies) she grows worse again. Terebinthina : General languor and weakness ; high fever, quick pulse with frequent headache and a sensation of dryness of the mucous surfaces; excessive meteoristic distention of the abdomen j fre- quent colic and rumbling in the bowels. Strangury or complete suppression of urine. Ustilago : Urine and stools dark and offensive ; aching of the womb ; lochia profuse, dark, bloody and offensive. Veratrum viride : Sudden attack (often ab- solutely instantaneous) of a chill or nervous chilli- ness and shuddering, with nausea ; followed by an intense fever, characterized by a full, hard, quick bounding pulse and much oppression in the chest ; congestion of the lungs and the head ; spasmodic twitching and restlessness ; sudden sup- pression of the lochia ; sudden severity is the char- AN OBSTETRIC MENTOR. 1 83 acteristic of Veratrum viride ; profuse cool long- lasting sweat ; delirium. This is certainly among the first drugs to be considered in every case of puerperal fever. The following drugs are also advised : Canth., Coff., Gels., Hyosc., Kali chlo. Dr. Marsden and Dr. Eaton place great confid- ence in the methodical use of Quinine, in conjunc- tion with other drugs. The former advises the 1 / 10 trituration and the latter 2 grains of the crude drug. Hygienic : Observe excessive cleanliness ; let the patient be kept clean by sponging with hot water and alcohol ; frequent changes of clothing, well aired and hot from the stove. Secure free ventilation at all hazards ; allow cooling drinks freely, of which milk is the chief : no stimulants. For spurious peritonitis : Verat. viride is the chief remedy and usually the only one needed (com- pare the preceding indications). Should it fail however, Compare also : 1. Aeon., Actea, Bell., Gels. Hyosc, Ign., Nux v., Opium, Puis., Spig., Zinc. val. 2. Cham., Coff., Coloc, Cupr., Ipec, Kali carb., Lach., Phos. Puerperal Insanity. For mania : 1. Actea, Bell., Hyosc, Plat, Strain., Sulph., Verat. alb., Verat. viride. 2. Aeon., Ars., Cann. indie, China, Gelsem., Glon., Petrol. For melancholia : 1. Actea, Aur., Helon., Kali carb., Verat. alb. 2. Ign., Lach, Lilium, Puis., Zinc. Aconitum : After fright or anger ; fear of 184 AN OBSTETRIC MENTOR. death, of strangers, of getting up ; intense anxiety ; reproaches others for mere trifles. Actea : Declares she will go crazy : a terrible gloom oppresses her and she is suspicious, indiffer- ent, taciturn, and tends to suicide ; irritable, the least thing makes her angry and destructive. Arsenicum : Weakness with nausea ; alterna- tions of hot and cold. Intense restlessness with rapid emanciation. Anczmic patients with suicidal tendencies. A sagacious alienist remarks " Aurum is often given in melancholia where Arsenicum is the remedy." Aurum : Very unhappy ; continual thought of suicide ; memory and intellect weak ; sleepless day and night ; prays all the time and says she is not fit for this world, which idea leads to suicidal broodings. ^Belladonna : Desire to escape or hide herself ; paroxysms of rage or fury. Sleepless nights, fear of ghosts. Desires others to kill her that she may be out of her misery ; moaning ; merry, but quar- relsome ; spits and bites at any one ; starts as if affrighted at any approach, or else imbecile stupor ; she acts as if stunned ; the former (active) condi- tion means Bell, high, the latter (depressed mental- ity) requires a low dilution to reach it. * Hyosc, Bell., and Stram. should be studied together, and may almost be said to represent three stages or phases of a single pathological condition. Under Hyosc, we find a con- gestive, or almost inflammatory condition, which produces loquicity and mania in fits of short duration. In Bell., we see the continued delirious rage and fury of on active inflam- mation at its height ; or the stupor of the post-inflammatory paralysis, while in Stram., the long continued cerebral lesion has produced a mania, which, in the violence of its unreasoning mental choros, more nearly resembles hydrophobia than any thing else. AN OBSTETRIC MENTOR. 185 Cannabis indic: Catalepsy; she imagines she is the Queen or the Virgin Mary ; distances and times exaggerated, and she becomes violently ma- niacal if left in darkness. China : Anaemia and nervous irritability from loss of blood ; delirium with illusions and halluci- nations ; anxiety and longing for death, or else in- difference and apathy. Gelsemium : Stupid as if intoxicated, with low muttering delirium ; sees demons ; fright, despond- ency ; passive congestion. Glonoine : Stupidity and muttering delirium. Helonias : Melancholia with sub-involution, uterine displacement, atonic leucorrhcea, etc. * Hyoscyamus : Loquacity and jolly mania with transient fits of frenzy. She does not know her relatives (Continually calls for those who stand beside her.) Complains of being poisoned and will neither eat, drink nor take medicine on that account ; complete loss of sense and modesty ; she throws off the bedding and other clothing and desires to go naked ; she calls for her husband to come and go to bed with her ; this drug is second to none in puer- peral mania. Ignatia : Persistent tearful or silent melancholy; she desires solitude ; when the child is still born or dies soon after birth. Kali garb.: Great sadness, weeps much and is afraid that she is going to die ; absence of mind, seems at a loss to know how to begin to say or do what she wishes ; makes several at- tempts but is finally compelled to give it up ; flatulently distended abdomen ; thirst or restless- ness. Lachesis : Mania with loquacity ; more often l86 AN OBSTETRIC MENTOR. melancholy with delusions that she is dead, or about to die ; follows Ars. or Bapt. well. Lilium : Religious mania, with hurried speech and actions, and anxiety about her salvation ; irrit- able and impatient ; melancholy with great appre- hension. Left-sided affections, particularly the ovary. Active uterine congestion with palpitation of the heart. Petroleum : Strange delusions, thinks there is another baby in bed with her requiring attention ; or thinks she has a third leg or arm ; sharp pains shooting up the dorsal spine into the occiput. Platina : Voluptuous crawling up and about the genitals ; very haughty, looks down very disdain- fully upon her attendants ; black tarry discharge from the vagina. Pulsatilla : Sad, weeping mood yet yields readily to persuasion and smiles even through her tears ; taciturn. When closing her eyes sees pictures and all sorts of strange sights and hears operatic airs ; difficult breathing after slight emotions. * Stramonium : Nymphomania with obscene ges- tures and acts (compare Hyosc, Bell., and Platina) ; desires light and company, much worse in darkness and solitude (also Cann. indie.) very loquacious in prayerful beseeching language; face red and bloated. Distorted visual hallucinations ; thinks she sees ver- min in the room and under the bed ; familiar ob- jects terrify her. Sulphur : Religious melancholy with despair of her own salvation and indifference to the lot of others. Forgets the names and words she would like to use ; obstinacy, dislikes to have any one near her ; flushes of heat, weak faint spells and cold feet ; light sleep. She arranges her clothing and hair in AN OBSTETRIC MENTOR. 187 a most fantastic manner and delights in grotesque apparel. Happiness is supposed to be a sulphur characteristic, but we have not found it confirmed in puerperal insanity. Veratrum album : Nymphomania with desire to embrace every body (even inanimate objects, compare Hyosc.), and desire to tear her clothes with lasciviousness ; religious melancholy with self- condemnation ; desire for cold water and other cool refreshing things ; cold sweat on the forehead. Veratrum viride : Puerperal mania after the convulsions which it accompanied have ceased. Hard, full, quick pulse. Silent and suspicious and sleepless ; both the Veratrums are noble remedies for puerperal mania and should be carefully com- pared with Bell., Hyosc, Platina and Stram. Zincum : Melancholy, fear of thieves, demons and other frightful figures ; weakness of mind, re- peats all questions before replying ; cannot keep her feet still, they are in constant motion. Hygienic : Rest and repose of the body are es- sential to the cure, and it is a great mistake to allow the patient to run about the apartment even ; much less should she roam the house. She may be secured so as to prevent this, and all chance of self-violence in the following manner : Stand her (and if necessary hold her) upon the floor while an attendant winds her up in sheets, beginning at the feet and leaving her arms free, the patient (and her bandaging) forming a sort of cocoon. Now the arms may be secured to the sides loosely and the patient likewise bound down to the bed. If it seems undesirable to move the patient from the bed, the restraint may be applied as follows : The patient lying on one side of the bed, spread a strong sheet upon the other. Place the. 1 88 AN OBSTETRIC MENTOR. patient upon the sheet and while attendants hold her arms by her sides and her legs and feet together down straight in the bed, wrap her up snugly by rolling her gently in the sheet and fasten the edges securely with safety pins. Many patients are so quieted by this " cocoon- ing " that the binding to the bed is unneces- sary. This method secures an easy and humane restraint which husbands the patient's strength and vitality. And so soon as a disposition to be quiet is evinced the restraint should be removed, being promptly restored when a fresh outbreak recurs. In >every case, the patient must be daily cleansed with a hot alcohol and water bath, and all soiled clothing removed. At the same time seclusion must be in- sisted upon j admit no one to a maniac save the physician and necessary attendants and when re- covery dawns be not over hasty to relax this rule. The diet should be liberal, eggs, milk and beef- tea the chief ; since anaemia nearly always marks these cases and the violence of the mental activity (which we cannot restrain as we do the physical) is like a consuming fire which if not furnished fuel feeds upon the already impoverished system. Some think the sleeplessness of the anaemic may be re- lieved by stimulants, but we avoid their use. While it is not wise to irritate by undue seventy and unnecessary exactions, never yield any impor- tant point : but gently, quietly and persistently carry out what is for the patient's good. We have given a teaspoonful of medicine twenty times within as many minutes to a patient who spat it out and finally carried the point and saw it swallowed. During the height of the disease as well as in con- valescence look sharply after all the organs and AN OBSTETRIC MENTOR. 189 functions of the body. See to it that the stomach, liver, kidneys, bladder, uterus, and bowels are not widely deviating from the normal. If the system be in an intense state, so to speak, decomposition is very rapid and the bowels should move every forty- eight hours at longest, being aided by injections if necessary. Convalescence established, protect your patient carefully from exposure to anything which will re- call her delusions ; be cautious about diet, exercise and company ; let her have a change of scene if possible. Finally one remedy cures rarely ; more often a nice sequence of drugs is necessary. The following scheme of drug study is suggested first y fever remedies, second, blood remedies, third, veg- etative remedies, fourth, nerve remedies. Should the mental symptoms not seem to give the picture,, examine carefully the physical status. Phlegmasia Alba Dolens. Compare : i. Am., Bell., Bry., Hamam., Kali carb., Nux v., Pulsat., Rhus. tox. 2. Ant. crud., Apis, Ars., Calc. carb., Carbol. ac, China, Hep., Iod., Lye, Merc, sol., Secale, Sepia, Sil., Sulph. Antimonium crud. : Enormous swelling in a chronic state. Red lines of absorbents traceable on the skin. Disposition to dry gangrene. Apis : Fever, restlessness, and tossing to and fro without relief. No thirst. Urine scanty or suppressed. Whitish transparent swelling. Sting- ing or sharp plunging pains. Arnica : Terribly sore, bruised, aching sensation in the inguinal and femoral regions beginning very soon after labor. 190 AN OBSTETRIC MENTOR. Arsenicum : Great restlessness and every motion produces a sensation of exhaustion. Thirst for small drinks frequently. Cold, wants to be covered up warm. Burning pains, swelling, pale and oede- matous. Belladonna: Cutting pains and heaviness in the thighs, hypogastrium and sexual parts. The least jar of the bed is painful. Fever with thirst. Cannot bear to be touched. Moaning and sleepless- ness. Red face and eyes. Cannot bear the least light or noise. Bryonia : Drawing or lancinating pains from the hip to the foot : aggravation from touch or the least motion. Copious perspiration without re- lief. Pulling sensation in the abdomen extending down the leg as if the menses would appear. Dry lips and mouth and thirst for copious draughts of cold water. Pale, pink swelling of the leg. Aggra- vation in the evening and early part of the night. Calcarea carb. : White swelling of the foot and leg with sensation of coldness as if covered with a damp cloth. Milk suppressed and general cold- ness. Carbolic acid : Foetid suppuration, exhaustion, right side especially. China : Great debility, a cachectic condition of the system with tumefaction of the limb. Hamamelis : We have no special indications for this twin brother to Arnica, but clinical experi- ence points to it as the chief drug in this trying disease. We use internally and externally, and have never seen suppuration where it was applied in the beginning of the disorder. Hepar : Where suppuration is inevitable and profuse. AN OBSTETRIC MENTOR. 191 Iodine : In obstinate cases marked by a scrofu- lous diathesis. Kali carb. : Stitching and shooting pains in the swollen foot and leg and in the abdomen, which is flatulently distended. Distressing pain in the back extending down into the glutei muscles. Restless- ness, with tossing and thirst. Lycopodium : Swollen foot and leg ; the saphena vein is swollen very large and is tender and can be distinctly traced. Loud rumbling of flatulence in the abdomen. Red sand in the urine, backache, better after micturition. Restless and tossing at night. Mercurius sol. : After Bell, or Bry. When suppuration threatens or is present. Hectic fever. It promotes absorption. Nux vomica : Red swelling of the leg with dark painful spots ; a powerless, bruised sensation of the leg and low down in the abdomen, with frequent urging to urinate and defecate. Loss of appetite. Aggravation after three o'clock in the morning. Great depression and irritability. Pulsatilla : Pale swelling of the foot and limb, with pains in the limb and hypogastrium. Suppression of milk and lochia. Thirstlessness. Offensive, clammy taste in the mouth after sleeping. She craves fresh, cool air. This drug is second only to Hamam. in this disorder. Rhus tox. : At the very outset there is loss of power to use the limb ; she cannot draw it up. A red streak marks the course of the saphena vein. Great restlessness, every change affording but a bit of relief. Worse after midnight and after wetting the part ; wants warm covering. Secale : Numb cold limbs. Diarrhoea. A stupid condition of the brain. I92 AN OBSTETRIC MENTOR. Sepia : Where chronic congestion or inflamma- tion of the uterus co-exist. Silicea : When suppuration leaves an ulcerative surface, with scanty discharge. Sulphur : Papular eruptions over the leg and whole body. Great numbness, heaviness and want of power in the limb. Hygienic : Keep cheerful and do not let your patient get disheartened. If doing fairly well, let well enough alone, and keep the affected parts wrapped up in flannel. If the swelling increase with alarming rapidity apply flannels wrung out in hot water medicated with the indicated drug (usually Hamam.) : let these be renewed as often as they get cool. If the swelling " points" and absolutely fluctuates and yet does not discharge, open it : under any other conditions the use of a knife is indefensible. When the swelling becomes an abscess or ulceration it loses its distinctive char- acter and should be treated accordingly. Pelvic Cellulitis. First Stage. (Congestive). 1. Aeon., Arn., Bell., Bry., Con., Merc, sol., Verat. viride. 2. Actea, Ars., Bar. carb., Kali carb., Plat.. Secale. Second Stage. (Effusive). 1. Apis, Ars., Bry., Rhus tox., Tart. em. 2. Canth., Colch., Digit., Helleb., Merc, sol., Sulph. Third Stage. (Suppurative). 1. Hepar., Merc. sol., Si/. 2. Calc. carb., Sulphur. The principal remedies are recognized by these : Pa7-ticular Indications. Aconitum : The drug in the beginning when the disease arises from a cold ; pressure on the crusal AN OBSTETRIC MENTOR. 1 93 nerve or its branches. Ludlam says, give low and frequently. It is only useful in the first stage. Arnica : After a long, severe or instrumental labor, and when the pain is excessive and the swel- ling little or nothing. Hypericum should also be considered in such a case. Like Aconite Arnica is chiefly useful in the first stage : Ludlam advises their alternation. Apis: This is the great remedy to promote ab- sorption, for which purpose it is only equaled by Tartar emetic, and finds its use in the second stage. Belladonna : Erysipelatous cellulitis. Low grade of fever with many nervous symptoms, head- ache, delirium, photophobia, etc. It is a correlative to Aconite in the first stage. Bryonia : The swelling is extremely sensitive to touch and she cannot bear contact or motion. First stage. Conium : Prominent swelling arising suddenly after a hard long instrumental labor, or after a blow or fall, or after rigid os uteri. Leucorrhcea of whitish or bloody mucus, very acrid and corrosive with pain in the small of the back. Study also Arnica and Hypericum, in the first stage. Silicea : When the suppuration is too long con- tinued, the ulcer becomes foul and the pus degen- erate. Third stage. Tartar emetic : Is the great absorbent of inflam- matory products in the pelvis and must be used low, rarely and persistently to secure its best effect in the second stage. Veratrum viride : This is probably the chief remedy for the first stage and will often abort the incipient inflammation. Suppression of milk and lochia. Intense nervous excitement, even to delirium 194 AN OBSTETRIC MENTOR. and mania. Vesical, rectal, and uterine tenesmus. Severe pains in (and tenderness of) the hypogas- trium. Abdominal tympanites. Hard, full, frequent pulse. Cases where the indications seem to call for both Aconite and Belladonna usually need Veratrum viride. Hygienic : During the first stage a light diet of milk and milk foods is wise ; but so soon as the original congestive onset is passed and we deal with a product of inflammation, a more liberal and stim- ulating diet is essential. Do not use alcohol how- ever : trust to milk or other good strong food. What was said of the knife in the preceding section applies here. CHAPTER XL Miliary Fever. Lacteal Variations. Milk Fever. Mastitis. Sore Nipples. For Miliaria. i. Aeon., Bry., Ipec, Merc. sol. 2. Ars., Bell., Valeriana. Aconitum : High fever and red (or white ?) rash. This drug will often break up this little plague if given early. Arsenicum : White miliaria with no (or little) heat, but excessive restlessness and thirst. Belladonna : Very red fine hot rash. Turgid tongue, papillae. Bryonia : Usually the only remedy needed when, after the fever subsiding, the rash and itching con- tinue. Ipecacuanha : Excessive sweatings and inces- sant nausea. Mercurius sol.: Persistent pustular headed eruption continuing after the fever. (Compare Juglans, cin. and tart, em.) Valeriana : Eruption with watering eyes, op- pressed chest, diarrhoea, bad taste and smell, trem- ulousness, creeping chilliness and occasional sweats. Hygienic : For deliverance from this harmless torment we may obtain fervent blessings. Keep the room cool and do not allow too warm or heavy bed- ding. Grateful relief is sometimes obtained by I96 AN OBSTETRIC MENTOR. spongings with very weak solutions of Acetic or Phosphoric acid and water. For Sore Nipples. 1. Ar^i., Calend., Castor equor., Ham., Phyt. 2. Agar., Calc. carb., Cham., Croton tig., Graph.,. Lye, Merc, sol., Phos., Puis., Sep., Sil., Sulph. Agaricus : Red, burning, itching nipples ; women who have chillblains. Arnica : Nipples feel sore as if bruised; often indicated and cures soon when early applied ; use internally and externally. Calc area carb.: An ulcer on the nipple dis- charging pus. Calendula : The remedy for a cracked or fls- sured nipple : use internally and externally. Castor equorum : Neglected cases where the nipple is nearly ulcerated off ; it only hangs as it were by small strings. Use internally and also ex- ternally, diluted one half with glycerine or sweet oil. From this treatment we have seen excellent results. Chamomilla : Nipples inflamed and very tender, she can hardly endure the child's nursing ; in fact, she* is very irritable, cross and impatient, and says she can't stand it and won't stand it. Croton tiglium : Every time the child draws at the nipple, a pain runs through to the scapula on that side, which is excruciating. The nipples are very sore and have an eczematous appearance. Graphites : Little vesicles on the nipples. The nipple oozes out a thick glutinous fluid which forms a crust, which is removed by nursing only to form again. 1 AN OBSTETRIC MENTOR. 197 Hamamelis : Where soreness and tenderness are the chief characteristics and Arnica fails. Lycopodium : The nipples bleed and are very sore ; the child draws so much blood that he vomits it up. Mercurius sol.: The nipples feel very raw and sore. Gums sensitive, teeth sore and leave their dents upon the tongue ; enlarged cervical glands. Phosphorus : The nipples are hot and sore and the abdomen feels weak and empty. Much heat in the lower part of the back across the kidney region. Phytolacca: Sore fissured nipples. Intense suf- fering on putting the child to the breast ; the pain seems to radiate from the nipple over the whole body. Pulsatilla : The pain from nursing extends into the chest, up to the neck and down the back ; often changes from place to place. Sepia : The nipples are sore and deeply cracked across the crown in various places. Silicea : The nipple is sore and tender, and ulcerates very easily. Sulphur : After nursing the nipple smarts and burns much ; it is chapped and bleeding about the base. Hygienic and topical : If proper remedies are given for abnormal conditions of the breast during pregnancy, and they are daily washed in cold water, and the nipples hardened, all trouble will be eas- ily avoided. Guernsey advises "to dissolve a few globules of the same remedy (as is given internally) in water or brandy and water and apply to the nip- ple after nursing." We confess to the best results with Arnica and Hamamelis internally and exter- nally in simple soreness, while a cracked nipple is I90 AN OBSTETRIC MENTOR. as surely cured by Calendula as an ulcerated one is by the dilute castor oil. An aphthous nipple will need a Hydrastis glycerole ; which failing, a dilu- tion of Arsenicum locally used sometimes affords magic relief. Dr. Eaton thinks that the Basilicon oint77ient excels all other applications for a fissured nipple. Ludlam advises for simple abrasion arrow root, cornstarch, gum arabic, borax and white sugar ; to the first, white oxide of zinc may be added, a drachm to an ounce. For aphthous ulceration in addition to Hydrastis, Baptisia and the mineral acids. For fissures he mentions the acids, elastic Collodion, a glycerole of gum benzoine and the yolk of an egg, four parts by weight to five of glycerine: A good nipple shield is a great help. Milk Fever. Rarely requires any treatment if the child is put to the breast within a few hours after birth and taught to nurse. If drugs seem necessary, compare : Aeon., Arn., Bell., Bry., Coff., Rhus tox. 3 Verat. virid. Lacteal Variations. No Milk Secreted : Agnus cast, Secale, Urtica urens. Milk Scanty : 1. Agnus cast., Asafcet., * Borax. 2. Bry., Calc. carb., China, Merc, sol., Phos. ac, Pul- sat. Milk Suppressed : 1. Aeon., Caust., Dulc> Puis. 2. Cham., Phyt., Verat virid. Milk, Too Profuse : Acetic ac, Calc. carb., Mentha pip., Pul., Phyt., Uron. nit. * Low Potency. AN OBSTETRIC MENTOR. 199 Galactorrhea : Bell., * Borax, Bry., Calc. carb., China, Con., Phos., Puis., Rhus tox., Stram. Cramps in Stomach (from nursing) : Carbo. an., Carbo veg., China, Phos. " Goneness " in Stomach (from nursing) : Carbo. an., Hydrast., Ign., Oleander, Sepia. Milk, Acid : Calcarea phosphorica. Milk, Bitter and Yellow : Rheum. Milk, Blueish : Lachesis. Milk Tastes Badly : Borax, Calc. phos., Merc, sol., Rheum. Milk, Tastes Salt : Calc. phos., Carbo. an. Milk, Too Thick : Borax. Milk, Too Thin : Calc. phos., Carbo an., China, Lach., Puis. Milk, Watery : Calc. phos., China, Kali b. (and stringy), Puis. Aconitum : Hot dry skin, much thirst, restless- ness and anxiety. The breasts are hot, hard and swollen, but contain little or no milk. Acetic acid : Milk normal in quality, but enormous in quantity. Agnus castus : Despairing sadness, frequently says she will die. Milk very scanty. Asafcetida : Excessive hysterical sensibility of the vital organism and the veins unnaturally dis- tended. Milk scanty; frequently indicated. Belladonna : Spontaneous and excessive flow of milk with large swollen, red, heavy breasts, cephalic congestion and sleeplessness. Borax : For a scanty flow of milk with stitches and aching in the breasts which she presses with the hand, they are so painful ; give hi a low dilution m * High dilution. .^ 200 AN OBSTETRIC MENTOR. While a profuse spontaneous flow or a vitiated se- cretion of thick, bad tasting, easy-curdling milk calls for a higher dilution. Bryonia : Her breasts are stony hard and, although swollen, are not red, but tormented by ten- sive, burning, sttching pains, and afford but little milk. Galactorrhea. Calcarea carb.: Mammae distended but the milk is scanty, and there seems a want of vital activity to bring it forward. Also profuse spontaneous milk flow. Calcarea phosphorica : Milk scanty, thick, salt, acid ; pains and burning in the mammae. Carbo animalis : Milk thin and salt ; nodosities in the mammae ; nursing causes stitching pains ; gastric cramps from nursing. Carbo veg. : Gastric dyspepsia and gastralgia from prolonged nursing, or nursing continued after a new conception. Causticum : Milk diminished or suppressed by over-fatigue, night watching and anxiety ; delicate light complexioned women. Chamomilla : Milk suppressed by anger; breasts very tender ; she is restless, fretful, cross and passionate. Such an one said : " I can't en- dure it and I wont." Cham, soon relieved. China: Weakness from flooding or profuse lochia. Aggravation every other day. Milk scanty, thin and watery. Cramps in stomach and debility from prolonged lactation. Dulcamara : Milk suppressed (or fails to be se- creted ?) from exposure to the cold and damp air : mammae swollen, painless, inactive, but their cuticle itches, and she is subject to eruptions caused by cold. AN OBSTETRIC MENTOR. 201 Kali bich. : The milk has the appearance of stringy white masses and water. Lachesis : The milk is blue and thin. She is very desolate and sad and unhappy. Merc. sol. : Milk scanty and tastes badly ; mammae. swollen and hard and feel raw and sore. Mentha pip. : Breasts swollen, engorged and full of very painful little lumps. Milk profuse. Phosphoric acid : Milk scanty, with great de- bility and great apathy. Pulsatilla : One of our best milk prompters for mild, tearful women apparently in a good con- dition, who have no milk. Or the breasts may be much swollen, and she full of erratic rheumatic pains. Milk thin and watery and the true milk globule almost entirely absent. Fever, but no thirst. Rheum.: Milk tastes badly (bitter) and is very yellow. Mother and child have painful sour diar- rhoea. Secale : After exhausting haemorrhages and ex- cessive after pains in thin, scrawny women, little or no milk flows into the breasts, which sting terribly. Urtica urea : Milk very scanty, or fails en- tirely to be secreted. Mastitis Puerperalis. * Study, i. Aeon., Bell., Bry., Graph., Hepar y Mentha pip., Phosph., Phyt., Sil. 2. Acetic ac, Apis, Aurum triph., Carbo an., Cham., Cistus, Con., Lach., Merc, sol., Rhus tox., Sulph., Verat. viride. Acetic acid : Breasts greatly and painfully distended ; threatening an abscess. * Compare also the remedies under " Sore Nipples " and " Lacteal Variations." 202 AN OBSTETRIC MENTOR. Aconitum : A chill followed by fever, etc., after exposure to a dry cold air. Apis : Hard swelling of the breasts with burn- ing, stinging pains, redness and inflammation. Aurum triphyllum ; Lumps deep in left breast, with aching pains. Belladonna : Breasts feel heavy and there are red streaks running like radii from a central point {usually the nipple) with pulsating pains, headache and dullness and stupidity. Right side especially. Bryonia : Breasts stony, hard and heavy, hot and painful but not very red. She feels sick and faint if she moves or is moved even to sitting up in bed. Stitching headache, fever, thirst and hot skin. This drug is often to be preferred even above Aeon, to meet the onset of mastitis, and a perspira- tion following its exhibition will justify its use when well chosen. Right side. Carbo an. : Breasts swollen and red with burn- ing, tearing pains. Terrible darting in the breasts which arrests her breathing while the child nurses. Right side. Chamomilla : Breasts inflamed, swollen and painful, with burning, lancinating pains. Cistus : Inflammation of the breasts from ob- struction of the lacteal ducts with sense of fullness in the chest. Scrofulous diathesis. Excessive sen- sibility to the cold air. Left side. Conium : Inflammation (of the left? breast) with stitching pains as if from needles. Graphites : Old cicatrices from former ulcera- tions impede the flow of milk and threaten the form- ation of an abscess. Guernsey says : " I have the greatest confidence in Graphites has never failed me." AN OBSTETRIC MENTOR. 203 Hepar : When suppuration seems inevitable give Hepar high ; dull pains in the breast. " Should not be given too soon," says Dr. Ostrom, "lest suppuration be thereby accelerated" * and need- lessly developed, we add — if fluctuation shows a very scanty, slow and illy distributed suppuration, or a?i extraordinary abundance of pus, give Hepar low and often. Right side. Lachesis : Bluish, inflamed breasts. Lancinating or hammering pains extending down the arm. Chills at night and heat by day. Mentha pip. : Hard lumps in the breasts which are exquisitely tender. Breasts full and caked. Merc. sol. : Hot, hard swelling of the breast with raw, sore feeling. Chilliness and throbbings proclaim suppuration, or abscesses exist which show no signs of healing ; sweating without relief. Phosphorus : Phlegmonous inflammation of the breasts. Red spots or streaks with stitching, cut- ting pains. Knotty abscesses or fistulous ulcers, or openings, with burning, stinging pains and of- fensive watery discharge. Hectic fever and night sweats. Left side. One of the best remedies for a mammary abscess or ulceration. Phytolacca : Chill followed by fever and painful engorgement of the breasts j hardness apparent from the first. Many hard, painful nodosities. Abscesses with large, fistulous, ulcerated openings, filled with unhealthy granulations and discharging a watery, foetid ichorous pus. Breast caked solid. Exquisite pain radiating from the nipple all over the body. This drug is homoeopathic to every stage of the disorder, and will cure 95$ of all cases if used * Treatise on the Breast, p. 156. 204 AN OBSTETRIC MENTOR. early and often, externally and internally in hot water, saturating flannel bandages. Rhus tox. : Mastitis from getting wet. Breasts red and swollen in streaks and painfully distended, or cold, empty, yet painful. Silicea : After the abscess a fistulous ulcer re- mains, discharging a thin, watery, offensive pus. The whole breast seems to be discharging away in pus, one lobe after another opening into one com- mon ulcer ; or there may be several orifices. The value of this drug in such cases cannot be over-esti- mated. Sulphur : Inflammation running in radii from the nipple. Profuse suppuration with chilliness in the fore part of the day, and heat in the after part. Old ulcerations, the breast feels like a raw sore. The breast feels hot, burning and stinging. Veratrum viride : Mastitis ushered in by in- tense continuous fever, hard, full rapid pulse, de- lirium, thirst, etc. Breasts being red and erysip- elatous. Hygienic : Common sense care of the breasts during pregnancy and lactation will do much to avert this justly dreaded inflammation. Advise the pregnant woman to give her breasts an air bath every day and to bathe them well at least once daily (and twice is better) with as cold water as she puts upon her face. The baby born, put it to the breast just as soon as the mother has reasonable rest from the fatigues of the labor. When the mother's hands and face are bathed (after the labor) let it always be with cool water, certainly not with hot, nor hardly warm. Do not have the hands put in it but let the mother wipe her hands and face with a sponge or towel wrung out in the c oo AN OBSTETRIC MENTOR. 205 water. Moreover caution all against undue ex- posure of the now active and filled or filling glands : she should not sit up while in a perspiration to nurse the child, but cool off first. After getting up, the breasts should be well covered when she goes out if the weather be cold. The best device we have seen for this purpose is a large piece of silk to cover both breasts completely and tuck in well. If de- sired two orifices may be cut for the nipples and the child nursed without removing this breast pro- tector. When seen during the first stages mastitis may frequently be aborted by wrapping the affected parts up in white flannels wrung out in boiling water medicated with whatever drug is indicated while the same is given internally, and changed frequently so as to keep up a steaming effect. These drugs are most often Bryonia, Phosphorus and Phy- tolacca, although we may prefer Veratrum viride if an erysipelatous redness prevails, or possibly Bella- donna or more rarely Rhus tox. If suppuration be a certainty, discard fomenta- tions and apply poultices, of which the linseed and the old-fashioned Indian meal poultice with a tenth part of poke root grated in it are best. Very rarely will any one poultice serve well many days, and the programme must be varied. In tedious cases of ulceration after mastitis, we have gotten fine re- sults from a soothing poultice by night and a stim- ulating ointment (like the basilicon) by day. The annoying little sore lumps which are so often the forerunners of mastitis, may be removed by very frequent rubbing (from base to apex) of the breast with a little lump of lard or vaseline the size of a walnut, in which three drops of peppermint have been thoroughly incorporated, while Mentha pip. 206 AN OBSTETRIC MENTOR. is given internally. The best breast pump is a hot quart bottle fitted to the nipple and cooled gradu- ally. For the use of this, the method of opening theabscess, etc., etc., we refer the reader to Dr. H. I. Ostrom's valuable monograph on the breasts, published by Stoddart & Co., Philadelphia. ERRATA. Page 102, seventh line, read 57 for 67. 103, fourteenth " " 115 "127. 120, foot note, " 119 " 157. 126, " " " 90 " 117. 161, " " " 136 " 182. 173, " " add 76. < 184, " " tenth line, read choas for choros. INDEX PAGE. Abdomen, cracking of the skin" of 76, 173 pains in walls of 86 pendulous after confinement 173 soreness of " 173 Abortion, in general 118 causes of 123 discharges in . 119 times of. 119 pains in 121 Adipsia 15 Affections, changed 112 After pains 164 Agued breast 201 Albuminuria. ... 56 Albuminurious retinitis 57 Alvine evacuations 40 Amaurosis 102 Amnion, dropsy of 59 Anorexia 15 Anuria 54 Anus, fissure and ulceration of 33 Aphthae of the vulva 74 Appetite, excessive, lost, or for various foods and sub- stances 15 Authorities consulted, list of 13 Asthma 46 Articulations of pelvis 95 Aversion, to food in general 24 to particular foods and drinks ».... 16 Back, pains in, during pregnancy 91 " " " abortion 121 Bathing during pregnancy 116 208 INDEX. Belching 24 Bladder remedies 67 Blindness 102 Borborygmus 40 Breast, gathering of the 201 pains in the, during pregnancy 85 Breath, shortness of 46 Bulsing 15 Cellulitis, pelvic 192 Cephalalgia 78 Child-bed fever 174 Chloasma 76 Chorea no Colic, from flatulency 40 Congestion of the cervix uteri 68 pulmonary 45 Constipation during pregnancy . .27, 140 after confinement 173 Convulsions 155 Cough (See Congestion, pulmonary) 47 Cramps 93 Deformity, to prevent (See also Fears and Frights) 115 Desires for various foods and drinks 16 Diarrhoea, in general 35 after confinement 173 painless or painful 40 Diathesis, to modify 115 Diet during pregnancv 1 16 Discharges in abortion 119 Disgust for food 24 Dropsy, in general 58 of the amnion ... 59 Dyscrasia, to overcome 115 Dyspnoea 46 Dystocia 129 Dysuria 51 Ears, affections of 100 Emotions, unusual 112 Enuresis 53 Eructations 19 Exhaustion during or after labor 153 Eyes, affections of < 102 Face-ache 78 INDEX. 209 Fainting, during and after labor 151 False pains = 88 False waters 59 Fears and frights 113 Fever, miliary 195 milk 198 puerperal 174 Flatulency, colic from 40 Fluor albus 73 Flooding 138 Foetus, too violent or incessant motions of .- 115 Gagging 124 Galactorrhea 199 Gastric catarrh 35 Gastric repertory 24 Haemorrhage during and after abortion 119 in general, after labor and various kinds of. 138 Haemorrhoids 30 Headache 78 Hearing, loss of 100 Heartburn 24 Heart, palpitation of 49 Hiccoughing 24 Hour-glass contraction* 136 Hunger, excessive 15 without appetite 15 Hydrorrhcea 59 Hygiene of pregnancy 116 Hysteria 105 Icterus. 27 Incontinence of urine 53 Insomnia 103 Intestinal repertory 40 Ischuria 54 Itching of the genitals 74 Jaundice 27 Kidney remedies 68 Labor, difficult 129 " to prevent 117 exhaustion during 153 fainting during 151 pains of abnormal 129 premature " 118 2IO INDEX. Lacteal variations 198 Leucorrhoea 73 Liver affections 27 moth 76 Lochia, variations of 167 Longing for various foods and substances 17 Lungs, congestions of. 45 Mania puerperalis. 183 Mastitis puerperalis 201 Mental alienation 112 Melancholy, puerperal 1 83 Metritis, puerperal 174 Micturition, difficult 51 Miliary fever 195 Milk, abnormalities of 199 suppressed or scanty 198 too profuse 198 Milk fever 190 Milk leg :.. 189 Miscarriage 118 Morning sickness 19. Motion, foetal, too violent or incessant 115 Myalgia abdominalis . 86 Nausea (morning sickness) 19 where felt 24 Neuralgia (head and face) 79 Nipples, soreness of 86, 196 Nursing, complaints from 199 CEdema of the feet 59 Odontalgia 79 Os uteri, rigidity and spasm of 134 Ovaritis, puerperal 174 Pains, false 88 in abdominal walls 86 in back , 91 " " in abortion 121 in breasts 85 in face 78 in head 78 in teeth 79 in uterus (in abortion) 121 predominating (in abortion) 119 Palpitation of the heart 49 INDEX. 211 Pelvic articulations . 95 Pelvic cellulitis 192 Peritonitis, puerperal 174 spurious 183 Phlegmasia alba dolens 189 Piles 30 Placenta, retention of 161 Preface 12 Prolapsus uteri 69 Prosopalgia 78 Pruritus pudendi. 74 Ptyalism 24 Puerperal fever 174 insanity 183 mania 183 melancholia 183 metritis 174 peritonitis 174 typhoid 174 ovaritis 174 Putrescence, uterine 174 Rash of lying-in women 195 Rectum, fissure and ulceration of 33 Retained, placenta 161 Retching (empty) 24 Retention of urine after labor 162 Retinitis albuminuria .... 57 Rigid os uteri 134 Risings into throat 24 Salivation 24 Sight, loss of 102 Sleeplessness 103 Sore nipples 86, 196 Stomach troubles 24 Stools with worms 44 various kinds of 41 various odors of 43 St. Vitus' dance no Taste, variations of 17 Thirst 15 Thirstlessness 15 Thirst with aversion to drink 16 Toothache 79 INDEX. Typhus puerperalis 1 74 Umbilicus, ulceration of 173 Ursemia , 56 Urethra remedies 67 Urinary concomitants 67 repertory. 63 Urination, difficult 51 too rare or often 66 Urine, incontinence of 53 odors of 64 retention of, after labor 162 sediments of 65 suppression and retention of 54 too much or little 66 various kinds of 63 Uterus, congestion of 68 displacements of 68 Uterus, putrescence of 174 Varicoses 96 Vertigo, repertory 99 Vomiting (morning sickness) 19 of various matters 24 from various causes 25 times of 25 after eating and drinking 26 Whites 73 Womb, displacements of 69 MHH