T R E A T I S E
ON  THE
DISEASES OF IAIARIED FEMAALES
DISORDERS OF PREGNANCY, PARTURIITION
AND LACTATION.
BY JOHN C. PETERS, M.D.
NEW-YORK:
WILLIAM RADDE, No. 322 BROADWAY.
PHILADELPHIA: RADEMACHER & SHEEK. BOSTON  OTIS CLA'.P.
ST. Louis: J. G. WESSELH(EFT.
LONDON: J. Epps, 112 GREAT RUSSELL-ST., BLOOMSBURY.
MANCHESTER: TURNER, 41 PICCADILLY.
1854.




Entered according to Act of Congress, in the year 1854, by
WILLIAM RADDE,
In the Clerk's Office of tle District Court of the United States for the Southern
District of New-York.
tIENRY LUDWIG, Printer,
45 Vesey-st., N. Y.








HOIHEOPATHIC BOOKS,
for sale by WM. RADDE, 322 Broadway, New-York.
Jahr9s New Manual: originally published under the name of Symptomen-Codex.  (Digest of Symptoms.)  This work is intended to facilitate a comparison of the parallel symptoms of the various Homceopathic
agents, thereby enabling the practitioner to discover the characteristic
symptoms of each drug, and to determine with ease and correctness what
remedy is most Homoeopathic to the existing group of symptoms. Translated, with important and extensive additions from various sources, by
Charles Julius Hempel, M. D., assisted by James M. Quin, M. D., with
revisions and clinical notes by John F. Gray, H. D.; contributions by
Drs. A. Gerald Hull, George W. Cook, and Dr. B. F. Joslin, of NewYork; and Drs. C. Hering, J. Jeanes, C. Neidhard, W. Williamson, and
J. Kitchen, of Philadelphia; with a Preface by Constantine Hering,
M. D., 2 vols., bound $11. 00.
The third volume is issued as a separate work, under the title of Complete Repertory of the Homceopathic Materia Medica.  By Charles J.
Hempel, M. D. 1224 pages. Price $6, or all 3 volumes at $17.
JahrS New  Manual of Homeopathic Practice; edited, with Annotations, by A. Gerald Hull, M. D. From the last Paris edition.  This is
the fourth American edition of a very celebrated work, written in French
by the eminent Homceopathic Professor Jahr, and it is considered the
the best practical compendium of this extraordinary science that has yet
been composed. After a very judicious and instructive introduction, the
work presents a Table of the Homceopathic Medicines, with their names
in Latin, English and German; the order in which they are to be studied,
with their most important distinctions and clinical illustrations of their
symptoms and effects upon the various organs and functions of the human
system. The second volume embraces an elaborate Analysis of the indications in disease, of the medicines adapted to cure, and a Glossary of
the technics used in the work, arranged so luminously as to form an admirable guide to every medical student. The whole system is here displayed with a modesty of pretensions, and a scrupulosity in statement,
well calculated to bespeak candid investigation.  This laborious work is
indispensable to the students and practitioners of Homceopathy, and
highly interesting to medical and scientific men of all classes. Complete
Symptomatology and Repertory, 2 vols., bound, $6. 00.
Jahr, Blr.. I, (X,, Clinical Guide, or Pocket-Repertory  for the
Treatment of Acute and Chronic Diseases.  Translated from the German, by C. J. Hempel, M. D.  1850. Bound, $1. 50.
Jalr, Dr. GI. t, X., Diseases of the Skin; or Alphabetical Repertory
of the Skin-symptoms and external alterations of substance, together
with the morbid phenomena observed in the glandular, osseous, mucous,
and circulatory systems, arranged with pathological remarks on the diseases of the skin.  Edited by C. J. Hempel, M. D. 1850. Bound, $1.
Jahr, Dr.., I. (,, and Grne lers New Homceopathic Pharmacopoeia arid
Posology, or the Mode of Preparing Homoeopathic Medicine, and the
Administration of Doses, compiled and translated from the German works
of Buchner, Gruner, and' the French work of Jahr, by C. J. Hempel,
M. D. 1850. Bound, $t 00.
Jahirs, Dr G. I.  G., and PossarrtS New  Manual of the Homceopapathic Materia Medica, arranged with reference to well authenticated observations at the sick bed, and accompanied by an alphabetical Repertory,
to facilitate and secure the selection of a suitable remedy in any given
case. 4th edition, enlarged by the Author. SYMPTOwATOLOGY and REPERTORY. Translated and edited by C. J. Hempel, MD. 1853. Bound,
3. 50.




AUTHOR'S PREFACE.
TiSfs work is compiled and arranged upon the same plan as tle
Treatise on Disorders of Menstruation, lately published.  I claim no
unusual amount of knowledge or experience  upon  the  subjects
of which it treats; in fact it was undertaken as much for my
own instruction as that of others.  It is intended more especially
for the junior medical practitioner, for experienced  nurses, and
for mothers.   I have sought to avoid  the confusing intricacy  of
complete and compendious treatises on Midwifery, and to escape
the trifling pomposity of catch-penny  popular works.  The works
of Cazeaux, Colombat, AMurphy, Whitehead, Tilt, Ticknor, Tracy,
Anderson, Churchill, Valleix, Vernois, Becqutrel, Leadam, Croserio, and Williamson have been freely used, and the language of
the re-spective authors has generally been adopted.
J. C. PETERS.
742 BROADWAY, NEw-YoRK.




TO 
JOHN A. MCVICKAR, M.ID.
LATE PHYSiCIAN TO'THE NEW-YORK LYING-IN-ASYLUM; LATE PROFESSOR OF MIDWIMEIkY
IN TH E UNIVERSITY OF TIIE CITY OF NEWV-YORK; LATE PREIDEN'r
OF THE IIAHINEMANN ACADEMY OF MEDICINE.
DEAR DOC'TR,
I have so frequently availed myself of your valuable assistance in cases of difficult and dangerous  parturition, that common  gratitude
compels me to dedicate this little treatise to you.
Yours sincerely and respectfully,
J. C. PETERSt




ON THE DISEASES
OF
PREGNANCY, PARTURITION, AND LACTATION,
ON MARRIAGE.
WE take it for granted that, in civilized countries, marriage
only takes place between persons of proper age, and from the
dictates of reason and personal affection. From 18 to 25
years of age may be considered the most proper period for
felmales to contract marriage; from 25 to 30 years for males.
Interest, superstition, and still more unworthy motives,
have, however, in all ages, led to earlier marriages.  According to ROBERTON, marriages of interest were, perhaps,
more abused in England, up to the year 1660, than in any
other country; and that not always for the interest of the
contracting female; but, on the contrary, frequently to her
great detriment in person and estate. Then, almost all the
property of the English realm was, by the policy of the laws,
supposed to be granted by, dependent upon, or holden of some
superior chief or lord; even wardship and marriage were
under the control of these grasping freebooters. The right
of wardship meant, that the lord had the guardianship of
his tenant during his minority, by virtue of which right
he had both the care of his person, and reserved to his own
use the profit of the estate, except the ward's sustenance and
clothing, the amount of which lay much at the mercy of
his lord.  Further, by a gross abuse of this custom in England, this right of wardship was often, by the lord, assigned
over to strangers; or it was put up to sale, or bequeathed
A




2        PREGNANOCY PARTURITION, AND LACTATIONo
by will, like any other kind of disposable property.  But,
besides the profit of the estate during the minority, the lord
had another perquisite connected with his guardianship, viz.,
the right of disposing of his ward, whether male or female,
in matrimony.  If the lord did not make over or sell his
right, he soon set about finding matches for his wards, either
by uniting them, if that were thought advantageous, with
members of his own fami]y, or of the families of relatives,
or by selling the marriage, i. e., if the ward, for example, were
a female, disposing of her hand to the best bidder, provided
he was of suitable rank; for the law forbade disparagement.
The marriage, in most of these cases, instead of being delayec  to the period of legal consent for the female, which
was 12 years, were often contracted at an age considerably
earlier, with a view to its being consummated when the
parties should arrive at puberty, or before that period.  But
it often happened that the lord, instead of exercising the
right of guardian, sold it to a stranger, one prompted by every
pecuniary, or baser motive, to abuse the delicate and important trust of education; without any ties of blood or regard,
to counteract the temptations of interest; or any snfficient
authority to restrain him  fiom  yielding to their influence.
Thus, William, Bishop of Ely, gave 220 marks for the custody
of Stephen de Beauchamp, and the right to mnarry him to
whom  he pleased; John, Earl of Lincoln, gave 3000 marks
to have the marriage of Richard de Clare for the benefit of
his eldest daughter, Matilda, &c., &c.  But the most curious
thing, says ROBERTON, connected with the treatment of this
species of property, is the extremely cool manner in which
wards were bequeathed, along with ordinary goods and chattels; thus, Sir John Cornwallis, in his will (1554), after a very
devout and pious exordium, says: I becqueath to my daughter, my wife's gown of black velvet; to my son I-enry, my
own gown of tawny taffeta; to my son Richard, my ward
MIargaret Lowthe, which I bought of my Lord of Norfolk, to
marry her himself, if they will be so contented; but, if not,
I will that he shall have the wardship and marriage of her,




MARRIAGE.                          3
with all the advantages and profits.  Sir Reginald Bray
says, in his will: "' Whereas, I have in my keeping Elizabeth
and Agnes, daughters and heirs of Henry Lovell, Esq., I will
that Elizabeth be married to one of my nephews, son to my
brother, John Bray, and the said Agnes to another son of my
said brother."
The dread of this unrighteous slaveship, that of wardship
and marriage, often operated with parents in marrying their
children at a tender age. Thus, Maurice, 4th Lord of Berkeley, was knighted at 7, and married at 8 years old, to
Elizabeth, daughter of Hugh, Lord Spencer, then but 8 years
old. This early marriage prevented wardship, the payment of
a large fine to the King, and assisted the party's own affairs
with family interest and powerful connections.  In fact, the
Lords of Berkeley, some years ago, differed but little in their
marriages from the customs of the most lascivious, depraved,
and mercenary of savages, or slave-holders.  The majority
of the Berkeleys were contracted in marriage at 7 or 8 years of
age, and in their family records more than a dozen instances occur of paternity before the age of 14. Throughout all England
such precocity was once unblushingly encouraged, assimilating the people of a Christian country, in this revolting feature, to the Pagan inhabitants of the'tropical regions.-RoBERTONT.
GRAFTON, however, a faithful chronicler in the reign of
Elizabeth, gives the following extremely curious display of humane and patriotic feeling:
" It is to be much lamented, that wards are bought and sold
as commonly as are beasts; and marriages are made with
them, that are many times very ungodly; for divers of them,
being of young and tender years, are forced to judge by another man's affections, and to see with another man's eye, and
to say yea with another man's tongue, and finally consent with
another man's heart.  For none of these senses be perfected
to the parties in that minority, and so the election being unfree, and the years unripe, each of them, almost of necessity,
must hate the other, whom yet they have had no judgment to




4        PREGNANCY, PARTURITION, AND LACTATION.
love.  And, certainly, the common bargaining and selling of
them is to be abhorred, for besides being stript out of almost
all the property they have, they are handled, as the common
saying is, like wards.  Who seeth not, daily, what innumerable inconveniences, divorces, yea, and some murders,
have proceeded from such marriages, or rather no marriages."
-ROBERTON.
According to the same author, the most curious instances of
early marriages, from superstition, still occur among the Hindoos. Upon an ancient theory of generation, much resembling
the latest modern ovarian theory, early marriages seem  to
have been instituted in India.  It was said, that if an unmarried girl has the menstrual secretion in her father's house, he
incurs a guilt equal to the destruction of the fietus; for the
girl is capable of conceiving, and should be allowed to conceive; menstruation being the loss of the ovum, which is
equivalent to the loss of a fcetus. According to the law of
the Shastras, females must be given in marriage before the
occurrence of menstruation; and that, should consummation
not take place until after this event, the marriage is a sin.
Accordingly, it is the custom  in Lower Bengal to send the
girl, at the age of 9 years to the house of her contracted
husband; and, in the opinion of Hindoo sages, if marriage
is not consummated before the first appearance of the menses,
the girl also becomes degraded in rank, and is contemptuously
placed in the order'"Brsalee."
Another order of Hindoos do not marry until soon after
puberty and first menstruation; but they have a disgusting
custom of marking this event in a girl's history, in the most
public manner. The poorer classes wear flowers in their hair
at the back of the head; and the richer give a feast on the
occasion; then, if the girl has been betrothed, she goes to
live at the bridegroom's house. In fact, all IHindoo girls of
~this class, are married as soon after as possible.
Finally, in some European countries, late marriages are enforced by law, and the laws against early and improvident
marriages are extremely strict. In W~urtembeIrg  no man is




IMARIAGE.                          5
allowed to marry, under the age of 25, unless permission has
been especially obtained or purchased; in Saxony, a man
liable to serve in the army, may not marry under 21; in
Mecklenburg, men do not generally marry until 25 or 30,
and the women not much earlier, etc.  In Bavaria, the clergy
are held responsible for the support of those poor persons
whom they marry without permission of the authorities, besides being fined. In Norway, no one can marry until he
has satisfied the clergyman that he is able to maintain a family. —ROBERTON.
The consequences of these stringent laws are not always
good; for illicit intercourse is almost necessarily at a premium, and it is a lamentable truth, that in the whole of South
Germany, more illegitimate children are born, than legitimate.
With great show of justice, it is asserted, that a girl is
hardly fit to receive attention in view of a future Marriage relation, before her lSth year.; at which time her understanding and discrimination are fully awake to guide her to a proper selection. If she then has been sufficiently in the company of men, and has perhaps tried her heart and hand a little
with a few innocent flirtations, she may be able, with her parent's assistance, to appreciate understandingly the character
of those who approach her, and make a wise selection. It is
his firm conviction, that the female constitution is only sufficiently consolidated and established at 21 years of age, to allow of Marriage, without injury to health and comfort.  A
few exceptions to this rule may be found, in which girls of 18
have acquired the mental and physical perfection, which the
majority only attain some years later. But then some naively say, a young lady of proper age and health of body and
mind, ought to marry as soon as she and her parents are
firmly convinced that she has found a worthy partner; and
no trifling cause should be allowed to divert her from  the
path of duty and happiness which nature intended her to follow and enjoy.  No petty selfishness, no fear of hardships or
troubles, should influence or agitate the mind to such an ex



6        PItEGNANCY, PARTURITION,  AND LACTATION.
ent as to suppress the kindlier feelings of her nature, at a time
of life, when it is naturally the most capable of exciting and
reciprocating love.  They take this grouncd because it is also
assumed that a greater degree of health generally attends
wives and mothers, than those who remain unmarried.
CONCEPTION.
The monthly development of ovules or germs of future beings, in the ovaries of the female, has been sufficiently dwelt
upon in my book upon the Disorders of M3enstruation. (See
pages 2 and 3).  As a matter of course, the most propel period for conception, or fecundation, will be that immediately
before orafter the flow of the menses  in fact, RACIBOSKYx has
actually ascertained that conception took place a little before
or after menstruation, in 15 females, all of whomn could designate precisely the period of exposure. CAZEAUJX truly says, it
is very evident that everything seems admirably prepared at
this period for the reproduction of the species; still he does
not believe that the aptitude for fecundation in the human
race is always limited to a few days, either preceding or following the menstrual periods; because he thinks that the excitement during intercourse may communicate itself to the
ovarian vesicles, and cause changes in them altogether similar to those experienced at the menstrual period.  Still, those
persons who are anxious to increase their families, had better
select the periods comprising a few days before and after the
monthly period, as the most proper time for that purpose.
While those, who for the various reasons of health, poverty,
&c., are necessarily obliged to have as small a family as the
exigencies of life will permit of, should at the very least exert
self-control at these times.
CAZEAUX sayS, it is extremely difficult, if not impossible, to
fix a precise period at which the fecundated ovule actually
reaches the cavity of the womb; in fact, it is extremely probable that the time varies, and in the present records of science there is no proof that such ovules have been seen in the
uterus of a woman, prior to the 10th or 12th day after concep



CONCEPTION. 
tion. This period coincides with that of the formation and expulsion of the delicate decidual membrane or cast, which, according to POUCHET, is found in the cavity of the womb at
every menstruation, even in virgins.
All these facts agree with the latest scientific assumption,
that the periodical monthly returns of ovarian activity and
congestion, tend to the growth, development, and expulsion
from the ovaries into the womb, of the ovules or germs of
future beings, one of which is sacrificed at each monthly period, unless conception take place; while the simultaneous
periodic activity and congestion of the womb tends to the
production of the envelopes or membranes, which should enshroud the germ, and if conception take place, to the proper
supply of it with blood, and materials for growth and development.
It is almost always desirable to ascertain the exact date of
conception.  CAZEAux thinks that the woman is apt to experience an emotion of painful pleasure, and a shuddering, preceding from the spine, pain in the region of the navel, sometimes a sensation of motion in the abdomen, and uneasy feelings in the region of the hips, followed by languor, fatigue, and
sleepiness, and the next day, by a sense of fulness, warmth, and'heaviness in the abdomen. With the aid of some such signs,
CAZEAUX says, that some females, especially those who have
already had children, are able to distinguish a prolific intercourse  he has met with too many women who are thus
adept, not to believe there is some truth in their assertions.
PREGNANCY.
This state commences at the instant of fecundation, and
terminates with the expulsion of the child from its mother's
body; it is supposed, on an average, to continue from 270
days, or 9 solar months, to 280 days, or 10 lunar months 
some authors think the labor is particularly apt to set in at
the exact time of what would be the 9th or 10th monthly
period after the "' suppression of Pregnancy."  We will say a




8        IPREGNANCY, PARTURITION9 AND LACTATION.
few words here on this point, as a woman scarcely imagines
that she has conceived, before she begins to calculate when
her Pregnancy will probably end. We are sorry to say that
there is a great variety in the length of gestation; there is, in
fact, according to IMERRIMAN, often a difference of 56 days
between the two extremes of natural, but early delivery, and
natural, but retardedj labor; he thinks that nearly 5 per
cent. of all women overrun the average term of 9 months, by
as much as 10 or 12 days.
[MERRIMIAN has furnished a summary of 150 gestations, in
each of which he noted theiprecise day of the menses' last
appearance. Of these,
5 women were delivered in the 37th week, Z. e., in fromz 252
to 259 days.
16 in the 38th week, orin from  262 to 266 days.
21   "   39th   "6             "  267 c6 273  "6
46   6   40th   G"    "    c  274 "' 280   " 
28   c   41st    cc"    "      6  281 " 287T 
18   "   42d       "    "      6  288 " 294   "
11   "   43d             66   6G  295     301   "
5   c   44th    6"        c     303 " 306   "
In my book, on the Disorders of Menstruation, it has been
shown, (see pages 16, 17, 21, 22,) that the period of regular
menstruation varies in many females; only from  61 to 71
per cent. following the 4-weekly, or lunar monthly, or 28 day
type. Hence, if the time of delivery is a multiple of the
menstrual period, those women who follow the 3-weekly menstrual type will probably have a delivery differing in time
from that of those who follow the 4-weekly, or 6-weekly type.
Again, as many women conceive just before an expected
menstrual period, which is then unexpectedly suppressed,
they are apt to commence their calculation from the period
before, and thus make their preparations for delivery, 2 or 3
weeks too early.
As soon as conception takes place, the consequent increased
flow of blood towards the womb sensibly increases, first the
volume of the uterine walls, and subsequently dilates their




PREGNANCY.                         9
cavity. This increase of size and volume is also kept up and
soon augmented by the deposit of some plastic and coagulable
lymph, probably merely an increase of the delicate deciduous
membrane, or cast, which we have seen is formed at each
menstrual period; but long before the arrival of the impregnated ovule from the ovaries and fallopian tubes, a kind of
pouch or vesicle has been formed in the womb for its reception, and to which ovologists have given the name of caducous
membrane. As soon as the ovule has arrived in the womb,
the uterus begins to develope, and its volume continues to
increase until the end of Pregnancy; but this progression in
the size of the womb is not uniform, for, according to the
observations of DESORMAEAUX, it is much slower in the earlier
months, and much more rapid in the later. According to
CAZEAJX, an accurate idea of this increase of the womb may
be formed from  the following table, which represents the
usual dimensions of the womb, at the principal periods of
Pregnancy.
Vertical diameter.  Transverse.  Antero-posterior.
3d month    23 inches          2  inh          2  inches 2.
4th-   4        33   "                 31           3 " 4
6th   "       83  6"           61  a           64 
9th   " 12 to14  "             9    "       81 to 91 
During the first three months, the womb, from its increase
or weight, settles or sinks lower down into the body; its base
or upper part is tilted a little backwards, and its neck is
advanced slightly forwards; besides, the presence of the large
bowel (rectum) on the left side, generally obliges the body of
the womb to lean over towards the right, and its neck is consequently directed a little to the left.  About the 3d month
and a half, or the 4th month, the womb, no longer finding
sufficient room  below, begins to rise or grow upwards; in
doing this, it leans towards the right side, at least 8 times
in 10. There are sufficient anatomical reasons for this right
lateral obliquity, but most old women think, that the sex of
the child exerts a decided influence upon the position of the
womb. As the womb rises, the bladder is also gradually




10        PREGNANCY, PARTURITION, AND LACTATION. 
pushed upwards, and its neck is more or less compressed, so
that an annoying vesical tenesmus is often produced by the
pressure exercised upon its neck and body by the womb, the
female being tormented by frequent ineffectual efforts to
urinate; these demands are always very urgent, and are
satisfied with the discharge of a few drops of urine, but are
again reproduced, with equal intensity, some minutes after.
It is proper to add, that the quantity of the urine is not generally augmented, although some persons, judging from the frequency of the discharges, have thought that it was.  It is
also right to state, that the irritability of the bladder, in the
earliest stages of Pregnancy, proceeds from  secondary congestive swelling of the neck of the bladder, rather than from
any pressure of the womb.  Pregnant women are also habitually costive, so that a voluminous tumor is apt to be formed
by the rectum, when distended with fecal matters, whereby
the whole intestinal canal is compressed, and often gives rise
to colics, and troubles in digestion.  The ovaries, too, being
adherent to the womb, are gradually carried upwards, and as
they are more sensitive than in the non-pregnant state, and
are less protected by the soft walls of the abdomen from
external injury, than when low down in the bones of the pelvis, and perhaps also rather more exposed to the influence of
cold, we are apt to have attacks of ovarian congestion and
inflammation occur, which may be the more readily overlooked and maltreated for colic, as these organs, in the latter
months of Pregnancy, are to be found as high up as mid-way
between the navel and hip-bones.
As the nerves and sensibilities of the womb are rapidly enlarged and increased during Pregnancy, so are all the distant
sensibilities or sympathies of the womb speedily aroused.
Among these, those of the stomach are among the earliest and
most common; in fact, nausea and vomiting is so common a
symptom, that most females are afflicted with it, and it frequently colmmences in the very earliest stages; whence many
women, taught by their feelings in former Pregnancies, recognize it as an almost certain sign of a new gestation.  At




PREGNANCY.                       11
times, however, it does not appear till the 3d or 4th month,
though seldom later than that; but it is not at all uncommon
to see it reappear near the end of Pregnancy, in some who
have been frequently tormented in this way, at the beginning.-CAZEAUX.
The breasts, which must be considered as appendages of
the uterine organs, quickly commence those changes preparatory to the accomplishment of the great function to which
they are destined soon after delivery; thus, in the very commencement, most women find their breasts to become tender
and swell up, and with some, this is so constant a sign, that
they do not hesitate to consider themselves enciente as soon
as it is perceptible.  The enlargement is fiequently attended by certain pricking sensations or positive painsj sometimes even by engorgement or enlargement of the glands of
the arm-pits. About the end of the 2d month, according to
oVIONTGOIMERY, but a little later, in the opinion of CAZEAUX,
the nipple begins to swell, becoming more erectile, more sensitive, and forms a more marked eminence: its color is also
deeper. The surrounding skin becomes the seat of a larger
afflux of blood and fluids, it becomes discolored, exhibiting at
first a bright yellowish tint, but soon becomes much darker
colored. MONTGOMERY, SMELLIE, and I-uNTEn, thought that
the changes which take place in the areola or circle around
the nipple, were positive evidences of Pregnancy; and the
latter celebrated surgeon, in one extraordinary instance, did
not hesitate when examining the dead body of a young female
in the dissecting room, to pronounce her pregnant from this
sole indication; as the examination proceeded, the hymen was
found still intact, but even this had no influence in changing
his opinion, and when the womb was opened, its correctness
was fully confirmed.-CAz EAUTx.
As these changes about the nipple are very important, and
easily verified by the woman herself, or at the very least, do
not compel a very disagreeable examination on the part of the
physician, it is but right to give them  in detail. The light,
rosy circle around the nipple becomes darker in color, vary



12        PREGNANCY, PARTURITION, AND LACTATION.
ing in depth of shade according to the complexion of the individual, being generally darker in those who have dark hair
and eyes, and in brunettes, than in blonds, or in feeble and
delicate women.  The circle is from - of an inch, to 1 inch
and a quarter in extent; the color grows darker and darker,
as Pregnancy advances, and affords anything but an agreeable
change to the eye, from  the delicately colored areola of the
virgin.  On the surface of this dark ring, but more especially
at that portion of it which surrounds the base of the nipple,
a number of small, immature, wart-like elevations, or granules, varying from 12 to 20 in number, soon appear, and attain an elevation of 1 or 2 lines above the surface of the skin.
These little knobs are formed by the enlargement of the sebaceous glands about the nipple, and apparently have an excretory duct, because, by pressing upon them, a serous, or serolactescent liquid may be made to ooze out.
At a later period, say about the fifth month, some small,
irregularly circular, freckle-like spots begin to show themselves upon the breast, immediately around the dark and
warty areola just described, and resembling the stains caused
by the sprinkling of a colored liquid, thus constituting another, but spotted and stained areola, which is not so well defined
as the first and smaller, darker and granular one, and in fact,
it not unfrequently affects a greater part of the skin covering
the breast, and then resembles the so-called " moth," or liver
spots, which so often appear on the face, neck, and hands of
some pregnant women, resembling large fieckles.  About the
same period of time, a number of large veins are seen distributed over the surface of the breast, and send numerous
small branches towards the small, dark areola around the nipple, and some of the smaller veins even traverse it. Along
the course of these veins, we may occasionally observe some
brilliant lines, closely resembling those foucnd on the skin of
the abdomen of pregnant women, though they are more marked in those females whose breasts were but slightly developed
before conception, but had experienced a sudden and rapid
increase of size. These silvered threads, or hairs, remain for




PREGNANCY.                      13
a longer or shorter period after delivery, and are sometimes
serviceable in a me(lico-legal point of view, in proving that the
female has had a child, although they cease to be of any value
as a diagnostic sign of her subsequent Pregnancies. These
changes about the nipple usually persist during lactation,
though when the woman does not suckle her own child, they
soon diminish after delivery, but do not wholly disappear;
hence they are more conclusive about the first child, than of
the others. Whenever they are found, they constitute an almost certain sign of Pqegynancy, and the physician may pronounce with great confidence the existence of Pregnancy in a
young woman who has never borne children, and whose
breasts present both a brownish colored areola around the
nipple, the granules, or small warts, or tubercles upon this
areola, and the freckled appearances around it, just described.
-CAZEAUX.
There are also important changes in the urine of pregnant
women, and probably connected with and dependent upon
the changes in the breasts. These changes in the character
of the urine are also very important, as they occur at a very
early period of Pregnancy, and with a little instruction, may
very easily be verified by the woman herself, or if needs be
by the physician, without any great encroachment upon the
modesty of any sensible married woman.  CAZEAUX says: for
several years past, the attention of a number of physicians has
been directed to certain changes exhibited by the urine of
pregnant women, but to NAUCHE is due the principal share of
the honor of this discovery; according to this accoucheur:
If the urine of a pregnant woman be received in a wineglass, and then permitted to settle in a light airy place, a nunmber of little white bodies, or corpuscules, will be found in suspension, but soon subside in the form of cloudy flakes, either
on the bottom or sides of the glass, the urine in the meantime becoming more limpid and transparent. This primary
deposit does not always occur, and is not absolutely peculiar
to the pregnant state; but in the course of 18 or 24 hours, a
number of small, brilliant, crystalline granules appear on the




14        PREGNANCYO  PARTURITION, AND LACTATION.
surface of the urine; at first, these granules are irregularly
isolated, and in some instances unite, so as to form  a thin
transparent layer, or pellicle, upon the surface of the water,
wvhich may only be observed when the glass is held obliquely.  The urine may remain in this state for several days,
though it may soon begin to manifest still more peculiar
signs of the presence of Pregnancy.  On the 2d, or during
the course of the 3d day, the whole of the urine becomes
clouded, and a decided scum or pellicle may be discerned,
formiing at first like a nebulous train, but soon acquiring
larger dimensions and greater thickness; all these characteristics are still more evident on the 3d and 4th days, when
small particles begin to fall from  the scum or pellicle, to the
bottom of the glass; by the 5th or 6th day, the first pellicle is
almost entirely destroyed, and Ihas settled to the bottom of the
vessel, forming a white crust there, but a new pellicle again
begins to form on the surface of the urine, less white than the
ilist one, and studded with little brilliant points, having a crystalline lustre, and a greenish tint, in place of the previous
milky appearance.  In the few succeeding days, the urine
evaporates more and more, and becomes thicker and greener;
finally, only at this late period putrefaction begins, and the
second pellicle is destroyed in turn, to make room for a third,
which is not nearly so characteristic in its appearance as the
second, and in fact resembles more or less closely that formed
on ordinary urine.  The characteristic pellicle resembles the
layer of fat that floats on the surface of cold broth, and it retains these characters for a long time, and gives off, especially
when thick, a strong cheesy odor.  The substance forming
the pellicle has been denominated eKiesteine, (fioml  xin!,s, swg,
gestation,) by Dr. NAUCHE, signifying the'product of Pregnancy; it rarely fails to develope itself in the urine of pregnant
womlen; in 85 cases, it was perfectly distinct in 68; slightly
but not very well marked in 11 more; and only absent in 6,
in most of whom  there were causes sufficient to account for
its absence.
The urine of healthy women, who are not pregnant, ex



PREGNANCY.                        15
hibits nothing similar to this, and if it any time furnishes a
pellicle, it has not the distinctive characteristics of Kiesteine.  The pellicle, which occasionally forms on the urine of
persons affected vwith consumption, affections of the joints,
catarrh of the bladder, or metastatic abcesses, does not
appear before the 5th or 6th, and is the product of putrefaction, whereas the true Kiesteine-pellicle appears on the 2d
day, is then developed slowly, and is quite independent of
putrefaction; its specific gravity is also greater than that
produced by any disease whatever. The formation of Kiesteine
in the urine is intimately associated with the formation of
milk in the breast; Drs. KA-NE and GOLDING BIRD attribute
it to an admixture of milk with the urine, and think that
as soon as the least quantity of milk is formed in the breast,
it will appear in the urine.  Dr. KANE has frequently proved
the presence of Kiesteine in the urine, at different periods of
Lactation; thus, in 44 suckling women out of 94, the perfect
IKiesteinic pellicle was developed, with all the characters it
exhibits during Pregnancy, and it was nearly always in
those cases where the flow of milk was limited, or rendered
difficult by some particular circumstance, and in which the
breasts were consequently more or less gorged, that Kiesteine
appeared in the urine, but it was found much more rarely
after delivery, whenever the mother nursed her infant, or her
breasts were properly drawn.  In short, the existence of liesteine during Pregnancy, and even after delivery, up to the
establishment of suckling, and its rare existence during Lactation, and its reappearance when suckling is suspended or
impeded,. at the time of weaning, for instance, serve to establish an intimate relation between the functions of the breasts,
and the Kiesteinic urine.-CAZEAUX. The prevalent theory is,
that soon after conception a small quantity of milk is formed
in the breast, and as it is not yet wanted for the child, it
is absorbed into the system, and thrown out of the body
through the agency of the kidneys; in proof of this, it is
well known that one of the earliest signs of Pregnancy, is
the formation of a small quantity of milk in the breasts, which




16       PREGNANCY, PARTURITION, AND LACTATION.
either oozes from, or may easily be forced from the nipples.
TANCHOU has observed Kiesteine in the urine of women who
had failed but once in their menstruation; KANE once detected it before the expiration of the 4th week, and again,
just prior to the 5th; the peculiar characteristics habitually
appear in the second month of Pregnancy, and acquire their
greatest development from  the 3d to the 6th month.CAZEAUX.
But the sign upon which most women rely is: Subppression
of the mennses.   Most females cease, it is true, to be regular
during Pregnancy; and, in fact, this is a law of such general
truth, that whenever it occurs in a healthy married woman,
without known cause, and is not attended with or followed by
disease, it is justly regarded as one of the most certain signs
of Pregnancy; but it is not generally known how frequently
one profuse menstrual flow occurs soon after conception, and
thus obscures the calculation as to the time of delivery. Again,
it is not uncommon in some young married women, who had
hitherto been quite regular, for the menses to become at once
suppressed, and to continue so for several months, without
other klown cause, than that the suppression has probably
resulted from the fatigue and excitement of the preparations
for marriage, or from the derangement produced by the natural shrinking and fear of modest women, from  close contact
with man. This accidental and temporary suppression may,
or may not, soon be converted into the suppression of Pregnancy; but in both cases, it is frequently accompanied by anz augmented volume of the abdomen, together with increased sensitiveness of the breasts, and as the mind so readily believes
what it either most ardently desires, or especially dreads,
nothing more is wanted in some cases, to found a hope or fear
of commencing Pregnancy.  Hence the physician must exercise a little discretion, when consulted for an opinion on such
a delicate subject. The menses may also continue during the
earlier months, or through the whole term of Pregnancy. This
subject will be treated of more fully hereafter.
hMost women quickly look for some alteration in their size




PREGNANCY.                      17
and shape, as soon as they imagine themselves pregnant; but
so many circumstances may cause an augmentation in the
size of the abdomen, that but little value can be attached to
this sign, unless corroborated by others. In fact, unless there
is, as is commonly the case, an increased formation of wind
in the stomach and bowels, the lower part of the belly isflatter during the first month after conception, than it was before,
probably because the womb settles down lower into the hips,
from its increased weight.  But generally, there is a peculiar,
but transient enlargement of the lower part of the abdomen,
soon after conception; but this is owing to a collection of wind
in the bowels, excited by the neighboring irritation of the
womb, and disappears after the lapse of a few weeks, when
the bowels have become accustomed to the unwonted stimulus; hence the actually pregnant woman often seems smaller
at the end of the 2d month, than during the first. But at the
beginning of the 3d month, or at 3 months and a half, the
lower part of the body suddenly becomes more prominent,
and the enlargement is thenceforth regular and always increasing, up to the full term of gestation.
In the earlier weeks of Pregnancy, the navel is also supposed to appear more depressed, or sunken than natural; its base
seems to be drawn downwards and backwards, caused probably by the sinking down of the womb into the pelvis, which
draws down the top of the bladder with it, and consequently
drags upon the urachus, which extends from  the bladder
to the navel. The circumference of the navel is apt to become the seat of a distressing feeling of weight, and is more
sensitive to touch and pressure, and this increased sensibility
sometimes extends over a considerable portion of the belly.
But at the end of the 3d month, i. e., as soon as the womb
begins to rise, the navel resumes its natural condition, and
finally becomes decidedly more prominent.
Finally, when Pregnancy occurs, it is generally attended
with some slight constitutional disturbance; there is necessarily
local congestion, or determination of blood to the womb, for the
support of the embryo contained within it. The consequence
B




18        PREGNANCY, PARTTURITION, AND LACTATION.
of this increased local action in so important an organ, and one
so liberally supplied with blood-vessels, nerves, and absorbents, is, that various symptoms arise affecting the system at
large; it is impossible for one part of the system to suffer'
without some other being almost simultaneously affected.  In
addition to this local congestion of the womb during Pregnancy, we have for the most part, though not invariably, a
state of moderate general plethora: there  being, under the
circumstances, a greater demand for blood, there is also a tendency to the formation of an increased supply of that important
fluid. The whole nervous system is also affected, and in consequence of these two causes combined, an irritable (in ordinary healthy cases, we cannot call it febrile) state of the system
is induced. The general circulation is more active in pregnant
women than in others, and this increased activity manifests
itself by a greater frequency of pulse; in fact, it is often harder
and more full than in the non-gravid state.  The blood drawn
from a vein generally exhibits a buffy coat, similar to that in
inflammatory diseases, its clot being both more voluminous
and more consistent than usual; sometimes, however, it contains a great deal of serum, the clot being small, but still covered with a whitish crust.  This condition, which may be considered as the normal one in gestation, is occasionally aggravated, and then general full-bloodedness, or fever may set in.
Pregnancy is also apt to be attended with changes of moral
temperament, and these changes, for convenience of description, may be divided into, 1st, despondency, 2d, irritability,
3d, hysteria, and 4th, mental derangement.-ANDERSON.
It not unfrequently happens, that women, previously of a
happy, cheerful disposition, become low and desponding, and
possessed of the most gloomy apprehensions as to the result
of their expected delivery.  This condition undoubtedly depends upon the peculiar state of the system, existing during
Pregnancy, but may be induced in some instances by hearing
of, or seeing unfortunate cases occur in fiiends, or by reading
books on midwifery, and fancying that all the worst events
therein related must of necessity happen to themselves. For



MANAGEMENT OF PREGNANCYo                 19
tunately, this condition often passes off  before Parturition
occurs.
Sometimes irritation of mind predominates, and the patient
becomes excited and irritable, and although perfectly conscious of this temporary change in her disposition, has little
or no control over its demonstrations; hence every allowance
should be made for a misfortune, which is too often considered as a fault, and erroneously regarded as perfectly under
the control of the patient.
An opposite, and certainly more desirable state occasionally shows itself, for the naturally  morose and irritable
female may, for a time, assume that mild and happy state,
which should be her natural one.
Finally, women who have already had children, have signs,
which indicate more or less certainly for them, individually,
the commencement of Pregnancy; thus, some always have
toothache, styes on the eyelids, or dark spots on the face,
neck, and hands, like 6 moth," or freckles; others are taken
at once with salivation, or have strange desires, or longing
for unusual articles of food, or sudden fainting fits. IIPPOCRATES thought, that immediately after conception, the eyes
become more sunken and languishing, and surrounded by
bluish circles, while the face seemed altered and thinner, and
reddish spots, or blotches made their appearance.
The more serious changes of body and mind will be treated of among the disorders of Pregnancy.
MANAGEMENT OF PREGNANCY.
TICKNOR's rules are:
1. That the woman should avoid all unnecessary, and especially violent exercise, or exertion; such as too fast walking,
running, dancing, &c.
2. To avoid all situations which may subject her to unpleasant sights, or seeming dangers.
3. To shun over-heated rooms, and stimulating liquors of
every kind.
4. To avoid all substances that have a tendency to produce




20        PREGNANCY, PARTURITION, AND LACTATION.
a costive state of the bowels, or those which give rise to indigestion, as rich food, late suppers, &c.
5. To take no substances, or drug, that shall give too frequent and too severe motion of the bowels, or such as too
severely constipate them, and especially not to disregard the
calls of nature, when they may be successfully attended to.
6. To remove from the chest, waist, abdomen, and limbs,
every compression or restraint, lest undue pressure should be
made upon them.
7. To avoid all substances that may have a tendency to
increase the irritability of the system, such as strong tea,
toffee, opium, and the too long indulgence in bed.
8. To shun all severe study, and night-watching.
9. To avoid the indulgence of all inordinate appetites.
10. Not to fear that her child will be marked, because certain longings have not been gratified.
11. Not to be apprehensive of evil consequences to her
child, because she has been disappointed, or frightened.
12. To guard against any sudden gust of passion.
13. To solicit and attain, as far as possible, tranquility and
equanimity of mind.
14. To turn a deaf ear to all tales of disaster, or horror,
which purport to have happened to a pregnant woman; for,
on investigation, they surely will nearly all prove to be false.
15. Not to indulge in gloomy forebodings, or unreasonable
fears for the event; nor to forget how rarely death happens,
during, or after a well-conducted labor.
16. Let her make up her mind to bear with manifold inconveniences during her Pregnancy, and some pain at the
time of her confinement; and, above all, to feel convinced that
the safety of labor does not depend upon the celerity with
which it is performed.
17. Let her be passive and obedient, feeling assured that
her friends and physician understand and feel for her situation and pains, and will faithfully relieve her of all that can
safely be spared her.
18. To examine carefully whether the nipples are of the




MANAGEMENT OF PREGNANCY,                21
proper size and shape; for there is much more danger of suffering with sore nipples, and broken breasts than any more
serious affection after confinement. In many instances the
nipple is naturally deficient, or has been so thoroughly comn
pressed during girlhood, married life, and Pregnancy, by tight
clothing, that after confinement there will be nothing that
can properly be called a nipple to be found. The suffering
then endured by the mother, if she attempts to nurse her
babe, is often dreadfully severe. TRACY suggests a very simple and efficient plan in these cases; it consists in winding
a bit of woollen thread or yarn two: or three times around the
base of the nipple (which has previously been drawn out sufficiently), and tying it moderately tight, but not so tight as to
interfere with the free circulation of the blood. Thus, the nipples may be kept permanently and sufficiently prominent; the
woollen threads may be worn constantly for many days without the least inconvenience, and with permanent good results.
From the very commencement of Pregnancy a state of mental tranquility is indispensable for the woman. Most women
believe that a strong impression upon the mother's mind may
communicate itself to the foetus, producing marks, deformity,
&c.; it would be far better for them to believe equally strongly,
that anger, jealousy, unfounded repinings and griefs, excessive irritability of mind and temper, &c., may be impressed
upon the unborn baby's brain and nervous system, rendering
it weakly or nervous, passionate or morose, mischievous or
unhappy, &c., &c. It is of the greatest importance that sincere and well-directed efforts should be made, and steadily
persevered in, by pregnant females, to keep down those injurious and degrading feelings and irregularities of temper, especially when the exciting causes of them  cannot be entirely
avoided. Apart from  those more serious accidents which
are often held up in terror to fractious and obstinate women,
the functions of the stomach, liver, &c., are strongly influenced
by the mind, and debility, indigestion, jaundice, and various
other functional disorders, may be added to the burthen of troubles which almost every pregnant woman is called upon to en



22        PREGNANCY5 PARTURITION, AND LACTATION.
dure as best she may. It is true, indeed, that accidents and
misfortunes often bring grief, sorrow, and distress, with a
force and pungency that no human heart can altogether resist;
but fretfulness and moroseness of temper, envious and jealous
feelings, peevishness, hatred, discontent, obstinacy, and perverseness of disposition, are to a certain degree under the control of reason, and a sense of propriety; although every woman
and physician knows, tlat, owing to the unusual irritability of
the physical system, induced and maintained by the state of
Pregnancy, the difficulty of controlling the feelings often becomes peculiarly great; but, by resisting with constancy and
firmness, the indulgence of any thoughts calculated to give
rise to any, and all unhappy emotions (for the emotions are in a
great measure dependent upon the thoughts), very much may
be done to secure both health of body and peace of mind.TRACY. When the woman has done all that lies in her power,
the province of the physician commences.  Much may be
done by means of remedies addressed to the stomach, liver,
bowels, kidneys, or nerves, if these be disordered; still, more
may be accomplished by remedies which act directly upon
the brain and nervous system.
Whlen there is anxiety, as iffrom? some pending misfortune,
Niccol., Kali hyd., Iod., Helleb., Verat., Mlezereum, Anacardium, Clematis, Agaricus, Alumina, Baryta, or Arsenicum,
may be indicated.
Those ladies who are exceedingly sensitive about their situation should use Baryta; for, according to Hempel's Complete Repertory, this remedy is indicated when a woman fancies, while walking in the street, that people are laughing at her,
and are criticising her, to her disadvantage, so that she dares
not look at anybody, and breaks out into a profuse perspiration from shame and fear. This remedy is peculiarly suitable
for those mothers who, according to Guernsey, attempt to
conceal the rotundity of their form, either from shame or some
other reason, with tight dresses, large shawls, or corsets tightly
laced.
When there is anxiety about thefuture, CICUTA may be'used,




MANAGEMENT OF PREGNANCY.                23
especially if the patient is extremely fearful that something
dangerous will occur.  If she is exceedingly apprehensive
of future suffering, Lauroceeasus may be given. When there
is great anxiety about the future, with sadness and weeping,
-Digitalis. If the patient is apt to become vexed, angry,
and impatient, when thinking about the future, Spigelia.
If she is apprehensive, and  thoughtful when  thinking
about her present state and future destiny, Anacacrdiun.
When the apprehension amounts to anguish, followed by
severe headache,.Et/hsa cynapcim.
When there is a fear of dying, DIGITALIS and INux. If
she wishes to be alone, and imagines that she will shortly die,
Cuprmin. When she has frequent thoughts of death, Coniun,;
with sadness, Grpchite. When she imagines that she will
soon die, although she is not sick, Nitric acid. When there is
apprehension of death, with difficulty of breathing, Lobelia,
although Ledum, Rhus, Sulph., Carb. an., Agnus castus,
Ammon. c., Ars. Asaf., and Baryta also deserve attention.
When the patient is apt to have strong antipathies against
many persons, Conium, Cicuta, Aurum, Ammon. mur., and
Calcarea may be used. When there is an antipathy against
many things, Camphor and Pulsat.
If she is apt to get angry at trifles, Bell., Ipec., Cham.,.Aurum, Nux, Petroleum, and Sepia.
When all her ailments. seem very distressing, and she is
very dissatisfied, Sepia, Petroleum, Puls., and Aurunm.
If she is inclined to find fault with everything, Arsen.,
Borax, Verat., and China.
If the patient and physician do their part, according to the
best of their abilities, the husband must also do his. He
must never forget the mutual love which should exist between
husband and wife, and that indulgence and charity for all
natural defects, tempers, inconveniences, and infirmities of
life, with which his wife is now peculiarly beset. No man can
form  an adequate idea of the manifold inconveniences and
annoyances to which a woman is subject while pregnant; and
it is incredible how much a wife often has to bear, when she




24        PREGNANCY, PARTURITION, AND LACTATION.
can least endure it, from a husband who is thoughtless, capricious, selfish, haughty, choleric, or dyspeptic, and intractable.
Still, however great the trial, the woman should never forget the importance of maintaining a proper state of the mind
and feelings; the effects of the contrary course descend to the
infant, and often seriously affect, if they do not absolutely determine the general disposition and many of the mental characteristics of the child. Many parents will, unfortunately,
have plain and unmistakable illustrations of the truth of this
assertion in their own families; it is against the production of
mental, rather than physical deformities in their offspring,
that pregnant women should be on their guard. The mental
state of the mothers of Napoleon and James the First of England, just previous to their confinement, may be cited as apt
proofs of the above assumption.  Napoleon's mother partook
of the dangers of civil war, and is said to have accompanied
her husband on horseback on some military expeditions,
shortly before being delivered of the future emperor; but the
mind of Napoleon's mother appears to have risen in proportion to the danger to which she was exposed, braved it, and
triumphed over it; while the circumstances in which Queen
Mary was placed were calculated to inspire her with fear
alone.  The murder of Rizzio was perpetrated by armed
men, with many circumstances of violence and terror, in the
presence of Mary, Queen of Scotland, shortly before the birth
of her son, afterwards James the First, of England; and the
constitutional liability of this monarch to emotions of fear, is
recorded as a characteristic of his mind; thus, he often started
involuntarily at the sight of a drawn sword, while Queen
Mary herself was not deficient in courage, and the Stewarts.
both before and after James I., were distinguished for their
valor, so that his cowardice was an exception to the family
character.I-RYAN.
Although the popular traditions which render many women exceedingly solicitous lest their infants should suffer
some physical deformity, through the influence of their own
minds, has but little truth in it, still it may be expected that




MANAGEMENT OF PREGNANCY.               25
some remarks should be made upon this point. TICKNOR
says, it is rather singular that women almost universally believe that a strong impression upon the mother's mind, may
communicate itself to the fcetus, producing marks, deformities, &c., while a majority of medical men ridicule the idea
as a great absurdity. To set the matter at rest, fairly, the
late Dr. WILLIAM HUNTER, of London, investigated this point
at the Lying-in Hospital, to which he was attached. In every
one of 2000 cases of labor, as soon as the woman was delivered, he inquired of her whether she had been disappointed
in any object of her longing, and if she replied in the affirmative, what it was;-whether she had been surprised by any
circumstance which had given her an unusual shock, and
what that consisted of;-whether she had been alarmed by
any object of an unsightly kind, and what that was. Then,
after making a note of each of the declarations of the women,
either in the affirmative or negative, he carefully examined the
child; and affirms, that never in a single instance of the 2000,
did he meet with a coincidence. IHe met with blemishes,
when no cause was acknowledged, and found none when it
had been insisted on.-BULL. But too generally the minds of
women are made up upon this subject, and their faith cannot
always be shaken by any argument which can be used. The
best safeguard against any bad consequences to the mother,
is to make a full and candid confession of her fears to her
husband, physician, mother, or some judicious friend; but
many allow the idea to haunt their imaginations night and
day, and become wretched and miserable, because, ashamed
of their weakness, they will impart their secret to none; they
will hardly confess it to themselves, yet does the impression
deepen upon their minds, and they look forward to the period
of confinement with the greatest dread and apprehension.
Thus, the whole period of Pregnancy is made a season of
needless trial, and suffering; and nothing pacifies their minds,
or can remove their long-cherished fears, except the birth of
an unblemished and healthy child.-BULL. TICKNOR shrewdly
advises, if any woman happen to be surprised by an unex



26        PREGNANCY, PARTUEITION, AND LACTATION.
pected sight, not to allow her mind to dwell upon it, but to
strive to eradicate the impression made, and substitute another
in its place; for the power ought to act both ways; so that if
it can m.car it also ought to unmar7c.
TICKNOR, also says, that all necessary advice in regard to
EXERCISE may be comprised in a few words.  Every kind of
exercise, or occupation that fatigues, or excites the circulation
should be avoided; so also, long walks, lifting, ascending
stairs, particularly in a hurry, dancing, riding on horseback,
or in a carriage, over rough roads.  But care must also be
taken not to run into the opposite extreme, that of being too
inactive.  If the custom has been to take considerable exercise before Pregnancy, let it be continued afterwards; only
let it be in moderation, such as riding in an easy carriage,
walking moderately, and the like. TRACY says, there is an
impression in some parts of the country, and more in England
than here, that pregnant women should carefully avoid exercise during the early months, and take more and more as the
time advances. But this is altogether erroneous, for during the
first few months, active exercise should be taken daily, to the
full extent of the powers of the individual, short, however, of
producing such fatigue as to interfere with quiet rest. The
exercise taken should be of such a character as will keep the
mind interested, and the body in more or less constant motion; gentle fatigue should be induced by continued moderate
action, and not by violent exertion.  Such exercise as this,
will operate most favorably as a preventive of a multitude of
the bad feelings which are apt to attend this state, and on that
account should never be omitted, unless for such reasons as
are connected with some peculiarity of the individual; as
for instance, a state of disease which renders active exercise
impossible without injury to the general health, or a tendency to abortion, when the patient may be obliged to keep
very quiet; but even then she should be in the fresh and
open air as much as possible.- As the time advances beyond
the fifth month, the amount of exercise should be diminished,
but gradually, until the expiration of the eighth month at least,




MANAGEMENT OF PREGNANCY.                 2T
if not longer; but generally during the last two weeks, the
patient feels brighter and easier, and feels more disposition to
move about than for some time previously; there are no objections to an increase of exercise then.-TRAcY.
The DIET should also be well regulated. Notwithstanding
the morning sickness and vomiting during the early periods
of Pregnancy, the appetite is frequently very craving, especially after the morning sickness has subsided, and an improper indulgence in rich and high-seasoned food, is among the
most common errors of females during this period. This
error is the more apt to be committed from the incorrect idea
entertained by many that, as the child draws its nourishment
firom the mother's system, a greater quantity of food is required during Pregnancy, than at other times. But there is
in many women a strong tendency to a plethoric, or fullblooded state of the system during Pregnancy, which, if not
counteracted, either by nausea or vomiting, or a properly
regulated and light diet, is very apt to produce unpleasant
consequences, such as headache, dizziness, a feeling of fulness,
or pressure within the head, and in the veins over the whole
system, swelling of the feet and limbs, piles, restlessness,
sleepless nights, and numerous other evils arising from the
taking of too much, or too nutritious food, and the consequent production of too much blood in the system. There
can certainly be no propriety in using such an increased
quantity of food that the system  becomes oppressed by it.
But it sometimes happens that the woman feels best after
having eaten more heartily, and then some latitude in diet
may be allowed, always doing so with caution, however, and
restraining it upon the first occurrence of any of the symptoms of over-feeding.-TRAcY. The appetite and taste are
generally altered by Pregnancy, and the vulgar attach great
importance to the different tastes and longings, and these, as
a general rule, may be gratified whenever wholesome aliments
are desired. TICKNOR goes even further, and says he has no
hesitation in saying, that when the longing is really urgent,
the risk of danger from indulging it'is much less than it




28       PREGNANCY, PARTURITION,  AND LACTATION.
would be from  disappointment; provided the craving is not
for anything absolutely disgusting, or injurious.  It is a fact,
though a remarkable one, that, in many cases where the
stomach craves really unwholesome articles, they maylbe
taken with impunity. This is well understood by most people; and it is generally believed that ill consequences never
result.  But this is a great mistake, for TIcKNOn has seen the
worst effects from this unnatural indulgence; and it must not
be forgotten, that when craving for unwholesome articles is
to be gratified, it must be done with the greatest caution, and
in moderation. When there is an appetite for charcoal, clay,
and other articles of this character, the case is one which
requires medical advice. A voracious appetite will require
a greater quantity of food than oredinary, but never so much
as to be injurious; a variable appetite may be satisfied by
frequent slight repasts; and a diminished appetite may be
stimulated by such food as the woman desires; but it is not
necessary for the growth of the fcetus, that the mother should
take more food than usual; she may take it to satiety.  Every
description of high-seasoned food, and the excessive use of
wines, liquors, ales, tea, and coffee, are highly injurious, both
to the mother and infant.  These liquors injure the pregnant
woman, and expose her to danger during Parturition, and to
fever and inflammation afterwards, while they arrest the
growth, and destroy the health of the infant. The simple
aliments, of the easiest digestion, and containing the most
nutriment in a small volume, are those most appropriate for
pregnant women.  They should take light repasts, and never
overload the stomach. The vulgar prejudice of advising them
to take more food than in a state of health, is highly pernicious, and induces indigestion, flatulency, spasms, diarrhcea,
and vomiting.  As before said, the appetite is capricious, and
hence the woman often fancies foods she disliked before conception, and dislikes those she always preferred. Thus, the
sight of animal food often disgusts some women for some
months. In short, the diet should consist of wholesome articles, such as beef, mutton, lamb, fowl, &c., either roasted




MANAGEMENT OF PREGNANCOY                  29
or boiled, in preference to broiled or baked; and all salted,
spiced, or smoked aliment ought to be taken sparingly, or not
at all, if the stomach is delicate, as they generally derange
it. The flesh of young animals, as veal, lamb, chicken, and
certain kinds of fish, are less nutricious than the other articles mentioned, and are therefore considered lighter.  Fatty
food, as pork, duck, eel, butter, oil, &c., generally disagree
with nervous, bilious, or dyspeptic persons, and those who
suffer from indigestion, flatulency, and lowness of spirits, and
especially during Pregnancy, when there already is more or
less tendency to nausea and vomiting. Farinaceous food, such
as bread, rice, potato, beans, peas, sago, arrow-root, tapioca,
and salep, are highly nutricious, though they may in some
cases induce heartburn, flatulency, and indigestion. Mucilagenous aliments, as carrots, turnips, parsnips, cabbages, and asparagus, ought to be taken but sparingly by pregnant women,
and those who suckle their infants, and then a little pepper
should be used with them.  Sweet foods, as sugar, dates,
fruits, &c., should be used in moderation.  Finally, as the
stomach is irritable and delicate in most pregnant women
during the first months, it is highly'necessary, both that their
food should be cut small, and then well masticated, to render
it more fitted, and more easily acted upon by the stomach;
and drink, too, should be used sparingly while eating, for if
the gastric juice be too much diluted, it cannot act upon the
food in an efficient manner.-RYAN. Most writers, and among
them BULL, are very decided about the propriety of moderation in eating; they assume that most persons habitually
take more food than is strictly required for the demands of
the body, in fact use a superfluity amply sufficient for the
wants of the child, for which only a very small quantity is
necessary. Nature corroborates this opinion, for almost the
first evidence of Pregnancy is the morning sickness, which
would seem to declare that only a small quantity of very
choice food should be taken. If the appetite in the earlier
months is variable and capricious, the woman should not be
too readily persuaded to humor and feed its waywardness, for




30       PREGNANCY, PARTURITION9 AND LACTATION.
she will very soon bring her system  into such a state that it
will require a larger supply than is compatible with her own
health, and that of her little one.  One marked exception
may be made to these general rules, viz., when the general
health was delicate and feeble before Pregnancy, but becomes
invigorated in consequence of this state, and the powers of
digestion increase, then a larger supply of nourishment will
be demanded and may be met without fear; for instead of
being injurious, it will be useful.  Finally, the female, toward
the conclusion of Pregnancy, should be particularly careful
not to be persuaded to eat in proportion of two persons, for it
may not only bring on vomriting, heartburn, constipation,
&c., but will contribute to the difficulties of labor, by the accumulation of impurities in the lower bowels.-BuLL.
Some of the alterations in the tastes and appetite of pregnant women require medical treatment.  Cocculus will be
found useful when there is an aversion to food and drink,
although the patient is hungry.  Colhicum, when the repugnance is so great that she shudders even when looking at
food, and still more when smelling it.  Cyclamen, when food
becomes repulsive after swallowing a little of it, followed by
nausea.  Gratiola and Manganese, when there is an aversion
to food, although it tastes well.  China, Arsen., and Sepia,
when the thought of food causes nausea. Sulphur, when the
patient has appetite, but aversion to food sets in on beginning
to eat.  lfoschus, when the sight of food makes one sick.
When there is an aversion to meat, Alumina, Bellad.,
Mere., Miezer., and MIuriatic acid may prove useful.  Causticum and Sulp)hur, when fresh meat causes nausea.  Ammon.
carb. and Zincuzm, when there is no desire for meat, or boiled
food.  IKali ccab., when food, especially meat, is repulsive.
Graphite, when meat and fish are repugnant, although the
former tastes well.
We have already alluded to the fastidious tastes, and capricious appetites of pregnant women; some will consider raw
oysters a great relish, though, previously to gestation, they
could not bear them; others cannot take cheese, although




MANAGEMENT OF PREGNANCY.                  31
previously fond of it; and some express a vehement desire
for fruit out of season, although they never longed for it
when it could be procured.  One lady always knew when
she was with child, by feeling a violent antipathy to wine
and tea, which at other times she took with pleasure, Mlany
have a strong aversion to butcher's meat, but one lady has
rendered herself celebrated, by a fancy to bite a baker's
shoulder, nor could she be satisfied, until the baker's consent
was purchased. DEWEES had a patient who was in the constant habit of eating chalk during her whole Pregnancy; her
calculation was three half-pecks for each gestation; she
finally became nearly as white as the substance itself, and it
eventually destroyed her; if she had been well dosed with
(icuta virosa, her life might probably have been saved. Another lady took a fancy to gin and water, which she drank
in large quantities; her child, when born, was small and
lanky, its voice was weak, its face wrinkled and ghastly,
and its belly collapsed; its skin  was mahogany colored,
and hung in folds all over its body; it finally died in convulsions; Arsen., Mosch., Silen., Hepar., or Sepia, might
have saved the baby's life, and mother's conscience.
The effects produced on the health of both mother and
child, are quite sufficient to show that the mother should
come under careful medical treatment, and that, in yielding
to these extreme fancies and caprices, we are incurring a mischief, instead of avoiding it.  Still the denial should be made
with gentleness and moderation, for these caprices generally
discover themselves by an air of pensiveness and dejection in
the mother; they are often very injurious and absurd, but entirely involuntary, and the woman generally continues anxious
and uneasy, till she has obtained her wishes. Frequently, whilst
women are under the influence of these desires, all reasoning
is thrown away upon them, and, if the proper homceopathic
treatment will not remove them, it may be proper to gratify
them  with the wished-for object, as abortion has often been
the consequence of a disappointment.  The success which is
said to attend the gratification of their desires, often renders




32       PREGNANCY, PARTURITION, AND LACTATION.
it difficult to deny them, and TULPIus boastingly cites the
case of a woman who devoured 1400 salt herrings during her
Pregnancy, and her infant was born equally fond of them,
and yet there was not a single mark of a herring, either
salt or fresh, upon its body.-CHURCHILL.
In many cases it is evident that the morbid tastes depend
upon disorder of the stomach, for the tongue is apt to be
coated, or even loaded, the mouth filled with viscid saliva,
and there are frequent eructations of glairy fluid, while the
patient is languid and dejected.
When there is a repugnance to milkc or butter, Carbo
veg., Arsen., China, Natrum carb., Puls., Ignatia, Phos., or
Bellad., may prove useful.
When there is an aversion for sweet things, Zincum, Sulph.,
Causticum, and Nitric acid, deserve attention.
When there is aversion to water, Bromine, Tobacco, and
China.
Aversion to fish, Zincum.
Aversion to vegetables, with desire for meat, Magnesia
carb.
Many unnatural desires may be overcome by the aid of
medicine. Thus, Cicuta is said to remove a great desire to
eat coal. Argen. nit., may overcome an urgent desire for
strong and acrid cheese. ScbacdiCa, when there is a ravenous
desire for sweet things, honey, dishes made of flour, especially
when alternating with aversion to meat.  Gratiola, when the
patient relishes bread only.  Sabina, Staphysag., Rhus,
Chelidonium, Bryon., and Phos. acid, are all said to give a
person a great desire and relish for milk. IHepar. sulph. may
remove a depraved taste for sour, and strong tasting food.
Conium  may be of benefit when the patient only desires
coffee, or sour, or salt things.  China, Lycop., or RAus, may
remove the excessive craving f6r dainties.  Arsen., Mosch.,
Silenium, Hepar, or Sepia, may aid in removing a depraved
taste for brandy, wine, or spirits. MAenyanthes and Graphite
may help in bringing about a healthy appetite for meat.
Silex and Verat. may eradicate the craving for raw, cold




MORNING SICKNESS.                       33
things, such as cucumbers or pickles, while Opium, Graph.,
Mosch., or Petrol., may remove an excessive craving for beer,
&c.
Dose and Administration.-The same doses and directions, as
given  for the management of morning  sickness, (see page
38), may be followed.
It would seem  hardly necessary to make any remarks upon
the subject of DRESS during pregnancy; but who has not seen
ladies in the sixth or seventh month of pregnancy, so tightly
laced for the sake of attending a ball or party, as to give but
little evidence of their size, or situation; and we must at least
enter a protest against this.
It is very important also, to keep the feet and stomach warm,
as allowing these parts to be habitually cold, predisposes to
colics, abortions, headache, &c.
MORNING  SICKNESS.
IN the early periods of pregnancy, most women experience
more or less of this; and the first intimation of it will most
likely be experienced upon rising from bed.  Before getting up
the patient may feel as well as usual, but while dressing begins
to feel nausea, followed by retching, and perhaps by vomiting
before leaving the room. Perhaps, it may not occur until some
little time after leaving the bed-room, or not till after breakfast,
which may be eaten with a good relish and almost immediately
be thrown up again, with but very little nausea; after which the
patient may feel as well as usual until the next morning.  This
symptom  may be present almost immediately after conception,
but more frequently it does not commence until after the lapse
of two or three weeks, and continues more or less constantly
and severely for several weeks, and in some instances, till near
the time of quickening, or even until confinement. In some
rare instances it does not occur before the last weeks of pregnancy and then is apt to be severe; in other cases it is altogether absent during the whole period of gestation.-TRACY.
In ordinary cases, it is not exceedingly violent and subsides
spontaneously about the time of quickening; but sometimes it
is excessively severe, continuing for a longer time than usual,
C




34               DISORDERS OF PREGNANCY.
the irritability of the stomach being excessive; so much so that
all food as soon as taken is rejected, and great weakness and
emaciation are the result.
Sometimes the vomitings are easy, and without much pain;
but at others, they are preceded by such violent and long-continued retchings as to throw the patient into a state of suffering,
and extreme agitation; often leaving behind them a distressing
pain at the pit of the stomach, which is increased by pressure,
and which may at first be mistaken for a symptom of inflammation; but it gradually wears away, and finally disappears
sometime after the vomiting has stopped.  These shocks and
severe strainings are felt at times in the lower portion of the
abdomen, and they may give rise to pains in the bowels, or to
true uterine contractions; followed by abortion.  But in general,
such vomitings are only painful and fatiguing to the patients
and should cause no serious alarm.  In fact, as CAZEAUX also
says that it must not be supposed that these vomitings, even
when prolonged, and oft-repeated are necessarily disastrous.
Cause.-The morning-sickness evidently seems due to the
sympathetic action of the womb upon the stomach, and does not
proceed from  derangement of the stomach  itself; but when
there is undue activity of the liver, there may be more or less
bile thrown up with the contents of the stomach.  CAZEAUX
thinks that in many cases the womb is distended with difficulty,
and likewise suffers from this distention, either at the beginning
or end of gestation, especially when the enlargement is rendered
greater by the presence of twins. or of a large quantity of waters.
In the latter stages of pregnancy, it is supposed to be owing to
the pressure of the womb upon the stomach.  But as the nerves
of the womb increase seventy-fold in size from  the beginning
to the end of pregnancy, the majority of cases are owing to the
increased nervous susceptibility of the womb, and the wellknown sympathy of the stomach with that organ.
Treatment.-Among the simpler modes of treatment, are:
the regulation of the diet, and a change in the times of eating
to those hours when the stomach is least apt to be sick.  Cold
food will sometimes be retained when other kinds are rejected;
acid drinks, mineral waters, and swallowing small pieces of ice,
have arrested some obstinate cases.  CROSERIO recommends




MORNING SICKNESS.                        35
Nux vomr. so confidently, that he asserts that a single close of
the 30th dilution in a glass of water, a tea-spoonful, two or
three times a day, will ordinarily remove as if by enchantment,
all these discomforts, so that the woman will pass through the
remaining  part of her pregnancy without perceiving them.
Still, he gives directions for the use of other remedies in the
more severe cases.  KROYHER of Presburg, asserts, that what
he calls minute? doses of Tincture of Nux vomica, are specific
against the troublesome vomiting in the early months of pregnancy; in order to ensure success the bowels must be kept
gently open, but not purged.  He says that Nux will certainly
cure the vomiting if it is the sympathetic effect of pregnancy
alone; but he advises one or two drops per dose, of the Tincture, gradually increased until ten or more drops are taken
every morning in bed, and again in the evening.  In many
cases it cures in a week, or shorter time; in others it must be
used longer.  RUECKERT gives five cases cured by Nux  in one
case, ~ grain doses of the powder were used; in another, the
3d dilution, and in a third, the 30th dilution.
DEBREYNE thinks the Colomba possesses a sort of specific
virtue against vomiting, nearly as great as Bark does in agues;
but he uses from  fifteen to twenty grains per dose, before
meals.
TICKNOR recommends Kreosote, a few drops in a tumbler
full of water, a swallow or two to be taken every half, one, or
two hours.  WAHLE has cured very obstinate cases with the
6th dilution, with  improvement after the  second  spoonful.
CORMACK of Dublin, says it is worthy of notice that Kreosote
though excellent in allaying vomiting, often excites nausea and
vomiting when they do not exist.  Still, he says it is one of the
best remedies for stopping vomiting, and seldom  fails in the
vomiting of pregnancy;  he advises from one to three drops, to
be taken from  five, to ten or fifteen minutes before getting out
of bed, and thinks that one dose is often sufficient; but in the
more troublesome cases in which nausea and vomiting occur at
intervals during the day, a dose should be given every two,
three, or four hours.  In the vomiting of hysterical persons it
is particularly useful; CORMACK used it in ten cases, not only'




36                DISORDERS OF PREGNANCY,
relieving the vomiting, but also calming the general nervous
excitement in every case but one.
PULTE recommends Tacbacumn, if with nausea there is fainting
and a deadly paleness of the face, relieved by being in the open
air; also when the patient loses flesh very fast, and vomits water,
or acid liquids, and mucus.
Sepia, if the nausea has lasted a great while, and appears
mostly in the morning, and there is a painful feeling of emptiness in the stomach, with burning and stinging.  Sepia and
Pulsat. are among the few remedies which act specifically upon
both the stomach, and the womb, and hence ought to prove particularly serviceable.
Veratrurn was used successfully in four cases; in two cases
the 1st dilution was given, in repeated doses; in one case, the
7th dilution; and in another, the 9th potency.  It is recommended when there is excessive sensibility of the nerves of the
stomach, and vomiting is excited by the least quantity of water,
by moving, or by setting up, and withstands all other remedies;
also vwhen the nausea is attended with great thirst; the patient
vomitirng after drinking ever so little, and having sour eructations, with great debility, and tendency to diarrlhoea.
Cuprt7u    and Zinc. when there is little nausea, but severe
spasmodic vomiting, and cramps in the stomach or chest set in
during the paroxysms of vomiting.
Bos -1st, 2d, or 3d dilution, every two, four, six or eight
hours.
Camp, or in small doses will often relieve, whlen a cold perspiration breaks out the head being hot, and the feet cold.
Dosec, —From one to three drops, every one two or four hours.
Secale is recommended when the severity of the vomiting
brings on labor-pains, and abortion threatens to set in.
Dose.-From one. to three drops of the 1st to the 3d dilution,
every five, ten, or fifteen minutes, in severe cases; every one,
two, or four hours in milder attacks.
Contium  is recommended by CROSERIO when there is decided
derangement of the womb; and TROUSSEAU accidentally learned
the value of Belladonna lotions applied over the region of the
womb, in the vomiting of pregnant women, by applying it to a
patient who was also suffering with violent uterine pain, with




MORNING SICKNESS.                        37
the effect of relieving both pain and vomiting; in subsequent
cases the Bell. proved equally serviceable, although no pain
was present.  They are thought to be particularly serviceable inthose cases where there is rigidity of the womb, wihich dilates
and enlarges too slowly for the rapid increase in the size of the
child, and thus causes uterine irritation, and sympathetic derangement of the stomach.
Aconite, in drop doses of the Tincture, relieved according to
RUECKERT the vomiting of an hysterical pregnant female; she
had nausea, retching and vomiting early in the morning; violent
colic, and renewed vomiting after every meal, and headache.
C-AILLY places great stress upon the presence of inflammation
of the decidua, or other uterine membranes, in causing severe
and long-continued, and even fatal vomiting in pregnant women.
In one of his cases, the patient died in the fourteenth week of
pregnancy and had vomited incessantly for three months; the
stomach was healthy, but the decidua was evidently inflamed.
A second case, also proved fatal in the fourteenth week, vomiting
having persisted from  the very commencement of pregnaoncy;
there was evident inflammatory engorgement of the decidua and
womb, with softening and thickening of the latter.  In these
cases, Aconite may be applied locally over the region of the
womb, in the same manner as above recommended for Bellad.;
a mere symptomatic treatment of the vomiting will not suffice;
the remedies for inflammation of the womb, must also be used.
Ipecac. is recommended by CRosERIO when the vomitings
are almost continual, and the woman rejects all, or the greater
part of her food, and when she vomits bile, pure or mixed with
mrucus.  He prefers the 6th dilution, repeated three times a
day.  On two other cases, Ipec. 1st dilution was used; and the
2d potency in two more.
DR. ELLIS iS in the habit of using Ipec. in doses not to
exceed one-eighth of a grain, for nausea and vomiting, and
rarely fails to quiet the stomach with it.
Aelthusa cytnapiumt   proved useful in three cases, in which
milk could not be borne, but was vomited off, as soon as taken.
It was given in the 3d dilution.
FerrumtL  is thought to be specific when the vomitingi occurs
after eating, and at no other time.




38                DISORDERS OF PREGNANCY.
Dss;, —One or two grains of the 1st, 2cd or 3d dilution.
SulpIutr was used in four most obstinate and chronic cases,
occurring in scrofulous and psoric individulals.
Bose.-The 1st dilution was used in two cases, and repeated
six or eight times; the 9th dilution was used in one case.
Hiydrocyanic acid is another honmoopathic remedy which has
become domesticated in allopathic practice; it is supposed to
be most indicated when there is great irritability of the stomach, while  Nux and  Ferrum  are conjectured  to be most
suitable, when  there  is a weak  and bloodless state  of the
stomach  owing  to the vital energies, nervous and vascular
activities being concentrated upon the womb, and hence diverted
from the stomach.
i)08  ld Aldmiinistration.,-The most successful potencies and
quantities have already been  alluded to in  most instances.
Of the liquid medicines, such as Nux, Kreosote, Tabacum, Veratrum, Camphor, Secale, Conium, Belladonna, Aconite and Ipecac, from  one to five drops of the proper tincture, or dilution
may be put in a wine-glass or tumbler half full of water, and
from one to three teaspoonsful given every night and morning
only, when the vomiting and nausea only occur in the morning;
and then the morning dose should be given while the patient
is still lying down in bed, and as long before rising as conven:ient.'When they occur after every participation in food and
drink, a dose should be given from one quarter to half of an hour
before each  indulgence.  When they recur frequently and irregularly at almost any time of the night or day, a dose may be
taken wbhenever the symptoms are most urgent, or after every
paroxysm of severe nausea or vomiting.
The dry medicines or powders, such as Sepia, Cuprum, Zincum, Ferrum, and Sulphur may be taken in (loses of one or two
grains of the proper potency, as often as above directed.
SALIVATION.
THIS symptom occasionally takes the,place of the morningsickness; it sometimes appears almost at the commencement
of pregnancy, and before the time Ibr the expected menses to
appear, previous to the fact of their suppression being known;




SALIVATION.                         39
then the woman is apt to feel as if she had taken a slight cold,
and as these feelings are often unaccompanied by nausea or any
other more common sign of pregnancy, the patient is apt to
suppose that her menses have been suppressed by cold.  But
if she is also troubled with a choking sensation which induces
cough, particularly in the morning, and finds her throat and
mouth lined with a mucus or saliva of a very peculiar character,
she may dismiss the cold-theory from  her mind and prepare
for something  more or less agreeable, as the case may be.
This mucus or saliva is very difficult to expel from  the mouth;
it is extremely white and a little frothy, and when ejected
assumes a round shape, about the size of a shilling piece; hence
the expression so common in some parts of the country, that
"Mrs. So and  So, is spitting English shillings, or cotton."
When this state of the saliva occurs, it points very certainly
to the presence of pregnancy.-TRACY.  At other times the
salivation is very profuse and severe, so as to resemble the
mercurial salivation, but differing from this in the absence of
fetor, although the taste may be exceedingly mawkish and
disagreeable.  It is generally of short duration and disappears
of its own accord.
Treatiment.-DESORMEAUX says that some candied sugar,
or a little gum arabic held constantly in the mouth, will render
it less distressing.  _Me.rcuzrizs is generally regarded as the
principal homoeopathic remedy.
Dose,-The 1st or 3d dilution may be taken  from  two to
four times a day according to the profusion of the flow of saliva.
Iodine, is perhaps more homoeopathic to this peculiar form  of
the disorder than Mercury, for the Iodine salivation is without
fetor.
Pulsatilla is said to be indicated when it is accompanied
with nausea and disgust for food.
Verairuti, when the patient is inclined to be cold and weak,
and to be troubled with diarrhoea.
MSulpihur will sometimes remove the most obstinate cases.
Digitalis and Nitric acid have also been recommrended.
Dose aAd Administration, —Same as for Merlcury.  (See above.)




40               DISORDERS OF PREGNANCYI
TOOTHACHE.
THIS may arise from a variety of causes:
1st. And frequently, it and a variety of erratic pains in the
face and teeth are induced by the increased irritability of the
nervous system, resulting from the new action which is going
on in the womb, and in these cases as there is no decay of
any particular tooth, the extraction of any tooth for its cure is
entirely out of the question.
2d. And also frequently it may arise from decay.  A  large
number of females already have unsound teeth before they
become pregnant; and an equally great number are unusually
predisposed to rapid caries of the teeth while carrying their
children; and in both instances, the above mentioned increased
irritability of the nervous system will render them exceedingly
subject to frequent and severe attacks of suffering.  TnRACY
says: "There is an impression somewhat prevalent that the
extracting of decayed teeth is liable to induce a miscarriage,
and it is but just to say that some eminent physicians have this
impression."  But he is fully satisfied that there is little, if
any foundation for it. Excepting in cases where the patient is
in very feeble health and her nervous system extremely excitable, he has no more hesitation about extracting them during
pregnancy, than at any other time.  He believes that in nearly
every instance when a miscarriage has followed their extraction, it would have occurred from  other causes if the tooth or
teeth had not been removed.  He has no doubt but that more
abortions take place from the irritation caused by decayed teeth,
which are allowed to remain foi fear of the results of their
extraction, than occur from their removal. This is certainly
the result of his experience, and some experienced dentists are
of the same opinion; they have every year, for many years,
extracted a large number of teeth under these circumstances,
and so far as they have learned, the operation has resulted
unfavorably in no one case.  Every danger of abortion may be
prevented by the use of a judicious anodyne given one or two
hours before the time appointed for the operation.
If the teeth be not too far decayed, the cavities should be
cleaned and filled with gold, if possible. In those cases in




TOOTHACHE.                         41
which the cavity cannot be filled with gold, and it is not advisable to extract the tooth, OSTERMANN'S filling may be usedthe cavity is to be well cleaned and dried; then forty-eight
parts of flocculent Anhydrous phosphoric acid, obtained by burning Phosphorus under a basin, is to be mixed with fifty-two or fiftyeight parts of pure unslaked lime, and the necessary quantity gently pressed into the tooth.  If the tooth be not well dried the mass
will become heated, and in expanding will be forced out of its
place; and the application must be quickly effected, for the
mixture becomes quite hard and useless in the course of two or
three minutes.  Thus, the cavity will be filled with bone-earth,
or Phosphate of lime; and if the filling be coated over with
a few drops of a solution of two drachms of pure Mastich, solved
in two drachms of absolute alcohol, and thickened with a proper
quantity of powdered silex, a filling will be made which approaches as nearly as possible to the natural structure of the
tooth and its enamel.
There are other very good temporary fillings, such as one
made by dissolving one scruple of Tannin and five grains of
Mastich in two drachms of Ether, then wetting a bit of cotton
with it and pressing it into the tooth.  Or, powdered West
Indian Gum Copal may be dissolved in pure alcohol, by the aid
of exposure to moderately warm air, and to this viscid alcoholic
solution powdered Asbestos may be added, in place of using
cotton.  Or, two drachms of picked Mastich, two drachms of
absolute alcohol, and nine drachms of dried Balsam of Tolu,
may be solved in a stoppered bottle by the aid of gentle heat;
and frequent shaking; when the Balsam is dissolved the whole
should be placed in a warm  situation, to allow the crude particles to deposite. This mixture is viscid and forms a firm
mass, when exposed to the air, which is neither acted upon by
the saliva, or other liquids. In order to apply it thoroughly
the tooth should be cleansed and dried carefully, and a bit of
cotton dropped in the balsam should be put into the cavity;
or powdered Asbestos, or powdered Phos. Lime, or powdered
Silex may be used in place of the cotton.
If it be absolutely necessary to extract the offending tooth,
great care should be exercised in selecting the right one, for the
pain sometimes extends sympathetically to a perfectly sound




42              DISORDERS OF PREGNANCY.
tooth, and is felt but slightly or not at all in the diseased one;
and toothache is very often removed by the extraction of a
different tooth from  the one pointed out as the offending one.
TRACY thinks that the diseased tooth will almost invariably be
found upon the same side with the painful one, and generally
in the same jaw, but not always; an under tooth is often
diseased when the pain is seated in a corresponding upper one;
and an upper one, when the pain is in the corresponding lower
tooth.
3d. The toothache is often secondary to an inflanmmation of
the gum, or:
4th. It may be the result of a general catarrhal affection.
The period of the commencement of the toothache, of course
varies; certain women suffer with toothache as soon as they
have conceived, and even recognize their condition by this
symptom; and generally speaking it is a complaint of the
earlier months of pregnancy, but some patients have attacks
of it throughout the whole period; and sometimes it never
occurs until within two or three days of the commencement
of labor. The pain varies in degree, and at different times;
sometimes it is dull and aching, and ceases at intervals; at
others, it is acut'e and piercing,and may continue night and
day, so that sleep is lost, the appetite may diminish, the
digestion become impaired, the patient become feverish and
abortion occur.
Treat2ernt. —This of course will vary according to the nature and seat of the disease. RUECKERT thinks that Bell.,
Cale., Magnesia and Sepia have proved most useful in the
toothaches of pregnant women.
ACONITE.
is recommended by IREUSSLER anainst piercing and throbbing
pains in the teeth, when attended with heat and redness of the
face, firom  congestion to the head. Also when the pain is so
severe as -to drive the patient almost frantic; when the toothache has been excited by exposure to sharp east winds, is attended with fever, quick, hard pulse, mental and bodily restlessness, violent and throbbing pain, generally occupying one
side only of the face, but then involving the whole side of one




TOOTHACHE.                            43
jaw, and attended with redness of the face. —In short, it is a
principal remedy in many neuralgic, rheumatic and inflammatory toothaches; I have long been in the habit of applying a
small part of a drop of Tinct. of the Root of Aconite, on a bit
of cotton to the cavity of aching and decayed teeth, generally
with almost immediate relief; I could  easily recall a dozen
instances in which the pain has been relieved in a very few
minutes.
It is often equally successful in purely neuralgic affections
of the face and teeth, when the latter are perfectly sound; it
must then be applied to the outside of the cheek, or to the gums
of the affected part; WAVTSON speaks very highly of Aconitine
ointment in neuralgia of the face; in one case of eight years
standing, of very acute neuralgia of the mental branch of the
fifth pair of nerves,  after exhausting almost every expedient
that ever has been recommended for the disease, a permanent
cure was effected in six clays, by the application of Aconitine
ointment, one grain to the drachm  of cerate, once or twice a
day; in this case no relapse had occurred at the end of six
years, although formerly the pain was excited by the slightest
causes; such as gentle friction of the hand, or a current of cool
air; the patient was soon enabled to face any wind or temperature with impunity.
RUECtKERT infers that Aconite is most useful against throbbing pains, with congestion to the head, and hea.t in the face.
D0sse —-See treatise on H-eadaches, page 4; do. on Apoplexy,
page 72;  Do. on disorders of Menstruation, page 36.  In one
instance, in a pregnant female, Aconite 200th, quickly relieved
a violent and throbbing toothache.
ANTIMONIUM CRUD. ET TARTAR.
MIALYI   foEnd it useful in many intermitting rheumatic toothaches, occurring regularly every evening, and not yielding to
small doses of Quinine.
Dose. —AtLY used one grain doses of the 2d trituration of
Antimr. Tart., repeated every twelve hours, and always he says
with rapid and permanent relief.
ARNICA
of course is used most frequently in pains of the teeth and
gums excited by mechanical injuries.




44               DISORDERS OF PREGNANCY.
Dose, —One or several drops of the tincture, or of the 1st, 2d,
or 3d decimal dilutions may be given every two, four, or six
hours.
ARSENICUM,
has a wide-spread reputation against neuralgic and catarrhal
toothaches; it is thought to be most useful when the sockets
of the teeth are inflamed, the teeth are loose, seem to project
from their sockets, and chewing or biting them  together produces the sensation as if they were forced into some sore or
ulcerated place, the pains being throbbing and piercing, the
gums reddened and painful, and all the pains increased by
touching, or lying on the painful side, by rest, and cold applications, and relieved by setting up, by restless moving about,
and by warm applications; it is still more indicated when the
pains quickly produce great debility and exhaustion, the patient
being feverish, with coldness of the hands, and especially of the
tips of the fingers.
Dose.-The 1st, 2d, or 3d dilution may be given every two,
four, six, or eight hours.
AMMON. MURIAT.
WATSON says that this remedy is very useful in a very
common, very distressing form of face-ache, which is sometimes
quite intractable under ordinary treatment; it is often called a
rheumatic pain, and is probably seated in the periosteum of the
jaw, as the extraction of bad or suspected teeth does not remove it;
it occupies the lower part of the face, the jaw principally, and the
patient cannot say where the pain is most intense. If it does not
yield after four doses, no good need be expected from the remedy.
Dose,-WATSON advises half drachm doses, three or four times
a day; the 1st, 2d, or 3d dilutions would  probably prove equally
successful in appropriate cases.
BARYTA,
Was found useful by GASPARY when a pale red swelling of
the gum  projected into the hollow of decayed teeth, attended
with swelling of the cheek, pains extending to the nose, eyes,
and temples, arid with violent throbbing in the ear.
Dose,-Baryta, c. 8th dilution, one drop per dose, cured a
case in four days.




TOOTHACHEo                         45
BELLADONNA.
The indications for the use of this remedy  are too well
known to require a minute enumeration of them. It is most
indicated in feverish, congestive and inflammatory toothaches,
both in sound and decayed teeth, when in addition to the excitement of the vascular system there is also great irritability of the
nervous system; when there is thirst, dryness and slight redness
of the throat and erysipelatous redness of the cheeks; when the
pains are much aggravated in the evening and at night, are
rending, digging and piercing in their character, and are apt to
occur in alternation with intense headache, which almost renders
the patient delirious.  GARDINER, however thinks Stramonium
more useful than Bellad.
Pose,-The 18th or 30th dilutions have been used most frequently.
HZosciazmus is indicated under nearly similar circumstances.
Dose,-The 9th and 12th dilutions have been given successfully.
BRYONIA..Many of the indications for the use of this remedy are anta-.gonistic of those pointed out for Arsenicum; thus, Bryonia-pains
are increased instead of being relieved by warmth and warm applications, and by lying on the sound side; and they are relieved
by cold water, free air, and by lying on the affected side.  It is
perhaps most useful in rheumatic and catarrhal toothaches,
especially when pains in the limbs and chest are also present;
when sound teeth are affected in preference to decayed ones. and
the pains are apt to shift their locality.
Dose.,The Tincture in solution, the 1st, 3d, 24th and 30th
dilutions have all been used with good effect.
CALCAREA CARB.,
Is thought most useful in the tooth-affections of women and
children, but especially in those of pregnant females; is serviceable both when the pains are seated in sound or decayed teeth,
and when they are exfoliations or growths upon the bone, with
more or less disease of the gums. It will relieve, even when
there is congestion of blood to the head, and the pains are increased by cold applications, but especially by exposure to a




46              DISORDERS OF PREGNANCY.
draught of cold air, and when the teeth are unusually sensitive
to cold.
Dose,-In one case. a coffee-spoon full of lime water was given
several times a cay; in 3 cases complicated with fistulous ulceration, the 30th dilution, was given successfully; and in I case
the 200th potency.
CARBO VEGETABILIS,
Has been used successfully when Mere., and Arsen., seem
indicated, but do not effect a perfect cure; especially when the
gums become ulcerated, bleed easily, retract from the teeth; and
the teeth become loose.  Its principal action seems to be directed
to the gums.
Dose.-The 9th dilution has been used successfully.
CAUSTICUM.
WEBER says he has cured innumerable cases of toothache with
this remedy; it has proved more successful in his hands than any
other, even when the pains were felt in all the teeth, or extended
over the temples into the forehead.  Badi'1     NGtRAUsE thinks
it most useful against chronic throbbing toothache, when the
gums are painful and bleed easily, and the pains extend to the
muscles of the face, or to the eye and ear.  H-ERTNraT assumes
that it is most serviceable when there is painful looseness and
lengthening of the teeth, with fistule; suppuration, painful sensitiveness and swelling of the gums.
D0Se, —WNEBER preferred the 30th dilution; Gnoss succeeded
in one case with the 400th potency.
CHAMOMILLA,
Is an admirable palliative remedy in the most violent attacks
of toothache, which seem  insupportable and almost drive the
patient to desperation; especially if the cheek of the affected side
be swollen and red.   Coffea and IgT'natia are useful agai-Lst
equally intense pains, without inflammation or swelling, occurrinog
in hysterical women, who are either very quiet, or still aind sad.
Dulcamcara is sometimes efficacious against toothache, caused
bytaking cold and attended with diarrhoea, especially if much
saliva collects in the mouth, and Ohamomilla seems indicated but
does not relieve.




TOOTHACHE.                          47
CHINA,
Is said to be the best remedy when toothache is attended with
excessive irritability of the whole body, and sleep is disturbed
by anxious and frightful dreams; -hen there is congestion to
the head, or excessive paleness and emaciation of the patient, attended with diarrhoea, night-sweat and lassitude.
Dose,-The 1st, 2d or 3d dilution may be given.
COLCHICUM,
Is most useful against rheumatic toothache, when the teeth
are sensitive to pressure, and there are rheumatic pains about
the jaw and in the maxillary joints, the pains being most severe
at night.
Bose —Same as for Bryonia.
CYCLAMEN.
My friend Dn. BELCHER has used this remedy most successfully against pains in decayed teeth, when there is a dull constant ache, with burning in the cheek, followed at times by
severe paroxysms of pain, which may drive the patient almost
frantic.  In some instances the relief was so decided that the
patients thought they were more benefitted than they had been
by almost any prescription in any other disease.  In some cases
the relief was very prompt; and in one instance a dull toothache
which had lasted a whole night, ceased in a few minutes.
Dose —The tincture in solution, has been used most frequently.
EUPHORBIUM,
Has been found very useful when the teeth are apt to crumble
and break off; also in toothache from decay, when the tooth feels
as if it were screwed, or forced into its socket, and is painful to
touch, even when gum-boils form, and the cheek is red, swollen
and inflamed. Phosphor and Phosphoric acid deserve attention
even when the bones of the jaw are involved.
Dose —The 15th dilution has been used successfully.
FLUORIC ACID,
Has cured fistulae about the teeth and gums, even when they
had lasted  as long as three years, and were attended with




48              DISORDERS OF PREGNANCY.
frequent and violent attacks of pain, with suppuration about the
roots of the teeth, with persistent tenderness to pressure.
0Dse, —The 3d and 30th dilutions have been used.
IjREOSOTE,
Is said to have been used successfully, in the 3d dilution, or
even the 24th, when applied to the cavity of decayed teeth,
especially when the gums are spongy and ulcerated.
MAGNESIA CARB.,
Has been found very useful by LOBETHAL in those toothaches
which occur during the first months of pregnancy; HAHNNEMANN
also advises it against the toothaches of pregnant women. GUTMANN thinks that it will cure those chronic cases in which
Chamomilla seems indicated, but fails to afford relief; while
RUJECKERT thinks it most serviceable against those toothaches
in which the pains extend over the whole side of the face, especially when the most violent paroxysms occur at night when the
patient is in bed, and force him  to rise. It has cured cases
which had already lasted for several, or as many as six nights
in succession, on the very first day on which it was administered.
Dose,-The 26th and 30th dilutions have been used most
frequently.
MERCURIUS.
The indications for the use of this remedy are too well known
to require repetition where; suffice it to say that it is not only
the most homeopathic remedy against many affections of the
teeth and gums, but also has been used more frequently and
successfully than any other homceopathic medicine.
ToDe,-It has been used in the form of an ointment applied
externally; also in the 2d trituration; in the 6th, 9th, 12th and
30th, given in repeated doses; while the 8th and 12th dilution
have also been used successfully in solution, in divided doses.
MBEZEREUM,
Is most indicated when the periosteum of the sockets of the
teeth is most involved, especially when the patient is very apt
to feel chilly, and the whole affected side of the head feels cold.
Dose.-The 1st, 12th and 30th dilutions have been used with
success.




TOOTHACHE.                            49
NUX VOMICA,
gnatia., and the North Pole of the Magnet are admirable remedies in nervous and spasmodic toothaches.
Det, —-The 30th dilution has been -used successfully in three cases.
PULSATILLA,
Is decided by RUECKERT to be most indicated in the tooth-.affections of gentle, quiet, bashful and lachrymose womnen, especially when the pains are confined to the left side of the face,
are of a catarrhal-rheumatic nature, and more apt to attack decayed than sound teeth; also when they extend to the whole of
one side of the face, to the ear, neck or head.  Pulsatilla-toothaches are apt to be attended with chilliness, paleness of the face,
heat, congestion and pain in the head, suppression of the menses,
menstrual cramps in the abdomen, anxiety and great restlessness; they are excited or aggravated in the evening or at night,
by the warmth of the bed, in a warm  room, by warm  food, and
by sitting or lying down.  Nux-vomica-toothaches on the contrary are most severe in the morning, are excited or aggravated
by exposure to the free cold air, by inhaling cold air, by cold
drinks and food, and by mental exertion, and walking about.
And vice-versa, Pulsatilla-toothaches are relieved by exposure
to the open air, and by holding cold water in the mouth, while
Nux-tooth-affections are relieved by warm applications.
Dose.-The 3d, 6th, 7th, 9th, 14th and 15th dilutions have all been
used successfully.
RHODODENDRON,
Has not been used as frequently as one would suppose from its
undoubted beneficial effect.  It is most beneficial against rheumatic and gouty toothache, when excited by rough, cold and damp
weather.
Dose,-In one case the 3d solution relieved in a few hours a toothache which had lasted for fourteen days, in spite of the use of many
apparently indicated remedies, in another case it proved equally useful
after the pains had persisted for several weeks, with only partial relief
from Nux and Mere.
RHUS TOXICODENDRONI,
Besides the well known indications for its use, has been found':
an excellent remedy against caries of the teeth in general, but
especially against that form  which, has. received the name of
lv




50               DISORDERS OF PREGNANCY.
crusted-caries, and which is usually connected with herpetic
eruptions.
Dose,-The 3d dilution has been used most frequently.
SABINA,
Is homoeopathic to the toothaches excited by metastasis of gout
from  the toes, and also, in those which arise in women who
menstruate during pregnancy.
Dose,-The 1st, 2d, or third dilution.
SECALE AND SEPIA
Are suitable against toothaches from sudden suppression of the
menses; in chronic throbbing toothaches in women who are
annoyed during pregnancy with large yellowish spots over the
face  arms and neck; with oppression of the chest, swelling
of the face,  ough, and enlargement of the glands of the neck.
Sepia is also said to be an invaluable remedy against pains
in the teeth, in pregnant women, especially when there is
great congestion to the head at night.
Dose,-Sepia 30, has been used most frequently.
SILEX,
Has cured enlargement of the bones of the jaw, and inflamination and suppuration about the sockets of the teeth, especially
when these parts are more affected than the teeth themselves.
Dosc-Silex 30, has been used most frequently.
SPIGELIA,
Is most indicated against nervous toothaches, especially when
burning and rending pains about the zygoma are also present,
or painst about the eyes, pressure upon the bladder, palpitation
of the hea.rt, and rattling in the chest; or when there are also
pains in the eyes and ears, heat in the mouth, and oppression
of the stomach.
Dose,-The 3d, 15th, and 30th dilutions have been used successfully.
STAPHYSAGRIA,
Ts suitable against caries of the teeth, and inflammations
about the periosteum, similar to those in which  Cyclamen,




ACIDITY OF THE STOMACH, &C.                    51
Mezeriun and Rhus, are indicated; but more especially when
the teeth become very black, are inclined to crumble off, the
gums being white, retracted and swollen, with apthe, ulcers,
and tubercles upon them.
Dose,-The 24th, and 30th dilutions have been given most frequently.
SULPHUR,
Is most indicated against chronic abscesses of the gums; when
coupled with considerable growth of proud-flesh, and exuberant
granulations.
DOsD, —The tincture has been used most frequently; the 30th dilution occasionally.
ACIDITY OF THE STOMACH AND HEARTBURN.
THESE are very distressing and common symptoms of pregnancy, often occurring very soon after conception; sometimes,
however, not until the fourth month; occasionally they are
absent altogether, although commonly most troublesome in the
latter half of pregnancy.
It is sometimes dependent upon  simple irritation  of the
stomach, attended with a great sense of heat there, at others,
by the formation of an acid, which rises into the throat, and
from  the sensation it causes is called Heartburn.  In some
cases it is a quite simple affection, and almost every female
knows that she may find transient relief by taking a little
M~agnesia, or chalk, or lime water, with or without milk.  But
at other times it is a much more complicated affection, which
withstands the efforts at relief suggested by. ordinary physicians.  The acids in the normal gastric juice are:
Muria,tic,
Lactic, and
Acetic —the former predominating, although in varying
states of the stomach, either may be in excess and require
peculiar treatment.  The chyme which is made from the fibrine
of meat, and coagulated albumen, contains much muriatic acid;
that which is made from quite fresh meat and milk, contains
an excess of lactic acid; while that which is made from starch,




52, DISORDERS OF PREGNANCY.
farinaceous sfbstances, and vegetables, contains much acetic
acid.  Hence, some kinds of acidity are aggravated by a meat
and milk diet, and relieved by vegetables and fruits, while the
more common variety is increased by a vegetable diet.
In some states of the system quite new and unusual acids are
formed, or get into the stomach, such as
Phosphoric acid,
Uric acid,
Oleic, or Butyric acid, and even
Fluoric acid.
The presence of these, of course, calls for quite peculiar treatrnent.  Phosphoric and Uric acids are apt to form  in the
stomach of those who eat a great deal of meat, and are subject
to gout, rheumatism, or nettlerash.  Oleic, or Butyric acid is
most common in the stomachs of those who indulge in the use of
made dishes, hashes, cheese, gravies and fatty food; thus, in the
Arctic regions, where the inhabitants live in winter almost exclusively upon seal-fat, fat sea-birds and rancid tallow, a most violent kind of pyrosis, or heartburn, is very common, and doubtless
arises from  the rancid Butyric acid, which is liberated, or generated in the stomach.
The presence of Fluoric acid is rendered evident by the rapidity with which it attacks the enamel of the teeth, causing
caries, especially of the front teeth.
All these different kinds of acids require their specific and peculiar antidotes.  The best antidotes for Muriatic acid are Zincum, Ferrum, Argentum  and Ammonia, while Soda, Plumbum
and Baryta are the best antidotes for Phosphoric acid.  The tendency to the formation of Uric acid is best antidoted by Cuprum
and Colchicum; while that of Lactic acid is best treated with
Zincum.
Again, an alkaline stomach is often mistaken for an acid one;
for alkaline dyspepsia or pyrosis, as it has frequently been
termed, is more common than is generally supposed, at least Dr.
Thompson, out of 40 to 50 patients seen daily at the Blenheim
Dispensary, generally met with one or two cases per day.  There
is generally some bilious derangement present, at least the patient is apt to have thirst, or bitter taste in the mouth, an aversion for meat, a craving for sour things, a dirty yellow, or yel



ACIDITY OF THE STOMACH, &C.                   53
lowish brown tongue and a dingy sallow skin; it may also be
attended with a putrid taste in the mouth, eructations like those
from spoiled eggs or oysters, and consisting of sulphuretted- or
phosphoretted hydrogen.  In the acid stomach, there is said to
be a burning sensation at the pit of the stomach, with acid ezuctations which do not alleviate the pain. In the alkaline stomach,
there is violent pain in that organ, frequently attended with
headache and faintness, and a sensation of spasm or constriction
of the stomach; this sensation increases until it becomes intolerable, and at last when the agony is complete, the patient is
suddenly aroused by a determination to the mouth of a large
quantity of fluid, which must be immediately evacuated, to give
place to a succession of similar occurrences; at last, however,
the flow of fluid becomes so abundant as to constitute an actual
stream, and it continues to flow from time to time, but gradually
diminishes in quantity, and at length ceases, with complete relief to the pain in the stomach. This relief is characteristic of
alkaline indigestion.
Treatment.-PULTE says, that Nux and Pulsatilla are the
principal remedies for dyspepsia, heartburn and acid stomach.
For an acid stomach he recommends frequent, but small quantities of Lemonade, or a mixture of one drop of Suldphuric acid
in a tumbler full of water, and says, that it will sooner and more
lastingly correct the acid in the stomach, than lime water or
magnesia, which at best only neutralize the acid already in the
stomach, without preventing its re-formation. LEADAM  recommends Nux 30., three globules to be put in six teaspoonsful of
water, and one teaspoonful to be taken three or four times a
day, until relieved; but LINNAEUS gave ten drop doses, three
times a day with much success.  Pulsatilla may prove useful
when there is an excess, or tendency to an excess of Butyric
acid in the stomach.  Stlphur and Phosphor may prove homceopathic when there is acidity and flatulence, with an excess
of sulphuretted- or phosphoretted hydrogen in the stomach.
Phosphoric acid has proved more successful than Sulphuric acid
in some cases; and a trituration and potency of Gunpowder has
often proved more useful than Sulphur, Garbo and Nitrum used
singly.
Arsen., Bell., Kali and Cale. have also been recommended.




54               DISORDERS OF PREGNANCY.
Several Old School physicians have accidentally hit upon the
use of Acids in heartburn.  Dr. Todd says, that Heartburn,
which is habitual, or of long-standing is sometimes more effectually relieved by acids, than alkalies.  Pemberton mentions
having seen it subdued by the juice of half a dozen lemons taken
daily, and recurring on the remedy being omitted.  Todd recommends 5 drop doses of dilute Sulphuric Acid, to be taken
every 4 hours; and has also used the dilute Phosphoric Acid
successfully.  Billing says, that alkalies relieve acidity of the
stomach for a time, but in order to cure it effectually, an Acid
should be used, such as dilute Sulphuric Acid.  Prout says,
that the injudicious use, and abuse of alkaline remedies, by old
school physicians, in acidity of the stomach is often a source of
great mischief.  Alkalies exert no curative effect; that is, they
will not prevent future acidity; on the contrary, when taken in
large doses, and at improper times, they cause an absolute increase of acid:  Thus, when a large quantity of alkali is taken
into an empty stomach, the immediate effect is that this organ in
endeavoring to return its natural condition, will throw out an
additional quantity of acid in order to neutralize the redundant
alkali. When alkaline remedies, therefore, are injudiciously persisted in, a daily contest ensues between the stomach and the
self-styled regular doctor.  If the constitution be sound, the
stomach in spite of the so-called regular doctor, usually gains
the ascendancy, but at the expense of extraordinary exertion in
the secretion of an excessive quantity of acid.  If, on the contrary, the vital process of the stomach be weak, the regular doctor may gain an easy and triumphant victory over the poor
stomach, but at the risk of still further enfeebling the vital
powers of that organ; and in both instances the general result will
be, that the diseased function of the stomach producing acidity
will be auzmented, rather than improved.  In Braithwaite's
Retrospect, Part 10, we learn that Dr. TRACY'S experience
with the vegetable acids, as correctives of acidity has been considerable; he has prescribed them in a large number of cases,
and in nearly all with decided benefit.  DR. T. himself was subject to repeated and severe attacks of inflammation of the eyes,
accompanied by acidity of the stomach, which he had attempted
to correct by the long and free use of Soda, but in vain; it had




PAINS,AND  CRAMPS IN THE STOMACH1 &C.               55
only a very slight and temporary effect.  He had for months
abstained from  acids, under the impression that they were not
suited to his state of health, but was once induced to take a glass
of Lemonade, and almost immediately experienced a very copious
eructation of gas, with great alleviation. The remedy was again
and again repeated with relief to the acidity, and the threatened affections of the eyes were always effectually prevented.
TRACY has fbund the vegetable acids uniformly and entirely
successful in removing the disposition to attacks of acidity of the
stomach in persons subject to them; and his impression is, that
in all such cases they can be relied upon with more confidence
than any other remedies.  In cases of acidity from pregnancy,
lie has found the sub-acid fruits of great service, while those that
are tart could not be borne, and the mineral acids were decidedly
injurious, while the whole range of alkalies and absorbents were
of little or no avail.
BRAITHWAITE says, this may seem a very unscientific (and
equally homccopathic) mode of procedure, but facts seem to corroborate the value of the practice in some cases.  DR. CHAPMAN, of Philadelphia, experienced relief from  the same treatment, and Professor Wistar informed him, that he had for a long
time ineffectually endeavored to relieve an opulent merchant,
" in the regular way," who was very speedily cured by drinking
copiously of sour beer, such as had been utterly condemned by
the brewers as spoiled and unsaleable.  DP,. CHAPMAN also had
under his care, in consultation, during nearly a whole winter, a
most distressing case, which proved utterly intractable to the
"' regular remedies," which promptly disappeared the next summer
as soon as the patient began to subsist upon the sour pie-cherry.
Nor is this the only instance in which Dr. C. has heard of cures
of acidity of the stomach ascribed to tart, and perhaps unripe
fruits of several kinds, and one especially from Professor Ilodge,
to apples; he also attended a case wvith DR. RHEA BARTON,
which yielded immediately to wheaten mush and vinegar, largely
and eagerly consumed.
PAINS AND CRAMPS IN THE STOMACH AND DUODENUM.
UNDER this title BuRNs has described an affection not very
uncommon with pregnant females; it consists of a cramp-like




a5                 DISORDERS OF PREGNANCY.
pain in the region of the stomach and duodenum, occasioning
considerable sufferin'g; it may be caused by errors in diet, cold,
or by mental emotion, and in some few cases it would appear to
be connected with the passage of a gall-stone, and may then give
rise to jaundice.  Occasionally it is a less simple affection, being
complicated with congestion to the head, threatening convulsions,
and attended with  tenderness of some portion of the spine.
(C-URCHILL.)
Pain in the stomach, or Gastrodynia, though generally speaking more transient, is far more severe in its symptoms, and is
commonly termed spasm  or cramp of the stomach.  It is often
sudden in its access, and its exciting cause may frequently be
traced to somne irregularity of diet; the action of cold will also
induce it.  There are violent neuralgic pains darting through
from the breast-bone to the back and shoulders, and not generally
confined to the stomach; there is great distension of the stomach
and flatulence, and the patient is very restless nd anxious.  It
generally passes off speedily under proper treatment, but occasionally it is somew hat obstinate; and the attacks are particularly
apt to be renewed; Lthe severity of the'suffering is so great that
it requires speedy and energetic treatment.
CONS TIPATI ON
NOTHING is more common, than for pregnrancy to change altogether the habit of the bowels; in cases where,  previously
they were quite regular, or even relaxed, they often become so
constipated as to require constant care and attention.  The degree, to which the constipation may be carried, varies much; in
ordinary cases three or four days intervene between each evacuation; but if the patient be careless about herself; one, two
or three weeks, or even months may elapse.  This state does not
always require that very active treatment, which some physicians
consider necessary; the experienced DENMAN says, he was formerly much more assiduous in preventing costiveness than at
the present time, having observed, that all women who go on
properly, especially in the early part of pregnancy, are liable to
this state of the bowels, which may have some relation to the
increased action of the womb at that time.  Costiveness, may
therefore, he assumes, be considered as a state of the bowels




CONSTIPATION.                          57
corresponding to the increased action of the womb, and will often
not prove injurious, as it is a common consequence, and almost
necessary result of pregnancy.
Still it is not at all safe to allow it to proceed to the extent
which some careless women and prejudiced physicians have fallen into the habit of doing.  The most frecquent consequences
of obstinate constipation are, continued headache, anxiety, giddiness, sleeplessness, distressing dreams, vomiting, displacement
of the womb, swellings of the veins of the legs, tedious labor,
painful, irregular and inefficient pains, obstruction to the passage
of the child) and great danger of child-bed fever subsequent to
delivery.  It also commonly induces general uneasiness, nervous
and febrile excitement, loss of appetite, restless nights and erratic pains in the bowels, while abortion may be brought on by
the severe efforts and straining required to relieve -a loaded
bowel of its hardened contents.  DENMAN says, that there is
reason to believe, that this complaint is often overlooked in practice, for it sometimes happens that the mass of indurated and impacted fces may be enormous, although a small quantity in a
liquid state may escape through the free spaces left by them, so
that no suspicion of the real state of the case may enter the
mind of the -woman, or her doctor, unless particular inquiries be
made, and the stools be inspected.
By inattention to the state of the bowels some women get
themselves into very unpleasant and awkward predicaments;
I once attended a newly married lady, who had been over two
weeks without any relief from the bowels, till finally the rectum
and colon became so loaded, that the womb was pushed downwards, and the vagina so much compressed, that the usual social
intercourse of married people was entirely out of the question,
and both husband and wife camle to the conclusion, that some
congenital mnalformation existed.  A  few  doses of Castor oil,
aided by copious emollient injections soon removed all obstacles.
CAPU'RON moet with cases where the fscal matters were so
hardened by their long retention in the bowels, that they had to
be extracted by the fingers and by instruments.  CAMPBELL
had a case i'n which the bowels were so overloaded, that after the
birth of the child, the attendant thought the woman had another
child to bear; the rectum was found distended to the size of a




58               DISORDERS OF PREGNANCY.
quart bottle, and the woman died of inflammation of the bowels;
fourteen pints of fecal matter were removed after death from
the small bowels, after the colon and rectum had been relieved
during life.  CHURCHILL once attended a labor, in which the
hollow  of the sacrum  was nearly filled up with a hard mass;
giving to the finger the sensation of a large growth upon the bone;
but a more careful examination proved it to be the lower bowel
filled up with hardened faeces; great difficulty was experienced
in emptying the bowels, and not until then did labor progress
favorably.  ASHWELL has known very serious delay during the
act of parturition to arise from  this cause, and has more than
once been obliged to empty the rectum mechanically before the
head of the child could be propelled into the world.
Hlamorrhoids, or piles are also a frequent consequence of the
obstruction offered to the return of blood by this local pressure.
ANDERSON places much stress upon the frequency of occurrence
of rhagades, or fissures about the anus, combined with spasmodic
constriction of the sphincter animuscle, caused by constipation.
Although it occurs in both sexes it is always more common
in females than males, owing to the greater neglect with which
they treat their bowels, and it is still more common in pregnant
females, as constipation is a powerful predisposing cause.  It
commences insidiously with an irritable itching and burning,
and pain confined to one point of the circumference of the anus 
the movement of the bowels is attended with excessive pain,
which persists for some time afterwards; the sphincter, or closing-muscle of the anus is spasmodically contracted; and the
most excruciating pain is experienced on introducing the finger,
or a bougie.  All these symptoms not only persist obtinately, but
increase; the pain becomes more and more severe, lasts longer:
and occurs at other times besides during the act of defecation 
the contraction of the sphincter becomes more powerful, until
finally it is almost impossible to force anything through it; and
the patient shrinks from the pain of having her bowels movel;
finally, the general health begins to fail, and her life is rendered
wretched by such severity of suffering.  The fissures are readily
discovered on examination.
Ccuses. —The constipation of pregnant women is generally
referred to the effect of the pressure of the enlarged womb upon




CONSTIPATION.                       59
the bowels; but frequently it is owing to torpor of the bowels, induced by the preponderating current of nervous and vascular energy towards the womb. IMBERT doubts very much whether this
tompression, which is so much thought about, exists in ordinary
cases, for while the womb is seated in the pelvis it is not large
enough to compress, much less obliterate the rectum; and when
it rises above the cavity of the pelvis, the bowels are behind
the womb, and unless the walls of the belly are unusually
rigid, they cannot be compressed so as to obliterate their canal.
Still, SIEBOLD has mentioned a mode in which the womb exerts
pressure on the bowels, which has not been alluded to by other
authors, viz, where the vertex, or top of the head of the child, is
directed towards one or the other hip, or sacro-iliac sy rhondrosis, i. e. in the 3th or 4th position of NAEGELE.
Other causes are: the sedentary and indolent habits of many
women; cramps of the bowels, arising from increased irritability,
and thus retaining the faces spasmodically; deficiency of bile
caused by frequent and copious voritings of that fluid.
Treatment.-CROSERIO with characteristic simplicity, thinks
that constipation may be generally remedied by a proper diet,
by increasing the proportion of vegetables and fruits, or adding
the use of a glass of pure fresh water after rising in the morning,
and by proper exercise.  In those numerous cases in which
these means do not suffice, he advises the use of a homceopathic
injection of three ounces of water, for the purpose of relieving the
rectum of a few small scybalae, and leaving the rest of the bowels
loaded. Still, he and TICKNOR place much stress upon the habit
of giving nature a chance to perform her office, by regular attendance every morning at the temple of cloacina, whether they experience an urgent call to do so, or not.
When constipation has been allowed to proceed so far as to
produce heat in the lower part of the stomach, weight and pressure upon the lower bowel, CRosERIO advises the decidedly inadequate means of giving Nux-vom. 30th dilution, in the evening,
and awaiting its action four or five days; if the effect is not
then produced he recommends the use of Sulphur 30th, one
dose ev  every evening for fifteen days more; and finally in the
most rebellious constipation, Bryonia 30th dilution, in a glass
full of water, a spoonful to be given every two hours, commencing




60               DISORDERS OF PREGNANCY.
in the morning; until the effect is experienced; in many cases
this will probably require fifteen days more.  PULTE recommends the alternate use of Nux, Opium and Platina, one dose
of six globules, every three or four hours; until an evacuation
is produced; but if many days elapse, or the evacuation be insufficient, he shrewdly observes that a full injection of cold water
will probably aid the effect of the medicine.  Bryonia and Ignatia are recommended if the bowels feel painful, and irritation
or inflammation is about to set in from procrastinating and insufficient treatment; while Lycopod. and SulIphurr may be tried,
if the constipation has already lasted a long time, notwithstanding
the above treatmient.
Nux-vomica is the remedy most frequently used by homo-opathists against constipation, even old school physicians are beginning to use it, claiming it however as an antipathic remedy,
on account of its tonic action upon the muscles and motor nerves,
thus giving tone and vigor to the muscular coat of the stomach
and bowels, and necessarily in creating peristaltic action, while
it directs again towards the bowels some portion of that nervous
energy, which has been drawn in preponderating  proportion
towards the impregnated womb.  BONET says that he has used
Nicx-vonica alone with but slight effect, but has ascertained
that an aperient scarcely able by itself to produce a single evacuation, caused active purgation when combined, or alternated
with N;ux; and thinks that it possesses not only the power of
stimulating the muscular fibres of the bowels, but also the property of increasing the activity of medicines that affect the
secretions; thus, when added to a single grain of Mercurius, it
will cause two or three bilious motions; and when combined
with a fraction of a grain of Aloes or Rhubarb, it will cause one,
or perhaps two full evacuations.  He has used Nux-vormica as
above, for months together and not only experienced no  bad
consequences, but found the disposition to costiveness materially
lessened, while daily relief has been produced during the whole
time.
Aluzmina is another homoeopathic remedy against habitual
constipation, which old school physicians are beginning to use.
ALDRIDGE says it will allay colic, cause alvine evacuations, and
promote the secretion of urine, when almost all other remedies




CONSTIPATION.                         61
fail.  PEREIRA says that Alum  has proved more  successful
against lead-colic and constipation n than any other agent or class
of remedies; it allays vomiting, abates flatulence, mitigates
pain, opens the bowels more certainly than any other remedy,
and frequently succeeds in these desirable results, when other
powerful drugs have failed.
I have frequently used Plumbun-aceticum Tn  th, or T'-th,
with very marked benefit; a dose given once or twice a day for
a few days, and then every one, two, four or more days will often
overcome the most obstinate and chronic constipation, and the
bowels will continue to perform their functions regularly for months
without further aid from medicine.  But some little adroitness
and astuteness is requisite to enable the physician to use this
and similar remedies successfully; for constipation may arise
from an irritable and spasmodic state of the colon, and a superficial
homoeopathist may be led to give Opiunm, when he should give
Nu.x or I natia; or it may arise from unusual sluggishness of
the muscular coat, or from a sub-paralytic state of the muscular
fibres and motar nerves of the bowels, and the routinist will probably give iux, in place of giving Opium or Plumvbum n; or it
may be caused by, or be connected with a deficient secretion of
bile and intestinal fluids, causing a dry state of the bowels, and
the mere symptomatologist will be as apt to give the antipathic
remedies Bryonia, Mercurius and Sulphur, as the homoeopathic
remedies, Calcarea, Alumina, Plumbum, or Opium.
According to HEMPEL'S complete Repertory, Ferrum-aceticum is indicated when there is constipation, with piles, and painful pressure while at stool.  Ferrum and Plumbum are both homceopathic to constipation from great dryness of the bowels, but
Ferlrum is homceopathic to the constipation of ruddy and plethoric persons, while Plumbum is homoeopathic to that of pale,
anaemic, chlorotic, and feeble persons with weak backs, and half
paralyzed legs.
Kali-bichrom., is indicated in periodical or habitual constipation, when there is pain across the loins, foul tongue, headache
and cold extremities.
Capsicum when the constipation proceeds from a heated state
of the abdomen.
Moschus is homoeopathic to that singular form of constipation




62                DISORDERS OF PREGNANCY.
which is induced or increased every time one takes Coffee; this
article generally exerting or stimulating a laxativeeffect upon
the bowels.
Veratrum, when constipation is caused by an excessive flow
of urine, which diverts the fluids from the bowels.
Belladonna, China and Phosphor are indicated when there
is constipation, with heat in the head, great distension of the abdomen, pressure in the pit of the stomach and dizziness.
Zincum-sulph.,    has been used very successfully by Dr. GEO.
STRONG; he gives a dose four or five times a day, for one or
two days, and then omits the medicine for one or several weeks;
three weeks is the shortest period of time within which he has
known flatulence and costiveness to return after their disappearance under the use of the Zinc. The medicine operates a little
singularly; at first there is an increase of flatulence upwards
and downwards, but in a day or two the patient who may have
been -o bloated after meals as to be obliged to loosen his waistband, finds himself less bloated, and his wind better for walking,
or going up-stairs; soon regular, large, but rarely loose evacuations make their appearance, preceded by a peculiar sensation
in the belly, not amounting to griping; occasionally a tingling
like the pricking of pins and needles is felt over the body,
and even along the limbs, from  a vivifying action upon the
nerves.
The Fel-Bovinun-inspissattum  is a most invaluable, natural
and non-medicinal palliative remedy against morbid irritability
of the stomach, when accompanied by vomiting soon after meals;
in acidity of the  stomach, with acid and curdled vomitings,
gripings and restlessness; and especially against the most obstinate constipation.  It prevents milk and other food from turning sour, and immediately dissolves milk again, when it has already coagulated; and is the most rapid solvent of hardened
faeces that has yet been discovered; it will soon produce copious
motions from the bowels, without the least sickness, or slightest
sensation of pain, or even the common feelings of uneasiness or
commotion in the bowels.  Its efficacy is much increased by
giving it in alternation, or combination with Nux-vomica.  It is
peculiarly serviceable in obstinate constipation of seven, ten or
fourteen days' standing; in which a few grains of it will produce




CONSTIPATION.                         63
as much effect as ten or twelve ounces of Castor oil, or from
twenty to thirty common purgative pills.  Finally, in those very
troublesome and serious cases where an immense mass of hardened fTces has become indurated and impacted in the rectum, so
that it cannot be moved off by any exertion of the patient, without intense suffering, and which is entirely rebellious to all
ordinary injections, so that it generally has been obliged to be
dug out with a spoon, a small injection of three or four ounces
of ox-gall and water will soon  solve and expel the hardened
masses pleasantly and effectually.
According to Dr. MADDENT (see Brit. Journ. of Hom., Vol.
7, p. 310) the rival systems of Homoeopathy and Allopathy
stand exactly opposed to each other in the treatment of constipation; thus, while Homoeopathy abounds in direct means for
ultimately curing constipation, it possesses but few resources for
palliation; Allopathy has a countless array of remedies which
temporarily remove the difficulty, but scarcely one direct mode of
effecting a permanent cure.  It is beyond doubt true in the abstract, that laxatives and cathartics ultimately tend to increase
the evil which they are given to remove, and that homceopathic
remedies which act slowly but directly in restoring natural function, have no such counterbalancing defect.  Arguing from these
abstract facts, many physicians have uniformly condemned cathaftics, and extolled the value of homocopathic remedies,; but
it not unfrequently happens, that the benefit gained by an immediate unloading of the bowels more than compensates for
the subsequent increased tendency to constipation; -which in
fact may be entirely prevented by using homceopathic remedies
in alternation or combination with the aperient. MADDEN is convinced, that it not unfrequently happens that a judicious aperient
will at once remove a state of things, which if treated otherwise,
would entail an illness requiring several days to overcome. There
is much unreasonable prejudice amonog homceopathic practitioners
upon this point: they will unhesitatingly condemn the use of
the mildest medicinal aperient, and yet will order their patients
to eat prunes, figs, roasted apples, green vegetables, brown
bread, &c., in hopes of producing the same result.  Now, where
is the difference? a dose of Castor oil, for example, produces an
increased action of the bowels, in virtue of its being an indiges



64                DISORDERS OF PREGNANCY.
tible oil, which passes through the whole intestinal tube, almost
unchanged, and perhaps exerts a slightly irritating effect upon
the mucous membrane, whereas the aliments above named produce the same results in virtue of their having either a large indigestible residuum  which irritates by its presence, as is the
case with green vegetables and brown bread, or by their con:
taining vegetable acids which directly and specifically irritate
the mucous membrane, as is thecase with the sub-acid fruits.
The result, therefore, is the same in both cases, but in the latter
is accompanied with conditions, which render it highly unsuitable in many important cases., It is, however, always objected
by the rigid followers of HAHNEI MANN, that the one great point
to be borne in mind, is that all laxative drugs interfere with the
action of our remedies, and hence must be eschelrved, however
useful they might otherwise be considered; but I (MAaIDDEN)
trust, I shall be enabled to prove,.that both practically and theoretically this interference has been greatly over-rated.
Again, in deciding upon the most suitable treatment for constipation, we must remember that the natural functions of the
bowels depend upon various circumstances, all of which must be
in  operation ere the natural action  can be performed.  For
example, appropriate diet and regular exercise are essential in
most instances to produce the desired effect; in spite of this,
we often hear of homoeopathists refusing any additional aid to
patients in whom the confined state of the bowels depends solely
upon the absence of these conditions; e. g. a person naturally
inclined to costiveness but who by dint of ra careful diet and regular exercise has maintained his health, meets with an accident;
(breaks his leg, for instance, and hence is confined to bed) and
the sudden cessation of his accustomed exercise, checks all tendency to natural action of the bowels, and it frequently happens
that the best-selected homoeopathic remedies will produce no result.  What then is to be done?  A  rigid homecopathist will
answer, wait patiently and be guided by the symptoms, and
no matter how longa time shall elapse without a movemnent of the
bowels, you need not interfere till there is distinct evidence of
constipation producing injurious results.  In this way,S I, (MiAD
DEN) have heard of six weeks being allowed to ela-pse without
any effort to relieve the patient, and when interference was at




CONSTIPATION.                           65
length imperative, the poor patient had to be delivered of his
load, by having it scooped out.  Is this justifiable?  _We may
no doubt be told, that cases of nearly as long lasting constipation, have frequently occurred which were not followed by any
evil results; but this surely does not warrant our voluntarily
permitting a patient to remain in such a condition; for to do
this, the advocates of the let-alone system, must be able to
prove  that it never does harm, which is quite out of their
power., The real question to be answered is this: Do mild
aperients do any harm  in cases such as above described? all
experience proves that they do not, and hence, I, (MADDEN,)
believe it to be our duty to resort to them  as soon as any
necessity  for interference  exists,  provided  the homoeopathic
remedies, fa il in producing the desired result.  I believe it,
as a rule, much safer to secure an action of the bowels, at least
every two, three, or four days, even at the expense of administering  some mild aperient, than to allow  the patient to continue so long in a condition which may at any time become
fraught with danger, and which at all times produces much
anxiety of mind, in himself and those around him.
There are many other conditions of occasional occurrence, in
which homoeopathic remedies will fail to relieve constipation,
such as some cases of pregnancy, of congestion of the abdominal
veins, of retro-flexion of the womb, and other cases where the
cause of the constipation is somewhat mechanical.  I, (MADDBEN) have met with so many evils resulting from the neglect
of the proper regulation of the bowels, by rigid homoeopathic
practitioners, that I cannot avoid directing very especial attention to this point.  About a year ago I was consulted by a lady
who had been lono an invalid, and had latterly been treated
according  to our system; her attendant, however, was among
the most rigid adherents to all the dogmas of our great master,
and accordingly allowed no other means, besides an occasional
lavement, to be employed to overcome the great tendency to
constipation under which she labored.  By degrees the enema
lost its effect, and she was then directed to increase the quantity and the frequency of its employment; a number of pelvic
symptoms which at this time manifested themselves were attributed  by her physician  to uterine  congestion,  W Vhen  1,
FE




66         DDISORDERS OF PREGNANCY.
(lfiADDElN) first saw her, she was exceedingly weak, complained
of constant dragging pains in the back, which prevented her
taking almost any exercise, and the bowels never showed any
symptoms of acting, unless she took two or three enemas of a
quart each. The lady herself had often thought that the lower
bowel was greatly distended; but her physician assured her that
her sufferings were uterine; on examination the rectum was enormously distended, extending entirely across the posterior wall of the
pelvis, and being fully three times its natural diameter. MADDEN.
i, (PETERS) have witnessed several similar cases; one old
lady, between 70 and 80 years of age, had been allowed to go
several weeks without any movement from the bowels; finally
her sufferings became so severe, that she felt compelled to take
an anodyne, for which she was severely reprimanded by her
strict homrnopathic attendant; but many days after she was
obliged to resort to the same means in order to obtain a little
sleep and cessation of suffering, and the physician immediately
abandoned her.  When I first saw  her she had fever, dryness
of the tongue and mouth, great tenderness of the abdomen to
touch, and almost agonizing pains in the bowels, most severe
at night; the abdomen was so much distended, hard and knotted,
that my first impression was, that she had a number of hard
malignant tumors of the liver, and mesentery; but equal quantities of Aloes and lHyosciamus, aided by laxative injections,
brought away almost fabulous quantities of feces, followed by
complete relief and rapid recovery, so that I was only obliged
to visit her three times in consultation.
DIARRHCEA.
TIns  often depends simply upon the nervous irritation induced by pregnancy; at other times it may arise from cold, to
which pregnant females are very subject, owing to defect of
drqss; or from disease of the mucous membrane of the bowels.
It sometimes follows conception so closely, that the patient has
her attention first drawn by it to her situation, and it may
return regularly every month, as though it were vicarious of
the menses.  CHURCHIIL gives the case of a lady who was
always seized immediately after conception by diarrhoea, wllich
returned with unfailing regularity  every  month during  the




DIARRIiEA.                            67
whole of her pregnancy, and was often accompanied on its
return by violent pains in the stomach.   The occurrence of
this periodical diarrhoea, was always considered by the lady
herself as an indubitable sign of pregnancy; it continued for
seven or eiglht days each month, and on each day she had from
fourteen to twenly-five copious discharges, and yet enjoyed a
moderately good state of health and spirits.  Although we have
seen that constipation is most common during pregnancy, yet
examples of diarrhoea are very numerous; in fact, however, many
of these attacks are caused by previous constipation, and alternate with it; or'both diarrhoea and constipation may coexist,
for we occasionally find fluid stools discharged while hard fiecal
matter is accumulating largely in the bowels. ANDERSON places
great stress upon this point, and emphatically urges, that it
must not be forgotten that diarrhoea frequently depends upon
the presence of extreme constipation; the bowels having been
neglected, their mucous membrane becomes irritated by the
hardened fseces, over which the watery discharge passes, the indurated masses being unable to come away on account of their
size and solidity.  In  such cases it becomes necessary to break
down the scybala by means of injections; or still more mechanical means, such as a spoon, gouge or other instrument.
In the severe cases in which there are inflammation and ulceration of the mucous membrane, the pain is great, often with a sense
of internal burning, the pulse is quickened, the tongue dry, skin
hot, with much thirst, the appetite is diminished, and vomiting
occasionally occurs; these cases are apt to prove fittal, or cause
abortion, about the third month.
PULSATILLA,
Is recommended, if the stools are slimy, greenish and watery,
preceded by colicky pains, the mouth being clammy and bitter,
without thirst, especially if the patient has chills, and the evacuations occur principally at night.
Boe,. —The l2th dilution has been used most frequently, according
to Rueckert.
SECALE,
Is also suitable against diarrhoea, when connected with derangement of the uterine organs and suppression of the menses,




68                 DISORDERS OF PREGNANCY.
especially when the passages are slimy  and mucous, and the
patient's tongue is coated with mucus, with a pasty taste in the
mouth, and much rumbling in the bowels.
B8ose, —The tincture in water; the 1st tiituration; and the 3d and:30th dilutions have all been used successfully.
PHOSPHORUS, AND PHOSPHORIC ACID
Are still more important remedies, when  the diarrhoea of
pregnant females proves obstinate and chronic, when the passages are painless and half liquid, occasioning general nervous
weakness, with some or great emaciation, and progressive undermining of the health.
Do0s-Phosphor. 30 was used successfilly in four cases; the tincture in several.  Phosphoric acid undiluted, in large and frequent
doses, and the 1st to the 9th dilutions have effected cures.
DULCAMARA,
Is indicated when the diarrhoea is caused by taking cold, the
passages being greenish or yellowish in color, more or less mucous and acid, being preceded by colic and followed by debility,
and generally taking place in the evening.
Dose,-The extract, tincture, 1st, 21st and 30th dilutions have been
used successfully.
BRYONIA,
Is recommended when the evacuations are almost involuntary,
have a fetid  smell and brown color, with much flatulence, especially if caused by taking cold and attended with cough; pain in
the side, or rheumatic pains in various parts of the body.
Doe, —The 5th dilution has been used most frequently.
RHIUS;
When the passages only occur after midnight.
Dose,-The 1st and other dilutions.
CHINA,
Has proved useful when the passages contain undigested food,
and take place soon after a meal, or at night.
Do0e,-The tincture, and 12th dilution have been given with success.
ARSENICUiM ABD SULPH-UR
Are often useful in intr1actable and chronic cases.
Dose,-Ars. has been g'ivte  in doses of' iLth of a grain;  and in the
6th, and 30th dilutiors.




JAUNDICE AND LIVER SPOTS.                     69
JAUNDICE AND LIVER  SPOTS.
SOME females acquire a dark; almost yellow  color of skin
during pregnancy, which must be carefully distinguished from
jaundice.  Others are often subject to yellow  or dingy stains,
which occur in patches over the face, or on the forehead, or
cheeks.
Treatment.-Sepia, Sulphur, Lycopodium, Phosphor  and
Arsenicum are the principal remedies.
True jaundice may occur either in the early, or in the later
months of pregnancy; in the former case it is probably owing to
that sympathy which all the digestive organs have with the
impregnated womb; or it may be connected with congestive enlargement of the liver, which continues during pregnancy and
terminates with it; or it may arise from inflammation of the
liver,  occurring accidentally, from  cold  or mental emotions,
such as chagrin.
Synzptoms.-In most cases it will be found that the patient
has been suffering from a disordered state of the stomach and
bowels previously; it often happens that irritation or inflammation of the pyloric orifice of the stomach, and of the duodenun is propagated along the biliary ducts to the liver, and then
jaundice is apt to set in after a fit of vomiting, accompanied with
tension and weight about the pit of the stomach and region of
the liver; —the dyspeptic symptoms are apt to increase after
the appearance of the jaundice.  In many of these cases the
liver will be found enlarged and projecting for one or several
inches below the edge of the ribs.
When inflammation of the liver is present, there will be
shiverings and flushings, cough, loss of appetite, pain in the
right side. with quickness of the pulse, high colored urine and
torpid bowels.
When jaundice occurs during the latter months of pregnancy
it generally arises from the pressure of the enlarged womb upon
the gall duct.
Treatment.-The more simple forms are easily removed by a
few doses of Mercurius and Chamomilla, in alternation, every
two, four, six or eight hours; more obstinate and torpid cases
require Sulphur and Nux in alternation every night and morning.




70               DISORDERS OF PREGNANCY.
When there is irritation and inflammation of the duodenum,
Colchicum  is the most homoeopathic remedy.  When there is
congestive enlargement of the liver,   Mercurius; Sabina and
Aloes are the principal remedies; when the liver is decidedly enlarged, the physician may be rendered anxious about the case,
but it is well known, that jaundice and decided enlargement of
the liver will often subside spontaneously a few days after delivery.  When there is well marked inflammation of the liver,
the region of that organ may be freely bathed with the tincture
of the root of Aconite, every two, four or six hours according to
the severity of the pain, fever and other symptoms, while Aconite, Bellad. and Mercurius should be used internally; in chronic and obstinate inflammation of the liver, Phosphorus is the
most homoeopathic remedy, although Sulphur and Cuprum may
be required in alternation.
HAEMORRHOIDS, OR PILES.
FEW  women bear children without becoming in some degree
affected with piles.  External piles rarely give rise to bleeding
to any great extent, while internal piles are very apt to bleed
profusely.  Both varieties are apt to become inflamed, and the
inflammation may go on to suppuration; when the matter is discharged the abscess may close, and the pile or dilated vein may
become obliterated; occasionally the opening remains fistulous,
or ulceration of the inner surface of the pile may occur, attended
with rather severe and burning pain, lasting for an hour or two
after a movement of the bowels, and the sitting posture is often
very painful; but the suffering is not nearly so great as that
occasioned by an irritable ulcer of the rectum.  The patient is
also apt to suffer severely at timnes from the protrusion of the
piles, not only after stool, but in a lax state of the sphincters the
piles may come down, even vwhen the patient stands or walks
about, so as to prove exceedingly troublesome, and interfere with
walking exercise.  The irritation of piles frequently extends to
the urinary organs, the patient being occasionally troubled with
a frequient desire to pass water, and even with difficulty in voiding it, from  spasm of the membranous portion of the urethra.
Although piles in pregnant females are generally caused or




HEMORRHOIDS, OR PILES.                      71
aggravated by the pressure of the enlarged womb upon the vessels of the lower bowel, still many females frequently suffer no
great inconvenience from  them, until irritated by an unusually
costive motion, or by the occurrence of an acrid diarrhoea, or
from  feverish excitement, when the pile becomes congested and
inflamed, and then they have what is termed "an attack of the
piles,"-that is to say, they suddenly experience a sensation of
heat, weight and fulness just within the rectum, followed by considerable pain at stool, and sometimes by irritation about the
bladder.  These symptoms, which are often attended with fever,
arise from inflammation and swelling of the piles.
When internal piles of some size protrude, they are liable to
be constricted and strangulated by the external sphincter; the
contracted muscle impedes the return of blood, and occasions
inflammatory swelling of the piles, until at length they become
strangulated and mortify; an occurrence of this kind is attended
with a good deal of pain and suffering, but is generally free from
danger.
One of the most common symptoms of internal piles is the
bleeding, which occurs when the bowels are evacuated.  The
bleeding varies greatly in amount; sometimes there are only a
few drops of blood; in other instances several ounces may be
voided.  The bleeding may also be irregular, occurring  only
after costive motions, or in certain states of the health; or it
may take place daily, producing the usual symptoms of derangement from  continued losses of blood; the complexion may become blanched, and the lips appear waxy; the patient may lose
flesh and strength, have a quick and small pulse, suffer from
throbbing in the temples, palpitations and difficulty of breathing
on making the slightest exertion, and at length finds her legs
and feet swollen from oedema.  The bleeding may be venous, or
arterial in character; it often unloads the congested and inflamed
vessels, and affords the patient much relief; but the bleeding
which most commonly occurs from internal piles is undoubtedly
arterial, taking place from arteries enlarged by the disease. An
artery of some size in the sub-mucous tissue may be exposed by
ulceration, and continue for some' time  to  pour out blood,
weakening the patient, and giving rise to the symptoms above
described.  On examination the surgeon may discover a red,




72                DISORDERS OF PREGNANICYfungous looking mass, from  which the bleeding is seen to proceed, and sometimes a small artery may be observed pumping
out blood; the blood then has a bright red color, and it is quite
a mistaken notion, that bleeding of this character is good for
the health of the patient.-(CURLING).
Attacks of piles are most common about the middle, and end
of pregnancy, but they may occur at any period.  Some women
are severely attacked -with them  immediately after delivery,
owing probably to the pressure on, and forcing down of the bowel
during labor.
Treatment.-In cases of internal piles, half a pint of cold
water thrown into the bowel in the morning, after breakfast, has
a very beneficial effect on the piles by constringing the blood
vessels, and softening the motions before the usual evacuations.
CUaRL NG says, that the relief afforded by this simple treatment,
combined with care in the living, is often remarkable; persons
-who have suffered more or less from piles for years have assured
him, that they have been quite free from  all annoyance since
they have regularly used the cold water lavement.  Those who
suffer with severe pain for one or several hours after each movement of the bowels, should either lie down for some time after
stool, or else change their habit of evacuation to the night, just
before bed time, so that they may have entire rest in the recumbent posture.
In many cases there is a slimy discharge and an evidently
unhealthy state of the mucous surface of the piles; Pulsatilla
may be given when there are discharges of blood and mucus, with
pains in the back, tendency to diarrhoea and difficulty of urination.  Capsi-cum, when there is great irritability of the gastric
and intestinal mucous membrane, with burning heat and itching
at the anus, with pain and heat during  urination.  Copoaiba and
Cubebs, when there is a profuse discharge of pus, or muco-pus
from the bowel.  Although  CGpsicum, or red-pepper is most
relied upon by hommopathists; yet in the old school the confection of black pepper, better known as W-ard's paste, has long
bren in great repute as a remedy for piles, and CURLING says,
there can be no doubt, that it exerts a beneficial influenee upon
the complaint; this preparation is supposed to pass through the
alimentary canal but little altered, and on reaching the rectum




HEEMORRHOIDS, OR PILES.                      73
to act directly upon the piles as a stimulating application; the
Cubebs pepper taken internally seems to relieve piles much in
the same way as the confection of black pepper. —(CURLING).
In cases where there is much irritation about the mucous nmembrane of the rectum, great relief may be obtained from the Balsam  of Copaiba.
When there is much inflammatory irritation with or without
discharge of blood, Aconite is the most appropriate remedy,
Belladonna and S,-ranlonium  are regarded as peculiarly suited
for females, when there is hemorrhoidal constipation from congestion, swelling, or inflammatory irritation of the piles, attended
with violent pains in the small of the back, discharge of blood
for several days, urgent tenesmus and spasmodic contraction of
the anus, with constant pressure and bearing down of the bowel~
Nux and Ignatia are most homceopathic when there is much
spasmodic irritation of the lower bowel; they are admirable palliatives, when there is a lax state of the sphincters, allowing the
piles to protrude when the patient stands or walks.  Igzatia
is most indicated, when the stools are soft; Nuxa, when they are
hard and constipated; while Sulphur is the m1ost important remedy where there is alternate constipation and diarrhoea.
When there is profuse bleeding from  the piles, Sabina, 2Millefolium and Aloes are the most important remedies.
Where there is ulceration of the rectum, Arselnicumz,    Acidnitric and Acid-muriat. are the most useful remedies.
In the majority of cases; the alternation of TN;x and Su1lphur,
one dose every evening, will soon produce a most marked alleviation of all hoemorrhoidal sufferings; if the constipation be
very obstinate, Ignatia and Opium  should be given in alternation every two or three hours until relief is obtained.  But I
regard Aloes as by far the most homccopathic and useful remedy; it may be given in alternation with Ferrtum, if the loss
of blood has already been very great, and a certain amount of
Ansemia has been produced.  TILT says, that he has never
seen piles produced by the frequent use of Aloes, but he has
often seen them relieved by it, and his experience is corroborated
by that of GIACOMINI, AvICENNA, STAHL and CULLEN.
Su/lphur and Aloes in alternation are almost specific against




74                D1SORDERS OF PREGNANCY.
piles, when attended with marked bilious derangement, or torpor
of the liver.
Calcarea and Sulphur have been given successfully against
the consequences of suppression of piles, such as continual vertigo, even when so severe, that the patient is apt to fall down
unconscious; congestion of blood to the head, constant aching in
the back of the head, palpitation of the heart, great excitability
of the whole vascular system, pulsations throughout the whole
body, violent, oppressive, stupefying headache, and weakness of
memory, with anguish and oppression of the chest froim  slight
physical exertions or moral emotions.
BosG, —~N:c has been used successfully in repeated doses of the
tincture; also in the 3d and 30th dilutions.  Sulphzur has been most
useful when given in the tincture, or 1st trituration, or in doses of,
of a grain.  Mluriatic acid, in the 1st dilution; Nitric acid, in the 5th
potency; Arscnictum, in the 30th dilution; Aconite and Belladonna in
the tincture, or 1st, or 3d dilution.
INCONTINENCE  OF URINE.
TH-IS inconvenience has already been alluded to, (see page
10).   During the early months of pregnancy it generally arises
from irritability of the neck of the bladder, or of the entire organ, in consequence of its sympathy with the womb.  The patient is tormented with a constant and painful desire to make
water; and often, if this desire be not instantly gratified, it is
discharged involuntarily.  The irritation is sometimes extended
to the vulva and is greatly aggravated by the passage of the
urine; the patient may suffer intensely, especially in the night,
from scalding, itching and pain of the external genital parts.
It may also arise from pressure of the womb upon the neck
of the bladder, giving rise to a partial and temporary paralysis
of it.  At a later period of gestation, the incontinence is owing
to the pressure of the enlarged womb upon the base and body
of the bladder, diminishing its capacity, and hence rendering the
calls to urinate frequent be they voluntary or involuntary. This
pressure may cause a tedious paralysis of the bladder, so that it
may be some time after delivery before its functions are perfectly
restored.  The incontinence will be much increased, if the pa



RETENTION  OF URINE.                       75
tient has a cough, as each paroxysni will be apt to let the urine
escape.
In some cases the condition of the patient is very distressing;
the constant discharge of urine excoriates the vulva more or
less, and the upper part of the thighs, so that the patient cannot move without pain, and the urinous odor may be extremely
offensive.
RETENTION  OF URINE.
THis seems to be an opposite condition from incontinence, or
inability to retain the urine, yet both are apt to arike from very
similar causes.  Irritation of the neck of the bladder may give
rise to frequent evacuations of urine, or if it proceed to a greater
degree, may cause spasmodic constriction, and consequent retention.  Pressure upon the neck of the bladder may irritate, or
completely compress and obliterate it; pressure upon the body
of the bladder may cause paralysis of this, and leave the neck
either naturally, or spasmodically contracted.  An  attack  of
piles, or swelling of the urethra, may also cause retention of
urine.
It is scarcely necessary to describe the symptomns of retention
of urine, although a few w-vords may be said about its consequences; these are: difficulty, or inability to evacuate the bladder; great distention of the bladder, so that it presses back
upon the womb, and may retrovert, or tilt it backwards; if relief be-not afforded, the pain and tension of the bladder may increase to agony, the abdomen become tender, and ultimately the
bladder may burst, and the urine be effused into the cavity of
the abdomen.
Should retention occur at the commencement of labor, the
consequences may be very serious; for the bladder may be forced
down into the cavity of the hips by the descent of the child's
head, and if it be not ruptured, which is very likely, the bladderi
will receive such a serious compression and contusion as will
doubtless excite inflammation, sloughing and perforation subsequently, and all the horrible consequences of vesico-vaginal fistula.
Treatment.-N-Vu   vomica is recommended both against re



76                DISORDERS OF PREGNANCY.
tention of urine from  paralysis of the bladder, and against incontinence of urine from0  morbid irritation of the neck of the
bladder, with frequent calls to urinate, with pain or urging,
without any particular change in the character of the urine. The
South Pole of the Magnet has also removed a kind of paralysis
of the bladder.  Cicutta, 3d dilution has cured paralysis of the
bladder, with involuntary urination.  Coniurn  30, has relieved
a painful retention of urine.  Cannabis has relieved obstinate
retention of urine, when accompanied by obstinate constipation.
Cannabis has also relieved the most violent irritation of the
bladder, with violent desire to urinate and discharge of a few
drops only of bloody and acrid urine.  Cantharides is homoeopathic to a very similar state to the above; also Capsicunm.
Staphis tria also relieves painful micturition, when the urine
is only passed drop by drop.  Rhus has cured incontinence of
urine, the urine being passed involuntarily unless the desire to
pass it is satisfied  immediately.  Pulsatillc, Bellad., Cina,
Magnes.-carb. and Antimon.-crud. also deserve attention in obstinate cases.  Dulcamara is efficient against tenesmus of the
bladder brought on, or aggravated by taking cold.  Sulphur is
said to have cured urinary fistula.
SPASM OF THE URETERS.
PREGNANT females are occasionally subject to accessions of
severe pain in the course of the ureters, leading up to the kidneys, and this CHURCHILL  SayS, DR]. BURNS attributes to
spasm of the ureters, probably owing to pressure upon these canals as they pass into the cavity of the hips  the attack consists of severe and sometimes intermitting pain, with distressing strangury, which may cause abortion if not relieved. Change
of position will sometimes relieve the pain by removing the
pressure; if Cannabis, Pulsat. or Cantharides do not afford relief, Opium should be resorted to, as it is not only anodyne, but
also homneopathic to irritation of the bladder and ureters, and to
difficulty or retention of urine.  Camphor is a useful palliative.  These attacks may be mistaken for colic, and for congestion or irritation of the ovaries. (See page 10).




WHITE-WEAKNESS.                          77
ITCHING  OF THE VULVA,
is not an uncommon accompaniment of pregnancy, owing probably to the increase of fluids in this part during gestation; at
times it is owing to an aphthous or cankered condition of the
mucus membrane of the vagina.
Treatenet.-Sulphur, Sepia, Opium and Borax are the most
important remedies.
CEDEMA  OF THE LABIA,
is rather rare during the early months of pregnancy; it is most
common during  the  seventh, eighth and ninth months.  In
many cases it is the result of pressure on the veins by the enlarged- wo-mb, and is most common in those females who have
such large hips that the womb can settle down into the pelvis.
In another class of cases it appears as part of a general disposition to dropsy.  It is attended with a sensation of fulness,
with more or less stiffness of the parts, and difficulty or pain in
moving. (See Dropsical affections).
MAURICEAU has described a variety in which there is always
considerable itching.  Aphthous inflammation may set in, and
erysipelas may even occur.  Still the whole affection generally
disappears soon after delivery.
Treatment.-Arsenicum, Digitalis and Apis-mell. are the
most important remedies.
WHITE- WEA KNESS,
or VAGINAL LEUCORRI-I(EA,
is an extremely frequent accompaniment of pregnancy, so much
so, that few females entirely escape, although it is rare for it to
produce serious effects.  It is worse before the womb rises from
the pelvis than subsequently, as it is frequently caused by the
gravid womb producing irritation, and by the slow return of the
blood from  the vagina, owing to the pressure of the womb,
coupled with the increased flow of blood to all the sexual parts,
which takes place during pregnancy.  The state of the patient's




78                DISORDERS OF PREGNANCY.
constitution has also much to do with the frequency and severity
of leucoilrrhoea during gestation.
WThen excessive it causes much debility and aggravates the
achinog in the backl  of which pregnant women so often complain;
but at the end of gestation it is said to render the labor more
easy;'by lubricating and relaxing the passages.
Frequently, the discharge is merely an excess of natural mucus, transparent, colorless and bland; occasionally it is thicker
and yellowish and greenish, but rarely acrid; sometimes it is
attended with acute inflammation.
7T-reatmtent.-Bovista is one of the most important remedies;
zSlphutr is said to cure many chronic cases; Pulsatilla, when
the discharge is thick like cream, and causes itching and irritation; Sepia, if the discharge is yellowish, greenish, fetid or
corrosive, and attended with bearing-down-pains.  Cocculus, if
it is reddish and attended with much colic and flatulency; Calcarea, when it is white and corrosive.
DISCHARGE OF WATERY FLUID FROM THE VAGINA.
HYDRORRI-HEA, OR FALSE WATERS.
PREGNANT females- are occasionally attaclcked with a fluid discharge from  the vagina, quite distinct firom  the leucorrhoea,
which has been described.  It may occur, once or several times
during pregnancy, and continue for a week or two, or it may
persist for several months.
These discharges are neither preceded or followed  by any
pains or contractions of the womb; their nature is such as to
interfere but slightly with the pregnancy, the latter advancing
as usual to its natural term, and at the time of delivery the true
bag of waters is regularly formed.
Most generally the female enjoys her usual health before the
discharge comes on, when she unexpectedly finds herself wet,
the fluid escaping drop by drop, or else she hears the peculiar
sound caused by the sudden discharge of a considerable quantity
of waters. In most cases she suffers no pain either during or
after the discharge, though slight uterine contractions may set
in; but if the patient keeps perfectly quiet, the pains soon cease




EXCESS OF WATERS, WITHOUT DISCHARGE.                 79
and everything resumes its natural order again. The discharged
waters are usually a little yellowish, very limpid, and at times
tinged with blood, leaving stains upon the linen, and having a
well marked spermatic odor.  The discharge is much influenced
and increased by mental emotions and bodily excitement; on the
other hand it augments in quantity during the most perfect
quietude, as for instance, at night during sleep.  In one case,
observed and treated by myself, the discharges only took place
at night, during rest or sleep, and then often amounted to one
or several pints.
CAZEAUX supposes, that the fluid is formed outside of the
membranes, between the internal surface of the womb and some
portion of the external surface of the membranes, which becomes
detached; that is to say, the fluid is secreted from the internal
surface of the womb, gradually detaches the membranes, thereby
forming a pouch for itself, until its constantly increasing quantity succeeds in separating them as far as the neck of the womb; 
when a discharge of the fluid takes place.  He thinks, that this
is the only supposition, which will account for the frequency and
abundancy of the discharges, without rendering the true waters
less abundant than usual at the time of confinement, and without
there being any marks of laceration of the membranes Prom
careful examination after delivery.
Treatment. —Although this is generally not a serious affection, still it is a very annoying one.  CI-IURCHILL thinks, that
nothing can be done except to keep the patient dry, quiet and
clean.  Arsenicum  and Digitalis deserve attention.  I once relieved a case with Arsenicum  in which there were sudden, frequent and profuse discharges of waters from the vagina.
EXCESS OF WATERS, WITHOUT DISCHARGE.
DROPSY OF THE AMNION.
IN this affection the principal suffering is mechanical, from
the pressure of the excessive quantity of Liquor amnii upon
the neighboring parts.  The womb is much larger than usual,
and proportionably more weighty, rendering the patient very uncomfortable in the upright position and in walking; if the walls




80                DISORDERS OF PREGNANCY.
of the abdomen be flaccid and weak, the womb may fall forwards,
causing what has been called pendulous belly; and adding greatly
to the distress.  Inmost cases considerable inconvenience is
felt from  the increased pressure on the bladder, and upon the
stomach and bowels.  It would naturally be supposed, that the
greater size of the womb and belly would more decidedly obstruct the various veins and blood-vessels of the legs, and cause
them  and the feet to swell more than usual; but this does not
appear to be the case.
The patient's urine is generally scanty; and the infant is
very apt to be enfeebled or diseased, or even to die before delivery.
The great distention of the womb sometimes occasions delay
in labor, from the too great stretching of the muscular structure
of the uterus, and flooding afterwards, from a kind of paralysis
from previous over-distention, which interferes with the due contraction of the womb.
Treatment.-The scanty secretion from the kidneys may be
increased by the use of Arsenicum, Digitalis, Scillle, Apis, or
Apocynum.  (See Dropsical affections).
MENSTRUATION DURING PREGNANCY.
BLOODY discharges are not very uncommon during pregnancy
— some females menstruate once or twice after conception; in
others the discharge returns for four, five or six months, or even
during the whole period of gestation.  In a few very rare cases
the menses appear for the first time during pregnancy, or only
during gestation.  Churchill thinks that there is not any risk
of abortion or premature labor, but these cases should be carefully and anxiously distinguished from those of placental presentation.
CHURCHILL thinks, that they are cases of vicarious menstruation, and that it is neither more or less difficult to account
for a monthly discharge of apparently menstrual fluid from the
vaginal mucous membrane, than from  the mucous membrane
of the gums, eyes, ears, or from  the surface of an ulcer. (See
my Book on Disorders of Menstruation, p. 116).  The discharge
or secretion may also take place from the internal surface of a




MENSTRUATION DURING PREGNANCY.                   81
portion of the womb, in the same way as suggested, when treating of False waters, or Watery discharges from the Vagina during
Pregnancy, see page 78).
WHITEHEAD, however, gives a different and probably very
satisfactory explanation; he says, all his patients had leucorrhcea in greater or less degree, accompanied by the train of sympathetic disturbances usually attendant upon these affections.
This product communicated yellowish stains to the linen upon
which it was deposited, and exhibited alkaline properties; evidences of a conclusive character as to its purulent character.
On examination with the speculum, inflammation or ulceration of one or both labia, or of the neck of the womb, complicated in some instances with warty excrescences growing from
the neck, or from some part of the vaginal membrane, or inflammation of the vagina, &c., was met with in every case, without
an exception.  Fifteen cases were submitted to vaginal examination while the blood was flowing. In not one of these did any
fluid whatever escape from the interior of the womb; the orifice
being completely occupied at the time by a plug of transparent
mucus.  On removing the accumulated secretion by means of a
piece of lint, the parts were immediately afterwards covered by
a coating of blood, which was distinctly seen issuing from innumerable pores on every part of the diseased surfaces, and
soon collected in sufficient quantities to trickle down into the
speculum.  WHITEUEAD thinks, that his experience is sufficiently ample to establish as a general rule, that the blood dicharged in cases of alleged menstruation during pregnancy is
not furnished by the lining membrane of the womb, or by any
healthy secreting surface, but by the lower extremity of the
womb, external to its cavity, or by the neighboring portions of
the vagina, one or the other being in a state of ulceration or
suppurative inflammation.
Treatment.-Arsenicum,  Cantharides, Argentum-nitricum
and Sabina, or Crocus, are the most important remedies, although
Cocculus, Kali, Phosphor and Rhus have been used successfully.
Where there is decided ulceration of the neck of the womb, weak
injections of Nitrate of Silver, Bichromate of Potash, Nitrate
of Mercury, or of Aurum-, or Stannum-muriaticum may be care"
fully used.
F




82               DISORDERS OF PREGNANCY.
Mercurius, Nitric-acid, Thuja and Sepia deserve attention,
also Kreosote and Sulph.-acid.
UTERINE  HI EMORRH AGE.
BLEEDING FROM THE WOMB.
THIS is an entirely different and much more serious affection
than menstruation during pregnancy.  It is almost always either
a precursor of abortion, or else is a sign of placental presentation.  This can only be decided by carefully watching the case,
or by a vaginal examination.  In the mean time, the patient
should be put to bed immediately, and preserve the horizontal
position not only until the complete cessation of the discharge,
but until all danger of its return is past.  Cold drinks and spare
diet should be given; the body kept cool; the bed covering light,
and the room moderate in temperature.
Treatvzent.-According to CROSERIO and LEADAM, if the
bleeding should occur in consequence of a muscular effort to
raise or carry anything, a violent exertion of the body, of a misstep, or fall, or blow upon the stomach or back, Arnica should
be given, either in the tincture or 3d dilution, and repeated
every five, ten or fifteen minutes, according to the urgency of
the case.
Ipecac. should be used if the flow of blood is copious, and
comes in a continued stream, attended with pains at the navel,
bearing down efforts, and pressure upon the womb, and lower
bowel, with chills, or general coldness, but heat of the head and
face, general lassitude and inclination to lie down.
ose.,-Either sufficient of the tincture or powder should be given
produce slight nausea, or else the 3d or 6th dilution may be used
every ten or fifteen minutes until relief ensues.
Chamomilla may be used, when nearly the same symptoms
are present as those mentioned as indicating the use of Ipecac.;
especially if the pains are like labor-pains.
Platina, when the blood is black and thick, but not coagulated
or grumous; when there is a dragging sensation from the back
to the groins, and the internal genitals are exceedingly sore and
tender to the touch.




RHEUMATISM OF THE WOMB.                      83
China and Ferrum  may be given, when the profuseness of
the discharge has caused great debility.
Crocus, when the blood is very black, clotted and viscid.
Sabina, when the discharge is bright and red, occurring in
jets, followed by the expulsion of clots.
Seceae, when the blood is black, tar-like and liquid, and the
patient is feeble, and has trembling or cramps of the limbs.
Belladonna, Hyosciamus, or Stramonium, when there is great
agitation, excessive vicacity, dimness of vision, some delirium,
twitching of the tendons, headache, &c.
N.B.  For further information see my book on Disorders of
Menstruation, p. 36 to 72, and the Chapter on Abortion in the
present work.
RHEUMATISM  OF THE WOMB.
THIS may arise from the general causes of rheumatism, such
as exposure to cold and wet, inadequate clothing, constitutional
tendency, &c.; but besides these, there is a peculiar susceptibility of the womb to the impression of cold under the attenuated
integuments of the abdomen during the latter months of gestation; for the abdomen is only covered at that particular point by
very light clothing, and the back, or sacro-lumbar region is often
but imperfectly protected by the short jacket, worn by the patient.
Symptoizs.-According to CAZEAUX  this disease exhibits
some well marked peculiarities, by which it can be easily recognized.  The principal symptom is pain, or a distressing sensation, which involves the whole, or a part of the womb; its intensity varies from  a simple feeling of heaviness to the most
painful dragging sensation.  When the rheumatism is seated at
the top or base of the womb, the pain is particularly apt to be
felt about the navel; it is increased by pressure, by the contraction of the walls of the belly, and sometimes even by the weight
of the bed clothes; and in many cases the patient is unable to
bear any movement whatever.  If seated somewhat lower, she
suffers from acute dragging sensations that run from the loins
towards the lower part of the belly, thighs, external genital organs, and the back along the ligaments of the womb.  Finally,.




84,              DISORDERS OF PREGNANCY.
where the lower portion, or neck of the womb, participates in the
affection, the seat of it can be detected by vaginal exploration,
which, however, gives rise to the most acute sufferings. But, of
all the causes which may aggravate these pains, there are none
more distressing than the incessant movements of the child.
Like all rheumatic pains, those of the womb are wandering,
and they occasionally pass rapidly from one part of the organ to
another; often, indeed, they disappear at once, and pass off to
some other part of the body.
They offer frequent and variable exacerbations in their duration and intensity, followed by remissions during which the patient only experiences a vague sensation of heaviness.'The
womb-pains are usually accompanied by pains in the lower bowel
and bladder (recto-vaginal tenesmus), which are the more distressing, the more the rheumatism is located in the lower part
of the womb.  The patient is then tormented by a continual desire to empty her bladder; the discharge of urine is attended
by a smarting sensation, and sometimes by acute suffering, while
at others it is even wholly impossible; and in many cases the
attempts to move the bowels are equally painful and ineffectual.
The attacks may be attended with chills, fever, extreme agitation and restlessness; towards the end of the paroxysms, a
profuse perspiration generally breaks out, which seems to be the
prelude of a decided improvement.  Then the general and feverish symptoms become moderated together with the pain in the
womb; but they reappear with the latter, after a variable period
ranging from a few hours to several days.
Influence of Rheumatism  of the womb over the progress
of Pregnancy.-The paroxysms are apt to be followed by pains
and contractions of the womb, and may bring on premature delivery.  The patient feels some acute and tensive pains, but this
feeling of tension is not uniform; for it increases to an extreme
degree, and then becomes weaker.  At first the womb becomes
hard and contracted, the mouth of the womb may dilate, though
its dilatation is at first slow and difficult; abortion is then imminent, but it is far from  being so frequent as might be supposed; and when it does occur, it is most common when there is
decided fever present.  The mouth of the womb has been known
to dilate to the extent of an inch in diameter, and then the bag




INFLAMMATION OF THE WOM3B.                    85
of waters, gradually retreated, the womb closed up again, and
the abortion did not take place.  Consequently, as long as the
dilatation [of the mouth of the womb does not amount to two
inches, we may reasonably hope to prevent labor from setting
in.  These uterine rheumatic pains may simulate those of parturition, and thus lead the practitioner to suspect, that labor has
regularly commenced, when in fact such is not the case.  The
character of the rheumatic pains will aid in preventing such an
error.  It is probably to some mistakes of this kind, that we
must refer those pretended instances of prolonged gestation, as
well as those cases, where the genuine travail of parturition was
developed, and afterwards suspended during several weeks or
months.  The influence of this disease over the Labor, and the
Puerperal functions will be treated of in a subsequent chapter.
Treatment.-The  local application of the tincture of the
Root of Aconite over the region of the womb is the most important part of the medical treatment.  Aconite may also be used
internally, or Bryonia, Pulsatilla, Colchicum, or Mercurius; according to the several and well known indications for the use of
these remedies in rheumatic affections.
INFLAMMATION OF THE WOMB.
THIS is much more frequent during pregnancy than in the
unimpregnated state, though less so than after confinement.  It
very seldom attacks the whole of the womb, except in the' early
months; the more advanced the pregnancy, the more limited is
the affection. It is generally seated in some portion of the body
or fundus of the womb, often in that part to which the afterbirth is attached; the muscular tissue is most frequently involved.
Sympotons.-The patient complains of a severe and constant
pain or stitch in some part of the enlarged womb, limited generally to a small space; there is tenderness on pressure, increased by walking and by the movements of the child; the
pain, unlike that of rheumatism of the womb, does not come on
in paroxysms. The bladder and rectum may be sympathetically
affected.  There is a quick pulse, hot skin, thirst and vomitingo




86              DISORDERS OF PREGNANCY.
It may terminate in resolution and the woman go to the full
time and be safely delivered; it may terminate in effusion of
lymph, firmly uniting the after-birth to the womb, requiring
manual assistance to remove it after delivery; it may cause
softening of a portion of the womb, followed by rupture during
the period of labor; or an abscess may form.-CHURCHILL.
Treatment.-The frequent and free application of the tincture of the Root of Aconite over the region of the inflamed part,
is all important.
Nux-voonica has proved a most efficient remedy in HARTMANN'S hands, when the fundus, neck, anterior or posterior surface of the wYomb was the seat of inflammation;-when there was
much fever, he gave Aconite previous to the use of Nux.
Belladonna and Mlgercurius are also suitable in severe and
obstinate cases; while Bryonia and Rhus may be useful, when
the serous surfaces are also involved.
Chamomilla and China are useful after the acute symptoms
have been subdued, and great nervousness and debility remain.
IRRITABILITY OF THE WOMB,
DEPENDS upon an excited and irritable state of the nerves
of the womb, and is nearly allied to hysteria.  The symptoms
consist of pain in the region of the womb, constant, but occasionally increased in severity, especially after exercise. There
is some tenderness to pressure over the pubes, and the womb
itself is tender on being touched per vaginam.-ANDERSON.
Treatmzent.-Agaricus and Stramonium are the most important remedies.
Cicuta-virosa, Cocculus, Conium, Ignatia, Magnesia-muriatica, Nux and Pulsat. are reliable remedies; also Argent.-nit.,
Bryon., Caust., Cham., Hyosc., Natrum-m.., Platina, Sepia and
Stannum. 
SPASM AND INFLAMMATION OF TIHE WOMB.
THE womb in some cases is affected with pain of a spasmodic
character, attended with inflammation; the symptoms are similar to those of irritation of the womab but far more severe. The




CRAMPS AND PAINS IN THE ABDOMEN, &C.                8T
pain is evidently spasmodic, and is felt in the back, hips and
groins, as well as in the region of the womb; there is great
tenderness on pressure, and some fever, and occasionally vomiting.
The result to be feared is abortion, after which in some cases
the patient may sink.
Treatment.-Aconite, Belladonna, Stramonium  and Secale
are the best remedies.  Ignatia, Kreosote, Nux-vom. and Thuja
also deserve attention.
CRAMPS AND PAINS IN THE ABDOMEN, BACK, AND
LOINS.
PREGNANT women are very subject to pains in the loins —
the bearing of the trunk backwards-the efforts made to support
the weight of the abdomen, and to maintain the equilibrium of
the body, &c. are sufficient to account for these sufferings.
Cramps, spasms, or irregular pains in different parts of the
lower half of the body, are a source of frequent and great annoyance to pregnant females.  There are various situations in
which the cramp or pain is felt, and the effects vary accordingly.
1. In the abdomen.-The patient may complain of pain or
stitches in one side or the other, generally the left, between the
false ribs and the crest of the ilium, or along the line of the superior insertion of the abdominal muscles. Again, the inferior
insertions may be similarily affected; in both cases it appears
to be owing to over-distension, which throws some of the muscular fibres into spasmodic action. The pain may be very severe,
effectually preventing the patient's taking exercise. It is influenced by the state of the stomach, more than cramp in any
other situation, and is often combined with heart-burn or waterbrash; but it is easily distinguished from pain in an internal
organ, by its spasmodic character.
CHURCHILL has seen this kind of cramp fix itself about the
symphysis pubis, and extend down into the labia pudendi, probably depending upon pressure, congestion, or dragging upon
the round ligament.
2. In the back. —The lumbar muscles are sometimes the seat




88              DISORDERS OF PREGNANCY.
of cramp; and when it is severe, it greatly impedes the movements of the patient, especially the assumption of the upright
position.
Occasionally, the distress is extended from the crest of the
ilium to the sacrum, affecting the origin of the muscles. It may
be the result of distension, or of pressure upon the nerves.
Treatment. —-Nux-vomica is thought to be generally the
best medicine, especially if the severest pains occur just when
the patient is going to bed.
Rhus is best suited, when lumbago has been caused by some
muscular effort, or by fatigue.
Arnica, when the pains are principally felt when coughing, or
walking about.
FALSE  PAINS.
SOME women are affected at the latter part of pregnancy with
pains somewhat resembling those of parturition, but in reality
quite unconnected with it.  The causes of these pains are various; they may depend upon flatulence or irritation  of the
bowels, accompanied either with constipation or diarrhoea, spasm
of the bowels, ureters, or biliary ducts, or possibly of the womb
itself, and they may be the result of inflammation with accompanying fever. They may be distinguished from true labor pains
by their situation and character, the irregularity of their recurrence, and in some instances by their being permanent.  On
placing the hand over the womb it is not felt growing hard and
contracting, as during a true labor pain, and a vaginal examination finds the mouth of the womb closed; or should it by
chance be a little open, it does not dilate any more.-ANDERSON.
Treatmnent.-Pulsatilla, Secale, Belladonna and Stramonium
are the most important remedies.
RIGIDITY AND LAXITY OF THE ABDOMEN.
IN first pregnancies we occasionally meet with great rigidity
of the abdomen; the womb increases in size, but the abdominal
walls do not give way in equal ratio, and a considerable amount
of distress is the result.  The greatest danger is, that such a




FALLING OF THE WOMB.                     89
degree of pressure will be exerted upon the kidneys as to cause
an interference with their functions, followed by dropsy and albuminaria.
Laxity of the abdomen generally occurs in women who have
borne many children; in these the abdominal walls are so loose,
that they are incapable of affording proper support to the enlarged womb, which consequently may fall in any direction.
Treatment.-In rigidity of the abdomen frictions with Sweet
Oil, or Glycerine, or the application of a Conium- or Belladonnaplaster, coupled with the internal use of Conium, Bellad., or
Stramonium will generally suffice.
For laxity of the abdomen,,Colocynth and Sepia internally,
or dry frictions, or frictions with tincture Nux-vomica, Angustura or Ignatia, together with the internal use of one or the
other of these remedies, or of Cuprum and Zincum, Cuprum and
Argentum in alternation may prove beneficial.
FALLING OF THE WOMB.
IN the early months of pregnancy, when the womb begins to
increase in size and weight, falling, or prolapsus is apt to occur;
this is attended with a sense of bearing down pain and uneasiness in the lower part of the back, and very frequently in the
lower part of the abdomen. This symptom can almost invariably
be alleviated and eventually cured by keeping the patient in a
recumbent posture.  Finally the womb increases so much in
size, that it must rise above the brim of the pelvis, there rests,
and is of course unable to sink or fall down again during this
pregnancy.  Sometimes, however, in a more advanced stage of
pregnancy, where the hips are unusually large, and the pelvis
consequently extremely capacious, a sudden prolapse may occur
during some act of unusual exertion.
Both these cases require attention; for in the first, the womb
having descended, and the patient continuing to go about, it enlarges within the pelvis and gradually becomes impacted therein;
in the 2d instance, the womb becomes at once impacted on account of its larger size.
Treatment.-The bladder must first be emptied by means of




90              DISORDERS OF PREGNANCY.
the catheter, and the fallen womb then carefully replaced in its
proper situation above the brim  of the pelvis; the recumbent
position must be persevered in, until the womb is sufficiently enlarged to maintain its location.
Aurum, Bellad., Calc., Kreosot, Mere., Nux-mosch., Nuxvomica, Sepia and Stannum are the principal remedies.
FALLING BACK OF THE WOMB.
RETROVERSION.
THE fundus or top of the womb becomes tilted backwards,
dropping below the promontory of the sacrumn, while the neck of
the womb is pushed forwards and upwards, frequently rising
above the symphysis pubis, and dragging the vagina up with it.
It is most common during the third or fourth month of pregnancy.
The rectum or lower bowel is pressed upon by the base of the
womb, and the neck of the bladder by the mouth and neck of
the uterus; the discharge of urine and fseces being thus interfered with.
Sy/mptoms.-These consist in retention of urine, which frequently sets in somewhat suddenly, and may be either partial or
complete.  Defecation is performed with difficulty, the faeces
being flattened, and coming away in small quantities. When the
retention of urine is not complete, only a small quantity is passed
at once; there is frequent desire to pass water, but the bladder
is never completely emptied; the urine eventually dribbles away
involuntarily, and the bladder becomes enormously distended, to
a sufficient extent to cause rupture if left to itself; or chronic
inflammation of the bladder may set in, even if relieved after
the retention has existed for any considerable length of time.
There is pain in the small of the back, thighs and pubis, with a
sensation of bearing down; and these symptoms coupled with
the fact of the patient being in the third or fourth month of
pregnancy, should lead one to suspect the nature of the case.
If there be much obstruction of the bladder, fluctuation may
be felt above the symphysis pubis.  After the bladder has been
emptied by the catheter, the womb will not be felt in its natural
position in front of the abdomen, above the symphysis pubis.




FALLING BACK OF THE WOMB.                    91
On examination per vaginam, the base of the womb will be felt
as a large tumor, lying between the vagina and rectum, and below the promontory of the sacrum; the mouth of the womb can
scarcely be reached with the finger, but is found directed upwards
and forwards above the symphysis pubis.  This, however, is
not invariably the case, for the neck of the womb is occasionally very flexible, may be doubled upon itself, and thus leave
the mouth in its natural situation while the fundus and superior
part of the neck are alone retroverted.
A  large pelvis, and wide hips may undoubtedly act as predisposing causes to this accident, but they are not by any means
essentially necessary; for the womb not having attained a sufficient size in the early months of pregnancy to prevent the possibility of its falling below the promontory of the sacrum, is capable of doing so in a pelvis of ordinary dimensions.  A distended bladder may be the immediate cause; this is particularly
apt to be the case, when there is torpor of the bladder, theurine
being retained for a longer period than natural, and finally voided
in large quantities.  This torpor is of course a more serious
disorder than irritability of this organ, as it is apt to give rise
to retroversion.  A loaded rectum may also cause tilting back
of the womb; sudden contraction of the abdominal muscles,
other circumstances being favorable; in fact any thing which
can tend to tilt the heavy body and base of the womb backwards,
where there is sufficient room for the force of gravity to carry it
below the brim of the pelvis.-ANDERSON.
Treatmnent.  Restoration of the womb to its natural location
and direction should be attempted as soon as the nature of the
case is made out; the bladder should be emptied at once, and
occasionally as soon as this is done, the displaced organ will return spontaneously to its natural position. The rectum should
also be thoroughly emptied, and then, if necessary, one or two
fingers should be introduced into the rectum and pressed against
the retroverted fundus of the womb; at the same time, two fin-,
gers of the other hand should be introduced into the vagina, and
the neck of the womb should be carefully and steadily depressed,
while the fundus is elevated.  This manipulation may generally
be done in the usual obstetric position on the left side; in some
rare cases the patient must be placed on her hands and knees,




92                DISORDERS OF PREGNANCY.
in order to get the influence of the force of gravity; in others,
the uterine-sound must be used.
Nux, Ignatia, Bellad., and Aurum  are all serviceable reme-'dies.  The patient should learn to lie upon her face, always
at night and frequently during the day time.
ANTIVERSIO N
IN this, the body of the womb is thrown forwards; it is exceedingly uncommon during pregnancy.  The symptoms are
similar to those of retroversion, but the signs on examination
are entirely different.  The enlarged womb may be felt above
the pubis, and the neck of the womb is found directed backwards
towards the promontory of the sacrum.
Treatment.-The patient should practice lying  upon the
back, with the knees drawn up.  The bladder and lower bowel
should be regularly and methodically emptied.  A bandage and
compress over the pubes may be serviceable; the fundus of the
womb may be pressed back; and the neck pushed forwards by
the physician.
FCETAL TURBULENCE.
THE motions of the unborn child are generally felt at four
months, or four and a half months;  frequently these movements are exceedingly feeble, at first only producing a kind of
tickling, or rather a sensation analogous to that which a spider's
claws excite in crawling; at other times they  are veritable
shocks,- which may be violent enough to elicit cries from the
mother; occasionally they become so violent as to be truly distressing, causing a sense of nausea, often attended with local
pain, and much general nervous agitation.  ANDERSON thinks
that this affection may' depend upon some preternatural sensibility of the womb itself, but more frequently it arises from a
* Of seventy cases the motions of the child were felt at the end of the third
month in nine cases; at three and a half months in eleven cases; at the fourth
month in twenty-one cases; at four and a half months in sixteen cases; not until
the fifth month in eight cases; at five and a half months in one case; in the
sixth month in four cases.




PALPITATION OF THE HEART.                    93
state of general nervous irritation, which is from time to time
determined to the womb.
Treatment. —Mechanical compression by means of an abdominal bandage will frequently prove of much service.  Agaricus or Stramonium  may remove the morbid sensibility of the
womb; while a general nervous condition may be alleviated by
Chamomilla, Sumbul, Cannabis-Indica, Coffea, &c.
PALPITATION OF THE HEART.
CHURCIHILL says, that almost all females suffer from attacks
of palpitation at some period or other of their pregnancy, especially those of a weakly, delicate body, or nervous temperament.
By some it is felt immediately after conception, and some even
have attacks after ordinary intercourse; by others it is only felt
at the period of quickening; and by a third class towards the
end of pregnancy.
Among the exciting causes may be enumerated mental emotions, disordered stomach and bowels, especially errors of diet
and flatulency; the motions of the child often give rise to it.
Syynlptomzs.The attack may come on suddenly, or be preceded by some nervous or gastric disorder; the patient feels the
heart strike violently against the ribs, so as to shake the whole
body; in general the heart's action is regular, although excessive; but in some cases a marked and frequent intermission may
be observed.  If asleep when the attack occurs, she starts up
suddenly; and if walking is obliged to stand still; the breathing becomes hurried or impeded, the nervous system may be disturbed by headache, giddiness, dimness of vision, noises in the
ears, and sensation of approaching apoplexy.-CHURCHILL.
It is not dangerous, although often distressing; for the hard
and increased action the heart may be either very sudden, and
violent, or persist night and (lay, for many days.
Treatmtent. —As it may be produced by excitement of the
mind and derangement of the digestive organs, the diet should
be carefully regulated, and the mindi kept at rest; some severe
attacks only subside after full, free and spontaneous vomiting;
if it arises from indigestion accompanied with much flatulence
and acidity, almost immediate temporary relief may be obtained




94                DISORDERS OF PREGNANCY.
by the administration of an alkali.  Sarsaparilla is useful when
there is painful palpitation; Zincum, when there is a painful
palpitation, with sharp stitches at every beat of the heart;
also Agaricus and Hepar-stuph.  Veratrumn and Nitric-acid,
when there is diarrhoea, anxiety, and hurried breathing. Aurum  and Aspararus, when there is anxiety and oppression
of the chest with lowness of spirits. Nitrate of Silver, when
there is palpitation with faintness and nausea. Amrmonia-carb.,
when there is a weak and sinking feeling at the pit of the
stomach.  Gratiola, when there is such violent palpitation, that
the whole body is shaken; also Crocus and Secale.  Spigelia
and Sabadilla, when there is palpitation, with throbbing in the
abdomen, and over the whole body.  Mercurialis, when there is
an undulating and throbbing motion in the stomach and abdomen, with pulsation of the abdominal aorta, and dizziness.
FAINTING,
Is not a frequent occurrence during gestation, except perhaps
at the time of quickening, and in the weakly, and delicate.  It
is ordinarily of no great importance; when organic disease of
the heart is present, it is very serious.  Towards the end of
pregnancy, fainting is regarded with great suspicion, not so much
for the immediate consequences, as for its effect upon the convalescence after parturition, It is also a very unpleasant occurrence at the time of labor; it sometimes follows each pain, causing great alarm, but without apparently retarding the progress
of delivery; but after delivery, from  slight over-exertion, or
from too active aperient medicine, fatal fainting may set in.
Ordinary fainting after confinement may easily be distinguished from  fainting in consequence of internal hremorrhage 
the latter is more prolonged, accompanied with fulness and tension of the abdomen, dull weight and pain in the pelvic region,
permanent blanching of the surface, and after a short time by
escape of blood'from the vagina.
Treatnent. —When there are repeated fainting fits, Cuprum
and Hyosciamus.-Arsenicum, Camphor, Am2monia, Cocculus,




SPITTING OF BLOOD.                      95
Moschus, Veratrum, Stramionliumz, Laurocerasus, Ferrumacet., NLux Petroleum and Opium all deserve attention.
DIFFICULTY OF' BREATHING,
MAY occur during the early months from a nervous aifection
and sympathy with the womb; it is also often connected with
the nervous palpitations already treated of; the attacks are generally, short, sudden, and not attended with plethora, congestion
or fever.
In the middle of pregnancy it is more frequently owing to
plethora, and the face is apt to be flushed, the pulse quick, head
heavy, &c.
In the latter months it generally arises from the pressure of
the enlarging womb; it is then apt to be most severe in first
pregnancies, owing to the resistance afforded by the abdomen in
expanding for the first time to so great an extent.
The attacks are not serious unless complicated with congestion, inflammation, or organic disease of the lungs.
Treatment. -MIoschus, Ipecac. and Aconite are the most important remedies.
COUGIH
THE Couigh, which is peculiar to pregnancy only, occurs in
the earlier and latter months; it is either constant, short and
teasing, or recurs in violent paroxysms, causing great distress
and inconvenience.
In the earlier months it is generally nervous, spasmodic and
sympathetic; there is rarely any expectoration, and no evidence
of catarrh, or disease of the lungs.  In the latter months it is
owing to a mechanical cause; the aorta is compressed, the circulation through the lungs somewhat arrested, and the lungs
irritated and rendered uneasy.
Treatment.-Conieum  is the  principal remedy.  Ipecac.,
Drosera, Ferrum-acet., Pulsatilla, Petroleurn, Plumbum-acet.,
Ratta, Mezereum; Cina and Sepia all deserve attention.




96               DISORDERS OF PREGNANCY.
SPITTING OF BLOOD.
THIS formidable disorder is fortunately very rare; in the
earlier months the attack may be simple, consisting of a secretion of blood from the mucous membrane of the air tubes, owing
probably to the sudden suppression of menstruation.
In the middle or latter months it may arise from  congestion
of the lungs; or more frequently from consumption, which often
runs its course quietly, and unnoticed during pregnancy.
Treatment.  Aconite, /Stibium and Ipecac. are the principal
remedies; although  Phosphor, Kreosote,  I-amamelis  and
Millefolium  deserve attention.  M]ercurius-solubilis, Arnica,
Arsenicum, Zincuni, Digitalis, Ferruetm-acetictum and Heparsulph. have been used successfully.
H E A D A C H E.
CHURCHILL says. that next to disturbance of the stomach,
headache is probably the most common complaint of pregnant
women.  In the early months it is generally of a nervous character; at a later period it most frequently arises from plethora.
In nervous headache there is seldom any quickness of pulse,
suffusion of the eye, or flushing of the face; in headache from
plethora the pulse is full, quick and strong, the face flushed, the
eyes bright or suffused, the eyelids heavy and closed, and there
may be intolerance of light and sound.  In some congestive
headaches, however, the face is pale.
Either variety may arise from constipation; or from scantiness
of the urine.
Treatzent.- ee Treatise on Headaches. Pulsatilla, Stramonium'17, Sepia, Aconitum, c&c. deserve attention.
SLEEPLESSNESS.
CHURCHILL says, there is scarcely a more distressing complaint to which pregnant women are subject, than sleeplessness.
It is not uncommon, and appears chiefly to attack females of a
delicate constitution, or of a nervous temperament. It may oc



SLEEPLESSNESS.                         97
cur at an early period of pregnancy, though it is more common
during the latter months, and may persist for a considerable
time.
It generally seems to be a purely nervous affection, excited
by want of exercise, excessive motion of the child, or uneasy
sensations in the womb; sometimes, however, it arises from a
plethoric and feverish state of the system.
If it persist long, the patient will suffer severely; become
restless, feverish, agitated, peevish and fanciful; her appetite
will diminish, the bowels and secretions generally become deranged; the skin get hot and dry, and the pulse quick; she
will complain of great weakness and misery, and ultimately her
judgment and mental faculties will become impaired.
Sometimes the patient will sleep well in the day; but not at
night.  At other times the rest is disturbed by frightful dreams.
Treatment.-Air and exercise are very important; a draught
of cold water just as the patient steps into bed, or wrapping a
wet towel around one hand, or bathing the feet at bedtime, will
often calm the nervous irritation.
Rhus is the best remedy, when the patient cannot sleep before
midnight.  Ranunculus-scel., when she always wakes after midnight.  Plunbum, for obstinate  sleeplessness for weeks together.  lioschus, when there is no sleep all night, or only momentary losses of consciousness.  lMercurius, when she sleeps
much in the daytime, but cannot sleep at night.  Ledurn and
Hyosciamus, when sleep is constantly interrupted by starting.
Causticumn, when she wakes every morning  at four o'clock,
Aconite, when there is sleeplessness from  pain.  Veratrumn.
when there is an intolerable feeling of heat, and restless tossing
about.  Ambra and Agaricus, when there is sleeplessness from
great activity  of mind and nervousness; also  Chanomnilla.
Graphite, when she cannot sleep before two o'clock at night.
Fluoric-acid, when there is no sleep until towards morning, and
then a very little slumber is sufficient to refresh the patient.
Bryonia and Causticum, when there is sleeplessness from vascular excitement, and dry heat.  Digitalis, when there is uneasy sleep, from  constant desire to urinate.  Cuprum, when
there is much vomiting.  Laurocerasus, when there is loss of
sleep from excitement and attacks of heat.  Nitric-acid, when
o




98               DISORDaES OF PREGNANCY.
icy coldness of the feet prevent sleep. Borax, when sleep is
disturbed by thirst and coldness of the body.  Anacardium,
when there are severe pains in the abdomen.
HYPOCHONDRIASIS.
Has been sufficiently treated of at p. 22 & 23.
PLETHORA,
Has been alluded to on p. 18.   Acute serous plethora is not
uncommon during pregnancy, and is apt to be attended with
bloating not only of the legs and feet, but also of the face arms
and hands; it then is a rost serious disorder, being often complicated with albuminuria and retention of urea in the systern
to be followed by severe headache, violent vomiting, and pain at
the pit of the stomach, and is too often succeeded by convulsions.
Treatment.-Aconite, Sulphur, Aurum, DQigitalis and Kalicarbonicum.
DROPSICAL AFFECTIONS.
DROPSY OF THE LEGS.
ACCORDING tO CHURCHILL during the latter months of pregnancy we frequently find patients complaining of a swelling
of the feet or legs, increasing towards evening, and occasioning a certain amount of inconvenience.  This dropsical swelling may be confined to the feet and legs, or it may involve
the thighs, vulva, and hips.  In the majority of these cases the
swelling is caused by the pressure of the gravid uterus simply.
When the effusion is the result of pressure, there are none but
mechanical symptoms; the limb is swollen, and of a semi-transparent, pearly appearance; it feels heavy, and the patient cannot walk as well as usual.  These inconveniences are much aggravated if the swelling extends to the thighs; the patient may
not be able to approximate them, and may find it as distressing
to sit, as to stand, or walk.  But little additional distress is occasioned during pregnancy by the swelling of the labia; but if




DROPSICAL AFFECTIONS.                     99
very large they may prove a very serious impediment to the
exit of the child during labor.  Change of posture has a great
effect upon the swelling of the legs; in the morning it is but
slightly perceptible, but during the day it increases, and towards
night it arrives at its maximum.  After delivery the effusion
disappears quickly; but previously it may be unpleasantly varied by an attack of erysipelas, or by phlegmonous inflammation
of the cellular tissue.
GENERAL DROPSY OF THE SKIN.  (Anasaraca).-In a few
cases the dropsy is more general and extends to the upper part
of the body, and to the hands and face. If the urine be scanty
or albuminous the case should be narrowly watched. Albuminuria, or Bright's disease, according to DEVILLIERS  and
REGNAULT is not a frequent complication of pregnancy, but
when it is present, cedema and eclampsia are the most frequent
indications of its presence.  Albuminuria and its effects are
more common in first than in later labors, and then generally
disappear after delivery. Dropsy of the face and hands, going
on occasionally to general anasarca, is one the most frequent
accompaniments of albuminuria in the pregnant female.  Albuminuria, when present during the last months of pregnancy,
denotes a marked tendency to puerperal convulsions.  Every
case of puerperal convulsidns seen by M. BLOT was accompanied
by albuminuria. The Albuminuria of pregnancy is generally
attended with dropsy of the face and hands, and lumbar pains;
it is almost always unattended by fever; is in most cases the
result of a simple functional hyperalmia of the kidneys, and disappears a few hours after delivery; this condition of pregnancy
is free from  danger as long as it is uncomplicated with congestion of the brain; but if severe headache and a peculiarly severe pain in the pit of the stomach be attended with profuse
bilious vomiting in a pregnant female, in the latter months of
gestation, albuminous urine also being present, then we may
almost certainly expect an attack of puerpual convulsions.
Treatment.-Arsenicuzn  is useful against elastic swellings;
also when there is swelling of the face and feet, with dryness
of the mouth and lips, distension -of the abdomen, diarrhoea,
colic and vomiting; or swelling of the right sight of the body




100              DISORDERS OF PREGNANCYo
down to the hip, with swelling of the left foot and leg; or
swelling of the face and body.
China, when there is swelling of the limbs.  Ledum-palustre,
when there is oedematous swelling of the whole body. Lactucavirosa, when there is a dropsical swelling of the whole body,
with asthmatic complaints, heaviness of the head, difficulty in
lying down, chills, shortness of breath, hacking cough and small
slow pulse.  Sepia, in chronic cases, when there is a swelling
of the wrist, elbow and ankle joints in the evening; or swelling
of the whole body, face, belly, legs and arms, extending down
to the wrist-joints, with shortness of breath, fever, and alterations
of chills and heat; also when there is swelling of the labia,
followed by a moist and itching eruption upon the inner surfaceo
Digitalis, when there is an elastic and painful swelling of the
legs. followed by a similar state of the arms and forearms,
slowly passing off, after some months, without increased secretion of urine; or when there is an elastic, white swelling of the
whole body, with painfulness to the touch, followed after many
weeks by anasarca, with great softness of the swelling. Rhutstoxicodendron, is most homoeopathic against acute inflammatory
cedema, especially of the face and eyelids; but it has also been
used successfully in large doses, against torpid and chronic anasarca.  Apis-mell., is indicated under almost similar circumstances to those which call for Rhus, Mezereumn or Cantharides,
Hellebore is also useful in chronic dropsy.  Secale-cornut., is
homoeopathic to watery, soft and painful swellings.  Crotalus
in swellings of the whole body.
HARTMANN regards Digitalis and Scilla as mere palliatives
in dropsy; he thinks, that Cantharides may prove useful, when
there is much irritation of the bladder; Kali-carb. is pronounced indispensable, when Anasarca and Ascites are consequent upon suppression of the menses.  Zincum-metallicum,
when there is great distress in the region of the kidneys.  Colchicun, when dropsy has been caused by suppressed perspiration, from exposure to cold, damp and foggy weather, or from
getting wet through to the skin; Dulcanara deserves attention
under the same circumstances; and Colchicumn  is peculiarly
homoeopathic to the severe pain in the stomach and violent
bilious vomiting, which is apt to precede an attack of convulsions,




DROPSICAL AFFECTIONS.                       101
during the progress of dropsy during pregnancy; also Bryonia
and Hellebore.   The indications for the use of Arselicum,
China and Hellebore are too well known to require repetition
here.  Aurum-muriaticum  cured a case of dropsy of one year's
standing, first causing a copious secretion of fine clear urine;
while Ononis-spinosa caused a secretion of turbid urine, of an
ammoniacal odor.
Dos. —According to RUECIERT, Arsenicum has been used successfully in six cases of dropsy, generally in the 30th dilution.  Bryonia
in two cases, in the 5th dilution.  Cainca, in two cases, in the 4th
dilution.  Camphor, in two cases, in the tincture.  China, in eight
cases, in the 4th dilution.  Convolvulus-arolus, in the 30th potency,
is said to have been found very useful in medematous swellings of all
kinds, in dropsy with abdominal obstructions, derangements and debility; it causes liquid stools and profuse flow of urine.  Digitalis,
has been given successfully in the tincture, 4th and 10th dilutions.,
Dulcamara, in two cases, in the tincture, and 7th dilution.  -Hellebore,
in twelve cases, in the tincture, 3d, 4th and 30th dilutions.  Kalicarb., Lactuca-virosa, Ledum  and Lycopodium, each in one case.
Mercuriuzs, in two cases, in the 1st and 3d dilutions.  Phosphor, in two
cases.  Rhus, 30th dilution in several cases.  Samnbucus-cort.int., in
one case.  And Stannum-muriat., in drop doses of the tincture.
A few words must be added on the treatment of Bright's disease of the kidneys in pregnant females.  I claim the credit of
being the first to point out a truly homoeopathic and specifically
curative remedy, viz: iMercurius-corrosivus, against at least
one variety of Bright's disease of the kidneys, (see Homoeopathic Examiner, New Series, Vol. 1, p. 285), as long ago as the
year 1846; (also, see my Treatise on Apoplexy, p. 42).  I am
sorry to be obliged to admit that MIercurius-corros. will not cure
all cases of Albuminuria in pregnant females; perhaps because
the disease, in them, often arises from a mechanical cause, viz:
from the pressure of the gravid uterus upon the kidneys, aided
somewhat by the unyielding and rigid state of the walls of the
abdomen in prinmaparte.  Emollients applied to the walls of the
abdomen, viz: Sweet-oil, Glycerine, aided by the frequent use
of warm  baths, warm  clothing, light diet, &c., &c. may aid in
relaxing the abdominal walls, and take off some of the pressure
of the womb upon the kidneys.  Position may aid somewhat; if
possible the anasarcous pregnant female should learn to lie upon




102              DISORDERS OF PREGNANCYo
her face, or at least upon one or the other side, and never upon
her back, at least not for any length of time.
If there be a deficiency of Urea in the urine, Colchicum
should be used in alternation with Mercurius-corrosivns.
FRERICHS has lately given an entirely new explanation of
the occurrence of convulsions and coma in Bright's disease in
general, and in the dropsical affections of pregnant women. It
is well known, that the most sudden and serious attacks of coma
and convulsions may occur, when there is but little dropsy, and
that there may be a great degree of dropsy, without even drowsiness, much less a tendency to convulsions; yet it very often
happens, that drowsiness and dropsy commence and increase together, until complete coma ensues.  FRERICHS is even of
opinion, that the symptoms of blood-poisoning are not immediately due to the accumulation of urea, or to that of any other
of the solid constituents of the urine in the blood, but that they
are occasioned by thie Carbonate of AmmZ onia, which results
from  the decomposition of urea within the blood vessels' He
supports his opinion by observation and experiment. He states
that the air expired by patients who are laboring under symptoms of Ursemic poisoning, (coma, convulsions, &c.) contains
an appreciable amount of Carbonate of Ammonia, as shown by
the restoration of the color of reddened litmus paper, which has
been moistened and placed before the mouth and nose; and by
the fumes which appear when a rod dipped in Muriatic-acid is
placed in the current of expired air.  The quantity of Carbonate of Ammonia in the expired air bears, he says, a proportion
to the intensity of the symptoms.  He also states, that the
blood in the same circumstances contains Carbonate of Ammonia, which is sometimes so abundant as to be detected by the
sense of smell, and to produce effervescence on the addition of
Muriatic-acid.
In addition to these observations, FRERICIS gives the result
of some experiments, which he performed on dogs. After injecting Urea into the veins of dogs, whose kidneys had been
previously extirpated, he found that the animals remained free
for some time (an hour, or more) from the symptoms of poisoning.
But after an interval, varying from one hour and a quarter to
eight hours, they became restless and vomited, and then were
seized with convulsions, followed by  drowsiness and stupor




DROPSICAL AFFECTIONS.                   103
Ammonia was detected in the expired air simultaneously with
the commencement of the convulsions; and after death, the
blood and the contents of the stomach contained large quantities
of Ammonia.
In another series of experiments, a solution of Carbonate of
Ammonia was injected into the blood of the dogs; Convulsions
came on immediately, and often were very violent, but they
were soon succeeded by drowsiness and stupor. The expired air
was at the same time charged with Carbonate of Ammonia, and
continued so for more than an hour, when the exhalation of Ammonia gradually ceased, and consciousness was restored. A fresh
injection of Carb. Ammnon. during the period of stupefaction
brought on a recurrence of convulsions with vomiting, and an
involuntary passage of urine and feces. After the lapse of
five or six hours the Ammonia again disappeared, and the dog's
consciousness and vivacity returned.
JOHNsoN says, these experiments are certainly in favor of
FRERICI-ICH   notion that the Carbonate of Ammonia,  which results from the decomposition of Urea, is the poisonous agent
in producing stupor, coma and convulsions, and not the urea
itself; and this being the case, it ceases to be surprising, that
a large accumulation of urea in the blood may sometimes be unassociated with any symptom of Uremic poisoning.  In order to
account for the decomposition of Urea in some cases of Bright's
disease, and not in others, FRERICHS assumes the presence of
some peculiar ferment in the former cases, which is not present
in the latter; but he has no knowledge of the nature of this
supposed ferment.
If these suppositions of FRERICHS be true, the use of Hartshorn and smelling salts should be rigidly kept from those females, especially when in their first pregnancy, who have any
dropsical symptoms or tendencies. The antidotes of Carb. Ammonia may also prove useful, such as Vinegar, Lemon- and
Orange-juice and Citric-acid, which convert the Carbonate into
the non-poisonous citrate of Ammonia.  Or the fumes of Muriatic-acid may be inhaled, which will convert the Carbonate into
the non-injurious MIuriate of Ammonia; or dilute Mluriatic, or
Nitric-acid may be given internally, to convert the free Carbonate into the Muriate or Nitrate of Ammonia.




104              DISORDERS OF PREGNANCY.
The convertion of urea into Carbonate of Ammonia is quite
easy; according to LEHMANN, if organic matters, either putrefying, or capable of undergoing putrefaction be mixed with an
aqueous solution of Urea, the latter is soon converted into Carbonic-acid and Ammonia.  Also, on heating Urea very slowly it
becomes converted into a white glistening body, Carbonic-acid
and Ammonia being evolved during the process.
Again, at a temperature a little above 120~, Urea begins to
develop Ammonia and to change into Cyamonic-acid; when rapidly heated it yields Cyanic-acid.  ience, in some stages of
Briht's Disease, Hydrocyanic-acid may be formed in the blood,
and the antidotes for this poison be required.
DROPSY OF THE BELLY.-These cases are almost always
examples of acute or inflammatory dropsy; they seldom occur
till the latter months of pregnancy; the pulse is apt to be quick,
with some fever and pain, but there is often very little tenderness; fluctuation is soon very evident, and there is unusual enlargement of the abdomen for the period of pregnancy; the
stomach is sometimes disordered, the skin dry and the urine
scanty.  It is generally preceded by some swelling of the feet
and ankles; it is apt to be followed by troublesome cough, difficult respiration, restless nights, frequent starting during sleep,
unpleasant dreams, and inability to remain long in the recumbent posture.
Treatenzt. —   ARTMANN regards Ilellebore as the most important remedy; next China; also Ferrum-aceticum.  Also
Digitalis, C'olchicum, Scilla and Dulcacnara.  He has seen
good effects from  Euphorbium, Cyparissius and from Slolanum-nigruz; Prunuzs-spinosa, Ledum and Arsenicum deserve
attentionC O N V U LS I   ON S.
THESE are generally supposed to be of three kincds, st: the
nervous or hysteric; 2d, the epileptic; and 3d, the apoplectic.
The Hysteric convulsions are most common during the early
months of pregnancy; they may be brought on by want of sleep,
excessive fatigue, disordered digestion: or in fact by any irritation of body or mind.




CONVULSIONS.                       105
The Epileptic convulsions are rare; seventy-nine cases only
occurred in 38,306 of labor, or 1 in about 485.  The majority of
these cases are connected with albuminuria; they are apt to be
preceded by a peculiar and intense pain in the forehead, severe
pain in the stomach, and by a tumid state of the face and hands.
Under allopathic treatment forty-two mothers were lost out of
one hundred and fifty-two cases, or more than one-fourth.
Apoplectic contvulsions seldom or never occur except towards
the termination, or after the conclusion of labor, they are generally caused by the stress upon the blood vessels of the brain
during the severe forcing labor-pains; they differ from the other
varieties by there being but little convulsion; the body and
limbs are thrown about for a short time, and then the patient
lies in a comatose state; there is little or no distortion of the
face, and no frothing at the mouth; the muscles are flaccid and
powerless; the breathing stertorous; there is no return  of
intelligence, and rarely any repetition of the paroxysm.
Treatment.-iDR. VWIELOBYCKI reports eleven  cases; viz:
one case treated successfully by bloodletting, cold to the head.
calomel, enemetas and blisters; another by bloodletting, Morphine, brandy and Armmonia; a third, by cold to the head, and
weak coffee; a fourth, by Hyosciamus 3d dilution, Coffea 3d and
Opium  2d; a fifth, by cold to the head, Nux 4th dilution, and
Aconite 5th; a sixth, by Chamomilla 1st dilution, Aconite 4th
and Bellad. 6thl; a seventh, by a cup of black Coffee, Cicu-ta 9th
and Aconite 6th; an eighth, by Chamomilla 2d and lHyosciamus
3d; a ninth, by Opium, Secale, Cofea, and Hyosciam.; a tenth,
by Ignatia and Mercurius-solubilis  the eleventh, by Pulsat.,
Secale and Opium.
He advises warm injections, and Nuxl if the convulsions are
connected with obstinate constipation; Aconite, if the skin be
hot and dry; Bryonia, if the abdomen be tender, with full pulse
and perspiration; if there be flatulence, and diarrhea with tenesmuls, Clialnomnilla, Mercurius and Hyosciazus; if there be
difficulty of urination, with coldness and pallor of the face, PZlsatillac; if the face be livid, purple and warm, Belladonna; if
there be a tendency to stupor, with stertorous breathing, or a
state of incoherent wandering, Opilum, which will render the
mind clear and calm, with a corresponding improvement of the




106               DISORDERS OF PREGNANCY.
other symptoms.  HIyosciamus, when there is an agitated or
ruffled state of the nervous system, with an over-active state of
the vascular; it acts like a charm, soothing and stilling the nervous system, while the labor goes on progressively.  If the labor
pains are deficient, they may be aroused by Secale or Pulsatilla.  (See Brit. Journ. of Homceopathy.)
HARTMANN  recommends Opium, Laurocerasus, Stramonium, Bellad., Hyoscianus and Aconite as the principal remedies.
Laurocerasus, when the convulsion comes on very suddenly;
either before or during parturition, attended with tetanic spasms
and loss of consciousness, interrupted by violent convulsions,
every ten or fifteen minutes, with feeble, hurried and scarcely
perceptible pulse.
A few strong doses of Opium will often postpone the attacks,
and thus afford time for the vital powers to react effectually
against the disease.  It acts very promptly after bioodletting,
and must be repeated not only after every attack of convulsion)
but also when there is the least indication of a return.
VARICOSE  VEINS.
A dilatation of the veins of the legs, followed by a thickening
of their coats, consequent upon the arrest of the ascending column of blood, is a very frequent accompaniment of pregnancy.
They are most frequent on the leg below the knee, but the
veins of the thighs are apt to be involved; more rarely the veins
of the labia majora. the vagina, and even of the os-uteri become
varicose.  When the womb is more inclined to one side of the
body than the other, then one limb will be affected, whilst the
other retains its natural condition.
Treatment. -Arsenicum, Pulsatilla and Ferrum-aceticum
have been recommended.  Lycopodiumz   has improved the varices of pregnant females; and Fluoric-acid has reduced by
one half, the numerous varicose veins of some aged persons.




ABORT1ON.                        107
PAIN AND TENSION  OF THE BREAST.
SOME patients complain of a pricking, or of acute pain in
one or both breasts; the pain may be constant, or recur in paroxysms, or even periodically; in most cases there is no fever,
the skin is cool' and pulse quiet, although the excess of pain may
cause sleeplessness and want of appetite; but in others, the
pulse becomes quick, skin hot, and even delirium may set in,
when the agony is great.
Treatnment.-Bryonia is regarded as the most important
remedy; if there be erysypelatous redness, heat and hardness,
Bellad. and Hepar-sulph. will be required, or Mercuriz's.
ABORTION.
WHEN this happens before the twentieth day, it has been
termed, Ovular abortion; before the sixth week, Miscarriage;
before the third month, Emtbryonic abortion; from the third to
the sixth month, Festal abortion; any time after the sixth month,
Premature birth; moles hydatids, &c., are called False births.
Abortions are much more frequent during the first two or
three months of pregnancy, than at any other time, owing to the
feeble attachments of the embryo to the womb; women with profuse menstruation, and those with dysmenorrhoea, are very apt
to abort, at what should be a regular menstrual period; especially those females who are subject to severe pain and suffering during the menstrual period, continual bearing-down, and
a sense of weight and dragging during menstruation, and also
during urination and defecation, particularly if they also have
pains about one or both ovaries.
Another cause of abortion is too great rigidity of the uterine
fibres, and an unyielding state of the walls of the womb, thus
opposing too great a resistance to the dilatation, which the organ
ought.to experience; this is apt to lessen after several abortions;
and hence in the postponing type of abortion, after it is repeated several times at an advanced period, the woman finally
goes her full time after the fourth or fifth pregnancy.
A third cause of abortion is feebleness and relaxation of the
neck of the womb; a state which DESORMEAUX has frequently




108               DISORDERS OF PREGNANCY.
found to exist in some females-this, especially if connected
with excessive contractibility and irritability of the womb, is
apt to lead to the anticipating type of abortion, in which miscarriage occurs each time at an earlier, and still earlier period
of time.
WHITEHEAD places great stress upon disease of the neck of
the womb as causing abortion; in three hundred and seventy-eight
cases, there was disease of the neck in two hundred and seventyfive; the cause was obscure in twenty-nine cases; there was
vascular congestion in fifteen cases; constipation of the bowels
in three cases; retroversion of the womb in three; placenta
prmvia in eight, &c.  In the majority of these cases, purulent,
yellowish, or sanious leucorrhoea was present, as a symptom
of ulceration of the neck of the womb.
Abortion is chiefly dangerous from the flowing, which may not
only take place at the time, but which may become constant and
exhausting even after the delivery of the foetus, owing to the
irritation  exerted by the retained membranes, and after-birth.
They should be carefully examined for, and removed.
Treatmenit.-Calcarea has been recommended, when the patient is plethoric, subject to profuse menstruation, leucorrhcea,
pains in the breasts, colics, pains in the loins, sick-headache,
rush of blood to the head and chest, &c.
Belladonna is the best remedy, when the above symptoms
become more urgent, and immediately threatening, especially if
bearing-down-pains set in.
Sabina, is the most homoeopathic remedy, when females naturally subject to profuse menstruation, have the premonitory
symptoms of abortion, and a little bright red blood has even
made its appearance.
Sepia is best suited, when there is an abundant leucorrhoea,
the patient being feeble, sad, melancholic, inclined to perspire
easily, and being very subject to uterine colics.
Secale is the most homoeopathic remedy, when the patient has
previously been subject to painful menstruation, and severe
forcing pains have already set in.




DISEASES OF PARTURITION.                   109
DISEASES OF PARTURITION.
FALSE LABOR.
WHEN called to a woman apparently in labor, the accoucheur
should first endeavor to ascertain whether she has really attained her full time, so as not to encourage a premature labor,
which might be prevented.  If the neck of the womb is not entirely effaced but still retains a certain degree of length, and
is hard and resistent; if the intervals during the pains are not
regular in their course, duration and return; and the belly has
not yet sunk down, then the physician should endeavor to arrest this premature or false labor by rest of body and mind, and
soothing treatment.-CAzEAU,.
There is another occurrence sometimes witnessed in the latter
weeks of gestation, which may place the most skilful practitioner
in default, viz: what has been designated as False labor, in
which some women after having nearly reached their full term
experience the true pains and contractions; the pains are regular, the membranes bulge out, and the mouth of the womb
dilates; at times these pains last from four to six hours, and
then go off; in others, the false labor is kept up for several hours,
then passes off, and returns again every evening perhaps for one,,
or two weeks.
Treatment.-Pulsatilla and Opium are the principal remedies; but constipation, flatulence, acidity, &c. should be obviated.
TREMBLINGS, AND CHILLS.
SOME nervous women are troubled with trembling and chills
in the very commencement of their labor, and which are sometimes sufficiently severe to cause much inquietude. These symptoms often coincide with an unusual rapidity in the dilatation of
the neck of the womb, and a speedy delivery.  Sometimes these
shiverings are renewed during, or immediately after labor, but
they rarely or never merit serious attention.
Treatiment. —Aconite, Cannabis-indica, and Sumbul are important remedies. Opium, when there is trembling, as if from




110              DISEASES OF PARTURITION.
fright, with quivering or distortion of every muscle, with coldness all over. Agaricus, Cuprum, Amnmon.-carb., and Cocculus,
deserve attention.  Gentiana-lutea, when shuddering like electric shocks proceed from the back, through the whole body, followed by great languor.  Veratrum, when there is trembling
with anguish about the heart and inclination to faint.
DERANGEMENT OF THE STOMACH, &c.
NAUSEA and vomiting are not uncommon during, or at the
commencement of labor; they are regarded as good signs, as
their presence is said to indicate that the mouth of the womb is
rapidly dilating.
Irritability of the bladder, and of the lower bowel, causing
the patient to have an almost constant desire for their evacuation
are not uncommon in the beginning of labor.  And during the
last moments of childbirth, the pressure on the lower part of the
rectum, produced by the child's head, creates an urgent desire to
empty the bowels; and many women yielding to a mistaken modesty, then wish to rise and retire to the water-closet; others,
may seize that opportunity to let the child drop upon the floor
in the hopes of sacrificing its life. It would of course be exceedingly imprudent to comply with their demands, especially
as the desire is often illusory; particularly in those cases in
which the bowels have been fully emptied shortly before the
commencement of labor.  CAZEAUX once had a patient who was
delivered upon the close-stool, without being able to rise, and he
not able to afford any assistance to mother or child.
As is well known, a small quantity of fDecal matter often escapes from  the rectum  during parturition; but if meconiumr
escapes from  the child during labor, in any other presentation,
than a breach one, it is always an unfavorable sign, as it usually
indicates a state of suffering of the child, generally from compression of the cord, and consequent congestion of the brain and
lungs, followed by relaxation of the sphincters.
Treatment.-Ipecac., Pulsat., and Hydrocyanic-acid are the
best remedies against excessive nausea; Bellad., Opium  and
Stramonium, or Ipecac. against tenesmus of the bowel; Can



NERVOUSNESS.                         111
nabis, against irritability of the bladder. Pressure on the cord
should be removed, when there is expulsion of meconiumo
NER VOU  S NES S,
MANY women suffer excessively from nervous agitation and
excitement during some one, or all the stages of labor; they
feel their pains acutely; lose their self-control, and lament in
the most heart-rending manner.
Treatment.-In these, and in very difficult and tedious cases,
Chloroform is the only reliable remedy.  It unquestionally diminishes the duration of labor, by relaxing the parts, soothing
the nervous system, and checking the irregular and spasmodic
pains which retard the proper expulsive efforts.  It takes away
the anguish and distress which often proceed from an extremity
of suffering almost beyond human endurance; and saves the
practitioner and friends from  witnessing those struggles and
that agony which often almost unnerves them. It diminishes
the shock of labor upon the system in general so that the patient often appears quite refreshed, and almost unaffected by
the powerful efforts she has made.
With the aid of Chloroform the duties of the practitioner become easy; every manipulation and assistance can be rendered
promptly and efficiently, as his feelings and attention are not occupied by cries and groans, struggles and agonies which time
alone can relieve, without the aid of Chloroform.. A severe and prolonged fainting fit is the only serious evil to
be expected from the use of Chloroform; but that must be at~
tended to in the most prompt and effectual manner; those women who are very apt to faint, especially if their health is
naturally delicate, should not insist upon the use of Chloroform.
SLOWNESS, OR  FEEBLENESS  OF  THE  CONTRACTIONS.
ACCORDING to CAZEAUX a Slowness or feebleness of the contractions of the womb may occur at the very commencement of
labor, and persist throughout its whole course.
Treatment.-According to Cazeaux we generally can only




112                DISEASES OF PARTURITION.
encourage the patient to have patience, and support her strength
with broth, claret or some other weak wine and water.  Zincum
and Cuprum  in alternation, at intervals of-five or ten minutes;
or Zincumn  and Argentum, or Platina may prove useful.  Many
homoeopa.thic physicians place great reliance upon Pulsatilla;
while Secale, Iux, Ignatia and Angustura deserve attention.
Pressure should also be made upon the vaginal surface of the
Perineum.n
A. In some cases the feebleness of the pains is owing to excessive distention of the womb, either from the presence of an
unusually great quantity of waters, or from  the presence of
twins. This over-distention renders the walls of the vwomb much
thinner than usual, and lessens their power of contraction; consequently the pains though feeble and only returning at distant
and irregular intervals, leave the patient in a state of anxiety
and continual suffering.
Treatmen2t.-In these cases an early and artificial rupture
of the membranes is the most important step; to be followed
by the use of proper medicines, if necessary.
B. In other cases the slowness and feebleness of the pains
may depend upon general plethora, or local congestion of the
womb.  The pains are at first quite energetic, but soon diminish
both in frequency and intensity; the womb and vagina are fuller
and more heated than common; the breathing may be labored;
the pulse hard and full; the face flushed; and the pains very
irregular both in force and fiequency.
Treatment.-Aconite is the most important remedy; Veratrum-viride and Digitalis, deserve attention.
C. Or there may be debility or inertia of the womb itself,
though the patient imay otherwise be perfectly healthy5 and the
other muscles of the organism  be endowed with their usual
energy.
Treat.ment, —~Secale is supposed to be the only reliable remedy.  In all.  these cases the. method of my fri.end Dr. BOLLES,
consisting in ms king decided pressure upon the inner surface of
the perinemum. in imitation of the pressure of the child's head,
is a most efficient and valuable mode of relieving feeblessness of
the contractions, andh inertia of the wombo




IRREGULARITY OF TIHE PAINS.                113
RELAXATION, OR SUSPENSION OF THE PAINS.
IT is not at all unusual to find a labor which has been progressing favorably, to become at once arrested, and the pains
which had been strong and frequent, diminish or even cease altogether.
A. Any vivid moral impression; the reception of exciting
news; injudicious remarks, or discussions in the lying-in chamber; or the presence of a disagreeable person may produce this
effect.
Treatnent.- 1Pulsatilla, Secale, and pressure upon the perinseum are the most important agents; tickling, or irritating the
os-uteri may be employed; or frictions over the region of the
womb; and the patient may be allowed to get up and walk about.
B. The occurrence of some other and violent distress or pain
may suspend the uterine contractions, such as distressing and
repeated vomitings; sharp pains or cramps in the muscles of
the back, belly or legs; gripings in the bowels; pains and
cramps from  the pressure of the child's head on the sacral
nerves.
Treatment.-Ipecac., Bellad., Colocynth, &c. may be used
with advantage.
IRREGULARITY OF THE PAINS.
ACCORDING to CAZEAUX, the pains may be irregular in their
progress, or they may be partial in their operation.
In the first variety there is no complete and perfect interval
between the pains; they are continuous, but much increased in
paroxysms, during which the sufferings are intolerable.
In the second variety only a portion of the womb contracts;
sometimes it is only the fundus, or one of the angles, or some
part of the body of the womb contracts spasmodically, while the
remainder scarcely does so at all; but still, the pains are no
less severe than if the whole organ were involved; on the contrary; they are often more so, although it is easy to ascertain by
ventral and vaginal examinations that the child does not advance
at all.
After a while the woman is apt to fall into a state of extreme
H




114               DISEASES OF PARTURITIONo
agitation; she weeps and becomes despondent; very often her
pulse becomes frequent and feverish; her face red and flushed;
skin hot; mind confused; and the limbs convulsively contracted 
the whole forming a state, which has been termed Uterine tetaznus.
Treatmnent.-Opium  is the most reliable remedy, although
Secale, Nux, Pulsatilla, and Ignatia are more homoeopathic.
TOO RAPID DELIVERY.
OCCASIONALLY we meet with cases in which the child is
delivered too rapidly, and such excessive rapidity of labor is apt
to be repeated at each successive confinement.  This peculiarity
has been found to be hereditary in certain families for three or
four generations in succession; and it has been supposed to be
most common in those females whose menstruation is difficult
and painful, the patient being tormented every month with violent colicky pains; it is supposed that this irritability of the
womb, will render her liable to excessive and energetic contractions during child-birth.
In these cases the pains are quite strong at the commencement of labor, they are very painful, last a long time, and are
separated by short intervals; the patient can not resist the inclination to bear down, and forcibly contract the muscles of her
body; she is excited and irritable, her head hot, face red and
puffed up; pulse full and quick.
In many instances one pain has scarcely terminated before
another begins, and sometimes the womb seems in a state of almost permanent contraction until the child is born.
Treatmenezt.-Secale is the most homoeopathic remedy, Sbut
Bellad.; Conium, Strammonium  and Chloroform  deserve atten-.tion.
CONTRACTION AND RIGIDITY OF THE VULVA.
THE rigidity of the external parts of generation is frequently
observed in women who do not become pregnant until late in
life, and also in very muscular girls who are stout and plethoric.




OEDEMA OF THE LABIA AND THROMBUS.                 115
)Most commonly the narrowness and rigidity gradually give
way; but often there are some slight or severe lacerations of
the vagina, or posture commissure.
It is not at all unusual in muscular women, in their first
child-bed, to find the labor progress very regularly at first, the
head of the child passing out of the mouth of the womb, and
descending well down upon the perinoeum, where its farther progress is at once arrested by the excessive rigidity of that part,
In some instances the uterine pains grow weaker and weaker,
and finally cease altogether; in others, the pains are kept up
as strong and vigorous as at the commencement of labor, and
yet they are unable to overcome the resistance of the perinaeum.
Treatmnent.-Stibium,L Conium and Tabacum are the remedies
most frequently used.  The application of cloths wrung out in
hot water, may be tried; also the free use of Sweet-Oil, Glycerine simple Cerate, Mutton-suet, &c.
CEDEMA OF THE LABIA AND THROMBUS.
DROPSICAL swelling of the  external genitals has already
been alluded to (see page 98).   It can be relieved speedily by
making one or several punctures with a lancet into the swollen
parts.
Thrombus is the effusion of blood into the external genital
parts; the vaginal veins are apt to become enlarged during
pregnancy, and one or the other of them may give way during
the latter months, or during labor, especially when the head or
breach of the child is about to clear the vulva.
The development of such a bloody tumor is generally announced by severe pain in the affected part, followed by the rapid formation of a more or less voluminous tumor of one or the other
labia. This tumefaction may attain a considerable size, and the
quantity of effused blood may be sufficient to weaken the patient.
Treatment.-Arnica, and Millefolium  may be used to stop
the hemorrhage; or some styptic application, such as Tannin,
Perchloride of Iron, Ice, &c.




116              DISEASES OF PARTURITION.
RIGIDITY OF THE NECK OF THE WOMB.
IN some cases the fibres of the neck of the womb seem to
possess an extraordinary degree of resistance. especially in very
young girls, or in middle aged women in their first labors, and
in premature confinements.
In some cases the neck of the womb is only more irritable
than usual; it is then thin, resistent; tough, hot, dry and
painful.
Rigidity of the neck is generally attended with severe pain
in the loins.
Spasmodic contraction of the neck may be present at the commencement of labor; may be overcome in part, until the waters
are discharged, when the neck is apt to contract again spasmodically; even after this is again overcome and the head of the
child has passed through the mouth of the womb, the neck may
again contract rigidly around the neck of the child, and has to
be dilated anew to allow the child's shoulders and body to pass.
Treatment.-Stibium, Stramonium  and Belladonna are the
most important remedies; the latter remedies may be applied
locally to the mouth of the womb.
OBLIQUITY OF THE ORIFICE.
THE neck of the womb is usually directed somewhat backwards; besides the posterior lip dilates more rapidly than the
anterior; hence any excess of these natural procedures will
cause the mouth of the womb to look directly towards the sacrum, and in the progress of labor the dilatation of the neck will
be very slow, because the expulsive efforts will be directed
against the anterior portion of the cervix, rather than against
the mouth of the womb.
Treatnent.-The woman should lie in bed even during the
early stages of labor; it will also be better for her to lie upon
her back, than upon her side; at the proper time the accoucheur
should hook the anterior lip with his finger, carefully bring it
to the centre of the vagina, and retain it there until a new contraction comes on; the head of the child will then probably be




MOLES.                          117
forced down into the opening and no longer permit the lip to
return to its unnatural position. The labor will then terminate
several hours sooner than it otherwise would.
SWELLING OF THE ANTERIOR LIP.
IT is not unusual to find the head descending into the cavity
of the pelvis, long before the complete dilatation of the mouth
of the womb, whereby the anterior lip is necessarily compressed
between the head of the child and the symphysis pubis, and considerable tumefaction may occur.
Treatment.-The lip should be pushed back during the intervals of the pains if possible; if this cannot be accomplished,
and the swelling be very great, tense and black, a number of
punctures may be made for the purpose of evacuating the infiltrated liquids.  At times, the progress of the child's head may
be aided by introducing the finger into the rectum, and pressing
against it.
MOLE S.
B]   mole is meant an organized, fleshy, insensible body, generally softish, sometimes hardish, of variable and indeterminate
shape, always the result of depraved conception, which after
having been begun and developed within the womb, instead of a
fetus, is sooner or later expelled.
These bodies have been called false germs, or embryonal
~moles, when they do not remain in the womb more than two or
three months, and are covered with the usual envelopes or membranes of the foetus, within which a transparent or bloody fluid
is enclosed, together with some traces of an embryo.
Hydatid moles consist in a degeneration of the placenta, or
after-birth, within which there is developed a greater or smaller
number of cysts, either separate or united, like the fruit of a
bunch of grapes.  This kind of mole is very common; often
attains a great size; remains for a long time in the womb; and
finally is expelled either in mass, or in broken pieces.
The fleshy molt does not require particular description.




118              DISEASES OF PARTURITIONo
The recognition of the presence of a mole within the womb is
extremely difficult during the early months, because the symptoms are equally characteristic of true pregnancy; in both cases
we find: suppression of the menses, swelling of the breasts, enlargement of the figure, disgust, nausea and general derangement of various functions. At a later period, the size of the
abdomen is apt to be greater than it is at a corresponding stage
of real pregnancy; it is generally more painful, harder, and
more equally distended; there is no balottement, and no motion
of a child; the weight of the womb seems greater and more fatiguing than when it contains a foetus; the woman suffers more
from pain in the loins, difficult urination and lassitude than she
does in an ordinary pregnancy, and often feels something like a
ball falling about within her as she turns from side to side. The
breasts enlarge at first, then shrink and shrivel up; and frequent
and irregular attacks of bleeding from the womb are apt to occur.  After the lapse of the first five months we can generally
decide upon the nature of the case from the absence of the signs
of true pregnancy, the presence of local uneasiness, and the recurrence of floodings.
Treatment. —We should generally wait until nature expels
the foreign body, and then use the same care and precautions as
in ordinary labor. In some cases the use of Secale is necessary;
in other cases the mouth of the womb must be dilated with the
hand, or with the aid of Belladonna-ointmentt, and the foreign
body removed with the fingers, or instruments.  Carbo-vegetabilis, Sulphur, Sabina and Bovista may be used to prevent the
growth of moles.
EXTRA UTERINE PREGNANCY.
Ti-HE commonest form  is tubal pregnancy.  The abdominal
-tumor rises out of the pelvis earlier than usual; is found far
over to one or the other side; is irregular and modulated in
form; and while the motions of the foetus are readily detected,
we find the size and weight of the womb but slightly increased,
and the neck of the womb but little shortened. It generally
terminates spontaneously before the fifth month, by the rupture
of the fallopian tube and escape of the child into the cavity of




DELIVERY OF THE AFTER-BIRTH.                 119
the abdomen, marked by the occurrence of sudden and acute
pain, rapid exhaustion, paleness and syncope; although these
may be preceded by labor-pains, dilatation of the mouth of the
womb, discharge of bloody and glairy mucus from the vagina,
and evident contractions in the womb and tumor.
Treatmzent.-In some cases it may be justifiable to resort to
the operation of Gastronomy (CAZEAUX); in case of rupture of
the tube, the only hope is in the judicious use of large doses of
Opium, as in cases of rupture of the bowels and womb,
DELIVERY OF THE AFTER-BIRTH.
IN a large number of cases, immediately after the birth of
the child, the after-birth will be found lying high up in the vagina, but completely within the reach of the accoucheur. In a
certain number of other cases the detachment of the after-birth
and its ejection from the womb into the vagina is effected in the
course of fifteen, twenty, or twenty-five minutes; but having
passed into the vagina, it sometimes remains there for several
hours without causing the least irritation by its presence, nor
the least bearing-down effort; on the contrary, the walls of the
vagina will often gradually contract around it and retain it there
for an indefinite period.
In all these cases, and they form the greater number, the accoucheur should make but little traction upon the cord, but carefully and gently pass his fingers up until he reach sufficient of
the placenta to grasp it and bring it down. If he cannot reach
it, some traction may be made upon the cord, pressure should be
made on the inner surface of the perineum, or posterior wall of
the vagina, and frictions to the hypogastric region with a cool or
cold hand.  Some practitioners regard these procedures as unjustifiable; but although the delivery of the after-birth may generally be left to the powers of nature without any serious inconvenience, yet it is equally true that it will b'e delayed a long
time in a large number of cases.  Now, such delay will not only
force the patient to remain in an uncomfortable situation, but so
long as the delivery is not completed, she will still consider herself exposed to numerous dangers, and her fears may have an
unfavorable influence over her conditiono




120               DISEASES OF PARTURITION.
If the after-birth be entirely retained within the womb, the
accoucheur may make pressure on the posterior wall of the vagina, irritate the mouth of the womb gently, use pressure and
frictions over the lower part of the belly, and allow at least one
full hour to elapse after the child is born, before proceeding to
more active measures, such as the introduction of the hand into
the womb, and the use of Ergot.
Retention of the after-birth from irregular or spasmodic contraction of the womb; or from  spasmodic contraction of either
the external or internal orifice, hour-glass contraction, or from
spasmodic contraction of the whole organ may be relieved by the
use of Nux, Ignatia or Secale, or if these fail, by Opium,
Bellac., or Stramonium, aided by the usual manipulations of
overcoming the stricture by careful introduction of the hand.
Adhesions of the placenta must be carefully overcome by mechanical means; the after-birth should be pealed ofi, and then
removed by the hand.  The details are given in every book on
midwifery.
HEMORRHAGE  BEFORE, DURING, OR AFTER THE DELIVERY OF THE AFTER-BIRTH.
THIS is one of the most frequent and at the same time the
most terrible of the accidents which complicate the delivery of
the after-birth.  This accident is frequently developed in the
course of a few  minutes after the child is born, though sometimes the inertia of the womb is secondary, as it were, not coming on for several hours, or even not until several days after.
The womb after having been fully and properly contracted after
the birth of the child or delivery of the after-birth, may become
relaxed by degrees, and ultimately give rise to a frightful humorrhage.
The signs by which the existence of flowing is made out, are
easily recognized; but the discharge is sometimes so sudden and
profuse that the woman's life is almost immediately seriously
endangered. The patient generally complains of a feeling of
weight about the stomach; and soon after, a pallor of the face,
dimness of vision, smallness of the pulse, debility and fainting
are apt to set in.




IHAIEMORRHAGE BEFORE THE DELIVERY, &C.             121
When the blood appears externally, there is no doubt about
the nature of the case; but when the bleeding is internal, and
confined to the cavity of the womb, the nature of the case may
escape detection, and at least only be recognized when it is too
late to remedy it.
The majority of these cases may be prevented by a little care
on the part of the accoucheur; as the body of the child is being
born, careful pressure should be made upon the body of the
womb, by a friend, nurse or assistant; and this pressure should
be continued without the least interruption until the bandage is
well applied. After delivery the patient should lie perfectly
fiat, with her thighs stretched out along side of each other, and
then be left in silence, and the most absolute rest of body and
mind for at least half an hour.  As soon after delivery as possible a perfectly clean and warm napkin should be applied to the
vulva, and the nurse authoritatively instructed to examine it at
least every three or five minutes.  Thus any unusual flowing
will be detected at a very early period.  Besides, I always have
a bladder, ice, Ergot and Ammonia at hand, in order that it may
be used immediately; if necessary. In case of any excessive
flowing, the bladder moderately filled with cracked ice should be
placed over the womb, on top of the bandage; a small bit of ice
may be introduced into the vagina moderately high up; and
Secale may be given every three, five, ten or fifteen minutes according to the urgency of the case; if great weakness or fainting set in, Ammonia should be used.  I never leave the most
favorable and ordinary case of confinement without having Secale already prepared for use, with stringent instructions to the
nurse to examine the napkin frequently, and give Secale, Ice,
&c. promptly, until I can be recalled.
If the tampon be necessary, I prefer Lint dipped in ice-water,
vinegar and water, or Alum-water, to any other. A coagulum
is more readily formed in the meshes of the lint, than in any
other material. Linen and Silk generally restrain the hmmorrhage very imperfectly.
According to CAZEAUX, when the physician has been fortunate
enough to restrain the flowing, he should still remain with his
patient for several hours, carefully watching the character and
amount of discharge from the vulva, and occasionally examniing




122              DISEASES OF PARTUURITION.
the region of the womb in order to detect any unusual increase
in size of it.
After a, profuse flowing the patient is naturally inclined to
sleep, and some persons think it better to prevent her from
slumbering too longlest the discharge should return without her
knowledge.  But sleep restores the exhausted powers, and ought
not to be too soon interrupted; but the patient should never be
left alone, and the pulse, size of the womb, and quantity of discharge should be frequently examined by the attendant.
Some patients are frequently tormented, after profuse floodings, by vomiting, or nausea and retching; the vomiting may
exhaust the patient and cause fainting, during which the flowing
may return again.
Troeal'zezt.-Ipecac., Pulsat., or Opium may be required.
INVERSION  OF THE WTOMB.
TiHs accident, according to CAZEAUX is always attended by
symptoms which are serious in proportion to the amount of inversion.  The patient not only suffers from pain, but is harassed
by a constant desire to urinate, and straining at stool, which are
often sufficient to render an inversion complete, which otherwise
would only have been partial.  The pain then often becomes excruciating, and the frightened sufferer is apt to faint away; the
pulse becomes feeble, or almost imperceptible.  The symptoms
are less severe when there is a simple depression of the base of
the womb; they are urgent when the fundus has been forced
down through the mouth of the womb, and this is firmly and
spasmodically contracted.  When.there is partial detachment of
the placenta there will be more or less flooding; and if there
be complete inertia of the womb, the flowing will be frightful;
when the after-birth is adherent there will be no discharge.
Inversion may happen in a very rapid labor, especially if the
patient happen to be standing while the child is born; it is more
frequently produced by pulling upon the cord, in overhasty attempts to deliver the placenta; and has happened when the patient has sat up too soon (within twelve hours) to have her bowels
or bladder relieved.




CONVALESCENCE AFTER PARTURITION.                 123
Treatment.-The patient should be placed upon her back,
with her hips raised, and the accoucheur.should pass his hand
into the cavity of the womb, and gently push the fundus up and
back.  A  mere symptomatic treatment of the pains and other
symptoms, is worse than useless.
CONVALESCENCE AFTER PARTURITION.
ACCORDING to MURPItHY  the activities of the nervous and
circulating systems, which were at their maximum of intensity
during the progress of child-birth, are reduced to their mininum
after delivery.  The pulse sinks; chills, more or less severe
may set in, so that the patient either complains of feeling cold,
or is actually shivering; she also experiences a certain amount
of depression, feels exhausted, and occasionally a slight temporary wandering of the mind gives more distinct evidence of the
exhaustion of the nervous power.
The first twelve hours which elapse after the birth of the
child should be essentially hours of repose; and, if by good
management the patient is left undisturbed during that, or even
a much shorter interval, and obtains some sound and refreshing
sleep, it is surprising how quickly she will be refreshed and restored.  The mother has forgotten all her sorrows, is cheerful,
disposed to talk, and so far as her own feelings are concerned,
it seems to her as if she could get up and go about as well as
before delivery.  In the next interval, say at the end of twentyfour hours more, a slight change may be observed; a new function, that of lactation is becoming active, and the circulation,
which was below par, now rises again to the febrile, or inflammatory standard; some chilliness, thirst and headache, followed
by perspiration, are felt; these symptoms finally  disappear
when the full secretion of milk is established, and no further
constitutional disturbance may be observed.
In the first period, or that immediately after delivery, the
causes of pain, sickness or other disturbance will generally be
found in the errors of those, who are in immediate attendance
upon the patient; the most perfect repose of the system is required, and much mischief may result, if the patient is kept in




124               DISEASES OF PARTURITION.
a constant state of worry and excitement after her delivery. The
accoucheur often has a right to complain of the well-intentioned
but too officious kindness of friends, when he finds on his next
visit, that his patient has not slept, that her pulse is quick, that
she has some headache, and is thirsty. These premonitions of a
more decided febrile paroxysm may be unnoticed by the friends
or nurse, but often excite alarm to the careful and experienced
practitioner.  It is not necessary that the patient should have
seen too many visitors in order to produce these results; the nurse
may very judiciously have expelled all intruders, and so far succeed in keeping her patient quiet; and who would have enjoyed
the repose so necessary for her, if unfortunately the nurse herself had not a strong prejudice in favor of making her " clean
and comfortable," that is, all the soiled sheets and bed clothes
have been forcibly removed, the patient's dress changed, and
after this and sundry other things have been done, the nurse
consoles herself with the belief that her charge will now sleep
comfortably.  But delicate women are very susceptible of nervous irritation at this time; if their rest be once disturbed, or
their sleep be put astray, they remain wakeful and unrefreshed;
presently the senses become more than usually excited; the
noise of their infant, although from  another apartment disturbs
them; light becomes exceedingly unpleasant to them, and finally,
although the nurse carefully darkens the room and closes the
bed-curtains, the patient does not sleep; and even if she does
fall into a slight dose, it is but momentary, for the slightest
noise or whispering awakes her.  After some hours, headache
will set in; and just as the secretion, of milk is fairly commencing,
it may be arrested by the presence of an irregular nervous fever,
chills occur at irregular intervals; the headache becomes more
severe; the pulse becomes frequent and perhaps irregular, and
sometimes delirium may set in.  A feverish and nervous disturbance of this kind may not be subdued for weeks, and often has
its origin in no other cause; than in a little want of knowledge in
the management of the patient immediately after her delivery.
MtURPI-IY has known a patient to be lifted up, drawn down to
the bottom  of the bed, then dragged up again, now to one side,
and then to the other in this process of changing the bed clothes,
who afterwards presented a most alarming train of nervous symp



CONVALESCENCE AFTER PARTURITION.                 125
toms; and all this because the nurse insisted upon making her' comfortable."
Too much excitement is not the only risk to which the woman
is exposed during this interval. Errors in diet may very easily
be committed.  After the patient has had a refreshing.sleep,
she is apt to feel, and thinks that she is perfectly well, and may
eat and enjoy whatever she can get hold of.  There is therefore
sometimes the greatest possible temptation to partake of too
hearty food, the mischief of which may not become apparent for
some time, viz, until reaction sets in; but when the pulse naturally begins to rise, and the milk to form, the natural febrile
paroxysm may be superseded by one of a more decided and serious character.
Treatmnent.-The chilliness should be met with warm clothing,
by some warm  tea, or gruel, or milk and water; if it persists,
or returns frequently, China or Arsenicum may be given.
If the patient be feverish, restless and nervous, Aconite and
Chamomilla may be administered.
If there be much headache with a tendency to delirium, Aconite and Belladonna.
Errors in diet, may be contracted by the use of some gentle
laxative medicine, or by Ipecac, or Pulsatilla.
For the treatment of obstinate sleeplessness, see page 96.
Other and frequent consequences of these cleanly and orderly
intermeddlings, are the occurrence of severe after pains, or of
more or less dangerous floodings.  The patient cannot be moved
about in this way without disturbing the bandage that was to
secure and support the womb. If the patient leave the horizontal posture, and she is often allowed to set bolt upright, the blood
will again accumulate in the uterine veins, blood is consequently
poured into the cavity of the womb, where if it go no farther,
and coagulates, will expose the patient to a severe attack of afterpains; but it may not coagulate, but flow away, and produce a
most violent and dangerous flooding.  The patient is thus exposed to the risk of her'life, at a time when every moment of
repose is of the highest value to her, and her physician is probably far away from her.
Treatment. —Severe after-pains require the use of Arnica,
Belladonna, Strammonium, Secale, or Opium.
For the treatment of flooding, see page 82.




126               DISEASES OF PARTURITION.
LACTATION MIILK-FEVER, &c.
THE second period of time after parturition is marked by an
increase in the force and frequency of the pulse; a slight chill,
some thirst and perhaps headache: the breasts are becoming distended.  If the previous management of the patient has been
judicious, or no other causes of disease be present, the patient
will pass safely over this period.  The distention of the breasts
and the natural fever that accompanies it, are relieved chiefly by
the child; when the milk flows freely, the fever subsides, and the
function of lactation is established; but very slight causes will
derange this natural process, such as improper food, agitation
of mind, exposure to cold.  In some cases the patient has a severe chill, followed by profuse perspiration, forming the so-called
milk-fever.  In other instances the formation of milk is too rapid, although there is not much fever; still the breasts become
tensely distended and painful, presenting a firm unyielding surface to the infant, who cannot grasp the nipple sufficiently to
nurse; hence the breasts are not relieved, and inflammation is
apt to set in.  In another set of cases the secretion of milk may
be suspended or suppressed, and the absence of milk is the precursor of some deeper-seated and more distant inflammation, or
of puerperal fever itself. Hence the practitioner should be very
solicitous that the function of lactation be safely established; if
he child is strong enough and healthy, and if the mother be
properly managed previously, this object is generally successfully accomplished. But, both local and constitutional causes
may throw  impediments in the way; the nipple may be badly
formed, either too small or too large, or perhaps flattened by the
fishionable corset, so as to formi a depression in place of a prominence, so tlat tahe child cannot properly grasp it.  Or it may
happen that the extremely delicate skin that covers the nipple
is very irritable and easily inflamed, consequently it will not
yield to the traction of the child; it gives way at the base of the
nipple; fissures are the result; they bleed easily, and in place
of a comfort and enjoyment, the nursing of the child becomes the
greatest source of anguish and distress to the mother.  Again, we
may meet with cases in which the breasts and nipples are' well
formed, nevertheless the milk will not flow, because the minute




LACTATION, MILK-FEVER, &C.                   127
milk-ducts are not free to transmit it; they may be plugged up
with a thick tenacious secretion which the child has not sufficient
suction-power to remove.
In another class of cases the milk is secreted scantily, and
what is extracted contains but little nourishment; the infant.
therefore, is never satisfied, and after having obtained what it
can it may sleep, exhausted by its efforts to draw the breasts;
but it is only a momentary dose, for it soon wakes up, becomes
feverish, cries constantly, and is ravenously hungry; the mother
has no farther supply, her anxiety contributing still more to arrest the secretion; and thus difficulties of no ordinary character
arise.
There are also certain constitutions where there is no deficiency of milk in the breasts, but it is of poor or bad quality;
the milk may be abundant, but it does not satisfy the child, or
possibly it may produce a considerable amount of irritation in
the stomach and bowels of the infant; the child may scarcely
have obtained a sufficient quantity before it is ejected from the
stomach, or if it pass down into the bowels there will soon be
evidences of irritation in its passage along the intestines and an
exhausting diarrhoea may place the infant in extreme danger of
its life; or it may be exposed to all the torments of colic, and
its wild screams that cannot be appeased, soon give evidence of
the agony it is enduring.-(MuRPLIY.)
Treatment —If the flow of milk be excessive, we must reduce
the force of the general circulation, and prevent the effects of
over-distention of the breasts.  Aconite and Antimony are the
most important remedies.  But Bryonia may be given if the
afflux of milk is very considerable and the breasts greatly distended, so as to produce pain and oppression of the chest: it will
generally relieve the tumid breasts and check the fever.  Still,
Belladonna may be required if there be violent pains in the
head, tendency to delirium, glistening of the eyes, and fever.
Warm  fomentations skilfully managed so'as to maintain  an
equal temperature around the distended breasts are often most
grateful to the patient; and gentle frictions with warm oil over
the surface are useful in promoting the absorption of the excess
of milk; when the distention and consequent irritation are relieved, the milk which has been arrested will frequently flow




128               DISEASES OF PARTURITION,
quite freely; if it be slow, the breast-pump may be used, or
what is still better, another child, odler and stronger, may be
applied, and will soon reduce the distention.  If it should happen that the milk-ducts are much obstructed, even these methods
may fail, and some female friend or nurse must be called upon;
their stronger powers of suction will soon remove these plugs,
and the milk then flows without difficulty.  As soon as this excessive distention is once overcome, it does not generally return,
provided caution be used in the diet of the patient, and some
gentle laxative medicines are given.
When the flow of milk, is deficient we have a far more difficult
case to manage; in the first place the babe must be fed artificially, so as to prevent its restlessness. It may then be applied
to the mother at longer intervals than usual, twice perhaps in
the day, and once at night, so as to allow the milk which is but
slowly secreted, time to accumulate.  The mother will generally
re(luire a more nutritious diet than can usually be given after
parturition; and if the deficiency of milk depends upon the exhaustion and diminished sustenance which have been caused by
a protracted  labor, even stimulants are sometimes necessary;
broth or soup may be given, and, with caution, warm negus. It
is there that the virtues of caudle shine so conspicuously.  It is
also essential that sufficient rest and sleep be secured the mother;
these patients are apt to be particularly restless, because the
desire of the mother to nurse her infant is too frequently strong
in proportion to her inability to do so; she is unwilling to resign
her little charge to the care of another, and becomes anxious,
irritable and sleepless.  But the more general causes of deficiency of milk would seem to be a lymphatic constitution, a
feebleness of arterial action, or of the vital energies; or a general constitutional debility produced by moral causes, depressing
mental emotions, or by an unhealthy pregnancy. In these cases,
LEADAM says that Agnus-castus is the most useful remedy; if
the mother is desirious of nursing, and the signs of milk are not
apparent in thirty-six hours after delivery, the Agnus should
be given at once; it is also equally useful, when the milk diminishes or disappears without any appreciable cause, or becomes
impoverished; Conium and Iodine also deserve attention.
DR. KALLENBACH  having noticed that when  Assafoetida




LACTATION, MILK-FEVER, &c.                     129
plasters had been applied to the pit of the stomach in hysterical
females for a long time, they were sometimes followed by swelling
of the breasts, from which a milky fluid oozed, gave it internally
with success in four cases.  LEADAM  has found it to materially
increase the flow of milk, improve its quality, and cause the child,
which before was pining and constantly disturbed by flatulent
colics, to thrive and cease crying.
THE USE OF THE BOFAREIA,
(; RICINUS COMMUNIS" OF BOTANISTS) AS A MEANS ADOPTED IBY THE NATIVES OP
THE CAPE DE VERD ISLANDS TO EXCITE LACTATION.
By Dr. J 0 iM'WILLIAM,.R.S, R.N., &c.
While engaged in an official investigation into the nature and
history  of a yellow  fever epidemy, prevailing in the Island of
Boa Vista, in the Cape de Verds, during the year 1846, my attention was called to a remedy commonly had recourse to there,
and in the other islands of the group, to accelerate and increase
the flow of milk from the breasts of childbearing women, in cases
where that secretion was tardy in appearing, or deficient in
quantity when it did appear.
I also learnt that, on occasions of emergency, this remedy
could be successfully applied to a still more important use,
namely, to produce milk in the breasts of women who are not
childbearing, or who even have not given birth to, or suckled a
child for many years.
The leaves of a plant, called, in the language of the countryY
Bofareira, but which, in reality is the'" iicinus Communis" of
botanists, and, occasionally, the leaves of the' Jatropha curcas,"
both belonging to the natural fa.mily  euphorbiacie, are the
means by which these interesting if not extraordinary results
are produced.
The Bofareira grows in most if not all, the Cape the Verd
Islands.  That used by the natives for the purposes I have mentioned, is called by them  the white bofareira, to distinguish it
from what appears to be nothing more than a variety of the same
species, the red bofareira.  The whiite, or that which possesses
galactagogue qualities, is recognized by the natives by the light.
green color of the stem of the leaf, whilst the leaf stem of the
r'ed is of a purplish red hue.  The latter plant is carefully.




130               DISEASES OF PARTURITION.
avoided, as it is said to be a powerful irritant, and, if applied as
it occasionally has been, by mistake, for the white, it produces
an immediate and often immoderate flow of the menses.
In cases of childbirth, when the appearance of the milk is delayed (a circumstance of not unfrequent occurrence in those
islands) a decoction is made by boiling well a handful of the
wohite Bofareira in six or eight pints of spring water.  The
breasts are bathed with this decoction for fifteen or twenty
minutes.  Part of the boiled leaves are then thinly spread over
the breasts, and allowed to remain until all moisture has been
removed from them by evaporation, and probably, in some measure, by absorption.  This operation of fomenting with the decoction and applying the leaves, is repeated at short intervals
until the milk' flows upon suction by the child, which it usually
does in the course of few hours.
On dccasions where milk is required to be produced in the
breasts of women who have not given birth to or suckled a child
for years, the mode of treatment adopted is as follows:
Two or three handfuls of the leaves of the Ricinus are taken
and treated as before.  The decoction is poured, while yet boiling, into a large vessel, over which the woman sits so as to receive the vapor over her thighs and generative organs, cloths
being carefully tucked around her so as to prevent the escape of
the steam. In this position she remains for ten or twelve minutes, or until the decoction cooling a little, she is enabled to
bathe the parts with it, which she does for fifteen or twenty
minutes more. The breasts are then similarly bathed, and gently
rubbed with the hands; and the leaves are afterwards applied
to them in the manner already described, These several operations are repeated three times during the first day.  On the
second day, the woman has her breasts bathed, the leaves applied, and the rubbing repeated three or four times.  On the
third day, the sitting over the steam, the rubbing, and the application of the leaves to, with the fomentation of, the breasts,
are again had recourse to.  A  child is now put to the nipple,
and, in a majority of instances, it finds an abundant supply of
milk.
In the event of milk not being secreted on the third day, the
same treatment is continued for another day, and if then there




LACTATION, MILK-FEVER, &C.                   131
still be want of success, the case is abandoned, as the person is
supposed not to be susceptible to the influence of the Bofareira.
Women with well-developed breasts are most easily affected
by the Bofareira. When the breasts are small and shrivelled,
the plant then is said to act upon the uterine system, bringing
on the menses, if their period be distant, or causing their immoderate flow if their advent be near,
Exposure to cold is carefully avoided by persons who are being
brought under the influence of the Bofareira. They scrupulously abstain from wetting with cold water either the hands or
the feet.
Maria, a dark mulatto woman, with woolly hair, thirty years
of age, tall, stout, and well-formed; menstruating regularly;
the mother of three children, the youngest of whom was three
years old, and had been weaned when under the age of one year,
was brought before me by Dr. A.lmeida, of Boa Vistca, on the
morning of the 30th of June, 1846, for the purpose of being
submitted to the action of the Bofareira.  She stated that when
her child was weaned, every trace of milk disappeared from her
breasts in the course of a few days.  I could not detect any sign
of pregnancy.  The breasts were like those of negro women in
general who have borne children, pendulous and flabby.  No sign
of milk was given out friom them upon careful expression of the
nipple.
The baths, fomentations, the application of the leaves, friction,
suction, &-c., were adopted in the manner and order I have already described.  On the second day there was a slight oozihg
of serous-looking milk from  the nipples, with slight increase of
size in the areolar portion of the breast.  On the third day the
milk was increased in quantity, and less watery. On the morning
of the fourth day there was evident enlargement of the lower part
of the mamma, and milk flowed abundantly upon the application
of a child to the nipple.
The use of the Bofareira in cases of childbirth, to accelerate
the flow of milk, is common, but comparatively rare as a means
of procuring a wet-nurse.  Some instances of the latter kind
occurred, in consequence of the death of mothers with children
at the breast during the progress of the Boa Vista epidemy of
1845-46, which decimated a population consisting almost wholly




132              DISEASES OF PARTURITION,
of blacks, with a few Europeans-Portuguese and English-and
a small proportion of mixed negro and European blood.
Generally, however, this use of the Bofareira is seldom called
for. Death in childbirth, or prolonged illness after parturition,
sometimes requires a kind relative or charitable neighbor, who
for the safety of the offspring, places herself under the influence
of the Bofareira.
The son of a wealthy landed proprietor of San Nicolao (well
known to my friend, Mr. George Miller, of that island,) a remarkably hale and robust-looking man, was wet-nursed by a
woman who gave him milk produced by the bofareira. The nurse
in this instance had borne two children in early life.  Her husband had died shortly after the birth of her second child; she
lived in a state of virtuous widowhood, and it was many years
after the death of her husband that she so generously submitted
herself to the bofareira, and nursed the infant in question.
Consul-General Rendall, of the Cape de Verds, informs me
that a lady, a native of Boa Vista; now residing at San Antonio,
and the wife of one of the foreign consuls, had a daughter in
1843.  "Having very little milk," says Mr. Consul Rendall,'she caused an old female servant to be prepared with the bofareira, and to act as wet-nurse, which she did in the most satisfactory manner, having plenty of good milk, although she had
not had a child for ten years previously.  The child is now
(March, 1847) a healthy one, and well-grown.; In short," continues M. Rendall. "women who use the bofareira are in two or
three days in order sufficient to nurse the child of a queen.
I have not been able to ascertain, from personal observation,
or from any very accurate information, what effect the bofareira
has upon virgins, or upon those who, although they have not borne
children, are nevertheless not virgins.  As regards the latter
class, however, an intelligent native midwife assured my most
able and observant friend, Mr. George Miller, of San Nicolao,
that the effect of the administration of the bofareira is much
the same upon them as upon them as upon childbearing women.
In some cases, but rarely, the decoction of the bofareira is
taken internally, with a view of assisting the action of its external application.
I regret not having been informed of the alleged difference in




LACTATION, MILK-FEVER, &C'                   133
the action of the white and red bofareiras, while I was at the
Cape de Verds, that I might have examined the latter plant
upon the spot.
The seeds of each plant were, however, kindly forwarded to
me by Mr. George Miller, and Sir William Hooker most readily
and obligingly examined them.  Sir William, in a note to me,
says,'What you remark as red bofareira and as white bofareira,
are both, not only of the genus'ricinus,' but also of one and the
same species-viz., ricinis communis, the common palma Christi,
or castor-oil plant. In our gardens, as well as abroad, the plants
vary, and your two plants vary a little in the form and size of
the seed, and especially in the color, but they are one and the
same species."
It is thus evident that the white and red bofareiras, if they
differ at all, can only be varieties of the same species. It is
known, however, that certain varieties of other plants, as thyme,
mint, &c., do yield different properties, and such may be the
case with the bofareiras.
I have thus stated all the facts that have come to my knowledge regarding this galactagogue of the Cape de Verds, which
I consider to be well worthy of a fair trial in this country.
Should its action in our more temperate regions be similar to
that which it exerts within the tropics, an interesting field of
inquiry will be opened, as regards its hygienic, medical, medicolegal, and other relations.
These, however, are points, the consideration of which had,better be reserved until it has been determined, by experiment;
how  far the bofareira can be successfully introduced into the
practice of this country.
Note.-Dr. Tyler Smith, to whom I showed my paper before
iny visit to Edinburgh, has written to inform me that he has in
several cases tried the bofareira in the manner described by me;
and he assures me that the effects of the plant grown in this
country fully bear out the facts I have detailed respecting
the use of this plant in the Cape de  Terd Islands, —Lacet,
September 7th, 1850, p. 294.




134              DISEASES OF PA-RTTURITION.
GALACTAGOGUE AND EMMENAGOGUE EFFECTS OF THE LEAVES OF
THE BOFAREIRA, (RICINUS COMMUNIS, OR PALMA CHRISTI.)
By Dr. TYLER SMITH.
[Dr. Smith states, that being struck by the facts related in
Dr. Mc William's paper, and learning for the first time that the
plant is no other than the ricinus communis, which grows as an
annual plant in this country, he determined to ascertain by
Dr. iM  WVilliams' wish, whether the plant when growing in our
latitudes, preserves its remarkable properties of stimulating the
mammary glands.  Dr. Smith says:]
In directing the use of the Bofareira leaves, which I have
procured from the Botanical Gardens at Chelsea, Kew, and the
Regent's Park, I have followed as nearly as possible the description of Dr. Mc William, with the exception of the application of the steam of the decoction to the generative organs.
The following are the cases in which the agent has been used
under my directions.
The following case was conducted by Mir. C. Stillman, one of
the house-surgeons of Queen Adelaide's Lying-in-Hospital.
Case I.-Mrs. C., twenty-four years of age, rather,tall and
thin, mother of two children, had weaned the last about six
weeks, and had still a little milk, of a very thin, serous character, left in the breasts. She commenced the use of the Bofareira,
on the morning of Wednesday, August 21st, by bathing the left
breast only, with a strong decoction of the leaves.  The leaves
themselves were afterwards applied to this breast.  In the
evening, she repeated the bathing; after which she perceived,
on squeezing the nipple, that her milk, which was at first thin
and watery, had now become quite thick.  After repeating the
application on Thursday the 22d, she felt throbbing pains in the
breast, accompanied by sickness and pains in the back, which
she described as being like after-pains, and the areola surrounding the left nipple had become much darker than the right; the
glandular follicles were also larger than in the nipple which had
not been under the influence of the Bofareira.  The difference
between the two breasts was very marked.  Having at this time
no more leaves, she was unable to continue the application.
On the following day, a fresh supply of the leaves was obtained,




LACTATION, MIILK-FEVER, &C.                   135
and she again bathed her left breast as before.  After two
applications, the catanmenia appeared before the regular time,
and the fomentations were not afterwards continued.
Case II. —Mrs. H., mother of four children, her youngest
child aged one year and five months, had been weaned more
than six months.  During the latter months of lactation, she
had little milk; the breasts were small, and the nipples contracted.  Before applying the Bofafreira, the breasts were carefully examined, to learn if they still contained any traces of
milk.  After much trial, she could squeeze from  her left breast
the smallest points of serum  from  the mouths of two or three
of the galactophorous ducts, as is the the case with most women
who have suckled; but from  the right breast not a trace of
moisture could be expressed.  The Bofareira was used night
and morning for four days, by bathing wvith the decoction, and
the application of the hot leaves to both breasts, in the manner
described by Dr. Mc William.  After the second application,
thick milk, like the colostrum, could be squeezed from  both
nipples, the breasts were considerably swollen, the glands in
the axills were also painful, and pains extended  down the
arms.  There were, in fact, in this case, all the symptoms
present, in a minor degree, which are usually observed in the
establishment of the milk after parturition.  Mrs. H. had also
distinct periodical pains in the back and abdomen, which she
compared  to after-pains.  A  leucorrhoeal discharge was also
produced.  At the end of the fourth day, milk flowed so freely
into a breast-pump, that there was no doubt she could have
suckled  a child; but at this point the application  of the
Bofareia was omitted, and the milk has since gradually disappeared.
Case III.-Mrs. D., a married laldy wlithout family, hearing
of the use of the Bofareira in the last case, wished it tried upon
herself.  As there was no possibility of injury she was supplied
with some of the leaves, and proceeded to use it.'The application, and the use of the decoction, produced swelling of the
breasts, pain in the back, and an increase of a leucorrhceal
discharge, to which she is subject; but there was no appearance of milk in the breasts.  At the time of using the Bofareira,
the catamenial discharge had ceased about a week.




136              DISEASES OF PARTURITIONo
Case IV.-M. L., a young woman, who had been delivered
three weeks, but whose milk, though profuse, was so poor as to
be little more than serum, used the Bofareira three times.
under its use the secretion from the breasts became markedly
thicker; but the child was unfortunately attacked with diarrhoea, and it was not thought advisable to continue the use of
this agent longer.
Case V.-L. M., a young woman, mother of one child, but
who had weaned her infant about a year and a half, applied the
Bofareira in the form of decoction and poultices two or three
times; but the pain and swelling were so considerable, that
she refused to go on with it.  She had a little serum  in' the
breasts, at the time when the use of the Bofareira was commenced.  The secretion speedily became milky.  This patient
had a leucorrhoea, which had been present, ever since the
weaning; and the uterine and vaginal irritation, upon which the
leucorrhoea depended, had kept up, in all probability, the serous
secretion from  the breasts, which is common enough in leucorrhceal cases.
Since the foregoing cases occurred, I have used the remedy
in a case of scanty menstruation of a remarkable kind.  Owing
to exposure to marsh malaria, some years ago, the patient had
scarcely a sign of colored discharge at the usual catamenial
periods.  She used the infusion of the leaves of the red Bofareira at the date of her period, applying the infusion and
leaves to the breasts, and the vapor to the genitals, with the
effect of producing, in two days, a considerable flow of the catamenia.  From  the effects in this case, and in one of the cases
already related, the Bofareira promises to be of considerable
value as a direct emmenagogue; at all events the cases in
which I have tried it, show that the plant does not lose its efficacy in this climate.  I hope that, in America and other parts
in which the plant is common, perennial instead of annual,
extensive trials of its efficacy both as an emmenagogue and a
galactagogue, will be made. —London Journal of i fedicine, Oct.
1850, p. 951.




SORE NIPPLES.                      137
SORE-NIPPLES.
ACCORDING to MURPHY, the local cause that chiefly interferes with nursing, is the extreme tenderness of the nipples, or
the fissures, or so called " sore-nipples."  If attention be paid
to the breasts before delivery, if the nipples be prepared or
hardened by astringents, weak brandy, Arnica- or Alum-water,
there will be less risk of accidents afterwards.  Still, this process of hardening may fail, or it may not have been tried; and
then, as soon as the child is applied to the breast it causes great
pain; inflammation follows, and a crack, or fissure in the nipple
is the consequence.  From  the moment this happens the patient's miseries begin; every time the child is applied, the
wound is opened and bleeds; the inflammation increases, the
nipple swells and becomes painful, even when the child is not
drawing upon it; but the pain becomes intolerable when the
child nurses; and thus a very slight inflammation in the beginning may soon become so severe and obstinate as to require
weeks before it is subdued.
The treatment of sore nipples is the treatment of inflammation; and the first and most important point is the prevention
of the fissure.  It is here that the watchfulness and intelligence
of the nurse is of the utmost importance.  It is not usual for
physicians to examine the breasts and nipples of his child-bed
patients every day, although there are many good reasons why
*he should do so, especially if he has the leas't reason to suspect
any deficiency or tenderness of the nipples, or inflammation.
The nurse has daily and hourly opportunities for observation;
if there be any great pain, unusual swelling, or redness of the
nipple, she must necessarily soon observe it, and always should
give timely notice to the physician.  But many women have an
unreasonable and foolish disinclination to expose their breasts to
the eye of the accoucheur, until several or many domestic remedies have been tried and failed. In the first stage a mild astringent will arrest farther trouble; MURPHY  has found Alumwhey a useful lotion; while Alum-curds may be applied as a
poultice to the nipple; the infant should be applied to the breast
as seldom as possible, and before doing so it is always well to
cover the nipple with a circular piece of gold beater's skin, or




138              DISEASES OF PARTURITION.
adhesive plaster, having a hole in the centre just sufficient to
leave the orifices of the milk-ducts uncovered.  This will lessen
the pressure and irritation of the infant's gums and render the
process of nursing ilore tolerable.  Nipple shields are generally
next to useless, if not injurious. The breasts should be gently
rubbed from  time to time with warm  oil, in order to help the
milk to flow more freely and easily.
Arnica, five drops of the tincture in a wine-glass full of water,
applied to the nipples several times a day, is said to be very
effectual in removing the tenderness and excoriation consequent
upon the first few applications of the child to the breast.
Chnamotilla, may be used internally and externally in the
same way as Arnica, when there is inflammation, swelling and
ulceration of the nipples.
Grajphite, when there is burning, aching, cracking and tenderness of the nipples.  A dose may be given every night and
morning.
tSulphutr, when the nipples are sore and deeply fissured; when
the cracks bleed and burn.
In some severe cases Sweet-oil and Lime-water may be applied frequently; or Magnesia-ointment; or Glycerine, or Collodion; or a solution of Nitrate of Silver, in the proportion of
ten grains to the ounce of water, which will form a slight eschar
leaving a sound cuticle after it falls off. In some of the severest
and most painful cases, Morphine is the only useful external application, but it must be washed off very carefully before the
child is allowed to nurse.
In order to prevent any trouble about the nipples they should
be washed off gently with warm  water, immediately after the
child has nursed, dried carefully, and then dusted with superfine
wheat-flour.
In difficult and obstinate cases Calcarea, Lycopodium, Mercurius, or Silex may be required; besides the internal use of
these remedies, a fine powder of Calcarea, Lycopodium, or Silex
may be applied externally; or a weak ointment of Mercurius, or
a fine powder of one drachm of white oxide of Zinc to one ounce
of fine powdered, or sifted arrow-root.  A wash of Borax is frequently useful.




DEPRESSED NIPPLES.                     139
DEPRESSED NIPPLES.
ACCORDING to MIURPHiY these  are extremely troublesome
and render the chance of nursing almost hopeless.  They may
be drawn out by the breast-puimp so as to enable a strong infant
to seize and maintain its grasp; but more frequently it fails to
do so, and the nipple gradually shrinks back to its former size
and place, while the infant is moving about its mouth to seize it.
Such cases as these, as well as those in which the nipples are
badly formed and shaped, often oblige the practitioner to discourage the reluctant mother from making any further attempts
to nurse her child.  But the simple plan of TRACY (see page
21) will often prove successful;  it consists in winding a bit of
woollen thread or yarn two or three times around the base of the
nipples (after this has been previously drawn out sufficiently),
and tying it moderately tight, but not so tight as to interfere
with the free circulation of the blood.  Thus, the nipple may be
kept permanently and sufficiently prominent; and the woollen
threads may be worn constantly for many days without the least
inconvenience, and with permanent good results.
If the mother still be unable to nurse her child, the secretion
of milk must be lessened or prevented; the remedies for excessive secretion of milk, must be used, viz:
Aconite, if the breasts be hard and knotted, the skin hot and
dry, the face red, and the patient restless and discouraged.
Bryonia may be given, if the Aconite does not relieve sufficiently; or Belladonna under nearly the same circumstances.
Calcarea is especially suitable if there be great fullness or
enlargement of the breasts, with tardiness in the formation of
milk.
hiuzts-toxicodendront, if there is a painful distention of the
breasts, with rheumatic pains throughout the body; swelling,
heat and redness of the breasts, headache, stiffness of the joints
and face.  ]Rhus is very serviceable at the time of weaning.
If the patient be of a full habit of body, small doses of Stibium may be given; some milk should be drawn from the breasts
at long intervals only, and a bandage or strips of adhesive plaster may be applied over them, so as to maintain a firm  and
equable pressure, and thus promote the absorption of the re



140               DISEASES OF PARTURITION.
mainder.  If there be much distention of the breasts, warm fomentations and warm  frictions will be found very serviceable.
Drinks of Citrate of  aagnesia, or Cream of Tartar are said to
be almost uniformly successful, when aided by low diet.
Many other affections of the breast may arise after confinement; for it must be recollected that each breast is composed of
an association of small glandular masses, or in other words that
each lobe is a perfect and independent gland, enjoying exclusively
its own vascular and nervous system, and having its own proper
duct, the separate orifice of which is at the nipple.  A  large
quantity of interlobular cellular tissue unites these lobes together, and the whole is at last surrounded by the investing
fibrous membrane, or mammary fascia.  Both around the margins and in front of the gland is a large quantity of fat; and
there also exists much fibre-tissue in the nipple between the
ducts and under the areola.  Hence inflammation and its results
may affect, and be limited to the nipple or areola, the cutaneous
or sub-cutaneous tissue, the lobes individually or collectively, and
the uniting fibro-cellular tissue; it may be either intra-lobular
or inter-lobular, or both combined.-BIRKETT.
Inflammnation of the mninutefollicular glands scattered over
the nipple, forms a peculiar variety of inflammation and fissures
of the nipple.  The first difficulty which the mother experiences
is a sensation of heat, then of tingling or smarting with a very
slight redness; the skin of the nipple becomes harsh and dry,
and upon careful examination one or more small vesicles will be
detected.  These in time become rubbed, the skin breaks, and
then a little oozing is noticed, with perhaps a minute ulcer or
crack at the most painful spot.  These appearances may be observed in any part of the nipple, from the apex to its base; or
even upon the areola; as the mischief advances the cracks extend, taking either a circular or longitudinal course  but the
former is most common.  The pain now  becomes very severe
when the infant nurses; the fissures divide and increase in extent and depth; the skin becomes entirely destroyed, or a circular fissure surrounding the base of the nipple threatens its
total destruction by sloughing.  The fissures and ulcers bleed
frequently so that the infant often vomits blood after nursing.
One of the most important and troublesome consequences of




DEPRESSED NIPPLES.                       141
this form of disease is secondary inflammation of the deep fibretissue uniting together the tubes or ducts in the nipple; the iifiammatory exudation and induration may cause obliteration of
one or more of the milk-ducts.  The inflammation may also extend to the glandular tissue, and give rise to deep and numerous
abscesses.
Treatment.-The preventive treatment consists in hardening
the nipples as soon as quickening begins; the nipple then should
be exposed to the air occasionally, washed with bland-soap and
water, and wetted night and morning with a little diluted Cologne-water, or with alcohol and water, or with Arnica-water.
After the birth of the child, too much care cannot be taken to
see that the nipple is carefully and properly washed and cleaned
after each application of the infant to the breast; the secretions
from the child's mouth, combined with the milk should never be
suffered to become dry upon the part. The nipple should also
be protected from the pressure and friction of the dress and bedclothes by some resisting body, such as a nipple-shield.
When the inflammation, fissures and abrasions are not very
severe they will often yield to protection, frequent ablution, aided
by some mild powder, such as Lycopodium, starch-powder, or
Carbonate of Magnesia, or one drachm of White Oxide of Zinc
mixed with one ounce of finely powdered and sifted arrow-root,
applied after the nipple has been carefully washed and dried.
When the soreness of the nipples is produced by an aphthous
inflammation of the child's mouth, a solution of Borax, or Chlorate of Potash, or the 1st dilution of Nitric-acid may be applied
three or four times a day, or more.
The internal and external use of Nitrate of Silver may be
tried; but the external application as ordinarily used is attended
with great pain, although the second or third application is not
as severe as the first.
Collodion is said to be a very useful application and preferable to most others.
Among the internal remedies, Graphite, Sepia, Zincum-metallicum deserve attention; also Petroleum, and Sanguinaria.




142              DISEASES OF PARTURITION,
MILK FEVER.
THIs according to COLOMBAT is not so much a disease as a
febrile movement requisite to form the secretion of milk in a.
woman recently delivered. It commences with shooting pains
and aching in the breasts, which become swollen; the glands
under the arm pit are also apt to become tender and enlarged.
These symptoms generally commence on the third day after the
birth of the child; in certain cases as early as the first or second
and sometimes even as late as the sixth. The pulse becomes
full and frequent, the skin hot and dry, face flushed, there is
thirst" whitish fur on  the tongue, scantiness of the urine,
more or less general agitation and headache.  This fever generally subsides in twenty-four hours; sometimes in the course of
six, eight or twelve.
While the milk-fever lasts, the lochial discharge diminishes,
or is temporarily suspended; but soon an abundant perspiration
sets in, and the lochia then again become as free as before the
attack.
If the child is applied early and sufficiently frequently to the
breast there is generally little or no milk-fever; the same holds
true of those women who perspire very copiously.
Treatment.-If the fever runs too high and the breasts are
very much swollen and painful, small doses of Aconite and Antimony should be relied upon; the breasts should also be drawn
regularly, at least every four hours, and sometimes every two
or three hours. The Sulphate of Potash enjoys a very longstanding reputation as an anti-lactic remedy.
ENGORGEMENT AND INFLAMMATION  OF THE
BREASTS.
Engorgement of the breasts generally appears on the fourth
or fifth day after delivery, and principally affects persons who
do not wish to nurse, or who do not apply the child to the breast
at least every four hours, both by night and day, or those who
have too great a flow of milk and nurse a feeble child, or have




ENGORGEMENT OF THE BREASTS.                   143
their nipples too small or large, or who have taken cold.  The
patient has chills and pain in the back followed by fever; the
breasts become hard and unequal, but preserve their natural
color; but the breasts may become caked or indurated, and the
secretion of milk will then be diminished or completely suspended, while the patient has pains in the whole of the breast,
which may even extend to the arm pits.
When inflammation has set in, the breasts gradually increase
in size, and become very painful and hard; they are excessively
hot and tense, and assume a reddish color; the pains lancinating
and pricking; fever sets in, with headache, which increases more
and more; the face is flushed, urine scanty with a whitish sediment; the faces exhale an acid odor; and lastly the inflamed
breast acquires considerable size and hardness, which may extend to the arm-pits and neck.  The pains may become so acute
that delirium sets in.
Simple engorgement generally terminates by resolution; while
suppuration is the most common termination of the really inflammatory variety.  We ascertain that suppuration is taking
place by the persistence and progressive increase of the inflammatory symptoms, and by the presence of hard lumps or cakes
in the breasts, together with throbbing pains and intolerable
shootings.  Finally fluctuation is discovered,
Treatment.-The preventive treatment consists in applying
the infant early to the breasts in order to empty them as soon
as they are filled; in keeping the breasts and person of the
patient warm; and by moderate diet.
When engorgement has once set in, a flaxseed poultice containing a little milk, castile-soap, or ten or twelve grains of
Soda, or Potash, may be applied; or Hlydridate of Potash-ointment, one drachm  to the ounce of simple cerate; or bits of
Canton-flannel, or Spongio-piline dipped in hot Pearlash-water,
not too strong.
Aconite and Antimony may be used internally; or Aconitec
and Bryonia; or Belladonna, or Mercurius may be given in alternation with Bellad., especially if transient chills and throbbings set in.
Phosphorus is another very usefulremedy when-the inflammation is active and rapid suppuration threatens; it will often:




144              DISEASES OF PARTURITION.
be found to quickly relieve the excessive pain, redness and swelling.  It is also useful against a fistulous, or indurated condition
of the breast.
Hepar-sulphur is indicated after the inflammatory symptoms
have somewhat abated, yet signs of suppuration are still present.
It may help to produce resolution, but is also said to expedite
the bursting of the abscess when it has already formed.
Nitric-acid is said to be useful, when there are hard nodosities
in the breasts.
Sulphur, when there is inflammation and induration of the
breasts; or erysipelatous inflammation with heat, hardness, and
redness radiating from the nipple.
Lycopodium, when there are hard, burning nodosities in the
breasts; with discharge of blood and sticky water from  the
nipples.
Conium, when there is hardness of the breasts with pains at
night.
Bromine and Sabina, when there is swelling of the breasts.
Mercurius-solubilis, when there is swelling of the breasts,
especially of the nipples, which are somewhat harder than natural.
Calcarea, when there is swelling and heat of the breasts, with
inflammation of the nipples.
Belladonna, when there is hardness, with excessive secretion
of milk, and some inflammation.
Rhus-toxicodendron, when there is painful distention of the
breasts, when the milk first begins to flow, with pain and itching
of the nipples.
Zincum, when there is distention of the breasts, with soreness
of the nipples.
If the abscess be small, it may be allowed to open of itself;
but if the engorgement and induration is extensive an opening should be made as soon as fluctuation is discovered; the
incision should be made, in the direction of one of,the radia
of a circle, of which the nipple is the centre; a bit of lint or
linen may be introduced into the opening to prevent its closing
too soon; the fears of some homoeopathic physicians about
lancing abscesses are founded upon the grossest ignorance and
prejudice.




ALTERATIONS OF THE MILiK.                    145
ALTERATIONS OF THE MILK.
According  to COLOMBAT, after nervous diseases the milk
is apt to become thin like water, or of a greenish color; it may
assume a yellowish  color in inflammations of the breast; a
saltish and disagreeable taste in inflammatory diseases, and
lastly, a sour smell after labor generally; while it contracts an
odor like that of garlic in persons who eat that substance.
To discover whether the consistence of the milk is too thin,
or too thick, it is merely necessary to put a drop on one of the
nails; if it adheres to it at first, and then spreads without
running, it is in a natural condition; if it runs, it is too thin;
and if it adheres to the nail without spreading, it is too thick.
In nervous women the milk is apt to be thin and not very nutritious, whilst it is also subject to important changes from the
slightest vexation, or other powerful mental emotions. Menstruation renders it thin and serous; Pregnancy makes it thick
and unfit for the nourishment of infants; salt-meats, highly
seasoned dishes, mealy vegetables, salads and fruits make it
more abundant and thinner; spirituous liquors, late hours, excessive sleep and all abundant secretions diminish it in quantity.
From the chemical examination of eighty-nine females VERNOIS and BECQUEREL have established the healthy standard
of human milk, as follows:
MEDIUM.  MAXIMUM.  MINIMUM.
Density................  1032.67   1046.48   1025.61
Water....................   889.08    999.98    832.30
Solid constituents...........    110.92    147.70        83.33
Sugar..................    43.64            59.55     25.22
Casein and extractive matters.   39.24         70.92     19.32
Butter...............              2.66       56.42      6.66
Salt.....................          11.38       3.38      0.55
In twenty-six cases the influence of the presence of Colostrum
from the first to the fifteenth day after delivery, was as follows 
K




146                 DISORDERS OF LACTATION.
MED1UM.
NORMAL
MAXIMUM.  MINIMUM.   MEDIUM.    STATE.
Density............ 1032.86   1025.61   1031.34   1032.67
Water                      882.97    870.34    872.45    889.08
Solid constituents....   147.70    117.03    127.55         110.92
Sugar.............           48.46      8 35.54    41.23       43.64
Casein  and  extractive
matters............    48.66          32.92      44.05       39.24
Butter..............        56.42      28.89       40.35      26.66
Salts..............          3.38       1.23        1.92       1.38
Hence the presence of colostrum  causes a partial diminution
of the density of milk,
constant diminution of the quantity of the water of milk,
constant increase of solid constituents,
constant but slight diminution of sugar,
notable increase of casein,
very muarked increase of butter,
increase of the salts.
As regards the influence of the age of the nurse:
MEDIUM,
15 TO 2 20 20 TO 25 25 TO 30 30 TO 35 35 TO 40 NORMAL
YEARS.  YEARS.  YEARS.  YEARS.  YEARS.  STATE.
Density....... 1032.24 1033.08 10032.20 1032.42 1032.74 1032.67
Water........   869.85  886.91  892.96  888.06  894.94  889.08
Solids........  130.15  113.09  107.04  111.94  105.06  110.92
Sugar.....         35.23   44.72   45.77   39.53   39.60   34.61
Casein,....    55.74   38.73   36.53   42.33   42.07   39.24
Butter......       37.38   28.21   33.48   28.61   22.33   26.66
Salts.......  1.80          1.43      26    1.44    1.06    1.38
Hence although  the difference is not very great, it will be
most desirable to have a wet-nurse froin 20 to 30 years of age.
As regards the age of the milk, the above authors have furnished the following table:




INFLUENCE OF THE AGE OF MILK FROM I TO 24 MONTHS.
I Day   I to 2   2 to 3   3 to 4   4 to 5   5 to    6 to 7   7 to 8   8 to 9   9 to 10 10 to  11 I to 13 12 to 18 I8 to 24jMedium
tot I                                                                                                                         Normali
Month. Months. Months. Months Months. Months. Months. Months. Months.;Months. Months. Months Months. Months, State.
Density.....   103169 1033.11 1032.70 1032.00 1032.10 1034.35 1034.97 1031.37 1032.88 1034.44 1031.61 1030.68 1034.05 1030.81 1032.67
Water......   872.84  872.99  886.16  889.67  888.25  901.51  891.35  889.49  891.65  889.28  900.63  889.04  891.34  876.55  889.08
Solids......    127.16  127.01  113.84  110.33  111.75   98.49  108.65  110.51  108.35  110.72   99.37  110.96  108.66  123.45  110.92
Sugar......    40.40   43.13   43.37   44.47   44.66   42.00   44.18   41.52   45.31   45.84   47.62   43.91   43.92   41.33   43.64
Casein, &c.....    45.38   48.26   37.92   36.96   38.28   38.63   38.86   35.02   38.79   38-57   31.06   41.06   36.98   37.32   39.24
Butter.....           39.55   34.05   31.221  27.79   27.31   26.57   24.35   22.79   23.06   25.03   19.47   24.61   26.44   43.47   26.66                      H
Salts.....             1.83    1.59       1.33     1.31     1.50     1.29     1.26     1.18      1.19     1.28     1.22     1.38     1.32     1.33     1.38      ^
^^"^^18^^~~~~~~~~C                                                                                               0
CDso   il
^0         X. p                               ^       ^^          0           f       f^0    ^ 
^^^^^^1                            ^    l~^^  0. s' ^ ^ ^t 0
020025                        ^              s ^          ^ ^      ~      s       ^^ ^..^                    - 0
Z ^ ^ ^                                 0
CD     ^                    at; 0S          p                                                                           Si
0             CD               ~~~                                                                   0
CD               CD                                                              0 0CD0 
ep      t2Z%                   tol            W0
C-~~~-  CD                     C0 -5                                                          CD~02   0'-5  55 ~~~~~ ~  ~~ ~~. e-sCD 55                0q',5 p            Z
CD~~~~~~t 
fz~~ P-A P —j0p0P aq                    CD  P




148                DISORDERS OF LACTATION.
STRONG      DELICATE   MEDIUM NORMIAL
CONSTITUTION. CONSTITUTION.    STATE.
Density...............    1032.97        1031.90      1032.67
Water............     911.19       887.59        889.08
Solids.....                    88.81       112.41        110.92
Sugar.....           32.55        42.88         43.64
Casein, &c............          28.98        39.21         39.24
Butter...............          25.96        28.78         26.66
Salts.......                   1.32          1.54         1.38
INFLUENCE OF PREGNANCY.
PREGNANCY FOR 3 MEDIUM NORMAL
MONTHS.         STATE.
Density.................        1030.67        1032.67
Water.....................              860.97         889.08
Solids........................          139.01         110.92
Sugar..........................          46.             464
Sugar.....                        46.47           43.64
Casein, &c.....................          34.52           39.24
Butter......................            55.97           26.66
Salts.....................   2.05            1.38
The principal influence of pregnancy on milk is to produce a
great increase in the quantity of butter; and it is remarkable
that the same effect is produced in the cow, the proportion of
butter increasing from 36.12 to 47.52.
THE INFLUENCE OF MENSTRUATION,
is variable; as a rule the density, quantity of water, and sugar
are somewhat diminished; and that of the solids and casein
decidedly increased, the butter and salt decidedly or slightly
augmented.  Still in two instances the solids increased from 111
and 113 to 142 and 144, and in another case, fell from 113 to 96.
The quantity of Sugar in one case fell from  54 to 35; increased in another from 39 to 47; and remained stationary at
44 in a third.
The quantity of Casein increased in one case from  35 to 40;
in another from 41 to 42; and fell in a third from 41 to 39.
The quantity of Butter increased in one case from 21 to 67;
in a second, from 29 to 52; and fell in a fourth, from 24 to 10.
Hence it is to be supposed that equally great changes will take
place in the state of the stomach and bowels of the infant.




ALTERATIONS OF MILK.                         149
INFLUENCE OF COMPLEXION AND COLOR OF THE HAIR.
It is supposed that the milk  of females with brown hair is
preferable to that of blondes.  The milk of persons with blond
hair is less dense; contains more water; less of solids, sugar,
casein, and salt; and a little more of butter.
INFLUENCE OF FOOD.
In nurses who are poorly fed the quantity of water in their
milk is apt to increase from 876 to 8983; the solids to diminish
from  123 to 104; the sugar to increase friom  41 to 45; the
casein to remain unaltered; and the butter to lessen from 43
to 18.
INFLUENCE OF THE QUANTITY OF THE MILK.
When  the breasts furnish  but. little milkl the density, and
water and butter are apt to increase; the  solids, sugar and
casein to diminish.
INFLUENCE OF ACUTE FEVERS.
IIEAN IN
FEVERS.      NORMAL MEAN.
Density.................               1031.20         1032.67
Water......................     884.91          889.08
Solids....................       115.09          110.92
Sugar...............              3.10           43.64
Casein, &c.....................             50.40            39.24
Butter........................             29.86           26.66
Salts....................          1,73             1.38
Hlence in fevers, there is a slight diminution of the density
of the milk, and a notable lessening of the water and sugar;
while there is an proportionate increase of solids, a marked
augmentation of casein and butter, and a slight increase of salt.
INFLUENCE OF SEVERE MORAL EMOTION.
MORAL EMOTION.  NORMAL MEAN.
Density................                1032.99         1032.67'Water.....................              908.93          889.08
Solids............                         91.07          110.92
Sugar.                                      84.92           43.64
Casein, &c.....................             50.00           39.24
Butter.......                  5.14           26.66
Salts-....... — -.    _1.01               1.38




150                 DISORDERS OF LACTATION,
In this case there was a sudden increase of water and casein 
and a very great diminution of the solids, sugar and butter.
INFLUENCE OF CHRONIC DISEASE.
NORMAL
MAXIMUM.  MINIMUM.   MEDIUM.    MEAN.
Density...........  1037.52   1027.07   1034.47   1032.67
Water........         923.58    832.96    885.50    889.08
Solids.....           167.04       89.51    114.50    110.92
Sugar...............        51.98      30.38       43.37      43.64
Casein, &c.........         47.49       12.70      37.06      39.24
Butter..............       73.05        6.90      32.57      26.66
Salts..............        3.38        0.61       1.50       1.38
In acute diseases the quantity of sugar is apt to be greatly
diminished  while it generally  remains  unaltered in chronic
affections.  On the other hand, the quantity  of casein is frequently very much increased in acute diseases, and lessened in
chronic.  The density and quantity of water is lessened in both
acute and chronic disorders; the solids, butter, and salt somewhat increased.  The inference would be, that when infants must
be partly  fed. while their mothers are suffering from acute disease, less milk and more sugar and water should be added to
their food; and more milk and less sugar in chronic affections.
INFLUENCE OF CONSUMPTION.
Without diarrhoea,  With diarrhca,
abscesses and ema-   &c.          Normal Mean. 
ciation.
Density.........    1031.84              1031.38        1032.67
Water.........           876.59          903.16           889.08
Solids...........        123.41            96.84          110.92
Sugar..........          42.14           43.45            43.64
Casein, &c.......          37.46           39.14            39.24
Butter............         41.82            12.76           26.66
Salts.............  1.99             1.49            1.38
The milk of decidedly consumptive females is markedly deficient in butter.




ALTERATIONS OF MILK.                         151
Sugar, Casein and Butter are the principal nutrient materials
in milk.
QUANTITY OF SUGAR.
MEDIUM.        MAXIMUM.        MINIMUM.
In health.......         43.64           59.55           25.22
In acute disease....      33.10           48.71            19.50
In chronic disease..      43.37           57.98            30.38
QUANTITY OF CASEIN.
MEDIUM.        MAXIMUM.        MINIMUM.
In health.......      39.24           70.92           193 2
In acute disease..       50.40           66.26            34,62
In chronic disease..      37.06           47.49            12.70
QUANTITY OF BUTTER.
MEDIUM.        MAXIMUM.        MINIMUM.
In health.........       26.66           56.42             6.66
In acute disease...      29.86           56.37             5.14
In chronic disease..      32.57           73.05             6.90
COMPARISON OF HUMAN AND COW'S. MILK.
IMEDIUM COW'S.  MEDIUM HUMAN.
Density....................           1033.38         1032.67
WVater.....................          864.06           889.08
Solids.....................             135.94           110.92
Casein, &c....................             55.15           39.24
Sugar........................             38.03            43.64
Butter..................                   36.12           26.66
Salts ee..................  6.64           1.38
Hence it is evident that cow's milk contains considerably more
casein, butter and salt than human milk, and less water, and
sugar.  Mother's milk is always very obviously alkaline, while
cows milk is either very feebly alkaline, often neutral, and sometimes slightly acid.  Therefore, when it is necessary to feed infants with cow's milk it should always be borne in mind that it
was originally intended for calves and not for babies, and that it
must be modified somewhat to suit the latter.  In the first place




152               DISORDERS OF LACTATIONo
more water and sugar must be added; then, as cow's milk is naturally less alkaline than mother's milk, some alkali should be
added, not only to supply this deficiency but also in some measure to neutralize the effects of the excess of butter. The natural alkalies and salts, &c. of human milk are: Carbonate of
Lime, Phosphate of Lime, Chloride of Sodium, Sulphate of Soda,
Magnesia, Soda, Lactate of Soda, Iron, and Chloride of Potash;
hence one or the other of these should be added according to the
peculiarities of the constitution and other requirements of the
child.
When there is an aphthous state of the mouth, with redness
and dryness of the tongue and throat, a little Chlorate of Potash in the milk will prove almost specific.
When there is much acidity of the stomach, with acid vomiting, sour diarrhoea, or constipation, Calcarea, Magnesia, or Soda,
may be added to the milk, according to the several indications
for the use of these remedies.
When there is a general delicacy of the child with a tendency
to rickets, Phosphate of Lime, or Ferrum must be used.
Alterations in the mother's milk produced by a violent fit of
anger, may be corrected by Chamomilla; by grief, with Ignatia,
or Aurum; by excessive jealousy, with -lyoscyamus; by taking
cold, with Dulcamara.
During the time of nursing, blood may be discharged from
the nipple, without there being crack or abrasion, or bruise about
it, or the breast; this is apt to occur in some delicate women, as
I have seen several remarkable instances, from local or general
weakness; Kreosote, Millifolium, Argenti-nitras, and Phosphoric-acid, or Arnica are the principal remedies.
There also appear to be well authenticated cases in which
milk containing Urea in excess has passed from the nipples in
consequence of more or less derangement of the kidneys, or obstruction to the passage of urine along its natural channels.
Colchicum and Nitric-acid are the best remedies.
When the milk is poor, thin and serous, altered in its quality,
rather than its quantity, and unfit for the proper nourishment
of the infant, Sulphur and Calcarea are the most important remedies; or Mercurius and Silex.
When the milk is yellow and bitter, Rheum; when it coagu



CHANGES IN THE WOMB AFTER PARTURITION.   153
lates and curdles readily, Borax; when it is repulsive to the infant, Cin., Merc., Silex, Borax, Carbo-an., Chaim., Nux., Puls.,
or Rheum may be required.
INCONTINENCE OF MILK.
The retentive power of the mouths of the milk-ducts on the
nipple is sometimes so greatly diminished as to permit the milk
when formed to flow away continually.  The yellow elastic tissue forms the chief uniting medium in the nipple, and a want of
it, or a loss of tone in its fibre may be the reason why incontenence  occurs.  The fibre tissue of the nipple differs very
widely from  the common uniting, or cellular tissue; even when
minutely examined it presents very little ordinary cellular tissue; that of which it is formed enjoys in the highest degree, a
contractile power; to the unassisted eye it has a pinkish tint, is
very dense and tough in its texture; when nmagnified it presents
the appearances peculiar to the yellow or contractile fibre. The
advantage of this structure is at once clear; when the milkducts become distended with milk, it would quickly flow away
incontinently, unless there were some arrangement to produce
moderate compression upon their extremities and closure of their
orifices.  And this condition is found to exist particularly within
a quarter of an inch of the apex the nipple, when the calibre of
the ducts is small.-(]3IRKETT.)
Treatment. —Borax is the most homoeopathic remedy, it may
be used when the milk flows from the breasts so profusely that
the bed becomes wet. BIRKETT suggests that astringent lotions
which are known to act so powerfully on the yellow fibre tissue
may be used with advantage.
CHANGES IN THE WOMB AFTER PARTURITION.
According to MURPHY it is necessary to have a clear apprehension of the condition of the womb after parturition from
what it was before the delivery of the child.
lst, The contraction of the fibres of the womb is becoming
permanent;




154              DISEASES OF PARTURITION.
2d, Absorption is going forward with unusual rapidity, for in
ten or twelve days the womb will be reduced to one-half or onethird of its size after delivery;
3d, The mucous surface in undergoing equally rapid changes,
the residue of the ovum and after-birth is being thrown off, the
ends of the large vessels which project from the surface where
the after-birth was attached are again shrinking to their former
size, and the tide of blood that for so many months had been
flowing towards this membrane is now ebbing fast away from it;
4th, The vagina is also contracting itself with great force, and
the abundant secretion which had been flowing from it is now
gradually ceasing and returning to its original state.
We have, therefore, to consider under these several heads, the
symptoms that present themselves while this change is going
forward, especially those that require our aid in the way of treatment.-M-URPHY.
AFT ER-PAINS,
frequently present themselves while the womb is contracting;
they are often severe, and depend upon different causes; they
also occur more frequently in women who have had many children, than in those who have just given birth to their first-born.
CocagulB collecting in the womb very commonly cause afterpains; blood is often poured slowly in the cavity of the womb,
during or soon after parturition, it coagulates, distends the walls
of the uterus and excites spasmodic contractions. If this happens soon after delivery the patient may experience pains as
severe as labor-pains, and relief is urgently called for. In some
instances this may be promptly afforded by using steady pressure over the base of the womb; the irritation excites a more
powerful contraction; the clot is expelled, and the patient is relieved.  This method, however can only be adopted within four
or six hours after delivery; at a later period the permanent contraction of the womb cannot thus be overcome, and it is better
not to make such attempts.  A warm stimulant enema will excite both the action of the bowels and womb, and the same straining efforts that expel the faeces will expel the clot, and relief is




AFTER-PAINS.                      155
experienced soon after. If not, hot fomentations and soothing
applications to the abdomen will usually succeed.
Wind or flatus in the intestines also often gives rise to severe
after-pains. This cause may generally be distinguished from
the former by a careful examination of the abdomen; when clots
are retained in the womb, the uterus is generally large, prominent and exceedingly painful on pressure; every other part of
the abdomen is free from  pain, and generally soft; but when
flatulence is the cause, the abdomen is swollen and tympanitic;
the womb cannot be felt, and the slightest touch gives intense
pain.  This very character, however, is a valuable means of distinguishing the pains so produced from those of inflammation;
a slight pressure causes great pain, but if it be increased the
pain diminishes until it quite disappears; if after this, the hand
be suddenly withdrawn from the abdomen. the pain instantly returns with increased violence, so that MuRPHY has known the
patient to scream  with the agony this simple act produces.
When inflammation is present with the tympanitis, the greater
the pressure, the greater the pain.
Treatnent.-MuRPHY thinks that Turpentine is the best
remedy for these flatulent pains. Arnica, China, Nux, Pulsatilla, Bryonia, Sulphur, Carb.-veg., Verat, and Lycopodium deserve attention.
Arnica and Bryonia are thought by some to be the best remedies for flatulent colic after delivery.
Colocynth, when there is a tightness in the upper part of the
abdomen, returning at short intervals and changing into severe
griping; or feeling in the whole abdomen as if squeezed between
stones.
Carb.-veg., when the pain and flatulence are caused by cold,
with cramping pains, distention of abdomen, and pain at short
intervals.
Cocculus, when the pain is high up about the epigastrium and
almost arrests the breathing, and is attended with qualmishness.
Both of these causes, viz, clots and flatulence, come into operation most frequently with women who have had many children,
and for an obvious reason. The muscles of the abdomen have
been so weakened by frequent pregnancies, that they give no
support to the bowels, when the uterus leaves the abdomen;




156               DISEASES OF PARTURITION.
consequently the intestines become over-distended with air and
colic is the result; so also the womb is deprived of that equable
pressure which is so important to it; it yields more readily to
the distention by the clots, and in place of expelling them, allows
them to accumulate and produce after-pains.
Neuralgic pains in the womb sometimes give rise to very severe suffering after confinement; the abdomen is soft and free
from  pain; the womb is not much increased in size, but feels
unusually firm  under the hand and is exceedingly painful to
pressure; it is closely allied to rheumatism  of the womb and
dysmenorrhcea, is sometimes coupled with a chronic inflammation
of the womb, which is only rendered acute when an increased
flow of blood is directed towards the uterus.
Treatment.-I prefer the local application of the tincture of
the Root of Aconite, over the region of the womb; from 4 to ~
teaspoonful may be applied every two, four, six or eight hours.
Chamomilla, Pulsat., and Cocculus deserve attention; also Conium, Hyosciamus and Opium.
LOCHIAL  DISCHARGE.
This flows from  the womb and vagina while their mucous
membranes are returning to their natural condition; at first it
is bloody, because the dark grumous blood which oozes from the
uterine veins is mixed with it; then it becomes greenish yellow,
thick and oleaginous; and'lastly thin and serous.
It may retain the sacnguineous color too long, and this may
be brighter than is safe for the patient, for then there is always
risk of flooding taking place, unless she retain the horizontal
position, and be kept quiet, and upon proper diet.
Tri'eatment. —Cinnamon, Sabina, Stramonium  and Secale are
the principal remedies.
The thick oleaginous appearance may become purulent, or
nzuco-purulent, and when this happens it indicates pre-existing
inflammation in the vagina, or neck of the womb.  The patient
may recover her health so as to be able to get up and go about
without much inconvenience; the discharge, however, continues
and may continue for months, and is soon attended with pain in
the back and loins, a sense of weight and bearing down. The




LOCHI.AL DISCHARGEo                     157
persistence or increase of the discharge forms a connecting link
between these symptoms and the previous confinement.  Thus,
the whole of her present distress will be attributed, perhaps
justly, to that period. The suspicion will arise that somnething
happened then that should not have happened; or that something was done that should not have been done, and it is very
probable that the physician will be charged with having neglected
his duties, and of being the cause of all the present mischief.
It is necessary to ascertain the cause of this purulent discharge 
it may arise from fissures or lacerations of the neck of the womb,
which have become inflamed  or there may be abrasions of the
vagina, or a slough may have separated, leavin(g an ulcer behind;
or the vagina may be generally inflamed.  Any, or all of these
causes will give rise to a purulent discharge, and may expose
the patient to months of protracted suffering long after her delivery,
Treaztment.-When there are lacerations of the neck of the
womb, Aconite-, Arnica- and Calendula-waters may be used in the
form of injections; and Graphite, Mercurius-solubilis or Petroleum should be given internally.
For inflammation and ulceration of the vagina, Ammon.-carb.,
Ambra-grisia, Cantharides, Mercurius-solubilis, Nitric-acid, Secale, Sulphur, or Thuja may be tried.
Caccarec  may be given when the discharge continues long,
without being profuse, but weakens the patient and deranges
her digestive organs; also when the flow is mucous, watery and
abundant, attended with much flatulence, pains, difficult digestion, diarrhoea and deficient secretion of milk.
Pulscatilla when the discharge is thick and mucous, with pains
in the loins, and despondency.
Sep/ia, if it is liquid and serous, or acrid and excoriating, or
purulent, with induration or ulceration of the neck of the womb.
Mfercurius, when the discharge is most abundant at night,
and there is a tendency to inflammation of the abdominal, or
sexual organs.
Siulpihur, when the discharge enfeebles the woman, and does
not yield to the other remedies; also Secale.
Sepia and Kreosote are also useful when the lochia are fetid, or
insupportably putrid; injections of a solution of Chlorate of




158              DISEASES OF PARTURITION.
Potash, or of Chloride of Zinc, or of Nitrate of Lead may be
used.
SUPPRESSION OF THE LOCHIA.
Warm and moist applications should be applied to the vulva.
Aconite is indicated when the suppression occurs soon after
delivery, and the patient has pains or inflammation in the abdomen, with anxiety, fever, and congestion to the chest or head.
The tincture of the Root of Aconite should be applied freely over
the region of the womb, if inflammation sets in.
Charzornilla, when the suppression is secondary to diarrhoea,
colics, or nervous distress in the head or teeth; a cup of warm
Chamomilla-tea may be allowed from time to time.
Bryomnia is useful when the lochia are suppressed, attended
with headache, fulness and heaviness of the head, backache, or
severe stitch in the side with cough, with or without scanty secretion of hot urine.
Colocynth, when the check is accompanied by violent colics,
with great flatulence and tympanitic swelling of the abdomen,
with or without diarrhoea.
Pulsatilla, if the milk be also much diminished or suppressed.
Belladonna, Stramoniumn  or Hyosciam.us if there are violent
pains in the head, redness of the face dilatation of the pupils,
frightful dreams, or delirium.
Platina, Secale and Nux, when the lochia are scanty and offensive.
POST-PARTEM INFLAMMATION.
Inflammation of the womb and its appendages is a frequent
consequence of parturition; the passages are left in such a condition that a very slight cause may light up inflammation; the
form  which this assumes is as various as the causes which produce it.  The inflammation' may be confined to the vagina and
mucous membrane of the womb; it may involve the substance
and body of the womb, ovaries, or peritonoeum; or the veins of
the womb may be its seat.  It may be acute, or sub-acute, sthenic or phlegmonous, or asthenic and typhoid.-~(MuRPIY.)




POST PARTEM  INFLAMMATION.                  159
INFLAMMATIONS OF THE MUCOUS MEMBRANE OF THE VAGINA AND
WOMB.
This form  is generally met with after a severe labor with
the first child; the vagina is less disposed to yield to the pressure and distention to which it is exposed, hence congestion
arises and inflammation may follow; too frequent vaginal examinations may be the exciting cause.
The symptoms are chiefly local; the patient complains of a
great degree of soreness at the vulva; the urine is retained,
which is perhaps the first symptom which attracts attention;
the lochial discharge is more than usually offensive;, and the
patient is wakeful and restless.  Retention  of urine is the
most important complication, and if an attempt is made to pass
the catheter, the pain is excruciating if it should not pass at
once into the urethra, for the vulva being inflamed, the nymphae,
vestibule, orifice of the urethra, and especially the clitoris, are
all exceedingly tender; the trumpet-shaped opening of the urethra is altogether changed, leaving only a pin-hole opening,
which is not easily discovered.
The pulse is generally frequent and hard; the abdomen may
be perfectly free from tenderness; the womb may bear pressure
without inconvenience; the iliac region and groins may be
without pain, but this frequent pulse is a certain index that
there is irritation or inflammation somewhere, and the probability
is that it has its seat in the mucous membrane of the vagina.
Simple inflammation of the vagina may terminate in resolution without any injury or abrasion of the passages; or it may
be followed by abrasions and superficial ulcerations of the mucous membranes; or it may end in slough. The last is the only
serious result, because the seat of the slough is usually so unfavorable; the urethra from  the pressure of the head against
the pubis, is sometimes so bruised, that a slough is the result,
and fistula the consequence; hence may be established one of the
most unmanageable and distressing affections to which the parturient female can be exposed, viz, a constant dribbling of urine
through the vagina.  Other sloughs may affect the womb, vagina,
or the retriculate cellular tissue between them and the peritonaeum, giving rise to lacerations of the womb, disease of the neck,




160              DISEASES OF PARTURITIONo
or those extensive suppurations that are described as pelvic abscesses; or peritonitis may result.
Treattent. -Warm  emollient vaginal injections of flaxseed,
slippery elm, quince-seeds, or marsh-mallow, or decoction of
poppies, or warm  fomentations and ablutions of the vulva may
be used.
Aconite and Stibium  should be given internally; or Pulsatilla, Copaiba, and other remedies for inflammation of the vagina.
Asthenic inflctmmcation of the vagina is a far more serious
result of labor, for the whole vagina is often quickly engaged in
the inflammation which sometimes extends to the womb; its tendency is to rapid gangrene, which is not confined to a small space,
but soon extends over a large surface, forming extensive sloughs.
The symptonms are: the dark, foul and offensive lochia; a
certain amount of tenderness and soreness of the vulva and vagina; while the attending typhoid or irritative fever is very
characteristic. The rapid pulse, dry furred tongue, burning surface and sallow aspect, are the common characters of this fever,
whether the cause be in the vagina, or in the womb; but MURPHY has observed that when the vagina is thus inflamed, pimples
appear about the lips, which soon become pustules that form
dark crusts, and thus, besides the usual sordes about the teeth
and gums, the mouth is sometimes encircled by a chain of these
pustules in different stages of maturity. There may be erysipelatous inflammation of the vagina, without true puerperal fever.
Treatment.-Antiseptic injections should be used, such as
the solutions of Chloride of Soda, or Chlorate of Potash, or
Kreosote-water, &c.  Arsenicum is the most important internal
remedy and should be given frequently and freely, assisted or
not by China and Camphor.
If sloughing take place, great attention must be paid to the
manner in which the denuded surfaces heal, lest adhesions, or
great contractions of the vagina take place; a small cylindrical
bougie should be carefully passed daily as far as the os-uteri,
and the surfaces touched lightly with a weak solution of Nitricacid, or Nitrate of Silver.




POST PARTEM INFLAMMATlONS.                 161
INFLAMMATION OF THE CAVITY OF THE NECK OF THE WOMB.
This is generally of a chronic character, and may be recognized by the appearance of a viscid mucous discharge, either
mixed with the lochia, or continuing long/after their decline. It
may be the result of lacerations of the neck of the womb, or
only of the mucous membrane that lines it.
The symptoms are seldom so severe as to interfere much with
the patient's recovery; she is generally -able to get up and go
about at the usual time, only she complains of a dull aching
pain about the loins and over the small of the back, increased
by the upright position and by exercise, but relieved by rest;
she also speaks of a whitish viscid mucus passing from the vagina.
Treatment.-This generally cannot well be undertaken until
the lochial discharge has ceased, and the viscid mucus alone remains.  Graphite may be given internally, or Nitric-acid; while
a solution of Nitrate of silver may be applied to the surface,
every fourth or sixth day.
Inflammation of the mucous membrane of the cavity of the
womb seldom occurs alone; either the fibrous structure of the
womb becomes engaged, or the inflammation extends to the uterine veins.
INFLAMMATION OF THE FIBROUS STRUCTURE OF THE WOMB.
Is generally the result of a severe and protracted labor, or of
sudden exposure to cold air, cold applications to the womb, or
from allowing the woman to lie too long in her wet clothes.
The symptoms generally appear in about forty-eight hours after
delivery; the pulse continues frequent, about one hundred, and
full; there is tenderness on pressure, either in the right or left
groin, more generally the left; the body of the womb feels rather
larger and firmer than usual, but if slightly touched the patient
does not complain, although if it be firmly compressed, the pain
produced will be very great; the lochial discharge is apt to be
suppressed, and the milk may not be secreted. If the inflammation be not promptly subdued, chills, thirst and symptomatic
fever will set in, and the inflammation seldom remains stationary,
but soon extends to the neighboring tissues, especially the periL




162              DISEASES OF PARTURITION.
tonmeum, when the nature of the case is completely altered, and
danger to the patient much increased.
Treatmnent.-This should be prompt; tenderness over the
womb or groins, attended with fever and quick pulse, should be
met by the free and frequent application of the tincture of the
Root of Aconite, over the whole hypogastric region. Aconite,
Stibium, Bryonia, Mercurius, &c. may  be given internally,
Warm fomentations may be applied to the region of the wombs
and to the vulva.
INFLAMMATION OF THE PERITONISUM.
This is generally a consequence of preceding inflammation cf
the fibrous tissue of the womb; metro-peritonitis is, perhaps,
the most frequent form of inflammation we meet with after labor,
It may be partial -and confined to the immediate neighborhood
of the womb, or general and spread over the whole peritoneum.
(MURPH AY,.)
The symptoms are sufficiently distinct.  Locally, the tenderness of the womb, and in either groin, is greater than in simple,
metritis; slight pressure causes much pain, which becomes intolerable if the pressure be increased. That portion of the abdomen about the seat of the inflammation becomes swollen and
puffy, so as to render the outline of the womb undefined. The
Dulse is quick, wiry and incompressible;. the countenance anxious; the tongue rather dry, with red edges and tip; there is
nausea and sometimes vomiting.
If the inflammation be not at once subdued, it will spread rapidly over the whole abdomen, the swelling of which becomes
general, accompanied by great tenderness over the entire surface;
the pulse becomes still more contracted and wiry, and the countenance more expressive of intense suffering. Vomiting now
becomes incessant, the respirations labored, and any effort at
respiration very painful and distressing, as the motions of the
diaphragm, &c., disturb the necessary quiet of the inflamed
parts; hence the patient lies on her back, having her knees,
drawn up and her chest raised, so as to prevent as much as possible the pain that inspirations produce; her breathing is neyer
full and deep, but each breath is cut short by a rapid expiration,
sometimes accompanied by a cough. The bowels are constipated,




POST PARTEM  INFLAMMATIONS.                 163
and the skin dry, with the exception of irregular partial sweat
about the neck.
These acute  symptoms rarely continue beyond twelve or
twenty-four hours, for if the inflammation is not soon controlled,
they are succeeded by those of constitutional exhaustion. The
abdomen becomes perfectly tympanitic, but sometimes loses its
acute tenderness; the pulse becomes extremely rapid, one hundred
and fifty or one hundred and sixty, and feeble; the countenance
cadaverous; the vomiting no longer continues convulsive, but a
greenish fluid is ejected from the stomach, with little or no effort; violent diarrhoea sets in; the extremities become cold, and
the surface more or less covered with a greasy perspiration; such
symptoms soon prove fatal.
Trecttrnent.-MURPHY decides that the ordinary allopathic
treatment of free depletion, followed by purgatives and mercury,
is very questionable in propriety; excessive depletion hastens
and confirms the stage of constitutional exhaustion, while Mercury is apt to cause an exhausting and fatal diarrhoea as soon as
the inflammation subsides, and purgatives are positively injurious,
because by exciting the peristaltic of the bowels, newly formed
adhesions are disturbed, and the inflammation is renewed; nature
endeavors, he says, to guard against these accidents by the supervention of an obstinate constipation, which often resists even
active purgatives. So long as the neighboring tissue the peritoneum is actively inflamed, the mucous membrane is torpid, but
as soon as the peritonitis yields the'-mucous membrane becomes involved, as is manifest by the diarrhoea that follows.
In opposition to this stereotype and ruinous treatment, MURPHY is inclined to recommend the free use of Opium; it not only
allays the high degree of nervous irritation, but also exerts a
direct antiphlogistic effect.
Fomentations, hot bran, or flaxseed poultices may be applied
to the abdomen; but the most important part of the external
treatment, is the free and frequent application of the tincture of
the Root of Aconite, viz, from  a. half to a whole teaspoonful,
every two, four or six hours, according to the severity of the
symptors.
I claim  the credit of being the first to point out the really
homceopathic remedies to peritonitis, (see Homoeopathic Examiner Vol. I. New Series, p. 338).  The Mineral-acids, Colo



164              DISEASES OF PARTURITION.
cynth, and Mercurius-corrosivus, are the only true homceopathic
remedies.  According to CHRISTISON, in poisoning with the
Mineral-acids, the outer or peritoneal surface of the abdominal
viscera is commonly either very vascular, or bears even more
unequivocal signs of inflammation, viz, effusion of fibrin, or adhesions among the different turns of the intestines. In this
respect, the action of the Mineral-acids differs from that of most
metallic remedies, which, with the exception of Mercurius-corrosivus, very seldom cause unequivocal peritoneal inflammation.
It is singular, for instance, that however severe the inflammation
of the mucous membrane of the stomach and bowels caused by
Arsenicum may be, inflammatory redness of the peritoneal coat
is seldom or never found; this contrasts strongly with the almost
specific action of the Mineral-acids, Mercurius-corrosivus -and
Colocynth in causing bona fide peritonitis.
Colocynth is said to be of great service, even in desperate
cases, when the abdomen is greatly distended and the pains insupportable, so that the patient cannot bear the least motion, or
pressure from the bed-clothes, but lies with her thighs drawn up
to the abdomen as closely as possible; also when there is diarrhoea with colicky pains every time the patient drinks.
Mercurius-solubilis and corrosivus are best suited against the
early and acutely inflammatory stage, or when there are signs of
effusion in the peritonaeum; when the patient has a dejected and
apprehensive look, with burning and almost inextinguishable
thirst, flow of saliva, burning and cutting pains in the abdomen,
with straining and bearing down to stool, with mucous and bloody
discharges; high colored and offensive urine, general and debilitating sweats.
Nitric, or Muriatic-acid is indicated, when the stage of exhaustion has commenced to set in.
Bryonia is probably more indicated against rheumatic inflammation of the womb, than in true peritonitis; still its well known
efficacy in pleurisy speaks somewhat for its application in the
treatment of inflammations of other serous membranes.
Chamomilla is doubtless not at all homceopathic to peritonitis,
but surely to pain and flatulent distention of the abdomen.
Nux, Rhus, Arsenicum, Hyoscyamus, Stramonium, Platina
and other remedies are probably only homoeopathic to some of




POST PARTEM INFLAMMATIONS.                   165
the symptoms or accidents of peritonitis, than to the disease
itself.
INFLAMMATION OF THE SUB-PERITONEAL TISSUE.
This is usually observed at a later period after delivery, than
the preceding inflammations; it may occur about the twelfth or
fourteenth day and often arises from the extention of a previously
existing inflammation of the womb; hitherto this variety of puerperal disease has been but little understood; it was only when
it terminated in the formation of extensive abscesses that it received any attention.
The symptoms which characterise it are frequently disguised
by the more prominent symptoms of the antecedent inflammation;
thus an attack of metritis may seem to yield, the womb becomes
free from pain on pressure, the abdomen is soft, and the patient
only complains of inability to move which she attributes to
weakness ratherthan pain; but the pulse remains frequent, and
a slight chill may have taken place.  If these signs pass unnoticed, the increasing weakness of the patient chiefly attracts attention  the chills may return, followed by irregular perspirations; she sleeps badly, and may complain of pain- in passing
water or faeces; sometimes a diarrhoea sets in. If the lochial
discharge has not subsided, it becomes very much diminished,
and the breasts shrink considerably; one or the other leg often
becomes the seat of severe neuralgic pains, and finally is found
to be swollen and cedematous, as well as retracted, or drawn up
to the body. If there be no fixed pain at any part of the abdomen, or groin, still a careful examination will detect some swelling, hardness or resistance. Finally, if the abscess be seated in
the iliac fossa it will point in one or the other groin; abscess
within the sheath of the iliacus internus and psoas muscles generally works its way down to the upper and inner part of the
thigh, or more rarely it points in the lumbar region. Pus in the
broad ligaments, or any other of the intra-pelvic folds of the
peritoneum, will in all probability burst either into the womb, or
vagina, bladder or rectum, or into the cavity of the peritoneum.
When there is much irritation of the bladder or rectum, or difficulty in passing water, or faeces, careful rectal and vaginal examinations shoiuld be frequently made in order to detect and let




166              DISEASES OF PARTURITION.
out the matter as soon as possible; it is not only allowable, but
decidedly desirable to puncture the rectum  or vagina in order
to empty the abscess as early as possible.
Treatmzent.-The local application of Aconite over the whole
hypogastrium, and repeated every two, four or six hours; Aconite and Stibium internally.
At a very early period the peculiar treatment of suppurative
inflammation must be put in force.  Tartar-emetic and Heparsulphur. are peculiarily homoeopathic to suppuration.
There are a variety of theories about the formation of pus;
one is, that the pus globules are blood globules deprived of their
colored envelopes, altered, swollen and enlarged. Another, is
that it arises from an alteration of the plastic or inflammatory
lymph, or from  the buffy coat of inflamed blood, which is thus
skimmed off. PAGE T says that the most frequent degeneration
of inflammatory lymph is into pus, and that many of the varieties of pus owe their peculiarities to the coincident degenerations
of the fibrin effused in inflammations; thus, if we watch the
process of an abscess, we may find one day a circumscribed, hard,
and quite solid mass of coagulable lymph or fibrine, and in a few
days later the solid mass has become fluid; now the solidity and
hardness are due to inflammatory lymph; the later fluid is pus,
and the change is the conversion of lymph into pus. It is generally said that suppurative inflammation has then taken place in
the centre of the swelling, and that its effects are bounded by
the plastic or adhesive inflammation; it might be said with greater justice, that of a certain quantity of lymph deposited in the
original area of inflammation, the central portions have degenerated into pus, while the outer portions have been maintained, or
even have become more highly developed.
A  third theory is that pus arises from a solution of the fat
contained in the inflamed part, and in proof, it has been found
that pus contains from  twenty-three to twenty-six, or twentyeight parts in a thousand of fat and cholesterine, while mucus
contains only two or three parts. The serum of pus also contains from twelve to thirteen thousandths of chloride of Sodium,
while that of the blood contains only from four to five.
Staphysagria is said to be specific against inflammatory supnrations;  Plumbun m-aceticum is said to cause the suppurative:




POST PARTEM  INFLAMMATIONS.                 167
process to cease.  Sulphur, Silex, Kali-hydriod., and Mercurius
are thought to be homoeopathic to different varieties of suppuration.
If these means fail to arrest the progress of the suppuration,
if chills take place, if the vagina become fuller, the womb more
fixed and other evidences of the formation of a large quantity of
pus be present, it will be necessary to support the strength of
the patient, because the quantity of pus which accumulates is in
almost direct proportion to her weakness.  China, Wine and
Opium, with a nutritious diet, are then essential.
INFLAMMATION OF THE VEINS OF THE WOMB.
This may be the consequence of a severe labor; it sometimes
follows violent floodings, as the cold applications so often used
may excite violent reaction and inflammation of these veins; the
removal of an adherent placenta also predisposes to it; or it may
arise from the absorption of putrid matter from the fragments of
a retained placenta, &c.
The symptoms are of a typhoid character; a chill occurs when
the milk should appear, no secretion of milk takes place, the
pulse becomes rapid and unsteady, the tongue dry, the face
pinched and sallow, the skin hot, without perspiration, the patient is restless, sleepless and sometimes incoherent; the lochial
discharge is very offensive. As the inflammation proceeds, the
chills return at irregular intervals; the pulse increases in frequency; the tongue becomes furred; sordes form about the teeth;
the face becomes more sallow and shrunk; the eye glassy; muttering delirium sets in; the whole surface is yellow and burning 
petichime and profuse sweats sometimes burst out.
The patient may die in two or three days; but if the patient
is to recover some distant part becomes inflamed and the uterine
phlebitis subsides; thus, the armpit, leg, groin or buttock may
become the seat of an inflammation which usually terminates in
the formation of pus, and when it is discharged the patient soon
recovers.
Treatment. —There is no form of inflammation that prostrates
the vital powers more completely than this; the treatment should
therefore be chiefly stimulant; weak solutions of Chlorate of
Soda or Potash may be injected into the vagina to correct the




t18             DISEASES OF PARTURITION.
fetor of the discharge; and China, Arsenicum, Kreosote, or Secale should be given freely.
ADHESIVE INFLAMMATION OF THE CRURAL AND PELVIC VEINS.
(Milk-Leg).
This is a sub-acute, or chronic, or more properly, a plastic inflammation of the veins in connexion with the womb; it may begin on the twelfth day after delivery, and sometimes as late as
the twentieth.
The symptoms are: a chill more or less distinct, some headache and nausea, quick small pulse, irritability and anxiety; the
patient then soon complains of pain and uneasiness about the
pelvis; she is restless, but cannot move without pain; she describes it as extending from the groin down the thigh and leg, or
perhaps she may be seized with a violent cramp-like pain in the
calf of the leg, or in the muscles of the hip; the groin is soon
discovered to be tumid, and the swelling extends down the thigh
and leg, so that in a day or two the whole limb is greatly enlarged, tense, shining and elastic; the pain then diminishes, but
the limb is immoveable. In some instances the swelling begins
from below, in the ham, or calf of the leg, or ankle, and extends
upwards. Pain is soon excited if the lymphatic glands or venous
trunks are pressed upon; red lines or spots may be observed
along the course of the lymphatics; the veins feel hard and
knotted like whip-cord. The pulse often rises to one hundred and
forty, small, quick and weak; the tongue is white, face pallid,
there is thirst and some nausea, the lochia and milk are generally
arrested. The patient gets very little sleep, and is often bathed
in the morning in a profuse perspiration.
This stage of the attack often lasts ten or fourteen days, when
the patient gradually begins to recover, but she may remain
lame even for months after the attack.
T,'eatment. —-The tincture of the Root of Aconite should be
applied freely over the course of the inflamed veins and lymphatics; Aconite should also be given internally.
Belladonna will relieve the crampy pain in the calf of the
leg, together with the swelling and inflammation of the veins and
lymphatics, especially if there is a tearing pain in the leg, rending in the joints, and a red blush over the limb.




EXCESSIVE LACTATION,                  169
Bryonia is most useful in the chronic stage, after the use of
Aconite, Stibium, or Belladonna; especially when there are
drawing and shooting pains from the hips to the feet; general
perspiration; great tenderness of the leg to touch or motion;
pain in the back, loins, hips and lower part of the abdomen 
stiffness and swelling without redness.
Pulsatilla is most indicated when the veins are more involved
than the lymphatics.
Rhus, when there is a chronic swelling, with great weakness
of the leg, and a typhoid condition.
Arsenicum, when the patient is very low, typhoid or hectic,
with delirium, or melancholy with excessive anguish, with severe
burning nocturnal pains, in the tumid and  edematous limb.
China, when the same symptoms are present and the attack has
come on after profuse flooding.
Mercurius, Sulphur and Antimony when suppuration threatens to set in.
Calcarea and Iodine when the patient is scrofulous.
Sepia, when there is chronic congestion or inflammation of the
womb.
PUERPERAL MANIA.
will be fully treated of in a forthcoming work on Nervous diseases and Mental derangements.
EXCESSIVE LACTATION.
Many poor women nurse their children from eighteen months
to two years in the belief that they will thus prevent pregnancy 
some delicate women who have had two or three children in quick
succession may have all the symptoms arising from undue suckling, when her infant is not more than two or three months oldo
Symptoms.-The earliest symptom is a dragging sensation in
the back when the child is in the act of nursing, and an exhausted feeling of sinking and emptiness afterwards; soon followed by loss of appetite, costiveness and pain in the left side,
then the head becomes affected almost with giddiness, great depression of spirits, sometimes'ith much throbbing and singing




ITO              DISEASES OF PARTURITION.
in the ears. Dry cough, short breathing and palpitation may
come on from  the slightest exertion.  Finally the patient becomes pale, thin and weak; night-sweats, swelling of the ankles,
and nervousness ensue.
Treatment.-Weaning should be commenced early; the attempt to force the supply of milk by large and frequent quantities of beer, wine or spirits will only tend to the more perfect
exhaustion of the mother.  If cocoa, wine-whey, weak milk,
punch, caudle, milk and water, cheese, &c. aided by frictions of
the breasts, do not suffice to keep up the strength of the patient
and a full supply of good milk, all farther attempts should at
once be abandoned.
China is the most important remedy when there is much weakness, noises in the ears, palpitation of the heart, swelling of the
legs, &c., especially if the patient has been subject to nightsweats, flowing, or leucorrhoea.
Causticum when the patient is irritable and easily vexed; vehement, or obstinately opiniated; forgetful, nervous; anxious or
despondent; with headache, noises in the ears, dimness of sight;
great appetite followed by emptiness and sense of goneness soon
after eating, twitchings and jerkings in various parts of the
body.
Calcarea and Phosphorus when the patient is scrofulous,
chlorotic or inclined to consumption, &c.Lycopodium, Pulsatilla, Rhus and Bryonia are often useful.
WEANING.
The average period for partial weaning, at least, is about the
ninth month.  When weaning is decided upon the mother should
remain quiet for several days, or at least use her arms but very
little; take light nourishment; drink as little as possible; and
keep the breasts warm.  The kidney and bowels should be gently
acted upon, not only to aid in diminishing or dispersing the milk,
but also to prevent that depression of spirits, lassitude, loss of
appetite, and general derangement of the health which so frequently  follow  weaning  when these  medicines have been.omitted.




WEANINGo                        171
Bryonia may be given if the milk continue in excessive quantity.
Belladonna, if there be much redness and painful distention
o the breasts.
Pulsatilla, Rhus and Calcarea are important remedies. VAN
SWIETEN has known the flow of milk to yield when an ounce or
two of a strong infusion of Sage was taken every three hours.
Phosphoric-acid is supposed to have a specific effect in carrying
off the milk through the kidneys. Frictions of the breast with
warm  sweet oil, or Camphor, or Hartshorn, or Opium liniment
are said to be useful.
The management of infants from their birth upwards is given
so fully in Hartmann's Diseases of Children, translated by Dr.
Hempel, that it is superfluous to treat of it here.








AP  END1IX
ITP has been thought that the value of this work would be increased by additig
in the form of an Appendix, the substance of a book, by Dr. A. F. A. Desberger
of Erfurt, which has been translated from the German, under the title of the
"LADIES' PERPETUAL CALENDAR."  The translator remarks in relation to it, that
"its utility must be at once apparent to every lady who favors it with her inspee
tion.  In Germany, its popularity is very considerable, as it tenders the service
of a faithful and confidential friend, especially to the young and newly married, in
matters of urgent interest, —where the inexperienced might hesitate, or not even
know how to go about to ask advice."
"The manner of reckoning with reference to the time of expected confinement,
is a subject which the sex, —particularly the junior members of it, —ought clearly
to understand. Much time is saved, and often great anxiety avoided, by being
able confidently to approximate to the hour of solicitude and hope.  In point
of economy, too, it is submitted, that the advantage of bespeaking the assistance
of the medical and other attendants at the proper time, is not to be overlooked d
while to the latter parties, neither is it of little consequence that they are not kept
in suspense, —perhaps suffering serious disappointment,-owing to the miscalculations of their patient."
The most valuable part of this book is the calendar, which is used as follows 
The regular period of pregnancy, —or the time from conception till confinement,
~is ten lunar months, or forty weeks, which amount to 280 days. It is frequently calculated at nine calendar months, that is to say, 273 days, or thirty-nine
weeks: but we have reason to consider forty weeks as the safer reckoning.
When the date of conception is known, the reckoning begins from that day. If
the time of conception be not known, then the reckoning must commence from the
day of the last monthly appearance. Look for this date in the first column of the
following tables, under the proper month, and the corresponding dates of the
middle and end of pregnancy will be found standing in the same line.
If neither the day of conception be known, nor the period of the last appearance
be recollected,-then, the time of quickening, or when the first motions of the
child were perceived, must be made use of  Finding this date in the middle
column of the table, the respective dates of the beginning and end of pregnancy
will be found to correspond.. Thus, suppose the day of quickening to be the 14th
of March: look for that table in which March stands in the middle column, (the
October table), and it will be seen that the confinement may be expected on the
2d of August.  We.give the various saints' days and holydays in the calendar,
because it is the custom with many women to reckon from dates of that description. The moveable feasts, however, such as Easter, Whitsuntide, &c., are
omitted, as less suited for the purpose. By the "Beginning," in the following
tables, we mean the time of conception; by the "Middle," the period of quickening; and by the " End," the time of labor,




174                        APPENDIX,
JANUARYe
BEGINNING.             MIDDLE.                 END.
JANUARY.               MAY.               OCTOBER,
1 CIRCUMCISION      20 Frances            8 Ephraim
2 Abel              21 Prudens            9 Denys
3 Enoch             22 Helena            10 Amelia
4 Titus             23 Desiderius        11 Burkard
5 Simeon            24 Esther            12 Erenfried
6 EPIPHANY          25 Urban             13 Edward Conf.
7 Melchior          26 Augustine         14 William
8 Lucian            27 Bede              15 Hedwig
9 Caspar            28 William           16 Gallus
10 Paul Hermit       29 Maximilian        17 Etheldreda
11 Erhard            30 Wigan             18 LUKE
12 Reynold           31 Petronella        19 Ptolemy
JUNE.
13. Hilarius          1 Nicomede          20 Wendelia
14 Felix              2 Macarius          21 Ursula
15 Habakkuk           3 Erasmus           22 Corduca
16 Marcellus          4 Ulrica            23 Severus
17 Anthony            5 Boniface          24 Solomon
18 Prisca             6 Benignus          25 Crispin
19 Ferdinand          7 Lucretia          26 Amandus
20 Fabian             8 Medard            27 Sabina
21 Agnes              9 Barnimus          28 SIMON and JUDE
22 Vincent           10 Onuphrius         29 Engelard
23 Emerantia         11 BARNABAS          30 IHartman
24 Timothy           12 Blandina          31 Wolfgang
NOVEMBER.
25 PAUL              13 Tobias             1 ALL SAINTS
26 Polycarp          14 Modestus           2 All Souls
27 Chrysostom        15 Vitus              3 Gotlieb
28 Charles           16 Justina            4 Charlotte
29 Samuel            17 Alban              5 Eric
30 Adelgunda         18 Paulina            6 Leonard
31 Valerius          19 Gervase            7 Erdman.._____




APPENDIX.                         175
[ —- __FEBRUARY.
F E B R IT A R Y.
BEGINNING.             MIDDLE.                END.
FEBRUARY,               JUNE.             NOVEMBER.
1 Bridget           20 Edward             8 Claude
2 Purific. of Mary  21 Jacobina           9 Theodore
3 Blaise            22 Acharius          10 Jonas
4 Veronica          23 Basilius          11 Martin
5 Agatha            24 JOHN BAPTIST    12 Cunibert
6 Dorothea          25 Elogius           13 Britius
7 Richard           26 Jeremias          14 Lewin
8 Solomon           27 Seven Sleepers   15 Machutus
9 Apollonia         28 Leo               16 Ottoman
10 Renata            29 PETER and PAUL  17 Hugh
11 Euphrosyne        30 Paul              18 Gotschalk
JULY.
12 Severinus          1 Theobald          19 Elizabeth
13 Benigna            2 Visita. of Mary   20 Edmund
14 Valentine          3 Cornelius         21 Presentation
15 Formosus           4 Martin            22 Cecilia
16 Juliana            5 Anselm            23 Clement
17 Constantia         6 Isaiah            24 Lebrecht
18 Concordia          7 Thomr. a Becket 25 Catharine
19 Susanna            8 Kilian            26 Conrade
20 Eucharius          9 Cyril             27 Lot
21 Eleanor           10 Felicity          28 Gunter
22 Peter             11 Pius              29 Noah
23 Reynard           12 Henry             30 ANDREW
DECEMBER,
24 MATTHIAS          13 Margaret            I Arnold
25 Victor            14 Bonaventure        2 Candida
26 Nestor            15 Swithin            3 Cassian
27 Hector            16 Eustace            4 Baibara
28 Justus            17 Alexis             5 Abigail
X                            _    _   _  _ _~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




176                        APPENDIX.
MARCH.
BEGINN ING.            MIDDLE.                END.
MARCH.                JULY.             DECEMBER.
1 Albin             18 Caroline           6 Nicholas
2 Louisa            19 Ruth               7 Antonia
3 Cunigund          20 Elias              8 Conception
4 Adrian            21 Daniel             9 Joachim
5 Frederick         22 Magdalen          10 Judith
6 Everard           23 Albertine         11 Waldemar
7 Perpetua          24 Christine         12 Epimachus
8 Philemon          25 JAMES             13 Lucy
9 Prudentius        26 Anne              14 Israel
10 Henrietta         27 Berthold          15 Johanna
11 Rosina            28 Innocent          16 Ananias
12 Gregory, M.       29 Martha            17 Lazarus
13 Ernest            30 Beatrice          18 Christopher
14 Zacchary          81 Germain           19 Manasses
AUGUST.
15 Isabella           1 Peter             20 Abraham
16 Syriac             2 Gustavus          21 THOMAS
17 Patrick            3 Augustus          22 Beata
18 Edward             4 Perpetua          23 Ignatius
19 Joseph             5 Dominick          24 Adam and Eve
20 Rupert             6 Transfiguration   25 CHRIST BORN
21 Benedict           7 Donatus           26 STEPHEN
22 Casimer            8 Ladislaus         27 JOHN
23 Everard            9 Romanus           28 INNOCENTS
24 Gabriel           10 Lawrence          29 Jonathan
25 Annunciation      11 Titus             30 David
26 Emanuel           12 Clara             31 Sylvester
JANUARY.
27 Hubert            13 Hildebrand          I CIRCUMCISION
28 Gideon            14 Eusebius           2 Abel
29 Eustace           15 Assumption         3 Enoch
30 Guido             16 Isaac              4 Titus
31 Philip            17 Bertram            5 Simeon




APPENDIX                           ITT7
A PRIL....e~.....~i~.~T..             I    ~I~P\T~l~o.
BEGINNING.              MIDDLE.                 END.
APRIL,               AUGUST,              JANUARY.
1 Theodore          18 Emnilia              6 EPIPHANY
2 Theodosia          19 Sebald              7 Melchior
3 Christian         20 Bernard              8 Lucian
4 Ambrose           21 Athanasius           9 Caspar
5 Maximus           22 Oswald              10 Paul Hermit
6 Sixtus            23 Zaccheus            11 Erhard
7 Celestine         24 BARTHOLOMEW    12 Reynold
8 Heilman           25 Lewis               13 Hilarius
9 Bogislaus         26 Irensus  14 Felix
10 Ezekiel            27 Gebard             15 Habakkuk
11 Herman             28 Augustine         1]6 Marcellus
12 Julius            29 John                17 Anthony
13 Justin             30 Benjamin           18 Prisca
14 Tiburtius         31 Rebecca             19 Ferdinand
SEPTEMBER.
15 Obadiah             1 Giles              20 Fabiaia
16 Cariseus            2 Rachel             21 Agnes
17 Rodolph             3 Mansuetus          22 Vincent
18 Florence            4 Moses              23 Emerantia
19 Werner              5 Nathaniel          24 Timothy
20 Sulpitius           6 Magnus             25 PAUL
21 Adolphus            7 Enurchus           26 Polycarp
22 Lothario            8 Mary               27 Chrysostom
23 GEORGsE             9 Bruno              28 Charles
24 Albert             10 Sosthenes          29 Samuel
25 MARK  11 Gerard                          30 Adelgunda
26 Raynar             12 Otilia             31 Valerius
FEBRUARY.
27 Anastasius         13 Christlieb          1 Bridget
28 Theresa            14 Exaltation          2 Purific. of Mary
29 Sibylla            15 Constantia          3 Blaise
30 Joshua             16 Euphemia            4 Veronica
M




17S                        APPENDIX.
MAY.
BEGINNING.             MIDDLE,                  END.
MAY.              SEPTEMBER.             FEBRUARY.
I PHILIP & JAMES 17 Lambert                 5 Agatha
2 Sigismund          18 Sigfred             6 Dorothea
3 Holy Cross         19 Januarius           7 Richard
4 Florian            20 Frederica           8 Solomon
5 Gothard            21 MATTHEW             9 Apollonia
6 John Evangelist  22 Maurice              10 Renata
7 Godfrey           23 Joel                11 Euphrosyn
8 Stanislaus'  24 John                12 Severinus
9 Job                25 Cleophas           13 Benigna
10 Gordian            26 Cyprian            14 Valentine
11 Mamertus           27 Cosmo              15 Formosus
12 Pancratius         28 Wenzel             16 Juliana
13 Servatius          29 MICHAEL            17 Constantia
14 Christiana         30 Jerome             18 Concordia
OCTOBER.
15 Sophia              1 Remigius           19 Susanna
16 Honoratus           2 Volrade            20 Eucharius
17 Pascal              3 Ewald              21 Eleanor
18 Livorius            4 Francis            22 Peter
19 Dunstan             5 Charity            23 Revnard
20 Frances             6 Faith              24 MATTHIAS
21 Prudens             7 Hope               25 Victor
22 Helena              8 Ephraim            26 Nestor
23 Desiderius          9 Denys              27 Hector
24 Esther             10 Amelia             28 Justus
MARCH.
25 Urban              11 Burkard             I Albin
26 Augustine          12 Erenfried           2 Louisa
27 Bede               13 Edward Conf.        3 Cunigund
28 William            14 William             4 Adrian
29 Maximilian         15 H edwig             5 Frederick
30 Wigan              16 Gallus              6 Everard
31 Petronella         17 Etheldreda          7 Perpetua




APPENDIX.                            179
JU NE.
BEGINNING.               3 MIDDLE.                END.
JUNE.                OCTOBER.                MARCH.
1 Nicomede           18 LUKE                  8 Philemlon
2 Macarius           19 Ptolemy               9 PrudentJus
3 Erasmus            20 Wendelia            10 Henrietta
4 Ulrica             21 Ursula               11 Rosina
5 Boniface           22 Corduca             12 Gregory, M.
6 Benignus           23 Severus              13 Ernest
7 Lucretia            24 Solomon             14 Zacchary
8 Medard             25 Crispin             15 Isabella
9 Barnimus           26 Amandus             16 Syriac
10 Onuphrius           27 Sabina              17 Patrick
I  BARNABAS           28 SIMON and JUDE   18 Edward
12 Blandina           29 Engelard             19 Joseph
13 Tobias             30 Hartman              20 Rupert
14 Modestus            31 Wolfgang            21 Benedict
NOVEMBER.
15 Vitus                1 ALL SAINTS          22 Casimer
16 Justina              2 All Souls           23 Everard
17 Alban                3 Gottlieb            24 Gabriel
18' Paulina             4 Charlotte           25 Annunciation
19 Gervase              5 Eric                26 Emanuel
20 Edward               6 Leonard             27 Hubert
21 Jacobina             7 Erdman              28 Gideon
22 Acharius             8 Claude              29 Eustace
5!3 Basilius            9 Theodore            30 Guido
24 JOHN BAPTIST        10 Jonas               31 Philip
APR I,.
25 Elogius             11 Martin               1 Theodore
26 Jeremi-ians         12 Cunibert             2 Theodosia
7 Seven Sleepers   13 Britius                  3 Christian
2:' Leo                14 Lewin                4 Ambrose
29 PE'rsa and PAUL  15 Machutus                5 Maximus
30 Paul                16 Ottoman              6 Sixtus
a;~li;-ic Pj;-li-.u V r rZO.._c~r~IF7Plw  ill+pr~ n~iiYZL~~SlfR.5 w  Ln~6;Ssreg~r'iE IrS  _ stL-=cS~i.:




180                       APPENDIXo.                               IJULY.
BEGINNI NG.            MIDDLE.                 END
JULY.              NOVEIEMBER.            APRIL.
I Theobald          17 Hugh                7 Celestine
2 Visita. of Mary   18 Gotschalk           8 Heilman
3 Cornelius         19 Elizabeth           9 Bogislaus
4 Martin            20 Edmund             10 Ezekiel
5 Anselm            21 Presentation      11 Herman
6 Isaiah            22 Cecilia            12 Julius
7 Thom., a Bechet  23 Clement             13 Justin
8 Kilian            24 Lebrecht           14 Tiburtius
9 Cyril             25 Catharine          15 Obadiah
10 Felicity          26 Conrade            16 Carisius
11 Pius              27 Lot                17 Rodolph
12 Henry             28 Gunter             18 Florence
13 Margaret          29 Noah               19 Werner
41 Bonaventure       30 ANDREW             20 Sulpitius
DECEMBER.
15 Swithin            1 Arnold             21 Adolphus
16 Enstace            2 Candida            22 Lothario
17 Alexis             3 Cassian            23 GEORGE
18 Caroline           4 Barbara            24 Albert
19 Ruth               5 Abigail            25 MARK
20 Elias              6 Nicholas           26 Raymar
21 Daniel             7 Antonia            27 Anastasius
22 Magdalen           8 Conception         28 Theresa
23 Albertine          9 Joachim            29 Sibylla
24 Christine         10 Judith             30 Joshua
MAY.
25 JAMIES            11 Waldemar            1 PHILIP & JAMES
26 Anne              12 Epimachus           2 Sigismund
27 Berthold          13 Lucy                3 Holy Cross
28 Innocent          14 Israel              4 Florian
29 Martha            15 Johanna             5 Gothard
30 Beatrice          16 Ananias             6 John Evangelist
31 Germain           17 Lazarus             7 Godfrey




APPENDIX.                          181
AUGUST.
BEGINNING.             MIDDLE.                 END.
AUGUST.             DECEMBER.                MAY,
1 Peter             18 Christopher         8 Stanislaus
2 Gustavus          19 Manasses            9 Job
3 Augustus          20 Abraham            10 Gordian
4 Perpetua          21 THOMAS             11 Mamertus
5 Dominick          22 Beata              12 Pancratius
6 Transfiguration    23 Ignatius          13 Servatius
7 Donatus           24 Adam and Eve    14 Christiania         j
8 Ladislaus         25 CHRIST BORN        15 Sophia
9 Romanus           26 STEPHEN            16 Honoratus
10 Lawrence          27 JOHN               17 Pascal
11 Titus             28 INNOCENTS          18 Livorius
12 Clara             29 Jonathan           19 Dunstan
13 Hildebrand        30 David              20 Frances
14 Eusebius          31 Sylvester          21 Prudens
JANUARY.
15 Assumption          1 CIRCUMCISION      22 Helena
16 Isaac               2 Abel              23 Desiderius
17 Bertram             3 Enoch             24 Esther
18 Emilia             4 Titus              25 Urban
19 Sebald              5 Simeon            26 Augustine
20 Bernard             6 EPIPHANY          27 Bede
21 Athanasius          7 Melchior          28 William
22 Oswald              8 Lucian            29 Mazimilian
23 Zaccheus            9 Caspar            30 Wigan
24 BARTHOLOMiEW    10 Paul Hermit          31 Petronella
JUNE.
25 Lewis              11 Erhard             I Nicomede
26 Ireneus            12 Reynold            2 Macarius
27 Gebard            13 Hilarius            3 Erasmus
28 Augustine          14 Felix              4 Ulrica
29 John              15 Habakkuk            5 Bonifacius
30 Benjamin           16 Marcellus          6 Benignus
31 Rebecca            17 Anthony            7 Lucretia




182                         APPENDIX,
SEPTEMBER.
BEGINNING.              MIDDLE.                END.
SEPTEMBER.             JANITARY  JUNE.
1 Giles.            18 Prisca               8 Medard
2 Rachel             19 Ferdinand           9 Barnimus
3 iMansuetus         20 Fabian             10 Onuphrius
4 Moses              21 Agnes              11 BARNABAS
5 Nathaniel         22 Vincent             12 Blandina
6 Magnus            23 Emerantia           13 Tobias
7 Enurchus          24 Timothy             14 Modestus
8 Mary              25 PAUL                15 Vitus
9 Bruno             26 Polycarp            16 Justina
10 Sosthenes          27 Chrysostom         17 Alban
11 Gerard             28 Charles            18 Paulina
12 Otilia             29 Samuel             19 Gervase
13 Christlieb         30 Adelgunda          20 Edward
14 Exaltation         31 Valerius           21 Jacobina
FEBRUARY.
15 Constantia          1 Bridget            22 Acharius
16 Euphemia            2 Purific. of Mary   23 Basilius
17 Lambert             3 Blaise             24 JOHN BAPTIST
1S Sigfred             4 Veronica           25 Elogius
19 Januarius           5 Agatha             26 Jeremias
20 Frederica           6 Dorothea           27 Seven Sleepers
21 MATTHIEW            7 Richard            28 Leo
22 Maurice             8 Solomon            29 PETER and PAUL
23 Joel                9 Apollonia          30 Paul
JULY.
24 John               10 Renata              I Theobald
25 Cleophas.          11 Euphrosyne          2 Visita. of Mary
26 Cyprian            12 Severinus           3 Cornelius
27 Cosmo              13 Benigna             4 Martin
28 Wenzel             14 Valentine           5 Anselm
29 MICHAEL            15 Formosus            6 Isaiah
30 Jerome             16 Juliana             7 Thom. a Becket




APPENDIX.                         183
OCT OBER.
BEGINNI NG.             MIDDLE.                END.
OCTOBER.             FEBRUARY.               JULY.
1 Remigius          17 Constantia          8 Kilian
2 Volrade           18 Concordia           9 Cyril
3 Ewald             19 Susanna            10 Felicity
4 Francis           20 Eucharius          11 Pius
5 Charity           21 Eleanor            12 Henry
6 Faith             22 Peter              13 Margaret
7 Hope              23 Reynard            14 Bonaventura
8 Ephraim           24 MATTHIAS           15 Swithin
9 Denys             25 Victor             16 Eustace
10 Amelia            26 Nestor             17 Alexis
11 Burkard           27 Hector             18 Caroline
12 Erenfried         28 Justus             19 Ruth
MARCH.
13 Edward Conf.        1 Albin             20 Elias
14 William            2 Louisa             21 Daniel
15 Hedwig             3 Cunigund           22 Magdalen
16 Gallus              4 Adrian            23 Albertine
17 Etheldreda         5 Frederick          24 Christine
18 LUKE               6 Everhard           25 JAMES
19 Ptolemy            7 Perpetua           26 Anne
20 Wendelia            8 Philemon          27 Berthold
21 Ursula              9 Prudentius        28 Innocent
22 Corduca           10 Henrietta          29 Martha
23 Severus            11 Rosina            30 Beatrice
24 Solomon           12 Gregory, M.        31 Germain
AUGUST.
25 Crispin           13 Ernest              I Peter
26 Amandus           14 Zachary             2 Gustavus
27 Sabina            15 Isabella            3 Augustus
28 SIMON and JUDE  16 Syriac                4 Perpetua
29 Engelard          17 PRBtrick            5 Dominick
30 Hartman           18 Edward              6 Transfiguration
31 Wolfgang          19 Joseph              7 Donatus




184                         APPENDIXo
NOVEMB ER.
BEGINNING.,.MIDDLE.                 END.
NOVEMIBER.              MARCH.               ~AUGUST.
I ALL SAINTS         20 Rupert               S Ladislaus
2 All Souls          21 Benedict             9 Romanus
3 Gottlieb           22 Casimer             10 Lawrence
4 Charlotte          23 Everard             11 Titus
5 Eric               24 Gabriel            12 Clara
6 Leonard            25 Annunciation       13 Hildebrand
7 Erdmann u          26 Emanuel             14 Eusebius
8 Claude             27 Hubert             15 Assumption
9 Theodore           28 Gideon             16 Isaac
10 Jonas              29 Eustace             17 Bertram
11 Martin             30 Guido               18 Emilia
12 Cunibert           31 Philip              19 Sebald
APRIL,
13 Britius             I Theodore            20 Bernard
14 Lewin               2 Theodosia  -        21 Athanasius
15 Machutus            3 Christian           22 Oswald
16 Ottoman             4 Ambrose             23 Zaccheus
17 Hugh                5 Maximus             24 BARTHOLOMEW
18 Gotschalk           6 Sixtus              25 Lewis
19 Elizabeth           7 Celestine          26 Irenaeus
20 Edmund              8 Heilman,27 Gebard
21 Presentation        9 Bogislaus           28 Augustine
22 Cecilia            10 Ezekiel             29 John
23 Clement            11 Herman              30 Benjamin
24 Lebrecht           12 Julius              31 Rebecca
SEPTEMBER.
25 Catharine          13 Justin               1 Giles
26 Conrad             14 Tiburtius            2 Rachel
27 Lot                15 Obadiah              3 Mansuetus
28 Gunter             16 Carisius             4 Moses
29 Noah               17 Rodolpl  5 Nathaniel
30 ANDREW             18 Florence             6 Magnus




APPENDIX.                         185
DECEMBER.
BEGINNING.             MIDDLE.                 END.
DECEMBER.              APRIL.             SEPTEMBER.
1 Arnold            19 Werner              7 Enurchus
2 Candida           20 Sulpitius           8 Mary
3 Cassian           21 Adolphus            9 Bruno
4 Barbara           22 Lothario           10 Sosthenes
5 Abigail           23 GEORGE             11 Gerard
6 Nicholas          24 Albert             12 Otilia
7 Antonia           25 MARK               13 Christlieb
8 Conception        26 Raymar             14 Exaltation
9 Joachim           27 Anastasius         15 Constantia
10 Judith            28 Theresa            16 Euphemia
11 Waldemar          29 Sibylla            17 Lambert
12 Epimachus         30 Joshua             18 Sigfried
MAY.
13 Lucy               1 PHILIP & JABIES  19 Januarius
14 Israel             2 Sigismund          20 Frederica
15 Johanna            3 Holy Cross         21 MATTHEW
16 Ananias            4 Florian            22 Maurice
17 Lazarus            5 Gothard            23 Joel
18 Christopher        6 John Evangelist  24 John
19 Manasses           7 Godfrey            25 Cleophas
20 Abraham             8 Stanislaus        26 Cyprian
21 THOMAs             9 Job                27 Cosmo
22 Beata             10 Gordian            28 Wenzel
23 Ignatius           11 Mamertus          29 MICHAEL
24 Adam and Eve    12 Pancratius           30 Jerome
OCTOBER.
25 CHRIST BORN       13 Servatius           1 Remigius
26 STEPHEN           14 Christiana          2 Volrade
27 JOHN              15 Sophia              3 Ewald
28 INNOCENTS         16 Honoratus           4 Francis
29 Jonathan          17 Pascal              5 Charity
30 David             18 Livorius            6 Faith
31 Sylvester         19 Dunstan             7 Hope








IN D E X.
A.                                                                 PAGE.
PAGE.   Apocynum  in Dropsy of Amnion,   80
Abortion,...................            107    Appendix,..................... 173
Acidity of Stomach,............  51    Argentum  nitricum  in  MenstruaAcids, in Heartburn,...........  54                tion during Pregnancy........  81
Acid, Nitric,...................   73    Arnica in Toothache,.........                    43
"    Muriat.,................  73    Arsenicum  44
Aconite, in Morning Sickness,...  37                  "      in Diarrhea,.........  68
"     Toothache,........   42                  "          Piles..............  73
"      "( Jaundice,...........  70                "         CEdema  of Labia,...       77'      " Piles,............   73                 "          False waters,......   79."..             Rheumatism  of                  "         Dropsy of Amnion,   80
Womb,.          85          "          Menstruation during' "' Inflammation ".....   86                                 Pregnancy,....  81
Aethusa Cynapium,...........  13    Aurum   in  Menstruation   during
Aethusa  Cynapium   in  morning                     Pregnancy,.................   81
sickness....................   37    Aversion to Meat,..............  30
After-birth, delivery of,......... 119                "        Fish..............   32
After-birth, hemorrhage before, du-'        Water,............  32
ring, and after,......               120          "        Milk and Butter,...  32
After pains,................... 154                   "        Sweet things,.......  32
Age, for marriage..............    4                  "        Vegetables,.........  32
Alterations of milk,............ 145
" taste, during  preg-                                       B.
nancy,..... 30    Baryta,......................   12
Alkaline Dyspepsia,............    52              "      in Toothache,...........  44
Aloes in Jaundice...............  70    Belladonna in Morning Sickness,.  37
"      Piles..................  73                 "          in Toothache......   45
Alumina in Constipation,........   60,            Jaundice,......      70
Ammon. mur. in toothache,......   44                  "              Piles,.........  73
Anacardium,..................   13                    "              Inflammation  of
Anger, inclination to............  13                                      Womb....  86
Anteversion of the Womb.......  92    Bleeding during Pregnancy,......   82
Antipathies,...................   13    Bofareira,............ 129
Antimony in Toothache,........   43    Borax in itching of Vulva........  77
Anxiety, about the future,.......  12    Bovista in Leucorrhcea,.........   78
Apis mell.,....................  77    Breasts, Pain and Tension of,..... 107
"        in Dropsy of Amnion,..  80                "    Engorgement of;...... 142




188                                     INDEX.
PAGE.                                          PAGE.
Breasts, Inflammation of,.......  143    Colchicum in Toothache,........  47
Bright's Disease,................ 101    Colchicum in Jaundice,.........  70
Bryonia in Toothache,.........   45    Conception,...................    6
"        Constipation,.......  59    Constipation,.................   56
"'      \Diarrhoa,...........  68    Convulsions................... 104
Contraction of Vulva.......... 114
C.                         Convalescence after Parturition,.. 123
Calendar, Ladies perpetual....... 174    Conium,...............   13
Calcarea in Toothache,..........  45                    " In Morning Sickness,...   36
Calcarea against Piles,..........  74            "    In Incontinence of Urine,   76
Calcarea in Leucorrhoea,.........    78    Cough,..................      95
Camphor in Morning Sickness,...  36    Cramps and  Pains in  Abdomen,
Against Spasm of Ure-               Back and Loins..............  87
ters,....    6 7  Crocus  in  Menstruation  during
Causticum in Toothache........  46               Pregnancy...................  81
Cannabis in Incontinence of Urine,  76    Crocus in Uterine Hemorrhage,..  83
Cantharides         "  76    Cuprum...............                                       13
"'      Against Spasm of Ure-'      In Morning Sickness,..   36
ters,....  76    Cubebs in Piles,................  72
Cannabis against Spasm of Ureters  76    Cyclamen in Toothache.........   47
Cantharides in Menstruation during Pregnancy..............   81                                 D.
Capsicum in Constipation,.......  61
-.Piles,.........   72    Delivery, too rapid,............. 114
"    of After-birth,.........  119
Incontinence of Urine, 76
Cop.iba  in Piles7,             2    Depressed Nipples........  11 & 139
Copaiba in Piles.................  72 
Carb~-veo  in Toothache..........  46    Digitalis in Salivation,........  39
Castor Oil Plant in Lactation,.... 129    De            ent   of the Stoach             10
Chamom a  in  U ine    e -         Desires during Pregnancy,.. 32 &  28
Chamomilla  in  Uterine  Hemor-                               C 
rhage.                               82    Diarrhcea,.....................  66
Diet during Pregnancy..........  27
Chamomillla in Toothache.......   46. 6e27
" Jaunldice..........  69    Difficulty of Breathing.........  95
Chills and Trembling,......... 109    Digitalis,....................-..  13
Chills and Trembling,.......... 109.China in Toothache,                   "    in OEdema of Labia....  77
China n Toothache,............  47
i~       False waters.........  79
China in Diarrhoea,............  68
Uterine Hemorrhage,...   83
^~. T  L   r FT'   Dropsy of tAhe Amion,..   79
Cicuta in Incontinence of Urine,.. 6                     o      
Cicuta,.......13 -                          Dropsical Affections,...........  98
Cocculus in Leucorrhcea........          8    Dropsy of the Legs..   98
Dulcamara in Diarrhcea..........   68
Cocculus during Pregnancy,.....  81
Coloba i ornin   Sic ss,...   3   Dying, fear of,.................  13




INI)' EX.                                         189
AGE.                                                 PAGE,
E.                            Inflamnmation of Mucous Membrane
Engorgement of Breasts......... 142                                         of Vaina  and
Euphorbium  in Toothache......  47                                        Womb,....... 159
Excess of Waters,..............  79                         4          Asthenic, ofVagina 160
Excessive Lactation............ 169                                     Cvity of nek  of
Exercise during Pregnancy.......  26                                       Womb,....... 161
Extra Uterine  Pregnancy,....... 118                                   Fibrous  Structur
of Womb...... 161
F.                                     6'         Peritoneum...... 162
Fainting,....................   94   Sub-Peritoneal tisFalling of the Womb..........   89                                        sue,.......... 165
"    back of the Womb......             90                         Post-Partem, 158to 169'"   forwards'               92  Veins of Womb,..  167
False Waters,.................   78                                     Crural and Pelvic
"  Labor,...................109                                         Veins........ 168'  Pains,...................  88                 Iodine in  Salivation...........  39
Fault-finding,................    13                Inversion of the Womb,......... 122
Feebleness  and  Slowness of Con-                    Ipecac in Morning  Sickness.....   37
traction,..................... II                    "       Uterine Hemorrhage,...   82
Ferrum  in Morning  Sickness,....   37               Irritability of Womb,...........  85
Ferrum-aceticum  in Constipation,   61               Irregularity of Pains,......... 113
Fcetal Turbulence,..............  92    Itching of the Vulva...........   77
Fluoric-acid in Toothache,.......  47                Jaundice......................  69
Full Bloodedness..............   98
K.
G.                            Kali-bichrom. in  Constipation,..  61
Graphite,.....................  13    Kiesteine,.....................   14
Kreosote in Morning Sickness,...  35
H.                                  "        Toothache,..........  48
Hameorrhoids,...............                70
Headache,...........    9....    96                             L.
Hydrocyanic-acid in Morning Sick-                    Lactation.............   126
ness,......................  38                        "      Excessive,............ 169
Hydrorrhcea...................  78    Ladies Perpetual Calendar,...... 174
Hypochondriasis,..........   98    Laurocerasus,.................   13
Ledum,......................    13
I.                            Leucorrhcea,..................   77
Ignatia in Constipation.........    60    Liver Spots,...................   69
",  Piles,...............   73    Lochial Discharge,.............. 156
Incontinence of Urine,...........  74               Lochia, suppression of..........  158
Inflammation of Womb..........    85                 Lobelia,......................   13
i"        Vagina,...,.....  159           Lycopodium  in Constipation,..      60




190                                          INDEX.
PAGE.                                               PAGE.
M.                            Nux  in Toothache............   49
Magnesia in Toothache,.........  48                                pepia,......                53
" Dyspepsia.............   53
Marriage......................    1                              eartbrn,......                 53
Menstruation during Pregnancy,               80                 Constipation...  59 to 60
Mercurius in Salivation.........              9   Jaunice...........  69
Toothache,.......  48es'       Pile s..................   73
"         Jaundice...........   69,
Jaundice. 69                R Sletention of Urine...75
IMezereurn in Toothache..........  48
"       Inflammation  of W omb,.   86
Milk-Fever.................. 126                                                    35
"       In Morning Sickness,...  35
-"      "                                142
Alterations of.............  14.
6   Healthy standard of....... 145    Obliquity of the Orifice,.........  116
Colu m  of..........   146      OEdel ma of tle Labia............   77
" olustFrjumn of,............  146
"c'     "                     115'   Age of Nurse............. 146
An e of.J...... f f i   147               Opium  in Constipation,.........   60
C  stitution ofNurse. 1            "       Itching of Vulva.......   77
"Co ilsuitetio n of Nurse.gn.....       148
Influence of Pregnancy,.    148            Ox-gall in  Constipation,........   62
"'       ~"        nMenstruation,    148                                 P.
"    "4         Complexion,...   149        Pains and Cramps of the Stomach,   55
"         "         Food.......... 149            Pain and Tension of Breasts,....  107
4         ~Quantity,..... 149              p Pains, Relaxation of........... 113
4'        " 6       Acute Fevers,   149              "    Suspensionof,........... 113
M M ioral Emrotions 149                 "    Irregularity of,........... 113
4"        6         Chronic disease 150           Palpitation of the Heart,.......    93
s4  4(         Consumption,   150    Parturition, Convalescence after,.. 123'  Quantity of Sugar in,...... 151.....Perpetual Calendar, Ladies....... 174
4'        "         Casein,....... 151           Piles........................   70
6"   " e      Butter........ 151    Phosphorus in Diarrha........   68
46  Comlparison with Cow's,....151               Phosphor in Acidity,............  53
4'  Incontinence of........... 153'   Platina in Constipation.........   60
Milk Leg.................... 168                          "      Uterine    emnorrhage,..   82
Millefoliun against Bleeding Piles,  73              Plethora,..............    98
Moles,.......................117                  Plumbum  in Constipation.......   61
5Morning Sickness,..............              3     Post-Partem  Inflammations.....  158
Mloschus in Constipation........    61              Pregnancy....................                 7
]~N.\~  "~                          extra-uterine,.......  118
Nervousness...................   111                             duration of.........            8
Nipples, Soreness of;,...........           137            "       state of Breasts in,..     11
"      Depressed.............. 139                   "        state of Urine,.......   13
Nitric-acid,......1.............    3                    "        management of,.....  19
"       in Salivation,.......           39           "       treatment of.........   22
NIlux....no.....,    o...'.....o.   13           6        supelrstitions about,.,.   24




INDEX.                                            191
PAGE.                                               PAGE,
Pregnancy, exercise in,.........   26    Sore Nipples................. 137
"       diet during,.........  27    Spasm  of the Ureters...........   76
perverted tastes during   30    Spasm  and Inflammation of Womb   86
menstruation during,..   80    Spitting of Blood...............   96
Puerperal Mania................ 169                Spigelia,.......................   13
Pulsatilla in Salivation.........  39'   in Toothache...........   50
c"         Leucorrhcea,......  78    Staphysagria in Toothache.......50
Toothache,........  49              Stramonium  in  Piles,...........   73
"t        Diarrhoea,..........  67    Sulphur in Morning Sickness,....                    38
"e       1Piles,.............  72  Salivation,..........   39
t"       Acidity............   53                  "        Toothache,..........   51
1L                            Sulphuric-acid in Acidity........  53
Relaxation of Pains,...........   113    Sulphur in Acidity.53
Retention of Urine,..........  75,        Constipation........  59
Retroversion of the Womb......   90                               Diarrhea,...........   68
Rheumatism  of Womb,..........  83                                 Jaundice,.........   69
Rhododendron in Toothache,....  49                                Piles.........
Rihus in Toothache.............   49                              Leucorrhea,..78
c"     Diarrhcea,..............   68.       Itching of Vulva......  77
Incontinence of Urine,..   76    Suspension  of Pains........... 113
Rigidity and Laxity of Abdomen,    88
Swelling of Anterior Lip,.......  117
cc   of the Neck of Womb,.. 116,'    of Vulva.............. 11T.
Tabacum  in Morning Sickness,...   36
S. i ~   ~   m    t   i'   r-n    Thrombus,........                 115
Sabina in  Toothache,...........   50               hro bus,..............115
"        Jaundice,............   70
It       Piles................   73           Trembling and Chills,.......... 109
"       Uterine Hemorrhage,.,   83                                     V.
Saliva ti8. 8                          Varicose Veins................ 106
Salivation,....................   38                              
Scilla in Dropsy  of Amnion..                80 n   Veratrum  in Morning Sickness,...   36
Scilla in Dropsy of Animon,......   80.a'liv,...n
"~        Salivation,.........   39
Secale in Morning  Sickness,.....  36
"c        Constipation,.......   62
"(       Toothache,...........  50
Diarrhea,...........  67                                         W.
"        Uterine Hemorrhage,...   83              Waters, excess of,.............   79
" False,................   78
Sepia in Morning Sickness,......  36                           Fl....'~ ~.    ~~ ~7
-       Toothache,............   50    TWeaning.....................170
Itching of Vulva                                White Weakness,..............   77
"  Leucorrhcea,.........        78    Womb, Changes of, after ParturiSilex in Toothache,............                     tio....................  15
Sleeplesep sneness...................  96                                 Z.
Slowness and Feebleness of Con-                     Zincum  in Morning  Sickness,.....   36
tions,.....................,      1I1'        Constipation,........    62