ARMY MEDICAL LIBRARY

         WASHINGTON
             Founded. 1836
Section.
Number
A12:£0_..
            Form 113c, W. D.. S. G. O.
"o  3—10543   (Revised June 13. 1936) 
 
 
COMPENDIUM
        OF THE THEORY  AND PRACTICE        /—

                      OF                   -?-> "•g*'


     MIDWIFERY,

                   Containing

PRACTICAL INSTRUCTIONS FOR THE MANAGEMENT OF

                   WOMEN

DURING PREGNANCY,  IN  LABOUR, AND IN CHILD-BED J

                    Calculated

  To correct the Errors, and to improve the Practice, of

                MIDWIVES ;

    As well as to serve  as an Introduction to the

              STUDY OF  THIS ART,

                      For                    /

 STUDENTS AND YOUNG PRACTITIONERS.

               Second Edition enlarged;
       By SAMUEL  BARD, M
Prefident of the College of Phyficians and Surgeons in the
       Univerfity of the State of New-York.

            —-•■—   Qi/ro
              NEW-YORK:          '
   PRINTED  AND SOLD  BY COLLINS AND CO.
          NO. 189, P ARL-STREET.

                  1812. 
             Diflria of New-York, ss.

                    JJE IT REMEMBERED, That on  the
                    feventh day  of  November, in the thirty-fixth
        (L. S.)      year of the independence of the United  States
                    of America,  Collins & Co. of the faid diitricl:,
                    have depofited in this office the title of a book,
the right whereof they claim as proprietors, in the words following,
to wit:  " A Compendium of the Theory and Practice of Midwi-
" fery;  containing Practical  Inftructions for the Management of
" Women during Pregnancy, in Labour, and in Child-Bed ;  calcu-
" lated to correct the Errors, and  to  improve the Practice, of Mid-
" wives; as well as to ferve as an  Introduction to  the  Study of this
" Art, for Students and young Practitioners.  Second edition en-
" larged.  By .Samuel Bard, M.  D.  Prefident  of the College of
" Phyficians  and  Surgeons in  the  Univerfity  of the State of
" New-York.''
   In conformity to the Act of the Congrefs of the United States,
entitled " An Aft for the  encouragement of learning, by  fecuring
" the copies of maps, charts, and books, to the authors and proprie-
" tors of fnch copies, during the time therein mentioned."  And alfo
to an act,  entitled " An  Act, fupplementary to  an  Act, entitled
" an Act for the encouragement  of  learning, by fecuring the co-
" pies of maps, charts, and  books, to the authors and proprietors of
" fuch copies, during the times therein mentioned, and extending
" the benefits thereof to the arts of defigning, engraving, and etching
" hiftoricil and other prints."
                                  CHARLES CLINTON,
                             Clerk of the Diftridof New-York. 
INTRODUCTION.
   HAVING frequently in the  course of my practice,
 and particularly  since  my residence in  the country,
 had occasion to observe how much our mid wives stand
 in  need of instruction,  and how  incapable most  of
 them  are, from pecuniary circumstances, as well  as
 from deficiency of education, to derive it from books
 of science, and systems of midwifery ; I have thought
 that a concise, cheap book, containing a set of plain
 but correct  directions  for their practice  in  natural
 labours, and for the relief  of such complaints, as fre-
 quently  accompany pregnancy and labour, or  which
 follow after  delivery,  would in  the present  state  of
 this country prove an useful  work.  This  I have at-
 tempted in the following essay, in which it has been
 my object to  be useful, rather than to appear learned;
 to say nothing but what is absolutely necessary and
 easily understood ; and to detail such facts and obser-
 vations,  as have  been long known,  and have received
 the stamp of time and experience, rather than to offer
 new opinions.
  In  a work of  this nature,  all claim to originality
 must necessarily  be relinquished,  and so  far  from
 aiming at it, I confess I have not hesitated occasion-
ally to use the language of others, where I have found
it sufficiently  clear and familiar for my purpose ; and
I hope this acknowledgment will be received, in place
of frequent references and marks, of quotation. 
4
INTRODUCTION.
    Thus  to instruct the ignorant, in what it  is con-
" fessed the learned are already  sufficiently informed,
 appears to be an humble attempt; but it is one I have
 nit found on the present subject altogether free from
 difficulty.  I have  endeavoured  to arrange the work
 in such order, and to clothe my opinions in such lan-
 guage  as  will  be intelligible and  instructive to  the
 most ignorant.  I have used  as  few technical terms
 as was consistent with perspicuity  and decency ;  and
 such asl have thought myself compelled to introduce,
 I have endeavoured to explain,  either in the progress
 of the work, or  by a  short glossary at the end of  the
 volume.
    Another difficulty has occurred from the  desire to
 be full and  explicit,  and yet not to say  too much.
 Convinced that the use of instruments, and the intro-
  duction of the hand into  the womb, as too frequently
  employed by the unskilful, is more desperate than the
  most desperate case  of labour left to nature ; it has
  been my wish to avoid, as much as was possible,  even
  mentioning these operations :  still I have thought it
  necessary to describe the treatment of some lingering
  and difficult labours,  and even of some  preternatural
  eases ;  in all which, although I constantly advise the
   midwife to  call for assistance, yet (especially in the
   country) as what is better than her own is not always
   at  hand, and  much important time may be lost be-
   fore it can be procured;  the  midwife ought  to be
   instructed how to employ  the interval  to advantage.
   In  attempting this,  it  has been found necessary to
   describe  some operations  and modes of  relief, to
   which the common midwives of our country,  from
   the great deficiency of their education, or rather from 
                 INTRODUCTION.                 S

having had no education at all, are  confessedly une-
qual : but is there any mode  by which this objection
can be removed, better than by endeavouring to spread
among  them the  necessary information ?   Partial
knowledge is, I  confess, on many  occasions more
dangerous  tlmn  absolute ignorance; but does  this
observation apply only to the midwives ? We must
know in part before we can be  fully informed; and I
cannot help hoping, that the midwife who has read and
understands this little  work, will be a more useful and
safe practitioner, than one who has never read this or
any other.   If to this argument,  another be added,
that in proportion as  the rules I have  given for the
conduct of natural labours are observed, the accidents
and difficulties which render labour tedious  and dan-
gerous will the more seldom  occur;  any objections
to which my work may appear liable, from the appre-
hension of teaching  too much, will, I  hope, be re-
moved.  An attempt has lately been made in this state
to regulate the practice of physic,  in which it seems
to have been the object of the legislature, by exacting
some proof of previous study .and learning, to improve
the knowledge of future practitioners.   Would not a
law to provide for the education of common midwivesj
and to compel them to give  some proof of knowledge
and ability, before they undertake the practice of their
profession, be equally useful ?  It will not, I believe,
be denied, that it is equally  necessary.  The princi-
ples, however, upon which such a law is to be found-
ed, should be well considered, as there is some reason
to believe that there is  greater safety in this branch
of  medicine from  modest,  unassuming ignorance,
                      A2 
6
INTRODUCTION.
than from that meddling presumption which frequent-
ly accompanies a little learning.
  The practice of midwifery  is  a most important
branch of physic and surgery, and like all just practice
in either, is founded in a knowledge of the anatomy
of the parts concerned ;  of their  structure,  situation,
and connections; of  the manner  in which  they per-
form their functions j and of the  changes which, un-
der different  circumstances, they naturally assume,
or which are  brought upon  them by disease.  Al-
though, therefore, it  is  allowed that a full  and accu-
rate account of these subjects would not  be very con-
sistent with a popular work, yet  some slight descrip-
tion of the pelvis, and the parts  concerned in preg-
nancy and  parturition, or affected by  circumstances
attending those states, appears absolutely  necessary,
not only to explain the very few  technical terms una-
 voidably made use of, but for the more easy compre-
hension  of the  nature  of those  functions,  and of the
 several complaints connected with them.  So much,
 therefore, being necessary, a  little more  has  been
 added,  with  a view  to  render the work acceptable to
 students and young practitioners, as an  introduction
 to the theory and practice of their art;  and  to  furnish
 them in one small volume, and at little expense, with
 copies of the most useful plates,  which are to be pro-
 cured only by the purchase of many expensive works.
 This has been the principal motive for the  addition of
 plates, which  being  rather sketches, than finished de-
 signs, and executed on wood, have been done at  no
 great expense.  They have been copied from the
 best works that could be met with, chiefly from Smel-
 iie, Hamilton, and Bell, with whom, however,  some 
INTRODUCTION.
V
liberties have been taken,  to adapt them as nearly as
possible to the same scale and to the same section of
the body:  to do which, the imagination of the drafts-
man has necessarily been in some  measure indulged.
Under such circumstances, it is impossible  they can
possess the accuracy of portraits, and all that has been
aimed at,  is to convey a clearer idea of  the relative
situation,  proportion,  and connection of the  parts,
than could be given in words.  For this reason, many
parts not necessary for the instruction of the practical
midwife, have  been altogether  omitted.   For very
obvious reasons,  I  have seldom entered into the ra-
tionale of the conduct I recommend, but  contenting
myself with giving such  practical directions,  as will
apply to most situations incident to pregnancy, labour,
and child-bed ; and which experience has sanctioned,
have explained the  reason of them only, when that
explanation is easy to  be  understood, or when it may
be made the ground of further advice.
   The learned reader will,  I apprehend, accuse me
of  a tedious tautology in many places,  and I plead
guilty to the charge ; but as  it consists  chiefly in the
repetition  of important and  necessary cautions, in-
tended to correct inveterate errors, and more strong-
ly to impress a  better practice ;  no man acquainted
with the ordinary practice of midwifery in this coun-
try, will, I am persuaded, think this the  least  useful
part of the work.  To such as wish for fuller informa-
tion on this subject, (and all who  mean to practice
midwifery ought  to wish it) I  recommend the writings
of Mr. White, of Manchester, Doct. R. Bland, Doct.
Denman, Mr.  John Burns,  of Glasgow,  and Baude-
locque j  but particularly those of Mr. White and Dr.. 
8
INTRODUCTION.
 Denman.  I take  pleasure in acknowledging my ob-
 ligations  to those two most  excellent writers, to the
 study of whose valuable  works, I have been indebted
 for much  improvement  in  my  former practice, as
 well as  many useful lessons which 1 have attempted
 to  detail  in  this performance.  By  the  writings of
 Bland and Burns, the student will  be confirmed in
 many of the useful cautions and sound practice which
 he will learn from  W'hite and Denman ; and in Bau-
 dclocque he will find a writer of extensive experience,
 great humanity, and one who has profited by  all the
 learning of his day, but  at the same time,  one who
 abounds in many  nice and minute distinctions, not
 easy to  be understood but by a reader of  considerable
 knowledge and experience : and on these is founded a
 variety of modes of relief, and frequent interpositions
 of art, which  on many occasions may be dispensed
 with, and which may lead a young and inexperienced
 practitioner into error.
  It may seem singular that in this enumeration of
 authors, I have  not mentioned Smellie, whose works
 are  in the hands of almost  every  practitioner  in this
country, and more generally  read  than any other  :
but although a great improver of the art of midwifery,
Smellie  certainly was not acquainted  with all the re-
sources  of nature in their full extent.  Having greatly
improved the  instruments of his day, he has described
their use with  great precision ; and I own  I am ap-
prehensive that many of his readers may thereby be
induced  to suppose  them equally safe in their hands, as
 they appear to have been  in his—and hence be led to
a more  frequent use of them than  modern practice
 has found necessary or safe.   I confess,  not without 
INTRODUCTION.
<J
severe regret, that towards the  latter end of thirty
years practice, I found much less occasion for the use
of instruments than  I did  in the beginning; and  I
believe we may certainly conclude  that  the person
who, in proportion to  the extent of his practice, meets
with most occasions for the use of instruments, knows
least of the powers of nature ;  and that he who boasts
of his skill in their application, is a very dangerous
man.
   I  mean not however, to proscribe  the  interposition
of art, or the use of  instruments in labour.  1 know
that on some occasions they are absolutely necessary,
and  have been,  in  skilful hands, the happy means of
preserving both mother and child : but such occasions
are confessedly rare ;  and we have the authority of the
best modern  authors, in saying, that instruments are
 not  found necessary once in ten times, when the co-
temporaries and immediate followers of Smellie  would
have applied them.   I have  been led into these re-
flections from a persuasion, grounded on the best in-
formation I have been able to procure, that that dread-
ful, murdering instrument  the crotchet,  is among us
 in the  country, too  frequently applied  in cases, in
 which if any instrument at all is necessary, the  safer
lever or the forceps may be used  with success.
   Let, therefore, the  student of midwifery study  first,
the  symptoms and  progress of natural labours, as
 they are described by White, Clarke, Denman, and
Burns, whence he will learn the powers and resources
 of nature ; and when  he is fully acquainted with these,
 he will be enabled to  form a more just opinion,  when
he ought to have recourse to art.    And let every prac-
titioner, when  he supposes himself called upon to put 
10
INTRODUCTION.
 in  practice a  remedy, by which the life of the infant
 is necessarily sacrificed, and that of the mother great-
 ly endangered, reflect, that in all such cases we reason
 only from strong probabilities ; that the resources of
 nature are almost infinite, and that the event frequent-
 ly disappoints our expectations.   No man, therefore,
 who has been fatigued by  several days  and nights
 careful  attendance, whose sympathy for the suffer-
 ings of his patient has been greatly excited, and whose
 fears for her safety are increased by the fears and  dis-
 tresses of her friends, can be sure he commands  that
 cool and dispassionate judgment,  which  alone ought
 to determine so intricate a question.  It is  his duty
 therefore, to call for  the counsel of some other, in
 whose  experience  and judgment  he has confidence,
 whose  mind is free  from the embarrassments under
 which his own labours, and who at all events will share
 his responsibility and lessen  his regrets.
  I cannot conclude this  introduction without further
advising every young person engaging in  the study of
 midwifery, not to  trust wholly to the information he
 may derive from books,  in an art, in which so much
 depends on that which  is to be obtained only from
 practice: but before  he  takes  upon himself so  im-
 portant an office, in which all the  resources of know-
 ledge and experience may be called  for in a moment;
 to spend at least one or two seasons, under the pro-
 fessor of this  branch of medical learning, at one of
 the colleges of New York, or some other of the learn-
 ed  institutions, of which our country has good reason
 to boast;  where he  will acquire  that  preliminary
 knowledge, without which, he  can never fully under-
 stand this or any other branch of medicine ; where he 
INTRODUCTION.
11
may have an opportunity to add experience to theory,
and while he is learning the rules, see their application
in actual practice:  for as  is  the  case in every other
mechanical  operation, so in those of midwifery ; al-
though the manner of performing them may be de-
scribed in words, and the principles on  which that
depends may be acquired by study, practice alone can
give that coolness and dexterity which  are necessary
to ensure success.
   I have been solicited by some of my  friends to add
to this second edition* of my little work, a chapter on
the  use  of  instruments;  but on mature reflection I
have concluded not to do  so.   My principal object in
writing it has been, to teaeh the progress and manage-
ment of natural labours, and to point out the wonder-
ful resources which nature  possesses, to overcome most
of the difficulties which may  oppose their  happy  ac-
complishment : and I will venture to assert, that the
better the rules here laid down are understood, and the
more steadily they are practised ; the less frequently
will the necessity of applying to instruments occur.-*-
But further, instruments never can be  called for sud-
denly ;  and time will alvrays be given to apply for the
assistance of some person,  whose  undoubted skill
and experience can judge of the necessity, and justify
their use.   Such persons  must draw their information
from more copious sources ;  from our public schools,
and the excellent works I  have  already recommended ;
especially those of  Doct. Denman, whose writings the
oftener they are read,  and the better they are under-
stood, will be the more admired :  and not more for the
good sense  and learning with which  they  are replete,
for the  knowledge and great  experience which they 
12
INTRODUCTION.
manifest, th^n for the humanity, caution and candour
with which they are written.
   I still learn with extreme regret, that with too many
of our practitioners, even when instruments are called
for, recourse is less frequently had to the comparative-
ly safe lever  and forceps,  than to  the  murdering
perforator and crotchet :—such practice never can be
correct, because  the cases  in which the lever and for-
ceps may be required, and when skilfully applied, will
oertainly afford  relief;  are infinitely more numerous
than those in which the crotchet can  be  necessary.
Whenever therefore a practitioner upon reflection finds,
that he has used the crotchet more frequently than he
has the lever or forceps ; and especially, if after hav-
ing used the crotchet  in any case, the same  woman
has a safe and happy delivery in a subsequent  labour,
he has not only  reason to apprehend he has been pre-
cipitate ; he may certainly conclude he has done very
wrong; because in all such cases the  subsequent la-
bour has proved that no obstacle existed, which could
not have been overcome by time, some of the reme-
dies recommended in severe and tedious labours, or by
the use of "the forceps ; by  which the life  of the mo-
ther might have been preserved, without  sacrificing
that  of the child.  Let me, therefore, once more beg
such persons as are unhappily in the habit of using the
crotchet, candidly to test their practice  by this  rule,
and seriously to  reflect upon the great criminality of
sacrificing the life of a human being to confused ap-
prehensions of danger, or to bold and precipitate ignor-
ance. 
TABLE   OF   CONTENTS.
CHAPTER  I.
   OF THE FEMALE PELVIS AND ITS CONTENTS.

    Sect" i.  Of the Bones and their Connections.

   1. General Observations.
   2. Definition.
   5. The bones which form the pelvis.
   A. Thtir connections.
   5 Connection between the sacrum and ilium.
   6. Connection between the pubes.
   7. Division of symphysis pubis.
   8. Angle between sacrum and loins.
   9. Coccyx.
   10. Effects of disease on these bones.

Sect. ii.   Of the openings and dimensions ofthefielvis.
   1 1. Superior opening or brim.
   12. Subject continued
   13. Dimensions of the brim.
   14. Lateral view and depth of the pelvis.
   15. Hollow of the sacrum.
   16. Coccyx.
   17. Ossification of the coccyx.
   18. Inferior opening of the  pelvis.
                       B 
14
CONTENTS.
19. Deformed pelvis.
20. Form and structure of the child's head.
21. Its passage through the pelvis.
22. Through a narrow pelvis.
23. General observations.

       Sec?, hi.   Contents of the pelvis.
24. Plate and description.
25. Observations.
26. Administering a clyster.
27. Introducing the  catheter.

  Sect. iv.   Of the womb and its appendages.
28. External appearance.
29 Internal appearance.
30. Cavity of the body.
 31. Canal of the neck.
 32 The fallopian tubes.
 33. Ovaria.        *

 Sect. v.   Changes  in consequence of conception.
 34. External appearance.
 35. Internal appearance, decidua vera.
 36. Ovaria.
 37. Descent of the  ovum.
 38. Corpus luteum.
 39. Growth of the womb.
 40. Development and changes of the neck.

       Sect. vi.  Structure of the ovum.
 41. When it first enters the cavity  of the womb. 
CONTENTS.
42. After the eighth week.
43. Sides of the womb retain their thickness.
44. Those of the neck grow thinner.
45. Decidua vera and reflexa.
46  Chorion.
47. Amnion.
48. Gelatinous fluid.
49. Vesicula alba.
50. Water of the ovum.
51. Placenta.
52. Posture of the foetus.
53. Its growth and development.
54. Quickening.
55. Cord and circulation in the foetus.
56. Placenta and circulation  with the mother.
57. Office of the placenta.
                CHAPTER II.
            Sect. i.   Menstruation.
 1. General observations.
 2. First appearance.
 3. In florid full habits.
 4. In relaxed feeble habits.
 5. Accidental suppre sion.
 6. Sparing and painful menstruation.
 7. Profuse menstruation.
 8. in healthy habits.
 9. In weakly and relaxed habits.
10. Subject continued.
11. Cessation of the menses. 
16                  CONTENTS.
              Sect. ii.   Conception.
   12. Whence to date.
   13. General symptoms of, necessary and useful.
   14. Sickness and vomiting.
   15. When moderate.
   16. Subject continued.
   17. When more  severe.
   18. Subject continued.
   19. In women of weakly and delicate habits.
  20. Subject continued.
  21. "Attended with foul stomach.
* 22. Heartburn.
  23. Subject continued.
  24. Fainting.
  25. Swelled breasts.
  26. Costiveness.
   27. Subject continued.
  28. Subject continued.
  29. Piles.
  30. Subject continued.
  31. Subject continued.
  32. Wandering pains, cramps, swelled legs, &e.
  33. Subject continued.
  34. Restlessness and want of sleep.
  35. Incontinence of urine.
  36. Strangury.
  37. Subject continued.
  38. Retroverted womb.
  39. Plate and description.
  40. Subject continued.
  41. Explanation.
  42. Prevention and cure. 
CONTENTS.
If
43. Subject continued.
44. Subject continued.
45. Epileptic fils.
46. At what periods they occur.
47. Prognosis.
48. Preceding symptoms.
49. Remedies.
50. Paralytic affections.
51. Fluor albus.

            Sect. hi.   Abortion.

52. General observations.
53. Abortion apt to be repeated.
54. To occur at particular periods.
55. Causes.
56. Subject continued.
57. Signs.
58 Absence of morning sickness.
59. Discharge of blood from the womb.
60. Prognostics.
61. Remedies.
 62, Subject continued.
63. Subject continued.
64. Famting.
65. Disengagement of the ovum.
 66. Discharge of water from the womb.
 67 Labour pains.
 68. Remedies.
 69. Habitual miscarriage.
 70 Preventive treatment.
 71. Subject continued.
                   B2 
18
CONTENTS.
               CHAPTER III.

              NATURAL LABOUR.

         Sect: i.  Approach of labour.
 1. General observations.
 2. Necessary first to understand natural labour.
 3. First symptoms.
 4. Caution to women.
 5. Prognostics.
 6. False pains.
 7. Examination how made.
 8. Signs of true and false pains.
 9. How to relieve.
10. Most certain signs of labour.

              Sect. ii.   Labour,
 11. Definition.          *
 12. Division into four stages.
 13. Importance of this division

           First stage of labour.
 14. Symptoms.
 15. Internal changes.
 16. Duration.
 17. Observation.
 18. Conduct of midwife.
 19. Examination, caution respecting
20. Unnecessary interference condemned.
21. How to employ this painful interval.
22. Patient to use no exertion. 
CONTENTS.
23 No cordials or heating food or drink.
24. Caution respecting prognostics.
25. Plates and description.
26. Preparation of bed and dress.

            Second stage of labour.
27. Description.
28. Of very different duration.
29. Causes of this.
30. Conduct of midwife.
31. Breaking of membranes.
            Third stage of labour.
32. Description.
33. Danger to perinaeum.
34. How to  prevent.
35. Proper posture of woman and midwife,
36. Necessary resistance to sudden delivery.
37. Relaxing applications.
38. Patient to exert herself with caution.
39. Delivery of child's head.
40. Dlivery of shoulders and trunk.
41. Great security of a slow  and successive
     livery.
42. Reasons for.
43. Plate and description.
           Fourth stage of labour.
44. Tying and cutting navel string.
45. Placenta generally to be left to nature.
46. How to excite contraction of the womb.
47. How to assist when  necessary.
48. Great danger of pulling at navel string. 
20
CONTENTS.
                 Care of the Patient.
    49. Contraction of womb to be excited.
    50. Proper bandage.
    51. Brandy, gin, and cordials to be avoided.
    52, Not to rise to an upright posture.
    53. Conclusion.


                 CHAPTER IV.
CAUSES AND REMKDItS OF TEDIOUS AND PRETERNA-
                 TURAL LABOUKS.
       Sect. i.   Tedious and difficult labours.
    1. Natural labours to be first studied and well un-
      derstood.
   2. Definition of tedious and difficult labours.
   3. Caution to midwives.
Obataclea Jrom the state  of the parts and form of the
                     mother.
   4. First child.
   6. State of the internal orifice, vagina, and  pe-
      rinaeum.
   7. Conduct of the midwife.
   8. Subject continued.
   9. Internal orifice remarkably thick and rigid.
   10. External orifice inflamed and swollen.
   11. Improper interference.
   12. Premature labour.
   13. Premature labour from irritable and weaken-
     ed habit.
   14. How to suppress. 
CONTENTS.
21
 15. Premature labour from early  breaking  the
     membranes.
 16. Narrow pelvis.
 17. Untoward presentation.    /
 18. Use of instruments seldom necessary.
 19. Crooked women.
 20. Rickets.
  Obstacles from the state of the mother's health.
 21. Nervous, low spirited, and weakly.
 22. Full and  strong habits.
 23. Mismanagement.
 24. Distended bladder.
 25. Exhausted strength*
 26  Convulsions.
 27. Cramps.
   Obstacles on the part of the child and secundines,
 28. Dead child.
 29. Large child.
 30. Rigid membranes.
 31. Large collection of water.
 32. Membranes stretched over child's head?
 33. Caution.
 34. Navel string.
 35. Twins.
 36. Flooding before delivery of the child.
 37. Causes.
 38. Remedies.
 39. Blood-letting.
 40. Rest.
41. Cold.
42. Stuffing the vagina.
43. Probability of return. 
22
CONTENTS.
44. Breaking membranes and delivery.
45. Mode of operation.
46. Subject continued.
      Sect. ii.  Preternatural labours.
47. Definition.
48. How to discover.
49. Call early for assistance.
50. Conduct in mean time.
51. In breech, knee, and feet presentations.
52. How and when to turn the belly of the child
     to the back of the mother.
53. To relax the tight navel string.
54. How to deliver the arms.
55. How to deliver the child's head.
56. To preserve perinaeum.
57. Caution.
58. Navel string.
59. Oblique womb.
 Sect. in.   Retained placenta and inverted womb.
60. Causes of retained placenta.
61. Never to  leave a patient undelivered.
62. Mode of assistance.
63. Hour glass contraction of womb.
64. Attachment of placenta.
65. Haemorrhage after birth of child.
66. Remedies.
67. Concealed haemorrhage.
68. Haemorrhage after delivery of placenta.
69. Caution.
              Inverted -womb.
70. Definition. 
CONTENTS.
23
   71. Case 1.
   72. Case 2.
   73. Case 3.
   74. Case 4.
   75. Observations.
   76. Conclusion.


                 CHAPTER V.

DISEASES OF WOMEN IN CHILD-BED, AND OF INFANTS
               DUUINC THli MONTH.

               Sect. i.   Child-bed.
     1. General observations.
     2. Care immediately after delivery.
     3. Regimen.
     4. Evacuations.
     5. After-pains.
     6. When to rise from bed.
     7. Lochial discharges.
     8. Lameness.
     9. Inflammation of external parts.
    10. Falling down of the womb.
    11. Milk fever.
    12. Tumour in breast.
    13. Sore nipples.

                 Child-bed fever.
    14. Symptoms of first stage.
    15. Natural crisis.
    16. Fatal termination. 
24
CONTENTS.
  17. Complex nature.
  18. Malignant stage.
  19. Caution.
 20. Treatment during first stage.
 22. Accession of putrid stage.
•23. Treatment during putrid stage.
                Swelled leg.
 24. Symptoms.
 25. Origin.
 76. Remedies.

                  Mania.
 27. Causes very obscure.
 28. Great caution  necessaiy in the use of severe
     remedies.
 29. Restraint.
 30. Remedies.
 31. Regimen.

           Sect. ii.  Care of child.
 32. Washing, &c.
 33. Evacuations
 34. Conical head and bruises.
 35.  Apparently dead.
 36. Red gum—jaundice—apthoe.
 37. Convulsions.
 38. Conclusion. 
       A  COMPENDIUM

OF  THE  THEORY AND PRACTICE OF

   MIDWIFERY.
               CHAPTER I.

OF  THE  FEMALE  PELVIS AND ITS  CONTENTS.
                  SECTION I.

        Of the Bones and their Connections.

   1. Of the  skeleton,  the  knowledge of the bones
of the pelvis or basin only is necessary to the practice
of midwifery; but of these the more  accurate her
knowledge, the better will the midwife understand
the causes of most of the difficulties which occur in
tedious and  dangerous labours; and will thereby  be
taught to  avoid many  errors in practice.   She will
therefore  do  well  not only to study their  form and
connections, from plates and descriptions, but, when-
ever she has  an opportunity,  to correct and improve
her knowledge, by  examining them on the skeleton.
But although it is impossible for a student of mid-
                      C 
 26   ,       Of the  Female Pelvis          [Chap. 1.

 wifery,  who wishes to attain to any excellence in his
 arti  to be too minute in  his enquiries into every par-
 ticular of the shape, dimensions, and structure of the
 female pelvis ;  yet, as the object I principally  have in
 view is rather to improve the knowledge, and to correct
 the errors, of those women who are already engaged
 in the practice, than  to  teach the art of midwifery ;
 I shall confine my observations to the most essential
 points, and  shall  dwell  very particularly on them ;
 being convinced that in this way I shall accomplish
my intentions in a  greater degree, than by burthening
 the  memory of my  reader, with a great  variety of
particulars.

                     PLATE I.
Female Pelvis.
 
 Chap. 1.]           and its Contents. '          27

   A, the last vertebra of the loins—B B B the sacrum
 —C C the pubes—D D the thigh bones and their sock-
 ets—E E the ilia—F F F F F F the brim of the pel-
 vis—G the coccyx—C 1 the arch of the pubes.
   2. The pelvis or basin  which is here  represented,
 is that large  irregular  circle of bone, which supports
 the body, by  its attachment to  the back-bone at the'
 bottom of the loins ; and by the sockets which  it af-
 fords to the heads of the thigh bones: and which con-
 tains and  defends  within its cavity, the bladder of
 urine, the rectum or straight gut, and between them
 the womb.
   3. It is formed behind by the os sacrum or rump-
 bone B B B:  on the sides by  the  ossa ilia, or hip-
 bones E E :  in frorU by the ossa pubis or share bones
 C C : and below by the  ischia, or the bones on which
 we sit H H:  with  a part of the  sacrum, and its ap-
 pendage,  the coccyx G, which in brutes  ends in the
 tail.   A marks the last vertebra of the loins, and
C 1 the arch  of the pubes ;  and  above,  its juncture,
called the symphysis pubis.
   4. All the   bones of the pelvis are connected by
rough surfaces, and an  intervening cartilage ; this is
most conspicuous in infancy, and more or less oblite-
rated  by age.  That which connects  the  ilium, is-
chium, and pubes is soonest obliterated, and before pu-
berty can only be discovered by  a rough line crossing
the sockets of the  thigh  bones; so that in the adult
those three  bones form  but one, and are commonly
so described under the  denomination of os innominar
turn ; but with a view  to the practice of midwifery, it
is most  convenient to consider them as  three distinct
bones. 
28             Of the Female Pelvis       [Chap. 1.

  5. The cartilaginous connection between  the  os
sacrum-and  ilium, is seldom quite obliterated  until in
advanced old age ;  and in young women during la-
bour it sometimes yields so much as to form an imper-
fect joint, which very much  weakens that part,  and
impairs the manner of walking through life.
  6. The connection in front between the bones of
the pubes is still looser, and approaches more nearly
to the structure of a joint; the anterior  extremity of
each bone  is  covered by a  cartilage, and connect-
ed and bound together by  vtry strong fibres, of a na-
ture between cartilage and ligament, passing in  every
direction from one to the other, and interspersed with
small  reddish  substances,  supposed to  be  synovial
glands.  This substance is  of the shape of a wedge,
thicker before than  behind, ,and forms  between the
bones of the pubes a species of articulation, seldom or
never quite  obliterated  even in  advanced life.  Con-
sequently whether from a natural  relaxation  and dis-
position  in these junctures to separate during labour,
or  from the effects of disease,  it is  most  frequently
here that such a separation is observed to take place ;
which,  according to the degree of  it,  or the sudden
violence with  which it is produced, is followed  by in-
flammation  and  abscess, excruciating  pain, tedious
and incurable lameness, and on some occasions even
by death.
  7. It was formerly  supposed,  that  these  sym-
physes or junctures between the bones of the  pelvis, |
always yielded somewhat during labour ; and that  in
severe labours  from contracted pelves,  they yielded
so much as  considerably to facilitate  delivery.   This
sentiment led at first to the practice of attempting to 
Chap. 1.]        and its  Contents.
29
promote the relaxation of these part3 by baths, poul-
tices, fomentations, and liniments ; and afterwards to
the proposal of an operation  to divide the symphysis
pubis.   But after the most attentive consideration of
this subject, by examining the bones on the skeleton,
and performing the operation on the dead body, it has
been  proved, that by the most  complete division of
the pubes, no enlargement of the pelvis can be ob-
tained, which  will compensate for the danger attend-
ing, or the ill consequences which  must  necessarily
follow this cruel operation.  The same arguments
prove, that all other attempts to soften and relax these
junctures must be absolutely useless.
   8. The articulation between  the  sacrum and the
spine is formed like those between the vertebras of the
back  bone by  an intervening cartilage,  very thick
before and very thin behind, by which shape the angle
at A, plate  3, between the sacrum and last vertebra
of the loins is formed.
   9. The coccyx G consists of three or  four articu-
lations, diminishing  from the top of the first to the
extremity of the last; each  piece is covered by carti-
lage,  and united to the  sacrum and to each other by
strong ligaments, so as  to allow of considerable  mo-
tion backwards ; most freely in youth, and diminishing
insensibly, until  by age it is obliterated ; which, when
it happens  early, occasions some  inconvenience in
labour.
   10. It is very manifest, by inspecting the plate, that
when a person stands upright, the weight of the body,
resting on the heads of the thigh bones, has a tenden-
cy to press those parts  of the pelvis which form the
sockets inwardly towards  the  sacrum}  and conse- 
30             Of the Female Pelvis      [Chap. I.

quently,  that  if at any  time the bones  should be
rendered soft and yielding by disease, the cavity  of
the pelvis might be contracted and deformed.  '1 his
actually takes  place, sometimes in adults, more fre-
quently in  rickety children.  Such  children, there-
fore, should never be  put on their feet, and taught to
walk, until by time and the use of the cold bath, they
shall have  got the better of the  disease ; but they
should be  suffered and  encouraged  to creep about,
until they have acquired so much strength as to get
on their legs of their own accord: this will afford the
best chance to preserve the natural shape ot the pelvis,
a matter of the first importance to girls, and on which,
not only their beauty, ease, and comfort, but the safe-
ty of their lives, when they come to be mothers, may
depend.  It is  of worse  consequence to  keep such
children constantly sitting, than to  make them  walk ;
because,  whilst the pressure is nearly the same, they
are deprived of that exercise which  would contribute to
their cure.   A crooked spine is generally, but not al-
ways, accompanied by a distorted pelvis.  All deformed
women, therefore, should well consider the great risk
they run by engaging in marriage ; that they probably
may never bring a living child into the world, and that
 at  every birth, their own lives must be exposed to the
utmost hazard.  The existence of a distorted pelvis
may be determined by a proper examination, before
marriage ;  and where from any deformity in the spine,
especially when accompanied by lameness, there is rea-
son to suspect it, it would be very prudent in a woman
to  submit to such examination before she determines
 to purchase  the title of mother,  and the comforts of
marriage at so dear a rate. 
Chap. 1.]        and its  Contents.               St

                  SECTION  II.

   Of the Openings and Dimensions of the Pelvis.

   11. Aft^r the fourth month of pregnancy, the
womb  rises out  of  the  pelvis, and as it increases in
size, rests on and is supported by an oval ridge formed
by these bones, and projecting a little inwardly,  called
the brim of the  pelvis, thi ough   which the child  must
pass at its birth ; and upon the form and  dimensions
of which, as far as the mother  is concerned,  the ease
and difficulty of labour very much depend ; it is there-
fore necessary that the midwife should form  as accu-
rate an idea as possible of the brim of the pelvis.
   12. The  brim of the pelvis  which is  marked in
the plate by the letters F F F F F F is formed behind,
by the upper part of the sacrum  F 1, and the lower part
of the last vertebra of the loins  A, which  join in such
a manner as to form a considerable angle jutting for-
ward : at the sides, by a prominent ridge on the inside
of the ilia, F 2 F 2, and in front by the pubes C.  The
form is an irregular oval, narrower from behind to the
forepart, from F 1, to C, and wider from side to side,
from F  2 to F 2, and  in  size so  wonderfully adapted
to that of the child's  head and shoulders, that notwith-
standing all the variety which occurs in the size  of
parents and their offspring,  and all the irregularities
of shape from  accident or disease, not one woman in
ten  thousand dies  undelivered where  nature is not
disturbed in her operations.   Whenever the  child's
head passes easily through this brim, we may expect
a speedy delivery ; because, although an irregularity
in the shape and contraction of the lower opening  of
the pelvis (see plate 4) may obstruct the birth, yet that
 does not so frequently  occur  as a contraction of the 
82             Of the  Female Pelvis       [Chap. 1.

brim ;  and whenever the lower opening is deformed,
the brim can hardly escape.
              PLATE II.

Superior  opening or brim of the Pelvis.
  F F F F F F the brim of the pelvis.
  F 1, C, direct and shortest diameter.
  F 2, F 2 transverse or longest diameter in the skeleton.
  G G,  diagonal or longest diameter in  the  living
subject.
  H 1 H 1, sharp processes of the ischia.
   13. This  plate  exhibits a view of the  pelvis,  so
placed as to  look more immediately through the brim
from above, by which its shape and dimensions, toge-
ther with the parts of each bone which form it, are more
easily and distinctly  seen.   Its shape is nearly  oval,
longest from side  to side from F 2 to, F 2,  and  nar-
rower from  pubes  to sacrum from F 1 to C.  Its  di- 
Chap. 1.]          and its Contents.             33
mensions are  in  a well-formed pelvis, from  side to
side from five to five and a quarter inches; and from
pubes to sacrum  from four to four and a  quarter
inches on the skeleton, when divested of the flesh and
membranes which in the living  subject  cover the
bones, and lessen  these dimensions about one inch,
but with.a lining which  will  yield considerably to
pressure.   This lining likewise, is  not of equal thick-
ness in all parts, but so  much thicker at the sides F 2
F 2, as to render that diameter of  the brim, in the liv-
ing subject,  somewhat less than the diagonal from G
toG.
                    PLATE  III.
            Lateral View  of the Pelvis.
 
 34            Of the Female  Pelvis       [Chap. 1.

   A, the last vertebra of the loins.
   F 1, the first vertebra of the sacrum.
   B, the sacrum.
   C, the pubes.
   D, the ilium.
   F F, the brim of the pelvis.
   G, the coccyx.
   H 1, sharp process of the ischium.
   H 2, blunt tuber of the ischium.
   I, hollow of the sacrum.
   K, coccyx when bent back.
   14. This plate represents a lateral  section of the
pelvis, in which the body  is supposed to be cleft per-
pendicularly  through the  back  bone behind,  and
through the symphysis pubis  (or joining of the share
bones) before.   It is designed  in the  first place, to
shew again the brim of the  pelvis F 1 F F C,  and
particularly to demonstrate how much the short dia-
meter of the brim depends upon the distance between
the projection of the sacrum  (formed between the
last  vertebra of the  loins A, and the first of the sa-
crum F l) and the pubes, or  share bone at C, the con-
traction of which space  in ill-formed women, is one
principal cause  of all the difficulties  which occur in
tedious and dangerous labours ; secondly, it shews the
depth of the pelvis behind, that is from the brim at
F, to the coccyx, about  five and a half or six inches,
when that bone is pushed as far back as  it will com-
monly yield, expressed by the  doited lines ending at
K ; at the  sides, from the brim F to H 1,  the  sharp
process  of  the  ischium; and  again from F to  H 2,
the blunt tuber  of the ischium  about three and a half
inches ; and before, where the depth of the pelvis is no 
Chap. 1.]           and its  Contents.            35

more than that of the pubes C, about one and a half,
or at most two inches.
  The  knowledge of these circumstances will  pre-
vent the midwife from being deceived in forming an
opinion, how far the child's head has advanced during
labour ; for  although it may readily be  felt under the
pubes, she must not therefore conclude it has descend-
ed much, if at all below the brim of the pelvis; unless
by passing the finger back, she  can at the same time
discover it filling the hollow of the sacrum, and be-
ginning to rest on the coccyx and perinsum.
  15. Lastly, this  plate  shews  the  hollow of the
sacrum  I, which greatly enlarges the size of the  pel-
vis below the brim, and facilitates delivery by allowing
the  child's head, as soon as it has passed the brim, to
retire backwards, as it sinks down upon the coccyx.
  16. The coccyx G  consists of  four small joints,
which being moveable, it retires when pressed upon
by the child's forehead, and increases the. distance be-
tween this small bone and the pubes about one inch ;
by which the vertex (or that  part of the child's head
on which the  hair diverges)  and which is commonly
the  presenting part, is allowed  more  easily  to  slip
from under the pubes.
  17. In  some subjects  a  little  advanced in life,
the coccyx is not only united as one bone to the sa-
crum, but the small bones of  which it is composed,
are  likewise firmly united  with each other, so that it
makes some resistance, and increases the difficulty  of
the first birth.  The contractions of the womb, how-
ever, will overcome this difficulty, and it  has often
been known to give way  with a crack heard  by the
midwife and attendants.   After  this,  in  subsequent
labours, the same difficulty seldom occurs. 
36           Of the Female Pelvis        [Chap. 1.

 .                  PLATE IV.

          Inferior Opening of the Pelvis.
  C, pubes.
  E 1, sacrum.
  G, coccyx.
  H 2 H 2, blunt tuber of ischium.
  H 1 H 1, sharp process of ischium.

  18. This plate  represents  the lower opening  of
the  pelvis, so placed as to look through it from below,
in which the principal circumstance worthy of remark
is, that the distance between the  tubers or blunt pro-
cesses of the ischia, e-n which we sit, H 2 H 2, as well
as that between  the sharp processes H 1 H  1, is nar-
rower than that from the coccyx  G, to the  lower edge
of the pubes C.   The lateral opening from tuber to 
Chap.  1.]        and its Contents.               37

tuber being from f >ur to four and a quarter  inches,
whilst  the transverse opening from pubes to coccyx,
when that small bone is pushed back as far as it will
easily yield, is from  five to five and a quarter inches.
By this change between  the diameters of the upper
and lower openings of the pelvis,  but particularly by
the convergence of the two sharp processes of the ischia
H  1 K 1, the child's  head,  which enters the pelvis di-
agonally, with one ear towards the pubes and the other
towards the sacrum;  that is, with the shortest diame-
ter of the head to the shortest diameter of the brim, is
made to turn as it descends through the pelvis, until
the vertex or hind  head  is brought under the pubes,
and the face falls into the hollow of the sacrum, where
it finds most room ; and  where the diameters of the
head are again adapted to those of the lower opening of
the pelvis,  through which  it has to pass.  By these
means too, the vertex or crown of the child's head,
which is in all respects its smallest part, is brought to
present to and first to pass the external orifice ; which
circumstance lessens  as much as possible the necessa-
ry distention  of the soft parts of the mother, and re-
lieves  them in a great measure, as  soon  as the vertex
slips from under the pubes, (see plate 17 and plate 18.)
In the first,  the child's head is  represen*ed enter-
ing the brim of the pelvis with one  ear to the pubes
and the other to the sacrum ; in the last, the  ears are
from side to side, the face in the hollow of the sacrum,
and the vertex presenting to the external orifice.
    19. In  some narrow and deformed pelves, the two
blunt  processes, called the tubers of the ischia, H 2 H
 2, as well as the two sharp points, H 1 H 1, plates 3 and
4, approach each other  so as to increase the difficulty, 
 38          Of the Female Pelvis        [Chap. 1.

 Which  the  bones  of the mother- oppose to the easy
 passage of  the  child's head.  As soon as the child's
 head has passed these, all danger from the  labour is
 generally over.  For although, in some labours, with
 a first child, and in women advanced in life before they
 bear children, the soft parts being of a firm and rigid
 texture, make  considerable resistance  to  the birth;
 yet when that is left to nature from the beginning, and
 they are not fretted and  inflamed by any officious  in-
 terposition of the  midwife, they soften  and  relax,
 sometimes  in a few  minutes,  generally  in  a few
 hours, so as to permit the child to pass without injury :
 and as the woman  is in no danger  all this time, there
 can be no pretence  for  interference.   Thus  we see
 that upon the size, shape, and  proportions, first of the
brim  or superior opening ; and secondly of the low-
er opening of the pelvis, almost all the difficulty  in
natural  labour depends ; and  that  when  the child's
head passes  easily through these, we  may expect a
speedy delivery.

                    PLATE  V.
Bones of the  Child's  Head.
 
"Chap  1.]         and its Contents.               39

   20. This plate shews the shape and proportions of
 the child's head, and the loose and imperfect manner in
 which the bones are formed and connected at birth ;
 by which structure it is capable (if time be given) of
 being moulded into a proper  shape,  more easily to
 pass through the brim and lower opening of the pelvis,
 especially when that  is  not  perfectly  well  formed.
 The  imperfect  edges  of these bones and their mem-
 branous connections,   not  only permit them to ap-
 proach, but when it is necessary, to overlap each other
 considerably ;  and, with little or no injury to the child,
 admit so great a change of shape, that the dimensions
 of the head are on some occasions completely chang-
 ed ; and the vertex or crown is pushed out into the form
 of a sugar loaf;  by which the difficulties occasioned by
 the large size of the head, and by all the lesser  de-
 grees of  contraction and deformity of the pelvis,  are
 so far diminished, as to  manifest that but  for this
 wise and  benevolent formation, many children must
 have perished, or many women have died undelivered.
 The dimensions of the child's head, are naturally so
 much  less than those of the openings of the  pelvis, a» to
 leave sufficient room for the fleshy coverings with which
 the pelvis is lined.  The longest diameter of the head is
 from the forehead to the hind-head, from A to B about
 four or four inches and  a quarter ; and the shortest
 from ear to ear, from C to D, about three or three and
 a quarter inches.
   21.  As has  been already  observed,   the  child's
 head enters the pelvis with one ear to the  pubes, and
the other to the  sacrum, or rather a little diagonally
towards the opposite sides of these bones ; and conti-
nues in that direction  until the basis of the skull pass- 
40            Of the  Female Pelvis        [Chap. 1.

es the  brim of the  pelvis: it  then begins to  turn
where it finds least resistance, the  pains  forcing it
down, whilst the  sharp processes of the ischia (see
plate 3, H I  H l)pressing diagonally on the sides of the
head, one  towards the crown and the other towards
the forehead, on  the opposite side  ; compel it as it
descends, to  turn with its  longest diameter towards
the longest diameter of the pelvis ; until the face falls
into the hollow of the sacrum,  the nape of the neck
against the pubes. and the vertex  or crown  to the ex-
ternal orifice.  Whilst the head of the child is mak-
ing these turns, so as  constantly to present its longest
diameter to the  longest diameter of the pelvis, the
body  of the child'makes  similar turns;  so as  to
enter the pelvis with the shoulders diagonally from side
to side : but as they descend, they are likewise by the
same  powers compelled to turn, by which means,
When they arrive at the lower opening of the pelvis, one
shoulder presents to the sacrum  and the other to the
pubes; and one passing through the external orifice a
little before  the other, lessens the necessary distention
of the soft parts. Besides the bones of the head, many
others which constitute one bone in the adult, ^re con-
nected less firmly  by  cartilages and  ligaments in the
foetus ; and all the joints of the foetus are much more
flexible and  moveable  than they are in the adult, so as
to yield considerably  in passing  through the pelvis,
and render the birth more easy.
  The dark spots in the drawings represent the open-
ings between the bones where they  are connected by
membranes. 
Chap. 1.]         and its  Contents.               4l


                    PLATE VI.
  22. This  plate  exhibits  a child's  head passing
through  a pelvis contracted  about one fifth in the
short diameter of the brim  from sacrum to pubes ;
which, from the structure just now  described, it is en-
abled to pass by the  force  of the natural pains, when
time is given.  It is true,  greater deformities than
this occur, and once in many  thousand cases, the
pelvis has been found so distorted and  contracted by
disease, that a living child could  not possibly pass
through if.   Of the degree of distortion, some opin-
                        D  2 
4-            Of the Female Pelvis       [Chap.  1.

ion may be formed by examining by the vagina: if
the projection of the sacrum cannot be  felt  by the
finger,  directed backwards  and upwards from under
the pubes, we may conclude there is no considerable
deformity ;  but if  we can reach it, we may judge  by
 the readiness with which we discover it, of the degree
 of the  distortion,  and  of the consequent obstacles it
 may present to delivery.   Much uncertainty, howe-
 ver,  attends forming an accurate  opinion on this sub-
 ject; and conclusions, which have determined  the use
 and  application of instruments,  have  been  admitted
 even by experienced practitioners, which have after-
 wards been found to be erroneous.
   23.  By reviewing and reconsidering all this  ap-
 paratus,  we may in some  measure understand  the
 economy of nature, and  the wonderful resources she
 possesses to accomplish this, her  great work, the birth
 of a child: and particularly we must  see, how una-
 vailing and absolutely useless, are all those dangerous
 but too common efforts which  many rnidwives make
  to  aid the delivery, by scooping and stretching the
  soft parts of the mother to  make room, as they vainly
  imagine, for the child to pass.  All resistance of  any
  consequence in a well conducted labour,  is made by
  the  bones, and this the midwife cannot lessen.  I shall
  have gained a great point when  I have convinced my
  reader of this important truth; and  if I succeed to
  any general extent, shall  have  in  a  great  measure
  accomplished the end and principal object  I have in
  view,  in composing this essay ;—removing from the
  minds of our rnidwives in general a  prejudice  the fruit-
  ful source of many dangerous errors in their practice ;
  and which are so common  in all countries, that there 
Chap.  1.]         and its  Contents.              4$

is  not a writer on midwifery who  does not reprobate
and complain of them, and attribute to them most of
the difficulties and danger which occur in  tedious la-
bours.   The knowledge of these circumstances is the
basis and grammar of all safe and judicious  practice
in midwifery.   They should, therefore, be carefully
studied  and  thoroughly understood  by every practi-
tioner.

                  SECTION III.
      PLATE  VII.

Contents of the Pelvis.
  24.   In this  lateral section of  the  pelvis,  the
bladder of urine,  the unimpregnated womb, and the
straight gut, are  represented pretty nearly in their
natural  situations. 
 44           Of the Female Pelvis        [Chap.  1.

   A, the last vertebra of the loins.
   B, the sacrum or rump bone.
   C, the pubes or share bones.
   D, the vagina, or canal  leading from the external
 orifice to the womb.  It is supposed cut through the
 middle, and the  right half removed, to shew its course
 and connection with the neck of the womb.  The low-
 er and posterior part is longest; the upper and anterior
 shortest.   It consists of two membranes, which are so
 lax, as to be formed into plaits and rugae on the inner
 surface, by which structure it admits of great and easy
 distention during labour ; and is, at the same time, so
 elastic, that it soon returns again  to its natural dimen-
 sions.  Between these two membranes run the blood
 vessels,  and among those are placed a considerable
 number of glands, which secrete a mucus, with which
 the vagina is always lined, and  which is greatly increas-
 ed during labour. Hence arises the danger and absur-
 dity of irritating  these very tender parts,  by frequent
 and unnecessary examination, by which the parts them-
 selves become inflamed, the secretion of this salutary
 mucus is checked, and the  dilitation of  the parts, and
 the easy passage of the child's head are prevented.
   E, the external orifice.
   F, the  bladder of urine, moderately  distended before
 the womb.
   G, the unimpregnated  womb, lying between the
 bladder of urine and the straight gut.
   H, the straight gut behind and below the womb.
   I,  the perinaeam, or that portion of skin which lies
between the external orifice and the anus.   It is about
two fingers broad in the natural state, but capable of
great distention in time of labeur,  unless it has been 
Chap.  1.]           and its Contents.            45

irritated  and  inflamed  by unnecessary  handling;
in which case it is very apt to be torn.
   K, the anus.
   L, the neek of the womb and internal orifice hang-
ing a little down into the vagina, in such manner, that
the anterior is longer than the  posterior lip.
   M, the urethra, or  urinary canal, connected with
the vagina and womb.
   N, the left thigh cut off.
   O, the buttock.

   25.  From this plate the midwife may not only learn
the names of the parts, and their relative situation and
connections; butshe will readily see and understand the
reason why  diseases or changes of the womb, bladder,
and straight gut constantly affect each other.  The
enlarged womb  must  press on the gut  and retard
the passage of the excrement; the neck of the womb
may press on the neck of the bladder and prevent the
exit  of the urine ; or the body of the womb may press
on the  fundus of the bladder and prevent its retention.
If the womb fall lower down  into the vagina than its
natural situation, it must drag the neck of the bladder
with it; or if the over distended bladder rises up above
the pubes, it must carry the neck of the womb with it;
and inflammation, tumours, or ulcers of either of these
parts must readily be communicated to the others.
   26  By   attending  particularly  to  the situation
and direction of the  straight gut, and the urinary ca-
nal ; she will be  taught more easily and more skilfully
to perform two common operations, administering a
clyster, and  introducing  the catheter to draw off the
urine.   No midwife should be unprovided with the 
46             Of the Female Pelvis       [Chap.  1.

necessary instruments for performing these opera-
tions ; a good clyster syringe, or at least a pipe and
two or three bladders, and a silver and an elastic ca-
theter: they cost but  little, and as soon  as  the mid-
wife has obtained the  reputation of performing these
operations  skilfully,  she will be amply repaid.   It
seems hardly necessary to give  directions for admi-
nistering a clyster; yet if the midwife  observes the
situation of the anus,  and course of the  straight gutj
she will see that by  raising  her  hands towards the
patient's thighs,  and directing the pipe  a little up-
wards, but  chiefly backwards, she will  introduce  it
with more ease; and by keeping it in that direction,
she  will throw the injection further up  the gut, and
consequently the operation will  prove more effectual.
It is a common error to choose too small a  pipe;  a
large pipe is more easily introduced than one that  is
too small.
  27.  Introducing  the  catheter,  in the  female,
when the midwife is properly  acquainted  with the
situation of the orifice, and the direction of the urinary
canal, is an  operation of little more difficulty than
administering a clyster; except  where certain  obsta-
cles occur, which are to be overcome, more by pa-
tience  and gently  repeated attempts,  than by any re-
markable skill.   From motives of delicacy alone, this
easy operation ought to be in the  hands of women ; but
what is of much more consequence is, that  if a man
is  to be sent  for every time it may be  necessary  to
perform  it, it will generally be neglected  too long,
particularly in the country ; to the very  great injury,
and in  some instances, danger of  the  patient.   The
orifice of the urethra or urinary canal, is situate under 
Chap.  1.]         tmd its Contents.              47

the arch of the pubes or share bones, and the  canal
making a slight curve ascends very little, and enters
the bladder almost immediately behind  it (M) ; it is
not above  one inch and a half long, so large  as to
admit a catheter of the  size of a goose-quill, and  so
little curved  that  a straight instrument is by some
preferred.  ' Having  discovered the orifice, the mid-
wife,  standing or  sitting on  the right side  of the  pa-
tient, and holding the instrument in-her right  hand,
with the hollow of the curve  towards the  patient is to
introduce it; directing the point at first  a little down-
wards  and backwards,  then gently depressing the
hand, raise the point a little upwards  and forwards : it
will  almost immediately enter the  bladder,  and the
urine will flow from its extremity.   If however, some
little difficulty should occur, patience, and gently mov-
ing the hand from side  to side, or upwards and down-
wards, will overcome it with very little or no force, and
with  little pain to the patient; at  any rate, force is
never  to be used  ; it is better to desist,  and make a
second or a third attempt: for whenever any difficulty
presents, it is owing to circumstances not  to be over-
come by violence, which can never do good, but may
do infinite mischief.  The causes^f  such difficulties,
and the manner of removing them, will be explained
hereafter;  one mean is putting the  instrument when
introduced  into the orifice,  into the hand  of the pa-
tient,  who, directed by her  own  feelings, will  some-
times succeed more easily  than any  other person : a
caution however,  necessary to be observed respecting
the  use of the catheter, is  not to introduce it unne-
cessarily,  or  before such  remedies as warm-bathing,
fomentations, a clyster, soft mucilaginous drink, No. 
 48            Of the Female Pehis       [Chap. 1.

 2, with nitre, or mild anodynes, No.  14, according  to
 the nature of the case; as shall hereafter be poinied out,
 have been tried : because, when it  has once been in-
 troduced, it  is frequently found  necessary to repeat
 the operation, from the increased sensibility it induces
 on the urethra and neck of the bladder.  In this plate,
 all the appendages to  the womb, the fallopian tubes
 and ovaria, together with the flesh,  musclesj and cel-
 lular niembran«,..which line and  fill  up the cavity of
the pelvis, and connect the several organs, are omitted
 in order  o exhibit a more distinct representation of the
 parts most essential for the information of the midwife.

                  SECTION IV.

                   PLATK VIII.
Of the Womb and its Appendages.
 
Chap. 1.]
and its Contents.
49
  28. This  plate is intended to represent the womb,
the fallopian tubes and ovaria dissected from the sur-
rounding membranes: on the right  side as they ap-
pear in the unimpregnated state,on the left soon after
conception.
  A, the uppermost part of the wombcalled the fundus.
  B, the body of the womb.
  C, the cervix or neck of the womb.
  D, the internal orifice, called os tincae.
  E, the fallopian tubes with their fringed extremities.
  F, the ovaria or egg-beds, by extirpating which, the
animal loses the power of conceiving;  they  are,
therefore,  supposed  to furnish  whatever the female
contributes to  generation.  All these organs are in-
closed in a duplicature of the peritonaeum, which leav-
ing them forms the  broad ligaments of the womb.

                    PLATE IX.
E 
50             Of the Female I'avis      \y\\A\>.  1.

  29. This plate represents the internal structure of
the same parts, after making a  perpendicular section
of the womb and  removing its anterior parts.

  A, the sides of the womb ; they are of very consi-
derable thickness, and  consist of muscular fibres run-
ning in  every direction,  leaving between them inter-
stices filled with a mucilaginous fluid.
  30. B, the cavity of the womb, of a triangular figure,
lined with a very delicate  membrane, and furnished
with numerous vessels,  which terminating  by open
mouths  in the cavity of the  womb, or bursting open
from time to time, yield the menstrual blood. This
has been frequently proved by the dissection of  wo-
men who have died during  the period of menstrua-
tion, in whom these vessels have been found very  tur-
gid, and  the whole cavity, but particularly that of the
fundus, spotted with bloody effusions.
  31. C, the canal  of the neck of the womb, lined
with a rugous membrane, between the folds of which
may be seen the open  mouths of vessels which secrete
a viscid  mucilage, which plugs up  the neck during
pregnancy.
  32. D, the fallopian tubes, cut open, showing them
to arise  from the upper angles of  the  cavity of the
womb, into which the  openings are so small as to ad-
mit only a hog's bristle ; from hence they gradually
enlarge, until they terminate at the  fringed extremi-
ties in orifices of the size of a large goose quill.
  33. The ovaria (plate 8, F) are two flat oval bodies
of a glandular appearance :  upon  cutting open such
as have been taken from the  body of a healthy young
woman, a number of vesicles,  from eight or ten  to 
Chap. 1.]         and its Contents.               51

fifteen or  twenty,  of different sizes, joined to the in-
ternal surface by cellular threads, and containing a
fluid, are discovered.   There is great reason to believe
these to be real  eggs, and that they contain the rudi-
ments  of the future  embryo.   They are generally
found in different states of maturity, some  very small
and obscure, others more distinct and prominent. (See
plate XI, fig. 1.)
  Changes in consequence of Conception and Pregnancy.
   34. Upon opening the body of  a woman who has
died within three  weeks after impregnation, all the
vessels of the wontb, the fallopian  tubes, and ovaria,
appear considerably enlarged; the parts  themselves
swollen,  and the  womb in particular more soft and
spongy:  the fimbriated extremities of one or both
the fallopian tubes appear turgid with blood, and turn-
ed inwards upon the ovarium of the same side, em-
bracing some parts of it very closely, in order to
receive from  it what the woman furnishes  in genera-
tion : somewhat as  represented on  the  left side of
plate 8.
   35. Upon making the same perpendicular section
of the womb at this time, as represented in  plate 9, the
cavity is found to be more or less lined with a shaggy
coat, consisting of very fine  and tender vessels, shoot-
ing  out from its  sides or hanging down from its fun-
dus. (See plate  10.)  This coat is first formed at the
fundus, neck, and orifices  of the fallopian tubes,  but
soon after lines  the  whole  cavity.  It  is never found
in the  unimpregnated state,  but is decidedly a pro-
duction  of pregnancy,  preparing  the womb for the
reception  and attachment of the ovum, and for the 
 52             Of the  Female Pelvis       [Chap. r.

 nourishment of the embryo ; it is separated and cast?
 off at delivery, hence called membrana elccidua, caduca,
 8tc.   Upon close examination in  its  most perfect
 state, it is  found to be a double membrane ; the out-
 ward coat, or  that next  the sides  of the womb, perfo-
 rated at the three openings of the fallopian tubes and
 neck of the womb ; the inner or that next the  cavity
 of the womb entire, without opening or perforation.
  36. The ovarium being  carefully examined at this
 period, from the second to the end of the fourth week
after conception, that part of it which was embraced by
 the fallopian tube has been found enlaiged, and rising
 from the surrounding surface, (plate 11, fig   2) and
 upon carefully dividing  the integuments which  cover
 this prominent part, a  small vesicle has been seen to
 escape  from  it; at other  times this  vesicle,  of the
 size of a pea,  has been found in the course of the tube
 towards the womb ;  and on some rare occasions, hav-
 ing altogether missed the orifice of the fallopian tube,
 it has fallen into the  cavity of the abdomen among the
 intestines.
  37.  Some  time between the fourth and the  eighth
 week, (the period has never been ascertained and proba-
 bly is not much limited,) the vesicle is to be found in
 the cavity of  the womb: it enters from the fallopian
 tube, through the opening in the outward coat of the
 deciduous  membrane,  insinuates itself between that
 and the inner coat, and as it increases in size,  pushes
 the inner coat down  before it, makes of it  an outward
 coat to itself, and forms what Doctor Hunter, from this
 circumstance of its being reflected ever the ovum, ha*
 called decidua reflexa. 
Chap. I.]           and its  Contents.            53

                    PLATE X.
   This plan is intended to illustrate this subject.
   A, represents the decidua vera lining the womb, and
formed before the ovum enters it.
   B, the ovum.
   C, the decidua reflexa, beginning to be formed by
the growth of the ovum behind it.   One end of this
oeconomy seems to be to secure the attachment  of the
placenta  to the fundus or upper parts of the sides
of the womb ; for although now and then the placenta
is found attached to other parts  of the womb,  and
sometimes even over the very orifice, yet this is an
accidental circumstance, probably owing to a want of
due resistance in the inner coat of the decidua ;  and
ninety-nine times out of  a hundred  the attachment
of the placenta is found to be near  the orifice of  the
fallopian  tube, most frequently towan'. the fundus.
   33. On examining the prominent part of the ova-
rium soon after  the vesicle has escaped from it,  a
fissure of the integument is observed, which, healing
after some little time, leaves a cicatrix or scar,  (plate
11, fig. 2) and these cicatrices are said always to equal
                      E 2 
54           Of the Femaie Pelvis       [Chap, ii'

the number of times a woman has conceived.  Tak-
ing off the  outward coat of the ovarium at this part,
with the upper part  of the  prominence, an  oblong
substance  of a   yellowish   colour,  appears  with-
in, very vascular, except at  its  centre,  which is
whitish, and  in the middle of the white part a small
cavity ;  these yellow substances,  called corpora lu-
tea, are found in the ovaria of all animals when preg-
nant, and always in proportion to  the number of con-
ceptions found at  that time  in the womb:  for which
reason they are supposed to be cavities  from which
the ova had escaped.

                    PLATE XI.
  Fig. 1, represents the ovarium of a healthy young
woman, cut open to shew the vesicles. 
Ghap. 1.]           end its  Contents.            55

   Fig. 2, shews the prominent part of the ovarium,
and the cicatrix through which the ovum passed.
   Fig. 3. The ovarium, cut open after impregnation,
shewing the corpus Iuteum and cavity from which the
ovum escaped.
   Such are the facts which have induced most modern
physiologists to conclude, that the female furnishes
the rudiments of the new animal, and that the office of
the male is to contribute to its form, and to excite and
stimulate it into life.
   39.  During the  early months  of pregnancy, the
womb receives a very slow and gradual increase of its
bulk, nor is it before, the end of the third or the begin-
ning of the fourth month, that it can be felt rising above
the pubes.   Before this period, its  increase is confined
to the fundus and body, which at first sink lower down
into the pelvis ;  and the neck so  far from being  di-
minished, is from the general turgescence rather
lengthened,  as well as enlarged in  all other dimen-
sions.   On examination, therefore, the internal orifice
is felt lower down in the vagina than  in the unimpreg-
nated state.   In the fifth month the womb  begins to
render the belly tense, and  may be felt like a ball,
rising to the middle point between the  pubes and the
navel; in the seventh it reaches to the navel; in the
eighth to half way  between that and the  extremity of
the breast bone ; in the ninth  it nearly touches that
bone, at least in the first pregnancy, when the resist-
ance made by the integuments prevents its hanging so
much over the pubes, as in after pregnancies it general-
ly does.
  40.  From the time that the  ovum fills the womb,
(that is,  from about the middle of the fourth month, 
 56         Of the Female Petvis         [Chap. 1.

 but not very evidently before the fifth or the beginning
 of the sixth month) the  thick and long neck of the
 womb  begins gradually to develop, and its cavity to
 become a part of the cavity of the womb, until at
length  nothing more than a mere ring remains,  which
 forms the internal orifice.  As the neck shortens, the
orifice  recedes from the touch, so that although easily
felt until the end of  the  fifth or sixth month,  it can
 hardly  be reached  during the ninth :  when  again
 the womb beginning to act, a  general subsidence of
the whole abdomen takes  place, and the internal ori-
fice is brought once more within reach.   By compar-
ing this corresponding  shortening of  the neck, and
 retirement of  the internal orifice of the womb, with
the height to which the  fundus rises at different pe-
riods of pregnancy, and the time at which the menses
ceased  to flow, an  experienced  practitioner  may at
 any period form a tolerable judgment how far the wo-
man has advanced.

                  SECTION V.

              Structure of the Ovum.
  41. It is generally allowed by anatomists, that the
ovum does not enter the cavity of the womb  before
the end oftne first month of pregnancy, but that it is
frequently found there soon after.  When first dis-
covered, it is a soft  oval  mass, fringed  with vessels,
and on  carefully examining it, it is  found  to consist of
three membranes,  with a small mucilaginous  body,
the future foetus, closely  attached  to the inner  mem-
brane,  and surrounded with water.
  4.2. By the end of the eighth week or  beginning 
6hap. 1.]          and its  Contents.              {i

of the third month,  all these circumstances have be-
come more distinct, and consequently better subjects
for examination.   The  ovum now is nearly as large
as a hen's egg ;  the  attachment to the womb by the
placenta has commenced; the  foetus, about the size
of a bee, has receded from the  fundus, and hangs in
the surrounding fluid suspended by the umbilical cord ;
as is represented in the following plan, in which  the
 front of the womb and ovum are supposed taken off,
whilst at the same time the fluids are supposed not to
escape, but to remain and keep all the membranes and
 foetus in their natural situation.
PLATE XII.
 
58           Of the Female Pelvis        [Chap. 1.

  43. A A, the sides of the womb, no way diminish-
ed in thickness,  which  thickness they retain through
the whole period of pregnancy : the increase of size
being a power  of growth with  which  the  womb is
endued, independent of any distending  force exerted
by its contents ;  and which is so conducted, as at every
period of pregnancy, until the membranes are broken
and discharged,  to allow room for the foetus to move
its limbs, and in some measure change its posture.
  44. The development  of the neck does  not  pro-
ceed entirely in  the same manner; but as it is distend-
ed,  rather grows thinner,  particularly at the lower
part, which sometimes is reduced to the thickness of
a few folds of paper, and  when stretched  over the
child's head, has in some few cases been burst by the
throes of labour, or by  the rude introduction of  the
hand, or by an unskilful use of instruments.
  45. B B, deeidua vera,  the deciduous membrane,
completely lining the cavity of the womb.
  C C, Decidua reflsxa, or the inner lamina of the de-
ciduous membrane reflected over the oviim, which by
the end of the third month fills the cavity of the womb,
so that the decidua vera and decidua reflexa blend  and
unite their spongy vessels ;  after this the neck  of the
womb, which is not lined with the decidua,  begins to
develop,  and  that membrane not being capable of ex-
tension, and perhaps having performed all that was re-
quired of it, begins to give way,  and at the bottom of
the ovum its own membranes, the chorion #nd amni-
on, frequently appear smooth and naked.
  46. D D, the outward membrane of  the ovum the
chorion, on the inside at all times smooth ; on the out-
side, in the early months, shaggy and vascular.  This 
 ^hap. l.j          and its Contents.              59

 flocculent surface of the chorion consists of the minute
 extremities of the vascular  system of the  ovum, by
 which it is  supposed to  absorb what is necessary for
 its growth, before its attachment  to the womb by the
 placenta is completely organized.
   47. E E, the amnion, a fine transparent membrane,
 which immediately involves the foetus ; it is very pel-
 lucid and thin  in the early  stages of  pregnancy, but
 acquires considerable thickness and strength in the lat-
 ter months.
    48. Between the chorion  and amnion a gelatinous
 fluid, as  transparent as crystal,  is interposed, more
 plentiful in the early months, and gradually diminish-
ing as the pregnancy advances, so that  in  the  latter
 months these membranes come in contact with  each
 other.   This fluid resembles the white of an egg, and
 is supposed  in the early months  to contribute to the
 support of the foetus, as the  white does to that of the
 chick.
    49. Between  these  membranes likewise, in the
 early months  of pregnancy, a  small vesicle (H) is
 found containing a white fluid, and thence called ve-
 sicula alba ; it is connected with the navel of the foetus
 by an artery and  vein ;  its use is not known.
   50. Within the amnion is contained a thin watery
<$!uid in which the foetus is  suspended; the  quantity
 of this fluid at first is very  great in proportion to the
 size of the foetus, by which  its minute and delicate
 texture is better  defended from injury ; but this pro-
 portion is gradually diminished, so that at full time,
 the  weight of the foetus exceeds  that  of the  water of
 the amnion three or four times ; yet the absolute quan-
 tity of this  water is commonly  greater, at the com- 
f*,
 £0            Of the Female Pelvis      [Chap. I.

 mencement  of labour  that  at any  other period   It
 differs too, greatly in different cases, so that while some
 women  scarcely  discharge  a  pint or half a pint,
 others discharge several quarts   In a healthy state, it
 is of the nature of the serum of the blood, mixed with
 a proportion of coagulable lymph, colourless, and with-
 out any disagreeable odour. On other occasions, full of
 flaky  matter, and  of a fetid odour.  During labour
 the membranes being forced through the orifice of the
 womb, in form of a sack filled with this fluid, assist in
 dilating that organ.
   51.  F, the placenta; as soon  as the ovum passes
 -from the  fallopian tube into the womb, through the
 opening in the outer coat of the decidua, and lodges
 between that and the reflected portion, the flocculent
 vessels of the chorion blend and unite with those of the
 decidua.  From the irritation of  this new substance,
a greater action is excited,  and an  increased flow  of
humours solicited to the part, and most probably the
 placenta begins immediately  to  be formed, although
 neither that nor the cord is very  apparent until several *
 weeks thereafter.
   52.  G, tkefatus, suspended by  a  short cord from
 the placenta, and hanging freely in the  water of the
 amnion.   The cord is  attached to  the  navel of the
 foetus, so that the head  and upper parts  of the trunk
 are the heaviest,  and consequently  the  head hangs
 down  towards  the neck  and internal orifice of the
 womb.   This is  the natural position  of the child,
 which, except in a few preternatural cases, it invaria-
 bly preserves from the beginning  to the end of preg-
 nancy ; and as  this is the most favourable presentation,
 nature  has made wonderful provision to  secure  it: 
 • Chap. 1.]            find its Contents.            61

   in the part at  which the ovum enters the womb, and
   that to which  the placenta is most  readily attached,
   both being near the fundus ;  in the quantity of water
   in  which the foetus swims, and in the part of the body
   of the child to  which the cord  is attached : so that we
   no longer wonder at the great regularity  which in this
   respect is observed.
      53. About the eighth week, the foetus, the s:ze of a
   bee, is still gelatinous, consisting of two oval masses,
   the head and the trunk ; on the largest two dark spots
   mark the  eyes, a small eminence the nose, and a small
   opening the mouth ; the limbs appear just sprouting
   from the shoulders and hips.   After this, the growth
   of the foetus,  and the development  of the parts very
   rapidly proceed, so that by  the sixth month it is per-
   fect in  shape  and form,  except that  the hips and
   lower extremities still bear (as  they d> even at birth)
   a less proportion to the head and trunk,, so  as to give
   those greatly the preponderance.
      54. Between  the fourth  and fifth month, the mo-
,  tionof the child first becomes  sensible to the mother,
   which sensation is called quickening, at which period
   women in general suppose themselves half gone.
      55. The cord, by which the foetus is suspended from
   the womb, consists of two arteries and a vein, singu-
   larly convoluted and twisted round each  other; the
   arteries  arising  from the internal iliacs of the foetus,
   come out at the navel, and  carry the  blood from the
   foetus to the placenta, into which they plunge and ra-
   mify into very  minute  branches.   The  vein, (which
   in  size is equal to both arteries)  begins  by its most
   minute  ramifications  in the placenta, and carries the
   blood from the placenta to the fetus ; entering like- 
  62             Of the Female  Pelvis       [Chap.  I.

  wise at the navel, it joins the vena portarum and vena'
  cava, and after sending a portion of the  blood to the
  liver, conveys the remainder directly to the right ven-
  tricle, of  the  heart:  from  hence  a small portion is
  distributed by the pulmonary artery  to the lungs, suf-
  ficient to  keep them pervious ; but as the foetus does
  not breathe, and the  lungs  cannot  expand, no more
  can pass  that way: the  foetus  is,  therefore supplied
  with a canal, (called ductus  arteriosus) which arising
  from the  trunk of the pulmonary  artery, carries  a
  large portion of blood immediately to the aorta ; ano-
  ther portion passes through a  hole in the septum
  of the  heart immediately from  the right into the
  left auricle, and from thence into the aorta, to be dis-  •
  tributed to every part of the body : and again to be re-
  turned successively by the internal iliacs,  and the ar-
  teries of the cord to the placenta.
    56. The placenta is a spongy cake, consisting of two
  portions, one manifestly  formed by  the minute rarhi-
* fixations  of  the vessels of the  cord, connected  by  a
  large portion  of  celiujar matter, which is properly
  called the foetal part of the placenta: the  other form-
  ed in like  manner, by elongated arteries and veins of
  the womb, and is the  maternal  part  of the placenta  :
  between and connecting these, may be discovered the
  decidua.  Neither the arteries nor veins of the maternal
  part ever inoscu'n'.e into continued canals with those
  of the foetal part  of the placenta ; but  the arteries of
  the one pouring out a certain portion  of the blood they
  carry, into  the cells of the  spongy substance  of the
  placenta ;  it is absorbed by the veins of the other part.
  If, therefore, the vessels  of the cord be  cut or rup-
  tured, the foetus bleeds to death, whilst  the mother 
Chap. 1.]        and its  Contents.               63

does not suffer; and if the placenta be torn from its
connection with the womb, so  as  to  rupture the ma-
ternal vessels, the mother bleeds to death; after which,
the foetus  has been taken from  the  womb  alive, or
when left, dies only  in consequence of the death of the
mother.
   57.  The blood of the  mother, after having been
duly prepared by  her powers of digestion  and respira-
tion, is deposited  in the cells of the placenta; whence
it is absorbed by the veins of the foetus, carried to the
heart, and thence distributed to every part of the body
for their nourishment and growth : having performed
these offices, a large proportion  of the blood  is sent
by the arteries of the cord to  the placenta, thence to
be absorbed by the veins of the   mother, and carried
into her habit to receive fresh  supplies of oxygen and
nutriment.
   Hence we  discover the office of the placenta to be
to receive from the parent, and convey to the embryo,
nourishment  and oxygen ; or  that vivifying  principle
which all animals derive from  the atmosphere. 
64               On Pregnancy,          [Chap. ~
             CHAPTER II.


6!* PREGNANCY, ITS SYMPTOMS AND DISEASES.
                  SECTION I.

                   Menstruation.

   1. Every woman believes that her health and ca-
pacity of becoming  a mother, depends upon the regu-
larity of the monthly discharge.  She has great rea-
son for this opinion, at the same time that it must be
confessed, there occurs great variety in this  respect
between  different women; and that every  deviation
from the common  standard in the same individual,
so far from being justly considered as the cause of'
the ill health which generally accompanies  it, ought
more frequently to be considered as the consequence j
and  that the preceding impaired state of health,  is
generally the cause  of  the  irregularity in menstrua-
tion.  All attempts, therefore, to relieve such irregu-
larities ought to be, and by  physicians  commonly are
directed, to alter and change  the  state of  general
health;  and much  harm has been done,  particularly
in consumptive and  other cases  of great weakness, by
attempts  to bring on and force this evacuation, at a
time when nature is unequal to it, and when  the re*
medies employed are often very injurious. 
Chap. 2.]     its Symptoms and Diseases.         65

   2.  Mothers, with  equal reason,  are anxious  for
their daughters about-the period of their first men-
struation, as  their future health may greatly  depend
upon the  happy establishment of this change  in their
constitutions: but in  this instance also,  it should be
known, that  success  depends upon  general  health ;
and consequently  upon their treatment  of their girls
in  infancy,  and during  their education from  early
ehildhood.  According as that has  been  well  or ill
conducted, perhaps in exact  proportion,1 as they have
been confined to a plain and simple diet; as they have
been indulged in constant and free exercise in  the
open air ; as they have been restricted from all weak-
ening habits, sedentary occupations,  indolence, soft
beds, and late hours in or out of bed; will they pass
happily through this critical period of their lives.
   3.  The only general rules that can  be given are,
that robust, florid, healthy  girls, when about  the age
of fourteen or fifteen  they begin to complain of flush-
ings, head-ach, and general uneasiness : should  observe
a spare diet,  consisting chiefly of vegetables, should
keep their bowels open, use moderate  exercise,  and
carefully  avoid all  that  is violent, particularly  in
crowded and heated  rooms.  If the symptoms conti-
nue or  increase,  and the evacuation  does not take
place, the safest and  most effectual remedy is period-
ically to lose three  or four  ounces of blood,  at the
end of twenty-eight day§, for  two  or three months ;
bathing the  feet and legs in warm water for a few
evenings  before, and postponing  the  bleeding a day
or two after each period, to see if  the natural  evacua-
tion does not  take place.
                        F2 
66               On Pregnancy,          [Chap. 2.

  4. On the contrary, relaxed  and feeble young wo-
men, who are much more subject to such delay in the
first appearance of the menstrual evacuation, should
make use of such remedies as tend to strengthen the
habit in general,  such as bitters (No.  16. a. b. c.) a
glass of good wine, constant exercise in the  open air,
particularly  riding on horse-back, or in a  common
waggon ;  should  use  the  cold  bath, and  if in their
power, should drink chalybeate waters, at some of the
public  watering places ;  and those to whom this may
be inconvenient, should take some mild preparation of
iron (No. 16. e.) this remedy should be  preceded by
a vomit, (No. 11. a. b.) and a cathartic (No. 9. b. c.)
to  cleanse the  first passages; by which means the
strengthening  remedies  will  have a  better effect.
Having by these  means strengthened  the habit, they
may take aloetic  medicines, (No. 10. a. b. c) a dose
or two of rhubarb and calomel (No. 9. c.) have sparks
drawn  from  them  at an  electric  machine, or employ
warm bathing, by sitting in a warm bath, so that the
water may rise  above  the hips.  This  last remedy
should be made use of a day or two before and after
the  expiration of twenty-eight days.  The retention
of the  menses  in young girls is frequently preceded or
accompanied by chlorosis,green sicknets, in which every
symptom of languor and feebleness prevails; a pale and
even greenish completion succeeds  to the rosy hue
of health ; the lips and  gun^g become almost white;
the  breath offensive; the skin under  the eyes puffy,
and of a leaden colour;  the whole body lax  and cede-
matous; the judgment, memory, and natural cheer-
fulness impaired ; the pulse is generally  slow and
feeble, but is easily excited by the slightest exertion, 
Chap. 2.3     its Symptoms and Diseases.         67

and then is accompanied by shortness of breath, pal-
pitations of the heart, faintness, and an unconqueiable
inclination to motion : the appetite becomes depraved,
and  seeks gratification in chalk, lime,  and  pieces of
wall and other improper substances ;  and the bowels
are commonly costive.   This disease  has by mosi au-
thors been attributed to some defect in the develop-
ment of the  organs of  generation :  by some it  has
been considered as the cause, by others as the conse-
quence of retained menstruation.  But a late ingenious
writer,  Doct. James Hamilton, attributes it rather to a
costive  habit of body, occasioning in a debilitated state
of the  stomach  and  bowels depraved appetite, and
consequent weakness : and the success of his practice
seems  to have confirmed his theory.   He directs in
the first place, effectually to remove the costiveness
by some active purges, such as (No. 9. b. c.d.) and to
persist  in their  use  until all the  sordes which have
been collecting,  perhaps for  a considerable  length of
time, be removed. After this is effected and not before,
the happiest  consequences  may be  hoped for from
the use of the strengthening remedies recommended
in the  last paragraph.   This  view  of the  subject
should suggest to mothers the great importance of at-
tending  to the state of  the bowels in  their girls ;  and
carefully  to  guard them against that habitual cos-
tiveness into which from neglect they are apt to fall.
   5.  In temporary and accidental suppression of the
menses from cold, the  common practice of bathing
the  feet and legs, or rather  sitting  in warm water,
with a  garter tied moderately tight above  the knee,
taking  a mild aloetic purge, 1N0. 10. b.) and drinking
warm catnep tea on going to  bed,  are very  useful 
 66                On Pregnancy,         [Chap. 2.

 remedies.  When these remedies do  not succeed in
 the first instance, they should be repealed two or three
 nigtits successively, a  litt'e before the proper period
 for the return of the evacuation : if they again fail, the
 patient should immediately after lose a few ounces of
 blood, and if she  be a woman of  a full and sanguine
 habit, this should be the first remedy.  After bleeding
 and purging, which in women of a plethoric  habit are
 never to be omitted, the volatile tinct.  of  gum guaia-
 cum, (a remedy first  recommended by  Doct.  Dewees,
 of Philadelphia) may  be  given, beginning soon  after
 the natural   period'with  one  teaspoonful, three times
 a day in a glass of white wine ;  this remedy is to be
 discontinued on the  approach of  the  natural period,
 and to be repeated as  soon  as  that  has passed.  Doct.
 Dewees speaks very confidently of the salutary effects
 of this remedy, asserting that  he has found it more
 certain than the peruvian bark in intermittents.
   In women of pale  complexions, and lax and feeble
 constitutions, this  remedy may not only be used with-
 out previous bleeding, but it may be necessary to con-
 nect it with some of the tonic remedies recommended
 in the preceding paragraph.
   6.  A sparing  and painful menstruation is  to some
 women a very  distressing complaint: besides care-
 fully observing  all  the rules of general health, it is
 necessary on these occasions, carefully to  avoid cold:
 to be confined for  a day or two, and  to take freely of
 tepid  drinks through the day, as well as on going to bed,
 so as  to preserve an easy  moisture  on the  skin ; to
 use the warm bath by  sitting in warm water, and when
 the pain is very  severe to  allay it by opium, (No. 14.
a.) a dose of camphor, in the quantity often grains in
 powder, mixed with a little molasses, will on some oc- 
Chap. 2.3     its Symptoms and Diseases.         69

casions  give immediate relief.  Should the first dose
fail, a second may be given in two or three hours, or
it may be added to a dose of laudanum.
  But painful  menstruation is on  some  occasions a
most distressing complaint, not to be relieved by pal-
liative  remedies, and  according  to an observation of
Doct. Denman, becomes frequently a cause of barren-
ness.   In such cases a membranous substance  is ob-
served to be  discharged at each period from  the
uterus; after  which the  pain ceases for that period,
but returns at  the next, and is again  relieved in the
same  way.   For this complaint also, Doct. Dewees,
considering it a rheumatic affection of the womb, re-
commends the  volatile tincture  of  gum guaiacum :
which  he informs  us, has in almost every instance
in which he has used it, answered his most sanguine
expectation ; and that  in many  instances of married
women, the painful menstruation  was no sooner re-
moved than they conceived.
   7. The natural quantity of this evacuation is so dif-
ferent in different women, that it is by its effects only
we can judge of what is scanty or profuse.   When a
scanty evacuation is followed by general uneasiness,
a sense of fulness, flushings, and head-ach, it maybe
considered morbid, and should be treated as a case of
suppression.   When a considerable  discharge is fol-
lowed  by languor,  paleness, and  general weakness,
it is to  be considered  as  profuse, and proper means
should be made use of to restrain it; but these  will
differ considerably according to the constitution of the
patient.
   8. When head-ach, an oppressed breathing, increas-
ed heat, and a full pulse, precede or accompany a sud- 
70              On  Pregnancy,            [Chap. 2.

den and profuse flow of the menses,  the  evacuation
frequently  becomes its own cure ; and if the woman
be careful to keep her bowels open, to  observe a spare
diet, to drink only cold water, to observe great modera-
tion in exercise, and  to keep her person cool  by  thin
clothing, a  hard bed, and a free exposure to air ;  she
may not only moderate the evacuation  in future, but
probably derive considerable advantage  from its present
excess.   If, notwithstanding these precautions, the
flow should continue or return, she must lose blood
from the arm, and after that, may cautiously have re-
course to the remedies which are directed in the fol-
lowing paragraph to check a profuse evacuation in wo-
men of weak and relaxed habits..
  9. In relaxed, feeble constitutions,  a profuse  flow
of the menses  is a more frequent and more serious
complaint.   During  the flow, such women should be
confined to a horizontal posture, on a hard bed;  keep
their persons cool; take cold drinks, rendered astrin-
gent by  an infusion of rose leaves,  or  oak bark,   and
acidulated with the acid of  vitriol, (No. 3. a. b.  c.) at
the same time  apply to the  external  parts and to the
pubes, cloths wet with cold water or  vinegar: and
in obstinate cases, take every four or every six hours
eight or ten drops of laudanum.  Vomits, which  have
a powerful effect in checking haemorrhages in  all
weakened and  relaxed  habits, are recommended, and
may be used in such cases of profuse menstruation,
with a good prospect of advantage.
   10. When these remedies fail, recourse may be had
in hot weather  to the cold bath, either by immersion
or by having a  pail  of cold  water poured over  their
persons, while silting in a tub, even during the  dis- 
Chap. 2.]     its Symptoms and Diseases.         71

charge :  of the success of this practice, I have known
some very  happy instances.   During the intervals of
the discharge, such patients should use all those means
which have been already recommended for improving
their  general health ; and when  the flow  is  almost
constant, its presence constitutes no objection  to the
moderate use of wine, nourishing diet,  chalybeates,
(No.  16. e.)  or even exercise, which, when moderate,
such as riding in a carnage, has often been known to
suppress it.  In obstinate  cases, astringent  infusions
(No. 8. d.) may be injected into the vagina with great
advantage  ; they must always be used cold, beginning
with such as are mild and gentle in their  operation,
and proceeding to the more powerful as the case may
require.
   11. At  a particular period  of  life, commonly be-
tween the  ages of forty and  fifty,  the menstrual  dis-
charge ceases with most  women; in some  it ceases
suddenly,  in others it goes  off gradually ; and when
unattended with symptoms of disease, requires no
 other attention than such  a regard  to temperance in
all things,  as will run no  risk of interrupting nature
in the important change she  is about to effect.  All
circumstances  of pain or  profusion, to which  at  this
time  women are very subject, must be treated as has
been  already recommended  (in  6, 7, 8, 9, 10); to
which may be  added, this general  observation;  that
every kind of  excess, particularly  that of spirituous
liquors,  subjects women at  this  time of life, to the
most serious and distressing  complaints : lastly, every
deviation from nature in  this  important evacuation,
 when obstinate in its kind,  or intricate  in  its cause,
 is a complaint in which  the advice of a respectable 
 72             On Pregnancy,            [Chap. 2.

 physician should be sought, as there are few diseases,
 the treatment of which require more  skill or pene-
 tration.

                  SECTION II.

                     Diseases.
  12.  Conception—A cessation of the  menstrual dis-
 charge, so generally takes  place upon conception, that
 with great propriety it is considered  as the first and
 most essential sign.  This is not, however, universally
 the case, as some few women observe a periodical dis-
 charge of blood from the vagina, for a few months af-
 ter having become pregnant: except, however, in such
 rare instances, or in the case of a woman becoming
 pregnant while  she suckles; women  may, with the
 greatest probability of being correct,  date the com-
 mencement of their reckoning, from the middle of the
 period between their last  menstruation, and the time
 when they should have menstruated again.  More ac-
 curacy than this is not necessary ; the approach of la-
 bour will commonly be indicated by unequivocal symp-
 toms, long enough  before to be  prepared for it; end
 any considerable error in the reckoning, is always at-
 tended with some anxiety and apprehension.
   13.  There  can be no doubt but that woman, as well
as every other animal, is endowed by nature with  the
powers which are necessary to perform  all her natural
functions; and this observation is so peculiarly appli-
cable to the states of pregnancy and parturition,  that
we risk little  in asserting,  that all the danger of these
states in a healthy, well-formed woman, arises from
some error or mismanagement.  Yet such is the con- 
Chap. 2.3    its  Symptoms and Diseases.         73

stitution,  especially  of the  human body,  that most
great changes, though natural, are productive of some
uneasiness :  thus pregnancy is attended with sickness,
labour with pain ;  which, utiiess excessive, so far from
being considered as disease,  and therefore  to be re*
moved, are either the necessary consequences of great-
er advantages and enjoyments, or somehow essential
to future health and safety,  and require only  to  be
regulated.   This  admirable observation, Dr. Denman
has, with great judgment, applied to every  symptom,
and many of the complaints to which  women are lia-
ble, from the commencement of pregnancy to their
perfect recovery, after delivery ; many of those, which
occur in  an earlier stage, are  to be considered as pre-
paratory to that  which is to follow ; and for this rea-
son we should interfere with  them with caution ; and
carefully avoid all violenf remedies, and every irregu-
larity or excess in diet or regimen ; which may not on-
ly interrupt  nature  in  her  present delicate and im-
portant  operations, but may  perhaps lay the founda-
tion of some untoward symptom  in the succeeding la-
bour, or some disease during child-bed.
  14. Among the symptoms of pregnancy, sickness
and  vomiting so  generally  occur  during  the first
months, as peculiarly to excite a suspicion, that they
are  somehow designed  by nature to contribute to  the
woman's safety; they likewise appear to be connected
with that of the child : at least, by their presence and
degree,  to mark its vigour  and lively state, and  by
their sudden disappearance, to indicate its death.
  15. When,  therefore, the  vomiting is  moderate,
and confined to the early parts of the day, it should be
left  to nature,  at least nothing more should be done,
                        G 
74
On Pregnancy,           [Chap. 2.
  than to direct a simple and light diet, to correct  acid-
  ity, to keep the bowels  open by magnesia, (No. 15.)
  and to strengthen the stomach by a cup of cold cha-
  momile tea, or a light infusion of gentian or columbo,
 (No. 16. b. d.)  By  such means, this symptom com-
 monly subsides within the first three or four months.
    16. Simply to correct sourness, a tea-spoonful  of
 fine chalk, or half a tumbler  of lime-water, (No. 15.
 c. d.) mixed with milk,  are frequently  found very ef-
 fectual ; but as  they have no tendency to open the
 bowels,  they are  not so proper as magnesia or soda,
 (No. 15. a. b.) when sickness is attended with  costive-
 ness: on the  contrary, when  it  is  attended with a
 lax, they are the most proper.
   17.  In other  cases, when this symptom   proves
 more severe, when the  stomach  continually  rejects
 whatever food is taken, and when the  vomiting not
 only continues through the day, but during the night,
 and especially when it is attended with a  full pulse,
 some feverish heat,  head-ach and dizziness,  the loss
 of five or six  ounces  of blood becomes  necessary,
 which may  be repeated in three or four days,  if these
 symptoms continue to call  for it: this is more safe
 than  to  take  away  a large quantity of blood at  one
 time, which is always dangerous in early pregnancy.
   18.  In these  cases, the  saline  draughts (No. 12.
 c. a.) are very proper ; or a few drops  of the elixir of
 vitriol, (No. 16. f.) or of the essence  of pepper-mint,
(No. 17.  b.)   Laudanum  or an opium plaster, or a
small blister, may be applied externally to the stom-
ach with advantage ;  but the internal use of laudanum
 should be avoided  as much  as  possible ; as,  besides 
Ghap. 2.3      its Symptoms and Diseases.        75

producing costiveness and weakening the stomach, its
frequent use has been supposed, by some men of great
experience, to have an ill effect upon the infant.
   19. In women of weak and delicate habits, bleed-
ing is to be used with caution ; and if too much blood
be drawn, or it be imprudently repeated, much harm
may be  done,  and a miscarriage will probably be the
consequence.   In  such  habits,  especially when at-
tended with great  irritability, these  symptoms fre-
quently become so excessive, and continue so long,
as greatly to reduce the patient's strength, and resist
all common efforts to remove them ; in such cases,
the external application of opium or a blister to the
stomach, are peculiarly  proper, and their good effects
will be greatly promoted  by  confining the patient to'
little or  no food or drink,  not more than a spoonful
or two at a time of new milk or cream, or an equal
quantity of weak spirits and water ; at the same time,
supporting the woman's strength by nutritious clys-
ters of milk, &c.  (No. 7. a. b.) adding thirty or forty
drops of laudanum to each  to occasion the clyster to
be longer retained.   In this way, laudanum will like-
wise contribute to allay the irritable state of the sto-
mach, without any, or at least, with fewer of the  ill con-
sequences which follow its introduction by the mouth.
  20. If this  plan be attempted,  it  will always be
necessary before its commencement,  to empty  the
lower bowels by a common clyster, (No. 5. a. b.) and
to continue to  do so at least once in two days, as long
as it shall  be  found necessary to persist in  it.   The
nourishing clysters of broth or milk, are always to be
repeated within one or  two  hours after the last has
come away ; and the laudanum is to be added or omit- 
76              On Pregnancy,            [Chap. 2.

ted, as may be found necessary.  Often they will not
be rejected at all, but be  totally absorbed, in which
case they should be  repeated two  or three times in
twenty-four hours.  When, by these means, the irri-
tability of the stomach has been relieved,  the patient
must return to  a  fuller diet with great caution, both
as it respects the quantity and quality of her food.
 21. In some cases,  when the stomach has become
charged with bilious and other depraved  fluids,  ac-
companied with an ill taste, a foul tongue, and a fetid
breath ; it will  be found of use to precede  all other
remedies by a mild emetic, (No. 11. a.) and if neces-
sary, to repeat it after  three  or  four days; but in
pregnant women, although mild  vomiting does  no
harm, and gentle emetics ate safe and  sometimes ne-
cessary ; the  violent  straining and cramps which are
apt to follow the use  of tartar-emetic, should never be
hazarded.
  22. In  cases of heart-burn,  arising from acidity,
magnesia, chalk,  and lime-water, (No. 15. a. c. d ) a
weak solution of pearl-ash, soda, or of the salt of worm-
wood, (No. 15. b.) will be found very useful remedies.
In some cases, in which a peculiar sensibility of the  *
upper orifice of the stomach,  more than any  particu-
lar State of its contents, seems  to be  the cause, a so-
lution of gum-arabic, (No. 2. c.)  or the white of an
egg beat up with  a little sugar  and water,  will give
relief.  This symptom  is frequently attended with a
lax,  which  when moderate should no farther be in-
terfered with, than by correcting those complaints of
the stomach on which it generally depends.  When
severe, mild emetics, (No.  11. a.)  bitters, (No. 16. d.
a. b.) and laudanum administered in clysters, (No. 6.
a.) will check it. 
Chap. 2-3     its Symptoms and Diseases.          77

  23. When  this disorder of the bowels is attended
with a tenesmus, or  a frequent bearing down, and
urging to go to stool,  it requires particular attention,
or the womb may be  brought into action, and a mis-
carriage be the  consequence.  In this case, a vomit,
(No. 11. a.) after that, rhubarb and magnesia, (No.
8.0) or rhubarb and  ipecacuanha, (No. 8. i) accom-
panied or succeeded by clysters of thin starch and lau-
danum, (No. 6. a.) are principally to be relied on.
   24. Fainting and hysteric fits  depend much on>the
same cause as the affections of the stomach :  and are
always aggravated  by  the disorders  of that organ;
relieving that, therefore, has a great tendency to carry
off these ; but  time alone  is frequently  the best re-
medy :  and if we add moderate e. ercise in the  open
air, such as riding  in  an  easy  carriage, little more
need in general be attempted.  In full habits, mode-
rate  bleeding  will be  of  use; but these symptoms
more frequently appear in weak and delicate habits,
in which bleeding, especially if repeated, only adds to
the weakness, and consequently does harm.
   25. Swelled and painful breasts,  are symptoms of
early pregnancy.  In full  habits this complaint may
require moderate bleeding and mild laxatives, (No 8.
g.) anointing the breasts with olive-oil or fresh  hog's
lard, and covering them with flannel or fur, frequent-
ly afford relief.  Above all  things, a  loose dress  is
absolutely necessary ;  and particular  care  should  be
taken not to press the nipple into the breast, by which
it has been sometimes really obliterated, so as to ren-
der it  impossible  to  suckle.   When any appearance
of this takes place, wearing a (hick ring of wax  over
it, so that the nipple may  protrude it, and at the same
                       G2 
78               On Pregnancy,          [Chap. 2.

lime be defended  from the pres-.ure of the clothes,
will tend greatlv  to form a good nipple: and any wo-
man who has experienced  the pain and trouble of a
small nipple, buried in the flesh, will not think this
attention, to obtain a good  one, thrown  away.  The
source  of this complaint is often laid,  very  early, in
the improper dress of young women ; and from its
very inconvenient and frequently distressing  conse-
quences, deserves the attention of mothers, from the
time their daughters commence women.
  26.  Costiveness, although mostly a disease of the lat-
ter months of pregnancy,  sometimes accompanies it
from the beginning : when neglected, it not only  be-
comes  a very serious evil in itself, but lays the founda-
tion for others of more consequence.  It is a complaint
easily prevented by a very moderate degree of atten-
tion, and regularity of habit; but it unfortunately  hap-
pens, that in this respect, women in general are very
inattentive indeed it seems to be a part of female edu-
cation  to be so, the ill consequences of which many
of them feel through life.
   27.  When not habitual, costiveness may depend,
in early pregnancy,  upon the state of the stomach ;
and is relieved by  the same remedies ; particularly by
magnesia, and soda, which at the same time that they
correct the acid in the stomach, form with it a neutral
salt, which proves laxative  ; when it does not, recourse
must be had to mild purgatives, such as castor-oil, leni-
tive electuary, sulphur, cream  of tartar, &c. (No. 8.)
but above all, to clysters,  (No. 5. a. b.) which  are al-
ways safe, and generally  effectual.  At any  rate, it
must be removed, or it may be the  source of greater
evils.  Strong purgatives should never  be used ; re- 
 Ghap. 2.]      its Symptoms and Diseases.        79

 peated clysters seldom or never fail ;  but the power of
 habit, when once established,  is  the best preventive :
 it is safe, easy,  and certain.  It sometimes happens,
 through extreme neglect,  that  a large  quantity  of
 hardened balls, become so lodged  in  the intestine, as
 to be almost immovable; whilst at the same time they
 suffer a small quantity of  fluid  matter regularly to
 pass, and thus deceive the patient.  The  previous
 symptoms, and the little relief afforded by such eva-
 cuations, point out the disease ;  which is  sometimes
 not to be relieved, until the effect of repeated injec-
 tions, castor-oil, 8cc. is aided by the introduction of the
 handle of a spoon, or some such  instrument, into the
 rectum, to break down the hardened excrements.
  29. Hemorrhoids.   Among the evils which a cos-
 tive  habit almost  necessarily brings with it, are the
 piles, to  which  many women are  subject, and from
 which, many of them  suffer  more than from  child-
 bearing.   A free and  regular state of the bowels, is
 almost  a certain preventive against this  painful dis-
 ease ; and if there was no  other motive, this alone
 would most amply repay all the  attention necessary
 to obtain it.   Attention alone is  necessary : we are
 all the creatures of habit: and good habits are, at least
 in this respect, as easily established as bad ones.
  30. The piles are seldom cured completely during
 pregnancy, and unfortunately, are apt  to be much in-
creased by labour.  A  spare and cooling  diet, open
 bowels,  and moderate bleeding,  are the best pallia-
tives : if they are  attended with a discharge of blood,
laxatives only  (No. 8. c. e.  f.)  are necessary ;  when
swelled  and  painful,  a bread and milk poultice, with
two or three teaspoonsful of laudanum added  to  it, 
 80             On Pregnancy,            [Chap 2.

and applied cold ;  or  Goulard's  cerate should first be
applied,  and  when the inflammation shall be some-
what abated,  one prepared  with powdered galls, (No.
 18. b. d ) will be found useful.
   31. All warm and  relaxing applications are hurt-
ful ;  and all kinds of heating food and drinks, particu-
larly  spices and spirituous liquors, will  infallibly  in-
crease the complaint :  indeed  it cannot be  too  fre-
quently repeated, ihat a heating diet, and particulaily
spirituous liquors,  are at all periods of pregnancy and
labour so dangerous and prejudicial, that they should
never be taken but by the advice of a physician.
   32. Wander ng pains, Sec.  Wandering pains about
the face and teeth  frequently occur during  the early
periods of pregnancy ; pains in the back  and loins,
cramps, numbness, swelled legs, and enlarged veins,
more generally  towards the latter end.  These com-
plaints are free from danger, but  often prove so trou-
blesome and inconvenient, as to require, at least, some
palliative remtaties.
   33. They  will be relieved in  full habits by small
bleedings,  by keeping  the bowels freely open, by a
spare diet, a  recumbent posture, moderate exercise,
and  frictions  with soft flannel morning and evening.
jEther,  (No.   19.  h.) or volatile oil, (No.  19. a.) ap-
plied to  the  parts, are sometimes of  use, and in the
case of pains in  the back and loins, and cramps, ano-
dyne  clysters, (No. 6.) now and  then  prove effectual
remedies; sometimes in the latter months of preg-
nancy, the enlarged womb  pressing on the veins and
absorbent  vessels,  and preventing the return of the
fluids into the circulation, occasion these  watery swel-
lings to extend to the parts of generation, by which 
Chap. 2J       Us Symptums and Diseases.       81

they are often so much swelled, as to prevent  the wo-
man from walking, and in  some measure even im-
pede delivery.  The only  remedy in this case, is to
puncture or  slightly scarify the parts with a fine lan-
cet, which is perfectly  safe, and may be repeated, if
necessary, even in time of labour ; a cloth, wrung out
of warm water, and applied to the parts, will promote
the easy and perfect evacuation of the water.
   34.   Restlessness and want  of sleep.   The  com-
plaints enumerated in the last paragraph, are frequent-
ly aggravated in the latter  months, by restlessness and
want of sleep, attended with some increased heat and
sense of suffocation ;  these require, in  addition to
small bleedings and empty bowels, a cooling regimen,
a hard bed, and a large airy chamber : in such cases,
opium is generally improper, and in its stead a tea-
spoonful of  the  sweet spirits of vitriol, or sweet spi-
rits of nitre,  (No. 14. c.) will be found soothing and
refreshing.
   35.  An incontinence of urine,  is sometimes  a trou-
blesome complaint about the third or fourth month of
pregnancy,  but  more  frequently  during the  latter
months.   In the  first instance, it will go off as soon
as the womb rises above the brim of the pelvis : in the
latter,  it admits of  no remedy before delivery,  when
it will cease  of course, the pressing  of the womb on
the bladder being removed.
   36.  A strangury or  suppression of urine during
pregnancy,  occurs at different periods, and is at all
times  a much  more serious and painful complaint;
and whenever it does occur, should command imme-
diate attention, because every  moment of delay not
only adds to the present uneasiness, but likewise in- 
82               On Pregnancy,          [Chap- 2.

creases the difficulty of removing it.   A full and dis-
tended bladder always predisposes  to this complaint.
Pregnant  women, therefore,  should on no account
ffece themselves  in situations which may lay  them
under restraint in this respect ;  and carefully attend-
ing to every call is very essential to their safety.
   37.  Such women, too, as are subject to any degree
of prolapsus or falling down of the womb, are particu-
larly liable to a suppression of urine, especially during
the first three or four months of pregnancy, when the
womb is always lower than it was before,  or than  it
generally is after that period.   As it increases in size
in this situation, it compresses the neck of the bladder,
urethra and rectum ; frequently occasioning constipa-
tion in the bowels, and a retention of urine, which ge-
nerally come on gradually, and increase as the  womb
increases in size, until it  becomes so large as  to rise
out of the pelvis, when again these  symptoms  are re-
lieved.   At other times these complaints, particularly
the suppression of urine, comes on suddenly, whilst the
woman is straip.ing at stool,  or forcibly discharging
her urine ;  and in this case the womb is frequently
found very low ;  the os tincx protruding the external
orifice.   In either case, the complaint may generally
be removed by pushing up the womb into the  pelvis,
and supporting it  there whilst the patient discharges
 her urine « or even this assistance may be avoided  by
 trying the effect of differenl postures ; by lying  on her
 back with the hips raised, or kneeling on the floor with
 the elbows resting on a  pillow, or by lying on  either
 side ; either of which attitudes may relieve the pres-
 sure on the urethra.  In all obstinate cases the  bowels
 should be opened by a copious injection, (No. 5. a. b ) 
Chap. 2.]       its  Symptoms and Diseases.      83

and if the  woman be of a full habit, and finds herself
flushed and heated, she should lose a little blood, and
drink, though not in large quantities, barley-warer, flax-
seed-tea, (No. 2.  a. b) almond milk, or one made of
pumpkin or melon seeds, (No- 13. b.) these, when the
suppression is only partial, and  attended  with  much
heat in discharging the urine, will generally afford re-
lief ; but  whenever a total suppression takes place, the
patient should avoid drink of any kind until she shall
be relieved, and  if she does not succeed  in her at-
tempts, recourse must be had to the  catheter, (Chap.
 1.27.)
   38.   Retrovcrted womb.   When a suppression of
urine occurs about the third or fourth month of preg-
nancy, when it is remedied with  difficulty, or only in
a partial  manner ;  when  it  returns  frequently,  and
especially if it be  attended  with a  painful bearing
down, and urging to go to stool ; we may apprehend
an approach, at least,  to this complaint; in which the
body and  fundus of the  womb,  instead of  rising up
through the brim of the  pelvis,  as  at  this period it
ought to do, is turned backwards  and downwards into
 the hollow of the sacrum.
   39.  Plate 13 represents the pelvis, with its contents,
in their natural  situation, about the third  or  fourth
 month of pregnancy. 
84             On Pregnancy-,           [Chap.
PLATE XIII.
  A, the jutting in of the sacrum, and last vertebra
of the loins.
  B, the hollow of the sacrum.
  C, the pubes or share bone.
  D, the vagina cut open.
  E, the external orifice.
  F, the bladder.
  G, the womb rising out of the pelvis,
  H, the rectum or straight gut.
  I, the perinaeum.
  K, the anus.
  L, the neck of the womb hanging far back in the
 vagina. 
Chap. 2.]       its Symptoms  and Diseases.
PLATE XIV.
  40.  Plate 14  represents the retroversion of the
womb, in which F the distended bladder rising out of
the pelvis, draws forward and upward L the neck of the
womb, which is naturally connected with it;  whilst at
the same time the full bladder pushes backwards and
downwards the body of the womb into the hollow of
the sacrum ; by which the neck and internal orifice of
the womb is brought to press the neck of the bladder
against the pubes, so as to prevent the passage of the
urine; and the body  of the womb at the same time
presses on the rectum, so as to prevent the discharge
from the bowels.
  41.  This view of  the  subject sufficiently explains
the nature  of this disease, and the danger to which a
woman exposes herself, who at this period of preg-
nancy is led from neglect,  the  forms of society, or
                      Ii 
 86              On Pregnancy,            [Chap. 2.

 any other cause, to retain her urine until the bladder
 becomes  distended; which,  in piopoition  to the de-
 gree of the distention, necessarily drags the neck and
 fore part of the  womb up with it, and  at  the same
 time pushes the fundus back towards the sacrum ; and
 brings the internal orifice to press the bladder strong-
 ly against the pubes, by which the urine  is suppressed.
 This displacement may take place slowly or suddenly.
 In the first case it seems to depend on the  continued
 pressure of the superincumbent intestines, r:n the  fun-
 dus of the womb, from  the  very  commencement of
 pregnancy : it begins to  manifest itself early, by a
 troublesome weight on  the  fundament, painful dig-
 gings in the groins, forepart of the thighs and loins, and
 a sort of uneasiness about the neck of the bladder  and
 rectum, which  excites a frequent inclination to  make
 water  and to go to stool   These symptoms progress
 from day to day, and from week to week, until a sup-
 pression of urine, and of the evacuation of the bowels
 comes on.   When it takes place suddenly, it may be
 produced by straining to vomit or to go to stool; or by
 a fall or blow, or any strong compression on  the belly ;
 especially  if at the same time a full bladder shall con-
 spire to drag up  the  neck of the womb, whilst  the
 pressure of the abdominal muscles pushes dovvn its fun-
 dus.   This seldom happens  before  the  beginning of
 the third month, when the uterus is considerably in-
creased in size ; and in this case  the painful symp-
 toms which indicate the disease very soon follows: at
 any rate, as soon as any suspicion of this disease exists,
 it should command our  most serious' attention,  be-
 cause as the womb continues daily to increase in size,
 its return to its  natural situation  must  become more 
Chap. 2.3     its Symptoms and Diseases.         87

and more difficult:  and further, when long confined to
this unnatural situation, it will at length become swol-
len and inflamed, which must render every effort to re-
place it more painful  and more difficult.   If, under
these circumstances, an examination by the  vagina be
made, the internal orifice of the womb either cannot
be felt at all, or is discovered high up under the pubes ;
but a large round tumour is discovered occupying the
inferior parts of the cavity of the pelvis ;  and if at the
same time a finger be introduced into the  anus, the
same tumour may be felt, pressing the rectum to the
hollow of the sacrum.   If both these examinations be
made at the same time, we may readily  discover that
the tumour is  confined between the vagina and the
rectum.
   42.  The prevention and cure are equally  evident:
the first consists in carefully  attending to the call of
nature, and on no occasion retaining the  urine for any
length of time; the latter, in emptying the  bladder
and rectum as soon as possible, which  alone will re-
move all  lesser degrees of this disease; and without
which, no other remedy can be of use.   Repeated in-
jections, (No. 5. b.) generally succeed  in  emptying
the intestines ;  but to evacuate the bladder is in  this
case, sometimes attended with  more than  common
difficulty.  If, therefore, the common attempts in dif-
ferent attitudes, fail, early recourse must be had to the
catheter; and if  the introduction of the common sil-
ver catheter cannot be easily  accomplished, a slender,
long and flexible catheter must be  procured: this in-
strument will  accommodate itself to the  confined pas-
sage, and be more easily  introduced.   (See Chap. IV.
No» 24. plate  19.)  If the midwife  do not soon sue- 
 88              On Pregnancy,           [Chap. 2.

 ceed by gentle  perseverance, the most skilful assist-
 ance must be sought;  for as has been already observ-
 ed, until the bladder shall  be  empty, no relief can be
 given;  and  when it is completely accomplished, the
 womb will probably return to its natural situation by its
 own propensity to rise  through the pelvis.
   43. The bladder and rectum being empty, place the
 woman so as to rest on her knees and elbows; then with
 two fingers ofone hand,introduced into the rectum,push
 the fundus of the womb  upwards and forwards, whilst
 you attempt to bring the neck down from the pubes, by
 one or two fingers of the other hand introduced into the
 vagina.  It  is hardly necessary to add, that the parts of
 the woman, as well as  the  fingers of the operator are
 to be  prepared for this operation by being well anointed
 with lard ;  and that we are always to aim at accom-
 plishing our purpose by gentle and persevering efforts;
 never by hurry and violence.  Should these attempts
 fail, recourse may be had to the method recommend-
 ed by Doct. Dewees, in  a note to his edition of Bou-
 delocque,  viz. having previously prepared the parts of
 the woman by anointing them well with lard, bleed'her
 standing until she shall faint,<hen immediately laying
her on her back, with her knees raised towards the ab-
domen,  introduce your hand into the vagina, with the
back of the hand towards the  hollow of the sacrum,
push up the fundus until it is placed above the projec-
tion of the sacrum.  In any case, especially, if the re-
duction is accomplished with care ; a pessary  should
be introduced into the vagina to prevent the womb re-
turning  to its former situation ;  and the  woman must
be kept  quiet, in  a horizontal posture for several days ;
she must not strain, to pass either urine or stool, but 
Chap. 2.3    its' Symptoms and Diseases.         89

both the bladder and rectum must be kept empty, by
the use of the catheter and injections.
   44.  It will sometimes happen, however, from neg-
lect, that this disease may have proceeded to a degree
not to be relieved by these gentle means: the suppres-
sion of the urine is total, the bearing down  and calls
 to stool violent, resembling the throes of labour ;  the
 tumour in the vagina is so low and large as  to occupy
 the whole cavity of the pelvis, so as to admit the fin-
 ger but a little way into the vagina, and these symp-
 toms are attended with fever and inflammation.   In
 this dangerous situation, the patient must first be
 plentifully bled ;  ease must then be procured by the
 free use of opium, (No. 14. a.) the bladder and rectum
 must be emptied; relaxing bathes, and  fomentations
 must be applied to the parts, and these remedies must
 be repeated  and continued until all symptoms of fever
 and inflammation have subsided : after which, the ef-
 forts to replace the womb may be steadily but cautious-
  ly persisted in, remembering,' however, that while the
  bladder and rectum yan be kept empty, there  is less
  danger  in  delay  thijj in violence.   This  complaint
  never occurs but  fronf the end  of the  third  to the be-
  ginning of the fifth month.
    45. Epileptic fits.  The state  of the womb has a
  great effect  on the female constitution ; and that great-
  er degree of sensibility and irritability by which women
  are distinguished from  men, receives great increase
  from  conception, which is  continued  through every
  period of pregnancy and labour. Hence, at such  times
  women are peculiarly subject to nervous, spasmodic,
  and convulsive diseases;  and hence, too, women  who
  are the inhabitants of populous cities, and in the  high-
                          H2 
SO                On Pregnancy,         [Chap. 2.

er spheres of life, who have been delicately bred, and
who indulge themselves in a dissipated and luxurious
life are much more liable to these dreadful andfatul dis-
eases than the mo>e hardy inhabitants of the country,
or than such as from constant labour and exercise en-
 joy more robust constitutions.
   46.  Women are liable to convulsions in every pe-
 riod  of pregnancy; seldom,  however, in  the  early
 months, more frequently toward* the latter end of preg-
 nancy, and still more so at the commencement of la-
 bour, when the first dilatation of the extremely sensible
 os uteri  seems to bring  them on.  'I hey are more
 apt to occur in a first, than in subsequent labours,from
 the great apprehension  and terror which some women
 suffer on that occasion ; and perhaps for a similar rea-
 son women,  whose labour is brought on by some dan-
 gerous accident, some sudden stroke  of affliction, who
 have suffered convulsion on  a  former occasion, and
 those  tinhappy women,  who, instead of rejoicing in the
birth  of  a child, dread consequent  reproach  more
 than the pain and danger,  are$avticulaily subject to
 convulsions.
   47.  The danger of convulsions is in general in pro-
 portion to the advanced state of pregnancy,  except
 v hen  they occur after labour pains have begun,  when
 a speedy delivery frequently carries them off:  in other
 respects the danger is to be estimated more from the
 heulth aivi constitution of the patient, from the vio-
 lence  of the fits,  and from the  degree of stupor and
 apopletie symptoms by  which they  are succeeded,
 than from the frequency of their recurrence.    When
 ei;h succeeding  fit is more violent, and  when they 
Chap. 2.3     its Symptoms and Diseases.         91

leave the patient more and more comatose, the danger
is most imminent
  48.  They ..re  frequently preceded by a very irrita-
ble and fretful state of mind, approaching to delirium,
and by a restlessness and unaccountable uneasiness of
body; by some degree of blindness, and the appearance
of motes dancing before the eyes ; by a swimming or
violent pain of the head, especially on stooping down ;
by a flushed countenance, a staring and protruded eye,
swelling of the veins of the neck, and throbbing of the
arteries of the head ; and sometimes by a cramp, or
violent pain in tne stomach, which  is  always a dan-
gerous symptom.
  49.  If due attention be paid to these threatening
symptoms, the fits may piobably be prevented by one
or two moderate bleedings; by opening the bowels with
salts, and keeping them free by occasional doses ; by a
low diet, cooling drinks, avoiding wine, much exercise,
and all violent passions.  The  same remedies are  ne-
cessary after the fits have come on, only  they must be
applied with greater vigour; the bleeding must be more
copious, and if the blood be drawn  from the jugular
veins, or temporal artery, it will be most efficacious  : at
any rate, cupping glasses, with  scarification should be
applied to the nape of the  neck or  temples ; and  the
bleeding must be copious and repeated according to  the
violence of the symptoms and strength of the patient;
and the effect of purgative remedies must be quicken-
ed by stimulating clysters, (No. 5. c. d.) Of the effects
of emetics, blisters  and anodynes, some doubts have
been entertained;  but where there are evident marks of
a loaded anddisturbedstomach,af:erbleedingandpurg-
ing,emetics are not only safe, but very efficacious, not on- 
92              On Pregnancy,            [Chap. 2-

ly as preventives: but after the fits have come on, blisters
are certainly not to be relied on but as auxiliaries ; and
as such should be applied to the head, between the shoul-
ders, or to the thighs.  Of opium we nave good reason
to be apprehensive, except it be in that species of con-
vulsion which sometimes  comes on after great fatigue
and exhaustion, by tedious labour, or considerable loss
of blood, in which anodynes, cordials and nourishment
are our only  resource.    Sudorifics, such  as tepid
drinks, mild essences, spirits and invigorating doses of
antimonials (No. 12. a. c. d.)*where there is an oppor-
tunity  afforded for their exhibition, are always safe,
and may be of use : their effects may be promoted  by
fomentations to the legs and abdomen,  and on some
occasions the v. arm bath has  found to suspend the at-
tack.  For the treatment of convulsions during labour,
see chap. iv. sect. 26.
   50.  Paralytic affections are more rare, but some-
times occur  during  pregnancy.   In this case  they
seem to depend solely upon  the  state of  the womb,
and are seldom cured before delivery, but  then, or
very  soon  after,   leave the patient perfectly  free.
Heating and  stimulating remedies increase the com-
plaint ;  but like all other diseases depending on uterine
irritation, they are  relieved by moderate bleeding, gen-
tle  purging, and a  cooling regimen.
   51.  Fluor  albus, the whites, is a disease  to which
pregnant women  are  frequently  liable, and when.it
occurs late, and is not  very profuse,  it requires no
remedy except cleanliness, by washing frequently with
cold water.   Delivery, which it may contribute to
render  easy, generally cures it.   But when it is pro-
fuse,  especially at the beginning of pregnancy, it is 
Chap. 2-3       its Symptoms and Diseases.       93

apt to bring on pains  in  the back and loins, and to
weaken  and relax the woman so much, as to endanger
a miscarriage.  In this case, as  well as in the unim-
pregnated state, it is cured  by washing freely with
cold water, or by bathing the whole person  in cold
water, by moderate exercise in the open air, by a plain
but nourishing diet, by strengthening remedies, such
as the peruvian bark and iron, (No. 16. c. e.) by astrin-
gent injections, (No. 20. a.  b. c. d. e.)  beginning  al-
ways with  such as are weak, and after a little time,
changing them  for such as are more powerful.
   When  fluor  albus  is  attended by  feverish  heat,
bleeding moderately, and  purgatives, (No. 9. b. c)
should precede  astringents;  and when  the discharge
is of a dark yellow or greenish colour, sharp and acrid,
so as to inflame and irritate  the neighbouring parts,
simple washing, and mild  alterative medicines, such
as  mild mercurials,  and the decoction of the woods,
(No. 13. c. d.) should  be used for one or  two weeks,
and then succeeded by strengthening  and astringent
remedies.  When in an unimpregnated state fluor al-
bus is accompanied by a regular and periodical flow of
 the mtnses, the discharge most probably comes from
the vagina, is generally  a  slight disease, and easily
cured.   But when under this discharge the menses are
obstructed, or they flow profusely and irregularly,  ac-
companied by pain in the back and loins, it is to be ap-
prehended that the womb is diseased,  the complaint
becomes  more  serious,  and generally  renders  the
woman barren,  as long as the discharge continues. 
94'             On Pregnancy,           [Chap. 2.


                 SECTION III.

Abortion: miscarriage before the end of the sixth month.
   52. This  is a subject  of great intricacy,  and not
easily discussed in a popular manner ;  at  the  same
time it is very interesting, happens  frequently,  and
deprives women  of  their health  and their  happiness.
Very strong and very weak women  are most  prone
to it; but the numbers of the strong bear no propor-
tion to those that are weakly ;' the numbers of  active
country women, to the more indolent and  inactive in-
habitants  of cities ; the number of women of good
sense, and  calm and steady  minds, to  the weak, the
irritable, and the passionate: and  hence a most im-
portant lesson, that good  health, and a good education
are the best  preventives  ; and that it  in  a  great de-
gree depends upon mothers, and the care they take  in
rearing their girls, to  lessen  this great and common
evil.
   53. Another observation is,  that women who  have
once miscarried, are apt to miscarry again at the same
period, and  that if once  the habit be  required, it be-
comes  very difficult  to remove ; perpetually disap-
pointing the hopes of patents.   Hence  the importance
of great care in a  young woman not  to  miscarry  in
her first pregnancy ;  and in  those who  have once mis-
 carried, to avoid  if possible, a  miscarriage in  their
 next pregnancy.
   54. Again, miscarriages are  most apt to occur be-
 tween the eighth and the twelfth week, and from the
 fifth to the  seventh month ;  these  periods,  therefore,
 will require  particular  attention ; though, indeed a 
Ohap. 2-3     its Symptoms and Diseases.        95

prudent  care is  at all times necessary, because the
cause and source of the miscarriage may be, and com-
monly is laid at  a much  earlier period than  that at
which it occurs;  and anxious solicitude may contri-
bute to bring on the evil it is intended to prevent.
   55.  To  be more   particular;  every  thing  which
tends to excite a  violent action of the heart and arte-
ries, and by that to occasion a separation of the after-
birth from the womb; an original, weak  and  feeble
attachment between  these organs, or  any thing which
may bring on a premature action of the womb, may
occasion miscarriage: hence, all violent passions, par-
ticularly  sudden  anger and  surprise ;  even great joy
has been known to occasion abortion in a few hours;
all  violent and unaccustomed  exercise,  particularly in
heated rooms and crowded assemblies ; all awkward
postures, and sudden exertions of the body ;  heating
and stimulating  food and drink, and a costive habit of
body, with the necessary  exertion it  occasions, may,
by exciting the action  of  the heart and arteries, and
forcibly detaching  the afier-birih  from  the womb,
occasion  early miscarriage ;  and when women more
advanced, either from neglect or habit, suffer the large
intestines to be filled with hardened  excrements, the
pressure of the enlarged  womb upon them,  will still
increase the accumulation, and occasion  so  much irri-
tation, pain,  and  tenderness, as to excite the contrac-
tions of the womb, and bring on miscarriage at any
period.
  56. On the other hand, all depressing passions, par-
ticularly grief and fear, an indolent  life, luxurious di-
et, late hours, both in bed and in company ; diarrhoea,
fluor albus, or any other debilitating disease, by  weak- 
 96               On  Pregiwncy,           [Chap. 2.

 ening the already weak attachment of the after-birth,
 render women liable to miscarriage from slight causes.
 What gives to the womb its disposition to contract,
 either at the full period, or at  any other  particular
 period of pregnancy, we do not know ;  but we know
 it  has such  disposition naturally towards the end of
 nine months,  and that, from disease or accident, or in-
 duced habit, it  may acquire it at any other period.
 In such cases, there often appears to exist a peculiar
 irritability of the  uterus,  inaependent  of general
 weakness, and that increased sensibility which is de-
 pendent thereon.  This  state is marked by  an im-
 patience of mind and restlessness of body,  ungovern-
 able timidity, anxious solicitude, and unseasonable fret-
 fulness in common occasions, which is always increas-
 ed by pregnancy, and  requires the exertion of much
 good temper, prudence, and discretion in  the friends,
 and no common fortitude and good sense in the patient
 to regulate and subdue.
   57. The signs of approaching miscarriage are,  ab-
 sence of the morning sickness,  subsidence of the
 breasts, a discharge of blood or of water from the  va-
 gina, and regular labour pains.
   58. The absence of the morning sickness, and the
 subsidence of the  breasts, both denote the death of
 the foetus.  On these  occasions the  sickness  ceases
 suddenly, and the foetus, which is discharged by the
 miscarriage which follows, generally shows marks of
previous disease.    The  breasts subside  gradually,
when the  constitution is deprived of  those energies
which the living foetus excites.   A coldness of the
 abdomen, and a cessation of motion  after quickening,
 are likewise said to denote  the death of  the foetus ; 
Chap, 2.3      its Symptoms and Diseases-          97

but both are very equivocal evidence of that event,
and many women have produced healthy children,
when from these symptoms they have been supposed
dead for some time.  It is evident, that in case of the
actual death of the foetus, we have  only to wait pa-
tiently for its expulsion.  Yet the woman is not to
abandon herself to a  careless conduct:  in  the  first
 place, because she may be  mistaken, and secondly,
because the delivery will always be easier and  safer
when left to nature, than when any how precipitated.
   59.  A discharge of blood from the womb, although
 a very  frequent, and generally  the  most  important
 symptom, is not necessarily followed by miscarriage.
 Some women suffer a discbarge of blood, both in
 quantity and in  other circumstances,  resembling men-
 struation, for one or two periods after conception, with
 no interruption to the regular progress of their preg-
 nancy ; but such discharge does not come from the
 cavity of the womb, nor follow after any accident, and
 is never attended by  labour pains ;  and a small dis-
 charge of blood, although the consequence of accident,
 and probably arising from a partial separation of the
 after-birth, may cease,  the  bleeding vessels may be
  plugged up by coagula,  and  the  woman  may, with
 great caution, be conducted to her full time.
    60.  Such  hxmorrhages as occur  before the expira-
  tion of the sixth month, are seldom  or never attended
  with any danger to the mother ;  but the tender em-
 bryo is generally destroyed by them.  After the sixth
  month, the  child more frequently  escapes, but  the
  mother is  brought into more danger.   When labour
  pains precede the discharge, abortion  can seldom be
                          I 
98             On  Pregnancy,             [Chap. 2.

prevented ; when they follow, it sometimes may ; but
even when we despair of pre renting the abortion, the
necessary means to  check and  restrain the haemor-
rhage, should be industriously pursued ; by which we
may save the patient the loss of much blood, and les-
sen the weakness and disease  which necessarily fol-
low.
  61. Whenever hemorrhage occurs before the fifth
or sixth month  of pregnancy, the first  remedy  is
blood-letting, which  should be  as  early as  possible,
and copious in proportion to the strength  of  the  pa-
tient ; and in this way, it will probably save the patient
the loss of more blood: as  it is unquestionable, that
one copious bleeding will do  more in stopping hae-
morrhage,  than taking away double, or three times
the quantity of blood at several intervals.   The bow-
els should be immediately opened by salts, (No. 9. a.1
and kept open by small dose^, repeated daily, (No. 8.
g.) and the woman must be confined as much as pos-
sible to a horizontal posture, and absolute rest.
   62. Every thing that will heat the body and quick-
en the pulse, must be carefully  avoided :  for this rea-
son, the bed should be hard  and the covering light ;
cold air should be freely  admitted  into the  chamber;
all cordials, spirituous liquors, spices, and stimulating
food, must be rejected ; the diet must  consist wholly
of vegetables, fruit, milk, butter-milk,  cold water,
lemonade, small-beer, ice, and iced  creams when they
can be procured.  The saline draughts, (No. 12. a. c.)
may be given every four or six  hours, and five  or six
drops of laudanum  maybe added  to each, but large
doses of laudanum  should be avoided.
   63.  Cloths wrung out of cold water or cold vine- 
Chap. 2.3    t its Symptoms and Diseases.        99

gar, should be applied to the back, bowels, thighs, and
to the external parts.   When the heat of the body,
as well as the haemorrhage, are very considerable, the
cold of these applications may be increased by ice or
snow, which on many occasions have  been introduced
into  the vagina with great advantage.  These cold
applications, however, should never be  continued so
long  as  to  occasion pain, or bring  on an  uninter-
rupted chill ; but after using them some time, a piece
of spunge or lint, dipped in cold port wine, vinegar, or
brandy, may be introduced  high  up  into the  vagina,
and at the same time, a compress applied  firmly over
the external orifice ; or cold astringent  liquors,  such
as a  decoction of oak bark, (^No.  20. b.) or a solution
of alum (No. 20. c.) may be  injected  into  the vagina,
and are frequently found effectual, especially  in small
discharges, whith come on in the early months, with-
out  any  evident  cause,  or  from slight accidents,
and which are unattended with pain ; which, although
not immediately threatening, if neglected,  increase as
the womb increases, and if allowed to continue, seldom
fail,at length,to bring on miscarriage.  The internal use
of astringents, which at one time were  much relied on
for restraining haemorrhage, were again in a great mea-
sure laid aside, from an opinion that their effects as as-
tringents could not be propagated  beyond the stomach
and  intestines, and only the mineral  acids combined
with  some mild vegetable astringents,  such  as rose
leaves and oak bark (No. 3. a. b.) (No. 16.  f.)  were re-
tained, rather as agreeable tonic drinks than from any
good opinion of their styptic quality.  But of late years
some respectable physicians have  ventured on the use 
100             On Pregnancy,           [Chap. 2.

of powerful mineral astringents, such as  the sulphats
of zinc and copper, (white vitriol and Roman vitriol) and
the acetate of lead ;  and their effects are said to have
proved so considerable and salutary, as to recommend
their use.  Doctor Dewees of Philadelphia was, I be-
lieve, among the first advocates of the sugar of lead,
which he assures us he has repeatedly given in doses
from two or three, to even ten grains,  in uterine he-
morrhage, with very great and immediate effect; and
that it may be  with safety repealed at short intervals
until  the hemorrhage shall be restrained.  This prac-
tice I am informed has been followed by many gentle-
men in  this country with success ; and I find it sanc-
tioned by Doctor John Burns, of Glasgow ; and even
Doctor Denman, who does not speak of it as a  remedy
of which he has had much  experience, still allows the
sugar of lead, as well as the  oil of turpentine to be
powerful medicines in hemorrhage. So that although
I confess I have no experience of these remedies my-
self, still, on such authority, I  do not hesitate to recom-
mend them.  With  regard  to the zinc and copper,
however, their use  must be  very limited, from their
strong effect as emetics; and as it respects the sugar of
 lead, I cannot omit  to advise the exhibition of castor
 oil, as soon as it may safely be done, in sufficient dose
 to open the bowels, and to  guard against the ill ef-
 fects which lead is known to have upon the bowels and
nervous system.
   64. Fainting is not only a common consequence of
 the loss of much blood ; but it is really the remedy
 which nature makes use of to  check it; although, there-
 fore, very alarming to persons unacquainted with its
 good effects, it should not be interfered with ; particu- 
Chap. 2.3     its Symptoms and Diseases.        101

larly when it first comes on, no efforts should be made
to rouse the patient by volatiles, or to prevent its recur-
rence by  cordials  ; but  she should be  left in  that
languid  state which accompanies  it, during which, the
blood moves slowly  through the vessels, and an op-
portunity  is afforded for the mouths  of the  bleeding
vessels to  contract, and to  be plugged up by coagula.
At the same time,  if labour  be  already  commenced,
the contraction of  the womb goes on :  for the womb
acts during  faintness, and  even after  death :  and no-
thing lessens the size of the bleeding  vessels  so much
as this  contraction : whenever,  therefore, this is ob-
served during  uterine  hemorrhage,  we may expect,
as far as the mother is concerned, a favourable termi-
nation.  Taking the hint from nature, we  sometimes
imitate the effects of fainting in hemorrhage, by such
remedies as bring on nausea and sickness.  This is one
motive for bleeding ; and whenever  a vein is opened
with this intention, the patient should sit up, that the
faintness may  come on with the  loss  of as little blood
as possible.   With the same intention, small doses of
nitre, but  particularly of ipecacuanha, (No.  12. e.  f.)
are not  only safe, but have been found very effectual ;
and although in  this case vomiting is not  wished,  no
danger  is to be apprehended from it when moderate ;
and since  the effects of the digitalis upon the pulse
have been known,  it has likewise been  recommended
in all active hemorrhages, to lessen the force and ra-
pidity of  the  circulation, which  it accomplishes in a
most surprising  manner. In cases, however, of uterine
hemorrhage, attended with great weakness,  I should
administer  it  with great, hesitation, lest the extreme
                       I  2 
  102             On Pregnancy,            [Chap. 2.

 languor and debility which it is apt to produce, should
 add to,  instead of lessen the danger of my patients.
 The tincture is the safest form, in which it can be used.
 When sufficient time has been allowed for  the  con-
 traction of  the  blood  vessels, and the  formation  of
 coagula, if  the fainting still continues to an alarming
 degree, dash cold water  on the face, give  a glass of
 wine, or any of  the cordials mentioned  under No. 17.
 A  great degree  c-/  restlessness and anxiety, with a
 heavy deep sighing, are mere immediately alarming
 after hemorrhage than fainting; but they seldom or
 never occur in early pregnancy.
   65. In some cases  of early  miscarriage, the  dis-
 charge of blood will be kept up by the  ovum sticking
 in the neck of the womb, after it has been thrown off
 from its surface : introducing one or two fingers into
 the  vagina, arid moving it from side to side, will fre-
-queiitly disengage it, and put an end to the complaint.
 In periods more advanced, from the fourth to the end
 of the sixth month, the foetus is generally more easily
 expelled ;  but the secundines are apt to be retained :
 such efforts as have just been described, may here be
 made ; or by irritating the internal orifice a little, the
 womb may  be excited  to throw it off" by more vigor-
ous contractions, but  nothing more should be  done ;
 and if these efforts fail, the cure must  be left  to na-
 ture, although, as it frequently does, it may  require
considerable time : several  weeks  or a  month may
 pass, before it will come away.   The evacuation  is
Sometimes brought on  by  pressure at stool, and it has
been  recommended to occasion stools by  stimulating
saline clysters ;  but  we must be governed by ihe ef-
fects  these have  in increasing the haemorrhage.   In 
 Chap. 2-3     its Symptoms  and Diseases.       105

 all these cases, the uterine discharges are apt to be-
 come very offensive, which must be remedied  as far
 as possible by great cleanliness, and by antiseptic and
 astringent, injections, (No. 20 a.)
   66.  It is allowed, that a discharge  of water from
 the womb, occasioned by a rupture of the membranes
 of the ovum, is necessarily followed, in a short time,
 by delivery ; but every watery discharge ftom the
 vagina is not a discharge of the liquor amnii, or that
 fluid which is contained within the membranes.  Some-
 times the glands about the neck of the womb secrete
 so thin a fluid,  as to resemble the liquor amnii : this
 is discharged at short intervals, or oozes continually
 for several weeks before delivery.   In these cases,
 the neck of the  womb is much relaxed, and the mu-
 cus by which the orifice is  sealed up  is dissolved or
 discharged.  It becomes, therefore, very  necessary
 that  the woman keep herself perfectly quiet, and as
 much as possible in a recumbent posture, for fear of
 breaking  the membranes.   And  if the complaint
 comes on long before the expiration  of the reckoning,
 she should use some astringent injection, (No. 20. a.
 b. c.) by which the relaxed glands may be strength-
 ened  and the discharge checked, so that she may go
 on to her full time with less danger.
   67. Labour pains.  Whenever, at  any  period of
 pregnancy, the womb has really begun  to  act, and
 such action is manifested by regular pains in the  back
 and loins, attended with pressing down and relaxation
 of the internal  orifice, it is hardly possible to prevent
 miscarriage : such action may  be suspended, and the
 miscarriage  thereby retarded ;  but the action of the
 womb almost sureiy returns, and expulsion sooner or
later  takes place.  Warning,  indeed, is sometimes 
104              On Pregnancy,         Chap. 2.3

given by uneasiness in the region of the womb, and
pains in the belly,  accompanied  by some piessing
down from the action of the abdominal muscles ; and
all hope is centred in  preventing those from bringing
on true pains:  the  necessary  remedies,  therefore,
must be applied early, or they will have no effect.
   68.  If  the woman be of a full Ivtbit, let her be im-
mediately bled, and if costive, let her bowels be emp-
tied by an injection, (No. 5. a. b.) after which, give  a
full dose of laudanum (No. 14. a.) or  rather an ano-
dyne clyster, (No. 6.) of eighty or one hundred drops,
and  let these  be repeated, in doses  of one quarter or
one  third, every hour or  every half hour, until  the
pain shall be  suppressed, or in case it should return.
This treatment is particularly proper when any sudden
passion has contributed to bring on  pain :  a calm
mind and absolute  rest, are essential to its efficacy ;
and  when the  alarm has  been great, the anodynes
should even precede the evacuations.  This treatment
is likewise particularly proper, when slight discharges
of blood, brought on by  accident,  begin to be  attended
with pain, or even when given with a view to  prevent
the  accession  of pain.   But after  the action of the
womb has really begun, opium, except as a palliative
to gain time, can be of no  use :  and it should always
be well considered how far  we may not protract the
cure, when we cannot prevent the miscarriage.
   69.  Habitual miscarriage.  It  has already been ob-
served, that women  may acquire a habit of miscarry-
ing at particular periods  of pregnancy.  Some few
women too, fall into labour as regularly at the end of
 seven or eight months, as the genera'ity of women
 do at the end of nine; without our being able to as- 
Chap. 2>3     its Symptoms and  Diseases.        105

sign any reason for it, except, that in such cases, the
child is generally  born dead.  It would be happy,  if
we had it in our power  to point  out the immediate
causes of these unfortunate habits,  so as to lead to
effectual remedies ;  but all we can do,  after  directing
the patient carefully to avoid those accidents to which
the first miscarriage  may fairly be  attributed,  is to
endeavour to  correct  such defects of general health
as they seem to be connected with.
   70.  When,  therefore, women of good health but
plethoric constitutions,  and subject to copious menstrua-
tion, fall into a habit of miscarrying,  let them be con-
fined to a  vegetable diet, and drink only water ; let
them use constant exercise, sleep but little, on a  hard
bed ; and keep their bowels freely open, by the daily
use of Glauber's salts, (No. 8. g.)  When, on the con-
trary,  a copious menstruation is connected with a pletho-
ric but a lax  habit,  as  is the  case with many fat wo-
men, the diet should indeed be light,  and consist chief-
ly of vegetables ; but  some  animal  food  may be al-
lowed, and a little port-wine  or claret  may  be mixed
with their drink;  the exercise  should be gradually
increased, but should never go the length of  fatigue,
and after conception, must be used with caution ; sea-
bathing and the shower-bath, are both very beneficial:
and in case of pains  in the back, to which such wo-
men are very subject, applying  to it cloths wet with
cold water, dashing  with cold  water,  and  injecting
cold water into the vagina, are useful.  After concep-
tion, the diet should still be sparing, and the cold bath
should  be persisted in.;  and ii at any time the  pulse
becomes remarkably full and  throbbing, a little blood
should  be taken from the arm.   When good health is 
 106              On Pregnancy,          [Chap. 2.

connected with a sparing menstruation, a vegetable diet,
moderate exercise, the daily use of the warm bath,
and drinking a pint of tepid water morning and even-
ing, may be recommended.   And when a sparing men-
struation is connected with a weakly and delicate consti-
tution, animal food,  some wine  and bitter purgatives,
(No. 10. a.b. ore.)  so as to keep  the bowels open,
are indicated; the  warm bath may  be occasionally
used, but not with so much freedom as  under better
health ; and in its place,  warm water with a little salt,
may be injected into the  vagina  two or three  times a
day.  In both these  last  constitutions, the warm bath
and aloetic  medicines should  be   discontinued after
conception ; and in all cases of habitual miscarriage,
women should live separate from their husbands, until
their  general health shall be restored, as  well as for
several months after conception.
   71.  The case  of  habitual abortion most difficult to
be remedied, is that in which women of good health fall
into labour regularly about the seventh or eighth month
of pregnancy, and are then delivered of dead  children,
or such as  are manifestly diseased,  ana in which  this
disease of the infant cannot be traced to any disease of
the parent, communicated  to it.   Such  women are ob-
served to suffer very little or not at all from the com-
mon  symptoms  of  early pregnancy ; and from  the
observation,  that the sickness of the mother is some-
how  connected with the  health of the  foetus,  it is re-
commended to weaken the action  of the stomach by
small doses of tartar-emectic, (No. ll.b.)  taken at
such long intervals,  as to bring on some  nausea and
sickness, but not to occasion  very active vomiting.
This  may  be repeated  occasionally,  as long  as the 
Chap. 2.3    its  Symptoms and Diseases.        107

natural sickness is  generally  observed to continue ;
the diet should be spare, the exercise  moderate, the
woman should  be occasionally bled, and she may use
the cold or the warm bath,  as  the circumstances of
her general health  may indicate.  In some cases of
frequent recurrence  of miscarriage at particular pe-
riods, long confinement to a horizontal posture, and a
spare diet, have been found successful.   It is hardly
necessary to add  again, that women  should be parti-
cularly careful  in a succeeding pregnancy, a little be-
fore and after the period of a former abortion. On this
subject,  the student  will  consult  with advantage an
essay of Mr. John Burns, of Glasgow. 
108            jYatural Labour.          [Chap. 3.
CHAPTER  III.
NATURAL  LABOUR.
                  SECTION I.


          The approach of Natural Labour.

   1.  We are told, that among the Indian nations of
this country, a woman finding  her labour approach,
retires alone to some secluded spot, and there, without
assistance, remains until she be delivered; when, hav-
ing washed her infant, and bathed herself in  the next
stream, she  returns to her cabin and her usual  occu-
pations.  The same is said to be the practice of the
natives of Abyssinia, and some other  parts of Africa,
and of those of the West-Indian  islands;  and that in
all those countries, few women are known to suffer any
ill consequences  from labour, or to die undelivered ;
and  Brydon tells us something very like of the ladies
of Sicily.  Although, therefore,  we make full  allow-
ance  for some  exaggeration in  these accounts, and
that it must be confessed, women in general, especial-
ly in  a state ot society, endure more pain, are exposed
to greater difficulties, and meet  with  more accidents
from labour,  than any  other animal; yet  we have
reason to believe, that much of this is owing to mis-
conduct j that beneficent Providence has endued wo- 
 Chap. 3.3        Natural Labour.              109

man as well as other  animals with powers, which,
when unimpaired, are  equal  to all  her natural func-
tions ; and that we may fairly conclude,  that the fre-
quent interference of art, in so essential and natural a pro-
cess as labour, cannot be necessary.
   2. The first rule, therefore, to be laid down for the
guidance of a midwife, is, that she is never to interfere
in the natural progress of labour, unless where  some
untoward circumstance or obstacle, too frequently the
effect of precipitancy and early mismanagement, dis-
turbs and puts nature out of her course; and that the
most essential knowledge which a midwife can obtain,
is that, of every symptom which marks the progress
of a natural labour when unassisted, or rather when un-
disturbed by  art;  of the manner in which  they suc-
ceed each other ;  and of the uses and effects of those
symptoms which precede, in preparing the  parts con-
cerned, for  those which are to follow.  For " natural
labour is, through its whole progress, a single process,
in which every preceding symptom is  absolutely ne-
cessary for the due accomplishment of that which is
to follow."—(Denman.)  Hence the great danger and
certain mischief of unnecessary and  preposterous in-
terference, by which  nature cannot be aided, but may
most materially be interrupted in her work.   Indeed,
this observation may  justly be extended to  the whole
period of pregnancy:  and perhaps  is  the  only  just
ground on which  we can account  for the greater fa-
cility and safety, with  which the women of rude and
unpolished nations in general, pass  through pregnan-
cy and labour, than women  in civil society,  especially
in the higher ranks of life ;  the unnatural  forms,  res-
                        K 
 110              Natural Labour.          [Chap. 5.

 traints, and habits  of which,  in many ways interfere
with this great work.
   3.  Sometimes a few days, at others,  two or three
weeks before the accomplishment of her reckoning,
a  woman begins to feel the  symptoms of  her ap-
proaching labour, she becomes anxious and apprehen-
sive of the event;  busies herself for the  reception and
accommodation of her  infant; moves with difficulty,
and frequently complains  of restlessness and pains in
her back and loins.   As  the period  approaches, her
belly subsides, and most in the most favourable cases ;
she is liable sometimes  to a strangury or suppression,
but more frequently to  an  incontinence  of urine.
Sometimes a lax  comes on,  but generally she is ra-
ther costive, and she perceives a discharge  of mucus
frequently tinged  with blood, from  the vagina.
   4. The anxiety, restlessness, and uneasiness of this
period, prompt many  women  to  wish  it over; and
some are so imprudent as to attempt to  shorten it by
rough exercise, such as riding in an uneasy carriage,
or some such means, with a  view to bring  on their
labour ;  but no conduct can be  more faulty or absurd ;
at any rate, they increase the present uneasiness ; and
should they succeed  in  their  attempts  to precipitate
their labour before nature  is properly prepared for it,
they will unquestionably render it more  tedious, more
painful, and more difficult. On the contrary, let them,
according to the indications of nature, and in imitation
of all other animals, give themselves  more rest than
usual, attend  carefully to the state of their bowels,
 keep  them  freely  open ; and if the woman be of a
 strong and  full habit, flushed and heated, it will be
 proper to lose a little blood. 
 Chap. 3.]          Natural Labour.              111

   5. The subsidence of the belly is a  favourable symp-
 tom, and shows  that the womb has not  only began
 to act, but is prepared to act in  a proper manner; the
 discharge from the vagina, shows that the parts are
 prepared to dilate ; the  strangury  is  owing to the
 pressure  of the  child's  head  upon  the neck of the
 bladder ;  the incontinence of urine to the same prey-
 sure on the fundus or body of the bladder, and hen*e,
 both are favourable symptoms, and indicate a natural
 presentation of the child.  The incontinence is attend-
 ed with no  pain, and admits of no  remedy until the
 cause  be removed by delivery; but the strangury is
 always painful, and may, by neglect become danger-
 ous  : the woman«is, therefore, to be directed  frequent-
 ly to attempt to discharge her urine, to try in various
 postures, and if she fails, and the suppression becomes
 complete, she must be relieved by the catheter, (27.)
 for by  delay, the  difficulty of relief will be increased,
 the  pain and distention  of the bladder  will interfere
 with labour,  and by over distention,  the bladder may
 lose  its power of contraction,  or even burst.   A mo-
 derate  lax is always  favourable, and should not be
 interfered with ;  if profuse, a few drops  of laudanum
 (No. 14  a.) will generally check it.  But  costiveness
 is not only distressing for the present, increasing heat,
 restlessness  and  pain,  but may  become  very incon-
 venient during labour.    If, therefore, a pregnant wo-
 man-has neglected to  pay attention  to  this  circum-
 stance before, she must now take care  to remove it
by some  mild laxative, (No. 8. a. b. c. d.) or rather by
 repeated injections, (No. 5. a. b.) which is  the best
mode at this late period, when all active medicines are
 improper. 
 112              Natural Labour.        [Chap. 3.

   G. False Pains frequently resemble true labour pains
 so exactly, as to be mistaken for them, particularly by
 young women  with their first  child, so  as to induce
 them to send for assistance ;  but they are carefully to
 be distinguished from true labour, or the mistake may
 lead to ;/uich mismanagement and error.  Let the
 midwife, therefore, on her arrival, first  enquire into
 the state of the bowels, and in case of costiveness, re-
 move  it by an injection, (No. 5. a. b.) if  the woman
 be strong, flushed,  with  a  full pulse and a hot  skin,
 she should lose a  little  blood ;  but  this evacuation
 must not  needlessly be had recourse to.   Let the pa-
 tient seek rest in a  horizontal posture,  and  promote
 moisture on  her skin by frequent draughts  of  weak
 teas :   by such means, all false pains will generally be
 removed.
  7. There  is, however, no absolute criterion, by
 which false pains can certainly be distinguished  from
 true labour pains; but by examining by the touch, the
 effect which  the pains have  upon  the internal orifice
of the womb.  By this operation we judge of the size
 of the pelvis, and its deformities :  we discover preg-
 nancy, its different periods, and the approach of la-
 bour ;  we distinguish  true pains,  from such as are
 false ;  we discover the  presentation of the child, and
 form an opinion of the progress and probable termina-
 tion of  the labour.  To  perform it with address, and
 to draw from it  certain  conclusions, requires great
 skill, to be acquired only  by experience : 1 shall there-
 fore content myself with  giving a few general  direc-
 tions respecting it.  To judge of the size and shape of
 the pelvis, the woman should  stand leaning a little
 back, and the forefinger of either hand being  well  an- 
ehap. 3.]         Natural Labour.               113

ointed, is to be introduced from before, with the  upper
edge applied to the arch of the pubes, the thumb over
the pubes, and the middle finger along the  perinjeum,
the point of the finger is to be directed upwards and
backwards, towards the angle formed by the projection
of the sacrum, and the spine.  (See plate 3d. A. E. I.)
If we cannot reach this, we may  conclude the pelvis
to be well formed in  its upper and transverse diame-
ter : if we reach it before  the finger is introduced its
whole length, we may apprehend some contraction ;
and we  form an opinion of the degree of deformity, by
the ease with which we reach it.   By throwing the
finger from  side  to side, and by directing it towards
 the sharp  processes  or blunt tubes of the ischia (plate
 3d. H 1. and H 2.) we judge of the size  and form of
 the lateral and inferior diameter  of  the  pelvis.   To
judge of the changes brought on the soft parts  by dis-
 ease  and  pregnancy, we should  be well acquainted
 with the feel and condition of these organs in a heal-
 thy and unimpregnated state, which can only be learn-
 ed by  frequent practice ;  and  which, besides, are so
 different in different women, and  in the same  women
 in different circumstances, that it  is almost impossible
 to give any description of them in words, by which
 an unexperienced person can be brought to form a cor-
 rect judgment.   To judge of the period of pregnancy,
 we compare the  neck of the womb, which in the early
 month, is comparatively long, in  the last almost obli-
 terated, and the situation of the os tince, (which in the
 early months is easily discovered  hanging down in the
 centre of the vagina, and in the last months, pointing
 back towards the sacrum, can hardly be reached) with
                        K2 
114           Natural Labour.          [Chap. 3.
  the perod at which the menses ceased,  and the tu-
  mour of the abdomen  as  described,  chap. 1  see. v.
  no. 39.  When a woman towards the end of pregnancy
  is attacked with pain, and we want to ascertain her real
  state, the examination will  be most conveniently made
  whilst  she lies on her left side, with her knees drawn
  up,and a pillow placedbttween them. The midwifesit-
  ting behind her, is to make the examination with the
  utmost caution and deliberaiion, carefully avoiding all
  rudeness, by which  the parts may be  irritated ;  and
  above all things, taking care to run no risk of bursting
  the membranes, if  the internal  orifice of the womb
  should be found  more open, and the membranes mure
  advanced through it than she expected.
     8. If she find the orifice of the womb pressed down,
  tense, and beginning to dilate during the pain,  ard
  again relaxed during the intermission ; if  then it be-
  comes soft and slippery, and especially if  she discov-
  ers a thick mucus tinged with blood  to ooze from it,
  she  may conclude  the  woman  to  be in  labour ;
  but if, on  the contrary, she discovers no extraordinary
* pressure during  the pain,  and that the internal orifice
  of the womb is not affected by it, she may be almost
  certain that the present pains are false, that the labour
  is not yet begun, and cannot be benefited by them.
     9. If, therefore, the means^ already directed, fail  to
  give ease, she  may  administer a moderate anodyne,
  (No. 14. a) which, after  the necessary evacuations,
  will certainly procure relief.   After such a call,  how-
  ever, the midwife should always be so far  attentive as
  to let it be known where  she may  be  found, as she
  may expect, within eight  or ten days, to be called to
  her patient in real labour. 
Chap.  3.3          Natural Labour.             115

   10.  The  discharge  of  mucus from  the vagina,
particularly when tinged with blood, (which generally
arises from a partial opening of the internal orifice of
the womb) is one of  the  most certain signs  of ap-
proaching  labour, though  it may precede it  several
days.

                  SECTION  II.

     Definition and Division of Natural Labour.
   11.  Natural  labour is defined  to  be such as is re-
gular in its progress, accomplished by the unassisted
efforts  of nature, and completed wiihin twenty-four
hours.   But my plan  of giving advice to rnidwives,
makes  it necessary  to assume a wider range, and to
consider all labours natural in which  the  head  of the
child presents, and which are completed,  though in a
longer  time, by the efforts of nature,  without the in-
troduction  of the hand  into the  womb, or the use of
instruments.
   12.  It will be convenient to  divide  the progress of
labour  into four stages.   The  first  is occupied  io
opening and dilating the internal orifice of the womb ;
the second in the passage of the child's head through
the bones ; the third in dilating  the external orifice,
and the delivery of the child ;  and the last in the de-
livery of the placenta,  or  the after-birth.  The first
stage commences with  true labour  pains,  and  ends
when the internal orifice of  the womb is completely
dilated ;  about which time,'the membranes common-
ly break, and the waters are discharged.  The  second
stage continues from  the perfect dilatation of the in-
ternal orifice of the  womb, until the child's head has 
116        •     Natural Labour.          [Chap. 3.

passed the brim of  the pelvis, (plate 1,2. 3 ) and de-
scended so low as to press on, and begin to dilate, the
soft parts.  The  third stage of labour now commen-
ces, until the soft  parts, being stretched and distended
into the form of a large protuberant tumour, the ex-
ternal orifice is so far dilated, as to suffer the head and
body of the child  to pass through it.   The last stage
is taken up in  the care of the infant, in tying and cut-
ting the navel string, and in receiving or gently aiding
the delivery of the after-birth.
   13.  It is very important,  that the midwife should
keep this division of labour into four distinct periods,
constantly in her mind, and perfectly understand what
is going on during each ;  by which she will avoid  all
unnecessary hurry and confusion : she will  expect no
more at any one period than is intended by  nature to
be then performed,  and will patiently wait for its ac-
complishment ; and particularly she will see the  im-
propriety, folly  and  danger of attempting, by  any
preposterous efforts of her own, to assist or hasten the
accomplishment of any one of these  periods,  by which
she can only interrupt  nature in her present operations,
and will surely render that period which is to follow,
more painful,  difficult, and  dangerous ;  for " every
regular symptom  of labour performs a double office ;
it not only accomplishes a present  object, but it pre-
pares the  parts which are next to be concerned, for
the more easy accomplishment of what is to follow."—
(Denman.)

              First Stage of Labour.
   14. The first stage of natural labour, which is oc-
cupied in opening  and dilating the internal orifice of 
Chap. 3.3         Natural Labour.             117

the womb, generally commences with pain in the loins
and back, stretching from thence across the abdomen
to the pubes, or forepart of the belly,  and ending  on
the upper part of the  thighs.  It soon leaves the wo-
man free, and returns again periodically, at longer or
shorter intervals.   These pains at first are slight, and
return  after  long intervals ; but  soon the  interval
grows shorter, and the  pain becomes exceedingly sharp
and  cutting,  at  which  time,  the  mucous discharge
from the vagina is  generally  discoloured by some
blood ; after  which, the very sharp and cutting sensa-
tion of the pains commonly abates ;  although, on the
whole, the pains grow stronger, return  at shorter in-
tervals, and the nisusor pressing down increases.
   15.  If an examination be made at  this period,
(which must always be done with the greatest caution,
and during the remission of the pain, for fear of break-
ing the membranes) this variety in the  sharpness and
severity of the pains, will be found to depend upon
the state of the internal  orifice of the womb ;  at first
its edges are more thick and  rigid, and the opening
small and hardly perceptible ; as the pains.continue,
the edges grovrthin and soft, the opening enlarges, and
after some time will admit  the end of  the finger ;  a
small bag is then felt  within,  which, during the pain
tightens  and  is distendtd, but as  the  pain remits be-
comes loose and flaccid ; as the internal orifice enlarges
this  bag passes through, and assists in dilating it, until
the thick edges of the orifice being entirely obliterated,
the membranous bag, no longer  supported by them
gives way, and the waters  are discharged.  Sickness
and  vomiting are frequent and salutary symptoms of
this  stage of labour: the nausea, contributes to the 
 118            Natural Labour.          [Chap. 3.

relaxation of the whole system, and the retching adds
somewhat to the dilating effects of the pains.
   16. The duration of this first stage is very different
in different women,  and in the  same woman in dif-
ferent labours;  but in general, it requires more  time
with the first child than with those which follow ;  and
in well-formed women, commonly takes up more time
than any other stage  of labour : in this  respect how-
ever there is so great variety, that it  is in vain to at-
tempt to assign any  time to the duration of a natural
labour, or of any of its stages.  Some  women are de-
livered in their sleep, in the room in  which they are
first seized, without being able to get to  their  beds,
or whilst on a visit, without having time allowed them
to return home, whilst others require many hours,
and some several days, for the  safe and happy accom-
plishment of a labour perfectly natural.   And in the
same woman, there is now and then almost as  great
variety in the duration of different labours.
   17. The first observation I shall make on this stage
of labour is, that no skill or art of the midwife, no exer-
tion of the  woman, can in the least contribute either to
lessen the severity of the pains, or  to shorten their dura-
tion.  They are  intended  by nature to accomplish a
necessary and important  object, the complete dilata-
tion of the internal orifice of the womb ; which, from a
rigid ring of some considerable  thickness, and gene-
rally close shut, is to  be softened, relaxed, and  worn
away  until it is absolutely obliterated, and so  astonish-
ingly enlarged, as to permit the child to pass through.
Hence we learn the reason why  more time  and  pain
are required to open  the orifice of the womb, the
breadth of half  a crown, than to  obtain all the rest of 
Chap. 3,]        Natural Labour.               119

the dilatation necessary for the delivery ; a fact which
young practitioners should constantly recollect, when
forming an opinion on the probable duration of labour ;
that on the one hand, they raaynotfaugue their patient
by occasioning unnecessary efforts in the beginning of
labour, nor expose her to the hazard of being delivered
alone towards its conclusion : and  hence  we see the
cause of the pains being more severe, cutting  and
grinding at the beginning, than towards the latter end
of this first stage :  whilst the lips of the internal orifice
are thick and rigid, they  make great  resistance,  and
are in some measure torn asunder by the force of the
pains ; but they continually  grow  thinner, are more
and more relaxed and  softened, make less resistance,
and are more easily distended.
   18.  But  although  the midwife,  during this stage,
can neither lessen her patient's pain, nor  shorten its
duration ; and although she is absolutely forbid inter-
fering in any manner with the progress of the labour,
her presence now, so far from being useless,  is very
necessary.   As soon as she arrives, she  should again
enquire into the state  of her patient's bowels, and un-
less  perfectly free, empty them by an injection, (No.
5. a. b.) indeed, whenever there is  time for it, it is a
good rule always to do this, as by its emollient as well
as evacuating effects, the injection has a tendency in
all respects to  promote and render labour easy,  and
is particularly necessary  and useful in the  case  of a
first child.   The midwife must likewise pay attention
to the  evacuation of urine, direct her  patient to dis-
charge it frequently, and if she fails in one to try ano-
ther posture, sitting  over warm  water, or lying on
cither side, on her back with  her hips raised ; on her 
  120            Natural Labour.          [Chap. 3.

 knees with her head low ; and should all these efforts
 fail, she may by introducing a finger under the pubes
 during the remissions of pain, endeavour to raise the
 child's  head a little from its  pressure on the neck of
 the bladder.  If, notwithstanding these  efforts, a total
 suppression should take  place, she  must  be relieved
 early in the labour by the catheter, (Chap. 1. 27.) for
 as the  labour advances the difficulty of discharging
 the urine  will increase; the pain  of the  distended
 bladder may become so  great as to intercept and sus-
 pend those of labour ;  and the bladder being over dis-
 tended, may lose  its power of contracting  ever after;
 it may  inflame and bring on fever, convulsions and
 death :  such  are  the evils which  may  follow a little
 neglect.
   19. After these attentions, the labour is  to be suf-
 fered to go on without any interference:  the pains
 continuing, gradually open the internal orifice of the
 womb  and  force  the membranes through  it in form
 of a purse, which acting as a soft wedge, contributes
 in the easiest  way to its farther dilatation.   Of this
 the midwife may  now and then assure  herself by ex-
 amination, but as seldom  as possible, taking special
 care not to fret and irritate the parts by too frequent
 repetition,  and always with  the greatest gentleness
 and caution, and during  the  remission of  the pains;
lest  the  membranes  should be burst, and  the water
let out before the internal orifice be  fully dilated; an
accident  which always protracts labour, and renders
it  more painful and  difficult.   Another  argument
against  frequent  and unnecessary examination,  is,
that it has  a tendency  to remove the natural mucus
already  secreted, and to inflame the tender lining of 
Chap. 3.3          Natural Labour.            121

the vagina, so as to check the farther secretion of this
salutary  discharge; which is intended  by nature  to
lubricate and soften all the parts to be distended in the
course of the labour.
  20.  But if  it be necessary to be  thus  cautious in
respect of a carefal and occasional examination, what
terms  shall I use  to condemn as it deserves, the
abominable practice of boring, scooping, and stretch-
ing the soft parts of the  mother, under the  prepos-
terous idea of  making room for  the child to pass.  It
is impossible to  censure  this idle,  indecent, and dan-
gerous practice too severely : it is always  wrong, nor
can there be  any one period  in any labour the most
easy and natural, the most tedious and difficult, the
most regular or preternatural,  in which it can be of
the least use; in which  it will not  unavoidably do
great mischief.  It will render an easy labour painful,
that which would be short, tedious; and one which, if
left to nature,  would  terminate  happily, highly dan-
gerous.  I know that I have to combat the prejudices
of many of my country-women on  this subject; and
'.hat, although I may convince the judgment of a sen-
sible midwife,  she will not always be suffered to exer-
cise it, unless  she has some firmness  and  self-posses-
sion, to resist the solicitations and importunities of her
patient, and her mistaken friends.   She will not only
be importuned on some occasions of a little delay, she
will be reproached with permitting her patient to suf-
fer without assistance ; and will even be   threatened
with application to  others, and thejoss of her reputa-
tion.   I speak from experience ; still however, if she
values her patient's safety, and  the approbation of her
                        L 
 122           Natural Labour.           [Chap. 3.

own mind, she must be firm, and the event will justify
her conduct, and establish her character.
   21.  Leaving,  therefore,  nature to her own unas-
sisted undisturbed efforts, the midwife is to encourage
her  patient  by appearing  perfectly calm and easy
herself, without  hurry or assumed importance;  by
assuring her, that as far as can now  be discovered,' all
matters are perfectly natural;  by entering into easy
conversation with her herself, and encouraging her to
do so with her friends.   She is  to direct her  to walk
about  the chamber, or from room to room ;  to sit or
to lie down, as she finds most agreeable to herself; and
if she can, to sleep  between her pains, which some
women are  much disposed  to do.   At a proper sea-
son the apparatus of a meal, or of the tea-table,  may
serve to while  away an hour ; and  every occasion of
this nature should be embraced to lessen impatience
and to protract  expectation.   Indeed, to  gain time
during this painful and irritable period, is an  acquisi-
tion of no inconsiderable moment ; for the time which
uninterrupted nature requires to bring about the great
changes which are now accomplishing, is always  ne-
cessary ; and  unquestionably  (provided no  morbid
cause prevents) women in general recover better after
a labour rather slow, than after such as are quick and
sudden.
   22.  Hence too, we  learn  the great impropriety of
directing the patient at this period, to assist her pains,
as it is called, by holding her breath, and exerting  her
strength;  by forcing,  straining,  and bearing down,
which  inevitably will exhaust and waste her strength
now in the beginning of labour, which may be very
necessary  for her  support  at  the conclusion of it. 
 Chap. 3-3       Natural Labour.               123

 Young women in their first labour, are most apt from
 impatience, to be guilty of this error; by which they
 necessarily overheat themselves, and may bring on fe-
 ver ;  it may likewise occasion the premature bursting
 of the membranes, an accident too apt to happen with-
 out any  such effort, when labour begins with very
 strong pains, and which will inevitably protract it.
   23. Another practice still more dangerous,  is that
 of giving strong heating aromatic teas, cordials, and
 spirituous liquors, with a view to strengthen the pains;
 but  which can only increase  the resistance to their
 proper effect, by heating the patient, bringing  on fe-
 ver, and checking the natural secretions.  On the con-
 trary, let the patient's food consist of cooling fruits,
 thin gruel, and  weak broths; and her drink of small
 beer,  lemonade, and weak  tea.  In summer,  let her
 chamber be kept ^cool by  open doors and windows ;
 and in winter, only comfortable by moderate fires.
   24. In this manner the first stage of labour is to be
 passed, now  and then cautiously examining its pro-
 gress, during the absence of the pains ; under which
 circumstance, and  when  the  internal orifice is suffi-
 ciently open to admit the finger, the head  of the child
 may easily be felt and  distinguished by its regular
 shape, smoothness and hardness within the lax mem-
 branes, and may be  made another source of consola-
 tion and encouragement to the patient, by assuring her
of it;  but be cautious how you predict a speedy  termi-
 nation of the labour ; unless in such cases, as former
experience in  the same woman may have convinced
you that you wid not be deceived : for many circum-
stances which you cannot now discover, may concur to
deceive you;  and nothing  will tend more to rencV 
\
124             Natural Labour.         [Chap. 3.

your patient anxious, and to rob you of her confidence,
than disappointment in this respect.
  25. Plates 15, 16, and 17, are intended to represent
these changes, and the  situation of the child during
the first stage of labour.

                   PLATE xv.
  This plate xv. shows theneckof the womb,oblitera-
ted by its perfect development during the latter months
of pregnancy ; at the  end of which,  it  makes  one
common cavity with the womb.   The development of
the neck, however, is not conducted on the same prin-
ciples as the enlargement of the womb :  the sides of
the womb  retain at  least,  their original  thickness
through the whole period of pregnancy ; but the neck
 >f the  womb grows thinner as it is developed, and at 
 Chap. 3-1         Natural Labour.              125

 the expiration  of the natural  period of pregnancy,
 sometimes becomes so thin, as to be in danger of being
 ruptured by a very small force ; an accident, which has
 occasionally happened, when from disease the internal
 orifice has not yielded ;  or from an untoward position,
 the pressure of the child's head has been made against
 it: but more frequently from hurry and want of skill
 in the introduction of the hand into the womb, or in
 the use of instruments.   The internal orifice  is here
 represented as a smooth ring, formed by its protube-
 rant lips, and this is its most perfect form ; but in this
 respect there is almost  an endless variety  in different
 women :  in some, it will be found smooth, very short,
 and close shut ; in others, irregular in  its shape, of
 different lengths,  and partly  or wholly open, so as to
 admit the finger.    Much experience,  therefore, is
 necessary to enable us to draw any conclusion, either
 of the period of pregnancy, or of the state of the labour,
 from the  state  of the internal orifice.  The head  of
 the child rests on  the brim of the pelvis, with the hind
 head towards one groin, and the  face  towards the
 symphysis, or  joining of the sacrum with the ilium
of the opposite  side, according to  the diagonal diame-
 ter of the pelvis, (G. G. plate 2.) this is the most fav-
ourable position for its entering the pelvis, and occurs
in most cases.
L2 
126            Natural Labour.          [Chap. 3.


                  PLATE XVI.
 This plate xvi. is designed to show the circumstances
which take place when the labour  is more advanced.
The head and body of the child retain the same di-
agonal position . respecting the pelvis ;  the  internal
orifice is  largely dilated,  but the membranes not yet
broken ; and the sides of the womb are kept at some
distance from the child's body by the retained waters.
Under these circumstances,  during every pain, the
waters are forced before the child's head, and raise it
up above the brim of the  pelvis ; at the same time
that the membranous sack  is forced through the in-
ternal orifice into the pelvis.   Upon the  cessation  of
the pain, the membranes become  flaccid, the waters
recede, and the head of the child falls down again  upon 
Chap. 3-3         Natural Labour.              127
the brim of the pelvis; and being  pressed with the
finger, retires  easily from it.   Hence we  see the
inutility of frequent  examination during  this period,
when little or nothing can be learnt from it; and when,
if it be made during the pain, there is great danger of
bursting  the membranes, and letting out the waters
before  the parts are properly dilated.
PLATE XVII.
  This plate xvn. shows the child's head engaged in
the pelvis, immediately  after  the membranes have
burst, when the waters being discharged, the sides of
the womb closely embrace the body and limbs of the
child ;  and the effect of almost every pain may be dis-
covered forcing the child's head through the pelvis* 
 128            Natural Labour.           [Chap. 3.

   26.  Sometime  during this  stage, the sooner th*
 better, the patient's dress and bed should be  arranged,
 which although matters of  lesser moment, are well
 worthy some attention.   A flannel  petticoat or two,
 and a short-gown, with the linen turned up under it,
 so as to  preserve  it  dry, or a short shift is the most
 convenient dress.  On that side of the  bed  on  which
 the  patient will lay when on her left side, a blanket,
 three or four double, should be first laid ; over that the
 lower sheet; over the sheet another folded blanket,
 and over  that  another sheet  four double; and laid
 across the bed  with one end hanging over, so that the
 midwife may take it on her lap when necessary  This
 arrangement will be found very convenient at all times
 during the labour; and by means of it, the paiient af-
 ter she is delivered, may be made dry and comforta-
 ble with very little fatigue.   When a cot is made use
 of,  it should be prepared in  the same way ;  and after
 delivery, it being  moved to the side of the bed, the
 patient is to be lifted from one to the other, without be-
 ing suffered to rise up.

              Second Stage of Labour.

   27. This stage of labour  commences with the full
 and complete dilatation of the  internal orifice of the
 womb, and is ended when the child's head  has sunk
 through the brim of the pelvis so low as to  begin to
rest upon and distend  the  soft  parts of the mother.
(See plate 18 )  These circumstances can  be certain-
ly known only  by  examination ; but there is likewise
a remarkable ch nge in the patient's feelings, and in
her manner of expressing them.   An experienced 
Chap. 3.3            Natural Labour.            129

midwife will form no inaccurate judgment of the pro-
gress of the  labour, only by observing her patient's
manner, and hearing, her cries.  Whilst the internal
orifice of the womb  is opening, the pains are cutting,
sharp, and grinding; the patient is restless,bears them
with impatience, and expresses her sense of them by
sharp and  shrill cries; but when this is accomplished,
or nearly so, the pains become more supportable, and
the patient finds  herself instinctively palled upon to
make some  voluntary exertion ; she lies quiet, holds
her breath, and expresses her sense of pain in a grave
tone of voice, or frequently bears them in silence.
   28. We have said that about the commencement
of this stage  of  labour, the membranes frequently
break, and the water  is discharged.  This, in well-
formed women, especially such as  have borne several
children, is generally a period of  some  little alarm;
as when the child is small,  the head falls almost by
its own  gravity through the  pelvis,  and  the delivery
succeeds  immediately;  for  this  circumstance   the
midwife should  always be  prepared ; and for some
time at  least, the patient should be laid  on  her bed,
that at  all events the  necessary  assistance may be
afforded, and that no accident may  happen from  hur-
ry,  confusion, or mismanagement.  But more fre-
quently this stage of labour  takes  up longer time;
and although in  a  perfectly well-formed woman and
a small child, it  may end in a few  minutes, after the
perfect  dilatation of the  internal orifice ; in others, it
may require many  hours,  even in  a labour  which,
from first to  last, may be accomplished in twenty four.
It is during this stage of labour that the  child's head,
 which  enters the  pelvis diagonally with one  ear to* 
 130             Natural Labour.          [Chap. 3.

 wards the pubes, and the  other towards the sacrum,
 (see plates 15, 16, 17.) gradually turns so as to throw
 the forehead into the hollow of the sacrum, the vertex
 to the pubes, and the ears from side to side.  (See plate
 18.) And it is the obstacles which occur to prevent this
 favourable turn in the position of the child's head, such
 as some deformity  in  the pelvis, some  disproportion
 between that and the child's head, or the  unfavoura-
 ble manner in which the head at first enters the pelvis,
 which protract this stage of labour, and now and then
 occasion it to be the most  tedious of any :  and some
 authors abound in directions for aiding  nature to over-
 come these obstacles, and for giving to the head of the
 child the most favourable position, by the hand, or by
 the assistance of some instrument.  But ninety-nine
 times out of a hundred,  all  such interference  is  not
 only unnecessary, but improper.
   29. The great point for  the midwife to know, is,
 that the  shorter or longer duration of this stage of
 labour, depends on the proportion  which exists  be-
 tween the size of the child's head and the openings of
 the pelvis, or upon some irregularity in its  shape, or
 some  awkwardness in the  presentation of the  head;
 circumstances absolutely out of her power to control:
 but which nature, when left to herself, most frequent-
 ly will vary so as wonderfully to adapt one to the oiher,
 in every  stage  and  pi ogress of the labour.   The im-
 perfect ossification of the bones in the  head of  the
 human foetus, and the loose manner in which they are
 eonnected by membranes, (see plate 5.)  is the provi-
 sion which nature has made for overcoming these dif-
ficulties;  where the  head  is large or the pelvis nar-
 row, the bones ride over one  another as  the head is 
Chap. 3.3         Natural Labour.             131

forced through  the brim, and  the shape of the head
becomes more oval and pointed ;  entering the brim of
the pelvis with one ear to the sacrum, and one to the
pubes ; that is with the narrowest part of the head to
the narrowest  part of the pelvis, it  turns as it de-
scends  where it finds most room ; until  the face is
brought into the hollow of the sacrum, and the ver-
tex or smallest most pointed part of the head, to the
external orifice.   In like  manner, most  untoward
presentations will be changed, when time is allowed,
and no mismanagement occurs;  so that, ultimately,
the delivery shall be accomplished by the least possi-
ble violence, and with more ease and less hazard to the
mother or child, and most probably in a shorter time
than could be  effected by any interference of  ours,
with safety to either.
   30. The principal object, therefore, of the midwife's
care in this stage of labour, especially when  it proves
tedious,  is to regulate her patient's conduct, to  sooth
her sufferings, to calm her fears, and above all things,
to avoid fatigue.   Although,  therefore, the  woman
feels some disposition to voluntary efforts,  she is not
to be encouraged to erert herself during the  pains,
more than she can well avoid ;  her utmost  exertion
can add little to the contractile force of the womb, and
only tends to fatigue and weaken her.
   31. The bursting of the membranes, likewise,  is a
circumstance of great uncertainty : it most frequently
happens at the end of the  first, or during the second
stage;  but  it  sometimes occurs with  the first pain,
 sometimes many days or even weeks before the com-
 mencement of labour; at other  times, after having
in the form of a distended sack,  contributed to dilate, 
 132         jYatural Labour.             [Chap. 3.

 the internal orifice of the womb, they continue in the
 same manner to dilate the vagina, the perineum, and
 external orifice ; and now and then  are  expelled, ei-
 ther in part, covering the child's head, or entire, with
 the placenta and waters.  But this is a circumstance
 by no means to be wished, as it may be followed by a
 dangerous flooding, or by an inversion of the womb;
 whenever, therefore, the bag appears at the external
 orifice, it should be ruptured, and  the waters let out,
 as they  can  be  of no farther use.  During this  stage
 of labour, women are less inclined  to move than  dur-
 ing the first stage; still they are  not be confined to
 one posture, but indulged, and even  encouraged occa-
 sionally to rise from the bed,  to walk about, and to
 take some pains leaning over the back of a chair, sup-
 ported by her  friends, or kneeling at the side of the
 bed.

              Third Stage of Labour.

   32. The third  stage of  labour begins at the time
 when the head of the child, having sunk through the
 pelvis, begins to rest on and to distend the soft parts of
 the mother ; and continues until these, being  stretch.
 ed and distended into the form of a large protuberant
 tumour, the external orifice is so far dilated, as to suf-
 fer the head and body  of the child  to pass through
 without injury.  The pains during this period, whilst
 the perineum and soft parts  are undergoing so great
distention, become more severe, and at last, when the
 head of the child is passing the external orifice, are
 most exquisite.   But  they are always least, when the
 labour has been suffered to go on from  the first with
little  or no interference : and much more excruciat- 
 Chap 3.]         Natural Labours.             133

 ing and dangerous, when these tender parts have been
 fretted and inflamed by improper conduct at the begfri-
 ning.
   33.  The part which is most apt to  suffer during
 this period, is the perineum, or that portion ol skin
 which extends from the anus to the external  orifice ;
 which, from the extent of one inch  or  an inch  and a
 half, is stretched to  that of four or five inches, and re-
 duced to the thinness of paper.  The perinaeum and
 adjoining parts are relaxed, and prepared for so  great
 a change by  the secretion of a large quantity of mu-
 cus, by which the parts are  softened, and a  dis poi-
 tion to yield and stretch is given to them ; at the same
 time that they are lubricated by it, so as to suffer the
 child's head to slide easily through them.  And when-
 ever there happens  to be a deficiency of this  mucus,
 or  when,  by improper  handling,  it has been rubbed
 off, and its secretion checked ; or when a violent and
 sudden labour does not  allow sufficient time for this
 secretion to take place, and  give to those parts a pro-
 per disposition  to dilate, the perineum is apt to  be
 torn, always an unfortunate accident, and one which
 sometimes subjects  the woman to great misery and in-
 convenience during the rest  of her life.
   34. To prevent this accident, is the principal busi-
 ness of the midwife ift a natural labour, and  her at-
 tention is to be  directed towards it, from  the very com-
 mencement of labour, to the complete delivery of her
 patient:  with  this in view,  she has been directed  to
" avoid irritating these extremely tender  parts, by fre-
 quent and unnecessary examination,' or any rude and
 preposterous attempts  to stretch  and  extend them;
 p.s well as to avoid heating her patient by improper
                      M 
 134            Natural Labour.          [Chap. 3.

diet, cordials, and spirituous liquors;  by  the use of
which  fever is brought on, the parts become rigid,
and are easily torn.   From the commencement  of
this stage of  labour,  a woman becomes less inclined,
and less able to move, and the delivery may be expect-
ed to be accomplished in a short lime.
   35.  The woman is now, therefore, to be laid on her
bed, in a  proper posture for  delivery : that is, on her
left side,  with her hips brought to the edge of the bed,
and her knees moderately drawn up, with  a pillow be-
tween them,  and her feet supported against the bed-
post, by a foot-board, or against some person sitting on
the bed ;  taking care not to draw her thighs tootmuch
up towards  the belly,  nor to separate the knees very
wide, both which  put  the perineum on  the stretch,
and increase  the  danger of its being lorn.   The bed
being in all respects  prepared as directed,  (26.) the
midwife  is to seat herself behind on a low chair, tak-
ing the end of the sheet which had been laid across
the bed, on her lap ;  she will  then  find herself most
conveniently  placed to afford every necessary assist-
ance ;  still however she has  nothing  to do,  and it
may require some lime before  she  will perceive the
perinaeum sufficiently distended, and the  external ori-
fice so far dilated, as that the crown of the child's heed
begins, during each pain, to protrude.   She is then to
take a soft cloth in her left  hand,  and  placing it over
the tumour,  with her fingers extended  towards the
back, and the palm over the perineum  reaching to the
external  orifice,  make  a gentle pressure  on the'tu-
mour during each pain, so as in some measure  to  re-
tard the  sudden  advance of the  child's head'; or ra-
ther to be ready to retard it, when a violent  pain sh:.'! 
 Chap. 3.3         Natural Labour.              135

 threaten too sudden a delivery.   For let  it again be
 recollected, that in a slow  labour  well managed from
 the beginning,  where the  soft parts are properly  pre-
 pared to yield, the perineum  never  is torn ;  and that
 all the danger of this unfortunate accident arises from
 a  sudden and violent labour,  or one which has  been
 mismanaged in the beginning.
   36.  It is seldom necessary to make any considera-
 ble resistance :  but as the child's head passes  through
 ihe external orifice, it is always proper,  whilst the left
 hand is  kept in the position just now described, to
 place the fingers and thumb of the right hand collect-
 ed together^ upon the protruding part  of  the child's
 head ;  in this position, the midwife has it in her pow-
 er to make such resistance with her right hand, as the
 rapidity with which it advances, may require ; and to
 make it on the head itself  rather than on the  perine-
 um ; the dilatation of which by too great pressure,
 will  be prevented,  and the perineum itself severely
 bruised.   Experience alone can teach the  degree of
 resistance required ; and until the midwife has acquir-
 ed that  experience, she must be cautious not !o make
 more than is necessaiy; by which, as much mischief
 may be clone  as by  any  kind  of interference.   And
 where the labour has been well  conducted from the
 beginning, much  is  seldom  required.  Even where
 from early mismanagement or from  any other cause,
 the parts are not properly prepared to dilate; and there
 is a dryness and rigidity of the  parts,  the natural  mu-
 cus may  and often does, during a few of the last pains,',
become so considerable as  to save the  perineum.
  37. In cases in which this does not take place, we
aro directed  to  anoint and lubricate the  parts with 
136              Natural Labour.         [Chap. 3.

pomatum, hog's lard, or oil;  and to  a  certain degree
this has its use ; but if it is to occasion much hand-
ling of the parts, it  may even be prejudicial.   I have,
therefore, commonly preferred  to  anoint the parts
once or twice, and over that  to apply a soft  flannel,
wrung out of warm water;  the woman finds this very
relieving, and on some occasions, I  have  continued it
for several hours, as I have  thought with real advan-
tage.
   38.  The sufferings of our patient at this moment,
are at  the highest, extremely severe, and sometimes
almost beyond  endurance ; and  in the hope of short-
ening  their continuance, she is often inclined, and too
frequently called on  to  exert  her utmost strength.
Still, however, her  present  safety and future comfort,
may very much depend upon  submission,  patience,
and gaining a little time : and all extraordinary exer-
tion beyond what she is in some measure compelled to
make, is hazardous.
   39.  Just before  the birth, the head is often found
to advance  during the pains, and to  retire again as
they remit: and this alternate advance and retiring, is
frequently of infinite consequence to the  safety of the
perinxum.   This has been thought  by  some unne-
cessarily to protract the sufferings of the woman ; and
we have been directed even by Smellie, to  prevent  it
by introducing one or two  fingers  into the anus, and
 pressing strongly against the brows of the child as the
 pain remits;  but this kind  of interference  is highly
 dangerous both to the mother and child.   Nature sel-
 dom does any thing  in vain, and  this successive ad-
 vance and retirement of the child's head is generally
 of infinite consequence, perhaps absolutely necessary 
Chap. 3.]          Natural Labour.             137

to the safety of the perineum, by the strength and elas-
ticity of which it is generally  occasioned,  and which,
after some little  time, will thereby become perfectly
relaxed, and easily distended; if, at last, it should hitch
on the child's chin, by introducing a finger within, dur-
ing the remission of the pain,  it may be slipped over
it, and with the next pain the head is generally deliver-
ed ;  but even  this must  not  be attempted before the
perineum is perfectly dilated.
   40. After  the delivery of the head,  a short respite
ensues ; but the pains soon  returning,  the  shoulders
of the child are perceived as they descend, to make
the same turns as the head had done just  before,  and
after a pain or two, are delivered, one to the belly and
the  other to  the back of  the  mother ; the next pain
advances it to the hips,  so that the arms of the  child
are delivered without any,  or at least, with very little
assistance.   Another short respite  now  takes placcy
whilst the  hips of  the child advance, and with one or
two  pains, are protruded, and the delivery of the child
is accomplished.
   41. Upon this slow,  gradual, and  successive deli-
very of the different parts  of the  child, and the con-
tractions of  the  womb, which severally  take  place
after the delivery of the head,  the shoulders,  and the
hips, depends in a great  measure  the  safe and easy
delivery of the after-birth, and  the  woman's security
against a flooding ;   for in  this way, time  is allowed
for the regular contraction of the womb from the fun--
dus, pressing down the after-birth before it : whereas,
in"a more sudden delivery,  when  the head, shoulders,
and  body of  the  child are  delivered by a single pain,
the  womb may and frequently  does contract from  its
                      M2 
 "S            Natural Labour.          [Chap. 3.

sides, protruding the child,  but retaining the placenta
high up in the fundus.   A midwife, therefore, should
never, as is too  frequently  done, take hold of the
child's head, and immediately drag it forth ; a very
common but a most  dangerous practice, generally
the cause of severe after-pains, and frequently of much
worse consequences : a ruptured perinaeum. retained
after-birth, and flooding ; or  an  inverted  womb, by
which the lives of many women have been lost.
   42.  The birth of  the child is always  followed  by
the discharge of what  water had been retained  in the
womb; frequently by some clots  of blood, and gene-
rally by some fresh blood flowing from those parts of
the womb, from which the after-birth has been wholly
or in part dttachedt  This generalfy continues until
the womb  has so far  contracted as to press on and
confine the after-birth :  and is the most important rea-
son for suffering the  body of the child to  be gradually
and slowly delivered  by successive pains:  by which
means, when at last it is  completely delivered, the
womb is  already so far contracted, as to secure the pa-
tient against a flooding, the most, if not the only dan-
geroi- c'Tiimstance attendant on a natural labour. 
Chap. 3.3        Natural, Labour.              139
PLATE XVIII
    43. This plate xvm. is intended  to  represent the
  situation of the child at the end of  the second and the
  commencement of the third stage of labour, when the
  head lias descended through the pelvis, and begins to
  rest on the perineum, the ears stand across the pelvis,
  the  face is in the hollow  of the sacrum,  and  the
 "▼eriex or crown offers to the external orifice.   When
.  the head has  descended thus low, the effect of the 
 140            Natural Labour.          [Chap. 3.

pains is to force the child's  chin, which  before rested
on the breast, more and more from that position ;  and
as the breast and shoulders  descend through the brim,
the chin,constantly receding from the  breast, passes
over the hollow of the sacrum ;  the nape of the neck
is pressed against the pubes, and  the  hind-head, as it
protrudes the external orifice, rises up from under the
arch of the  pubes, until  the chin, at  last, arriving at
the  external orifice, slips  from behind  the perineum,
and is delivered.   Hence  we  see, that a moderate
pressure of the hand, on the perinaeum, during the lat-
ter part of this period of labour, not only tends to sup-
port and preserve the perineum from being torn,  but
being directed towards the pubes, as  it  always ought
to be, promotes the effect of the pains in accomplish-
ing the delivery.

               Fourth Stage of Labour.

   44.  After the child is delivered, let  it lie in an easy
posture, on its side, a little reclined towards the back,
with its head covered, but with its mouth exposed to
the air, until it  breathes and cries, and until the pulse
in the navel string has ceased, or at »least become
very feeble ; after which,  tie the navel  string with a
thread four double, (that it may not endanger cutting
the string) in two  places, one about  two inches from
the child's body,  the  other about two  inches  above,
and  take care to  cut it between the knots ; an  error
on either side might be fatal :  if below the first knot,
to the child already born ;  if above the second, in case
of twins, to that in the womb.
  45.  The child  being removed, a soft cloth is. to be 
Chap. 3.]
Natural Labour.
141
applied to the.mother.  In a little time, from ten to
thirty minutes, the pains, which generally cease for a
short time after the  birth of the child, will probably
return, and push the after-birth down below the brim
of the pelvis into the vagina ;  of which, if it is  not
immediately delivered,  the  midwife  may satisfy her-
self, by taking the string in her left hand,  and passing
a finger of her right along it up into the  vagina; if
within the length of her finger, she can  reach that
part of the placenta to which  the cord  is attached,
she may  rest satisfied that all is safe, because, at  any
rate, the placenta b within her reach.
    46. If, on the contrary, she cannot reach the root
 of the string, let her examine the patient's belly ;  she
 probably will find the  womb  soft and flaccid, resting
 on the lower side, or  perhaps hanging a little  over
 the pubes ; by taking it  in  the hollow of her hand,
 compressing it moderately, raising  it  up towards its
 natural  position,  and at the same  time  rubbing the
 surface briskly with  the  hand, she will soon perceive
 the womb to contract in size, and to  assume the form
 of a ball  of considerable firmness;  after this,  a  very
 few puins will probably deliver the placenta ; and as
 no danger can arise from delay, except in the  case of
 flooding, the effect of  the  pains  should  be relied on
 for at least another hour.  The defect of pains is the
 most common cause of delay in the delivery of the
 placenta, and  this inaction of the womb is a very com-
 mon consequence of fatigue, after a severe or tedious
 labour, especially if mismanaged; but this weakness,
  so far from being  a reason lor hasle and precipitance,
  is a most powerful argument  for waiting, and making
  no attempts to separate  and  extract the  placenta ; a 
142              Natural Labour.         [Chap. 3.

hasty delivery of which, before the  womb has begun
to contract with some degree of vigour, will expose
the patient to  the great danger of a flooding, or in-
version  of the womb.  Under such  circumstances,
therefore, our efforts must be directed to compose the
patient's mind, to cool her when overheated, and to
recruit her strength by mild cordials, (No. 17. a. b. c.)
and good nourishment:  whilst at  the  same time we
attempt to excite the action of the womb as directed
above.
   47. But if, notwithstanding a due action of the womb,
manifested by pain, and a round contracted ball under
the pubes ; the delivery of the placenta is protracted
beyond  one or two hours, and the woman and her
friends  become  impatient, there can be no  danger,
under these circumstances, cautiously  to give  some
assistance.   Let the midwife,  therefore, twisting the
cord round her finger, or wrapping it  in a  dry cloth,
draw it as far back as possible, and put it just so much
on the stretch as to prevent the placenta retiring as
the patient  expires;  for  while  the cord is  on the
stretch,  the  placenta  will be found  to descend at
every  inspiration,  and  to ascend  during  expira-
tion.  Whilst she  thus  holds  the cord in her left
hand, she may give a better direction  to  the small
force applied  to it, by introducing  two fingers of the
right hand under  the pubes as high as  possible  to-
wards the  root of  the cord, and with them press it
back towards the sacrum, and  at the same time draw
the string over the fingers as over a pulley.  Whilst
introducing the fingers for this  purpose, she will fre-
quently find an edge of the placenta hanging through
the internal orifice, and by pressing against that in- 
Chap.  3.3       Natural  Labour.               143

stead of the cord, or by taking hold of it between the
fingers and  thumb, and attempting to carry it into
the hollow of the sacrum,  she will greatly promote
the delivery.
   48.  But the midwife must always be very careful
how she exerts any considerable force on the string,
which  in some  instances is small, in others inserted
by  several branches into the placenta, and'easily torn
from it:  at all times  an ^convenient,  and on  some
occasions a very serious accident.  Or if the string
should be so strong as  to endure much force, more
terrible accidents may follow ; the  placenta may be
torn from its attachment to the  womb, of which a
violent flooding  must  be  the consequence ; or the
womb  may be in part or wholly inverted, (Uirned in-
side out) and actually brought out of the body, which
has frequently been  the unhappy consequence of im-
prudent force  applied to the cord.  This terrible ac-
cident  is most  likely  to  happen  after great fatigue,
when  the woman is much exhausted,  no pains ensue
after the  birth of the child, and the  womb instead of
contracting, remains large and flaccid.  Let it, there-
fore, be  an  invariable rule,  not even to tighten the
cord, or put it the least on the stretch, until the womb
can be felt, by the hand  applied to the woman's belly,
contracted and reduced to a kind of globe of conside-
rable firmness.
   ■19.  The placenta being delivered, unless in  cases
in which  the womb appears to act  with considerable
vigour, it will be of advantage that the  midwife oe an
assistant  continues for some little time to rub the
abdomen over the womb, by  which its contraction will
be excited, the danger of a flooding lessened, and tbt 
144
Natural Labour.        [Chap. 3.
 expulsion of any clots it may contain will be prompted;
 which will lessen those severe after-pains which arise
 from the future efforts of the womb  to expel them,
 when by delay they have acquired greater tenacity and
 adhesion.
   50.  Let then a  soft cloth be applied to the parts of
 the mother, a towel  four or five  double to the belly,
 and over that a broad bandage round her waist is to be
 pinned so low as to take innthe belly, and afford some
 support to its loose and relaxed sides; but not so tight as
 to give the least uneasiness.   The use of such a band-
 age  has been-ecMUested ;  and no doubt, when  a twisted
 handkerchief,  is applied in  the form of a cord,  and
 drawn very tight, as is too frequently done, it may do
 much mischief; but when a broad bandage is skilful-
 ly applied, as  above directed, it will be  found  very a-
 greeable and comfortable to the woman, and in addi-
 tion to friction, has a tendency to  prevent  and  relieve
 that faintness, which is  sometimes very alarming to
 newly delivered women.
   51.  Remove the pillow from between the patient's
 knees, and the wet clothes from under her,  and give
 her a little thin gruel, with a spoonful or two  of wine ;
 but avoid brandy,  spirits, gin, and all  kinds of cor-
 dials.
  52.  If she have been delivered on a cot, let it be ta-
 ken  to the side of  the bed,  and let  her be  removed
from one  to the other without rising at  all to an up-
right posture, which is always dangerous immediately
 after delivery.   It is  still better, if she can be made
tolerably comfortable, to let her lie for an hour or two
upon the cot ; she may,  however, turn from one side 
Chap. 3.3         Natural Labour.              145

to the other, and extend and move her limbs, so as to
obtain an easy posture.
  53.  By such prudent management, in at least nine-
ty-nine cases out of  a hundred, nature will be found
perfectly equal to a safe  and happy delivery ;  and it
will  be accomplished with as little  pain, and in as
short a  space of time, as is consistent with the wo-
man's  safety ; and of the few  cases which  may not
proceed with such uninterrupted regularity,the greater
number will  be brought to a happy  conclusion,  only
by exerting  a little more patience in the conduct of
the labour.
o 
On the Causes and Remeelies    [Chap. 4.
               CHAPTER IV.

ON  THE  CAUSES  AND  REMEDIES OF TEDIOUS AND
              DIFFICULT LABOURS.
                  SECTION  I.

           Tedious ,'xl  Difficult Labours.

   1. Such is  the  progress of natural labour, which
should be  studied  most particularly by every person
undertaking the profession of a midwife; and to which,
if it were possible, they  ought for a long time to con-
fine their practice ; for they only, who are conversant
to  natural labours,  and thoroughly understand, in all
their  minutiae, the process and  resources of nature,
can be qualified to  give  assistance  in such  labours as
are difficult or preternatural.
   2.  When labour is terminated within twenty-four
hours, it may be considered as sufficiently speedy ;
when  protracted beyond  forty-eight  hours, tedious ;
and when beyond  three days, very difficult; but still
may be perfectly natural, and when not protracted by
preposterous attempts to hasten it, will not probably
be more tedious than is necessary for the safety of the
woman.
   3.  It cannot, therefore, be too frequently repeated
or too strongly impressed upon a midwife, that in a
natural labour, she has nothing to do  but to calm her 
  Chap. 4.3   of Tedious and Difficult Labours.      147

  patient's spirit and  fortify her with  patience ;  to re-
  gulate  her  conduct,  her diet,  and evacuations; to
  check all violent efforts; to prevent the accidents of
  premature and hasty  delivery }  to receive the child,
  tie the  navel  string,  and  deliver the  after-birth in
  the cautious manner directed,  (Chap. Ill, 44, &c.)
  There are, however, many circumstances, some of natu-
  ral occurrence, but  more frequently of erroneous con-
  duct in the beginning of labour, which may greatly dis-
  tress the patient,  precipitate labour, or render it un-
  naturally  tedious  and difficult.  Upon  this subject,
  Doctor Denman with great candour, says " it would be
  unpardonable  to make an operation which is not sup-
  ported by experience ; but I am now fully convinced,
  that the  far greater number of really difficult labours, to
  which I  have been called, and 1 must not conceal the
  truth on this occasion, many of these which have been
  originally under my own care, were not of that descrip-
  tion from unavoidable necessity, but were rendered
  such by  improper management in the commencement or
^ course of the labour; nor does the disturbance of the or-
  der of labour  depend on  the practitioner alone; for
  the intractability of the patient herself, or of her friends
  and attendants is too frequently productive of the  same
  effect."   With this sentiment, founded on great ex-
  perience, and dictated  by benevolence, impressed on
  our minds, let us now consider  such complaints and
  causes of slow  and difficult  labours, as may probably
  be  relieved  without manual assistance  or  the use
  of instruments. 
 148       On the Causes and Remedies     [Chap. 4*

 Obstacles from the State of the Parts, and the Form of
                   the Mother.

  4. First child.   In the first place, the midwife is to
 recollect, that it is so common, that in some measure
 it may be said  to be natural, and therefore  necessary,
 for women with their first child, although young, well
 formed, and healthy, to have much more tedious la-
 bours than with  those which  follow.   The same de-
 lay happens more certainly, and  in a greater degree,
 when women are advanced beyond thirty years of age
 before they have a child.
   5.  On the part of the womb, this may perhaps arise
 in  some  measure from  want of habit,  whence it
 contracts either feebly or irregularly: we  perform all
 actions, the involuntary as well as such as  are volun-
 tary, more easily and readily, and with greater effect,
after than  before we have been accustomed to them.
Some degree of timidity and apprehension with  which
almost every woman is affected, at the commencement
of labour, especially in the case of  a first child, may
contribute  to render the pains at first more weak and
ineffectual, and less regular than they otherwise would
be, although it is perfectly  natural  and common for
 them to be so in the beginning of every labour.  Very
fat women are  observed to be subject to slow labours,
from  a remarkably feeble  action of  the womb, with
which  their labours  frequently begin ; and in some
cases of twins,  and some in which the womb is over-
 distended by a very large collection of water, a slow
labour follows from the same cause.  In all such,  as
 well as in  many others in which  the pains were sup-
 posed to be weak  and  ineffectual it was formerly the 
Chap. 4.3   of Tedious and Difficult Labours.     149

practice to endeavour  to excite the action of the womb
by hot and stimulating  medicines:  prescriptions for
this purpose (the pulvis  ad parlum) are to be found in
Pharmacopoeias  of  no very  early date ;  and it is still
too frequently the practice to  give hot  spicy  drinks,
gin,  and other spirituous liquors,  with intention to
strengthen the pains.  But in truth,  we know  no re-
medies by which we can immediately act on the womb
and  promote its contractions ; and  all such as are
given with this intention do much mischief, by  over-
heating  the patient,  exciting fever, and wasting her
strength.  Time,  patience, leaving  the patient at li-
berty to walk about her chamber, to sit or lie as she
finds most agreeable,  calling her attention off from her
present situation, by agreeable conversation  between.
her  pains, and  giving  her confidence  by proper en-
aouragement, are, in such cases our only remedies, and
seldom or  never  fail.  Repeated emollient clysters,
 No. 4. a. b.) in  the beginning of labaur are always of
use ; and now and then one  that is  stimulating, i No.
5. a. b. c) after the  labour  has somewhat advanced,
may be admissible.
   6. With regard to the other soft parts, the internal
orifice of the womb, the vagina, perineum, and exter-
nal orifice, slow labours certainly do fi equently  arise,
particularly in the  case of a  first child, from greater
rigidity and resistance ;  whence they are less disposed
to yield  and dilate; and longer time is necessary to
overcome this resistance, and to give them the proper
disposition to relax.
   7. It becomes,  therefore,  more  necessary for the
midwife, in all such  labours, to be  very careful of all
improper interference, either by frequent examination
                       N2 
Onthf Causes anal Remedies      [Chap. 4.
or rude handling;  by heating food or drink, particu-
larly by  the use of cordials,  or spirituous liquors of
any kind; by which fever or  inflammation may be
excited, the soft parts become  dry, and their natural
rigidity may be increased.
   8. She must be more attentive to avoid all extraor-
dinary  and unnecessary exertion on  the  part  of  the
patient, by  which  she  may  be  fatigued; and that
strength  exhausted in  the beginning  of her labour,
which will be required to support her at the end; and
she must arm her with  more patience, by candidly
informing her of the absolute necessity  there is,  in
her case,  for longer time  than usual to accomplish her
delivery with safety.  Above all things, she must take
care not to  be hurried  heiself;  bin by  a calm and
composed manner,  to  give  her patient confidence in
her skill, and by gentleness and humanity, to  soothe
her sufferings.
   D. It sometimes happens, that  the internal orifice
of the  womb is found remarkably thick and rigid, es-
pecially in women advanced in life ;  in such cases, all
the advice already  given respecting patience, quiet,
dilution,  r.n:! cool regimen ;  and all  the  cautions res-
pecting improper interference of the  midwife, in at-'
tempts to stretch and dilate the parts, are more parti-
cularly necessai y ;  on  account of the importance of
the part itself, its extreme  sensibility,  and  the great
danger of inflaming it.  Nor is it uncommon  to find
the other soft parts which are concerned in delivery, as
well as the internal orifice, rigid and unyielding to the
efforts of labour ; in all such cases, besides the cautions
just given,  frequent clysters of warm  water, and  ex-
 ternal fomentations, either by sitting over hot water, 
 Chap. 4.3  of Tedious and Difficult Labours.     151

 or. applied  by means of large flannels  wrung out of
 warm water, will be found of great use, but the reme-
 dy most to be relied on,  is bleeding copious indeed, in
 proportion  to the strength of the patienr, but still not
 such as unnecessarily  to waste that  strength  which
 may be required before  her delivery is accomplished :
 and for this reason, u will be of advantage, (according to
 the advice of Doctor Dewees)  to  keep  the woman
 standing while the blood flows from a large 01 ifice,  so
 as to occasion with the least loss of blood, some de-
 gree of faintness.
   10. Sometimes, when women have been  ill-treated
 in the beginning of labour, the external parts become
 so swollen  and  inflamed, as  actually  to protract deli-
 very ; in this  case,  bleeding, clysters, and cool  regi-
 men ; rest, with emollient fomentations and poultices,
 (No. 18. g)aie useful.
   11. The same causes may occur in women who have
already  had children : the womb may  act, at first, fee-
bly or irregularly, and  the other soft parts may be na-
turally,  or from some accidental cause, more rigid than
is commonly the case; the pains may  have  been inter-
rupted or rendered irregular,  and  the  soft parts irrita-
ted, and in some measure inflamed, and the secretion
of the natural mucus prevented by improper diet,  and
ungovernable conduct on  the part of the patient, or by
improper and unskilful interference on the part of the
midwife in the beginning of labour.  In all the cases
of this paragraph, the most tedious and distressing pe-
riods of labour are the first stage, whilst the internal
orifice of the womb is dilating, or the third, when the
perineum and other external parts are undergoing the 
 152       On the Causes and Remedies     [Chap. 4.

necessary distention.  In all, gentleness, patience, and
time, are our best remedies.
   12. Premature labours,  which come on before ihe
complete term of pregnancy, and consequently, before
the soft parts of the mother are properly prepared for
it, require for that reason, longer time to  be accom-
plished ; for nothing is more just than that admirable
observation of Dr. Denman, aod which cannot be too
often recollected :  " That the whole period, from con-
ception to recovery after child-birth, is  a progressive
process, in which from first to last, one period  is con-
stantly preparing the parts concerned for those chang-
es which they are to undergo  in that which is to fol-
low ; and that if nature be interfered with, or precipi-
tated in either, there must be some  increased difficul-
ty or danger to be overcome in the next.''
   13.  Every thing which tends  to  render  a woman
weak and irritable ; (among which  all the debilitatii g
practices of a luxurious life may be reckoned,) render
her liable, from slight causes, to be thrown premature-
ly into labour.  Nature, however, will not be hurried,
or put out of her course with impunity ;  and a labour
of two or three days, which might  have been finished
in a few hours, is the penalty  women frequently  pay
for a few  trifling  indulgences.
   14. Whenever, therefore, we have good  reason to
suppose the access of labour  premature, it should be
suppressed ; bleeding in proportion  to the strength of
the patient, emptying the bowels by  an injection, (No.
5. a.) rest in an horizontal posture, and opiates, so as
to procure ease, (No. 14.  a ) are the means; but to be
successful, they must be early commenced, and par.
ticularly rest and quiet must be persisted in. 
 Chap. 4.]     of Tedious and Difficult Labours.   153

   15.  Among the  causes  which frequently bring on
 premature labour, is the early breaking of the mem-
 branes, and the. discharge or dribbling of the waters.
 This sometimes happens several weeks before the full
 time ;  and I think I have observed,  from its repeated
 recurrence in the same woman, that some  are parti-
 cularly liable to this accident;  which is almost sure to
 be succeeded by a  labour more tedious  and  painful,
 than when the membranes remain  entire until after
 the full accomplishment of  the first stage  of labour.
 This accident may likewise occasion the death of the
 infant, which, if alive at the  commencement of labour,
 is sure of being so until after  the breaking of the
 membranes  ; but when that happens  early  in labour,
 the child is sometimes born dead, probably from the
 continued pressure of the womb on some part of the
 cord, or on the placenta, so as to intercept the circula-
 tion between the mother and the child : a very strong
 argument against the early rupture of the membranes.
   16.  Narrow pelvi.«, or large head.  When the se-
 cond stage of labour is most tedious ; when, after the
complete dilatation of the  internal orifice, the  child's
 head  remains a long time  high and almost out of
 reach ; when its entrance into, and its  descent through
 the pelvis are observed to  be  remarkablv slow; and
when the  bones of the child's head,  in coming down,
 are observed  to overlap each other,  and the present-
 ing part becomes sharp and prominent, the difficulty
 may arise, either  from a narrow and distorted pelvis,
 or from the child's head being  remarkably large.   In
 most of these cases, more care and longer  time only
 are necessary.  When left  to  time,  the repetition of
 the pains will, at last, mould  and shape the head to 
 154       On the  Causes and  Remedies   [Chap. 4.

 the form and dimensions of  the pelvis ; and in gene-
 ral, it will pass with more ease and safety, both to the
 child and mother, than  can  be effected  by any other
 means.   The child's head  being too firmly ossified,
 by  which it is less disposed to  yield to pressure, is
 another cause of delay at this period  of labour, but
 which time will generally overcome.
   17. The same observation may be extended to most
 of those cases in which  the  child's head  presents un-
 towardly : offering with  the fontanelle or  opening, the
 forehead, face, chin, or ear; in most of which, time and
 patience, with good management in the beginning of
 labour, will effect the delivery :  for in these cases, un-.
 embarrassed  nature is  fruitful in resources, and  will
 either squeeze the child's head into a more convenient
 form, or turn and alter its position, so as to adapt it to
 the passage.
   18. Even Smellie asserts, that not above six women
 out of a thousand require the use of instruments to
 accomplish their delivery ;  but it is well ascertained,
 that Smellie  too frequently had  recourse to  instru-
 ments ;  and later and more accurate calculations make
 the number not above four or  five out of two thou-
 sand ; and that  even  in England, where great num-
 bers of  children  employed in unhealthy manufac-
 tures, added  to all those educated in  her great cities,
 compared with the very opposite  treatment of chil-
dren in our happy country,  must increase, in a  ten-
 fold degree, the number of crooked and distorted wo-
 men.
   19. Every  crooked woman has not necessarily a
 distorted pelvis,  and consequently a difficult labour ;
 and where the curvature is confined to  the spine, and 
Chap. 4.3  of Tedious and Difficult Labours.     155

the lower extremities do not partake of the distortion,
it often happens that  crooked women have large and
capacious pelves, and consequently, easy labours.   In
every such case, however, there is sufficient reason for
apprehension, to put us on our guard : and every wo-
man who, from this cause, has once had a tedious and
difficult labour, must necessarily be exposed to the
same difficulties  in a  future  one.   The  midwife,
therefore, should be prepared for it ; and by carefully
avoiding every thing in diet  or conduct, which may
heat, inflame, or fatigue her patient,  will preserve her
strength, and render the labour as easy and safe, as the
nature of the case wHl permit.
   20.  Women who have been  rickety during child-
'bood, and  are crooked from that cause, are  most apt
to have distorted pelves  ; mothers, therefore, knowing
the beginning of  such distortion to be commonly laid
in infancy  and childhood, should be  particularly care-
ful, by attending to the  first appearance of rickets in
their daughters, by strengthening  their constitutions,
by exercise in the open  air, and cold bathing during
 infancy, and by carefully avoiding much confinement
 to a sitting posture during childhood ; but on the con-
 trary, by indulging their natural dispositions  to play-
 fulness and exercise, preserve their health and vigour,
 as well as the regularity and beauty ofrtheir form, and
 thereby fit them for safe  and easy labours.  Nor is it
 only by injuring the shape of the bones, that misman-
 agement in childhood  unfits women for easy child-
 bearing, but by  preventing firmness  and  vigour in
 general, and occasioning a weak,  feeble, and  irritable
 habit.   A  sedentary life and luxurious education*, are
 the chief causes of all the evils  which women suffer 
 156       On the Causes  and Remedies    [Chap. 4,

 during pregnancy and labour.  Keep children, there-
 fore, out of doors, in constant exercise ; allow them a
 full but plain and simple diet; and when  grown up to
 be young women, let them live more agreeably to na-
 ture ;  let them avoid late hours and crowded rooms,
 indulgence in soft beds, and luxurious diet;  let them
 walk, ride, and dance.  Then let  them extend some-
 thing like the same discipline to their minds and tem-
 pers ;  avoid all irritability of disposition, all affected
 delicacy and  timidity ; and  in their place, cultivate
 calm and steady minds, and they will probably insure
 to themselves safe and easy labours.

    Obstacles from the State of the Mother's Health.

   21.   In  nervous and low-spirited women,  and in
 cases of great weakness, either from mere delicacy of
 constitution,  or   the consequence of  disease,  every
 thing depends upon calm and steady management.
 The patient is not to be put on her labour too early ;
 her strength is to be supported by proper diet of good
broths and gruel, with some wine ;  but carefully avoid
 spirituous liquors, and  every thing that will heat or
fatigue;  necessary rest is  to be  procured, and time
gained by moderate opiates, (No. 14   a.") by these
means,  nature will  generally be found equal  to  the
accomplishment  of a safe and happy delivery.  For
 in all such  cases, even  where women have  been re-
duced  to great weakness  by consumptive  and other
diseases ; the resistance is generally proportioned to
 the strength of the patient.  The contractile power
of the womb, which is not a  voluntary action, is less
impaired than such as depend on the will and the pow- 
Chap. 4.3   of Tedious  and Difficult Labours.     157

er of the muscles ;  and although such patients  fre-
quently suffer  from the  consequences of  delivery,
their lanom-j. are commonly short and easy.
  22.  In  cases of an  opposite nature, in strong  and
healthy women, of rigid fibres  and full habits, with
strong pulses,  and more  heat than natural, bleeding,
open bowels, and cool regimen, are necessary.   An
easy moisture may be brought on  the skin by tepid
drinks ; and repeated  clysters of warm water should
be administered, not  only  to keep  the bowels free,
but that they may act as a partial bath, and relax  the
parts.
  23.  When, in  either case, the natural pains have
been  interrupted, and the labour protracted by mis-
management in the beginning, it must be remedied
by an opposite treatment: the patient must be  sup-
ported by proper diet,  consisting of broth and gruel,
with a little wine, and rest must be procured by  mo-
derate anodynes,  (No. 14. a.) the  natural  pains  will
at length  return ; the  woman will  acquire  resolution
and strength, and the  labour will  probably end hap-
pily.   In  these cases it sometimes  happens, that  the
woman is worn out with irregular,  tedious,  and inef-
fectual pains :  in such cases, a larger anodyne of  fifty
or sixty drops, aided by an anodyne clyster, so as to
suppress  those  irregular pains, and procure a  few
hours sleep, is frequently attended with the most hap-
py effects.  This is a case, hovrever, which requires
some judgment; and large anodynes must not hastily
be  had recourse to on  every occasion of impatience,
lest we interrupt those pains which are essential to the
labour.
                         O 
 158        On the Causes and Remedies   [Chap. 4.

   24. A distended bladder.  When the head has been
 long wedged in the pelvis, pressing the urethra strong-
 ly against the pubes, the collection of urine will  be
 sometimes so great,  as not oniy by the pain and dis-
 tress it occasions to  interrupt the pains, and disturb
 the progress of the labour, but to endanger the  burst-
 ing of the bladder ;  whilst, at the same time to draw
 off  the urine is  attended  with  great  difficulty, and
 sometimes  is found to be  impossible.   A very small
 catheter, in which, however,  the perforations through
 which  the urine  is to pass are  large,  will  be  much
 more easily introduced, than the large catheter  which
 is recommended in common cases : a flatted catheter
 invented by  a Doctor Kelly,  and recommended  by
 Doctor Denman,  is probably still bettet.  The intro-
 duction of either must  be assisted by  pushing up the
 head a little from the brim of the  pelvis, whenever
 that is possible.  When the head of the child has pass-
 ed the brim, and descended into the hollow of the  sa-
 crum, the pressure on the urethra is frequently reliev-
 ed, and the  urine is found to dribble  away  in small
 quantities.   Somet-Mies,  during the  pains,  at others
 during the intermissions  of pain ; and this  may  be
 promoted by introducing  two fingers under the pubes,
 in such manner  as to leave a  small  space between
 them for the urethra, and pressing the child's head back
 into the hollow of the sacrum, between  or during the
 pains, as shall be fi.und  best to answer our purpose.
 But when in this way we cannot procure relief,  we
must attempt it  by  the  catheter,  the  introduction of
 which will be much facilitated, by paying attention  to
 the changes which under these  circumstances take
 place in the length and direction of the urethra. 
Chap. 4.3  of Tedious  and Difficult Labours.     159
PLATE XIX.
   This plate  xix. taken from Bell's anatomy,  is in-
tended to explain these circumstances :  A, the child's
head sunk low in the pelvis ;  C, the neck of the blad-
der pressed  between that and the pubes  D; in conse-
quence of which, the  urethra  is greatly elongated ',
and  the bladder E, distended with urine  above  the
brim of the pelvis, is sometimes so greatly enlarged,
as to reach to the pit of the stomach.   If, under these
circumstances, the catheter be introduced in the usual
way, as at F, the operator will find great  difficulty, and
probably be  foiled in the attempt;  but if, after intro-
ducing the point  of the instrument, the  handle is in-
clined  very  much  back towards the perineum, as in
the position G, the point will glide up  between the 
160        On the  Causes and Rejnediea    [Chap. 4.

child's head and the pubes with very  little difficulty.
The symptoms attending a suppression of urine and
distended bladder, during the last stage of labour, are
occasionally so very distressing and dangerous, that
constant attention should be given to  prevent it, and
every means in our  power made use of to relieve it as
soon as discovered : when loo long neglected, it will
sometimes be found impossible to discharge the urine
until after the child is delivered ;  and to prevent  the
danger of the bladder, either bursting or sloughing, it
may in some extreme cases become necessary to deliver
the woman by means of the forceps.   After which the
catheter should be introduced even before the delivery
of  the placenta.
   25. When, under the circumstances of good health,
regular pains, and good management from  the begin-
ning, in which proper care has been taken not to fa-
tigue and exhaust the patient, the labour is protracted
to a  tedious  length, the patient's strength begins to
decline, her pulse grows weak, and the external parts
begin  to swell, danger is  to be apprehended, and the
best advice  and assistance should be  procured; be-
cause it is in such cases, when the child presents wilh
the head, that  the  interposition of art, and the use of
instruments  may become necessary ;   whereas, in
cases of great weakness, with trifling pains and feeble
exertions from the beginning, it is best to rely on time,
rest and nourishment.
   26. Convulsions,   occuring at the beginning or dur-
ing the continuance of labour, are always  to be con-
sidered dangerous,  and the best advice and assistance
should be procured as soon as possible.   In the mean
time, let the midwife empty the bowels by  a  stimula- 
Chap. 4-3   oj Tedious and Difficult Labours.     161

ting clyster, (No. 5. b. c.) even although from the pa-
tient's having lately had stools, that may not appear
very necessary.  Let her attend to  the evacuation of
urine, and not trusting to any report of the patient or
her attendants, assure herself that the bladder is emp-
ty, by examining, with her hand applied to the region
of the bladder over the pubes.   Let her keep her pa-
tient quiet and cool, and promote perspiration by tepid
drinks; let her be bled plentifully  in proportion to her
general health and strength ;  and  where the symp-
toms are violent,  and the countenance much flushed,
if the blood be drawn from the  jugular vein or the
temporal artery,  it will probably have  more imme-
diate effect. Let a large blister be  applied between the
shoulders.  After having emptied  the vessels by bleed-
ing, and the bowels by clyster, an emetic, (No.  11. b.
c.) will frequently be found of great use, particularly
if the stomach be distended, or it should appear that
the patient had eaten freely not long before the access
of the fit.   After proper evacuations by bleeding and
purging, the emetic is peculiarly beneficial,  in cases
of giddiness,  some  defect in vision, and  head-ach ;
which frequently precede  convulsions,  and then will
often prevent the more severe disease.  Hysterics and
slight convulsions, out of which the woman awakes in
her senses, are seldom dangerous ;  and if the child is
observed to advance with each fit, nothing more than
the general evacuations  above recommended, which
will not interfere,with the progress  of the labour, will
be necessary.  But when the fits are attended with froth-
ing at the mouth  and laborious breathing, and when,
between them, the patient lies in an insensible letbargic
                        O  2 
162       On the Causes and Remedies    [Chap. 4.

state, they become  extremely dangerous.   In this
case after evacuations, copious in proportion  to  the
strength of the patient, delivery may become our only
remedy.  When  convulsions come on at the end of
pregnancy, after labour has commenced, or even be-
fore any other symptoms of labour ; still, if they are
observed to return at regular intervals, and on  exami-
nation are found to have any effect on the internal ori-
fice  of the womb ;  if that is found  soft, moist, put
on the stretch during the convulsion, or beginning to
dilate, we  may hope, and it frequently happens, that
the woman is relieved  by a speedy delivery.   In this
case nothing more is to be done than has been recom-
mended in  the last paragraph ;  and the labour is to
be suffered to go on uninterruptedly ; but if again it
shall appear to be at a stand, it may then be proper to
break the membranes, and let out the water ; from
which alone the convulsions have been known to cease,
or the labour  pains have been rendered more effectual,
and the delivery has been hastened.   But, if notwith-
standing, the  convulsions continue, perhaps increase,
and the labour appears at a stand, it may become ab-
solutely necessary to save the patient's life, to deliver
her by art: and if an experienced operator be at hand,
and the orifice of the womb be sufficiently dilated, in-
troducing the hand into the womb, and delivering the
child by the  feet, may  very  properly be attempted.
But all attempts to  distend and open the internal ori-
fice, are highly dangerous, and most probably will in-
crease the  convulsions:  where, therefore, such diffi-
culties oppose the introduction of  the hand, we must
rely upon the evacuations already recommended, and
stimulating clysters, (No. 5. b. c.) and after these, solid 
Chap. 4.3   of Tedious and Difficult Labours.      163

opium, to the quantity of a grain every hour, or thirty
drops of laudanum, as far as three doses, or  powerful
anodyne clysters, (No. 6. a.) consisting each of one
hundred drops of laudanum, may  be repeated at like
intervals,  until the  convulsions shall  be  suspended.
But the use of opium in these cases is always of doubt-
ful  efficacy,  and as soon  as  it can be procured, the
warm-bath, which  is always safe, and frequently effi-
cacious, should be tried.   The patient will sometimes
remain  free  from the convulsions as  long as she re-
mains in the bath ; when this  proves to be the case,
leave her there  for a considerable time ; let her take
her pains in  the bath,  until the labour  is so far ad-
vanced, that probably a very few pains may terminate
it ; and should the fits return upon taking her out, let
her be returned to it,  and delivered in it.   Dr. Den-
man  mentions  dashing cold water on the face, at the
approach of  the fits,  and  continually  repeating it as
often as they were indicated, as an effectual remedy to
keep them off, whilst at the same  time the labour may
be going on to a happy termination ; or, at least, may
advance so far as to render  the  interposition of art
more safe  and easy.   If the convulsions come on, or
are protracted until the second stage of labour shall
be nearly completed, and the child's head have fallen
low down  in the pelvis ; the delivery may be accom-
plished by the forceps ; or if the  head should be too
high, and the continuance and violence of  the convul-
sions, such as to make us despair of the woman's re-
covery, especially if she lay between them in an uninter-
rupted stupor ;  in such an extreme case it may be ne-
cessary,and we perhaps may be justifiable,in having re-
course to the perforator and crotchet; but it should al- 
 164        On the Causes  and Remedies   [Chap. 4.

ways be recollected that the chance of saving the mo-
ther is not very great, and that sometimes, w hen we have
least expected it, the labour has suddenly advanced,
and  both the mother  and child  have been  saved.
Whether the delivery of the child be accomplished by
nature or art on these occasions, that of the placenta
is  never to be forced, or even hastened, unless a flood-
ing should make it necessary.  When the convulsions
continue after delivery,  the case becomes extremely
dangerous, and our  hopes  of recovery almost anni-
hilated : still however, the remedies  recommended
on their commencement, are to be continued as far as
the strength  of the patient shall make them safe.
   27.  Cramps in the thighs are very common during
labour, but seldom continue  beyond the first  stage,
whilst the internal orifice  is opening :  frictions with
warm spirits, with the addition of one half laudanum,
the volatile  liniment, (No. 19. a.) or the  application
of ether, (No. 19.  h.)  will  generally  relieve them.
When they  occur in the  side and belly,  they are
sometimes very distressing, and interrupt the pains of
labour ;  in such cases,  after  due evacuations, it may
be necessary to remove them by the internal use of
laudanum, which may be given in doses of twenty or
thirty drops,  and repeated every half hour until it pro-
duces a proper effect.

   Obstacles on the part of the Child and Secundines.
   28.  Dead Child.  It was formerly a  received opin-
 ion, and  even  still some are apprehensive, that the
child being dead, may occasion the labour to be more
tedious and difficult; but the truth  is, that the child
 is absolutely passive as to its birth, and that dead chil-
dren  are delivered after a labour, as perfectly natural 
Chap. 4.3   of Tedious and Difficult Labours.    165

and easy in every stage, as those  that  are  alive and
healthy.
  29. A small child is certainly (all other circumstan-
ces being the same) delivered after a more easy la-
bour, than one that is very large ;  and the size of the
infant alone may occasion labour to be very  tedious ;
but this circumstance can only be conjectured before
birth ; nor is it of  much consequence, as  time and
prudence, in such cases, will accomplish the  delivery ;
and the only caution necessary, is carefully  to avoid
fatiguing the patient, or breaking the membranes too
early.
  30.  The  membranes giving way very early in la-
bour, or some time  before its commencement, has
been  already mentioned (15) as a frequent cause of
premature, and consequently, of tedious and difficult
labour.  On the contrary, it  sometimes happens, that
in conseqence of the membranes  being remarkably
strong,  the labour will  be  protracted, until,  from that
circumstance alone,  it becomes alarming.   In such
cases, the membranes remain  a  long time pushed
down, during every pain, into the vagina, yet neither
breaking nor advancing, although the internal orifice
of the womb be fully dlated; breaking them, and let-
ting out the water,  has under these circumstances
been  found to promote immediate delivery.
   3L. At other times, where the internal  orifice of
the womb  has  been largely open for a considerable
time, and the head of the child is found to  make no
advance; and at the same time, upon examining dur-
ing the intervals of the pains, the head is  found to
recede from the finger, and give the sensation of float-
ing back into the womb, we may conclude there to be 
 166       On the  Causes and Remedies    [Chap. 4.

 a very large  quantity of  water, and  that the womb,
 contracting on this, has  little effect upon the body of
 the child.  Breaking the membranes, by discharging
 the water, and bringing the womb to act immediately
 upon the body of the child, may promote  the  deliv-
 ery.
   32.  In other cases, in which the membranes are ve-
 ry strong, the head  of the child may be forced, by  the
 pains, low  down,  with  the membranes  stretched
 smooth over it, and no water between them.  In this
 case, likewise, when they are found  to retard the la-
 bour, scratching with the nail will cause them to sepa-
 rate, and suffer the head to pass through them.
   33.  I mention this remedy,  however, with some
 apprehension, because it may, and  actually has hap-
 pened, that the neck of the womb, stretched very thin
 over the child's head, has been mistaken for the mem-
 branes, and great injury has been done in consequence
 of the mistake.   Let,  therefore, every case in which
 it may be thought necessary to break the membranes,
 be  well  considered.   Their breaking  too early, is
 much more frequently the cause of delay ; and a case
 can hardly be supposed, in which uninterrupted  na-
 ture will not at length overcome this obstacle.   Con-
 siderable experience, therefore, ought to concur with
 mature  deliberation, in forming  the determination to
 break the membranes.
  34.  Navel-string.  A  short  navel-string,  or  one
 twisted round the neck of the child, is said sometimes
 to protract delivery;  and   this  is  supposed  parti-
cularly  to be the cause,  when the  child's  head, ad-
 vancing  with  effectual pains, is observed  to retire
 again during their  intermission; but it is  not very 
Chap. 4.3  of Tedious and Difficult Labours.      167

probable, that either of these circumstances do ever
retard dtlivery, because the fundus of the womb must
descend as fast as the child advances.  In the case of
a short n;»vel-string,  which can never be  discovered
until after  delivery, nothing can be done ;  and where
it is twisted round the child's neck, it is not easy, nor
is  it necessary, to make  any attempts  to relieve it,
until after  the delivery of the head : when it  should
be untwisted by turning it over the head, or, which  is
generally more easy, it may be slipped over the snoul-
ders as  they advance ;  otherwise it may occasion a
separation  of the placenta  and a flooding, or possibly
an  inversion  of the  womb.  Sometimes  the navel-
string  is proiruded  along  the side  of,  or before the
child's head : and when this is discovered,  an attempt
may be  made, during the intermission of the pains,
to put  it with the finger beyond the brim of the pelvis,
and retaining  it there until a pain forces  the child's
head  before it; the finger  may then be cautiously
withdrawn, and  the  navel-string will  sometimes re-
main above, but more frequently  it will  follow the
finger  ;  and if it continues down so long as to become
cold, and lose its pulsation, the child may be lost.  In
this case,  let  it be carefully kept  within  the vagina,
which  is the best way of preserving its  natural  heat
and pulsation  as long as possible.  It may be kept
there  by  cloths wrung out  of warm water, pressed
against the external parts.   Nothing more within ihe
power of the midwife can be done, and the  only reme-
dy beyond these, is a recourse to instruments, or turn-
ing the child, and delivering by the feet;  both which
have  been recommended.  But long experience and
great dexterity only can justify either of those means; 
 168         Onthe Causes and Remedies     [Chap 4.

because, we can never say positively the child will be
lost if we omit them, or that it will be saved by them ;
and the mother is always exposed to some danger by
 either.
   35.  Twins  are generally delivered  after a labour
more slow than that of a single child.  The case is to
be suspected, from the unusually  large size of the wo-
man from  the very  beginning of pregnancy, and is
 easily ascertained  by laying the lutod on the abdomen
 of the woman, immediately after  the birth of the first
 child.   It should be a rule  never to inform the mother
 of it;  and the first caution  necessary, is never to make
 the least attempt to deliver the after burthen, but to
 tie the end  of the navel-string, if  that was not done
 before cutting it.   The delivery of the  second child is
 to be conducted by the  same rules as that of the first,
 leaving it in all cases, except that of a cross-birth, to
 nature.  It is generally, from the small  size of the
 child,  accomplished with more ease, and in less time
 than that of a single child ;  yet in the case  of a cross-
 birth,  when good and experienced assistance can be
 procured, it should not be left  to  nature, but it should
 be turned  and delivered by the feet.  Tihe delivery of
 the placenta, after the birth of the second  child, is not
 to be hurried, except in the case of flooding ; but, in
 all respects, conducted  by  the same rules as after one
 child.
   36. Flooding.   It  was  said, (Chap. II. 57.) that
 floodings before the seventh month, are almost always
 free from, danger,  and never admit of manual  assist-
 ance.  Those, on the  contrary, which  occur during
 the last three last months of pregnancy, are never free
 from danger; the woman's safety depends upon de- 
Chap. 4.3   of Tedious and Difficult Labours.      16?

livery, and " it is a practice established  by high and
multiplied authority, and sanctioned by success, to de-
liver a woman by art, in all cases of dangerous hemor-
rhage,  without confiding in the resources of the con-
stituii >n  "—(Dcunm.)
   But the introduction of the hand into the womb es-
pecially  under circumstances of such alarm and terror
as frequently  accompany these cases, is an operation
which requires great skill, joined to calm reflection
and steady resolution ; and should never be attempted
but by persons whose knowledge, experience, and for-
titude, qualify them  for so arduous a task.  Presum-
ing, therefore, that on every occasion of flooding after
the sixth* month, the best advice that can be procured
will immediately be applied to, we will consider such
palliarive remedies, as in all cases, which  will admit of
delay, are first to  be tried, r:id which may gain time
until proper assistance can be procured.
  37. The immediate cause of hemorrhage in  these
cases, may always be referred  to  a  separation of the
placenta  from its attachment  to the womb, which is
either accidental or necessary :  accidental, when from
external violence, great  fatigue, or bodily exertion,
such us violent straining at stool,  lifting heavy bodies,
or some  such  imprudence, the large vessels,  which
necessarily pass between the womb and  placenta, are
torn asunder ;  or necessary, when the placenta, being
wholly or in  part attached over the internal orifice of
the womb, when in the last months the neck is nearly
obliterated, and the orifice begins to give way,  a sepa-
ration between the womb and placenta must necessari-
ly take place.   But this is a distinction which  cannot
be  made with certainty,  until  the orifice of the womb
                        P 
 170       On the Causes and Remedies     [Chap. 4

be so far relaxed as to admit the finger; and when dis-
covered, it has no influence  upon  the  palliative treat-
ment, can  only serve to excite greater vigilance, and
to enforce the necessity of delivery by  art, as soon as
the state of the parts will admit the operation.
  38. A small show of blood is not uncommon at the
commencement of labour, or during its progress, and
if moderate, may be disregarded, except in  so far as
to keep  the woman tranquil and cool; confining her to
a horizontal posture ; laying her on a matrass or straw-
bed ; strictly forbidding all kinds of hot drinks, animal
food, spirituous liquors and cordials ;  and being very
careful  that the bladder  and  bowels are kept empty.
The progress of the labour  generally suspends the
hemorrhage,  and delivery cures it.   But no woman
who suffers a discharge of blood, at any period during
the three last months of pregnancy, can be considered
free from danger until she be delivered ; because the
hemorrhage  is very apt to return, and generally with
increasing violence as the period advances.
  39. Blood letting is generally the first remedy thought
of in all cases of uterine hemorrhage ; and when they
 are accompanied by increased heat, a strong pulse, and
 a flushed countenance, and  particularly after violent in-
jury, is  unquestionably proper ; but in advanced preg-
 nancy, it frequently requires some consideration ; be-
 cause at these periods,  the hemorrhage  is  often so
 profuse, that the loss of a pound or even  half a pound
 of  blood, in addition to what the patient  is necessari-
 ly losing, may turn the scale against her.
   40.  Absolute rest, in a  horizontal  posture, is the
 most essential requisite in restraining uterine hemor-
 rhage ;  it must be strictly observed while the flow con- 
Chap. 4.3   Of Tedious and Difficult Labours.     17t

tinues, and persevered in for a considerable time after
it has subsided ; nor can we,  with any  prudence, re-
mit a watchful attention until the woman by delivery,
is placed out of danger.
  4)   The application of cold, is another remedy of es-
sential efficacy in restaining hemorrhage.   At the
commencement and  during  the active stage, it may
be applied  with great freedom,  with intention to re-
duce the general heat, and to calm and lessen the force
of the circulation, as directed (Chap. II. 60.)  but cold
must not be  used with such freedom after the  first
stage of hemorrhage,  and  when the discharge either
from its violence or continuance, has gone so far as to
reduce the natural heat  and  strength of the  patient,
the general and vigorous application  of cold must be
discontinued.   Pale lips, a  feeble pulse, and cold  ex-
tremities, not only forbid the farther  use of cold, but
may  even  require warm applications,  to preserve
what remains of life,  until  other remedies may prove
effectual.  But cold not  only possesses the power to
lessen the heat of the body, and to reduce the  force of
the circulation ; but  its  topical  application  likewise
promotes the coagulation of  the  blood  by which the
mouths of the bleeding vessels are plugged   up, and
stimulates the womb to contraction, by which  their di-
ameters are diminished.   With this intention, there-
fore, even where  its general  application may   be
thought unadvisable,  cloths, wrung out of cold water
or vinegar,  may be applied to the  external parts, and
cold water may be injected, or ice oi snow may be in-
troduced into the vagina, or a dossil  of lint, wet with
cold vinegar, spirits, or a strong solution of alum,  or 
172        On the Causes and Remedies    [Chap, 4.

sugar  of lead,  may  be" introduced  far up into the
vagina.
   42.  Stuffing the vagina.   Some authors, particular-
ly Baudelocque and Burns, both teachers of eminence,
and  practitioners of great experience, recommend
stuffing the vagina with soft linen, with intention to
to stop the flow of blood, and promote the formation of
coagula.   I confess I have no experience of this re-
medy,  and  from the slight  manner in which  Doctor
Denman mentions it, I suspect he was not quite sat-
isfied of its safety and utility ;  still, however, it stands
upon so good authority, that I  do not think I should be
justified to pass it over in silence.   It is particularly
recommended  in cases of  considerable  discharge,
which have resisted the first remedies, bleeding, rest,
and cold, and where the  internal orifice of the womb
is still so firm, as to render manual interference impro-
per.   Under  these circumstances, Mr. Burns asserts
its advantages to be  great and speedy, and that he
knows  no method more  safe or effectual for restrain-
ing the hemorrhage ; nor can there be a case in which
it is more  advisable,  than  when  a midwife wishes to
gain  time, until such assistance as she can rely on
can be  procured.  The method of performing it, is to
mo'i6ten soft  old  linen  with cold water, vinegar, or
spirits, and introducing first one  corner high up into
the vagina, gradually press in more and more, until
the vagina is  well filled  with  it; then laying  a thick
compress  over the external  parts, confine it  by the
hand  or bandage.   The  principal  objection  to this
remedy seems to be, that it may  only conceal instead
of check  the hemorrhage, and  as  sometimes hap-
pens from other causes,  the woman may continue to 
Chap. 4-3   of Tedious and Difficult Labours.     173

bleed internally, although  that is  not manifested by
any external discharge : increasing weakness, a flut-
tering pulse,  paleness, and languor, particularly if ac-
companied by an increased  distention  of the belly,
point out this most dangerous state: and when  they
occur, they seldom admit  of  any palliative  remedy;
delivery is the only sure resource, and must be prompt-
ly decided on.
  43. By the means here  recommended, (39, 40, 41,
42,) we shall most probably succeed in restraining the
haemorrhage, at least so long  as may be requisite
to prepare the parts for delivery,  when that shall ul-
timately become  necessary; but the calm obtained
is too often deceitful, and the haemorrhage will fre-
quently  return, either spontaneously  or upon the
slightest error,   Sometimes after a considerable dis-
charge, even  in the seventh or eighth month, the wo-
man may go  on  to her full time ; but still, let the in-
termission have been ever  so long or ever so com-
plete,  we are never to remit a watchful attention to
our patient until she be delivered.  She must be more
than commonly  careful of motion, or any  thing that
will excite the   circulation :   her bowels must be  kept
constantly open  by  small  doses of salts, (No. 8. g.)
her diet must be cooling, and  consist chiefly of vege-
tables, and taken in small  quantities at a time.   It is
too common  a practice under circumstances of weak-
ness, after hemorrhage, to give  nourishing diet, and
in full quantity, to recruit the strength ; and a  good
appetite frequently tempts to indulgence ; but no er-
ror is more  dangerous, or tends more certainly to a,
renewal of the hemorrhage.
                      P2 
 174      On the Causes and Remedies      [Chap. 4.

   44.  When flooding occurs at the commencement
of labour, or when labour pains accompany it, and the
internal orifice is so far dilated as to admit the  finger,
it may easily be  discovered by the feel of the present-
ing part of the ovum,  whether that be the placenta or
not.  The placenta presents a rough, soft,  thiek,  and
spongy substance ; the membranes,  one that is smooth
and thin ; sometimes  a small edge of  the placenta
may be felt on one side of the orifice, and  the mem-
branes over the remainder.  The  probability  of re-
straining the hemorrhage, is much greater when no
part of the placenta can be discovered : and the  mode
of relief is somewhat different.   When  it is  clearly
ascertained that the membranes, and not  the placenta,
present,  breaking the  membranes and  discharging
the water, will bring the womb to clasp  firmly round
the body of the child ;  by which the size  of the bleed-
ing vessels will be diminished,  and the  hemorrhage
checked ;  at the  same  time, the strength of the pains
will probably increase, and the  delivery will soon be
accomplished.  But when the  placenta is attached
over the mouth of the  womb,  then as the labour ad-
vances, more and more of the  placenta  must be torn
from its attachment to  the womb, and the hemorrhage
is necessarily increased : the introduction of the hand
and turning the child, is the only remedy.  This ope-
ration is most easily performed before the waters are
discharged from  the womb: the membranes, there-
fore, in this case, must not be  broken, until it is de-
termined to proceed to  immediate delivery.
  45. Introduction of the hand.   Whenever this ope-
ration is  determined on, let  the  hand be  lubricated
with good oil, or fresh  hog's  lard, and gently passing 
 Chap. 4.3   of Tedious and Difficult Labours.     175

 it into the  vagina, introduce first one finger into the
 internal orifice, gently dilate it until it will admit two,
 and go on  with slow  and gentle attempts until it will
 admit the hand:  remembering always, that  by the
 natural contractions of the womb, the orifice  will be
 more safely and easily dilated than by the  finger.
 Whenever, therefore, pains occur, our efforts to dilate
 are to be suspended, and the pains are to be permitted
 to produce their effect on the hand.  When the pains
 cease, a gentle distention is again to be made, which
 will probably  soon occasion  another pain, which is
 again to be  permitted to produce its natural effect;  in
 this way we are to proceed, until the orifice is so far
 dilated as to admit the hand without violence.   This
 being accomplished, if the hand  can be easily  passed
 over that part of the placenta which is already sepa-
 rated,  until it  reaches  the membranes, that is to be
 done ; and breaking the membranes, it is to be  passed
 into the womb until it arrives at  the feet; if  not,  or
 if the flooding  is profuse,  it  may be passed through
 the placenta ; by which, indeed, the  life  of the child
 may be endangered, but  under such circumstances,
 there  can be no doubt, whether the child is to be put
 to some hazard, or the mother's danger to be greatly
 increased. The hand being introduced into the womb,
 the operation  is to be finished as directed, (53, 54,
 55,56.)
  46. There cannot  be an occasion in which more
caution, tenderness, and steadiness on the part of the
 operator, or more resolution  and  submission  on the
 part of the  patient, are required.  It frequently hap-
 pens,  that  the first introduction of the  hand into the
 womb, even into the vagina, exciting the contractions
 of the womb, checks the hemorrhage,  and then,  al- 
 176       On the Causes and Remedies     [Chap. 4.

 though we are  never to desist, we may act with de-
 liberation : on other  occasions the flooding is so* se-
 vere  and profuse, that no time is to be lost, but the
 delivery is to be  accomplished as soon as can be, with-
 out so much  violence as will add to the danger.   In
 all cases of profuse flooding at the latter end of preg-
 nancy,  every  means of checking  the hemorrhage,
 should be put in practice, because  the  loss even of a
 small quantity of blood may turn the scale against our
 patient-  It is  in   such cases therefore, that we may
 with the greatest freedom have recourse to  the reme-
 dy  recommended by Doctor  Dewees, the sugar of
 lead ;  because the danger is so imminent, that all les-
 ser apprehensions of ill consequences from  the reme-
 dy, must  be overlooked; but  the Doctor assures us,
 that this is a remedy  not  only very  efficacious,  but
 perfectly safe.

               Preternatural  Labours.

  47.  Preternatural  labours,  are all those  in which
 the body  of the child is delivered before the head ; in
which the feet, knees, or breech of the child presents;
or in which the child, lying across,  presents  with the
 arm,  shoulder, thigh, back, or belly.  It is hardly ne-
cessary to say, that all these, as soon  as discovered,
 should be put  into the hands of the most  skilful and
experienced practitioner.  But still, as in  some par-
ticularly of the first set, in which the feet, knees, and
 breech of the child present, nature, unassisted, or with
very little assistance,  is frequently equal to the deli-
very, in well-formed women ;  and as in all, the mode
 of assistance is attended with little difficulty.or hazard, 
Chap. 4.3   of Tedious and Difficult Labours.     177

when performed in proper season, after the parts of
the mother are fully dilated, and before the waters of
the womb have flowed off;  but of great difficulty and
proportionate danger, when they have been discharged
so long as that the womb contracts closely about  the
body of the child; it becomes necessary to give such
directions as may instruct the midwife  how  she is to
act, either before  better  assistance can arrive,  or in
case it cannot be procured.
   48. Although a cautious examination, after the in-
ternal orifice of the  womb  is  fully dilated, may  fre-
quently discover that the presentation is  preternatu-
ral ; yet it is not easy to distinguish any one case from
any other,  before the breaking of the membranes and
discharge of the waters : after which,  the presenting
part, falling down  into  the  vagina, may  be known:
the feet from the hand, by  the shortness of the toes
compared with the length of the fingers ;  by the long-
er great toe and the shorter thumb ; by the heel com-
pared with the wrists.   The breech is known by the
softness of the feel, by the chink between the buttocks,
by the anus or privates of  the child, and by the dis-
charge of  the  blixk  stools  accompanying  the other
signs ; for alone,  this  is no  proof of a preternatural
presentation :  the back, belly,  or breast, by the broad
flat surface,  presenting  neither  the  roundness  nor
hardness of the  head, nor the other circumstances
which attend  the  presentation of the breech.  The
principal caution  in forming an opinion on the parts
presenting, is not to  mistake a hand for  a foot, be-
cause the smallest  attempt  to extract by the arm,
must inevitably do mischief and increase the difficulty
of the  delivery;  which in the case of an arm presen- 
 178       On the Causes and Remedies     [Chap. 4.

 tation, is always to be performed by turning and de-
 livering by the feet.
   49. In either  of these cases, the best assistance
 should be immediately sought; because, when it be-
 comes necessary  to force the delivery not a moment
 should be lost; it is much more easily  accomplished
 before than  after  the discharge of  the waters.  If,
 therefore, the midwife should discover,  or  have good
 reason to suspect the unnatural presentation, (and she
 mav always suspect it, even before the breaking of the
 membranes,  if after the full dilatation of the internal
 orifice, she can discover no part of the child) she should
 not conceal it from the friends of the patient, that they
 may procure such advice and  assistance as they may
 wish, in time.
   50. In the mean time, she is  to conduct herself as
 in a natural labour, except as it regards  the posture of
 the woman;  which, in preternatural cases,  will be
 found  most  convenient on  her back,  with her hips
 brought down to the edge of the bed, her feet in the
 laps of an assistant on each side,  and  the midwife be-
 tween, with a double sheet spread under the woman, and
 on her own and on the laps of.the assistants, which will
 defend her patient from-the access of cold air.  Above
 all things, the midwife i«s to take care not to break the
 membranes,  nor to 'atigue  her patient;  because in
all these cases, the most perfect relaxation of the parts,
 and all the woman's strength, may be required.
  51. In presentations of the breech, knees, and feet,
the labour will proceed (though particularly  in the
first)  more  slowly than in  natural  presentations,
until the child is advanced as far as the arm-pits ; and
 the midwife will find it necessary to give no other assist- 
Chap. 4J    of Tedious and Difficult Labours.     179

ance, than to wrap a soft cloth round that part which
is already delivered, and cautiously and slowly extract
during each pain; or in cases of the breech, which
sometimes advances  very slowly indeed, she  may,
when the external parts of the mother begin to be dis-
tended, introduce a finger  Into  each  of the child's
groins, and by that means afford some assistance dur-
ing each pain.
  52.  As soon as the child has advanced as far as the
hips,  the midwife is  to consider whether it presents
with its belly, to the belly or to the back of the mother,
or to either side ;  and  if it presents otherwise than
with  the belly to the buck of the mother, she is then
to turn the child into that position.   To do this, having
the  legs and thighs wrapped in a soft cloth,  she is to
take a firm but not a rude hold of them in both hands,
and during each pain,  gradually turn the body until
the  belly  of the child  is fully to  the back of the mo-
ther, taking care to turn towards that side which  will
soonest and with least force bring it into that position.
In performing^this part of the operation, great care
and  deliberation  are  to be practised ;  repeated and
moderate efforts, during the pains,  will always suc-
ceed ;  neither the child nor  the  mother are in any
danger from a little delay, and both may be greatly in-
jured by hurry and violence.
  53.  The  midwife  is next  to  examine the navel-
string, and if she finds it stretched  tight,  she is to in-
troduce a finger between it  and the child's belly, and
pull it so far down, as  to take it  off the stretch ; and
this is to be repeated from time to time, until the de-
livery is accomplished,  lest, by the tight cord, the cir- 
 180       On the Causes and Remedies      [Chap. 4

 eulation between the mother and  the  child should be
 intercepted, and the child lost.
   54.  With this caution, the midwife is  to persist in
 moderate efforts lo promote delivery, by cautiously
 extracting duimg the  pains,  from  side to side, and
 from  pubes  to sacrum ; and if the head is found to
 follow with no  great force,  the delivery  will, in this
 manner,  be accomplished ;  but if the  head does not
 follow wilh moderate assistance, the aims of the child
 must next be  brought down : to do this, let a finger of
 either hand (that  which may be  found most easy) be
 introduced under the pubes, and  passing it over the
 back and shoulder of the child, carry it along the arm
 to the  elbow, and along the fore-arm to  the  wrist,
 making no effort to draw down the arm until  the  fin-
 ger reaches the elbow of the child ; after which, as it
 passes on to the wrist, a very moderate force will turn
it out under the child's breast.   Having delivered one
arm,  the  other will probably be delivered with more
ease ;  but it must always be  remembered, that cau-
tion and dexterity are  more necessary than  force, by
which, unskilfully applied, there will be great danger
of breaking the child's arm.
  55.  The  midwife  is  in the  next place,  to lay the
body  of the child on her left arm,  and passing  two
fingers of that  hand into the vagina, she is to intro-
duce them into the child's mouth,  and draw the lower
jaw a little down, so that, if possible, she  may extend
her fingers a little  above the  upper  jaw along  the
child's nose ;  then placing  the  fingers of  her right
hand  across  the  nape of the child's  neck, she may
cautiously extract during the pains, sometimes pulling
towards the sacrum, at others up  towards the pubes, 
©hap. 4-3  of Tedious and Difficult Labours.      181

and again from  side to side, (but always being very
careful, if her fingers are in the child's mouth.; not to
use any force on the jaw, (lest she dislocate  it) turil
the chin is brought down to the external orifice ; men
standing up, and  raising the  body of the cl i;d up to-
wards  the  belly of the mother, the child's face .will
turn outfiom the perineum,  and the head will be de-
livered.
   56.  In all  these cases, there is  more danger of la-
cerating  the perineum than in natural  labours ; the
operation, therefore, is to be finished with the utmost
caution and deliberation, and an assistant may be di-
rected to support the perinaeum, by applying one hand
to it during the operation.
   57.  In giving the  description of the manner in
which  the delivery  is to be accomplished in  breech,
knee, and footling cases, let it not be supposed that I
advise any midwife  or inexperienced person to under-
take it, when the advice  and assistance of any more
experienced person  can be procured. In every well-
formed woman, and where the child is not above the
common size, the labour will  generally be accomplish-
ed by the natural efforts, or with very little assistance ;
but  where the pelvis  is in the  smallest degree  con-
tracted, or the child but little above the common  size,
it is more frequently attended with great difficulty and
danger, particularly to the child, which may  often be
lost by a little delay, occasioned by want-of that com-
posure and regularity of proceeding,  which experience
alone can give.  In all cross-births, that is, where one
arm, the breast, back, or belly of the child presents,
there is a necessity  for turning the child, and bringing
it by the feet. 
  182       On the Causes and Remedies     [Chap.  4.

   58.  The presentation of the navel-string is,  by some
 authors, considered as a preternatural case ; and from
 the imminent danger to  which the child is  exposed
 from this accident, we are directed by some to intro-
 duce the hand into the womb, turn the child, and de-
 liver by the feet.  But this requires much considera-
 tion, or wemay frequently expose the mother to great
 danger, when  we cannot  possibly  save the child.
 When  the cord presents,  it always falls down into the
 vagina  as soon as the membranes break  ; and  this  is
 one strong argument against early breaking the mem-
 branes, because, until they do break, the child is in no
 danger, and its life commonly depends upon the most
 speedy delivery  afterwards.  Some women  are ob-
 served  to 'be  particularly liable  to this accident ;  in
 such, every precaution should be recollected, and prac-
 tised from the beginning.  If the pulsation has alrea-
 dy ceased in the cord, the child is certainly dead, and
 therefore the case  must be  left to nature; or  if the
 cord descends early in  the labour, before ihe os tince
 be dilated, it must likewise be left to nature ; because
 the child will probably  die before  time can be  allowed
 for a delivery in  which the safety of the mother  is
 duly appreciated ;  but if the internal orifice be fully
 dilated,  and the case is discovered before the waters
 have drained off, and the child be living; the hand may
 be introduced, and the child be delivered by the feet.
 In performhv  the operation, take care  to  carry up
 the navel string between the fingers of the hand which
is inttoduced, and then, as  there will be no  danger
irom its compression, the operation may be performed
with due care and deliberation.
  59. Some  writers mention an oblique womb,  (by 
Chap. 4.3   of Tedious and Difficult Labours.      183

which is understood, the womb ascending into the
abdomen, with its  fundus more inclined lo one  side
than to  the other,  or  hanging over the pubes)  as a
frequent cause of difficult labours, but  in reality, the
distended womb always hangs forward over the pubes,
or inclines to one or the other side, generally to the
right ;  and never is so 1placed, as that  a section of the
body through the  back-bone, would divide the womb
into two equal parts ;  nor unless the obliquity is  very
considerable indeed, is it ever observed to occasion any
difficulty in labour.  When the belly is very pendulous
over the pubes, it should be suspended long before la-
bour, by abroad belt, which will take in the bottom of
the belly, and which is to be hung by straps over the
shoulders ; and during labour,  the woman should lie
chiefly  on her back,  and be  delivered in that posture.
 When  the obliquity is on either side in a considerable
degree, the  woman should be  laid, during labour, on
 the opposite side,  and  in most cases this is all that is
 necessary to be done.   But  in some extraordinary in-
 stances, when the  internal orifice of the womb is found
 very far back, or very much to  the side opposite that
 to which the fundus inclines  ; and  it is in a great mea-
 sure out of reach of the finger ;  the child's head  is ob-
 served  lo descend, covered by the distended  neck of
 the womb.  In this case ihe woman  is to be caution-
 ed against making any voluntary  efforts,  she is to be
 carefully kept  in a horizontal posture, and the labour
 is to be suffered  to progress slowly.  But if at the
 same time, it r. found that no change is made  in the
 position or dilatation of the internal  orifice ; and the
 head advances, pushing down and stretching the neck
 of the  womb over it;  we may cautiously intioduce one 
»84       On the Causes and Remedies    [Chap. 4

or two fingers into the internal orifice, and slowly, but
steadily bring it during each pain, towards the centre
of the vagina, retaining it  in that situation, until it be
found to remain and dilate, and the .membranes begin
to protrude ;  after which nothing  more will be neces-
sary.   By these gentle efforts all the unhappy conse-
quences which have been  apprehended from  this ob-
lique  situation of  the womb, such as  inflammation,
mortification, and the bursting or  turning the neck of
the womb, will be avoided  ; take care however that by
unnecessary interference you do not occasion the very
evils, you wish to prevent.  Nine  times out of ten,
patience, and a proper posture, will accomplish all that
is required.

                 SECTION III.

                A  retained Placenta.

   60.  In all the cases here mentioned, and also in the
most natural  labour, when the child has  been most
happily delivered, it will sometimes happen, that the
delivery of the after-birth does not follow ; the pains
and the contraction of  the womb ceasing altogether ;
or the womb, contracting irregularly, from its sides
instead of the fundus, in  the form of an hour-glass,
locks up the after-birth within its upper chamber ; or
the after-birth may be unnaturally attached to the
womb.
   61. Having, under these  circumstances, waited  a
due time ;  and having, ineffectually, put in practice all
the means recommended, (Chap.  III. 46) for recruit-
ing the patient's strength, and exciting the action of 
Chap. 4J  of Tedious and Difficult Labours.     185

the womb, it may at length become necessary to de-
liver the patient by art; for although, on  many  occa-
sions, the placenta has been  naturally and safely deli-
vered after several days, yet it has so frequently hap-
pened, that the  woman has lost  her life, either by a
flooding, or by a malignant fever in consequence of  its
retention, that it has become an invariable rule,  not to
leave the patient until the delivery  shall be accom-
plished.   But in  giving this opinion, or in describing
the manner of performing the operation, I hope I shall
give no encouragement to rashness or impatience :
let it ever be remembered, that the introduction  of the
hand into the womb, is  always attended with  some
hazard, and that it is only justifiable when it becomes
the lesser evil.   No  consideration? therefore, of mere
expedience,  either to gratify  the impatience of the
patient or her friends, or to relieve the midwife from
a  tedious attendance, can justify it.  Our patient's
safety must be  the sole consideration ; and except in
cases of flooding, that is never put to  immediate ha-
zard.                              ,^
   62.  Fortunately,  the  introduction of  the  hand in
these cases, often proves the most powerful stimulus
to the womb, and immediately excites its contractions,
and frequently, nothing more is necessary than using
the cord as a conductor, carefully and slowly to pass
the hand into the vagina, and thence into the womb,
as directed,  (,45);  the hand being introduced, if the
placenta be  still  attached, press with the back of the
hand against it; or,  passing  the fingers along the
cord to the root where the large vessels divide and en-
ter the placenta, press and endeavour to gather it up
between the fingers, which probably will excite the
                        Q2 
186      On the  Causes and  Remedies     [Chap. 4.

contraction of the womb to throw it  off;  or if the
placenta already lies  loose in the cavity of the womb,
move the fingers gently against the sides of the womb,
to excite its contractions ; but never  withdraw the
hand until the womb is felt to contract upon it,  then
grasping the loosened placenta, slowly bring it for-
ward.
   63. Whenever the womb is discovered to be con-
tracted in any part, so as to form two chambers like
an hour-glass, nothing more is ne6essary than slowly
and steadily to dilate the contracted  ring, by intro-
ducing first one finger, then two, and so on, as direct-
ed (45) until it will admit the hand  easily : for if the
hand be forced through this ring, before the contrac-
tion is overcome,  it may cling  so  closely round the
wrist as to impede the operation.
   64.  When it happens that any part of the placenta
adheres so  firmly, that the contractions of the womb,
excited even by the  introduction of the hand, will not
separate it;  it may become  necessary, beginning at
any part already separated, slowly and gentle to  insin-
uate the fingers between the womb and the placenta,
so as to detach the  remainder; but in doing this, let
it ever  be remembered, that there is no danger  in be-
ing deliberate, but that every thing is to  be appre-
hended from hurry, confusion, and violence.  Fven
in cases of violent flooding, where it may be necessary
immediately to introduce the hand, it  must not be
suddenly withdrawn, but must be kept in  the womb
for  some time, moving it gently about to  excite its
contractions ; and until they take place, should not  be
withdrawn.    Whilst these attempts are making, the
womb  must be supported, and its fundus kept steady. 
Chap. 4-3  of Tedious and Difficult Labours.     187

by an assistant, or by the hand of the operator, which
is at liberty ; and as  soon as the placenta is delivered,
the farther contraction of the womb is to be excited
by frictions and moderate pressure.
   65.  Flooding after the birth of the child.  Every wo-
man looses some blood after delivery, in general from
half a pound to one pound :   how much beyond this
is to be deemed excessive, is a  question not  to be  an-
swered with precision ; we can only  judge  from its
effects, and the midwife's experience must, in a great
measure, be her guide.  At  any rate, a discharge of
blood soon after the birth of the child, though it be
considerable, is  no argument  for  immediately,  and
 without consideration, hastening the delivery of  the
 placenta.  Such cases generally arise from an atony
 (or total.inactivity) of the  womb, which suffers  the
 large  vessels, opening on the  placenta, to  pour out
 their  contents,  for  want of  that contraction which
 should close their orifices.
    66.  Our efforts, therefore,  should first be directed
 to cool the patient when over-heated,  by  lightening
 the bed-clothes, letting fresh air into the chamber, and
 to excite the  contraction of- the womb  by a proper
 support, and brisk frictions on the abdomen ; and by
 the liberal application of cold,  by wet cloths applied to
  the belly, thighs, and external parts ;  by dashing cold
  water smartly on the abdomen, or by throwing it for-
  cibly into the vagina by means of a clyster syringe, or
  by the introduction of a piece of sponge, wet with cold
  water, vinegar, or spirits, or a piece of ice or snow in-
  to the vagina.  In the greater number of cases,  such
  efforts will succeed to bring on the contraction of the
  womb, by which the placenta will be safely delivered, 
188        On the Causes and Remedies    [Chap. 4.

and  the flooding suppressed.  But the midwife ts, on
no account  whatever, under the circumstance of a
flooding, to attempt  to  bring away the  placenta  by
pulling at the navel string ;  by which  she will, infalli-
bly, either  increase  the flooding or invert  the womb.
It is much safer, when it becomes necessary by the
continuance or violence of  the  flooding, to introduce
the  hand, and accomplish  the delivery,  as directed,
(45, 62.)
   67.  It now and then happens,  that although there is
but little appearance of external  haemorrhage, the wo-
man may still be losing so much blood, as to bring her
life into  great  danger.   In such cases,  the placenta
may commonly be felt  at the internal orifice, which
it closes so perfectly as  to prevent the  discharge.  An
increasing weakness and  faintness, with a  pale coun-
tenance, a feeble pulse, and at the same lime, an  in-
creasing  distention of the  belly, mark  this  dangerous
state; which is to be relieved only by  speedy delivery.
   68.  la other cases, a violent hemorrhage may con-
tinue or come on, after the complete and  perfect de-
livery of the placenta.   In this  most dangerous case,
the womb never contracts with much  effect, and until
it shall,  the flooding w ill continue.   All the means,
therefore,  directed  to excite the  contractions cf  the
womb, (66) particularly brisk frictions to  the belly, and
the  free  application of cold, must be put in  practice
without hesitation  ;  with this  caution, however, that
it is in cases of sudden  and  violent haemorrhage, cold
applications may be  used with the greatest freedom ;
but that, where the  hemorrhage has  continued for a
long time, and the patient has  already been  greatly
weakened by it, we must be  more sparing in their use, 
Chap. 4-3   of Tedious and Difficult Labours.     189

and confine their  application to the vagina, by the in-
troduction  of a sponge, wet with  cold water, vinegar,
port-wine  or spirits ; or if they can be had, a piece of
ice or snow, covering the external orifice with a cloth
wet  with cold water or  vinegar ; whilst at the same
time, the patient's strength is supported by some mo-
derate cordial, a glass  of wine, a bit of toasted  bread
soaked in wine, a little gruel with wine, or any of the
cordials mentioned, (No.  17.)
   69. Inverted  womb.  In this terrible disease, the
 womb is turned inside out, and the fundus is brought
 through the internal and external orifice like a purse
 or bag, of which the  bottom is pressed through the
 mouth.  The following cases, which have fallen with-
 in my knowledge, will afford some useful observations
 on this subject.
   70. Case  1.   A lady, very tall, after a labour rather
 tedious and severe, was at last, by one long and severe
 pain,  delivered of her second child.   On tying the
 navel-string, I observed it to be remarkably thick and
 very  short,  and  on  taking hold of  it between my
 thumb and finger, (for I could not twist it round my
 finger) I  perceived, as I thought, the placenta to be
 descending ; not however by successive pains, but by
 one  continued  uninterrupted descent, until  it was
 thrown out of the vagina; and, to my very great as-
 tonishment, with it came the whole volume  of the
  womb.   It is not easy to express my  feelings  at that
 moment; still however, I commanded so much pre-
  sence of mind, as  neither to lose my time nor alarm
  my  patient.  The placenta, which was already in part
  separated, was immediately detached, and my fingers
  being applied to the  fundus of the womb, it was im- 
190        On  the Causes and Remedies  [Chap.  4.
mediately and completely reverted, the hand and arm
being introduced as high as the elbow,  then slowly
withdrawn.   No flooding or other ill consequence en-
sued, and the patient speedily recovered.  It was se-
ven  years before this lady became  again pregnant ;
her labour was then natural and happy ; she has since
had a fourth child, and now enjoys good health.
   71.  Case 2.   The gentleman who communicates to
me  this case, found the patient in the very last stage of
labour ; standing, supported by her friends, in a very
awkward posture,  between upright  and  recumbent.
The child was  born in this posture, immediately after
he  entered  the  room;  the  navel-string was  wound
 round the neck, and the greater part of the placenta
 protruded the external orifice, slightly adhering to the
 fundus of the womb, which was  found very low down
 in the  vagina :  no  flooding ^ensued.   The case being
 perfectly new to the physician, he contented himself
 with gently pushing up the fundus as high as he could
 with his fingers ; and ordering himself to be sent  for
 incase of flooding or any unusual occurrence, he went
 home to reflect upon it.   In about eight  or ten hours,
 the husband called on him in great  agitation,  and  in-
 formed him, that a substance as large as an ox's blad-
 der blown  up,  had come out of the vagina.   In  this
 situation he found his  patient, with very little  hs-
 morrhage, but very faint, and a pulse not to be felt at
 the wrists.   He immediately grasped the womb with
 both hands, and compressed it until he could grasp it
 with one, then with the  fingers of the other, he push-
 ed  the fundus  through  the  external and  internal or-
 ifices, pursuing it until he had restored it to its natural
 situation ;  and letting his hand remain  until the womb
 contracted   about  it,  then gently withdrew it.  The 
Chap. 4.3   of Tedious and Difficult Labours.     191

faintness immediately  went off, the  pulse  returned,
and the patient had a quick and good getting up.  It
is now nine years since this happened, the woman has
since enjoyed good health, her menstruation has been
regular and moderate, but she has  never since been
pregnant.
  72.  Case 3.   A lady,  after a labour rather severe,
was delivered of her first child ;  the  placenta did not
follow in less than two hours, and  was then  delivered
with so much pain, that  from that circumstance, as
well as from what followed, there is reason  to believe
much mismanagement occurred.  From some time
before the delivery, a suppression of urine took place,
which  continued unrelieved above three days, during
all which time, in  addition to much  pain, she  com-
phined  of a continual  nisus, as if something was to
come away.  On the fourth day,  while sitting on the
pan, and endeavouring to pass  her urine, the whole
womb was suddenly thrown out of the vagina.   It was
eight or ten hours before  medical assistance could be
procured ;  but in the mean time, the nurse, a prudent
and experienced woman,  grasped the womb and en-
deavoured to  replace  it;  and actually  saved her pa-
tient's  life, by  preventing  the midwife from rudely
attempting to bring it away, which she  insisted  on
doing, asserting it to be  a  part  of the placenta left
behind.  By the time the physician arrived, the nurse
had so far succeeded, as to replace the womb within
the vagina ; the urine  was immediately drawn off by
the catheter, but it was then found to  be impossible
lo revert the womb.   For upwards  of thirty  years,
this lady remained subject to profuse  haemorrhages,
and consequently endured a very feeble state of health, 
193       On  the Causes and Remedies   [Chap.  4.

but has survived until the  menses have ceased, and
now enjoys a perfect state of health.
  73.  Case 4.  A lady, after a labour in all respects
perfectly natural, was delivered of her fourth child  on
Sunday.  The gentleman who  attended, has assured
me that no force was applied to  the navel-string, but
that the placenta was delivered by the natural pains :
on  examining  after the deliverance, he discovered a
tumour in  the vagina, the nature  of which  did not
immediately occur to him ; a slight convulsion and
a considerable hemorrhage ensued, but soon ceased.
Apprehensive  of renewing the  hemorrhage, no far-
ther examination was made, and the lady was put to
bed, apparently as well as she usually had been.  The
usual after-pains  followed; in addition  to which,  on
Tuesday night she complained  of  much uneasiness,
and a feeling, as she expressed,  as if something want-
ed to  come away; and Wednesday morning, after
a throe a little more severe, the womb was protruded
from the vagina, as large as a pint decanter, and  re-
sisted  every attempt that was  made to replace it.   I
saw the patient at noon of the same day, after which,
such attempts as were thought justifiable, were again
made to revert the womb, and  persisted in  above  an
hour,  in all the variety that could  be devised,  but
without any sensible  effect.  An  emollient  fomenta-
tion was then directed, and the protruded wemb was
ordered to be covered with a piece of  fine linen, spread
with  simple ointment, and to be  suspended by a T
bandage; the  bowels to  be kept  open,  the bladder
empty, and every means to avoid inflammation to be
strictly pursued.  After this, two women, who both
professed to have seen and relieved  similar cases, 
 Chap. 4.3   of Tedious and Difficult Labours.     193

 were successively applied to, and both appeared to have
 treated the complaint very properly, with soft  emol-
 lient applications ; and the last  particularly, to have
 persevered with great attention and tenderness.   Un-
 der this management, the  protruded womb gradually
 diminished in size, and after seven or eight days, that
 is, on the Tuesday or Wednesday following, with very
 little assistance, was suddenly retracted from the hand
 into the  vagina.
   74. From these cases, we may deduce some very
 useful lessons.   It is evident,  that in the first case I
 mistook the inverting womb tor the natural descent of
 the placenta.   Doctor Denman remarks  upon a  si-
 milar case, that the accoucheur ought to have known
 better; and perhaps, had  I examined the abdomen
 over  the pubes, I might have suspected what was
 going on, by the absence  of the round tumour which
 ri usually felt thtere, and by discovering, in place of it,
 an evident hollow.   In that case,  instead of promot-
 ing the delivery of the placenta, 1  ought  to have de-
 sisted ; to have examined by the vagina, which would
 have  ascertained the case, and the womb might then
 have been  reverted before ihe inversion  was  com-
 pleted ; which  unquestionably  would have  been an
 easier and a safer operation,  than what I was after-
 wards obliged to perform.   The same  observation
 may be made on the second and third cases : had the
nature of the tumours, discovered in the  vagina, been
understood, both wombs  might have  been  immedi-
ately  reverted.   But a still  more important lesson
may be learned from these cases :  which is,  that if a
spontaneous  inversion of  the womb cannot  (as Dr.
Denman seems to  believe)  happen without undue
                        R 
194
On the Causes  and Remedies   [Chap. 4.
force applied to the cord ;  yet it may commence from
other causes,' such as a very short navel-string, or one
twisted round the child's neck ; and that a very slight
additional force, especially  when  aided  by an impro-
per posture, or even a distended bladder, may com-
plete the inversion.   Hence we  derive  an additional
argument for always delivering  a woman in an hori-
zontal posture, and  never applying any force at all to
the navel-string, until we  are  satisfied of the due and
natural contraction  of the  womb, by feeling it, in  the
form of a firm ball, above the pubes.   From the  se-
cond, third, and fourth cases, we learn, that a partial
inversion of the  womb having taken place, if it be  not
immediately reverted, a total  inversion will probably
ensue, partly,  perhaps, from the  continued  action of
the womb, but most probably from that of the abdo-
minal muscles, brought on by  the pain and uneasiness
the patient suffers :  hence the  great importance of the
rule, immediately to revert the  womb, and  restore it
to its  natural  situation, as soon as  the complaint  is
discovered.  It is hardly possible to mistake  any other
tumour existing in  the  vagina, for a  reverted womb ;
nor can any danger arise  from such mistake ;  but the
most unhappy consequences,  even  immediate death,
has followed,   from  having  mistaken  an inverted
womb for a tumour of another kind, and endeavouring
to extract it.  Dr.  Denman informs us, that he never
was able to revert and  replace the womb, when <t had
been inverted  above four hours;  and he adds  the tes-
timony of Dr. Hunter and Dr. Ford, to the same fact;
but  in  the second  case  here  enumerated,  we have a
happy  instance of  the  reversion being accomplished
after eight hours, that too, in a case of a total inversion. 
Chap. 4-3    of Tedious and Difficult Labours.     195

We are not, therefore, to despair; but  in  all cases,
carefully to attempt to replace the womb ; still, how-
ever, these attempts are to be made with great cau-
tion and much tenderness,  lest by  rude efforts, we
bring on inflammation, increase the present  danger,
or add greatly  to the future  misery of the patient, by
preventing that spontaneous contraction of the womb,
which, from the third and fourth cases, we have  rea-
son to expect,  and by which, after several d:".ys, we
find the womb may be  replaced  within the vagina.
Lastly,  we learn that even  a total inversion  may be
easily reduced, when immediately attem . ed ; and that
the parts, though greatly injured, will at length recover
a healthy state, so that the woman  may again  become
a mother;  that a violent hemorrhage, so far from be-
ing a necessary consequence of a total inversion, most
probably, according to a remark of Dr. Hamilton,  is
not very likely to  happen;  and,  therefore,  that  we
may take time to act with  coolness and composure,
so as to accomplish the reduction safely and  perfectly.
We are likewise led  to question the propriety of the
rule  hitherto  given,  not to separate the  placenta be-
fore having reverled the womb.   The  only reason
for this maxim, is  the  apprehension of a  flooding;
but if a flooding is not likely to  ensue after a com-
plete inversion, as  most  of the cases seem  to prove,
then the  placenta should  be first separated, vhich
will facilitate the replacement of the womb.  Partial
inversions, however,  seem generally to be attended by
flooding;  in such, therefore, the womb should be rer
verted before the placenta is separated.
   75.  The means by which these alarming, and too
frequently fatal accidents, may very generally be pre- 
 196       On the Causes, Remedies, &c.    [Chap. 4.

 r-er.ted, have  been  already  more  than once pointed
 out;  but they  cannot be  too frequently repeated.
 Keep your patient's mind  calm, and her person cool,
 irom   the  beginning of  labour;  carefully avoid all
 unnecessary fatigue, and every  kind of heating  food
 imd drink ;  suffer the labour to proceed with as little
 interference as possible ; check  all  impatience in your
 patient,  and most carefully  guard  against  any  in
 yourself: and when, at last, the delivery  comes  on,
 an far from hastening it, if the pains are  strong and
'the advance of the child rapid, prudently retard it, and
 cr.rcfully avoV the application of any force to  the  na-
 V'-l string, or even to encourage in the woman any ef-
 forts  to expel it, until the womb can be felt contracted
 like a ball above the pubes.  In a labour so conducted,
 nature w ill conquer most difficulties, and after  it, these
 untoward accidents seldom or never occur. 
Chap. 5.3     Of the Diseases of Women, &c.      197
                CHAPTER V.


OF THE DISEASES OF WOMEN IN CHII.O BED, AND OF
           INFANTS DURING THE MONTH.
                  SECTION I.

                    Child-Beel.

  1. Among savages and half-civilized nations, wo-
men make little or no change  in  their general con-
duct, in consequence of child-birth ; but return to their
usual occupations, almost  immediately after delivery.
Even  among us,  the more  hardy  individuals of the
labouring women, submit to a very short confinement:
nor is it now so general among the  higher  classus of
society, to be confined to bed for eight or ten days, and
to be  restricted to  a particular regimen for a much
longer time, as it formerly was.   I believe,  in S3 do-
ing, they are approaching to a wiser and more natural
conduct.   But nevertheless, women are not  to  lay-
aside all attention to their situation, at this time. Dur-
ing labour, they undergo great changes, generally suf-
fer much pain and fatigue, as well as great evacuations:
by which their strength must necessarily be reduced,
and their  frames  become more irritable and suscepti-
ble of disease: consequently, there must be more haz-
                      R 2 
198 Of the Diseases of Women in Child-Bed, [Chap. 5.

ard from every kind of exposure and error.  Whilst
the womb, too, is returning to the unimpregnated state,
they are exposed lo some complaints which require
attention ; and this attention must  always be in pro-
portion to the former habits of the woman, as well as
to her general health and strength, and  to the fatigue
and distress she has undergone in her labour.
   2. The first  requisite is  to change  the woman's
posture, and to regelate her bed, which, when she has
been greatly  exhausted, should not be  attempted for
some hours ;  at least, no more  should immediately be
done, than to put dry clothes under her,  extend  her
limbs,  and perhaps  turn her on her back, or on the
other side ; give her some mild cordial nourishment,
such as gruel or panada, with a little wine, and if she
complains of much pain, twenty-five or thirty drops
of laudanum.  As soon as she is properly recruited,
the opposite side of the bed being prepared, she may
be removed to it; or if she  had been delivered on a
cot, that.being brought to the side of the bed, she may
be carefully  removed from one to the other ; taking
care not to suffer her to rise  to an  erect posture im-
mediately after even the  most favourable  labour;
by which she imy be exposed to some troublesome
complaints, and from which circumstance alone, many
women have  fainted, and some have losjt  their lives.
If the bed have been properly prepared before, and pro-
per care have been taken during labour, it will be no
difficult matter to  keep  the woman clean and  dry,
which  are circumstances very  necessary to be attend-
■-■el to throughout her confinement.
   3. A very strict, though  a very  different regimen,
has been directed bydiffmr.t ruthors, for child-bed 
Chap. 5.]   and of Infants during the Month.     199

women.  Some, under the idea of the weakened state
of their patients, have ordered a warm cordial, stimu-
lating diet;  whilst others, fiom apprehension of fe-
ver, have restricted them to one that is very low and
abstemious.   But  all general  rules  on this  subject,
except that the diet should be temperate, are liable to
error.   In  ordinary  cases, common food,  avoiding
gross meats and spirtuous liquors, may be moderately
indulged in ; to such as are much reduced, some wine
and light animal food should  be allowed ; while such
as are more'robust and of inflammatory habits, should
avoid animal food, and cordials of all kinds, and re-
strict themselves, for some days at least, to tea, gruel,
&c.   Whenever it can be procured, good  ripe  fruit
may be  taken  freely; heated  rooms,  a load of bed-
clothes, and close confined air, are always prejudicial.
   4. Evacuations.  Upon the supposition that the ad-
vice already given, with regard to  the  state of the
bowels, before and during labour, has been attended
to,  it is most probable that in  this respect, there will
be no occasion for the interposition of art, at least for
 one or two days ;  but the state of the bladder must
always be attended to from the first;  and unless the
woman pass her urine  at least twice  in twenty-four
 hours, it must, be promoted by injections  of warm
 water, and by fomentations externally  applied, which
 are  most conveniently made by an  ox's bladder, half
filled with warm water.   If these means should  not
succeed, and the bladder  become distended and pain-
 ful, recourse  must  be  had to  the catheter, (Chap. I.
 27.)  These attentions  become most nvcessary, in
 those cases in  which women  have not been able to
 discharge their urine for some hours before delivery; 
 200 Of the Diseases of Women in Child-Bed,  [Chap. 5.

 and if, within twenty four  or thirty-six  hours,  they
 have no  evacuation  from  the bowck*, a few stools
 should be procured by castor-oil, (No. 8. f.)  or mag-
 nesia, (No, 8 a. b. c)
   After-pains. Pains in the belly which come on and
 go off like labour pains, which leave the belly without
 soreness,  and are frequently  succeeded by the dis-
 charge of small clots of blood from the womb, are
 more or less common after most labours.  These are
 called after-pains, are generally less severe after a firm
 labour, always so after a slow  labour, that  has been
 well  conducted; in which  the  delivery  of  the head,
 shoulders, and hips of the child, have succeeded eaeh
 other after short intervals; and that  of  the placenta
 has not been hurried, but  left  to  the natural pains.
 When moderate, they should not be interfered with,
 as they arise from the  natural contractions  of the
 womb, expelling small clots of blood which remain in
 its cavity, or in  the orifices of the enlarged veins, that
 terminate on that part of its surface to which  the after-
birth had been  attached.   When severe, they will  be
 mitigated by a bladder of warm water applied to the
abdomen, or by an anodyne of thirty or forty drops of
laudanum, or the sudorific  draught, (No. 12. b.) pro-
moting its effects by tepid drinks, such as balm or
weak catnep tea.   The too  common  practice of giv-
ing, on this occasion, spirituous liquors, hot spices, and
strong infusions of sage and pennyroyal, is not only
unnecessary, but really dangerous.
   6.  After one or  two days, women should  rise from
their beds, and  sit up for a longer or a  shorter time,
every day, according to their strength and inclination.
This change of situation will promote the natural dis- 
  Chap. 6.3   and of Infants during the Month.     201

  charges, and, at  the  same time,  greatly refresh the
  woman  ; but it is not prudent  to  indulge in walking
  about,  until the womb and its ligaments have in some
  measure resumed their natural size and situation.   It
  is impossible  to fix any  period  when this will  be
  accomplished;  but  unquestionably,  weakly  women
  must submit to a longer confinement to a horizontal
  posture, than the more robust: and even these should
  not stand upright for any  length of  time, nor walk
  about for several days.
    7. Lochia. The natural discharges which flow from
  the womb  after delivery, require no other  attention,
  than sitting up  a short time  every day, to promote
  their evacuation and cleanliness.  They commonly
  suffer a check during the second  or third day, when
•  the breasts begin to be distended with  milk; but this
  is a natural occurrence, which need excite  no alarm,
  and they will again flow in a  proper quantity, as soon
  as  the  slight  fever, with  which  the coming of the
  milk is  generally attended, subsides.   They flow in a
  greater or less quantity, according to circumstances of
  strength  and constitution   in the patient; and when
  profuse or obstructed, are symptoms of general health,
  or particular disease ; and as such, will be remedied
  by the treatment necessary to remove  the complaints,
  of which their profusion or obstruction is the necessary
   consequence.
     8. Lameness.  It has been already  remarked  that,
   in consequence of severe  labours, or of previous dis-
   ease, the  junctures of the  bones of the pelvis, some-
   times so far give way, as to occasion very  painful ob-
   stinate lameness after delivery.   Rest, for a long time
   in an horizontal posture, frictions with warm liniments, 
202  Of the Diseases of Women in Child-Bed, [Chap. 5.

(No. 19.) and after  the  danger  of inflammation  has
subsided, such  remedies as strengthen the  constitu-
tion, such as the peruvian bark and chalybeates, (No.
 16. c. e.) and cold bathing, are the proper remedies :
during the use of which, the support obtained by  the
proper application of a bandage, will ever be found  a
vere useful auxiliary.   On other occasions, inflamma-
tion may take place on those parts, and may be fol-
lowed  by suppuration, a most dangerous and distress-
ing complaint.   Whenever, therefore, a patient, after
delivery, complains of pain in those regions, the cause
should be carefully enquired into,  and immediately
attended to : that,  by early bleeding and blistering,
suppuration and all its dreadful  consequences  may, if
possible, be prevented.
   9.  Soreness and  Inflammation of the external parts.
 After  severe labours, especially when badly managed
 and rudely treated, the external parts are sometimes
 abraded, swollen, and inflamed ; frequent washing and
 bathing  with warm milk and water, and anointing with
 alittle very fresh hog's lard, in which a small quantity of
 fresh mutton suet has been melted, or with the simple
 cerate, (No. 18. a,) are in general the best remedies.
 When the injury has been very great,  fomentations
 and poultices may  be necessary.  Lacerations of the
perineum seldom require any  thing more than these
 at first; after  the inflammation and swelling  have
 subsided, the simple cerate, (No. 18.  a.)  spread on
 lint should be applied.  Whenever laceration extends
 into the  vagina, besides t^ese applications, a dossil of
lint, dipped into  the melted grease, should be intro-
duced pretty high up the vagina, to prevent the sides
adhering.   Some attention is  necessary to keep the 
Chap. 5.3    and of Infants during the Month.      203
knees  together, whilst  the wound is uniting;  but
stitches, in general, do more harm than good.
  10.  Prolapms or falling down of the womb, though
not always a disease depending on pregnancy, may be
a consequence of mismanagement in a former labour,
and is  always increased  during the first month  of a
succeeding pregnancy.  General  weakness predispo-
ses to this disease, may  be the principal source,  and
always increases it, from whatever other  cause it is
derived.   Great voluntary exertions, and preposterous
efforts in the beginning of labour, before the internal
orifice  of the womb is sufficiently open, may subject
any  woman  to this troublesome complaint; but are
most apt to bring it on in  such as are of weak and
relaxed habits, or in such as have been subject  to it
before  ; and therefore, although always wrong,  should
more  carefully be avoided in  such cases.  In such
women as are subject to this complaint, it is always
increased during  the first three or  four months of
pregnancy ; but as soon as the womb rises out  of the
pelvis, (that is, after  the fourth month) it grows bet-
ter, and generally disappears by ths seventh or eighth
 month ;  but after that, may return again in a slight
 degree.   Careful attention,  during the  succeeding
 labour, to keep the woman in  a horizontal posture, to
 avoid  all voluntary efforts, and unnecessary straining,
 and to support the internal orifice, by one or two fin-
 gers introduced into the vagina, during  every pain,
 will  prevent any increase of the complaint at lhat
 time ; and longer confinement than usual to  a  hori-
 zontal posture, after child-birth, will sometimes entire-
 ly remove  it.   Cleanliness, and washing out the va-
 gina  by means of  a syringe,  at first with <nilk and 
 204 Of the Diseases of Women in Child-Bed, [Chap. 5.

 water,  then with an astringent infusion of green tea,
 or of oak bark, (No. 20. b.)  with  the addition  of a
 small quantity of vinegar or spirits,  will contribute to
 the cure ; at first, the injections should be tepid, but
 after eight or ten days,  when the irritability of the
 woman s habit is diminished,  when  the flow of milk
 is fully  established, and the disposition  to chill and
 fever ht.s subsided, they should be  used cold.   When
 the disease is considerable, or proves obstinate, these
 milder astringents may be  changed for the solution of
 lead, (No. 20. d.) or while vitriol, (No. 20. e.) which
 are more powerful.  When women begin to rise  out
 of bed, the womb should be supported by  a  sponge,
 squeezed out of  some of these astringent liquors, in-
 troduced into the vagina, and  kept there by means of
 a T  bandage and compress;  or a small ball of elastic
 gum moderately distended with cotton, may be used
 for this purpose; either must be withdrawn, and clean-
 sed two or three times a  day.   Such means, persisted
 in with due care, will generally prove effectual; but it
 sometimes happens, particularly in labouring women,
 who are  compelled  to return to their ordinary occupa-
 tions too soon, after delivery,  that  this complaint, by
 neglect, acquires a considerable magnitude, and a ten-
 dency to inflammation, which,  in the first instance, re-
 quires only cooling purges, (No. 9. a )'and a spare diet,
 with  emollient fomentations and poultices, until the
 swelling, pain and inflammation shall be removed, be-
fore the womb can be replaced ; and after that,  besides
astringent injections, the  use of a  pessary, to support
it in  its  natural  situation.  In very  weakly  women,
remedies, strengthening to  the constitution in general,
such as  the  peruvian  bark, and preparations of iron, 
Chap. 5-3    and of Infants during the Month.      205

(No. 16. e. c.) and the cold bath either partial or gene-
ral, must accompany the local applications.
   11. Milk fever.   About  the third day after delivery,
the breasts  become turgid from  the milk secreted  in
them, and at the same time, the  uterine discharges
commonly diminish.   This period is generally attend-
ed with some  heat,  thirst, head-ach,  and fever;  all
which, however, may in general be prevented, or, at
least, very much diminished, by  putting the child ear-
ly to the breast, emptying the bowels by an emollient
injection, (No. 5.  a. b ) restricting the patient to a low
diet, keeping up  an easy moisture on the skin,  by
means of tepid drinks, aided by the soiritus mindereri,
(No. 12. a.)  These remedies altogether prevent,  or
generally put an end to this complaint  within twenty-
four hours;  but if the symptoms are preceded by  an
ague, and after that run righ, in robust and full-habited
women, it may likewise be necessary  to lose a  little
blood.  Rubbing the breast all over, except the nipple,
with a little  fresh  lard, or butter  from  the chiwn,  or
simple cerate, (No. : 8. a.) softened with a little good
oil, allows  them  to distend with more ease ;  it is
likewise common  with some nurses,  to.-$cover  them
with cabbage  leaves,  wilted with warm  vinegar,  by
which they are sweated and  relaxed :  this is a useful
practice;  but when they can be  procured, any other
broad leaf,  particularly  those  of the button-wood  or
burdock,  or beet, are to be preferred, as they are not
so apt to become offensive.
   12.  When a lump appears in the breast, it is com-
mon to have recourse  to  fomentations and poultices ;
but as these have a tendency to promote imposthuma-
uon, and as an imposthumated breast is always a pain-
                       S 
206 Of the Diseases of Women in Child-Bed, Chap. 5.3

ful, and sometimes a  very severe disease, it is best, if
possible, to disperse it.   To this  end,  if  the woman
be  strong, let her lose a little blood ;  let her be purged
daily by (No. 8. e ) let her breast be frequently bathed
with  a mixture of one part  vinegar and  three parts
water, applied milk warm,' and keep  it  covered with a
linen cloth, constantly wet with (No.  19. c.) observe
rather a low diet, and  keep  a little moisture on the
skin, by (No.  12. a. or b.)  By these means,  in a few
days, the  tumour will  probably  disappear ;  or if the
discussion should not  be effected,  the imposlhumation
will be less, which is  gaining no inconsiderable advan-
tage.   When it is found that it will come forward, a
milk and  bread poultice, (No. 18. g.) may then be ap-
plied, and repeated two or three times  in  twenty-four
hours, until the imposthumalion shall burst, or at least,
until the skin shall become very thin ;  when a  small
opening may be made in the most depending part.
Should any hardness remain after the discharge of the
matter, let the part be anointed twice  or three  times
a day with camphorated  oil, (No. 19. b.)  and cover it
with soft flannel; if the hardness should not soon yield
to this treatment, let a plaster of common diachilon,
or a mercurial plaster be worn over it.
   13. Soren'pptes are a  very  painful,  and sometimes
a very obstinate disease ;  the simple cerate, (No. 18.
a.)  by supplying, in some  measure,  the place of the
natural mucus, with which the nipple is defended, will
mitigate the pain ; and using a ring  of wax, just suffi-
cient to let the nipple  through,  by  defending it from
the friction of the clothes, contributes to their healing.
When they become ulcerated, washing,  at first with a 
[Chap. 5.  and of Infants during the Month.      207

solution of lead, (No. 20. d.) and after a few days, with
spirits, with a solution of alum, in brandy, of white vit-
riol, (No. 20. e.) or of borax (No. 20. f.) in water, and
dressing with cerate, made by mixing finely powdered
red precipitate with common cerate, (No. 18. a.) are all
recommended ; but simply keeping a linen cloth, con-
stantly wet with rum, over the nipple,  will frequently
do more than either; but then it must be kept con-
stantly wet; and as this  is one of the easiest remedies,
it should be first tried :  the great variety of remedies
recommended, proves the obstinacy of this complaint;
and I confess I have  frequently failed  to  give  much
relief, until, by time, the nipple has become accustom-
ed to the friction of the  child's mouth ; and in a few
instances, 1 have been compelled to advise weaning or
procuring a nurse for the child.
   14.  Puerperal or  child-bed fever.  The  puerperal
f ver begins with cold chills, succeeded by great heat,
and accompanied by its  characteristic symptom, a re-
markable soreness of the  belly, which in no respect
resembles  after-pains, never  remits as  they do, and
is always increased  by  pressure.   The  patient often
complains of the'slightest touch, and sometimes even
of the weight of the bed-clothes.  This soreness is
generally confined, at first, to the parts over the womb,
just below the navel; at other times, it extends more
generally over the  abdomen,  and  sometimes affects
the bladder,  so as to occasion  a frequent and painful
discharge of the urine ;  and the rectum,  bringing  on
a frequent and painful urging to stool.
   15,   When the symptoms of inflammation, and the
fever end soon in a copious perspiration, diminishing 
208  Of the Diseases of li%men in Child-Bed, [Chap. 5.

the heat, and lessening the  pain ;  the disease is fre-
quently carried off by  this natural crisis, within one
or two days;  but when the  attack is violent,  when
the cold chill  is severe, and the  succeeding heat very
great, and especially, if that  is imprudently increased
by hot, spicy, and spirituous liquors, too frequently
given to put an end to the chill, or by a load of bed-
clothes and by hot drinks, continued after it has subsid-
ed ; the soreness and pain Increase, the belly swells, the
secretion  of the milk, and the natural discharges are
checked or suppressed, and the patient dies of a sud-
den  mortification, or  the disease runs rapidly into a
putrid state.
   16. In this, the patient complains of a loathing and
offensive  taste, nausea and  vomiting, the belly is un-
commonly distended ; a purging, and profuse clammy
sweats come  on;  the discharges from the bowels and
womb become highly offensive ;  the pulse, althou&'i
at first strong and fui!,  soon  sinks ; red and purple
spots appear on the skin ; the patient's strength fails,
her countenance,  is  expressive of great languor and
extreme anxiety,  and she commonly dies within a few
days.
   17.  This combination,  or rather  this sudden suc-
cession of putrid to inflammatory symptoms,  is  what
constitutes the intricate nature and  fatal tendency of
this disease :  and is thaMvhich has introduced  much
confusion  and some contradiction into the writings of
physicians, respecting it.  In cold climates and sea-
sons, in robust constitutions, in the country, and after
severe or  mismanaged  labours,  the   inflammatory
symptoms run i.igh, and constitute the danger: these
are to be cured only by the free use of the lancet.  In 
Chap. 5-3      and of Infants during the Month.   209

feeble women, in some confined districts of large ci-
ties, in small, close apartments, and  in the wards of
an hospital, the putrid symptoms are  apt  to succeed
so rapidly, as to  demand the attention of the physi-
cian very early, and to render the evacuation of blood-
letting a doubtful, if not a dangerous remedy.
   18.  And again, at particular seasons, and  in con-
fined districts,  particularly in the atmosphere  of a
crowded hospital, this disease has appeared simply  as
a putrid and maglignant fever, with no decided symp-
tom of inflammation, or if any, so transient as to com-
mand no notice,  and to  require but little attention.
And on some occasions, the air of a district,  or the
wards  of  a lying-in hospital,  have  become  conta-
minated and pestilential, so that every child-bed wo-
man, within  the influence of that asmosphere, has
been infected, and not one in ten or twenty has reco-
vered.
   19.  This  short  history  of puerperal fever will, I
hope, enable us to lay down  the most  simple and effi-
cacious mode of treatment; and one, which any intel-
ligent nurse may understand: so far,  at least,  as  to
prevent her committing some gross errors, which are
too common, and which may  render the best medical
advice  afterwards ineffectual.   Whenever, therefore,
a child-bed  woman is attacked with chills, let it  be
remembered, that it may end  in a very severe dis-
ease ; and that the woman's safety very much depends
upon good  management in  the beginning.
  20.  This consists in putting an end to the  chill as
soon as possible, but in such a way  as will not increase
the fever which  is  to follow.  Let  some additional
bed-clothes be put on the patient; let a bottle or blad-
                       S2 
2J0  Of the Diseases of Womenin Child-Bed, [Chap. 5.

der filled with warm water, or a hot brick, quenched
with vinegar and wrapped in flannel, be  put to her
feet; and let her limbs be rubbed with warm flannel,
which has the best effects in restoring an  equable cir-
culation of the blood;  give  her frequent draughts of
warm catnep, balm, or weak sage tea.;  but avoid all
kinds of cordials, spiced wines, gin, and other spirit-
uous liquors, as you would the most fatal poison.   As
 soon as the cold chill has  ceased, and  the  patient
grows warm,  remove the warm  applications,  and
lighten the bed clothes ; but do it  gradually, for fear
of bringing back  the chill;  with the same caution,
draw open the bed-curtains,  and admit  fresh air into
the room ;  give cool drinks, acidulated with  lemon-
juice, currant-juice,  tamarinds, or a little good vine-
gar, sweetened with brown sugar or molasses.   If the
patient be very hot, take off more bed-clothes, admit
more air, particularly in summer, and give the drinks
actually cold.  Continue this treatment until the  heat
of the body is reduced nearly to the natural standard ;
or until the patient breaks out into  a free,  easy per-
spiration, which generally takes place as soon as she
is sufficiently cooled.   Nothing so much  interferes
with  natural perspiration, as  a very  hot skin; and
hence, nothing is  so dangerous as to attempt, in the
beginning  of fevers, to get the better of the chill by
cordials and spirituous liquors ; the heating effects of
 which remain  after the chill  has gone off; or of at-
tempting to force a sweat, after the chill has subsided,
by a great load of bed clothes, in a confined air, and
heated room ; and by hot drinks, by which the heat of
the body is increased, and the  intention of promoting
a kindly  perspirati-jn  most  effectually counteracted, 
Chap. 5.3     and of Infants during the Month.   211

Any tendency likewise,  which  the succeeding fever
may have to assume a putrid form, is, by these means,
greatly  increased :  all child-bed fevers have this ten-
dency in a considerable degree, and when erroneously
treated by  a  hot regimen, very soon  become  putrid.
On the contrary, it generally happens, that as soon as
the heat of the patient  is reduced  nearly to a  natural
standard, an easy relieving moisture breaks out, and
that paroxysm of the fever,  at  least,  is  terminated:
hence the salutary tendency of washing  the body, in
the hot  stage of malignant fevers,  with  cold  vinegar
or cold water, with  intention to  shorten  the  hot fit,
and bring on  the sweating stage :  a practice  which,
although inadmissible in the case of child-bed women,
may serve to explain the reason of the cool treatment
I have recommended.  As soon as the hot stage goes
off, and the skin becomes  moist, the cold drinks must
again be changed  for such  as are at least tepid or
milk warm ;  and by taking frequently of such,  and ly-
ing quiet under a moderate weight of bed-clothes, the
perspiration is to be  encouraged  and kept up  for se-
veral hours, until the  fullness, quickness, and hard-
ness of the pulse have  subsided.   But here  again let
it be remembered, that profuse sweating, long contin-
ued in a close confined air, greatly weakens the  pa-
.tient, postpones the complete crisis of the fever,  and
above all other things, increases its putrid tendency.
All that is necessary and salutary is an easy moisture,
which lessens the heat, and relieves the anxiety of the
patient; this should be promoted and kept  up, under
the use of cool, or at most, tepid drinks, light cover-
ing, and the air of the  chamber kept so cool and re-
freshed, as to give no offence to  a person entering it. 
212  Of the Diseases of Women in Child-Bed, [Chap. 5.

from  the  open air ; until  all anxiety and restlessness
are removed, and the  pulse has  returned nearly to a
natural standard.  I have been thus particular in de-
scribing the conduct which the nurse  is  to  observe
in the treatment of child bed women, or indeed of any
other person, on  the first  attack of fever, because I
fear it is not generally well understood, and because I
am convinced, that if  attentively pursued, it will, on
many occasions, put an end to a serious disease in the
first stage, and save the patient from a dangerous ill-
ness.
   21. I have chosen, for the  same  reasons, not to
interrupt it by directions for the  medical treatment;
which, however, is very important, and  particularly so
at the commencement of puerperal fever.  If, there-
fore, the cold chill be succeeded  by a  high* degree of
fever  ; if the pulse be  strong and full, and the patient
robust; or if she have suffered  any violence during la-
bour, and particularly if she complain of much pain
and soreness in the belly, she should be immediately,
and in proportion to her strength, copiously bled ; and
if these symptoms are not  mitigated, this evacuation
should be repeated within twelve or twenty-four hours  ;
the bowels should be emptied by mild purgatives, (No.
8. b. f. g) (No. 9. b,) or rather by emollient clysters,
(No.  5. a. b.) frequently injected, not  only  as evacu-
ants,  but  as  a  fomentation to  the  whole abdomen,
The effect of tepid drinks, in promoting perspiration,
is to  be   aided by the draughts, (No.  12. a. or c.) or
the antimonial solution, (No. 12  d.) which, if it should
excite so  much sickness as to  empty  the  stomach by
gentle vomiting, it would be so much  the better.  A 
Chap. 5.3     and of Infants during the Month.   218

fomentation, by means of a flannel wrung out of warm
water, with the addition  of a  quarter  part vinegar,
should be  applied  over  the whole  abdomen, and  a
large blister upon that part which is particularly sore.
  22. A putrid tendency is  indicated  by nausea, vo-
miting,  and purging, with a belly  much  distended,
putrid and offensive discharges both from the bowels
and womb, and clammy  unrelieving sweats; a pulse
fallen in strength, but increased  in  quickness, and a
a countenance expressive of great languor  and  inex-
pressible distress.
   23. The  first approach of these symptoms should
not only be carefully watched,  but so far anticipated,
as to excite  great caution in the use  of the lancet, un-
der circumstances favouring,, or  increasing putrefac-
tion ;  such as a hot season of the year, in a  large city,
and confined district; in a hospital or small confined
room ; and absolutely to forbid it on the approach of
the second stage of the disease :  cool air, light cover-
ing,  cool  acescent drinks, mild antimonals, (No  !2.
d.)or rather the draughts, (No  12. a. or c.) given in
the act of effervescence, are now to be  persisted in ;
and in addition to those,  almost  daily vomits of ipe-
cacuanha, in doses of five or six grains.  By these re-
medies, the stomach and bowels are cleansed, and a
gentle perspiration kept  up,  at  the same time that
the diarrhoea and other putrid  symptoms  are either
prevented or checked  If necessary, the bowels must
be kept open by small  doses of  rhubarb and vitriol-
ated  tartar, or rhubarb  and calomel, (No.  9. b. c.)
When purging is profuse,  it may be checked by the
addition of five or six drops of laudanum to two grains 
214  Of the Diseases of Women in Child-Bed, [Chap. 5.

of ipecacuanha, given every four or every six hours,
or by the clyster, (No. 6. a ) of twenty or thirty drops
of laudanum,  and repeated  twice or three  times in
twenty-four hours; bu*  it is  not  safe, absolutely to
suppress the diarrhoea, which always gives some relief.
All drinks are to be cool and  acidulated,  and the nau-
sea may be checked by the draughts (No. 12.c.) given
during the effervescence ;  fresh air is to be admitted
into the chamber, and the most perfect cleanliness ob-
served, by frequent change of linen, and  carrying out
every offensive or excrementitious matter as soon as
possible.  When  the putrid  symptoms resist these
remedies,  wint, colomba root, and the peruvian bark,
(No. 16. c. d.)  must be substituted in  their stead ; but
from the inflammatory symptoms with  which puer-
peral fever generally commences, it does not bear
those remedies early ; and the cool regimen, acescent
drinks, and neutral draughts, vomits, and mild evacua-
tions by the bowels, are generally sufficient  without
them.   For a  more particular description of the symp-
toms and  treatment of this disease, than is consistent
with my design,  1 must refer my  reader  to the ad-
mirable writings  of  Mr. White of   Manchester, and
of Dr. Denman.
  24. Swelled leg.  Child-bed women are liable to  a
very peculiardisease, of which a swelling of the low-
er extremities, preceded and accompanied  by great
pain, and an inability to move, are the most conspicu-
ous symptoms.   It seems no way connected with any
preceding  complaint, or peculiarity  of  constitution ;
nor to depend  on the kind  of  labour  which  precedes
it, or on the treatment before  or ^after child-birth.   It 
Chap. 5.3   and of Infants during the Month.      215

occurs at any period from the first  or second day, to
two or three weeks  after delivery; it is preceded by
general uneasiness, lowness  of spirits, slight  pains
about the womb, and a  lochial  discharge, peculiarly
offensive;  but  these   symptoms  seldom command
much attention, until  the patient is seized with pain
on the inside of the  limb  commonly about the calf
of the  leg, which soon extends from the heel  tothe
groin, along  the course of  the absorbent lymphatics;
the limb soon after begins  to swell;  the soreness ex-
tends all over  it,  so that it cannot bear  the  slightest
touch,  and every attempt  to move, gives exquisite
pain ; the  skin becomes glossy and pale ; the  coun-
tenance is expressive of great anguish ; nd dejection ;
the pulse is quick;  the heat  of the  skin increased;
the tongue white, and the urine turbid and muddy.
  25.  These  symptoms strongly mark the absorp-
tion  of some morbid  and poisonous  matter, which,
although  irritating and inflaming to the obstructed
vessels, is depressive of the powers of life, and  weak-
ening to the constitution in  general.
  26.  Hence all  free  and copious  evacuations, by
bleeding or purging, have been found not only use-
less, but prejudicial in this  complaint; and  gently
aperient and sudorific medicines, (No. 12. a. c.)  with a
diet  rendered  cordial  by  the  moderate use of wine
from the   beginning,  most useful.   The limb may
be embrocated with camphorated oil, with or without
the addition of opium, (No. 19. a. b.) and slightly co-
vered with soft flannel.  The severity of the  pain may
be allayed, and necessary rest procured, by sudorific
anodynes, (No. I 2. b.) Under this treatment alone,
properly persisted in, the patient generally recovers; 
216  Of the Diseates of Women in Child-Bed, [Chap. 5.

for although  very  tedious and  distressing, this com-
plaint has seldom proved fatal, and there is great rea-
son to believe, that the very few cases in which it has,
have been aggravated by mismanagement.  My friend,
Dr. David Hosack, of New-York, informs me, that he
has found squills and  calomel (No. 13. a.) peculiarly
beneficial in this disease.  I  have had no experience
in the use of this remedy ;  but independent of the re-
liance I have in his assurance, I think it promises so
well, both as an alterative and diuretic, that I am much
inclined to recommend it.

                      Mania.

  27. Mania is a disease to which pregnant, and par-
ticularly child bed women, seem to be  peculiarly dis-
posed ; and this predisposition very probably originates
in that very irritable state, which the whole habit as-
sumes in consequence of pregnancy and  labour.  It
is often seen to come  on  from very slight, or rather
from no evident cause, during those states ; in women
who are at all other times free from any disposition.'of
that nature,  and  generally  subsides again in  a few
weeks after delivery, without any efforts  made  to re-
move it; it sometimes returns, after successive labours,
in the same woman.  It has been supposed connected
with the secretion of the milk, and several cases which
have fallen under my observation, have  so far confirm-
ed  this opinion, as to have been attended with a sud-
den and total suppression of the secretion of that fluid;
but that may as probably have been the effect, as the
cause of the  mania, which,  inmost cases, interferes
with all the natural secretions.  We are perfectly ig- 
Chap. 5.3  and cf Infants during the Month.     217

norant of the causeof mania ;  our practice, therefore,
is purely palliative* and empirical, and we often see the
disease subside, after having,  in  vain, exhausted  all
known remedies.
   28. These considerations should  make us cautious
in the use of very active remedies, such  as  copious
bleeding, powerful purges, blisters,  absolute restraint,
and harsh treatment, which have unquestionably been
too incautiously and indiscriminately  applied in com-
mon cases of mania ; but in women weakened by the
complaints of pregnancy and childbed, they must be
peculiarly improper, and can only tend to fix and ren-
der that disease permanent, which would probably
subside  in a little time,  under a  more gentle and
soothing, but at the same time a firm and steady treat-
ment.
   29.  All the restraint, therefore, that such unhappy
women should be subjected to,  should  be such as is
necessary to  prevent their, doing mischief to  them-
selves or others; and  under  such, their harmless
wishes will be gratified with advantage ; unnecessary
contradiction can only serve to bring on  a  furious fit,
the very violence of which  must exhaust and weaken
and consequently increase that irritability, on which
we have great reason  to believe, the complaint in a
great measure depends.
   30.  In the first stage of the mania, of pregnant  or
puerperal women, some degree of fever is not uncom-
mon ;  at this period, therefore, some mild evacuations,
such  as gentle purging, (No. 8. g. or No. 9. a. b c)
or by clysters, and  the sudorific draughts, (No.  12.  a.
d.) are very proper; an  occasional  emetic  has  been
found peculiarly useful, and on some few occasions of
                     T 
218  Of the Diseases of Women in Child-Bed, [Chap. 5.

extraordinary vigour, small bleedings, particularly by
cupping about  the temples or neck, have proved suc-
cessful.   The patient should  be kept perfectly quiet;
the  room as  much darkened as she will peimit, unless
in cajes  of  great melancholy  and dejec ion ;  as few
objects as possible should be  offered to her  attention ;
and every circumstance  that can alarm, irritate, or
 depress her  spirits, most carefully  avoided.  Opium,
 in large doses, has been recommended ;  but the weak-
 ness and increased irritability which succeed their use,
 seem to forbid large  doses, particularly during the ex-
 istence  of fever ;  but small doses, united to suclorifics,
 (No. 12. b.) may then be found to  calm irritation, as
 well as  to excite perspiration.   Camphor has likewise
 been recommended, and by some, in very large doses :
 but we  know too little of the operation of large doses
 of camphor, to recommend them : in small quantities,
  combined with  asafetida and ammoniac, (No. 14. d.)
  it may  be  tried with some probability of advantage.
  Blisters  have been  generally  fount! prejudical, but
  have been supposed useful when applied to the head,
  and repealed, so as to bring on a purulent  discharge,
  which end  is  better procured  by  caustic, by which a
  more permanent discharge is  obtained, and repeated
  irritation avoided.  After the first stage, a brisk vo-
  mit, (No. 11. b. c.) has  appeared more evidently use-
  ful than any other very active remedy,  and now and
  then has been  immediately  succeeded by a peiftct
  cure.   When, in this way,  it  has failed,  a repetition
  of vomiting,  to  a  moderate degree, has been found
  very beneficial.  This remedy, therefore, should not
  u« neglected :  it tends to rouse all the  healthy actions
  of the organs, and in a particular manner to  improve 
Chap. 5.3   and of Infants during the Month.     219

the appetite and digestion ; on some occasions, it re-
quires a large quantity of tartar-emetic,  given  in  di-
vided doses, before jt will operate.   The state of the
bowels must be constantly attended to,  and  regulated
by clysters or mild cathartics,(No. 8. No. 9.)
  31. The diet should be neither abstemious  nor sti-
mulating, but consist chiefly of vegetables, milk, eggs,
and light meats, with such a use of wine,  as  under all
circumstances of health and strength, would be  con-
sidered at least moderate.  Country air and  moderate
exercise,  will be found, in due time, very  conducive
to recovery, both from the   general salubrity of the
country, as well as the greater proportion of liberty and
amusement, consistent with quiet and retirement, in
which the patient may be there indulged.  It is abso-
lutely necessary to command  and controul  maniacal
patients, and this is one reason for separating them
from their friends, and very near  connections,  whom
they are less inclined to obey  than strangers, and
ag.unst whom they are apt to entertain violent antipa-
thies and resentment.

                     Child.

   32.  As soon as the child is separated from the mo-
ther, let it be carefully covered from the cold, by wrap-
ping it in warm, soft flannel, leaving such an opening
only, as is sufficient to admit the air necessary  for its
breathing ; place it in an easy posture, and a warm situ-
ation, where it may lie until the mother shall be safely
put to bed.   In washing the  child,  make use  of soft
warm water only, or milk and water, and be not over
anxious to rub the skin perfectly clean ;  by which it is 
220  Of the Diseases of Women in Child-Bcd,  [Chap. 5.

often fretted and inflammed, which is more frequently
the cause of that galling,  in the creases  of  the skin,
to which new-born infants are liable, than any small
portion of the natural mucus which may be left adher-
ing to it;  let it be dried perfectly with soft  old linen,
and a< soon as can be done w ith proper care, let it be
defended from the access of ccld air by soft, wirm, and
loose clothing.   Ee'gin  with the head, which maybe
washed and warmly covered  before the  body  is ex-
posed.  As soon as the body and  limbs  are washed,
examine the navel-string, to  see if it be  properly  se-
cured ; then wrapping it in apiece of old  linen, dou-
ble it up  against the child's belly in such  manner, as
will not put the attachment at the navel on the stretch,
and secure it by a bandage pinned round the child's
body, but by no means tight.  In doing this, ever  re-
member  that nothing is more tender and delicate than
a new-born infant, nor  anything more sudden than
the great changes to which it is exposed :  from a kind
of vegetable life, it now breathes and cries ; from be-
ing at absolute rest, it is handled and turned  in  va-
rious postures ; and from being totally  immersed in
warm water, it is exposed to the access and irritation
of the cold  air.   If,  therefore, we  were  to make use
of no more caution than we  should think  necessary
for an adult, under similar circumstances, we ought
to take care to handle it with great gentleness, to  lay
it in  an easy posture, and carefully to defend it from
the cold.
   33.  Hitherto  the child has been  supported  by ab-
sorption, more like a plant than an  animal; as yet it
has taken nothing into the stomach ; we ought, there-
fore, to be very careful  what  we introduce.  Nature 
Chap. 5.3    and of Infants during the Month.    2<Srf

has provided the milk of the mother as its most pro-
per  nourishment,  and  there  cannot be  a doubt, but
that the more it depends on that only, during the ear-
ly months, the  better.   Let  it,  therefore,  be put to
the breast as soon as "the mother  has recovered a lit-
tle from her fatigue, and in the  interim, give it no-
thing ; the  mother's breasts  being  flaccid, with  no
appearance of milk,  is  no argument against this sa-
lutary practice : the suction of the child  will bring a
flow of  milk into them, sooner and  more safely than
it will come without it; and the very first flow of milk
is peculiarly fitted for the infant,  as,  from  its purga-
tive quality, it tends to carry off  the black excremer
titious matter, which has been collecting in the child's
bowels during  the whole period of pregnancy.  If,
therefore, the child should not, by this means, obtain a
free and plentiful evacuation from its  bowels within
twenty-four  hours, it  will be  necessary  to promote
stools by a teaspoonful of castor-c";!; or if that  is not
to be had, a little molasses and water, or a  simple in-
jection.
   34.  After difficult labours, when  the head  of the
child has been long locked between the bones of the
pelvis, it  will frequently be  moulded into  a conical
shape, with the  bones in some measure  overlapping
each other.   In these cases, none, or at least, very
slight attempts  are to be made to replace thtm ; but
they should  chiefly be left to nature,  which, in a few
days, will restore it to its natural  form;  when the
scalp is much bruised and swollen, a cloth, wet with
vinegar or  spirits, should  be laid over it.   In breech
presentations, the private parts of the child are apt to
suffer, and sometimes appear much swollen and per-
                      T 2 
222  Of the Diseases of Women in Chilel-Bed,  [Chap. 5.

fectly black;  but little is likewise to be apprehended
from this  injury, which is  soon  relieved by fomenta-
tions, with the addition of vinegar and spirits, or cloths
wet with camphorated spirits or vinegar.
   35. Children are frequently born  apparently dead,
whose lives, by  a little care  may  be  restored.   In
such cases, carefully  avoid all rude handling, or sud-
den  motion ; let the infant be laid in an easy posture,
with its mouth exposed to the  air, and its head so sup-
ported, as neither  to  be bent back nor  forward ;  if a
feeble child, and pale, leave it attached to the placen-
ta as long as there is any pulsation in the navel-string ;
but  if the child appears to have been healthy  and
strong,  and the face  purple  and livid, cut the cord,
and  let it  bleed one  or two tablespoonsful before ty-
ing ;  be  careful, howeve", to  keep the end between
the thumb and finger, so as to command the flow of
blood, and take care to tie it  securely. After  it has
been separated  frorn the mother, let it be laid, with
the same  care  and attention,  on the lap of an assist-
ant,  near  the fire, and wrapped in warm flannel; let
its bowels, breast, and limbs, be continually but gent-
ly rubbed  with flannel wet with warm spirits ;  brush
the soles, palms, and  back, briskly with a soft brush ;
with a finger  clear the child's mouth  and throat of
any  mucus that may  clog them; apply an onion or
hartshorne to the  skin and nose, and  by means of the
finger, rub a little of either on  the inside of the mouth,
now  and  then   close  the  nostrils, and blow forcibly
into  the  mouth;  then  removing your own mouth,
press  the chest  gently down, so as to force out the
air, and in this  way imitate breathing ; administer a
warm, stimulating clyster, (No. 5.  b.) immerse the 
Chap. 5-3     and of Infants during the Month.    223

child in a bath, made  stimulating by the addition of a
little spirits, and so warm as to be rather hot to a tender
hand, and continue gentle frictions while in the bath ;
persevere in these endeavours for at least one or two
hours ; even after a longer time, many happy instances
have occurred of success.   A faint sighing, or a feeble
pulsation of the heart, are  the first signs of returning
life, which are to be encouraged  by gentle persever-
ance ;  but carefully avoid all sudden and rude motion,
by which it may be extinguished as easily as a candle
just beginning to flame.
   36.  In common  cases  of  suspended animation,
there can be no doubt, but that the best means of sti-
mulating the heart is, to oxygenate the blood, by throw-
ing fresh air into the  lungs: and  the  best  means of
doing  this is to make use of a bent silver tube, one
end of which being  introduced into the  windpipe,
the other is fixed to the nose of a common bellows, by
means of a piece  of leather, first attached to the tube,
and then tied to the bellows by a piece of pack thread
wound  round  it, as recommended by  Doctor John
Augustine Smith, professor of anatomy and surgery
in the college of physicians and surgeons of New-York.
But it should  be  remembered, that the insensibility of
new-born infants  is  seldom a case simply of suspended
animation, but commonly arises from the compression
which the  brain suffers whilst passing  through the
pelvis.   Leaving the child therefore  attached to the
mother, by  which the oxygenation of the blood .is pre-
served, whilst some gentle means of nursing the ner-
vous energy are  put in practice, should always be first
tried in feeble infants, and in such  as are strong, with
 swoln and livid  faces, cutting the navel-string, and 
224   Of the Diseases of Women in Bhild-Bed,  [Chap. 5.

drawing off some blood, as directed above, should not
be omitted.  In far the greater number of asses these
gentle means, aided as  above directed, will succeed ;
but as they will also sometimes fail, every practitioner
of midwifery should be provided with the most  conve-
nient apparatusfor oxygenating the blood, by throwing
fresh air into the lungs,   I have therefore given below
a plate of the tube, recommended by  Doctor  Smith,
and of the proper size and curvature which he  has as-
certained.^ actual experiments, and with which he
has been so obliging as to furnish the engraver.  The
manner of using this instrument is sufficiently obvious
to any person properly qualified to practice midwifery ;
but I confess I should notchooseto put itintothe hands
of the generality of female practitioners,  or any other
person not sufficiently acquainted  with the anatomy of
the parts, to render its application safe and effectual;
or not apprised  of the great tenderness  and delicacy
with which a new-born infant should be handled.

                    Blue Child.

   37. Some children, soon after birth, are observed to
change colour; the face, neck, and  extremities  be-
come livid, the lips and nails perfectly  blue, the pulse
irregular, and the extremities cold ; at the same time
the lungs are  not fully expanded, the child breathes
with difficulty, and in an interrupted  manner, and, in
some instances,  the respiration is, for a short time,
totally suspended.  Whilst this  is the case, the dis-
colouration increases, and the pulse frequently stops ;
in a few moments respiration is renewed,  the colour
changes  to a more  lively tint, the pulse  beats with 
Chap. 5.]   and of Infants during the Month.      225
                                           .4
more freedom and regularity, and the  natural heat
returns.   These  symptoms subside, and return at ir-
regular periods,  and  are frequently  brought  on by
motion ;  and even when  the child lies perfectly quiet,
are apt to continue and increase until they put an end
to the child's life, generally  within a few clays;  yet
some  instances have  occurred, in which they have
come on later, and a few in which they have continu-
ed  for several yeats.   The causes  have been traced
by dissection, in several instances, to a continuance of
that state of circulation, by which the foetus exists in
the womb ;  in which the blood, passing by the ductus
arteriosus and foramen ovale, the lungs  are not  ex-
panded, and the oxygenation of the foetal blood is de-
rived from the mother.  If, therefore, after birth, the
Same circumstances  continue, or  if from  mal-con-
formation, the blood finds any other passage from the
right to  the left ventricle of the heart, only a part of
the blood can pass through the lungs, and consequent-
ly, the whole  mass will receive but a  partial oxygen-
ation.
   Thus it is attempted to account for the symptoms,
and generally fatal termination of this complaint.;
yet  it  must be confessed, that such  symptoms  may
arise from other and less incurable sources ; and  less-
er degrees of the complaint, even upon  this supposi-
tion, may yield to time and  good management;  the
foetal passages may gradually close up, and the blood,
after some time, may assume a course  more natural
to a breathing animal; proper remedies, therefore, to
remove  all lesser sources of interrupted respiration,
as well as to palliate the symptoms of this  complaint,
should never be  omitted.   In all such cases, there- 
 226 Of the Diseases of Women in Child-Bed, [Chap. 5.

 fore, empty the child's bowels by a clyster  of  warm
 catnep tea,  with the addition of a small teaspoonful
 of common salt; let it be immersed in  a warm bath,
 made  stimulant by the addition of one  sixth part bran-
 dy or spirits ; while in the bath, be careful to keep it
 in an easy posture,  and gently  rub  its limbs with a
 soft hand ;  at the same time, feed it moderately with
 some cordial nourishment, such as wine whey,  which
 is peculiarly proper when, as commonly happens, the
 subject is a delicate and feeble infant.  These  reme-
 dies must be persisted in, until the symptoms  remit,
 and repeated as often as they recur.   '1 wo very hap-
 py instances of their  success, with a minute descrip-
 tion of the  disease as it occurred in those, are related
 by Dr. David Hosack, in the first volume of the Me-
 dical Repository, page 507.

   38.  New-born children are particularly  subject to
 three  diseases : a red eruption, called the red gum,
 a jaundice,  and aphthoe or the  sprue  ;  against  these,
 early purging is  the best preventive,  as well as  the
 best cure ; molasses and  castor-oil answer well at first,
 but after some  time, these complaints  are  generally
 combined with  griping ;  for relief of which,  magnesia
 or  prepared chalk, with  a little rhubarb and aniseed-
 water. (No. 15.) are better adapted ; when a diarrhoea
 accompanies these complaints, the rhubarb  and  mag-
 nesia should be omitted, and the chalk, combined with
 gum-arabic (No.  15.  a. e.) substituted in their place  ;
 and when the pain and griping are severe,  laudanum
may be added, (No. 14. b.) Be careful, however, never
 to give laudanum to new-born infants but in this way,
 combined with so much water, as to divide the dose ve- 
Chap. 6.3   and of Infants during the Month.      227

ry minutely. I once knew a child of several weeks old,
killed by ten drops of laudanum, and another brought
into great danger by less than two drops.  In aphthoe,
the sprue, it is too common a practice  to rub the crust
from the child's tongue ; this not only puts the infant
to  pain, butnhe crust is sure to return in  a greater
degree: a small quantity of molasses, frequently put
into the child's mouth, or a* little finely powdered bo-
rax, mixed with sugar, (No 20  f.) are the best topical
applications.
   39.  Convulsions are  a -very  terrible  and alarming
complaint in new-born  infants; they commonly arise
from the  state  of the  stomach  and bowels;  and
emptying  these  by  castor-oil  clysters, and  a mild
emetic, (No. 11. a.) together with bathing the child
up to the chin, every time they come on,  in warm
water, with the  addition of a  little  spirits,  are the
principal remedies.   After having done this, recourse
may be had to the moderate use of opium, in the
manner above directed ; and a very small blister may
b* applied  between the  shoulders, which should be
removed after one or two hours, and  the part covered
 with a piece of linen, spread  with fresh mutton or veal
 suet, or a little simple cerate, i^No. 17. a.)   Blisters,
 left long applied to young infants, are very apt to ul-
 cerate and  become not  only exquisitely  painful, but
 truly dangerous ; for which reason it  is always best,
 in the  fir:t place, to try the effect of some other sti-
 mulating application, such as the juice  of an onion,
 or a piece of flannel, moistened with the common vo-
 latile liniment,  (No.  19. a.) applied to the spine. 
 228 Of Diseases of Women in Child-Bed, ifc. [Chap. 5.

                 CONCLUSION.

   Convinced that a general knowledge of the nature
 of pregnancy  and labour, and of  the  symptoms and
 complaints which attend them, will  frequently  pre-
 vent much unnecessary  alarm ; will,  on many occa-
 sions, point out  safe and easy  remedies, and on all,
 enable women to act with  self-possession, steadiness,
 and composure, the  author has  attempted  to ex-
 plain them in easy and  intelligible  language.  His
 principal objects have been, lo check the too  frequent
 interposition of art,  and to restore nature to her just
 authority ; to  accomplish which, he  believes  it neces-
 sary,  not only to improve the knowledge and correct
 the errors of rnidwives, but likewise to remove many
 prejudices  and groundless apprehensions from the
 minds  of their patients.  He  has,  therefore,  endea-
 voured to divest his  subject of all my Aery, with a view
 to adapt his work to the comprehension of women in
 general,  as well  as to  professional characters;  not,
 however, without some apprehension, that so  long a
 catalogue of ills, to  which  woman is  .exposed, may,
 in some weak  minds,  excite  more  fears,  than the
 knowledge of their remedies may give  confidence. Let
 them not, however,  be discouraged : few  women suf-
 fer materially from them ; and the probability  that
 any one individual  shall escape all  that  are serious,
 is greatly in her favour.  Provident nature is wonder-
 fully kind to pregnant women ;  and  when she is  pro-
 perly consulted, attended to, and obeyed from the be-
 ginning ; not weakened  by excess  of  any kind ; nor
thwarted and  put out of her course by  preposterous 
Chap. 5.3    and of Infants during the Month.    229
mismanagement in her progress,  vvill,  nine hundred
and  ninety-nine times out of a thousand, can v  her
Votary safely through all the wonderful changes of this
eventful period.

            Plate referred to at page 224.
CJ 
APPENDIX.
  IN this appendix are given, not only all the  reme-
dies referred to in the  foregoing  essay,  but  receipts
for  their  preparation,  their proper  closes,  and  direc-
tions for their general  use.  Some few, likewise, ure
added with a view to render it more complete, as a do-
mestic pharmacopoeia,  for the use of families at a dis-
tance from medical advice ; or on slight occasions,
when it may  not be necessaiy  to call in a physician.
A variety are given under each particular head, that in
the country, when one is not to be  had, its place may
readily be supplied by another , and they are general-
ly arranged* in  the order of their activity, that ihey
may more easily be adapted to particular cases.
  The  doses here  prescribed,  are all intended  for
adu'ts.   Whenever it  is  desired  to  adapt them to
young personsor children, the  following  proportions
may be taken : for. a  youth  of fifteen years,  three-
fourths;  for a  child  often  ye.irs,  one half; and  for
one of five, one quarter of the dose  directed : varying
the dose a little as the patient's  years vary, or as the
constitution is more or le^s robust or  weakly.   More
precision  than this is unnecessary,  as (except  in the
instance of laudanum, respecting,  which,  the  direc-
tions are very particular) no remedy here mentioned,
is of so active or dangerous  a  nature, as to render a
slight variation of much consequence ; and a very lit- 
Appendix.
 tie experience will  enable any  intelligent person to
 adapt mem to particular subjects,  with  as much ac-
 curacy as can be required.

               No.  \.   Sudorific drinks.

    Warm water,  balm,  catnip, or  weak sage tea.  Of
 these, warm water, although the least pleasant, is the
 m°st efficacious; it excites  some  nausea,  and there-
 by, powerfully promotes perspiration.   They  may
 be all rendered  more  agreeable,  and  quench  thirst
 more effectually, by the addition of ;.ny of the follow-
 ing acids,  with  a little sugar : lemon-juice,  currant-
juice, tamarinds, cream >jf  tartar, or guod vinegar,  in
 such quantities as shall  be moat agreeable  to the pa-
 tient.

            No.  2.   Mucilaginous Drinks.

   a.  Flaxseed tea, marsh -mallow  tea,  or one made of
 quince needs.
   b. Barley watf.r, is made by boiling two tablespoons-
 fol of pearl barley, first washed in cold water, in three
 pints of waier, until one  third is  wasted ; a handful
 of stoned raisins or  of  sliced figs, may be  added to-
wards the end of ihe boiling.
   c.  Solution  of gum-arabic,  is  made  by boiling one
 ounce of picked-gum arable in little more than a quart
of water, until it  is  dissu.\cd.   All these  are useful
to sheathe and defend  very  sensible  parts fiom  the
 irritation of acrid humours, as is the case in a tickling
cough and common  ;ax ; or i>ioody-iiu\, heat of  r.ne,
Sec in all  which, tne  natural  mucus of the parts is
defective. 
23>                 Appendix.

             No. 3.   Astringent Drinks.

  a. Infus'on of roses.   Upon a large handful of dried"
red rose leaves, pour a pint of boiling  water ; let them
infuse half an hour.
  b  Infusion of oak bark.  Upon a handful of white-
oak bark, shred fine,  pour a quart of boiling water;
let it stand one hour,  then boil a few minutes.
  c.  Infusion of galls.   Upon  a quarter of an ounce
of galls, bruised, pour a quart of boiling  water; let
tbem infuse  one mur,  then boil  for a fow minutes.
A small quantity of cinnamon adds greatly to  the fla-
vour of b. ore.  and acidulating any of  them with the
acid of vitriol, (No. 16. f.) renders  it more efficacious;
they should be  taken cold,  to the quantity  of half a
gill, or a wineglassful, every hour or two.

                    Clysters.

           No. 4.   Simple and Emollient.

   a- Warm  water.
   b.  Milk and water in equal parts.
   c.  Flax-seed tea.
   d.  Mallow tea.
   e.  Infusioi *>i quince seeds.
   f. B'-.iley Water.
   g.  Soiutfon  of gum-arabic.
   h.  Very  thin starch, made by boiling fine wheat
flour with water.
   From had a  pint to a pint, to be administered a little
n ore tr.aii milk-warm.  They are all useful and  tffi-
cactcu   where n.eit  .euxing  a> c.  e   oi.ient  tflects■
are required;  die addition  of the  mucilaginous sub- 
AhpentUx.
233
 stances will occasion them to be loncrev reto'ned 'han
 simple water would be, arid  are particularly  prober,
 when any irritation, or remarkable tenderness of the
 intestine  exists: with  the same  intention, a  lable-
 spoonful of good sweet-oil, fresh  hog's lard, or hesh
 butter from the churn may be added ; but unless per-
 fectly fresh, should be omitted, as the least rancidity
 will irritate and  injure.

     No 5.  Purgative and Stimulating Clysters.

   Any of the above, No. 4* witli the addition of
  a.  1'vtj  table spo jnsfui of molasses  or of brown
 sugar.
   b. Two or three teaspoonsful of  common  salt.
   c. Haifa tablespoonfol of common soap.
   d.  Where ciysters are  required to be simply sti-
 mulating, increase the quantity of common salt by one
 or two tea-spoonsful
  e. And towards the end of fevers, when an antisep-
 tic is desired, the clyster may consist of a strong in-
 fusion of chamomile flowers, with one or two table-
 spoonsful of vinegar.

             No  6.  Anodyne Clysters.

   a.  A gill or common teacup full of new milk, or of
 any of the mucilaginous  substances  mentioned, (No.
 4.) with th« addition of laudanum, in such  quantity as
directed.  In general, a.patient will bear three times
 the quantity of laudanum,  administered in this  way,
 that would be a proper dose when taken into the sto-
 mach ; so that, if to procure rest, twenty-five  drops
would be given  in a draught, seventy-five may be ad-
ministered in a clyster and  the sickness and  other
                     U 2 
234
A/ipcndix.
ill consequences, which  some  persons complain ot
after laudanum taken into the stomach, seldom follow,
not, at least, in the same  degree  when it is adminis^
teted by clyster.

            No. 7.  Nourishing Clysters.

   a. From half a pint to apint  of good  strong soup,
 made of fresh meat, without salt, pepper, or any ve-
 getable.
   b. The same quantity  of new milk, with or without
 two or three teaspoonsful of brandy.
   Should  these  be too soon  discharged, laudanum
 may be added, in quantity from twenty lojforly drops',
 but no more than shall be found necessary.

               No. 8.  Mild Laxatives*

   a. Magnesia.  One or two large teaspoonsful.
   b   Mugxcfi'c; ad cream of artar, ground to an im-
  palpable powder in equal parts ; one or two teaspoons-
  ful of the mixture at a dose.
    c. Magnesia.   One  teaspoonful with three or four
  grains of rhubarb in fine powder.
    Magnesia is a!w ys proper when  the patient com-
  plains of a sour stomach ;  the cream of tartar adds to
  its purgative effects where  that is not the case;  the
  addition of rhubarb is  useful in weak stomachs and
  bowels ;  calcined or Glass's  magnesia, is less apt to
  distend the stomach with air, but is too expensive for
  ordinary  use.   New milk, except when cream of tar-
   tar is added, is the best vehicle.
     d. Cnam of tartar.   One ounce in  very  fine pow-
   ier, in a  pint of common water, or of barley water,. 
Appendix.                 233-
(No. 2. b.) sweetened with molasses or  brown sugar;
and taken  in the quantity of a small tea cup-ful, two
or three times a day,  is a very agreeable and certain
laxative ; the vessel must be shook whenever it is taken.
   e. Cream of tartar and flowers of brimstone, in equal
quantities ; a teaspoonful  of the mixture, two or three
times a day, in molasses.   This is supposed to be pos-
sessed of peculiarly good  qualities in cases of piles and
eruptions.
   f. Castor-oil   One large  tablespoonful to a dose;
 a very small quantity of spirits in  the bowl of the
 spoon, occasions this  viscid oil to be taken and retain-
 ed with  more ease.  No  medicine  is more effectual in
 finding  its way through  the  bowels, and, therefore,
 should precede all others in cases of obstinate cos-
 tiveness ;  but, in such cases, should be  accompanied
 or followed by more active purgatives.
    g.  Glauber's salts.   One ounce  dissolved in a quart
  of water,  of which, a tea-cup-ful, taken once, twice, or
  three times a day, sits well  on the stomach, and will
  be found, in most cases,  an  useful, codling, and con-
  venient laxative.
    h. Lenitive electuary.   Take lenitive electuary of
   the shops, or molasses,  or the syrup of any preserved
   fruit, two ounces;  of the  flowers of brimstone  and
   cream  of tartar,  each half an ounce ; of salt-pe-
   tre  one  quarter  of  an   ounce; let  the salts be
   finely  powdered, and mix  the whole  well together.
   This makes an agreeable laxative, supposed to be pos-
   sessed of peculiar advantages in cases of piles : a large
   teaspoonful may be taken two  or three times a day,
   according to its  effects
     i. Rhubarb and ipecacuanha.   In the quantity o£ 
236                  Jippenelix.
 four  grains of rhubarb to two  of ipecacuanha, is a
 most useful medicine in all  cases of disordered bow-
 els, attended with griping and  fever ;  le-^s  doses, of
 one half or one quarter of this quantity, will be  found
 a very effectual remedy in  the common lax to which
 children and  infants art  liable  in  hot weather; the
 dose  may be repeated every eight or twelve hours,  or
 given only going  to bed,  according to the urgency of
 the symptoms.

               No. 9.  Active Purges.

   a.  Glauber's salts, \n doses of one ounce, one ounce
 and a quarter, or one ounce and  an half, dissolved in a
 pint of water.  This is a most safe  and active purge,
 particularly in the beginning of  fevers ; it is offensive
 to the palate, and  for that reason, some persons wish
 to dissolve it m les:* water, and  to take the whole at
 one dose ; but in this way it is more apt to offend the
 stomach and be rejected.
   b.  Rhubwb and vitriolattd tartar, in  equal  quanti-
 ties, ground  very  well together ; fifteen  grains, taken
 going to  rest, and repeated in  the  morning, will be
 found an efficacious remedy,  whenever it is  required
 to cleanse the  stomach and bowels of bilious and other
 offensive matter ;  as is the case  in common intermit-
 tent and remitting fevers; the recurrence of which,
a  prudent  use of  this remedy  will  very  frequently
prevent; it is very easily  made  into pills  with a little
molasses, in which form it keeps perfectly well, and
 is always ready>
   c.  Rhubarb  and calomel.   About, thirty grains of
rhubarb and six or eight of cuiomel.  This is an ac- 
Appendix.                  237
Live  purge, very  proper to destroy  and  evacuate
worms, and is frequently  given with  good effect  in
the beginning of dysenteries.   When a  certain but
moderate effect is-  required, give one  ciuarter part  of
the above  dose every six or eight  hours ; it  should
always  be  taken mixed in molasses or syrup,  on  ac-
count of the weight of the calomel,  which,  in  a thin-
ner vehicle, would be lost.
   d. Jalap.  This  active purgative  should  always be
ground, very fine, with one half or an equal quantity
of some hard neutral salt, vitriolaied tartar or cream
of tartar) and one  quarter part or one third as much
ginger or cloves ; in this it acts in a less quantity, and
gripes  much  less  than when  given  alone.  Thirty^
forty, or fifty grains of this mixture is an active purge,,
particularly useful in  carrying off cold, watery  hu-
mours;  thin gruel or weak  broth, should be drunk
freely during  the operation  of a purge, except in the
last instance, when it is best to  drink but little.

                 No. 10. Aloetics.

   a. Anderson's Hills. All aloetic medicines are found
to irritate  the  lower intestines, and consequently, the
womb in a particular manner ; and for that  reason,
they are generally  forbid during pregnancy, and in
eases of piles ; but many persons, from the small dose
in which these p. .s operate,  and the convenience of
keeping them, are habituated to their use, and in such
cases  they may oe continued even during  pregnancy,
but they should never be chosen at thai period.
   b. Tine ure of myrrh and aloes, called elixir  propri-
 etatis   Infuse, of bruised m> rrh, two  ounces  in a
 smart of good brandy  or spirits of the honest proof, 
238
Appendix.
 for three or four days, keeping it in the sun or near u
 fi e, and shaking it frequently ,  then add. of socotonne
 aioes, three ounces ;  after it his -tood three  or lour
 days longer, still occasionally shaking the vessel, pour
 off the clear  liquor; add  half a pint more  spirits to
 the residuum, and after stauding three  or four clays
 longer, decant and mix them together :  it is  absolute-
 ly necessary the brandy and spirits should be of ihe
 highest proof.   This is a convenient, sale, and agree-
 able domestic medicine;  useful in all cases  m  which
 aloes are directed, and particularly so for  children
 with  weak stomachs  and bowels, arid distended bel-
 lies ;  who, from that cause, are subject  to indigestion
 and worms.  From a very  small to a  very  large tea-
 spoonful, according to their ages, is a proper dose for
 children from one to eight years old ; a grown person
 may taice two large teaspoonsful ;  it should be mixed
 first with blown sugar, and then diluted with a table-
 spoonful or  two of hot water, or common, or what  is
 better, tansy tea, and taken fasting.   This   dose,  in
 the cases above mentioned, should be repeated for
 three or four mornings, and then  omitted  for some
 time ; when  desired to act  immediately  as   a purga-
 tive, it  may be  repeated in  three or four hours, until
 it produces a proper effect.
   c  Aloetic pills.   Take socotorine aloes 1-4 ounce,
 of gum-guaiacum thirty grains, tariar-emetic twelve
 grains ; let the tartar emelic be first ground with the
 gum-guaiacum ; then add the  aloes in small quanti-
 ties, until they are  intimately mixed,  with  as  much
syrup as is  necessary ; form the whole into fifty pills ;
 one, two, or three, to be taken at bed-lime,  as a sub-
stitute for Anderson's pills. 
Appendiat.
■229
                 No. 11.  Emetics.

  a. Ipecacuanha.   This, when good,  is sufficiently
active in most cases,  and certainly the safest emetic
we are  possessed of; from twenty to thirty grains is
a full dose ; from three to ten,  taken at. the distance
of ten  or fifteen minutes, for  two or three doses, is a
safer mode in cases of pregnancy, and proves equally
efficacious.   When it is  wished that  it may operate
on the   bowels, or particularly in  cases  of dysentery,
small and  repeated doses are most certain ;  in  this
way, too, it powerfully promotes  perspiration, which
renders it very useful in the beginning of all fevers.
  b  Tartar-emetic.  "Six  grains,  dissolved in ten or
twelve  tablespoansful  of hot water ;   of  which,  two
may be taken at first, and one repeated every ten  mi-
nutes, until it operates sufficiently.  In this way,  tar-
tar-emetic  is most safely given in all cases in which it
is proper,  as in the beginning of intermitting  and
bilious  fevers, but should never  be given to pregnant
women.
  c. Ipecacuanha fifteen grains, tartar-emetic from one
to three grains.   This is a very effectual emetic, when-
ever a  sudden operation  is required.   Warm  water,
or chamomile tea should  be drank during the opera-
tion  of an emetic ; but the stomach is not to be over-
loaded  with them:  half a  pint, or at  most, a pint, is
sufficient, at one time, on the  stomach.

                No. 12   SudoHfies.

  a. Mindererus's spirits.  Take a quarter of an ounce
of volatile alkali, (salt of hartshorn  pour ou it good
vinegar, by small quantities at a time, until it shall be 
24C
Appendix.
neutralised, (that is, as long as it  shall continue to
effervesce or rise in foam, and until neither the sour-
ness of the vinegar, nor the  ley-like taste of the salt
prevails.)   This is  a very useful  medicine in  all fe-
vers ; a tablespoonful may be given every hour,  in any
Warm drink, until the patient shall bre^k out in  a  free
perspiration, and then be continued every three  hours.  .
  b. Sudorific anodyne.  To  a large tablespoonful of
the above, (a ) add twenty-five  or  thirty drops  of lau-
danum.   This is one of the best forms in  which lau-
danum can be given, whenever it shall  be  proper in
.fevers.
   c. Effervescing  draught.   Take fifteen grains of
pearl ash,  salt  of  womiwood, or salt  of  hartshorn,
dissolved in a tablespoonful of  water,  in one cup ; in
another, two large  teaspoonsful of lime-juice or lemon-
juice, or one tablespoonful of very good vinegar,  with
one or two tablespounsful of water, sweetened  ; pour
one to the  other, and let  the patient drink them im-
mediately, while they effervesce.   When  made  with
fresh lime or lemon-juice, this is an  elegant,  pleasant,
and useful medicine in all .fevers, and peculiarly effect-
ual in  removing nausea and  vomiting; it may  be re-
peated every two or three hours.
   d. Tartar-emetic.   Dissolve  two grains of tartar-
emetic in eight tablespoonsful of hot water; give one
tablespoonful every two or three hours.
    e. Ipecacuanha, in doses of one or two grains, of the
powder, every two or three hours ;  given in molasses
or  syrup.
    f. Salt-fietre,  in doses of ten,  fifteen,  or  twenty
 grains, mixed with a little hard sugar or syrup, or mo-
 lasses, very two or three hours. 
Appendix.
241
   These three (d. e. f.)  by the  nausea they excite
powerfully lessen the force of the  circulation, and pro-
mote perspiration.  They are particularly proper in
the beginning of fevers,  attended  with  symptoms  of
inflammation; and are  likewise  used  in  the active
stage of hxmorrhages, attended with a strong pulse
and increased  heat; but are improper towards the end,
when  the  patient  has  been  much weakened by the
previous disease.

         No.  13.  Diurcctics and Alteratives.

   a. Take dried squills, in fine powder, twenty grains,
prepared calomel, thirty grains,  mucilage of gum-
arabic, or thick  starch, as much as is  sufficient  to
make into twenty pills ; two of Which are to be taken
going to rest.    These pills powerfully promote urine
and are very efficacious in carrying off cold, phlegma-
tic humours, in all dropsical swellings.
  b. Pound a handful of the kernels of pumpkin seeds
or melon seeds, or blanched sweet almonds, with a
small quantity of hard white sugar, to a smooth paste ;
then add a quart of boiling water, and a quarter of an
ounce of salt petre, or half an  ounce of sweet spirits
of nitre, and rub them well together.   This is a plea-
sant and  mild diuretic,  particularly useful where  the
discharge of urine is attended with heat and pain ;  a
tea-cup-ful  may  be taken every two or three hours.
  c.  Calomel,  in doses  of one or two  grains,  given
every night or every other night, drinking with it the
following diet drink  (d.)  These together, make a
powerful alterative for  blotches on the skin,  foul erup-
tions, and all  other cases, in  which the object is  to
remove obstructions, and sweeten the humours.   An
                         X 
242
Appendix.
occasional warm  bath greatly promotes  their  good
effects, whilst at the same time it contributes to pre-
vent the mercury attacking the mouth, and  bringing
on salivation, which during the.use  of  calomel,  must
be carefully  watched and guarded against, by  avoiding
cold, and suspending the medicine,  from time to time,
for a few days
   d. Alterative eliet  drink.   Boil one ounce of the bor-
ings of lignum vitse, and two ounces of split sarsapa-
rilla, in three pints of water, until it comes to  a quart;
then strain  it  through linen ; to be drunk in one or
two days, by divided doses    The sarsaparilla, which
is the least efficacious,  is by  far  the most expensive
article in this diet drink ;  it may, therefore, be omit-
ted, adding in  its place half an ounce  more of lignum
vitx, or two ounces of p-rsley roots.   In  either case,
a  small  handful  of stoned  raisins, or two or three
sliced figs, or half an ounce  of liquorice root, will ren-
der it more  agreeable.

        No. 14.  Anodynes and Antispasmodics.

   a. Laudanum.  This medicine should be purchased
from a good apothecary, who makes  it  according to
the established receipts.  To a  grown person, unac*
 customed to laudanum, twenty five or thirty drops is
 a common, forty or fifty drops is a full dose,  in cases
 of great pain; but  this must be  increased to  a  larger
 dose for such  persons  as  are  accusiomed to its  use;
 or in cases  of severe and obstinate pain ; or, which is
 a safer mode, give  at first a common  do-e, and repeat
 ten or fv. teen drops every  twenty or  thirty  minutes^
 until the pain shall subside. 
Appendix.
245
  b.  N. B.  In  giving  laudanum to infants, (which
should be avoided as much as possible) always drop
eight or ten  drops  of laudauuir. into a tea-cup, then
add as many teaspoonsful of water.  Of this, give  the
child, if under two  months old,  half a teaspoonful;
if above, three months, one teaspoonful;  and although
that dose should not relieve, do not repeat it in  less
time than half an hour: indeed, to all young children,
laudanum should be given oniy in this way, increasing
the dose one drop for every year.
   c.  Sweet spirit of vitriol,  or  sweet  spirit of' nitre.
These lessen heat, slake thirst, and  calm uneasy feel-
ings ; and are, therefore, very proper in feverish com-
plaints, during pregnancy, and  on other  occasions;
one small teaspoonful in a cup of cold water, is a com-
mon  dose,  and  may  be repeated every four, six, or
eight hours.
   d.  Gum pills.  Take  asafcetida three parts, gum-
ammoniac two parts,  camphor one  part;  beat  them
very well together, and with as much syrup  as is ne-
cessary make into pills of the size of a common pea;
from  three to five may be taken at a dose,  and repeat-
ed as often as shall  be found necessary ; not, however,
exceeding three or four doses in a day   This  is a
powerful antispasmodic, and very useful in  all nervous
and hysterical complaints.   When it is wished to  ren-
der the mass purgative, add as much socotorine aloes
as of camphor.

    No. 15.   Absorbents, and Correctors of Acidity.

  a. Magnesia.   One  or two teaspoonsful to  taken
occasionally, mixed in  milk. 
^44
Appendix.
  b. Pearl-aslifs, salt  rf wormwood, fossil alkali.   Of
either, ten or fifteen giains, dissolved in a glass of cold
water, may be taken occasionally ;  either of these, or
or magnesia are proper  in all cases of  sour stomach,
attended with costiveness.
  c. Fine  washed chalk, or what is purchased under
the name  of prepared crab's eyes  ; from half a  tea-
spoonful to one or two teaspoonsful, mixed in milk OP
water, to be taken occasionally.
  d. IJme-water.  This  is made by  pouring a small
quantity of boiling  water upon quick-lime, leaving it
to  slake ;  then adding more boiling  water, to  the
quantity of two gallons  of water  to half  a pound of
lime;  let  it stand,  now then stirring  it, until cold;
then let it subside, pour off the clear water,  and keep
it in bottles, close stopped ;  a-gill, with  about half as
much, or an equal quantity of new milk, may be taken
once or'twice a day.   Either  of these, but particularly
 the lime-water, will be  found an  useful  corrector of
 acidity, in  all cases  of weak stomachs and bowels, at-
 tended with purging.
   e.  fake magnesia  one drachm, powdered  rhubarb
 ten grains, powdered gum-arabic two drachms, com-
 mon water half a gill ; from  a teaspoonful to a dessert-
 spoonful} according to the child's age.    : his makes a
 useful medicine to correct   green stools and griping
 in infants.   After it has properly  cleansed the bowels,
half a teaspoonful or a teaspoonful of the anodyne mix-
 ture, (No. 14. b.)  may  be  occasionally added ; and in
 ©as'.s of lax, fi'ie chalk or crab's eyes may be substitu-
  ted for magnesia. 
Appendix.
245
     No. 16.  Bitters and straightening Remedies,
  a.  Chamomile tea, made strong and drvi.k  cold, in
the quantity of a tea-cup-ful,  three  or  four  times a
day.
  b.  Gentian and ora?igc peel, of each a quarter of an
ounce, bruised, to  be infused  in a pint of cold water
for twelve hours,  then  decanted  or strained;  when
used  in  hot we ther,  add hall a gill of brandy.   A
wine-glass-ful  may be taken three  times a day.   Bit-
ters are propelly considered strengthening remedies;
when not continued  too  long, they  improve  the  ap-
petite and strengthen the stomach  and bowels ;  but a
constant and long continued use  of them is generally
prejudicial.
   c. Peruvian bark  is  one of  the  best strengthening
remedies ; it may be taken in powder, to the quantity
of a teaspoonful, three  times a day.  When  taken to
stop the return  of inlermittents, one ounce, at least,
must be taken between the fits ;  when it purges, four
or five drops of laudanum  may be added to a few of
the first closes ; but whenever  it is wished that it may
prove  purgative,  add five  grains of rhubarb to each
dose ;  and  in quartan  or  other  obstinate intermit-
tents, some aromatic, such  as cloves or ginger, in the
quantity of one sixth or one eighth part, will increase
its efficacy; new  milk, a little spirits  and water, or
wine, particularly port  wine, are its  proper  vehicles.
When the doses are to be frequently  repeated, as soon
as owe is taken, put another, with  a  small quantity of
wine or water, into  a  glass, by which  means  it will
become equally  and universally moist,  and may be
mixed  more  easily and more smoothly.  Children,.
 and such persons  as  cannot  be induced to  take the 
246
Appendix.
 bark in sufficient quantities to cure intermittents, may
 be relieved by administering it  in the form of a clys-
 ter : in this way the dose should equal, at least, four
 common doses;  it  must be mixed  very smoothly
 with a  small quantity of new milk, and a proper quan-
 tity of laudanum ; for a grown person, from  twenty
 to thirty drops may be added  to each portion, to occa-
 sion  it to be  retained ; a second portion must not be
 administered until the prior  dose has come away, un-
 less that be retained  above four or six hours, and then
 the laudanum should be omitted until after the  bowels
 are again cleared of the bark.
  d. Columba.  Of this  root, twenty  grains,  in fine
 powder, may be  taken two or three times a day, mix-
 ed in water ;  or boil  one quarter of an ounce, bruised,
 in little more than half a pint of water, for six or eight
 minutes, so as to strain off' half a pint;  of this decoc-
 tion, two tablcspoonsful are to be taken three cr four
 times  a clay : this bitter is supposed to be  peculiarly
 serviceable  in cases  of weak stomachs  and bowels,
attended with lax, and abounding in bilious crudities.
  e.  Iron filings, if made with a fkie file, will require
 no other preparation; the dose is five or six  grains,
 or about as much as a  common pinch of snuff, with
an-equal quantity ofpowdered ginger, to be mixed in
syrup or molasses, and taken two or three times in a
day.   In this simple form, iron-acts as  well as in any
more laborious preparation.   It is a  most useful tonic
in all pale and related habits, subject to watery swell-
ings  ;  particularly  for children of  this description,
with pale faces and  distended  bellies, whose  com-
 plaints are  frequently accompanied  by worms.  The
dose  for young or old (provided the filings are made 
Appendix.
247
with a fine file) may be  much the same, as  no more
acts than what is dissolved.
  f. Vitriolic acid.  Add  one part of common oil of
vitriol, as it is bought from the shops, to six times the
quantity  of  water, by weight; from ten to twenty or
thirty drops may be taken at a dose, in a glass of cold
water, sweetened agreeably; or  it may be added to
any bitter or astringent  infusion, (No. 16. No. 3.)
When it is desired to give a large dose, as is  some-
times recommended,  in haemorrhage, combined with
astringents, mixing it first  with  a large quantity of
sugar, so far softens or  neutralizes  the taste, as to
enable the patient  to swallow  it  more readily :  in a
small quantity it very speedily quickens the appetite.

                 No. 17.  Cordials.
   a.  Glass of wine, or a little brandy toddy.
   b.  Essence of pepper-mint.   From four or  five to
eight or ten drops, dropped  on sugar, or mixed with
water.
   c.  Compound spirits of lavender.  A teaspoonful- on
a lump of sugar, is to  be suffered to dissolve in the
mouth, and gradually swallowed.
   d.  Two or three drops of the  oil  of cinnamon, on
powdered sugar, and so swallowed, washing it down
with a little  wine and  water, is a most powerful cordial
in cases of great languor, and faintness from loss of
blood. 
243
Ajtpendix,
               Local  Applications.

            No. 18.   Cerates and Poultices
   a.  Simple cerate.   Take yellow wax two parts, fresh
 olive oil five  parts;  or take yellow  wax  two parts,
 fresh hog's lard eight parts ; melt them slowly toge-
 ther.  Some variety must be made  in these  propor-
 tions, as they are to be used in summer or winter.
   b.  Saturnine cerate:  lead ointment   Take simple
 oerate eight parts, white lead one part, rub them  to-
 gether until  they shall  be intimately mixed,  and be-
 come perfectly smooth.
   d.  Cerate with galls.  Take galls, finely powdered,
 one quarter of an  ounce, camphor thirty grains, fresh
 hog's lard  one ounce; first mix the camphor, finely
 powdered,  intimately with  the  lard;  then add the
 powdered galls.   This ointment is  very  useful in
 piles, especially after the inflammation has somewhat
 abated.
   f.  White mercurial ointment.  Mix one part of the
 white precipitate of mercury  with eight parts of hog's
 lard.   This is a  very valuable ointment for an obsti-
 nate itching eruption, to which many persons are sub-
 ject about the groin and neighbouring  parts.  Even
 when it does not cure the disease, which it sometimes,
 as well as all other remedies, fails to do, its use, joined
 with  frequent washing with cold water, will keep tha
 patient much at ease.   A very small quantity is to be
rubbed on  the part affected,  after washing  at  night,
until the itching subsides; the ointment should then
 be omitted, until the complaint, being renewed, de-
 mands it to be repeated. 
Appendix.
249
  g. Bread and milk poultice.   Boil  the crumb of
stale wheat bread in new milk, for a short time ; then
take it from the  fire, and beat it  fine; after  which,
boil it again until it is perfectly smooth and of a proper
consistence, taking care that it does not burn.  It is of
more consequence than is commonly imagined, that
a poultice  should be thus  carefully made,  so that it
may lay  perfectly smooth  on an inflamed part; it
should never be applied so hot as to give any pain.

      No. 19.   Warm and discutient Liniments.

  a. Volatile liniment is made by  mixing one part of
strong spirits of hartshorn, with two or three parts of
good sweet oil, good hog's  lard, or fresh butter from
the churn ; they should unite into an uniform, white,
soapy  mixture ; and .*f they do not, ii is owing to the
spirits of hartshorn not being sufficiently caustic.
When lard or  butter are made  use of they should be
first meited;  they  may then, like the oil, be mixed
with the spirit of hartshorn, by shaking  them together
a vial.
   b. Camphor, dissolved  in oil or strong  spirits, in
the proportion of one ounce to a pint;  they vvill unite,
by first warming  the  oil or spirits in a vial, then add-
ing the camphor, and shaking them well together.
   c.  Opodeldoc.   Take of the  best hard  soap two
ounces,  camphor one ounce, very strong  spirits one
 pint;  mix the soap \ with  the  spirits,  and let them
 stand  in a moderate heat until the  soap is dissolved,
 occasionally shaking the vial; 'hen  add the camphor,
 and coniinue  to  shake the vessel frequently, until the
 whole is  dissolved. 
25©
Appendix.
  These are very useful in sprains, bruises, and rheu-
matic  affections, and wherever the object is to dis-
perse  swellings, tumours,  and  internal inflamma-
tions.  The last answers all the  purposes of Steers's
opodeldoc.
  d. Mindereri's spirits,  (No. 12. a) applied  milk-
warm, by  means of a soft  flannel,  very powerfully
tends to discuss an incipient tumour or other inflam-
matory swellings.
  g  Warm plaster   Take  of the gum plaster and
Burgundy  each one ounce,  of  blistering plaster one
quarter of an ounce ; melt them and mix them toge-
ther.   This is a most useful application, wherever it
is required to keep up a constant perspiration, and gen-
tle  irritation of tha skin, over anv particular part  af-
fected with  rheumatism  or any  internal pain,  unat-
tended with external inflammation
  h. JEther.  The method  of applying aether,  is to
pour about  a teaspoonful  into the  hollow of the  hand,
and immediately apply it over the part affected, keep-
ing the hand on the part until the  xther is evaporated,
or as long as the patient can bear the  heat it excites.
No  remedy so  suddenly and   effectually removes
cramps and all spasmodic pains.

  No. 20.  Astringent and Antiseptic Lotions and In-
                     jections.

  a.. Vinegar or spirits, with water or chamomile tea,
in the proportion of one  eighth or one sixth ; an infu-
sion of red rose leaves or green tea.
  b.  lake oak bark one ounce, or galls half an ounce ;
teoii either in three half pints of water, until one third 
Appendix.                  251
is  evaporated; one sixth or one eighth of vinegar or
spirits, may be added to these when cold
   c. Alum : one quarter of an ounce, dissolved in a
pint of water by boiling them .together.
   d. Sugar rf lead.   Dissolve thirty grains in  half a
pint of rain water.
   e. White vitriol.   Dissolve sixteen  grains of white
vitriol in half a pint of rain or brook water.
   f. Borax. Mix one  part  of  fine powdered  borax
with two parts ol powdered loaf sugar. 
CONTENTS  OF THE APPENDIX.
  No. 1. Sudorific drinks.
  2.  Mucilaginous drinks.
  3.  Astringent drinks.
  4.  Simple and emollient clysters.
  3.  Purgative and stimulating clysters-
  6.  Anodyne clysters.
  7.  Nutritious clysters.
  8.  Mild  laxatives.
  9.  Active purges.
 10.  Aloetics.
 11. Emetics.
12. Sudorifics.
13. Diuretics and alteratives.
14. Anodynes and antispasmodics.
15. Absorbents or correctors of acidity.
16. Bitters and strengthening remedies.
 17. Cordials.

            Local  Applications.

18. Cerates and poultices.
 19. Warm and discutient liniments.
20. Astringent and antiseptic lotions and injections. 
GLOSSARY.
/
   Abdomen, the belly.
   Articulation, joint.
   Abortion, miscarriage.
   Amnion, inner membrane of the ovum.
   Atony, want of strength.
   Cartilage, smooth substance  covering ends of
 bones.
   Catheter, instrument to draw off urine.
   Cervix, neck of womb or  bladder.
   Coccyx, termination of rump bone.
   Chorion, outer membrane of ovum.
   Decidua vera, decidua rejle.xa, membrane lining
 the womb and covering the ovum.
   Development, unfolding.
   Embryo, first rudiments of child in the womb.
   Fallopian tubes, canals leading into the womb,
   Feet us, child in the womb.
   Fimbriated, fringed.
  Fluor albus, the whites.
  Fontanelle, opening on the top of the child's
head.
  Fundus, upper part of the womb or bladder.
  JHasmorrhage, bleeding,
  Ilium, hip bone.
  Inverted^ turned inside out. 
rJJ4
Glossary.
  Ischium, bone on which we sit.
  Ligament, strong membrane connecting bones.
  Lochia!,  discharges from the womb,  after deli-
very.
  Mtnstntation, monthly discharge.
  Morbid,  diseased.
  Os tinea;, internal orifice of the womb.
  Ossa, bones.
  Ossification, becoming bone.
  Ovum, egg; the child with the membranes and
waters entire.
  Ovaria, two oval substances connected with the
womb.
  Parturition, child-birth.
  Pelvis, basin, or that circle of bone, which forms
the base of the trunk.
  Peritoneum, membrane which covers the intes-
tines.
  Perinasum, portion of the skin between the anus
and «-xiernal orifice.
  Placenta, after-birth.
  Fresentation, manner in which the child offers.
  Premature, too early, unripe.
  Prognostic, prediction.
   Puberty, about fifteen or sixteen years of age.
   Puerperal, belonging to child-birth.
   Regimen, whatever relates to diet, exercise,  or
 manner of life.
   Rectum, straight gut.
   Retroverted, turned backwards, 
                Glossary.                15$- *

Rugous, in folds.
Sacrum, rump bone.
Spine, back bone.
Secundines, alttr-birth, &c.
Symphysis, connection of certain bones>
Synovial mucus of the joints.
 Vertebra, a joint of the back bone.
 Vesicle, a very small bladder.
 Vagma, passage leading to the womb.
 Urethra, passage leading to the bladder.
 Uterus, the womb.
 Umbilical, belonging to the navel. 
 
/Ved. Hist.
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