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CURATIVE MEDICINE.

PART IX.

DISEASES PECULIAR TO WOMEN.

List of Diseases.—The diseases peculiar to the female sex comprise those of the uterus (womb), ovaries and their appendages, the vagina, external generative organs and mammary glands (breasts).

Divisions of Woman's life.—The life of a woman may be devided[sic] into five periods. They are infancy, puberty, maturity, the menopause and senility.

Period of Puberty.—Puberty is the period in which the child becomes the woman, this is the period when she begins to menstruate. It is the time when the breasts begin to assume a rounded form, her general contour becomes shapened, and her generative organs have reached their full development. Maturity extends from puberty to the menopause, and is the period during which women bear children.

MENSTRUATION.

A Mother's Duty.—Menstruation or the monthly flow, is characterized by a bloody discharge from the womb, and occurs at regular periods, usually every twenty-eight to thirty days. It is the duty of every mother to explain to her female offspring this condition of affairs, detailing when it occurs, how often to expect it, and the use of the napkin during this period. Too many mothers, on account of a mock modesty, allow their children to pass through the establishment of this function in total ignorance. Such practice, however, should be condemned.

Beginning of Menstruation.—I have often seen children run to their mother when the first drop of blood appeared, frightened beyond description. The first flow usually appears between the ages of twelve to fourteen. In the torrid zone it appears two or three years earlier, thus these children are capable of child bearing at so early a period.

Frequency of Menstruation.—Every woman is a law unto herself. As before stated, menstruation usually appears every twenty-eight to thirty days, some women, however, menstruate every four to six weeks and are in perfect health. A napkin should always be worn during the flow; surprising as it may seem, many fail to do so.

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DISORDERS OF MENSTRUATION.

Suppressed Menstruation (Amenorrhea).—This is a term applied to the absence of menstruation, between puberty and the menopause.

Causes.—Pregnancy, and when nursing; anemia (impoverishment of the blood) is a very frequent cause; consumption, debilitating diseases, non-development of the generative organs; obesity and after the ovaries have been removed.

Symptoms.—Amenorrhea may come on suddenly or be of gradual development. The former variety is often the result of some violent excitement, fright or mental shock due to the setting in of some fever or other acute disease, or to that common and very dangerous cause, especially in young girls, imprudent exposure to cold or wet during the monthly flow.

Symptoms in Anemic Persons.—If due to anemia the patient has a pallor, and the margins of the lips will be pale, she will look "bleached out," shortness of breath, palpitation of the heart, swelling of the feet and ankles, headache and constipation.

Symptoms in Consumptives.—If due to consumption, cough and night sweats will be present, accompanied by marked emaciation (wasting away). When amenorrhea comes on gradually it is apt to indicate some serious chronic disease, which should be immediately investigated and attended to by a skillful physician.

Cessation of Menses.—When the cessation of the menses is part of such a severe malady as consumption or Bright's disease, it often appears to be only nature's method of economizing the failing strength of the invalid, so that any interference would be likely to prove positively hurtful. On the other hand, the natural reappearance of the menses after a stoppage in the course of a chronic malady may be welcomed as a favorable indication of a tendency toward improvement.

Symptoms Attending Stopped Menses.—The constitutional disturbance from abrupt suppression of the monthly flow is generally very great. There is usually severe pain in the region of the womb, similar in character to that of colic, and hysterical excitement, or even convulsions, and mania, may be the direct effect.

Treatment.—When due to anemia, iron is the best remedy, given in the form of Bland's pill, one four to five times a day. When taking iron it is always a good rule to take a dose of epsom salts once a week, In order to counteract the constipating effect of the drug. Other remedies are, a teaspoonful of the elixir of quinine, iron and strychnia, three to four times a day; the pill of the same ingredients, one four to five times a day; permanganate of potash, two grains three times a day; or the binoxide of manganese, ten grains three to four times a day.

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When to Avoid Medicines.—The possibility that absence of the monthly period may be due to pregnancy should always be borne in mind, in which case it would be dangerous and criminal to administer any of the usual remedies for restoring the flow.

Treatment When Due to Cold.—When due to exposure to cold and wet resort to hot mustard foot baths or hip baths, mustard plasters to the inside of the thighs, calves of the legs and ankles. A hot sitz-bath is also worthy of trial. This consists of partially filling a "foot tub" with hot water, allowing the patient to sit in it, and covering her with a blanket. She should remain in the bath for five to ten minutes. The buttocks and thighs are then thoroughly dried, and she is put to bed. If constipated the bowels should be regulated. (See Constipation.) Vaginal injections of hot water are also to be employed. (See How to Use the Douche.)

Treatment of Young Girls.—The treatment of delayed menstruation m young girls, who have passed the age of puberty must be on general principles adapted to improving the general health, unless there are signs of the menstrual blood being retained inside the womb, a dangerous condition which should always be considered in such instances and relieved as early as possible by a surgical operation.

PAINFUL MENSTRUATION (DYSMENORRHEA).

Meaning of the Disease.—By this is meant painful menstruation. The pain may occur before, during or after the flow. Many varieties have been described, such as the obstructive, congestive, mechanical, neuralgic, and so forth, but it is very difficult at times to differentiate them.

Causes.—Usually due to the womb being out of its normal position, tumors, and inflammatory diseases of the womb and ovaries.

Symptoms.—A woman who enjoys health not only menstruates regularly, but does so with perfect freedom from suffering, but unfortunately there are very few members of the female sex who pass through the whole period of their sexual vigor without being called upon to endure more or less frequently attacks of dysmenorrhea.

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Pain With the Flow.—Some women experience great pain with each flow, from the commencement of puberty, every month, until the change of life relieves them. With the majority, however, pain is only the exceptional accompaniment. With some women marriage effects a cure, whilst in others, especially when there is sterility, it either aggravates or originates the dysmenorrhea. Under no circumstance, however, would a physician advise a woman suffering with dysmenorrhea to be married in the blind hopes that it would effect a cure.

Bearing-Down Pains.—Bearing-down pains, not severe, are often present; accompanied by a sensation of weight. The pains as a rule are cramp-like, and intermittent, varying in severity. At times the pains are followed by the expulsion of blood clots which oftentimes affords relief. Severe pains as a rule necessitate the sufferer going to bed, where she may have to remain for several hours to a day or two. As a rule constipation is present, again diarrhoea may be troublesome.

Nausea.—Nausea followed by vomiting adds to the severity of the attack. Headache is invariably present. The pains may extend from the lower part of the abdomen down both legs. Pain in the back is oftentimes quite marked, the sensation being that of the back splitting open.

Treatment.—The existence of dysmenorrhea depends upon so many conditions that the treatment employed in one case will seldom relieve the next. During the attack of pain, the patient should take a hot sitz-bath, and if the suffering is very severe, may have a suppository of half a grain of opium combined with a quarter of a grain of belladona. Under no consideration should a hypodermic injection of morphine be given, without a physician's advice. Again, a sitz-bath may be given, followed by a turpentine stupe, and ten grains of Dover's powder. Tincture of belladonna five drops every three hours may be given; or the following: antipyrine five grains every hour until four doses are taken, then every three hours until relieved; acetanilid five grains in the same manner; tincture of gelsemium ten drops every three hours; bromide of soda or potassium twenty to thirty grains every three hours; or as a final resort, if the above-named remedies fail to afford relief, morphine, either by the mouth or a hypodermatic[sic] injection, but only on the advice of a physician. Hot vaginal injections should also be tried, using at least a gallon of water.

Purgation.—Often when the attack is accompanied by constipation, a purgative dose of epsom salts or aloes will be of service.

Attention to the General Health.—Between the attacks attend to the general health. Employ the tonics mentioned in the treatment of amenorrhoea. Take plenty of out-of-door exercise. Avoid undue excitement, straining or heavy lifting, the bicycle and dancing, as the time for the flow approaches.

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Prevention of the Pain.—An endeavor should be made to prevent the pain if possible. The best drug for this purpose is tincture of gelsemium, five drops after meals, to begin ten days before the flow is expected. This is to be continued until the flow is well established, then cease until within ten days of the next period. It will prove advantageous at times to combine with the gelsemium five drops of the tincture of cannabis indica.

When Drugs Fail.—If drugs fail to afford relief, then it may be neccessary[sic] to dilate and curet (scrape) the womb, an operation which, when properly performed, will give excellent results. This operation will only keep the patient in bed ten days, and at the end of the second week, she will be able to resume her routine duties.

EXCESSIVE MENSTRUATION (Menorrhagia and Metrorrhagia).

Meaning of the Disease.—When the monthly flow persists longer than usual or is excessive in amount it is called menorrhagia. When there is a bloody discharge from the womb between the monthly periods it is termed metrorrhagia.

Causes.—Both may be due to obstruction of the general circulation of the blood, from disease of the heart, lungs and liver. Tumors of the womb, inflammatory disease of the womb, ovaries and tubes. The more frequent causes are, getting out of bed too soon after confinement, retained portions of conception, due to improper care during a miscarriage (see Miscarriage), polypus tumors of the womb and cancer.

Symptoms.—Anyone suffering from either of these conditions should be examined by a physician in order that he may ascertain the exact cause and remove it; otherwise delay due to home treatment, should the cause be a dangerous one, may prove fatal. In a woman otherwise having a normal flow, she will notice that the flow lasts a day or two longer, or may be excessive in amount, requiring a greater number of napkins than usual.

Excessive Flow.—The flow may be so excessive as to require rest in bed. When a large amount of blood is lost there will be pallor of the skin, dizziness, headache, extreme prostration, specks will appear before the eyes, she may feel as though she was falling through the bed. Or again, if the condition present is a metrorrhagia, there will be a discharge of blood between the periods, which discharge if it becomes excessive will give rise to the same symptoms just mentioned.

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Treatment.—In the treatment of menorrhagia there are two indications to be fulfilled, first to check the present hemorrhage; and, second, to remove the cause upon which it depends, and so obviate the certainty of its recurrence. To accomplish the first of these desirable objects, which should not, however, be attempted in any monthly period, until the usual amount of blood has been eliminated from the system, say until the second or third day of the flow, try half a teaspoonful of ergot every three hours. Rest in bed is, however, an important part of the treatment, without which all the good accomplished by skillful medical care may be speedily dissipated. Other remedies are, half a teaspoonful of hydrastis canadensis every three hours; half a teaspoonful of witch hazel every three hours; gallic acid, 5 grains every four hours. A very good prescription for bleedings of this kind is as follows: 

Rx.---Ext. hydrastis fluid (colorless)................... 1 ounce
      Ext. ergot fluid................................. 1/2 ounce
      Ext. hamamelis fluid............................... 1 ounce
      Aqua, q. s......................................... 3 ounces
          M.
  Sig. One teaspoonful every three hours.

Plugging the Vagina.—If these remedies fail and the case is an urgent one, it will be necessary to tampon or plug up the vagina with pieces of raw cotton, lamb's wool, or linen cloth, taking care not to employ an undue amount of force in introducing these materials. They should have a string securely attached to them in order to facilitate their removal. In no case should such a plug or tampon be allowed to remain longer than twenty-four to thirty-six hours, for fear of poisoning the system with the putrifying blood entangled in it. When the tampon has been removed, if the bleeeding is not checked, tampon again.

Removal of Tumors.—If the bleeding is due to the presence of tumors, it will be necessary to have them removed.

Further Treatment.—Frequently medicines and tampons fail to control the hemorrhages, especially when there is proud flesh in the womb, and when the muscles of the womb are unable to contract. In such an event the only procedure is to dilate and curet the womb, which operation will remove the source of the trouble. In some cases of dysmenorrhea enlargement and congestion of the ovaries appear to be the important factors in the production of the malady. Such attacks are apt to be very intractable, unless the disordered condition of the ovaries are remedied, usually by an operation.

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LEUCORRHEA OR WHITES.

Character of Whites.—This prevalent, troublesome and disagreeable condition, vulgarly termed the "whites," consists of a discharge of mucus or muco-pus from the womb, neck of the womb and vagina. It is very similar to that occurring from the nose during a cold in the head. In fact, the condition of the mucous membrane giving rise to leucorrhea is often one of catarrhal inflammation.

Causes.—It may be brought on by taking cold; by local excitement; by inflammation of the neck of the womb, the womb proper or the lining membrane of the womb; oftentimes the trouble is localized in the mucous membrane of the vagina; disease of the ovaries and tubes may also be at fault. It is frequently due to a "run down" system, yet women in perfect health may be affected; in the latter class it is probably nature's method of overcoming an excess in the richness of the blood.

Character of the Discharge.—The character of the discharge varies; it may be thick and tenacious, or it may be liquid, when it will run down the limbs in a stream and greatly soil the clothing. As ordinarily seen, it is not usually accompanied with much pain, but when very profuse, distress in the back and a dragging sensation in the lower part of the pelvis, often described as a bearing down feeling, are the symptoms most frequently observed. The discharge is generally more abundant a little while before, and for two or three days after the occurrence of the flow. In fact, when the leucorrhea is severe, this increase of the flow of whitish matter sometimes continues for a couple of weeks after the monthly period with increased violence, showing how greatly it depends upon a congestion of the parts concerned for its production.

Treatment.—The treatment of this rather intractable malady, besides the necessary attention to the general health, by the use of tonics and nourishing food, consists of the employment of astringent injections into the vagina. For building up the health the following pill will be found of service: 

Rx.---Acidi arseniosi (arsenious acid) .................... 1 grain
      Ferri reducti (reduced iron)......................... 5 grains
      Quinia sulph. (quinine) ............................ 20   "
  M. Fiat in pil.  No. XX. Sig.---One pill after each meal and 
      at bed-time.

Additional Treatment.—If the leucorrhea is due to irritation of the ovaries, apply a cantharidal plaster over the groin on both sides. The best results, however, are attained by the employment of vaginal injections, such as a teaspoonful of creolin to two quarts of hot water; twenty grains of sulphate of zinc, or ten grains of sulphate of copper in the same quantity of water; thirty grains of alum to the pint; and a teaspoonful of lysol to two quarts of water are all worthy of a trial. A very cheap injection is made by adding one ounce of powdered oak bark to each pint of water, or one ounce each of tannic acid and glycerine to two quarts of water.

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Treatment for Fetid Discharge.—When the discharge is fetid, permanganate of potassium should be used one-half drachm to one pint of water. This solution will stain linen, so be careful to avoid splashing it over the douche pan. (See How to Use the Douche.) Another very good drug to eradicate the odor of this discharge is bichloride of mercury. The druggists dispense a tablet containing seven and seven-tenth grains of the drug. One of these tablets added to two quarts of water makes a solution the strength of which is 1-4000. Such a solution should be used two or three times a day. All the injections above mentioned can be used night and morning, but if the discharge is profuse, three times a day will not be too often.

An Injection for Whites.—A very useful astringent injection for leucorrhea, whatever may be its cause, may be made by ordering: 

Rx.---Zinc sulphat (sulphate of zinc).................... 1 drachm
      Alumin sulph. (sulphate alum)...................... 1   "
      Glycerine ......................................... 6 ounces
  Sig.---A tablespoonful to each quart of water.

This injection can be used night and morning.

Local Applications.—When the leucorrhea is caused by catarrhal inflammation of the cavity of the womb, as is frequently the case, injections into the vagina are, of course, almost worthless, and local applications made by a physician are very important, and should be faithfully persevered in, sometimes for many months.

HOW TO USE THE DOUCHE OR VAGNAL INJECTION.

Varieties of Syringes.—Before proceeding further let me describe the proper manner of taking a douche. First the varieties of syringes. These are numerous, but for practical purposes there are only two which are used to any extent. They are the Davidson, or bulb syringe, and the Fountain syringe.

The Bulb Syringe.—The bulb syringe is not to be recommended, because it is dirty, a great deal of muscular energy is required to work it, hence is tiresome and necessitates too much preparation for its use. If is very difficult to employ this syringe while lying down, and this is the only position in which a douche should be taken.

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Using the Bulb Syringe.—In using this kind of a syringe generally a pint of the solution is placed in a basin over which the woman squats, and by squeezing the bulb forces the liquid into the vagina as fast as it runs out, thereby filling the syringe joints with the vaginal secretions, and returning to the vagina as soon as they flow away the impurities which have left it. If, however, a woman prefers this kind of a syringe, and insists on sitting over a bucket or other receptacle, then the solution should be placed in one basin, and that which is forced into the vagina permitted to run into the vessel upon which she is sitting.

Object of Using the Syringe.—The object of using the syringe is to bathe the vagina and neck of the womb. By sitting on a vessel the latter is prevented, for just as soon as a woman sits down, then the vagina is doubled on itself in such a manner as to prevent the solutions reaching the womb.

The Fountain Syringe.—The Fountain syringe is to be advocated, not only for this purpose, but for all-round family use. This syringe consists of a bag of soft rubber with a long rubber tube and a series of hard rubber nozzles. The largest size is intended for the vagina. The "Alpha" is the best, because it has a valve at the opening which prevents the solution from running out at the top. This is a great advantage because the bag can be laid on the floor, a shelf or anywhere without spilling its contents.

Proper Way to Take Vaginal Injections.—The proper way to take a vaginal injection is as follows: First fill the douche bag, which should hold at least two or four quarts, with the solution which is to be used. Hang it on a nail, which should be driven near the bed. Then place the douche pan on the bed. A good douche pan should be large and capable of holding at least one to two gallons. They are made of tin and agateware. Then lie down in bed, placing the douche pan under you in such a position that the buttocks rest on the top of the pan, in order that the solution after leaving the vagina will run directly into the pan without splashing over.

Improper Positions in Douching.—This is the correct way to take a douche. The other methods of sitting over a basin, or standing over a vessel, are to be condemned. This is the only way in which the womb can be bathed with the solution used, and not less than one to two quarts should be employed when a drug has been added, and when plain hot water is used, four to six quarts will not be too many.

Temperature of Douches.—All vaginal douches should be as hot as the patient can stand, and under no circumstances should cold water be used, as it is injurious. In exceptional cases hot water increases the pain instead of relieving it, and is then advantageously replaced by lukewarm water.

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What Women Should Avoid.—Under no condition should a woman endeavor to introduce the small nozzle into the womb, or endeavor to force a solution of any kind into the womb. This is an exceedingly dangerous practice, and many a woman by so doing has sown the seed of pelvic inflammation, which has only been relieved by the removal of both ovaries, and in some cases the womb.

CONSTIPATION.

Woman a Constipated Animal.—The eminent Dr. Goodell once said: "Woman is a constipated animal." While we do not desire to class the gentler sex as an animal, still this statement contains a great deal of truth, for, by far the greater majority of women are constipated.

Causes.—This troublesome state can be attributed to a number of causes, the most frequent of which is leading a sedentary life; omitting daily exercise, which tends to excite the secretions of the bowels and liver to their proper activity. Another very frequent cause is laziness pure and simple, the patient failing to go to stool when informed by nature that such should occur.

A Very Frequent Cause.—Modesty is a very frequent cause of constipation in women, because a woman prefers to suffer rather than to go to a closet which may be somewhat publicly situated. Heredity, muscular weakness, hepatic torpor, lack of secretions in the lower bowel, backward displacement of the womb and lacerations of the perineum are frequent causes of constipation.

Symptoms.—General weakness, a feeling of languor and mental depressions are frequent symptoms; nervousness, headache, loss of appetite and a furred tongue may also occur. Individuals differ in this matter, one feels wretched all day without the accustomed evacuation, another is comfortable all the week except on the day which, by purge or enema, the bowels are relieved.

More Serious Symptoms.—When persistent the accumulation of the feces leads to serious symptoms, such as ulceration of the colon, peforation of the bowel, piles and inflammation of the bowels. The bowel contents may become dry and hard, forming large masses, which can only be removed by a physician with a great deal of difficulty.

Nausea.—In women who have been habitually constipated, attacks of diarrhoea with nausea and vomiting should excite suspicion, and lead to a thorough examination of the lower bowel.

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Poisoning.—Part of the bowel contents may be absorbed by the system, giving rise to a general poisoning, which will recur at stated periods, until the constipation is cured. Costiveness is the recognized cause not only of hemorrhoids, of pelvic congestion, of inflammation of the womb and of disorders of the digestive apparatus, but also of the fecal poisoning just mentioned. For if diseases breed from bad drainage without the body, how much more from bad drainage and defective sewerage within the body! Feeble mothers beget feeble children—children who are carried from the womb to the grave, or who peak and pine under the heritage of ill health.

Other Causes.—Such then being the condition of the majority of American women, what is the cause? Probably no single cause has had so much influence in producing the peculiarly delicate condition for which women living in the country and in small towns in America are notorious, as the discomfort, inconvenience, and frequent repulsiveness, and, I may add, indecent exposure, of their closet accommodations.

Insufficiency of Closet.—In the teeming tenement house of any of our large cities there is usually but one closet, and that is invariably a cesspool, wet and foul, reeking with filth, poisoned by noisome stenches, defiled by lewd couplets or by obscene cuts, indecent from thin partitions and wide chinks, or from being preoccupied by one of the opposite sex. Under such conditions what woman can avoid schooling herself into the habit of resisting the evacuation of her bowels ?

Inconvenient Privies.—In the small houses of tradesmen and of mechanics the water closet is rarely to be found, nor are the houses of the better classes always supplied with this luxury. The privy is then usually placed at the farther end of the yard, and approached by a long and unsheltered path. It is, therefore, almost inaccessible in bad weather or on dark nights, and is overlooked by the backbuildings of all the neighboring houses.

Risk to Women.—To a delicate woman the exposure to the weather is a serious risk; to one who is menstruating it is a constant menace; while to the refined woman the exposure to view compels the postponement of her physical duties to nightfall, or until driven to them by a sheer necessity which knows no law.

Country Closets.—Nor does the condition of the closets in the country present a more agreeable contrast. In many parts of the Southern and Western States a clump of bushes, the shelter of a rock, the nearest grove affords the only accommodations. But take the most thickly settled States, where is the small farm house whose privy invites rather than repels an operation of the bowels?

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Privy a Misnomer.—The very name of privy is a misnomer. How seldom is the building hidden by clumps of evergreen, or a screen of lattice work. How often is it not an embarrassing distance from the house, at the end of a long trail, or, at least, of a long unkept path, which frequently runs parallel with a street or with a road.

The Outlandish Privy.—Where in the country, and for that matter in cities also, is not to be found the privy made up of rough boards rudely spiked together, with cracks wide enough to spoil all privacy, with a door without a bolt, and generally hanging by one hinge, with a crescent shaped hole for a window, and with its sole object of furniture a barrel of rasping corncobs? When is it ever sheltered from the rude blasts of winter, or not poisoned by noisome stenches, acrid vapors and unclean flies? After such an unsightly but truthful picture, can we wonder that the calls of nature are looked upon as grievous dispensations of Providence, as hateful duties which are to be put off as long as possible and obeyed as seldom as necessary?

Repellant Conditions.—Imagine now broad daylight, with its busy traffic, a rainy or a dark night, the grass wet with dew, or the ground covered with snow, or the temperature, perchance, many degrees below zero. Under such circumstances what woman can respond to the calls of nature without putting herself to great discomfort, to great risk, indeed, if she be menstruating, or without blunting the edge of her womanly sense of decorum.

The Antidote.—I have told you the bane; now what is the antidote? Clearly such closets as a civilized Christian people—a people living in the twentieth century are not degraded in using; closets that are decent, comfortable and accessible; closets that invite rather than repel those in which an operation of the bowels is not tantamount to being buffeted by satan for a season.

Country Earth Closets.—In cities, and in towns which are supplied with water works and good drains, the use of the water closet ought to become universal. In the country, where such a luxury can be attained by the rich alone, the earth closet is the only substitute; I cannot too strongly urge its adoption.

Treatment.—Much may be done by systematic habits. Set a certain time of the day, and at that time go to the closet and endeavor to have an evacuation. Continue with this each day, and permit nothing to interfere with this duty at that particular time. The desire to go to stool should always be granted; when there is a desire, go by all means.

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Treatment of Stout Women.—In stout women with flabby abdomens the muscles should have the support of a bandage. Exercise is of great value; by far the best being horseback riding at least an hour a day, or every other day. Massaging the abdominal muscles is also of value. Much good can be accomplished by the daily use of the "home gymnasium," or dumb bells and Indian clubs.

Diet.—The diet should also be regulated. Very often if a plateful of cracked wheat is used at breakfast each morning, and bran bread taken in addition, a chromic tendency to constipation can be removed. Milk is not to be recommended. Green or canned corn is of great service. Fruits also do good. Nothing is so good as a glass of cold water taken on arising in the morning just before breakfast; or if the cold cannot be borne, then a glass of as hot water as can be swallowed may be substituted. It must be remembered that strawberries, raspberries and blackberries are constipating rather than purgative. Coffee has a binding effect on some persons; brandy is distinctly constipating, whereas whiskey has no influence one way or the other.

Treatment by Medicines.—The use of drugs for the relief of constipation consists in those that unload the bowel, which has become filled, and those which will cure the tendency. Let us consider the first variety. For this purpose may be mentioned epsom salts, half to one tablespoonful, preferably taken in the morning on an empty stomach; mercury, in the form of calomel, one-fifth of a grain every hour until about ten doses are taken, then following with a bottle of citrate of magnesia; castor oil, half to one tablespoonful, or twenty grains of powdered rhubarb at bedtime.

To Cure Tendency.—Of the second class, half to one teaspoonful of the fluid extract of cascara sagrada at bedtime; fluid extract of liquorice in the same manner; or a dessertspoonful of phosphate of soda in one-quarter of a glass of hot water before breakfast. Rhubarb is not to be recommended for constant use, as it is astringent, and after the bowels have moved the constipation will be more pronounced than before. Mercury is exceedingly harmful if used continuously as a purge, and is the cause of much ill health, bad teeth, and digestive troubles. Castor oil is notorious for its tendency to ultimate constipation.

Very Best Drugs.—Of the curative class of drugs none compare to cascara sagrada, which should be used in the form of the tasteless fluid extract, or cascara cordial. This is the only drug which moves the bowels and at the same time tends to make the future movements more easy and regular; the dose is ten to twenty drops of the fluid extract every night at bedtime, or one to six teaspoonfuls of the cordial. If the fluid extract, in the doses above mentioned, fails to act, increase the quantity each night until at least a teaspoonful is necessary.

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The following two prescriptions will be of value: 

      Aloes ............................................ 20 grains
      Extract of nux vomica ............................. 4   "
      Extract of physostigma ............................ 3   "
      Extract of belladonna ............................. 4   "
  Make into twenty pills. Take one pill at night or one night and morning.

Or 

      Resin of podophyllum............................... 2 grains
      Extract of nux vomica ............................. 4   "
      Extract of physostigma ............................ 3   "
      Extract of belladonna ............................. 4   "
  Make into twenty pills. Take one at night or night and morning.

Injections.—The employment of enemas, or injections, as a routine practice is to be discouraged. In cases where it is neccesary to use them for temporary relief, and to get rid of the gas, a little soap, common salt, and a few drops of turpentine may be added to the water.

DISEASES OF THE EXTERNAL GENITAL ORGANS.

Vulvitis.—This is an inflammation of the vulva, the part so often referred to by women as their "person" or "privates." It is divided into several different varieties, which can only be distinguished by a physician.

Causes.—One of the most frequent is lack of cleanliness; irritating discharges from the vagina and womb, which trickle over the parts; tight fitting drawers, which rub and chafe; injuries, as striking against a chair, or falling on an object; self abuse; excessive or brutal intercourse; pregnancy; fevers; may follow a long and difficult labor; and is apt to occur during an attack of diabetes.

Symptoms.—General discomfort, sensations of burning which amount at times to severe pain; burning pain during urination; the parts are usually swollen and very red. In diabetic vulvitis the itching is intense, and oftentimes is the first symptom of diabetes. Every woman who passes large quantities of water and suffers from intense itching of these parts should have her urine analyzed to see if it is due to diabetes. Owing to the fever and swelling the parts at first are dry, due to the lack of secretion; but as this increases the parts become raw and very painful.

Treatment.—Cleanliness is the first consideration. Warm sitz-baths, hot vaginal injections of plain water, or water to which has been added creolin one-half a teaspoonful to two quarts, borax a teaspoonful to the quart, or a dessertspoonful of salt to the quart. Use these several times a day. After thoroughly cleansing the parts, they may be dusted with talcum powder, starch, or starch and bismuth, equal quantities, bismuth or borax.

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Checking the Beginning.—Oftentimes the attack can be checked at the beginning by applications of lead-water and laudanum. The best way to apply this is to soak a piece of absorbent cotton, about the size of the hand, with it, and place it in between the legs.

Treatment by Injection.—If the irritation is due to worms, a rectal injection will usually remove them. If the itching is very severe try hot vaginal injections of bichloride of mercury, seven grains to the quart; salicylic acid the same strength; or a solution of hyposulphite of soda, one ounce to the pint of water. After the parts have been dried any of the following will be found beneficial: benzoated zinc ointment; iodoform ointment; solution of carbolic acid, half a teaspoonful to a cup of water; nitrate of silver, eight grains to the ounce of distilled water, and painted over the parts oftentimes affords the greatest relief. The bowels should be kept freely open.

PRURITUS (ITCHING OF) VULVA.

Definition.—By pruritus is meant itching; the privates are the one part of a woman most frequently affected with this troublesome condition. Pruritus is not a disease, but a symptom of other conditions.

Causes.—It is of frequent occurrence during pregnancy, and very often the result of uncleanliness; is invariably caused by irritating discharges from the vagina; may be associated with tumors of the parts, and is often present during the course of diabetes.

Symptoms.—Intense itching, the woman is almost driven to desperation, and scratches the parts until they bleed. The itching is usually aggravated by walking or becoming warm in bed. This condition may be so marked as to lead to melancholia. The intense suffering causes loss of sleep, exhaustion, and sometimes alarming nervous depression. The more the patient is compelled to scratch, the more the parts are irritated.

Treatment.—Remove the cause if it can be found. In order to remove irritating discharges sitz-baths and vaginal douches, as described in the treatment of vaginitis, are used. After thorough cleansing of the parts they may be dusted with calomel, bismuth, starch or lycopodium powder. The calomel is generally preferred. Before applying the powder first dry the parts. Great relief is sometimes experienced from a gauze ompress[sic] over the vulva, saturated with a solution of lead-water and laudanum, equal parts. This dressing should be frequently changed.

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Auxiliary Treatment.—The intense itching which appears at night after retiring can often be prevented by applying to the vulva cloths wrung out in hot water. Ointments are useful from their soothing effects and, in addition, they protect the parts from the irritating discharges. These are iodoform ointment, sulphur ointment and zinc ointment.

HEMATOMA (BLEEDING) OF THE VULVA.

This term is applied to any hemorrhage which may occur in the tissues of the privates. It usually occurs on one side, rarely on both.

Causes.—The most frequent are falling on a sharp substance; very often while housecleaning a woman will stand on a chair which, should it slip, may cause her to fall in such a manner as to straddle the back of it; the insane may self-inflict wounds in this spot. Among other causes are intercourse, pregnancy, tumors and diseases of the blood-vessels supplying the affected parts.

Symptoms.—The symptoms are practically those of injury to any other part of the body. The bleeding may be very profuse, especially if there is a cut. If the parts are only bruised the bleeding will be more or less extensive, the blood simply pouring out into the tissues, causing a swelling of the parts. There will be pain of a sharp or tearing nature, which may be accompanied by faintness. If the swelling is large, it may press on the urethra, and cause difficulty in passing water.

Treatment.—The bleeding may be controlled by the application of ice or by using pressure or both. Simply take a clean napkin and hold it tightly against the injured parts. After the blood has been in the tissues for a few hours a hard blood-clot forms. If this is not absorbed within a few days the part should be lanced and the clot turned out. If the swelling is small, lead-water and laudanum applied to the parts on pieces of gauze may cause it to disappear.

TUMORS OF THE VULVA.

The vulva, like any other portion of the body, is subject to the occurrence of tumors which may or may not be malignant. If such a tumor growth should occur a physician should be consulted, in order that he may diagnose its exact nature and institute the proper treatment. Too often innocent looking growths have been allowed to go unattended, which, when too late, have been found to be cancers.

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SKIN DISEASES OF THE VULVA.

The skin of the vulva may be affected with various skin diseases, as eczema, erythema, acne, herpes, prurigo, scabies, pediculi and erysipelas.

Causes.—The various diseases are due to irritating discharges from the vagina or womb, menopause, vesico-vaginal fistula, indigestion, diabetes, and in stout persons during exceedingly hot weather.

Scabies.—Scabies is due to the parasite acarus scabiei. This parasite may spread from some other part of the body. This itch-mite burrows into the skin and gives rise to intense itching, which increases when the body is warm. It is usually due to uncleanliness and coming in contact with uncleanly persons similarly affected.

Crabs.—Pediculi are often found about the external genitals. This is also a parasite, commonly called "the crabs." These parasites localize themselves in the hair, and can be seen clinging to it. They are generally contracted through intercourse with indecent women. Too often husbands thus affected bring them home and innocently cause a similar condition with their wives.

Treatment.—Hot vaginal injections, as advised for diseases of the vagina. Local soothing applications should be made, such as bismuth powder, ten per cent. solution of carbolic acid, benzoated zinc oxide ointment three to four times a day; powdered zinc oxide three to four times a day; acetanilid and chalk equal quantities, three to four times a day; carbolized zinc ointment three times a day, and lycopodium powder several times daily. If scabs are present wash them off with almond or other bland soap, after which apply any of the above ointments. Keep the bowels open daily, resorting to the treatment as advised for constipation.

Accessory Treatment.—If scabies are the cause take a warm bath with free use of soap, followed by dusting the parts with sulphur. Sulphur ointment has been highly recommended.

If due to pediculi, the best treatment is to shave the hair and thoroughly rub in a ten per cent. ointment of oleate of mercury three times a day, or blue ointment four times a day; bichloride of mercury, five grains to a pint of water, bathing the parts several times daily; or carbolic acid solution several times daily.

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VAGINISMUS, OR CONTRACTION OF VAGINA,

Vaginismus is a painful spasmodic contraction of the vagina which more or less prevents intercourse.

Causes.—Very frequently due to an extremely sensitive condition of the remnants of the hymen, which will produce violent contraction of the muscles of the vagina. It may also be caused by a fissure of the vagina, erosions of the parts, fissures of the anus and an urethral caruncle.

Treatment.—If due to a caruncle it should be taken out, which operation will confine the woman to bed for five to seven days. When due to a thick hymen it will need the attention of a physician. Among the remedies which may be tried at home are injections of a teaspoonful of laudanum to a pint of hot water; an ointment of iodoform; or fifteen to twenty grains of bromide of sodium three to four times a day.

COCCYGODYNIA.

It consists of a very painful condition of the muscles at the very tip of the spine. Is most common in women who have borne children.

Causes.—Injuries during childbirth, blows and falls striking the tip of the spine, cold or exposure of the buttocks, and uterine or ovarian diseases.

Symptoms.—Severe pains in the region of the tip of the spine, increased by motion.

Treatment.—During the acute attacks it may be necessary for a physician to administer hypodermic injections of morphine to relieve the pain. As a rule an operation will be the only treatment to render a complete cure.

URETHRAL CARBUNCLE.

This is a small raspberry-like growth which is very sensitive, and to be found at the mouth of the urethra.

Causes.—These are uncertain. No definite cause has as yet been decided upon.

Symptoms.—It gives rise to severe itching and pain. During urination, as the water runs over it, the pain is more or less excruciating, so marked that women will oftentimes withhold from passing their water Until they are further unable to withstand the calls of nature.

Treatment.—An operation is imperative, as no other treatment will afford relief.

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DISEASES OF THE VAGINA.

ATRESIA OF THE VAGINA.

Causes.—This means an absence of the vagina, or a closure of it. The child may be born this way, in which case it is due to improper development in the womb. Or, as is more frequently the case, it is acquired, due to caustic remedies carelessly applied, a long and tedious labor, extensive ulcerations, and a hymen which does not have an opening.

Symptoms.—In children born with this deformity it is often not noticed until puberty, when the child should menstruate. In fact, menstruation does occur, but owing to the absence of the opening in the hymen it is prevented from escaping and accumulates in the womb. Each month menstrual pains will recur, but there will be a failure of the blood to escape.

Treatment.—This is purely operative.

VAGINITIS.

Vaginitis is an inflammation of the vagina.

Causes.—A rundown system, anemia, systemic conditions producing congestion of the pelvis, such as pregnancy and tumors. May be due to friction produced by a badly fitting pessary, to irritating discharges from the womb, to excessive coition.

Symptoms.—Feeling of heat in the vagina; pain in the pelvis; at times a frequent desire to pass water; itching and burning about the entrance to the vagina; backache; loss of appetite and at times nausea.

Treatment.—When the inflammation is acute keep quiet, not necessarily in bed. Keep the bowels open, and give a light diet, no meat. If there is much pain use a five-grain opium suppository. If the itching is severe take frequent warm sitz-baths and vaginal douches of hot water containing either of the following: Borax one teaspoonful to the pint, sugar of lead water one teaspoonful to the pint, or half a teaspoonful of creolin to two quarts. These injections should be used several times daily.

MALIGNANT TUMORS OF THE VAGINA.

The vagina may be the seat of cancer. It may begin here, or spread to this canal from the bladder, rectum or womb.

Symptoms.—Cancer usually appears from thirty to forty-five years. The important symptoms are hemorrhage, which often follows straining at stool, or after coition; a foul discharge, which is very repulsive; it may be thick, but as a rule is watery; pain, this is always present, but not, as a rule, until after the disease is well developed.

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Treatment.—The diseased tissue should be removed, of course, by a surgeon. If the disease is well advanced before discovered, as a rule it is too late for operation. If such be the case the indications are to maintain the strength of the patient, relieve the pain and counteract the foul smelling discharge. The first may be accomplished by tonics and out-of-door exercise. These cases, as a rule, are not bedridden until a short time before death. To relieve the pain resort to opium. This is the only drug on which we can rely. Begin with a sixth of a grain four to five times a day, gradually increasing it as needed during the course of the disease. For counteracting the odor of the discharge the best drug to use is permanganate of potash, in a vaginal douche, five grains to two quarts of water. These douches should be used as often during the day.

Auxiliary Treatment.—A woman suffering from this disease should always wear a napkin, which should be burned as soon as removed from her person. Allow plenty of fresh air to circulate in the room. Those who handle any cloths which come in contact with these discharges should wash their hands at once, using plenty of soap and warm water.

DISEASES OF THE UTERUS OR WOMB.

INFLAMMATION OF LINING MEMBRANE OF WOMB (ENDOMETRITIS).

Inflammation of Lining Membrane of Womb.—This is an inflammation of the lining membrane of the womb.

Causes.—Often due to taking cold just before or while menstruating. The introduction of unclean instruments into the womb; the introduction of knitting needles and other instruments by women in an endeavor to produce an abortion. Gonorrhea is oftentimes at the bottom of the trouble. Inflammation of the womb often spreads to this membrane, or the inflammation may begin in this membrane and spread to the womb.

Symptoms.—There is a sensation of weight in the pelvis and slight pain. The discharge is at first profuse, thin and watery, but later becomes thick and tenacious, like the white of an egg. Menstruation may or may not be painful.

Treatment.—During the acute attack rest in bed, with an ice bag over the lower part of the abdomen, or if this is not comfortable, a hot water bag. The bowels should be well moved, preferably by a dose of epsom salts. The diet should consist of liquids, cornstarch, gelatine and the like. Large quantities of hot water should be used as vaginal injections three to four times a day.

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Inflammation of the Womb.—A new and effective remedy for this disease consists of a mixture of five ounces of vaseline with three drachms of boracic acid. Make this into fifty suppositories and insert one in the vagina each night on retiring; or, if found more convenient, take a small piece of the mass, about the size of a cherry, and insert as above. This treatment serves also to correct irregularity of the menses.

INFLAMMATION OF WALLS OF WOMB (METRITIS).

Inflammation of Walls of Womb.—Metritis is an inflammation of the muscular walls of the womb.

Causes.—The most frequent cause is getting out of bed too soon after a confinement; abortions; exposure to cold during menstruation will give rise to it, also sexual excesses and lacerations of the womb.

Symptoms.—The acute attacks usually begin with a chill, generally followed by a fever. Pain is more or less marked, and may extend down the legs, and be especially troublesome on the left side of the abdomen over the ovary. The monthly flow is apt to be accompanied by a great deal of pain.

Treatment.—The treatment is the same as endometritis.

FIBROUS TUMORS OF THE UTERUS.

Symptoms.—They give rise to pain, more or less severe at times, and to hemorrhages, which may cause death. The pain is especially severe during the menstrual period. The hemorrhages may occur several times between the monthly periods, or the monthly period itself may last for a week to ten days.

Treatment.—For the pain, morphine as a rule is the only drug which affords relief, one-sixth to one-fourth of a grain every four hours. Tincture of gelsemium, ten drops every three hours, may prove of service. For the bleeding try a teaspoonful of the fluid extract of hydrastis every three hours, or a teaspoonful of the fluid extract of ergot every four hours. If drugs fail to control the hemorrhage it may be necessary to pack the vagina with gauze, which pressing against the womb usually controls it. The following is a very good prescription, which should be tried in all cases of bleeding from the womb:

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Rx.---Extract of hydrastis fluid (colorless)............... 1  ounce
      Extract of hamamelis fluid .......................... 1    "
      Extract of ergot fluid .............................. 1/2  "
      Peppermint water, to make............................ 3  ounces
  M. Sig.---Teaspoonful every four hours.

POLYPUS TUMOR OF THE WOMB.

Character.—This disease, which is one of the most common causes of excessive hemorrhage from the womb at the monthly periods, is of considerable importance. The term polypus is employed to designate especially a tumor which is attached to the inner surface of the womb by a well defined neck or pedicle.

Symptoms.—The most important is profuse menstruation. After a time as the tumor grows larger, and becomes more of an irritant, there are likewise frequent discharges of blood between the periods, often amounting to attacks of flooding. There is also a leucorrheal discharge which may be tinged with blood. Occasionally there are paroxysms of pain.

Treatment.—Unless the tumor is removed the case is hopeless. The operation simply consists in twisting the polypus off of its pedicle or neck. The patient is required to stay in bed ten days to two weeks.

ULCERATION OF THE WOMB.

Cause.—In a majority of cases inflammation of the neck of the womb is soon followed by ulceration. This appears around the neck of the womb, and just within the womb's neck.

Symptoms—1. The inflammations and ulcerations mix and run into each other, resulting in raw places, granulations or pimply surfaces, and hardened parts. Sometimes the pimply patches become red and hard, the whole surface spongy, and bleeding will set in on the slightest touch.

2. As ulceration progresses it wrecks the mouth of the womb and eats deeply into the womb cavity, giving it an unsightly appearance. Pus or matter flows freely at times and at other times scantily. It may be thick and yellow, or thin and of lighter color. A sensation of heat and smarting exists and sometimes severe pain in the right side of the abdomen and in the back part of the head.

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Menstruation.—Ulceration generally changes the character of the menstruation. Sometimes it becomes profuse and painful, at others scanty; and then it may be either frequent or tardy, giving rise to distress and pain in the lower part of the bowels and even in the groins and thighs.

Treatment—1. A tea made of the white pond lily affords an excellent remedy. It should be used internally and as an injection; in the former case in doses of half a teacupful three times daily. The fluid extract may be used in place of the tea in ten- to fifteen-drop doses twice a day.

2. Tannic acid, or in place of it a decoction of oak bark, used as an injection night and morning, gives excellent results.

3. The application of tannic acid directly to the ulcers has effected many cures.

4. Half a teaspoonful of boracic acid to a pint of water, injected when warm, and repeated twice a day, is a highly recommended remedy.

5. A decoction of golden seal used twice a day as an injection has been found to give satisfactory relief.

Accessory Treatment.—Where injections are depended upon, their virtue can be increased by simple injections of warm water between-times, and as often as every two or three hours.

CANCER OF THE WOMB.

Character.—The womb is the one part of a woman's body most frequently attacked by cancer. The disease may begin in the neck or the body of the womb. When situated in the neck of the womb it looks not unlike a cauliflower, hence the term "cauliflower cancer."

Causes.—It is more frequent among the whites. The lower classes are more susceptible than the upper. It is extremely rare that a woman who has not borne a child, is ever affected with cancer of the womb. In unmarried women who have had cancer of this organ the confession of an abortion has often been elicited, showing that pregnancy had occurred. As a rule a badly-lacerated cervix (neck of the womb), is very prone to cancer, the disease invariably starting in such a state of affairs.

Heredity plays a more or less important role, especially when cancer existed in the mother, or the mother's side of the family.

Symptoms.—In the very early stages they are absent. As the disease progresses the following will appear: 1. Hemorrhages. 2. Uterine discharges. 3. Pain. 4. Visceral disorders. 5. Cachexia.

Hemorrhage.—This is usually the first symptom, and is generally due to ulceration and breaking down of the parts. Unfortunately it Is attributed to the irregularities of the menopause, or to a return of the monthly flow after that period. Hence it is the bleeding of cancer is very often disregarded until it has progressed beyond the hope of a cure. The reappearance of hemorrhage two or three years after the menopause is strong proof of cancer and should receive immediate attention.

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Examination.—Every woman who has passed the fortieth year, and has vaginal bleeding, or leucorrheal discharge mixed with blood, should at once consult a, physician and insist upon an examination being made. Too often women through a mock modesty or for other reasons refuse to have an examination, and this stubbornness has cost many a woman her life. The symptoms of many of the diseases of the womb and ovaries are similar and it requires a thorough examination, at times under an anesthetic, in order to ascertain the true condition of the pelvic organs.

Pain.—This does not appear early, but late in the disease, as a rule too late for an operation. As the disease progresses the pain will spread over the entire portion of the lower abdomen, especially so when the bladder and rectum become involved; the pain is excruciating and intolerable. This torture is constant and does not ease of its own account. A woman suffering from cancer of the womb truly does live a hell upon earth.

Visceral Disorders.—These are generally due to the extension of the disease, or to the pressure of the womb on the surrounding organs. The bladder becomes very irritable, there is a constant desire to pass urine, and the patient will strain and strain in an endeavor to squeeze out a few drops in order to obtain a little relief. As the ulceration progresses fistulas may develop, the openings extending into the womb, the bowels or the rectum. Constipation becomes very troublesome.

Cachexia.—This is a characteristic symptom, and appears several weeks after the onset of the disease. It consists of a peculiar yellowish discoloration of the skin of the entire body. It is marked by emaciation, and the patient may waste away to "skin and bones."

Treatment.—If seen early and the disease is limited to the womb this organ should be removed at once. If the disease does not return in three years then the woman is fairly safe. But if the disease is not limited to the womb and has spread into the surrounding structures, and an operation be performed, the cancer is very liable, and invariably does, return.

Use of Morphine.—If the woman refuses operation, or should an operation be performed and the disease return, there is only one drug that will ease the pain, and that is morphine. The patient must practically be kept under its influence. In short she becomes an opium fiend, not through choice, but from necessity. This drug may be given, one-quarter of a grain three to four times daily, increasing the dose as required; but always by the advice of a physician.

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Checking the Hemorrhage.—If the hemorrhage becomes troublesome it may be necessary to curet the womb in order to control it. Drugs have little or no effect on it. Packing the vagina with antiseptic gauze will at times prove beneficial.

Injections.—The discharge must be attacked with might and main. For this purpose resort entirely to vaginal injections, using permanganate of potassium, seven grains to two quarts of water, three to four times daily; bichloride of mercury, same strength and as often. These douches at times weaken the patient, in that case probably two a day will be sufficient, but never less than this. The odor of the room may be very disagreeable, in order to counteract this place around the floor in saucers, pure carbolic acid, and air the room as often as possible.

DISPLACEMENTS OF THE WOMB.

Character.—The womb, like every other organ of the body, is subject to deviation from its normal position. The womb is situated in the pelvis between the bladder and the rectum. The bladder is attached to the front of the neck of the womb while the rectum is very close to, but not intimately atttached to the back of the womb.

When the womb becomes displaced the whole organ may turn forward, anteversion, or backward, retroversion. Or the womb may bend on itself. If the top of the womb falls forward then it is called anteflexion, or if it should fall backward then it would be retroflexion.

The symptoms and causes of the displacements vary more in degree than kind.

FORWARD DISPLACEMENTS.

Causes.—-The most frequent causes are changes in the uterine tissues, following an abortion or confinement. Lack of proper muscular support plays an important part, also congestions, tumors, lacerations of the pelvic floor, tightly fitting clothing, and prolapse of the vagina.

Symptoms.—Dysmenorrhea and sterility are frequently present. Leucorrhea may be troublesome. When the displacement is so great that the womb presses on the bladder, this organ will become irritated, causing frequent urination, and a more or less constant distress in the lower part of the abdomen. This irritation may give rise to inflammation of the bladder.

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Treatment.—If the menstruation is painful use the remedies as described for dysmenorrhea. For the leucorrhea, employ the remedies advised for that condition. If inflammation be present local treatments with the hot vaginal douches are to be employed. If a tumor is the cause it should be removed. The ideal treatment is to replace the organ.

BACKWARD DISPLACEMENTS.

These include retroversion and retroflexion. These are the most frequent varieties, and are more or less easily controlled.

Causes.—General lack of muscular tone of the uterine muscles, improper care during confinement, wearing a tight binder too long after being confined, tumors, pregnancy, falls, blows, distended bladder and lacerations of the perineum.

Symptoms.—Painful menstruation, as a rule, the first day or two of the flow, frequent miscarriages, leucorrhea, constant dull aching pain in the small of the back, dragging pains in the lower portion of the abdomen and thighs, headache, constipation, the bowel movements are at times painful, the bladder may be irritable, and at times the urine may escape when the woman laughs heartily.

Treatment.—1. First of all the organ must be replaced in its normal position. If not fastened down by inflammation a physician can replace it; at times an anesthetic may be required. After the organ is replaced the physician will introduce a pessary to keep it in its normal position. A pessary is a rubber ring of various shapes. This instrument should be removed at least once a month, cleansed and replaced. While the pessary is In the vagina, use a douche of lukewarm water once a day. If the pessary feels uncomfortable, or is painful on getting up or sitting down, it should be taken out and replaced; if still giving rise to trouble, it is in all probability too large, and a smaller one should be tried.

2. If inflammation exists, this is to be cured by local treatments and hot vaginal douches. For the leucorrhea, see description of that condition. For constipation, see constipation.

3. If the pessary maintains the uterus in its normal position, and relieves all the symptoms, then it is optional with the patient whether or not she will submit to an operation. If, however, the local treatments, and all other remedies fail to afford relief, then it will become necessary to open the abdomen, and perform one of the many operations for sewing the womb in its proper position.

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4. If the uterus is fastened down by inflammation, local treatments will do no good, and an operation will be the only proper treatment.

PROLAPSUS (FALLING) OF THE WOMB.

Prolapsus of the womb is a descent of the organ below its proper position in the pelvis, better known as "falling of the womb," and may occur in two different degrees. The term prolapsus is applied to any falling downward of the organ, which is not so great that the womb passes outside the body; whilst the latter, called procidentia, is that condition in which the uterus escapes partially or entirely beyond the external organs of generation.

Causes.—Falling of the womb is more apt to occur after maturity is attained, and appears especially in those who have led laborious lives or who have exercised themselves too much in lifting or carrying heavy weights. Hence cooks, laundresses, market-women and nurses, who lift and carry large and heavy infants, are especially liable to suffer from prolapsus. Women who have borne children are more frequently affected than those who are sterile, and lingering or instrumental labors, or getting up too soon after confinement, particularly predispose to it. Among the direct causes may be found congestion, hypertrophy or tumors of the uterus. Violent bearing-down efforts in labor, straining in obstinate constipation and forced respirations, such as occur in coughing, lifting heavy weights, and so forth, are also direct causes of falling of the uterus.

Symptoms.—The symptoms of this complaint are sensations of fullness and weight about the pelvis, wearisome backache, and leucorrhea. Menstruation is not usually interfered with and obstinate constipation is very common.

As the prolapse increases the bladder will be pulled down which will interfere with its functions; such as frequent desire to void urine, the inability to completely empty it each time, resulting in an inflammation of its mucous membrane. The rectum will be dragged down in the same manner, giving rise to more or less difficulty in the bowel movements.

Treatment.—In the first stage, consists in the employment of a pessary to bold the womb up to its proper level. If the perineum is lacerated, this must be repaired, otherwise a pessary will drop out. The only satisfactory treatment for this condition, especially when the womb hangs out, is an operation, which consists in amputating the neck of the womb, sewing up the lacerations of the perineum, and opening the abdomen in order to stitch the womb where it belongs. Nothing else will afford relief. This condition too often generates cancer of the womb, and if the women so affected would only consent to have this operation done they will be free from all the symptoms caused by this displacement, and oftentimes will be fortunate enough to prevent a cancerous growth of these parts.

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DISEASES OF THE OVIDUCTS.

The oviducts are two tubes, one on each side of the womb, and convey the egg from the ovary into the uterine cavity each month. These ducts are subjected to inflammatory disease, which may terminate in a good recovery or develop into an abscess.

Salpingitis.—This is an inflammation of the oviduct. It may effect one or both sides.

Causes.—Usually due to gonorrhea, or poisoning following labor, catching cold during the menstrual period, and excessive exercise. A cause usually overlooked is disrobing and lying down in a draught after a prolonged exercise, when the body is very much overheated.

Symptoms.—This disease may be acute or chronic. During the acute stage there will be fever, a great deal of pain on the side of the inflamed tube. This pain is increased on walking or standing. The patient while lying on her back prefers to have the knees drawn up and the lower part of the abdomen is extremely sensitive.

During the chronic stage there is pain in the affected side, which is increased on walking, running up and down stairs, intercourse and sweeping. Menstruation as a rule is painful, coming on a few days before the flow.

Treatment.—Rest in bed during the acute attacks, and thorough purgation of the bowels. Copious hot water vaginal douches, at least twice a day. Ice bags over the lower portion of the abdomen are highly recommended.

DISEASES OF THE OVARIES.

The ovary may be attacked by inflammation, which may or may not form an abscess, tumors, benign and malignant, which may be solid or cystic.

Ovaritis.—By this is meant an inflammation of the ovary,

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Cause.—A frequent cause in young girls is too close confinement in school, at work or overstudy. May be due to blood poisoning following a miscarriage or confinement, to gonorrhea, inflammation of the womb, salpingitis and using a cold instead of a hot vaginal douche, standing in a draught after being overheated, or while the body is in an overheated condition, jumping into a very cold bath.

Symptoms.—The pain is excruciating, and is situated low down in the abdomen, near the groin; this pain oftentimes shoots down the leg of the affected side. The pain may extend into the back and hip. The lower part of the abdomen is extremely sensitive, and the sufferer will not permit anyone to touch it. Even the weight of the bed clothing may give rise to so much distress that a prop will be necessary in order to prevent the bedclothing coming in contact with the skin. Fever will be present, the height of which will depend on the severity of the attack. Voiding urine, and the bowel movements may be accompanied by more or less pain. These symptoms occur during an acute attack.

Treatment.—During the acute attack rest in bed is imperative. An ice bag should be applied over the affected ovary, providing the skin is not too sensitive to stand it. If this is not well borne, try a hot water bag, or flaxseed poultice. In addition to these, which always tend to ease the pain, opium should be given by the mouth or with a hypodermic needle. When the pain is so great as to demand opium, of course only a physician should prescribe it.

Accessory Treatment.—At times any of the following drugs may afford relief. Antipyrine five grains every three hours; acetanilide four grains every three to four hours; or the two combined, giving two grains of each every three hours; or the tincture of gelsemium ten drops every three to four hours, in a teaspoonful of water; for reducing the fever tincture of aconite one drop every hour. The following prescription is often of value in all varieties of inflammation of the ovary, irrespective of the cause: 

Rx.---Tincture of gelsemium ........................... 2 drachms
      Tincture of cannabis indica...................... 2    "
      Peppermint water ................................ 3 ounces
  One teaspoonful, repeat in two hours, then every three hours.

When the inflammation becomes chronic, local treatments should be persevered in for several weeks; combined with hot vaginal injections. If there be leucorrhea use the remedies advocated under that headine.

If the local treatments do not afford relief then it will be necessary to have an operation, which will consist in removing the ovary if badly diseased, or if slightly so then only that portion which is affected.

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Pyosalpinx.—If an acute attack of ovaritis does not get well, or develops into a chronic condition, and pus forms, then it is called pyosalpinx; which means pus in the tube or oviduct.

Symptoms.—They will be those of ovaritis, only more so. Chills may also be present, due to the absorption of the poisonous material from the pus.

Treatment.—This consists in the removal of the ovary and tube, as no other procedure will effect a cure. Too often women suffering from this condition will delay operation until the last possible moment, which delay invariably costs their life.

Displacement of the Ovary.—The ovary may drop down from its normal position, in so doing it always falls back of the womb. This is called prolapsus of the ovary.

Prolapsus of the Ovary—Causes.—Generally due to enlargement of the ovary, which may be caused by inflammation or tumors. A sudden fall or misstep will at times cause an ovary of normal size to fall downward, which will invariably become inflamed.

Symptoms.—Pain located deep down in the pelvis, which may be of a dull aching character, or sharp and shooting. The bowel movements are frequently painful, due to the distended rectum pressing against the ovary. Intercourse is very painful and may be accompanied by nausea.

Treatment.—Local treatments and the use of the hot vaginal douche may afford some relief, but invariably it is necessary to remove the ovary, which operation will require a rest in bed of three to four weeks.

TUMORS OF THE OVARY.

The tumors of the ovary may be solid or cystic. The former may be benign or malignant. The solid tumors are divided into the fibrous, muscular and cancer, the latter of which is extremely rare.

Cystic Tumors of the Ovary.—These cysts are divided into the small and large. The former attain the size of an egg or the fist, while the latter may grow to any size, holding many gallons of liquid.

Causes.—The immediate cause is very obscure; usually due to inflammation of the ovary, sudden amenorrhea, excessive intercourse and blows on the abdomen. These tumors may be present at any age, from infancy to advanced old age, but are most common during the period of sexual activity, between the twentieth and fortieth years. Strange to say they are most frequent in the unmarried woman and those who have not borne children.

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Symptoms.—1. The woman may first notice that one side of the abdomen is larger than the other, and later on will be able to feel a lump on that side. This may increase rapidly in size, the whole abdomen becoming distended, and looking not unlike pregnancy. Indeed the woman herself may suspect that she is pregnant. Later on, there will be a sensation of weight in the pelvis, the bowel movements will be painful and the bladder very irritable, due to the pressure of the tumor. Painful and profuse menstruation is of frequent occurrence.

2. As the tumor increases in size there will be pressure symptoms, swelling of the legs, due to pressure on the blood-vessels, the privates may become swollen, due to the pressure on their blood supply; when the tumor becomes sufficiently large to press on or near the diaphragm there will occur shortness of breath. Besides these the face will have a pinched expression, characteristic of this kind of tumor; there will be marked loss of weight and general debility.

3. Pain more or less constant will be present, and at times violent in character. This may be due to peritonitis, caused by the irritation of the tumor.

Treatment.—1. The only cure is, of course, operation. If the cysts are very small, about the size of a pea, they can be removed from the ovary, and this organ allowed to remain. But, on the other hand, if they are the size of a pigeon's egg or larger, then it will be necessary to remove the ovary with the tumor.

2. The old method of tapping the cyst and drawing off its contents is to be condemned as dangerous.

3. The operation of ovariotomy, or removal of the ovary, will necessitate the patient remaining in bed three to four weeks.

LACERATIONS OF THE PERINEUM.

Character.—-This consists of tears of the anterior and posterior walls of the vagina, during childbirth. The laceration may extend through the posterior vaginal wall into the perineal body.

Symptoms.—1. When the anterior or front wall of the vagina becomes torn the support of the bladder is usually disturbed, and there will be more or less trouble in voiding urine. In addition there will be an inability to entirely empty the bladder each time, which may result in inflammation of the bladder.

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2. When the posterior or back wall of the vagina is torn the symptoms are more marked. This laceration as a rule extends through the muscle which is the main support of the womb from below, by holding up the pelvic floor, and in this way supporting the womb. These muscles are two in number, one on either side.

Treatment.—1. After labor the parts should be thoroughly inspected to see if a laceration has occurred. If so it should be sewed up at the time. When a physician tells a woman that she is torn, and it is no fault of his that such does happen, and desires to insert stitches, she should allow him to do so. Too often women will not permit it, and they regret it only once, and that is as long as they live.

2. If the tears are sewed right after the baby is born they will invariably heal and the parts will be restored to the same condition they were in prior to labor. If not the muscles and tissues do not heal together and the woman will begin to suffer from all kinds of pelvic symptoms, such as forward and backward displacements of the womb, prolapse of this organ, prolapse of the bladder and obstinate constipation.

3. These lacerations are divided into complete and incomplete. The first consists of those in which the tear extends through the bowel, the latter a tear of any extent near, or down to, but not through the bowel. If these lacerations are not repaired at the time, then it will only be a question of time before such an operation will be necessary, so why not permit the physician to do as he thinks best at the time these lacerations occur.

4. If the laceration is complete there will be a loss of control of the bowels, and they will move without the knowledge of the woman. If the tears are not repaired at the time, it is useless to attempt it less than three months after labor, if so a poor result will usually be otained[sic].

GONORRHEA.

Character.—This is an inflammatory disease commonly called "the clap." Greater than any other danger, presented to woman, is sexual intercourse with a man who has gonorrhea or syphilis; the former is the more destructive. The attack of gonorrhea in the male at the time of intercourse may be acute, chronic, or one which had not been thoroughly cured.

A Serious Disease.—While gonorrhea in man in most cases is a trifling disorder, although there are exceptions, in which it leaves a serious condition or becomes fatal, are not so vary rare; in woman it is one of the most serious diseases.

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Many an innocent and previously healthy woman, shortly after marriage to a man who supposed, himself to have been cured of gonorrhea years before, may get a destructive gonorrheal infection.

Diseases Induced by Gonorrhea.—When we take into consideration that a gonorrheal infection in a woman may cause inflammation of the vulva, vagina, urethra, bladder, lining membrane of the womb, the womb itself, the tubes and the ovaries; that the inflammation of the tubes and ovaries as a rule result in abscesses, nay more, that too often both ovaries have to be removed, and oftentimes the womb with it, then you will realize the dangers of an attack of this disease in a woman.

Causes.—They have been mentioned, intercourse with a man who has had an attack of gonorrhea, or is still suffering from an old attack which has not been thoroughly cured, and yet his physician has probably discharged him as "cured." Very frequently you will hear a person say that it was contracted from a water closet; this is impossible, especially with a man, but, a woman, under very rare circumstances, may come in contact with pus which has escaped from the male on to the seat of the closet. I have never heard of such an instance happening; although it is possible it is extremely improbable.

Symptoms.—1. These consist first, of a burning and itching sensation in the "privates," followed in a day or two by a discharge, which in a few days generally becomes profuse. The pain in these parts then becomes more or less unbearable. Each time the bladder is emptied there is a burning, scalding sensation, due to the urine flowing over the inflamed parts.

2. If the inflammation spreads to the urethra and bladder, there will be all the symptoms of cystitis (which see). If the disease extends to the uterus, there will be all the symptoms of acute inflammation of the womb, which will necessitate the woman going to bed. As the disease spreads to the tubes and ovaries the pain in the lower part of the abdomen will become intense and the fever increase; both of which will become intensified if abscesses form.

Treatment.—This consists in vaginal injections of permanganate of potash, five grains to a quart of hot water four times daily; bichloride of mercury, seven and one-half grains to the quart, same as above; or applications to the vagina of nitrate of silver, thirty to forty grains to the ounce of water. The latter should be done by a physician. A woman who has the symptoms first mentioned may at once suspect she has gonorrhea, and should consult a physician immediately and place herself under his care.

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DISEASES OF THE BLADDER.

The bladder may be irritable and yet not inflamed, so a special description will be made.

Irritability of the Bladder.—This may arise from purely functional causes and is of frequent occurrence in nervous women. Oftentimes present in diseases of the womb and vagina, and when the front wall of the vagina has been lacerated. Also present in displacements of the womb. It may follow abdominal operations and parturition (childbirth).

Symptoms.—Similar to those of cystitis. The urine from an irritable bladder is always clear, never contains pus.

Treatment.—Build up the constitution by the use of tonics. (See Anemia.) Regulate the bowels. The following may be tried: 

Rx.---Atropine sulphate ............................... 1/2 grain
      Distilled water ................................. 4   ounces
  Five drops in water after meals.

  If the woman is extremely nervous fifteen grains of the bromide of
  potassium or sodium every tour hours will prove of value.

If the woman is extremely nervous, fifteen grains of the bromide of potassium or sodium every four hours will prove of value.

Cystitis.—This is an inflammation of the mucous membrane of the bladder and may be acute or chronic.

Causes.—Acute cystitis may be caused by exposure to cold; gonorrhea; dirty instruments, particularly a catheter; pressure of the child during labor; inflammation of the peritoneum or pelvic organs; blows and falls when the bladder is distended with urine, and the improper use of certain drugs.

Chronic cystitis may be a continuation of the acute form, especially by pressure of the uterus during pregnancy, or large tumors.

Symptoms.—1. The acute form frequently begins with a chill, followed by fever, which is not very high. There is considerable pain in the lower portion of the abdomen, difficult and painful urination, and the urine is very cloudy. The desire to urinate at night may be very troublesome, and is apt to become more or less constant. There is a continuous feeling of pressure and weight over the bladder.

2. In the chronic condition the pain is not so severe, but the constant desire to pass water, especially at night, is very distressing. When there is a desire to pass water the patient must go at once, being unable to hold her water. If she should lift heavy weights or cough the water may dribble away.

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Treatment.—1. All instruments that are introduced into the bladder should be thoroughly cleansed and rendered antiseptic.

The acute form is best treated by rest in bed and an ice bag over the bladder. If the latter is not tolerated, then try a hot water bag. A very good drink is flaxseed tea. If the pain is severe, one-half grain of opium suppository will afford relief, repeating in about three hours if necessary. The following prescription will be found very useful: 

Rx.---Tincture of aconite .............................. 1 drachm
      Sweet spirits of nitre ........................... 1 ounce
      Liquor potassii citratis ......................... 6 ounces
  A dessertspoonful every four hours.

All alcoholic liquors must be restricted, and the diet should consist of milk and broths.

2. If the disease becomes chronic the patient should be kept on a bland diet. Vegetables, such as asparagus and those containing salts, and all alcoholic liquors should be prohibited.

3. If the urine is highly acid it should be rendered neutral by the benzoate of sodium; if it is alkaline, it should be rendered less irritating by the acetate of citrate of potassium.

4. Salol five grains four times a day is an excellent drug for this condition. Mineral waters such as Bethesda, Vichy and Buffalo Lithia are to be taken, at least several glassfuls a day.

5. Great relief is afforded by washing out the bladder, of course this can be done only by a physician.

6. If the water constantly dribbles away, it may be cured by stretching the neck of the bladder. This will necessitate remaining in bed for about a week.

Stone.—Stone in the bladder of course requires an operation for its removal. There is a prevalent idea that a stone in the bladder can be dissolved by medicines and lithia water. This is a false impression, and a great many quacks take advantage of it, generally to extort money from the sufferer.

DISEASES OF THE FEMALE BREAST.

The breast is subject to inflammation, abscesses and tumors.

MASTITIS OR MAMMITIS, INFLAMMATION OF THE BREAST.

Causes.—This may be produced by blows on the breast, or to any of the usual causes of inflammation. It may occur at any age, and in either sex. An acute attack is more often found present in nursing women during the first week or month after delivery. If such happens it is invariably due to cracked nipples.

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Symptoms.—At first only an uneasiness of the breast is noticed, then a chill occurs "which is usually followed by fever. The gland becomes intensely swollen, red and exceedingly painful. The inflammation may be so great as to cause an abscess.

Treatment.—This consists in preventing an abscess from forming. To accomplish this wash the nipples thoroughly three to four times a day, and stop the baby nursing the affected breast. The breast should be emptied of milk, by the cautious use of the breast pump. Cloths saturated in a solution of lead water and laudanum should be applied several times a day, and over these lay an ice bag.

ABSCESS OF THE BREAST.

If the inflammation does not subside an abscess invariably results.

Treatment.—1. If it appears that pus is forming hot applications should be made, preferably flaxseed poultices, to be renewed as soon as they become cooled.

2. As soon as pus is detected the breast should be incised and the cavity drained.

3. Too often women refuse to allow their physician to lance the breast, thinking it will come to a head and be well in a few days. This is a great mistake. The breast should be freely opened, in order that the pus can easily run out. If necessary an anesthetic should be taken, in order that the physician may accomplish thorough work. At times it may be necessary to insert a drainage tube; depending entirely upon the time which has elapsed from the formation of the pus until the time it is incised.

TUMORS OF THE BREAST.

These may be benign or malignant. Tumors of the former type can be readily removed, and will not give rise to further trouble. On the other hand, those of the latter class, which are of a cancerous nature, are very apt to return, unless operated on early and thoroughly.

CANCER OF THE BREAST.

Character.—Very often a woman will strike her breast against a hard object; or may be struck by a fist. This blow may be followed by a lump, which in a few days may disappear.

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Again, a woman while dressing may notice a lump in the breast, and think nothing further about it, or may try to cure it by rubbing in camphorated oil, or other household liniments.

These lumps frequently are the early stages of cancer, and the longer the delay the greater the risk. When a woman discovers a lump in the breast she should consult a physician at once in order that he may properly treat and watch it. If the lump continues to grow and remains hard then he will, or rather, should advise an operation. Under such circumstances these lumps are invariably a beginning cancer.

Treatment.—If the lump is small then it may not be necessary to remove the entire muscles, but simply the breast. On the other hand, if the lump is large and of long standing, or if the breast is immovable, that is, cannot be moved from side to side, then the breast, muscles and all surrounding tissue will demand removal. Recurrence may follow. Many women can be cured of cancer of the breast, providing they will consult a good physician early, which is, as soon as a lump is noticed; and if such does not become smaller or disappear in two weeks, submit at once to an operation.

Beware of Quacks.—It is surprising the number of women who will scorn the advice of a physician, and place themselves under the care of a charlatan or a quack. This class has killed more women than any of the most malignant of diseases, and yet the State will sanction their existence. Beware of quacks, especially when a cancer exists. These deceivers and money extortionists, advertise to remove these growths by the "roots." Such growths have no roots. And yet how many women will stand the torture of the acids which they apply to eat out the tumor, in preference to a clean cut operation, under an anesthetic, which will keep them in bed only two weeks. While the "eating out the roots" process requires a torture of several weeks.

SOME INTERESTING FACTS OF GREAT VALUE TO WOMEN.

Preventing Disease.—Education has a great influence in the development of diseases peculiar to women. During early childhood, when the pelvic organs are undergoing their development, the child must not be confined to the house and at school all day. She should be allowed as many hours recreation a day as feasible, in order that she may enjoy out-door exercise, and obtain all the fresh air possible, which is of so vital importance to her constitution. Too long daily practice at the piano or organ is also harmful.

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What to Avoid.—Everything that causes an increase of blood to the womb and ovaries should be avoided. In this category belong sexual excitement brought on by reading suggestive novels; by looking at obscene pictures; by masturbation (self-abuse); sodomy and even normal coition if performed too violently.

Care of the Skin.—The care of the skin is of great importance. Baths, daily or two or three times a week, should be encouraged. The accumulation of dirt blocks up the sweat glands, and nature is unable to throw off the impurities through these vessels. The Jewesses from Russian Poland are very susceptible to disease, and their appearance conveys to one the idea that they never wash their bodies.

Overwork.—All work and no play is a fruitful cause of ill health. Every woman who has the cares of a household should indulge in open-air exercise, or daily walks. Golf, horseback riding, walks, gathering flowers and the like, are to be highly commended, because they combine exercise with open air.

Proper Food.—There is room for improvement regarding food. Many girls have a loathing for food in the morning,, and often take nothing but a cup of coffee, and at times not even that, and go to school, and allow their brains to work for hours on an empty stomach. Such a practice is to be condemned in the strongest terms. It is not only a very bad habit, but it spoils the appetite, tends to cause a sour stomach, and impoverishes the blood which leads to nervous disturbances. The same may be said of candy, the immoderate use of which among girls and women corresponds to alcoholic beverages and tobacco in men.

Mode of Dressing.—Some few suggestions regarding the mode of dressing may be of value. One of the most frequent causes of congestion of the pelvis is the "decollete" evening dress and the bell-shaped nether garments. High heels, when worn at an early age are apt to change the normal inclination of the pelvis, a cause of tedious and difficult labors.

Tight Lacing.—Of much more importance is the use of the corset. A loose corset at the best is more or less binding. Tight lacing, of course, should be avoided, it displaces the various organs in the abdomen, pushing them in all directions, excepting the normal, and causes a crowding down of the pelvic organs, hence a fruitful cause of diseases of women.

The Menstrual Period.—Neglect during menstruation is one of the most fruitful causes of female diseases. Dancing and skating during this period should not be permitted. Sexual intercourse at this time, to say the least, is a repulsive habit, yet it is not of rare occurrence. Such a practice is very apt to result in a pyosalpinx (abscess of the oviduct, which see).

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Marriage with Disease.—Marriage with existing disease of the pelvic organs is a frequent cause of unhappiness for both husband and wife. Disease of such organs may prove destructive of all sexual desire or may prevent the possibility of conception. But if these should not ensue, there still remains the greater and more appalling danger of defective child development in the womb, or of the actual transmission of disease to offspring. Such calamities are all too frequent, and those who would enter the marriage estate should feel certain that their pelvic organs are free from diseased conditions.

Evil of Abortions.—Abortions, however brought about, play their part in causing inflammatory and nervous wrecks of women. They are the source of many serious and, ofttimes, permanent diseases. Causes of abortion are very numerous. Among those most common are displacement of the womb, ulceration of the neck of the womb. too much exercise, heavy lifting, jar from a slip or fall, strong emetics, powerful purging, etc.

Treatment of Abortion.—If the symptoms are slight, it may be that nothing more than a few days rest will be required, keeping the body as much as possible in a horizontal position, taking occasional cooling drinks, and at bedtime a pill composed of one grain of camphor and two grains of sugar of lead. In addition, a mustard plaster may be applied to the lower part of the back to allay any pain that may be experienced. If the conditions are severe, and flooding should set in, accompanied with marked symptoms of miscarriage, a napkin wetted with cold water, or vinegar and water, should be laid upon the external genitals, and pulverized alum mixed with a little honey must be given internally every half hour. If the symptoms are not thus allayed, recourse must be had to the plugging of the vagina with pieces of cloths soaked in a solution of alum or tannin; fill the vagina full and then place a fold of linen in the genital fissure and apply a bandage. Remove the plug in from five to ten hours, and replace if the discharge continues.

Conception.—Every young couple intending to enter the marriage relation should know what a terrible curse they are liable to transmit to their future children through ignorance of the vital principles which regulate reproduction. This attended to, it then remains with the mother to mold the infant growing within her by being herself at the time what she would like her child to be.

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The physical obstacles to conception are chiefly those diseases which have been previously described. When it is dependent on the causes which produce painful menstruation, or profuse menstruation, or a suppression of menstruation, the remedies are the same as are pointed out for those complaints. If inflammation of the ovaries be the cause, a cure may be effected, provided the inflamed condition be removed. If inflammation or ulceration of the neck of the womb be the obstacle, the remedy may be found in the treatment recommended for these affections.

CHANGE OF LIFE (MENOPAUSE).

This is better known as the "change of life," also called the climacteric.

Time and Character.—It comes on gradually, extending over a period of three to four years; it comprises the times when the monthly flow begins to be irregular, gradually diminishes and ceases altogether. As a rule in most women it begins about the age of forty-five, but invariably so between forty-five and fifty years. Those who menstruate early continue to menstruate longer than these who begin late, hence have a late menopause. Those who suffer from a chronic inflammation of the womb or are weakened by severe uterine hemorrhages begin to change life sooner than a healthy woman.

When the menopause comes on gradually the woman is not very liable to have severe disturbances, but if it comes on abruptly the discomforts are very bad, and the general strain of symptoms are marked.

Dangers of the Period.—This period is a critical point of a woman's life. Too often women while passing through this stage pay little attention to it, and every bad symptom is attributed to the "change of life." This is the time of all others that cancer of the womb and breasts are prone to develop. Every woman with a lump in her breast, which develops during this period, should consult a physician at once. Whenever bleeding takes place from the vagina, after the menopause has ended, invariably signifies beginning cancer, and the woman should immediately submit to an examination.

Symptoms—1. The first symptom of the menopause is irregularity in the menstrual flow, as regards the time and quantity. The intervals between the menstrual periods will become extended, say every five to six, seven or eight weeks. Sometimes, on the contrary, menstruation becomes more frequent. The periods last longer, say six to eight days. There will be congestion of the head, causing a red face, headache and indistinct vision, buzzing sounds in the head and ears, dizziness, the sleep is disturbed by dreams, and at the time the flow should occur may have bleeding of the nose.

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2. Besides the above, there may be catarrh of the stomach and intestines, congestion of the liver rendering it torpid; the kidney disturbances generally appear in the form of a sediment in the urine. Leucorrhea may be very troublesome. An eruption of the skin of the face may occur, and there may be intense itching, burning or smarting sensations all over the body. The vulva may be the seat of most distressing itching.

3. A very disagreeable feature of the "change" is the fever and sweats; this consists in a rush of blood to the head, the body becomes very warm and then breaks out into a profuse perspiration. This may occur at any time and place. When others think the room very cool, she will think it exceedingly warm.

4. The heart is often affected in the form of palpitations and shortness of breath. The nervous system also shows evidences of a general upset. Sometimes the limbs become very trembly. The temper is subject to great changes, and the sexual appetite may be greatly increased. She may become delirious, or even go insane.

5. The organs of generation undergo marked changes. The uterus, vagina, vulva, ovaries and breast all shrink and become greatly reduced in size.

Treatment.—1. Although this is a perfectly natural process, which is of normal occurrence in every woman's life, conditions will arise demanding interference.

Above all keep the bowels open. For the sediment in the urine it is well to drink Vichy or Seltzer water freely during the day; or to take half a teaspoonful of bicarbonate of soda in a tumblerful of water in the course of the day.

2. The congestion of the head and the disturbances of vision are relieved by hot foot-baths, with or without mustard, and of the cold water eye douche five minutes three times daily.

3. Lukewarm general bath taken three times a week will keep the skin in good condition, which is of value.

4. Those women who have a tendency to stoutness should adhere to a restricted diet, such as fish, meat, green vegetables, lettuce, salad and juicy fruits. Milk and beer are prohibited.

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5. The few women who lose flesh must be well fed, and have chocolate and plenty of milk to drink, providing they can digest them.

6. A sudden suppression of the flow during this period is particularly dangerous, hence she should avoid getting the feet wet, wet skin, and should not take a cold bath nor wash the privates with cold water. All these refer to when the menses are present.

7. If hemorrhages occur employ the remedies advocated for the treatment of menorrhagia and metrorrhagia.

8. If the bleeding is quite profuse, pack clean pieces of linen tightly in the vagina, and allow them to remain until a physician is consulted, which should be immediately. This method of packing the vagina will control the bleeding until the physician arrives and institutes more radical measures.

ABORTION.

Meaning.—Abortion is the expulsion of the product of conception. from the womb. It is also called miscarriage, by which name it is better known. Amongst the laity at large the term miscarriage is generally used when this accident happens without any violence on the part of the mother, whereas abortion is applied when attempts have been made to bring on this condition by the introduction into the womb of instruments.

Divisions.—Abortion has been divided into spontaneous or natural and accidental. A better division is spontaneous and artificial. The latter class is divided into therapeutic and criminal; therapeutic abortion is that in which it is done by the physician in the interest of the mother's life or health, while criminal abortion is without this or any other justification. It is further divided into complete and incomplete; threatened and inevitable.

Complete Abortion.—By complete is meant that all the product of conception, fetus and afterbirth, is expelled; incomplete, when only a part of it comes away, invariably the fetus, the afterbirth or part of it remaining in the womb; when the symptoms of an abortion appear, and it can be checked, it is spoken of as a threatened abortion; whereas if it is inevitable, when in spite of all that is done, miscarriage occurs.

Criminal Abortions.—The greater number of miscarriages occur in the first three months of pregnancy. It has been shown by statistics that criminal abortion is more frequent from the third to the sixth month than in the first two months. The explanation of this fact is due, that up to three months the woman hopes that there is simply a delay in the appearance of the flow, but when this hope fails she is ready to resort to any procedure to end a pregnancy which now becomes almost certain; on the other hand when six months have elapsed the life of the child has become so manifest that she shrinks from its destruction. Movements of the fetus in the womb make successful appeals to the mother's conscience, if not to her love also, for the salvation of the new life which dwells within her womb as its sanctuary.

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Dangers of Abortion.—It is surprising the number of criminal abortions that occur yearly, and which fail to come to notice, unless the victim dies, when an expose is made by the coroner. And even then many women die with the names of the abortionist and her seducer sealed upon her cold lips. Women do not for one instant think of the damage which is wrought to their generative organs, when they introduce a knitting needle or "what not" into the womb in order "to open it," so that a miscarriage will occur. Inflammations, displacements of the womb, and pelvic abscesses, and abscesses of the ovaries too frequently follow these foolhardy attempts. How many women have sacrificed their lives in this criminal and damnable manner?

Causes.—1. The causes of this unfortunate condition are numerous, they may be due to disease of the fetus, placenta, womb or the mother. Then again the father may be at fault. For instance, men who are confirmed alcoholics, or suffering from consumption or syphilis will invariably have a serious effect on their offspring, in that if pregnancy should occur the fetus dies within a month or so after conception. Abortion is of frequent occurrence in the wives of men who work in lead.

2. Violent exercise, as running, dancing, jumping, riding on a hard trotting horse or over a rough road; lifting heavy weights, falls, blows, tight corsets, surgical operations, especially if on the organs of generation, are very prone to cause an abortion. Frequency of intercourse is not an unfrequent cause.

3. Among other causes which may be attributed to the mother, are infectious diseases, such as typhoid fever, during which she is very apt to abort; syphilis, this is one of the most frequent causes; backward displacement of the womb plays a very important part in this condition; a pregnant woman working in a tobacco factory is very liable to miscarry.

4. Again violent sneezing or cough may be the cause. Tumors of the womb and malignant disease of this organ are also active factors; though as a rule a woman with cancer of the womb rarely becomes pregnant, the same applies to large fibrous tumors, and the smaller when located in the cavity of the womb. High altitudes will also produce an. abortion, and it is asserted that in certain mountainous countries pregnant women descend to the valleys to escape the accident.

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5. Medicines play an important role in the causation of this accident, such as active cathartics, laxatives and even emetics. The administration of quinine has been followed by miscarriage, although oftentimes it has been attributed to the disease and not to the medicine. But many of these drugs cannot be blamed for the accident, as there usually exists a tendency of some kind to a miscarriage.

6. The fetus may be affected by the same diseases as the mother, which if it should cause the death of the fetus will produce an abortion. Excessive distension of the womb due to plural pregnancy is apt to produce premature contractions of the womb, with a resulting miscarriage.

Symptoms—1. There may be premonitory symptoms such as flushing of the face, alternate flushes, and of heat and chilliness, pain in the back, irritability of the bladder which may extend to the rectum.

The characteristic symptoms are hemorrhage and pains. These pains begin in the lower part of the abdomen and on both sides of the same, in the groin or just above it. As the condition progresses these pains extend to the back, and later on pass around to the front. The pains begin first, to be soon followed by a bloody discharge, or vice versa. Some cases have a gush of watery fluid early in the attack, which may be slightly discolored with blood; this discharge does not necessarily indicate rupture of the ovum and hence that miscarriage is inevitable, for it may occur from inflammatory diseases of the womb.

2. The flow of blood is very much greater than that which occurs in menstruation; large clots are very apt to be passed, in which, if carefully sought for, the ovum may be found.

3. After seven or eight weeks of pregnancy the symptoms of abortion are quite plain. Prior to that time it may be mistaken for a case of painful menstruation.

4. If the pregnancy has advanced beyond three months the fetus as a rule escapes first, soon to be followed by the afterbirth. If the afterbirth is not expelled the woman is liable to suffer from hemorrhages until it is removed. These hemorrhages may be so great as to cause a fatal result, providing the woman has not a physician in attendance.

Treatment—1. If a woman is subject to repeated miscarriages she should exercise every care to place herself in the best surroundings during each pregnancy. At the regular time each monthly flow is expected she should remain in bed for a few days, this will give the body absolute rest and may tide her over to full time. If she has been in the habit of aborting at a special time, say the third or fourth month, when that period is reached she should go to bed several days before the time expected and remain there at least two weeks.

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2. If the abortions are due to syphilis, a course of mercury and iodide of potash should be instituted. If due to a backward displacement of the womb, this should be corrected by placing the womb in its normal position and holding it there with a pessary, or by an operation if necessary. Sexual intercourse during pregnancy should be prohibited, as this is a very frequent cause of miscarriage.

3. When a pregnant woman feels pains in the lower part of the abdomen, soon followed by the discharge of blood, or a sudden discharge of blood followed by pain, she has in all probability a threatened miscarriage. She should loosen all her clothing and lie down; her drinks should be cold; twenty drops of laudanum with half a teacupful of water should be injected into the rectum, or a half grain opium suppository may be inserted. If the symptoms are not abated in one hour the injection or suppository should be repeated, and again at the end of the second and third hours if needed. If the patient is very restless and nervous, twenty to thirty grains of chloral may be added to one of the opium injections; if such is done do not use warm water, but the yolk of an egg and some warm milk, in order to prevent the drug from irritating the bowel.

4. The opium may be continued from day to day as long as there is hope of arresting the abortion. Meantime once in two days the bowels should be opened by a warm water injection, or by a mild laxative. Should the pain and hemorrhage cease it is better for the patient to remain in bed for three or four days after this cessation; when she gets up she should only gradually resume her usual habits of life, even then as an experiment, and be prepared to return to bed at the first recurrence of the former symptoms.

5. Unfortunately in the majority of cases the hemorrhages do not cease, or having stopped return, and the abortion is apparently inevitable, or the flow may be so great that it will be necessary to complete the abortion in order to save the life of the woman.

6. If the abortion is inevitable stop the bleeding and empty the womb. Hot water injections may be valuable to accomplish the former. If they do not suffice, then the vagina should be tightly packed with antiseptic gauze, antiseptic lamb's wool, or pieces of boiled linen or muslin. In order to hold the packing in place a napkin should be tightly applied.

7. When an inevitable abortion is assured the physician may pack the vagina with tampons and allow them to remain for eighteen or twenty-four hours, and usually when removed the ovum (if it has not been previously expelled) and the after-birth will be found forced out of the womb. If the after-birth does not come away in twenty-four hours the woman should be placed under an anesthetic and the womb emptied of its contents. If not the discharge in a few days will have a very bad odor, and the patient develop blood poisoning.

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Every woman who has a miscarriage should remain in bed at least ten days to two weeks after such an occurrence. The women who do not properly attend to this accident are the ones who later in after life pay the penalty, which either means chronic invalidism, or the removal of one or all of her pelvic organs which may or may not result in death.

CONCEPTION.

Character.—A woman who has conceived is pregnant; pregnancy begins with conception and ends with labor, providing an abortion does not occur. It is normal when the uterine cavity contains the fecundated ovule or ovules; and abnormal, ectopic or extra-uterine, should it or they be outside of that cavity.

The Ovule or Egg.—Each month when menstruation occurs an egg or ovule, as it is called, escapes from the ovary. An ovule may come from the one ovary, or from both, or two or more may come from the one, and so forth. Leading from the ovary into the cavity of the womb is a tube called the oviduct. When the egg or ovule drops from the ovary, it falls into the end of this tube, which by a wave-like motion conveys it to the cavity of the womb, where it remains until the next menstrual period, when it is carried off with the flow. A new one is then deposited.

Twins.—If one ovule passes down and the woman becomes pregnant that month the result will be one baby; if there are two ovules and impregnation occurs, the result will be twins, and so on.

Ectopic Pregnancy.—On account of disease, or from other causes, the progress of the ovule or egg may become obstructed, then the egg or eggs will become lodged in the tube. Should it or they become impregnated while lodged in the tube, the pregnancy will be an extra-uterine or ectoptic pregnancy.

How Pregnancy Occurs.—How does impregnation occur? When the male has intercourse with the female the semen of the male is deposited in the vagina of the female in such a position as to "bathe" the neck of the womb. The heat of the parts causes this gelatinous seminal discharge to liquefy. The semen is merely a solution to convey the spermatozoids. The spermatozoid is composed of a head, of a tail and of an intermediate segment, sometimes called the body. The entire length of the human spermatozoid is not more than 1-500 to 1-325 of an inch. The spermatozoids have an eel-like motion, the tail being the motile power. The spermatozoids move along until one of them comes in contact with the ovule, the head then enters the latter, and the tail drops off. Conception then occurs. Although there are thousands of the spermatozoids in each seminal discharge it only requires one to fecundate the ovule.

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Movement of Spermatozoids.—Their rate of movement varies. It has been estimated about three inches in three hours. They have been found alive in men who have been executed seventy and even seventy-two hours after death. In the human female they were found endowed with active movements in the neck of the womb seven or eight days after coition. In temperate climates boys of twelve years may have discharges simulating the seminal fluid, but it is unusual for spermatozoids to be found in these discharges before they are fifteen or sixteen years old. One careful investigator claims that about one-half of men between sixty and eighty years of age are capable of fecundation.

STERILITY.

Causes.—1. When a woman is unable to become pregnant she is said to be sterile or barren. At least one marriage out of every eight is childless. It is commonly believed that the fault is always, or nearly always, to be found in the wife, but modern investigation has shown that the husband is at fault in about one case out of every six. When the male is at fault it may be due to impotence, which is an inability to perform the sexual act to aspermatism, although he may succeed in getting an erection he may be unable to have an ejaculation of semen; or to zoöspermia, the condition in which the ejaculated semen does not contain spermatozoids, and, therefore, has no fertilizing power. Or again the testicles may be improperly developed.

2.—If the female is at fault it may be due to the absence of the ova. In chronic inflammatory diseases of the ovaries the ovule may disappear, or the end of the oviduct may become closed. If such be the case, the egg will drop into the general peritoneal cavity and be absorbed. Another cause is incapacity for sexual intercourse, such as absence of the female organs of intercourse, inflammatory diseases and tumors of the vulva and vagina. If the perineum is badly torn the seminal fluid will flow out, a cause of sterility.

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3. A frequent cause is a very small opening in the neck of the womb, which is not sufficiently large to permit the spermatozoids to enter.

Treatment.—If due to inflammatory disease resort to the remedies described for the various inflammations of the generative organs.

If the end of the oviduct is occluded, and tumors are present, or should the perineum be badly torn, or a small opening in the neck of the womb be the cause, then an appropriate operation will be the only procedure which will tend toward future conception.

Lack of Orgasm.—A condition for which a physician is frequently consulted is lack of the normal feeling of the highest sexual excitement, called orgasm. With such the fault is probably due to some imperfection in the nervous system. The lack of orgasm may be found in otherwise healthy women, and not a barrier to conception.

In those who have never experienced the orgasm it is incurable. With others the use of tonics, galvanic battery, and such drugs as damiana, phosphorus and cantharides may prove of value.

UTERINE PREGNANCY.

Nature's Most Wonderful Miracle.—It has been well said that every pregnant woman should be looked upon as a laboratory in which nature is performing that most wonderful of all her miracles, the fashioning of a new human being, and that nothing should be allowed in any way to disturb or derange this most important operation. Could such an idea be constantly kept in mind not only by mothers themselves, but by all those who surround or even momentarily approach the female who is performing the most sublime duty of her sex, that of continuing the race, and every effort made to aid her in accomplishing this great function in the most perfect manner possible, what vast improvements might be looked for, even in the next generation of mankind.

First Indication of Pregnancy.—The first indication of pregnancy is generally the stoppage of the monthly periods, and it is also one of the most reliable of the early indications. It should be remembered, however, that there is no certain sign of pregnancy, none which has not been found to fail, and lead into errors which were profoundly mortifying, if not worse, up to the time when the heart of the infant can be heard to beat through the walls of the mother's abdomen. This beat of the child's heart can seldom be positively identified before the fifth month, and often not until the sixth.

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Failure of Signs.—In some instances pregnancy may occur and yet the monthly flow continue. This is quite common for one or two months, and less frequent for four or five. In fact, some mothers assert that the first intimation they had of being pregnant was quickening or feeling the motion of the child, which generally makes itself evident about four and a half months from the date of conception.

The Morning Sickness.—Morning sickness occurs with most females for the first few months of pregnancy, and some females when pregnant suffer intensely from it. It usually comes on whilst dressing, not being felt on first getting up, and when not very severe often passes off later in the day to recur, however, the next morning. It differs from other forms of sickness, such as those which are due to disease of the stomach itself, in that as soon as the vomiting is over the patient is often perfectly well again, and can take food immediately afterward. The sensitiveness of the stomach to odors and flavors, and the peculiar ease with which feelings of nausea are brought on by such impressions is a very significant sign, and rarely fails, if supported by the other usual symptoms, to indicate pregnancy when it is well marked.

Changes in Mammary Gland.—Changes which occur in the mammary glands are valuable corroborative signs. They consist in the enlargement and puffiness of the nipple, the darkening and increase of size of the areola, and occasionally the secretion of milk. These indications show themselves during the second and third months.

Quickening Period.—Quickening is the feeling of the movements of the child, which is so constantly noticed by the mother about the end of four and a half months, or just half way through the pregnancy, that it often helps to fix the time of the approaching confinement. The first sensation is described as being like the fluttering of a bird, or the creeping of an insect, but after a few weeks it becomes progressively more decided, and more perceptibly like the struggles of an infant with human arms and legs. The popular idea that up to the time of quickening the child in the womb is not alive is, of course, totally erroneous, because if the infant was not living from the very day of conception it would not grow and develop. It is only felt primarily at this period because before the date of quickening its struggles have been too feeble and made too deeply in the cavity of the abdomen to be perceptible.

Changes in Abdomen.—In the early months of pregnancy the abdomen is often even flatter than in the unimpregnated female, but after the period of quickening enlargement occurs, and in the latter months becomes so great as to cause, in many instances, a good deal of distress by mere

(Continued on page pg0572)

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OVARY AND MAMMARY GLAND.

    FIGURE NO. 1.---The ovary, showing the vesicular bursted and the 
large grume which fills its cavity.

    FIGURE No. 2.---Change in the breast from pregnancy.
        A. Nipple.
        B. Sebaceus tubercles.
        C. Spots in the branded areolo.
        D. Marks due to the enlargement of the skin.

    FIGURE No. 3.---Lobes of a mammary gland.
        A. Acinos.
        B. Canaliculi or small canals.
        C. Conduit formed by several small canals.

    FIGURE NO. 4.---Mammary gland.

    FIGURE NO. 5.---Mammary gland in woman.
        a. Nipple.
        b. Areola.
        c, c, c, c, c. The gland lobes.
        1. Breast or enlarged part of one of the conduits which carry milk.
        2. Extremities of the conduits which carry milk.

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Image: ../figures/png120/fi0571-01.png Image: ../figures/png120/fi0571-02.png Image: ../figures/png120/fi0571-03.png Image: ../figures/png120/fi0571-04.png Image: ../figures/png120/fi0571-05.png

OVARY AND MAMMARY GLAND.

For an explanation ot the illustrations see text on opposite page.

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pressure, distension and weight. The stretching of the skin necessary to render it capable of covering the uterine tumor generally gives rise to numerous cracks in its surface, which remain as whitish scars through after life.

Changes in Disposition.—Changes in temper and disposition, longings for strange and unsuitable food, drowsiness, toothache, heartburn, palpitation of the heart, and so forth, are less constant and therefore less reliable symptoms of pregnancy, some of which, however, occur in a large proportion.of the cases.

Duration of Pregnancy.—This average date is usually considered for the fruit of the womb two hundred and eighty days, or forty weeks, or a week over nine calendar months, from the day of the cessation of the menstrual discharge when last seen at the commencement of pregnancy. In order to be able to make this calculation accurately it is a good plan for every married woman to keep upon a calendar a regular account of the day in each month when she ceases to be unwell, so that if at any time before the next period impregnation should occur, she may have at hand the precise datum upon which to base her preparations. The date of quickening, when that is a prominent symptom, as is the case in most pregnancies, ought also to be carefully noted.

Pregnancy Table.—The table given below is one which will prove reasonably accurate:

 

Jan.  1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Oct.  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  1  2  3  4  5  6  7Nov.
Feb.  1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 .. .. ..
Nov.  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30  1  2  3  4  5 .. .. .. Dec.  
March 1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Dec.  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  1  2  3  4  5Jan.  
April 1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 ..
Jan.  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  1  2  3  4 ..Feb.  
May  1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Feb.  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28  1  2  3  4  5  6  7March  
June  1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 ..
March  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  1  2  3  4  5  6 ..April  
July  1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
April  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30  1  2  3  4  5  6  7May  
Aug.  1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
May  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  1  2  3  4  5  6  7June  
Sept. 1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 ..
June  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30  1  2  3  4  5  6  7 ..July  
Oct.  1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
July  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  1  2  3  4  5  6  7Aug.  
Nov.  1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 ..
Aug.  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  1  2  3  4  5  6 ..Sept.  
Dec.  1  2  3  4  5  6  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Sept.  7  8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30  1  2  3  4  5  6  7Oct.  

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Explanation.—Find in the top line the date of the last menstruation the figure below will indicate the date when the confinement may be expected. If the date of menstruation is April 8, then the date of expected confinement will be January 13.

Care During Pregnancy.—The pregnant woman should ask herself, before making even a trivial variation from habits of life, which have been proved by experience conducive to her individual health, "can this change produce any injurious effect upon the future, mental or physical, of my darling baby?" and unless the answer is unequivocally in the negative, it is her duty to refrain from incurring unknown risks by alteration of diet, exercise, sleep, clothing, and so forth, which, previous experience has taught her, contribute most effectually to the preservation of her perfect sanitary condition.

Food During Pregnancy.—The amount of food taken into the system during the early period of pregnancy, as intimated by nature in the broad hint of morning sickness, should be rather less and of a more easily digested quality than at ordinary times. But in the latter months, when the infant is rapidly developing and material must be supplied for muscles and bones in abundance, the quantity of aliment should be largely increased. It is better, however, to eat more frequently than to run any risk of over-loading the stomach at such a time.

Exercise.—The amount of exercise should also be ample, since this is vitally important for the proper assimilation of food into the blood, whence it is transferred to the fetus in the womb, and contributes, of course, every atom of the material composing the little body. Care must be taken, however, to avoid violent exercise of any kind for fear of bringing on abortion with all its dangers to the mother, and in the earlier, months with certain destruction to the child.

Child Blemishes.—As regards the production of blemishes and deformities in the infant by mental impressions of the mother during pregnancy, there is a large amount of evidence that such an effect is produced, although many of the stories of such occurrences are grossly exaggerated or totally without foundation. At the same time a calm and equable frame of mind is greatly to be desired during the whole period, and anything which is likely to operate in the direction of causing mental shock, depression or excitement should be scrupulously avoided.

Treatment.—1. Among the diseases of pregnancy are excessive vomiting, which may be treated with tablespoonful doses of lime-water, iced carbonic acid water, or iced champagne, ginger, bismuth, hydrocyanic acid, and two-grain doses of oxalate of cerium; heart-burn, from which half a teaspoonful of bicarbonate of soda or ten drops of aromatic spirits of ammonia affords relief.

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2. If the nausea is due to a prolapsed or backward displaced womb the condition will be relieved by replacing the womb and inserting a lamb's wool tampon. A method which often suffices is to give the mother a cup of hot tea and a cracker about an hour before she arises.

3. Any of the following, cocaine in the dose of two to three drops of a 4 per cent. water solution, every fifteen minutes until ten doses are taken; one drop of tincture of aconite every hour; and tincture of nux vomica, ten drops in water every four hours.

The following prescriptions are advocated: 

      Tincture of nux vomica ........................ 2   drachms
      Hydrochloric acid ............................. 1/2 ounce
      Essence of pepsin ............................. 3   ounces
  Teaspoonful after each. meal and at bed-time.

Or, 

      Bismuth subnitrate ............................ 2   drachms
      Tincture of aconite .......................... 10   drops
  Make into ten powders. One powder every hour.

Or, 

      Carbolic acid or creosote .................... 10   drops
      Subnitrate of bismuth ......................... 2   drachms
  Make into ten powders. One every two hours.

Treatment of Excessive Vomiting.—The nausea and vomiting may be so pronounced as to be uncontrollable and is then called the hyperemesis of pregnancy. When this exists nothing will remain on the stomach, and the woman rapidly loses flesh and becomes very much exhausted. When blood appears in the vomited matter of these cases the termination, as a rule, is unfavorable.

The treatment consists of emptying the womb, in other words, producing an abortion, and is one of the exceedingly few reasons for which a physician is justified in producing an abortion.

Treatment of the Constipation.—Constipation, which must be meddled with very cautiously by the aid of mild saline laxatives, such as a teaspoonful of rochelle salt, a dessertspoonful of castor oil, or injections of soap and water; and piles, the discomfort of which can be palliated only by the use of some such ointment as that already recommended.

Treatment of the Toothache.—If toothache comes on care must be taken that sound teeth are not extracted in the vain hope of relieving it. When teeth decay rapidly in pregnancy it seems sometimes to be due to the removal of the bony materials for the purpose of building up the skeleton of the fetus, and efforts should be made by supplying the lime salts as phosphates or hypophosphites mixed with the food to remedy the difficulty. Finely powdered bones have been shrewdly recommended.

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Treatment of the Enlarged Veins.—Enlargement of the veins of the legs should be treated by bandages or elastic stockings, and dropsy of the feet and ankles should lead to an immediate examination of the urine, lest some tendency to albuminuria may be threatening.

Treatment of the Bladder.—Irritation about the bladder, perhaps with incontinence and retention, occasion much inconvenience, but can often be relieved by gentle laxatives and diuretics, such as the cream of tartar, or, if very troublesome, by a belladonna and opium suppository. The patient should, however, be guarded against the possibility of becoming fond of the action of anodynes, especially opium or chloral, at this trying time.

LABOR.

Definition.—Labor is the end of pregnancy, and may be defined as the process by which the fetus and the afterbirth are separated from the mother. Nature's design being the continuance of the race, the fetus must have reached such development before its expulsion that it is viable, that is, capable of living external to the mother. If, therefore, the product of conception be expelled before such capability, the process is not called labor, but abortion or miscarriage.

Premature labor.—Should labor occur in the seventh or eighth month It is called premature, because the fetus has not attained its perfect development; if labor be delayed beyond nine months it is called postponed, if the fetus be alive, but missed labor if it be dead.

Parturition.—Parturition is a term very often used instead of labor. When parturition occurs, with the efforts of the womb and the woman alone, it is called natural; but if it is necessary to render aid, usually by the application of forceps, it is called an artificial or instrumental labor. In order that a labor may be natural the fetus must not exceed the normal size and the presentation must be normal, also the passageway and the muscular forces required to cause the expulsion of the passenger.

Duration of labor.—This varies with race, place, climate, manner of living, heredity, physical conformation, whether first or subsequent labor, and with the sex, presentation and position of the child. Labor is shorter in warm than in cold climates, in savage than in civilized races, in women in the country accustomed to plain food, out-door exercises and regular habits, than in those leading opposite lives in the city. In the primipara (a woman who is having her first baby) it is longer than in the multipara (a woman who has had more than one child); it is also longer when the face or buttocks come first instead of the head, and with male than female children.

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Labor with First Child.—As a rule the primipara is in labor fifteen to twenty hours; the multipara six to eight hours. If the primipara is thirty-five years old and more, labor may be prolonged for twenty-one to twenty-seven hours; above forty-one years labor is very apt to be thirty-three hours.

Duration of Second Stage.—The second stage of labor is generally one-third that of the first stage. The majority of labors begin between 9 and 12 P. M., and end between 9 P. M. and 9 A. M.

Birth Presentation.—The presentation of the child varies. By far the greater majority of the children are born head first. The child may present by the head, buttocks (when it is called a breech), face and either shoulder. The vertex or head may demand forceps application at times, especially if at the expiration of any hour during the second stage it fails to progress. Should the face present, the physician will endeavor to push it up and change it to a vertex, otherwise it will be necessary to apply forceps. Such a child will have a blackened face, which discoloration at the end of a week or ten days will disappear.

Buttock Presentation.—If the buttocks present, more or less difficulty will occur and it may be necessary to apply force to the after-coming head.

Shoulder Presentation.—A shoulder presentation will require an entire change of the position of the child, as this is an impossible labor. As a rule both feet are brought down first, the head being born last.

Preparations for Labor.—The lying-in chamber should be large enough for suitable ventilation, and yet not so large as to be with difficulty heated. Every precaution to secure for the invalid a full supply of unpolluted air should be instituted, and conveniences for affording hot water at short notice are of importance. The bed should be a hair or spring mattress, which ought to be covered with some water-proof material; over this a thick, old spread, newspapers or comfortable, to absorb the blood and other discharges, should be laid, and this again covered with a sheet. The remaining bed-covering must be arranged according to the season of the year. In this room should be collected all the clothing which will be needed for the comfort of the mother and expected infant, and besides the articles of every-day use there should be provided a strong sheet, which can be tied around the post at the foot of the bed, for the patient to pull upon during her pains, a firm cushion for her to press her feet against if she so desires, an abundant supply of towels, plenty of soap and warm water, a pound or so of lard free from salt, a few yards of flannel, a soft, warm shawl or small blanket to receive the baby in before it is washed, sharp-edged but blunt-pointed scissors to cut the cord or navel string, eight yards of coarse sewing cotton doubled eight times and knotted at the two ends for tying the cord, a binder of strong new muslin about a yard and a half in length and half a yard wide, or larger if needful, and a paper of large strong safety pins for fastening the same around the invalid's abdomen after she is delivered.

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The Mother's Dress.—The dress of the patient should be the usual chemise and night-dress rolled up around her waist, so as to keep them from being soiled, and a sheet folded in four and pinned around her limbs as a skirt, fastening it at the right side so that it can easily be unpinnned and slipped down out of the way when the labor is completed.

Stages of Labor.—Labor, parturition or confinement, is divided into three stages. The first consists in the dilation of the mouth of the womb, sufficiently large to permit the fetus to escape. The second constitutes the birth of the child. The third is the expulsion of the placenta or after-birth.

First Stage of labor.—During the first stage of labor the patient may walk about the room, sit up in a chair or lie upon a lounge, as is most agreeable to her, but when the mouth of the uterus is dilated to the size of a silver half dollar she should take her position upon her left side, with her hips near the edge of the bed, and about a foot lower down than she is accustomed to lying. In this posture the medical attendant can best aid her in her trial until toward the end of the process, when some advantage is often gained by placing the patient upon her back.

Preparing the Nipples.—Preparation of the nipples should be made by washing them with strong green tea, or solution of a drachm of tannin in two ounces of cologne water, twice daily for three weeks before confinement, in order to harden the skin and render it less liable to crack and become sore whilst nursing.

Period of Actual labor.—The period of actual labor is generally ushered in with slight griping pains in the abdomen, and more or less aching in the back, which come on at first, perhaps, at intervals of half an hour, lasting for a minute at a time; then at intervals of ten or fifteen minutes, and so on until they grow severe and the space of respite between them dwindles to five, four, or even three minutes.

Pains and length of First Stage.—In the first stage of labor the pains have a cutting or tearing character, and are commonly felt in the stomach or lower part of the abdomen, and also in the back. They are accompanied by a frequent desire to pass water, produced by the pressure of the child's head upon the urinary bladder as it descends, and often by a disposition to evacuate the bowels, from a similar cause. Pressure of the head likewise frequently produces severe cramps in the legs, which may be partly relieved by friction, but often disappears as the labor progresses. The duration of this stage varies greatly, but in a labor of twelve hours' duration, the usual proportion would probably be ten hours in the first stage, an hour and three-quarters in the second stage, and fifteen minutes in the third.

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Pains of Second labor.—In the second stage of labor the character of the pains and the expulsive efforts which accompany them is changed. They now become what are commonly called bearing-down pains, in which the patient almost instinctively endeavors to aid the contractions of the uterus in its efforts to empty itself, by straining as if at stool; and, indeed, should she seem reluctant to yield to this disposition, she ought to be instructed to bear down exactly as if her bowels were being moved whilst constipated. The cries emitted are generally more like prolonged grunts, and can be readily recognized at a considerable distance by one who is familiar with their peculiarities. After a continuance of these pains for one, two or more hours the child's head, if that comes first, as happens in probably nineteen out of every twenty cases, begins to press upon the external parts or vulva, and finally, with an unusually forcible pain, often with a piercing cry from the mother, her baby's head emerges into the world. As a rule, the next pain expels the shoulders and hips, the rest of the body offering little resistance to the expulsive efforts of the womb after the head is born.

Third Stage of Labor.—The third stage, consisting in the delivery of the placenta, is usually attended with one or two slight pains, by which the after-birth is forced out of the womb into the vagina, whence it must usually be removed by the medical attendant.

Although in the majority of cases any intelligent person could successfully manage a case of labor, there are numerous accidents, malpositions and complications, which may occur without any warning in any particular case, so that if skilled medical assistance can possibly be procured it should by all means be sent for. The man or woman who neglects this runs a terrible risk of being the murderer of the mother, or of the child, perhaps of both.

Duty of Midwife.—But if no qualified physician is procurable, the acting midwife should from time to time, say every ten minutes during the second stage of labor, anoint the vulva or external parts of generation of the patient freely with lard, at the same time examining very gently, with the finger, what progress is being made in the descent of the head, supposing, as is usually the case, that forms the presenting part, as this too frequently causes puerperal sepsis, which see.

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The Delivery.—The moment the head is born the finger should be repassed in around the infant's neck, so as to find out whether the navel-string is wound around it, as not unfrequently happens. If such is the case, the cord should be pulled down a little, and the mother urged to bear down for the child's sake, as rapidly as possible, and complete the birth; when the cord must be immediately loosened and slipped over the baby's head to save it from strangulation. At the same moment the head of the child comes into the world the midwife's other hand should be placed upon the lower portion of the mother's abdomen, and the uterus pressed upon gently.

Treating the Womb.—As the body of the child is born the uterus should contract to the size of a ball, apparently about five inches in diameter, and if this does not take place, the womb should be firmly grasped through the walls of the abdomen, in the hand, and so stimulated to due contraction. This is very important, because, if it does not occur promptly the patient may bleed to death in a very few minutes.

Attending the Child.—As soon as the womb is found to be properly contracted into this hard ball, attention should be turned to the child. If it cries at once, the cord may be immediately tied an inch and a half from its attachment to the infant, with the sewing-cotton already provided, and then cut half an inch above this again, that is, half an inch further away from the child, squarely off. The baby is then to be lifted up, with both hands clasped around its body, for it is very slippery, and received by an attendant in the flannel or old blanket, which has also been prepared. The attendant ought either to hold it until the labor is completed, or to place it on its left side, in some safe situation, preferably in its cradle or crib, not in an arm-chair, where it may be crushed to death by being sat upon.

Expelling the After-birth.—During this time the midwife should keep her hand upon the patient's abdomen, gently pressing and kneading the womb occasionally, in order to promote the recurrence of a contraction, strong enough to expel the placenta. As long as the after-birth remains the woman is not safe from dangerous or fatal flooding; but whilst the uterus continues firmly contracted, and feels like a hard. ball under the fingers of the midwife, there is but little danger. After five or ten minutes, if slight pains come on, the mother should bear down a little, and the cord be gently pulled upon, when, in many instances, the placenta comes away. As it reaches the vulva, the patient should be told to cease her efforts, and the midwife should twist the after-birth round and round on itself, eighteen or twenty times, gradually withdrawing it at the same moment. This is to wind the membranes, or bag which held the water into a string, if possible, inside the vagina, and perhaps the uterus, so that they may all come away with the placenta in safety. The mass, when removed, should be laid away for subsequent careful examination, in order to determine whether any part has been left in the mother, as the effects of such an accident are much to be dreaded.

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Contracting the Womb.—The attention of the midwife should be, however, immediately returned to the mother, and her hand at once applied again over the abdomen, when the womb ought to be felt as a ball of some three and a half inches in diameter, or about the size of the new-born baby's head, and even harder than before. If not so felt, firm pressure and friction over the abdomen must be made to induce it to contract. Should it not do so within a minute or two the midwife must introduce her hand up the vagina into the cavity of the womb, under strictly antiseptic precautions, and pulling out the clots of blood she will probably find there, strive again to excite the womb to its proper contraction.

To Prevent Flooding.—Should these efforts prove unavailing, not a moment is to be lost, for the next five minutes will perhaps cost the patient her life by flooding. Let, therefore, a piece of ice, a sponge dipped in vinegar, or a peeled and gashed lemon, be carried up with one hand and rubbed around inside of the womb, whilst the other hand of the widwife, by firm pressure and friction over the patient's abdomen, contributes to stimulate that uterine contraction in which lies the mother's only safety. Or a teaspoonful of ergot, repeated in fifteen to twenty minutes. As soon as this is accomplished, as it probably will be by these remedies, a tight bandage should be pinned around the patient's body, with two or three folded napkins beneath it, pressing upon the part of the abdomen over the womb, to prevent relaxation, which happily seldom occurs when thus treated.

Making the Mother Comfortable.—After being securely bandaged, the patient may be lifted up a little, out of the wettest part of the bed, if it can be done without any effort on her part; but for fear of flooding, the more quiet the parturient is kept for the first two hours after labor, or until the blood has had time to clot firmly in the large, open-mouthed veins of the uterine cavity, the less is her danger. When the patient is made as comfortable as possible, a clean napkin, loosely folded, is to be placed between the thighs, but not pressed up tightly against the vulva, lest it act as a plug and prevent the detection of flooding, should that come on.

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Should the Child Not Cry.—In case the child does not cry when first born, its mouth should be carefully cleared of mucus and other obstruction, and a little cold water sprinkled upon its breast. Should this fail in rousing a gasping effort at breathing, the baby, still attached to the cord, if that is pulsating, should be put into a basin of very warm water, and after a minute or two, when the surface of its body is well heated, the dash of cold water over its face and breast again tried. If still unsuccessful, the baby should be wrapped up in hot flannels, and artificial respiration, by blowing into the mouth whilst the nostrils are held, and then forcing the air out by compressing the chest, attempted as a forlorn hope. The writer has found the results of dry heat, applied by cautious roasting before a fire, promising enough to warrant further employment in otherwise hopeless cases.

Baby's First Bath.—If, on the contrary, the child cries lustily, and the mother is doing as well as can be expected, the cord should be again examined to verify the fact of its being securely ligated, and the baby given its first bath. The infant should be rubbed all over with lard, to soften the vernix caseosa or cheesy matter with which it is more or less covered, then well washed with white castile soap and milk-warm water and thoroughly dried.

Dressing the Navel.—The cord is dressed by being drawn through a hole cut in the middle of a piece of soft old linen, folded once, and trimmed to four inches square, and after being wrapped in this is laid upward on the baby's stomach, and bound in place by a belly-band of silver flannel, fitted snugly but not too tight, and secured by safety-pins or a few stitches.

Of the Wrong Presentations.—The management of labor when the back of the head does not come down first, and especially when the buttocks, feet, or arms present, is so apt to be difficult and dangerous that a physician ought always to be summoned, even from a great distance and at the utmost inconvenience, should any signs of a "cross-birth," as it is popularly called, be detected, or should unusual delay in delivery render obstruction probable. It will sometimes be a comfort to a woman in labor who is anxiously awaiting the physician's arrival to be reminded that if the birth comes before the doctor it will be because everything is all right, whilst on the contrary, if there be anything wrong, the physician will usually have ample time to reach her before his services are actually needed.

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After-Management of Labor.—The management after labor should be such as will best avoid any excitement, either mental or physical, liable to light up inflammatory action in the womb, which has just been the subject of such momentous change. The patient, in ordinary cases, ought to remain in bed until the twelfth or the fourteenth day, partaking of semi-solid food until the third day, when the bowels should be moved. For this purpose she may be given a bottle of the citrate of magnesia in two doses, one-half hour apart, salts or an enema. After the bowels have been thoroughly moved, solid food should be given. She should not receive company for at least three days, but devote all her energies to the task of recovering as speedily as possible, both on her own account and for the sake of the frail, new life so utterly dependent upon her care.

PUERPERAL DISEASES.

Character.—The puerperium, or the puerperal stage, is the two weeks following the birth of the child. It begins immediately upon the expulsion of the placenta.

Among the diseases of the puerperal state may be mentioned after-pains, which, though seldom troublesome subsequent to first deliveries, may in others cause more suffering than the labor itself.

Treatment.—They can, however, be greatly relieved by the use of ergot just as delivery is accomplished, and of one-half grain opium suppositories, or forty-drop laudanum injections, or a Dover's powder, in two or three hours if they persist.

Sore Nipples.—Soreness of the nipples and cracked nipples are very apt to come on in patients with tender skins from the constant irritation of the baby's gums in nursing, and are unfortunately very difficult to heal, because the same irritation which originated the trouble in the first place is continually kept up.

Treatment of Nipples.—Vaseline, zinc ointment, laudanum and nitrate of silver sometimes succeed in curing the sore, but the most successful plan is to use a wooden shield with a rubber nipple if the baby can be persuaded to consent to the innovation. Women who suffer in succeeding pregnancies from this condition may do much to prevent its recurrence. About three months prior to the expected date of confinement rub the nipples night and morning with cocoa butter and expose them several hours daily in the sunlight. Before and after nursing the nipples of the mother and the mouth of the baby should be washed with a solution of a teaspoonful of boric or boracic acid in a tumblerful of water. The nipples should be thoroughly dried.

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Danger of Cracked Nipples.—The great danger of cracked nipples is that it may lead to abscess of the mammary glands (the so-called gathered breasts).

CHILD-BED FEVER OR PUERPERAL FEVER.

Character.—Puerperal fever is a very dangerous disease, which is invariably due to a lack of antisepis[sic]. All cloth or napkins that come in contact with the vulva of the woman which have not been boiled, the hands of those attending to her unless thoroughly washed, all instruments used unless rendered aseptic will carry dirt of some kind, giving rise to this condition, which, practically speaking, is blood poisoning.

It generally comes on or about the third to the fourth day after delivery with a violent chill, great thirst and extreme prostration.

Symptoms.—The uterine discharge, or lochia, which should persist for ten days to two weeks, becomes very foul, the odor of which is nauseating, or it quickly dries up.

The fever may run very high, and diarrhoea with obstinate vomiting may set in. The mind soon grows clouded, if the attack be a severe one, muttering delirium makes its appearance, and the patient often dies on the third to the seventh day of the attack in a condition similar to that observed in typhus fever.

Treatment.—A large majority of the cases prove fatal, but full doses of twenty to thirty grains of quinine, with one-thirtieth grain of strychnine sulphate every two to three hours, succeeds in saving a small proportion of the cases. If an abscess forms, be it in the pelvis or elsewhere, it should be incised and drained. Cold sponge baths every two to three hours will reduce the fever, and an ice bag to the head will oftentimes prevent brain complications.

Puerperal Mania.—This is a form of insanity liable to come on a week or ten days after confinement, in which there is frequently a singular aversion to the child, and perhaps to the husband also. A tendency to suicide is also prominent, and patients thus affected should be watched with the most unremitting care. Under perfect rest, nourishing diet, moderate stimulation and sedatives persons generally recover.

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Puerperal Convulsions.—These may come on before or during labor, as well as in the month following delivery. They are generally due to accumulation of urea in the blood, the consequence of temporary Bright's disease, resulting probably from the pressure of the uterus containing the fetus upon the kidneys. The treatment has already been pointed out under the head of uremia.

Milk-Leg.—This is an inflammation of the lymphatics of the limb, coming on especially toward the end of the second week after labor and deriving its name from the milk-white appearance usually presented by the skin of the affected part. As the febrile state of the system is apt to cause drying up of the milk, it was formerly supposed that in some mysterious way the lacteal fluid was transferred to the leg. At first it may be quite painful, but after the integument becomes accustomed to distention, the sensations are rather those of weight and discomfort than of positive suffering. The treatment is by laudanum or turpentine fomentations at first, and later with stimulating and anodyne liniments, which hasten a little the naturally tardy convalescence. The ordinary duration of the affection is from a month to six weeks.

MANAGEMENT OF THE INFANT.

Suckling the Baby.—After a baby has received its first bath, and been for the first time introduced to the mysteries and miseries of clothes, it should be put to the breast for the purpose of extracting whatever nourishment nature has there provided for it, and also as the commencement of its education in the art of nursing, a business upon which its life for some months will depend. Curiously enough whilst some children take hold of the breast as if by instinct, others must be taught to nurse, and show for this vital operation all the perverse unwillingness of Shakespeare's schoolboy, notwithstanding it is the one thing in the world they have to do.

Mother's Milk the Best.—Every mother ought, if possible, to suckle her own infant, not only for her own sake but for that of the child. Statistics show that babies nursed by their mothers, amid the unfavorable surroundings of prison life, thrive better than those who are brought up by hand in healthy country districts outside, and no woman in good health, who can furnish the nourishment, should be spared the reproach of risking the life and health of her offspring if she refuses to perform her maternal duties in this regard. A mother undertaking the suckling of her infant should, moreover, do so with a mind fully alive to its importance, and with a firm determination that no pleasures of society or of fashion shall interfere with its conscientious performance, or else she had better not attempt it at all.

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Amount of Breast Milk.—The amount of milk contained in the breast, especially with the first child, is very small for two or three days, but in some forty-eight hours the rush of milk, as it is called by nurses, commences, and is often attended with some fever, and marked pain and soreness in the breasts. The remedy for this disturbance in the mother's system is, however, very simple and conveniently at hand, and as the child, which, if healthy and vigorous, generally has a good appetite, draws out the milk which nature has provided for its special benefit, all these uneasy sensations soon subside. If the coming in of the milk is unusually delayed, it may be necessary to give the baby a little cow's milk, well diluted and sweetened with sugar of milk; but this is seldom required.

Mothers to Avoid Excitement.—During the time a mother is nursing her infant every care should be used to avoid any violent mental excitement or shock, which is exceedingly apt to influence the secretion of the mammary glands to a certain extent, just as it does that of the lachrymal gland, and render the lacteal fluid temporarily unwholesome or poisonous to the infant; or it may completely suppress the secretion of milk, with very serious consequences to both the parent and her offspring.

The Wet Nurse.—If, for any reason, the mother is unwilling or unable to suckle her infant, the next best chance for the baby's life is to procure a good wet nurse. When such an alternative is adopted, great care should be exercised in selecting the foster-mother, and the physician's advice ought always to be obtained upon this important subject.

Bringing Up by Hand.—Should the mother fail to nurse her child, and no good wet nurse is procurable, the child must be brought up by hand, a species of manipulation which contributes, it is probable, more than anything else to swell the lists of infant mortality in most large cities, as well as to some extent in country districts. Although goat's milk is used occasionally in this country as an infant's food, practically the choice is narrowed down in most cases to cow's milk, and the great object should be to secure this from healthy animals, pure and free from all admixture, as pointed out in an earlier chapter upon milk as an article of diet, and in a perfectly fresh condition.

Testing the Milk.—All milk used for the feeding of young infants, especially in the summer, should be carefully tested, and particularly in regard to its acidity, with litmus paper. If found to be acid it ought to be at once rejected, and a sample of pure, sweet milk obtained.

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Putting Baby to the Breast.—A new-born infant is not hungry, consequently it need not be put to the breast for three or four hours or more. This will also give the mother a chance to obtain a little needed rest. For the first twenty-four to thirty-six hours the baby should be put to the breast every four to six hours. The subsequent twenty-four hours about every three to four hours. About the third day or so, when the milk is well established, the baby should be nursed every two to three hours.

Time for Nursing.—Under no consideration nurse the baby between 11 P. M. and 5 to 6 A. M. If mothers would only institute this from the time of birth, both she and the baby will obtain a good night's sleep. Should the baby awaken, change its position, and give it a little water to drink, and invariably it will go off to sleep. Another bad practice is to give the baby the breast every time it cries, in order to quiet it. It should be conquered from the beginning, so do so.

Weaning the Child.—The time for weaning, generally about the age of nine months, should be determined partly by the growth of the teeth, presuming, of course, that the mother's health is not suffering in the meanwhile. When the first lower middle incisor teeth appear, which usually happens about the sixth or seventh month, the mother may begin to diminish the number of times for suckling more rapidly, at the same time replacing the breast milk, of which the infant is deprived, by cow's milk thickened with oatmeal, barley or wheat flour, and so forth. After the child has four teeth it should be weaned, although if the infant is feeble, or the season unfavorable, the period of nursing may be extended a few months longer.

Dilution of Milk.—If the new-born baby is not nursed and fresh cow's milk is employed, it should at first be diluted with half its bulk of pure, tepid water, sweetened with a teaspoonful of sugar of milk to one-quarter of a pint of milk, and a few grains of salt. Condensed milk will not require sweetening, but should be freely diluted so as to resemble human milk in color. For the first month of a child's life it may be mixed in the proportion of one part of the condensed milk to ten or twelve of warm water.

Cleanliness of Nursing Bottle.—The most rigorous cleanliness of the nursing bottle and nipples must be insisted on, and under no consideration should the long rubber flexible tube apparatus be employed. It is an exceedingly dirty arrangement, as it cannot be properly cleaned. Simply use a very plain bottle, keeping the nipples in a soda solution.

Foods Other than Milk.—When a child does not seem to thrive well upon pure or diluted cow's milk, it has often been advised to resort speedily to mixtures of milk with meat broths, raw eggs, and so forth. Bretonneau reported, as early as 1818, that when children under his care who were suffering with tabes mesenterica, were fed with milk and meat broth, they rapidly improved, and other authorities recommend this mixture as the next best thing to woman's milk.

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EXTRA UTERINE PREGNANCY.

This constitutes a pregnancy occurring in the oviduct and not in the cavity of the womb.

Symptoms.—1. The woman will have all the symptoms of pregnancy. A pregnancy of this kind invariably follows a long period of sterility. The woman who has previously menstruated regularly will miss a period and consult a physician. If he examines her to ascertain the cause of the stoppage of the flow, and this variety of pregnancy is present, he will find the uterus very slightly enlarged and a mass to one side of it.

2. About four to eight weeks, as the fetus continues to grow, the distended tube may rupture, or the contents may be expelled through the end of the tube (tubal abortion).

3. If the tubal abortion or rupture occurs, the woman will first notice a sudden, sharp, severe pain in the abdomen. This will be followed by fainting spells which may or may not end in death, due to the loss of blood.

Treatment.—If the condition is recognized prior to rupture, the woman should submit to an operation at once, before rupture takes place, which accident invariably terminates in death.

If the woman is not seen by a physician until rupture does occur she should be operated on at once, in order that the bleeding vessels may be tied. In a few rare cases nature checks the bleeding, which will be followed by a second rupture, usually with fatal results.

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GENERAL RULES FOR MOTHERS ON MANAGEMENT OF INFANTS.

Washing and Dressing.—The new-born infant, while it is being washed and dressed, may have some butter and sugar given to it, though this food is by no means absolutely necessary, unless the infant cries, and it may be applied to the breast when there is milk, in half an hour or an hour after delivery, or as soon as the mother has recovered from the fatigues of parturition.

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Suckling.—The infant ought to be applied to the breast every two hours, or as often as it awakes from sleep. Lactation or suckling generally prevents sore breasts and nipples.

Wet-Nurse Diet.—A wet-nurse ought to avoid spiced, salted, smoked, and oily animal substances, and also crude vegetables, pickles, unripe fruit and spirituous or vinous liquors, unless when delicate.

Best Drinks.—Light broths, milk, whey, coffee, home-brewed ale, stout or porter, are the best drinks, and a pint or a pint and a half of the two last is sufficient during twenty-four hours.

Tea and Coffee.—Tea and coffee may be used moderately.

Conduct of Wet-Murse.—A wet-nurse ought to attend most closely to the infant committed to her care, and avoid all crowded assemblies, balls, theatres, etc.

Temper of Wet-Nurse.—A hired wet-nurse ought to be healthy, good tempered, careful, fond of children, watchful at night, patient, sprightly, cheerful, active, have a good supply of milk, and a healthful infant of her own.

Treatment of Wet-Nurse.—She ought to be treated most kindly by parents who intrust their infant to her care.

Substitute for Human Milk.—The best substitute for human milk is that of the ass or cow, with a sixth part of tepid water and some loaf sugar. Three tablespoonfuls are sufficient for each repast for a new-born infant. Asses' milk has a decidedly sedative effect.

Boiled Milk.—The milk should not be boiled or repeatedly heated. The inferior animals of the mammiferae are nourished with milk only.

Warmth.—The infant ought to be kept warm, clean, and changed whenever it wets or soils itself, and in such cases dried or washed and powdered, and a clean napkin applied.

Hunter's Rule.—John Hunter well observed, "give children plenty of milk, plenty of sleep and plenty of flannel."

Cereal Foods.—Farinaceous aliments ought to be used sparingly at first, and mixed with milk. They are most appropriate before the time of weaning.

Weaning.—Ablactation or weaning may be accomplished when the infant is vigorous, after the appearance of the milk-teeth, which varies from the sixth to the twelfth month.

When Not to Wean.—Weaning ought not to be attempted when the infant is delicate, teething or laboring under any severe disease, as the breast is the best sedative for infants, even if the milk is deteriorated. It ought not to be commenced during winter.

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How to Wean.—Weaning should be commenced gradually, and not suddenly, the infant being first accustomed to ordinary food; for in the last case it becomes fretful, peevish and rapidly out of health.

Consult Children's Likes.—Children have their likes and dislikes as well as adults, and ought not to be compelled to use any food which they disrelish. Light puddings, eggs, fresh fish, gravies, soups or broths mixed with arrow-root, mealy potato, bread crumb, ripe fruits, such as apples, pears, oranges, strawberries, grapes, etc., the pips or seeds being removed, may be used in moderation by infants from the second to the fifth year.

Proper Meats.—Boiled or roasted meats are best for children; fried, broiled, stewed or minced are less proper.

Regulation of Food.—Solid animal food is improper for young children, as they do not sufficiently masticate it, and it produces irritation in stomach and bowels. Too much food is generally given to infants, but they ought to be left to their own discretion or inclination as to the quantity.

Sleep.—The infant ought to be allowed to sleep and wake whenever it pleases. All violent rocking in chairs, cots or cradles is injurious to the brain and to the general health.

Position in Bed.—It ought to be placed on the right side in bed, to facilitate the passage of the milk or food from the stomach into the bowels. It may also be turned on the left side, and of all positions the back or face is the worst.

Clothing.—The clothing should always be suited to the season, so that exposure to cold and damp should be avoided. Exposure to cold and improper food are the most prolific causes of diseases of infants. It is computed that half mankind perish from cold before the end of the third year.

Air and Exercise.—Air and exercise in the nurse's arms, or in a carriage, or on foot, are as necessary for children as for adults.

How to Exercise.—An infant is exercised by being carried in the arms, rocked in a cot or cradle, by rubbing its body or limbs at the time of dressing or stripping, by dandling, by its laughing and crying, by riding in a carriage, by crawling, walking, jumping, running, dancing, and so forth.

Walking Period.—The infant finally acquires power to assume the erect position, to stand alone, walk along chairs, and so forth, when it ought to be carefully watched and assisted.

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Place on the Floor.—It ought to be placed on the carpet, with its toys about it, when it will move about to collect them.

Danger from Falls.—It is now exposed to falls and injuries, which often destroy its life.

Cleanliness.—Cleanliness and bathing are essential to infants. Frequent washing with tepid water, either locally or generally, is highly beneficial. This is beneficial at all times, and indispensable in cold weather. Cold bathing is now universally condemned for delicate or feeble children.

Hardening.—Exposure to the air is necessary, but hardening, as it is properly termed, is most injurious, and often induces fatal inflammations of the respiratory organs. The clothing should always prevent the bad effects of the weather.

Teething.—Dentition or teething is a natural process, and unaccompanied by pain when the infant is in perfect health and properly managed as regards diet, clothing, cleanliness, sleep, air, exercise, and so forth. But it is in general a painful process, as few infants are properly managed or brought up by mothers or nurses, and very few are in good health.

Incision of Gums.—Incision of the gum over a projecting tooth is highly beneficial. Other diseases, which are sympathetically excited by teething, as cough, diarrhoea, and so forth, are to be treated on ordinary principles.

Vaccination.—Every healthful infant ought to be vaccinated after the sixth week, to prevent the danger and mutilations caused by small-pox, and too often death itself.

Kindness.—Children ought to be treated with kindness, and all corporeal chastisement avoided until reason is developed. "Spare the rod and spoil the child," is now an obselete maxim. Moral management is universally preferred by all enlightened individuals.

Severity.—Severity towards children is cruel and most injudicious. When correction is necessary, it should be inflicted with regret and gentleness, and never with a display of anger.

Jealousy.—A feeling of jealousy ought never to be allowed to exist between children; there should be no marked preference.

Diseases.—The infantine constitution is frail, and easily injured by external agents, and hence the frequency of diseases. The diagnosis of these complaints is difficult, as the sufferer cannot, in some cases, give any, and in others, a proper account of the symptoms.

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Education.—Literary education ought not to be commenced until the age of six or seven years; but the nature and uses of external objects should be always explained to children.

Infant Schools.—Infant schools are very superior to the old-fashioned establishments, as they combine exercise, amusement and competition with instruction.

Picture Knowledge.—Much knowledge may be communicated by the representations of pictures or figures of birds, beasts, fishes, insects, herbs, trees, fruits and mechanical inventions.

Regard for Truth.—The utmost regard for truth, and abhorrence of falsehood, should be always inculcated.

Candor.—An open and candid disposition ought to be applauded, and an acknowledged fault rebuked with mildness and then forgiven.

Questions and Answers.—All questions put by children ought to be clearly answered, and the nature of surrounding objects explained to them correctly.

Behavior.—An affable, modest and polite behavior should be cultivated and applauded.

Memory.—The memory and intelligence must not be too much excited, as disease of the brain and bad health may be rapidly induced.

Prodigies.—Children who are prodigies in learning, music and other pursuits, are generally destroyed by premature disease in the brain, water in the head, and many other complaints.

Countenance.—They should be taught to maintain a lively and cheerful countenance.

Speaking.—Attention should be paid to a correct articulation and pronunciation.

Hurting.—They ought to be constantly cautioned against hurting themselves with surrounding objects, and the danger, pain, and bad consequences explained to them.

Treatment of Diseases.—The greatest judgment is required in treating the diseases of children, and medical aid ought to be procured whenever it can be obtained. The science and practice of infantile medicine require deep study and extensive observation.

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Last Modified: Monday, 13-May-2013 15:31:46 EDT